External Publications Using GUI Data

Background
The incidence and prevalence of childhood chronic disease is increasing worldwide. Obesity, poor diet and lifestyle may be more prevalent in children with a chronic disease than in their healthier contemporaries. The Growing Up in Ireland (GUI) study is a nationally representative cohort study of children living in the Republic of Ireland. The study has collected information from 8568 9-year-old Irish children on their experiences within their families, childcare settings, schools and communities, and how these impact on all aspects of children’s development.

Aims
This study aims to establish the prevalence of parentally reported chronic disease in children in Ireland and to describe their diet and lifestyle.

Methods
This study analyzed data from the Growing Up in Ireland longitudinal child cohort study and compared the diet, lifestyle and prevalence of obesity in children with and without a parentally reported chronic disease.

Results
Overall, 954 parents in the sample (11.1%) reported that their child had a chronic illness and 43.4% of these children are hampered by it in their daily activities. Respiratory disorders were the commonest type of chronic disease (46%) reported. Children with a chronic illness were more likely to be overweight or obese (32.9% compared to 25.0% of those without a chronic illness, p < 0.001). Children with chronic illness were also found to have a poorer diet, take less exercise and experienced significantly more social isolation than their peers (all p < 0.05).

Conclusions
Public health measures to address diet and lifestyle choices need to be cognisant of the needs of children with chronic diseases and tailor activities offered to be inclusive of all children. Medical professionals having contact with children with chronic conditions need to remember to reinforce the importance of diet and lifestyle whenever possible and to explore with families solutions to barriers to making healthy diet and lifestyle choices.

This paper explores the role of antenatal care in determining mode of birth in the Irish healthcare system using data from the Growing Up in Ireland study. Results indicate that midwifery-led antenatal care is independently associated with significantly higher rates of normal delivery and significantly lower rates of elective caesarean section relative to consultant-led care in both the public and private sectors. Given concerns over increasing rates of caesarean section, our results are consistent with calls nationally and internationally for further investment in midwifery-led antenatal care services, and for stricter regulation of the actors, both providers and patients, engaged in the private antenatal care pathway.

Background
Psychotic experiences (PEs) are commonly reported in adolescence and are associated with a range of negative outcomes. Few targets for intervention for PEs have been identified. One potential target is self-concept: an individual’s beliefs about his/her personal attributes. Improvements in self-concept have been shown to reduce psychotic symptoms in patients with schizophrenia but no study has investigated the relationship between changes in self-concept and risk of PEs in the general population.

We aimed to investigate: (a) the relationship between child and adolescent self-concept and adolescent PEs; and (b) whether changes in self-concept between childhood and adolescence were associated with risk of adolescent PEs.

Method
Using data from age 9 and age 13 (n = 7,423) of the child cohort (Cohort’98) from the Growing Up in Ireland study we investigated the relationship between self-concept at age 9 and age 13 and PEs at age 13. PEs were measured using the Adolescent Psychotic Symptoms Screener and self-concept was measured using the Piers Harris-II. Using a stratified analysis, we investigated the relationship between change in self-concept between age 9 and age 13 and the risk of PEs at age 13. Additionally we investigated changes across the six self-concept subscales.

Results
Psychotic experiences were reported by 13% of participants at age 13. ‘Very low’ self-concept at age 9 was associated with an increased risk of PEs at age 13 (Adjusted-OR: 2.74, CI: 1.80–4.19), and ‘High’ self-concept at age 9 was associated with a decreased risk of PEs at age 13 (Adjusted-OR: 0.77, CI: 0.60–0.97). The stratified analysis indicated that improvements in self-concept reduced the odds of adolescent PEs and decline in self-concept increased the odds of adolescent PEs. This effect was noted across the majority of the self-concept subscales.

Conclusions
There is a strong relationship between self-concept and PEs. The antecedents of low self-concept may be a useful target for preventative psychiatry. Broad-spectrum interventions targeting self-concept in childhood may help to reduce the incidence of PEs in adolescence

Background
Taking oral antibiotics during childhood has been linked with an increased risk of childhood obesity. This study assessed any potential association in number of courses of antibiotics taken between 2–3 and 4–5 years of age and body mass trajectory up to age 5.

Methods
The study was a secondary analysis of 8186 children and their parents from the infant cohort of the Irish National Longitudinal Study of Children. Antibiotic use was measured by parental recall between ages 2–3 and 4–5. Longitudinal models described the relationship between antibiotic exposure and body mass index (BMI) standard deviation scores and binary outcomes, and examined interactions between covariates, which included socioeconomic status, diet assessed by food frequency questionnaires and maternal BMI.

Results
Any antibiotic usage between 2 and 3 years did not predict risk of overweight or obesity at age 5. Four or more courses of antibiotics between 2 and 3 years were independently associated with obesity at age 5 (odds ratio 1.6, 95% confidence interval 1.11–2.31). Effect size was modest (coefficient + 0.09 body mass SD units, standard error 0.04, P = 0.037). Maternal BMI modified the relationship: ≥ 4 courses of antibiotics between 2 and 3 years were associated with a + 0.12 body mass SD units increase in weight at age 5 among children of normal-weight mothers (P = 0.035), but not in children of overweight mothers.

Conclusions
Number of antibiotic courses, rather than antibiotic use, may be an important factor in any link between early antibiotic exposure and subsequent childhood obesity. Research is needed to confirm differential effects on babies of normal versus overweight/obese mothers independent of socioeconomic factors.

The transition from primary to secondary school represents one of the key junctions in the educational career of young people. Research has shown that much of the challenge in this transition stems from changing social structures and encountering different learning environments. However, the transition experiences of students with special educational needs (SEN) have received relatively little attention. Drawing on large-scale longitudinal data from over 7000 young people, we examine the extent to which students with different SEN experience additional transition barriers to their peers. The findings show that young people with SEN are more likely to experience a negative transition to secondary school. Furthermore, the type of need matters and students with general learning disabilities and intellectual disabilities are three times more likely to experience poor transition compared to young people without SEN. Transition experiences also vary by gender and socio-economic status, with girls and lower socio-economic groups more at risk. This paper highlights the importance of supporting students through to their second year in secondary education, promoting positive teacher–student interactions and providing additional supports for those with lower achievement in primary school. For students with disabilities, the research highlights a need for more effective transition supports, particularly during the pre-transition period.

Keywords
Transition, academic supports, social supports, special educational needs, secondary school

Background
Social inequalities in the prevalence of childhood overweight and obesity are well-established, but less is known about when the social gradient first emerges and how it evolves across childhood and adolescence.

Objective
This study examines maternal education differentials in children’s body mass trajectories in infancy, childhood and adolescence using data from four contemporary European child cohorts.

Methods
Prospective data on children’s body mass index (BMI) were obtained from four cohort studies—Generation XXI (G21—Portugal), Growing Up in Ireland (GUI) infant and child cohorts, and the Millennium Cohort Study (MCS—UK)—involving a total sample of 41,399 children and 120,140 observations. Children’s BMI trajectories were modelled by maternal education level using mixed-effect models.

Results
Maternal educational inequalities in children’s BMI were evident as early as three years of age. Children from lower maternal educational backgrounds were characterised by accelerated BMI growth, and the extent of the disparity was such that boys from primary-educated backgrounds measured 0.42 kg/m2 (95% CI 0.24, 0.60) heavier at 7 years of age in G21, 0.90 kg/m2(95% CI 0.60, 1.19) heavier at 13 years of age in GUI and 0.75 kg/m2 (95% CI 0.52, 0.97) heavier in MCS at 14 years of age. The corresponding figures for girls were 0.71 kg/m2 (95% CI 0.50, 0.91), 1.31 kg/m2 (95% CI 1.00, 1.62) and 0.76 kg/m2 (95% CI 0.53, 1.00) in G21, GUI and MCS, respectively.

Conclusions
Maternal education is a strong predictor of BMI across European nations. Socio-economic differentials emerge early and widen across childhood, highlighting the need for early intervention.

Objective
This paper examines the joint impact of maternal employment and childcare during infancy on childhood weight at ages three and five in the context of weak social support for early childhood care and education.

Method
Using three waves of longitudinal data from the Growing-Up in Ireland survey (n = 8,393 age three, n = 8,039 age five), propensity score matching is used to address the endogeneity of employment and childcare decisions. Selection on observables is used to assess potential bias arising from selection on unobservables whereby unobserved characteristics of the mother or child may jointly influence child weight and maternal employment and childcare.

Results
Full-time maternal employment at nine months combined with either formal or informal childcare increases the likelihood of being overweight at three years by 8.1% and 5.9% respectively, but only for children of highly educated mothers. Similar results are observed for part-time employment coupled with informal (7.5%) or parental (8.0%) care. The results for mothers with lower levels of education are either not significant or favourable. While the majority of the effects dissipate by age five, there is some evidence that full-time maternal employment coupled with informal care increases the risk of being overweight at both ages three and five for children of higher-educated mothers. An assessment of selection bias finds that the estimates of full-time employment combined with formal childcare by well-educated mothers are a lower bound, such that the true effect on child weight may be understated.

Conclusions
The findings for Ireland are consistent with studies from the United States and the United Kingdom, and are in contrast to findings from the rest of Europe, suggesting the role of institutional factors, such as the lack of subsidised, universal, high-quality childcare.

Growing Up in Ireland (GUI) is a two-cohort, longitudinal study of children and young people. The study aims to describe the health and development of Irish children across a range of topics; these include physical and mental health, family socio-demographic status, education, and the child’s behaviour, attitudes and key relationships. The study has been collecting data since 2007, beginning with a child cohort at nine years old (n = 8,568) and then an infant cohort at nine months old (n = 11,134). These data provide researchers and policy makers with a unique analytical tool to explore the well-being of children in Ireland. This paper provides an overview of all the stages involved in the development of the study, from its inception, to the establishment of the study’s aims, objectives and design, the ongoing data collection and panel maintenance, and the many uses of GUI data today.

The notion that digital-screen engagement decreases adolescent well-being has become a recurring feature in public, political, and scientific conversation. The current level of psychological evidence, however, is far removed from the certainty voiced by many commentators. There is little clear-cut evidence that screen time decreases adolescent well-being, and most psychological results are based on single-country, exploratory studies that rely on inaccurate but popular self-report measures of digital-screen engagement. In this study, which encompassed three nationally representative large-scale data sets from Ireland, the United States, and the United Kingdom (N = 17,247 after data exclusions) and included time-use-diary measures of digital-screen engagement, we used both exploratory and confirmatory study designs to introduce methodological and analytical improvements to a growing psychological research area. We found little evidence for substantial negative associations between digital-screen engagement—measured throughout the day or particularly before bedtime—and adolescent well-being.

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.

Several approaches frame childbirth as an event that can reduce partnership quality, generate work-family conflicts, intensify financial pressures, and increase separation risk. The present study discusses theories of separation in relation to pregnancy intentions leading to a birth and analyses data from Growing Up in Ireland. Transition rate models of parental separation nine months to five years after childbirth show higher risks of separation after pregnancies described as “somewhat too early”, “much too early” and after “unwanted” pregnancies. These differences are due partly to sociodemographic factors that influence unplanned pregnancies and subsequent separation. Increases in workfamily conflicts after birth do not increase separation risk.

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

It is well established that stressful life events (e.g., family bereavements or moving to a new country) are damaging to psychological health and well-being. Indeed, social relationships are often noted as an important factor that can influence well-being and buffer the negative effects of stress. However, the quality and source of these relationships, particularly for adolescents, are often overlooked. Using the Growing Up in Ireland Survey, a population-based study of 13-year-old Irish adolescents (N = 7,525; 51.1% female), the current study examines the quality of both parent and peer relationships as potential mechanisms explaining the association between stressful life events and psychological well-being indices in adolescents. As expected, results showed that stressful life events negatively impacted the psychological well-being of adolescents. Parallel mediation analyses indicated that both parent and peer relationship quality mediated this association. Further exploratory analyses found that for girls, greater numbers of stressful life events were associated with poorer quality relationships with both their parents and peers, and in turn, these were linked to lower levels of psychological well-being. For boys, this effect was only evident for parental relationship quality, but not peers. The implication of these findings for adolescent’s psychological well-being, particularly for girls, is discussed.

This article explores the role that home-learning activities (HLAs) play in the relationship between social origin and cognitive development using an Irish birth cohort study, Growing Up in Ireland. Numerous studies using different measures of the home-learning environment (HLE) have shown that it has considerable influence on young children’s cognitive development, and that the HLE is often linked to social origin. We find a social gradient in vocabulary even at age 3 years, with the largest gaps for mothers’ education. Family income, mothers’ education, and social class are also associated with vocabulary independently, though these associations are reduced by adding all three measures simultaneously. The extent of HLAs helps explain a very small part of the education differences and none of the income or social class differences in vocabulary. We find some evidence that HLAs may be more salient for children from families with low income and lower social class backgrounds in terms of supporting vocabulary development, thereby compensating somewhat for disadvantage. HLAs also appear to encourage vocabulary development between age 3 and 5, and play a role in reducing the gap in vocabulary between high- and low-income children.

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.

This report uses data from the ‘98 cohort of Growing Up in Ireland (GUI) to examine when, where and how young people receive information on sex and relationships, and the role of this information in shaping sexual competence (or readiness) and behaviours among Irish adolescents.

New ESRI research, funded by HSE Health and Wellbeing, examines how 4 key risk factors for disease (smoking, alcohol consumption, physical activity, diet) cluster together among young adults. Using data from the Growing up in Ireland ’98 Cohort at 17 years of age, the research identified 3 distinct health behaviour clusters among young adults in Ireland: a ‘healthy’ group, an ‘unhealthy group’ and an ‘unhealthy smokers and drinkers group’.

Objective
This study examines the association between attention-deficit/hyperactivity disorder (ADHD) and overweight/obesity in a large-scale longitudinal study of children, while controlling for a range of psychosocial factors.

Method
Data were obtained from Growing Up in Ireland, a nationally representative and longitudinal study of approximately 6500 children who were assessed at 9 and 13 years of age. Body mass index (BMI) was determined using measured height and weight, ADHD status was determined by parent reports of professional diagnoses and ADHD symptoms were measured using the Strengths and Difficulties Questionnaire (SDQ).

Results
The associations between ADHD status, ADHD symptoms (SDQ) and BMI category at age 9 and 13 years were evaluated using logistic regression. Adjustments were made for child factors (sex, developmental coordination disorder, emotional symptoms, conduct problems, birth weight and exercise) and parental factors (socio-economic status, parental BMI, parental depression, and maternal smoking and alcohol use during pregnancy). Logistic regression indicated that ADHD status was not associated with BMI category at 9 or at 13 years of age, but children with ADHD at 9 years were significantly more likely to be overweight/obese at 13 years than those without ADHD. However, when other child and parental factors were adjusted for, ADHD status was no longer significantly associated with weight status. Female sex, low levels of exercise, overweight/obese parents and prenatal smoking during pregnancy consistently increased the odds of childhood overweight/obesity.

Conclusions
While ADHD and overweight/obesity co-occur in general populations, this relationship is largely explained by a variety of psychosocial factors.

Keywords
ADHD, longitudinal, obesity, overweight, psychosocial

Background
Public health policies attempt to increase parental identification of child overweight and obesity. The objective of the present research was to determine the cross-sectional, prospective and longitudinal associations between parental identification of child overweight and child mental health problems.

Methods
We made use of two cohort studies of Australian (Longitudinal Study of Australian Children, LSAC) and Irish children (Growing up in Ireland Study, GUI) that measured parental identification of child overweight and child mental health problems. Participant included 6502 (LSAC) and 7503 (GUI) children (49% female) and their parents. Child mental health problems were measured using child, parent and teacher-reported Strengths and Difficulties Questionnaires (SDQ) at ages 9/10 years old to 12/13 years old. In all analyses we controlled for child Z-BMI.

Results
In LSAC children whose parents identified them as being overweight at age 10 experienced worse mental health at age 10 (β = 0.21, SE = 0.04) and age 12 (β = 0.13, SE = 0.04) than children whose parents failed to identify them as overweight. In GUI children whose parents identified them as being overweight at age 9 experienced worse mental health at age 9 (β = 0.20, SE = 0.04) and age 13 (β = 0.22, SE = 0.04). In LSAC parental identification of child overweight at age 10 did not significantly predict changes in mental health problems from age 10 to 12 (β = −0.02, SE = 0.03). In GUI parental identification of child overweight was predictive of increases in mental health problems from age 9 to 13 (β = 0.08, SE = 0.03).

Conclusions
Parental identification of child overweight and obesity is associated with worse child mental health, independent of child body weight. Parents should be aware of the potential stigma and mental health difficulties associated with labelling a child as overweight.