摘要:Objectives. We examined the relationship between material hardship reported by low-income caregivers and caregivers’ assessments of their children's overall health. Methods. We used logistic regression techniques to analyze data from 1073 children aged 5 through 11 years whose caregivers participated in multiple waves of the Illinois Families Study. Results. Caregivers’ reports of food hardship were strongly associated with their assessments of their children's health. Other sources of self-reported material hardship were also associated with caregivers’ assessments of their children's health, but the effects disappeared when we controlled for caregiver physical health status and mental health status. Proximal measures of material hardship better explained low-income children's health than traditional socioeconomic measures. There were no statistically significant cumulative effects of material hardships above and beyond individual hardship effects. Conclusions. Our findings highlight the importance of developing and supporting programs and policies that ensure access to better-quality food, higher quantities of food, and better living conditions for low-income children, as well as health promotion and prevention efforts targeted toward their primary caregivers as ways to reduce health disparities for this population. In 2005, 17.6% of US children and adolescents younger than 18 years lived below the federal poverty line ($19 350 for a family of 4 including 2 children), 1 and 7.7% lived in extreme poverty (50% below the federal poverty line). 2 Studies have repeatedly shown that mortality and morbidity are higher among poor children than among nonpoor children. 3 – 9 However, the health of children within a given income category has also been shown to vary. According to data reported in the 2005 National Health Interview Survey (NHIS), 4.7% of children living in poverty were in fair or poor health, and 39.3% were in excellent health. 3 Although predictors and correlates have not been adequately explored, other health indicators have shown similar variation. 5 , 10 In the majority of studies examining health disparities among children, conventional measures of socioeconomic status (SES), such as family income, parental education, and parental employment, have been used as predictors. 11 – 13 However, some researchers suggest that such measures are “distal” in nature and that proximal measures of economic well-being, including material hardship, may be more informative in assessments of health variations among low-income children. 14 – 16 Most studies that have shown significant associations between material hardship and children's physical health have focused on a single type of hardship. 17 – 21 Studies on housing hardship have investigated the effects of housing instability, poor-quality housing, and overcrowding on children's physical health separately. Overall, studies have shown that children living in poor-quality or overcrowded housing are more likely than are children living in better housing conditions to be in poor health and to experience accidents and injuries, infectious diseases, and lead poisoning. 22 – 27 Most studies on housing instability and children's physical health have focused primarily on homeless children. Although these studies have produced inconsistent results, generally they have shown that homeless children are more likely to be in poor health than are children who are not homeless. 17 , 18 , 28 – 31 Improvements in food insecurity 32 and food insufficiency 33 measures have led to increased research on food hardship and US children's health in recent years. 34 This body of literature shows that children from households experiencing food insecurity or food insufficiency have more acute and chronic health conditions and are in poorer health than are their counterparts not experiencing these conditions. 19 – 21 , 35 , 36 The concept of unmet medical needs is generally used to describe the degree to which individuals’ health problems are unaddressed by their health care providers. 37 , 38 Approximately 4.7 million (7.3%) children in the United States have at least 1 unmet medical need, and near-poor or poor children are 3 times as likely as nonpoor children to experience unmet medical needs. 37 Most research in this area has focused on identifying risk factors associated with unmet medical needs. 37 – 41 Cross-sectional studies examining the effects of unmet medical needs on children's health have produced inconsistent findings. 37 , 38 Although other economic difficulties (e.g., lack of durable goods or limited access to transportation) have also been identified as domains of material hardship, 15 , 16 no studies to our knowledge have investigated their associations with health outcomes among children. Our goal was to use data primarily derived from survey interviews to determine the relative and cumulative effects of material hardship on low-income children's physical health. Building from previous studies, we examined how interrelated indicators of material hardship are associated in different ways with children's health. Our use of multiple indicators reduced concerns related to potential omitted variable bias in our analyses. We used caregivers’ perceptions of their children's overall health as a measure of children's health status. On the basis of recent health theories suggesting the importance of focusing on positive health rather than illness, 42 , 43 we focused on factors distinguishing children reported to be in exceptional physical health from children reported to be in optimal or suboptimal health. Our research questions were as follows: What are the independent effects of different self-reported measures of material hardship on caregivers’ assessments of their children's physical health? How do proximal self-reported measures of material hardship differ from traditional SES measures in explaining low-income caregivers’ assessments of their children's health? Do these material hardship measures have a cumulative effect on children's physical health above and beyond individual hardship effects?