Anna Pearce

Factors associated with uptake of measles, mumps, and rubella vaccine (MMR) and use of single antigen vaccines in a contemporary UK cohort: prospective cohort study

Objectives To estimate uptake of the combined measles, mumps, and rubella vaccine (MMR) and single antigen vaccines and explore factors associated with uptake and reasons for not using MMR. Design Nationally representative cohort study. Setting Children born in the UK, 2000-2. Participants 14 578 children for whom data on immunisation were available. Main outcome measures Immunisation status at 3 years defined as “immunised with MMR,” “immunised with at least one single antigen vaccine,” and “unimmunised.” Results 88.6% (13 013) were immunised with MMR and 5.2% (634) had received at least one single antigen vaccine. Children were more likely to be unimmunised if they lived in a household with other children (risk ratio 1.74, 95% confidence interval 1.35 to 2.25, for those living with three or more) or a lone parent (1.31, 1.07 to 1.60) or if their mother was under 20 (1.41, 1.08 to 1.85) or over 34 at cohort child’s birth (reaching 2.34, 1.20 to 3.23, for ≥40), more highly educated (1.41, 1.05 to 1.89, for a degree), not employed (1.43, 1.12 to 1.82), or self employed (1.71, 1.18 to 2.47). Use of single vaccines increased with household income (reaching 2.98, 2.05 to 4.32, for incomes of ≥£52 000 (€69 750,

Is childcare associated with the risk of overweight and obesity in the early years? Findings from the UK Millennium Cohort Study

102 190)), maternal age (reaching 3.04, 2.05 to 4.50, for ≥40), and education (reaching 3.15, 1.78 to 5.58, for a degree). Children were less likely to have received single vaccines if they lived with other children (reaching 0.14, 0.07 to 0.29, for three or more), had mothers who were Indian (0.50, 0.25 to 0.99), Pakistani or Bangladeshi (0.13, 0.04 to 0.39), or black (0.31, 0.14 to 0.64), or aged under 25 (reaching 0.14, 0.05 to 0.36, for 14-19). Nearly three quarters (74.4%, 1110) of parents who did not immunise with MMR made a “conscious decision” not to immunise. Conclusions Although MMR uptake in this cohort is high, a substantial proportion of children remain susceptible to avoidable infection, largely because parents consciously decide not to immunise. Social differentials in uptake could be used to inform targeted interventions to promote uptake.

Gaining children's perspectives: a multiple method approach to explore environmental influences on healthy eating and physical activity.

Background:A recent assessment of childcare in OECD (Organisation for Economic Co-operation and Development) countries highlighted the potential for childcare to widen inequalities. Although childcare offers a potential setting for obesity prevention, little research has analysed the association between childcare and overweight, particularly in different socio-economic groups.Objectives:Our primary objective was to explore the association between childcare and overweight (including obesity), both overall and by socio-economic background, in a contemporary UK cohort of children at age 3 years (N=12 354). Our secondary objective was to explore infant feeding as a potential mediator between childcare in infancy and overweight at age 3 years.Results:After controlling for confounders, children who were cared for in informal childcare (75% grandparents) between the age of 9 months and 3 years were more likely to be overweight than those cared for only by a parent (adjusted risk ratio (aRR)=1.15, 95% confidence interval (CI) 1.04–1.27), particularly if they were in full-time childcare (aRR=1.34, 95% CI 1.15–1.57). When stratifying by socio-economic background, the increased risk of overweight in informal childcare (compared with parental care) was limited to children from more advantaged groups: those whose mother was from a managerial or professional background (aRR=1.23, 95% CI 1.02–1.47), had a degree (RR=1.43, 95% CI 1.13–1.83) or lived in a couple household (RR=1.18, 95% CI 1.06–1.32). There was no association between formal childcare and overweight. Infant feeding did not mediate the association between childcare use in infancy and overweight at age 3 years.Conclusions:Children from more advantaged families who use informal childcare are at increased risk of overweight. The UK governments drive to support parents into paid employment should be accompanied by health-related information and support for both informal and formal carers. As the majority of informal carers were grandparents, the recent government announcement to provide grandparents with National Insurance credits for caring for grandchildren provides a potential opportunity for health promotion.

The rise of food poverty in the UK

In order to inform local action for health improvement, this pilot study used multiple methods to explore childrens perspectives of environmental influences on their eating and physical activity. Thirty-nine children aged 9-11 years from a North London local authority took photos, drew maps, and attended focus groups. We found that the approach engaged children and that each of the methods returned useful, complementary information. The results highlighted a number of areas for local policymakers and practitioners to consider when developing work to prevent childhood obesity. We conclude that these methods of gaining childrens views should be further developed and tested.

Barriers to childhood immunisation: Findings from the Longitudinal Study of Australian Children

Garcia Rada highlights the rise in child poverty and child malnutrition in Catalonia, Spain, since the economic crisis.1 But closer to home, the number of malnutrition related admissions to hospital in England has doubled since 2008-09 (figure⇓).2 Admissions related to malnutrition and number of people using food banks …

Do early‐life exposures explain why more advantaged children get eczema? Findings from the U.K. Millennium Cohort Study

Highlights • A known group of under-immunising parents in Australia are conscientious objectors.• However we found that most under-immunising parents do not disagree with immunisation.• These parents experience a heterogeneous range of barriers to immunisation.• Eg low social contact, psychological distress, large families, child health concerns.• Tailored interventions are required to address these varying needs.

Residential mobility and uptake of childhood immunisations: findings from the UK Millennium Cohort Study

Atopic dermatitis (eczema) in childhood is socially patterned, with higher incidence in more advantaged populations. However, it is unclear what factors explain the social differences.

The role of poverty in explaining health variations in 7-year-old children from different family structures: findings from the UK Millennium Cohort Study

It has been hypothesised that lower vaccine uptake in childhood among some groups, such as children of lone parents or from larger families, may be due to their higher levels of residential mobility. This paper aimed to explore this association in a large cohort of children born in the UK at the turn of the century. Using multi-variable Poisson regression we found that children who lived in families which had moved during pregnancy or more frequently were more likely to be partially immunised with the primary immunisations and unimmunised against measles, mumps and rubella. Mobility was not associated with being unimmunised with the primary vaccines, or with single measles, mumps and rubella antigen vaccine use. These findings suggest that policies are needed to encourage the building and maintenance of relationships between health care professionals and parents, before and after they move, and better use of IT systems to aid follow-up of mobile families.

Does the home environment influence inequalities in unintentional injury in early childhood? Findings from the UK Millennium Cohort Study

Background Despite rises in reconstituted and lone-parent families, relatively little is known about how the health of children in different family types varies, and the extent to which any differences might be explained by poverty. The authors examined this using cross-sectional data on 13 681 seven-year-olds from the Millennium Cohort Study. Methods The authors estimated RRs and 95% CIs for having poor physical (general health, long-standing illness, injury, overweight, asthma, fits) and mental health (using strengths and difficulties scores) according to family structure using Poisson regression. The authors adjusted for confounders (aRR) and then investigated the role of poverty as a mediator by entering a poverty score (based on income, receipt of benefits, subjective poverty and material deprivation) into the main model. Results Children living in reconstituted and lone-parent families were at a slight increased risk of poor health compared with those living with two natural parents. Adjusting for poverty tended to remove the elevated risk of poor physical health in children living in lone-parent and reconstituted families. However, for the mental health outcomes, poverty tended to remove the elevated risk for lone parents but not for reconstituted families. For example, the aRR for borderline–abnormal total difficulties fell from 1.45 (1.22 to 1.72) to 1.34 (1.13 to 1.59) in children living in reconstituted families and from 1.29 (1.14 to 1.45) to 1.05 (0.92 to 1.19) in those living with lone parents. Conclusions Poor physical and mental health was slightly more prevalent in children living in lone-parent or reconstituted families. Poverty reduction may help to reduce these differences, especially for children living with lone parents; however, alternative mechanisms should be also explored, particularly for children living in reconstituted families.

Exploring the impact of early life factors on inequalities in risk of overweight in UK children: findings from the UK Millennium Cohort Study

Background Children from disadvantaged backgrounds are more likely to experience unintentional injuries and poor home environments. The aim of this study was to explore the home environment as a potential mediator between socioeconomic circumstances and unintentional injuries, in the UK Millennium Cohort Study (n=14 378). Methods RRs and 95% CIs for being injured in the home between age 9 months and 3 years were estimated according to four measures of socioeconomic circumstances: social class, maternal education, lone parenthood status and tenure. Proxy indicators of housing quality (build type, storey, garden access, rooms per capita, central heating and presence of damp) and safety equipment use (use of fireguards, safety gates, electric socket covers and smoke alarms) were then controlled for in order to observe potential mediation. Results Children from routine and manual backgrounds were more likely to be injured than those from managerial and professional backgrounds (RR=1.33, 95% CI 1.21 to 1.47), as were children of lone parents (compared with couple families) (RR=1.23, 95% CI 1.12 to 1.36), those whose mothers had no educational qualifications (compared with a degree) (RR=1.42, 95% CI 1.24 to 1.63) and those living in socially rented accommodation (compared with owned/mortgaged homes) (RR=1.35, 95% CI 1.24 to 1.46). However, controlling for the indicators of housing quality and safety equipment use did not alter the elevated risk of injury experienced by children from less advantaged backgrounds. Conclusions In this contemporary UK cohort, proxy indicators of the home environment did not appear to explain socioeconomic inequalities in injuries. Research exploring alternative explanations for inequalities in injuries could help contribute to the design or adaptation of policies to reduce them.