How Early Do Social Determinants of Health Begin to Operate on Children? Results from the Fragile Families and Child Wellbeing Study

Background: The powerful impact of social determinants on health is well established. One of the mechanisms by which social determinants have been shown to have an effect on health is related to perceptions of power and exclusion associated with discriminatory practices. Thus, a key aspect of the environment is the inducement of vigilance which in turn results in stress and harmful health effects. But how early in life do these determinants begin to operate? Using national data from the Fragile Families and Child Wellbeing Study, we examined the influence of school environment on the health outcomes of 9- and10-years-old children. We used bullying as a measure of power dynamics in the social environment. Bullying is a particularly revealing variable as it represents not only aggressive behavior among school-aged children, but it involves intimidation and a real or perceived power imbalance.

Methods: Our analytic sample consisted of 3301 children from the Fragile Families survey data, a birth cohort nearly 5,000 children born in large U.S. cities between 1998 and 2000. The survey provides rich information on children’s environments based on child interviews during the elementary school years. Our key variables of interest were child health outcomes and bullying. Children were asked to rate their health: “in general, how’s your health, from excellent to poor.” Self-rated health has been demonstrated to be a valid predictor of an individual’s health status. Children were asked if they were being left out in the lunch room, if someone picked on them while they were doing something, and if they were frequently hit in school. Demographic variables included in the analyses were mother’s race, relationship status, education, and religiosity. We control for child’s chronic health conditions and level of neighborhood violence. Multinomial logistic regression models were estimated to predict child’s self-rated health.

Results: Overall, 66.6% of children reported very good to excellent health, 28.2% reported good health, and 5.2% reported poor to fair health. Regardless of demographic characteristics and family and neighborhood environment, experiences of school bullying significantly predicted a child’s self-rated health. Furthermore, in comparison to children with no experience being bullied, the worse a child was being bullied at school, the less likely he or she was to report excellent to very good health. Children who experienced all three forms of bullying were 67% less likely to report excellent or very good health versus poor to fair health compared to children who did not experience any bullying (OR=0.33, p<0.001). Children who experienced two types of bullying were 49% less likely to report excellent or very good health (OR=0.51, p<0.01). Children who experienced one type of bullying at school did not differ significantly from children who had not experienced bullying.

Implications: Our study provides evidence of the health vulnerability to social environments characterized by intimidation and power imbalance even at a very young age. Ensuring healthy development for youth requires that we recognize the harmful effects on health and that we create interventions at much earlier stages of life.