Doctor of Philosophy in Population and Public Health (PhD)
Intersectoral and placed-based approaches to fostering equity in children's development
Dissertations completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest dissertations.
The full abstract for this thesis is available in the body of the thesis, and will be available when the embargo expires.
Early childhood is a critical developmental period when children form social and emotional sensitivities that will support or undermine their mental health throughout their lives. It is estimated that over half of lifetime mental health problems develop before the age of fourteen, and yet early identification and intervention efforts are often hindered by limited recognition of early mental health indicators and a general absence of population-level monitoring systems. This dissertation addresses these gaps, applying a novel approach (person-centered analysis) to identify latent profiles of social-emotional functioning within population cohorts of children entering Kindergarten in British Columbia from 2001 to 2012. Early childhood social-emotional functioning was measured using the teacher-rated Early Development Instrument (EDI) population health survey that includes measures of internalizing and externalizing behaviours (readiness to explore, aggression, hyperactivity) as well as social competence. Latent profile analysis was used to identify distinguishable profiles of early childhood social-emotional functioning at a population-level. Unique profiles of social-emotional functioning were identified consistently across the three analyses included in this dissertation, with over 55% of children demonstrating overall high social-emotional functioning, over 40% of children demonstrating relative vulnerabilities in internalizing and externalizing behaviours, and approximately 3% of children experiencing multiple comorbid vulnerabilities on nearly all measures. Chapter 2 identifies social gradients in the severity of early childhood social-emotional vulnerabilities, with boys and lower income children over-represented in lower functioning social-emotional profiles. Chapter 3 examines children’s likelihood of depression, anxiety, conduct disorder, attention deficit hyperactivity disorder, and multiple conditions, and finds that the profile group to which children belong in Kindergarten is predictive of their experience of mental health conditions up to ten years later. Chapter 4 demonstrates that children’s Kindergarten social-emotional profile group is also predictive of their self-reported well-being in middle childhood, with evidence that supportive relationships with adults and peers partially mediates these associations. These studies inform our understanding of patterns of early childhood social-emotional functioning by identifying social conditions and behaviour patterns predictive of children’s future mental health outcomes that can be targeted earlier in the life course to help mitigate mental health problems and promote well-being.
Theses completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest theses.
In Canada, community-based, integrated youth services have gained popularity as models of care that have the potential to address some of the longstanding challenges with youth mental health services. While context has been recognized as an important aspect in the implementation of these models, there is a lack of knowledge regarding how different features of community context might influence the way different models of these community-based, integrated youth services develop in general and their integration processes in particular. This study addresses this gap by examining how specific domains of community context influenced the development of Foundry Centres, which are integrated youth services established in different communities across British Columbia through the Foundry initiative. To explore community context further, community coalition action theory (CCAT) was applied as an organizing framework from the community coalition literature. The research described in this thesis emerged from my experience working on an independent developmental evaluation of Foundry’s proof-of-concept phase where new questions came to light during the analysis process. Using a multiple case study approach informed by an ecological perspective, this thesis examined the influence of seven domains of community context on the development of two Foundry Centres. The data used for this study included 50 interviews carried out for the evaluation as well as nine new interviews. Framework analysis revealed that all seven domains of community context influenced the development of the Foundry Centres, with community collaboration, norms and values, and readiness influencing the broadest range of factors associated with development. Moreover, the integration experiences at both centres were highly sensitive to community context, particularly community collaboration, geography, readiness and needs. Overall, the CCAT offered a relevant framework from which to understand the influence of community context on the development of community-based, integrated youth services. Future studies may enhance its relevance by shifting to a more holistic conceptualization of context where the combined effects of contextual domains are assessed. The evidence generated from this research may be used to support and guide future implementations of community-based, integrated youth services that are sensitive to communities’ rich histories and diverse, place-based identities.
Background: The Family Stress Model suggests that socioeconomic status (SES) and family supports (e.g., social supports, community supports and resources) are key predictors of child health. However, it is recognized that there is a gap in the literature applying this knowledge to young children. In this study, a modified version, where there was only a focus on three components of the Family Stress Model is applied to test the main and moderating effects among these variables and their ability to predict overall health in toddlers (ages 12-24 months). Purpose: The purpose of this study was to analyze and identify key findings from the Toddler Development Instrument (TDI) data regarding the associations between economic hardship (household income), social supports (access to family supports) and child health, using a modified Family Stress Model. Methods: Binary logistic regression was used to perform analysis on 803 surveys collected from participating parents of toddlers aged 12-24 months as part of the TDI pilot project data collected through the Human Early Learning Partnership (HELP) at the University of British Columbia (UBC). Data were collected from families across British Columbia, Canada at family and community centers, using convenience sampling. Results: Results showed that SES (household income) and access to family supports was significantly associated with child health. Additionally, access to family supports mediated the relationship between household income and child health. Moderating effects of access to family supports on the relationship of household income and child health were not found to be significant. Conclusions: The study findings support the Family Stress Model and add evidence to the literature that SES and access to family supports are predictors of child health. Attention to these predictors can help researchers, policy makers and providers prioritize areas of support for families with young children.
No abstract available.
BACKGROUND: Understanding the measurement of life satisfaction and its association with social supports among children from diverse language backgrounds is a key step of measuring healthy child development in British Columbia (BC). The Satisfaction with Life Scale adapted for Children is a self-report measure of child life satisfaction and has exhibited sound psychometric properties for a representative population of children in BC. If found to show measurement equivalence (ME) across subgroups, SWLS-C means and correlates can be meaningfully compared across such subgroups. Peer and adult support positively relate to SWLS-C scores for BC children overall but such relationships are unknown for specific language background groups. Using language background as a proxy for cultural background, this thesis examined: 1) the cross-cultural ME of the SWLS-C; 2) cross-cultural differences in SWLS-C means; 3) the cross-cultural ME of peer support and adult support scales; 4) cross-cultural associations of peer and adult support with SWLS-C scores. METHOD: Participants were 20,119 BC children (Mage 9.2; 50.2% male) who completed the SWLS-C, peer support, and adult support scales as part of a child health survey (the Middle-Years Development Instrument). ME of the SWLS-C, peer support, and adult support scales was examined across eight cultural (i.e., language) background groups. Means and inter-relationships of the SWLS-C, peer support, and adult support scales were estimated across cultural background groups.RESULTS: Findings supported ME between the English group and: all other cultural background groups for the SWLS-C, three other cultural background groups for the peer support scale, and six other cultural background groups for the adult support scale. Relative to the English group, SWLS-C means differed for several cultural background groups - variation consistent with mean differences for the peer support and adult support scales. Within each cultural background group, peer and adult support scale scores positively related to SWLS-C scores. DISCUSSION: This thesis provided evidence for meaningful comparison of life satisfaction, peer support, and adult support means across diverse cultural background groups, highlighting differences in life satisfaction between cultural background groups of children, but underscored the importance of fostering adult and peer support to promote healthy child development.
Background: Indigenous leaders are deeply concerned about the overrepresentation of Indigenous children in Canada’s child welfare system. However, few studies have addressed the relationship between family disruption, cultural connectedness, substance use and mental health among Indigenous families within the context of historical and intergenerational trauma. Objective: First, a scoping review examined culturally safe services and interventions to support Indigenous families involved in substance use. Second, the incidence of child apprehension and association with suicide attempt was investigated among young Indigenous mothers who have used drugs. Methods: A scoping review was conducted of the empirical literature examining interventions for Indigenous families involved in substance use in Canada, Australia, New Zealand and the United States. For longitudinal analysis, we utilized data collected every 6 months between 2008 and 2016 by the Cedar Project, a prospective cohort study involving young Indigenous people who use drugs in Vancouver and Prince George, British Columbia, Canada. A recurrent event Cox proportional hazards model was used to estimate the independent effect of child apprehension on suicide attempt among female participants. Unadjusted and adjusted hazard rations (HRs) were reported with 95% confidence intervals. Results: There were few studies in the research literature evaluating culturally safe services and interventions for Indigenous families involved in substance use. We found an independent association between child apprehension and suicidal behaviour: young Indigenous mothers who reported recent child apprehension were twice as likely to attempt suicide over the study period. We discovered other risk factors for suicidal behaviour, including having a parent attend residential school, sexual assault, violence, and overdose. Young Indigenous mothers who had a traditional language spoken in the home growing up were almost half as likely to attempt suicide. Conclusion: Our results provide evidence to suggest the child welfare system perpetuates intergenerational trauma among Indigenous communities. Young Indigenous mothers in this study were more likely to attempt suicide after their children were apprehended, which was compounded by historical and lifetime trauma. However, cultural connectedness may protect against suicidal behaviour in this population. Indigenous jurisdictional control over child welfare and more culturally safe services are urgently needed to keep families together.
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