title: Informal child care and adolescent psychological well-being: Hong Kong's "Children of 1997" birth cohort.
abstract: BACKGROUND
  Informal child care (child care by untrained family members, relatives or employees in the home) in Western populations is often associated with poorer psychological well-being, which may be confounded by socioeconomic position. We examined the association of informal child care, common in non-Western settings, with adolescent psychological well-being, using Hong Kong's Chinese "Children of 1997" birth cohort.
  
  
  METHODS
  Multivariable linear regression was used to examine the adjusted associations of informal child care (at 0.5, 3, 5 and 11 years) with parent-reported Rutter score for child behavior at 11 years, self-reported Culture-Free Self-Esteem Inventories score at 11 years and self-reported Patient Health Questionnaire-9 depressive symptom score at 13 years. Model comparisons were used to identify the best representation of child care, in terms of a critical period of exposure to informal child care (independent variable) at a specific age, combination of exposures to informal child care at several ages or an accumulation of exposures to informal child care.
  
  
  RESULTS
  Child care was not associated with behavioral problems. A model considering child care at 3 years best represented the association of child care with self-esteem while a model considering child care at 5 years best represented the association of child care with depressive symptoms. Informal child care at 3 years was associated with lower self-esteem (-0.70, 95% confidence interval (CI) -1.26 to -0.14). Informal child care at 5 years was associated with more depressive symptoms (0.45, 95% CI 0.17 to 0.73).
  
  
  CONCLUSIONS
  In a developed non-Western setting, informal child care was associated with lower self-esteem and more depressive symptoms.
authors.affiliation: School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China.
authors.forename: Cherry Y
authors.initials: CY
authors.lastname: Leung
authors.affiliation: School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China.
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Leung
authors.affiliation: School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China; CUNY School of Public Health and Hunter College, New York, United States of America.
authors.forename: C Mary
authors.initials: CM
authors.lastname: Schooling
mesh_terms: D000293:Adolescent; D041923:Adolescent Development / Q000502:physiology*; D002648:Child; D002654:Child Care; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong; D006801:Humans; D007223:Infant; D008297:Male; D008954:Models, Biological