Influence of Multiple Social Risks on Children's Health

Larson, Kandyce; Russ, Shirley A.; Crall, James J.; Halfon, Neal

doi:10.1542/peds.2007-0447

Cited by 225 publications

(173 citation statements)

References 52 publications

(29 reference statements)

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“…The Rochester Longitudinal Study assessed 10 risks and found that children with eight or more risks had rates of poor academic performance that were seven times greater than for children with zero to three risks (78). Subsequent studies support the view that the number of adversities in children's environment affects their healthy development independent of the occurrence of any individual adverse exposure (79)(80)(81).…”

Section: Increasing Complexitymentioning

confidence: 76%

Rigor, vigor, and the study of health disparities

Adler

Bush²,

Pantell

2012

Proc. Natl. Acad. Sci. U.S.A.

104

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Health disparities research spans multiple fields and methods and documents strong links between social disadvantage and poor health. Associations between socioeconomic status (SES) and health are often taken as evidence for the causal impact of SES on health, but alternative explanations, including the impact of health on SES, are plausible. Studies showing the influence of parents' SES on their children's health provide evidence for a causal pathway from SES to health, but have limitations. Health disparities researchers face tradeoffs between "rigor" and "vigor" in designing studies that demonstrate how social disadvantage becomes biologically embedded and results in poorer health. Rigorous designs aim to maximize precision in the measurement of SES and health outcomes through methods that provide the greatest control over temporal ordering and causal direction. To achieve precision, many studies use a single SES predictor and single disease. However, doing so oversimplifies the multifaceted, entwined nature of social disadvantage and may overestimate the impact of that one variable and underestimate the true impact of social disadvantage on health. In addition, SES effects on overall health and functioning are likely to be greater than effects on any one disease. Vigorous designs aim to capture this complexity and maximize ecological validity through more complete assessment of social disadvantage and health status, but may provide less-compelling evidence of causality. Newer approaches to both measurement and analysis may enable enhanced vigor as well as rigor. Incorporating both rigor and vigor into studies will provide a fuller understanding of the causes of health disparities.methodology | social determinants of health | cumulative risk G ood health and longevity are unequally distributed in populations. Although some unavoidable variations in health emanate from individual differences in vulnerability to disease, others are linked to membership in socially disadvantaged groups. The latter are unjust and have been the focus of considerable research and policy (1). Research on these health disparities has demonstrated consistent graded associations between various components of socioeconomic status (SES) and a wide range of health indicators; at each step up the social ladder, whether indexed by higher income, education, and/or occupational level, rates of morbidity and mortality decrease (2). The prevailing understanding of this relationship is that SES is a "fundamental cause" of health status (3), which operates through physical and/or psychosocial resources that are more readily available as SES increases, and hardships and adverse exposures that are more intense and frequent as SES decreases.Evidence for the SES-health gradient comes primarily from cross-sectional data linking contemporaneous measures of SES in adulthood with prevalence of disease, poor health, or mortality. Smaller literatures have established associations between socioeconomic conditions in childhood and childhood health, and betwe...

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Section: Increasing Complexitymentioning

confidence: 76%

Rigor, vigor, and the study of health disparities

Adler

Bush²,

Pantell

2012

Proc. Natl. Acad. Sci. U.S.A.

104

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“…They were apt to reside in poor-quality housing, live in neighborhoods with comparatively high crime rates, lack access to health care, and generally have more stressful and less healthful lives . Although the cumulative effects on their health and wellbeing of continued exposure to a mixture of chemical and non-chemical (e.g., psychosocial) stressors is unknown, the potential threat is both real and immediate (Morello-Frosch and Shenassa, 2006;Sexton et al, 2006;Larson et al, 2009;Sexton and Linder, 2010).…”

Section: Discussionmentioning

confidence: 99%

Using exposure biomarkers in children to compare between-child and within-child variance and calculate correlations among siblings for multiple environmental chemicals

Sexton¹,

Ryan

2011

J Expo Sci Environ Epidemiol

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Longitudinal measurements of biomarkers for metals, phthalates, environmental tobacco smoke, organochlorine and organophosphate pesticides, polychlorinated biphenyls, and volatile organic compounds were made in blood and/or urine from a stratified, random sample of more than 100 elementary school-aged children living in an inner-city section of Minneapolis. Repeated measures of 31 exposure biomarkers indicate that between-child variance (B-CV) was greater than within-child variance (W-CV) for 8 compounds, B-CV was a significant proportion of total variance for 9 compounds, and variances were homogeneous for 14 compounds. Among siblings living in the same household, positive correlations were observed for biomarker concentrations of polychlorinated biphenyls, organochlorine pesticides, metals, and volatile organic chemicals in blood, and total cotinine in urine. Biologic markers confirm that children from a low-income, ethnically diverse neighborhood experienced concurrent exposure to a variety of hazardous environmental chemicals during their everyday activities. Future monitoring studies should examine the nature and magnitude of children's cumulative exposure to both chemical and non-chemical stressors, especially in disadvantaged populations.

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“…Preterm infants from disadvantaged backgrounds may be especially vulnerable to such outcomes because of factors such as inadequate social support, financial strain, and poorer access to health care services. 2 Home visiting is 1 strategy to improve a range of maternal-child health outcomes, including preterm birth, in highrisk populations. Currently, anestimated 400 publicly and privately funded home visiting programs provide services for at least 500 000 families in the United States, 3 and an investment of federal funding in this intervention has been made through the Patient Protection and Affordable Care Act (PPACA) to expand and implement programs.…”

mentioning

confidence: 99%

Home Visiting and Outcomes of Preterm Infants: A Systematic Review

2013

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METHODS: Searches of Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Cochrane Controlled Trial Register, PsycINFO, and Embase were conducted. Criteria for inclusion were (1) cohort or controlled trial designs; (2) homebased, preventive services for infants at medical or social risk; and (3) outcomes reported for infants born preterm or low birth weight (,2500 g). Data from eligible reports were abstracted by 2 reviewers. Random effects meta-analysis was used to synthesize data for developmental and parent interaction measures. RESULTS:Seventeen studies (15 controlled trials, 2 cohort studies) were reviewed. Five outcome domains were identified: infant development, parent-infant interaction, morbidity, abuse/neglect, and growth/ nutrition. Six studies (n = 336) demonstrated a pooled standardized mean difference of 0.79 (95% confidence interval 0.57 to 1.02) in Home Observation for Measurement of the Environment Inventory scores at 1 year in the home-visited groups versus control. Evidence for other outcomes was limited. Methodological limitations were common.

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Influence of Multiple Social Risks on Children's Health

Cited by 225 publications

References 52 publications

Rigor, vigor, and the study of health disparities

Rigor, vigor, and the study of health disparities

Using exposure biomarkers in children to compare between-child and within-child variance and calculate correlations among siblings for multiple environmental chemicals

Home Visiting and Outcomes of Preterm Infants: A Systematic Review

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