Linking Canadian Administrative Data: Income Trajectories, Residential and School Mobility, and Grade 3 Academic Achievement.

Objective The objective is to examine the association between trajectories of childhood residential and school mobility and academic achievement (literacy, numeracy) in Grade 3 using linked whole-population administrative data in Manitoba, Canada. Secondarily, we assessed childhood residential/school mobility based on neighbourhood income levels (moving in/out of low- or mid-/high-income neighbourhoods). Approach This retrospective cohort study used linkable, de-identified administrative data (health, education, national census, provincial survey) from the provincial Population Research Data Repository housed at the Manitoba Centre for Health Policy (MCHP). Among kindergarteners from 2005 to 2014 (n = 83,894), those not having continuous residency in Manitoba, valid education assessments, and relevant family-level covariates were excluded. We followed this eligible cohort from kindergarten to Grade 3 based on various neighbourhood income trajectories of residential and school mobility. To assess Grade 3 literacy and numeracy scores based on trajectories, log-binomial regression models were conducted using SAS® version 9.4. Results The total cohort included 36,754 children; at the end of kindergarten, 14.2% resided in low-income neighbourhoods, and 84.8% lived in mid-/high-income neighbourhoods. Moving between two low-income neighborhoods between kindergarten to Grade 3 was associated with an increased risk of poor Grade 3 numeracy and literacy scores (numeracy aRR=1.39 [1.16,1.67]; literacy aRR=1.31 [1.08,1.59]). When moving between neighborhood income levels, the association was stronger for children moving into low-income neighbourhoods (e.g., mid-/high-income to low-income: numeracy aRR=1.41 [1.19,1.67]) than children moving into mid/high-income neighbourhoods (e.g., low-income to mid-/high-income: numeracy aRR=1.31 [1.08,1.59]). Changing schools between kindergarten and Grade 3 was also associated with poorer numeracy and literacy scores in Grade 3 (numeracy aRR=1.31 [1.22,1.40]; literacy aRR=1.34 [1.24,1.44]); however, the strength varied based on residential mobility patterns. Conclusion Moving homes/schools can differentially impact children’s educational attainment depending upon the income level of residing neighborhood(s). Stakeholders should recognize different levels of risks related to mobility and provide support accordingly to reduce the adverse impact. Support systems should be tailored to not only children but also families and neighbourhoods

Maternal Mental Health, Child Distress and Family Strain During the COVID-19 Pandemic: Linking the Provincial Longitudinal Cohort with the COVID-19 Impact Survey Data in Canada.

Objective To understand the impact of the COVID-19 pandemic on families in Canada by specifically examining the relationship between maternal mental distress (MD), child distress (CD) and family strain (FS) trends over time. We linked the Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal cohort data and COVID-19 Impact Survey (CIS). Approach Three waves of CIS (March 2020 to July 2021), collected from APrON longitudinal cohort, were used. Demographic variables from APrON were linked with CIS. Mothers’ depression, anxiety, and/or stress scores were standardized separately for different symptoms, averaged at each wave, and combined as one maternal MD variable (low/medium/high). CD was measured across emotional, conduct, hyperactivity, and peer problem scales (low/high). FS was defined as COVID-19 straining family relationships, including partners, parent-child, and siblings (yes/no). Latent class analyses were performed to identify and categorize membership across the variables. To address the objective, multiple logistic regression models were conducted. Results The sample consisted of 157 participants were included in the study; 19.1% reported FS during COVID-19. Three latent classes were formed for maternal MD: consistently low (36.9%), medium (44.0%), and high (19.1%) across the follow-up period. Two latent classes were formed for CD: consistently low (79.6%) and high (20.4%). When adjusted for COVID-19 related covariates (e.g., maternal worries about child’s well-being/education, family difficulty with childcare/schoolwork) and socioeconomic status, mothers with medium and high levels of maternal MD were at increased odds of experiencing FS during the COVID-19 pandemic compared to those with a low level of distress (medium aOR = 3.90[1.08, 14.03]; high aOR = 4.57[1.03, 20.25]). The adjusted association between child distress and FS was not statistically significant (aOR = 1.75[0.59, 5.20]). Conclusion Understanding how MD could affect family strain is important as many families recover from the pandemic. More distressed individuals experience greater FS over time, suggesting this association as a chronic problem. Stakeholders should tailor support systems to longer-term, family-level interventions improving family relationships and maternal-child MHD impacted by COVID-19

Prenatal Exposure to Intimate Partner Violence and Developmental Health in Children at Kindergarten: Linking Canadian Population-Level Administrative Data.

Objective Using population-wide administrative data, the objective was to provide Canadian evidence on the longitudinal relationship between maternal intimate partner violence (IPV) victimization and children’s developmental health. Using provincial prosecution records, we examined developmental vulnerability (DV) at kindergarten of children prenatally exposed to maternal IPV victimization compared to unexposed counterparts. Approach This retrospective cohort study linked administrative datasets (legal, health, education, social services) from the Population Research Data Repository at the Manitoba Centre for Health Policy. Exposed mother-child pairs with 1+ prosecution record of maternal IPV victimization during pregnancy between 2003 and 2018 in Manitoba (n = 1,117) were matched to unexposed pairs (1:3) based on sex/birthdate of child and neighbourhood income. DV at kindergarten was measured across 5 domains (physical, social, emotional, language/cognitive [LC], communication/general knowledge) using the Early Developmental Instrument (EDI). Children without eligible EDI scores were excluded. Multiple logistic regression models were conducted to address the objective. Results The eligible cohort included 927 children (exposed n=229, unexposed n=698); 31.07% of the cohort was developmentally vulnerable in one or more domains (1/+) and 19.53% was developmentally vulnerable in two or more domains (2/+). Children who were prenatally exposed to maternal IPV victimization had increased odds of vulnerability across all 5 developmental domains (e.g., physical health/wellness: OR=2.83[1.95,4.10]; LC development: OR=2.45[1.65,3.64]). Unadjusted ORs showed statistically significant associations between maternal exposure of prenatal IPV victimization and DV in 1/+ (OR=2.70[1.98,3.68]) and 2/+ (OR=2.48[1.75,3.50]). When adjusted for covariates (e.g., maternal income assistance, mental health, child abuse history), no statistically significant relationship was found for any of the domains (e.g., LC development: aOR=0.98[0.53,1.81]), 1/+ (aOR=1.17[0.72,1.88]), and 2/+ (aOR=1.14[0.67,1.95]). Conclusion The unadjusted, statistically significant associations suggest children exposed to maternal IPV victimization prenatally may face associated social/health risks. The finding highlights the need to consider potential factors that put children at risk of DV when developing and implementing support systems/interventions for children exposed to maternal IPV victimization

The Overlap Between the Child Welfare and Youth Justice Systems in Manitoba, Canada

Introduction Manitoba has one of the highest rates of children taken into care of child welfare services (Child and Family Services; CFS) in the world, and also one of the highest youth incarceration rates in Canada. Policy-makers recognize there is overlap between these systems; the extent of that overlap is unknown. Objectives and Approach We linked CFS, Justice, and Population Health Registry data to quantify the overlap between having a history of CFS during childhood (0-17 years) and being charged with a crime as a youth (12-17 years). Using a cohort approach, we selected all individuals in Manitoba who were born in 1988 (N=28,178); those not in the province at any time from 12-17 years were excluded, leaving a final cohort of 18,182. The cohort was divided into 3 groups according to CFS involvement: CFS out-of-home care (1,148); CFS in-home services (3,395); no CFS (13,639). Criminal charges between 12-17 years were identified. Results 6.3% of our cohort had CFS out-of-home care, 18.7% received CFS in-home services, and 75% had no CFS involvement. 10.5% of the cohort were charged of a crime between 12-17 years. Almost half (46.6%) of youth who had CFS out-of-home care had criminal charges, compared to 19.4% of youth who had CFS in-home services, and 5.3% of youth with no CFS. Despite accounting for only 6.3% of the cohort, youth who had out-of-home care accounted for 28.0% of youth with criminal charges. Indigenous (First Nations (FN) and Metis) children/youth were over-represented in both systems; for example, 24.5% of FN youth had been in care compared to 3.1% of non-Indigenous; and 32.2% of FN youth were charged with a crime compared to 6.6% of non-Indigenous youth. Conclusion/Implications There is substantial overlap between the child welfare and youth justice systems, with overrepresentation of Indigenous youth in both systems. Culturally appropriate programs and policies aimed at supporting parents, families and communities to care for their own children will likely have long-term positive impacts on the youth justice system

No Strings Attached: The Impact of an Unconditional Prenatal Income Supplement on First Nations Birth and Early Childhood Outcomes

Introduction In Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), an unconditional income supplement provided during the second and third trimester of pregnancy. HBPB is associated with improved birth outcomes for Manitoba women; its association with birth outcomes for First Nations (Indigenous) women is unknown. Objectives and Approach To determine the association between HBPB and First Nations’ (FN) newborn and early childhood outcomes, we linked whole-population data from health, public health, family services and education. We included only FN women receiving income assistance during pregnancy (n=7074) to develop comparable treatment (received HBPB; n=5283) and comparison (no HBPB; n=1791) groups. Propensity score weighting adjusted for differences in maternal characteristics between groups. Multi-variable regressions compared groups on breastfeeding initiation, low birth weight, preterm birth, small- and large-for-gestational age, Apgar scores, complete immunizations at 1 and 2 years, and developmental vulnerability in kindergarten measured with the Early Development Instrument (EDI). Results Receipt of the HBPB was associated with reductions in low birth weight births (adjusted Relative Risk (aRR): 0.77; 95% CI: 0.63, 0.93) and preterm births (aRR: 0.78 (0.68, 0.90)), and increases in breastfeeding initiation (aRR: 1.05 (1.00, 1.09)) and large-for-gestational age births (aRR: 1.11 (1.01, 1.23)). HBPB receipt during pregnancy was also associated with increases in 1- and 2-year immunizations for FN children (aRR: 1.14 (1.09, 1.19), and aRR: 1.28 (1.19, 1.36), respectively). Reductions in the risk of being developmentally vulnerable in the language and cognitive domain of the EDI were also found for FN children whose mothers had received the HBPB during pregnancy (aRR: 0.85 (0.74, 0.97). Conclusion/Implications A modest unconditional income supplement during pregnancy was associated with improved birth outcomes, increased immunization rates, and improved language and cognitive development at kindergarten for children born to low-income First Nations women. Long-term strategies to address structural inequities and the ongoing effects of colonization are also needed

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

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