Health across early childhood and socioeconomic status: Examining the moderating effects of differential parenting

https://doi.org/10.1016/j.socscimed.2012.01.017Get rights and content

Abstract

Variations in parenting within the family (i.e. differential parenting) are associated with various domains of child adjustment, whereby disfavoured siblings exhibit poorer social and emotional outcomes. To date there is no research examining the effects of differential parenting on children's general health, or the way in which differential parenting interacts with socioeconomic markers to predict general health over time. The present study assessed 501 Canadian families at 2 time points separated by 18 months. Differential maternal negativity predicted worse health 18 months later. Moreover, the association between maternal education and child health was strongest when children were also exposed to high levels of differential negativity. Findings indicate that multiple forms of social disadvantage (i.e. between families and between siblings) can operate independently or in a cumulative fashion to predict health across early childhood.

Highlights

► Differential maternal negativity between siblings predicts poorer child health 18 months later, controlling for a variety of possible confounding variables. ► The association between maternal education and later child health was strongest when children were also exposed to high differential negativity, suggesting a contingent relationship between predictors. ► Multiple forms of social disadvantage (i.e. between families and between siblings) can operate independently or in combination with one another to predict child health.

Introduction

Prior to conception and continuing throughout infancy and childhood, the pathways towards human health and well-being are influenced by the family socioeconomic context (Conger & Donnellan, 2007; Repetti, Taylor, & Saxbe, 2007; Schofield et al., 2011). However, socioeconomic status (SES) is not the only aspect of family life that plays a critical role in the development of health inequities (Shokonoff, Boyce, & McEwen, 2009; Wilkinson & Marmot, 2003). Interpersonal environments and emotional climates within the family can influence child health directly, and can buffer or exacerbate the effects of SES (Bradley & Corwyn, 2002). Researchers have focused on the ways in which between-family variations in parent–child relationships impact the association between SES and child development (e.g. Burchinal, Roberts, Zeisel, Hennon, & Hooper, 2006; Werner & Smith, 2001). However, there have not been any studies examining the way in which within-family variations in parenting moderate the effects of SES on child health. This within-family variation, or Differential Parenting, refers to sibling differences in rearing environments, whereby one child receives more warmth and affection, or hostility and negativity, relative to his or her sibling. Although differential parenting is more likely to occur under settings of socioeconomic risk and contextual stress (Henderson, Hetherington, Mekos, & Reiss, 1996; Jenkins, Rasbash, & O'Connor, 2003), no studies have examined the way in which these factors combine to predict early measures of general child health over time.

Differential parenting has a negative impact on child psychosocial, behaviour and emotional outcomes (Boyle et al., 2004; Burt, McGue, Iacono, & Krueger, 2006; Caspi et al., 2004; Conger & Conger, 1994; Jenkins et al., 2009; Pike & Kretschmer, 2009; Richmond & Stocker, 2009). These findings can be considered through the lens of distributive justice, where emphasis is placed upon the conditions in which the goods and harms within a social group are fairly distributed in order to maximize well-being for all individuals (Deutsch, 1985). Issues of distributive justice “occur not only at the societal level but also in intimate social relations” (p. 1. Deutsch, 1985), such as within-family relationships. Existing studies on differential parenting have largely focused on child psychosocial health. Thus, the first goal of the present study was to examine how differential parenting contributes to child general health beyond the influence of SES. Moreover, as many studies have shown that risks combine in the prediction of child well-being (Jenkins, 2008), the second study goal was to examine if differential parenting moderated the effects of SES on child health. We hypothesized that exposure to social and familial disadvantage would predict the worst health outcomes. Such findings may illustrate that the “struggles and power imbalances” influencing health within society (p. 1, Hofrichter, 2003) can interact with sources of inequality within the immediate family context.

The SES-health relationship can be considered through social causation principles, whereby the conditions of low SES influence health outcomes; and social selection principles, whereby less healthy persons experience downward social mobility (see Conger & Donnellan, 2007; Schofield et al., 2011). Although there is evidence for both relationships, the current study is an evaluation of social causation. Consistent with this, researchers have argued that SES influences child health via three pathways: a) inequitable allocation of resources like nutrition, healthcare, housing, and education; b) stress reactions caused by parenting, environmental hazards, adverse life events, violence, and neighbourhood problems and c) health behaviours like tobacco, alcohol and illicit substance abuse and exercise (Bradley & Corwyn, 2002; McEwen & Seeman, 1999; McEwen & Stellar, 1993; Repetti et al., 2007). Following improvements in our understanding of socioeconomic gradients (Hertzman & Boyce, 2010; Keating & Hertzman, 1999) and the physiological consequences of adverse rearing environments (Rutter, 2002; Rutter & O'Connor, 2004), researchers now suggest that biological stress reactions may be the most important link between child health and contextual risk (Caserta et al., 2008; Evans, 2003).

Similar to the effects of SES, there is unequivocal evidence citing the importance of early family environments in child developmental health (Repetti et al., 2007). The effects of parenting on child health may be best conceptualized by examining the associations between parental behaviour and the human stress or emotional system (Jenkins, 2008). Often emerging as a function of negative parenting, there are health consequences associated with the chronic activation of these biological stress pathways (Boyce, 2007; Repetti et al., 2007).

The effects of poor parenting and family adversity on various indicators of child health have been documented. One study examined the impact of parental sensitivity and parental conflict in kindergarten on cardiovascular health during middle-school (Bell & Belsky, 2008a). Early parental warmth predicted a variety of outcomes including heart rate and diastolic and systolic blood pressure, even when controlling for SES. Parenting quality has been linked to early asthma onset, as well. In a prospective cohort study of children with a genetic risk of asthma, problems with caregiving, postpartum depression, and low maternal support during infancy were associated with an increased risk of onset before age 3, and again before age 8 (Klinnert et al., 2001). Parenting behaviour has also been linked to child stress hormones. Children of mothers who express higher levels of warmth and involvement have steeper diurnal cortisol rhythms, a pattern that is thought to be indicative of better health (Pendry & Adam, 2007). Thus, similar to the effects of SES, one possible mechanism by which parenting may be related to child health is through the chronic and persistent activation of the biological stress response systems.

Parenting can be viewed as a form of social capital: it is a resource – in the form of a relationship – that predicts developmental well-being and success in society across the lifespan (Coleman, 1990). Not unlike the inequitable distribution of economic capital within nations, social capital (i.e. parenting resources) can be inequitably distributed within families (Boyle et al., 2004). Most studies examining parenting and child health measure a single parent–child dyad. Such research cannot reveal the complex ways in which parenting operates within a family.

Jenkins (2008) notes that measured environments can be divided into the family-level and child-specific. Factors that all siblings experience similarly operate at the family-level, (e.g. family conflict, maternal depression, or divorce). Conversely, there are experiences that differ for each sibling, (e.g. unique peer or school context). Dimensions of parenting can be conceptualized using family-level and child-specific distinctions. The family-level average of a particular parenting construct is conceptualized as Ambient Parenting (AP), referring to the amount of that dimension present in the household atmosphere (Jenkins et al., 2009). The child-specific deviations from this family average is referred to as Differential Parenting (DP), and can be conceptualized as the amount of negativity or positivity a child experiences relative to the family average. The fact that siblings are more dissimilar than similar after controlling for genetic effects is partially attributable to non-shared environmental influences like differential parenting (Turkheimer & Waldron, 2000). There is a large literature citing the effects of differential parenting on various psychosocial, behavioural and emotional outcomes, including delinquency, sibling relationships, aggression, and emotional disturbance (cited above). Seeing as there are similar biological pathways underlying the parental effects on child mental and physical health (Repetti et al., 2007), it is likely that such associations exist between indicators of general child health and differential parenting.

There are multiple factors that play into the emergence of differential parenting. Though we have cited literature on the effects of differential parenting on child psychosocial functioning, it is also true that children with behavioural or emotional problems elicit higher levels of differential treatment. Parents are reactive to the aggressive behaviour patterns of their children (Granic & Patterson, 2006) and this pattern may be greater under situations of socioeconomic stress (Jenkins et al., 2003). In other words, differential parenting both impacts child behaviour (Burt et al., 2006) and arises from sibling differences (Richmond, Stocker, & Rienks, 2005). While child characteristics certainly contribute to the emergence of differential parenting, the focus of the current study is on the later health consequences of this differential treatment, regardless of its origin. That is, we are interested in the health consequences of differential parenting: a family process that likely emerges through a complex interaction between factors at parent and child levels, and environmental risk factors.

Environmental risks have been found to operate contingently in the prediction of children's mental health. Rutter's cumulative risk model (Rutter, 1983, Rutter, 1993) suggests that individual risk factors transmit minimal harm when present in isolation; multiple risks, however, confer great harm when they combine in a cumulative fashion. Evans (2003) has shown that the aggregation of risks, including poverty, single parenthood, and low parental education, is also associated with heightened cardiovascular and neuroendocrine dysfunction and increased body fat.

Poor quality parent–child relationships may leave children vulnerable to the consequences of other environmental risks. For example, Simons and colleagues (Simons et al., 2006), showed that African American boys exposed to high levels of racial discrimination only exhibited antisocial, violent and delinquent behaviour if parents were unsupportive. Similarly, in a sample of adopted children, Kriebel and Wentzel (2011), showed that the highest levels of behavioural problems were experienced by those with high levels of pre-adoption risk and low levels of child-centred parenting in the adoptive home. The effects of biological risk factors (including blood lead levels) are also moderated by parenting quality in the prediction of child cognitive outcomes (Hubbs-Tait et al., 2009). Taken together, this body of research suggests that the effects of non-parenting risk factors are most pronounced under situations of negative parenting.

It should be noted, however, that risks may combine with one another in a fashion other than that suggested by the cumulative risk model. The Blaxter Hypothesis (1990) suggests that negative health behaviours exert greater influence in high SES populations because these persons have “further to fall” and because other factors may be more important for low SES groups. There is evidence in support of the Blaxter Hypothesis, though this pattern is often observed among adults (e.g. Schafer, Ferraro, & Williams, 2011). Given the outcome of interest and the developmental population in question, the current study proposed and tested a cumulative model. Consistent with the literature cited above, it was hypothesized that low SES and high differential parenting would combine to create the poorest health outcomes.

In summary, the first goal of this study was to test the hypothesis that differential parenting predicts later child health, over and above socioeconomic status and ambient parenting. The second goal was to test the hypothesis that the children most susceptible to the negative influence of SES were those who were disfavoured by parents.

Section snippets

Participants

Participants for the current study are from the Intensive sample of the Kids Families and Places Study (http://kfp.oise.utoronto.ca/). All of the women giving birth to infants in the cities of Toronto and Hamilton, Ontario (Canada) between April 2006 and September 2007 were considered for participation. Families were recruited through a program called Healthy Babies Healthy Children, run by Toronto and Hamilton Public Health, which contacts the parents of all registered newborn babies within

Missing data

There was a moderate amount of missing data on some variables (0–28%). Recommendations laid out by Graham (2009) were utilized for the handling of missing data. Descriptive statistics and a correlation matrix of continuous variables are reported using data derived from Estimation Maximization (Little and Rubin, 1987, Little and Rubin, 2002). Multiple Imputation, as described by Schafer (1999) and Rubin (1987), was utilized for hypothesis testing. Simulation studies have demonstrated that in

Discussion

The goals of the current study were to test two hypotheses: 1) differential parenting will predict later child health and 2) the interaction between socioeconomic status and differential parenting will predict later child health. Both hypotheses received support in the case of differential maternal negativity, but not for differential positivity. Higher levels of differential negativity were associated with higher odds of poorer health while controlling for a variety of confounding variables

Acknowledgements

We are grateful to the families who give so generously of their time, to the Hamilton and Toronto Public Health Units for facilitating recruitment of the sample and to Mira Boskovic for project management. The grant ‘Transactional Processes in Emotional and Behavioural Regulation: Individuals in Context’ was awarded to Jennifer M. Jenkins and Michael Boyle from the Canadian Institutes of Health. The study team includes: Janet Astington, Cathy Barr, Kathy Georgiades, Chris Moore, Greg Moran, Tom

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