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Inequities and Interventions in Children's Health and Wellbeing

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 January 2025) | Viewed by 24688

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Dr. Hui Huang

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Guest Editor

School of Social Work, University of Texas at Arlington, Arlington, TX 76019, USA
Interests: child welfare; health disparity; substance use; juvenile justice

Dr. Qi Wu

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Guest Editor

School of Social Work, Arizona State University, Phoenix, AZ 85004, USA
Interests: child maltreatment; complex effects of out-of-home placements on child mental and behavioral health; sequelae of problem behavior among maltreated and system-involved youth; kinship care and kin caregiver's mental health
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Special Issue Information

Dear Colleagues,

Children from disadvantaged circumstances are more likely to experience physical and mental health issues than their more advantaged peers. Examples of these issues are low birthweight, obesity, infectious diseases, and anxiety. Disadvantaged children are also more likely to have adverse childhood experiences, such as child abuse and neglect, childhood poverty, exposure to violence at home and in the community, which comprises their well-being (e.g., health and mental health, behavioral health, educational achievement). Socioeconomic disadvantages are the root causes of these inequalities. Interventions need to disrupt pathways to create more equitable health and wellbeing trajectories.

This Special Issue is interested in manuscripts that that address a wide range of issues and topics related to: (1) inequalities in children’s health and well-being and/or (2) innovative thinking and intervention to reduce such inequalities. Qualitative, quantitative, mixed methods, and review papers are welcome.

Dr. Hui Huang
Dr. Qi Wu
Guest Editors

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Keywords

inequalities among children
disadvantaged or vulnerable children
children’s health
children’s wellbeing
social-emotional wellbeing
children’s welfare
policies
interventions
programs and services
child maltreatment
exposure to violence
protective care
youth justice
children’s health insurance

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Published Papers (9 papers)

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Research

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19 pages, 3130 KiB

Open AccessArticle

Internalizing Pathways to Adolescent Substance Use from Adverse Childhood Experiences

by Michelle G. Villar, Nicole M. Fava, Robert A. Zucker and Elisa M. Trucco

Int. J. Environ. Res. Public Health 2024, 21(11), 1408; https://doi.org/10.3390/ijerph21111408 - 24 Oct 2024

Viewed by 1903

Abstract

The mediating role of anxious, depressive, and somatic symptoms was examined in the association between adverse childhood experiences (ACEs) and adolescent substance use, with attention to the unique effects of each set of symptoms within the same model. Adolescents (n = 701) were assessed over time (ages 3–17) in a majority male (70.5%) and white (89.9%) sample. Findings indicate that depressive symptoms mediated the association between ACEs and adolescent cigarette and marijuana use. Although significant indirect effects remained when accounting for externalizing behavior, a novel protective pathway emerged through parent-reported youth anxiety and alcohol use. Assessing internalizing symptoms as separate facets within the same model is critical if we are to inform prevention programs that are tailored to the individual needs of youth who have experienced ACEs. Full article

(This article belongs to the Special Issue Inequities and Interventions in Children's Health and Wellbeing)

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13 pages, 2185 KiB

Open AccessArticle

Co-Design Model of Support for Child and Family Health Nurse Practice with Culturally and Linguistically Diverse Families

by Mehrnoush Bonakdar Tehrani, Stacy Blythe, Suza Trajkovski and Lynn Kemp

Int. J. Environ. Res. Public Health 2024, 21(10), 1274; https://doi.org/10.3390/ijerph21101274 - 25 Sep 2024

Cited by 1 | Viewed by 1674

Abstract

Culturally and linguistically diverse (CALD) mothers with young children face multiple inequities in accessing primary health services, such as language barriers, social isolation, low health literacy, and the availability of appropriate interpretation services. These inequities are persistent and indicate that child and family health nurse (CFHN) services, the providers of primary healthcare in many developed countries, require better support to address the needs of these families. This study engaged with CFHNs and healthcare interpreters to co-design a model of support for practice using workshops that included individual and collective brainstorming and visual representations. Transcripts of the discussion were analysed using thematic analysis. CFHNs and interpreters were able to articulate their perfect service model: a central multidisciplinary team of CFHNs, interpreters, and bilingual educators who could facilitate nurse–interpreter and nurse–interpreter–client relationships, allowing CFHNs and interpreters to do their jobs properly. This central structural component would support and be supported by rapport, trust, client choice and access, continuity of care, and cultural comfort. The study concluded that CALD mothers’ access and engagement require CFHNs to have support for their cultural comfort through the mechanism of bilingual educators and the expansion of healthcare interpreters’ role and scope in working with CFHNs in the delivery of services. Full article

(This article belongs to the Special Issue Inequities and Interventions in Children's Health and Wellbeing)

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13 pages, 711 KiB

Open AccessArticle

Internet-Based Prevention of Re-Victimization for Youth with Care Experience (EMPOWER-YOUTH): Results of a Randomized Controlled Trial

by Birgit Wagner, Olivia Lucia Marie Emmerich and Betteke Maria van Noort

Int. J. Environ. Res. Public Health 2024, 21(9), 1159; https://doi.org/10.3390/ijerph21091159 - 30 Aug 2024

Viewed by 1189

Abstract

Traumatic experiences and maltreatment are highly prevalent among adolescents in foster or institutional care and have severe long-term effects on mental health. Childhood maltreatment increases the risk of revictimization. This study aimed to evaluate the efficacy of the internet-based prevention program EMPOWER YOUTH in reducing victimization experiences among youth with care experience. A total of 163 youth, that is, adolescents in foster or institutional care, adopted adolescents, or young care leavers aged 14 to 21 years (M_age = 17.68 years; SD = 2.11) were randomized to the six-module guided program or a wait-list control group. The primary endpoint was the decrease in victimization experiences at an 18-week follow-up. Secondary endpoints included risk perception, aggressive tendencies, empathy, prosocial behavior, depressiveness, post-traumatic stress symptoms, and loneliness. About half of the youth exhibited increased psychopathology. No significant interaction between time-point and group was found for victimization measures, though both groups saw a significant reduction over time (p = 0.012, η_p² = 0.06; p = 0.017, η_p² = 0.06). The intervention group showed a significant increase in perception of thrill-seeking and rebellious risks (p = 0.036, η_p² = 0.04; p = 0.026, η_p² = 0.05). While EMPOWER YOUTH effectively increased risk perception of thrill-seeking and rebellious behaviors, it should be considered an add-on to more intensive interventions for common mental health disorders in this vulnerable group, rather than a stand-alone online program. Full article

(This article belongs to the Special Issue Inequities and Interventions in Children's Health and Wellbeing)

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22 pages, 403 KiB

Open AccessArticle

Outdoor Time in Childhood: A Mixed Methods Approach to Identify Barriers and Opportunities for Intervention in a Racially and Ethnically Mixed Population

by Magdalena K. Haakenstad, Maria B. Butcher, Carolyn J. Noonan and Amber L. Fyfe-Johnson

Int. J. Environ. Res. Public Health 2023, 20(24), 7149; https://doi.org/10.3390/ijerph20247149 - 6 Dec 2023

Viewed by 2505

Abstract

A growing body of literature suggests that outdoor time is beneficial for physical and mental health in childhood. Profound disparities exist in access to outdoor spaces (and the health benefits thereof) for children in communities of color. The objectives of this research were to: (1) identify challenges and solutions to outdoor time for children; (2) assess the importance of outdoor time for children; and (3) evaluate results stratified by race/ethnicity. Using a convergent mixed methods approach, we conducted a thematic analysis from 14 focus groups (n = 50) with outdoor educators, parents with children attending outdoor preschools, and community members with children. In addition, 49 participants completed a survey to identify challenges and solutions, perceived importance, and culturally relevant perspectives of outdoor time. The main challenges identified for outdoor time were safety concerns, inclement weather, lack of access to outdoor spaces, and parent work schedules. The primary proposed solution was integrating outdoor time into the school day. Nearly all participants, independent of racial identity, reported that outdoor time improved physical and mental health. Overall outdoor time was lower in participants from communities of color (~8 h/week) compared to their White counterparts (~10 h/week). While 50% of people of color (POC) reported that outdoor time was an important cultural value, only 18% reported that people in their respective culture spent time outside. This work contributes to accumulating knowledge that unique barriers to outdoor time exist for communities of color, and the children that live, learn, and play in these communities. Increasing outdoor time in school settings offers a potential solution to reduce identified barriers and to promote health equity in childhood. Full article

(This article belongs to the Special Issue Inequities and Interventions in Children's Health and Wellbeing)

19 pages, 387 KiB

Open AccessArticle

Race, Poverty, and Foster Care Placement in the United States: Longitudinal and Cross-Sectional Perspectives

by Fred Wulczyn, Xiaomeng Zhou, Jamie McClanahan, Scott Huhr, Kristen Hislop, Forrest Moore and Emily Rhodes

Int. J. Environ. Res. Public Health 2023, 20(16), 6572; https://doi.org/10.3390/ijerph20166572 - 13 Aug 2023

Cited by 3 | Viewed by 2823

Abstract

Although the connections between race, poverty, and foster care placement seem obvious, the link has not in fact been studied extensively. To address this gap, we view poverty and placement through longitudinal and cross-sectional lenses to more accurately capture how changes in poverty rates relate to changes in placement frequency. The longitudinal study examines the relationship between poverty rate changes and changes in the placement of Black and White children between 2000 and 2015. The cross-sectional study extends the longitudinal analysis by using a richer measure of socio-ecological diversity and more recent foster care data. Using Poisson regression models, we assess the extent to which changes in race-differentiated child poverty rates are correlated with Black and White child placement frequencies and placement disparities. Regardless of whether one looks longitudinally or cross-sectionally, we find that Black children are placed in foster care more often than White children. Higher White child poverty rates are associated with substantially reduced placement differences; however, higher Black child poverty rates are associated with relatively small changes in placement disparity. Black and White child placement rates are more similar in counties with the fewest socio-ecological assets. Full article

(This article belongs to the Special Issue Inequities and Interventions in Children's Health and Wellbeing)

15 pages, 355 KiB

Open AccessArticle

Experiences of Undocumented Parents Reuniting with Children Who Entered the United States as Unaccompanied Minors

by Maryam Rafieifar, Miriam Potocky, Hui Huang, Richard L. Beaulaurier and Sloan Bruan Lorenzini

Int. J. Environ. Res. Public Health 2023, 20(5), 4496; https://doi.org/10.3390/ijerph20054496 - 3 Mar 2023

Cited by 5 | Viewed by 3110

Abstract

In 2021, the United States saw an exponential influx of unaccompanied migrant children crossing the U.S.–Mexico border. Upon apprehension at the border, unaccompanied children are placed in the Office of Refugee Resettlement (ORR) temporary shelter facilities. The ORR is responsible for locating, vetting, and releasing the children to their family, guardians, or a suitable sponsor. Undocumented parents seeking reunification may fear cross-examination and background checks. This study aimed to explore the experiences of undocumented families reunified with their children with the help of a community-based organization (CBO). A collective case study method was used to collect qualitative data from seven parents. Respondent parents expressed their rationale for allowing their children to cross the U.S.–Mexico border, their experience with the ORR, and the reasons they pursued community-based guidance. The results document the depth of trauma and difficulties parents of unaccompanied migrant children face with American service providers. It is recommended that immigration-related government agencies form relationships with culturally diverse organizations that are trusted by immigrant communities. Full article

(This article belongs to the Special Issue Inequities and Interventions in Children's Health and Wellbeing)

13 pages, 565 KiB

Open AccessArticle

Social Inequalities: Do They Matter in Asthma, Bronchitis, and Respiratory Symptoms in Children?

by Agata Wypych-Ślusarska, Karolina Krupa-Kotara and Ewa Niewiadomska

Int. J. Environ. Res. Public Health 2022, 19(22), 15366; https://doi.org/10.3390/ijerph192215366 - 21 Nov 2022

Cited by 7 | Viewed by 3038

Abstract

Background: Social inequalities (e.g., poverty and low level of education) generate inequalities in health. Aim: The aim of the study was to determine the relationships between indicators of social inequalities and the frequency of respiratory symptoms, asthma, and bronchitis in children. Material and Methods: In 2019, an epidemiological cross-sectional study on 3237 students from elementary schools in Silesia Voivodships (South Poland) was conducted. The students’ parents completed a questionnaire based on the International Study on Asthma and Allergies in Childhood (ISAAC). Social inequalities in the children’s families were determined according to parents’ education and professional status (working vs. unemployed), self-assessment of economic status, and housing conditions. To determine the influence of social factors on the occurrence of asthma, bronchitis, and respiratory symptoms, the odds ratio (OR) was calculated. Results: Children living in apartments with traces of mold had a higher risk of developing asthma (OR = 1.5, 95%CI: 1.17–1.96; p = 0.002) or bronchitis (OR = 1.4, 95%CI: 1.13–1.72; p = 0.002), wheezing attacks at nights (OR = 1.4; 95%CI: 1.01–1.93), wheezy in the last 12 months (OR = 1.6; 95%CI:1.24–2.08; p < 0.001), and chronic cough (OR = 1.9; 95%CI: 1.49–2.46; p < 0.001). Exposure to environmental tobacco smoke (ETS) was associated with higher risk of cough (OR = 1.5 95%CI: 1.22–1.96; p < 0.001) and dyspnea in the last 12 months (OR = 1.4; 95%CI: 1.04–2.00; p = 0.02). Low socioeconomic status (SES) was associated with increased risk of chronic cough (OR = 1.5; 95%CI: 1.09–2.03; p = 0.009) and increased risk of wheezy in the last 12 months (OR = 1.4; 95%CI: 1.06–1.97; p = 0.008). Asthma and bronchitis were not dependent on parents’ education or professional status. Conclusions: Social inequalities have significant impacts on the occurrence of respiratory symptoms, bronchitis, and asthma in children. Interventions aimed at preventing bronchitis and childhood asthma should also focus on social health determinants. Full article

(This article belongs to the Special Issue Inequities and Interventions in Children's Health and Wellbeing)

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13 pages, 495 KiB

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Reviewing Publicly Available Reports on Child Health Disparities in Indigenous and Remote Communities of Australia

by Kedir Y. Ahmed, Julaine Allan, Hazel Dalton, Adrian Sleigh, Sam-ang Seubsman and Allen G. Ross

Int. J. Environ. Res. Public Health 2023, 20(11), 5959; https://doi.org/10.3390/ijerph20115959 - 25 May 2023

Cited by 2 | Viewed by 4255

Abstract

Developing programs that ensure a safe start to life for Indigenous children can lead to better health outcomes. To create effective strategies, governments must have accurate and up-to-date information. Accordingly, we reviewed the health disparities of Australian children in Indigenous and remote communities using publicly available reports. A thorough search was performed on Australian government and other organisational websites (including the Australian Bureau of Statistics [ABS] and the Australian Institute of Health and Welfare [AIHW]), electronic databases [MEDLINE] and grey literature sites for articles, documents and project reports related to Indigenous child health outcomes. The study showed Indigenous dwellings had higher rates of crowding when compared to non-Indigenous dwellings. Smoking during pregnancy, teenage motherhood, low birth weight and infant and child mortality were higher among Indigenous and remote communities. Childhood obesity (including central obesity) and inadequate fruit consumption rates were also higher in Indigenous children, but Indigenous children from remote and very remote areas had a lower rate of obesity. Indigenous children performed better in physical activity compared to non-Indigenous children. No difference was observed in vegetable consumption rates, substance-use disorders or mental health conditions between Indigenous and non-Indigenous children. Future interventions for Indigenous children should focus on modifiable risk factors, including unhealthy housing, perinatal adverse health outcomes, childhood obesity, poor dietary intake, physical inactivity and sedentary behaviours. Full article

(This article belongs to the Special Issue Inequities and Interventions in Children's Health and Wellbeing)

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15 pages, 352 KiB

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Patterns of Socioeconomic Inequities in SDGs Relating to Children’s Well-Being in Thailand and Policy Implications

by Orratai Waleewong and Khanuengnij Yueayai

Int. J. Environ. Res. Public Health 2022, 19(20), 13626; https://doi.org/10.3390/ijerph192013626 - 20 Oct 2022

Cited by 2 | Viewed by 2233

Abstract

Thailand faces many wealth inequities and child health-related problems. This study aimed to describe Thai child health and determine socioeconomic inequities following the child flourishing index, a tool used to measure children’s wellbeing based on the key relevant Sustainable Development Goals. The data from Thailand Multiple Indicator Cluster Survey 2019 were used to examine five indicators where Thailand had not yet achieved good results. The association of socioeconomic status with the five outcomes was explored using logistic regressions, comparing pseudo R-squared, and population attributable fraction analyses. Household wealth, urbanization, education, and primary language were significantly associated with Thai child health. Over 10% of children under 5 years were stunted and had a low birth weight. Fourteen percent of teenage girls had already become mothers. Living in poor households and rural areas, having a head-of-household who was non-Thai speaking, non-Buddhist, and had a low education were identified as risk factors for children with undernutrition status and low birth weight. However, having a head-of-household who spoke a non-Thai language was a protective factor against teenage mothers and having early marriages. Households with better economic status and education provided significant benefits for children and women’s health. The result of this study calls for public policies and multisectoral actions in the wider social and economic spheres that address the social determinants that span across lives and generations. Furthermore, specific social protection programs should be designed to be accessible by these most vulnerable and disadvantaged people. Full article

(This article belongs to the Special Issue Inequities and Interventions in Children's Health and Wellbeing)

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