Hardship-Free Households Are Associated With Optimal Caregiver and Child Health

Families living with low incomes experience a higher risk of material hardships associated with poor health. To understand the potentially protective role of hardship-free households, the authors examined associations between the absence of material hardships among families with low incomes and child health and healthcare utilization and caregiver health outcomes.

Researchers interviewed a sentinel sample of caregivers of publicly insured children aged <4 years in hospital settings in 5 U.S. cities (2012-2017). Exposure to material hardships (food insecurity, housing instability, healthcare hardship, and energy insecurity) was categorized as 0, 1, or ≥2 hardships. Outcome measures included child health (overall and oral health), anthropometrics, developmental risk, lifetime hospitalizations, composite well-child measure, caregiver health, and depressive symptoms. Multivariable logistic regression models examined the associations between hardships and child and caregiver health.

Among 16,320 families, 41.0% experienced 0 hardships, 28.2% experienced 1 hardship, and 30.8% experienced ≥2 hardships. After covariate control, children from hardship-free households experienced lower adjusted odds of lifetime hospitalizations, fair/poor health, fair/poor oral health, developmental risk, and higher odds of wellness than children from household that experienced ≥2 hardships, and caregivers had lower odds of fair/poor health and depressive symptoms. Children and their caregivers from households with 1 hardship showed lower adjusted odds of lifetime hospitalizations, fair/poor health, fair/poor oral health, and higher odds of wellness than those from household that experienced ≥2 hardships, and caregivers had lower odds of fair/poor health and depressive symptoms.

Living without material hardships may contribute to positive physical and developmental/behavioral health among children and caregivers. Findings support the importance of policies to decrease material hardships among families with low incomes.