Uncertain steps into adulthood: Does economic precariousness hinder entry into the first co-residential partnership in the UK?

This study uses prospective data spanning 27 years (1991-2018) to explore the relationship between economic precariousness and transitions to first co-residential partnership among Britons aged 18-34 across three dimensions: age, historical time, and sex. Economic precariousness is measured using eight objective and subjective indicators, including income, employment, housing, and financial perceptions. Our results show that economic precariousness has a strong negative relationship with entering the first co-residential partnership among those aged 20-30, but the pattern is less clear among the youngest and oldest. Objective measures are easier to interpret than subjective measures. Historical analyses suggest that not being employed decreases the probability of union formation more in recessionary periods than in non-recessionary ones. Among working women, low labour income started to be a predictor of union formation in the most recent periods. Labour income is the only indicator presenting trends in line with our hypotheses across all dimensions.

The Changing Association Between Homeownership and the Transition to Parenthood.

The literature suggests a positive link between homeownership and the transition to parenthood. However, in recent decades, couples' preference for becoming homeowners before having their first child has been undermined by rising housing unaffordability and housing uncertainty. An archetypal example is Britain, where homeownership rates among young adults have fallen substantially as a result of low wages, unemployment, reductions in the availability of mortgage credit, and rising house prices. This situation has produced a housing crisis. Using longitudinal data from the British Household Panel Survey (1991-2008) and the United Kingdom Household Longitudinal Study (2009-2016), we apply multilevel, discrete-time event-history techniques to a sample of women aged 18-42. We investigate whether and how the link between homeownership and entering parenthood has changed in Britain in recent decades. Our findings reveal that in comparison with the 1990s, the likelihood of becoming a parent has declined among homeowners, whereas childbearing rates among private renters have remained stable. Thus, owner-occupiers and private renters have become more similar in terms of their likelihood of entering parenthood. Overall, our findings question the classical micro-level assumption of a positive link between homeownership and transition to parenthood, at least among Britain's "Generation Rent." These findings are subsequently interpreted in terms of increased housing uncertainty.

Socioeconomic risk factors for labour induction in the United Kingdom.

BACKGROUND: Labour induction is a childbirth intervention experienced by a growing number of women globally each year. While the maternal and socioeconomic indicators of labour induction are well documented in countries like the United States, considerably less research has been done into which women have a higher likelihood of labour induction in the United Kingdom. This paper explores the relationship between labour induction and maternal demographic, socioeconomic, and health indicators by parity in the United Kingdom. METHOD: Logistic regression analyses were conducted using the first sweep of the Millennium Cohort Study, including a wide range of socioeconomic factors such as maternal educational attainment, marital status, and electoral ward deprivation, in addition to maternal and infant health indicators. RESULTS: In fully adjusted models, nulliparous and multiparous women with fewer educational qualifications and those living in disadvantaged places had a greater likelihood of labour induction than women with higher qualifications and women in advantaged electoral wards. CONCLUSIONS: This paper highlights which UK women are at higher risk of labour induction and how this risk varies by socioeconomic status, demonstrating that less advantaged women are more likely to experience labour induction. This evidence could help health care professionals identify which patients may be at higher risk of childbirth intervention.

Assessing the parental SES gradient in young Britons' partnership expectations, attitudes and its potential mediators.

A well-documented trend in family demography is that young adults from disadvantaged backgrounds tend to enter their first partnership earlier and forego marriage more often than their advantaged counterparts. Yet, limited research has explored whether there is also an association between parental background and expectations for partnership formation, which are considered important precursors of behaviours. Further, few studies have explored the potential mechanisms mediating these differences. This paper uses data from the British Household Panel Survey and Understanding Society to analyse the relationships between parental socioeconomic status and young Britons' expectations for marriage, cohabitation, and attitudes towards ideal age at marriage. Using the KHB decomposition as a mediation method, we verify whether these relationships are explained by two mechanisms measured during the young adults' adolescence: family structure socialisation and academic socialisation. We find that marriage expectations are socially stratified in the UK. Those from the least advantaged backgrounds have significantly lower expectations for marriage than the most advantaged, but this difference does not hold for cohabitation. Those from the least advantaged backgrounds are also more uncertain about their ideal age at marriage. Academic socialisation mediates these relationships to a limited extent. Family structure socialisation mediates a greater percentage, especially living with a single parent, rather than married parents, during adolescence.

Educational Gradient of Multi-partner Fertility: First Estimates for the UK.

Recent demographic changes in Western countries have resulted in higher rates of partnership dissolution and serial partnering, and an increase in childbearing across multiple partnerships. This has given rise to more complex family dynamics including multi-partner fertility (MPF), defined as having biological children with two or more partners. Yet estimates of MPF in the UK have not previously been available. This paper describes an 'indirect approach' to estimate the prevalence of MPF in the UK, for men and women, given different assumptions. The paper additionally explores differences in MPF according to own and parental educational attainment. Amongst those born in Britain in 1970, 12-14% of men and 15-18% of women experienced MPF by age 42, depending on the assumptions made. For most of the cohort, MPF occurred with two different coresidential partners. We have established that MPF is a common family formation in the UK, but there are large educational disparities in MPF prevalence.

Quantifying the effect of interpregnancy maternal weight and smoking status changes on childhood overweight and obesity in a UK population-based cohort.

BACKGROUND: Maternal preconception and pregnancy exposures have been linked to offspring adiposity. We aimed to quantify the effect of changes in maternal weight and smoking status between pregnancies on childhood overweight/obesity (≥ 85th centile) and obesity (≥ 95th centile) rates in second children. METHODS: Records for 5612 women were drawn from a population-based cohort of routinely collected antenatal healthcare records (2003-2014) linked to measured child body mass index (BMI) age 4-5 years. We applied the parametric G-formula to estimate the effect of hypothetical changes between pregnancy-1 and pregnancy-2 compared to the natural course scenario (without change) on child-2 BMI. RESULTS: Observed overweight/obesity and obesity in child-2 at age 4-5 years were 22.2% and 8·5%, respectively. We estimated that if all mothers started pregnancy-2 with BMI 18·5-24·9 kg/m² and all smokers stopped smoking, then child-2 overweight/obesity and obesity natural course estimates of 22.3% (95% CI 21.2-23.5) and 8·3% (7·6-9·1), would be reduced to 18.5% (17.4-19.9) and 6.2% (5.5-7.0), respectively. For mothers who started pregnancy-1 with BMI 18·5-24·9 kg/m², if all smokers stopped smoking, child-2 overweight/obesity and obesity natural course estimates of 17.3% (16.0-18.6) and 5·9% (5·0-6·7) would be reduced to 16.0% (14.6-17.3) and 4·9% (4·1-5·7), respectively. For mothers who started pregnancy-1 with BMI ≥30 kg/m², if BMI was 18·5-24·9 kg/m² prior to pregnancy-2, child-2 overweight/obesity and obesity natural course estimates of 38.6% (34.7-42.3) and 17·7% (15·1-20·9) would be reduced to 31.3% (23.8-40.0) and 12.5 (8.3-17.4), respectively. If BMI was 25.0-29.9 kg/m² prior to pregnancy-2, these estimates would be 34.5% (29.4-40.4) and 14.6% (11.2-17.8), respectively. CONCLUSION: Interventions supporting women to lose/maintain weight and quit smoking between pregnancies could help reduce rates of overweight/obesity and obesity in second children. The most effective interventions may vary by maternal BMI prior to the first pregnancy.

Exploring the associations between number of children, multi-partner fertility and risk of obesity at midlife: Findings from the 1970 British Cohort Study (BCS70).

BACKGROUND: Early parenthood, high parity, and partnership separation are associated with obesity. However, the emergence of non-marital partnerships, serial partnering and childbearing across unions, means that it is important to consider their association to obesity. This paper examined the associations between number of biological children and multi-partner fertility (MPF)-defined as having biological children with more than one partner, with obesity at midlife. METHOD: The sample consisted of 2940 fathers and 3369 mothers in the 1970 British Cohort Study. The outcome was obesity (BMI 30 or over) at age 46. Fertility and partnership histories ascertained the number of live biological children and MPF status by age 42. The associations were tested using logistic regression adjusting for confounders at birth, age 10 and age 16. Adult factors recorded at age 42 including age at first birth, smoking status, alcohol dependency, educational attainment and housing tenure were considered as mediators. RESULTS: For fathers, obesity odds did not differ according to number of children or MPF. In unadjusted models, mothers with one child (OR 1.24 95%CI 1.01-1.51), mothers who had two children with two partners (OR 1.45 95%CI 1.05-1.99), and mothers who had three or more children with two or more partners (OR 1.51 95%CI 1.18-1.93) had higher odds of obesity. In adjusted models, there remained an association between mothers with one child and odds of obesity (OR 1.30 95%CI 1.05-1.60). All other associations were attenuated when confounders were included. CONCLUSIONS: Mothers who had children with multiple partners had higher odds of obesity. However this association was completely attenuated when parental and child confounders were accounted for; suggesting that this association may be explained by confounding. Mothers who had one child only may be at increased odds of obesity, however this could be due to multiple factors including age at first birth.

Sleep hours and quality before and after baby: Inequalities by gender and partnership.

While prior studies have examined sleep across the lifecourse, few studies have investigated sleep around the birth of a child, one of the most important events to cause sleep deprivation. This study investigates changes in sleep hours and quality, paying attention to differences by gender and partnership status. Using the UK Household Longitudinal Study, we follow approximately 1,000 participants as they transition into parenthood in a three-year window. We use OLS and logistic regression to analyze changes in sleep hours and sleep quality. Results suggest that women's sleep is reduced by an average of 0.7 hours (42 min) on becoming a mother. Whilst before parenthood women sleep more than men, after childbirth women and men sleep similar amounts. Cohabiting men experience a greater reduction in sleep by around 0.5 hours (30 min) than married men, to the level similar to women, suggesting that new cohabiting fathers may experience more sleep disturbances.

A conceptual framework for characterising lifecourse determinants of multiple long-term condition multimorbidity.

Objective: Social, biological and environmental factors in early-life, defined as the period from preconception until age 18, play a role in shaping the risk of multiple long-term condition multimorbidity. However, there is a need to conceptualise these early-life factors, how they relate to each other, and provide conceptual framing for future research on aetiology and modelling prevention scenarios of multimorbidity. We develop a conceptual framework to characterise the population-level domains of early-life determinants of future multimorbidity. Method: This work was conducted as part of the Multidisciplinary Ecosystem to study Lifecourse Determinants and Prevention of Early-onset Burdensome Multimorbidity (MELD-B) study. The conceptualisation of multimorbidity lifecourse determinant domains was shaped by a review of existing research evidence and policy, and co-produced with public involvement via two workshops. Results: Early-life risk factors incorporate personal, social, economic, behavioural and environmental factors, and the key domains discussed in research evidence, policy, and with public contributors included adverse childhood experiences, socioeconomics, the social and physical environment, and education. Policy recommendations more often focused on individual-level factors as opposed to the wider determinants of health discussed within the research evidence. Some domains highlighted through our co-production process with public contributors, such as religion and spirituality, health screening and check-ups, and diet, were not adequately considered within the research evidence or policy. Conclusions: This co-produced conceptualisation can inform research directions using primary and secondary data to investigate the early-life characteristics of population groups at risk of future multimorbidity, as well as policy directions to target public health prevention scenarios of early-onset multimorbidity.

Multidisciplinary ecosystem to study lifecourse determinants and prevention of early-onset burdensome multimorbidity (MELD-B) - protocol for a research collaboration.

Background: Most people living with multiple long-term condition multimorbidity (MLTC-M) are under 65 (defined as 'early onset'). Earlier and greater accrual of long-term conditions (LTCs) may be influenced by the timing and nature of exposure to key risk factors, wider determinants or other LTCs at different life stages. We have established a research collaboration titled 'MELD-B' to understand how wider determinants, sentinel conditions (the first LTC in the lifecourse) and LTC accrual sequence affect risk of early-onset, burdensome MLTC-M, and to inform prevention interventions. Aim: Our aim is to identify critical periods in the lifecourse for prevention of early-onset, burdensome MLTC-M, identified through the analysis of birth cohorts and electronic health records, including artificial intelligence (AI)-enhanced analyses. Design: We will develop deeper understanding of 'burdensomeness' and 'complexity' through a qualitative evidence synthesis and a consensus study. Using safe data environments for analyses across large, representative routine healthcare datasets and birth cohorts, we will apply AI methods to identify early-onset, burdensome MLTC-M clusters and sentinel conditions, develop semi-supervised learning to match individuals across datasets, identify determinants of burdensome clusters, and model trajectories of LTC and burden accrual. We will characterise early-life (under 18 years) risk factors for early-onset, burdensome MLTC-M and sentinel conditions. Finally, using AI and causal inference modelling, we will model potential 'preventable moments', defined as time periods in the life course where there is an opportunity for intervention on risk factors and early determinants to prevent the development of MLTC-M. Patient and public involvement is integrated throughout.

Comparing the odds of postpartum haemorrhage in planned home birth against planned hospital birth: results of an observational study of over 500,000 maternities in the UK.

BACKGROUND: The aim of this study is to compare the odds of postpartum haemorrhage among women who opt for home birth against the odds of postpartum haemorrhage for those who plan a hospital birth. It is an observational study involving secondary analysis of maternity records, using binary logistic regression modelling. The data relate to pregnancies that received maternity care from one of fifteen hospitals in the former North West Thames Regional Health Authority Area in England, and which resulted in a live or stillbirth in the years 1988-2000 inclusive, excluding 'high-risk' pregnancies, unplanned home births, pre-term births, elective Caesareans and medical inductions. RESULTS: Even after adjustment for known confounders such as parity, the odds of postpartum haemorrhage (≥1000ml of blood lost) are significantly higher if a hospital birth is intended than if a home birth is intended (odds ratio 2.5, 95% confidence interval 1.7 to 3.8). The 'home birth' group included women who were transferred to hospital during labour or shortly after birth. CONCLUSIONS: Women and their partners should be advised that the risk of PPH is higher among births planned to take place in hospital compared to births planned to take place at home, but that further research is needed to understand (a) whether the same pattern applies to the more life-threatening categories of PPH, and (b) why hospital birth is associated with increased odds of PPH. If it is due to the way in which labour is managed in hospital, changes should be made to practices which compromise the safety of labouring women.

Understanding the early life mediators behind the intergenerational transmission of partnership dissolution.

Whilst research has demonstrated an intergenerational transmission of partnership dissolution, there is limited evidence as to the early life course pathways through which these associations operate, and whether these differ by gender. Many studies have not considered prospective data from early childhood, thus potentially neglecting the importance of the early childhood period in explaining this intergenerational transmission. Given that serial partnering has become increasingly commonplace it is important research considers those who experience multiple partnership dissolution. This paper examines, using data from the 1970 British Birth Cohort Study, the early life mediators underpinning the association between parental separation and the number of offspring partnership dissolutions. Among both men and women there is a significant unadjusted relationship between parental separation and the experience of multiple partnership dissolutions in adulthood. These associations were reduced once parental confounders and childhood mediators are included. Formal mediation analyses demonstrated that early life mediators accounted for more of the association in men than women. Mediators included childhood living standards, and for men child cognition and child behaviour, and for women maternal mental wellbeing. Parental separation and many early life mediators were related to the likelihood of multiple partnership dissolutions through age at first partnership.

The mediating pathways between parental separation in childhood and offspring hypertension at midlife.

Social life course determinants of adult hypertension are relatively unknown. This paper examines how parental separation before age 10 relates to hypertension at age 46. Adjusting for parental confounders and considering the role of adult mediators, we aim to quantify unexplored mediating pathways in childhood using prospectively collected data. Data from the 1970 British Birth Cohort Study are utilised. Hypertension is measured by health care professionals at age 46. Potential mediating pathways in childhood include body mass index (BMI), systolic and diastolic blood pressure, illness, disability, family socioeconomic status (SES) and cognitive and developmental indicators at age 10. Additionally, we explore to what extent childhood mediators operate through adult mediators, including health behaviours, family SES, BMI and mental wellbeing. We also test for effect modification of the relationship between parental separation and hypertension by gender. Nested logistic regression models test the significance of potential mediating variables. Formal mediation analysis utilising Karlson Holm and Breen (KHB) method quantify the direct and indirect effect of parental separation on offspring hypertension at midlife. There was an association between parental separation and hypertension in mid-life in women but not men. For women, family SES and cognitive and behavioural development indicators at age 10 partly mediate the relationship between parental separation and hypertension at age 46. When adult mediators including, health behaviours, family SES, BMI and mental wellbeing are included, the associations between the childhood predictors and adult hypertension are attenuated, suggesting that these childhood mediators in turn may work through adult mediators to affect the risk of hypertension in midlife. We found family SES in childhood, cognitive and behaviour development indicators at age 10, including disruptive behaviour, coordination and locus of control in childhood, to be important mediators of the relationship between parental separation and midlife hypertension suggesting that intervening in childhood may modify adult hypertension risk.

Estimating fertility rates using the ONS Longitudinal Study--what difference does the inclusion of non-continually resident members make?

Among datasets available for fertility research in England and Wales, the Office for National Statistics (ONS) Longitudinal Study (LS) is unique in its construction and scale. The large number of individuals who are part of the study means that it is an important dataset for estimating fertility trends in England and Wales by age and parity. This article uses the LS to estimate age-specific fertility rates (ASFRs) for England and Wales between 1991 and 2001. This necessitates great care to ensure that the exposure to risk of birth for female LS members is fully understood. To achieve this, two forms of residential history are defined - consistent cases where the residential information for the LS member is potentially complete for the whole decade and inconsistent cases where there is certainly some form of incompleteness in the residence information. By considering 'all consistent cases', that is both the continuously resident plus those who are not continuously resident but appear to have a complete residential history, we obtain ASFRs which are slightly lower than official statistics figures, but closer to these official figures than ASFRs produced when restricting the sample to LS members who remain continuously resident between 1991 and 2001. The fertility of those consistent cases who are not continuously resident is substantially higher than the rates of continuously resident cases.

The changing demography of mid-life, from the 1980s to the 2000s.

This article examines changes between 1984 and 2007 in the demographic and socio-economic circumstances of British men and women in mid-life. Changing living arrangements in mid-life reflect historical changes in the occurrence and timing of life events such as marriage and parenthood, as well as increased longevity. In order to place mid-life in this wider demographic context, the article first reviews changes over time in kin availability across the adult life course using the British Household Panel Survey (2001) and Understanding Society (2009). The article goes on to use data from the General Household Survey (1984-2007) to document shifts over time in living arrangements for those aged 20- 79. In the final part of the article we focus specifically on those aged between 45 and 64 and examine how their characteristics in terms of marital status, educational attainment, activity status and housing tenure have changed over the past quarter century.

Civil partnerships five years on.

The Civil Partnership Act 2004, which came into force in December 2005 allowing same-sex couples in the UK to register their relationship for the first time, celebrated its fifth anniversary in December 2010. This article examines civil partnership in England and Wales, five years on from its introduction. The characteristics of those forming civil partnerships between 2005 and 2010 including age, sex and previous marital/civil partnership status are examined. These are then compared with the characteristics of those marrying over the same period. Further comparisons are also made between civil partnership dissolutions and divorce. The article presents estimates of the number of people currently in civil partnerships and children of civil partners. Finally the article examines attitudes towards same-sex and civil partner couples both in the UK and in other countries across Europe.

Maternal smoking behaviour across the first two pregnancies and small for gestational age birth: Analysis of the SLOPE (Studying Lifecourse Obesity PrEdictors) population-based cohort in the South of England.

Maternal smoking is established to cause adverse birth outcomes, but evidence considering maternal smoking change across successive pregnancies is sparse. We examined the association between self-reported maternal smoking during and between the first two pregnancies with the odds of small for gestational age (SGA) birth (<10th percentile) in the second infant. Records for the first two pregnancies for 16791 women within the SLOPE (Studying Lifecourse Obesity PrEdictors) study were analysed. This is a population-based cohort of prospectively collected anonymised antenatal and birth healthcare data (2003-2018) in Hampshire, UK. Logistic regression was used to relate maternal smoking change to the odds of SGA birth in the second infant. In the full sample, compared to never smokers, mothers smoking at the start of the first pregnancy had higher odds of SGA birth in the second pregnancy even where they stopped smoking before the first antenatal appointment for the second pregnancy (adjusted odds ratio (aOR) 1.50 [95% confidence interval 1.10, 2.03]). If a mother was not a smoker at the first antenatal appointment for either her first or her second pregnancy, but smoked later in her first pregnancy or between pregnancies, there was no evidence of increased risk of SGA birth in the second pregnancy compared to never smokers. A mother who smoked ten or more cigarettes a day at the start of both of her first two pregnancies had the highest odds of SGA birth (3.54 [2.55, 4.92]). Women who were not smoking at the start of the first pregnancy but who subsequently resumed/began smoking and smoked at the start of their second pregnancy, also had higher odds (2.11 [1.51, 2.95]) than never smokers. Smoking in the first pregnancy was associated with SGA birth in the second pregnancy, even if the mother quit by the confirmation of her second pregnancy.

Stability and change in fertility intentions in Britain, 1991-2007.

The very low fertility experienced in several European countries in recent decades in the presence of higher intended family sizes has renewed interest in fertility intentions data. While the overall level of childbearing in Britain over the past few decades has remained relatively stable and high in comparison with many other European countries, we have seen sizeable increases in the age at which childbearing starts. This study uses data from the 1991 to 2007 General Household Surveys to examine trends in family intentions data in an attempt to arrive at a better understanding of these recent fertility developments. First, time trends in intended family size are compared with trends in observed fertility. Next, aggregate changes in intentions regarding the level and timing of fertility across the life course for cohorts are investigated together with the extent to which these aggregate intentions are matched by the subsequent childbearing of cohorts. Finally, both change across the life course and uncertainty in family intentions are examined. We conclude by discussing what these findings might tell us about contemporary reproductive decision making.

Understanding the decline in under-18 conception rates throughout England's local authorities between 1998 and 2017.

We consider England's two-decade teenage conception decline in the context of societal changes: rising educational aspirations; growing second- and third-generation teenage ethnic minority populations; increased deprivation associated with economic recession and post-2008 Government austerity; and changing housing availability. Using England's Local Authority Districts (LAD) 1998-2017, we explore the role of area characteristics in explaining spatial differences in under-18 conception rates and how changing characteristics may explain temporal changes. Urban/rural distinctions in teenage conceptions are largely minimised after considering LAD characteristics. Area characteristics continue to partly explain teenage conception rates but are better at explaining area differences than variation over time.

Trends in the prevalence and incidence of orphanhood in children and adolescents <20 years in rural KwaZulu-Natal South Africa, 2000-2014.

BACKGROUND: In South Africa, large increases in early adult mortality during the 1990s and early 2000s have reversed since public HIV treatment rollout in 2004. In a rural population in KwaZulu-Natal, we investigate trends in parental mortality and orphanhood from 2000-2014. METHODS: Using longitudinal demographic surveillance data for a population of approximately 90,000, we calculated annual incidence and prevalence of maternal, paternal and double orphanhood in children and adolescents (<20 years) and, overall and cause-specific mortality of parents by age. RESULTS: The proportion of children and adolescents (<20 years) for whom one or both parents had died rose from 26% in 2000 to peak at 36% in 2010, followed by a decline to 32% in 2014. The burden of orphanhood remains high especially in the oldest age group: in 2014, 53% of adolescents 15-19 years had experienced the death of one or both parents. In all age groups and years, paternal orphan prevalence was three-five times higher than maternal orphan prevalence. Maternal and paternal orphan incidence peaked in 2005 at 17 and 27 per 1,000 person years respectively (<20 years) before declining by half through 2014. The leading cause of parental death throughout the period, HIV/AIDS and TB cause-specific mortality rates declined substantially in mothers and fathers from 2007 and 2009 respectively. CONCLUSIONS: The survival of parents with children and adolescents <20 years has improved in tandem with earlier initiation and higher coverage of HIV treatment. However, comparatively high levels of parental deaths persist in this rural population in KwaZulu-Natal, particularly among fathers. Community-level surveillance to estimate levels of orphanhood remains important for monitoring and evaluation of targeted state welfare support for orphans and their guardians.