66 research outputs found
Associations between newborn thyroid-stimulating hormone concentration and neurodevelopment and growth of children at 18 months
No full textThe study aimed to assess the associations between newborn thyroid stimulating hormone concentration (TSH), a marker of iodine nutrition in early life, and childhood neurodevelopment and growth using data collected from two pregnancy studies, one in a borderline iodine deficient setting (DOMInO Study) and one in an iodine sufficient setting (PINK Study). TSH data were obtained from routine newborn screening. Neurodevelopment was assessed at 18 months using the Bayley Scales of Infant and Toddler Development third edition (Bayley-III). Weight, height and head circumference were measured at 18 months. In total, 1467 children were included in the analysis. Comparing the highest with the lowest TSH quartile, the Mean Differences (MDs) in the Bayley-III scores ranged from -2.0 (95% CI: -4.7, 0.7) to -2.2 (95% CI: -5.8, 1.3) points in DOMInO and 1.0 (95% CI: -1.6, 3.6) to 2.0 (95% CI: -0.4, 4.4) points in PINK in the cognitive, language and motor scales; the MDs in the anthropometric z scores ranged from -0.01 (95% CI: -0.5, 0.5) to -0.5 (95% CI: -0.9, -0.1) in both studies. A 1 mIU/L increase in TSH was associated with -0.3 (95% CI: -0.9, 0.2) point and 0.2 (95% CI: -0.3, 0.7) point changes in the mean cognitive score in the DOMInO and PINK, respectively. A null association between TSH and growth was also observed in both studies. Longitudinal studies that utilize newborn TSH data and examine neurodevelopmental outcomes at later ages are warranted, as neurodevelopmental assessments in older children are more predictive of later achievement.Molla Mesele Wassie, Lisa Gaye Smithers, Lisa Nicole Yelland, Maria Makrides and Shao Jia Zho
Prevalence and characteristics of overweight and obesity in indigenous Australian children: a systematic review
No full textAccepted author version posted online: 17 Jun 2015Evidence-based profiling of obesity and overweight in Indigenous Australian children has been poor. This study systematically reviewed evidence of the prevalence and patterns of obesity/overweight, with respect to gender, age, remoteness and birth weight, in Indigenous Australian children, 0-18 years (PROSPERO CRD42014007626). Study quality and risk of bias were assessed. 25 publications (21 studies) met inclusion criteria, with large variations in prevalence for obesity or overweight (11% to 54%) reported. A high degree of heterogeneity in study design was observed, few studies (6/21) were representative of the target population, and few appropriately recruited Indigenous children (8/21). Variability in study design, conduct and small sample sizes mean that it is not possible to derive a single estimate for prevalence although two highquality studies indicate at least one in four Indigenous Australian children are overweight or obese. Four of six studies reporting on gender, found overweight/obesity higher in girls and eight studies reporting on overweight/obesity by age suggest prevalence increases with age with one high quality large national study reporting total overweight/obesity as 22.4% of children aged 2-4 years, 27.5% of those aged 5-9, 38.5% aged 10-14 and 36.3% aged 15-17. Three of four studies, reporting obesity/overweight by region, found lower rates for children living in more remote areas than urban areas.Suzanne Marie Dyer, Judith Streak Gomersall, Lisa Gaye Smithers, Carol Davy, Dylan T Coleman, Jackie Mary Stree
Psychological Network of Stress, Coping and Social Support in an Aboriginal Population
No full textOver the past decades, increasing research interest has been directed towards the psychosocial factors that impact Aboriginal health, including stress, coping and social support. However, there has been no study that examined whether the behaviours, cognitions and emotions related to stress, coping and social support constitute a psychological network in an Aboriginal population and that examined its properties. To address this gap, the current study employed a new methodology, network psychometrics, to evaluate stress, coping and social support in an Aboriginal Australian population. This study conducted a secondary analysis of the South Australian Aboriginal Birth Cohort (SAABC) study, a randomised controlled trial in South Australia, which included 367 pregnant Aboriginal women at study baseline. The Gaussian Graphical Model was estimated with least absolute shrinkage and selection operator (LASSO). Node centrality was evaluated with eigencentrality, strength and bridge centrality. Network communities were investigated with the walktrap algorithm. The findings indicated that stress, coping and social support constituted a connected psychological network in an Aboriginal population. Furthermore, at the centre of the network were the troubles experienced by the Aboriginal pregnant women, bridging their perceptions of stress and coping and constituting a potential target for future interventions.Pedro Henrique Ribeiro Santiago, Gustavo Hermes Soares, Lisa Gaye Smithers, Rachel Roberts, and Lisa Jamieso
Safety and efficacy of high dose docosahexaenoic acid for the preterm infant.
No full textThere has been substantial research demonstrating improvements in visual and cognitive performance of preterm infants after feeding formulas containing n-3 long chain polyunsaturated fatty acid (LCPUFA). The amount of docosahexaenoic acid (DHA) estimated to be accrued by the fetus in the last trimester of gestation is greater than that supplied in current preterm formulas and breast milk of average DHA content (~0.3% of total fat in Western women). Yet many trials have compared infants fed formula containing concentrations near 0.3% DHA with infants fed formula containing no LCPUFA. No research has addressed whether the average breast milk DHA milk results in optimal development of preterm infants. The focus of this thesis was to compare the efficacy and safety of supplementing preterm infants with milk containing docosahexaenoic acid (DHA) at concentrations that meet the estimated in utero accretion rate (~1%) compared with current clinical practices (~0.3%).
In a double-blind, randomised controlled trial (RCT), infants born <33 weeks gestation were assigned to receive milk containing one of two doses of DHA. Treatment group infants received milk containing high dose DHA (1%) and infants in the control group infants received milk containing standard levels DHA (0.2 - 0.35%). Lactating mothers consumed capsules containing either tuna oil (900mg DHA) or soy oil (no DHA) that resulted in breast milk with either a high or typical concentration of DHA. Standard preterm formula milk with a corresponding DHA composition was fed to infants if formula feeds were required. The intervention period was from five days of commencing enteral feeds through to the infants estimated due date (EDD). Primary efficacy assessment was sweep visual evoked potential (VEP) acuity at 4 months corrected age (CA). Secondary efficacy outcomes included VEP acuity at 2 months CA and VEP latency at 2 and 4 months CA. Infant anthropometry was assessed regularly throughout the trial and the primary safety outcome was weight at 4 months CA. Other clinical safety data including incidence and severity of diseases commonly associated with prematurity were also assessed.
The success of the intervention was demonstrated with infants in the treatment group having a significantly higher level of erythrocyte membrane DHA at EDD compared with the control group (% total erythrocyte phospholipids (mean ± SD), treatment group 6.8 ±1.2, control group 5.2 ± 0.7, p<0.0005). The primary efficacy outcome of acuity at 4 months CA was significantly higher in the treatment compared with the control group infants (mean ± SD acuity (in cpd) treatment group 9.6 ± 3.7, control group 8.2 ± 1.8, p = 0.025).
No significant differences were found in acuity at 2 months CA or latency at 2 or 4 months CA between infants in the control and treatment groups. No significant differences in weight, length or head circumference were found between treatment compared with control infants at EDD or at 4 months CA. Nor were any differences found in other clinical outcomes commonly associated with prematurity including, tolerance, necrotising enterocolitis, sepsis, retinopathy of prematurity, bronchopulmonary dysplasia or intraventricular haemorrhage. Increasing milk DHA to 1% of total fat suggests that the DHA requirement of preterm infants may be higher than the level available in preterm formula or breast milk of Australian women. Addressing both breast and formula milks demonstrates wide generalisability of these findings to common feeding practices in neonatal nurseries. Further studies are needed to determine whether this feeding strategy and dose of DHA is capable of improving other aspects of infant development.Thesis (Ph.D.) -- University of Adelaide, School of Paediatrics and Reproductive Health, 200
Iodine nutrition in early life and childhood neurodevelopment and growth
No full textIodine is a micronutrient required for optimal development and growth. Mandatory iodine fortification of bread was implemented in Australia in October 2009 following the re-emergence of iodine deficiency. However, there are limited data on the iodine status of South Australians and populations at risk, particularly pregnant women. There is a concern about the inconsistent classification of iodine status in the general population and pregnant women by different markers. Evidence on the association between iodine nutrition in early life, and neurodevelopment and growth in populations with mild iodine deficiency to iodine sufficiency, is inconsistent. Newborn thyroid stimulating hormone (TSH) concentration has been suggested as a marker of iodine nutrition in early life. This thesis aims to assess: 1) the agreement between markers of iodine status, 2) iodine status (including pregnant women) in South Australia, before and after the mandatory iodine fortification using the newborn TSH concentration and urinary iodine concentration (UIC), and 3) associations between newborn TSH concentration and childhood neurodevelopment and growth. A systematic review was conducted to assess agreement between markers of population-level iodine status (median UIC, newborn TSH concentration and goitre prevalence), while urinary iodine data, including an estimated 24-h urinary iodine excretion (UIE), UIC, iodine-to-creatinine ratio (I/Cr), and UIC-corrected for creatinine, were used to assess agreement between markers of individual-level iodine status in pregnant women. The results of the systematic review showed that at a population level, newborn TSH concentration >5 mIU/L greater than 3% had a better agreement with goitre prevalence than median UIC to define iodine deficiency in populations. At an individual level, I/Cr from spot urine samples had a better agreement with the estimated 24-h UIE compared with UIC or UIC~Cr markers in pregnant women. Based on the newborn TSH concentration, South Australia was classified as mildly iodine deficient in both pre- and post-fortification periods in contrast to iodine sufficiency defined by median UIC post-fortification. Iodine status of pregnant women was classified as iodine deficiency pre-fortification and iodine sufficiency post-fortification by the UIC marker. Utilising developmental outcome data from two studies, a null association was observed between newborn TSH and childhood neurodevelopment or growth at 18 months. However, poorer neurodevelopment or growth in infants with high TSH in a borderline iodine deficient setting and better neurodevelopment in infants with high TSH in iodine sufficient setting cannot be excluded. In conclusion, monitoring of iodine status using multiple markers is required to identify populations or population groups at increased risk of iodine deficiency disorders. Re-evaluation of current TSH criteria for classifying iodine status in populations is suggested. As neurodevelopmental assessments at 18 months of age may not be stable, data-linkage studies that utilise newborn TSH data and examine neurodevelopmental outcomes at later ages are warranted in populations where newborn screening is routinely performed.Thesis (Ph.D.) -- University of Adelaide, School of Agriculture, Food and Wine, 202
Postprandial Hyperglycaemia Screening and Pregnancy Outcomes-Lessons From COVID -19
No full textPublOnlineBackground: During COVID-19, the diagnosis and treatment of GDM differed from conventional criteria. In Australia, during the alternative testing period, women with fasting glucose < 4.7 mmol/L were not diagnosed with GDM.Aim: To describe the maternal and neonatal outcomes of pregnant women with fasting blood glucose < 4.7 mmol/L for whom the diagnosis and treatment pathways differed before and during COVID-19.Materials and Methods: An Australian population-based data linkage study involving 3891 women with fasting blood glu-cose < 4.7 mmol/L between 24 and 32 weeks of gestation categorised into three groups: women diagnosed with GDM by postpran-dial hyperglycaemia (PPGDM; n = 226); normal glucose tolerance group (NGT; n = 3125) and women not tested for postprandial hyperglycaemia, mostly during COVID-19 (LFBG; n = 540). Perinatal outcomes were compared using generalised linear models.Results: There were no differences between PPGDM and NGT groups in the risk of large for gestational age infants (RR 0.98,95% CI: 0.63–1.52) although the mean birth weight (MD −103.43, 95% CI: −175.46 to −31.40)) was lower in the PPGDM group.The maternal and neonatal outcomes in the LFBG group were mostly comparable to the NGT group.Conclusion: In our study, the Australian COVID-19 GDM screening protocol, which includes initial fasting glucose testing,reduced the need for an OGTT in 67% of pregnant women. Diagnosis and treatment for postprandial hyperglycaemia in women with lower FBG should consider the benefits, as well as the financial, logistical and psychological costs involved.Beenu Bastian, Lisa Gaye Smithers, Ansar Kunjunju, Alexia Pape, Monique Francoi
Psychometric properties of the Social Support Scale (SSS) in two Aboriginal samples
No full textIn Australia, despite social support increasingly being reported as playing an important role in influencing health outcomes of Aboriginal and Torres Strait Islanders, measures of social support have not yet been validated for Aboriginal people. The current study aimed to evaluate the validity and reliability of the Social Support Scale in an Aboriginal and/or Torres Strait Islander population. The Social Support Scale (SSS) is a 4-item psychological instrument that was designed to evaluate four social support functions, instrumental, informational, emotional and appraisal support. Data included participants from two different samples: (1) Teeth Talk Study (n = 317), an oral-health randomized controlled trial (RCT) conducted with Aboriginal adults; and (2) the South Australian Aboriginal Birth Cohort Study (n = 367), a prospective longitudinal birth cohort study in which pregnant Aboriginal women were interviewed at baseline. The SSS psychometric properties were examined with Graphical Loglinear Rasch Models (GLLRM). The overall fit to a GLLRM was established (χ2(96)sample1 = 52.7, p = 0.06; χ2(25)sample2 = 22.2, p = 0.62) after accounting for local dependence between items 3 and 4. Item 2 displayed differential item functioning by employment status in Sample 1. Regarding dimensionality, the SSS was unidimensional in both samples (γobs1 = 0.80; γexp1 = 0.78, p = 0.65; γobs2 = 0.75, γexp2 = 0.77, p = 0.16). The instrument also displayed good reliability (Rsample1 = 0.82, Rsample2 = 0.84). Despite a few identified limitations (such as poor targeting), the findings indicated that the SSS is a promising instrument to provide culturally-valid and reliable measurement of social support among Aboriginal and/or Torres Strait Islander adults. Future studies should further investigate the instrument psychometric properties in other Aboriginal samples and the development and inclusion of culturally-sensitive items are also recommended.Pedro Henrique, Ribeiro Santiago, Lisa Gaye Smithers, Rachel Roberts, Lisa Jamieso
Stress beyond coping? A Rasch analysis of the Perceived Stress Scale (PSS-14) in an Aboriginal population
No full textThe history of colonization contributed to Aboriginal and Torres Strait Islanders becoming one of the most disadvantaged groups in Australia. The multiple social inequalities, and therefore the constant insecurities for many about low income, poor living conditions, unemployment, and discrimination, generate chronic stress in this population. In the Baby Teeth Talk Study, an oral-health randomized controlled trial, the Perceived Stress Scale (PSS-14) was administered to 367 pregnant Aboriginal women at baseline. The aim of the present study was to evaluate the validity and reliability of the PSS-14 in an Aboriginal population. The study analysed: (a) model fit; (b) dimensionality; (c) local dependence; (d) differential item functioning; (e) threshold ordering and item fit; (f) targeting; (g) reliability; and (h) criterion validity. The dimensionality analysis indicated a two-factor structure, with negatively and positively worded items clustering together and 21.7% (95% Agresti-Coull C.I. [17.8%, 26.2%]) statistically significant t-tests between the persons' estimates. After the creation of composite items, the revised Perceived Distress (χ2 (21) = 11.74, p = 0.946) and Perceived Coping (χ2 (28) = 17.63, p = 0.935) subscales fitted the Rasch model. Reliability was modest (PersonSeparationIndexdistress = 0.72; PersonSeparationIndexcoping = 0.76). The latent correlation between the Perceived Distress and Perceived Coping subscales was r = 0.14. It is hypothesized that the social inequalities experienced by the Aboriginal population are so pronounced that even Aboriginal pregnant women that perceived themselves as coping well with life challenges ended up endorsing items regarding high levels of stress. The present research showed that a revised PSS-14 is a culturally valid and modestly reliable psychological instrument to measure stress in a population of pregnant Aboriginal women in Australia.Pedro Henrique Ribeiro Santiago, Rachel Roberts, Lisa Gaye Smithers,
Lisa Jamieso
The incidence, risk factors and implications of type 1 diabetes: whole-of-population linked-data study of children in South Australia born from 1999-2013
No full textThe aim of this doctoral thesis was to study the incidence, risk factors and outcomes of type 1 diabetes for children in South Australia, born from 1999-2013. The incidence of type 1 diabetes has doubled in the last four decades in many countries including Australia, and has substantial individual and economic consequences. Evidence from studies on type 1 diabetes aetiology and its implications is mixed. In this thesis, the linkage of multiple population-wide administrative data over 15 years, and use of rigorous epidemiological approaches has resulted in a better understanding of the risk factors and implications of type 1 diabetes. There are four studies in this doctoral thesis. In the first descriptive study, the incidence of type 1 diabetes was estimated by individual and area-level socioeconomic characteristics among children (aged ≤11 years) in South Australia, born from 2002-2013. Findings of the study showed that type 1 diabetes incidence rates differed depending on the measures of socioeconomic characteristics. Individual-level indicators showed higher type 1 diabetes incidence among more advantaged children, however, there was no clear area-level socioeconomic patterning of type 1 diabetes. Area-level measures of socioeconomic position are likely to have a greater risk of misclassification from true socioeconomic position, which suggests that the use of area-level measures may be misleading. Socioeconomic position is a major determinant of health and can modify the risk factors of type 1 diabetes. For example, as per hygiene hypothesis, the socioeconomically dis-advantaged children are less likely to have type 1 diabetes, which is supported by the findings of individual-level socioeconomic patterning of type1 diabetes in the first study. In addition, socioeconomically disadvantaged women are less likely to have a caesarean birth and more likely to smoke in pregnancy. I chose to study these two risk factors of type 1 diabetes because the evidence was inconsistent, and some studies had methodical limitations. Evidence about the effect of caesarean section on childhood type 1 diabetes is mixed; ranging from very small or no risk to 20-30% increased risk. A prevailing theory is that exposure to the gut and vaginal microbiota during a vaginal birth protects against type 1 diabetes. Therefore, in the second study, the impact of caesarean birth on childhood type 1 diabetes (aged ≤15 years) was estimated. This involved linking multiple administrative datasets of children in South Australia, born from 1999-2013. The question was extended to whether type 1 diabetes risk differed for children born by prelabour or intrapartum caesarean to further test the idea of microbiota exposure on type 1 diabetes. That is because children born by prelabour caesarean do not get exposure to maternal vaginal microbiota, and intrapartum caesarean births may have some exposure. Findings of the study obtained from Cox proportional hazard regression analysis showed a negligible 5% higher incidence (HR = 1.05, 95% CI 0.86-1.28) for caesarean births compared with normal vaginal delivery, with wide confidence intervals including the null. Contrary to the hypothesis of a higher type 1 diabetes risk for prelabor caesarean (because of non-exposure to maternal vaginal microbiota) type 1 diabetes risk for intrapartum caesarean was slightly higher (HR = 1.08, 95% CI 0.82-1.41) than prelabor caesarean (HR = 1.02, 95% CI 0.79-1.32). This negligible risk of type 1 diabetes for children who had caesarean birth, either prelabor or intrapartum, and the potential for unmeasured confounding suggested that birth method induced variation in neonatal microbiota might not be involved in modifying type 1 diabetes risk. Like caesarean section, maternal smoking in pregnancy is also a debated risk factor for childhood type 1 diabetes. Evidence about maternal smoking on childhood type 1 diabetes is inconsistent; studies have been small, and many did not adjust for important confounders or address missing data. In the third study of this doctoral thesis, the effect of maternal smoking in pregnancy on childhood type 1 diabetes was estimated using Cox proportional hazard regression analysis, once again by linking multiple administrative datasets of children in South Australia, born from 1999-2013. The analytical approach for this study ranged; from Cox proportional hazard analysis with adjustment for wide range of confounders using the SA ECDP linked data, involving multiple imputation for missing data; to conducting meta-analysis in order to get more precise estimate. But smoking is notoriously residually confounded, therefore, I made special efforts to investigate the possibility of residual confounding by using a negative control and E-value. The findings demonstrated that maternal smoking in pregnancy was associated with a 16% (HR 0.84, 95% CI 0.67, 1.08) lower childhood type 1 diabetes incidence, compared with unexposed children, which was also supported by the meta-analytic estimates of population-based cohort studies (HR 0.72, 95% CI 0.62, 0.82) and case-control studies (OR 0.71, 95% CI 0.55, 0.86). The negative control outcome and E-value analyses indicated the potential for residual confounding in the effect of maternal smoking on childhood type 1 diabetes. Triangulation of evidence from this study along with the results of similar population-based studies, suggested a small reduced risk of childhood type 1 diabetes for children exposed to maternal smoking in pregnancy. However, the mechanisms linking maternal smoking in pregnancy with childhood type 1 diabetes require further investigation. In the fourth study of this thesis, the impact of childhood type 1 diabetes on children’s educational outcomes in year/grade 5 at age ~10 were estimated, linking population-wide data of children in South Australia, born from 1999-2005. In this study, a doubly-robust analytical method called augmented inverse probability weighting (AIPW) was used to compute the average treatment effect of type 1 diabetes on children’s educational outcomes. AIPW gives an unbiased estimate if either the outcome model or the treatment model is correctly specified. The findings of this study demonstrated that children with type 1 diabetes are not disadvantaged in terms of educational outcomes in year 5, potentially reflecting improvement in type 1 diabetes management in Australia. In summary, the work in this doctoral thesis has demonstrated that type 1 diabetes incidence differed depending on the measure of socioeconomic position. The hygiene hypothesis was only supported by the individual-level socioeconomic pattering of type 1 diabetes incidence in South Australia. The involvement of birth method induced variation in neonatal microbiota in type 1 diabetes was not supported by the caesarean and childhood type 1 diabetes study. Despite the evidence of residual confounding in the estimate of maternal smoking in pregnancy on childhood type 1 diabetes, triangulation of the evidence suggested small reduced risk for children exposed to maternal smoking in pregnancy, but further research will be needed to understand the mechanism. The findings of similar educational outcomes for children with and without type 1 diabetes, highlighted the importance of improvements in diabetes management.Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 202
Children’s temperament and parenting practices in the first five years of life and cognitive, academic and adiposity outcomes in later childhood and adolescence
No full textThe aims of this thesis are to examine the associations between children’s temperament, parenting practices and three important public health outcomes: cognitive ability, academic achievement and adiposity. While there have been decades of psychological research in this area, this thesis takes a contemporary epidemiological approach to the topic and addresses some of the methodological limitations of past studies by using more advanced methods and longitudinal data from both Australia and the UK. There are four papers in this thesis. The first study examined whether norms in the Revised Infant Temperament Questionnaire (RITQ) were suitable for use in a population sample of UK infants. The RITQ was normed on a small group of US infants in 1978 and has never been updated. Findings showed that 15% of children would be classified as temperamentally difficult using norms empirically derived from the UK infant data, compared to 24% using RITQ’s norms, suggesting that potential misclassification of infant temperament occurred from using different norms. This study highlighted the need for more recent and culturally-specific temperament norms to categorise infant temperament. Temperament categories defined using the norms in this study were used in subsequent analyses in study 3 and 4. Children’s temperament may influence parenting, which is known to affect cognitive and academic outcomes. Most studies of temperament have not adequately accounted for parenting practices when examining the effect of temperament on cognitive and academic outcomes. To properly handle parenting practices at age 4 to 5 years as an intermediate variable, the second study used a marginal structural model to examine the controlled direct effects of temperament at 2 to 3 years on cognitive and academic outcomes at 6 to 7 years in a nationally representative sample of Australian children. Temperament dimensions measured in this study were reactivity, approach, and persistence. This study found that the controlled direct effects of temperament on cognitive and academic outcomes was small. The largest effect (0.11 SD) was for persistence on verbal ability. Since temperament had such a small influence on children’s cognitive and academic outcomes, this thesis then examined parenting as the exposure, as parenting may have a greater influence on cognitive ability than temperament. The associations between parenting practices (warmth and control) and children’s IQ in the UK cohort were explored in study 3. Temperament was contextualised as an effect-measure modifier, a variable that may modify the associations between warmth, control and IQ. Low parental warmth and high parental control at 24 to 47 months were associated with lower IQ at age 8 years. Effect sizes for warmth and control were 0.03 SD and 0.15 SD, respectively. Counter to the study’s hypothesis, temperamentally easier children were more susceptible to the negative effects of low warmth and high control parenting than temperamentally difficult children. Besides cognitive and academic outcomes, there is some evidence that parenting and temperament may influence children’s adiposity. The fourth study focused on two more specific dimensions of parenting, namely parental feeding control and using food to soothe a child. The associations between feeding control, using food to soothe, and body mass index (BMI) and fat mass were explored in the UK cohort. Whether these associations differed for children with different temperaments were examined using an analysis of effect-measure modification. Contrary to some studies, higher parental feeding control at age 42 to 65 months was associated with lower BMI at ages 7 and 15 years and fat mass at age 15 years. No association between using food to soothe (42 months) and BMI (7 and 15 years) or fat mass (15 years) were found. Using two large, longitudinal observational studies from different countries, different temperament tools, and measures of temperament at different ages, the research in this thesis indicated that the effect sizes for temperament on cognitive, academic and adiposity outcomes are at best, very small. The differential susceptibility theory suggested by previous psychological studies, that temperamentally difficult children were more vulnerable to the detrimental effects of negative parenting, was not supported in the UK cohort and using contemporary epidemiological methods. It is recommended that future studies adjust rigorously for important confounders and use large, representative samples when examining the effect-measure modification by temperament of the associations between parenting and cognitive, academic and adiposity outcomes.Thesis (Ph.D.) (Research by Publication) -- University of Adelaide, School of Public Health, 2016
- …
