PATHS Equity for Children: a program of research aimed at monitoring equity in children’s outcomes Marni D. Brownell, PhD CPHA Annual Conference Toronto,

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PATHS Equity for Children: a program of research aimed at monitoring equity in children’s outcomes Marni D. Brownell, PhD CPHA Annual Conference Toronto, ON: May 27, 2014

Manitoba Centre for Health Policy (MCHP) University of Manitoba, Faculty of Health Sciences, College of Medicine, Department of Community Health Sciences Use a Repository of datasets to study health services, population and public health support the development of evidence-informed policy, programs and services that maintain and improve the health and well-being of Manitobans.

Using data in MCHP Repository to study child health and development At birth: Birth weight Gestational age Apgar scores Breastfeeding Complications FF screen Preschool: Child care School Entry: EDI School enrolment Special needs (age 8) Grade 3 assessment School enrolment Grade retention Special needs (ages 11-13) Grade 7/8 assessments School enrolment Grade retention Special needs (ages 14-19) Grade 12 assessments High school marks Special needs High school completion Prenatal: FF screen Prenatal care Maternal serum screen At all stages: health status (hospitalizations, doctor visits, medications prescribed), immunization, residence (area-level measures; region, number of moves), family composition (marital status, number of siblings), family or youth receipt of income assistance, involvement with child welfare, clinical datasets (e.g., FASD) Birth/Health/Education Linkages

Grade 12 Performance by Socioeconomic Status (SES) Language Arts Standards Test Pass/Fail rates of test writers17/18 year olds who should have written Brownell, Roos, Fransoo, et al., 2006

PATHS Equity: PAthways To Health and Social Equity Multi-disciplinary, cross-sector collaboration Integrated KT Use Repository to evaluate programs in childhood –Did the program work? –Did the program reduce inequities? 14 separate sub-projects; integrative projects This Programmatic Grant to Reduce Health Inequity was supported by the Canadian Institutes of Health Research ( and the Heart & Stroke Foundation of Canadawww.cihr-irsc.gc.ca

PATHS Projects Project Year 1Year 2Year 3Year 4Year 5 Baby Friendly Hospital Initiative Physician Integrated Network Early Intervention for ADHD Early Psychosis Prevention & Intervention In-School Teen Clinics Healthy Baby Program Families First Home Visiting Social Housing CSI Summer Learning Enrichment Healthy Buddies Roots of Empathy Full-Day Kindergarten Qualitative Analysis: Understanding the Mechanisms of Inequity Public Health Sensitive Conditions Integrative Analysis

Manitoba Healthy Baby Program: Compared low income women receiving benefit to those not receiving Propensity Scoring used to ensure comparability of groups Is receipt of the HB prenatal benefit associated with better outcomes? Has there been a change in equity?

Receipt of Healthy Baby Benefit RR (95 % CI) Breastfeeding Initiation1.06 ( )* Low 5-minutes Apgar Score0.93 ( ) Low Birth Weight (< 2,500 g)0.71 ( )* Pre-term Birth (GA < 37 weeks)0.76 ( )* Small for Gestational Age0.90 ( )* Large for Gestational Age1.13 ( )* Complete Immunization (one year old)1.13 ( )* Complete Immunization (two year old)1.20 ( )* Hospital Readmission (within 28 days of birth)1.02 ( ) Hospital Readmission (within 2 years of birth)1.01 ( ) Decrease Increase

Framework for Equities From our data we can form three groups: –Group 1: ELIGIBLE to receive Healthy Baby Benefit (Q1 to Q3) and RECEIVED Benefit –Group 2: ELIGIBLE to receive Healthy Baby Benefit (Q1 to Q3) and DID NOT RECEIVE Benefit –Group 3: NOT ELIGIBLE to receive Healthy Baby Benefit (Q4 to Q5) DID NOT RECEIVE Benefit

Framework for Equities Comparison A (With Healthy Baby) Comparison B (Without Healthy Baby) LBW GROUP1 / LBW GROUP3 LBW GROUP2 / LBW GROUP3 LBW GROUP 1 - LBW GROUP 3 LBW GROUP 2 - LBW GROUP 3 Test whether inequality in A is different from B

Health Baby Impact on Health Equality Risk Difference With Healthy Baby Benefit LBW, High Income – LBW, Low Income Without Healthy Baby Benefit LBW, High Income – LBW, Low Income Higher Risk Low Income vs. High Income Lower Risk Low Income vs. High Income

Thank You / Questions umanitoba.ca/centres/mchp facebook.com/mchp.umanitoba twitter.com/mchp_umanitoba