External Publications Using GUI Data

Chapter 11 discusses healthcare use among children and the extent to which the current system of healthcare financing in Ireland leads, in particular, to differences in patterns of the use of GP services by children that are not predicted by their need for healthcare. The analysis investigates not only variations in use levels but also considers the demand implications of future policy proposals around extending free GP care to further cohorts of children.

Chapter 12 considers the prevalence of anti-social behaviour in the early teenage years in Ireland, the nature of this behaviour and the extent to which anti-social behaviour is associated with socio-economic characteristics of the family, family structure and other factors such as parenting style, the adolescent’s self-esteem and peer influences.

Chapter 6 provides a detailed discussion of the history of childcare provision in Ireland throughout the 20th century before investigating trends in non-parental childcare for infants in the first few years of life. The role of the Free Pre-school Year, a major policy shift in the Irish context, is also discussed.

Chapter 8 examines aspects of provision for children with special educational needs and considers their inclusion within Irish mainstream education in recent years. It considers how much of the education and care of children with special needs in the early decades of the 20th century was provided by religious orders before going on to discuss how, since the early 1990s, there has been a substantial shift in focus from segregated educational provision towards a more inclusive view of special education, mainly delivered within mainstream schools. In particular, the chapter considers the proportion of children with special educational needs and variations in levels according to the background characteristics of the children in question.

Child chronic illness/ disability can present significant challenges for children, families and society that require appropriate policy responses; yet little is known about the demands placed on families resources from an economics perspective in terms of its impact on household income and the extra income required to achieve the same standard of living as families who do not have a child with a chronic illness/disability. The paper uses data from the Growing Up in Ireland National survey dataset for nine year olds. It is the first study to empirically investigate the impact of child chronic illness/disability on earnings, standard of living and the extra cost of disability together. It is also the first study to explicitly address endogeneity in the standard of living model by using a two-stage process where residuals were harvested to provide efficient estimates. The findings show that families experience significant disadvantage and economic hardship due to reduced household income and a lower standard of living due to the extra cost of disability that would require considerable income to compensate. Policy implications of these findings suggest that a tiered approach to disability support payments which encompass broader criteria for inclusion based on varying severity levels be introduced to alleviate the financial hardship and compromised economic wellbeing of families affected. In addition, more innovative policies are required to implement appropriate timely access to health and social care services and flexi parental employment, which in turn requires the provision of adequate access to high quality educational and care facilities.

Childhood obesity is a growing concern worldwide. The association between childhood obesity and maternal smoking and/or paternal smoking has been reported. However, few studies have explored the association between childhood obesity and exposure to carers’ smoking status. This study aimed to assess the impact of carers’ smoking status on childhood obesity in a cohort of children enrolled in the Growing up in Ireland (GUI) study. Participants from the GUI infant cohort were categorized into four groups based on their exposure status: Neither caregiver smoked (60.4%), only primary caregiver smoked (13.4%), both caregivers smoked (10.9%). Exposure to primary carers’ smoking (98% are biological mothers) was found to be significantly associated with childhood overweight/obesity at age three (Odds Ratio: 1.30, 95% CI: 1.17–1.46) and at age five (OR: 1.31, 95% CI: 1.16–1.49). Exposure to both carers’ smoking status was significantly associated with increased odds of childhood overweight/obesity across both waves. These findings emphasize the health burden of childhood obesity that may be attributable to maternal smoking postnatally and through early childhood in Ireland.

Keywords
growing up in Ireland, childhood obesity, primary carer, secondary carer

Children born preterm have poorer outcomes than children born full-term, but the caregiving environment can ameliorate some of these differences. Recent research has proposed that preterm birth may be a plasticity factor, leading to better outcomes for preterm than full-term infants in higher quality environments. This analysis uses data from two waves of an Irish study of children (at 9 months and 3 years of age, n = 11,134 children) and their caregivers (n = 11,132 mothers, n = 9998 fathers) to investigate differences in how caregiving affects social, cognitive, and motor skills between full-term, late preterm, and very preterm children. Results indicate that parental emotional distress and quality of attachment are important for child outcomes. Both being born very preterm and late preterm continue to be risk factors for poorer outcomes at 3 years of age. Only fathers’ emotional distress significantly moderated the effect of prematurity on infants’ cognitive and social outcomes—no other interactions between prematurity and environment were significant. These interactions were somewhat in line with diathesis stress, but the effect sizes were too small to provide strong support for this model. There is no evidence that preterm birth is a plasticity factor.

Children live in a technology-mediated world, and most young people use a variety of technologies in their daily lives. However, despite intense public discourse, we have little empirical evidence on how technology use impacts on children’s development across a number of psycho-social domains. Research that has been conducted tends to be largely small-scale or cross-sectional in nature and most often focused on (young) adults rather than children. Using longitudinal data on one-in-eight Irish children, we use econometric methods to test for associations between early mobile phone ownership and two measures of children’s psycho-social development between 9 and 13 years of age. We examine the Piers Harris Self-Concept Scale, reported by children, and the Strengths and Difficulties (SDQ) score, completed by the primary caregiver. We find no generalised associations between early mobile phone ownership and psycho-social outcomes. However, there is evidence that associations differ by gender and across psycho-social sub-domains. We find no robust associations affecting boys, but girls who receive phones earlier fare less well in terms of their behavioural adjustment and academic self-concept scores at 13 years of age, all else being equal. Further research is needed to identify causal mechanisms and explore possible mediating effects of family/social context.

KEYWORDS: Mobile phone ownership; psychological adjustment; self-concept; gender; longitudinal data; Piers Harris; SDQ

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.

Children with disabilities experience significantly poorer socio-emotional outcomes than their peers without disabilities. However, research evidence is scarce about children with both disability and migration background, the group which this study aimed to investigate using data from a national longitudinal study. Secondary data analyses were conducted on a sample of 7290 children (weighted with missing values imputed). Significant differences in socio-emotional outcomes were found in relation to impairment status but not in relation to migration. Having an impairment and activity limitation significantly increased the likelihood of experiencing poorer socio-emotional outcomes over time. Our findings highlight a higher risk of socio-emotional problems among children with disabilities, especially among children from lower income backgrounds and with parents with lower educational attainment. These findings clearly require policy development on two fronts: to raise professional and community awareness on these issues and to strengthen the capacity of health, education and social care systems to support schools, families, and communities.

Children, particularly those of preschool ages (below 3 years), spend the majority of time indoors in the family home. Home conditions can impact upon occupant’s health, with energy poverty identified as a public health concern in Europe and internationally. Children growing up in energy poor homes may be especially vulnerable to health impacts, though the area is relatively understudied. This study addresses a gap in understanding, examining the effect of household energy poverty on the health of resident children using longitudinal data from two cohorts – an Infant Cohort (aged 9 months to 5 years) and a Child Cohort (aged 9 years to 17–18 years), growing up in Ireland.

Panel logistic regression models adjust for a range of covariates including socioeconomic and household information as well as smoking in the household. For the Infant Cohort, household energy poverty was associated with a 1.41 times higher odds of child respiratory illness (p = 0.003; 95% Confidence Interval (CI) 1.12–1.77), and 1.47 times the odds of child wheezing (p < 0.001; 95% CI 1.25–1.74). The odds of a young child being rated as very healthy was lower (point estimate: 0.85, p = 0.011; 95% CI 0.75–0.96). For older children, the relationships were not statistically significant. The risk that energy poverty presents for the health of young children merits continued policy attention.

Children’s parent and teacher relationships contribute to school adjustment and achievement, yet few studies have examined interactions between these relationships, particularly for father-child relationships. Using the Growing Up in Ireland birth cohort (N = 7,507 children, 50.3% male), we examined child-adult relationship quality – rated by mothers and fathers at age 3 and teachers at age 5 – as predictors of behavioural adjustment (rated by teachers) and academic achievement (formal reading assessments and self-reported academic self-concepts) at age 9. Controlling for prior levels of problem behaviours, verbal ability, and family SES, results indicated small and comparable independent effects of children’s parent and teacher relationships on school adjustment and achievement. For mothers and teachers, moderation analyses showed a cumulative risk pattern for conflictual relationships and a compensatory pattern for close relationships. Children are likely to benefit from improving closeness and reducing conflict in adult-child relationships and interventions that involve mothers, fathers, and teachers.

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.

Collecting accurate and detailed dietary intake data is costly at a national level. Accordingly, limited dietary assessment tools such as Short Food Questionnaires (SFQs) are increasingly used in large surveys. This paper describes a novel method linking matched datasets to improve the quality of dietary data collected. Growing Up in Ireland (GUI) is a nationally representative longitudinal study of infants in the Republic of Ireland which used a SFQ (with no portion sizes) to assess the intake of “healthy” and “unhealthy” food and drink by 3 years old preschool children. The National Preschool Nutrition Survey (NPNS) provides the most accurate estimates available for dietary intake of young children in Ireland using a detailed 4 days weighed food diary. A mapping algorithm was applied using food name, cooking method, and food description to fill all GUI food groups with information from the NPNS food datafile which included the target variables, frequency, and amount. The augmented data were analyzed to examine all food groups described in NPNS and GUI and what proportion of foods were covered, non-covered, or partially-covered by GUI food groups, as a percentage of the total number of consumptions. The term non-covered indicated a specific food consumption that could not be mapped using a GUI food group. “High sugar” food items that were non-covered included ready-to-eat breakfast cereals, fruit juice, sugars, syrups, preserves and sweeteners, and ice-cream. The average proportion of consumption frequency and amount of foods not covered by GUI was 44 and 34%, respectively. Through mapping food codes in this manner, it was possible, using density plots, to visualize the relative performance of the brief dietary instrument (SFQ) compared to the more detailed food diary (FD). The SFQ did not capture a substantial portion of habitual foods consumed by 3-year olds in Ireland. Researchers interested in focussing on specific foods, could use this approach to assess the proportion of foods covered, non-covered, or partially-covered by reference to the mapped food database. These results can be used to improve SFQs for future studies and improve the capacity to identify diet-disease relationships.

Despite dramatic changes in Irish special education policy during the last decade, there is little understanding of the factors influencing how special educational needs (SEN) are identified and whether identification varies across different school contexts. International research has tended to focus on how individual child characteristics influence SEN identification. Less attention has been given to other factors such as teacher characteristics or school social mix. Using data from the nine-year-old cohort of the Growing Up in Ireland study, this article examines which children are most likely to be identified with different SEN types taking into account student social background characteristics, teacher characteristics and school social mix. Findings show that children attending highly disadvantaged school contexts are far more likely to be identified with behavioural problems and less likely to be identified with learning disabilities than children with similar characteristics attending other schools. It seems that ‘behavioural’ issues take precedence over learning difficulties in these schools pointing to a culture of care/containment rather than academic progress.

Keywords
SEN identification, gender, social background, teacher characteristics, school context

Despite the right of disabled people to full social and economic inclusion, many face multiple day-to-day and systemic challenges. These include but are not limited to additional expenses, access to housing, and everyday accessibility difficulties. Surveys show the general public hold positive attitudes towards policies that seek to enable disabled people to overcome these challenges, but standard survey methods are susceptible to response biases that may overestimate this support. This study aimed to test whether two such biases influence support for disability policy in Ireland: social desirability bias (i.e. the tendency for survey respondents to alter their responses in order to present themselves in a positive light); and inattention to the implications of policy support (e.g. that welfare policies require funding). Together the survey experiments covered a range of policy issues and types of disability, as identified in previous research and in consultation with the disability advisory group for the project.

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.

Digital technologies have become an increasingly prominent feature of children’s lives both within and outside educational environments (McCoy, Quail, and Smyth 2012. Influences on 9-Year-Olds’ Learning: Home, School and Community. Dublin: Department of Children and Youth Affairs). Despite considerable media debate, we have little robust evidence on the impact of technology use on children’s development, both academically and socially. Much of the literature in this area relies on small-scale cross-sectional studies. Using longitudinal data on 8500 9-year-old children in Ireland, we examine the influence of early mobile phone ownership on children’s performance in reading and maths between 9 and 13 years of age. Across both reading and maths domains, children who already report owning a phone by the age of nine fare less well in terms of their academic development as they move into adolescence. The measured effects are sizeable, implying about 4 percentile lower ranking on standardised tests for an average student. Our results are consistent with the idea that there may be significant educational costs arising from early mobile phone use by children. Parents and policymakers should consider whether the benefits of phone availability for children are sufficiently large to justify such costs. We suggest a range of direct and indirect cognitive effects that could help explain these results.

KEYWORDS: Mobile phone ownership; child development; academic outcomes; early owners; longitudinal data

Drawing on curriculum differentiation theory, this paper discusses exemptions from learning Irish granted to Irish post-primary students. In order to explore the profile of students granted such exemptions, the study utilises data from a national longitudinal study, Growing Up in Ireland. Additional information is provided by administrative data collected by the Department of Education and Skills to show trends in the number of exemptions granted over time. The findings show that factors impacting on being exempt include gender, social class, having a special educational need at primary school and being born outside Ireland.

Keyword(s): post-primary schools, curriculum differentiation, exemptions from Irish, Ireland

Early nutrition plays a pivotal role in long-term health. The World Health Organization (WHO) recommends exclusive breastfeeding during the first six months of life, with the gradual introduction of solids after this period. However, studies in the Republic of Ireland (ROI) have shown poor compliance with guidelines. The ROI continues to have one of the lowest breastfeeding rates worldwide. Our objective was to analyse differences in breastfeeding and complimentary feeding behaviours between Irish and non-Irish mothers residing in the ROI, as well as the role of acculturation on these behaviours, using the national longitudinal study, Growing Up in Ireland (GUI). Mothers (n = 11,134) residing in the ROI were interviewed when their infants were nine months of age. The percentage of Irish mothers who initiated breastfeeding was 49.5%, as opposed to 88.1% among the non-Irish cohort (p < 0.001). Breastfeeding initiation reduced from 89.4% of non-Irish mothers who had arrived within the last year to five years ago to 67.5% for those who had arrived 11 to >20 years ago (p < 0.001). Our results indicate that cultural differences are an important factor in shaping patterns of infant feeding in the ROI. Reviewing existing support and education policies for parents is required to achieve the implementation of desirable infant feeding practices.

Keywords: infant feeding; breastfeeding; complimentary feeding; acculturation