title: Differences in problem behaviour among ethnic minority and majority preschoolers in the Netherlands and the role of family functioning and parenting factors as mediators: the Generation R Study.
abstract: BACKGROUND
  Studies have shown that, compared to native counterparts, preschoolers from ethnic minorities are at an increased risk of problem behaviour. Socio-economic factors only partly explain this increased risk. This study aimed to further unravel the differences in problem behaviour among ethnic minority and native preschoolers by examining the mediating role of family functioning and parenting factors.
  
  
  METHODS
  We included 4,282 preschoolers participating in the Generation R Study, an ethnically-diverse cohort study with inclusion in early pregnancy. At child age 3 years, parents completed the Child Behavior Checklist (CBCL/1,5-5); information on demographics, socio-economic status and measures of family functioning (maternal psychopathology; general family functioning) and parenting (parenting stress; harsh parenting) were retrieved from questionnaires. CBCL Total Problems scores in each ethnic subgroup were compared with scores in the Dutch reference population. Mediation was evaluated using multivariate regression models.
  
  
  RESULTS
  After adjustment for confounders, preschoolers from ethnic minorities were more likely to present problem behaviour than the Dutch subgroup (e.g. CBCL Total Problems Turkish subgroup (OR 7.0 (95% CI 4.9; 10.1)). When considering generational status, children of first generation immigrants were worse off than the second generation (P<0.01). Adjustment for socio-economic factors mediated the association between the ethnic minority status and child problem behaviour (e.g. attenuation in OR by 54.4% (P<0.05) from OR 5.1 (95% CI 2.8; 9.4) to OR 2.9 (95% CI 1.5; 5.6) in Cape Verdean subgroup). However, associations remained significant in most ethnic subgroups. A final adjustment for family functioning and parenting factors further attenuated the association (e.g. attenuation in OR by 55.5% (P<0.05) from OR 2.2 (95% CI 1.3; 4.4) to OR 1.5 (95% CI 1.0; 2.4) in European other subgroup).
  
  
  CONCLUSIONS
  This study showed that preschoolers from ethnic minorities and particularly children of first generation immigrants are at an increased risk of problem behaviour compared to children born to a Dutch mother. Although socio-economic factors were found to partly explain the association between the ethnic minority status and child problem behaviour, a similar part was explained by family functioning and parenting factors. Considering these findings, it is important for health care workers to also be attentive to symptoms of parental psychopathology (e.g. depression), poor family functioning, high levels of parenting stress or harsh parenting in first and second generation immigrants with young children.
authors.affiliation: The Generation R study group, Erasmus University Medical Centre, Rotterdam, The Netherlands. i.flink@erasmusmc.nl
authors.forename: Ilse J E
authors.initials: IJ
authors.lastname: Flink
authors.forename: Pauline W
authors.initials: PW
authors.lastname: Jansen
authors.forename: Tinneke M J
authors.initials: TM
authors.lastname: Beirens
authors.forename: Henning
authors.initials: H
authors.lastname: Tiemeier
authors.forename: Marinus H
authors.initials: MH
authors.lastname: van IJzendoorn
authors.forename: Vincent W V
authors.initials: VW
authors.lastname: Jaddoe
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Hein
authors.initials: H
authors.lastname: Raat
mesh_terms: D000328:Adult; D002653:Child Behavior Disorders / Q000208:ethnology*; D002675:Child, Preschool; D005006:Ethnicity / Q000523:psychology*; D005195:Family Relations / Q000208:ethnology*; D005260:Female; D006801:Humans; D008297:Male; D008913:Minority Groups / Q000523:psychology*; D009426:Netherlands; D016487:Parenting / Q000208:ethnology* / Q000523:psychology; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult