Intergenerational Social Networks and Health Behaviors Among Children Living in Public Housing

Objectives. In a survey of families living in public housing, we investigated whether caretakers’ social networks are linked with children’s health status.Methods. In 2011, 209 children and their caretakers living in public housing in suburban Montgomery County, Maryland, were surveyed regarding their health and social networks. We used logistic regression models to examine the associations between the perceived health composition of caretaker social networks and corresponding child health characteristics (e.g., exercise, diet).Results. With each 10% increase in the proportion of the caretaker’s social network that exercised regularly, the child’s odds of exercising increased by 34% (adjusted odds ratio = 1.34; 95% confidence interval = 1.07, 1.69) after the caretaker’s own exercise behavior and the composition of the child’s peer network had been taken into account. Although children’s overweight or obese status was associated with caretakers’ social networks, the results were no longer significant after adjustment for caretakers’ own weight status.Conclusions. We found that caretaker social networks are independently associated with certain aspects of child health, suggesting the importance of the broader social environment for low-income children’s health.Health inequalities often endure across several generations.1,2 Studies have linked grandparental and parental childhood exposures,3,4 social class,5 educational attainment,6,7 and health behaviors8 to offspring health. Neighborhood environments have been postulated to play an important role in the persistence of intergenerational inequalities. Research conducted by Sharkey has shown that children whose parents grew up in disadvantaged, segregated neighborhoods are highly likely to themselves live in disenfranchised neighborhoods as adults.1 Although social scientists have noted the important contributions of neighborhood social processes to health outcomes,9 the question of whether social networks play a role in connecting neighborhood environments to intergenerational inequality remains unresolved.Understanding how social networks influence health behaviors and outcomes is an evolving area of research in public health.10,11 Studies have linked the likelihood of particular health-related behaviors and attributes among adults, such as smoking, alcohol consumption, obesity, and poor mental health, to the characteristics of their friends and relations.11–14 Research also has shown associations between children’s peer networks and aspects of their health, including physical activity, weight, and substance use.15–21 Despite growing interest in social networks and health, little is known about intergenerational social networks or how the social networks of one generation may affect the health and well-being of the next.Caretaker social networks may be related to child health through at least 2 mechanisms. First, the adults in a caretaker’s social network may shape a child’s health directly by serving as adult role models, modeling behaviors and conveying social norms.22 Second, a caretaker’s social network may have an indirect effect, mediated by the caretaker, on a child’s health.22 In this formulation, the caretaker may select network members with similar health beliefs and behaviors, given the tendency for individuals with shared characteristics to establish ties (a phenomenon known as homophily),23 or social network members with different characteristics may influence caretakers to express new norms or behaviors (termed induction).13 By reinforcing or shaping the caretaker’s attitudes and behaviors, caretaker social networks may, in turn, influence children. It is widely recognized that caretakers play a critical role in their children’s health by providing food, shelter, and care; teaching children about healthy eating; creating opportunities for physical activity; and molding children’s understanding of health and related behavioral norms.24–28We examined associations between caregivers’ social ties and children’s health among families living in suburban subsidized housing. Specifically, we assessed whether relationships exist between caregivers’ social networks and their children’s health and whether these associations are independent of caretakers’ own health characteristics.We focused on suburban families living in subsidized housing for several reasons. First, although subsidized housing programs provide important benefits to residents,29–31 the physical and mental health of these populations is often poor.32–35 Second, suburban neighborhoods, on average, now house more poor residents than do central US cities, and the number of families in suburban public housing continues to grow.36,37 Third, families receiving housing assistance are at the bottom of the income distribution, with most such households earning less than $20 000 annually.38 Fourth, caretakers’ social networks may play important roles among families living in certain types of public housing in which friends and neighbors serve as informal caretakers by watching one another’s children.39 This may be particularly important in single-parent households, which made up the majority of households in our study.Studies of public housing residents have shown that their social networks may be affected by neighborhood context.39–42 Using data from Montgomery County, Maryland, we previously found that adults living in wealthier communities had more socioeconomically diverse and, to a limited extent, healthier social networks.41,43 Similarly, research from the Moving to Opportunity experiment revealed that participants who received housing vouchers to move to low-poverty neighborhoods (from high-poverty neighborhoods) were more likely to have at least 1 college-educated friend than those who remained in public housing developments in high-poverty neighborhoods.44 Given the well-documented relationship between income and health and the evidence of limited intergenerational mobility among children who grow up in poor households and neighborhoods,45,46 determining the extent to which associations exist between caretakers’ social networks and children’s health allows consideration of whether caretakers’ relationships may maintain or disrupt intergenerational inequalities known to affect factors critical to health.