title: Neighbourhood variation and inequity of primary health service use by mothers from London-Middlesex, Ontario.
abstract: OBJECTIVE
  Primary health service use (P-HSU) may be influenced by contextual characteristics and is equitable when driven by need. Contextual effects and inequity of maternal P-HSU were determined.
  
  
  METHODS
  Participant data from a London-Middlesex, Ontario, prenatal cohort were linked by residential address to contextual characteristics. Multilevel logistic regression estimated contextual effects and tested for effect measure modification of need factors.
  
  
  RESULTS
  Maternal P-HSU varied between neighbourhoods. The effect of obesity was different for rural mothers living in low- (OR = 0.26) and middle-income households (OR = 0.15) and for urban mothers living in high-income households (OR = 2.82). The effect of having a health condition was greatest in mothers with three or more children (OR = 2.41).
  
  
  CONCLUSIONS
  Differences in maternal P-HSU exist between neighbourhoods, and enabling factors modified need factors' effects, identifying subgroups of mothers with inequitable P-HSU. RESULTS have the potential to inform Canadian health policy with regard to contextual effects and inequity of P-HSU.
authors.affiliation: Western University, London, Ontario, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Holtz
authors.affiliation: Associate Professor, Western University; Scientist, Children's Health Research Institute, London, Ontario, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Gilliland
authors.affiliation: Professor, Western University, London, Ontario, Canada.
authors.forename: Amardeep
authors.initials: A
authors.lastname: Thind
authors.affiliation: Assistant Professor, Western University; Scientist, Children's Health Research Institute, London, Ontario, Canada.
authors.forename: Piotr
authors.initials: P
authors.lastname: Wilk
authors.affiliation: Professor, Western University; Scientist, Children's Health Research Institute, London, Ontario, Canada.
authors.forename: M Karen
authors.initials: MK
authors.lastname: Campbell
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006304:Health Status; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008603:Mental Health; D009035:Mothers / Q000706:statistics & numerical data*; D009765:Obesity / Q000453:epidemiology; D009864:Ontario; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors