Social Equity Research Centre, RMIT University, Melbourne, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia.
Centre for Urban Research, RMIT University, Melbourne, Australia.
Health Place. 2024 Sep;89:103327. doi: 10.1016/j.healthplace.2024.103327. Epub 2024 Jul 29.
This study investigated the relationship between geographic availability (and quality) of local early childhood education and care services and children's early mental health outcomes for all children entering their first year of full-time school in Melbourne, Australia.
We capitalise on a unique population linked dataset, the Australian Early Development Census - Built Environment, which combines geospatial measures of children's neighbourhoods with demographic information and child mental health outcomes for all school entrants in Australia's 21 most populous cities and towns. Objective early childhood education and care service location and quality exposures were developed for each study child based on home addresses. Four geographic availability exposures (counts within 3 km) were examined for cross-sectional associations with child mental health outcomes (externalising and internalising difficulties, competence). We estimated associations using multilevel logistic regression (Markov Chain Monte Carlo estimation) adjusting for child demographics and stratifying by urbanicity.
Children with higher counts of high-quality preschool services within 3 km of home had lower odds of difficulties and higher odds of competence. Overall, exposures were most consistently associated with children's competence. Across all outcomes, the most consistent patterning was observed for children living in the inner city and middle ring. Results varied depending on whether service quality was accounted for in measures of availability. Geographic availability of early childhood services showed patterning by neighbourhood disadvantage and by maternal education.
We found some evidence that geographic availability of high-quality preschools was associated with better child mental health outcomes, but results varied by urbanicity. While future research is required to unpack these differences, these findings indicate the importance of accounting for both geographic availability and service quality simultaneously in future research, policy and practice.
本研究调查了澳大利亚墨尔本所有进入全日制学校第一学年的儿童的当地幼儿教育和保育服务的地理可得性（和质量）与儿童早期心理健康结果之间的关系。
我们利用了一个独特的人口关联数据集，即澳大利亚早期发展普查-建筑环境，该数据集将儿童邻里的地理空间测量与澳大利亚 21 个人口最多的城市和城镇所有入学儿童的人口统计信息和儿童心理健康结果相结合。根据家庭住址，为每个研究儿童制定了客观的幼儿教育和保育服务位置和质量暴露情况。我们检查了四个地理可得性暴露情况（3 公里内的计数）与儿童心理健康结果（外化和内化困难、能力）的横断面关联。我们使用多层逻辑回归（马尔可夫链蒙特卡罗估计）进行估计，根据儿童人口统计学数据进行调整，并按城市划分进行分层。
家中 3 公里范围内有更多高质量学前服务计数的儿童，其出现困难的几率较低，能力较高的几率较高。总体而言，暴露情况与儿童的能力最一致相关。在所有结果中，内城和中环地区的儿童表现出最一致的模式。结果因可用性测量中是否考虑服务质量而有所不同。幼儿服务的地理可用性显示出与邻里劣势和母亲教育有关的模式。
我们发现一些证据表明，高质量幼儿园的地理可得性与儿童心理健康结果较好有关，但结果因城市而异。虽然需要进一步研究来阐明这些差异，但这些发现表明，在未来的研究、政策和实践中，同时考虑地理可用性和服务质量非常重要。
