Trajectories of children's health inequalities and the role of parental resources
Date of Award
Doctor of Philosophy (PhD)
Andrew S. London
Health inequalities, Child health, Parental resources, Racial inequalities, Gender differences
Using growth curve modeling and data from the 1992-2006 waves of the National Longitudinal Survey of Youth 1979 cohort Child and Young Adult sample, I find both direct effects of child characteristics (i.e., age, race, sex) and various relative impact of parental resources conceptualized as financial, human, and social capital on a child's maternally rated health status. I extend my analysis to evaluate the impact of a chronic health condition, childhood asthma. I find that asthma has a profound impact on a child's health trajectory and that it operates differently for children of diverse race or ethnicities. I also utilize group-based trajectory modeling comparatively to explore the latent characteristics in children or parental resources that go unnoticed in traditional growth cure modeling with limited success.
Building on established racial inequalities in cross-sectional research, my results show a racial disparity over time in children's health. White children are in better health and their advantage over minority children is maintained during childhood. However, black and Hispanic children have different trajectories. The initial disparity between black and white children remains consistent during childhood, even when controlling for sex, age, family income, maternal education, health insurance status, household structure, family size and maternal marital status, and results in diverging pathways for white and black children. The initial disparity between Hispanic and white children, however, is controlled for by parental resources and control measures. Little has been written to date about sex differences in health for children in a longitudinal framework. While I find an initial, observable advantage in health for girls, my results also show a steeper decline in the health trajectory for girls over time that result in girls falling below boys by the age of 18. Children born at low birth weight experience a significant reduction in their health status trajectory that is not explained by any other measures in my study. However, the effect slows over time and allows for low birth-weight (LBW) children to catch up to non-LBW children as they age.
In terms of parental resources, human and financial capital matter greatly for children's health. Maternal education and family income each exert a robust positive effect on child health. For income, specifically, there is a notable diverging destinies effect for children from high and low income families resulting in much poorer overall health for children in low income families and better average health for children in high income families. While there are separate pathways for child health based on maternal education they are more parallel and sustained differences rather than completely divergent pathways. I find no difference between children who have public health insurance from those children who have private insurance indicating a possible positive impact for public insurance in stabilizing the health of otherwise disadvantaged children. However, being dually insured by both public and private insurance results in a lower health status trajectory throughout childhood. This pathway is not explained by any of the demographic or other parental resource measures included in the study.
Looking at a variety of measures of social capital/resources I find that family size has no discernable impact on children's health. Children in other family households (families that are not comprised of either a single mom or both parents) have poorer health trajectories as they age. Finally having a widowed mom reduces child health over age, while children with married, never married or separated/divorced moms' health trajectories converge together over age. Overall these findings suggest that additional measures of parental resources, beyond income, are important and should continue to be explored in future research.
My results show that asthma has a significant and large relative impact on health, so that children who are diagnosed with asthma are in poorer overall health and this disparity remains during childhood. This suggests that chronic health conditions that begin in childhood are an understudied and potentially significant factor in the emergence of adult health disparities. While further exploration is needed to evaluate the unequal ways in which a chronic health condition can affect the most disadvantaged children in our population. I also find that asthma appears to interact with other measures of disadvantage in unique ways within my population. For example, Hispanic children with asthma show an increase in their health status over time that could be due to better controlled asthma with fewer symptoms whereas black children continue to decline as they age with asthma perhaps because their asthma is less controlled. (Abstract shortened by UMI.)
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Parker, Wendy M., "Trajectories of children's health inequalities and the role of parental resources" (2010). Sociology - Dissertations. Paper 64.