provide data on the education level of the father. Death records contain data on the decedent’s occupation and, beginning only in 2003, educational level. No information regarding parental SES is gathered on death certificates, a serious omission in the case of child deaths.

Other than gross indications of economic status by receipt of public health insurance, clinical data almost never contain any measure of SES, whether about income, education, or occupation of parents. Studies using clinical data or vital statistics sometimes rely on proxy measures of SES obtained by linking addresses to census tract data and attributing to individuals the SES characteristics of their neighborhoods, for example, mean levels of income or of educational achievement in a census tract. Given the heterogeneous nature of families living in a given neighborhood, neighborhood-based measures of family SES contain considerable error (Geronimus, Bound, and Neidert, 1996; Demissie et al., 2000).

When data on neither income nor education are available, race and ethnicity are often used as proxy measures of social class, based on knowledge of the higher frequency of low income among black and other minority groups. The fallacies of doing so are illustrated in data showing the health disadvantage for low-income white people in Appalachia, which is home to predominantly white populations (Centers for Disease Control and Prevention, 1998b). Thus, using race and ethnicity as proxies for social class makes invisible the health problems of low-income white children. Saliently, the risk of dying is higher in low-income groups, even after taking into account health risk behaviors (Lantz et al., 1998).

The National Survey of Early Childhood Health (NSECH) includes detailed assessment of hours and activities spent by parents with children; breast-feeding practices; daily routines including the frequency of playing, singing, and reading to the child; number of children’s books in the household; disciplinary practices; parental perceptions of infant temperament; the role of parenting, and their perception of themselves as parents; and pediatric care (including an assessment from the parent’s point of view of the usefulness of their provider’s health prevention education efforts). The NSECH also assesses family income, medical insurance coverage and adequacy, child care and child care affordability, and receipt of nutritional benefits such as WIC and other low-income benefits.

The Child Well-Being and Welfare module used in two states assesses income, health care coverage, day care utilization and costs, employment, income and job stability, relocation information, reading in the household, and information regarding school and out-of-school extracurricular involvement of the child. Parents are also asked questions about their relationship with and feelings about the child. The National Survey of Children with Special Health Care Needs (NSCSHCN) collected data on children with a wide range of health conditions and included a few questions on the effect on the family, but virtually no data on family structure.

The National Child Abuse and Neglect Data System, a partnership between the U.S. Department of Health and Human Services and the states, collects an-



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement