Low health-related quality of life in school-aged children in Tonga, a lower-middle income country in the South Pacific

Background:
Ensuring a good life for all parts of the population, including children, is high on the public health agenda in most countries around the world. Information about children’s perception of their health-related quality of life (HRQoL) and its socio-demographic distribution is, however, limited and almost exclusively reliant on data from Western higher income countries.

Objectives:
To investigate HRQoL in schoolchildren in Tonga, a lower income South Pacific Island country, and to compare this to HRQoL of children in other countries, including Tongan children living in New Zealand, a high-income country in the same region.

Design:
A cross-sectional study from Tonga addressing all secondary schoolchildren (11–18 years old) on the outer island of Vava’u and in three districts of the main island of Tongatapu (2,164 participants). A comparison group drawn from the literature comprised children in 18 higher income and one lower income country (Fiji). A specific New Zealand comparison group involved all children of Tongan descendent at six South Auckland secondary schools (830 participants). HRQoL was assessed by the self-report Pediatric Quality of Life Inventory 4.0.

Results:
HRQoL in Tonga was overall similar in girls and boys, but somewhat lower in children below 15 years of age. The children in Tonga experienced lower HRQoL than the children in all of the 19 comparison countries, with a large difference between children in Tonga and the higher income countries (Cohen’s d 1.0) and a small difference between Tonga and the lower income country Fiji (Cohen’s d 0.3). The children in Tonga also experienced lower HRQoL than Tongan children living in New Zealand (Cohen’s d 0.6).

Conclusion:
The results reveal worrisome low HRQoL in children in Tonga and point towards a potential general pattern of low HRQoL in children living in lower income countries, or, alternatively, in the South Pacific Island countries.

Is iron and zinc nutrition a concern for vegetarian infants and young children in industrialized countries?

Well-planned vegetarian diets are considered adequate for all stages of the life cycle, despite limited data on the zinc status of vegetarians during early childhood. The bioavailability of iron and zinc in vegetarian diets is poor because of their higher content of absorption inhibitors such as phytate and polyphenols and the absence of flesh foods. Consequently, children as well as adult vegetarians often have lower serum ferritin concentrations than omnivores, which is indicative of reduced iron stores, despite comparable intakes of total iron; hemoglobin differences are small and rarely associated with anemia. However, data on serum zinc concentrations, the recommended biomarker for identifying population groups at elevated risk of zinc deficiency, are sparse and difficult to interpret because recommended collection and analytic procedures have not always been followed. Existing data indicate no differences in serum zinc or growth between young vegetarian and omnivorous children, although there is some evidence of low serum zinc concentrations in vegetarian adolescents. Some vegetarian immigrants from underprivileged households may be predisposed to iron and zinc deficiency because of nondietary factors such as chronic inflammation, parasitic infections, overweight, and genetic hemoglobin disorders. To reduce the risk of deficiency, the content and bioavailability of iron and zinc should be enhanced in vegetarian diets by consumption of fortified cereals and milk, by consumption of leavened whole grains, by soaking dried legumes before cooking and discarding the soaking water, and by replacing tea and coffee at meals with vitamin C-rich drinks, fruit, or vegetables. Additional recommended practices include using fermented soy foods and sprouting at least some of the legumes consumed. Fortified foods can reduce iron deficiency, but whether they can also reduce zinc deficiency is less certain. Supplements may be necessary for vegetarian children following very restricted vegan diets.

Longitudinal levels and bouts of objectively measured sedentary time among young Australian children in the HAPPY study

To examine differences in sedentary time and bouts during and outside of childcare/school periods, and changes in sedentary time and bouts over 1-year among children who remained in childcare (childcare subsample) and among those who transitioned to school (school transition subsample).

A Cross-Cultural Evaluation of the Personal Wellbeing Index – School Children in Samples of Australian and Portuguese Adolescents

The practice of comparing nations on subjective wellbeing (SWB) is becoming commonplace, with many countries ranked by economists and social scientists alike according to average levels of SWB based on survey responses. Such large, multi-national population surveys have the potential to generate insights into the causes and correlates of SWB within different cultural groups, as well as inform policy regarding how to improve the wellbeing of citizens. At the heart of these large-scale research endeavors are SWB measures that function equivalently between the various participating cultural groups. For this reason, it is concerning that their remains a paucity of research that supports measurement equivalence for many SWB instruments commonly employed. Thus, it remains unclear whether variations in SWB across cultures reflect true differences, or whether these differences reflect measurement biases (e.g., response bias inherent within a particular cultural group). The aim of this study was to examine the psychometric equivalence of the Personal Wellbeing Index–School Children (PWI-SC) in convenience samples of Australian and Portuguese adolescents using multiple-group confirmatory factor analysis. Participants comprising the Australian sample were 1104 Victorian high-school students aged between 12 and 19 years (M = 14.42, SD = 1.63). Participants comprising the Portuguese sample were 573 high-school students living in Portugal aged between 12 and 18 years (M = 14.32, SD = 1.72). The results demonstrated strict factorial invariance between both versions of the PWI-SC, suggesting that this scale measures the same underlying construct in both samples. Moreover, these findings provide preliminary support for quantitative comparisons between Australian and Portuguese adolescents on the SWB variable as valid.

Negotiating and creating intercultural relations: Chinese immigrant children in New Zealand early childhood education centres

A multiple-case study investigation of the experiences of eight Chinese immigrant children in New Zealand early childhood centres suggested that the immigrant children’s learning experiences in their first centre can be understood as a process of negotiating and creating intercultural relations. The children’s use of family cultural tools, such as the Chinese language, was a distinctive feature of their learning experiences, simultaneously revealing and extending their exploration of the intercultural practices and their establishment of a sense of belonging. In the presence of Chinese-speaking peers who acted as ‘bridges’ and ‘boundary objects’, the Chinese language was actively used by the immigrant children in English-speaking early childhood centres and, as a result, they created intercultural relations which: (i) bridged the two cultures; (ii) brought the cultures into convergence; (iii) enabled the children to claim group identity; and (iv) battled intercultural constraints. The absence of Chinese speakers, on the other hand, constrained possibilities for intercultural relations. The focus on intercultural relations in this study is expected to lead to educational initiatives to support the incorporation of diverse cultures in early childhood services.

Fundamental movement skills of preschool children in Northwest England

This cross-sectional study examined fundamental movement skill competency among deprived preschool children in Northwest England and explored sex differences. A total of 168 preschool children (ages 3-5 yr.) were included in the study. Twelve skills were assessed using the Children's Activity and Movement in Preschool Motor Skills Protocol and video analysis. Sex differences were explored at the subtest, skill, and component levels. Overall competence was found to be low among both sexes, although it was higher for locomotor skills than for object-control skills. Similar patterns were observed at the component level. Boys had significantly better object-control skills than girls, with greater competence observed for the kick and overarm throw, while girls were more competent at the run, hop, and gallop. The findings of low competency suggest that developmentally appropriate interventions should be implemented in preschool settings to promote movement skills, with targeted activities for boys and girls.

Normative data for the strengths and difficulties questionnaire for young children in Australia

AIM: The aim of this study was to report normative data for the parent-reported Strengths and Difficulties Questionnaire (SDQ) from a large population cohort of young children aged 4-6 years from Victoria, Australia, to establish age- and sex-specific cut-off values for future use, and to determine the scale reliability of the SDQ for children aged 4-6 years. METHODS: Parents of children (n = 53 372) entering their first year of school in Victoria in 2010 completed a survey via a 15-page School Entrant Health Questionnaire reporting on the physical and emotional well-being of their child (including the SDQ), use of child health and other support services, and a range of socio-demographic variables. Reliability was assessed and norms generated. Appropriate cut-off values for each SDQ scale and total difficulties scale were generated for each age group separately for each sex. RESULTS: The five scales of the SDQ and total difficulties scale generally had acceptable internal reliability. Mean SDQ scale scores differed for both sex and age, although only a narrow age range is examined in this study. Cut-off values were marginally higher for girls (lower for prosocial) and generally increased with age. CONCLUSIONS: This study has utilised a large Australian population sample of children to generate age- and sex-specific cut-off values that define SDQ scores as 'normal', 'borderline' or 'abnormal' for Australian children aged 4-6 years.

Social connections among parents of pre-school-age children in an inner and outer area of Melbourne, Australia

Abstract
Parents’ social connectedness is an important factor in child health and development outcomes and has been strongly linked to place. This study aimed to compare social connectedness amongst parents in inner versus outer-suburbs of Melbourne using a mixed methods approach. Parents were recruited via playgroups, mother’s groups and preschools and interviewed face- to-face regarding their social networks, with a second open-ended interview focusing on parents’ ideals and experiences of raising children in their current location. Parents in the two areas identified a similar number of contacts, but had differently structured networks. Outer-suburban parents were more likely than inner-suburban parents to have very few contacts, and to name their general practitioner as among their significant contacts. They were less likely to have more extended networks or to include neighbours among their contacts. Parents in both areas had met at least some of their network members through local organisations or services with outer-suburban parents having met a greater proportion of their contacts in this way. Qualitative interview data supported the network analysis revealing the different priorities parents placed on neighbours, barriers experienced in connecting with neighbours in the outer- suburbs and the consequent heavy reliance on organised activities to form social connections. The different types of social connections parents in inner and outer Melbourne made in relation to raising their preschool-aged children revealed in this study have implications for both service delivery and social planning of new developments.

I was running away from death - the pre-flight experiences of unaccompanied asylum seeking children in the UK

OBJECTIVE: To collect information about the pre-flight experiences of unaccompanied asylum seeking children (UASC) in the UK to increase the understanding of support needed on arrival in the UK. METHODS: Retrospective social services case file and legal statement review and semi-structured in-depth interviews with 100 UASC. RESULTS: Nearly half of all UASC have experienced separation from or loss of parents and/or family members (47%), and a further 41% had personally experienced or witnessed violence. Sexual violence (such as rape) was reported by 24% of African girls. Many children reported complex journeys to the UK. CONCLUSIONS: UASC arrive in the UK with a variety of potentially traumatic experiences. Whilst research is starting to identify some of the experiences of UASC, further culturally appropriate research is needed to identify their health and social needs after arrival. Further research will help to identify the specific experiences of UASC, indicating where services should be improved to deal with their complex and diverse needs.

‘Cemented in their cells’: a human rights analysis of Blessington, Elliott and the life imprisonment of children in New South Wales

In 2010, two Australians, convicted in childhood of rape and murder, lodged a joint submission with the United Nations Human Rights Committee, claiming that successive changes to sentencing legislation in New South Wales breached their human rights by denying them any meaningful prospect of release. In this article, we examine the political, legislative and procedural moves that have resulted in Australian children being sentenced to life without parole or release. We argue that successive legislative changes in various Australian jurisdictions have resulted in a framework for sentencing decisions that is considerably out of step with international legal standards for criminal justice. These increasingly punitive legislative changes exacerbate Australia’s already declining record of cooperation with UN processes, and reveal Australia’s reluctance to respect the legitimacy and authority of international law. Against this troubling context, the views of the Human Rights Committee serve as a much-needed reminder about the importance of a principled approach to child sentencing that forecloses neither the goal of rehabilitation nor the prospect of release and reintegration.

Health literacy and the determinants of obesity: a population-based survey of sixth grade school children in Taiwan

BACKGROUND: Health literacy has become an important health policy and health promotion agenda item in recent years. It had been seen as a means to reduce health disparities and a critical empowerment strategy to increase people's control over their health. So far, most of health literacy studies mainly focus on adults with few studies investigating associations between child health literacy and health status. This study aimed to investigate the association between health literacy and body weight in Taiwan's sixth grade school children.

METHODS: Using a population-based survey, 162,209 sixth grade (11-12 years old) school children were assessed. The response rate at school level was 83%, with 70% of all students completing the survey. The Taiwan child health literacy assessment tool was applied and information on sex, ethnicity, self-reported health, and health behaviors were also collected. BMI was used to classify the children as underweight, normal, overweight, or obese. A multinomial logit model with robust estimation was used to explore associations between health literacy and the body weight with an adjustment for covariates.

RESULTS: The sample consisted of 48.9% girls, 3.8% were indigenous and the mean BMI was 19.55 (SD = 3.93). About 6% of children self-reported bad or very bad health. The mean child health literacy score was 24.03 (SD = 6.12, scale range from 0 to 32). The overall proportion of obese children was 15.2%. Children in the highest health literacy quartile were less likely to be obese (12.4%) compared with the lowest quartile (17.4%). After controlling for gender, ethnicity, self-rated health, and health behaviors, children with higher health literacy were less likely to be obese (Relative Risk Ratio (RRR)&thinsp;= 0.94, p < 0.001) and underweight (RRR = 0.83, p < 0.001). Those who did not have regular physical activity, or had sugar-sweetened beverage intake (RRR > 1.10, p < 0.0001) were more likely to report being overweight or obese.

CONCLUSIONS: This study demonstrates strong links between health literacy and obesity, even after adjusting for key potential confounders, and provides new insights into potential intervention points in school education for obesity prevention. Systematic approaches to integrating a health literacy curriculum into schools may mitigate the growing burden of disease due to obesity.

Investigative Interviewing of Aboriginal children in cases of suspected sexual abuse

This study examined the investigative interviewing of Australian Aboriginal children in cases of alleged sexual abuse, with a focus on three commonly included components of interview protocols: ground rules, practice narrative, and substantive phase. Analysis of 70 field transcripts revealed that the overall delivery and practice of ground rules at the beginning of the interview was positively associated with the spontaneous usage of rules in children's narratives of abuse. When specifically examining the "don't know" rule, however, only practice had an effect of children's usage of the rule (as opposed to simple delivery or no delivery at all). Children spoke more words overall, and interviewers used more open-ended prompts during the substantive phase when the interviews contained a practice narrative. Children most often disclosed sexual abuse in response to an open-ended prompt; however, they produced the most words in response to suggestive prompts. This article concludes with a discussion of the effectiveness of ground rules, practice narratives, and questioning with Aboriginal children.

Understanding home literacy practices of young children in vulnerable communities: what we can learn from the research

Research indicates that children who arrive m school with limited experiences of literacy are frequently at a disadvantage with progress in school. Without the necessary literate cultural capital, they have difficulty learning to read and write, falling further behind their classmates throughout their schooling. It is important that we focus on what language and literacy experiences are occurring in the home and how these can be further supported.This chapter acknowledges the important role that families play in young children's language and literacy development, drawing attention to the importance of the home as a site for supporting the literacy growth of children. Data, to inform the chapter, are drawn from two sources. One source is a large-scale survey investigation that gained insight into the different home literacy practices of preschool children in some disadvantaged areas of Victoria. The data provide a snapshot into what literacy practices occur in these homes. The second source is a case study of a single family taken from a targeted literacy intervention program in the north-west of Victoria. This study highlights possibilities for supporting families in literacy interactions with their young children in the home. The findings from both studies point to practical approaches and strategies that promote and support home literacy practices. This chapter argues that supporting families in their role is just as important as these families supporting their children's language and literacy learning.