Is the healthy start scheme associated with increased food expenditure in low-income families with young children in the United Kingdom?

Background Healthy Start is a food assistance programme in the United Kingdom (UK) which aims to provide a nutritional safety-net and enable low-income families on welfare benefits to access a healthier diet through the provision of food vouchers. Healthy Start was launched in 2006 but remains under-evaluated. This study aims to determine whether participation in the Healthy Start scheme is associated with differences in food expenditure in a nationally representative sample of households in the UK. Methods Cross-sectional analyses of the Living Costs and Food Survey dataset (2010–2017). All households with a child (0–3 years) or pregnant woman were included in the analysis (n = 4869). Multivariable quantile regression compared the expenditure and quantity of fruit and vegetables (FV), infant formula and total food purchases. Four exposure groups were defined based on eligibility, participation and income (Healthy Start Participating, Eligible Non-participating, Nearly Eligible low-income and Ineligible high-income households). Results Of 876 eligible households, 54% participated in Healthy Start. No statistically significant differences were found in FV or total food purchases between participating and eligible non-participating households, but infant formula purchases were lower in Healthy Start participating households. Ineligible higher-income households had higher purchases of FV. Conclusion This study did not find evidence of an association between Healthy Start participation and FV expenditure. Moreover, inequalities in FV purchasing persist in the UK. Higher participation and increased voucher value may help to improve programme performance and counteract the harmful effects of poverty on diet.

Early support: Evaluation of the pilot projects and the development of an implementation model

Early support is an overall concept of health promoting and preventive measures for families with children up to 3 years. This includes direct interventions for children as well as offers and measures for parents and other caregivers. Based on a first research project, which showed that health and social services are repeatedly confronted with stressful family situations, but that families are often only supported late or too late, there were implemented two pilot projects in an urban and rural area of Northern Italy (called South Tyrol). The projects were evaluated using a multimethod approach, analysing existing documentation, and through focus groups, interviews, and qualitative questionnaires. The results of all the different research methods show very uniformly that many professionals and responsible persons were insufficiently informed about the health promotional and preventive potential of early support and about the importance of a good collaboration and network for a healthy start in live at the beginning of the projects. It took two years of intensive process to improve cooperation, but also knowledge and competences in this area. Through the intensive coordinated cooperation in a core team of public social and health services and psychologists (family counselling), a significant improvement could be achieved not only for these members of this core team, but above all also for the entire departments of the collaborating services. Professionals reported that not only has the quality of their work improved significantly because of this process, but there is also a noticeable lightening of the workload, which must be of great importance in the burdening fields of social and health services. Building on the results of the evaluation of these projects a model was developed of how a system of early support that accompanies families in a healthy start can be implemented in the whole region. The implementation is approved for 2022. Key messages The aim of early support is to build systems to strengthen and support all families preventively. Interdisciplinary cooperation in early support teams led to improved quality of work and lower workloads.

Hepatic fat in early childhood is independently associated with estimated insulin resistance: The Healthy Start Study

Background Fatty liver disease is a common metabolic abnormality in adolescents with obesity, but remains under-studied in early childhood. Objectives To describe hepatic fat deposition in prepubertal children and examine associations with metabolic markers and body composition. Methods Data were from 286 children ages 4-8 years old in the Healthy Start Study, a longitudinal pre-birth cohort in Colorado. Assessments included magnetic resonance imaging to quantify hepatic and abdominal fats, fasting blood draws to measure metabolic markers, and air displacement plethysmography to measure body composition (fat mass and fat-free mass). Results The median (IQR) for hepatic fat was 1.65% (1.24%,2.11%). Log-transformed hepatic fat was higher in Hispanic [Mean (95% CI): 0.63 (0.52,0.74)] vs. non-Hispanic white children [0.46 (0.38,0.53), p=0.01] and children with overweight/obesity [0.64 (0.49,0.79)] vs. normal-weight [0.47 (0.40,0.53), p=0.02]. Higher log-hepatic fat was associated with higher insulin [β(95% CI): 1.47 (0.61,2.33) uIU/mL, p=0.001] and estimated insulin resistance (homeostatic model assessment) [0.40 (0.20,0.60), p<0.001] in the full sample, and glucose [5.53 (2.84,8.21) mg/dL, p<0.001] and triglycerides [10.92 (2.92,18.91) mg/dL, p=0.008] in boys, in models adjusted for sociodemographics, maternal/perinatal confounders, and percent body fat. Log-hepatic fat was also associated with abdominal subcutaneous adipose tissue [7.37 (1.12,13.60) mm 2, p=0.02] in unadjusted models, but this was attenuated and insignificant after adjusting for confounders. Conclusions While hepatic fat was low in children 4-8 years old, it was independently associated with estimated insulin sensitivity and exhibited sex-specific associations with glucose and triglycerides, suggesting hepatic fat may be an early indicator of metabolic dysfunction in youth.

The roles of attachment style and maternal depression in the development of childhood depression

This study aimed to determine how stable parent ratings of their infant's temperament/attachment style is across one year of development and establish if there is a specific pathway that leads to child depression and or internalizing and externalizing behaviors originating with maternal depression or insecure attachment styles between the infant and their mothers. The data for this study was collected as part of a multisite, randomized trial of Hawaii's Healthy Start Program (HSP) (Duggan et al., 2004). The Hawaii Healthy Start Program (HSP) is a home visiting program targeted at families at-risk of child abuse and neglect. The racial and ethnic characteristics for total participants are as follows: 12 percent identified as White, 9 percent identified as Asian, 13 percent identified as Pacific Islander, 20 percent identified as Filipino, 20 percent identified as Native Hawaiian, 27 percent identified as Black/ Multiracial (Duggan et al. 1999). The mean age for participating mothers was 23.4 (SD = 5.8) and 68 percent of the families had incomes belopoverty line (Duggan et al., 1999). The following measures were used in the present study: The Bate's Attachment Scale, The Center for Epidemiological Studies Depression Scale (CES-D), The Child Behavioral Checklist (CBCL), and The Children's Depression Inventory (CDI). Unlike the majority of literature, the present findings suggest that maternal depression and attachment issues during the first year of life served as only a very modest risk for future child internalizing symptoms. Similar to the findings regarding child depression, relations between parent and teacher rated externalizing symptoms, maternal depression, and attachment were fairly small. Only for parent rated externalizing symptoms there was a small association between externalizing score and maternal depression and a small association between parent rating of externalizing behaviors and parent ratings of child attachment. Keywords: child depression, child externalizing behaviors, maternal depression