PUB 460 Lecture 9 - Families and Health.pdf

FAMILIES AND HEALTH PUB 460 Dr. Gauri Desai Family • Pre-20th century: Husband, wife, children, and the extended family • The past 50 years: the definition of family has evolved to include the diversity of familial composition including: • Transactional, transitional, and situational families • Bl...

FAMILIES AND HEALTH PUB 460 Dr. Gauri Desai Family • Pre-20th century: Husband, wife, children, and the extended family • The past 50 years: the definition of family has evolved to include the diversity of familial composition including: • Transactional, transitional, and situational families • Blended families • LGBTQ+ Families • Family: Group of two or more people (one of whom is a householder) related by birth, marriage, or adoption and residing together….U.S. Census Bureau, 2019 Family • Nuclear families: children "living with two parents who are married to one another and are each biological or adoptive parents to all children in the family” • Single-parent families: children living with a single adult of either gender • Unmarried biological or adoptive families: children living with two unmarried parents who are each biological/adoptive parents to all the family's children • Blended families: children living with one biological/adoptive parent and that parent's spouse Family • Cohabiting families: children living with one biological/adoptive parent and that parent's unmarried cohabiting partner • Extended families: children living with one or two parents, and at least one related, non-parent adult (age 18+) such as a grandparent or adult sibling • "Other" families: children living with adults who are not their biological or adoptive parents. Family • Reduction in two-parent households and an increase in one-parent family households. • More than 25% of American children grow up without a father in the household. • 5% of children live with their grandparents who are primary caregivers. Family Family LGBTQ+ Families • An estimated 3 million LGBT Americans have had a child and as many as 6 million American children and adults have an LGBT parent. • More than 111,000 same-sex couples are raising an estimated 170,000 biological, step, or adopted children. • Same-sex couple parents and their children are more likely to be racial and ethnic minorities. • ~39% of individuals in same-sex couples who have children under age 18 in the home are people of color, compared to 36% of those in different-sex couples who are non-White. • Among children under 18 living with same-sex couples, half (50%) are non-White compared to 41% of children living with different-sex couples https://williamsinstitute.law.ucla.edu/wp-content/uploads/LGBT-Parenting-US-Feb-2013.pdf LGBTQ+ Families • LGBT individuals and same-sex couples raising children experience some economic disadvantages • Single LGBT adults raising children are 3X more likely than comparable non-LGBT individuals to report household incomes near the poverty threshold. • Married or partnered LGBT individuals living in two-adult households with children are 2X as likely as comparable non-LGBT individuals to report household incomes near the poverty threshold. • The median annual household income of same-sex couples with children under age 18 in the home is lower than comparable different-sex couples ($63,900 versus $74,000, respectively). https://williamsinstitute.law.ucla.edu/wp-content/uploads/LGBT-Parenting-US-Feb-2013.pdf LGBTQ+ Families https://williamsinstitute.law.ucla.edu/wp-content/uploads/LGBT-Parenting-US-Feb-2013.pdf Family Structure and Prenatal Health • Women’s health behaviors during pregnancy affect not only their children’s uterine environment before birth, but subsequently the health of their children at birth • Married women are more likely to – • Receive prenatal care • Take prenatal vitamins • Married women are less likely to – • Report smoking and drinking in the last trimester of pregnancy • Unmarried but romantically involved or cohabiting women exhibit a similar pattern of prenatal care behavior • As relationship commitment increases, so does the level of positive prenatal health behaviors women tend to exhibit https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk Family Structure and Prenatal Health However, • Other factors associated with marriage or cohabitation, or unobserved characteristics may be underlying these associations • In one study, marital status had no significant impact on prenatal care investments for college-educated mothers • Part of the marriage benefit is likely due to other, unobserved characteristics that sort couples into different relationship categories. • Promoting responsible parenthood, rather than marriage per se, could be a better focus for policymakers interested in improving prenatal health behaviors. https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk Family Structure and Birth Outcomes • Similar pattern as prenatal care • Children born to unmarried mothers are more likely than those born to married mothers to experience a host of adverse birth outcomes— stillbirth, preterm delivery, LBW, and small for gestational age • Cohabiting mothers less likely to have adverse birth outcomes than single, non-cohabiting mothers • Some of these patterns persist after taking into account variables related to SES https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk Family Structure and Infant Mortality • Few studies on this association, but the existing evidence supports a similar pattern of “marriage benefit” • US infant mortality rates were 75% higher for infants of unmarried mothers than the rates for infants of married mothers • Little is known about whether infant mortality rates among children in nonmarital family structures differ • We do not know whether or to what extent differences in infant mortality rates exist between married and cohabiting mothers or cohabiting and single mothers. https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk Family Structure and Breastfeeding • The American Academy of Pediatrics recommends that women exclusively breastfeed their children up to six months of age, and preferably continue (with other food) for up to 24 months • Married mothers are more likely to initiate breastfeeding and to breastfeed for longer durations than are unmarried mothers https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk Family Structure and Breastfeeding • Mothers involved in non-cohabiting romantic partnerships are the least likely to initiate breastfeeding compared to women in all other types of relationships, including those who are single and not romantically involved • This finding is not replicated in all studies • To further speculate, it seems possible that involvement in dating or visiting relationships may actually discourage mothers from breastfeeding • More research is needed to help parse out the mechanisms that influence women’s decisions to breastfeed https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk Family Structure and Breastfeeding • Much research on the association between family structure and children's chances of growing up in poverty, struggling or succeeding academically • Less research on health outcomes • Health outcomes during childhood/young adulthood may impact health outcomes later in life, or those of future generations • ACEs and their life course impact https://ifstudies.org/blog/family-structure-and-childrens-health/ Family Structure and Child Health • Chronic conditions assessed: Down syndrome, muscular dystrophy, cystic fibrosis, sickle cell anemia, autism, diabetes, arthritis, congenital heart disease, or any other heart condition https://ifstudies.org/blog/family-structure-and-childrens-health/ Children <18 y in single-parent families (3.2%) were more likely to have one or more chronic condition than children in nuclear (2.2%), unmarried biological or adoptive (1.9%), or extended (2.4%) families and were comparable to children living in the remaining family types Family Structure and Child Health • Emotional or behavioral difficulties assessed: Emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, prosocial behavior https://ifstudies.org/blog/family-structure-and-childrens-health/ Children aged 4–17 living in nuclear families (3%) were less likely to have definite or severe emotional or behavioral difficulties than children in singleparent (7.4%), unmarried biological or adoptive (5.7%), blended (8.4%), cohabiting (7.6%), extended (5.1%), or other (9.6%) families. Underlying Mechanisms • Multiple, multifaceted, complex mechanisms • Understanding the mechanisms by which family structure affects child health outcomes is necessary and important for policy • Mechanisms are interrelated, not mutually exclusive https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk Underlying Mechanisms 1. Maternal mental health • Maternal mental health is a well-known predictor of infant health outcomes • Maternal depression and maternal stress during pregnancy have been associated with adverse birth outcomes, such as preterm birth and LBW • Family structures influence maternal mental health, e.g., stress and depression • Maintaining a positive relationship with the child’s biological father, rather than marital status per se, predicts less maternal parenting stress Family structure Maternal mental health Infant health outcomes https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk Underlying Mechanisms 2. Father’s involvement • “Engaging fathers” [7:31] - https://www.youtube.com/watch?v=EpGqhronTU&ab_channel=usgovACF • Fathers may have the greatest impact on infant health by encouraging or discouraging women to seek prenatal care and refrain from unhealthy behaviors, such as smoking and consuming alcohol while pregnant • Married and cohabiting fathers are more likely to be involved with their children by virtue of proximity • Men who are not married to or living with their child’s mother experience more difficultly being involved, and hence participate less • Nonmarital unions tend to be less stable and when these relationships dissolve, father involvement drastically declines, • Especially when the relationship is terminated when children are very young https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk Underlying Mechanisms 3. Quality of the mother-father relationship with one another • Whether marital, nonmarital, or non-romantic, relationships that are abusive, stressful, or unstable may have negative consequences for both maternal and infant health • Women in good relationships, compared to women in poor relationships, are less likely to experience stress or depressive symptoms, use illicit substances, or smoke during pregnancy • Caveat: relationship quality is difficult to measure https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk Underlying Mechanisms 4. Parenting practices • Parenting practices have no bearing on birth outcomes, but do influence child health • Toddlers from single-parent or divorced families experienced worse health outcomes and received less medical attention than toddlers in two-parent families https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk Underlying Mechanisms 4. Parenting practices • Spending time with and monitoring children is easier in two-parent homes where parents can share responsibilities • Single parents typically have less time to spend with their children and exhibit less control over the household because, as primary care providers, they juggle more competing demands for their time • Family relations characterized by conflict, inadequate nurturing and neglect threaten child health https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk Policies 1. Aid to Families with Dependent Children (AFDC) • Was a federal assistance program in the United States in effect from 1935 to 1997, created by the Social Security Act (SSA) and administered by the United States Department of Health and Human Services • Provided financial assistance to children whose families had low or no income • Administered by States that received federal funding https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk https://en.wikipedia.org/wiki/Aid_to_Families_with_Dependent_Children Policies 1. Aid to Families with Dependent Children (AFDC) • Was primarily created for white single mothers, who were expected not to work. • Black mothers, who had always been in the labor force, were not considered eligible to receive benefits • Civil Rights Movement expanded the scope of welfare entitlements to include black women • 1961: A change in the law permitted; extended benefits to families where the father was unemployed https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk https://en.wikipedia.org/wiki/Aid_to_Families_with_Dependent_Children Policies 1. Aid to Families with Dependent Children (AFDC) • The words "families with" were added to the name in 1962, partly due to concern that the program's rules discouraged marriage • In 1967 the federal government began requiring states to establish the paternity of children eligible for the program, and extended benefits to "unemployed male parents with a work history” • Criticisms: • Ineffective • Promoted dependency on the government • Lack of incentives to find jobs • Encouraged behaviors detrimental to escaping from poverty https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk https://en.wikipedia.org/wiki/Aid_to_Families_with_Dependent_Children Policies 2. Temporary Assistance for Needy Families (TANF) • Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) is a United States federal law passed by the 104th United States Congress • It replaced the AFDC with the TANF program; TANF began on July 1, 1997 • TANF provides cash assistance to indigent American families through the United States Department of Health and Human Services • It is a grant given to each state to run its own welfare program and designed to be temporary in nature • Grant has a maximum benefit of two consecutive years and a five-year lifetime limit and requires that all recipients of welfare aid must find work within two years of receiving aid https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk https://en.wikipedia.org/wiki/Temporary_Assistance_for_Needy_Families Policies 2. Temporary Assistance for Needy Families (TANF) • Funds may be used for the following reasons: • To provide assistance to needy families so that children can be cared for at home • To end the dependence of needy parents on government benefits by promoting job preparation, work and marriage • To prevent and reduce the incidence of out-of-wedlock pregnancies • To encourage the formation and maintenance of two-parent families https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk https://en.wikipedia.org/wiki/Temporary_Assistance_for_Needy_Families Policies 2. Temporary Assistance for Needy Families (TANF) Some specifications of the program: • • • • Lifetime ban on the use of food stamps through TANF for people convicted of drug felonies. Although it applied to all 50 states by default, states were also given the option to opt out of the ban. As of May 2019, only two states (South Carolina and West Virginia) have a lifetime ban for drug felons. Part of criminal justice reforms lawmakers have passed in aiming to prevent recidivism or the tendency for convicted criminals to reoffend https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk https://en.wikipedia.org/wiki/Personal_Responsibility_and_Work_Opportunity_Act Policies 2. Temporary Assistance for Needy Families (TANF) Some specifications of the program: • • • Some immigrants entering the United States ineligible for federal public benefits during the first five years after securing "qualified" immigrant status (specific definitions of what “qualified” entails) All other immigrants, including illegal immigrants, temporary residents, and those who are unlawfully present in the U.S., are considered "not qualified". With a few exceptions, excluded people in both categories from eligibility for many benefits: TANF, food stamps, Supplemental Security Income (SSI), Medicaid, and State Children's Health Insurance Program (CHIP) https://digitalcommons.library.tmc.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1117&context=childrenatrisk https://en.wikipedia.org/wiki/Personal_Responsibility_and_Work_Opportunity_Act Policies 2. Temporary Assistance for Needy Families (TANF) Criticisms of the program: • Why the TANF program fails as a safety net for single mothers, other vulnerable Americans [6:28]: https://www.youtube.com/watch?v=FDiXxAqSN8M&ab_channel=PBSNe wsHour Question Bank 1. Married individuals have been observed to have increased use of prenatal care and have improved birth outcomes compared to unmarried individuals. Marriage, per se, is not the underlying factor that drives these results. Rather, a few other factors are thought to be underlying these findings. Please explain any one/any two of these factors. Housekeeping  Short HW 3 and case study HW 2 are open; due on 9/28 at 1:00 pm  Short HW 4 and case study HW 3 (on this week’s topic) are open – due on 10/3 at 1:00 pm – this is 10/5 is the exam