Decreasing nonmarital births and strengthening marriage to reduce poverty

Since the 1970s, the share of U.S. children growing up in single-parent families has doubled, a trend that has disproportionately affected disadvantaged families. Paul Amato and Rebecca Maynard argue that reversing that trend would reduce poverty in the short-term and, perhaps more important, improve children's growth and development over the long term, thus reducing the likelihood that they would be poor when they grew up. The authors propose school and community programs to help prevent nonmarital births. They also propose to lower divorce rates by offering more educational programs to couples before and during marriage. Amato and Maynard recommend that all school systems offer health and sex education whose primary message is that parenthood is highly problematic for unmarried youth. They also recommend educating young people about methods to prevent unintended pregnancies. Ideally, the federal government would provide tested curriculum models that emphasize both abstinence and use of contraception. All youth should understand that unintended pregnancies are preventable and have enormous costs for the mother, the father, the child, and society. Strengthening marriage, argue the authors, is also potentially an effective strategy for fighting poverty. Researchers consistently find that premarital education improves marital quality and lowers the risk of divorce. About 40 percent of couples about to marry now participate in premarital education. Amato and Maynard recommend doubling that figure to 80 percent and making similar programs available for married couples. Increasing the number of couples receiving services could mean roughly 72,000 fewer divorces each year, or around 65,000 fewer children entering a single-parent family every year because of marital dissolution. After seven or eight years, half a million fewer children would have entered single-parent families through divorce. Efforts to decrease the share of children in single-parent households, say the authors, would almost certainly be cost effective in the long run and could reduce child poverty by 20 to 29 percent.     

Effects of poverty on children's dental health

While dental decay has decreased significantly during the last decade because of community fluoridation and other factors, children of low-income families have not benefited as greatly as others from this decrease and still remain at significant risk for dental disease. Published reports of dental disease among low-income families and data from the 1986 National Health Interview Survey indicate that children from low-income families have (1) higher dental disease rates, (2) higher percentages of unmet dental need, and (3) significantly lower utilization rates for dental care services, especially preventive activities. Even with the rapid growth of dental insurance, children of low-income families still experience barriers, having both a lower rate of dental insurance and lower use of dental services even with insurance. Notwithstanding these difficulties, there is much the medical care delivery system can do to decrease the effect of poverty on the dental health of children. Health care professionals can assist in identifying a source of dental care, encourage early dental visits for children, promote preventive dental procedures including routine visits and sealants, and increase parents' awareness of dental disease and the importance of dental health.     

How to reduce DEHP in your NICU: a plan of simple steps to promote change

The integration of research into practice can be a challenge; however, the DEHP-reduction steps provided in this column should make the process simpler and faster. DEHP's link to adverse effects makes it crucial for neonatal nurses to do their best to protect their patients using a preventative approach. As critically ill neonates and infants continue to be exposed to DEHP-leaching devices, neonatal nurses can be at the forefront in taking precautionary action to reduce DEHP exposure among their most vulnerable patients.     

Longitudinal patterns of poverty and health in early childhood: exploring the influence of concurrent, previous, and cumulative poverty on child health outcomes

ABSTRACT: BACKGROUND: Although the links between poverty and health have often been studied , the dynamics of poverty and physical health in early childhood remain under-investigated. In particular, it is not known whether the health of young children is affected differently from that of adults by patterns of poverty unique to them. METHODS: We examined patterns of health from 5 to 41 months of age as a function of concurrent, lagged, and chronic exposure to insufficient income. Using data from the first four rounds of the Quebec Longitudinal Study of Child Development, we performed multilevel logistic and multilevel Poisson regressions and latent growth curve analyses to explore associations between exposure to poverty and mother-reported asthma-like attacks, and maternal perception of health status controlling for neonatal, maternal, and environmental characteristics. RESULTS: The mean number of mother-reported asthma-like attacks significantly decreased as children aged. The likelihood of being perceived in a poorer health status also decreased across time. Concurrent poverty was associated with more mother-reported asthma-like attacks and with a higher risk of being perceived in poorer health status. One-period-lagged poverty was associated with more mother-reported asthma-like attacks and this remained significant after controlling for concurrent poverty. The number of mother-reported asthma-like attacks was significantly higher among children in the chronic poverty class compared to those in the never-poor class, particularly at 17 and 29 months. Perceived health status at 5-months was significantly poorer among chronically poor children compared to never-poor children. CONCLUSION: Exposure to poverty negatively affects two major health indicators in early childhood -- maternal perception of child health and mother-reported asthma-like attacks. Patterns of the effects vary according to timing and duration of poverty exposure. Further longitudinal research is warranted to disentangle time-specific from cumulative effects of poverty on child health.     

How does poverty beget poverty?

Although Canadian poverty rates are less than our neighbours to the south, the consequences of growing up poor affects the Canadian economy and its social fabric. As a relatively wealthy nation, Canada is challenged by high rates of single-parent families, the working poor and a budding population of newcomers with fewer resources. Family poverty primarily risks affecting childrens’ achievements and academic attainments. Not performing on a par with their middle-class peer group places these children at greater risk for academic failure and its concomitant behavioural problems. Associated variables such as single-parenthood and ineffective child-rearing account for much of the remaining risk for psychosocial maladjustment. Childhood poverty, especially of the persistent kind, risks charting a developmental course toward low academic attainment, poor health behaviours and attitudes, and adult depression. Such characteristics become more daunting when those who are not resilient become the parents of the next generation.Bien que les taux de pauvreté au Canada soient plus faibles que chez nos voisins du Sud, les conséquences d’une enfance dans la pauvreté influent sur l’économie et le tissu social du Canada. Les taux élevés de monoparentalité et de petits salariés ainsi qu’une population bourgeonnante de nouveau-venus aux ressources plus limitées constituent un défi pour le Canada, une nation relativement prospère. La pauvreté familiale risque surtout de nuire aux réalisations et au rendement scolaire des enfants. Puisque leur rendement n’équivaut pas à celui de leurs camarades des classes moyennes, ces enfants sont plus vulnérables à l’échec scolaire et aux troubles de comportement concomitants. Des variables connexes, comme la monoparentalité et des pratiques éducatives inefficaces, représentent une grande partie du risque résiduel d’inadaptation psychosociale. La pauvreté des enfants, notamment lorsqu’elle persiste, risque d’ouvrir la voie à un développement favorisant un faible rendement scolaire, des comportements et des attitudes néfastes en matière de santé et une dépression à l’âge adulte. Ces caractéristiques deviennent plus décourageantes lorsque les enfants non résilients deviennent les parents de la génération suivante.     

A completed audit to reduce hospital outpatients non-attendance rates

An audit loop for patients failing to attend a paediatric outpatient department was completed by repeating the analysis three years after interventions were put into place. The 1995 study had shown non-attendance for clinic visits was 34%, varying from 32.5% for Europeans and 50% for Asian patients. A follow up study in 1998 showed a fall to 12.04% and 13.5%, respectively, with an overall rate of 12.3%. The Manor Hospital NHS Trust had the lowest non-attendance rate of the 30 hospitals in the West Midlands region for the year 1996-7.     

The impact of poverty on the current and future health status of children

Child poverty in Canada is a significant public health concern. Because child development during the early years lays the foundation for later health and development, children must be given the best possible start in life. Family income is a key determinant of healthy child development. Children in families with greater material resources enjoy more secure living conditions and greater access to a range of opportunities that are often unavailable to children from low-income families. On average, children living in low-income families or neighbourhoods have poorer health outcomes. Furthermore, poverty affects children’s health not only when they are young, but also later in their lives as adults. The health sector should provide services to mitigate the health effects of poverty, and articulate the health-related significance of child poverty, in collaboration with other sectors to advance healthy public policy.     

A completed audit to reduce hospital outpatients non-attendance rates.

An audit loop for patients failing to attend a paediatric outpatient department was completed by repeating the analysis three years after interventions were put into place. The 1995 study had shown non-attendance for clinic visits was 34%, varying from 32.5% for Europeans and 50% for Asian patients. A follow up study in 1998 showed a fall to 12.04% and 13.5%, respectively, with an overall rate of 12.3%. The Manor Hospital NHS Trust had the lowest non-attendance rate of the 30 hospitals in the West Midlands region for the year 1996-7.