Family structure and child health outcomes in the United States

Testing the Multiple Disadvantage Model of Health with Ethnic Asian Children: A Secondary Data Analysis

This study of ethnic Asian children in the United States asked whether their health exhibited relationship with any of six factors: social disorganization, social structural factors, social relationships, the health of their parents, their access to medical insurance, acculturation. The sample of 1350 ethnic Asian children was extracted from the 2018 National Survey of Children's Health. Logistic regression results showed that these children's excellent/very good/good health was associated positively with safe neighborhoods, family incomes, family cohesiveness, family support, and receipt of Temporary Assistance for Needy Families (TANF). In turn, health was associated negatively with single-mother households. Implications of the present results in terms of interventions promoting family support, TANF participation, safe neighborhoods, and professionals' cultural competency are discussed.

COVID-19 pandemic fatigue and its sociodemographic and psycho-behavioral correlates: a population-based cross-sectional study in Hong Kong

Pandemic fatigue is a growing public health concern of the lingering COVID-19 pandemic. Despite its widespread mass media coverage, systematic empirical investigations are scarce. Under the Hong Kong Jockey Club SMART Family-Link Project, we conducted online and telephone surveys amid the pandemic in February to March 2021 to assess self-reported pandemic fatigue (range 0-10) in Hong Kong adults (N = 4726) and its associations with sociodemographic and psycho-behavioral (high vs low to moderate) variables. Data were weighted by sex, age, and education of the general population. Binary logistic regression models yielded adjusted odds ratios (aORs) for high pandemic fatigue (score ≥ 7) for sociodemographic and psycho-behavioral variables. 43.7% reported high pandemic fatigue. It was less common in older people (55-64 years: aOR 0.56, 95% CI 0.39-0.82; 65 + years: 0.33, 0.21-0.52) versus age group 18-24 years, but more common in those with tertiary education (1.36, 1.15-1.62) versus secondary or below. High pandemic fatigue was positively associated with depressive symptoms (aOR 1.83, 95% CI 1.55-2.17), anxiety symptoms (1.87, 1.58-2.20), loneliness (1.75, 1.32-2.31), personal fear of COVID-19 (2.61, 2.12-3.23), family fear of COVID-19 (2.03, 1.67-2.47), and current alcohol use (1.16, 1.00-1.33), but negatively associated with self-rated health (0.79, 0.68-0.92), personal happiness (0.63, 0.55-0.72), personal adversity coping capability (0.71, 0.63-0.81), family adversity coping capability (0.79, 0.69-0.90), family well-being (0.84, 0.73-0.97), family communication quality (0.86, 0.75-0.98), and frequent home exercise (0.82, 0.69-0.96; versus less frequent). We first used a single-item tool to measure COVID-19 pandemic fatigue, showing that it was common and associated with worse mental health, lower levels of personal and family well-being and alcohol use.

Contributions of the Fragile Families and Child Wellbeing Study to Child Development

We describe the promise of the Fragile Families and Child Wellbeing Study (FFCWS) for developmental researchers. FFCWS is a birth cohort study of 4,898 children born in 1998-2000 in large US cities. This prospective national study collected data on children and parents at birth and during infancy (age 1), toddlerhood (age 3), early childhood (age 5), middle childhood (age 9), adolescence (age 15), and, in progress, young adulthood (age 22). Though FFCWS was created to understand the lives of unmarried parent families, its comprehensive data on parents, children, and contexts can be used to explore many other developmental questions. We identify six opportunities for developmentalists: (a) analyzing developmental trajectories, identifying the importance of the timing of exposures for later development, (c) documenting bidirectional influences on development, (d) understanding development in context, (e) identifying biological moderators and mechanisms, and ( f ) using an urban-born cohort that is large, diverse, and prospective.

Understanding School-Aged Childhood Obesity of Body Mass Index: Application of the Social-Ecological Framework

In order to understand the prevalence of school-aged childhood obesity in the United States and suggest better methods to prevent and treat the public health problem, we examined it with significant and identifiable factors within the social-ecological model. To investigate the association between social-ecological factors and child obesity/overweight (BMI), we used the 5th wave of the Fragile Families and Child Wellbeing Study. The dataset included information on 9-year-old children. The sample size for our study was 2054. We utilized multiple normal distributions for missing values and the Ordinary Least Square regression analysis. Black and Hispanic children were more likely to be obese/overweight than White children; children with higher physical activity were negatively associated with higher obesity; older mothers were more likely to be associated with children's obesity; family structure was also significantly related to the likelihood of childhood obesity; finally, school environment was significantly associated with child obesity. To combat childhood obesity, more school physical activities should be implemented, such as increasing physical education opportunities as well as building more sizable playgrounds and accessible recreation facilities at school and in communities. School environments also should be pleasant and safe for children. Health practitioners need to assess home environments to intervene for children's health.

Health and Well-Being of Adolescents in Different Family Structures in Germany and the Importance of Family Climate

The family is of exceptional and lifelong importance to the health of adolescents. Family structure has been linked to children’s and adolescents’ health and well-being; a nuclear family has been shown to be indicative of better health outcomes as compared with a single-parent family or a step-family. Family climate is rarely included in studies on children’s and adolescents’ health and well-being, albeit findings have indicated it is importance. Using data from n = 6838 students aged 12–13 years from the German National Educational Panel Study, this study shows that stronger familial cohesion and better a parent-child relationship are associated with better self-rated health, higher life satisfaction, more prosocial behavior, and less problematic conduct, and that these associations are stronger than those for family structure. Surveys on young people’s health are encouraged to include family climate above and beyond family structure alone.

Relationship between household composition and intergenerational post-disaster mental health in two-parent families: Evidence from Japan

BACKGROUND

Previous literature has neglected the effect of household composition on mental health, especially in the context of post-disaster recovery.

METHODS

Open access data from the 2015 Social Survey on Living and Disaster Recovery (SSLDR) in Japan are used. A total of 689 respondents (346 from Fukushima and 343 from Sendai) made up of people living in two-parent families are examined in the current study. Pearson's Chi-square Test and ANOVA are applied to assess the differences between four groups: Fukushima parent generation, Fukushima child generation, Sendai parent generation, and Sendai child generation. The method of multiple linear regression is used to explore the association factors of intergenerational mental health in two city sites, respectively.

RESULTS

Fukushima child generation tended to have the worst mental health status. In two city sites, the child generation tended to have a less degree of neighborhood connectedness than those in the parent generation. Variables of household composition, daily worries, and gender have significant associations with mental health in either two cities or one of them.

LIMITATIONS

The 2015 SSLDR datasets were collected by means of investigation through a series of questionnaires. Errors may exist if the respondents did not honestly or fully report their household composition. And there is some complexity in some attempted analysis models that is not fully included in the imputation model.

CONCLUSION

Household composition has significant association with intergenerational mental health in the context of post-disaster recovery. Our results highlight the need to look for appropriate and targeted supporting mechanisms.

Comparing Neighborhoods of Children With Autism Spectrum Disorder in a Medicaid Waiver Program and a State Population, 2007-2015

OBJECTIVE

This study investigated equity in enrollment in a Medicaid waiver program for early intensive behavioral intervention for children with autism spectrum disorder (ASD).

METHODS

State administrative, Medicaid, and U.S. Census data for children enrolled in the waiver program between 2007 and 2015 (N=2,111) were integrated. Multivariate and bivariate analyses were used to compare enrollees' neighborhood demographic characteristics with those of the state's general population, with controls for enrollees' age, sex, and race-ethnicity.

RESULTS

Findings indicate that in general, enrollment was equitable. During the years in which there were inequities, children who lived in neighborhoods of privilege were favored. These neighborhoods had higher median incomes, lower poverty levels, and fewer female-headed households and were located in urban areas.

CONCLUSIONS

As states work to provide equitable treatment to children with ASD and their families, it is important to track potential inequities between children who do and do not enroll in services and to use this information to inform outreach efforts. States may turn to South Carolina for insight on how to ensure equity.

Racial Disparities in Children's Health: A Longitudinal Analysis of Mothers Based on the Multiple Disadvantage Model

This secondary data analysis of 4373 mothers and their children investigated racial disparities in children's health and its associations with social structural factors, social relationships/support, health/mental health, substance use, and access to health/mental health services. The study drew on longitudinal records for mother-child pairs created from data in the Fragile Families and Child Wellbeing Study. Generalized estimating equations yielded results showing children's good health to be associated positively with mother's health (current health and health during pregnancy), across three ethnic groups. For African-American children, good health was associated with mothers' education level, receipt of informal child care, receipt of public health insurance, uninsured status, and absence of depression. For Hispanic children, health was positively associated with mothers' education level, receipt of substance-use treatment, and non-receipt of public assistance. Implications for policy and intervention are discussed.

Family Structure and Child Health: Does the Sex Composition of Parents Matter?

The children of different-sex married couples appear to be advantaged on a range of outcomes relative to the children of different-sex cohabiting couples. Despite the legalization of same-sex marriage in the United States, whether and how this general pattern extends to the children of same-sex married and cohabiting couples is unknown. This study examines this question with nationally representative data from the 2004-2013 pooled National Health Interview Survey (NHIS). Results reveal that children in cohabiting households have poorer health outcomes than children in married households regardless of the sex composition of their parents. Children in same-sex and different-sex married households are relatively similar to each other on health outcomes, as are children in same-sex and different-sex cohabiting households. These patterns are not fully explained by socioeconomic differences among the four different types of families. This evidence can inform general debates about family structure and child health as well as policy interventions aiming to reduce child health disparities.

Routinely sleeping away from home and the association with child asthma readmission

The increased prevalence of transitions between households may have implications for child asthma morbidity. We, therefore, sought to enumerate the prevalence of regularly spending nights sleeping away from home among children admitted to the hospital for asthma and to examine the relationship of nights away to asthma-related readmission. This was a population-based, prospective cohort of 774 children, aged 1-16 years, who were admitted with asthma or bronchodilator-responsive wheezing and enrolled in the Greater Cincinnati Asthma Risks Study. The study took place at Cincinnati Children's Hospital Medical Center, an urban, academic children's hospital in the Midwest. The primary exposure was regularly spending nights away from home. Selected covariates included caregiver marital status, shift work, child's race, income, psychological distress, and running out of/not having medications on hand. The primary outcome was asthma-related readmission within 12 months. A total of 19 % were readmitted within 12 months. The 33 % of children that spent ≥1 night away from home per week were significantly more likely to be readmitted than those who spent no nights away (25 % vs. 16 %, p = 0.002). Spending nights away from home [adjusted relative risk (aRR) 1.5, 95 % confidence interval (CI) 1.2-2.0] and lower income (aRR 2.6, 95 % CI 1.1-6.4) were the strongest independent predictors of readmission after adjusting for child age, gender, and race, and caregiver marital status, shift work, risk of psychological distress, and running out of meds. Increased awareness of the multiple settings in which children with asthma live may help shape more comprehensive approaches to asthma care.

Adverse childhood experiences of low-income urban youth

BACKGROUND AND OBJECTIVE

Current assessments of adverse childhood experiences (ACEs) may not adequately encompass the breadth of adversity to which low-income urban children are exposed. The purpose of this study was to identify and characterize the range of adverse childhood experiences faced by young adults who grew up in a low-income urban area.

METHODS

Focus groups were conducted with young adults who grew up in low-income Philadelphia neighborhoods. Using the nominal group technique, participants generated a list of adverse childhood experiences and then identified the 5 most stressful experiences on the group list. The most stressful experiences identified by participants were grouped into a ranked list of domains and subdomains.

RESULTS

Participants identified a range of experiences, grouped into 10 domains: family relationships, community stressors, personal victimization, economic hardship, peer relationships, discrimination, school, health, child welfare/juvenile justice, and media/technology. Included in these domains were many but not all of the experiences from the initial ACEs studies; parental divorce/separation and mental illness were absent. Additional experiences not included in the initial ACEs but endorsed by our participants included single-parent homes; exposure to violence, adult themes, and criminal behavior; personal victimization; bullying; economic hardship; and discrimination.

CONCLUSIONS

Gathering youth perspectives on childhood adversity broadens our understanding of the experience of stress and trauma in childhood. Future work is needed to determine the significance of this broader set of adverse experiences in predisposing children to poor health outcomes as adults.