Two-parent Households Research Articles

Income poverty in households with children: Finland 1987-2011

The child poverty rate has increased noticeably in Finland since the mid-1990s. In this paper, we use register-based data to analyse how parents’ labour market status influences the likelihood of households with children being found in poverty, as measured by the equivalent taxable household income, and particularly whether and how these effects have varied over the study period 1987-2011. In households with parents in unemployment or outside the labour force, the likelihood of poverty increased markedly during the study period, as compared to those with employed parents. Growing divisions in society might be one reason to the development. The contribution of education and other characteristics on the difference in the poverty risk by labour market status is minor in single-parent households, and only slightly larger in two-parent households.

Intra-household Behavioral Responses to Cash Transfer Programs. Evidence from a Regression Discontinuity Design

Summary Considering two-parent households with children, this study investigates the behavioral responses of men and women to a cash transfer program in Uruguay – Asignaciones Familiares-Plan de Equidad (AFAM-PE). We examine its effect on labor market responses, marital dissolution, and the decision-making process regarding the use of money. The assignment mechanism to the AFAM-PE exogenously alters the distribution of non-labor income across applicant households by targeting the monetary transfer (usually) to the female spouse. Our identification strategy exploits both the female targeting and a discontinuity in eligibility for enrollment into the program. Based on a regression discontinuity design and on a follow-up survey matched with program’s administrative records, this study finds that the program has significant negative effects on the formality choice of women at the eligibility cut-off. These responses seem to be associated with a lower rate of moving from unregistered jobs to formality. We also find suggestive evidence that the program results in women taking greater (perceived) responsibility for decisions in specific spheres of household expenditures. This study, represents one of the first efforts to analyze the distributional effects of CCT programs on different couples members’ behavioral responses. It offers relevant considerations for the ongoing debate about the impacts of these kind of programs on women’s agency in developing countries, suggesting the need to discuss new designs for social assistance that reduce discouraging effects on formality.

008-Sample Demographics and Cultural Responsiveness in Psychosocial and Behavioral Interventions with Adolescents with Type 1 Diabetes: A Systematic Review

Background: The rate at which new cases of Type 1 diabetes (T1D) in youth <20 years old is increasing in the U.S. is a mounting pediatric public health concern; and age, race and ethnicity have significant impacts. Specific social determinants of health and sociodemographic (SD) characteristics –racial/ethnic minority, low SES, single parent home and underinsured—have consistently been associated with poorer glycemic control (GC) and self-management (SM) in adolescents with T1D. Purpose: The purpose of this systematic review was to evaluate sample demographics, and culturally responsive recruitment and reporting methods used in psychosocial and behavioral interventions focused on improving SM and GC in adolescents with T1D, to identify if studies were targeting these high risk groups and if current methods were being tailored to reach them. Description of Topic: Using a social determinants of health and health equity theoretical perspective, this review applied a culturally responsive research (CRR) framework to evaluate relevant interventions. Intervention studies, from 2006 to 2016, focused on adolescents (13–18yo) with T1D and improving SM and GC by psychosocial or behavioral methods, obtained from PsychInfo, PubMed and CINAHL, were evaluated using a CRR rubric. Twenty-eight studies met inclusion criteria; 14 reported on fewer than 3 of 7 SD categories. Of those that reported, overall study samples used convenience sampling methods, focused predominantly on white, middle-high income, moderately GC'd adolescents from two-parent households with private insurance. Majority of studies scored poorly in cultural responsiveness in reporting analysis and interpretation, and moderately in culturally responsive reporting of SD descriptions of participants. Overall, studies lacked detailed recruitment and sampling methods, as relates to cultural inclusivity, neglecting to apply deliberate recruitment efforts and use of culturally responsive assessments for difficult to reach high risk groups. Clinical Implications: Pediatric endocrinology nurse interventionists must increase targeted efforts towards recruiting and sampling more high risk groups, by devising successful, culturally responsive methods of recruitment and sampling through community based participatory research, and including expanded SD reporting. These efforts will engage high risk participants and improve existing and novel interventions by making them relevant to the unique needs, goals and priorities of highest risk SD groups within pediatric endocrinology.

The Role of Family for Youth Friendships: Examining a Social Anxiety Mechanism.

The quality of family relationships and youth friendships are intricately linked. Previous studies have examined different mechanisms of family-peer linkage, but few have examined social anxiety. The present study examined whether parental rejection and family climate predicted changes in youth social anxiety, which in turn predicted changes in friendship quality and loneliness. Possible bidirectional associations also were examined. Data for mothers, fathers, and youth (M age at Time 1 = 11.27; 52.3% were female) from 687 two-parent households over three time points are presented. Results from autoregressive, cross-lagged analyses revealed that father rejection (not mother rejection or family climate) at Time 1 (Fall of 6th Grade) predicted increased youth social anxiety at Time 2 (Spring of 7th Grade), which in turn, predicted increased loneliness at Time 3 (Spring of 8th Grade). The indirect effect of father rejection on loneliness was statistically significant. Mother rejection, father rejection, and a poor family climate were associated with decreased friendship quality and increased loneliness over time. Finally, there was some evidence of transactional associations between father rejection and youth social anxiety as well as between social anxiety and loneliness. This study's findings underscore the important role of fathers in youth social anxiety and subsequent social adjustment.

Coming Up Short: Family Composition, Income, and Household Savings

AbstractObjective: Existing research on savings and liquid-asset accumulation is largely quantitative and focuses on descriptions of how income inequality leads to the ability or inability to save. What has been left out of this body of research is an in-depth exploration of the role family composition may play in the way that households accumulate liquid assets. The purpose of this research is to understand how lower and higher income single- and two-parent families characterize reasons for saving, obstacles to saving, and strategies to save. Method: A diverse sample of 42 parents of kindergarteners were asked questions about household saving at 2 time points. Results: Compared to other family types, lower income single mothers report little savings and aspirations toward very short-term savings horizons as a result of persistent income shortfalls. Unlike two-parent households, lower-income single mothers discussed their reasons for avoiding mainstream financial institutions and opting to use cash instea...

Food Insecurity and Social Capital Among Middle School Students

This study examines the relationship between social capital, poverty, limited food accessibility, and food insecurity among fifth to seventh graders ( N = 317), ages 10 to 14, attending a middle school in Northwest Arkansas. Using survey data that overcomes methodological limitations of previous research on youth food insecurity, we answer the following questions: Does social capital have a direct impact on youth food insecurity? And, does social capital buffer the influence of negative circumstances on youth food insecurity? The broader theoretical question asks “In places where there is an abundance of natural, economic, and technological resources, what stands in the way of consistent access to food for everyone?” Regression analysis finds that various indicators of social capital have a significant relationship with food insecurity even after controlling for multiple sociodemographic and circumstantial factors. In addition, significant moderating effects reveal the unique capability of two-parent households to buffer the impact of poverty and limited accessibility.

Female-Headed Households Associated with Lower Childhood Stunting Across Culturally Diverse Regions of Pakistan: Results from a Cross-Sectional Household Survey.

Objectives Early childhood stunting adversely influences long-term cognitive and health outcomes. There is limited evidence on whether female empowerment within households could reduce its prevalence. We investigated this relationship in Punjab, Pakistan, which has high stunting rates and a sizeable proportion of female-headed households, and whether this relationship differed across three provincial regions with diverse cultural attitudes towards the role of women in society. Methods Using cross-sectional data from the 2011 Multiple Indicator Cluster Survey, we identified 13,412 children aged 1-4 from 8985 two-parent households in three culturally distinct regions in Punjab, Pakistan. Logistic regression models assessed whether the likelihood of stunting was associated with female-headed households, a proxy for female empowerment, and whether this relationship differed by region. Regressions controlled for child- and household-level covariates. Results Children had 26% lower odds of stunting among female-headed households (OR 0.74, CI 0.60, 0.90). The interaction term for female-headed households and child stunting by provincial region was not statistically significant, suggesting that the relationship holds across the three culturally distinct regions. Conclusions for Practice Female empowerment was associated with lower rates of stunting among young children, and the results did not vary by provincial region. This suggests that women can play important roles as agents of change, even in areas where females have limited freedoms. Greater investments in public education and awareness campaigns to improve health literacy might have important spillover effects for child health and improve the success of existing public health interventions targeting childhood stunting.

The baseline characteristics of parents and African American girls in an online obesity prevention program: A feasibility study.

The objective of this paper was to identify the relationships and associations between child and parent characteristics with child fruit and vegetable (FV) consumption in an online obesity prevention program for 8–10 year old African American girls. Girls and a parent (n = 342 child-parent pairs) in the southwestern US completed baseline data collection from 2012 to 2014. Girls and a parent completed self-report questionnaires online. Girls also completed two unannounced 24 hour telephone-based dietary recalls. The relationships of parent demographic characteristics, child FV intake, and psychosocial variables (child and parent) were examined by analysis of variance. Pearson correlation coefficients were calculated to determine the relationships between psychosocial variables and child FV intake. Child FV intake was significantly greater in the highest household education (p = 0.001) and income groups (p = 0.004). FV home availability was higher with older parents (p = 0.007) and two-parent households (p = 0.033). Child FV intake was positively related to child FV preferences (p < 0.001), FV home availability (p = 0.022), and FV home accessibility (p = 0.002) but was negatively related to family barriers to FV consumption (p = 0.000). The study highlighted significant findings between child FV consumption and parent psychosocial variables and demographic characteristics that may offer insights for the design of effective obesity prevention interventions for 8–10 year old African American girls.ClinicaTrials.gov (NCT01481948).

Psychosocial impact on families with an infant with a hypoplastic left heart syndrome during and after the interstage monitoring period - a prospective mixed-method study.

To investigate parents' experiences, coping ability and quality of life while monitoring their sick child with hypoplastic left heart syndrome at home. Interstage home monitoring for children with hypoplastic left heart syndrome reduces interstage mortality between Norwood stages I and II. Little is known about the psychosocial impact of interstage home monitoring. Prospective mixed-method study. This study assessed the psychosocial impact on parents during interstage home monitoring. This contains for quantitative assessment the Short Form Health Survey questionnaire and the Impact of Family Scale administered one and five weeks following discharge before and after stage II. For qualitative assessment, semi-structured interviews focussing on the postdischarge coping strategies were conducted twice, five weeks after hospital discharge before and after stage II. Ten infants (eight males) with hypoplastic left heart syndrome (n=7) or other types of univentricular heart malformations (n=3), and their parents (nine mother/father two-parent households, one single mother) were included. There were no interstage deaths. Mental Health Composite Summary scores were low in both parents (mothers: 40·45±9·07; fathers: 40·58±9·69) and lowest for the item 'vitality' (mothers: 37·0±19·46; fathers: 43·12±25·9) before and after stage II. Impact of Family Scale values showed higher daily and social burdens for mothers. 'Becoming a family' was the most important task as coping strategy to equilibrate the fragile emotional balance. The parents judged interstage home monitoring as a protective intervention. Although psychosocial burden before and after stage II remains high, becoming a family is an essential experience for parents and confirms their parenthood. Healthcare professionals must be aware of parents' needs during this vulnerable interstage period and to provide psychosocial and nursing support.

Parent-Child Connectedness and Long-Term Risk for Suicidal Ideation in a Nationally Representative Sample of US Adolescents.

Few studies have addressed on the role of parent-child connectedness (PCC) on adolescents' risk for suicidal ideation from a longitudinal, developmental perspective. This study examined PCC during adolescence and risk of suicidal ideation into adulthood among a nationally representative sample of American adolescents. The study includes 13,234 adolescents aged 11-18 from the National Longitudinal Study of Adolescent to Adult Health (Add Health) who were surveyed during adolescence (1994-1995) and then again in early adulthood (2008-2009). Multinomial logistic regression estimated the association between PCC during adolescence and having ideation during the adolescence period only, in adulthood only, and in both adolescence and adulthood as compared with those without suicidal ideation. After adjusting for depressive symptoms and other parent and adolescent characteristics, adolescents in two-parent households who reported higher PCC during adolescence had lower relative risk of having ideation during adolescence alone and in both adolescence and adulthood. In mother-only households, higher mother connectedness was also associated with decreased risk of having adolescent ideation. PCC is an important modifiable target for the prevention of suicidal ideation from adolescence into adulthood.

A comparison of families of children with autism spectrum disorders in family daily routines, service usage, and stress levels by regionality

ABSTRACTPurpose: To explore whether family routines, service usage, and stress levels in families of children with autism spectrum disorder differ as a function of regionality. Methods: Secondary analysis of data was undertaken from 535 surveys. Univariate and multivariate analyses were performed to investigate differences between families living in densely populated (DP) areas and less densely populated (LDP) areas. Results: Families living in LDP areas were found to: (1) have reduced employment hours (a two-parent household: Exp (B) = 3.48, p < .001, a single-parent household: Exp (B) = 3.32, p = .011); (2) travel greater distance to access medical facilities (Exp (B) = 1.27, p = .006); and (3) report less severe stress levels (Exp (B) = 0.22, p = .014). Conclusions: There were no differences in family routines; however, flexible employment opportunities and travel distance to medical services need to be considered in families living in LDP areas.

What parents don't know: Disclosure and secrecy in a sample of urban adolescents

Research with two-parent European households has suggested that secrecy, and not disclosure of information per se, predicts adolescent adjustment difficulties. The present study attempted to replicate this finding using data from a 4-wave study of 358 poor, urban adolescents (47% male; M age = 12 yrs) in the United States, most of whom (>92%) were African American. Adolescents self-reported secrecy, disclosure, depressive symptoms, and delinquency at each wave. Confirmatory factor analyses revealed that a two-factor model with secrecy and disclosure as separate, but correlated, factors was a better fit than a one-factor model. However, predictive models differed from previous research. Secrecy did not predict depressive symptoms, rather depressive symptoms predicted secrecy. For delinquency, there were significant paths from both secrecy to delinquency and delinquency to secrecy, as well as from delinquency to disclosure. These results did not differ by age or sex. Comparisons with previous findings are discussed.

Racial Trends and Differences in the Intergenerational Transmission of Education

I estimate the intergenerational transmission of education in the United States between 1980 and 2013. I find that intergenerational persistence in education has increased substantially among blacks in recent years while remaining stable among whites and Hispanics. I observe this trend when using data from the Panel Study of Income Dynamics as well as the National Longitudinal Surveys of Youth. I demonstrate that much of the increase in educational persistence among blacks is due to decreases in upward mobility. The increase in black educational persistence is found in both two-parent and single-parent households, and I do not find similar trends and differences when estimating intergenerational income persistence.

The Roles of Family Factors and Relationship Dynamics on Dating Violence Victimization and Perpetration Among College Men and Women in Emerging Adulthood.

Using data from the International Dating Violence Study, this study examined the roles of early socialization, family social structure, and relationship dynamics factors on physical aggression in dating among U.S. college students in emerging adulthood. The interaction effects between these three domains of interest (early socialization, family social structure, and relationship dynamics) were explored to understand the underlying mechanisms that influenced victimization and perpetration in dating. In general, we found that family and relational variables associated with dating victimization and perpetration were fairly similar. Among the early socialization variables, experience of childhood neglect and having witnessed domestic violence were significantly related to victimization and perpetration. Living in a two-parent household appeared to exert a protective effect, although associations with parental education were not statistically significant. Furthermore, the participants were more likely to experience victimization or impose aggression in dating relationships which were characterized by conflicts, distress, dominance, or psychological aggression. Overall, for the participants who came from a two-parent household, dominance in dating was linked to less violence. When the participants faced higher levels of psychological aggression, adverse early socialization factors were associated with higher levels of dating violence victimization and perpetration. Research and practice implications were discussed.

Blame Their Mothers: Public Opinion About Maternal Employment as a Cause of Juvenile Delinquency

Juvenile justice reformers and practitioners have long blamed mothers for juvenile delinquency, identifying maternal employment as a key cause of youthful offending. The current study uses data from registered voters ( N = 10,144) to examine public views about whether maternal employment in two-parent households promotes juvenile delinquency. The results show that only a small minority of citizens blame working mothers for youth crime. The findings also reveal that views about the criminogenic consequences of maternal employment for children are predicted by factors that are strongly associated with gendered self-interest and exposure to nonegalitarian narratives. Implications of the findings are discussed.

Mother’s educational level and single motherhood: Comparing Spain and Italy

1. IntroductionOn average, 15% of European children live in one-parent households, most of them headed by women, and this kind of household has a higher risk of poverty than couple-headed households (OECD 2014). Furthermore, there is evidence that under some conditions, nurturing children in single-mother households has negative consequences for the children's cognitive and emotional development that affect them throughout their entire lives (see Sigle-Rushton and McLanahan 2004 for a review). In Southern European countries, described as family-based welfare regimes (Esping-Andersen 1999), state protection for children is among the lowest in the European Union. However, when comparing poverty ratios between children nurtured in single-parent families and those in two parent households, family-based regimes show smaller differences than other welfare regimes. In the mid-1990s the risk of poverty among children residing in single-parent families was as much as twice as high as the risk of poverty among children residing in two-parent households, while this ratio was much higher in the other Western nations (Luxembourg Income Study, Key Figures. Data from mid-1990's)It seems paradoxical that the relative standard of living of children in single-parent households is better where state social investment is lower. However, this ceases to be such a paradox when we take into consideration the composition effect of single parenthood in Southern Europe. Previous studies with data from the 1990s or early 2000s showed a positive relationship between single motherhood and educational level in Southern Europe (Flaquer, Almeda, and Navarro 2006; Garriga 2010; McLanahan 2004), while this relationship was negative in Northern Europe (McLanahan 2004; Kennedy and Thomson 2010). Furthermore, a high percentage of single mothers in Southern Europe live with their parents in order to balance work and family life or escape from poverty (Trevino 2006; Flaquer and Garriga 2009).The purpose of our study is to examine whether such a composition effect still exists in Southern Europe, given the changing social context characterized by: a) a dramatic change in labor market conditions, b) huge changes in the ethnic composition of the younger population as a result of massive immigration waves, and c) deep-seated changes in family values affecting divorce, cohabitation, and out-of-wedlock patterns. Given that all these changes have not happened with equal intensity among all southern countries, we have selected Spain and Italy as two cases representing two different trends (Moreno and Mari-Klose 2013). Our results confirm that the relationship between educational level and single parenthood has been clearly inverted in Spain, where we have observed a positive association between less-educated women and single motherhood, where the risk of becoming a single mother is now higher among the less-educated. Similar changes, though lower in intensity, are happening in Italy among younger women and in the wealthiest regions. All in all, these changes seem more related to long-term trends than to any effect derived from the economic crisis or migration.2. The Second Demographic Transition and educational variation in single parenthoodSingle parenthood arises from widowhood, out-of-wedlock birth, divorce, and remarriage. Single parenthood is an option for very young girls who get pregnant out of wedlock, most of them from working-class or underclass backgrounds (Kearney and Levine 2012). This source of single parenthood is more frequent in the American continent than in Western Europe, with the exception of the United Kingdom and Ireland, and is very rare in Southern Europe (Part et al. 2013). Widowhood is another source of single parenthood, and for a long time it was the main cause of single parenthood in societies where divorce was forbidden or tightly restricted by law, such as in pre-democratic Spain (Flaquer 1998). Widowhood is more frequent among the lower social strata, given their shorter life expectancy. …

Family policies and single parent poverty in 18 OECD countries, 1978–2008

This study examined to what extent family policies differently affect poverty among single-parent households and two-parent households. We distinguished between reconciliation policies (tested with parental leave and the proportion of unpaid leave) and financial support policies (tested with family allowances). We used data from the Luxembourg Income Study Database, covering 519,825 households in 18 OECD countries from 1978 to 2008, combined with data from the Comparative Family Policy Database. Single parents face higher poverty risks than coupled parents, and single mothers more so than single fathers. We found that employment reduces poverty, particularly for parents in professional occupations and for coupled parents who are dual earners. Longer parental leave, a smaller proportion of unpaid leave, and higher amounts of family allowances were associated with lower poverty among all households with children. Parental leave more effectively facilitated the employment of single mothers, thereby reducing their poverty more than among couples and single fathers. We found some evidence that family allowances reduced poverty most strongly among single fathers. An income decomposition showed that family allowances reduce poverty among two-parent households with up to 3 percentage points, and among single-parent households (mothers and fathers) up to 13 percentage points.

Childhood Risk of Parental Absence in Tanzania.

Although parents might not live with their children for a variety of reasons, existing accounts of parental absence often examine one cause in isolation. Using detailed longitudinal demographic surveillance data from Rufiji, Tanzania, this article examines parental absence due to death, migration, child relocation, union dissolution, and union formation from 2001-2011. Employing survival analysis, the article quantifies children's risk of absence by cause and investigates sociodemographic variation in this risk. Of children born into two-parent households, 25% experience maternal absence by age 10, and 40% experience paternal absence by the same age. Roughly one-quarter of children are born into single-mother families with an absent father at birth, and nearly 70% of these children experience maternal absence as well by age 10. Despite the emphasis on orphanhood in the research and policy communities, parental death is the least common cause of absence. Furthermore, although demographic and socioeconomic characteristics are strong predictors of absence, variation in these relationships across causes underscores the distinctiveness and similarity of different reasons for absence.

Racial and Ethnic Disparities in Early Childhood Obesity: Growth Trajectories in Body Mass Index.

The aims of this study are to describe growth trajectories in the body mass index (BMI) among the major racial and ethnic groups of US children and to identify predictors of children's BMI trajectories. The Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) was used to identify predictors of BMI growth trajectories, including child characteristics, maternal attributes, home practices related to diet and social behaviors, and family sociodemographic factors. Growth models, spanning 48 to 72months of age, were estimated with hierarchical linear modeling via STATA/Xtmixed methods. Approximately one-third of 4-year-old females and males were overweight and/or obese. African-American and Latino children displayed higher predicted mean BMI scores and differing mean BMI trajectories, compared with White children, adjusting for time-independent and time-dependent predictors. Several factors were significantly associated with lower mean BMI trajectories, including very low birth weight, higher maternal education level, residing in a two-parent household, and breastfeeding during infancy. Greater consumption of soda and fast food was associated with higher mean BMI growth. Soda consumption was a particularly strong predictor of mean BMI growth trajectory for young Black children. Neither the child's inactivity linked to television viewing nor fruit nor vegetable consumption was predictive of BMI growth for any racial/ethnic group. Significant racial and ethnic differences are discernible in BMI trajectories among young children. Raising parents' and health practitioners' awareness of how fast food and sweetened-beverage consumption contributes to early obesity and growth in BMI-especially for Blacks and Latinos-could improve the health status of young children.

Clinical Implications of Psychosocial Factors on Pediatric External Fixation Treatment and Recommendations

Pediatric limb reconstruction using circular external fixation is a prolonged treatment that interrupts patients' daily function. Patient personality characteristics and expectations may interfere with planned treatment, making complicated medical procedures more challenging. The aims of this study are to identify factors impacting treatment outcome and recommendations for preoperative evaluation and planning. (1) Are there group differences between patients with and without a preexisting mental health condition(s) in terms of unplanned reoperations? (2) Does the number of surgical procedures before current external fixator placement correlate with the number of unplanned readmissions, unplanned reoperations, and days spent in circular external fixation? (3) Are there group differences between single- compared with two-parent households in terms of inpatient narcotic doses, length of inpatient stay, number of unplanned readmissions, length of readmission(s), and/or unplanned outpatient clinic visits? (4) Does patient age at the time of surgery have an impact on treatment duration, postoperative complications, and treatment outcome? This is a retrospective chart review of pediatric patients who underwent limb reconstruction between 2008 and 2012. Patients with limb length discrepancy > 4 cm or severe angular deformity and who agreed to intervention were treated with circular external fixation. Sixty-seven patients were included; 16 patients were excluded. Statistical analyses included Pearson r correlation and t-test. Patients who reported preexisting mental health diagnosis (13%) had more unplanned reoperations than patients who did not (no mental health diagnosis; 87%) (mental health diagnosis 3.4 ± 10.3 versus no mental health diagnosis 0.2 ± 0.5 reoperation[s], p = 0.022). Number of previous surgical procedures correlated with number of unplanned reoperations (r = 0.448, p < 0.001), number of unplanned readmissions (r = 0.375, p < 0.001), and number of days in an apparatus (r = 0.275, p = 0.018). Compared with patients from two-parent households, patients from single-parent households received a greater number of inpatient narcotic doses (single-parent 129 ± 118 versus two-parent 73 ± 109 doses, p = 0.039), longer length of inpatient stay (single-parent 73 ± 63 versus two-parent 40 ± 65 days, p = 0.036), more unplanned readmissions (single-parent 0.4 ± 0.1 versus two-parent 0.2 ± 0.2 readmission, p = 0.024), longer hospitalization when readmitted (single-parent 5 ± 11 versus two-parent 1 ± 3 day(s), p = 0.025), and fewer unplanned outpatient visits (single-parent 0.2 ± 0.8 versus two-parent 0.9 ± 1.1 visit, p = 0.005). Apparatus applications with successful outcome had higher average age than those with poor outcome (successful outcome 16 ± 3 versus poor outcome 13 ± 4 years old, p = 0.011). Age at time of apparatus application correlated with number of prescribed antibiotics (r = 0.245, p = 0.036) and number of days in an apparatus (r = 0.233, p = 0.047). As a result of the inherent challenges of limb reconstruction, surgical candidates should be preoperatively assessed and mitigating psychosocial factors managed to maximize successful treatment outcome. Level IV, therapeutic study.