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Taxes, legislation and politics are social determinants of health, which can impact health through multiple pathways. The purpose of this study was to review regulations regarding sugar-sweetened beverage (SSB) taxation and describe taxation/exemption of various beverage categories. We reviewed SSB taxation regulations from Mexico, the United Kingdom, Berkeley, Philadelphia, San Francisco and South Africa. Supplementary government documents and academic publications were also reviewed to further discern beverage taxation/exemption and zero-rating. There were a number of beverage types that fell clearly into typically taxed or exempt/zero-rated categories across all six jurisdictions (e.g. pop/soda as taxed and water as zero-rated). Exemptions and ambiguities within the six regulations can generally be grouped as a lack of clarity regarding the meaning and use of milk; the meaning of ‘medical purposes’ and ‘supplemental’; the point at which a beverage is prepared; the form of concentrate (i.e. liquid/frozen/powder) or medium used (e.g. water, coffee); and location of preparation or business size of retailer. SSB tax regulations are complex, unclear, vary across jurisdiction and leave several beverage types with added sugar exempt from taxation or at risk of a legal challenge. Lastly, tax exemptions generally reflect and perpetuate existing sociopolitical dynamics within the food system.

Objectives Over three decades ago, the Aboriginal Justice Inquiry identified structural racism in Canada’s justice system. Although rates of youth criminal charges and incarcerations have declined substantially since then, it is unclear whether First Nations youth are treated differently than non-First Nations youth for similar offences. Our study addressed this question. Approach This retrospective cohort study of youth born 1991-2001 and living in Manitoba between ages 12-17 used whole-population linked administrative data to identify youth charged with a crime (N=13,543). First Nations youth (n=7,081) were compared with all other Manitoba (AOM) youth (n=6,462) on whether their criminal charge proceeded or was dropped, deferred or diverted. The study applied an intersectionality theoretical framework. Individual (age, type and severity of charge, ever in child protection care, youth and/or mother diagnosed mental disorder, maternal incarceration, number of siblings, urban/rural residence) and social strata (First Nations identity, income, sex) factors were adjusted for using multi-level models. Results After accounting for other factors, First Nations youth had a higher risk of a charge proceeding than AOM (adjusted Relative Risk (aRR) 1.16, 95% CI 1.12-1.20). There was no difference in charges proceeding for male First Nations youth compared with male AOM, whereas among females, the risk was greater for First Nations (aRR 1.31, 95% CI 1.26-1.36). Low income and a history of being in the care of the child protection system increased the risk of charges proceeding for AOM only (aRR 1.16, 95% CI 1.13-1.18; aRR 1.13, 95% CI 1.07-1.20); for First Nations, there was no increased risk of charges proceeding associated with these intersecting factors. Conclusion These findings provide quantitative evidence of the intersecting structural racism in the youth criminal justice system previously identified by First Nations leaders. Future research will follow this cohort to determine whether more judicial sanctions are applied to First Nations youth throughout the justice process, including within criminal courts and corrections.

Objective Manitoba has one of the highest incarceration rates among Canadian provinces, and because of Canada’s racist and colonial policies, the number of Métis women in custody is disproportionately high. In this study, we examined birth outcomes among Métis and all other Manitoba women who were incarcerated while pregnant. Approach Using linked administrative health and justice system data, we developed a 2004-2017 cohort of mother-infant dyads with a live birth (n= mothers; n= infants). We identified all Métis mother-infant dyads, and then divided them into 3 mutually exclusive groups: a) prenatal incarceration; b) post-natal incarceration; c) no incarceration. We developed matched comparison groups for each exposure based on Métis identity, maternal age, geography and income, and, after adjusting for other potentially confounding variables (e.g., maternal age, maternal mental health, and socioeconomic factors), we examined risk differences in birth outcomes among Métis women and infants between exposure groups. Results The cohort included n=534 mothers who were incarcerated while pregnant (a), n=1,677 mothers incarcerated postnatally (b), and n=14,084 mothers never incarcerated (c). When we compared prenatal vs postnatal incarceration (a vs b), we found that women incarcerated during the prenatal period were more likely to have a low birth weight infant (RD: 4.2, 95% CI: 3.0, 5.4), preterm birth (RD: 5.1, 95% CI: 3.7, 6.5) or Caesarean birth (RD: 5.5, 95% CI: 3.8, 7.1) and were less likely to have a large-for-gestational-age infant (RD: -3.8, 95% CI: -5.1, -2.5) or to initiate breast feeding (-3.4, 95% CI: -5.5, -1.3). In the prenatal vs no incarceration comparison (a vs c), the same outcomes were statistically significant as above; however, the risk differences were even more pronounced. Conclusion Prenatal incarceration is associated with poor birth outcomes for all mothers and infants in Manitoba; however, Métis women and children are disproportionately affected, further perpetuating inequities they may already experience. Canadians must acknowledge the harms of racist policies and practices, and work to support the health and well-being of Métis people.

Objectives Indigenous children in Canada, including Metis children, are taken into care by the child welfare system at a disproportionately high rate. The objective of this study was to explore factors related to having a child taken into care from Metis families in Manitoba, and specifically from Metis mothers experiencing incarceration. Approach The cohort comprised all mother-child dyads in Manitoba, Canada with live births between Jan 1, 2004-Dec 31, 2014. The factors we examined included the mother experiencing incarceration after the birth of a child, having prior interaction with the legal system, socioeconomic status, maternal age, and mother’s mental health disorder diagnoses. Using the Cox proportional hazards model, unadjusted and adjusted hazard ratios describing the risk of a child being taken into care by five years of age were generated for three exposure groups: no incarceration, prenatal incarceration, and postnatal incarceration. Results Before adjustment, mothers experiencing incarceration after the birth of a child had greater risk of having a child taken into care (HR 9.3; 95% CI 7.7-11.3) compared with women who did not experience incarceration; after adjusting for measured confounders, their elevated risk dropped to aHR 6.1 (5.0-7.4). After further adjustment for prior custody in the prenatal period, mothers experiencing incarceration had 3.8 times the risk (3.0-5.0), and after adjusting for maternal mental health disorders, this dropped to 2.6 times the risk (2.0-3.4). In fully adjusted models, other factors associated with having a child taken into care included receiving diagnoses for a substance use disorder (aHR 2.6; 2.1-3.2) and for psychosis (aHR 2.4; 1.4-4.1) during the five years prior to the child’s birth. Conclusion Due to colonialism, Metis women experience high levels of social and mental health complexity, placing their children at increased risk of being taken into care. Responding to the Truth and Reconciliation Commission’s Calls to Action to redress the harms of colonialism is necessary to support Metis children’s health and well-being.

Objective The objective was to examine the relationship between maternal intimate partner violence (IPV) victimization and children’s developmental health using linked population-wide administrative datasets. We examined developmental vulnerability (DV) at kindergarten of children exposed to maternal IPV victimization aged 0 to 5 using provincial prosecution records compared to unexposed counterparts. Approach This retrospective cohort study linked administrative datasets (legal, health, education, social services) from the Population Research Data Repository at the Manitoba Centre for Health Policy. Exposed mother-child pairs with 1+ prosecution records of maternal IPV victimization during early childhood (child aged 0 to 5) between 2003-2018 in Manitoba (n = 5,728) were matched to unexposed pairs (1:3) based on sex/birthdate of child and neighbourhood income. DV at kindergarten was measured across 5 domains (physical, social, emotional, language/cognitive [LC], communication/general knowledge) using the Early Developmental Instrument (EDI). Children without eligible EDI scores were excluded. Multiple logistic regression models were conducted. Results The cohort included 5321 children (exposed n=1365, unexposed n=3956). 32.98% of the cohort was developmentally vulnerable in one or more domains (1/+) and 19.60% was developmentally vulnerable in two or more domains (2/+). Unadjusted relationships between maternal IPV victimization from age 0 to 5 and developmental vulnerability at kindergarten were statistically significant across all 5 domains (e.g., LC OR=2.76 [2.36, 3.23]) and in 1/+ (OR=2.72 [2.39, 3.09]) as well as 2/+ (OR=2.89 [2.51, 3.34]) domains. After adjusting for covariates, children who were exposed to maternal IPV victimization from ages 0 to 5 had increased odds of being developmentally vulnerable in social competence (aOR=1.33 [1.07, 1.66]) and emotional maturity (aOR=1.29 [1.03, 1.62]), also in 2/+ domains (aOR=1.42 [1.15, 1.73]) at kindergarten, compared to unexposed counterparts. Conclusion The study provided Canadian population-wide evidence of the association between maternal IPV victimization and early childhood development, specifically later socio-emotional vulnerability. Interventions and support systems for this population of families should be developed and implemented, with an emphasis on mitigating long-term socio-emotional developmental risks in children exposed to IPV.

Objective Using population-wide administrative data, the objective was to provide Canadian evidence on the longitudinal relationship between maternal intimate partner violence (IPV) victimization and children’s developmental health. Using provincial prosecution records, we examined developmental vulnerability (DV) at kindergarten of children prenatally exposed to maternal IPV victimization compared to unexposed counterparts. Approach This retrospective cohort study linked administrative datasets (legal, health, education, social services) from the Population Research Data Repository at the Manitoba Centre for Health Policy. Exposed mother-child pairs with 1+ prosecution record of maternal IPV victimization during pregnancy between 2003 and 2018 in Manitoba (n = 1,117) were matched to unexposed pairs (1:3) based on sex/birthdate of child and neighbourhood income. DV at kindergarten was measured across 5 domains (physical, social, emotional, language/cognitive [LC], communication/general knowledge) using the Early Developmental Instrument (EDI). Children without eligible EDI scores were excluded. Multiple logistic regression models were conducted to address the objective. Results The eligible cohort included 927 children (exposed n=229, unexposed n=698); 31.07% of the cohort was developmentally vulnerable in one or more domains (1/+) and 19.53% was developmentally vulnerable in two or more domains (2/+). Children who were prenatally exposed to maternal IPV victimization had increased odds of vulnerability across all 5 developmental domains (e.g., physical health/wellness: OR=2.83[1.95,4.10]; LC development: OR=2.45[1.65,3.64]). Unadjusted ORs showed statistically significant associations between maternal exposure of prenatal IPV victimization and DV in 1/+ (OR=2.70[1.98,3.68]) and 2/+ (OR=2.48[1.75,3.50]). When adjusted for covariates (e.g., maternal income assistance, mental health, child abuse history), no statistically significant relationship was found for any of the domains (e.g., LC development: aOR=0.98[0.53,1.81]), 1/+ (aOR=1.17[0.72,1.88]), and 2/+ (aOR=1.14[0.67,1.95]). Conclusion The unadjusted, statistically significant associations suggest children exposed to maternal IPV victimization prenatally may face associated social/health risks. The finding highlights the need to consider potential factors that put children at risk of DV when developing and implementing support systems/interventions for children exposed to maternal IPV victimization.

Introduction Routine health care information systems only capture a portion of violence against women because some victimized women may not seek health care and some events may not require medical attention. Population-based estimates of the risk of violent injury (VI) among women with a history of intimate partner victimization (IPV) are lacking. Objectives and Approach To determine the risk of violent injury following IPV among women living in Manitoba, Canada, 2004-2016. Linked administrative justice, healthcare, and social databases were used. Exposure began after a woman was first involved with the Manitoba Justice system as a victim of IPV, assessed through provincial prosecution and disposition records. IPV victims (n= 20,469) were matched to three non-victims (n= 61,407) on age, relationship status and place of residence at the date of the IPV incident. The main outcomes were first health care use for violent injury and violent death. Outcomes were assessed through emergency department, hospital and vital statistics records. Conditional Cox Regression was used to obtain Hazard Ratios with 95% confidence intervals (CI). Results The crude risk of VI was 8.5 per 1000 women among non-victims and 55.8 among victims of IPV. Compared to non-victims, IPV victims were 3.8 [95% confidence interval (CI): 3.4, 4.3] times more likely to suffer IIIO and 4.5 [95% CI: 2.3, 9.0] times to have a violent death, after adjustment. Victims had approximately half the risk of VI if the accused is on probation. Conclusion / Implications Justice System-identified victims of IPV are at higher risk of assault and violent death than women not exposed to IPV. Justice involvement represents an opportunity for prevention of violent injury and homicide among IPV victims.

Introduction The leveraging of multi-sector, whole-population, linked administrative data is advantageous for conducting research on complex real-world problems. However, such large and complex data repositories can sometimes appear impersonal and overwhelming. Establishing organizational empathy (OE) in the context of a multi-sector partnership between academic, government and community representatives can help us understand the data better for social policy research. Evidence stemming from this research can then inform policy decisions, ultimately increasing the potency of linked data analysis and creating more meaningful student experiences. Our objective is to examine the role of OE in the student research experience. Objectives and Approach SPECTRUM (Social Policy Evaluation Collaborative Team Research at Universities in Manitoba) is a multi-disciplinary partnership working to provide evidence-based solutions to ‘wicked’ social issues by using linked data from multiple sectors. SPECTRUM provides fellowships to students to become partners in the collaboration. Students have participated in quarterly workshops, building relationships with community leaders, government decision-makers and academic researchers. Students are from various faculties, bringing their unique frameworks and research interests to the collective. Through OE, students observe and participate in SPECTRUM, relating its goals and outcomes to society and their own research. Results Student inclusion in SPECTRUM enhances the partnership by providing a greater range of perspectives and facilitates the development of OE among SPECTRUM members. Students are using linked administrative data, while actively engaging in dialogue with stakeholders, thereby enriching their knowledge and understanding of research. Conclusion / Implications Data linkage involves more than just use of the repository; it requires establishing common ground since the data have different meaning to each partner. OE developed through SPECTRUM provides invaluable insight into and context for the data. Knowledge transfer among members of the partnership will enrich SPECTRUM’s research outcomes while building capacity among Students.

Introduction Children who have a history of involvement in child protection services (CPS) are over-represented in the youth and adult criminal justice systems. There are significant health and socioeconomic implications for individuals involved in either or both CPS and the justice system. Understanding the ‘overlap’ between these two systems would provide insight into the health and social needs of this population. This protocol describes a research programme on the relationship between the child welfare and the youth justice systems, looking specifically at the population involved in both CPS and the youth justice system. We will examine the characteristics associated with involvement in these systems, justice system trajectories of individuals with a history of CPS involvement and early adult outcomes of children involved in both systems.Methods and analysis Administrative data sets will be linked at the individual level for three cohorts born 1991, 1994 and 1998 in Manitoba, Canada. Involvement in CPS will be categorised as ‘placed in out-of-home care’, ‘received in-home services, but was not placed in care’ or ‘no involvement’. Involvement in the youth justice system will be examined through contacts with police between ages 12 and 17 that either led to charges or did not proceed. Individual, maternal and neighbourhood characteristics will be examined to identify individuals at greatest risk of involvement in one or both systems.Ethics and dissemination The study was approved by the University of Manitoba Health Research Ethics Board and permission to access data sets has been granted by all data providers. We also received approval for the study from the First Nations Health and Social Secretariat of Manitoba’s Health Information Research Governance Committee and the Manitoba Metis Federation. Strategies to disseminate study results will include engagement of stakeholders and policymakers through meetings and workshops, scientific publications and presentations, and social media.

Introduction Manitoba has one of the highest rates of children taken into care of child welfare services (Child and Family Services; CFS) in the world, and also one of the highest youth incarceration rates in Canada. Policy-makers recognize there is overlap between these systems; the extent of that overlap is unknown. Objectives and Approach We linked CFS, Justice, and Population Health Registry data to quantify the overlap between having a history of CFS during childhood (0-17 years) and being charged with a crime as a youth (12-17 years). Using a cohort approach, we selected all individuals in Manitoba who were born in 1988 (N=28,178); those not in the province at any time from 12-17 years were excluded, leaving a final cohort of 18,182. The cohort was divided into 3 groups according to CFS involvement: CFS out-of-home care (1,148); CFS in-home services (3,395); no CFS (13,639). Criminal charges between 12-17 years were identified. Results 6.3% of our cohort had CFS out-of-home care, 18.7% received CFS in-home services, and 75% had no CFS involvement. 10.5% of the cohort were charged of a crime between 12-17 years. Almost half (46.6%) of youth who had CFS out-of-home care had criminal charges, compared to 19.4% of youth who had CFS in-home services, and 5.3% of youth with no CFS. Despite accounting for only 6.3% of the cohort, youth who had out-of-home care accounted for 28.0% of youth with criminal charges. Indigenous (First Nations (FN) and Metis) children/youth were over-represented in both systems; for example, 24.5% of FN youth had been in care compared to 3.1% of non-Indigenous; and 32.2% of FN youth were charged with a crime compared to 6.6% of non-Indigenous youth. Conclusion/Implications There is substantial overlap between the child welfare and youth justice systems, with overrepresentation of Indigenous youth in both systems. Culturally appropriate programs and policies aimed at supporting parents, families and communities to care for their own children will likely have long-term positive impacts on the youth justice system.