Low-risk Families Research Articles

Fear of COVID-19 and parental violence: The mediating role of parental burnout and child perceived as difficult

BackgroundSince the beginning of the COVID-19 pandemic, there has been a worldwide increase in the incidence of child abuse. Studies show that the pandemic context contributes to exacerbate several risk factors usually associated with the use of violent disciplinary practices. ObjectiveThis study aims to better understand the role of parental burnout and child perceived as difficult as a parental stressor in the link between fear of COVID-19 and the use of parental violence (minor and severe physical violence and repeated psychological aggression). ParticipantsThe sample includes 467 mothers living in Québec (Canada) with a child aged 5 or less. MethodAn online questionnaire, administered one year after the beginning of the COVID-19 pandemic in Québec (March to May 2021), was used to measure parental violence, parental burnout, parental stress related to the perception of the child as difficult and fear of COVID-19. Serial mediation analyses were performed. ResultsThe main analyses confirmed the indirect association between fear of COVID-19 and the three forms of parental violence studied, through parental burnout and the child perceived as difficult. Unlike physical violence (minor and severe), the association between fear of COVID-19 and repeated psychological aggression is explained only by parental burnout. ConclusionsThis study has identified new mechanisms that allow a better understanding of processes underlying parental violence during the pandemic. It also shows that parental violence can also occur in low-risk families. It is crucial to develop strategies to prevent the use of violent disciplinary practices in future socio-health crises such as the COVID-19 pandemic.

Risk of cancer in individuals with Lynch-like syndrome and their families: a systematic review

BackgroundLynch-like syndrome (LLS) tumors have similar clinicopathological features to Lynch syndrome (LS) tumors but have no identifiable pathogenic germline mismatch repair gene variant. However, cancer risks in LLS patients and first-degree relatives (FDRs) are not well defined.MethodsTo clarify LLS-associated cancer risks, a systematic review of all studies examining all cancer risks in LLS was performed. Searching of Medline, Embase, Pubmed, Cochrane and CINAHL databases and reference/citation checking identified relevant studies published between January 1, 1980 and February 11, 2021. Joanna Briggs Institute Appraisal Tools assessed the risk of bias.ResultsSix studies (five cohort/one cross-sectional) were eligible for study inclusion. One study found no difference in colorectal cancer (CRC) incidence between LLS and LS patients or CRC risks at aged 70 years. Three studies found CRC incidence in LLS FDRs was higher than the general population but lower than LS FDRs. Two studies showed no difference in CRC diagnosis age between LLS patients and LS patients. Endometrial cancer risks in LLS patients were higher than the general population but lower than LS patients.ConclusionEvidence of elevated CRC risks in LLS patients and FDRs supports increased colonoscopy surveillance strategies for LLS patients and FDRs in line with current recommendations for LS. Due to heterogeneity amongst LLS populations, extended intervals between screening may be advised for low-risk families. Studies to resolve the molecular characterization and definition of LLS are needed to clarify cancer risks associated with LLS which in turn may individualize surveillance strategies for LLS patients and families.

Cognition Mediates Playfulness Development in Early Childhood: A Longitudinal Study of Typically Developing Children.

Play, children's central occupation, and playfulness, its behavioral manifestation, are the foci of occupational therapy intervention. However, information about the development of playfulness behavior and the role of cognitive function is limited. To explore the development of playfulness and its relation to cognitive functioning from infancy to toddlerhood. Longitudinal study with data collected at ages 6 mo, 18 mo, and 24 mo. Laboratory (age 6 mo) and home (ages 12 and 18 mo). Eighty-six typically developing children drawn from a convenience sample of 109 low-risk families of middle to upper socioeconomic status. The Mullen Scales of Early Learning (MSEL) to assess cognitive functioning and the Test of Playfulness (ToP) to assess children's playfulness. ToP scores were significantly higher at age 24 mo than at age 6 mo, t(88) = -60.30, p < .001, 95% confidence interval (CI) [-1.47, -1.38]. Correlation analysis revealed that the more playful the infant was at age 6 mo, the higher their cognitive functioning was at age 18 mo and the more playful they were at age 24 mo. Toddlers with higher cognitive performance at age 18 mo demonstrated more playful behavior at age 24 mo (β = 0.120, SE = 0.05, 95% CI [0.0377, -0.2276]). Children's playfulness is evident as early as age 6 mo and continues to develop through toddlerhood, depending on their cognitive growth. Occupational therapists play a key role in working with families with young children, promoting cognitive development to further the development of playfulness behaviors. What This Article Adds: Understanding the development of playfulness and exploring its relationship with cognitive functioning in typically developing children fills important gaps in occupational therapy knowledge and contributes to delivery of early intervention, especially when cognition or playfulness are at risk. Our findings confirmed that cognitive functioning contributes to the development of playfulness.

When families, organizational culture, and policy collide: A mixed method study of alternative response

ObjectiveAlternative response (AR) is a family-centered, preventative approach for child protection systems. This study first examined what family and case factors predicted re-investigation and then explored which organizational factors influence caseworker and agency implementation of AR. MethodUsing administrative data from child protection reports, AR families (N = 9,959) and traditional response (TR) families (N = 13,974) were followed for 18 months to determine re-investigation rates using multilevel modeling where families were nested in county of residence. Four focus groups with 14 participants were conducted to discuss the quantitative findings, organizational culture, and implementation of AR. ResultsAR families had lower odds of re-investigation; males and younger children also had lower odds. Families with multiple children, prior investigations, receipt of Medicaid, and medium/high risk had higher odds of re-investigation. AR caseworkers provided insights regarding the intersection of family factors, organizational culture and support, and agency implementation of AR. Although participants supported AR, their ability to implement it was influenced by agency support and availability of resources to carry out the basic requirements of the policy. A clear distinction in responses emerged between those who held dual cases versus those holding only AR cases. ConclusionAlthough AR reduces the odds of re-investigation for low-risk families and was endorsed by caseworkers, AR policy in practice is complex and requires further evaluation, particularly from the perspective of AR caseworkers who faced implementation hurdles.

Headspace for parents: qualitative report investigating the use of a mindfulness-based app for managing parents' stress during COVID-19.

Stress can compromise parental well-being and may contribute to harsh and critical parenting styles, which are in turn associated with children's conduct problems. Coronavirus disease 2019 (COVID-19)-related restrictions are likely to have exacerbated parental stress as, for many, UK-based family life was altered considerably. Mindfulness has been demonstrated to improve stress management and emotion regulation when delivered to parents in person, however, more accessible online interventions are under-researched. To provide preliminary data on family well-being and parent-child relationships as well as the acceptability and usability of the Headspace app - a self-delivered mindfulness-based intervention - for parents in low-risk families during the early days of the COVID-19 pandemic. We provided 12 parents with access to Headspace, and collected qualitative data (semi-structured interviews and 5 minute speech samples) immediately following the initial COVID-19 lockdown in the UK. The resulting transcripts were thematically analysed. Most parents reported Headspace to be acceptable and useful - improvements in parents' own sleep were particularly noted - and there was high adherence to the intervention. However, difficulties related to family well-being and parent-child relationships following the lockdown were also reported. As a result of the confounding impact of COVID-19 restrictions, and varied access to app content, we were unable to determine any outcomes to be a result of practising mindfulness specifically. However, COVID-19 has had a profound impact on many UK-based families, including those previously at low risk, and our results demonstrate that Headspace may have beneficial effects for parents. There is a need to more rigorously test this tool with a broader range of families.

Maximizing the return on investment in Early Childhood Home Visiting through enhanced eligibility screening

BackgroundThe MIECHV (Maternal, Infant, and Early Childhood Home Visiting) program invests substantial federal resources to prevent child maltreatment and emergency medical costs. Eligibility is based on screening of demographic or clinical risk factors, but because screening accuracy in predicting poor outcomes is unknown, assignment to home-visiting might miss high-risk families or waste resources on low-risk families. ObjectivesTo guide eligibility decisions, this study tested accuracy of demographic and clinical screening in predicting child maltreatment and emergency medical care. Participants and settingA population-representative sample of 201 birthing mothers (39.8% Black, 33.8% Latina) in Durham, NC, was enrolled between July 2009, and December 2010, and followed through December 2015. MethodsParticipants were screened demographically (i.e., Medicaid, first-born, teenage, no high school diploma) and clinically (i.e., health/health care, parenting readiness, home safety, and parent mental health) at birth and followed through age 60 months, when Child Protective Services and hospital records were reviewed. Cox hazard models tested accuracy of prediction from screening variables. ResultsDemographic factors did not significantly predict outcomes, except having Medicaid/uninsured predicted more emergency medical care and being first-born was a (surprising) protective factor against a child maltreatment investigation. In contrast, clinical factors strongly predicted both maltreatment investigations (Hazard Ratio = 4.01 [95% CI = 1.97, 8.15], sensitivity = 0.70, specificity = 0.64, accuracy = 0.65) and emergency medical care (Hazard Ratio = 2.14 [95% CI = 1.03, 2.14], sensitivity = 0.50, specificity = 0.69, accuracy = 0.58). ConclusionsEven with added costs for clinical screening, selecting families for home visiting based on assessed clinical risk will improve accuracy and may yield a higher return on investment. The authors recommend a universal system of screening and care to support birthing families.

Rates of contributory de novo mutation in high and low-risk autism families

Autism arises in high and low-risk families. De novo mutation contributes to autism incidence in low-risk families as there is a higher incidence in the affected of the simplex families than in their unaffected siblings. But the extent of contribution in low-risk families cannot be determined solely from simplex families as they are a mixture of low and high-risk. The rate of de novo mutation in nearly pure populations of high-risk families, the multiplex families, has not previously been rigorously determined. Moreover, rates of de novo mutation have been underestimated from studies based on low resolution microarrays and whole exome sequencing. Here we report on findings from whole genome sequence (WGS) of both simplex families from the Simons Simplex Collection (SSC) and multiplex families from the Autism Genetic Resource Exchange (AGRE). After removing the multiplex samples with excessive cell-line genetic drift, we find that the contribution of de novo mutation in multiplex is significantly smaller than the contribution in simplex. We use WGS to provide high resolution CNV profiles and to analyze more than coding regions, and revise upward the rate in simplex autism due to an excess of de novo events targeting introns. Based on this study, we now estimate that de novo events contribute to 52–67% of cases of autism arising from low risk families, and 30–39% of cases of all autism.

Cost-effectiveness analysis of a school- and community-based intervention to promote a healthy lifestyle and prevent type 2 diabetes in vulnerable families across Europe: the Feel4Diabetes-study

The Feel4Diabetes-study implemented a school- and community-based intervention to promote healthy lifestyle and prevent type 2 diabetes mellitus (T2DM) in six European countries. The intervention included a special focus on families at increased T2DM risk. The current study evaluates the intervention's cost-effectiveness.A Markov-type health economic model was developed to predict the incidence of T2DM and its complications. Incremental cost-effectiveness ratios (lifetime horizon, societal perspective) were calculated based on the overall intervention effect on health behaviour, and stratified for low- and high-risk families. Sensitivity analyses captured input parameters uncertainty. A budget impact analysis was performed.The increase in children's water consumption and physical activity led to a modest gain in quality adjusted life years (QALYs) at a low intervention cost and budget impact. Medical cost savings due to avoided illness could only be achieved on the very long-term (>30 years). The intervention in its entirety was cost-effective (more QALYs at a reasonable investment) in Belgium, Finland, Bulgaria, and Hungary, while being dominant (net savings and more QALYs) in Greece and Spain. Results were cost-effective for the low-risk families, who only received the school- and community-based intervention component. Results for the high-risk families were only cost-effective (with considerable uncertainty) in Greece and Spain, but not when the intervention would need to be repeated.The Feel4Diabetes-intervention is potentially cost-effective, especially in countries with a high overweight and obesity prevalence, at a limited budget impact. The incremental financial investments to reach and support high-risk families did not result in the hoped-for health benefits.

Familial resemblance in mental health symptoms, social and cognitive vulnerability, and personality: A study of patients with depressive and anxiety disorders and their siblings

BackgroundInvestigating siblings of probands with affective disorders enables the identification of psychopathology-related risk features. Leveraging data from an older adult sample, as compared to most previous sibling studies, enabled us to study more definitive clinical profiling across the lifespan. We examined prevalence of depressive/anxiety disorders in siblings, proband-sibling resemblance in psychopathology-related features, and whether unaffected siblings showed higher levels of these features than healthy controls. MethodsThe sample (N=929; Mage=50.6) consisted of 256 probands with lifetime depressive and/or anxiety disorders, their 380 siblings, and 293 healthy controls without affected relatives. Fifteen psychopathology-related features were investigated across four domains: mental health symptoms, social vulnerabilities, cognitive vulnerabilities, and personality. ResultsLifetime disorders were present in 50.3% of siblings. Prevalence was 2-3 times higher than Dutch population frequencies. We found small to medium probandsibling resemblance across psychopathology-related features (ρ=0.10-0.32). Unaffected siblings reported poorer interpersonal functioning and more negative life events, childhood trauma, and rumination than healthy controls. LimitationsDue to the cross-sectional study design, the directionality of effects cannot be determined. No inferences can be made about potential differences in familial resemblance in psychopathology-related features between high- and low-risk families. ConclusionsSiblings of probands with affective disorders are at higher risk for depressive/anxiety disorders. Even when unaffected, still show higher psychosocial vulnerability than healthy controls. Nevertheless, the only modest proband-sibling resemblance across psychopathology-related features suggests that individual mechanisms differentiate clinical trajectories across the lifespan. Identification of these mechanisms is crucial to improve resilience in subjects with familial risk.

A cumulative risk index for use in the medical home.

Previous studies have described the effect of sociodemographic factors on early development. We describe development of a simple cumulative risk index (CRI) based on four sociodemographic factors and explore the concurrent and predictive relationship of this index to a measure of the cognitive home environment in early childhood and to later school functioning. This was a secondary data analysis of children from an urban pediatrics clinic. Baseline data were collected at 10-23 months (n= 324) with primary follow-up 6months later at 18-35 months (n= 179) and secondary follow-up at 8-10years (n= 68). A CRI score was derived at baseline using maternal education, marital status, race/ethnicity and child insurance. Baseline and primary follow-up included three subscales of the STIMQ, a measure of the cognitive home environment. Effectiveness of CRI was examined using analysis of variance (ANOVA) with linear contrasts. Chi-square examined differences in school function between children from CRI high-risk (CRI 3-4) and low-risk (CRI 0-2) families. CRI had a negative impact in early childhood on STIMQ subscale scores (p<0.007-0.05) that increased as the number of risk factors increased (p<0.05). Significantly more children from high-risk families (CRI 3-4) were rated as having poor school performance than children from low-risk families (CRI 0-2) (p<0.05). We showed that a practice-friendly CRI, based on characteristics typically available in the medical record, could help identify families less likely to support development concurrently at 1 year of age and predictively at 2-3years. School functioning at 8 to 10years was also significantly better in children with a low CRI at 1 year. The CRI could be a useful tool for both clinicians and researchers needing a simple tool for risk assessment.

The First Cigarette Smoking Experience and Future Smoking Behaviors Among Adolescents with Different Parental Risk: a Longitudinal Analysis in an Urban Iranian Population.

Longitudinal research among Iranian adolescent smoking is limited. The current study aimed to investigate (1) the first smoking experience (FSE) and future smoking behaviors of adolescents with different parental risk factors and (2) the association between age of the FSE and future smoking behaviors over a 12-year follow-up. Based on Tehran Lipid and Glucose Study (TLGS) database, 1487 adolescents (12-18years) with complete baseline parental data were recruited. Using two-step cluster analysis, families were classified as either high or low risk; these were based on parental risk factors including age, education, employment, and smoking status. Participants were examined four times in 12years and their data were used for survival analysis. After exclusion of 24 cases who were smokers at baseline, Cox proportional hazard modeling was used to evaluate the effect of parental clusters on the FSE in 1463 nonsmoking adolescents who completed all prospective follow-ups. Logistic regression analysis was used to examine the effect of the age of FSE on future smoking behaviors. The mean age of adolescents was 14.63 ± 2.07years at baseline. Adolescents in the high-risk cluster group were 49% more likely to try smoking for their first time, and 55% more likely to smoke in the future. Compared with girls, boys had 83% higher chance of trying their first cigarette. Moreover, 1-year delay in the FSE resulted in 25% reduction in the probability of smoking in the future. The findings show that compared with adolescents living in low-risk families, teenagers living in high-risk families are at greater risk of smoking at an earlier age; therefore, this group could benefit from gender- and culture specific preventive interventions.

Exploring the interrelatedness of risk factors for child maltreatment: A network approach

BackgroundTheories on the etiology of child maltreatment generally focus on the interaction between multiple risk and protective factors. Moreover, the quadratic model of cumulative risk describes a threshold at which the risk of child maltreatment increases exponentially, suggesting a synergistic effect between risk factors. ObjectiveThis study explored the interrelatedness of risk factors for child maltreatment. Participants and settingThe sample consisted of risk assessments performed for both high-risk families (n = 2,399; child protection services) and lower risk families (n = 1,904; community outreach services). MethodsNetwork analyses were performed on parental risk factors. Three networks were constructed: a cross-sample network, a high-risk network, and a lower risk network. The relations between risk factors were examined, as well as the centrality of each risk factor in these networks. Additionally, the networks of the two samples were compared. ResultsThe networks revealed that risk factors for child maltreatment were highly interrelated, which is consistent with Belsky’s multi-dimensional perspective on child maltreatment. As expected, risk factors were generally stronger related to each other in the high-risk sample than in the lower risk sample. Centrality analyses showed that the following risk factors play an important role in the development of child maltreatment: “Caregiver was maltreated as a child”, “History of domestic violence”, and “Caregiver is emotionally absent”. ConclusionsWe conclude that studying the interrelatedness of risk factors contributes to knowledge on the etiology of child maltreatment and the improvement of both risk assessment procedures and interventions for child maltreatment.

Supporting Strategic Investment in Social Programs: a Cost Analysis of the Family Check-Up.

High-quality evidence about the costs of effective interventions for children can provide a foundation for fiscally responsible policy capable of achieving impact. This study estimated the costs to society of the Family Check-up, an evidence-based brief home-visiting intervention for high-risk families implemented in the Early Steps multisite efficacy trial. Intervention arm families in three sites were offered 4 consecutive years of intervention, when target children were ages 2 through 5. Data for estimating total, average, and marginal costs and family burden (means and standard deviations, 2015 USD, discounted at 3% per year) came from a detailed database that prospectively documented resource use at the family level and a supplemental interview with trial leaders. Secondary analyses evaluated differences in costs among higher and lower risk families using repeated measures analysis of variance. Results indicated annual average costs of $1066 per family (SD = $400), with time spent by families valued at an additional $84 (SD = $99) on average. Costs declined significantly from ages 2 through 5. Once training and oversight patterns were established, additional families could be served at half the cost, $501 (SD = $404). On the margin, higher risk families cost more, $583 (SD = $444) compared to $463 (SD = $380) for lower risk families, but prior analyses showed they also benefited more. Sensitivity analyses indicated potential for wage-related cost savings in real-world implementation compared to the university-based trial. This study illustrates the dynamics of Family Check-up resource use over time and across families differing in risk.

Trajectories of maternal aggression in early childhood: Associations with parenting stress, family resources, and neighborhood cohesion

BackgroundThe effects of family risk on parenting can be ameliorated or exacerbated depending on factors internal (e.g., appraisals, regulation) and external (e.g., resources, social support) to the role of parenting. Therefore, it is important to distinguish between sources of stress when exploring associations with parenting behaviors. ObjectiveWe aimed to identify trajectories of maternal aggression among families across various levels of risk, and explore associations with factors internal and external to parenting. Participants and settingParticipants included children in large U.S. cities born between 1998 and 2000, followed through age 9, in the Fragile Families and Child Well-being Study with medical records data available (N = 3529). MethodLatent growth curve modeling was conducted to identify trajectories of maternal aggression measured through a survey at child age 3, 5, and 9. Correlates of maternal aggression (i.e., family risk for maltreatment, income-to-poverty ratios, maternal education, parenting stress, and neighborhood cohesion) were measured through medical records and maternal surveys at birth, age 1, and age 3. ResultsMaternal aggression similarly declined between child age 3 and 9 across low-, moderate-, and high-risk families. Across all families, neighborhood social cohesion was significantly, negatively associated with maternal aggression, (β’s = −.20 to −.28, p’s < .001) and increases in parenting stress were significant predictors among Low Risk (β = .12, p = .006) and High Risk (β = .10, p = .02) families. ConclusionThe results suggest that families could benefit from supportive neighborhood environments or parenting stress reduction techniques, regardless of level of risk at birth.

Genetic and clinical characterization of BRCA-associated hereditary breast and ovarian cancer in Navarra (Spain)

BackgroundGenetic testing for BRCA1/2 genes is widely used as a strategy to reduce incidence and morbidity of hereditary breast and ovarian cancer (HBOC). The purpose of this study is to analyse the demographic and molecular characteristics of BRCA germline mutations in Navarra, Spain, and to investigate the clinical profile of hereditary and sporadic breast cancer (BC) and ovarian cancer (OC) in the Community.MethodsThe study includes 1246 individuals assessed for BRCA1/2 genetic testing in Navarra, during 2000–2016, and a cohort of BC (n = 4384) and OC (n = 561) from the population-based Navarra Cancer Registry. Distribution and molecular characteristics of BRCA1/2 mutations, as well as, comparative analysis of the clinical course, pathologic features and overall survival (OS) of patients in different risk groups were investigated.ResultsBRCA mutation detection rate was 16%, with higher proportion (63%) of BRCA2 families. Nineteen per cent of mutations were recurrent, one of which, BRCA2 c.6024dupG, showed high association to OC. BRCA carriers had double risk (95% CI = 1.04–4.33) of developing multiple malignancies than low risk families and were diagnosed at a much earlier age (16.6 and 11.7 years difference for BC and OC, respectively) when compared to the general population. For BC, BRCA carriers showed a more advanced histological stage, higher risk of bilateral neoplasms (OR = 4.3; 95% CI = 1.3–11.4, for BRCA2 carriers) and worse OS rate at 5-, 10- and 15- years, than women with sporadic tumors. For OC, over 70% of patients of all risk groups showed advanced stages at diagnosis, with the highest among BRCA1 carriers (91%). Furthermore, they also had higher probability of developing ovarian bilateral tumors (OR = 7.8, 95% CI = 1.7–55.7, for BRCA1 carriers) than the general population. Five-year OS rate was worse among women with sporadic OC than BRCA carriers, but it levelled out over the 15-year period.ConclusionsIn addition to national similarities in the HBOC-BRCA1/2 associated mutational spectrum, we identified a recurrent BRCA2 pathogenic variant (c.6024dupG), highly associated to OC in Navarra. Carriers of BRCA1/2 mutations showed a more severe BC and OC phenotype and had a worse overall prognosis when compared to a large cohort of women with sporadic counterpart tumors.

Adolescents’ Attachment: Content and Discriminant Validity of the Friends and Family Interview

There are few methods to assess attachment representations during adolescence, all showing strengths and limits. The Friends and Family Interview (FFI) is the only narrative interview considering a wide range of relevant domains in adolescents’ life, including peer and sibling relationships, as well as self-esteem, relations with parents and reflective functioning. However, the FFI has been used sparingly with community samples, never with adolescents older than 14-years, and few studies have investigated its psychometric characteristics. This study aimed at investigating the content and discriminant validity of the FFI, comparing the distribution of FFI classifications with the distribution observed in adolescents in response to the Adult Attachment Interview (AAI), based on national and international meta-analytic reports. This paper also aimed to consider FFI classifications and rating scales with respondents’ gender, age, verbal intelligence and internalizing-externalizing problems. Participants were 110 adolescents aged 11–17 years (M = 14.22, 50% boys), recruited from schools in North-west Italy, coming from low risk families. Measures administered were the FFI, the Verbal Comprehension Index of the Wechsler Intelligence Scale for Children-IV (ICV-WISC-IV) for verbal skills, the Child Behavior Checklist 6–18 years (CBCL) for internalizing–externalizing problems. The distribution of FFI classifications overlapped with the AAI distribution seen in a national meta-analysis, while less insecure dismissing and disorganized FFI responses were found compared to the AAI distribution in the international meta-analytic report; girls were more secure and less dismissing than boys, while FFI classifications were unrelated to adolescents’ age, verbal skills, or internalizing–externalizing problems, although relevant correlations were found with some of the FFI rating scales. Within a culturally-oriented perspective, the FFI appears to be a reliable and valid method to investigate adolescent IWMs in both research and clinical settings.

Distribution of body mass index in children with different parental risk: Findings of a family-based cohort study in a West-Asian population

Using quantile regression analysis, the current study, conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) aimed to assess the effects of parental risk clusters on different percentiles of Body Mass Index (BMI) distribution in children. Participants included 2296 school-aged children who had participated in the baseline assessment of the TLGS and were followed for an approximate duration of fifteen years. Parental socio-demographic, behavioral and clinical characteristics were considered to determine risk clusters. Comparing of the high- to the low-risk parental clusters showed that after adjusting for age in boys, BMI was significantly higher at the 75th (1.82, p = 03), 85th (1.78, p = 0.007) and 95th (1.66, p = 0.03) percentiles; and in girls it was significantly higher at the 25th (1.45, p = 0.003), 50th (1.05, p = 0.015), 95th (2.31, p = 0.018) and 97th (2.44, p = 0.006) percentiles in the high risk cluster. Our data indicate that during a long-term follow up, children with a high-risk family are more likely to have higher BMI, compared to their counterparts in low-risk families, a difference observed mainly at the upper percentiles of BMI distribution for both genders and at all ages, findings that should be considered for strategies aimed at preventing childhood obesity and its consequences.

Applying behavioural insights to child protection: venturing beyond the low-hanging fruit

AbstractWe explore whether simple behavioural insights techniques can be successful for addressing a policy issue within one of society's more complex and difficult sectors: child protection. Child protection reporting practices in New South Wales, Australia, reveal that the public's primary response is to report to the statutory authority, who only deal with cases of the highest risk. As a result, a large volume of statutory resources are spent processing lower-risk reports that lead to no benefits for lower-risk families and slow down response times for families that require a statutory response most. Our goal was to reduce lower-risk reporting by encouraging alternative responses to these situations. To do this, we altered report feedback for cases deemed lower risk in order to make alternative responses more salient and we added a persuasive message framed as a gain or loss. We then examined subsequent reporting accuracy. We found that our trial was linked to a modest improvement in reporting accuracy, though the results may have been diluted by a spill-over effect. We discuss how facilitating a greater behavioural change likely requires multi-organization collaborations, extending the range of insights drawn from behavioural science and/or addressing issues from multiple angles.

The prevent ovarian cancer program (POCP): Identification of ovarian cancer-associated mutations in self-referring women from low-risk families

Objective: The aim of this study was to perform comprehensive germline testing and genetic counselling in women with a first-degree relative (FDR) who died from ovarian high-grade serous carcinoma (HGSC) but did not receive BRCA1/2 genetic testing.

Intergenerational transmission of family adversity: Examining constellations of risk factors.

This study adopts a socio-ecological approach to examine multiple factors and processes assumed to shape the intergenerational transmission of social disadvantage, including influences of social change, social causation and social selection. Moving beyond approaches focusing on cumulative risk indices, this study uses latent class analysis to examine how different socio-economic and psycho-social risk factors combine within families and to what extent and how constellations of risk are transmitted from one generation to the next. We draw on data collected for the longitudinal and national representative 1970 British Cohort Study, comprising information on more than 11,000 cohort members and their parents. We identified four distinct risk configurations among the parent generation (G1): low-risk families (57.6%), high-risk families (16.3%), high-risk single-parents (24%) and ethnic minority families (2.1%). Within their offspring (G2) we identified five distinct risk configurations: low-risk families (62%), low-risk no-children (15.1%), moderate-risk single parents (10.1%), moderate-risk large families (8.9%), high socio-economic and high psycho-social risk (4%). There is evidence of structural mobility, and the findings suggest that intergenerational transmission of disadvantage is not just a systemic tendency towards social reproduction, but also reflects processes of social change and social selection. We conclude that a socio-ecological model provides a useful framework for a more comprehensive understanding of the multiple processes involved in the transmission of inter-cohort inequality.