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1.  Parental agreement of reporting parent to child aggression using the conflict tactics scales 
Child abuse & neglect  2012;36(6):510-518.
Objectives
This study examined mothers’ and fathers’ reporting congruency using the Parent-Child Conflict Tactics Scales. We asked if the mother's report of the father's parenting aggression was consistent with the father's self-report of parenting aggression and if the father's report of the mother's parenting aggression was consistent with the mother's self- report of those same behaviors. We assessed moderators of parental reporting congruency: severity of the aggression, interparental conflict, child temperament, and child gender.
Methods
Participants were from the Child Development Project, a longitudinal study beginning when children were in kindergarten. The analyses herein included 163 children for whom 2 parents provided data about their own and their spouse or partner's behavior toward the child. Most parents (87%) were married. Mothers and fathers independently completed the Parent-Child Conflict Tactics Scale, both with respect to their own behavior toward the child and with respect to their partner's behavior toward the child. Mothers completed the retrospective Infant Characteristics Questionnaire to assess child temperament. Mothers and fathers completed measures of interparental conflict.
Results
Both fathers and mothers self-reported more frequently engaging in each behavior than the other parent reported they did. Parents were more congruent on items assessing harsher parenting behavior. Furthermore, there was more agreement between parents regarding fathers’ behavior than mothers’ behavior. Analyses of interparental conflict, child difficult temperament, and child gender as moderators yielded findings suggesting that mothers’ and fathers’ reports of their own and their spouses’ harsh parenting behaviors were more concordant in couples with low levels of conflict, for children with easy temperaments, and for boys versus girls.
Conclusions
Prior studies indicate only a moderate level of agreement in couples’ reports of violence between intimate partners and suggest that perpetrators tend to underreport their use of aggression. The results of this study suggest that parents may be more consistent in their reports of parent to child violence using the Parent-Child Conflict Tactics Scales than they are when reporting intimate partner violence. The results suggest that parental reports of their spouse's parent to child aggression are reliable.
doi:10.1016/j.chiabu.2012.04.005
PMCID: PMC3682483  PMID: 22763358
2.  Exposure to Cigarette Smoke In Utero 
Epidemiology (Cambridge, Mass.)  2008;19(4):628-633.
Background
Smoking during pregnancy has been associated with asthma, obesity, and decreased cognitive functioning in the offspring. To study the role of in utero smoking exposure in offsprings’ adult health outcomes, it may be necessary to rely upon reports by the offspring themselves.
Methods
We studied 34,949 mother-daughter pairs participating in the Nurses’ Health Study II for whom data on the daughter’s early passive cigarette smoke exposure had been obtained from both mother and daughter. We calculated sensitivity and specificity of daughter’s early exposure to smoke (using mother’s report as the gold standard), as well as κ statistics. Mother and daughter reports were also analyzed as risk factors for asthma and birthweight to demonstrate face validity.
Results
Sensitivity of daughters’ reported prenatal exposure ranged from 74% to 85%, while specificity was between 90% and 95% (κ = 0.72– 0.81). Daughter’s reported childhood exposure as a proxy for mother’s report of smoking during pregnancy had a sensitivity of 89% and specificity of 88%. Results were similar for daughter’s report of father’s smoking during her childhood. Maternal smoking during pregnancy is consistently associated with reductions in offspring birthweight, and with asthma risk in offspring. The daughter’s risk of being very low (<1500 g) or low birthweight (<2500 g) or of having asthma were similar when exposure was defined according to mother’s report, daughter’s report of fetal smoke exposure, and daughter’s report of mother’s smoking during childhood.
Conclusions
Daughter’s report of mother’s smoking prenatally and in childhood are good proxy measures for mother’s own report of smoking during pregnancy.
doi:10.1097/EDE.0b013e3181761cbd
PMCID: PMC3938965  PMID: 18467961
3.  Sex differences in parent and child pain ratings during an experimental child pain task 
Research in the field of pediatric pain has largely ignored the role of fathers in their children’s pain experiences. The first objective of the present study was to examine the effect of the presence of mothers versus fathers on children’s subjective ratings, facial expressions and physiological responses to acute pain. The second objective was to examine whether child and parent sex influence parents’ proxy ratings of their children’s pain. The final objective was to compare levels of agreement between mothers’ and fathers’ assessments of their children’s pain. Participants included 73 children (37 boys, 36 girls), four to 12 years of age, along with 32 fathers and 41 mothers. Children undertook the cold pressor pain task while observed by one of their parents. During the task, the children’s heart rates and facial expressions were recorded. Children provided self-reports and parents provided proxy reports of child pain intensity using the seven-point Faces Pain Scale. Neither child nor parent sex had a significant impact on children’s subjective reports, facial expressions or heart rates in response to acute pain. Fathers gave their sons higher pain ratings than their daughters, whereas mothers’ ratings of their sons’ and daughters’ pain did not differ. Kappa statistics and t tests revealed that fathers tended to be more accurate judges of their children’s pain than mothers. Overall, this research highlights the importance of examining both parent and child sex differences in pediatric pain research.
PMCID: PMC2671311  PMID: 18592059
Agreement; Assessment; Child; Cold pressor; Pain; Parent
4.  Self-reported social class in adolescents: validity and relationship with gradients in self-reported health 
Background
Analyzing social differences in the health of adolescents is a challenge. The accuracy of adolescent's report on familial socio-economic position is unknown. The aims of the study were to examine the validity of measuring occupational social class and family level of education reported by adolescents aged 12 to 18, and the relationship between social position and self-reported health.
Methods
A sample of 1453 Spanish adolescents 12 to 18 years old from urban and rural areas completed a self-administered questionnaire including the Child Health and Illness Profile-Adolescent Edition (CHIP-AE), and data on parental occupational social class (OSC) and level of education (LE). The responsible person for a sub-sample of teenagers (n = 91) were interviewed by phone. Kappa coefficients were estimated to analyze agreement between adolescents and proxy-respondents, and logistic regression models were adjusted to analyze factors associated with missing answers and disagreements. Effect size (ES) was calculated to analyze the relationship between OSC, LE and the CHIP-AE domain scores.
Results
Missing answers were higher for father's (24.2%) and mother's (45.7%) occupational status than for parental education (8.4%, and 8.1% respectively), and belonging to a non-standard family was associated with more incomplete reporting of social position (OR = 4,98; 95%CI = 1,3–18,8) as was agreement between a parent and the adolescent. There were significant social class gradients, most notably for aspects of health related to resilience to threats to illness.
Conclusion
Adolescents can acceptably self-report on family occupation and level of education. Social class gradients are present in important aspects of health in adolescents.
doi:10.1186/1472-6963-7-151
PMCID: PMC2151765  PMID: 17892550
5.  Mothers’ and Fathers’ Autonomy-Relevant Parenting: Longitudinal Links with Adolescents’ Externalizing and Internalizing Behavior 
Journal of youth and adolescence  2013;43(11):1877-1889.
The goal of this study was to advance the understanding of separate and joint effects of mothers’ and fathers’ autonomy-relevant parenting during early and middle adolescence. In a sample of 518 families, adolescents (49% female; 83% European American, 16% African American, 1% other ethnic groups) reported on their mothers’ and fathers’ psychological control and knowledge about adolescents’ whereabouts, friends, and activities at ages 13 and 16. Mothers and adolescents reported on adolescents’ externalizing and internalizing behaviors at ages 12, 14, 15, and 17. Adolescents perceived their mothers as using more psychological control and having more knowledge than their fathers, but there was moderate concordance between adolescents’ perceptions of their mothers and fathers. More parental psychological control predicted increases in boys’ and girls’ internalizing problems and girls’ externalizing problems. More parental knowledge predicted decreases in boys’ externalizing and internalizing problems. The perceived levels of behavior of mothers and fathers did not interact with one another in predicting adolescent adjustment. The results generalize across early and late adolescence and across mothers’ and adolescents’ reports of behavior problems. Autonomy-relevant mothering and fathering predict changes in behavior problems during early and late adolescence, but only autonomy-relevant fathering accounts for unique variance in adolescent behavior problems.
doi:10.1007/s10964-013-0079-2
PMCID: PMC4061285  PMID: 24337705
externalizing; internalizing; father; mother; parental knowledge; psychological control
6.  Information Management Strategies Within Conversations About Cigarette Smoking: Parenting Correlates and Longitudinal Associations With Teen Smoking 
Developmental psychology  2012;49(8):1565-1578.
The present study examined smoking-specific and general parenting predictors of in vivo observed patterns of parent–adolescent discussion concerning adolescents’ cigarette smoking experiences and associations between these observed patterns and 24-month longitudinal trajectories of teen cigarette smoking behavior (nonsmokers, current experimenters, escalators). Parental solicitation, adolescent disclosure, and adolescent information management were coded from direct observations of 528 video-recorded parent–adolescent discussions about cigarette smoking with 344 teens (M age = 15.62 years) with a history of smoking experimentation (321 interactions with mothers, 207 interactions with fathers). Adolescent initiation of discussions concerning their own smoking behavior (21% of interactions) was predicted by lower levels of maternal observed disapproval of cigarette smoking and fewer teen-reported communication problems with mothers. Maternal initiation in discussions (35% of interactions) was associated with higher levels of family rules about illicit substance use. Three categories of adolescent information management (full disclosure, active secrecy, incomplete strategies) were coded by matching adolescents’ confidential self-reported smoking status with their observed spontaneous disclosures and responses to parental solicitations. Fully disclosing teens reported higher quality communication with their mothers (more open, less problematic). Teens engaged in active secrecy with their mothers when families had high levels of parental rules about illicit substance use and when mothers expressed lower levels of expectancies that their teen would smoke in the future. Adolescents were more likely to escalate their smoking over 2 years if their parents initiated the discussion of adolescent smoking behavior (solicited) and if adolescents engaged in active secrecy.
doi:10.1037/a0030720
PMCID: PMC3737289  PMID: 23148939
adolescent–parent communication; disclosure; secrecy; cigarette smoking; observational research
7.  Influence of parental employment status on Dutch and Slovak adolescents' health 
BMC Public Health  2006;6:250.
Background
Recent research shows the possibility that the link between parental employment status and children's health can be affected by different cultural or societal settings. The aim of this study was to explore whether the effect of father's and mother's employment status on several aspects of adolescents' health differs between Slovakia and the Netherlands.
Methods
Two data sets were used: 2616 Slovak adolescents (mean age 14.9) and 2054 Dutch adolescents (mean age 16.3). Self-rated health, GHQ-12, long-term well-being and Rosenberg self-esteem scale were used to assess the health of adolescents. Parental employment status was classified into the following categories: employed, unemployed, disabled, housewife (among mothers only). Logistic regression analyses were done separately for males and females.
Results
Results indicate that having an unemployed father negatively influences self-rated health and long-term well-being of Slovak male adolescents, but has no effect on the health of Dutch adolescents. Secondly, having a disabled father has a negative effect on the psychological well-being of Dutch males and the self-rated health of females, but does not influence the health of Slovak adolescents. Thirdly, having a mother who is disabled, unemployed or a housewife has a negative effect on the self-esteem of Slovak adolescents. Fourthly, Dutch males whose mother was a housewife had worse long-term well-being than those with an unemployed mother, whereas Dutch females whose mother was a housewife reported better psychological well-being than those with an employed mother.
Conclusion
To conclude briefly our results, father's unemployment seems to be a better predictor of health for Slovak adolescents, father's disablement of health for Dutch ones. Mother's employment status seemed to be important for the self-esteem of Slovak adolescents and mother as a housewife for the health of Dutch ones. This suggests that the link between parental employment status and the health of their children may vary between countries, and therefore further studies involving various cultures are needed.
doi:10.1186/1471-2458-6-250
PMCID: PMC1624828  PMID: 17038169
8.  Does maternal smoking during pregnancy predict the smoking patterns of young adult offspring? A birth cohort study 
Tobacco Control  2006;15(6):452-457.
Objective
To examine the association between maternal smoking during pregnancy and the development of smoking behaviour patterns among young adult offspring.
Method
Data were from the Mater‐University of Queensland Study of Pregnancy (MUSP), a birth cohort of 7223 mothers and children enrolled in Brisbane, Australia, in 1981. The development of smoking behaviours (early or late onset, or combination of onset and prevalence patterns) among offspring at age 21 years with different patterns of maternal smoking (never smoked, smoked before or after pregnancy but not during pregnancy, or smoked during pregnancy) were compared. Maternal smoking information was derived from the prospectively collected data from the beginning of pregnancy until the child was 14 years of age. Analyses were restricted to the 3058 mothers and children whose smoking status was reported.
Results
The proportion of young adults who smoked regularly, either with early onset or late onset, was greater among those whose mothers had smoked during pregnancy compared with those whose mothers had never smoked. The smoking patterns among those adolescent offspring whose mothers stopped smoking during pregnancy, but who then smoked at other times during the child's life, were similar to those whose mothers had never smoked. This association was robust to adjustment for a variety of potential covariates.
Conclusions
The findings provide some evidence for a direct effect of maternal smoking in utero on the development of smoking behaviour patterns of offspring and provide yet another incentive to persuade pregnant women not to smoke.
doi:10.1136/tc.2006.016790
PMCID: PMC2563674  PMID: 17130374
9.  Adolescents' proxy reports of parents' socioeconomic status: How valid are they? 
STUDY OBJECTIVE—Children's proxy reports on indicators of their parents' socioeconomic status (SES) have either been used uncritically or dismissed as invalid. This paper examines the validity of young adolescents' reports of parental SES by comparing adolescent reports with parents' own reports of SES.
DESIGN, SETTING AND PARTICIPANTS—In 1990, 924 13 year olds, along with 648 of their fathers and 735 of their mothers, participated in the baseline survey of The Norwegian Longitudinal Health Behaviour Study. Data on parental occupation were collected from both adolescents and parents at baseline, while data on parental education were collected at follow up from the adolescents at age 15 and from their parents when the adolescents were 19 years old.
MAIN RESULTS—Three different ways of grouping the SES categories based on occupational data were investigated, and the strength of agreement was good for all three groups, with κ statistics ranging from 0.65 to 0.86. There were no significant improvements of agreement when comparing adolescent data from age 15 to adolescent data from age 13. The strength of agreements between the adolescents' and parents' reports of parental education were fair; κ statistics were 0.30 and 0.38 for fathers' and mothers' education, respectively. The proportions of unclassified answers or no responses from the adolescents were similar for questions on occupation and education, and ranged from 11% to 16%.
CONCLUSIONS—The agreement between adolescents' and parents' reports of SES based on occupation was judged to be good, but adding a few specific questions may cue the adolescent to provide more detailed information, thereby reducing the numbers of unclassified answers or non-responders.


Keywords: proxy; socioeconomic status; adolescents
doi:10.1136/jech.55.10.731
PMCID: PMC1731778  PMID: 11553657
10.  Prevalence and predictors of home and automobile smoking bans and child environmental tobacco smoke exposure: a cross-sectional study of U.S.- and Mexico-born Hispanic women with young children 
BMC Public Health  2006;6:265.
Background
Detrimental effects of environmental tobacco smoke (ETS) exposure on child health are well documented. Because young children's primary exposure to ETS occurs in homes and automobiles, voluntary smoking restrictions can substantially reduce exposure. We assessed the prevalence of home and automobile smoking bans among U.S.- and Mexico-born Hispanics in the southwestern United States, and examined the influence of mother's country of birth and smoking practices on voluntary smoking bans and on child ETS exposure.
Methods
U.S.- and Mexico-born Hispanic mothers of children aged 2 through 12 years were systematically sampled from health clinics in Albuquerque, New Mexico. In-person interviews were conducted with 269 mothers (75.4% response rate) to obtain information on main study outcomes (complete versus no/partial home and automobile smoking bans; child room and automobile ETS exposure) and risk factors (mother's country of birth, maternal and household smoking behaviors). Data were analyzed with chi square tests and logistic regression models.
Results
Three-fourths (74–77%) of U.S.-born and 90–95% of Mexico-born mothers reported complete automobile and home smoking bans. In multivariate analyses, mother's U.S nativity, mother's current smoking, and presence of other adult smokers in the home were associated with significantly increased odds of not having a complete home or automobile smoking ban. Mother's smoking was associated with child ETS exposure both indoors (odds ratio [OR] = 3.31) and in automobiles (OR = 2.97). Children of U.S.-born mothers had increased odds of exposure to ETS indoors (OR = 3.24; 95% confidence interval [CI]: 1.37–7.69), but not in automobiles. Having complete smoking bans was associated with substantially reduced odds of child ETS exposure both indoors (OR = 0.10; 95% CI: 0.04–0.27) and in automobiles (OR = 0.14; 95% CI: 0.05–0.36).
Conclusion
This study of Hispanic mothers in the southwestern U.S. indicates that there are substantial differences between U.S.- and Mexico-born mothers in the prevalence of home and automobile smoking bans, and resulting child ETS exposure. Tobacco interventions to increase smoke-free environments for U.S. Hispanic children should focus on both home and automobile smoking practices, especially among U.S.-born mothers, and utilize strategies that impact smoking practices of all household members.
doi:10.1186/1471-2458-6-265
PMCID: PMC1636637  PMID: 17069652
11.  Adolescent and adult first time mothers' health seeking practices during pregnancy and early motherhood in Wakiso district, central Uganda 
Reproductive Health  2008;5:13.
Background
Maternal health services have a potentially critical role in the improvement of reproductive health. In order to get a better understanding of adolescent mothers'needs we compared health seeking practices of first time adolescent and adult mothers during pregnancy and early motherhood in Wakiso district, Uganda.
Methods
This was a cross-sectional study conducted between May and August, 2007 in Wakiso district. A total of 762 women (442 adolescents and 320 adult) were interviewed using a structured questionnaire. We calculated odds ratios with their 95% CI for antenatal and postnatal health care seeking, stigmatisation and violence experienced from parents comparing adolescents to adult first time mothers. STATA V.8 was used for data analysis.
Results
Adolescent mothers were significantly more disadvantaged in terms of health care seeking for reproductive health services and faced more challenges during pregnancy and early motherhood compared to adult mothers. Adolescent mothers were more likely to have dropped out of school due to pregnancy (OR = 3.61, 95% CI: 2.40–5.44), less likely to earn a salary (OR = 0.43, 95%CI: 0.24–0.76), and more likely to attend antenatal care visits less than four times compared to adult mothers (OR = 1.52, 95%CI: 1.12–2.07). Adolescents were also more likely to experience violence from parents (OR = 2.07, 95%CI: 1.39–3.08) and to be stigmatized by the community (CI = 1.58, 95%CI: 1.09–2.59). In early motherhood, adolescent mothers were less likely to seek for second and third vaccine doses for their infants [Polio2 (OR = 0.73, 95% CI: 0.55–0.98), Polio3 (OR = 0.70: 95% CI: 0.51–0.95), DPT2 (OR = 0.71, 95% CI: 0.53–0.96), DPT3 (OR = 0.68, 95% CI: 0.50–0.92)] compared to adult mothers. These results are compelling and call for urgent adolescent focused interventions.
Conclusion
Adolescents showed poorer health care seeking behaviour for themselves and their children, and experienced increased community stigmatization and violence, suggesting bigger challenges to the adolescent mothers in terms of social support. Adolescent friendly interventions such as pregnancy groups targeting to empower pregnant adolescents providing information on pregnancy, delivery and early childhood care need to be introduced and implemented.
doi:10.1186/1742-4755-5-13
PMCID: PMC2648938  PMID: 19116011
12.  Earlier Mother's Age at Menarche Predicts Rapid Infancy Growth and Childhood Obesity 
PLoS Medicine  2007;4(4):e132.
Background
Early menarche tends to be preceded by rapid infancy weight gain and is associated with increased childhood and adult obesity risk. As age at menarche is a heritable trait, we hypothesised that age at menarche in the mother may in turn predict her children's early growth and obesity risk.
Methods and Findings
We tested associations between mother's age at menarche, mother's adult body size and obesity risk, and her children's growth and obesity risk in 6,009 children from the UK population-based Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort who had growth and fat mass at age 9 y measured by dual-energy X-ray absorptiometry. A subgroup of 914 children also had detailed infancy and childhood growth data. In the mothers, earlier menarche was associated with shorter adult height (by 0.64 cm/y), increased weight (0.92 kg/y), and body mass index (BMI, 0.51 kg/m2/y; all p < 0.001). In contrast, in her children, earlier mother's menarche predicted taller height at 9 y (by 0.41 cm/y) and greater weight (0.80 kg/y), BMI (0.29 kg/m2/y), and fat mass index (0.22 kg/m2/year; all p < 0.001). Children in the earliest mother's menarche quintile (≤11 y) were more obese than the oldest quintile (≥15 y) (OR, 2.15, 95% CI 1.46 to 3.17; p < 0.001, adjusted for mother's education and BMI). In the subgroup, children in the earliest quintile showed faster gains in weight (p < 0.001) and height (p < 0.001) only from birth to 2 y, but not from 2 to 9 y (p = 0.3–0.8).
Conclusions
Earlier age at menarche may be a transgenerational marker of a faster growth tempo, characterised by rapid weight gain and growth, particularly during infancy, and leading to taller childhood stature, but likely earlier maturation and therefore shorter adult stature. This growth pattern confers increased childhood and adult obesity risks.
Earlier age at menarche may be a transgenerational marker of faster growth, particularly during infancy, leading to taller childhood stature but earlier maturation and hence shorter adult stature.
Editors' Summary
Background.
Childhood obesity is a rapidly growing problem. Twenty-five years ago, overweight children were rare. Now, 155 million of the world's children are overweight and 30–45 million are obese. Overweight and obese children—those having a higher than average body mass index (BMI; weight divided by height squared) for their age and sex—are at increased risk of becoming obese adults. Such people are more likely to develop heart disease, diabetes, and other health problems than lean people. Many factors are involved in the burgeoning size of children. Parental obesity, for example, predisposes children to being overweight. In part, this is because parents influence the eating habits of their offspring and the amount of exercise they do. In addition, though, children inherit genetic factors from their parents that make them more likely to put on weight.
Why Was This Study Done?
To prevent childhood obesity, health care professionals need ways to predict which infants are likely to become obese so that they can give parents advice on controlling their children's weight. In girls, early menarche (the start of menstruation) is associated with an increased risk of childhood and adult obesity and tends to be preceded by rapid weight gain in the first two years of life. Because age at menarche is inherited, the researchers in this study have investigated whether mothers' age at menarche predicts rapid growth in infancy and childhood obesity in their offspring using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). In 1991–1992, this study recruited nearly 14,000 children born in Bristol, UK. Since then, the children have been regularly examined to investigate how their environment and genetic inheritance interact to affect their health.
What Did the Researchers Do and Find?
The researchers measured the growth and fat mass of 6,009 children from ALSPAC at 9 years of age. For 914 of these children, the researchers had detailed data on their growth during infancy and early childhood. They then looked for any associations between the mother's age at menarche (as recalled during pregnancy), mother's adult body size, and the children's growth and obesity risk. In the mothers, earlier menarche was associated with shorter adult height and increased weight and BMI. In the children, those whose mothers had earlier menarche were taller and heavier than those whose mothers had a later menarche. They also had a higher BMI and more body fat. The children whose mothers had their first period before they were 11 were twice as likely to be obese as those whose mothers did not menstruate until they were 15 or older. Finally, for the children with detailed early growth data, those whose mothers had the earliest menarche had faster weight and height gains in the first two years of life (but not in the next seven years) than those whose mothers had the latest menarche.
What Do These Findings Mean?
These findings indicate that earlier mother's menarche predicts a faster growth tempo (the speed at which an individual reaches their adult height) in their offspring, which is characterized by rapid weight and height gain during infancy. This faster growth tempo leads to taller childhood stature, earlier sexual maturity, and—because age at puberty determines adult height—shorter adult stature. An inherited growth pattern like this, the researchers write, confers an increased risk of childhood and adult obesity. As with all studies that look for associations between different measurements, these findings will be affected by the accuracy of the measurements—for example, how well the mothers recalled their age at menarche. Furthermore, because puberty, particularly in girls, is associated with an increase in body fat, a high BMI at age nine might indicate imminent puberty rather than a risk of long-standing obesity—further follow-up studies will clarify this point. Nevertheless, the current findings provide a new factor—earlier mother's menarche—that could help health care professionals identify which infants require early growth monitoring to avoid later obesity.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040132.
The Avon Longitudinal Study of Parents and Children has a description of the study and results to date
The US Centers for Disease Control and Prevention provides information on overweight and obesity (in English and Spanish)
US Department of Health and Human Services's program, Smallstep Kids, is an interactive site for children about healthy eating (in English and Spanish)
The International Obesity Taskforce has information on obesity and its prevention
The World Heart Federation's Global Prevention Alliance provides details of international efforts to halt the obesity epidemic and its associated chronic diseases
The Child Growth Foundation has information on childhood growth and its measurement
doi:10.1371/journal.pmed.0040132
PMCID: PMC1876410  PMID: 17455989
13.  Attention Deficit/Hyperactivity Disorder Symptoms and Depression Symptoms as Mediators in the Intergenerational Transmission of Smoking 
Drug and alcohol dependence  2012;126(1-2):147-155.
Background
Attention deficit/hyperactivity disorder and depression have been found to be comorbid with smoking behaviors, and all three behavioral syndromes have been shown to be familially transmitted. The present paper reports on the results of analyses testing whether child attention deficit/hyperactivity disorder and depression symptoms were mediators in the intergenerational transmission of cigarette smoking.
Method
Path analyses using bootstrapped mediation procedures were conducted on data from a community sample of 764 families (one or both parents and one adolescent offspring) from the Indiana University Smoking Survey. Parents reported on their smoking behaviors, ADHD, and depression and their child’s ADHD, while offspring reported on their smoking behaviors and depression.
Results
Although fathers’ and mothers’ smoking status, depression, and ADHD were not significantly correlated with boys’ smoking initiation, there was a significant mediated (indirect) pathway from mothers’ depression to boys’ smoking initiation through boys’ depression. Several parental variables were significantly correlated with smoking initiation in girls, and the pathways from mothers’ smoking status, mothers’ ADHD, and fathers’ smoking status to girls’ smoking initiation were significantly mediated by girls’ ADHD.
Conclusions
For adolescent girls, the intergenerational transmission of ADHD appears to be important in understanding the intergenerational transmission of cigarette smoking. Sex differences in the intergenerational transmission of psychopathology as it leads to smoking initiation were also discussed.
doi:10.1016/j.drugalcdep.2012.05.003
PMCID: PMC3458141  PMID: 22682659
smoking initiation; attention deficit/hyperactivity disorder; depression; familial transmission
14.  First-Year Maternal Employment and Child Development in the First Seven Years 
Using data from the first 2 phases of the NICHD Study of Early Child Care, we examine the links between maternal employment in the first 12 months of life and cognitive, social, and emotional outcomes for children at age 3, age 4½, and first grade. Drawing on theory and prior research from developmental psychology as well as economics and sociology, we address three main questions. First, what associations exist between first-year maternal employment and cognitive, social, and emotional outcomes for children over the first seven years of life? Second, to what extent do any such associations vary by the child’s gender and temperament, or the mother’s occupation? Third, to what extent do mother’s earnings, the home environment (maternal depressive symptoms, sensitivity, and HOME scores), and the type and quality of child care mediate or offset any associations between first-year employment and child outcomes, and what is the net effect of first-year maternal employment once these factors are taken into account?
We compare families in which mothers worked full time (55%), part time (23%), or did not work (22%) in the first year for non-Hispanic white children (N=900) and for African-American children (N=113). Comparisons are also made taking into account the timing of mothers’ employment within the first year. A rich set of control variables are included. OLS and SEM analyses are constructed.
With regard to cognitive outcomes, first, we find that full-time maternal employment in the first 12 months of life (but not part-time employment) is associated with significantly lower scores on some, but not all, measures of cognitive development at age 3, 4 ½, and first grade for non-Hispanic white children, but with no significant associations for the small sample of African-American children Part-time employment in the first year is associated with higher scores than full-time employment for some measures. Employment in the second and third year of life is not associated with the cognitive outcomes. Second, we examine the role of the child’s gender and temperament and the mother’s occupation in moderating the associations between first-year maternal employment and cognitive outcomes, but find few significant interactions for either child characteristics or mother’s occupation. Third, we examine the role of an extensive set of potential mediators – the mother’s earnings, the home environment, and the type and quality of child care. We find that mothers who worked full time have higher income in the first year of life and thereafter, that mothers who worked part time have higher HOME and maternal sensitivity scores than mothers who did not work or worked full time, and that mothers who worked either full time or part time were more likely to place their children in high-quality child care by age 3 and 4 ½ and their children spent more time in center-based care by age 4 ½ than in families where mothers did not work in the first year of life. However, we also find some links between first-year maternal employment and elevated levels of maternal depressive symptoms thereafter. Turning to results from structural equation modeling, we find that the overall effects of first-year maternal employment on the cognitive outcomes are neutral. This occurs because significantly negative direct effects of full-time first-year employment are offset by significantly positive indirect effects working through more use of center-based care and greater maternal sensitivity by age 4 ½.
Regarding social and emotional outcomes, several findings, again limited to non-Hispanic white children, stand out. First, we find no significant associations between first-year maternal employment and later social and emotional outcomes (including attachment security) when comparing children whose mothers worked full-time or part-time in the first year with the reference group of children whose mothers did not work in the first year, although in models that take the timing of employment within the first year into account, we find some significant associations between full-time maternal employment in the first year and higher levels of caregiver- or teacher-reported externalizing problems at age 4 ½ and first grade. Second, part-time maternal employment by 12 months tends to be associated with fewer externalizing problems at age 4 ½ and first grade than full time maternal employment by 12 months. These results are unchanged when we allow for the possibility of moderation by child characteristics or maternal occupation. Third, the results from SEM models indicate that, while neither full-time nor part-time first-year employment has significant total effects on children’s externalizing behavior problems at age 4 ½ or first grade, part-time first-year employment has indirect positive effects, working primarily through differences in the home environment and maternal sensitivity. Another important finding from the SEM models is that center-based care, which is often associated with maternal employment, is not significantly associated with elevated levels of child behavior problems.
Taken together, our findings provide new insight as to the net effects of first-year maternal employment as well as the potential pathways through which associations between first-year maternal employment and later child outcomes, where present, come about. Our SEM results indicate that, on average, the associations between first-year maternal employment and later cognitive, social, and emotional outcomes are neutral, because negative effects, where present, are offset by positive effects. These results confirm that maternal employment in the first year of life may confer both advantages and disadvantages and that for the average non-Hispanic white child, those effects balance each other.
doi:10.1111/j.1540-5834.2010.00562.x
PMCID: PMC4139074  PMID: 25152543
15.  Comparison between observed children's tooth brushing habits and those reported by mothers 
BMC Oral Health  2011;11:22.
Background
Information bias can occur in epidemiological studies and compromise scientific outcomes, especially when evaluating information given by a patient regarding their own health. The oral habits of children reported by their mothers are commonly used to evaluate tooth brushing practices and to estimate fluoride intake by children. The aim of the present study was to compare observed tooth-brushing habits of young children using fluoridated toothpaste with those reported by mothers.
Methods
A sample of 201 mothers and their children (aged 24-48 months) from Montes Claros, Brazil, took part in a cross-sectional study. At day-care centres, the mothers answered a self-administered questionnaire on their child's tooth-brushing habits. The structured questionnaire had six items with two to three possible answers. An appointment was then made with each mother/child pair at day-care centres. The participants were asked to demonstrate the tooth-brushing practice as usually performed at home. A trained examiner observed and documented the procedure. Observed tooth brushing and that reported by mothers were compared for overall agreement using Cohen's Kappa coefficient and the McNemar test.
Results
Cohen's Kappa values comparing mothers' reports and tooth brushing observed by the examiner ranged from poor-to-good (0.00-0.75). There were statistically significant differences between observed tooth brushing habits and those reported by mothers (p < 0.001). When observed by the examiner, the frequencies of dentifrice dispersed on all bristles (35.9%), children who brushed their teeth alone (33.8%) and those who did not rinse their mouths during brushing (42.0%) were higher than those reported by the mothers (12.1%, 18.9% and 6.5%, respectively; p < 0.001).
Conclusions
In general, there was low agreement between observed tooth brushing and mothers' reports. Moreover, the different methods of estimation resulted in differences in the frequencies of tooth brushing habits, indicative of reporting bias. Data regarding children's tooth-brushing habits as reported by mothers should be considered with caution in epidemiological surveys on fluoridated dentifrice use and the risk of dental fluorosis.
doi:10.1186/1472-6831-11-22
PMCID: PMC3175471  PMID: 21888664
16.  How do Mothers, Fathers, and Friends Influence Stages of Adolescent Smoking? 
Parent and friend influences may differentially promote or deter adolescent smoking at discrete stages. Drawing from national (Add Health) data, a partial proportional odds ordinal regression model was utilized to examine the multivariate influence of parent and friend variables and their interactions on transitions across smoking stages (Never Smokers, Experimenters, Intermittent, Regular/Established) separately for mother-child pairs (N = 15,983) and father-child pairs (N = 1,142). Friend smoking status was by far the strongest predictor across smoking stages. Gender differences indicated males with one or more daily smoking friends are at higher risk for regular smoking relative to females. Fathers’ smoking status had a direct effect on teen smoking across all stages, whereas mothers’ smoking was significant in influencing which stage of smoking teens exhibited. Moreover, maternal smoking status had an indirect effect by moderating the association between teen smoking and the closeness of the mother-teen relationship. Mothers who smoke were found to have a stronger impact on the transition to regular smoking compared to mothers who do not smoke regardless of the number of smoking friends the teen reports. Results have implications for stage-matched and family-based prevention and intervention programs.
PMCID: PMC3514408  PMID: 23226718
adolescent health; parent-child relationships; social environment; adolescence risk-taking avoidance education
17.  Is There an Association Between Maternal Pap Test Use and Adolescent Human Papillomavirus Vaccination? Implications and Contribution 
Purpose
To identify the association between mother’s recent receipt of a Pap test and daughter’s uptake and completion of the three-shot human papillomavirus (HPV) vaccination series.
Methods
We used cross-sectional data from the 2008 to 2010 Behavioral Risk Factor Surveillance System from 9 U.S. states and Puerto Rico and logistic regression models to examine the association between mother’s receipt of a Pap test in the past 3 years and daughter’s uptake and completion of the three-shot HPV vaccination series among adolescent girls aged 9-17 years (N = 4,776).
Results
Approximately one-quarter of adolescent girls began the HPV vaccination series, and 13.6% completed the three-shot series. Uptake and completion were more likely among girls whose mothers had obtained a Pap test within the past 3 years—for HPV uptake, odds ratio: 1.342, 95% confidence interval: 1.073-1.692; for HPV completion, odds ratio: 1.904; 95% confidence interval: 1.372-2.721—but the relationship between mother’s recent Pap test and vaccine uptake was explained by the mother’s use of a personal doctor and obtaining a routine physical examination in the past year.
Conclusions
HPV vaccination uptake and completion were more likely among adolescent girls whose mothers obtained a recent Pap test. Interventions designed to educate mothers on the importance of HPV vaccination and to facilitate relationships between physicians and mothers may prove successful at increasing HPV vaccination among adolescent girls.
doi:10.1016/j.jadohealth.2012.05.015
PMCID: PMC4130478  PMID: 23332487
18.  Human Papillomavirus Vaccine Communication: Perspectives of 11–12 Year-Old Girls, Mothers, and Clinicians 
Vaccine  2013;31(42):10.1016/j.vaccine.2013.07.033.
Objectives
Because little is known about the content of human papillomavirus (HPV) vaccine-related discussions with young adolescent girls in clinical settings, we explored communication between 11–12 year-old girls, mothers, and clinicians regarding HPV vaccines and concordance in reports of maternal and clinician communication.
Methods
We conducted individual interviews with 33 girls who had received the quadrivalent HPV vaccine in urban and suburban clinical settings, their mothers, and their clinicians. Data were analyzed using qualitative methods.
Results
From the perspectives of both girls and mothers, clinicians and parents were the preferred sources of HPV vaccine information for girls. Vaccine efficacy and risks/benefits of vaccination were the most commonly reported desired and actual topics of discussion by mothers, girls, and clinicians. Clinician recommendation of vaccination was reported by nearly one-fifth of girls and nearly half of mothers. The most common concordant messages were related to efficacy of the vaccine, with concordance in 70% of triads. The most common discordant messages were related to sexual health. Approximately half of clinicians (16) reported discussing sexual health, but only 5 mothers (15%) and 4 girls (12%) reported this. Triads recruited from suburban (vs. urban) practices had higher degrees of concordance in reported vaccination communication.
Conclusions
HPV vaccine efficacy and safety are important topics for clinicians to discuss with both girls and mothers; educating mothers is important because parents are a preferred source of vaccine-related information for girls. Because girls may be missing important vaccine-related messages, they should be encouraged to actively engage in vaccine discussions.
doi:10.1016/j.vaccine.2013.07.033
PMCID: PMC3818111  PMID: 23916986
Adolescents; Human papillomavirus (HPV); HPV vaccination; Communication
19.  Weight growth in infants born to mothers who smoked during pregnancy. 
BMJ : British Medical Journal  1995;310(6982):768-771.
OBJECTIVE--To determine whether maternal smoking during pregnancy causes impairment in growth after birth. DESIGN--Longitudinal study. SETTING--Six medical university centres of six towns of north, central, and south Italy. SUBJECTS--12,987 babies (10,238 born from non-smoking mothers, 2276 from mothers smoking one to nine cigarettes a day, and 473 from mothers smoking > or = 10 cigarettes a day) entered the study. MAIN OUTCOME MEASURES--Difference in weight gain between children born to smoking mothers and those born to non-smoking mothers. Weight was measured at birth and at 3 and 6 months of age. Maternal smoking habit was derived from interview on third or fourth day after delivery. RESULTS--Compared with children born to mothers who did not smoke during pregnancy, the birth weights of children born to mothers who smoked up to nine cigarettes a day were 88 g (girls) and 107 g (boys) lower; in children born to mothers who smoked > or = 10 cigarettes a day weights were 168 g and 247 g lower. At six months of age for the first group the mean weight for girls was 9 g (95% confidence interval -47 g to 65 g) higher and for boys 64 g (-118 g to -10 g) lower than that of children born to mothers who did not smoke. The corresponding figures for the second group were 28 g (-141 g to 85 g) lower for girls and 24 g (-136 g to 88 g) lower for boys. CONCLUSIONS--The deficits of weight at birth in children born to mothers who smoked during pregnancy are overcome by 6 months of age. These deficits are probably not permanent when smoking habit during pregnancy is not associated with other unfavourable variables (such as lower socioeconomic class).
PMCID: PMC2549163  PMID: 7711580
20.  Active and passive maternal smoking during pregnancy and birth outcomes: the Kyushu Okinawa Maternal and Child Health Study 
Background
In Western countries, active maternal smoking during pregnancy is recognized as the most important preventable risk factor for adverse birth outcomes. However, the effect of passive maternal smoking is less clear and has not been extensively studied. In Japan, there has been only one epidemiological study which examined the effects of active smoking during early pregnancy on birth outcomes although the effects of passive smoking were not assessed.
Methods
Study subjects were 1565 mothers with singleton pregnancies and the babies born from these pregnancies. Data on active maternal smoking status in the first, second, and third trimesters and maternal environmental tobacco smoke (ETS) exposure at home and work were collected with self-administered questionnaires.
Results
Compared with children born to mothers who had never smoked during pregnancy, children born to mothers who had smoked throughout their pregnancy had a significantly increased risk of small-for-gestational-age (SGA) (adjusted odd ratio [OR] = 2.87; 95% confidence interval: 1.11 − 6.56). However, active maternal smoking only in the first trimester and active maternal smoking in the second and/or third trimesters but not throughout pregnancy were not significantly associated with SGA. With regard to the risk of preterm birth, the adjusted ORs for the above-mentioned three categories were not significant; however, the positive linear trend was significant (P for trend = 0.048). No significant association was found between active maternal smoking during pregnancy and the risk of low birth weight. There was a significant inverse relationship between active maternal smoking during pregnancy and birth weight; newborns of mothers who had smoked throughout pregnancy had an adjusted mean birth weight reduction of 169.6 g. When classifying babies by gender, a significant positive association between active maternal smoking throughout pregnancy and the risk of SGA was found only in male newborns, however, the interaction was not significant. Maternal ETS exposure at home or work was not significantly associated with any birth outcomes.
Conclusions
This is the first study in Japan to show that active maternal smoking throughout pregnancy, but not during the first trimester, is significantly associated with an increased risk of SGA and a decrease in birth weight. Thus, women who smoke should quit smoking as soon as possible after conception.
doi:10.1186/1471-2393-13-157
PMCID: PMC3750375  PMID: 23919433
21.  Lone mothers in Sweden: trends in health and socioeconomic circumstances, 1979-1995 
STUDY OBJECTIVE: To study trends in the health and socioeconomic circumstances of lone mothers in Sweden over the years 1979-1995, and to make comparisons with couple mothers over the same period. DESIGN: Analysis of data from the annual Survey of Living Conditions (ULF), conducted by Statistics Sweden from 1979-1995. Comparison of demographic, socioeconomic and health status of lone and couple mothers and how these have varied over the 17 years of the study. Main outcome measures include prevalence of self perceived general health and limiting longstanding illness. PARTICIPANTS AND SETTING: All lone mothers (n = 2776) and couple mothers (n = 16,935) aged 16 to 64 years in a random sample of the Swedish population in a series of cross sectional surveys carried out each year between 1979 and 1995. MAIN RESULTS: The socioeconomic conditions of lone mothers deteriorated during the period 1979-1995, with increasing unemployment and poverty rates. Lone mothers had worse health status than couple mothers throughout the period. In comparison with the first two periods, the prevalence of less than good health increased among both lone and couple mothers from the late 1980s onwards. For lone and couple mothers who were poor, their rates of less than good health were similar in the early 1980s, but in 1992-95 poor lone mothers were significantly more likely to report less than good health than poor couple mothers. Unemployed lone mothers had particularly high rates of ill health throughout the study period. CONCLUSIONS: As in other European countries, lone mothers are emerging as a vulnerable group in society in Sweden, especially in the economic climate of the 1990's. While they had very low rates of poverty and high employment rates in the 1980s, their situation has deteriorated with the economic recession of the 1990's. The health status of lone mothers, particularly those who are unemployed or poor, appears worse than that of couple mothers and in some circumstances may be deteriorating. Further study is needed to elucidate the mechanisms mediating their health disadvantage compared with couple mothers.
 
PMCID: PMC1756818  PMID: 10656083
22.  Childhood myopia and parental smoking 
Aim: To examine the relation between exposure to passive parental smoke and myopia in Chinese children in Singapore.
Methods: 1334 Chinese children from three schools in Singapore were recruited, all of whom were participants in the Singapore Cohort study Of the Risk factors for Myopia (SCORM).
Information on whether the father or mother smoked, number of years smoked, and the number of cigarettes smoked per day during the child’s lifetime were derived. These data were correlated with contemporaneously obtained data available in SCORM. The children’s cycloplegic autorefraction, corneal curvature radius, and biometry measures were compared with reported parental smoking history.
Results: There were 434 fathers (33.3%) and 23 mothers (1.7%) who smoked during their child’s lifetime. There were no significant trends observed between paternal smoking and refractive error or axial length. After controlling for age, sex, school, mother’s education, and mother’s myopia, children with mothers who had ever smoked during their lifetime had more “positive” refractions (adjusted mean −0.28 D v −1.38 D) compared with children whose mother did not smoke (p = 0.012).
Conclusions: The study found no consistent evidence of association between parental smoking and refractive error. There was a suggestion that children whose mothers smoked cigarettes had more hyperopic refractions, but the absence of a relation with paternal smoking and the small number of mothers who smoked in this sample preclude definite conclusions about a link between passive smoking exposure and myopia.
doi:10.1136/bjo.2003.033175
PMCID: PMC1772214  PMID: 15205241
myopia; passive smoking; cross sectional; risk factor; Singapore
23.  Exposure to teachers smoking and adolescent smoking behaviour: analysis of cross sectional data from Denmark 
Tobacco Control  2002;11(3):246-251.
Objective: To determine whether adolescent smoking behaviour is associated with their perceived exposure to teachers or other pupils smoking at school, after adjustment for exposure to smoking at home, in school, and best friends smoking.
Design: Logistic regression analysis of cross sectional data from students in Denmark.
Subjects: 1515 grade 9 students (mean age 15.8) from 90 classes in 48 Danish schools.
Outcome measure: Self reported smoking behaviour; daily smoking and heavy smoking, defined as those smoking more than 20 cigarettes per week.
Results: Of the students in this study, 62% of boys and 60% of girls reported being exposed to teachers smoking outdoors on the school premises. The proportion of boys and girls reporting to have been exposed to teachers smoking inside the school building were 86% and 88%, respectively. Furthermore, 91% of boys and 92% of girls reported that they had seen other students smoking outdoors on the school premises. Adolescents' perceived exposure to teachers smoking outdoors on the school premises was significantly associated with daily smoking, having adjusted for sex, exposure to teachers smoking indoors at school and pupils smoking outdoors at school, as well as the smoking behaviour of mother, father, and best friend (odds ratio (OR) 1.8, 95% confidence interval 1.2 to 2.8). Adolescents' perceived exposure to teachers smoking inside the school building was not associated with daily smoking (OR 0.9, 95% CI 0.5 to 1.6) and perceived exposure to pupils smoking outdoors was not associated with daily smoking (adjusted OR 1.5, 95% CI 0.5 to 4.4). There were similar findings with heavy smoking as the outcome variable.
Conclusions: Teachers smoking during school hours is associated with adolescent smoking. This finding has implications for future tobacco prevention strategies in schools in many countries with liberal smoking policies where it might provide support for those working to establish smokefree schools.
doi:10.1136/tc.11.3.246
PMCID: PMC1759003  PMID: 12198278
24.  Young Children's Probability of Dying Before and After Their Mother's Death: A Rural South African Population-Based Surveillance Study 
PLoS Medicine  2013;10(3):e1001409.
Brian Houle and colleagues examine the temporal relationship between mother and child death by using 15 years of data (1994–2008) from household surveys conducted in the Agincourt sub-district of South Africa.
Background
There is evidence that a young child's risk of dying increases following the mother's death, but little is known about the risk when the mother becomes very ill prior to her death. We hypothesized that children would be more likely to die during the period several months before their mother's death, as well as for several months after her death. Therefore we investigated the relationship between young children's likelihood of dying and the timing of their mother's death and, in particular, the existence of a critical period of increased risk.
Methods and Findings
Data from a health and socio-demographic surveillance system in rural South Africa were collected on children 0–5 y of age from 1 January 1994 to 31 December 2008. Discrete time survival analysis was used to estimate children's probability of dying before and after their mother's death, accounting for moderators. 1,244 children (3% of sample) died from 1994 to 2008. The probability of child death began to rise 6–11 mo prior to the mother's death and increased markedly during the 2 mo immediately before the month of her death (odds ratio [OR] 7.1 [95% CI 3.9–12.7]), in the month of her death (OR 12.6 [6.2–25.3]), and during the 2 mo following her death (OR 7.0 [3.2–15.6]). This increase in the probability of dying was more pronounced for children whose mothers died of AIDS or tuberculosis compared to other causes of death, but the pattern remained for causes unrelated to AIDS/tuberculosis. Infants aged 0–6 mo at the time of their mother's death were nine times more likely to die than children aged 2–5 y. The limitations of the study included the lack of knowledge about precisely when a very ill mother will die, a lack of information about child nutrition and care, and the diagnosis of AIDS deaths by verbal autopsy rather than serostatus.
Conclusions
Young children in lower income settings are more likely to die not only after their mother's death but also in the months before, when she is seriously ill. Interventions are urgently needed to support families both when the mother becomes very ill and after her death.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Over the past few years, there has been enormous international effort to meet the target set by Millennium Development Goal 4—to reduce the under-five child mortality rate by two-thirds from the 1990 level by 2015. There has been some encouraging progress, and according to the latest figures from the World Health Organization, in 2011, just under 7 million children less than five years died, a fall of almost 3 million from a decade ago. However, such efforts must also consider the health of the mother, as it is now also well established that the health of children is intrinsically linked to their mother's health: there is strong evidence from low- and middle-income countries that children's risk of dying increases around the time of their mother's death, particularly relating to the HIV pandemic in Africa.
Why Was This Study Done?
Previous studies examining the timing of a child's death relative to that of their mother have mainly focused on the period after the mother's death. So far, there have been few studies examining the link between a child's death and the period when his/her mother becomes ill and unable to care for and feed her child. In this study from the Agincourt sub-district in northeast South Africa, the researchers investigated the relationship between young children's chance (odds) of dying and the timing of their mother's death, particularly to examine whether there were critical periods of risk for children before their mother's death.
What Did the Researchers Do and Find?
The researchers used the health and socio-demographic surveillance system in the area, which had 15 years (1994–2008) of information from yearly household surveys. The researchers focused on young children (0–6 months, 7–23 months, and 24–59 months) whose mothers had died, and through a statistical model, analysed the changes in the child's chance (odds) of dying from a year before the mother's death through to any time after her death during the study period. The cause of the mother's death was identified from verbal autopsy and categorized as being related to AIDS or tuberculosis (chronic) or other (mostly acute) causes not related to these infections. The researchers took other factors into account in their analysis and compared the odds of dying for children whose mothers died with those whose mothers were alive.
Using these methods, the researchers found that a total of 1,244 children (3% of the total sample) died between 1994 and 2008. Importantly, the researchers found that although the period when children are more likely to die began to increase in the period 6–11 months before their mother's death, there were three distinct periods of a much higher chance (odds) of death: the period 1–2 months before the month in which their mother died (odds ratio 7.1), the month of her death (odds ratio 12.6), and the period 1–2 months following her death (odds ratio 7.0). Furthermore, during the five-month period around the time of their mother's death, children (both boys and girls) aged 0–6 months were about nine times more likely to die than children aged 24–59 months. Finally, children were about 1.5 times more likely to die if their mother died of an AIDS/tuberculosis-related cause.
What Do These Findings Mean?
These finding suggest that in low-income settings, young children are more likely to die in the months before their mother's death, when she is seriously ill, not just in the period after her death. The chance of dying is particularly increased in very young children (0–6 months) and in children whose mother died of HIV/tuberculosis-related causes. Although this study had several limitations, such as limited information on the child's cause of death, this study highlights the urgent need for proactive and coordinated community-based interventions to support families, especially vulnerable children, when a mother becomes seriously ill, in addition to the period following her death.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001409.
The Countdown to 2015 initiative has the latest country information on progress in reducing maternal, neonatal, and child deaths
The World Health Organization has more information on Millennium Development Goal 4
The Joint United Nations Joint Programme on HIV/AIDS has information about the number of deaths from HIV-related causes
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) has more information on the research platform that made this study possible
doi:10.1371/journal.pmed.1001409
PMCID: PMC3608552  PMID: 23555200
25.  Discrepancies in Adolescents’ and their Mothers’ Perceptions of the Family and Adolescent Anxiety Symptomatology 
SYNOPSIS
Objective
This study examines relations between adolescents’ and their mothers’ perceptions of the family and adolescent anxiety symptomatology.
Design
Surveys were administered to 145 15- to 18-year-old adolescents and their mothers.
Results
Adolescents viewed the family more negatively than did their mothers. In addition, adolescent girls’ perceptions of the family (satisfaction and communication) negatively predicted later adolescent anxiety symptomatology. Significant interactions between adolescent and mother reports of family satisfaction and communication also were found for girls, but not for boys. For girls, discrepant family perceptions with their mothers appeared to protect them from anxiety if their mothers had negative perceptions of the family.
Conclusions
Understanding the similarities and differences among family members’ perspectives yields useful predictive information that cannot be obtained from studying these perspectives in isolation from one another.
doi:10.1080/15295192.2014.870009
PMCID: PMC3947635  PMID: 24634608

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