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. 2024 Jul 1;154(2):e2023064551. doi: 10.1542/peds.2023-064551

Trajectories of Housing Insecurity From Infancy to Adolescence and Adolescent Health Outcomes

Kristyn A Pierce a,✉, Alan Mendelsohn a, Brandon Smith b, Sara B Johnson b,c, Carol Duh-Leong a
PMCID: PMC11291963  PMID: 38946454

Abstract

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DOI: 10.1542/6353448118112
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Video Abstract

BACKGROUND AND OBJECTIVES

Housing insecurity is associated with adverse effects on child growth and development cross-sectionally; less is known about its cumulative, long-term effects. This study describes longitudinal experiences of housing insecurity during childhood from infancy (age 1 year) to adolescence (age 15 years) and examines their associations with adolescent health outcomes.

METHODS

Using data from the Future of Families and Child Wellbeing Study, we created a composite measure of housing insecurity using 5 indicators (eg, skipping a rent or mortgage payment, eviction) for participants at ages 1, 3, 5, 9, and 15 years. We used group-based trajectory modeling to identify distinct patterns of housing insecurity, sociodemographic predictors of these patterns, and how these patterns relate to adolescent health outcomes.

RESULTS

We identified 3 trajectories of housing insecurity from infancy to adolescence: secure, moderately insecure, and highly insecure. Adolescents who experienced moderately and highly insecure housing had decreased odds of excellent health (adjusted odds ratio, 0.81; 95% confidence interval [CI], 0.69–0.95; adjusted odds ratio, 0.67; 95% CI, 0.50–0.92, respectively) and more depressive symptoms (adjusted incidence rate ratio, 1.05; 95% CI, 1.02–1.08; 1.13; 95% CI, 1.08–1.19, respectively) than adolescents with secure housing. Adolescents who experienced highly insecure housing reported significantly higher anxiety symptoms (adjusted incidence rate ratio, 1.05; 95% CI, 1.003–1.113).

CONCLUSIONS

Housing insecurity starting in infancy was associated with poorer adolescent health outcomes. These longitudinal patterns emphasize the need for novel screening mechanisms to identify housing insecurity when it emerges, as well as policies to prevent housing insecurity and its associated health outcomes.

What’s Known on This Subject:

Housing is widely recognized as a social determinant of health. In children, housing insecurity has been associated with a variety of negative physical and mental health outcomes. Existing studies typically examine housing insecurity at a single point in time.

What This Study Adds:

We contextualize the cumulativeness and long-term impact of housing insecurity in childhood by describing longitudinal patterns of housing insecurity experienced from infancy to adolescence and how these patterns prospectively relate to adolescent health outcomes.

Housing insecurity is the experience of not having a stable, affordable, and safe home.1 Distinct from housing quality, housing insecurity extends beyond the physical home to the intangible “feeling of home”: one’s lived experience of stability where they reside.2–4 No universal criteria defines housing insecurity yet, but researchers have used 1 or more of the following hardships to indicate its presence: overcrowding, difficulty paying rent or mortgage, eviction, homelessness, or frequent moves.1,2,5,6

Housing is increasingly recognized as an adverse social determinant of health given its associations with physical and mental health.1,3,7 It may influence child health directly or through disruptions to caregiving or other hardships (eg, inconsistent health insurance coverage, scrutiny from welfare systems).8–10 In children, it is associated with attention problems, internalizing and externalizing behaviors, and decreased wellbeing.2,11,12 In parents, housing insecurity is associated with poorer health, increased depressive symptoms, and parenting stress.6,13

Housing insecurity can occur concurrently with, and adversely alter, trajectories of healthy child growth and development.5,6,14 Life course researchers have shown that prolonged, cumulative experiences of hardship and instability (eg, stress from unpredictability) during key stages in childhood can lead to long-term health effects.5,15,16 Examining housing insecurity as a longitudinal pattern with child development may provide unique insight into how they intersect and influence adolescent outcomes, highlighting optimal periods for intervention.13,17–20

Studies identifying longitudinal patterns of housing insecurity have focused mainly on adults (eg, urban fathers, vulnerably housed individuals).21–23 Kang identified 4 distinct trajectories of housing stability in low-income households with and without children: chronically unstable, mostly unstable, mostly stable, and consistently stable.21 Aubry also identified 4 longitudinal trajectories of housing stability in vulnerably housed adults: moderate to low, moderate to high, high to moderate, and high sustained housing stability.22 Less is known about longitudinal experiences of housing insecurity for children and their relationships with adolescent health outcomes.21

To address this gap, we use longitudinal data from the Future of Families and Child Wellbeing Study (FFCWB), an ongoing national birth cohort study.24 We assessed indicators of housing insecurity (eg, skipping rent, eviction) and applied group-based trajectory modeling (GBTM) to identify patterns of housing insecurity across childhood from infancy (age 1 year) to adolescence (age 15 years). We hypothesized that: (1) we would identify distinct, varying patterns of housing insecurity with 1 mostly secure group; (2) certain sociodemographic characteristics would be associated with patterns of insecurity; and (3) patterns reflecting increased housing insecurity would have increased odds of poor health outcomes in adolescence.

Methods

Study Design/Participants

We performed a secondary analysis of FFCWB data. As previously described, 4898 participants were enrolled at birth across 20 large, nationally representative US cities with varying local welfare support systems.24 Nonmarital births were oversampled (3:1) to represent births in each city, leading to an oversample of individuals from minoritized racial and ethnic groups with financial disadvantage, to whom nonmarital births disproportionally occur.24,25 Birthing parents (individuals who gave birth) were interviewed after delivery (baseline) and when their children were 1, 3, 5, 9, and 15 years old. Our institution’s institutional review board deemed this study exempt from human subjects review because these were publicly available, deidentified data.

Measures

Housing Insecurity

We created an index measure of housing insecurity using the following indicators based on previous studies: skipping a rent or mortgage payment, doubling up (sharing housing with other families), eviction, homelessness (spending at least 1 night in the past year sleeping in a shelter, car, abandoned building, or another place not meant for residence), or moving more than once during any year since the last timepoint.1,2,10,21–23,26 We created a count of these indicators, from 0 (secure) to 5 (highly insecure), to measure the severity of housing insecurity experienced at each timepoint (ages 1, 3, 5, 9, 15 years).

Adolescent Health Outcomes

The primary outcomes at age 15 years were self-reported overall health (SRH) and depressive and anxiety symptoms. SRH was measured with 1 Likert-scaled question: “In general, how is your health?” with 5 answer choices from “poor” (1) to “excellent” (5).27 This question has demonstrated validity across several contexts as a predictor of mortality and overall health.28–30 We dichotomized SRH by coding “very good” (4) and “excellent” (5) as 1. Dichotomized versions of this measure yield results comparable to its original ordinal form.31

Depressive symptoms were measured with an adolescent-tailored adaptation of the 5-item Center for Epidemiologic Studies Depression Scale.32,33 Anxiety symptoms were measured with 6 modified questions from the Brief Symptom Inventory 18, Anxiety Subscale.34 Responses were scored on a 4-point scale and summed into overall scores for each outcome. Depression and anxiety scores ranged from 5 to 20 and 6 to 24, respectively, with higher scores indicating more symptoms.

Sociodemographic Characteristics

At baseline, birthing parents reported their age (years), racial and ethnic identity (white, non-Hispanic; Black, non-Hispanic; Hispanic; other), level of education (eg, less than high school, high school/equivalent), household income (Federal Poverty Level [FPL] proximity), nativity (United States born or not), relationship status with the child’s nonbirthing parent (eg, married, cohabitating), household size (number of people in household collected at age 3 years), the child’s biological sex, and first-born status (yes/no).24

Statistical Methods

Analytic Sample

We included participants with at least 1 housing measure (N = 4714, 96.2% of the main sample) in our analytic sample. Nearly 75% (3476/4898) of participants had housing measurements at 4 or more timepoints. Incomplete case analysis was preferred over a complete case approach to reduce bias from loss to follow-up, which would likely be higher in families experiencing housing insecurity.35 Sensitivity analyses were conducted in a subsample of children with complete data across all 5 timepoints.

Group-Based Trajectory Modeling

GBTM is a statistical methodology that uses longitudinal data (eg, clinical or behavioral measures) to identify clusters of individuals who follow similar developmental, behavioral, or experiential trajectories over time.36–38 Trajectory models estimate group patterns and may not represent each individual experience exactly. GBTM is useful for modeling incomplete data because it accommodates all available information and provides maximum-likelihood estimations of model parameters.39,40

Following previously outlined model-selection procedures, we used GBTM to identify distinct trajectories of housing insecurity from ages 1 to 15 years using our housing insecurity index measure.36,41 A zero-inflated Poisson model was chosen because the housing insecurity index measure had excess zeroes (70% or more) at every timepoint.41 The number of trajectory groups was determined using Bayesian information criterion. Several polynomial variations and orders were tested, with an a priori zero-term to represent a “consistently secure” trajectory of housing.36 The final model maximized Bayesian information criterion and entropy, contained group posterior probabilities that exceeded the recommended 0.70 threshold, and demonstrated consistency between observed and model-estimated group membership probabilities.39,41 Participants were assigned to the trajectory group in which they had the highest probability of membership.

Hypothesis Testing

Groupwise comparisons were made using analysis of variance or χ2 testing, depending on variable type. Logistic regression was used to model SRH. As demonstrated previously, the distributional nuances (eg, overdispersion, variance patterns) of depressive and anxiety symptom scores were not suitable for linear regression.42 Poisson regression was used to model anxiety symptoms. Negative binomial regression was used to model depression symptom scores because its variance exceeded the mean.43 Baseline sociodemographics significantly associated with the housing groups were considered as covariates.44 The child’s biological sex was included a priori because of its relationship with adolescent health.45,46 Final models were selected in a backward stepwise manner and model assumptions (eg, distribution of outcome, independence of observations) were adequately met.

Tests were 2-tailed and α was set to .05. Statistical analyses were completed using Stata (version 17).47 GBTM procedures were completed using the “traj” package.48

Results

Trajectories of Childhood Housing Insecurity Based on Group-Based Trajectory Modeling

The final group-based trajectory model contained 3 distinct trajectories of housing insecurity experienced from ages 1 to 15 years: no insecurity (“secure”); intermittent-moderate insecurity (“moderately insecure”); and high insecurity in early childhood, trending toward security in adolescence (abbreviated to “highly insecure”) (Fig 1). Most children were classified into the secure (2230/4714, 47.3%) and moderately insecure (2188/4714, 46.4%) groups, whereas 296 (6.3%) children were classified into the highly insecure group. Model summary statistics are in Supplemental Table 4.

FIGURE 1.

FIGURE 1

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Trajectories of housing insecurity experienced by focal child from ages 1 to 15 (n = 4714).

Sample and Trajectory Group Characteristics

Table 1 describes the sociodemographics for the FFCWB sample overall and by housing group. Educational attainment and household income were higher in the secure group and more parents in the secure group were married (34.6%). The highly insecure group had the largest proportions of parents who had not completed high school (51.5%) and who were living below the FPL (46.3%).

TABLE 1.

Baseline Sociodemographic Characteristics Overall and by Housing Group (n = 4714)

Variable Sample Secure Moderately Insecure Highly Insecure P
n = 4714 n = 2230 n = 2188 n = 296
Parent characteristics n (%) n (%) n (%) n (%)
Birthing parent’s age, y; mean (SD) 25.3 (6) 26.4 (6.3) 24.3 (5.6) 23.6 (5.46) <.001a
Race/ethnicity <.001a
 White, non-Hispanic 993 (21.1) 558 (25.1) 364 (16.7) 71 (24)
 Black, non-Hispanic 2242 (47.7) 936 (42.1) 1161 (53.2) 145 (49)
 Hispanic 1284 (27.3) 624 (28) 591 (27.1) 69 (23.3)
 Other 184 (3.9) 107 (4.8) 66 (3) 11 (3.7)
Education <.001a
 Less than high school 1615 (34.3) 635 (28.5) 828 (37.9) 152 (51.5)
 High school or equivalent 1433 (30.4) 655 (29.4) 699 (32) 79 (26.8)
 Some college or technical education 1153 (24.5) 549 (24.6) 547 (25) 57 (19.3)
 College degree or higher 508 (10.8) 390 (17.5) 111 (5.1) 7 (2.4)
Household income <.001a
 0%–49% FPL 883 (18.7) 336 (15.1) 474 (21.7) 73 (24.7)
 50%–99% FPL 810 (17.2) 339 (15.2) 407 (18.6) 64 (21.6)
 100%–199% FPL 1220 (25.9) 520 (23.3) 609 (27.8) 91 (30.7)
 200%–299% FPL 731 (15.5) 324 (14.5) 363 (16.6) 44 (14.9)
 300%+ FPL 1070 (22.7) 711 (31.9) 335 (15.3) 24 (8.1)
Parental relationship <.001a
 Married 1149 (24.4) 772 (34.6) 350 (16) 27 (9.1)
 Cohabitating 1717 (36.4) 704 (31.6) 885 (40.5) 128 (43.2)
 Visiting 1229 (26.1 507 (22.8) 639 (29.2) 83 (28)
 Friends 286 (6.1%) 120 (5.4) 142 (6.5) 24 (8.1)
 No/limited contact 332 (7) 126 (5.6) 172 (7.9) 34 (11.5)
People living in household <.001a
 <3 1355 (32.2) 589 (30) 674 (34) 92 (34.3)
 4–5 2033 (48.3) 1029 (52.5) 894 (45.1) 110 (41)
 >6 822 (19.5) 342 (17.5) 414 (20.9) 66 (24.6)
US born 3928 (83.5) 1772 (79.6) 1884 (86.4) 272 (91.9) <.001a
Focal child characteristics
Biological sex .94
 Male 2459 (52.2) 1159 (52) 1147 (52.4) 153 (51.7)
 Female 2255 (47.8) 1071 (48) 1041 (47.6) 143 (48.3)
First-born 1802 (38.4) 865 (38.9) 834 (38.2) 103 (34.8) .39
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FPL, federal poverty level.

a

P < .05.

Trajectory Group Experiences

None of the children categorized into the secure group experienced any indicators of housing insecurity during the study. Table 2 and Fig 2 show frequency of housing insecurity indicators and prevalence of each individual indicator over time, respectively.

TABLE 2.

Frequency of Housing Insecurity Indicators Experienced at Each Timepoint for the Moderately and Highly Insecure Groups

Indicators reported in the moderately insecure group
Timepoint, y Age 1 Age 3 Age 5 Age 9 Age 15
n = 2039 n = 1986 n = 1961 n = 1744 n = 1421
 None 1057 (51.8%) 1313 (66.1%) 1267 (64.6%) 980 (56.2%) 1108 (78%)
 1 indicator 758 (37.2%) 592 (29.8%) 592 (30.2%) 622 (35.7%) 280 (19.7%)
 2 indicators 177 (8.7%) 78 (3.9%) 85 (4.3%) 100 (5.7%) 27 (1.9%)
 3 or more indicators 47 (2.3%) 3 (0.2%) 17 (0.9%) 42 (2.4%) 6 (0.4%)
Indicators reported in the highly insecure group
Timepoint, y Age 1 Age 3 Age 5 Age 9 Age 15
n = 267 n = 271 n = 258 n = 226 n = 154
 None 37 (13.9%) 22 (8.1%) 42 (16.3%) 78 (34.5%) 105 (68.2%)
 1 indicator 69 (25.8%) 67 (24.7%) 81 (31.4%) 88 (38.9%) 36 (23.4%)
 2 indicators 84 (31.5%) 104 (38.4%) 63 (42.4%) 35 (15.5%) 8 (5.2%)
 3 or more indicators 77 (28.8%) 78 (28.8%) 72 (27.9%) 25 (11.1%) 5 (3.2%)
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FIGURE 2.

FIGURE 2

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Prevalence of individual housing insecurity indicators experienced from ages 1 to 15 years for the (A) moderately insecure and (B) highly insecure groups.

Most children in the moderately insecure group experienced 1 or 0 housing insecurity indicators at each timepoint. More than half in the highly insecure group experienced 2 or more housing insecurity indicators until age 5 years. Housing insecurity was most prevalent at ages 1 and 3 years, respectively, for the moderately and highly insecure groups (Table 2). The most common indicators for both insecure groups were skipping rent and doubling up (Fig 2). These indicators peaked at age 9 years for the moderately insecure group. In the highly insecure group, most indicators began to decrease in prevalence at ages 3 or 5 years. At age 15 years, more than two-thirds (68.2%) of the highly insecure group did not experience any indicators (Table 2).

Housing Insecurity and Outcomes at Age 15 Years

Approximately 73% (3437/4714) of adolescents had at least 1 outcome measure available. Unadjusted and adjusted comparisons of outcomes at age 15 years between the housing groups can be found in Table 3. The housing groups had significantly different SRH, and depressive and anxiety symptom scores at age 15 years.

TABLE 3.

Unadjusted and Adjusted Analyses of Outcomes at Age 15 y Based on Housing Group

Outcome n Secure Moderately Insecure Highly Insecure P (Unadjusted)
Excellent or very good self-reported health
 Unadjusted, n (%) 3434 1120 (74.4%) 1195 (70%) 146 (66.1%) .003a
 Adjusted OR [95% CI] 3427 Ref. 0.81 [0.69–0.95]a 0.67 [0.50–0.92]a
Depression score
 Unadjusted mean (SD) 3383 7.7 (2.9) 8.1 (3) 8.8 (3.3) <.001a
 Adjusted IRR [95% CI] 3376 Ref. 1.05 [1.03–1.08]a 1.14 [1.08–1.20]a
Anxiety score
 Unadjusted, mean (SD) 2250 10.5 (3.3) 10.8 (3.2) 11.2 (3.2) .03a
 Adjusted IRR [95% CI] 2248 Ref. 1.02 [0.99–1.05] 1.06 [1.01–1.11]a
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Adjusted analyses controlled for baseline household income, parent racial/ethnic identity, and child's biological sex. CI, confidence interval; IRR, incidence rate ratio; OR: odds ratio; Ref., reference group.

a

P < .05.

More adolescents in the secure group reported “very good” or “excellent” SRH than those in the insecure groups. Adolescents in the moderately and highly insecure groups had a 19% (95% confidence interval [CI], 0.69–0.95) and 33% (95% CI, 0.5–0.91) lower odds, respectively, of reporting “very good” or “excellent” SRH than those in the secure housing group (Table 3).

Adolescents in the highly insecure housing group reported more depressive symptoms on average than their secure and moderately insecure counterparts. Adolescents in the moderately and highly insecure groups reported depressive symptoms at rates of 1.05 (95% CI, 1.03–1.08) and 1.1 (95% CI, 1.08–1.2) times higher, respectively, than adolescents in the secure group (Table 3).

Of the 3 housing groups, adolescents in the secure housing group reported the lowest anxiety symptoms. Individuals in the highly insecure group reported anxiety symptoms at a rate 1.06 times higher than the secure group (95% CI, 1–1.1) (Table 3). Anxiety symptoms reported in the moderately insecure group did not significantly differ from the secure group.

Discussion

In a sample of US children with socioeconomic disadvantage followed from infancy to adolescence, we identified 3 distinct longitudinal experiences of housing insecurity: secure, moderately insecure, and highly insecure. The rate of housing insecurity (52.7%) in the FFCWB sample, which we selected to examine long-term health effects of specific material hardships, reflects a similar rate reported in another study of low-income households with children.49 Baseline educational attainment, marital status, and household income were associated with more secure trajectories. At age 15 years, adolescents in the secure group had better SRH, and lower anxiety and depressive symptoms compared with those who experienced insecure housing. These findings contribute knowledge about patterns of housing insecurity throughout childhood and their associations with adolescent health.

Our study is among the first to identify trajectories of housing insecurity in a sample of children. Although similar to the 4 trajectory models of housing insecurity identified by Kang and Aubry, our model did not contain trajectories of sustained or increasing insecurity, reinforcing evidence that households with children were less likely to experience chronically unstable housing.21,22 The absence of these “mostly unstable” experiences for FFCWB participants could be due to increased access to safety net programs for households with children. Parents may also describe housing insecurity differently than individuals without children. Future research may employ qualitative methods to understand the lived experiences of families with children who have fluctuating housing insecurity and identify the mechanisms that protect them from more severe experiences of insecurity.

Although our trajectories are not an exact representation of each individual child’s experience, estimating them generated novel information about childhood housing insecurity and allowed us to identify priorities for intervention and future research. In line with life course research, even though children in both insecure groups experienced periods of security, those periods did not diminish the cumulative effects of insecure housing on adolescent health. Because the highest proportions of children in the insecure groups experienced housing insecurity in the first 3 years of life, early childhood may represent a vulnerable period to screen and help families experiencing housing hardships. The reduction of insecurity indicators for the highly insecure group over time, though encouraging, may be partially attributed to loss of follow-up in the FFCWB study, particularly from those experiencing housing insecurity. Children with the highest degree of insecurity may fall through the cracks because of their ever-changing housing situations. Children experiencing fluctuating housing insecurity may also be harder to identify, especially because there are not yet validated screening tools for clinicians to use in practice.50 Our results highlight the potential long-term consequences if current public health measures do not identify children experiencing housing insecurity and underscore the need for innovative screening efforts beyond just health systems.

Our work extends current literature showing that deleterious effects of housing insecurity may begin as early as the first year of life. Studies connecting experiences of housing insecurity during various periods of child development to health outcomes later in life have had inconsistent results, which may be due to the child’s age at the time of the analysis and who is reporting the information (eg, child versus parent).9,13,17–20 We demonstrated that prolonged experiences of housing insecurity spanning the first 15 years of life, regardless of severity, were predictive of poorer SRH and more symptoms of depression in adolescence. Adolescents in the highly insecure group had higher anxiety symptoms, despite the gradual improvement of this trajectory after age 3 years. Therefore, highly insecure housing early in life may have lasting effects regardless of experiences later in childhood, further reinforcing our recommendation for interventions as early as possible. Future studies should examine child psychiatric symptoms longitudinally with housing experiences to clarify the role of housing in mental health across developmental stages.

Though socioeconomic characteristics were significantly different among the housing groups, the differences were not distinct enough to provide any “contextually significant” information about risk factors for housing insecurity. For example, many households in both insecure housing groups had incomes that were well above the FPL, strengthening previous evidence that financial hardship alone is not a reliable indicator of material hardship.51 Controlling for racial and ethnic identity in our adjusted models showed that housing disparities likely had additional health effects exacerbating the well-documented health disparities experienced by racial and ethnic minority groups. Consequently, we contextualized housing insecurity as a social determinant of health existing independently and comorbidly with other drivers of health disparities. Risk factors for housing insecurity are likely rooted in larger systemic issues (eg, systemic racism, discrimination of female-headed households), and future studies should consider this broader context.45,52,53

Though the children in FFCWB were born >20 years ago, the context is the same or worse for families with children today; the national rate of 1-parent households has increased, the cost of living is higher, and individuals’ buying power has not caught up.54,55 The expiration of pandemic-era federal assistance programs that may have lessened families’ growing financial burden, and the twofold increase in the supplemental child poverty measure from 2021 to 2022 leaves more families in need, fewer resources for providers to offer, and increased urgency for solutions.56,57

Our study has several limitations to consider when interpreting the results. Our composite measure of housing insecurity is imperfect because of the dichotomization of each individual indicator; a child who spent 1 night or several months in a place not meant for residence were counted equally. Housing hardships are likely underrepresented because housing insecurity may limit participant ability to participate in long-term research, biasing the FFWCB sample toward participants with secure housing. Moreover, indicators and outcomes could have been underreported because of social desirability bias or mistrust of research entities from historical mistreatment of minoritized racial and ethnic groups. Alternatively, because these data come from individuals from marginalized racial and ethnic groups and with lower incomes who are already disadvantaged, they may overestimate housing insecurity rates as they exist in the general population.

Conclusions

Housing insecurity is a complex, systemic issue with unique implications for children. Examining housing insecurity over years helped detect relationships with adolescent health outcomes not observed in previous cross-sectional analyses. Our findings extend evidence of the cumulative nature of housing insecurity, therefore emphasizing the importance of early intervention for families with children experiencing housing insecurity.

Housing insecurity is preventable and addressable through policy and public health intervention. Future work is needed to validate a universal measure for housing insecurity and implement screening and referral procedures for families with young children to appropriate services. In addition to traditional settings for screening, health systems would benefit from partnering with public health professionals to screen for housing insecurity in community spaces (eg, churches, recreational centers), where they may be able to engage parents of children living in overcrowded or precarious housing. Screening is only half of the battle, and providers need more resources to offer once families experiencing housing insecurity are identified. Policy efforts should prioritize affordable housing accessibility and financial support programs for families with children since skipping rent and doubling up were the most common indicators for the insecure groups. Stakeholders should seek to understand how pandemic-era financial assistance programs succeeded in diminishing child poverty and how they can be adapted into permanent protections for families with young children.

Supplementary Material

Supplemental Information
peds.2023-064551SupplementaryData.pdf (403.7KB, pdf)

Glossary

FFCWB

Future of Families and Child Wellbeing Study

FPL

federal poverty level

GBTM

group-based trajectory modeling

SRH

self-reported health

Footnotes

Ms Pierce and Dr Duh-Leong conceptualized and designed the study, carried out the analyses, reviewed the analyses, drafted the initial manuscript, and reviewed and revised the manuscript; Dr Mendelsohn substantially contributed to the conception of the study and analyses, reviewed the analyses, and reviewed and revised the manuscript; Drs Smith and Johnson substantially contributed to the conception of the study and analyses and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

FUNDING: Dr Duh-Leong acknowledges support from National Institutes of Health/NIEHS (K23ES035461) and the Sala Elbaum Pediatric Research Scholars Program.

CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose.

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