Professor Richard Layte

The aim of this mixed methods research is to describe and explore progress of the SHCP in relation to best evidence, develop a theory of change for the programme, incorporate the findings into a research-based tool for the SHCP areas, and to inform ongoing programme monitoring and future direction.

A person's physical growth, psychological development and personal behaviours in adolescence are the foundation upon which the life course is built. Health behaviours established in adolescence will likely continue into adulthood with long-term implications for health and life-expectancy. For example, 80% of teenagers measured as obese will remain obese as adults and so experience a substantially higher risk of disease later in life. Health and psychological development in adolescence can also have life-long consequences if they obstruct the person's acquisition of important skills and educational qualifications. Educational failure brings with it more unemployment, lower pay and a greater risk of experiencing poverty across the life-course, all of which are associated with worse psychological and physical health and well-being. This project seeks to understand how family, neighbourhood environment and parental social and economic position interact with individual characteristics such as such as sex, personality and temperament to shape mental health, health behaviours and educational outcomes at the end of secondary schooling and the cusp of adulthood. We ask three inter-linked questions: "how do peer relationships and exposure to social media influence the risk of developing anxiety and depression?"; "how do family, neighbourhood and individual characteristics shape the development of health behaviours such as diet, exercise, smoking and alcohol consumption?"; "did the financial crisis and recession experienced in Ireland between 2008 and 2014 influenced educational outcomes at the end of senior cycle and if so, how?" The project will use innovative statistical methods and quasi-experimental designs to analyse large-scale, longitudinal data from two national cohort studies following child development from birth to 18 years. Research findings from this project will provide evidence about what factors in the child's environment in childhood and adolescence are modifiable and so possible targets for changes in policy and practice.

Convergent findings from neuroscience, psychology and the social sciences indicate that the foundations of educational achievement, lifelong health, economic productivity, and responsible citizenship (i.e. `flourishing") are formed early in life. For example, inequalities in child educational performance by family socioeconomic position emerge in infancy and increase over time, driven in part by gaps in cognitive development. Inequalities in non-cognitive skills (NCS), e.g. emotional and behavioural adjustment also play a role, but current theories and evidence cannot explain why NCS vary by family socioeconomic position. FLOURISH proposes that NCS are `embodied structures" which are shaped by `relational structures", i.e. the social and economic patterning of social connection across different settings (e.g. home, neighbourhood and school). In addition, FLOURISH proposes that social connection and NCS shape child and adolescent behaviours and educational achievement through psychosocial mechanisms, reproducing inequalities in life chances, health and well-being by SEP. Drawing on four child cohort studies from different countries with longitudinal data on over 93,000 individuals and cross-sectional data on over 455,000 individuals plus state of the art data science using innovative quasi-experimental methods, FLOURISH will provide insight into the social and economic structuring of social connection. In addition, a randomised intervention study with disadvantaged adolescents with qualitative longitudinal process assessment will assess the value of an innovative group-based intervention. By triangulating large-scale quantitative analysis with experimental evidence and qualitative understanding, FLOURISH will explore whether and how social connection contributes to observed patterns of NCS by sex between infancy and early adulthood and the mediating role of NCS in the social patterning of educational achievement and adolescent behaviours.

The life course approach recognises that SES is an important determinant of a wide range of material, behavioural, environmental, and psychosocial exposures that shape health through multiple, complex and interacting pathways. The pernicious effects of living in low SES environments can be seen every major organ system of the body prompting some investigators to suggest that SES may operate through general mechanisms that contribute to a range of biological processes affecting multiple organ systems. Allostatic Load (AL) has been posited as a potential explanatory framework for understanding the biological embedding of SES over the life course. We propose to examine the theoretical and empirical utility of AL as an intermediate construct on the pathway between SES and health using The Irish Longitudinal Study on Ageing (TILDA).

Over the past 35 years there has been a sustained increase in the Caesarean section (CS) rate in developed countries including Ireland. In 1993, the Department of Health and Children in Ireland reported a CS rate of 13%. By 1999, the next year for which data are available, the rate was 20.4%, increasing to 26.9% by 2009. To date there has been little research on trends in CS in Ireland. In a recent publication the WHO (WHO et al 2009) have stated that there is no empirical evidence for an optimum percentage but questions remain as to why CS rates have been increasing over time. Significant variation in CS rates across hospitals in Ireland also raise concerns about the efficacy of the procedure in some instances. Rates of CS in Irish hospitals varied from 18.6% to 36.4% in 2009 and all but 3 of the 19 maternity units in the Irish hospital system experienced an increase in their CS rate over the period from 1999 to 2009. This project uses linked data from two national databases, the Hospital In-Patient Enquiry scheme (HIPE) and the National Perinatal Reporting System (NPRS) and an in depth prospective study from a large Dublin maternity hospital to investigate the factors that explain the increase in CS in Ireland and the pattern of variation across Irish hospitals. The project will investigate the role of changing maternal characteristics (e.g. increasing age, lower parity (previous births) and obesity), clinical risk factors for CS (e.g. malpresentation, pre-eclampsia, diabetes), changing clinical practices and organisational structures (e.g. private practice, staffing and policy). By understanding the processes associated with growing use of CS in Irish maternity hospitals the project will contribute to the development and improvement of policy and practice in maternity care.