Family structure and respiratory health: a longitudinal approach

Lidia Panico, University College London

This inter-disciplinary project investigates the relationship between family structure and changes in family structure over the first five years of life and childhood respiratory health. The two main aims are: (1) to determine whether family structure and changes in family structure are associated with children’s physical health in the Millennium Cohort Study; (2) to explore potential pathways through which these associations operate. In spite of much public debate around families, marriage and child outcomes, UK literature on this topic remains incomplete. This thesis aims to fill two gaps: first, testing whether there is a link with children’s physical health, rather than more commonly reported outcomes such as cognitive function or education achievements. Respiratory health was chosen, as it represents a high disease burden for young British children. Second, few studies use prospective, longitudinal data and methods. Cross sectional studies cannot examine the direction of the relationship, nor capture the dynamics of changes in family structure. These analyses employ graphical chain models, a technique that allows the testing of a complex model made up of variables ordered a priori following a theoretical ordering. In unadjusted analyses, family structure presented a consistent gradient in respiratory health: cross-sectionally, children living with married parents had better health than those living with cohabiting parents, while those living with lone parents had the worst health. Longitudinally, those who experienced changes in family structure fared worse than those living with continuously married parents, with some important exceptions. In fact, an important highlight of this work is that those who experience changes in family structure are a heterogeneous group with different backgrounds and outcomes. Socio-economic factors were important predictors of family structure and respiratory health. More proximal pathways through which socio-economic characteristics and family structure affected respiratory health included damp, breastfeeding and maternal mental health.