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Vanzella-Yang A, Vergunst F, Domond P, Vitaro F, Tremblay RE, Bégin V, Côté S. Childhood behavioral problems are associated with the intergenerational transmission of low education: a 16-year population-based study. Eur Child Adolesc Psychiatry 2024; 33:595-603. [PMID: 36932229 DOI: 10.1007/s00787-023-02193-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
The intergenerational transmission of low educational attainment is well-documented, but little is known about how behavioral problems in childhood explain this association. Drawing upon a population-based cohort study (n = 3020) linked to administrative records, we investigated the extent to which inattentive, internalizing, externalizing, and prosocial behaviors at child ages 6-8 years accounted for associations between parental education and child's risk of failing to graduate from high school. We adjusted for economic, demographic, cognitive, and perinatal factors, as well as parental mental health. Using logistic regressions and the Karlson-Holm-Breen decomposition method, we found that childhood behaviors together explained 19.5% of the association between mother's education and child's high school graduation status at age 22/23, and 13.7% of the association between father's education and this same outcome. Inattentive behaviors were most strongly associated with failure to graduate from high school, while the role of other behaviors was modest or negligible. Inattentive behaviors may represent a mediational pathway between parental education and child education. Early interventions targeting inattentive behaviors could potentially enhance the prospects of intergenerational educational mobility.
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Affiliation(s)
- Adam Vanzella-Yang
- School of Public Health, University of Montreal, Montreal, Canada.
- Sainte-Justine Hospital Research Center, University of Montreal, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
| | - Francis Vergunst
- School of Public Health, University of Montreal, Montreal, Canada
- Sainte-Justine Hospital Research Center, University of Montreal, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
- Special Needs Education, University of Oslo, Oslo, Norway
| | - Pascale Domond
- School of Public Health, University of Montreal, Montreal, Canada
- Sainte-Justine Hospital Research Center, University of Montreal, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Frank Vitaro
- Sainte-Justine Hospital Research Center, University of Montreal, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
- School of Psychoeducation, University of Montreal, Montreal, Canada
| | - Richard E Tremblay
- Sainte-Justine Hospital Research Center, University of Montreal, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
- Department of Pediatrics and Department of Psychology, University of Montreal, Montreal, Canada
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - Vincent Bégin
- Department of Psychoeducation, University of Sherbrooke, Sherbrooke, Canada
| | - Sylvana Côté
- School of Public Health, University of Montreal, Montreal, Canada
- Sainte-Justine Hospital Research Center, University of Montreal, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
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Domond P, Orri M, Vergunst F, Bouchard S, Findlay L, Kohen D, Hébert M, Vitaro F, Tremblay RE, Geoffroy MC, Côté S. Childhood Abuse, Intimate Partner Violence in Young Adulthood, and Welfare Receipt by Midlife. Pediatrics 2023; 151:190634. [PMID: 36748241 DOI: 10.1542/peds.2022-057379] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To investigate prospective associations between type of child abuse (physical, sexual, both), timing (childhood, young adulthood, both), and welfare receipt into middle-age. METHODS Database linkage study using the Quebec Longitudinal Study of Kindergarten Children cohort born in 1980 and government administrative databases (N = 3020). We assessed parental tax returns, family and personal background characteristics (1982-1987). At age 22 years, participants answered retrospective questionnaires on experienced childhood abuse (physical, sexual abuse < age 18 years) and intimate partner violence (IPV) (ages 18-22). Main outcome was years on social assistance, on the basis of participant tax returns (ages 23-37 years). Analysis included weights for population representativeness. RESULTS Of 1690 participants (54.4% females) with available data, 22.4% reported childhood abuse only, 14.5% IPV only, and 18.5% both. Prevalence of childhood physical, sexual, and both was 20.4%, 12.2%, and 8.3%, respectively. Adjusting for socioeconomic background and individual characteristics, we found that childhood physical abuse alone and physical or sexual abuse combined were associated with a two-fold risk of welfare receipt, as compared to never-abused (adjusted incidence risk ratio 2.43, 95% confidence interval [CI], 1.65-3.58; and adjusted incidence risk ratio 2.04, 95% CI, 1.29-3.23, respectively). Repeated abuse (childhood abuse combined with adult IPV) had a three-fold risk (adjusted incidence ratio 3.59, 95% CI, 2.39-5.37). CONCLUSIONS Abuse across several developmental periods (childhood and young adulthood) is associated with increased risks of long-term welfare receipt, independently of socioeconomic background. Results indicate a dose-response association. Early prevention and targeted identification are crucial to preventing economic adversity that may potentially lead to intergenerational poverty.
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Affiliation(s)
- Pascale Domond
- Ste-Justine University Hospital Research Centre.,Department of Social and Preventive Medicine, School of Public Health
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Canada
| | - Francis Vergunst
- Ste-Justine University Hospital Research Centre.,Department of Social and Preventive Medicine, School of Public Health.,Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Samantha Bouchard
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Canada
| | - Leanne Findlay
- Health Analysis Division, Statistics Canada, Ottawa, Canada
| | - Dafna Kohen
- Health Analysis Division, Statistics Canada, Ottawa, Canada
| | - Martine Hébert
- Department of Sexology, University of Quebec at Montreal, Montreal, Canada
| | | | - Richard E Tremblay
- Ste-Justine University Hospital Research Centre.,Departments of Pediatrics and Psychology, University of Montreal, Montreal, Canada.,School of Public Health, Physiotherapy, and Sport Science, University College Dublin, Dublin, Ireland
| | - Marie-Claude Geoffroy
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Canada
| | - Sylvana Côté
- Ste-Justine University Hospital Research Centre.,Department of Social and Preventive Medicine, School of Public Health
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Bouchard S, Langevin R, Vergunst F, Commisso M, Domond P, Hébert M, Ouellet-Morin I, Vitaro F, Tremblay RE, Côté SM, Orri M, Geoffroy MC. Child Sexual Abuse and Employment Earnings in Adulthood: A Prospective Canadian Cohort Study. Am J Prev Med 2023:S0749-3797(23)00054-5. [PMID: 36849276 DOI: 10.1016/j.amepre.2023.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/27/2023]
Abstract
INTRODUCTION Child sexual abuse remains a worldwide concern with devastating consequences on an individual's life. This longitudinal study investigates the associations between child sexual abuse (official reports versus retrospective self-reports) and subgroups by perpetrator identity (intrafamilial and extrafamilial), severity (penetration/attempted penetration, fondling/touching, noncontact), and chronicity (single, multiple episodes) and employment earnings in adulthood in a cohort followed for over 30 years. METHODS The Quebec Longitudinal Study of Kindergarten Children database was linked to child protection services (official reports of sexual abuse) and to Canadian government tax returns (earned income). The sample included 3,020 individuals in Quebec French-language school kindergartens in 1986/1988, followed until 2017, and assessed with retrospective self-reports at age 22 years. Tobit regressions were used for associations with earnings (ages 33-37 years), adjusting for sex and family socioeconomic characteristics in 2021-2022. RESULTS Individuals who experienced child sexual abuse had lower annual earnings. Those with retrospective self-reported sexual abuse (n=340) earned $4,031 (95% CI= -7,134, -931) less annually at ages 33-37 years than nonabused individuals (n=1,320), with pronounced differences for those with official reports (n=20), earning $16,042 (95% CI= -27,465, -4,618) less. Individuals self-reporting intrafamilial sexual abuse earned $4,696 (95% CI= -9,316, -75) less than those who experienced extrafamilial sexual abuse, whereas those self-reporting penetration/attempted penetration earned $6,188 (95% CI= -12,248, -129) less than those who experienced noncontact sexual abuse. CONCLUSIONS Earnings gaps were highest for severest child sexual abuse (official reports, intrafamilial, penetrative). Future studies should investigate the underlying mechanisms. Improving support for victims of child sexual abuse could yield socioeconomic returns.
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Affiliation(s)
- Samantha Bouchard
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Rachel Langevin
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Francis Vergunst
- CHU Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montréal, Montreal, Quebec, Canada; Deparment of Special Needs Education, Faculty of Educational Sciences, University of Oslo, Oslo, Norway
| | - Melissa Commisso
- Department of Psychology, Faculty of Arts and Sciences, Concordia University, Montreal, Quebec, Canada
| | - Pascale Domond
- CHU Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montréal, Montreal, Quebec, Canada
| | - Martine Hébert
- Department of Sexology, University of Quebec at Montreal, Montreal, Quebec, Canada
| | | | - Frank Vitaro
- School of Psycho-Education, University of Montréal, Montreal, Quebec, Canada
| | - Richard E Tremblay
- Department of Pediatrics, Psychology, and Psychiatry, University of Montréal, Montreal, Quebec, Canada
| | - Sylvana M Côté
- CHU Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montréal, Montreal, Quebec, Canada
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marie-Claude Geoffroy
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada; McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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Orri M, Vergunst F, Turecki G, Galera C, Latimer E, Bouchard S, Domond P, Vitaro F, Algan Y, Tremblay RE, Geoffroy MC, Côté SM. Long-term economic and social outcomes of youth suicide attempts. Br J Psychiatry 2021; 220:1-7. [PMID: 35049472 DOI: 10.1192/bjp.2021.133] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Youth who attempt suicide are more at risk for later mental disorders and suicide. However, little is known about their long-term socioeconomic outcomes. AIMS We investigated associations between youth suicide attempts and adult economic and social outcomes. METHOD Participants were drawn from the Quebec Longitudinal Study of Kindergarten Children (n = 2140) and followed up from ages 6 to 37 years. Lifetime suicide attempt was assessed at 15 and 22 years. Economic (employment earnings, retirement savings, welfare support, bankruptcy) and social (romantic partnership, separation/divorce, number of children) outcomes were assessed through data linkage with government tax return records obtained from age 22 to 37 years (2002-2017). Generalised linear models were used to test the association between youth suicide attempt and outcomes adjusting for background characteristics, parental mental disorders and suicide, and youth concurrent mental disorders. RESULTS By age 22, 210 youths (9.8%) had attempted suicide. In fully adjusted models, youth who attempted suicide had lower annual earnings (average last 5 years, US$ -4134, 95% CI -7950 to -317), retirement savings (average last 5 years, US$ -1387, 95% CI -2982 to 209), greater risk of receiving welfare support (risk ratio (RR) = 2.05, 95% CI 1.39 to 3.04) and were less likely to be married/cohabiting (RR = 0.82, 95% CI 0.73 to 0.93), compared with those who did not attempt suicide. Over a 40-year working career, the loss of individual earnings attributable to suicide attempts was estimated at US$98 384. CONCLUSIONS Youth who attempt suicide are at risk of poor adult socioeconomic outcomes. Findings underscore the importance of psychosocial interventions for young people who have attempted suicide to prevent long-term social and economic disadvantage.
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Affiliation(s)
- Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Canada; Department of Psychiatry, McGill University, Canada; and Bordeaux Population Health Research Centre Inserm U1218, University of Bordeaux, France
| | - Francis Vergunst
- Ste-Justine Hospital Research Center and Department of Social and Preventive Medicine, University of Montreal, Canada
| | - Gustavo Turecki
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Canada; and Department of Psychiatry, McGill University, Canada
| | - Cédric Galera
- Bordeaux Population Health Research Centre Inserm U1218, University of Bordeaux, France; and Department of Child and Adolescent Psychiatry, Charles Perrens Hospital, France
| | - Eric Latimer
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Canada
| | - Samantha Bouchard
- Department of School/Applied Child Psychology, McGill University; Canada
| | - Pascale Domond
- Ste-Justine Hospital Research Center and Department of Social and Preventive Medicine, University of Montreal, Canada
| | - Frank Vitaro
- School of Psychoeducation, University of Montreal, Canada
| | | | - Richard E Tremblay
- Department of Pediatrics and Psychology, University of Montreal, Canada; and School of Public Health, Physiotherapy & Sport Science, University College Dublin, Ireland
| | - Marie-Claude Geoffroy
- Department of School/Applied Child Psychology, McGill University, Canada; McGill Group for Suicide Studies, Douglas Mental Health University Institute, Canada; and Department of Psychiatry, McGill University, Canada
| | - Sylvana M Côté
- Bordeaux Population Health Research Centre Inserm U1218, University of Bordeaux, France; and Department of Social and Preventive Medicine, University of Montreal, Canada
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Vergunst F, Zheng Y, Domond P, Vitaro F, Tremblay RE, Nagin D, Park J, Côté SM. Behavior in childhood is associated with romantic partnering patterns in adulthood. J Child Psychol Psychiatry 2021; 62:842-852. [PMID: 33058195 DOI: 10.1111/jcpp.13329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most people will partner at some point during their lives. Yet little is known about the association between childhood behavior and patterns of long-term romantic partnering in adulthood. METHODS In this population-based cohort study, behavioral ratings were prospectively obtained from teachers when children (n = 2,960) were aged 10-12 years - for inattention, hyperactivity, aggression-opposition, anxiety, and prosociality - and linked to their tax return records from age 18 to 35 years (1998-2015). We used group-based based trajectory modeling to estimate the probability of partnership (marriage/cohabitation) over time and multinomial logistic regression models to examine the association between childhood behavior and trajectory group membership. The child's sex and family socioeconomic background were adjusted for. RESULTS Five distinct trajectories of partnering were identified: early-partnered (n = 420, 14.4%), mid-partnered (n = 620, 21.3%), late-partnered (n = 570, 19.2%), early-partnered-separated (n = 460, 15.5%), and delayed-or-unpartnered (n = 890, 30.0%). Participants in the early-partnered-separated and delayed-or-unpartnered trajectories were more likely to have left high school without a diploma and to have lower earnings and higher welfare receipt from age 18 to 35 years. After adjustment for sex and family background, inattention and aggression-opposition were uniquely and additively associated with increased likelihood of following an early-partnered-separated trajectory, while inattention and anxiety were associated with an increased likelihood of following a delayed-or-unpartnered trajectory. Childhood prosocial behaviors were consistently associated with earlier and more sustained patterns of partnership. CONCLUSIONS Children with behavioral problems are more likely to separate or to be unpartnered across early adulthood. This may have consequences for their psychological health and wellbeing and that of their families.
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Affiliation(s)
- Francis Vergunst
- School of Public Health, University of Montreal, Montreal, QC, Canada.,Ste-Justine Hospital Research Center, Montreal, QC, Canada
| | - Yao Zheng
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
| | - Pascale Domond
- School of Public Health, University of Montreal, Montreal, QC, Canada.,Ste-Justine Hospital Research Center, Montreal, QC, Canada
| | - Frank Vitaro
- Ste-Justine Hospital Research Center, Montreal, QC, Canada.,School of Psychoeducation, University of Montreal, Montreal, QC, Canada
| | - Richard E Tremblay
- Ste-Justine Hospital Research Center, Montreal, QC, Canada.,Department of Pediatrics and Psychology, University of Montreal, Montreal, QC, Canada.,School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - Daniel Nagin
- Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
| | | | - Sylvana M Côté
- Ste-Justine Hospital Research Center, Montreal, QC, Canada.,Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada.,Charles Perrens Hospital Center, INSERM U1219, University of Bordeaux, Bordeaux, France
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Vergunst F, Zheng Y, Domond P, Vitaro F, Tremblay R, Nagin D, Park J, Cote S. Behaviour in childhood is associated with distinct patterns of partnering in adulthood. Eur Psychiatry 2021. [PMCID: PMC9528314 DOI: 10.1192/j.eurpsy.2021.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Childhood behavioral problems are highly prevalent in school-aged children and are associated with poor long-term outcomes. Yet little is known about their association with patterns of partnering in adulthood. Objectives To (1) describe patterns of partnering from age 18-35 years in a large population-based sample, and (2) examine the association between childhood behavioural problems and adult partnering patterns. Methods Behavioural ratings were prospectively obtained from teachers when children (n=2960) were aged 10-12 years – for inattention, hyperactivity, aggression-opposition, anxiety and prosociality – and linked to their tax return records from age 18-35 years. We used group-based trajectory modelling to identify distinct trajectories of partnering (married or cohabitating) and multinomial regression models to examine the association between childhood behaviour and trajectory group membership. Results
Five distinct trajectories of partnering were identified: early-partnered (n=420, 14.4%), mid-partnered (n=620, 21.3%), late-partnered (n=570, 19.2%), early-separated (n=460, 15.5%), and delayed-or-unpartnered (n=890, 30.0%). After adjustment for sex and family background, children rated as being anxious or inattentive were more likely to remain unpartnered from age 18 to 35 years, while those rated as aggressive-oppositional or inattentive were more likely to separate and return to unpartnered status. Prosocial behaviours were consistently associated with earlier and more sustained partnership. Participants in the early-separated and delayed-or-unpartnered trajectories were also more likely to have left high school without a diploma and to have lower earnings. Conclusions Childhood behavioural problems were associated with increased likelihood of being unpartnered and of partnership dissolution, which has implications for the psychological health and wellbeing of individuals and their families.
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Domond P, Orri M, Algan Y, Findlay L, Kohen D, Vitaro F, Tremblay RE, Côté SM. Child Care Attendance and Educational and Economic Outcomes in Adulthood. Pediatrics 2020; 146:peds.2019-3880. [PMID: 32527751 DOI: 10.1542/peds.2019-3880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To test associations between onset of formal child care (in infancy or as a toddler), high school graduation, and employment earnings from ages 18 to 35 years. METHODS A 30-year prospective cohort follow-up study, with linkage to government administrative databases (N =3020). Exposure included formal child care, if any, by accredited caregivers in centers or residential settings at ages 6 months and 1, 1.5, 2, 3, and 4 years. A propensity score analysis was conducted to control for social selection bias. RESULTS Of 2905 participants with data on child care use, 59.4% of male participants and 78.5% of female participants completed high school by age 22 to 23. Mean income at last follow-up (n = 2860) was $47 000 (Canadian dollars) (SD = 37 700) and $32 500 (SD = 26 800), respectively. Using group-based trajectory modeling, we identified 3 groups: formal child care onset in infancy (∼6 months), formal child care onset as a toddler (after 2.5 years), and never exposed. After propensity score weighting, boys with child care started in infancy had greater odds of graduating than those never exposed (odds ratio [OR] 1.39; 95% confidence interval [CI]: 1.18-1.63; P < .001). Boys attending child care had reduced odds of low income as young adults (infant onset: OR 0.60 [95% CI: 0.46-0.84; P < .001]; toddler onset: OR 0.63 [95% CI: 0.45-0.82; P < .001]). Girls' graduation rates and incomes revealed no significant association with child care attendance. CONCLUSIONS For boys, formal child care was associated with higher high school completion rates and reduced risk of adult poverty. Benefits for boys may therefore extend beyond school readiness, academic performance, and parental workforce participation.
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Affiliation(s)
- Pascale Domond
- Sainte-Justine Hospital Research Center, Montreal, Canada.,Social and Preventive Medecine, School of Public Health and
| | - Massimiliano Orri
- Sainte-Justine Hospital Research Center, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Yann Algan
- Sciences Po, Fench Economic Observatory (OFCE), Paris, France
| | - Leanne Findlay
- Health Analysis Division, Statistics Canada, Ottawa, Canada
| | - Dafna Kohen
- Health Analysis Division, Statistics Canada, Ottawa, Canada
| | - Frank Vitaro
- Sainte-Justine Hospital Research Center, Montreal, Canada.,School of Psychoeducation, University of Montreal, Montreal, Canada
| | - Richard E Tremblay
- Sainte-Justine Hospital Research Center, Montreal, Canada.,Departments of Pediatrics, Psychology, and.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; and
| | - Sylvana M Côté
- Sainte-Justine Hospital Research Center, Montreal, Canada; .,Social and Preventive Medecine, School of Public Health and.,Bordeaux Population Health Research Center, French National Institute of Health and Medical Research U1219, University of Bordeaux, Bordeaux, France
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