Measuring the impact of universal childcare program on mental health and substance use behaviours in adolescents: evidence from a longitudinal cohort in Quebec
Notice bibliographique
Résumé
Background Social inequalities in health emerge during early childhood. Interventions such as access to quality childcare services have the potential to promote child development, mitigate inequalities in health, and affect the development of human capital. The Quebec Family Policy proposed a series of new measures, including universal childcare and parental leave, and was implemented in 1997 with this objective in mind. It represents a unique opportunity to evaluate the effects of a universal and subsidized childcare program on child health outcomes and socioeconomic inequalities in health. Few studies have evaluated the long-term health effects of childcare and previous research on behavioural and mental health outcomes has produced heterogeneous results. Objectives The primary objective of this study was to measure the impact of Quebec's universal childcare policy, and specifically the utilization of subsidized childcare, on children's health, including mental health outcomes and substance use in adolescence. A secondary objective was to evaluate whether the impact varies across socioeconomic status (SES), given that the Quebec Family Policy's aim is to alter the distribution of social determinants of health. MethodsData from a longitudinal cohort of children born in Quebec between October 1997 and July 1998 (n= 2,120) was used. Primary childcare arrangement was classified as CPE care (Centre de la Petite Enfance affiliated settings; subsidized), non-CPE care (non-affiliated non-subsidized settings), or no formal childcare. Primary outcomes were behaviors, mental health, and substance use in adolescents at age 15, including: internalized and externalized behaviours, physical aggression, depressive and anxiety symptoms, and substance use. A multitude of child and family characteristics were included in the analysis to control for potential confounding using propensity score inverse propensity weights (PS-IPW). The association between childcare attendance, comparing CPE-care to other childcare arrangements, and outcomes of interest, were estimated by Poisson regression with robust variance estimation or logistic regression, according to the outcome measured, and reported as average treatment effects. Finally, we examined if socio-economic status acted as an effect measure modifier between childcare arrangement and the outcomes of interest, in order to assess the implications of subsidized childcare on social inequalities in health. Results While baseline characteristics of participants differed significantly for key covariates including maternal education, income and employment status, we achieved comparability between participants with different childcare arrangements after PS-IPW weighting. Overall, there were no substantial risk differences in outcomes at age 15 between children exposed to CPE-type care compared to non-CPE care, and between children exposed to CPE-type care and those with no formal childcare. Likewise, the effects of childcare on reported outcomes by level of SES did not differ consistently, except for 0.14 (95%CI 0.02-0.27; p=0.02) and 0.11 (95%CI 0.01-0.22; p=0.04) increases in the probabilities of smoking and having smoked more than once per month in the past 12 months respectively, among children whose family belonged to the bottom quartile of the SES index and who attended a CPE-type care compared to those not in formal childcare; these results were not reproducible when using maternal education as the indicator of SES. Conclusion Overall, there was no consistent evidence that exposure to different childcare arrangements, following the implementation of the Quebec universal childcare program, influenced externalized and internalized behaviours, or substance use, in adolescence. Additionally, we did not observe differential impacts of subsidized childcare by socio-economic status on these outcomes.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».