Economic Deprivation and Children's Health: Differences between Material Hardship and Income Poverty

Background: While income poverty is the dominant measure of economic precarity in the US, increasing attention to material hardship – the experience of unmet basic needs – has elevated the importance of differentiating material hardship from income poverty in order to examine whether the two constructs capture meaningfully different economic experiences with differing consequences for wellbeing. Indeed, some limited prior evidence indicates material hardship may be a better predictor than income of some measures of wellbeing. This paper examines the relative strengths of material hardship and income poverty in predicting child health outcomes and further examines unique associations within specific ethnoracial groups.

Methods: This paper draws on panel data (N=3,056) from the Future of Families and Child Wellbeing Study (FFCWS) to assess how exposures to early childhood material hardship and income poverty, separately and together, predict adolescent health outcomes, accounting for a robust set of family covariates. Child health outcomes include health status, internalizing and externalizing behavior, anxiety, depression, and substance use. The paper aims to identify associations not causal relationships while still accounting for as much variation due to individual and family differences as possible. We use OLS regression, examining the associations between material hardship and income poverty with child health outcomes. We also examine interaction models to assess ethnoracial group differences in the associations between economic precarity and health outcomes.

Results: Results indicate that in unadjusted models, childhood material hardship and income poverty are both significantly associated with most adolescent health outcomes except for child health status; although, material hardship is not associated with anxiety while income poverty is not associated with internalizing behaviors. In models examining the joint impacts of material hardship and income poverty and controlling for family characteristics, material hardship but not income poverty predicts statistically significantly worse depression (b=0.05, p<.01), externalizing behavior problems (b=0.021, p<.01), and internalizing behavior problems (b=.047, p<.001). Meanwhile, income poverty but not material hardship predicts statistically significantly worse anxiety (b=.033, p<.05). Interaction models indicated that the associations of income poverty and material hardship with child health outcomes did not differ by child ethnoracial group. However, child ethnoracial group was statistically significant on its own in two of the fully controlled models. Black children were less likely than white children with the same level of economic deprivation to experience anxiety (b=-0.086, p<.05) and internalizing behavior problems (b=-0.115, p<.001), and Latinx children similarly had fewer internalizing behavior problems than white children (b=-0.071, p<.001).

Implications: This paper conceptualizes material hardship as a valuable and distinct construct capturing fundamental experiences of economic need and thus as a potentially important predictor of wellbeing outcomes which are sensitive to experiences of economic privation. Results indicate that, indeed, income poverty and material hardship have different associations with child health outcomes, suggesting the importance of examining multiple measures of economic need, and material hardship specifically, in seeking to understand and intervene to improve child health and wellbeing. Limited evidence also supports the value of considering the differential impacts of material hardship and income poverty across ethnoracial groups.