Disadvantaged children at greater relative risk of thinness (as well as obesity): a secondary data analysis of the England National Child Measurement Programme and the UK Millennium Cohort Study

Introduction: Young children living in more disadvantaged socio-economic circumstances (SECs) are at an increased risk of overweight and obesity. However, there is scant research examining the prevalence and social distribution of thinness in early childhood, despite potential negative consequences for health and development across the life-course. Methods: We examined the social gradient in thinness (and overweight and obesity for comparison) for 2,620,422 four-to-five year olds attending state maintained primary schools from 2007/8 to 2011/12, in the England National Child Measurement Programme (NCMP), and 16,715 children from the UK Millennium Cohort Study (MCS), born in 2000–2002, and measured at ages of three, five and seven. Children were classified as being thin, healthy weight (and, for completeness, overweight or obese) using international age and sex adjusted cut-offs for body mass index (BMI). Prevalences (and 95 % confidence intervals (CIs)) were estimated, overall, and according to SECs: area deprivation (NCMP, MCS); household income, and maternal social class and education (MCS only). Relative Risk Ratios (RRRs) and CIs for thinness, overweight and obesity were estimated in multinomial models by SECs (baseline healthy weight). In the MCS, standard errors were estimated using clustered sandwich estimators to account for repeated measures, and, for thinness, RRRs by SECs were also estimated adjusting for a range of early life characteristics. Results: In 2007/8 to 2011/12, 5.20 % of four-to-five year old girls (n = 66,584) and 5.88 % of boys (78,934) in the NCMP were thin. In the MCS, the prevalence of thinness was 4.59 % (693) at three, 4.21 % (702) at five, and 5.84 % (804) at seven years. In both studies, and for all measures of SECs, children from the most disadvantaged groups were more likely to be thin than those from the most advantaged groups. For example, MCS children whose mothers had no educational qualifications were fifty percent more likely to be thin (RRR 1.5 (CI: 1.24, 1.8)) than those whose mothers had a degree. These patterns were attenuated but remained after adjusting for early life characteristics. Conclusions: Children from more disadvantaged backgrounds are at elevated relative risk of thinness as well as obesity. Researchers and policymakers should consider environmental influences on thinness in addition to overweight and obesity

Have health inequalities changed during childhood in the New Labour generation? Findings from the UK Millennium Cohort Study

Objectives: To examine how population-level socioeconomic health inequalities developed during childhood, for children born at the turn of the 21st century and who grew up with major initiatives to tackle health inequalities (under the New Labour Government). Setting The UK. Participants: Singleton children in the Millennium Cohort Study at ages 3 (n=15 381), 5 (n=15 041), 7 (n=13 681) and 11 (n=13 112) years. Primary outcomes: Relative (prevalence ratios (PR)) and absolute health inequalities (prevalence differences (PD)) were estimated in longitudinal models by socioeconomic circumstances (SEC; using highest maternal academic attainment, ranging from ‘no academic qualifications’ to ‘degree’ (baseline)). Three health outcomes were examined: overweight (including obesity), limiting long-standing illness (LLSI), and socio-emotional difficulties (SED). Results: Relative and absolute inequalities in overweight, across the social gradient, emerged by age 5 and increased with age. By age 11, children with mothers who had no academic qualifications were considerably more likely to be overweight as compared with those with degree-educated mothers (PR=1.6 (95% CI 1.4 to 1.8), PD=12.9% (9.1% to 16.8%)). For LLSI, inequalities emerged by age 7 and remained at 11, but only for children whose mothers had no academic qualifications (PR=1.7 (1.3 to 2.3), PD=4.8% (2% to 7.5%)). Inequalities in SED (observed across the social gradient and at all ages) declined between 3 and 11, although remained large at 11 (eg, PR=2.4 (1.9 to 2.9), PD=13.4% (10.2% to 16.7%) comparing children whose mothers had no academic qualifications with those of degree-educated mothers). Conclusions: Although health inequalities have been well documented in cross-sectional and trend data in the UK, it is less clear how they develop during childhood. We found that relative and absolute health inequalities persisted, and in some cases widened, for a cohort of children born at the turn of the century. Further research examining and comparing the pathways through which SECs influence health may further our understanding of how inequalities could be prevented in future generations of children

Characteristics of 5-year-olds who catch-up with MMR: findings from the UK Millennium Cohort Study

Objectives To examine predictors of partial and full measles, mumps and rubella (MMR) vaccination catch-up between 3 and 5 years. Design Secondary data analysis of the nationally representative Millennium Cohort Study (MCS). Setting Children born in the UK, 2000–2002. Participants 751 MCS children who were unimmunised against MMR at age 3, with immunisation information at age 5. Main outcome measures Catch-up status: unimmunised (received no MMR), partial catch-up (received one MMR) or full catch-up (received two MMRs). Results At age 5, 60.3% (n=440) children remained unvaccinated, 16.1% (n=127) had partially and 23.6% (n=184) had fully caught-up. Children from families who did not speak English at home were five times as likely to partially catch-up than children living in homes where only English was spoken (risk ratio 4.68 (95% CI 3.63 to 6.03)). Full catch-up was also significantly more likely in those did not speak English at home (adjusted risk ratio 1.90 (1.08 to 3.32)). In addition, those from Pakistan/Bangladesh (2.40 (1.38 to 4.18)) or ‘other’ ethnicities (such as Chinese) (1.88 (1.08 to 3.29)) were more likely to fully catch-up than White British. Those living in socially rented (1.86 (1.34 to 2.56)) or ‘Other’ (2.52 (1.23 to 5.18)) accommodations were more likely to fully catch-up than home owners, and families were more likely to catch-up if they lived outside London (1.95 (1.32 to 2.89)). Full catch-up was less likely if parents reported medical reasons (0.43 (0.25 to 0.74)), a conscious decision (0.33 (0.23 to 0.48)), or ‘other’ reasons (0.46 (0.29 to 0.73)) for not immunising at age 3 (compared with ‘practical’ reasons). Conclusions Parents who partially or fully catch-up with MMR experience practical barriers and tend to come from disadvantaged or ethnic minority groups. Families who continue to reject MMR tend to have more advantaged backgrounds and make a conscious decision to not immunise early on. Health professionals should consider these findings in light of the characteristics of their local populations

The Stress-Buffering Model of Social Support in Post-Acute Brain Injury Rehabilitation

Currently, 3.2-5.3 million Americans (1.1-1.7%) live with long-term disability resulting from acquired brain injury (ABI). Despite two to three million more being treated yearly for milder injuries and released without further services, those with enduring problems often require ongoing rehabilitation and support. The immediate and long-term costs of ABI are substantial, as are the burdens associated with lifelong sequelae. A clear understanding of prognostic indicators—only some of which have been identified—could assist in reducing these costs and burdens. Social support, which has been linked with physical health and function in populations across the world, is one likely indicator. Family stress, which may influence the availability of social support and which has been independently linked to functional outcomes in various populations, is another. Somewhat surprisingly, the relationship of either with functional outcomes in ABI has yet to be firmly established. Framed by the Stress-Buffering Model of social support, this study examined the extent to which family stress predicts physical function following ABI and whether and how social support moderates this relationship. Data for this study was obtained from a national brain injury database (OutcomeInfo). OutcomeInfo houses demographic, injury, medical, service, and administrative information, as well as ratings and scores from the Mayo-Portland Adaptability Inventory—Fourth Edition (MPAI-4). The MPAI-4 is a questionnaire designed for use in post-acute rehabilitation and support programs, intended to allow facilities to track outcomes and changes throughout treatment. Bivariate Pearson and partial correlation were used in this study to gather preliminary information about the Stress-Buffering Model’s applicability within these post-acute services. Bivariate Pearson correlations revealed no significant relationships between family stress or friend support and physical function. Partial correlations revealed no significant relationships when controlling for several personal and contextual variables both individually and concurrently. This study had several limitations, and results should not be generalized at this point. Despite the lack of significant results, this study presents a coherent conceptual framework within which to examine these relationships further and provides a research design upon which future investigators may build

Do bedroom screens and the mealtime environment shape different trajectories of child overweight and obesity? Research using the Growing Up in Scotland study

Objective: To investigate how mealtime setting, mealtime interaction and bedroom screens are associated with different trajectories of child overweight and obesity, using a population sample. Methods: Growth mixture modelling used data from children in the Growing Up in Scotland Study born in 2004/5 (boys n = 2085, girls n = 1991) to identify trajectories of overweight or obesity across four time points, from 46 to 122 months. Using data from children present at all sweeps, and combining sexes (n = 2810), mutually adjusted associations between primary exposures (mealtime setting, mealtime interaction and bedroom screens) and trajectory class were explored in multinomial models; controlling for early life factors, household organisation and routines, and children’s diet patterns, overall screen use, physical activity and sleep. Results: Five trajectories were identified in both sexes: Low Risk (68% of sample), Decreasing Overweight (9%), Increasing Overweight (12%), High/Stable Overweight (6%) and High/Increasing Obesity (5%). Compared with the Low Risk trajectory, High/Increasing Obesity and High/Stable Overweight trajectories were characterised by early increases in bedroom screen access (respective relative risk ratios (RRR) and 95% confidence intervals: 2.55 [1.30–5.00]; 1.62 [1.01–2.57]). An informal meal setting (involving mealtime screen use, not eating in a dining area and not sitting at a table) characterised the High/Increasing Obesity and Increasing Overweight trajectories (respective RRRs compared with Low Risk trajectory: 3.67 [1.99–6.77]; 1.75 [1.17–2.62]). Positive mealtime interaction was associated with membership of the Increasing Overweight trajectory (RRR 1.64 [1.13–2.36]). Conclusion: Bedroom screen access and informal mealtime environments were associated with higher-risk overweight and obesity trajectories in a representative sample of Scottish children, after adjusting for a wide range of confounders. Findings may challenge the notion that positive mealtime interaction is protective. Promoting mealtimes in a screen-free dining area and removing screens from bedrooms may help combat childhood obesity

The Use of Measuring While Drilling and Wireline Logging to Identify the Geological Strata in Qatar

In the field of engineering and construction in the Middle East, it is a common practice to economize a geotechnical investigation using a conventional scope, based on the lowest price. This tends to compromise the project integrity by either under- or over-designing the structure. However, a carefully considered ground investigation and engineering evaluation should be practiced in the early stages, to reduce the unknowns related to geology, ground strength and behavior, ultimately optimizing the geotechnical design, and project constructability and efficiency. This begs the question of whether 'cheap and conventional' can ever equate to 'quality' and what can be done to improve the geotechnical investigations. This paper focuses on ground investigations on rocks and presents the key advantages of utilizing instrumented drilling boreholes in combination with rotary coring boreholes, to collect accurate and good quality data on an accelerated schedule. The study identifies the bias of a conventional geotechnical investigation, highlighting how this can be reduced through the use of instrumented drilling and wireline logging, and how the data collected can define the typical trends observed in the Qatar stratigraphy through correlation from instrumented and rotary coring boreholes drilled in several locations across Qatar. The findings have significant implications on revolutionizing the current ground investigations in Qatar, providing a geotechnical investigation alternative that delivers more complete and high-quality data

Distinct patterns of socio-economic disparities in child-to-adolescent BMI trajectories across UK ethnic groups: a prospective longitudinal study

Background: In many high‐income countries, body mass index (BMI)/obesity levels are inversely associated with socio‐economic position (SEP). Little is known whether socio‐economic patterns in BMI trajectories throughout childhood differ by ethnicity, especially in the United Kingdom. Objectives: To investigate socio‐economic disparities in child‐to‐adolescent BMI trajectories and risks of overweight and obesity during adolescence across ethnic groups. Methods: Mixed‐effects fractional polynomial and multinomial regression models were applied to estimate socio‐economic differences in BMI trajectories (3‐14 years) and risk of overweight/obesity at 14 years, respectively, in the UK Millennium Cohort Study (n = 15 996). Analysis was stratified by ethnicity. Result: Poverty was associated with higher BMI in children of White and South Asian origins, with a small difference at 3 years, which widened with age to 0.75 kg/m2 (95% CI, 0.59‐0.91) and 0.77 kg/m2 (0.26‐1.27) at 14 years for the White and South Asian groups, respectively. There was a reverse income‐BMI association in children of Black (African‐Caribbean) origin with the poverty group having a lower BMI (−0.37 kg/m2 [−0.71 to ‐0.04] at 5 years; −0.95 kg/m2 [−1.79 to −0.11] at 14 years). These patterns also presented with maternal education as a SEP indicator and for obesity at 14 years. Conclusions: Socio‐economic advantage may not be universally associated with lower BMI, which should be considered when planning obesity interventions. The positive SEP‐BMI association in children of Black origin requires replication and merits further investigation into underpinning mechanisms

Increased household financial strain, the Great Recession and child health-findings from the UK Millennium Cohort Study.

Background: There is a growing body of evidence associating financial strain (FS) with poor health but most of this research has been cross-sectional and adult-focused. During the ‘Great Recession’ many UK households experienced increased FS. The primary aim of this study was to determine the impact of increased FS on child health. Methods: We analysed the Millennium Cohort Study, a longitudinal study of children born in the UK between 2000 and 2002. Surveys at 7 years (T1, 2008) and 11 years (T2, 2012) spanned the ‘Great Recession’. Three measures of increased FS were defined; ‘became income poor’ (self-reported household income dropped below the ‘poverty line’ between T1 and T2); ‘developed difficulty managing’ ( parental report of being ‘financially comfortable’ at T1 and finding it ‘difficult to manage’ at T2); ‘felt worse off’ ( parental report of feeling financially ‘worse off’ at T2 compared with T1). Poisson regression was used to estimate risk ratios (RR), adjusted risk ratios (aRR) and 95% CIs for six child health outcomes: measured overweight/obesity, problematic behaviour as scored by parents and teachers, and parental reports of fair/poor general health, long-standing illness and bedwetting at T2 (N=13 112). In subanalyses we limited our sample to those who were above the poverty line at T2. Results: Compared with those who were not financially strained at both time points, children in households which experienced increased FS were at an increased risk of all unhealthy outcomes examined. In most cases, these increased risks persisted after adjustment for confounding and when limiting the sample to those above the poverty line. Conclusions: FS is associated with a range of new or continued poor child health outcomes. During times of widespread economic hardship, such as the ‘Great Recession’, measures should be taken to buffer children and their families from the impact of FS, and these should not be limited to those who are income poor

Weight gain in early years and subsequent body mass index trajectories across birthweight groups: a prospective longitudinal study

Background: Rapid weight gain (RWG) in early-life is associated with increased risk of childhood obesity and is common among low-birth weight infants. Few studies have compared body mass index (BMI) trajectories of children experienced RWG to those who did not, across birth weight groups. We investigated the association between RWG in early-life and subsequent BMI trajectory and whether the association differs by birth weight. Methods: We included term singletons from the UK Millennium Cohort Study (n = 10 637). RWG was defined as an increase in weight z-scores (derived using UK–WHO growth reference) between birth and 3 years >0.67. Mixed-effect fractional polynomial models were applied to examine the association between RWG and BMI trajectories (5–14 years). Models were further adjusted for confounders and stratified by birth weight-for-gestational-age group. Results: Mean BMI trajectories were higher in children who experienced RWG in early-life, compared with their non-RWG counterparts. RWG was associated with higher BMI at five years [by 0.76 kg/m2 (95% CI: 0.67–0.85) in boys and 0.87 kg/m2 (0.76–0.97) in girls]; the difference persisted into adolescence [1.37 kg/m2 (1.17–1.58) and 1.75 kg/m2 (1.52–1.99) at 14 years, respectively]. Differences remained after adjustment and were particularly greater for children born large-for-gestational-age than those born small- and appropriate-for-gestational-age. Mean BMI trajectories for large-for-gestational-age children with RWG exceeded international reference curves for overweight (for obesity at some ages in girls). Conclusions: RWG was associated with higher BMI trajectories throughout childhood and adolescence, especially in large-for-gestational-age children. Strategies for obesity prevention need to address factors during and before infancy and preventing excessive weight gain among infants who have already had adequate growth in utero

Financial strain, parental smoking, and the great recession: an analysis of the UK Millennium Cohort Study

Introduction: During the recent “Great Recession,” many families in the United Kingdom experienced increased financial strain (FS). The aim of this study was to determine if increases in FS, occurring over the period of the “Great Recession,” were associated with increased risks of persistent and relapsed tobacco use among parents. Methods: We analyzed the Millennium Cohort Study, a longitudinal study of 18819 children born in the United Kingdom between 2000 and 2002. Surveys at 7 (T1, 2008) and 11 years (T2, 2012) spanned the “Great Recession.” Three measures of increased FS were defined; “became income poor” (self-reported household income dropped below the “poverty line” between T1 and T2); “developed difficulty managing” (parental report of being “financially comfortable” at T1 and finding it “difficult to manage” at T2); “felt worse off” (parental report of feeling financially “worse off” at T2, compared to T1). Poisson regression was used to estimate risk ratios (RR), adjusted RRs (aRR), and 95% confidence intervals for three outcomes: “persistent tobacco use,” “new reported tobacco use,” and “relapsed tobacco use.” Results: Parents in households which “became income poor” over the period of the “Great Recession” were significantly more likely to report “persistent tobacco use” (aRR = 2.17 [1.83–2.57]) or “new reported tobacco use” (aRR = 1.72 [1.04–2.83]). Ninety-five percent of “new reported tobacco users” had evidence of prior tobacco use suggesting the majority were “relapsed tobacco users.” Similar patterns were seen for those who “developed difficulty managing” and “felt worse off.” Conclusions: Increased tobacco use among financially strained families has the potential to widen inequalities and undermine the public health policies that have had positive impacts on tobacco consumption in the United Kingdom