Child Rearing in America: Challenges Facing Parents with Young Children

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Child Rearing in America Challenges Facing Parents with Young Children

Child Rearing in America, a rich and well-researched volume, comes in the wake of intense national interest in young children. Leading scholars from diverse disciplines use relevant data from The Commonwealth Survey of Parents with Young Children to present a wealth of new information about the lives of families with very young children. They explore how parents spend their time with their children, the economic and social challenges they face, and the supports they receive to improve their children’s health and development. Such a broad portrait based on nationally representative data has not been attempted before. Drawing on their extensive expertise and research in the issues being addressed, the contributors examine and elaborate on the Survey findings. They synthesize the major themes emerging from the data and consider the family, community, and policy implications to frame and interpret the results. What emerges is a picture of the complex forces that influence families and child-rearing in the early years. Neal Halfon is Professor of Pediatrics, School of Medicine, and Professor of Community Health Sciences, School of Public Health, at the University of California, Los Angeles, where he serves as Director of the Institute for Children, Families, and Communities. Kathryn Taaffe McLearn is a Senior Fellow and Research Scientist at The National Center for Children in Poverty, Mailman School of Public Health, Columbia University. For the past seven years she has served as the assistant vice president at The Commonwealth Fund, where she oversaw and co-designed a national pediatric initiative, Healthy Steps for Young Children. Mark A. Schuster is Associate Professor of Pediatrics, School of Medicine, and Associate Professor of Health Services, School of Public Health, at the University of California, Los Angeles, and Senior Natural Scientist at RAND. He is Director of the UCLA/RAND Center for Adolescent Health Promotion, which conducts community-based research on adolescent health.

Child Rearing in America Challenges Facing Parents with Young Children

Edited by NEAL HALFON University of California, Los Angeles

KATHRYN TAAFFE McLEARN Columbia University

MARK A. SCHUSTER University of California, Los Angeles, and RAND

          The Pitt Building, Trumpington Street, Cambridge, United Kingdom    The Edinburgh Building, Cambridge CB2 2RU, UK 40 West 20th Street, New York, NY 10011-4211, USA 477 Williamstown Road, Port Melbourne, VIC 3207, Australia Ruiz de Alarcón 13, 28014 Madrid, Spain Dock House, The Waterfront, Cape Town 8001, South Africa http://www.cambridge.org © Neal Halfon, Kathryn Taaffe McLearn, Mark A. Schuster 2004 First published in printed format 2002 ISBN 0-511-03016-9 eBook (Adobe Reader) ISBN 0-521-81320-4 hardback ISBN 0-521-01264-3 paperback

To our families and parents

Contents

Tables Figures Contributors Acknowledgments 1 Introduction and Overview Neal Halfon, Kathryn Taaffe McLearn, Mark A. Schuster part i conditions of families with young children 2 Resources Devoted to Child Development by Families and Society M. Rebecca Kilburn, Barbara L. Wolfe 3 Preparing for Parenthood: Who’s Ready, Who’s Not? Constance T. Gager, Sara S. McLanahan, Dana A. Glei part ii child-rearing practices 4 Meeting the Challenges of New Parenthood: Responsibilities, Advice, and Perceptions Allison Sidle Fuligni, Jeanne Brooks-Gunn 5 Reading, Rhymes, and Routines: American Parents and Their Young Children Pia Rebello Britto, Allison Sidle Fuligni, Jeanne Brooks-Gunn 6 Child Discipline in the First Three Years of Life Lawrence S. Wissow 7 Breastfeeding in the United States Today: Are Families Prepared? Wendelin M. Slusser, Linda Lange

page ix xiii xv xix 1

21 50

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Contents

8 Depressive Symptoms in Parents of Children Under Age 3: Sociodemographic Predictors, Current Correlates, and Associated Parenting Behaviors Karlen Lyons-Ruth, Rebecca Wolfe, Amy Lyubchik, Ronald Steingard part iii delivery of health services to mothers and children 9 Prenatal Care, Delivery, and Birth Outcomes Paul H. Wise 10 Access to Health Care for Young Children in the United States Paul W. Newacheck, Miles Hochstein, Kristen S. Marchi, Neal Halfon 11 Anticipatory Guidance: What Information Do Parents Receive? What Information Do They Want? Mark A. Schuster, Michael Regalado, Naihua Duan, David J. Klein part iv future directions and policy implications 12 New Models of Pediatric Care Barry Zuckerman, Steven Parker 13 Families with Children Under 3: What We Know and Implications for Results and Policy Neal Halfon, Kathryn Taaffe McLearn Index

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263 293

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367 413

Tables

2.1 Characteristics Influencing Both Financial and Time Resources page 27 2.2 Allocation of Purchased Resources 28 2.3 Child’s Health Insurance by Provider and Income Category 31 2.4 Allocation of Time Resources 32 2.5 Psychological Resources 35 2.6 Human Capital Resources 37 2.7 Parents’ Use of Government Resources for Child Development 38 2.8 Other Sources of Support for Families with Young Children 39 2.9 Incidence of Risk Factors in Surveyed Families 41 2.10 Number of Risk Factors in Survey Families 42 2.11 Incidence of Risk Factors Relative to Entire Sample 43 3.1 Means and Frequency Distributions for Readiness to Parent Outcome and Predictor Variables 58 3.2 Bivariate Relationships between Parents’ Characteristics and Readiness Indicators 63 3.3 Effects of Parents’ Characteristics on the Odds of Pregnancy Intention Status 66 3.4 Effects of Parents’ Characteristics on the Odds of Parent Education Class Attendance 68 3.5 Effects of Parents’ Characteristics on the Odds of Social Support 69 3.6 Effects of Parents’ Characteristics on the Odds of Coping with Parenthood 71 3.7 Effects of Parents’ Characteristics on Overall Readiness 73 3.8 Effects of Readiness Indicators on Parenting Behaviors 74 3.9 Predicted Likelihood of Being Ready for Parenthood, by Mother’s Marital Status and Education Level 76 ix

Tables

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4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12

4.13 4.14 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 6.1 6.2

Division of Child Care Responsibilities in Two-Parent Families (%) Logistic Regression Predicting Incidence of Mother as Primary Caregiver Satisfaction with Time Spent with Child in Two-Parent Families Linear Regressions Predicting Satisfaction with Time Spent with Child Satisfaction with Time Spent with Child in Single-Parent Families Parents Receiving Parenting Information from Hospital Logistic Regression Predicting Information Given at the Hospital Top Four Sources of Parenting Advice Logistic Regression Predicting Information-Seeking from Health Professionals Use of Media Sources for Parenting Advice Logistic Regression Predicting Parent Seeking Information from Media Sources Parents Attending Parenting Classes, by Education and Marital Status (Percentage of parents in each education category) Logistic Regression Predicting Attending Parenting Class Linear Regression Predicting Parental Frustration Levels Frequency of Shared Book Reading Frequency of Playing with Child Maintenance of Family Routines Comparison of Parents Who Read to Their Child Weekly and Daily Comparison of Parents Who Play with Their Child Daily and Weekly Comparison of Parents Who Hug or Cuddle Their Child Daily and Weekly Comparison of Parents Who Do and Do Not Follow Daily Routines Effects of Parental Depression on Daily Shared Book Reading Effects of Parental Depression on Daily Playing with Child Effects of Parental Depression on Following Daily Routines Effects of Information-Seeking on Shared Book Reading Effects of Information-Seeking on Daily Shared Book Reading Effects of Information-Seeking on Daily Playing with Child Daily Shared Book Reading: Results from Two Studies Reported Use of Disciplinary Practices by Child Age (%) Correlates of Spanking by Child Age

90 92 93 94 95 98 98 100 101 102 103

103 104 108 122 123 125 127 128 129 130 131 132 133 134 135 136 141 156 157

Tables 6.3 Logistic Regression Analysis of Factors Associated with Ever Spanking an Infant 6.4 Logistic Regression Analysis of Factors Associated with Ever Spanking a Child Age 12–36 Months 6.5 Correlation of Disciplinary Practices and Parent-Child Activities with Parent Reports of Ever Spanking Their Child 6.6 Characteristics of Parents and Children in Four Clusters, Defined by Discipline and Parent-Child Interactions 7.1 Association between Maternal Characteristics and Health Services Indicators and Infant Feeding Choice for Biological Mothers (%) 7.2 Unadjusted Odds of Breastfeeding Initiation Compared with Never Breastfeeding for Biological Mothers 7.3 Likelihood of Breastfeeding Initiation Compared with Never Breastfeeding, Controlling for Significant Demographic and Health Services Factors (n = 1178) 7.4 Unadjusted Odds of Breastfeeding Duration of Greater than 1 Month, compared with Breastfeeding Duration of Less than 1 Month, for Biological Mothers 7.5 Likelihood of Breastfeeding Duration Greater than 1 Month Compared with Breastfeeding Duration of Less than 1 Month, by Demographic and Health Services Factors (n = 661) 8.1 Potential Predictors and Correlates of Parental Depressive Symptoms: Bivariate Statistics 8.2 Percentage of Parents Endorsing Two or More Depressive Symptoms by Sociodemographic Factors, Prebirth Events, and Current Circumstances 8.3 Hierarchical Regression Model of Factors Associated with Mothers’ Depression: Sociodemographic Factors, Stressful Events, Health, Social Support, and Parenting Confidence 8.4 Hierarchical Regression Model of Factors Associated with Fathers’ Depression: Sociodemographic Factors, Stressful Events, Health, Social Support, and Parenting Confidence 8.5 Parent-Child Interactions Associated with the Level of the Parent’s Depressive Symptoms: Bivariate Odds Ratios 8.6 Predictors of Less Optimal Parent-Child Interactions: Multivariate Analyses 9.1 Prenatal Care Initiation by Health Insurance Coverage 9.2 Association of Selected Variables with Late Initiation of Prenatal Care: Unadjusted (Univariate) and Adjusted (Logistic Regression Model) Odds Ratios 9.3 Association of Selected Variables with Early Discharge, Readmission, and Not Breastfeeding: Adjusted (Logistic

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165 170

190 193

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198 228

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236 242 245 276

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10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 11.1

11.2

11.3 11.4 11.5

Regression Model) Odds Ratios and 95% Confidence Intervals Usual Source of Care and Site of Care: U.S., 1993–94 Access Indicators for the Usual Source of Care: U.S., 1993–94 Missed Care: U.S., 1993–94 Delayed Care and Inability to Obtain Care Due to Cost: U.S., 1993–94 Average Annual Physician Contacts: U.S., 1993–94 Satisfaction with Usual Provider among Young Children with a Usual Source of Care: U.S., 1996 Need for and Receipt of Information on Early Childhood Development: U.S., 1996 Percentage of Families Reporting Ever Receiving Specific Services and How Useful They Considered Them: U.S., 1996 Difficulties Paying for Care: U.S., 1996 Percentage of Parents Who Had Not Discussed Each Topic, Who Could Use More Information, and Who Were in “Unaddressed Need” Groups Parents’ Mean Percentile Score for Number of Topics They Did Not Discuss and for Number of “Unaddressed Need” Groups They Are In Receipt of Services and Usefulness of Services Ratings of Clinicians among Parents Whose Child Usually Sees the Same Health Professional Percentage of Parents Who Gave at Least One Nonexcellent Rating and Percentage Willing to Pay an Extra $10 per Month for Anticipatory Guidance Discussions and Special Services

283 300 302 303 305 306 308 310 311 313

326

327 333 334

335

Figures

2.1 Incidence of Additional Risk Factors, Given One Risk Factor by Race/Ethnicity page 42 4.1 Which person are you most comfortable talking with about how to raise your children? 99 4.2 In general, how well do you feel you are coping with the demands of parenthood? 105 4.3 In a typical day, how many times would you say you feel frustrated or aggravated with your child’s behavior or that he/she gets on your nerves? 106 6.1 Child Discipline and Parent-Child Interactions in Clusters 168 8.1 Prevalence of Depression among Mothers and Fathers in Three Types of American Families 227 8.2 When the Child Is Not Firstborn: Prevalence of Depression among Mothers by Family Profile 234 8.3 Percentage of Parents Who Feel Aggravated with Their Young Children Two or More Times a Day by Parental Depressive Symptoms 244 8.4 Percentage of Parents Who Are Low on Two or More Types of Positive Interaction by Parental Depressive Symptoms 247 9.1 Month of Prenatal Care Initiation by Household Income 275 9.2 Maternal Hospital Stay for Vaginal and Cesarean Section Deliveries 282 9.3 Parents Reporting That Their Newborn Spent Too Little Time in the Hospital 285 13.1 Influence of Risk Reduction and Health Promotion Strategies on Health Development 375

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13.2 Strategies to Improve School Readiness Trajectories 13.3 Readiness to Learn Trajectory: Service Sectors and Programs That Influence School Readiness 13.4 Service Organization for Early Child Development and Parenting

Figures 402 403 405

Contributors

Pia Rebello Britto, PhD, Research Scientist, Center for Children and Families, Teachers College, Columbia University. Jeanne Brooks-Gunn, PhD, Virginia and Leonard Marx Professor of Child Development and Education; Co-Director, Center for Children and Families, Teachers College, Columbia University; Director, Columbia University Institute of Child and Family Policy. Naihua Duan, PhD, Professor in Residence, Department of Psychiatry and Biobehavioral Sciences, School of Medicine, Department of Biostatistics, School of Public Health, University of California, Los Angeles. Allison Sidle Fuligni, PhD, Research Scientist, Center for Children and Families, Teachers College, Columbia University. Constance T. Gager, PhD, Visiting Assistant Professor, Department of Sociology, University of Pennsylvania. Dana A. Glei, PhD, Independent Research Consultant, Santa Rosa, California. Neal Halfon, MD, MPH, Professor of Pediatrics and Community Health Sciences, UCLA Schools of Medicine and Public Health; Director, UCLA Center for Healthier Children, Families and Communities. Miles Hochstein, PhD, Assistant Director, National Center for Infancy and Early Childhood Health Policy of the Center for Healthier Children Families and Communities, UCLA, Los Angeles, California. M. Rebecca Kilburn, PhD, Director, RAND Child Policy Project; Senior Economist, RAND, Santa Monica, California. David J. Klein, MS, Senior Quantitative Analyst, RAND, Santa Monica, California. xv

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Contributors

Linda O. Lange, DrPH, RN, Research Coordinator, Child and Family Health Program; Associate Director, UCLA Breastfeeding Resource Program, UCLA Center for Healthier Children, Families and Communities. Karlen Lyons-Ruth, PhD, Associate Professor of Psychiatry, Cambridge Hospital, Harvard Medical School. Amy Lyubchik, PhD, Postdoctoral Fellow in Psychiatry, Harvard Medical School. Kristen Skenfield Marchi, MPH, Principal Research Analyst, Department of Family and Community Medicine, University of California, San Francisco. Sara S. McLanahan, PhD, Professor, Sociology and Public Affairs, Princeton University, Director, Center for Research on Child Wellbeing. Kathryn Taaffe McLearn, PhD, Senior Fellow and Research Scientist, National Center for Children in Poverty, Mailman School of Public Health, Columbia University. Paul W. Newacheck, DrPH, Professor of Health Policy and Pediatrics, University of California, San Francisco. Steven Parker, MD, Director, Division of Developmental and Behavioral Pediatrics, Boston Medical Center; Associate Professor of Pediatrics, Boston University School of Medicine. Michael Regalado, MD, Associate Professor of Pediatrics and Community Health Sciences, UCLA Schools of Medicine and Public Health. Mark A. Schuster, MD, PhD, Associate Professor of Pediatrics and Health Services, UCLA Schools of Medicine and Public Health; Senior Natural Scientist, RAND; Director, UCLA/RAND Center for Adolescent Health Promotion. Wendelin M. Slusser, MD, MS, Assistant Clinical Professor of Pediatrics, UCLA School of Medicine; Director, Breastfeeding Resource Program, UCLA Center for Healthier Children, Families and Communities. Ronald J. Steingard, MD, Professor of Psychiatry and Pediatrics; Vice Chair, Child and Adolescent Psychiatry, University of Massachusetts Medical School, University of Massachusetts Medical Center. Paul H. Wise, MD, Professor of Pediatrics, Boston University School of Medicine and Boston Medical Center; Lecturer, Harvard Medical School; Associate, Department of Medicine, Children’s Hospital, Boston, MA. Lawrence S. Wissow, MD, MPH, Associate Professor of Health Policy and Management, Johns Hopkins School of Public Health.

Contributors

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Barbara L. Wolfe, PhD, Professor, Department of Economics and Population Health Sciences, University of Wisconsin, Madison. Rebecca J. Wolfe, Doctoral Candidate, Department of Psychology, Harvard University. Barry Zuckerman, MD, The Joel and Barbara Alpert Professor of Pediatrics, Professor of Public Health, Chairman of Pediatrics, Boston University School of Medicine; Chief of Pediatrics, Boston Medical Center.

Acknowledgments

We would like to acknowledge The Commonwealth Fund, which provided the financial support that made this book possible. We express our gratitude to Anne MacKinnon for her expert and gifted editing of the manuscript, to Phinney Leah Ahn for her tireless assistance in helping prepare the manuscript, to Naihua Duan, PhD, for his assistance with statistical analyses, and to David Klein, MA, for his management of the dataset. We would like to thank the contributors for the rich scientific perspectives and insights they brought to each of their chapters. We also acknowledge the support of our editor, Julia Hough.

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1 Introduction and Overview Neal Halfon, Kathryn Taaffe McLearn, and Mark A. Schuster

recent perspectives on early childhood The well-being of young children has become a popular topic as expansions of knowledge in the neuro- and behavioral sciences have documented the importance of the first three years in children’s long-term learning, behavior, and health. Recent scholarly books and national research conferences have examined these issues from a variety of perspectives. In 1997, the National Academy of Sciences convened a three-year, multidisciplinary commission to examine and report on the science of early childhood. In 1999, RAND issued Investing in Our Children, which documented the benefits and savings associated with targeted early intervention programs. In 1996, 1997, and 2000, Time and Newsweek devoted entire special issues to the development of the young child. In 1997, the White House hosted conferences on childcare and on early child development and learning. Federal agencies have signaled their interest by expanding data collection on the early life predictors of educational success and supporting expansions of the Head Start program for children from birth to age 3. Numerous states have initiated aggressive early childhood agendas, focusing on childcare, health care, universal preschool, home visiting, and family support (Cauthen et al. 2000). All these efforts are evidence of a recognition of the importance of early child experience and a growing commitment to public policy that fosters the healthy development of our youngest children. The burgeoning focus on early childhood issues in the United States must also be understood in a broader context of concern expressed by the American public about children and their families. Recent polling data from Public Agenda suggest that 82 percent of Americans believe it is harder to be a child today than in past years. By a margin of almost two to one, Americans believe that most parents face times when they really need help raising their children (Public Agenda 1997). The current domestic 1

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policy focus on improving educational opportunities and outcomes, and a constellation of related political factors, all suggest that the coming decade presents a window of opportunity to address the concerns and needs of families with young children. This strong interest in the lives and potential life trajectories of young children is also being driven by concerns that many young children are seriously and predictably at risk for poor long-term developmental and educational outcomes. For nearly 20 years, poverty rates for children younger than 6 years of age have exceeded 20 percent nationally; in several major urban areas, poverty rates continue to exceed 30 percent. These high rates of early childhood poverty have persisted despite sustained economic growth for most of the 1990s. The deleterious effects of growing up in poverty on child health and development are increasingly well recognized (Duncan and Brooks-Gunn 1997). And there is evidence to suggest that poverty may be especially damaging to the child in the early years (Shonkoff and Phillips 2000). Of related concern is the growing recognition that disparities in health and social outcomes of children, youth, and adults have their origins in disparities that begin early in life (Keating and Hertzman 1999). Disparities in health and emotional states that develop early in life not only persist but are often compounded over time. As one economist writing about policies to foster the growth of human capital observed, “Early learning begets later learning and early success begets later success just as early failure begets later failure” (Heckman 1999). A host of short- and long-term research studies in various fields is providing empirical evidence that disparities in human development manifest early in life and persist across decades. For example, the British 1946 National Birth Cohort Study, which followed more than 5,000 children over half a century, clearly documents that events in early childhood are independent predictors of cardiovascular, respiratory, and neurological health in mid-adulthood (Wadsworth and Kuh 1997; Smith 1999). Children in the cohort who experienced frequent lower respiratory infection in the first two years of life were much more likely to have chronic obstructive pulmonary disease in middle age. Other research studies on emotional and cognitive development have also established links between early life experiences and long-term emotional and intellectual functioning. As the scientific evidence has grown, theoretical constructs to explain the role of family and environmental contexts on child health and development have also evolved significantly. Subtle and important differences in approaches persist, yet a remarkable consensus has emerged. Researchers in a range of disciplines generally accept that family contexts, relationships, and activities play an important role in determining child development and health outcomes (Boyce et al. 1998).

Introduction and Overview

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Changing Views of Childhood and Family Our understanding of childhood and the social roles of children has changed dramatically over the past century. Children are shaped by the culture in which they grow, and American children do not all begin with the same chances for success. What parents bring to the job of nurturing their children’s development, especially in the early years, is recognized as a critical influence, but so too are political forces, practical economics, and implicit ideological commitments to children and their families. As such, childhood has become a focus of study in many different academic disciplines, each providing a unique perspective on the roles, needs, and prospects of children and their optimal development. r Economists have focused on the cost of raising children and on household inputs needed to produce the circumstances necessary for children’s attainment (Becker 1973). Some studies have examined economic incentives that influence family choices of child care arrangements, health care, and other factors that directly impact the ability to provide for children (Leibowitz 1974; Haveman and Wolfe 1995). Recent research has also focused on the effects of certain kinds of jobs and work relationships on how parents feel, and therefore on how they are able to support their children’s development when they return home from the workplace. r Sociologists have focused on family and social structures and their influence on children’s development and life course transitions. Studies such as Glen Elder’s classic Children of the Great Depression demonstrate that historical forces shape the social trajectories of families, determine the availability of educational and employment opportunities, and thus influence behavior and development (Elder 1974). More recently, Robert Sampson studied adolescents coming of age in Chicago’s inner city in order to dissect the webs of social processes and relationships that influence the life courses of adolescents (Sampson 1997). r Psychologists have examined emotional and cognitive development and the determinants of the onset of psychopathology (Sroufe 1997; Rutter 1996). A range of longitudinal studies display the impact of early life experiences and specific traumatic events, such as childhood sexual abuse, on the developing self. r Pediatricians and child health specialists have focused on the determinants of health status and risks to child health (Hoekleman and Pless 1988), and especially on changes in those areas over the past century. Epidemiological studies had documented dramatic reductions in infant mortality due to improved living conditions and medical care, decreases in childhood infection as a result of immunizations and antibiotics, and the persistent threat of injury as a cause of morbidity and mortality.

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Changes in the epidemiology of childhood health and disease have also given rise to what some pediatric researchers have termed the “new morbidities” – conditions such as child abuse, learning disorders, and psychopathology that may be heavily influenced by social factors (Haggerty 1975). While each of these research traditions approaches the subject of children and childhood differently, using different conceptual models and analytical tools, each has also necessarily focused on and highlighted the changing nature of the family. While families still play an essential role in the lives of all children, families are changing in size, structure, earning potential, and expectations. Children born in the year 2000 are much more likely to experience divorce, to live in a single-parent household, and to feel certain stresses and demands than were children born 50 years earlier. Today’s children are also more likely to be raised by parents who are better educated, who are more isolated from extended family relationships, and in two-parent households, who are both employed to support the family. What we expect parents to know and do to promote and support their child’s development has also changed. Social norms for parents and parenting expectations have shifted dramatically over the century, and these changes seem to have accelerated over the past decade. Norms regarding acceptable childcare, discipline, and education have been redefined, even during the past two decades. Parents have access to growing volumes of information about child development, discipline, and parenting techniques from a range of professional and eclectic purveyors. Talk shows, specialty magazines, and now the internet have the capacity to provide non-stop information on what to do and how to encourage a child’s future development. Yet little is known about how good this advice is, whether parents who need it are gaining access to it, or whether they are able to act on it in ways that actually promote the development of their children. Is this information helping parents be better parents? We simply do not know. The New Focus on Early Childhood Just as childhood and children have become the focus of study and debate, early childhood has grown to become a field in its own right, with its own areas of research focus and public policy concern. r Economists have highlighted the wisdom of investing in the youngest children, when the potential for return is greatest (Heckman 1999). Recent reports from RAND and the National Bureau of Economic Research have reviewed the economic assumptions that underlay the provision of intervention services early in childhood and calculated the costs and benefits of programs specifically targeted at improving the development of children from birth to age 3 (Karoly 1997; Heckman 1999).

Introduction and Overview

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r Developmental psychologists have suggested that young children 0–3 learn more about the world, other people, and language than what was previously understood (Gopnik 1999). They have outlined mechanisms that “program” various behavioral response strategies, as well as the role of critical relationships in providing the emotional scaffolding that supports learning and cognitive development (Dawson 1994; Sroufe 1997). r In neurobiology, researchers have highlighted the exceptional flexibility and activity of the brain of the young child, and how profoundly its neuronal structure and function can be influenced by experience. The early neurobiology of cognitive function is coming into greater focus, as are the neurobiology of early emotional states and the influence of selective experiences in the “wiring” of the brain (Schore 1994; Fox 1995). r Epidemiologists and child health researchers have highlighted the origins of adult conditions and disease states that begin early in life. This work suggests that metabolic pathways and response patterns set forth during the first years of life may influence the onset of coronary artery disease, diabetes, and hypertension five or six decades later (Barker 1998; Kuh and Ben-Shlomo 1997). One study, for example, traced the possible programming effect of breast milk on cholesterol metabolism, while another explored the possible influence of early nutrition and growth on non-insulin dependent diabetes (Lucas 1998). r Sociologists and developmental psychologists have juxtaposed the fact that most American parents are now employed outside the home against the fact of young children’s dependence on others for caregiving and nurturing. Even the youngest children are now likely to be cared for by non-family members and childcare centers. r Last, a growing number of studies have demonstrated that life course trajectories can be altered by interventions that change the dynamic relationships within a family early in life (Olds 1997; Ramey 1992; Campbell and Ramey 1995). Although enriched early intervention programs do not seem to alter long-term cognitive outcomes measured by IQ, they substantially alter noncognitive skills and social attachments of participating children and families. Public Policy and Leadership in Early Childhood At the beginning of the 1990s, Beyond Rhetoric (National Commission on Children 1991) and the Carnegie Corporation’s Starting Points (1994) set a new and broader public policy context for considering the needs of families with young children. And in late 2000, the Institute of Medicine and National Research Council released a seminal report, From Neurons to Neighborhoods (Shonkoff and Phillips 2000), which

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provided a guide to what science-based policies and programs could mean for our nation’s youngest children. The 1997 White House conferences examined the public policy implications of new findings from brain research literature and the role of childcare as more women are employed as full-time workers. Several federal agencies have focused new attention on the development of young children, collecting new data, launching new programs, and expanding oversight and support for states and local communities that are trying to make a difference in the lives of young children. Over the past 15 years, federal legislation has formed the basis for a more defined set of social policies on young children. Each legislative effort not only demonstrated a concern with the development of young children but recognized that the most important single instrumental method for supporting the development of young children is to build family capacity. r Passed in 1986 and fully implemented in the early 1990s, the Individuals with Disabilities Education Act (IDEA) Part C legislation has funded states to identify and address the needs of young children with developmental disabilities and those who are at risk for having developmental disabilities through a comprehensive family-focused approach. r Head Start has grown and expanded during the 1990s, and the federal government created Early Head Start for children 0–3 in 1996. The Early Head Start model also employs early intervention to build family capacity, drawing on home visiting techniques that have been developed and tested over the past two decades. r The 1992 Family and Medical Leave Act allows mothers and fathers to take an unpaid leave of up to 12 weeks in a 12-month period without penalty in the workplace after the birth, adoption, or foster placement of a child and when they need to care for a sick child. At the state level, there has also been widespread policy activity focused on young children. A few examples illustrate the range of these new state initiatives. r North Carolina’s Smart Start Program is an early childhood initiative to promote school readiness in children. r Vermont has created Success by Six, a statewide health and developmental improvement campaign that has had a significant impact on several child outcomes. r California’s Proposition 10, the Children and Families First Act, passed in 1998, is a major initiative that will provide about $700 million annually to improve services focused on children 0–5. Proposition 10 also builds a new quasi-governmental infrastructure in each county to serve as a community outcomes trust for young children.

Introduction and Overview

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the purpose of this book This book is about families with very young children. It offers a broad and in-depth look at families with infants and toddlers: how they prepared for parenthood, how they spend their time together, the nature and patterns of their routines and practices, their relationships with extended family members and their other supports, and the stresses and strains they experience. Its perspective is multidiscplinary, exploring the range of social, economic, family, and individual factors that interact to alter and shape the development of young children. The contributors include scholars and practitioners from different disciplines, including economics, sociology, developmental psychology, psychiatry, pediatrics, and health policy. The impetus for preparing the book was a unique survey conducted in 1995–96 by The Commonwealth Fund. The Commonwealth Survey of Parents with Young Children provides a representative snapshot of the conditions of families with young children – and the pressures and concerns faced by parents in shaping the home environments and lifestyles of those families. A national sample of more than 2,000 mothers and fathers answered questions about a broad spectrum of topics, including preparation for parenthood, birth of a child, family economic structure, participation in the workforce, child-rearing practices and discipline, child and family health, and access to and satisfaction with child health and developmental services. Their responses were the starting point for many of the analyses presented in this book. The survey did not to focus on child-care issues since so many other surveys, national studies, and books have recently been written about the subject. In fact, the decision was made to focus on more neglected topics relevant to the parents of young children – what they do and believe and the resources they need, especially from the health care system. The contributors were encouraged to complement their analysis of the survey data with other national datasets, a wide range of published studies on families with young children, and relevant theoretical frameworks. Each chapter builds on the survey data to provide a well-rounded analysis of an important area of family life and to examine policies and programs that address the needs of young children and their families. The book is also unique in its focus on the role of the health-care system and health-care providers in supporting the child-bearing and childrearing needs of families. While other recent studies have examined the influence of child-care environments, there has been much less attention paid to health-care providers–representatives of one of the main societal institutions with continuous and ongoing contact with families and young children. Their interactions are sufficiently intense during the first three years of life to provide a unique access point for transferring information and initiating interventions that can benefit children’s health and well-being.

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The richness of the survey dataset allowed the contributors to examine in detail the patterns of child rearing, the routines and rhythms of family life, and certain behaviors that are potentially sentinel indicators of how mothers and fathers interact with their young children. We have paid particular attention to family routines, especially those focused on reading and early literacy, breastfeeding, and discipline. We believe that the focus on these behaviors and the examination of similarities and differences across geographical regions, racial and ethnic groups, and different family structures tells a great deal about the similarities and differences that exist for children living in the United States today. Survey Methods The Commonwealth Fund developed the Survey of Parents with Young Children to provide an overview of the health and social conditions of families with young children in the United States. It is the first national survey of a representative sample of parents with children ages 0–3 to focus on factors that have been shown by recent research to be important in determining child health and development outcomes, and it also has the advantage of including a large number of fathers in the sample. Questions cover a period beginning before conception and include the early childhood years. Parents were asked about planning to have a child, strategies for child rearing, the challenges of taking care of children while meeting other responsibilities, social supports, and interactions with the medical system. It does not include some important topics, such as childhood immunizations and child care, that have already been covered in detail by other national surveys. A total of 2,017 parents were surveyed during 25–minute telephone interviews carried out between July 1995 and January 1996. Stratified random-digit dialing was used to obtain a nationally representative sample of parents with children 0–3 years of age in the United States. The sample included 1,320 mothers and 697 fathers. African American and Hispanic households were oversampled to facilitate subgroup analyses, and results were weighted accordingly. With oversampling, the sample included 392 non-Hispanic African American parents and 419 Hispanic parents, along with 1,109 non-Hispanic white parents, 84 “other” parents, and 13 parents who did not report race or ethnicity. Respondents were screened by telephone for eligibility, and those who were eligible were asked to participate in an interview. Eligible respondents included biological parents, adoptive parents, stepparents, or other guardians of a child younger than 3 years old living in their households. (Overall, fewer than 1 percent were non-parents.) When two parents were present at the time of the interview, one was randomly selected to participate in the interview. Parents who did not live with their children were

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excluded. Many of the interview questions were specific to a child younger than 3. If the respondent had more than one child younger than 3 years old, either the oldest or youngest age-eligible child was randomly selected as the index child about whom specific interview questions were asked. This sampling procedure excluded middle children when there were more than two age-eligible children in the same family. Because only 1 percent of families in the study had more than two age-eligible children, this exclusion should not result in any serious bias in the sample. Among 66,633 telephone numbers sampled, eligibility status was determined for 82 percent (54,462) through screening; other means for determining eligibility included the following: telephone number not in service (12,132) and number was for a business, telephone booth, fax, or modem line (7,808). Among 34,522 who completed screening, 8.6 percent (2,959) were found to be eligible to participate in the study. Of those who met the eligibility criteria, 68 percent (2,017) completed the phone interview. The results are weighted to represent the overall distribution of parents with children younger than 3 years old in the United States. For all statistical inference testing, standard errors were adjusted for the design effect (due to unequal sampling probabilities and stratification) using the sandwich variance estimator (StataCorp 1997). Organization of the Book The editors recruited contributors who are experts in their fields and represent a variety of disciplines. After completing their first drafts, the lead contributors gathered at The Commonwealth Fund for a two-day meeting of cross-disciplinary discussion of the findings. In addition, a statistician was available for consultation and review of statistical methods for the analyses. The editors guided the development of the chapters and reviewed analyses and content. The book is organized into four parts. Part I describes the contemporary conditions of families in the United States with children birth to age 3. Part II examines contemporary child-rearing practices. Part III focuses on the health-care system and parents’ relationships with healthcare providers. Part IV looks toward the policy implications of the survey findings. Part I includes two chapters that chronicle the conditions that affect a family’s ability to care for their young children. In the opening chapter of the section (Chapter 2), economists Kilburn and Wolfe present models of child development, highlighting the important role of resource allocation. The authors suggest that four types of resources – financial, time, psychological, and human capital – are inputs to child development. The chapter documents the allocation of resources in these categories by parents, the

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government, and others from the prenatal period through the first three years of a child’s life; it then develops an index of risk factors for young children. A unique aspect of the chapter and the Survey of Parents with Young Children is the unparalleled information on two important resources for child development: human capital and psychological resources. The authors note that these two resources have received little attention, despite their increasing prominence in the discourse on child-development modeling. They conclude that although parents provide the majority of inputs, a large number of families struggle to provide inputs for their young children. Government inputs are relatively common and mainly serve as a safety net, conditional on a family’s being in need or at risk. In Chapter 3, sociologists Gager, McLanahan, and Glei discuss the psychosocial and familial characteristics associated with being ready to parent among mothers and fathers who have had a child within the last three years. Based on numerous studies that document that intended pregnancies are associated with better parenting and child outcomes, this chapter focuses on two questions: What proportion of parents is ready and what risk factors are associated with preparation for parenthood? The authors examine four dimensions of readiness: intention to become pregnant, participation in childbirth and child rearing classes, availability of social support from family and friends, and psychological resources or preparedness. The authors conclude that the vast majority of mothers and fathers appear to have been prepared for their new responsibilities as parents. At the same time, they caution that some parents seem to have been unprepared for their new responsibilities, and that the likelihood of being unprepared is higher among racial and ethnic minorities and parents with low educational attainment. Some findings were inconsistent with previous work, and the authors suggest possible implications for social policy and programs. For example, these data indicate that closeness to kin appears to be a function of family structure rather than race or ethnicity, and that parents living in nontraditional families are more likely to live near a grandparent. Somewhat surprisingly, first-time parents appear to be more prepared than other parents on almost all indicators of readiness to parent. Part II contains five chapters, which together provide a rich and contemporary picture of child rearing in U.S. families. Each focuses on a set of parenting behaviors that are believed to influence the trajectory of a child’s health and development. These chapters also present a more in-depth analysis of the data on psychological, time, and human capital resources presented in the opening chapter by Kilburn and Wolfe. Developmental psychologists Fuligni and Brooks-Gunn present data in Chapter 4 about how today’s parents of infants and toddlers divide the child-rearing responsibilities, where parents turn for advice and support, and how well they feel they are managing their parenting responsibilities. The findings provide some important information about the effects of

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employment patterns, and especially the large numbers of mothers with young children in the workforce, on child rearing patterns. Fuligni and Brooks-Gunn find higher rates of shared caregiving than other recent studies of two-parent families, yet mothers are still the primary caregivers of young children, often working the “second shift.” The authors report that parents are coping well with the demands of parenthood in general, but are pressed for time and would like more time with their young children. The data suggest that certain groups of parents – those with low incomes or education or who are unemployed – tend not to avail themselves of formal supports and child-rearing information that can make parenting more satisfying and positive. In Chapter 5, Britto, Fuligni, and Brooks-Gunn examine the frequency with which parents of young children engage in three representative parenting practices: shared book reading, daily routines (bed, nap, and meal time), and nurturing activities such as hugging and cuddling. Summarizing a substantive body of research, the authors suggest that these three parenting activities provide unique opportunities for stimulating cognitive, social, physical, and emotional development in young children. Several common threads emerge from the data that have practice and policy implications. First, the age of the child is an important determinant of parental activities, with parents of infants less likely to read to them and parents of toddlers less likely to play with them, although research indicates that both activities are important for both age groups. Second, only about half of parents with children 1 year or older maintain daily routines. This chapter also adds to existing literature suggesting that young, low income, less-educated parents are less likely to engage in child-rearing activities associated with fostering children’s healthy cognitive, social, and emotional development. The authors discuss the relevance of their findings for welfare reform and initiatives for at-risk parents. Discussing discipline, pediatrician and child psychiatrist Wissow opens Chapter 6 with an extensive review of the history of physical punishment in the United States and the current debate surrounding this particular type of child discipline. Wissow defines both discipline and punishment and summarizes the findings from large national surveys about discipline and child-rearing practices. He notes evidence that the use of physical punishment is declining, although it is practiced in about half of American families, and that parents use it despite having relatively little faith in its effectiveness. Wissow goes on to present findings from the Commonwealth Survey, the only representative study with data about discipline solely from parents of infants and toddlers. The data suggest that counseling about disciplinary practices and alternatives to spanking needs to take place early: More than 40 percent of parents reported that they could use more information on how to discipline their young children. By the time children are 18 months old, more than a third have been spanked.

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Wissow also identifies the contexts in which spanking takes place, and explains that spanking is most common among a group of parents who tend to be single, have low incomes, and experience more depressive symptoms. These parents were also less likely than others to use nonphysical punishments, such as time out or taking things away. Also, parents of firstborn children were less likely than parents with more children to say they could use more information about discipline – a finding that suggests that parents with more children may be more receptive to parenting advice or that having one child is less stressful. In Chapter 7, Slusser and Lange provide the reader with a unique portrait of the social, demographic, and family factors that influence the decision to breastfeed in the United States today, as well as the role of support and encouragement by professionals. As the authors explain in their chapter, “Breastfeeding in the United States Today: Are Parents Prepared,” breastfeeding is one of the most important child-rearing and healthpromoting behaviors in infancy, yet it is frequently ignored in policy discussions and books on child health and development or family policy. Slusser and Lange present a comprehensive review of the physical and psychosocial benefits of breastfeeding for both child and mother, the economic savings for families, and social barriers to breastfeeding. Their analysis confirms previous findings that education remains the strongest demographic predictor for breastfeeding. Mothers with the lowest breastfeeding rates include single, low-income women, African Americans, those who receive government assistance, and those with lower levels of education. According to the survey, almost three-quarters of mothers report being encouraged to breastfeed in the hospital and that professional support was associated with the initiation of breastfeeding but not its duration. The authors conclude with a discussion of the policy, programmatic, and legislative efforts to overcome barriers to breastfeeding. Part II closes with a discussion by Lyons-Ruth, Wolfe, Lyubchik, and Steingard of the prevalence and impact of parental depressive symptoms on child rearing. The authors begin Chapter 8 with an extensive literature review documenting the increased incidence of maternal depression among women of childbearing age and its association with impairments in adaptive parenting behaviors and developmental outcomes for children. The Commonwealth data confirm widespread developmental findings that negative correlates of parental depression are evident during a child’s first three years of life. Unique in the inclusion of both mothers and fathers, the data indicate that parents of both genders who are depressed are less likely to play, read, maintain routines, and hug or cuddle their infant or toddler, and are more likely to be frustrated, aggravated, and use negative discipline such as yelling, spanking, and hitting. The authors suggest that even as parental depression constitutes a risk factor for young children, young children constitute a risk factor for adult depression.

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Among fathers who assume primary child-rearing responsibility, the rate of depressive symptoms is equal to that of mothers who are their children’s primary caretakers. Part III focuses on the delivery of health services to young children and their families in three chapters on diverse topics: prenatal care and perinatal services, young children’s access to health care, and the parent-physician relationship. In Chapter 9, on prenatal care and perinatal services, Wise describes recent trends in the use of prenatal care and the implications of a changing medical marketplace – most notably, early discharge – on the care of mothers and newborns. The author concludes that although a vast majority of women in the United States start prenatal care early, powerful social disparities still exist in the use of prenatal care. A mother’s income, race, age, educational status, and intention to become pregnant are all associated with prenatal care utilization and attendance at childbirth classes. The survey findings also document that lack of insurance significantly elevates the chance that a woman will begin prenatal care late or not at all, and not attend childbirth classes. Wise judiciously suggests that these factors are likely to be highly interactive, “reflecting the underlying clustered expression of social status in American daily life.” The author reports that one-day hospital stays have become common throughout the United States, with no associated wide-scale use of at-home follow-up for low-risk mothers. The survey shows that despite their concerns about short stays, mothers report high levels of satisfaction with their hospital care. In Chapter 10, Newacheck, Hochstein, Marchi, and Halfon provide a comprehensive profile of young children’s access to health care in the United States using two complementary data sources: the Commonwealth Fund Survey of Parents with Young Children and the 1993–94 National Health Interview Survey and its supplements on access to care and health insurance coverage. The authors show that partly as a result of Medicaid expansions, the vast majority of young children have a usual source of health care, yet there is still a group of infants and toddlers – many of them poor, minority, or uninsured – who are more likely than other young children to go without a usual source of pediatric care. These children are significantly less likely to receive their care in a physician’s office, private clinic, or HMO, and more likely to use community health centers and hospital outpatient clinics. The authors also document the fact that poor and uninsured children face the greatest obstacles in obtaining needed services such as dental care, prescriptions, or mental health services. Using both datasets, the authors report that poor, nonwhite, and uninsured parents are more likely to report being dissatisfied with the health care their child receives and less likely to get information on child growth and development. Nearly one in ten young children had no coverage for preventive services such as well child care and immunizations.

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Part III closes in Chapter 11 with a discussion by Schuster, Regalado, Duan, and Klein of the parent-physician relationship, the evolution of the role of the physician as educator and counselor, and the expectations of the physician in this role for parents with young children. The authors suggest that the pediatric clinician’s role has been transformed over time by multiple factors, including changes in traditional pediatric morbidity and mortality, the growth of pediatric subspecialties, increased knowledge about normal child development, and parents’ expectation that the health system will address psychosocial concerns in addition to traditional child health issues. They also note that the current literature gives little indication of how adequately pediatric clinicians are meeting parents’ needs for child-rearing information. Using the Commonwealth Fund Survey of Parents with Young Children, the authors find that most parents are not discussing child-rearing information with their child’s doctor, despite the fact that they say they want more information on learning, discipline, sleep, toilet training, and other topics. Schuster, Regalado, Duan, and Klein conclude that parent satisfaction with care is positively related to the number of topics discussed and the breadth of services provided. Part IV presents a discussion of future directions and policy implications. In Chapter 12, pediatricians Zuckerman and Parker describe new models of pediatric care, and list sociocultural forces that influence the need for new models: rapid social change, growing income inequity, new knowledge about early development, and the link between parental health and child health. The chapter draws on the data highlighted in the rest of the book as well as research literature on early intervention. The authors suggest that pediatric practice needs to strengthen its emphasis on child development, using five related strategies: (1) expanding child development services, (2) creating a two generation approach to child health, (3) strengthening links to other services, (4) providing parental support, and (5) serving as an advocate for parents. Building on their clinical experience and work with families, Zuckerman and Parker suggest a clinical model, Healthy Steps, as one approach to enhance pediatric care. The authors conclude with a discussion of the potential benefits of developmentally oriented primary care interventions in an era of cost containment. In the concluding chapter (Chapter 13), editors Halfon and McLearn consider how the research findings and interpretations presented by the authors could inform social and health policy for families with very young children. The discussion begins by considering the family, community, and policy context of early childhood, then goes on to summarize major findings and suggest policy implications. In looking across the chapters, what becomes clear is that income, education, employment, and other family relationships are important predictors

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of child-rearing practices and behaviors. The encouraging news is that the survey data indicate that information and guidance can make a difference in parents’ child-rearing practices and their ability to cope with the demands of parenthood. The discouraging news is that the United States has not yet been able to translate what has emerged from research on child development and family functioning into universal policy responses. The health-care system potentially plays a major role in the lives of young children, yet it misses important opportunities to help many parents do their best in rearing young children. Using new information and examples of innovation in communities across the United States, local communities can pursue integrated strategies to promote the healthy development of their youngest residents. Moreover, state and federal policy makers must consider a more integrated policy response based on the services and supports that many families with young children need.

references Barker, D. (1998). Mothers, babies, and health in later life. Edinburgh, Scotland: Churchill Livingstone. Becker, G., & Lewis, H.G. (1973). On the interactions between the quantity and quality of children. Journal of Political Economy, 81(2), S279–288. Boyce, W.T., Frank, E., Jensen, P.S., Kessler, R.C., Nelson, C.A., & Steinberg, L. (1998). Social context in developmental psychopathology: Recommendations for future research from the MacArthur Network on psychopathology and development. Development and Psychopathology, 10, 143–164. Brooks-Gunn, J., & Duncan, G.J. (1997). The effects of poverty on children. The Future of Children, 7(2), 55–71. Campbell, F.A., & Ramey, C.T. (1995). Cognitive and school outcomes for highrisk African American students at middle adolescence: positive effects of early intervention. American Education Research Journal, 32(4), 743–772. The Carnegie Corporation of New York. (1994). Starting Points: Meeting the needs of our youngest children. New York: Carnegie Corporation. Cauthen, N., Knitzer, J., & Ripple, C. (2000). Map and Track: State Initiatives for young Children and Families. New York, NY: National Center for Children in Poverty. Dawson, G., Hessel, D., & Frey, K. (1994). Social influences on early developing biological and behavioral systems related to risk for affective disorder. Development and Psychopathology, 6, 759–779. Duncan, G.J., & Brooks-Gunn, J. (1997). Consequences of Growing up Poor. New York: Russell Sage Foundation. Elder, G. (1974). Children of the Great Depression. Chicago: University of Chicago Press. Farkas, S., & Johnson, J. (1997). Kids These Days: What Americans Really Think about the Next Generation. New York: The Public Agenda, 17. Fox, N.A., Rubin, K.H., Calkins, S.D., Marshall, T.R., Coplan, R.J., Porges, S.W., Long, J.M., & Stewart, S. (1995). Frontal activation asymmetry and social competence at four years of age. Child Development, 66, 1770–1784. Gopnik, M. (1999). Familial language impairment: More English evidence. Folia Phoniatrica Logopedica, 51(1–2), 5–19.

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Halfon, N., Inkelas, M., & Hochstein, M. (2000). The health development organization: An organizational approach to achieving child health development. The Milbank Quarterly, 78(3), 447–497. Haggerty, R.J., Roghmann, K.J., & Pless, I.B. (1975). Child health and the community. New York: John Wiley & Sons. Haveman, R., & Wolfe, B. (1995). The determinants of children’s attainments: A review of methods and findings. Journal of Economic Literature, 33, 1829–1878. Heckman, J.J. (1999). Policies to foster human capital. NBER Working Paper Series, Working Paper 7288. Cambridge: National Bureau of Economic Research. Hoekleman, R.A., & Pless, I.B. (1988). Decline in mortality among young Americans during the 20th century: Prospects for reaching national mortality reduction goals for 1990. Pediatrics, 82(4), 582–595. Karoly, L., Greenwood, P.W., Everingham, S.S., Hoube, J., Kilburn M.R., Rydell, C.P., Sanders, M., & Chiesa, J. (1997). Investing in our children. Santa Monica: RAND Corp. Keating, D.P., & Hertzman, C. (1999). Developmental health and the wealth of nations: Social, biological and educational dynamics. New York: The Guilford Press. Kuh, D., & Ben-Shlomo, Y. (1997). A life course approach to chronic disease epidemiology. New York: Oxford University Press. Leibowitz, A. (1974). Home investment in children. Journal of Political Economy, 82(2), S111–131. Lerner, R.M. (1998). Theories of human development: Contemporary perspectives. In W. Damon & R.M. Lerner (eds.), Handbook of Child Psychology. New York: John Wiley. Lucas, A. (1998). Programming by early nutrition: An experimental approach. Journal of Nutrition, 128, 401S–406S. National Commission on Children. (1991). Beyond rhetoric: A new American agenda for children and families. Washington DC: U.S. Government Printing Office. NRC National Survey of Health and Development. Paediatric Perinatal Epidemiology, 111(1), 2–20. Olds, D.L., Eckenrode, J., Henderson, C.R., Kitzman, H., Powers, J., Cole, R., Sidora, K., Morris, P., Pettitt, L.M., & Luckey, D. (1997). Long-term effects of home visitation of maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial. JAMA, 278(8), 637–643. Penn, A.A., & Shatz, C.J. (1999). Brain waves and brain wiring: The role of endogenous and sensory-driven neural activity in development. Pediatric Research, 45(4), 447–458. Ramey, C.T., Bryant, D.M., Wasik, B.G., Sparling, J.J., Fendt, K.H., & LaVange, L.M. (1992). Infant health and development program for low birth weight, premature infants: Program elements, family participation, and child intelligence. Pediatrics, 3, 454–465. Rutter, M. (1996). Developmental psychopathology: Concepts and prospects. In M. Lenzenweger & J. Havgaard (eds.), Frontiers of developmental psychopathology. New York: Oxford University Press. Sampson, R.J., Raudenbush, S.W., & Earls, F. (1997). Neighborhoods and violent crime: A multilevel study of collective efficacy. Science 277, 918–924.

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Schore, A.N. (1994). Affect regulation and the origin of the self: The neurobiology of emotional development. Hillsdale, NJ: Lawrence Erlbaum, Assoc. Shonkoff, J.P., & Phillips, D. (2000). From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington, DC: National Academy Press. Smith, J. (1999). Healthy bodies and thick wallets. The dual relation between health and economic status. Journal of Economic Perspectives, 13(2), 145–166. Sroufe, L.A. (1997). Psychopathology as an outcome of development. Development and Psychopathology, 9(2), 251–268. StataCorp. Stata Statistical Software: Release 5.0. College Station, TX: Stata Corporation. 1997. Wadsworth, M.E., & Kuh, D. (1997). Childhood influences on adult health: A review of recent work from the British 1946 national birth cohort study, the NRC National Survey of Health and Development. Paediatric Perinatal Epidemiology, 111(1), 2–20.

part

I

CONDITIONS OF FAMILIES WITH YOUNG CHILDREN

2 Resources Devoted to Child Development by Families and Society M. Rebecca Kilburn and Barbara L. Wolfe

Both the public sector and families invest heavily in children’s development. One estimate of the average total cost of these investments per child is about $16,030 annually (1992 figures, converted to 1999 dollars), or about 15 percent of GDP (Haveman and Wolfe 1995). Of the total average spending on a child from birth to age 18, about one-third represents public investment and the other two-thirds, private expenditure. This ratio of public to private investment in children is not constant throughout childhood or across the income distribution. Over two-thirds of government spending on children supports education, which typically does not begin until age 5. Before children enter elementary school, the family is the primary source of inputs into child development. In recent years, the child development literature has elevated the early years to a new place of prominence in the human life course. Since inputs into early child development are primarily the purview of parents, realizing the potential of early development requires an understanding of parenting behaviors and the contextual factors that influence parents’ allocation of resources. The Commonwealth Survey of Parents with Young Children focuses on families with children in their early years, from birth to age 3. This chapter documents the allocation of resources to child development made by parents, government, and others during this critical period of development. In doing so, we recognize that families’ investments in children include not only purchased goods and services but also considerable time. In their estimates of spending on children, Haveman and Wolfe (1995) include direct out-of-pocket costs, such as food, housing, and health care, along with indirect costs, or the value of time parents spend caring for children. They estimate that about 80 percent of parents’ expenditures on children are in the form of direct costs, with the remaining 20 percent due to indirect time costs. They admit, however, that their estimate of indirect time costs is necessarily a “lower bound” because of the 21

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challenges inherent in accounting for all the time parents spend caring for children.

child development models and the importance of resources Many different approaches are used to model child development and the role of families and society in that process. These approaches reflect a range of aspects of young children’s growth and development, including cognitive development, physical growth, emotional maturation, social functioning, and more. They also span academic disciplines, encompassing the social sciences, medical science, demography, and others. Prominent child development models include the economic or rational choice framework (see Haveman and Wolfe 1995; Becker and Tomes 1986), the ecological context model (Bronfenbrenner 1979; Garbarino 1990), social capital theory (Coleman 1988), and other perspectives (see discussion in Brooks-Gunn et al. 1995). Rather than selecting one model to describe child development, we choose in this discussion to emphasize similarities among the various approaches. Since the intersections of the models often guide data collection, this discussion should help place the Commonwealth Survey in the context of the child-development literature and highlight the unique features of the data. One similarity that connects many child-development models is the recognition that children do not start life with equal chances of success. That is, most approaches to child development identify factors that may place some children at higher risk of poor outcomes. These factors, often called “risk factors,” may include disadvantaged socioeconomic status, physical disabilities, parents’ psychological problems, or other characteristics that have been linked to developmental shortcomings (see Karoly et al. 1998; Meisels and Wasik 1990). A second similarity is that most models characterize child development as a process. That is, child development happens over time and has numerous phases, and subsequent development builds on foundations established at earlier ages (see discussion in Brooks-Gunn et al. 1995; Werner 1990). As a result, research on children’s development often focuses on a particular age or period of development, such as prenatal development, adolescence, or preschool years. As part of the recognition of child development as a multistage process, some models consider outcomes of earlier stages to be inputs at later stages (Brooks-Gunn et al. 1995). For example, the social skills and pre-reading skills a child develops in preschool can be considered inputs into development in the early elementary school years. Third, the majority of models view a child’s environment as playing a key role in development. Many view child development as taking place in a

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multilayered context that involves not only families but also schools, communities, and varying levels of government (Blank 1997). The bioecological systems perspective characterizes the relationship between individuals and their environment – nature and nurture – as a bidirectional interaction that produces an individual’s actual traits from his or her potential traits (Sameroff et al. 1987; Bronfenbrenner and Ceci 1994). According to this model, without appropriate environmental stimulation, some traits may not develop fully even if an individual inherits the genotypic predisposition to exhibit the trait. Finally, all models of child development stress the importance of resources, which provide inputs into the child-development process. In the early years that are the focus of the Commonwealth Survey, these resources are provided predominantly by parents. Although government allocates some resources to early childhood programs for all families (such as educational campaigns regarding immunizations and subsidized vaccines), it targets more resources to families at higher risk of being unable to provide adequate resources for child development due to specific parental circumstances such as poverty or chemical dependence. For these families, the government might provide special assistance, such as children’s health insurance or free vaccinations. In addition to parents and the public sector, other individuals, including extended family members, religious organizations, or neighbors, may also provide inputs into child development. This analysis of the resources allocated to support child development in the early years examines the four types recognized by Brooks-Gunn et al. (1995): financial, time, psychological, and human capital. Financial resources, or the economic means to purchase goods and services that promote child development, are referred to in this chapter as “purchased resources.” The relationship between purchased resources and children’s outcomes has been explored extensively through data collection and analysis (see, for example, Mayer 1997b; Duncan and Brooks-Gunn 1997). Parents’ investment of time in children’s development has received less research attention, although its importance has captured the interest of the public: In a recent opinion poll, the small amount of time parents spent with their children was cited as the number one problem for U.S. families (Benton Foundation 1998). “Time investments” are not restricted to time spent in enriching activities, such as reading. Rather, these inputs are a measure of all time spent producing child-related goods and services in the home rather than purchasing them in the market. Child care, for example, can be purchased in the market or provided by a parent. In standard models of economic choice, the decision to produce a good using purchased resources or time resources relies on the quantity of both available, the relative price of the good in terms of income or time, and the parents’ efficiency in converting time to income (see Becker and Michael 1976, for an exposition of this model). For example, children’s meals can be produced using

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varying amounts of parents’ time and purchased goods or by purchasing meals from a restaurant. As discussed in more detail later, because families’ purchased resources are strongly related to income earned during time parents spend working, purchased resources and time resources are inextricably linked. Although adequatepurchased resources and time are critical to a family’s ability to provide inputs into child development, the availability of those resources does not guarantee that parents will allocate them in a way that optimizes child development. In addition to making choices about how much purchased and time resources they devote to child development, families must also decide how to alleviate allocate resources to various alternative uses within the realm of child development (see, for example, Leibowitz 1974 and Mulligan 1997). These allocation decisions are related to the two remaining types of resources: psychological and human capital resources. While analyses of purchased resources and time resources focus on the quantity of inputs families provide for child development, analyses of psychological and human capital resources stress the quality of the resources. “Psychological resources” are emotional, cognitive, and behavioral factors such as parental knowledge, depression, or substance abuse that can play a role in child development. A substantial body of research points as well to the importance for child development of another type of psychological resource: parenting style (Maccoby and Martin 1983; Beckwith 1976; Barnard and Kelly 1990). The term “parenting style” refers to a collection of behaviors that includes, for example, degree of willingness to allow a toddler to explore and tendency to display warmth toward the child. The hazards of parents’ drug and alcohol use for child development have been recognized for some time (Sher 1991; Bauman and Levine 1986). The role of parents’ depression, and in particular the depression of low-income mothers, in children’s development has received more attention in recent years (Beckwith 1990). The last type of resource that contributes to child development is human capital. In this context, “human capital” denotes the skills and knowledge parents bring to their decision making, interaction, and other behaviors that affect child development. To deliver an appropriate diet to a child, for example, a family needs knowledge about nutrition, as well as adequate financial and time resources to purchase and prepare food. Parents’ human capital may be acquired through experience, but it can also be increased through information from health care providers, reading, or other avenues.

the allocation of resources to support child development The common features of child-development models provide a context for describing the results of the Commonwealth Survey of Parents with Young Children. In this section, we generate a portrait of parents’ and societal

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support for child development as portrayed by these data. The survey interviewed 2,017 parents of children less than age 3, focusing on inputs to child development in the prenatal period, birth, and infancy. While some surveys target families that meet some risk factor criteria, the Commonwealth study interviewed a random sample of parents with small children. Eligible parents included biological parents, adoptive parents, step parents, or guardians of a child under age 3 living in their household. At each sampled household, either the child’s mother or father was randomly selected to complete the interview. Of the 2,017 families interviewed, 1,320 respondents were mothers or female guardians and the remaining 697 were fathers or male guardians. Blacks and Hispanics were oversampled to generate large enough samples for comparative analysis. To account for the fact that blacks and Hispanics were not sampled in proportion to their true representation in the population, all statistics in this chapter are weighted to reflect the national population of parents in the United States with children less than 3 years old. A comparison of the demographic characteristics of the Commonwealth Survey data to a nationally representative sample, the 1994 Current Population Survey, indicates a very close match on every item. The survey asked all respondents to provide information about experiences during pregnancy, as well as immediately after the child’s birth. The children in the survey are about equally distributed across each of the first three years of age. Nearly a fifth (18 percent) of the children are between 0 and 5 months of age, and another 14 percent are 6 months to 1 year old. About a third (36 percent) are 1 year old, and nearly another third (32 percent) are 2 years old. Less than half the children (41 percent) are the firstborn child of the mother. The sample contains almost equal numbers of boys (51 percent) and girls (49 percent). The majority of the children live in families with two or fewer children (71 percent). Another 18 percent of families have three children, and 11 percent have four or more children. We examine information collected by the survey regarding the resources devoted to young children’s development. We begin by discussing the resources parents allocate to support child development, distinguishing between families’ purchased, time, psychological, and human capital resources. Next, we describe the families’ reliance on government resources for child-development inputs. Finally, we enumerate other sources of support for child development that do not come from families or government. Parental Inputs: Purchased Resources and Time Resources The standard economic model of family decision making (Becker 1991) posits that a parent has a total amount of time, say T, that can be divided between working, TW , and not working, T N , where T = TW + T N . The more time a parent spends working – the higher is TW – the more financial resources will be available to a family to purchase direct-cost items such

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as food, housing, and health care (Haveman and Wolfe 1995), yet the less time the parent will have to engage in activities that contribute to child development. Haveman and Wolfe categorize these as indirect costs of investing in children. In the parlance of economic models of household decision making, the time not spent working is available to devote to “home production.” This relationship between purchased resources and time resources formalizes the reason that two-parent households are better able to invest in children: With two parents in the household, 2T rather than T amount of time is available to allocate between working and not working. The net result is that most two-parent families are able to choose a combination of purchased and time resources that exceeds the choices available to most one-parent families. An unresolved question in the literature is the relative merit of allocating more time to home production or to procuring financial resources through employment (Mayer 1997a; Smith et al. 1997). For single mothers, welfare reform policy has chosen employment: Temporary Assistance for Needy Families, the program that has replaced the prior federal welfare system, encourages mothers to work rather than be full-time caregivers for their children. The Survey of Parents with Young Children reports on several characteristics that influence the total time available to a family to devote to working or home production, including number of parents in the household and their employment status. Although current divorce rates are high by historical standards, and nonmarital births continue to rise (Zill and Nord 1994), the overwhelming majority of families in the sample (86 percent) contain two adults (Table 2.1). Nearly every two-parent household has at least one parent devoting part of his or her time to paid employment (97 percent) that produces financial resources available to the family. In single-parent families, less than half (43 percent) of parents are in the labor force. The difference is even more striking when rates of full-time participation in the labor force are considered: 95 percent of two-parent families have a parent who works full time, compared with 30 percent of one-parent families. The difference between the two groups of families is less dramatic when comparing the availability of parents for home production. Despite their high employment rates, two-parent families do not seem to be sacrificing time for home production. Among two-parent families, about two-thirds (66 percent) have a parent available for home production at least part time, a share very similar to that found among single-parent families (70 percent). Surprisingly, only 40 percent of two-parent families have a parent who is not employed and is therefore available to care full-time for the child, compared with 57 percent of single-parent families. Parental employment varies a great deal with the age of the youngest child, with parents being more likely to work as children get older. Although the survey sample includes only families with children 3 years

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table 2.1. Characteristics Influencing Both Financial and Time Resources Variable

Category

(%)

Marital status of parents

Married/living as married No longer married Never married Full-time Part-time Not employed Full-time/full-time Full-time/part-time Full-time/not emp Not emp/not emp Other combinations 1 2 3 4 or more

86 4 10 30 12 57 34 20 40 3 2 35 36 18 11

Single-parent households Employment status of parent Two-parent households Employment status of parents

Number of children under 18 in household

old or younger, the data exhibit this pattern. For example, among single parents, nearly two-thirds (65 percent) of parents with children less than 18 months old do not work; after a child’s second birthday, however, less than half (48 percent) of single parents are not working. Similarly, in twoparent families, at least one parent is at home in 44 percent of households where the child is less than 6 months old; for families with a child above age 2, the share is 34 percent. To summarize, children in single-parent and two-parent families are about equally likely to have a parent who engages in home production at least part time. Children in two-parent families are more likely to have a parent who spends time working, making purchased resources available from earnings. Another critical facet of family resources for child development is the number of individuals in the family. The fewer children in a family, the further the available money and time will go. Economic models of investment in children formalize this notion by specifying a multiplicative relationship between the number of children and the amount invested in each child (Becker 1991). The number of children is referred to as child “quantity,” or n, and the amount invested in each child as child “quality,” or q. The amount the family allocates to child investment, I, is then related to the quantity and quality of children as I = nq. This simple relationship implies that for any level of investment in children, as the number of children (n) rises, the amount invested in each child (q) must fall.1 Approximately one-third (35 percent) of parents in the survey have only one child under age 18 in the household, and another third (36 percent) 1 This exposition assumes a unitary price of a unit of quality in Becker’s model.

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28 table 2.2. Allocation of Purchased Resources Variable Trimester of pregnancy in which mother first visited health professional Total annual family income

Category

First trimester Second trimester Third trimester/never