Parent-child Relationship Among Low-income Families in Hong Kong

Study Overview
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Brief Summary
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This is a prospective cohort study building upon the existing cohort study on the effectiveness of the Trekkers Family Enhancement Scheme. This study will sample 200 low-income parent-child pairs and follow them up for 24 months with yearly assessment on parental stress and child health using both subjective measures and objective physiological parameters. Additional data on parenting style, neighbourhood cohesion, child physical assault and neglect potential, parental mental health and HRQOL and family disharmony will also be collected at each assessment time point for testing mediating and moderating mechanisms between parental stress and child health. The baseline assessment will be carried out in 2016-17 with three repeated assessments after 6 months, 12 months, and 24 months.

Detailed Description
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Study aims To examine the relationship between parental stress and child health. To evaluate the stress of parents as indicated by their subjective perception of mental health, quality of life and allostatic load on the body. To evaluate the health of children as indicated by their well-being, behaviors, body mass index (BMI) z-score and telomere length. To examine the correlation between changes in parental stress and changes in child health over time. To identify the moderators and mediators of the relationship between parental stress and child health. Eligible participants in the main cohort study will be approached by call or during face-to-face sessions. Parents who express interest in participation will be provided with an information sheet about the research and asked to sign the consent form for themselves and for their children. After providing consent, the parent of each parent-child pair will complete a set of structured questionnaires on parental mental health and HRQOL, parenting style, neighborhood cohesion, and their children's well-being and behaviors. Physical examination including blood pressure, heart rate, weight, height, and waist-to-hip ratio will also be carried out on both parents and children. A swab of buccal cells will be taken from each child. Venous blood will be sampled from each parent. This study will have four assessment waves: Baseline, T2 follow up (6 months), T3 follow up (12 months), and T4 follow up (24 months). Physical health data and biological samples will be collected by research nurses and research assistants during health assessment session held in community centers. Questionnaire data will be collected by trained interviewers during telephone survey. To minimize attrition, a package of questionnaires and a sheet of instructions and equipment (i.e. brushes) for swab-taking at home may also be sent to parents upon request.

Official Title
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In-depth Exploration of a Bidirectional Parent-child Relationship and Its Mediating and Moderating Factors Among Low-income Families in Hong Kong

Conditions
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Child Development, Parent-Child Relations

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Family monthly household income does not exceed 75% of Hong Kong's median monthly household income At least one parent and one child aged 6 to 16 years of the same family have given consent to participate in the main cohort study Exclusion Criteria: Parents cannot speak or read Chinese; Children were born prematurely and/or with a congenital deformity; and Neither parent is the primary caregiver of the child.

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Child CHQ General Health Perception subscale score from baseline, 6 months, 12 months to 24 months | Quality of life: Child Health Questionnaire - Parent Form 50 (CHQ-PF50) is a parent proxy measure of children's physical and psychological wellbeing, with 50 items grouped into 12 multi-item subscales. Its Chinese version has been shown to have good psychometric properties in local Chinese children | baseline, 6 months, 12 months and 24 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Child SDQ Totally Difficulty score from baseline, 6 months, 12 months to 24 months | Strength and Difficulties Questionnaire (SDQ) is a 25-item parent-completed questionnaire measuring children's behavioral issues. The SDQ, with 5 subscales, has been translated into traditional Chinese and tested with satisfactory reliability and validity in local children. | baseline, 6 months, 12 months and 24 months | 
| Change in Child telomere length from baseline to 24 months | Telomere length will be measured by the method adapted from that originally published by Cawthon. For each sample, the telomere length will be represented by the relative ratio of the telomere repeat copy number (T) to the single copy gene 36BA copy number (S). The T/S ratio will be determined by quantitative polymerase chain reaction (qPcR) using a 7900HT Thermocycler (Applied Biosystems). | baseline and 24 months | 
| Change in Parental allostatic load index from baseline, 6 months, 12 months to 24 months | A review of literature has identified a set of physiological parameters that can reflect allostatic load and yet be conveniently measured, including blood pressure, heart rate, body-mass-index, waist-to-hip ratio, lipid profile, fasting glucose and glycosylated haemoglobin. An index score of allostatic load will be calculated by summing the number of parameters that fall into the highest risk quartile defined by local clinical practice guidelines | baseline, 12 months and 24 months | 
| Change in Parental SF-12v2 HRQOL scores from baseline, 6 months, 12 months to 24 months | The SF-12 Health Survey-Version 2 (SF-12v2) is a 12-item quality of life assessment instrument that covers 8 subscales. The Chinese version of SF-12v2 has been validated and normed in local Chinese population | baseline, 6 months, 12 months and 24 months | 
| Change in Parental DASS Stress subscale score from baseline, 6 months, 12 months to 24 months | Depression Anxiety Stress Scale (DASS) has 3 subscales, each with 7 items rating the severity/frequency of symptoms of stress, anxiety and depression respectively. DASS also has well-established psychometric properties and been validated in Chinese population. | baseline, 6 months, 12 months and 24 months |