Latent classes and longitudinal patterns of material hardship as predictors of child well-being.

This study examined the associations of multifaceted material hardship measured cross-sectionally and longitudinally with children's wellbeing in the United States. Results from linear regression and child fixed effects models indicated that more intense material hardship had consistent, detrimental associations with child health status and internalizing and externalizing behaviors. More intense longitudinal patterns of material hardship were consistently associated with behaviors only. These findings examine new, multifaceted measures of material hardship and suggest associations between child wellbeing, particularly behavior challenges, and exposure both to multiple forms of material hardship and to more intense long-term patterns of hardship.

The mediating role of neighborhood social cohesion and trust in the relationship between childhood material hardship and adolescent depression.

OBJECTIVE: The purpose of this study is to examine the association between childhood material hardship and adolescent depression and how the relationship is mediated by neighborhood social cohesion and trust. Previous studies on childhood material hardship and adolescent depression have consistently pointed to the importance of social and environmental contexts in explaining health inequalities among children in socially disadvantaged families. However, little is known about the extent to which neighborhood social context contributes to increasing or decreasing the strength of the association between childhood material hardship and adolescent depression. METHOD: Using data from the Future of Families and Child Wellbeing Study (FFCWS) waves 3 and 6, this study conducted Structural Equation Modeling (SEM) analysis to examine whether levels of neighborhood social cohesion and trust mediates the association between childhood material hardship and adolescent depression. The study sample consisted of 2,096 children at age 3 and 15. RESULTS: Findings from the SEM analysis suggest that childhood material hardship is linked with higher levels of adolescent depression and this pathway is partially mediated by neighborhood social cohesion and trust. DISCUSSION: Results suggest that neighborhood conditions played a role in mediating the association between childhood material hardship and adolescent depression. The implications of the findings are discussed in relation to policy and practice.

Impact of the monetary value of housing assistance on adult health outcomes.

OBJECTIVE: To assess the impact of the dollar value of federal low-income housing assistance on adult health outcomes and whether this impact varies across housing assistance programs. DATA SOURCES: We use the National Health Interview Survey (NHIS) from 1999 to 2016 linked with administrative records from the Department of Housing and Urban Development (HUD) tracking receipt of low-income housing assistance from 1999 to 2017. DESIGN: We use two approaches to assess the impact of the value of housing assistance among HUD housing assistance recipients on outcomes capturing overall health and mental health, chronic and acute health conditions, health care hardship, and food insecurity. First, we use multivariable regression models that adjust for a wide array of possible confounders. Second, we use an instrumental variable approach in which the county-level supply of HUD housing serves as an instrument for the value of housing assistance. DATA COLLECTION/EXTRACTION METHODS: Our sample includes all 12,031 adult HUD linkage-eligible NHIS respondents who were currently in HUD housing at the time of their NHIS interview. PRINCIPAL FINDINGS: We find the most consistent associations between the value of housing assistance and measures of health care hardship, a relationship that is most robust for Housing Choice Voucher recipients, where we find a $100 increase in the value of housing assistance is associated with a 6.2 percentage point decrease in probability of needing but not being able to afford medical care. We find little evidence that the value of housing assistance impacts overall health or chronic health outcomes. CONCLUSIONS: The relationship between the value of housing assistance and health likely operates via an income effect, wherein receipt of a more valuable benefit frees up resources to spend on needed care. Policy changes to increase the value of housing assistance may have tangible health benefits for tenants receiving housing assistance.

Child protective services contact and youth outcomes.

BACKGROUND: Few studies have investigated whether Child Protective Services (CPS) contact influences child wellbeing, independent of underlying maltreatment and not considered as a proxy for such maltreatment. OBJECTIVE: The present study estimates the association between CPS contact and child delinquency, education, substance use, and mental health and development. PARTICIPANTS AND SETTING: The study used data from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort study of children born in 20 US cities. Study outcomes were based on age-15 interviews with the focal children and their caregivers with sample sizes ranging from 2088 to 2327 across outcomes. METHODS: The relationship between CPS contact and child wellbeing was estimated using the propensity score method of inverse probability of treatment weighting. RESULTS: CPS contact was associated with an 88% increase in the probability of smoking (p = .010), a 29 % increase in externalizing behavior (p < .001), a 27% increase in internalizing behavior (p = .001), a 18 % increase in the probability of being expelled (p = .32), a 7.5 % increase in a depression (p = .002), a 6.9 % increase in anxiety (p = .002), a 6.2 % reduction in happiness (p = .008), a 6.0 % increase in impulsivity (p < .001), and a 5.5 % increase in school troubles (p < .001). CONCLUSIONS: Despite a federal mandate to improve child wellbeing, we found no evidence that contact with the child welfare system improves child outcomes. Rather, CPS contact was associated with worse mental health and developmental outcomes.

Inequities in Child Protective Services Contact Between Black and White Children.

Child protective services (CPS) contact occurs at substantially higher rates among Black than White families. The present study considers systemic racism as a central driver of this disparity and emphasizes racialized poverty as a possible mechanism. We used data from the Fragile Families and Child Wellbeing Study and logistic regression analyses to assess the associations between income poverty, a racialized experience, and CPS contact, separately among Black and White families. Results indicated that income poverty was a significant predictor of CPS contact among White families, who were protected by higher income. In contrast, income per se was not a significant predictor of CPS contact among Black families, who were instead impacted by racialized family regulation and consequences of poverty, such as poor health and depression. Refundable state Earned Income Tax Credit (EITC) policies were protective for Black families, and more expansive Temporary Assistance for Needy Families (TANF) programs decreased CPS contact for Black and White families. Implications include centering systemic racism and specifically racialized poverty as causes of racial inequities in CPS contact and rethinking the role of CPS in protecting children.

"I Have Nowhere to Go": A Multiple-Case Study of Transgender and Gender Diverse Youth, Their Families, and Healthcare Experiences.

Transgender and gender diverse (TGD) youth experience health disparities due to stigma and victimization. Gender-affirming healthcare mitigates these challenges; yet, we have limited understanding of TGD youth's healthcare experiences in the U.S. Midwest and South. Using a multiple case study design, we aimed to develop an in-depth and cross-contextual understanding of TGD youth healthcare experiences in one Midwestern state. Families with a TGD child under 18 were recruited with the goal of cross-case diversity by child age, gender, race, and/or region of the state; we obtained diversity in child age and region only. Four white families with TGD boys or non-binary youth (4-16) in rural, suburban, and small towns participated in interviews and observations for one year; public data were collected from each family's community. Thematic analysis was used within and across cases to develop both family-level understanding and identify themes across families. Findings include a summary of each family as it relates to their child's TGD healthcare experiences as well as the themes identified across cases: accessibility and affirming care. Although limited by a small sample with lack of gender and race diversity, this study contributes to our understanding of TGD youth healthcare in understudied regions.

Talking (or Not) About Sexual Violence: Newspaper Coverage of the Confirmation Hearings of Justices Thomas and Kavanaugh.

The ways in which sexual violence is portrayed in the media contribute to communities' understanding of violence and can influence survivor outcomes. The parallel cases of the confirmation hearings of Justices Kavanaugh and Thomas provide an opportunity to measure if and how the cultural zeitgeist has shifted around issues of sexual violence. This study sought to answer two questions: (a) When a supreme court nominee is accused of sexual violence, have the ways the mainstream media discussed the violence in newspaper headlines changed between 1991 and 2018? To what extent and how? (b) Have the ways the mainstream media characterizes the nominee and the accuser within and between 1991 and 2018 changed? How? Headlines were collected systematically from eight major U.S. newspapers, resulting in a data set of 373 headlines from 1991 and 249 from 2018. Qualitative thematic analysis was used to examine the characterizations of the accuser, nominee, and violence. Supplemental chi-square analyses were used to compare how violence was categorized in the two years. While less victim-blaming and minimization of sexual violence occurred in the 2018 headlines, newspapers continued to avoid naming the sexual violence. The characterizations of the nominee, accuser, and violence became depersonalized in 2018, focusing on politics rather than the people and issues at hand, likely reflecting a highly politicized American public. Despite the heightened attention to sexual violence that current movements have sparked, our analysis of comparable cases in 1991 and 2018 suggests newspaper headlines continued to avoid naming sexual violence as violence in 2018 as in 1991, and furthermore, contemporary language about sexual violence and its survivors and perpetrators has not changed to reflect an increased response to survivor healing and perpetrator change. Rather, shifts in language suggest survivors and perpetrators may be politicized as tools for parties and politicians to debate larger issues or stake political positions.

Policies to reduce food insecurity: An ethical imperative.

A quarter of U.S. households receive food assistance, yet more than 11% still experience food insecurity annually. We argue that an expansion-oriented approach to food and nutrition assistance policy is an ethical imperative. Drawing on values from the Capability Approach and Social Empathy Model and supported by empirical evidence, we propose an ethical framework characterized by four principles that can be used to assess and inform the development of just food policies. We argue that policies should (1) embrace compassion, (2) create opportunity, (3) consider essential needs, and (4) promote knowledge and empathy. In an applied case, we evaluate current SNAP policy in terms of those principles and offer recommendations to promote justice in the design and implementation of SNAP and other food policies.

The Impact of Community Size, Community Climate, and Victimization on the Physical and Mental Health of SGM Youth.

Sexual and gender minority (SGM) youth experience high rates of victimization leading to health disparities. Community size and community climate are associated with health outcomes among SGM youth; however, we lack studies that include them as covariates alongside victimization to understand their collective impact on health. This study utilized minority stress theory to understand how community context shapes experiences of victimization and health among SGM youth. SGM youth in one Midwestern U.S. state completed an online survey (n = 201) with measures of physical health, mental health, community context, and victimization. Data were analyzed via multiple regression using a path analysis framework. Results indicate that perceived climate was associated with mental, but not physical, health; Community size was unrelated to health outcomes. Victimization mediated the association between community climate and mental health.

Food Insecurity and Child Health.

OBJECTIVES: Food insecurity is an important public health problem facing children in the United States. Although a number of previous studies suggest that food insecurity has negative impacts on health, these studies have not dealt thoroughly with issues of selection bias. We use propensity scoring techniques to approximate the causal effects of food insecurity on children's health and health care use outcomes. METHODS: We use nationally representative data from the 2013-2016 waves of the National Health Interview Study (N = 29 341). Using inverse probability of treatment weighting, a propensity scoring method, we examine a broad range of child health outcomes and account for a comprehensive set of controls, focusing on a sample of children 2 to 17 years old. RESULTS: Household food insecurity was related to significantly worse general health, some acute and chronic health problems, and worse health care access, including forgone care and heightened emergency department use, for children. Compared to rates had they not been food insecure, children in food-insecure household had rates of lifetime asthma diagnosis and depressive symptoms that were 19.1% and 27.9% higher, rates of foregone medical care that were 179.8% higher, and rates of emergency department use that were 25.9% higher. No significant differences emerged for most communicable diseases, such as ear infections or chicken pox, or conditions that may develop more gradually, including anemia and diabetes. CONCLUSIONS: Policies used to reduce household food insecurity among children may also reduce children's chronic and acute health problems and health care needs.