External Publications Using GUI Data

The Growing Up Healthy in Families Across the Globe project is an international collaboration examining the potential for harmonised analysis using five longitudinal studies (from New Zealand, Ireland and Scotland). All five studies follow the lives of children, are interested in the dynamics of family change and work to inform policy to potentially improve population well-being across the life-course. Comparative analysis from harmonised longitudinal studies, where change over time is emphasised, provides a unique view to determine how and why environments change, which environments are supportive and which are not. This paper discusses the challenges and tasks involved when preparing and conducting harmonised analysis, and initial findings from the Growing Up Healthy project are discussed. The studies were, from New Zealand, Te Hoe Nuku Roa, the Pacific Island Families Study and Growing Up in New Zealand, and from Scotland and Ireland Growing Up in Scotland and Growing Up in Ireland. Post hoc data harmonisation of measures resulted in the identification of several closely aligned variables. The harmonised descriptive variables from the five studies highlight many similarities across the studies. A risk factor model to predict child development outcomes (using the Strengths and Difficulties Questionnaire) was developed and resulted in very similar patterns of risk in New Zealand, Ireland and Scotland. Risks included: maternal relationship status, maternal education, smoking in pregnancy, maternal self-reported health and maternal long-standing illness. The insights will be of interest to all those concerned with child development in contemporary New Zealand, Ireland, Scotland and other similar countries.

Children with disabilities experience significantly poorer socio-emotional outcomes than their peers without disabilities. However, research evidence is scarce about children with both disability and migration background, the group which this study aimed to investigate using data from a national longitudinal study. Secondary data analyses were conducted on a sample of 7290 children (weighted with missing values imputed). Significant differences in socio-emotional outcomes were found in relation to impairment status but not in relation to migration. Having an impairment and activity limitation significantly increased the likelihood of experiencing poorer socio-emotional outcomes over time. Our findings highlight a higher risk of socio-emotional problems among children with disabilities, especially among children from lower income backgrounds and with parents with lower educational attainment. These findings clearly require policy development on two fronts: to raise professional and community awareness on these issues and to strengthen the capacity of health, education and social care systems to support schools, families, and communities.

This paper examines multidimensional poverty for three waves of a cohort of Irish children ranging from ages 9 to 17. Poverty is measured over the dimensions of health, education and family resources and both unidimensional and multidimensional poverty is examined. Both show a clear gradient with respect to maternal education. The dynamics of both unidimensional and multidimensional poverty are also analysed. The greatest degree of mobility is observed with respect to family resources. Mobility also is higher for children whose mothers have lower levels of education, with net movements into rather than out of poverty.

Although there is a wealth of research addressing the association between mental health and school absenteeism, there are calls for a better understanding of how mental health difficulties might predict SAPs (Egger et al., 2003; Finning et al., 2022; Ingul et al., 2019; Wood et al., 2012). The aim of this paper was to create a more nuanced understanding of SAPs by exploring how different constellations of mental health difficulties might be predictive of absenteeism in 9-year-olds. Using a sample of Irish 9-year-olds (N = 8570) from the Growing Up In Ireland Study (GUI’98), the research used latent class analysis (LCA) to identify combinations of mental health symptoms. Twenty items from the Strengths and Difficulty Questionnaire (SDQ) were used to measure a range of emotional and behavioural difficulties. The analysis yielded four mental health classes—High Risk of Emotional and Behavioural Difficulties (EBD), High Risk of Emotional Difficulties (ED), High Risk of Behavioural Difficulties (BD) and Low Risk of Emotional and Behavioural Difficulties (EBD). The study assessed whether rates of student absenteeism varied across different classes of mental health as identified through LCA and explored risk factors associated with different classes. Children in the high-risk mental health symptomology groups had significantly higher odds of absenteeism compared to the low-risk class and significantly greater odds of experiencing multiple family, school and demographic risk factors. The distinct profiles of mental health symptoms observed within the classes and their patterns of associations with risk factors and days absent indicated classes were theoretically distinct. The results illustrate the importance of recognising the relationship between mental health and school absenteeism in primary school children when developing early intervention strategies for SAPs. As one of the few studies to focus on 9-year-olds, the current study contributes to current knowledge on the complexities of emerging SAPs in primary school children.

Keywords
Mental health, School attendance problems, School avoidance, Truancy, Risk factors

Background
Taking oral antibiotics during childhood has been linked with an increased risk of childhood obesity. This study assessed any potential association in number of courses of antibiotics taken between 2–3 and 4–5 years of age and body mass trajectory up to age 5.

Methods
The study was a secondary analysis of 8186 children and their parents from the infant cohort of the Irish National Longitudinal Study of Children. Antibiotic use was measured by parental recall between ages 2–3 and 4–5. Longitudinal models described the relationship between antibiotic exposure and body mass index (BMI) standard deviation scores and binary outcomes, and examined interactions between covariates, which included socioeconomic status, diet assessed by food frequency questionnaires and maternal BMI.

Results
Any antibiotic usage between 2 and 3 years did not predict risk of overweight or obesity at age 5. Four or more courses of antibiotics between 2 and 3 years were independently associated with obesity at age 5 (odds ratio 1.6, 95% confidence interval 1.11–2.31). Effect size was modest (coefficient + 0.09 body mass SD units, standard error 0.04, P = 0.037). Maternal BMI modified the relationship: ≥ 4 courses of antibiotics between 2 and 3 years were associated with a + 0.12 body mass SD units increase in weight at age 5 among children of normal-weight mothers (P = 0.035), but not in children of overweight mothers.

Conclusions
Number of antibiotic courses, rather than antibiotic use, may be an important factor in any link between early antibiotic exposure and subsequent childhood obesity. Research is needed to confirm differential effects on babies of normal versus overweight/obese mothers independent of socioeconomic factors.

This study investigates the long-term effects of victimization from middle adolescence to late adolescence and early adulthood, examining emotional and behavioral problems, peer relationships, and smoking habits and sleeping difficulties. The study also explores how these outcomes can persist into early adulthood, taking into consideration early victimization experiences, gender, cognitive ability, and family social class. The total sample included 7525 participants, spanning the ages of 13, 17, and 20, from the Child Cohort of the Growing Up in Ireland study (48.9% male). The path analysis model suggests that victimization is associated with behavioral problems at age 17, and it is also linked to emotional problems and sleeping difficulties at both ages 17 and 20. Additionally, sleeping difficulties, smoking habits, and indices of emotional and behavioral adjustment exhibit some stability between ages 13 and 17, as well as 17 and 20. Theoretical and practical implications are discussed.

Bullying can occur at all ages and has been associated with several negative impacts on the psychological and emotional well-being of victims. While the transition to adulthood may be an opportunity for victims to escape bullying, prior research has suggested some continuity of victimisation experiences into adulthood. However, research on victimisation among young adults remains scarce and no prior study has examined this issue in the Irish context. Binary logistic regression was used to examine the likelihood of victimisation at age 20 based on the respondent’s prior victimisation history and other risk factors, using data from 4693 respondents in the Growing Up in Ireland National Longitudinal Study at age 9, 13, 17 and 20. Moreover, the risk of depression and levels of global self-esteem at age 20 were examined in terms of (long-term) victimisation experiences. Respondents who were previously victimised in adolescence and respondents who were chronically victimised in childhood and adolescence were approximately 3.5 and 4 times more likely to be victimised at age 20 respectively than respondents who were never victimised. The negative outcomes of victimisation regarding the risk of depression and lower levels of self-esteem were more severe for respondents who experienced more persistent prior victimisation. In conclusion, more persistent long-term victimisation experiences are associated with more severe negative outcomes and an increased risk of continued victimisation throughout the transition to adulthood compared to less persistent or no prior victimisation. Therefore, supporting affected individuals to escape victimisation as early as possible is crucial.

Background
Early and risky adolescent alcohol use have each been associated with adult alcohol consumption. However, it remains unclear whether these behaviours independently predict later-life substance use when considered jointly, and research examining links with substances other than alcohol is limited. This study addresses these gaps by examining longitudinal associations between age at first alcohol and risky adolescent alcohol use, with alcohol, tobacco, cannabis and other drug use in early adulthood, and aims to identify critical periods for public health interventions.

Methods
Growing Up in Ireland is a nationally representative cohort (recruited aged 9 [Wave 1], born 1997–1998). Survey-weighted logistic regression examined whether age at first alcoholic drink and risky alcohol use at age 17 (Alcohol Use Disorders Identification Test scores) independently predict high-risk alcohol (AUDIT > 15), tobacco, cannabis and other drug use at age 20. Models were adjusted for age, sex, academic ability, personality, psychological factors, socioeconomic status, familial, peer and neighbourhood substance use.

Results
The study included 4554 participants (49.8% female). Early alcohol use was common, with 27% reporting use aged 14 or younger. By age 20, 14% reported high-risk alcohol, 38% tobacco, 24% cannabis and 28% other drug use. Older age at first alcohol was associated with dose-response reductions in the odds of high-risk alcohol, tobacco, cannabis and other drug use at age 20, relative to those initiating alcohol at 14 or younger. Adolescents with high-risk alcohol use had double the odds of tobacco (adjusted odds ratio (aOR) 2.1, 95% confidence intervals (CI) 1.3–3.30) and other drug use (aOR 2.5, 95% CI 1.6–4.1) and an 11-fold increase in the odds of continued high-risk alcohol use (aOR 11.5, 95% CI 7.0–18.6) at age 20, relative to adolescents with low-risk alcohol use.

Conclusions
Age at first alcohol and risky adolescent alcohol use independently predict substance use in early adulthood when considered jointly in extensively adjusted models. These findings highlight the continued urgent need for public health interventions that address factors associated with early alcohol use and support adolescents who use alcohol in a high-risk manner given their elevated risk of progression to more serious substance use as adults.

This nationally representative study of Irish infants explores whether the set of child and environmental factors established as predicting language outcomes aged 3 years would also predict language and communication development as early as age 9 months. Associations between infant and environmental characteristics and infant language outcomes at 9 months, as measured on the ASQ 10-month communication questionnaire, were explored in a series of bivariate logistic regression models and in a fully adjusted multivariable logistic regression model. Infant gender, health, birthweight and temperament were significantly associated with passing the ASQ communication measure at 9 months. Being an only child and having some experience of relative childcare predicted positive communication outcomes. Infants of older mothers and mothers who spoke less to the child while doing other things were significantly less likely to pass. Infants of mothers with the lowest educational level were more likely than their peers to pass at 9 months. Unlike language outcomes at 3 years, low maternal education does not appear to be a risk factor for poorer outcomes at 9 months. This study adds significantly to the infant language development literature by focussing on communication outcomes in early infancy and identifying protective and risk factors at such an early stage.

Introduction
Despite a growing body of research on associations between adolescent digital use and well-being, few studies have investigated these associations a) longitudinally and b) across socioeconomic status. The present study uses high-quality longitudinal data to examine how digital engagement shapes socioemotional and educational outcomes from early to late adolescence across socioeconomic status (SES).

Methods
Participants are 7685 individuals (49.0% female) from the 1998 birth cohort of the longitudinal Growing Up In Ireland (GUI) survey. The survey was administered to Irish parents and children between 2007 and 2016 (at ages 9, 13, and 17/18). Fixed-effects regression modeling was used to establish associations between digital engagement and socioemotional and educational outcomes. Further Fixed-Effects models were analyzed separately by SES, to assess how associations between digital use and adolescent outcomes differ by socioeconomic groups.

Results
Results show that digital screen time increases markedly from early to late adolescence, but to a higher extent among low-SES versus high-SES groups. Heavy levels of digital screen time (i.e., 3+ hours daily) are associated with declines in well-being, particularly for external and prosocial functioning, while engagement in learning-oriented digital activities and gaming is associated with better adolescent outcomes. Yet, low-SES adolescents are globally more harmed than high-SES adolescents by their digital engagement, and high-SES adolescents benefit more from moderate levels of digital use and from engaging in learning-oriented digital activities.

Conclusions
This study suggests that digital engagement is associated with socioeconomic inequalities in adolescents’ socioemotional well-being and, to a lesser extent, educational outcomes.

Background
Preventing child mental health problems and child obesity have been recognized as public health priorities. The aim of the present study was to examine whether being breastfed (at all or exclusively) in infancy was a predictor of mental well-being and protective against risk of obesity at age 9.

Methods
Cross-sectional data from a large, nationally representative cohort study in the Republic of Ireland was used (n = 8357). Data on breastfeeding were retrospectively recalled. Child mental well-being was assessed using a parent-completed Strengths and Difficulties Questionnaire (SDQ). Child’s height and weight were measured using scientifically calibrated instruments.

Results
Logistic regression analyses indicated that, after controlling for a wide range of potential confounding variables, being breastfed in infancy was associated with a 26% (P < 0.05) reduction in the risk of an abnormal SDQ score at 9 years. Being breastfed remained a significant predictor of child mental well-being when child obesity was controlled for, indicating that being breastfed, independent of child obesity, is a predictor of child mental well-being. The results of a second logistic regression indicated that, after controlling for a wide range of potential confounding variables, being breastfed for between 11 and 25 weeks was associated with a 36% (P < 0.05) reduction in the risk of obesity at 9 years, while being breastfed for 26 weeks or longer was associated with a 48% (P < 0.01) reduction in the risk of obesity at 9 years.

Conclusions
Breastfeeding in infancy may protect against both poor mental well-being and obesity in childhood.

Background
Health disparities for children with intellectual disabilities can be challenging to measure due to many other factors that can impact health and healthcare use. The aim of the current study was to use longitudinal cohort data to compare children with intellectual disability (ID) in Ireland between 2006 and 2014 on healthcare utilisation and unmet need, at ages 9 and 13, using a propensity score matching (PSM) approach.

Methods
Using data from the Growing up in Ireland study, PSM was used to identify an appropriate control sample to compare with a sample of children with ID (n = 124). Participants were matched on variables that are known to influence healthcare utilisation to reduce the impact of confounding variables between groups so that differences between the groups can be estimated. Logistic regression was used to estimate effects at ages 9 and 13.

Results
Children with ID were no more likely to have visited a general practitioner or emergency department in the past 12 months than children without ID. They did have a greater likelihood of visiting a doctor in a hospital in the past 12 months and of having an overnight stay in hospital by age 9. Primary caregivers of children with ID were more likely to report unmet health needs at ages 9 and 13.

Conclusions
This approach is a novel means of comparing healthcare use in this population by balancing the impact of other factors that may result in inequities, to which children with ID may be more vulnerable.

This paper, for the first time, presents estimates of the causal impact of overweight and obesity on self-rated health (SRH) using instrumental variables (IV) econometric methods. While a number of previous studies have sought to better understand the determinants of SRH, there is no consensus in relation to the impact of overweight and obesity. Using data from a large nationally representative sample of Irish parents and their children, we estimate a range of ordered probit models to isolate the causal effect of overweight and obesity on SRH. Our data includes independently and objectively recorded weight and height measures for parents and their children and we instrument for parental body mass index (BMI) status using the BMI of a biological child. After controlling for a range of individual, socioeconomic, health and lifestyle related variables, we find that being overweight has a negligible impact on SRH, while being obese has a practically and statistically significant negative impact on SRH, with these effects most pronounced for those who are most obese. We find only minor differences in these effects across gender.

Gender inequality in housework divisions is persistent. This study examined early-emerging patterns in gender roles via children’s gendered housework time in the Irish context using time-use diary and questionnaire data, controlling for key demographic variables. This study utilized longitudinal “Growing up in Ireland” data, comparing the same children’s behaviour at age 9 and 13. Participants were a nationally representative, weighted sample of school going children living in Ireland, including 4,135 girls, 3,831 boys and their caregivers. The results highlight that inequalities in domestic chores occur at nine and are even greater at 13: girls do more housework and children tend to do “gender typical” chores. Consequences are discussed in relation to gender inequality and policy implications.

Large-scale international migration continues apace. From a health-care services perspective, it is important to understand the influence of migrant heritage on utilization, to allocate resources appropriately and facilitate equity. However, the differences in utilization across different migrant groups remain poorly understood, particularly so for paediatric populations. This paper contributes to filling this gap in knowledge, examining the health-care contact of children for whom their primary caregiver is foreign-born, using longitudinal data from two nationally representative surveys. The study setting is Ireland, which provides an interesting case as a small, open European country, which for the first-time experienced net inward migration in the past two decades. For both cohorts, panel regression models, adjusting for socioeconomic and health indicators, demonstrated lower utilization of general practitioner (GP) services for children of caregivers from ‘less-advanced, non-Anglosphere, non-European Union (EU)’ nations, relative to native-born counterparts. Relatively lower attendances at Emergency Departments and hospital nights were also observed for this group, as well as for children born to EU (non-UK) caregivers. The insights provided are instructive for policymakers for which immigration is a substantial phenomenon in current and future population demographics.

Objective
This study aims to examine the associations between prenatal exposure to maternal smoking, birth weight and persistent offspring psychiatric symptoms. Additionally, we aim to examine whether the relationship between prenatal maternal smoking and persistent offspring psychiatric symptoms is mediated by offspring birth weight.

Methods
This study used the Growing Up in Ireland (GUI) longitudinal cohort. The GUI is a nationally representative longitudinal study of children which consisted of three data collection waves, at ages 9, 13, and 17 years. Logistic regression analysis was used to examine associations between prenatal tobacco exposure, and offspring psychiatric symptoms. Linear regression was used to examine associations between prenatal tobacco exposure and offspring birth weight. We conducted a mediation analysis examining potential etiological pathways linking maternal smoking during pregnancy, offspring birth weight, and later offspring psychiatric symptoms. All analyses were adjusted for confounders including household income, maternal level of education, and family psychiatric history. Additionally, examination of birth weight and subsequent psychiatric symptoms also was controlled for prematurity.

Results
We found that the association between prenatal tobacco exposure and later psychiatric symptoms is mediated by birth weight.

Conclusions
This work provides further evidence that maternal smoking during pregnancy is an important modifiable lifestyle factor that has an impact not just on the physical health of offspring but also their mental wellbeing. Supporting women with structured smoking cessation programs at the earliest stages of pregnancy should be a public health priority.

Background
Parental incarceration (PI) is associated with adverse developmental outcomes for children affected. However, research in this area often reports conflicting results with few studies following children across time in non-U.S. populations. Additionally, more research is called for using multi-informant perspectives rather than relying on adult reports of child outcomes alone.

Methods
This study used data from the first two waves of a nationally representative cohort study of 8,568 children aged 9 years and followed up at age 13 living in the Republic of Ireland (2007–2012). Propensity score matching was used to match children who had experienced PI by the age of nine to children who had not experienced PI by sociodemographics and experience of other stressful events. Mental health, as measured by self-concept (Piers-Harris II) and externalizing and internalizing difficulties (strength and difficulties questionnaire), was compared across both groups.

Results
Fifty of the 8,568 children (weighted percentage 0.9%) reported experiencing PI by the age of nine. These children came from more socially disadvantaged homes and were more likely to have experienced other potentially stressful life events. In comparison to a matched sample of children not affected by PI, children affected by PI reported higher levels of anxiety at age nine. Longitudinal analysis indicated these children affected by PI also reported lower levels of happiness at age 13 with higher levels of emotional difficulties reported by their primary caregiver.

Conclusions
Children of incarcerated parents face a greater array of life challenges. PI had an association with child-reported levels of anxiety at age nine. PI also had a medium-term association on caregiver assessments of emotional difficulties of children affected as well child-reported levels of happiness over time.

Aim
To explore the association between weight and bullying; considering victims and perpetrators as two aspects of bullying, and subjective perception and objective measurement as two aspects of weight.

Methods
This study is based on the first wave of data collection from Growing Up in Ireland – the National Longitudinal Study of Children. The two-stage sample design included a sample of 910 primary schools in Ireland, from which a sample of 8568 nine-year-old children and their families was randomly selected. Analysis is based on statistically reweighted data to ensure that it is representative of all 9-year-olds in Ireland.

Results
Significantly (P < 0.001) more girls were overweight or obese (33.1%: 23.1% overweight and 10% obese) than boys (25.2%: 18.3% and 6.9%). Children who were body mass index (BMI) classified as overweight or obese were significantly (P < 0.001) more likely to be victimised when compared with children whose BMI was not classified as overweight or obese. BMI-classified thinness was not significantly associated with victimisation; however, the body image of being skinny or very skinny was significantly (P = 0.015) associated with being victimised. Bullying perpetration was not associated with BMI-derived weight classification but was significantly (P < 0.001) associated with the child’s own self-description of weight.

Conclusions
Overall body image was found to have a stronger association with victimisation and bullying perpetration than objective BMI-derived weight classification. Further research investigating the mediating role of body image in the relationship between weight, victimisation and bullying is necessary to better understand this association.

Background
Unintended pregnancy is associated with increased risk for adverse neonatal and early childhood outcomes spanning an array of indicators, but it remains unclear whether these risks hold independent of other biological, social and environmental risk factors.

Methods
This study uses data from the first wave of the ‘Growing Up in Ireland Study’, a large nationally representative cohort study of more than 11 000 infants, to examine the risk factors associated with unintended pregnancy. Adopting a staged approach to the analysis, the study investigates whether pregnancy intention influences maternal health behaviours during pregnancy independent of background characteristics, and whether pregnancy intention carries any additional risk for adverse infant and maternal health outcomes when we adjust for background characteristics and prenatal behaviours.

Results
The study confirmed that sociodemographic factors are strongly associated with unintended pregnancy and that unintended pregnancy is associated with a range of health compromising behaviours that are known to be harmful to the developing fetus. While there was little evidence to suggest that pregnancy intention was associated with adverse neonatal outcomes or developmental delay independent of other covariates, there was strong evidence that intention status had a bearing on the mother’s psychosocial health. Unintended pregnancy was associated with increased risk of depression (risk ratio 1.36 [95% confidence interval 1.19, 1.54]), and higher parenting stress (risk ratio 1.27 [95% confidence interval 1.16, 1.38]).

Conclusions
Ascertaining the mother’s pregnancy intention during the first antenatal visit may represent a means for monitoring those at greatest risk for adverse mother and child outcomes.