Growing up in Scotland: parenting and children's health

CHAPTER 1 INTRODUCTION

1.1 Background

There is mounting evidence that parenting is associated with child and adolescent physical and emotional health (Repetti et al. 2002). Various aspects of parenting may be involved. A review for the World Health Organization has suggested connection (love), behavioural control, respect for individuality, modelling of appropriate behaviour and provision of resources as five essential dimensions of parenting for health (World Health Organization 2007). Estimates of the extent to which parenting is responsible for individual variation in children's health vary, depending on which dimension of parenting is considered and its relevance for a particular health outcome (McLeod et al. 2007a; McLeod et al. 2007b).

Parenting is socially patterned - that is, parents with different socio-economic characteristics approach their parenting role in different ways - and this may explain some of the inequalities in health outcomes that are found between different socio-economic groups (Conger et al. 1992; Dodge et al. 1994; Belsky et al. 2007; Conger and Donnellan 2007).

1.2 Policy relevance

The wellbeing of individual children and young people is the first value and principle stated in the Scottish Government's programme initiated in 2008, Getting it Right for Every Child. This builds on the issue of health inequalities highlighted in the Scottish Government report Equally Well (Scottish Government 2008, page 3), which stressed the need to address the "inter-generational factors that risk perpetuating Scotland's health inequalities from parent to child, particularly by supporting the best possible start in life for all children in Scotland".

Parents play a vital role in their children's health and wellbeing. The Scottish Government's 2005 report on Health For All Children refers to the importance of a child's caregivers, in providing "good basic care, stimulation and emotional warmth, guidance and boundaries, safety and stability". ¹ With a clear reference to possible inequalities in parenting, it adds: "It is important to establish a picture of the ability of parents and caregivers to understand and meet the needs of their child. Family circumstances can have a significant impact on the ability and confidence of parents and caregivers to look after their child and encourage their progress and development" (Scottish Executive 2005, page 45).

There are similar policy concerns in England and Wales, with the Healthy Child Programme for the under fives now extended from age 5 to age 19 years, and recognition of the important role played by parenting: "The parent-child relationship is vital to children's development, learning, achievement and wider wellbeing. Poor parenting is a risk factor for mental health problems while good parent-child relationships reduce the risk of children adopting unhealthy lifestyles, such as smoking" (Department of Health/Department for Children 2009, page 30).

Research evidence in this area will inform policy directed at reducing health inequalities by interventions that promote support for parents and effective parenting.

1.3 Other UK cohort studies

Much research on parenting comes from the US, although the UK can begin to draw on evidence gathered from recent UK cohort studies. The ALSPAC and Millennium Cohort Studies have found associations between parenting and children's physical and mental health (Waylen et al. 2008; Lexmond and Reeves 2009), and support for the hypothesis that parenting is one way in which family socio-economic status ( SES) impacts on children's mental health (Kiernan and Huerta 2008). Data from the Millennium Cohort Study has been used to undertake an extensive exploration of which factors at age 3 predict a child's development and health at age 5 (Hobcraft and Kiernan 2010). While this research is restricted to two health outcomes (social, emotional and behavioural difficulties, and general health) and uses only the sample of children surveyed in England, it includes parenting behaviours at age 3 as predictor variables. As such, results are compared with this report's findings in Chapter 4.

1.4 Growing Up in Scotland

This report is based on analysis of the first five sweeps (2005/06 to 2009/10) of the Growing Up in Scotland study ( GUS). Growing Up in Scotland ( GUS) has collected measures of parenting at each interview, but so far there has been no comprehensive examination of associations between different components of parenting and child health and health behaviours. GUS research findings to date have accumulated evidence of socio-economic inequalities in child health and health behaviours, together with some evidence that parenting varies by socio-economic status, for example in relation to diet and exercise at sweep 3 (Marryat et al. 2009). The sweep 4 analysis of inequalities in health (Bromley and Cunningham-Burley, 2010) did not examine whether parenting helped to account for inequalities found across the whole sample. Its analysis of resilience among children in the most deprived groups suggested that some aspects of parenting (related to home learning environment) were important for avoiding negative outcomes in these groups.

1.5 Aims and scope of this report

This report has two aims. The first aim is to explore which aspects of parenting may be important for child health and health behaviours. The second is to investigate the extent to which variation in parenting practices may help to account for inequalities in child health and health behaviours associated with family adversity.

This study focuses on aspects of parenting that may be considered as 'generic' or 'day-to-day' in nature, pertaining to the overall quality of the parent-child relationship and parental control. It does not consider parenting that is likely to be associated only with specific health outcomes (such as parental control of diet, or parental modelling of physical exercise), although some parenting items that relate to specific behaviours have been used as part of more general measures.

The child's main carer interviewed in the Growing Up in Scotland study was almost always the child's mother. This study is restricted to 3,486 cases where the child's natural mother has provided information at all five sweeps, ensuring that information on the child's health and parenting was always given by the same respondent. However, this means that the study is essentially about mothering rather than fathering.

Associations between parenting and health are explored before and after adjustment for socio-demographics, family poverty and maternal depression, in order to see whether parenting may have effects over and above these other known influences on child health and health behaviours.

The study then investigates associations between an index of family adversity and health. This index is based on socio-demographics, family poverty and maternal depression. We explore whether inequalities in child health and health behaviours linked to family adversity are reduced when we account for variation in parenting behaviour. This would suggest that some of the variations in child health and health behaviours across children with different levels of family adversity are in fact explained by differences in the parenting behaviours they experience.

The analysis in this report uses information from families in the birth cohort that took part in all of the first five sweeps of GUS. Some families who initially took part in GUS did not do so for all of the subsequent sweeps. All of the statistics have been weighted by a specially constructed weight to adjust for non-response and sample selection. Both weighted and unweighted sample sizes are given in each table. Standard errors have been adjusted to take account of the cluster sampling. ²

1.6 Technical Appendix

Readers interested in the details of the analyses should consult the Technical Appendix published alongside this report.