Do socioeconomic and birth order gradients in child maltreatment differ by immigrant status?

BACKGROUND: While literature has documented strong gradients in child maltreatment (CM) by socioeconomic status and family composition in the general population, how these patterns extend to immigrants remain inconclusive. Using population-based administrative data, we examined, for the first time, whether gradients in CM by neighbourhood income and childbirth order vary by immigrant status. METHODS: We used linked hospitalisation, emergency department visits, small-area income, birth and death records with an official Canadian immigration database to create a retrospective cohort of all 1 240 874 children born from 2002 to 2012 in Ontario, Canada, followed from 0 to 5 years. We estimated rate ratios of CM among immigrants and non-immigrants using modified Poisson regression. RESULTS: CM rates were 1.6 per 100 children among non-immigrants and 1.0 among immigrants. CM was positively associated with neighbourhood deprivation. The adjusted rate ratio (ARR) of CM in the lowest neighbourhood income quintile versus the highest quintile was 1.57 (95% CI 1.49 to 1.66) for non-immigrants and 1.33 (95% CI 1.15 to 1.54) for immigrants. The socioeconomic gradient disappeared when restricted to children of immigrant mothers arrived at 25+ years and in analyses excluding emergency department visits. Compared to a first child, the ARR of CM for a fourth or higher-order child was 1.75 (95% CI 1.63 to 1.89) among non-immigrants and 0.57 (95% CI 0.44 to 0.74) among immigrants. CONCLUSIONS: Immigrants exhibited lower CM rates than non-immigrants across neighbourhood income quintiles and differences were greatest in more deprived neighbourhoods. The contrasting birth order gradients between immigrants and non-immigrants require further investigation.

Receipt of routine preventive care among infant daughters and sons of immigrant mothers in Ontario, Canada: a retrospective cohort study.

OBJECTIVES: To explore gender disparities in infant routine preventive care across maternal countries of birth (MCOB) and by mother tongue among infants of Indian-born mothers. SETTING: Retrospective population-based administrative cohort in Ontario, Canada (births between 2002 and 2014). PARTICIPANTS: 350 366 (inclusive) healthy term singletons belonging to families with a minimum of one opposite gender child. OUTCOME MEASURES: Fixed effects conditional logistic regression generated adjusted ORs (aORs) for a daughter being underimmunised and having an inadequate number of well-child visits compared with her brother, stratified by MCOB. Moderation by maternal mother tongue was assessed among children to Indian-born mothers. RESULTS: Underimmunisation and inadequate well-child visits were common among both boys and girls, ranging from 26.5% to 58.2% (underimmunisation) and 10.5% to 47.8% (inadequate well-child visits). depending on the maternal birthplace. Girls whose mothers were born in India had 1.19 times (95% CI 1.07 to 1.33) the adjusted odds of inadequate well-child visits versus their brothers. This association was only observed among the Punjabi mother tongue subgroup (aOR: 1.26, 95% CI 1.08 to 1.47). In the Hindi mother tongue subgroup, girls had lower odds of underimmunisation than their brothers (aOR: 0.73, 95% CI 0.54 to 0.98). CONCLUSIONS: Gender equity in routine preventive healthcare is mostly achieved among children of immigrants. However, daughters of Indian-born mothers whose mother tongue is Punjabi, appear to be at a disadvantage for well-child visits compared with their brothers. This suggests son preference may persist beyond the family planning stage among some Indian immigrants.

Differences in Early Childhood Maltreatment by Maternal Birthplace and Child Sex.

OBJECTIVE: To identify patterns of health system-identified early childhood maltreatment by maternal birthplace and child sex, within a multicultural society with universal access to healthcare. STUDY DESIGN: This retrospective population-based cohort study included 1240946 children born in Ontario, Canada, between 2002 and 2012, and followed from birth to age 5 years using administrative data. Modified Poisson regression was used to estimate adjusted rate ratios for maltreatment-physical abuse or neglect-among the children of immigrant vs nonimmigrant mothers. Conditional logistic regression was used to estimate further the odds of maltreatment comparing a daughter vs son of the same mother. RESULTS: Maltreatment rates were 36% lower (adjusted rate ratio, 0.64; 95% CI, 0.61-0.66) among children of immigrant mothers (10 per 1000) than those of nonimmigrant mothers (16 per 1000). Maltreatment rates were 27%-48% lower among children of maternal immigrant groups relative to that among Canadian-born mothers, except children of Caribbean-born mothers (16 per 1000). No significant differences were seen between daughters and sons in the odds of early childhood health system-identified maltreatment by maternal birthplace. CONCLUSIONS: Health system-identified maltreatment in early childhood is highest among children of Canadian- and Caribbean-born mothers. Maltreatment did not differ between daughters and sons of the same mother. These data may inform strategies aimed at decreasing maltreatment among vulnerable groups.

A Scoping Review of Socioeconomic Inequalities in Distributions of Birth Outcomes: Through a Conceptual and Methodological Lens.

INTRODUCTION: The extant literature has examined social inequalities in high-risk categories of birth weight and gestational age (i.e., low birth weight and preterm birth) with little attention given to their distributional nature. As such, a scoping review was conducted to understand how researchers have conceptualized and analyzed socioeconomic inequalities in entire distributions of these birth outcomes. METHODS: Bibliographic databases were searched from their inception until August 2016 for articles from five similar, English-speaking, advanced capitalist democracies: Canada, United States, United Kingdom, Australia and New Zealand. RESULTS: Twenty-one studies were included in the review, all of which provided rationales for examining socioeconomic inequalities in the entire distribution of birth weight. Yet, only three studies examined non-uniform associations of socioeconomic factors across the distribution of birth weight using conditional quantile regression, while the majority focused on mean birth weight using descriptive analysis or linear regression to analyze inequalities. Nevertheless, study results indicated that socioeconomic inequalities exist throughout the distribution of birth weight, extending beyond the high-risk category of low birth weight. DISCUSSION: Although social inequalities in distributions of birth weight have been conceptualized, few studies have analytically engaged with this concept. As such, this review supports further investigation of distributional inequalities in birth outcomes using methodology which allows one to empirically quantify and explain differences in population risk distributions, rather than solely between infants born low birth weight or preterm birth, versus not.

Postoperative Voiding Dysfunction: The Preferred Method for Catheterization.

OBJECTIVES: Bladder drainage can be achieved by clean intermittent self-catheterization (CISC), transurethral indwelling catheterization (TIC), or with a suprapubic tube (SPT). The primary objective of this study was to determine patient preference for catheter type in the management of potential voiding dysfunction after pelvic organ prolapse (POP) surgery. METHODS: Between 2012 and 2016, patients scheduled for POP surgery were recruited into the study. Before surgery, patients were informed of the potential for postoperative voiding dysfunction and the catheter choices were discussed. Each patient's choice was recorded along with baseline information, surgery performed, and perioperative details. After surgery, voiding dysfunction, length of catheter use, scores on a catheter satisfaction questionnaire, as well as uroflowmetry and urine culture testing were assessed. RESULTS: Of those recruited to the study (N = 150), 6.7% chose CISC, 7.3% chose TIC, and 86% chose SPT. Catheter satisfaction score 1 week after surgery was significantly better for SPT compared with CISC and TIC (P = 0.005). In addition, at week 1, 33% of CISC, 25% of TIC, and 13% of SPT had a PVR of more than 30% (P = 0.002) on uroflowmetry, and 33% of CISC, 50% of TIC, and 24% of SPT had a positive urine culture (P = 0.05). CONCLUSIONS: This study has shown that patients prefer SPT over CISC and TIC for management of voiding dysfunction after POP surgery. Use of SPT showed better satisfaction rates, better uroflowmetry results, and lower infection rates 1 week after surgery. Patient preference is an important factor in this decision and can help facilitate a clinical approach.

Interventions to reduce adverse health outcomes resulting from manifestations of gender bias amongst immigrant populations: a scoping review.

BACKGROUND: Immigrants to Western countries increasingly originate from countries with pervasive gender inequalities, where women experience disproportionately high rates of threats to their well-being. Health and social services in countries of settlement encounter several adverse outcomes linked to gender bias among immigrant groups. Little is known about interventions implemented to address manifestations of gender bias among immigrant populations. METHODS: A scoping review was undertaken to describe the literature on existing interventions and determine knowledge gaps. Nine academic and grey literature databases were searched for literature, with four reviewers screening the results. RESULTS: Of the 29 included reports, most targeted domestic violence amongst the Latino population in the United States, with few interventions focusing on other outcomes, populations, and settings. The majority reported achieving their objective, although 13 interventions were not evaluated. CONCLUSIONS: Future research and practice to address gender bias among immigrants may benefit from expanding on ethnic diversity, designing and reporting evaluations, addressing the context of gender inequities, tailoring to local community needs, and engaging community-based groups.

Sex Ratios at Birth Among Indian Immigrant Subgroups According to Time Spent in Canada.

OBJECTIVES: To examine whether son-biased male to female (M:F) ratios at birth among linguistically different subgroups of Indian immigrants vary according to duration of residence in Canada. METHODS: We analyzed a retrospective cohort of 46 834 live births to Indian-born mothers who gave birth in Canada between 1993 and 2014. The M:F ratio at birth was calculated according to the sex of previous live births and stratified by (1) time since immigration to Canada (<10 and ≥10 years) and (2) mother tongue (Punjabi, Gujarati, Hindi, and other). We estimated adjusted odds ratios (aORs) using multivariate logistic regression to assess the probability of having a male newborn with 5-year increases in duration of residence in Canada for each language group. ORs were adjusted for married status, knowledge of English/French, maternal education at arrival and age and neighbourhood income at delivery. RESULTS: Among all Indian immigrant women with two previous daughters, M:F ratios were higher than expected (1.92, 95% CI 1.73-2.12), particularly among those whose mother tongue was Punjabi (n = 25 287) (2.40, 95% CI 2.11-2.72) and Hindi (n = 7752) (1.63, 95% CI 1.05-2.52). M:F ratios did not diminish with longer duration in Canada (Punjabi 5-year aOR 1.03, 95% CI 0.81-1.31; Hindi 5-year aOR 0.94, 95% CI 0.42-2.17). CONCLUSION: Among the Punjabi and Hindi women with two previous daughters, longer duration of residence did not attenuate son-biased M:F ratios at the third birth. Gender equity promotion may focus on Punjabi- and Hindi-speaking Indian immigrant women regardless of how long they have lived in Canada.

Partner Disengagement from Pregnancy and Adverse Maternal and Infant Outcomes.

OBJECTIVE: To assess whether partner disengagement from pregnancy is associated with adverse maternal and infant outcomes. MATERIALS AND METHODS: We analyzed data from the 2006-2007 Canadian Maternity Experiences Survey, comprising a cross-sectional representative sample of 6,421 childbearing women. Multiple logistic regression assessed the association between adverse outcomes and three indicators of partner disengagement: (1) partner did not want the pregnancy, (2) partner argued more than usual in the year prior to the baby's birth, and (3) partner was absent at the delivery. RESULTS: Of all respondents, 3.8% had partners who did not want the pregnancy, 16.1% argued more than usual with their partner in the past year, and 7.6% had partners who were absent at the delivery. Women whose partner did not want the pregnancy were more likely to report intimate partner violence (IPV) (adjusted odds ratio [AOR] 3.55; 95% confidence interval [95% CI] 2.36-5.14), elevated depressive symptoms in the extended postpartum period (AOR 2.56, 95% CI 1.70-3.83), and nonroutine child healthcare visits after birth (AOR 1.54, 95% CI 1.13-2.11). Women whose partner argued more in the past year had higher odds of IPV (AOR 4.82, 95% CI 3.69-6.30), elevated depressive symptoms in the extended postpartum period (AOR 3.63; 95% CI 2.84-4.64), and nonroutine child healthcare visits (AOR 1.49, 95% CI 1.26-1.77), after adjustment for potential confounders. CONCLUSIONS: Partner disengagement is common and is associated with adverse maternal and infant outcomes. Affected women may benefit from special assistance during pregnancy and after delivery.

Female Pelvic Medicine and Reconstructive Surgery in Canada: A Survey of Obstetrician-Gynecologists and Urologists.

OBJECTIVE: The aim of this study was to assess the current status of female pelvic medicine and reconstructive surgery (FPMRS) in Canada, including level of training, practice patterns, barriers to practice and opinions among obstetrician-gynecologists (OB/GYNs) and urologists. METHODS: Electronic surveys were distributed to 737 OB/GYNs through the Society of Obstetricians and Gynaecologists of Canada and to 489 urologists through the Canadian Urological Association. RESULTS: Complete responses were collected from 301 (41%) OB/GYNs and 39 (8%) urologists. Of the OB/GYN respondents, 57% were generalists (GEN), and 22% completed FPMRS fellowship training (FPMRS-GYN). OB/GYN GENs were less likely than FPMRS-GYNs to report comfort with pelvic organ prolapse quantification assessment, urodynamic testing, cystoscopy, treatment of mesh complications, and management of overactive bladder. Urologists were less likely than FPMRS-GYNs to report comfort completing a pelvic organ prolapse quantification assessment, fitting pessaries, and treating mesh complications but more likely to report comfort managing overactive bladder. FPMRS-GYNs were more likely than other providers to report high volumes (>20 cases in the past year) of vaginal hysterectomy, as well as incontinence and prolapse procedures. OB/GYN GENs and urologists frequently cited lack of formal training in residency as a barrier to performing FPMRS procedures, whereas FPMRS-GYNs reported a lack of operating room facilities and support personnel. Overall, 76% of the respondents were of the opinion that FPMRS should be a credentialed Canadian subspecialty (92% FPMRS-GYN, 69% OB/GYN GEN, 59% urologists). CONCLUSIONS: OB/GYN GENs reported low case volumes and cited inadequate training in residency as a barrier to surgically managing pelvic floor disorders. Most respondents felt that FPMRS should be a credentialed subspecialty.

A scoping review of female disadvantage in health care use among very young children of immigrant families.

Preference for sons culminates in higher mortality and inadequate immunizations and health care visits for girls compared to boys in several countries. It is unknown if the negative consequences of son-preference persist among those who immigrate to Western, high-income countries. To review the literature regarding gender inequities in health care use among children of parents who migrate to Western, high-income countries, we completed a scoping literature review using Medline, Embase, PsycINFO and Scopus databases. We identified studies reporting gender-specific health care use by children aged 5 years and younger whose parents had migrated to a Western country. Two independent reviewers conducted data extraction and a quality assessment tool was applied to each included study. We retrieved 1547 titles, of which 103 were reviewed in detail and 12 met our inclusion criteria. Studies originated from the United States and Europe, using cross-sectional or registry-based designs. Five studies examined gender differences in health care use within immigrant groups, and only one study explored the female health disadvantage hypothesis. No consistent gender differences were observed for routine primary care visits however immunizations and prescriptions were elevated for boys. Greater use of acute health services, namely emergency department visits and hospitalizations, was observed for boys over girls in several studies. Studies did not formally complete gender-based analyses or assess for acculturation factors. Health care use among children in immigrant families may differ between boys and girls, but the reasons for why this is so are largely unexplored. Further gender-based research with attention paid to the diversity of immigrant populations may help health care providers identify children with unmet health care needs.

Intergenerational transmission of the healthy immigrant effect (HIE) through birth weight: A systematic review and meta-analysis.

This review examines intergenerational differences in birth weight among children born to first-generation and second-generation immigrant mothers and the extent to which they vary by country of origin and receiving country. We searched MEDLINE, EMBASE, Web of Science, PubMed, and ProQuest from inception to October 2014 for articles that recorded the mean birth weight (in grams) or odds of low birth weight (LBW) of children born to immigrant mothers and one subsequent generation. Studies were analyzed descriptively and meta-analyzed using Review Manager 5.3 software. We identified 10 studies (8 retrospective cohort and 2 cross-sectional studies) including 158,843 first and second-generation immigrant women. The United States and the United Kingdom represented the receiving countries with the majority of immigrants originating from Mexico and South Asia. Six studies were meta-analyzed for mean birth weight and seven for low birth weight. Across all studies, there was found to be no statistically significant difference in mean birth weight between first and second-generation children. However, the odds of being LBW were 1.21 [95% CI, 1.15, 1.27] times greater among second-generation children. Second-generation children of Mexican descent in particular were at increased odds of LBW (OR = 1.47 [95% CI, 1.28, 1.69]). In the United States, second-generation children were at 34% higher odds of being LBW (OR = 1.34 [95% CI, 1.13, 1.58]) when compared to their first-generation counterparts. This effect was slightly smaller in the United Kingdom (OR = 1.18 [95% CI, 1.13, 1.23]). In conclusion, immigration to a new country may differentially influence low birth weight over generations, depending on the mother's nativity and the country she immigrates to.

Maternal and paternal birthplace and risk of stillbirth.

OBJECTIVES: To evaluate the influence of maternal and paternal country of origin on stillbirth risk. METHODS: We conducted a retrospective case-control study of all deliveries in Ontario between 2002 and 2011. We included 1373 stillbirths and 1 166 097 live births that had a documented country of origin for both parents. All newborns were singleton, born at between 20 and 42 weeks' gestation, and weighed 250 g to 7000 g. We computed adjusted odds ratios (aOR) and 95% confidence intervals for the risk of stillbirth associated with parental country of origin. Models were adjusted for infant sex, maternal age, parity, marital status, and residential income quintile. RESULTS: Compared with parent pairs in which both parents were Canadian-born, the aOR of stillbirth was higher whether immigrant parents came from the same country (aOR 1.32, 95% CI 1.16 to 1.51) or from different countries (aOR 1.34, 95% CI 1.08 to 1.65). The risk of stillbirth was highest for immigrant parents coming from the same country if that country had a high domestic stillbirth rate (aOR 1.60, 95% CI 1.30 to 1.97). CONCLUSION: Maternal and paternal country of origin influences stillbirth risk. Foreign-born couples, especially those originating from a country with a high stillbirth rate, are at greater risk. Attention should focus on identifying genetic and environmental risk factors for stillbirth among specific immigrant groups, including developing prevention strategies for high-risk couples.

Objectif : Évaluer l'influence du pays d'origine de la mère et du père sur le risque de mortinaissance. Méthodes : Nous avons mené une étude cas-témoins rétrospective portant sur tous les accouchements ayant eu lieu en Ontario entre 2002 et 2011. Nous avons inclus 1 373 mortinaissances et 1 166 097 naissances vivantes pour lesquelles le pays d'origine des deux parents avait été documenté. Tous les enfants visés étaient issus d'une grossesse monofœtale, étaient nés entre 20 et 42 semaines de gestation, et présentaient un poids se situant entre 250 g et 7 000 g. Nous avons calculé des rapports de cotes corrigés (RCc) et des intervalles de confiance à 95 % pour ce qui est du risque de mortinaissance associé au pays d'origine parental. Les effets exercés sur les modèles par le sexe du nouveau-né, l'âge maternel, la parité, l'état matrimonial et le quintile de revenu résidentiel ont été neutralisés. Résultats : Par comparaison avec des paires de parents comptant deux personnes nées au Canada, le RCc de la mortinaissance était plus élevé lorsque les parents immigrants provenaient du même pays (RCc, 1,32; IC à 95 %, 1,16 - 1,51) ou de pays différents (RCc, 1,34; IC à 95 %, 1,08 - 1,65). Le risque de mortinaissance atteignait son apogée lorsque les parents immigrants provenaient d'un même pays au sein duquel le taux domestique de mortinaissance était élevé (RCc, 1,60; IC à 95 %, 1,30 - 1,97). Conclusion : Le pays d'origine de la mère et du père exerce une influence sur le risque de mortinaissance. Les couples nés à l'étranger, particulièrement ceux qui proviennent d'un pays comptant un taux élevé de mortinaissance, sont exposés à un risque accru. Nous devrions nous centrer sur l'identification des facteurs de risque génétiques et environnementaux de mortinaissance au sein de groupes particuliers d'immigrants, ainsi que sur l'élaboration de stratégies de prévention à l'intention des couples exposés à des risques élevés.

Time-use patterns and the recreational use of prescription medications among rural and small town youth.

PURPOSE: To examine the relationship between rural and small town adolescents' time-use and an increased risk for recreational use of prescription drugs in rural settings. METHODS: Rural students in grades 9 and 10 (n = 2,393) were asked about past-year recreational use of prescription medications and their time-use in structured and unstructured activity contexts in the 2009/2010 Cycle of the Canadian Health Behaviour in School-aged Children survey. Time-use patterns of rural and small town youth from across Canada were examined using multilevel, multivariate Poisson regression analyses to determine whether they may impact the risk of this kind of substance use. FINDINGS: Peer time outside school hours and nonparticipation in extracurricular activities were significantly associated with rural youths' recreational use of prescription drugs. Peer drug use, unhappy home lives and frequent binge drinking explained most of these associations. CONCLUSIONS: Structured and unstructured activity contexts within rural settings play a role in the nonmedical use of prescription medications. Results support interventions aimed at increasing structured time-use opportunities in addition to focusing on peer contexts and multiple risk-taking behaviors among rural youth.

Recreational use of prescription medications among Canadian young people: identifying disparities.

OBJECTIVES: While the recreational use of prescription medications is widely recognized as a growing public health issue, there are limited epidemiological studies on patterns of use in Canada, particularly studies identifying populations at highest risk. The objective of this study was to describe recreational prescription drug use among Canadian adolescents by age, sex, socio-economic, immigration and geographic status. METHODS: Data were obtained from grade 9 and 10 students participating in the 2009/2010 cycle of the nationally representative Canadian Health Behaviour in School-aged Children study (n=10,429). Students were asked about past-year recreational use of pain relievers, stimulants and sedative/tranquilizer medications. Cross-tabulations and multi-level Poisson regression were conducted to evaluate the prevalence of use and to explore disparities. RESULTS: Approximately 7% of students reported past-year recreational use of one or more prescription medication(s). Females reported 1.25 times the risk of recreational use of pain relievers as compared with males (95% confidence interval [CI]: 1.04-1.51). Students of lower socio-economic status (SES) were 2.41 times more likely to report recreational use of any type of medication (95% CI: 1.94-2.99). Recreational use of pain reliever medications was highest among rural youth living in close proximity to urban centres. Rates for all medications were similar between immigrant and non-immigrant students. CONCLUSIONS: Recreational prescription drug use disproportionately affects certain subgroups of youth, including females, those of lower SES and those in some rural settings more than others. These results provide foundational data to inform preventive efforts aimed at management of the nonmedical use and divergence of prescription medications.

Neurodevelopment of children following prenatal exposure to venlafaxine, selective serotonin reuptake inhibitors, or untreated maternal depression.

OBJECTIVE: Effects on child neurodevelopment of neurotransmitter reuptake inhibitors used as antidepressants during pregnancy have not been adequately studied. The authors compared the effects of prenatal exposure to venlafaxine (serotonin-norepinephrine reuptake inhibitor), selective serotonin reuptake inhibitors (SSRIs), and maternal depression. METHOD: A cohort derived from a prospectively collected database included four groups of children born to 1) depressed women who took venlafaxine during pregnancy (N=62), 2) depressed women who took SSRIs during pregnancy (N=62), 3) depressed women who were untreated during pregnancy (N=54), and 4) nondepressed, healthy women (N=62). The children's intelligence and behavior outcomes were evaluated with standardized instruments at one time point between the ages of 3 years and 6 years, 11 months. RESULTS: The children exposed to venlafaxine, SSRIs, and maternal depression during pregnancy had similar full-scale IQs (105, 105, and 108, respectively). The IQs of the venlafaxine and SSRI groups were significantly lower than that of the children of nondepressed mothers (112). The three groups exposed to maternal depression had consistently, but nonsignificantly, higher rates of most problematic behaviors than the children of nondepressed mothers. Severity of maternal depression in pregnancy and at testing predicted child behavior. Maternal IQ and child sex predicted child IQ. Antidepressant dose and duration during pregnancy did not predict any cognitive or behavioral outcome. CONCLUSIONS: Factors other than antidepressant exposure during pregnancy strongly predict children's intellect and behavior. Depression during pregnancy is a significant risk factor for postpartum depression. Children of depressed mothers may be at risk of future psychopathology.