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Depression, anxiety, stress
Poor Health of Their Children
Psychiatric disease, Suicide and suicide attempt, injury, addiction, less school engagement, violence
Meet Ms. Sheer
"That first year, I lost like 80 pounds. The stress just took hold of my body.“
-pressures of raising the newborn son +
-feeling that she'd been cast out of her social network
Account for significant portion of the population of Canada and it is growing
Single mothers have about 1.9 million children,
and the average number of children they have per family is greater than
single-father families and couple families.
40% of single mother families have 2 children or more.
This is an important public health issue because...
Source: 2006 Statistics Canada, Catalogue no. 91-213-X.
16% of all families
Population in thousands
Source: U.S. Census Bureau, Current Population Survey, 2007 Annual Social and Economic Supplement
Around 50% of single mother families live under $35,000 per year. Every year, their income is increasing, but slowly.
Source: 1997 Canadian Medical Association,
Single mothers in Ontario: sociodemographic, physical and mental health characteristics
Ellen Lipman, David Offord, Machael Boyle
Galarneau (2005). Earnings of temporary versus permanent employees”. Perspectives on Labour and Income, Spring 2005 17(1). Ottawa: Statistics Canada Catalogue no. 75-001-XPE.
Townson, Hayes (2007). Women and the Employment Insurance Program: The Gender Impact of Current Rules on Eligibility and Earnings Replacement. Ottawa: Status of Women in Canada.
Mason(2003). Listening to lone mothers: Paid work, family life, and childcare in Canada. Journal of Children & Poverty
National Council of Welfare (2008). Welfare incomes, 2006 and 2007. National Council of Welfare Reports
Aboriginal: 31% are single mothers
Non-Aboriginal: 13% are single mothers
Statistics Canada (2006). Aboriginal Peoples in Canada in 2006: Inuit, Metis and First Nations, 2006 Census: First Nations people.
Statistics Canada (2006). Education and income of lone parents. Perspectives on Labour and Income: Spring 2006, 18(1). Ottawa: Statistics Canada
Erika Lauren Williston
Woo Jin Park
Yang Kevin Wu
Yi Ming Shen
Poor Physical Environment
1. Sexual Education
2. Collaborative Care
Poor Physical Environment
Poor Physical Environment
Poor Physical Environment
3. Childcare Subsidies
But! There are some Success Stories
Implementation of collaborative care:
More patients met criteria for recovery.
Patients claimed to be much more satisfied than the usual care.
Implementation of teleconferencing:
Had better outcomes than on-site collaborative care.
Acknowledgments, Data Sources, Key references
Health disparities in single mothers
Mental Disorders, Malnutrition, Children's Health etc.
Sexual Education, Collaborative Care, Childcare Subsidies
Cultural, ethical and contextual
Promote government action
1. 2006 Statistics Canada, Catalogue no. 91-213-X.
2. Canadian Journal of Public Health, January- Februiary 2004, Commentary: Single-mother families in Canada, Enza Gucciardi, Nalan Celasun, Donna E. Stewart
3. 1997 Canadian Medical Association, Single mothers in Ontario: sociodemographic, physical and mental health characteristics Ellen Lipman, David Offord, Machael Boyle
4. Statistics Canada, 2011 Census of Population and Statistics Canada catalogue no. 98-312-XCB.
5. U.S. Census Bureau, Current Population Survey, 2007 Annual Social and Economic Supplement
6. Lefebvre P, Merrigan P, Verstraete M. Dynamic Labour Supply Effects of Childcare Subsidies: Evidence from a Canadian Natural Experiment on Universal Child Care," Labour Economics. 2009. 16(5): 490-502
7. Haeck C, Lefebvre P, Merrigan P. Quebec’s universal childcare: the long term impacts on parental labour supply and child development. 2012.
8. Blau D, Tekin E. The determinants and consequences of child care subsidies for single mothers in the USA. Journal of Population Economics. 2007. 20, 4: 719-741.
9. Tekin E. Single Mothers Working At Night: Standard Work And Child Care Subsidies. Economic Inquiry, Western Economic Association International. 2007. 45(2): 233-250, 04.
10. Scott EK, London AS, Hurst A. Instability in patchworks of child care when moving from welfare to work. Journal of Marriage and the Family. 2005. 67(2): 370-386.
11. Forry N. The Impact of Child Care Subsidies on Low-Income Single Parents: An Examination of Child Care Expenditures and Family Finances. Journal of Family and Economic Issues. 2009. 30(1): 43-54.
12. Canada Child tax benefit. (2013) Canada Revenue Agency. http://www.cra-arc.gc.ca/cctb/
13. The Régie des rentes du Québec and child assistance. 2013. The Régie des rentes du Québec. http://www.rrq.gouv.qc.ca/en/programmes/soutien_enfants/Pages/soutien_enfants.aspx
14. Sanchez G, Miguel R. 2002. Targeting child poverty in Canada. Theses and Dissertations (Comprehensive). Paper 234.
15.Oringanje C, Meremikwu MM, Eko H, Esu E, Meremikwu A, Ehiri JE. Interventions for preventing unintended pregnancies among adolescents. The Cochrane library. 2009 Oct 7
16.Council on Communications and Media. American Academy of Pediatrics. Policy statement--sexuality, contraception, and the media. Pediatrics. 2010;126(3):576.
Religious beliefs against contraception
Collaborative Care and Teleconferencing
Risk of miscommunication
Childcare Subsidy/ Daycare
Language and cultural disparities
Sally: Single mother of three children.
- Fantastic family child care provider
- Dream again of getting back into the workforce
-vehicle to get back into the workforce
Martha: Single mother of one child.
"It was a system that changed my life because I got to understand again, whoo, I can back into the work force."
Child Care Subsidies and Child Development: How Four
Mothers Story their Experiences of their Child(ren)’s Development
B.S.W. The University of British Columbia, 2009
Who are single mothers?
Sauve R. Connections: Tracking the links
between jobs and family. Contemporary Family
Trends. Ottawa: The Vanier Institute of the
Full-time Employment rate
High proportion of young single mothers.
High proportion of unintended pregnancies.
Sexual education as primary intervention.
Several mechanisms have been proposed:
- Free contraceptives
- Proper contraceptive usage
- Comprehensive education (versus abstinence only education)
PICO: Does the implication of education to young women decrease the rate of single mothers?
Sexual education: an effective intervention?
- Positive response, lowering of unplanned pregnancies in all researches
Common characteristics of successful programs include:
1. Specific and straightforward goals (ex:
unplanned pregnancy prevention, condom usage)
2. Specific pinpointing of problems (ex: lack of cooperation, abstinence)
3. Specific methods and strategies to solving the problems(ex: positive attitude, perception of risk, self-efficacy)
Researches presented unclear randomization.
Researches may be victims of self-report bias.
Impact of social and psychological problems not discussed in sexual education.
Effect of media and technology in teenagers.
Finding other ways of educating other than at school.
Emphasis on education/intervention on males as well.
Sexual education: Limitations
Childcare Subsidy and Day Care
What is available?
Canada Child Benefit
Child Assistance Plan
PICO: Do childcare subsidies and/or affordable daycare improve the health of single mothers and their children?
The Régie des rentes du Québec and child assistance. 2013. The Régie des rentes du Québec. http://www.rrq.gouv.qc.ca/en/programmes/soutien_enfants/Pages/soutien_enfants.aspx
The evidence shows…
Data from several studies was extrapolated following implementation in the US and Canada:
Increased involvement of women in the labor force
Promote/strengthen the economy
Increase family financial stability
Decreased degree of poverty
Limited number of spaces/unequal distribution of spaces
Poor quality of day care
Insufficient information distribution
Small sample size
Inappropriate population selection
Depression (unipolar) among single mothers
Collaborative care including teleconferencing
PICO: Does collaborative care, including teleconferencing, yield better outcomes for depressed single mothers than the usual care?
On site record
Short periods for RCT
Use different methods (e.g.: CBT instead of Behavioral Activation)
Both single mothers appreciated the child care subsidy for being able to go back to the work force.
(And the Use of Technology)
Source: 2003 Lancet,
Mortality, severe morbidity, and injury in children living with
Single parents in Sweden: a population-based study
Gunilla Ringbäck Weitoft, Bengt Haglund, and Måns Rosén
Proximal Causes of Health Problems
in Single Mothers
Lack of Physical Activity
Lack of Sleep
Parental Psychiatric History
Source: Statistics Canada, 2011 Cencus of Population and Statistics Canada catalogue no. 98-312-XCB
17. Campbell-Grossman CK, Hudson DB, Keating-Lefler R, Heusinkvelt S., New mothers network: the provision of social support to single, low-income,
African American mothers via e-mail messages. Journal of Family Nursing [Internet]. 2009 May [cited 2013 Sept 28]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19211545
18. Fortney JC, Pyne JM, Mouden SB, Mittal D, Hudson TJ, Schroeder GW, Williams DK, Bynum CA, Mattox R, Rost KM., Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial. Am J Psychiatry. 2013 Apr 1 [Cited 2013 Sept 28]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23429924
19. Richards DA, Hill JJ, Gask L, Lovell K, Chew-Graham C, Bower P, Cape J, Pilling S, Araya R, Kessler D, Bland JM, Green C, Gilbody S, Lewis G, Manning C, Hughes-Morley A, Barkham M., Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial. BMJ. 2013 Aug 19 [Cited 2013 Sept 28[. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23959152
20. Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ., Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med. 2006 Nov 27 [Cited 2013 Sept 28]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17130383