The United States' Record-Low Child Poverty Rate in International and Historical Perspective: A Research Note.

In 2021, the federal government of the United States expanded a set of income transfers that led to strong reductions in child poverty. This research note uses microdata from more than 50 countries and U.S. data spanning more than 50 years to place the 2021 child poverty rate in historical and international perspective. We demonstrate that whether using the Supplemental Poverty Measure (SPM), relative poverty measures, or an absolute poverty measure, the U.S. child poverty rate in 2021 was at its lowest level since at least 1967. The U.S. tax and transfer system reduced the 2021 SPM child poverty rate by more than 75% relative to the pre-tax/transfer child poverty rate; this reduction was three times the mean reduction effect between 1967 and 2019. These policy changes improved the country's standing from having a relative poverty rate twice that of Germany's in 2019 to the same as Germany's in 2021. Moreover, the U.S. progressed from reducing child poverty at less than half the rate of Norway in 2019 to a rate comparable to Norway in 2021. However, the U.S. success was temporary: after the expiration of the 2021 income provisions, the child poverty rate doubled and returned to being higher than in most other high-income countries.

Assessing reduction in multidimensional childhood poverty in India: a decomposition analysis.

BACKGROUND: Empirically, the official measurement of multidimensional poverty often shows children as the poorest age group. According to Global Multidimensional Poverty Index report, Africa and South Asia bear the highest burden multidimensional child poverty (MCP). Around one-third of children aged 0-4 are multidimensionally poor in India. Policymakers in India must have appropriate information on child poverty to alleviate poverty. The purpose of this paper is to examine MCP trends and track efforts to reduce child poverty at the national level across geographic regions, castes, and religious groups. METHODS: We used the Alkire-Foster method to calculate the MCP index (MCPI) among children aged 0-4 using the latest two rounds of National Family Health Survey data (2015-16 and 2019-21). We applied the Shapley decomposition method to analyse the marginal contribution of incidence and intensity that lead to changes in MCPI. RESULTS: In India, the incidence of child poverty reduced by more than 40% between 2015-16 and 2019-21 (46.6-27.4%) and the MCPI reduced by half (24.2-12.6%). The relative decline in MCPI has been largest for urban areas, northern regions, Other Backward Classes (OBCs) and Hindus. Children from rural areas, Scheduled Castes (SCs), Scheduled Tribes (STs), and Muslim households are the poor performers. When focusing exclusively on the poor child, we found all the population subgroups and geographic locations reduced the censored headcount ratios in all 14 indicators. Across places of residence, castes, religions, and regions the, indicators like electricity, birth registration, drinking water, assisted delivery, sanitation and cooking fuel made significant improvements between 2015-16 to 2019-21. CONCLUSION: The study indicates that by studying the MCPI over time, one can identify the priorities in policy development to achieve the Sustainable Development Goals.

The increasing association between child poverty and children in out-of-home care - an ecological longitudinal analysis of Finnish municipalities in the period 1992-2021.

BACKGROUND: International evidence indicates that child poverty increases the risk of child welfare intervention needs but Finland, paradoxically, has low child poverty rates and high child welfare intervention rates. We investigate the extent to which the rate of social assistance use in families with children, as a proxy for child poverty, can be associated with the rate of children in out-of-home care in Finnish municipalities. METHODS: Data on the annual rate of social assistance use and out-of-home care were drawn from national registers for 216 Finnish municipalities from 1992 to 2021. Linear regression models were utilised to investigate the extent to which the social assistance use rate explained child out-of-home care rates, both spatially and temporally, across municipalities and years while adjusting for the unemployment rate. RESULTS: The rate of out-of-home care increased from some 700 to 1600 per 100,000 children over the period 1992-2021. A percentage point higher rate of the social assistance use was associated with 44-72 more children placed in out-of-home care per 100,000 children, net of the unemployment rate. This association was stronger in more recent time periods. A smaller association was observed within municipalities over time: a percentage point increase in social assistant use was linked to some 4-25 more children placed in out-of-home care per 100,000 children. CONCLUSION: Out-of-home care is increasingly concentrated in Finnish municipalities with high rates of families receiving social assistance. Preventative child welfare interventions are therefore required in areas with higher rates of economic difficulties among families.

Attention Bias and Anxiety: The Moderating Effect of Sociocultural Variables in Rural Latinx Youth.

Attention bias confers risk for anxiety development, however, the influence of sociodemographic variables on the relationship between attention bias and anxiety remains unclear. We examined the association between attention bias and anxiety among rural Latinx youth and investigated potential moderators of this relationship. Clinical symptoms, demographic characteristics, and a performance-based measure of attention bias were collected from 66 rural Latinx youth with clinical levels of anxiety (33.3% female; Mage = 11.74; 92.4% Latinx, 7.6% Mixed Latinx). No moderating effects for age or gender were found. Youth below the poverty line displayed an attention bias away from threat in comparison to youth above the poverty line, who displayed an attention bias towards threat. Among youth below the poverty line, this bias away from threat was associated with increased anxiety. Findings highlight the importance of economic adversity in understanding the relationship between attention bias and anxiety.

Maternal Distress and Adolescent Mental Health in Poor Chinese Single-Mother Families: Filial Responsibilities-Risks or Buffers?

Single motherhood and poverty have a significant, negative impact on mothers and their children. When their mothers experience maternal distress, adolescent children have to take up more instrumental and emotional filial responsibilities to comfort their mother and adapt to related changes. Based on 325 mother-child dyads of Chinese single-mother families experiencing economic disadvantage, this study examined the relationship between maternal distress and adolescent mental health problems (indexed by anxiety and depression) and the moderating roles of instrumental and emotional filial responsibilities. Results indicated that maternal distress was positively associated with anxiety and depression in adolescent children. In addition, instrumental filial responsibility intensified the associations of maternal distress with adolescent anxiety and depression. Moreover, the moderating role of emotional filial responsibility in the predictive relationship between maternal distress and adolescent anxiety was different in boys and girls. Adolescent girls with more emotional filial responsibility reported higher adolescent anxiety than did those who shouldered less emotional filial responsibility when their mother exhibited more distress, whereas the relationship between maternal distress and adolescent anxiety was stable in boys, regardless of emotional filial responsibility. In short, the present study showed that parentification was likely to occur in poor Chinese single-mother families, and adolescent children who took up a more caregiving role in the family exhibited poorer mental health. Family counselling and tangible support for single-mother families experiencing economic disadvantage are urged.

Child Poverty and Health: The Role of Income Support Policies.

Policy Points Child poverty is associated with both short- and long-term health and well-being, and income support policies can be used to improve child health. This article reviews the types of income support policies used in the United States and the evidence of the effectiveness of these policies in improving child health, highlighting areas for future research and policy considerations specific to income support policies.

Childhood Cancer Death When Life Transpires Where High Childhood Poverty Has Persisted for Decades.

It is increasingly clear that social determinants of health impact health, well-being, and quality of life. How these factors can impact cancer-related mortality has only recently included the impact on childhood cancer mortality. Hoppman and colleagues examined the impact of historically prevalent poverty on children with cancer in Alabama, a state with elevated pediatric poverty. Their findings provide a revised framework for understanding the contribution of neighborhood-level factors to pediatric cancer outcomes, identifying previously unrecognized gaps and directing us toward new study approaches to better inform interventions at the individual, institutional and policy levels to improve childhood cancer survival. We provide additional commentary on the implications of these findings, unanswered questions, and considerations for the next generation of interventions to improve childhood cancer survival. See related article by Hoppmann et al., p. 380.

Interventions addressing maternal and child health among the urban poor and homeless: an overview of systematic reviews.

BACKGROUND: Inequalities in access to and utilization of maternal and child health (MCH) care are hampering progress on the path to achieving the Sustainable Development Goals. In a number of Low- and Middle-Income Countries (LMICs) population subgroups at disproportionate risk of being left behind are the urban poor. Within this neglected group is the further neglected group of the homeless. Concomitantly, a number of interventions from the antenatal period onward have been piloted, tested, and scaled in these contexts. We carried out an overview of systematic reviews (SRs) to characterize the evidence around maternal and child health interventions relevant to urban poor homeless populations in LMICs. METHODS: We searched Medline, Cochrane Library, Health Systems Evidence and EBSCOhost databases for SRs published between January 2009 and 2020 (with an updated search through November 2021). Our population of interest was women or children from urban poor settings in LMICs; interventions and outcomes corresponded with the World Health Organization's (WHO) guidance document. Each SR was assessed by two reviewers using established standard critical appraisal checklists. The overview was registered in PROSPERO (ID: CRD42021229107). RESULTS: In a sample of 33 high quality SRs, we found no direct relevant evidence for pregnant and lactating homeless women (and children) in the reviewed literature. There was a lack of emphasis on evidence related to family planning, safe abortion care, and postpartum care of mothers. There was mixed quality evidence that the range of nutritional interventions had little, unclear or no effect on several child mortality and development outcomes. Interventions related to water, sanitation, and hygiene, ensuring acceptability of community health services and health promotion type programs could be regarded as beneficial, although location seemed to matter. Importantly, the risk of bias reporting in different reviews did not match, suggesting that greater attention to rigour in their conduct is needed. CONCLUSION: The generalizability of existing systematic reviews to our population of interest was poor. There is a clear need for rigorous primary research on MCH interventions among urban poor, and particularly homeless populations in LMICs, as it is as yet unclear whether the same, augmented, or altogether different interventions would be required.

Associations between early childhood poverty and cognitive functioning throughout childhood and adolescence: A 14-year prospective longitudinal analysis of the Mauritius Child Health Project.

Associations between childhood poverty and cognitive outcomes have been examined from multiple perspectives. However, most evidence is based on cross-sectional data or longitudinal data covering only segments of the developmental process. Moreover, previous longitudinal research has mostly relied on data from Western nations, limiting insights of poverty dynamics in low- and middle-income countries. Here, we use data from the Mauritius Child Health Project, a large-scale prospective longitudinal study conducted in a then low-income country, to examine long-term associations between poverty in early childhood and cognitive performance across childhood and adolescence. Poverty-related factors were assessed at age 3 years and comprised indicators of psychosocial adversity and malnutrition. Cognitive functioning was assessed at ages 3 and 11 years by using standardized intelligence measures and at age 17 years by means of a computerized test battery. Using multiple hierarchical regression models, we found that chronic malnutrition and parental characteristics showed similar-sized, independent associations with initial cognitive functioning at age 3 as well as at age 11 years. For age 17 years, however, associations with early childhood risk factors vanished and instead, cognitive functioning was predicted by performance on prior cognitive assessments. Sex was also found to be a powerful predictor of cognitive trajectories, with boys improving and girls worsening over time, regardless of the level of their initial exposure to risk. The current findings indicate that, to prevent cognitive impairment, interventions tackling poverty and malnutrition should focus on the infancy period and be designed in a gender-sensitive way.

Mapping of Pediatric COVID-19 Cases in Miami-Dade and Broward Counties: an Analysis of Sociodemographic Disparities.

BACKGROUND: Numerous studies have shown a disproportionate impact of COVID-19 infection on Black and Hispanic Americans in the adult patient population. However, few studies have been done with pediatric populations. The aim of this study is to identify the prevalence and distribution of COVID-19 cases among pediatric patients in Miami-Dade and Broward counties and identify any sociodemographic disparities. METHODS: A total of 10,087 children/adolescents ages zero years-old to 20 years-old were tested from July 1, 2020, to December 31, 2020. ArcGIS was used to map cases and obtain sociodemographic data. SPSS software was used to determine significance of data trends and create a predictive model. RESULTS: There were 1,161 pediatric COVID-19 cases detected. White Hispanics and Black Hispanics had statically significantly higher cases when compared to White non-Hispanics and Black non-Hispanics. Percentage of households on food stamps, percentage of households below the poverty line, percentage of minority populations, and percentage of Hispanic population showed a positive correlation with detected pediatric COVID-19 cases. Alternatively, areas with higher median household incomes and higher educational status were negatively correlated with COVID-19. Percentage of Hispanic population and percentage of households below the poverty line were predictive of pediatric COVID-19 cases. CONCLUSION: There was a disproportionate impact of pediatric COVID-19 infection on zip codes of lower socioeconomic status and increased racial/ethnic minority populations. This study demonstrates the need for public health policies that prioritize testing children/adolescents in these communities.

Child poverty and health inequalities in the UK: a guide for paediatricians.

One in three children in the UK lives in relative poverty. There are clear and consistent links between child poverty and paediatric morbidity and mortality. In this review, we discuss drivers for family poverty in the UK, and how this leads to poor child health outcomes. We present a framework for healthcare professionals and institutions to consider interventions and strategies relating to socioeconomic health inequalities. We will focus on approaches to mitigate the effects of child poverty on children using our services at a local level and outline the importance of healthcare workers advocating for structural and high-level policy change to address the deep-rooted societal problems that cause child poverty.

Persistent Child Poverty and Mortality in a Cohort of Children with Cancer in Alabama.

BACKGROUND: One-fifth of U.S. counties are designated persistent child poverty counties (≥20% of children in poverty since 1980). The association between a persistent child poverty environment and mortality in children with cancer is unknown. METHODS: Our cohort includes 2,089 children with cancer (2000-2016) in Alabama. We used multivariable Cox proportional hazards modeling (adjusted for sociodemographics/clinical characteristics) to assess mortality by persistent child poverty designation at 1, 5, and 10 years from diagnosis. Distance to treatment was subsequently explored. RESULTS: Forty-two percent of the cohort lived in a persistent child poverty county; they were more likely to be African American (P < 0.0001), have public/no insurance (P = 0.0009), and live >100 miles to treatment (P < 0.0001). Children in persistent child poverty counties were 30% more likely to die by 5 years [95% confidence interval (CI) = 1.06-1.59; P = 0.012]. Distance (per 20-mile increase) to treatment was associated with a 9% increased mortality risk (P < 0.0001). Children with both exposures (distance >100 miles and persistent child poverty) faced the highest mortality risk at 5 years (HR = 1.80; 95% CI = 1.39-2.33; P < 0.0001). In subanalysis, children exposed to persistent child poverty were at higher risk for cancer-related mortality. However, the risk of health-related mortality did not differ. CONCLUSIONS: Among children with cancer from the Deep South, persistent child poverty was a prevalent exposure associated with inferior overall survival. Distance to treatment was independently associated with inferior survival. Children with both exposures had the highest risk of mortality. IMPACT: Persistent child poverty is associated with inferior survival among children with cancer; mechanisms underlying this disparity warrant investigation. See related commentary by Orjuela-Grimm and Beauchemin, p. 295.

Childhood poverty and mental health disorders in early adulthood: evidence from a Brazilian cohort study.

BACKGROUND: We examined the association between childhood poverty and mental health disorders (MHD) in childhood and early adulthood. We also investigated whether the association between poverty in childhood and MHD is mediated by exposure to stressful life events (SLE). METHODS: We used data from a prospective community cohort of young people assessed at baseline (M = 9.7 years, SD = 1.9), first (M = 13.5 years, SD = 1.9), and second (M = 18.2 years, SD = 2.0) follow-ups (N = 1,590) in Brazil. Poverty was assessed using a standardized classification. Exposure to 20 different SLE was measured using the Life History instrument. Psychiatric diagnoses were evaluated using the Development and Well-Being Assessment. Latent growth models investigated the association between poverty at baseline and the growth of any MHD, externalizing, and internalizing disorders. Mediation models evaluated whether the association between childhood poverty and MHD in early adulthood was mediated by exposure to SLE. RESULTS: Poverty affected 11.4% of the sample at baseline and was associated with an increased propensity for presenting externalizing disorders in adolescence or early adulthood (standardized estimate = 0.27, p = 0.016). This association was not significant for any disorder or internalizing disorders. Childhood poverty increased the likelihood of externalizing disorders in early adulthood through higher exposure to SLE (OR = 1.07, 95 CI% 1.01-1.14). Results were only replicated among females in stratified analyses. CONCLUSIONS: Childhood poverty had detrimental consequences on externalizing MHD in adolescence, especially among females. Poverty and SLE are preventable risk factors that need to be tackled to reduce the burden of externalizing disorders in young people.

Prevalence and correlates of multidimensional child poverty in India during 2015-2021: A multilevel analysis.

Despite increasing research and programs to eradicate poverty, poverty still exists and is a far greater concern for children than adults, leading child poverty to become a political, economic, and social issue worldwide and in India. The current study aims to find variations in the prevalence of child poverty and associated factors in India during 2015-21. In the current study, we used two consecutive rounds of the National Family Health Survey (NFHS-4, 2015-16 & NFHS-5, 2019-21) to estimate child poverty (aged 0-59 months) using the Alkire-Foster method. The multilevel logistic regression analyses were performed to find the important cofounder and cluster level variation in child poverty. The results show that about 38 percent of children were multidimensionally poor in 2015-16, which reduced to 27 percent in 2019-21. The decomposition analysis suggests that contribution of nutrition domain to child poverty increases over time, whereas the standard of living substantially declines from NFHS-4 to NFHS-5. The multilevel analysis results show that the age and sex of the child, age and years of schooling of the mother, children ever born, religion, caste, wealth quintile and central, northeast, north and west regions are significantly associated with child poverty over time. Further, the variance participation coefficient statistics show that about 12 percent of the variation in the prevalence of child poverty could be attributed to differences at the community level. The prevalence of child poverty significantly declines over time, and the community-level variation is higher than the district-level in both surveys. However, the community-level variation shows increases over time. The finding suggests a need to improve the nutritional status and standard of living of most deprived households by promoting a child-centric and dimension-specific approach with more focus on PSU-level intervension should adopt in order to lessen child poverty in India.

Pobreza, traumas tempranos, déficit atencional y deserción educacional: un círculo de daño. Lecciones aprendidas en el Programa Soymás, La Pintana / Poverty, early trauma, attention deficit and educational dropout: a circle of harm. Lessons learned in the Soymás Program, La Pintana

El antecedente de maltrato infantil y el Trastorno por Déficit de Atención e Hiperactividad (TDAH), son condiciones que tienen una alta prevalencia en los jóvenes de sectores vulnerables. Analizamos su relación con deserción escolar, que también es mayor en tales contextos. La deserción es un fenómeno multifactorial, influenciado por factores propios del estudiante, de la institución, del contexto familiar y del entorno social. Presentamos hallazgos en la Fundación Soymás, institución de formación para madres adolescentes, localizada en La Pintana, una de las comunas con mayor pobreza en Chile, donde la deserción en 2022 fue 45%. De acuerdo a la encuesta ACES de 10 eventos traumáticos en la niñez, 50% de las estudiantes sufrió 3 o más, y 21% 7 o más. Al menos un 40% de la población cumplía criterios de TDAH y un 30% adicional manifestaba síntomas sugerentes (versus 4,5% de TDAH reportado en adolescentes del país). Constatamos una asociación directa entre las tres variables: Maltrato, TDAH y Deserción. Estos hallazgos deberían ser considerados en políticas públicas, reforzando la necesidad de colaboración entre Salud y Educación.

A history of child abuse and Attention Deficit Hyperactivity Disorder (ADHD) are conditions that have a high prevalence in young people from vulnerable sectors. We analyze its relationship with school dropout, which is also higher in such contexts. Dropout is a multifactorial phenomenon, influenced by factors specific to the student, the institution, the family context, and the social environment. We present findings at the Soymás Foundation, a training institution for adolescent mothers, located in La Pintana, one of the counties with the highest poverty in Chile, where dropout in 2022 was 45%. According to the ACES survey of 10 traumatic events in childhood, 50% of the students suffered 3 or more, and 21% 7 or more. At least 40% of the population met the criteria for ADHD and an additional 30% manifested suggestive symptoms (versus 4.5% of ADHD reported in adolescents in the country). We found a direct association between the three variables: Abuse, ADHD and Desertion. These findings should be considered in public policies, reinforcing the need for collaboration between Health and Education.

Ameliorating Child poverty through Connecting Economic Services with child health Services (ACCESS): study protocol for a randomised controlled trial of the healthier wealthier families model in Sweden.

BACKGROUND: Sweden is often held up as an example of a country with low child deprivation; yet, rates of relative deprivation are rising. Every municipality in Sweden is required to provide free, timely and accessible budget and debt counselling under the Social Services Act. The services have been encouraged to perform preventative practice with families; however, this has not been realised. The Healthier Wealthier Families (HWF) model embeds universal screening for economic hardship into child health services and creates a referral pathway to economic support services. Given the universal child health system in Sweden, which is freely available and has excellent coverage of the child population, implementation of the HWF model has potential to support families to access the freely available municipal budget and debt counselling and ultimately improve rates of child deprivation in Sweden. METHODS/DESIGN: We will conduct a two-arm randomised waitlist-control superiority trial to examine the effectiveness and cost-effectiveness of the HWF model in the Sweden. A longitudinal follow-up with the cohort will explore whether any effects are maintained in the longer-term. DISCUSSION: HWF is a collaborative and sustainable model that could maximise the effectiveness of current services to address child deprivation in Sweden. The study outlined in this protocol is the first effectiveness evaluation of the HWF model in Sweden and is a crucial step before HWF can be recommended for national implementation within the child health services. TRIAL REGISTRATION: Clinicaltrials.gov; NCT05511961. Prospectively registered on 23 August 2022. https://clinicaltrials.gov/ct2/show/NCT05511961.

Exposure to Childhood Poverty and Racial Differences in Economic Opportunity in Young Adulthood.

Young adults in the United States, especially young Black adults, experience high poverty rates relative to other age groups. Prior research has largely attributed racial disparities in young adult poverty to differential attainment of benchmarks related to education, employment, and family formation. This study investigates that mechanism alongside racial differences in childhood poverty exposure. Analyses of Panel Study of Income Dynamics data reveal that racial differences in childhood poverty are more consequential than differential attainment of education, employment, and family formation benchmarks in shaping racial differences in young adult poverty. Whereas benchmark attainment reduces an individual's likelihood of poverty, racial differences in benchmark attainment do not meaningfully explain Black-White poverty gaps for three reasons. First, childhood poverty is negatively associated with benchmark attainment, generating strong selection effects into the behavioral characteristics associated with lower poverty. Second, benchmark attainment does not equalize poverty rates among Black and White men. Third, Black children experience four times the poverty rate of White children, and childhood poverty has lingering negative consequences for young adult poverty. Although equalizing benchmark attainment would reduce Black-White gaps in young adult poverty, equalizing childhood poverty exposure would have twice the reduction effect.

Dramatic Drop in U.S. Childhood Poverty.

Safety net programs are credited, along with employment opportunities for parents.