Tag Archives: children’s health

Marriage Revisited and Long Acting Birth Control

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Millennials are marrying later and less often. Comedian Aziz Ansari recently released Modern Romance, a smart and hilarious book of sociological research that discusses how technology provides us endless access to potential partners. So many options leave many millennials like myself wondering, “Why choose?” However, the luxury of choice does not extend to everyone. While marriage is declining overall across many high income countries, minorities and those with less education are even less likely to marry, for very different reasons. Researchers suggest that this pattern could be due to men’s increased difficulty in finding stable jobs, or changes in social norms surrounding marriage and family formation.

The latest issue of the Future of Children provides a timely reflection on the state of marriage and its effect on child wellbeing a decade following our original 2005 volume on Marriage. Some key results show that despite their best efforts, policies to improve the family by encouraging marriage, such marriage education and programs to improve education and workforce opportunities that would make men more “marriageable,” have fallen short. However, many couples that do not marry are not avoiding childbearing: 41% of births occur to unmarried parents. While cohabiting was once considered a precursor to marriage, it is increasingly replacing marriage, while the birth rate has remained similar, around 45 per 1,000 people, since 1990.

The Fragile Families study, which follows the health and social welfare of almost 5,000 unmarried and married parents and their children, shows that unmarried parents are less likely to stay together until their child is 5, and disruptions to family relationships can be harmful to the child’s wellbeing.

So, how do we help children? The Future of Children policy brief offers several concrete suggestions, such as offering long-acting reversible contraceptives (which include the implant and IUD, or intrauterine device) to help women delay unintended pregnancies until they are in stable relationships and ready for children. This recommendation comes at a time when IUDs are used more than ever in the US: 12% of contraceptive users chose an IUD, up from 2.6% of users in 2002. Both implants and IUDs have by far the lowest failure rates of any modern method (except permanent sterilization) and are extremely safe. Programs to provide these services can be funded through a number of mechanisms, which are discussed in detail in the brief.

For more information on the current state of marriage and childbearing and evidence for reducing unplanned pregnancy and childbirth, check out the latest issue of the Future of Children.

Children’s Neighborhoods, Homes, and Health

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One of my favorite things to do is explore cities on foot. Of course, I like some cities more than others—New York City being among my favorites. Until recently, I hadn’t quite articulated what makes a city attractive and appealing to me. Then I came across a video by the School of Life, an organization based out of London. According to the video, some of the things people tend to enjoy about cities include order and variety in physical structures, visible life such as street-level businesses with large windows, and a sense of mystery about places to discover.

These are things that adults might think about when exploring or moving to a new neighborhood, but what about children? What do they need and how does their housing and neighborhood affect their health and wellbeing? In the Future of Children, Ingrid Gould Ellen and Sherry Glied summarize what we know from research. One thing is clear—poor children tend to live in more disadvantaged environments.

For instance, poor children are more likely to live in inadequate housing. The U.S. Census Bureau considers a unit inadequate for reasons such as not having hot and cold running water, no bathtub or shower, no flushing toilet, and having exposed wiring. Recent estimates indicate that 11% of poor households with children and 5.9% of all households with children were physically inadequate, respectively. Thankfully, these figures have been cut in half since the 1970s. Nevertheless, children living in these circumstances probably experience greater emotional and behavioral problems and may perform worse in school.

The physical condition of children’s neighborhoods and what happens in them is also important. For example, when violent crime occurs close to where a child lives, that child is likely to perform poorer on cognitive tests within the next week. Car pollution is associated with asthma and even premature birth. As for the physical condition of things, poorly maintained playgrounds, crumbling sidewalks, and littered glass may result in physical injury or less outdoor activity. We should keep in mind that injuries and homicide are among the leading causes of death among children.

What can we do to make children’s homes and neighborhoods healthier and safer?

Speed bumps and safe walking/biking paths can reduce rates of child pedestrian injuries.

Installing window bars on apartment buildings can reduce fall-related deaths among children.

Introducing the E-ZPass at toll booths can reduce pollution in nearby residential areas. This strategy has been shown to reduce the incidence of preterm births in these neighborhoods.

There are many things we can do to make the homes and neighborhoods of children safe and healthy. However, Ellen and Glied caution that improvements to housing and neighborhoods can increase costs, thereby driving out low-income families. While subsidies can offset these costs for some families, the authors suggest that policymakers experiment with offering subsides to more families while reducing the size of the subsidy available per family. To learn more, see the Future of Children issue, “Policies to Promote Child Health.”

Child Health and Health Care Access

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Many celebrated outside the Supreme Court two weeks ago following SCOTUS’s decision to allow health care subsidies through the Affordable Care Act (ACA). I was among those who breathed a sigh of relief at home after reading that our coverage through the Marketplace would be continued. Now as life returns to normal and we no longer have to worry for the time being, let’s not forget the importance of health care access, especially for children, and the fact that there are still children who don’t have it. Exactly how important is health care access? Lindsey Leininger and Helen Levy joined forces in the latest Future of Children issue to tell us about the influence access has on child health.

Research on this question has had varying results, but Leininger and Levy argue that, overall, access to care does improve child health and that the influence is often more significant for those who are marginalized. The classic RAND Health Insurance Experiment, for instance, suggested that in the population as a whole, the generosity of insurance coverage did not significantly determine overall health. However for high-risk (meaning low-income) children, generosity of coverage did affect health.

Studies on Medicaid eligibility show further evidence: in the year after implementation, mortality fell among nonwhite infants, and this effect persisted for at least 10 years. Also, among children in low-income families, those who experienced more years of Medicaid eligibility were in better health. A variety of other studies have associated expansions of Medicaid eligibility with reductions in child mortality. With regard to Medicaid enrollment, positive effects have also been seen, such as increased enrollment leading to decreases in hospital admissions for conditions that could be well-managed by primary care.

Leininger’s own research has shown that lack of coverage can be a strong detriment to child health. Her study showed that each additional month without coverage was associated with a small, statistically significant decline in the probably of a child seeing a doctor for a well-visit or any other visit. A four-month spell of being uninsured, for example, resulted in a 4 percent decrease in the likelihood of any visit and a 9 percent decrease in the likelihood of a well-visit.

So insurance coverage is good for child health, especially for marginalized children. But according to our authors, although “the ACA builds on the earlier successes of Medicaid expansion and CHIP to promote children’s access to care… challenges remain.” Access to care improves child health, but it is not the only factor. For example one study cited by Leininger and Levy estimates that lack of access to medical care explains only about 10% of early mortality in the population as a whole; less than genetics (30%), social circumstances (15%), and behavioral factors (40%). To improve children’s health overall and consider policies that may do so, we must also consider the larger picture. To learn more about other factors that influence children’s health, read the full Future of Children issue on Child Health.

Child and Public Health in a Libertarian Legal Framework

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Earlier this year the West Coast saw a measles outbreak, another recurrence in a string of previously eradicated childhood illnesses. Stories of parents’ various objections to vaccination quickly flooded the news, underscoring the main question: who is responsible for these public health crises, families or the state? While some people may have been surprised or confused to see such illnesses return, Clare Huntington and Elizabeth Scott’s explanation of children’s health in a legal framework for The Future of Children provides valuable context.

The U.S. legal system, say Huntington and Scott, “gives parents the authority and responsibility to make decisions about their children’s health care, and favors parental rights over society’s collective responsibility to provide for children’s welfare” or, in the case of vaccination, overall public health. They call this a libertarian legal framework as a way to describe the legal context in which parents are permitted to make their own decisions about child health. There are exceptions, such as when a child’s life is in danger or when a child is in juvenile justice custody; however, since parental rights are constitutionally protected, a high standard of harm must be met before intervention can occur.

In public health cases such as vaccination, where can the line of “harm” be drawn? Currently, all healthy children are required to receive vaccinations in order to attend school. However, almost all states offer exemptions for religious beliefs and many also offer them for other philosophical convictions. The balance between the libertarian argument and public health theoretically rests on the understanding that those with strong beliefs both deserve their right to decide and are a small enough segment of the population that the overall public interest of immunity is still met. However the return of some childhood illnesses shows that this balance is no longer being maintained.

Now many states are tightening their exemption policies. For example, California (origin of the measles outbreak) is on the verge of eliminating philosophical exemptions. For some states, making these adjustments may be more difficult. As Huntingdon and Scott put it, “without an affirmative legal obligation to promote children’s [or public] health, governmental investment is optional.” In this context, public health policy is often reactive rather than proactive or preventative.

Recent shifts in both cultural and legal views of vaccination deliver an immediate and crucial example of the libertarian legal context for child health policy and its limits. To read further on current issues in children’s health, see our latest issue of The Future of Children, “Policies to Promote Child Health.”

Food insecurity and child care for low-income families

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So far, we’ve written several blogs about how characteristics of children’s parents can influence food security. As the authors of our Fall 2014 research report remind us, however, three-quarters of children spend some portion of their preschool years in the care of people other than their parents, so we need to look at how child-care arrangements may also influence food insecurity among children. This is especially important given that children in center-based care may receive a majority of their nutritional needs at their center rather than in the home.

The research report highlights a study by Heflin, Arteaga, and Gable that compared child care by parents to child care by someone else, among low-income families. Specifically, they examined five types of child-care arrangements: child-care by parents, by a relative, by someone unrelated to the child in a home care setting, in a child-care center, and in Head Start. They found that compared with children cared for exclusively by their parents, low-income preschoolers attending a child-care center had lower levels of both food insecurity in general and of very low food security. Children cared for by a relative were less likely to experience food insecurity in general but equally likely to experience very low food security and children cared for by an unrelated adult were more likely to experience very low food security.

The finding that low-income preschoolers attending child-care centers had lower levels of food insecurity and very low food security compared to those cared for by their parents has several theoretical explanations. First, parents of these children may be better able to work while their children attend the center, which increases household income. Second, these children may receive some of their nutritional needs directly through the child-care center.

While school-based nutrition programs have proven to help alleviate food insecurity for some children, this research reminds us that preschool children must also be considered in policy discussions. Improving access to child-care services for low-income parents of preschool children may improve food security within this age group.

Health of Caregivers and Childhood Food Insecurity

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We often assume that low household income causes children’s food insecurity. But the Future of Children’s recent research report highlights a number of additional factors that contribute to food insecurity. One notable risk factor is a caregiver who faces mental or physical health problems.

The latest research shows that even when we account for income level, caregivers’ health is still central to children’s food security. For example, a recent paper in the Journal of Children and Poverty found that mothers in food-secure families had better overall health and were less likely to report substance use compared with mothers in food-insecure households. Craig Gunderson and James Ziliak‘s Future of Children report cites a number of health factors that can contribute to children’s food insecurity, including parental depression, parental drug use, or living with an adult with a disability.

What can we do to help children in these situations? The authors point out that the effect of caregiver’s mental and physical health on family food security raises concerns about families’ ability to navigate the welfare system. A caregiver’s health problems may also be exacerbated by lack of access to services. While the authors argue that improved access to services could improve food security, they also state that we need further research on how policy makers can create more accessible systems. The authors offer one suggestion to address the risk factor of substance use: ensuring that mothers who seek substance use treatment are enrolled in SNAP and WIC, if they are eligible. Perhaps a similar idea could be implemented in other contexts where caregivers receive medical or mental health treatment.

As more researchers explore the relationship between food security and health, new policy possibilities may come to light. However, the research highlighted in the Future of Children report makes us aware that health contributes to food security, and low income is not the only indicator of risk. In following blog posts, we will explore additional factors that influence food security. To learn more about health and food insecurity, see the Future of Children‘s Fall 2014 research report.

Health Care Coverage for Adults Improves Children’s Health

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A new health care bill is taking form in Congress, setting off a national conversation about what an ideal health care plan for the country should look like. Two recent volumes of The Future of Children address the importance of health care for children: “Children’s Health and Social Mobility” in Opportunity in America, and “A Health Plan to Reduce Poverty” in The Next Generation of Antipoverty Programs.
The nation’s health care concerns are not just about coverage, but also about having healthier citizens – and healthy lifestyles begin in childhood. One way to increase child health is to increase their parents’ access to healthcare—parents who are proactive about their own health are often better at getting their kids preventative care too, rather than just going to hospital emergency rooms when problems emerge. Although nearly all children in families with incomes under 200 percent of poverty are eligible for either Medicaid or the State Children’s Health Insurance Program (SCHIP), the parents of these poor and near-poor children often lack health insurance.
Parents who leave welfare normally lose coverage after one year unless their employer provides it, and many employers of low-wage workers do not offer health insurance. As a result, many of the working poor and near-poor have no coverage at all, and the idea of losing Medicaid even discourages adults from working. More available and affordable health care would both remove this disincentive from work and benefit children’s health. Beyond increasing health care coverage for parents, a government plan should also educate parents as “the primary gatekeepers for their children’s health.” Even if health care is available, parents must learn how to make the best use of preventative care and medical information.
Health issues of low-income children have major consequences for both them and society at large. These children may miss more classes or be less able to concentrate on studies, ultimately making them less likely to stay in school. Education challenges and health issues persisting into adulthood may decrease earnings and socioeconomic status. This has wider consequences, as lower-income families may require more state support while contributing fewer tax dollars. In addition, education is often seen as “the great equalizer” and the means by which the American Dream operates, so if the poor health of lower-income children limits their social mobility then America may not be living up to its full promise. These situations are problems for all of society, not just those most directly affected, so health care reform that improves child health should be universally appealing.