Adiposity and behavioural self-regulation in the early years of Quebec's universal childcare policy: a population-based, longitudinal study of children age 0 to 13 years

Not all Canadian children are provided with the resources and support needed for healthy development. The high prevalence of childhood obesity in Canada is one such unjust burden on youth, and socioeconomically disadvantaged children disproportionately suffer. Early childhood weight gain and behavioural self-regulation are independent predictors of adolescent health, and self-regulation may play a role in weight gain. Affordable high-quality preschool childcare programs should possibly be part of the public health approach to prevention of obesity and the promotion of child well-being. However, Quebec’s universal childcare policy, les Centres de la petite enfance (CPE), has had mixed results. This thesis examines the effect of preschool childcare on adiposity and self-regulation, and of self-regulation on adiposity in Quebec children age 6 to 13 years.The study population included 1657 children participating in l’Étude longitudinale du développement de l’enfant au Québec (ELDEQ), a representative survey of Quebec children born in 1997-98. ELDEQ coincided with the early years of the CPE program and the participants became eligible for it at 2 years old. This context and the rich longitudinal data from ELDEQ provided an opportunity to estimate overall and sub-group causal effects of childcare on self-regulation and adiposity, and whether effects changed with age. Nevertheless, to minimize confounding, account for serial outcomes, and maintain representativeness in these observational studies, a variety of sophisticated statistical methods was needed.In manuscript 1, serial measures of BMI z-score and obesity status from age 6 to 13 years were regressed on detailed measures of childcare used from 2 to 5 years, and adjusted for pre-childcare variables using Bayesian multilevel (generalized) linear models. Population-averaged treatment effects were estimated for four counterfactual childcare profiles: 1) parental care, 2) center-based, 3) CPE-regulated home-based, and 4) unregulated home-based. Centre-based childcare led to higher adiposity than CPE-regulated home-based care and parental care. However, CPE-regulated home-based care was slightly favourable compared to unregulated home-based care.In manuscript 2, I used a similar analytic strategy to estimate the effect of preschool childcare on self-regulation from age 6 to 12 years. First, I estimated plausible values of latent self-regulation scores at 6, 7, 8, 10 and 12 years from manifest behaviours of inattentiveness, hyperactivity, and impulsivity rated by mothers and teachers. CPE-regulated centre- and home-based care had small detrimental effects on self-regulation compared parental care. In both manuscripts 1 and 2, effect measure modification by family disadvantage and sex was somewhat unclear, but less advantaged children were generally not at higher risk of adiposity or self-regulation deficits due to childcare type.In manuscript 3, I estimated the association between serial measures of adiposity from age 7 to 13 years and the 3-year mean of self-regulation score prior to each adiposity measure, controlling for confounders. Self-regulation was not associated with mean BMI z-score or probability of obesity, regardless of age and sex.High-quality public childcare has demonstrated benefits for children’s cognitive and social development, and for mothers’ labour force participation, but there is little evidence from past research or the results of this thesis that public childcare programs have had benefits for adiposity or self-regulation in school-aged children, generally, or in disadvantaged children. Likewise, while the promotion of self-regulation may have many benefits, it is unlikely to be an effective obesity prevention strategy in early and middle childhood. The intensification of the services offered in public childcare may achieve positive results on adiposity and self-regulation, but broader structural and environmental improvements offer more promise

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