A Multilevel Analysis of the Contribution of Individual, Socioeconomic and Geographical Factors on Kindergarten Children’s Developmental Health: A Saskatchewan Province-Wide Study

Abstract

In current literature of child public health, a growing number of studies has been dedicated to early childhood development with a focus on child developmental health measured via the teacher completed Early Development Instrument (EDI). Using multilevel modeling as the optimal statistical method to analyze hierarchical EDI data, this study determines the strength of the effect and significance of predictors of children’s 5 EDI outcomes, vulnerability, and the multiple vulnerability by taking into account the hierarchy present in its design. In addition, this study conducts an extensive epidemiological review of the risk factors associated with a child’s developmental health at each level of the hierarchy, at cross-levels of the hierarchy and their variations across different levels of the hierarchy. This cross-sectional study considered 9045 Saskatchewan children who were ages 4-8 years in the 2008-2009 school years. Individual child characteristics, EDI domains, and vulnerability data were collected by the Ministry of Education teachers in the provincial 2008 EDI project; neighborhood contextual Census data were compiled by SPHERU staff at the University of Saskatchewan. Multilevel linear and logistic models were used to analyze the data. According to the results, individual characteristics, such as being Aboriginal, an ESL learner, male, and being absent from school; neighborhood characteristics such as income inequality; and geographical characteristics such as living in a large city have negative effects on EDI scores and exacerbating the odds of vulnerability. Compounding effects of Aboriginal-special skills, large city-Aboriginal, and large city-neighborhood median income were positive on the above outcomes with considerable either significance or strength, while those of neighborhood income inequality-Aboriginal, and large city-neighborhood income inequality were negative with notable significance and strength. Furthermore, neighborhood contextual variables contribute to a considerable proportion of health outcome variations and the results associated with neighborhood income inequality give further evidence of the income inequality hypothesis. The findings of this study recommend provincial child public health policy makers’ extended attention to Aboriginal children, children with ESL status, those children living in neighborhoods with high income inequality and children from Regina.