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In the post-World War II era, there have been dramatic changes to the environment that appear to be having a detrimental impact on the lifestyles and incidental physical activities of young people. These changes are not trivial and have the potential to influence not only physical health, but also mental health and child development. However, the evidence of the impact of the built environment on physical activity to date is inconsistent. This review examines the evidence on the association between the built environment and walking for transport as well as physical activity generally, with a focus on methodological issues that may explain inconsistencies in the literature to date. It appears that many studies fail to measure behaviour-specific environmental correlates, and insufficient attention is being given to differences according to the age of study participants. Higher levels of out-of-school-hours physical activity and walking appear to be significantly associated with higher levels of urban density and neighbourhoods with mixed-use planning, especially for older children and adolescents. Proximate recreational facilities also appear to predict young people's level of physical activity. However, there are inconsistencies in the literature involving studies with younger children. Independent mobility increases with age. For younger children, the impact of the built environment is influenced by the decision-making of parents as the gatekeepers of their behaviour. Cross-cultural differences may also be present and are worthy of greater exploration. As children develop and are given more independent mobility, it appears that the way neighbourhoods are designed - particularly in terms of proximity and connectivity to local destinations, including schools and shopping centres, and the presence of footpaths - becomes a determinant of whether children are able, and are permitted by their parents, to walk and use destinations locally. If older children and adolescents are to enjoy health and developmental benefits of independent mobility, a key priority must be in reducing exposure to traffic and in increasing surveillance on streets (i.e. 'eyes-on-the-street') through neighbourhood and building design, by encouraging others to walk locally, and by discouraging motor vehicle use in favour of walking and cycling. Parents need to be assured that the rights and safety of pedestrians (and cyclists) - particularly child pedestrians and cyclists - are paramount if we are to turn around our 'child-free streets', now so prevalent in contemporary Australian and US cities. There remains a need for more age- and sex-specific research using behaviour- and context-specific measures, with a view to building a more consistent evidence base to inform future environmental interventions. [ABSTRACT FROM AUTHOR]

BACKGROUND: Increasing use of computers by children has raised concerns over the potential impact on their cognitive, social, educational, visual and physical development. Despite this concern, there are no large-scale studies relating the use of computers to specific health indicators in children as they reach school age. METHODS: A cross-sectional analysis of 1600 5-year-old Western Australian children participating in a longitudinal cohort study was conducted to ascertain their computer use, other activities (watching television and videos, playing electronic games, reading and looking at books, drawing on paper and moderate to vigorous physical activity), and specific health indicators. RESULTS: More than half (56%) of the children used computers each week. Computer use was significantly related to TV viewing (OR 1.97 weekday) and electronic game use (console games OR 2.48 weekday, 1.81 weekend; hand-held games OR 1.88 weekend) and negatively associated with vigorous physical activity on weekends (OR 0.72). Computer use was also significantly related to socio-economic indicators such as the mother being older (40+ years, OR 1.70 weekend, 1.73 weekday), tertiary educated (OR 1.63 weekend) and studying (OR 1.52 weekend, 1.41 weekday). Almost 1% children were reported to have complained of tired or sore muscles, and 2.2% had complained of tired or sore eyes, after watching television or using a computer. CONCLUSION: A substantial proportion of 5-year-old Western Australian children are using computers. Computer use was related to other sedentary activities and less vigorous activity. While musculoskeletal and vision problems are not widespread, their presence and the sedentary nature of computer use is of public health concern. [ABSTRACT FROM AUTHOR]

Question: Is pre-existing maternal mental illness associated with pregnancy loss?People: 1960 women enrolled in the National Comorbidity Survey, 963 of whom (49.1%) had a DSM-III-R psychiatric diagnosis. Exclusions: women with conduct disorder, antisocial personality disorder, and non-affective psychosis; and women who were currently pregnant or had only terminations and no previous live births or pregnancy losses. Setting: General population, USA; data first collected in the 1990s.Risk factors: DSM-III-R psychiatric diagnosis of anxiety (general anxiety disorder, panic disorder, simple phobia, social phobia, agoraphobia, post-traumatic stress disorder), affective (depression, dysthymia or mania), or substance disorders (drug or alcohol dependence or abuse; not including tobacco) whose age at onset indicated that they preceded pregnancy. Other risk factors were assessed and adjusted for by multivariable logistic regression analyses.Outcomes: Self-reported pregnancy loss (miscarriage or stillbirth). This was assessed with one yes/no question about whether a pregnancy Ioss had occurred; the number and dates of losses were recorded.METHODSDesign: Retrospective cohort analysis.Follow-up period: Survey retrospectively assessed mental health and pregnancy outcome over women's lifetime; average age of women at survey was 36.6 years.MAIN RESULTSOverall, 30.9% of women reported experiencing pregnancy loss. Women with mental health disorders before pregnancy were more likely to experience miscarriage or still-birth than women without disorders (adjusted OR 1.80, 95% CI 1.35 to 2.41). When results were analysed by type of disorder, women with substance use disorders or affective disorders were significantly more likely to experience pregnancy loss than women without these diagnoses, but this was not the case for anxiety disorders (substance use disorders: adjusted OR 1.44, 95% CI 1.01 to 2.06; affective disorders: adjusted OR 1.61, 95% CI 1.03 to 2.50; anxiety disorders: adjusted OR 1.09, 95% CI 0.80 to 1.48). These associations were independent of other risk factors for pregnancy loss.CONCLUSIONSMaternal mental illness, specifically affective and substance disorders, is associated with an increased risk of pregnancy loss, independent of the known risk factors tested. [ABSTRACT FROM AUTHOR]

A randomised clinical trial was conducted to assess the impact of the 'Go and Grow with CF' intervention program on nutrition and pancreatic enzyme knowledge and self-management skills. Forty-two children with cystic fibrosis aged six to 11 years and 55 carers of two- to 11-year-old children participated in the program. Separate but similar validated questionnaires were used for face-to-face interviews with children with cystic fibrosis and for telephone interviews with carers on three occasions. The questionnaires were designed to assess nutrition and pancreatic enzyme knowledge and self-management skills. The improvement in knowledge of the children's intervention group was significant immediately post-intervention (P = 0.001) but not at follow-up 12 months later. Children's knowledge for both the intervention and control groups was associated with their appropriate self-management score immediately (P = 0.02 and P=0.03, respectively) and 12 months post-intervention (P = 0.01 and P = 0.00, respectively). The home-based 'Go and Grow with CF' program was found to be effective in increasing children's knowledge in the short-term. The absence of a longterm effect of the program on nutrition and pancreatic enzyme knowledge and behaviours may be due to the need for regular ongoing education and counselling. [ABSTRACT FROM AUTHOR]

Background: Digital technology is ubiquitous in the lives of many children and parents. To better understand any influence of technology use by infants, and mothers, on child development, technology use should be considered within the broader family system context in which children develop. This study aimed to investigate associations between infant and maternal technology use and infant 12-month development, taking into consideration other family factors., Methods: This cross-sectional study used data from ORIGINS participants, collected at 12-months of age: maternal and child technology use (TechU-Q), sociodemographic factors (e.g. child sex, household income), parental mental health (DASS-21), and child development (Ages and Stages Questionnaire). Linear regression was used for analyses., Results: When family factors were considered, higher infant mobile touchscreen device (MTSD) use was associated with poorer infant development for gross motor, problem-solving, and total ASQ-3 scores. In contrast there were no associations between infant television (TV) watching or maternal technology use and total ASQ-3 scores. Higher maternal technology use was associated with higher infant technology use. Poorer maternal and paternal mental health were associated with poorer infant development. Poorer maternal mental health was also associated with higher infant TV watching and higher maternal MTSD use., Conclusion: There is a complex relationship between technology use, parental mental health and other family factors that together influence infant development. To improve infant development outcomes, less focus should be on infant or maternal technology use, and more on supporting the family as a whole, and parental mental health in particular., (© 2024. The Author(s).)

Purpose: Despite the volume of accumulating knowledge from prospective Aboriginal cohort studies, longitudinal data describing developmental trajectories in health and well-being is limited. The linkage of child and carer cohorts from a historical cross-sectional survey with longitudinal health-service and social-service administrative data has created a unique and powerful data resource that underpins the Western Australian Aboriginal Child Health Survey (WAACHS) linked data study. This study aims to provide evidence-based information to Aboriginal communities across Western Australia, governments and non-government agencies on the heterogeneous life trajectories of Aboriginal children and families., Participants: This study comprises data from a historical cross-sectional household study of 5289 Aboriginal children from the WAACHS (2000-2002) alongside their primary (N=2113) and other (N=1040) carers, and other householders. WAACHS data were linked with Western Australia (WA) government administrative datasets up to 2020 including health, education, child protection, police and justice system contacts. The study also includes two non-Aboriginal cohorts from WA, linked with the same administrative data sources allowing comparisons of outcomes across cohorts in addition to between-group comparisons within the Aboriginal population., Findings to Date: Linked data coverage rates are presented for all WAACHS participants. Child health outcomes for the WAACHS children (Cohort 1) are described from birth into adulthood along with other outcomes including child protection and juvenile justice involvement., Future Plans: Analysis of data from both the child and carer cohorts will seek to understand the contribution of individual, family (intergenerational) and community-level influences on Aboriginal children's developmental and health pathways, identify key developmental transitions or turning points where interventions may be most effective in improving outcomes, and compare service pathways for Aboriginal and non-Aboriginal children. All research is guided by Aboriginal governance processes and study outputs will be produced with Aboriginal leadership to guide culturally appropriate policy and practice for improving health, education and social outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

This study explores the allocation of time, particularly to sleep, among children and adolescents in response to daily daylight variation. Utilising a dataset of over 50,000 time-use diaries from two Australian cohorts spanning 16 years and employing an individual fixed effects estimator, we uncover a substantial causal impact of daily daylight duration on sleep patterns. Our findings reveal that days with longer daylight hours are associated with a decrease in total sleep duration, primarily driven by a later sleep onset time. Additionally, longer daylight hours correspond to reduced time spent on personal care and media activities, with increased dedication to school and physical activities. Furthermore, we identify socio-demographic factors moderating these effects, such as older age and weekend days exerting a stronger influence on sleep duration, while females and children of unemployed mothers exhibit a subtle impact. These insights contribute to our understanding of how environmental factors shape daily routines and offer implications for designing schedules that promote positive developmental outcomes in young individuals., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Francis Mitrou reports financial support was provided by Australian Research Council Centre of Excellence for Children and Families over the Life Course. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

As families increase their use of mobile touch screen devices (smartphones and tablet computers), there is potential for this use to influence parent-child interactions required to form a secure attachment during infancy, and thus future child developmental outcomes. Thirty families of infants (aged 9-15 months) were interviewed to explore how parents and infants use these devices, and how device use influenced parents' thoughts, feelings and behaviours towards their infant and other family interactions. Two-thirds of infants were routinely involved in family video calls and one-third used devices for other purposes. Parent and/or child device use served to both enhance connection and increase distraction between parents and infants and between other family members. Mechanisms for these influences are discussed. The findings highlight a new opportunity for how hardware and software should be designed and used to maximise benefits and reduce detriments of device use to optimise parent-infant attachment and child development. Practitioner Summary: Many families with infants regularly use smartphones and tablet computers. This qualitative study found that how devices were used either enhanced or disrupted feelings of parent-infant attachment. Practitioners should be aware of the potential beneficial and detrimental impacts of device use among families given implications for attachment and future child development.

Purpose: Previous studies showed that unfavourable weather conditions discourage physical activity. However, it remains unclear whether unfavourable weather conditions have a differential impact on physical activity in children compared with adults. We aim to explore the differential impact of weather on time allocation to physical activity and sleep by children and their parents., Method: We use nationally representative data with time use indicators objectively measured on multiple occasions for >1100 Australian pairs of 12-13-year-old children and their middle-aged parents, coupled with daily meteorological data. We employ an individual fixed effects regression model to estimate the causal impact of weather., Results: We find that unfavourable weather conditions, as measured by cold or hot temperatures or rain, cause children to reduce moderate- and vigorous-intensity physical activity time and increase sedentary time. However, such weather conditions have little impact on children's sleep time or the time allocation of their parents. We also find substantial differential weather impact, especially on children's time allocation, by weekdays/weekends and parental employment status, suggesting that these factors may contribute to explaining the differential weather impact that we observed. Our results additionally provide evidence of adaptation, as temperature appears to have a more pronounced impact on time allocation in colder months and colder regions., Conclusion: Our finding of a negative impact of unfavourable weather conditions on the time allocated to physical activity by children indicates a need to design policies to encourage them to be more physically active on days with unfavourable weather conditions and hence improve child health and wellbeing. Evidence of a more pronounced and negative impact on the time allocated to physical activity by children than their parents suggests that extreme weather conditions, including those associated with climate change, could make children vulnerable to reduced physical activity., Competing Interests: Declaration of competing interest The authors declare that they have no relevant or material financial interests that relate to the research described in this paper. This research was partly funded by the Australian Research Council Centre of Excellence for Children and Families over the Life Course (#CE140100027, Zubrick; #CE200100025, Mitrou and Christian) and Australian National Heart Foundation Future Leader Fellowship (#102549, Christian). However, the funders do not involve in study design; in the collection, analysis and interpretation of data; in the writing of the articles; and in the decision to submit it for publication., (Copyright © 2023 Elsevier B.V. All rights reserved.)

This paper examines whether adolescents can be reliably categorized into subgroups based on their patterns of anxiety levels over time and whether low levels of social support from parents, peers, and their school, and high levels of peer victimization, predict a pattern of increasing anxiety. Participants were 3392 youth from the Longitudinal Study of Australia's Children (LSAC). Youth-reported anxiety was measured at three occasions at ages 12/13 years, 14/15 years, and 16/17 years, with social support and victimization assessed at age 12/13 years. Anxiety trajectories were identified using latent class growth mixture modelling, and predictors of class membership were examined using multinomial logistic regression analyses. Three discrete classes of anxiety trajectories were identified. Most youth fell within a stable-low anxiety symptom class (89.5% males; 78.2% females), with smaller percentages in low-increasing (5.6% males; 14.4% females) or high-decreasing (4.9% males; 7.4% females) classes. Low support from parents and teachers, low sense of school belonging, and high peer victimization predicted membership of the low-increasing anxiety trajectory class, irrespective of gender. Social support did not moderate the effect of peer victimization upon the risk of developing anxiety, with peer victimization remaining a risk factor even when adolescents experienced good social support from parents, peers, and school. The findings highlight the need for screening in early adolescence to identify those who are experiencing low social support and high peer victimization and are thus at increased risk of developing anxiety problems. These youth could then be offered targeted intervention to reduce the likelihood of anxiety development., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: In Australia, the health and education sectors provide universal early childhood services for the same population of children. Therefore, there is a strong imperative to view service use and outcomes through a cross-sectoral lens to better understand and address the service needs of young children and their families., Objectives: To investigate patterns of health and education service use from birth through Kindergarten (age four years), the associations with cumulative risks, and developmental vulnerability in the first year of full-time school (age five years)., Methods: A retrospective cohort study that used population-wide linkage of health and education administrative data records for 5,440 children with a Tasmanian 2015 Australian Early Development Census (AEDC) record who were born in Tasmania (2008-2010)., Results: Four service use patterns were identified: Regular (46% of children), Declining (24%); Low (18%); and Selective service use (12%). Regular service use (aOR 0.8, 95% CI 0.7 to 0.9), adjusted for cumulative risks, was associated with decreased odds of developmental vulnerability, compared to the other service use groups. Low (OR 6.1, 95% CI 4.5 to 8.2) and Declining service use (OR 2.5 95% CI 1.9 to 3.4) were more likely for children with the highest levels of cumulative risks. Low and Declining service use, adjusted for cumulative risks were associated with increased odds of developmental vulnerability, compared to the Regular service use group., Conclusion: This study provides a whole population view of the differential use of universal services and the complex risk circumstances that influence service use. The association between patterns of multiple risk and service use points to barriers to service use, and the varying level of developmental vulnerability within each service use group draws attention to children who may benefit from higher sustained participation in core health and education services across the whole of early childhood., Competing Interests: Statement on conflicts of interest: The authors declare they have no conflicts of interest.

Background: The impacts of the COVID-19 pandemic have been vast and are not limited to physical health. Many adolescents have experienced disruptions to daily life, including changes in their school routine and family's financial or emotional security, potentially impacting their emotional wellbeing. In low COVID-19 prevalence settings, the impact of isolation has been mitigated for most young people through continued face-to-face schooling, yet there may still be significant impacts on their wellbeing that could be attributed to the pandemic., Methods: We report on data from 32,849 surveys from Year 7-12 students in 40 schools over two 2020 survey cycles (June/July: 19,240; October: 13,609), drawn from a study of 79 primary and secondary schools across Western Australia, Australia. The Child Health Utility Index (CHU9D) was used to measure difficulties and distress in responding secondary school students only. Using comparable Australian data collected six years prior to the pandemic, the CHU9D was calibrated against the Kessler-10 to establish a reliable threshold for CHU9D-rated distress., Results: Compared to 14% of responding 12-18-year-olds in 2013/2014, in both 2020 survey cycles almost 40% of secondary students returned a CHU9D score above a threshold indicative of elevated difficulties and distress. Student distress increased significantly between June and October 2020. Female students, those in older Grades, those with few friendships or perceived poor quality friendships, and those with poor connectedness to school were more likely to score above the threshold., Conclusions: In a large dataset collected during the first year of the COVID-19 pandemic, the proportion of secondary school students with scores indicative of difficulties and distress was substantially higher than a 2013/2014 benchmark, and distress increased as the pandemic progressed, despite the low local prevalence of COVID-19. This may indicate a general decline in social and emotional wellbeing exacerbated by the events of the pandemic., Trial Registration: ANZCTRN (ACTRN12620000922976). Retrospectively registered 17/08/2020. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380429&isReview=true ., (© 2022. The Author(s).)

This study explores how the first wave of the COVID-19 pandemic influenced family routines, relationships and technology use (smartphones and tablet computers) among families with infants. Infancy is known to be an important period for attachment security and future child development, and a time of being susceptible to changes within and outside of the family unit. A qualitative design using convenience sampling was employed. A total of 30 mothers in Perth, Western Australia participated in semi-structured interviews by audio or video call. All mothers were parents of infants aged 9 to 15 months old. Interviews were audio-recorded and transcribed, and data were analysed using thematic analysis to code and identify themes in an inductive manner. Families described staying home and stopping all external activities. Three themes relating to family interactions and wellbeing were found: enhanced family relationships; prompted reflection on family schedules; and increased parental stress. Two themes related to family device use were found: enabled connections to be maintained; and source of disrupted interactions within the family unit. Overall, participants described more advantages than downsides of device use during COVID-19. Findings will be of value in providing useful information for families, health professionals and government advisors for use during future pandemic-related restrictions.

Mobile touch screen devices (smartphones and tablet computers) have become an integral part of many parents' and children's lives, with this interaction linked to physical, mental and social outcomes. Despite the known importance of parent-child attachment, evidence on the association between device use and attachment was yet to be reviewed. Following protocol pre-registration, databases were searched, papers screened, and methodological quality assessed. Three papers met the inclusion criteria, and reported some negative associations between duration of parent/child smartphone use and attachment outcomes. A narrative synthesis on two groups of related papers found child time using any screen technology (including television viewing), and child 'problematic' internet, mobile phone, gaming and social media use, was negatively associated with attachment outcomes. Currently there is limited direct evidence on any association between time parents or children spend using these devices and parent-child attachment to support time guidelines for families and professionals working with families. Practitioner summary: Many parents and children regularly spend time using smartphones and tablet computers. This systematic review found limited evidence evaluating associations between child/adolescent or parent time using devices and parent-child attachment. Until quality evidence exists, practitioners should be alert to potential impacts of device use on family relationships and child outcomes.

Introduction: Australians who are Not in Employment, Education or Training (NEET) and receive income support span a wide spectrum of working ages. Australian research has concentrated on NEETs aged 15-29 years, in line with international standards. This paper investigates extending the NEET concept to include all working age persons 15-64 years and the value added to welfare policy through analysis of a new linked dataset., Methods: An observational study design was implemented with individuals aged 15-64 years recorded as receiving Department of Social Services (DSS) income support payments from September 2011 being linked with Australian Bureau of Statistics (ABS) Census data from August 2011 to create a linked dataset for analysis. Descriptive analyses were undertaken of NEET status by Census socio-demographic characteristics, and we modelled the adjusted likelihood of NEET status by Census demographics., Results: Some 1.37 million or 45.2% of linked DSS payment recipients qualified as NEET. Of NEETs, more than twice as many were female, nearly half were aged 45-64 years, and under 1-in-5 were aged 15-29 years. Multivariate analyses showed that NEETs were more likely to be older, have low educational attainment, have a disability, and to be Indigenous., Conclusions: Young NEETs aged 15-29 years represented less than 20% of linked DSS payment recipients classified as NEET, suggesting that standard NEETs reporting neglects information on around 80% of the working age NEET population in Australia. Combined with other demographic insights, these results have implications for welfare policy, and indicate a wider range of demographics should be considered under the NEET classification. This may also have implications for Organisation for Economic Co-operation and Development (OECD) reporting., Competing Interests: Statement of Conflicts of Interest: None declared.

Introduction: There is a global trend towards place-based initiatives (PBIs) to break the cycle of disadvantage and promote positive child development. Co-location is a common element of these initiatives and is intended to deliver more coordinated services for families of young children. This paper examines how co-locating early childhood services (ECS) from health and education in Child and Family Centres (CFCs) has impacted collaboration between services., Methods: This ethnographic study included 130 participant observation sessions in ECS between April 2017 and December 2018 and semi-structured interviews with 45 early childhood service providers and 39 parents/carers with pre-school aged children., Results: Service providers based in CFCs reported that co-location of services was facilitating local cooperation and collaboration between services. However, insufficient information sharing between services, prioritising client contact over collaborative practice and limited shared professional development remained barriers to collaborative practice. For parents, co-location improved access to services, but they experienced services independently of each other., Discussion and Conclusion: Co-location of ECS in CFCs contributed to greater cooperation and collaboration between services. However, for the potential of CFCs to be fully realised there remains a need for governance that better integrates service policies, systems and processes that explicitly support collaborative practice., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2021 The Author(s).)

Background: Regular physical activity provides children with health and developmental benefits. This study investigated if active play and walking with the family dog was associated with better social-emotional development in young children., Methods: We surveyed 1646 parents to ascertain if families with pre-schoolers owned a dog, and the frequency per week their child went on family dog walks or actively played with their dog. The parent-report version of the Strengths and Difficulties Questionnaire (SDQ) was used to measure children's social-emotional development., Results: Children from dog-owning households had reduced likelihood of conduct problems (odds ratio (OR) = 0.70; 95% confidence interval (CI): 0.54, 0.90), peer problems (OR = 0.60; 95% CI: 0.46, 0.79), and total difficulties (OR = 0.77; 95% CI: 0.59, 0.99) and increased likelihood of prosocial behavior (OR = 1.34; 95% CI: 1.06, 1.68) compared with children without a dog. Within dog-owning households, family dog walking at least once/week (OR = 1.45; 95% CI: 1.02, 2.08) and active play with the family dog three or more times/week (OR = 1.74; 95% CI: 1.16, 2.59) increased the likelihood of prosocial behaviors. Family dog walking at least once/week also reduced the likelihood of total difficulties (OR = 0.64; 95% CI: 0.42, 0.96)., Conclusions: Our findings highlight the possible physical activity and social-emotional developmental benefits of family dog ownership for pre-schoolers, and that these benefits may present in early childhood., Impact: Young children from dog-owning families had lower peer problems and conduct problems, and higher prosocial behaviors than children from non-dog-owning families. Children of dog-owning families who walked or played with their dog more often also had better prosocial behaviors. Positive social-emotional development was associated with dog ownership, family dog walking, and dog play in young children. Highlights that the social-emotional benefits of owning a dog may begin early in childhood. Due to the high level of pet ownership in households with children, these findings suggest having a dog and interacting with it through play and walking may be important mechanisms for facilitating young children's social-emotional development.

Introduction: Amidst the evolving COVID-19 pandemic, understanding the transmission dynamics of the SARS-CoV-2 virus is key to providing peace of mind for the community and informing policy-making decisions. While available data suggest that school-aged children are not significant spreaders of SARS-CoV-2, the possibility of transmission in schools remains an ongoing concern, especially among an aging teaching workforce. Even in low-prevalence settings, communities must balance the potential risk of transmission with the need for students' ongoing education. Through the roll out of high-throughput school-based SARS-CoV-2 testing, enhanced follow-up for individuals exposed to COVID-19 and wellbeing surveys, this study investigates the dynamics of SARS-CoV-2 transmission and the current psychosocial wellbeing impacts of the pandemic in school communities. Methods: The DETECT Schools Study is a prospective observational cohort surveillance study in 79 schools across Western Australia (WA), Australia. To investigate the incidence, transmission and impact of SARS-CoV-2 in schools, the study comprises three "modules": Module 1) Spot-testing in schools to screen for asymptomatic SARS-CoV-2; Module 2) Enhanced surveillance of close contacts following the identification of any COVID-19 case to determine the secondary attack rate of SARS-CoV-2 in a school setting; and Module 3) Survey monitoring of school staff, students and their parents to assess psycho-social wellbeing following the first wave of the COVID-19 pandemic in WA. Clinical Trial Registration: Trial registration number: ACTRN12620000922976., Competing Interests: Telethon Kids Institute authors report grants from the Western Australian Department of Health during the conduct of this study. DC and AB report grants from the Western Australian Department of Health outside the submitted work. AB is an employee of the Western Australian Department of Health. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Mullane, Thomas, Epstein, Mandzufas, Mullan, Whelan, Lombardi, Barrow, Ang, Leahy, Cameron, Lester, Cooper, Stevenson, Hartman, McKenzie, Mitrou, Zubrick, Coffin, Cross, Bowen and Gething.)

Background: Maternal stressful life events during pregnancy have been associated with immune dysregulation and increased risk for asthma and atopy in offspring. Few studies have investigated whether prenatal stress is associated with increased overall or specific infectious diseases in childhood, nor explored sex differences. We sought to examine the relationship between the nature and timing of maternal stress in pregnancy and hospitalisation with infection in offspring., Methods: Between 1989 and 1992, exposure data on stressful life events were collected from pregnant women (Gen1) in the Raine Study at 18 and 34 weeks' gestation and linked to statutory state-wide hospital morbidity data. We examined associations between the number, category and timing of maternal prenatal stress events and overall and clinical groups of offspring (Gen2) infection-related hospitalisation until age 16 years, adjusting for maternal age, education, and smoking in pregnancy in addition to the presence of siblings at birth., Results: Of 2,141 offspring with complete stress in pregnancy data available, 1,089 had at least one infection-related hospitalisation, with upper respiratory tract infections the most common (n = 556). Each additional stressful life event during pregnancy was associated with increased risk in male offspring for hospitalisation with all infection types. There was little evidence of these associations in girls., Conclusions: Increased exposure to stressful life events in utero is associated with sex-specific infection-related hospitalisations in childhood. Prenatal stress may adversely affect early immune development for boys and increase the risk of more severe infections. Mechanistic understanding would inform preventative interventions., Competing Interests: The authors have declared that no competing interests exist.

Background: Increased allostatic load is linked with racial discrimination exposure, providing a mechanism for the biological embedding of racism as a psychosocial stressor. We undertook an examination of how racial discrimination interacts with socioecological, environmental, and health conditions to affect multisystem dysregulation in a First Nations population., Methods: We conducted latent class analysis (LCA) using indicators of life stress, socioeconomic background, and physical and mental health from a nationally representative sample of Australian Aboriginal adults (N = 2056). We used LCA with distal outcomes to estimate the effect of the latent class variable on our derived allostatic load index and conducted a stratified analysis to test whether allostatic load varied based on exposure to racial discrimination across latent classes., Results: Our psychosocial, environmental, and health measures informed a four-class structure; 'Low risk', 'Challenged but healthy', 'Mental health risk' and 'Multiple challenges'. Mean allostatic load was highest in 'Multiple challenges' compared to all other classes, both in those exposed (4.5; 95% CI: 3.9, 5.0) and not exposed (3.9; 95% CI: 3.7, 4.2) to racial discrimination. Allostatic load was significantly higher for those with exposure to racial discrimination in the 'Multiple challenges' class (t = 1.74, p = .04) and significantly lower in the 'Mental health risk' class (t = - 1.67, p = .05)., Conclusions: Racial discrimination may not always modify physiological vulnerability to disease. Social and economic contexts must be considered when addressing the impact of racism, with a focus on individuals and sub-populations experiencing co-occurring life challenges.

This study tested a new program for helping smokers with severe mental illness to reduce their tobacco use, together with determining the feasibility of such research in community mental health settings in Australia. Five Neami National sites trialled a Consumer Centred Tobacco Management program called Kick the Habit (n = 34). The intervention included two weeks of free Nicotine Replacement Therapy (patches only) but participants also used a variety of self-funded delivery types in addition or as an alternative to the subsidised nicotine patch. At the 3-month follow-up, Kick the Habit participants had reduced their number of daily cigarettes, dependency levels and average weekly expenditure on tobacco. Although a larger study is required, Kick the Habit represents a promising intervention for tobacco management in community mental health services. The challenges and lessons learnt for scaling up to a larger trial and integration into business-as-usual practice across multiple sites are discussed.

Objective: To investigate the longitudinal association between pet ownership and children's social-emotional development., Study Design: Two time-points of data from the Longitudinal Study of Australian Children were analyzed for children at ages 5 (n = 4242) and 7 (n = 4431) years. The Strengths and Difficulties Questionnaire (SDQ) measured children's social-emotional development. Pet ownership status and type (dog, cat, other) as well as sociodemographic and other potential confounders were collected. Longitudinal panel regression models were used., Results: Overall, 27% of children had abnormal scores on 1 or more SDQ scales. By age 7, 75% of children had pets with ownership highest in single-child households. Owning any type of pet was associated with decreased odds of abnormal scores for emotional symptoms (OR, 0.81; 95% CI, 0.67-0.99), peer problems (OR, 0.71; 95% CI, 0.60-0.84), and prosocial behavior (OR, 0.70; 95% CI, 0.38-0.70), compared with non-pet owners. Dog ownership was associated with decreased odds of abnormal scores on any of the SDQ scales (OR, 0.81; 95% CI, 0.71-0.93). For children without any siblings, only the prosocial behavior scale was significantly associated with pet ownership (OR, 0.21; 95% CI, 0.07-0.66). In longitudinal models, cat-only and dog-only groups were associated with fewer emotional symptoms and peer problems compared with non-pet owners., Conclusions: Early school age is an important period for family pet acquisition. Pets may protect children from developing social-emotional problems and should be taken into account when assessing child development and school readiness. Children without siblings may benefit most in terms of their prosocial behavior., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Early childhood is a critical time to address risk factors associated with developmental vulnerability. This study investigated the associations between clusters of early life risk factors and developmental vulnerability in children's first year of full-time school at age 5., Design: A retrospective cohort study., Setting: Population-wide linkage of administrative data records for children born in Tasmania, Australia in 2008-2010., Participants: The cohort comprised 5440 children born in Tasmania in 2008-2010, with a Tasmanian 2015 Australian Early Development Census (AEDC) record and a Tasmanian Perinatal Collection record., Outcome Measure: The AEDC is a national measure of child development across five domains: physical health and well-being, social competence, emotional maturity, language and cognitive skills (school-based), and communication skills and general knowledge. Children who scored below the 10th percentile on one or more AEDC domains were classified as developmentally vulnerable. Children with special needs are not included in the AEDC results., Results: Latent class analysis identified five clusters of risk factors: low risks (65% of children), sociodemographic and health behaviour risks (24%), teenage mother and sociodemographic risks (6%), birth risks (3%), and birth, sociodemographic and health behaviour risks (2%). In this sample population, 20% of children were classified as developmentally vulnerable, but the proportion varied substantially by latent class. Logistic regression showed increased odds of developmental vulnerability associated with sociodemographic and health behaviour risks (OR 2.26, 95% CI 1.91 to 2.68, p<0.001), teenage mother and sociodemographic risks (OR 2.01, 95% CI 1.50 to 2.69, p<0.001), and birth, sociodemographic and health behaviour risks (OR 3.29, 95% CI 2.10 to 5.16. p<0.001), but not birth risks (OR 1.34, 95% CI 0.88 to 2.03, p=0.1649), relative to the reference group., Conclusions: The patterning of risks across the five groups invites consideration of multisectoral policies and services to address complex clusters of risk factors associated with developmental vulnerability., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)