Various aspects of the relationship between parent and child influence the child's social and emotional development [1, 2] and there is increasing evidence that specific aspects of the parent-child relationship are also associated with general physical health both in childhood and in adulthood with more negative relationships being associated with poorer general health outcomes [3-6]. Relationships between parenting and more specific conditions such as obesity and oral health are also reported. An increased risk of obesity has been shown to be associated with parenting styles which might be considered authoritarian ie low warmth and high control or "demandingness" [7, 8] and there is some emerging work on similar associations between parenting and oral health in childhood [9-11]. There is also evidence parenting is socially patterned and that parenting changes over time as a function of changes in sociodemographic factors eg changes in the mother's health, the availability of social support and also (to a lesser extent) changes in financial circumstance; deterioration in these sociodemographic factors is associated with a reduced (less warm and supportive) parenting score over time whereas improvements in maternal health specifically are associated with an increased (more warm and supportive) parenting score. These changing relationships may in part explain some of the social patterning which can be observed in inequalities in child health.

Parent-child relationships have been classified and measured in a variety of ways but key aspects which are proving to be robust are the mother's (or main carer's) sensitivity towards and attunement to the needs of the child [12], different parenting styles [13], discipline [14] and also specific aspects of the parent-child relationship such as maternal warmth and support and hostility towards / rejection of the child [15]. As well as the provision of sustenance and stimulation, children also need their parents or carers to provide support, structure and supervision if they are to develop optimally [16]. Research has shown that parent-child relationships which are warm and supportive are associated with positive child social, emotional and physical outcomes [15, 16] whereas cold, neglecting relationships between parent and child increase the risk of problematic outcomes [3].

The aim of this proposal is to examine aspects of the parent-child relationship which have been measured over time in the ALSPAC cohort and to investigate their associations with and ability to predict child health outcomes both generally [6] and with regard to specific outcomes such as obesity and oral health. We are also interested to determine further the role of sociodemographic factors on parenting and child health outcomes. In particular we plan to investigate whether the warmth, support and control between parent and child are associated with specific conditions such as obesity and oral health but we would also like to investigate whether we can replicate a study undertaken on the NICHD Study of Early Child Care to determine the extent to which parenting mediates the detectable effects of socioeconomic risk on health in childhood [4].

Methods

Study Population: The Avon Longitudinal Study of Parents and Children (ALSPAC: see www.alspac.bris.ac.uk) cohort is ideally placed to investigate these relationships as it has various measures of child health and also measures of the parent-child relationship and associated socio-demographic factors over time. ALSPAC is a population-based study which has been described in detail elsewhere ([17].

Measures of Health: Measures of health include maternal assessment of the child's general health (annually), number of physical symptoms in the last 12 months (annually) and also more specific measures such as DXA estimates of fat and muscle which are available at several timepoints between 9 and 17 years years. Oral health is measured via maternal report throughout childhood with questions on brushing teeth, visits to the dentist etc and via child report at 8 and 10 years. Actual observations of child dentition are also available for a subsample of the cohort in early childhood and a questionnaire about oral health is currently being administered to the cohort (age 17). Measures of the parent-child relationship include measures of attachment which have been collected between 18 months and 6 years, measures of warmth and support as well as of control, hostility and resentment (available in early childhood at eight and 33 months) and also measures of physical discipline (shouting, smacking etc) which have been collected regularly between 18 months and 6 years.

Potential confounders: A report by Waylen and Stewart-Brown [18] has shown that the sociodemographic factors associated with parenting include maternal age and education level, maternal physical and mental health (measured annually), social support and financial circumstance. Variables such as the presence of the mother's romantic partner (measured at each time point) and also ethnic group should also be accounted for.

Other possible confounders include child gender, age and birth weight / length and also gestational age; a second measure of infant weight and length collected at eight months in order to develop a measure of early rapid weight gain (models of growth have also been developed using study data); food frequency questionnaires at various ages, dietary intake of different food types including sweets and chocolate measured from 6 months onwards by maternal report and also child self-report at 10 years and diet diaries completed at 7, 10 and 13 years; the mother's occupation and that of her partner, maternal height and pre-pregnancy (used to calculate maternal BMI), maternal tobacco use both during and after pregnancy; the amount of time the child spends watching TV / playing outside or with other children (from early childhood onwards).

References

[1] Maccoby EE, Martin JA, Hetherington EM. Socialization in the context of the family: parent-child interaction. In: Anonymous, ed. Mussen Manual of Child Psychology. New York: Wiley 1983:1--102.

[2] Patterson G, DeBaryshe B, al e. A developmental perspective on antisocial behaviour. American Journal of Psychology. 1989;44:329-35.

[3] Repetti RL, Taylor SE, Seeman TE. Risky families: family social environments and the mental and physical health of offspring. Psychological Bulletin. 2002;128(2):330-66.

[4] Belsky J, Bell B, Bradley RH, Stallard N, Stewart-Brown SL. Socioeconomic risk, parenting during the preschool years and child health age 6 years. Eur J Public Health. 2007 January 12, 2007:ckl261.

[5] Stewart-Brown S, Fletcher L, Wadsworth MEJ. Parent-child relationships and health problems in adulthood in three UK national birth cohorts. European Journal of Public Health. 2005;15(6):640-6.

[6] Waylen A, Stallard N, Stewart-Brown S. Parenting and health in mid-childhood: a longitudinal study. Eur J Public Health. 2008;18(3):300-5.

[7] Rhee KE, Lumeng JC, Appugliese DP, Kaciroti N, Bradley RH. Parenting styles and overweight status in first grade. Pediatrics. 2006;117(6):2047-54.

[8] Ambrosini G, Oddy W, Robinson M, O'Sullivan T, Hands B, de Klerk N, et al. Adolescent dietary patterns are associated with lifestyle and family psycho-social factors. Public Health Nutrition. 2009;12(10):1807-15.

[9] Law CS. The impact of changing parenting styles on the advancement of pediatric oral health. J Calif Dent Assoc. 2007;35(3):192-7.

[10] Amin M, Harrison R. Understanding parents' oral health behaviors for their young children. Qualitative Health Research. 2008;19(1):116-27.

[11] Astrom A. Parental influences on adolescents' oral health behavior: two year follow-up of the Norwegian Longitudinal Health Behavior Study participants. European Journal of Dental Sciences. 1998;106:922-30.

[12] Ainsworth MDS, Bell SM, Stayton DJ, Schaffer H. Individual differences in strange-situation behaviour of one-year olds. In: Anonymous, ed. The origins of human social relations. New York: Academic Press 1971.

[13] Baumrind D. Current patterns of parental authority. Developmental Psychology. 1971;4(2):1-103.

[14] Gershoff ET. Corporal punishment by parents and associated child behaviors and experiences: A meta-analytic and theoretical review. Psychological Bulletin. 2002 Jul;128(4):539-79.

[15] Barber BK, Stolz HE, Olsen JA. Parental support, psychological control and behavioural control: assessing relevance across time, culture and method. Report. Oxford, UK: Society for Research in Child Development; 2005.

[16] Bradley R, Caldwell BM. Caregiving and the regulation of child growth and development: describing proximal aspects of the caregiving system. Developmental Review. 1995;15:38-85.

[17] Golding J, Pembrey M, Jones R. ALSPAC--the Avon Longitudinal Study of Parents and Children. I. Study methodology. Paediatr Perinat Epidemiol. 2001;15(1):74-87.

[18] Waylen A, Stewart-Brown S. Parenting in ordinary families: diversity, complexity and change. York: Joseph Rowntree Foundation; 2008.