Kammi K. Schmeer

Health insurance and child mortality in Costa Rica

This study uses a natural experiment approach to evaluate the effect of health insurance on infant and child mortality. In the 1970s Costa Rica adopted national health insurance, which expanded childrens insurance coverage from 42 percent in 1973 to 73 percent by 1984. Aggregate infant and child mortality rates dropped rapidly during this period, but this trend had begun prior to the insurance expansion, and may be related to other changes during this period. We use county-level vital statistics and census data to isolate the causal insurance effect on mortality using county fixed effects models. We find that insurance increases are strongly related to mortality decreases at the county level before controlling for other time-varying factors. However, after controlling for changes in other correlated maternal, household, and community characteristics, fixed effects models indicate that the insurance expansion could have explained only a small portion of the mortality change. These results question the proposition that health insurance can lead to large improvements in infant and child mortality, and that expanding insurance to the poor can substantially narrow socioeconomic differentials in mortality.

Father absence due to migration and child illness in rural Mexico

Little research to date has assessed the importance of the presence of fathers in the household for protecting child health, particularly in developing country contexts. Although divorce and non-marital childbearing are low in many developing countries, migration is a potentially important source of father absence that has yet to be studied in relation to child health. This study utilizes prospective, longitudinal data from Mexico to assess whether father absence due to migration is associated with increased child illness in poor, rural communities. Rural Mexico provides a setting where child illness is related to more serious health problems, and where migration is an important source of father absence. Both state- and individual-level fixed effects regression analyses are used to estimate the relationship between father absence due to migration and child illness while controlling for unobserved contextual and individual characteristics. The state-level models illustrate that the odds of children being ill are 39% higher for any illness and 51% higher for diarrhea when fathers are absent compared with when fathers are present in the household. The individual-level fixed effects models support these findings, indicating that, in the context of rural Mexico, fathers may be important sources of support for ensuring the healthy development of young children.

Early childhood economic disadvantage and the health of Hispanic children

This research provides a longitudinal view of early childhood economic deprivation and its associations with health among young Hispanic children born in the United States. Of additional interest is whether economic deprivation is associated with child health similarly across all Hispanic children or whether associations differ by maternal nativity or country of origin. Fragile Families and Child Wellbeing data and multinomial logistic regression are used to estimate the effects of total years in poverty, material hardship, and lack of health insurance on Hispanic childrens health status at age 5 and change in health status between ages 1 and 5. Results show that multiple measures of early childhood economic deprivation have additive negative associations with Hispanic child health, and that living more years in poverty is associated with declining health status among young Hispanic children. Interaction effects indicate that early childhood poverty has stronger associations with lower age 5 health status and declining health between ages 1 and 5 for children with foreign-born Hispanic mothers than for those with native-born Hispanic mothers. No differences were found in the associations between economic deprivation and child health by maternal country of origin. These results suggest an important role of economic resources for protecting Hispanic child health, and that poor Hispanic children with immigrant mothers may be at particularly high risk of developing health problems as they move out of infancy and into early childhood.

Intra-population variation in anemia status and its relationship to economic status and self-perceived health in the Mexican Family Life Survey: implications for bioarchaeology.

Recently scholars have advocated for the use of a critical biocultural approach in bioarchaeology, where osteological and dental markers of stress are used to understand the broader biosocial context of past populations. However, the ability to accomplish this task rests on the assumption that ultimate-level environmental stressors and well-being in the past can be reconstructed from the prevalence of pathologies in skeletal collections. Here we test this assumption using anemia prevalence in the Mexican Family Life Survey. Specifically we test three hypotheses: (1) that individuals sharing the same household are more likely to share anemia status; (2) anemia status is a predictor of economic status (a common proxy for broader environmental context); and (3) anemia status is related to self-rated health. Results demonstrate that: anemia status was not commonly shared between household members; there was a significant overlap in economic status between anemic and nonanemic individuals (i.e., anemia poorly predicted economic status) and; while anemia status was associated with self-perceived health, the majority of those who reported poor health were nonanemic while a significant number of those who reported very good health were anemic. We argue that these findings are likely related to variation in individual frailty, which is shaped by biological and cultural risk factors. Therefore, we advocate for greater incorporation of individual frailty into bioarchaeological investigations, and, in effort to overcome some of the difficulties associated with this task, increased use of data from living populations and greater collaboration between bioarchaeologists and human biologists.

Household Income during Childhood and Young Adult Weight Status Evidence from a Nutrition Transition Setting

This article explores whether household income at different stages of childhood is associated with weight status in early adulthood in a nutrition transition setting (a developing country with both underweight and overweight populations). I use multinomial logistic regression to analyze prospective, longitudinal data from Cebu, Philippines. Results suggest that increasing prenatal income is associated with lower risk of being underweight at age 21, while increasing income during childhood is associated with an increased risk of being overweight at age 21. When gender differences are considered, prenatal income has an important protective effect against the risk of being overweight for girls. For boys, prenatal income has little effect on overweight status, but early childhood income increases their risk of becoming overweight. For both boys and girls, income in mid-childhood (ages 9–12) is associated with a particularly high risk of becoming overweight by age 21, net of earlier income. These results suggest that, in this nutrition transition setting, childhood income operates through complex developmental and behavioral mechanisms to affect early adult overweight status; and that increasing household income after birth may do little to prevent underweight status in early adulthood.

Socioeconomic status inequalities in low-grade inflammation during childhood

Background Family socioeconomic status (SES) is an important source of child health disparities in the USA. Chronic stress is one way SES may impact childrens physiology with implications for later health inequalities. These processes may work differently across childhood due to differences in exposure and susceptibility to stressors at different ages. We assess associations between family SES and one biomarker of chronic stress exposure—low-grade inflammation detected by elevated C reactive protein (CRP)—and evaluate differences in the associations by child age. Methods We used nationally representative data from the National Health and Nutrition Examination Survey and Tobit regression models to estimate SES associations with CRP and the moderating effects of age for children age 2–18 years. Our sample was limited to CRP ≤10 mg/l to focus on low-grade inflammation (N=13 165). Results Children whose parent had less than a high school degree had 35% higher CRP than those with a college graduate parent; and, poor children had 24% higher CRP than those with high family income, net of controls. When childrens body mass index was accounted for, low education and poverty associations were reduced to 19% and 15%, respectively. Child age interactions were negative and significant for both parental education and family income. Conclusions This study provides new evidence that SES is associated with low-grade inflammation in children, and that these associations may be particularly strong during early and mid-childhood. Future research should further our understanding of stressors related to low family SES that may lead to immune system dysregulation during childhood.

Maternal resources and household food security: evidence from Nicaragua.

OBJECTIVE Women (especially mothers) are theorized as critical to reducing household food insecurity through their work and caregiver roles. The present study tests these assumptions, assessing how maternal economic and social resources are associated with food insecurity in households with young children. DESIGN Data from a population-based sample of households was collected in León, Nicaragua (n 443). Data include a newly validated measure of household food insecurity (ELCSA), maternal resource measures, and household economic status and demographics. Regression analysis tests the statistical associations (P<0·05) of maternal resources with household, adult-specific and child-specific food insecurity. SETTING Municipality of León, Nicaragua. SUBJECTS Households with children aged 3-11 years in rural and urban León. RESULTS Only 25% of households with young children were food secure, with 50% mildly food insecure and 25% moderately/severely food insecure. When mothers contributed substantially to household income, the odds of moderate/severe household food insecurity were 34% lower than when their spouse/partner was the main provider. The odds of food insecurity were 60% lower when mothers managed household money, 48% lower when mothers had a secondary (v. primary) education, 65% higher among single mothers and 16% lower with each indicator of social support. Results were similar for adult- and child-specific food insecurity. CONCLUSIONS This research provides new evidence that maternal economic and social resources are important for reducing household food insecurity and adult- and child-specific food insecurity. Womens social status, social support and access to economic resources need to be enhanced as a part of policies aimed to reduce food insecurity in high-poverty settings.

Union Type and Depressive Symptoms Among Mexican Adults

Diversity in union type is increasing around the world as cohabitation and higher order unions become more prevalent in developing and developed countries. This necessitates a more nuanced understanding of how different union types relate to individual well-being across social settings. In this study, the authors analyze nationally-representative data from Mexico in cross-sectional and change models to evaluate differences in depressive symptoms across union type (marital vs. cohabiting and first vs. higher order unions) among Mexican men and women. The findings suggest that cohabiting unions do not provide the same mental health benefits as marital unions (especially for men). Repartnering is also associated with higher depressive symptoms (especially for women), which indicates possible lasting mental health disadvantages of divorce/separation or entrance into lower quality second unions. These results suggest that the changing family context in Mexico, which includes increasing cohabitation and union instability, may have important consequences for individuals’ psychological well-being.

Household food insecurity and child health

Abstract Food insecurity, the lack of consistent access to sufficient quality and quantity of food, affects an estimated 800 million people around the world. Although household food insecurity is generally associated with poor child nutrition and health in the USA, we know less about household food insecurity and child health in developing countries. Particularly lacking is research assessing how associations between household food insecurity and childrens health outcomes may differ by child age and among children beyond age 5 years in low‐income settings. We use data from a population‐based sample of households with children ages 3–11 years (N = 431) in León, Nicaragua to consider how household food insecurity is associated with three measures of child health: illness, anaemia and low height‐for‐age. Our results provide new evidence that even mild household food insecurity is detrimental to childrens health; and that child age conditions the associations between household food insecurity and child health. We find that food insecurity is especially harmful to health during early childhood, but continues to have significant associations with health into middle childhood (up to ages 7–8 years). We discuss the potential implications of these results for future child health research and policies in low‐income countries.

Union transitions and changes in BMI among adults in Mexico.

This study utilizes nationally representative, longitudinal data from the Mexico Family Life Survey to examine the associations between union transitions and changes in body mass index (BMI) among adults in Mexico. Results from change score regression models (N = 11,339) indicate larger BMI gains for those entering a union than for those remaining single, net of baseline weight status and socioeconomic controls. Further, a significant moderating effect of baseline weight status suggests that overweight individuals entering a union gain almost two BMI points more than overweight single individuals during this three-year period. Individuals experiencing a union dissolution gain less BMI than those entering a union, but are predicted to lose BMI (as found in the United States) only if they are overweight before the transition.