Suchergebnisse

IntroductionThe quality of early education children receive influences their developmental trajectories, with long-term effects extending into adulthood. First Nations children face many structural barriers to academic success. Few studies have examined the impact of education programs on removing these barriers to support better outcomes amongst First Nations children.
Objectives and ApproachWe examined educational outcomes associated with full-day (FDK) versus half-day (HDK) kindergarten among First Nations children using data from the Manitoba Population Research Data Repository. We linked children's education records with the Manitoba Health Registry and the First Nations Registry to identify all First Nations children who attended kindergarten in a Winnipeg school division (1998-2011). Children enrolled FDK were age- and sex- matched to children enrolled in HDK. Propensity scores used to adjust for confounding. Outcomes included academic achievements in grades 3, 7, and 8 and high school graduation. We used generalized linear models to test for differences in education.
ResultsWe identified 324 First Nations children enrolled in FDK and 595 matches in HDK in the study period. Among these, 37% FDK and 31% HDK students met or approached numeracy expectations in grade 3; and 30% FDK and 33% HDK met or approached numeracy expectations in grade 7. For reading expectations, 37% FDK and 33% HDK met or approached grade 3 reading expectations; in grade 8, roughly half of each group met or approached expectations for reading and writing. High school graduation rate for First Nations children in both FDK and HDK children was 60%. We found no differences in education outcomes when we tested for differences between HDK and FDK children.
Conclusion/ImplicationsEducation outcomes did not differ between First Nations children enrolled in FDK vs. HDK programs. Kindergarten programs may be insufficient to overcome structural barriers to academic success that these children face. Culturally appropriate education strategies may be needed to support improved outcomes amongst this population.

IntroductionOut-of-school or after-school programs are designed to support healthy behaviours, boost academic achievement and strengthen social skills. The Boys and Girls Clubs of Winnipeg (BGCW) in Manitoba, Canada, have been offering out-of-school programs to children and adolescents in low-income neighbourhoods for more than 40 years. Many BGCW participants face considerable risk of poor health, social and educational outcomes due to challenges they experience at home, in school and in their communities.
ObjectiveWe examined whether BGCW participation among children and adolescents aged 5-18 is associated with improved school outcomes and lower risk of justice system encounters and adverse health outcomes.
MethodsWe linked de-identified data on BGCW participation for children and adolescents born 1987-2010 to administrative data from the healthcare system, education system, and social services in the Population Research Data Repository, Manitoba Centre for Health Policy. The exposure group (n = 8,990$) included children and adolescents who visited BGCW at least once from 2005—2016. The comparison group (n = 69,980) comprised children and adolescents matched on school year and neighbourhood who had never participated in BGCW.
ResultsParticipation in BGCW was significantly associated with better scores in grade 3 numeracy and grade 7 student engagement assessments. The risk of justice system encounters among adolescents (aged 12—17) dropped as the frequency of BGCW participation increased, as did justice system encounters among young adults (aged 18—24) who had participated in BGCW as adolescents. The likelihood of teen pregnancy among female adolescents (aged 13—19) and sexually transmitted infections among adolescents (aged 13—19) also declined as the frequency of participation in BGCW increased.
ConclusionsThe findings suggest that participation in BGCW is associated with positive outcomes for children and adolescents in multiple domains and despite socioeconomic and family challenges faced by many in this population.

ABSTRACTObjectiveThe objective of this population health intervention research was to determine the effectiveness in improving children's outcomes of a provincial home visiting program for at-risk families in Manitoba, Canada. Home visiting programs have been evaluated in highly structured and supervised conditions which may provide different results than those evaluated in real-world delivery systems.
ApproachIn this retrospective cohort study, data for 4,562 children from home visiting program families and 5,184 comparison children were linked to de-identified administrative health, social services, and education data held securely at the Manitoba Centre for Health Policy. Inverse probability of treatment weights were used to address the selection bias inherent in delivering a voluntary program. We used generalized linear modelling to calculate program effects among those exposed to the program, those unexposed and the average effect. Child outcomes examined included being taken into care of child welfare, hospitalizations for maltreatment-related injuries, and child development scores at school entry.
ResultsThe home visiting program was associated with lower rates of children being taken into care and lower rates of hospitalization for maltreatment-related injuries. For being taken into care by child's first birthday, the adjusted Risk Ratio (aRR) was 0.75 (95% Confidence Interval [CI]: 0.66, 0.86); for being taken into care by second birthday, aRR=0.79, (95% CI: 0.70, 0.88); and for hospitalizations for maltreatment-related injuries by third birthday, aRR=0.59 (95% CI: 0.35, 0.99). Similar program effects would be expected among comparison children if they had received the program (i.e., average treatment effect for the untreated). No differences between groups were found across five domains of child development at school entry.
ConclusionHome visiting programs can be an effective strategy for decreasing child maltreatment at a population level. Home visiting program enhancements are necessary to improve child development scores when children enter school. Use of population-based linkable data systems provides an opportunity to evaluate interventions using large, real-world samples, adjusting for a wide range of risk factors, and examining a variety of outcomes.

ABSTRACT
ObjectiveDespite the implementation of full-day kindergarten (FDK) in several Canadian provinces, there is little evidence on the long-term outcomes associated with this program. Our objective was to use population-level linked data sources from Manitoba, Canada, to determine whether FDK results in better long-term academic outcomes and reduced inequities in outcomes.
ApproachUsing data held in the Manitoba Centre for Health Policy Data Repository we examined provincial reading and numeracy assessments in grades 3, 7, and 8 and a performance index in grade 9 for students in two Manitoba school divisions between 1999-2012. In School Division A (SDA), FDK is targeted in the lowest SES schools; in School Division B (SDB) FDK was gradually introduced universally. SDA FDK students were matched using propensity scores to students in an adjacent school division with similar socioeconomic status (SES) but no FDK; in SDB a stepped-wedge design was used. Logistic regressions accounted for confounders including classroom effects and sex. Gamma sensitivity analyses were used to assess sensitivity of results to unmeasured confounding. The Kakwani Progressivity Index (KPI) determined how FDK affected equity.
ResultsThere were 224-544 children in FDK and 869-1923 non-FDK matches in SDA, depending on the outcome examined; numbers in SDB ranged from 335-707 (FDK) and 222-475 (non-FDK). Including interactions, 35 comparisons were examined in SDA and 24 in SDB. None of the outcomes examined in SDB showed statistically significant effects of FDK that were robust to unmeasured confounding. In SDA there were only 3 statistically significant and robust findings of benefits of FDK, all related to math. Comparisons of KPIs for FDK and non-FDK children in both school divisions demonstrated inequities in outcomes associated with SES, however there were no significant differences in equity between the FDK and non-FDK children for any of the outcomes.
ConclusionsOur findings indicate no apparent benefits of universal FDK, and limited benefits from targeted FDK, specifically long-term improvements in numeracy for low-income girls. No reductions in inequity were found. Decisions regarding FDK implementation should weigh the costs of this program against the limited long-term academic benefits.

ObjectivesLack of consistent and relevant Indigenous identifiers in Canadian data sources leads to misclassification and under-recognition of the health and social issues impacting Indigenous Peoples, further perpetuating the harms of colonization. We are evaluating and optimizing our approach for identifying First Nations (FN) individuals in administrative data in Manitoba.
MethodsIn partnership between the First Nations Health and Social Secretariat of Manitoba and the Manitoba Centre for Health Policy, we sought to evaluate to what extent four distinct Manitoba datasets derived from surveillance and social programs were able to identify FN individuals among a cohort of children in low-income Winnipeg neighbourhoods between 2005-2016. In choosing data sources to identify FNs, the population and research question were considered.
We then compared the number of FNs identified in each dataset to the First Nations population research file, considered gold standard, but cognizant of its roots in colonial systems of registration.
ResultsThe total cohort comprised N=78,864; among these, n=27,347 children were identified as FN in either the FN registry or at least one of the datasets. The FN registry was the most sensitive dataset and identified 85.7% of these individuals. The two program datasets identified 58.2% and 46.2%, and the surveillance-based datasets each identified less than 10%.
The First Nations Registry is critical to accurately identify FN individuals. Our analyses demonstrated that without it we would miss 23.5% of those identified as FN in at least one other dataset. However, using it alone could potentially cause us to miss 15% of FN individuals identified in other datasets.
The proportions of FN individuals that would be missed by excluding any of the other datasets were smaller (<6%).
ConclusionWe found inconsistent FN identification across the datasets evaluated. Among the issues is that some datasets rely on self-identification. In Manitoba, no single administrative dataset can reliably and comprehensively identify FN individuals, and linking multiple datasets together is currently our best approach.

IntroductionThe Boys & Girls Clubs of Winnipeg (BGCW) provide out-of-school programs to children and youth living in low-income neighbourhoods in Winnipeg, Canada. These programs aim to set participants on a path to success by supporting healthy behaviours, academic achievement and social skills. First Nation children and youth make up a substantial proportion of BGCW participants, but there are few empirical data available on how the programs influence health, social and education outcomes in this population.
Objectives and ApproachWe linked BGCW attendance records for all Manitoba children born 1987-2010 to the individual-level administrative health, social and education data in the population-based Data Repository at the Manitoba Centre for Health Policy in Winnipeg. The comparison group of non-participants was matched on age and neighbourhood of residence. We narrowed the cohort to First Nation participants by linking to datasets containing First Nation identifiers. Education outcomes were examined using a generalized additive model, and health and justice system outcomes with a time-to-event model, adjusted for socioeconomic status, mother's mental health and age at first birth, and involvement in the child welfare system.
Results3,754 First Nation children and youth participated in BGCW from 2005-2016. The comparison group comprised 23,593 First Nation children and youth. Greater BGCW participation was associated with higher likelihood of performing well in grade 3 numeracy, but not other education outcomes (grade 3 reading, grade 7 student engagement or mathematics, grade 7/8 reading/writing, or graduating high school). Greater BGCW participation was also associated with lower risk of becoming involved with the justice system among youth aged 12-17 (i.e., lower risk of being charged with a crime) and with lower risk of teen pregnancy.
Conclusion / ImplicationsParticipation in BGCW programs may contribute to improved health, justice and education outcomes for First Nation children and youth in Winnipeg.

IntroductionThe province-wide Families First Home Visiting Program (FFHV) provides home visiting to families with children living in conditions of risk. It remains unknown if First Nations families are benefiting from the program. Using existing administrative and population-wide data is an innovative practice to evaluate programs that have been scaled up.
Objectives and ApproachThe objective is to determine FFHV's effectiveness at improving outcomes for First Nations children and parents. The partnership with First Nations Health and Social Secretariat of Manitoba facilitated access to First Nations identifiers and provided guidance in conducting the study. Program data from 4,010 First Nations children and parents were linked at an individual-level to administrative data housed at the Manitoba Centre for Health Policy. We compared the predictive probability of outcomes of program and non-program families. Inverse probability of treatment weights were used to adjust for confounders related to both entry into FFHV and the outcomes under study.
ResultsThe cohort of First Nations children and parents was successfully linked through an individual scrambled health identifier. FFHV was associated with higher rates of child immunization at age one (71% versus 66%) and age two (47% versus 41%) and parental involvement in community support groups (21% versus 17%). It was also associated with lower rates of being in care of child welfare at age one (10% versus 14%) and age two (15% versus 19%); maltreatment-related hospitalizations at age three (0.4% versus 1.0%); and child victimization as measured by justice system records (1.7% versus 3.0%). However, there were no differences in being "not ready for school" between the two groups of children, nor between the groups of mothers in physician visits for mental health reasons.
Conclusion/ImplicationsHome visiting services can play a role in supporting healthy development of First Nations children by providing support to parents and connecting children to health and social services, however, there also remains an urgent need for long term strategies to address structural inequality and the ongoing effects of colonization.

ABSTRACT
ObjectivePerinatal outcomes have improved overall in developed countries over the last several decades but remain poor for disadvantaged populations. In Manitoba, Canada, the Healthy Baby Prenatal Benefit (HBPB), a cash transfer to low-income pregnant women, was introduced with the goal of improving perinatal outcomes. The objective of this study was to use linked administrative and program datasets to determine whether this unconditional income supplement was associated with improved birth outcomes for a low-income population.
ApproachThis study used data from the PATHS Data Resource, which contains population-level health and social service records as well as program data for approximately 600,000 children in Manitoba, Canada, over a 30-year period, linkable at the individual level. All mother-newborn pairs, from 2003-2010, who met the following criteria were included for analyses: i) the mother was on social assistance (i.e., low income); ii) the infant was born in hospital; and, iii) the pair had a newborn risk screen (n=14,591), documenting factors such as prenatal alcohol and tobacco exposure and maternal and family characteristics. Low-income women who received HBPB (exposed, 10,738) were compared with low-income women who did not receive HBPB (unexposed, 3,853) on several outcomes: low birth weight, preterm, small- and large-for-gestational age, 5-minutes Apgar scores, breastfeeding initiation, neonatal readmission, and newborn hospital length of stay (LOS). Covariates from the risk screens were used to develop propensity scores to construct Inverse Probability of Treatment Weights, to balance differences between exposed and unexposed groups in regression models. Gamma sensitivity analyses assessed sensitivity to unmeasured confounding. Population attributable and preventable fractions were calculated.
ResultsHBPB exposure was associated with reductions in low birth weight (adjusted risk ratio, aRR=0.71, 95% CI=0.63, 0.81), preterm (aRR=0.76 (0.69, 0.84)) and small-for-gestational age (aRR=0.90 (0.81, 0.99)) births and increases in breastfeeding (aRR=1.06 (1.03, 1.09)) and large-for-gestational age births (aRR=1.13 (1.05, 1.23)). For vaginal births, HBPB was associated with shortened LOS (mean=2.86, p<0.0001). Results for breastfeeding, low birth weight, preterm and LOS were robust to unmeasured confounding. Reductions of 21% (95% CI 13.6, 28.3) of low birth weight and 17.5% (11.2, 23.8) of preterm were associated with receipt of the HBPB.
ConclusionsA modest income supplement during pregnancy was associated with improved birth outcomes for infants born to low-income women. Placing conditions on income supplements to low income pregnant women may not be necessary to promote prenatal and perinatal health. Linked administrative data can be a valuable tool for program evaluation.

IntroductionAdministrative data studies routinely report that First Nations mothers and children experience a disproportionate burden of poor health. Due to the nature of administrative data, research often takes a deficits-oriented approach. First Nations health research needs to consider the role that community- and individual-level strengths play in promoting wellbeing and examine how these interact with the delivery and outcomes of health programs.
Objectives and ApproachThe First Nations Health and Social Secretariat of Manitoba (FNHSSM) and the University of Manitoba partnered to construct measures of community-level strengths that can be linked with administrative data to examine the delivery and outcomes associated with population health programs delivered in First Nations communities.
We linked data from the FNHSSM-administered Regional Health Survey (RHS) with administrative data housed in the Manitoba Population Research Data Repository. We identified 60 questions from the child, youth, and adult versions of the RHS to measure community strengths. We used principal component analysis to identify strength-based constructs. We used Eigen values and percent of variance explained to determine the final number of factors. We used random group resampling and bootstrap methods to test for community-level homogeneity. Community-level factor scores were calculated as the scaled combination of RHS questions within each factor and averaged to the community.
ResultsWe identified 12 constructs of community strength: 5 from child responses, 4 from youth, and 3 from adult responses. Strength-based constructs common to all age groups included knowledge of traditional language, involvement in cultural events, and connection with community.
Conclusion / ImplicationsColonial approaches to health research perpetuate deficit-based dialogues and negative portrayal of First Nations peoples. First Nations health research should consider how community strengths promote health and interact with program delivery. Including measures of community strength leads to richer understandings of factors that promote wellness among First Nations peoples.

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

While home visiting programs are among the most widespread interventions to support at-risk families, there is a paucity of research investigating these programs under real-world conditions. The effectiveness of Families First home visiting (FFHV) was examined for decreasing rates of being in care of child welfare, decreasing hospitalizations for maltreatment-related injuries, and improving child development at school entry. Data for 4,562 children from home visiting and 5,184 comparison children were linked to deidentified administrative health, social services, and education data. FFHV was associated with lower rates of being in care by child's first, second, and third birthday (adjusted risk ratio [aRR] = 0.75, 0.79, and 0.81, respectively) and lower rates of hospitalization for maltreatment-related injuries by third birthday (aRR = 0.59). No differences were found in child development at kindergarten. FFHV should be offered to at-risk families to decrease child maltreatment. Program enhancements are required to improve child development at school entry.

IntroductionEarly education outcomes influence children's educational trajectories with long-term effects extending into adulthood. Aboriginal peoples face numerous systemic barriers to academic success. It remains unknown if full-day kindergarten (FDK) is associated with improved academic outcomes among Metis children – a distinct Aboriginal people recognized by the Canadian Constitution.
Objectives and ApproachThe Manitoba Metis Federation and the Manitoba Centre for Health Policy partnered to identify whether FDK was associated with improved short- and long-term outcomes among Metis children. We created a cohort of Metis children by linking several provincial databases held in the Manitoba Population Research Data Repository (1998-2011). Education data were used to identify all Metis children who attended FDK (n=247) vs half day kindergarten (HDK; n=547). FDK children were matched by age and sex to children in HDK. We used a step-wedged design and applied propensity scores to adjust for measured confounding. We tested for differences in grades 3, 7, 8 outcomes and high school graduation using generalized linear models.
ResultsFDK children were more likely to live in a low-income neighbourhood. 72% FDK and 74% HDK students met or approached numeracy expectations in grade 3; and 55% FDK and 48% HDK met or approached numeracy expectations in grade 7. For reading expectations, 77% FDK and 75% HDK met or approached grade 3 reading expectations; in grade 8, 62% in each group met or approached expectations for reading and writing. High school graduation rate for FDK children was 84% and for HDK children was 64%. After adjusting for confounding we found FDK children were more likely to graduate high school than HDK children; other outcomes were non-significant.
Conclusion / ImplicationsKindergarten programs may be insufficient to overcome structural barriers that Metis children face. Culturally appropriate education strategies are needed to support improved outcomes amongst this population.

IntroductionIn Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), a prenatal income supplement. Research has demonstrated positive outcomes associated with HBPB, but it remains unknown if Metis women and children – who are of mixed European and Aboriginal descent and one of the most marginalized populations in Canada -- benefit from the program.
Objectives and ApproachThe Manitoba Metis Federation and the Manitoba Centre for Health Policy partnered to determine the impact of HBPB on Metis newborn and early childhood outcomes. We included all Metis women giving birth in Manitoba 2003-2011 who received income assistance during pregnancy (n=4,852), adjusting for differences between those receiving (n=3,681) and not receiving (n=1,171) HBPB with propensity score weighting. We used multi-variable regressions to compare outcomes between groups: breastfeeding initiation, low birth weight, preterm birth, small- and large-for-gestational age, Apgar scores, birth hospitalization length of stay (LOS), neonatal readmissions, infant hospitalizations, vaccinations at age 1 and 2, and child development scores at kindergarten.
ResultsHBPB receipt was associated with reductions in low birth weight (adjusted Relative Risk (aRR): 0.74 (95% CI: 0.58-0.94)) and preterm births (aRR: 0.78 (0.65-0.94)), and increases large-for-gestational age births (aRR: 1.21 (1.06-1.39)) and neonatal readmissions (aRR: 1.58 (1.05-2.37)). Birth hospitalization LOS was lower for newborns whose mothers received HBPB (Mean Difference 0.29 days). HBPB was associated with increases in vaccinations for children aged 1 (aRR: 1.08 (1.00-1.15)) and 2 (aRR: 1.12 (1.05-1.18)). No significant associations were found for small-for-gestational age births, Apgar scores, breastfeeding initiation, infant hospitalizations or child development scores.
Conclusion / ImplicationsA modest unconditional prenatal income supplement to low-income Metis women was associated with improved birth outcomes and child vaccinations; however, an association with increased neonatal readmissions warrants further exploration. Lack of significant associations between HBPB and child development measures suggests more sustained support may be necessary to improve longer-term outcomes.