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Study demonstrates a powerful association between decreasing social class and poor health and behavior problems in children

Children from higher social classes (defined by parental education and work status) are likely to be healthier than those in the poorest social classes. Two differences in particular stand out. Children in the poorest social classes have less family involvement, an aspect of resilience considered key to good health. They also are more likely to have a history of disruptive behaviors, which can lead to injury or illness or disrupt social development. This suggests that families in the lower social class may face difficulties in providing the support and resources their children need for positive health, explains Barbara Starfield, M.D., M.P.H., of Johns Hopkins University.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS07045), Dr. Starfield and her colleagues examined parent and child responses to the Child Health and Illness Profile (CHIP)-Child Edition at five sites across the United States. They analyzed scores that parents gave their children 6 to 11 years old and that children gave themselves in six health domains: satisfaction with health (perceived health status and self-esteem); comfort (including restricted activity that interferes with comfort); resilience (family involvement, social problem-solving, and fitness-related activity); risk avoidance (risky or disruptive behaviors that can lead to illness or injury or behaviors that prevent it); achievement (academic performance and peer relations); and medical or psychosocial disorders. The researchers correlated these scores for children of low, middle, and upper socioeconomic status (SES).

Parent reports placed twice the proportion of lower social class children in the poorest health profile (22, 11, and 10 percent respectively, for low, middle and upper SES). Children with disorders in the lowest social class had significantly poorer scores than children with similar disorders in the highest social groups. Child-reported scores showed no significant differences in domain mean scores by social class, only trends toward better health among the higher social classes in all domains except satisfaction.

For more information, see "Social class gradients and health in childhood," by Dr. Starfield, Judy Robertson, B.S., and Anne W. Riley, Ph.D., in the July/August 2002 Ambulatory Pediatrics 2(4), pp. 238-246.

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