Patricia Lucas explains why the School for Policy Studies is researching dental decay

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Data released by Public Health England on 30 September 2014 has shown what many interested in health in the early years know already.  Over 80,000 3-year-old children in England – about 12% – suffer from a completely preventable disease.  Dental decay is painful, the treatments are unpleasant, and decayed, missing and filled teeth affect appearance.  Oral disease can have very serious consequences: in Bristol alone 721 children aged 0-19 years (of whom 155 were under 5) were admitted hospital for extraction of decayed teeth in a one year period (2012/13).

Tooth decay is of importance for us in the School for Policy Studies because while rates have reduced dramatically since the 1970s, there remain important and significant inequalities.  Closer examination of

data suggests geographical and social disparities in oral health.  Children from more disadvantaged backgrounds are significantly more likely to have early tooth decay and to need teeth extracted under general anaesthetic.  In Bristol, while the rate of child dental decay was on a par with the UK average in 2008, the DMFT (decayed, missing, filled, in teeth) index for children in South Bristol, an area of high deprivation, is currently twice the city average.  Ashley and Lawrence Hill wards experience nearly three times as many dental fillings in under 5 years old, compared to neighbouring Bishopston and Redland wards.

The Public Health England (PHE) report points out that the most important cause of dental decay is sugar in diet, and the most important preventive action is fluoride (in toothpaste or water).  The response from PHE focuses on the former, but it is important not to ignore the latter, and to understand the policy context for this.  Despite clear evidence that very small amounts of fluoride in water supplies reduces dental decay, few water supplies are fluoridated in the UK.  Water supplies are a shared resource, and public and legislative barriers mean addition of fluoride seldom happens.  In the absence of this, use of fluoridated toothpaste and fluoride varnishes by dentists are the next line of defence.

One difficulty for local policy makers is that we don’t have good enough data on oral health in childhood.  The new PHE Survey is important, but sampled just 211 3 year olds in Bristol.  We need better local data to really understand what is happening to have a reliable estimate of the local rate, including how this varies between areas.

Our study, which is part of the BoNEE project, will improve our understanding of oral health inequalities among children in Bristol.  We will do this by looking at dental hospital records of who is attending for dental extractions, by understanding better what happens when children do visit the dentist, and by gathering parents views and experiences of oral health services in Bristol.

This project is in collaboration with colleagues at University Hospitals Bristol NHS Foundation Trust, the University of Bristol’s School of Oral and Dental Sciences, and Bristol City Council.

Patricia is Head of the Centre for Research in Health and Social Care in the School for Policy Studies at the University of Bristol.

 

Progress on the FAB kids outreach project

FAB1Mark Edwards, Active7 Trial Manager in the School for Policy Studies, reflects on the first term of delivering the FAB Kids outreach workshop in schools. Mark previously blogged on this project here

It’s been a busy term. Aside from their full-time jobs, Exercise, Nutrition and Health Sciences (ENHS) staff and students have worked hard to get the FAB (Food, Activity, and Bodies) Kids project up and running in schools. Taking the workshop from drawing board to school hall has been an arduous task, but seeing the children (and teachers) learn from and enjoy the workshop activities makes the efforts worthwhile. It has been a rewarding process for FAB staff; going into schools and being in dialogue with small groups of children, learning from them and hearing their stories (sometimes fascinating, other times bizarre), and quickly(!) getting to grips with controlling groups of over-excited children.

Between May and early July, 13 staff and student volunteers have delivered the FAB workshop to 355 children. Workshops have been delivered in 8 mainstream primaries, one Special Educational Needs school, and one fee paying school. We’ve also taken FAB to the Big Bang (Cirencester) and Bridgwater Science Festivals.

What has been the impact?

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So what have the children learnt? At the end of each workshop we ask them just this question. As you’d expect (or hope) from a health-focused workshop, lots of children came away with the message that they should ‘always keep healthy and fit and drink what’s right for you’.  Many took away messages they can use in their day-to-day lives, such as ‘some drinks that appear to be healthy have a lot of added sugar’ and the ‘more you exercise the less likely you are going to have heart problems’. Others memorised interesting snippets  such as ‘Diet Coke contains an ingredient that is in fireworks’, ‘there are over 600 muscles in your body’ and ‘the average heart rate for children is 70-100 beats per minute’. One child was simply speechless (or ironic beyond his years); ‘Absolutely epic! I can’t get any of it out of my head because I learnt so much!’ Whilst most were more conservative in their comments, we hope and think that all children have taken something – however little – from the workshop that may help them to improve their lifestyle.

What did the teachers think?

School staff provide more formal evaluation of the workshop. The three individual workshop activities and the workshop overall (separate questions) were rated ‘very good’ by all teachers. It was interesting to see how teachers engaged with the workshop, with some using it as a way to develop their own knowledge, and experimenting with props and asking questions as if they themselves were participants. The qualitative feedback they provided is testament to the enthusiasm of the staff delivering the workshop. Comments from teachers include:

‘A perfect morning’s learning where the children enjoyed themselves! They loved learning the new facts. All brilliant, staff energetic and formed great relationships with children.’

‘All interactivity was brilliant! Children really enjoy learning in a different way with various approaches.’

‘All the activities were interactive, stimulating and fun for the children. They were enthusiastic and engaged throughout and certainly enjoyed what they were doing.’

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‘Really loved the jigsaw/children very engaged. Children liked the booklets and enjoyed all the activities.’

‘All members of the team had a lovely manner with children and quickly established a positive rapport. Not always easy! The resources were all well organised, interesting and engaging.’

Where next?

Although we are delighted with this term’s progress, we are not complacent and have identified several areas for improvement (which will be made over the summer). In September, MSc students will be invited to assist with the delivery of the workshop. As such, we will be designing training sessions and delivery manuals over the next few months. The plan is to allow trained MSc students to deliver the workshop, giving some supervisory roles, and gradually reducing the hands-on involvement of ENHS staff. In September we will begin to book in more schools to receive the workshop.

FAB_team

If you would like any further information on the FAB Kids workshop please visit www.fab-kids.org or email fab-kids@bristol.ac.uk.

FAB team members: Bethan Baker Williams, Rachael Pound (MSc student), Mark Edwards, Laura Pool, Kate Banfield, Byron Tibbitts, Jo Kesten and Sarah Harding.

ENHS is a research centre in the School for Policy Studies. Staff work on a variety of projects focusing on physical activity and nutrition, and their associations with health across the life course. Much research in ENHS is conducted with children in local schools.

Driving outcomes

David B photoDavid Berridge reflects on some older and newer research that he has undertaken on children’s residential care

Over my research career I’ve undertaken several studies of children’s residential care in England.   Like others, I sometimes wonder why I select the topics that I do, although research funding being as it is, you often have to take the opportunities as they come along.  As a young graduate my first jobs in the late 1970s were in residential settings with teenagers.  I’m not sure that we were particularly effective; we didn’t know exactly what we were trying to do and the knowledge base was much less developed than now.  At least I tried to offer professional friendship (there’s an interesting concept, similar to what continental European social pedagogues aspire to) as well as introducing young people to a wider range of interests, sports and situations.

On becoming a researcher, my first main study of children’s homes in 1985 (long out of print) entailed me undertaking fieldwork and living for a week in 20 different homes.  All this happened in the first year I was married, which didn’t make me especially popular.  Others  have followed (studies rather than marriages).  Residential care is now a small service in England compared with many other European countries but caters for a very troubled minority.  It continues to attract negative publicity, including the sexual exploitation of residents by groups of local men.  Whatever its other shortcomings, to its credit the current UK Coalition government is taking some positive steps to strengthen children’s residential services.

The latest project that I finished recently is a somewhat unusual one – Driving Outcomes:  Resilience, Learning to Drive and Young People Living in Residential Care.  It entailed a small pilot which offered driving lessons to a group of six older adolescents living in a group of residential homes in Bristol.  Raising funding took time but the project and a qualitative evaluation proceeded thanks to the generosity of the AA Charitable Trust, British Academy and University of Bristol.  Readers can find out more about the research here but it is interesting to reflect on some of the issues.  A journal article should  be available later in the year once it grinds its way through the academic peer review process.

In a nutshell, although only one of the six young men had so far passed his driving test, pupils, professionals and heads of homes  interviewed felt that the initiative had been very successful.  The person who passed said that it had changed his life.  For others, there were perceived benefits in raising self-esteem and self-confidence, as well as in encouraging close relationships with supportive adults.  These stand out in the resilience literature as important in helping young people overcome the effects of early adversity, including abuse, neglect, family breakdown and parental rejection.  Learning to drive may help combat some of the stigma associated with being in care and social exclusion, as well as an important symbolic transition to adulthood, which children in care may otherwise find difficult.  I keep explaining that you wouldn’t expect driving and cars to be a panacea (‘silver bullet’) for complex personal, social and structural problems.  However, the limited evidence, and theoretical justification, suggest that driving may be of disproportionate benefit.

Furthermore, it is often commented that it is unacceptable that the State doesn’t provide for children separated from their families and living in care in the same way as we would for our own children.  Examples include the low educational attainment and the inadequate support (‘accelerated transitions’) for care leavers.  The statement is rarely (never?) questioned.  How realistic is it?  For example, our son or daughter may ask us to look over and help with a school essay; would we do so with the same commitment and conscientiousness as a foster carer, residential worker or social worker?  This is one reason why adoption works particularly well as parents are more likely to provide the limitless support or ‘unconditional love’ that children need.  How else can the State replicate this in more temporary legal and social work circumstances?  How can it be expressed for adolescents in care?  What is a close approximation?  A useful article helps unpick some of these issues.

On reflection, starting off the driving lesson initiative was one effort in this direction.  Providing opportunities is no doubt more straightforward than guaranteeing care and emotional support. We often arrange driving lessons for our own children, so why shouldn’t we do the same as ‘corporate parents’?  In England at least, this has so far been unusual for residential settings, although foster carers may have made their own arrangements.  What other experiences might there be that could have a similar effect to strengthen resilience?  High educational attainment is probably best.  No doubt sports, caring for animals, music and drama work for some.  Another might be seeking part-time work, which is very uncommon if not unknown from my past residential studies.  Getting involved in advocacy work for children in care/Care Councils could work too.

It would be interesting to know what others think.

David is Professor of Child and Family Welfare in the School for Policy Studies at the University of Bristol.

Children, parents and screen-viewing: New evidence from the School for Policy Studies

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Russ Jago from the Centre for Exercise, Nutrition & Health Sciences discusses a recent paper in the International Journal of Behavioural Nutrition and Physical Activity on parent and child screen-viewing and its implications.

A body of evidence has shown that screen-viewing (watching TV, using the internet, playing games consoles) is associated with adverse health effects such as increased risk of heart disease, type 2 diabetes and obesity among adults. Recent research has also shown that screen-viewing is associated with adverse health effects among children and adolescents such as increased risk of obesity, higher cholesterol levels and poorer mental well-being. Collectively these findings indicate that there is a need to understand children and adolescent’s levels and patterns of screen-viewing among children and adolescents and identify ways in which the screen-viewing levels of children can be reduced. To date the bulk of this work has focussed on older-aged primary school aged children and adolescents with a lack of information about the screen-viewing patterns of younger children. This gap is important because previous work has shown that screen-viewing patterns are established in early life and then track through childhood into adulthood. Thus, there is a need to examine levels of screen-viewing among children at the start of primary school and the key factors that are associated with these patterns.

A relatively under-explored area of research is how patterns of screen-viewing may be shared between children and their parents. It seems logical that children who live in homes in which the parents engage in high levels of screen-viewing may be more likely to spend more time screen-viewing. Previous work has suggested that associations may exist between parent and child screen-viewing but again current research has been dominated by studies that have included older children and restricted to assessments of mothers’ TV viewing. These studies have not provided information on other forms of screen-viewing such as computer use or the roles of dads. These gaps are important as our previous work has shown that TV viewing is becoming a less dominant form of screen-viewing with other types of viewing such as tablet and smart-phones becoming more dominant.

In our current paper we attempted to look at these issues by examining the screen-viewing patterns of 1078 Year 1 (5-6 year old) children and their parents. These data are from the British Heart Foundation funded B-Proact1V project which was conducted in 63 primary schools in the greater Bristol area. We asked the parents to complete a survey reporting their own screen-viewing patterns and those of their child. In households in which there were 2 adults we asked the second parent to also report on his or her screen-viewing behaviour. We then examined levels of screen-viewing for the children and the parents and associations between parent and child screen-viewing. We found that 12 per cent of boys and eight per cent of girls in this age group watched more than two hours of TV on a weekday, with 30 per cent of parents exceeding this threshold. Figures were much higher at weekends, with 45 per cent of boys, 42 per cent of girls, 57 per cent of fathers and 53 per cent of mothers watching more than two hours of TV each day.

When we examined the associations between parent and child screen-viewing we found that children were at least 3.4 times more likely to spend more than two hours per day watching TV if their parents watched two or more hours of TV, compared to children whose parents watch less than two hours of TV. There were, however, different patterns for parents’ computer use in which daughters were 3.5 times more likely to use a computer at the weekends if their fathers spent more than 30 minutes a day doing so. There was, however, no evidence that sons were similarly influenced.

What do the results mean?

The results support our hypothesis that parents are strong influences on children’s screen-viewing behaviours and also show that it is not just mums but also dads who have important influences. These findings therefore imply that strategies which focus on reducing the screen-viewing habits of the entire family are likely to be important. Moreover, the results suggest that future behaviour change strategies need to focus on a broad range of screen-viewing behaviours and look at the factors that lead to screen-viewing and if they differ for weekdays versus weekend days. Over the next few months we will be analysing further data from this project to try and answer some of these more specific questions on how these behaviours are formed and how they might be changed.

Paper: ‘Cross-sectional associations between the screen-time of parents and young children: differences by parent and child gender and day of the week’ by R. Jago, J. Thompson, S. Sebire, L. Wood, L. Pool, J.Zahra and D. Lawlor in the International Journal of Behavioral Nutrition and Physical Activity, 2014, 11:54, doi:10.1186/1479-5868-11-54