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No abstract available

Direct, indirect and buffering effects of support for mothers on children's socio-emotional adjustment

Support for mothers may improve children’s socioemotional adjustment, yet few studies have consideredthe benefits of formal support (from health and social work professionals) in addition to social support(from family and friends) or explored the mechanisms. These issues were addressed using a birth cohort(n�2,649) to explore how mothers’ perceptions of social and formal support when children were ages10–22 months predicted trajectories of children’s externalizing and internalizing problems from 58 to122 months. We tested mediating pathways from support to child adjustment via 3 family stressorsmeasured at 46–58 months (maternal distress, economic strain, and dysfunctional parenting) andexamined whether support buffered effects of stressors on child adjustment. Social and formal supportwere simultaneously associated with lower child externalizing and internalizing problem trajectoryintercepts at 90 months but did not predict trajectory slopes. Social support effects were mediated mainlyvia lower maternal distress, which then reduced children’s problems via lower dysfunctional parenting,or more directly. Additional indirect effects involved lower economic strain. Formal support effects weremediated to a lesser extent by reduced dysfunctional parenting. Two buffering effects were found: socialsupport reduced effects of economic strain on internalizing problems, and formal support reduced effectsof dysfunctional parenting on internalizing problems. Findings suggest measures promoting families’social integration should benefit children’s socioemotional adjustment via improved parental psycho-logical and economic resources and by buffering impacts of economic strain. Enhancing access to healthand welfare services through greater awareness and trust should benefit children’s adjustment, viaimproved parenting and by buffering impacts of dysfunctional parenting

Environmental tobacco smoke exposure among infants, children and young people: now is no time to relax

No abstract available

Parenting stress and parent support among mothers with high and low education

Current theorising and evidence suggest that parenting stress might be greater among parents from both low and high socio-economic positions (SEP), compared to those from intermediate levels; due to material hardship among parents of low SEP, and to employment demands among parents of high SEP. However, little is known about how this socio-economic variation in stress relates to the support that parents receive. This study explored whether variation in maternal parenting stress in a population sample was associated with support deficits. In order to obtain a clearer understanding of support deficits among high-and low-educated mothers, subgroups were distinguished according to mothers’ migrant and single parent status. Participants were 5865 mothers from the Growing Up in Scotland study, interviewed when their child was 10 months old. Parenting stress was greater among mothers with either high or low education than among mothers with intermediate education, although it was highest for those with low education. Support deficits accounted for around 50% of higher stress among high-and low-educated groups. Less frequent grandparent contact mediated parenting stress among both high- and low-educated mothers, particularly migrants. Aside from this common feature, different aspects of support were relevant for high- compared with low-educated mothers. For high-educated mothers, reliance on formal childcare and less frequent support from friends mediated higher stress. Among low-educated mothers, smaller grandparent and friend networks and barriers to professional parent support mediated higher stress. Implications of differing support deficits are discussed

Caring for a relative with dementia: anticipatory grief and social death

The study derived its data from semi-structured interviews with 100 relatives of patients with a primary diagnosis of dementia. At the time of the interview, the dementia sufferer lived with the carer in 61 cases, in their own home in 16 cases, and in long-term institutional care in 23 cases. The interviews were based on a `Carers' Questionnaire' which has evolved via preliminary unstructured exploratory interviews with carers, followed by a pilot study employing an initial draft of the questionnaire. The study demonstrated that caregiving relatives generally acknowledged dementia to be an illness which would result in continued deterioration and death in the sufferer; that is, as a terminal illness, bringing both current and future losses. The emotional and behavioural reactions which previous studies have labelled `anticipatory grief' were experienced - to varying degrees - by the caregiving relatives of dementia sufferers. While partly simply a response to the burdens of the caregiving situation, they could also be attributed in part as the response to the loss of the person of the dementia sufferer. The majority of carers believed they had experienced grief, and the underlying structure of their reactions was similar to that of conventional grief. The results of the study showed that taken as whole, there was considerable stability in the emotional and behavioural reactions of the caregiving relatives of dementia sufferers over time. Against this background, there was a sub-group of approximately one-third of the sample of carers whose shock, or disbelief, or hope was greater earlier on in the process of their relatives' dementia, and whose acceptance of the illness and the future had increased over time. There was, however, no evidence of a phasic emergence of a variety of discrete stages in the carers' reactions, nor of an end-point of resolution or acceptance. The different components of the emotional and behavioural reactions of caregiving relatives were associated with different caregiver and sufferer characteristics. Initial shock was associated with learning the diagnosis and prognosis suddenly. Current carer shock, denial or hope were associated with sufferers who were younger, were spouses or siblings, and were demanding, with carers who were older, with less time since onset of the dementia. Protest, questioning and guilt were more likely in younger carers, those who perceived dementia as a horrible/worst illness, and those reporting a poor relationship with the sufferer. Reactions of yearning or preoccupation were more likely in carers who perceived dementia as a horrible/worst illness, and who were not helped by a religious or other belief. Carer depression was associated with demanding sufferer behaviour, perceiving dementia as a horrible/worst illness, and reporting a poor relationship with the sufferer. Finally, carer acceptance was more likely when they perceived dementia as the consequence of aging or just an illness, and when they had greater general knowledge regarding dementia. Whilst not labelling it as such, some carers did perceive their dementing relative in terms which could be regarded as `socially dead'. Three factors comprised the underlying structure of social death. Factor one, `Anticipate Death', relating to thinking in a variety of ways about the sufferer's death, had occurred for between half and three-quarters of the sample. `Anticipate Death' was associated with variables suggesting that the dementia sufferer had lived too long, and that the carer was fed up (angry or depressed) with the situation. Factor Two, `Life Pointless', relating to elements of social death such as believing that the sufferer's death would be a blessing, had occurred - to varying degrees - for at least half the sample. This was the only social death factor to be associated with a carer's belief that they had experienced grief. It was also related to a lack of carer hope or bargaining behaviours (perhaps representing the acceptance of the inevitability of the sufferer's decline), with increased sufferer dependency, with the carer's perception of dementia as a horrible/worst illness, and their reporting a poor relationship with the sufferer. Social Death Factor Three, `Sufferer Unaware', relating to sufferer lack of awareness of, and response to, their environment, was endorsed by the vast majority of the caregiver sample. It was associated with increased impairment in the sufferer (perhaps representing `loss of the person'). Those carer emotional and behavioural reactions most clearly representing distress were associated with increased subjective burden. Belief that they had experienced grief was associated with a reduction in a carer's perceived coping ability. None of the social death factors was linked to carer subjective burden or coping. Finally, with regard to institutionalisation, there was no evidence that placement in long-term care triggered either the social death of dementia sufferers or anticipatory grief in their relatives. Among community carers, preference for institutional care was not directly related to any of the anticipatory grief reactions. It was, however, associated with social death factor `Life Pointless'. This suggests that if a carer perceives the continuation of their dementing relative's life as meaningless, then the removal of the physical presence of the sufferer to institutional care may be more acceptable, or even welcomed

'Now I care': a qualitative study of how overweight adolescents managed their weight in the transition to adulthood

Objectives: A qualitative study of recalled experiences of early adolescent overweight/obesity revealed low levels of weight-related concern. This further analysis aimed to explore weight-related concern and weight-loss efforts as participants transitioned into adulthood. Design, participants and methods: Participants were 35 young adults from a population-based cohort study who had body mass index (BMI) >95th centile between ages 11 and 15 and participated in semistructured interviews aged 24. At age 24, they were categorised as: ‘slimmers’ (N=13) who had lower BMI Z-scores at 24 than their adolescent peak and were not obese (BMI<30 kg/m2); ‘relapsers’ (N=8, of whom 2 were morbidly obese (BMI>35 kg/m2) at age 24); ‘stable’ (N=3, of whom 1 morbidly obese); and ‘gainers’ (N=11, of whom 5 morbidly obese). Themes were identified and coded using NVivo qualitative data analysis software, blind to participants’ current weight status. Results: Contrasting with the lack of concern recalled in respect of earlier adolescence, weight-related concerns and/or desire to lose weight generally increased around the time of school leaving and almost all participants described some form of exercise (formal/informal) and dietary weight-control strategies. Among ‘slimmers’, there was some (subtle) evidence of more consistent use of exercise, self-monitoring of diet and exercise and of lifestyle changes becoming habitual and/or part of identity. Few participants had accessed professional support. Diet clubs seemed to have been used most by ‘gainers’, some only recently. Labour-market and housing transitions were strong influences, described as facilitating weight losses by some, but increases by others. For some participants, it appeared that weight loss was simply a by-product of these transitions. Conclusions: In contrast to earlier adolescence, even the heaviest participants tended to show actual weight loss action or preparation for action. The transition to adulthood could thus be a key life stage for interventions

Potential value of the current mental health monitoring of children in state care in England

Background: Routine screening to identify mental health problems in English looked-after children has been conducted since 2009 using the Strengths and Difficulties Questionnaire (SDQ). Aims: To investigate the degree to which data collection achieves screening aims (identifying scale of problem, having an impact on mental health) and the potential analytic value of the data set. Method: Department for Education data (2009–2017) were used to examine: aggregate, population-level trends in SDQ scores in 4/5- to 16/17-year-olds; representativeness of the SDQ sample; attrition in this sample. Results: Mean SDQ scores (around 50% ‘abnormal’ or ‘borderline’) were stable over 9 years. Levels of missing data were high (25–30%), as was attrition (28% retained for 4 years). Cross-sectional SDQ samples were not representative and longitudinal samples were biased. Conclusions: Mental health screening appears justified and the data set has research potential, but the English screening programme falls short because of missing data and inadequate referral routes for those with difficulties

Adolescent socio-economic and school-based social status, health and well-being

Studies of adults and adolescents suggest subjective socio-economic status (SES) is associated with health/well-being even after adjustment for objective SES. In adolescence, objective SES may have weaker relationships with health/well-being than at other life stages; school-based social status may be of greater relevance. We investigated the associations which objective SES (residential deprivation and family affluence), subjective SES and three school-based subjective social status dimensions ("SSS-peer", "SSS-scholastic" and "SSS-sports") had with physical symptoms, psychological distress and anger among 2503 Scottish 13-15 year-olds. Associations between objective SES and health/well-being were weak and inconsistent. Lower subjective SES was associated with increased physical symptoms and psychological distress, lower SSS-peer with increased psychological distress but reduced anger, lower SSS-scholastic with increased physical symptoms, psychological distress and anger, and lower SSS-sports with increased physical symptoms and psychological distress. Associations did not differ by gender. Objective and subjective SES had weaker associations with health/well-being than did school-based SSS dimensions. These findings underline the importance of school-based SSS in adolescence, and the need for future studies to include a range of school-based SSS dimensions and several health/well-being measures. They also highlight the need for a focus on school-based social status among those working to promote adolescent health/well-being