Evidence increasingly suggests that mental health problems are associated with insults during critical times of brain development, and also by exposures over an individual's life course. These include in-utero exposures, which may lead to subtle neurobehavioral difficulties, and contextual exposures such as neighbourhood quality and quality of child-rearing environment. Much of the work in this area to date has focused on early life determinants of schizophrenia, and to a lesser extent depression and suicide. Further, there is a body of evidence relating birthweight to cognitive function in childhood, though a recent sibling-based analysis suggested that this association was driven by fixed familial factors such as background socioeconomic position and behaviours/exposures that are similar for all siblings within a family. (1)

However, there is relatively little work on the role of early alcohol exposure on the occurrence of a range of cognitive, behavioural and emotional difficulties. Exposure to alcohol consumption in pregnancy is an example of the effects of an exposure during a sensitive period. The teratogenic effects of alcohol causes a variety of adverse developmental outcomes including Foetal Alcohol Syndrome (FAS) and Foetal Alcohol Effects. (2) Whereas consistent excessive drinking in pregnancy is definitely associated with more severe symptoms, the evidence is unclear as to the impact of more moderate drinking exposure on milder forms of developmental outcomes. However concerns remains over the fact that even moderate consumption of alcohol in pregnancy may increase the risk of mild cognitive impairment, ADHD and learning and behavioural difficulties. (2) Finally there is emerging evidence pointing to an association between alcohol and tobacco use in pregnancy and the development of addictive behaviours, such as addiction to alcohol. (3-6)

The mechanisms underlying these associations are unknown. It is assumed that the effects are due to specific intrauterine exposure, but genetic factors and shared familial factors (including socioeconomic position, shared/learnt familiar behaviours) may well explain any link between moderate alcohol consumption in pregnancy and later effects on offspring cognitive function and behaviour. One way to further explore this would be to compare associations of maternal alcohol consumption during pregnancy with offspring outcomes to the same associations with paternal alcohol consumption. To date no previous study has done this.

There are only a handful of studies with the capacity to test the early development of alcohol problems in children. Further evidence is needed to assess whether in-utero exposure to moderate alcohol consumption truly contributes to later developmental problems. If this is so it is also important to understand the mechanisms underlying these associations.

The aim of this proposal is to use ALSPAC data in order to determine whether intra-uterine exposure to alcohol consumption (assessed by maternal self-report of alcohol consumption during pregnancy) is related to poorer cognitive function, academic difficulties, behavioural problems (eg Attention Deficit Hyperactivity Disorders) during the childhood years and addictive behaviours later in adolescence. The association of maternal alcohol consumption during pregnancy with these offspring outcomes will be compared to similar associations with paternal alcohol consumption (based on self-report by the partner of the mother with restriction to those who define themselves as the biological father). This comparison will facilitate our ability to determine whether there is a true intrauterine effect, since if there is one would anticipate associations only with maternal alcohol consumption. Similar association with paternal intake would suggest that genetic factors and/or shared family environmental factors explain the association rather than specific intrauterine effects.

No outline received

No outline received

No outline received

(No outline received).

This project will address the question of health inequalities, by addressing the relationships between measures of socio-economic deprivation and respiratory health, particularly wheezing illnesses, asthma and lung function.The first part of the study will focus on the detailed information on respiratory health and socio-economic factors in the Avon Longitudinal Study of Parents and Children (ALSPAC) to determine the association of socio-economic deprivation and respiratory outcomes during childhood.We will further investigate these associations by attempting to identify explanatory variables, including lifestyle (smoking, diet) and environmental exposures.Observed associations will then be examined using a lifecourse epidemiological approach to investigate whether associations that we observe in a contemporary population of children (ALSPAC) are reproducible across previous generations in the United Kingdom and whether deprivation in childhood is associated with adult respiratory outcomes, independently of adult socio-economic status.In turn, this will allow us to explore the possible effects of social mobility on adult respiratory health. The project brings together expertise on the analysis of inequalities in health from an economics perspective, with a focus on measures of access to resources, and the exploitation of dynamics in data and the use of GIS tools to map local features to individuals (in the Department of Economics), childhood respiratory epidemiology, including assessment of asthma and lung function in a longitudinal birth cohort sample (Department of Community-based Medicine) and the multidisciplinary specialty of lifecourse epidemiology, including access to archived information on other existing cohorts (Department of Social Medicine).Therefore, this is a unique opportunity to build a global, comprehensive picture of the factors associated with socio-economic deprivation in the U.K. and their potential effects on an important aspect of public health.

Obstructive respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD) are among the commonest chronic health problems of children and adults in the United Kingdom. However, a review of the evidence on inequalities in Britain did not mentionasthma as a health issue related to poverty. Within countries there have been studies that have examined the relationship between socio-economic status and prevalence of asthma. While there does appear to be a consistent relationship between allergy prevalence and high socio-economic status, there is conflicting evidence with regard to asthma with studies showing increased or decreased prevalence in higher socio-economic groups and others showing no socio-economic gradient. However, one of the problems of interpreting these studies is that many of them are based on cross-sectional surveys and results may be inconsistent across time. For example, we have previously demonstrated differences in social factors associated with wheeze between infants and adults. This may relate to differentpathological aetiologies of wheezing in these two populations.Wheezing in infancy is associated with respiratory tract infection on a background of abnormal airway development, as evidenced by reduced lung function shortlyafter birth. Social factors, including exposure to tobacco smoke, have been demonstrated to be strongly associated with reduced airway function in infancy and a tendency to wheeze in the first few years after birth and factors associated with deprivation, such as crowded living conditions, larger family size and a reduced tendency to breast feeding will tend to increase the risk of respiratory infections. Although wheezing tends to resolve in the majority of these children by the age of 3 years, there is increasing interest in the long-term implications of impaired lung function in infancy and the possible relationship with COPD in adult life. Although COPD is generally regarded as a smoking-related illness, only a minority of active smokers develop the condition and, in observational studies that have examined early life factors, these have been shown to have a greater effect on COPD mortality than active smoking in later life. Therefore, in order to fully understand the nature of associations between markers of socio-economic deprivation and respiratory health and diseases, it is necessary to design studies that have the capacity to examine short and long term outcomes, preferably in the context of a longitudinal cohort design. The Avon Longitudinal Study of Parents and Children is a birth cohort study that has followed a population of children, recruited during their mothers' pregnancies with expected dates of delivery between April 1991 and December 1992. The study has included repeat questionnaires about respiratory symptoms at approximately annual intervals since birth and has objective measurements of lung function at 8 1/2 years of age. During the course of the proposed project, a further measurement of lung function will be available at 15 1/2 years (MRC funded). The ALSPAC study has also collected detailed information on lifestyle and environment (housing type, type of heating/cooking used, reported damp or mould in the home, household cleaning product use, parental smoking, and detailed dietary diaries from the mother and child). This presents the opportunity to carry out a uniquely detailed study of socio-economic influences on respiratory symptoms and function from birth to adolescence. To address the longer term respiratory health questions, we will use the approach of lifecourse epidemiology to investigate exposures at different stages of development that may contribute to the risk of diseases in adults, either by accumulation of exposure over time or by exposures acting at critical periods of development, or by interactions of these. The Department of Social Medicine, University of Bristol has extensive expertise in lifecourse epidemiological approaches using a combination of contemporary and historical cohort studies. We aim to study the Boyd-Orr cohort which was based on the Carnegie survey of diet and health (1937-9) of 4973 children and has information on socio-economic factors, diet and growth in childhood and respiratory follow up including MRC respiratory questionnaire responses and spirometry. We would also seek to collaborate with the 1958 and 1970 British birth cohort studies, which have also collected information on respiratory outcomes.

Children from deprived homes emerge from our schools with substantially lower levels of educational attainment. These educational deficits emerge early in children's lives, even before entry into school and widen throughout childhood.

But little is known about how family background affects education attainment. This project will consider the influences on children's skill development, in its broadest sense, focussing particularly on soft skills, and on attitudes to education amongst children from low-income backgrounds

(No outline received).