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. Moore Kassim Mbwana Margot Bloch Child Trends

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 6

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 Engagement Participation 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

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Child Well-Being Domain Summary Positive Well-beingNegative Well-being DomainsDefinition% 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

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Positive Well-beingNegative Well-being DomainsDefinition% 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% PositiveNegative

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% Positive Negative

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% Positive Negative

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) PositiveNegative

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  Pearson correlations for overall negative CWB and overall negative contextual well-being are 0.44 with domains ranging from

Validity of indices – Child well-being and contextual correlations 45

CWB & Contextual well-being are different measures. 46 Positive Child Well-BeingPositive 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

Research in the Service of Children