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Background
The COVID-19 pandemic has been dubbed the “biggest public health crisis since the Second World War”. In Ireland, schools were closed for 141 days, dramatically altering the day to day lives of children in Ireland. This research aimed to evaluate the overall wellbeing of schoolchildren in Ireland and capture the prevalence and factors contributing to poor mental health.

Methods
A cross-sectional study was performed based on data from the Growing Up in Ireland COVID-19 web survey of the ’08 Infant cohort. Mental Health Inventory-5 scores were used to assess children at risk of mental health disorders. Logistic regression examined associations between various demographic and psychosocial factors and risk of mental health disorders.

Results
This study included 2,867 primary caregiver- child dyads. Almost 25% of 12/13-year-olds were at risk of mental health disorders (MHDs). An adjusted logistic regression model found associations between being at higher risk of MHDs and factors such as reduced physical activity levels (OR 1.35, 95% CI 1.10-1.66), spending less time outdoors (OR 1.48, 95% CI 1.18-1.85), increased screen-time (OR 1.35, 95% CI 1.09-1.67) and increased arguments with PCGs (OR 3.44, 95% CI 2.78-4.27). Having a trusted adult confidante reduced the risk of MHD (OR 0.25, 95% CI 0.14-0.45).

Conclusions
The prevalence of 12/13-year olds at elevated risk of MHD was high, indicating an urgent need for enhancement of child and adolescent mental health services in Ireland. Physical activity, time outdoors and supportive relationships with primary caregivers were positively associated with reduced MHD risk.

Key messages

• Children were impacted by the COVID-19 restriction measures in a way that was disproportionate to their risk.
• To reduce the risk of poor mental health outcomes for a generation of “quarantweens” we need to place children front-andcentre of our response as we recover from COVID-19.

Background
Poverty is associated with poor outcomes, yet exposure to distinct poverty trajectories in early childhood is not well understood.

Objective
To understand the prevalence of different trajectories of household poverty and their association with mid-childhood and primary-parent(mother) indicators of physical health and psychopathology in Ireland.

Methods
We used a nationally representative, prospective cohort (Growing-up-in-Ireland– Infant-Cohort). Household poverty included lowest third income decile, subjective poverty and material deprivation when children were aged 9-months(m),3,5,9-years(y). We used group based multi-trajectory-cluster-modelling to classify trajectories of poverty. Using multivariate logistic regression, adjusted with separate child and mother confounders, we assessed the association of poverty trajectories from 9m to 9y with child outcomes (overweight, any longstanding illness and psychopathology) at age 9y and the same poverty trajectories over the same 9y period with mother outcomes (overweight, any longstanding illness and depression).

Results
Of 11,134 participants, four trajectories were identified: never-in-poverty (43.1%), material/subjective>monetary-poverty (16.1%), monetary>material-poverty (25.6%), and persistent-poverty (15.2%). Children in persistent-poverty compared with never in poverty experienced higher odds of being overweight at 9y (adjusted odds ratio aOR 1.70,95% CI 1.34, 2.16), having a longstanding illness (aOR 1.51,95% CI 1.20, 1.91) and psychopathology (aOR 2.06,95% CI 1.42, 2.99). The outcomes for primary parent (99.7% were mothers) had higher odds of being overweight (aOR 1.49,95% CI 1.16, 1.92), having a longstanding illness (aOR 2.13,95% CI 1.63, 2.79), and depression (aOR 3.54,95% CI 2.54, 4.94).

Conclusions
Any poverty trajectory was associated with poorer psychopathology and physical wellbeing in late childhood for children and their mothers in Ireland.

What is already known on this subject?
Poverty is understood as having both objective (e.g. low household income) and subjective dimensions (e.g., perception of being poor relative to others, poverty related anxiety). Evidence highlights the association between child poverty exposure and child and mother wellbeing outcomes.

What this study adds?
Our study examined predicted trajectories of multi-dimensional poverty and child and mother outcomes using a large national cohort. We identified that any poverty trajectory in childhood had a higher odds of being associated with poor well-being outcomes.

How this study might affect research, practice or policy?
This study highlights the need for strategies to ameliorate any poverty exposure as all poverty trajectories resulted in poorer wellbeing outcomes. Strategies should be considered to ameliorate any poverty exposure in early childhood (e.g., school based resourcing).

What does young adulthood look like for individuals who had mental health problems across childhood? Using the Growing Up in Ireland cohort (born in 1998 and studied from ages 9 to 20) we explored the association between mental health problems between ages 9 and 13, and subsequent poor outcomes in the same individuals at ages 17-20. We consider educational/economic outcomes, health service use, poor mental and physical health, social isolation, substance abuse, and subjective wellbeing in young adults. In a previous study that used latent class modelling, we identified four groups which captured mental health in a general population sample of children. Between ages 9 and 13, children could be grouped into: a low symptoms group (∼65%), an ‘externalising’ group with ADHD or conduct symptoms (∼20%), an ‘internalising’ group with depressive, anxiety or peer issues (∼10%), or a group showing many combined mental health symptoms (∼2%). All mental health problem groups had elevated odds across all 7 adverse outcomes in young adulthood. The 5 areas of young adult functioning most related to childhood mental health were: education/economics, subjective wellbeing, mental health, social isolation and substance abuse. Poor educational/economic outcomes were as likely as poor mental health (OR ∼ 2) in individuals with childhood psychopathology. The 3 childhood problem groups showed different risk profiles in young adulthood. For instance, the childhood internalising group had lower odds of substance abuse than all other groups, but had the highest odds of poor physical health by adulthood. Findings point to the need for a wider range of preventative supports for children and adolescents with a history of mental health problems, beyond just mental health support. These include interventions to improve physical health, treat substance abuse, reduce social isolation, and improve adverse educational and economic outcomes.

We analyse parental smoking and cessation (quitting) associations with teenager e-cigarette, alcohol, tobacco smoking and other drug use, and explore parental smoking as a mechanism for social reproduction. We use data from Waves 1–3 of Growing Up in Ireland (Cohort ’98). Our analytic sample consisted of n = 6,039 participants reporting in all 3 Waves. Data were collected in Waves 1 and 2 when the children were 9 and 13 years old and in Wave 3 at age 17/18 years. Generalized Estimating Equations (GEE) models were used to analyse teenage substance use at Wave 3. Parental smoking was associated with significantly increased risk of all teenage substance use, adjusted odds ratios were aOR2.13 (ever e-cigarette use); aOR1.92 (ever alcohol use); aOR1.88 (current alcohol use); aOR1.90 (ever use of other drugs); aOR2.10 (ever-smoking); and aOR1.91 (current smoking). Primary caregiver smoking cessation (quitting) was associated with a lower risk for teenager current smoking aOR0.62, ever e-cigarette use aOR 0.65 and other drug use aOR 0.57. Primary caregiver smoking behaviour had greater associations than secondary, and age13 exposure more than age 9. Habitus seems to play a role and wealth was protective for teenage smoking. The findings suggest that prevention interventions should target both caregivers and their children.

Children’s parent and teacher relationships contribute to school adjustment and achievement, yet few studies have examined interactions between these relationships, particularly for father-child relationships. Using the Growing Up in Ireland birth cohort (N = 7,507 children, 50.3% male), we examined child-adult relationship quality – rated by mothers and fathers at age 3 and teachers at age 5 – as predictors of behavioural adjustment (rated by teachers) and academic achievement (formal reading assessments and self-reported academic self-concepts) at age 9. Controlling for prior levels of problem behaviours, verbal ability, and family SES, results indicated small and comparable independent effects of children’s parent and teacher relationships on school adjustment and achievement. For mothers and teachers, moderation analyses showed a cumulative risk pattern for conflictual relationships and a compensatory pattern for close relationships. Children are likely to benefit from improving closeness and reducing conflict in adult-child relationships and interventions that involve mothers, fathers, and teachers.

Little is known about the link between childhood and adolescent mental health (MH) difficulties and political outcomes in adulthood. This represents an important knowledge gap in understanding early individual-level factors for future political outcomes. Using the Growing up in Ireland cohort, following 8,568 children from nine to 20 years, we examine how different MH difficulties, and co-occurrence, are associated with various political outcomes. The results show childhood/adolescent MH difficulties are important predictors of political outcomes at age 20. Adolescents with chronic co-occurring MH difficulties starting in childhood report a lower interest in politics, lower trust in politicians, are less likely to register to vote, and if voting, are more likely to vote for an anti-establishment party. Adolescents with chronic emotional MH difficulties starting in childhood report a higher likelihood of voting for an anti-establishment party, but also show a higher probability of political activism and low external political efficacy.

This article draws on the Growing Up in Ireland study and the Scottish sample of the Millennium Cohort Study to explore the factors influencing inequalities in children’s cognitive skills on entry to primary education. It adopts a multidimensional comparative approach, which directly compares the effects of parental education and household income on several cognitive outcomes (vocabulary, language, reading and numbers) among five-year-old children and examines the extent to which inequalities in these outcomes are mediated by the home learning environment (HLE) and early childhood education (ECE). Home learning environment plays a stronger role in explaining actual vocabulary differences in Ireland while it plays a stronger role in school readiness (teacher-assessed skills) in Scotland. In both countries, use of centre-based care at 9 months and 3 years was markedly higher among the top income quintile. Centre-based care is found to play a mediating role in school readiness in Scotland. Nonetheless, the findings point to important direct effects of family background even when HLE and childcare are taken into account. The analyses point to differences in the trajectory of early skill development in the two countries, with the impact of early skill development being more marked in Scotland than Ireland. Comparative analyses of this kind thus yield important insights for policy development by highlighting potential domains (such as childcare) or timing (preschool or within-school) for intervention.

Background
There are few prospective studies of factors that mediate the association between exposure to adverse childhood experiences (ACEs) and obesity in adolescence. Our aim was to address this limitation.

Methods
We used prospective data from the Growing up in Ireland cohort study, with measurements at 9, 13, and 18 years old. The exposures were 14 adverse experiences before age 9. The main outcome was body mass index (BMI) at 18 years. Mediators were daily activity, diet quality, self-image and behavioural difficulties at 13 years.

Results
Among the 4561 adolescents in the final cohort, 77.2% experienced any adversity, 50.5% were female and 26.7% were overweight/obese at 18 years. BMI Z was higher at ages 9 (0.54 vs 0.43, p < 0.05, 95% CI of difference: −0.22, −0.01) and 13 years (0.50 vs 0.35, p < 0.05, 95% CI of difference: −0.25, −0.06), in those exposed to an ACE, compared to those unexposed. Structural equation models revealed that behavioural difficulties (β = 0.01; 95% CI: 0.007–0.018, p < 0.001) and self-concept (β = 0.0027; 95% CI: 0.0004–0.0050, p = 0.026) indirectly mediate the association between exposure to ACEs and BMI at 18 years.

Conclusions
The association between ACEs and BMI in adolescence is mediated by behavioural difficulties and self-concept.

Impact

• In a previous study, we found modest associations between exposure to a range of adverse childhood experiences and weight gain at 13 years of age.
• The strength of the association between adverse childhood experiences and weight gain was lower at 18 years of age compared to the association observed at 13 years and was no longer significant after controlling for confounding and including possible mediators.
• The association between adverse childhood experiences and BMI in adolescence is indirectly mediated by behavioural difficulties and self-concept.

Background
There are no early, accurate, scalable methods for identifying infants at high risk of poor cognitive outcomes in childhood. We aim to develop an explainable predictive model, using machine learning and population-based cohort data, for this purpose.

Methods
Data were from 8858 participants in the Growing Up in Ireland cohort, a nationally representative study of infants and their primary caregivers (PCGs). Maternal, infant, and socioeconomic characteristics were collected at 9-months and cognitive ability measured at age 5 years. Data preprocessing, synthetic minority oversampling, and feature selection were performed prior to training a variety of machine learning models using ten-fold cross validated grid search to tune hyperparameters. Final models were tested on an unseen test set.

Results
A random forest (RF) model containing 15 participant-reported features in the first year of infant life, achieved an area under the receiver operating characteristic curve (AUROC) of 0.77 for predicting low cognitive ability at age 5. This model could detect 72% of infants with low cognitive ability, with a specificity of 66%.

Conclusions
Model performance would need to be improved before consideration as a population-level screening tool. However, this is a first step towards early, individual, risk stratification to allow targeted childhood screening.

Impact
• This study is among the first to investigate whether machine learning methods can be used at a population-level to predict which infants are at high risk of low cognitive ability in childhood.
• A random forest model using 15 features which could be easily collected in the perinatal period achieved an AUROC of 0.77 for predicting low cognitive ability.
• Improved predictive performance would be required to implement this model at a population level but this may be a first step towards early, individual, risk stratification.

This study examines how the presence of outdoor areas such as parks and playgrounds affects children’s well-being and how this effect is moderated by families’ socioeconomic status. Specifically, I aim to answer two research questions. First, does the presence of outdoor areas in children’s neighborhoods affect their well-being? Second, is there a differential effect depending on children’s socioeconomic status? The main part of the study uses data from the International Survey of Children’s Well-Being. The results suggest that the presence of outdoor areas in children’s neighborhoods has a positive effect on their well-being. In addition, the estimated effect of outdoor areas is larger for children from families with low socioeconomic status. Finally, findings from the Growing Up in Ireland data set suggest that children’s mental problems are a plausible mechanism through which outdoor areas affect children’s well-being. These findings have meaningful policy implications. Efforts to provide access to appropriate outdoor areas may be more likely to benefit disadvantaged children and thus reduce inequality in children’s well-being.