Chaos as a social determinant of child health: Reciprocal associations?

This study informs the social determinants of child health by exploring an understudied aspect of children's social contexts: chaos. Chaos has been conceptualized as crowded, noisy, disorganized, unpredictable settings for child development (Evans, Eckenrode, & Marcynyszyn, 2010). We measure chaos at two levels of children's ecological environment – the microsystem (household) and the mesosystem (work-family-child care nexus) – and at two points in early childhood (ages 3 and 5). Using data from the Fragile Families and Child Wellbeing Study (N = 3288), a study of predominantly low-income women and their partners in large US cities, we develop structural equation models that assess how maternal-rated child health (also assessed at ages 3 and 5) is associated with latent constructs of chaos, and whether there are important reciprocal effects. Autoregressive cross-lagged path analysis suggest that increasing chaos (at both the household and maternal work levels) is associated with worse child health, controlling for key confounders like household economic status, family structure, and maternal health status. Child health has little effect on chaos, providing further support for the hypothesis that chaos is an important social determinant of child health in this sample of relatively disadvantaged children. This suggests child health may be improved by supporting families in ways that reduce chaos in their home and work/family environments, and that as researchers move beyond SES, race, and family structure to explore other sources of health inequalities, chaos and its proximate determinants may be a promising avenue for future research.

► We used longitudinal data from primarily low-income mothers to assess how chaos is associated with young children's health. ► Data came from 3288 mothers in the Fragile Families and Child Wellbeing Study. ► Mothers reported young children experiencing higher levels of household and maternal work chaos had worse health. ► Using structural equation models to test reciprocal effects, we find that children's health does not predict later chaos. ► Results suggest that chaos in children's immediate and distal environments have implications for child health.