Working with family to promote health adolescent development

In recent years a sea change has occurred in thinking about interventions for families with adolescent children. A range of intervention strategies has been proposed, including parent education, adolescent education, family therapy, and community change. These associations arise, in part, from a higher likelihood sole-parent families will experience traumatic conflict around family breakdown, lack of supervision due to the parent's work pressures, and limited family income resulting in higher exposure to community risk factors, which demonstrated reduced parental drug use and improved family management, and the Strengthening Families Program, which demonstrated increased children's protective factors, reduced substance use in both adolescents and parents, and improved parenting behaviours are currently investigating the impact of an integrated multi-level secondary school intervention, resilient families, which incorporates communication training for students, an information night for parents, sequenced parent education groups, and brief family therapy.

The lifestyle of our kids (LOOK) project : outline of methods

This methods paper outlines the overall design of a community-based multidisciplinary longitudinal study with the intent to stimulate interest and communication from scientists and practitioners studying the role of physical activity in preventive medicine. In adults, lack of regular exercise is a major risk factor in the development of chronic degenerative diseases and is a major contributor to obesity, and now we have evidence that many of our children are not sufficiently active to prevent early symptoms of chronic disease. The lifestyle of our kids (LOOK) study investigates how early physical activity contributes to health and development, utilizing a longitudinal design and a cohort of eight hundred and thirty 7–8-year-old (grade 2) school children followed to age 11–12 years (grade 6), their average family income being very close to that of Australia. We will test two hypotheses, that (a) the quantity and quality of physical activity undertaken by primary school children will influence their psychological and physical health and development; (b) compared with existing practices in primary schools, a physical education program administered by visiting specialists will enhance health and development, and lead to a more positive perception of physical activity. To test the first hypothesis we will monitor all children longitudinally over the 4 years. To test the second we will involve an intervention group of 430 children who receive two 50 min physical education classes every week from visiting specialists and a control group of 400 who continue with their usual primary school physical education with their class-room teachers. At the end of grades 2, 4, and 6 we will measure several areas of health and development including blood risk factors for chronic disease, cardiovascular structure and function, physical fitness, psychological characteristics and perceptions of physical activity, bone structure and strength, motor control, body composition, nutritional intake, influence of teachers and family, and academic performance.

The impact of parental multiple sclerosis on the adjustment of children and adolescents.

Thirty-one parents with multiple sclerosis (MS) participated in a study to investigate the adjustment of their children, 24 boys and 24 girls aged 4 to 16 years. The majority of parents believed that their illness had an effect on their children. The perception of parents regarding their children's problems in the areas of emotions, concentration, behavior, or social interactions indicated that the children were at three times greater risk than the general community of developing psychological problems. In contrast, actual symptom scores reported by parents revealed that, although these children were at greater risk than the general community of developing peer problems, little difference was found on hyperactivity, emotional symptoms, conduct problems, or total difficulties. Parental negative affect predicted both parental reports of peer problems and perceptions that the parents' illness had an effect on their children. Parental relationship satisfaction and family income did not predict parental reports of children's level of adjustment. These results indicate that children of parents with MS demonstrate more difficulties in how they relate to others, the distress they experience, and how they manage their lives, rather than revealing higher levels of symptoms. Since the data were based on parental reports of their children's problems, the results may also be due to negative affect among the parents.

Maternal predictors of preschool child-eating behaviours, food intake and body mass index : a prospective study

This study extends McPhie et al. (2011)'s [Maternal correlates of preschool child eating behaviours and body mass index: A cross-sectional study. International Journal of Pediatric Obesity, Early Online, 1–5.] McPhie et al. (2011)’s cross-sectional research, by prospectively evaluating maternal child-feeding practices, parenting style and mother–child interactions as predictors of child-eating behaviours, food habits and weight. A sample of 117 mothers of preschoolers (63 girls, 54 boys) participated at two time-points, Time 1 (T1) and Time 2 (T2), 12 months apart. Results from the two path models revealed maternal pressure to eat at T1 positively predicted change in child enjoyment of food. Maternal warmth at T1 negatively predicted child unhealthy food habits at T2. At T1, family income and maternal control negatively predicted change in child body mass index z-scores (BMIz); maternal pressure to eat at T1 also positively predicted change in child BMIz. There were significant results specific to each model. Both final path models provided an adequate fit. Our findings suggest childhood obesity is predicted by a complex interplay of demographic, maternal and child variables.

A path model of psychosocial and health behaviour change predictors of excessive gestational weight gain

This study aimed to evaluate a conceptual model of psychosocial, behaviour change, and behavioural predictors of excessive gestational weight gain (GWG). Background: Excessive GWG can place women and their babies at risk of poor health outcomes, including obesity. Models of psychosocial and behaviour change predictors of excessive GWG have not been extensively explored; understanding the mechanisms leading to excess GWG will provide crucial evidence towards the development of effective interventions. Method: Two hundred and eighty-eight pregnant women (≤18 weeks gestation) were recruited to a prospective study. Demographic, psychosocial, health behaviour change, and behavioural factors were assessed at 17 (Time 1, T1) and 33 weeks (Time 2, T2) gestation. Pre-pregnancy and final pregnancy weight were obtained and women were classified with/without excessive GWG. Logistic regressions refined the list of predictors of excessive GWG; variables with p < .1 were included in a path analysis. Results: Age, family income, T2 depression, T2 pregnancy-specific coping, T1 buttocks dissatisfaction, T2 GWG-specific self-efficacy, T1 dietary readiness, T1 dietary importance, and T1 vegetable intake predicted excessive GWG in the logistic regressions and were included in the path model. The baseline path model demonstrated poor fit. Once statistically and theoretically plausible paths were added, adequate model fit was achieved (χ² = 21.61(9), p < .05; RMSEA = .07; CFI = .93); this revised model explained 19.5% of the variance in excessive GWG. Women with high T1 buttocks dissatisfaction were more likely to exhibit low levels of dietary readiness. Women with low dietary readiness were more likely to have a lower vegetable intake, which predicted excessive GWG. Women with higher T2 depressive symptoms were more likely to report lower GWG self-efficacy and gain excessively. Conclusion: Future behavioural GWG trials should consider combining psychosocial and health behaviour change factors to optimise GWG.

Is cost-related non-collection of prescriptions associated with a reduction in health? Findings from a large-scale longitudinal study of New Zealand adults

OBJECTIVE: To investigate whether cost-related non-collection of prescription medication is associated with a decline in health. SETTINGS: New Zealand Survey of Family, Income and Employment (SoFIE)-Health. PARTICIPANTS: Data from 17 363 participants with at least two observations in three waves (2004-2005, 2006-2007, 2008-2009) of a panel study were analysed using fixed effects regression modelling. PRIMARY OUTCOME MEASURES: Self-rated health (SRH), physical health (PCS) and mental health scores (MCS) were the health measures used in this study. RESULTS: After adjusting for time-varying confounders, non-collection of prescription items was associated with a 0.11 (95% CI 0.07 to 0.15) unit worsening in SRH, a 1.00 (95% CI 0.61 to 1.40) unit decline in PCS and a 1.69 (95% CI 1.19 to 2.18) unit decline in MCS. The interaction of the main exposure with gender was significant for SRH and MCS. Non-collection of prescription items was associated with a decline in SRH of 0.18 (95% CI 0.11 to 0.25) units for males and 0.08 (95% CI 0.03 to 0.13) units for females, and a decrease in MCS of 2.55 (95% CI 1.67 to 3.42) and 1.29 (95% CI 0.70 to 1.89) units for males and females, respectively. The interaction of the main exposure with age was significant for SRH. For respondents aged 15-24 and 25-64 years, non-collection of prescription items was associated with a decline in SRH of 0.12 (95% CI 0.03 to 0.21) and 0.12 (95% CI 0.07 to 0.17) units, respectively, but for respondents aged 65 years and over, non-collection of prescription items had no significant effect on SRH. CONCLUSION: Our results show that those who do not collect prescription medications because of cost have an increased risk of a subsequent decline in health.

Cigarette smoking is negatively associated with family average income among urban and rural men in regional Mainland China

Socio-economic status (SES) has a strong influence on cigarette smoking behaviour. However, as a more sensitive and realistic index of SES, family average income (FAI) has little studied regarding its association with smoking. With a response rate of 90.1%, a cross-sectional study was conducted among randomly selected urban-rural participants (n  = 29,353) between October of 2000 and March of 2001 in Nanjing, China. The proportion of male participants who were current smokers was 54.7%; for females it was 2.2%. After adjustment for possible confounding variables (area of residence, age, education, occupation) males in the middle (OR 0.76; 95% CI 0.69–0.84) and higher (OR 0.64; 95% CI 0.57–0.71) FAI tertiles had lower odds of being smokers than did males in the lower FAI tertile. There were no differences by FAI category in the odds of being an ex-smoker. Therefore, current smoking among adult males is inversely associated with family average income in a regional Chinese population. FAI may inform the targeting of campaigns or other initiatives, particularly in populations where material prosperity is low in some social groups.

Family average income and diagnosed Type 2 diabetes in urban and rural residents in regional mainland China.

Aims: To explore the relationship between family average income (FAI; an index of socio-economic status) and Type 2 diabetes in a region of mainland China. Methods: Population-based cross-sectional study, conducted between October 2000 and March 2001 in administrative villages (n = 45) randomly selected from three urban districts and two rural counties of NanJing municipality, mainland China, with a regional population of 5.6 million. Participants were all local residents aged ≥ 35 years old (n = 29 340); 67.7% from urban areas, 32.3% from rural areas, 49.8% male and 50.2% female. Results: The response rate of eligible participants was 90.1%. The overall prevalence of self-reported Type 2 diabetes was 1.9%. After adjustment for possible confounding variables (age, gender, area of residence, body mass index, educational level, smoking status, occupational and leisure-time physical activity), participants in the higher and middle FAI categories were more than twice as likely to have Type 2 diabetes as those in the lower FAI category. Conclusions: The prevalence of Type 2 diabetes is positively related to socio-economic status (indexed by FAI) in Chinese at the population level. After controlling for potential confounding factors, people in higher socio-economic status groups are more likely to have Type 2 diabetes. These associations are consistent with other effects of epidemiological transition and identify a need for preventive initiatives.

Family average income and body mass index above the healthy weight range among urban and rural resicents in regional Mainland China

Objective: To explore the relationship between family average income (FAI; an index of socio-economic status) and body mass index (BMI; a widely used, inexpensive indicator of weight status) above the healthy weight range in a region of Mainland China. Design: Population-based cross-sectional study, conducted between October 1999 and March 2000 on a sample of regular local residents aged 35 years or older who were selected by random cluster sampling. Setting: Forty-five administrative villages selected from three urban districts and two rural counties of Nanjing municipality, Mainland China, with a regional population of 5.6 million. Subjects: In total, 29 340 subjects participated; 67.7% from urban and 32.3% from rural areas; 49.8% male and 50.2% female. The response rate among eligible participants was 90.1%. Results: The proportion of participants classified as overweight was 30.5%, while 7.8% were identified as obese. After adjusting for possible confounding variables (age, gender, area of residence, educational level, occupational and leisure-time physical activity, daily vegetable consumption and frequency of red meat intake), urban participants were more likely to be overweight or obese relative to their rural counterparts, more women than men were obese, and participants in the lowest FAI tertile were the least likely to be above the healthy weight range. Conclusions: The proportion of adults with BMI above the healthy weight range was positively related to having a higher socio-economic status (indexed by FAI) in a regional Chinese population.

Applying socio-cultural lenses to childhood obesity prevention among African migrants to high-income western countries : the role of acculturation, parenting and family functioning

Migration from third-world and low-income countries to high-income Western countries presents significant challenges for individuals and families, and for health service providers in the receiving societies. Cultural conflicts related to preferred body size/shape and parenting practices, together with differential inter generational rates and styles of acculturation, can affect nutritional and lifestyle choices and be associated with high rates of childhood obesity. Using African cultures as an example, this paper examines these issues. It concludes that, in designing and implementating obesity prevention programmes, health service providers need to understand these factors and how they play out.

The cost of seasonal respiratory illnesses in Australian children: the dominance of patient and family costs and implications for vaccine use

Respiratory viral infections are one of the next group of diseases likely to be targeted for prevention in childhood by the use of vaccines. To begin collecting necessary epidemiology and cost information about the illnesses caused by these viruses, we conducted a prospective cohort study in 118 Melbourne children between 12 and 71 months of age during winter and spring 2001. We were interested in calculating an average cost per episode of community-managed acute respiratory disease, in identifying the key cost drivers of such illness, and to identify the proportion of costs borne by the patient and family. There were 202 community-managed influenza-like illnesses identified between July and December 2001, generating 89 general practitioner visits, and 42 antibiotic prescriptions. The average cost of community-managed episodes (without hospitalisation) was $241 (95% CI $191 to $291), with the key cost drivers being carer time away from usual activities caring for the ill child (70% of costs), use of non-prescription medications (5.4%), and general practice visits (5.0%). The patient and family met 87per cent of total costs. The lowest average cost occurred in households from the highest income bracket. Acute respiratory illness managed in the community is common, with the responsibility for meeting the cost of episodes predominantly borne by the patient and family in the form of lost productivity. These findings have implications for preventive strategies in children, such as the individual use of, or implementation of public programs using, currently available vaccines against influenza and vaccines under development against other viral respiratory pathogens.

Exploring low-income women's welfare stigma through rich point analysis

The project described in this presentation was the final component of my PhD thesis which explored how Centrelink policies mediated social citizenship for low-income women. I first analysed the Centrelink Information Handbook, and then collected ethnographic data through observations and interviews. The first two of my research questions were quite deductive in nature, as I applied Levitas' (1998) conceptual framework of social exclusion to the Centrelink Information Handbook and low-income women's experiences. This third research question, to explore how low-income women's social citizenship was socially and politically mediated, however, required a more unstructured approach.

Quality of life of Australian family carers : implications for research, policy and practice

Abstract As part of an international,multicentered project, the burden of care, health, and subjective well-being experienced by select Australian family carers supporting a relative with disability at home were investigated. Some 448 family carers residing in New South Wales and Tasmania completed a battery of instruments, including a self-report demographic survey, the Family Caregiver Burden Inventory, the General Health Questionnaire, and the Personal Wellbeing Index. Respondents were predominantly females (mean
age = 48 years), married, and supporting a son or daughter with an intellectual disability (mean age = 18 years). Although caring for their family member was not perceived to be a burden, respondents reported notable limitations on their social networks and social activities. They reported higher levels of unemployment than would be expected for the general population and were over represented in lower income groups. They reported seriously low levels of mental health and personal well-being when compared with the general population. The findings revealed that this group of family carers were at high risk of social and economic disadvantage and at high risk of mental health challenges. Social policy makers and service providers should take these factors into account, both in the interests of promoting the health and well-being of the carers and considering the long-term needs of family members with disability who rely on family carers for daily support when designing services.

Impact of the extended family on microenterprise growth in Ghana : a case study of Accra

This study examines the extended family's impact on microenterprise growth at the individual level, where microenterprise operators have some control over constraints affecting their operations. Beyond the individual level, microenterprise operators have little control over constraints such as government policies and regulations, competition from import-substitution industries and exploitation by corrupt officials. Therefore, it is at the individual level that the extended family serves as a crucial parameter of microenterprise growth and the success with which MEs graduate from the informal sector into the mainstreams of small business. Within this domain, this author has examined the extended family and found that there is a need for policy makers and MED administrators to adopt a more culturally sensitive approach to microenterprise growth if the extended family is to be engaged as a partner in their efforts to support microenterprises as a source of income and employment generation, A central question posed is why most writers on microenterprise activities in Ghana have neglected the extended family as a factor that should be considered in the design of microenterprise growth strategies and policies? The answer to this question was explored in the process of data gathering for this thesis and the results are presented here, especially in chapter 3 below. Suffice it to note here that this neglect has many roots, not least of which is the proclivity of mainstream economics, modern administration practice and the objectivity of double entry accounting based documentation procedures to focus on measurable growth in the formal sectors of the economy and structural constraints such as the lack of finance, lack of market demand, lack of access to technology and government regulations. Consequently, a noticeable trend among these writers is that they rightly advocate finance be made accessible to microenterprises, however, few question whether the finance is effectively used towards microenterprise growth. This issue is crucial in the face of evidence from this study which shows that finance accessed towards microenterprise growth is often put to other uses that negate growth thus keeping microenterprises within the bounds of the informal sector as against graduating out of the informal sector. As a result, these writers have neglected the intimate relations between the extended family and microenterprises, and most importantly, the constraint that the extended family inflicts on microenterprise growth at the individual level of activity. This study, by targeting the growth of the individual microenterprise in the socio-cultural context in which this growth must be achieved, has highlighted the constraint that the extended family does pose on MED. However, the study also shows that these constraints are important not because there is anything inherently wrong with the extended family, but because the socio-economic and policy environment is not consistent with the positive role that the extended family can and should play in the graduation of microenterprises from the informal to the formal sector of the economy in Ghana.

Mental health and life satisfaction of young Australians : the role of family background

This paper uses the Household, Income and Labour Dynamics in Australia Survey to investigate the factors that influence young Australians’ mental health and life satisfaction, with an emphasis upon the role of family background. It also explores male and female differences concerning those background effects. The results indicate a particularly significant negative association between parental divorce and well-being, and suggest that the timing of divorce matters. Distinguishing the samples by gender shows that this relationship remains significant only for females. Past living arrangements consistently turn out to be statistically insignificant whether the sample used is the total, males or females. The current living arrangements, however, appear to be significantly associated with both mental health and life satisfaction of males. Adding potentially confounding characteristics to our basic regression, which includes only the family background variables, suggests that some of the ‘aggregate’ effects of family background might work indirectly through the mediating variables such as education or lifestyles, though most of them remain direct. Among those, marital status, education, labour market experience and lifestyles seem to be the major factors explaining the dispersion in well-being of young Australians. Income and wealth, on the other hand, have only a minor impact.