Releases Saturday 28 July 2001
No 7306 Volume 323

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(1) ANTISOCIAL CHILDREN ARE A FINANCIAL
DRAIN ON SOCIETY, BUT PARENTAL TRAINING
CAN HELP

(2) LOW INCOME SMOKERS SUPPORT SMUGGLING
TO MAINTAIN HABIT

(3) DEPRIVED AREAS SHOW GREATEST INCREASE
IN TEENAGE PREGNANCIES

(4) CHILDREN IN CARE ARE A GREATER RISK OF
DEATH

(5) HEALTH SYSTEM FAILS CHILDREN EXPOSED TO
DEMOSTIC VIOLENCE



(1) ANTISOCIAL CHILDREN ARE A FINANCIAL
DRAIN ON SOCIETY, BUT PARENTAL TRAINING
CAN HELP

(Financial cost of social exclusion: follow up study of
antisocial children into adulthood)
http://bmj.com/cgi/content/full/323/7306/191

(Multicentre controlled trial of parenting groups for
childhood antisocial behaviour in clinical practice)
http://bmj.com/cgi/content/full/323/7306/194

(Commentary: nipping conduct problems in the bud)
http://bmj.com/cgi/content/full/323/7306/194

Children who display antisocial behaviour cost society 10
times more than those with no problems and are at high risk
of lifelong social exclusion, concludes a study in this week's
BMJ. However, a second study reports that parental
training programmes can be a cost effective way to nip
serious antisocial behaviour in children in the bud.

In the first study, Scott and colleagues tracked the costs to
the public sector of 142 children with different levels of
antisocial behaviour, from age 10 to their late 20s. By age
28, costs for individuals with serious antisocial behaviour
were 10 times higher than for those with no problems.
Crime incurred the greatest cost, followed by special
educational provision, foster and residential care, and state
benefits. Early interventions to reduce antisocial behaviour in
childhood could result in large cost savings, they conclude.

In the second study, the team identified 141 highly antisocial
children aged 3-8 years. The parents of 90 children
completed a training programme; the remaining 51 parents
received no such training. Children in the training group
showed a large reduction in antisocial behaviour, while
those in the control group did not change.

Although such parenting programmes are only just beginning
to become available in the United Kingdom, they show
promise as a cost effective way to reduce the personal and
economic burden of antisocial behaviour in children and to
prevent criminality and social exclusion, conclude the
authors.

Contact:

Stephen Scott, Senior Lecturer in Child and Adolescent
Psychiatry, King's College London, London, UK
Email: s.scott@iop.kcl.ac.uk

(2) LOW INCOME SMOKERS SUPPORT SMUGGLING
TO MAINTAIN HABIT

("They're doing people a service" ± qualitative study of
smoking, smuggling, and social deprivation)
http://bmj.com/cgi/content/full/323/7306/203

Low income smokers living in socially deprived areas view
cigarette and tobacco smuggling as a positive way of dealing
with the increasing costs of cigarettes, concludes a study in
this week's BMJ. This suggests that they may show little
support for tackling smuggling until more government action
is taken to help them quit.

Researchers at the University of Edinburgh interviewed 50
male and 50 female smokers, aged 25-40 years and living in
two socially deprived areas, about their smoking behaviour.
They found that most smokers wanted to quit but perceived
a lack of support to help them to stop smoking. Strategies
to maintain smoking in the face of increasing cigarette prices
and low income included buying contraband products,
particularly in pubs.

Respondents viewed smuggling as a reasonable response to
the perceived high prices of cigarettes and considered that
smugglers were providing a valuable service. Many smokers
criticised the government for its high tobacco taxation and
the lack of local services to help them stop smoking.

The government has already taken action to reduce
smuggling, but more needs to be done, say the authors.
Given that deprived areas have the highest rates of smoking
and lowest levels of quitting, at the very least it is essential
that smoking cessation services are expanded to become
more accessible to disadvantaged smokers in Britain, they
conclude.

Contact:

Amanda Amos, Senior Lecturer, Department of Community
Health Sciences, University of Edinburgh Medical School,
Edinburgh, Scotland
Email: amanda.amos@ed.ac.uk

(3) DEPRIVED AREAS SHOW GREATEST INCREASE
IN TEENAGE PREGNANCIES

(Changing patterns of teenage pregnancy: population based
study of small areas)
http://bmj.com/cgi/content/full/323/7306/199

From the 1980s to the 1990s rates of teenage pregnancy in
Scotland increased more rapidly in areas of greater
socioeconomic deprivation, finds a study in this week's
BMJ. This finding has implications for allocating resources
to achieve government targets in reducing pregnancy rates
by 2010.

Research carried out at Glasgow University investigated the
impact of socioeconomic deprivation on teenage pregnancy
and the extent of local variation in Scotland, and how both
had changed between the 1980s and 1990s.

Among teenagers aged less than 18, the annual pregnancy
rate increased in more deprived areas, but there was no
change, on average, among teenagers in more affluent areas.
Among 18-19 year olds, the pregnancy rate decreased in
more affluent areas and increased in more deprived areas.

The results also show that in the 1990s, socioeconomic
deprivation explained more than half of the local variation in
rates of teenage pregnancy, more than double the amount
explained by deprivation in the 1980s.

Improved access to contraception and sex education may
play important roles in helping to reduce unwanted teenage
pregnancies, but the increased impact of deprivation in the
1990s suggests other social processes behind the patterns
of change, concludes the author.

Contact:

Alice McLeod, National Evaluation of Sure Start, Birkbeck
College, London, UK
Email: a.mcleod@psychology.bbk.ac.uk

(4) CHILDREN IN CARE ARE A GREATER RISK OF
DEATH

(Mortality in children registered in the Finnish child welfare
registry: population based study)
http://bmj.com/cgi/content/full/323/7306/207

Children in care are more likely to die before age 18
compared with the general population of the same age,
conclude researchers from Finland in this week's BMJ. The
results indicate the need for continuing attention to be paid
to the transition period from foster care to independence.

The study analysed deaths among all children in Finland
who were taken into care between 1991 and 1997. During
the study period 106 individuals (32 females and 74 males)
died. In both sexes, this represents a higher death rate than
would have been expected in the general population and in
the most socially disadvantaged groups in Finland.

Substance misuse, accidents, and suicide accounted for the
higher death rate in this group. Deaths related to alcohol and
drug misuse also occurred at a higher rate than expected.
Deaths from illness can be attributed to an increase in acute
and chronic health conditions and developmental delays
among children in foster care, add the authors.

The child protection system does not cause the deaths, but
it fails to protect adolescents from self endangering
behaviour both within the system and during adaptation to
independent living, say the authors. Continuing attention
needs to be paid to the transition period from foster care to
independence, they conclude.

Contact:

Mirjam Kalland, Researcher, Save the Children, Helsinki,
Finland Mobile: +358 40 76 77 225 Email:
mirjam.kalland@pela.fi

(5) HEALTH SYSTEM FAILS CHILDREN EXPOSED TO
DEMOSTIC VIOLENCE

(The health of children in refuges for women victims of
domestic violence: cross sectional descriptive survey)
http://bmj.com/cgi/content/full/323/7306/210

(Editorial: Reaching all children)
http://bmj.com/cgi/content/full/323/7306/176

Children whose mothers are victims of domestic violence
are at high risk of physical and psychological ill health, yet
these children are being failed by the health system, finds a
study in this week's BMJ. New strategies are urgently
needed to meet the needs of these largely "invisible"
children.

Researchers in Cardiff assessed 148 children living in
refuges for women victims of domestic violence. Records
from the child health system were incorrect or unavailable
for over half the children and uptake of routine health
assessments and immunisations was low.

Nineteen per cent of children aged 3-4 years had
developmental problems and almost half the children aged
3-15 years displayed probable mental health difficulties.
Concerns about physical, emotional and behavioural
wellbeing was expressed by mothers of 113 (76%)
children.

Child health surveillance should be accessible to all children
yet, in effect, these children form a largely invisible
population, outside the health system and poorly served by
it. We are concerned that, without dedicated services to
which these families can be referred, many fall through the
system.

The authors argue that time spent in a refuge provides a
window of opportunity to review the health and
developmental status of these children. Specialist health
visitors could provide support and advocacy and facilitate
access to mainstream services, they conclude.

Contact:

Judith Shankleman, Sure Start Health Visitor, Splott Clinic,
Cardiff, Wales


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