How Early do Social Determinants of Health Begin to Operate? Results From the Fragile Families and Child Wellbeing Study

• Published in: Journal of pediatric nursing Vol. 37; pp. 42 - 50
• Main Authors: Zhang, Anao, Padilla, Yolanda C., Kim, Yeonwoo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2017
• Subjects: Age Factors; Aggression - psychology; Bullying; Bullying - prevention & control; Bullying - statistics & numerical data; Child; Child Rearing - psychology; Child Welfare - psychology; Child, Preschool; Children; Female; Health Surveys; Humans; Interviews as Topic; Logistic Models; Longitudinal Studies; Male; Multivariate Analysis; Risk Assessment; Self-Assessment; Self-rated health; Sex Factors; Social climate; Social Determinants of Health; Social Environment; Texas; Time Factors; Vulnerable Populations - psychology; Vulnerable Populations - statistics & numerical data; Bullying; Social determinants of health; Self-rated health; Children; Social climate
• ISSN: 0882-5963; 1532-8449
• DOI: 10.1016/j.pedn.2017.06.018

From a life course perspective, important insights about how social determinants of health operate can be gained by analyzing the various forms that social climate can take in different life periods. For children, a critical aspect of social climate is exposure to bullying. Bullying can serve as a proxy for power imbalance and social exclusion analogous to adult social climate of discrimination and racism.
We used the Year 9 follow-up data of the Fragile Families and Child Wellbeing Study (N=3301) that, for the first time included interviews with the children. We drew on a national sample of children and their families, which allowed us to account for broader contextual variables and represented a broad range of geographic areas and schools. Multinomial logistic regression was used to estimate the effects of exposure to bullying on self-rated health among primarily 9- to 10-year-old children while controlling for socio-demographic and diagnosed health-conditions.
Both frequency and forms of bullying were positively associated with lower odds of reporting excellent, very good or good health. The effect of forms of bullying on children's self-rated health fell on a gradient. Subgroup analysis indicated a significant effect on self-rated health for children who experienced peer rejection but not for those who experienced physical aggression.
The results of the study provide new evidence that the harmful health consequences of power imbalance and discriminatory practices may extend to children in early development. It also accentuates the need to study social determinants of health from both an ecological/contextual and a developmental angle.
Echoing a plethora of nursing literature on the critical role of psycho-social pediatric care, this study further encourages pediatric nurses to expand their assessment and intervention priorities beyond a familial and developmental perspective, and to consider the evident physical health consequence of a child's overall social climate determinants.
•Perceptions of power imbalance and exclusion affect children’s self-rated health as early as elementary school.•Social exclusion in school is associated with lower odds of “excellent or very good” or “good” self-rated health.•Rejection from peers is a more important determinant of children’s self-rated health than is physical aggression.