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Children’s well-being: A balanced view -- positive and negative micro
indices of child well-being.by
Kristin A. Moore, Ph.D., Kassim Mbwana, M.P.P., and Margot Bloch
Kristin A. MooreKassim Mbwana
Margot Bloch
Child Trendswww.childtrends.org
Purpose
Recently, macro child well-being indices have been developed that focus on negative outcomes and contexts at the population level
Micro-level data can different and very, insightful indices
But positive measures are needed to assess child well-being
And child well-being should be distinguished from children’s contexts
2
Micro Indices
Children’s circumstances can be described for each individual child, across multiple developmental domains, and then aggregated.
3
Micro-level data: the NSCH Using the National Survey of Children’s Health 2003 (NSCH
2003), both positive and negative well-being indices are created. The indices assess children’s well-being and contextual well-being domains.
The 2003 NSCH:– collected data on over 100, 000 children ages 0-17 (parent
reports);– Is representative at state and national levels, enables state
comparisons;– Includes measures across multiple domains, positive and
negative behaviors; and– Has information on child well-being and children’s contexts.
4
The Domains Child well-being:
– Physical health;– Psychological health;– Social health; and – Educational Achievement and cognitive development.
Contextual well-being– Family context;– Community context;– Socio-demographic context; and– Educational context.
5
Child Well-being Domains
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Physical Health Health Status
– Overall Health Status• 1=Excellent or very good; 0= good, fair or poor.
• 1=Fair or poor; 0= good, very good or excellent.
– Oral Health Status• 1=Excellent or very good; 0= Good, fair or poor.
• 1=Fair poor or no natural teeth; 0= good, very good or excellent.
Chronic Health Conditions– 1= Absence of condition; 0= Presence of condition.
• Limiting condition, asthma, sensory disability, skeletal or muscular disability, diabetes, developmental delay or physical impairment.
– 1= Child with special health care need (CSHCN); 0= Child with no special health care need.
7
Physical Health cont’d. Health Risk Behaviors
– Eating Disorder• 1= Parent not at all concerned; 0= Parent concerned a lot or a little.
• 1= Parent concerned a lot; 0= Parent concerned a little or not at all.
– Substance abuse• 1= Parent not at all concerned; 0= Parent concerned a lot or a little.
• 1= Parent concerned a lot; 0= Parent concerned a little or not at all.
Health Promoting Behaviors– Adequate sleep
• 1= At least 6 nights a week; 0= Fewer than 6 nights a week.
• 1= 2 or fewer nights a week; 0= 3 or more nights a week.
– Vigorous exercise• 1= At least 3 days a week; 0= Fewer than 3 days a week.
• 1= 2 or fewer days a week; 0= 3 or more days a week
– TV Viewing• 1= Fewer than 3 hours a day; 0= At least 3 hours a day.
• 1= 3 or more hours per day; 0= Fewer than 3 hours per day
8
Psychological Health Internalizing Problems
– Depression or anxiety• 1= Absence of condition; 0= Presence of condition.
• 1= Presence of condition; 0= Absence of condition.
– Parent concern about depression or anxiety• 1= Parent not at all concerned; 0= Parent concerned a lot or a little.
• 1= Parent concerned a lot; 0= Parent concerned a little or not at all.
– Child feels unhappy, sad, or depressed• 1= Never or sometimes in the past month; 0= Usually or always.
• 1= Usually or always; 0= Sometimes or never.
Externalizing Problems– Behavior or conduct problems (diagnosed)
• 1= Absence of condition; 0= Presence of condition.
• 1= Presence of condition; 0= Absence of condition.
– ADHD (diagnosed)• 1= Absence of condition; 0= Presence of condition.
• 1= Presence of condition; 0= Absence of condition.
9
Psychological Health cont’d.
Self-esteem– Parent Concern about self-esteem
• 1= Parent not at all concerned or a little concerned; 0= Parent concerned a lot.
• 1= Parent concerned a lot; 0= Parent concerned a little or not at all.
– Child feels worthless or inferior• 1= Never in the past month; 0= Sometimes, usually, or always.
• 1= Sometimes, usually, or always; 0= Never
Coping skills– Parent concern about coping skills
• 1= Parent not at all concerned or a little concerned; 0= Parent concerned a lot.
• 1= Parent concerned a lot; 0= Parent concerned a little or not at all.
10
Social Health Parent-child Relationship
– Closeness• 1= Very close; 0= Somewhat close, not very, not close at all.
• 1= Not very close or not close at all; 0= Very close and somewhat close.
– Communication• 1= Very well; 0= Somewhat well, not well, not well at all.
• 1= Not well and not well at all; 0= Very well and somewhat well.
Activity EngagementParticipation in:– Sports– Clubs or organizations– Organized events or activities– Community service or voluntary work
For all:• 1= Yes in the past year; 0= No.
• 1= No in the past year; 0= Yes
11
Social Health cont’d. Positive Social Behaviors
– Child shows respect for teachers and neighbors– Child gets along well with other children– Child tries to understand peoples feelings– Child tries to resolve conflicts
For all:• 1= Usually or always; 0= Never or sometimes.
• 1= Never; 0= Sometimes, usually, or always.
Negative Social Behaviors– Child argues too much– Child bullies or is cruel or mean to others– Child is disobedient– Child is stubborn, sullen, or irritable.
For all:• 1= Never or sometimes; 0= Usually or always.
• 1= Sometimes, usually, or always; 0= Never.
12
Educational achievement and cognitive development
School Problems– Home contacted because of problems at school
• 1= Never or once in the past year; 0= More than once.
• 1= More than once; 0= Never or once in the past year.
– Grade repetition since kindergarten• 1= No; 0= Yes.
• 1=Yes; 0= No.
Learning Difficulties– Parent concern about learning difficulties
• 1= Parent not at all concerned; 0= Parent concerned a lot or a little.
• 1= Parent concerned a lot; 0= Parent a little or not at all concerned.
– Learning disability (diagnosed)• 1= Absence of condition; 0= Presence of condition.
• 1= Presence of condition; 0 = Absence of condition.
13
Educational achievement and cognitive development cont’d.
Cognitive Development– Child reads for pleasure
• 1= Any time in an average day; 0= None.
• 1= No time reading for pleasure or child cannot read; 0= Any time reading.
Achievement– Parent concern about achievement
• 1= Parent not at all or a little concerned; 0= Parent concerned a lot.
• 1= Parent concerned a lot; 0= Parent a little or not at all concerned.
14
15
Child Well-Being Domain Summary
Positive Well-being Negative Well-being
Domains Definition % for 6-11 yrs
Definition % for 6-11 yrs
Physical Health Status
3 of 4 positive sub-domains 58% 2 of 4 negative sub-domains 11%
Psychological Health
3 of 4 positive sub-domains 65% 2 of 4 negative sub-domains 11%
Social Health 3 of 4 positive sub-domains 67% 2 of 4 negative sub-domains 16%
Educational Achievement & Cognitive
3 of 4 positive sub-domains 65% 2 of 4 negative sub-domains 28%
All Well-being Summary Positive on 4 of 4 domains 31% Negative on 3 of 4 domains 6%
16
Percentage of children ages 6-11 with 0-4 domains of positive and negative child well-being.
17
Validity: CWB and Parent’s Education
18
Validity: CWB and Gender
19
Contextual Well-being Domains
20
Family Context Parental Engagement
– Parent attends child’s activities or events• 1= Usually or always in the past year; 0= Never or sometimes.
• 1= Never; 0= Sometimes, usually, or always.
– Parent has met child’s friends• 1= All or most; 0= Some, none or child has no friends.
• 1= None or no friends; 0= Some, most, or all.
– Family has TV rules• 1= Yes or no TV; 0= No.
• 1= No; 0= Yes or no TV.
– Family eats meals together• 1= At least 4 meals a week; 0= Less than 4 meals.
• 1= 3 or fewer meals; 0= 4 or more meals.
Home Environment– Parent exercises regularly
• 1=Yes in the past month; 0= No.
• 1= No; 0= Yes in the past month.
– Household members use cigarettes, cigars, or pipe tobacco• 1= No; 0= Yes.
• 1= Yes; 0= No.
– Home considered safe• Always; 0= Never, sometimes, or usually.
• 1= Never or sometimes; 0= Usually or always.
21
Guardian Functioning– Parent physical health status
• 1= Excellent or very good; 0= Good, fair, or poor.
• 1= Fair or poor; 0= Excellent, very good, or good.
– Parent mental health status• 1= Excellent or very good; 0= Good, fair, or poor.
• 1= Fair or poor; 0= Excellent, very good, or good.
– Parent copes with demands of parenting• 1= Very well; 0= Somewhat, not well, or not well at all.
• 1= Never; 0= Sometimes, usually or always (4-item Coping Scale)
– Parent has emotional help with parenting• 1= Yes; 0= No.
• 1=No; 0= Yes.
Health Coverage– Health care insurance
• 1= Currently and consistently insured over past year; 0= Not currently or consistently insured.
• 1= Not currently or consistently insured; 0= Consistently insured.
– Dental insurance• 1= Yes; 0= No.
• 1= No; 0= Yes.
– Personal doctor or nurse• 1= Yes; 0= No.
• 1=No, 0= Yes.
– Preventive medical care visits• 1= At least one visit in the past year; 0= No visits.
• 1= No visits; 0= At least one in the past year. 22
Family Context cont’d.
Community Context Supportive Neighborhood Environment
– Neighbors help each other• 1= Definitely or somewhat agree; 0= Somewhat or definitely disagree.
• 1= Definitely or somewhat disagree; 0= Definitely or somewhat disagree.
– Neighbors can be counted on• 1= Definitely agree; 0= Somewhat agree, somewhat or definitely disagree.
• 1= Definitely or somewhat disagree; 0= Definitely or somewhat agree.
Neighborhood Support for Parenting– Neighbors watch out for each other’s children
• 1= Definitely agree; 0= Somewhat agree, somewhat or definitely disagree.
• 1= Definitely or somewhat disagree; 0= Definitely or somewhat agree.
– Neighbors can be trusted to help each other’s children• 1= Definitely agree; 0= Somewhat agree, somewhat or definitely disagree.
• 1= Definitely or somewhat disagree; 0= Definitely or somewhat agree.
23
Community Context cont’d.
Safe Neighborhood– Neighborhood considered safe
• 1= Always; 0= Never, sometimes, or usually.
• 1= Never or sometimes feels child is safe; 0= Usually or always.
– Bad influences in neighborhood• 1= Definitely or somewhat disagree; 0= Definitely or somewhat agree.
• 1= Definitely or somewhat agree; 0= Definitely or somewhat disagree
Safe School– School considered safe
• 1= Always; 0= Never, sometimes or usually.
• 1= Never or sometimes; 0= Usually or always
– Parent concern about bullying• 1= Parent not at all concerned; 0= Parent concerned a lot or a little.
• 1= Parent concerned a lot or a little; 0= Parent not at all concerned.
24
Socio-demographic Context Socio-economic Well-being
– Household income• 1= At or above 200% of federal poverty level; 0= Below 200%.
• 1= Below 200% of federal poverty level; 0= At or above 200%.
Human Capital– Highest level of household education
• 1= More than high school; 0= High school or less.
• 1= Less than high school; 0= High school or more.
Family Structure– Family structure
• 1= Two parent biological/adoptive; 0= Two parent stepfamily, single mother/no father present or other.
• 1= Two parent stepfamily, single mother/no father present or other; 0= Two parent biological/adoptive
Family Size– Number of children in household
• 1= Fewer than 4; 0= 4 or more.
• 1= 4 or more children; 0= Fewer than 4.
25
26
Positive Well-being Negative Well-being
Domains Definition % for 6-11 yrs
Definition % for 6-11 yrs
Family Context
3 of 4 positive sub-domains 37% 2 of 4 negative sub-domains 9%
Community Context
3 of 4 positive sub-domains 35% 2 of 4 negative sub-domains 25%
Socio-demographic
Context
3 of 4 positive sub-domains 57% 2 of 4 negative sub-domains 33%
All Contextual Well-being Summary
Positive on 2 of 3 domains 41% Negative on 2 of 3 domains 16%
27
Child Contextual Domains Summary
28
Percentage of children ages 6-11 with 0-3 domains of positive and negative contextual child well-being.
Validity: Contextual Well-being and Parent’s Education
29
Validity: Contextual Well-being and Gender
30
Overall Findings
31
5.7%-11.9%12%-16%16.1%-21.9%22%-29.9%
Percentage of Children Age 5-17 in Families in Poverty 2003
Source: U.S. Census Bureau, Small Area Income and Poverty Estimates (SAIPE) Program
Child Well-being Findings
33
64.5%-71.7%59.9%-64.4%56.4%-59.8%46.8%-56.3%
Child Well-Being for 6-11 Year Olds, by State – Physical Health Status
Positive
4.7%-7.3%7.4%-9.6%9.7%-12.2%12.3%-18.2%
Negative
69.4%-76.1%
66.3%-69.3%
62.7%-66.2%
50.0%-62.6%
Child Well-Being for 6-11 Year Olds, by State – Psychological Health Status
5.7%-9.7%
9.8%-11.7%
11.8%-12.3%
12.4%-16.2%
Positive Negative
72.0%-76.1%
70.3%-71.9%
65.9%-70.2%
56.9%-65.8%
Child Well-Being for 6-11 Year Olds, by State – Social Health Status
7.0%-11.2%
11.3%-13.7%
13.8%-17.7%
17.8%-24.4%
Positive Negative
73.2%-79.6%
67.5%-73.1%
62.6%-67.4%
47.3%-62.5%
Child Well-Being for 6-11 Year Olds, by State – Educational Attainment and Cognitive Development
14.3%-20.2%
20.3%-26.0%
26.1%-30.3%
30.4%-45.6%
Positive Negative
61.9%-70.7%
56.5%-61.8%
50.4%-56.4%
37.6%-50.3%
Child Well-Being for 6-11 Year Olds, by State – Overall*
* (8 or more subdomains out of a possible 16)
1.7%-3.6%
3.7%-4.6%
4.7%-5.7%
5.8%-9.4%
Positive Negative
* (12 or more subdomains out of a possible 16)
Child Contextual Well-being Findings
39
40.1%-49.7%
37.6%-40.0%
36.1%-37.5%
Child Well-Being for 6-11 Year Olds, by State – Family Context
28.1%-36.0%
4.6%-6.5%
6.6%-8.0%
8.1%-9.6%
Positive Negative
9.7%-15.7%
39.6%-44.3%
37.1%-39.5%
33.9%-37.0%
Child Well-Being for 6-11 Year Olds, by State – Community Context
25.5%-33.8%
11.3%-18.6%
18.7%-22.3%
22.4%-27.0%
27.1%-48.6%
PositiveNegative
61.8%-74.2%
59.1%-61.7%
53.5%-59.0%
43.8%-53.4%
Child Well-Being for 6-11 Year Olds, by State – Socio-Demographic Context
16.5%-28.5%
28.6%-31.8%
31.9%-36.9%
37.0%-53.6%
PositiveNegative
30.5%-38.3%
26.4%-30.4%
21.9%-26.3%
15.5%-21.8%
Contextual Child Well-Being for 6-11 Year Olds, by State – Overall*
* (9 or more subdomains out of a possible 12)
2.1%-5.3%
5.4%-7.3%
7.4%-9.3%
9.4%-22.1%
* (6or more subdomains out of a possible 12)
Positive Negative
Validity of indices – Child well-being and contextual correlations
Correlations between child well-being and contextual
well-being are real but moderate.
Pearson correlations for overall positive CWB and overall positive contextual well-being are 0.44 with domains ranging from 0.14 - 0.33.
Pearson correlations for overall negative CWB and overall negative contextual well-being are 0.44 with domains ranging from 0.13 - 0.33.
44
Validity of indices – Child well-being and contextual correlations
45
CWB & Contextual well-being are different measures.
46
Positive Child Well-Being Positive Contextual Child Well-Being
47
Further Research
Conceptualizing each domain of well-being– Identifying new constructs
Develop new measures– For example to measure educational context
Improve selection of cut-points by using– Classical psychometric approaches– Cutting-edge approaches like
• Item Response Theory
• Cluster and profile analysis
• Latent class analysis
International comparisons of children’s well-being
48
www.childtrends.orgwww.childtrendsdatabank.org
Research in the Service of Children1979-2009