What you see is what you get? Questioning the relationship between objective and subjective appraisals of neighbourhood resources in relation to health.

BACKGROUND: Some research concerned with place and health has used the study of opportunity structures in neighbourhoods to understand how place might get under the skin. It has become somewhat common to assume that objective indicators of opportunity structures are in some way equivalent to people's access to them. The general objective of this study, therefore, was to evaluate the level of convergence between objective and subjective evaluations of neighbourhood resources in Winnipeg, Canada. METHODS: Winnipeg residents (n = 1,102) were sampled from 59 neighbourhood units to permit hierarchical linear modelling and to enable the testing of Winnipeg residents' individual-level subjective appraisals within neighbourhood-level objective characteristics. Several databases provided objective neighbourhood data on premature mortality rates, crime, housing, recreation programs, education, and household income. To evaluate subjective appraisals of these resources, data were gathered from the Winnipeg Quality of Life Survey (WQLS). RESULTS: We found that, when controlling for individual- and neighbourhood-level confounders, the objective data at hand match relatively well with participants' subjective perceptions of housing and crime, while neighbourhood-level premature mortality rates and the objective numbers of recreation programs across neighbourhood are not significant predictors of their subjective counterparts. CONCLUSION: It may be that objective measures of some opportunity structures should be accompanied by subjective measures to ensure a more complete understanding of the impact of these resources on population health.

Transitions in breastfeeding: daily parent diaries provide evidence of behavior over time.

This study addressed a key question for assessing breastfeeding duration: at what point is an infant considered no longer exclusively breastfed or no longer breastfed at all? Mothers provided longitudinal infant feeding data via daily checklists. Transitions between exclusive to partial breastfeeding and partial to no breastfeeding were compared across 11 time periods for 10 age groups of infants. Daily transitions between exclusive and partial breastfeeding were common, especially for infants 6 months of age and younger, and transitions from partial to no breastfeeding occurred much more quickly than transitions from exclusive to partial breast-feeding. Ages at supplementation and weaning calculated in 1-day or 7-day spans correlated highly (intraclass correlation = .99). These results support the Breastfeeding Definitions and Data Collection Periods guideline recently developed by the Breastfeeding Committee for Canada and may bring the breastfeeding research and clinical communities closer to a consensus on the definition of breastfeeding over time.

Using a population-based health information system to study child health.

OBJECTIVE: This paper describes the population-based analyses of measures of child health status used throughout this supplement. METHODS: The articles in this supplement examine health-related data for children 0 to 19 years. Most analyses cover the period from April 1, 1994 to March 31, 1999. Administrative and survey data were used to assess child health and well-being. For regional comparisons, data were broken down by subregions of Manitoba, called Regional Health Authorities (RHAs), and neighbourhoods of Winnipeg, called Winnipeg Community Areas (Winnipeg CAs). The premature mortality rate (PMR) was used as a proxy of the overall health of the population. All graphs comparing rates among RHAs and Winnipeg CAs rank these subregions in the same order, from lowest to highest PMR. Income was operationalized by dividing the province's population into urban and rural quintiles based upon household income. Other aspects of methodology are discussed. RESULTS: Results are presented in the articles that follow this one. CONCLUSION: The relationships between key child health indicators and geographic and socioeconomic factors for Manitoba children are discussed in the articles following this one.

Community resources and determinants of the future health of Manitobans.

BACKGROUND: Life history studies in health show that some of the key determinants of health inequalities lie in biological and social experiences at the earliest times of life. The objectives of this research were to describe the regional distribution of childhood determinants of adult health, such as school achievement, and the environments which contribute to their development. METHODS: Using Manitoba data from the National Population Health Survey, the National Longitudinal Survey on Children and Youth, the Department of Education, Training and Youth, the Department of Family Services and Housing, the Library Association website and the Agriculture and Food website, the regional distribution of Grade 3 standards test scores and neighbourhood resources such as child care services, libraries, sports participation and food costs were determined for 12 Regional Health Authorities and 12 Winnipeg Community Areas, ranked by a measure of population healthiness, the premature mortality rate. Findings were also reported by income level and larger geographic regions. RESULTS: Children living in neighbourhoods with less healthy populations were more likely to have poorer school performance, as indicated by Grade 3 math standards test scores. They were-also more likely to change schools, less likely to participate in sports, and had decreased access to affordable food and licenced day care. They had similar access to library books as children living in more healthy neighbourhoods, although book lending rates were not measured. CONCLUSION: We documented regional variation in the availability of resources to support healthy childhood development.