Parenting Students and Indicators of Financial Stability, Health, and Academic Success: Findings from a Population-Based Sample of Public Urban University Students.

Parenting students constitute a significant portion of the college population, with 22% of undergraduate students nationwide managing the dual responsibilities of parenthood and education. Single-parenting students face disproportionate challenges to achieving academic success. This study examines the health, financial, and academic aspects of parenting students attending a large, urban public university, specifically comparing single parents to their married or cohabiting counterparts and non-parenting students in New York City. We collected data from 2104 participants, including 142 single parents and 119 married or cohabiting parents, through a cross-sectional survey. Using adjusted regression models, we evaluated the associations between parenting status and financial, health, and academic factors. Our findings reveal that, in comparison to non-parents, single parents are significantly more likely to carry debt (adjusted odds ratio [aOR] 1.81), rely on food assistance (aOR 5.03), and achieve slightly lower GPAs (ß - 0.11). Single parents also work more hours (aOR 1.66) and have an increased likelihood of facing debt (aOR 2.66), housing difficulties (aOR 2.80), food insecurity (aOR 2.21), and lower GPAs (ß - 0.22) compared to their married or cohabiting peers. The disaggregation of single and married or cohabiting parents reveals significant disparities, emphasizing the vulnerability of single-parenting students in higher education. Targeted interventions addressing issues like food security and housing are essential to support the academic success of single parents.

Rising nonmarital first childbearing among college-educated women: Evidence from three national studies.

Levels of nonmarital first childbearing are assessed using recent administrations of the National Longitudinal Survey of Youth, 1997 Cohort; the National Longitudinal Study of Adolescent to Adult Health; and the National Survey of Family Growth. Results confirm that the higher a woman's educational attainment, the less likely she is to be unmarried at the time of her first birth. A comparison over time shows increases in nonmarital first childbearing at every educational level, with the largest percentage increase occurring among women with college degrees at the BA or BS level or higher. This article projects that 18 to 27% of college-educated women now in their thirties who have a first birth will be unmarried at the time. In addition, among all women who are unmarried at first birth, women with college degrees are more likely to be married at the time of their second birth, and, in a majority of cases, the other parent of the two children was the same person. A growing proportion of well-educated women, and their partners, may therefore be pursuing a family formation strategy that proceeds directly to a first birth, and then proceeds, at a later point, to marriage, followed by a second birth. Possible reasons for the increase in nonmarital first births among the college-educated include the stagnation of the college wage premium; the rise in student debt; decreasing selectivity; and the growing acceptability of childbearing within cohabiting unions, which have become a common setting for nonmarital childbearing, and among single parents.

Same-sex male couples and single men having children using assisted reproductive technology: a quantitative analysis.

RESEARCH QUESTION: How do same-sex male couples (SSMC) and single men perceive their experience of using assisted reproductive technology (ART) in Canada; what factors contribute to their experience and the decisions made throughout the ART process? DESIGN: This cross-sectional study used an anonymous online survey to gather exploratory data (between August 2018 and August 2019) about participant experience and decision-making considerations, for SSMC and single men internationally who had undergone ART in Canada. The survey was accessed by 145 individuals; 98 participants were included in the final analysis. Statistical Package for the Social Sciences (SPSS) was used for quantitative analysis. RESULTS: Four out of five participants had a positive overall experience of using ART in Canada. Having the social support of knowing others who had previously pursued ART, and needing to work with multiple egg donors, were found to affect overall experience significantly. Agencies were the most common way for intended parents to connect with third parties. Major factors men considered when choosing an egg donor included medical history, physical attributes, personality and temperament, ethnicity, and education; they tended to select gestational surrogates who had similar lifestyle values to themselves. Most coupled survey respondents created embryos using each partner's spermatozoa (73.6%). CONCLUSIONS: This exploratory study expands on limited knowledge of the current topic, identifying key areas for future research. Most SSMC and single men, domestic and internationally, had a positive experience pursuing ART in Canada to have children. Research on the experiences of SSMC and single men and decision-making considerations should continue.

Healthcare services and medication use among widowed partners of patients deceased due to cancer - results from the Survey of Health, Ageing and Retirement in Europe (SHARE).

OBJECTIVE: This study aimed to quantify the effect of a cancer death on healthcare and medication use among widowed individuals (Widowed-Cancer), by comparing this population with partnered individuals and with widowed individuals whose partners were deceased due to cardiovascular diseases (Widowed-CVD). METHODS: Data were retrieved from the Sixth Wave of the Survey of Health, Ageing and Retirement in Europe - SHARE, conducted in 2015, in 18 countries. Widowed-Cancer were matched by country, sex, age and educational level with currently partnered individuals (1:2; n = 901 and n = 1802, respectively) and with Widowed-CVD (1:1; n = 606 and n = 606, respectively). Adjusted odds ratios (OR) and 95% confidence intervals (95%CI) were computed using logistic regression. RESULTS: The use of drugs for sleep problems (OR = 1.42, 95%CI:1.12-1.80) and anxiety or depression (OR = 1.56, 95%CI:1.20-2.03) was more common among Widowed-Cancer than in partnered individuals; a tendency towards higher odds of being hospitalised in the previous year was also observed in Widowed-Cancer (OR = 1.20, 95%CI:0.98-1.47). Among participants whose partners were deceased in 2015, Widowed-Cancer were more likely than Widowed-CVD to report ≥10 contacts with medical doctors or nurses in the previous year (OR = 3.32, 95%CI:1.20-9.24; P for interaction = .042) and a higher use of drugs for sleep problems (OR = 14.43, 95%CI:1.74-119.84; P for interaction = .027). CONCLUSION: Widowed individuals whose partners were deceased due to cancer had a higher use of healthcare, which highlights the importance of improving the quality of end-of-life care, even during widowhood.

Determinants for early introduction of complementary foods in Australian infants: findings from the HSHK birth cohort study.

OBJECTIVE: The purpose of this study was to examine the timing of introduction of complementary (solid) foods among infants in South Western Sydney, Australia, and describe the maternal and infant characteristics associated with very early introduction of solids. METHODS: Mother-infant dyads (n = 1035) were recruited into the "Healthy Smiles Healthy Kids" study by Child and Family Health Nurses at the first post-natal home visit. Data collected via telephone interviews at 8, 17, 34 and 52 weeks postpartum included timing of introduction of solids and a variety of maternal and infant characteristics (n = 934). Multiple logistic regression was used to identify factors independently associated with the risk of introducing solids very early, which for the purpose of this study was defined as being before 17 weeks. RESULTS: The median age of introduction of solids was 22 weeks. In total, 13.6% (n = 127) of infants had received solids before 17 weeks and 76.9% (n = 719) before 26 weeks of age. The practice of introducing solids early decreased with older age of the mother. Compared to women < 25 years of age, those who were 35 years or older were 72% less likely to introduce solids very early (OR = 0.28, CI95 0.14-0.58). Single mothers had more than twice the odds of introducing solids before the age of 17 weeks compared to married women (OR = 2.35, CI95 1.33-4.16). Women who had returned to work between 6 to 12 months postpartum were 46% less likely to introduce solids very early compared with those who were not working at the child's first birthday (OR = 0.54, CI95 0.30-0.97). Women born in Vietnam and Indian sub-continent had lower odds of introducing solids very early compared to Australian born women (OR = 0.42, CI95 0.21-0.84 and OR = 0.30, CI95 0.12-0.79, respectively). Infants who were exclusively formula-fed at 4 weeks postpartum had more than twice the odds of receiving solids very early (OR = 2.34, CI95 1.49-3.66). CONCLUSIONS: Women who are younger, single mothers, those not working by the time of child's first birthday, those born in Australia, and those who exclusively formula-feed their babies at 4 weeks postpartum should be targeted for health promotion programs that aim to delay the introduction of solids in infants to the recommended time.

Household Composition and Gender Differences in Parental Time Investments.

Recent research has documented the relatively poor performance of boys, especially those from single-mother households, on a number of outcomes. Differences in noncognitive skills are often cited as a main contributing factor. However, we still know little about the underlying mechanisms driving differences in noncognitive skills and other outcomes. This article provides empirical evidence that parental time investments, defined as the amount of time that parents spend participating in activities with their child, change differentially by child gender following a transition from a two-parent to single-mother household. Boys experience larger investment reductions following the change in household structure, which may help facilitate previously documented gender gaps in noncognitive skills for those in single-mother households. Boys lose an estimated additional 3.8 hours per week in fathers' time investments, nearly 30% of average weekly paternal investments across the sample. The difference is increasing with age, concentrated in leisure and entertainment activities, with little to no evidence that mothers increase investments in boys relative to girls after such transitions.

The Dynamics of U.S. Household Economic Circumstances Around a Birth.

With the arrival of an infant, many households face increased demands on resources, changes in the composition of income, and a potentially heightened risk of income inadequacy. Changing household economic circumstances around a birth have implications for child and family well-being, women's economic security, and public program design, yet have received little research attention in the United States. Using data from the Survey of Income and Program Participation, this study provides new descriptive evidence of month-to-month changes in household income adequacy and the composition of household income in the year before and after a birth. Results show evidence of significant declines in household income adequacy in the months around a birth, particularly for single mothers who live without other adults. Income from public benefit programs buffers but does not eliminate declines in income adequacy. Results have implications for policies targeted at this period, including public benefit and parental leave programs.

Use of tobacco, alcohol and cannabis in late adolescence: roles of family living arrangement and socioeconomic group.

BACKGROUND: France has one of the highest levels in Europe for early use of legal and illegal psychoactive substances. We investigate in this country disparities in adolescent problematic substance use by family living arrangement and parental socioeconomic group. METHODS: The data used were from the 2017 nationally-representative ESCAPAD survey, conducted among 17-year-olds in metropolitan France (N = 39,115 with 97% response rate). Prevalence ratios (PR) were estimated using modified Poisson regression. RESULTS: Adolescents living in non-intact families (44%) reported daily smoking, binge drinking and regular cannabis use (respectively ≥3 episodes and ≥ 10 uses in the last 30 days) much more frequently than those living in intact families (for example, the PR estimates for father single parent families were respectively 1.69 (1.55-1.84), 1.29 (1.14-1.45) and 2.31 (1.95-2.74)). Socioeconomic differences across types of families did little to explain the differential use. Distinctive socioeconomic patterns were found: a classical gradient for smoking (PR = 1.34 (1.22-1.47) for the most disadvantaged group relative to the most privileged); an inverse association for binge drinking (PR = 0.72 (0.64-0.81) for the most disadvantaged relative to the most privileged), and no significant variation for cannabis use. CONCLUSION: Our findings shed light on the consistency of the excess use of adolescents from non-intact families and on the substance-specific nature of the association with parental socioeconomic group. Preventive approaches at the population level should be complemented by more targeted strategies.

Excess Early (< 34 weeks) Preterm Rates Among Non-acknowledged and Acknowledged Low Socioeconomic Position Fathers: The Role of Women's Selected Pregnancy-Related Risk Factors.

OBJECTIVE: To determine the proportion of the excess early preterm birth (< 34 weeks, PTB) rates among non-acknowledged and acknowledged low socioeconomic position (SEP) fathers attributable to White and African-American women's selected pregnancy-related risk factors for PTB. METHODS: Oaxaca-Blinder decomposition methods were performed on the Illinois transgenerational birth-file of infants (1989-1991) and their parents (1956-1976) with appended U.S. census income information. The neighborhood income of father's place of residence at the time of his birth and at the time of his infant's birth were used to measure lifetime SEP. RESULTS: Among non-Latina White women, the early PTB rate for non-acknowledged (n = 3260), acknowledged low SEP (n = 1430), and acknowledged high SEP (n = 9141) fathers equaled 4.02%, 1.82%, and 1.19, respectively; p < 0.001. White women's selected pregnancy-related risk factors for PTB (inadequate prenatal usage, suboptimal weight gain, and/or cigarette smoking) were responsible for 19.3% and 41.2% of the explained disparities in early PTB rates for non-acknowledged and acknowledged low (compared to acknowledged high) SEP fathers, respectively. Among African-American women, the early PTB rate for non-acknowledged (n = 22,727), acknowledged low SEP (n = 4426), and acknowledged high SEP (n = 365) fathers equaled 6.72%, 4.34%, and 3.29%, respectively; p < 0.001. African-American women's selected pregnancy-related risk factors for PTB were responsible for 21.4% and 20.2% of the explained disparities in early PTB rates for non-acknowledged and acknowledged low SEP fathers, respectively. CONCLUSIONS: Non-Latina White and African-American women's selected pregnancy-related risk factors for PTB explain a significant percentage of excess early PTB rates among non-acknowledged and acknowledged low (compared to acknowledged high) SEP fathers.

Advanced paternal age and the risk of spontaneous abortion: an analysis of the combined 2011-2013 and 2013-2015 National Survey of Family Growth.

BACKGROUND: Maternal and paternal age at first birth are increasing across the global population. Spontaneous abortion, one of the most common abnormal pregnancy outcomes, is known to occur more frequently with increasing maternal age. However, the relationship of advanced paternal age and spontaneous abortion is poorly understood, and previous results have yielded conflicting results. OBJECTIVE: To examine the influence of paternal age on the risk of spontaneous abortion among singleton pregnancies conceived without assisted reproductive technologies. MATERIALS AND METHODS: This was a retrospective, case-control study using combined pregnancy data from the Centers for Disease Control and Prevention's 2011-2013 and 2013-2015 National Survey of Family Growth. Spontaneous, singleton pregnancy data from women aged 15-45 years were analyzed. Ongoing pregnancies, induced abortions, ectopic pregnancies, preterm births, and intrauterine fetal deaths were excluded. Bivariate associations of pregnancy outcome (spontaneous abortion at <20 weeks and ≤12 weeks vs. live birth at ≥37 weeks) and paternal age were determined, along with those of maternal age and selected demographic and pregnancy characteristics. Significant associations were included in a multivariable logistic regression, which accounted for multiple pregnancies derived from the same respondent. RESULTS: A total of 12,710 pregnancies from 6979 women were analyzed, consisting of 2300 (18.2%) spontaneous abortions and 10,410 (81.8%) term live births. Median maternal and paternal ages were 25 and 28 years, respectively. After adjusting for maternal age, race/ethnicity, socioeconomic status, marital status, and pregnancy intention, pregnancies resulting in spontaneous abortions had 2.05 (95% confidence interval, 1.06-2.20) times the odds of being from a father aged 50 years or older, vs. 25-29 years of age. These relationships remained significant when defining SABs at ≤12 weeks (adjusted odds ratio, 2.30; 95% confidence interval, 1.17-4.52). CONCLUSION: Paternal age may increase the odds of spontaneous abortion, independent of selected factors, including demographics, pregnancy intention, and maternal age. This association was robust across several gestational age-based definitions of spontaneous abortion, even after adjustment.

The Effect of the Earned Income Tax Credit on Housing and Living Arrangements.

As rents have risen and wages have not kept pace, housing affordability in the United States has declined over the last 15 years, impacting the housing and living arrangements of low-income families. Housing subsidies improve the housing situations of low-income families, but less than one in four eligible families receive a voucher. In this article, we analyze whether one of the largest anti-poverty programs in the United States-the Earned Income Tax Credit (EITC)-affects the housing (eviction, homelessness, and affordability) and living arrangements (doubling up, number of people in the household, and crowding) of low-income families. Using the Current Population Survey, the American Community Survey/decennial census, and the Fragile Families and Child Wellbeing Study, we employ a parameterized difference-in-differences strategy to examine whether policy-induced expansions to the EITC affect the housing and living arrangements of single mothers. Results suggest that a $1,000 increase in the EITC improves housing by reducing housing cost burdens, but it has no effect on eviction or homelessness. Increases in the EITC also reduce doubling up (living with additional, nonnuclear family adults)-in particular, doubling up in someone else's home-and reduce three-generation/multigenerational coresidence, suggesting that mothers have a preference to live independently. We find weak evidence for a reduction in overall household size, yet the EITC does reduce household crowding. Although the EITC is not an explicit housing policy, expansions to the EITC are generally linked with improved housing outcomes for single mothers and their children.

Analysis of gestational surrogates' birthing experiences and relationships with intended parents during pregnancy and post-birth.

BACKGROUND: This study investigated the surrogates' birth experiences, their levels of emotional struggle at relinquishment, how often they thought about the surrogacy children, and the surrogate-parent relationship dynamics during pregnancy and post-birth. METHODS: Data were collected from 06/2016 to 02/2017 using an anonymous questionnaire. Participants were Canadian gestational surrogates who had completed the process with or without a successful live birth, and who were at various stages of an ongoing surrogacy. For this paper, only a subgroup of cases with a successful live birth was selected for analysis. RESULTS: The data set included 131 births involving 90 surrogates who delivered 157 babies (105 singletons and 26 sets of twins). Their mean age at the time of surrogacy was 31.7 ± 5 years (range: 21-47y). More than one-third (37.4%) of the cases were for intended parents who were same-sex male couples and single men. Surrogates assisting Canadian-resident intended parents had an overall better birthing experience compared with those assisting nonresidents. There was none or very little struggle with the relinquishment of the baby in 96.9% of cases. Continued contact with parents after the births was reported in 93.0% of cases. Surrogates were significantly more likely to have frequent post-birth contact with same-sex and single fathers compared with heterosexual parents and single mothers (76.6% vs 54.3%). CONCLUSIONS: Same-sex male couples and single men can develop a long-lasting relationship with their surrogates even when no intended female partners are involved. The development of institutional practice guidelines in standardizing surrogacy birth practice is paramount in optimizing surrogates' care.

Dual Versus Single Parental Households and Differences in Maternal Mental Health and Child's Overweight/Obesity.

Objectives Mothers report higher levels of psychological stress than fathers. s. Psychological stress is posited to influence parenting practices that could increase children's obesity risk. However, previous studies have not investigated several aspects of maternal mental health and the moderating role of household structure on children's obesity risk. The objective was to investigate associations of maternal mental health with child obesity risk, and whether these associations differed by household structure (single-parent vs. dual parent/multigenerational). Methods Mothers and their 8-12 year old children (N = 175 dyads) completed baseline questionnaires on mothers' mental health and child anthropometrics. Separate logistic regressions assessed associations of standardized maternal mental health indicators with the odds of child overweight/obesity, controlling for child age, and women's BMI, age, education, employment status, and annual income. Household structure was investigated as a moderator of these relationships.Results There were no statistically significant relationships between maternal mental health characteristics and odds of child overweight/obesity. Among single mothers only, greater anxiety was associated with higher risk of child overweight/obesity [OR (95% CI) = 3.67 (1.27-10.62); p = 0.0163]; and greater life satisfaction was marginally associated with lower risk of child overweight/obesity [OR (95% CI) = 0.44 (0.19-1.01); p = 0.0522]. Mothers' life satisfaction may lower risk for their children's overweight/obesity, whereas higher anxiety may increase this risk, particularly among children living in single-mother households. Conclusions for Practice Future interventions could increase resources for single mothers to buffer the effects of stress and lower pediatric obesity risk.

Father Absence and Accelerated Reproductive Development in Non-Hispanic White Women in the United States.

Girls who experience father absence in childhood also experience accelerated reproductive development in comparison with peers with present fathers. One hypothesis advanced to explain this empirical pattern is genetic confounding, wherein gene-environment correlation (rGE) causes a spurious relationship between father absence and reproductive timing. We test this hypothesis by constructing polygenic scores for age at menarche and first birth using recently available genome-wide association study results and molecular genetic data on a sample of non-Hispanic white females from the National Longitudinal Study of Adolescent to Adult Health. We find that young women's accelerated menarche polygenic scores are unrelated to their exposure to father absence. In contrast, polygenic scores for earlier age at first birth tend to be higher in young women raised in homes with absent fathers. Nevertheless, father absence and the polygenic scores independently and additively predict reproductive timing. We find no evidence in support of the rGE hypothesis for accelerated menarche and only limited evidence in support of the rGE hypothesis for earlier age at first birth.

Childcare by grandparents in married and cohabiting couples: evidence from Italy.

The process of union formation and the context of childrearing have profoundly changed with the spread of cohabitation in the last few decades. It is only recently that some attention has been paid to the implications of these changes for family ties. This study considers, with reference to Italy, a specific relationship between individuals in couples and their family of origin - childcare by grandparents. The aim of the paper is twofold. First, we investigate whether children of cohabiting couples are cared for by their grandparents to a lower extent compared to children of married couples. Second, the current study examines whether potential differences decrease over time. The data used are from two rounds of cross-sectional and nationally representative survey conducted in Italy in 2003 and in 2009. Our results show that in 2003 both in the provision and the intensity of grandparents' childcare, children of cohabiting parents were less likely to have their grandparents involved than children of married parents. However, the differences between marriages and cohabitations disappear in recent years.

Does It Matter What She Wants? The Role of Individual Preferences Against Unmarried Motherhood in Young Women's Likelihood of a Nonmarital First Birth.

Most young people in the United States express the desire to marry. Norms at all socioeconomic levels posit marriage as the optimal context for childbearing. At the same time, nonmarital fertility accounts for approximately 40 % of U.S. births, experienced disproportionately by women with educational attainment less than a bachelor's degree. Research has shown that women's intentions for the number and timing of children and couples' intent to marry are strong predictors of realized fertility and marriage. The present study investigates whether U.S. young women's preferences about nonmarital fertility, as stated before childbearing begins, predict their likelihood of having a nonmarital first birth. I track marriage and fertility histories through ages 24-30 of women asked at ages 11-16 whether they would consider unmarried childbearing. One-quarter of women who responded "no" in fact had a nonmarital birth by age 24-30. The ability of women and their partners to access material resources in adulthood were, as expected, the strongest predictors of the likelihood of nonmarital childbearing. Nonetheless, I find that women who said they would not consider nonmarital childbearing had substantially higher hazards of fertility postponement and especially of marital fertility, even after controlling for race/ethnicity, mother's educational attainment, family of origin intactness, self-efficacy and planning ability, perceived future prospects, and markers of own educational attainment and work experience into early adulthood.

The Association Between Childhood Seizures and Later Childhood Emotional and Behavioral Problems: Findings From a Nationally Representative Birth Cohort.

OBJECTIVES: Emotional/behavioral disorders are often comorbid with childhood epilepsy, but both may be predicted by social disadvantage and fetal risk indicators (FRIs). We used data from a British birth cohort, to assess the association of epilepsy, single unprovoked seizures, and febrile seizures with the later development of emotional/behavioral problems. METHODS: A total of 17,416 children in the 1958 British birth cohort were followed up until age 16 years. Logistic and modified Poisson regression models were used to determine a) the association of social disadvantage at birth and FRI with epilepsy, single unprovoked seizures, and febrile seizures at 7 years, and emotional/behavioral disorders in later childhood, and (ii) the association of childhood seizures by age 7 years with emotional/behavioral disorders in later childhood, after accounting for social disadvantage and FRI. RESULTS: Higher scores on FRI and social disadvantage were associated with emotional/behavioral problems at 7, 11, and 16 years, but not with seizure disorders at age 7 years. Epilepsy was associated with emotional/behavioral problems at 7 years (odds ratio [OR] = 2.50, 95% confidence interval [CI] = 1.29-4.84), 11 years (OR = 2.00, 95% CI = 1.04-3.81), and 16 years (OR = 5.47, 95% CI = 1.65-18.08), whereas single unprovoked seizures were associated with emotional/behavioral problems at 16 years (OR = 1.44, 95% CI = 1.02-2.01), after adjustment for FRI and social disadvantage. Febrile convulsions were not associated with increased risk for emotional/behavioral problems. CONCLUSIONS: Emotional/behavioral problems in children are related to an earlier diagnosis of epilepsy and single unprovoked seizures after accounting for social disadvantage and FRI, whereas febrile convulsions are not associated with emotional/behavioral problems.

Work-Family Trajectories and the Higher Cardiovascular Risk of American Women Relative to Women in 13 European Countries.

OBJECTIVES: To investigate whether less-healthy work-family life histories contribute to the higher cardiovascular disease prevalence in older American compared with European women. METHODS: We used sequence analysis to identify distinct work-family typologies for women born between 1935 and 1956 in the United States and 13 European countries. Data came from the US Health and Retirement Study (1992-2006) and the Survey of Health, Aging, and Retirement in Europe (2004-2009). RESULTS: Work-family typologies were similarly distributed in the United States and Europe. Being a lone working mother predicted a higher risk of heart disease, stroke, and smoking among American women, and smoking for European women. Lone working motherhood was more common and had a marginally stronger association with stroke in the United States than in Europe. Simulations indicated that the higher stroke risk among American women would only be marginally reduced if American women had experienced the same work-family trajectories as European women. CONCLUSIONS: Combining work and lone motherhood was more common in the United States, but differences in work-family trajectories explained only a small fraction of the higher cardiovascular risk of American relative to European women.

Lone parents, health, wellbeing and welfare to work: a systematic review of qualitative studies.

BACKGROUND: Lone parents and their children experience higher than average levels of adverse health and social outcomes, much of which are explained by high rates of poverty. Many high income countries have attempted to address high poverty rates by introducing employment requirements for lone parents in receipt of welfare benefits. However, there is evidence that employment may not reduce poverty or improve the health of lone parents and their children. METHODS: We conducted a systematic review of qualitative studies reporting lone parents' accounts of participation in welfare to work (WtW), to identify explanations and possible mechanisms for the impacts of WtW on health and wellbeing. Twenty one bibliographic databases were searched. Two reviewers independently screened references and assessed study quality. Studies from any high income country that met the criteria of focussing on lone parents, mandatory WtW interventions, and health or wellbeing were included. Thematic synthesis was used to investigate analytic themes between studies. RESULTS: Screening of the 4703 identified papers and quality assessment resulted in the inclusion of 16 qualitative studies of WtW in five high income countries, USA, Canada, UK, Australia, and New Zealand, covering a variety of welfare regimes. Our synthesis found that WtW requirements often conflicted with child care responsibilities. Available employment was often poorly paid and precarious. Adverse health impacts, such as increased stress, fatigue, and depression were commonly reported, though employment and appropriate training was linked to increased self-worth for some. WtW appeared to influence health through the pathways of conflict and control, analytical themes which emerged during synthesis. WtW reduced control over the nature of employment and care of children. Access to social support allowed some lone parents to manage the conflict associated with employment, and to increase control over their circumstances, with potentially beneficial health impacts. CONCLUSION: WtW can result in increased conflict and reduced control, which may lead to negative impacts on mental health. Availability of social support may mediate the negative health impacts of WtW.

Maternal profiles and social determinants of malnutrition and the MDGs: What have we learnt?

BACKGROUND: Maternal socio-demographic and health profiles are important determinants of malnutrition in children. In the 1990s, malnutrition was associated with low-birth-weight, young mothers and low maternal socio-economic status at Princess Marie Louise Children's Hospital (PML). It is not known how this has changed by efforts to achieve the Millennium Development Goals. We examined socio-demographic and health profiles of mothers of children with acute malnutrition and those without the condition to identify risk factors for malnutrition and focus on preventive efforts. METHODS: An unmatched case-control study was conducted in 2013 at PML, the largest facility for treating malnourished children in Ghana in 2013. Mothers of children with moderate and severe acute malnutrition were compared with mothers of well-nourished children. Weight-for-height was used to classify malnutrition. Record forms and a semi-structured questionnaire were used for data collection. An analysis was done with Stata 11.0 software. RESULTS: Altogether, 371 mothers were studied consisting of 182 mothers of malnourished children and 189 mothers of well-nourished children. Mothers of malnourished children were more likely to be unmarried or cohabiting, have lower family incomes, HIV infection and chronic disease. They were less likely to stay with or provide alternative care for their child. Awareness and use of social services, health insurance and a cash transfer programme were low. A remarkable reduction in the number of malnourished children occurred when families earned more than $250 USD a month. Over-nutrition was present in both groups of mothers. CONCLUSION: Low family income, unmarried status and type of child care were the main social determinants of malnutrition. There appears to be a reduction in the number of other poor socio-demographic characteristics in both the study and control groups compared to results from a previous study at the same centre, probably because of efforts toward attaining the MDGs. These findings suggest that prevention and optimum management need to involve multidisciplinary teams consisting of health professionals, social workers and/or key workers to enable families at risk to access social care and social protection interventions (MDG 1). This will make the management of malnutrition more effective, prevent relapse, protect the next child and address maternal over-nutrition.