Published online February 1, 2008
PEDIATRICS Vol. 121 No. 2 February 2008, pp. 337-344 (doi:10.1542/peds.2007-0447)
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ARTICLE

Influence of Multiple Social Risks on Children's Health

Kandyce Larson, PhDa,b, Shirley A. Russ, MD, MPHa,,c, James J. Crall, DDS, ScDa,d,e and Neal Halfon, MD, MPHa,b,f

a UCLA Center for Healthier Children, Families, and Communities, Los Angeles, California
b Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
c Department of Academic Primary Care Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California
d National Oral Health Policy Center, Los Angeles, California
e UCLA School of Dentistry, Los Angeles, California
f Department of Health Services, School of Public Health; and Department of Public Policy, School of Public Affairs, University of California, Los Angeles, Los Angeles, California

OBJECTIVE. Social risk factors such as growing up in poverty, racial/ethnic minority status, and maternal depression have been associated with poorer health outcomes for children. This study examined the strength of association of 8 social risk factors, both individually and as part of a cumulative social risk index, on parent-reported child health status.

METHODS. We performed an analysis of cross-sectional data from the 2003 National Survey of Children's Health, a telephone survey of 102353 parents of children aged 0 to 17 years. In bivariate and multivariate logistic regression models, 8 social risk factors were tested as independent predictors of 4 parent-reported child health outcomes: global health status, dental health, socioemotional health, and overweight. These risk factors were combined into a categorical "social risk index" ranging from low risk (0 risk factors) to very high risk (≥6 risk factors), and risk gradients were examined using linear polynomial testing and multivariate logistic regression.

RESULTS. The percentage of children in poorer health increased with the number of social risk factors across all health outcomes. More than half of children had ≥2 risk factors, and 24% had ≥4. Low maternal mental health, black or Hispanic race/ethnicity, <200% of the federal poverty level, low household education, unsafe neighborhoods, and lack of health insurance increased the odds for less than very good child health in adjusted models.

CONCLUSIONS. Multiple social risk factors have a cumulative effect on parent-reported child health status across physical and socioemotional domains, demonstrating a very strong risk gradient effect. These findings emphasize the importance of addressing multiple levels of social risk to achieve improvements in child health.

Key Words: social environment • health outcomes • children • risk factors

Abbreviations: NSCH—National Survey of Children's Health • FPL—federal poverty level • OR—odds ratio • CI—confidence interval

Accepted Jul 25, 2007.




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