Developing concise measures of childhood activity limitations

Health and development among Mexican, black and white preschool children: An integrative approach using latent class analysis

BACKGROUND

Building on an emerging scientific consensus that the concept of child health should encompass chronic conditions, functional abilities, and developmental domains, we delineate the multidimensional health statuses of Mexican, non-Hispanic black, and non-Hispanic white preschool children in the United States. This integrative approach provides the foundation for an in-depth analysis of health disparities.

OBJECTIVE

The research objectives are: (1) to demonstrate a new methodological approach to identifying the major child health statuses; (2) to document differences in the prevalence of those health statuses among children in the largest ethnoracial groups in the U.S.; and (3) to assess whether key sources of disadvantage account for ethnoracial disparities in children's health.

METHODS

With data from a nationally representative sample, we use latent class analysis to estimate a set of latent health statuses that capture the nature of health at age four. The latent class membership of children is predicted using multinomial logistic regression.

RESULTS

Mexican and non-Hispanic black children are more likely than non-Hispanic white children to fall into health statuses distinguished by low cognitive achievement and multiple developmental problems. Mexican children are the most likely to be classified into these problematic health statuses. This pattern persists in multivariate models that incorporate potential explanatory factors, including health at birth, socio-demographic characteristics, home environment, well-child care and center-based child care.

CONCLUSIONS

Latent class analysis is a useful method for incorporating measures of physical conditions, functional problems, and development into a single analysis in order to identify key dimensions of childhood health and locate ethnoracial health disparities.

The challenges faced by caregivers of children with impairments of psychological functions: a population-based cross-sectional study

OBJECTIVE

To assess the challenges faced by caregivers of children with impairments of psychological functions (IPFs).

METHOD

Data came from the 2001 Participation and Activity Limitation Survey, a post-census national survey of people with disabilities residing in the 10 Canadian provinces. Interviews of caregivers of children aged 5 to 14 years with a disability (n = 3908) were conducted between September 2001 and January 2002.

RESULTS

Caregivers of children with IPFs who are severely limited in their everyday activities were more likely to: need respite care; be refused a child care program or service; not receive health services for their children when needed; and not take a job, quit work, and work fewer hours to care for their children.

CONCLUSIONS

This highlights the importance of both removing barriers and obstacles to the full participation of children with IPFs in everyday activities and improving their caregivers' access to health and child care services. It also argues in favour of family-centred care that explicitly considers caregivers' concerns, identifies their needs and problems, and supports families in their caregiving roles.

Healthcare-Related Financial Burden among Families in the U.S.: The Role of Childhood Activity Limitations and Income

This study examined the impact of childhood activity limitations on family financial burden in the U.S. We used ten complete panels (1996-2006) of the Medical Expenditure Panel Survey (MEPS) to evaluate the burden of out-of-pocket healthcare expenditures for 17,857 families with children aged 0-17 years. Multivariate generalized linear models were used to examine the relationship between childhood activity limitation status and both absolute and relative financial burden. Families of children with limitations had higher absolute out-of-pocket healthcare expenditures than families of children without limitations ($594.36 higher; p<0.05), and were 54% more likely to experience relative burden (p<0.05). Substantial socioeconomic disparities in financial burden were observed. Policies are needed to enable these families to access appropriate and affordable healthcare services.

The impact of childhood activity limitations on parental health, mental health, and workdays lost in the United States

OBJECTIVE

The aim of this study was to determine if and to what extent the onset and persistence of childhood activity limitations (ongoing, resolved, or newly reported) resulted in subsequent adverse health, mental health, and work attendance outcomes among parents in the United States.

METHODS

A study was conducted using 10 panels (1996-2005) of the Medical Expenditure Panel Survey (MEPS), a household survey of a nationally representative sample of the civilian noninstitutionalized population in the United States. Participants in this study were 18 827 parents and their children aged 0 to 17 years.

RESULTS

During the 2-year study period, 15.6% of parents reported caring for a child aged 0 to 17 years with a limitation. Parents of children with any activity limitation were significantly more likely to experience subsequent poor health and mental health. Parents of children with ongoing or newly reported limitations had an increased number of lost workdays as compared with parents of children without limitations. Moreover, caring for multiple children with activity limitations was predictive of adverse parental mental health outcomes. Parents of children with ongoing activity limitations had significantly increased odds of poor mental health compared with parents of children with resolved limitations.

CONCLUSIONS

Caring for a child with activity limitations affects the health, mental health, and work attendance of parents. These findings indicate that child health can importantly influence the health and work behavior of the family and that health care providers should consider a family-centered approach to care.

Association of functional limitation with health care needs and experiences of children with special health care needs

OBJECTIVE

The goal was to evaluate whether having a functional limitation was associated with health care needs and experiences of children with special health care needs.

METHODS

We used caregivers' responses in the National Survey of Children with Special Health Care Needs (2001). Functional limitation was categorized as severe, some, or no limitation. We performed analyses of the relationships of functional limitation to measures of health care needs and experiences.

RESULTS

Children with special health care needs with severe functional limitation were more likely to have received specialized educational services, to have had physician visits, and to have needed health services, compared with those with no limitation. They had significantly greater odds of delayed care, unmet health care and care-coordination needs, referral problems, dissatisfaction, and difficulty using health services, compared with those without limitation. Caregivers of children with special health care needs with severe limitation were twice as likely as those with no limitation to report that providers did not spend enough time, listen carefully, provide needed information, and make family members partners in the child's care. Compared with children with special health care needs without limitation, those with severe limitation had worse health insurance experiences, in terms of insurance coverage, copayments, being able to see needed providers, and problems with health insurance. The impact on families (financial problems, need to provide home care, or need to stop or to cut work) of children with special health care needs with severe functional limitation was much greater than the impact on families of children with special health care needs without limitation. For most measures examined, results for some limitation were between those for severe limitation and no limitation.

CONCLUSIONS

Functional limitation is significantly associated with the health care needs and experiences of children with special health care needs.

Conceptualizing childhood health problems using survey data: a comparison of key indicators

Background

Many definitions are being used to conceptualize child health problems. With survey data, commonly used indicators for identifying children with health problems have included chronic condition checklists, measures of activity limitations, elevated service use, and health utility thresholds. This study compares these different indicators in terms of the prevalence rates elicited, and in terms of how the subgroups identified differ.

Methods

Secondary data analyses used data from the National Longitudinal Survey of Children and Youth, which surveyed a nationally representative sample of Canadian children (n = 13,790). Descriptive analyses compared healthy children to those with health problems, as classified by any of the key indicators. Additional analyses examined differences between subgroups of children captured by a single indicator and those described as having health problems by multiple indicators.

Results

This study demonstrates that children captured by any of the indicators had poorer health than healthy children, despite the fact that over half the sample (52.2%) was characterized as having a health problem by at least one indicator. Rates of child ill health differed by indicator; 5.6% had an activity limitation, 9.2% exhibited a severe health difficulty, 31.7% reported a chronic condition, and 36.6% had elevated service use. Further, the four key indicators captured different types of children. Indicator groupings differed on child and socio-demographic factors. Compared to children identified by more than one indicator, those identified only by the severe health difficulty indicator displayed more cognitive problems (p < 0.0001), those identified only by the chronic condition checklist had a greater likelihood of reporting allergies or asthma (p < 0.0001), and those identified as having elevated service use only were more affluent (p = 0.01) and showed better overall health (p < 0.0001). Children identified by only a single indicator were less likely to have serious health problems than those identified by two or more indicators.

Conclusion

We provide information useful to researchers when selecting indicators from survey data to identify children with health problems. Researchers and policy makers need to be aware of the impact of such definitions on prevalence rates as well as on the composition of children classified as being in poor health.

The effect of new insurance coverage on the health status of low-income children in Santa Clara County

OBJECTIVE

To examine whether providing health insurance coverage to undocumented children affects the health of those children.

DATA SOURCES/STUDY SETTING

The data come from a survey of 1235 parents of enrollees in the new insurance program ("Healthy Kids") in Santa Clara County, California. The survey was conducted from August 2003 to July 2004.

STUDY DESIGN

Cross-sectional study using a group of children insured for one year as the study group (N=626) and a group of newly insured children as the comparison group (N=609). Regression analysis is used to adjust for differences in the groups according to a range of characteristics.

DATA COLLECTION

Parents were interviewed by telephone in either English or Spanish (most responded in Spanish). The response rate was 89 percent.

PRINCIPAL FINDINGS

The study group-who were children continuously insured by Healthy Kids for one year-were significantly less likely to be in fair/poor health and to have functional impairments than the comparison group of newly insured children (15.9 percent versus 28.5 percent and 4.5 percent versus 8.4 percent, respectively). Impacts were largest among children who enrolled for a specific medical reason (such as an illness or injury); indeed, the impact on functional limitations was evident only for this subgroup. The study group also had fewer missed school days than the comparison group, but the difference was significant only among children who did not enroll for a medical reason.

CONCLUSIONS

Health insurance coverage of undocumented children in Santa Clara County was associated with significant improvements in children's health status. The size of this association could be overstated, since the comparison sample included some children who enrolled because of an illness or other temporary health problem that would have improved even without insurance coverage. However, even after limiting the study sample to children who did not enroll for a medical reason, a significant association remained between children's reported health and their health coverage. We thus cautiously conclude that Healthy Kids had a favorable impact on children's health.

Time away from "smelling the roses": where do mothers raising children with disabilities find the time to work?

Using the Australian Time Use survey (TUS), this study examined time allocation among working parents raising children with disabilities. Findings showed that raising children with disabilities reduced the time working mothers had for leisure activities, but increased the time for socializing activities. Consistent with the literature, the latter effect probably reflects the special need of working mothers raising children with disabilities for strong social networks offering regular support. While a mother's time for personal care was reduced by a child with a disability, a father's time for personal care was unaffected. Thus, mothers were relatively more disadvantaged than fathers in terms of total time for themselves. This study offers new knowledge on the impact of childhood disability on working parents' time for personal care and leisure, activities that can improve their psychological and physical well-being.