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104, [email protected]. Conflict of Interest: None to declare. PubMed Central CANADA. Author Manuscript / Manuscrit d'auteur. Can J Public Health.
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PubMed Central CANADA Author Manuscript / Manuscrit d'auteur Can J Public Health. Author manuscript; available in PMC 2012 July 1. Published in final edited form as: Can J Public Health. 2012 January 1; 103(1): 76–80.

Parental Characteristics Associated With Childcare Use During the First 4 Years of Life: Results From a Representative Cohort of Québec Families Marie-Claude Geoffroy, PhD1, Jean Richard Séguin, PhD2,3, Éric Lacourse, PhD2,4, Michel Boivin, PhD5, Richard Ernest Tremblay, PhD2,6,7, and Sylvana Marie Côté, PhD2,8 1MRC

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Center of Epidemiology for Child Health, Centre for Paediatric Epidemiology & Biostatistics, Institute of Child Health, University College London, London, England 2Ste-Justine Hospital Research Center; University of Montreal, Montreal, QC 3Department of Psychiatry, University of Montreal, Montreal, QC 4Department of Sociology, University of Montreal, Montreal, QC 5School of Psychology, Laval University, Québec, QC 6International Laboratory for Child and Adolescent Mental Health, University of Montreal, Montreal, QC; INSERM U669, France 7School of Public Health and Population Science, University College Dublin, Dublin, Ireland 8Department of Social and Preventive Medicine, University of Montreal, Montreal, QC

Abstract Objective—Studies have shown that children growing up in socio-economically disadvantaged families have poorer cognitive scores than children growing up in more advantaged families, and that high-quality childcare services can reduce this gap. This effect may be attenuated, however, if disadvantaged families are less likely than better-off families to use childcare and if they use childcare of lower quality. The aim of this study was to identify factors related to parental decisions to use formal and informal childcare. Methods—Data were obtained from the Québec Longitudinal Study of Child Development, a birth cohort of children born in 1997/1998 in the Canadian province of Québec (n=1,504). Children receiving formal (e.g., family and centre) and informal (e.g., grandparents, aunt, nanny) childcare from 5 months to 4 years of age were compared to those receiving exclusively parental care on key psycho-socio-economic family factors.

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Results—Maternal unemployment during pregnancy, younger maternal age (at initiation of childbearing) and higher number of siblings (e.g., ≥2) were related to a lower probability of a child receiving either formal or informal childcare (compared to parental care). In addition, low levels of maternal education, higher levels of overprotection, and lower levels of home stimulation were related to a lower probability of a child receiving formal childcare, but not informal childcare. Insufficient income was not associated with childcare use. Conclusion—Maternal education and maternal employment were the main socio-economic barriers to childcare participation in a province offering low-cost childcare services. Future initiatives may consider prioritizing childcare access to underserved children and other (e.g., literacy-based) interventions to facilitate access.

© Canadian Public Health Association, 2012. All rights reserved. Correspondence: Dr. Marie-Claude Geoffroy, MRC Center of Epidemiology for Child Health - Centre for Paediatric Epidemiology & Biostatistics, University College London - Institute of Child Health, 30 Guilford Street, London WC1N 1EH, Tel: 44 (0) 7403 115 104, [email protected]. Conflict of Interest: None to declare.

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Keywords Socio-economic factors; health literacy; child daycare centres Evidence from interventional (e.g., High Scope Perry preschool,1 Carolina Abecedarian Project,2 Sure Start Local Programmes3) and prospective observational studies4–8 showed that the provision of childcare to disadvantaged children could promote cognitive growth and academic success, thereby attenuating socio-economic inequalities in education. Although participation in childcare may bridge a gap in development created by social disadvantage, this beneficial effect may not be attained if disadvantage reduces the likelihood of participating in childcare.9 Differences in childcare participation on the basis of education, family situation, family size, maternal age, maternal employment status and parenting style and beliefs have been reported elsewhere,10–14 but these have not been studied in the context of a low-cost childcare system such as the one in place in the province of Québec since 1997.

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Importantly, childcare use alone may not be sufficient to reduce the inequality gap; it may be that childcare of high quality is needed. Previous results with the Québec Longitudinal Study of Child Development (QLSCD) supported this notion by showing that children of mothers with low levels of education in formal childcare, which typically provided higher levels of cognitive stimulation,15 had better academic readiness and achievement than those in informal childcare or parental care.5 The moderate to large effect sizes obtained for formal childcare were comparable to those reported in interventional studies targeting disadvantaged children.16 Information about the characteristics of users of different types of childcare (e.g., formal and informal) services is needed in order to examine whether the disparities identified in previous studies are also found in the context of a low-cost childcare system, as is available in the province of Québec. A better understanding of users’ characteristics could point to the strategies needed to facilitate childcare. Therefore, this study will compare the use of formal and informal childcare versus parental care on key psycho-socioeconomic family characteristics in a large representative sample of Québec families.

METHODS Participants

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The QLSCD originally comprised 2,120 singleton live births registered in the Québec live birth registry in 1997–1998. The sample is representative of children born in the province of Québec with the exception of those born in 3 administrative regions and children born extremely prematurely (www.jesuisjeserai.stat.gouv.qc.ca). Informed written consent was obtained from all participating parents. Ethics approval for the study was obtained from the Québec Institute of Statistics. The study sample was based on 1,504 participants with complete information on childcare and psycho-socioeconomic characteristics. To draw inferences to the target population, each participant was assigned a weight, which represents the inverse probability of being selected in the original sample. Table 1 presents the descriptive statistics for the sample. Measures Outcomes Variables: Childcare Types—Childcare information was obtained at each data collection point (i.e., at 5 months and at 1.5, 2.5, 3.5 and 4 years). Following our previous work,5 childcare arrangements were classified into 3 broad categories: 1) ‘formal Can J Public Health. Author manuscript; available in PMC 2012 July 1.

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childcare’ represents care by non-relatives taking place either in a residential home (e.g., family childcare) or in a non-residential ‘school-like’ setting (e.g., childcare centre); 2) ‘informal childcare’ represents care by relatives taking place in a residential home, or care by a non-relative in the children’s own home; and 3) ‘parental care’ represents care by either parent. The “main childcare arrangement” reflected the type of childcare attended for the most hours. In the 1997–2003 period, 64.8% (n=975) of children were in formal childcare for a weekly average of 23.1 hours (SD = 10.09, median = 20), and 15.6% (n=235) were in informal childcare for a weekly average of 18.6 hours (SD = 10.16, median = 16).

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Predictor Variables: Psycho-socio-economic—Socio-economic indicators measured at 5 months of age were maternal levels of education (did not graduate from high school versus graduated from high school), maternal employment during pregnancy (employed versus unemployed) and income insufficiency (yes versus no). Insufficient income was computed from the before-taxes low income cut-off set by Statistics Canada.17 This index takes into account the size of the household and the region where it is located (e.g., urban versus rural, population density). The low income cut-off is an income level at which, on average, a person (or family) spends 20% more of their total income on food, shelter and clothing than an average person or family in a similar location. Other social and psychological factors were: family situation (1 parent versus 2 parents), sibsize (0 versus 1 or ≥2), maternal childbearing age. Maternal depressive symptoms were assessed with a short version of the Center for Epidemiologic Studies Depression Scale18 and included 13 items scored as 0 (never) to 3 (often). Home stimulation levels were obtained by summing two standardized subscales of the Home Observation for Measurement of the Environment Inventory Short-Form19 (cognitive stimulation: Cronbach alpha (α) = 0.85, and emotional relationship between the mother and the child: α = 0.87; highest values reflect a more stimulating environment). Parenting was measured with two scales from the Parental Cognitions and Conduct Toward the Infant Scale completed by the mothers:20 1) perceived parental impact (e.g., my behaviour has little effect on the intellectual development of my infant, α = 0.69; higher values reflect positive parenting); 2) over-protection (e.g., I can never bring myself to leave my infant with a baby-sitter: α = 0.58; higher values reflect poorer parenting). Statistical analyses

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To estimate whether the likelihood of participating in formal or informal childcare versus parental care differed as a function of psycho-socio-economic factors, we used multinomial logistic regressions. Logistic regressions for the following comparisons were conducted: 1) formal childcare versus parental care; 2) informal childcare versus parental care. We produced unadjusted odds ratios (UOR) and confidence intervals (95% CI) for being enrolled in formal and informal childcare (compared with parental care) for the 10 psychosocio-economic factors, and adjusted odds ratios (AOR) when all the factors were simultaneously included in the model.

RESULTS Results of the multinomial logistic regressions adjusting for all variables included in the model (see Table 2) indicate that maternal unemployment during pregnancy, younger maternal age (at initiation of childbearing) and a larger number of siblings (e.g., ≥2) were associated with lower participation in formal childcare (compared to parental care) as well as informal childcare (compared to parental care). For instance, the use of formal and informal childcare was about 80% less frequent among children of mothers who were unemployed during pregnancy than among children of employed mothers. In addition, low levels of maternal education, higher levels of overprotection, and lower levels of home

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stimulation were associated with lower participation in formal childcare (but not informal childcare) compared to parental care. Indeed, participation in formal childcare, which is typically of higher quality than informal childcare,15,21 was 67% less frequent among children of mothers with lower levels of education than among children of mothers with higher levels of education. This difference could not be attributed to the fact that mothers with low levels of education were more likely to be unemployed during pregnancy and to have an insufficient income.

DISCUSSION Using a representative sample of Québec families, we found that children were not equally likely to participate in childcare, with lower rates of participation among the most disadvantaged children, especially those of mothers who were unemployed during pregnancy and those of mothers with lower levels of education. Importantly, families with a sufficient income were not less likely to use childcare than those with a sufficient income once other factors were taken into account. Other demographic characteristics (i.e., large number of siblings and younger maternal age at initiation of childbearing) were also related to lesser utilization of formal and informal childcare arrangements.

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There is a strong association between low education levels and poor literacy.22,23 Previous studies showed associations between poor literacy and poor access to health care services,24 although one study failed to find that link.23 It is therefore plausible that the high correlation between formal childcare use and maternal education is explained by maternal level of literacy, a factor which could potentially be improved by educational interventions. Alternatively, the fact that mothers with lower levels of education are less likely to use formal childcare than mothers with higher levels of education may reflect differences in childrearing beliefs and values. One qualitative study conducted in Wisconsin (for the New Hope experimental study) reported that parents living in poverty tend to believe that formal childcare, especially when the caregiver is unknown, could compromise their child’s moral development, and therefore alternative forms of care are more attractive to them.25

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Formal (but not informal) childcare was less frequent among children of mothers with high levels of overprotection and providing lower levels of stimulation at home. Overprotective behaviours, by restricting children’s independence and autonomy, have been linked to the development of mental health problems.26 Formal childcare services may offer social opportunities to facilitate the adjustment of children of overprotective mothers. The quality of the home environment and the levels of stimulation in the home have been previously associated with the use of childcare centres14 as well as childcare quality.27 Interestingly, we found that parents who provide high levels of stimulation at home are also those who are the most likely to use formal childcare. Therefore, children from these families cumulate several advantages. There is evidence that individuals from advantaged socioeconomic backgrounds benefit more from universal programs than those from lower socio-economic backgrounds, partly because they make greater use of services.9 The present study supports this notion by showing a higher use of childcare services by socioeconomically advantaged families. Indeed, the implementation in Québec of a childcare network with some characteristics of a universal program (i.e., widely available and low cost) was accompanied by an increase in the use of regulated (but not of unregulated) childcare compared to the rest of Canada, and this was more pronounced among families with higher income.28 Following the notion that targeted programs are more effective than universal ones to reach disadvantaged families,9 facilitating the use of child-care by unemployed mothers with low levels of education could reduce the disparity in childcare use. There are three main reasons for this. First, both low

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levels of maternal education and unemployment have been associated with poorer quality of parenting and home environment.5,29 Second, low levels of maternal education have been associated with poorer outcomes in the offspring.5,30 Third, socio-economically disadvantaged children attending formal childcare show a reduced achievement gap.4–8,29 We make some additional recommendations to facilitate child-care access among children of mothers with low levels of education and/or literacy. For instance, a) childcare-related information and enrolment forms may be rewritten at a less challenging level; b) families may be reached by teaching them internet navigation skills, or by providing them with childcare information via means other than the internet (the latter being the main tool to access childcare services in Québec). For instance, pamphlets could be available at pediatric clinics or at local community centres; c) health professionals providing support to disadvantaged families may inform them about childcare options and about procedures to register their children (as early as during pregnancy), and actively explore barriers.

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Our results need to be interpreted in light of the study’s limitations. First, the almost-free out-of-pocket childcare network (i.e., parents pay $7/day for childcare) currently available in Québec was only fully implemented during the final two years of the study, limiting our ability to assess the impact of the network on social selection. Second, although we controlled for key important covariates, disparities in childcare participation may be explained by unmeasured confounds. For instance, although extremely premature children were excluded from the target QLSCD cohort, having a child with severe developmental delay or disability may also influence parental decisions about childcare settings. However, such cases were so rare that we could not investigate their role in this study. Third, we examined selection into the main type of childcare service used during the preschool years and not selection associated with the variety of settings that may have been used.

CONCLUSION The fact that disadvantaged children are less likely to be enrolled in any form of childcare, and informal childcare in particular, could produce the unintended consequence of maintaining the gap in education instead of decreasing it. Reducing inequalities in child-care use, and particularly in formal childcare use, may further contribute to reducing socioeconomic inequalities in children’s education and health. This study represents a first step in identifying socio-economic and psychological family characteristics influencing childcare decisions. Studies examining in more detail the decision-making process behind childcare choices are needed in order to gain a better understanding of the discrepancies in child-care use.

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Acknowledgments Funding/Support: This research was supported by the Ministère de la santé et des services sociaux du Québec (Québec Government’s Ministry of Health and Social Services), the Fonds de recherche en santé du Québec (FRSQ) and Canada’s Social Science and Humanities Research Council (SSHRC). Marie-Claude Geoffroy was supported by a fellowship from the Canadian Institutes of Health Research (CIHR) and Michel Boivin was supported by the Canada Research Chair Program. We thank the following for providing data collection and management: Mireille Jetté and Bertrand Perron from the Institut de la Statistique du Québec; the Fonds québecois de la recherche sur la société et la culture (FQRSC); CIHR; and the staff of the Research Unit on Children’s Psychosocial Maladjustment. Thanks also to CharlesÉdouard Giguère for his contribution to the data analysis, and to the participants of the QLSCD.

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References

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old infants in a large twin and singleton sample. J Child Psychol Psychiatry. 2005; 46(6):612–30. [PubMed: 15877767] 21. Japel, C.; Tremblay, R.; Côté, S. [Accessed November 18, 2011] Quality Counts! Assessing the quality of daycare services based on the Quebec Longitudinal Study of Child Development. Choices Institute for Research on Public Policy. 2005. Available at: http://www.irpp.org/choices/archive/vol11no5.pdf 22. Rootman I, Ronson B. Literacy and health research in Canada: Where have we been and where should we go? Can J Public Health. 2005; 96:S62–S77. [PubMed: 16078556] 23. Sanders LM, Thompson VT, Wilkinson JD. Caregiver health literacy and the use of child health services. Pediatrics. 2007; 119(1):e86–e92. [PubMed: 17200263] 24. Luman ET, McCauley MM, Shefer A, Chu SY. Maternal characteristics associated with vaccination of young children. Pediatrics. 2003; 111(5):1215–18. [PubMed: 12728141] 25. Lowe ED, Weisner TS. ‘You have to push it-who’s gonna raise your kids? ’: Situating child care and child care subsidy use in the daily routines of lower income families. Children and Youth Services Rev. 2004; 26(2):143–71. 26. Lieb R, Wittchen H-U, Hofler M, Fuetsch M, Stein MB, Merikangas KR. Parental psychopathology, parenting styles, and the risk of social phobia in offspring: A prospectivelongitudinal community study. Arch Gen Psychiatry. 2000; 57(9):859–66. [PubMed: 10986549] 27. NICHD ECCRN. Familial factors associated with the characteristics of non-maternal care for infants. J Marriage Fam. 1997; 59(2):389–408. 28. Kohen D, Dahinten VS, Khan S, Hertzman C. Child care in Québec access to a universal program. Can J Public Health. 2008; 99(6):451–55. [PubMed: 19149384] 29. Côté SM, Boivin M, Nagin DS, Japel C, Xu Q, Zoccolillo M, et al. The role of maternal education and nonmaternal care services in the prevention of children’s physical aggression problems. Arch Gen Psychiatry. 2007; 64(11):1305–12. [PubMed: 17984399] 30. Melhuish EC, Sylva K, Sammons P, Siraj-Blatchford I, Taggart B, Phan MB, et al. The early years: Preschool influences on mathematics achievement. Science. 2008; 321(5893):1161–62. [PubMed: 18755959]

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PMC Canada Author 45.1

53.1

One-parent family

Can J Public Health. Author manuscript; available in PMC 2012 July 1. 26.14 5.55 5.82 4.65 8.31

Maternal depressive symptoms

Home levels of stimulation

Maternal overprotection

Perceived parental impact

1.89

2.29

1.75

5.15

4.82

SD

M

Maternal age at childbearing

173

445

510

85

1041

247

873

54.6

63.8

≥2

1

Continuous factors ±

  

68.3

0

Number of siblings

65.2

Two-parent family

Family situation

Other social and psychological factors

72.7

231

51.7

Unemployed

884

Employed

Maternal employment during pregnancy

Insufficient

Sufficient

166

961

n

68.7

46.6

Income levels of sufficiency

68.5

Did not graduate from high school

%

Graduated from high school

Maternal education

Socio-economic Factors

Categorical Factors

Formal

8.27

4.81

5.57

5.09

25.59

M

12.9

15.9

17.5

19.4

15.8

12.4

17.6

14.8

16.2

18.5

15.3

%

2.12

2.07

1.90

5.46

5.22

SD

41

111

31

31

252

68

211

66

209

66

215

n

Informal

8.02

5.46

5.27

6.15

25.22

M

32.5

20.3

14.2

27.5

19.0

42.5

9.7

33.6

15.1

34.8

16.1

%

2.15

2.24

1.89

5.21

5.65

SD

103

142

106

44

303

233

117

150

194

124

226

n

Parental Care

Descriptive Statistics*

Descriptive Statistics of Psycho-socio-economic Factors by Childcare Types

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Page 9

Data source: Institut de la Statistique du Québec.

*

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Based on available n.

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Can J Public Health. Author manuscript; available in PMC 2012 July 1. 0.89 [0.78, 1.00] 1.35 [1.18, 1.54] 0.69 [0.61, 0.79] 1.14 [1.02, 1.28]

Maternal depressive symptoms

Home levels of stimulation

Maternal overprotection

Perceived parental impact

Data source: Institut de la Statistique du Québec.

1.23 [1.08, 1.39]

Maternal age at childbearing

0.39 [0.27, 0.56]

0.63 [0.46, 0.85]

≥2

1

Continuous factors ±

  

ref (1.00)

0

Number of siblings

ref (1.00) 0.47 [0.31, 0.73]

One-parent family

0.14 [0.10, 0.19]

ref (1.00)

0.29 [0.22, 0.38]

ref (1.00)

0.28 [0.21, 0.38]

ref (1.00)

UOR (95% CI)

Two-parent family

Family situation

Other Social and Psychological Factors

Unemployed

Employed

Maternal employment during pregnancy

Insufficient

Sufficient

Income levels of sufficiency

Did not graduate from high school

Graduated from high school

Maternal education

Socio-economic Factors

Categorical Factors

*

***

***

*

**

***

***

***

***

***

p

0.93 [0.82, 1.06]

0.86 [0.74, 1.00]

1.19 [1.03, 1.38]

1.08 [0.93, 1.25]

0.79 [0.68, 0.92]

0.54 [0.36, 0.82]

0.73 [0.52, 1.02]

ref (1.00)

1.25 [0.74, 2.12]

ref (1.00)

0.19 [0.13, 0.26]

ref (1.00)

0.71 [0.48, 1.05]

ref (1.00)

0.43 [0.30, 0.63]

ref (1.00)

AOR (95% CI)

Formal Childcare versus Parental Care

*

*

**

**

***

***

p

1.17 [1.00, 1.37]

0.72 [0.60, 0.85]

1.16 [0.98, 1.38]

0.76 [0.63, 0.90]

1.10 [0.92, 1.30]

0.41 [0.25, 0.66]

0.62 [0.42, 0.92]

ref (1.00)

0.77 [0.44, 1.33]

ref (1.00)

0.17 [0.12, 0.25]

ref (1.00)

0.38 [0.26, 0.56]

ref (1.00)

0.52 [0.35, 0.77]

ref (1.00)

UOR (95% CI)

*

***

**

**

***

***

***

p

1.00 [0.84, 1.19]

0.89 [0.72, 1.06]

1.03 [0.86, 1.24]

0.89 [0.73, 1.08]

0.77 [0.63, 0.94]

0.54 [0.32, 0.91]

0.73 [0.48, 1.10]

ref (1.00)

1.78 [0.92, 3.46]

ref (1.00)

0.20 [0.13, 0.31]

ref (1.00)

0.72 [0.42, 1.20]

ref (1.00)

0.74 [0.46, 1.18]

ref (1.00)

AOR (95% CI)

p

*

*

***

Informal Childcare versus Parental Care

Multinomial Logistic Regressions (n=1,504)

Psycho-socio-economic Factors Influencing Parents’ Decision About Childcare Arrangements in a Representative Sample of Québec Families

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PMC Canada Author Manuscript p≤0.001

***

p≤0.01;

p≤0.05;

**

*

± Continuous factors were entered as Z-scores into the multinomial regression models.

CI indicates 95% confidence interval.

AOR indicates adjusted odds ratio when all variables are included in the model.

UOR indicates unadjusted odds ratio.

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