Linking Family Economic Hardship to Early Childhood Health: An Investigation of Mediating Pathways
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Linking Family Economic Hardship to Early Childhood Health: An Investigation of Mediating Pathways Hui-Chin Hsu1 • Kandauda A. S. Wickrama1
Ó Springer Science+Business Media New York 2015
Abstract Objectives The underlying mechanisms through which family economic adversity influences child health are less understood. Taking a process-oriented approach, this study examined maternal mental health and investment in children, child health insurance, and child healthcare as mediators linking family economic hardship (FEH) to child health. Methods A structural equation modeling was applied to test the hypothesized mediating model. Results After adjustment for sociodemographic risk factors, results revealed: (1) a significant direct path linking FEH to poor child health (effect size = .372), and (2) six significant mediating pathways (total effect size = .089). In two mediating pathways, exposures to FEH undermined mothers’ mental health: in the first pathway poor maternal mental health led to decreased parental investment, which, in turn, contributed to poor child health, whereas in the second pathway the adverse effect of poor maternal mental health was cascaded through child unmet healthcare need, which resulted in poor child health. One pathway involved child insurance status, where the effect of FEH increased the likelihood to be uninsured, which led to unmet healthcare need, and, in turn, to poor health. Three pathways involved preventive care: in one pathway FEH contributed to poor preventive care, which led to unmet
& Hui-Chin Hsu [email protected] Kandauda A. S. Wickrama [email protected] 1
Department of Human Development and Family Science, University of Georgia, Athens, GA 30602-3622, USA
healthcare need and then to poor health; in the other two pathways where poor preventive care respectively gave rise to decreased investment in children or poor maternal mental health, which further contributed to poor child health. Conclusions Results suggest that the association between FEH and children’s health is mediated by multiple pathways. Keywords Early childhood health Family economic hardship Maternal mental health Parenting Preventive care Abbreviations FEH Family economic hardship NSECH National Survey of Early Childhood Health SEM Structural equation modeling CFI Comparative fit index RMSEA Root mean square error of approximation
Significance Children in disadvantaged families are at risk for poor health. Multiple factors and complex cascading pathways are expected to underlie the link between family economic hardship and child health. Results demonstrate that maternal mental health, parental investment in children, child insurance status, the quality of well-child preventive care, and sick-child health care are factors involved in the complex mediating cascades. Better understanding of the mediating pathways can inform interventions and policies.
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Matern Child Health J
Introduction Children in poverty are at risk for poor health [1–3], which has a long-lasting impact on adult health [4]. The effe
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