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UK guidelines for youth recommend daily physical activity and five portions of fruit and vegetables per day. This study examined the prevalence and clustering of meeting recommendations among 10- to 15-year old.Data for 3,914 youth, from the first wave of Understanding Society: the UK Household Longitudinal Study, were analysed. Clustering was assessed using the observed/expected ratio method.A minority of youth met both recommendations, and these behaviours were clustered. The odds of meeting both recommendations were lower for older youth and for Pakistani and Bangladeshi youth; boys in lower income households were less likely to meet both recommendations.Most youth met neither recommendation and the behaviours clustered with variations by ethnicity and socioeconomic conditions.

OBJECTIVE--To test the hypothesis that reduced fetal growth leads to altered plasma insulin-like growth factor-1 (IGF-1) concentrations in childhood. DESIGN--A follow up study of 4 year old children whose birth weights were recorded, and of 7 year old children whose weight, length, head circumference, and placental weight were measured at birth. SETTING--Pune, India, and Salisbury, England. SUBJECTS--200 children born during October 1987 to April 1989 in the King Edward Memorial Hospital, Pune, weighing over 2.0 kg at birth and not requiring special care, and 244 children born during July 1984 to February 1985 in the Salisbury Health District and still living there. MAIN OUTCOME MEASURE--Plasma IGF-1 concentrations. RESULTS--In both groups of children, and consistent with findings in other studies, plasma IGF-1 concentrations were higher in taller and heavier children, and higher in girls than boys. Allowing for sex and current size, concentrations were inversely related to birth weight (Pune p = 0.002; Salisbury p = 0.003). Thus at any level of weight or height, children of lower birth weight had higher IGF-1 concentrations. The highest concentrations were in children who were below average birth weight and above average weight or height when studied. Systolic blood pressures were higher in children with higher IGF-1 concentrations (Pune p = 0.01; Salisbury p = 0.04). CONCLUSIONS--Children of lower birth weight develop higher circulating concentrations of IGF-1 than expected for their height and weight. This is consistent with the hypothesis that under-nutrition in utero leads to reprogramming of the IGF-1 axis. The increase of plasma IGF-1 concentrations in low birthweight children may also be linked to postnatal catch-up growth. High IGF-1 concentrations may be one of the mechanisms linking reduced fetal growth and high blood pressure in later life.

Background Wheeze is one of the most common chronic conditions in childhood. Understanding its social risk factors is important for prevention. However, studies examining inequalities in wheeze have shown inconclusive results. This is potentially due to the complexities of differentiating between wheezing illnesses, which have different underlying causes, many associated with socio-economic disadvantage but some with advantage (e.g. atopy). We therefore investigated inequalities in typologies of wheeze and atopy, using longitudinal data and objective atopic status. Methods We used data from the Southampton Women’s Survey (SWS), a population-based study of non-pregnant 20–34 year (y) old women, resident in Southampton (UK), 1998–2002. Offspring, born 1998–2007, were followed through childhood. Information included maternal-reported wheeze (6 months (m), 12 m, 2 y, 3 y, 6 y), and skin prick tests for atopic sensitisation (12 m, 3 y, 6 y). Longitudinal typologies of wheeze and atopy were created using latent class analysis in children with complete data at 6 y ( n = 1258; 40% of original recruits, 69% of those seen at 6 y). Two- to seven-class measures were assessed based on model fit and interpretability. Children were assigned to the class to which they had the highest probability of belonging. Socio-economic differences in wheeze were examined with relative risk ratios (RRRs [95% confidence intervals]), according to maternal highest academic qualifications (GCSEs/None; A-Levels; Diploma/Degree). Sensitivity analyses included: weighting analyses to account for uncertainty of class assignment, using an alternative measure of socio-economic circumstances (maternal occupation), and imputing missing data. Analyses were conducted in Stata 13.0 (and ‘SAS PROC LCA’ plug-in). Results Five classes of wheeze and atopy emerged: ‘No Wheeze, No Atopy’ (53%), ‘Non-atopic Early Wheeze’ (15%); ‘Non-atopic Remitting Wheeze’ (16%); ‘Atopic Increasing/Persistent Wheeze’ (7%); ‘Atopy Only’ (10%). Compared with children whose mothers had GCSEs/None, those whose mothers had a Diploma/Degree were less likely to experience ‘Non-atopic Remitting Wheeze’ (RRR = 0.55 [0.37–0.82]), no less likely to experience ‘Non-atopic Early Wheeze’ (1.13 [0.77–1.70]), and more likely to have ‘Atopy Only’ (1.79 [1.12–2.89]). In analyses restricted to atopic children, those whose mothers had a Diploma/Degree were less likely to develop ‘Atopic Increasing/Persistent Wheeze’ (0.49 [0.24–0.98]). There were few differences between those with A-levels and GCSEs/None. Sensitivity analyses produced similar patterns. Conclusion Children of mothers with lower educational qualifications were more likely to experience non-atopic remitting wheeze and, if they had atopy, to develop persistent wheeze. These findings require replication in larger samples and beyond the age of 6 y (including in the SWS). Future research to explain these inequalities will help shape interventions.

Background There is limited evidence on the prospective associations of activity levels with adiposity indicators in young people. This study assessed whether physical activity (PA) and sedentary time (ST) in primary school-aged children are associated with adiposity at the start of secondary school, and whether these associations differed by sex or ethnic group. Methods We analysed data from the Millennium Cohort Study, a longitudinal study of social, economic and health-related circumstances of children born in the United Kingdom between September 2000 and January 2002. At the fourth contact, when the Cohort were aged 7, PA and ST were assessed objectively using Actigraph GT1M accelerometers. Valid data (2 days with ≥ 10 hours of recorded time) was obtained from 6497 singleton children. These data were used to derive average daily minutes of moderate-to-vigorous physical activity (MVPA), average daily minutes spent in ST and total physical activity. Measures of adiposity (body mass index (BMI), fat mass index (FMI) and fat free mass index (FFMI)) were obtained at seven and 11 years of age. Results In cross-sectional analyses, total PA levels were inversely associated with FMI (3.7% (95% confidence interval (CI): 2.7; 4.7) reduction per 150 cpm increase), as was MVPA (4.2% (CI: 3.2; 5.2) reduction per 20 minute/day increase). Associations were stronger in Black and South Asian ethnic groups. Total PA and MVPA were not associated with FFMI. ST was positively associated with FMI (1.3% (CI: 0.2; 2.3) increase per 50 minute/day increase) and inversely associated with FFMI (0.5% (CI: 0.2; 0.7) reduction per 50 minute/day increase). Longitudinally, MVPA at age seven remained inversely associated with FMI at age 11 (1.5% (CI: 2.6; 0.4) reduction per 20 minute/day increase). No association was found between total PA and ST and any of the later adiposity measures. Conclusion Seven year old children who are more physically active are less likely to be obese at that age and at age eleven years. These associations were particularly evident in children from Black or South Asian ethnicity at age seven and in boys at age 11; these findings highlight the importance of promoting higher levels of physical activity in primary school-aged children. Measurements of fat mass also provide valuable insights into ethnic differences in associations between activity and adiposity.

Background Relatively little is known about how clustering of energy-balance related behaviours (EBRBs) in young children influences weight status in later childhood. We assessed clustering of six ERBs in 5-year-old British children (on primary school entry), and explored whether this predicted weight status at 11 years (upon transition to high school). Methods We used complete-case data from 9,726 children who participated in the Millennium Cohort Study, a nationally representative prospective cohort of children born in the UK. Mothers reported their 5-year-old child’s EBRBs (fruit consumption; sweetened drink consumption; active transport to school; frequency of sport/exercise; TV viewing; computer use). Body Mass Index (BMI) was objectively measured at 5 and 11 years. Latent Class Analysis was used to derive clusters of EBRBs (using the Latent Gold package), accounting for child’s sex, ethnicity, BMI at age 5, and maternal educational attainment. Multivariable linear regression was used to estimate whether EBRB clusters at age 5 predicted BMI z-score in 11-year-olds (using STATA13/SE ). Results Four EBRBs clusters were identified ( in order of prevalence ): ‘low screen-time, sweetened drinks’ (32%); ‘healthy’ (28%); ‘unhealthy’ (26%); and ‘high screen-time’ (14%). Children in the ‘healthy’ cluster had low screen-time, frequent sport participation, and a good diet (high fruit, low sweetened drinks consumption); the opposite EBRBs were observed in 5-year-olds assigned to the ‘unhealthy’ cluster. Those in the ‘low screen-time, sweetened drinks’ and ‘high screen-time’ clusters exhibited a mixture of EBRBs, with moderate sports participation and fruit intake. Children in the ‘healthy’ cluster were more likely to be girls, have mothers with higher educational attainment, and were less likely to be obese at age 5; those in the ‘unhealthy’ cluster were more likely to have lower educated mothers. ‘High screen-time’ children were more likely to be boys and from middle-income homes. In regression analyses, compared to children in the ‘healthy’ cluster, being in any other cluster was associated with higher BMI z-scores at age 11 [‘low screen-time, sweetened drinks’: z BMI 0.16 [0.10, 0.23] higher; ‘unhealthy’: 0.19 (0.12, 0.26); and ‘high screen-time’: 0.24 (0.16, 0.33)]. Conclusion Four clusters of energy-balance related behaviours were identified in 5-year-old UK children, and clusters appeared to be socially graded. Even after accounting for socio-demographic factors, as early as age 5, clusters of less healthy EBRBs predicted higher BMI z-scores in middle childhood, and how these EBRBs cluster may also be important. Potential pathways and mediating factors will be described.

Aims Financial strain (FS) describes an imbalance between resources and need. FS can be experienced by both the rich and poor. There is a growing body of research associating FS with poor health, but most has been cross-sectional and adult focused. The ‘Great Recession’ is a time when many households in the UK experienced increased FS and families with children were disproportionately affected. The primary aim of this study was to determine if increases in household FS, over the period of the ‘Great Recession’, were associated with poor child health outcomes. Methods We examined data from the Millennium Cohort Study, a longitudinal study of children born in the UK between 2000–2002. Surveys carried out at age 7 yrs (T1) and 11 yrs (T2) spanned the ‘Great Recession’ (2007–12). At age 11 yrs 13,112 participants took part. Three different measures of increased FS were defined. “ Became income poor ”; dropped below the ‘poverty line’ between ages 7 yrs and 11 yrs. “ Developed difficulty managing ”; parental report of being ‘financially comfortable’ at 7 yrs and finding it ‘difficult to manage’ at 11 yrs. “Felt worse off”; Parental report of feeling financially worse off at age 11 yrs, compared to 7 yrs. Poisson regression was used to estimate risk ratios and 95% confidence intervals for poor health outcomes (overweight/obesity, problematic behaviour, general health score, long-standing illness and bedwetting), according to the three measures of FS. In a sub-analysis the sample was limited to households which were non-income poor at T2 (household income >60% median). Results Increased FS, between 7 and 11 yrs, was associated with a significantly increased risk of every poor health outcome examined in children, at age 11 yrs (see Table 1). There was marked consistency across all three measures in predicting poor health outcomes. In the sub-analysis, of non-income poor households, the increased risk of poor health outcomes persisted [data not shown]. Conclusion Increased FS has strong and consistent associations with poor health among children. Consequently, measures which reduce FS may also improve children’s health and wellbeing. During times of widespread economic hardship, such as the ‘Great Recession’, measures should be taken to buffer children and their families from the impact of FS. This may include ‘ring-fencing’ specific welfare or public services. The results also emphasise that the effects of FS are not limited to the income-poor.

Background Despite rises in reconstituted and lone-parent families, relatively little is known about how the health of children in different family types varies, and the extent to which any differences might be explained by poverty. The authors examined this using cross-sectional data on 13 681 seven-year-olds from the Millennium Cohort Study. Methods The authors estimated RRs and 95% CIs for having poor physical (general health, long-standing illness, injury, overweight, asthma, fits) and mental health (using strengths and difficulties scores) according to family structure using Poisson regression. The authors adjusted for confounders (aRR) and then investigated the role of poverty as a mediator by entering a poverty score (based on income, receipt of benefits, subjective poverty and material deprivation) into the main model. Results Children living in reconstituted and lone-parent families were at a slight increased risk of poor health compared with those living with two natural parents. Adjusting for poverty tended to remove the elevated risk of poor physical health in children living in lone-parent and reconstituted families. However, for the mental health outcomes, poverty tended to remove the elevated risk for lone parents but not for reconstituted families. For example, the aRR for borderline–abnormal total difficulties fell from 1.45 (1.22 to 1.72) to 1.34 (1.13 to 1.59) in children living in reconstituted families and from 1.29 (1.14 to 1.45) to 1.05 (0.92 to 1.19) in those living with lone parents. Conclusions Poor physical and mental health was slightly more prevalent in children living in lone-parent or reconstituted families. Poverty reduction may help to reduce these differences, especially for children living with lone parents; however, alternative mechanisms should be also explored, particularly for children living in reconstituted families.

OBJECTIVES High blood pressure (BP) is a major public health issue, both in the United Kingdom and worldwide. Although BP levels in UK adults are declining, there is little published information on BP trends in children, a particular concern in the context of the rising levels of childhood adiposity. Our aims are to determine whether BP in children has changed over time and whether the change reflected trends in adiposity. METHODS We collated data from seven population-based BP studies conducted in the United Kingdom between 1980 and 2008. Children of white European origin were included (9-11 years, mean 10.3 years). Adjustments were made to account for differences in mean ages, BP devices and cuff sizes used in different studies. RESULTS Mean SBP increased over time both in boys and girls: annual increases were 0.45 mmHg (95% CI: 0.43, 0.48) for boys; 0.51 mmHg (0.49, 0.53) for girls. Mean BMI increased by 0.064 kg/m(2) (0.060, 0.068) per year for boys; 0.070 kg/m(2) (0.065, 0.074) for girls; the prevalence of overweight/obesity increased from 5.7 to 21.1% and from 9.7 to 24.1%, respectively. The SBP trends occurred both in children with low and high BMI, but were more marked in low BMI group; BMI explained only 15.3% (15.1%, 15.6%) of increases in SBP for boys and 14.9% (14.6%, 15.1%) for girls. The BMI/SBP association appeared to become weaker over time (P

Objectives To investigate parental smoking behaviours between England and Scotland after the smoke-free legislation in Scotland came into effect in 2006 and examine inequalities in maternal smoking behaviours between countries. Methods 5954 white mothers and 3757 fathers resident in England and 1522 white mothers and 904 fathers resident in Scotland who participated in the Millennium Cohort Study (a prospective nationally representative cohort study) when the cohort child was age 9 months (before legislation) and 5 years (after legislation in Scotland but not in England). The main outcome measures were smoking at 9 months and 5 years, quitting smoking by 5 years, starting smoking by 5 years. Results In England and Scotland approximately 30% of parents reported smoking at 9 months with only a slight decrease in smoking at 5 years. There were no differences between countries in parental smoking after the smoke-free legislation in Scotland came into effect, taking into account prior smoking levels. Light smokers (1–9 cigarettes/day) from Scotland were less likely to quit by 5 years than those from England, but there were no differences between countries among heavy smokers (10+ cigarettes/day). Non-smoking mothers from Scotland (6.2%) were less likely to start smoking by 5 years than mothers from England (7.3%). Mothers from more disadvantaged circumstances in both countries were more likely to report that they smoked or started smoking. In England quitting was also socially patterned, but in Scotland, after the legislation was introduced, the gradients in quitting smoking were flatter across social groups. Conclusions Smoking behaviours among parents with young children remained relatively stable, highlighting the need for additional tobacco control efforts to support smoking cessation. However, the smoke-free legislation does not appear to widen health inequalities and may even help reduce them by encouraging quitting across socioeconomic groups.

Brain natriuretic peptide (BNP) is important in the diagnosis and management of heart failure (HF). Sometimes, very high BNP levels encountered in clinical settings seem to be out of proportion to the severity of HF. The authors retrospectively identified 113 patients with 129 admissions with a BNP value3000 pg/mL regardless of diagnosis. The data set was analyzed using the Student t test and bivariate analysis. Fewer than half of patients were admitted for HF. In 14 patients (10.9%), no signs of HF were found. The BNP level of those with and without HF was similar. There was no difference in BNP level in patients with and without systolic dysfunction or renal dysfunction and between different age groups. Extreme values of BNP do not necessarily correlate with the presence of HF, cardiomyopathy, or kidney dysfunction. When the magnitude of BNP elevation is very high, its clinical significance is limited.

Objective To investigate the relation between breastfeeding, use of docosahexaenoic acid (DHA)-fortified formula and neuropsychological function in children. Design Prospective cohort study. Setting Southampton, UK. Subjects 241 children aged 4 years followed up from birth. Main outcome measures IQ measured by the Wechsler Pre-School and Primary Scale of Intelligence (3rd edn), visual attention, visuomotor precision, sentence repetition and verbal fluency measured by the NEPSY, and visual form-constancy measured by the Test of Visual-Perceptual Skills (Non-Motor). Results In unadjusted analyses, children for whom breast milk or DHA-fortified formula was the main method of feeding throughout the first 6 months of life had higher mean full-scale and verbal IQ scores at age 4 years than those fed mainly unfortified formula. After adjustment for potential confounding factors, particularly maternal IQ and educational attainment, the differences in IQ between children in the breast milk and unfortified formula groups were severely attenuated, but children who were fed DHA-fortified formula had full-scale and verbal IQ scores that were respectively 5.62 (0.98 to 10.2) and 7.02 (1.56 to 12.4) points higher than children fed unfortified formula. However, estimated total intake of DHA in milk up to age 6 months was not associated with subsequent IQ or with score on any other test. Conclusions Differences in children9s intelligence according to type of milk fed in infancy may be due more to confounding by maternal or family characteristics than to the amount of long-chain polyunsaturated fatty acids they receive in milk.

In 2008, the National Institute for Health Research (NIHR) set up a new Public Health Research (PHR) programme. This aims to provide ‘new knowledge on the benefits, costs, acceptability and wider impacts of non-NHS interventions intended to improve the health of the public and reduce inequalities in health’. It has a budget of £10 m per annum. It will fund high-quality research to answer questions that matter to people in public health. The approaches will include both evidence synthesis and primary research. The primary research designs will be rigorous but not limited to randomized controlled trials (RCTs) and the programme is particularly interested in evaluating natural experiments. It works in both commissioned and researcher-led modes and its detailed plans are set out on the NIHR and the programme’s own websites. This paper describes some of the strategic and scientific challenges the PHR programme will have to address, and considers how it can contribute to developing evidence that is useful to public health decision-makers and practitioners. It illustrates these challenges with reference to a specific example of the National Institute for Health and Clinical Excellence (NICE) public health guidance—‘Interventions in schools to prevent and reduce alcohol use among children and young people’ (referred to hereafter as ‘alcohol and schools’).

Background: There is little known about potential mechanisms underlying the association between maternal employment and childhood obesity. The relationships between maternal hours worked per week (none, 1–20 hours, 21+ hours) and children’s dietary and physical activity/inactivity habits were examined. Where mothers were employed, the relationships between flexible work arrangements and these health behaviours were also examined. Methods: Data from 12 576 singleton children age 5 years in the UK Millennium Cohort Study were analysed. Mothers reported information about their employment patterns. Mothers also reported on indicators of their child’s dietary (crisps/sweets, fruit/vegetables, sweetened beverage, fruit consumption), physical activity (participation in organised exercise, transport to school) and inactivity (television/computer use) habits at age 5. Results: After adjustment for potential confounding and mediating factors, children whose mothers worked part-time or full-time were more likely to primarily drink sweetened beverages between meals (compared to other beverages), use the television/computer at least 2 hours daily (compared to 0–2) or be driven to school (compared to walk/cycle) than children whose mothers had never been employed. Children whose mothers worked full-time were less likely to primarily eat fruit/vegetables between meals (compared to other snacks) or eat three or more portions of fruit daily (compared to two or fewer). Although in unadjusted analyses children whose mothers used flexible work arrangements engaged in healthier behaviours, relationships were no longer significant after adjustment. Conclusions: For many families the only parent or both parents are working. This may limit parents’ capacity to provide their children with healthy foods and opportunities for physical activity. Policies and programmes are needed to help support parents and create a health-promoting environment.

BACKGROUND: Trials in developing countries suggest that improving young children's diet may benefit cognitive development. Whether dietary composition influences young children's cognition in developed countries is unclear. Although many studies have examined the relation between type of milk received in infancy and subsequent cognition, there has been no investigation of the possible effect of variations in the weaning diet. METHODS: We studied 241 children aged 4 years, whose diet had been assessed at age 6 and 12 months. We measured IQ with the Wechsler Pre-School and Primary Scale of Intelligence, visual attention, visuomotor precision, sentence repetition and verbal fluency with the Developmental Neuropsychological Assessment (NEPSY), and visual form-constancy with the Test of Visual Perceptual Skills. RESULTS: In sex-adjusted analyses, children whose diet in infancy was characterised by high consumption of fruit, vegetables and home-prepared foods ('infant guidelines' dietary pattern) had higher full-scale and verbal IQ and better memory performance at age 4 years. Further adjustment for maternal education, intelligence, social class, quality of the home environment and other potential confounding factors attenuated these associations but the relations between higher 'infant guidelines' diet score and full-scale and verbal IQ remained significant. For a standard deviation increase in 'infant guidelines' diet score at 6 or 12 months full-scale IQ rose by .18 (95% CI .04 to .31) of a standard deviation. For a standard deviation increase in 'infant guidelines' diet score at 6 months verbal IQ rose by .14 (.01 to .27) of a standard deviation. There were no associations between dietary patterns in infancy and 4-year performance on the other tests. CONCLUSIONS: These findings suggest that dietary patterns in early life may have some effect on cognitive development. It is also possible that they reflect the influence of unmeasured confounding factors.

CONTEXT: Most studies of infant diet and later body composition focus on milk feeding; few consider the influence of variations in the weaning diet. OBJECTIVE: Our objective was to examine how variations in milk feeding and the weaning diet relate to body composition at 4 yr. STUDY POPULATION: A total of 536 children participating in a prospective birth cohort study. DESIGN: Diet was assessed at 6 and 12 months of age. Compliance with weaning guidance was defined by the infant's score for a principal component analysis-defined dietary pattern (infant guidelines) at 12 months. Infants with high infant guidelines scores had diets characterized by high consumption of fruit, vegetables, and home-prepared foods. Body composition was assessed at 4 yr by dual x-ray absorptiometry. RESULTS: Longer duration of breastfeeding was associated with lower fat mass at 4 yr [4.5 kg, 95% confidence interval (CI) of 4.3-4.7 kg, in children breastfed for 12 months or more, compared with 5.0 (95% CI 4.7-5.3) kg in children never breastfed (P = 0.002)] but was not related to body mass index. Children with high infant guidelines scores had a higher lean mass [12.6 (95% CI 12.3-12.9) kg in children in the top quarter of the distribution, compared with 12.0 (95% CI 11.7-12.4) kg in children in the bottom quarter (P = 0.001)]. These associations were independent and were little changed by adjustment for confounding factors. CONCLUSIONS: These data suggest that variations in both milk feeding and in the weaning diet are linked to differences in growth and development, and they have independent influences on body composition in early childhood.

The concept of the socioeconomic lifecourse is increasingly informing understanding of the social patterning of cigarette smoking. We investigated lifecourse influences on (i) women's smoking status (smoker/non-smoker) before pregnancy and (ii) quitting in pregnancy in the UK Millennium Cohort study. Our analyses included conventional measures of the socioeconomic lifecourse (woman's childhood circumstances, education, current socioeconomic circumstances) and measures of her domestic lifecourse (age of becoming a mother, current cohabitation status), as well as parity (first/subsequent child). In analyses of quitting, we also included pre-pregnancy cigarette consumption. Our study underlined, firstly, the importance of lifecourse disadvantage. Those experiencing greater disadvantage with respect to their childhood circumstances, education and current circumstances were at greater risk of being a smoker before pregnancy. A disadvantaged domestic lifecourse - earlier entry into motherhood and lone motherhood-further increased the risk. Poorer childhood circumstances, educational disadvantage, poorer current circumstances and early motherhood also significantly increased the odds of quitting in pregnancy. Secondly, parity was a major predictor of smoking behaviour. First-time mothers had higher odds both of smoking before pregnancy and quitting in pregnancy. The effects of parity were independent of women's lifecourse. Our study supports tobacco control policies which recognise and address inequalities across the lifecourse. However, our study suggests that the dye is not irrevocably cast by social disadvantage: first pregnancy uniformly increases the chances of quitting. Interventions which help smokers having their first baby to quit have an important part to play in promoting maternal and child health.

Background: The aim of the study was to determine whether maternal employment is associated with two indicators of family health behaviour in pre-school children—childhood vaccination uptake, and childhood overweight including obesity—in OECD countries. Methods: Narrative systematic review of nine medical/social science databases (1980–2007), relevant websites, retrieved article reference lists and consultation with experts. Relevant articles in English published from 1980 were included; studies of pregnancy, single occupational groups and non-OECD countries were excluded. Results: 8924 abstracts yielded 21 eligible articles: 15 on vaccination and 6 on overweight. Meta-analysis was not possible. Vaccination uptake appeared at least as good or better for children of employed as unemployed mothers. Child overweight may be more prevalent with maternal employment, particularly if long hours are worked. Conclusions: Maternal employment may have variable effects on pre-school children’s health. Policies promoting parental employment should monitor and evaluate the effect on the health and wellbeing of all members of the family.

Objectives. The primary aim was to examine the relationships between perceived and objective measures of the neighbourhood environment, measured in late infancy, and subsequent overweight (including obesity) in 3-year-old children and their mothers. The secondary aim was to assess whether moving residence confounded these relationships. Methods. We analysed data on 8 154 children and their mothers from the UK Millennium Cohort Study who had participated since birth and were living in England. At the first contact (late infancy), mothers reported their perceptions of their neighbourhood environment, and objective measures of the neighbourhood environment were obtained by linking national deprivation data to each child's postcode. We conducted logistic and multilevel regression analyses to examine perceived and objective measures of the neighbourhood environment, respectively, and overweight at the second contact (3 years) in children and their mothers. All analyses were adjusted for moving residence. Results. There were few consistent patterns between measures of the neighbourhood environment (perceived or objective) and early childhood overweight. However, mothers’ risk of overweight increased with increasingly poor neighbourhood conditions (perceived) or residence in areas of increasing deprivation (objective), after adjustment for individual socio-demographic factors. All relationships were maintained after adjustment for moving residence. Conclusions. While area-level factors have limited influence on the development of overweight in preschool children, they are likely to affect overweight in their mothers. Policies need to address both individual and environmental factors to tackle obesity and its determinants across the life course.

To use an ecological systems approach to examine individual-, family-, community- and area-level risk factors for overweight (including obesity) in 3-year-old children.A prospective nationally representative cohort study conducted in England, Wales, Scotland, Northern Ireland. Participants included 13 188 singleton children aged 3 years in the Millennium Cohort Study, born between 2000 and 2002, who had complete height/weight data. The main outcome measure was childhood overweight (including obesity) defined by the International Obesity TaskForce cut-offs for body mass index.23.0% of 3-year-old children were overweight or obese. In the fully adjusted model, primarily individual- and family-level factors were associated with early childhood overweight: birthweight z-score (adjusted odds ratio, 1.36, 95% CI 1.30 to 1.42), black ethnicity (1.41, 1.11 to 1.80) (compared with white), introduction to solid foods4 months (1.12, 1.02 to 1.23), lone motherhood (1.32, 1.15 to 1.51), smoking during pregnancy (1-9 cigarettes daily: 1.34, 1.17 to 1.54; 10-19: 1.49, 1.26 to 1.75; 20+: 1.34, 1.05 to 1.70), parental overweight (both: 1.89, 1.63 to 2.19; father only: 1.45, 1.28 to 1.63; mother only: 1.37, 1.18 to 1.58), prepregnancy overweight (1.28, 1.14 to 1.45) and maternal employmentor =21 hours/week (1.23, 1.10 to 1.37) (compared with never worked). Breastfeedingor =4 months (0.86, 0.76 to 0.97) (compared with none) and Indian ethnicity (0.63, 0.42 to 0.94) were associated with a decreased risk of early childhood overweight. Children from Wales were also more likely to be overweight than children from England.Most risk factors for early childhood overweight are modifiable or would allow at-risk groups to be identified. Policies and interventions should focus on parents and providing them with an environment to support healthy behaviours for themselves and their children.

In order to inform local action for health improvement, this pilot study used multiple methods to explore children's perspectives of environmental influences on their eating and physical activity. Thirty-nine children aged 9-11 years from a North London local authority took photos, drew maps, and attended focus groups. We found that the approach engaged children and that each of the methods returned useful, complementary information. The results highlighted a number of areas for local policymakers and practitioners to consider when developing work to prevent childhood obesity. We conclude that these methods of gaining children's views should be further developed and tested.

Background: Long-chain omega-3 polyunsaturated fatty acids are thought to be important for fetal neurodevelopment. Animal studies suggest that a deficiency of omega-3 fatty acids may lead to behavioural or cognitive deficits. As oily fish is a major dietary source of omega-3 fatty acids, it is possible that low intake of fish during pregnancy may have adverse effects on the developing fetal brain. Methods: We used the Strengths and Difficulties Questionnaire and the Wechsler Abbreviated Scale of Intelligence to assess behavioural problems and intelligence in 217 nine-year-old children. The mothers of these children had participated in a study of nutrition during pregnancy during which fish intake was assessed in early and late gestation. Results: Children whose mothers had eaten oily fish in early pregnancy had a reduced risk of hyperactivity compared to those whose mothers did not eat oily fish: OR .34, 95% CI .15 to .78, after adjustment for potential confounding factors. Children whose mothers had eaten fish (whether oily or non-oily) in late pregnancy had a verbal IQ that was 7.55 points higher (95% CI .75 to 14.4) than those whose mothers did not eat fish. There were, however, no significant associations between fish intake in pregnancy and other behavioural problems or full-scale and performance intelligence, after adjustment for potential confounding factors. Conclusions: Although maternal fish intake in pregnancy was associated with hyperactivity scores and verbal IQ in children, in general, how much fish women ate during pregnancy appeared to have little long-term relation with neurodevelopmental outcomes in their child.

Objective: To examine UK country and English regional differences in childhood overweight (including obesity) at 3 years and determine whether any differences persist after adjustment for individual risk factors. Design: Nationally representative prospective study. Setting: England, Wales, Scotland and Northern Ireland. Participants: 13 194 singleton children from the UK Millennium Cohort Study with height and weight data at age 3 years. Main outcome measure: Overweight (including obesity) was defined according to the International Obesity TaskForce cut-offs for body mass index, which are age and sex specific. Results: At 3 years of age, 23% (3102) of children were overweight or obese. In univariable analyses, children from Northern Ireland (odds ratio 1.30, 95% confidence interval 1.14 to 1.48) and Wales (1.26, 1.11 to 1.44) were more likely to be overweight than children from England. There were no differences in overweight between children from Scotland and England. Within England, children from the East (0.71, 0.57 to 0.88) and South East regions (0.82, 0.68 to 0.99) were less likely to be overweight than children from London. There were no differences in overweight between children from other English regions and children from London. These differences were maintained after adjustment for individual socio-demographic characteristics and other risk factors for overweight. Conclusions: UK country and English regional differences in early childhood overweight are independent of individual risk factors. This suggests a role for policies to support environmental changes that remove barriers to physical activity or healthy eating in young children.

About 20 million children are born each year with low birth weight, overwhelmingly in low income countries. The consequences emerge initially as infant and child mortality, predominantly from infecti

It has been hypothesised that lower vaccine uptake in childhood among some groups, such as children of lone parents or from larger families, may be due to their higher levels of residential mobility. This paper aimed to explore this association in a large cohort of children born in the UK at the turn of the century. Using multi-variable Poisson regression we found that children who lived in families which had moved during pregnancy or more frequently were more likely to be partially immunised with the primary immunisations and unimmunised against measles, mumps and rubella. Mobility was not associated with being unimmunised with the primary vaccines, or with single measles, mumps and rubella antigen vaccine use. These findings suggest that policies are needed to encourage the building and maintenance of relationships between health care professionals and parents, before and after they move, and better use of IT systems to aid follow-up of mobile families.

OBJECTIVE. The objective of this study was to describe the health status and health-related quality of life preference-based outcomes of children with diagnosed bilateral permanent childhood hearing impairment and a comparison group of English-speaking children with normal hearing. METHODS. We studied 120 children who were aged 7 to 9 years and had bilateral permanent childhood hearing impairment of moderate or greater severity, identified from a cohort of 156733 children who were born in 8 districts of southern England, and 63 English-speaking children with normal hearing and the same place of birth and age at assessment. Principal caregivers were interviewed by using the Health Utilities Index Mark III questionnaire for proxy-assessed usual health status assessment. Levels of function within each of the 8 attributes of the Health Utilities Index Mark III (cognition, vision, hearing, speech, ambulation, dexterity, emotion, and pain) were recorded. RESULTS. Bilateral permanent childhood hearing impairment is associated with significantly increased proportions of suboptimal levels of function and significantly lower single-attribute utility scores in 6 of the 8 attributes of the Health Utilities Index Mark III: vision, hearing, speech, ambulation, dexterity, and cognition. Compared with the children with normal hearing, the mean multiattribute utility score for the children with hearing impairment was significantly lower for both the whole group and the moderate, severe, and profound severity subgroups. The differences in the distributions of the multiattribute utility scores between the children with hearing impairment as a group and the children with normal hearing and between each of the severity subgroups and the children with normal hearing all were statistically significant. CONCLUSIONS. This study provides rigorous evidence of an association between bilateral permanent childhood hearing impairment and diminished health status and health-related quality of life preference-based outcomes during midchildhood.

An increasing number of preschool children are becoming overweight. Although many risk factors have been identified for school-age children, less is known about this young age group. Ecological models have been developed to illustrate how individual characteristics, family characteristics, community-level factors, and policies may influence weight gain. We used this model to review factors that influence overweight in children, aged six months to five years, which are amenable to policy intervention in resource-rich countries. We found strong evidence for a direct association between childhood overweight and maternal prepregnancy body size, maternal smoking during pregnancy, and children's television/media use; strong evidence for an inverse relationship between breastfeeding and overweight, and moderate evidence for children's physical activity. There was limited research on community-level factors, policies and interventions. Future policies and interventions should be subject to evaluation and aim to support parents and young children to develop health-related behaviours that may prevent early childhood overweight.

BACKGROUND: Associations between growth and size during infancy and adult disease have led some to recommend that interventions in infancy might benefit lifelong health. Any such recommendations should be informed by both the scientific evidence for relationships between infancy and later outcomes and the views and opinions of those who care for babies. METHODS: Separate, but interlinked, systematic reviews were conducted of the epidemiological evidence relating infant size or growth to later health and of lay perspectives on infant size and growth. Findings were compared and integrated to consider policy implications. RESULTS: Lay and scientific perspectives both cast infant growth and size as an indicator of other aspects of an infant's life, rather than being of fundamental importance. While the scientific literature is most often concerned with infants at the extreme ends of the population distribution, and towards long-term outcomes, the literature on lay perspectives suggests a focus on defining the 'normal' range, and on current health. CONCLUSIONS: Differences and similarities between scientific and lay perspectives on health can highlight areas of agreement, as well as areas of potential misunderstanding or miscommunication.

CONTEXT: Evidence suggests that babies' fat mass at birth is greater if their mothers were themselves fatter during pregnancy, but it is unclear whether this association persists into childhood. OBJECTIVE: Our objective was to examine the relation between maternal size in pregnancy, early growth and body composition in children. DESIGN AND SETTING: We conducted a prospective cohort study in Southampton, United Kingdom. PARTICIPANTS: Participants included 216 9-yr-old children whose mothers had participated in a study of nutrition during pregnancy. MAIN OUTCOME MEASURES: Fat mass and lean mass were measured by dual-energy x-ray absorptiometry and adjusted for height (fat mass index and lean mass index). RESULTS: Fat mass index at age 9 yr was greater in children whose mothers had a larger mid-upper arm circumference in late pregnancy or a higher prepregnant body mass index. For 1 sd increase in maternal mid-upper arm circumference in late pregnancy, fat mass index rose by 0.26 [95% confidence interval (CI) 0.06-0.46] sd in boys and by 0.44 (95% CI 0.31-0.57) sd in girls. For 1 sd increase in maternal prepregnant BMI, fat mass index rose by 0.26 (95% CI 0.04-0.48) sd in boys and by 0.42 (95% CI 0.29-0.56) sd in girls. CONCLUSIONS: Mothers with a higher prepregnant body mass index or a larger mid-upper arm circumference during pregnancy tend to have children with greater adiposity at age 9. The extent to which this is attributable to genetic factors, the influence of maternal lifestyle on that of her child, or maternal adiposity acting specifically during pregnancy on the child's fat mass cannot be determined in this study.

Background The inclusion of qualitative studies in systematic reviews poses methodological challenges. This paper presents worked examples of two methods of data synthesis (textual narrative and thematic), used in relation to one review, with the aim of enabling researchers to consider the strength of different approaches. Methods A systematic review of lay perspectives of infant size and growth was conducted, locating 19 studies (including both qualitative and quantitative). The data extracted from these were synthesised using both a textual narrative and a thematic synthesis. Results The processes of both methods are presented, showing a stepwise progression to the final synthesis. Both methods led us to similar conclusions about lay views toward infant size and growth. Differences between methods lie in the way they dealt with study quality and heterogeneity. Conclusion On the basis of the work reported here, we consider textual narrative and thematic synthesis have strengths and weaknesses in relation to different research questions. Thematic synthesis holds most potential for hypothesis generation, but may obscure heterogeneity and quality appraisal. Textual narrative synthesis is better able to describe the scope of existing research and account for the strength of evidence, but is less good at identifying commonality.

Background Atopic dermatitis (eczema) is one of the most common conditions of childhood, and can have a serious effect on children’s and families’ quality of life. Previous studies have suggested that childhood eczema is socially patterned, with higher incidence in more advantaged populations, but it is unclear what explains these differences. We therefore explored the epidemiology and risk factors for eczema, in a contemporary UK birth cohort, with a focus on socio-economic circumstances and the extent to which any socio-economic gradient might be explained by other early-life risk factors for eczema. Methods Longitudinal analysis of the United Kingdom Millennium Cohort Study (MCS), based on 14,499 who participated in sweeps of the study at ages 9 months and 5 years. At 5 years mothers were asked about whether their child has “ever had eczema”. Odds ratios (OR) and 95% confidence intervals (CI) for eczema were estimated using logistic regression, according to maternal education. Maternal, antenatal and early life characteristics were explored to assess if they explained the associations found between maternal education and eczema. Results 35.1% of children had ever had eczema by age five. Children of mothers with degree level qualifications were more likely to have eczema compared to children of mothers with no educational qualifications (OR 1.52 95% CI 1.31–1.76) and there was a clear gradient across the socioeconomic spectrum. Maternal atopy, breastfeeding (1–6 weeks and 6 months or more), introduction of solids under 4 months or cow’s milk under 9 months, antibiotic exposure in the first year of life and “grime” exposure were independently associated with an increased risk of eczema. Female sex, Pakistani and Bangladeshi ethnicity, smoking during pregnancy and exposure to environmental tobacco smoke (ETS) and other siblings were independently associated with a reduced risk for eczema. When these factors were entered into the main model, the OR for eczema in children whose mothers had a degree reduced to 1.26 (95% CI 1.03 to 1.5). Conclusion In this representative UK cohort, there was a significant excess of childhood eczema reported in more advantaged children and this was attenuated when accounting for maternal, antenatal and early life factors.

Recent studies have shown associations between size and body proportions at birth and health outcomes throughout the life cycle, but there are few data on how neonatal phenotype varies in different populations around the world.Data from the UK, Finland, India, Sri Lanka, China, DR Congo, Nigeria, and Jamaica (n=22,067) were used to characterize geographical differences in phenotype in singleton, live-born newborns. Measurements included birth weight, placental weight, length, head, chest, abdominal and arm circumferences, and skinfolds.Neonates in Europe were the largest, followed by Jamaica, East Asia (China), then Africa and South Asia. Birth weight varied widely (mean values 2,730-3,570 g), but in contrast, head circumference was similar in all except China (markedly smaller). The main difference in body proportions between populations was the head to length ratio, with small heads relative to length in China and large heads relative to length in South Asia and Africa.These marked geographical differences in neonatal phenotype need to be considered when investigating determinants of fetal growth, and optimal phenotype for short-term and long-term outcomes.

Infant and childhood growth result from and reflect a range of influences in pre- and postnatal life. These include nutrition, burden of infection and the psycho-social environment. Nutrition in young children is dependent on individual level factors such as fetal experience, infant feeding and weaning practices, and on societal factors such as education of women and economic conditions. The relationship of early postnatal growth to adult disease may be indicative or causal, and may reveal both biological and sociological processes. Although non-insulin-dependent diabetes mellitus (NIDDM) and obesity are risk factors for ischaemic heart disease, the relationships of these three conditions to infant growth differ. Poor infant growth has been associated with higher levels of NIDDM and ischaemic heart disease, but lower levels of adult obesity. Most research has been of populations living in developed countries at different stages of nutritional transition. However, differences in context are not simply limited to the stage of the nutritional transition. They also need to consider the nature of that transition and its social correlates, which may result in the clustering of aetiological influences such as increased body mass and poverty. The size of effect of the relationship of infant growth to adult disease is important not only to determine its relative aetiological importance but also for its potential for public health policy. Such policy also needs to consider the relationships of infant growth to a range of outcomes, both health and human capital, which are not the subject of this workshop.

OBJECTIVE. The objective of this study was to estimate the economic costs of bilateral permanent childhood hearing impairment (PCHI) in the preceding year of life for children aged 7 to 9 years. METHODS. A cost analysis was conducted by using a birth cohort of children born between 1992 and 1997 in 8 districts of Southern England, of which half had been born into populations exposed to universal newborn screening (UNS). Unit costs were applied to estimates of health, social, and broader resource use made by 120 hearing-impaired children and 63 children in a normally hearing comparison group. Associations between societal costs per child and severity of hearing impairment, language ability score, exposure to UNS, and age of confirmation were analyzed, including adjustment for potential confounders in a linear regression model. RESULTS. The mean societal cost in the preceding year of life at 7 to 9 years of age was £14092.5 for children with PCHI, compared with £4206.8 for the normally hearing children, a cost difference of £9885.7. After adjusting for severity and other potential confounders in a linear regression model, mean societal costs among children with PCHI were reduced by £2553 for each unit increase in the z score for receptive language. Using similar regression models, exposure to a program of UNS was associated with a smaller cost reduction of £2213.2, whereas costs were similar between children whose PCHI was confirmed at 9 months. CONCLUSIONS. The study provides rigorous evidence of the annual health, social, and broader societal cost of bilateral PCHI in the preceding year of life at 7 to 9 years of age and shows that it is related to its severity and has an inverse relationship with language abilities after adjustment for severity.

Inverse associations between birthweight and later risk of major chronic diseases, notably cardiovascular disease, diabetes, and osteoporosis, have been found in various studies.1 Birthweight is determined by length of gestation and the combination of the early trajectory of fetal growth and the capacity of the fetal supply line to maintain this trajectory in late gestation. Studies in early pregnancy, assisted reproductive technology, and animal experiments indicate that both genetic and environmental factors are important in establishing the fetal growth trajectory and the fetal supply line; environmental factors include transgenerational influences and the mother's body composition, endocrine profile, diet, and physical activity around the time of conception.2 As these influences may change during early pregnancy, there is a need to characterize women before conception.