Available online 21 November 2023

Author links open overlay panel, , , , , AbstractBackground

Parents of children with special health care needs (CSHCN) are at risk of poorer health outcomes. Material hardships also pose significant health risks to parents. Little is known about how protective factors may mitigate these risks, and if effects are similar between mothers and fathers.

Methods

This was a cross-sectional survey study conducted using the US 2018/2019 National Survey of Children’s Health, including parents of children 0-17 with income <200% of the Federal Poverty Level. Separately, for parents of children with and without special health care needs (N-CSHCN), weighted logistic regression measured associations between material hardship, protective factors (family resilience, neighborhood cohesion and receipt of family-centered care) and two outcomes: mental and physical health of mothers and fathers. Interactions were assessed between special health care needs status, material hardship and protective factors.

Results

Sample consisted of parents of 16,777 children, 4,440 were parents of CSHCN. Most outcomes showed similar associations for both mothers and fathers of CSHCN and N-CSHCN: material hardship was associated with poorer health outcomes, and family resilience and neighborhood cohesion associated with better parental health outcomes. Family-centered care was associated with better health of mothers but not fathers. Interaction testing showed that the protective effects of family resilience were lower among fathers of CSHCN experiencing material hardship.

Conclusions

Family resilience and neighborhood cohesion are associated with better health outcomes for all parents, though these effects may vary by experience of special health care needs, parent gender and material hardship.

What’s New

Protective factors such as family relationships, neighborhood cohesion and family-centered care are associated with better health outcomes for most parents. Particularly for fathers, experience of material hardship may reduce these protective effects.

Section snippetsINTRODUCTION

Poverty is a well-established social determinant of health. Material hardships, or difficulty meeting basic needs, are poverty-related risks that are associated with higher mortality1 and increased incidence of multiple chronic conditions among parents.2 Understanding how material hardships affect parents’ health, particularly in the context of poverty, is important for two reasons. Firstly, parental health is paramount to child health, as parental physical and mental illness decrease time and

Design and Study Sample

We conducted a cross-sectional study using the 2018/2019 National Survey of Children’s Health (NSCH). The NSCH is a national population-based survey of a primary caregiver of child 0-17 years, designed to be representative of children in the United States, funded and directed by the United States Health Resources and Services Administration. Study design and complete datasets can be retrieved from https://mchb.hrsa.gov/data-research/national-survey-childrens-health. The survey asks if there is

Study Sample

Our initial sample consisted of 16,777 children in households with income below 200% of the Federal Poverty Level, weighted to represent more than 29 million US children. Of these, 4,440 (21%) had special health care needs. Characteristics of study participants are presented in Table 1. Approximately 86% (14,386) of children in our sample included a mother, step-mother or foster mother, and 60 % (10,108) included a father, step-father or foster father. Our final models included 13,035

DISCUSSION

In this study of material hardship, protective factors, and parental health, we found that material hardship was associated with worse parental physical and mental health and that family resilience and neighborhood cohesion were similarly associated with better parental health outcomes. These associations were generally similar between parents of N-CSHCN and CSHCN. Measures of interactions between material hardship and protective factors showed that, for most, the associations with better

CONCLUSIONS

In summary, this study of the health of parents of children with and without special health care needs with low-income found that multiple protective factors, including family resilience, neighborhood cohesion and family-centered care are associated better mental and physical health and possibly buffer the effects of material hardship. Design of clinical and community programs, and the policies that support such programs, should consider the benefits to parents of interventions which promote

Uncited reference

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Declaration of Competing Interest

The authors have no conflicts of interest relevant to this article to disclose.

Acknowledgements/Funding

None to declare

Potential Conflicts of Interest

The authors have no conflicts of interest relevant to this article to disclose.

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© 2023 Published by Elsevier Inc. on behalf of Academic Pediatric Association