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Spontaneous reporting of adverse drug reactions (ADRs) is an important source of information for post-marketing drug safety evaluation. Most countries have public access to reporting systems, but patients report only 3% of all ADRs. Little is known about factors affecting patient reporting. Our aim was to explore patients’ experiences reporting ADRs and their views on the usability of the Canadian Vigilance reporting forms on MedEffect. An interpretive description qualitative study was used. Adults in Canada, who experienced an ADR, were invited to participate through social media (Kijiji, Facebook, Twitter) and by associations (e.g., Patients Canada or Canadian Arthritis Society). Participants were interviewed in English and French using structured interview guides. Inductive content analysis was used. Fifteen interviews were conducted from October 2014 to May 2015. Two participants reported ADRs to MedEffect, and others to physicians and/or pharmacists. Motives for reporting were intolerable side effect impacting daily activities and encouragement from others to report (e.g., family, colleagues). Factors that interfered with reporting were physicians normalized or minimized the side effect, confusion on what to report, no feedback after report submission to MedEffect, and previous experience with side effects. MedEffect forms were described as comprehensive and important, but its usability was affected by the number of questions and complexity of some questions. Most participants were unaware of MedEffect and reported ADRs to physicians and pharmacists. Several barriers and motives affected patients’ reporting of ADRs. MedEffect form could be simplified for use by patients.

BACKGROUND Caregivers of children with health problems (CHPs; usually mothers) experience more physical and psychological health problems than those of children without health problems (non-CHPs). Primarily cross-sectional and survey-driven, this literature has not yet explored whether these health differences existed before the birth of the CHPs, or are exacerbated postbirth. METHODS Using linked administrative health data on all mother-child dyads for children born in the year 2000 in British Columbia, Canada, we examined maternal health before, during, and after the birth of CHPs, and compared it between mothers of CHPs and non-CHPs with piecewise growth curve modeling. RESULTS Compared with mothers of non-CHPs, mothers of CHPs had more physician visits (8.09 vs. 11.07), more medication types (1.81 vs. 2.60), and were more likely to be diagnosed with selected health conditions (30.9% vs. 42.5%) 4 years before the birth of the child. Over the 7-year postbirth period, the health of the 2 groups of mothers further diverged: while mothers of CHPs showed increases on physician visits and types of medication, mothers of non-CHPs did not experience any changes in physician visits and had less steep increases for types of medication. CONCLUSIONS Health issues associated with having a child with a health problem may begin well before the birth of the child, but also appear to be exacerbated postbirth. The health challenges of caregivers of CHPs may be multifactorial, involving both preexisting conditions and the stresses associated with caring for a child with health problems.

Purpose To examine household income trajectories of children with and without neurodisability over a period of 6 years. Method We used four cycles of the Canadian National Longitudinal Survey of Children and Youth, a longitudinal study of the development and well-being of Canadian children from birth into adulthood. Results While household income increased over time for both groups, families of children with neurodisability had consistently lower household income compared to families of children without neurodisability even after controlling for child and family socio-demographic characteristics. The presence of an interaction effect between parent work status and child with neurodisability at baseline indicated that among children whose parent(s) were not working at baseline, household incomes did not differ between children with and without neurodisability. Conclusions The association between child with neurodisability and lower household income may not hold for all types of parents', working status is an important consideration. Implications for Rehabilitation Findings support the health selection hypothesis that health status shapes diverging economic conditions over time: children with a ND have lower household incomes than children without a ND child across all waves of the Canadian National Longitudinal Survey of Youth. Income gaps did not increase or decrease over time; rehabilitation services and policies must consider the lower average incomes associated with raising a child with a ND. Social assistance support likely plays a key role in closing the gap, especially for non-working families.

OBJECTIVES: To test associations between onset of formal child care (in infancy or as a toddler), high school graduation, and employment earnings from ages 18 to 35 years. METHODS: A 30-year prospective cohort follow-up study, with linkage to government administrative databases (N =3020). Exposure included formal child care, if any, by accredited caregivers in centers or residential settings at ages 6 months and 1, 1.5, 2, 3, and 4 years. A propensity score analysis was conducted to control for social selection bias. RESULTS: Of 2905 participants with data on child care use, 59.4% of male participants and 78.5% of female participants completed high school by age 22 to 23. Mean income at last follow-up (n = 2860) was $47 000 (Canadian dollars) (SD = 37 700) and $32 500 (SD = 26 800), respectively. Using group-based trajectory modeling, we identified 3 groups: formal child care onset in infancy (∼6 months), formal child care onset as a toddler (after 2.5 years), and never exposed. After propensity score weighting, boys with child care started in infancy had greater odds of graduating than those never exposed (odds ratio [OR] 1.39; 95% confidence interval [CI]: 1.18–1.63; P < .001). Boys attending child care had reduced odds of low income as young adults (infant onset: OR 0.60 [95% CI: 0.46–0.84; P < .001]; toddler onset: OR 0.63 [95% CI: 0.45–0.82; P < .001]). Girls’ graduation rates and incomes revealed no significant association with child care attendance. CONCLUSIONS: For boys, formal child care was associated with higher high school completion rates and reduced risk of adult poverty. Benefits for boys may therefore extend beyond school readiness, academic performance, and parental workforce participation.

The aim of this study was to identify children with neurodevelopmental disorders and disabilities (NDD/D) and compare their healthcare service utilization to children without NDD/D using provincial linked administrative data.The sample included children aged 6 to 10 years (n=183 041), who were registered with the British Columbia Medical Services Plan. Diagnostic information was used for the identification and classification of NDD/D in six functional domains. Healthcare service utilization included outcomes based on physician claims, prescription medication use, and hospitalization.Overall, 8.3% of children were identified with NDD/D. Children with NDD/D had higher healthcare service utilization rates than those without NDD/D. Effect sizes were: very large for the number of days a prescription medication was dispensed; large for the number of prescriptions; medium for the number of physician visits, different specialists visited, number of different prescription medications, and ever hospitalized; and small for the number of laboratory visits, X-ray visits, and number of days hospitalized.The findings have policy implications for service and resource planning. Given the high use of psychostimulants, specialized services for both NDD/D and psychiatric conditions may be the most needed services for children with NDD/D. Future studies may examine patterns of physician behaviours and costs attributable to healthcare service utilization for children with NDD/D.Children with neurodevelopmental disorders and disabilities (NDD/D) have higher healthcare service utilization than those without. Based on provincial population-based linked administrative health data, a sizeable number of children are living with NDD/D. Given the high use of psychostimulants, specialized services for children with both NDD/D and psychiatric conditions may be the most needed services for children with NDD/D.

Aim The aim of the present study was to determine the barriers and motives influencing consumer reporting of adverse drug reactions (ADRs). Methods A systematic review, guided by the Cochrane Handbook, was conducted. Electronic searches included MEDLINE, EMBASE, PsycINFO, CINAHL, PubMed and the Cochrane Database of Systematic Reviews from 1964 to December 2014. Eligible studies addressed patients' perceptions and factors influencing ADR reporting. Studies about healthcare professional (HCP) reporting of ADRs were excluded. Studies were appraised for quality, and results were analysed descriptively. Results Of 1435 citations identified, 21 studies were eligible. Studies were primarily conducted in the UK, the Netherlands and Australia. The identified barriers to patient reporting of ADRs (n = 15 studies) included poor awareness, confusion about who should report the ADR, difficulties with reporting procedures, lack of feedback on submitted reports, mailing costs, ADRs resolved and prior negative reporting experiences. The identified motives for patients reporting ADRs (n = 10 studies) were: preventing others from having similar ADRs, wanting personal feedback, improving medication safety, informing regulatory agencies, improving HCP practices, responding to HCPs not reporting their ADRs and having been asked to report ADRs by HCPs. Conclusions Most patients were not aware of reporting systems and others were confused about reporting. Patients were mainly motivated to make their ADRs known to prevent similar suffering in other patients. By increasing patient familiarity and providing clear reporting processes, reporting systems could better achieve patient reporting of ADRs.

BackgroundPhysical and sedentary activities have been identified as potentially modifiable risk factors for many diseases, including mental illness, and may be effective targets for public health policy and intervention. However, the relative contribution of physical activity versus sedentary behaviour to mental health is less clear. This study investigated the cross-sectional association between physical activity, sedentary activity and symptoms of depression and anxiety at age 14–15 in the National Longitudinal Survey of Children and Youth (NLSCY).MethodsRespondents aged 14–15 years between 1996 and 2009 who reported on symptoms of depression in the NLSCY were included (n=9702). Multinomial logistic regression was used to assess the relationship between physical and sedentary activity and symptoms of depression and anxiety. Joint models including both physical and sedentary activity were also explored. Models were adjusted for sex, ethnicity, immigration status, family income, parental education, recent major stressful life events and chronic health conditions.ResultsThe odds of having moderate and severe symptoms of depression and anxiety compared with no symptoms was 1.43 (1.11 to 1.84) and 1.88 (1.45 to 2.45) times higher, respectively, in physically inactive youth relative to physically active youth. The odds of having moderate and severe symptoms of depression and anxiety compared with no symptoms was 1.38 (1.13 to 1.69) and 1.31 (1.02 to 1.69) times higher, respectively, in sedentary youth relative to non-sedentary youth. In joint models including both physical and sedentary activity, sedentary activity was not consistently associated with symptoms of depression and anxiety.ConclusionsBoth physical inactivity and sedentary activity appear to be significantly related to symptoms of depression and anxiety. The importance of distinguishing these two behaviours has relevance for research as well as policies targeting physical activity and mental health in youth.

Background Using linked administrative health data, this study compared the health and healthcare service utilization between mothers of children with and without neurodevelopmental disabilities (NDD), before, during, and after the birth of a child. Methods The population (N = 25,388) was based on a cohort of children born in 2000 and who were, along with their mothers, continuously registered with the British Columbia’s universal health insurance program between 2000 and 2007. Results Compared to mothers of children without NDD, mothers of children with NDD were more likely to have chronic conditions and higher service utilization before child birth. Mothers of children with NDD showed a smaller increase in physician visits in the year before birth but a greater increase in different prescription drugs in the year after birth. There was no further divergence (or convergence) in health and service utilization between the groups in the 7-year period post-birth. Conclusions Differences in health and healthcare service utilization between mothers of children with and without NDD existed before the birth of the child and did not diverge in the 7 years post-birth. Replication of these findings is warranted as well as follow-up analyses examining longer term outcomes for mothers beyond 7 years post-birth.

Although rates of daily smoking among Inuit have been decreasing since 1991, Inuit are still much more likely to smoke relative to the Canadian population as a whole. However, little population-based empirical research has identified characteristics associated with cigarette use among this population.Based on data from the 2012 Aboriginal Peoples Survey, sex-specific logistic regression analyses, informed by an Inuit social determinants of health framework, described associations between current smoking and selected socio-demographic characteristics among Inuit men and women aged 18 or older who resided in Inuit Nunangat.In 2012, 75% of Inuit men and 74% of Inuit women reported that they smoked cigarettes either daily or occasionally. Inuit men and women had lower odds of smoking if they were high school graduates. Among Inuit men, the odds of smoking were lower for those in higher-income households. Among Inuit women, the odds of smoking were lower for those who had postsecondary education or lived in food-secure households; odds were higher for women who had attended a residential school. Inuit of both sexes had significantly higher odds of smoking if they lived in crowded conditions or in homes where a regular smoker was present.Some correlates of smoking among Inuit in Inuit Nunangat appear to be sex-specific. Findings from this study identify some of the protective and risk factors for smoking among this population and can help inform smoking prevention and cessation programs.

Contrary to a large and growing literature on center-based childcare workers, we know little about the work and health experiences of those providing childcare services in their homes. This study examines the job content, context, and requirements of regulated Home-Based Childcare workers in Canada. It is based on the qualitative analysis of eleven individual semistructured interviews. These workers perform business administration tasks and more housekeeping and domestic work than those in the center-based childcare, which affect their health and well-being. In addition, they reported factors related to the context and the content of their job such as the high physical and mental efforts, the absence of contact with other adults during working hours, the lack of external help, the exposure to noise and bad odors, the interference of work with personal and family life, the precarious remuneration, and the lack of benefits as potential factors that may affect their health.

BACKGROUND Participation in extracurricular activities can have positive effects on youth, with greater participation associated with higher academic as well as better socioemotional and behavioral outcomes. Little research has examined differential effects of in-school and out-of-school activities. METHODS This study examines in-school and out-of-school extracurricular activities for 14- to 17-year-olds using a population-based sample of Canadian youth. Associations with socioemotional and academic outcomes, and having tried smoking, alcohol, and marijuana were examined. RESULTS Weekly participation in both in-school and out-of-school activities were associated with positive and negative outcomes. In particular, youth who participated in out-of-school activities or in both in-school and out-of-school activities had better socioemotional outcomes. Academic outcomes were associated with in-school and out-of-school sports and nonsport activities. Youth who participated weekly in nonsport activities regardless of the context (in-school or out-of-school) were less likely to have tried smoking, alcohol, or marijuana. However, weekly participation in in-school sports was associated with an increased likelihood of failing a course; youth who participated weekly in out-of-school sports were more likely to have tried alcohol. CONCLUSION The findings suggest that participation in extracurricular activities, regardless of context, encourage positive youth development.

Background and objectives. Inuit populations may be at increased risk for experiencing poor nutrition or hunger due to limited access and availability to food. The prevalence and correlates of parental perceptions of hunger among a nationally representative sample of Inuit children in Canada have not yet been reported. Design. Data are from the 2006 Aboriginal Children's Survey (ACS). Sociodemographic information, dietary behaviours and hunger status were parent-reported via a household interview for Inuit children aged 2–5 years (n=1,234). Prevalence of hunger was calculated among Inuit children by sociodemographic factors and by dietary behaviours. In addition, a multivariate logistic regression model was conducted to determine factors associated with parental perception of ever experiencing hunger. Results. The prevalence of Inuit children in Canada aged 2–5 years ever experiencing hunger was 24.4%. Children who were reported to have experienced hunger consumed milk and milk products (p0.05). The majority (81%) of Inuit parents/guardians of ever-hungry children sought help from family or friends. Factors associated with an increased likelihood of experiencing hunger include sociodemographic characteristics (such as income and household size), living in an Inuit region and living in a community with cultural activities. Conclusion. About 1 in 4 Inuit children were reported by their parents to have experienced hunger, and hunger was associated with region, sociodemographic and community factors. Future research could further examine the impact of ever experiencing hunger on the health status of Inuit children and their families in Canada.Keywords: Inuit; hunger; children; social determinants; Aboriginal Children's Survey(Published: 24 April 2013)Citation: Int J Circumpolar Health 2013, 72: 20324 - http://dx.doi.org/10.3402/ijch.v72i0.20324

Objectives. We used Canadian population-based data to examine changes in the health of caregivers of children with complex health problems compared with caregivers of healthy children over a 10-year time period. Methods. The National Longitudinal Survey of Children and Youth collected data biennially from 9401 children and their caregivers in 6 waves from 1994–1995 to 2004–2005. We conducted growth-curve analyses of these data to model self-reported general health and depressive symptoms for 4 groups of caregivers: caregivers of healthy children, and caregivers of children with 1, 2, or at least 3 of 4 conceptually distinct indicators of child health problems. We modeled covariates for children (age, gender, only-child status) and caregivers (age, gender, education, income, marital status). Results. After we controlled for covariates, caregiver health outcomes worsened incrementally with increasing complexity of child health problems. Change in self-reported general health and depressive symptoms over the 10-year period was consistent across all groups of caregivers. Conclusions. Poorer health among caregivers of children with health problems can persist for many years and is associated with complexity of child health problems. Attention to parental health should form a component of health care services for children with health problems.

In this article we replicate and extend findings from Duncan et al. (2007). The 1st study used Canada-wide data on 1,521 children from the National Longitudinal Survey of Children and Youth (NLSCY) to examine the influence of kindergarten literacy and math skills, mother-reported attention, and mother-reported socioemotional behaviors on 3rd-grade math and reading outcomes. Similar to Duncan et al., (a) math skills were the strongest predictor of later achievement, (b) literacy and attention skills predicted later achievement, and (c) socioemotional behaviors did not significantly predict later school achievement. As part of extending the findings, we incorporated a multiple imputation approach to handle missing predictor variable data. Results paralleled those from the original study in that kindergarten math skills and Peabody Picture Vocabulary Test-Revised scores continued to predict later achievement. However, we also found that kindergarten socioemotional behaviors, specifically hyperactivity/impulsivity, prosocial behavior, and anxiety/depression, were significant predictors of 3rd-grade math and reading. In the 2nd study, we used data from the NLSCY and the Montreal Longitudinal-Experimental Preschool Study (MLEPS), which was included in Duncan et al., to extend previous findings by examining the influence of kindergarten achievement, attention, and socioemotional behaviors on 3rd-grade socioemotional outcomes. Both NLSCY and MLEPS findings indicated that kindergarten math significantly predicted socioemotional behaviors. There were also a number of significant relationships between early and later socioemotional behaviors. Findings support the importance of socioemotional behaviors both as predictors of later school success and as indicators of school success.

Children's leisure-time or unorganized physical activity is associated with positive physical and mental health, yet there is little information available on tracking and predicting participation throughout the childhood and adolescent years. The purpose of the current study was to explore patterns of unorganized physical activity participation of children ages 4 through 17 years. Longitudinal data from the Canadian National Longitudinal Survey of Children and Youth were analyzed using semiparametrice group-based trajectory modeling Participation in unorganized physical activity was best represented by two trajectory groups for boys (n = 4,476) and girls (n = 4,502). For boys, these groups were labeled regular participation and infrequent participation. For girls, there was also a regular group and a second group that reflected infrequent and decreasing participation throughout childhood and adolescence. A higher educational level for parents and having two parents in the home predicted regular participation for boys. For girls, none of the examined variables were significant predictors. The results suggest that boys have a relatively stable pattern of unorganized physical activity throughout childhood and adolescence; however, for some girls, participation declines in adolescence.

Background:Few longitudinal studies of physical activity have included young children or used nationally representative datasets. The purpose of the current study was to explore patterns of organized physical activity for Canadian children aged 4 through 17 years.Methods:Data from 5 cycles of the National Longitudinal Survey of Children and Youth were analyzed separately for boys (n = 4463) and girls (n = 4354) using multiple trajectory modeling.Results:Boys' and girls' organized physical activity was best represented by 3 trajectory groups. For boys, these groups were labeled: high stable, high decreasing, and low decreasing participation. For girls, these groups were labeled: high decreasing, moderate stable, and low decreasing participation. Risk factors (parental education, household income, urban/rural dwelling, and single/dual parent) were explored. For boys and girls, having a parent with postsecondary education and living in a higher income household were associated with a greater likelihood of weekly participation in organized physical activity. Living in an urban area was also significantly associated with a greater likelihood of weekly participation for girls.Conclusions:Results suggest that Canadian children's organized physical activity is best represented by multiple patterns of participation that tend to peak in middle childhood and decline into adolescence.

Objectives. We used population-based data to evaluate whether caring for a child with health problems had implications for caregiver health after we controlled for relevant covariates. Methods. We used data on 9401 children and their caregivers from a population-based Canadian study. We performed analyses to compare 3633 healthy children with 2485 children with health problems. Caregiver health outcomes included chronic conditions, activity limitations, self-reported general health, depressive symptoms, social support, family functioning, and marital satisfaction. Covariates included family (single-parent status, number of children, income adequacy), caregiver (gender, age, education, smoking status, biological relationship to child), and child (age, gender) characteristics. Results. Logistic regression showed that caregivers of children with health problems had more than twice the odds of reporting chronic conditions, activity limitations, and elevated depressive symptoms, and had greater odds of reporting poorer general health than did caregivers of healthy children. Conclusions. Caregivers of children with health problems had substantially greater odds of health problems than did caregivers of healthy children. The findings are consistent with the movement toward family-centered services recognizing the link between caregivers' health and health of the children for whom they care.

BACKGROUND: Five cycles of data from the Canadian National Longitudinal Survey of Children and Youth (1994/5–2002/3) were used to examine patterns of child care use in Quebec and the rest of Canada to explore the impact of Quebec’s implementation of universal child care. METHODS: Rates of overall use as well as use of regulated (child care centre, family child care) and non-regulated care (sitter, nanny, relative, family child care) were examined for preschoolers aged 0–5 years in Quebec as compared to the other provinces and by family household income. Chi-square tests were used to examine significance of differences. RESULTS: Since the implementation of Quebec’s child care program, Quebec demonstrated substantial increases in child care use, particularly in the use of regulated care (from 10% prior to program compared to 30% by 2002) whereas the use of unregulated care did not demonstrate a significant increase in Quebec as compared to the other provinces (1994 to 2002). Furthermore, the use of regulated care by low-income families was greater in Quebec than elsewhere in Canada, although the greatest increase in use of regulated care was for children from high-income families. CONCLUSION: Findings suggest that since the introduction of Quebec’s universal child care program, there was an increase in the use of regulated child care for families of preschoolaged children in the province, although by 2002 Quebec had not achieved the coverage of universal child care programs attained by many European countries.

Objective Predictive factors associated with prescription of psychostimulant drugs to children remain poorly understood. We aimed to identify child-related factors that predict receipt of methylphenidate (MPH: Ritalin) by children in a large population-based study. Methods With data from time 1 (1994–1995) and time 2 (1996–1997) of the National Longitudinal Survey of Children and Youth, we analyzed the role of child background, and behavioral and functional characteristics, all measured at time 1, in predicting receipt of MPH at time 2 in a series of logistic regression models. Results Parent- and teacher-reported attention-deficit/hyperactivity disorder (ADHD) symptoms were consistent and significant predictors of receipt of MPH (odds ratios [ORs] ranging from 5.3–7.0, and from 3.2–4.1, respectively), particularly when concordant. Parent-reported aggressive behaviors (OR 1.91, 95% confidence interval [CI], 1.24–2.96) and teacher-reported internalizing symptoms (OR 3.01, 95% CI, 1.74–5.54) also predicted receipt of MPH, whereas higher levels of academic functioning predicted lower likelihood of receiving MPH (OR 0.54, 95% CI, 0.34–0.85), even after controlling for child background characteristics, ADHD symptoms, and prior receipt of MPH. Across models, male gender predicted a higher likelihood of receiving MPH (ORs ranging from 3.5–4.5) over and above ADHD and other behavioral symptoms. The strongest predictor of MPH receipt across models was prior receipt of MPH (ORs ranging from 83.7–128.3). Conclusions Child characteristics and behavioral symptoms other than ADHD symptoms predict prescription and uptake of MPH, possibly attributable to their serving as clinically convenient indicators of impairment. Gender effects in receipt of stimulant medications among children with ADHD symptoms warrant further investigation.

The present study used Canadian National Longitudinal data to examine a model of the mechanisms through which the effects of neighborhood socioeconomic conditions impact young children's verbal and behavioral outcomes (N= 3,528; M age = 5.05 years, SD= 0.86). Integrating elements of social disorganization theory and family stress models, and results from structural equation models suggest that both neighborhood and family mechanisms played an important role in the transmission of neighborhood socioeconomic effects. Neighborhood disadvantage manifested its effect via lower neighborhood cohesion, which was associated with maternal depression and family dysfunction. These processes were, in turn, related to less consistent, less stimulating, and more punitive parenting behaviors, and ultimately, poorer child outcomes.

Background Elderly adults should avoid medications with anticholinergic effects since they may increase the risk of adverse events, including falls, delirium, and cognitive impairment. However, data on anticholinergic burden are limited in subpopulations, such as individuals with Parkinson disease (PD). The objective of this study was to determine whether anticholinergic burden was associated with adverse outcomes in a PD inpatient population. Methods Using the Cerner Health Facts1database, we retrospectively examined anticholinergic medication use, diagnoses, and hospital revisits within a cohort of 16,302 PD inpatients admitted to a Cerner hospital between 2000 and 2011. Anticholinergic burden was computed using the Anticholinergic Risk Scale (ARS). Primary outcomes were associations between ARS score and diagnosis of fracture and delirium. Secondary outcomes included associations between ARS score and 30-day hospital revisits. Results Many individuals (57.8%) were prescribed non-PD medications with moderate to very strong anticholinergic potential. Individuals with the greatest ARS score (4) were morelikely to be diagnosed with fractures (adjusted odds ratio (AOR): 1.56, 95% CI: 1.29-1.88) and delirium (AOR: 1.61, 95% CI: 1.08-2.40) relative to those with no anticholinergic burden. Similarly, inpatients with the greatest ARS score were more likely to visit the emergency department (adjusted hazard ratio (AHR): 1.32, 95% CI: 1.10-1.58) and be readmitted (AHR: 1.16, 95% CI: 1.01-1.33) within 30-days of discharge. Conclusions We found a positive association between increased anticholinergic burden and adverse outcomes among individuals with PD. Additional pharmacovigilance studies are needed to better understand risks associated with anticholinergic medication use in PD. Fil: Crispo, James A. G.. University of Ottawa; Canadá. University of Pennsylvania; Estados Unidos Fil: Willis, Allison W.. University of Pennsylvania; Estados Unidos Fil: Thibault, Dylan P.. University of Pennsylvania; Estados Unidos. University of Ottawa; Canadá Fil: Fortin, Yannick. University of Ottawa; Canadá Fil: Hays, Harlen D.. Cerner Corporation; Estados Unidos Fil: McNair, Douglas S.. Cerner Corporation; Estados Unidos Fil: Bjerre, Lise M.. University of Ottawa; Canadá Fil: Kohen, Dafna E.. University of Ottawa; Canadá Fil: Pérez Lloret, Santiago. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentina Fil: Mattison, Donald R.. University of Ottawa; Canadá. Risk Sciences International; Canadá Fil: Krewski, Daniel. University of Ottawa; Canadá. Risk Sciences International; Canadá

Housing conditions have been associated with child health. Inuit children are generally in poorer health than other Canadian children. They are also more likely to live in crowded households, in dwellings that need major repair, and to be exposed to second-hand smoke in the home.This study uses the 2006 Aboriginal Children's Survey to examine associations between physical and psychosocial housing characteristics and physical and mental health outcomes of Inuit children aged 2 to 5.Physical and psychosocial housing characteristics were associated with selected indicators of Inuit children's health. The presence of a smoker in the home, homeownership, and parental housing satisfaction were associated with specific physical and/or mental health outcomes, even after adjusting for other housing factors and family and child sociodemographic characteristics.Housing conditions were associated with the physical and mental health of young Inuit children, even when sociodemographic factors were taken into account. Homeownership and housing satisfaction appeared to be particularly important for young Inuit children's health.

Bisphenol A (BPA) is a synthetic industrial chemical commonly used in consumer products. Results from the Canadian Heath Measures Survey (CHMS) indicate that more than 90% of children and youth aged 6 to 19 have detectable levels of urinary BPA. Childhood concentration levels of BPA have been linked with negative behavioural outcomes.The data are from the first two cycles (2007 to 2009 and 2009 to 2011) of the CHMS, which collected biomonitoring indicators via spot blood and urine samples. Behavioural outcomes--hyperactivity/inattention, emotional symptoms, conduct problems, peer problems, and prosocial behavior--were assessed with Goodman's Strengths and Difficulties Questionnaire. Geometric mean urinary BPA concentration was examined overall and by demographic and socioeconomic correlates. Six multiple logistic regression analyses were conducted to investigate associations between childhood BPA concentrations and risk status for each outcome.Children aged 6 to 8 had higher BPA concentrations than did older children and youth. Concentrations were significantly higher among children and youth exposed to second-hand smoke every day or almost every day and those in low or lower-middle income households. Higher BPA concentrations were associated with increased odds of hyperactivity among girls and lower prosocial behaviour among boys.These findings suggest an association between urinary BPA concentration and children's behavioural outcomes.

Few studies have examined the potential of linked administrative data for research on child health. This analysis describes the application of a non-categorical survey-based tool, the Children with Special Health Care Needs (CSHCN) Screener, to administrative data.Five Screener items were applied to linked administrative health data from Population Data British Columbia. Hospital admissions and demographic and community characteristics for a cohort of children aged 6 to 10 in 2006 were examined to validate the use of these items.Overall, 17.5% of children were identified as CSHCN. An estimated 14% of children used more medical care and 5.2% had more functional limitations than is usual for children of the same age; 3.3% were prescribed long-term medication; 1.9% needed/received treatment or counselling; and 0.1% needed/received special therapy. Boys were more likely than girls to be identified as CSHCN.With some limitations, the CSHCN Screener can be applied to Canadian administrative health data.

Background. Caring for any child involves considerable resources, but the demands for these resources are often increased when caring for a child with a disability. These demands have implications for the psychologic and physical health of the caregiver (CG). Although a number of recent trends in health care stress the importance of studying and promoting the health of CGs of children with disabilities, the literature in this area exhibits 2 major weaknesses, ie, most studies draw conclusions from relatively small, potentially biased, clinic-based samples and the majority of work has focused on the psychologic health of CGs, whereas little research has been undertaken to study their physical well-being. The goal of this study was to compare the physical and psychologic health of CGs of children with cerebral palsy (CP) with that of the general population of CGs.Methods. Data on the physical and psychologic health of 468 primary CGs of children with CP, drawn from 18 of 19 publicly funded children's rehabilitation centers in Ontario, Canada, were collected with a self-completed questionnaire and a face-to-face interview. Identical items and scales had been administered previously to nationally representative samples of the Canadian population in 2 large-scale Canadian surveys, ie, the National Population Health Survey (NPHS) and the National Longitudinal Study of Children and Youth (NLSCY). Subsamples of those data, restricted to adult residents of the province of Ontario who were parents, allowed a comparison of our sample of CGs of children with CP with parent samples from both the NLSCY (n = 2414) and the NPHS (n = 5549).Outcome Measures. Demographic variables included CG age, gender, education, income, and work-related variables. Psychologic health and support variables included social support, family functioning, frequency of contacts, distress, and emotional and cognitive problems. Physical health variables included the number and variety of chronic conditions, vision, hearing, and mobility problems, and experience of pain.Results. CGs of children with CP had lower incomes than did the general population of CGs (proportion with income over $60 000: CG: 40.9%; NLSCY: 51.4%), despite the absence of any important differences in education between the 2 samples. Results showed that CGs of children with CP were less likely to report working for pay (CG: 66%; NLSCY: 81.2%), less likely to be engaged in full-time work (CG: 67.5%; NLSCY: 73.2%), and more likely to list caring for their families as their main activity (CG: 37.2%; NLSCY: 28.4%). Measures of support showed no difference in reported social support (CG: mean score: 14.5; SD: 3.4; NLSCY: mean score: 14.3; SD: 2.7) or family functioning (CG: mean score: 8.6; SD: 5.6; NLSCY: mean score: 9.0; SD: 4.9) between the 2 samples, although the CG sample did report a statistically greater number of support contacts (CG: mean score: 4.5; SD: 0.7; NPHS: mean score: 4.2; SD: 0.9). Measures of psychologic health showed greater reported distress (CG: mean score: 4.7; SD: 4.4; NPHS: mean score: 2.2; SD: 2.7), chronicity of distress (CG: mean score: 5.5; SD: 1.4; NPHS: mean score: 5.2; SD: 1.1), emotional problems (CG: 25.3% indicating problems; NPHS: 13.7%), and cognitive problems (CG: 38.8%; NPHS: 14.3%) among CGs of children with CP. They also reported a greater likelihood of a variety of physical problems, including back problems (CG: 35.5% reporting the condition; SE: 2.2%; NLSCY: 12.2%; SE: 0.7%), migraine headaches (CG: 24.2%; SE: 2.0%; NLSCY: 11.2%; SE: 0.7%), stomach/intestinal ulcers (CG: 8.4%; SE: 1.3%; NLSCY: 1.7%; SE: 0.3%), asthma (CG: 15.8%; SE: 1.7%; NLSCY: 6.3%; SE: 0.5%), arthritis/rheumatism (CG: 17.3%; SE: 1.8%; NLSCY: 7.3%; SE: 0.5%), and experience of pain (CG: 28.8%; SE: 2.1%; NPHS: 11.0%; SE: 0.5), as well as a greater overall number of chronic physical conditions (CG: 24.1% reporting no chronic conditions; NLSCY: 55.2%).Conclusions. Although many families cope well despite the added challenges of caring for a child with a disability, our findings suggest that the demands of their children's disabilities can explain differences in the health status of parents and that parents of children with CP are more likely to have a variety of physical and psychologic health problems. Many of these findings are consistent with a stress process model, in which stress from caregiving can directly or indirectly affect a variety of measures of health, although some of the findings (asthma and arthritis) seem to strain this hypothesis. Alternate interpretations of these findings include the possibility that parents who are in regular contact with the health care system may have more opportunities to discuss and receive attention for their own health concerns than do comparison adults or that the greater number of health issues reported by CGs is related to the nature of our study, perhaps leading these parents to focus on their health and well-being in more depth than is usually feasible in a population survey. CGs of children with CP also had lower incomes, despite the absence of any important differences in education. The findings are consistent with the idea that the financial burden of caring for a child with a disability results in part from a reduced availability of these parents to work for pay.Implications for Service Providers. Physicians and other health care professionals should be aware of the important relationship between child disability and CG health. Family-centered policies and services that explicitly consider CG health are likely to benefit the well-being of both CGs and their families. Future work should address the extent to which the family-centeredness of services, as experienced by CGs, is associated with better health outcomes for parents and their families.

Few national studies of hospitalizations due to injuries among the First Nations population have been conducted.Based on 2004/2005 to 2009/2010 data from the Discharge Abstract Database, this study examines associations between unintentional injury hospitalizations, socio-economic status and location relative to an urban core in Dissemination Areas (DAs) with a high percentage of First Nations identity residents versus a low percentage of Aboriginal identity residents.Unintentional injury hospitalization rates were higher in the less affluent and the most remote DAs. When DAs with the same socio-economic status and location were compared, the risk of hospitalizations was greater in high-percentage First Nations identity DAs relative to low-percentage Aboriginal identity DAs.Socio-economic conditions and remote location accounted for some, but not all, of the differences in unintentional injury hospitalizations between high-percentage First Nations identity and low-percentage Aboriginal identity DAs. This suggests that characteristics not measured in this analysis--such as environmental, behavioural or other factors--play an additional role in DA-level unintentional injury hospitalization risk.

The goal of current national and state legislation on welfare reform is to decrease the number of people who are dependent on public assistance, most of whom are mothers and their young children. Mothers' patterns of welfare receipt in the 3 years following the birth of a child were examined vis-à-vis their associations with maternal emotional distress (General Health Questionnaire), provision of learning experiences (Home Observation of the Measurement of the Environment), parenting behavior, and the child's cognitive test score (Stanford-Binet) in the third year of life. The data set was the Infant Health and Development Program, an eight-site randomized clinical trial designed to test the efficacy of educational and family support services in reducing developmental delays in low-birthweight, preterm infants (N = 833). Strong negative associations were found between receiving welfare and parenting behavior and child outcomes at age 3 years. Outcomes varied depending on when the mother received public assistance (earlier or later in her child's first 3 years) and family poverty status on leaving welfare. The parenting behavior of mothers who had left welfare by their child's third birthday was more likely to be authoritarian if she had left public assistance without also leaving poverty. Implications of these findings for the well-being of children in low-income families are discussed.

Objectives—This study examines gender and age differences in maternal reports of injuries in a cross sectional group of children aged 0–11 years. The cause, nature, body part injured, and location of injury are explored, as are the associations with family socioeconomic indicators and associations with limitations in activities. Methods—Data for 22 831 children and their families come from cycle 1 of the Canadian National Longitudinal Survey of Children and Youth collected in 1995. Descriptive analyses and χ2 tests for trends are used to examine injury variations by child gender and age. Logistic regressions are used to examine the relationship between socioeconomic indicators and injury and the associations between injury and limitations in activities. Results—Consistent with findings from hospital data, boys experience more injuries than girls, and injuries increase with child age. Falls are the most common sources of maternally reported injuries, followed by scalds/poisonings for young children and sports injuries for school aged children. The majority of injuries occur in or around the home for young children, but at school for older children. For maternal reports of childhood injuries, single marital status is a risk factor for boys. Conclusions—Maternally reported injuries occur in 10% of Canadian children and many of these are associated with limitations in activities. Preventative strategies should take both child age and gender into consideration.

Based on the results of Statistics Canada's 2006 Aboriginal Children's Survey, this article presents an overview of how often First Nations children living off reserve, Métis children and Inuit children aged 2 to 5 consume various types of food, including foods considered traditional or country among Aboriginal people. The frequency with which First Nations children living off reserve and Métis children consumed items from major food groups tended to be similar. While lower percentages of Inuit children were reported to regularly consume items from these food groups, relatively high percentages of Inuit children consumed traditional or country foods. Around two-thirds of all Aboriginal children ate fast food and processed foods at least once a week, and just over half had salty snacks, sweets and desserts at least once a day. Consumption patterns varied, depending on whether children lived in a Census Metropolitan Area/Census Agglomeration.

Speech and language skills are an important developmental milestone for all children, and one of the most prevalent forms of developmental delay among Aboriginal children. However, population-based indicators of Aboriginal children's language outcomes are limited.Data from the Aboriginal Children's Survey (ACS) were used to examine measures of language for Aboriginal children who were 2 to 5 years of age. Responses to ACS questions on ability in any language were examined in exploratory factor analyses to determine possible language indicators. Construct validity was examined by regressing language outcomes onto socio-demographic characteristics known to be associated with children's language.Four language outcomes were identified and labelled: expressive language, mutual understanding, story-telling, and speech and language difficulties.The conceptualization of items from the ACS into separate language indicators can be used by researchers examining young Aboriginal children's language outcomes.

Many First Nations children live in communities that face diverse social and health challenges compared with their non-Aboriginal peers, including some of the most socio-economically challenging situations in Canada. These differences can be seen in broad indicators of the social determinants of health. Studies of mortality in Aboriginal populations across Canada are often restricted by the lack of Aboriginal identifiers on national death records. While some studies have utilised a record-linkage approach, this is often not possible for the entire country or for recent data. Some researchers have adopted a geographic approach and examined mortality and morbidity in areas that have a high percentage of Aboriginal identity residents, and have uniformly reported elevated rates of mortality and morbidity compared with other areas. The purpose of this article was to examine child and youth mortality (aged 1 to 19 years) in areas where a high percentage of the population identified as First Nations in comparison with areas where there is a low percentage of Aboriginal identity residents.Using a geographic threshold table approach, areas with a high percentage of Aboriginal identity peoples were classified as either First Nations, Métis, or Inuit communities based on the predominant identity group. The upper one-third of the total Aboriginal population distribution was used as a cut-off for high percentage First Nations areas, where 97.7% of the population aged 1-19 were of First Nations identity in 2006 (Age-standardized mortality rates for children and youth in high-percentage First Nations identity areas were significantly higher than in low-percentage Aboriginal identity areas. The rate ratio for all-cause mortality for boys was 3.2 (CI: 2.9-3.6) for 2005-2007 and 3.6 (CI: 3.2-4.2) for girls. Mortality rates for injuries had the largest difference, with rate ratios of 4.7 (CI: 4.0-5.5) and 5.3 (CI:4.5-6.3) for boys in 2000-2002 and 2005-2007 and 5.5 (CI: 4.4-6.8) and 8.3 (CI: 6.8-10.1) for girls in the same period.A strength of this study is that it is the first to use national-level vital statistics registration data across two time periods to report mortality by cause for children and youth living in high-percentage First Nations areas. Vital events were geographically coded to high-percentage First Nations identity areas and compared with low-percentage Aboriginal identity areas at the Dissemination Areas level. This area-based methodology allows for mortality to be calculated for children and youth by sex and by detailed cause of death for multiple time periods. The results provide key evidence for the persistent differences in the causes of death for children and youth living in high-percentage First Nations identity areas.

Because Vital Statistics data do not include information on Inuit identity in all jurisdictions, mortality rates cannot be calculated specifically for Inuit. However, Inuit in Canada are geographically concentrated--78% live in Inuit Nunangat, and 82% of the area's total population identify as Inuit. While there are limitations, geographic approaches can be employed to calculate mortality for the population of that area.The Vital Statistics Database (1994 to 2008) and population estimates were used to calculate age-standardized mortality rates (ASMRs) in five-year intervals around the 1996 and 2006 Census years. Mortality rates were calculated for 1- to 19-year-olds living in Inuit Nunangat and those living elsewhere in Canada.The ASMR in 2004-2008 for 1- to 19-year-olds in Inuit Nunangat was 188.0 deaths per 100,000 person-years at risk, five times the rate (35.3) elsewhere in Canada. The disparity had not narrowed over the previous decade. In Inuit Nunangat, injuries were responsible for 64% of deaths of children and teenagers, compared with 36% in the rest of Canada.The persistently high mortality rates for children and teenagers living in Inuit Nunangat, compared with the rest of Canada, are important in understanding the health and socio-economic situation of residents of this region.

This population-based study examined correlates of three parenting behaviors (positive interactions, consistency, and ineffective parenting) that have been shown to differ in children with neurodevelopmental disorders (NDDs), with and without externalizing behavior problems (EBPs), as compared to children with neither condition.The sample of children aged 4-11 (N = 14,226) was drawn from the Canadian National Longitudinal Survey of Children and Youth (NLSCY). Analyses examined the associations of child, parental, and social context factors with parenting behaviors, and whether they differed by child health group.Child age, family functioning, and social support variables were significant predictors of all three parenting behaviors. Significant interaction effects highlight the importance of the child's sex, birth order, and support received from community or social service professionals, and that these factors have differential impacts on parenting behaviors depending on the child's health group.Other Child, parent, and social context factors are associated with parenting behaviors but these associations vary by the child's health group. Parenting behaviors differ for children with NDDs with and without EBPs. These findings offer important implications for practice and research and point to the importance of considering multiple contexts of influence, as well as their interactions, in understanding differences in parenting behaviors.

The impact of asthma on school performance particularly compared with that of other chronic conditions, is relatively unexplored, and the results of analyses that have been conducted are inconclusive. This article examines associations between asthma and school functioning.The data are from the 1998/1999 National Longitudinal Survey of Children and Youth. The study pertains to a sample of 8,914 children aged 7 to 15. Descriptive and regression analyses were used to examine associations between asthma severity and scores on standardized math and reading tests, and maternal ratings of school performance. School absence and the use of educational services were considered as potential mediators. Comparisons were made with children who had other chronic conditions or no chronic conditions.Compared with children who did not have a chronic condition, children with asthma scored lower on standardized math and reading tests and had less favourable mother-reported school performance. Those with the most severe asthma had the poorest outcomes. These associations persisted when adjusting for child and family factors. The poorer scholastic outcomes were not mediated by school absence. However, the use of educational services appeared to mediate low math scores for children with severe asthma.The relationship between asthma and children's school functioning may be of interest to physicians and educators. Educational support and remedial services may be beneficial.

Purpose: Children with neurodevelopmental disorders (Neuro) pose complex parenting challenges, particularly if the condition co-occurs with behaviour problems. Such challenges are likely to impact caregiver health and well-being. This study explores the extent to which caregivers of children with both Neuro and behaviour problems differ in their physical and psychosocial outcomes from caregivers of children with either condition or neither condition. Method: The first wave of data collected in the National Longitudinal Survey of Children and Youth in Canada (1994) was used to identify four groups of caregivers of 4-to 11-year-old children: caregivers of children with a Neuro disorder and externalising behaviour problems (Both; n = 414), caregivers of children with a Neuro disorder only (Neuro Only; n = 750), caregivers of children with an externalising behaviour problem only (Ext Only; n = 1067), and caregivers of children with neither health condition (Neither; n = 7236). Results: Caregivers in the Both group were least likely to report excellent or very good health, and more frequently reported chronic conditions such as asthma, arthritis, back problems, migraine headaches, and limitations in activities as compared to the Neither group. This group also exhibited higher depression scores, experienced more problematic family functioning and reported lower social support than the Neither group. Scores for caregivers in the Ext Only and Neuro Only groups tended to lie between the Both and Neither group scores and often did not differ from one another. Conclusions: Caregivers of children with both neurovelopmental disorders and behaviour problems exhibited a greater number of health and psychosocial problems. While addressing children's behaviour problems, health care professionals should also consider caregiver physical and psychosocial health, as this may also have an impact on children's well-being.

Objective : To examine independent and combined effects of child, family and neighborhood on medically attended childhood injuries. Methods : Logistic modeling of longitudinal data (n=9796) from the Census Linked National Longitudinal Survey of Children and Youth. Results : Child age and gender were strong predictors of injuries. Smaller effects were found for parenting, neighborhood cohesion among difficult children less than 2 years old, and neighborhood disadvantage among aggressive children 2-3 years old. Conclusion : Neighborhood in addition to parenting can affect injury risk. Further research is needed into the influence of neighborhood disadvantage and the processes of neighbor's cohesion at different childhood stages.

This study examined the association of census level, observational, and parent-reported neighborhood characteristics on the verbal and behavioral competencies of a national sample of Canadian preschoolers (N = 3,350). Children's verbal ability scores were positively associated with residing in neighborhoods with affluent residents and negatively associated with residing in neighborhoods with poor residents and in neighborhoods with low cohesion, even after controlling for family socioeconomic factors. Behavior problem scores were higher when children lived in neighborhoods that had fewer affluent residents, high unemployment rates, and neighborhoods with low cohesion, after controlling for family socioeconomic factors. These findings are discussed in light of neighborhood studies of children in the United States in the mid-1990s.

A variety of family processes have been hypothesized to mediate associations between income and young children's development. Maternal emotional distress, parental authoritative and authoritarian behavior (videotaped mother-child interactions), and provision of cognitively stimulating activities (Home Observation for Measurement of the Environment [HOME] scales) were examined as possible mediators in a sample of 493 White and African American low-birth-weight premature infants who were followed from birth through age 5. Cognitive ability was assessed by standardized test, and child behavior problems by maternal report, when the children were 3 and 5 years of age. As expected, family income was associated with child outcomes. The provision of stimulating experiences in the home mediated the relation between family income and both children's outcomes; maternal emotional distress and parenting practices mediated the relation between income and children's behavior problems.

To examine the concordance of mother and teacher ratings of children born at different birth weights on measures of school functioning, behavioral problems, and social competencies, we used a prospective cohort study involving children in two previously studied multisite birth cohorts whom we recontacted at 8 to 10 years of age. This provided a multisite sample of 784 low birth weight children and 334 normal birth weight children. Teacher reports of children's behaviors were obtained from 80% of the 1400 teachers contacted. We found that birth weight and neonatal health were associated with both maternal and teacher reports; that maternal characteristics, e.g., low levels of education and poor mental health, were associated with the greatest discrepancies in reports; and that although mothers' reports of objective measures were accurate, their assessments of behavioral problems and social competence often differed from those of teachers.

Purpose Although therapeutic options and clinical guidelines for Parkinson’s disease (PD) have changed significantly in the past 15 years, prescribing trends in the USA remain unknown. The purpose of this population-based cohort study was to examine patterns of inpatient antiparkinson drug use between January 2001 and December 2012 in relation to clinical guideline publication, drug introduction/withdrawal, and emerging safety concerns. Methods A total of 16,785 inpatients receiving pharmacological treatment for PD were identified in the Cerner Health Facts database. Our primary outcome was standardized (age, sex, race, and census region) annual prevalence of antiparkinson drug use. We also examined antiparkinson medication trends and polypharmacy by age and sex. Results The most frequently prescribed antiparkinson drugs between 2001 and 2012 were levodopa (85 %) and dopamine agonists (28 %). Dopamine agonist use began declining in 2007, from 34 to 27 % in 2012. The decline followed publication of the American Academy of Neurology’s practice parameter refuting levodopa toxicity, pergolide withdrawal, and pramipexole label revisions. Despite safety concerns for cognitive impairment and falls, individuals ≥80 years of age demonstrated stable rates of dopamine agonist use from 2001 to 2012. Polypharmacy was most common in younger patients. Conclusions Dopamine agonist use declined from 2007 to 2012, suggesting that increased awareness of safety issues and practice guidelines influenced prescribing. These events appear to have minimally influenced treatment provided to older PD patients. Antiparkinson prescribing trends indicate that safety and best practice information may be communicated effectively. Electronic supplementary material The online version of this article (doi:10.1007/s00228-015-1881-4) contains supplementary material, which is available to authorized users.

Background Many definitions are being used to conceptualize child health problems. With survey data, commonly used indicators for identifying children with health problems have included chronic condition checklists, measures of activity limitations, elevated service use, and health utility thresholds. This study compares these different indicators in terms of the prevalence rates elicited, and in terms of how the subgroups identified differ. Methods Secondary data analyses used data from the National Longitudinal Survey of Children and Youth, which surveyed a nationally representative sample of Canadian children (n = 13,790). Descriptive analyses compared healthy children to those with health problems, as classified by any of the key indicators. Additional analyses examined differences between subgroups of children captured by a single indicator and those described as having health problems by multiple indicators. Results This study demonstrates that children captured by any of the indicators had poorer health than healthy children, despite the fact that over half the sample (52.2%) was characterized as having a health problem by at least one indicator. Rates of child ill health differed by indicator; 5.6% had an activity limitation, 9.2% exhibited a severe health difficulty, 31.7% reported a chronic condition, and 36.6% had elevated service use. Further, the four key indicators captured different types of children. Indicator groupings differed on child and socio-demographic factors. Compared to children identified by more than one indicator, those identified only by the severe health difficulty indicator displayed more cognitive problems (p < 0.0001), those identified only by the chronic condition checklist had a greater likelihood of reporting allergies or asthma (p < 0.0001), and those identified as having elevated service use only were more affluent (p = 0.01) and showed better overall health (p < 0.0001). Children identified by only a single indicator were less likely to have serious health problems than those identified by two or more indicators. Conclusion We provide information useful to researchers when selecting indicators from survey data to identify children with health problems. Researchers and policy makers need to be aware of the impact of such definitions on prevalence rates as well as on the composition of children classified as being in poor health.