Cumulative hardship and wellness of low-income, young children: multisite surveillance study.
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.
Frank
Deborah A
DA
Boston Medical Center, Department of Pediatrics, Boston, MA 02118, USA. dafrank@bu.edu
Casey
Patrick H
PH
Black
Maureen M
MM
Rose-Jacobs
Ruth
R
Chilton
Mariana
M
Cutts
Diana
D
March
Elizabeth
E
Heeren
Timothy
T
Coleman
Sharon
S
Ettinger de Cuba
Stephanie
S
Cook
John T
JT
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