Impact of Low Maternal Education on Early Childhood Overweight and Obesity in Europe.

BACKGROUND: Comparable evidence on adiposity inequalities in early life is lacking across a range of European countries. This study investigates whether low maternal education is associated with overweight and obesity risk in children from distinct European settings during early childhood. METHODS: Prospective data of 45 413 children from 11 European cohorts were used. Children's height and weight obtained at ages 4-7 years were used to assess prevalent overweight and obesity according to the International Obesity Task Force definition. The Relative/Slope Indices of Inequality (RII/SII) were estimated within each cohort and by gender to investigate adiposity risk among children born to mothers with low education as compared to counterparts born to mothers with high education. Individual-data meta-analyses were conducted to obtain aggregate estimates and to assess heterogeneity between cohorts. RESULTS: Low maternal education yielded a substantial risk of early childhood adiposity across 11 European countries. Low maternal education yielded a mean risk ratio of 1.58 (95% confidence interval (CI) 1.34, 1.85) and a mean risk difference of 7.78% (5.34, 10.22) in early childhood overweight, respectively, measured by the RII and SII. Early childhood obesity risk by low maternal education was as substantial for all cohorts combined (RII = 2.61 (2.10, 3.23)) and (SII = 4.01% (3.14, 4.88)). Inequalities in early childhood adiposity were consistent among boys, but varied among girls in a few cohorts. CONCLUSIONS: Considerable inequalities in overweight and obesity are evident among European children in early life. Tackling early childhood adiposity is necessary to promote children's immediate health and well-being and throughout the life course.

Parental stress affects the emotions and behaviour of children up to adolescence: a Greek prospective, longitudinal study.

Systematic research about the continuity of mental health problems from childhood to adolescence is limited, but necessary to design effective prevention and intervention strategies. We used a population-based representative sample of Greek adolescents, followed-up from birth to the age of 18 years, to assess early influences on and the persistence of mental health problems in youth. We examined the role of peripartum, early development and parental characteristics in predicting mental health problems in childhood and adolescence. Results suggest a strong relationship between behavioural problems in childhood and adolescence for both genders, while emotional problems were more likely to persist in boys. Age and sex-specific models revealed significant positive associations between higher scores on the behavioural and emotional problems scales and higher frequency of accidents in preschool years, physical punishment in early childhood, lack of parental interest in child's school and activities, and perceived maternal stress in all children. Perceived paternal stress was associated with higher scores on the Total and Internalizing problems scales in the total population. Our results suggest that early interventions are necessary as mental health problems strongly persist from childhood to late adolescence. The adverse effects of parental stress and poor care-giving practices on child's psychopathology need to be recognised and improved.

Can we be optimistic about asthma in childhood? A Greek cohort study.

OBJECTIVE: To examine the prevalence and natural course of asthma from childhood to adolescence in a population-based, Greek birth cohort and to identify associated factors. METHODS: Longitudinal information on asthma symptoms, physician diagnosed and treated, was available for 2133 children at 7 and 18 years of age. RESULTS: The prevalence of current asthma was 9.0% and 5.0% at 7 and 18 years, respectively. The prevalence of lifetime asthma was 26.3% at 18 years. More than half of the children (58.2%) with early onset asthma were asymptomatic at 7 years and only 7.6% continued to have symptoms during adolescence. However, in 48.2% of those with late onset asthma, symptoms persisted up to 18 years. Logistic regression analyses showed that male gender, family history of atopy, active adolescent smoking and maternal smoking were significantly positively associated with lifetime asthma at 18 years. In addition, smoking during pregnancy was associated with an increased risk for persistence of asthma symptoms at 18 years. Asthma during childhood and active adolescent smoking were positively associated, and daily consumption of fruit and vegetables was negatively associated with current asthma at 18 years of age. Finally, children who were breastfed had a lower risk for lifetime asthma at 7 years. CONCLUSION: The prevalence of asthma symptoms at 7 and 18 years of age was low throughout Greece. Our results suggest that, among others, nutrition is an important correlate of asthma in Greek children.

The generation gap in numbers: parent-child disagreement on youth's emotional and behavioral problems: a Greek community based-survey.

OBJECTIVE: To evaluate discrepancies between parent and child reports on youth's emotional and behavioral problems in a representative, community based sample of Greek 18-year-olds, and to identify associated factors. METHODS: A total of 2,927 completed pairs of parent-child questionnaires were studied, including the child behavior checklist (CBCL) and the youth self-report (YSR). Linear regression analysis was used to identify both child and parental characteristics significantly associated with parent/child disagreement on scores for youth's Internalising, Externalising and Total problems scales for both genders separately. RESULTS: Although there was a strong correlation between scores on the YSR and CBCL corresponding scales, parent/child discrepancies were more likely to occur when the later: had good academic performance, were dissatisfied from their self-image or their life. Parental factors that influence discrepancies in parent/child scale scores were: low paternal education for both genders, father being the informant for boys, and maternal stress and lack of awareness of leisure activities for girls. CONCLUSION: The associations found highlight the contributions of both parents and children to the discrepancies on emotional and behavioral problems in adolescence. This study may facilitate constructive parenting practices through generations.

Does exclusive breastfeeding increase after hospital discharge? A Greek study.

To monitor the rate of exclusive breastfeeding in Greek maternity wards and to investigate possible changes in infant-feeding practices during the first month after hospital discharge, the authors questioned 4310 Greek mothers from 7 hospitals on the fourth day postpartum. Odds ratios were calculated to estimate the effects of health system, demographic, psychosocial, and environmental factors. Any breastfeeding and full breastfeeding initiation rates were 85% and 23%, respectively. One month postpartum, the corresponding rates of any and exclusive breastfeeding were 79% and 61%, respectively. Mothers of infants who lacked continuous rooming-in while in the maternity ward (OR, 2.08; 95% CI, 1.27-3.40) and with previous experience of breastfeeding (OR, 1.46; 95% CI, 1.19-1.79) were more likely to reestablish exclusive breastfeeding at home despite the use of supplementation in the maternity ward. It seems women are capable of overcoming supplementation in hospital and can revert to exclusive breastfeeding at home.

Improvement of sun-related knowledge and protection practice.

The aim of this study was to examine changes in sun-related knowledge and sun protection practice among Greek mothers and children during 1993-2002. A total of 315 mothers in 1993 and 295 mothers in 2002, with their 649 and 491 children respectively, were randomly selected to answer the same questionnaire on sun-related issues. Sun knowledge and protection practice were determined by an index score. Significantly more mothers in 2002 compared to 1993 had 'good' (58.9% versus 16%) and 'excellent' levels (28% versus 6%) of sun knowledge (p<0.001). In 2002, 40% of the mothers and children (versus 27% and 30% each in 1993) had 'good' levels of sun protection practice, while 28% of the mothers and 26% of the children (versus none in 1993) reported 'excellent' levels (p<0.001). Knowledge and sun protection practice were significantly improved, probably due to an information campaign conducted between both surveys.

Mother's education and the risk of preterm and small for gestational age birth: a DRIVERS meta-analysis of 12 European cohorts.

BACKGROUND: A healthy start to life is a major priority in efforts to reduce health inequalities across Europe, with important implications for the health of future generations. There is limited combined evidence on inequalities in health among newborns across a range of European countries. METHODS: Prospective cohort data of 75 296 newborns from 12 European countries were used. Maternal education, preterm and small for gestational age births were determined at baseline along with covariate data. Regression models were estimated within each cohort and meta-analyses were conducted to compare and measure heterogeneity between cohorts. RESULTS: Mother's education was linked to an appreciable risk of preterm and small for gestational age (SGA) births across 12 European countries. The excess risk of preterm births associated with low maternal education was 1.48 (1.29 to 1.69) and 1.84 (0.99 to 2.69) in relative and absolute terms (Relative/Slope Index of Inequality, RII/SII) for all cohorts combined. Similar effects were found for SGA births, but absolute inequalities were greater, with an SII score of 3.64 (1.74 to 5.54). Inequalities at birth were strong in the Netherlands, the UK, Sweden and Spain and marginal in other countries studied. CONCLUSIONS: This study highlights the value of comparative cohort analysis to better understand the relationship between maternal education and markers of fetal growth in different settings across Europe.

Inattention, hyperactivity, impulsivity--epidemiology and correlations: a nationwide greek study from birth to 18 years.

We examined the prevalence of inattention, hyperactivity, and impulsivity (attention-deficit hyperactivity disorder [ADHD]-like symptoms) at 7 and 18 years in a Greek birth cohort, and associated factors. Information was derived from a representative sample of 2695 Greek individuals followed-up from birth to18 years through 3 questionnaire surveys (1983, 1990, 2001). At 7 years, the prevalence of hyperactivity was 7%, inattention 9.5%, and impulsivity 7% for all children, while a significant decrease was observed at 18 years. Adverse perinatal factors, poor academic performance, fights or quarrels with peers, comorbidity, and a higher frequency of physical punishment and accidents during childhood were found to be associated with ADHD-like symptoms at 7 years. Factors identified to be related with these symptoms at 18 years included male gender, maternal stress, smoking during pregnancy, physical punishment, and psychological problems in childhood. These longitudinal findings provide significant information for health and educational planning in Greece and other countries.

Tracking of overweight and obesity in Greek youth.

OBJECTIVES: The aim of this study was to determine the prevalence and tracking of overweight and obesity in a representative sample of Greek youth and the relation with child and parental factors. METHODS: Data were derived from 2 follow-ups of the Greek 1983 National Perinatal Survey by means of a questionnaire completed by parents in 1990 and parents/adolescents in 2001. Parent- and self-reported height and weight measurements were available for 7,219 participants aged 7, and 2,842 participants aged 18. RESULTS: The overall overweight/obesity prevalence was 24.3% at age 7, and 15.1% at age 18. The overweight prevalence increased from childhood to adolescence in boys (16.1 to 19.1%) and decreased in girls (19.2 to 8.0%), while the obesity prevalence showed a decrease in both boys (6.2 to 3.6%) and girls (5.8 to 1.0%). Overall, tracking of weight status was 73.7%. More boys (49.2%) remained overweight/obese than girls (24.7%). At age 7, overweight/ obesity was positively associated with male gender, paternal education, and urban residence. Overweight/obesity also correlated with male gender at age 18, and with parental weight status. CONCLUSIONS: The prevalence of overweight among Greek youth is high and showed an increase from childhood to adolescence in boys, and a decrease in girls.

Relationship between eating behavior, breakfast consumption, and obesity among Finnish and Greek adolescents.

OBJECTIVE: To investigate the relationship between eating-related behaviors, particularly breakfast consumption, and weight status in Finnish and Greek adolescents. METHODS: A total of 6,468 16-year-old Finnish adolescents and 2,842 17- and 18-year-old Greek adolescents, based on the latest follow-up of 2 population-based cohorts, were studied. Univariate analysis examined the associations between breakfast consumption, family meals, emotional eating, bingeing, and weight status in both populations. Multiple logistic regression models focused on the relationship between breakfast consumption and overweight/obesity taking potential confounders into account. RESULTS: Daily breakfast consumption was associated with lower levels of overweight/obesity among Finnish and Greek boys, but not among girls. Adjusting for confounders did not change the result among Greek boys, but adjustment for father's body mass index, weight control, and fear of getting fat attenuated the association among Finnish boys. CONCLUSIONS AND IMPLICATIONS: This study highlights the importance of breakfast consumption, particularly among male adolescents, in obesity prevention programs.

Social determinants of self-reported emotional and behavioral problems in Greek adolescents.

OBJECTIVE: This study aimed to assess the social factors associated with self-reported emotional and behavioral problems among Greek adolescents. METHODS: At age 18, a population-based sample of 3373 Greek adolescents completed the Youth Self-Report (YSR) questionnaire. RESULTS: The results from the multivariate analysis indicated that both lack of intimate friendships and not having parental monitoring were independently associated with problem behavior among both male and female adolescents. Engagement in sexual activities was significantly associated with higher YSR scores among both genders. Absence of academic motivation was associated with higher YSR scores in girls only. CONCLUSIONS: Our results confirm that social factors, including negative family functions, lack of academic motivation and not having close friends, were associated with emotional and behavioral problems among adolescents and imply the need to develop a supportive social network for adolescents.

Comparison of self-reported emotional and behavioural problems in adolescents from Greece and Finland.

AIM: To compare self-reported emotional and behavioural problems among Greek and Finnish adolescents. METHODS: Youth Self-Report scores were analysed for 3373 Greek adolescents aged 18 years and 7039 Finnish adolescents aged 15-16 years from the general population in both countries. The impact of country, gender, place of residence, socioeconomic status (SES) and family stability on the scores was evaluated. RESULTS: Only country and gender yielded small to medium effect on the scores. Greek boys scored significantly higher than Finns on 10 of the 11 YSR syndromes, particularly on the anxious/depressed scale. Greek girls scored significantly lower than Finnish girls on the somatic complaints and delinquent behaviour scales. In general, girls scored higher than boys on both internalising and externalising problems. The gender by country interaction revealed that Finnish girls reported more externalising problems. CONCLUSION: The main differences marked in this comparison were the higher level of anxiety and depression in Greeks than Finns and the higher level of externalising problems in Finnish girls than boys. Cultural standards could play an important role in explaining these differences. Overall, it seems that only a small number of differences exist between a northern and southern European region.

Working mothers breastfeed babies more than housewives.

AIM: To examine the prevalence and determinants of breastfeeding and to identify perinatal, sociodemographic, psychosocial and environmental factors associated with maternal infant feeding intention. METHODS: A sample of 3734 Greek mothers that delivered their infants in 2000 was recruited in a longitudinal cohort study. Data on duration of breastfeeding was based on a questionnaire answered by 76.6% of the participants at 8-12 months postpartum. RESULTS: The rates of any breastfeeding at 3 and 6 months were 52% and 24%, respectively. The corresponding rates of exclusive breastfeeding were 37% and 17%. From Cox regression analysis mother's intention to breastfeed for a short time and upbringing in the area of Athens were significantly associated with early termination of any breastfeeding and exclusive breastfeeding. A positive intention to breastfeed was influenced by maternal entitlement more than 6 months, delivery in autumn or winter, mother's upbringing abroad and previous breastfeeding experience. CONCLUSIONS: The rates of any breastfeeding and exclusive breastfeeding during the first year of life were fairly satisfactory. Programs to support breastfeeding are necessary and should encourage women to feel positive to breastfeed, focusing particularly on non-working mothers, mothers with a maternity entitlement less than 6 months and mothers who lack previous breastfeeding experience.

Prevalence of recurrent complaints of pain among Greek schoolchildren and associated factors: a population-based study.

AIM: To determine the prevalence of recurrent complaints of pain (RCP) in Greek children, and to examine associations with socio-demographic characteristics and psychosocial factors. METHODS: Cross-sectional study comprising a nationally representative population of 8130 7-y-old Greek schoolchildren. Data were collected by mailed questionnaires (response rate 89%). RCP was defined as present if at least one of the complaints of headache, abdominal pain or limb pain occurred at least once a week. RESULTS: The RCP prevalence rate was 7.2%, with significant gender differences (8.8% of girls, 5.7% of boys; p<0.001). RCP was significantly positively associated with a chronic health problem among the children, frequent change of residence, poor school performance, often watching TV and rarely playing with other children. There were no statistically significant associations of RCP with family structure and socio-economic status. CONCLUSION: The results are indicative of the prevalence of RCP in Greek schoolchildren. This study enlightens the psychosocial component of RCP and emphasizes the importance of gathering information on children's social background in medical settings.