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The human, social, and material assets present at birth vary widely across infants born each year and are tied to good outcomes and resilience throughout the life course. We summarized and developed an index using California’s vital birth records to characterize the number of assets children have at birth, including how communities vary in the distribution of children at different asset levels. The results of our literature review resulted in a list of 12 indicators constructed from fields available on vital birth records that comprise the Strong Start Index.
Methods
Specifically, information regarding infant health and circumstances surrounding the birth, family socioeconomic, maternal health behaviors and access to services, and the age, education, and nativity of both parents. De-identified birth records were used to construct a Strong Start Index dataset, reflecting all California births registered for calendar year 2016. This dataset included geocoded residential addresses assigned to census tracts, thus allowing each record, which included birth assets and a resulting Strong Start Index score (0-12), to be assigned to a California census tract. We calculated preliminary descriptive statistics using this dataset, as well as performed external validity checks in order to confirm our efforts weren’t duplicative of other indices, but also related to actual child outcomes (i.e., child protection services (CPS) involvement and child death). We then linked birth records to both CPS and death records using a probabilistic linkage methodology. We performed bivariate analyses using tabulations with Fisher’s exact tests and logistic regressions. The quality of model fit was assessed via Pseudo-R2 and AUC.
Results
Statewide, babies are born with an average of nine of the 12 Strong Start resources. In some neighborhoods, however, babies are born with an average of only six resources, while in others babies have 11 resources on average. The average number of assets present in 2016 was highest among Asian Pacific Islanders (mean=10.0, sd=1.50) and lowest among Black/African Americans (mean=7.8, sd 2.3). The Strong Start Index demonstrated a strong, graded relation with the predicted probability of CPS involvement (Pseudo-R2=0.108; AUC: 0.732) and death (Pseudo-R2=0.064; AUC: 0.737) before age 5.
Conclusions and Implications
A review of literature and external validity checks confirm that the Strong Start Index adds unique insight into the conditions into which children are born in California and its scores are related to at least two important indicators of child health and well-being. Monitoring the distribution of assets among newborns in different communities can help ensure our investments are intentional and equitable.