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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.

OBJECTIVE: To assess how mothers are feeling and coping during lockdown, and to identify the potential pathways that can assist them. METHODS: A descriptive analysis of maternal mental health, coping, support, activities, lockdown consequences was conducted. Women living in the UK with an infant aged ≤12 months completed an online survey. Linear regression was used to identify predictors of maternal mental health and coping. RESULTS: A majority of the 1329 participants reported feeling down (56%), lonely (59%), irritable (62%), and worried (71%) to some extent since lockdown began, but 70% felt able to cope. Support with her own health (95% confidence interval [CI] 0.004-0.235), contacting infant support groups (95% CI -0.003 to 0.252), and higher gestational age of the infant (95% CI 0.000-0.063) predicted better mental health. Travelling for work (95% CI -0.680 to -0.121), the impact of lockdown on the ability to afford food (95% CI -1.202 to -0.177), and having an income

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.

BackgroundDepression and anxiety affect up to 20% of new and expectant mothers during the perinatal period; this rate may have increased due to COVID-19 and lockdown measures. This analysis aimed to assess how mothers are feeling and coping during lockdown, and to identify the potential pathways that can assist them.Methods1329 women living in the UK aged ≥18 years with an infant ≤12 months of age completed an anonymous online survey. Descriptive analysis of maternal mental health, coping, support received, activities undertaken and consequences of lockdown was conducted. Linear regression was used to predict maternal mental health and coping, using activities, support, and consequences of the lockdown as predictors, while adjusting for age, gestational age, ethnicity, income, marital status and number of children.ResultsMore than half of the participants reported feeling down (56%), lonely (59%), irritable (62%) and worried (71%), to some or high extent since lockdown began. Despite this, 70% felt able to cope with the situation. Support with her own health (95% CI .004,235), contacting infant support groups (95% CI -.003, .252), and higher infant gestational age (95% CI .000, .063) predicted better mental health. Travelling for work (95% CI -.680, - .121), lockdown having a major impact on the ability to afford food (95% CI -1.202, -.177), and having an income lower than 30k (95% CI -.475, -.042) predicted poorer mental health. Support with her own health and more equal division of household chores were associated with better coping.ConclusionDuring lockdown, a large proportion of new mothers experienced symptoms of poor mental health; mothers of infants with lower gestational age, with low income, and who are travelling to work were particularly at risk. However, greater support for maternal health and with household chores showed positive associations with maternal mental health and coping. These findings highlight the urgent need to assess maternal mental health, and to identify prevention strategies for mothers during different stages of lockdown.

BackgroundThe COVID-19 New Mum Study is recording maternal experiences and infant feeding during the period of UK lockdown. This report from week 1 of the survey aims to (1) provide information relevant for those supporting this population; (2) identify groups currently under-represented in the survey.MethodsWomen living in the UK aged ≥18 years with an infant ≤12 months of age completed an anonymous online survey (https://is.gd/covid19newmumstudy). Information/links are shared via websites, social media and existing contacts.ResultsBetween May 27thand June 3rd2020, 1365 women provided data (94% white, 95% married/with partner, 66% degree/higher qualification, 86% living in house; 1049 (77%) delivered before lockdown (BL) and 316 (23%) during lockdown (DL). Delivery mode, skin-to-skin contact and breastfeeding initiation did not differ between groups. DL women had shorter hospital stays (pConclusionLockdown has had an impact on maternal experiences, resulting in distress for many women. Survey participants are currently not representative of the population; notably, groups at greater risk are under-represented. Increasing the diversity of participants is a priority.Survey fundingNone. All research at Great Ormond Street Hospital NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health is made possible by the NIHR Great Ormond Street Hospital Biomedical Research Centre. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Background\ud The Healthy Child Programme is the universal public health system in England to assess and monitor child health from 0 to 19. Following a review of measures for closer monitoring at age 2 years, the Department of Health for England implemented the Ages & Stages Questionnaires®, Third Edition (ASQ?3™; Hereon, ASQ?3).\ud \ud Aim\ud The aim of this study was to evaluate the acceptability and understanding of the ASQ?3 in England by health professionals and parents.\ud \ud Method\ud A mixed?methods approach was used. This paper reports on the qualitative data drawn from interviews with 40 parents and 12 focus groups with 85 health professionals. The data were analysed using applied thematic analysis.\ud \ud Findings\ud Overall, parents and health professionals found the ASQ?3 acceptable and understandable and could use it as a measure at age 2 years. The ability to work in partnership was valued.\ud \ud Some limitations included potential to cause anxiety, concerns around the safety of some of the items, and use of Americanized language. Health professional's training in the use the ASQ?3 was inconsistent.\ud \ud Conclusion\ud The ASQ?3 is an acceptable and understandable measure to use as part of the 2?year assessment with some adaptations to the English context and some standardized training for health professionals.

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.

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.

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.

Introduction Young children living in more disadvantaged socio-economic circumstances (SECs) are at an increased risk of overweight and obesity. However, there is scant research examining the prevalence and social distribution of thinness in early childhood, despite potential negative consequences for health and development across the life-course. Methods We examined the social gradient in thinness (and overweight and obesity for comparison) for 2,620,422 four-to-five year olds attending state maintained primary schools from 2007/8 to 2011/12, in the England National Child Measurement Programme (NCMP), and 16,715 children from the UK Millennium Cohort Study (MCS), born in 2000–2002, and measured at ages of three, five and seven. Children were classified as being thin, healthy weight (and, for completeness, overweight or obese) using international age and sex adjusted cut-offs for body mass index (BMI). Prevalences (and 95 % confidence intervals (CIs)) were estimated, overall, and according to SECs: area deprivation (NCMP, MCS); household income, and maternal social class and education (MCS only). Relative Risk Ratios (RRRs) and CIs for thinness, overweight and obesity were estimated in multinomial models by SECs (baseline healthy weight). In the MCS, standard errors were estimated using clustered sandwich estimators to account for repeated measures, and, for thinness, RRRs by SECs were also estimated adjusting for a range of early life characteristics. Results In 2007/8 to 2011/12, 5.20 % of four-to-five year old girls (n = 66,584) and 5.88 % of boys (78,934) in the NCMP were thin. In the MCS, the prevalence of thinness was 4.59 % (693) at three, 4.21 % (702) at five, and 5.84 % (804) at seven years. In both studies, and for all measures of SECs, children from the most disadvantaged groups were more likely to be thin than those from the most advantaged groups. For example, MCS children whose mothers had no educational qualifications were fifty percent more likely to be thin (RRR 1.5 (CI: 1.24, 1.8)) than those whose mothers had a degree. These patterns were attenuated but remained after adjusting for early life characteristics. Conclusions Children from more disadvantaged backgrounds are at elevated relative risk of thinness as well as obesity. Researchers and policymakers should consider environmental influences on thinness in addition to overweight and obesity. Electronic supplementary material The online version of this article (doi:10.1186/s12939-015-0187-6) contains supplementary material, which is available to authorized users.

Garcia Rada highlights the rise in child poverty and child malnutrition in Catalonia, Spain, since the economic crisis.1 But closer to home, the number of malnutrition related admissions to hospital in England has doubled since 2008-09 (figure⇓).2 Admissions related to malnutrition and number of people using food banks …

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