The evolution of health outcomes from childhood to adolescence

Using data from the Canadian National Longitudinal Survey of Children and Youth (NLSCY), this study examines how and why health outcomes exhibit persistence during the period from childhood to adolescence. We examine the distribution of health outcomes and health transitions using descriptive analysis and explore the determinants of these distributions by estimating the contributions of family SES, unobserved heterogeneity and state dependence and also allowing for heterogeneity of state dependence parameters across categories of neighborhood status. Our analysis indicates that children living in poorer neighborhoods, in neighborhoods with lower education levels and in neighborhoods with more families headed by lone-parents tend to experience poor health status for longer after a transition to it, while children tend to experience multiple health drops living in poorer neighborhoods, in neighborhoods with less educated people, in neighborhoods with more families headed by lone-parents and in neighborhoods with more families living in rental accommodation.

Families with school-age children

Most working parents face a common dilemma--how to care for their children when they are not in school but the parents are at work. In this article Kathleen Christensen, Barbara Schneider, and Donnell Butler describe the predictable and unpredictable scheduling demands school-age children place on working couples and single working parents. The authors assess the potential capacity of schools to help meet the needs of working families through changes in school schedules and after-school programs and conclude that the flexibility parents need to balance family-work responsibilities probably cannot be found in the school setting. They argue that workplaces are better able than schools to offer the flexibility that working parents need to attend to basic needs of their children, as well as to engage in activities that enhance their children's academic performance and emotional and social well-being. Two types of flexible work practices seem especially well suited to parents who work: flextime arrangements that allow parents to coordinate their work schedules with their children's school schedules, and policies that allow workers to take short periods of time off--a few hours or a day or two-to attend a parent-teacher conference, for example, or care for a child who has suddenly fallen ill. Many companies that have instituted such policies have benefited through employees' greater job satisfaction and employee retention. Yet despite these measured benefits to employers, workplaces often fall short of being family friendly. Many employers do not offer such policies or offer them only to employees at certain levels or in certain types of jobs. Flexible work practices are almost nonexistent for low-income workers, who are least able to afford alternative child care and may need flexibility the most. Moreover the authors find that even employees in firms with flexible practices such as telecommuting may be reluctant to take advantage of them, because the workplace culture explicitly or implicitly stigmatizes or penalizes employees for choosing these work arrangements. The authors conclude by making a case for creating a workplace culture that supports flexibility. Such a culture, they argue, would enable working parents to better meet the responsibilities of their jobs as they care for and build strong relationships with their children.

Family structure as a risk factor for women's sexual victimization: a study using the Danish registry system

This study estimated the risk of sexual victimization associated with different family structures. Based on the Danish Civil Registration System, all female visitors to the Centre for Rape Victims (CRV) at the University Hospital in Aarhus, during a two-year period (January 2005 to December 2006) were identified (N = 214) along with a control group (N = 4,343) that was matched by age and residential location. The family structure in the preceding year was used as a predictor variable in a logistic regression model. Results indicted that, compared to those who were married with children at home, being single with children at home significantly increased the likelihood of having visited the CRV. This is consistent with the research literature that has shown that single women with children are at risk for disadvantage on a range of socioeconomic and psychological factors as well as at risk for interpersonal violence.

Social and economic consequences of HIV and AIDS on children: case study of a high-density community in Harare, Zimbabwe

We present results from a household-based survey that was conducted in Mabvuku, a high-density community in Zimbabwe. The objective of the study was to improve understanding of social and economic consequences of HIV and AIDS on children. Children affected by HIV and AIDS (CABA) formed the treatment group while those not affected by HIV and AIDS (non-CABA) were the control group. We found that many of the differences in the socio-economic indicators that we studied between CABA and non-CABA were not significant. Therefore our results indicate a gloomy scenario for all the children. These results are consistent with existing literature which indicates that the impact of HIV and AIDS is exacerbated by poverty. Based on evidence from this paper, we conclude that programmes and interventions targeted at children should encompass both CABA and non-CABA within a framework of sustained commitment to improving the lives of these children. We hope that our findings will be used in the formulation of interventions and strategies to improve the situation of children affected by HIV and AIDS and/or living in impoverished communities.

Family structure and children's health in the United States: findings from the National Health Interview Survey, 2001-2007

OBJECTIVES

This report presents statistics from the 2001-2007 National Health Interview Survey (NHIS) on selected measures of physical health and limitations, access to or utilization of health care, and behavior or emotional well-being for children under age 18 by family structure, sex, age, race, Hispanic origin, parent's education, family income, poverty status, home tenure status, health insurance coverage, place of residence, and region.

SOURCE OF DATA

NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention's National Center for Health Statistics, and is representative of the civilian noninstitutionalized population of the United States. Information about one randomly selected child per family is collected in a face-to-face interview with an adult proxy respondent familiar with the child's health.

HIGHLIGHTS

Children in nuclear families were generally less likely than children in nonnuclear families to be in good, fair, or poor health; to have a basic action disability; to have leaming disabilities or attention deficit hyperactivity disorder; to lack health insurance coverage; to have had two or more emergency room visits in the past 12 months; to have receipt of needed prescription medication delayed during the past 12 months due to lack of affordability; to have gone without needed dental care due to cost in the past 12 months; to be poorly behaved; and to have definite or severe emotional or behavioral difficulties during the past 6 months. Children living in single-parent families had higher prevalence rates than children in nuclear families for the various health conditions and indicators examined in this report. However, when compared with children living in other nonnuclear families, children in single-parent families generally exhibited similar rates with respect to child health, access to care, and emotional or behavioral difficulties.

The effect of lone motherhood on the smoking behavior of young adults

We provide evidence that living with an unmarried mother during childhood raises smoking propensities for young adults in Germany.

Parenthood--a contributing factor to childhood obesity

Prevalence of childhood obesity and its complications have increased world-wide. Parental status may be associated with children's health outcomes including their eating habits, body weight and blood cholesterol. The National Health and Nutrition Examination Survey (NHANES) for the years 1988-1994, provided a unique opportunity for matching parents to children enabling analyses of joint demographics, racial differences and health indicators. Specifically, the NHANES III data, 1988-1994, of 219 households with single-parents and 780 dual-parent households were analyzed as predictors for primary outcome variables of children's Body Mass Index (BMI), dietary nutrient intakes and blood cholesterol. Children of single-parent households were significantly (p < 0.01) more overweight than children of dual-parent households. Total calorie and saturated fatty acid intakes were higher among children of single-parent households than dual-parent households (p < 0.05). On average, Black children were more overweight (p < 0.04) than children of other races. The study results implied a strong relationship between single-parent status and excess weight in children. Further studies are needed to explore the dynamics of single-parent households and its influence on childhood diet and obesity. Parental involvement in the development of school- and community-based obesity prevention programs are suggested for effective health initiatives. Economic constraints and cultural preferences may be communicated directly by family involvement in these much needed public health programs.

Social adversity predicts ADHD-medication in school children--a national cohort study

AIMS

To test the hypothesis that psychosocial adversity in the family predicts medicated ADHD in school children.

METHOD

ADHD-medication during 2006 was identified in the Swedish Prescribed Drug Register in national birth cohorts of 1.1 million 6-19 year olds. Logistic regression models adjusted for parental psychiatric disorders were used to test our hypothesis.

RESULTS

There was a clear gradient for ADHD medication with level of maternal education, with an adjusted odds ratio of 2.20 (2.04-2.38) for the lowest compared with the highest level. Lone parenthood and reception of social welfare also implied higher risks of ADHD-medication with adjusted ORs of 1.45 (1.38-1.52) and 2.06 (1.92-2.21) respectively. Low maternal education predicted 33% of cases with medicated ADHD and single parenthood 14%.

CONCLUSIONS

Social adversity in the family predicts a considerable proportion of ADHD-medication in school children in Sweden.

Cost of eating: whole foods versus convenience foods in a low-income model

BACKGROUND AND OBJECTIVES

Financial limitations in low-income populations, those at highest risk for poor health outcomes, may preclude adherence to recommended dietary guidelines. We examine the financial burden of shopping for foods to meet national dietary recommendations in a supermarket compared to eating primarily in a fast-food restaurant.

METHODS

Using a single-parent, low-income model, we obtained whole food costs (healthy) from local supermarkets and from fast-food outlets (convenient). Using cost per calorie as a metric for comparison, we used estimated single-parent, low-income living expenses to determine the relative costs of meeting national dietary guidelines.

RESULTS

Average food costs for healthy and convenience diets accounted for 18% and 37% of income, respectively. Dairy products and vegetables accounted for the largest cost percentages of diet costs (36% and 28%, respectively). The cost per calorie of a convenience diet was 24% higher than the healthy diet. Both models resulted in net financial loss over the course of a year for a single-parent, low-income family.

CONCLUSIONS

Food costs represent a significant proportion of annual income. Diets based heavily on foods from convenient sources are less healthy and more expensive than a well-planned menu from budget foods available from large supermarket chains.

Socioeconomic correlates of rates of child maltreatment in small communities

This study expands the research on neighborhood effects and child maltreatment by examining the structural conditions, including religion and nationality, in small towns in Israel. The results are compared with those in inner-city and suburban neighborhoods in Western countries. Five community structural variables were statistically correlated with investigated cases of child maltreatment: adults' unemployment rate, rate of new immigrants, rate of children in single-parent families, population gain or loss, and the community's location in relation to a central city. A multivariate regression analysis of these variables explained 44% of the variance.

Mothers, men, and child protective services involvement

This study used data on 2,297 families from the Fragile Families and Child Wellbeing Study to examine whether Child Protective Services (CPS) involvement varies by maternal relationship status. Families were categorized according to whether the mother was living with a (male) partner or spouse, was involved in a dating relationship, or was not romantically involved. Families in which the mother was romantically involved were further delineated by whether her partner was the biological father of none, some, or all of the children in her household. Results indicated that families in which the mother was living with a man who was not the biological father of all children and those in which she was not romantically involved were significantly more likely to be contacted by CPS than those in which she was living with the biological father of all resident children. These findings withstood the inclusion of detailed controls for the mother's characteristics and behaviors and (in two-parent families) her partner's characteristics and behaviors, suggesting that they are not fully explained by observable social selection factors.

Witnesses to hunger: participation through photovoice to ensure the right to food

Currently 30.2% of female-headed households with children in the United States experience food insecurity, defined as the lack of access to enough food for an active and healthy life. In 2007, approximately 12.4 million children were at risk for hunger. When female-headed households and households with children have the highest prevalence of food insecurity and hunger in the US, the participation of low-income mothers in the development and administration of policies and programs related to nutrition and poverty are fundamental to the process of ending hunger and improving child well-being. In this article, we describe the Witnesses to Hunger program, a participatory advocacy project that uses the "photovoice" technique to engage mothers to take photos and record their stories about poverty and hunger with the intent to inform social welfare policy in the US. Witnesses to Hunger is grounded in the human rights framework that is supported by international conventions on the rights of women, the rights of the child, and economic, social, and cultural rights. The Witnesses to Hunger program works to increase civic participation of low-income women and to maintain a strategic public awareness campaign. After introducing the Witnesses to Hunger program, this article describes the past decade of unchanging food insecurity disparities, demonstrates the lack of participatory dialogue in health and welfare programs, and provides examples of how Witnesses to Hunger counters the conventional dialogue about welfare. Throughout, this paper demonstrates how the participatory approach of the Witnesses to Hunger program improves our understanding of basic human needs and the social determinants of health, and informs legislators on how to improve health and welfare policy.

Disparities and predictors of emergency department use among California's African American, Latino, and White children, aged 1-11 years, with asthma

OBJECTIVES

The purpose of this study was to determine factors associated with use of emergency departments by African American, Latino, and White children aged 1-11 years in California.

METHODS

I conducted a secondary analysis of parental reports of emergency department use by children with asthma (defined as doctor's diagnosis of asthma). An overall sample of 1313 children with asthma was identified from the California Health Interview Survey, 2001.

RESULTS

African American children were 1.82 times (95% CI 1.23-1.25) and Latino children were 1.23 times (95% CI 1.21-1.25) more likely than White children to visit the ED for asthma symptoms. Severity of symptoms, having private health insurance, being from a single-family home, and childhood disability factors were also associated with emergency department use.

CONCLUSIONS

Health insurance type, being from a single-parent home, and asthma severity and disability predict the use of emergency department use for African American, Latino, and White children with asthma in California.

Relationships between socioeconomic backgrounds, caries associated microflora and caries experience in 12-year-olds in Bosnia and Herzegovina in 2004

AIM

To present the prevalence of dental caries in Bosnia and Herzegovina (BH), to estimate the levels of salivary mutans streptococci and lactobacilli and compare them with caries prevalence in 12-years-old children from different socioeconomic backgrounds.

STUDY DESIGN AND METHODS

A survey was carried out in 8 cantons of the Federation of BH (FBH) and in Republic Srpska (RS) in 2004. The final sample included 560 12-year-olds. The clinical examinations focused on dental status, expressed as DMFT index, and they were carried out by one examiner, following WHO standard methodologies. Additionally, the study involved 109 12-years old children from Sarajevo, divided in three groups, based on their socioeconomic background. For measuring lactobacillus and mutans streptococci (MS) count in saliva Dentocult LB and Dentocult SM-Strip Mutans were used. Levels of MS and lactobacilli were expressed as a score between 0 and 3, indicating very low to very high levels of SM and lactobacilli.

RESULTS

The average DMFT of the 12-year-olds was 4.16+/-2.92. On average, 91% of the 12-year-olds were affected with dental caries. The SiC Index was 7.41+/-3.31. Investigating the relationship between caries associated microflora and caries experience in children of different socioeconomic status showed the following: significant difference in caries prevalence was found in children with different living conditions, where children with high socioeconomic status had better oral health compared to the other two groups. For mutans streptococci, 25.7% of the children had mutans class 0, 24.8% class 1, 34.9% class 2 and 14.6% class 3. The mean DMFT for mutans class 0 was 3.50, for class 1 was 4.30, for class 2 was 5.62 and for class 3 was 6.0. For lactobacilli, 38.5% of the children had lactobacilli class 0, 25.7% class 1, 23.9% class 2 and 11.9% class 3. The mean DMFT for lactobacilli class 0 was 4.3, for class 1 was 4.9, for class 2 was 4.8 and for class 3 was 6.0. No significant differences in the level of mutans streptococci and lactobacilli were found between the groups.

CONCLUSION

There is moderate caries prevalence among BH 12-year-olds (DMFT 4.16+/-2.92). Caries experience varies between children with different living condition but no relation between levels of salivary mutans streptococci and lactobacilli and socioeconomic status of children could be found.

HIV/AIDS and family support systems: A situation analysis of people living with HIV/AIDS in Lagos State

Current statistics about the HIV/AIDS epidemic in Nigeria do not reveal the broader social and economic impacts of the disease on the family.The study therefore primarily aimed to address the socio-economic effects of HIV infection on individuals and their families.The study was carried out in Lagos State. In-depth interviews were employed to collect information from 188 people living with HIV/AIDS through support groups in the state, while four focus group discussions were conducted to elicit information from people affected by AIDS about the socio-economic impacts of HIV/AIDS on families in Nigeria. From the survey, among people living with HIV/AIDS, 66% of females and males were in the age group 21-40 years, while 10% were older people above 60 years of age. Findings revealed that as HIV/AIDS strikes at parents, grand parents are assuming responsibility for bringing up the children of the infected persons and the orphans of those killed by the virus. It was striking that some of the older caregivers could not meet the requirement of these children.They are often forced to work more than they would have, or borrow in order to cope with the needs of these extra mouths. Some of the infected people have sold their properties to enable them to cope with the economic effects of the virus, while their children have had to drop out of school, since they could not afford the school fees and other related expenses. It was suggested that PLWHA should be economically empowered with adequate medical treatment, in order to reduce the impact of the disease on the family.

Family structure is associated with oral pain in 12-year-old Greek schoolchildren

OBJECTIVE

To determine the prevalence, associated correlates and impact of oral pain in 12-year-old schoolchildren in Stayroypoli, Greece.

DESIGN AND METHOD

Cross-sectional survey of all schoolchildren attending the last year of government primary schools using self-administered questionnaires. Approval was granted by the Greek Ministry of Education and Religion. Cooperation was obtained from the schools. Children whose parents did not refuse their participation were invited to complete a questionnaire. Oral pain prevalence was estimated and association with sociodemographic/economic factors tested. Associations between pain experience and impact on daily activities were examined.

RESULTS

Of the 296 children registered, 225 (76.0%) were present on the days data were collected. Usable questionnaires were completed by 187 children (83.1%). Oral pain in the previous 4 weeks, reported by 70 (37.4%), was more likely to affect children living with one parent/other people (OR 3.0, 95% CI = 1.2-7.4, P = 0.013) and those who brushed less than twice a day (OR 2.8, 1.5-5.2, P = 0.001). Impact on daily activities was reported by 64 children (91.4%). The most commonly stated impacts were eating (40.0%), cleaning teeth (25.7%) and sleeping (18.6%).

CONCLUSIONS

Oral pain prevalence was high in 12-year-old schoolchildren in Stayroypoli, is associated with family structure, and impacts substantially on daily activities.

Legacies of Advantage and Disadvantage: The Case of Teen Mothers

OBJECTIVES

The life trajectories of teen mothers and their children were examined with data from a larger longitudinal study.

DESIGN

All 5 waves of the study were designed from the hermeneutic tradition.

SAMPLE

Sixteen families began the study in 1988-1989 (Time 1) and were invited to participate in subsequent studies (1993, 1997, 2001, and 2005). Twenty-eight informants participated in the fifth wave of the study (Time 5).

MEASUREMENT

This analysis capitalized on the diversity of teen mothers' family backgrounds to examine the life chances of mothers and their first-born children as mothers entered their 30s. Three domains are addressed: teen mothers' educational attainment, their social class status, and their oldest child's school progress and sexual activity.

RESULTS

Teen mothers' life trajectories reflected legacies of unequal life chances that began in childhood and persisted into their 30s. Mothers with childhood advantages fared better over time than impoverished mothers, and a legacy of advantage contributed to a cushion of safety and opportunity for their teenaged children.

CONCLUSION

The powerful legacy of social class and racial divisions on teen mothers' long-term outcomes challenges the view that teen mothering leads to a downward spiral with negative repercussions for mothers and children.

Spirituality and resilience in families in which a parent has died

This preliminary study explored the prevalence of spirituality in family resilience in the adaptation process after the loss of a parent. Twenty-five families who lost a parent between one and six years previously were identified by four postgraduate students in their respective neighborhoods in Cape Town, South Africa. Each of the single parents (M age=48.3 yr., SD=7.7), 19 women and six men, were asked to indicate verbally in what way spirituality or religion had contributed to family adaptation after the death of the spouse. The semistructured interviews supplied evidence that a relationship between spirituality and family resilience does indeed exist.

Risk behaviours, victimisation and mental distress among adolescents in different family structures

BACKGROUND

Previous studies have shown an elevated risk with regard to social and behavioural domains in adolescents of single parents. However, the diversity of single parent families concerning gender of the resident parent has seldom been taken into account when investigating the relation between family structure and children's negative outcomes. Thus, the aim of this study was to investigate risk behaviours, victimisation and mental distress among adolescents in different family structures using more detailed sub-groups of single parents (i.e., single mother, single father and shared physical custody).

METHODS

The sample consisted of 15,428 ninth graders from all municipal and private schools in the county of Stockholm (response rate 83.4%). Risk behaviours included use of alcohol, illicit drugs and smoking. Victimisation was measured by experiences of exposure to bullying and physical violence. Mental distress was assessed with the anxious/depressed and aggressive behaviour syndrome scales in the Youth Self Report (YSR). Bivariate and multivariate logistic regression analyses were used to investigate the associations between family structure and outcome variables.

RESULTS

Adolescents in single-mother/father families were at higher risk of risk behaviours, victimisation and mental distress than their counterparts in two-parent families. However, after control for possible confounders the associations between victimisation, aggressive behaviour problems and single motherhood were no longer significant, whereas these relations remained for children living with single fathers. Adolescents in shared physical custody run no increased risk of any of the studied outcomes (except drunkenness) after adjustment for covariates. Post hoc analyses revealed that adolescents in single-father families were at higher risk for use of alcohol, illicit drugs, drunkenness, and aggressive behaviour as compared to their peers in single-mother families, whereas no differences were found between adolescents in single-mother families and those in shared physical custody.

CONCLUSIONS

Children of single parents should not be treated as a homogenous group when planning prevention and intervention programmes. Researchers and professionals should be aware of and consider the specific problems of single parent children and that their problems may vary depending on their living arrangements.

What Children Do on the Internet: Domains Visited and Their Relationship to Socio-Demographic Characteristics and Academic Performance

HomeNetToo is a longitudinal field study designed to examine the antecedents and consequences of home Internet use in low-income families. Participants included 140 children, mostly 13-year-old African American (83%) boys (58%), living in single-parent households (75%) where the median annual income was $15,000 (USD). This report focuses on children's Internet activities, socio-demographic characteristics related to their Internet activities, and the relationship between academic performance and Internet activities. Overall, findings indicate that low-income children initially use the Internet primarily for entertainment. As home Internet use loses its novelty children become more focused in their Internet activities, reducing the number of websites they visit and visiting more websites targeted to their specific interests. Pornography websites are popular initially, especially among boys, but their popularity decreases dramatically after 3 months. Age, race, and sex have little influence on which websites are most popular. Academic performance predicts subsequent Internet activities, and Internet activities predict subsequent academic performance. Directions for future research to identify mechanisms that mediate the relationship between Internet activities and academic performance and implications for the digital divide are discussed.

Differences in risk factors for partial and no immunisation in the first year of life: prospective cohort study

OBJECTIVE

To compare demographic, social, maternal, and infant related factors associated with partial immunisation and no immunisation in the first year of life in the United Kingdom.

DESIGN

Prospective cohort study.

SETTING

Sample of electoral wards in England, Wales, Scotland, and Northern Ireland, stratified by measures of ethnic composition and social disadvantage.

PARTICIPANTS

18,488 infants born between September 2000 and January 2002, resident in the UK and eligible to receive child benefit (a universal benefit available to all families) at age 9 months.

MAIN OUTCOME MEASURE

Immunisation status at 9 months of age, defined as fully immunised, partially immunised, or not immunised.

RESULTS

Overall in the UK, 3.3% of infants were partially immunised and 1.1% were unimmunised; these rates were highest in England (3.6% and 1.3%, respectively; P < 0.01). Residence in ethnic or disadvantaged wards, larger family size, lone or teenaged parenthood, maternal smoking in pregnancy, and admission to hospital by 9 months of age were independently associated with partial immunisation status. In contrast, a higher proportion of mothers of unimmunised infants were educated to degree level or above (1.9%), were older (3.1%), or were of black Caribbean ethnicity (4.7%).

CONCLUSIONS

Mothers of unimmunised infants differ in terms of age and education from those of partially immunised infants. Interventions to reduce incomplete immunisation in infancy need different approaches.

Tooth brushing and social characteristics of families in 32 countries

OBJECTIVES

To compare the reported tooth brushing behaviour among adolescents in relation to age, gender and parental occupation, family affluence, single parent family and at least one parent not working but staying at home.

METHODS

Representative samples of 11-, 13- and 15 year old pupils in 32 countries completed an anonymous standardised questionnaire during school hours.

RESULTS

Large differences in prevalences of reported tooth brushing were found between countries for both genders: from 16-80 % for boys and 26-89% for girls. In some countries the prevalence of more-than-once-a-day tooth brushing increased by increasing age, whereas in others it declined. High occupational status and family affluence were clearly related to a high prevalence of more-than-once-a-day tooth brushing. Children living in two parent families had higher prevalences of recommended tooth brushing in only a few countries.

CONCLUSIONS

Within the European continent and in North America, gender, family affluence and parental occupation were significantly associated with reported tooth brushing frequency among adolescents. The association between family characteristics, such as absence of one of the parents and the supervisory role of the parents, and brushing behaviour of the children appeared to be rather weak and inconsistent.

[Psychosocial risk assessment among families receiving assistance from the social services]

This study analyses the psychosocial risk profiles that better discriminate between three levels of risk: low, middle and high. We also examine to what extent the assessments of the level of risk made by professionals of social services are consistent with their decision of initiate a "risk declaration" expedient. For this purpose, 468 cases of families (245 two-parents and 223 one-parent) were examined through the Psychosocial Risk Profile of the Family. Discriminant analysis showed that social exclusion and family violence profiles discriminate between high and middle-low levels of risk in two-parent families. Negligence and family violence plus maternal inadequacy and children maladjustment discriminate between high and middle-low levels of risk in one-parent families. There is a high consistence between the assessment of psychosocial risk and the decision to initate a procedure of a "risk declaration" in both families, with a tendency to overestimate the middle risk in one-parent families.