Geographic Comparison of Dietary Intake and Quality in Manitoba Adolescents.

Purpose: The Food and Nutrition for Manitoba Youth (FANS) study examined dietary intakes, food behaviours, food security status, health indicators, and body mass index of a cohort of grade 9 students. This paper describes regional differences and similarities in dietary intake (food and nutrients) and quality of youth participants in the FANS study.Methods: Grade 9 students completed a web-based survey on dietary intakes (24-hour recall), food behaviours, self-reported health indicators, and sociodemographic variables. Nutrient intakes were compared with national guidelines and diet quality was assessed using a modified Healthy Eating Index.Results: A total of 1587 students participated from northern, rural, and urban regions in Manitoba. Northern and rural students had higher intakes of sugar, sodium, and saturated fat compared with urban. Northern students consumed fewer grain products compared to urban, and more servings of "other" foods compared with rural and urban. While most participants were classified into the "needs improvement" or "poor" Healthy Eating Index categories, significantly more northern participants were in the "poor" category.Conclusions: Most adolescents in the study are at nutritional risk; however, there are additional vulnerabilities for those in rural and northern communities. Dietitians can use results to advocate for and plan interventions to improve adolescent nutrition.

Identifying newborn discharge to child protective services: Comparing discharge codes from birth hospitalization records and child protection case files.

PURPOSE: Newborn removal by North America's child protective services (CPS) disproportionately impacts Indigenous and Black families, yet its implications for population health inequities are not well understood. To guide this as a domain for future research, we measured validity of birth hospitalization discharge codes categorizing newborns discharged to CPS. METHODS: Using data from 309,260 births in Manitoba, Canada, we compared data on newborns discharged to CPS from hospital discharge codes with the presumed gold standard of custody status from CPS case reports in overall population and separately by First Nations status (categorization used in Canada for Indigenous peoples who are members of a First Nation). RESULTS: Of 309,260 newborns, 4562 (1.48%) were in CPS custody at hospital discharge according to CPS case reports and 2678 (0.87%) were coded by hospitals as discharged to CPS. Sensitivity of discharge codes was low (47.8%), however codes were highly specific (99.8%) with a positive predictive value (PPV) of 81.4%, and a negative predictive value (NPV) of 99.2%. Sensitivity, PPV and specificity were equal for all newborns but NPV was lower for First Nations newborns. CONCLUSIONS: Canadian hospital discharge records underestimate newborn discharge to CPS, with no difference in misclassication based on First Nations status.

Intimate Partner Violence Among International and Interprovincial Migrants: A Population-Based Analysis of Canadian Linked Immigration and Justice Data.

Factors associated with IPV among immigrant women are not well understood. Using linked immigration and justice data, we compared the incidence of justice-identified IPV (JIIPV) among 58,564 international immigrant women born outside of Canada, 30,098 women born in other Canadian provinces (i.e., interprovincial migrants), and 88,662 long-term Manitoban resident women. International immigrant women had the lowest incidence of JIIPV compared to matched long-term Manitobans (adjusted hazard ratio (aHR) 0.49, 95% CI: 0.43-0.56) and interprovincial migrants (aHR 0.56, 95% CI: 0.43-0.73). Among immigrants, JIIPV varied substantially according to birthplace, increased with length of residence, and was less frequent among secondary immigrants.

Transnational prenatal care among migrant women from low-and-middle-income countries who gave birth in Montreal, Canada.

OBJECTIVES: There is little research examining transnational prenatal care (TPC) (i.e., prenatal care in more than one country) among migrant women. Using data from the Migrant-Friendly Maternity Care (MFMC) - Montreal project, we aimed to: (1) Estimate the prevalence of TPC, including TPC-arrived during pregnancy and TPC-arrived pre-pregnancy, among recently-arrived migrant women from low- and middle-income countries (LMICs) who gave birth in Montreal, Canada; (2) Describe and compare the socio-demographic, migration and health profiles and perceptions of care during pregnancy in Canada between these two groups and migrant women who received no TPC (i.e., only received prenatal care in Canada); and (3) Identify predictors of TPC-arrived pre-pregnancy vs. No-TPC. METHODS: The MFMC study used a cross-sectional design. Data were gathered from recently-arrived (< 8 years) migrant women from LMICs via medical record review and interview-administration of the MFMC questionnaire postpartum during the period of March 2014-January 2015 in three hospitals, and February-June 2015 in one hospital. We conducted a secondary analysis (n = 2595 women); descriptive analyses (objectives 1 & 2) and multivariable logistic regression (objective 3). RESULTS: Ten percent of women received TPC; 6% arrived during pregnancy and 4% were in Canada pre-pregnancy. The women who received TPC and arrived during pregnancy were disadvantaged compared to women in the other two groups (TPC-arrived pre-pregnancy and No-TPC women), in terms of income level, migration status, French and English language abilities, access barriers to care and healthcare coverage. However, they also had a higher proportion of economic migrants and they were generally healthier compared to No-TPC women. Predictors of TPC-arrived pre-pregnancy included: 'Not living with the father of the baby' (AOR = 4.8, 95%CI 2.4, 9.8), 'having negative perceptions of pregnancy care in Canada (general experiences)' (AOR = 1.2, 95%CI 1.1, 1.3) and younger maternal age (AOR = 1.1, 95%CI 1.0, 1.1). CONCLUSION: Women with more capacity may self-select to migrate during pregnancy which results in TPC; these women, however, are disadvantaged upon arrival, and may need additional care. Already-migrated women may use TPC due to a need for family and social support and/or because they prefer the healthcare in their home country.

Food Behaviours and Health Indicators in Manitoba Adolescents and Relation to the Healthy Eating Index.

Adolescence is a vital period of growth and development, both of which are dependent on adequate nutrition; however, concerns persist about poor nutrition and inappropriate food behaviours. In addition to nutrition assessment, the context of food and health behaviour is necessary to understand how dietary choices are shaped and related to diet quality. This study describes food-related behaviours and health indicators associated with dietary quality among adolescents in Manitoba, Canada. A stratified two-stage sampling method was used to collect data on the diet, food behaviours and health indicators of 1587 grade nine students. Diet quality was analysed using the Healthy Eating Index-Canada. Several food behaviours and health indicators varied by gender and school region (urban, rural, northern). The Independent Samples t-test and one-way ANOVA (analysis of variance) assessed differences between groups on the Healthy Eating Index-Canada. Higher Healthy Eating Index-Canada scores were found for those eating family dinners more frequently; consuming breakfast and lunch more frequently; consuming breakfast at home; eating lunch and morning snacks at school; purchasing fewer meals and snacks from cafeterias and vending machines; believing that food and nutrition education is important; not attempting to lose weight; being classified as 'healthy weight'; and getting more sleep. Many Manitoba youth are exhibiting food and health behaviours that increase their risk of having a poor diet.

The prevalence and predictors of household food insecurity among adolescents in Canada.

OBJECTIVES: Household food insecurity is almost four times more prevalent among adolescents than among older adults in Canada, and it adversely affects their health. Our objective was to describe the sociodemographic and geographic patterning of household food insecurity among adolescents. METHODS: Our analytic sample comprised all 12-17-year-old respondents to the 2017-2018 Canadian Community Health Survey with complete data on household food insecurity (n = 8416). We used bivariate and multivariable logistic regression models to identify respondent- and household-level sociodemographic characteristics associated with household food insecurity. RESULTS: The prevalence of household food insecurity among adolescents was 20.7%. The adjusted odds of food insecurity were significantly elevated among adolescents who identified as Black or Indigenous (aOR 1.80), those living with a single parent (aOR 1.60), those living with a greater number of children ≤ 5 years (aOR 1.45) or 12-17 years (aOR 1.25), those in rented accommodation (aOR 1.98), those in households with only secondary school education (aOR 1.38), and those in households reliant on social assistance (aOR 2.03). Higher before-tax income was protective (aOR 0.99). In comparison with Ontario, the adjusted odds of food insecurity among adolescents were higher in Nunavut (aOR 6.77), Northwest Territories (aOR 2.11), and Alberta (aOR 1.48), and lower in Manitoba (aOR 0.66). CONCLUSION: The markedly higher odds of exposure to household food insecurity among adolescents who are Black or Indigenous and those living in households characterized by markers of social and economic disadvantage highlight the need for more effective policy interventions to protect vulnerable families from this hardship.

RéSUMé: OBJECTIFS: L'insécurité alimentaire des ménages est près de quatre fois plus prévalente chez les adolescents que chez les personnes âgées au Canada, et elle nuit à leur santé. Nous avons cherché à décrire la structuration sociodémographique et géographique de l'insécurité alimentaire des ménages chez les adolescents. MéTHODE: Notre échantillon d'analyse comprenait tous les répondants de 12 à 17 ans du cycle 2017-2018 de l'Enquête sur la santé dans les collectivités canadiennes, ainsi que les données complètes sur l'insécurité alimentaire des ménages (n = 8 416). Nous avons utilisé des modèles de régression logistique bivariés et multivariés pour déterminer les caractéristiques sociodémographiques des répondants et des ménages associées à l'insécurité alimentaire des ménages. RéSULTATS: La prévalence de l'insécurité alimentaire des ménages chez les adolescents était de 20,7 %. Le risque relatif rapproché d'insécurité alimentaire était significativement élevé chez les adolescents s'identifiant comme étant noirs ou autochtones (rapport de cotes ajusté [RCa] 1,80), vivant avec un seul parent (RCa 1,60), vivant avec un grand nombre d'enfants de ≤ 5 ans (RCa 1,45) ou de 12 à 17 ans (RCa 1,25), vivant dans des logements locatifs (RCa 1,98), vivant dans des ménages n'ayant fait que des études secondaires (RCa 1,38) et vivant dans des ménages dépendant de l'aide sociale (RCa 2,03). Le revenu élevé avant impôt était un facteur de protection (RCa 0,99). Comparativement à l'Ontario, le risque relatif rapproché d'insécurité alimentaire chez les adolescents était plus élevé au Nunavut (RCa 6,77), aux Territoires du Nord-Ouest (RCa 2,11) et en Alberta (RCa 1,48), et plus faible au Manitoba (RCa 0,66). CONCLUSION: Le risque nettement plus élevé d'exposition à l'insécurité alimentaire des ménages chez les adolescents noirs ou autochtones et chez ceux vivant dans des ménages caractérisés par les indicateurs de défavorisation sociale et économique montre que des interventions stratégiques plus efficaces sont nécessaires pour protéger les familles vulnérables de cette épreuve.

Assessing the migrant mortality advantage among foreign-born and interprovincial migrants in Manitoba, Canada.

OBJECTIVES: Studies on mortality differentials between international immigrants and non-immigrants produced mixed results. The mortality of interprovincial migrants has been less studied. Our objectives were to compare mortality risk between international immigrants, interprovincial migrants, and long-term residents of the province of Manitoba, Canada, and identify factors associated with mortality among migrants. METHODS: We conducted a retrospective matched-cohort study to examine all-cause and premature mortality of 355,194 international immigrants, interprovincial migrants, and long-term Manitoba residents (118,398 in each group) between January 1985 and March 2019 using linked administrative databases. Poisson regression was used to estimate adjusted incidence rate ratios (aIRR) with 95% confidence intervals (CI). RESULTS: The all-cause mortality risk of international immigrants (2.3 per 1000 person-years) and interprovincial migrants (4.4 per 1000) was lower than that of long-term Manitobans (5.6 per 1000) (aIRR: 0.43; 95% CI: 0.42, 0.45 and aIRR: 0.81; 95% CI: 0.80, 0.84, respectively). Compared with interprovincial migrants, international immigrants showed lower death risk (aIRR: 0.50; 95% CI: 0.47, 0.52). Similar trends were observed for premature mortality. Among international immigrants, higher mortality risk was observed for refugees, those from North America and Oceania, and those of low educational attainment. Among internal migrants, those from Eastern Canada had lower mortality risk than those migrating from Ontario and Western Canada. CONCLUSION: Migrants had a mortality advantage over non-migrants, being stronger for international immigrants than for interprovincial migrants. Among the two migrant groups, there was heterogeneity in the mortality risk according to migrants' characteristics.

RéSUMé: OBJECTIFS: Les études sur les écarts dans la mortalité entre les immigrants internationaux et les non-immigrants produisent des résultats mitigés. La mortalité des migrants interprovinciaux est moins étudiée. Nous avons cherché à comparer le risque de mortalité des immigrants internationaux, des migrants interprovinciaux et des résidents à long terme de la province du Manitoba, au Canada, et à cerner les facteurs associés à la mortalité chez les migrants. MéTHODE: Nous avons mené une étude de cohorte assortie rétrospective pour examiner la mortalité toutes causes confondues et la mortalité prématurée chez 355 194 immigrants internationaux, migrants interprovinciaux et résidents à long terme du Manitoba (118 398 dans chaque groupe) entre janvier 1985 et mars 2019 à l'aide de bases de données administratives maillées. Par régression de Poisson, nous avons estimé les rapports de taux d'incidence ajustés (RTAa) avec des intervalles de confiance (IC) de 95 %. RéSULTATS: Le risque de mortalité toutes causes confondues des immigrants internationaux (2,3 pour 1 000 personnes-années) et des migrants interprovinciaux (4,4 pour 1 000) était plus faible que celui des résidents à long terme du Manitoba (5,6 pour 1 000) (RTAa : 0,43; IC de 95 % : 0,42, 0,45 et RTAa : 0,81; IC de 95 % : 0,80, 0,84, respectivement). Comparativement aux migrants interprovinciaux, les immigrants internationaux présentaient un risque de mortalité plus faible (RTAa : 0,50; IC de 95 % : 0,47, 0,52). Des tendances semblables ont été observées pour la mortalité prématurée. Chez les immigrants internationaux, un risque de mortalité plus élevé a été observé chez les réfugiés, les immigrants de l'Amérique du Nord et de l'Océanie et ceux ayant un faible niveau d'instruction. Chez les migrants intérieurs, ceux de l'Est du Canada présentaient un risque de mortalité plus faible que ceux de l'Ontario et de l'Ouest canadien. CONCLUSION: Les migrants présentaient un avantage sur le plan de la mortalité par rapport aux non-migrants; cet avantage était plus prononcé chez les immigrants internationaux que chez les migrants interprovinciaux. Dans ces deux groupes de migrants, il y avait hétérogénéité dans le risque de mortalité selon les caractéristiques des migrants.

Prevalence and sociodemographic correlates of marriage among adolescent mothers in Canada, 1989-2018.

OBJECTIVES: Female marriage before age 18 is a global health issue related to gender inequality, but it is understudied in Canada. This study examined marriage trends among mothers aged < 18 versus older mothers and the sociodemographic correlates of marriage among adolescent mothers aged < 18 and older adolescent mothers. METHODS: Using the Canadian Vital Statistics - Birth Database, marriage prevalence was estimated by maternal age groups (< 18-year, 18-19-year, 20-24-year, and 25-49-year) between 1989-1990 and 2017-2018 (n = 10,399,250). Multivariable logistic regression was then used to examine the sociodemographic characteristics associated with marriage within adolescent maternal age group (< 18-year, 18-19-year, and 20-24-year) among births registered between 2000 and 2018. RESULTS: From 1989-1990 to 2017-2018, marriage prevalence declined 80.5%, 60.2%, 47.3%, and 16.0% in the < 18-year, 18-19-year, 20-24-year, and 25-49-year groups, respectively. Within the < 18-year, 18-19-year, and 20-24-year adolescent maternal age groups, older maternal age, larger parental age gap, foreign-born parents, rurality, and earlier birth period were associated with higher adjusted odds of marriage. Higher maternal neighbourhood income was associated with marriage among births to mothers aged 18-19 and 20-24 years but not among those to mothers aged < 18 years. CONCLUSION: Marriage prevalence declined among mothers of all ages, but the shifts away from marriage appear stronger among younger mothers. The sociodemographic correlates of marriage are generally similar among mothers below age 18 and slightly older adolescent mothers.

RéSUMé: OBJECTIFS: Le mariage des filles de moins de 18 ans est un problème de santé mondial lié aux inégalités entre les sexes, mais il est insuffisamment étudié au Canada. Notre étude porte sur les tendances du mariage chez les mères de < 18 ans comparativement aux mères plus âgées et sur les corrélats sociodémographiques du mariage chez les mères adolescentes de < 18 ans et les mères adolescentes plus âgées. MéTHODE: À l'aide de la Base canadienne de données de l'état civil ­ Naissance, nous avons estimé la prévalence des mariages selon le groupe d'âge maternel (< 18 ans, 18-19 ans, 20-24 ans et 25-49 ans) entre 1989-1990 et 2017-2018 (n = 10 399 250). Au moyen d'une analyse de régression logistique multivariée, nous avons ensuite examiné les caractéristiques sociodémographiques associées au mariage dans les groupes d'âge des mères adolescentes (< 18 ans, 18-19 ans et 20-24 ans) pour les naissances enregistrées entre 2000 et 2018. RéSULTATS: De 1989-1990 à 2017-2018, la prévalence des mariages a baissé de 80,5 %, 60,2 %, 47,3 % et 16,0 % dans les groupes de < 18 ans, de 18-19 ans, de 20-24 ans et de 25-49 ans, respectivement. Dans les groupes d'âge des mères adolescentes de < 18 ans, de 18-19 ans et de 20-24 ans, un âge maternel plus avancé, une plus grande différence d'âge des parents, la naissance des parents à l'étranger, la ruralité et la période de naissance plus précoce étaient associées à une probabilité de mariage ajustée plus élevée. Le revenu maternel plus élevé selon le quartier était associé au mariage pour les naissances de mères de 18-19 et de 20-24 ans, mais pas chez les mères de < 18 ans. CONCLUSION: La prévalence du mariage a baissé chez les mères de tout âge, mais l'abandon du mariage semble plus prononcé chez les mères plus jeunes. Les corrélats sociodémographiques du mariage sont généralement semblables chez les mères de moins de 18 ans et les mères adolescentes légèrement plus âgées.

The Food and Nutrition Security for Manitoba Youth (FANS) study: rationale, methods, dietary intakes and body mass index.

BACKGROUND: Good nutrition and access to healthy foods are essential for child growth and development. However, there are concerns that Canadian children do not have a healthy diet, which may be related to dietary choices as well as lack of access to healthy foods. The FANS (Food and Nutrition Security for Children and Youth) study examined the nutrition and food security status of youth in the province of Manitoba, Canada. This paper describes methods, dietary intakes, and body mass index for the FANS study.  METHODS: This cross-sectional study included 1587 Manitoba grade nine students who completed a self-administered web-based survey. Data was collected on demographic characteristics, dietary intake (24-h recall), food behaviors, food security, and self-report health indicators. Dietary data was compared to national dietary guidelines (Dietary Reference Intakes and Canada's Food Guide). Mean and median nutrient and food group intakes were calculated with corresponding measures of variability. Chi-square tests compared percentage of respondents not meeting key nutrients and food groups. Significant differences in percentage of total servings for each food group were determined by a Kruskal-Wallis test, and differences between different caloric groups were assessed using Dunn's test for post-hoc comparisons.  RESULTS: Half of study respondents were female (50.5%). Median energy intake was higher in males (2281 kcal) compared with females (1662 kcal), with macronutrient distribution of 52%, 16%, and 32% for carbohydrates, protein, and fats respectively. Most participants consumed inadequate fibre (94%), vitamin D (90%), and calcium (73%), while median sodium intakes exceeded recommendations for males but not females. A majority of participants did not meet Health Canada's recommendations for food group servings: Vegetables and Fruit (93%), Milk and Alternatives (74%), Meat and Alternatives (57%) and Grain Products (43%). Other Foods, including sugar sweetened beverages and juice, were consumed by most participants. Higher energy consumers had a greater proportion of food servings coming from Other Foods. 72.1% of students were classified as having a healthy weight and 25% were classified as overweight or obese. CONCLUSION: Poor dietary intakes and body mass index values indicate an urgent need for policy and program strategies to support healthy eating habits and food awareness in Manitoba youth.

Marital status, immigration, and reproductive health among adolescent mothers in Canada, 1990-2018: A population-based, observational study.

Immigrants to Canada increasingly come from regions where child marriage (<18 years) is prevalent. We described the prevalence, demographic characteristics, and reproductive health correlates of marriage among births to Canadian-born and foreign-born adolescent mothers. Using Canadian birth registrations from 1990 to 2018, marriage prevalence, parental birth region, and parental age gap were examined by maternal birthplace (Canada and 12 world regions) among births to mothers <18 years. Adjusted odds ratios (AORs) of preterm birth (PTB), small for gestational age (SGA), and repeat birth were estimated for the joint associations of adolescent maternal age group (<18-year, 18-19-year, and 20-24-year), marriage, and nativity status (n = 1,904,200). Depending on maternal birthplace, marital births represented 2.6% to 81.8% of births to mothers <18 years. Marriage among mothers giving birth at <18 years was associated with higher proportions of parents from the same birthplace and larger parental age gaps. AORs of PTB tended to increase with lower maternal age. AORs of SGA were generally higher among births to foreign-born mothers. Marriage was associated with lower AORs of PTB and SGA among births to Canadian-born mothers and PTB among births to foreign-born mothers in the older adolescent age groups, but no association existed in the <18-year group. Marriage was positively associated with repeat birth in all adolescent age groups, with stronger associations in the <18-year group. The reproductive health correlates of marriage are similar between births to Canadian-born and foreign-born mothers <18 years but some differ between births to mothers <18 years and those to older adolescent mothers.

Psychosocial and behavioral health indicators among immigrant and non-immigrant recent mothers.

BACKGROUND: Perinatal risk factors can vary by immigration status. We examined psychosocial and behavioral perinatal health indicators according to immigration status and immigrant characteristics. METHODS: We conducted a population-based cross-sectional study of 33,754 immigrant and 172,342 non-immigrant childbearing women residents in Manitoba, Canada, aged 15-55 years, who had a live birth and available data from the universal newborn screen completed within 2 weeks postpartum, between January 2000 and December 2017. Immigration characteristics were from the Canadian federal government immigration database. Logistic regressions models were used to obtain Odds Ratios (OR) with 95% confidence intervals (CI) for the associations between immigration characteristics and perinatal health indicators, such as social isolation, relationship distress, partner violence, depression, alcohol, smoking, substance use, and late initiation of prenatal care. RESULTS: More immigrant women reported being socially isolated (12.3%) than non-immigrants (3.0%) (Adjusted Odds Ratio (aOR): 6.95, 95% CI: 6.57 to 7.36) but exhibited lower odds of depression, relationship distress, partner violence, smoking, alcohol, substance use, and late initiation of prenatal care. In analyses restricted to immigrants, recent immigrants (< 5 years) had higher odds of being socially isolated (aOR: 9.04, 95% CI: 7.48 to 10.94) and late initiation of prenatal care (aOR: 1.50, 95% CI: 1.07 to 2.12) compared to long-term immigrants (10 years or more) but lower odds of relationship distress, depression, alcohol, smoking and substance use. Refugee status was positively associated with relationship distress, depression, and late initiation of prenatal care. Secondary immigrants, whose last country of permanent residence differed from their country of birth, had lower odds of social isolation, relationship distress, and smoking than primary migrants. There were also differences by maternal region of birth. CONCLUSION: Immigrant childbearing women had a higher prevalence of social isolation but a lower prevalence of other psychosocial and behavioral perinatal health indicators than non-immigrants. Health care providers may consider the observed heterogeneity in risk to tailor care approaches for immigrant subgroups at higher risk, such as refugees, recent immigrants, and those from certain world regions.

The perinatal epidemiology of child and adolescent marriage in Brazil, 2011-2018.

Brazil is one of the top contributors of girl child marriages in the world and one of the United Nations' members that committed to end child marriage by 2030 as part of the Sustainable Development Goals. Child marriage is an indicator of gender inequality associated with poor health outcomes. However, the perinatal epidemiology of minor mothers (<18 years) according to marital status has been insufficiently studied. We used 23,163,209 birth registrations (2011-2018) to describe the sociodemographic distribution of births to minor mothers. The association between adverse outcomes and marital status and maternal age was restricted to 7,953,739 births of mothers aged ≤15, 16-17, 18-19, 20-24 years. Multinomial logistic models were used for very (24-31 weeks) and moderately preterm birth (32-36 weeks), and severe (<3rd percentile) and moderately small-for-gestational age (SGA) (3rd to <10th percentile). Logistic models were used for binary outcomes. The proportion of births to minor mothers in the study period was 8.9%, composed of those of single (6.1%), common-law (2.4%) and married girls (0.4%). Births to minor mothers decreased over time (p-value <0.001), were more common in the North Region (13.2%) and among Indigenous (17.4%). Very and moderately preterm birth increased with decreasing age but within each age group, rates were highest among single, followed by common-law and lowest among married mothers. A similar pattern was observed for SGA, low Apgar and late prenatal care initiation. Repeat birth and low age-appropriate education were less common among married compared to single mothers in all age groups, except among ≤15-year-olds [Adjusted Odds Ratio (AOR): 2.56; 95% Confidence Interval (95%CI): 2.40, 2.74 and AOR: 1.30; 95%CI: 1.03, 1.64, respectively]. The association between perinatal indicators and marital status among adolescents is strongly modified by decreasing maternal age. Marital status is relevant for the understanding of early pregnancies.

Reproductive health among married and unmarried mothers aged less than 18, 18-19, and 20-24 years in the United States, 2014-2019: A population-based cross-sectional study.

BACKGROUND: Studies in low- and middle-income regions suggest that child marriage (<18 years) is a risk factor for poor reproductive outcomes among women. However, in high-income-country contexts where childbearing before age 18 occurs predominantly outside marriage, it is unknown whether marriage is adversely associated with reproductive health among mothers below age 18. This study examined the joint associations of marriage and adolescent maternal age group (<18, 18-19, and 20-24 years) with reproductive, maternal, and infant health indicators in the United States. METHODS AND FINDINGS: Birth registrations with US resident mothers aged ≤24 years with complete information on marital status were drawn from the 2014 to 2019 Natality Public Use Files (n = 5,669,824). Odds ratios for the interaction between marital status and maternal age group were estimated using multivariable logistic regression, adjusting for covariates such as maternal race/ethnicity and nativity status, federal program participation, and paternal age. Marriage prevalence was 3.6%, 13.2%, and 34.1% among births to mothers aged <18, 18-19, and 20-24 years, respectively. Age gradients in the adjusted odds ratios (AORs) were present for most indicators, and many gradients differed by marital status. Among births to mothers aged <18 years, marriage was associated with greater adjusted odds of prior pregnancy termination (AOR 1.64, 95% CI 1.52-1.77, p < 0.001), repeat birth (AOR 2.84, 95% CI 2.68-3.00, p < 0.001), maternal smoking (AOR 1.24, 95% CI 1.15-1.35, p < 0.001), and infant morbidity (AOR 1.07, 95% CI 1.01-1.14, p = 0.03), but weaker or reverse associations existed among births to older mothers. For all maternal age groups, marriage was associated with lower adjusted odds of late or no prenatal care initiation, sexually transmitted infection, and no breastfeeding at hospital discharge, but these beneficial associations were weaker among births to mothers aged <18 and 18-19 years. Limitations of the study include its cross-sectional nature and lack of information on marriage timing relative to prior pregnancy events. CONCLUSIONS: Marriage among mothers below age 18 is associated with both adverse and favorable reproductive, maternal, and infant health indicators. Heterogeneity exists in the relationship between marriage and reproductive health across adolescent maternal age groups, suggesting girl child marriages must be examined separately from marriages at older ages.

Pain-driven emergency department visits and food insecurity: a cross-sectional study linking Canadian survey and health administrative data.

BACKGROUND: As the leading cause of emergency department visits in Canada, pain disproportionately affects socioeconomically disadvantaged populations. We examine the association between household food insecurity and individuals' pain-driven emergency department visits. METHODS: We designed a cross-sectional study linking the Canadian Community Health Survey 2005-2017 to the National Ambulatory Care Reporting System 2003-2017. Food insecurity was measured using a validated questionnaire. We excluded individuals with missing food insecurity status, individuals younger than 12 years and jurisdiction-years with partial emergency department records. We assessed emergency department visits driven by pain at different sites (migraine, other headaches, chest-throat pain, abdomen-pelvis pain, dorsalgia, joint pain, limb pain, other pain) and their characteristics (frequency, cause, acuity and time of emergency department visit) in Ontario and Alberta. We adjusted for sociodemographic characteristics, lifestyle and prior non-pain-driven emergency department visits in the models. RESULTS: The sample contained 212 300 individuals aged 12 years and older. Compared with food-secure individuals, marginally, moderately and severely food-insecure people had 1.42 (95% confidence interval [CI] 1.20-1.68), 1.64 (95% CI 1.37-1.96) and 1.99 (95% CI 1.61-2.46) times higher adjusted incidence rates of pain-driven emergency department visits, respectively. The association was similar across sexes and significant among adults but not adolescents. Food insecurity was further associated with site-specific pain, with severely food-insecure individuals having significantly higher pain incidence than food-secure individuals. Severe food insecurity predicted more frequent, multicause, high-acuity and after-hours emergency department visits. INTERPRETATION: Household food insecurity status is significantly associated with pain-driven emergency department visits in the Canadian population. Policies targeting food insecurity may reduce pain and emergency department utilization.

Intimate Partner Violence Among Persons With Mental Health-Related Disabilities in Canada.

This study examined the elevated risk of intimate partner violence (IPV) among persons with mental health-related disabilities (MH-RD) and the extent to which known risk factors accounted for this phenomenon. Data were drawn from a nationally representative sample of 33,127 Canadians collected in 2014 as part of Statistics Canada's General Social Survey. Results showed that respondents with MH-RD had more than three-fold increased odds of both overall and severe IPV victimization. Although females were more likely to possess a MH-RD, males and females with MH-RD reported similarly elevated odds of IPV victimization. Risk factors that contributed to a significant reduction in elevated odds of IPV for respondents with MH-RD were child maltreatment (CM), respondents' nonprescription drug abuse, and perpetrators' jealous, monitoring, and socially isolating behaviors. The inability to test additional risk factors and bidirectionality in the relationship between MH-RD and IPV may have contributed to the failure to fully account for these respondents' elevated odds of IPV. Future research is needed to understand the complex mechanisms contributing to the elevated risk of IPV and enhance prevention and intervention strategies for this underresearched and underserved vulnerable population.

Changes in health indicator gaps between First Nations and other residents of Manitoba.

BACKGROUND: The Truth and Reconciliation Commission of Canada has called for better reporting of health disparities between First Nations people and other Canadians to close gaps in health outcomes. We sought to evaluate changes in these disparities using indicators of health and health care use over the last 2 decades. METHODS: We used linked, whole-population, administrative claims data from the Manitoba Centre for Health Policy for fiscal years 1994/95 to 1998/99 and 2012/13 to 2016/17. We measured indicators of health and health care use among registered First Nations and all other Manitobans, and compared differences between these groups over the 2 time periods. RESULTS: Over time, the relative gap between First Nations and all other Manitobans widened by 51% (95% confidence interval [CI] 42% to 60%) for premature mortality rate. For potential years of life lost, the gap widened by 54% (95% CI 51% to 57%) among women and by 32% (95% CI 30% to 35%) among men. The absolute gap in life expectancy widened by 3.14 years (95% CI 2.92 to 3.36) among men and 3.61 years (95% CI 3.38 to 3.84) among women. Relative gaps widened by 20% (95% CI 12% to 27%) for ambulatory specialist visits, by 14% (95% CI 12% to 16%) for hospital separations and by 50% (95% CI 39% to 62%) for days spent in hospital, but narrowed by 33% (95% CI -36% to -30%) for ambulatory primary care visits, by 22% (95% CI -27% to -16%) for mammography and by 27% (95% CI -40% to -23%) for injury hospitalizations. INTERPRETATION: Disparities between First Nations and all other Manitobans in many key indicators of health and health care use have grown larger over time. New approaches are needed to address these disparities and promote better health with and for First Nations.

The international Perinatal Outcomes in the Pandemic (iPOP) study: protocol.

Preterm birth is the leading cause of infant death worldwide, but the causes of preterm birth are largely unknown. During the early COVID-19 lockdowns, dramatic reductions in preterm birth were reported; however, these trends may be offset by increases in stillbirth rates. It is important to study these trends globally as the pandemic continues, and to understand the underlying cause(s). Lockdowns have dramatically impacted maternal workload, access to healthcare, hygiene practices, and air pollution - all of which could impact perinatal outcomes and might affect pregnant women differently in different regions of the world. In the international Perinatal Outcomes in the Pandemic (iPOP) Study, we will seize the unique opportunity offered by the COVID-19 pandemic to answer urgent questions about perinatal health. In the first two study phases, we will use population-based aggregate data and standardized outcome definitions to: 1) Determine rates of preterm birth, low birth weight, and stillbirth and describe changes during lockdowns; and assess if these changes are consistent globally, or differ by region and income setting, 2) Determine if the magnitude of changes in adverse perinatal outcomes during lockdown are modified by regional differences in COVID-19 infection rates, lockdown stringency, adherence to lockdown measures, air quality, or other social and economic markers, obtained from publicly available datasets. We will undertake an interrupted time series analysis covering births from January 2015 through July 2020. The iPOP Study will involve at least 121 researchers in 37 countries, including obstetricians, neonatologists, epidemiologists, public health researchers, environmental scientists, and policymakers. We will leverage the most disruptive and widespread "natural experiment" of our lifetime to make rapid discoveries about preterm birth. Whether the COVID-19 pandemic is worsening or unexpectedly improving perinatal outcomes, our research will provide critical new information to shape prenatal care strategies throughout (and well beyond) the pandemic.

Examining the relationship between food insecurity and causes of injury in Canadian adults and adolescents.

BACKGROUND: Food insecurity, as an indicator of socioeconomic disadvantages and a determinant of health, may be associated with injury by increasing risk exposure and hampering risk mitigation. We examined the association between food insecurity and common causes of injury in the general population. METHODS: Linking the Canadian Community Health Survey 2005-2017 to National Ambulatory Care Reporting System 2003-2017, this retrospective cohort study estimated incidence of injury-related emergency department (ED) visits by food insecurity status among 212,300 individuals 12 years and above in the Canadian provinces of Ontario and Alberta, adjusting for prior ED visits, lifestyle, and sociodemographic characteristics including income. RESULTS: Compared to those in food-secure households, individuals from moderately and severely food-insecure households had 1.16 (95% confidence interval [CI] 1.07-1.25) and 1.35 (95% CI 1.24-1.48) times higher incidence rate of ED visits due to injury, respectively, after confounders adjustment. The association was observed across sex and age groups. Severe food insecurity was associated with intentional injuries (adjusted rate ratio [aRR] 1.81; 95% CI 1.29-2.53) including self-harm (aRR 1.87; 95% CI 1.03-3.40) and violence (aRR 1.79; 95% CI 1.19-2.67) as well as non-intentional injuries (aRR 1.34; 95% CI 1.22-1.46) including fall (aRR 1.43; 95% CI 1.24-1.65), medical complication (aRR 1.39; 95% CI 1.06-1.82), being struck by objects (aRR 1.43; 95% CI 1.07-1.91), overexertion (aRR 1.31; 95% CI 1.04-1.66), animal bite or sting (aRR 1.60; 95% CI 1.08-2.36), skin piercing (aRR 1.80; 95% CI 1.21-2.66), and poisoning (aRR 1.65; 95% CI 1.05-2.59). Moderate food insecurity was associated with more injuries from violence (aRR 1.56; 95% CI 1.09-2.21), falls (aRR 1.22; 95% CI 1.08-1.37), being struck (aRR 1.20; 95% CI 1.01-1.43), and overexertion (aRR 1.25; 95% CI 1.04-1.50). Moderate and severe food insecurity were associated with falls on stairs and being struck in non-sports settings but not with falls on same level or being struck during sports. Food insecurity was not related to transport injuries. CONCLUSIONS: Health inequity by food insecurity status extends beyond diseases into differential risk of injury, warranting policy intervention. Researchers and policymakers need to address food insecurity as a social determinant of injury to improve health equity.

Linking national immigration data to provincial repositories: The case of Canada.

BACKGROUND: Canadian health data repositories link datasets at the provincial level, based on their residents' registrations to provincial health insurance plans. Linking national datasets with provincial health care registries poses several challenges that may result in misclassification and impact the estimation of linkage rates. A recent linkage of a federal immigration database in the province of Manitoba illustrates these challenges. OBJECTIVES: a) To describe the linkage of the federal Immigration, Refugees and Citizenship Canada Permanent Resident (IRCC-PR) database with the Manitoba healthcare registry and b) compare data linkage methods and rates between four Canadian provinces accounting for interprovincial mobility of immigrants. METHODS: We compared linkage rates by immigrant's province of intended destination (province vs. rest of Canada). We used external nationwide immigrant tax filing records to approximate actual settlement and obtain linkage rates corrected for interprovincial mobility. RESULTS: The immigrant linkage rates in Manitoba before and after accounting for interprovincial mobility were 84.8% and 96.1, respectively. Linkage rates did not substantially differ according to immigrants' characteristics, with a few exceptions. Observed linkage rates across the four provinces ranged from 74.0% to 86.7%. After correction for interprovincial mobility, the estimated linkage rates increased > 10 percentage points for the provinces that stratified by intended destination (British Columbia and Manitoba) and decreased up to 18 percentage points for provinces that could not use immigration records of those who did not intend to settle in the province (New Brunswick and Ontario). CONCLUSIONS: Despite variations in methodology, provincial linkage rates were relatively high. The use of a national immigration dataset for linkage to provincial repositories allows a more comprehensive linkage than that of province-specific subsets. Observed linkage rates can be biased downwards by interprovincial migration, and methods that use external data sources can contribute to assessing potential selection bias and misclassification.