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Counts NZ, Feinberg ME, Lee JK, Smith JD. Modeling Long-Term Budgetary Impacts of Prevention: An Overview of Meta-analyses of Relationships Between Key Health Outcomes Across the Life-Course. JOURNAL OF PREVENTION (2022) 2024; 45:177-192. [PMID: 38157132 DOI: 10.1007/s10935-023-00744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 01/03/2024]
Abstract
Budget analysis entities often cannot capture the full downstream impacts of investments in prevention services, programs, and interventions. This study describes and applies an approach to synthesizing existing literature to more fully account for these effects. This study reviewed meta-analyses in PubMed published between Jan 1, 2010 and Dec 31, 2019. The initial search included meta-analyses on the association between health risk factors, including maternal behavioral health, intimate partner violence, child maltreatment, depression, and obesity, with a later health condition. Through a snowball sampling-type approach, the endpoints of the meta-analyses identified became search terms for a subsequent search, until each health risk was connected to one of the ten costliest health conditions. These results were synthesized to create a path model connecting the health risks to the high-cost health conditions in a cascade. Thirty-seven meta-analyses were included. They connected early-life health risk factors with six high-cost health conditions: hypertension, diabetes, asthma and chronic obstructive pulmonary disorder, mental disorders, heart conditions, and trauma-related disorders. If confounders could be controlled for and causality inferred, the cascading associations could be used to more fully account for downstream impacts of preventive interventions. This would support budget analysis entities to better include potential savings from investments in chronic disease prevention and promote greater implementation at scale.
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Affiliation(s)
- Nathaniel Z Counts
- Mental Health America, 500 Montgomery St, Suite 820, Alexandria, VA, 22314, USA.
| | - Mark E Feinberg
- Department of Human Development and Family Studies, Pennsylvania State University, State College, PA, USA
| | - Jin-Kyung Lee
- Department of Human Development and Family Studies, Pennsylvania State University, State College, PA, USA
| | - Justin D Smith
- Division of Health System Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
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Ortelan N, de Almeida MF, Pinto Júnior EP, Bispo N, Fiaccone RL, Falcão IR, Rocha ADS, Ramos D, Paixão ES, de Cássia Ribeiro-Silva R, Rodrigues LC, Barreto ML, Ichihara MYT. Evaluating the relationship between conditional cash transfer programme on preterm births: a retrospective longitudinal study using the 100 million Brazilian cohort. BMC Public Health 2024; 24:713. [PMID: 38443875 PMCID: PMC10916064 DOI: 10.1186/s12889-024-18152-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Preterm births increase mortality and morbidity during childhood and later life, which is closely associated with poverty and the quality of prenatal care. Therefore, income redistribution and poverty reduction initiatives may be valuable in preventing this outcome. We assessed whether receipt of the Brazilian conditional cash transfer programme - Bolsa Familia Programme, the largest in the world - reduces the occurrence of preterm births, including their severity categories, and explored how this association differs according to prenatal care and the quality of Bolsa Familia Programme management. METHODS A retrospective cohort study was performed involving the first live singleton births to mothersenrolled in the 100 Million Brazilian Cohort from 2004 to 2015, who had at least one child before cohort enrollment. Only the first birth during the cohort period was included, but born from 2012 onward. A deterministic linkage with the Bolsa Familia Programme payroll dataset and a similarity linkage with the Brazilian Live Birth Information System were performed. The exposed group consisted of newborns to mothers who received Bolsa Familia from conception to delivery. Our outcomes were infants born with a gestational age < 37 weeks: (i) all preterm births, (ii) moderate-to-late (32-36), (iii) severe (28-31), and (iv) extreme (< 28) preterm births compared to at-term newborns. We combined propensity score-based methods and weighted logistic regressions to compare newborns to mothers who did and did not receive Bolsa Familia, controlling for socioeconomic conditions. We also estimated these effects separately, according to the adequacy of prenatal care and the index of quality of Bolsa Familia Programme management. RESULTS 1,031,053 infants were analyzed; 65.9% of the mothers were beneficiaries. Bolsa Familia Programme was not associated with all sets of preterm births, moderate-to-late, and severe preterm births, but was associated with a reduction in extreme preterm births (weighted OR: 0.69; 95%CI: 0.63-0.76). This reduction can also be observed among mothers receiving adequate prenatal care (weighted OR: 0.66; 95%CI: 0.59-0.74) and living in better Bolsa Familia management municipalities (weighted OR: 0.56; 95%CI: 0.43-0.74). CONCLUSIONS An income transfer programme for pregnant women of low-socioeconomic status, conditional to attending prenatal care appointments, has been associated with a reduction in extremely preterm births. These programmes could be essential in achieving Sustainable Development Goals.
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Affiliation(s)
- Naiá Ortelan
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil.
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation. Edifício Tecnocentro, Rua Mundo, 121, Trobogy, Salvador, Bahia, 41745-715, Brazil.
| | | | - Elzo Pereira Pinto Júnior
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Nivea Bispo
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Institute of Mathematics and Statistics, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Rosemeire L Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Institute of Mathematics and Statistics, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Ila Rocha Falcão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Aline Dos Santos Rocha
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
| | - Dandara Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Enny S Paixão
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rita de Cássia Ribeiro-Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- School of Nutrition, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Laura C Rodrigues
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
- Collective Health Institute, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Maria Yury T Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute (IGM), Oswaldo Cruz Foundation (FIOCRUZ-BA), Salvador, Bahia, Brazil
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Moolla A, Mdewa W, Erzse A, Hofman K, Thsehla E, Goldstein S, Kohli-Lynch C. A cost-effectiveness analysis of a South African pregnancy support grant. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002781. [PMID: 38329926 PMCID: PMC10852248 DOI: 10.1371/journal.pgph.0002781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/14/2024] [Indexed: 02/10/2024]
Abstract
Poverty among expectant mothers often results in sub-optimal maternal nutrition and inadequate antenatal care, with negative consequences on child health outcomes. South Africa has a child support grant that is available from birth to those in need. This study aims to determine whether a pregnancy support grant, administered through the extension of the child support grant, would be cost-effective compared to the existing child support grant alone. A cost-utility analysis was performed using a decision-tree model to predict the incremental costs (ZAR) and disability-adjusted life years (DALYs) averted by the pregnancy support grant over a 2-year time horizon. An ingredients-based approach to costing was completed from a governmental perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were performed. The intervention resulted in a cost saving of R13.8 billion ($930 million, 95% CI: ZAR3.91 billion - ZAR23.2 billion/ $1.57 billion - $264 million) and averted 59,000 DALYs (95% CI: -6,400-110,000), indicating that the intervention is highly cost-effective. The primary cost driver was low birthweight requiring neonatal intensive care, with a disaggregated incremental cost of R31,800 ($2,149) per pregnancy. Mortality contributed most significantly to the DALYs accrued in the comparator (0.68 DALYs). The intervention remained the dominant strategy in the sensitivity analyses. The pregnancy support grant is a highly cost-effective solution for supporting expecting mothers and ensuring healthy pregnancies. With its positive impact on child health outcomes, there is a clear imperative for government to implement this grant. By investing in this program, cost savings could be leveraged. The implementation of this grant should be given high priority in public health and social policies.
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Affiliation(s)
- Aisha Moolla
- SAMRC/Wits Centre for Health Economics and Decision Science ‐ PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Winfrida Mdewa
- SAMRC/Wits Centre for Health Economics and Decision Science ‐ PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Agnes Erzse
- SAMRC/Wits Centre for Health Economics and Decision Science ‐ PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science ‐ PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evelyn Thsehla
- SAMRC/Wits Centre for Health Economics and Decision Science ‐ PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Susan Goldstein
- SAMRC/Wits Centre for Health Economics and Decision Science ‐ PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ciaran Kohli-Lynch
- SAMRC/Wits Centre for Health Economics and Decision Science ‐ PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Francis J, Mildon A, Tarasuk V, Frank L. Household food insecurity is negatively associated with achievement of prenatal intentions to feed only breast milk in the first six months postpartum. Front Nutr 2024; 11:1287347. [PMID: 38356859 PMCID: PMC10865492 DOI: 10.3389/fnut.2024.1287347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
Background Household food insecurity (HFI) has been associated with suboptimal breastfeeding practices. Postpartum factors reported by caregivers include stressful life circumstances and maternal diet quality concerns. It is unknown whether prenatal breast milk feeding intentions, a well-established predictor of breastfeeding outcomes, differ by HFI status. We explored associations between HFI and prenatal intentions to feed any and only breast milk in the first 6 months postpartum, and achievement of these intentions. Methods We utilized data from self-identified biological mothers with children 6-12 months of age who responded to a retrospective, cross-sectional online infant feeding survey conducted in Nova Scotia, Canada. HFI (yes/no) was assessed using the Household Food Security Survey Module. Prenatal intentions to feed any and only breast milk were assessed based on responses to five options for infant milk feeding plans. Achievement of intentions was assessed by breast milk and formula feeding practices in the first 6 months. Multivariable logistic regressions were conducted, adjusting for maternal socio-demographics. Results Among 459 respondents, 28% reported HFI; 88% intended to feed any breast milk and 77% intended to feed only breast milk, with no difference by HFI status. Of those intending to feed any breast milk, 99% succeeded, precluding further analysis. Among mothers who intended to provide only breast milk, only 51% achieved their intention, with lower odds among those with HFI (aOR 0.54, 95% CI 0.29-0.98). Conclusion HFI was not associated with intentions for feeding breast milk in the first 6 months postpartum, but mothers with HFI were less likely to achieve their intention to provide only breast milk. Further research is needed to understand the underlying reasons for this and to guide intervention designs to address HFI and help mothers reach their breastfeeding goals.
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Affiliation(s)
- Jane Francis
- Department of Sociology, Acadia University, Wolfville, NS, Canada
| | - Alison Mildon
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Valerie Tarasuk
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Lesley Frank
- Department of Sociology, Acadia University, Wolfville, NS, Canada
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Falcão IR, Ribeiro-Silva RDC, Fiaccone RL, Alves FJO, Rocha ADS, Ortelan N, Silva NJ, Rebouças P, Pinto Júnior EP, de Almeida MF, Paixao ES, Pescarini JM, Rodrigues LC, Ichihara MY, Barreto ML. Participation in Conditional Cash Transfer Program During Pregnancy and Birth Weight-Related Outcomes. JAMA Netw Open 2023; 6:e2344691. [PMID: 38015506 PMCID: PMC10685879 DOI: 10.1001/jamanetworkopen.2023.44691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/10/2023] [Indexed: 11/29/2023] Open
Abstract
Importance There is limited evidence of the association of conditional cash transfers, an important strategy to reduce poverty, with prevention of adverse birth-related outcomes. Objective To investigate the association between receiving benefits from the Bolsa Família Program (BFP) and birth weight indicators. Design, Setting, and Participants This cohort study used a linked data resource, the Centro de Integracao de Dados e Conhecimentos Para Saude (CIDACS) birth cohort. All live-born singleton infants born to mothers registered in the cohort between January 2012 and December 2015 were included. Each analysis was conducted for the overall population and separately by level of education, self-reported maternal race, and number of prenatal appointments. Data were analyzed from January 3 to April 24, 2023. Exposure Live births of mothers who had received BFP until delivery (for a minimum of 9 months) were classified as exposed and compared with live births from mothers who did not receive the benefit prior to delivery. Main Outcomes and Measures Low birth weight (LBW), birth weight in grams, and small for gestational age (SGA) were evaluated. Analytical methods used included propensity score estimation, kernel matching, and weighted logistic and linear regressions. Race categories included Parda, which translates from Portuguese as "brown" and is used to denote individuals whose racial background is predominantly Black and those with multiracial or multiethnic ancestry, including European, African, and Indigenous origins. Results A total of 4 277 523 live births (2 085 737 females [48.8%]; 15 207 among Asian [0.4%], 334 225 among Black [7.8%], 29 115 among Indigenous [0.7%], 2 588 363 among Parda [60.5%], and 1 310 613 among White [30.6%] mothers) were assessed. BFP was associated with an increase of 17.76 g (95% CI, 16.52-19.01 g) in birth weight. Beneficiaries had an 11% lower chance of LBW (odds ratio [OR], 0.89; 95% CI, 0.88-0.90). BFP was associated with a greater decrease in odds of LBW among subgroups of mothers who attended fewer than 7 appointments (OR, 0.85; 95% CI, 0.84-0.87), were Indigenous (OR, 0.73; 95% CI, 0.61-0.88), and had 3 or less years of education (OR, 0.76; 95% CI, 0.72-0.81). There was no association between BFP and SGA, except among less educated mothers, who had a reduced risk of SGA (OR, 0.83; 95% CI, 0.79-0.88). Conclusions and Relevance This study found that BFP was associated with increased birth weight and reduced odds of LBW, with a greater decrease in odds of LBW among higher-risk groups. These findings suggest the importance of maintaining financial support for mothers at increased risk of birth weight-related outcomes.
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Affiliation(s)
- Ila R. Falcão
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Rita de Cássia Ribeiro-Silva
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | - Rosemeire L. Fiaccone
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | | | - Aline dos Santos Rocha
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | - Naiá Ortelan
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Natanael J. Silva
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Barcelona Institute for Global Health, Hospital Clinic, Barcelona, Spain
| | - Poliana Rebouças
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | | | | | - Enny S. Paixao
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Júlia M. Pescarini
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura C. Rodrigues
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maria Yury Ichihara
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Mauricio L. Barreto
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
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Margerison CE, Zamani-Hank Y, Catalano R, Hettinger K, Michling TR, Bruckner TA. Association of the 2021 Child Tax Credit Advance Payments With Low Birth Weight in the US. JAMA Netw Open 2023; 6:e2327493. [PMID: 37556140 PMCID: PMC10413172 DOI: 10.1001/jamanetworkopen.2023.27493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/26/2023] [Indexed: 08/10/2023] Open
Abstract
IMPORTANCE Infants and pregnant people in the US fare worse on almost all health measures compared with those in peer nations. Families in the US are more likely to live in poverty and have a less generous social safety net, which has generated debate over the contribution of economic conditions to this disparity. OBJECTIVE To assess the association between temporary increases in income during pregnancy through the 2021 expanded Child Tax Credit (CTC) and birth outcomes. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study applied a comparison-population, interrupted time series design to data from US birth certificates (January 1, 2014, through December 31, 2021) to test whether the log odds of low birth weight (LBW) among monthly cohorts of births exposed to the CTC would coincide with a decreased incidence of LBW. All singleton live births to US residents aged 15 to 49 years with available data were included. EXPOSURE Monthly birth cohorts exposed to the CTC were defined as those born to parous people during the CTC advance payment period from July through December 2021. MAIN OUTCOMES AND MEASURES The main outcome was the natural logarithm of the odds of LBW (<2500 g) among monthly birth cohorts. RESULTS Among included births (n = 28 866 466), 61.2% were to parous people, the majority were to people aged 20 to 39 years (91.7%), and 6.5% were born LBW. The odds of LBW increased above expected values in 5 of the 6 months of the CTC payments (range of increases, 3.3%-5.4% across the 5 months). The outlier-adjusted odds of LBW increased, on average, by 4.2% (95% CI, 2.7%-5.7%) among the monthly birth cohorts exposed to the CTC. CONCLUSIONS AND RELEVANCE This study found that the odds of LBW among birth cohorts exposed to the CTC increased above expected values in 5 of the 6 months of the CTC advance payments. Additional research is needed to evaluate rival explanations for this increase in LBW among births exposed to the CTC payments.
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Affiliation(s)
- Claire E. Margerison
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
| | - Yasamean Zamani-Hank
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
- Now with Department of Family Medicine, College of Human Medicine, Michigan State University, East Lansing
| | - Ralph Catalano
- School of Public Health, University of California, Berkeley
| | - Katlyn Hettinger
- Department of Economics, Michigan State University, East Lansing
| | - Timothy R. Michling
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
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Stewart E, Pearce A, Given J, Gilbert R, Brophy S, Cookson R, Hardelid P, Harron KL, Leyland A, Wood R, Dundas R. Identifying opportunities for upstream evaluations relevant to child and maternal health: a UK policy-mapping review. Arch Dis Child 2023; 108:556-562. [PMID: 37001969 PMCID: PMC10314013 DOI: 10.1136/archdischild-2022-325219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/19/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE Interventions to tackle the social determinants of health can improve outcomes during pregnancy and early childhood, leading to better health across the life course. Variation in content, timing and implementation of policies across the 4 UK nations allows for evaluation. We conducted a policy-mapping review (1981-2021) to identify relevant UK early years policies across the social determinants of health framework, and determine suitable candidates for evaluation using administrative data. METHODS We used open keyword and category searches of UK and devolved Government websites, and hand searched policy reviews. Policies were rated and included using five criteria: (1) Potential for policy to affect maternal and child health outcomes; (2) Implementation variation across the UK; (3) Population reach and expected effect size; (4) Ability to identify exposed/eligible group in administrative data; (5) Potential to affect health inequalities. An expert consensus workshop determined a final shortlist. RESULTS 336 policies and 306 strategy documents were identified. Policies were mainly excluded due to criteria 2-4, leaving 88. The consensus workshop identified three policy areas as suitable candidates for natural experiment evaluation using administrative data: pregnancy grants, early years education and childcare, and Universal Credit. CONCLUSION Our comprehensive policy review identifies valuable opportunities to evaluate sociostructural impacts on mother and child outcomes. However, many potentially impactful policies were excluded. This may lead to the inverse evidence law, where there is least evidence for policies believed to be most effective. This could be ameliorated by better access to administrative data, staged implementation of future policies or alternative evaluation methods.
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Affiliation(s)
- Emma Stewart
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Joanne Given
- School of Nursing and Paramedic Science, Ulster University, Coleraine, Londonderry, UK
| | - Ruth Gilbert
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Richard Cookson
- Centre for Health Economics, University of York, York, North Yorkshire, UK
| | - Pia Hardelid
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Katie L Harron
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alastair Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rachael Wood
- Public Health Scotland, Edinburgh, UK
- Usher Institute, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Boccia D, Maritano S, Pizzi C, Richiardi MG, Lioret S, Richiardi L. The impact of income-support interventions on life course risk factors and health outcomes during childhood: a systematic review in high income countries. BMC Public Health 2023; 23:744. [PMID: 37087420 PMCID: PMC10121417 DOI: 10.1186/s12889-023-15595-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/04/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND In high income countries one in five children still lives in poverty, which is known to adversely shape the life course health trajectory of these children. However, much less is understood on whether social and fiscal policies have the capacity to reverse this damage, which intervention is likely to be most effective and when these interventions should be delivered to maximise their impact. This systematic review attempts to address these questions by looking at the impact of income-support interventions, delivered during the first 1,000 days of life, on cardiovascular, metabolic, respiratory and mental health outcomes. METHODS The review was restricted to experimental or quasi experimental studies conducted in high income countries. Studies were retrieved from multidisciplinary databases as well as health, economic, social sciences-specific literature browsers. All papers retrieved through the search strategy were double screened at title, abstract and full text stage. Relevant data of the selected studies were extracted and collected in tables, then summarised via narrative synthesis approach. Robustness of findings was assessed by tabulating impact by health outcome, type of intervention and study design. RESULTS Overall, 16 relevant papers were identified, including 15 quasi-experimental studies and one randomized control trial (RCT). Income-support interventions included were unconditional/conditional cash transfers, income tax credit and minimum wage salary policies. Most studies were conducted in United States and Canada. Overall, the evidence suggested limited effect on mental health indicators but a positive, albeit small, effect of most policies on birth weight outcomes. Despite this, according to few studies that tried to extrapolate the results into public health terms, the potential number of negative outcomes averted might be consistent. CONCLUSIONS Income-support interventions can positively affect some of the health outcomes of interest in this review, including birth weight and mental health. Given the large number of people targeted by these programs, one could infer that - despite small - the observed effect may be still relevant at population level. Nonetheless, the limited generalisability of the evidence gathered hampers firm conclusions. For the future, the breadth and scope of this literature need to be broadened to fully exploit the potential of these interventions and understand how their public health impact can be maximised.
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Affiliation(s)
- Delia Boccia
- Faculty of Population and Health Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK
- Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin, Italy
| | - Silvia Maritano
- Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin, Italy.
- University School for Advanced Studies IUSS Pavia, Pavia, Italy.
| | - Costanza Pizzi
- Department of Medical Sciences, University of Turin and CPO-Piemonte, Turin, Italy
| | - Matteo G Richiardi
- Centre for Microsimulation and Policy Analysis, Institute for Social and Economic Research, University of Essex, Colchester, UK
| | | | - Lorenzo Richiardi
- Centre for Microsimulation and Policy Analysis, Institute for Social and Economic Research, University of Essex, Colchester, UK
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Davis BA, Arcaya MC, Williams DR, Krieger N. The impact of county-level fees & fines as exploitative revenue generation on US birth outcomes 2011-2015. Health Place 2023; 80:102990. [PMID: 36842240 DOI: 10.1016/j.healthplace.2023.102990] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/30/2022] [Accepted: 02/08/2023] [Indexed: 02/28/2023]
Abstract
Fees and fines collected through courts and law enforcement can comprise a considerable proportion of revenue for local governments. Law enforcement, as agents of revenue generation, change policing behavior to increase revenue, at times targeting Black and brown neighborhoods to bolster municipal budgets. This structural racism in revenue generation has not yet been assessed as an exposure for adverse health. Using the 2012 Census of Governments, and 2011-2015 vital statistics from the National Center of Health Statistics, we examine the relationship between countyaverage fees and fines as a percent of total own-source revenue and county-level characteristics, and risk of preterm birth and low birthweight across the United States. Mothers residing in counties with the greatest reliance on fees and fines had 1.08 (95% CI: 1.03-1.12) times the odds of preterm birth and 1.07 (95% CI: 1.02-1.11) times the odds of low birthweight than mothers residing in counties with the least reliance on fees and fines, controlling for individual- and county-level covariates. The addition of countylevel racial composition, and the Index of Concentration at the Extremes (ICE), reduced these associations yet remained statistically significant. Future studies should continue to examine how racist, exploitative revenue generation through police and court activities influences the health of residents.
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Affiliation(s)
- Brigette A Davis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Mariana C Arcaya
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of African and African American Studies, Harvard University, Cambridge, MA, USA.
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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10
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Fuller AE, Zaffar N, Cohen E, Pentland M, Siddiqi A, Vandermorris A, Van Den Heuvel M, Birken CS, Guttmann A, de Oliveira C. Cash transfer programs and child health and family economic outcomes: a systematic review. CANADIAN JOURNAL OF PUBLIC HEALTH 2022; 113:433-445. [PMID: 35088347 PMCID: PMC8794041 DOI: 10.17269/s41997-022-00610-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
Objectives Family income is an important determinant of child and parental health. In Canada, cash transfer programs to families with children have existed since 1945. This systematic review aimed to examine the association between cash transfer programs to families with children and health outcomes in Canadian children (ages 0 to 18) as well as family economic outcomes. Methods We reviewed academic and grey literature published up to November 2021. Additional studies were identified through reference review. We included any study that examined children 0–18 years old and/or their parents, took place in Canada and reported Canada-specific data, and reported child, youth and/or parental health outcomes, as well as family economic outcomes. Risk of bias was assessed by two reviewers using a modified Newcastle-Ottawa Scale. Synthesis Our search yielded 23 studies meeting the inclusion criteria out of 7052 identified. Eight studies in total measured child health outcomes, including birth outcomes, child overall health, and developmental and behavioural outcomes, and four directly addressed parental health, including mental health, injuries, and obesity. Most studies reported generally positive associations, though some findings were specific to certain subgroups. Some studies also examined fertility and labour force participation outcomes, which described varying effects. Conclusion Cash transfer programs to families with children in Canada are associated with better child and parental health outcomes. Additional research is needed to evaluate the mechanisms of effects, and to identify which types and levels of government transfers are most effective, and target populations, to optimize the positive effects of these benefits. Supplementary Information The online version contains supplementary material available at 10.17269/s41997-022-00610-2.
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Affiliation(s)
- Anne E Fuller
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
- Department of Health Research Methods, Evidence and Impact, McMaster University, Toronto, Ontario, Canada.
| | - Nusrat Zaffar
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Eyal Cohen
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ashley Vandermorris
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Meta Van Den Heuvel
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
- ICES, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Health Economics and Hull York Medical School, University of York, York, UK
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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11
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Price JT, Sebastião YV, Vwalika B, Cole SR, Mbewe FM, Phiri WM, Freeman BL, Kasaro MP, Peterson M, Rouse DJ, Stringer EM, Stringer JSA. Risk of Adverse Birth Outcomes in Two Cohorts of Pregnant Women With HIV in Zambia. Epidemiology 2022; 33:422-430. [PMID: 35067569 PMCID: PMC9516482 DOI: 10.1097/ede.0000000000001465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A trial of progesterone to prevent preterm birth among HIV-infected Zambian women [Improving Pregnancy Outcomes with Progesterone (IPOP)] found no treatment effect, but the risk of the primary outcome was among the lowest ever documented in women with HIV. In this secondary analysis, we compare the risks of preterm birth (<37 weeks), stillbirth, and a composite primary outcome comprising the two in IPOP versus an observational pregnancy cohort [Zambian Preterm Birth Prevention Study (ZAPPS)] in Zambia, to evaluate reasons for the low risk in IPOP. METHODS Both studies enrolled women before 24 gestational weeks, during August 2015-September 2017 (ZAPPS) and February 2018-January 2020 (IPOP). We used linear probability and log-binomial regression to estimate risk differences and risk ratios (RR), before and after restriction and standardization with inverse probability weights. RESULTS The unadjusted risk of composite outcome was 18% in ZAPPS (N = 1450) and 9% in IPOP (N = 791) (RR = 2.0; 95% CI = 1.6, 2.6). After restricting and standardizing the ZAPPS cohort to the distribution of IPOP baseline characteristics, the risk remained higher in ZAPPS (RR = 1.6; 95% CI = 1.0, 2.4). The lower risk of preterm/stillbirth in IPOP was only partially explained by measured risk factors. CONCLUSIONS Possible benefits in IPOP of additional monetary reimbursement, more frequent visits, and group-based care warrant further investigation.
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Affiliation(s)
- Joan T Price
- From the Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
- University of North Carolina Global Projects Zambia, Lusaka, Zambia
| | - Yuri V Sebastião
- From the Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bellington Vwalika
- From the Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | - Stephen R Cole
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Felistas M Mbewe
- University of North Carolina Global Projects Zambia, Lusaka, Zambia
| | | | - Bethany L Freeman
- From the Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Margaret P Kasaro
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
- University of North Carolina Global Projects Zambia, Lusaka, Zambia
| | - Marc Peterson
- From the Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dwight J Rouse
- Department of Obstetrics and Gynecology, Brown University, Providence, RI, USA
| | - Elizabeth M Stringer
- From the Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey S A Stringer
- From the Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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12
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Crockett LK, Ruth CA, Heaman MI, Brownell MD. Education Outcomes of Children Born Late Preterm: A Retrospective Whole-Population Cohort Study. Matern Child Health J 2022; 26:1126-1141. [PMID: 35301671 DOI: 10.1007/s10995-022-03403-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Early life exposures can have an impact on a child's developmental trajectory and children born late preterm (34-36 weeks gestational age) are increasingly recognized to have health and developmental setbacks that extend into childhood. OBJECTIVES The purpose of this study was to assess whether late preterm birth was associated with poorer developmental and educational outcomes in the early childhood period, after controlling for health and social factors. METHODS We conducted a retrospective cohort study using administrative databases housed at the Manitoba Centre for Health Policy, including all children born late preterm (34-36 weeks gestational age (GA)) and at full-term (39-41 weeks GA) between 2000 and 2005 in urban Manitoba (N = 28,100). Logistic regression was used to examine the association between gestational age (GA) and outcomes, after adjusting for covariates. RESULTS Adjusted analyses demonstrated that children born late preterm had a higher prevalence of attention deficit hyperactivity disorder (ADHD) (aOR = 1.25, 95% CI [1.03, 1.51]), were more likely to be vulnerable in the language and cognitive (aOR = 1.29, 95% CI [1.06, 1.57]), communication and general knowledge (aOR = 1.24, 95% CI [1.01, 1.53]), and physical health and well-being (aOR = 1.27, 95% CI [1.04, 1.53]) domains of development at kindergarten, and were more likely to repeat kindergarten or grade 1 (aOR = 1.52, 95% CI [1.03, 2.25]) compared to children born at term. They did not differ in receipt of special education funding, in social maturity or emotional development at kindergarten, and in reading and numeracy assessments in the third grade. CONCLUSIONS Given that the late preterm population makes up 75% of the preterm population, their poorer outcomes have implications at the population level. This study underscores the importance of recognizing the developmental vulnerability of this population and adequately accounting for the social differences between children born late preterm and at term.
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Affiliation(s)
- L K Crockett
- Department of Community Health Sciences, Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 374(1) - 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.
| | - C A Ruth
- Manitoba Centre for Health Policy, University of Manitoba, 408 - 727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - M I Heaman
- College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | - M D Brownell
- Department of Community Health Sciences, Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 374(1) - 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.,Manitoba Centre for Health Policy, University of Manitoba, 408 - 727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada
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13
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Moledina A, Magwood O, Agbata E, Hung J, Saad A, Thavorn K, Pottie K. A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1154. [PMID: 37131928 PMCID: PMC8356292 DOI: 10.1002/cl2.1154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Homelessness has emerged as a public health priority, with growing numbers of vulnerable populations despite advances in social welfare. In February 2020, the United Nations passed a historic resolution, identifying the need to adopt social-protection systems and ensure access to safe and affordable housing for all. The establishment of housing stability is a critical outcome that intersects with other social inequities. Prior research has shown that in comparison to the general population, people experiencing homelessness have higher rates of infectious diseases, chronic illnesses, and mental-health disorders, along with disproportionately poorer outcomes. Hence, there is an urgent need to identify effective interventions to improve the lives of people living with homelessness. Objectives The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness. Search Methods In consultation with an information scientist, we searched nine bibliographic databases, including Medline, EMBASE, and Cochrane CENTRAL, from database inception to February 10, 2020 using keywords and MeSH terms. We conducted a focused grey literature search and consulted experts for additional studies. Selection Criteria Teams of two reviewers independently screened studies against our inclusion criteria. We included randomised control trials (RCTs) and quasi-experimental studies conducted among populations experiencing homelessness in high-income countries. Eligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid agonist therapy. Outcomes of interest were housing stability, mental health, quality of life, substance use, hospitalisations, employment and income. Data Collection and Analysis Teams of two reviewers extracted data in duplicate and independently. We assessed risk of bias using the Cochrane Risk of Bias tool. We performed our statistical analyses using RevMan 5.3. For dichotomous data, we used odds ratios and risk ratios with 95% confidence intervals. For continuous data, we used the mean difference (MD) with a 95% CI if the outcomes were measured in the same way between trials. We used the standardised mean difference with a 95% CI to combine trials that measured the same outcome but used different methods of measurement. Whenever possible, we pooled effect estimates using a random-effects model. Main Results The search resulted in 15,889 citations. We included 86 studies (128 citations) that examined the effectiveness and/or cost-effectiveness of interventions for people with lived experience of homelessness. Studies were conducted in the United States (73), Canada (8), United Kingdom (2), the Netherlands (2) and Australia (1). The studies were of low to moderate certainty, with several concerns regarding the risk of bias. PSH was found to have significant benefits on housing stability as compared to usual care. These benefits impacted both high- and moderate-needs populations with significant cimorbid mental illness and substance-use disorders. PSH may also reduce emergency department visits and days spent hospitalised. Most studies found no significant benefit of PSH on mental-health or substance-use outcomes. The effect on quality of life was also mixed and unclear. In one study, PSH resulted in lower odds of obtaining employment. The effect on income showed no significant differences. Income assistance appeared to have some benefits in improving housing stability, particularly in the form of rental subsidies. Although short-term improvement in depression and perceived stress levels were reported, no evidence of the long-term effect on mental health measures was found. No consistent impact on the outcomes of quality of life, substance use, hospitalisations, employment status, or earned income could be detected when compared with usual services. SCM interventions may have a small beneficial effect on housing stability, though results were mixed. Results for peer support interventions were also mixed, though no benefit was noted in housing stability specifically. Mental health interventions (ICM, ACT, CTI) appeared to reduce the number of days homeless and had varied effects on psychiatric symptoms, quality of life, and substance use over time. Cost analyses of PSH interventions reported mixed results. Seven studies showed that PSH interventions were associated with increased cost to payers and that the cost of the interventions were only partially offset by savings in medical- and social-services costs. Six studies revealed that PSH interventions saved the payers money. Two studies focused on the cost-effectiveness of income-assistance interventions. For each additional day housed, clients who received income assistance incurred additional costs of US$45 (95% CI, -$19, -$108) from the societal perspective. In addition, the benefits gained from temporary financial assistance were found to outweigh the costs, with a net savings of US$20,548. The economic implications of case management interventions (SCM, ICM, ACT, CTI) was highly uncertain. SCM clients were found to incur higher costs than those receiving the usual care. For ICM, all included studies suggested that the intervention may be cost-offset or cost-effective. Regarding ACT, included studies consistently revealed that ACT saved payers money and improved health outcomes than usual care. Despite having comparable costs (US$52,574 vs. US$51,749), CTI led to greater nonhomeless nights (508 vs. 450 nights) compared to usual services. Authors' Conclusions PSH interventions improved housing stability for people living with homelessness. High-intensity case management and income-assistance interventions may also benefit housing stability. The majority of included interventions inconsistently detected benefits for mental health, quality of life, substance use, employment and income. These results have important implications for public health, social policy, and community programme implementation. The COVID-19 pandemic has highlighted the urgent need to tackle systemic inequality and address social determinants of health. Our review provides timely evidence on PSH, income assistance, and mental health interventions as a means of improving housing stability. PSH has major cost and policy implications and this approach could play a key role in ending homelessness. Evidence-based reviews like this one can guide practice and outcome research and contribute to advancing international networks committed to solving homelessness.
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Affiliation(s)
| | - Olivia Magwood
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
| | - Eric Agbata
- Bruyere Research Institute, School of EpidemiologyPublic Health and Preventive MedicineOttawaCanada
| | - Jui‐Hsia Hung
- Faculty of Medicine, School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | - Ammar Saad
- Department of Epidemiology, C.T. Lamont Primary Care Research Centre, Bruyere Research InstituteUniversity of OttawaOttawaCanada
| | - Kednapa Thavorn
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
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14
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Abstract
Depression is a common and debilitating condition that adversely affects functioning and the capacity to work and establish economic stability. Women are disproportionately burdened by depression, and low-income pregnant and parenting women have particularly high rates of depression and often lack access to treatment. As depression can be treated, it is a modifiable risk factor for poor economic outcomes for women, and thus for children and families. Recent national and state health care policy changes offer the opportunity for community-based psychological and economic interventions that can reduce the number of pregnant and parenting women with clinically significant depressive symptoms. Moreover, there is strong evidence that in addition to benefiting women's well-being, such reforms bolster children's emotional and social development and learning and help families rise out of poverty. This review summarizes the mental health and economic literature regarding how maternal depression perpetuates intergenerational poverty and discusses recommendations regarding policies to treat maternal depression in large-scale social services systems.
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Affiliation(s)
- Megan V Smith
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA; .,The Child Study Center, Yale University School of Medicine, New Haven, Connecticut 06519, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut 06510, USA.,Women's Health Research at Yale, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA; .,Women's Health Research at Yale, Yale University School of Medicine, New Haven, Connecticut 06510, USA.,Department of Psychology, Yale University, New Haven, Connecticut 06511, USA
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15
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Interventions to reduce preterm birth in pregnant women with psychosocial vulnerability factors-A systematic review. Midwifery 2021; 100:103018. [PMID: 33979766 DOI: 10.1016/j.midw.2021.103018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Pregnant women with psychosocial vulnerability factors face a higher risk of preterm birth, a heavier burden of perinatal morbidity and mortality and less social health equity. Prevention of preterm birth in this group has proved difficult, and more knowledge is needed to ensure evidence-based care and improve prevention. This study aimed to determine the effectiveness of preventive interventions to reduce preterm birth among pregnant women with psychosocial vulnerability factors. DESIGN A systematic review of preventive interventions was conducted, searching the databases Cinahl, Cochrane Library, Embase, ProQuest, PsycInfo, PubMed and Scopus to identify RCT's. The search was completed on October 14, 2019. Using the Cochrane Collaboration tools, quality assessments were made, and independent single-data extraction was conducted. Due to heterogeneity in, e.g., participant characteristics, intervention content and duration, the data were synthesised qualitatively. Included studies were ranked in evidence-based hierarchical order, elucidating the risk of bias of each individual study, all of which were ranked as having a medium or low level of evidence. FINDINGS We identified 1,562 articles, of which five focused on prevention of preterm birth, met our predefined criteria for inclusion and quality assessment, and were therefore included. Interventions consisted of home visits in two studies, group meetings in one study, phone calls in one study, and physical massage in the last study. Four transverse themes arose: intervention intensity, initiation, continuity of care, and the healthcare professionals' educational background. KEY CONCLUSIONS The evidence base for interventions aiming to prevent preterm birth among pregnant women with psychosocial vulnerabilities is limited. Interventions based on ten antenatal group meetings initiated during the second trimester and facilitated by the same midwife have the greatest likelihood of being effective. Continuity in intervention delivery and healthcare professional's educational background may positively impact the efficiency of the intervention. Further research is needed to address questions about the impact of intervention initiation and intensity and its degree of continuity and mode of delivery.
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16
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Enns JE, Nickel NC, Chartier M, Chateau D, Campbell R, Phillips-Beck W, Sarkar J, Burland E, Katz A, Santos R, Brownell M. An unconditional prenatal income supplement is associated with improved birth and early childhood outcomes among First Nations children in Manitoba, Canada: a population-based cohort study. BMC Pregnancy Childbirth 2021; 21:312. [PMID: 33879074 PMCID: PMC8059008 DOI: 10.1186/s12884-021-03782-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Manitoba, Canada, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit, an unconditional income supplement of up to CAD $81/month, during their latter two trimesters. Our objective was to determine the impact of the Healthy Baby Prenatal Benefit on birth and early childhood outcomes among Manitoba First Nations women and their children. METHODS We used administrative data to identify low-income First Nations women who gave birth 2003-2011 (n = 8209), adjusting for differences between women who received (n = 6103) and did not receive the Healthy Baby Prenatal Benefit (n = 2106) with using propensity score weighting. Using multi-variable regressions, we compared rates of low birth weight, preterm, and small- and large-for-gestational-age births, 5-min Apgar scores, breastfeeding initiation, birth hospitalization length of stay, hospital readmissions, complete vaccination at age one and two, and developmental vulnerability in Kindergarten. RESULTS Women who received the benefit had lower risk of low birth weight (adjusted relative risk [aRR] 0.74; 95% CI 0.62-0.88) and preterm (aRR 0.77; 0.68-0.88) births, and were more likely to initiate breastfeeding (aRR 1.05; 1.01-1.09). Receipt of the Healthy Baby Prenatal Benefit was also associated with higher rates of child vaccination at age one (aRR 1.10; 1.06-1.14) and two (aRR 1.19; 1.13-1.25), and a lower risk that children would be vulnerable in the developmental domains of language and cognitive development (aRR 0.88; 0.79-0.98) and general knowledge/communication skills (aRR 0.87; 0.77-0.98) in Kindergarten. CONCLUSIONS A modest unconditional income supplement of CAD $81/month during pregnancy was associated with improved birth outcomes, increased vaccination rates, and better developmental health outcomes for First Nations children from low-income families.
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Affiliation(s)
- Jennifer E Enns
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Nathan C Nickel
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Rhonda Campbell
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | | | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Elaine Burland
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Rob Santos
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, R3E 3P5, Canada.
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17
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Chanchlani N, Buchanan F, Gill PJ. Les effets indirects de la COVID-19 sur la santé des enfants et des jeunes. CMAJ 2021; 193:E229-E236. [PMID: 33558415 PMCID: PMC7954548 DOI: 10.1503/cmaj.201008-f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Neil Chanchlani
- Royal Devon and Exeter NHS Foundation Trust ( Chanchlani); Université d'Exeter (Chanchlani), Exeter, Royaume-Uni; Institut des politiques, de la gestion et de l'évaluation de la santé (Buchanan, Gill), Université de Toronto; Hôpital pour enfants malades (SickKids) de Toronto (Buchanan, Gill); Département de pédiatrie (Gill), Université de Toronto, Toronto, Ontario
| | - Francine Buchanan
- Royal Devon and Exeter NHS Foundation Trust ( Chanchlani); Université d'Exeter (Chanchlani), Exeter, Royaume-Uni; Institut des politiques, de la gestion et de l'évaluation de la santé (Buchanan, Gill), Université de Toronto; Hôpital pour enfants malades (SickKids) de Toronto (Buchanan, Gill); Département de pédiatrie (Gill), Université de Toronto, Toronto, Ontario
| | - Peter J Gill
- Royal Devon and Exeter NHS Foundation Trust ( Chanchlani); Université d'Exeter (Chanchlani), Exeter, Royaume-Uni; Institut des politiques, de la gestion et de l'évaluation de la santé (Buchanan, Gill), Université de Toronto; Hôpital pour enfants malades (SickKids) de Toronto (Buchanan, Gill); Département de pédiatrie (Gill), Université de Toronto, Toronto, Ontario
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Montoya-Williams D, Salloum RG, Lorch SA. New Strategies to Tackle the Combined Biological and Social Context of Preterm Birth. Am J Perinatol 2021; 38:202-204. [PMID: 31480082 DOI: 10.1055/s-0039-1695774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Preterm birth rates in the population and associated racial inequities have remained relatively unchanged in the United States despite research aimed at prevention. This is potentially the result of the multifactorial pathophysiologic pathways that result in preterm birth, where biological and social drivers intersect in unique ways for different women. The field of dissemination and implementation (D&I) science may address this issue by promoting the contextually-aware uptake of science into health and health care delivery. STUDY DESIGN In this paper, we describe how the field of D&I science may afford new perspectives on preterm birth prevention to researchers and tools to design studies that translate clinical trial data into measurable changes at the level of the population. We discuss key examples where the perspectives and tools of D&I science have been used in conjunction with quality improvement methodology to change preterm birth rates in large population studies. We build on these case studies and suggest future D&I science-informed studies that could be explored. CONCLUSION Incorporating D&I scientific principles into the design of studies to prevent preterm birth may allow future research to better address the varied ways in which social forces comingle with biological risk factors to result in preterm birth.
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Affiliation(s)
- Diana Montoya-Williams
- Division of Neonatology, University of Pennsylvania School of Medicine, Attending Neonatologist at the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Florida
| | - Scott A Lorch
- Department of Pediatrics, Division of Neonatology, University of Pennsylvania, Philadelphia, Pennsylvania
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19
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Odom GC, Cottler LB, Striley CW, Lopez-Quintero C. Perceived Risk of Weekly Cannabis Use, Past 30-Day Cannabis Use, and Frequency of Cannabis Use Among Pregnant Women in the United States. Int J Womens Health 2020; 12:1075-1088. [PMID: 33235517 PMCID: PMC7678496 DOI: 10.2147/ijwh.s266540] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND While accumulated evidence has shown that the prevalence of cannabis use among pregnant women in the US has increased in recent years, little is known about the specific subpopulations affected. The aim of this study was to estimate the prevalence and correlates of the perceived risk of weekly cannabis use, past 30-day cannabis use, and frequency of past 30-day cannabis use among US pregnant women. METHODS We analyzed data from 2,247 pregnant women 14 to 44 years of age surveyed in the 2015 to 2017 cross-sectional National Survey on Drug Use and Health. Analyses account for the sampling design. Primary outcomes included perceived risk of weekly cannabis use, past 30-day cannabis use, and frequency of cannabis use. We conducted multivariable logistic and negative binomial regression models to assess the associations between the primary outcomes and multiple correlates. RESULTS Among US pregnant women, 21.6% (95% CI=19.4, 23.8) did not perceive any risk associated with weekly cannabis use, 5.3% (95% CI=4.2, 6.5) used cannabis in the past 30 days, and among past-month users, the average number of days of use was 15.6 (95% CI=13.5, 17.7). Pregnant women living below the poverty line were both more likely to perceive no risk of weekly cannabis use (aOR=1.8; 95% CI=1.3, 2.5) and use cannabis more often in the past 30 days (aOR=2.9; 95% CI=1.5, 5.7) than pregnant women within an income bracket of more than two times the federal poverty threshold. Age, race, trimester of pregnancy, co-use of tobacco and/or alcohol were also associated with these outcomes. CONCLUSION Younger age, living in poverty, early trimester of pregnancy, and co-use of tobacco and/or alcohol increased the odds of cannabis use among pregnant women. As cannabis legalization spreads and cannabis use is increasingly perceived as safe, there is a growing need for research to determine the reasons why women in the identified at-risk subgroups are using cannabis during pregnancy.
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Affiliation(s)
- Gage C Odom
- Department of Epidemiology, University of Florida, Gainesville, FL32611, USA
| | - Linda B Cottler
- Department of Epidemiology, University of Florida, Gainesville, FL32611, USA
| | - Catherine W Striley
- Department of Epidemiology, University of Florida, Gainesville, FL32611, USA
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20
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Pentland M, Cohen E, Guttmann A, de Oliveira C. Maximizing the impact of the Canada Child Benefit: Implications for clinicians and researchers. Paediatr Child Health 2020; 26:214-217. [PMID: 34267828 DOI: 10.1093/pch/pxaa092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/15/2020] [Indexed: 11/14/2022] Open
Abstract
Child poverty remains a persistent problem in Canada and is well known to lead to poor health outcomes. The Canada Child Benefit (CCB) is a cash transfer program in effect since 2016, which increased both the benefit amount and number of families eligible for the previous child benefit. While the CCB has decreased child poverty rates, not all eligible families have participated. Clinicians can play an important role in screening for uptake of the program and helping families navigate the application process through several free resources. While prior research on past programs has shown benefit of similar cash transfer programs to both child and parental outcomes (both health and social), the CCB has not yet been extensively studied. Research would be valuable in both assessing the cost effectiveness of the program, especially across different income groups, and improving implementation in hard-to-reach populations.
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Affiliation(s)
| | - Eyal Cohen
- Division of Paediatric Medicine and Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario.,Department of Paediatrics, University of Toronto, Toronto, Ontario.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Ontario.,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario
| | - Astrid Guttmann
- Division of Paediatric Medicine and Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario.,Department of Paediatrics, University of Toronto, Toronto, Ontario.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Ontario.,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.,ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Ontario.,Centre for Addiction and Mental Health, Toronto, Ontario.,Centre for Health Economics/Hull York Medical School, University of York, York, UK
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21
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Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: a systematic review. LANCET PUBLIC HEALTH 2020; 5:e342-e360. [PMID: 32504587 DOI: 10.1016/s2468-2667(20)30055-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 02/26/2020] [Accepted: 03/09/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Permanent supportive housing and income assistance are valuable interventions for homeless individuals. Homelessness can reduce physical and social wellbeing, presenting public health risks for infectious diseases, disability, and death. We did a systematic review, meta-analysis, and narrative synthesis to investigate the effectiveness and cost-effectiveness of permanent supportive housing and income interventions on the health and social wellbeing of individuals who are homeless in high-income countries. METHODS We searched MEDLINE, Embase, CINAHL, PsycINFO, Epistemonikos, NIHR-HTA, NHS EED, DARE, and the Cochrane Central Register of Controlled Trials from database inception to Feb 10, 2020, for studies on permanent supportive housing and income interventions for homeless populations. We included only randomised controlled trials, quasi-experimental studies, and cost-effectiveness studies from high-income countries that reported at least one outcome of interest (housing stability, mental health, quality of life, substance use, hospital admission, earned income, or employment). We screened studies using a standardised data collection form and pooled data from published studies. We synthesised results using random effects meta-analysis and narrative synthesis. We assessed certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. FINDINGS Our search identified 15 908 citations, of which 72 articles were included for analysis (15 studies on permanent supportive housing across 41 publications, ten studies on income interventions across 15 publications, and 21 publications on cost or cost-effectiveness). Permanent supportive housing interventions increased long-term (6 year) housing stability for participants with moderate support needs (one study; rate ratio [RR] 1·13 [95% CI 1·01-1·26]) and high support needs (RR 1·42 [1·19-1·69]) when compared with usual care. Permanent supportive housing had no measurable effect on the severity of psychiatric symptoms (ten studies), substance use (nine studies), income (two studies), or employment outcomes (one study) when compared with usual social services. Income interventions, particularly housing subsidies with case management, showed long-term improvements in the number of days stably housed (one study; mean difference at 3 years between intervention and usual services 8·58 days; p<0·004), whereas the effects on mental health and employment outcomes were unclear. INTERPRETATION Permanent supportive housing and income assistance interventions were effective in reducing homelessness and achieving housing stability. Future research should focus on the long-term effects of housing and income interventions on physical and mental health, substance use, and quality-of-life outcomes. FUNDING Inner City Health Associates.
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Chanchlani N, Buchanan F, Gill PJ. Addressing the indirect effects of COVID-19 on the health of children and young people. CMAJ 2020; 192:E921-E927. [PMID: 32586838 DOI: 10.1503/cmaj.201008] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Neil Chanchlani
- Royal Devon and Exeter NHS Foundation Trust (Chanchlani); University of Exeter (Chanchlani), Exeter, UK; Institute of Health Policy, Management and Evaluation (Buchanan, Gill), University of Toronto; The Hospital for Sick Children (Buchanan, Gill); Department of Paediatrics (Gill), University of Toronto, Toronto, Ont.
| | - Francine Buchanan
- Royal Devon and Exeter NHS Foundation Trust (Chanchlani); University of Exeter (Chanchlani), Exeter, UK; Institute of Health Policy, Management and Evaluation (Buchanan, Gill), University of Toronto; The Hospital for Sick Children (Buchanan, Gill); Department of Paediatrics (Gill), University of Toronto, Toronto, Ont
| | - Peter J Gill
- Royal Devon and Exeter NHS Foundation Trust (Chanchlani); University of Exeter (Chanchlani), Exeter, UK; Institute of Health Policy, Management and Evaluation (Buchanan, Gill), University of Toronto; The Hospital for Sick Children (Buchanan, Gill); Department of Paediatrics (Gill), University of Toronto, Toronto, Ont
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23
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Katz A, Enns J, Smith M, Burchill C, Turner K, Towns D. Population Data Centre Profile: The Manitoba Centre for Health Policy. Int J Popul Data Sci 2020; 4:1131. [PMID: 32935035 PMCID: PMC7473284 DOI: 10.23889/ijpds.v5i1.1131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objective To profile the Manitoba Centre for Health Policy (MCHP), a population health data centre located at the University of Manitoba in Winnipeg, Canada. Approach We describe how MCHP was established and funded, and how it continues to operate based on a foundation of trust and respect between researchers at the University of Manitoba and stakeholders in the Manitoba Government’s Department of Health. MCHP’s research priorities are jointly determined by its scientists’ own research interests and by questions put forward from Manitoba government ministries. Data governance, data privacy, data linkage processes and data access are discussed in detail. We also provide three illustrative examples of the MCHP Data Repository in action, demonstrating how studies using a variety of Repository datasets have had an impact on health and social policies and programs in Manitoba. Discussion MCHP has experienced tremendous growth over the last three decades. We discuss emerging research directions as the capacity for innovation at MCHP continues to expand, including a focus on natural language processing and other applications of artificial intelligence techniques, a leadership role in the new SPOR Canadian Data Platform, and a foray into social policy evaluation and analysis. With these and other exciting opportunities on the horizon, the future at MCHP looks exceptionally bright.
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Affiliation(s)
- A Katz
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, Canada R3E 3P5
| | - J Enns
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, Canada R3E 3P5
| | - M Smith
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, Canada R3E 3P5
| | - C Burchill
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, Canada R3E 3P5
| | - K Turner
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, Canada R3E 3P5
| | - D Towns
- Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, Manitoba, Canada R3E 3P5
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24
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Struthers A, Metge C, Charette C, Enns JE, Nickel NC, Chateau D, Chartier M, Burland E, Katz A, Brownell M. Understanding the Particularities of an Unconditional Prenatal Cash Benefit for Low-Income Women: A Case Study Approach. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019870967. [PMID: 31434525 PMCID: PMC6709438 DOI: 10.1177/0046958019870967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We explored the particularities of the Healthy Baby Prenatal Benefit (HBPB), an
unconditional cash transfer program for low-income pregnant women in Manitoba,
Canada, which aims to connect recipients with prenatal care and community
support programs, and help them access healthy foods during pregnancy. While
previous studies have shown associations between HBPB and improved birth
outcomes, here we focus on how the intervention contributed to
positive outcomes. Using a case study design, we collected data from government
and program documents and interviews with policy makers, academics, program
staff, and recipients of HBPB. Key informants identified using evidence and
aligning with government priorities as key facilitators to the implementation of
HBPB. Program recipients described how HBPB helped them improve their nutrition,
prepare for baby, and engage in self-care to moderate the effect of stressful
life events. This study provides important contextualized evidence to support
government decision making on healthy child development policies.
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Affiliation(s)
- Ashley Struthers
- 1 George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Colleen Metge
- 2 Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Catherine Charette
- 1 George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada.,2 Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jennifer E Enns
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nathan C Nickel
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mariette Chartier
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Elaine Burland
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marni Brownell
- 3 Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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25
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Guhn M, Emerson SD, Mahdaviani D, Gadermann AM. Associations of Birth Factors and Socio-Economic Status with Indicators of Early Emotional Development and Mental Health in Childhood: A Population-Based Linkage Study. Child Psychiatry Hum Dev 2020; 51:80-93. [PMID: 31338644 DOI: 10.1007/s10578-019-00912-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Using a linked population-based database established on healthcare, socio-economic, and survey datasets in British Columbia, Canada, we examined how biological, socio-demographic, and socio-economic status (SES) factors at birth related to children's emotional development and mental health. One analysis examined teacher-rated anxiety, hyperactivity, and aggression for kindergarten children (Mage = 5.7; n = 134,094). Another analysis examined administrative healthcare records comprising of physician-assigned diagnostic codes for mental health conditions (conduct disorder, attention deficit hyperactivity disorder, anxiety disorder and depression) from ages 5 through 15 (n = 89,404). Various factors at birth, including gestational age, birthweight, and maternal demographics, were related to emotional development and mental health in childhood. Across outcomes, low SES indicated detrimental associations with various aspects of children's emotional development and mental health (e.g., adjusted odds of mental health conditions were 25-39% higher for children of low income families versus others). Findings reinforce evidence that poverty (reduction) is a primary public health issue.
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Affiliation(s)
- Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Scott D Emerson
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Dorri Mahdaviani
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Anne M Gadermann
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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Dench D, Joyce T. The earned income tax credit and infant health revisited. HEALTH ECONOMICS 2020; 29:72-84. [PMID: 31758742 DOI: 10.1002/hec.3972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 06/10/2023]
Abstract
Hoynes, Miller, and Simon (2015), henceforth HMS, report that the national expansion of the Earned Income Tax Credit (EITC) is associated with decreases in low birth weight. We question their findings. HMS's difference-in-differences estimates are unidentified in some comparisons, while failed placebo tests undermine others. Their effects lack a plausible mechanism as the association between the EITC and prenatal smoking also fails placebo tests. We contend that the waning of the crack epidemic is a possible confound, but we show that any number of policies directed at poor women also eliminate the effect of the EITC when aggregated to the national level. Identifying small, causal effects of a national policy at a single point in time is exceedingly challenging.
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Affiliation(s)
- Daniel Dench
- Program in Economics, Graduate Center, City University of New York, New York, NY
| | - Theodore Joyce
- Department of Economics & Finance, Baruch College & Graduate Center, City University of New York & National Bureau of Economic Research, New York, NY
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Associations between unstable housing, obstetric outcomes, and perinatal health care utilization. Am J Obstet Gynecol MFM 2019; 1:100053. [PMID: 33345843 DOI: 10.1016/j.ajogmf.2019.100053] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND While there is a growing interest in addressing social determinants of health in clinical settings, there are limited data on the relationship between unstable housing and both obstetric outcomes and health care utilization. OBJECTIVE The objective of the study was to investigate the relationship between unstable housing, obstetric outcomes, and health care utilization after birth. STUDY DESIGN This was a retrospective cohort study. Data were drawn from a database of liveborn neonates linked to their mothers' hospital discharge records (2007-2012) maintained by the California Office of Statewide Health Planning and Development. The analytic sample included singleton pregnancies with both maternal and infant data available, restricted to births between the gestational age of 20 and 44 weeks, who presented at a hospital that documented at least 1 woman as having unstable housing using the International Classification of Diseases, ninth edition, codes (n = 2,898,035). Infants with chromosomal abnormalities and major birth defects were excluded. Women with unstable housing (lack of housing or inadequate housing) were identified using International Classification of Diseases, ninth edition, codes from clinical records. Outcomes of interest included preterm birth (<37 weeks' gestational age), early term birth (37-38 weeks gestational age), preterm labor, preeclampsia, chorioamnionitis, small for gestational age, long birth hospitalization length of stay after delivery (vaginal birth, >2 days; cesarean delivery, >4 days), emergency department visit within 3 months and 1 year after delivery, and readmission within 3 months and 1 year after delivery. We used exact propensity score matching without replacement to select a reference population to compare with the sample of women with unstable housing using a one-to-one ratio, matching for maternal age, race/ethnicity, parity, prior preterm birth, body mass index, tobacco use during pregnancy, drug/alcohol abuse during pregnancy, hypertension, diabetes, mental health condition during pregnancy, adequacy of prenatal care, education, and type of hospital. Odds of an adverse obstetric outcome were estimated using logistic regression. RESULTS Of 2794 women with unstable housing identified, 83.0% (n = 2318) had an exact propensity score-matched control. Women with an unstable housing code had higher odds of preterm birth (odds ratio, 1.2, 95% confidence interval, 1.0-1.4, P < .05), preterm labor (odds ratio, 1.4, 95% confidence interval, 1.2-1.6, P < .001), long length of stay (odds ratio, 1.6, 95% confidence interval, 1.4-1.8, P < .001), emergency department visits within 3 months (odds ratio, 2.4, 95% confidence interval, 2.1-2.8, P < .001) and 1 year after birth (odds ratio, 2.7, 95% confidence interval, 2.4-3.0, P < .001), and readmission within 3 months (odds ratio, 2.7, 95% confidence interval, 2.2-3.4, P < .0014) and 1 year after birth (odds ratio, 2.6, 95% confidence interval, 2.2-3.0, P < .001). CONCLUSION Unstable housing documentation is associated with adverse obstetric outcomes and high health care utilization. Housing and supplemental income for pregnant women should be explored as a potential intervention to prevent preterm birth and prevent increased health care utilization.
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Pottie K, Mathew CM, Mendonca O, Magwood O, Saad A, Abdalla T, Stergiopoulos V, Bloch G, Brcic V, Andermann A, Aubry T, Ponka D, Kendall C, Salvalaggio G, Mott S, Kpade V, Lalonde C, Hannigan T, Shoemaker E, Mayhew AD, Thavorn K, Tugwell P. PROTOCOL: A comprehensive review of prioritized interventions to improve the health and wellbeing of persons with lived experience of homelessness. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:e1048. [PMID: 37133294 PMCID: PMC8356496 DOI: 10.1002/cl2.1048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Kevin Pottie
- Department of Family MedicineUniversity of OttawaOttawaCanada
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
| | - Christine M. Mathew
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
| | - Oreen Mendonca
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
| | - Olivia Magwood
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
| | - Ammar Saad
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
- Department of EpidemiologyUniversity of OttawaOttawaCanada
| | - Tasnim Abdalla
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
| | | | - Gary Bloch
- Inner City Health Associates, St. Michael's HospitalUniversity of TorontoTorontoCanada
| | - Vanessa Brcic
- Faculty of MedicineUniversity of British ColumbiaVancouverCanada
| | - Anne Andermann
- Center for Health and WellbeingPrinceton UniversityPrincetonNew Jersey
- Faculty of MedicineMcGill UniversityQuebecCanada
| | - Tim Aubry
- School of PsychologyUniversity of OttawaOttawaCanada
| | - David Ponka
- Department of Family MedicineUniversity of OttawaOttawaCanada
| | - Claire Kendall
- Department of Family MedicineUniversity of OttawaOttawaCanada
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
| | | | | | - Victoire Kpade
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
- Faculty of MedicineMcGill UniversityQuebecCanada
| | - Christine Lalonde
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
| | - Terry Hannigan
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
| | - Esther Shoemaker
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
| | - Alain D. Mayhew
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
| | - Kednapa Thavorn
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
| | - Peter Tugwell
- Centre for Global HealthBruyere Research InstituteOttawaCanada
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
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29
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Heaman MI, Martens PJ, Brownell MD, Chartier MJ, Derksen SA, Helewa ME. The Association of Inadequate and Intensive Prenatal Care With Maternal, Fetal, and Infant Outcomes: A Population-Based Study in Manitoba, Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:947-959. [PMID: 30639165 DOI: 10.1016/j.jogc.2018.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Little is known about how prenatal care influences health outcomes in Canada. The objective of this study was to examine the association of prenatal care utilization with maternal, fetal, and infant outcomes in Manitoba. METHODS This retrospective cohort study conducted at the Manitoba Centre for Health Policy investigated all deliveries of singleton births from 2004-2005 to 2008-2009 (N = 67 076). The proportion of women receiving inadequate, intermediate/adequate, and intensive prenatal care was calculated. Multivariable logistic regression was used to examine the association of inadequate and intensive prenatal care with maternal and fetal-infant health outcomes, health care use, and maternal health-related behaviours. RESULTS The distribution of prenatal care utilization was 11.6% inadequate, 84.4% intermediate/adequate, and 4.0% intensive. After adjusting for sociodemographic factors and maternal health conditions, inadequate prenatal care was associated with increased odds of stillbirth, preterm birth, low birth weight, small for gestational age (SGA), admission to the NICU, postpartum depressive/anxiety disorders, and short interpregnancy interval to next birth. Women with inadequate prenatal care had reduced odds of initiating breastfeeding or having their infant immunized. Intensive prenatal care was associated with reduced odds of stillbirth, preterm birth, and low birth weight and increased odds of postpartum depressive/anxiety disorders, initiation of breastfeeding, and infant immunization. CONCLUSION Inadequate prenatal care was associated with increased odds of several adverse pregnancy outcomes and lower likelihood of health-related behaviours, whereas intensive prenatal care was associated with reduced odds of some adverse pregnancy outcomes and higher likelihood of health-related behaviours. Ensuring women receive adequate prenatal care may improve pregnancy outcomes.
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Affiliation(s)
- Maureen I Heaman
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB; Department of Obstetrics, Gynecology and Reproductive Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB.
| | - Patricia J Martens
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB; Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB
| | - Marni D Brownell
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB; Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB
| | - Mariette J Chartier
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB; Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB
| | - Shelley A Derksen
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB
| | - Michael E Helewa
- Department of Obstetrics, Gynecology and Reproductive Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
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Heaman MI, Martens PJ, Brownell MD, Chartier MJ, Thiessen KR, Derksen SA, Helewa ME. Inequities in utilization of prenatal care: a population-based study in the Canadian province of Manitoba. BMC Pregnancy Childbirth 2018; 18:430. [PMID: 30382911 PMCID: PMC6211437 DOI: 10.1186/s12884-018-2061-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 10/16/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Ensuring high quality and equitable maternity services is important to promote positive pregnancy outcomes. Despite a universal health care system, previous research shows neighborhood-level inequities in utilization of prenatal care in Manitoba, Canada. The purpose of this population-based retrospective cohort study was to describe prenatal care utilization among women giving birth in Manitoba, and to determine individual-level factors associated with inadequate prenatal care. METHODS We studied women giving birth in Manitoba from 2004/05-2008/09 using data from a repository of de-identified administrative databases at the Manitoba Centre for Health Policy. The proportion of women receiving inadequate prenatal care was calculated using a utilization index. Multivariable logistic regressions were used to identify factors associated with inadequate prenatal care for the population, and for a subset with more detailed risk information. RESULTS Overall, 11.5% of women in Manitoba received inadequate, 51.0% intermediate, 33.3% adequate, and 4.1% intensive prenatal care (N = 68,132). Factors associated with inadequate prenatal care in the population-based model (N = 64,166) included northern or rural residence, young maternal age (at current and first birth), lone parent, parity 4 or more, short inter-pregnancy interval, receiving income assistance, and living in a low-income neighborhood. Medical conditions such as multiple birth, hypertensive disorders, antepartum hemorrhage, diabetes, and prenatal psychological distress were associated with lower odds of inadequate prenatal care. In the subset model (N = 55,048), the previous factors remained significant, with additional factors being maternal education less than high school, social isolation, and prenatal smoking, alcohol, and/or illicit drug use. CONCLUSION The rate of inadequate prenatal care in Manitoba ranged from 10.5-12.5%, and increased significantly over the study period. Factors associated with inadequate prenatal care included geographic, demographic, socioeconomic, and pregnancy-related factors. Rates of inadequate prenatal care varied across geographic regions, indicating persistent inequities in use of prenatal care. Inadequate prenatal care was associated with several individual indicators of social disadvantage, such as low income, education less than high school, and social isolation. These findings can inform policy makers and program planners about regions and populations most at-risk for inadequate prenatal care and assist with development of initiatives to reduce inequities in utilization of prenatal care.
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Affiliation(s)
- Maureen I. Heaman
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Patricia J. Martens
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113 - 750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB R3E 3P5 Canada
| | - Marni D. Brownell
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113 - 750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB R3E 3P5 Canada
| | - Mariette J. Chartier
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113 - 750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB R3E 3P5 Canada
| | - Kellie R. Thiessen
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Shelley A. Derksen
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB R3E 3P5 Canada
| | - Michael E. Helewa
- Department of Obstetrics, Gynecology and Reproductive Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, WR120-735 Notre Dame Avenue, Winnipeg, MB R3E 0L8 Canada
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Siddiqi A, Rajaram A, Miller SP. Do cash transfer programmes yield better health in the first year of life? A systematic review linking low-income/middle-income and high-income contexts. Arch Dis Child 2018; 103:920-926. [PMID: 29705725 DOI: 10.1136/archdischild-2017-314301] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 03/26/2018] [Accepted: 04/03/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Decades of research unequivocally demonstrates that no matter the society, socioeconomic resources are perhaps the most fundamental determinants of health throughout the life course, including during its very earliest stages. As a result, societies have implemented 'cash transfer' programmes, whichprovide income supplementation to reduce socioeconomic disadvantage among the poorest families with young children. Despite this being a common approach of societies around the world, research on effects of these programmes in low-income/middle-income countries, and those in high-income countries has been conducted as if they are entirely distinct phenomena. In this paper, we systematically review the international literature on the association between cash transfer programmes and health outcomes during the first year of life. METHODS We conducted a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Using a variety of relevant keywords, we searched MEDLINE, EMBASE, CINAHL, Cochrane Reviews, EconLit and Social Sciences Citations Index. RESULTS Our review yielded 14 relevant studies. These studies suggested cash transfer programmes that were not attached to conditions tended to yield positive effects on outcomes such as birth weight and infant mortality. Programmes that were conditional on use of health services also carried positive effects, while those that carried labour-force participation conditionalities tended to yield no positive effects. DISCUSSION Given several dynamics involved in determining whether children are healthy or not, which are common worldwide, viewing the literature from a global perspective produces novel insights regarding the tendency of policies and programmes to reduce or, to exacerbate, the effects of socioeconomic disadvantage on child health.
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Affiliation(s)
- Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada.,Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Akshay Rajaram
- Faculty of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Steven P Miller
- Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
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Weber A, Harrison TM, Steward D, Ludington-Hoe S. Paid Family Leave to Enhance the Health Outcomes of Preterm Infants. Policy Polit Nurs Pract 2018; 19:11-28. [PMID: 30134774 DOI: 10.1177/1527154418791821] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prematurity is the largest contributor to perinatal morbidity and mortality. Preterm infants and their families are a significant vulnerable population burdened with limited resources, numerous health risks, and poor health outcomes. The social determinants of health greatly shape the economic and psychosocial resources that families possess to promote optimal outcomes for their preterm infants. The purposes of this article are to analyze the resource availability, relative risks, and health outcomes of preterm infants and their families and to discuss why universal paid family leave could be one potential public policy that would promote optimal outcomes for this infant population. First, we discuss the history of family leave in the United States and draw comparisons with other countries around the world. We use the vulnerable populations conceptual model as a framework to discuss why universal paid family leave is needed and to review how disparities in resource availability are driving the health status of preterm infants. We conclude with implications for research, nursing practice, and public policy. Although health care providers, policy makers, and other key stakeholders have paid considerable attention to and allocated resources for preventing and treating prematurity, this attention is geared toward individual-based health strategies for promoting preconception health, preventing a preterm birth, and improving individual infant outcomes. Our view is that public policies addressing the social determinants of health (e.g., universal paid family leave) would have a much greater impact on the health outcomes of preterm infants and their families than current strategies.
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Affiliation(s)
- Ashley Weber
- 1 University of Cincinnati College of Nursing, Cincinnati, OH, USA
| | - Tondi M Harrison
- 2 The Ohio State University College of Nursing, Columbus, OH, USA
| | - Deborah Steward
- 2 The Ohio State University College of Nursing, Columbus, OH, USA
| | - Susan Ludington-Hoe
- 3 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Mah SM, Sanmartin C, Harper S, Ross NA. Childbirth-Related Hospital Burden by Socioeconomic Status in a Universal Health Care Setting. Int J Popul Data Sci 2018; 3:418. [PMID: 32935000 PMCID: PMC7299465 DOI: 10.23889/ijpds.v3i1.418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Hospital utilization varies across socioeconomic and demographic strata in Canada, a country with a universal health care system. Rates of adverse birth outcomes are known to differ among women of high and low socioeconomic status (SES), but less is known of the excess hospital burden related to SES over the course of childbirth across Canadian provinces. OBJECTIVE To examine length of stay and risk of hospitalization surrounding delivery, relative to women's socio-demographic characteristics. METHODS A population-based record linkage between the Canadian Community Health Survey (CCHS) years 2005-2011 and the Discharge Abstract Database (DAD) allowed the tracking of hospital utilization for linked survey respondents between 2005 and 2011. Hourly length of stay for delivery, risk of readmission, and risk of admission prior to delivery was modeled by socio-demographic factors, controlling for other clinical and individual-level characteristics. RESULTS There were 21,914 complete delivery records from 15,458 female CCHS respondents who agreed to link and share their information. Average length of stay (for both vaginal and Caesarian deliveries) dropped over the study period from 67.86 hours in 2005 to 59.37 hours in 2011. In multivariate analyses, women with the lowest income had on average, two-hour longer stays for vaginal delivery as compared to high-income women (IRR 1.04, 95% CI 1.00-1.08) and higher risk of admission prior to delivery (OR 1.43, CI 1.13-1.81). Low-income women, Aboriginal women and women living in rural areas were also at elevated risk for longer hospital stays and for hospital admission prior to delivery. There was no consistent socioeconomic patterning of hospital burden for Caesarian deliveries. CONCLUSION The length of hospital stays for childbirth has declined in Canada. Length of stay remains modestly longer, and risk of hospitalization in the perinatal period higher, for low income women, Aboriginal women and rural women. The absence of egregious income-related differences in hospital burden related to childbirth is reassuring for the equity goals of the Canadian health care system. The persistence of marginally longer, and in turn, costlier visits for low-income and Aboriginal women before and during delivery is, however, suggestive that resources targeted to the prenatal period might be highly cost-effective if they achieve population-wide reductions in length of stay and hospitalization in the perinatal period.
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Marcil LE, Hole MK, Wenren LM, Schuler MS, Zuckerman BS, Vinci RJ. Free Tax Services in Pediatric Clinics. Pediatrics 2018; 141:peds.2017-3608. [PMID: 29776980 DOI: 10.1542/peds.2017-3608] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The earned income tax credit (EITC), refundable monies for America's working poor, is associated with improved child health. Yet, 20% of eligible families do not receive it. We provided free tax preparation services in clinics serving low-income families and assessed use, financial impact, and accuracy. METHODS Free tax preparation services ("StreetCred") were available at 4 clinics in Boston in 2016 and 2017. We surveyed a convenience sample of clients (n = 244) about experiences with StreetCred and previous tax services and of nonparticipants (n = 100; 69% response rate) and clinic staff (n = 41; 48% response rate) about acceptability and feasibility. RESULTS A total of 753 clients received $1 619 650 in federal tax refunds. StreetCred was associated with significant improvement in tax filing rates. Of surveyed clients, 21% were new filers, 47% were new users of free tax preparation, 14% reported new receipt of the EITC, and 21% reported new knowledge of the EITC. StreetCred had high client acceptability; 96% would use StreetCred again. Families with children were significantly more likely to report StreetCred made them feel more connected to their doctor (P = .02). Clinic staff viewed the program favorably (97% approval). CONCLUSIONS Free tax services in urban clinics are a promising, feasible financial intervention to increase tax filing and refunds, save fees, and link clients to the EITC. With future studies, we will assess scalability and measure impact on health. StreetCred offers an innovative approach to improving child health in primary care settings through a financial intervention.
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Affiliation(s)
- Lucy E Marcil
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; .,Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Michael K Hole
- Department of Pediatrics, Dell Medical School and.,Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin, Austin, Texas; and
| | - Larissa M Wenren
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | | | - Barry S Zuckerman
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Robert J Vinci
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
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Wall-Wieler E, Brownell M, Singal D, Nickel N, Roos LL. The Cycle of Child Protection Services Involvement: A Cohort Study of Adolescent Mothers. Pediatrics 2018; 141:peds.2017-3119. [PMID: 29844137 DOI: 10.1542/peds.2017-3119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if adolescent mothers who were in the care of child protection services (CPS) when they gave birth to their first child are more likely to have that child taken into CPS care before the child's second birthday than adolescent mothers who were not in the care of CPS. METHODS Linkable administrative data were used to create a population-based cohort of adolescent mothers whose first child was born in Manitoba, Canada between April 1, 1998, and March 31, 2013 (n = 5942). Adjusted odds ratios (aOR) of having that first child taken into care before their second birthday were compared between mothers who were in care (n = 576) and mothers who were not in care (n = 5366) at the birth of their child by using logistic regression models. RESULTS Adolescent mothers who were in care had greater odds of having their child taken into care before the child's second birthday (aOR = 7.53; 95% confidence interval [CI] = 6.19-9.14). Specifically, their children had higher odds of being taken into care in their first week of life (aOR = 11.64; 95% CI = 8.83-15.34), between 1 week and their first birthday (aOR = 3.63; 95% CI = 2.79-4.71), and between their first and second birthday (aOR = 2.21; 95% CIl = 1.53-3.19). CONCLUSIONS Findings support an intergenerational cycle of involvement with CPS. More and better services are required for adolescent mothers who give birth while in care of CPS.
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Affiliation(s)
- Elizabeth Wall-Wieler
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; and
| | - Marni Brownell
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; and.,Manitoba Centre for Health Policy, Winnipeg, Canada
| | - Deepa Singal
- Manitoba Centre for Health Policy, Winnipeg, Canada
| | - Nathan Nickel
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; and.,Manitoba Centre for Health Policy, Winnipeg, Canada
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada; and.,Manitoba Centre for Health Policy, Winnipeg, Canada
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Brownell M, Enns J. Reducing child mortality in high-income countries: where to from here? Lancet 2018; 391:1968-1969. [PMID: 29731174 DOI: 10.1016/s0140-6736(18)30938-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/13/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P5, Canada.
| | - Jennifer Enns
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P5, Canada
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Maternal Behavioral Health: Fertile Ground for Behavior Analysis. Perspect Behav Sci 2018; 41:637-652. [PMID: 31976417 DOI: 10.1007/s40614-018-0143-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
The World Health Organization has identified four behavioral health priorities as risk factors for noncommunicable diseases in maternal populations: tobacco use, harmful alcohol use, poor nutrition, and lack of physical activity. These risk factors also significantly affect pregnant and immediately postpartum mothers, doubling the health risk and economic burden by adversely affecting maternal and birth or infant outcomes. Psychosocial and behavioral interventions are ideal for pregnant and immediately postpartum women as opposed to pharmacotherapy. Among other behavioral interventions, the use of incentives based on the principles of reinforcement has been a successful yet controversial way to change health behaviors. Implementing an incentive-based intervention in maternal health often brings up social validity concerns. The existing guideline on how to develop and conduct research in incentive-based interventions for maternal health lacks enough information on the specific variables to control for to maintain the intervention's effectiveness. This article outlines some of the critical variables in implementing an effective behavior-analytic intervention and addressing social validity concerns to change maternal behaviors in a sustainable manner, along with specific research topics needed in the field to prevent adverse maternal, birth, and infant outcomes.
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Orr SK, Dachner N, Frank L, Tarasuk V. Relation between household food insecurity and breastfeeding in Canada. CMAJ 2018; 190:E312-E319. [PMID: 29555861 PMCID: PMC5860892 DOI: 10.1503/cmaj.170880] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Qualitative studies have suggested that food insecurity adversely affects infant feeding practices. We aimed to determine how household food insecurity relates to breastfeeding initiation, duration of exclusive breastfeeding and vitamin D supplementation of breastfed infants in Canada. METHODS We studied 10 450 women who had completed the Maternal Experiences - Breastfeeding Module and the Household Food Security Survey Module of the Canadian Community Health Survey (2005-2014) and who had given birth in the year of or year before their interview. We used multivariable Cox proportional hazards models and logistic regression to examine the relation between food insecurity and infant feeding practices, adjusting for sociodemographic characteristics, maternal mood disorders and diabetes mellitus. RESULTS Overall, 17% of the women reported household food insecurity, of whom 8.6% had moderate food insecurity and 2.9% had severe food insecurity (weighted percentages). After adjustment for sociodemographic factors, women with food insecurity were no less likely than others to initiate breastfeeding or provide vitamin D supplementation to their infants. Half of the women with food insecurity ceased exclusive breastfeeding by 2 months, whereas most of those with food security persisted with breastfeeding for 4 months or more. Relative to women with food security, those with marginal, moderate and severe food insecurity had significantly lower odds of exclusive breastfeeding to 4 months, but only women with moderate food insecurity had lower odds of exclusive breastfeeding to 6 months, independent of sociodemographic characteristics (odds ratio 0.60, 95% confidence interval 0.39-0.92). Adjustment for maternal mood disorder or diabetes slightly attenuated these relationships. INTERPRETATION Mothers caring for infants in food-insecure households attempted to follow infant feeding recommendations, but were less able than women with food security to sustain exclusive breastfeeding. Our findings highlight the need for more effective interventions to support food-insecure families with newborns.
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Affiliation(s)
- Sarah K Orr
- Public Health Ontario (Orr); Department of Nutritional Sciences (Dachner, Tarasuk), University of Toronto, Toronto, Ont.; Department of Sociology (Frank), Acadia University, Wolfville, NS
| | - Naomi Dachner
- Public Health Ontario (Orr); Department of Nutritional Sciences (Dachner, Tarasuk), University of Toronto, Toronto, Ont.; Department of Sociology (Frank), Acadia University, Wolfville, NS
| | - Lesley Frank
- Public Health Ontario (Orr); Department of Nutritional Sciences (Dachner, Tarasuk), University of Toronto, Toronto, Ont.; Department of Sociology (Frank), Acadia University, Wolfville, NS
| | - Valerie Tarasuk
- Public Health Ontario (Orr); Department of Nutritional Sciences (Dachner, Tarasuk), University of Toronto, Toronto, Ont.; Department of Sociology (Frank), Acadia University, Wolfville, NS
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Brownell M, Nickel NC, Chartier M, Enns JE, Chateau D, Sarkar J, Burland E, Jutte DP, Taylor C, Katz A. An Unconditional Prenatal Income Supplement Reduces Population Inequities In Birth Outcomes. Health Aff (Millwood) 2018; 37:447-455. [DOI: 10.1377/hlthaff.2017.1290] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Marni Brownell
- Marni Brownell is a professor at the Manitoba Centre for Health Policy, University of Manitoba, in Winnipeg
| | - Nathan C. Nickel
- Nathan C. Nickel is an assistant professor at the Manitoba Centre for Health Policy
| | - Mariette Chartier
- Mariette Chartier is an assistant professor at the Manitoba Centre for Health Policy
| | - Jennifer E. Enns
- Jennifer E. Enns is a postdoctoral fellow at the Manitoba Centre for Health Policy
| | - Dan Chateau
- Dan Chateau is an assistant professor at the Manitoba Centre for Health Policy
| | - Joykrishna Sarkar
- Joykrishna Sarkar is a data analyst at the Manitoba Centre for Health Policy
| | - Elaine Burland
- Elaine Burland is a research associate at the Manitoba Centre for Health Policy
| | - Douglas P. Jutte
- Douglas P. Jutte is an associate professor at the School of Public Health, University of California, Berkeley, and an adjunct scientist at the Manitoba Centre for Health Policy
| | - Carole Taylor
- Carole Taylor is a data analyst at the Manitoba Centre for Health Policy
| | - Alan Katz
- Alan Katz is a professor at the Manitoba Centre for Health Policy
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Chartier M, Nickel NC, Chateau D, Enns JE, Isaac MR, Katz A, Sarkar J, Burland E, Taylor C, Brownell M. Families First Home Visiting programme reduces population-level child health and social inequities. J Epidemiol Community Health 2017; 72:47-53. [PMID: 29122995 DOI: 10.1136/jech-2017-209321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 10/12/2017] [Accepted: 10/27/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Home visiting has been shown to reduce child maltreatment and improve child health outcomes. In this observational study, we explored whether Families First, a home visiting programme in Manitoba, Canada, decreased population-level inequities in children being taken into care of child welfare and receiving complete childhood immunisations. METHODS De-identified administrative health and social services data for children born 2003-2009 in Manitoba were linked to home visiting programme data. Programme eligibility was determined by screening for family risk factors. We compared probabilities of being taken into care and receiving immunisations among programme children (n=4575), eligible children who did not receive the programme (n=5186) and the general child population (n=87 897) and tested inequities using differences of risk differences (DRDs) and ratios of risk ratios (RRRs). RESULTS Programme children were less likely to be taken into care (probability (95% CI) at age 1, programme 7.5 (7.0 to 8.0) vs non-programme 10.0 (10.0 to 10.1)) and more likely to receive complete immunisations (probability at age 1, programme 77.3 (76.5 to 78.0) vs non-programme 73.2 (72.1 to 74.3)). Inequities between programme children and the general population were reduced for both outcomes (being taken into care at age 1, DRD -2.5 (-3.7 to 1.2) and RRR 0.8 (0.7 to 0.9); complete immunisation at age 1, DRD 4.1 (2.2 to 6.0) and RRR 1.1 (1.0 to 1.1)); these inequities were also significantly reduced at age 2. CONCLUSION Home visiting programmes should be recognised as effective strategies for improving child outcomes and reducing population-level health and social inequities.
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Affiliation(s)
- Mariette Chartier
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nathan C Nickel
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer E Enns
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael R Isaac
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joykrishna Sarkar
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elaine Burland
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carole Taylor
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Nickel NC, Warda L, Kummer L, Chateau J, Heaman M, Green C, Katz A, Paul J, Perchuk C, Girard D, Larocque L, Enns JE, Shaw S. Protocol for establishing an infant feeding database linkable with population-based administrative data: a prospective cohort study in Manitoba, Canada. BMJ Open 2017; 7:e017981. [PMID: 29061626 PMCID: PMC5665324 DOI: 10.1136/bmjopen-2017-017981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Breast feeding is associated with many health benefits for mothers and infants. But despite extensive public health efforts to promote breast feeding, many mothers do not achieve their own breastfeeding goals; and, inequities in breastfeeding rates persist between high and low-income mother-infant dyads. Developing targeted programme to support breastfeeding dyads and reduce inequities between mothers of different socioeconomic status are a priority for public health practitioners and health policy decision-makers; however, many jurisdictions lack the timely and comprehensive population-level data on infant-feeding practices required to monitor trends in breastfeeding initiation and duration. This protocol describes the establishment of a population-based infant-feeding database in the Canadian province of Manitoba, providing opportunities to develop and evaluate breastfeeding support programme. METHODS AND ANALYSIS Routinely collected administrative health data on mothers' infant-feeding practices will be captured during regular vaccination visits using the Teleform fax tool, which converts handwritten information to an electronic format. The infant-feeding data will be linked to the Manitoba Population Research Data Repository, a comprehensive collection of population-based information spanning health, education and social services domains. The linkage will allow us to answer research questions about infant-feeding practices and to evaluate how effective current initiatives promoting breast feeding are. ETHICS AND DISSEMINATION Approvals have been granted by the Health Research Ethics Board at the University of Manitoba. Our integrative knowledge translation approach will involve disseminating findings through government and community briefings, presenting at academic conferences and publishing in scientific journals.
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Affiliation(s)
- Nathan Christopher Nickel
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, Universityof Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lynne Warda
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, Universityof Manitoba, Winnipeg, Manitoba, Canada
- Injury Prevention and Child Health, Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Leslie Kummer
- Academic General Pediatrics, Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joanne Chateau
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, Universityof Manitoba, Winnipeg, Manitoba, Canada
| | - Maureen Heaman
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chris Green
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, Universityof Manitoba, Winnipeg, Manitoba, Canada
- Population & Public Health, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, Universityof Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julia Paul
- Field Services Training Unit, Health Security Infrastructure Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Carolyn Perchuk
- Population & Public Health, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Darlene Girard
- Population & Public Health, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Lorraine Larocque
- Department of Public Health, Northern Health Region, Thompson, Manitoba, Canada
| | - Jennifer Emily Enns
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, Universityof Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Souradet Shaw
- Department of Surveillance and Epidemiology, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
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Jones MK, Bloch G, Pinto AD. A novel income security intervention to address poverty in a primary care setting: a retrospective chart review. BMJ Open 2017; 7:e014270. [PMID: 28821508 PMCID: PMC5724129 DOI: 10.1136/bmjopen-2016-014270] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 06/05/2017] [Accepted: 06/09/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the development and implementation of a novel income security intervention in primary care. DESIGN A retrospective, descriptive chart review of all patients referred to the Income Security Heath Promotion service during the first year of the service (December 2013-December 2014). SETTING A multisite interdisciplinary primary care organisation in inner city Toronto, Canada, serving over 40 000 patients. PARTICIPANTS The study population included 181 patients (53% female, mean age 48 years) who were referred to the Income Security Health Promotion service and engaged in care. INTERVENTION The Income Security Health Promotion service consists of a trained health promoter who provides a mixture of expert advice and case management to patients to improve income security. An advisory group, made up of physicians, social workers, a community engagement specialist and a clinical manager, supports the service. OUTCOME MEASURES Sociodemographic information, health status, referral information and encounter details were collected from patient charts. RESULTS Encounters focused on helping patients with increasing their income (77.4%), reducing their expenses (58.6%) and improving their financial literacy (26.5%). The health promoter provided an array of services to patients, including assistance with taxes, connecting to community services, budgeting and accessing free services. The service could be improved with more specific goal setting, better links to other members of the healthcare team and implementing routine follow-up with each patient after discharge. CONCLUSIONS Income Security Health Promotion is a novel service within primary care to assist vulnerable patients with a key social determinant of health. This study is a preliminary look at understanding the functioning of the service. Future research will examine the impact of the Income Security Health Promotion service on income security, financial literacy, engagement with health services and health outcomes.
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Affiliation(s)
| | - Gary Bloch
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Andrew D Pinto
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
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Elgar FJ, Gariépy G, Torsheim T, Currie C. Early-life income inequality and adolescent health and well-being. Soc Sci Med 2016; 174:197-208. [PMID: 27986310 DOI: 10.1016/j.socscimed.2016.10.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/11/2016] [Accepted: 10/15/2016] [Indexed: 11/16/2022]
Abstract
A prevailing hypothesis about the association between income inequality and poor health is that inequality intensifies social hierarchies, increases stress, erodes social and material resources that support health, and subsequently harms health. However, the evidence in support of this hypothesis is limited by cross-sectional, ecological studies and a scarcity of developmental studies. To address this limitation, we used pooled, multilevel data from the Health Behaviour in School-aged Children study to examine lagged, cumulative, and trajectory associations between early-life income inequality and adolescent health and well-being. Psychosomatic symptoms and life satisfaction were assessed in surveys of 11- to 15-year-olds in 40 countries between 1994 and 2014. We linked these data to national Gini indices of income inequality for every life year from 1979 to 2014. The results showed that exposure to income inequality from 0 to 4 years predicted psychosomatic symptoms and lower life satisfaction in females after controlling lifetime mean income inequality, national per capita income, family affluence, age, and cohort and period effects. The cumulative income inequality exposure in infancy and childhood (i.e., average Gini index from birth to age 10) related to lower life satisfaction in female adolescents but not to symptoms. Finally, individual trajectories in early-life inequality (i.e., linear slopes in Gini indices from birth to 10 years) related to fewer symptoms and higher life satisfaction in females, indicating that earlier exposures mattered more to predicting health and wellbeing. No such associations with early-life income inequality were found in males. These results help to establish the antecedent-consequence conditions in the association between income inequality and health and suggest that both the magnitude and timing of income inequality in early life have developmental consequences that manifest in reduced health and well-being in adolescent girls.
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Affiliation(s)
- Frank J Elgar
- Institute for Health and Social Policy, McGill University, Montreal, Canada.
| | - Geneviève Gariépy
- Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Torbjørn Torsheim
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Candace Currie
- Child and Adolescent Health Research Unit, School of Medicine, University of St. Andrews, St. Andrews, Scotland, United Kingdom
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