title: Parenting stress in US families: implications for paediatric healthcare utilization.
abstract: OBJECTIVE
  According to family stress models, parental responses to stress disrupt interactions between parent and child and may lead to parental inability to seek timely medical care for their child. The objective of this study was to quantitatively assess the relationship between high parenting stress and child healthcare utilization.
  
  
  METHODS
  We used the 2003-2004 National Survey of Children's Health to determine the prevalence of parenting stress in US families and associated socio-demographic variables. We used weighted logistic regression to investigate associations between parenting stress and healthcare utilization, controlling for other parental psychosocial and socio-demographic variables. The primary independent variables were parenting stress, parental mental health, parental coping and social support. The main dependent variables were emergency care, sick visits to primary care and preventive care in the past 12 months.
  
  
  RESULTS
  Nationally, 13% of children lived in households with at least one parent experiencing high parenting stress. Socio-demographic variables associated with the highest odds of parenting stress included Black race, special needs status and non-English primary language. Parents with high parenting stress had a higher odds (adjusted odds ratio 1.24, 95% confidence interval 1.10-1.41) of seeking emergency care for their children compared with parents with low parenting stress, controlling for other parental psychosocial factors and socio-demographic variables.
  
  
  CONCLUSIONS
  Having a parent who is experiencing high parenting stress is associated with greater utilization of paediatric emergency care. Interventions targeted at parenting stress may provide families with needed support and reduce unnecessary emergency care utilization.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. Raphael@bcm.edu
authors.forename: Jean L
authors.initials: JL
authors.lastname: Raphael
authors.forename: Y
authors.initials: Y
authors.lastname: Zhang
authors.forename: H
authors.initials: H
authors.lastname: Liu
authors.forename: A P
authors.initials: AP
authors.lastname: Giardino
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D005192:Family Health; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008962:Models, Theoretical; D015999:Multivariate Analysis; D016487:Parenting / Q000523:psychology*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013315:Stress, Psychological / Q000453:epidemiology*; D014481:United States