External Publications Using GUI Data

Background
Population-based studies provide important data to inform policy and service planning for vulnerable children in society. The aim of this study was to characterise social and educational circumstances and self-concept among a nationally representative sample of 13 year olds with developmental disabilities in Ireland.

Methods
A cross-sectional, secondary analysis of data collected from the Growing Up in Ireland (GUI) study was conducted. Descriptive statistics were used to calculate the reported prevalence of disabilities as reported by parents. Differences across the groups (those with and without disabilities) were analysed in relation to gender, socio-economic and school factors. Special education support received in school was described. The association between low self-concept scores (as measured by the Piers Harris Self-Concept Scales 2) and disability type was examined by use of multi-level logistic regression.

Results
Seventeen percent (17.36%) of the sample was reported to have a diagnosis of one or more developmental disabilities. Those with a disability were more likely to live in poorer households, have poorer health status, to experience more episodes of bullying at school, and to have more negative views of school (p<0.05) than their typically-developing peers.

Forty nine percent of children with developmental disabilities were not receiving support in school as reported by parents. Discrepancies in the nature of support received were identified across disability types. Adjusting for individual and school level factors, a disability diagnosis was associated with increased odds of low self-concept scores on three of five self-concept domains. Further associations were identified which differed across disability type.

Conclusions
The findings show that 13 year olds with a disability in Ireland have complex social and educational needs. Findings also suggest significant levels of unmet educational need across this age group. Apparent inequities in access to support in school require further investigation. Reliable measures to provide robust prevalence figures about childhood disabilities in Ireland are needed.

The prevalence of obesity in children is rapidly rising, leading to many serious consequences worldwide. In 2005, the World Health Organisation (WHO) Regional Office for Europe issued recommendations and guidelines for regular collection of data on weight, height, and waist and hip circumference in children worldwide in order to monitor prevalence trends of growth, overweight and obesity. The Department of Health and the Health Service Executive commissioned the National Nutrition Surveillance Centre, based at the School of Public Health, Physiotherapy and Population Science in University College Dublin, to carry out this surveillance work in the Republic of Ireland.

This report presents the findings from three waves of the WHO Childhood Obesity Surveillance Initiative survey in the Republic of Ireland in 2008, 2010 and 2012. In 2008, 163 randomly selected primary schools participated in this project and in the first round the protocol as set out by the WHO for participating countries was followed. The target age was children aged exactly 7 years. In the subsequent two waves, the same WHO protocol was followed and the same schools were contacted again and this time, as well as 7-year-olds, 9-year-olds were also selected for participation in the second round. In the third round, 7-year, 9-year, as well as 11-year-olds were included.

This means that there are three cross-sectional surveys of 7-year-old children, two cross-sectional surveys of 9-year-olds and one cross-sectional comparison group of 7-, 9- and 11-year-old children. Using a unique identifier there are also two cohort groups of the same children followed on two separate occasions from ages 7 to 9 and ages 9 to 11, respectively. In this report, we also compare the data on 9-year-old children to the findings from the Growing Up in Ireland Cohort study.

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.

This paper examines multidimensional poverty for three waves of a cohort of Irish children ranging from ages 9 to 17. Poverty is measured over the dimensions of health, education and family resources and both unidimensional and multidimensional poverty is examined. Both show a clear gradient with respect to maternal education. The dynamics of both unidimensional and multidimensional poverty are also analysed. The greatest degree of mobility is observed with respect to family resources. Mobility also is higher for children whose mothers have lower levels of education, with net movements into rather than out of poverty.

This retrospective cross-sectional paper examines the relationship between early breastfeeding exposure and children’s academic test scores at nine years of age independent of a wide range of possible confounders. The final sample comprised 8226 nine-year-old school children participating in the first wave of the Growing Up in Ireland study. The children were selected through the Irish national school system using a 2-stage sampling method and were representative of the nine-year population. Information relating to breastfeeding initiation and exposure duration was obtained retrospectively at nine years of age via parental recall and children’s academic performance was assessed using standardised reading and mathematics tests. Hierarchical linear regression analysis with robust standard errors to control for clustering at the school level was used to quantify the effect of breastfeeding on children’s test scores. Propensity score matching was used to compare treatment effects across groups defined by their propensity to breastfeed. In unadjusted analysis, children who were breastfed scored 8.67 percentage points higher on reading and 7.42 percentage points higher on mathematics compared to those who were never breastfed. While the breastfeeding advantage attenuated appreciably when adjusted for a range of child, maternal, socio-economic and socio-environmental characteristics, children who were breastfed continued to enjoy a significant test score advantage of 3.24 (p < 0.001) and 2.23 (p < 0.001) percentage points on reading and mathematics respectively compared to those who were never breastfed. Any amount of breastfeeding was associated with significantly higher test scores than no exposure, but evidence of a dose-response relationship was weak. The results of the propensity score matching analysis indicated that the test score advantage of breastfed children is robust and that the magnitude of the effect varies across groups defined by their propensity to breastfeed, being largest amongst the most socially disadvantaged and falling to near zero among the most advantaged group.

The present study examines whether breastfeeding is associated with neuro-developmental advantages at 9 months of age on a standardised measure of infant development in a large cohort study of Irish children. It is hypothesised that if breast-milk confers an independent benefit, infants who were never breastfed will have reached fewer developmental milestones than those who were partially or exclusively breastfed, after controlling for putative confounding variables. Families with infants aged 9-months were recruited as part of a nationally representative sample for the birth cohort of the Growing Up in Ireland study (n = 11,134). Information was collected from mothers on breastfeeding practices, socio-demographic characteristics and developmental progress during a household interview. Parent-report items on development covered communication, gross motor, fine motor, problem solving and personal-social skills. Analysis of pass/fail status in each developmental domain using binary logistic regression showed a positive effect of any breastfeeding on gross motor, fine motor, problem solving and personal-social skills (but not communication) and these remained after adjustment for a range of confounding variables. There was, however, little evidence of a dose–response effect or advantage of exclusive over partial breastfeeding. A clear advantage of breastfeeding on infant development was demonstrated. However, the lack of a dose–response association on pass rates suggests that the breastfeeding effect may be confounded by other unobserved factors or that there is a critical threshold during which time the effect of breast milk may be particularly salient for bolstering brain development.

The sudden health and economic crisis brought about by the COVID-19 pandemic affords an opportunity to examine the impact of economic disruption to children and families. Any negative effects on the well-being of children are important to consider in relation to both short- and long-term outcomes. Using pre-pandemic and mid-pandemic waves of the longitudinal Growing Up in Ireland study, we examined whether the impact of economic disruption was equivalent for families who were (or were not) financially vulnerable pre-pandemic. We then investigated whether economic disruption was associated with a negative effect on the emotional well-being of 12-year-olds, and if there was evidence for such a negative effect being mediated through a lack of material resources or strain on family dynamics. Our results indicated that middle-income rather than lowest-income families experienced the most economic disruption, likely reflecting the sector-specific nature of business closures in the pandemic. Families who were financially vulnerable pre-pandemic were less likely to have had suitable resources for homeschooling. Both falls in income and strain in family relationships, such as arguing more with their parents, were associated with poorer scores on a measure of the child’s emotional well-being. The emergency income support payment introduced at the start of the pandemic appeared to have a protective effect on the association between family income loss and child well-being, which has wider implications for policy on child poverty.

Keywords
COVID-19, pandemic, economic resources, financial strain, child well-being, family relationships, homeschooling

Background
Unintended pregnancy is associated with increased risk for adverse neonatal and early childhood outcomes spanning an array of indicators, but it remains unclear whether these risks hold independent of other biological, social and environmental risk factors.

Methods
This study uses data from the first wave of the ‘Growing Up in Ireland Study’, a large nationally representative cohort study of more than 11 000 infants, to examine the risk factors associated with unintended pregnancy. Adopting a staged approach to the analysis, the study investigates whether pregnancy intention influences maternal health behaviours during pregnancy independent of background characteristics, and whether pregnancy intention carries any additional risk for adverse infant and maternal health outcomes when we adjust for background characteristics and prenatal behaviours.

Results
The study confirmed that sociodemographic factors are strongly associated with unintended pregnancy and that unintended pregnancy is associated with a range of health compromising behaviours that are known to be harmful to the developing fetus. While there was little evidence to suggest that pregnancy intention was associated with adverse neonatal outcomes or developmental delay independent of other covariates, there was strong evidence that intention status had a bearing on the mother’s psychosocial health. Unintended pregnancy was associated with increased risk of depression (risk ratio 1.36 [95% confidence interval 1.19, 1.54]), and higher parenting stress (risk ratio 1.27 [95% confidence interval 1.16, 1.38]).

Conclusions
Ascertaining the mother’s pregnancy intention during the first antenatal visit may represent a means for monitoring those at greatest risk for adverse mother and child outcomes.

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.

Whether school composition makes a difference for student outcomes has been the subject of much controversy. This article draws on Growing Up in Ireland data, a rich source of information on nine-year-old children along with the characteristics of their school and classroom teacher. In contrast to many studies which rely on a single measure of social background, the use of a range of measures (including social class, parental education and income) allows us to provide precise estimates of differences in performance between schools designated as disadvantaged and other schools. The analyses also provide new insights into the processes underlying such differences. Only the most disadvantaged schools, those in Urban Band 1, are found to have a contextual effect for both reading and mathematics. This achievement gap is found to reflect differences in teacher experience and turnover, the concentration of additional learning needs, absenteeism levels and children’s engagement in school.

Keywords
school social mix, primary education, academic performance

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.

The world-wide COVID-19 pandemic significantly disrupted education, with school closures leading to a shift to remote learning. Existing and emerging research has shown that even a relatively short period of missed school has negative consequences for academic and social outcomes among children and young people, especially for those from more vulnerable families. While emerging research drawing on cross-sectional data has focussed on how the pandemic has affected immigrant youth, there is a paucity of longitudinal studies in this field. In this paper, we used the longitudinal Growing Up in Ireland study to investigate and analyse the wellbeing of migrant-origin 12-year-olds in Ireland during the COVID-19 pandemic. Our research shows that compared to their Irish peers, immigrant adolescents had poorer wellbeing, partly related to differences in family support for remote learning, in experiences of poor-quality interaction with peers and in levels of family strain.

The world-wide COVID-19 pandemic significantly disrupted education, with school closures leading to a shift to remote learning. Existing and emerging research has shown that even a relatively short period of missed school has negative consequences for academic and social outcomes among children and young people, especially for those from more vulnerable families. While emerging research drawing on cross-sectional data has focussed on how the pandemic has affected immigrant youth, there is a paucity of longitudinal studies in this field. In this paper, we used the longitudinal Growing Up in Ireland study to investigate and analyse the wellbeing of migrant-origin 12-year-olds in Ireland during the COVID-19 pandemic. Our research shows that compared to their Irish peers, immigrant adolescents had poorer wellbeing, partly related to differences in family support for remote learning, in experiences of poor-quality interaction with peers and in levels of family strain.

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.