title: Linking Family Economic Hardship to Early Childhood Health: An Investigation of Mediating Pathways.
abstract: OBJECTIVE
  The underlying mechanisms through which family economic adversity influences child health are less understood. Taking a process-oriented approach, this study examined maternal mental health and investment in children, child health insurance, and child healthcare as mediators linking family economic hardship (FEH) to child health.
  
  
  METHODS
  A structural equation modeling was applied to test the hypothesized mediating model.
  
  
  RESULTS
  After adjustment for sociodemographic risk factors, results revealed: (1) a significant direct path linking FEH to poor child health (effect size = .372), and (2) six significant mediating pathways (total effect size = .089). In two mediating pathways, exposures to FEH undermined mothers' mental health: in the first pathway poor maternal mental health led to decreased parental investment, which, in turn, contributed to poor child health, whereas in the second pathway the adverse effect of poor maternal mental health was cascaded through child unmet healthcare need, which resulted in poor child health. One pathway involved child insurance status, where the effect of FEH increased the likelihood to be uninsured, which led to unmet healthcare need, and, in turn, to poor health. Three pathways involved preventive care: in one pathway FEH contributed to poor preventive care, which led to unmet healthcare need and then to poor health; in the other two pathways where poor preventive care respectively gave rise to decreased investment in children or poor maternal mental health, which further contributed to poor child health.
  
  
  CONCLUSIONS
  Results suggest that the association between FEH and children's health is mediated by multiple pathways.
authors.affiliation: Department of Human Development and Family Science, University of Georgia, Athens, GA, 30602-3622, USA. hchin@uga.edu.
authors.forename: Hui-Chin
authors.initials: HC
authors.lastname: Hsu
authors.affiliation: Department of Human Development and Family Science, University of Georgia, Athens, GA, 30602-3622, USA. wickrama@uga.edu.
authors.forename: Kandauda A S
authors.initials: KA
authors.lastname: Wickrama
mesh_terms: D000067576:Child Health / Q000191:economics*; D004467:Economics / Q000706:statistics & numerical data*; D005190:Family; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D009035:Mothers / Q000523:psychology; D010290:Parents; D013315:Stress, Psychological / Q000191:economics
keywords: Early childhood health; Family economic hardship; Maternal mental health; Parenting; Preventive care