2003). In addition, children’s behaviors may directly affect parents’ ability to adhere to a treatment regimen (Searle et al., 2000), just as parental response styles may affect the likelihood of a child’s complying with specific requests (Patterson and Fisher, 2002).

Cultural construction of health and disease may also affect compliance with certain treatments by both parents and children. For example, in many cultures, so-called teething diarrhea is considered to be a normal part of growth and development and thus health-seeking behavior or adherence to treatment regimens for the “illness” would be unlikely (Stanton et al., 1992).

In sum, all these psychological factors, whether a child’s perceptions of peer norms, self-efficacy beliefs, attitudes about health and health care, or level of motivation to pursue specific health care behaviors, contribute to health-related choices and behaviors. With increasing age, children’s behaviors, such as substance use, academic performance, violence, suicide, and auto accidents, constitute a major influence on future health. According to findings from the Global Burden of Disease study, these behavioral aspects of health are likely to exert even greater prominence in coming decades, as behavioral and life-style-related health conditions (e.g., auto accident injuries, consequences of smoking, depression) increase in their relative effect on children’s health and illness (Murray and Lopez, 1996).

Complicating this point, however, is the fact that certain behaviors and emotions can serve both as health influences and outcomes. Determining when a behavior is an influence rather than a health outcome can be difficult, because children’s current behaviors can affect both future behaviors and subsequent health outcomes. Regardless of the classification and especially due to the inability to distinguish behaviors as health influences or outcomes, data on children’s health behavior are an important component of a system that seeks to track child health and health behaviors.


The physical environment affects children’s health by exposing them to a wide variety of external conditions. These include chemical, biological, and physical influences that exert their impact by being taken into the body (e.g., lead, methyl mercury, persistent organic pollutants) or interacting with body surfaces (e.g., ultraviolet light, physical abuse, particulate matter in air pollution) or the senses (e.g., noise, odors). The built environment affects the ways in which children are differentially exposed to some of these influences. Exposure is the sum of all exposure factors over the course of time, including the home, school, child care, and play areas. Exposures during the prenatal period can also affect children’s health.

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