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Objectives PAX, a mental health promotion approach, has been shown to decrease negative mental health outcomes and improve academic achievement. These effects have yet to be shown among Indigenous children. We evaluated PAX for improving First Nations children’s outcomes following a research process wherein community members and researchers work more collaboratively. Approach Building on a long-term relationship with Swampy Cree Tribal Council, community members, First Nations leaders and researchers worked together through all phases of the project. This cluster randomized controlled trial used population-based health, social services, and education administrative data that allowed de-identified individual-level linkages across all databases through a scrambled health number. Our cohort of 725 children from 20 First Nations schools were randomized to PAX (n=469, 11 schools) or wait-list control (n=256, 9 schools). We used propensity score weighting and multi-level modeling to estimate the differences over time (2011 up to 2020) between children exposed to PAX and those who were not. Results Differences in baseline characteristics were found between the two groups of children, despite the cluster randomization. After applying propensity score weights, children in the PAX group had significantly greater decreases in conduct problems (β:-1.08, standard error(se):0.2505, p

Introduction Manitoba Public Health Nurses (PHNs) attempt to visit all families with newborns shortly after discharge from birth hospitalizations. Since 2000, PHNs have completed the Families First Screen (FFS) at these visits, to identify families at risk for child maltreatment. The information captured in FFS is a valuable tool for research. Objectives and Approach Our objective was to clean and validate FFS data and link to health data in the Manitoba repository in order to determine the percent of births in Manitoba hospitals that had FFS. We identified all babies born in Manitoba hospitals 2000-2015 using ICD-9-CM /ICD-10-CA codes. Mothers were identified through the Health Registry (Mom_Baby Link File) using scrambled Personal Health Identification Numbers (sPHINs). FFS data were linked to births via baby’s sPHIN. Determining which FFS records linked to babies required several steps of cleaning and validating the data to account for differences in birthdates between files, missing sPHINs, and multiple records. Results For example, in 2014 there were 16,079 births and 14,002 FFS records; 13,524 FFS had mother and/or baby sPHIN. For those missing baby sPHIN (9,295), 99.8% were retrieved via the Mom_Baby Link File. Linking the FFS to the hospital births we found: 3,043 births didn’t have an FFS; 12,762 had a single FFS, and 274 births had multiple FFS (i.e., baby associated with more than one mother, FFS and/or form date). To ensure that the baby was only associated with one mother and one FFS the most current FFS was kept. We found that in 2014, 81.07% (13,036/16,079) of the births had an FFS. In the longitudinal analysis, the percent of births with an FFS ranged from 74.6% in 2000 to 81.1% in 2014. Conclusion/Implications We were able to achieve good linkage between FFS and health registry data, allowing this rich data source to be used for research on maternal and child health. Information on percent of births with FFS has been shared with policy-makers over the years and changes to screening practices implemented.

ABSTRACT Objective Perinatal 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. Approach This 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. Results HBPB 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