Cumulative hardship and wellness of low-income, young children: multisite surveillance study

Pediatrics. 2010 May;125(5):e1115-23. doi: 10.1542/peds.2009-1078. Epub 2010 Apr 12.


Objectives: The goals were to generate a cumulative hardship index and to evaluate its association with the well-being of children 4 to 36 months of age without private health insurance.

Methods: Cross-sectional surveys were linked to anthropometric measures and medical record review at 5 urban medical centers (July 1, 2004, to December 31, 2007). Cumulative hardship index scores ranged from 0 to 6, with food, housing, and energy each contributing a possible score of 0 (secure), 1 (moderately insecure), or 2 (severely insecure) to generate scores indicating no hardship (score of 0), moderate hardship (scores of 1-3), or severe hardship (scores of 4-6). The outcome was a composite indicator of child wellness, including caregivers' reports of children's good/excellent heath, no hospitalizations, not being developmentally at risk, and anthropometric measurements within normal limits. Covariates were selected a priori and through association with predictors and outcomes.

Results: Of 7141 participants, 37% reported no material hardship, 57% moderate hardship, and 6% severe hardship. Multivariate logistic regression analyses showed ordinal association between the cumulative hardship index and children's adjusted odds of wellness (severe versus no hardship, adjusted odds ratio [AOR]: 0.65 [95% confidence interval [CI]: 0.51-0.83]; severe versus moderate hardship, AOR: 0.73 [95% CI: 0.58-0.92]; moderate versus no hardship, AOR: 0.89 [95% CI: 0.79-0.99]).

Conclusion: Increasing levels of a composite measure of remediable adverse material conditions correlated with decreasing adjusted odds of wellness among young US children.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers / statistics & numerical data
  • Anthropometry
  • Child, Preschool
  • Cross-Sectional Studies
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Health Status*
  • Health Surveys
  • Humans
  • Infant
  • Life Change Events*
  • Logistic Models
  • Male
  • Medically Uninsured / psychology
  • Medically Uninsured / statistics & numerical data*
  • Population Surveillance*
  • Poverty / psychology
  • Poverty / statistics & numerical data*
  • Primary Health Care / statistics & numerical data
  • Psychosocial Deprivation*
  • Quality of Life / psychology