A pediatric virtual care evaluation framework and its evolution using consensus methods.

BACKGROUND: The use of virtual care has increased dramatically in response to the COVID-19 pandemic, yet evidence is lacking regarding the impact of virtual care on patient outcomes, particularly in pediatrics. A standardized evaluation approach is required to support the integration of virtual care into pediatric health care delivery programs. The objective of this work was to develop a comprehensive and structured framework for pediatric virtual care evaluation. This framework is intended to engage and guide care providers, health centres, and stakeholders towards the development of a standardized approach to the evaluation of pediatric virtual care. METHODS: We brought together a diverse multidisciplinary team, including pediatric clinicians, researchers, digital health leads and analysts, program leaders, a human factors engineer, a family advisor and our manager of health equity and diversity. The team reviewed the literature, including published evaluation frameworks, and used a consensus-based method to develop a virtual care evaluation framework applicable to a broad spectrum of pediatric virtual care programs. We used an iterative process to develop framework components, including domains and sub-domains, examples of evaluation questions, measures, and data sources. Team members met repeatedly over seven months to generate and provide feedback on all components of the framework, making revision as needed until consensus was reached. The framework was then applied to an existing virtual care program. RESULTS: The resulting framework includes four domains (health outcomes, health delivery, individual experience, and program implementation) and 19 sub-domains designed to support the development and evaluation of pediatric virtual care programs. We also developed guidance on how to use the framework and illustrate its utility by applying it to an existing pediatric virtual care program. CONCLUSIONS: This virtual care evaluation framework expands on previously developed frameworks by providing additional detail and a structure that supports practical application. It can be used to evaluate a wide range of pediatric virtual care programs in a standardized manner. Use of this comprehensive yet easy to use evaluation framework will inform appropriate implementation and integration of virtual care into routine practice and support its sustainability and continuous improvement.

Childhood Abuse, Intimate Partner Violence in Young Adulthood, and Welfare Receipt by Midlife.

OBJECTIVE: To investigate prospective associations between type of child abuse (physical, sexual, both), timing (childhood, young adulthood, both), and welfare receipt into middle-age. METHODS: Database linkage study using the Quebec Longitudinal Study of Kindergarten Children cohort born in 1980 and government administrative databases (N = 3020). We assessed parental tax returns, family and personal background characteristics (1982-1987). At age 22 years, participants answered retrospective questionnaires on experienced childhood abuse (physical, sexual abuse < age 18 years) and intimate partner violence (IPV) (ages 18-22). Main outcome was years on social assistance, on the basis of participant tax returns (ages 23-37 years). Analysis included weights for population representativeness. RESULTS: Of 1690 participants (54.4% females) with available data, 22.4% reported childhood abuse only, 14.5% IPV only, and 18.5% both. Prevalence of childhood physical, sexual, and both was 20.4%, 12.2%, and 8.3%, respectively. Adjusting for socioeconomic background and individual characteristics, we found that childhood physical abuse alone and physical or sexual abuse combined were associated with a two-fold risk of welfare receipt, as compared to never-abused (adjusted incidence risk ratio 2.43, 95% confidence interval [CI], 1.65-3.58; and adjusted incidence risk ratio 2.04, 95% CI, 1.29-3.23, respectively). Repeated abuse (childhood abuse combined with adult IPV) had a three-fold risk (adjusted incidence ratio 3.59, 95% CI, 2.39-5.37). CONCLUSIONS: Abuse across several developmental periods (childhood and young adulthood) is associated with increased risks of long-term welfare receipt, independently of socioeconomic background. Results indicate a dose-response association. Early prevention and targeted identification are crucial to preventing economic adversity that may potentially lead to intergenerational poverty.

Income trajectories of families raising a child with a neurodisability.

PURPOSE: To examine household income trajectories of children with and without neurodisability over a period of 6 years. METHOD: We used four cycles of the Canadian National Longitudinal Survey of Children and Youth, a longitudinal study of the development and well-being of Canadian children from birth into adulthood. RESULTS: While household income increased over time for both groups, families of children with neurodisability had consistently lower household income compared to families of children without neurodisability even after controlling for child and family socio-demographic characteristics. The presence of an interaction effect between parent work status and child with neurodisability at baseline indicated that among children whose parent(s) were not working at baseline, household incomes did not differ between children with and without neurodisability. CONCLUSIONS: The association between child with neurodisability and lower household income may not hold for all types of parents', working status is an important consideration.Implications for RehabilitationFindings support the health selection hypothesis that health status shapes diverging economic conditions over time: children with a ND have lower household incomes than children without a ND child across all waves of the Canadian National Longitudinal Survey of Youth.Income gaps did not increase or decrease over time; rehabilitation services and policies must consider the lower average incomes associated with raising a child with a ND.Social assistance support likely plays a key role in closing the gap, especially for non-working families.

Understanding the Perceived Mental Health of Canadians During the COVID-19 Pandemic.

BACKGROUND: While the physical health implications of the COVID-19 pandemic are regularly publicly available, the mental health toll on Canadians is unknown. This article examines the self-perceived mental health of Canadians during the COVID-19 pandemic and explores associations with various concerns after accounting for socioeconomic and health factors. DATA: The cross-sectional Canadian Perspectives Survey Series 1 collected information related to COVID-19 in late March and early April 2020 concerning labour market participation, behaviours, and health for the Canadian population 15 years and older living in the 10 provinces. METHODS: Socioeconomic and health characteristics of respondents as well as concerns about the impact of COVID-19 were examined to determine differences in experiencing excellent or very good compared to good, fair or poor perceived mental health. RESULTS: Just over half of Canadians aged 15 and older (54%) reported excellent or very good mental health during the COVID-19 pandemic. Several concerns were also associated with mental health. Notably, after considering the effects of socioeconomic and health characteristics, women, youth, individuals with a physical health condition and those who were very or extremely concerned with family stress from confinement were less likely to report excellent or very good mental health. DISCUSSION: These findings point to particular risks for lower perceived mental health during the COVID-19 pandemic. Results highlight various concerns of Canadians which may be associated with mental health, in particular, family stress in the home.

Child Care Attendance and Educational and Economic Outcomes in Adulthood.

OBJECTIVES: To test associations between onset of formal child care (in infancy or as a toddler), high school graduation, and employment earnings from ages 18 to 35 years. METHODS: A 30-year prospective cohort follow-up study, with linkage to government administrative databases (N =3020). Exposure included formal child care, if any, by accredited caregivers in centers or residential settings at ages 6 months and 1, 1.5, 2, 3, and 4 years. A propensity score analysis was conducted to control for social selection bias. RESULTS: Of 2905 participants with data on child care use, 59.4% of male participants and 78.5% of female participants completed high school by age 22 to 23. Mean income at last follow-up (n = 2860) was $47 000 (Canadian dollars) (SD = 37 700) and $32 500 (SD = 26 800), respectively. Using group-based trajectory modeling, we identified 3 groups: formal child care onset in infancy (∼6 months), formal child care onset as a toddler (after 2.5 years), and never exposed. After propensity score weighting, boys with child care started in infancy had greater odds of graduating than those never exposed (odds ratio [OR] 1.39; 95% confidence interval [CI]: 1.18-1.63; P < .001). Boys attending child care had reduced odds of low income as young adults (infant onset: OR 0.60 [95% CI: 0.46-0.84; P < .001]; toddler onset: OR 0.63 [95% CI: 0.45-0.82; P < .001]). Girls' graduation rates and incomes revealed no significant association with child care attendance. CONCLUSIONS: For boys, formal child care was associated with higher high school completion rates and reduced risk of adult poverty. Benefits for boys may therefore extend beyond school readiness, academic performance, and parental workforce participation.

Medical Student Psychological Distress and Mental Illness Relative to the General Population: A Canadian Cross-Sectional Survey.

PURPOSE: To provide national data on Canadian medical students' mental health and show how their mental health compares with that of similarly aged postsecondary graduates from the general population. METHOD: In 2015-2016, the authors conducted a survey of medical students in all years of study at all 17 Canadian medical schools. The surveys included validated items and instruments to assess for psychological distress, suicidal ideation, and diagnosed mood and anxiety disorders. Comparative analyses were performed between medical students and similarly aged postsecondary graduates using data from the Canadian Community Health Survey-Mental Health 2012. RESULTS: The participation rate across all medical students was 40.2% (4,613/11,469). Relative to the general population of postsecondary graduates aged 20-34, medical students aged 20-34 had significantly higher rates of diagnosed mood disorders, diagnosed anxiety disorders, suicidal ideation, and psychological distress. Among medical students, being female was associated with having a mood or anxiety disorder, lifetime suicidal ideation, moderate or severe psychological distress, and higher mean Kessler Psychological Distress Scale 6-item summative scores. Being in clinical training was associated with having suicidal ideation, moderate or severe psychological distress, and mood and anxiety disorders. CONCLUSIONS: Compared with postsecondary graduates from the general population, medical student respondents had significantly higher rates of psychological distress, suicidal ideation, and mood and anxiety disorders. Further research is needed to understand the factors that are contributing to these higher rates.

Longitudinal child data: What can be gained by linking administrative data and cohort data?

INTRODUCTION: Linked administrative data sets are an emerging tool for studying the health and well-being of the population. Previous papers have described methods for linking Canadian data, although few have specifically focused on children, nor have they described linkage between tax outcomes and a cohort of children who are particularly at risk for poor financial outcomes. OBJECTIVE AND METHODS: This paper describes a probabilistic linkage performed by Statistics Canada linking the Montreal Longitudinal Experimental Study (MLES) and the Quebec Longitudinal Study of Kindergarten Children (QLSKC) survey cohorts and administrative tax data from 1992 through 2012. RESULTS: The number of valid cases in the original cohort file with valid tax records was approximately 84%. Rates of false positives, false negatives, sensitivity, and specificity of the linkage were all acceptable. Using the linked file, the relationship of childhood behavioural indicators and adult income can be investigated in future studies. CONCLUSIONS: Innovative methods for creating longitudinal datasets on children will assist in examining long-term outcomes associated with early childhood risk and protective factors as well as an evidence base for interventions that promote child well-being and positive outcomes.

Depression and suicidal ideation among Canadians aged 15 to 24.

BACKGROUND: Among Canadians aged 15 to 24, the rate of depression is higher than at any other age, and suicide is the second leading cause of death. The current study provides detailed information about depression and suicidal ideation among young Canadians, including their use of mental health support. DATA AND METHODS: Data from the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH) were used to describe rates and experiences of depression and suicidal ideation among Canadians aged 15 to 24, including psychosocial characteristics of those who had depression or reported suicidal thoughts. Characteristics associated with seeking professional support were also examined. RESULTS: About 11% of Canadians aged 15 to 24 had experienced depression in their lifetime; 7%, in the past year. Approximately 14% reported having had suicidal thoughts in their lifetime; 6%, in the past year. Lifetime depression and suicidal thoughts were moderately correlated (r = .34, p ⟨ .001). Individuals with lifetime depression had more than four times the odds of seeking professional support in the previous year, compared with those who did not have lifetime depression; those with lifetime suicidal thoughts had more than three times the odds of seeking professional support, compared with those who did not have lifetime suicidal thoughts. Psychosocial factors such as negative social interactions and lower perceived ability to deal with stress were associated with depression and suicidal thoughts, although these associations differed for males and females. INTERPRETATION: The findings suggest that many young Canadians have depression and/or suicidal thoughts. Their odds of seeking professional support are significantly high.

Validation of the 10-item Kessler Psychological Distress Scale (K10) in the 2012 Aboriginal Peoples Survey.

BACKGROUND: The 10-item Kessler Psychological Distress Scale (K10) is a short measure of non-specific psychological distress, which has been shown to be a sensitive screen for the Diagnostic and Statistical Manual of Mental Disorders criteria for anxiety and mood disorders. The scale has yet to be validated as a measure of psychological distress for Aboriginal peoples in Canada. DATA AND METHODS: Using the 2012 Aboriginal Peoples Survey (APS), this study examined the psychometric properties of the K10 for First Nations people living off reserve, Métis, and Inuit aged 15 or older. The factor structure and internal consistency of the K10 were examined via confirmatory factor analysis and Cronbach's alpha, respectively. Descriptive statistics by sex, education, household income, and age group were provided for the scale. K10 construct validity was further assessed by examining associations with mental health variables in the 2012 APS: self-rated mental health, self-reported diagnosed mood and anxiety disorders, and self-reported suicidal ideation in the past 12 months. RESULTS: A unidimensional "Distress" model with correlated errors was a good fit to the data. Cronbach's alpha values were satisfactory. K10 mean scores were positively skewed, with most respondents reporting few or no distress symptoms. Females and respondents with lower education and household income levels had significantly higher distress. Respondents aged 55 or older had significantly lower distress than their younger counterparts. K10 mean scores were significantly higher for respondents who reported poor mental health, a diagnosed mood disorder, a diagnosed anxiety disorder, or suicidal ideation in the past 12 months. Results were consistent across all three Aboriginal groups. INTERPRETATION: Based on the 2012 APS, the total score of the K10 appears to be psychometrically sound for use as a broad measure of non-specific psychological distress for First Nations people living off reserve, Métis, and Inuit.

Measuring psychological engagement in youth activity involvement.

Although psychological engagement (e.g., enjoyment, concentration) may be critical in fostering positive outcomes of youth activity participation, too few studies have been conducted to establish its role in development. Furthermore, an established measurement tool is lacking. In the current study, we evaluated a brief engagement measure with two Canadian samples of youth (Sample 1, N = 290, mean age = 16.9 years, 62% female; Sample 2, N = 1827, mean age = 13.1 years, 54% female). We conducted a confirmatory factor analysis with structural equation modeling to examine the hypothesized structure of the model. We also assessed the measure's validity by testing relations between engagement and both perceived outcomes and positive features of activity settings. Psychological engagement was best captured by three latent cognitive, affective, and relational/spiritual factors and a second-order latent factor. Also, as anticipated, psychological engagement was associated with features of the activity setting and perceived impact.

Bisphenol A and child and youth behaviour: Canadian Health Measures Survey 2007 to 2011.

BACKGROUND: Bisphenol A (BPA) is a synthetic industrial chemical commonly used in consumer products. Results from the Canadian Heath Measures Survey (CHMS) indicate that more than 90% of children and youth aged 6 to 19 have detectable levels of urinary BPA. Childhood concentration levels of BPA have been linked with negative behavioural outcomes. DATA AND METHODS: The data are from the first two cycles (2007 to 2009 and 2009 to 2011) of the CHMS, which collected biomonitoring indicators via spot blood and urine samples. Behavioural outcomes--hyperactivity/inattention, emotional symptoms, conduct problems, peer problems, and prosocial behavior--were assessed with Goodman's Strengths and Difficulties Questionnaire. Geometric mean urinary BPA concentration was examined overall and by demographic and socioeconomic correlates. Six multiple logistic regression analyses were conducted to investigate associations between childhood BPA concentrations and risk status for each outcome. RESULTS: Children aged 6 to 8 had higher BPA concentrations than did older children and youth. Concentrations were significantly higher among children and youth exposed to second-hand smoke every day or almost every day and those in low or lower-middle income households. Higher BPA concentrations were associated with increased odds of hyperactivity among girls and lower prosocial behaviour among boys. INTERPRETATION: These findings suggest an association between urinary BPA concentration and children's behavioural outcomes.

Professional and informal mental health support reported by Canadians aged 15 to 24.

BACKGROUND: The prevalence of mental health problems in Canada is highest among youth and young adults. Relatively little is known about where they seek support and the factors related to help-seeking. DATA AND METHODS: Based on the 2012 Canadian Community Health Survey-Mental Health, this study describes professional and informal mental health support reported by Canadians aged 15 to 24. RESULTS: In 2012, 12% of 15- to 24-year-olds reported that, in the previous 12 months, they had consulted health professionals about emotional, mental or substance use problems; 27% reported consulting informal sources such as family and friends. Young Canadians with mood, anxiety or substance disorders, one or more chronic physical conditions, higher levels of distress, or who had a traumatic childhood experience were more likely than their contemporaries who did not have these risk factors to report contact with professional and informal sources of support. Those with multiple needs-related factors had significantly higher odds of reporting contact with professional and informal sources. INTERPRETATION: More than one in ten young Canadians consulted professionals and about a quarter sought informal support for mental health problems in the past year. The percentages were higher among those with multiple risk factors.

Developmental milestones among Aboriginal children in Canada.

BACKGROUND: Windows of achievement provide age ranges for the attainment of early developmental skills. Group-specific research is warranted given that development may be influenced by social or cultural factors. OBJECTIVES: To examine developmental milestones for Inuit, Métis and off-reserve First Nation children in Canada, based on developmental domains collected from the 2006 Aboriginal Children's Survey. Sociodemographic and health predictors of risk for developmental delay were also examined. RESULTS: The ranges in which children achieve certain developmental milestones are presented. Gross motor and self-help skills were found to be achieved earlier (across the three Aboriginal groups), whereas language skills were achieved slightly later than in Canadian children in general. Furthermore, health factors (eg, low birth weight, chronic health conditions) were associated with late achievement of developmental outcomes even when sociodemographic characteristics were considered. CONCLUSIONS: Findings suggest that the timing of milestone achievement may differ for Aboriginal children, highlighting the importance of establishing culturally specific norms and standards rather than relying on those derived from general populations. This information may be useful for practitioners and parents interested in identifying the age ranges for development, as well as age ranges indicating potential for developmental risk and opportunities for early intervention among Aboriginal children.

HISTORIQUE: Les tranches d'âge auxquelles certaines habiletés précoces du développement sont acquises s'inscrivent dans des fenêtres de réalisation. Des recherches au sein de certains groupes s'imposent, puisque des facteurs sociaux ou culturels peuvent influer sur le développement. OBJECTIFS: La présente étude visait à examiner les étapes du développement des enfants inuits, métis et des Premières nations vivant hors réserve au Canada, d'après les étapes du développement colligées dans l'Enquête sur les enfants autochtones de 2006. Les chercheurs ont également évalué les données sociodémographiques et les prédicteurs de risque de retard du développement liés à la santé. RÉSULTATS: Les tranches d'âge auxquelles les enfants atteignent certaines étapes du développement sont présentées. Les étapes liées à la motricité globale et à l'autonomie étaient réalisées plus tôt (dans les trois groupes autochtones), tandis que les aptitudes langagières l'étaient un peu plus tard que chez l'ensemble des enfants canadiens. De plus, des facteurs liés à la santé (p. ex., petit poids de naissance, maladie chronique) s'associaient à l'atteinte tardive des étapes du développement, même lorsqu'on tenait compte des caractéristiques sociodémographiques. CONCLUSIONS: Selon les observations, l'atteinte des étapes du développement diffère peut-être chez les enfants autochtones. Il est donc d'autant plus important de dégager des normes adaptées à la culture plutôt que de se fier à celles dérivées des populations en général. Cette information peut être utile pour les praticiens et les parents désireux de déterminer les tranches d'âge pour l'atteinte des étapes du développement et celles qui évoquent un problème de développement, de même que les possibilités d'intervention rapide auprès des enfants autochtones.

Organized extracurricular activities: are in-school and out-of-school activities associated with different outcomes for Canadian youth?

BACKGROUND: Participation in extracurricular activities can have positive effects on youth, with greater participation associated with higher academic as well as better socioemotional and behavioral outcomes. Little research has examined differential effects of in-school and out-of-school activities. METHODS: This study examines in-school and out-of-school extracurricular activities for 14- to 17-year-olds using a population-based sample of Canadian youth. Associations with socioemotional and academic outcomes, and having tried smoking, alcohol, and marijuana were examined. RESULTS: Weekly participation in both in-school and out-of-school activities were associated with positive and negative outcomes. In particular, youth who participated in out-of-school activities or in both in-school and out-of-school activities had better socioemotional outcomes. Academic outcomes were associated with in-school and out-of-school sports and nonsport activities. Youth who participated weekly in nonsport activities regardless of the context (in-school or out-of-school) were less likely to have tried smoking, alcohol, or marijuana. However, weekly participation in in-school sports was associated with an increased likelihood of failing a course; youth who participated weekly in out-of-school sports were more likely to have tried alcohol. CONCLUSION: The findings suggest that participation in extracurricular activities, regardless of context, encourage positive youth development.

Dietary habits of Aboriginal children.

Based on the results of Statistics Canada's 2006 Aboriginal Children's Survey, this article presents an overview of how often First Nations children living off reserve, Métis children and Inuit children aged 2 to 5 consume various types of food, including foods considered traditional or country among Aboriginal people. The frequency with which First Nations children living off reserve and Métis children consumed items from major food groups tended to be similar. While lower percentages of Inuit children were reported to regularly consume items from these food groups, relatively high percentages of Inuit children consumed traditional or country foods. Around two-thirds of all Aboriginal children ate fast food and processed foods at least once a week, and just over half had salty snacks, sweets and desserts at least once a day. Consumption patterns varied, depending on whether children lived in a Census Metropolitan Area/Census Agglomeration.

Perceived need for mental health care in Canada: Results from the 2012 Canadian Community Health Survey-Mental Health.

BACKGROUND: Past research and national survey data on Canadians' perceived need for mental health care (MHC) have focused on unmet needs overall, and have not considered specific types of MHC needs or the extent to which needs are met. DATA AND METHODS: Using data from the 2012 Canadian Community Health Survey-Mental Health, this article describes the prevalence of perceived MHC needs for information, medication, counselling and other services. The degree to which each type of need was met is explored. Associations between risk factors for having MHC needs and the extent to which needs were met are investigated. RESULTS: In 2012, an estimated 17% of the population aged 15 or older reported having had an MHC need in the past 12 months. Two-thirds (67%) reported that their need was met; for another 21%, the need was partially met; and for 12%, the need was unmet. The most commonly reported need was for counselling, which was also the least likely to be met. Distress was identified as a predictor of perceived MHC need status. INTERPRETATION: Many Canadians are estimated to have MHC needs, particularly for counselling. People with elevated levels of distress are significantly more likely to have unmet and partially met MHC needs than to have fully met MHC needs, regardless of the presence of mental or substance disorders.

Measures of language outcomes using the Aboriginal Children's Survey.

BACKGROUND: Speech and language skills are an important developmental milestone for all children, and one of the most prevalent forms of developmental delay among Aboriginal children. However, population-based indicators of Aboriginal children's language outcomes are limited. DATA AND METHODS: Data from the Aboriginal Children's Survey (ACS) were used to examine measures of language for Aboriginal children who were 2 to 5 years of age. Responses to ACS questions on ability in any language were examined in exploratory factor analyses to determine possible language indicators. Construct validity was examined by regressing language outcomes onto socio-demographic characteristics known to be associated with children's language. RESULTS: Four language outcomes were identified and labelled: expressive language, mutual understanding, story-telling, and speech and language difficulties. INTERPRETATION: The conceptualization of items from the ACS into separate language indicators can be used by researchers examining young Aboriginal children's language outcomes.

Hunger among Inuit children in Canada.

BACKGROUND AND OBJECTIVES: Inuit populations may be at increased risk for experiencing poor nutrition or hunger due to limited access and availability to food. The prevalence and correlates of parental perceptions of hunger among a nationally representative sample of Inuit children in Canada have not yet been reported. DESIGN: Data are from the 2006 Aboriginal Children's Survey (ACS). Sociodemographic information, dietary behaviours and hunger status were parent-reported via a household interview for Inuit children aged 2-5 years (n=1,234). Prevalence of hunger was calculated among Inuit children by sociodemographic factors and by dietary behaviours. In addition, a multivariate logistic regression model was conducted to determine factors associated with parental perception of ever experiencing hunger. RESULTS: The prevalence of Inuit children in Canada aged 2-5 years ever experiencing hunger was 24.4%. Children who were reported to have experienced hunger consumed milk and milk products (p<0.001); fish, eggs and meat (p<0.05); fruits (p<0.001); and vegetables (p<0.001) significantly less often than never-hungry children. Fast food and processed foods, soft drinks and juice, and salty snacks, sweets and desserts were consumed as often as never-hungry children (all p>0.05). The majority (81%) of Inuit parents/guardians of ever-hungry children sought help from family or friends. Factors associated with an increased likelihood of experiencing hunger include sociodemographic characteristics (such as income and household size), living in an Inuit region and living in a community with cultural activities. CONCLUSION: About 1 in 4 Inuit children were reported by their parents to have experienced hunger, and hunger was associated with region, sociodemographic and community factors. Future research could further examine the impact of ever experiencing hunger on the health status of Inuit children and their families in Canada.

Informal caregiving for seniors.

Based on data from the 2008/2009 Canadian Community Health Survey-Healthy Aging, this study examines the characteristics of people aged 45 or older who reported caring for a senior. It also describes the nature of the care provided and the positive and negative aspects of caregiving. More than one-third (35%) of Canadians aged 45 or older reported caring for a senior with a short- or long-term health condition or limitation. Compared with non-caregivers, those providing care to a senior were more likely to be women. They tended to be younger and more likely to live in higher-income households and to be postsecondary graduates. More than half the people receiving care were parents or parents-in-law, and they usually did not live with the caregiver. The most common form of care provided was transportation. A third of caregivers had been providing assistance for at least five years. Virtually all (95%) of them reported positive aspects of caregiving, but more than half (56%) experienced challenges and difficulties.

The health of Inuit children under age 6 in Canada.

OBJECTIVES: Previous research has suggested that Inuit children experience poor health as compared to their non-Aboriginal counterparts, although social determinants such as family and social conditions, lifestyle or behaviour, and cultural factors may be at play. The purpose of the current study was to examine the parent-reported health of Inuit children under 6 years of age living in Canada. STUDY DESIGN AND METHODS: Data from the 2006 Aboriginal Children's Survey were used to examine measures of Inuit child health as rated by parents including child health, limitations to physical activity, chronic conditions, ear infections, and dental problems. Associations between social determinants of health and parent-rated Inuit child health were also explored. RESULTS: Most Inuit children under age 6 were reported by their parents or guardians to be in excellent or very good health. The most common chronic conditions identified were asthma, speech and language difficulties, allergies, lactose intolerance, and hearing impairment. Several social determinants of health were associated with child health, including parental education, household income, breastfeeding, and perceived housing conditions. CONCLUSIONS: The findings show that social determinants of health, including both socio-economic and household characteristics, are associated with Inuit child health.