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Hardship-Free Households Are Associated With Optimal Caregiver and Child Health
Journal article   Open access   Peer reviewed

Hardship-Free Households Are Associated With Optimal Caregiver and Child Health

Richard Sheward, Stephanie Ettinger de Cuba, Diana B. Cutts, Deborah A. Frank, Ana Poblacion, Eduardo Ochoa, Félice Lê-Scherban, Maureen M. Black, Sharon M. Coleman, Timothy C. Heeren, …
AJPM Focus, v 5(1), pp 100422-100422
01 Feb 2026
DOI: https://doi.org/10.1016/j.focus.2025.100422
PMID: 41159066
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/j.focus.2025.100422View
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Abstract

Child health Food insecurity Health disparities Low-income families Material hardships Social determinants of health
•Hardship-free households show significantly better child and caregiver health outcomes.•There are gradient effect across hardship levels (0 hardship -> 1 hardship -> ≥2 hardships) for most outcomes.•Study should shift focus from a deficit-based to a strengths-based approach to hardships.•Findings support multifaceted hardship prevention over targeted interventions alone.•Safety-net programs are important but do not fully mediate hardship–health relationships. Families living with low incomes experience a higher risk of material hardships associated with poor health. To understand the potentially protective role of hardship-free households, the authors examined associations between the absence of material hardships among families with low incomes and child health and healthcare utilization and caregiver health outcomes. Researchers interviewed a sentinel sample of caregivers of publicly insured children aged <4 years in hospital settings in 5 U.S. cities (2012–2017). Exposure to material hardships (food insecurity, housing instability, healthcare hardship, and energy insecurity) was categorized as 0, 1, or ≥2 hardships. Outcome measures included child health (overall and oral health), anthropometrics, developmental risk, lifetime hospitalizations, composite well-child measure, caregiver health, and depressive symptoms. Multivariable logistic regression models examined the associations between hardships and child and caregiver health. Among 16,320 families, 41.0% experienced 0 hardships, 28.2% experienced 1 hardship, and 30.8% experienced ≥2 hardships. After covariate control, children from hardship-free households experienced lower adjusted odds of lifetime hospitalizations, fair/poor health, fair/poor oral health, developmental risk, and higher odds of wellness than children from household that experienced ≥2 hardships, and caregivers had lower odds of fair/poor health and depressive symptoms. Children and their caregivers from households with 1 hardship showed lower adjusted odds of lifetime hospitalizations, fair/poor health, fair/poor oral health, and higher odds of wellness than those from household that experienced ≥2 hardships, and caregivers had lower odds of fair/poor health and depressive symptoms. Living without material hardships may contribute to positive physical and developmental/behavioral health among children and caregivers. Findings support the importance of policies to decrease material hardships among families with low incomes. [Display omitted]

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#10 Reduced Inequalities
#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Public, Environmental & Occupational Health
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