A prospective cohort study to investigate parental stress and child health in low-income Chinese families: protocol paper

Rosa Sze Man Wong, Esther Yee Tak Yu, Vivian Yawei Guo, Eric Yuk-Fai Wan, Weng-Yee Chin, Carlos King Ho Wong, Colman Siu Cheung Fung, Keith Tsz Suen Tung, Wilfred Hing-Sang Wong, Patrick Ip, Agnes Fung Yee Tiwari, Cindy Lo Kuen Lam, Rosa Sze Man Wong, Esther Yee Tak Yu, Vivian Yawei Guo, Eric Yuk-Fai Wan, Weng-Yee Chin, Carlos King Ho Wong, Colman Siu Cheung Fung, Keith Tsz Suen Tung, Wilfred Hing-Sang Wong, Patrick Ip, Agnes Fung Yee Tiwari, Cindy Lo Kuen Lam

Abstract

Introduction: Chronic stress has adverse effects on health. Adults and children from low-income families are subject to multiple sources of stress. Existing literature about economic hardship mostly focuses on either adults or children but not both. Moreover, there is limited knowledge on the relationship between parental generalised stress and child health problems. This study aims to explore the bidirectional relationship between parental stress and child health in Chinese low-income families and to identify other modifiable factors influencing this relationship.

Methods and analysis: This prospective cohort study will sample 254 low-income parent-child pairs and follow them up for 24 months with assessments at three time points (baseline, 12 and 24 months) on parental stress, health-related quality of life (HRQOL) and child health and behaviour using both subjective measures and objective physiological parameters. This study will collect data using standardised measures on HRQOL and behaviours of children as well as on HRQOL, mental health and stress levels of parents along with physiological tests of allostatic load and telomere length. The mediating or moderating effect of family harmony, parenting style and neighbourhood conditions will also be assessed. Data will be analysed using latent growth modelling and cross-lagged path analysis modelling to examine the bidirectional effect of parental stress and child health over time. Mediation and moderation analysis will also be conducted to examine the mechanism by which the variables relate.

Ethics and dissemination: This study was approved by the institutional review board of the University of Hong Kong-the Hospital Authority Hong Kong West Cluster, reference no: UW 16-415. The study findings will be disseminated through peer-reviewed publications and international conferences.

Trial registration number: NCT03185273; Pre-results.

Keywords: bidirectional relationship; child health; health-related quality of life; low-income families; parental stress.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Study conceptual model. Potential confounders include baseline sociodemographic information (parental age and gender, child age and gender, household income, parental occupation and marital status), parental history of smoking, drinking and illicit drug use, parental and child history of comorbidities and child cognitive skills. BMI, body mass index.
Figure 2
Figure 2
Hypothesised cross-lagged path model predicting child health and parental stress from baseline to 24-month follow-up.

References

    1. Santiago CD, Kaltman S, Miranda J. Poverty and mental health: how do low-income adults and children fare in psychotherapy? J Clin Psychol 2013;69:115–26. 10.1002/jclp.21951
    1. Lantz PM, House JS, Mero RP, et al. . Stress, life events, and socioeconomic disparities in health: results from the Americans' Changing Lives Study. J Health Soc Behav 2005;46:274–88. 10.1177/002214650504600305
    1. Guedes A, Bott S, Garcia-Moreno C, et al. . Bridging the gaps: a global review of intersections of violence against women and violence against children. Glob Health Action 2016;9:31516 10.3402/gha.v9.31516
    1. He W, James SA, Merli MG, et al. . An increasing socioeconomic gap in childhood overweight and obesity in China. Am J Public Health 2014;104:e14–22. 10.2105/AJPH.2013.301669
    1. Ip P, Ho FK, So HK, et al. . Socioeconomic gradient in childhood obesity and hypertension: a multilevel population-based study in a Chinese community. PLoS One 2016;11:e0156945 10.1371/journal.pone.0156945
    1. The Goverment of the Hong Kong Special Administrative Region. Hong Kong Poverty Situation Report. Hong Kong: The Goverment of the Hong Kong, 2013:169.
    1. Subramanian SV, Kawachi I. Income inequality and health: what have we learned so far? Epidemiol Rev 2004;26:78–91. 10.1093/epirev/mxh003
    1. Wong RSM, Guo VY, Ip P, et al. . Mothers’ health-related quality of life: Its relationship with children’s health-related quality of life and behavior in low-income families. Fam Med Community Health 2016;4:4–12. 10.15212/FMCH.2016.0124
    1. Lam CLK, Guo VY, Wong CKH, et al. . Poverty and health-related quality of life of people living in Hong Kong: comparison of individuals from low-income families and the general population. J Public Health 2017;39:258–65. 10.1093/pubmed/fdw046
    1. Conger RD, Wallace LE, Sun Y, et al. . Economic pressure in African American families: a replication and extension of the family stress model. Dev Psychol 2002;38:179–93. 10.1037/0012-1649.38.2.179
    1. Evans GW, Kim P. Childhood poverty, chronic stress, self-regulation, and coping. Child Dev Perspect 2013;7:43–8. 10.1111/cdep.12013
    1. Neece CL, Green SA, Baker BL. Parenting stress and child behavior problems: a transactional relationship across time. Am J Intellect Dev Disabil 2012;117:48–66. 10.1352/1944-7558-117.1.48
    1. Stone LL, Mares SH, Otten R, et al. . The Co-Development of Parenting Stress and Childhood Internalizing and Externalizing Problems. J Psychopathol Behav Assess 2016;38:76–86. 10.1007/s10862-015-9500-3
    1. Slack KS, Holl JL, McDaniel M, et al. . Understanding the risks of child neglect: an exploration of poverty and parenting characteristics. Child Maltreat 2004;9:395–408. 10.1177/1077559504269193
    1. Masarik AS, Conger RD. Stress and child development: a review of the family stress model. Curr Opin Psychol 2017;13:85–90. 10.1016/j.copsyc.2016.05.008
    1. Cronin S, Becher E, Christians KS, et al. . Parents and stress: understanding experiences, context, and responses. St. Paul, MN: University of Minnesota Extension, Children, Youth and Family Consortium, 2015.
    1. Belsky J. The determinants of parenting: a process model. Child Dev 1984;55:83–96. 10.2307/1129836
    1. Juster RP, McEwen BS, Lupien SJ. Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev 2010;35:2–16. 10.1016/j.neubiorev.2009.10.002
    1. McEwen BS. Allostasis and allostatic load: implications for neuropsychopharmacology. Neuropsychopharmacology 2000;22:108–24. 10.1016/S0893-133X(99)00129-3
    1. UNICEF (United Nations Childrens' Fund). Child poverty in perspective: an overview of child well-being in rich countries. Innocenti Report Card 7. Florence, Italy: UNICEF Inncenti Research Centre, 2007.
    1. Luecken LJ, Lemery KS. Early caregiving and physiological stress responses. Clin Psychol Rev 2004;24:171–91. 10.1016/j.cpr.2004.01.003
    1. National Research Council. Children’s health, the Nation’s wealth: assessing and improving child health. Washington, DC: National Academic Press, 2004.
    1. Drury SS, Theall K, Gleason MM, et al. . Telomere length and early severe social deprivation: linking early adversity and cellular aging. Mol Psychiatry 2012;17:719–27. 10.1038/mp.2011.53
    1. Ip P, Chung BH, Ho FK, et al. . Prenatal Tobacco Exposure Shortens Telomere Length in Children. Nicotine Tob Res 2017;19:111–8. 10.1093/ntr/ntw139
    1. Asok A, Bernard K, Roth TL, et al. . Parental responsiveness moderates the association between early-life stress and reduced telomere length. Dev Psychopathol 2013;25:577–85. 10.1017/S0954579413000011
    1. Gotlib IH, LeMoult J, Colich NL, et al. . Telomere length and cortisol reactivity in children of depressed mothers. Mol Psychiatry 2015;20:615–20. 10.1038/mp.2014.119
    1. Theall KP, Brett ZH, Shirtcliff EA, et al. . Neighborhood disorder and telomeres: connecting children’s exposure to community level stress and cellular response. Soc Sci Med 2013;85:50–8. 10.1016/j.socscimed.2013.02.030
    1. Bowers ME, Yehuda R. Intergenerational Transmission of Stress in Humans. Neuropsychopharmacology 2016;41:232–44. 10.1038/npp.2015.247
    1. Rodriguez CM, Green AJ. Parenting stress and anger expression as predictors of child abuse potential. Child Abuse Negl 1997;21:367–77. 10.1016/S0145-2134(96)00177-9
    1. Ridout KK, Levandowski M, Ridout SJ, et al. . Early life adversity and telomere length: a meta-analysis. Mol Psychiatry 2017. 10.1038/mp.2017.26
    1. Norman RE, Byambaa M, De R, et al. . The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS Med 2012;9:e1001349 10.1371/journal.pmed.1001349
    1. Ip P, Wong RS, Li SL, et al. . Mental health consequences of childhood physical abuse in chinese populations: a meta-analysis. Trauma Violence Abuse 2016;17:571–84. 10.1177/1524838015585317
    1. Conger RD, Conger KJ, Martin MJ. Socioeconomic status, family processes, and individual development. J Marriage Fam 2010;72:685–704. 10.1111/j.1741-3737.2010.00725.x
    1. Katz LF, Woodin EM. Hostility, hostile detachment, and conflict engagement in marriages: effects on child and family functioning. Child Dev 2002;73:636–52. 10.1111/1467-8624.00428
    1. Guo VY, Yu EYT, Wong RSM, et al. . Maternal mental quality of life mediates the associations between intimate partner abuse against mothers and their children’s behaviours and quality of life in low-income Chinese families. Qual Life Res 2017;26:3297–306. 10.1007/s11136-017-1664-8
    1. Halliday JA, Palma CL, Mellor D, et al. . The relationship between family functioning and child and adolescent overweight and obesity: a systematic review. Int J Obes 2014;38:480–93. 10.1038/ijo.2013.213
    1. Cousino MK, Hazen RA. Parenting stress among caregivers of children with chronic illness: a systematic review. J Pediatr Psychol 2013;38:809–28. 10.1093/jpepsy/jst049
    1. Egeland B, Breitenbucher M, Rosenberg D. Prospective study of the significance of life stress in the etiology of child abuse. J Consult Clin Psychol 1980;48:195–205. 10.1037/0022-006X.48.2.195
    1. Crouch JL, Behl LE. Relationships among parental beliefs in corporal punishment, reported stress, and physical child abuse potential. Child Abuse Negl 2001;25:413–9. 10.1016/S0145-2134(00)00256-8
    1. Pinquart M, Kauser R. Do the associations of parenting styles with behavior problems and academic achievement vary by culture? Results from a meta-analysis. Cultur Divers Ethnic Minor Psychol 2018;24:75–100. 10.1037/cdp0000149
    1. Sokol RL, Qin B, Poti JM. Parenting styles and body mass index: a systematic review of prospective studies among children. Obes Rev 2017;18:281–92. 10.1111/obr.12497
    1. Minh A, Muhajarine N, Janus M, et al. . A review of neighborhood effects and early child development: how, where, and for whom, do neighborhoods matter? Health Place 2017;46:155–74. 10.1016/j.healthplace.2017.04.012
    1. Fung CS, Yu EY, Guo VY, et al. . Development of a Health Empowerment Programme to improve the health of working poor families: protocol for a prospective cohort study in Hong Kong. BMJ Open 2016;6:e010015 10.1136/bmjopen-2015-010015
    1. Cohen J. Statistical power analysis for the behavior science. Mahwah, NJ: Lawrance Eribaum Association, 1988.
    1. Harris RJ. A primer of multivariate statistics. Hove, UK: Psychology Press, 2001.
    1. Green SB. How many subjects does it take to do a regression analysis. Multivariate Behav Res 1991;26:499–510. 10.1207/s15327906mbr2603_7
    1. Landgraf JM, Abetz L, Ware JE, et al. . Child Health Questionnaire (CHQ): a user’s manual. Boston: Health Institute, New England Medical Center Boston, 2013.
    1. Lee SL, Cheung YF, Wong HS, et al. . Chronic health problems and health-related quality of life in Chinese children and adolescents: a population-based study in Hong Kong. BMJ Open 2013;3:e001183 10.1136/bmjopen-2012-001183
    1. Lai KY, Luk ES, Leung PW, et al. . Validation of the Chinese version of the strengths and difficulties questionnaire in Hong Kong. Soc Psychiatry Psychiatr Epidemiol 2010;45:1179–86. 10.1007/s00127-009-0152-z
    1. Cawthon RM. Telomere measurement by quantitative PCR. Nucleic Acids Res 2002;30:47e–47. 10.1093/nar/30.10.e47
    1. Dinsdale H, Ridler C, Ells L. A simple guide to classifying body mass index in children. Oxford: National Obesity Observatory, 2011.
    1. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995;33:335–43. 10.1016/0005-7967(94)00075-U
    1. Wang K, Shi HS, Geng FL, et al. . Cross-cultural validation of the Depression Anxiety Stress Scale-21 in China. Psychol Assess 2016;28:e88–100. 10.1037/pas0000207
    1. Lam C, Wong C, Lam E, et al. . Population norm of Chinese (HK) SF-12 health survey-version 2 of Chinese adults in Hong Kong. Hong Kong Practitioner 2010;32:77–86.
    1. Lam ET, Lam CL, Fong DY, et al. . Is the SF-12 version 2 Health Survey a valid and equivalent substitute for the SF-36 version 2 Health Survey for the Chinese? J Eval Clin Pract 2013;19:200–8. 10.1111/j.1365-2753.2011.01800.x
    1. Kavikondala S, Stewart SM, Ni MY, et al. . Structure and validity of Family Harmony Scale: An instrument for measuring harmony. Psychol Assess 2016;28:307–18. 10.1037/pas0000131
    1. Chan KL, Brownridge DA, Fong DY, et al. . Violence against pregnant women can increase the risk of child abuse: a longitudinal study. Child Abuse Negl 2012;36:275–84. 10.1016/j.chiabu.2011.12.003
    1. Wu P, Robinson CC, Yang C, et al. . Similarities and differences in mothers’ parenting of preschoolers in China and the United States. Int J Behav Dev 2002;26:481–91. 10.1080/01650250143000436
    1. Olivari MG, Tagliabue S, Confalonieri E. Parenting Style and Dimensions Questionnaire: A Review of Reliability and Validity. Marriage Fam Rev 2013;49:465–90. 10.1080/01494929.2013.770812
    1. Chou KL. Perceived discrimination and depression among new migrants to Hong Kong: the moderating role of social support and neighborhood collective efficacy. J Affect Disord 2012;138:63–70. 10.1016/j.jad.2011.12.029

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