Racial discrimination and the health and wellbeing of Aboriginal and Torres Strait Islander children: Does the timing of first exposure matter?

Racial discrimination has been observed to negatively impact on the health of Aboriginal and Torres Strait Islander children, although evidence surrounding periods of greater vulnerability to the stressor of racism have not yet been explored in this population. We compared first exposure to interpersonal racism at either ages 4–5 years or 7 years with no exposure to examine the influence of sensitive periods of racism exposure on mental health and physiological outcomes during middle childhood (7–12 years). The study cohort comprised 1,759 Aboriginal and Torres Strait Islander children aged 4–12 years from waves 2–8 (2009–2015) of the Footprints in Time: 1The Longitudinal Study of Indigenous Children (LSIC) dataset. Multilevel logistic regression was used in all analysis. We observed a larger effect (OR: 2.8; 95% CI: 1.4–5.4) for negative mental health with first exposure at 4–5 years compared to 7 years (OR: 2.1; 95% CI: 1.2–3.6), referenced to children with no exposure. Effect sizes were similar in both exposure groups for the significantly increased risk of sleep difficulties, while a stronger adverse effect on behavioural issues was found at 7 years (OR: 2.2; 95% CI: 1.3–4.0) relative to 4–5 years (OR: 1.7; 95% CI: 0.8–3.7). No significant associations were found with general health, obesity or being underweight. This study generates new evidence surrounding sensitive periods of exposure to racism in Aboriginal and Torres Strait Islander children. A pattern of consistently greater adverse effects on mental and physiological health was not observed with first exposure at 4–5 compared to 7 years, although initial evidence indicates that first exposure to racism at these ages increases the likelihood of negative mental health relative to children without racism exposure. Longitudinal data extending from earlier to later developmental periods will allow further investigations into the presence of sensitive periods of exposure to racism in these children

Caregiver-perceived racial discrimination is associated with diverse mental health outcomes in Aboriginal and Torres Strait Islander children aged 7–12 years

Background Racial discrimination is acknowledged as a central social determinant of Australian Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) health, although quantitative empirical literature on the impacts of racism on Aboriginal children remains sparse. We use a novel, longitudinal dataset to explore the relationship between caregiver-perceived racism exposure and a range of mental health and related behavioural and physiological outcomes in childhood. Method The study cohort comprised 1759 Aboriginal children aged 4–12 years from waves 2–8 (2009–2015) of the Footprints in Time: The Longitudinal Study of Indigenous Children (LSIC) dataset. We examined exposure to caregiver-perceived racism between 4 and 11 years as a predictor for mental health and related outcomes at ages 7–12 and substance use at 10–12 years. Unadjusted models and models adjusted for remoteness, community-level and family-level socio-economic status, child age and gender were used in analysis. Multilevel logistic regression was used in all analysis. Results In fully adjusted models, perceived exposure to racism at ages 4–11 was associated with twice the risk of negative mental health (95% CI: 1.3–3.0), sleep difficulties (95% CI: 1.4–3.0), and behaviour issues at school (95% CI: 1.2–2.9), 1.7 times the risk of obesity (95% CI: 1.1–2.5), and nearly 7 times the risk of trying cigarettes (95% CI: 1.1–43.9). Increased risks were also found for being underweight and trying alcohol though estimates did not reach statistical significance. There was no evidence that racism was associated with poorer general health. Conclusion Exposure to racial discrimination in Aboriginal children increased the risk for a spectrum of interrelated psychological, behavioural and physiological factors linked to negative mental health. Our results further affirm the importance of interventions aimed at reducing the prevalence of racial discrimination for the benefits of population health and health inequalities. The services and institutions which aim to support the mental health and wellbeing of Aboriginal children should also support interventions to reduce racism and implement accountable policies which prioritise this goal

Socioeconomic disparities in physical health among Aboriginal and Torres Strait Islander children in Western Australia

Objective. Few empirical studies have specifically examined the relationship between socio-economic status (SES) and health in Indigenous populations of Australia. We sought to provide insights into the nature of this relationship by examining socio-economic disparities in physical health outcomes among Aboriginal and Torres Strait Islander children in Western Australia. Design. We used a diverse set of health and SES indicators from a representative survey conducted in 20002002 on the health and development of 5289 Indigenous children aged 017 years in Western Australia. Analysis was conducted using multivariate logistic regression within a multilevel framework. Results. After controlling for age and sex, we found statistically significant socio- economic disparities in health in almost half of the associations that were investigated, although the direction, shape and magnitude of associations differed. For ear infections, recurring chest infections and sensory function problems, the patterns were generally consistent with a positive socio-economic gradient where better health was associated with higher SES. The reverse pattern was found for asthma, accidents and injuries, and oral health problems, although this was primarily observed for area-level SES indicators. Conclusion. Conventional notions of social position and class have some influence on the physical health of Indigenous children, although the diversity of results implies that there are other ways of conceptualising and measuring SES that are important for Indigenous populations. We need to consider factors that relate specifically to Indigenous circumstances and culture in the past and present day, and give more thought to how we measure social position in the Indigenous community, to gain a better understanding of the pathways from SES to Indigenous child health

Preschool Children and Behaviour Problems: A Prospective Study

Toddler/child behaviour problems have received relatively little previous attention. Prior studies have implicated a wide variety of factors in the aetiology of child behaviour problems but many of these factors are correlated and little is known about their independent contributions. Four broad categories of factors have been associated with child behaviour problems: (1) maternal social and economic characteristics; (2) maternal lifestyle; (3) maternal mental state/child-rearing practices; and (4) maternal and child physical health. The study took a sample of 5296 families from the Mater-University of Queensland Study of Pregnancy (MUSP) for whom 5-year prospective data are available. The major predictors of toddler behaviour problems were the mother's and child's health, and the mother's mental state. The mother's sociostructural characteristics and lifestyle made little or no additional contribution to the prediction models. It is, however, salutary to note that the majority of children who are classified as having high levels of troublesome behaviour do not fall into any of the risk categories. A variety of explanations and interpretations of the data is considered

Racial discrimination and allostatic load among First Nations Australians: A nationally representative cross-sectional study

Background Increased allostatic load is linked with racial discrimination exposure, providing a mechanism for the biological embedding of racism as a psychosocial stressor. We undertook an examination of how racial discrimination interacts with socioecological, environmental, and health conditions to affect multisystem dysregulation in a First Nations population. Methods We conducted latent class analysis (LCA) using indicators of life stress, socioeconomic background, and physical and mental health from a nationally representative sample of Australian Aboriginal adults (N = 2056). We used LCA with distal outcomes to estimate the effect of the latent class variable on our derived allostatic load index and conducted a stratified analysis to test whether allostatic load varied based on exposure to racial discrimination across latent classes. Results Our psychosocial, environmental, and health measures informed a four-class structure; ‘Low risk’, ‘Challenged but healthy’, ‘Mental health risk’ and ‘Multiple challenges’. Mean allostatic load was highest in ‘Multiple challenges’ compared to all other classes, both in those exposed (4.5; 95% CI: 3.9, 5.0) and not exposed (3.9; 95% CI: 3.7, 4.2) to racial discrimination. Allostatic load was significantly higher for those with exposure to racial discrimination in the ‘Multiple challenges’ class (t = 1.74, p = .04) and significantly lower in the ‘Mental health risk’ class (t = − 1.67, p = .05). Conclusions Racial discrimination may not always modify physiological vulnerability to disease. Social and economic contexts must be considered when addressing the impact of racism, with a focus on individuals and sub-populations experiencing co-occurring life challenges

Racial discrimination and child and adolescent health in longitudinal studies: A systematic review

Rationale The association between racial discrimination and adverse health outcomes has been documented across an increasing body of evidence in recent years, although a close examination of longitudinal studies has not yet taken place. This review applied a life course lens in examining the evidence for a longitudinal association between racial discrimination exposure during childhood and adolescence, and later mental and physical health outcomes. Method Medline, PsycINFO, Global Health, ERIC, CINAHL Plus, Academic Search Premier and SocINDEX were searched from earliest records to October 2017 for eligible articles. Results were described through a narrative synthesis of the evidence. Results Findings from 46 studies reported in 88 empirical articles published between 2003 and 2017 were identified. Studies were primarily based on cohorts from the United States, comprised of young people aged 11–18 years, and were published since 2010. Data were most frequently collected over two to three timepoints at intervals exceeding 12 months. Statistically significant associations with racial discrimination were most commonly reported for behaviour problems including delinquency and risk-taking behaviour, with significant adverse effects found in 74% of these associations. Statistically significant adverse effects were also reported in 63% of associations with health-harming behaviours including substance use, and 61% found associations with mental health outcomes. Consistently significant associations were reported between accumulated racism and later health outcomes, and the health effects of racism were reported to vary with developmental periods, although few studies featured these analyses. Conclusions Evidence from this review highlights that the duration and timing of exposure to racial discrimination matters. This review emphasises the need to gain evidence for the mechanisms linking early racism exposure to adverse health outcomes in later life. Future longitudinal research can address this need by capitalising on prospective cohort studies and ensuring that proposed analysis informs variable selection and timing of data collection

187 Racial discrimination, life stress and allostatic load in Aboriginal and Torres Strait Islander adults

Background Increased allostatic load is linked with racial discrimination exposure, providing a mechanism for the biological embedding of racism as a psychosocial stressor. We undertook an examination of how racial discrimination interacts with socioecological, environmental and health conditions to affect multisystem dysregulation in a First Nations population. Methods We conducted latent class analysis (LCA) using indicators of life stress, socioeconomic background and physical and mental health from a nationally representative sample of Australian Aboriginal adults (N = 2 056). We used LCA with distal outcomes to estimate the effect of the latent class variable on our derived allostatic load index and conducted a stratified analysis to test whether allostatic load varied based on exposure to racial discrimination across latent classes. Results Our socioecological, environmental and health measures informed a four-class structure; ‘Low risk’ (30.8%), ‘Challenged but healthy’ (27.8%), ‘Mental health risk’ (24.0%) and ‘Multiple challenges’ (17.4%). Mean allostatic load was highest in ‘Multiple challenges’ compared to all other classes, both in those exposed (4.5; 95% CI: 3.9, 5.0) and not exposed (3.9; 95% CI: 3.7, 4.2) to racial discrimination. Allostatic load was significantly higher for those with exposure to racial discrimination in the ‘Multiple challenges’ class (t = 1.74, p=.04) and significantly lower in the ‘Mental health risk’ class (t=-1.67, p=.05). Conclusions Racial discrimination may not always modify physiological vulnerability to disease. Social and economic contexts must be considered when addressing the impact of racism, with a focus on individuals and sub-populations experiencing co-occurring life challenges. Key messages Racial discrimination can increase physiological dysregulation in Aboriginal and Torres Strait Islander adults with a profile of psychosocial stress and adverse health

Gender differences in time allocation contribute to differences in developmental outcomes in children and adolescents

Using over 50 thousand time-use diaries from two cohorts of children, we document significant gender differ- ences in time allocation in the first 16 years in life. Relative to males, females spend more time on personal care, chores and educational activities and less time on physical and media related activities. These gender gaps in time allocation appear at very young ages and widen overtime. We provide novel evidence that gender differ- entials in time investment are quantitatively important in explaining a female advantage in most cognitive and non-cognitive skills. Moreover, gender disparity in educational time outside of school is the most important factor contributing to gender test score gaps and its contribution is more pronounced for higher performing students. By contrast, gender differences in media time are the main factor explaining gender gaps in non- cognitive skills. As children age, gender differences in time allocation play an increasing role in explaining gender gaps in both cognitive and non-cognitive skills.Ha Trong Nguyen, Sally Brinkman, Huong Thu Le, Stephen R. Zubrick, Francis Mitro