Family structure and multiple domains of child well-being in the United States: a cross-sectional study.
BACKGROUND
We examine the association between family structure and children's health care utilization, barriers to health care access, health, and schooling and cognitive outcomes and assess whether socioeconomic status (SES) accounts for those family structure differences. We advance prior research by focusing on understudied but increasingly common family structures including single father families and five different family structures that include grandparents.


METHODS
Our data on United States children aged birth through 17 (unweighted N = 198,864) come from the 1997-2013 waves of the National Health Interview Survey, a nationally representative, publicly available, household-based sample. We examine 17 outcomes across nine family structures, including married couple, cohabiting couple, single mother, and single father families, with and without grandparents, and skipped-generation families that include children and grandparents but not parents. The SES measures include family income, home ownership, and parents' or grandparents' (depending on who is in the household) employment and education.


RESULTS
Compared to children living with married couples, children in single mother, extended single mother, and cohabiting couple families average poorer outcomes, but children in single father families sometimes average better health outcomes. The presence of grandparents in single parent, cohabiting, or married couple families does not buffer children from adverse outcomes. SES only partially explains family structure disparities in children's well-being.


CONCLUSIONS
All non-married couple family structures are associated with some adverse outcomes among children, but the degree of disadvantage varies across family structures. Efforts to understand and improve child well-being might be most effective if they recognize the increasing diversity in children's living arrangements.
Department of Health and Behavioral Sciences, Campus Box 188, PO Box 173364, Denver, CO 80217-3364 USA.
Patrick M
PM
Krueger
School of Public Health, University of California, Berkeley, USA.
Douglas P
DP
Jutte
University of Maryland, School of Public Health, College Park, Maryland USA.
Luisa
L
Franzini
Department of Sociology, University of Pennsylvania, Philadelphia, PA USA.
Irma
I
Elo
Department of Sociology, University of Texas, Texas, USA.
Mark D
MD
Hayward
Access to health care; Children; Extended family; Family; Grandparent; Health; School; Single parent; Utilization of health care