Nichola Shackleton

Improving rates of overweight, obesity and extreme obesity in New Zealand 4-year-old children in 2010–2016

Prevalence of childhood obesity is high in developed countries, and there is a growing concern regarding increasing socio‐economic disparities.

Student- and school-level belonging and commitment and student smoking, drinking and misbehaviour

Objectives: It has been suggested that students are healthier in schools where more students are committed to school. Previous research has examined this only using a proxy measure of value-added education (a measure of whether school-level attendance and attainment are higher than predicted by students’ social profile), finding associations with smoking tobacco, use of alcohol and illicit drugs, and violence. These findings do not provide direct insights into the associations between school-level aggregate student commitment and health behaviours, and may simply reflect the proxy measure being residually confounded by unmeasured student characteristics. We examined the previously used proxy measure of value-added education, as well as direct measures at the level of the school and the student of lack of student commitment to school to see whether these were associated with students’ self-reported smoking tobacco, alcohol use and school misbehaviour. Design: Cross-sectional survey. Setting: A total of 40 schools in south-east England. Methods: Multi-level analyses. Results: There were associations between school- and student-level measures of lack of commitment to school and tobacco smoking, alcohol use and school misbehaviour outcomes, but the proxy measure of school-level commitment, value-added education, was not associated with these outcomes. A sensitivity analysis focused only on violent aspects of school misbehaviour found a pattern of associations identical to that found for the measure of misbehaviour. Conclusion: Our study provides the first direct evidence in support of the Theory of Human Functioning and School Organisation.

Are teachers' judgements of pupils' ability influenced by body shape?

Background:Evidence indicates that teachers can judge pupils on the basis of their physical appearance, including their body shape. Teacher bias towards obese pupils has been suggested as a potential pathway through which obese children attain relatively lower academic levels. The aim of this study was to investigate whether teachers’ judgements of pupils’ ability are influenced by the body shape of the child.Methods:The sample includes English, singleton children in state schools from the Millennium Cohort Study. The data were taken from the fourth wave of data collection, when the children were approximately 7 years old. In all, 5086/5072 children had teacher ability ratings of reading and maths. Logistic regression analyses were used to test whether teachers’ perceptions of the child’s reading and mathematics ability were influenced by the pupil’s waist circumference, conditional upon cognitive test scores of reading and maths ability.Results:After adjustment for cognitive test scores, no significant overall relationship was found between the pupil’s waist circumference and the teacher’s judgements of ability. No statistically significant differences were observed in the probability of being judged as above average after further adjustments were made for potential confounders.Conclusions:There is little evidence that teachers’ judgements of pupils’ ability are influenced by obesity.

Is there a link between low parental income and childhood obesity

The association between familial socioeconomic status and child obesity has created the expectation that low familial income increases the risk of child obesity. Yet, there is very little evidence in the United Kingdom to suggest that this is the case. This article focuses on whether low familial income and family poverty are associated with an increased risk of child obesity. Data from the Millennium Cohort Study (age 7) are analysed. Sequential logistic regression analyses are used to determine whether income has a direct link to childhood weight. The results show no direct relationship between familial income/poverty and weight in childhood. Numerous robustness checks provide considerable evidence that low familial income has no association with children’s weight status in the United Kingdom. The results demonstrate that social inequalities in child weight are not driven by differences in income.

A new measure of unhealthy school environments and its implications for critical assessments of health promotion in schools

Abstract The theory of human functioning and school organisation informed by Basil Bernstein’s sociology of education suggests that to gain the commitment and promote the health of students, particularly those from disadvantaged backgrounds, schools require radical transformations eroding various ‘boundaries’: between and among staff and students; between students’ academic learning and broader social development and welfare; and between schools and their local communities. Existing research examining this theory has reported associations between school-level proxy measures of student commitment and lower rates of student smoking, drinking alcohol, use of drugs and violence. But this research has not directly assessed whether reduced school boundaries explain this. We piloted a new scale derived from teacher reports to measure unhealthy school boundaries and examined its inter-item reliability and its criterion validity in terms of associations with various measures of school commitment and smoking. Data on boundaries came from 101 teachers across 40 schools. Data on student commitment and smoking came from 6667 students. We assessed reliability by examining correlations between scale-items and criterion validity in terms of associations with student-reported commitment and smoking. Inter-item reliability was sub-optimal but better within the subscales about boundaries between academic/broader learning and schools/local communities. The scale had good criterion validity, strongly associated with reduced student-reported school commitment and increased student-reported smoking. We reflect on the implications of these findings in terms of critical perspectives on health promotion in schools and the strengths and limitations of quantitative research in examining health behaviours as opposed to practices.

Pre-pregnancy body mass index and breastfeeding initiation, early cessation and longevity: evidence from the first wave of the UK Millennium Cohort Study

Background International evidence indicates relationships between pre-pregnancy body mass index (BMI) and breastfeeding behaviours. This study aims to assess associations between key points in the breastfeeding trajectory (initiation, early cessation and longevity) and pre-pregnancy BMI in a recent, nationally representative British cohort. It also aims to explore in the British context potential moderation by mothers’ ethnic group. Methods The sample comprises 17 113 mothers from the UK Millennium Cohort Study who have information on pre-pregnancy BMI. Associations between pre-pregnancy BMI categories and breastfeeding initiation, early cessation and longevity are tested using logistic regression. Directed acyclic graphics identify appropriate minimal adjustment to block biasing pathways and classify total and direct effects. Results After adjusting for confounders, there are large differences in breastfeeding early cessation and longevity by pre-pregnancy BMI group. Differences in propensity to initiation are negligible. Having begun breastfeeding, overweight and obese mothers are more likely to cease in the first week and less likely to continue past 4 months. Observed potential mediators within pregnancy and delivery provide little explanation for relationships. Evidence for moderation by ethnicity is scant. Conclusions The causal mechanisms underlying relationships between pre-pregnancy overweight, obesity, and breastfeeding behaviours require further research. However, this study suggests pre-pregnancy BMI as one predictive measure for targeting support to women less likely to establish breastfeeding in the early days, and to continue beyond 4 months. The nature of support should carefully be considered and developed, with mind to both intended and potential unintended consequences of intervention given the need for additional investigation into the causes of associations.

Longitudinal deprivation trajectories and risk of cardiovascular disease in New Zealand

ABSTRACT We used longitudinal information on area deprivation status to explore the relationship between residential‐deprivation mobility and Cardiovascular Disease (CVD). Data from 2,418,397 individuals who were: enrolled in any Primary Health Organisation within New Zealand (NZ) during at least 1 of 34 calendar quarters between 1st January 2006 and 30th June 2014; aged between 30 and 84 years (inclusive) at the start of the study period; had no prior history of CVD; and had recorded address information were analysed. Including a novel trajectory analysis, our findings suggest that movers are healthier than stayers. The deprivation characteristics of the move have a larger impact on the relative risk of CVD for younger movers than for older movers. For older movers any kind of move is associated with a decreased risk of CVD. HIGHLIGHTSAnalysed longitudinal linked anonymised records covering 94% of NZs adult population.Applied trajectory analysis to analyse patterns of residential deprivation‐mobility.On aggregate stayers in deprived areas had the highest risk of a CVD event.There is a moderating effect of age on the relationship between residential deprivation‐mobility and CVD.