Browsing by Author "Tough, Suzanne C."

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    All Our Babies Cohort Study: recruitment of a cohort to predict women at risk of preterm birth through the examination of gene expression profiles and the environment
    (BioMed Central, 2010-12-30) Gracie, Sara K.; Lyon, Andrew W.; Kehler, Heather L.; Pennell, Craig E.; Dolan, Siobhan M.; McNeil, Deborah A; Siever, Jodi E.; McDonald, Sheila W.; Bocking, Alan D.; Lye, Stephen J; Hegadoren, Kathy M.; Olson, David M; Tough, Suzanne C.
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    All Our Families: Five Year Follow-Up (Q7) Descriptive Report March 2020
    (2020-03) Tough, Suzanne C.; McDonald, Sheila W.; Wu, Muci
    The All Our Families cohort includes over 3,000 mothers and children who have been participants since the mothers were pregnant. This report is a summary of information collected when the children were 5 years of age. Recruitment into the All Our Families (formerly All Our Babies) cohort began in 2008 and concluded in 2011. Since then, we have collected information twice during pregnancy and at 4 months postpartum, as well as 1 year, 2 years, 3 years and 5 years post-birth. This report presents findings from All Our Families mothers and children at 5 years of age and integrates information from earlier time points. The history of this cohort is described and more details can be found at allourfamiliesstudy.com.
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    All Our Families: Three Year Follow-up (Q6) Descriptive Report December 2018
    (2018-12) Tough, Suzanne C.; McDonald, Sheila W.; Wu, Muci
    The All Our Families cohort includes over 3,000 mothers and children who have been participants since mothers were pregnant. This report is a summary of information collected when the children were 3 years of age. Recruitment into the All Our Families (formerly All Our Babies) cohort began in 2008 and concluded in 2011. Since then, we have collected information twice during pregnancy and at 4 months postpartum, as well as 1 year, 2 years, and 3 years post-birth. This report presents findings from All Our Families mothers and children at 3 years of age and integrates information from earlier time points. The history of this cohort is described briefly below, more details can be found on allourfamiliesstudy.com.
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    Association between childhood adversities and premature and potentially avoidable mortality in adulthood: a population-based study
    (2023-10-18) Bhattarai, Asmita; Dimitropoulos, Gina; Bulloch, Andrew G.; Tough, Suzanne C.; Patten, Scott B.
    Abstract Background The association of childhood adversities with mortality has rarely been explored, and even less studied is the question of whether any excess mortality may be potentially preventable. This study examined the association between specific childhood adversities and premature and potentially avoidable mortality (PPAM) in adulthood in a representative sample of the general population. Also, we examined whether the associations were potentially mediated by various adult socioeconomic, psychosocial, and behavioral factors. Methods The study used data from the National Population Health Survey (NPHS-1994) linked to the Canadian Vital Statistics Database (CVSD 1994–2014) available from Statistics Canada. The NPHS interview retrospectively assessed childhood exposure to prolonged hospitalization, parental divorce, prolonged parental unemployment, prolonged trauma, parental problematic substance use, physical abuse, and being sent away from home for doing something wrong. An existing definition of PPAM, consisting of causes of death considered preventable or treatable before age 75, was used. Competing cause survival models were used to examine the associations of specific childhood adversities with PPAM in adulthood among respondents aged 18 to 74 years (rounded n = 11,035). Results During the 20-year follow-up, 5.4% of the sample died prematurely of a cause that was considered potentially avoidable. Childhood adversities had a differential effect on mortality. Physical abuse (age-adjusted sub-hazard ratio; SHR 1.44; 95% CI 1.03, 2.00) and being sent away from home (age-adjusted SHR 2.26; 95% CI 1.43,3.57) were significantly associated with PPAM. The associations were attenuated when adjusted for adulthood factors, namely smoking, poor perceived health, depression, low perceived social support, and low income, consistent with possible mediating effects. Other adversities under study were not associated with PPAM. Conclusion The findings imply that the psychological sequelae of childhood physical abuse and being sent away from home and subsequent uptake of adverse health behavior may lead to increased risk of potentially avoidable mortality. The potential mediators identified offer directions for future research to perform causal mediation analyses with suitable data and identify interventions aimed at preventing premature mortality due to potentially avoidable causes. Other forms of adversities, mostly related to household dysfunction, may not be determinants of the distal health outcome of mortality.
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    Association of prenatal medical risk with breastfeeding outcomes up to 12 months in the All Our Families community-based birth cohort
    (2021-09-15) Scime, Natalie V.; Metcalfe, Amy; Nettel-Aguirre, Alberto; Tough, Suzanne C.; Chaput, Kathleen H.
    Abstract Background Prenatal medical risk describes physical health issues or biological factors that predate or arise during pregnancy which heighten the risk of adverse outcomes, and often warrant specialized obstetric care. The influence of the nature and magnitude of prenatal risk on breastfeeding outcomes remains poorly understood. The objective of this study was to determine the association between prenatal medical risk and breastfeeding initiation and duration up to 1 year postpartum. Methods We analysed a subset of data from the All Our Families longitudinal cohort (n = 2706) of women in Calgary, Canada who delivered a liveborn infant between 2008 and 2010. Data were collected from self-report questionnaires and medical records. Women with complete data on prenatal medical risk factors and breastfeeding outcomes were included in this analysis. Prenatal medical risk was operationalized as one integer score of risk severity and four binary risk types capturing pre-pregnancy characteristics, past obstetric problems, current obstetric problems, and substance use. Outcomes were breastfeeding initiation defined as the infant ever receiving breast milk, and duration operationalized as still breastfeeding at 4 months, at 12 months, and time to breastfeeding cessation in weeks. We used logistic regression and Cox regression with right censoring at 52 weeks or attrition to calculate odds ratios (OR) and hazard ratios (HR), respectively, adjusting for sociodemographic vulnerability, parity, mode of delivery, and gestational age. Results Prenatal medical risk severity and type were not significantly associated with breastfeeding initiation, with the exception of pre-pregnancy risk type (OR 0.45; 95% CI 0.26, 0.77). Risk severity was associated with lower odds of breastfeeding to 4 months (OR 0.94; 95% CI 0.90, 0.99), 12 months (OR 0.93; 95% CI 0.87, 0.98), and earlier breastfeeding cessation (HR 1.05; 95% CI 1.02, 1.08). Associations with shorter breastfeeding length across the first postpartum year were observed for pre-pregnancy, current obstetric, and substance use risk types, but not past obstetric problems. Conclusion Prenatal medical risk is associated with shortened duration of breastfeeding. Women with prenatal medical risk may benefit from the proactive arrangement of lactation support before and following delivery to promote continued breastfeeding.
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    Breastfeeding difficulties in the first 6 weeks postpartum among mothers with chronic conditions: a latent class analysis
    (2023-02-02) Scime, Natalie V.; Metcalfe, Amy; Nettel-Aguirre, Alberto; Nerenberg, Kara; Seow, Cynthia H.; Tough, Suzanne C.; Chaput, Kathleen H.
    Abstract Background Breastfeeding difficulties frequently exacerbate one another and are common reasons for curtailed breastfeeding. Women with chronic conditions are at high risk of early breastfeeding cessation, yet limited evidence exists on the breastfeeding difficulties that co-occur in these mothers. The objective of this study was to explore clusters of breastfeeding difficulties experienced up to 6 weeks postpartum among mothers with chronic conditions and to examine associations between chronic condition types and breastfeeding difficulty clusters. Methods We analyzed 348 mothers with chronic conditions enrolled in a prospective, community-based pregnancy cohort study from Alberta, Canada. Data were collected through self-report questionnaires. We used latent class analysis to identify clusters of early breastfeeding difficulties and multinomial logistic regression to examine whether types of chronic conditions were associated with these clusters, adjusting for maternal and obstetric factors. Results We identified three clusters of breastfeeding difficulties. The “physiologically expected” cluster (51.1% of women) was characterized by leaking breasts and engorgement (reference outcome group); the “low milk production” cluster (15.4%) was discerned by low milk supply and infant weight concerns; and the “ineffective latch” cluster (33.5%) involved latch problems, sore nipples, and difficulty with positioning. Endocrine (adjusted relative risk ratio [RRR] 2.34, 95% CI 1.10–5.00), cardiovascular (adjusted RRR 2.75, 95% CI 1.01–7.81), and gastrointestinal (adjusted RRR 2.51, 95% CI 1.11–5.69) conditions were associated with the low milk production cluster, and gastrointestinal (adjusted RRR 2.44, 95% CI 1.25–4.77) conditions were additionally associated with the ineffective latch cluster. Conclusion Half of women with chronic conditions experienced clusters of breastfeeding difficulties corresponding either to low milk production or to ineffective latch in the first 6 weeks postpartum. Associations with chronic condition types suggest that connections between lactation physiology and disease pathophysiology should be considered when providing breastfeeding support.
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    Can the adverse childhood experiences (ACEs) checklist be utilized to predict emergency department visits among children and adolescents?
    (2021-09-25) Bhattarai, Asmita; Dimitropoulos, Gina; Marriott, Brian; Paget, Jaime; Bulloch, Andrew G. M.; Tough, Suzanne C.; Patten, Scott B.
    Abstract Background Extensive literature has shown an association of Adverse Childhood Experiences (ACEs) with adverse health outcomes; however, its ability to predict events or stratify risks is less known. Individuals with mental illness and ACE exposure have been shown to visit emergency departments (ED) more often than those in the general population. This study thus examined the ability of the ACEs checklist to predict ED visits within the subsequent year among children and adolescents presenting to mental health clinics with pre-existing mental health issues. Methods The study analyzed linked data (n = 6100) from two databases provided by Alberta Health Services (AHS). The Regional Access and Intake System (RAIS 2016–2018) database provided data on the predictors (ACE items, age, sex, residence, mental health program type, and primary diagnosis) regarding children and adolescents (aged 0–17 years) accessing addiction and mental health services within Calgary Zone, and the National Ambulatory Care Reporting System (NACRS 2016–2019) database provided data on ED visits. A 25% random sample of the data was reserved for validation purposes. Two Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression models, each employing a different method to tune the shrinkage parameter lambda (namely cross-validated and adaptive) and performing 10-fold cross-validation for a set of 100 lambdas in each model were examined. Results The adaptive LASSO model had a slightly better fit in the validation dataset than the cross-validated model; however, it still demonstrated poor discrimination (AUC 0.60, sensitivity 37.8%, PPV 49.6%) and poor calibration (over-triaged in low-risk and under-triaged in high-risk subgroups). The model’s poor performance was evident from an out-of-sample deviance ratio of − 0.044. Conclusion The ACEs checklist did not perform well in predicting ED visits among children and adolescents with existing mental health concerns. The diverse causes of ED visits may have hindered accurate predictions, requiring more advanced statistical procedures. Future studies exploring other machine learning approaches and including a more extensive set of childhood adversities and other important predictors may produce better predictions. Furthermore, despite highly significant associations being observed, ACEs may not be deterministic in predicting health-related events at the individual level, such as general ED use.
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    Causal assessment of dietary acid load and bone disease: a systematic review & meta-analysis applying Hill’s epidemiologic criteria for causality
    (BioMed Central, 2011-04-30) Fenton, Tanis R.; Tough, Suzanne C.; Lyon, Andrew W.; Eliasziw, Misha; Hanley, David A.
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    Cohort Profile: The All Our Babies pregnancy cohort (AOB)
    (Oxford University Press, 2017-01) Tough, Suzanne C.; McDonald, Sheila W.; Collisson, Beverly Anne; Graham, Susan A.; Kehler, Heather L.; Kingston, Dawn E.; Benzies, Karen Marie
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    Cohort Profile: The All Our Babies pregnancy cohort (AOB)
    (Oxford University Press on behalf of the International Epidemiological Association, 2017-01) Tough, Suzanne C.; McDonald, Sheila W.; Collisson, Beverly Anne; Graham, Susan; Kehler, Heather L.; Kingston, Dawn E.; Benzies, Karen Marie
    Why was the cohort set up? All Our Babies (AOB) is a community-based, longitudinal pregnancy cohort developed to investigate the relationships between the prenatal and early life periods and outcomes for infants, children and mothers. The design of AOB follows a life course perspective, whereby the influence of early events on long-term health and development of both mothers and children are investigated through examining factors across life stages. AOB spans pregnancy, birth and early postpartum through childhood, and therefore provides the unique opportunity to describe the relations between prenatal events and early life development and to examine key factors that influence child and mother well-being over time. AOB was originally designed to measure maternal and infant outcomes during the perinatal period, with a particular emphasis on barriers and facilitators to accessing health care services in Calgary, Alberta. Approximately 1 year after recruitment had started, an additional objective,to examine biological and environmental determinants of adverse birth outcomes, specifically spontaneous pre-term birth, was added. Recognition of the opportunity to continue to collect relevant life course information on the AOB families, collaborations with content experts and securing additional funding has enabled ongoing follow-up of AOB mother-child dyads. The overall objective was to further investigate risk and protective factors for optimal child development, and to understand the trajectory and impact of poor maternal mental health over time. Mothers have completed questionnaires from pregnancy to 3 years postpartum, and consented to providing the research team with access to their obstetric medical records. Data collection for a 5-year follow-up questionnaire is ongoing. A subgroup within the cohort participated in the ‘prediction of preterm birth’ component and provided blood samples during pregnancy and an umbilical cord blood sample. The continuation of follow-up to 8 years is under way.
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    Comparison of sample characteristics in two pregnancy cohorts: community-based versus population-based recruitment methods
    (BioMed Central, 2013-12-06) Leung, Brenda; McDonald, Sheila W.; Kaplan, Bonnie J.; Giesbrecht, Gerald F.; Tough, Suzanne C.
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    Connections First: Community perceptions of social connections
    (2020-04-14) Walsh, Jessica-Lynn Ann; Tough, Suzanne C.; McDonald, Sheila W.; Patten, Scott B.
    Introduction: Community-based social connections and natural supports promote well-being in children and youth, and their families. Natural supports are informal reciprocal connections that consist of close relationships with friends and family, and broader associations, including neighbours, organizations and local businesses. Similarly to social connections, natural supports aim to create supportive and healthy environments with an emphasis on locality. This study investigated how urban communities are working to promote natural supports to address vulnerability. Methods: Using classical grounded theory, community champions were interviewed regarding their knowledge and perceptions of natural supports strategies, and key facilitators and barriers. Categories, themes and sub-themes were identified, and a theory emerged. Results: The overarching theory that emerged to advance natural supports strategies in urban community settings was: Building a community’s ability to shift from disconnected to naturally supportive to empower residents and families: the need for action to accelerate connection and asset development. Community connectors and assets facilitate natural supports strategies and social connections within urban community settings. Limited access to space, and difficulties recruiting and retaining volunteers were identified barriers. Conclusion: The findings of this study enable knowledge users, such as planners and policy-makers, to optimally invest and develop community natural supports strategies to enhance social connections and remediate vulnerability for children and youth, and their families. Future directions of this study include implementation and evaluation of natural supports strategies within communities.
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    A Developmental Cascade from Prenatal Stress to Child Internalizing and Externalizing Problems
    (Oxford University Press on behalf of the Society for Pediatric Psychology : Journal of Pediatric Psychology, 2019-05) Hentges, Rochelle F.; Graham, Susan; Plamondon, André R.; Tough, Suzanne C.; Madigan, Sheri L.
    This study utilized a developmental cascade approach to test alternative theories about the underlying mechanisms behind the association of maternal prenatal stress and child psychopathology. The fetal programming hypothesis suggests that prenatal stress affects fetal structural and physiological systems responsible for individual differences in child temperament, which further increases risk for internalizing and externalizing problems. Interpersonal models of stress transmission suggest that maternal stress influences child mental health via early parenting behaviors. We also examined a continuation of stress hypothesis, in which prenatal stress predicts child mental health via the continuation of maternal stress in the postpartum period.
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    Exclusive Breastfeeding and Assisted Reproductive Technologies: A Calgary Cohort
    (OMICS Group Corporation, 2012-04-25) O'Quinn, Candace; Metcalfe, Amy; McDonald, Sheila W.; Raguz, Nikolett; Tough, Suzanne C.
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    Gauging knowledge of developmental milestones among Albertan adults: a cross-sectional survey
    (BioMed Central, 2010-04-08) Rikhy, Shivani; Tough, Suzanne C.; Trute, Barry; Benzies, Karen; Kehler, Heather; Johnston, David W.
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    Getting more than they realized they needed: a qualitative study of women's experience of group prenatal care
    (BioMed Central, 2012-03-21) McNeil, Deborah A.; Vekved, Monica; Dolan, Siobhan M.; Siever, Jodi; Horn, Sarah; Tough, Suzanne C.
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    Heterogeneous Trajectories of Delayed Communicative Development From 12 to 36 Months: Predictors and Consequences
    (Wolters Kluwer Health Inc. : Society for Developmental & Behavioral Pediatrics, 2019-06) Hentges, Rochelle F.; Madigan, Sheri L.; Plamondon, André R.; Racine, Nicole M.; Collisson, Beverly Anne; Tough, Suzanne C.; Graham, Susan
    The objective of the study was to identify distinct trajectories of delayed communicative development from 12 to 36 months and examine differences in risk factors and developmental outcomes for each trajectory.
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    How Might We Understand Mothers’ Experiences of the VID-KIDS Intervention? More than Meets the Eye
    (2021-02-09) Bon Bernard, Jennifer; Letourneau, Nicole Lyn; Tough, Suzanne C.; Moules, Nancy Jean; Tryphonopoulos, Panagiota; McCaffrey, Graham
    Postpartum depression (PPD) is a complex public health concern that can disrupt the healthy interaction between a mother and her infant. An impairment in this foundational relationship is perceived by infants to be a toxic stressor, and as a result negative long-term outcomes on growth and development can ensue. Parenting interventions in the early years of an infant’s life that aim to modify this significant stressor are a type of support that can alleviate potential concerns associated with the experience of PPD. Video-Feedback Interaction Guidance for Improving Interactions Between Depressed Mothers and their Infants (VID-KIDS) is an example of a parenting intervention that has been evaluated to improve the quality of mother-infant interactions when mothers are experiencing PPD, improve maternal depression and decrease infants stress levels. To ensure successful uptake of VID-KIDS in public health care settings, it is essential that maternal perspectives are heard and applied accordingly. The goal of this research project was to understand the perspectives of mothers who participated in the VID-KIDS intervention, as this was a gap that required further exploration. Four mothers were interviewed, following the tenets of hermeneutics, to understand the meaning that they attached to this experience. The findings of this study provided encouragement that VID-KIDS makes a positive difference in the lives of mothers and their infants when experiencing PPD.
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    Influence of interpersonal violence on maternal anxiety, depression, stress and parenting morale in the early postpartum: a community based pregnancy cohort study
    (BioMed Central, 2012-12-15) Tough, Suzanne C.; Malta, Lise A.; Hegadoren, Kathy M.; Weller, Carol A.; McDonald, Sheila W.