Alison Teyhan

Antibiotic exposure in the first two years of life and development of asthma and other allergic diseases by 7.5 yr: A dose-dependent relationship

Antibiotic use in infancy disrupts gut microflora during a critical period for immune system development. It is hypothesized that this could predispose to the development of allergic diseases. We investigated the associations of antibiotic use in the first 2 yr of life with the development of asthma, eczema or hay fever by age 7.5 yr in a longitudinal birth cohort.

Emergence of ethnic differences in blood pressure in adolescence: The Determinants of Adolescent Social Well-Being and Health Study

The cause of ethnic differences in cardiovascular disease remains a scientific challenge. Blood pressure tracks from late childhood to adulthood. We examined ethnic differences in changes in blood pressure between early and late adolescence in the United Kingdom. Longitudinal measures of blood pressure, height, weight, leg length, smoking, and socioeconomic circumstances were obtained from London, United Kingdom, schoolchildren of White British (n=692), Black Caribbean (n=670), Black African (n=772), Indian (n=384), and Pakistani and Bangladeshi (n=402) ethnicity at 11 to 13 years and 14 to 16 years. Predicted age- and ethnic-specific means of blood pressure, adjusted for anthropometry and social exposures, were derived using mixed models. Among boys, systolic blood pressure did not differ by ethnicity at 12 years, but the greater increase among Black Africans than Whites led to higher systolic blood pressure at 16 years (+2.9 mm Hg). Among girls, ethnic differences in mean systolic blood pressure were not significant at any age, but while systolic blood pressure hardly changed with age among White girls, it increased among Black Caribbeans and Black Africans. Ethnic differences in diastolic blood pressure were more marked than those for systolic blood pressure. Body mass index, height, and leg length were independent predictors of blood pressure, with few ethnic-specific effects. Socioeconomic disadvantage had a disproportionate effect on blood pressure for girls in minority groups. The findings suggest that ethnic divergences in blood pressure begin in adolescence and are particularly striking for boys. They signal the need for early prevention of adverse cardiovascular disease risks in later life.

AIDS mortality in African migrants living in Portugal: evidence of large social inequalities

Objective: To examine infectious disease and AIDS mortality among African migrants in Portugal, gender and socio-economic differences in AIDS mortality risk, and differences between African migrants to Portugal and to England and Wales. Methods: Data from death registrations, 1998–2002, and the 2001 Census were used to derive standardised death rates by country of birth, occupational class (men only), and marital status. Results: Compared with people born in Portugal, African migrants had higher mortality for infectious diseases including AIDS. There was considerable heterogeneity among Africans, with those from Cape Verde having the highest mortality. Death rates were more than five times higher among those who were unmarried than those who were. A larger proportion of Africans were unmarried accounting for some excess mortality. Death rates were also higher among men from manual occupational classes than among men from non-manual. A comparison with England and Wales shows that death rates for infectious disease and AIDS in Portugal are much higher and Africans in Portugal also fare worse than Africans in England and Wales. Conclusion: AIDS mortality rates were higher among Africans than those born in Portugal and were associated with socio-environmental factors. Further research is required to interpret the excess mortality among Africans and there is a need to ensure the inclusion of relevant data items on ethnicity in national monitoring and surveillance systems.

Child Allergic Symptoms and Well-Being at School: Findings from ALSPAC, a UK Cohort Study

Background Eczema and asthma are common conditions in childhood that can influence children’s mental health. Despite this, little is known about how these conditions affect the well-being of children in school. This study examines whether symptoms of eczema or asthma are associated with poorer social and mental well-being in school as reported by children and their teachers at age 8 years. Methods Participants were from the Avon Longitudinal Study of Parents and Children. Measures of child well-being in school were child-reported (n = 6626) and teacher reported (n = 4366): children reported on their enjoyment of school and relationships with peers via a self-complete questionnaire; teachers reported child mental well-being using the Strengths and Difficulties Questionnaire [binary outcomes were high ‘internalizing’ (anxious/depressive) and ‘externalizing’ (oppositional/hyperactive) problems (high was >90th percentile)]. Child rash and wheeze status were maternally reported and symptoms categorised as: ‘none’; ‘early onset transient’ (infancy/preschool only); ‘persistent’ (infancy/preschool and at school age); and ‘late onset’ (school age only). Results Children with persistent (OR 1.29, 95% CI 1.02 to 1.63) and late onset (OR 1.48, 95% CI 1.02 to 2.14) rash were more likely to report being bullied, and children with persistent wheeze to feel left out (OR 1.42, 95% CI 1.10 to 1.84). Late onset rash was associated with high teacher-reported internalising behaviours (OR 1.61, 95% CI 1.02 to 2.54), and persistent rash with high externalising behaviours (OR 1.37, 95% CI 1.02 to 1.84). Child sleep and maternal mental health explained some of the associations with teacher-reported mental well-being. Conclusion Symptoms of eczema or asthma can adversely affect a child’s social and mental well-being at primary school. This suggests interventions, such as additional support or education of peers, should begin at early stages in schooling.

Trends in suicide among migrants in England and Wales 1979–2003

Objective. Trends in suicide death rates among migrants to England and Wales 1979–2003 were examined. Methods. Age-standardised rates derived for eight country of birth groups. Results. For men born in Jamaica, suicide death rates increased in 1999–2003. There were declines in rates for men and women from India and from Scotland, men from East Africa and Northern Ireland and women from the Republic of Ireland. For both men and women born in Scotland or the Irish Republic, despite declines for some, rates remained higher than for England and Wales born. Rates among men from Pakistan were consistently lower than men born in England and Wales. Conclusion. These analyses indicate declining trends for most migrant groups and for England and Wales-born women, but adverse trends in death rates for some country of birth groups.

An evaluation of the impact of 'Lifeskills' training on road safety, substance use and hospital attendance in adolescence

Highlights • Lifeskills training is for 10–11 year olds and covers many safety domains.• Evaluated using longitudinal cohort data linked to hospital attendance data.• Attendance at A&E common but hospital admissions coded as due to an accident rare.• Lifeskills attendance associated with some reported safer behaviours in adolescence.• Use of cycle helmets and reflective/fluorescent clothing low overall.

Parental alcohol use and risk of behavioral and emotional problems in offspring

Objective The majority of studies that have examined parental alcohol use and offspring outcomes have either focused on exposure in the antenatal period or from clinical populations. This study sought to examine proximal and distal associations between parental alcohol use and offspring conduct problems and depressive symptoms in a population birth cohort. Methods We used prospective data from a large UK based population cohort (ALSPAC) to investigate the association between parental alcohol use, measured in units, (assessed at ages 4 and 12 years) with childhood conduct trajectories, (assessed on six occasions from 4 to 13.5 years, n = 6,927), and adolescent depressive symptoms (assessed on four occasions from ~13 to ~18 years, n = 5,539). Heavy drinking was defined as ≥21 units per week in mothers and partners who drank 4+ units daily. Results We found little evidence to support a dose response association between parental alcohol use and offspring outcomes. For example, we found insufficient evidence to support an association between maternal alcohol use at age 4 years and childhood conduct problems (childhood limited: OR = 1.00, 95% CI = .99, 1.01; adolescent onset: OR = 0.99, 95% CI = .98, 1.00; and early-onset persistent: OR = 0.99, 95% CI = .98, 1.00) per 1-unit change in maternal alcohol use compared to those with low levels of conduct problems. We also found insufficient evidence to support an association between maternal alcohol use at age 4 years and adolescent depressive symptoms (intercept: b = .001, 95% CI = -.01, .01, and slope: b = .003, 95% CI = -.03, .03) per 1-unit change in maternal alcohol use. Results remained consistent across amount of alcohol consumed (i.e., number of alcohol units or heavy alcohol use), parent (maternal self-reports or maternal reports of partner’s alcohol use), and timing of alcohol use (assessed at age 4 or age 12 years). Conclusions There is no support for an association between parental alcohol use during childhood and conduct and emotional problems during childhood or adolescence.

Changes in marital quality over 6 years and its association with cardiovascular disease risk factors in men: findings from the ALSPAC prospective cohort study

Background Marital relationship quality has been suggested to have independent effects on cardiovascular health outcomes. This study investigates the association between changes in marital relationship quality and cardiovascular disease (CVD) risk factors in men. Methods We used data from The Avon Longitudinal Study of Parents and Children, a prospective birth cohort study (Bristol, UK). Our baseline sample was restricted to married study fathers with baseline relationship and covariate data (n=2496). We restricted final analysis (n=620) to those with complete outcome, exposure and covariate data, who were married and confirmed the study child’s father at 6.4 years and 18.8 years after baseline. Relationship quality was measured at baseline and 6.4 years and operationalised as consistently good, improving, deteriorating or consistently poor relationship. We measured CVD risk factors of blood pressure, resting heart rate, body mass index, lipid profile and fasting glucose at 18.8 years after baseline. Results Improving relationships were associated with lower levels of low-density lipoprotein (−0.25 mmol/L, 95% CI −0.46 to −0.03) and relative reduction of body mass index (−1.07 kg/m2, 95% CI −1.73 to −0.42) compared with consistently good relationships, adjusting for confounders. Weaker associations were found between improving relationships and total cholesterol (−0.24 mmol/L, 95% CI −0.48 to 0.00) and diastolic blood pressure (−2.24 mm Hg, 95% CI −4.59 to +0.11). Deteriorating relationships were associated with worsening diastolic blood pressure (+2.74 mm Hg, 95% CI 0.50 to 4.98). Conclusions Improvement and deterioration of longitudinal relationship quality appears associated with respectively positive and negative associations with a range of CVD risk factors.

Response to: ‘On the approach for determining association between changes in marital quality and cardiovascular disease risk factors’ by MM Pike

We thank Ms Pike1 for her interest in our study. As is highlighted in the Discussion section of our paper,2 we agree that the exclusion of divorced men from our final analyses could have influenced the findings. This is one of many potential sources of bias that we identified in our discussion, including the exclusion of those whose marriages dissolved prior to or during the study, loss to follow-up bias due to participant attrition and the reduced likelihood that wives in poor quality relationships would have asked their partners to attend the follow-up clinic and hence would be missing. We highlighted these differences in our comparison of baseline covariate data, finding that, ‘as expected, men who were excluded from the analysis were more likely to be poorer, drink more alcohol and have worse marital quality.’ As noted in our discussion, we believe that ‘these biases would systematically attenuate any true relationship so that our observed findings may underestimate the true effect.’ We would not seek to generalise our findings to divorced men as post-divorce risk factors may well change due to different life circumstances, …

Adult psychosocial outcomes of men and women who were looked-after or adopted as children: prospective observational study

Objective To investigate whether men and women who were looked-after (in public care) or adopted as children are at increased risk of adverse psychological and social outcomes in adulthood. Design, setting Prospective observational study using the Avon Longitudinal Study of Parents and Children, which recruited pregnant women and their male partners in and around Bristol, UK in the early 1990s. Participants 8775 women and 3654 men who completed questionnaires at recruitment (mean age: women 29; men 32) and 5 years later. Exposure Childhood public care status: looked-after; adopted; not looked-after or adopted (reference group). Outcomes Substance use (alcohol, cannabis, tobacco) prepregnancy and 5 years later; if ever had addiction; anxiety and depression during pregnancy and 5 years later; if ever had mental health problem; social support during pregnancy; criminal conviction. Results For women, 2.7% were adopted and 1.8% had been looked-after; for men, 2.4% and 1.4%, respectively. The looked-after group reported the poorest outcomes overall, but this was not a universal pattern, and there were gender differences. Smoking rates were high for both the looked-after (men 47%, women 58%) and adopted (men 44%, women 40%) groups relative to the reference group (both 28%). The looked-after group were at increased risk of a high depression score (men: 26% vs 11%, OR 2.9 (95% CI 1.5 to 5.6); women: 24% vs 9%, 3.4 (2.2 to 5.0)). A high anxiety score was reported by 10% of the reference women, compared with 26% of those looked-after (3.0 (2.0 to 4.5)) and 17% of those adopted (1.8 (1.2 to 2.6)). Looked-after men and women reported the lowest social support, while criminal convictions and addiction were highest for looked-after men. Adjustment for adult socioeconomic position generally attenuated associations for the looked-after group. Conclusions The needs of those who experience public care as children persist into adulthood. Health and social care providers should recognise this.