Measuring the impact of universal childcare program on mental health and substance use behaviours in adolescents: evidence from a longitudinal cohort in Quebec
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".