Nathan Nickel

University of Manitoba | UMN · Manitoba Centre for Health Policy

Administrative databases are often used to manage systems or to investigate research questions. The data may be derived from population registries, vital statistics or other records of life events, or from information on services. Questions that may be addressed by administrative datasets include the determinants of variation in utilization, costs,...

Objectives: We explored differences in health and education outcomes between children living in social housing and not, and effects of social housing's neighborhood socioeconomic status. Methods: In this cohort study, we used the population-based repository of administrative data at the Manitoba Centre for Health Policy. We included children age...

The PATHS Data Resource is a unique database comprising data that follow individuals from the prenatal period to adulthood. The PATHS Resource was developed for conducting longitudinal epidemiological research into child health and health equity. It contains individual-level data on health, socioeconomic status, social services and education. Indiv...

Unlabelled: BACKGROUND, OBJECTIVES: The Ten Steps to Successful Breastfeeding are not, as yet, the norm in the United States. This study examined how noncompliance with each of the Steps, and combinations of 2 Steps, influence duration of breastfeeding at the breast. Methods: Data were from the national Infant Feeding Practices Study II. The out...

Objectives: The Ten Steps to Successful Breastfeeding is a proven approach to support breastfeeding in maternity settings; however, scant literature exists on the relative impact and interpretation of each step on breastfeeding. We assessed the Ten Steps and their relationship with in-hospital breastfeeding rates at facilities serving low-wealth p...

Background A lack of safety data on postpartum medication use presents a potential barrier to breastfeeding and may result in infant exposure to medications in breastmilk. The type and extent of medication use by lactating women requires investigation. Methods Data were collected from the CHILD Cohort Study which enrolled pregnant women across Can...

Purpose: The Food and Nutrition for Manitoba Youth (FANS) study examined dietary intakes, food behaviours, food security status, health indicators, and body mass index of a cohort of grade 9 students. This paper describes regional differences and similarities in dietary intake (food and nutrients) and quality of youth participants in the FANS study...

Objective Breastfeeding is associated with reduced postpartum depression, stronger parent-child relationships, and fewer behavioral disorders in early childhood. We tested the mediating roles of postpartum depression and parent-child relationship in the association between breastfeeding practices and child behavior. Study design We used standardiz...

Background Differential access to healthcare has contributed to a higher burden of illness and mortality among First Nations compared to other people in Canada. Throughout the Coronavirus Disease 2019 (COVID-19) pandemic, First Nations organizations in Manitoba partnered with public health and Manitoba government officials to ensure First Nations h...

Importance Alcohol-related hospitalizations are common and associated with significant cost to the health care system. We have a limited understanding of the characteristics of individuals who experience alcohol-related hospitalizations, which limits our capacity to prioritize those at the highest risk of postdischarge harm. Objective To identify...

Background There are concerns that many children do not have healthy diets, which may be related to dietary choices as well as lack of access to healthy foods. The Food and Nutrition Security for Manitoba Youth (FANS) study examined diet, nutrition-related behaviours and food security of 1587 grade nine students in Manitoba, Canada. Results show th...

Background: Addressing the risk of people from gender and sexual minority (GSM) groups experiencing inequities throughout the cancer continuum requires a robust evidence base. In this scoping review, we aim to map the literature on cancer outcomes among adults from GSM groups and the factors that influence them along the cancer continuum. Methods...

We document community responses to the COVID-19 pandemic among Inuit living in the province of Manitoba, Canada. This study was conducted by the Manitoba Inuit Association and a Council of Inuit Elders, in partnership with researchers from the University of Manitoba. We present findings from 12 health services providers and decision-makers, collect...

Across Canada, the COVID-19 pandemic placed considerable stress on territorial and provincial healthcare systems. For Nunavut, the need to continue to provide access to critical care to its citizens meant that medical travel to provincial points of care (Edmonton, Winnipeg and Ottawa) had to continue through the pandemic. This complexity created ch...

This study, a partnership between <Organization 1> and <Organization 2>, investigated whether attending full-time kindergarten (FTK) was associated with better educational outcomes for Metis students in Manitoba, who may face unique barriers to academic success. We utilized linked administrative data from the Manitoba Population Research Data Repos...

Background There are gaps in our understanding of treatment needs among people who use methamphetamine. We examined the demographics, perceived treatment needs, barriers to accessing care, and stigma experienced by an inpatient sample of people who use methamphetamine. Methods This study surveyed a convenience sample of patients admitted to psychi...

Problem: In Canadian society, public policies guide the development and administration of social services and systems, including the public education system, the justice system, family services, social housing and income support. However, because social services are often planned and implemented in a ‘siloed’ manner, coordination and collaboration...

Objectives Adolescent vaping has become a public health concern. The aim of this study was to examine the associations between adolescent vaping and subsequent use of other substances and risk factors for polysubstance use. Methods The Well-being and Experiences Study is a longitudinal, intergenerational study conducted in Manitoba, Canada. The sa...

Introduction: Allergic conditions, such as asthma, hay fever and eczema, are some of the most common conditions impacting children globally. There is a strong incentive to study their determinants to improve their prevention. Asthma, hay fever and eczema are influenced through the same immunological pathway and often copresent in children ('the at...

Background and Objectives: Guidance around maternity care practices and infant feeding during the COVID-19 pandemic changed over time and was sometimes conflicting. Hospital maternity practices influence breastfeeding, an important preventive strategy against viral illness. Most birthing hospitals in Mississippi are enrolled in CHAMPS, a quality im...

Adolescence is a vital period of growth and development, both of which are dependent on adequate nutrition; however, concerns persist about poor nutrition and inappropriate food behaviours. In addition to nutrition assessment, the context of food and health behaviour is necessary to understand how dietary choices are shaped and related to diet qual...

There is a notable lack of research related to trends in Inuit accessing health services throughout the land known as Canada. Given Nunavut’s reliance on specialised services provided in the Northwest Territories, Alberta, Manitoba, and Ontario, this gap is particularly problematic, making it more difficult for Nunangat to proactively plan new prog...

Background The Qanuinngitsiarutiksait study aimed to develop detailed profiles of Inuit health service utilization in Manitoba, by Inuit living in Manitoba (approximately 1,500) and by Inuit from the Kivalliq region of Nunavut who travel to Manitoba to access care not available in Nunavut (approximately 16,000 per year). Methods We used health adm...

Background Good nutrition and access to healthy foods are essential for child growth and development. However, there are concerns that Canadian children do not have a healthy diet, which may be related to dietary choices as well as lack of access to healthy foods. The FANS (Food and Nutrition Security for Children and Youth) study examined the nutr...

Introduction Rising use of methamphetamine is causing significant public health concern in Canada. The biological and behavioural effects of methamphetamine range from wakefulness, vigour and euphoria to adverse physical health outcomes like myocardial infarction, haemorrhagic stroke, arrhythmia and seizure. It can also cause severe psychological c...

Background: Perinatal risk factors can vary by immigration status. We examined psychosocial and behavioral perinatal health indicators according to immigration status and immigrant characteristics. Methods: We conducted a population-based cross-sectional study of 33,754 immigrant and 172,342 non-immigrant childbearing women residents in Manitoba...

Objective Manitoba has one of the highest incarceration rates among Canadian provinces, and because of Canada’s racist and colonial policies, the number of Métis women in custody is disproportionately high. In this study, we examined birth outcomes among Métis and all other Manitoba women who were incarcerated while pregnant. ApproachUsing linked a...

Objectives Lack of consistent and relevant Indigenous identifiers in Canadian data sources leads to misclassification and under-recognition of the health and social issues impacting Indigenous Peoples, further perpetuating the harms of colonization. We are evaluating and optimizing our approach for identifying First Nations (FN) individuals in admi...

Objective Post-acute COVID-19 (or ‘long COVID’) manifests as a wide range of long-lasting symptoms affecting multiple organ systems. We are developing criteria for identifying long COVID cases using administrative, clinical, survey and other data from Manitoba, Canada, with the ultimate goal of examining long COVID prevalence, risk factors, prognos...

ObjectiveA multi-disciplinary E2A group was established as part of a linked administrative data study examining methamphetamine use in Manitoba. In this presentation we will share our experiences of establishing an E2A, embedding stakeholders in the research process, and outline an iterative engagement plan for the remaining study years. ApproachTh...

Objectives Indigenous children in Canada, including Metis children, are taken into care by the child welfare system at a disproportionately high rate. The objective of this study was to explore factors related to having a child taken into care from Metis families in Manitoba, and specifically from Metis mothers experiencing incarceration. ApproachT...

Objectives Perinatal risk factors can vary by immigration status. To advance knowledge on sociobehavioral health risks among pregnant and childbearing immigrant women, we compared perinatal health indicators between immigrant and non-immigrants, overall, and according to key immigrant characteristics (refugee status, secondary migration, birth regi...

Objectives Red River Métis are Indigenous people hailing from the Canadian Prairies who have historically experienced poor health outcomes due to colonial practices. Researchers from the Manitoba Métis Federation (MMF) partnered with health services researchers to test whether MMF-led COVID initiatives were associated with access to COVID-19 testin...

Objectives First Nations (FN) organizations worked with public health and governments to improve FN access to COVID-19 vaccines by prioritizing FN communities in vaccination initiatives. FN researchers and data scientists partnered to test whether these efforts were associated with increased access to COVID-19 vaccines among FN compared with all ot...

ObjectivesSPECTRUM is a unique multi-disciplinary, cross-sector collaborative research partnership between academics, government, and community organizations in Manitoba working together to address complex social problems. In our first research project, partners identified the need for quantitative evidence around outcomes of children involved with...

Objectives Generations of racist and colonial policies have resulted in First Nations (FN) people being systematically over-represented in Canada’s legal system. FN researchers partnered with data scientists at the University of Manitoba to document the birth outcomes associated with experiences of prenatal incarceration among FN families. Approach...

Objectives Over three decades ago, the Aboriginal Justice Inquiry identified structural racism in Canada’s justice system. Although rates of youth criminal charges and incarcerations have declined substantially since then, it is unclear whether First Nations youth are treated differently than non-First Nations youth for similar offences. Our study...

Objective The objective was to examine the relationship between maternal intimate partner violence (IPV) victimization and children’s developmental health using linked population-wide administrative datasets. We examined developmental vulnerability (DV) at kindergarten of children exposed to maternal IPV victimization aged 0 to 5 using provincial p...

Objective Using population-wide administrative data, the objective was to provide Canadian evidence on the longitudinal relationship between maternal intimate partner violence (IPV) victimization and children’s developmental health. Using provincial prosecution records, we examined developmental vulnerability (DV) at kindergarten of children prenat...

Objectives Responding to the Truth and Reconciliation Commission of Canada’s (TRC) Call to Action #19 to close the gap in maternal/child outcomes, the goal of this study was to provide a baseline for select outcomes and demonstrate how an Indigenous/decolonizing framework can be applied to population health research involving Indigenous people. App...

IntroductionOut-of-school or after-school programs are designed to support healthy behaviours, boost academic achievement and strengthen social skills. The Boys and Girls Clubs of Winnipeg (BGCW) in Manitoba, Canada, have been offering out-of-school programs to children and adolescents in low-income neighbourhoods for more than 40 years. Many BGCW...

Abstract Background Network analysis, a technique for describing relationships, can provide insights into patterns of co-occurring chronic health conditions. The effect that co-occurrence measurement has on disease network structure and resulting inferences has not been well studied. The purpose of the study was to compare structural differences am...

Introduction: Out-of-school or after-school programs are designed to support healthy behaviours, boost academic achievement and strengthen social skills. The Boys and Girls Clubs of Winnipeg (BGCW) in Manitoba, Canada, have been offering out-of-school programs to children and adolescents in low-income neighbourhoods for more than 40 years. Many BG...

Background Breastfeeding beyond infancy (12 months) remains atypical in the United States, United Kingdom, Canada, and Australia, and the role of health care providers is unclear. The objective of this study was to compare women's perceptions of provider support and other factors affecting breastfeeding beyond infancy across countries, among women...

Communities and Hospitals Advancing Maternity Practices (CHAMPS) is a public health initiative, operating in Mississippi since 2014, to improve maternal and child health practices and reduce racial disparities in breastfeeding. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, this study assessed CHAMPS, which used...

Background: Amid rising concern about opioid use across Canada, Métis leaders in Manitoba are seeking information on prescription opioid dispensing in Red River Métis populations to assist with planning and implementing appropriate evidence-based harm-reduction strategies in their communities. We examined patterns of prescription opioid dispensing...

Manitoba is home to approximately 1,500 Inuit, and sees 16,000 consults yearly from the Kivalliq region of Nunavut to access services. The purpose of our study was to develop detailed profiles of Inuit accessing services in Manitoba, by using administrative data routinely collected by Manitoban agencies, to support the development of Inuit-centric...

For more than 30 years, the Manitoba Centre for Health Policy has been conducting research and evaluation to provide timely and critical evidence to answer real-world policy questions. Our experienced team of research scientists, analysts and other staff work extensively with policy-makers at the macro, meso and micro levels of government to suppor...

BACKGROUND AND OBJECTIVES Race is an important predictor of breastfeeding prevalence in the United States, with rates being lowest among Black populations. The Communities and Hospitals Advancing Maternity Practices (CHAMPS) program works with hospitals and communities to implement the Baby-Friendly Hospital Initiative, increase breastfeeding rates...

Background Vaping among adolescents and young adults is a significant public health concern worldwide. Understanding which risk factors are associated with vaping is important to help inform evidence-based prevention and intervention strategies. There are several gaps in the current literature examining these associations such as limited longitudin...

The authors of this article argue that instrument development studies can be situated within constructive realism, an intermediary ontology between the representative constructed items and objectivist goals of measurement. The Delphi method uses constructionist processes by gathering expert opinions about the variable they wish to measure. Despite...

Objective Update the evidence on use of pharmacotherapy for alcohol use disorder in a Canadian population. Methods Using whole-population administrative data from Manitoba, Canada, we identified all residents age 12+ who were first diagnosed with alcohol use disorder between April 1, 1996 and March 31, 2015, and compared characteristics of those w...

Introduction Decades of research demonstrate that First Nations, Metis and Inuit (FN/M/I) populations have differential access to diagnostic and therapeutic healthcare. Emerging evidence shows that this continues to be the case during the SARS-CoV-2 pandemic. In an effort to rectify these differences in access to care, our team, which is co-led by...

Background and Aims High-risk alcohol consumption is associated with compromised health. This study aimed to compare the incidence of alcohol-related cancers, diabetes, ischemic heart disease (IHD), and mortality between those with and without an indication of alcohol use disorder (AUD). Design Retrospective, population-based, matched cohort study...

Background: First Nations (FN) women have a higher risk of diabetes than non-FN women in Canada. Prenatal education and breastfeeding may reduce the risk of diabetes in mothers and offspring. The rates of breastfeeding initiation and participation in the prenatal program are low in FN communities. Methods: A prenatal educational website, social...

Background In Manitoba, Canada, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit, an unconditional income supplement of up to CAD $81/month, during their latter two trimesters. Our objective was to determine the impact of the Healthy Baby Prenatal Benefit on birth and early childhood outcomes among Manitoba First Nations...

Existing writing self-efficacy instruments have assessed the concept through mechanical and process features of writing to the neglect of the influence of situated context. The purpose of this study was to develop and test the Situated Academic Writing Self-Efficacy Scale (SAWSES) based on Bandura’s self-efficacy theory and a model of socially cons...

Nursing programs are complex systems that articulate values of relationality and holism, while developing curriculums that privilege metric‐driven competency‐based pedagogies. This study used an interpretive approach to analyze interviews from 20 nursing students at two Canadian Baccalaureate programs to understand how nursing's educational context...

Introduction Roughly 30% of children in Manitoba are vulnerable in one or more important areas of development at school entry. The Healthy Baby Community Support Program (HBCSP) is a universally accessible supported playgroup that operates across Manitoba to support mothers and babies up to 1 year postpartum. Objectives and Approach This study use...

Background Policies to increase Australian Indigenous children’s participation in preschool aim to reduce developmental inequities between Indigenous and non-Indigenous children. This study aims to understand the benefits of preschool participation by quantifying the association between preschool participation in the year before school and developm...

Introduction Early education outcomes influence children’s educational trajectories with long-term effects extending into adulthood. Aboriginal peoples face numerous systemic barriers to academic success. It remains unknown if full-day kindergarten (FDK) is associated with improved academic outcomes among Metis children – a distinct Aboriginal peop...

Introduction In Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), a prenatal income supplement. Research has demonstrated positive outcomes associated with HBPB, but it remains unknown if Metis women and children – who are of mixed European and Aboriginal descent and one of the most marginalized populati...

Introduction Administrative data studies routinely report that First Nations mothers and children experience a disproportionate burden of poor health. Due to the nature of administrative data, research often takes a deficits-oriented approach. First Nations health research needs to consider the role that community- and individual-level strengths pl...

Introduction The leveraging of multi-sector, whole-population, linked administrative data is advantageous for conducting research on complex real-world problems. However, such large and complex data repositories can sometimes appear impersonal and overwhelming. Establishing organizational empathy (OE) in the context of a multi-sector partnership be...

Introduction Resilience is a key factor in healthy development of children who have experienced adversity in early life. Current methods of assessment involve using questionnaires - few of which are appropriate for young children, most are time consuming and rely on parent recall, thereby introducing bias. Additionally, widespread implementation of...

Introduction Canada has one of the highest rates of prescription opioid consumption globally. Little is known about the prevalence and determinants of opioid use among citizens of the Metis nation – one of three Aboriginal groups recognized by the Canadian constitution. Objectives and Approach Our objectives were to (i) identify trends in prescrip...

Introduction The Boys & Girls Clubs of Winnipeg (BGCW) provide out-of-school programs to children and youth living in low-income neighbourhoods in Winnipeg, Canada. These programs aim to set participants on a path to success by supporting healthy behaviours, academic achievement and social skills. First Nation children and youth make up a substanti...

Introduction The Boys & Girls Clubs of Winnipeg (BGCW) provide out-of-school programs to children and youth living in low-income neighbourhoods in Winnipeg, Canada. These programs aim to set participants on a path to success by supporting healthy behaviours, academic achievement and social skills. Metis children and youth make up a substantial prop...

Background In Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), which provides up to CAD $81.41/month during the second and third trimesters of pregnancy. In research conducted in partnership with the Manitoba Metis Federation, we examined the association of the HBPB with Metis birth and early childhood...

Breastfeeding and human milk (HM) are critically important to maternal, infant and population health. This paper summarizes the proceedings of a workshop that convened a multidisciplinary panel of researchers to identify key priorities and anticipated breakthroughs in breastfeeding and HM research, discuss perceived barriers and challenges to achie...

Objective Mood and anxiety disorders (MADs) are common conditions with multiple aetiologies. Exposure to antibiotics has been proposed as a possible risk factor in animal studies. We aimed to assess maternal antibiotic use in pregnancy and child antibiotic use in the first three years of life, collectively called early life, as potential risk facto...

Objectives: This article articulates the complexity of modeling in First Nations, Metis, and Inuit contexts by providing the results of a modeling exercise completed at the request of the First Nations Health and Social Secretariat of Manitoba. Methods: We developed a model using the impact of a previous pandemic (the 2009 H1N1) to generate estimat...

Background: Alcohol is the drug most commonly used by Canadians, with multiple impacts on health and health service use. We examined patterns of short- and long-term health service use among people with a diagnosis of alcohol use disorder. Methods: In this retrospective matched cohort study, we used population-based administrative data from the...

Background: It is unclear whether intrauterine exposure to maternal diabetes is associated with risk factors for cardiovascular disease and related end points in adulthood. We examined this potential association in a population-based birth cohort followed up to age 35 years. Methods: We performed a cohort study of offspring born between 1979 and...

School‐based healthy living interventions are widely promoted as strategies for preventing obesity. The peer‐led Healthy Buddies™ curriculum has been shown to improve obesity‐related outcomes in school‐aged children. We examined whether these improvements existed among subgroups of children stratified by sex, income level and urban/rural geography....

Introduction Children who have a history of involvement in child protection services (CPS) are over-represented in the youth and adult criminal justice systems. There are significant health and socioeconomic implications for individuals involved in either or both CPS and the justice system. Understanding the ‘overlap’ between these two systems woul...

To monitor the progress of the COVID-19 outbreak, ensure equitable access to testing and treatment, and provide up-to-date information to Indigenous decision-makers engaged in setting up measures to protect their communities, the Manitoba Inuit Association (MIA) mobilized to work with the First Nation Heath and Social Secretariat of Manitoba, Ongom...

Background The Families First Home Visiting (FFHV) program aims to enhance parenting skills and strengthen relationships between parents and their children. Previous research found FFHV to be effective at decreasing child maltreatment in the general population of Manitoba, but whether it is beneficial specifically for First Nation families has not...

Background The contemporary incidence and prevalence of thoracic aortic aneurysm and dissection (TAAD) remains understudied. Epidemiological research on TAAD has been limited by incomplete case identification within administrative data sources. The objectives of this study were to develop a case identification method, and determine the incidence an...

Objective: This qualitative study explores teens' perspectives on facilitators and barriers to accessing school-based clinics, emphasizing the importance of youth self-report. Methods: We conducted in-person interviews with teens (N = 25) at 2 high schools that had school-based clinics in Winnipeg, Manitoba (Canada). We supplemented the interviews...

We explored the particularities of the Healthy Baby Prenatal Benefit (HBPB), an unconditional cash transfer program for low-income pregnant women in Manitoba, Canada, which aims to connect recipients with prenatal care and community support programs, and help them access healthy foods during pregnancy. While previous studies have shown associations...

Objective To determine whether the Families First Home Visiting (FFHV) programme, which provides home visiting services to families across Manitoba, is associated with improved public health outcomes among First Nations families facing multiple parenting challenges. Design Retrospective cohort study using population-based administrative data. Set...

Objective The Manitoba Infant Feeding Database (MIFD) is being piloted as a surveillance system leveraging infant vaccination visits as a point of contact to collect infant feeding data during the first year of life. The objective of this study was to assess data quality and acceptability of the MIFD as a sustainable population-based surveillance s...

Background Children born to adolescent mothers generally perform more poorly on school readiness assessments than their peers born to adult mothers. It is unknown, however, whether this relationship extends to the grandchildren of these adolescent mothers. This paper examines the multi-generational outcomes associated with adolescent motherhood by...

Results of adjusted logistic regression models for school readiness by mother’s adolescent motherhood status (n = 14,298). (DOCX)

Results of adjusted logistic regression models for school readiness by intergenerational adolescent motherhood status (n = 14,298). (DOCX)

Defining childhood covariates. (DOCX)

Definitions of childhood covariates between birth and age 5. (DOCX)

Results of adjusted logistic regression models for school readiness by grandmother’s adolescent motherhood status (n = 14,298). (DOCX)

Background: Race is a predictor of breastfeeding rates in the United States, and rates are lowest among African American infants. Few studies have assessed changes in breastfeeding rates by race after implementing the Ten Steps to Successful Breastfeeding (hereafter referred to as the Ten Steps), and none have assessed the association between impl...

Overweight and obese mothers in the United States (U.S.) have disproportionately lower rates of exclusive breastfeeding than mothers of normal weight. The Ten Steps to Successful Breastfeeding (Ten Steps), a series of evidence‐based practices designed to support breastfeeding initiation, duration, and exclusivity, demonstrate effectiveness at the p...