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Background Parental smoking strongly influences adolescent smoking, yet few studies have examined factors that may protect against this. We investigated whether skills-based components of positive mental health (‘mental health competence’, MHC) modified the association between parental and teenager smoking, in the UK-representative Millennium Cohort Study (approximately 18 000 children, born 2000–02; analytic sample: n = 10 133). Methods Cohort members (CMs) reported at 14 years (y) whether they had ever smoked cigarettes. A dichotomized variable indicated whether one/both parents smoked when CMs were 11 y. A four-class latent MHC measure captured learning skills and prosocial behaviours at 11 y: High, High–Moderate, Moderate, Low. We examined effect measure modification (on the additive scale) by comparing risk differences (RDs) for CM smoking according to parental smoking, within each MHC class. We then estimated RDs for CM smoking according to combinations of parental smoking and MHC. Analyses accounted for confounding, sample design, attrition and item missingness. Results CMs were more likely to smoke cigarettes if their parent(s) smoked (27%) than CMs with no parent(s) who smoked (11%; RD: 16%). When stratified by MHC, RDs were stronger for low MHC (21%; 95% CI 11–31%) than other MHC classes (ranging: 7–11%). Compared to CMs with high MHC and non-smoker parents, those with low MHC and parent(s) who smoked had an RD of 28% (95% CI 20–36%). This was greater than the sum of RDs for those with low MHC and non-smoker parent(s) [7% (2–14%)] plus those with high MHC and whose parent(s) smoked [11% (7–15%)]. There was limited effect measure modification by moderate or High–Moderate MHC. Conclusion Improving MHC to moderate levels may help reduce intergenerational transference of smoking.

Despite decades of significant effort in research, policy, and prevention, suicide rates have continued to rise to the current peak of 14.6 per 100,000 deaths. This has resulted in a concerted effort to identify biomarkers associated with suicidal behavior in the brain, to provide predictions that are better than the chance of discerning who will die by suicide. We propose that the lateral habenula (LHb), and its dysfunction during a suicidal crisis, is a critical component of the transition from suicidal ideations to self-harm. Moreover, the LHb—a key functional node in brain reward circuitry—has not been ascribed a contributory role in suicidal behavior. We argue that the LHb anchors a “suicide circuit” and call for suicide researchers to directly examine the role of the LHb, and its long-term modulation, in response to the negative affect in suicidal behavior. Discerning the neural mechanisms of this contribution will require the collaboration of neuroscientists and psychologists. Consequently, we highlight and discuss research on LHb as it relates to suicidal ideation, suicidal behavior, or death by suicide. In so doing we hope to address the bench-to-bedside translational issues currently involved in suicide research and suggest a developmental framework that focuses on specific structures motivated by theoretical anchors as a way to incorporate neurobiological findings within the context of clinical theory.

Parenting programmes can improve parenting quality and, in turn, children's mental health. If scaled-up, they have the potential to reduce population inequalities and prevalence in child mental health problems (MHP). However, this cannot be investigated with trials. Using data from the UK Millennium Cohort Study (18,000 children born 2000–2002), we simulated population impact of scale-up of seven parenting programmes. Predicted probabilities of child MHP (Strengths and Difficulties Questionnaire) by household income quintile (Risk ratios [RRs] and differences [RDs], 95% confidence intervals [CI]) were estimated from logistic marginal structural models, adjusting for parenting quality scores (Child-Parent Relationship Scale at 3 years) and confounders. The impact of scaling-up parenting programmes was simulated by re-estimating predicted probabilities of child MHP after increasing parenting scores according to intervention intensity, targeting mechanisms and programme uptake levels. Analyses included data from 14,399 children, with survey weights and multiple imputation addressing sampling design, attrition and item missingness. Prevalence of child MHP at 5 years was 11.3% (11.4% unadjusted), with relative and absolute income inequalities (RR = 4.8[95%CI:3.6–5.9]; RD = 15.8%[13.4–18.2]). In simulations, universal, non-intensive parenting programmes reduced prevalence (9.4%) and absolute inequalities (RR = 5.0[95%CI:3.8–6.2]; RD = 13.6%[11.5–15.7]). Intensive programmes, targeting a range of potential risk criteria (e.g. receipt of means-tested benefits), reduced inequalities (RR = 4.0[95%CI:3.0–4.9]; RD = 12.4%[10.3–14.6] and, to a lesser extent, prevalence (10.3%). By simulating implementation of parenting programmes, we show that universal non-intensive and targeted intensive approaches have the potential to reduce child MHP at population level, and to reduce but not eliminate inequalities, with important implications for future policy and practice., Highlights • We simulated the potential impact on child MHP prevalence and inequalities of scaling up parenting skills interventions. • Results suggest that universal parenting programmes might reduce child MHP prevalence. • Additional targeted, intensive interventions would be necessary to reduce inequalities.

Purpose:\ud Promoting positive mental health, particularly through enhancing competencies (such as prosocial behaviors and learning skills), may help prevent the development of health risk behaviors in adolescence and thus support future well-being. Few studies have examined how mental health competencies in childhood are associated with adolescent health risk behaviors, which could inform preventative approaches.\ud \ud Methods:\ud Using UK Millennium Cohort Study data (n = 10,142), we examined how mental health competence (MHC) measured at the end of elementary school (11 years) is associated with self-reported use of cigarettes, e-cigarettes, alcohol, illegal drugs, antisocial behavior, and sexual contact with another young person at age 14 years. A latent measure of MHC was used, capturing aspects of prosocial behavior and learning skills, categorized as high MHC, high–moderate MHC, moderate MHC, and low MHC. Logistic and multinomial regression estimated odds ratios and relative risk ratios for binary and categorical outcomes, respectively, before and after adjusting for confounders. Weights accounted for sample design and attrition and multiple imputation for item missingness.\ud \ud Results:\ud Those with low, moderate, or high-moderate MHC at age 11 years were more likely to have taken part in health risk behaviors at age 14 years compared with those with high MHC. The largest associations were seen for low MHC with binge drinking (relative risk ratio: 1.6 [95% confidence interval: 1.1–2.4]), having tried cigarettes (odds ratio: 2.2 [95% confidence interval: 1.6-3.1]) and tried illegal drugs (odds ratio: 2.0 [95% confidence interval: 1.3-3.1) after adjusting for confounders (which attenuated results but largely maintained significant findings).\ud \ud Conclusions:\ud MHC in late childhood is associated with health risk behaviors in midadolescence. Interventions that increase children's MHC may support healthy development during adolescence, with the potential to improve health and well-being through to adulthood.

BackgroundBoth adverse childhood experiences (ACEs) and adverse childhood socioeconomic conditions (SECs) in early life are associated with poor outcomes across the life course. However, the complex interrelationships between childhood SECs and ACEs are unclear, as are the consequences for health outcomes beyond childhood. We therefore assessed the extent to which early-life ACEs mediate the relationship between SECs and socioemotional behavioural problems, cognitive disability and overweight/obesity in adolescence.MethodsWe used longitudinal data from the UK Millennium Cohort Study (MSC). Outcomes assessed at age 14 were socioemotional behavioural problems, cognitive disability and overweight/obesity. SECs at birth were measured by maternal education. Potentially mediating ACEs measured up to 5 years were verbal and physical maltreatment, parental drug use, domestic violence, parental divorce, maternal mental illness and high frequency of parental alcohol use. We used counterfactual mediation analysis to assess the extent to which ACEs mediate the association between SECs at birth and behavioural, cognitive and physical outcomes at age 14, estimating total (TE), natural direct and indirect effects, and mediated proportions.ResultsChildren with disadvantaged SECs were more likely to have socioemotional behavioural problems (relative risk (RR) 3.85, 95% CI 2.48 to 5.97), cognitive disability (RR 3.87, 95% CI 2.33 to 6.43) and overweight/obesity (RR 1.61, 95% CI 1.32 to 1.95), compared to those with more advantaged SECs. Overall, 18% of the TE of SECs on socioemotional behavioural problems was mediated through all ACEs investigated. For cognitive disability and overweight/obese, the proportions mediated were 13% and 19%, respectively.ConclusionACEs measured up to age 5 years in the MCS explained about one-sixth of inequalities in adolescents behavioural, cognitive and physical outcomes.

Background: \ud \ud The World Health organization (WHO) recommends that children engage in 60 min daily moderate-to-vigorous physical activity (dMVPA). Just half of children in the UK achieve these levels (with similarly low levels in other high-income countries). Thus, the dMVPA target is a focus of national obesity strategies. However, the potential impact of increased physical activity on prevalence and inequalities in childhood overweight is unknown. Using objective data from the Millennium Cohort Study (∼18 000 children born 2000–02) we simulated a series of hypothetical physical activity intervention scenarios: achievement of the target, and more realistic increases demonstrated in trials.\ud \ud Methods: \ud \ud Predicted probabilities of overweight and obesity (using measured heights and weights at age 11) were estimated in multinomial marginal structural models, adjusting for dMVPA (measured with accelerometers at age 7) and confounding. Inequalities were assessed according to household income quintiles [risk ratios (RRs) and risk differences (RDs)]. Intervention scenarios were simulated by re-estimating predicted probabilities of overweight/obesity after manipulating (increasing) dMVPA by varying amounts, for different eligibility criteria and with varying uptake. Analyses included 6493 children with accelerometer data. Survey weights and multiple imputation addressed sampling design, attrition and item missingness.\ud \ud Results: \ud \ud In all, 27% children were overweight/obese, with relative and absolute inequalities in the expected direction; 51% children were achieving 60 min dMVPA, with those from the lowest income quintile achieving, on average, 3 min more dMVPA than those from the highest income quintile. A simulation of universal achievement of the dMVPA target reduced the prevalence of overweight/obesity to 22%, but increased relative inequalities (absolute inequalities were unchanged). Smaller increases in dMVPA (informed by intervention evidence) did little to reduce prevalence or inequalities, even when targeting high-risk groups.\ud \ud Conclusions: \ud \ud Universal achievement of the WHO dMVPA target, if attainable, would reduce prevalence of childhood overweight and obesity but not inequalities. Scale-up of more realistic interventions would have limited impact.

ObjectiveWe assessed whether maternal mental health problems increased rates for child injury during the preschool years and mid-childhood, and the extent to which associations could be accounted for by a range of potential explanatory factors.DesignWe analysed the UK Millennium Cohort Study, a nationally representative sample with data collected throughout childhood. Multinomial regression was used to investigate whether two measures of maternal mental health (diagnosed depression/anxiety and psychological distress) were associated with subsequent childhood injury. Models adjusted for sociodemographics, parenting and child externalising behaviours.Main outcome measureMaternal report of unintentional injuries (none, 1, 2+) recorded at three data collection periods (3–5 years; 5–7 years; 7–11 years).ResultsThe analytic sample comprised n=9240 families who participated 3–11 years with complete data on exposures and outcomes (multiply imputing missing covariates). Exposure to maternal mental health problems was associated with increased rates of subsequent childhood injuries. Associations attenuated after adjustment for potential explanatory factors, although they remained elevated. For example, high maternal distress was associated with injuries 3–5 years (adjusted relative risk ratio (aRRR): 1 injury=1.18, 95% CI 0.86 to 1.61; 2+ injuries=2.22, 95% CI 1.22 to 4.02); injuries 5–7 years (aRRR: 1 injury=1.31, 95% CI 0.97 to 1.76; 2+ injuries=1.84, 95% CI 1.09 to 3.09); and injuries 7–11 years (aRRR: 1 injury=1.03, 95% CI 0.81 to 1.31; 2+ injuries=1.33, 95% CI 0.97 to 1.81).ConclusionsChildren exposed to mothers with mental health problems had higher rates of childhood injury than those not exposed. If further investigation of this association suggests causality then it will be important to test measures that address mothers’ mental health issues with a view to reducing injuries among their children.

BackgroundPsychological distress is common among women of childbearing age, and limited longitudinal research suggests prolonged exposure to maternal distress is linked to child mental health problems. Estimating effects of maternal distress over time is difficult due to potential influences of child mental health problems on maternal distress and time-varying confounding by family circumstances.MethodsWe analysed the UK Millennium Cohort Study, a nationally representative sample with data collected throughout childhood. Adopting a marginal structural modelling framework, we investigated effects of exposure to medium/high levels of maternal psychological distress (Kessler-6 score 8+) on child mental health problems (Strengths and Difficulties Questionnaire borderline/abnormal behaviour cut-off) using maternal and child mental health data at 3, 5, 7 and 11 years, accounting for the influence of child mental health on subsequent maternal distress, and baseline and time-varying confounding.ResultsPrior and concurrent exposures to maternal distress were associated with higher levels of child mental health problems at ages 3, 5, 7 and 11 years. For example, elevated risks of child mental health problems at 11 years were associated with exposure to maternal distress from 3 years [risk ratio (RR) 1.27 (95% confidence interval (CI) 1.08–1.49)] to 11 years [RR 2.15 (95% CI 1.89–2.45)]. Prolonged exposure to maternal distress at ages 3, 5, 7 and 11 resulted in an almost fivefold increased risk of child mental health problems.ConclusionsPrior, concurrent and, particularly, prolonged exposure to maternal distress raises risks for child mental health problems. Greater support for mothers experiencing distress is likely to benefit the mental health of their children.

Purpose The authors provide a structured review of reported cases of floor-of-mouth hematoma during or after dental implantation and frequent causes and management and present a related case. Materials and Methods An online search of the medical literature was conducted from 1990 through 2016. The following search terms were used: floor of mouth hematoma, sublingual hematoma, dental implant hematoma, implant in mandible, and complication of dental implant. Abstracts were screened for relevance to the aims of the review. Relevant reports in the English language were included and referenced. The articles were reviewed for patient demographics, implant location, coagulopathy, pre- or postoperative imaging, airway management, treatment of the hematoma, and management of the offending implant. Results The literature search identified 25 reported cases. Hemorrhage was caused by perforation of the lingual cortex in 84% of cases (n = 21). Airway obstruction resulted in emergency intubation or tracheostomy in 68% of patients (n = 17). Most cases (n = 18; 72%) required surgical management in the hospital setting. Management of the offending implant was reported inconsistently. Of 17 reported cases, 5 implants had to be removed, 9 remained in situ, and in 3 cases implant placement was abandoned. Only 1 case involved preoperative 3-dimensional (3D) imaging before implant insertion. The authors report on an additional case with a serious floor-of-mouth hematoma that required immediate surgical evacuation and hemostasis. Conclusion Serious complications, such as floor-of-mouth hematoma after dental implant insertion, can occur, which could be life-threatening. Preoperative 3D imaging helps to visualize the individual mandibular shape, which could decrease the incidence of serious complications. If injury to vessels of the floor of the mouth cannot be confidently excluded, then further assessment and treatment are recommended before the patient is discharged.

Supplemental Digital Content is available in the text., Background: One in four children 5–16 years (y) of age shows signs of mental health problems in the United Kingdom; risk is higher in economically disadvantaged groups. Greater physical activity is associated with lower risk of internalizing problems such as depression and anxiety. We simulated the potential impact of population-wide physical activity interventions on overall prevalence of internalizing problems, and by family income. Interventions were based on the World Health Organization (WHO) children’s target of 60 minutes (min) of moderate-to-vigorous physical activity per day and trial evidence. Methods: Data were from the UK Millennium Cohort Study, a population-representative cohort of children born in 2000–2002. Household income (5 y) was the exposure; internalizing problems (outcome) were measured using the Strengths and Difficulties Questionnaire (11 y). Of 18,296 singletons, 6,497 had accelerometer physical activity data (mediator, manipulated to simulate interventions) at 7 y. We predicted probabilities of outcome according to exposure in marginal structural models, weighted for attrition and confounding, and adjusted for observed mediator. We then re-estimated probabilities in different physical activity intervention scenarios, assessing income inequalities in internalizing problems with risk ratios (RRs) and differences (RDs) according to income quintile. Results: Simulating universal achievement of the WHO target led to little change in prevalence (10% [95% CI = 8%, 12%]) and socioeconomic inequalities in internalizing problems; RR: 2.2 (1.1, 3.4); RD: 8% [5%,13%]). More modest increases in physical activity achieved weaker results. Conclusions: Our simulations suggest that large increases in moderate-to-vigorous physical activity in the United Kingdom would have little effect on prevalence and inequalities in child mental health problems.

The objective of this study was to understand how pain patients and health care providers (HCPs) are engaging on Twitter and what insights this engagement might provide. By identifying how information is spread by and between these audiences, organizations such as patient advocacy groups may be better poised to develop and share materials that facilitate online communication between HCPs and pain patients, with an end goal of improving a shared decision-making process around pain management. We analyzed the Twitter audiences most engaged on pain topics by conducting a Social Network Analysis (SNA) of a large network of connected users on Twitter. The analysis segmented users based on the sources they cited and measured their influence based on who follows them. As a point of comparison, we also conducted an SNA of Twitter audiences most engaged on oncology topics. Oncology was chosen as a comparison due to what was perceived to be a highly developed online network of both patients and physicians. The populations included in this research included 12,086 accounts that were highly engaged on pain-related topics, and 12,617 accounts that were highly engaged on oncology-related topics. Network statistics were generated for variables including: word use, sources cited, retweets, and mentions. We also statistically analyzed the Twitter follow relationships among select HCPs and patient groups within each SNA. The creation of separate pain and oncology SNAs allowed the team to compare relationships and engagement related to these topics. We found that on Twitter, pain patients and providers appear to interact less than oncology patients and providers. Pain patients do not appear to follow medical professionals or share medical or health-related information on Twitter to the same extent as oncology patients. In addition, we found that pain patients do not communicate on Twitter in the same language as HCPs. Our results are important because they underscore that challenges in communication are not just problematic in face-to-face interactions, but also in digital social network (Twitter) interactions, serving as an additional roadblock to what can be shared decision-making opportunities around pain management. Contributing to this roadblock is access to quality information and a potential need for an online, evidence-based resource hub that could benefit the pain patient community in the same way that cancer.gov serves as a source of aggregated materials for oncology patients and HCPs. This study is an illustration of how social media networks like Twitter can be used to better understand the relationships, language gaps, and shared resources between pain patients and providers and offers a template for using digital social network (Twitter) interactions to research other difficult-to-treat or rare disease states.

Background/objectives Maternal psychological distress is associated with a range of adverse child outcomes. We sought to determine whether children’s exposure to medium or severe distress at 5 years was associated with increased risks of overweight and obesity when they were aged 11 years. We also investigated whether any association was attenuated after accounting for potential confounding and mediating factors. Subjects/methods We analysed data from the UK Millennium Cohort Study, a nationally representative sample with data collected throughout childhood, imputing missing covariates (analytic sample: n = 9206). Multinomial regression was used to examine whether maternal psychological distress (Kessler-6 scale, using medium and severe score thresholds) at 5 years of age predicted children’s objectively measured overweight and obesity at 11 years, adjusting for sex and ethnicity. We then carried out a series of models incorporating potential confounders (early life and socio-demographic, recorded at 9 months) and mediators (physical activity and dietary factors, at 7 years) in turn, and then simultaneously. Results A third of mothers reported distress when their child was aged 5 years (29% medium; 4% severe distress), and over a quarter of children were overweight at 11 years (22% overweight; 6% obese). Risks of obesity at 11 years increased with severity of maternal distress at 5 years (medium distress: relative risk ratio (RRR) = 1.43, 95% confidence interval [CI] 1.17–1.75; severe RRR = 2.27, CI 1.42–3.63). Adjusting for each set of explanatory factors in turn (particularly early years and socio-demographic confounding factors) reduced but did not eliminate these elevated risks. However, risks were attenuated in the fully adjusted model (medium: RRR = 1.14, CI 0.92–1.41; severe: RRR = 1.26, CI 0.75–2.11). Conclusions We demonstrated that maternal psychological distress, particularly if severe, at 5 years was associated with risk of obesity (but not overweight) at 11 years. Accounting for potential explanatory factors attenuated this association to non-significance, suggesting a range of mechanisms may be implicated. Future research should seek to disentangle the potentially complex pathways linking explanatory factors, maternal distress and child obesity.

Background Most smokers initiate before the age of eighteen, and smoking in adolescence is strongly influenced by parental smoking habits. Despite this, few studies have examined factors which may protect teenagers against the risk of having a smoking parent. We investigated whether skills-based components of positive mental health in childhood (Mental Health Competence, MHC) modified the association between parent and teenager smoking, using contemporary data from the UK-representative Millennium Cohort Study (∼18 000 children, born 2000–2002; analytic sample: n=10,133). Methods Cohort members (CMs) reported whether they had ever smoked cigarettes or e-cigarettes at 14 years(y). A dichotomised variable indicated whether one or both parents reported their own tobacco use when CMs were 11 y. A four-class latent measure of MHC captured learning skills and prosocial behaviours at 11 y: High, High-Moderate, Moderate, Low. We examined effect modification in two ways. First, we compared risk differences (RD; estimated using binary regression) for CM smoking according to parental smoking, across levels of MHC. Second, we estimated RDs for CM smoking according to combinations of parental smoking and MHC. Confounding by socio-economic and demographic characteristics and parent’s mental health was adjusted for. Survey weights accounted for sample design and attrition; multiple imputation addressed item missingness. Results Similar proportions of CMs had ever smoked cigarettes (17%) and e-cigarettes (18%), although overlap was moderate (40% who had smoked either had smoked both). CMs were more likely to have ever smoked cigarettes if at least one parent smoked (RD: 16%[13–184]) (baseline: no parents who smoke[11%]). This elevated risk was observed across all levels of MHC, but was greatest for Low MHC (RD: 21%[11–31] (RDs in other MHC groups: 7%–12%). When combining parental smoking and MHC (baseline: no smoking parent, high MHC), those with Low MHC and a smoking parent had a RD of 28%(20–36). This was higher than the sum of RDs in CMs with Low MHC but a non-smoking parent (7%[1–14]) and with High MHC but a smoking parent (11% [7–15]). Thus, Low MHC carried an excess risk. There was little evidence of effect modification by Moderate or High-Moderate MHC. Results were similar for e-cigarettes. Conclusion The association between parent smoking and teenage smoking initiation was considerably stronger in those with Low MHC in contemporary, UK-representative data. These results require replication in other populations, and at older ages (examining progression to regular smoking), but imply that MHC improvement before transition to secondary school holds potential to buffer against an important smoking risk factor. The views expressed are those of the authors and not necessarily those of the funders.

Wellington South Community Patrol (WSCP) is an affiliate of the Community Patrols New Zealand (CPNZ) and fits into the safety, security and not-for-profit sectors or industries. Wellington South Community Patrol is registered as a charitable trust, as are most community patrol groups, and they get support in terms of training and funding from CPNZ. The intention of this study is to understand the reasons individuals volunteer their time and skills for free. The findings will help to recruit, manage and retain volunteers. The key findings were:  Volunteers are not in it for the money  People can be motivated by recognition and rewards  Volunteer mind-sets can be developed later in life. Many volunteers grow up in families where volunteering is the norm  The appealing factors of volunteering are belongingness, safety, sense of achievement, satisfaction, increased knowledge and career benefits.

Background The 2016 Childhood Obesity Plan included a target of 60 min(m) daily moderate-vigorous physical activity (dMVPA). In the UK Millennium Cohort Study (~18 000 children born 2000–2002) we examined how the prevalence and social distribution of childhood overweight/obesity might change if physical activity (PA) interventions aimed at this target were rolled-out under different scenarios of eligibility, uptake and effectiveness. Methods dMVPA at 7 years(y) was captured with accelerometers, over one week, adjusted for total wear-time. At 11y, children were classified as healthy, overweight (including obese), using measured heights and weights and International Obesity Task Force cut-offs. Socio-economic circumstances (SECs) were represented by maternal education (GCSEs/None; A-Levels+). Predicted probabilities of overweight were estimated by fitting marginal structural models, adjusting for dMVPA, and accounting for baseline and intermediate confounding with inverse-probability-treatment-weights. Inequalities were assessed with risk ratios (RRs) and risk differences (RDs). Intervention scenarios were simulated by re-estimating predicted probabilities after modifying the dMVPA variable by a given amount (reflecting effectiveness), for eligible children only (for targeted interventions), and with random sampling (where uptake Analyses included 6344 children in the MCS PA study. Survey weights and multiple imputation addressed sampling design, attrition and item missingness. Sensitivity analyses using complete cases and alternative adiposity (fat mass) and SECs (income) measures produced similar conclusions. Results 28.4% children were overweight and those from lower SECs were at greater risk (RR: 1.36 [95% CI: 1.25–1.49]; RD: 9.6%[9.2–9.9]). 49% achieved 60 m dMVPA, although mean dMVPA was greater in low SECs groups (64.5 m vs. 61.8 m). Simulations showed that, with an additional 30 m dMVPA for all children, 96% would achieve 60 m dMVPA. Prevalence of overweight would decline significantly (to 22.4%), relative inequality would increase (RR 1.40 [1.27–1.55]), whereas absolute inequality would fall slightly (RD 8.3%[8.0–8.6]). More realistic simulations, using effect sizes from meta-analyses and assuming 77% uptake, were less promising. A universal 4.6 m increase in dMVPA would lead to negligible reductions in overweight (27.7%), with no change in inequality (RR 1.37 [1.26–1.49]; RD 9.5%[9.2–9.8]). Intensive, targeted interventions achieving an additional 9.6 m dMVPA in deprived neighbourhoods would not alter population-level prevalence of overweight (28.1%) or inequality (RR 1.35 [1.24–1.47]; RD 9.1%[8.7–9.4]). Conclusion A simulation of the government’s ambitious PA target (in nationally-representative, objective data) achieved only a moderate reduction in population prevalence of childhood overweight and a slight narrowing of absolute (but not relative) inequalities. More realistic scenarios (modelling effects of trialled interventions) did not reduce prevalence of overweight and, even when targeted at deprived areas, inequalities remained.

Background Positive mental health (not simply absence of mental disorder) may hold potential for fostering resilience and reducing risks of poor health and well-being. However, it is challenging to define and measure. One promising conceptualisation is mental health competence (MHC), comprising age-relevant developmental tasks and abilities. To date MHC has not been investigated in UK children. Methods We developed a measure of MHC in the UK Millennium Cohort Study (MCS) (~18 000 children born 2000–2002) using seven items addressing learning skills and prosocial behaviours, reported by mothers at age 11 (n=12082). Latent class analysis (LCA) was used to identify classes of MHC, and children were assigned to the class they had the highest probability of belonging to. We investigated associations between MHC classes and child’s physical health (healthy weight, overweight or obese, based on measured heights and weights, using International Obesity Task Force cut-offs; maternal report of unintentional injuries since age 7 [none, 1, 2+]) and poor mental well-being (low self-esteem [SE] and low life-satisfaction [LS] reported by the child; maternal report of child’s emotional problems [EP], all dichotomised at the bottom decile of scores). Relative risk ratios (aRRR, 95% CI) and odds ratios (aORs, 95% CI) were used to examine three-category and binary outcomes respectively, adjusting for potential confounding. Survey weights accounted for sample design and attrition. Analyses were undertaken in Stata/SE 13.1. Results Four classes were identified (ranging from high to low MHC): “High learning skills and high prosocial behaviour” (37%), “Moderate learning skills and high prosocial behaviour” (36%), “Moderate learning skills and moderate prosocial behaviour” (19%), and “Low learning skills and moderate prosocial behaviour” (8%). Risks of 2+injuries were raised in “Moderate learning and high prosocial behaviour” (aRRR: 1.4 [95%CI:1.2–1.7]) and “Low learning skills and moderate prosocial behaviour” (aRRR: 1.4 [95%CI:1.1–1.9]) as compared to “High learning and high prosocial behaviour”. Associations with MHC were absent or weak for single injury, overweight and obesity. Compared to “High learning skills and high prosocial behaviour”, odds of poor mental well-being were elevated for children from all other classes, with highest odds for “Low learning skills and moderate prosocial behaviour” (SE: aOR: 2.9 [95%CI:2.3–3.6]; EP: aOR: 4.2 [95%CI:3.4–5.1]; LS: aOR: 3.0 [95%CI:2.4–3.7]). Conclusion Lower MHC, using a composite measure developed in a representative sample of UK children, was associated with injuries, low self-esteem and life-satisfaction, and emotional problems, but not overweight and obesity. Identifying and promoting MHC at the population-level may provide an opportunity to improve health in children and young people.

Background Parenting programmes aim to support parents’ skills and confidence, improving parenting and, in turn, children’s mental health. Thus they have the potential to reduce population prevalence (and inequalities) in child mental health problems. We modelled the potential population impact of scale-up of parenting interventions in a national cohort. Based on review evidence, we simulated interventions with effect sizes of 0.9SD (intensive) and 0.4SD (standard). Methods We used data from the UK Millennium Cohort Study, following 18 000 children born 2000–2002. Parenting was assessed by Child-Parent Relationship Scale (CPRS: Short-Form) score when the child was 3 years. Child mental health problems (CMHP) at 5 years were assessed by Strengths and Difficulties Questionnaire (SDQ) total score, dichotomised using an established cut-off. Socio-economic circumstances were represented by mother’s highest academic qualifications ( Predicted probabilities of CMHP were estimated, fitting marginal structural models to examine the mediating effect of parenting, accounting for confounding using inverse-probability-treatment-weights. Inequalities were assessed with Risk Ratios (RR [95% CIs]). A series of intervention scenarios were simulated by re-estimating predicted probabilities after modifying the CPRS score (to reflect effectiveness) for eligible children (targeting). We analysed data from 14 540 children, using Stata 13.1. Survey weights and multiple imputation addressed missing data. Results Overall prevalence of CMHP at 5 years was 10.8%, and children of mothers with low educational attainment had a greater risk of CMHP (RR=2.46 [95%CI:2.24–2.70]). Focusing on three parenting intervention scenarios, we showed changes in CMHP prevalence and inequalities compared to those observed: 1. Universal (standard support to all parents): prevalence change −2.5%; inequality RR=2.56[2.30–2.85]; 2. Targeted (intensive support to families receiving means-tested benefits): prevalence change −1.4%; inequality RR=2.11[1.91–2.34]; 3. Progressive universal (intensive support for families receiving benefits and standard support for others): prevalence change −3.2%; inequality RR=2.35[2.10–2.62]. Conclusion Large inequalities in CMHP were apparent by age 5 years. In simulated scenarios, inequality was reduced through an intervention that explicitly set out to provide intensive support to disadvantaged families. In contrast, reductions in overall prevalence were more likely to be achieved by universal interventions. A progressive universal approach (combining intensive support for disadvantaged families with standard support for others) led to a reduction in both population prevalence and inequality. Nevertheless, in all intervention scenarios, inequalities in CMHP remained strong. These results suggest that parenting interventions may contribute to a reduction in CMHP inequalities, particularly when including targeted support for disadvantaged families.

Background: Levels of paid employment in two parent and lone parent families have increased in the UK but evidence of its impact on child socioemotional behaviour is limited and inconsistent.\ud \ud Methods: We conducted a longitudinal analysis using the first four sweeps of the Millennium Cohort Study (9 months, 3 years, 5 years and 7 years) to investigate the influence of family employment trajectories in the early years on socioemotional behaviour at 7 years, unadjusted and adjusted for covariates. In addition, mothers’ employment was investigated separately.\ud \ud Results: Children from families where no parent was employed for one or more sweeps were at a greater risk of socioemotional problem behaviour compared with those where a parent was continuously employed, even after adjustment for covariates. Children of mothers who were non-employed for one or more sweeps were at greater risk of problem behaviour compared with mothers who were employed at all sweeps. Adjustment for covariates fully attenuated the excess risk for children whose mothers had moved into employment by the time they were 7 years. In contrast, the elevated risk associated with continuous non-employment and a single transition out of employment was attenuated after adjustment for early covariates, fathers’ employment, household income and mothers’ psychological distress at 7 years, but remained significant.\ud \ud Conclusions: Family and mothers’ employment were associated with a lower risk of problem behaviour for children in middle childhood, in part explained by sociodemographic characteristics of families and the apparent psychological and socioeconomic benefits of employment. Results for mothers’ transitions in or out of the labour market suggest that child problem behaviour is influenced by current status, over and above diverse earlier experiences of employment and non-employment.

OBJECTIVE: Little is known about whether levels of physical fitness, which is related to adiposity and physical activity (PA), have changed in children, particularly the progressive increase in childhood obesity levels. We aimed to examine the time trends in resting pulse rate (a marker of physical fitness) among UK children, in order to better understand the trends in levels of physical fitness in recent decades. DESIGN AND SETTING: We used a cross-sectional study design and included data on over 22 000 children aged 9-11 years (mean 10.3 years) from five population-based studies conducted in the UK between 1980 and 2008. MAIN OUTCOME MEASURES: Resting pulse rate (bpm). RESULTS: Observed mean resting pulse rate was higher for girls than boys (82.2 bpm vs 78.7 bpm). During the study period mean pulse rate increased by 0.07 bpm/year (95% CI 0.04 to 0.09) among boys and to a lesser extent among girls, by 0.04 bpm/year (0.01 to 0.06) (p

Background Smoking, diet, exercise, and alcohol are leading causes of chronic disease and premature death, many engage in two or more of these behaviours concurrently. The paper identified statistical approaches used to investigate multiple behavioural risk factors. Method A scoping review of papers published in English from 2000 to 2011 was conducted; papers are related to concurrent participation in at least two of the behaviours. Statistical approaches were recorded and categorised. Results Across 50 papers, two distinct approaches were identified. Co-occurrence analyses focused on concurrent but independent behaviours, represented by prevalence of behavioural combinations and/or by the summing behaviours into risk indexes. Clustering analyses investigated underlying associations between the concurrent behaviours, with clustering identified by divergences in observed and expected prevalence of combinations or through identification of latent or unobservable clusters. Co-occurrence was more frequently reported, but the use of clustering techniques and, in particular, cluster analytic and latent variable techniques increased across the study period. Discussion The two approaches investigate concurrent participation in multiple health behaviours but differ in conceptualisation and analysis. Despite differences, inconsistency in the terminology describing the study of multiple health behaviours was apparent, with potential to influence understandings of concurrent health behaviours in policy and practice.

Background: Maternal employment has increased in European countries, but levels of employment are lower among mothers whose children have a limiting long-term illness or disability. However, we do not know whether having a child with a limiting illness prevents take-up or maintenance of paid employment or whether ‘common causes’, such as lack of qualifications or maternal disability lead to both maternal unemployment and childhood illness. Longitudinal data have the potential to distinguish between these. Methods: We analyzed four waves (3, 5, 7 and 11 years) of the Millennium Cohort Study (MCS) to examine the relationship between childhood limiting illness and maternal employment, unadjusted and adjusted for covariates. Multinomial regression models were used to test the association between child illness and trajectories of maternal employment. Fixed effects models assessed whether a new report of a child illness increased the odds of a mother exiting employment. Results: At every wave, maternal employment was more likely if the child did not have a limiting illness. After adjustment for covariates, childhood illness was associated with risks of continuous non-employment (adjusted Relative Risk Ratio = 1.46 [Confidence Interval: 1.21, 1.76]) or disrupted employment (aRRR = 1.26 [CI: 1.06, 1.49]), compared with entering or maintaining employment. If a child developed a limiting long-term illness, the likelihood of their mother exiting employment increased (adjusted Odds Ratio = 1.27 [CI: 1.05, 1.54]). Conclusions: ‘Common causes’ did not fully account for the association between child illness and maternal employment. Having a child with a limiting illness potentially reduces maternal employment opportunities.

Objectives: To examine how population-level socioeconomic health inequalities developed during childhood, for children born at the turn of the 21st century and who grew up with major initiatives to tackle health inequalities (under the New Labour Government).\ud \ud Setting The UK.\ud \ud Participants: Singleton children in the Millennium Cohort Study at ages 3 (n=15 381), 5 (n=15 041), 7 (n=13 681) and 11 (n=13 112) years.\ud \ud Primary outcomes: Relative (prevalence ratios (PR)) and absolute health inequalities (prevalence differences (PD)) were estimated in longitudinal models by socioeconomic circumstances (SEC; using highest maternal academic attainment, ranging from ‘no academic qualifications’ to ‘degree’ (baseline)). Three health outcomes were examined: overweight (including obesity), limiting long-standing illness (LLSI), and socio-emotional difficulties (SED).\ud \ud Results: Relative and absolute inequalities in overweight, across the social gradient, emerged by age 5 and increased with age. By age 11, children with mothers who had no academic qualifications were considerably more likely to be overweight as compared with those with degree-educated mothers (PR=1.6 (95% CI 1.4 to 1.8), PD=12.9% (9.1% to 16.8%)). For LLSI, inequalities emerged by age 7 and remained at 11, but only for children whose mothers had no academic qualifications (PR=1.7 (1.3 to 2.3), PD=4.8% (2% to 7.5%)). Inequalities in SED (observed across the social gradient and at all ages) declined between 3 and 11, although remained large at 11 (eg, PR=2.4 (1.9 to 2.9), PD=13.4% (10.2% to 16.7%) comparing children whose mothers had no academic qualifications with those of degree-educated mothers).\ud \ud Conclusions: Although health inequalities have been well documented in cross-sectional and trend data in the UK, it is less clear how they develop during childhood. We found that relative and absolute health inequalities persisted, and in some cases widened, for a cohort of children born at the turn of the century. Further research examining and comparing the pathways through which SECs influence health may further our understanding of how inequalities could be prevented in future generations of children.

Objectives To identify patterns of co-occurrence and clustering of 6 common adverse health conditions in 11-year-old children and explore differences by sociodemographic factors. Design Nationally representative prospective cohort study. Setting Children born in the UK between 2000 and 2002. Participants 11 399 11-year-old singleton children for whom data on all 6 health conditions and sociodemographic information were available (complete cases). Main outcome measures Prevalence, co-occurrence and clustering of 6 common health conditions: wheeze; eczema; long-standing illness (excluding wheeze and eczema); injury; socioemotional difficulties (measured using Strengths and Difficulties Questionnaire) and unfavourable weight (thin/overweight/obese vs normal). Results 42.4% of children had 2 or more adverse health conditions (co-occurrence). Co-occurrence was more common in boys and children from lower income households. Latent class analysis identified 6 classes: ‘normative’ (57.4%): ‘atopic burdened’ (14.0%); ‘socioemotional burdened’ (11.0%); ‘unfavourable weight/injury’ (7.7%); ‘eczema/injury’ (6.0%) and ‘eczema/unfavourable weight’ (3.9%). As with co-occurrence, class membership differed by sociodemographic factors: boys, children of mothers with lower educational attainment and children from lower income households were more likely to be in the ‘socioemotional burdened’ class. Children of mothers with higher educational attainment were more likely to be in the ‘normative’ and ‘eczema/unfavourable weight’ classes. Conclusions Co-occurrence of adverse health conditions at age 11 is common and is associated with adverse socioeconomic circumstances. Holistic, child focused care, particularly in boys and those in lower income groups, may help to prevent and reduce co-occurrence in later childhood and adolescence.

Objective: To describe levels of physical activity, sedentary time and adherence to Chief Medical Officers (CMO) physical activity guidelines among primary school-aged children across the UK using objective accelerometer-based measurements. Design: Nationally representative prospective cohort study. Setting: Children born across the UK, between 2000 and 2002. Participants: 6497 7-year-old to 8-year-old singleton children for whom reliable accelerometer data were available for at least 10 h a day for at least 2 days. Main outcome measures: Physical activity in counts per minute (cpm); time spent in sedentary and moderate-to-vigorous intensity physical activity (MVPA); proportion of children meeting CMO guidelines (≥60 min/day MVPA); average daily steps. Explanatory measures: Gender, ethnicity, maternal current/most recent occupation, lone parenthood status, number of children in the household and country/region of residence. Results: The median daily physical activity level was 595 cpm (IQR 507, 697). Children spent a median of 60 min (IQR 47-76) in MVPA/day and were sedentary for a median of 6.4 h/day (IQR 6-7). Only 51% met CMO guidelines, with girls (38%) less active than boys (63%). Children took an average of 10 229 (95% CI (8777 to 11 775)) steps each day. Children of Indian ethnicity were significantly less active overall than all other ethnic groups. Children of Bangladeshi origin and those living in Northern Ireland were least likely to meet CMO guidelines. Conclusions: Only half of 7-year-old children in the UK achieve recommended levels of physical activity, with significant gender, ethnic and geographic variations. Longitudinal studies are needed to better understand the relevance of these (in)activity patterns for long-term health and well-being. In the meantime population-wide efforts to boost physical activity among young people are needed which are likely to require a broad range of policy interventions.