PRISM :: Browsing by Author "Tough, Suzanne"

Browsing by Author "Tough, Suzanne"

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Open Access
A harmonized analysis of five Canadian pregnancy cohort studies: exploring the characteristics and pregnancy outcomes associated with prenatal alcohol exposure
(2023-02-28) Schmidt, Rose A.; Wey, Tina W.; Harding, Kelly D.; Fortier, Isabel; Atkinson, Stephanie; Tough, Suzanne; Letourneau, Nicole; Knight, Julia A.; Fraser, William D.; Bocking, Alan
Abstract Background As a teratogen, alcohol exposure during pregnancy can impact fetal development and result in adverse birth outcomes. Despite the clinical and social importance of prenatal alcohol use, limited routinely collected information or epidemiological data exists in Canada. The aim of this study was to pool data from multiple Canadian cohort studies to identify sociodemographic characteristics before and during pregnancy that were associated with alcohol consumption during pregnancy and to assess the impact of different patterns of alcohol use on birth outcomes. Methods We harmonized information collected (e.g., pregnant women’s alcohol intake, infants' gestational age and birth weight) from five Canadian pregnancy cohort studies to consolidate a large sample (n = 11,448). Risk factors for any alcohol use during pregnancy, including any alcohol use prior to pregnancy recognition, and binge drinking, were estimated using binomial regressions including fixed effects of pregnancy cohort membership and multiple maternal risk factors. Impacts of alcohol use during pregnancy on birth outcomes (preterm birth and low birth weight for gestational) were also estimated using binomial regression models. Results In analyses adjusting for multiple risk factors, women’s alcohol use during pregnancy, both any use and any binge drinking, was associated with drinking prior to pregnancy, smoking during pregnancy, and white ethnicity. Higher income level was associated with any drinking during pregnancy. Neither drinking during pregnancy nor binge drinking during pregnancy was significantly associated with preterm delivery or low birth weight for gestational age in our sample. Conclusions Pooling data across pregnancy cohort studies allowed us to create a large sample of Canadian women and investigate the risk factors for alcohol consumption during pregnancy. We suggest that future pregnancy and birth cohorts should always include questions related to the frequency and amount of alcohol consumed before and during pregnancy that are prospectively harmonized to support data reusability and collaborative research.
Open Access
A qualitative inquiry on pregnant women’s preferences for mental health screening
(2017-10-03) Bayrampour, Hamideh; McNeil, Deborah A; Benzies, Karen; Salmon, Charleen; Gelb, Karen; Tough, Suzanne
Abstract Background Approaches to screening can influence the acceptance of and comfort with mental health screening. Qualitative evidence on pregnant women’s comfort with different screening approaches and disclosure of mental health concerns is scant. The purpose of this study was to understand women’s perspectives of different mental health screening approaches and the perceived barriers to the communication and disclosure of their mental health concerns during pregnancy. Methods A qualitative descriptive study was undertaken. Fifteen women, with a singleton pregnancy, were recruited from a community maternity clinic and a mental health clinic in Calgary, Canada. Semi-structured interviews were conducted during both the 2nd and 3rd trimesters. Data were analyzed using thematic analysis. Results Preferences for mental health screening approaches varied. Most women with a known mental health issue preferred a communicative approach, while women without a known mental health history who struggled with emotional problems were inclined towards less interactive approaches and reported a reluctance to share their concerns. Barriers to communicating mental health concerns included a lack of emotional literacy (i.e., not recognizing the symptoms, not understanding the emotions), fear of disclosure outcomes (i.e., fear of being judged, fear of the consequences), feeling uncomfortable to be seen vulnerable, perception about the role of prenatal care provider (internal barriers); the lack of continuity of care, depersonalized care, lack of feedback, and unfamiliarity with/uncertainty about the availability of support (structural barriers). Conclusions The overlaps between some themes identified for the reasons behind a preferred screening approach and barriers reported by women to communicate mental health concerns suggest that having options may help women overcome some of the current disclosure barriers and enable them to engage in the process. Furthermore, the continuity of care, clarity around the outcomes of disclosing mental health concerns, and availability of immediate support can help women move from providing “the best answer” to providing an authentic answer.
Open Access
Aboriginal Children and Their Caregivers Living with Low Income: Outcomes from a Two-Generation Preschool Program
(Springer Verlag Open Choice, 2010-07-14) Benzies, Karen; Tough, Suzanne; Edwards, Nancy; Mychasiuk, Richelle; Donnelly, Carlene
Open Access
Adverse Childhood Experiences and Adult Depression: Resilience as a Moderator
(2016) Poole, Julia; Dobson, Keith; Yeates, Keith; Tough, Suzanne; Letourneau, Nicole
Adverse childhood experiences (ACEs), such as childhood abuse and neglect, have been identified as salient risk factors for adult depression. However, not all individuals who experience ACEs go on to develop depression. To assess the extent to which resilience- or the ability to demonstrate stable levels of functioning despite adversity- moderates the association between ACEs and depression, 4,006 adult primary care patients completed self-report questionnaires on their childhood experiences and current depressive symptoms and resilience. Results indicated that resilience moderated the association between ACEs and depression, F(10, 3039) = 174.36, p < .001, R2 = .365. Specifically, the association between ACEs and depression was stronger among individuals with low resilience relative to those with high resilience. Findings have the potential to inform the development of a treatment program aimed to reduce symptoms of depression among primary care patients with a history of childhood adversity.
Open Access
Caring for pregnant refugee women in a turbulent policy landscape: perspectives of health care professionals in Calgary, Alberta
(2018-06-26) Winn, Anika; Hetherington, Erin; Tough, Suzanne
Abstract Background Female refugees can be a vulnerable population, often having suffered through traumatic events that pose risks to their health, especially during pregnancy. Pregnancy can be an entry point into the health care system, providing health care professionals the opportunity to gain women’s trust, connect refugees with resources, and optimize the health of mother and child. Policies surrounding the provision and funding of health care services to refugees can impact access to and quality of care. The aim of our study was to understand the experiences of health care professionals caring for pregnant refugee women in Calgary, AB, taking into consideration recent contextual changes to the refugee landscape in Canada. Methods We conducted ten semi-structured interviews with health care professionals who provided regular care for pregnant refugee women at a refugee health clinic and major hospital in Calgary, Alberta. Interviews were recorded, transcribed, and analyzed using an interpretive description methodology. Results Health care providers described several barriers when caring for pregnant refugees, including language barriers, difficulty navigating the health care system, and cultural barriers such as managing traditional gender dynamics, only wanting a female provider and differences in medical practices. Providers managed these barriers through strategies including using a team-based approach to care, coordinating the patient’s care with other services, and addressing both the medical and social needs of the patient. The federal funding cuts added additional challenges, as many refugees were left without adequate health coverage and the system was complicated to understand. Health care providers developed creative strategies to maximize coverage for their patients including paying out of pocket or relying on donations to care for uninsured refugees. Finally, the recent Syrian refugee influx has increased the demand on service providers and further strained already limited resources. Conclusion Health care providers caring for pregnant refugee women faced complex cultural and system-level barriers, and used multiple strategies to address these barriers. Additional system strains add extra pressure on health care professionals, requiring them to quickly adjust and accommodate for new demands.
Open Access
Early childhood services and outcomes for Albertan children with disabilities
(PolicyWise for Children & Families, 2019-07-19) Russell, Matthew; Zhang, Yunqi; Lamba, Navjot; Zwicker, Jennifer; Tough, Suzanne; Cui, Xinjie
Early support for children with disabilities is thought to be more impactful than later support. This report examined how preschool and kindergarten children (3 to 5 years old) with disabilities’ early service use related to their educational achievement and mental health service use outcomes. Analyses tested for differences in outcomes between children based on their special education disability type and severity and public service use patterns. This report found that (1) children with severe disability were more likely to be below educational expectations and to use mental health services as well as that these outcomes differed based on type of disability, and (2) non-educational and educational service use patterns predicted educational achievement and mental health service use. In addition, this report found that families in poorer neighbourhoods were less likely to use family disability supports when their child with a severe disability was not meeting educational expectations than families in richer neighbourhoods. These findings provide policy-relevant evidence that service providers can use to plan early services to support children with disabilities.
Open Access
Effect of Remote Peer-Counsellor- delivered Behavioral Activation and Peer-support for Antenatal Depression on Gestational Age at Delivery: a single-blind, randomized control trial
(2023-03-30) Chaput, Kathleen H.; Freeman, Makayla; McMorris, Carly; Metcalfe, Amy; Cameron, Emily E.; Jung, James; Tough, Suzanne; Hicks, Laurel M.; Dimidjian, Sona; Tomfohr-Madsen, Lianne M.
Abstract Background Antenatal depression (AD) is the most common complication of pregnancy in developed countries and increases the risk of preterm birth (PTB). Many pregnant individuals with AD do not obtain treatment due in part to risks associated with antidepressant medications, the expense and wait times for psychological services, and perceived stigma. Accessible and timely treatment of antenatal depression is crucial to minimize foetal impacts and associated long-term child health outcomes. Previous studies show that behavioural activation and peer support are promising avenues of treatment for perinatal depression. Additionally, remote and paraprofessional counselling interventions show promise as more accessible, sustainable, and cost-effective treatment avenues than traditional psychological services. The primary aim of this trial is to test the effectiveness of a remote, behavioural activation and peer support intervention, administered by trained peer para-professionals, for increasing gestational age at delivery among those with antenatal depression. The secondary aims are to evaluate the effectiveness for treating AD prior to delivery, with persistence into the postpartum; improving anxiety symptoms; and improving parenting self-efficacy compared to controls. Methods A two-arm, single-blinded, parallel groups randomized controlled trial (RCT) with repeated measures will be conducted. Participants scoring >10 on the Edinburgh Postnatal Depression Scale will be recruited from the larger P3 cohort and invited to enroll. Assessments will be conducted prior to 27 weeks’ gestation at trial intake (T1), post-intervention, prior to delivery (T2), 5–6 months postpartum (T3), and 11–12 months postpartum (T4) and will include self-report questionnaires and linked medical records. Discussion Our remote, peer paraprofessional-delivered behavioural activation plus peer support intervention has the potential to successfully reduce symptoms of AD, which may in turn decrease the risk of PTB and subsequent health impacts. The current trial builds on previous findings and uses a patient-oriented approach to address priorities for patient care and to provide a cost-effective, accessible, and evidence-based treatment to pregnant individuals with AD. Trial registration International Standard Randomised Controlled Trial Number (ISRCTN) registry (ISRCTN51098220) ISRCTN51098220. Registered on April 7, 2022.
Open Access
Epidemiology of postpartum depression: a prospective study
(2006) Davey, Heather Lynn; Tough, Suzanne
Open Access
Estimating physician workload in the pediatric emergency department
(2007) Millar, Kelly Rae; Tough, Suzanne
Open Access
Experiences of Albertan Families with Young Children during the COVID-19 Pandemic: Descriptive Report
(2020-11-30) McDonald, Sheila; Edwards, Sarah; Hetherington, Erin; Racine, Nicole; Mueller, Melissa; McArthur, Brae Anne; Madigan, Sheri; Dewey, Deborah; Letourneau, Nicole; Tough, Suzanne; Geisbrecht, Gerald
This report describes data collected from Albertan families on the COVID-19 Impact Survey implemented in May 2020, which built on a unique collaboration across two longitudinal cohorts in Alberta: The All Our Families study (AOF) and the Alberta Pregnancy Outcomes and Nutrition study (APrON). Our objectives were as follows: (1) Describe household infections of COVID-19 in Alberta among families with school-aged children; (2) Describe urban Albertan family experiences of the pandemic within the first 3-4 months of the outbreak across the areas of financial impact, maternal mental health and well-being, school and daily life, and relationships in the home; and (3) Describe associations among key predictor variables (e.g., financial impact) and outcomes (e.g., maternal anxiety, concern for child’s well-being). Study Sample: AOF and APrON Cohort participants reflect families parenting at least one child in between the ages of 8 and 12. While the respondents represent a broad range of income, education and ethnicity, they are typified by adequate income, food and housing security and partnered marital status. Highlighted Results: Physical Impact: At the time of data collection in May, 2020, over 90% of families did not have personal experience with COVID-19, either through personal infection, infection of a child, extended family member or close friend. Vaccine Intentions: Although over 60% of mothers and their children would obtain a COVID-19 vaccine when available, almost 30% are undecided and 8% would not obtain a vaccine. Financial Impact: In 58% of all families, at least one parent experienced job loss, loss of main income source, or reduced employment hours. One in five mothers reported difficulty meeting financial needs for the household, and 5% of families were experiencing food insecurity. Over 40% of respondents reported at least some impact on their ability to meet financial obligations. Mental Health and Wellness Impact: Mothers reported elevated levels of stress (21%), anxiety (25%) and depression (35%). Approximately 26% of mothers reported having limited coping skills. Almost 90% of mothers have undertaken more domestic tasks in the home. Mothers also reported that their children showed increased sadness and behavioural challenges. The COVID-19 pandemic has had profound financial and mental health impact on some families. Investment in strategies to alleviate financial stress, provide parenting supports, and alleviate mental health concerns is critical. Suggested Citation: McDonald S, Edwards S, Hetherington E, Racine N, Mueller M, McArthur BA, Madigan S, Dewey D, Geisbrecht G, Letourneau N, Tough S. Experiences of Albertan Families with Young Children during the COVID-19 Pandemic: A Descriptive Report. Calgary, Alberta: University of Calgary; 2020.
Open Access
Factors Influencing Fine and Gross Motor Development among Children 24 Months of Age: Results from the All Our Families Study
(2017) Dodd, Shawn X.; Tough, Suzanne; Hagel, Brent; Cabaj, Jason; Nettel-Aguirre, Alberto
Objective: The objective of this study was to identify factors influencing fine and gross motor development of Albertan children at 24 months of age. Methods: This is a secondary analysis of data from the All Our Families study, a prospective pregnancy cohort. Multivariable logistic regression was performed to identify factors influencing motor development. Results: Early developmental delays, maternal abuse and maternal postpartum drug use were associated with an increased odds of suboptimal gross motor development at 24 months of age. Pregnancy complications were associated with a reduction in risk for gross motor delays. Early developmental delays, NICU admission and maternal postpartum alcohol consumption were associated with an increased risk for delays in fine motor development at 24 months of age. Conclusion: Delayed motor development at 24 months of age may be mitigated through detection and intervention of early cognitive, social and motor developmental delays.
Open Access
Impact of maternal depression and anxiety on immunization status of children: a prospective cohort study
(2024-06-17) MacDonald, Shannon E.; Dhungana, Manisha; Stagg, Victoria; McDonald, Sheila; McNeil, Deborah; Kellner, James D.; Tough, Suzanne; Saini, Vineet
Abstract Background Maternal depression and anxiety can have a detrimental impact on birth outcomes and healthy child development; there is limited knowledge on its influence on immunization schedule adherence. Therefore, the objectives of this study were to determine the impact of maternal depression and anxiety in the perinatal period on prolonged vaccine delay of childhood vaccines. Methods In this prospective cohort study, we analyzed linked survey and administrative data of 2,762 pregnant women in Calgary, Alberta, Canada. Data were collected at two time-points: prenatal (< 25 weeks of gestation) and postpartum (4 months postpartum). We used multivariable logistic regression to examine the association between depression and anxiety with prolonged immunization delay, adjusting for covariates. Results In multivariable analysis, maternal depression at either time point was not associated with prolonged delay for DTaP-IPV-Hib (OR 1.16, 95% CI 0.74–1.82), MMR/MMRV (OR 1.03, 95% CI 0.72–1.48), or all routine childhood vaccines combined (OR 1.32, 95% CI 0.86–2.04). Maternal anxiety at either time point was also not associated with prolonged delayed for DTaP-IPV-Hib (OR 1.08, 95% CI 0.77–1.53), MMR/MMRV (OR 1.07, 95% CI 0.82–1.40), or all vaccines combined (OR 1.00, 95% CI 0.80–1.26). In both the depression and anxiety models, children of Canadian-born mothers had higher odds of prolonged delay, as did those with low-income mothers. Conclusion Health care providers can be reassured that maternal depression and anxiety do not appear to influence maternal commitment to routine immunization. Findings suggested that low income and household moves may influence adherence to vaccine schedules and health care providers may want to provide anticipatory guidance to these families.
Open Access
Impact of prenatal screening on future resource utilization in pregnancy
(2012-09-26) Metcalfe, Amy Lynn; Tough, Suzanne
In 2007, the Society of Obstetricians and Gynaecologists of Canada first recommended that prenatal screening for fetal aneuploidy be offered to all pregnant women. This is an important change in clinical obstetrics as previously these services had only been routinely offered to women who would be 35 or older at the time of delivery; however, maternal age alone is a poor predictor of fetal aneuploidy. Obtaining reliable data on prenatal screening utilization is problematic in Canada as these data are not collected in a systematic way nationally and, in many cases, not even provincially. This study aimed to understand utilization of prenatal screening in an Albertan context; to examine the impact of different prenatal screening strategies on health care utilization in pregnancy; and to estimate the incremental cost of prenatal screening when accounting for all of direct medical costs of this procedure including ancillary service use. Data on health resource utilization that occurred in the three months prior to pregnancy, during pregnancy and three months post-partum were collected from twelve unique clinical and administrative databases. Using deterministic linkage, participants from multiple databases were linked based on personal health number, gender and date of birth. This study found that utilization of prenatal screening tends to impact utilization of prenatal diagnostic services but not overall health resource utilization, and that there is a cost for prenatal screening but this cost may be less than what is suggested in the literature due to differences between hypothetical utilization patterns and actual resource utilization. It also suggests that current techniques used to identify women who have an increased risk of carrying a fetus with aneuploidy, may also be useful for identifying women who are at an increased risk of a variety of adverse pregnancy outcomes. With the rapid development of non-invasive prenatal testing, additional clinical changes in prenatal screening and diagnosis are likely to occur in the next few years. However, prior to abandoning screening in favour of non-invasive prenatal testing, the results of this work suggest that a more thorough evaluation of the impact of prenatal screening on non-aneuploidy outcomes may be warranted.
Open Access
Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination
(2019-01-10) McNeil, Deborah A; Mueller, Melissa; MacDonald, Shannon; McDonald, Sheila; Saini, Vineet; Kellner, James D; Tough, Suzanne
Abstract Background Understanding reasons for and against vaccination from the parental perspective is critical for designing vaccination campaigns and informing other interventions to increase vaccination uptake in Canada. The objective of this study was to understand maternal vaccination decision making for children. Methods Mothers participating in a longitudinal community-based pregnancy cohort, the All Our Babies study in Calgary, Alberta, completed open-ended survey questions providing explanations for the vaccination status of their child by 24 months postpartum. Qualitative responses were linked to administrative vaccination records to examine survey responses and recorded child vaccination status. Results There were 1560 open-ended responses available; 89% (n = 1391) provided explanations for vaccinating their children, 5% (n = 79) provided explanations for not vaccinating/delaying, and 6% (n = 90) provided explanations for both. Themes were similar for those vaccinating and not vaccinating/delaying; however, interpretations were different. Two broad themes were identified: Sources of influence and Deliberative Processes. Sources of influence on decision making included personal, family, and external experiences. Deliberative Processes included risk, research, effectiveness, and balancing risks/benefits. Under Deliberative Processes, responsibility was a category for those vaccinating; while choice, instrumental/practical, and health issues were categories for those not vaccinating/delaying. Mothers’ levels of conviction and motivation provided a Context for understanding their decision making perspectives. Conclusions Vaccination decision making is complex and impacted by many factors that are similar but contribute to different decisions depending on mothers’ perspectives. The results of this study indicate the need to examine new intervention approaches to increase uptake that recognize and address feelings of pressure and parental commitment to choice.
Open Access
Maternal risk factors for cesarean delivery in Alberta
(2005) Chen, Sophie Yue; Tough, Suzanne
Open Access
Meconium alcohol and drug screening
(2007) Hicks, Matthew Stephen; Sauve, Reginald S.; Tough, Suzanne
Open Access
Patterns of health care utilization and mental health characteristics of pregnant and early postpartum women
(2013-01-28) Weller, Carol; Tough, Suzanne
Abstract Introduction: The Society of Obstetricians and Gynaecologists of Canada’s (SOGC) goal of prenatal care is to “reduce perinatal mortality and morbidity, while supporting women’s medical, social and psychological needs.” Research objective: To describe the association between a) maternal characteristics and care provider, and b) between prenatal care (PNC) utilization and risk of postpartum depression (PPD). Methods: Questionnaires administered (N=1347) twice during pregnancy and at four months postpartum measured risk of PPD. PNC utilization was compared to scores on the Edinburgh Postpartum Depression scale, controlling for known risk factors. Results: Adequacy of prenatal care was not related to PPD. Women with lower income were more likely to have received inadequate prenatal care. Differences were observed among women who received their prenatal care from different providers. Conclusion: The lack of evidence of an association between adequate PNC utilization and PPD suggests that there may be missed opportunities to support women’s psychological needs.
Open Access
Prediction of breastfeeding outcomes: Results from the All Our Babies study
(2013-01-21) Nagulesapillai, Tharsiya; Tough, Suzanne
Objective: The objective of this study was to examine and compare predictors of any breastfeeding and exclusive breastfeeding at 4 months postpartum between women residing in Canada for 5+ years and those new to Calgary and Canada. Methods: As part of a longitudinal study, women completed questionnaires about pregnancy experiences and breastfeeding practices. Bivariate analysis and multivariable logistic regression were conducted to identify the prevalence and predictors associated with breastfeeding outcomes at 4 months postpartum. Results: While numerous variables were found to be predictive of breastfeeding outcomes, the key factors were perceived prenatal physical health, pre-pregnancy BMI and smoking status prior to and during pregnancy. These three factors were consistently found to be predictive of both breastfeeding outcomes across all populations assessed. Conclusion: Although certain predictors of breastfeeding duration were similar between the groups, several were dissimilar, suggesting that these groups might benefit from different strategies to optimize breastfeeding outcomes.
Open Access
Protocol for a rapid scoping review to examine child health and well-being indicator frameworks in OECD countries
(2022-09-26) Roth, Christiane; Zwicker, Jennifer; Hagel, Brent; Boynton, Heather; Crowshoe, Lynden F.J.; Dimitropoulos, Gina; Exner-Cortens, Deneira; Metcalfe, Amy; Russell-Meyhew, Shelly; Schwartz, Kelly Dean; Thomas, Karen; Tough, Suzanne
The purpose of the rapid scoping review is to identify commonly recognized domains/dimension and indicators considered important to the measurement of child health and wellbeing of children and youth to inform the development of a wellbeing indicator framework. Understandings of the concept and importance of health and wellbeing has evolved in the recent decades to encompass wider determinants of health. The concept of wellbeing or quality of life in particular, has become increasingly relevant at the international and national policy levels as a measure for a country’s overall performance. Wellbeing or quality of life indicator frameworks can help monitor health and wellbeing over time in a given jurisdiction and guide the development of cross–sectoral wellbeing policies and strategies to improve overall wellbeing outcomes of the population. This protocol describes our approach to a scoping review, which will gather comprehensive data on how child health and wellbeing is defined and measured across the globe. The protocol is based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist, which will also guide its reporting. The scoping review will include peer-reviewed articles and information from a grey literature search of inter-governmental organizations and official documents of OECD countries. Data will be synthesized to showcase what child health and wellbeing is commonly comprised of (dimensions/domains/components) and which indicators and sources are used to measure the concept.
Open Access
Quality of life and satisfaction with care in a pediatric neurology clinic
(2004) Mah, Jean Kit-Wah; Tough, Suzanne; Verhoef, Marja J.