Profiles of Risk: Maternal Health, Socioeconomic Status, and Child Health
| Date | 01 June 2013 |
| DOI | http://doi.org/10.1111/jomf.12021 |
| Published date | 01 June 2013 |
| Author | Nancy S. Landale,Jessica Halliday Hardie |
JESSICA HALLIDAY HARDIE University of Missouri – Kansas City
NANCY S. LANDALE Pennsylvania State University∗
Profiles of Risk: Maternal Health, Socioeconomic
Status, and Child Health
Child health is fundamental to well-being and
achievement throughout the life course. Prior
research has demonstrated strong associations
between familial socioeconomic resources and
children’s health outcomes, with especially poor
health outcomes among disadvantaged youth
who experience a concentration of risks, yet little
is known about the influence of maternal health
as a dimension of risk for children. This research
used nationally representative U.S. data from
the National Health Interview Surveys in 2007
and 2008 ( N=7,361) to evaluate the joint impli-
cations of maternal health and socioeconomic
disadvantage for youth. Analyses revealed
that maternal health problems were present
in a substantial minority of families, clustered
meaningfully with other risk factors, and had
serious implications for children’s health. These
findings support the development of health
policies and interventions aimed at families.
Understanding the social factors that underlie
disparities in children’s health is of major
concern to scholars of inequality. Poor health
in childhood can contribute to a trajectory of
Department of Sociology, University of Missouri – Kansas
City, 5100 Rockhill Rd., 208 Haag Hall, Kansas City, MO
64110 (hardiej@umkc.edu).
∗Population Research Institute, Pennsylvania State
University, 703 Oswald Tower, University Park, PA
16802 – 6211.
Key Words: child well-being, family health, inequality,
intergenerational, parenting.
relatively low attainment and well-being later
in life. Children with serious health problems
are more likely to drop out of school, have
health problems in adulthood, and earn lower
incomes than their healthy counterparts (Case
& Paxson, 2006). Identifying the sources of
child health disparities is essential to the
development of effective policies and programs
to reduce inequalities in children’s development
and achievement over the life course.
Prior research has demonstrated unequivo-
cally that the social and economic resources of
children’s families are critical to their health.
Family members share economic resources,
home and community environments, and social
networks, all of which have an impact on health.
Family income is related linearly to children’s
overall health (Case, Lubotsky, & Paxson,
2002), and low parental education and growing
up in a single-parent family increase the likeli-
hood that children will experience poor health
outcomes (Bauman, Silver, & Stein, 2006; Mont-
gomery, Kiely, & Pappas, 1996). These factors
operate on children’s physical and mental health
in an additive fashion (Bauman et al.; Evans,
2003) and influence various health outcomes in
a similar manner (Braveman, Cubbin, Egerter,
Williams, & Pamuk, 2010; Currie & Lin, 2007).
Apart from identifying inheritable genetic
traits, less attention has been paid to link-
ages between parental health and chil-
dren’s well-being. We propose that parents’
health is an additional dimension of fam-
ily inequality that contributes to disparities in
Journal of Marriage and Family 75 (June 2013): 651 –666 651
DOI:10.1111/jomf.12021
652 Journal of Marriage and Family
children’s health, and we tested this propo-
sition using data from the 2007 and 2008
National Health Interview Surveys (NHIS;
see http://www.cdc.gov/nchs/nhis.htm). We first
show how socioeconomic and health dispari-
ties cluster within families. We then employ
multivariate models to examine disparities in
children’s health, showing how socioeconomic
and health risk profiles are correlated with chil-
dren’s health outcomes. Our analysis makes
several contributions to the literatures on mul-
tiple risks, family health, and social inequality.
First, our use of latent class analysis (LCA) to
show how socioeconomic and health disadvan-
tages cluster within families provides unique
insight into the distribution of risk in Ameri-
can families. As expected, we found groups of
mothers who face socioeconomic disadvantages
only, health disadvantages only, both disadvan-
tages, and neither. We also found a significant
proportion of mothers who had limited access
to socioeconomic resources and health care but
did not report health problems, and a smaller
group, composed mostly of disadvantaged sin-
gle mothers who smoked, had limited access to
health care, and a slight elevation in the risk of
depression but few other health disadvantages.
Second, we examine associations between these
clusters of risk and children’s health outcomes.
For some outcomes, socioeconomic and mater-
nal health disadvantages were associated with
negative child health outcomes at about the same
rate when each was the sole source of risk. When
combined, however, these factors posed much
higher levels of risk for child health problems
than either alone. Finally, we identify key differ-
ences across outcomes in patterns of association
with socioeconomic and health disadvantage by
using seven diverse child health indicators. By
demonstrating that socioeconomic and health
disadvantage converge to produce categorical
profiles of risk, we advance theories of family
life, health, and inequality, thereby deepening
our understanding of how inequality is replicated
across generations within families.
MULTIPLE RISKS
According to the multiple-risk perspective, the
concentration of social disadvantage matters
for children’s well-being (Evans & English,
2002; Liaw & Brooks-Gunn, 1994; Sameroff,
Seifer, Barocas, Zax, & Greenspan, 1987). Risk
factors include poverty, family instability, poor
housing conditions, and other circumstances
that may contribute to children’s exposure
to stress and health hazards. To assess risk,
researchers typically determine cutoff thresholds
of disadvantage (e.g., poverty thresholds)
and then use them to construct dichotomous
indicators of risk, which are summed to create
an index of disadvantage (Rutter, 1983, 1993).
Poverty, low parental education, and fragile
family structures are particularly salient sources
of risk. Impoverished parents cannot provide
the same health-promoting resources, such as
high-quality medical care, good nutrition, child
care, and exercise opportunities, as middle-class
parents can. In addition, the neighborhoods in
which poor families reside have fewer medical
facilities, quality grocery stores, and safe out-
door spaces than higher income neighborhoods
(Drewnowski & Specter, 2004; Weir, Etelson,
& Brand, 2006), and they carry a greater risk
of environmental hazards (Morello-Frosch,
Zuk, Jerrett, Shamasunder, & Kyle, 2011).
Poorly educated parents may encounter barriers
in communicating with health personnel and
understanding health-promotion literature
(Schillinger et al., 2002). They also take a less
proactive approach to health care than parents
with more human capital (e.g., education;
Sabates & Feinstein, 2005). Finally, single
parents are limited in the time and attention they
can devote to caregiving, promoting children’s
development, and health care (Dawson, 1991).
These factors appear to operate additively
for a range of youth outcomes, includ-
ing obesity, allostatic load, IQ, and behav-
ioral problems (Appleyard, Egeland, van Dul-
men, & Sroufe, 2005; Evans, 2003; Sameroff
et al., 1987). One study used the NHIS data
set to show that three indicators of family
disadvantage—poverty, low parental education,
and single-parent household—were positively
and additively related to whether a parent
reported that his or her child had a chronic con-
dition or activity limitation and negatively and
additively related to better overall health (Bau-
man et al., 2006). Risk indices regularly include
these socioeconomic and demographic sources
of inequality (Appleyard et al., 2005; Burchi-
nal, Roberts, Hooper, & Zeisel, 2000; Evans
& English, 2002; Liaw & Brooks-Gunn, 1994).
Research taking the multiple-risks perspec-
tive has thus far not considered maternal
health problems as an additional risk fac-
tor for children yet, given the strong and
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