Auswahl der wissenschaftlichen Literatur zum Thema „Low-income parents – Northern Ireland“

Abstract Objectives The first lockdown enforced in the United Kingdom to limit the spread of COVID-19 had serious financial consequences for some lower-income households, which were already at risk of suboptimal food choices. Particularly in Northern Ireland, where 10% of the population live in food insecure households, the pandemic has potentially further exacerbated the nutritional challenges experienced by low-income families. This paper aimed to explore the impact of the COVID-19 lockdown on food-related decisions as experienced by economically disadvantaged families in Northern Ireland, UK. Methods A qualitative study collected data through online individual interviews. Participation was open to parents of children 2–17 years old who self-identified as living on a tight budget in urban and rural areas of Northern Ireland. A sampling matrix enabled equal representation of single- and two-parent households, as well as younger (<12 y) and older children (>12 y). Photovoice and participatory mapping techniques were employed to capture participant data. A thematic approach was utilised for data analysis. Results A total of 12 interviews were conducted. Five distinct themes were found, reflecting families’ food-related decisions that were affected by the COVID-19 lockdown: 1) food planning; 2) food purchasing; 3) meal preparation; 4) eating and feeding behaviours and 5) eating food prepared outside the house. Changes included an increase in home food preparation, but also in unhealthy snacking. Fear of being exposed to carriers of the virus led to infrequent food shopping and greater reliance on supermarket home deliveries. Long waiting times in-between food shops encouraged food planning but were also a barrier to providing daily fresh foods including fruit and vegetables to their families. Financial constraints were exacerbated during lockdown and led to a search for new ways to budget when food shopping. Food donations from the community and the government were important to maintain food security, particularly in single-parent families. Conclusions This study highlights that the COVID-19 lockdown influenced a broad range of dietary decisions of economically disadvantaged families and offers an insight into the nutritional challenges they experienced. Funding Sources The work was completed with financial support from internal funds of Queens University Belfast.

AimTo identify issues encountered by pharmacy healthcare professionals with regards to problems that they have experienced, complaints received, queries and feedback by the patients or parents or caregivers in terms of medication administration for children and young people aged 0 to18 years old.MethodAn online survey using the Online Surveys tool was devised to obtain healthcare professionals’ perspective regarding medication administration problems encountered by parents, caregivers or paediatric patients when administering or taking their medication at home. The survey was sent to the members of the Neonatal and Paediatric Pharmacists Group (NPPG), who represent different geographical areas within the UK and further afield. Informed consent was obtained from participants. This study was reviewed and approved by the Life and Health Sciences Ethics Committee, Aston University.Results37 pharmacists and 1 technician completed the survey. The majority of the respondents 23/38 were currently practicing in England, with 6/38 respondents being registered pharmacists outside the UK, 1/38 was practicing in Northern Ireland, 3/38 within Scotland and 4/38 were practicing in Wales. 71.1% of the respondents strongly agreed that parents or caregivers require further training when it comes to medication delivery to their children. In addition, when asked about their concerns regarding prescribed medication to children aged between 0 to18 years old, respondents expressed a different level of concern regarding each age group. Regarding neonates, the main concern was the suitability of the prescribed formulation and the ability of the parents to accurately measure and administered a low dose volume. In contrast, for children aged between 28 days to 12 years, the common concerns were associated with palatability, which will further reflect upon child compliance and the parent or caregiver’s ability to understand medication instructions and administration. Finally, for older aged children, adherence was a common concern. Furthermore, liquid formulations (suspensions (60.5%), solutions (55.3%) and injections (44.7%)) were predominantly used among children aged 0 to 18 years old within both in and outpatients setting. Overall, the majority of the respondents expressed that counselling time between the patient and pharmacists and the need to provide further training and educational material to parents and young people is an important issue to improve understating in regards medication use.ConclusionThe findings suggest that medication administration problems occur frequently among paediatric patients, and the nature of these problems varies among each age group. Medication training for both parents and young people could be a key factor to help reduce this problem. Future research is needed to investigate and gain insight into personal experiences with medication use and administration from a parent and/or young person’s perspective. This will help to highlight the current problem in the UK and further develop potential interventions to reduce medication administration errors by parents of children aged 0 to 16 years old and by young people up to the age of 18 years.

ObjectivesThis study aimed to assess the cost-effectiveness of the Steps Towards Alcohol Misuse Prevention Programme (STAMPP) compared with education as normal (EAN) in reducing self-reported heavy episodic drinking (HED) in adolescents.DesignThis is a cost-effectiveness analysis from a public sector perspective conducted as part of a cluster randomised trial.SettingThis study was conducted in 105 high schools in Northern Ireland and in Scotland.ParticipantsStudents in school year 8/S1 (aged 11–12) at baseline were included in the study.InterventionsThis is a classroom-based alcohol education curricula, combined with a brief alcohol intervention for parents/carers.Outcome measuresThe outcome of this study is the cost per young person experiencing HED avoided due to STAMPP at 33 months from baseline.ResultsThe total cost of STAMPP was £85 900, equivalent to £818 per school and £15 per pupil. Due to very low uptake of the parental component, we calculated costs of £692 per school and £13 per pupil without this element. Costs per pupil were reduced further to £426 per school and £8 per pupil when it was assumed there were no additional costs of classroom delivery if STAMPP was delivered as part of activities such as personal, social, health and economic education. STAMPP was associated with a significantly greater proportion of pupils experiencing a heavy drinking episode avoided (0.08/8%) and slightly lower public sector costs (mean difference −£17.19). At a notional willingness-to-pay threshold of £15 (reflecting the cost of STAMPP), the probability of STAMPP being cost-effective was 56%. This level of uncertainty reflected the substantial variability in the cost differences between groups.ConclusionsSTAMPP was relatively low cost and reduced HED. STAMPP was not associated with any clear public sector cost savings, but neither did it increase them or lead to any cost-shifting within the public sector categories. Further research is required to establish if the cost-effectiveness of STAMPP is sustained in the long term.Trial registration numberISRCTN47028486; Results.

ObjectivesTo assess the effectiveness of a combined classroom curriculum and parental intervention (the Steps Towards Alcohol Misuse Prevention Programme (STAMPP)), compared with alcohol education as normal (EAN), in reducing self-reported heavy episodic drinking (HED) and alcohol-related harms (ARHs) in adolescents.Setting105 high schools in Northern Ireland (NI) and in Scotland.ParticipantsSchools were stratified by free school meal provision. Schools in NI were also stratified by school type (male/female/coeducational). Eligible students were in school year 8/S1 (aged 11–12 years) at baseline (June 2012).InterventionA classroom-based alcohol education intervention, coupled with a brief alcohol intervention for parents/carers.Primary outcomes(1) The prevalence of self-reported HED in the previous 30 days and (2) the number of self-reported ARHs in the previous 6 months. Outcomes were assessed using two-level random intercepts models (logistic regression for HED and negative binomial for number of ARHs).ResultsAt 33 months, data were available for 5160 intervention and 5073 control students (HED outcome), and 5234 and 5146 students (ARH outcome), respectively. Of those who completed a questionnaire at either baseline or 12 months (n=12 738), 10 405 also completed the questionnaire at 33 months (81.7%). Fewer students in the intervention group reported HED compared with EAN (17%vs26%; OR=0.60, 95% CI 0.49 to 0.73), with no significant difference in the number of self-reported ARHs (incident rate ratio=0.92, 95% CI 0.78 to 1.05). Although the classroom component was largely delivered as intended, there was low uptake of the parental component. There were no reported adverse effects.ConclusionsResults suggest that STAMPP could be an effective programme to reduce HED prevalence. While there was no significant reduction in ARH, it is plausible that effects on harms would manifest later.Trial registration numberISRCTN47028486; Post-results.

BackgroundAlcohol use in young people remains a public health concern, with adverse impacts on outcomes such as health, well-being, education and relationships.ObjectivesTo assess the effectiveness and cost-effectiveness of a combined classroom curriculum and parental intervention on self-reported alcohol use [heavy episodic drinking (HED)] and alcohol-related harms (indicators such as getting into fights after drinking, poorer school performance and trouble with friends and family).DesignA two-arm, cluster randomised controlled trial with schools as the unit of randomisation.SettingA total of 105 post-primary schools in Northern Ireland (NI) and Glasgow/Inverclyde Educational Authority areas.ParticipantsA total of 12,738 male and female secondary school students (intervention delivered when students were in school year 9 in NI or S2 in Scotland in the academic year 2012–13 and aged 12–13 years) were randomised. Randomisation and baseline (T0) surveys took place when children were in school year 8 or S1. Schools were randomised (1 : 1) by an independent statistician to the Steps Towards Alcohol Misuse Prevention Programme (STAMPP) or to education as normal (EAN). All schools were stratified by free school meal provision. Schools in NI were also stratified by school type (male/female/coeducational).InterventionsSTAMPP combined a school-based alcohol harm reduction curriculum [an adapted version of the School Health and Alcohol Harm Reduction Project (SHAHRP)] and a brief parental intervention designed to support parents in setting family rules around drinking. The classroom component comprised two phases delivered over 2 years, and the parental component comprised a standardised presentation delivered by a trained facilitator at specially arranged parent evenings on school premises. This was followed up a few weeks later by an information leaflet mailed to all intervention pupils’ parents highlighting the main points of the evening.Main outcome measures(1) Self-reported HED (defined as self-reported consumption of ≥ 6 units in a single episode in the previous 30 days for male students and ≥ 4.5 units for female students) assessed at 33 months from baseline (T3); and (2) the number of self-reported harms (harms caused by own drinking) assessed at T3.Data sourcesSelf-completed pupil questionnaires.ResultsAt final follow-up (T3), data were available for 5160 intervention and 5073 control pupils for the HED outcome, and for 5234 intervention and 5146 control pupils for the self-reported harms outcome. The intervention reduced self-reported HED compared with EAN (p < 0.001), but did not reduce self-reported harms associated with own drinking. The odds ratio for the intervention effect on HED was 0.596 (standard error 0.0596, 95% confidence interval 0.490 to 0.725). The mean cost of delivery per school was £818 and the mean cost per individual was £15. There were no clear cost savings in terms of service utilisation associated with the intervention. The process evaluation showed that the classroom component engaged and was enjoyed by pupils, and was valued by teachers. Schools, students, intervention trainers and delivery staff (teachers) were not blind to study condition. Data collection was undertaken by a team of researchers that included the trial manager and research assistants, some of whom were not blinded to study condition. Data analysis of primary and secondary outcomes was undertaken by the trial statistician, who was blinded to the study condition.LimitationsAlthough the classroom component was largely delivered as intended, there was very low attendance at the parent/carer event; however, all intervention pupils’ parents/carers received an intervention leaflet.ConclusionsThe results of this trial provide some support for the effectiveness and cost-effectiveness of STAMPP in reducing heavy episodic (binge) drinking, but not in reducing self-reported alcohol-related harms, in young people over a 33-month follow-up period. As there was low uptake of the parental component, it is uncertain whether or not the intervention effect was accounted for by the classroom component alone.Trial registrationCurrent Controlled Trials ISRCTN47028486.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 5, No. 2. See the NIHR Journals Library website for further project information. The Public Health Agency of NI and Education Boards of Glasgow/Inverclyde provided some intervention costs. Diageo provided funds to print some workbooks. The remaining intervention costs were internally funded.

Abstract Background Factors contributing to suicidal behaviour are complex and multi-faceted. This study took an ecological approach to examine the association between area-level factors and rates of self-harm in Northern Ireland. Methods Data on self-harm presentations to emergency departments (EDs) were obtained from the Northern Ireland Self-harm Registry. The study included residents of Northern Ireland aged 16–64 years. Deprivation was measured using the Northern Ireland Multiple Deprivation Measure 2017. Population density and social fragmentation were calculated using measures from the 2011 census. Associations between area-level factors and self-harm rates were explored using negative binomial regression. Results Between 2013 and 2015, 14 477 individuals aged 16–64 years presented to EDs in Northern Ireland following self-harm. The rate of self-harm was 472 per 100 000 and was higher for male residents (478 vs. 467). Self-harm rates were highest in urban areas—680 per 100 000 in Belfast City and 751 per 100 000 in Derry City. Rates of self-harm in Northern Ireland were more than four times higher in the most deprived areas. A positive association with rates of self-harm held for the deprivation domains of employment, crime, education, health and income. There was a moderate association with population density. Some gender differences emerged, with associations with male rates of self-harm more pronounced. Conclusion These findings indicate that self-harm rates are highest for those residing in highly deprived areas, where unemployment, crime and low level of education are challenges. Community interventions tailored to meet the needs of specific areas may be effective in reducing suicidal behaviour.

BackgroundUnderstanding of the psychological impact of politically motivated violence is poor.AimsTo examine the prevalence of post-traumatic symptoms subsequent to the ‘troubles' in Northern Ireland.MethodA telephone survey of 3000 adults, representative of the population in Northern Ireland and the border counties of the Irish Republic, examined exposure to political violence, post-traumatic stress disorder (PTSD) and national identity.ResultsTen per cent of respondents had symptoms suggestive of clinical PTSD. These people were most likely to come from low-income groups, rate national identity as relatively unimportant and have higher overall experience of the ‘troubles' than other respondents.ConclusionsDirect experience of violence and poverty increase the risk of PTSD, whereas strong national identification appears to reduce this risk.

We analyse data collected from a survey of Northern Irish low-income households experiencing varying degrees of financial hardship and examine how debt affects health and health-related behaviours. Our results indicate that the subjective experience of feeling financially stressed has a robust relationship with most aspects of health, including ability to self-care, problems performing usual activities, pain problems and psychological health. In contrast, the size of the debt, the type of debt or the number of different lenders does not add any extra explanatory power. Additionally, our results indicate that the pathway from financial difficulties to worse health runs through worse diets and increased consumption of cigarettes and drugs. This research is timely as household debt burdens will soon surpass the high levels seen at the time of the financial crisis and the introduction of welfare reform in Northern Ireland will put additional strain on low-income households.

Objectives: To investigate knowledge, beliefs and practices associated with parental antibiotic misuse.Methods: This cross sectional study was conducted among the parents visited 4 major shopping malls (selling medicines) of Tabuk, Saudi Arabia from June to December 2015. Self-prescription of antibiotics for a child in the past year was defined as antibiotic misuse was noted.Results: From 610 parents (60.5% mothers and 39.5% fathers) 11.6% reported selfprescription. Responded parents differed by age, education, number of children and profession. Parents responded that antibiotics should be used for runny nose, sore throat, cough and fever (50%); to reduce symptom severity and duration (57.7%), should be stopped on clinical improvement (28.7%), are effective in viral infections (68.6%) and if used by the other family members should be given to the children (20.1%). Determinants of misuse in a multivariable model, were income, number of kid, type of infection treated last year, knowledge of diseases requiring antibiotics, or being unsure, using same antibiotics used by the other family person, unsure of such use and adjusting for the type of responding parent. Logistic regression model shows that those who incorrectly had knowledge that any type of infection with fever needs to be treated by antibiotics had twice the odds of misusing antibiotic (AOR: 2.17, 95%CL: 1.19-3.96), Parents who believed that it was acceptable to administer the same antibiotics to their children that were used for a similar illness by any other family member in the past; had thrice the Odds of using non-prescribed antibiotics (AOR=3.01, 95% CI=1.77-5.37). Similarly, those who were not sure about the use of prior antibiotics by any other family member were also three times more likely to misuse antibiotics (AOR:3.00,95%CI/ :1.00-9.01). Parents reporting monthly income of less than SAR 5000 had twice the Odds of misusing anti biotics (OR:2.00,95% CI:1.05-3.83).Conclusion: Parents having low income, more than two kids below 12 years age, low education level, inappropriate beliefs and practices are vulnerable for misusing antibiotics in their children.Bangladesh J Child Health 2016; VOL 40 (2) :64-71

This chapter focuses on two women leaders, Theresa Mahler and Mary Young, and describes how they helped the coalition navigate female networks, create alliances with men inside and outside the legislature, and finally secure a permanent public child care program, even if only for California's low-income working mothers. As legislative chair for the Northern California Association for Nursery Education (NCANE), Mahler served as the key spokeswoman for nursery school educators and child care supervisors throughout the postwar struggles to secure permanent, publicly funded child care. A soft-spoken, unassuming woman who became president and later legislative chairman of the California Parents' Association for Child Care (CPACC), Young spoke on behalf of California's low-income working families, particularly single mothers.

Abstract Meeting Mennonites Was For Me an oasis in the dry and barren desert. A Presbyterian from birth and elder in my local congregation, this “new” denomination came into my frame of reference in casual conversation in 1980 with a colleague who was working with youth on urban justice issues in England. He had visited the London Mennonite Centre and counted among his friends Alan and Eleanor Kreider. He spoke of a quality of community life, worship where justice and peace issues were not on the edge but central, and a people who took Jesus’ call to peacemakers as a serious call for today. To say I was interested would be an understatement. I read John Howard Yoder’s Politics of Jesus (1972), and I knew then I had to learn more about this church. At that point in my life, I was youth director of the Belfast YMCA, at that time a mainly Protestant and evangelical youth organization. I was responsible for running a social education and recreation program for several hundred youth in the sixteen to twenty-five age group, mostly from low-income inner city backgrounds, with a healthy mix of male and female, Catholic and Protestant. Young people with regular jobs were the exception, as the youth often came from neighborhoods where over 70 percent of the people were on welfare. Few experiences in my life had prepared me for the hopeless injustice faced by those youth. I understood in stark terms the connection between social deprivation and political violence. Many of the young people I worked with had lives outside the YMCA in the junior ranks of paramilitary organizations on both sides of our divided society.

Governments have expanded early childhood education and care (ECEC) in recent decades—often in the name of social investment—yet some do so in ways that are more congruent with social investment objectives than others. To explain these differences, this chapter analyzes ECEC expansions in six countries—France, Germany, Ireland, Slovenia, New Zealand, and Norway—whose systems differ in terms of quality, accessibility to low-income families, and the quality of work for ECEC staff. Two factors explain these differences. One is whether ECEC programs are administered by educational or social welfare administrations, which shapes protagonists involved in program expansion. Left political power is the second factor influencing the nature of ECEC expansion: Left and right governments have expanded spending on ECEC in recent years, yet only left parties do so in ways congruent with social investment goals. These governments are therefore more likely to develop programs that invest in children, their parents, and ECEC workers.

The Children’s Aid Society (CAS) early childhood initiative is located in two of our New York City community schools, Primary School (PS) 5 and PS 8, in the Washington Heights section of northern Manhattan. This initiative was conceived as a partnership between the New York City Board of Education and CAS. The collaboration brought newborns and their families into the schools in which the children would complete fifth grade. The initiative began in 1994 and has been in full operation since 1996. Since then, the need for such a project has been confirmed and experience has provided insights into how a program for pregnant women and children through age five (often called a Zero to Five Program) can be effectively implemented within a public school. The CAS Zero to Five model connects two federally funded programs—Early Head Start (birth to age three) and Head Start (ages three to five)—to provide comprehensive educational and social services to low-income families and their children. The population attending the Zero to Five Program confronts the obstacles facing all new immigrant families living in poverty in an urban setting. In both schools more than 75% of the families are from the Dominican Republic; another 20% come from other Central and South American countries. The parents’ language is Spanish, and language barriers and acculturation issues result in social isolation. In addition, because many residents lack legal documentation, they are reluctant to access health and social services. The few early childhood programs in the neighborhood all have long waiting lists. A majority of the families share overcrowded apartments with other families or extended family; whole families often live in one bedroom where books and age-appropriate toys are scarce and there may be little child-centered language interaction. However, in spite of the difficulties, these parents have a drive to succeed and they understand the importance of education. By combining and linking Early Head Start and Head Start programs and integrating them into a community school, the CAS Zero to Five Program provides children and families with quality educational, health, and social services, after which the children transition into public school classes within the same building.