Aya Isumi

Association of adverse childhood experiences with shaking and smothering behaviors among Japanese caregivers.

Shaking and smothering in response to infant crying are life-threatening child abuse. Parental childhood abuse history is known to be one of the most robust risk factors for abusing their offspring. In addition to childhood abuse history, other adverse childhood exposures (ACEs) need to be considered due to co-occurrence. However, few studies have investigated the impact of ACEs on caregivers shaking and smothering their infant. This study aims to investigate the association of ACEs with shaking and smothering among caregivers of infants in Japan. A questionnaire was administered to caregivers participating in a four-month health checkup between September 2013 and August 2014 in Chiba City, Japan, to assess their ACEs (parental death, parental divorce, mentally ill parents, witness of intimate partner violence, physical abuse, neglect, psychological abuse and economic hardship), and shaking and smothering toward their infants (N=4297). Logistic regression analysis was used to examine the cumulative and individual impacts of ACEs on shaking and smothering. Analyses were conducted in 2015. A total of 28.3% reported having experienced at least one ACE during their childhood. We found that only witness of IPV had a significant association with shaking of infant (OR=1.93, 95% CI: 1.03-3.61). The total number of ACEs was not associated with either shaking or smothering. Our findings suggest that shaking and smothering in response to crying can occur regardless of ACEs. Population-based strategies that target all caregivers to prevent shaking and smothering of infants are needed.

Relationship Between Leaving Children at Home Alone and Their Mental Health: Results From the A-CHILD Study in Japan

Leaving children at home alone is considered a form of “neglect” in most developed countries. In Japan, this practice is not prohibited, probably because this country is considered to have relatively safe communities for children. The impact of leaving children at home alone on their mental health is a controversial issue, and few studies have examined it to date. The aim of this study was to examine the impact of leaving children aged 6 or 7 years at home alone on their mental health, focusing on both the positive and negative aspects; that is, resilience, difficult behavior, and prosocial behavior. Data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study were used. The caregivers of all children in the first grade in Adachi City, Tokyo, were targeted, of whom 80% completed the questionnaire (n = 4,291). Among the analytical sample which comprises those who completed both exposure and outcome variables (n = 4,195), 2,190 (52.2%) children had never been left at home alone, 1,581 (37.7%) children were left at home alone less than once a week, and 424 (10.1%) children were left at home alone once a week or more. Child resilience was measured using the Childrens Resilient Coping Scale, and difficult behavior (emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems) and prosocial behavior using the Strength and Difficulty Questionnaire. Multivariate regression analyses were performed to examine the dose-response association between leaving children at home alone and child mental health, followed by propensity-score matching as a pseudo-randomized controlled trial to reduce potential confounding. The results showed that leaving children at home alone once a week or more, but not less than once a week, was associated with total difficulties scores, especially conduct problems, hyperactivity/inattention, and peer relationship problems. These findings indicate that leaving children at home alone should be avoided in Japan, as is recommended in North America.

Parental time of returning home from work and child mental health among first-year primary school students in Japan: Result from A-CHILD Study

Introduction: Child mental health is known to be influenced by parental work hours. Although literature suggests that parent-child interaction mediates the association, few studies have directly measured the parental time of returning home from work. We analyzed data from a school-based survey to examine the association between parental time of returning home from work and child mental health. Methods: We used a sample of 2,987 first-year primary school students derived from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study that examined the impact of family environment and lifestyle on child health in Adachi City, Tokyo, Japan. We analyzed the associations between reported parental time of returning home and the continuous Strengths and Difficulties Questionnaire (SDQ) scores using multivariable regression modeling. Results: Children whose parents both returned home late (later than 6 p.m. for the mother and later than 8 p.m. for the father), or at irregular times, had higher scores in total difficulties (β = 1.20, 95% CI: 0.55 to 1.85), the “conduct problems” subscale (β = 0.37, 95% CI: 0.13 to 0.60), and the hyperactivity/inattention subscale (β = 0.53, 95% CI: 0.24 to 0.82) compared with children whose parents both returned home earlier. Mediation analyses indicated that the percentage of the total association between parental time of returning home and the SDQ scores, which was mediated by parent-child interaction, was 20% (95% CI: 10 to 46) for total difficulties, 17% (95% CI: 7 to 49) for conduct problems, and 23% (95% CI: 11 to 52) for hyperactivity/inattention. Conclusions: Late or irregular returning home times for both parents had an adverse effect on child mental health, and the relationship was partly mediated by reduced frequency of parent-child interaction.

Does Eating Vegetables at Start of Meal Prevent Childhood Overweight in Japan? A-CHILD Study

Background: Because eating behaviors are established early in life, it is important to instill healthy eating habits in children. However, no published studies have examined the effects of what is habitually consumed first at a meal on childrens body weight in real settings. The aim of this study was to examine the associations between what was consumed (vegetables, rice/bread, meat/fish, or soup) at the start of a meal and childhood overweight in Japan. Methods: We used cross-sectional data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study, a population-based study comprising all first-grade students in Adachi City, Tokyo, Japan, performed in 2015. Through a questionnaire, we identified what types of food children ate first at meals. The questionnaire was completed by 4,040 caregivers. We used corresponding school health check-up data (height and weight) to assess overweight in each child. Results: The proportions of what was consumed first at a meal were 11.6, 23.3, 25.4, 9.8, and 29.9% for vegetables, meat/fish, rice/bread, soup, and undetermined (variable), respectively. Multivariate logistic regression showed the odds ratio of being overweight was 1.83 in children who ate meat/fish first (95% CI: 1.27–2.64, p < 0.01) compared with children who ate vegetables first. In contrast, the odds ratios in children who consumed rice/bread or soup first compared with children who ate vegetables first were 1.11 (95% CI: 0.76–1.61, p = 0.59) and 1.29 (95% CI: 0.83–2.01, p = 0.26), respectively. Conclusion: Children who eat meat/fish at the start of a meal are more likely to be overweight than those who eat vegetables at the start of a meal. Future studies are needed to investigate the mechanisms of how the order in which food is consumed at a meal affects weight status in children.

Mediating effects of parental psychological distress and individual-level social capital on the association between child poverty and maltreatment in Japan

Child poverty is well known as a major risk factor for child maltreatment. However, it is not known whether parental psychological distress and individual-level social capital mediate the association. We examined the mediation effect of these two factors on the association between child poverty and maltreatment. In the Adachi Child Health Impact of Living Difficulty (A-CHILD) Study, a questionnaire was administered to all caregivers of first-grade children in every public elementary school in Adachi City between July and November 2015, and valid responses were used for analysis (N = 3944). Logistic and Poisson regression analyses were employed to examine the association between child poverty and maltreatment. Child poverty was defined in this study as meeting one of these criteria: 1) household income less than 3 million yen; 2) deprivation of specific material items that children or the household requires, or 3) experience of being unable to pay for lifeline utilities. Child maltreatment (physical abuse, neglect, and psychological abuse) was answered by parents. We confirmed a robust association between child poverty and maltreatment. Mediation analysis indicated that parental psychological distress mediated more than 60% of the association between child poverty on physical abuse and psychological abuse, while individual-level social capital mediated only 10% of the association with any type of maltreatment. In addition, structural equation modeling analysis revealed that the association was mediated by both parental psychological distress and social capital simultaneously. The findings suggest that supporting parental psychological distress may be an effective intervention to remedy the negative impact of child poverty on maltreatment.

Synergistic Effects of Unintended Pregnancy and Young Motherhood on Shaking and Smothering of Infants among Caregivers in Nagoya City, Japan

Background Shaking and smothering in response to infant crying are forms of child abuse that often result in death. Unintended pregnancy and young motherhood are risk factors of such child maltreatment that are often comorbid, few studies have examined their synergistic effect on shaking and smothering of infants. We examined the synergistic effects of unintended pregnancy and young motherhood on shaking and smothering among caregivers of infants in Japan. Methods In this retrospective cohort study, a questionnaire was administered to caregivers enrolled for a health check for 3- to 4-month-old infants between October 2013 and February 2014 in Nagoya City, Japan. The questionnaire data were linked to those from pregnancy notification forms registered at municipalities and included information on women’s age and feelings about their pregnancy (N = 4,159). Data were analyzed using logistic regression analysis in 2016. Results Shaking and smothering of 3- to 4-month-old infants occurred at least once in the past month in 2.0 and 1.5% of cases, respectively. Of all participants, 24.8% reported unintended pregnancy while 7.3% were younger than 25 years old. Infants of young mothers (under 25 years old) with unintended pregnancy were 2.77 [95% confidence interval (CI): 1.15–6.68] and 5.61 (95% CI: 2.40–13.1) times more likely to be shaken and smothered, respectively, than those of older mothers with intended pregnancy. In addition, the odds ratio of young mothers with unintended pregnancy regarding smothering was significantly higher than that of older mothers with unintended pregnancy (odds ratio: 2.12; p = 0.02). Conclusion Our findings suggest a synergistic effect of unintended pregnancy and young motherhood on smothering. Infants of young mothers with unintended pregnancy are at greater risk of abuse, especially smothering. Prevention strategies are required for young women with unintended pregnancies.