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Biomedical subjects

Nick Spencer

Publications and source records attributed to Nick Spencer.

14 recordsLinked to original sources
PubMed2006

Child abuse registration, fetal growth, and preterm birth: a population based study.

OBJECTIVES: To study the relation of intra-uterine growth and gestational age with child protection registration in a 20 year whole population birth cohort. SETTING: West Sussex area of England. STUDY DESIGN: Retrospective whole population birth cohort. OUTCOMES: Child protection registration; individual categories of registration-sexual abuse, physical abuse, emotional abuse, and neglect. Population and PARTICIPANTS: 119,771 infants born in West Sussex between January 1983 and December 2001 with complete data including birth weight, gestational age, maternal age, and postcode. RESULTS: In all categories of registration a linear trend was noted such that the lower the birth weight z score the higher the likelihood of child protection registration. Similar trends were noted for gestational age. All these trends were robust to adjustment for maternal age and socioeconomic status. CONCLUSIONS: The results of this study suggest that lower levels of fetal growth and shorter gestational duration are associated with increased likelihood of child protection registration in all categories including sexual abuse independent of maternal age or socioeconomic status. This study does not permit comment on whether poor fetal growth or preterm birth predispose to child abuse and neglect or the association arises because they share a common pathway.

Adult↗
PubMed2005

Explaining the social gradient in smoking in pregnancy: early life course accumulation and cross-sectional clustering of social risk exposures in the 1958 British national cohort.

Smoking in pregnancy is a major determinant of low birthweight and a range of adverse infant health outcomes. There is a well-established social gradient in smoking in pregnancy in the US and northern Europe. Social gradients in health-related behaviours may result from longitudinal accumulation and cross-sectional clustering of social risk exposures. There is, however, no published confirmation of this explanation in empirical data with smoking in pregnancy as the outcome. This study aimed to test the effects of longitudinal accumulation and cross-sectional clustering of social risk exposures on smoking in pregnancy using data on the first pregnancies of 3163 female members of the 1958 British national cohort. Social class at birth and aged 11 years was used to create three dichotomous variables representing cumulative social class (both manual, one manual and one non-manual, both non-manual) early in the lifecourse. Cross-sectional clustering of social risk was represented by four dichotomous variables created from combinations of maternal age (<20 vs. 20+), own social class (manual vs. non-manual) and educational attainment (low vs. other). Cumulative social class in early childhood was associated with smoking in pregnancy in bivariate analysis but not after adjustment for cross-sectional clustering of social risk exposures. However, women who had been in the manual social groups at birth and 11 years were at increased risk of cross-sectional clustering of social risk exposures around pregnancy suggesting a pathway from early lifecourse risk exposure to social risk factors associated with a high risk of smoking in pregnancy. These findings suggest that the social gradient in smoking in pregnancy results from longitudinal accumulation and cross-sectional clustering of social risk exposures. Interventions aimed at reducing social inequalities in smoking in pregnancy need to account for cumulative and cross-sectionally clustered effects of social risk exposures.

Adolescent↗
PubMed2005

Smoking behaviour change among fathers of new infants.

Protecting infants from exposure to parental tobacco smoke is key to positive health outcomes in childhood and later life. While mothers' smoking has been well researched, fathers' smoking has received little attention. This paper reports data from a cross-sectional survey of 286 smoking fathers in the English Midlands, interviewed when their infants were 8-14 weeks old. It examines whether fathers attempt and successfully achieve two smoking behaviours positively associated with infant health: quitting and not smoking in the home. The birth of a new baby was not associated with attempting or successfully quitting smoking for the majority of fathers. Less than 20% had tried to quit and only 4% had successfully quit smoking since the birth of their baby. Half of the participants reported that they had not changed their cigarette consumption since their baby's birth. Not smoking in the home appeared to be a more achievable behaviour for many fathers; 78.0% had attempted and 60% had successfully achieved not smoking in home. Independent predictors of attempting to quit were fathers' own cigarette consumption and level of knowledge about infant exposure to tobacco smoke. Attempting to abstain from smoking in the home and being successful in the attempt were both independently associated with partner's smoking status, number of financially dependent children and father's social class. Findings suggest that promoting reductions in cigarette consumption and improving knowledge levels among fathers about passive smoking in infants may encourage more quit attempts. Not smoking in the home is a more achievable behaviour and is linked to fathers' caring and economic circumstances and their partner's smoking status. Influences on fathers' smoking behaviour appear to be multi-factorial. Understanding father's smoking and developing health promotion strategies to protect infants from passive smoking is likely to depend on research which can bridge the caring and economic spheres of their lives.

Adolescent↗
PubMed2005

Social paediatrics.

Social paediatrics is an approach to child health that focuses on the child, in illness and in health, within the context of their society, environment, school, and family. The glossary clarifies the range of terms used to describe aspects of paediatric practice that overlap or are subsumed under social paediatrics and defines key social paediatric concepts. The glossary was compiled by a process of consultation and consensus building among the authors who are all members of the European Society for Social Paediatrics. Social paediatricians from outside Europe were included giving a more international perspective.

Child↗
PubMed2005

Does material disadvantage explain the increased risk of adverse health, educational, and behavioural outcomes among children in lone parent households in Britain? A cross sectional study.

OBJECTIVE: To test the hypothesis that material disadvantage explains the increased risk among children and young people of adverse health, educational, and behavioural problems associated with living in lone parent households in Britain STUDY DESIGN: Secondary analysis of a cross sectional survey of a representative sample of British households with children and youthMain outcomes: Parent reported fair/poor health, longstanding illness and disability, statement of special educational needs, suspension and/or expulsion from school, and in trouble with the police. PARTICIPANTS: Data were available on 15 636 (8049 boys and 7587 girls) aged 0-18 years in 8541 households in the third sweep (2001) of the British government's families and children study RESULTS: Lone parenthood was associated with increased risk of health and educational problems, and antisocial behaviour among boys and girls in a logistic regression model adjusting for child's age alone. Adding age of main carer, number of dependent children, and child's rank in the household made little difference to the associations. Addition of housing tenure, household hardship index, and an interaction term for lone parenthood and hardship eliminated the relation with lone parenthood for all outcomes except parent reported health among girls. Similar results were obtained for households headed by lone parents for at least a year. An interaction effect of lone parenthood with hardship for parent reported health and statement of special educational needs was noted. CONCLUSION: Adverse effects of lone parenthood on health, education, and antisocial behaviour were apparently explained by material disadvantage in this cross sectional sample of British households with children and youth.

Adolescent↗
PubMed2005

Maternal education, lone parenthood, material hardship, maternal smoking, and longstanding respiratory problems in childhood: testing a hierarchical conceptual framework.

BACKGROUND: Maternal smoking and low socioeconomic status are known to be associated with each other and with longstanding respiratory problems in childhood but their interrelation has received little attention. In this paper, the interrelations is studied using a conceptual hierarchical framework among children aged 0-11 years in a representative sample of British households with children. METHOD: With data from the family and children study, this paper tested a conceptual hierarchical framework, in which maternal education acting through lone parenthood would influence material hardship and all three would have effects on maternal smoking increasing the risk of children's longstanding respiratory problems. RESULTS: Among children 0-2, maternal education and material hardship had indirect effects on respiratory problems mediated through more proximal variables. After adjustment for maternal education, the effect of lone parenthood was partially mediated through material hardship and maternal smoking. Adjustment for socioeconomic status variables attentuated but did not eliminate the effect of maternal smoking (odds ratio=2.04, 95% confidence interval=1.30, 3.20). Among children 3-11, the effect of maternal education was partially mediated through proximal variables. Lone parenthood and material hardship had indirect effects only. Adjustment for confounding eliminated the effect of maternal smoking (odds ratio=1.06, 95% confidence interval=0.88, 1.26). CONCLUSIONS: Reducing childhood longstanding respiratory problems will require attention to background socioeconomic status factors in addition to maternal smoking.

Adolescent↗
PubMed2005

Disabling conditions and registration for child abuse and neglect: a population-based study.

OBJECTIVE: To study the relationship between disabling conditions and registration for child abuse and neglect in a 19-year whole-population birth cohort. SETTING: West Sussex area of the United Kingdom. STUDY DESIGN: Retrospective whole-population cohort. MAIN OUTCOMES: Child-protection registration, physical abuse, sexual abuse, emotional abuse, and neglect. POPULATION AND PARTICIPANTS: Infants born in West Sussex (119729) between January 1983 and December 2001 with complete data including birth weight, gestational age, maternal age, and postal code. RESULTS: Cerebral palsy, speech and language disorder, learning difficulties, conduct disorders, and nonconduct psychological disorders were all significantly associated with child-protection registration before adjustment, and all but cerebral palsy retained significance after adjustment for birth weight, gestational age, and socioeconomic status. Autism and sensory disabilities (vision and hearing) were not associated with an increased risk of child-protection registration. Conduct disorders and moderate/severe learning difficulty were associated with registration in each of the 4 categories after adjustment for socioeconomic status, birth weight, and gestational age. Children with speech and language disorders and mild learning difficulties were at increased risk of physical abuse, emotional abuse, and neglect. Nonconduct psychological disorders were associated with all categories except neglect, and cerebral palsy was associated with all categories except physical abuse and neglect. CONCLUSIONS: Children with disabling conditions seem to be at increased risk of registration for child abuse and neglect, although the pattern of registration varies with the specific disabling condition. The strong association with registration noted for conditions such as conduct disorder and learning difficulties is likely to arise, in part, because these conditions share a common etiologic pathway with child abuse and neglect.

Child↗
PubMed2004

Health needs of young offenders.

Health services' input to the Youth Offending Teams (YOTs) is an integral component of the YOTs' philosophy. Fifty young people aged 14-18 years, who attended two representative YOTs consecutively, completed a health checklist and a strengths and difficulties questionnaire. They were interviewed on the health of the nation outcome scales for children and adolescents and their perceptions of health needs and services. The young people reported high rates of accidents and injuries, admissions to hospital, emotional and peer relationships difficulties. Their perceptions of what mental illness means varied between stigma, aggression, lack of coping, previous experiences and physical ill-health. Only five young people expressed a wish to receive mental health help. The findings are discussed in relation to health services provision to the YOTs.

Adolescent↗
PubMed2003

Effect of strategies to reduce exposure of infants to environmental tobacco smoke in the home: cross sectional survey.

OBJECTIVE: To examine parents' reported knowledge and use of harm reduction strategies to protect their infants from exposure to tobacco smoke in the home, and the relation between reported use of strategies and urinary cotinine to creatinine ratios in the infants. DESIGN: Cross sectional survey. SETTINGS: Coventry and Birmingham. MAIN OUTCOME MEASURES: Parents' reported knowledge and use of harm reduction strategies and urinary cotinine to creatinine ratios in their infants. PARTICIPANTS: 314 smoking households with infants. RESULTS: 86% of parents (264/307) believed that environmental tobacco smoke is harmful, 90% (281/314) believed that infants can be protected from it in the home, and 10% (32/314) were either unaware of measures or reported using none. 65% of parents (205/314) reported using two or more measures, but only 18% (58/314) reported not allowing smoking in the home. No difference was found in mean log e transformed urinary cotinine to creatinine ratio in infants from households that used no measures compared with households that used less strict measures. Mean log cotinine to creatinine ratios were significantly different in households banning smoking in the home compared with those using less strict or no measures. Banning smoking in the home was independently associated with a significant reduction in urinary cotinine to creatinine ratio by a factor of 2.6 (1.6 to 4.2) after adjustment for average household cigarette consumption, tenure, and overcrowding. CONCLUSIONS: Less than a fifth of parents in smoking households ban smoking in the home. Banning smoking was associated with a small but significant reduction in urinary cotinine to creatinine ratio in infants, whereas less strict measures compared with no measures had no effect on the infants' exposure to environmental tobacco smoke.

Adult↗
PubMed2003

Social, economic, and political determinants of child health.

This article presents a brief overview of the effects of social, economic, and political factors on child health. It starts by highlighting child poverty in rich nations, in particular the United Kingdom and the United States, and identifies the economic and political factors underlying this phenomenon. The evidence linking socioeconomic status and child health is briefly reviewed with particular attention to birth weight and child mental health-2 of the most important public health challenges in the 21st century. The implications for pediatricians of high levels of child poverty and the effect that these have on children are discussed.

Birth Weight↗