Mothers' and Children's Mental Distress and Family Strain during the COVID-19 Pandemic: A Prospective Cohort Study.

BACKGROUND: The COVID-19 pandemic had a widespread impact on families with dependent children. To better understand the impact of the pandemic on families' health and relationships, we examined the association between mothers' and children's mental distress and family strain. METHODS: Three waves of the COVID-19 Impact Survey were analyzed, collected from a subsample of mother-child pairs (n = 157) from the Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal cohort in Alberta, Canada. Latent class analyses were performed to determine patterns and group memberships in mothers' and children's mental distress and family strain. Multivariable logistic regression models were conducted to test associations between mothers' and children's mental distress and family strain trajectory classes. RESULTS: Mothers with medium/high levels of mental distress were at increased odds of experiencing high family strain compared to those with low levels of distress (medium aOR = 3.90 [95% CI: 1.08-14.03]; high aOR = 4.57 [95% CI: 1.03-20.25]). The association between children's mental distress and family strain was not significant (aOR = 1.75 [95% CI: 0.56-5.20]). CONCLUSION: Mothers' mental distress, but not children's, was associated with family strain during the pandemic. More distressed individuals experienced greater family strain over time, suggesting that this association may become a chronic problem.

Overlap between child protection services and the youth justice system: protocol for a retrospective population-based cohort study using linked administrative data in Manitoba, Canada.

INTRODUCTION: Children who have a history of involvement in child protection services (CPS) are over-represented in the youth and adult criminal justice systems. There are significant health and socioeconomic implications for individuals involved in either or both CPS and the justice system. Understanding the 'overlap' between these two systems would provide insight into the health and social needs of this population. This protocol describes a research programme on the relationship between the child welfare and the youth justice systems, looking specifically at the population involved in both CPS and the youth justice system. We will examine the characteristics associated with involvement in these systems, justice system trajectories of individuals with a history of CPS involvement and early adult outcomes of children involved in both systems. METHODS AND ANALYSIS: Administrative data sets will be linked at the individual level for three cohorts born 1991, 1994 and 1998 in Manitoba, Canada. Involvement in CPS will be categorised as 'placed in out-of-home care', 'received in-home services, but was not placed in care' or 'no involvement'. Involvement in the youth justice system will be examined through contacts with police between ages 12 and 17 that either led to charges or did not proceed. Individual, maternal and neighbourhood characteristics will be examined to identify individuals at greatest risk of involvement in one or both systems. ETHICS AND DISSEMINATION: The study was approved by the University of Manitoba Health Research Ethics Board and permission to access data sets has been granted by all data providers. We also received approval for the study from the First Nations Health and Social Secretariat of Manitoba's Health Information Research Governance Committee and the Manitoba Metis Federation. Strategies to disseminate study results will include engagement of stakeholders and policymakers through meetings and workshops, scientific publications and presentations, and social media.

In Utero Antidepressants and Neurodevelopmental Outcomes in Kindergarteners.

OBJECTIVES: To determine if in utero selective serotonin reuptake inhibitor (SSRI) or selective serotonin norepinephrine inhibitor (SNRI) exposure is associated with developmental vulnerability in kindergarten among children whose mothers were diagnosed with prenatal mood or anxiety disorder. METHODS: Linkable administrative data were used to create a population-based cohort of 266 479 mother-child dyads of children born in Manitoba, Canada, between 1996 and 2014, with follow-up through 2015. The sample was restricted to mothers who had a mood or anxiety disorder diagnosis between 90 days before conception (N = 13 818). Exposed women had ≥2 SSRI or SNRI dispensations during pregnancy (n = 2055); unexposed mothers did not have a dispensation of an SSRI or SNRI during pregnancy (n = 10 017). The Early Development Instrument (EDI) was used to assess developmental health in kindergarten children. The EDI is a 104-component kindergarten teacher-administered questionnaire, encompassing 5 developmental domains. RESULTS: Of the 3048 children included in the study who met inclusion criteria and had an EDI, 21.43% of children in the exposed group were assessed as vulnerable on 2 or more domains versus 16.16% of children in the unexposed group (adjusted odds ratio = 1.43; 95% confidence interval 1.08-1.90). Children in the exposed group also had a significant risk of being vulnerable in language and/or cognition (adjusted odds ratio = 1.40; 95% confidence interval 1.03-1.90). CONCLUSIONS: Exposure to SSRIs or SNRIs during pregnancy was associated with an increased risk of developmental vulnerability and an increased risk of deficits in language and/or cognition. Replication of results is necessary before clinical implications can be reached.

Association between participation in the Families First Home Visiting programme and First Nations families' public health outcomes in Manitoba, Canada: a retrospective cohort study using linked administrative data.

OBJECTIVE: To determine whether the Families First Home Visiting (FFHV) programme, which provides home visiting services to families across Manitoba, is associated with improved public health outcomes among First Nations families facing multiple parenting challenges. DESIGN: Retrospective cohort study using population-based administrative data. SETTING: Manitoba, Canada. PARTICIPANTS: First Nations children born in Manitoba in 2003-2009 (n=4010) and their parents enrolled in FFHV compared with non-enrolled families with a similar risk profile. INTERVENTION: FFHV supports public health in Manitoba by providing home visiting services to First Nations and non-First Nations families with preschool children and connecting them with resources in their communities. OUTCOMES: Predicted probability (PP) and relative risk (RR) of childhood vaccination, parental involvement in community support programmes and children's development at school entry. RESULTS: FFHV participation was associated with higher rates of complete childhood vaccination at age 1 (PP: FFHV 0.715, no FFHV 0.661, RR 1.08, 95% CI 1.03 to 1.14) and age 2 (PP: FFHV 0.465, no FFHV 0.401, RR 1.16, 95% CI 1.08 to 1.25), and with parental involvement in community support groups (PP: FFHV 0.149, no FFHV 0.097, RR 1.54, 95% CI 1.27 to 1.86). However, there was no difference between FFHV participants and non-participants in rates of children being vulnerable in at least one developmental domain at age 5 (PP: FFHV 0.551, no FFHV 0.557, RR 1.00, 95% CI 0.91 to 1.11). CONCLUSIONS: FFHV supports First Nations families in Manitoba by promoting childhood vaccination and connecting families to parenting resources in their communities, thus playing an important role in fulfilling the mandate of public health practice.

Poverty and Early Childhood Outcomes.

BACKGROUND: Children born into poverty face many challenges. Exposure to poverty comes in different forms, and children may also transition into or out of poverty. In this study, we examine the relationships among various outcomes and different levels of poverty (household and/or neighborhood poverty) at different points during a child's first 5 years. METHODS: We used linkable administrative databases, following 46 589 children born in Manitoba, Canada, between 2000 and 2009 to age 7. Poverty is defined as those receiving welfare and those living in low-income neighborhoods. Four outcomes are measured in the first 5 years (placement in out-of-home care, externalizing mental health diagnosis, asthma diagnosis, and hospitalization for injury), with school readiness assessed between ages 5 and 7. RESULTS: Children born into poverty had greater odds of not being ready for school than children not born into poverty (adjusted odds ratio = 1.54, 1.59, 1.26 for children born in household and neighborhood poverty, household poverty only, and neighborhood poverty only, respectively; all significant at P < .05). Similar patterns were seen across outcomes. For those born into neighborhood poverty, the odds of school readiness were higher only if children moved before age 2. CONCLUSIONS: The level of poverty (household or neighborhood) and its duration modify the relationship between early poverty and childhood outcomes. Covariate adjustment generally weakens but does not eliminate these relationships.

Evaluating the Manitoba Infant Feeding Database: a Canadian infant feeding surveillance system.

OBJECTIVE: The Manitoba Infant Feeding Database (MIFD) is being piloted as a surveillance system leveraging infant vaccination visits as a point of contact to collect infant feeding data during the first year of life. The objective of this study was to assess data quality and acceptability of the MIFD as a sustainable population-based surveillance system. METHODS: Internal completeness and internal validity were measured to assess data quality. Internal completeness was defined as the number of completed data fields out of the total number of data fields. Internal validity was defined as the proportion of translation errors from one level of the system, the paper questionnaire, to the next, the electronic database. A survey assessed staff's acceptance of data collection and submission processes. RESULTS: A total of 947 records were reviewed. Data were 98.5% complete. Discrepancies were noted in 13.5% of data. The survey response rate was 78.4%. Nearly all respondents reported that the MIFD data collection tool was easy to use (96.6% agreed or strongly agreed). Whereas some challenges were identified, the majority were willing to continue with the MIFD data collection tool and process (93.1%). CONCLUSION: Results from this evaluation suggest that the MIFD data collection process worked well; however, data validation will require human resources. The MIFD approach provides a sustainable mechanism for collecting data on infant feeding for surveillance and research purposes.

The multigenerational effects of adolescent motherhood on school readiness: A population-based retrospective cohort study.

BACKGROUND: Children born to adolescent mothers generally perform more poorly on school readiness assessments than their peers born to adult mothers. It is unknown, however, whether this relationship extends to the grandchildren of these adolescent mothers. This paper examines the multi-generational outcomes associated with adolescent motherhood by testing whether the grandchildren of adolescent mothers also have lower school readiness scores than their peers; we further assessed if this relationship was moderated by whether the child's mother was an adolescent mother. METHODS: We used population-based data to conduct the retrospective cohort study of children born in Manitoba, Canada, 2000-2009, whose mothers were born 1979-1997 (n = 11,326). Overall school readiness and readiness on five domains of development were analyzed using logistic regression models. RESULTS: Compared with children whose mothers and grandmothers were both ≥ 20 at the birth of their first child, those born to grandmothers who were < 20 and mothers who were ≥ 20 years old at the birth of their first child had 39% greater odds of being not ready for school (95% CI: 1.22-1.60). Children whose grandmothers were ≥ 20 and mothers were < 20 at the birth of their first child had 25% greater odds of being not ready for school (95% CI: 1.11-1.41), and children born to grandmothers and mothers who were both <20 at the birth of their first child had 35% greater odds of being not ready for school (95% CI: 1.18-1.54). CONCLUSIONS: These findings suggest a multigenerational effect of adolescent motherhood on school readiness.

Placement in Care in Early Childhood and School Readiness: A Retrospective Cohort Study.

The current study examined school readiness for children placed in care of child protection services before age 5. This association was assessed using a population-based cohort of children born in Manitoba, Canada, between 2000 and 2009 ( n = 53,477) and subcohorts of discordant siblings (one sibling taken into care, one sibling not taken into care; n = 809) and discordant cousins ( n = 517). In the population analysis, children placed in care were significantly less likely to be ready for school; this difference was not seen in the discordant sibling or cousin analysis. The findings suggested that differences in school readiness for children placed in care are a result of broader social factors affecting families, not placement into care.

Income inequality, structural racism, and Canada's low performance in health equity.

In 2017, the Commonwealth Fund released a report evaluating 11 countries' healthcare systems on a variety of domains; one of these domains was health equity. Canada's score on health equity placed it among the bottom three countries. This article applies a conceptual framework for health equity developed by the World Health Organization's Commission on the Social Determinants of Health to reflect upon and discuss mechanisms that may help to explain Canada's low score. We discuss the role that two societal-level constructs-income inequality and structural racism-play in shaping population health and health equity. We use publically available data to examine whether income inequality correlates with the Commonwealth Fund report's equity measures. We also comment on the role that Canada's history of colonialism may play in its health equity ranking.