Chaos as a social determinant of child health: Reciprocal associations?
Chaos as a social determinant of child health: Reciprocal associations?
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DOI：
10.1016/j.socscimed.2013.01.038
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发表时间：
2013-10-01
影响因子：
5.4
通讯作者：
Taylor, Miles
中科院分区：
文献类型：
--
作者：
Dush, Claire M. Kamp;Schmeer, Kammi K.;Taylor, Miles
这项研究通过探索儿童社会环境中一个未被充分研究的方面：混乱，为儿童健康的社会决定因素提供信息。混乱被概念化为儿童发展的拥挤、喧闹、无组织、不可预测的环境（Evans、Eckenrode 和 Marcynyszyn，2010）。我们在儿童生态环境的两个层面——微观系统（家庭）和中观系统（工作-家庭-儿童保育关系）以及幼儿期的两个阶段（3岁和5岁）测量混乱程度。脆弱家庭和儿童福祉研究 (N = 3288) 是一项针对美国大城市的低收入女性及其伴侣的研究，我们利用该研究的数据开发了结构方程模型，用于评估母亲对儿童健康的评价（也在 3 岁和 5 岁进行评估）与潜在的混乱结构之间的关系，以及是否存在重要的相互影响。自回归交叉滞后路径分析表明，在控制了家庭经济状况、家庭结构和孕产妇健康状况等关键混杂因素的情况下，不断增加的混乱（在家庭和孕产妇工作层面）与儿童健康状况恶化有关。儿童健康对混乱几乎没有影响，这进一步支持了以下假设：在相对弱势的儿童样本中，混乱是儿童健康的重要社会决定因素。这表明，通过支持家庭减少家庭和工作/家庭环境中的混乱，可以改善儿童健康，并且随着研究人员超越社会经济地位、种族和家庭结构，探索健康不平等的其他来源，混乱及其直接决定因素可能是未来研究的一个有希望的途径。 (C) 2013 Elsevier Ltd. 保留所有权利。
This study informs the social determinants of child health by exploring an understudied aspect of children's social contexts: chaos. Chaos has been conceptualized as crowded, noisy, disorganized, unpredictable settings for child development (Evans, Eckenrode, & Marcynyszyn, 2010). We measure chaos at two levels of children's ecological environment the microsystem (household) and the mesosystem (work-family-child care nexus) and at two points in early childhood (ages 3 and 5). Using data from the Fragile Families and Child Wellbeing Study (N = 3288), a study of predominantly low-income women and their partners in large US cities, we develop structural equation models that assess how maternal-rated child health (also assessed at ages 3 and 5) is associated with latent constructs of chaos, and whether there are important reciprocal effects. Autoregressive cross-lagged path analysis suggest that increasing chaos (at both the household and maternal work levels) is associated with worse child health, controlling for key confounders like household economic status, family structure, and maternal health status. Child health has little effect on chaos, providing further support for the hypothesis that chaos is an important social determinant of child health in this sample of relatively disadvantaged children. This suggests child health may be improved by supporting families in ways that reduce chaos in their home and work/family environments, and that as researchers move beyond SES, race, and family structure to explore other sources of health inequalities, chaos and its proximate determinants may be a promising avenue for future research. (C) 2013 Elsevier Ltd. All rights reserved.