Nancy E. Reichman

Fragile Families: sample and design

Abstract This paper provides important background information on the Fragile Families and Child Wellbeing Study, and is the first and only paper to provide detailed information on the research methodology and sampling strategies employed. The bulk of the paper is devoted to a detailed description of the three-stage sampling process that was used to obtain a nationally representative sample of non-marital births in large US cities. First, it was necessary to sample cities that, collectively, were nationally representative and had maximum variation in policy regimes. Next, it was necessary to sample hospitals so as to be representative of non-marital births in each city. Finally, we sampled births in order to be representative of those at each hospital. The paper concludes with some general information about the study and a simple description of the baseline non-marital sample from the first seven cities.

Low Birth Weight and School Readiness

In the United States black women have for decades been twice as likely as white women to give birth to babies of low birth weight who are at elevated risk for developmental disabilities. Does the black-white disparity in low birth weight contribute to the racial disparity in readiness? The author summarizes the cognitive and behavioral problems that beset many low birth weight children and notes that not only are the problems greatest for the smallest babies, but black babies are two to three times as likely as whites to be very small. Nevertheless, the racial disparities in low birth weight cannot explain much of the aggregate gap in readiness because the most serious birth weight-related disabilities affect a very small share of children. The author estimates that low birth weight explains at most 3-4 percent of the racial gap in IQ scores. The author applauds the post-1980 expansions of Medicaid for increasing rates of prenatal care use among poor pregnant women but stresses that standard prenatal medical care cannot improve aggregate birth outcomes substantially. Smoking cessation and nutrition are two prenatal interventions that show promise. Several early intervention programs have been shown to improve cognitive skills of low birth weight children. But even the most promising programs can narrow the readiness gap only a little because their benefits are greatest for heavier low birth weight children and because low birth weight explains only a small share of the gap. The author stresses the importance of reducing rates of low birth weight generally and of extending to all children who need them the interventions that have improved cognitive outcomes among low birth weight children. But because black infants are more likely to be born at the lowest birth weights, preventing low birth weight—when researchers learn how to—is likely to be more effective than early intervention in narrowing birth weight-related racial gaps in school readiness.

Impact of Child Disability on the Family

Families with disabled children represent a sizeable share of all American households. Living with a disabled child can have profound effects on the entire family, which in turn can affect the health and well-being of the child who is disabled. Much needs to be learned about how children’s health affects their parents, siblings, and other family members and about how family characteristics and resources modify those associations. Numerous programs and organizations provide resources for disabled children and their families, but the system is extremely fragmented and difficult to navigate. This commentary reviews what is known about the effects of child disability on the family, provides an overview of the complex needs of and multitude of resources available to families of disabled children, and concludes with suggested directions for practice, research, and public policy.

Was the economic crisis of 2008 good for Icelanders? Impact on health behaviors

This study uses the 2008 economic crisis in Iceland to identify the effects of a macroeconomic downturn on a range of health behaviors. We use longitudinal survey data that include pre- and post-reports from the same individuals on a range of health-compromising and health-promoting behaviors. We find that the crisis led to large and significant reductions in health-compromising behaviors (such as smoking, drinking alcohol or soft drinks, and eating sweets) and certain health-promoting behaviors (consumption of fruits and vegetables), but to increases in other health-promoting behaviors (consumption of fish oil and recommended sleep). The magnitudes of effects for smoking are somewhat larger than what has been found in past research in other contexts, while those for alcohol, fruits, and vegetables are in line with estimates from other studies. Changes in work hours, real income, financial assets, mortgage debt, and mental health, together, explain the effects of the crisis on some behaviors (such as consumption of sweets and fast food), while the effects of the crisis on most other behaviors appear to have operated largely through price increases.

Psychosocial factors and the timing of prenatal care among women in New Jersey's HealthStart program.

CONTEXT Helping high-risk pregnant women obtain prenatal care early is the main policy goal of most U.S. publicly funded programs aimed at reducing the incidence of low birth weight and infant mortality It is therefore crucial to understand the factors that influence when women initiate prenatal care. METHODS The effects of psychosocial and demographic risk factors on the timing of entry into prenatal care were estimated using data on roughly 90,000 Medicaid recipients who participated in New Jerseys HealthStart prenatal care program. RESULTS Overall, 37% of women began prenatal care in the first trimester. Multivariate logistic regression indicated that women who lived in poor housing conditions and those who smoked, drank or used hard drugs had a reduced likelihood of entering care early (odds ratios, 0.8-0.9), while those who had clinical depression or who experienced domestic violence or abuse had elevated odds of early entry (1.1-1.2). The risk factor with the greatest impact on the timing of prenatal care was the wantedness of the pregnancy; women whose pregnancy was unwanted had dramatically reduced odds of entering care early (0.4). Separate analyses of women of varying racial and ethnic backgrounds demonstrated the differential effects of risk factors, the importance of including ethnicity with race and the universal impact of wantedness across racial and ethnic groups. CONCLUSIONS Entry into prenatal care for at-risk women is affected by factors from multiple domains. It is important for prenatal programs to recognize the complexity of the issue as well as the barriers that different subgroups of women face.

Paternal Age as a Risk Factor for Low Birthweight

OBJECTIVES We examined associations between paternal age and low birth-weight in the US urban population. METHODS Using a population-based sample of 4621 births, we used multiple logistic regression analysis to estimate associations between paternal age and low birthweight, controlling for maternal age, other demographic factors, and the childs gender. RESULTS When the childs gender and the mothers race/ethnicity, birthplace, parity, marital status, and health insurance type were controlled, teenaged fathers were 20% less likely and fathers older than 34 years were 90% more likely than fathers aged 20 to 34 years to have low-birthweight babies. The associations were significant when maternal age was also controlled. No racial/ethnic differences in associations between paternal age and low birthweight were found. CONCLUSIONS We identified paternal age as an independent risk factor for low birthweight in the US urban population, suggesting that more attention needs to be paid to paternal influences on birth outcomes and to the interactive effects of urban environments and individual risk factors on health.

Low Birthweight and Asthma Among Young Urban Children

OBJECTIVES We assessed whether the association between low birthweight and early childhood asthma can be explained by an extensive set of individual- and neighborhood-level measures. METHODS A population-based sample of children born in large US cities during 1998-2000 was followed from birth to age 3 years (N=1803). Associations between low birthweight and asthma diagnosis at age 3 years were estimated using multilevel models. Prenatal medical risk factors and behaviors, demographic and socioeconomic characteristics, and neighborhood characteristics were controlled. RESULTS Low-birthweight children were twice as likely as normal birthweight children to have an asthma diagnosis (34% vs 18%). The fully adjusted association (OR= 2.36; P<.001) was very similar to the unadjusted association (OR= 2.48; P<.001). Rates of renter-occupied housing and vacancies at the census tract-level were strong independent predictors of childhood asthma. CONCLUSIONS Very little of the association between low birthweight and asthma at age 3 can be explained by an extensive set of demographic, socioeconomic, medical, behavioral, and neighborhood characteristics. Associations between neighborhood housing characteristics and asthma diagnosis in early childhood need to be further explored.

Racial and Ethnic Disparities in Low Birthweight Among Urban Unmarried Mothers

ObjectivesWe examined racial and ethnic disparities in low birthweight (LBW) among unmarried mothers and the extent to which demographic, economic, psychosocial, health, health care, and behavioral factors explain those disparities.MethodsUsing a sample of 2,412 non-marital births from a national urban birth cohort study, we estimated multiple logistic regression models to examine disparities in LBW between non-Hispanic white (NHW), non-Hispanic black (NHB), U.S.-born Mexican-origin (USMO), and foreign-born Mexican-origin (FBMO) mothers.ResultsNHW mothers were almost as likely as NHB mothers to have LBW infants. USMO mothers had 60% lower odds and FBMO mothers had 57% lower odds than NHW mothers of having LBW infants. FBMO mothers had no advantage compared to USMO mothers. Controlling for prenatal health and behaviors substantially reduced the LBW advantages for USMO and FBMO mothers. The odds of LBW for NHB mothers relative to NHW mothers increased with the addition of the same covariates.ConclusionsRacial and ethnic disparities in LBW among unmarried mothers—an economically disadvantaged population—do not mirror those in the general population. Prenatal health and behaviors are strongly associated with LBW in this group and explain a sizable portion of the Mexican-origin advantage. The lack of a significant black-white disparity in this group suggests that poverty plays an important role in shaping racial disparities in the general population. The finding that controlling for prenatal health and behaviors widens rather than narrows the racial disparity suggests that efforts to ameliorate black-white disparities in LBW should focus on social and health risks throughout the life course.

Health Across the Life Span in the United States and England

This study systematically compared health indicators in the United States and England from childhood through old age (ages 0-80 years). Data were from the 1999-2006 National Health and Nutrition Examination Survey for the United States (n = 39,849) and the 2003-2006 Health Survey for England (n = 69,084). Individuals in the United States have higher rates of most chronic diseases and markers of disease than their same-age counterparts in England. Differences at young ages are as large as those at older ages for most conditions, including obesity, low high-density lipoprotein cholesterol, high cholesterol ratio, high C-reactive protein, hypertension (for females), diabetes, asthma, heart attack or angina (for females), and stroke (for females). For males, heart attack or angina is higher in the United States only at younger ages, and hypertension is higher in England than in the United States at young ages. The patterns were similar when the sample was restricted to whites, the insured, nonobese, nonsmoking nondrinkers, and specific income categories and when stratified by normal weight, overweight, and obese weight categories. The findings from this study indicate that US health disadvantages compared with England arise at early ages and that differences in the body weight distributions of the 2 countries do not play a clear role.

Sources of Support, Child Care, and Hardship among Unwed Mothers, 1999–2001

Welfare rolls have declined substantially since 1994. However, little is known about the coping strategies that poor mothers use to manage the competing demands of rearing and supporting their children under the new welfare regime. This article uses data from the national Fragile Families and Child Wellbeing study to describe the sources of support and child‐care arrangements upon which unwed mothers relied, as well as the difficulties they faced, approximately 5 years after welfare reform. Findings suggest that levels of hardship among unwed mothers are high and that cohabitation and employment are not associated with improved material conditions.