External Publications Using GUI Data

Objective
This study aims to examine the associations between prenatal exposure to maternal smoking, birth weight and persistent offspring psychiatric symptoms. Additionally, we aim to examine whether the relationship between prenatal maternal smoking and persistent offspring psychiatric symptoms is mediated by offspring birth weight.

Methods
This study used the Growing Up in Ireland (GUI) longitudinal cohort. The GUI is a nationally representative longitudinal study of children which consisted of three data collection waves, at ages 9, 13, and 17 years. Logistic regression analysis was used to examine associations between prenatal tobacco exposure, and offspring psychiatric symptoms. Linear regression was used to examine associations between prenatal tobacco exposure and offspring birth weight. We conducted a mediation analysis examining potential etiological pathways linking maternal smoking during pregnancy, offspring birth weight, and later offspring psychiatric symptoms. All analyses were adjusted for confounders including household income, maternal level of education, and family psychiatric history. Additionally, examination of birth weight and subsequent psychiatric symptoms also was controlled for prematurity.

Results
We found that the association between prenatal tobacco exposure and later psychiatric symptoms is mediated by birth weight.

Conclusions
This work provides further evidence that maternal smoking during pregnancy is an important modifiable lifestyle factor that has an impact not just on the physical health of offspring but also their mental wellbeing. Supporting women with structured smoking cessation programs at the earliest stages of pregnancy should be a public health priority.

For the first time, data on children and adolescents with disabilities in Ireland are reported based on the Active Healthy Kids Global Alliance Para Report Card methodology. The most recent data from the last 10 years were used in the grading process (A+ to F), and indicators with insufficient data were graded as incomplete. Of the 10 indicators from the Global Matrix Para Report Cards, grades were assigned to Overall Physical Activity (F), Organized Sport (D), Active Transport (D−), Sedentary Behaviors (D−), Family & Peers (C), School (C−), Community & Environment (B−), and Government (B). Irish disability sport organizations were invited to assess the research-led audit and provided commentary around the final grading. The contextual discussion of the grades is presented through the lens of strengths, weaknesses, opportunities, and threats with the purpose being to provide direction for the reduction of physical activity disparities among children with disabilities.

Background
Research has demonstrated positive associations between adverse childhood experiences (ACEs) and substance use behaviours in young adults. However, many of these are based on cross-sectional data. The pathway between ACEs and substance misuse among emerging adults is also not fully understood and few studies have investigated potential mediating factors.

Methods
We analysed data from the Child Cohort of the Growing Up in Ireland study, a nationally representative longitudinal sample of children recruited at 9 years of age (n = 4,729). Logistic regression was used to examine individual and cumulative ACE exposure relationships with substance use at age 20 years. Mediation analyses were used to assess whether parental and peer relationships and school engagement mediate ACE history associations with substance use behaviours.

Results
ACE exposure relationships with current cannabis use, other illicit drug use and problematic drug use were observed. In particular, young adults who had experienced 2 ACEs or 3 + ACEs had an approximate two-fold (OR=1.80, 95 % CI: 1.29, 2.51) and approximate three-fold (OR=2.94, 95 % CI: 2.06, 4.19) increased odds of problematic drug use, respectively, when compared to participants who had experienced no ACEs during the study period. Mediation analyses suggested that parent and peer attachment and liking school partially mediate relationships between ACEs and substance use behaviours.

Conclusions
Children who have experienced ACEs are at higher risk of future substance use and problematic drug use. In supporting these children, identified mediators such as interpersonal relationships and school engagement may help guide selection of prevention interventions.

Economic recessions have been linked to adult health, but few studies have examined how recessions influence the health of young children. This study examined the impact of life transitions linked to the recent financial crisis on the health of young children in Ireland. Data came from the Growing Up in Ireland Infant Cohort Study (n = 11,134), which assessed children before (2008), during (2011), and after (2013) the Great Recession that followed the financial crisis of 2008 and incorporated questions on the impacts of the financial crisis on families. Using fixed-effects models to control for confounding, we found that a reduction in welfare benefits during the recession was associated with a significant increase in the risks of asthma (β = 0.014, 95% confidence interval (95% CI): 0.004, 0.023) and atopy (β = 0.014, 95% CI: 0.001, 0.027). While parental job loss was not associated with child health, a reduction in working hours was associated with increased reports of child health problems (β = 0.024, 95% CI: 0.004, 0.043), as were difficulties affording basic necessities (β = 0.019, 95% CI: 0.001, 0.038). Results suggest that failing to protect vulnerable families and children during economic recessions may have long-lasting implications for child health.

Objective
The purpose of this study was to examine the relationship between maternal obesity that is calculated 9 months after delivery and sociodemographic variables.

Study Design
A national cohort of mothers was sampled 9 months after delivery as part of the Growing Up in Ireland Study Infant Cohort. Sociodemographic and clinical details were recorded at the interview by trained fieldworkers who used validated questionnaires. Body mass index was calculated based on weight and height measurements at the postpartum interview. The unadjusted and adjusted odds of obesity were calculated for predictor variables with the use of logistic regression analysis.

Results
Of the 10,524 mothers whose cases were studied, the mean age was 31.6 ± 5.5 years, and the mean parity was 1.0 ± 1.1. The mean body mass index after delivery was 25.7 ± 5.4 kg/m2; 16.8% of the women (n = 1768) were obese. Postpartum maternal obesity levels were associated positively on univariable analyses with smoking, lower household income, African nationality, earlier completion of full-time education, gestational weight gain, lower breast-feeding duration, and increasing parity. On multivariable analysis, maternal obesity was associated with increasing parity in lower income households, but not in higher income households.

Conclusion
Public health interventions that are aimed at decreasing obesity levels after childbirth should prioritize women who are disadvantaged socioeconomically.

Keywords
maternal obesity, parity, postpartum weight

The first 1000 days of life are a period of unique sensitivity and plasticity during which critical cognitive abilities are formed. Routine developmental screening tools aim to identify infants who would benefit from early intervention. While these tools have been validated for detecting children with more severe neurodevelopmental disorders, their ability to identify the larger proportion with below average cognitive function has not been sufficiently explored. The aim of this study was to examine the validity of the Ages and Stages Questionnaire (ASQ), for identifying children with later below average cognitive function.

The study population (n=8260) is formed from two national cohort studies, the Growing Up in Ireland (GUI) Infant cohort (n=7,444) and the Cork BASELINE cohort (n=816). The ASQ was completed at 8 months and 24-27 months respectively. Cognitive assessments were performed at age 5. Those scoring <1 standard deviation (SD) below the mean were categorised as below average cognitive function. Applying the currently used onward referral criterion (one fail in any domain) the sensitivity, specificity, positive and negative predictive values of the 8- and 24-27- month ASQ for detecting children with later below average cognitive function were calculated.

In the GUI cohort n=905 participants (12.5%) had scores <1SD below the mean on the Picture Similarities Scale. In the BASELINE cohort n=101 participants (13.4%) had an IQ <1SD below the cohort mean. Applying the currently used onward referral criterion (failing in any one domain in the ASQ), the sensitivity of the 8-month ASQ for detecting children scoring <1SD below the mean on the Picture Similarities Scale at age 5 was 16.4% (95% CI 14.0-19.0). The specificity was 92.0% (95% CI 91.3-92.6), with a positive predictive value (PPV) of 22.6% (95% CI 19.5-26.0) and a negative predictive value (NPV) of 88.5% (95% CI 87.7%-89.2%).

In the BASELINE cohort n=468 participants completed the 24-month ASQ and n=316 the 27-month ASQ. Applying the same onward referral criterion to the 24- and 27- month ASQ combined, the sensitivity for detecting those with an IQ <1SD below the cohort mean was 20.8% (95% CI 13.6-30.2) and the specificity was 91.1% (95% CI 88.6-93.2).

The ASQ has a low sensitivity for identifying children with below average cognitive function at age 5. The findings of this study suggest that if we are to intervene early in the developmental trajectory for children with below average cognitive function alternative methods of identifying high risk infants are needed.

Children with below average cognitive function represent a substantial yet under-researched population for whom academic and social demands, which increase in complexity year by year, pose significant challenge. Effects on emotional-behavioural development (EBD) are not well understood. The aim of this study was to compare trajectories of EBD for children with and without below average cognitive function. The underlying hypothesis was that trajectories of EBD would differ between groups, with divergence occurring as children are subject to increasingly complex cognitive demands.

Participants consist of 7,000 children and caregivers who completed the Growing Up in Ireland survey at age 3,5 and 9 years. Cognitive function was measured at age 3 using the Picture Similarities Scale. A t-score 1-2 standard deviations below the mean was categorised as below average cognitive function (n=767), and scores above this categorised as average cognitive function (n=6418). EBD was measured using the Strengths and Difficulties Questionnaire (SDQ) at age 3,5 and 9. Repeated measures ANOVA was used to examine the difference between the overall group means across the repeated measures of SDQ, the SDQ change over time, and the interaction between cognitive group and change over time. Further analysis of trajectories was performed using latent growth curve analysis.

Compared to those with average cognitive function, a significantly higher proportion of children with below average function were male (61.8% v 38.2%, χ2 (1, N=7134) = 42.07 p<0.001), born to a single parent family (22.4% v 14.7%, χ2 (1, N=7134) = 23.15 p<0.001), and had a parent who smoked (35.6% v 25.8%, χ2 (1, N=7134) = 33.23 p<0.001). Children with below average cognitive function had significantly higher mean total SDQ scores at all ages. Repeated measures ANOVA demonstrated a significant group-by-time interaction effect (F(2,7182)=4.649, p=0.010). The mean difference (MD) in SDQ between cognitive groups increased over time (MD Age 3:0.87, 95% confidence interval (CI) 0.53-1.21, Age 9 MD:1.49,95% CI 1.08-1.91). For those with average or above cognitive function the overall SDQ decreased between age 3-9 (MD: -0.49 95% CI -0.65—0.33). This decrease was not seen for those with below average function, who had a non-statistically significant increase in SDQ between age 3-9.

Children with below average cognitive function experience higher and worsening mean SDQ scores throughout childhood. A scalable method of early identification of children at risk for below average cognitive function should be a research priority for public health, enabling early intervention for cognitive and adaptive outcomes.

To date, studies using cross-sectional methodologies make up a majority of the literature surrounding children with autism spectrum disorders and participation in physical activity and screen time. Longitudinal studies are needed to examine how physical activity and screen time behaviors co-develop for children with and without an autism spectrum disorder. To address this research gap, this study compared how physical activity and screen time levels changed over time (9 to 18 years of age) between youth with autism spectrum disorder and youth with neurotypical development. Data on the levels of moderate-to-vigorous physical activity, light physical activity, television-, and video game-based screen time, collected as a part of the “Growing up in Ireland” study, were compared between youth with autism spectrum disorder and a propensity-matched sample of youth with neurotypical development (n = 88 per group; 176 in total). Robust regression analyses indicated that children with autism spectrum disorder became less active over time compared to children with neurotypical development and that video game screen time also differed significantly between the groups when children were 9 years old. These findings elucidate important disparities present between these groups of children during pivotal developmental times.

Background
Physical activity plays an important role in optimising physical and mental health during childhood, adolescence, and throughout adult life. This study aims to identify individual, family and environmental factors that determine physical activity levels in a population sample of children in Ireland.

Methods
Cross-sectional analysis of the first wave (2008) of the nationally representative Growing Up in Ireland study. A two-stage clustered sampling method was used where national schools served as the primary sampling unit (response rate: 82%) and age eligible children from participating schools were the secondary units (response rate: 57%). Parent reported child physical activity levels and potential covariates (parent and child reported) include favourite hobby, total screen time, sports participation and child body mass index (measured by trained researcher). Univariate and multivariate multinomial logistic regression (forward block entry) examined the association between individual, family and environmental level factors and physical activity levels.

Results
The children (N = 8,568) were classified as achieving low (25%), moderate (20%) or high (55%) physical activity levels. In the fully adjusted model, male gender (OR 1.64 [95% CI: 1.34-2.01]), having an active favourite hobby (OR 1.65 [95% CI: 1.31-2.08]) and membership of sports or fitness team (OR 1.90 [95% CI: 1.48-2.45]) were significantly associated with being in the high physical activity group. Exceeding two hours total screen time (OR 0.66 [95% CI: 0.52-0.85]), being overweight (OR 0.41 [95%CI: 0.27-0.61]; or obese (OR 0.68 [95%CI: 0.54-0.86]) were significantly associated with decreased odds of being in the high physical activity group.

Conclusions
Individual level factors appear to predict PA levels when considered in the multiple domains. Future research should aim to use more robust objective measures to explore the usefulness of the interconnect that exists across these domains. In particular how the family and environmental settings could be useful facilitators for consistent individual level factors such as sports participation.

Identifying the clustering and correlates of physical activity (PA) and sedentary behavior (SB) is very important for developing appropriate lifestyle interventions for children and adolescents. This systematic review (Prospero CRD42018094826) aimed to identify PA and SB cluster patterns and their correlates among boys and girls (0-19 years). The search was carried out in five electronic databases. Cluster characteristics were extracted in accordance with authors’ descriptions by two independent reviewers and a third resolved any disagreements. Seventeen studies met the inclusion criteria and the population age ranged from six to 18 years old. Nine, twelve, and ten cluster types were identified for mixed-sex samples, boys, and girls, respectively. While girls were in clusters characterized by “Low PA Low SB” and “Low PA High SB”, the majority of boys were in clusters defined by “High PA High SB” and “High PA Low SB”. Few associations were found between sociodemographic variables and all cluster types. Boys and girls in “High PA High SB” clusters had higher BMI and obesity in most of the tested associations. In contrast, those in the “High PA Low SB” clusters presented lower BMI, waist circumference, and overweight and obesity. Different cluster patterns of PA and SB were observed in boys and girls. However, in both sexes, a better adiposity profile was found among children and adolescents in “High PA Low SB” clusters. Our results suggest that it is not enough to increase PA to manage the adiposity correlates, it is also necessary to reduce SB in this population.

Background
Ireland has one of the lowest BF rates in the world. This study investigates the association between breastfeeding and infant health in Ireland.

Methods
A cross-sectional, secondary analysis of data collected from Growing Up in Ireland (GUI): the National Longitudinal Study of Children was conducted. The average morbidity for 2212.

infants exclusively breastfed for at least 90 days (EBF90days) was compared to data for 3987 infants in the non-breastfed (Non-BF) group. Data were weighted using entropy balancing to ensure the comparability of groups. Sensitivity analyses considered alternative definitions of the breastfeeding group.

Results
Infants who were EBF90days were significantly less likely to be admitted to hospital (CI: − 0.06 to − 0.03), spent less nights in hospital (CI: − 0.37 to − 0.11), and were less likely to develop respiratory diseases including asthma (CI: − 0.03 to − 0.01), chest infections (CI: − 0.12 to − 0.08), snuffles/common colds (CI: − 0.07 to − 0.02), ear infections (CI: − 0.08 to − 0.04), eczema (CI: − 0.08 to − 0.04), skin problems (CI: − 0.04 to − 0.00), wheezing or asthma (CI: − 0.06 to − 0.03), vomiting (CI: − 0.03 to − 0.00), and colic (CI: − 0.04 to − 0.01). Further outcomes such as current health of the infant at time of interview (CI: − 0.04 to − 0.00), feeding problems (CI: − 0.04 to − 0.02) and sleeping problems (CI: − 0.02 to − 0.00) indicated a protective effect of EBF90days versus Non-BF. However, these infants were also more likely to fail to gain weight (CI: 0.01 to 0.02) and were at a slightly higher risk of developing nappy rash (CI: 0.00 to 0.02).

Conclusion
Exclusive breastfeeding for 90+ days is associated with protection against childhood morbidity. Given the protective effect of breastfeeding on adverse health effects in infants, policy makers should prioritise policies that support, promote and protect exclusive breastfeeding.

Background
Meeting physical activity and screen time guidelines has been associated with improved health in children. Research has shown that lifestyle behaviours happen in combination and can be tracked into later life. Thus, a complex approach is needed to identify the effects of physical activity and screen time altogether. This study aims to identify clusters of both behaviours in a cohort of Irish 3-year-old children (n = 8833) and determine the association with sociodemographic characteristics and behaviours at age 5 and 7-8.

Methods
Data from the “Growing Up in Ireland” study collected between 2010 and 2016 was used in this study. Two-step cluster analysis was used to understand how physical activity and recreational screen time behaviours group together among 3-year-old children. Binary logistic regressions were conducted to examine if cluster placement at age 3 determined physical activity and recreational screen time behaviours at age 5 and 7-8 years, while controlling for gender of child, gender, age and employment status of the primary caregiver.

Results
Six clusters were identified in 9771 (49.3% female) 3-year-old children with the majority falling into a “High Active & Mixed Screen Time” (23.2%). Those in the “High Active & Mixed Screen Time” cluster at age 3 were more likely to engage in all physical activities reported at age 5 (p < 0.01) and age 7-8 (p < 0.01) when compared to a “Low Active & Screen Time Exceed” cluster. Children categorised in a “Moderate Active & Screen Time Below” and “Moderate Active & Screen Time Exceed” were more likely to engage in the same physical activities at age 5 and 7-8 (p < 0.05 – p < 0.01). However, children in the latter cluster were also more likely (p < 0.05) to play on a computer or tablet device.

Conclusions
This paper highlights the importance of establishing positive health-related behaviours during early childhood, as this predicts future engagement in health-promoting activities. Regardless of screen time level, being part of a cluster with moderate or high levels of physical activity positively influences a child’s future physical activity at age 5 and again at age 7 -8 years. The multiple layers of influence on a child’s development should be leveraged to support the adoption of health-enhancing behaviours.

Background
The use of dietary quality scores/indices to describe diet quality in children has increased in the past decade. However, to date, few studies have focused on the use of these scores on disease outcomes such as childhood obesity and most are developed from detailed dietary assessments. Therefore, the aims of this study were: firstly to construct a diet quality score (DQS) from a brief dietary assessment tool; secondly to examine the association between diet quality and childhood overweight or obesity; thirdly we also aim to examine the associations between individual DQS components and childhood overweight or obesity.

Methods
A secondary analysis of cross sectional data of a sample of 8,568 9-year-old children and their families as part of the Growing Up in Ireland (GUI) study. Subjects were drawn from a probability proportionate to size sampling of primary schools throughout Ireland over the school year 2007–2008. Height and weight were measured by trained researchers using standardised methods and BMI was classified using the International Obesity Taskforce cut-points. The DQS (un-weighted) was developed using a 20-item, parent reported, food frequency questionnaire of foods consumed over the past 24 h. Adjusted odds ratios for overweight and obesity were examined by DQS quintile, using the first quintile (highest diet quality) as the reference category.

Results
The prevalence of normal weight, overweight and obese was 75, 19 and 6 % respectively. DQS ranged from -5 to 25, higher scores indicated higher diet quality in the continuous score. In analyses adjusted for gender, parent’s education, physical activity and T.V. viewing, child obesity but not overweight was significantly associated with poor diet quality: OR of 1.56 (95 % CI 1.02 2.38) in the 5th compared to the 1st DQS quintile. Findings from individual food items were inconsistent.

Conclusions
The findings suggest that diet quality may be an important factor in childhood obesity. A simple DQS developed from a short dietary assessment tool is significantly associated with childhood obesity.

Reflecting the neglect of childhood disability in social stratification research, there is a notable dearth of research on the mechanisms underpinning disability differentials in educational outcomes. Drawing on rich longitudinal data collected at 9, 13 and 17 years as part of Ireland’s ‘Growing Up in Ireland’ study, we look at the impact of special educational needs (SEN) identification in primary school on upper secondary outcomes. A bioecological framework and the Process–Person–Context–Time model allow us to understand how interactions with family, teachers, friends and school—as proximal processes—relate to early school leaving and post-school planned pathways after accounting for personal and context characteristics. Overall, young people identified at age 9 as having SEN are at increased risk of early school leaving and are more likely to plan to attend further education and training, rather than higher education. However, after accounting for proximal processes and personal and context variables, students identified at age 9 as having SEN are no longer distinct in terms of secondary attainment and post-school planning. Instead, these young people are more likely to experience forms of vulnerability that are important in shaping these outcomes. These key educational outcomes are strongly shaped by family and school-related factors—both proximal processes and context characteristics—suggesting that efforts to support retention and pathway planning should be underpinned by an ecological understanding of young people’s trajectories and the cumulative disadvantages they face.

Key insights

What is the main issue that the paper addresses?

Using a bioecological framework and Growing Up in Ireland data, this paper explores early school leaving and post-school plans among young adults identified in primary school as having special educational needs (SEN). This is a key topic, as young people with SEN are at greater risk of early school leaving and less likely to attend higher education.

What are the main insights that the paper provides?

As a group, young people identified in primary school as having SEN are more likely to experience economic vulnerability and to attend schools with a socioeconomically vulnerable profile. After accounting for these and other key personal and contextual characteristics, childhood SEN status is no longer a significant factor in early school leaving or post-school plans.

Background
Bullying has a profound and enduring impact on academic achievement. However, there is a lack of clarity surrounding the specific mechanisms of this relationship.

Aims
This study examined the link between bullying at age 9 and Numeracy/Literacy achievement at age 15 to determine if this relationship is partially or fully explained by psychological difficulties at age 13.

Sample
Secondary data analysis was completed on waves 1, 2 and 3 of child cohort (Cohort’98) of the Growing Up in Ireland (GUI) study, respectively, at 9 years (N = 8568), 13 years (N = 7527) and 15 years of age (N = 6216).

Results
Longitudinal path mediation model was conducted with bullying at age 9 as the predictor, total (emotional and behavioural) difficulties at age 13 as the mediator and Numeracy/Literacy scores at age 15 as outcomes revealing significant indirect effects of bullying on achievement, via psychological difficulties.

Conclusions
We discuss the impact of bullying on the student’s psychological well-being, the relationship between bullying and academic attainment and how this may be tackled to avoid consequences throughout education and later in life.

Educational Impact and Implications
This study emphasizes the need for schools to address the emotional and behavioural difficulties occurring as a result of bullying in order to improve the overall educational experience of a child. Existing interventions can be built upon by focusing on the continuous remediation of such psychological difficulties.

This paper assesses the role of shadow education (SE), i.e., organised learning activities outside formal schooling, in the lives of secondary school students of different social backgrounds and in different school settings, in a high-stakes context. It draws on multilevel analysis of longitudinal Growing Up in Ireland data, alongside narratives from in-depth case study research in 10 schools. Framed within a social reproduction approach, we show how access to SE as an educational resource is socially stratified, accessible to those with greater levels of family resources, and those attending schools with higher socio-economic student intakes. SE is viewed as an investment, particularly among students with average and above average levels of prior attainment, while high attaining students are less likely to use SE. Perhaps reflecting the normalisation of SE in the Irish context, students do not directly link engagement in such tuition to their socio-emotional wellbeing.

Background
Orofacial clefts occur when the lips or the roof of the mouth do not fuse properly during the early weeks of pregnancy. There is strong evidence that periconceptional use of folic acid can prevent neural tube defects but its effect on oral clefts has generated debate.

Aim
To identify factors associated with suboptimal periconceptional use of folic acid and its potential effect on oral clefts.

Design and setting
The population-based infant cohort of the national Growing Up in Ireland study, which consists of 11 134 9-month-old infants.

Method
Data collection comprised questionnaires conducted by interviewers with parents in parents’ homes. Characteristics of mothers who did or did not take folic acid before and during pregnancy, as well as the effect of folic acid use on the prevalence of cleft lip and palate were recorded.

Results
The prevalence of cleft lip and palate was 1.98 (95% confidence interval [CI] = 1.31 to 2.99) per 1000 9-month-olds. The odds ratio for cleft lip was 4.36-fold higher (95% CI = 1.55 to 12.30, P = 0.005) for infants of mothers who did not take folic acid during the first 3 months of pregnancy, when compared with those who did have a folate intake during the first trimester. Folic acid use was suboptimal in 36.3% (95% CI = 35.4 to 37.2) of the sample.

Conclusion
These findings support the hypothesis that taking folic acid may partially prevent cleft lip and palate. They are particularly relevant for GPs, because they are usually the first port of call for women before and during early pregnancy.

Keywords
cleft lip, epidemiology, folic acid, general practice, infant