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Background: The evidence on the association between neighborhood-level socioeconomic status (SES) and health disorders in young children is scarce. This study examined the prevalence of health disorders in Canadian kindergarten (5-6 years old) children in relation to neighborhood SES in 12/13 Canadian jurisdictions., Methods: Data on child development at school entry for an eligible 1,372,980 children out of the total population of 1,435,428 children from 2004 to 2020, collected using the Early Development Instrument (EDI), were linked with neighborhood sociodemographic data from the 2006 Canadian Census and the 2005 Taxfiler for 2,058 neighborhoods. We examined the relationship using linear regressions. Children's HD included special needs, functional impairments limiting a child's ability to participate in classroom activities, and diagnosed conditions., Results: The neighborhood prevalence of health disorders across Canada ranged from 1.8 to 46.6%, with a national average of 17.3%. The combined prevalence of health disorders was 16.4%, as 225,711 children were identified as having at least one health disorder. Results of an unadjusted linear regression showed a significant association between neighborhood-level SES and prevalence of health disorders ( F (1, 2051) = 433.28, p  < 0.001), with an R 2 of 0.17. When province was added to the model, the R 2 increased to 0.40 ( F (12, 2040) = 115.26, p  < 0.001). The association was strongest in Newfoundland & Labrador and weakest in Ontario., Conclusion: Our study demonstrated that the prevalence of health disorders among kindergarten children was higher in lower SES neighborhoods and varied by jurisdiction in Canada, which has implications for practice and resource allocation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Janus, Brownell, Reid-Westoby, Pottruff, Forer, Guhn and Duku.)

Introduction: This study examined profiles of social connectedness among early adolescents in grade 7 before the COVID-19 pandemic was declared (Winter 2020), and in grade 8 during the second Wave of the pandemic (Winter 2021)., Method: Linked data from 1753 early adolescents (49% female) from British Columbia, Canada who completed the Middle Years Development Instrument survey in grades 7 and 8 were used. Participants reported on life satisfaction, depressive symptoms, and connectedness with peers and adults at home, school and in the community. We used Latent Profile Analysis to identify connectedness profiles at both time points, and Latent Transition Analysis to examine transitions in connectedness profiles over time. Multiple regression analyses examined the associations between profile membership in grade 7 and mental well-being in grade 8, and the associations between transitions in profile membership (i.e., increase vs. decrease in connectedness over time) and mental well-being., Results: Connectedness in multiple domains in grade 7 was related to significantly higher levels of mental well-being in grade 8, controlling for demographics, well-being in grade 7, and COVID-related mental health worries. Well-being was highest when students felt highly connected in all domains and lowest when they felt lower levels of connection. Increases in connectedness were associated with improvements in mental well-being and decreases with a decline in well-being over time., Conclusions: Experiencing connectedness with peers and adults is critical for the mental well-being in early adolescence. Providing opportunities to connect is important in the context of major societal challenges such as the COVID-19 pandemic., (© 2023 The Authors. Journal of Adolescence published by Wiley Periodicals LLC on behalf of Foundation for Professionals in Services to Adolescents.)

Objectives: Poverty exposes children to adverse conditions that negatively impact development. However, there is limited understanding on how different types of poverty may affect children of various immigration backgrounds differently in outcomes such as school readiness. This study examined these relationships between household and/or neighbourhood poverty, poverty timing, and immigration background with school readiness outcomes at kindergarten., Methods: This study utilized a retrospective, population-based cohort of administrative records linked with surveys completed by kindergarten teachers for 15 369 children born in British Columbia, Canada. The exposures investigated were neighbourhood poverty (residing in a neighbourhood in the lowest income-quintile) and/or household poverty (receiving a health insurance subsidy due to low household income). Experiencing both neighbourhood and household poverty simultaneously was defined as "combined" household and neighbourhood poverty. The outcome of vulnerability on school readiness domains was assessed at kindergarten (47.8% female; mean age = 6.01 years) using teacher ratings on the Early Development Instrument (EDI)., Results: Children exposed to combined poverty between age 0 and 2 had greater odds of being vulnerable in two or more domains of school readiness than children not exposed to any poverty during this period (adjusted odds ratio (aOR) = 2.07, 95% CI: [1.74; 2.47], p < 0.001). The effect of combined poverty was larger than household poverty only (aOR = 1.54, 95% CI: [1.31; 1.82], p < 0.001) or neighbourhood poverty only (aOR = 1.49, 95% CI: [1.30; 1.70], p < 0.001). Combined poverty was associated with negative outcomes regardless of timing. Both non-immigrants (aOR = 2.40, 95% CI: [1.92; 3.00], p < 0.001) and second-generation immigrants (aOR = 1.63, 95% CI: [1.22; 2.17], p < 0.001) experiencing combined poverty scored lower on school readiness., Conclusions: Children who experienced combined poverty had lower levels of school readiness at kindergarten, regardless of timing and immigration background., (© 2023 The Authors.)

Despite anxiety being a prevalent mental health problem in children, little data exist on the pervasiveness and levels of anxiety symptoms in kindergarteners. Data from the Early Development Instrument, a teacher-completed, population-level measure of child development, were collected across Canada from 2004 to 2015. The final analytic sample consisted of 974,319 children of whom 2.6% were classified as "highly anxious". Compared to children who exhibited "few to none" anxious behaviors, highly anxious children were more likely to be male, have English/French as a second language, and have a special needs designation. Furthermore, compared with their less anxious peers, highly anxious children had between 3.5 and 6.1 higher odds of scoring below the 10 th percentile cut-off in physical, social, language/cognitive and communication domains. Our findings suggest that anxious behaviors are related to children's overall health and illustrate the consistency and extensiveness of anxiety at a very young age among Canadian children., (© 2022. The Author(s).)

The COVID-19 pandemic and related school disruptions have led to increased concerns for the mental health of teachers. This study investigated how the challenges and systemic supports perceived by teachers during the COVID-19 pandemic were associated with their mental health and workplace well-being. This cross-sectional, survey-based study was conducted in February 2021, just prior to the third wave of the pandemic in British Columbia (BC), Canada (N = 1,276). Four multivariable linear regression models examined the associations between teachers' pandemic-related challenges (pandemic-related personal stressors, teacher workload, difficulty implementing safety measures, meeting students' needs), systemic supports (education system mental health and well-being support), and four mental health (psychological distress, and quality of life) and workplace well-being outcomes (job-related positive affect, turnover intentions), adjusting for sociodemographic and school characteristics. The Pratt index (d) was used to assess the relative importance of each predictor. A thematic qualitative analysis was conducted on teachers' open-ended responses. Teachers' workplace well-being (job-related positive affect and turnover intentions) was predominantly associated with their perceptions of education system support for their mental health and well-being (d = 46%, d = 41%, respectively). The most important predictor of general mental health (psychological distress and quality of life) was the number of COVID-19 related personal stressors teachers reported (d = 64%, d = 43%, respectively). The qualitative analyses corroborated and expanded upon the quantitative findings. Understanding pandemic-related challenges and supports impacting teacher mental health and workplace well-being equips us to make evidence-informed policy decisions to support teachers now and in future school disruptions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Gadermann et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: A methodological review of 78 empirical articles focusing on the neurodevelopmental outcomes of at-risk infants was conducted., Aims: To examine ways language and terminology are used to describe methods, present results, and/or state conclusions in studies published during 1994-2005, a decade reflecting major advances in neurodevelopmental research and in medical intervention. More specifically, to investigate to what extent the design of the study and the language in the results section aligned in regard to causality., Methods: A process of search and selection of studies published in pediatric journals was conducted through Google Scholar. Criteria of inclusion and exclusion, following PRISMA, were used. Selected studies reported neurodevelopmental outcomes of infants and young children considered at-risk, and were further categorized accordingly to their study designs. Language use in regard to whether the presentation and interpretation of results may convey causal relationships between birth risk factors and neurodevelopmental outcomes was examined following two analytical steps., Results: Forty out of 78 studies, (51.28 %) used causality-implying language (e.g., effect, predict, influence) notwithstanding that the study design was non-causal., Conclusions: Anticipating the next generation of neurodevelopmental-outcomes research, a framework that aims to raise awareness of the importance of language use and the impact of causality-related terms often used in longitudinal studies is proposed. The objective is to avoid ambiguities and misunderstandings around causal or non-causal connections between birth risk factors and developmental outcomes across diverse audiences, including early intervention practitioners working directly with infants and their families., Competing Interests: Declaration of competing interest The authors declares that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: Evidence from systematic reviews suggests that adult immigrants living in areas of higher immigrant density (areas with a higher proportion of foreign-born residents) tend to experience fewer mental health problems-likely through less discrimination, greater access to culturally/linguistically appropriate services, and greater social support. Less is known about how such contexts are associated with mental health during childhood-a key period in the onset and development of many mental health challenges. This study examined associations between neighbourhood immigrant density and youth mental health conditions in British Columbia (BC; Canada)., Methods: Census-derived neighbourhood characteristics were linked to medical records for youth present in ten of BC's largest school districts from age 5 through 19 over the study period (1995-2016; n = 138,090). Occurrence of physician assessed diagnoses of mood and/or anxiety disorders, attention deficit hyperactivity disorder (ADHD), and conduct disorder was inferred through International Classification of Diseases (ICD) diagnostic codes in universal public health insurance records. Multi-level logistic regression was used to model associations between neighbourhood characteristics and odds of diagnoses for each condition; models were stratified by generation status (first-generation: foreign-born; second-generation: Canadian-born to a foreign-born parent; non-immigrant)., Results: Higher neighbourhood immigrant density was associated with lower odds of disorders among first-generation immigrant youth (e.g., adjusted odds of mood-anxiety disorders for those in neighbourhoods with the highest immigrant density were 0.67 times lower (95% CI: 0.49, 0.92) than those in neighbourhoods with the lowest immigrant density). Such protective associations generally extended to second-generation and non-immigrant youth, but were-for some disorders-stronger for first-generation than second-generation or non-immigrant youth., Conclusions: Findings suggest there may be protective mechanisms associated with higher neighbourhood immigrant density for mental health conditions in immigrant and non-immigrant youth. It is important that future work examines potential pathways by which contextual factors impact immigrant and non-immigrant youth mental health., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Introduction: The COVID-19 pandemic has had widespread effects on adolescent mental health. However, little is known about support-seeking, unmet need and preferences for mental health care among adolescents., Methods: The Youth Development Instrument (YDI) is a school-administered survey of adolescents (N = 1928, mean age = 17.1, SD = 0.3) across British Columbia, Canada. In this cohort, we assessed the characteristics of accessed mental health supports, prevalence of unmet need and preferences for in-person versus internet-based services., Results: Overall, 40% of adolescents obtained support for mental health, while 41% experienced unmet need. The most commonly accessed supports were family doctors or pediatricians (23.1%) and adults at school (20.6%). The most preferred mode of mental health care was in-person counselling (72.4%), followed by chat-based services (15.0%), phone call (8.1%) and video call (4.4%). The adjusted prevalence of accessing support was elevated among adolescents with anxiety (adjusted prevalence ratio [aPR] = 1.29, 95% CI: 1.10-1.51), those who used alcohol (1.14, 1.01-1.29), gender minorities (1.28, 1.03-1.58) and sexual minorities (1.28, 1.03-1.45). The adjusted prevalence of unmet need was elevated among adolescents with depression (1.90, 1.67-2.18), those with anxiety (1.78, 1.56-2.03), females (1.43, 1.31-1.58), gender minorities (1.45, 1.23-1.70) and sexual minorities (1.15, 1.07-1.23)., Conclusion: Adolescents of gender or sexual minority status and those with anxiety were more likely than others to have discussed mental health concerns and also to have reported unmet need. The most common sources of support were primary health care providers and adults at school, while the most and least preferred modes of support were in-person and video call services, respectively., Competing Interests: The authors have no conflicts of interest relevant to this article to disclose.

Background: Sleep debt is linked to poor health behaviours, and adolescents may be especially vulnerable to deficit from the mismatch of their late chronotype with socially determined sleep timing. We aimed to investigate the potential association between social jetlag and sugar-sweetened beverages (SSBs) consumption among adolescents., Methods: Cross-sectional data from 1031 adolescents (13-18 years) who participated in the population-based British Columbia Adolescent Substance Use Survey in 2012. Regression analysis using interaction terms estimated the associations between social jetlag (using self-reported weekday/weekends sleep times) and odds of SSB intake in girls and boys., Results: On average, adolescents reported 1.59 (SD 0.73) hours of social jetlag, but girls had significantly more social jetlag (1.64) than boys (1.52). Most adolescents (84%) reported consuming SSBs, and significantly more boys (87%) than girls (81%); median SSB intake in boys was 1-2 times per week and in girls less than once per week. Significant differences in girls consuming any SSB were seen across levels of social jetlag. The odds of any SSB intake were significantly higher in adolescents with social jetlag between 1 and 2 h [odds ratio (OR): 1.6 (1.14-2.38)] and over 2 h [OR 1.87 (1.11-3.14)], compared with 1 h or less; associations were stronger and only significant in girls., Conclusions: This study is the first to show social jetlag is a common sleep deficit that is associated with SSB intake in adolescents, particularly among teen girls., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Public Health Association.)

Objective: We recently found that the risk of diagnosed non-affective psychotic disorder between the ages of 13 and 19 was lower for immigrant adolescents compared to those without a personal or parental migration history in British Columbia (BC), Canada. In the current study, we further examined the risk for migrants compared to non-migrants by region of origin and immigrant generation (first vs. second), adjusting for several demographic factors and migration class., Methods: Administrative data were used to construct a cohort of individuals born 1990-98 and residing in South-Western BC ( N  = 193,400). Cases were identified by either one hospitalization or two outpatient physician visits with a primary diagnosis of a non-affective psychotic disorder. Poisson regression was used to estimate incidence rate ratios (IRR) of a diagnosed non-affective psychotic disorder by region of origin among first- and second-generation migrants compared to non-migrants, adjusting for sex, birth year, neighbourhood income and low family income., Results: Risk of diagnosed non-affective psychotic disorder was lower among first-generation migrants from East Asia (IRR = 0.34[95% CI: 0.25-0.46]), South-Asia (IRR = 0.47[95% CI: 0.25-0.89]) and South-East Asia (IRR = 0.55[95% CI: 0.32-0.93]) and second-generation migrants from East Asia (IRR = 0.49[95% CI: 0.35-0.69]) and South Asia (IRR = 0.52[95% CI: 0.37-0.73]), compared to non-migrants. Adjusting for migration class attenuated but did not fully explain variation in risk by region among first-generation migrants. No groups exhibited a significantly elevated risk of the diagnosed non-affective psychotic disorder compared to non-migrants., Conclusion: Findings from this study underline the complexity of the association between migration and psychotic disorders. Future research should investigate why certain groups of migrants are less likely to be diagnosed and whether there are specific sub-groups that face an elevated risk.

Organized activity participation has been linked to children's emotional wellbeing. However, a scarcity of literature considers the role of immigrant background. This study's primary objective was to measure the association between organized activity participation and emotional wellbeing among a population-based sample of Grade 7 children in British Columbia, Canada. We also examined whether this relationship depended on immigration background. Our sample included 14,406 children (47.8% female; mean age = 12.0 years). 9,393 (65.2%) children were of non-immigrant origin (48.9% female; mean age = 12.1 years). 5,013 children (34.8%) were of immigrant origin (45.8% female; mean age = 12.0 years; 40.8% first-generation). Participants completed the Middle Years Development Instrument, a self-report survey measuring children's wellbeing and assets. We used odds ratios and the χ 2 test to compare the organized activity participation of non-immigrant and immigrant-origin children. We used multiple linear regression to measure associations between participation and indicators of emotional wellbeing and assessed whether associations varied based on immigrant background, controlling for demographic factors and peer belonging. Participation in any activity was similar among non-immigrant and immigrant-origin children (OR 1st-gen =1.06, p =0.37; OR 2nd-gen =0.97, p =0.62). Immigrant generation status modified the relationship between participation and emotional wellbeing (χ SWL 2 =3.69, p =0.03; χ Dep 2 =12.31, p <0.01). Beneficial associations between participation and both life satisfaction and depressive symptoms were observed among non-immigrant children only, although associations were small. We conclude that immigrant background modestly modified the association between organized activity participation and emotional wellbeing., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)

Functional abilities in children with autism spectrum disorder (ASD) are highly heterogenous, and impairments can overlap with non-ASD neurodevelopmental disorders. We compared the profiles of children assessed for ASD with and without an ASD diagnosis using a retrospective cohort study of 101,739 children born in British Columbia (2000-2008). The children were grouped into the following five comparison groups: (1) ASD- (n = 1131), (2) ASD+ (n = 1583), (3) Ministry of Education designated ASD+ (n = 654), (4) special need other than ASD (n = 11,663), and (5) typically developing (n = 86,708). Five developmental domains were assessed using the Early Development Instrument. ANCOVA was used to control for covariates, Tukey's HSD test for multiple comparisons, and Cohen's d for effect size. The ASD- group had slightly higher scores than the ASD+ group with small to medium effect sizes in all domains (d = 0.20-0.48). The ASD- group had slightly higher scores than the Ministry of Education ASD+ group in only three domains with small effect sizes (d = 0.21-0.25). The ASD- group had lower scores in all domains compared to the typically developing group with large effect sizes in all domains (d = 1.12-1.77). The ASD- group received less education funding at school entry than both ASD+ groups. Overall, only small to medium differences in development were detected between the ASD- and ASD+ groups. While these children differ diagnostically, they share similar functional profiles and have substantially more difficulties than typically developing children. Therefore, differences in levels of support at school entry raise critical questions of equity. LAY SUMMARY: Comparison of children in British Columbia who have been referred for an autism assessment, with or without a diagnosis, shows similarities in their functional and developmental profiles in kindergarten. Furthermore, both groups of children have more difficulties than typically developing children. However, children who have been referred for assessment without an autism diagnosis receive less financial support at school entry, raising important questions on equity., (© 2022 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals LLC.)

Background: Early adolescence is a time of psychological and social change that can coincide with declines in mental health and well-being. This study investigated the psychological and social impacts of the COVID-19 pandemic from the perspective of students who responded to a survey in Grades 7 and 8 (ages 12-14) in British Columbia (BC), Canada. The objectives of this study were (i) to provide an overview on early adolescents' experiences and social-emotional well-being during the pandemic; and (ii) to examine whether changes in social experiences as well as feeling safe from getting COVID-19 at school were associated with changes in well-being outcomes over the course of a year., Methods: A sample of n = 1,755 students from a large public school district self-reported on their life satisfaction, optimism, and symptoms of sadness across two time points: First, in their Grade 7 year (pre-pandemic; January to March, 2020) and then 1 year later in their Grade 8 year (during the pandemic; January to March, 2021). In Grade 8, students also reported on pandemic-specific experiences, including changes in mental health, social relationships, and activities, as well as coping strategies and positive changes since the pandemic. Data were collected online using the Middle Years Development Instrument (MDI), a population-based self-report tool that assesses children's social-emotional development and well-being in the context of their home, school, and neighborhood. Multivariable linear regression analyses were used to examine associations between pandemic-related changes in relationships and perceived safety from getting COVID-19 at school with changes in well-being outcomes., Results: Students reported a range of experiences, with a large proportion reporting moderate concerns and impacts of the pandemic, including worries about their mental health and missing school activities. Students reported significantly lower optimism, lower life satisfaction, and higher sadness compared to the previous year. Within the sample, improvements in relationships with parents and other adults at home was associated with higher well-being during the pandemic., Implications: Results from this study can inform decision making of policy-makers, educators, and practitioners working with youth, by providing information on students' experiences during the pandemic and identifying factors that may be protective for students' mental health during and beyond the pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Gadermann, Thomson, Gill, Schonert-Reichl, Gagné Petteni, Guhn, Warren and Oberle.)

Background: Growing evidence suggests that exposure to green space is associated with improved childhood health and development, but the influence of different green space types remains relatively unexplored. In the present study, we investigated the association between early-life residential exposure to vegetation and early childhood development and evaluated whether associations differed according to land cover types, including paved land., Methods: Early childhood development was assessed via kindergarten teacher-ratings on the Early Development Instrument (EDI) in a large population-based birth cohort (n = 27,539) in Metro Vancouver, Canada. The residential surrounding environment was characterized using a high spatial resolution land cover map that was linked to children by six-digit residential postal codes. Early-life residential exposure (from birth to time of EDI assessment, mean age = 5.6 years) was calculated as the mean of annual percentage values of different land cover classes (i.e., total vegetation, tree cover, grass cover, paved surfaces) within a 250 m buffer zone of postal code centroids. Multilevel models were used to analyze associations between respective land cover classes and early childhood development., Results: In adjusted models, one interquartile range increase in total vegetation percentage was associated with a 0.33 increase in total EDI score (95% CI: 0.21, 0.45). Similar positive associations were observed for tree cover (β-coefficient: 0.26, 95% CI: 0.15, 0.37) and grass cover (β-coefficient: 0.12, 95% CI: 0.02, 0.22), while negative associations were observed for paved surfaces (β-coefficient: -0.35, 95% CI: -0.47, -0.23)., Conclusions: Our findings indicate that increased early-life residential exposure to vegetation is positively associated with early childhood developmental outcomes, and that associations may be stronger for residential exposure to tree cover relative to grass cover. Our results further indicate that childhood development may be negatively associated with residential exposure to paved surfaces. These findings can inform urban planning to support early childhood developmental health., (Copyright © 2022. Published by Elsevier Ltd.)

Objectives: To estimate the diagnosed incidence of non-affective psychotic disorder between the ages of 13 and 19 years in South-Western British Columbia (BC) and to examine variation in risk by sex, family and neighbourhood income, family migration background, parent mental health contact and birth year., Methods: Linked individual-level administrative data were used to construct a cohort of individuals born in 1990-1998 and residing in South-Western BC ( n  = 193,400). Cases were identified by either one hospitalization or two outpatient physician visits within 2 years with a primary diagnosis of a non-affective psychotic disorder (ICD-10: F20-29, ICD-9: 295, 297, 298). We estimated cumulative incidence, annual cumulative incidence and incidence rate between the ages of 13 and 19 years, and conducted Cox proportional hazards regression to estimate associations between sociodemographic factors and risk over the study period., Results: We found that 0.64% of females and 0.88% of males were diagnosed with a non-affective psychotic disorder between the ages of 13 and 19 years, with increasing risk observed over the age range, especially amongst males. Incidence rate over the entire study period was 106 per 100,000 person-years for females and 145 per 100,000 person-years for males. Risk of diagnosis was elevated amongst those in low-income families and neighbourhoods, those with a parent who had a health service contact for a mental disorder, and more recent birth cohorts. Risk was reduced amongst children of immigrants compared to children of non-migrants., Conclusions: Findings from this study provide important information for health service planning in South-Western BC. Future work should examine whether variations in diagnosed incidence is driven by differences in health service engagement or reflect genuine differences in risk.

Background: Refugee children face numerous challenges associated with pre-migration trauma and post-migration adaptation. Much research pertaining to refugee children's well-being focuses on psychiatric symptoms. Relatively few studies have examined how social context factors-such as perceptions of peer belonging, and support from adults at home and at school-contribute to the emotional health of refugee children. Informed by social-ecological theories emphasizing dynamic interactions between the contexts in which children develop, we examined associations between social context factors and emotional health in refugee children., Methods: Data were drawn from a population-based data linkage in British Columbia, Canada. The analytic sample included 682 grade 4 students (M age 9.2 years; 46.3% female) with a refugee background who responded to the Middle Years Development Instrument (MDI) during the 2010/2011-2016/2017 school years. The MDI is a self-report survey of children's social and emotional competencies and social context factors completed at school. Regression analyses were used to examine associations of social context factors (school climate, supportive adults at school and at home, and peer belonging) with indicators of emotional health (life satisfaction, self-concept, optimism, and sadness). Refugee generation status (first/second) was considered through stratification and testing of interactions with social context factors., Results: Perceived supportive school climate, support from adults in school and at home, and peer belonging were each independently associated with better emotional health. Results were similar for first- and second-generation children., Conclusion: Taken together, results suggest a unique role of the school context to refugee children's emotional health. School-based programming that promotes positive school climate can be considered as an important approach to support newcomer refugee children and their families., (© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Emerging studies have associated low greenspace and high air pollution exposure with risk of child attention deficit/hyperactivity disorder (ADHD). Population-based studies are limited, however, and joint effects are rarely evaluated. We investigated associations of ADHD incidence with greenspace, air pollution, and noise in a population-based birth cohort., Methods: We assembled a cohort from administrative data of births from 2000 to 2001 (N ∼ 37,000) in Metro Vancouver, Canada. ADHD was identified by hospital records, physician visits, and prescriptions. Cox proportional hazards models were applied to assess associations between environmental exposures and ADHD incidence adjusting for available covariates. Greenspace was estimated using vegetation percentage derived from linear spectral unmixing of Landsat imagery. Fine particulate matter (PM 2.5 ) and nitrogen dioxide (NO 2 ) were estimated using land use regression models; noise was estimated using a deterministic model. Exposure period was from birth until the age of three. Joint effects of greenspace and PM 2.5 were analysed in two-exposure models and by categorizing values into quintiles., Results: During seven-year follow-up, 1217 ADHD cases were diagnosed. Greenspace was associated with lower incidence of ADHD (hazard ratio, HR: 0.90 [0.81-0.99] per interquartile range increment), while PM 2.5 was associated with increased incidence (HR: 1.11 [1.06-1.17] per interquartile range increment). NO 2 (HR: 1.01 [0.96, 1.07]) and noise (HR: 1.00 [0.95, 1.05]) were not associated with ADHD. There was a 50% decrease in the HR for ADHD in locations with the lowest PM 2.5 and highest greenspace exposure, compared to a 62% increase in HR in locations with the highest PM 2.5 and lowest greenspace exposure. Effects of PM 2.5 were attenuated by greenspace in two-exposure models., Conclusions: We found evidence suggesting environmental inequalities where children living in greener neighborhoods with low air pollution had substantially lower risk of ADHD compared to those with higher air pollution and lower greenspace exposure., (Copyright © 2022. Published by Elsevier Ltd.)

Background: Research has shown that longer hours of screen time are negatively associated with children's healthy development. Whereas most research has focused on school-age children, less is known about this association in early childhood. To fill this gap, we examined the association between screen time and developmental health in preschool-aged children., Methods: This study draws from a data linkage on children (N = 2983; Mean age = 5.2, SD = 0.3 years, 51% male) in British Columbia (BC), Canada, who entered Kindergarten in public elementary schools in 2019. Parent reports on children's screen time, health behaviors, demographics, and family income collected upon kindergarten entry (09/2019), were linked to teacher reports on children's developmental health, collected halfway through the school year (02/2020). Screen time was assessed with the Childhood Experiences Questionnaire. Developmental vulnerability versus developmental health in five domains (physical, social, emotional, language and cognition, and communication skills) was measured with the Early Development Instrument., Results: Logistic regression analyses using generalized estimating equation showed that children with more than one hour of daily screen time were more likely to be vulnerable in all five developmental health domains: physical health and wellbeing (odds ratio [OR] =1.41; 95% confidence interval [CI], 0.99 - 2.0; p=0.058), social competence (OR=1.60; 95% CI, 1.16 - 2.2; p=0.004), emotional maturity (OR=1.29; 95% CI, 0.96 - 1.73; p=0.097), language and cognitive development (OR=1.81; 95% CI, 1.19 - 2.74; p=0.006) and communication skills (OR=1.60; 95% CI, 1.1 - 2.34; p=0.015) compared to children reporting up to one hour of screen time/day. An interaction effect between income and screen time on developmental health outcomes was non-significant. Results were adjusted for child demographics, family income, and other health behaviors., Conclusions: Daily screen time that exceeds the recommended one-hour limit for young children, as suggested by the Canadian 24-h Movement Guidelines for Children and Youth (Tremblay et al. BMC Public Health. 17:874, 2017; Tremblay J Physical Activity Health. 17:92-5, 2020) is negatively associated with developmental health outcomes in early childhood. Screen-based activities should thus be limited for young children. Future research needs to examine the underlying mechanisms through which screen time is linked to developmental vulnerabilities., (© 2022. The Author(s).)

Importance: There remains limited understanding of population-level patterns of mental disorder prevalence for first- and second-generation immigrant and refugee children and youth and how such patterns may vary across mental disorders., Objective: To examine the diagnostic prevalence of conduct, attention-deficit/hyperactivity disorder (ADHD), and mood/anxiety disorders in immigrant, refugee, and nonimmigrant children and youth in British Columbia, Canada., Design, Setting, and Participants: This retrospective, population-level cohort study examined linked health administrative records of children and youth in British Columbia (birth to age 19 years) spanning 2 decades (1996-2016). Physician billings, hospitalizations, and drug dispensations were linked to immigration records to estimate time-in-British Columbia-adjusted prevalence of mental disorder diagnosis among children and youth from immigrant or refugee backgrounds compared with those from nonimmigrant backgrounds. Analyses were conducted from August 2020 to November 2021., Main Outcomes and Measures: The diagnostic prevalence of conduct, ADHD, and mood/anxiety disorders were the main outcomes. Results were stratified by migration category (immigrant, refugee, nonimmigrant), generation status (first- and second-generation), age, and sex., Results: A total of 470 464 children and youth in British Columbia were included in the study (227 217 [48.3%] female). Nonimmigrant children and youth represented 65.5% of the total study population (307 902 individuals). Among those who migrated, 142 011 (87.8%) were first- or second-generation immigrants, and 19 686 (12.2%) were first- or second-generation refugees. Diagnostic prevalence of mental disorders varied by migration category, generation status, age, and sex. Children and youth from immigrant and refugee backgrounds (both first- and second-generation), compared with nonimmigrant youth, generally had a lower prevalence of conduct disorder (eg, age 6-12 years: first-generation immigrant, 2.72% [95% CI, 2.56%-2.90%] vs nonimmigrant, 7.03% [95% CI, 6.93%-7.13%]), ADHD (eg, age 6-12 years: first-generation immigrant, 4.30% [95% CI, 4.10%-4.51%] vs nonimmigrant, 9.20% [95% CI, 9.08%-9.31%]), and mood/anxiety disorders (eg, age 13-19 years: first-generation immigrant, 11.07% [95% CI, 10.80%-11.36%] vs nonimmigrant, 24.54% [95% CI, 24.34%-24.76%]). Among immigrant children and youth, second-generation children and youth generally showed higher prevalence of conduct, ADHD, and mood/anxiety disorders than first-generation children and youth (eg, ADHD among second-generation immigrants aged 6-12 years, 5.94% [95% CI, 5.75%-6.14%]; among first-generation immigrants aged 6-12 years, 4.30% [95% CI, 4.10%-4.51%]). Second-generation refugee children had the highest diagnostic prevalence estimates for mood/anxiety in the 3-to-5-year age range relative to first- and second-generation immigrant and nonimmigrant children (eg, second-generation refugee, 2.58% [95% CI, 2.27%-2.94%] vs second-generation immigrant, 1.78% [95% CI, 1.67%-1.89%]). Mental disorder diagnoses also varied by age and sex within immigrant, refugee, and nonimmigrant groups., Conclusions and Relevance: These findings show differences in diagnostic mental disorder prevalence among first- and second-generation immigrant and refugee children and youth relative to nonimmigrant children and youth. Further investigation is required into how cultural differences and barriers in accessing health services may be contributing to these differences.

Background: Exposure to greenspace is associated with improved childhood development, but the pathways behind this relationship are insufficiently understood. Therefore, we aimed to investigate the association between lifetime residential exposure to greenspace and early childhood development and evaluate the extent to which this association is mediated by reductions in traffic-related air pollution and noise., Methods: This population-based birth cohort study comprised singleton births in Metro Vancouver, BC, Canada, between April 1, 2000, and Dec 31, 2005. Children and mothers had to be registered with the mandatory provincial health insurance programme, Medical Services Plan, and have lived within the study area from the child's birth to the time of outcome assessment. Early childhood development was assessed via teacher ratings on the Early Development Instrument (EDI), and we used the total EDI score as the primary outcome variable. We estimated greenspace using percentage vegetation derived from spectral unmixing of annual Landsat satellite image composites. Lifetime residential exposure to greenspace was estimated as the mean of annual percentage vegetation values within 250 m of participants' residential postal codes. Multilevel modelling, adjusted for eight covariates, was used to investigate associations between greenspace exposure and EDI scores. We estimated the mediation effects of nitrogen dioxide (NO 2 ), fine particulate matter (PM 2·5 ), and noise levels using causal mediation analyses., Findings: Of the 37 745 children born in Metro Vancouver between April 1, 2000, and Dec 31, 2005, 27 372 were included in our final study sample. In the adjusted model, 1 IQR increase in percentage vegetation was associated with a 0·16 (95% CI 0·04-0·28; p=0·0073) increase in total EDI score, indicating small improvements in early childhood development. We estimated that 97·1% (95% CI 43·0-396·0), 29·5% (12·0-117·0), and 35·2% (17·9-139·0) of the association was mediated through reductions in NO 2 , PM 2·5 , and noise, respectively., Interpretation: Increased exposure to residential greenspace might improve childhood development by reducing the adverse developmental effects of traffic-related exposures, especially NO 2 air pollution. Our study supports the implementation of healthy urban planning and green infrastructure interventions., Funding: Canadian Institutes of Health Research., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Indigenous leaders are gravely concerned over disproportionate representation of Indigenous children in Canada's child welfare systems. Forced separation from children is deeply traumatizing for mothers and detrimental to the wellbeing of Indigenous families, communities and Nations. This study examined relationships between child apprehension and suicide attempt within a cohort of young Indigenous women impacted by substance use. We utilized data collected every 6 months (2008-2016) by the Cedar Project, an Indigenous-governed cohort study involving young Indigenous people who use drugs in British Columbia, Canada. Recent child apprehension was defined as having a child apprehended by the Ministry of Child and Family Development since last visit. Recurrent event Cox proportional hazards models estimated the independent effect of child apprehension on maternal suicide attempt. Among 293 participants, 78 (27%) reported 136 child apprehensions; incidence of first apprehension was 6.64 (95%CI: 5.25-8.29) per 100 person-years. Forty-seven (16%) participants reported 75 suicide attempts with an incidence of 4.00 (95%CI: 2.94-5.33) per 100 person-years. Participants who reported recent child apprehension (HR: 1.88, 95%CI: 1.00-3.55), had a parent attend residential school (HR: 4.12, 95%CI: 1.63-10.46), experienced recent sexual assault (HR: 4.04, 95%CI: 2.04-7.99), violence (HR: 2.54, 95%CI: 1.52-4.27) or overdose (HR: 4.97, 95%CI: 2.96-8.35) were more likely to attempt suicide. Participants who had a traditional language spoken in the home growing up were half as likely to attempt suicide (HR: 0.49, 95%CI: 0.23-1.01). Results suggest that child welfare systems in Canada perpetuate historical and intergenerational trauma among young Indigenous mothers. Indigenous self-determination over child welfare and culturally safe services are urgently needed to end cycles of child apprehension and support the wellbeing of families, communities and Nations., Competing Interests: The authors have declared that no competing interests exist.

Background: Several studies have assessed the relationship between exposure to natural environments (NEs) and childhood mental health and development. In most cases, a positive association has been found, but results are inconsistent, and the strength of association is unclear. This inconsistency may reflect the heterogeneity in measurements used to assess NE., Objectives: This systematic review aims to identify the most common NE metrics used in childhood mental health and development research. Our second aim is to identify the metrics that are most consistently associated with health and assess the relative strength of association depending on type of NE exposure measurement, in terms of metric used (i.e., measurement technique, such as remote sensing), but also rate (i.e., spatial and temporal exposure)., Methods: We used the PRISMA protocol to identify eligible studies, following a set of pre-defined inclusion criteria based on the PECOS strategy. A number of keywords were used for retrieving relevant articles from Medline, Embase, PsychINFO, and Web of Science databases between January 2000-November 2020. From these, we extracted data on type of NE measurement and relative association to a number of indicators of childhood mental health and development. We conducted a systematic assessment of quality and risk of bias in the included articles to evaluate the level of evidence. Case studies and qualitative studies were excluded., Results: After screening of title (283 studies included), abstract, and full article, 45 studies were included in our review. A majority of which were conducted in North America and Europe (n = 36; 80%). The majority of studies used land use or land covers (LULC, n = 24; 35%) to determine exposures to NEs. Other metrics included the normalized difference vegetation index (NDVI), expert measures (e.g., surveys of data collection done by experts), surveys (e.g., self-reported assessments), and use of NE (e.g., measures of a participant's use of NE such as through GPS tracts or parent reports). Rate was most commonly determined by buffer zones around residential addresses or postal codes. The most consistent association to health outcomes was found for buffers of 100 m, 250 m, 500 m, and within polygons boundaries (e.g., census tracts). Six health categories, academic achievement, prevalence of doctor diagnosed disorders, emotional and behavioral functioning, well-being, social functioning, and cognitive skills, were created post hoc. We found sufficient evidence between NDVI (Landsat) and emotional and behavioral well-being. Additionally, we found limited evidence between LULC datasets and academic achievement; use of NE, parent/guardian reported greenness, and expert measures of greenness and emotional and behavioral functioning; and use of NE and social functioning., Discussion: This review demonstrates that several NE measurements must be evaluated further before sufficient evidence for a potential association between distinct NE exposure metrics and childhood mental health and development can be established. Further, we suggest increased coordination between research efforts, for example, by replication of studies and comparing different NE measurements systematically, so that effect sizes can be confirmed for various health outcomes. Finally, we recommend implementing research designs that assess underlying pathways of nature-health relations and utilize measurement techniques that adequately assess exposure, access, use, and perception of NEs in order to contribute to a better understanding of health impacts of surrounding natural environments., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Background: Though prenatal antidepressant exposure has been associated with adverse developmental outcomes, the extent to which the effects are due to prenatal drug exposure or underlying maternal mood disturbances is unclear., Methods: This was a population-based retrospective cohort study using administrative data from British Columbia, Canada (n = 94,712). Analyses were designed to remove confounding effects of prenatal antidepressant exposure from maternal mood. First, children prenatally exposed to antidepressants were matched to unexposed children using high-dimensional propensity scores (HDPS). Second, children whose mothers had used antidepressants throughout pregnancy were compared against those whose mothers discontinued treatment., Results: In all, 3.87% (n = 3661) of children in the overall study population were prenatally exposed to antidepressants. In both analyses, we report increased odds for lower levels of physical independence (HDPS: OR, 1.14; 95% CI, 1.00-1.30; continuers/discontinuers: OR, 1.14; 95% CI, 0.99-1.32), and higher levels of anxious behaviors (HDPS: OR, 1.30; 95% CI, 1.01-1.66; continuers/discontinuers: OR, 1.32; 95% CI, 1.01-1.72) associated with antidepressant use in pregnancy. All other relationships were not significant using these methods., Conclusions: Prenatal antidepressant exposure was selectively associated with worse anxious behaviors and physical independence at kindergarten age, with no effects on other developmental domains. Effects are also likely attributable to maternal mental illness severity or other unmeasured confounding factors., Impact: Selective associations between prenatal antidepressant exposure and children's anxiety and physical independence at kindergarten were identified, with no impact on other developmental domains. Contradictory reports have emerged regarding the association of adverse child outcomes with prenatal antidepressant exposure. These inconsistencies may be due to differences in control for confounding. Effects of prenatal antidepressant exposure on anxious behaviors and physical independence are likely also attributable to severity of underlying maternal mood disorders, highlighting the importance of maternal mental health for developmental health.

Objective: To further understandings of household food insecurity in First Nations communities in Canada and its relationship with obesity., Design: Analysis of a cross-sectional dataset from the First Nations Food, Nutrition and Environment Study representative of First Nations communities south of the 60th parallel. Multivariate logistic regression was used to assess associations between food insecurity and sociodemographic factors, as well as the odds of obesity among food-insecure households adjusting for sociodemographic characteristics., Setting: Western and Central Canada., Participants: First Nations peoples aged ≥19 years., Results: Forty-six percent of First Nations households experienced food insecurity. Food insecurity was highest for respondents who received social assistance; had ≤10 years of education; were female; had children in the household; were 19-30 years old; resided in Alberta; and had no year-round road access into the community. Rates of obesity were highest for respondents residing in marginally food-insecure households (female 56·6 %; male 54·6 %). In gender-specific analyses, the odds of obesity were highest among marginally food-insecure households in comparison with food-secure households, for both female (OR 1·57) and male (OR 1·57) respondents, adjusting for sociodemographic variables. For males only, those in severely food-insecure (compared with food-secure) households had lower odds of obesity after adjusting for confounding (OR 0·56)., Conclusions: The interrelated challenges of food insecurity and obesity in First Nations communities emphasise the need for Indigenous-led, culturally appropriate and food sovereign approaches to food security and nutrition in support of holistic wellness and prevention of chronic disease.

Background: The Early Development Instrument (EDI) was developed as a population-level assessment of children's developmental health at school entry. EDI data collection has created unprecedented opportunities for population-level studies on children's developmental outcomes. The goal of this narrative review was to synthesize research using the EDI to describe how it contributes to expanding the understanding of the impacts of social determinants on child development and how it applies to special populations., Methods: Select studies published in peer-reviewed scientific journals between 2015 and 2020 and incorporating the social determinants of health perspectives were chosen to highlight the capability of the EDI to monitor children's developmental health and contribute knowledge in the area of early childhood development., Results: A number of studies have examined the association between several social determinants of health and children's developmental outcomes, including hard-to-reach and low-frequency populations of children. The EDI has also been used to evaluate programs and interventions in different countries., Conclusions: The ability of the EDI to monitor children's developmental outcomes in various populations has been consistently demonstrated. The EDI, by virtue of its comprehensive breadth and census-like collection, widens the scope of research relating to early childhood development and its social determinants of health.

Objectives: The goal of this study was to investigate socio-demographic and contextual factors in relation to the frequency of outdoor play in the neighbourhood in early childhood, drawing from a large sample of children in British Columbia, Canada., Methods: Parents/caregivers of 2280 4- to 5-year-old children completed the Childhood Experiences Questionnaire (CHEQ) in 2018. Binary logistic regression analyses were conducted to predict the likelihood of children participating in everyday outdoor play in their neighbourhood based on the child's gender, family ethnicity (i.e., European origin vs. other), household income (i.e., less vs. equal/more than CDN$75,000), population centre (i.e., urban vs. rural) and parent's trust in neighbours (i.e., trusting vs. not trusting neighbours to look out for children)., Results: Thirty-five percent of children in this study met recommendations of playing outdoors every day. Children whose parents perceived strong trust in neighbours were twice as likely to play outdoors in their neighbourhood every day, when compared with those whose parents perceived low trust in neighbours. Additionally, children from families with higher incomes (equal/more than $75,000) were significantly more likely to play outdoors daily than those with lower incomes, but only if they resided in rural areas. Last, children with European family backgrounds were 64% more likely to play outdoors every day compared with those with non-European backgrounds., Conclusion: Findings from this study contribute to an emerging body of work examining socio-economic, demographic and contextual factors associated with children meeting the recommendations for everyday outdoor play in their neighbourhood.

The prevalence of Fetal Alcohol Spectrum Disorder (FASD) may be underestimated as it can be difficult to diagnose in early childhood possibly reflecting unique developmental trajectories relative to other Neurodevelopmental Disabilities (NDDs). Using data collected via the Early Development Instrument (EDI) between 2010 and 2015, we examined the prevalence of kindergarten children with FASD and their concurrent developmental outcomes. We found that the prevalence of FASD ranged from 0.01 to 0.31%. A greater percentage of children with FASD had teacher-reported home problems that interfered with their classroom functioning. Overall children with FASD had higher mean scores on the developmental domains compared to children with NDDs. Results of the current study can inform strategies and policies for early identification and intervention.

This study examines adolescents' (N = 28,712; 49% female; M age  = 12.25, SD age  = 0.51) recreational screen time and participation in extracurricular activities during after-school hours in association to indicators of positive (optimism, satisfaction with life) and negative (anxiety, depressive symptoms) mental health and wellbeing. Data were drawn from a population-level study with the Middle Years Development Instrument (MDI) with grade 7 students in British Columbia (BC), Canada. The research was implemented in public school districts between 2014 and 2018. We found that adolescents who participated in extracurricular activities (e.g., sports, arts programs, community programs) were significantly less likely to engage in recreational screen-based activities (e.g., watching programs, browsing the internet, playing computer games) for 2 or more hours after school. Findings from Multilevel Structural Equation Modeling analyses showed that extracurricular participation was associated with higher levels of satisfaction with life and optimism, and lower levels of anxiety and depressive symptoms. In contrast, longer screen time (≥2 h/day) was associated with lower levels of satisfaction with life and optimism, and higher levels of anxiety and depressive symptoms; shorter screen time (<2 h/day) was associated with favorable mental health and wellbeing. For screen time, the effect was moderated by gender; the association between longer screen time and poorer mental health and wellbeing was significantly more pronounced for girls than boys. For both boys and girls, mental health and wellbeing were most favorable if they participated in extracurricular activities and reported less than 2 h of recreational screen time per day., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background and Purpose: E-health interventions can provide Canadian adolescents (13-17 years old) with personalized support to help them modify their obesogenic behaviors. However, use of e-health interventions among adolescents has not been extensively examined. This study examined user characteristics and parenting practices associated with adolescents' initial use of the Aim2Be app; a health behavior modification intervention delivered through a smartphone app. Methods: A total of 371 adolescent-parent dyads completed a baseline assessment and were invited to use the Aim2Be app. Mean adolescent age was 14.9 years and 50.1% were male ( n  = 186). Mean adult age was 44.1 years and 34.7% were male ( n  = 129). Using Mplus (v.8), path analyses were completed to identify adolescent characteristics and parenting practices that were significantly associated with initial use of the app. Analyses were then stratified to explore whether these associations were confounded by parents' gender. Results: 79.2% of adolescents ( n  = 294) initially used the Aim2Be app. Adolescent engagement in healthy behaviors was directly associated with increased odds of using the app (odds ratio [OR] = 1.08; 95% confidence interval [CI] = 1.01-1.14), whereas autonomous motivation was indirectly associated (OR = 1.02; 95% CI = 1.00-1.04). Structure parenting practices were indirectly associated with increased odds of using the app (OR = 1.02; 95% CI = 1.00-1.04). When analyses were stratified by parent's gender, differences in the associations emerged. Conclusions: Both user characteristics and parenting practices were significantly associated with adolescents' initial use of Aim2Be. These findings will help inform future e-health interventions increase user engagement by identifying the characteristics of individuals who are not accessing the intervention, as well as identifying factors of the household environment that support use.

Objective: To examine the relationship between developmental health and neighbourhood socioeconomic status (SES) in kindergarten children with disabilities., Design: Cross-sectional study using population-level database of children's developmental health at school entry (2002-2014)., Setting: 12 of 13 Canadian provinces/territories., Measures: Taxfiler and Census data between 2005 and 2006, respectively, were aggregated according to custom-created neighbourhood boundaries and used to create an index of neighbourhood-level SES. Developmental health outcomes were measured for 29 520 children with disabilities using the Early Development Instrument (EDI), a teacher-completed measure of developmental health across five domains., Analysis: Hierarchical generalised linear models were used to test the association between neighbourhood-level SES and developmental health., Results: All EDI domains were positively correlated with the neighbourhood-level SES index. The strongest association was observed for the language and cognitive development domain (β (SE): 0.29 (0.02)) and the weakest association was observed for the emotional maturity domain (β (SE): 0.12 (0.01))., Conclusions: The magnitude of differences observed in EDI scores across neighbourhoods at the 5th and 95th percentiles are similar to the effects of more established predictors of development, such as sex. The association of SES with developmental outcomes in this population may present a potential opportunity for policy interventions to improve immediate and long-term outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Studies have consistently demonstrated a gradient between median neighbourhood income and child developmental outcomes. By investigating statistical outliers-neighbourhoods with children exhibiting less or more developmental vulnerability than that predicted by median neighbourhood income-there is an opportunity to identify other neighbourhood characteristics that may be enhancing or impeding early childhood development., Objective: Testing a variety of neighbourhood factors, including immigrant or ethnic concentration and characteristics of structural disadvantage (proportion of social assistance recipients, homes in need of major repair, residents with high school education only, lone parent families, and residents moving in the last year) we sought to identify factors associated with more or less developmental vulnerability than that predicted by median neighbourhood income, for young children., Methods: For this cross-sectional study we used validated Early Development Instrument (EDI) data (2003-2013) linked to demographic and socioeconomic Census and Tax Filer data for 98.3% of Canadian neighbourhoods (n=2,023). The purpose of the instrument is to report, at a population-level, children's school readiness. Children's developmental vulnerability was assessed in five domains (physical health and well-being, emotional maturity, social competence, language and cognitive development, and communication and general knowledge) in relation to the 10th percentile from a national normative sample. Levels of children's neighbourhood vulnerability were determined per domain, as percent of children vulnerable at a given domain. Neighbourhoods were grouped into three cohorts, those having lower than predicted, as predicted, or higher than predicted children's vulnerability according to neighbourhood median income. Using multivariable binary logistic regression we modelled the association between select neighbourhood characteristics and neighbourhoods with lower or higher than predicted vulnerability per domain, compared to neighbourhoods with predicted vulnerability. This allowed us to determine neighbourhood characteristics associated with better or worse child developmental outcomes, at a neighbourhood-level, than that predicted by income., Results: In neighbourhoods with less child developmental vulnerability than that predicted by income, high or low immigrant concentration and ethnic homogeneity was associated with less vulnerability in physical (adjusted odds ratio (aOR) 1.66, 95% CI: 1.43, 1.94), social (aOR 1.30, 95% CI: 1.11, 1.51), and communication domains (aOR 1.24, 95% CI: 1.03, 1.47) compared to neighbourhoods with vulnerability concordant with income. Neighbourhood ethnic homogeneity was consistently associated with less developmental vulnerability than predicted by income across all developmental domains. Neighbourhood-level structural disadvantage was strongly associated with child developmental vulnerability beyond that predicted by median neighbourhood income., Conclusion: Canadian neighbourhoods demonstrating less child developmental vulnerability than that predicted by income have greater ethnic and ethnic-immigrant homogeneity than neighbourhoods with child developmental vulnerability concordant with income. Neighbourhood social cohesion and cultural identity may be contributing factors. Neighbourhood structural disadvantage is associated with poorer early childhood development, over and above that predicted by neighbourhood income. Neighbourhood-level policy and programming should address income and non-income related barriers to healthy child development., Competing Interests: Conflicts of Interest: The authors declare they have no conflicts of interest.

Using a linked population-based database established on healthcare, socio-economic, and survey datasets in British Columbia, Canada, we examined how biological, socio-demographic, and socio-economic status (SES) factors at birth related to children's emotional development and mental health. One analysis examined teacher-rated anxiety, hyperactivity, and aggression for kindergarten children (M age  = 5.7; n = 134,094). Another analysis examined administrative healthcare records comprising of physician-assigned diagnostic codes for mental health conditions (conduct disorder, attention deficit hyperactivity disorder, anxiety disorder and depression) from ages 5 through 15 (n = 89,404). Various factors at birth, including gestational age, birthweight, and maternal demographics, were related to emotional development and mental health in childhood. Across outcomes, low SES indicated detrimental associations with various aspects of children's emotional development and mental health (e.g., adjusted odds of mental health conditions were 25-39% higher for children of low income families versus others). Findings reinforce evidence that poverty (reduction) is a primary public health issue.

Poverty has a well-established association with poor developmental outcomes in children but is often found to be a weak predictor of outcomes for migrant children. Building on theory focused on the developmental competencies of minority children, the current study used a systematic and novel analytic approach to disentangle the relationship between income and developmental outcomes for different groups of migrant children. Utilizing a population-based cohort of children in British Columbia, Canada (N = 23,154), the study examined whether income differently predicted the kindergarten to Grade 7 (K-7) literacy and numeracy trajectories of migrant children (economic, family, and refugee groups), in comparison to non-migrants. By applying Group-Based Trajectory Modeling (GBTM), the study found that lower income was generally associated with lower K-7 literacy and numeracy achievement trajectories. The relationship between income and achievement did not differ for migrant children in comparison to non-migrant children, with the exception of one sub-group of high-achieving economic class migrant children, which appeared to be less impacted by low income levels. Follow-up binomial logistic regression analysis found that parental education levels at migration and English language ability predicted which migrant children would be high literacy and numeracy achievers despite low income. The results suggest that basic associations between poverty and the outcomes of migrant children mask an underlying complexity: For most migrant children, poverty was just as predictive of detrimental academic outcomes as it was for non-migrant children and being in the exceptional sub-group of high-achieving, low-income migrant children was partly accounted for by other protective factors., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Sex differences in early child development (ECD) are well documented, as is the socioeconomic status (SES) gradient in early development outcomes. However, relatively little is known about whether the SES gradient in ECD outcomes varies by sex. This study examines whether the association between neighbourhood SES and developmental health outcomes of Canadian kindergarten children is different for girls than for boys. Individual-level child development data, collected using the Early Development Instrument (EDI), were combined with neighbourhood-level socioeconomic data from Statistics Canada's Census and Tax Filer databases. Using an SES index comprising 10 socioeconomic variables, we show a significant cross-level interaction between neighbourhood SES and sex in relation to children's developmental outcomes: the neighbourhood SES gradient in child outcomes is steeper for males than for females. This finding was consistent across all five developmental domains measured by the EDI, for overall developmental health, and across geographical regions in Canada. Further research using family-level SES data, data from multiple time points and countries, and qualitative studies would help to further contextualize the observed interactions., Competing Interests: None., (© 2019 The Authors.)

Extracurricular participation plays an important role in positive youth development. Yet, little is known about the stability and change in extracurricular participation from middle childhood to early adolescence. Also, there is a gap in knowledge about the underlying processes that drive developmental outcomes associated with extracurricular participation. The present study examined transitions in extracurricular participation from grade 4 to 7, and investigated whether shifting from non-participation to participation in activities was associated with better mental health, considering peer belonging as a mediator. Latent Class Analyses of early adolescents' (50% female) self-reports on the Middle Years Development Instrument in grades 4 and 7 (N = 10,149) revealed four clusters of extracurricular involvement at both grade levels (i.e., "no activities", "all activities", "sports only", "individual activities"). Latent Transition Analysis showed that young people were most likely to stay in the same activities cluster from grade 4 to 7. About 10% were non-participants in grade 4 and had moved to activities by grade 7. In this subgroup, moving from non-participation to both sports and to all activities was associated with better mental health over time; this pathway was fully mediated by higher levels of peer belonging. The results suggest that supporting non-participants to join extracurricular activities can have implications for their mental health. Practical implications for communities, such as removing potential barriers to involvement before the onset of adolescence, are discussed.

This study examined profiles of participation in extracurricular activities (ECAs) in 4th grade children (N = 27,121; Mean age = 9.20 years; SD = .54; 51% male) in British Columbia, Canada. Latent class analyses were used to establish activity profiles and determine class membership; ANCOVA was used to investigate differences in mental wellbeing (optimism, life satisfaction, self-concept) and perceived overall health between groups. Data came from a cross-sectional, population-level child self-report survey (i.e., the Middle Years Development Instrument) implemented with 4th grade children in public schools. We found four distinct ECA profiles: participation in "All Activities", "No activities", "Sports" (i.e., individual and team sports), and "Individual activities" (i.e., educational programs, arts/music, individual sports). Wellbeing and health scores were highest for children in the "All Activities" and the "Sports" clusters, and lowest for those in "No Activities" and the cluster reflecting individual activities (i.e., "Individual activities"). Results are discussed in the context of previous research, and with respect to practical relevance., Competing Interests: The authors have declared that no competing interests exist.

Background: Despite its popularity, issues concerning the estimation of power in multilevel logistic regression models are prevalent because of the complexity involved in its calculation (i.e., computer-simulation-based approaches). These issues are further compounded by the fact that the distribution of the predictors can play a role in the power to estimate these effects. To address both matters, we present a sample of cases documenting the influence that predictor distribution have on statistical power as well as a user-friendly, web-based application to conduct power analysis for multilevel logistic regression., Method: Computer simulations are implemented to estimate statistical power in multilevel logistic regression with varying numbers of clusters, varying cluster sample sizes, and non-normal and non-symmetrical distributions of the Level 1/2 predictors. Power curves were simulated to see in what ways non-normal/unbalanced distributions of a binary predictor and a continuous predictor affect the detection of population effect sizes for main effects, a cross-level interaction and the variance of the random effects., Results: Skewed continuous predictors and unbalanced binary ones require larger sample sizes at both levels than balanced binary predictors and normally-distributed continuous ones. In the most extreme case of imbalance (10% incidence) and skewness of a chi-square distribution with 1 degree of freedom, even 110 Level 2 units and 100 Level 1 units were not sufficient for all predictors to reach power of 80%, mostly hovering at around 50% with the exception of the skewed, continuous Level 2 predictor., Conclusions: Given the complex interactive influence among sample sizes, effect sizes and predictor distribution characteristics, it seems unwarranted to make generic rule-of-thumb sample size recommendations for multilevel logistic regression, aside from the fact that larger sample sizes are required when the distributions of the predictors are not symmetric or balanced. The more skewed or imbalanced the predictor is, the larger the sample size requirements. To assist researchers in planning research studies, a user-friendly web application that conducts power analysis via computer simulations in the R programming language is provided. With this web application, users can conduct simulations, tailored to their study design, to estimate statistical power for multilevel logistic regression models.

Importance: More than 50% of lifetime mental health disorders develop by early adolescence, and yet it is not well understood how early childhood social-emotional functioning varies in populations or how differences in functioning may be associated with emerging mental health conditions., Objectives: To identify profiles of social-emotional functioning at kindergarten school entry (age 5 years) and to examine to what extent profiles are related to early-onset mental health conditions (ages 6-14 years)., Design, Setting, and Participants: This prospective cohort study followed up a population cohort of 34 552 children in British Columbia, Canada, from birth (born 1996-1998) to age 14 years (last follow-up, December 31, 2011). Data were analyzed from the Developmental Trajectories cohort that links British Columbia child development data from the Early Development Instrument (EDI) to British Columbia Ministry of Health and Ministry of Education records. Data were analyzed between May and September 2017., Exposures: Early childhood social-emotional functioning (defined as social competence, internalizing, and externalizing symptoms) rated by the children's kindergarten teachers., Main Outcomes and Measures: Occurrences of physician-assessed mental health conditions throughout childhood and early adolescence, including depression, anxiety, conduct disorder, and attention-deficit/hyperactivity disorder (ADHD), calculated from billing codes from the International Classification of Diseases, Ninth Revision recorded in provincial health insurance data., Results: Data from 34 323 children (mean [SD] age, 5.7 [0.3] years; 17 538 [51.1%] were boys) were analyzed at kindergarten and followed up to age 14 years (15 204 completed follow-up). Latent profile analysis identified 6 unique social-emotional functioning profiles at school entry, with 41.6% of children (n = 14 262) exhibiting comparative vulnerabilities in internalizing or externalizing behaviors. Prevalence of mental health conditions from ages 6 to 14 years was 4.0% for depression, 7.0% for anxiety, 5.5% for conduct disorder, 7.1% for ADHD, and 5.4% for multiple conditions. Zero-inflated Poisson analyses showed an association between social-emotional functioning profiles at kindergarten school entry and physician-assessed mental health conditions by age 14 years (range of adjusted odds ratios: depression, 1.10 [95% CI, 0.76-1.60] to 2.93 [95% CI, 1.93-4.44]; anxiety, 1.00 [95% CI, 0.74-1.36] to 1.73 [95% CI, 1.11-2.70]; conduct disorder, 2.17 [95% CI, 1.41-3.34] to 6.91 [95% CI, 4.90-9.74]; ADHD, 1.46 [95% CI, 1.11-1.93] to 8.72 [95% CI, 6.46-11.78]; and multiple conditions, 1.20 [95% CI, 0.88-1.63] to 6.81 [95% CI, 4.91-9.44]). Children with higher teacher ratings of aggression and hyperactivity had more frequent consultations for conduct disorder, ADHD, and multiple conditions., Conclusions and Relevance: This study's findings suggest that more than 40% of children enter the school system with relative vulnerabilities in social-emotional functioning that are associated with early-onset mental health conditions. The results raise important questions for using population-level early childhood development monitoring in the context of universal and proactive mental health strategies.

Introduction: Deficiencies in childhood development is a major global issue and inequalities are large. The influence of environmental exposures on childhood development is currently insufficiently explored. This project will analyse the impact of various modifiable early life environmental exposures on different dimensions of childhood development., Methods: Born to be Wise will study a Canadian cohort of approximately 34 000 children who have completed an early development test at the age of 5. Land use regression models of air pollution and spatially defined noise models will be linked to geocoded data on early development to analyse any harmful effects of these exposures. The potentially beneficial effect on early development of early life exposure to natural environments, as measured by fine-grained remote sensing data and various land use indexes, will also be explored. The project will use data linkages and analyse overall and age-specific impact, including variability depending on cumulative exposure by assigning time-weighted exposure estimates and by studying subsamples who have changed residence and exposure. Potentially moderating effects of natural environments on air pollution or noise exposures will be studied by mediation analyses. A matched case-control design will be applied to study moderating effects of natural environments on the association between low socioeconomic status and early development. The main statistical approach will be mixed effects models, applying a specific software to deal with multilevel random effects of nested data. Extensive confounding control will be achieved by including data on a range of detailed health and sociodemographic variables., Ethics and Dissemination: The study protocol has been ethically approved by the Behavioural Research Ethics Board at the University of British Columbia. The findings will be published in peer-reviewed journals and presented at scholarly conferences. Through stakeholder engagement, the results will also reach policy and a broader audience., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The Satisfaction With Life Scale adapted for Children (SWLS-C) is a self-report measure of children's quality of life and has exhibited sound psychometric properties. In light of increasing ethno-cultural diversity, it is important to understand child life satisfaction across diverse subgroups. Employing children's language background as a proxy for cultural background among children in British Columbia, Canada, we examined (a) the cross-cultural measurement equivalence of the SWLS-C; and (b) cross-cultural relations of peer support and adult support with SWLS-C., Methods: Participants were 20,119 children (M age 9.2; 50.2% boys) who provided data as part of a self-report child health survey (the Middle-years Development Instrument). Measurement equivalence across eight language/cultural background groups was tested via multi-group confirmatory factor analysis. Multi-level analyses were used to compare: a) SWLS-C means; and b) associations of peer support and adult support with SWLS-C scores, by language/cultural background., Results: Findings supported strict measurement equivalence between the English language/cultural background group and all other language/cultural background groups for the SWLS-C. Relative to the English language background group, SWLS-C means differed for several language/cultural background groups. Within every language/cultural background group, however, peer and adult support scale scores were significant positive correlates of SWLS-C scores., Conclusions: This study provided evidence for measurement equivalence of a life satisfaction measure across children from diverse language/cultural backgrounds and identified between-group differences in the level of child life satisfaction that were generally consistent with prior theory and findings. Moreover, results provided evidence of promotive associations of adult support and peer support with life satisfaction among diverse groups of children.

Objectives: The present study examined the degree to which early adolescents' relationship experiences in school (i.e., peer group belonging, peer victimization, and supportive relationships with adults)-at the individual level and at the school-level-were associated with their dispositional optimism, concurrently and over time., Method: Self-report data from over 4000 4th and 7th graders were obtained via a population-level measure designed to assess students' supportive relationships, well-being, and resilience (i.e., the Middle Years Development Instrument). An indicator for family income (SES) was obtained through tax filer information., Results: Multilevel modeling revealed that in Grade 4, greater peer belonging, fewer experiences of peer victimization, and higher levels of adult support in school were linked to higher optimism, above and beyond the effects of sex, age, English as a Second Language (ESL), and SES. Additionally, school-wide levels of peer belonging and adult support (i.e., indicators of a supportive social school climate) were significant positive school-level predictors of optimism. Longitudinally, school-wide peer belonging in Grade 4 was associated to increases in students' optimism from 4th to 7th grade., Conclusions: The findings suggest that positive relationship experiences in school are key contributors to positive mental health, over and above the absence of negative relationship experiences (i.e., victimization). These findings also suggest that being embedded in a school with a positive social relational climate contributes to students' current and future positive mental health, over and above individual relationships with peers and adults. The present research extends previous research by identifying contextual assets that are linked to dispositional optimism and can be applied in the context of school-based intervention programs to promote positive mental health in schools., (Copyright © 2018. Published by Elsevier Ltd.)

The Canadian Neighbourhoods and Early Child Development (CanNECD) database is a unique resource for research on child developmental health and well-being within the socioeconomic and cultural context of Canadian neighbourhoods. This paper describes the CanNECD database and highlights its potential for advancing research at the intersection of child development, social determinants of health, and neighbourhood effects. The CanNECD database contains cross-sectional population-level child developmental health data from all across Canada collected through regional implementation of the Early Development Instrument (EDI), geo-coded information on residential neighbourhoods covering all of Canada, and socioeconomic and demographic variables from the Canada Census and Income Taxfiler database. Individuals are not identified in the database, as no identifying information, such as names and addresses, is attached to the EDI record. At data collection, each individual child is given a unique number which is a combination of site, school, and position on a class list. Each neighbourhood receives a unique identifier which then is linkable across datasets. The nearly 800,000 EDI records spanning 2003-2014 and representing all Canadian provinces and territories (with the exception of Nunavut) are compiled in a secure electronic collection system at the Offord Centre for Child Studies, McMaster University in Hamilton, Canada. Early studies using the EDI demonstrated its utility as a tool for assessing child developmental health at a population level, and its potential for both community-level and large-scale monitoring of child populations. Research using the CanNECD database is now examining to what extent social determinants and the steepness of the social gradients of developmental health differ between geographical jurisdictions and between different sub-populations. We are also working to identify outlier neighbourhoods in which EDI scores are substantially higher or lower than predicted by a neighbourhood's demographic and socioeconomic characteristics, and exploring other potentially important determinants of children's developmental health. Finally, we are examining the extent to which change-over-time in aggregate EDI scores varies geographically, and how well it coincides with changes in socioeconomic factors. Thus, the CanNECD database offers the opportunity for research that will inform national policies and strategies on child developmental health., Competing Interests: Conflict of Interest Statement: The authors declare that they have no competing interests.

This paper examined measurement invariance (MI), both across gender and over time, of the Satisfaction With Life Scale adapted for Children (SWLS-C). Adapted from the adult SWLS, the SWLS-C is a self-report measure for children and adolescents to assess their life satisfaction. The sample comprised elementary school students in British Columbia, Canada (n = 4,026) who responded to the SWLS-C in Grade 4 (M(age) = 9.3, SD = 0.6; 48.9% girls) and approximately 3 years later in Grade 7. We examined MI regarding gender, time, and both gender and time (i.e., interactional invariance) using Clustered Repeated Measures Multi-Group Confirmatory Factor Analysis with a mean- and variance-adjusted weighted least squares (WLSMV) estimation. Residual invariance by gender was supported at Grades 4 and 7; scalar invariance was supported longitudinally for each gender and overall. In the "interactional" model, including gender and time, analyses indicated scalar MI, but not residual MI. Analyses of latent factor means indicated that SWLS-C scores significantly decreased for both girls and boys from Grade 4 to Grade 7. The decrease was more pronounced for girls, but gender differences at either age were not significant. The pattern of observed mean scores differed, as it indicated no significant decrease for boys' SWLS-C scores, but significant gender differences at both time points. However, given the lack of residual invariance, comparisons of observed SWLS-C mean scores across gender and over time may be compromised. The different results for latent and observed mean SWLS-C scores highlight the importance of routinely conducting MI analyses for group comparisons. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Introduction: Health disorders early in life have tremendous impact on children's developmental trajectories. Almost 80% of children with health disorders lack the developmental skills to take full advantage of school-based education relative to 27% of children without a health disorder. In Canada, there is currently a dearth of nationally representative data on the social determinants of early childhood development for children with health disorders. Evidence from Canada and other countries indicate that poorer developmental outcomes in typically developing children are associated with lower socioeconomic status (SES). However, to date, it is not known whether this relationship is stronger among children with health disorders. The study's objectives are to estimate the prevalence and to investigate social determinants of developmental outcomes for young children with health disorders, using the Early Development Instrument (EDI)., Methods and Analysis: Study objectives will be achieved through three steps. First, using existing EDI data for 10 provinces and 2 territories collected from 2004 to 2015, we will investigate differences in developmental health outcomes among children with identified health disorders. Second, population-level EDI data will be linked with neighbourhood sociodemographic census data to explore associations between socioeconomic characteristics and rates of specific diagnoses among children aged 5-6 years, including trends over time. Third, for 3 of these 12 regions, additional health and/or education databases will be linked at an individual level. These data will be used to establish differences in EDI outcomes in relation to the age-of-onset of diagnosis, and presence of intervention or treatment., Ethics and Dissemination: Study methodologies have been approved by the Hamilton Integrated Research Ethics Board. The results of the analyses of developmental health outcomes for children with health disorders combined with SES will have implications for both health service delivery and school-based intervention strategies. Results will contribute to a framework for public policy., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Ethnic minorities form an increasingly large proportion of Canada's population. Living in areas of greater ethnic density may help protect mental health among ethnic minorities through psychosocial pathways such as accessibility to culturally appropriate provision of mental health care, less discrimination and a greater sense of belonging. Mood and anxiety disorders are common psychiatric disorders., Aim: This study examined whether ethnic density of regions was related to mood and anxiety disorders among ethnic minorities in Canada., Method: Responses by ethnic minority individuals to the 2011-2014 administrations of the Canadian Community Health Survey ( n =  33,201) were linked to health region ethnic density data. Multilevel logistic regression was employed to model the odds of having mood and/or anxiety disorders associated with increasing region-level ethnic density and to examine whether sense of community belonging helped explain variance in such associations. Analyses were adjusted for individual-level demographic factors as well as region-level socio-economic factors., Results: Higher ethnic density related to lower odds of mood and/or anxiety disorders for Canadian-born (but not foreign-born) ethnic minorities. Sense of community belonging did not help explain such associations, but independently related to lower odds of mood and/or anxiety disorders. These findings remained after adjusting for regional population density and after excluding (rural/remote) regions of very low ethnic density., Conclusion: Ethnic density of regions in Canada may be an important protective factor against mental illness among Canadian-born ethnic minorities. It is important to better understand how, and for which specific ethno-cultural groups, ethnic density may influence mental health.

Background: Very little research exists that looks at the Ages and Stages Questionnaire simultaneously from a modern latent variable point of view and by looking at its psychometric properties over time., Aims: To explore the latent factor structure of the ASQ using Exploratory Structural Equation Modeling techniques for ordinal data and investigate its change over time using the method of vertical scaling from multidimensional Item Response Theory., Study Design: Longitudinal, with the same children being assessed at multiple timepoints., Subjects: Children measured using the 12, 14, 16, 18, 20, 22, 24, 27, 30, 33, 36, 42, 48month questionnaires of the ASQ. Initial sample (12months) consisted of 2219 children and final sample (48months), 892 children due to drop-out., Outcome Measures: Ages and Stages Questionnaire, 3rd version (ASQ-3)., Results: Results indicate that all ASQ-3 age questionnaires examined showed the proposed 5-factor structure (except the 12-month version) but with different patterns over time. The Gross Motor domain had the fewest misfitting items, from 12months onwards. The Personal-Social domain and the Problem Solving domain had larger numbers of misfitting items. Results from the vertical scaling analysis showed that both the Problem-Solving and Personal-Social dimensions also exhibited the most complex patterns of change over time., Conclusions: The psychometric properties of the ASQ-3 seem to be both time-dependent and domain-dependent. Earlier questionnaires reflect a latent structure that was not as well-defined as for later versions. Also, domains such as Communication and Gross Motor appear to be much more reliably measured than others, such as Problem-Solving and Personal-Social., (Copyright © 2017 Elsevier B.V. All rights reserved.)