Trajectories of Exposure to Neighborhood Deprivation and the Odds of Experiencing Intimate Partner Violence Among Women: Are There Sensitive Periods for Exposure?

Neighborhood disadvantage is commonly hypothesized to be positively associated with intimate partner violence (IPV) against women. However, longitudinal investigation of this association has been limited, with no studies on whether the timing of exposure matters. We used data from 2,115 women in the UK-based Avon Longitudinal Study of Parents and Children. Exposure to neighborhood-level deprivation was measured at 10-time points from baseline (gestation) until age 18. Family-level socioeconomic characteristics were measured at baseline. At age 21, participants self-reported whether they had experienced any IPV since age 18. We used a three-step bias-adjusted longitudinal latent class analysis to investigate how different patterns of neighborhood deprivation exposure were associated with the odds of experiencing IPV. A total of 32% of women experienced any IPV between ages 18 and 21. Women who consistently lived in deprived neighborhoods (chronic high deprivation) or spent their early childhoods in more deprived neighborhoods and later moved to less deprived neighborhoods (decreasing deprivation) had higher odds of experiencing IPV compared to those who consistently lived in non-deprived neighborhoods. The odds of experiencing IPV did not consistently differ between women who lived in non-deprived neighborhoods during early childhood and later moved to deprived neighborhoods (increasing deprivation) and those stably in non-deprived neighborhoods. Living in more deprived neighborhoods during early childhood, regardless of later exposure, was associated with higher odds of experiencing later IPV. This is congruent with prior research demonstrating the persistent effects of early neighborhood disadvantage on health and well-being. Replication, and underlying mechanisms, should be assessed across contexts

Socioeconomic factors associated with asthma prevalence and severity among children living in low-income South African communities

Background. Rates of asthma, poverty and social deprivation are high among young people in South Africa (SA), yet asthma interventions largely remain focused on biomedical factors. Objective. To investigate associations between socioeconomic factors and childhood asthma.Methods. We recruited 6 002 children aged 10 - 17 years from six low-income urban and rural sites in three SA provinces. Self-report questionnaires measured health status, sociodemographics and socioeconomic factors. Logistic regression and mediation analyses were used to test models of risk factors for asthma prevalence and severity (frequency of attacks). Results. Child anxiety (odds ratio (OR) 1.08; 95% confidence interval (CI) 1.04 - 1.12) and community violence (OR 1.14; 95% CI 1.00 - 1.30) were associated with increased odds of having asthma. Children doing more outdoor housework (OR 0.83; 95% CI 0.71 - 0.98) and living in greater poverty (OR 0.93; 95% CI 0.88 - 0.99) had lower odds of having asthma. Severe asthma was predicted by child depression (OR 1.14; 95% CI 1.03 - 1.26) and greater household poverty (OR 1.14; 95% CI 1.01 - 1.28). Most socioeconomic factors operated in ‘risk pathways’, wherein structural factors (e.g. urban living) were associated with individual factors (e.g. fewer outdoor tasks), which predicted greater odds of having asthma or severe exacerbations.Conclusions. This study suggests the need to consider the context of childhood asthma in SA for improved prevention and treatment. A multidisciplinary approach may be more effective than a biomedical model, given the plausible effects of psychosocial stress and poverty on asthma outcomes

Intimate partner violence victimisation in early adulthood:Psychometric properties of a new measure and gender differences in the Avon Longitudinal Study of Parents and Children

Objectives To evaluate the psychometric properties of a novel, brief measure of physical, psychological and sexual intimate partner violence (IPV) and estimate the overall prevalence of and gender differences in this violence. Design Data are from the Avon Longitudinal Study of Parents and Children (ALSPAC), a birth-cohort study. Setting Avon, UK. Participants 2128 women and 1145 men who completed the questionnaire assessment at age 21. Outcome measures Participants responded to eight items on physical, psychological and sexual IPV victimisation at age 21. Participants indicated whether the violence occurred before age 18 and/or after and led to any of eight negative impacts (eg, fear). We estimated the prevalence of IPV and tested for gender differences using χ2 or t-tests. We evaluated the IPV victimisation measure based on internal consistency (alpha coefficient), dimensionality (exploratory factor analysis) and convergent validity with negative impacts. Results Overall, 37% of participants reported experiencing any IPV and 29% experienced any IPV after age 18. Women experienced more frequent IPV, more acts of IPV and more negative impacts than men (p Conclusions The prevalence of IPV victimisation in the ALSPAC cohort was considerable for both women and men. The strong and consistent gender differences in the frequency and severity of IPV suggest clinically meaningful differences in experiences of this violence. The ALSPAC measure for IPV victimisation was valid and reliable, indicating its suitability for further aetiological investigations.</p

Effectiveness of Cash-plus Programmes on Early Childhood Outcomes Compared to Cash Transfers Alone: A Systematic Review and Meta-analysis in Low- and Middle-income Countries

Background: To strengthen the impact of cash transfers, these interventions have begun to be packaged as cash-plus programmes, combining cash with additional transfers, interventions, or services. The intervention’s complementary (“plus”) components aim to improve cash transfer effectiveness by targeting mediating outcomes or the availability of supplies or services. This study examined whether cash-plus interventions for infants and children <5 are more effective than cash alone in improving health and well-being

Depressive symptoms among children attending community based support in South Africa - pathways for disrupting risk factors

CITATION: Sherr, L. et al. 2020. Depressive symptoms among children attending community based support in South Africa – pathways for disrupting risk factors. Clinical Child Psychology and Psychiatry, 25(4): 984–1001. doi:10.1177/1359104520935502The original publication is available at https://journals.sagepub.com/description/CCPChildren in Southern Africa are exposed to high rates of structural and family adversities. This study tests whether services from Community Based Organisations (CBOs) in South Africa can promote children's resilience against depression exposed to such adversities. Two linked longitudinal studies were conducted, comprising n = 1848 children aged 9 to 13 years. One group received CBO services, whilst the other (quasi-control) did not. Analyses used interaction terms in regression models to test for potential moderation effects of CBO attendance, and marginal effects models to interpret significant interactions. Two interaction effects were shown, demonstrating moderation effects of CBO attendance on common structural disadvantages. First, children exposed to community violence showed increased depression (contrast = 0.62 [95%CI 0.43, 0.82], p < .001), but this association was removed by CBO access (contrast = 0.07 [95%CI -0.28, 0.43], p = .682). Second, children living in informal housing showed increased depression (contrast = 0.63 [95%CI 0.42, 0.85], p < .001), however, this association was removed by CBO access (contrast = 0.01 [95%CI -0.55, 0.56], p = .977). CBO attendance is associated with fewer depressive symptoms, and can buffer against important structural adversities of poor housing and violence that are common in high HIV-prevalence areas. However, CBO attendance was not able to remove the increased psychosocial distress associated with some family-level vulnerabilities such as orphanhood and abuse. These findings highlight the centrality of CBO-provided psychosocial support for children in Southern Africa, and suggest areas for bolstering provision.https://journals.sagepub.com/doi/10.1177/1359104520935502Publishers versio

Can synthetic controls improve causal inference in interrupted time series evaluations of public health interventions?

Interrupted time series designs are a valuable quasi-experimental approach for evaluating public health interventions. Interrupted time series extends a single group pre-post comparison by using multiple time points to control for underlying trends. But history bias-confounding by unexpected events occurring at the same time of the intervention-threatens the validity of this design and limits causal inference. Synthetic control methodology, a popular data-driven technique for deriving a control series from a pool of unexposed populations, is increasingly recommended. In this paper, we evaluate if and when synthetic controls can strengthen an interrupted time series design. First, we summarize the main observational study designs used in evaluative research, highlighting their respective uses, strengths, biases and design extensions for addressing these biases. Second, we outline when the use of synthetic controls can strengthen interrupted time series studies and when their combined use may be problematic. Third, we provide recommendations for using synthetic controls in interrupted time series and, using a real-world example, we illustrate the potential pitfalls of using a data-driven approach to identify a suitable control series. Finally, we emphasize the importance of theoretical approaches for informing study design and argue that synthetic control methods are not always well suited for generating a counterfactual that minimizes critical threats to interrupted time series studies. Advances in synthetic control methods bring new opportunities to conduct rigorous research in evaluating public health interventions. However, incorporating synthetic controls in interrupted time series studies may not always nullify important threats to validity nor improve causal inference

Can social protection improve sustainable development goals for adolescent health?

Background The first policy action outlined in the Sustainable Development Goals (SDGs) is the implementation of national social protection systems. This study assesses whether social protection provision can impact 17 indicators of five key health-related SDG goals amongst adolescents in South Africa. Methods We conducted a longitudinal survey of adolescents (10-18 years) between 2009 and 2012. Census areas were randomly selected in two urban and two rural health districts in two South African provinces, including all homes with a resident adolescent. Household receipt of social protection in the form of ‘cash’ (economic provision) and ‘care’ (psychosocial support) social protection, and health-related indicators within five SDG goals were assessed. Gender-disaggregated analyses included multivariate logistic regression, testing for interactions between social protection and socio-demographic covariates, and marginal effects models. Findings Social protection was associated with significant adolescent risk reductions in 12 of 17 gender-disaggregated SDG indicators, spanning SDG 2 (hunger); SDG 3 (AIDS, tuberculosis, mental health and substance abuse); SDG 4 (educational access); SDG 5 (sexual exploitation, sexual and reproductive health); and SDG 16 (violence perpetration). For six of 17 indicators, combined cash plus care showed enhanced risk reduction effects. Two interactions showed that effects of care varied by poverty level for boys’ hunger and girls’ school dropout. For tuberculosis, and for boys’ sexual exploitation and girls’ mental health and violence perpetration, no effects were found and more targeted or creative means will be needed to reach adolescents on these challenging burdens. Interpretation National social protection systems are not a panacea, but findings suggest that they have multiple and synergistic positive associations with adolescent health outcomes. Such systems may help us rise to the challenges of health and sustainable development.</p

Reducing child abuse amongst adolescents in low- and middle-income countries:A pre-post trial in South Africa

Background: No known studies have tested the effectiveness of child abuse prevention programmes for adolescents in low- or middle-income countries. ‘Parenting for Lifelong Health’ (http://tiny.cc/whoPLH) is a collaborative project to develop and rigorously test abuse-prevention parenting programmes for free use in low-resource contexts. Research aims of this first pre-post trial in South Africa were: i) to identify indicative effects of the programme on child abuse and related outcomes; ii) to investigate programme safety for testing in a future randomised trial, and iii) to identify potential adaptations. Methods: 230 participants (adolescents and their primary caregivers) were recruited from schools, welfare services and community-sampling in rural, high-poverty South Africa (no exclusion criteria). All participated in a 12-week parenting programme, implemented by local NGO childcare workers to ensure real-world external validity. Standardised pre-post measures with adolescents and caregivers were used, and paired t-tests were conducted for primary outcomes: abuse (physical, emotional and neglect), adolescent behaviour problems and parenting (positive and involved parenting, poor monitoring and inconsistent discipline), and secondary outcomes: mental health, social support and substance use. Results: Participants reported high levels of socio-economic deprivation, e.g. 60% of adolescents had either an HIV-positive caregiver or were orphaned by AIDS, and 50% of caregivers experienced intimate partner violence. i) indicative effects: Primary outcomes comparing pre-test and post-test assessments showed reductions reported by adolescents and caregivers in child abuse (adolescent report 63.0% pre-test to 29.5% post-test, caregiver report 75.5% pre-test to 36.5% post-test, both p&lt;0.001) poor monitoring/inconsistent discipline (p&lt;.001), adolescent delinquency/ aggressive behaviour (both p&lt;.001), and improvements in positive/involved parenting (p&lt;.01 adolescent report, p&lt;.001 caregiver report). Secondary outcomes showed improved social support (p&lt;.001 adolescent and caregiver reports), reduced parental and adolescent depression (both p&lt;.001), parenting stress (p&lt;.001 caregiver report) and caregiver substance use (p&lt;.002 caregiver report). There were no changes in adolescent substance use. No negative effects were detected. ii) Programme acceptability and attendance was high. There was unanticipated programme diffusion within some study villages, with families initiating parenting groups in churches, and diffusion through school assemblies and religious sermons. iii) potential adaptations identified included the need to strengthen components on adolescent substance use and to consider how to support spontaneous programme diffusion with fidelity. Conclusions: The programme showed no signs of harm and initial evidence of reductions in child abuse and improved caregiver and adolescent outcomes. It showed high acceptability and unexpected community-level diffusion. Findings indicate needs for adaptations, and suitability for the next research step of more rigorous testing in randomised trials, using cluster randomization to allow for diffusion effects

Building a systematic model of risk and protective factors for intimate partner violence against women: the role of long-term community and structural disadvantages

Background: Intimate partner violence (IPV) is estimated to affect at least 1 in 3 women, making it the most common form of violence perpetrated against women. While there is ample research studying IPV, there have been relatively few studies of patterns of risk over time and even less that have investigated the longitudinal relationship between IPV and community- or structural-level factors. Objectives: (1) Systematically summarise the longitudinal risk and protective factors for IPV against women; and, using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) in the United Kingdom, evaluate: (2) the measurement and prevalence of IPV; (3) the dynamic relationship between objective and perceived measures of neighbourhood environments, and (4) the effect of long term exposure to neighbourhood-level deprivation on the risk of experiencing IPV among women. Method: This thesis used a variety of quantitative methods, including: a systematic, meta- analytic review; psychometric analysis; trajectory analysis; and marginal structural models using inverse probability weighting. I reviewed all available prospective-longitudinal studies of at least one risk or protective factor for IPV against women. My remaining empirical work used ALSPAC data from mothers and their children enrolled from birth between 1991-1992. When enrolled children were aged 21, they responded to a novel 8-item scale of physical, psychological, and sexual IPV experiences. Additionally, 18 years of data on neighbourhood environments, including the Indices of Multiple Deprivation, and family-level characteristics were available. Results: Few prospective-longitudinal studies on IPV against women have been conducted outside the United States or that investigated any community- or structural-level risk or protective factors. Among women participating in ALSPAC for 21 years, 32% had experienced IPV between ages 18-21 alone, with variations in their exposure to neighbourhood-level deprivation over the study period â demonstrating the need for further etiological study using appropriate longitudinal methods. Accounting for time- varying socioeconomic characteristics and sample attrition, I found that long-term exposure to more versus less deprived neighbourhoods over the first 18 years of life was associated with experiencing more frequent IPV and a higher risk of experiencing any IPV in early adulthood among participating women. Conclusions: This thesis synthesised, for the first time, the longitudinal literature on the risk and protective factors for IPV against women and contributed both methodologically and substantively to a major evidence gap identified: the association between neighbourhood-level deprivation and IPV. My findings demonstrate that long-term neighbourhood disadvantages predict women's increased risk of experiencing IPV and the value of longitudinal epidemiologic methods in advancing our understanding of IPV and its potential causes.</p

How do perceived and objective measures of neighbourhood disadvantage vary over time? Results from a prospective-longitudinal study in the UK with implications for longitudinal research on neighbourhood effects on health.

BackgroundTheories of health outcomes often hypothesize that living in more socially and economically disadvantaged neighbourhoods will lead to worse health. Multiple measures of neighbourhood disadvantage are available to researchers, which may serve as better or worse proxies for each other across time. To inform longitudinal study design and interpretation we investigated how perceived and objective measures of neighbourhood disadvantage vary over time and the factors underlying this variation.MethodsData were from 8,918 mothers with at least three time-points of neighbourhood data in the Avon Longitudinal Study of Parents and Children in the UK. We analyzed measures of objective (Indices of Multiple Deprivation) and perceived (neighbourhood quality, social cohesion, and stress) exposure to neighbourhood disadvantage at 10 time-points over 18 years. We used group-based trajectory modelling to determine the overlap in participants' trajectories on the different measures and evaluated the baseline factors associated with different perceived trajectories over time.ResultsThere was evidence of heterogeneity in both perceived and objective measures of neighbourhood disadvantage over time (e.g., on the objective measure, 5% of participants moved to more deprived neighbourhoods, 11% moved to less deprived neighbourhoods, 20% consistently lived in deprived neighbourhoods, and 64% consistently lived in non-deprived neighbourhoods). Perceived social cohesion showed the weakest relationship with exposure to objective neighbourhood deprivation: most participants in each trajectory group of objective neighbourhood deprivation followed non-corresponding trajectories of perceived social cohesion (61-80%). Accounting for objective deprivation exposure, poorer socioeconomic and psychosocial indicators at baseline were associated with following more negative perceived neighbourhood trajectories (e.g., high neighbourhood stress) over time.ConclusionTrajectories of perceived and objective measures of neighbourhood disadvantage varied over time, with the extent of variation depending on the time point of measurement and individual-level social factors. Researchers should be mindful of this variation when choosing and determining the timing of measures of neighbourhood disadvantage in longitudinal studies and when inferring effect mechanisms