Multilevel determinants of children's health outcomes
| dc.contributor.advisor | Muhajarine, Nazeem | en_US |
| dc.creator | Vu, Lan Thi Hoang | en_US |
| dc.date.accessioned | 2005-09-05T22:29:44Z | en_US |
| dc.date.accessioned | 2013-01-04T04:56:32Z | |
| dc.date.available | 2006-09-06T08:00:00Z | en_US |
| dc.date.available | 2013-01-04T04:56:32Z | |
| dc.date.created | 2005-08 | en_US |
| dc.date.issued | 2005-08-17 | en_US |
| dc.date.submitted | August 2005 | en_US |
| dc.description.abstract | Background: Children’s health, particularly in the early years, forms the basis of future health and development and plays a significant role in predicting individual life and opportunities. Thus, studies which enhance the understanding of the determinants of children’s health status are needed. Previous research on children’s health had focused on the family’s and infant’s characteristics and ignored the potential impact of macro-level influences. The objectives of this thesis were (i) to examine the independent effects of neighbourhood factors on childhood health outcomes, (ii) to explore neighbourhood moderating effects on the associations between some individual risk factors and childhood health outcomes, and (iii) to quantify the contribution of neighbourhood factors to childhood health outcomes.Method: The study population included 9,888 children born to women residing in Saskatoon during three years, 1992-1994. The data used in this study were extracted from three sources. The information related to birth outcomes and the mother’s characteristics was extracted from the birth registration files maintained by Saskatchewan’s Vital Statistics Branch. The health services utilization information was generated from Saskatchewan Health’s computerized administrative databases. The information related to the neighbourhood characteristics was obtained from Statistics Canada’s 1991 Census, from local sources such as the Planning Department of the City, and two specialized neighbourhood surveys. Six domains of neighbourhood were examined in this study: socio-economic disadvantage, social interaction, physical condition, population density, local programs and services, and unhealthy lifestyle norm. This study was divided into two focused topics corresponding to two children’s health outcomes: low birth weight (LBW) and children’s hospitalizations (both incidence and length of stay). Multilevel modelling was employed to examine the independent/moderating impacts of neighbourhood characteristics on these children’s health outcomes. GIS mapping was used to visualize the associations between neighbourhood characteristics and children’s health outcomes.Findings of focused topic 1: There was a significant variation across Saskatoon neighbourhoods in the distribution of LBW rate. This significant variation was attributed to both the characteristics of individuals living within the neighbourhoods as well as the characteristics of the neighbourhood of residence. Neighbourhood variables were both independent risk factors for LBW and moderators for the association between maternal characteristics and LBW. Specifically, a greater level of socio-economic disadvantage, a lower level of program availability and accessibility within the neighbourhoods were associated with a higher risk of LBW. A significant interaction between neighbourhood social interaction and single parent status was found. The risk of single parent status on LBW was mitigated by a greater level of social interaction within neighbourhoods. With individual level variables held constant, three neighbourhood variables predicted LBW, together contributing to a change in LBW rate of 7.0%.Findings of focused topic 2: This focused topic employed a longitudinal/multilevel design to examine the effects of socio-economic status at multiple levels on children’s hospitalization. The key findings of this focused topic are the following: (i) There was a gradient association between the number of adverse birth outcomes and childhood hospitalization; (ii) There was a significant interaction between family income and adverse birth outcomes (i.e., the effect of adverse birth outcomes on childhood hospitalization was heightened among those children living in low income families); (iii) Neighbourhood characteristics, specifically neighbourhood socio-economic disadvantage, neighbourhood physical condition, and neighbourhood population density had independent effects on childhood hospitalization over and above the effect of family income; (iv) With individual level variables held constant, three neighbourhood variables (i.e., neighbourhood socio-economic disadvantage, physical condition and population density) together accounted for a variation of 40% in the incidence rate of hospitalization, and two neighbourhood variables (i.e., neighbourhood socio-economic disadvantage and physical condition) together accounted for a change in the length of stay per hospitalization from 2.88 days to 5.18 days across neighbourhoods.Conclusion: Both individual and neighbourhood characteristics determined childhood health outcomes examined. Neighbourhood factors acted as independent risk factors as well as moderators on the association between individual risk factors and health outcomes. The contribution of neighbourhood factors to children’s health outcomes was quite substantial. The findings suggest that future interventions aimed at improving children’s health status in Saskatoon may be enhanced by targeting both high risk individuals and high risk neighbourhoods. The geographical variations in children’s health outcomes reported in this study are modifiable; they can be altered through public policy and urban planning, and through the efforts of families and children. | en_US |
| dc.identifier.uri | http://hdl.handle.net/10388/etd-09052005-222944 | en_US |
| dc.language.iso | en_US | en_US |
| dc.subject | low birth weight | en_US |
| dc.subject | use of hospital services | en_US |
| dc.subject | multilevel analysis | en_US |
| dc.subject | Children's health | en_US |
| dc.title | Multilevel determinants of children's health outcomes | en_US |
| dc.type.genre | Thesis | en_US |
| dc.type.material | text | en_US |
| thesis.degree.department | Community Health and Epidemiology | en_US |
| thesis.degree.discipline | Community Health and Epidemiology | en_US |
| thesis.degree.grantor | University of Saskatchewan | en_US |
| thesis.degree.level | Doctoral | en_US |
| thesis.degree.name | Doctor of Philosophy (Ph.D.) | en_US |