Prospective associations between neighborhood features and body mass index in Montreal adolescents.

PURPOSE: To investigate the association between the neighborhood built environment and trajectories of body mass index (BMI) in youth. METHODS: Data were collected in a prospective study of 1293 adolescents in Montreal. Built environment variables were obtained from public databases for road networks, land use, and the Canadian Census. Anthropometric data were collected when participants were ages 12.5, 15 and 17 years. We undertook hierarchical cluster analysis to identify contrasting neighborhood types based on features of the built environment (e.g., vegetation, population density, walkability). Associations between neighborhood type and trajectories of BMI z-score (BMIz) were estimated using multivariable linear mixed regression analyses, stratified by sex. RESULTS: We identified three neighborhood types: Urban, Suburban, and Village. In contrast to the Urban type, the Suburban type was characterized by more vegetation, few services and low population density. Village and Suburban types were similar, but the former had greater land use diversity, population density with more parks and a denser food environment. Among girls, living in Urban types was associated with decreasing BMIz trajectories. Living in Village types was associated with increasing BMIz trajectories. No associations were observed among boys. CONCLUSIONS: Neighborhoods characterized by greater opportunities for active living appear to be less obesogenic, particularly among girls.

Predictors of breastfeeding exclusivity among migrant and Canadian-born women: results from a multi-centre study.

The objective of this study was to examine and compare predictors of breastfeeding exclusivity among migrant and Canadian-born women. As part of a longitudinal study, a sample of 1184 mothers were recruited from 12 hospitals in Canada and completed questionnaires at 1 and 16 weeks post-partum that included diverse questions from the following domains: demographic, social, migration, obstetrical, breastfeeding and maternal mood. After bivariate analysis, multivariate logistic regression analysis was completed to examine and compare predictors of exclusive breastfeeding at 16 weeks post-partum. Among migrant women, factors predictive of breastfeeding exclusivity included non-refugee immigrant or asylum-seeking status, residence in Toronto or Vancouver, maternal age of ≥35 years, feels most comfortable in the country of origin or nowhere and higher Gender-related Development Index of the country of origin. Factors predictive of not exclusively breastfeeding included maternal age of <20 years, not planning to exclusively breastfeed, not making the decision to breastfeed before pregnancy and not exclusively breastfeeding at 1 week post-partum. Among Canadian-born women, factors predictive of a lower likelihood of breastfeeding exclusivity included not living with father of infant, infant neonatal intensive care unit admission, planned duration of exclusive breastfeeding for <6 months, not exclusively breastfeeding at 1 week post-partum and Edinburgh Postnatal Depression Scale score of ≥10. The only similar risk factor predicting a lower likelihood of breastfeeding exclusivity between migrant and Canadian-born women was not exclusively breastfeeding at 1 week post-partum; all other risk factors were dissimilar, suggesting that these groups might benefit from different strategies to optimise breastfeeding outcomes.

Cesarean section rate differences by migration indicators.

PURPOSE: To answer the question: are there differences in cesarean section rates among childbearing women in Canada according to selected migration indicators? METHODS: Secondary analyses of 3,500 low-risk women who had given birth between January 2003 and April 2004 in one of ten hospitals in the major Canadian migrant-receiving cities (Montreal, Toronto, Vancouver) were conducted. Women were categorized as non-refugee immigrant, asylum seeker, refugee, or Canadian-born and by source country world region. Stratified analyses were performed. RESULTS: Cesarean section rates differed by migration status for women from two source regions: South East and Central Asia (non-refugee immigrants 26.0 %, asylum seekers 28.6 %, refugees 56.7 %, p = 0.001) and Latin America (non-refugee immigrants 37.7 %, asylum seekers 25.6 %, refugees 10.5 %, p = 0.05). Of these, low-risk refugee women who had migrated to Canada from South East and Central Asia experienced excess cesarean sections, while refugees from Latin America experienced fewer, compared to Canadian-born (25.4 %, 95 % CI 23.8-27.3). Cesarean section rates of African women were consistently high (31-33 %) irrespective of their migration status but were not statistically different from Canadian-born women. Although it did not reach statistical significance, risk for cesarean sections also differed by time since migration (≤2 years 29.8 %, >2 years 47.2 %). CONCLUSION: Migration status, source region, and time since migration are informative migration indicators for cesarean section risk.