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New from NCH - ::s
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New from NCHS presents and ana4?zes statistics from the National Center of Health Statistics that are relevant to public health. The department is edited by Mary Grace Kovar, DrPH. Contributions for this department should be addressed to her as follows: Mary Grace Kovar, DrPH, National Centerfor Health Statistics, 6525 Belcrest Road, Room 1120, Hyattsvdle, MD, 20782.
Family Structure and Child Health Family structure has an important role in determining children's well-being. Accidents, injuries, and poisonings are more likely to occur in disrupted families. Children from divorced or single-parent families have more emotional, behavioral, and academic problems than children living in traditional mother-father families. The relationship between family structure and a child's health is especially important because so many children live
Ne9ver-nanie mod r and ro hnW
motwrand
r_ fte II I FIUE1rcn iliuino
FIGURE I-Percent distribution of children 17 years old and younger by family type, United States, 1988.
1526 American Joum al of Public Health
....' ........-.......:,:::,:: :::' ::: :::::S:..S.::........:.:::::::..:::. ::: ::: :': 'S:'V -..........--.. -----
in nontraditional families. In 1988, 61% of all children in the United States 17 years old and younger lived with both their biological parents, 11% lived in a singleparent household with their biological mother who was formerly married to the child's father, 9% lived with a biological mother and a nonbiological father, usually a stepfather, and 8% lived in a singleparent household headed by a biological mother who was never married to the child's biological father (Figure 1). A variety of family arrangements were reported for the remaining children. These data are from a new report based on the 1988 National Health Interview Survey on Child Health (NHISCH).' A description of the NHIS-CH is in the report. The NHIS has been described in this column before and a full description has been published.2In brief, the NHIS is a continuing national survey of the health of people residing in households in the United States. For the NHIS-CH, one sample child 17 years old or younger was selected from each family with a child in that age range. Information about the sample child was collected by interviewing the adult member of the family who knew most about the child's health, in most cases the child's mother. Interviews were completed for 17 110 children; the overall response rate was 91%. Family structure was strongly associatedwith race and poverty status (Table 1). Children living in two-parent households, whether a nuclear family or a stepfamily, were far morelikely to be White than childrenliving in other types of families; childrenliving with a never married mother were far morelikely to be Black. Far fewer children in two-parent families lived inpoverty than children in single-parent families. The proportion ofchildren living in poverty ranged from 11% of those in a nuclear family and 14% of thoseliving in step-families
S'S :::::'
~
~
'':::::
to 40%o of those living with a formerly married mother, and 66% of those living with a never married mother. Children in disrupted families were more likely to have had an accident, injury, or poisoning within the year before the interview. Children living with formerly married mothers alone or with mothers and stepfathers were more likely to have had an accident, injury, or poisoning in the past year than were other children; 17% and 16% (age-adjusted), respectively, compared with 14% of children overall. With that exception, there waslittle variation in children's physical health by family type. Several conditions selected for their association with stress and other emotional problems were examined, but there were inconsistent findings for children with frequent headaches, stammer or speech defects, and bedwetting problems. Asthma was more prevalent among children living in fatherless families than in two-parent families, but the difference was not statistically significant. However, there was a strong relationship between family type and all the indicators of emotional well-being. The indicators were school performance, rating on a behavior problems index, and treatment for emotional/behavioral problems. Examination of school performance showed that children in nuclear families had the fewest difficulties in school. Children living with both their biological parents were about half as likely to have repeated a grade in school compared with children in all other types of families. Eleven percent (age-adjusted) of children in nuclear families repeated a grade compared with 20% of childrenliving in stepfamilies or 21% livingwith a formerly married mother and 30% living with a never married mother. The same patterns were
November 1991, Vol. 81, No. 11
New from NCHS
smoke both before and after birth; devel-
rAILEI V~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~......... opmental, learning, and emotional prob-
lems; and regular sources of medical care. O Barbam Bknm, MPA Deborah Dawson, PhD The authors are with the National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md. S-iymIII ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~02~1L6~~~~~~~~....... ~~~ .............I(0 2&3 PZ~~~~~~~~~~ ~~~~5Z104 290(1J~~~~~~...............29......1............. Requests for reprints should be sent to 1044ym 261(04 24k(04 ~~~4yOw~~~~~~~ 2049(14 112)355(1.............................................4 Barbara Bloom, MPA, National Center for 1547yusre167(04 13.0(04 223 (1.1) IOA(04 247(12)~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~................ Rio.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~...... Health Statistics, Centers for Disease Control, 24.0(0?) WM 915(0*) 762(1*) L4...(1*PA(I2)~~~~~~~~~~~~~~~~~~~~~~~~~~....... 6525 Belcrest Road, Hyattsville, MD 20782. ....................(1..
..OQO(OA.. 1GO,OP..IO...IOOA.O ti.........................
..
Ediicd~~~~~~~ofmotw*I~~~~~~...... LasIhmnt2y..s lOOPS) 16.7(4 225(1.4) Ilyim s4249(03) 432(1..................1..................4 422(04 k& UwI2....0.04.1A0.7.32(1) MiuaIk*h~~~~~~~~~~~~~~~~~~omiaa ......... ..................
........
(1..
400(1.)........ 63(2) 32314
Acknowledgments
The 1988 National Health Interview Survey on Child Health was developed by the National 3.......04... Center for Health Statistics in coliaboration with ........9(.......(1 the Center for Chronic Disease Prevention and 27.0(03) 271(05) 271(1*) 17(15) 32.0(1.6 Health Promotion, Centers for Disease Control; 205(03) 223(04 1~~~~~~~~~~~~~~~~~~(12) B2~~~~~~~~~8)22~~~~...(.....) 30G%urm~~~~~~~~~~~221(04 392(03) 13.4(14 42(04 321(1.5)~~~~~~~~~~~~~~~~~~~~~~~~~~............ the Bureau of Maternal and Child Health and Resources Development, Health Resources and Services Administration; and the National Institute of Child Health and Human Development, National Institutes of Health. ......O.......
108409%
.....
Ordering Information
found for problems requiring a parentteacher conference and for suspensions or expulsions. Behavioral problems were assessed by a 32-item index designed to measure antisocial behavior, anxiety/depression, headstrong behavior, hyperactivity, dependency, and peer conflict/social withdrawal. The index showed that children in nuclear families had the lowest scores for behavioral problems. Correspondingly, these children were the least likely to have seen a therapist or counselor about a problem in the previous year. These data are from 1988 when two out of five children lived in nontraditional families. However, the proportion of children who will live in such families at some time during childhood is much higher. Therefore, the risk for children is higher than it appears from a survey taken at one point in time. The report presents findings from only one section of the 1988 NHIS-CH. Other reports from the same data set on child care arrangements; health insur-
November 1991, Vol. 81, No. 11
ance and medical care; developmental, learning and emotional problems; and children's exposure to environmental cigarette smoke have also been published.3-6 Reports on the incidence of childhood infectious diseases, sources of medical care used by minority children, and the use of medical services by children with special health care needs are forthcoming. The 1988 NHIS-CH is the second survey on child health included as part of the NHIS. The first child health survey was conducted in 1981. Many of the questions from the 1981 questionnaire were repeated in 1988, including items on child care arrangements; family relationships and mobility; characteristics of the child's birth, including prenatal care, hospitalization, and birthweight; chronic medical conditions; general health habits, including bedtime, sleeping arrangements, and seat belt use; school attendance and performance; and behavioral problems. New items in 1988 addressed children's potential exposure to cigarette
Copies of Vital and Health Statistics reports are available from the US Government Printing Office, Washington, DC 20402. Prices are given in the GPO catalogue. For Family Structure and Children's Health by D. Dawson, Vital and Health Stat. 10(178), order stock no. 017-022-01136-1. The price is: $2.75. Copies of Advance Data reports are available without charge as long as supplies last from the Scientific and Technical Information Branch, National Center for Health Statistics, Centers for Disease Control, Room 1064, 6525 Belcrest Road, Hyattsville, MD 20782. Tel: 301/436-8500. Advance Data reports are also published as rapidly as possible in Vital and Health Stat 16 for indexing in Index Medicus and sale by GPO. Copies of public-use computer tapes for the basic NHIS and for most data collected through the data systems ofthe National Center for Health Statistics are available from the National Technical Information Service, Springfield, VA 22161. Copies of the public-use computer tapes for special studies based on the National Health Interview Survey are available from the Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control, Room 850, 6525 Belcrest Road, Hyattsville, MD 20782. The price for the 1981 Study of Child Health is $160. The price for the 1988 NHIS-CH is $200. Tel: 301/
436-7087.
References 1. Dawson DA. Family structure and children's health. Vital Health Stat.
1991;10(178). 2. Kovar MG, Poe G. The National Health Interview Survey: design and procedures. Vital Health Stat. 1985;1(18). 3. Dawson DA, Cain VS. Child care arrngements: health of our nation's children. Adv Data Vitl Health Stat. 1990;187.
American Joumal of Public Health 1527
New from NCHS
learning, and emotional problems: health of our nation's children. Adv Data Vital Health Stat. 1990;190. 6. Overpeck MD, Moss AJ. Children's expo-
4. Bloom B. Health insurance and medical care: health of our nation's children. Adv Data Vital Health Stat. 1990;188. 5. Zill N, Schoenborn CA. Developmental,
sure to environmental cigarette smoke before and after birth: health of our nation's children. Adv Data Vital Health Stat. 1991;202.
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New from NCH - ::s
--
New from NCHS presents and ana4?zes statistics from the National Center of Health Statistics that are relevant to public health. The department is edited by Mary Grace Kovar, DrPH. Contributions for this department should be addressed to her as follows: Mary Grace Kovar, DrPH, National Centerfor Health Statistics, 6525 Belcrest Road, Room 1120, Hyattsvdle, MD, 20782.
Family Structure and Child Health Family structure has an important role in determining children's well-being. Accidents, injuries, and poisonings are more likely to occur in disrupted families. Children from divorced or single-parent families have more emotional, behavioral, and academic problems than children living in traditional mother-father families. The relationship between family structure and a child's health is especially important because so many children live
Ne9ver-nanie mod r and ro hnW
motwrand
r_ fte II I FIUE1rcn iliuino
FIGURE I-Percent distribution of children 17 years old and younger by family type, United States, 1988.
1526 American Joum al of Public Health
....' ........-.......:,:::,:: :::' ::: :::::S:..S.::........:.:::::::..:::. ::: ::: :': 'S:'V -..........--.. -----
in nontraditional families. In 1988, 61% of all children in the United States 17 years old and younger lived with both their biological parents, 11% lived in a singleparent household with their biological mother who was formerly married to the child's father, 9% lived with a biological mother and a nonbiological father, usually a stepfather, and 8% lived in a singleparent household headed by a biological mother who was never married to the child's biological father (Figure 1). A variety of family arrangements were reported for the remaining children. These data are from a new report based on the 1988 National Health Interview Survey on Child Health (NHISCH).' A description of the NHIS-CH is in the report. The NHIS has been described in this column before and a full description has been published.2In brief, the NHIS is a continuing national survey of the health of people residing in households in the United States. For the NHIS-CH, one sample child 17 years old or younger was selected from each family with a child in that age range. Information about the sample child was collected by interviewing the adult member of the family who knew most about the child's health, in most cases the child's mother. Interviews were completed for 17 110 children; the overall response rate was 91%. Family structure was strongly associatedwith race and poverty status (Table 1). Children living in two-parent households, whether a nuclear family or a stepfamily, were far morelikely to be White than childrenliving in other types of families; childrenliving with a never married mother were far morelikely to be Black. Far fewer children in two-parent families lived inpoverty than children in single-parent families. The proportion ofchildren living in poverty ranged from 11% of those in a nuclear family and 14% of thoseliving in step-families
S'S :::::'
~
~
'':::::
to 40%o of those living with a formerly married mother, and 66% of those living with a never married mother. Children in disrupted families were more likely to have had an accident, injury, or poisoning within the year before the interview. Children living with formerly married mothers alone or with mothers and stepfathers were more likely to have had an accident, injury, or poisoning in the past year than were other children; 17% and 16% (age-adjusted), respectively, compared with 14% of children overall. With that exception, there waslittle variation in children's physical health by family type. Several conditions selected for their association with stress and other emotional problems were examined, but there were inconsistent findings for children with frequent headaches, stammer or speech defects, and bedwetting problems. Asthma was more prevalent among children living in fatherless families than in two-parent families, but the difference was not statistically significant. However, there was a strong relationship between family type and all the indicators of emotional well-being. The indicators were school performance, rating on a behavior problems index, and treatment for emotional/behavioral problems. Examination of school performance showed that children in nuclear families had the fewest difficulties in school. Children living with both their biological parents were about half as likely to have repeated a grade in school compared with children in all other types of families. Eleven percent (age-adjusted) of children in nuclear families repeated a grade compared with 20% of childrenliving in stepfamilies or 21% livingwith a formerly married mother and 30% living with a never married mother. The same patterns were
November 1991, Vol. 81, No. 11
New from NCHS
smoke both before and after birth; devel-
rAILEI V~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~......... opmental, learning, and emotional prob-
lems; and regular sources of medical care. O Barbam Bknm, MPA Deborah Dawson, PhD The authors are with the National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md. S-iymIII ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~02~1L6~~~~~~~~....... ~~~ .............I(0 2&3 PZ~~~~~~~~~~ ~~~~5Z104 290(1J~~~~~~...............29......1............. Requests for reprints should be sent to 1044ym 261(04 24k(04 ~~~4yOw~~~~~~~ 2049(14 112)355(1.............................................4 Barbara Bloom, MPA, National Center for 1547yusre167(04 13.0(04 223 (1.1) IOA(04 247(12)~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~................ Rio.~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~...... Health Statistics, Centers for Disease Control, 24.0(0?) WM 915(0*) 762(1*) L4...(1*PA(I2)~~~~~~~~~~~~~~~~~~~~~~~~~~....... 6525 Belcrest Road, Hyattsville, MD 20782. ....................(1..
..OQO(OA.. 1GO,OP..IO...IOOA.O ti.........................
..
Ediicd~~~~~~~ofmotw*I~~~~~~...... LasIhmnt2y..s lOOPS) 16.7(4 225(1.4) Ilyim s4249(03) 432(1..................1..................4 422(04 k& UwI2....0.04.1A0.7.32(1) MiuaIk*h~~~~~~~~~~~~~~~~~~omiaa ......... ..................
........
(1..
400(1.)........ 63(2) 32314
Acknowledgments
The 1988 National Health Interview Survey on Child Health was developed by the National 3.......04... Center for Health Statistics in coliaboration with ........9(.......(1 the Center for Chronic Disease Prevention and 27.0(03) 271(05) 271(1*) 17(15) 32.0(1.6 Health Promotion, Centers for Disease Control; 205(03) 223(04 1~~~~~~~~~~~~~~~~~~(12) B2~~~~~~~~~8)22~~~~...(.....) 30G%urm~~~~~~~~~~~221(04 392(03) 13.4(14 42(04 321(1.5)~~~~~~~~~~~~~~~~~~~~~~~~~~............ the Bureau of Maternal and Child Health and Resources Development, Health Resources and Services Administration; and the National Institute of Child Health and Human Development, National Institutes of Health. ......O.......
108409%
.....
Ordering Information
found for problems requiring a parentteacher conference and for suspensions or expulsions. Behavioral problems were assessed by a 32-item index designed to measure antisocial behavior, anxiety/depression, headstrong behavior, hyperactivity, dependency, and peer conflict/social withdrawal. The index showed that children in nuclear families had the lowest scores for behavioral problems. Correspondingly, these children were the least likely to have seen a therapist or counselor about a problem in the previous year. These data are from 1988 when two out of five children lived in nontraditional families. However, the proportion of children who will live in such families at some time during childhood is much higher. Therefore, the risk for children is higher than it appears from a survey taken at one point in time. The report presents findings from only one section of the 1988 NHIS-CH. Other reports from the same data set on child care arrangements; health insur-
November 1991, Vol. 81, No. 11
ance and medical care; developmental, learning and emotional problems; and children's exposure to environmental cigarette smoke have also been published.3-6 Reports on the incidence of childhood infectious diseases, sources of medical care used by minority children, and the use of medical services by children with special health care needs are forthcoming. The 1988 NHIS-CH is the second survey on child health included as part of the NHIS. The first child health survey was conducted in 1981. Many of the questions from the 1981 questionnaire were repeated in 1988, including items on child care arrangements; family relationships and mobility; characteristics of the child's birth, including prenatal care, hospitalization, and birthweight; chronic medical conditions; general health habits, including bedtime, sleeping arrangements, and seat belt use; school attendance and performance; and behavioral problems. New items in 1988 addressed children's potential exposure to cigarette
Copies of Vital and Health Statistics reports are available from the US Government Printing Office, Washington, DC 20402. Prices are given in the GPO catalogue. For Family Structure and Children's Health by D. Dawson, Vital and Health Stat. 10(178), order stock no. 017-022-01136-1. The price is: $2.75. Copies of Advance Data reports are available without charge as long as supplies last from the Scientific and Technical Information Branch, National Center for Health Statistics, Centers for Disease Control, Room 1064, 6525 Belcrest Road, Hyattsville, MD 20782. Tel: 301/436-8500. Advance Data reports are also published as rapidly as possible in Vital and Health Stat 16 for indexing in Index Medicus and sale by GPO. Copies of public-use computer tapes for the basic NHIS and for most data collected through the data systems ofthe National Center for Health Statistics are available from the National Technical Information Service, Springfield, VA 22161. Copies of the public-use computer tapes for special studies based on the National Health Interview Survey are available from the Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control, Room 850, 6525 Belcrest Road, Hyattsville, MD 20782. The price for the 1981 Study of Child Health is $160. The price for the 1988 NHIS-CH is $200. Tel: 301/
436-7087.
References 1. Dawson DA. Family structure and children's health. Vital Health Stat.
1991;10(178). 2. Kovar MG, Poe G. The National Health Interview Survey: design and procedures. Vital Health Stat. 1985;1(18). 3. Dawson DA, Cain VS. Child care arrngements: health of our nation's children. Adv Data Vitl Health Stat. 1990;187.
American Joumal of Public Health 1527
New from NCHS
learning, and emotional problems: health of our nation's children. Adv Data Vital Health Stat. 1990;190. 6. Overpeck MD, Moss AJ. Children's expo-
4. Bloom B. Health insurance and medical care: health of our nation's children. Adv Data Vital Health Stat. 1990;188. 5. Zill N, Schoenborn CA. Developmental,
sure to environmental cigarette smoke before and after birth: health of our nation's children. Adv Data Vital Health Stat. 1991;202.
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