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

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

Researchers interviewed a sentinel sample of caregivers of publicly insured children <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 associations between hardships and child and caregiver health.

Among 16,320 families, 41.0% experienced 0 hardships, 28.2% 1 hardship, and 30.8% ≥2 hardships. After covariate control, compared to children with ≥2 hardships, 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, and caregivers had lower odds of fair/poor health and depressive symptoms. Compared with ≥2 hardships, 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, 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.