The peer mental health stigmatization scale-revised (PMHSS-R): Psychometric properties and cross-cultural factorial invariance in university students in Ireland and Argentina.

INTRODUCTION: The study aimed to assess the psychometric quality of the Peer Mental Health Stigmatization Scale - Revised (PMHSS-R), by examining its factorial structure among young adults in Ireland and Argentina. METHOD: A total of 429 participants aged between 18 and 25 years old were recruited (n = 187 Ireland, n = 242 Argentina). The PMHSS-R was completed by Irish participants and was translated, pilot-studied, and subsequently completed by Argentinian participants. RESULTS: A Confirmatory Factor Analysis demonstrated optimal factor loadings for an eight-item solution and acceptable internal consistency for both scale dimensions in the Argentinian sample. Satisfactory levels of partial scalar invariance were achieved between countries, indicating that the scale measures mental health stigma consistently across cultures. DISCUSSION AND CONCLUSIONS: Our findings highlight the PMHSS-R as a cross-culturally valid and reliable psychometric instrument to evaluate interventions targeting stigma. In conclusion, the PMHSS-R can be used in cross-cultural research to compare levels of mental health stigma and investigate the interplay between stigma and other psychologically relevant constructs between different countries and cultural contexts.

The Components and Characteristics of Safety Management Plans Used to Reduce the Risk of Self Harm: A PRISMA Scoping Review.

BACKGROUND: The term "safety management planning" can be thought of as having evolved to constitute a number of different intervention types and components used across various clinical settings with various populations. This poses a challenge for effective communication between clinicians and likely variability in the clinical effectiveness of these interventions. AIM: This PRISMA Scoping Review aims to review the literature to ascertain which intervention components and characteristics currently fall under this umbrella term as well as in which contexts the plans are delivered and who is involved in the process. METHOD: Published research studies in PsycINFO, CINAHL Plus, MEDLINE, Science Direct and Web of Science were reviewed. Grey literature was searched using the databases Base and OpenGrey as well as through the search engine Google. RESULTS: 2853 abstracts were initially identified for screening and 74 pieces of literature informed the final review, with 54 derived from the published academic literature and 20 from the grey literature. Results indicated that the safety plans are used with a wide variety of populations and often include components related to identifying warning signs, internal coping strategies, accessing social professional support amongst other components. CONCLUSION: Although most safety management plans described appeared to be based on specific interventions, there was a large amount of heterogeneity of components and characteristics observed. This was particularly the case with regards to safety management planning within the grey literature.

HIGHLIGHTSThis review explored what is currently meant by the term "safety management planning" within the academic and grey literature.While the majority of safety management planning interventions are based on specific researched interventions, many safety management planning tools vary in their characteristic and components.Evidence from within the grey literature suggests the use of safety management planning in a community setting, without clinical supervision.

A systematic scoping review of peer support interventions in integrated primary youth mental health care.

Peer support, defined as the social and emotional support offered and received by individuals with a shared experience of mental health difficulties, is gaining popularity in youth mental health settings. This systematic scoping review aimed to collate and synthesise the evidence on key aspects of peer support interventions within integrated youth services and educational settings. Specifically, it synthesised evidence on the (1) assessed mental health outcomes in peer support interventions, (2) key characteristics and associated roles of peer support workers (PSWs) and (3) barriers and facilitators to implementation. A search of peer reviewed articles from January 2005 to June 2022 across five electronic databases (PsychINFO, Pubmed, Scopus, ERIC and CINAHL) was conducted. A total of 15 studies retrieved in the search met the inclusion criteria and were included in the review. This review supports previous research indicating that peer support has potential for improving recovery related outcomes. While a variety of interventions and PSW roles were reported, studies could be strengthened by providing more in-depth information on intervention content. Examples of barriers to implementation included staff concerns around confidentiality of peer support relationships as well as PSWs' confidence in their roles. Facilitators included positive support from staff members and role clarity.

Parents' Information Needs in Relation to Adolescent Self-Harm: Perspectives of Parents and Professionals.

OBJECTIVE: Discovering that an adolescent is self-harming is extremely distressing for parents and this distress can be compounded by lack of easily accessible and well targeted information on what they can do to help. Some research has even suggested that parental distress can be an obstacle to seeking professional help. This paper describes two studies that sought to identify the information needs of parents in the immediacy of discovering self-harm and in ongoing efforts to support their child. METHOD: Study 1: on-line survey of 128 parents who had experienced their child's self-harm; study 2: two-round Delphi method with 29 professionals who provide therapeutic interventions to adolescents who self-harm. The primary aim of both studies was to elicit views on parents' information needs in relation to supporting adolescents who self-harm. RESULTS: There was a high level of agreement between parents and professionals on the needs for information on topics such as: communication, psychoeducation, managing emotional responses, parenting strategies and interventions. The professionals also emphasized the need for parents to practice self-care and the value of teaching alternative coping strategies to adolescents. Parents placed greater emphasis than professionals on the need for information on future therapeutic needs. CONCLUSION: Despite the agreement between parents and professionals on most of the information needed, there were sufficient differences in emphasis to confirm the importance of consulting with both groups. The findings can be used to develop information sources that are specifically tailored to the needs of parents at all stages of adolescent self-harm.

Parents want psychoeducation on self-harm and help managing emotional responsesProfessionals emphasize parent self-care and teaching adolescents other ways to copeParents should be consulted to ensure their information needs are fully understood.

Qualitative analysis of the cognitive triad in a sample of the general population in response to the COVID-19 pandemic.

This paper explored cognitive responses to the COVID-19 pandemic in those selfreporting depressive symptoms during a period of realistic health, economic and social threat. Negative cognitions are a key therapy target for evidence-based psychological interventions. A cross-sectional survey was conducted with a convenience sample from the general population between December 2020 and February 2021. Adult respondents (n = 555) completed open text-box questions which provided prompts of the cognitive triad: "I am…/I am not…"; "Other people are…/Other people are not…"; "The world is…". These qualitative data were analysed using reflexive thematic analysis. Thematic responses were compared between people who self-reported moderate depressive symptoms (n = 223) and those who did not (n = 332). Fourteen independent themes were identified. Those self-reporting depressive symptoms described significantly fewer positive cognitions across all three aspects of the cognitive triad, X2 = 60.40 p < 0.01;  X2 = 10.51 p < 0.05; X2 = 12.22 p < 0.01. Those self-reporting depressive symptoms also reported more self-referent negative cognitions. These data highlighted that an absence of positive cognitions differentiated the two groups more greatly than negative cognitions. These data have implications for the cognitive targets in psychological therapies in realistic high-stress situations. This paper explored cognitive responses to the COVID-19 pandemic in those selfreporting depressive symptoms during a period of realistic health, economic and social threat. Negative cognitions are a key therapy target for evidence-based psychological interventions. A cross-sectional survey was conducted with a convenience sample from the general population between December 2020 and February 2021. Adult respondents (n = 555) completed open text-box questions which provided prompts of the cognitive triad: "I am…/I am not…"; "Other people are…/Other people are not…"; "The world is…". These qualitative data were analysed using reflexive thematic analysis. Thematic responses were compared between people who self-reported moderate depressive symptoms (n = 223) and those who did not (n = 332). Fourteen independent themes were identified. Those self-reporting depressive symptoms described significantly fewer positive cognitions across all three aspects of the cognitive triad, X2 = 60.40 p < 0.01;  X2 = 10.51 p < 0.05; X2 = 12.22 p < 0.01. Those self-reporting depressive symptoms also reported more self-referent negative cognitions. These data highlighted that an absence of positive cognitions differentiated the two groups more greatly than negative cognitions. These data have implications for the cognitive targets in psychological therapies in realistic high-stress situations.

A meta-analysis of targeted interventions for reducing suicide-related behaviour and ideation in adolescents: Implications for trial design.

INTRODUCTION: Suicidality among young people is a significant societal issue. The current study conducted a meta-analysis of community and clinical interventions targeting suicide attempts, self-harm, and suicidal ideation in adolescents. METHODS: Interventions targeting suicide attempts, self-harm and suicidal ideation were identified by searching PsychINFO, Medline, CINAHL and Embase in line with the PRISMA statement. Study quality was determined using a risk of bias tool. Meta-analyses examined the efficacy of the interventions. Effect sizes were calculated for suicidal ideation data (continuous data) using Hedge's g for standardised mean differences. Suicide attempts and self-harm (dichotomous data) were calculated using odds ratios (ORs). RESULTS: Seventeen RCTs were included in the meta-analysis. No significant differences were found between treatment and control groups on measures of suicide attempts or self-harm. A small effect-size was observed on measures of suicidal ideation (g = 0.47). A secondary meta-analysis investigated change over time in treatment as usual conditions, finding significant large effect-sizes for suicide attempts (OR = 18.67), self-harm (OR = 12.77), and suicidal ideation (g = 0.86). LIMITATIONS: The methodological decision to focus on specific outcomes over a broad definition of self-harm excluded some papers, which have been included in other reviews. It is unlikely to have significantly affected the overall results. The review was not preregistered. CONCLUSIONS: These twin findings highlight the importance overcoming the methodological difficulty of discerning effective interventions during a period of baseline improvement. We suggest that future trials should move away from broadly addressing "suicidality/self-harm" and encourage a greater targeting of at-risk individuals.

Perceived barriers to vegetable intake among urban adolescents from socioeconomically disadvantaged backgrounds: A qualitative study from the perspective of youth workers and teachers.

Eating habits established during adolescence have been shown to track into adulthood. Adolescents from lower socioeconomic status groups tend to have lower intakes of vegetables as compared with their more affluent peers. However, there is limited evidence about the determinants of vegetable intake in this population group. Therefore, this study aimed to explore the barriers to vegetable intake in adolescents living in socioeconomically disadvantaged areas through the perspective of school teachers and youth workers. A total of 20 semi-structured interviews were conducted with post-primary school teachers and youth workers from disadvantaged areas in Dublin, Ireland. Thematic analysis was applied to analyze the data. Eleven themes were identified and fitted within the Socioecological Model of Health: adolescent's food preferences, lack of early exposure and familiarity with vegetables, lack of interest, knowledge and skills at the individual and family level, parenting practices around nutrition, living difficulties, peers' influence and social norms around nutrition, dual role of social media, lack of resources and support to promote healthy eating, competition between unhealthy food vs. vegetables, lack of adequate approaches & initiatives at the community and at the public policy levels, and lack of State support to promote healthy eating. Although several actions could be taken at the personal and interpersonal levels, more efforts are needed at the organizational, community and public policy levels to improve dietary choices and vegetable intake among adolescents in socioeconomically deprived areas. These findings will inform the development of tailored intervention strategies and policies for these vulnerable youths.

A Systematic Review of Help-Seeking Interventions for Parents of Adolescents.

PURPOSE: Parents do not always seek timely help for adolescents when the need arises. Although interventions to increase parental help-seeking have been evaluated and published, no systematic review of these interventions has been conducted. The aim of this systematic review is to collate, synthesise, and evaluate research on help-seeking interventions for parents of adolescents. METHODS: Six electronic databases were searched from inception to May 2020 using terms related to the concepts of "parent" and "help-seeking" and focusing on parents of adolescents (aged 10-19 years). Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies; the Behavioural Change Taxonomy was used to code behavioral change techniques, and "promising interventions" were identified using pre-established criteria. RESULTS: Eighteen studies met inclusion criteria, with six rated strong for design and methodology. The most frequently identified Behavioural Change Taxonomies included a credible source delivering the intervention, supporting parents, and providing prompts/cues regarding services/appointments. Four interventions were identified as "promising" because of strong methodology, significant positive outcomes, and strong evidence-base. CONCLUSIONS: More high-quality, theory-driven parental help-seeking interventions using common outcome measures are needed to advance the literature in this area. Future research should replicate the promising interventions identified to develop best practice guidelines.

Do stigma and level of social anxiety predict adolescents' help-seeking intentions for social anxiety disorder?

BACKGROUND: Many adolescents meeting diagnostic criteria for social anxiety disorder (SAD) do not seek help or access timely professional supports. The current study investigated two hypothesized barriers to adolescents' seeking help for SAD: stigma and SAD symptoms. METHOD: Three hundred fifteen adolescents (52% female; mean age = 14.85 years) read a vignette describing a hypothetical peer with symptoms of SAD and completed measures of their own help-seeking intentions, SAD symptoms, stigma awareness and agreement. RESULTS: The majority of adolescents reported that the vignette character needed help. Adolescents with more SAD symptoms, and those with greater stigma awareness, were less likely to indicate they would seek help from an adult they know (e.g., parent or teacher) for similar symptoms. CONCLUSIONS: Both SAD symptoms and perceptions of societal stigma may act as barriers to help-seeking for young people indicating the importance of intervention with young people, and the adults with whom they interact regularly.

Social Anxiety and Depression Stigma Among Adolescents.

BACKGROUND: The stigma associated with mental disorders in adolescence has a range of detrimental consequences, negatively impacting help-seeking behaviours and quality of life. Social anxiety typically has its onset during adolescence, but the associated stigma is not well understood. This study was designed to improve understanding of social anxiety and depression stigma in adolescence by examining demographic and personal variables that predict them both. METHODS: Three hundred and fifteen adolescents (150 males, 165 females), from 2nd and 4th year of secondary school (mean ages 13.92 and 15.92 years respectively), completed the Peer Mental Health Stigmatization Scale to measure both personal and perceived stigma towards vignettes depicting social anxiety and depression. They also answered demographic questions and completed the Social Anxiety Scale for Adolescents. RESULTS: Hierarchical multiple regression revealed that gender predicted both personal and perceived stigma towards depression and personal stigma towards social anxiety. Males scored higher on measures of personal stigma whereas females had higher scores on perceived stigma. Ability to accurately identify symptoms described in a vignette, predicted lower personal stigma towards social anxiety and higher perceived stigma towards depression. Depression was more stigmatized than social anxiety. LIMITATIONS: The study used vignettes to represent individuals with depression and social anxiety so participant responses may not reflect their behaviour towards real peers. CONCLUSIONS: Findings emphasise the importance of separately considering personal and perceived stigma for each condition and highlight gender differences in stigma responses that need to be considered in intervention design.

Psychometric properties of the Peer Mental Health Stigmatization Scale-Revised in adolescents and young adults.

AIM: This study aimed to examine the factorial validity and reliability of the Peer Mental Health Stigmatization Scale (PMHSS) in adolescents and young adults. METHODS: Young people (N = 963) aged 12 to 25 years (M = 16.1, SD = 3.08) were recruited across two studies. Study 1 included adolescents (n = 776) recruited from secondary schools and study 2 included young adults (n = 187) recruited from universities. All participants completed the PMHSS. RESULTS: Exploratory factor analysis resulted in a bi-factorial solution of the PMHSS by retaining 11 items out of the original 16 that loaded on the latent factors of stigma agreement and stigma awareness. Confirmatory factor analysis established the factor structure of the tool in adolescents and young adults. CONCLUSIONS: This shorter version of the PMHSS remains the only validated tool that measures stigma awareness and stigma agreement in youth. We recommend that this version is used in future research.

General practitioners' training and their attitudes towards young people who self-harm: A cross-sectional survey.

AIM: Self-harm is common among adolescents and young adults and carries increased risk of suicide and other negative outcomes, yet only a small proportion will seek professional help. General practitioners (GPs) are a potentially valuable source of help as most young people visit their GP regularly for other reasons. The primary aim of this research was to explore GPs' empathy and attitudes towards young people who self-harm and how these are related to GP specialist training. METHOD: GPs completed questionnaires regarding their training, levels of empathy, perceived knowledge and attitudes towards young people who self-harm. The cross-sectional design included a random sample of 178 GPs and 47 GPs-in-training in the Republic of Ireland. Bootstrapped mediation analysis using structural equation modelling (SEM) was applied to explore the pattern of relationships among GP-training, empathy, perceived knowledge of self-harm and attitudes towards youth who self-harm. RESULTS: The SEM results revealed that the model had a very good fit to the data. Empathy was the strongest predictor of attitudes towards self-harm even if GPs had received youth mental health training and fully mediated the effect of youth mental health training on perceived knowledge of self-harm. Specialized training in self-harm was a stronger predictor of perceived knowledge than empathy but had no association with negative attitudes. CONCLUSIONS: The findings emphasize positive outcomes associated with GP training and highlight potential differences in the effects associated with specific vs general training in youth mental health. These differences may be used to inform the design and implementation of continuing professional development.

Exploring the Impact of COVID-19 on Mental Health Outcomes in Children and Adolescents: A Systematic Review.

The psychological impact of the COVID-19 pandemic has been widely discussed during the past few months, with scholars expressing concern about its potential debilitating consequences on youth mental health. Hence, this research aimed to provide a systematic review of the evidence on the COVID-19 pandemic's impact on youth mental health. We conducted a mixed methods integrated review to identify any empirical study that focused on young people ≤ 18 years old. Eight databases were systematically searched to identify studies of any type of research design. The selection procedure followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The protocol of this systematic review was registered with PROSPERO (protocol ID: CRD4202019375). Twelve studies deemed eligible for data extraction (n = 12,262). The findings show that COVID-19 has an impact on youth mental health and is particularly associated with depression and anxiety in adolescent cohorts. The quality appraisal indicated that all studies were of low or moderate methodological quality. The COVID-19 pandemic is affecting young people's lives, and thus generating robust research evidence to inform policy decisions is essential. Hence, the methodological quality of future research should be drastically improved.

Personal and perceived public mental-health stigma as predictors of help-seeking intentions in adolescents.

This study aimed to determine predictors of help-seeking intentions for symptoms of depression/anxiety and self-harm in adolescents. It focused on personal and perceived public stigma to gather data of value for the design of anti-stigma interventions. Participants (n = 722; 368 girls) were recruited from three cohorts of secondary school students in Ireland (mean ages: 1st = 12.9 years; 3rd = 14.9 years; 5th = 16.6 years). Hierarchical regression models indicated that perceived public stigma is a significant unique predictor of help-seeking intentions for depression [F(4, 717) = 13.4, p < .001] and self-harm [F(4, 717) = 13.5, p < .001]. This indicates that young people's beliefs about other people's stigma towards mental health problems was a stronger predictor of help-seeking intentions than their own stigma beliefs. These findings highlight the importance of looking separately at different types of stigma when investigating the role of stigma in predicting help-seeking intentions.

Labelling effects and adolescent responses to peers with depression: an experimental investigation.

BACKGROUND: The impact of illness labels on the stigma experiences of individuals with mental health problems is a matter of ongoing debate. Some argue that labels have a negative influence on judgments and should be avoided in favour of information emphasising the existence of a continuum of mental health/illness. Others believe that behavioral symptoms are more powerful influencers of stigma than labels. The phenomenon has received little attention in adolescent research, despite the critical importance of the peer group at this developmental stage. This study employs a novel experimental design to examine the impact of the depression label and continuum information on adolescents' responses to peers with depression. METHODS: Participants were 156 adolescents, 76 male, 80 female (M = 16.25 years; SD = .361), assigned to one of three conditions (Control, Label, Continuum). Participants respond to four audio-visual vignette characters (two clinically depressed) on three occasions. Outcome measures included judgment of the mental health of the vignette characters and emotional responses to them. RESULTS: Neither the provision of a depression label or continuum information influenced perceptions of the mental health of the characters in the audio-visual vignettes or participants' emotional responses to them. CONCLUSION: The findings have implications for the design of interventions to combat depression stigma with adolescents. Interventions should not necessarily target perceptions of psychiatric labels, but rather perceptions of symptomatic behaviour.

Child Care Exposure Influences Childhood Adiposity at 2 Years: Analysis from the ROLO Study.

BACKGROUND: The first 2 years of life are instrumental for childhood physical development. Factors contributing to childhood obesity are difficult to determine; child care exposure is one to consider, by influencing food preference and physical activity development. OBJECTIVE: To investigate the association of child care exposure with adiposity at 2 years. METHODS: Data were collected as part of the secondary analysis of the prospective ROLO study (randomized control trial of low glycemic index diet) in Dublin, Ireland. Mothers were recruited antenatally and followed up at 2 years postpartum. Maternal and childhood anthropometric data and lifestyle questionnaires, reporting on child care attendance (defined as nonparental care), exposure (weeks), and infant-feeding practices, were collected. RESULTS: Anthropometric measures and lifestyle data were collected for 273 mothers and children aged 2 years, 52.7% of whom attended child care. Child care was predominately provided by a nonrelative (83.7%), either in a crèche (57%) or by a childminder (26.7%). More than half (56.2%) of the children attended child care part-time (≤30 hours/week). Central adiposity measures (abdominal circumference, waist:height ratio) and total adiposity (sum of all skin folds) were significantly elevated in children with increasing time in child care. Children provided with "meals and snacks" had elevated adiposity measures versus those given "snacks or no food." No difference in the infant-feeding practices was identified between the child care groups. CONCLUSIONS: Children attending child care have higher total and central adiposity, proportional to exposure. More research is required to investigate this link to appropriately design health promotion and obesity prevention programs targeting children at 2 years.

Adolescents' beliefs about the fairness of exclusion of peers with mental health problems.

Stigma research suggests that exclusion of peers with mental health problems is acceptable, however, no research has explored young people's beliefs about the fairness of exclusion. Group interviews with 148 adolescents explored judgements about the fairness of excluding peers with ADHD or depression from dyads and groups. Young people evaluated exclusion of peers with ADHD or depression from dyads and groups, with the exception of group exclusion of the peer with ADHD, as mostly unfair. Beliefs about the fairness of exclusion were influenced by the attributions that they applied to the target peer's behaviour, social obligations and loyalty within friendships and concerns about the adverse psychological effects of exclusion. Furthermore, their evaluations were influenced by personal beliefs about the social and personal costs of including the target peer. Evaluations of exclusion highlight novel avenues for to develop knowledge on the stigma of mental health problems.

Retrospective accounts of self-stigma experienced by young people with attention-deficit/hyperactivity disorder (ADHD) or depression.

OBJECTIVE: Little is known about self-stigma experienced by young people with mental health problems, despite the fact that research has demonstrated its existence. In the present study, we sought to investigate the experiences of self-stigma in childhood and adolescence, and particularly the nature of change in self-stigma across this developmental period. Young adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) or depression before their 18th birthdays were interviewed about their experiences within their peer groups during childhood and adolescence. METHODS: This qualitative study involved open-ended interviews with 16 young adults aged 18-30 years. Interviews focused on the experience of stigmatization, responses to stigma, and how these changed over time. RESULTS: Three main themes pertaining to self-stigma emerged: (a) being different, (b) peer stigmatization and associated experiences of self-stigma, and (c) selective disclosure and a move toward greater openness. The findings also suggested that the passing of time and changes in young people's social networks and/or degrees of recovery were associated with changes in their experiences of self-stigma. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: During childhood and adolescence, self-stigma is characterized by a sense of being different from peers and negative self-evaluation as a consequence of that difference. However, our findings also demonstrated that some young people were prepared to challenge the stigma they experienced. Further research is needed to understand the factors that contribute to these differing responses and to develop antistigma interventions that facilitate the inclusion of young people with mental health problems in their peer groups.

Peer Mental Health Stigmatization Scale: psychometric properties of a questionnaire for children and adolescents.

BACKGROUND: The nature of stigmatizing attitudes towards children and adolescents with mental health problems has received little empirical attention, despite consensus that such attitudes are widespread. As a consequence, much less is known about stigma in childhood and adolescence and methods of stigma measurement are frequently borrowed from the adult literature. For research on this topic to develop, a theoretically based and developmentally appropriate measure is needed. This study aimed to develop a theory-based peer stigma questionnaire suitable for children and adolescents. METHOD: Participants were 562 children and adolescents aged 9-16 years (M = 12.99 years; SD = 1.6 years) in the Republic of Ireland, 316 female, all were White. The Peer Mental Health Stigmatization Scale (PMHSS) contains 24 statements (negative and positive) about peers with mental health problems that are rated on a 5-point scale. Participants also completed the Strengths and Difficulties Questionnaire. Re-test data was collected after 2 weeks from 109 participants. RESULTS: Principal Components Analysis on the negative statements indicate the presence of two components: Stigma Agreement, personal endorsement of stigmatising statements and Stigma Awareness: awareness of prevailing societal stigma towards youth with mental health problems. The positive statements include three components: Intellectual Ability, Recovery and Friendship. CONCLUSIONS: The PMHSS is a psychometrically sound instrument with good retest reliability suitable for use with older children and teenagers. Initial use of the scale suggests that personal endorsement of stigma is lower than perceptions of public stigma.

Young children's food brand knowledge. Early development and associations with television viewing and parent's diet.

Brand knowledge is a prerequisite of children's requests and choices for branded foods. We explored the development of young children's brand knowledge of foods highly advertised on television - both healthy and less healthy. Participants were 172 children aged 3-5 years in diverse socio-economic settings, from two jurisdictions on the island of Ireland with different regulatory environments. Results indicated that food brand knowledge (i) did not differ across jurisdictions; (ii) increased significantly between 3 and 4 years; and (iii) children had significantly greater knowledge of unhealthy food brands, compared with similarly advertised healthy brands. In addition, (iv) children's healthy food brand knowledge was not related to their television viewing, their mother's education, or parent or child eating. However, (v) unhealthy brand knowledge was significantly related to all these factors, although only parent eating and children's age were independent predictors. Findings indicate that effects of food marketing for unhealthy foods take place through routes other than television advertising alone, and are present before pre-schoolers develop the concept of healthy eating. Implications are that marketing restrictions of unhealthy foods should extend beyond television advertising; and that family-focused obesity prevention programmes should begin before children are 3 years of age.