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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health
health at both individual and environmental levels in adults, but there are few such studies of children in the United States.
Analysis of the association of SES with health measures would be facilitated by the longitudinal and simultaneous ascertainment of most or all of the important SES components—income, education, occupation, and wealth. Analysis of the effect of income (or wealth) should be mindful of the likely confounding of influences as well as of interactions between SES levels and other influences. For example, Hispanics have better health than the majority population, despite having worse health behaviors and lower average income and education (Hayes-Bautista, 2003; Morales et al., 2002).
Most broad-based neighborhood studies rely on data gathered in the decennial census. Every 10 years, the U.S. Census Bureau provides information that can be used to construct neighborhood-based measures, such as the fraction of individuals who are poor, the fraction of adults with a college degree, and the fraction of adult men without jobs. Such data are available for census tracts as well as larger geographically defined areas. Matching neighborhood-level census information to survey or administrative data requires only a valid street address. The administrative, academic, and commercial value of such matched data has led to the development of a number of efficient address-matching computer programs, as well as a healthy market providing matching and other geography-related commercial services, including geographic information systems. Although such techniques have been useful in managing and analyzing neighborhood data, they are often cumbersome to apply to national datasets.
All in all, apart from privacy and confidentiality issues surrounding the need to gather and store information about the exact addresses of individuals and families, the decennial censuses provide the geographic dimension of demographic and many economic risk factors.
The Census Bureau is developing the American Community Survey (ACS)—a “rolling census” that involves a continuous sample survey of the nation’s population. Two noteworthy advantages to such a design are much lower cost and timelier information. The survey is designed to provide geographically specific demographic and economic information more frequently than once a decade (the interval depends on the size of geographic area). However, the fate of the ACS was not certain during the committee’s deliberation, as it was not yet funded by the U.S. Congress.
The social organization of neighborhoods’ (values and interactions of neighbors) appears influential for children’s health (Sampson, Morenoff, and Gannon-Rowley, 2002), but measures of social organization are unlikely to make their way into the decennial census or ACS. Approaches for measuring social organization