Predictors of Poor Functional Status in Adult Fontan Patients Living at Moderate Altitude.

Patients who have undergone Fontan palliation have reduced exercise tolerance measured by maximal oxygen consumption (VO2 max). Declining exercise capacity is associated with increased morbidity and mortality. The impact of hemodynamics and other variables on this population's functional status is not well understood. This study sought to identify variables that predict low VO2 max in Fontan patients living at moderate altitude (5,000-8,000 feet). We performed a retrospective cohort study of 44 adult Fontan patients living at moderate altitude who had undergone cardiopulmonary exercise testing (CPET) and cardiac catheterization. We evaluated hemodynamic parameters measured during catheterization, imaging results, and laboratory studies for correlation with VO2 max measured during CPET. Our study cohort (median age 30 years, 52% female) had exercise impairment with mean VO2 max of 21.6 mL/kg/min. Higher trans-pulmonary gradient (TPG) (p < 0.001) and mean pulmonary artery (PA) pressure (p = 0.013) were predictors of lower maximal and submaximal VO2. Higher BNP values correlated with lower VO2 max (p = 0.01). Platelet count, GGT, albumin, and pulmonary vasodilator therapy did not correlate with VO2 max. None of the studied variables were associated with higher minute ventilation to peak carbon dioxide production (VE/VCO2 slope) or change in VO2 max over time. In conclusion, higher TPG and mean PA pressure predicted lower exercise tolerance amongst our cohort of adult Fontan patients living at moderate altitude. Future studies are needed to determine if these clinical variables represent viable therapeutic targets that could result in improved exercise tolerance and outcomes in patients with Fontan circulation.

Greater income inequality is associated with higher rates of intimate partner violence in Latin America.

OBJECTIVE: The aim of the study was to examine the association between income inequality and experiences of past-year intimate partner violence. STUDY DESIGN: Multiple country population-based surveys. METHODS: We examined associations between experiences of past year physical or sexual violence perpetrated by an intimate partner and income inequality using correlation tests. Income inequality was measured using both the Gini coefficient and ratios between the incomes of the richest 10% and the poorest 10%; data on gross domestic product (GDP) per capita were also retrieved. All income data were sourced from Human Development Reports closest to the year each violence survey was administered. RESULTS: A positive association between income inequality and intimate partner violence was statistically significant using either the 10:10 ratio of income inequality (r = 0.78, P = 0.003) or the Gini coefficient (r = 0.69, P = 0.011). Including GDP per capita as a covariate slightly strengthened these associations (r = 0.79, P = 0.004 and r = 0.73, P = 0.011, respectively). CONCLUSIONS: To our knowledge, this is the first quantitative study of societal income inequality and intimate partner violence. Despite the small sample of countries, there is a significant association between higher inequality and higher levels of violence.

Association of food security status with overweight and dietary intake: exploration of White British and Pakistani-origin families in the Born in Bradford cohort.

BACKGROUND: Food insecurity has been associated with dietary intake and weight status in UK adults and children although results have been mixed and ethnicity has not been explored. We aimed to compare prevalence and trajectories of weight and dietary intakes among food secure and insecure White British and Pakistani-origin families. METHODS: At 12 months postpartum, mothers in the Born in Bradford cohort completed a questionnaire on food security status and a food frequency questionnaire (FFQ) assessing their child's intake in the previous month; at 18 months postpartum, mothers completed a short-form FFQ assessing dietary intake in the previous 12 months. Weights and heights of mothers and infants were assessed at 12-, 24-, and 36-months postpartum, with an additional measurement of children taken at 4-5 years. Associations between food security status and dietary intakes were assessed using Wilcoxon-Mann-Whitney for continuous variables and χ2 or Fisher's exact tests for categorical variables. Quantile and logistic regression were used to determine dietary intakes adjusting for mother's age. Linear mixed effects models were used to assess longitudinal changes in body mass index (BMI) in mothers and BMI z-scores in children. RESULTS: At 12 months postpartum, White British mothers reported more food insecurity than Pakistani-origin mothers (11% vs 7%; p < 0.01) and more food insecure mothers were overweight. Between 12 and 36 months postpartum, BMI increased more among food insecure Pakistani-origin mothers (ß = 0.77 units, [95% Confidence Interval [CI]: 0.40, 1.10]) than food secure (ß = 0.44 units, 95% CI: 0.33, 0.55). This was also found in Pakistani-origin children (BMI z-score: food insecure ß = 0.40 units, 95% CI: 0.22, 0.59; food secure ß = 0.25 units, 95% CI: 0.20, 0.29). No significant increases in BMI were observed for food secure or insecure White British mothers while BMI z-score increased by 0.17 (95% CI: 0.13, 0.21) for food secure White British children. Food insecure mothers and children had dietary intakes of poorer quality, with fewer vegetables and higher consumption of sugar-sweetened drinks. CONCLUSIONS: Food security status is associated with body weight and dietary intakes differentially by ethnicity. These are important considerations for developing targeted interventions.

Ethnic differences in the clustering and outcomes of health behaviours during pregnancy: results from the Born in Bradford cohort.

Background: Pregnancy is a time of optimal motivation for many women to make positive behavioural changes. We aim to describe pregnant women with similar patterns of self-reported health behaviours and examine associations with birth outcomes. Methods: We examined the clustering of multiple health behaviours during pregnancy in the Born in Bradford cohort, including smoking physical inactivity, vitamin d supplementation and exposure to second-hand smoke. Latent class analysis was used to identify groups of individuals with similar patterns of health behaviours separately for White British (WB) and Pakistani mothers. Multinomial regression was then used to examine the association between group membership and birth outcomes, which included preterm birth and mean birthweight. Results: For WB mothers, offspring of those in the 'Unhealthiest' group had lower mean birthweight than those in the 'Mostly healthy but inactive' class, although no association was observed for preterm birth. For Pakistani mothers, group membership was not associated with birthweight differences, although the odds of preterm birth was higher in 'Inactive smokers' compared to the 'Mostly healthy but inactive' group. Conclusions: The use of latent class methods provides important information about the clustering of health behaviours which can be used to target population segments requiring behaviour change interventions considering multiple risk factors. Given the dominant negative association of smoking with the birth outcomes investigated, latent class groupings of other health behaviours may not confer additional risk information for these outcomes.

Education to improve quality of life of people with chronic inflammatory skin conditions: a systematic review of the evidence.

Patient and carer education has been proposed as a way of improving health-related quality of life (HRQoL) among people with chronic inflammatory skin conditions. This systematic review aimed to assess the effects of education that specifically addresses HRQoL among people with chronic inflammatory skin conditions. We searched 12 literature databases and other sources (up to July 2014). Seven randomized controlled trials (RCTs) met the review inclusion criteria. Data from these RCTs were extracted and critically appraised. Two RCTs showed that for psoriasis in adults, group-based and text message education (as adjuncts to usual care) resulted in better HRQoL and disease severity outcomes than comparators, respectively. One RCT found that group-based education for children with eczema (atopic dermatitis) and their parents resulted in greater improvements in parents' HRQoL and in the children's disease severity than no education at 12 months. The remaining RCTs evaluated an educational session for psoriasis, a website for carers of children with eczema, information on skincare and make-up use given to women with acne, and an itch-coping programme for a range of conditions, all as adjuncts to usual care. None of these RCTs found statistically significant effects on HRQoL or disease severity compared with usual care. Common features of the effective interventions were long delivery (over 6 weeks to 3 months) and delivery by a multidisciplinary team. Overall, the evidence base is currently limited and generally has an unclear risk of bias. There is a need for more large RCTs evaluating piloted and theory-based interventions.

Social Vulnerability Index and Dental Caries in Children: An Exploratory Study.

OBJECTIVE: This retrospective cross-sectional study evaluated the association between caries outcomes in a pediatric population visiting a dental clinic and the social vulnerability index, an area-based measure capturing 4 main social determinants of health: socioeconomic status, household composition/disability, minority status/language, and housing/transportation. METHODS: The Centers for Disease Control Social Vulnerability Index (SVI) and electronic dental record data of children (0 to 18 y) reporting a caries diagnosis at the Children's Hospital Colorado in 2020 were extracted for 9,201 children. Logistic regressions were used to test the association between SVI and the presence or absence of dental caries, adjusting for age, sex, ethnicity, and race. RESULTS: Children with a caries diagnosis had a greater mean overall SVI percentile (62.0, standard deviation [SD] = 29.1) compared with patients without a caries diagnosis (59.1, SD = 29.8; P < 0.001). With each 10-point increase in the overall SVI percentile, having a caries diagnosis visit was 2.7% more likely compared with having a visit without a caries diagnosis (odds ratio [OR] 1.027, 95% confidence interval [CI] 1.012, 1.042; P = 0.0004). Those with an overall SVI percentile between 51 and 75 were 23% more likely to have a caries diagnosis compared with those with a percentile ≤25 (OR 1.23, 95% CI 1.07, 1.42; P = 0.003), and those with a percentile >75 were 23.6% more likely to have a caries diagnosis compared with those with a percentile ≤25 (OR 1.236, 95% CI 1.09, 1.40; P = 0.001). CONCLUSION: Children (0 to 18 y) living in socially vulnerable environments or areas were more likely to have a caries diagnosis at their dental exam. KNOWLEDGE TRANSFER STATEMENT: This study showed an association between social determinants of health demonstrating social vulnerability and dental caries in children. Ultimately, understanding upstream factors for children living in socially vulnerable areas could support policymakers in creating more effective policies to support socially vulnerable populations.

Rapid review: Ten ways to improve support for minoritised informal adult carers at local government policy level to redress inequality.

Objective: To rapidly identify and summarise evidence on key factors that affect access to support for minoritised informal adult carers which could be addressed at the level of local government policy-making. Study design: Rapid evidence review. Methods: A rapid umbrella review was undertaken of systematic reviews of qualitative, quantitative and/or mixed method studies. Systematic reviews were identified through database searches (Medline, Cochrane, Proquest), key author searching, referrals by experts (n = 2) of key reviews, and citation and reference checking of identified reviews in September-October 2023. Systematic review evidence was supplemented with grey literature identified by practitioners (n = 2) as locally-relevant. Data was extracted directly into a table and findings synthesised narratively by theme. Results: Many factors were identified as affecting access to support for minoritised unpaid adult carers, including: inattention to socio-cultural diversity; issues of representation, racism and discrimination; and socio-economic inequality. Factors were themed around ten areas for local action, including: the importance of recognising intersectional disadvantage and diversity; ensuring support is socio-culturally appropriate; paying attention to gendered hierarchies in service design; identifying and 'designing out' racism and discrimination; addressing exclusions that minoritised carers with additional communication needs face; mitigating socio-economic inequality; and taking a 'whole system' approach that improves integration, routine data collection and support service evaluation. Conclusions: We identified ten potential ways in which inequalities in support for minoritised unpaid adult carers could be addressed locally. Although the existing evidence base is limited, these ten areas could usefully be targeted for further investigation in research and within local policy development.

Which women are at an increased risk of a caesarean section or an instrumental vaginal birth in the UK: an exploration within the Millennium Cohort Study.

OBJECTIVE: To explore the maternal demographic factors associated with operative births (instrumental vaginal births or caesarean section), after adjustment for health, interpersonal, pregnancy, labour and infant covariates. DESIGN: Nationally representative cohort study. SETTING: Women giving birth in the UK, during the period 2000-2002. SAMPLE: A total of 18,239 mother-infant pairs. METHODS: Multinomial logistic regression models were estimated to explore the relationship between demographic characteristics and mode of birth, stratified by parity. MAIN OUTCOME MEASURES: Self-reported mode of birth, defined as unassisted vaginal birth, instrumental vaginal birth, emergency caesarean section and planned caesarean section. RESULTS: For primiparous women, operative births rose steeply with increasing maternal age. Women from lower occupational status households were at an increased risk of planned caesarean section. Mode of birth differed significantly by ethnicity. For multiparous women, a younger age at first birth was protective of a later caesarean section or instrumental vaginal birth at the cohort birth. Women with qualifications normally taken at the age 18 years were at an increased risk of planned caesarean section compared with women with degree-level qualifications. Mode of birth differed significantly by ethnicity, and non-UK born women were at an increased risk of emergency caesarean section. CONCLUSIONS: The sociodemographic characteristics of UK women independently predict mode of birth. Further research is needed to establish to what extent sociodemographic differences in mode of birth are a reflection of the attitudes and behaviours of women, or health professionals, and are therefore amenable to change.

Combined Gait and Grasping in Autistic and Non-Autistic Youths.

This study was designed to extend research on motor skill development in autism spectrum disorder using a dual-task skill. Nine autistic and 18 non-autistic youths walked without grasping or while reaching to grasp a small or large object. Step extremity ratio, percent time in double support, and normalized speed were quantified. We hypothesized that gait would differ between autistic and non-autistic youth and that differences would be moderated by the phase (approach and grasp) and the complexity of the task (walking and grasping versus walking alone). Although gait parameters were similar during the walking-only trials, the combined task resulted in slower speed and shorter steps in autistic youth, particularly during the grasp phase. These findings, while in a small sample, offer preliminary evidence that autistic youth who show typical gait during simple assessments of motor ability may have difficulties in more complex tasks that require the coordination of movements.

Interaction of prenatal exposure to cigarettes and MAOA genotype in pathways to youth antisocial behavior.

Genetic susceptibility to antisocial behavior may increase fetal sensitivity to prenatal exposure to cigarette smoke. Testing putative gene x exposure mechanisms requires precise measurement of exposure and outcomes. We tested whether a functional polymorphism in the gene encoding the enzyme monoamine oxidase A (MAOA) interacts with exposure to predict pathways to adolescent antisocial behavior. We assessed both clinical and information-processing outcomes. One hundred seventy-six adolescents and their mothers participated in a follow-up of a pregnancy cohort with well-characterized exposure. A sex-specific pattern of gene x exposure interaction was detected. Exposed boys with the low-activity MAOA 5' uVNTR (untranslated region variable number of tandem repeats) genotype were at increased risk for conduct disorder (CD) symptoms. In contrast, exposed girls with the high-activity MAOA uVNTR genotype were at increased risk for both CD symptoms and hostile attribution bias on a face-processing task. There was no evidence of a gene-environment correlation (rGE). Findings suggest that the MAOA uVNTR genotype, prenatal exposure to cigarettes and sex interact to predict antisocial behavior and related information-processing patterns. Future research to replicate and extend these findings should focus on elucidating how gene x exposure interactions may shape behavior through associated changes in brain function.

Pregnancy weight gain: still controversial.

During the 20th century, recommendations for maternal weight gain in pregnancy were controversial, ranging from rigid restriction to encouragement of ample gain. In 1990, the Institute of Medicine (IOM) recommended weight-gain ranges with the primary goal of improving infant birth weight. These guidelines were widely adopted but not universally accepted. Critics have argued that the IOM's recommendations are unlikely to improve perinatal outcomes and may actually increase the risk of negative consequences to both infants and mothers. We systematically reviewed studies that examined fetal and maternal outcomes according to the IOM's weight-gain recommendations in women with a normal prepregnancy weight. These studies showed that pregnancy weight gain within the IOM's recommended ranges is associated with the best outcome for both mothers and infants. However, weight gain in most pregnant women is not within the IOM's ranges. All of the studies reviewed were observational and there is a compelling need to conduct experimental studies to examine interventional strategies to improve maternal weight gain with the objective of optimizing health outcomes.

The management of ASCUS cervical cytologic abnormalities and HPV testing: a cautionary note.

A recently published study of the management of low-grade cytologic smears compared immediate colposcopy to human papillomavirus (HPV) triage and entry cytology smears (conservative management) as three triage techniques for managing atypical squamous cells of undetermined significance (ASCUS) smears (Atypical Squamous Cells of Undetermined Significance/Low-grade Squamous Intraepithelial Lesion Triage Study [ALTS]). The study reported a high sensitivity (96.3%) for HPV testing using hybrid capture 2 to detect cervical intraepithelial neoplasia (CIN) III. The authors concluded that HPV testing is a viable option for managing ASCUS smears. We have reviewed the published data from the ALTS trial and have found a large excess of colposcopies and biopsies in the HPV arm in comparison with the conservative management (cytology) arm. In addition, the ALTS trial quality control and pathology review results raise doubts about the diagnostic validity of the study to establish standards of clinical practice. Furthermore, until the 2-year follow-up analysis of the conservative management arm is completed to detect CIN III, a valid comparison between HPV triage and conservative management is not possible. We conclude that, based on published data, HPV testing for routine clinical management of low-grade cytologic abnormalities (ASCUS smears) is not warranted, and that HPV testing is currently an investigational tool.

92K-GL (MMP-9) and 72K-GL (MMP-2) are produced in vivo by human oral squamous cell carcinomas and can enhance FIB-CL (MMP-1) activity in vitro.

Previous studies have shown a correlation between the production of certain matrix metalloproteinases (MMPs), especially the gelatinases, by malignant tumors and the progression of these cancers as they invade and metastasize through the extracellular matrix and basement membranes. However, very few of these studies examined this relationship in human oral cancer in vivo, and none addressed the issue of how combinations of the MMPs may further enhance tumor progression. To determine which MMPs are produced in vivo by human oral cancers, we used specific anti-human-MMP antibodies and immunocytochemistry (ICC) methods to examine oral cancer tissue specimens from 20 surgery patients. The ICC data indicated that 72-kDa (72K-GL) and 92-kDa gelatinases (92K-GL) were produced in vivo by discreet clusters of tumor cells and by stromal fibroblasts, vascular endothelial cells (72K-GL), and PMNs (92K-GL). Some stromal fibroblasts near the tumors also appeared to produce fibroblast-type collagenase (FIB-CL), a finding confirmed by Western blot analysis of media conditioned by oral tumor explant cultures. ICC results indicated that 5 of the 20 tumors coincidentally produced all three MMPs. To examine how the two gelatinases and FIB-CL may interact in vitro to degrade fibrillar type I collagen, a major structural component of the extracellular matrix, we used a modified FIB-CL activity assay. Combinations of the gelatinases and FIB-CL were incubated with a 3H-collagen substrate, with the results compared with the combination of stromelysin-1 (SL-1, a superactivator of FIB-CL) and FIB-CL. 92K-GL caused a nine-fold increase in collagenase activity, equivalent to SL-1, while 72K-GL produced a four-fold increase. These results indicate that human oral cancers produce 92K-GL, 72K-GL, and FIB-CL in vivo and that the gelatinases and FIB-CL cooperate to enhance collagen degradation greatly in vitro.

Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review.

PURPOSE: Interest in the effects of neighbourhood or local area social characteristics on health has increased in recent years, but to date the existing evidence has not been systematically reviewed. Multilevel or contextual analyses of social factors and health represent a possible reconciliation between two divergent epidemiological paradigms-individual risk factor epidemiology and an ecological approach. DATA SOURCES: Keyword searching of Index Medicus (Medline) and additional references from retrieved articles. STUDY SELECTION: All original studies of the effect of local area social characteristics on individual health outcomes, adjusted for individual socioeconomic status, published in English before 1 June 1998 and focused on populations in developed countries. DATA SYNTHESIS: The methodological challenges posed by the design and interpretation of multilevel studies of local area effects are discussed and results summarised with reference to type of health outcome. All but two of the 25 reviewed studies reported a statistically significant association between at least one measure of social environment and a health outcome (contextual effect), after adjusting for individual level socioeconomic status (compositional effect). Contextual effects were generally modest and much smaller than compositional effects. CONCLUSIONS: The evidence for modest neighbourhood effects on health is fairly consistent despite heterogeneity of study designs, substitution of local area measures for neighbourhood measures and probable measurement error. By drawing public health attention to the health risks associated with the social structure and ecology of neighbourhoods, innovative approaches to community level interventions may ensue.

Preterm birth among African American and white women: a multilevel analysis of socioeconomic characteristics and cigarette smoking.

STUDY OBJECTIVE: Research shows that neighbourhood socioeconomic factors are associated with preterm delivery. This study examined whether cigarette smoking and individual socioeconomic factors modify the effects of neighbourhood factors on preterm delivery. DESIGN: Case-control study. SETTING: Moffit Hospital in San Francisco, California. PARTICIPANTS: 417 African American and 1244 white women, including all preterm and a random selection of term deliveries 1980-1990, excluding non-singleton pregnancies, congenital anomolies, induced deliveries, and women transported for special care. US census data from 1980 and 1990 were used to characterise the women's neighbourhoods, defined as census tracts. RESULTS: Cigarette smoking increased the risk of preterm delivery among both African American (OR=1.77, 95% confidence intervals (CI) (1.12 to 2.79)) and white women (OR=1.25, 95% CI (1.01 to 1.55)). However, cigarette smoking did not attenuate or modify the association of neighbourhood factors with preterm delivery. Among African American women, having public insurance modified the relation between neighbourhood unemployment and preterm delivery; among women without public insurance, the risk of preterm delivery was low in areas with low unemployment and high in areas with high unemployment, while among women with public insurance the risk of preterm delivery was highest at low levels of neighbourhood unemployment. CONCLUSIONS: Cigarette smoking was associated with preterm delivery, especially among African Americans. Adverse neighbourhood conditions had an influence on preterm delivery beyond that of cigarette smoking. The effects of some neighbourhood characteristics were different depending on individual socioeconomic status. Examining socioeconomic and behavioural/biological risk factors together may increase understanding of the complex causes of preterm delivery.

Nicotine-conditioned locomotor activity in rats: dopaminergic and GABAergic influences on conditioned expression.

Little is known about the processes that mediate acquisition and expression of conditioned associations between contextual cues and psychomotor effects of nicotine. In four separate experiments using rats, an environment repeatedly paired with nicotine acquired the ability to elicit increases in activity even in the absence of drug. This conditioned effect was sensitive to nicotine dose. Rats that had 0.6 or 1.2 mg/kg nicotine, but not 0.3 mg/kg, paired with the environment were more active than an unpaired control group (Experiment 1). In Experiment 2, control groups eliminated accounts based on nonspecific effects of nicotine and inhibitory conditioning decreasing activity in the unpaired controls of Experiment 1. Pretreatment on the test day with 100 mg/kg of gamma vinyl-GABA (GVG), a compound that inhibits the enzyme required to breakdown GABA, partially blocked the expression of locomotor conditioning without impairing activity in controls (Experiment 3). In Experiment 4, pretreatment on the test day with the dopamine D(1) receptor antagonist SCH-23390 (0.03 mg/kg) blocked expression of nicotine-conditioned locomotor activity; the D(2)/D(3) receptor antagonist eticlopride did not. Thus, the dopamine D(1) receptor subtype appears to play a role in context-elicited increases in activity conditioned by nicotine; GABA may also modulate the expression of this conditioned effect.

Orthodontic in vivo bond strength: comparison with in vitro results.

The purpose of the present study was to test a new in vivo debonding device and compare in vivo bond strengths recorded by this device with in vitro bond strengths recorded by a universal testing machine such as the Instron. For the in vitro part of the study, 60 extracted premolar teeth were divided into 2 groups of 30 each. Both groups of 30 teeth had 3M Unitek Victory Twin brackets, precoated with Transbond XT composite resin, bonded to them. Shear bond strength tests were carried out in vitro using the universal testing machine on one group of 30 teeth while the debonding device was used on the other group of 30 teeth. The mean shear bond strength of the group debonded using the universal machine was 11.02 MPa and that of the group debonded with the debonding device was 12.82 MPa. For the in vivo part of the study, 8 patients randomly assigned to the research clinician from patients in The University of Alabama School of Dentistry, Department of Orthodontics, had a total of 60 premolar teeth bonded with 3M Unitek Victory Twin brackets. Following comprehensive orthodontic treatment (average time of 23 months), shear bond strength tests were carried out using the debonding device, which can measure debonding forces in vivo. The mean shear bond strength recorded in vivo was 5.47 MPa. Statistically significant differences were found between all 3 groups tested. The results appear to indicate that mean bond strengths recorded in vivo following comprehensive orthodontic treatment are significantly lower than bond strengths recorded in vitro.

The effects of socioeconomic incongruity in the neighbourhood on social support, self-esteem and mental health in England.

Analyses of neighbourhood socioeconomic characteristics and health indicators consistently show that health is worse in poorer neighbourhoods. However, some studies that examined neighbourhood effects separately for individuals of different socioeconomic position found that poor people may derive health benefits from living in poor neighbourhoods where they are socioeconomically congruous. This study investigates whether such patterns may be driven by psychosocial factors. The sample consisted of 4871 mothers in the Millennium Cohort Study aged 14-53. The outcomes analysed were neighbourhood friendship, emotional support, self-esteem and depression or anxiety. Neighbourhood status was classified by residents' educational and occupational status derived from the 2001 Census. We used multilevel logistic regression, adjusting for mothers' socio-demographic characteristics: first analysing health by neighbourhood status separately for the highest and lowest status mothers, then testing for modification in the association between neighbourhood status and health, by individual status. Results show that for highest status mothers, living in mixed or high status neighbourhoods compared to low status neighbourhoods significantly reduced the odds of having no friends in the neighbourhood by 65%. Living in high status neighbourhoods compared to low status neighbourhoods also significantly reduced the odds of depression or anxiety for highest status mothers by 41%. No associations were found for emotional support or self-esteem amongst highest status mothers. No associations were found for any outcome among lowest status mothers. In conclusion, low status mothers in England did not have better social support, self-esteem, or mental health when living in low status neighbourhoods compared to high status neighbourhoods; any benefits of socioeconomic congruity may have been counteracted by neighbourhood deprivation. Nevertheless, we found that mothers of high status do have significantly better neighbourhood friendship and mental health when living in socioeconomic congruity within neighbourhoods. Whether these associations are causal or are another reflection of material advantage remains unclear.

Smoking in pregnancy and disruptive behaviour in 3-year-old boys and girls: an analysis of the UK Millennium Cohort Study.

BACKGROUND: Maternal smoking during pregnancy has been consistently associated with disruptive behaviour in male offspring; however, results for girls are inconsistent and little is known about emergent patterns in young children. Additionally, it is unclear whether maternal smoking is independently associated in offspring with hyperactivity-inattention or only when it co-occurs with conduct problems. Further, few studies have controlled for a broad range of maternal psychosocial problems. METHODS: Associations between self-reported smoking in pregnancy and maternal reports of externalising behaviour were analysed in more than 13 000 3-year-old boys and girls in the UK Millennium Cohort Study. Conduct and hyperactivity-inattention problems were assessed using the Strength and Difficulties Questionnaire. RESULTS: Boys whose mothers persistently smoked throughout pregnancy were at significant risk of conduct and hyperactivity-inattention problems compared with sons of non-smokers: the effect was stronger for heavy smokers. After excluding children with co-occurring problems, conduct-only problems remained a significant risk for sons of heavy smokers, OR 1.92 (95% CI 1.29 to 2.86); and hyperactivity-inattention only for sons of light or heavy smokers, OR 1.79 (95% CI 1.27 to 2.51) and 1.64 (1.10 to 2.46). Daughters of light or heavy smokers were at significant risk of conduct-only problems, OR 1.73 (95% CI 1.14 to 2.61) and 1.73 (1.06 to 2.83). Relative to non-smokers, daughters of pregnancy quitters had significantly reduced odds of having conduct 0.61(0.39 to 0.97) or co-occurring problems 0.26(0.08 to 0.82), although only 79 and 20 girls met these criteria, respectively. All findings were robust to controlling for key social and psychosocial factors. CONCLUSIONS: Associations between maternal smoking during pregnancy and disruptive behaviour in 3-year-old children vary by sex, smoking status and whether or not conduct or hyperactivity problems occur together or separately.