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Reports and Briefs

Profiles of Risk No. 9: Child Health

This ICPH research brief is the ninth in a series that highlights the characteristics of families with young children who become homeless in the urban United States. The series explores poverty in the context of housing status and puts a spotlight on the characteristics that make families who experience homelessness different from otherwise similar poor families who consistently maintain stable housing. The current brief explores differences in child well-being and examines how child health differs by housing status. The results indicate that children who face housing instability experience poor health from an early age.


Figure 1
Source: ICPH analysis of Fragile Families and Child Wellbeing data, n=1,777. Excluded are mothers who did not participate in the year-five survey, do not live with the focal child at least half of the time at year five, do not have valid sample weights, do not have valid measurements for weight at birth, or report an average (baseline to year five) income-to-poverty ratio greater than 1.25. Differences in low-birth-weight babies are statistically significant at 10% for always stably housed vs. ever-homeless or ever-at-risk women. Differences in prenatal smoking are statistically significant at 10% for all three groups. Differences in prenatal alcohol consumption are statistically significant at 10% for always stably housed vs. ever-homeless or ever-at-risk women. Difference in prenatal drug use are statistically significant at 10% for ever-homeless vs. ever-at-risk and always stably housed women.

Low Birth Weight

Early childhood health is predictive of future cognitive, social, emotional, and physical development. This brief examines differences in child health by housing status, using data from the Fragile Families and Child Wellbeing Study (FFCWS), a national survey that followed nearly 5,000 families for five years after the birth of each family’s focal child (see description).

Figure 1 presents adverse birth outcomes and maternal prenatal behaviors by housing status between years one and five—ever homeless or doubled up, ever at risk of homelessness, or always stably housed. Clear differences in the prevalence of low weight births are apparent between stably housed mothers and their unstably housed counterparts.[i] Approximately 2% of babies born to stably housed mothers were considered to have low birth weight, compared with 9% and 10% of babies born to ever-at-risk and ever-homeless mothers, respectively. Maternal behaviors, such as tobacco use, alcohol consumption, and neglect of prenatal care are associated with low birth weight.[ii] While virtually all poor mothers saw doctors at least once during pregnancy regardless of housing status, homeless mothers reported higher rates of smoking (24%), alcohol use (12%), and drug use (7%) during pregnancy; at-risk and stably housed mothers reported smoking at 16% and 6%, drinking alcohol at 11% and 6%, and using drugs at 2% and 1%, respectively. These findings support existing research that shows that homeless women engage more frequently in risky health behaviors that are linked to poor child health outcomes than their stably housed peers (see “In Context: Poverty and Health.”).

While many low-birth-weight babies develop normally, they are more likely to experience physical and developmental problems throughout their lifetimes than normal-weight children. Low birth weight has been associated with infant mortality, brain damage, mental retardation, blindness, asthma, and ear infections, as well as higher frequencies of hospitalizations and surgeries.[iii] Low-birth-weight children are also more likely to suffer learning disabilities, behavioral problems, and attention disorders and to perform poorly at school.

In Context
Poverty and Health

Poverty and housing instability are linked to poor child health outcomes through multiple pathways. Maternal poverty is associated with prenatal risks such as smoking and poor nutrition as well as chronic stressors such as crowded homes, unemployment, and violence.[iv] Community poverty also impacts health; asthma is linked to environmental hazards such as dust mites, dampness, mold, cockroaches, air pollution, and poor housing quality.[v] Homelessness exacerbates the negative health impacts of poverty. Maternal health—specifically the cyclical relationships among homelessness, poor health, and risky behaviors such as drug and alcohol use—is linked to child health outcomes.[vi] The high prevalence of depression in poor and homeless mothers may also lead to health impairments in their children; maternal depression has been linked to increased likelihood of child asthma and utilization of acute care. Symptoms of depression may impede a mother’s ability to notice health problems, keep doctor appointments, and adhere to treatment regimes.


[i] Low birth weight is a widely used determinant of infant health. Babies born at weights below 2,500 grams are considered to be low weight. Excluded from our FFCWS sample are children born as part of a multiple birth or who have incomplete birth-weight data.

[ii] John Rogers, “Tobacco and Pregnancy: Overview of Exposures and Effects,” Birth Defects Research (Part C) 84 (2008): 1–15; Vincent Jaddoe, et al., “Moderate Alcohol Consumption During Pregnancy and the Risk of Low Birth Weight and Preterm Birth. The Generation R Study,” Annals of Epidemiology 17, no. 10 (2007): 834–40; Julia Phillippi, “Women’s Perceptions of Access to Prenatal Care in the United States: A Literature Review,” Journal of Midwifery & Women’s Health 54, no. 3 (2009): 219–25.

[iii] Nancy Reichman, “Low Birth Weight and School Readiness,” The Future of Children 15, no. 1 (2005): 91–116; Maureen Hack, Nancy Klein, and H. Taylor, “Long-Term Developmental Outcomes of Low Birth Weight Infants,” The Future of Children 5, no. 1, (1995): 176–96; Maureen Hack, et al., “School-Age Outcomes in Children with Birth Weights Under 750 g.,” New England Journal of Medicine 331, no. 12 (1994):753–59.

[iv] N. Nagahawatte and Robert Goldenberg, “Poverty, Maternal Health and Adverse Pregnancy Outcomes,” Annals of New York Academy of Sciences 1136 (2008): 80–85; Paula Braveman, et al., “Poverty, Near-Poverty, and Hardship Around the Time of Pregnancy,” Maternal and Child Health Journal 14 (2010): 20–35.

[v] David Rosenstreich, et al., “The Role of Cockroach Allergy and Exposure to Cockroach Allergen in Causing Morbidity Among Inner-City Children with Asthma,” New England Journal of Medicine 336, no. 19 (1997): 1356–63; C. Aligne, et al., “Risk factors for Pediatric Asthma: Contributions of Poverty, Race, and Urban Residence,” American Journal of Respiratory and Critical Care Medicine 162 (2000): 873–77; Asthma and Allergy Foundation of America; Willine Carr, Lisa Zeitel, and Kevin Weiss, “Variations in Asthma Hospitalizations and Deaths in New York City,” American Journal of Public Health 82, no. 1 (1992): 59–65.

[vi] Kristin Turney, “Maternal Depression and Childhood Health Inequalities,” Journal of Health and Social Behavior 52 (2011): 314; Judith Stein, Michael Lu, and Lillian Gelberg, “Severity of Homelessness and Adverse Birth Outcomes.” Health Psychology 19, no. 6 (2000): 524–34; Jung Min Park, Angela Fertig, and Stephen Metraux, “Changes in Maternal Health and Health Behaviors as a Function of Homelessness,” Social Service Review 85, no. 4 (2011): 565–85. Please visit http://www.icphusa.org to access “Profiles of Risk: Maternal Health and Well Being.


A Hand Still Raised: How New York City's Homeless Students Fit into Charter Schools
2/2013

One Degree of Separation: Education, Sex, and Family Planning among New York City's Homeless Mothers
10/2012

Profiles of Risk No. 10: Father Involvement
8/2012


Low-weight Births and Maternal Prenatal Behaviors
(by housing status years 1–5)


Asthma at Age 5
(by housing status years 1–5)


Emergency Room Visits at Age 1
(by housing status years 1–5)


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