Patterns of Time Use among 12-Year-Old Children and Their Life Satisfaction: A Gender and Cross-Country Comparison.

Despite the importance of children's time use to their quality of life, relatively few international comparative studies have focused on the patterns of children's time use and their relationship with quality of life. This study, therefore, aimed to examine the typologies of time use among 12-year-old children by gender and their relationship with their quality of life. We used the second wave of data from the International Survey of Children's Well-Being collected from 16 countries. Children's time use, gender, satisfaction with time use, and life satisfaction were included as the key variables. Latent class analysis using MPLUS 7.0 was utilized. Gender differences in the classification of time-use patterns were identified. Three latent classes (G1, G2, and G3) were identified for girls. Overall high activity group (G1) had the highest level of satisfaction, whereas family helpers (G3) had the lowest level of satisfaction with their time use and life in general. Boys, however, were classified into four classes (B1, B2, B3, and B4). Overall high activity group (B4) had the highest levels of satisfaction with their time use and life in general. The results show that children who actively engage in various activities experience the most satisfaction with their lives and time. Substantial gender differences in time use, particularly around typical gender roles (e.g., housework and family caring), are noteworthy. Programs and policies that encourage children to reduce digital time and enhance activities in other areas are also discussed.

Social networks and health-promoting behaviors among North Korean refugees in South Korea.

Poor health behaviors among North Korean refugees (NKRs) in South Korea are serious risk factors hindering their overall well-being. Despite their significance, little is known about the roles of social networks in promoting health behaviors of NKRs. Thus, we examined how social network characteristics were associated with health-promoting behaviors among 202 NKRs. We found that social networks featuring members of religious organizations were positively associated with overall health-promoting behaviors, health responsibility, exercise, and nutrition, whereas networks with South Korean friends were negatively associated with nutrition. Findings suggest that health interventions facilitating religion-based network ties may promote health behaviors among NKRs.

How Do Time Use and Social Relationships Affect the Life Satisfaction Trajectory of Korean Adolescents?

This study investigated the life satisfaction trajectory of Korean adolescents, and factors associated with changes in life satisfaction. Specifically, we focused on how changes in time use and social relationships were associated with changes in life satisfaction. Using three waves of the Korean Children and Youth Panel Survey, we conducted a series of multilevel growth curve modeling analyses. The results indicate that Korean adolescents' life satisfaction decreased over a three-year period, and that time spent on leisure and sleeping were both significant predictors of changes in life satisfaction. Life satisfaction decreased at a slower rate for adolescents whose relationships with peers and teachers positively increased over time. Findings highlight the importance of ensuring adequate amount of sleep and providing various opportunities for leisure activities in improving Korean adolescents' life satisfaction. Furthermore, social relationships, specifically with teachers and peers should be the focus of prevention and intervention for adolescents to maintain and improve their level of life satisfaction.

Young Adult Unemployment and Later Depression and Anxiety: Does Childhood Neighborhood Matter?

Young adulthood represents a developmental period with disproportionately heightened risk of losing a job. Young adult unemployment has been linked to increased mental health problems, at least in the short term. However, their possible long-term impacts, often referred as "scarring effects," have been understudied, possibly underestimating the magnitude of mental health burden that young adult unemployment generates. This longitudinal study examined whether duration of unemployment during young adulthood is associated with later mental health disorders, after accounting for mental and behavioral health problems in childhood. Furthermore, the current study investigated whether childhood neighborhood characteristics affect this association and if so, in what specific functional ways. Data were drawn from a longitudinal study of developmental outcomes in a community sample in Seattle. Data collection began in 1985 when study participants were elementary students and involved yearly assessments in childhood and adolescence (ages 10-16) and then biennial or triennial assessments (ages 18-39; N = 677 at age 39; 47% European American, 26% African American, 22% Asian American, and 5% Native American; 49% female). The current study findings suggest that duration of unemployment across young adulthood increased mental health problems at age 39, regardless of gender. Childhood neighborhood characteristics, particularly their positive aspect, exerted independent impacts on adult mental health problems beyond unemployment experiences across young adulthood. The current findings indicate a needed shift in service profiles for unemployed young adults-a comprehensive approach that not only facilitates reemployment but also addresses mental health needs to help them to cope with job loss. Further, the present study findings suggest that childhood neighborhoods, particularly positive features such as positive neighborhood involvement, may represent concrete and malleable prevention targets that can curb mental health problems early in life.

Effects of welfare and maternal work on recommended preventive care utilization among low-income children.

OBJECTIVES: We examined how maternal work and welfare receipt are associated with children receiving recommended pediatric preventive care services. METHODS: We identified American Academy of Pediatrics-recommended preventive care visits from medical records of children in the 1999-2004 Illinois Families Study: Child Well-Being. We used Illinois administrative data to identify whether mothers received welfare or worked during the period the visit was recommended, and we analyzed the child visit data using random-intercept logistic regressions that adjusted for child, maternal, and visit-specific characteristics. RESULTS: The 485 children (95%) meeting inclusion criteria made 41% of their recommended visits. Children were 60% more likely (adjusted odds ratios [AOR` = 1.60; 95% confidence interval [CI] = 1.27, 2.01) to make recommended visits when mothers received welfare but did not work compared with when mothers did not receive welfare and did not work. Children were 25% less likely (AOR = 0.75; 95% CI = 0.60, 0.94) to make preventive care visits during periods when mothers received welfare and worked compared with welfare only periods. CONCLUSION: The Temporary Assistance for Needy Families maternal work requirement may be a barrier to receiving recommended preventive pediatric health care.

State Medicaid policies and the health care access of low-income children with special health care needs living in the American South.

BACKGROUND: The policy correlates that improve or impede the health care access of children with special health care needs (CSHCN), and particularly children living in the South, are not well understood. METHODS: We analyzed data from the 2005-2006 National Survey of CSHCN (n = 4560 Southern children and 8788 non-Southern children). State Medicaid policy predictors included the frequency of Medicaid eligibility renewals (6 or 12 months) and the level of reimbursement provided for high-complexity and moderate-complexity pediatric office visits. Hierarchical generalized linear modeling was used to examine the association between state Medicaid policy features and 5 indicators of health care access (delayed or foregone care, difficulty using services, difficulty getting referrals, unmet routine care needs, and unmet specialty care needs), after controlling for child, family, and state factors. RESULTS: Low-income Southern CSHCN who lived in states with less-frequent Medicaid eligibility renewal requirements and higher health care provider reimbursement rates had significantly better health care access than did their Southern counterparts in states with more-frequent Medicaid eligibility renewals and lower reimbursement rates. LIMITATIONS: These data are cross-sectional, and causality cannot be inferred. CONCLUSION: Policymakers interested in addressing state budget gaps should be concerned that doing so by increasing the frequency of Medicaid eligibility renewals or by cutting health care provider reimbursement rates may well result in adverse health care access for low-income Southern CSHCN.

State-level income inequality and family burden of U.S. families raising children with special health care needs.

Growing evidence supports the hypothesis that income inequality within a nation influences health outcomes net of the effect of any given household's absolute income. We tested the hypothesis that state-level income inequality in the United States is associated with increased family burden for care and health-related expenditures for low-income families of children with special health care needs. We analyzed the 2005-06 wave of the National Survey of Children with Special Health Care Needs, a probability sample of approximately 750 children with special health care needs in each state and the District of Columbia in the US Our measure of state-level income inequality was the Gini coefficient. Dependent measures of family caregiving burden included whether the parent received help arranging or coordinating the child's care and whether the parent stopped working due to the child's health. Dependent measures of family financial burden included absolute burden (spending in past 12 months for child's health care needs) and relative burden (spending as a proportion of total family income). After controlling for a host of child, family, and state factors, including family income and measures of the severity of a child's impairments, state-level income inequality has a significant and independent association with family burden related to the health care of their children with special health care needs. Families of children with special health care needs living in states with greater levels of income inequality report higher rates of absolute and relative financial burden.

Welfare, maternal work, and on-time childhood vaccination rates.

OBJECTIVE: To examine effects of Temporary Assistance for Needy Families welfare cash assistance and maternal work requirements on "on-time" childhood vaccination rates. METHODS: A stratified random sample of Illinois children from low-income families affected by welfare reform was monitored from 1997 to 2004. Medical records from pediatricians' offices and Medicaid claims data were used to identify the timeliness of 18 recommended vaccinations. Random-intercept logistic models were used to estimate on-time vaccine administration as a function of welfare receipt and maternal work with adjustment for characteristics of the children and mothers and time-varying covariates pertaining to the administration window for each recommended vaccine dose. RESULTS: Of all recommended vaccinations, 55.9% were administered on time. On-time vaccination rates were higher when families were receiving welfare than not (57.4% vs 52.8%). Children in families that either were receiving welfare or had working mothers were 1.7 to 2.1 times more likely to receive vaccinations on time compared with children in families that were not receiving welfare and did not have working mothers. When vaccine doses were stratified according to welfare status, maternal work was associated with decreased on-time vaccination rates (odds ratio: 0.73 [95% confidence interval: 0.59-0.90]) when families received welfare but increased on-time vaccination rates (odds ratio: 1.68 [95% confidence interval: 1.27-2.22]) when they did not receive welfare. CONCLUSIONS: These results indicate that maternal work requirements of Temporary Assistance for Needy Families had negative effects on timely administration of childhood vaccinations, although receipt of welfare itself was associated with increased on-time rates.

The impact of health-promoting behaviors on low-income children's health: a risk and resilience perspective.

This study's objective was to examine whether five child health-promoting behaviors by caregivers would be associated with caregivers' assessments of their children's health as "excellent," controlling for an array of risk factors for adverse health outcomes. The study used the third and fourth waves of the Illinois Families Study--Child Well-being Supplement--a four-year panel study examining the impact of welfare reform on the well-being of the youngest children of current and former welfare recipients. Logistic regression techniques were used. The analytic results show that low-income children whose caregivers exercise child health-promoting behaviors (for example, mealtime routines, dental hygiene practices, safety practices), with the exception of having a regular bedtime, are more likely to be reported as having excellent health than their low-income counterparts. Moreover, a statistically significant cumulative effect above and beyond the individual effects of health-promoting behaviors was found. The findings suggest that child health-promoting behaviors by caregivers can make a difference in promoting better health for low-income children. Although large systemic changes (for example, changes in health care policy) are needed to reduce overall health disparities and to enhance health for all members of society, individual health-promoting behaviors may lead to incremental improvements in low-income children's health.

Suppression of racial disparities for children with special health care needs among families receiving Medicaid.

This study examines whether the US public health insurance program Medicaid suppresses racial disparities in parental identification of service needs of their children with special health care needs (CSHCN). We analyze data from the 2001 US National Survey of CSHCN (n = 14,167 children). We examine three outcomes which were parental identification of (a) the child's need for professional care coordination, (b) the child's need for mental health services, and (c) the family's need for mental health services. A suppression analysis, which is a form of mediation analysis, was conducted. Our results show a disparity, reflected in a negative direct effect of race for all three outcomes: Black parents of CSHCN are less likely to report a need for services than White parents of CSHCN and Medicaid coverage was associated with reduced racial disparities in reporting the need for services. These analyses suggest receipt of Medicaid is associated with a suppression of racial disparities in reported need for services.

Children with co-occurring anxiety and externalizing disorders: family risks and implications for competence.

This study used data from 340 mother-child dyads to examine characteristics of children with co-occurring diagnoses of anxiety and externalizing disorders and compared them with children with a sole diagnosis or no diagnosis. Comparisons were made using 4 child-diagnostic groups: anxiety-only, externalizing-only, co-occurrence, and no-problem groups. Most mothers were characterized by low income and histories of psychiatric diagnoses during the child's lifetime. Analyses using multinomial logistic regressions found the incidence of co-occurring childhood disorders to be significantly linked with maternal affective/anxiety disorders during the child's lifetime. In exploring implications for developmental competence, we found the co-occurrence group to have the lowest level of adaptive functioning among the 4 groups, faring significantly worse than the no-problem group on both academic achievement and intelligence as assessed by standardized tests. Findings underscore the importance of considering co-occurring behavior problems as a distinct phenomenon when examining children's developmental outcomes.

Material hardship and the physical health of school-aged children in low-income households.

OBJECTIVES: We examined the relationship between material hardship reported by low-income caregivers and caregivers' assessments of their children's overall health. METHODS: We used logistic regression techniques to analyze data from 1073 children aged 5 through 11 years whose caregivers participated in multiple waves of the Illinois Families Study. RESULTS: Caregivers' reports of food hardship were strongly associated with their assessments of their children's health. Other sources of self-reported material hardship were also associated with caregivers' assessments of their children's health, but the effects disappeared when we controlled for caregiver physical health status and mental health status. Proximal measures of material hardship better explained low-income children's health than traditional socioeconomic measures. There were no statistically significant cumulative effects of material hardships above and beyond individual hardship effects. CONCLUSIONS: Our findings highlight the importance of developing and supporting programs and policies that ensure access to better-quality food, higher quantities of food, and better living conditions for low-income children, as well as health promotion and prevention efforts targeted toward their primary caregivers as ways to reduce health disparities for this population.

Family Economic Well-Being Following the 1996 Welfare Reform: Trend Data from Five Non-Experimental Panel Studies.

This analysis summarizes trends in family economic well-being from five non-experimental, longitudinal welfare-to-work studies launched following the passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). The studies include a sizable group of parents and other caregivers who received TANF at the point of sample selection or shortly thereafter, and share a wide range of similar measures of economic well-being. This analysis provides descriptive information on how these families are faring over time. Our results confirm what has been found by previous studies. Many families remain dependent on public benefits, and are either poor or near-poor, despite gains in some indicators of economic well-being. We caution that these aggregate statistics may mask important heterogeneity among families.

Welfare, Work, and Health Care Access Predictors of Low-Income Children's Physical Health Outcomes.

This analysis examines whether young children's (N= 494) general physical health is associated with parental employment, welfare receipt, and health care access within a low-income population transitioning from welfare to work. A latent physical health measure derived from survey and medical chart data is used to capture children's poor health, and parental ratings of child health are used to identify excellent health. Controlling for a host of factors associated with children's health outcomes, results show that children of caregivers who are unemployed and off welfare have better health than children of caregivers who are working and off welfare. Children whose caregivers are unemployed and on welfare, or combining work and welfare, have health outcomes similar to children of caregivers who are working and off welfare. Health care access characteristics, such as gaps in health insurance coverage, source of primary care setting, and type of health insurance are associated with children's general physical health. Implications of these results for state TANF programs are discussed.

Understanding the risks of child neglect: an exploration of poverty and parenting characteristics.

A strong association between poverty and child neglect has been established, but the mechanisms that explain this relationship have not been clearly articulated. This research takes advantage of survey and child maltreatment administrative data about families with young children and assesses the influence of poverty and parenting characteristics on subsequent child neglect. The authors find that indicators of poverty, such as perceived material hardship and infrequent employment, and parenting characteristics, such as low parental warmth, use of physical discipline, and allowing a child to engage in frequent television viewing, are predictive of child neglect. Parenting characteristics do not appear to mediate the link between perceived hardship and neglect, although they suppress the link between employment and neglect. Results from this study provide information that is highly relevant to the approach and design of child maltreatment prevention and intervention strategies.