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Supporting Families: Associations between Neighborhood Support and Child Health OutcomesAugust 24, 2023:
The circumstances of peoples’ lives have great influence over their health, often much more than genetics or access to health care—a concept known as “social determinants of health.” One such social determinant is social capital, which includes the networks of relationships that people rely on for help and to help others to exist and function in society.
We wanted to understand how one measure of social capital—living in a supportive neighborhood—may affect people’s health status and other risk factors. Our study focused on children, using data from the National Survey of Children’s Health (NSCH), which asks parents about their kids’ health, certain risk factors, and questions about their perceptions of social support in their neighborhoods.
Parents reported the extent to which they agreed—from “strongly disagree” to “strongly agree”—with three related questions about giving and receiving help in their neighborhoods. Children were defined as living in a supportive neighborhood if their parents agreed with all three questions and “strongly agree” with at least one of them:
- People in this neighborhood help each other out.
- We watch out for each other's children in this neighborhood.
- When we encounter difficulties, we know where to go for help in our community.
The NSCH includes nationally representative data for children age 0-17 in all 50 states. This survey provides important information on child and family characteristics, as well as parental perceptions of neighborhood support. In the NSCH, children with special health care needs are identified with a five-item screener based on whether they have health needs such as prescription medication or specialized therapies for a condition expected to last longer than 12 months. We assessed which groups of children were more likely to live in supportive neighborhoods, and how this support correlated with child health and access to health care. We pooled 2020-2021 data (n=88,891) to enhance our ability examine the relationship between neighborhood support and the health status of children with greater precision and reliability.
To understand how supportive neighborhoods relate to children’s health, we focused on five child health measures including access to and use of health care, and exposure to a set of health risk factors known as adverse childhood experiences (ACEs). The measures were based on parents’ responses:
- Parent-reported child health status, measured as fair/poor vs. excellent/very good/good
- Parent-reported oral health status, measured as fair/poor vs. excellent/very good/good
Health care access and use
- Emergency room (ER) visit in the past year (one or more)
- Any past-year forgone health care in the past year (medical, dental, vision, or mental health care)
- Exposure to two or more ACEs. This composite measure was based on parent recollection for a list of potentially traumatic experiences in the child’s household, such as difficulty affording basic necessities, divorce, death of a parent, exposure to violence in the home or neighborhood, and living with someone experiencing mental illness or substance abuse.
We found that slightly over half (56.4%) of all children lived in neighborhoods that their parents reported as supportive (Figure 1). The lowest rates of children living in supportive neighborhoods were reported for subgroups of children who were black (44.8%) or Hispanic (45.3%); who lived in households in which English was not the primary language (44.5%); who had family incomes below the federal poverty level (45.6%); or whose parents had an education of high school or less (46.3%). Children with special health care needs were also less likely to live in supportive neighborhoods (50.5%). The differences in children’s neighborhood support by race/ethnicity, household language, income, education, and special health care needs were significant and consistent in our tabulation of population rates and multivariate analysis.
Figure 1. Neighborhood support by child characteristics
Importantly, we also found that children living in supportive neighborhoods had fewer ER visits, better access to health care (less forgone health care); better health status (less likely to have fair/poor health and oral health); and a lower prevalence of having two or more ACEs (Figure 2). Exposure to multiple ACEs is a risk factor for a number of long-term health conditions. The significant association between neighborhood support and better child outcomes shown in Figure 2 remained consistent in multivariate analysis.
Figure 2. Rates of child outcomes by neighborhood support
Our study highlights the importance of one measure of social capital—living in supportive neighborhoods—for a range of child outcomes including ER use, forgone care, overall and oral health status, and ACEs. This research bolsters the arguments for policies that support social networks and supports in the communities where children live, such as school and community health resources.
For children, community resources are important for their long-term outcomes. Strong neighborhoods support population health in nuanced ways that go beyond a neighborhood’s more obvious features, such as parks where people can exercise and grocery stores where people can buy healthy food. For example, previous research has shown that living in supportive neighborhoods with social networks to care for kids can mitigate the negative impact of traumatic experiences on child mental health. Our study found that neighborhood support is also associated with a reduced likelihood of ACEs and a range of beneficial child health outcomes.
This analysis was originally presented at the Academy Health Annual Research Meeting in Seattle, WA, on 6.26.2023.
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