Katina D'Onise

Can preschool improve child health outcomes? A systematic review

Early childhood development interventions (ECDIs) have the potential to bring about wide ranging human capital benefits for children through to adulthood. Less is known, however, about the potential for such interventions to improve population health. The aim of this study was to examine the evidence for child health effects of centre-based preschool intervention programs for healthy 4 year olds, beyond the preschool years. Medline, Embase, ERIC, Psych Info, Sociological Abstracts, the Cochrane Library, C2-SPECTR and the Head Start database were searched using terms relating to preschool and health from 1980 to July 2008, limited to English language publications. Reference lists and the journal Child Development were hand searched for eligible articles missed by the electronic search. There were 37 eligible studies identified. The reviewed studies examined a range of interventions from centre-based preschool alone, to interventions also including parenting programs and/or health services. The study populations were mostly sampled from populations at risk of school failure (76%). Only eight of the 37 studies had a strong methodological rating, 15 were evaluated as at moderate potential risk of bias and 14 as at high potential risk of bias. The review found generally null effects of preschool interventions across a range of health outcomes, however there was some evidence for obesity reduction, greater social competence, improved mental health and crime prevention. We conclude that the great potential for early childhood interventions to improve population health across a range of health outcomes, as anticipated by policy makers worldwide, currently rests on a rather flimsy evidence base. Given the potential and the increasingly large public investment in these interventions, it is imperative that population health researchers, practitioners and policy makers worldwide collaborate to advance this research agenda.

Who uses complementary and alternative therapies in regional South Australia? Evidence from the Whyalla Intergenerational Study of Health

OBJECTIVE o assess the prevalence of complementary and alternative medicine (CAM) and service use for people with a chronic disease in rural and regional Australia, where reported prevalence of CAM use is higher. METHODS ata were from the Whyalla Intergenerational Study of Health, a population representative cross sectional study of 1146 people recruited in 2008-2009. Self-reported chronic disease diagnosis and health service use including CAM use were collected. Complementary and other medicines were recorded at a clinic visit in a reduced sample (n=722) and SF36 data were collected by questionnaire. RESULTS round 32% of respondents reported complementary medicine use and 27% CAM service use. There was no difference in the overall prevalence of CAM use among those with and without a chronic disease (OR 0.9, 95% CI 0.7-1.3). Greater age- and sex-adjusted use of complementary medicines was associated with the ability to save money (OR 1.75, 95% CI 1.17-2.63), but not with any other socioeconomic position indicator. Those who reported using prescribed medication were more likely to report using complementary medicines (OR 2.09, 95% CI 1.35-3.24). CONCLUSIONS he prevalence of CAM use in this regional community appeared lower than reported in similar communities outside of South Australia. Mainstream medicine use was associated with complementary medicine use, increasing the risk of an adverse drug interaction. This suggests that doctors and pharmacists should be aware of the possibility that their clients may be using complementary medicines, and the need for vigilance regarding potential side effects and interactions between complementary and mainstream therapies.

Does attendance at preschool affect adult health? A systematic review

BACKGROUND Early child development interventions can set children on positive social and educational trajectories. The aim of this review was to examine the evidence for the adult health impacts of centre-based preschool interventions for preschoolers. METHODS Medline, Embase, ERIC, Psych Info, Sociological Abstracts, the Cochrane Library, C2-SPECTR and the Head Start database were searched (1980-2008), and reference lists were searched for articles missed by the electronic search. RESULTS The 12 eligible articles reviewed reported multi-faceted interventions and involved disadvantaged populations in all but one study. Limitations included a restricted range of health outcomes, reliance on self-report measures (11 studies), small sample sizes (nine studies with <100 in each arm) and a relatively young adult age at follow-up. There were positive intervention effects across the majority of behavioural outcomes, and a suggestion of a reduction in symptoms of depression. Non-communicable disease outcomes (e.g. diabetes mellitus) tended to have adverse or near-zero effect estimates. CONCLUSIONS The reviewed articles provide some support for the role of early childhood interventions to improve health behaviours but not chronic disease outcomes. Population health researchers should become more involved in the evaluation of preschool interventions as there is great potential for broad population health benefit.

Folate status and health behaviours in two Australian Indigenous populations in north Queensland

OBJECTIVE To assess nutritional status using red-cell folate (RCF) and associated health behaviours including fruit and vegetable intake, smoking, drinking and physical activity in two Indigenous populations living in remote northern Australia. DESIGN A cross-sectional survey conducted during 1998-2000. SETTING Twenty-six rural communities in north Queensland, Australia. SUBJECTS A total of 2524 Indigenous people aged 15 years and over was included in the study. Self-reported fruit and vegetable intake, tobacco smoking, alcohol intake and physical activity were recorded. RCF was measured using the Bayer Advia Centaur automated immunoassay system. The association between low RCF (RCF<295 nmol/l) and risk factors was analysed using general linear models adjusted for demographic factors and covariates, namely BMI, diabetes and dyslipidaemia. RESULTS The prevalence of RCF deficiency was higher in Aboriginal participants compared with Torres Strait Islanders (25.6 % v. 14.8 %, P < 0.001). Young women of childbearing age were more likely to have low RCF. Among Aboriginal adults, smoking was strongly associated with low RCF (risk ratio = 1.9, 95 % CI 1.5, 2.5 in females and risk ratio = 2.9, 95 % CI 1.9, 4.2 in males). CONCLUSIONS Indigenous Australians, especially women of childbearing age, had high prevalence of low RCF. Smoking was associated with insufficient folate independent of fruit and vegetable intake and alcohol consumption in the Aboriginal population. This population with an already higher risk of obesity and higher rate of tobacco smoking should be targeted to improve nutrition status to prevent ill health such as diabetes and CVD.

Does an early childhood intervention affect cardiometabolic risk in adulthood? Evidence from a longitudinal study of preschool attendance in South Australia

OBJECTIVES There is an expectation that a positive social, cognitive and behavioural trajectory from early childhood developmental interventions will lead to improved population health and reduced health inequalities. However, there is limited direct evidence for this. The aim of this study was to assess the effect of participation in the South Australian Kindergarten Union preschool programme on adult cardiovascular biomedical risk factors. Kindergarten Union preschools delivered high-quality, comprehensive services to children aged 2-4 years and their families, including education, parenting and health services. STUDY DESIGN Retrospective population-based cohort study. METHODS The effect of attendance at a Kindergarten Union preschool on a range of cardiometabolic risk factors was assessed using data from the North West Adelaide Health Study 1999-2007. The study sample was taken from participants in the 2007 survey (n = 1064, 44.8% attended preschool) who lived in South Australia as children and were born during the years 1937-1969. RESULTS Preschool attendance had a beneficial effect on hypertension in adulthood [prevalence ratio 0.82, 95% confidence interval (CI) 0.69-0.97] and an indication of benefit on hypercholesterolaemia (prevalence ratio 0.86, 95% CI 0.71-1.05), but had no effect on dyslipidaemia, central obesity, high fasting blood glucose or metabolic syndrome. CONCLUSIONS This study found that preschool attendance was associated with reduced risk of hypertension in adulthood, but no effect was seen for the other cardiometabolic factors. These findings may reflect differing causal pathways and trajectories of these risk factors from childhood to adulthood, but confirmation from other studies is required.

Lifelong effects of attendance at Kindergarten Union preschools in South Australia

While there is some evidence of long-term social benefits from early childhood educational interventions conducted in socially disadvantaged populations in the USA, there is limited evidence of similar benefits in different populations and countries. This study examined a range of social outcomes of adults aged 34-67 years who, between 1940 and 1972, attended a Kindergarten Union preschool in South Australia, a comprehensive, high-quality, centre-based preschool program. There were modest benefits on educational attainment, risk of unemployment and income, but no evidence was found to support effects on type of occupation, full-time employment or housing tenure. Preschool programs have the potential to enhance human capital development into adulthood.

Barriers to better three- dose coverage with HPV vaccination in school-based programs

1. Communicable Disease Control Branch, Department of Health, South Australia 2. Public Health, School of Population Health, University of Adelaide, South Australia 3. Department of Health – Epidemiology, South Australia4. Victorian Cytology Service Registries - National HPV Vaccination Program Register, Victoria

Benefits of modest weight or waist circumference loss in a remote North Queensland Indigenous population

Objective : To quantify the potential benefit to individuals of differing magnitudes of weight or waist circumference loss in an Indigenous population.

Have purpose-built vaccine refrigerators reduced the cost of vaccine losses in South Australia?

Objectives: There is limited epidemiological data on the performance of different refrigerator types for vaccine storage in the real world. This study aims to measure if the introduction of purpose‐built vaccine refrigerators has reduced the cost of vaccine losses in South Australia.

Can attending preschool reduce the risk of tobacco smoking in adulthood? The effects of Kindergarten Union participation in South Australia

Background Innovative strategies beyond the health system are required to reduce the prevalence of smoking. Early child development interventions are examples of interventions that can help set children on positive social and educational trajectories, which in turn may also reduce the prevalence of smoking. The aim of this study was to examine the effect of attendance at Kindergarten Union preschools on tobacco smoking in adulthood. Methods Kindergarten Union preschools delivered comprehensive services to children and their families, including education, parenting and health services, with a number of features consistent with contemporary ideas of high-quality service delivery. Using a retrospective cohort design with data from the North West Adelaide Health Study, this study examined different aspects of smoking behaviour in adults aged 34–67 years who attended a Kindergarten Union preschool at some stage between 1940 and 1972. Data were analysed using generalised linear model poisson regression with robust variance estimates, adjusting for both child and adult socio-economic factors and history of parental smoking. Results People who attended preschool had a reduced risk of ever smoking (prevalence ratio 0.87, 95% CI 0.77 to 0.98) and a reduced risk of current smoking in adulthood (prevalence ratio 0.77 (95% CI 0.59 to 1.00)), compared with those who did not attend preschool. There was no effect of preschool attendance on age at smoking uptake, age at quitting or the probability of quitting smoking. Conclusion Attendance at the high-quality Kindergarten Union preschools was associated with a reduction in the initial uptake of smoking and thus the probability of being a current smoker. Among their other potential social benefits, high-quality, universal preschool programmes have the potential to help reduce smoking prevalence across the population.