External Publications Using GUI Data

None of the many critical moments in Ireland’s often tumultuous history was more significant or defining than the Easter Rising of 1916. Central to the Rising was the Proclamation of Independence, in which Pádraig Pearse declared the new nation’s resolve to cherish all its children equally. CHERISHING ALL THE CHILDREN EQUALLY? brings together contributions from a range of disciplines to shed light on the processes of child development and to investigate how that development is influenced by a variety of demographic, family and socio-economic factors. Making extensive use of research and data that have emerged over recent years from the Growing Up in Ireland longitudinal study of children, the book considers whether or not all children can participate fully and equitably in contemporary Irish society. It asks whether or not we do, in fact, cherish all our children equally in modern Ireland, regardless of their family circumstances, health or ethnic background.

TABLES OF CONTENTS:

1. Introduction
2. Changing Perceptions and Experiences of Childhood, 1916-2016
3. Children and Families, Then & Now
4. Is Family Structure a Source of Inequality in Children’s Lives?
5. Parental Investment & Child Development
6. Inequalities in Access to Early Care and Education in Ireland
7. Inequalities from the Start? Children’s Integration into Primary School
8. Insights into the Prevalence of Special Educational Needs
9. The Experiences of Migrant Children in Ireland
10. Social Variation in Child Health & Development: A Life-course Approach
11. Child Access to GP Services in Ireland: Do User Fees Matter?
12. Anti-Social Behaviour at Age 13
13. Child Economic Vulnerability Dynamics in the Recession
14. Concluding Observations

The microbiome-gut-brain axis plays a role in anxiety, the stress response and social development, and is of growing interest in neuropsychiatric conditions. The gut microbiota shows compositional alterations in a variety of psychiatric disorders including depression, generalised anxiety disorder (GAD), autism spectrum disorder (ASD) and schizophrenia but studies investigating the gut microbiome in social anxiety disorder (SAD) are very limited. Using whole-genome shotgun analysis of 49 faecal samples (31 cases and 18 sex- and age-matched controls), we analysed compositional and functional differences in the gut microbiome of patients with SAD in comparison to healthy controls. Overall microbiota composition, as measured by beta-diversity, was found to be different between the SAD and control groups and several taxonomic differences were seen at a genus- and species-level. The relative abundance of the genera Anaeromassillibacillus and Gordonibacter were elevated in SAD, while Parasuterella was enriched in healthy controls. At a species-level, Anaeromassilibacillus sp An250 was found to be more abundant in SAD patients while Parasutterella excrementihominis was higher in controls. No differences were seen in alpha diversity. In relation to functional differences, the gut metabolic module ‘aspartate degradation I’ was elevated in SAD patients. In conclusion, the gut microbiome of patients with SAD differs in composition and function to that of healthy controls. Larger, longitudinal studies are warranted to validate these preliminary results and explore the clinical implications of these microbiome changes.

Caesarean section (CS) rates are increasing globally and exceed 50% in some countries. Childhood obesity has been linked to CS via lack of exposure to vaginal microflora although the literature is inconsistent. We investigated the association between CS birth and the risk of childhood obesity using the nationally representative Growing-Up-in-Ireland (GUI) cohort. The GUI study recruited randomly 11134 infants. The exposure was categorised into normal vaginal birth (VD) [reference], assisted VD, elective (planned) CS and emergency (unplanned) CS. The primary outcome measure was obesity defined according to the International Obesity Taskforce criteria. Statistical analysis included multinomial logistic regression with adjustment for potential confounders. Infants delivered by elective CS had an adjusted relative risk ratio (aRRR) = 1.32; [95% confidence interval (CI) 1.01–1.74] of being obese at age three years. This association was attenuated when macrosomic children were excluded (aRRR = 0.99; [95% CI 0.67–1.45]). Infants delivered by emergency CS had an increased risk of obesity aRRR = 1.56; [95% CI 1.20–2.03]; this association remained after excluding macrosomic children. We found insufficient evidence to support a causal relationship between elective CS and childhood obesity. An increased risk of obesity in children born by emergency CS, but not elective, suggests that there is no causal effect due to vaginal microflora.

Background
Energy poverty, typified by cold homes and/or an inability to afford energy bills, presents risks to the mental health of occupants. Parents of young children may be especially susceptible to a mental health toll from energy poverty since they have a significant care obligation and spend much of their day at home.

Methods
Data from the Growing Up in Ireland study inform this longitudinal analysis.

Results
A 1.64 greater odds of maternal depression were estimated for households containing young children characterized by energy poverty [P = 0.000; 95% confidence interval (CI): 1.31–2.05]. For energy poor households with older children (9 years and above), the odds of maternal depression were also higher [odds ratio (OR) 1.74, P = 0.001; 95% CI: 1.27–2.39]. Fathers of young children had greater odds of depression in energy poor households (OR 1.59, P = 0.002; 95% CI: 1.19–2.12), though the deleterious effect on mental health was not statistically significant for fathers of older children.

Conclusions
Energy poverty increases the likelihood of depression in parents. These findings merit policy attention since a mental health burden is in itself important, and more widely, parental well-being can influence child development and outcomes.

Purpose
We investigated the hypothesis that mode of delivery affects childhood behavior and motor development and examined whether there are sex-specific associations, i.e., whether males and females have different risk estimates.

Methods
Families with infants born between December 2007 and May 2008 (N = 11,134) were randomly selected and recruited to the Growing Up in Ireland study. Mode of delivery was classified into spontaneous vaginal delivery; instrumental vaginal delivery; emergency Cesarean section (CS); and elective CS. The ‘Ages and Stages Questionnaire’ was completed at age 9-months and the ‘Strengths and Difficulties Questionnaire’ at 3 years. Data were weighted to represent the national sample (N = 73,662) and multivariate logistic regression was used for the statistical analyses.

Results
At age 9 months, elective CS was associated with a delay in personal social skills [adjusted odds ratio, aOR 1.24; (95 % confidence interval, CI 1.04, 1.48)] and gross motor function [aOR 1.62, (95 % CI 1.34, 1.96)], whereas emergency CS was associated with delayed gross motor function [aOR 1.30, (95 % CI 1.06, 1.59)]. At age 3 years there was no significantly increased risk of an abnormal total SDQ score across all modes of delivery.

Conclusions
Children born by elective CS may face a delay in cognitive and motor development at age 9 months. No increase in total SDQ score was found across all modes of delivery. Further investigation is needed to replicate these findings in other populations and explore the potential biological mechanisms.

Co-payments for prescription drugs are a common feature of many healthcare systems, although often with exemptions for vulnerable population groups. International evidence demonstrates that cost-sharing for medicines may delay necessary care, increase use of other forms of healthcare and result in poorer health outcomes. Existing studies concentrate on adults and older people, particularly in the US, with relatively less attention afforded to paediatric and European populations. In Ireland, prescription drug co-payments were introduced for the first time for medical cardholders (i.e. those with public health insurance) in October 2010, initially at a cost of €0.50 per item, rising to €1.50 in January 2013, and further increasing to €2.50 in December 2013. Using data from the Growing Up in Ireland longitudinal study of children, and a difference-in-difference research design, we estimate the impact of the introduction (and increase) of these co-payments on health, healthcare utilisation and household financial wellbeing. The introduction of modest co-payments on prescription items was not estimated to impinge on the health of children and parents from low-income families. For the younger Infant Cohort, difference-in-difference estimates indicated that the introduction (and increase) in co-payments was associated with a decrease in GP visits and hospital nights, and a decrease in the proportion of households reporting ‘difficulties with making ends meet’. In contrast, for the older cohort of children (the Child Cohort), co-payments were associated with an increase in GP visiting, and an increase in household deprivation. While the parallel trends assumption for difference-in-difference analysis appeared to be satisfied, further investigation revealed that there were other time-varying observable factors (such as exposure to the economic recession over the period) that affected the treatment and control groups, as well as the two cohorts of children differentially, that may partly explain these divergent results. For example, while the analysis suggests that the introduction of the €0.50 co-payment in 2010 was associated with an increase in the probability of treated families in the Child Cohort being deprived by 9.4 percentage points, the proportion of treated families experiencing unemployment and reductions in household income also increased significantly around the time of the co-payment introduction. This highlights the difficulty in identifying the effect of the co-payment policy in an environment in which assignment to the treatment (i.e. medical cardholder status) was not randomly assigned.

Background
The aim of this study was to use a social-ecological approach to examine the influence of individual, social, and environmental factors on moderate-to-vigorous physical activity (MVPA) and screen-time in a sample of 9-year-old children in Ireland.

Methods
The sample was 1509 boys and girls from the Growing Up in Ireland (GUI) national study. MVPA, screen time, and individual, social, and environmental variables were assessed via questionnaires completed by children, their parents, and their teachers. Multiple regression was used to identify factors that correlated with children’s MVPA and screen-time levels.

Results
For boys, factors such as activity with friends (P < .0001) and popularity (P < .01) were associated with MVPA, while factors such as BMI (P < .01) and MVPA (P < .01) were associated with screen time. Similarly for girls, factors such as activity with friends (P < .0001) and sociability were associated with MVPA, however factors such as BMI (P < .05), and access to play space (P < .05) were more closely associated with screen time.

Conclusion
Social factors were more closely associated with MVPA, while individual factors were significantly correlated with screen time for both boys and girls. Correlates differed for boys and girls, suggesting that interventions should consider both the target population as well as the activity behavior.

Large-scale international migration continues apace. From a health-care services perspective, it is important to understand the influence of migrant heritage on utilization, to allocate resources appropriately and facilitate equity. However, the differences in utilization across different migrant groups remain poorly understood, particularly so for paediatric populations. This paper contributes to filling this gap in knowledge, examining the health-care contact of children for whom their primary caregiver is foreign-born, using longitudinal data from two nationally representative surveys. The study setting is Ireland, which provides an interesting case as a small, open European country, which for the first-time experienced net inward migration in the past two decades. For both cohorts, panel regression models, adjusting for socioeconomic and health indicators, demonstrated lower utilization of general practitioner (GP) services for children of caregivers from ‘less-advanced, non-Anglosphere, non-European Union (EU)’ nations, relative to native-born counterparts. Relatively lower attendances at Emergency Departments and hospital nights were also observed for this group, as well as for children born to EU (non-UK) caregivers. The insights provided are instructive for policymakers for which immigration is a substantial phenomenon in current and future population demographics.

Background
Historically, breastfeeding rates in Ireland have been low compared with international averages. It has been suggested that maternal ethnicity and citizenship may influence breastfeeding rates, with ethnic minorities thought more likely to breast feed.

Aim
The aim of this study is to investigate the association among maternal citizenship, ethnicity, birthplace and breast feeding. It is hypothesised that Irish mothers (identified through Irish citizenship, self-identified Irish ethnicity or Irish birthplace) are less likely to breast feed than non-Irish mothers.

Methods
The study population of Growing Up in Ireland: the National Longitudinal Study of Children was used for this study. Analysis was restricted to 11 092 biological mother and infant pairs with a complete breastfeeding history. Logistic regression analysis was used to estimate ORs and 95% CIs for breast feeding relative to maternal citizenship and ethnicity, controlling for the confounding effects of other maternal variables.

Results
Results indicated that 55.9% (6202 of 11 092) of mothers had initiated breast feeding, with only 7.9% (874 of 11 092) of mothers currently breast feeding their infant (at 9 months of age). Irish citizens (4693 of 9368, 50.0%) were significantly less likely to have initiated breast feeding compared with non-Irish citizens (1503 of 1695, 88.7%). Irish born mothers (4179 of 8627, 48.8%) were also significantly less likely to have initiated breast feeding than mothers born elsewhere (2023 of 2462, 82.2%).

Conclusions
Maternal citizenship and ethnicity appear to be the strongest influencing factors on breastfeeding initiation and duration. However, this raises a possibility that the increase in breastfeeding rates seen recently may be the result of increased immigration into Ireland, rather than the success of policy and research efforts.

A large body of international literature has documented a correlation between nontraditional family structure and poorer child outcomes, yet researchers continue to disagree as to whether the association represents a true causal effect. This article extends this literature by employing propensity score matching using the first wave of data from the Growing up in Ireland child cohort study. We argue that the Irish case is of particular interest given the highly selective nature of non-marriage. We find that, on average, non-marriage has negative effects on a child educational development at age 9 but the effects are smaller in relation to health outcomes and the child’s self-concept. However, selection effects account for a non-trivial proportion of the differences in child outcomes across lone-mother and cohabiting families although hidden bias remains an important issue. This has important implications for policies which promote marriage as the key to child development as it appears that much of the benefits of marriage are not related to marriage per se but to the socio-economic background of mothers.

Objectives
Maternal health behaviours (MHBs) can influence pregnancy outcomes. Despite efforts internationally to encourage positive MHBs, women often fail to comply with pregnancy guidelines. International studies show differences in MHBs between nationalities and an effect of time spent in the host country. There is limited Irish data in this area, with no previous research relating to the effect of time in Ireland.

Study design
This study is a cross-sectional analysis of the Growing Up in Ireland infant cohort, a nationally representative longitudinal study.

Methods
Examination of the MHBs of non-Irish nationals during pregnancy and the effect of time in Ireland on the said behaviours.

Results
An association was found between time spent in Ireland and increased alcohol consumption prevalence. Those living in Ireland for ≤5 years were 60.8% less likely to consume alcohol during pregnancy (0.000) and 29.3% less likely to take folic acid before conception (0.021). Those who smoked during pregnancy were 98.6% more likely to consume alcohol (0.000) and those who consumed alcohol were 95.2% more likely to smoke during pregnancy (0.000).

Conclusions
The results demonstrate differences in MHBs and the influence of time living in Ireland. These findings are of relevance for policy and intervention planning to optimise pregnancy outcomes among non-nationals.

There is now fairly substantial evidence of a socioeconomic gradient in low birth weight for developed countries. The standard summary statistic for this gradient is the concentration index. Using data from the recently published Growing Up in Ireland survey, this paper calculates this index for low birth weight arising from preterm and intrauterine growth retardation. It also carries out a decomposition of this index for the different sources of low birth weight and finds that income inequality appears to be less important for the case of preterm births, while father’s education and local environmental conditions appear to be more relevant for intrauterine growth retardation. The application of the standard Blinder–Oaxaca decomposition also indicates that the socioeconomic gradient for low birth weight appears to arise owing to different characteristics between rich and poor, and not because the impact of any given characteristic on low birth weight differs between rich and poor.

Parenting style has been highlighted as an important factor in child and adolescent outcomes for a range of indicators including health and educational achievement. The fostering of a positive self-concept and closer parental monitoring of school involvement are two of the suggested mechanisms by which parenting style may affect educational achievement. In recent years, much research has tended to focus on adolescents and there is considerably less information for middle childhood. This paper looks at the role of maternal parenting style (based on child-reports) on academic achievement for a large sample of 9-year-old children who took part in the Growing Up in Ireland study. It shows that an authoritative parenting style was associated with higher scores on measures of reading and maths relative to neglectful or uninvolved styles, however the expected advantage over an authoritarian parenting style did not emerge (and tended to reverse post-adjustment for mediators), and other socio-demographic characteristics such as maternal education were stronger predictors. Adjustments for possible mediating variables had a complex effect on the earlier models and suggest that authoritative parenting may have an indirect effect through both parental monitoring and the promotion of positive self-concept, especially the latter.

Keywords
parenting style, academic achievement, middle childhood, self-concept

This study identified ways to improve the social and educational outcomes of children with disabilities, including informing parents about the school and post-school options available.

Differentials in physical activity (PA) between social and economic groups has been shown to contribute significantly to social gradients in health and life expectancy, yet relatively little is known about why differentials in PA emerge. This paper uses longitudinal data on a nationally representative sample of 6,216 young people aged between 9 and 18, from Ireland, to measure the role of family, school and neighbourhood level factors in accounting for differentials in PA trajectories between groups of young people, defined by level of maternal education, whilst adjusting for the individual characteristics of the young person (sex, age, personality, body mass index and health-status). Levels of PA fall significantly across the sample between 9 and 18, and the decline in PA is larger for the children of lower educated mothers. We find a clear gradient in PA at each age by maternal education for both males and females. Descriptive analyses found social gradients in the majority of our risk factors. Using multi-level, linear spline regression models to decompose differentials between groups, we find that family-level mechanisms account for the biggest proportion of the differential in PA for both males (50.8%) and females (35.1%). Differences in income across maternal education categories accounted for 24.1% of the differential for males and 14.7% among females, making it the second most effective mechanism in explaining the social patterning of PA. Neighbourhood-level processes resulted in a modest reduction in the same differential, while school level processes had the effect of equalising differences in PA across maternal education groups.

This paper discusses the role of grandparents in informal childcare in Ireland. It considers how recent demographic change and government policy on childcare have the potential to place greater pressures on the provision of grandparent childcare. It illustrates research literature that has examined the prevalence and intensity of grandparent care, factors influencing such care, and the role and needs of grandparents in childcare. We argue that there are significant gaps in Irish research evidence about the extent of, role and needs of grandparents as childcarers and outline a data and research agenda that builds on previous research in this area.

Keywords
Childcare, Policy, Grandparents, Intergenerational

This paper draws on longitudinal data to examine the extent to which parents’ educational expectations shape academic development and changes in self-concept among young people with different types of disability. The analysis is based on the Growing Up in Ireland longitudinal study, which tracked 7423 children between the primary to secondary school years, 21% of whom were identified with one of four main disability types. Our conceptual framework assumes that parental expectations at age 9 will be influenced by both the child’s disability and child’s academic achievement at that stage, as well as being influenced by other factors such as parent’s own education, family economic vulnerability, family relationships and family structure. Therefore, we take these factors into account in tracing the consequences of parental expectations at age 9, on academic and social outcomes at age 13 after the transition to secondary education. Among young people with a disability, poorer self-concept at age 13 is partly explained by lower parental expectations, particularly for those with general learning and emotional/behavioural disabilities. Similarly, parental expectations are a significant influence on children’s academic outcomes and partly explain the effects of disability status on academic development. Parents’ beliefs about their children’s abilities have a strong influence on achievement and self-concept, raising important issues around the need to promote equality of opportunity, raising awareness of the educational opportunities available, promoting positive expectations and engagement with school and the importance of promoting a range of opportunities for achievement.

Keywords
Parental expectations, socio-economic background, disability type, examination performance, self-concept

Introduction
The aim of this paper was to examine the role of perinatal, obstetric and post partum factors on maternal and paternal stress. It will present the first examination of the role of prenatal, obstetric, post-partum, and demographic variables in parenting stress for mothers and fathers at 9 months.

Methods
Data from 6821 parental dyads of 9-month-old infants were extracted from the Growing Up in Ireland National Longitudinal Study of Children. Participants completed the Parental Stress Scale, the Dyadic Adjustment Scale, the Quality of Attachment Sub-scale from the Maternal and Paternal Postnatal Attachment Scales, and a single item health status question from the Short Form 12 Health Survey. Information on prenatal care, pregnancy complications, obstetric outcomes, infant health, and participant demographics were also collected. Separate hierarchical linear regressions were conducted for mothers and fathers

Results
Mothers reported higher levels of parenting stress than fathers (p < 0.001). Maternal parenting stress was predicted by attachment, own health status, average sleep, occupation, household income, and having a very rapid labor. Paternal parenting stress was predicted by attachment and own health status.

Discussion
A range of perinatal factors was associated with an increased risk of higher parenting stress at 9 months post-partum and the roles of these factors differ between mothers and fathers. These findings are important for predicting and reducing risk of parenting stress in both genders.

Keywords
Attachment, obstetric outcomes, parenting stress, prenatal, well-being