Family food environments as determinants of preschool-aged children`s eating behaviours: implications for obesity prevention policy. A review.

Children's eating behaviours are fundamental to their health. Dietary surveys indicate that children's food consumption is likely to promote a range of diet-related diseases, including overweight and obesity, which are associated with a range of psychosocial and physical disorders. With the prevalence of overweight and obesity rapidly increasing, opportunities for informed prevention have become a focus of strategy. Diet is recognised as important in the genesis of obesity. We present data that demonstrate that eating behaviours are likely to be established early in life and may be maintained into adulthood. We review literature that shows that children's eating behaviours are influenced by the family food environment. These findings suggest that the family environment should be considered in developing obesity prevention strategy for children, yet the current strategy focuses primarily on the school environment. Those factors in the family environment that appear to be important include: parental food preferences and beliefs, children's food exposure; role modelling; media exposure; and child-parent interactions around food. However, the existing data are based on small scale and unrepresentative US samples. At a population level, we have few insights regarding family food environments and consequently little information about how such environments influence children's eating behaviours and thus their risk for obesity. We suggest research that may promote a better understanding of the role of family food environments as determinants of children's eating behaviour, and consider the implications for obesity prevention in Australia. (Aust J Nutr Diet 2001;58:19-25)

Promoting the health and well being of older carers : a proactive strategy

Research has indicated that carers are concerned about their ageing status, their deteriorating health and their ability to continue to care for their dependants. Given that the health care system will become increasingly reliant on carers the health care needs of carers should be a concern for all health care professionals. This paper describes the first stage of a project designed to enhance older carers health promotion knowledge and skills and improve their health promoting behaviours. This stage investigated the mental and physical health status of older carers. It also sought information on older carers' levels of participation in health related and social activities and identification of barriers to participation in these types of activities. The results highlighted that carers responding to the survey experienced compromised physical and mental health. Many carers reported being unable to participate in social and health-type activities as they were unable to leave the care recipient. Of note, is that carers identified their own mental fragility and felt they needed further emotional support.

Teachers' work hours, work-family conflict and health: the mediating effects of perceived control and organisational support

Teachers are among those working longer hours more than ever before. the implications of these long hours on teachers' health, through work-family conflict, control over hours worked and organisational support were investigated. 120 teachers, of whom 91 (59.3% female) reported
working in excess of 37 1/2 hours in the week prior, participated in the study. Long hours, work-family conflict, control and organisational support, explained 69% of the variance in health. There was no direct effect of long worked hours on health however long hours did have a direct impact on work-family conflict, organisational support, and control and, through
these, teachers' health. Work-family conflict exerted a direct negative impact on health. These findings are discussed in individual and organisational tenns.

Assessing cost-effectiveness in mental health : family interventions for schizophrenia and related conditions

Objective: Existing evidence suggests that family interventions can be effective in reducing relapse rates in schizophrenia and related conditions. Despite this, such interventions are not routinely delivered in Australian mental health services. The objective of the current study is to investigate the incremental cost-effectiveness ratios (ICERs) of introducing three types of family interventions, namely: behavioural family management (BFM); behavioural intervention for families (BIF); and multiple family groups (MFG) into current mental health services in Australia.

Method: The ICER of each of the family interventions is assessed from a health sector perspective, including the government, persons with schizophrenia and their families/carers using a standardized methodology. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis based on disability-adjusted life years (DALYs) averted. The second stage involves application of 'second filter' criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using multivariate probabilistic sensitivity analysis.

Results: The most cost-effective intervention, in order of magnitude, is BIF (A$8000 per DALY averted), followed by MFG (A$21 000 per DALY averted) and lastly BFM (A$28 000 per DALY averted). The inclusion of time costs makes BFM more cost-effective than MFG. Variation of discount rate has no effect on conclusions.

Conclusions: All three interventions are considered 'value-for-money' within an Australian context. This conclusion needs to be tempered against the methodological challenge of converting clinical outcomes into a generic economic outcome measure (DALY). Issues surrounding the feasibility of routinely implementing such interventions need to be addressed.

Managing the family`s health: preferences and experiences of women with different work and family arrangements.

Balancing the needs of work and family is a subject of much debate.The purpose of this research was to explore how families manage their children's health within the context of different work and family arrangements.In-depth interviews were conducted with women who were at home full time (8) or in paid work over 30 hours a week (7). Women had at least one child under the five years of age. Findings revealed there was no simple relationship between women's working arrangements and how they managed their children's health. All women, irrespective of their working arrangements, held similar preferences for managing their children's health.However, most women experienced either time or financial constraints that meant they had to compromise their original preferences. In some cases this meant children missed out on receiving health services. Workplace support, extended family support and general satisfaction with work and family arrangements appeared to be important factors for the small number of women who had no problems in managing their children's health. The implications of these findings are discussed.

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.

Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke

Background: Exposure to other people’s cigarette smoke (environmental tobacco smoke, or ETS) is an important child health issue.
Objectives: To determine the effectiveness of interventions aiming to reduce exposure of children to ETS.
Search strategy: The Tobacco Addiction Group register of studies was searched.MEDLINE, EMBASE and four other health and psychology databases were searched electronically, bibliographies of retrieved primary studies were checked and specialists in the area consulted.
Selection criteria: Controlled trials with or without random allocation were included in this review if they addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0-12 years). All mechanisms for reduction of children’s environmental tobacco smoke exposure, and smoking prevention, cessation, and control programmes targeting these participants are included. These include smoke free policies and legislation, health promotion, social behavioural therapies, technology, education and clinical interventions.
Data collection and analysis: Two reviewers independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcomes, no summary measures were possible and results were synthesised using narrative summaries.
Main results: Nineteen studies met the inclusion criteria, one of which was subsequently excluded. Three interventions were targeted at populations or community settings, seven studies were conducted in the well child health care setting and eight in the ill child health care setting. Twelve of these studies are from North America. In 12 of the 18 studies there was reduction of ETS exposure for children in both intervention and comparison groups. In only four of the 18 studies was there a statistically significant intervention effect. Three of these successful studies employed intensive counselling interventions targeted to smoking parents. There is little difference between the well infant, child respiratory illness and other child illness settings as contexts for parental smoking cessation interventions. The fourth successful intervention was in the school setting targeting the ETS exposure of children from smoking fathers.
Authors’ conclusions: Brief counselling interventions, successful in the adult health setting when coming from physicians, cannot be extrapolated to adults in the setting of child health. There is limited support for more intensive counselling interventions. There is no clear evidence for differences between the respiratory, non-respiratory ill child, well child and peripartum settings as contexts for reduction of children’s ETS exposure.

Does family intervention for adolescent substance use impact parental mental health? A systematic review

Adolescent substance abuse is a prevalent problem and both individual and group family interventions are increasingly being used to assist families to cope. A literature review was conducted to identify whether individual and group family interventions for adolescent substance abuse enhance the mental health of parents and other family members. The review also sought to identify direct and indirect effects of family intervention processes on depressive symptoms and general distress. Based on quality criteria a total of nine studies were included. Of these, six quantitatively examined family intervention outcomes on family member mental health, with all six reporting positive effects. Four of the nine studies measured levels of depressive symptoms and three of these four studies reported significant direct effects of family intervention on parental depression. The positive effects were also found in the three qualitative studies included in the review. Indirect therapeutic mechanisms that contributed to mental health improvements included: reduction of stress symptoms, improved coping, improved family functioning, more effective parenting behaviours, attitude changes, perceived changes in relative’s substance use, and improved social support. The available literature suggests that a number of determinants of family mental health may potentially be impacted through family intervention for adolescent substance abuse. However, definitive conclusions cannot be made at this point as the literature is mostly descriptive and there have been few longitudinal studies or randomised controlled trials.

Lesbian parents negotiating the health care system in Australia

Twenty Australian lesbian-parented families were interviewed in multigenerational family groups about the interface between their public and private worlds. Experiences of the health care bureaucracy were difficult, whereas many participants found individual providers to be approachable and caring. Three strategies were used for disclosure of their sexual orientation to health care providers: private, proud, and passive. Influences on the strategy used included family formation, role of the non-birth parent, geographic location, and expected continuity of care. Parents displayed a high degree of thoughtful planning in utilizing their preferred disclosure strategy in order to optimize safety, particularly for their children.

Lesbian family disclosure: Authenticity and safety within private and public domains

Definitions of family and disclosure of family configuration are important themes for understanding the experiences of contemporary lesbian-parented families. Drawing on multi-generational family interviews with 20 lesbian-parented families in Victoria, Australia, we explore how participants describe and present their families in public contexts. We found a marked difference in experience between lesbian-parented stepfamilies and lesbian-parented de novo families where children are conceived and raised by lesbian parents from birth. Family members adopted a variety of strategies when disclosing parents’ sexual orientation in mainstream social institutions such as health care settings and schools. Some chose a proud, open strategy; while others were more private; yet others chose a passive strategy, particularly when dealing with health care providers, and a selective strategy when dealing with schools. These strategies demonstrate
the fine balance that families must strike between being publicly authentic and creating safety by protecting themselves from negative attitudes.

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.