Tess Gregory

Jurisdictional, socioeconomic and gender inequalities in child health and development: analysis of a national census of 5-year-olds in Australia

Objectives Early child development may have important consequences for inequalities in health and well-being. This paper explores population level patterns of child development across Australian jurisdictions, considering socioeconomic and demographic characteristics. Design Census of child development across Australia. Setting and participants Teachers complete a developmental checklist, the Australian Early Development Index (AEDI), for all children in their first year of full-time schooling. Between May and July 2009, the AEDI was collected by 14 628 teachers in primary schools (government and non-government) across Australia, providing information on 261 147 children (approximately 97.5% of the estimated 5-year-old population). Outcome measures Level of developmental vulnerability in Australian children for five developmental domains: physical well-being, social competence, emotional maturity, language and cognitive skills and communication skills and general knowledge. Results The results show demographic and socioeconomic inequalities in child development as well as within and between jurisdiction inequalities. The magnitude of the overall level of inequality in child development and the impact of covariates varies considerably both between and within jurisdiction by sex. For example, the difference in overall developmental vulnerability between the best-performing and worst-performing jurisdiction is 12.5% for males and 7.1% for females. Levels of absolute social inequality within jurisdictions range from 8.2% for females to 12.7% for males. Conclusions The different mix of universal and targeted services provided within jurisdictions from pregnancy to age 5 may contribute to inequality across the country. These results illustrate the potential utility of a developmental census to shed light on the impact of differences in universal and targeted services to support child development by school entry.

Data Resource Profile: The Australian Early Development Index (AEDI)

Every 3 years, the Australian Government conducts a developmental census across the entire population of children in their first year of full-time schooling (median age 5 years). The first developmental census was conducted in 2009, including 261,147 children, and in 2012 data were collected on 289,973 children-representing 97.5% and 96.5% of the estimated eligible population, respectively. The questionnaire is completed by teachers on the basis of at least 1 months knowledge of the child, including aspects of physical, social, emotional, language and cognitive development, as well as data on special needs. Teachers are also asked to include details of the childs care arrangements and attendance in early education programmes in the years preceding school. Demographic and geographical data are recorded at the individual and area levels.

Demographic, social cognitive and social ecological predictors of intention and participation in screening for colorectal cancer

BackgroundPrevious research points to differences between predictors of intention to screen for colorectal cancer (CRC) and screening behavior, and suggests social ecological factors may influence screening behavior. The aim of this study was to compare the social cognitive and social ecological predictors of intention to screen with predictors of participation.MethodsPeople aged 50 to 74 years recruited from the electoral roll completed a baseline survey (n = 376) and were subsequently invited to complete an immunochemical faecal occult blood test (iFOBT).ResultsMultivariate analyses revealed five predictors of intention to screen and two predictors of participation. Perceived barriers to CRC screening and perceived benefits of CRC screening were the only predictor of both outcomes. There was little support for social ecological factors, but measurement problems may have impacted this finding.ConclusionsThis study has confirmed that the predictors of intention to screen for CRC and screening behaviour, although overlapping, are not the same. Research should focus predominantly on those factors shown to predict participation. Perceptions about the barriers to screening and benefits of screening are key predictors of participation, and provide a focus for intervention programs.

Psychosocial Variables Associated with Colorectal Cancer Screening in South Australia

BackgroundPopulation screening reduces mortality from colorectal cancer, yet factors associated with uptake of screening are incompletely understood.PurposeThe purpose of the study was to determine demographic and psychosocial factors associated with participation in faecal occult blood test (FOBT)-based colorectal cancer (CRC) screening in an average risk community programme in Adelaide, South Australia.MethodA questionnaire consistent with the Preventive Health Model was used to determine demographic and psychosocial differences between previous FOBT-based screening participants (n = 413, response rate 93.2%) and non-participants (n = 481, response rate 47.9%). Results were analysed by univariate and multivariate generalised linear modelling, and factors associated with participation were identified.ResultsFactor analysis of psychosocial items revealed an optimal three-factor solution (knowledge, faecal aversion, belief in the value of screening). Following multivariate analyses, two psychosocial and two demographic factors remained as predictors of FOBT screening behaviour: (1) items related to faecal aversion (Aversion), relative risk (RR) = 0.61, CI = 0.55–0.69, (2) perceptions about the value of screening (Value), RR = 1.45, CI = 1.13–1.85, (3) age band 65–69 (Age, five age bands, relative to age 50–54), RR = 1.43, CI = 1.16–1.76 and FOBT type (Test; three tests, Hemoccult®, FlexSure®, InSure® randomly assigned, relative to Hemoccult®: FlexSure®: RR = 1.41, CI = 1.17–1.71, InSure®: RR = 1.76, CI = 1.47–2.11.ConclusionsThe psychosocial factors associated with non-participation in FOBT-based CRC screening are amenable to interventions designed to improve participation. The small relative risks values associated with each predictor, however, raise the possibility that additional factors are likely to influence screening participation.

Predictors of re-participation in faecal occult blood test- based screening for colorectal cancer.

BACKGROUND There is little information on longitudinal patterns of participation in faecal occult blood test (FOBT) based colorectal cancer (CRC) screening or on demographic or behavioural factors associated with participation in re-screening. The lack of an agreed system for describing participatory behaviour over multiple rounds also hampers our ability to report, understand and make use of observed associations. Our aims were to develop a system for describing patterns of participatory behaviour in FOBT-based CRC screening programs and to identify factors associated with particular behavioural patterns. METHOD A descriptive framework was developed and applied to a data extract of screening invitation outcomes over two rounds of the NBCSP. The proportion of invitees in each behaviour category was determined and associations between behaviour patterns and demographic and program factors were identified using multivariate analyses. RESULTS We considered Re- Participants, Dropouts, Late Entrants and Never Participants to be the most appropriate labels for the four possible observed participatory categories after two invitation rounds. The screening participation rate of the South Australian cohort of the NBCSP remained stable over two rounds at 51%, with second round Dropouts (10.3%) being balanced by Late Entrants (10.5%). Non-Participants comprised 38.7% of invitees. Relative to Re-Participants, Dropouts were older, more likely to be female, of lower SES, had changed their place of residence between offers had a positive test result in the first round. Late Entrants tended to be in the youngest age band. CONCLUSIONS Specific demographic characteristics are associated with behavioural sub-groups defined by responses to 2 offers of CRC screening. Targeted group-specific strategies could reduce dropout behaviour or encourage those who declined the first invitation to participate in the second round. It will be important to keep first round participants engaged in order to maximise the benefit of a CRC screening program.

Parenting practices at 24 to 47 months and IQ at age 8: Effect-measure modification by infant temperament

Cognitive development might be influenced by parenting practices and child temperament. We examined whether the associations between parental warmth, control and intelligence quotient (IQ) may be heightened among children in difficult temperament. Participants were from the Avon Longitudinal Study of Parents and Children (n = 7,044). Temperament at 6 months was measured using the Revised Infant Temperament Questionnaire and classified into ‘easy’ and ‘difficult’. Parental warmth and control was measured at 24 to 47 months and both were classified into 2 groups using latent class analyses. IQ was measured at 8 years using the Wechsler Intelligence Scale for Children and dichotomized (<85 and ≥85) for analyzing effect-measure modification by temperament. Linear regression adjusted for multiple confounders and temperament showed lower parental warmth was weakly associated with lower IQ score [β = -0.52 (95% CI 1.26, 0.21)], and higher parental control was associated with lower IQ score [β = -2.21 (-2.95, -1.48)]. Stratification by temperament showed no increased risk of having low IQ in temperamentally difficult children [risk ratio (RR) = 0.97 95% CI 0.65, 1.45)] but an increased risk among temperamentally easy children (RR = 1.12 95% CI 0.95, 1.32) when parental warmth was low. There was also no increased risk of having low IQ in temperamentally difficult children (RR = 1.02 95% CI 0.69, 1.53) but there was an increased risk among temperamentally easy children (RR = 1.30 95% CI 1.11, 1.53) when parental control was high. For both parental warmth and control, there was some evidence of negative effect-measure modification by temperament on the risk-difference scale and the risk-ratio scale. It may be more appropriate to provide parenting interventions as a universal program rather than targeting children with difficult temperament.

Inspection time predicts individual differences in everyday functioning among elderly adults: testing discriminant validity

Aim:  Inspection time (IT) is a processing speed measure, recently investigated as a biomarker of ageing. This study examined whether earlier IT predicts subsequent problems in everyday functioning in community‐dwelling elderly people.

Gestational age and school achievement: a population study

Objective Academic achievement varies according to gestational age but it is unclear whether achievement varies within ‘term’ (37–41 weeks gestation) or for ‘post-term’ births (≥42 weeks). We examined gestational age from preterm to post-term against a national minimum standard for academic achievement in population data. Design Literacy and numeracy data of 8-year-old South Australian grade 3 children in 2008–2010 were linked to routinely collected perinatal data (N=28 155). Results Longer gestation from 23 to 45 weeks was associated with lower risk of poor literacy and numeracy. Adjusted relative risks for being at or below national minimum standard ranged from 1.12 (95% CI 1.03 to 1.22) for ‘late preterm’ (32–36 weeks) for numeracy, to 1.84 (95% CI 1.48 to 2.30) for ‘early preterm’ (23–31 weeks) for writing. Within term, every additional week of gestational age was associated with small decreased risks of poor literacy and numeracy (eg, relative risks for poor numeracy 1.10, 95% CI 1.01 to 1.20 for 37 weeks). Population-attributable fractions for poor achievement were highest among children born ‘early term’ (37–39 weeks) due to their higher population prevalence. Conclusions Shorter gestational age was associated with increased risk of poor literacy/numeracy. While children born ‘early term’ experience only between 1% and 10% increased risk, they constitute a larger proportion of children with poor educational achievement than preterm children, and thus are important to consider for supportive interventions to improve population-level achievement gains. The seemingly lower risk for post-term children showed large error estimates and warrants further consideration within even larger populations.

The controlled direct effect of temperament at 2-3 years on cognitive and academic outcomes at 6-7 years

There is widespread interest in temperament and its impact upon cognitive and academic outcomes. Parents adjust their parenting according to their child’s temperament, however, previous studies have not accounted for parenting while estimating the association between temperament and academic outcomes. We examined the controlled direct effect of temperament (2-3 years) on cognitive and academic outcomes (6-7 years) when mediation by parenting practices (4-5 years) was held constant. Participants were from the Longitudinal Study of Australian Children (n=5107). Cognitive abilities were measured by the Peabody Picture Vocabulary Test (verbal) and the Matrix Reasoning test (non-verbal). Literacy and numeracy were reported by teachers using the Academic Rating Scale. Mothers reported children’s temperament using the Short Temperament Scale for Toddlers (subscales: reactivity, approach, and persistence). Parenting practices included items about engagement in activities with children. Marginal structural models with inverse probability of treatment weights were used to estimate the controlled direct effect of temperament, when setting parenting to the mean. All temperament subscales were associated with cognitive abilities, with persistence showing the largest controlled direct effect on verbal (β=0.58; 95%CI 0.27, 0.89) and non-verbal (β=0.19; 0.02, 0.34) abilities. Higher persistence was associated with better literacy (β=0.08; 0.03, 0.13) and numeracy (β=0.08; 0.03, 0.13), and higher reactivity with lower literacy (β=−0.08; −0.11, −0.05) and numeracy (β=−0.07; −0.10, −0.04). There was little evidence that temperamental approach influenced literacy or numeracy. Overall, there was a small controlled direct effect of temperament on cognitive and academic outcomes after accounting for parenting and confounders.

The social impacts of mining on local communities in Australia

ABSTRACT The mining industry forms an important pillar of the global economy. While the economic impacts of mining have been thoroughly explored and social impacts recently have received growing attention, increasingly, mining developments are being required to consider how they affect local communities and implement strategies to minimise negative impacts they may be causing. Research is limited, but growing, and studies have identified how mining developments can affect nearby communities and town residents. This article conducted a critical literature review that synthesises contemporary Australian research on the social impacts of mining on local communities. It identified 68 studies organised into seven themes: adverse impacts of increasing non-resident workforces; pressures on infrastructure, housing and services; income inequality; poor child development and education outcomes; pressures on families and relationships; drug and alcohol abuse; and impacts on Aboriginal and Torres Strait Islanders. These themes discuss the breadth of findings and critical knowledge gaps of existing research.