title: Cumulative hardship and wellness of low-income, young children: multisite surveillance study.
abstract: The goals were to generate a cumulative hardship index and to evaluate its association with the well-being of children 4 to 36 months of age without private health insurance.
  
  
  
  Cross-sectional surveys were linked to anthropometric measures and medical record review at 5 urban medical centers (July 1, 2004, to December 31, 2007). Cumulative hardship index scores ranged from 0 to 6, with food, housing, and energy each contributing a possible score of 0 (secure), 1 (moderately insecure), or 2 (severely insecure) to generate scores indicating no hardship (score of 0), moderate hardship (scores of 1-3), or severe hardship (scores of 4-6). The outcome was a composite indicator of child wellness, including caregivers' reports of children's good/excellent heath, no hospitalizations, not being developmentally at risk, and anthropometric measurements within normal limits. Covariates were selected a priori and through association with predictors and outcomes.
  
  
  
  Of 7141 participants, 37% reported no material hardship, 57% moderate hardship, and 6% severe hardship. Multivariate logistic regression analyses showed ordinal association between the cumulative hardship index and children's adjusted odds of wellness (severe versus no hardship, adjusted odds ratio [AOR]: 0.65 [95% confidence interval [CI]: 0.51-0.83]; severe versus moderate hardship, AOR: 0.73 [95% CI: 0.58-0.92]; moderate versus no hardship, AOR: 0.89 [95% CI: 0.79-0.99]).
  
  
  
  Increasing levels of a composite measure of remediable adverse material conditions correlated with decreasing adjusted odds of wellness among young US children.
authors.affiliation: Boston Medical Center, Department of Pediatrics, Boston, MA 02118, USA. dafrank@bu.edu
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Frank
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Casey
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Black
authors.forename: Ruth
authors.initials: R
authors.lastname: Rose-Jacobs
authors.forename: Mariana
authors.initials: M
authors.lastname: Chilton
authors.forename: Diana
authors.initials: D
authors.lastname: Cutts
authors.forename: Elizabeth
authors.initials: E
authors.lastname: March
authors.forename: Timothy
authors.initials: T
authors.lastname: Heeren
authors.forename: Sharon
authors.initials: S
authors.lastname: Coleman
authors.forename: Stephanie
authors.initials: S
authors.lastname: Ettinger de Cuba
authors.forename: John T
authors.initials: JT
authors.lastname: Cook
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000886:Anthropometry; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000523:psychology / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D011610:Psychosocial Deprivation; D011788:Quality of Life / Q000523:psychology