Children In Ontario Research Articles

Burden of Illness Associated With Respiratory Syncytial Virus, Influenza, and Coronavirus Disease 2019 in Infants and Young Children in Ontario, Canada, 2018-2023: A Population-Based Canadian Immunization Research Network Study.

As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transitions to endemicity and respiratory syncytial virus (RSV) and influenza reestablish their seasonal circulation patterns, understanding their comparative burden on infants and children can guide health system responses and funding priorities. This was a population-based cohort study of children aged <5 years in Ontario, Canada, from September 2018 to August 2023 using linked health administrative databases. Seasonal cohorts comprised 731 838 to 763 660 children. RSV- and influenza-related hospital admission rates immediately decreased in March 2020. In 2021-2022, RSV-related admissions rebounded but remained 8%-11% lower than prepandemic seasons, whereas 2022-2023 RSV-related admissions increased 105%-113% versus prepandemic seasons and peak admissions occurred in November versus December. Influenza did not rebound until 2022-2023, when admissions were 28%-37% higher than prepandemic seasons. Coronavirus disease 2019 (COVID-19)-related admissions remained low until 2021-2022 and were lower than RSV-related admissions across all age groups during prepandemic and pandemic seasons. By contrast, 2021-2022 COVID-19-related admissions exceeded prepandemic influenza-related admissions by 30%-40% but decreased by 45% in 2022-2023 and were lower than prepandemic influenza-related admissions, except among infants aged <12 months who remained at highest risk. There was no distinct seasonal pattern for COVID-19-related admissions during the study. RSV remains a major cause of childhood hospitalization. Although COVID-19 appears to be receding, its disease burden as it transitions to endemicity remains to be established. The unprecedented peaks in RSV-related hospital admissions during 2022-2023, together with the return of influenza and ongoing SARS-CoV-2 transmission, underscore the need to strengthen systems for real-time surveillance and to proactively prepare for critical healthcare scenarios.

A mixed methods study of early childhood providers’ perceptions of the acceptability and feasibility of parenting for lifelong Health tip sheets in Ontario, Canada

BackgroundUniversal parenting campaigns are efficient, cost-effective and can eliminate barriers to accessing conventional, face-to-face parenting interventions. The aims of the CHAMPP4KIDS study were to assess Canadian early childhood providers’ perceptions of the acceptability and feasibility of implementing a universal parenting resource, the Parenting for Lifelong Health tip sheets.MethodsUsing a convergent mixed method design, an online survey of providers working with families with young children in Ontario, Canada was followed by focus group discussions with a subset of providers to explore their perceptions of using the tip sheets in their professional practice.ResultsProviders generally perceived the tip sheets to be acceptable but had reservations with respect to the feasibility of distributing the sheets to their clients as standalone, universal parenting resources. Providers agreed the tip sheets covered topics pertinent to caregivers’ concerns, offered useful strategies and, therefore, had the potential to be valuable, engaging resources for families. However, many providers said the sheets would only be effective as complementary resources to facilitated in-person sessions, especially for high-needs families.ConclusionProviders suggested that future iterations of these resources take into consideration more accessible design and formatting, literacy levels, word choice and further cultural adaptation. Insight into the nuances and potential divergence between provider perceptions of universal materials’ acceptability and feasibility can help adapt materials to pre-emptively respond to potential implementation barriers, facilitate intervention fidelity and, ultimately, increase the likelihood of intervention acceptability and feasibility of both providers and caregivers.

The Effects of a Morphological Awareness Intervention on Reading and Spelling Ability of Children With Dyslexia

This paper examines the effects of a morphological awareness intervention on the word reading and spelling skills of Grades 4 to 6 children with dyslexia. Sixteen children in eastern Ontario, Canada, received 20 hours of morphologically oriented instruction spread over 6 weeks and eight served as controls, and all received a battery of reading and spelling tests before and after the intervention. Students were taught the nature of morphology and the types of morphemes, how words could be assembled from morphemes or deconstructed into morphemes to make meaning from print and access the correct pronunciation, and how to use morphology in reading and spelling words. Repeated measures analyses of variance and analyses of covariance indicated that the experimental group showed significantly larger gains than the control group on measures of morphological awareness, morphological decoding, morphological analysis, and morphological spelling. There were no significant effects on word reading (fluency and accuracy) or on standardized spelling measures.

Pediatric Respiratory Syncytial Virus Hospitalizations, 2017-2023

Respiratory syncytial virus (RSV) transmission was disrupted worldwide following the COVID-19 pandemic, and further study is required to better understand these changes. To compare observed and expected RSV hospital and intensive care unit (ICU) admission rates and characteristics of admitted children during the 2021-2022 and 2022-2023 seasons. A population-based cohort study of all children aged younger than 5 years in Ontario, Canada, July 1, 2017, through March 31, 2023, was conducted. Individual and neighborhood-level sociodemographic and clinical characteristics were identified from administrative data, including age, palivizumab eligibility, complex medical conditions, rurality, and living in a marginalized neighborhood. The main outcome was RSV-associated hospitalization. Secondary outcomes included ICU admissions, mechanical ventilation, extracorporeal membrane oxygenation, and in-hospital death. Poisson generalized estimating equations were used to model weekly age- and sex-specific hospitalization rates and estimate expected rates in the postpandemic era; adjusted rate ratios (RRs) and 95% CIs are reported. This cohort study included approximately 700 000 children per study year. Compared with prepandemic years (2017-2018, 2018-2019, and 2019-2020), the 2021-2022 RSV season peaked slightly earlier, but overall admission rates were comparable (289.1 vs 281.4-334.6 per 100 000, or approximately 2000 admissions). The 2022-2023 season peaked a month earlier and resulted in more than twice as many hospitalizations (770.0 per 100 000; n = 4977 admissions). The proportion of children admitted to an ICU in 2022-2023 (13.9%) was slightly higher than prepandemic (9.6%-11.4%); however, the population-based rate was triple the prepandemic levels (106.9 vs 27.6-36.6 per 100 000 children in Ontario). With the exception of palivizumab-eligible children, all sociodemographic and health status characteristics were associated with lower-than-expected RSV hospitalization rates in 2021-2022. In contrast, older age of patients was associated with higher-than-expected rates in 2022-2023 (ie, 24-59 months: RR, 1.90; 95% CI, 1.35-2.66). There were notable differences in RSV epidemiologic characteristics in Ontario following the COVID-19 pandemic. It is not yet clear whether and how long atypical RSV epidemics may persist. Clinicians and program planners should consider the potential for ongoing impacts to health care capacity and RSV immunization programs.

Carriage of Haemophilus influenzae serotype A in children: Canadian Immunization Research Network (CIRN) study.

Haemophilus influenzae serotype a (Hia) has recently emerged as an important cause of invasive disease, mainly affecting young Indigenous children. Carriage of H. influenzae is a pre-requisite for invasive disease and reservoir for transmission. To better understand the epidemiology of invasive Hia disease, we initiated a multicentre study of H. influenzae nasopharyngeal carriage among Canadian children. With prior parental consent, we collected nasotracheal tubes used during general anaesthesia in healthy children following routine dental surgery in a regional hospital of northwestern Ontario and a dental clinic in central Saskatchewan. In northwestern Ontario, all children were Indigenous (median age 48.0 months, 45.8% female); in Saskatchewan, children were from various ethnic groups (62% Indigenous, median age 56.3 months, 43.4% female). Detection of H. influenzae and serotyping were performed using molecular-genetic methods. A total of 438 nasopharyngeal specimens, 286 in northwestern Ontario and 152 in Saskatchewan were analyzed. Hia was identified in 26 (9.1%) and 8 (5.3%) specimens, respectively. In Saskatchewan, seven out of eight children with Hia carriage were Indigenous. The carriage rates of Hia in healthy children in northwestern Ontario and Saskatchewan are comparable to H. influenzae serotype b (Hib) carriage among Alaska Indigenous children in the pre-Hib-vaccine era. To prevent invasive Hia disease, paediatric conjugate Hia vaccines under development have the potential to reduce carriage of Hia, and thus decrease the risk of transmission and disease among susceptible populations. Addressing the social determinants of health may further eliminate conditions favouring Hia transmission in Indigenous communities.

Physical activity and unexpected weight change in Ontario children and youth during the COVID-19 pandemic: A cross-sectional analysis of the Ontario Parent Survey 2.

The objective of this study was to investigate the association between children's parent-reported physical activity levels and weight changes during the COVID-19 pandemic among children and youth in Ontario Canada. A cross-sectional online survey was conducted in parents of children 5-17 years living in Ontario from May to July 2021. Parents recalled their child's physical activity and weight change during the year prior to their completion of the survey. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multinomial logistic regression for the association between physical activity and weight gain or loss, adjusted for child age and gender, parent ethnicity, current housing type, method of school delivery, and financial stability. Overall, 86.8% of children did not obtain 60 minutes of moderate-to-vigorous physical activity per day and 75.4% of parents were somewhat or very concerned about their child's physical activity levels. For all physical activity exposures (outdoor play, light physical activity, and moderate-to-vigorous physical activity), lower physical activity was consistently associated with increased odds of weight gain or loss. For example, the adjusted OR for the association between 0-1 days of moderate-to-vigorous physical activity versus 6-7 days and child weight gain was 5.81 (95% CI 4.47, 7.56). Parent concern about their child's physical activity was also strongly associated with child weight gain (OR 7.29; 95% CI 5.94, 8.94). No differences were observed between boys and girls. This study concludes that a high proportion of children in Ontario had low physical activity levels during the COVID-19 pandemic and that low physical activity was strongly associated with parent reports of both weight gain and loss among children.

“It’s Not a System of Care”: Black Youth’s Stories of Family Separation and Anti-Black Racism in Ontario’s Child Welfare System

The Black family unit and community plays a critical role in Black youths’ self-development, cultural socialization, and ability to navigate the impacts of structural anti-Black racism embedded in Canadian society. However, Black families are at an increased risk of separation from their children in Ontario’s child welfare system. Utilizing anti-Black racism theory, this study investigates the narratives of 27 Black Caribbean youth in the Greater Toronto Area with lived experience in out-of-home care. Using a narrative inquiry as a methodological approach, the findings reveal that Black youth in out-of-home care experienced: (1) social, psychological, and cultural isolation; (2) the disregard of their hygiene and unique hair needs and; (3) a critical conscious awareness of anti-Black racism. Recommendations for practice, research, and policy are discussed to adequately respond to the needs of Black children and their families.

Latin American children in Ontario child welfare: An examination of investigation disparities

Despite literature indicating that children and families of certain racial and ethnic backgrounds are more likely to experience child welfare involvement than white children and families, there is limited research on Latin American children’s child welfare involvement within the Canadian context. This study provides the first investigation of potential differences and disparities in child welfare involvement for Latin American children in Ontario, Canada, by conducting a secondary analysis of data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018 (OIS-2018). The OIS-2018 collected data on child protection investigations from investigating workers, including characteristics of the investigated child, their caregivers, and their household, as well as characteristics of the investigation and short-term investigative dispositions. Incidence rates and disparity indices were calculated, and descriptive and bivariate analyses compared investigations involving Latin American children to those involving white children across key characteristics. While comprising a relatively small proportion of the investigation population, Latin American children were more than twice as likely to be investigated as white children. Consistent with this investigation disparity, significant differences were also observed in rates of substantiation and placement in out-of-home care. Investigations involving Latin American families more frequently involved concerns about family violence and were more likely to be initiated by police, but they were less likely to involve concerns about child or caregiver risks. These findings underscore a need to focus on Latin American experiences in the child welfare system, their service trajectories, and practice and policy considerations that can adequately respond to this community’s unique needs.

‘I’m going to call my friend to join us': connections and challenges in online video interviews with children during COVID-19

ABSTRACT This paper explores research with children through repeated online video interviews during the COVID-19 pandemic. It provides insight into the geographical and relational affordances provided by online interviewing, including repeated online interviewing, and discusses some of the kinds of unpredictability that can uniquely arise during online interviews. We draw on a qualitative research study conducted with children in Ontario, Canada, that explored their early pandemic experiences. With attention to children’s participation, knowledge production and relationality, we reflect on the challenges, advantages and unexpected ethical moments that arose through using online video interviews. We provide a comprehensive reflection on our longitudinal, online research with children during a global crisis by focusing on three areas: building relationships in online interviews; entering and exiting children’s worlds; and unexpected ethical challenges of online interviewing. Within these three areas we provide insight into relational dynamics shaped by the online space, how online video interviews with children can provide opportunities for them to share their feelings, the importance of careful planning when exiting research projects, and how online engagements provided relational spaces for understanding, building rapport, finding comfort, listening, and sharing during the early days of COVID-19.

Validating the Perceived Active School Travel Enablers and Barriers – Child (PASTEB-C) questionnaire

ObjectivesPresently, child-specific tools and instruments related to active school travel (AST) are lacking. This methodological shortcoming often contributes to suboptimal AST behaviour evaluations and intervention programming. The aim of this paper was to develop and validate a theoretically informed child-specific scale regarding multiple perceived barriers and enablers known to impact children's participation in AST. Study designMixed methods. MethodsA mixed-methods and multistudy scale development approach featuring the application of social-ecological theory, a validation pilot study (n = 80), and test-retest study (n = 96) was conducted in collaboration with children in Ontario, Canada. In tandem with completing cognitive interviews and online surveys, multiple analyses, including a qualitative thematic analysis, along with weighted Cohen's kappa, Cronbach's alpha, and confirmatory factor analysis were undertaken. ResultsQualitative analyses of the developed tool addressed face validity concerns related to the response options and definitions of terms used. Following the reliability analyses of 40 items, two confirmatory factor analyses were run to assess the construct validation of perceived AST barriers and enablers, and resulted in the development of the 24-item Perceived Active School Travel Enablers and Barriers – Child (PASTEB-C) questionnaire. ConclusionThe developed PASTEB-C questionnaire may be used to inform the programming and development of AST interventions, as well as conduct child-specific AST research.

The association between household food insecurity and healthcare costs among Canadian children.

To examine the relationship between household food insecurity and healthcare costs in children living in Ontario, Canada. We conducted a cross-sectional, population-based study using four cycles of the Canadian Community Health Survey (2007-2008, 2009-2010, 2011-2012, 2013-2014) linked with administrative health databases (ICES). We included Ontario children aged 1-17years with a measure of household food insecurity (Household Food Security Survey Module) over the previous 12months. Our primary outcome was the direct public-payer healthcare costs per child over the same time period (in Canadian dollars, standardized to year 2020). We used gamma-log-transformed generalized estimating equations accounting for the clustering of children to examine this relationship, and adjusted models for important sociodemographic covariates. As a secondary outcome, we examined healthcare usage of specific services and associated costs (e.g. visits to hospitals, surgeries). We found that adjusted healthcare costs were higher in children from food-insecure than from food-secure households ($676.79 [95% CI: $535.26, $855.74] vs. $563.98 [$457.00, $695.99], p = 0.047). Compared with children living in food-secure households, those in insecure households more often accessed hospitals, emergency departments, day surgeries, and home care, and used prescription medications. Children from food-secure households had higher usage of non-physician healthcare (e.g. optometry) and family physician rostering services. Even after adjusting for measurable social determinants of health, household food insecurity was associated with higher public-payer health services costs and utilization among children and youth. Efforts to mitigate food insecurity could lessen child healthcare needs, as well as associated costs to our healthcare systems.

Morbidity and healthcare use among mothers of children with cancer: A population-based study.

The impact of a child's cancer diagnosis on subsequent maternal physical health is unclear. We identified all Ontario children diagnosed less than 18years with cancer between 1992 and 2017. Linkage to administrative databases identified mothers who were matched to population controls. We identified physical health conditions, acute healthcare use, and preventive healthcare use through validated algorithms using healthcare data, and compared them between exposed (child with cancer) and unexposed mothers. Predictors of health outcomes were assessed among exposed mothers. We identified 5311 exposed mothers and 19,516 matched unexposed mothers. For exposed mothers, median age at last follow-up was 48years, (interquartile range: 42-53). Exposed mothers had an increased risk of cancer (hazard ratio [HR] 1.2, 95% confidence interval [95% CI]: 1.0-1.5, p=.03), but not of any other adverse physical outcomes or of increased acute healthcare use. Exposed mothers were more likely to receive influenza vaccinations (odds ratio 1.4, 95% CI: 1.3-1.5, p<.0001), and underwent cancer screening at the same rate as unexposed mothers. Among exposed mothers, bereavement was associated with a subsequent increased risk of cancer (HR 1.7, 95% CI: 1.2-2.5, p=.004) and death (HR 2.2, 95% CI: 1.2-4.1, p=.01). Mothers of children with cancer are at increased risk of developing cancer, but not of other adverse physical health outcomes, and were equally or more likely to be adherent to preventive healthcare practices. Bereaved mothers were at increased risk of subsequent cancer and death. Interventions targeting specific subpopulations of mothers of children with cancer or focused on screening for specific cancers may be warranted.

Gaps in childhood immunizations and preventive care visits during the COVID-19 pandemic: a population-based cohort study of children in Ontario and Manitoba, Canada, 2016–2021

ObjectiveWe aimed to estimate the changes to the delivery of routine immunizations and well-child visits through the pandemic.MethodsUsing linked administrative health data in Ontario and Manitoba, Canada (1 September 2016 to 30 September 2021), infants <12 months old (N=291,917 Ontario, N=33,994 Manitoba) and children between 12 and 24 months old (N=293,523 Ontario, N=33,001 Manitoba) exposed and unexposed to the COVID-19 pandemic were compared on rates of receipt of recommended a) vaccinations and b) well-child visits after adjusting for sociodemographic measures. In Ontario, vaccinations were captured using physician billings database, and in Manitoba they were captured in a centralized vaccination registry.ResultsExposed Ontario infants were slightly more likely to receive all vaccinations according to billing data (62.5% exposed vs. 61.6% unexposed; adjusted Relative Rate (aRR) 1.01 [95% confidence interval (CI) 1.00-1.02]) whereas exposed Manitoba infants were less likely to receive all vaccines (73.5% exposed vs. 79.2% unexposed; aRR 0.93 [95% CI 0.92-0.94]). Among children exposed to the pandemic, total vaccination receipt was modestly decreased compared to unexposed (Ontario aRR 0.98 [95% CI 0.97-0.99]; Manitoba aRR 0.93 [95% CI 0.91-0.94]). Pandemic-exposed infants were less likely to complete all recommended well-child visits in Ontario (33.0% exposed, 48.8% unexposed; aRR 0.67 [95% CI 0.68-0.69]) and Manitoba (55.0% exposed, 70.7% unexposed; aRR 0.78 [95% CI 0.77-0.79]). A similar relationship was observed for rates of completed well-child visits among children in Ontario (aRR 0.78 [95% CI 0.77-0.79]) and Manitoba (aRR 0.79 [95% CI 0.77-0.80]).ConclusionThrough the first 18 months of the pandemic, routine vaccines were delivered to children < 2 years old at close to pre-pandemic rates. There was a high proportion of incomplete well-child visits, indicating that developmental surveillance catch-up is crucial.

Right to Read Implies Opportunity to Read

This paper extends discussion of the Ontario Human Rights Commission (OHRC) (2022a, 2022b) report entitled Right to Read, which recommended significant changes to both reading instruction and special education programs aimed at providing equitable opportunities for all children to develop strong reading skills. In a critique of the OHRC report (Cummins, 2022), I endorsed the report’s call for the establishment of an identification and intervention infrastructure to support students who are struggling to develop reading skills. However, I also critiqued the report’s misrepresentation of the strong reading achievements of Ontario students and the scapegoating of “balanced literacy.” Klein (2022) disputed this characterization of the OHRC report, highlighting the important contributions of the report to special education policies. In continuing this dialogue, I argue that the OHRC report has omitted consideration of significant dimensions of literacy acquisition and development that are directly relevant to preventing reading difficulties among Ontario children. Specifically, I argue that beyond the systematic teaching of phonics and other foundational literacy skills, which the OHRC report emphasizes almost exclusively, literacy policies should ensure that all children experience extensive opportunities for literacy socialization, which must involve active engagement with print, in both the preschool and early elementary years.

The burden of psychiatric disorders associated with orofacial cleft pathology among children in Ontario, Canada

Individuals with orofacial cleft (OFC) may be at a higher risk of developing psychiatric disorders (PD) than the general population. We determined the risk of psychiatric diagnoses in children with OFC in Canada. This population-based retrospective cohort study used health administrative data from the province of Ontario, Canada. Children with OFC who were born between April 1, 1994, and March 31, 2017, in Ontario were matched to five non-OFC children based on sex, date of birth, and mother's age. We determined the rate of events and time-to-event for first diagnosis of PD in children aged ≥3 years (y), and for intellectual developmental delay (IDD) from birth. Risk factors for PD and IDD were assessed using 1-way ANOVA for means, Kruskal-Wallis for medians, and the χ2 test for categorical variables. There were 3051 children with OFC (matched to 15,255 controls), of whom 2515 patients with OFC (12,575 controls) had a complete follow-up to the third birthday. Children with OFC were more likely to have PD than controls (54.90 vs. 43.28 per 1000 patient-years, P<.001), with a mean age to first diagnosis of 8.6±4.2y. The cleft palate group had the highest risk (HR 1.33, 95% CI 1.18-1.49). Children with OFC also had a higher risk of IDD than non-OFC children (27.78 vs. 3.46 per 1000 patient-years, p<.001). Children born with OFC in Ontario had a higher risk of psychiatric diagnosis and IDD compared to controls. Further research is also required to better understand the predictors of variation in risk, including geographic location and the presence of congenital abnormalities, and identify potential areas for intervention. Level II.

Impact of a Publicly-Funded Pharmacare Program on Prescription Stimulant use Among Children and Youth: A Population-Based Observational Natural Experiment.

Stimulants are first-line pharmacotherapy for individuals with attention-deficit hyperactivity disorder. However, disparities in drug coverage may contribute to inequitable treatment access. In January 2018, the government of Ontario, Canada, implemented a publicly-funded program (OHIP+) providing universal access to medications at no cost to children and youth between the ages of 0 and 24. In April 2019, the program was amended to cover only children and youth without private insurance. We studied whether these policy changes were associated with changes in prescription stimulant dispensing to Ontario children and youth. We conducted a population-based observational natural experiment study of stimulant dispensing to children and youth in Ontario between January 2013 and March 2020. We used interventional autoregressive integrated moving average models to estimate the association between OHIP+ and its subsequent modification with stimulant dispensing trends. The implementation of OHIP+ was associated with a significant immediate increase in the monthly rate of stimulant dispensing of 53.6 individuals per 100,000 population (95% confidence interval [CI], 36.8 to 70.5 per 100,000) and a 14.2% (95% CI, 12.8% to 15.6%) relative percent increase in stimulant dispensing rates between December 2017 and March 2019 (1198.6 vs. 1368.7 per 100,000 population). The April 2019 OHIP+ program amendment was associated with an increase in monthly stimulant dispensing trends of 10.2 individuals per 100,000 population (95% CI, 5.0 to 15.5), with rates increasing 7.5% (95% CI, 6.2% to 8.7%) between March 2019 and March 2020 (1368.7 vs. 1470.8 per 100,000 population). These associations were most pronounced among males, children and youth living in the highest income neighbourhoods and individuals aged 20 to 24. A publicly-funded pharmacare program was associated with more children and youth being dispensed stimulants.

Parent-Reported Changes in Ontario Children’s Physical Activity Levels during the COVID-19 Pandemic

The COVID-19 pandemic resulted in closures of physical-activity-supporting environments, including playgrounds, outdoor recreation facilities (e.g., basketball courts), and community centers, which impacted children's movement opportunities. This study evaluated changes in Ontario children's physical activity levels during the COVID-19 pandemic and explored the impact of family sociodemographic markers on children's activity. Parents (n = 243; Mage = 38.8 years) of children aged 12 and under (n = 408; Mage = 6.7 years) living in Ontario, Canada, completed two online surveys between August and December 2020 (survey 1) and August and December 2021 (survey 2). Generalized linear mixed-effects models were used to estimate changes in the proportion of children who accumulated 60 min of physical activity per day pre-lockdown, during lockdown, and post-lockdown in Ontario. Results revealed a significant non-linear trajectory whereby the proportion of children achieving 60 min of physical activity per day pre-lockdown (63%) declined during lockdown (21%) and then increased post-lockdown (54%). Changes in the proportion of children engaging in 60 min of daily physical activity were moderated by several demographic variables. Efforts are needed to provide parents of young children with a wider variety of resources to ensure children are obtaining sufficient levels of physical activity regardless of the presence of community lockdowns.

Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada

Screening for amblyopia in primary care visits is recommended for young children, yet screening rates are poor. Although the prevalence of amblyopia is low (3%-5%) among young children, universal screening in schools and mandatory optometric examinations may improve vision care, but the cost-effectiveness of these vision testing strategies compared with the standard in primary care is unknown. To evaluate the relative cost-effectiveness of universal school screening and mandated optometric examinations compared with standard care vision screening in primary care visits in Toronto, Canada, with the aim of detecting and facilitating treatment of amblyopia and amblyopia risk factors from the Ontario government's perspective. An economic evaluation was conducted from July 2019 to May 2021 using a Markov model to compare 15-year costs and quality-adjusted life-years (QALYs) between school screening and optometric examination compared with primary care screening in Toronto, Canada. Parameters were derived from published literature, the Ontario Schedule of Benefits and Fees, and the Kindergarten Vision Testing Program. A hypothetical cohort of 25 000 children aged 3 to 5 years was simulated. It was assumed that children in the cohort had irreversible vision impairment if not diagnosed by an optometrist. In addition, incremental costs and outcomes of 0 were adjusted to favor the reference strategy. Vision testing programs were designed to detect amblyopia and amblyopia risk factors. For each strategy, the mean costs per child included the costs of screening, optometric examinations, and treatment. The mean health benefits (QALYs) gained were informed by the presence of vision impairment and the benefits of treatment. Incremental cost-effectiveness ratios were calculated for each alternative strategy relative to the standard primary care screening strategy as the additional cost required to achieve an additional QALY at a willingness-to-pay threshold of $50 000 Canadian dollars (CAD) ($37 690) per QALY gained. School screening relative to primary care screening yielded cost savings of CAD $84.09 (95% CI, CAD $82.22-$85.95) (US $63.38 [95% CI, US $61.97-$64.78]) per child and an incremental gain of 0.0004 (95% CI, -0.0047 to 0.0055) QALYs per child. Optometric examinations relative to primary care screening yielded cost savings of CAD $74.47 (95% CI, CAD $72.90-$76.03) (US $56.13 [95% CI, $54.95-$57.30]) per child and an incremental gain of 0.0508 (95% CI, 0.0455-0.0561) QALYs per child. At a willingness-to-pay threshold of CAD $50 000 (US $37 690) per QALY gained, school screening and optometric examinations were cost-effective relative to primary care screening in only 20% and 29% of iterations, respectively. In this study, because amblyopia prevalence is low among young children and most children in the hypothetical cohort had healthy vision, universal school screening and optometric examinations were not cost-effective relative to primary care screening for detecting amblyopia in young children in Toronto, Canada. The mean added health benefits of school screening and optometric examinations compared with primary care screening did not warrant the resources used.

Cost-effectiveness modelling of birth and infant dose vaccination against hepatitis B virus in Ontario from 2020 to 2050.

The World Health Organization recommends universal birth dose vaccination for hepatitis B virus (HBV), yet only 3 provinces and territories in Canada provide birth dose vaccination, and Canadian-born children in Ontario are acquiring HBV before adolescent vaccination. We sought to determine whether birth and/or infant HBV vaccination is cost-effective. We used a dynamic HBV model that incorporates population by year, disease stage, sex and the influence of immigration to quantify the disease and economic burden of chronic HBV infection in Ontario from 2020 to 2050. We compared 4 vaccination scenarios, which included a birth dose vaccine and variations of the 2 subsequent doses (either alone or as a part of the hexavalent vaccine) and a hexavalent-only strategy in infancy with the current adolescent vaccination strategy. Our costing estimates were based on values from 2020. All 4 infant vaccination approaches prevented an additional 550-560 acute and 160 chronic pediatric HBV infections from 2020 to 2050 compared with adolescent vaccination. Whereas birth dose could be cost-effective, incorporating vaccination into a hexavalent vaccine was cost saving. By 2050, the hexavalent approach led to $428 000 in cost savings per disability-adjusted life years averted. At the current prevalence in Ontario, a switch to birth dose or infant dose will be cost-effective or even cost saving. Introducing any form of infant HBV immunization in Ontario will prevent acute and chronic pediatric HBV infections.

90 An analysis of COVID-19 public health measure adherence among parents and children and the corresponding effects of lockdowns and school closures

Abstract Background Public health preventive measures have been a necessary intervention in preventing COVID-19 transmission. Objectives The objectives of this study were 1) To investigate how the adherence to COVID-19 public health measures among parents and children in Ontario changed over time; 2) To determine if provincial lockdowns were associated with higher adherence to public health measures among parents; 3) To determine if school closures were associated with higher adherence to public health measures among children. Design/Methods A longitudinal study was conducted in children aged 0-10 years and their parents through the TARGet Kids! COVID-19 Study of Children and Families in the Greater Toronto Area, Canada (April 2020 -May 2021). Parents completed weekly questionnaires on sociodemographics and public health practices. The primary exposure was calendar date. Secondary exposures were provincial lockdowns and school closures. The primary outcome was adherence to public health preventive measures (staying home, limiting visitors in the home, avoiding contact with others, socially distancing, and handwashing, measured as number of days practicing per week) measured separately for parents and children. Linear mixed effects regression and piecewise linear splines mixed effects models were conducted. Results 819 children and their parents contributed 13,220 observations to the study over 13 months. Mean age was 5.6 years (SD=2.7) and 373 were female (45.5%). 273 children (35.1%) had a parent who worked as an essential worker and 254 (35.4%) of families lived in a COVID-19 ‘hotspot’. The number of days per week that parents adhered to all 5 public health measures decreased by 0.029 days (p&amp;lt;0.001), and by 0.146 days for children (p&amp;lt;0.001) over the study duration. For parents, adherence to the five public health measures decreased over time during the first lockdown (β=-0.06, p&amp;lt;0.001) and first reopening (β=-0.01, p&amp;lt;0.001), but increased again during the second lockdown (β=0.01, p&amp;lt;0.001). For children, adherence to the five public health measures decreased over time during the first school closure, increased during the second closure, and decreased during second reopening (β=-0.04, p&amp;lt;0.01). See Figure 1. Conclusion Parents and children both decreased in their adherence to social distancing, staying at home, and avoiding contact with others over time. Lockdown after a period of reopening increased parent adherence to public health measures and school closures increased adherence in children. Supports may be necessary to help children and parents maintain adherence to public measures over prolonged periods of lockdown and school closure.