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Associations between maternal experiences of racism and early child health and development: findings from the UK Millennium Cohort Study
  1. Yvonne Kelly1,
  2. Laia Becares2,
  3. James Nazroo2
  1. 1Institute for Social & Economic Research (ISER), University of Essex, Colchester, UK
  2. 2School of Social Sciences, The Cathie Marsh Centre for Census and Survey Research (CCSR), University of Manchester, Manchester, UK
  1. Correspondence to Professor Yvonne Kelly, Institute for Social & Economic Research (ISER), University of Essex, Wivenhoe Park, Colchester, UK; ykelly{at}essex.ac.uk

Abstract

Background Emerging evidence suggests that experienced racism might help explain observed ethnic inequalities in early child health and development. There are few studies outside the US context and none that consider mothers' experiences of racism in relation to a range of early childhood health and developmental markers.

Methods The authors used cross-sectional data from the UK Millennium Cohort Study on 2136 mothers and their 5-year-old children from ethnic minority groups. Measures of racism tapped two dimensions of mothers' experience: perceived frequency of racist attacks in residential area and interpersonal racism. Markers of child health and development were obesity; socioemotional difficulties; cognitive: verbal, non-verbal and spatial ability test scores.

Results There was a suggestion that the mothers' experience of interpersonal racism was associated with an increased risk of obesity (‘received insults’ OR=1.47; ‘treated unfairly’ OR=1.57; ‘disrespectful treatment by shop staff’ OR=1.55), but all CIs crossed 1.0, and size estimates were attenuated on further statistical adjustment. Perception of racism in the residential area was associated with socioemotional difficulties (fully adjusted coefficient=1.40, SE=0.47) and spatial abilities (fully adjusted coefficient=−1.99, SE=0.93) but not with verbal or non-verbal ability scores. Maternal experiences of racist insults were associated with non-verbal ability scores (fully adjusted coefficient=−1.70, SE=0.88).

Conclusion The results suggest that mothers' experienced racism is linked to markers of early child health and development. Interventions that aim to improve early child development and address ethnic health inequalities need to incorporate approaches to tackling racism at all levels of society.

  • Child
  • minority health
  • prejudice
  • socioeconomic factors
  • epidemiology
  • ethnicity
  • inequalities
  • longitudinal studies

http://dx.doi.org/10.1136/jech-2011-200814

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    Introduction

    A vast array of factors influence the course of child development,1 with stressful environments linked to unfavourable developmental profiles.2 Ethnic inequalities in markers of early child health and development have been documented,3–8 with explanations including roles for socioeconomic, ‘cultural’ and genetic factors.9 Relevant here, to our understanding of the formation of inequalities in child health and development, is an emerging literature on experienced racism and/or discrimination.10 ,11 Conceptually, racism at institutional and interpersonal levels serves to structure the distribution of risks and opportunities throughout the lifecourse.11 Children may experience racism and discrimination directly and/or vicariously, and, in turn, these experiences may influence psychological and physiological processes that lead to poor health and developmental outcomes.12 ,13 Further, evidence suggests that vicariously experienced racism and discrimination influences child health and development via aspects of the family environment such as supportive parenting and racial socialisation.14–16 For instance, parental support and sensitivity exhibited towards children are more likely to diminish under stressful conditions, including experienced racism and discrimination.14 Consequently, these stressors decrease the likelihood of parents being able to provide warm caring environments and increase the risk of harsh parenting practices,11 and such conditions do not promote favourable developmental outcomes in children.

    Studies have employed a variety of methods to capture experiences of racism and discrimination among children and young people, and both direct17–25 and vicarious26 ,27 experiences have been linked to health and development in childhood. Reports suggest that experienced racism is negatively associated with birthweight and gestation,28–30 socioemotional well-being,17–24 ,26 childhood illnesses,27 and markers of metabolic processes.25 Most intensively studied are older children and adolescents, with only a handful of studies considering potential associations with health and development among young children.19 ,26 ,27 Few studies have examined mothers' experienced racism on developmental outcomes in early childhood.26 ,27 Moreover, the bulk of work done in this field is from the USA, with a paucity of studies from elsewhere.10 ,11 ,27

    To our knowledge there are no prior population based studies of young children set in the UK on experienced racism and markers of health and development. This paper adds to what is already known by examining the links between different dimensions of mothers' reported racism and health and developmental outcomes in their children during early childhood. To do this we use data from the UK Millennium Cohort Study (MCS), an ethnically diverse population based sample, on mothers' experience of racism and child obesity, socioemotional difficulties and cognitive test scores covering verbal, non-verbal and spatial abilities.

    Methods

    Millennium Cohort Study

    The MCS is a nationally representative longitudinal study of infants born in the UK between September 2000 and January 2002. The survey design, recruitment process and fieldwork have been described in detail elsewhere.31 Briefly, households were identified through the Department of Work and Pensions Child Benefit system (in the UK, this monetary benefit is universally received) and were selected on the basis of where the family was resident shortly after the time of birth. The sample is clustered at the electoral ward (an administrative unit level) such that disadvantaged residential areas and areas with a high proportion of ethnic minority people are over-represented.

    The survey sweeps have occurred when cohort members were aged about 9 months (MCS1), 3 years (MCS2) and 5 years (MCS3). At MCS1, 18 552 families were recruited to the study (corresponding to an 85% interview rate). At MCS2, a further 692 families joined the survey, giving a total of 19 244. Loss to follow-up by MCS3 reduced the sample to 15 246 (79.2%). Across ethnic minority groups, there were differences in response rates, ranging from 75.8% for Indian mothers to 66.2% for Black Caribbean mothers. Ethnic group was measured as a self-assigned variable, with available responses derived from the 2001 UK census question.

    During the MCS3, home visit questions were asked about experiences of racism and discrimination, socioeconomic circumstances, demographic characteristics and the child's socioemotional behaviour. In addition, cognitive assessments were carried out by trained interviewers, and anthropometric measurements were taken.

    Ethical approval for the MCS was gained from the relevant ethics committees, and parents gave informed consent before interviews took place and separate written consent for cognitive assessments.

    Experienced racism and discrimination

    During the age 5 interview, all survey main respondents (98% mother of cohort member), hereafter referred to as the mother, were asked about the frequency of racist insults and attacks in their residential area with the following question: “… how common are insults or attacks to do with someone's race or colour?” Response categories ranged from 0: not at all common, to 3: very common (dichotomised into 0: not at all/not very common and 1: fairly/very common). Mothers from ethnic minority groups were asked four questions about their own experiences of racism and discrimination over the previous 12 months:

    1. “… how often has someone said something insulting to you because of your race or ethnicity?”

    2. “… how often have you been treated unfairly just because of your race or ethnicity?”

    3. “… how often has a shopkeeper or salesperson treated you in a disrespectful way just because of your race or ethnicity?”

    4. “… how often have members of your family been treated unfairly just because of their race or ethnicity?”

    Response categories were never, once or twice, several times, many times, can't say and were dichotomised into 0: never and 1: once or more. These items were developed for use in the Millennium Cohort Study.

    Although all questions tap into experiences of racism and discrimination in the children's environment, different domains of experiences of racism and discrimination can be distinguished in the measures. For example, the question on the frequency of attacks and insults in the residential area captures the kind of neighbourhoods children live in and is perhaps a wider measure of experienced racism and discrimination compared with measures one to four above, which reflect experiences of interpersonal racism. In the present study, we were interested in understanding the association between different domains of racism and discrimination and early child health and development, so we opted not to combine all five measures into a scale of racism and discrimination. The five racism variables were only moderately correlated (web table A1). Therefore, we decided to examine their individual and mutually adjusted associations with markers of child health and development. This approach allowed us to distinguish which of the five constructs had the strongest association with the outcomes of interest.

    Anthropometric measurements

    During home visits, cohort members' height and weight were measured in a standard manner. Obesity was defined using age- and gender-specific cut-points as recommended by the International Obesity Task Force.32

    Socioemotional difficulties

    Mothers were asked to complete the Strengths and Difficulties Questionnaire (SDQ), age 4–15 years version (http://www.sdqinfo.com). The SDQ is a validated tool that has been shown to compare favourably with other measures for identifying difficulties, for example, hyperactivity and attention problems.33 ,34 The SDQ asks questions about five domains of social and emotional behaviour, namely: conduct problems, hyperactivity, emotional symptoms, peer problems and pro-social behaviour. Scores from the first four domains are summed to construct a total difficulties score, which was analysed as a continuous variable with higher values indicating increased difficulties. The SDQ has been used and validated in ethnically diverse populations.35

    Cognitive ability assessments

    Cognitive ability was assessed using widely validated age appropriate tests from the British Ability Scale that have been shown to be predictive of later child cognitive performance.36 These were: the Naming Vocabulary test, which assesses verbal ability/expressive language by asking children to name items pictured in a booklet; the Picture Similarities test, which assesses non-verbal/problem-solving ability by asking children to place a picture card against the most similar in concept among a set of four other pictures, and the Pattern Construction test, which assesses spatial ability and consists of a set of timed tasks for the child, copying and constructing patterns with coloured tiles and cubes. These assessments use age-related starting points and alternative stopping points to protect the motivation and self-esteem of the child.36 Mean age standardised t-score values for British Ability Scale subscales are reported with higher values indicating more favourable outcomes.

    Covariates

    Factors thought to confound the association between maternal experience of racism and child health and development were considered in analytical models. Cohort member's gender, mother's age at the time of birth, languages spoken at home (only or mostly English vs other) and ethnicity were taken into account. Markers of socioeconomic position were family income (<£10 400, £10 400–£20 800, £20 801–£31 200, £31 201–£52 000, more than £52 000 and ‘refusal and don't know’) and highest parental educational qualification (NVQ equivalence scale: NVQ5 Higher degree, NVQ4 First degree/diploma, NVQ3 A/AS levels, NVQ2 GCSE grades A–C, NVQ1 GCSE grades D–G, Overseas qualification, None). The Index of Multiple Deprivation 2004,37 in deciles, was used as a measure of area-level deprivation. Models that examined children's socioemotional difficulties score included children's age and were adjusted for mother's current mental health, assessed with the six-item version of the Kessler questionnaire on psychological distress.38

    Sample

    Because of the moderating effect of multiple birth on markers of child development,39 we analysed data for singleton children from Indian (n=416), Pakistani (n=716), Bangladeshi (n=294), Black Caribbean (n=348) and Black African (n=362) ethnic groups and excluded data from children assigned to other ethnic minority groups as they had too few respondents. This gave a total of 2136 children included in our analysis.

    Analytical approach

    We found that markers of experienced racism and child health and development varied across ethnic groups (table 1). On one hand, it can be argued that people from ethnic minority groups have common experiences resulting from social stratification. On the other hand, diversity within and across minority groups could result in different experiences linked to appearance, national origin and heritage. We decided to test empirically whether associations between experienced racism and markers of child health and development varied by ethnic group. We did this by examining the statistical significance of a likelihood ratio test of the difference between a model without and with an interaction term of racism and ethnic group. Results were not statistically significant (web table A2). Therefore, we present models adjusted for but not stratified by ethnic group.

    View this table:
    Table 1

    Distribution of experienced racism, markers of childhood development and covariates by ethnicity

    To examine the independent contribution of each racism and discrimination measure on markers of child development, models were fitted in three steps: step 1 examined the five measures of racism and discrimination individually, adjusting for mother's age at time of birth, gender, languages spoken at home and ethnicity; step 2 included additional adjustments for socioeconomic position (family income, highest parental educational attainment and area deprivation) and step 3 additionally modelled all racism and discrimination measures simultaneously. For models on socioemotional difficulties, mother's mental health and child's age were adjusted for in all steps, 1–3. This approach to statistical modelling allowed us to examine the different ways that racialised identities of mothers are associated with markers of child health and development. In step 1, we were able to explore the individual contribution of different measures of racism and discrimination to early child health and development. In step 2, we were able to examine the additional contribution of wider structural socioeconomic inequalities to early child health and development. In step 3, we were able to assess the independent contribution of each measure of experienced racism and discrimination, above and beyond socioeconomic influences and other markers of racism and discrimination.

    Data analysis

    Data were analysed using Stata V.11.1 (Stata Corporation, 2009). Bivariate analyses examining covariates by cohort member's ethnicity were weighted to take account of the stratified and clustered sample design and the unequal probability of being sampled. Given the hierarchical nature of the MCS, with individuals (level 1) nested within residential areas (level 2), multilevel modelling was used, allowing us to correct for non-independence of observations due to geographic clustering. Complete case analysis reduced sample sizes for obesity =2072 (97.0%), socioemotional difficulties =1767 (82.3%), verbal ability =2062 (96.5%), non-verbal ability =2064 (96.6%) and spatial ability =2061 (96.5%). Associations between maternal experiences of racism and obesity were examined using random effects multilevel logistic regression models. Associations between maternal experience of racism with socioemotional difficulties and cognitive test scores were conducted using random effects multilevel linear regression models.

    Results

    The mean age of cohort members in the sample was 5.22 years (SE: 0.25). Mothers of Black African and Indian cohort members tended to be older, and mothers of Pakistani and Bangladeshi cohort members tended to have worse mental health and be more likely to live in socioeconomically disadvantaged circumstances (table 1) compared with mothers from other ethnic minority groups. Children from Bangladeshi, Black Caribbean and Black African groups were most likely to be obese, and those from Pakistani, Bangladeshi and Caribbean groups had unfavourable socio-emotional profiles, while Pakistani and Bangladeshi children had the lowest cognitive test scores.

    About 12% of mothers reported that racist insults or attacks were fairly/very common in their residential area. 23% of mothers reported that they had experienced verbal insults in the previous 12 months, 20% reported having experienced unfair treatment due to race or ethnicity, 17% reported experiencing disrespectful treatment from shop staff and 23% reported that a family member had been treated unfairly due to their race or ethnicity. The patterning of reported experienced racism varied according to ethnic group. For example, Bangladeshi mothers were most likely to perceive problems to do with racism in their residential areas, while Black Caribbean and African mothers were most likely to report unfair treatment, disrespectful treatment in shops and unfair treatment of family members (table 1).

    Experienced racism and early child health and development

    There were no statistically significant associations between measures of racism and risk of obesity (table 2). However, there was a suggestion that the mother's interpersonal experiences of racism was associated with an increased risk of obesity, for example, in step 1 of the analysis: ‘received insults’ OR=1.47; ‘treated unfairly’ OR=1.57; ‘disrespectful treatment by shop staff’ OR=1.55, but all CIs crossed 1.0, and size estimates were attenuated on further adjustment for covariates.

    View this table:
    Table 2

    ORs (95% CI) of obesity in ethnic minority cohort members by main respondents' experiences of racism and discrimination

    There was a strong and statistically significant association between the measure of racism in the residential area and socioemotional difficulties (step 3: coefficient=1.4, SE=0.47). ‘Disrespectful treatment from shop staff’ was associated with unfavourable socioemotional difficulties scores, but there was no association with other measures of interpersonal racism (table 3).

    View this table:
    Table 3

    Regression coefficients (SE) for socioemotional difficulties in ethnic minority cohort members by main respondents' experiences of racism and discrimination

    There were mixed results for markers of cognitive ability. Verbal ability was not associated with any measure of racism and discrimination (table 4). We did consider the possibility that this lack of association was a result of confounding with English language ability and included language spoken at home in the model to adjust for this, but this adjustment made only a small difference to model results. Non-verbal ability score was associated with just one marker of interpersonal racism—‘received insults’ (step 3: coefficient=−1.70, SE=0.88, table 4). Spatial ability was strongly associated with the measure of racism in the residential area (step 3: coefficient=−1.99, SE=0.93) but not with markers of interpersonal racism (table 4).

    View this table:
    Table 4

    Regression coefficients (SE) for cognitive test scores in ethnic minority cohort members by main respondents' experiences of racism and discrimination

    Discussion

    Main findings

    We expected that mothers' experience of racism and discrimination would be related to unfavourable developmental outcomes in their 5-year-old children. Our findings were mixed and suggested that mothers' perceptions of racism in their area of residence was negatively associated with socioemotional difficulties and spatial ability scores, while we found consistent but weak associations between measures of mother's interpersonal experience of racism and child obesity.

    Interpretation

    Our results are consistent with prior work that has shown links between experienced racism and socio-emotional well-being17–24 ,26 and markers of adiposity25 in children. Most relevant to our findings are the few studies that have examined experienced racism in relation to markers of early child health and development. Szlacha and colleagues19 studied 8-year-old Puerto Rican children in the USA and reported directly experienced racism to be associated with socioemotional difficulties. Caughey et al 26 showed that parental experience of racism was linked to anxiety and depression in their 3–4-year-old children but that effects were less marked for children whose parents ‘coped’ with their experiences. And, in an Australian study, Priest and colleagues27 showed that carers' experienced racism was linked to an increased likelihood of illnesses among their children.

    Our findings suggest different patterns of association between different domains of mothers' experienced racism and markers of physical, socio-emotional and cognitive development. This is perhaps not surprising given the vast array of environmental factors that influence different aspects of child development, alongside consideration of the pathways via which vicariously experienced racism and discrimination is hypothesised to affect child development. For example, experienced racism or feeling fearful about racist victimisation40 might impact on what parents allow their children to do and constrain their capacity to provide conditions that foster healthy child development.14 ,15 Furthermore, the characteristics of residential areas shape the likelihood of encountering optimal social conditions, economic resources and opportunities,40 ,41 and these in turn heavily influence the likelihood of engaging in certain types of behaviours that promote healthy development. In the case of socioemotional difficulties, these arise from processes to do with interactions between a child and individuals in his/her environment.1 Therefore, living in an area where racist attacks are perceived to be common may lead to children spending less time outside the home environment than might otherwise be the case, thus limiting the breadth of interactions and experiences with others outside the home setting. This may be further compounded by the impact of poor parental mental health, linked to experienced racism and discrimination, which in turn is likely to lead to non-favourable parent–child interactions and parenting behaviours.11 ,14 ,15 ,26 These proximal influences combine to negatively impact on socioemotional, as well as cognitive development.42 ,43 Obesity arises from a complex nexus of environmental influences, and we found only weak links with maternal experiences of racism and discrimination. But experienced racism and discrimination might reduce opportunities for physical activity and be linked to an increased tendency to consume fatty energy-dense foods44; however, we were not able to test these downstream pathways in the current study.

    Strengths and limitations

    Our study is the first to use data on mothers' experiences of racism and discrimination from a contemporary nationally representative sample of young children from the UK, analysing data on widely validated measures of child development. The cross-sectional nature of the data does, however, limit the extent of causal inferences that can be drawn from our findings. On the other hand, several studies have demonstrated longitudinal relationships between experienced racism and poor mental health in children,20 ,21 thus strengthening causal inference. Another limitation is in the measurement of experienced racism and discrimination, which is confined to one marker of the areas in which people live and a limited set of questions on interpersonal experiences of racism and discrimination. This might mean that with the measures available, we were not able to adequately capture the full range of chronic and acute experienced racism. The item on ‘disrespectful treatment by shop staff’ is not mutually exclusive from the ‘treated unfairly’ measure and might be viewed as a subset of broader experiences. Furthermore, we are not able to assess how often study participants frequented shops and hence the proportion of time they were exposed to discrimination of this type. These limitations in the available data might help account for the lack of association we observed between interpersonal experiences of racism by mothers and markers of socioemotional and cognitive development. On the other hand, self-report measures similar to these have been used in a number of other studies exploring the impact of racism on health.45–47 However, these studies examined adult health, and measures may not be sensitive to dimensions of experienced racism that could influence child health and development. Unfortunately, data on directly experienced racism reported by children themselves were not available for this particular study.

    Conclusions

    Our work adds to the growing body of evidence linking experienced racism with unfavourable developmental profiles in children. Improvements in our understanding of whether and how experienced racism, at interpersonal and institutional levels, influences child development are key to identifying points for intervention. We know that early child health and development has long-term implications for health throughout the lifecourse. Interventions aimed at reducing child obesity and improving socioemotional and cognitive outcomes should not just focus efforts on proximal influences, such as diet, physical activity and parenting. Attention also needs to be paid to the upstream precursors inherent in racialised stereotypes at individual and institutional levels.9 ,48 ,49

    What is already known on this subject

    • Prior work suggests links between experiences of racism and discrimination with markers of child health.

    • Most prior work has focused on adolescents and has been conducted in the USA.

    What this study adds

    • In a contemporary UK setting, we examine associations between mothers' experiences of racism and markers of child health and development in their 5-year-old children.

    • Results suggest that experienced racism is associated with socioemotional difficulties and non-verbal ability and weakly associated with an increased risk of obesity.

    Acknowledgments

    We would like to thank the Millennium Cohort Study families for their time and cooperation, as well as the Millennium Cohort Study team at the Institute of Education. The Millennium Cohort Study is funded by ESRC grants to Professor Heather Joshi (study director).

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    Supplementary materials

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    Footnotes

    • Funding This research received a specific funding from Economic and Social Research Council, grant number RES-177-25-0012.

    • Provenance and peer review Not commissioned; externally peer reviewed.