Abstract
This cross-sectional study investigates the association between parental health and flourishing among children aged 6 months to 5 years in the US.
Introduction
Flourishing is a key factor for child health trajectory.1,2,3,4,5 The National Survey of Children’s Health (NSCH) began collecting measures of flourishing in 2011 and reported 1 in 2 children in the US were flourishing.1,2 Subsequently, deciphering factors that promote flourishing became an important public health focus.1,2,3,4,5,6 Parental health and childhood flourishing are interrelated, yet elucidating parental health factors that are associated with childhood flourishing is needed.1,2,3,4,5,6 Our objective was to examine the association between parental health and flourishing among young children in the US.
Methods
This cross-sectional study was exempt from review because it used publicly available, deidentified data, in accordance with 45 CFR §46. Nationally representative data were analyzed from 2021 NSCH of young children aged 6 months to 5 years (n = 30 912). Survey respondents provided voluntary consent. We followed the STROBE reporting guideline. The primary outcome was flourishing defined by responding “always/usually” to the following questions: (1) Is this child affectionate and tender? (2) Does this child bounce back quickly when things do not go their way? (3) Does this child show interest and curiosity in learning new things? (4) Does this child smile and laugh? The primary outcome was dichotomized into flourishing (score = 4) and not flourishing (scores 0-3).6
The main exposure of composite overall parental health was examined from the father and/or mother response options that included “absent,” “fair/poor,” “good,” or “excellent/very good” to the following questions: “If this child’s mother/father is a primary caregiver and lives in the household, what is the mother’s/father’s physical health status?” The same structure was used to ask about father and/or mother parental mental health status. The responses to the aforementioned 16 questions for each parent were scored with −1 for “absent” to a maximum score of 2 for “excellent/very good” and combined into a composite overall parental health category. Composite scores were then split into tertiles of low (scores −4 to 2), medium (scores 3 to 7), and high (scores of 8). Additional characteristics from previous flourishing literature were assessed including child age, sex, race and ethnicity, adverse experiences, and insurance; and parent and/or caregiver education level, aggravation, emotional support, and coping with daily demands of raising a child; and family household income, family resilience, and smoking in household.1,2,3,4,5,6 Weighted baseline composite overall parent health category and flourishing characteristics were compared using the Pearson χ2 test for independence. A weighted multivariable logistic regression analysis calculated unadjusted odds ratio (OR) and adjusted OR (aOR) of flourishing by composite overall parental health category. Weighted subgroup analysis explored the association of father’s and mother’s physical and mental health individual responses with odds of flourishing. Several models were run in a stepwise fashion using established variables from prior flourishing literature and eliminated collinearity.1,2,3,4,5,6 Two-sided P < .05 was considered statistically significant. Statistical analysis was performed using Stata/SE 18 (StataCorp).
Results
Among 30 912 children aged 6 months to 5 years included in the study, 15 977 (51.7%) were male and 14 935 (48.3%) were female. The majority (81%) of children aged 6 months to 5 years in the US were flourishing in this study. As overall composite parental health category increased, rates of flourishing increased (low: 5454 [75.0%]; medium: 5717 [77.0%]; high: 14 571 [86.0%]; P < .001). After adjusting for differences in Table 1 including caregiver level of education, family resilience, parental aggravation, parental coping, and emotional support with parenthood, there were no associations between composite overall parental health category and childhood flourishing. Subgroup analysis found worse mother’s physical health status was associated with reduced flourishing (“poor/very poor”: aOR, 0.68 [95% CI, 0.49-0.95]; “good”: aOR, 0.81 [95% CI, 0.67-0.97]) as compared with responses of “excellent/very good” (Table 2). Father’s physical health of “poor/very poor” was also negatively associated with flourishing (aOR, 0.59 [95% CI, 0.40-0.87]).
Table 1. Weighted Parent-Child Characteristics Among Children Aged 6 Months to 5 Years in the US by Composite Overall Parental Health Categorya.
| Characteristics | No. (%) | P value | ||
|---|---|---|---|---|
| Composite overall parents health score | ||||
| Low (n = 7164) | Medium (n = 7169) | High (n = 16 579) | ||
| Flourishing | ||||
| Scores 0-3 (not flourishing) | 1710 (25.0) | 1452 (23.0) | 2008 (35.0) | <.001 |
| Score 4 (flourishing) | 5454 (75.0) | 5717 (77.0) | 14 571 (86.0) | |
| Child’s age, y | ||||
| 0 | 327 (7.6) | 362 (7.6) | 970 (9.1) | .21 |
| 1 | 804 (17.0) | 957 (17.0) | 2362 (19.0) | |
| 2 | 1416 (18.0) | 1537 (17.0) | 3636 (19.0) | |
| 3 | 1463 (19.0) | 1436 (21.0) | 3164 (18.0) | |
| 4 | 1505 (20.0) | 1461 (20.0) | 3262 (19.0) | |
| 5 | 1649 (19.0) | 1416 (18.0) | 3185 (17.0) | |
| Child’s sex | ||||
| Male | 3672 (50.0) | 3680 (53.0) | 8625 (51.0) | .48 |
| Female | 3492 (50.0) | 3489 (47.0) | 7954 (49.0) | |
| Child’s race and ethnicityb | ||||
| Black, non-Hispanic | 1077 (25.0) | 200 (7.9) | 515 (6.9) | <.001 |
| Hispanic | 1322 (30.0) | 925 (24.0) | 1882 (21.0) | |
| Multiracial, non-Hispanic | 1251 (13.0) | 919 (11.0) | 2214 (12.0) | |
| White, non-Hispanic | 3514 (32.0) | 5125 (57.0) | 11 968 (60.0) | |
| Income level of child’s household, % FPL | ||||
| 0-199 | 3731 (63.0) | 1761 (34.0) | 3071 (25.0) | <.001 |
| 200-299 | 1174 (16.0) | 1268 (21.0) | 2446 (15.0) | |
| 300-399 | 769 (7.8) | 1249 (14.0) | 2575 (14.0) | |
| ≥400 | 1490 (14.0) | 2891 (31.0) | 8587 (46.0) | |
| Adequacy of child’s insurance | ||||
| Adequate | 5285 (74.0) | 4809 (68.0) | 12 226 (73.0) | <.001 |
| Not adequate | 1420 (17.0) | 2149 (28.0) | 3766 (22.0) | |
| Uninsured | 422 (8.3) | 206 (3.7) | 562 (5.4) | |
| Current health insurance status of child | ||||
| Insured | 6717 (91.0) | 6959 (96.0) | 16 001 (95.0) | <.001 |
| Not insured | 422 (8.3) | 206 (3.7) | 562 (5.4) | |
| Consistency of insurance coverage of child | ||||
| Consistently insured | 6561 (89.0) | 6827 (94.0) | 15 797 (93.0) | <.001 |
| Currently uninsured/had gap | 560 (11.0) | 302 (6.2) | 649 (6.4) | |
| Type of health insurance | ||||
| Public | 3371 (55.0) | 1342 (26.0) | 2064 (19.0) | <.001 |
| Private | 2802 (29.0) | 5255 (64.0) | 13,374 (72.0) | |
| Public and private | 439 (5.3) | 304 (5.6) | 455 (3.0) | |
| Uninsured | 422 (8.3) | 206 (3.7) | 562 (5.4) | |
| Child has special health care needs | ||||
| None | 6002 (87.0) | 6095 (86.0) | 15 051 (92.0) | <.001 |
| Yes, less complex | 244 (2.7) | 262 (3.1) | 462 (1.8) | |
| Yes, more complex | 918 (11.0) | 811 (11.0) | 1066 (6.4) | |
| No. of adverse childhood experiences for child | ||||
| 2 or more | 1642 (23.0) | 459 (8.0) | 232 (1.8) | <.001 |
| 1 | 1959 (26.0) | 1258 (21) | 1103 (8.4) | |
| 0 | 3173 (46.0) | 5,450 (71.0) | 15 237 (90.0) | |
| Highest education of child’s caregiver | ||||
| Less than high school | 373 (16.0) | 79 (6.4) | 187 (3.9) | <.001 |
| High school degree or GED | 1733 (30.0) | 735 (16.0) | 1113 (11.0) | |
| Some college/technical | 2111 (25.0) | 1511 (20.0) | 2423 (15.0) | |
| College degree or higher | 2947 (29.0) | 4844 (57.0) | 12 836 (70.0) | |
| Family resilience index scorec | ||||
| 0 or 1 | 554 (8.3) | 395 (7.0) | 149 (1.0) | <.001 |
| 2 or 3 | 726 (12.0) | 943 (14) | 687 (4.2) | |
| 4 | 5,120 (70.0) | 5814 (78.0) | 15 681 (94.0) | |
| Parent coping | ||||
| Not very well or not at all | 183 (2.3) | 209 (3.9) | 85 (0.6) | <.001 |
| Somewhat well | 2726 (34.0) | 3946 (54.0) | 5337 (31.0) | |
| Very well | 4,013 (59.0) | 3005 (42.0) | 11 129 (68.0) | |
| Parental aggravation | ||||
| Usually/always feel aggravation | 379 (4.5) | 437 (6.7) | 453 (2.3) | <.001 |
| Emotional help parenthood | ||||
| Yes, spouse/partner | 3241 (41.0) | 5821 (77.0) | 14,396 (83.0) | <.001 |
| Yes, not from spouse/partner | 2047 (26.0) | 262 (3.5) | 269 (1.9) | |
| Did not receive support | 1466 (27.0) | 1048 (19.0) | 1813 (14.0) | |
| Coping with daily demands of raising children | ||||
| Very well | 4013 (59.0) | 3005 (42.0) | 11 129 (68.0) | <.001 |
| Somewhat well | 2726 (34.0) | 3946 (54.0) | 5337 (31.0) | |
| Not very well | 183 (2.3) | 209 (3.9) | 5337 (31.0) | |
| Someone living in household smokes | ||||
| Yes | 1320 (20.0) | 981 (14.0) | 1048 (7.6) | <.001 |
| No | 5409 (80.0) | 6155 (86.0) | 15 475 (92.0) | |
Abbreviations: FPL, federal poverty level; GED, General Educational Development.
Children who were institutionalized were not included.
Self-reported race.
Family resilience index score based on responses to the following 4 survey items: “When your family faces problems, how often are you likely to do each of the following?” (1) Talk together about what to do, (2) Work together to solve our problems, (3) Know we have strengths to draw on, and (4) Stay hopeful even in difficult times. Response options to the 4 items are: none of the time, some of the time, most of the time, or all of the time. To meet each individual indicator, a response of either most of the time or all of the time was required.
Table 2. Weighted Flourishing Among Young Children Aged 6 Months to 5 Years in the United States by Composite Overall and Individual Physical and Mental Parental Health.
| Parental health status | Not flourishing, index score 0-3 | Flourishing, index score 4 | Unadjusted odds ratio (95% CI) | Adjusted odds ratio (95% CI)a |
|---|---|---|---|---|
| Composite overall parental health | ||||
| High | 2008 (35.0) | 14 571 (52.0) | 1 [Reference] | 1 [Reference] |
| Medium | 1452 (25.0) | 5717 (20.0) | 0.55 (0.46-0.65) | 0.80 (0.67-0.96) |
| Low | 1710 (40.0) | 5454 (28.0) | 0.48 (0.41-0.57) | 0.83 (0.67-1.03) |
| Mother physical health | ||||
| Excellent/very good | 2882 (53.0) | 18 247 (68.0) | 1 [Reference] | 1 [Reference] |
| Good | 1297 (23.0) | 4542 (17.0) | 0.58 (0.59-0.68) | 0.81 (0.67-0.97) |
| Poor/very poor | 557 (13.0) | 1366 (6.9) | 0.42 (0.33-0.55) | 0.68 (0.49-0.95) |
| Absent mother | 434 (11.0) | 1587 (8.3) | 0.56 (0.43-0.74) | 0.95 (0.69-1.30) |
| Mother mental health | ||||
| Excellent/very good | 2526 (50.0) | 16 962 (66.0) | 1 [Reference] | 1 [Reference] |
| Good | 1430 (25.0) | 5237 (17.0) | 0.54 (0.45-0.64) | 0.70 (0.58-0.84) |
| Poor/very poor | 780 (14.0) | 1956 (8.8) | 0.49 (0.39-0.61) | 0.93 (0.71-1.23) |
| Absent mother | 434 (11.0) | 1587 (8.3) | 0.55 (0.42-0.72) | 0.94 (0.68-1.29) |
| Father physical health | ||||
| Excellent/very good | 2574 (45.0) | 16 584 (59.0) | 1 [Reference] | 1 [Reference] |
| Good | 1053 (18.0) | 4359 (16.0) | 0.66 (0.55-0.80) | 0.86 (0.70-1.06) |
| Poor/very poor | 426 (8.9) | 1226 (5.4) | 0.46 (0.35-0.62) | 0.59 (0.40-0.87) |
| Absent father | 1117 (28.0) | 3573 (20.0) | 0.54 (0.45-0.65) | 0.84 (0.66-1.07) |
| Father mental health | ||||
| Excellent/very good | 2618 (49.0) | 16 875 (62.0) | 1 [Reference] | 1 [Reference] |
| Good | 949 (15.0) | 3834 (13.0) | 0.67 (0.55-0.81) | 0.88 (0.72-1.07) |
| Poor/very poor | 486 (8.1) | 1460 (5.9) | 0.58 (0.43-0.77) | 0.86 (0.58-1.29) |
| Absent father | 1117 (28.0) | 3573 (20.0) | 0.56 (0.47-0.68) | 0.87 (0.68-1.11) |
Adjusted for caregiver education, family resilience, parental coping, parental aggravation, and emotional support.
Discussion
Mother’s reported physical health status was associated with flourishing among young children in the US. Further investigation into the interplay of parent health, family unit, and social determinants of health such as education, income, and caregiver support are warranted. Limitations include single period, caregiver reported, and exclusion of children in long-term facilities.
Data Sharing Statement
References
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