Zeitschriftenartikel 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

A high prevalence of dental caries in the pediatric population is a major health problem. At highest risk are low-income minority groups, including refugee and immigrant populations. Consequences of oral disease include pain, difficulty eating and speaking, poor school performance, and poor self-esteem. Parent involvement in oral health education is crucial. This program provided oral health education for Latino immigrant parents in a northern California school district. A pretest–posttest was administered to measure changes in oral health knowledge and reported oral health behaviors following two sessions of oral health education. This program provides a framework for school nurses who are in an ideal position to implement similar programs that address the oral health needs of the pediatric population, particularly those of the Latino immigrant community.

Poverty impacts negatively on children’s health and future life chances. Access to the UK’s National Health Service (NHS) is based on clinical need rather than the ability to pay but horizontal inequities in access exist. Children North East, a charity supporting children experiencing poverty, are working with partners to reduce the impacts of poverty on NHS access. This collaborative study aimed to understand barriers to healthcare access faced by families living on low incomes to validate and support further development of a Poverty Proofing© healthcare tool. Twenty-four parents and eight Voluntary Community Social Enterprise sector staff participated in qualitative interviews or focus groups. Data were analysed thematically, and three main themes were identified as impacting access to healthcare: hidden costs, securing appointments and developing relationships with healthcare providers. We conclude that low-income families experience both financial and other barriers to accessing NHS healthcare and that these barriers are exacerbated for low-income families living in remote/rural areas.

BackgroundRising food bank use in the past decade in the UK raises questions about whether food insecurity has increased. Using the 2016 Food and You survey, we describe the magnitude and severity of the problem, examine characteristics associated with severity of food insecurity, and examine how vulnerability has changed among low-income households by comparing 2016 data to the 2004 Low Income Diet and Nutrition Survey.MethodsThe Food and You survey is a representative survey of adults living in England, Wales, and Northern Ireland (n=3118). Generalised ordered logistic regression models were used to examine how socioeconomic characteristics related to severity of food insecurity. Coarsened exact matching was used to match respondents to respondents in the 2004 survey. Logistic regression models were used to examine if food insecurity rose between survey years.Results20.7% (95% CI 18.7% to 22.8%) of adults experienced food insecurity in 2016, and 2.72% (95% CI 2.07% to 3.58%) were severely food insecure. Younger age, non-white ethnicity, low education, disability, unemployment, and low income were all associated with food insecurity, but only the latter three characteristics were associated with severe food insecurity. Controlling for socioeconomic variables, the probability of low-income adults being food insecure rose from 27.7% (95% CI 24.8% to 30.6 %) in 2004 to 45.8% (95% CI 41.6% to 49.9%) in 2016. The rise was most pronounced for people with disabilities.ConclusionsFood insecurity affects economically deprived groups in the UK, but unemployment, disability and low income are characteristics specifically associated with severe food insecurity. Vulnerability to food insecurity has worsened among low-income adults since 2004, particularly among those with disabilities.

Members of low-income households in the UK are more likely to have patterns of food and nutrient intakes that are less inclined to lead to good health outcomes in the short and long term. Health inequalities, including the likelihood of child and adulthood obesity, have long been documented in the UK and show little sign of improving so far, despite 10 years of attention from a government that has committed itself to addressing them. Following the Acheson Inquiry into Inequalities in Health (1998) in England a number of initiatives to tackle inequalities in food and diet were established, both nationally and within the devolved nations of Scotland, Wales and Northern Ireland. Nevertheless, until recently, there has been no overall strategic policy addressing the food and nutritional needs of low-income households. The present paper reviews how the problems have been constructed and understood and how they have been addressed, briefly drawing on recent evaluations of food and nutrition policies in Scotland and Wales. The contemporary challenge is to frame cross-cutting policy initiatives that move beyond simple targeting and local actions, encompass a life-course approach and recognise both the diversity of households that fall into ‘low-income’ categories and the need for ‘upstream’ intervention.

In Northern Ireland, nearly 30% of children are thought to be at risk of going hungry in the summer holidays when they are unable to access free school meals. Community groups, voluntary groups, local authorities, and faith groups have responded to this concern by developing and delivering holiday programmes that enable children from low-income families to take part in activities and access food. The current study used purposive sampling to investigate children’s and young people’s views of holiday provision, from across three holiday clubs, in Northern Ireland. Both primary school children (n = 34; aged 4–11) and secondary school children (n = 31; aged 12–17) showed high levels of awareness of poverty and food insecurity and associated pressures and stresses on households. Importantly, children and young people did not feel stigmatised about attending holiday provision, suggesting a positive and inclusive culture towards holiday club attendance. Children reported that they enjoyed the range of activities provided at holiday clubs and reported that attendance improved their self-confidence, especially for some older children, who acted as peer mentors to younger attendees, helped them to develop new skills, and provided them with opportunities to socialise with peers in a safe environment, out with their normal social groupings in school. Older children showed a high level of shrewdness and knowledge of sectarian divides in communities but spoke positively about how different religious or cultural backgrounds did not matter in terms of meeting and making new friends in holiday club settings. In terms of food provision, the findings of this study suggest that further work needs to be done to support children to access and eat healthy, nutritious food.

Background and Purpose: The prevalence of childhood obesity remains a concern in the United States and puts children at risk for poor health. As parents are the primary caretakers of their children, the practice of mindful food parenting may help parents moderate their child’s food consumption and food choices. The purpose of this research was to identify the factors associated with mindful food parenting practices among Hispanic and non-Hispanic white parents in two low-income schools in rural northern California. Methods: Two hundred ninety three parents of 3rd through 5th grade elementary school children completed a four part mindful food parenting practices survey developed to measure the factors associated with mindful food parenting practices. Results: Exploratory factor analysis revealed four mindful food parenting practices domains which were positively associated with several mindful food parenting practices such as eating family meals together and present-centered awareness (p=0.001) and cooking meals at home and hungerfullness awareness (p=0.001). Several demographic variables were associated with the mindful food parenting practices. Conclusions: As parents are more mindful and attentive to their child’s eating behaviors, there is a greater potential for a positive parental impact on their child’s food intake and types of foods consumed, and indirectly, the health of their child.

COVID-19-related school closures and the need for millions of learners to learn at home created additional pressures for parents and caregivers who were suddenly responsible for their children's education, often with limited support or resources. When schools closed, a flood of home learning materials and activities circulated online, but too few of these solutions focused on the home learning needs of learners with disabilities in low-income contexts, where online learning is rarely an option. The Enabling Education Network and Norwegian Association of Disabled developed guidance materials for all learners that encouraged appropriate, achievable, and low-stress learning activities in easy-to-read and visual formats, which are now available in online and printed formats. These materials were informed by an online survey that captured a snapshot of the extent to which home learning support and resources were provided, and recorded the perspective of parents, families, and education professionals about learners' situations in 27 countries in the months leading up to July 2020. In this paper, we focus on survey responses from the Democratic Republic of the Congo and northern Syria that describe the inclusive home learning provision available. We compared these findings with responses from other countries and identified four key areas of learning that emphasize the importance of localized approaches to inclusive education, drawing on community networks, and positioning teachers and parents as important community resources for education in emergencies.

One way of measuring the deprivation or poverty of persons is to use money-based measures: a person is regarded as ‘poor’ if his/her income (or expenditure) falls below a poverty line value. Such an approach – usually termed poverty analysis – has spawned a large literature embodying several sophisticated measures of poverty. The downside to this is that low income or expenditure may not be very good indicators of deprivation. Another way, usually termed ‘deprivation analysis’, is to define an index whose value, for each person, is the number (or proportion) of items from a prescribed list that he/she possesses: persons are then regarded as ‘deprived’ if their index value is below some threshold. This offers an alternative method of identifying deprived persons. The disadvantage of deprivation analysis is that it measures deprivation exclusively in terms of the proportion of deprived persons within the total number of persons. The purpose of this paper is to bridge the gap between poverty and deprivation analysis by constructing a wider set of measures of economic inequality and by showing, with data for Northern Ireland, how they might be applied. The result is an analysis sensitive to intra-population heterogeneity.

Foodborne diseases pose a primary global health concern, affecting people across high- and low-income countries, with the less privileged often suffering the most. This research proposes the adoption of a Hygiene Rating Scheme (HRS) to help customers make informed decisions about where and what to eat. The scheme has already demonstrated success in countries such as the United States, Northern Ireland, Wales, and England in reducing the risk of foodborne diseases. This article highlights the significance of Nigeria embracing the HRS and its potential to combat foodborne diseases. Adopting the scheme will incentivize food business owners to improve their sanitary conditions and food quality by implementing Good Manufacturing Practices (GMPs). The scheme’s transparent inspection results make it easier for customers to choose higher-rated outlets, reducing the cost of disease outbreaks and promoting public health. In conclusion, the HRS provides a practical solution to addressing the issue of foodborne diseases and promoting food safety.

ObjectivesGlobal incidence and attention to childhood cancer is increasing and treatment abandonment is a major cause of treatment failure in low- and middle-income countries. The purpose of this study was to gain an understanding of factors contributing to non-adherence to treatment.DesignA prospective cohort study with 2 year follow-up of incidence, family-reported motives and risk factors.SettingThe largest tertiary paediatric oncology centre in Northern Vietnam.ParticipantsAll children offered curative cancer treatment, from January 2008 to December 2009.Primary and secondary outcome measuresFamily decision to start treatment was analysed with multivariable logistic regression, and family decision to continue treatment was analysed with a multivariable Cox model. This assessment of non-adherence is thereby methodologically consistent with the accepted definitions and recommended practices for evaluation of treatment abandonment.ResultsAmong 731 consecutively admitted patients, 677 were eligible for treatment and were followed for a maximum 2 years. Almost half the parents chose to decline curative care (45.5%), either before (35.2%) or during (10.3%) the course of treatment. Most parents reported perceived poor prognosis as the main reason for non-adherence, followed by financial constraints and traditional medicine preference. The odds of starting treatment increased throughout the study-period (OR 1.04 per month (1.01 to 1.07), p=0.002), and were independently associated with prognosis (OR 0.51 (0.41 to 0.64), p=<0.0001) and travel distance to hospital (OR 0.998 per km (0.996 to 0.999), p=0.004). The results also suggest that adherence to initiated treatment was significantly higher among boys than girls (HR 1.69 (1.05 to 2.73), p=0.03).ConclusionsNon-adherence influenced the prognosis of childhood cancer, and was associated with cultural and local perceptions of cancer and the economic power of the affected families. Prevention of abandonment is a prerequisite for successful cancer care, and a crucial early step in quality improvements to care for all children with cancer.

Abstract A climatology is developed for tornadoes during 1980–2012 in the British Isles, defined in this article as England, Scotland, Wales, Northern Ireland, Republic of Ireland, Channel Islands, and the Isle of Man. The climatology includes parent storm type, interannual variability, annual and diurnal cycles, intensities, occurrence of outbreaks (defined as three or more tornadoes in the same day), geographic distribution, and environmental conditions derived from proximity soundings of tornadoes. Tornado reports are from the Tornado and Storm Research Organization (TORRO). Over the 33 years, there were a mean of 34.3 tornadoes and 19.5 tornado days (number of days in which at least one tornado occurred) annually. Tornadoes and tornado outbreaks were most commonly produced from linear storms, defined as radar signatures at least 75 km long and approximately 3 times as long as wide. Most (78%) tornadoes occurred in England. The probability of a tornado within 10 km of a point was highest in the south, southeast, and west of England. On average, there were 2.5 tornado outbreaks every year. Where intensity was known, 95% of tornadoes were classified as F0 or F1 with the remainder classified as F2. There were no tornadoes rated F3 or greater during this time period. Tornadoes occurred throughout the year with a maximum from May through October. Finally, tornadoes tended to occur in low-CAPE, high-shear environments. Tornadoes in the British Isles were difficult to predict using only sounding-derived parameters because there were no clear thresholds between null, tornadic, outbreak, and significant tornado cases.

Children of Hispanic origin bear a high risk of obesity. Child weight gain trajectories are influenced by the family environment, including parent feeding practices. Excessive body fat can result in unhealthful metabolic and lipid profiles and increased risk of metabolic diseases. The objective was to estimate criterion validity of an obesity risk assessment tool targeting Spanish-speaking families of Mexican origin using anthropometric measures and blood values of their young children. A cross-sectional study design with five data collection sessions was conducted over an eight-week period and involved 206 parent/child dyads recruited at Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children in Northern California. Main outcome measures were criterion validity of Niños Sanos, a pediatric obesity risk assessment tool, using anthropometric measures and blood biomarkers. Niños Sanos scores were inversely related to child BMI-for-age percentiles (p = 0.02), waist-for-height ratios (p = 0.05) and inversely related to blood biomarkers for the metabolic index (p = 0.03) and lipid index (p = 0.05) and positively related to anti-inflammatory index (p = 0.047). Overall, children with higher Niños Sanos scores had more healthful lipid, metabolic and inflammatory profiles, as well as lower BMI-for-age percentiles and waist-to height ratios, providing evidence for the criterion validity of the tool. Niños Sanos can be used by child obesity researchers, by counselors and medical professionals during clinic visits as a screening tool and by educators as a tool to set goals for behavior change.

Drug addiction has spread at a frightening rate in the whole world, especially in the South Asian countries such as Bangladesh which needs to be analyzed, discussed and eradicated. This present survey based study was conducted with an aim to discover the scenery of drug addiction in northern region of Bangladesh. Researchers also uncovered the factors, problems and effects of drug addiction, age of first drug used, source of money to buy drugs and effective measures to prevent this problem etc. Total 600 youngsters from Pabna, a northern part of Bangladesh were directly interviewed by using self-construct questionnaire. Age range of the participants was between 12 and 35. Result showed, low income participants were highly addicted (58.62%) and family problems (43.93%) were the most prevalent cause of addiction. Participants involved in sports had lower drug addiction propensity (36.38%). Addicted young consumed more nicotine (95.04%), alcohol (63.93%) and marijuana (44.28%). Among addicts, youngs started using drugs mostly between 15 to 18 years age. Parent’s income (42%) was the prime source of money to buy drugs and 91% of addicted young faced complications. Counseling (71.2%) and systematic penalty (66.4%) were the best preventive measures for drug addiction. The young generations of Bangladesh are cankering their crucial youth time in addiction and they should be rescued by counseling, monitoring and treating them with care and affection from the parents, society and government. Keywords: Drug Addiction, Survey, Young People, Pabna, Bangladesh

Background Suboptimal utilization of antiretroviral therapy (ART) services remains a problem among adolescents in low- and middle-income countries, which has a negative impact on their response to treatment and increases the risk of developing resistance. Optimal use is essential to enhancing treatment efficacy. We investigated the optimal use of ART service and predictors among adolescents living with HIV (ALHIV) in northern Uganda. Methods We used a cross-sectional study design to collect quantitative data from 293 ALHIV at three health facilities in Lira municipality, northern Uganda. We used an interviewer-administered questionnaire and data abstraction form. Data were analysed using SPSS version 23 software. Descriptive analysis and logistic regressions were performed to determine the relationship between the predictor and outcome variables. Statistical significance was determined at P-value<0.05 and the adjusted odds ratio with a 95% confidence interval was used. Results The level of utilization of ART services was suboptimal among 27.6% (81/293) of the participants, and only 63.1% (185/293) were virally suppressed. Of the participants who were optimally utilizing ART services, the majority 86.8% (184/212) were virally suppressed. Age 10–14 years (aOR = 3.34), the presence of both parents (aOR = 1.85), parental and peer reminders (aOR = 2.91) and (aOR = 0.49) respectively, and being on ART for five years or less were the characteristics related with optimal utilization of ART services. Conclusions and recommendations Not all ALHIV used ART services to their full potential. However, factors such as participants’ age, the presence of both parents, reminders from parents and peers, and being on ART for some time were all related to the optimal use of ART services. There is a need for developing strategies to increase family and peer support with a focus on older adolescents if the 95-95-95 goal is to be achieved in this age group.

SUMMARYThe requirement for inorganic fertilizer nitrogen (N) by winter wheat crops in the United Kingdom is derived using the Department for Environment, Food and Rural Affairs (Defra) Fertilizer Manual. In the experimental programme described and discussed in the present paper, the appropriateness of these recommendations for winter wheat grown in Northern Ireland is examined.Yield response to N varied in experiments conducted on two winter wheat cultivars (cvars) in Northern Ireland from 2007 to 2009. Consequently the optimum N rate (Nopt, defined as the rate of applied N where the value of the increase in yield equals the cost of the increment in fertilizer applied and beyond which additional N would not repay its cost) also varied from year to year. The band of fertilizer N rates over which margins were reduced by £20 (GBP) and £50 also varied from year to year. Changes in the N:grain price ratio affected Nopt to differing extents in the three experiments depending on the shape of the yield v. N response.Nopt should therefore be considered as a range of N rates because (1) it varies from year to year and probably also field to field and (2) the margin of income from grain over cost of fertilizer varies little over a range of N rates because of the shape of the asymptotic response of yield to N. Alternatively, in high rainfall areas (annual rainfall >700 mm) of England, Wales and Northern Ireland, where Table C of the Fertilizer Manual (formerly RB 209) is used to determine soil nitrogen supply (SNS) index, a single N rate could be adopted at SNS indices of 2 or less (equating to soil N supplies of 100 kg/ha or less). A rate of 240 kg N/ha could be adopted based on the over-years function fitted to all results in the three experiments reported in the present paper and including treatments that vary in the splitting of N applied between the two applications and in their timing.Grain N concentration rarely exceeded the guideline 19 mg/g for feed wheat crops identified in the Fertilizer Manual (Anon. 2010). Overall, N taken up by the crops was used efficiently, and particularly so at lower N rates. However, at low fertilizer N rates the contribution from ‘free’ soil N inflates the ‘apparent’ value of grain yield produced. The responses of yield and grain N concentration to N show that crop processes work to maximize yield at the expense of N concentration in the grain. Therefore there is less need to be concerned about identifying the optimum N rate and predicting fertilizer N requirement with a high degree of precision. Instead growers could assess and adjust the efficiency of their N use based on grain N concentration generally, rather than specifically assess whether their fertilizer N applications were close to Nopt. Essentially as grain N concentration increases, yield/kg of applied fertilizer N decreases. Thus at low grain N concentrations, yield could be increased by increasing N applications and at high grain N concentrations yield could be maintained and profitability increased by reducing N applications.

Abstract This article addresses the challenge of promoting physical activity through a focus on equity and engaging physically inactive citizens through the development of inclusive strategies within parkrun UK—a free, volunteer-led, weekly mass community participation running event. We discuss how a UK-based action research design enabled collaboration with volunteer event organizers to understand participant experiences, constraints and develop localized inclusive practices. In contrast with ‘expert’-driven health behaviour interventions, our research pursued a ‘ground up’ approach by asking what can be learnt from the successes and challenges of organizing community events, such as parkrun UK, to promote inclusion? A modified participatory action research approach was used with four parkrun sites across England, Scotland and Northern Ireland, that involved quantitative and qualitative analysis of survey data (n = 655) that informed the process. Our analysis explored parkrunners’ and volunteer organizers’ perceptions relating to (i) the demographics of parkrun participation and (ii) actions for change in relation to the challenges of engaging marginalized groups (women, ethnic minorities, low income, older people, those with disabilities or illness). We discuss the challenges and opportunities for addressing (in)equity and inclusion through volunteer-based organizations and the implications for translating knowledge into organizational strategies.

Objectives: Breastfeeding is the optimal method of infant nutrition. Despite this, rates of breastfeeding in high-income countries are low and mirror wider health inequalities with women from under-served populations being least likely to breastfeed. In the UK, adolescent mothers from areas of high socio-economic deprivation are among the least likely groups to initiate and continue breastfeeding. This study aimed to examine young women’s experiences of breastfeeding, with a particular focus on information provision and relationships with healthcare practitioners. Methods, design and setting: Data were collected through qualitative focus groups and interviews with 27 adolescent mothers from areas of socio-economic deprivation in Belfast (Northern Ireland), Bristol (South West England) and Middlesbrough (North East England). Questions focused on the support young mothers receive for breastfeeding with a particular focus on the importance of healthcare practitioners in breastfeeding practices. Results: Although young mothers were well-informed about the benefits of breastfeeding, they lacked basic information which led to early cessation. Moreover, mismatched cultural health capital between healthcare practitioners and adolescent mothers led to perceived strained relationships wherein young mothers felt undermined and not listened to. We suggest that this arises from an intersection of age-related lack of confidence and low cultural health capital arising from differences in socio-economic status. Conclusions: Recommendations are offered for a more holistic approach to young mothers’ maternal health and the use of peer supporters.

This study aimed to further knowledge about elementary school students’ views on food environment, and the effects of the Harvest of the Month (HOTM) program on their dietary attitudes and behaviors. Three focus groups were conducted with a total of 24 fourth, fifth, and sixth grade students from low-income schools in northern California who received the National School Lunch Program and HOTM during the school year. Focus groups were tape-recorded, transcribed, and coded for specific themes. Following the intervention, participants expressed a desire for more healthy food options in the school cafeteria and wanted to receive more school and family support for healthy eating. The HOTM program created a positive environment that appeared to influence their dietary attitudes and behaviors, peer and family perceptions of healthy eating, and participants’ attitudes toward their schools. Specifically, cooking demonstrations, tasting activities, and take-home recipes provided them with a means to share with their parents what they had learned about fruits and vegetables. School food policy interventions may become more effective if they are combined with interventions based on nutrition education. Future research should focus on exploring effective and synergistic ways of implementing both types of interventions among children.

IntroductionWorldwide, 10%–20% of children and adolescents experience mental health conditions. However, most such disorders remain undiagnosed until adolescence or adulthood. Little is known about the factors that influence mental health in children and adolescents, especially in low and middle-income countries (LMIC), where environmental threats, such as poverty and war, may affect optimal neurodevelopment. Cohort studies provide important information on risks and resilience across the life course by enabling tracking of the effects of early life environment on health during childhood and beyond. Large birth cohort studies, including twin cohorts that can be aetiologically informative, have been conducted within high-income countries but are not generalisable to LMIC. There are limited longitudinal birth cohort studies in LMIC.MethodsWe sought to enhance the volume of impactful research in Sri Lanka by establishing a Centre of Excellence for cohort studies. The aim is to establish a register of infant, child and adolescent twins, including mothers pregnant with twins, starting in the districts of Colombo (Western Province) and Vavuniya (Northern Province). We will gain consent from twins or parents for future research projects. This register will provide the platform to investigate the aetiology of mental illness and the impact of challenges to early brain development on future mental health. Using this register, we will be able to conduct research that will (1) expand existing research capacity on child and adolescent mental health and twin methods; (2) further consolidate existing partnerships and (3) establish new collaborations. The initiative is underpinned by three pillars: high-quality research, ethics, and patient and public involvement and engagement (PPIE).Ethics and disseminationEthical approval for this study was obtained from the Ethics Review Committee of Sri Lanka Medical Association and Keele University’s Ethical Review Panel. In addition to journal publications, a range of PPIE activities have been conducted.

The resources available to breeding seabirds within their foraging ranges can influence productivity, either directly through the quality and quantity of food consumed by chicks, or indirectly by affecting the foraging behaviour and efficiency of parent birds. Where local resource availability is low, or the quality of resources are poor, species with flexible time-energy budgets can increase their foraging effort to provide adequate energy and nutrients to their chicks, although this may come at the expense of nest attendance. We investigated provisioning rates and nest attendance in European Herring Gulls Larus argentatus from seven colonies across southwest Scotland and Northern Ireland during two chick-rearing periods (2013 and 2014) in relation to the food resources used by these colonies. We observed variation in provisioning rates and nest attendance between colonies, and variation between years in nest attendance. We found no significant relationships between these behaviours and the proportion of intertidal prey consumed, suggesting that provisioning rate and nest attendance did not differ between resource types at the colony level. We also found no evidence that variation in behaviours was related to breeding success. Our results suggest that, within this region, the type of resources consumed had a greater influence on Herring Gull breeding success than differences in two proxies of foraging efficiency (provisioning rate and nest attendance), although other factors may also have influenced breeding success. Our work highlights the benefit of determining what food resources are provided to chicks, in addition to measuring foraging behaviours, to fully understand the consequences of consuming different resources on the breeding success of generalist foragers.

Introduction One in every two cases of caries in deciduous teeth occurs in low- and middle-income countries (LMICs). The aim of the World Health Organisation’s (WHO) Healthy Schools Program is to improve the oral health of children. This study explored perceptions of implementation of the Ugandan oral health schools’ program in Gulu district, northern Uganda. Methods Semi-structured interviews were conducted with a purposive sample of 19 participants including health and education officials, community leaders, policy makers, teachers, and parents. All interviews were transcribed verbatim and analysed thematically. Results Our study identified three themes: (1) components of oral health promotion, (2) implementation challenges of oral health promotion, and (3) development of an oral health policy. The components of oral health promotion in schools included engagement of health workers, the community, companies, skills-based education, and oral health services. Participants were concerned about insufficient funding, unsatisfactory skills-based education, and inadequate dental screening. Participants reported that there was an urgent need to develop oral health policy to guide implementation of the program at scale. Conclusions Schools provided oral health promotion that aligned with existing features of the WHO’s health-promoting school framework. Implementation of this strategy could be enhanced with increased resources, adequate oral health education, and explicit development of oral health policy.

INTRODUCTION: Brazil has been called a nation in nutrition transitional because of recent increases in the prevalence of obesity and related chronic diseases. With overweight conditions already prevalent among middle-income populations, there exists a need to identify factors that influence nutrition behavior within this group. OBJECTIVE: To address this subject, a research study was implemented among middle-class adolescents attending a large private secondary school in Manaus, Amazonas, Brazil. The study determined the availability and accessibility of snack foods as well as subjects’ attitudes and preferences towards, and the influence of family and friends on healthy (high-nutrient density) snack choices. METHODS: The 4-stage process included: (a) a nutrition expert focus group discussion that reported local nutrition problems in general and factors related to adolescent nutrition, (b) an adolescent pilot survey (n=63) that solicited information about snacking preferences and habits as well as resources for nutrition information and snack money; (c) a survey of various area food market sources to determine the availability and accessibility of high nutrient density snacks; and (d) a follow-up adolescent survey (n=55) that measured snack food preferences and perceptions about their cost and availability. RESULTS: Results included the finding that, although affordable high nutrient density snacks were available, preferences for low nutrient density snacks prevailed. The adolescents were reportedly more likely to be influenced by and obtain nutrition information from family members than friends. CONCLUSION: From study results it is apparent that a focus on food availability will not automatically result in proper nutritional practices among adolescents. This fact and the parental influence detected are evidence of a need to involve adolescents and their parents in nutrition education campaigns to improve adolescent snack food choices.

The paper presents a socio-economic and demographic portrait of parents with many children in the Komi Republic, aged 25-49, based on the results of 2017 sociological survey on determining the level and quality of life of the popula-tion of the northern region. In order to study the total sampling size, 70 respondents having three or more children, aged 25-49, were selected. To compare the data obtained on some issues, a comparison with the results of the survey as a whole for the entire group of respondents aged 25-49, without taking into account the number of children, was made. The study allowed us to make a number of conclusions. All three types of reproductive attitudes in large families are at a high level and correspond to extended type of reproduction. The highest is the average desired number of children. Among the large families, there are fewer people with higher education than in the whole array of respondents, and more of those with secondary special education. The housing problem is acute for a significant part of large families: almost a third of large families have cramped housing conditions. 40% of parents with many children, with all the desire to improve their housing conditions, cannot afford it in the near future. Low personal incomes (taking into account wages and other sources) are twice as likely to have large families than the general population, without taking into account number of children. The average per capita incomes of families differ significantly depending on the level of childbearing – due to the growing dependency burden on the budget. The most disturbing fact is that four out of ten families with three or more children have an average per capita income below the subsistence minimum in the Komi Republic. At the end of the paper, recommendations for improving the financial situation of families with three or more children are proposed.

Education is an important human capital; and, it is the fundamental right of every human being irrespective of gender to acquire knowledge through education. Social scientists have highlighted the significance of female education without which socio-economic growth, especially in Asia, remains slow. However, gender disparity in education persists in rural peripherals of Pakistan, Afghanistan, Bhutan, India, Iran, Nepal and Bangladesh (UNESCO 2015). This deplorable situation is subject to multiple socio-economic and cultural barriers. In order to unveil these militating attributes, present investigation was conducted in three districts of the Punjab province in Pakistan from March to June 2016. The province is divided into three different zones: Northern, Central and Southern. From each zone, one district was purposively selected as the study area. From the selected districts (Sargodha, Khushab and Bhakhar), 100 rural households from each district were selected through multi-stage simple random sampling technique. The data were collected from 300 household heads and from their spouses through in-depth individual interviews to find out the difference in opinion of the male and female respondents. The collected data was analysed using SPSS. Paired t-test was used to find out the difference in responses of male and female respondents. In order to find out the difference in intensity of factors in the three districts, F-test was applied. Results showed that there is highly significant difference between age of male family heads and their spouses (wives) (χ2=50.121 and P<0.05). Similar trend was found in educational status of male heads and their spouses. Cross tabulation indicated that educational status of wives was low as compared to their husbands. Analysis showed that a number of socio-economic factors are responsible for the existing gender disparity with reference to education in the study areas. Respondents identified low income, high educational expenditures, low educational level of parents (especially the mother), and security concerns of parents regarding sexual harassment as the major factors impeding female education. Results of the F-test showed that there exists difference in intensity of factors in the three study districts of Punjab which contribute towards gender disparity in education. Highest intensity (x =2.74/3.00) was found in district Bhakhar as it is a remote district of Punjab with higher poverty rate, followed by district Khushab and Sargodha. It is recommended that the Government at the national level should take serious steps in creating conducive environment to enhance female enrolment rate in rural localities.

Background The practice of traditional and complementary medicine is increasing in most low-and middle-income countries especially for chronic communicable and non-communicable diseases. In this study, we aimed to understand how people gain healing power and become traditional health practitioners (THPs), perceived causes of illnesses, and how THPs diagnose illnesses. Methods This was a cross-sectional qualitative interview-based study. We used semi-structured in-depth guides to collect data from THPs identified through the Acoli cultural institutions and snowball sampling technique. The study team visited the THPs and interviewed them in their homes. Some THPs allowed the study team to visit them more than once and as well observe their healing practices and medicines. Thematic analysis approach was used to analyze the data. Atlas.ti version 9.2 was used to support data analysis. Results Twenty two THPs aged 39–80 years were included in the study. Most of the respondents were male, and married. We identified three main themes: (i) how people gain healing power and become traditional health practitioners; (ii) perceived causes of illnesses; and (iii) how illnesses are diagnosed. The majority of respondents reported that most people become THPs through: inheriting healing power from their parents or grandparents; transfer of healing powers from senior healers; instructions during visions and dreams; and, acquiring healing power during spirits possessions. Perceived causes of illnesses included: fate and natural causes, spirits attacks, curses by elders, witchcraft, contagion and infections, poor hygiene, heredity, and malevolent actions. THPs diagnose illnesses through various approaches including consultations with spirits, observing patterns of occurrences and events, evaluation of symptoms and signs of illnesses, use of bones from animals/birds and other objects to diagnose illnesses, performing diagnostic rituals, and using biomedical laboratory testing in health facilities. Conclusion Healing knowledge and powers are acquired in particular ways that can be traced to appraise authenticity of healers during registration and licensing to ensure safety of patients. Understanding perspectives of the THPS on causes of illnesses and how diagnoses are made potentially informs strategies for integration and or collaboration between the national biomedical health system and traditional health practices.

Public schools located in rural areas in Sri Lanka seem to be neglected and both educational resources and infrastructure facilities are extremely poor in most of these types of schools. This project is an interventional project carried out in a rural school located in Moneragala district with the aim of supporting to improve education and wellbeing of the students learning in the selected school. Few major issues were identified including inadequate infrastructure and sanitary facilities, poor road accesses, inadequate staff, non-availability of quality and adequate amount of reading materials and nonexistence of School Health Programmes. Few interventions were applied to rectify few prioritized issues which investigators make intervene. Applied interventions successfully improved the problems prioritized. Students and the staff members were very satisfied about the intervention. However, study found that major interventions are required at the national level to rectify the issues identified. Nevertheless, such simple interventions can be applied by any organization and or individual level to help education and wellbeing of the future generation in Sri Lanka. rural children. Most children have to contribute to family income. Most parents in these communities cannot afford the education of their children [5]. Some schools have no drinking water and sanitary facilities, lab facilities, electricity and the communication facilities are not available. Road accesses to most of these schools are very unsatisfactory. Some researchers have found that wild attacks are common in the schools located in Northern and North eastern provinces. Most of them are underfunded and difficult in fulfilling basic requirements required for the education. Teacher shortage is severe and skilled teachers turn away from rural schools due to lack of amenities mainly unavailability of quarters. Rural students frequently have high dropout and low level of reading and numeracy due to these issues. Moreover, the student performances are low in stated provinces. As many studies highlighted a few challenges such as lack of robust national policy, unplanned policy changes done by the political leaders, politicization of recruiting procedures and inability of identifying real needs of the country which hinders the attempts taken by the relevant authorities [6].

Delinquency in adolescence is rooted in a complex multifaceted system that comprises several factors such as personal characteristics, family, school, peers, and community, all of which are embedded in the sociocultural context in which they are present. There is a paucity of research on juvenile delinquency and its risk factors across many regions, especially low- and middle-income countries, including Arab countries. This study aimed to develop an understanding of the personal, familial, and behavioral characteristics of Arab juvenile delinquents in the distinctive sociocultural context of Jordan. All juveniles who were incarcerated at the time of data collection (N = 197) were targeted using a convenience sampling approach from a total of 11 juvenile rehabilitation centers distributed over the northern, middle, and southern regions of the country. Anonymous surveys were used to collect data on juvenile delinquents’ personal, familial, psychosocial, and behavioral characteristics. A total of 186 juvenile delinquents completed the study questionnaire (9.7% females). About 52% were not attending school regularly, 32% had divorced, separated, or deceased parents, 6% reported receiving a diagnosis of mental illness, and 91% reported they never sought psychological support of any kind. Regarding substance consumption, 70% were smokers, 26% were alcohol consumers, and 15% were on drugs. About 12% spent more than 7 h on their cellphones, and 43% reported dedicating no time for physical activity. Theft was the most frequently reported offense (35%), followed by quarreling with peers (25%), and possession of drugs (9%). Approximately 42% reported that their friends encouraged them to cause trouble, while the majority (74%) reported that their school had no positive or negative influence on their behavior. Several behavioral problems were detected, with females showing significantly higher scores in impulsivity, inattention, emotional lability, and social problems compared to their male counterparts. Severity of the conduct problems was negatively associated with the length of engagement in physical activities, while both impulsivity and inattention scores were positively associated with the length of engagement in watching TV and using cellphones (all p < 0.05). Overall, these juvenile delinquents have unsatisfactory academic and schooling experiences, engage in unhealthy lifestyles and exhibit several behavioral problems. Differences in juvenile delinquency risk factors across different sociocultural contexts can influence prevention efforts. Comprehensive prevention strategies that reduce risk and develop protective factors need to target juveniles early in their development and consider factors related to their families, schools, peers, and communities.

Khanna A, Goyal RS, Bhawsar R. Menstrual practices and reproductive problems Study of adolescent girls in Rajasthan. J Health Manag. 2005;7(1):91–107. Ersoy B, et al. Effects of different socioeconomic conditions on Menarche in Female Turkish Students. Early Hum Dev. 2004;76(2):115–25. Dongre AR, Deshmukh PR, Garg BS. The effect of community-based health education interventions on menstrual hygiene management among rural Indian adolescent girls. World Health Popul. 2007;9(3):48–54. Tang CS, Yeung DY, Lee AM. Psychosocial correlates of emotional Responses to menarche among Chinese adolescent girls. J Adolescent Health. 2003;33(3):193–201. Adhikari P, et al. Knowledge and practice regarding menstrual hygiene in rural adolescent girls in Nepal. Kathmandu Univ Med J (KUMJ). 2007;5(3):382–6 Ali TS, Rizvi SN. Menstrual knowledge and practices of female adolescents in urban Karachi, Pakistan. J Adolescent. 2010;33(4):531–41. Bobhate P, Shrivastava S et al.. This was a cross-sectional study of knowledge and practices regarding reproductive health among female adolescents in an urbsluminf Mumbai. J Fam Reprod Health. 2011;5(4):117–24. Dasgupta A, Sarkar M. Menstrual hygiene: how hygienic is the adolescent girl? Indian J Community Med. 2008;33(2):77–80. Goel MK, Kundan M. Psycho-social behavior of urban Indian adolescent girls during menstruation. Australas Med J. 2011;4(1):49–52. Shanbhag D, Shilpa R, D’Souza N, Josephine P, Singh J, Goud BR. Perceptions regarding menstruation and Practices during menstrual cycles among high school going adolescent girls in resource-limited settings around Bangalore City, Karnataka, India. Int J Collab Res Inter Med Public Health. 2012;4(7):1353–62. Tiwari H, Oza UN, Tiwari R. Knowledge, attitudes and beliefs about Menarche of adolescent girls in Anand District, Gujarat. East Mediterr Health J. 2006;12(3-4):428–33. Thakre SB, Thakre SS, Reddy M, Rathi N, Pathak K, Ughade S. Menstrual hygiene: knowledge and practice among adolescent school girls of Saoner, Nagpur district. J Clin Diagn Res. 2011;5(5):1027–33. Yasmin S, Mallik S, Manna N, Ahmed A, Paria B. Menstrual hygiene among adolescent school students: an in-depth cross-sectional study in an urban community of West Bengal, India. Sudan J Public Health. 2013;8(2):60–4. Oche MO, Umar AS, Gana GJ et al.. Menstrual health: Unmet needs of adolescent girls in Sokoto, Nigeria. Sci Res Essays. 2012;7(3):410–8. Ray S, Dasgupta A. Determinants of menstrual hygiene among adolescent girls: a multivariate analysis. Natl J Commun Med. 2012;3(2):294–301. Boosey R, Prestwich G, Dave T. Menstrual hygiene management amongst Schoolgirls in the Rukungiri district of Uganda and their impact on their education: A cross-sectional study. Pan African Med J. 2014;19:253. Nemade D, Anjenaya S, Gujar R. Effect of health education on statistics and practices about menstruation among adolescent faculty girls of Kalamboli, Navi-Mumbai. fitness of Popul-Perspect issues. 2009;32(4):167–75 Narayan okay, Srinivasa D, Pelto P, Veerammal S. Puberty Rituals, Reproductive Understanding, and Health of Adolescent Girls in South India. Asia-percent Popul J. 2001;16(2):225–38. ARORA A, Mittal A, Pathania D, Mehta C, Bunger R. Impact of health education on understanding and practices about menstruation among adolescent college women in the rural part of the district Ambala, Haryana. Ind J Comm health. 2013;25(4):492–7. Lawan UM, Yusuf NW, Musa AB. Menstruation and menstrual hygiene among adolescent college women in Kano, Northwestern Nigeria. Afr J Reprod fitness. 2010;14(3):201–7. Zegeye DT, Megabiaw B, Mulu A. Age at menarche and the menstrual pattern in younger secondary college humans in Northwest Ethiopia. BMC Women’s Fitness. 2009;nine:29. Thakre SB, et al. Town-rural versions of menstrual troubles and practices of Female college students in Nagpur, India. Indian Pediatr. 2012;49(9):733–6. Udgiri R, Angadi MM, Patil S et al.. Expertise and practices concerning menstruation among adolescent women in a town slum in Bijapur. J Indian Med Assoc. 2010;108(8):514–6. Marvan ML, Molina-Abolnik M. Mexican youngsters’ revel in of menarche and attitudes toward menstruation: function of communique among moms and daughters. J Pediatr Adolesc Gynaecol. 2012;25(6):358–63. Sharma M, Gupta S. Menstrual sample and abnormalities in the immoderate college girls of Dharan: A cross-sectional test of the boarding faculty of Nepal Med Coll J.2003;5(1):34–6. Adinma ED, Adinma JI. Menstrual traits among south-eastern Nigerian adolescent faculty women West Afr J Med. 2009;28(2):110–3. Reis N, Kilic D, Engin R, Karabulutlu O. Sexual and reproductive health desires of adolescent girls from conservative and low-income households in Erzurum, Turkey. fitness of Popul Perspect trouble. 2011;3(6):370–7. Bosch AM, Hutter I, van Ginneken JK. Perceptions of teens and their months for reproductive and sexual development in MATLAB, Bangladesh. Int J Adolesc Med health. 2008;20(three):329–42 Dhingra R, Kumar A, Kour M. Understanding and Practices Associated with Menstruation Among Tribal (Gujjar) Adolescent Women. Ethno-remedy. 2009;3(1): 43–8 El-Gilany AH. Badawi. El-Fedawy S. Menstrual hygiene among adolescent schoolgirls in Mansoura, Egypt. Am. Reprod health subjects. 2005;13(26):147–52. Gumanga SK, Kwame-Aryee RA. Menstrual trends in a few adolescents women in Accra, Ghana. Ghana Med J. 2012;46(1):3–7. Dambhare DG, Wagh SV, Dudhe JY. Age at menarche and menstrual cycle the patterns among adolescent women in India. Glob J Health Sci. 2012;4(1): a hundred and 5–11. Kotecha PV, et al. Reproductive fitness focuses on rural college-going young people in the Vadodara district. Indian J sex Transm Dis. 2009;30(2): 94–9. Mudey A, Kesharwani N, Mudey GA et al.. Pass-sectional observed attention concerning secure and hygienic practices among faculty-going adolescent girls in a rural area of Wardha District, India. Glob J Health Sci. 2010;2(2):225–31 Ray S, et al. Knowledge and information on psychological, physiological, and gynecological problems among adolescent girls in eastern India. Ethiopia J Health Sci. 2011;21(3):183–9. Jarrah SS, Kamel AA. Attitudes and practices of school-aged girls towards menstruation. Int J Nurs Pract. 2012;18(3):308–15. Lee LK, et al. Menstruation among adolescent girls in Malaysia: A cross-sectional school survey. Singapore Med J. 2006;47(10):869–74. Wong LP. Attitudes toward menstruation, menstrual-related symptoms, and pre-menstrual syndrome among adolescent girls: A rural school-based survey. Women's Health. 2011;51(4):340–64. Wong LP. Premenstrual syndrome and dysmenorrhea: urban-rural and multipath differences in perception, impact, and treatment-seeking. J Pediatr Adolesc Gynaecol. 2011;24(5):272–7. Aniebue UU, Aniebue PN, Nwankwo TO. Impact of pre-menarcheal training on menstrual practices and hygiene in Nigerian schoolgirls. Pan Afr Med J. 2009;2:9. Iliyasu Z, et al. Sexual and reproductive health communication between mothers and adolescent daughters in Northern Nigeria. Health Care Women Int. 2012;33(2):138–52. Ajah LO, et al. Adolescent reproductive health challenges among schoolgirls in southeast Nigeria: Knowledge of menstrual patterns and contraceptive adherence. Patient Preference Adherence. 2015;9:1219–24. Chandraratne NK, Gunawardena NS. Premenstrual syndrome: The experience of a sample of Sri Lankan adolescents. J Pediatr Adolesc Gynecol. 2011;24(5):304–10. Abd El-Hameed NA, Mohamed MS, Ahmed NH, Ahmed ER. Assessment of dysmenorrhea and menstrual hygiene practices among adolescent girls in some nursing schools in LL-Minia governorate, Egypt. J Am Sci. 2011;7(9):216–23. Eswi A, Helal H, Elarousy W. Menstrual attitudes and knowledge of Egyptian female adolescents. J Am Sci. 2012;8(6):555–65. Omidvar S, Begum K. Factors influencing hygienic practices during menses among girls from South India: A cross-sectional study. Int J Collab Res Intern Med Public Health. 2010;2(12):411–23. Wong LP. Attitudes towards dysmenorrhea, impact, and treatment-seeking among adolescent girls: A rural school-based survey. Aust J Rural Health. 2011;19(4):218–23. Wong LP, Khoo EM. Menstrual-related attitudes and symptoms among Multiracial Asian adolescent females. Int J Behav Med. 2011;18(3):246–53. Sommer M. Ideologies of sexuality, menstruation, and risk: girls’ experiences of puberty and schooling in northern Tanzania. Cult Health Sex. 2009;11(4):383–98. Crichton J, et al. Emotional and psychosocial aspects of menstrual poverty in resource-poor settings: A qualitative study of the experiences of adolescent girls in an informal settlement in Nairobi. Health Care Women Int. 2013;34(10):891–916. Mason L, et al. ‘We keep it secret so no one should know’–a qualitative study to explore young schoolgirls’ attitudes and experiences with menstruation in rural western Kenya. PLoS One. 2013;8(11):e79132. Munthali AC, Zulu EM. The timing and position of initiation rites in preparing younger human beings for formative years and accountable reproductive behavior in Malawi. Afr J Reprod fitness. 2007;11(three): hundred and 50–67. fifty-three. McMahon SA, et al. ‘The girl together with her duration is the one to hang her head’ Reflections on menstrual management amongst schoolgirls in rural Kenya. BMC Int fitness haul rights. 2011;eleven:7. Sommer M. An early window of possibility for promoting girls’ health: Policy implications of the woman’s puberty e-book task in Tanzania. Int. Electron J Health Microbiol. 2011; 14:77–92 Dorgbetor G. Mainstreaming MHM in colleges through the play-primarily based approach: training discovered in Ghana. Waterlines. 2015;34(1): 41–50.56. Marvan ML, Vacio A, Espinosa-Hernandez G. Menstrual-associated changes expected with the aid of premenarcheal girls dwelling in rural and urban areas of Mexico. Soc Sci Med. 2003;56(4):863–8. Marvan ML, Vacio A, Espinosa-Hernandez G. A contrast of menstrual adjustments anticipated through pre-menarcheal kids and changes skilled with the aid of publish-menarcheal children in Mexico. J Sch health. 2001;71(9):458–61 Pitangui AC, et al. Menstruation disturbances: incidence, characteristics, and effects on the daily activities of adolescent girls residing in Brazil. J Pediatr Adolesc Gynecol. 2013;26(three):148–52 Santina T, Wehbe N, Ziade F. Exploring dysmenorrhea and menstrual reviews among Lebanese lady young people. East Mediterr Health J. 2012;18(8):857–63. Chaudhuri A, Singh A. How do school women cope with dysmenorrhea? J Indian Med Assoc. 2012; 10(5):287–91. Sommer M. Where the training machine and Girls’ bodies collide: The Social and fitness impact of ladies’ stories of menstruation and training in Tanzania. J Adolesc. 2010;33(4):521–9. Patil MS, Angadi MM. Menstrual patterns among adolescent girls in the rural regions of Bijapur. Al Ameen J Med Sci. 2013;6(1):17–20. Rana B, Prajapati A, Sonaliya KN, Shah V, Patel M, Solanki A. Assessment of menstrual hygiene practices among adolescent females in the Kheda district of Gujarat Kingdom, India. Healthline J. 2015;6(1):23–9. Sharma P, et al. Troubles associated with menstruation among adolescent girls. Indian J Pediatr. 2008; seventy-five (2): one hundred twenty-five–9, 65. Juyal R, Kandpal SD, Semwal J. Social elements of menstruation-associated practices in adolescent women in the district Dehradun. Indian J Network Fitness. 2013;25(three):213–6. Haque SE, et al. The impact of a school-based instructional intervention on menstrual health: An intervention examine among adolescent women in Bangladesh. BMJ Open. 2014;4(7):e004607. Bodat S, Ghate MM, Majumdar JR. School absenteeism during menstruation among rural adolescent girls in Pune. Natl J Community Med. 2013; four(2):212–6. Joshi D, Buit G, González-Botero D. Menstrual hygiene control: training and empowerment for women? Waterlines. 2015;34(1): 51–67. Sir Bernard Law et al. Sanitary pad interventions for girls’ schooling in Ghana: A pilot study. PLoS One. 2012;7(10):e48274 Oster E, Thornton R. Menstruation, sanitary products, and school attendance: Evidence from a randomized evaluation. Am Econ J. 2011;3(1):91–100. Mason L, Laserson K, Oruko K et al. Adolescent schoolgirls’ experiences of Menstrual cups and pads in rural western Kenya: A qualitative study. Waterlines. 2015;34(1):15–30. Kabir H, et al. Treatment-seeking for selected reproductive health problems: Behaviors of unmarried female adolescents in two low-performing areas of Bangladesh. Reprod Health. 2014;11:54. Nair MK, et al. Menstrual disorders and menstrual hygiene practices of girls in higher secondary schools. Indian J Pediatr. 2012;79 Suppl 1:S74–8. Baidya S, Debnath M, Das R. Reproductive health problems among rural adolescent girls of the Mohanpur Block of the West Tripura District. Al Ameen J Med Sci. 2014;7(1):78–82. Wong LP, Khoo EM. Dysmenorrhea in a multiethnic population of adolescent Asian girls. Int J Gynaecol Obstet. 2010;108(2):139–42. Poureslami M. Assessing knowledge, attitudes, and behavior of adolescent girls in suburban districts of Tehran about dysmenorrhea and menstrual hygiene. J Int Womens Stud. 2002;3(2):51–61. Eryilmaz G, Ozdemir F. Evaluation of menstrual pain management approaches by Northeastern Anatolian adolescents. Pain Manag Nurs. 2009;10(1):40–7. Wasnik VR, Dhumale D, Jawarkar AK. A study of the menstrual pattern and problems among rural school-going adolescent girls in the Amravati district of Maharashtra, India. Int J Res Med Sci. 2015;33(55):1252–6. Fakhri M, et al. Promoting menstrual health among Persian adolescent girls from a low socioeconomic background: A quasi-experimental study. BMC Public Health. 2012;12:193. Allah ESA, Elsabagh EEM. Impact of a Health education intervention on Knowledge and Practice about Menstruation among female secondary school students in Zagazig City. J Am Sci. 2011;7(9):737–47. Sumpter C, Torondel B. A systematic review of the health and social effects of menstrual hygiene management. PLoS One. 2013;8(4):e62004. Nanda PMA, Mukherjee S, Barua A Mehl GL, Venkatraman CM. A study To evaluate the effectiveness of WHO tools: an orientation program on adolescent health for healthcare providers and adolescent job aid in India. Geneva: International Center for Research on Women, 2012. Vandenhoudt H, et al. Evaluation of a U.S. evidence-based parenting intervention in rural Western Kenya: From parents’ matters! To families matter! AIDS Educ Prev. 2010;22(4):328–43. Sommer M, Ackatia-Armah N, Connolly S, Smiles D. A comparison of menstruation and education experiences of girls in Tanzania, Ghana, Cambodia, and Ethiopia. Compare. 2014;45(4):589–609. Children, S.t. Adolescent Sexual and Reproductive Health. 2015. Available from: http://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.9080949/k.F576/ Adolescent_Sexual_and_Reproductive_Health.htm Health, I.f.R. Meeting the Needs of Adolescents: Introducing CCycle-Smart2013. Available from: http://irh.org/blog/meeting-the-needs-of-adolescents introducing-the cycle smart-kit/ Health, I.f.R. A3 project. Available from: http://irh.org/projects/a3_project/. Accessed 15 Oct 2014. Kettaneh APS, Todesco M. Good policy and practice booklet no. 9: puberty education and menstrual hygiene management. Paris: United Nations Educational, Scientific, and Cultural Organization, 2014. Always. Tips and advice: “The talk.” Available from: http://always.com/en-us/ tips-and-advice/the-talk. Accessed 15 Oct 2014. George R. Celebrating womanhood: How is better menstrual hygiene management the path to better health, dignity, and business? Geneva: Water Supply and Sanitation Collaboration Council, 2013. Sommer M. V. E., Worthington, N., Sahin M. WASH in schools empowers girl’s education: proceedings of the menstrual hygiene management in schools virtual conference 2012. in Menstrual Hygiene Management in Schools Virtual Conference. New York, NY: United Nations Children’s Fund and Columbia University; 2012. Kanotra SK, Bangal VB, Bhavthankar DP. Menstrual Patterns and Problems among adolescent girls in rural areas. International Journal of Biomedical and Advance Research. 2013; 4(8):551–

Abstract Objective: The aim of this study was to investigate the social and environmental factors involved in the food decision-making processes of families living on lower incomes on the Island of Ireland. Design: A qualitative design was employed for this study, using photovoice and creative mapping methods. Parents were requested to take photos and draw maps of their food environments. Interviews were then conducted with parents, using the materials produced by parents as a cue to discuss their food environments, influences and decision-making processes around food choices. Setting: Participants were interviewed online via Microsoft Teams. Participants: Participants were parents or guardians of children between the ages of 2 and 18 who self-defined as ‘living on a tight budget.’ Results: Twenty-eight participants were recruited and interviewed for this study, including 12 parents in Northern Ireland and 16 in the Republic of Ireland. The findings were mapped on to Bronfenbrenner’s Ecological Systems Theory and showed that multiple, overlapping and intersecting factors at the individual, micro-, meso-, exo-, macro- and chrono-system were implicated in family food choices. Upstream factors in particular, including structural, policy and commercial determinants, appear to be significant drivers of behaviour. Conclusions: While the findings suggest that a complex range of factors are involved in family food choices, it is clear that policy measures and regulations are needed to stave off the impacts of rising social inequality and food poverty. Health promoters should strive to find non-stigmatising interventions to bridge the nutritional divide experienced by lower-income families.

Abstract Background The first UK-wide lockdown to prevent the spread of COVID-19 had a serious financial impact on low-income households, a population already in higher risk of food insecurity and poor dietary choices. Qualitative data on the impact of COVID-19 lockdown on food decisions of UK families are scarce. This study aimed to explore how the measures to control the spread of COVID-19 influenced the food-related decisions of socioeconomically deprived families in Northern Ireland. Methods A qualitative study captured data from online individual interviews. Participation was open for parents of children 2–17 years old 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 parents of younger children (<12y) and adolescents (≥12y). Data were collected by using the methods of Photovoice and mapping exercise. Data were analysed through a thematic approach. Results Twelve online interviews were conducted and five distinct themes were identified 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. Conclusions The restrictions put in place to inhibit the spread of COVID-19 influenced all aspects of dietary decisions of low-income families. Changes observed during this period included frequent consumption of homemade meals, but also increased unhealthy snacking. Infrequent food shopping encouraged good meal planning, but was also a barrier to securing adequate fresh food. Food-related support including school meal assistance contributed to families’ food security, particularly those of single parents.

AbstractFood portion sizes routinely consumed by children have increased over time and consumption of larger portion sizes is associated with higher weight status. Parents often have the critical role of deciding portion sizes of foods to serve their children. It is not well understood, however, how parents decide the amount of food to serve. This research aimed to investigate parental views on portion sizes of foods and beverages served to children.A purposive sample of preschools and primary schools geographically located in either urban or rural areas of Northern Ireland and the Republic of Ireland, and classified as either high or low deprivation were recruited. Selected schools were invited to facilitate this research. Parents with at least one child aged 2–12 years attending a recruited school were then invited to participate in a focus group. A maximum of three groups were scheduled with interested parents at each school. One researcher moderated the focus groups, assisted by another researcher in all groups where possible. A semi-structured discussion guide was followed, using probes to stimulate discussion. The guide explored practices in portioning foods and beverages for children, factors influencing portioning and views on portion sizes of foods and beverages served to children. Discussions were audio-recorded, transcribed verbatim and data was analysed thematically. Nvivo software was used to manage the coded data.Focus groups (n = 24) ranging in size from 3–12 parents were conducted across 19 schools. The response rate from parents at recruited schools ranged from 1–16%. A total of 144 parents (86% female, mean age 46y) participated, of which 60% had a child attending a high deprivation school and 64% had a child attending a rural school. Factors influencing parental portioning included seven themes comprised of sub-themes: parent knowledge (portion size knowledge, serving a learned amount), parent motivations (ensure child is fed, encourage healthier food), child-related factors (appetite, body size, food preferences, eating patterns), family influence (spouses and grandparents serving), food retail and other settings (restaurants, takeaways, special occasions), socio-cultural influences (parent childhood experiences, parents’ portion size norms) and portioning resources used (serve ware, utensils, hand sizes).Parents’ main concern regarding the amount they feed their children was to ensure that they are fed a sufficient amount to feel full. Parents learned this amount through experience and felt it was specific to each child's appetite. These findings will inform future interventions and information campaigns to help parents understand child portion sizes.

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Department for the Economy, Northern Ireland Background Family-based eHealth interventions have potential to reduce cardiovascular disease (CVD) risk and improve health of parents and children. Purpose To evaluate the effectiveness of family-based eHealth interventions to reduce parent and child CVD risk. Methods Systematic review. Five electronic databases were searched (CENTRAL; MEDLINE; CINAHL; EMBASE; PsycINFO) up to April 2020. Data extraction included: study design, setting, methodology, eHealth technology, experiment/control group constituents, risk factors, outcomes, incentivisation and limitations. Data were synthesised narratively. Cochrane methodology was used to assess risk of bias and reporting quality. Results In total, 2193 articles were screened and seven trials included for review. The most consistently improved CVD risk factor across parents and children was reduced alcohol use, whilst reduction in BMI the least consistently improved. Behaviour-change theoretical underpinning, extended follow-up duration, interactivity and incentivisation were identified as effective components of these interventions. Four studies were assessed as overall ‘low risk’ of bias and three studies had concerns with randomisation and intention-to-treat analysis. Conclusions: This is the first systematic review to evaluate family-based eHealth interventions to reduce CVD risk. Despite a paucity in high-quality trials, there is evidence of their potential effectiveness. Recommended, more high quality, behaviour-change-theory-based, clearly reported interventions with explicit outcomes.

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Department for the Economy, Northern Ireland Introduction Controllable cardiovascular disease (CVD) risk factors are often initiated in the family home, yet risk reduction is seldom targeted toward families. Participatory design of eHealth interventions with end-users has potential to increase acceptability and adherence of such interventions. Despite their shared risk of developing CVD, few eHealth interventions target both parents and children at CVD risk. Therein lies an evidence gap; the need for coproduction of a family-based eHealth intervention aimed at early CVD prevention. Purpose The aim of this study was to identify the perceptions of families towards the design, functionality and acceptability of an eHealth, family-based, CVD prevention intervention. Methods Thee online focus groups comprising six families were conducted between April and May 2021. Families consisted of at least one parent who met CVD risk factor criteria, and at least one child aged five to 17 years. Content analysis and narrative synthesis were used to identify categories and subcategories regarding development of and engagement with the proposed intervention. Additionally, quantitative, and demographic measures were used to determine psychosocial and health profiles. Results Three categories were identified from the focus groups: 1) previous experiences of using health-related apps or devices 2) expectations of a newly developed eHealth family-based CVD prevention intervention 3) motivators for engagement with the intervention Goal setting, rewards, accountability, adaptability, recording achievements and competition were considered crucial motivators for engagement for both parents and children. Participants welcomed the intervention, and advised they would prefer a free, personalised, easy-to-use, non-time-consuming intervention, with multiple content formats, and additional information available should they seek to access it. Parents conveyed satisfactory general self-efficacy and quality of life, low anxiety and depression and high perceived social support. Conclusions Overall, families were constructive and forthcoming towards the idea of an eHealth, family-based CVD prevention intervention. These findings informed a prototype of a family-based eHealth intervention aimed at early CVD prevention. The prototype is currently being developed with plans for piloting via a randomised controlled trial in the home environment, by families as an early intervention for the prevention of CVD.

Abstract Background Healthy Start (HS) is a government scheme in England, Wales and Northern Ireland that offers a financial payment card and free vitamins to families experiencing low income. Pregnant women and families with children < 4 years can use the HS card to buy fruit, vegetables, cow’s milk, infant formula and pulses. HS was fully digitalised in March 2022. While digitalisation has improved the user experience for many families, in the context of the cost-of-living crisis and increasing dietary inequalities, it is important to understand why HS is not reaching more families. This study aimed to (i) assess the perceptions and experiences of HS from stakeholders across the system including those who promote, implement and are eligible for HS, and (ii) identify recommendations to improve the scheme’s effectiveness and uptake. Methods The study design was a post-implementation rapid qualitative evaluation using stakeholder interviews. Data were collected between January and June 2023 via semi‐structured interviews (50% online; 50% in person) with 112 stakeholders, including parents (n = 59), non‐government organisations (n = 13), retailers (n = 11) and health and community professionals (n = 29) at national and local levels. Findings were confirmed by a sub-sample of participants. Results Six core themes cut across stakeholders’ perceptions and experiences, and stakeholders collectively outlined seven recommendations they felt could be acted upon to maximise uptake and efficiency of HS, with actions at both national and local levels. A novel finding from this study is that raising awareness about HS alone is unlikely to result automatically or universally in higher uptake rate. Recommendations include: continuing to provide this scheme that is universally valued; the need for many families to be provided with a helping hand to successfully complete the application; reframing of the scheme as a child’s right to food and development to ensure inclusivity; improved leadership, coordination and accountability at both national and local levels. Conclusions HS provides benefits for child development and family wellbeing. The study’s recommendations should be actioned by national and local governments to enable all families eligible for the scheme to benefit from this nutritional safety net.

In today's society there is evidence of a culture of the 'empowered consumer' -- an image of the consumer as a citizen rather than a subordinate. In fact, human rights language is increasingly coming to the fore in the consumption debate. The consumer has been allocated rights by the United Nations whereby all human beings are born free and equal and have civil, political, economic and social rights (McGregor 44). However, as citizens we also have responsibilities of an environmental and social concern. Food retailing and equality of shopping provision is one such concern. Food is a basic right. According to the Universal Declaration of Human Rights everyone has a fundamental right to be free from hunger and have access to safe and nutritious food. Social exclusion refers to those in the population who are unable to participate in economic, political, social and cultural life. Social exclusion is different from, but related to, poverty since it further marginalises the most disadvantaged -- for example, those who cannot access a large supermarket. In keeping with the rights/responsibilities language, the consumer has a basic right to food and the retailer has the social responsibility to supply the needs of the consumer. It is in this respect that food is an ethical issue and has social justice implications. Inability to consume, or have access to, sufficient food of nutritional quality is a global concern. In North America the issue is one of 'food insecurity' or 'food poverty' due to inadequate finance to purchase sufficient food. In the United Kingdom the same problem arises within the context of access to food stores. This is identified as a 'food (shopping) desert', where due to restricted access social exclusion can arise. The term 'food deserts' was first used by the Low Income Project Team of the Nutrition Task Force in 1996 and was succinctly defined by Tessa Jowell (Government Health Minister) in 1997 when she stated that a food desert was an area "where people do not have easy access to healthy, fresh foods particularly if they are poor and have limited mobility". The term 'food desert' is an emotive one referring to a unique tool of social polarisation and exclusion (Lang 5). The issues compounding the problem include low income, locational policy of supermarkets with the acquisition of edge-of-town / out-of-town sites, consumer mobility, car ownership levels and food availability. This research study focuses on Northern Ireland -- a region of the UK on the periphery of Europe. The Province of Northern Ireland (Ulster) is a sparsely populated (122 people per km²), predominantly rural area with the highest unemployment and poverty statistics in the United Kingdom. Similarly, Northern Ireland has a proportionately high degree of non-car ownership (35%) which further complicates the equation since shopping is increasingly becoming a car-borne activity necessitating transportation to edge-of-town superstores. Those not able to avail themselves of large edge-of-town superstores are being socially excluded, since inner-city areas are becoming denuded of food stores. Those that do exist usually have a limited range of food items, usually non-perishable, or are specialist shops stocking high priced items. It is the aim of the study to identify the characteristics, extent and location of food deserts in both rural and urban areas of Northern Ireland. It is a particularly apt time to do so since Northern Ireland is experiencing a 'retail revolution' with the arrival of the major UK grocery multiples and subsequent situational policies to locate off-centre. Similarly, there are plans to curtail out-of-town developments which has been viewed by some smaller retailers as "too little, too late". With the above in mind, it is a timely study for Northern Ireland. Multiple research tools of both a qualitative and a quantitative nature have been employed including consumer focus groups, shopping diaries, comparative shopping exercises, consumer questionnaires and retail interviews. This will enable sufficient validation of results. The focus groups provide qualitative depth (Colquhoun 39) and serve to highlight the issues of shopping inequality from the point of view of different consumer groups which could be identified as potentially vulnerable in the food poverty stakes; the elderly, the disabled, the unemployed or low income families, lone-parent families and females in general; to whom falls the responsibility for provisioning the household, organising the kitchen and doing the household's cooking (Murcott 11). Basically, food is gendered -- women are mainly in charge (Vaines 13). The respondents in this study demonstrate exactly that point since 77% of the sample were female and reported that they were responsible for household shopping. This point is particularly prevalent with regard to access to cars. In fact over 50% of women in 1991-1993 either lived in households without a car or were non-drivers in a household with a car. Similarly, although there is a rising proportion of women who work they still do most of the shopping and spend twice as much time as men provisioning the household (Piachaud & Webb 18). Ultimately, anything that affects the purchaser also affects the purchasing experience -- in this case physical access to the foodstore. Comparative shopping exercises illustrate the availability and price indices of food and reiterate the price differences between the smaller independents, the local corner shops and the supermarkets. Initial research using the British Ministry of Agriculture, Fisheries and Food's "Low Cost, Healthy Diet" (Leather 75) provides evidence of a cost differential of £1.41, or a 26% cost penalty by shopping at a corner store rather than a superstore. Availability among corner shops similarly compared unfavourably with the supermarkets, with the smallest stores offering minimal fresh fruit and vegetables and regularly offering no 'economy' branded equivalent to an established manufacturer's brand. This supports previous research which found that in areas where small shops do exist they offer only a limited overpriced range of processed foods (Elliott 5), and it is generally accepted that those who can shop at supermarkets can generally benefit from lower prices and more choice (Piachaud & Webb 32). The benefits of supermarkets are not therefore available to all. Shopping diaries further illustrate this point with the dichotomy existing where the lower-income consumer shops more frequently and locally than does her higher-income counterpart and it is these same consumers who patronise the smaller, often more expensive corner shop. Many consumers like the convenience of large supermarkets where they have access to a vast range of items and do not mind paying premium prices on some items for this convenience. Supermarkets do not offer low prices on all items, but do stock economy lines as well as premium priced items. The consumer questionnaire provides some quantitative analysis and statistical weight to the data and was analysed using the χ-square test on SPSS for Windows Version 8. With the χ-square test the important detail is the significance level (reported as a p-value). A p-value of less than 0.05 indicates that the two groups are significantly different at a confidence level of 95% -- in other words, it can be concluded that the author is 95% certain that the result is statistically significant and free from error. Four areas of the Province were sampled -- two rural and two urban. The sample was 77% female and the median age group fell between 45 to 54 years. The social class status was skewed towards the lower socio-economic classes and only 12% fell into social classes A or B. The mean household income was £151 to £200 per week. The survey was interviewer-assisted and pointed to some interesting correlations between levels of satisfaction with store location and distance travelled, product choice and the decision to continue shopping in the town centre. Thirty percent of the sample stated that they shop at off-centre complexes and 70% of the sampled households shop in the town centre or closer to home. This sample also provides evidence that shopping is largely a car-borne activity with 58% of the sample using the family car. Journey distance is significantly influenced by degree of satisfaction with locality: p<0.01 and is supported with the evidence that 64% of the respondents stated that they shop less than fifteen minutes from home. Similar relationships exist between reported satisfaction with locality and differing degrees of satisfaction for product choice: p<0.01. A significant bias similarly exists between those who continue to shop in the town centre after the advent of the UK multiples into Northern Ireland in 1996 and those who do not: p<0.05 with a bias towards those continuing to shop in the town centre reporting high satisfaction levels. Ultimately, perceived adequacy of shopping provision influences satisfaction with store locality: p<0.05. Although the majority of respondents' weekly shopping is conducted at a multiple there is still an identified need for the local corner shops and independents since approximately 29% of respondents buy essentials like bread, milk and other basic grocery provision there. In fact, 98% of those surveyed reported that every town centre should have a food store, and 82% noticed a reduction in the number of food stores locally in recent years. In a concluding open question in the survey attitudes towards off-centre supermarkets were gauged. Responses ranged from positive in nature ("better parking facilities") to indifferent ("I never bother with them") to negative ("they [out-of-town supermarkets] only suit people with cars" and "they hurt the small shopkeeper"). From a retail management point of view, the multiple stores perceive (or want the consumer to believe) that they have a "social responsibility" but suggest that it should be a coalition between retailers and councillors to rejuvenate the town centres and it is not their sole responsibility. The corner shops argue their business position has survived but allude to the fact that the migration to out-of-town sites by the supermarkets has "created a void in the town centre". The issue is complex. While it is true that the multiples have brought shoppers a number of benefits -- price, choice and quality -- they have also both directly (siting shops outside town centres and in high income areas) and indirectly (undermining the economies of small, local outlets) increased costs on disadvantaged consumers in terms of time, physical effort and transport. This has led to a degree of social exclusion amongst certain consumer groups, although this was not quantitatively expressed as significant via the medium of the questionnaire in this preliminary study. It should be remembered that food and mealtimes are imbued with social and cultural meaning (Lang 27) and that "food is a vehicle for social control" (7). In fact food desertification has been likened to the "food equivalent of disconnecting the water supply" (27) and initiatives should be considered to alleviate food poverty and rejuvenate town centres throughout the Province. A multidisciplinary approach is necessary with input from retailers, councillors, health promotion personnel and education bodies to bring about a policy to eradicate this form of social exclusion and disadvantage. References Colquhoun, A. "Food Retailing in Transition: Memories of Traditional Grocer Shops in the 1950s." Strugnell and Armstrong. Elliott, V. "Food Deserts Threaten Health of Poor and Old." Sunday Times 5 Nov. 1997: 5. Lang, T. "Running On Empty." Demos Collection 12 (1997). 25-7. ---. "Food Education and the Citizen: Whose Responsibility?" Strugnell and Armstrong 7. Leather, S. "Less Money, Less Choice: Poverty and Diet in the United Kingdom Today". Your Food: Whose Choice? Ed. National Consumer Council. London: HMSO, 1992. 72-94. McGregor, S. "Globalising Consumer Education: Shifting from Individual Consumer Rights to Collective Human Responsibilities." Strugnell and Armstrong 43-52. Murcott, A. "Is It Still a Pleasure to Cook for Him? Social Changes in the Household and the Family." Strugnell and Armstrong 11. Piachaud, D. and J. Webb. The Price of Food: Missing Out on Mass Consumption." London: London School of Economics and Political Science, 1996. 32. Strugnell, C. J. "Food Deserts: Fact or Fiction." Nutrition and Food Science 6. MCB UP. 349-50. Strugnell, C.J. and G. A. Armstrong, eds. Consumer Education: An International Dimension. Conference Proceedings of the XIXth International Consumer Studies and Home Economics Research Conference. Belfast: University of Ulster, 1999. Vaines, E. "The Sacred Nature of Food: A Family Perspective" Strugnell and Armstrong 13. Citation reference for this article MLA style: Sinead Furey, Heather McIlveen, Christopher Strugnell. "Food Deserts: An Issue of Social Justice." M/C: A Journal of Media and Culture 2.7 (1999). [your date of access] <http://www.uq.edu.au/mc/9910/deserts.php>. Chicago style: Sinead Furey, Heather McIlveen, Christopher Strugnell, "Food Deserts: An Issue of Social Justice," M/C: A Journal of Media and Culture 2, no. 7 (1999), <http://www.uq.edu.au/mc/9910/deserts.php> ([your date of access]). APA style: Sinead Furey, Heather McIlveen, Christopher Strugnell. (1999) Food deserts: an issue of social justice. M/C: A Journal of Media and Culture 2(7). <http://www.uq.edu.au/mc/9910/deserts.php> ([your date of access]).

Abstract Background Recruitment into clinical trials is challenging and there is a lack of evidence on effective recruitment strategies. Personalisation of invitation letters is a potentially pragmatic and feasible way of increasing recruitment rates at a low-cost. However, there is a lack of evidence concerning the effect of personalising of study invitation letters on recruitment rates. Methods We undertook a Study Within A Trial (SWAT) to investigate the effect of personalised versus non-personalised study invitation letters on recruitment rates into the host feasibility trial ENGAGE, a feasibility study of an internet-administered, guided, Low Intensity Cognitive-Behavioural Therapy based self-help intervention for parents of children previously treated for cancer. An intervention group (n = 254) received a personalised study invitation letter and the control group (n = 255) received a non-personalised study invitation letter. The primary outcome was the proportion of participants in the intervention group and the control group enrolled into the ENGAGE host feasibility trial. Secondary outcomes relating to the recruitment and screening process, and retention were examined. Differences in proportions between groups for the primary and secondary outcomes were estimated using logistic regression. Results Of the 509 potential participants, 56 (11.0%) were enrolled into the ENGAGE host feasibility trial: personalised: 30/254 (11.8%) and non-personalised: 26/255 (10.2%). No statistically significant effect on personalisation of enrolment was found (OR 1.18, 95% CI 0.68–2.06). No statistically significant differences were found for any secondary outcome. Conclusions Personalisation of study invitations had no effect on recruitment. However, given the small study sample size in the present SWAT, and lack of similar embedded recruitment RCTs to enable a meta-analysis, additional SWATs to examine the personalisation of study invitation letters are warranted. Trial registration ISRCTN57233429; ISRCTN18404129; SWAT 112, Northern Ireland Hub for Trials Methodology Research SWAT repository (2018 OCT 1 1231) (https://www.qub.ac.uk/sites/TheNorthernIrelandNetworkforTrialsMethodologyResearch/FileStore/Filetoupload,939618,en.pdf).

Understanding factors influencing parents' involvement in education activities is essential in tailoring strategies to encourage and maximize their participation. This study assessed predictors of parental home involvement in low-income families in four regions of Northern Tanzania. The questionnaires assessed 1176 parents of grade two children from 55 primary schools invited to teacher-parent meetings. The hierarchical multiple regression analyses showed that parents' perception of general school invitation, specific teacher invitation, specific child invitation, parents' knowledge and skills, parents' level of education, and marriage conditions were the strongest predictors of parental home involvement. However, parents' past school experience (valence) did not predict their present involvement at home. This study underscores the pivotal role of teachers and schools in instigating and fostering parental involvement at home. Teachers can create a collaborative learning environment beyond the classroom by implementing activities designed to arouse parents' interest and stimulate their desire to participate actively in their children's learning. The study recommends the interconnectedness of the educational ecosystem, where the efforts of schools and teachers serve as catalysts for meaningful parental involvement at home.

Background The information provided to potential trial participants plays a crucial role in their decision-making. Printed participant information sheets for trials have received recurrent criticism as being too long and technical, unappealing and hard to navigate. An alternative is to provide information through multimedia (text, animations, video, audio, diagrams and photos). However, there is limited evidence on the effects of multimedia participant information on research recruitment rates, particularly in children and young people. Objectives The study objectives were as follows: to develop template multimedia information resources through participatory design, for use when recruiting children and young people to trials to evaluate the multimedia information resources in a series of Studies Within A Trial, to test their effects on recruitment and retention rates, and participant decision-making, by comparing the provision of multimedia information resources instead of printed participant information sheets, and comparing the provision of multimedia information resources in addition to printed participant information sheets. Design Two-phase study: multimedia information resources development including qualitative study; user testing study; readability metrics; enhanced patient and public involvement multimedia information resources’ evaluation comprising Studies Within A Trial undertaken within host trials recruiting children and young people. Setting United Kingdom trials involving patients aged under 18. Participants Development phase: n = 120 (children and young people, parents, clinicians, trial personnel). Evaluation phase: n = 1906 (children and young people being asked to take part in trials). Interventions Multimedia information resources (comprising text, audio, ‘talking heads’ video, trial-specific and trial-generic animations). Printed participant information sheets. Main outcome measures Primary outcome: trial recruitment rate comparing multimedia information resource-only with printed participant information sheet-only provision. Secondary outcomes: trial recruitment rate comparing combined multimedia information resource and printed participant information sheet with printed participant information sheet-only provision; trial retention rate; quality of participant decision-making. Results for each trial were calculated and combined in a two-stage random-effects meta-analysis. Results Phase 1 generated two multimedia information resource templates: (1) for children aged 6–11 years; (2) for children aged 12–18 years and parents. In the Phase 2 Studies Within A Trial the multimedia information resources improved trial recruitment, when compared to printed information alone [odds ratio (OR) = 1.54; 95% confidence interval (CI) 1.05 to 2.28; p = 0.03; I2 = 0%]. When printed participant information sheet-only provision was compared to combined multimedia information resource and printed participant information sheet provision, there was no effect on trial recruitment (OR = 0.89; 95% CI 0.53 to 1.50; I2 = 0%). There were no differences between multimedia information resource and printed participant information sheet on trial retention or participant decision-making quality. In a study within a hypothetical trial setting, multimedia information resource-only provision produced higher ratings of ‘information was easy to understand’ (Z = 3.03; p = 0.003) and ‘I had confidence in decision-making’ (Z = 2.00; p = 0.044) than printed participant information sheet-only provision. Limitations It was not possible to include data from three Studies Within A Trial in the meta-analysis due to limited sample size, and questionnaire return rates were low, which reduced the strength of the findings. Conclusions Use of multimedia information increased the rate of recruitment to trials involving children and young people compared to standard patient information sheets. Future work There should be further evaluation of the effects of multimedia information on recruitment to trials involving children and young people. It would be valuable to assess any impacts of multimedia information resources on communication between trial recruiters, children and young people, and parents. Study registration This trial is registered as TRECA ISRCTN 73136092 and Northern Ireland Hub for Trials Methodology Research SWAT Repository (SWAT 97). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 14/21/21) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 24. See the NIHR Funding and Awards website for further award information.

AbstractBetween 2022 and 2024, there was no devolved government functioning in Northern Ireland. This protracted absence of government occurred in the aftermath of the Covid‐19 pandemic and during what is arguably the worst economic crisis of recent years. Women are more vulnerable to hardship during economic crisis and thus it is unsurprising that the Cost‐of‐Living Crisis is hitting women hardest. This paper examines increasing food insecurity for women in Northern Ireland and the implications for the realisation of their human right to an adequate standard of living. The UK Government has ratified the International Covenant on Economic, Social and Cultural Rights, which provides a legal duty to ensure that everyone has adequate access to food. However, increasing numbers of food banks and ill health related to insufficient food intake indicates that there is a fundamental problem. This article draws on 20 focus groups with 250 women on a low‐income to explore their experiences of the Cost‐of‐Living Crisis in Northern Ireland. The research found that women routinely skipped meals; described feelings of shame and guilt associated with struggling to feed their children; and discussed difficulties associated with purchasing food. Much of the pain associated with the hunger experienced by these women and children is hidden within the private sphere of the home. This article intends to shine a light on women's experiences and will reflect on the necessary policy change required to ensure compliance with international human rights obligations.