Award Title: A study of the relationship between inequalities in early child development and subsequent health outcomes in early adolescence to inform policies and interventions to improve health and reduce health inequalities.
Funder: Department of Health and Social Care

Abstract: Background Reducing child health inequalities is a global health priority and evidence suggests that early child development is crucial for future wellbeing. Healthy weight and socio-emotional behaviour in early adolescence are known to be predictive of obesity and mental health in adulthood. However the relationship between inequalities in early child development and these early adolescent health consequences remain poorly understood. This project will identify, and quantify the strength of, causal pathways between inequalities in early child development and body weight and socio-emotional behaviour in adolescence. The findings will inform the development of key policies, of cross-sector relevance, needed to effectively reduce health inequalities and increase wellbeing in early adolescence and throughout the subsequent life course. Research Question What are the mediating pathways between inequality in early child development, and body weight and socio-emotional behaviour in adolescence, and where should we intervene in these pathways to improve outcomes and reduce inequalities for adolescents? Objectives For health outcomes of healthy weight and socio-emotional behaviour in early adolescence:	Identify what is already known about the pathways linking early child development to these outcomes. 	Using the Millennium Cohort Study (MCS), elucidate the mediating pathways between inequalities in early child development and these outcomes 	Quantify the strength of relationships along each mediating pathway. 	Quantify the potential effect on adolescent health outcomes of targeting interventions along each mediating pathway 	Identify targets for intervention and policy implications of the above.Methods A comprehensive participatory systematic review (involving a series of workshops with national and local stakeholders across health and education sectors) will synthesise evidence on and develop a conceptual model of the pathways linking early child development (age 3) to health outcomes, and inequalities in, body weight and socio-emotional behaviour in early adolescence (age 11) (Objective1). This model will be used in causal mediation analysis of MCS data (using structural equation modelling) to identify, and quantify the strength of causal pathways (Objectives 2 &3). Estimates from the causal mediation analyses, combined with effect estimates from controlled trials and systematic reviews, will be used to simulate the effects of intervening on the main mediating pathways (Objective 4). Implications for policy will be explored through a second round of participatory engagement with national and local stakeholders, using a deliberative dialogue approach (Objective 5).Timelines 	Participatory systematic review submitted for publication by the end of year 1. 	Longitudinal analysis on the mediating pathways complete and papers submitted for publication by end of year 2 	Recommendations for policy produced and disseminated from end of year 3.Anticipated impact and dissemination This research will fill a critical evidence gap by providing a comprehensive synthesis and novel conceptual model of the relationship between inequalities in early years development and later health outcomes in early adolescence. It will identify the mediating pathways susceptible to intervention to mitigate the effect of inequalities in early child development on later health consequences. Working closely with policy stakeholders in health and education, recommendations of cross-sectoral relevance will be generated to inform actionable policies to reduce health inequalities.

Lay Abstract: What is the aim of this study? The aim of this study is to understand how development in children at age 3 (how well children can think and understand as they prepare for school) affects weight and mental health at age 11 (early adolescence). These measures of health in adolescence are important because they predict obesity and mental health in adulthood and are major public health challenges for the NHS. The study will identify what factors are important for supporting children's health as they grow up. Findings will help policymakers decide where to focus support to improve health in early adolescence.Why is this study important? This study is important because poorer children have worse health and development than richer children do and this difference is growing, resulting in inequalities in health. If we are to reduce this difference, we need to understand how development at a young age affects health at a later age. Understanding how factors such as the home environment, parental stress and social circumstances affect children's health as they grow up will identify where and how to provide support. The work could lead to policy changes that have long-term benefits on improving health and future life chances of the most disadvantaged children.How will the research be carried out? This study has three phases: Phase 1I will review literature on how early child development affects weight and mental health in early adolescence. In addition, I will hold workshops to discuss the findings. In the workshops, I will speak with and listen to views from parents, policy makers, local councillors, public health and education practitioners and voluntary sector staff. From the workshops and literature review I will produce a model (a mathematical tool) indicating how early child development affects health.Phase 2I will apply the model produced from phase 1 to a big dataset of 18827 children born across the UK in 2000. This will test the findings from phase 1. It will identify the factors that affect early adolescent health and which of the factors are the most important.Phase 3:I will discuss the factors, identified in phase 2, with similar groups of people I spoke with in phase 1. Together we will make recommendations for policy makers. These recommendations will state how best to support children as they grow up to improve levels of healthy weight and good mental health. Recommendations will also highlight how to reduce the difference in these health outcomes between the richest and poorest children.How will the public be involved in this research? I have developed this research plan with charitable organisations and local authority child health and education leads and parents. I will assemble a more permanent public involvement panel to develop the research project further and:	further shape the design of the study; 	highlight any practical issues with the research plan including the best way of engaging children with research findings; 	comment upon the language used in documents for the public; and 	help to promote the findings What will happen to the findings of this research? This research will lead to:	An understanding of how early child development affects health in early adolescence 	An understanding of how to support children to improve levels of healthy weight and good mental health in adolescence 	Recommendations for policy makers on how to reduce health inequalitiesFindings from each phase of this study will be:	Published in academic journals, presented at conferences and developed into visual summaries. 	Presented to relevant organisations via meetings and updates in newsletters, websites and blogs.

Research Activity Codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health Categories: GENERIC HEALTH RELEVANCE