Analyzing Differences in Child Well-Being Among U.S. States

This article develops a comprehensive composite state-level index of child well-being modeled after the Foundation for Child Development’s Child Well-Being Index (CWI) to assess state differences in child well-being among the 50 U.S. states in 2007. The state-level CWIs are composed of 25 state-level indicators clustered into seven different domains or dimensions of child well-being. In addition to examining state rankings and the inter-relationship among domains across states, statistics on 27 demographic, economic, and policy characteristics of the states are analyzed in a regression analysis with respect to their ability to explain state differences in the CWIs. Because of the large number of explanatory variables and the potential redundancy created thereby, a principal components analysis/composite index method is applied. This leads to three composite indices that simplify the regressor space and explain 66.0 % of the variance. A second regression that adds three key policy measures to the three structural indices explains 79.5 % of the variance. Key findings of the study pertaining to how the resources available to children provided by families, communities, and the public sector relate to child well-being are discussed.     

Linguistic Disparities in Child Health and Presence of a Medical Home Among United States Latino Children

ObjectiveThe impact of household language on Latino-White and Latino intragroup disparities in child health and having a medical home in the United States is poorly understood. This study aimed to examine these disparities 1) between Whites and Latinos (overall and stratified by English-primary-language [EPL] and non-English-primary-language [NEPL] households); 2) within Latinos, stratified by household language; and 3) potential moderation of disparities by social determinants.MethodsCross-sectional analysis of nationally representative sample of children 0 to 17 years old from the 2016–2018 National Survey of Children's Health. We evaluated associations of child race/ethnicity and household language with child health and presence of a medical home. Multivariable logistic regression was used to compare groups of interest, adjusting for sociodemographic factors and health needs. Moderation was assessed using interaction terms for household income, parental educational attainment, and child insurance coverage.ResultsAmong 81,514 children, 13.5% were NEPL Latino, and 19.4% were EPL Latino. Compared with EPL Whites, both EPL and NEPL Latinos had reduced odds of excellent/very good health (adjusted odds ratio [aOR]: 0.70; 95% confidence interval [CI]: 0.58–0.84; and aOR: 0.42; 95% CI: 0.33–0.53) and presence of a medical home (aOR: 0.62; 95% CI: 0.56–0.69; and aOR: 0.45; 95% CI: 0.37–0.54), respectively. Among Latinos, NEPL (vs EPL) was also associated with reduced odds of excellent/very good health (aOR: 0.61; 95% CI: 0.46–0.83), and presence of a medical home (aOR: 0.66; 95% CI: 0.48–0.78); these associations were magnified by adverse social determinants.ConclusionsStriking Latino-White and within-Latino medical-home disparities persist in the United States, particularly for NEPL Latino children. Interventions should target social determinants and the rich sociocultural and linguistic diversity of the Latino population.     

A State Level Assessment of the Well-Being of Black Children in the United States

In the United States, reports on child well-being that only focus on the national level mask enormous variations across states. Child well-being reports that focus on state-level data typically assess only the well-being of all children which masks important differences among subgroups of children. This report addresses the two shortcomings of previous research identified above by examining variation in the well-being of Black children across the states. The well-being of Black children in each state is assessed using a ten item index of well-being. First, the well-being of Black children in each state is examined relative to Black children in other states. Second, the gap between the well-being of Black children and White children in the same state is measured and states are assessed based on this black/white gap. The relationship between state rankings based on the two perspectives is discussed. Finally, several potential explanatory variables are examined in relation to the well-being of Black children compared to Black children in other states, and the Gap between Black children and White children in the same state.     

Prevalence and Correlates of Food Allergy Among Medicaid-Enrolled United States Children

ObjectiveThe objective of this study is to provide a comprehensive epidemiological profile detailing food allergy (FA) prevalence and related correlates among Medicaid-enrolled children.MethodsThe 2012 Medicaid Analytic eXtract person-level 100% files for 50 states and the District of Columbia were analyzed. The analytic sample of 23,825,160 included all children ages 0 to 19 years as of January 1, 2012 who were continuously enrolled in Medicaid in 2012. The prevalence of FA was measured using International Classification of Diseases, Ninth Revision, Clinical Modification codes and compared with other atopic conditions (atopic dermatitis, allergic rhinitis, and asthma). Logistic regression was used to evaluate child characteristics associated with FA.ResultsThe prevalence of FA among Medicaid-enrolled children was less than 1% (0.6%). State-level prevalence ranged from a high of 1.4% in Alaska to a low of 0.2% in Nevada. Race and ethnicity were associated with FA such that Asian, Black, and Pacific Islander/Native Hawaiian children had a higher odds of FA, while Hispanic and Native American children had 15% and 24% lower odds of FA, respectively, compared with White children.ConclusionsCompared with estimates of parent-reported, physician-diagnosed FA in the general population, the claims-based prevalence of FA among Medicaid-enrolled children is substantially lower. Racial and ethnic differences are consistent with the general population. The findings signal a need to better understand reasons for these differences including awareness, access to care, and service utilization patterns in this population.     

Consistencies and Differences Across States in the Well-Being of Non-Hispanic White,Hispanic and Non-Hispanic Black Children in the United States

Most analysis of racial differences in child well-being in the United States focus only on national level data and most state-level analysis of child well-being focus only on the total child population (all races combined). This analysis addresses the two limitations in previous research noted above by providing a state-level analysis of child well-being for the three largest race/Hispanic groups, namely Non-Hispanic White, Hispanic and Non-Hispanic Black. The analysis is based ten commonly-used indicators of child well-being. First, the values for each of the ten indicators for each of three groups are examined in each state. This shows that the disadvantaged position of Hispanic and Non-Hispanic Black children relative to Non-Hispanic White children is pervasive across all ten indicators and all states. Next, the well-being of children in each state relative to the well-being of children in their group in other states is assessed using a ten-item composite index of child well-being. Results show there is only modest positive correlations of relative well-being among the states for all three groups. Only two states are in the top ten states for all three groups. Likewise, there are only two states that were among the ten worst states for all three groups. This analysis indicates that using child well-being measures for the total population in a state does not adequately reflect child well-being of Hispanic and Non-Hispanic Black children.     

Immigrant Children and Child Welfare in the United States: Demographics, Legislation, Research, Policy, and Practice Impacting Public Services

This article summarizes the presentation given at the 2nd International Conference of the International Society for Child Indicators (ISCI) in November 2009, in Sydney, Australia. The intent of the paper is to build a framework of strategic advancement of child wellbeing of a subgroup of vulnerable children, utilizing national indicators from the variety of disciplines mentioned in the title. The paper discusses indicators that have been used to advance the knowledge development, research, policy, advocacy, and practice accomplishments of the Migration and Child Welfare National Network. This national initiative, under the leadership of the American Humane Association, represents a collaborative effort of more than a dozen national organizations, universities, state child welfare agencies, immigrant serving agencies, and child welfare and other professionals across the United States and other nations including Mexico and other Latin American countries whose children are impacted by the issues mentioned in this paper.     

Child Protection in the United States: An Examination of Mandated Reporting of Child Maltreatment

Child protection is one of the key indicators of a society’s health. In the U.S. all states have enacted laws which require certain professionals who regularly come into contact with children to report suspected maltreatment. Passage of these laws has resulted in an unprecedented increase in the number of reports of child maltreatment made to U.S. child protective services (CPS), yet this increase has not been systematically studied to determine whether this increase in reports is actually reducing the incidence of child maltreatment. This paper describes and compares the reporting practices of four mandated reporting groups in the U.S. over a 3-year period. Data from the National Child Abuse and Neglect Dataset (NCANDS) were analyzed. NCANDS is a national database created by the US Department of Health and Human Services (DHHS) of reports of maltreatment made to child protective services agencies (CPS) in the US. Results indicate that each reporter group has a somewhat unique profile of reports and responses from the child protection agencies to which they report. Significant differences were found related to the type of maltreatment reported and the rate of report substantiation by CPS. While some differences can be easily explained, others require more research and have broad implications for the professional education and training of mandated reporters.     

Finding the Right Balance Between Standardisation and Flexibility: A Compendium of Indicators for Measuring Child Well-Being

Understandings of child well-being are culturally embedded and highly contextualised. Its multifaceted nature, including dimensions of health, education, child social capital and psychosocial well-being, creates significant conceptual and methodological challenges for selection of standard indicators. This is particularly true for programmes that cover small areas where context is paramount in determining locally significant outcomes. Child focused International Non Governmental Organizations, such as World Vision, work in country contexts as different as Albania and Angola, with types of programmes ranging from advocacy to emergency, yet are seeking to report regionally and globally for advocacy and accountability purposes. How is it possible to measure context specific child well-being in such diverse situations? This article will present a compendium of indicators organized under a common set of child well-being outcomes. The compendium drew on globally recognized instruments such as MICS, literacy tests, and child self perception surveys to provide a wide selection of indicators. A three-step process for selecting indicators empowers programmers to choose indicators appropriate to their context. The compendium was piloted in Zambia with community-based programmers. The pilot had mixed results with programmers having some difficulty defining links between project activities and higher level outcomes. Refining the list of indicators to a manageable number was also a challenge. Questions were raised on the sequencing and use of focus group discussion. In conclusion, a compendium of indicators initially appears to be a workable solution for large organisations to measure well-being, but there is a requirement for specific capacity building for staff.     

Mapping Children’s Neighborhood Perceptions: Implications for Child Indicators

A growing literature on small-area effects has linked neighborhood conditions with indicators of child well-being. This paper addresses some of the challenges in identifying and understanding these linkages, with a focus on children’s definitions and perceptions of their neighborhood geographies. The study included 60 children aged 7 to 11 and one of their parents in five neighborhoods (census tracts). Neighborhood maps were elicited from both children and parents. Child and parent maps showed only a modest correlation, suggesting that children have their own conceptions of their neighborhoods. Also, home range was not equated with children’s definitions of neighborhood boundaries. Accurate and meaningful measures of neighborhood, including child-centered measures, are needed. Child-centered neighborhood indicators are an important complement to the measures that are increasingly available for standard neighborhood units. The neighborhood is a potentially important context for improving child well-being by developing area-based programs to address spatial inequality in child well-being. This study was supported by a grant from the William T. Grant Foundation (Korbin), and by grant RR024990 from the National Institutes of Health, Bethesda, MD. No real or potential conflicts of interests are associated with this work.     

International Variation in Child Subjective Well-Being

Does the subjective well-being of children vary between countries? How does it vary? What explains that variation? In the past the subjective well-being of children has been compared at country level using published data derived from comparable international surveys, most commonly the Health Behaviour of School-aged Children survey. The league tables of child well-being produced in this way are fairly consistent. Thus for example the Netherlands consistently comes top of the rankings of OECD countries. Why is this? How does the Netherlands achieve this? In seeking to explain these national rankings we tend to explore associations with other national league tables. Thus in the UNICEF Report Card 11 (RC11), country ranking on subjective well-being were compared with country rankings on more objective domains of well-being—material, health, education, housing and so on, all at a country level. In this paper we explore international variations in subjective well-being using individual level data from the HBSC 2009–10 survey. We use similar indicators of subjective well-being as were used in RC11. We establish that the components form a reliable index. The ranking of countries is very similar to that obtained at a country level. We also explore the distribution of subjective well-being. We then control for a number of factors associated with variations in subjective well-being at an individual level and, using linear regression with a country fixed effects model, establish whether national differences in subjective well-being are still sustained having taken into account these independent factors. There are some changes in the ranking of countries having taken account of, particularly, behavioural indicators such as bullying. A multilevel model, taking into account country and school level effects, shows that that the effects of child characteristics on subjective well-being vary across countries.     

Identifying Children at Risk for Being Bullies in the United States

ObjectiveTo identify risk factors associated with the greatest and lowest prevalence of bullying perpetration among U.S. children.MethodsUsing the 2001–2002 Health Behavior in School-Aged Children, a nationally representative survey of U.S. children in 6th–10th grades, bivariate analyses were conducted to identify factors associated with any (once or twice or more), moderate (two to three times/month or more), and frequent (weekly or more) bullying. Stepwise multivariable analyses identified risk factors associated with bullying. Recursive partitioning analysis (RPA) identified risk factors which, in combination, identify students with the highest and lowest bullying prevalence.ResultsThe prevalence of any bullying in the 13,710 students was 37.3%, moderate bullying was 12.6%, and frequent bullying was 6.6%. Characteristics associated with bullying were similar in the multivariable analyses and RPA clusters. In RPA, the highest prevalence of any bullying (67%) accrued in children with a combination of fighting and weapon-carrying. Students who carry weapons, smoke, and drink alcohol more than 5 to 6 days/week were at greatest risk for moderate bullying (61%). Those who carry weapons, smoke, have more than one alcoholic drink per day, have above-average academic performance, moderate/high family affluence, and feel irritable or bad-tempered daily were at greatest risk for frequent bullying (68%).ConclusionsRisk clusters for any, moderate, and frequent bullying differ. Children who fight and carry weapons are at greatest risk of any bullying. Weapon-carrying, smoking, and alcohol use are included in the greatest risk clusters for moderate and frequent bullying. Risk-group categories may be useful to providers in identifying children at the greatest risk for bullying and in targeting interventions.