Health inequalities: new concerns about the children of single mothers.

OBJECTIVES--To show that the exclusion from conventional class based analyses of child mortality of children whose parents are classified as "unoccupied" produces a misleading picture of health inequalities. DESIGN--Reanalysis of data published in the childhood supplement of the registrar general''s decennial supplement on occupational mortality in England and Wales, which compares numerator data for registrations of deaths in children over the age of 1 but below their 16th birthday in 1979, 1980, 1982, and 1983 with data about children aged 1-15 who were enumerated at the 1981 census. RESULTS--Parents who are classified as "unoccupied" largely consist of economically inactive single mothers. Their children are estimated to represent 89% of the 614,000 aged 1-15 classified as "unoccupied" in the childhood supplement. They have the worst mortality record of all social groups--an age specific death rate of 68.8/100,000 a year, 42% worse than in social class V (48.4/100,000) and worse than that of social class I (22.8) by a factor of 3. At older ages (10-15 years) these children have a relative risk of death of 4.14 relative to classes I and II; the risk is 2.58 in children 0-4 and 2.56 in those 5-9. Relative risks of child mortality in social classes I and II in comparison to classes IV and V suggests a progressive shallowing from 2.08 at ages 1-4 to 1.37 at ages 10-15. When unoccupied parents were combined with classes IV and V and compared with classes I and II, however, inequalities seemed to be pervasive throughout childhood; the relative risks were 2.21 for those aged 1-4 and 1.98 for those aged 10-15. CONCLUSION--Children classified as unoccupied are almost certainly living in poverty as well as experiencing relatively high risks of mortality. Class based analyses which exclude them therefore produce a misleading picture of inequalities in child health. The implications for health policy are profound. Strategies to promote the nation''s health should acknowledge the importance of material and social deprivation more explicitly.     

Giving Voice to Children's Voices: Practices and Problems, Pitfalls and Potentials

In this article, I explore the lessons that the anthropological debates of the 1980s about writing culture might have for contemporary childhood research within anthropology and the social sciences more generally. I argue that the current rhetoric about "giving voice to children," commonplace both inside and outside the academy, poses a threat to the future of childhood research because it masks a number of important conceptual and epistemological problems. In particular, these relate to questions of representation, issues of authenticity, the diversity of children's experiences, and children's participation in research, all of which need to be addressed by anthropologists in their own research practices with children. Unless anthropologists do so, childhood research risks becoming marginalized once more and will fail to provide an arena within which children are seen as social actors who can provide a unique perspective on the social world about matters that concern them as children.     

The Westermarck effect revisited: a psychophysiological study of sibling incest aversion in young female adults

Research on human inbreeding avoidance has uncovered at least two central cues to the detection of siblings: witnessing an infant being taken care of by one's mother (i.e. maternal perinatal association) and growing up in close proximity to a child (the so-called Westermarck effect). Both cues have been supported by fieldwork in populations under specific cultural conditions, and by survey research mainly in student populations. Both types of research have relied often on self-reporting. Unfortunately, this method is frequently colored by ceiling effects and notions of social desirability. In order to circumvent this problem, we explored a complementary method for investigating incest aversion that involved measuring psychophysiological responses during an imagery task. As such, we analyzed data on 63 heterosexual female students who viewed pictures of sexual and non-sexual activities while imagining performing these activities with either their partner or their brother. In female subjects with only (one or more) older brothers—a proxy for lacking maternal perinatal association with an opposite-sex sibling—the duration of coresidence with brother(s) predicted activity in the mm. levator labii superioris and alaeque nasi, facial muscles that are highly active when a subject expresses facial disgust. The strength of these responses was also predicted by the frequency of having bathed and shared a bedroom with a brother in early childhood; two activities that may serve as additional cues for relatedness as it can be expected that they are typically performed with genetically related children. As a result, the psychophysiological approach not only complements the use of self-reports in recent research on incest aversion, but also has the potential to fine-tune well-established cues for sibling detection, or to uncover additional ones.     

Do Maternal Knowledge and Attitudes towards Childhood Immunizations in Rural Uganda Correlate with Complete Childhood Vaccination?

Improving childhood vaccination coverage and timeliness is a key health policy objective in many developing countries such as Uganda. Of the many factors known to influence uptake of childhood immunizations in under resourced settings, parents’ understanding and perception of childhood immunizations has largely been overlooked. The aims of this study were to survey mothers’ knowledge and attitudes towards childhood immunizations and then determine if these variables correlate with the timely vaccination coverage of their children. From September to December 2013, we conducted a cross-sectional survey of 1,000 parous women in rural Sheema district in southwest Uganda. The survey collected socio-demographic data and knowledge and attitudes towards childhood immunizations. For the women with at least one child between the age of one month and five years who also had a vaccination card available for the child (N = 302), the vaccination status of this child was assessed. 88% of these children received age-appropriate, on-time immunizations. 93.5% of the women were able to state that childhood immunizations protect children from diseases. The women not able to point this out were significantly more likely to have an under-vaccinated child (PR 1.354: 95% CI 1.018–1.802). When asked why vaccination rates may be low in their community, the two most common responses were “fearful of side effects” and “ignorance/disinterest/laziness” (44% each). The factors influencing caregivers’ demand for childhood immunizations vary widely between, and also within, developing countries. Research that elucidates local knowledge and attitudes, like this study, allows for decisions and policy pertaining to vaccination programs to be more effective at improving child vaccination rates.     

Childhood antecedents of schizophrenia and affective illness: social adjustment at ages 7 and 11.

OBJECTIVE--To investigate the social adjustment in childhood of people who as adults have psychiatric disorders. DESIGN--Subjects in a prospectively followed up cohort (the national child development study) who had been admitted as adults to psychiatric hospitals were compared with the rest of the cohort on ratings of social behaviour made by teachers at the ages of 7 and 11 years. SUBJECTS--40 adult patients with schizophrenic illnesses, 35 with affective psychoses, and 79 with neurotic illness who had been admitted for psychiatric reasons by the age of 28. 1914 randomly selected members of the cohort who had never been admitted for psychiatric treatment. MAIN OUTCOME MEASURES--Overall scores and scores for overreaction (externalising behaviour) and underreaction (internalising behaviour) with the Bristol social adjustment guide at ages 7 and 11. RESULTS--At the age of 7 children who developed schizophrenia were rated by their teachers as manifesting more social maladjustment than controls (overall score 4.3 (SD 2.4) v 3.1 (2.0); P < 0.01). This was more apparent in the boys (5 (2.6)) than the girls (3.4 (1.8)) and related to overreactive rather than underreactive behaviour. At both ages prepsychotic (affective) children differed little from normal controls. By the age of 11 preneurotic children, particularly the girls, had an increased rating of maladjustment (including overreactions and underreactions). CONCLUSION--Abnormalities of social adjustment are detectable in childhood in some people who develop psychotic illness. Sex and the rate of development of different components of the capacity for social interaction are important determinants of the risk of psychosis and other psychiatric disorders in adulthood.     

Paternal investment and status-related child outcomes: timing of father's death affects offspring success

Recent work in human behavioural ecology has suggested that analyses focusing on early childhood may underestimate the importance of paternal investment to child outcomes since such investment may not become crucial until adolescence or beyond. This may be especially important in societies with a heritable component to status, as later investment by fathers may be more strongly related to a child's adult status than early forms of parental investment that affect child survival and child health. In such circumstances, the death or absence of a father may have profoundly negative effects on the adult outcomes of his children that cannot be easily compensated for by the investment of mothers or other relatives. This proposition is tested using a multigenerational dataset from Bangalore, India, containing information on paternal mortality as well as several child outcomes dependent on parental investment during adolescence and young adulthood. The paper examines the effects of paternal death, and the timing of paternal death, on a child's education, adult income, age at marriage and the amount spent on his or her marriage, along with similar characteristics of spouses. Results indicate that a father's death has a negative impact on child outcomes, and that, in contrast to some findings in the literature on father absence, the effects of paternal death are strongest for children who lose their father in late childhood or adolescence.     

Family mealtimes: A contextual approach to understanding childhood obesity

There has been a growing interest in the role that shared family mealtimes may play in promoting the health and well-being of children. Families that regularly eat their main meal together four or more times a week are more likely to have children who do better in school, are of average weight, less likely to use drugs and alcohol at an early age, and consume more fruits and vegetables. The mere fact that families eat together does not address the process by which shared family mealtimes may protect children from unhealthy weight gain. Just as there is no simple explanation for the rising rates of obesity, the link between shared family mealtimes and childhood obesity is a complex one including socioeconomic and cultural context. In this paper, we provide an overview of how shared family mealtimes are embedded in a socio-cultural context that may either support or derail healthy eating patterns for children and youth. Evidence from an observational study of 200 family mealtimes demonstrates the complex interplay between socio-economic factors, family mealtime behaviors, and child obesity status. Families who had a child of healthy weight spent more time engaged with each other during the meal, expressed more positive communication, and considered mealtimes more important and meaningful than families who had a child who was overweight or obese. Using a cumulative risk model, it was found that the combination of family level and neighborhood risk factors predicted child overweight status. Recommendations are made for future research directions and policies directed toward families living in diverse economic circumstances.     

Physical growth in a transitional economy: the aftermath of South African apartheid

The economic transition in developing countries is not always the result of the change from a centrally-planned to a free-market economy, but may be found within an already existing free-market economy as a result of profound political change, as in South Africa. The release of Nelson Mandela in February 1990 heralded an end both to the political system of apartheid and to the concomitant social, political, and economic disenfranchisement of 30 million non-White people in South Africa. The first freely elected non-White government came to power in 1994 and initiated a number of social and economic reforms aimed at alleviating the worst consequences of apartheid. This paper examines the effect of post-apartheid economic and social transition on the growth and development of urban children. Over 4000 children born in Soweto and Johannesburg were enrolled in the Birth to Ten (BTT) birth-cohort study in 1990. Whilst these children were born with lower birth weights than in developed countries, they did grow strongly in infancy, particularly in weight, to reflect normal reference values for body mass index (BMI) by 1 year of age. While post-apartheid social and economic changes were expected to take some time to affect child growth and development, the rate of change has been slower than expected. Data from the BTT study demonstrate that the growth of White children continues to be superior to that of their non-White peers and differences that existed at birth and during infancy have not diminished during childhood and early adolescence. Whatever factors are changed at the national or community levels during economic (and social) transition in South Africa appear not yet to have resulted in improved child physical growth.     

The Curious Relation between Theory of Mind and Sharing in Preschool Age Children

Young children have long been known to act selfishly and gradually appear to become more generous across middle childhood. While this apparent change has been well documented, the underlying mechanisms supporting this remain unclear. The current study examined the role of early theory of mind and executive functioning in facilitating sharing in a large sample (N = 98) of preschoolers. Results reveal a curious relation between early false-belief understanding and sharing behavior. Contrary to many commonsense notions and predominant theories, competence in this ability is actually related to less sharing. Thus, the relation between developing theory of mind and sharing may not be as straightforward as it seems in preschool age children. It is precisely the children who can engage in theory of mind that decide to share less with others.     

The Imagined Child: Ambiguity and Agency in Australian Intercountry Adoption

The adoption by Australian couples of children from ‘overseas’ involves claborate processes of bureaucratic assessment, approval and ‘parent education’. This paper explores adults' notions of ‘child’(ren) from ‘overseas’, which help shape and constitute such social processes, not only with couples seeking to adopt, but also with those cultural brokers who assess, regulate and ‘educate’ couples pursuing adoption, such as social workers and psychologists. The ways in which the adoptive ‘child’ is imagined and anticipated by counsellors and would‐be parents alike are explored through ethnographic data from South Australia. However, the proclivities of prospective adoptive parents to imagine their child‐to‐be are attenuated by certain social knowledge in relation to countries of origin. This leads to an exploration of ambiguities and tensions between the intercountry adoptive child as a tabula rasa and as a culturally and historically constituted person. The significance of ambiguities and contradictions for the child's agency and identities is highlighted, within the context of certain social policies around adoption. The chronological age of the child at the time of ‘allocation’ to its adoptive parents is considered as constituting a cultural fulcrum, upon which the identity and situational significance of the ‘origins’ of the child are deemed to subsequently turn.     

THE MISTREATED CHILD

“The battered child” has recently attracted the attention of physicians and social workers, but despite the fact that inflicted trauma produces characteristic x-ray changes, physicians are often reluctant to admit this cause. The neglected child may be more difficult to diagnose and is probably more common. The most typical example is the infant who is admitted to the hospital for “failure to thrive,” yet gains weight rapidly while away from his parents.The parents of both types of children are likely to be immature and inadequate, but much more study is required before the factors common to these parents are known, to say nothing of the means required for prevention and treatment.When the physician suspects that the parent is causing the difficulties manifested by the child, he should seek the help of a social worker in clarifying the situation and in contacting the appropriate social or legal agency. A greater awareness of the problems of these children should result in more rapid recognition of the condition, the establishment of well-defined methods of handling such cases, and ultimately better legislation to safeguard the child''s rights to a safe and healthy childhood.     

WPA guidance on the protection and promotion of mental health in children of persons with severe mental disorders

This guidance details the needs of children, and the qualities of parenting that meet those needs. Parental mental disorders can damage the foetus during pregnancy through the action of drugs, prescribed or abused. Pregnancy and the puerperium can exacerbate or initiate mental illness in susceptible women. After their birth, the children may suffer from the social disadvantage associated with severe mental illness. The parents (depending on the disorder, its severity and its persistence) may have intermittent or prolonged difficulties with parenting, which may sometimes result in childhood psychological disturbance or child maltreatment. This guidance considers ways of preventing, minimizing and remedying these effects. Our recommendations include: education of psychiatrists and related professions about the effect of parental mental illness on children; revision of psychiatric training to increase awareness of patients as caregivers, and to incorporate relevant assessment and intervention into their treatment and rehabilitation; the optimum use of pharmacological treatment during pregnancy; pre-birth planning when women with severe mental illness become pregnant; development of specialist services for pregnant and puerperal women, with assessment of their efficacy; community support for parenting by mothers and fathers with severe mental disorders; standards of good practice for the management of child maltreatment when parents suffer from mental illness; the importance of multi-disciplinary teamwork when helping these families, supporting their children and ensuring child protection; the development of child and adolescent mental health services worldwide.     

Sociodemographic characteristics and intentions for further births in France

The purpose of this study, which interviewed 356 couples of childbearing age in the Lyon region of France, was to analyze the different attitudes of men and women towards parenthood, and to identify the social and personal characteristics which may modify these attitudes. The 2 groups in the study, the 183 couples who wanted an additional child and the 127 who did not, were compared in relation to socioeconomic status, woman's work status, woman's age at 1st birth, and absence of a child of each sex. (46 couples with conflicting intentions were excluded.) The couples intending to have further children on average had significantly fewer children, were younger, and less frequently had a child of each sex. The other factors were statiscally insignificant. The fertility rate of couples not wanting more children was above the replacement rate of 2.6. The rate for couples intending to have another child was comparable at 2.4, except that the average 5 year age differences between the 2 groups was higher than the usual interval between 2 births, reinforcing the trend toward a model family of 2 or 3 children and greater intervals between consecutive births.     

Operations for harelip and cleft palate; the emotional complications in children

Mothers of children who need reconstructive operations for defects present at birth are likely to feel guilty, particularly if the pregnancy was unwanted. The physician treating the child is in a position to reassure the mother and assuage her guilt. To the child, the meaning of a surgical experience depends not on the type or seriousness of the actual operation, but on the type and depth of imaginings which it stimulates. For children between two and four, the anxiety of separation from the mother is greater than that aroused by the anesthetic. A good relationship with the mother will insulate the child against many traumatic events.A surgical operation is an important and stressful experience for a child, activating the great childhood fears of abandonment, of mutilation, and of death. Very frequently, children with harelip and cleft palate, by the time definitive restorative surgery is contemplated, have had emotional experiences that make them more than usually vulnerable to the harmful effects of operation. If the child can discuss the products of his imagination about the operation and have them corrected by someone he trusts, the total response will be more adequate. Talking out and playing out help prevent the development of excessive and harmful emotional reactions.     

OPERATIONS FOR HARELIP AND CLEFT PALATE—The Emotional Complications in Children

Mothers of children who need reconstructive operations for defects present at birth are likely to feel guilty, particularly if the pregnancy was unwanted. The physician treating the child is in a position to reassure the mother and assuage her guilt.To the child, the meaning of a surgical experience depends not on the type or seriousness of the actual operation, but on the type and depth of imaginings which it stimulates. For children between two and four, the anxiety of separation from the mother is greater than that aroused by the anesthetic. A good relationship with the mother will insulate the child against many traumatic events.A surgical operation is an important and stressful experience for a child, activating the great childhood fears of abandonment, of mutilation, and of death. Very frequently, children with harelip and cleft palate, by the time definitive restorative surgery is contemplated, have had emotional experiences that make them more than usually vulnerable to the harmful effects of operation. If the child can discuss the products of his imagination about the operation and have them corrected by someone he trusts, the total response will be more adequate. Talking out and playing out help prevent the development of excessive and harmful emotional reactions.     

Implications of Overweight Onset and Persistence for Social and Behavioral Development Between Kindergarten Entry and Third Grade

The current study examines the social and behavioral development of school-age children with different histories of overweight onset. Eight thousand children from the Early Childhood Longitudinal Study–Kindergarten Cohort (ECLS-K) participated. Three groups of children were identified for analysis: (1) those who were persistently overweight from kindergarten and/or first grade through third grade; (2) those who were overweight only at third grade; and, (3) those who were never overweight between kindergarten and third grade. Models controlled for child, parent, and family characteristics and tested the linear and quadratic effects of time, the main effects of overweight group and gender, and the interactions among time, overweight group, and gender. Results revealed an effect of overweight on children's social and behavioral functioning, with several effects moderated by gender and time. Findings are discussed within the context of gender and development during early middle childhood.     

Maternal adverse childhood experiences,child mental health,and the mediating effect of maternal depression: A cross-sectional,population-based study in rural,southwestern Uganda

Objectives

This study aimed to examine the intergenerational effects of maternal adverse childhood experiences (ACEs) and child mental health outcomes in rural Uganda, as well as the potentially mediating role of maternal depression in this pathway. Additionally, we sought to test the extent to which maternal social group membership attenuated the mediating effect of maternal depression on child mental health.

Methods

Data come from a population-based cohort of families living in the Nyakabare Parish, a rural district in southwestern Uganda. Between 2016 and 2018, mothers completed surveys about childhood adversity, depressive symptoms, social group membership, and their children's mental health. Survey data were analyzed using causal mediation and moderated-mediation analysis.

Results

Among 218 mother–child pairs, 61 mothers (28%) and 47 children (22%) showed symptoms meeting cutoffs for clinically significant psychological distress. In multivariable linear regression models, maternal ACEs had a statistically significant association with severity of child conduct problems, peer problems, and total child difficulty scores. Maternal depression mediated the relationship between maternal ACEs and conduct problems, peer problems, and total difficulty, but this mediating effect was not moderated by maternal group membership.

Conclusions

Maternal depression may act as a potential mechanism linking maternal childhood adversity with poor child mental health in the next generation. Within a context of elevated rates of psychiatric morbidity, high prevalence of childhood adversity, and limited healthcare and economic infrastructures across Uganda, these results emphasize the prioritization of social services and mental health resources for rural Ugandan families.     

Context-dependent model-based biases in cultural transmission: children's imitation is affected by model age over model knowledge state

Many animals, including humans, acquire information through social learning. Although such information can be acquired easily, its potential unreliability means it should not be used indiscriminately. Cultural ‘transmission biases’ may allow individuals to weigh their reliance on social information according to a model's characteristics. In one of the first studies to juxtapose two model-based biases, we investigated whether the age and knowledge state of a model affected the fidelity of children's copying. Eighty-five 5-year-old children watched a video demonstration of either an adult or child, who had professed either knowledge or ignorance regarding a tool-use task, extracting a reward from that task using both causally relevant and irrelevant actions. Relevant actions were imitated faithfully by children regardless of the model's characteristics, but children who observed an adult reproduced more irrelevant actions than those who observed a child. The professed knowledge state of the model showed a weaker effect on imitation of irrelevant actions. Overall, children favored the use of a ‘copy adults’ bias over a ‘copy task-knowledgeable individual’ bias, even though the latter could potentially have provided more reliable information. The use of such social learning strategies has significant implications for understanding the phenomenon of imitation of irrelevant actions (overimitation), instances of maladaptive information cascades, and cumulative culture.     

Modeling Social Transmission Dynamics of Unhealthy Behaviors for Evaluating Prevention and Treatment Interventions on Childhood Obesity

Research evidence indicates that obesity has spread through social networks, but lever points for interventions based on overlapping networks are not well studied. The objective of our research was to construct and parameterize a system dynamics model of the social transmission of behaviors through adult and youth influence in order to explore hypotheses and identify plausible lever points for future childhood obesity intervention research. Our objectives were: (1) to assess the sensitivity of childhood overweight and obesity prevalence to peer and adult social transmission rates, and (2) to test the effect of combinations of prevention and treatment interventions on the prevalence of childhood overweight and obesity. To address the first objective, we conducted two-way sensitivity analyses of adult-to-child and child-to-child social transmission in relation to childhood overweight and obesity prevalence. For the second objective, alternative combinations of prevention and treatment interventions were tested by varying model parameters of social transmission and weight loss behavior rates. Our results indicated child overweight and obesity prevalence might be slightly more sensitive to the same relative change in the adult-to-child compared to the child-to-child social transmission rate. In our simulations, alternatives with treatment alone, compared to prevention alone, reduced the prevalence of childhood overweight and obesity more after 10 years (1.2–1.8% and 0.2–1.0% greater reduction when targeted at children and adults respectively). Also, as the impact of adult interventions on children was increased, the rank of six alternatives that included adults became better (i.e., resulting in lower 10 year childhood overweight and obesity prevalence) than alternatives that only involved children. The findings imply that social transmission dynamics should be considered when designing both prevention and treatment intervention approaches. Finally, targeting adults may be more efficient, and research should strengthen and expand adult-focused interventions that have a high residual impact on children.     

Parent predictors of child weight change in family based behavioral obesity treatment

Family based behavioral treatment for overweight and obese children includes parenting skills targeting the modification of child eating and activity change. The purpose of this study was to examine parenting skills and parent weight change as predictors of child weight change in a sample of 80 parent/child dyads who were enrolled in a family based behavioral weight loss program for childhood obesity. Eighty overweight and obese children and their parents who enrolled in treatment in two sites were included in the study. Variables included those related to parent modeling (parent BMI), home food environment, parenting (parent and child report), and demographics. Results suggested that parent BMI change was a significant predictor of child weight, in that a reduction of 1 BMI unit in the parent was associated with a 0.255 reduction in child BMI. None of the other variables were significant in the final model. This study is consistent with other research showing that parent weight change is a key contributor to child weight change in behavioral treatment for childhood obesity. Researchers and clinicians should focus on encouraging parents to lose weight to assist their overweight and obese child in weight management.