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

Effects of child long-term illness on maternal employment: longitudinal findings from the UK Millennium Cohort Study

Background: Maternal employment has increased in European countries, but levels of employment are lower among mothers whose children have a limiting long-term illness or disability. However, we do not know whether having a child with a limiting illness prevents take-up or maintenance of paid employment or whether ‘common causes’, such as lack of qualifications or maternal disability lead to both maternal unemployment and childhood illness. Longitudinal data have the potential to distinguish between these. Methods: We analyzed four waves (3, 5, 7 and 11 years) of the Millennium Cohort Study (MCS) to examine the relationship between childhood limiting illness and maternal employment, unadjusted and adjusted for covariates. Multinomial regression models were used to test the association between child illness and trajectories of maternal employment. Fixed effects models assessed whether a new report of a child illness increased the odds of a mother exiting employment. Results: At every wave, maternal employment was more likely if the child did not have a limiting illness. After adjustment for covariates, childhood illness was associated with risks of continuous non-employment (adjusted Relative Risk Ratio = 1.46 [Confidence Interval: 1.21, 1.76]) or disrupted employment (aRRR = 1.26 [CI: 1.06, 1.49]), compared with entering or maintaining employment. If a child developed a limiting long-term illness, the likelihood of their mother exiting employment increased (adjusted Odds Ratio = 1.27 [CI: 1.05, 1.54]). Conclusions: ‘Common causes’ did not fully account for the association between child illness and maternal employment. Having a child with a limiting illness potentially reduces maternal employment opportunities

Mixed modes and measurement error: Using cognitive interviewing to explore the results of a mixed modes experiment

This paper explores the use of cognitive interviewing as a pre-planned follow-up to a quantitative mixed modes experiment. It describes both the quantitative and cognitive interview phases and results. The goal for both was to explore measurement error differences between (computer-assisted personal interviewing - CAPI, computer-assisted telephone interviewing - CATI and computer-assisted web interviewing - CAWI). The cognitive interviewing produced evidence that in particular circumstances, supported or challenged the quantitative results. This is illustrated through the use of five examples. In conclusion, this novel application of cognitive interviewing was useful, with implications for survey design and interpretation of quantitative findings

The effect of mode and context on survey results: analysis of data from the Health Survey for England 2006 and the Boost Survey for London.

BACKGROUND: Health-related data at local level could be provided by supplementing national health surveys with local boosts. Self-completion surveys are less costly than interviews, enabling larger samples to be achieved for a given cost. However, even when the same questions are asked with the same wording, responses to survey questions may vary by mode of data collection. These measurement differences need to be investigated further. METHODS: The Health Survey for England in London ('Core') and a London Boost survey ('Boost') used identical sampling strategies but different modes of data collection. Some data were collected by face-to-face interview in the Core and by self-completion in the Boost; other data were collected by self-completion questionnaire in both, but the context differed. Results were compared by mode of data collection using two approaches. The first examined differences in results that remained after adjusting the samples for differences in response. The second compared results after using propensity score matching to reduce any differences in sample composition. RESULTS: There were no significant differences between the two samples for prevalence of some variables including long-term illness, limiting long-term illness, current rates of smoking, whether participants drank alcohol, and how often they usually drank. However, there were a number of differences, some quite large, between some key measures including: general health, GHQ12 score, portions of fruit and vegetables consumed, levels of physical activity, and, to a lesser extent, smoking consumption, the number of alcohol units reported consumed on the heaviest day of drinking in the last week and perceived social support (among women only). CONCLUSION: Survey mode and context can both affect the responses given. The effect is largest for complex question modules but was also seen for identical self-completion questions. Some data collected by interview and self-completion can be safely combined

Effects of visual and aural communication of categorical response options on answers to survey questions

Whether questions and answers are transmitted between interviewer and respondent by visual or aural communication can affect the responses given. We hypothesise that communication channel can affect either the respondent's understanding of the question or the tendency to satisfice. These effects may be mediated by the cognitive ability and motivation of the respondent and by the type and difficulty of the question. We test our hypotheses using data from a large-scale controlled experiment. We find support for the notion that visual presentation improves understanding of the question and reduces the tendency to satisfice. We also find that effects are stronger for respondents of higher cognitive ability and for motivated respondents

Blockade of adenosine A2A receptors prevents protein phosphorylation in the striatum induced by cortical stimulation

©2006 Society for NeurosciencePrevious studies have shown that cortical stimulation selectively activates extracellular signal-regulated kinase 1/2 (ERK1/2) phosphorylation and immediate early gene expression in striatal GABAergic enkephalinergic neurons. In the present study, we demonstrate that blockade of adenosine A2A receptors with caffeine or a selective A2A receptor antagonist counteracts the striatal activation of cAMP– protein kinase A cascade (phosphorylation of the Ser845 residue of the glutamate receptor 1 subunit of the AMPA receptor) and mitogenactivated protein kinase (ERK1/2 phosphorylation) induced by the in vivo stimulation of corticostriatal afferents. The results indicate that A2A receptors strongly modulate the efficacy of glutamatergic synapses on striatal enkephalinergic neurons.This work was supported by the Intramural Research Program of the National Institutes of Health, National Institute on Drug Abuse, Department of Health and Human Services

Temporal effects of maternal psychological distress on child mental health problems at ages 3, 5, 7 and 11: analysis from the UK Millennium Cohort Study

Background: Psychological distress is common among women of childbearing age, and limited longitudinal research suggests prolonged exposure to maternal distress is linked to child mental health problems. Estimating effects of maternal distress over time is difficult due to potential influences of child mental health problems on maternal distress and time-varying confounding by family circumstances. Methods: We analysed the UK Millennium Cohort Study, a nationally representative sample with data collected throughout childhood. Adopting a marginal structural modelling framework, we investigated effects of exposure to medium/high levels of maternal psychological distress (Kessler-6 score 8+) on child mental health problems (Strengths and Difficulties Questionnaire borderline/abnormal behaviour cut-off) using maternal and child mental health data at 3, 5, 7 and 11 years, accounting for the influence of child mental health on subsequent maternal distress, and baseline and time-varying confounding. Results: Prior and concurrent exposures to maternal distress were associated with higher levels of child mental health problems at ages 3, 5, 7 and 11 years. For example, elevated risks of child mental health problems at 11 years were associated with exposure to maternal distress from 3 years [risk ratio (RR) 1.27 (95% confidence interval (CI) 1.08–1.49)] to 11 years [RR 2.15 (95% CI 1.89–2.45)]. Prolonged exposure to maternal distress at ages 3, 5, 7 and 11 resulted in an almost fivefold increased risk of child mental health problems. Conclusions: Prior, concurrent and, particularly, prolonged exposure to maternal distress raises risks for child mental health problems. Greater support for mothers experiencing distress is likely to benefit the mental health of their children

Is it a good idea to optimise question format for mode of data collection? Results from a mixed modes experiment

It is common practice to adapt the format of a question to the mode of data collection. Multi-coded questions in self-completion and face-to-face modes tend to be transformed for telephone into a series of 'yes/no' questions. Questions with response scales are often branched in telephone interviews, that is, converted into two or more questions, each with shorter response lists. There has been limited research into the impact of these format differences on measurement, particularly across modes. We analyse data from an experiment that contrasted these question formats in face-to-face, telephone and web surveys. The study also included a cognitive interviewing follow-up to further explore the quantitative findings

The role of the interviewer in producing mode effects: Results from a mixed modes experiment comparing face-to-face, telephone and web administration

The presence of an interviewer is hypothesised to motivate respondents to generate an accurate answer and reduce task difficulty, but also to reduce the privacy of the reporting situation.The prevalence of indicators of satisficing (e.g., non-differentiation, acquiescence, middle categories, primacy and recency, and item nonresponse) and socially desirable responding were studied experimentally across modes and also through cognitive interviewing. Results show differences between interviewer and self-completion modes: in levels of satisficing for non- differentiation, acquiescence, and middle categories and socially desirable responding. There were also unexpected findings of a CATI primacy/positivity bias and of different ways of satisficing

Crowding and Cognitive Development: The Mediating Role of Maternal Responsiveness Among 36-Month-Old Children

Residential crowding in both U.S. and U.K. samples of 36-month-old children is related concurrently to the Bracken scale, a standard index of early cognitive development skills including letter and color identification, shape recognition, and elementary numeric comprehension. In the U.S. sample, these effects also replicate prospectively. Statistical controls for income, child gender, maternal age, and maternal education are incorporated throughout. In both samples the association between crowding and cognitive development are mediated by maternal responsiveness. Mothers in more crowded homes are less responsive to their children. © 2010 Sage Publications