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

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Micro Indices

Children’s circumstances can be described for each individual child, across multiple developmental domains, and then aggregated.

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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.

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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.

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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.

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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

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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.

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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.

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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

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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.

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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.

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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.

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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%

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Percentage of children ages 6-11 with 0-4 domains of positive and negative child well-being.

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Validity: CWB and Parent’s Education

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Validity: CWB and Gender

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Contextual Well-being Domains

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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.

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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.

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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.

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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.

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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%

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Child Contextual Domains Summary

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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

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Validity: Contextual Well-being and Gender

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Overall Findings

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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

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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

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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.

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Validity of indices – Child well-being and contextual correlations

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CWB & Contextual well-being are different measures.

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Positive Child Well-Being Positive Contextual Child Well-Being

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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

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