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There is limited research on the longer-term impact of fostering on caregivers’ own children. This study investigates whether the existing children in a fostering household differ from young people in non-caregiving households in the timing of their transitions to key adult roles, known to affect later health and life chances. Using data from the ONS Longitudinal Study, we pooled records from census years 1971 to 2001 and linked them to follow-up records from 1981 to 2011. We identified 2656 children living with a foster child and compared their profiles on the “big five” transitions to roles of adulthood — finishing school; leaving home; finding work and becoming financially independent; getting married; and having children — with those of other children without a foster child in the household (N = 209,453). We fitted multiple exposure models that controlled for childhood sociodemographic confounders, with standard errors adjusted for clustering of records in childhood, to estimate the prevalence of the five roles measured in early adulthood. We found that achieving the transition to adulthood for caregivers’ children was indicated based on four roles. The exception was leaving home. There was some evidence that caregivers’ children might cope better with the transition to adulthood if they were older than the foster child or were female. The findings suggest that supporting foster parents with delaying their children’s transition to adulthood could become part of the role of supervising social workers. Discussing with parents and their adolescent children what barriers might be preventing them from staying in school and what is prompting them to want to leave school and go out to work would be a first step, since educational qualifications have become so dominant for more recent generations of young people aspiring to take up other adult roles.

Autism can be diagnosed from 2 years of age, although most autistic people receive their diagnosis later than this after they have started education. Research is required to understand why some autistic children are diagnosed late, and the level and nature of unmet need prior to diagnosis for late-diagnosed children.We examined trajectories of emotional, behavioural and social difficulties (EBSDs) across childhood and adolescence, comparing 'earlier-diagnosed' (diagnosed 7 years or younger) with 'late-diagnosed' (diagnosed between 8 and 14 years) autistic children. Data were from the Millennium Cohort Study, a population-based UK birth cohort. EBSDs were measured using the parent-report Strengths and Difficulties Questionnaire, at 3, 5, 7, 11 and 14 years. We used Growth Curve Modelling to investigate levels and rates of change in these difficulties, and to compare earlier- (n = 146) and late-diagnosed (n = 284) autistic children.Aged 5, earlier-diagnosed autistic children had more emotional (i.e., internalising), conduct, hyperactivity and social difficulties; although clinical difficulties in these areas were nevertheless common in late-diagnosed children. There was a faster annual increase in scores for all domains for late-diagnosed children, and by age 14 years, they had higher levels of EBSDs. These results persisted when we ran adjusted models, to account for the late-diagnosed group having higher rates of late-diagnosed attention deficit/hyperactivity disorder, higher IQ, a higher proportion of females and older and more educated mothers.Emotional, behavioural and social difficulties are associated with, and may influence, the timing of autism diagnosis. Late-diagnosed autistic children often have high levels of mental health and social difficulties prior to their autism diagnosis, and tend to develop even more severe problems as they enter adolescence.

Background: Maternal depression is a major determinant of offspring mental health. Yet, little is understood about how the duration and timing of maternal depression shapes youth risk for depressive symptoms, which if understood could inform when best to intervene. This study aimed to determine how the timing and duration of maternal depression was related to offspring depression in emerging adulthood, and if these associations varied by sex. Methods: We analysed data from the Avon Longitudinal Study of Parents and Children (a prenatal cohort in the Avon area of England, 1991–2003), n = 3,301. We applied the structured lifecourse modelling approach to maternal depression (assessed at 13 points from prenatal period to adolescence) and emerging adult depressive symptoms (age 21). Lifecourse models assessed were accumulation (sum of timepoints when maternal depression was reported), sensitive periods (each period assessed as one during which maternal depression has a stronger effect) and instability (frequent fluctuations in maternal depression). Results: Female adolescents (n = 2,132) had higher SMFQ scores (mean = 6.15, SD = 5.90) than males (n = 1,169, mean = 4.87, SD = 4.82). Maternal depression was most common in the infancy period (21.2% males; 21.4% females). For males, accumulation was the most appropriate lifecourse model; for each additional period of maternal depression, depressive symptoms in emerging adulthood increased by 0.11 (95% CI: 0.07, 0.15, one-sided p value ≤.001). For females, exposure to maternal depression was associated with increasing depressive symptoms in emerging adulthood, with the largest effect in mid-childhood (increase of 0.27 units, 95% CI 0.03–0.50, p =.015 for difference between mid-childhood and other time-periods) and a smaller, equal effect at all other time-periods (increase of 0.07 units per time-period, 95% CI: 0.03–0.12, p =.002). Conclusions: This study highlights the importance of ongoing maternal depression for the development of depression in offspring through to emerging adulthood. Because long-term exposure to maternal depression was particularly important, early interventions are warranted.

ObjectivesTo examine if gestational age groups predict the development of social competence difficulties (SCDs) from childhood into mid-adolescence and to assess the mediation by maternal psychological distress during infancy on these trajectories.DesignNationally representative population-based birth cohort (UK Millennium Cohort Study).Participants15 821 children born in 2000–2002.Outcome measuresSCDs (derived from peer and prosocial subscales of Strengths and Difficulties Questionnaire) were assessed by parent report when the participants were aged 3, 5, 7, 11 and 14 years. Maternal psychological distress was self-rated using Rutter Malaise Inventory when the children were 9 months of age. Data were modelled using latent growth curve analysis.ResultsDevelopmental trajectories of SCDs were U-shaped in all groups. Very preterm (VP) children (ConclusionThere was a dose–response association between gestational age and the trajectories of SCDs. Monitoring and providing support on social development throughout childhood and adolescence and treating early maternal psychological distress may help children who were born earlier than ideal, particularly those born VP.

Objectives:Exposures to adverse events are associated with impaired later-life psychological health. While these associations depend on the type of event, the manner in which associations for different event types depend on when they occur within the life course has received less attention. We investigated associations between counts of adverse events over the life course, and wellbeing and mental health outcomes in older people, according to their timing (age of occurrence), orientation (self or other) and, both their timing and orientation.Design:Linear and logistic random-effects models for repeated observations.Setting:England, 2002–2015.Participants:A total of 4,208 respondents aged >50 years with 22,146 observations across Waves 1–7 of the English Longitudinal Study of Ageing.Measurements:Cumulative adversity was measured by counts of 16 types of events occurring within four age ranges over the life course using retrospective life history data. These were categorized into other- (experienced through harms to others) and self-oriented events. Outcomes included CASP-12 (control, autonomy, self-realization, and pleasure), the eight-item Centre of Epidemiological Studies Depression Scale, and self-appraised subjective life satisfaction.Results:Additional adverse events were associated with lower CASP-12 and life satisfaction scores, and higher odds of probable depressive caseness. In childhood, other-oriented events had a larger negative association with later-life wellbeing than self-oriented events; the converse was found for events occurring in adulthood.Conclusions:Events occurring at all life course stages were independently associated with both later-life wellbeing and depression in a cumulative fashion. Certain age ranges may represent sensitive periods for specific event types.

Many countries have implemented policies to extend working lives in response to population ageing, yet there remains little understanding of what drives paid work in later life, nor how this is changing over time. This paper utilises the 1988/89 Survey of Retirement and Retirement Plans, the 1999 British Household Panel Survey and the 2008 English Longitudinal Study of Ageing, to investigate drivers of paid work in the ten years surrounding state pension age (SPA) for women and men in, comparing cohorts born in the 1920s, 1930s and 1940s. Using optimal matching analysis with logistic and multinomial regression models, the study assesses the relative importance of lifecourse histories, socio-economic circumstances and contemporaneous factors, in determining paid work in mid- and later life. Participation in paid work in the five years preceding and beyond SPA increased markedly for men and women across cohorts, with women's lifecourses and engagement with paid work changing considerably in these periods. However, for women, a lifetime history of paid work remained a crucially important predictor of paid work in later life, and this relationship has strengthened over time. Experiencing divorce has also become an important driver of paid work around SPA for the youngest cohort. Having children later, and still having a mortgage, also independently predict labour force participation for women and men. Across all cohorts and for women and men, working at these older ages was a function of higher income and better health. These findings suggest that policies which enable people to maintain ties to paid work across the lifecourse may be more effective at encouraging later-life employment than those concerned only with postponing the retirement transition.

Background: Maternal depression influences offspring mental health. Yet little is understood about how the duration and timing of maternal depression shapes youth risk for depressive symptoms, which if understood could inform when best to intervene. Consequently, this study aimed to determine how the timing and duration of maternal depression was related to offspring depression in late adolescence, and variations by sex.Methods: We used data from the Avon Longitudinal Study of Parents and Children (a prenatal cohort in the Avon area of England, 1991-2003), n=3,301. We applied a structured lifecourse modelling approach to maternal depression (assessed at thirteen points from prenatal period to adolescence) and late adolescent depressive symptoms (age 21). Lifecourse models assessed were accumulation (sum of timepoints when maternal depression was reported), sensitive periods (each period assessed as one during which maternal depression has a stronger effect) and instability (frequent fluctuations in maternal depression).Results: Female adolescents (n=2,132) had higher SMFQ scores (mean=6.15, SD=5.90) than males (n=1,169, mean=4.87, SD=4.82). Maternal depression was most common in the prenatal period (21.1% males; 22.2% females). For males, accumulation was the most appropriate model; for each additional period of maternal depression, depressive symptoms in late adolescence increased by 0.11 (95% CI: 0.07,0.15, 1-sided p value≤0.001). For females, exposure to maternal depression was associated with increasing depressive symptoms in late adolescence, with the largest effect in mid-childhood (increase of 0.27 units, 95% CI 0.03-0.50, p=0.015 for difference between mid-childhood and other time-periods) and a smaller, equal effect at all other time-periods (increase of 0.07 units per time-period, 95% CI: 0.03-0.12, p=0.002).Conclusions: This study highlights the importance of ongoing maternal depression for the development of depression in offspring through to late adolescence. Because long-term exposure to maternal depression was particularly important, early interventions are warranted.

This exploratory study aimed to explore the association between depression and self-harming behaviour in adolescence and the timing of diagnosis for autism spectrum disorder. We analysed data on 11,320 14 year olds, including 396 children with autism spectrum disorder, from the UK Millennium Cohort Study. Exposures were the timing of diagnosis for autism spectrum disorder confirmed by parental report at ages 5, 7, 11 and 14. Outcomes were depression measured by the Short Mood and Feelings Questionnaire (scores ⩾12) and self-report of self-harming behaviour, both assessed at age 14. Data were analysed using multivariable regression analysis. 91% of the autism spectrum disorder group had within-typical-range cognitive ability. After adjusting for child and family confounders, there was a positive linear trend between diagnostic age and depression, with children diagnosed between ages 7 and 11 and children diagnosed after age 11 showing increased symptoms (odds ratio = 2.21 and 3.58, respectively). A similar trend was observed for self-harming behaviour, with children diagnosed after age 11 showing the strongest association (odds ratio = 3.16). These results suggest the importance of earlier diagnosis in preventing secondary mental health problems in this population, particularly among those without cognitive delays. Further studies replicating across a wider intellectual spectrum and clarifying the underlying mechanism are warranted. Lay Abstract Children with autism spectrum disorder are at increased risk of depression and self-harming behaviours. The question of whether timing of diagnosis of autism spectrum disorder is associated with these consequences in adolescence has not yet been studied. This exploratory study aimed to explore the association between depression and self-harming behaviour in adolescence and the parent-reported timing of diagnosis for autism spectrum disorder using a large population-based cohort in the United Kingdom. Most of the children with autism spectrum disorder in our study had within-typical-range cognitive ability. We found a linear association between timing of autism spectrum disorder diagnosis and depression and self-harming behaviour in adolescence; later diagnosis of autism spectrum disorder, particularly diagnosis in adolescence, was associated with the increased risk of self-reported depressive symptoms and self-harming behaviour in adolescence among children with autism spectrum disorder. Our findings, albeit observational, suggest that interventions targeting the earlier diagnosis of autism spectrum disorder and approaches to improve person–environment fit may help prevent secondary mental health problems in this population, particularly among those without cognitive delays and those diagnosed late. Further studies replicating across a wider intellectual spectrum and clarifying the underlying mechanism are warranted.

This study aimed to identify determinants of a late autism spectrum disorder diagnosis, including diagnoses made ‘very late’ (i.e., in adolescence), using the Millennium Cohort Study, a nationally representative population-based cohort in the United Kingdom. Children diagnosed with autism spectrum disorder by age 14 (N = 581) were included and grouped by the parent-reported timing of diagnosis: before school (up to age 5), during primary school (age 5–11) and during secondary school (age 11–14). Predictors of diagnostic timing, at the child, family and school levels, were investigated using multinomial logistic regression. Most (79%) children with autism spectrum disorder were diagnosed after school entry, and 28% were not diagnosed until secondary school. Among those not diagnosed until secondary school, 75% had been identified at age 5 years by a parent and/or teacher as having socio-behavioural difficulties. Being diagnosed after starting school was predicted by living in poverty (adjusted relative risk ratio: primary = 1.90, 95% confidence interval: 1.03–3.53; secondary = 2.15, 1.05–4.42) and/or having no initial parental concerns (primary = 0.32, 0.15–0.70; secondary = 0.19, 0.09–0.43). Having typical-range intelligence also predicted diagnosis during secondary school. The result indicates that those without cognitive delays and poorer children were at risk of ‘very late’ (i.e. adolescent) diagnosis. Strategies to promote earlier identification, targeting age at primary school entry, could help those more likely to be diagnosed late. Lay abstract Despite policy emphasis on early identification, many children with autism spectrum disorder are diagnosed late, with some being diagnosed as late as in adolescence. However, evidence on what determines the timing of autism spectrum disorder diagnosis including children diagnosed in adolescence is lacking. Understanding these determinants, particularly in those diagnosed later than is ideal, can inform the development of effective strategies to improve earlier identification of autism spectrum disorder. This study used a nationally representative population-based cohort in the United Kingdom to explore child, family and school level predictors of timing of autism spectrum disorder diagnosis. In the United Kingdom, 79% of the children with autism spectrum disorder were diagnosed after entering primary school and 28% during secondary school. Among those not diagnosed until secondary school, 75% had shown social difficulties noticed by parents and/or teachers at age 5 years. The results suggest that healthcare providers should be aware that, even for universal systems of care, those living in poverty and having higher intelligence are most likely to miss out on a timely diagnosis. Strategies to promote earlier identification among school-aged children, including targeting primary school entry age (i.e. around age 5) and that encouraging referrals for a formal assessment at the first report of concerns over the child’s social development may benefit those children who would otherwise be diagnosed later.

Changes in paid labor in families have occurred within the wider context of societal changes in gendered attitudes to work. However, changes in behavior and attitudes are not necessarily correlated with each other, and their associations with family relationships are complex. This study uses data from over 12,000 two-parent families in the U.K.’s Millennium Cohort Study, a nationally representative cohort of children born during 2000–2002. The study investigates the potential association between relationship satisfaction and discordance between attitudes to maternal employment and mothers’ actual participation in paid labor, as well as agreement in attitudes within couples. Results show that attitudes in favor of maternal employment and actual maternal employment are generally associated with better relationship satisfaction for both mothers and fathers. In addition, discordance between an individual’s attitudes and behavior in relation to maternal employment, and discordant attitudes within couples, is both associated with significantly lower relationship satisfaction compared with concordant couples.

Purpose In Great Britain, few studies documented mental health trends in young adults in the years preceding 2020, the mental health dimensions affected, and how these compare with changes observed during the COVID-19 pandemic. Methods Long-term trends in mental health among 16–34 year old men and women between 1991 and 2018, and changes between 2018–19 and July–September 2020 were examined using all waves from the British Household Panel Study (1991–2008), the UK Household Longitudinal Study (2009–20), and the first five UKHLS COVID-19 waves administered in April, May, June, July, and September 2020. Findings are based on the GHQ-12 continuous score (0–36), clinically significant cases (4 + /12) and severe cases (7 + /12) for mental distress, and item endorsements. Results Between 1991 and 2018, the prevalence of cases (4 + /12) increased from 14–22% to 19–32% across groups. Increases were largest in women aged 16–24. In April 2020, the risk of caseness (4 + /12) increased across groups by 55% to 80% compared to the 2018–19 baseline. This increase, however, rapidly diminished over time: in July–September 2020, there was only a higher risk of caseness (4 + /12) in men aged 25–34 (prevalence ratio = 1.29, 95% CI 1.01–1.65) compared to the 2018–19 baseline. Conclusion Whereas distress surged in April 2020, its return to pre-pandemic levels by September 2020 highlights the nuanced impact that the pandemic may have over time. Given the magnitude of the decline in mental health over the past decade, attention must be given to young adults once the pandemic ends.

BackgroundThe evidence on the association between adverse childhood experiences (ACEs) and psychological distress in adulthood tends to rely on cross-sectional studies. In this 50-year long longitudinal study, we examined the association between both prospectively and retrospectively reported ACEs and adulthood trajectories of psychological distress between age 23 and 50. We also studied potential effect modifiers of these associations, spanning social and developmental domains of child development.MethodsThe sample comprised 8,055 participants of the 1958 National Child Development Study. Psychological distress was measured by the Malaise Inventory at ages 23-50. We used growth curve analysis and multinomial regression.ResultsAfter accounting for covariates, those with more ACEs experienced persistently higher psychological distress between age 23 and 50, with a graded relationship observed. The associations were relatively consistent across prospectively and retrospectively reported ACEs. Those with prospective or retrospective ACE score of 1 compared with 0, had on average between 0.27 and 0.39 higher distress throughout adulthood. In relative terms, the prospective ACE score of 2+ (vs 0) was associated with 3.31 and the retrospective ACE score of 4+ (vs 0) with 5.76 (95% CI 4.24 to 7.82) times higher risk of being in the “high symptoms”, compared with the “low symptoms” trajectory of distress. None of the potential effect modifiers altered the association between ACEs and trajectories of distress.ConclusionIf the associations between ACEs and trajectories of distress are causal, this emphasises the need to act early to prevent psychopathology across the adult life course.

BackgroundChildren who spent time in non-parental care report poor outcomes in many aspects of their later lives on average, but less is known about differences by ethnicity. We examined whether the health, socioeconomic, family, and living arrangements of adults who had been in non-parental care across the first three decades of adult life varied by ethnicity (White, Black, South Asian).MethodsWe used longitudinal data from the Office for National Statistics Longitudinal Study (LS). Participants were aged

This article uses data from the UK Household Longitudinal Study to describe how contemporary British couples divide a range of work types. Our findings support the hypothesis, suggested by previous authors, that a shared egalitarian ideology is required for gender equality in divisions of work. In response to bargaining theories, the article also hypothesises that differentials in educational attainment within couples are more strongly associated with gender divisions of work when a couple’s gender ideology is in conflict. Interaction analysis does not support this hypothesis.

Evidence suggests that health-related behaviours (HRBs) cluster in mid-adulthood and are associated with social circumstances (i.e. economic circumstances, cultural norms, employment relations) at the same age. However, little is known about the level of stability in HRB cluster membership during mid-adulthood and how social circumstances in early mid-adulthood may influence movement between HRB clusters during mid-life. Data were taken from a British cohort born in 1958 (N = 12,784), to examine the stability of membership of three HRB clusters: 'Risky', 'Moderate Smokers' and 'Mainstream' (the latter pattern consisting of more beneficial HRBs such as not smoking, moderate alcohol consumption, being physically active), between ages 33 and 42. The relationship between social circumstances at age 33 and movement between HRB clusters during mid-adulthood was also examined. HRB cluster membership was relatively stable during mid-adulthood, over 60% of the participants remained in the same cluster at both ages. However, there was considerable probability of movement from the 'Risky' and 'Moderate Smokers' clusters at age 33 to the 'Mainstream' cluster at age 42. Members of the 'Risky' cluster had a lower probability of transitioning to the 'Mainstream' cluster (men = 17%, women = 9%, p 0.001) in comparison to the 'Moderate Smokers' cluster (men = 26%, women = 27%, p 0.001). Social circumstances at age 33 did not influence change in HRB cluster membership between ages 33 and 42 (p 0.05). Movement from the 'Risky' and 'Moderate Smokers' cluster to the 'Mainstream' cluster during mid-adulthood highlights improvements for most HRBs. Person-centred interventions are required to prevent persistent negative HRBs amongst 'Risky' cluster members.

The association between socioeconomic position (SEP) and dementia is well studied. However, scant attention has been given to the relationship with mild cognitive impairment (MCI), often considered a transient state between normal cognition and dementia. The purpose of this study was to determine the role of various SEP markers such as education and wealth on transitioning to MCI and dementia over a four-year period using data from the English Longitudinal Study of Ageing, a national representative sample of the English population aged 50+. We ascertained MCI and dementia over four years, using a validated algorithm based on physician diagnosis and lower cognitive performance (1 standard deviation below the mean) on multiple standardised tests adjusted for age and education. A Multistate Markov survival model was utilised to investigate whether different SEP markers increased the risk of specific transitions between normal cognitive performance and MCI or dementia, with the latter being considered an absorbing state. During the study period, a quarter of participants progressed to MCI from the normal state. Being in the lowest quintile of wealth was associated with a lower probability of transitioning back to a normal cognitive state from MCI, compared with those in the highest quintile. Greater wealth was weakly associated with a lower risk of transitioning from normal cognitive state to MCI and from MCI to dementia. The overall results imply that socioeconomic advantage might be protective against rapid progression from mild to more severe neurocognitive disorders such as dementia in later life.

Background: Evidence suggests social media use is associated with mental health in young people but underlying processes are not well understood. This paper i) assesses whether social media use is associated with adolescents' depressive symptoms, and ii) investigates multiple potential explanatory pathways via online harassment, sleep, self-esteem and body image. Methods: We used population based data from the UK Millennium Cohort Study on 10,904 14 year olds. Multivariate regression and path models were used to examine associations between social media use and depressive symptoms. Findings: The magnitude of association between social media use and depressive symptoms was larger for girls than for boys. Compared with 1–3 h of daily use: 3 to

BackgroundChildren who spent time in non-parental care report poor outcomes in many aspects of their later lives on average, but less is known about differences by type of care. We examined whether socioeconomic, family, and living arrangements of adults who had been in non-parental care across the first three decades of adult life varied by type of care (residential, non-relative and relative).MethodsWe used longitudinal data from the Office for National Statistics Longitudinal Study (LS). Participants were aged

Birth order may foster specific roles for individuals within the family and set in train a dynamic that influences the development of specific behaviors. In this paper, we explored the relationship between birth order, sex, timing of sexual initiation, and its consequences for risky sexual behavior and sexual health. We conducted a path analysis to simultaneously estimate direct and indirect effects using data from the National Survey of Sexual Attitudes and Lifestyles (NATSAL-3). Whereas women born as only-children were more likely to sexually debut at later ages, middle-child boys were significantly more prone to initiate sexual intercourse earlier compared with first-borns. As expected, early sexual initiation was associated with riskier behaviors and sexual health outcomes. These associations were partially moderated by siblings role as confidants about sexuality. Our findings have implications for preventive programs aimed at promoting healthy sexual debuts and behaviors over the life span.

Few have examined how employment is linked to trends in mental health among young adults across economic contexts in more recent years. To better understand the burden of non-employment and mental distress in this age group, this study examines the association of short-term (

Background Children who spend time in non-parental care report worse health later in life on average, but less is known about differences by type of care. We examined whether self-rated health of adults who had been in non-parental care up to 30 years later varied by type of care. Methods We used longitudinal data from the office for National Statistics Longitudinal Study. Participants were aged Results For combined census years, sample sizes were 157 896 dependent children with 10 years of follow-up, 166 844 with 20 years of follow-up and 173 801 with 30 years of follow-up. For all follow-up cohorts, longitudinal study members who had been in care in childhood, had higher odds of rating their health as ‘not good’ vs. ‘good’; with highest odds for residential care. For example, 10-year follow-up odds ratios were 3.5 (95% confidence interval: 2.2–5.6) for residential care, 2.1 (1.7–2.5) for relative households and 2.6 (2.1–3.3) for non-relative households, compared with parental households after adjustment for childhood demographics. Associations were weakest for 10-year, and strongest for 20-year, follow-up. Additional adjustment for childhood social circumstances reduced, but did not eliminate, associations. Conclusion Decades after children and young people are placed in care, they are still more likely to report worse health than children who grew up in a parental household.

BackgroundPreterm birth and maternal psychological distress are associated with an increased risk for social competence difficulties; however, little is known about how this risk changes over time and across gestational age. This study aimed to examine mean developmental trajectories of social competence difficulties from early childhood to mid- adolescence by gestational age groups: very preterm (VP, MethodsData were analysed on 15,821 participants from the UK Millennium Cohort Study participants, a nationally-representative birth cohort. Social competence difficulties were assessed by parent report when the participants were aged 3, 5, 7, 11 and 14 years. Maternal psychological distress was self-rated when the children were 9 months of age. Data were modelled using latent growth curve analysis.ResultsThe developmental trajectories of social competence difficulties were u-shaped in all groups showing a decline from age 3 to 7, followed by a stable low period and then an increase during adolescence. VP children (n=173) showed pronounced difficulties throughout (b=0.94, SE=0.36 at age 14). MLP children (n=1,130) and early-term children (n=3,232) showed greater difficulties compared with their full-term peers around age 7, which resolved by age 14 (b=0.20, SE=0.13; 0.03, 0.07, respectively). Maternal psychological distress during infancy mediated 20% of the above association for VP.ConclusionsThe effect of gestational age on developmental trajectories of social competence difficulties can be dose-response. Monitoring and providing support on social development throughout childhood and into their adolescence and treating early maternal psychological distress may benefit preterm children, particularly those born VP.

Background The adverse life-long consequences of being looked-after as a child are well recognised, but follow-up periods for mortality risk have mostly ended in young adulthood and mortality suggested to differ by age of placement, gender and cohort in small samples. Methods Data on 353,601 Office for National Statistics Longitudinal Study (LS) members during census years 1971–2001, and Cox proportional hazards regression models with time-varying covariates (age as the timescale), were used to examine whether childhood out-of-home care was associated with all-cause mortality until the end of 2013. After adjusting for baseline age and age2, gender, born outside the United Kingdom, number of census observations in childhood and baseline census year we tested whether mortality risk varied for those in care by age, gender and baseline census year, by separate assessment of interaction terms. Supplementary analyses assessed robustness of findings. Results Adults who had been in care at any census (maximum of two) had an adjusted all-cause mortality hazard ratio 1.62 (95% CI 1.43, 1.86) times higher than adults who had never been in care. The excess mortality was mainly attributable to deaths categorised as self-harm, accidents and mental & behavioural causes. Mortality risk was elevated if the LS member was initially assessed in 1981 or 2001, compared to 1971. There was no significant variation in mortality risk for those in care by age or gender. The main findings were consistent irrespective of choice of comparison group (whole population, disadvantaged population), care placement (residential, non-residential) and age at death (all ages, adulthood only). Conclusions In this large, nationally representative study of dependent children resident in England and Wales, those who had been in care during childhood had a higher risk of mortality long after they had left care on average, mainly from unnatural causes. No differences by age or gender were found. Children in care have not benefitted from the general decline in mortality risk over time.

Background: Autism can be diagnosed from two years of age, although most autistic people receive their diagnosis later than this, after they have started education. Research is required to understand: (1) why some autistic children are diagnosed late; and (2) the level and nature of unmet need prior to diagnosis for late-diagnosed children. To this end, we examined trajectories of emotional, behavioural and social difficulties (EBSDs) across childhood and adolescence, comparing ‘earlier-diagnosed’ (diagnosed 7 years or younger) with ‘late-diagnosed’ (diagnosed between 8 and 14 years) autistic children. Methods: Data were from the Millennium Cohort Study, a population-based UK birth cohort. EBSDs were measured using the parent-report Strengths and Difficulties Questionnaire, at 3, 5, 7, 11 and 14 years. We used Growth Curve Modelling to investigate levels and rates of change in these difficulties, and to compare earlier- (n=196) and late-diagnosed (n=286) autistic children. Outcomes: Aged 5, earlier-diagnosed autistic children had more emotional, hyperactivity and social difficulties; although clinical difficulties in these areas were nevertheless common in late-diagnosed children. There was a faster annual increase in scores for all domains for late-diagnosed children, and by age 14 years, they had higher levels of emotional, conduct and social difficulties. Interpretation: EBSDs are associated with, and may influence, timing of autism diagnosis. Late-diagnosed autistic children often have high levels of mental health and social difficulties prior to their autism diagnosis, and tend to develop even more severe problems as they enter adolescence. Funding: This work was supported by the Medical Research Council (MR/N022572/1), the Economic and Social Research Council (ES/N007921/1 & ES/R008930/1), the National Institute of Health Research, Autistica, and the Japan Foundation for Paediatric Research. Declaration of Interests: None reported. Ethics Approval Statement: Ethical approval was gained from NHS Multi-Centre Ethics Committees, and parents gave informed consent before interviews took place.

Objectives The incidence of oral cancer has been rapidly increasing in India, calling for evidence contributing to a deeper understanding of its determinants. Although disadvantageous life‐course socioeconomic position (SEP) is independently associated with the risk of these cancers, the explanatory mechanisms remain unclear. Possible pathways may be better understood by testing which life‐course model most influences oral cancer risk. We estimated the association between life‐course SEP and oral cancer risk under three life‐course models: critical period, accumulation and social mobility. Methods We recruited incident oral cancer cases (N = 350) and controls (N = 371) frequency‐matched by age and sex from two main referral hospitals in Kozhikode, Kerala, India, between 2008 and 2012. We collected information on childhood (0‐16 years), early adulthood (17‐30 years) and late adulthood (above 30 years) SEP and behavioural factors along the life span using interviews and a life‐grid technique. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for the association between life‐course SEP and oral cancer risk using inverse probability weighted marginal structural models. Results Relative to an advantageous SEP in childhood and early adulthood, a disadvantageous SEP was associated with oral cancer risk [(OR = 2.76, 95% CI: 1.99, 3.81) and (OR = 1.84, 95% CI: 1.21, 2.79), respectively]. In addition, participants who were in a disadvantageous (vs advantageous) SEP during all three periods of life had an increased oral cancer risk (OR = 4.86, 95% CI: 2.61, 9.06). The childhood to early adulthood social mobility model and overall life‐course trajectories indicated strong influence of exposure to disadvantageous SEP in childhood on the risk for oral cancer. Conclusions Using novel approaches to existing methods, our study provides empirical evidence that disadvantageous childhood SEP is critical for oral cancer risk in this population from Kerala, India.

Introduction Transitions into work and family life during young adulthood exacerbate differences in the progression of smoking over the life-course. Few have considered how changes in smoking and the transition to adulthood in the past two decades have influenced these relationships over time. Methods We compared the distribution of smoking at ages 25–26 across transition milestones among 3764 men and 4568 women in the 1970 British Cohort study (1996) and 3426 men and 4281 women in the Next Steps study (2015–16). We regressed occasional and daily smoking status on educational attainment, economic activity, living arrangements, relationship status, and parenthood, adjusting for family background, socio-demographics, and smoking history. Results There were few differences in associations between the 1996 and 2015-16 samples. Young men and women were less likely to smoke if they had higher education, were homeowners, and cohabited with a partner. Women were less likely to smoke occasionally if they were full-time students, and men were less likely to smoke daily if they were employed full-time and not living with children. However, comparing associations in 2015–16 to 1996: 1) in men, higher education had a weaker negative association and living with a partner had a stronger negative association with daily smoking; 2) in women, independently renting had a weaker positive association with daily smoking. Conclusions Despite considerable changes in smoking and the transition to adulthood over the past two decades, the distribution of smoking at ages 25–26 across transition milestones has been relatively stable during this time period in Great Britain., Highlights • Smoking at ages 25–26 was associated with economic activity, living arrangements, relationship status, and parenthood in 1996 and 2015–16. • Differences in smoking across transition milestones differed by gender. • Differences in smoking did not substantially change between 1996 and 2015–16.

This study uses multi-channel sequence analysis to characterize work-family life course types between the ages of 16 and 42, and multivariable logistic regression to examine their association with psychological distress at age 42/43 for men and women in three nationally-representative British birth cohorts born in 1946 (N = 2,858), 1958 (N = 9,140), and 1970 (N = 7,095). We hypothesised that work-family life courses characterized by weaker links to employment and earlier transitions to partnerships and parenthood would be associated with a greater probability of psychological distress at age 42, and that this association would be become more pronounced across cohorts. Levels of psychological distress were higher amongst men and women with weaker long-term ties to employment, although these were largely explained by early life factors. Teen mothers had higher levels of psychological distress in the two later-born cohorts, and this remained unexplained in adjusted models for the 1970 cohort.

Social exclusion is a dynamic multi-dimensional process that is interactive in nature. The complex interplay between domains, whereby each domain can act as a determinant, indicator and/or outcome of social exclusion, hinders understanding of the process and the mechanisms through which social exclusion exists. This article highlights the need to disentangle these pathways and move beyond descriptive accounts of social exclusion, presenting a new working framework that allows direct hypothesis testing of these between-domain relationships. Whilst this working framework can be applied to any population, this article focuses on older adults. Life events that can drive social exclusion such as bereavement and changes in health are more likely to occur in later life, and occur more frequently, increasing the risk of social exclusion for this population. Rooted in the new working framework, this article presents the construction of later life social exclusion measures for use with Understanding Society – the United Kingdom Household Longitudinal Study. The validity of these measures are considered by examining the characteristics of those aged 65 years and over who score the highest, and therefore experience the greatest level of exclusion. This new working framework and developed social exclusion measures provide a platform from which to explore the complex relationships between domains of social exclusion and ultimately provide a clearer understanding of this intricate multi-dimensional process.

Purpose Previous research on time trends of young people’s mental health in Britain has produced conflicting findings: evidence for deterioration in mental health during the late 20th century followed by stability and slight improvement during the early 21st century is contrasted with evidence showing continued deterioration. The present study adds to the evidence base by assessing time trends in means, variances, and both low and high psychological distress scores covering a similar period. Methods GHQ-12 (Likert scale) was regressed on time (adjusting for age) using a sample of young people aged 16–24 between 1991 and 2008 from the British Household Panel Study. Change in variance was assessed using Levene’s homogeneity of variance test across 9-year intervals. Polarisation was assessed by a comparison of the prevalence of scores ≥1 standard deviation and ≥1.5 standard deviations above and below the pooled mean. Results There was a small but significant increase in mean GHQ-12 among young women (b 0.048; 95% CI 0.016, 0.080) only. Variance increased significantly (p

Background To assess relationships between age at first birth and cardiovascular risk factors in a large longitudinal study of men and women. By assessing associations for both genders, we were able to investigate biological versus social and behavioural explanations from early life through to adulthood. Methods Multiply-imputed data on more than 7600 men and women of a British birth cohort study (National Child Development Study, 1958 British birth cohort) were used. Cardiovascular risk factors at age 44/45 years included body mass index, waist:hip ratio, blood pressure (systolic and diastolic), cholesterol (total, low and high-density lipoprotein), triglycerides, glycated haemoglobin, C reactive protein, von Willebrand factor and fibrinogen. Age at first birth was categorised as 34 years. Results Being younger than 20 years of age at time of first birth was associated with an adverse cardiovascular profile by mid-life. Conversely, older parents had a lower cardiovascular risk as captured by lower body mass index, waist:hip ratio, blood pressure, high and low-density lipoprotein cholesterol, triglycerides, glycated haemoglobin, C reactive protein and fibrinogen. The relationship between age at first birth and cardiovascular risk factors was graded. Few differences between men and women were observed. Associations were largely unchanged after adjustment for early life factors but were partially mediated through adult social and behavioural factors. Conclusions Age at first birth is inversely associated with differences in cardiovascular risk factors in mid-life in a large prospective birth cohort. Our results potentially suggest a social and behavioural rather than a biological explanation.

Correspondence: Afshin Zilanawala, Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT. Tel: +44 (0)20 7679 5615, e-mail: afshin.zilanawala{at}ucl.ac.uk. Background: Development of verbal skills during early childhood and school age years is consequential for children’s educational achievement and adult outcomes. We examine ethnic differences in longitudinal latent verbal profiles and assess the contribution of family process and family resource factors to observed differences. Methods: Using data from the UK Millennium Cohort Study and the latent profile analysis, we estimate longitudinal latent verbal profiles using verbal skills measured 4 times from age 3–11 years. We investigate the odds of verbal profiles by ethnicity (reported in infancy), and the extent observed differences are mediated by the home learning environment, family routines, and psychosocial environment (measured at age 3). Results: Indian children were twice as likely (OR = 2.14, CI: 1.37–3.33) to be in the high achieving profile, compared to White children. Socioeconomic markers attenuated this advantage to nonsignificance. Pakistani and Bangladeshi children were significantly more likely to be in the low performing group (OR = 2.23, CI: 1.61–3.11; OR = 3.37, CI: 2.20–5.17, respectively). Socioeconomic and psychosocial factors had the strongest mediating influence on the association between lower achieving profiles and Pakistani children, whereas for Bangladeshi children, there was mediation by the home learning environment, family routines, and psychosocial factors. Conclusion: Family process and resource factors explain ethnic differences in longitudinal latent verbal profiles. Family resources explain verbal advantages for Indian children, whereas a range of home environment and socioeconomic factors explain disparities for Pakistani and Bangladeshi children. Future policy initiatives focused on reducing ethnic disparities in children’s development should consider supporting and enhancing family resources and processes.

Background Education is a strong predictor of voting in most Western countries. New studies, predominantly from the United States, question the role of health as a mechanism reinforcing social inequalities in voting over the life-course. In the United Kingdom, we previously found that heavy smoking, physical inactivity, poor self-reported health, and, to a lesser extent, drinking over the recommended limit were each associated with a lower probability of voting in the 1958 National Child Development Study (NCDS). Building on these findings, this study examines the proportion of the association between educational attainment and voting that is mediated through these health indicators. Methods We used the data of 6,166 NCDS participants who responded to each sweep between the ages of 23 and 50. We examined educational attainment at the age of 23, smoking, drinking, physical activity, self-reported health at the ages of 23, 32, and 42, and voting behaviour at the age of 42, 46, and 50. Adjusting for non-response and attrition using inverse-probability weights and missingness using multiple imputation, we compared prevalence ratios to examine: 1) the direct effect of having a higher level of education on voting when accounting for these health indicators, and 2) the proportion of its total effect that is eliminated by this adjustment. Results Contrasting extreme groups, we found that participants with a degree (NVQ5/6) at the age of 23 were 25%, 28%, and 32% more likely to have voted in the last general election compared to those with no qualifications at the ages of 42, 46, and 50. Adjusting for health indicators at the ages of 23, 32, and 42, participants with a degree remained 19%, 24%, and 27% more likely to have voted at the ages of 42, 46, and 50, respectively. This translates into an average proportion eliminated of 22%, 18%, and 16% across these age points. Testing mediators separately, we found that smoking, physical activity, and self-reported health were each likely to contribute to the ‘education-voting’ association. Discussion In keeping with health promotion principles, health represents beyond the absence of disease a resource for individuals, their social network, and their communities. Our findings suggest that health and its behavioral determinants are likely to explain a portion of social inequalities in voting over the life-course. Research and intervention should address the specific health-related mechanisms through which current electoral processes may unequally influence voter turnout across social groups.

A large body of literature has shown marked differences in the average levels of resources and child well-being across different family structures. Studies have examined cognitive, educational and behavioural outcomes; less is known about differentials in physical health, and about dynamics in early childhood. Furthermore, up to the present time, less emphasis has been placed on describing the underlying mechanisms relating childhood experiences of family structure to health. In this paper, we hypothesize that socio-economic characteristics and family structure trajectories will affect every-day, more proximal processes (material, behavioural and family stress pathways) directly experienced by the child, which will in turn affect child health. Using the UK Millennium Cohort Study, a nationally representative cohort of over 19 000 children born in 2001 and living in the UK shortly thereafter, we employ Graphical Chain Models to map the processes linking family structure trajectories to three physical health outcomes at age 5: overweight/obesity, respiratory health, and accidental injury. We construct family trajectories to highlight two components: status (distinguishing between married, cohabiting and single parents), and (in)stability. We show that both status, the (in)stability of that status, and their interplay, are important components of family structure trajectories which correlate to children's early physical health. Analyses highlight the relative importance of distinct pathways across different health outcomes. As well as some outcome-specific paths, we find that “family stress” variables appeared to underscore the relationship between family structure and child physical health, pointing to the importance of such variables in understanding how family structure relates to early child health.

BACKGROUND/OBJECTIVES: We estimated the risk of infection associated with the duration of exclusive breastfeeding (EBF). SUBJECT/METHODS: We analysed the data on 15 809 term, singleton infants from the UK Millennium Cohort Study. Infants were grouped according to months of EBF: never

This study investigated longitudinal relationships between fathers’ involvement, as measured by reading, and child socioemotional behavior between infancy and age 7 in 9,238 intact two-parent families from the U.K. Millennium Cohort Study, a national cohort of British children born between 2000 and 2002. Once a variety of covariates and the potential bidirectional nature of relationships were taken into account, a path model showed that fathers’ involvement with their children in infancy significantly predicted better socioemotional behavior at age 3, although the relationship was not strong. Fathers’ reading with their children between ages 3 and 7 was not significantly associated with child socioemotional behavior, but mothers’ reading with their children at age 3 was significantly associated with improved child socioemotional behavior at ages 3 and 5. Results also suggested that parenting in the 21st-century British context remains fairly gendered. Both mothers and fathers were more likely to engage in physical activities with their sons and artistic activities with their daughters. Fathers’ reading was socially patterned in predicted directions.

Background Although the effects of individual-level factors on wellbeing change following work exit have been identified, the role of welfare-state variables at the country level has yet to be investigated. Methods Data on 8037 respondents aged 50 years and over in 16 European countries were drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA). We employed multilevel models to assess determinants of change in wellbeing following work exit, using CASP-12 change scores. After adjusting for institutionally defined route and timing of work exit, in addition to other individual-level variables, we tested country-level variables including welfare-state regime and measures of disaggregated welfare spending to determine their associations with wellbeing change and the proportion of between-country variance explained. Results Individuals whose exit from paid work was involuntary or diverged from the typical retirement age experienced declines in wellbeing. Country effects accounted for 7% of overall variance in wellbeing change. Individuals residing in countries with a Mediterranean welfare regime experienced more negative changes in wellbeing, with a difference of –2.15 (–3.23, –1.06) CASP-12 points compared with those in Bismarckian welfare states. Welfare regime explained 62% of between-country variance. National per-capita expenditure on non-healthcare in-kind benefits (services) was associated with more positive wellbeing outcomes. Conclusions National expenditure on in-kind benefits, particularly non-healthcare services, is associated with more favourable wellbeing change outcomes following work exit in early old age. Welfare-state effects explain the majority of between-country differences in change in wellbeing.

Background The adverse life-long consequences of being looked after as a child are well recognised. However, systematic evidence on outcomes for looked-after children beyond the early adult years is currently very limited. Methods Data were used from »1 20 000 dependent children (aged Results In this nationally-representative sample of children in England and Wales, approximately 1.4% of dependent children were looked after in non-parental households, 3664 children in relative households, 2351 in unrelated households and 1007 in residential care. From 1971 to 2001, there was a general trend of an increasing percentage of dependent children residing in relative households (0.4% to 1.2%) and decreasing percentage in residential care (0.3% to 0.1%)(p-values Additional analysis to be presented will make step-wise adjustments for childhood demographics and social circumstances. Conclusion Decades after children and youths are placed in out-of-home care; they are still likely to report worse health than children who grew up in a parental household. Future work from this project will investigate how much of these associations are due to socio-demographic selection into different care experiences, compared to effects of being in care.

Background Adolescents are among the highest consumers of social media while research has shown that their well-being decreases with age. The temporal relationship between social media interaction and well-being is not well established. The aim of this study was to examine whether the changes in social media interaction and two well-being measures are related across ages using parallel growth models. Methods Data come from five waves of the youth questionnaire, 10-15 years, of the Understanding Society, the UK Household Longitudinal Study (pooled n = 9859). Social media interaction was assessed through daily frequency of chatting on social websites. Well-being was measured by happiness with six domains of life and the Strengths and Difficulties Questionnaire. Results Findings suggest gender differences in the relationship between interacting on social media and well-being. There were significant correlations between interacting on social media and well-being intercepts and between social media interaction and well-being slopes among females. Additionally higher social media interaction at age 10 was associated with declines in well-being thereafter for females, but not for males. Results were similar for both measures of well-being. Conclusions High levels of social media interaction in early adolescence have implications for well-being in later adolescence, particularly for females. The lack of an association among males suggests other factors might be associated with their reduction in well-being with age. These findings contribute to the debate on causality and may inform future policy and interventions.

Internalising and externalising behaviours may have heterogeneous patterns across childhood. Different aspects of young children's proximal family environments may influence these behavioural profiles. Previous studies have used indicators of family instability at one point in time or collapsed several indicators into an index. We assess whether patterns in internalising and externalising behaviours across childhood are in part determined by changes and events in multiple domains of the family environment across early childhood. Using Millennium Cohort Study data and Latent Profile Analysis, we created longitudinal latent profiles for internalising and externalising behaviour using child behaviour scores at ages 3, 5, 7, and 11. Time-varying markers of children's environments from ages 3-11 years included: poverty, family structure, number of siblings, residential moves, maternal depression, and hospital admissions. We derived five internalising profiles and two externalising profiles. Transitions into and out of poverty (ORs range: 1.9-3.3), changes in maternal depression (ORs range: 2.3-7.8), and persistent experiences of poverty and maternal depression had the strongest and most consistent associations with children's behaviours at all ages; early childhood experiences of maternal depression and poverty had independent longitudinal associations with children's behaviours; and residential moves were only related to externalising behaviours. This study emphasises the importance of investigating interrelated features of a child's proximal family environment alongside examining patterns in children's behaviour across childhood. To best support children and their families, policy solutions should focus on alleviating family poverty and depression and consider the holistic nature of a child's family environment.