Healthcare-Related Financial Burden among Families in the U.S.: The Role of Childhood Activity Limitations and Income.

This study examined the impact of childhood activity limitations on family financial burden in the U.S. We used ten complete panels (1996-2006) of the Medical Expenditure Panel Survey (MEPS) to evaluate the burden of out-of-pocket healthcare expenditures for 17,857 families with children aged 0-17 years. Multivariate generalized linear models were used to examine the relationship between childhood activity limitation status and both absolute and relative financial burden. Families of children with limitations had higher absolute out-of-pocket healthcare expenditures than families of children without limitations ($594.36 higher; p<0.05), and were 54% more likely to experience relative burden (p<0.05). Substantial socioeconomic disparities in financial burden were observed. Policies are needed to enable these families to access appropriate and affordable healthcare services.

Stress-mediated quality of life outcomes in parents of childhood cancer and brain tumor survivors: a case-control study.

PURPOSE: To determine if caring for a child with cancer or a brain tumor affects parental health and mental health and if and to what extent stress mediates the relationship between case status and parental quality of life. METHODS: In person interviewer-assisted surveys were administered to 74 case dyads (children diagnosed with cancer or a brain tumor and their parents) and 129 control dyads (children without health problems and their parents from a community sample) to assess health-related quality of life and perceived levels of stress. RESULTS: Parents of children with cancer or a brain tumor had significantly worse health-related quality of life, including worse overall mental health. Overall physical health was no different between cases and controls. Staged multivariate analysis revealed that worse health-related quality of life is completely mediated by perceived stress in these parents. CONCLUSIONS: The experience of caring for a child with cancer is not in itself related to poor quality of life, but is related to an increased level of stress that may adversely impact parental mental health and quality of life.

Child disability screening, nutrition, and early learning in 18 countries with low and middle incomes: data from the third round of UNICEF's Multiple Indicator Cluster Survey (2005-06).

BACKGROUND: Child disability is an emerging global health priority. To address the need for internationally comparable information about the frequency and situation of children with disabilities, UNICEF has recommended that countries include the Ten Questions screen for disability in the Multiple Indicator Cluster Survey (MICS) programme. We examined child disability screening and its association with nutrition and early learning in countries with low and middle incomes. METHODS: Cross-sectional data for the percentage of children screening positive for or at risk of disability were obtained for 191 199 children aged 2-9 years in 18 countries participating in the third round of MICS in 2005-06. Screening results were descriptively analysed according to sociodemographic, nutritional, early-learning, and schooling variables. We constructed a weighted analysis to account for the sampling design in every country and tested for differences within countries using chi(2) analyses. FINDINGS: A median 23% (range 3-48) of children aged 2-9 years screened positive for disability in the 18 participating countries. For children aged 2-4 years, screening positive for disability was significantly more likely in children who were not breastfed versus those who were (median 36% [9-56] vs 26% [4-51]) in eight of 18 countries, in children who had not received vitamin A supplementation versus those who had (36% [7-53] vs 29% [4-50]) in five of ten countries assessed, in children who met criteria for stunting (26% [6-54]) or being underweight (36% [3-61]) versus those who did not (25% [3-42] and 26% [4-43], respectively) in five of 15 countries assessed for stunting and in seven of 15 countries assessed for being underweight, and in those who participated in few early-learning activities versus others (31% [7-54] vs 24% [4-51]) in eight of 18 countries. Children aged 6-9 years who did not attend school screened positive for disability more often than did children attending school (29% [2-83] vs 22% [3-47]) in eight of 18 countries. INTERPRETATION: Our results draw attention to the need for improved global capacity to assess and provide services for children at risk of disability. Further research is needed in countries with low and middle incomes to understand and address the role of nutritional deficiencies and restricted access to learning opportunities as both potential antecedents of childhood disability and consequences of discrimination. FUNDING: UNICEF; Department of Population Health Sciences, University of Wisconsin-Madison, USA.

The impact of childhood activity limitations on parental health, mental health, and workdays lost in the United States.

OBJECTIVE: The aim of this study was to determine if and to what extent the onset and persistence of childhood activity limitations (ongoing, resolved, or newly reported) resulted in subsequent adverse health, mental health, and work attendance outcomes among parents in the United States. METHODS: A study was conducted using 10 panels (1996-2005) of the Medical Expenditure Panel Survey (MEPS), a household survey of a nationally representative sample of the civilian noninstitutionalized population in the United States. Participants in this study were 18 827 parents and their children aged 0 to 17 years. RESULTS: During the 2-year study period, 15.6% of parents reported caring for a child aged 0 to 17 years with a limitation. Parents of children with any activity limitation were significantly more likely to experience subsequent poor health and mental health. Parents of children with ongoing or newly reported limitations had an increased number of lost workdays as compared with parents of children without limitations. Moreover, caring for multiple children with activity limitations was predictive of adverse parental mental health outcomes. Parents of children with ongoing activity limitations had significantly increased odds of poor mental health compared with parents of children with resolved limitations. CONCLUSIONS: Caring for a child with activity limitations affects the health, mental health, and work attendance of parents. These findings indicate that child health can importantly influence the health and work behavior of the family and that health care providers should consider a family-centered approach to care.