Social Determinants Of Child Health Research Articles

Parental migration, socioeconomic deprivation and hospital admissions in preschool children in England: national birth cohort study, 2008 to 2014

BackgroundA third of children born in England have at least one parent born outside the United Kingdom (UK), yet family migration history is infrequently studied as a social determinant of child health. We describe rates of hospital admissions in children aged up to 5 years by parental migration and socioeconomic group.MethodsBirth registrations linked to Hospital Episode Statistics were used to derive a cohort of 4,174,596 children born in state-funded hospitals in England between 2008 and 2014, with follow-up until age 5 years. We looked at eight maternal regions of birth, maternal country of birth for the 6 most populous groups and parental migration status for the mother and second parent (UK-born/non-UK-born). We used Index of Multiple Deprivation (IMD) quintiles to indicate socioeconomic deprivation. We fitted negative binomial/Poisson regression models to model associations between parental migration groups and the risk of hospital admissions, including interactions with IMD group.ResultsOverall, children whose parents were both born abroad had lower emergency admission rates than children with parents both born in the UK. Children of UK-born (73.6% of the cohort) mothers had the highest rates of emergency admissions (171.6 per 1000 child-years, 95% confidence interval (CI) 171.4–171.9), followed by South Asia-born mothers (155.9 per 1000, 95% CI 155.1–156.7). The high rates estimated in the South Asia group were driven by children of women born in Pakistan (186.8 per 1000, 95% CI 185.4–188.2). A socioeconomic gradient in emergency admissions was present across all maternal regions of birth groups, but most pronounced among children of UK-born mothers (incidence rate ratio 1.43, 95% CI 1.42–1.44, high vs. low IMD group). Patterns of planned admissions followed a similar socioeconomic gradient and were highest among children with mothers born in Middle East and North Africa, and South Asia.ConclusionsOverall, we found the highest emergency admission rates among children of UK-born parents from the most deprived backgrounds. However, patterns differed when decomposing maternal place of birth and admission reason, highlighting the importance of a nuanced approach to research on migration and health.

Investigating social determinants of child health and their implications in reducing pediatric traumatic injury: A framework and 17-year retrospective case-control study protocol.

Traumatic physical injuries are the number one cause of hospitalization and death among children in Canada. The majority of these injuries are preventable. The burden from injury can be reduced through prevention programs tailored to at-risk groups, however, existing research does not provide a strong explanation of how social factors influence a child's risk of injury. We propose a theoretical framework to better understand social factors and injury in children and will examine the association between these social factors and physical traumatic injury in children using large population-wide data. We will examine data from 11,000 children hospitalized for traumatic physical injury and 55,000 matched uninjured children by linking longitudinal administrative and clinical data contained at the Manitoba Centre for Health Policy. We will examine 14 social determinants of child health measures from our theoretical framework, including receipt of income assistance, rural/urban status, socioeconomic status, children in care, child mental disorder, and parental factors (involvement with criminal justice system, education, social housing, immigration status, high residential mobility, mother's age at first birth, maternal Axis I mental disorder, maternal Axis II mental disorder and maternal physical disorder) to identify groups and periods of time when children are at greatest risk for traumatic physical injury. A conditional multivariable logistic regression model will be calculated (including all social determinant measures) to determine odds ratios and adjusted odds ratios (95% confidence interval) for cases (injured) and controls (non-injured). Health Information Privacy Committee (HIPC No. 2017/2018-75) and local ethics approval (H2018-123) were obtained. Once social measures have been identified through statistical modelling, we will determine how they fit into a Haddon matrix to identify appropriate areas for intervention. Knowing these risk factors will guide decision-makers and health policy.

District-level religious composition and child health in India

BackgroundCommunity characteristics are a significant social determinant of child health. Little is known about the effects of social heterogeneity as a specific factor that might impact health. This paper aims to fill the void in research on the health effects of India’s district-level religious heterogeneity.MethodsWeighted state fixed effects multivariate logistic regression was applied to India’s Third District Level Household Survey (2007–2008). The dependent variables were death of a child under five and indicators of healthcare utilization. The key independent variables were the proportions in the district who were Hindu, Muslim, Christian, Buddhist, and Sikh. The analysis controlled for generic community diversity, household religion, and socioeconomic status. Separate, sub-group analysis focused on Muslims only, Christians only, and Buddhists only.ResultsMultivariate fixed effects models show that a 1% point increase in the proportion of Muslim, Christian, or Buddhist households in a community is associated with respective odds ratios of child death of 1.008, 1.009, and 1.012 of experiencing the death of a child. The impact of a household’s own religious affiliation is statistically insignificant in these models. Higher proportions of Muslims and Christians in a community lower the odds of BCG (a vaccine for childhood tuberculosis) receipt and child healthcare-seeking.ConclusionsHouseholds residing where there are higher levels of religious minorities in India experience worse child survival. These effects are not mediated by the household’s own religious affiliation. There is evidence that health system performance and quality is systematically worse in communities with higher proportions of religious minorities. Our study can help policymakers identify communities where children may be at higher risk based on community heterogeneity and the potential for insufficient collective action. Policymakers might consider flagging these communities for special attention, because social heterogeneity is likely to be of long duration.

Child mortality in Africa and south Asia: a multidimensional research and policy framework

Child mortality in Africa and south Asia: a multidimensional research and policy framework

Unpacking the connection between parental incarceration and parenting stress: The mediating role of child health and health care strains

Research points to parental incarceration as a social determinant of child health. Still, the extent to which the elevated health burden of children exposed to parental incarceration impacts parenting stress remains unclear. The current research addresses this gap in the literature using recent data from the 2016–2020 National Survey of Children's Health - a nationally representative sample of non-institutionalized U.S. children ages 0 to 17. Findings reveal a direct association between children's exposure to parental incarceration and multiple parenting stress indicators, including finding the child difficult to parent, feeling irritated by the child, feeling angry with the child, and parenting coping challenges. Notably, mediation analysis revealed that, collectively, child health and health care strains account for approximately 45% of the association between children's exposure to parental incarceration and the overall stress of parenting the focal child. Findings demonstrate how children's exposure to parental incarceration can have broader ripple effects on other family members by shifting child health and health care burdens in ways that heighten parenting stress. The findings underscore the health and health care needs of children with incarcerated parents as a top criminal justice and public health priority.

1444Housing disadvantage in childhood and health: A systematic review

Abstract Background Housing has been recognised as one of the important determinants of health outcomes. However, little is known of the contribution of these pathways to children’s health and wellbeing and their pattern of health throughout life. This review aims to provide a synthesis of longitudinal studies linking experiences of disadvantaged housing in childhood to health outcomes. Methods A literature search was performed on four databases including Medline, EMBASE, PsycINFO, and Web of Science from 2000 to 2020. Peer-reviewed longitudinal studies assessing the association between housing disadvantage in childhood and subsequent physical and mental health were included. The methodological quality of selected studies was appraised using the ROBINS-I tool. A narrative synthesis was developed due to study heterogeneity. Results Forty-five cohort studies were included, and no randomised controlled trial met the inclusion criteria. The majority of the studies was evaluated to have a moderate risk of bias. Across the studies, while many relationships remained mixed, consistent evidence of detrimental impact was identified between: poor housing conditions and mortality; inadequate heating and respiratory illness; frequent residential moves and psychiatric mortality and morbidity. Little evidence is found between overcrowding in childhood and health outcomes. Conclusions Evidence from longitudinal studies indicates that poor housing experience in childhood may impact health later in life. Key messages The findings stressed housing as a key social determinant of child health, and interventions designed to mitigate housing disadvantage may have significant health gains across the life span

Father Presence, Father Engagement, and Specific Health and Developmental Outcomes of Mongolian Pre-School Children.

This study explored father involvement as a social determinant of child health within the context of macro-environmental changes in Mongolia. Using data for children aged 3–4 from UNICEF’s Multiple Indicator Cluster Surveys, this cross-sectional analysis examined the association between father presence and engagement with child health and educational outcomes. Multivariate regression modeling was employed to identify associations between father presence, engagement, and child outcomes including fever, respiratory illness, diarrhea and preschool attendance. In unadjusted analyses, father engagement was associated with higher odds of preschool attendance (Odds Ratio (OR) = 1.12; 95% Confidence Interval (CI) 1.04–1.20) but not with child illness (OR = 1.04; 95% CI 0.95–1.14). Father engagement was no longer associated with preschool attendance after controlling for potentially confounding variables (ORadj = 0.95; 95% CI 0.88–1.03). Unadjusted and adjusted analyses showed that father presence was not associated with acute illness or preschool attendance. Results also suggest that a larger proportion of children were engaged in activities by their mother compared to their father or other adults. Data indicate that father presence and engagement were not associated with child illness or preschool attendance. Factors such as maternal education, household wealth, and region of residence are stronger predictors of preschool attendance and should continue to be considered for promoting child health and development in Mongolia.

Parental Incarceration, Child Adversity, and Child Health: A Strategic Comparison Approach.

Background: Research points to parental incarceration as an important social determinant of child health. Even so, studies examining the health impact of parental incarceration in the context of diverse childhood stressors and adversities are lacking. Methods: The present study uses a large, nationally representative sample to compare U.S. children who were exposed to parental incarceration to a strategic comparison group of U.S. children who were not exposed to parental incarceration, but were nonetheless exposed to alternative family stressors and adversities. Results: The initial findings generally reveal worse health among children exposed to parental incarceration compared to those who are not exposed. Even so, these differences were partially or completely attenuated when comparing the incarceration-exposed group to more comparable groups of children exposed to a varying degree of alternative stressors/adversities. Conclusions: Programmatic efforts targeting parental incarceration as a means of promoting child health may be enhanced by adequately addressing co-occurring family stressors and child adversities.

Challenges and opportunities in addressing social determinants of child health in Cambodia: perspectives and experience of frontline providers in two health districts.

ObjectivesOther forces related to socio-economic and cultural factors, besides biomedical and behavioural fields, also influence health but receive little attention in health research. This study aims to illuminate social determinants of health and to identify challenges and opportunities in addressing social determinants of child health (SDCH) in rural Cambodia.MethodsThis is a qualitative study based on interviews of frontline primary health care providers, health officials, local authorities and community volunteers in two health districts in Cambodia. The data were supplemented by secondary data on different aspects of the districts and Cambodia.ResultsPoverty, lack of basic commodities and adverse social conditions remained problems for population health. While access to health services was considered adequate, households and communities had several major risk exposures. Challenges in addressing SDCH were the high prevalence of social and household adverse conditions, and the lack of training of providers, of information about social services, of effective coordination and of trust in public services. Opportunities were present, including social services being existent albeit poor functioning, the traditional practice of social inquiry, existing frontline providers being open to further information and training, existing subnational coordination bodies at district and provincial levels, and use of evidence in planning and resource allocation.ConclusionAddressing SDCH requires broad and coordinated efforts of stakeholders from multiple sectors. Among the prerequisites are to leverage the existing structures and mechanisms, training primary health care providers and providing them with adequate information about local resources and available supports. Improving social care services and infrastructures requires strong coordination, planning and adequate resource allocation.

Trends in inequalities in Children Looked After in England between 2004 and 2019: a local area ecological analysis

ObjectiveTo assess trends in inequalities in Children Looked After (CLA) in England between 2004 and 2019, after controlling for unemployment, a marker of recession and risk factor for child maltreatment.DesignLongitudinal...

Parenting and social determinants of health

Social determinants of health is a concept relevant to parenting in two ways. First, parenting behavior is a social determinant for child health and development; effective parenting is essential for successful emotional, physical and cognitive development. Second, social determinants of health are critical to the development and sustainability of adequate parenting behaviors, which, in term, are a social determinant of child health. Key social determinants related to parenting include economic stability, education, social and community context, neighborhood and built environment, access to health care and parenting interventions, and racism.

Burden of moderate to severe anaemia and severe stunting in children < 3\u2009years in conflict-hit Mount Cameroon: a community based descriptive cross-sectional study

BackgroundArmed conflict is a significant social determinant of child health with nuanced effects. There is a dearth of knowledge on the public health issues facing vulnerable populations in conflict-stricken areas. The objective was to determine the prevalence and determinants of moderate to severe anaemia (MdSA) and severe stunting (SS) in children ≤3 years in conflict-hit Dibanda, Ekona and Muea in the Mount Cameroon area.MethodsHaematological parameters were obtained using an automated haematology analyser while undernutrition indices standard deviation (SD) scores (z- scores), were computed based on the WHO growth reference curves for 649 children in a community based cross-sectional study in 2018. Binomial logistic regression models were used to evaluate the determinants of MdSA and SS against a set of predictor variables.ResultsAnaemia was prevalent in 84.0% (545) of the children with a majority having microcytic anaemia (59.3%). The prevalence of MdSA was 56.1% (364). Educational level of parents/caregiver (P < 0.001) and site (P = 0.043) had a significant negative effect on the occurrence of MdSA. Stunting, underweight and wasting occurred in 31.3, 13.1 and 6.3% of the children, respectively. Overall, SS was prevalent in 17.1% (111) of the children. The age groups (0.1–1.0 year, P = 0.042 and 1.1–2.0 years, P = 0.008), educational levels (no formal education, P < 0.001 and primary education P = 0.028) and SS (P = 0.035) were significant determinants of MdSA while MdSA (P = 0.035) was the only significant determinant of SS. On the contrary, age group 0.1–1 year (OR = 0.56, P = 0.043) and site (Dibanda, OR = 0.29, P = 0.001) demonstrated a significant protective effect against SS.ConclusionsModerate to severe anaemia, severe stunting and wasting especially in children not breastfed at all are public health challenges in the conflict-hit area. There is a need for targeted intervention to control anaemia as well as increased awareness of exclusive breast feeding in conflict-hit areas to limit the burden of wasting and stunting.

117 Using composite area-level measures as a proxy for self-report family income

Abstract Background Socioeconomic status (SES) is a well-established social determinant of child health. When reliable self-report family income is unavailable, area-level measures, such as median neighbourhood income, are commonly used as a proxy. However, median neighbourhood income is not a good proxy for self-report family income. Newer area-level measures, such as the Neighbourhood Equity Score (NES) and the Child and Family Inequities Score (CFIS) are composite scores comprised of indicators of well-being such as income, parental education and physical surroundings. Objectives The primary objective was to evaluate the agreement between self-report family income and three area-level measures: median neighbourhood income, NES, and CFIS. The secondary objective was to examine the association between self-report family income, NES, and CFIS with two health indicators associated with SES: overweight/obesity (BMI z-score&amp;gt;1) and short breastfeeding duration (&amp;lt;6 months). Design/Methods We conducted a cross-sectional study using data from a healthy urban Canadian cohort of young children (0-5 years) attending a scheduled health supervision visit in primary care. Parents completed a questionnaire including family income, postal code and breastfeeding duration. Research assistants measured height and weight (to calculate body mass index). Postal code was used to determine each area-level measure. Agreement between self-report family income and area-level measures was evaluated using kappa coefficients. The percentage of families accurately classified by area-level measures compared with self-report family income was calculated. Multivariable logistic regression was used to evaluate the association between self-report family income, NES, and CFIS (quintiles) with the two health indicators (present/absent). Results 5149 children were included (mean age 21 months). Agreement between self-report family income and both NES and CFIS was ‘fair’ (weighted k=0.29 for both), and agreement with median neighbourhood income was ‘poor’ (weighted k=0.09). Accurate classification between self-report family income and the three measures were: median neighbourhood income (5.6%), NES (32.2%), CFIS (32.4%). For children in the lowest vs. highest quintile, the odds (95% CI) of overweight/obesity were: self-report family income OR=2.75 (1.60-4.72), NES OR=2.02 (1.23-3.30), CFIS OR=2.04 (1.25-3.33); and having short breastfeeding duration: self-report family income OR=1.61 (1.32-1.97), NES OR=1.84 (1.50-2.25), CFIS OR=1.84 (1.46-2.31). Conclusion Agreement and accurate classification between self-report family income was strongest for composite area-level measures (NES and CFIS), compared with median neighbourhood income. Both self-report family income and composite area-level measures supported the same conclusion that lower SES was associated with poorer health outcomes. These newer measures may be more appropriate than median neighbourhood income when self-report family income is unavailable.

Family Structure as a Social Determinant of Child Health

ABSTRACT Maternal marital status may contribute to health disparities among children; marriage often associates with better outcomes. Using data from the Fragile Families and Child Wellbeing Study, we tested separate structural equation models to compare direct and indirect relationships between maternal economic hardship, parenting stress, and adolescent self-rated health among 3,146 married and unmarried mothers. Although parenting stress did not associate with adolescent health for either group, economic hardship directly associated with poorer adolescent self-reported health for only unmarried mothers, and unmarried mothers had a stronger negative relationship between economic hardships and parenting calling for policies to address these disparities.

Social determinants of under-5 child health: A qualitative study in Wolkayit Woreda, Tigray Region, Ethiopia.

Despite the significant reductions seen in under-5 child mortality in Ethiopia over the last two decades, more than 10,000 children still die each year in Tigray Region alone, of whom 75% die from preventable diseases. Using an equity lens, this study aimed to investigate the social determinants of child health in one particularly vulnerable district as a means of informing the health policy decision-making process. An exploratory qualitative study design was adopted, combining focus group discussions and qualitative interviews. Seven Focus Group Discussions with mothers of young children, and 21 qualitative interviews with health workers were conducted in Wolkayit district in May-June 2015. Data were subjected to thematic analysis. Mothers’ knowledge regarding the major causes of child mortality appeared to be good, and they also knew about and trusted the available child health interventions. However, utilization and practice of these interventions was limited by a range of issues, including cultural factors, financial shortages, limited female autonomy on financial resources, seasonal mobility, and inaccessible or unaffordable health services. Our findings pointed to the importance of a multi-sectoral strategy to improve child health equity and reduce under-5 mortality in Wolkayit. Recommendations include further decentralizing child health services to local-level Health Posts, and increasing the number of Health Facilities based on local topography and living conditions.

Effects of armed conflict on child health and development: A systematic review.

BackgroundArmed conflicts affect more than one in 10 children globally. While there is a large literature on mental health, the effects of armed conflict on children’s physical health and development are not well understood. This systematic review summarizes the current and past knowledge on the effects of armed conflict on child health and development.MethodsA systematic review was performed with searches in major and regional databases for papers published 1 January 1945 to 25 April 2017. Included studies provided data on physical and/or developmental outcomes associated with armed conflict in children under 18 years. Data were extracted on health outcomes, displacement, social isolation, experience of violence, orphan status, and access to basic needs. The review is registered with PROSPERO: CRD42017036425.FindingsAmong 17,679 publications screened, 155 were eligible for inclusion. Nearly half of the 131 quantitative studies were case reports, chart or registry reviews, and one-third were cross-sectional studies. Additionally, 18 qualitative and 6 mixed-methods studies were included. The papers describe mortality, injuries, illnesses, environmental exposures, limitations in access to health care and education, and the experience of violence, including torture and sexual violence. Studies also described conflict-related social changes affecting child health. The geographical coverage of the literature is limited. Data on the effects of conflict on child development are scarce.InterpretationThe available data document the pervasive effect of conflict as a form of violence against children and a negative social determinant of child health. There is an urgent need for research on the mechanisms by which conflict affects child health and development and the relationship between physical health, mental health, and social conditions. Particular priority should be given to studies on child development, the long term effects of exposure to conflict, and protective and mitigating factors against the harmful effects of armed conflict on children.

The Effects of Armed Conflict on Children.

More than 1 in 10 children worldwide are affected by armed conflict. The effects are both direct and indirect and are associated with immediate and long-term harm. The direct effects of conflict include death, physical and psychological trauma, and displacement. Indirect effects are related to a large number of factors, including inadequate and unsafe living conditions, environmental hazards, caregiver mental health, separation from family, displacement-related health risks, and the destruction of health, public health, education, and economic infrastructure. Children and health workers are targeted by combatants during attacks, and children are recruited or forced to take part in combat in a variety of ways. Armed conflict is both a toxic stress and a significant social determinant of child health. In this Technical Report, we review the available knowledge on the effects of armed conflict on children and support the recommendations in the accompanying Policy Statement on children and armed conflict.

Trends in social determinants of child health and perinatal outcomes in European countries 2005–2015 by level of austerity imposed by governments: a repeat cross-sectional analysis of routinely available data

ObjectiveTo assess whether the level of austerity implemented by national governments was associated with adverse trends in perinatal outcomes and the social determinants of children’s health (SDCH) in rich countriesDesignLongitudinal...

Intergenerational Associations of Parent Adverse Childhood Experiences and Child Health Outcomes.

Adverse childhood experiences (ACEs) robustly predict future morbidity and mortality. Researchers are just beginning to investigate intergenerational effects. We hypothesize there are intergenerational associations between parent ACE exposure and worse child health, health behaviors, and health care access and use. We linked data from 2 population-based cross-sectional telephone surveys in Philadelphia, Pennsylvania, that were used to ask parents about their past exposure to ACEs and their child's health, respectively. Participants were 350 parent-child dyads. Logistic regression models adjusted for parent and child characteristics. Parent ACE score was used to summarize indicators of parents' childhood adversity. Child health outcomes were poor overall health status, asthma diagnosis, obesity, low fruit and vegetable consumption, any soda consumption, inadequate physical activity, excessive television watching, no health insurance, no usual source of health care, and no dental examination in past 12 months. Of adult participants, 80% were female participants and 45% were non-Latino African American. Eighty-five percent of parents had experienced ≥1 ACE and 18% had experienced ≥6 ACEs. In adjusted models, each additional parent ACE was associated with higher odds of poor child overall health status (odds ratio [OR] = 1.19; 95% confidence interval [CI]: 1.07-1.32), asthma (OR = 1.17; 95% CI: 1.05-1.30), and excessive television watching (OR = 1.16; 95% CI: 1.05-1.28). The full scope of the health effects of ACEs may not be limited to the exposed individual, highlighting the need for a 2-generation approach to addressing the social determinants of child health.

The social determinants of child health

Abstract Social determinants of health have long been recognised but their importance is often overlooked. Globally social determinants are responsible for most childhood illness and death. In the UK, conditions which constitute a large part of paediatric practice are socially patterned. Social determinants exert their influence on child health through a complex inter-relationship of more distal social factors such as income and education with more proximal factors such as health behaviours. The pathways by which the social determinants exert their influence operate over time and across generations. Socially related risk and protective factors cluster in different social groups and accumulate over time. Social determinants are profoundly influenced by social and political decisions which are beyond the control of parents and individual paediatricians. Societies can protect children against the adverse effects of social disadvantage. National paediatric societies have a key role in promoting policies which protect children. This brief review summarises the impact of social determinants on children's health in the UK and considers the role of paediatricians in reducing the health inequities generated by these determinants.