drug abuse, and suicide attempts. The likelihood of multiple health risk factors in adulthood were greater when multiple types of negative childhood exposures were experienced (Felitti, Anda, et al., 1998). An analysis specific to mental health outcomes identified a significant relationship between an emotionally abusive family environment and the level of adverse experience with negative mental health outcomes (Edwards, Holden, et al., 2003).


Poverty. By whatever index used, poverty is a highly prevalent risk factor for children in the United States. In 2007, 18 percent of all U.S. children lived in families with incomes below 100 percent of the federal poverty line; the percentage was higher among ethnic minorities (10 percent of white children, 28 percent of Latino children, and 35 percent of African American children) (U.S. census). However, this measure does not fully capture the proportion of families who do not have sufficient resources to meet their basic needs for housing, child care, food, transportation, health care, miscellaneous expenses, and taxes. The Economic Policy Institute estimated that more than 2.5 times the number of families with incomes at or below the federal poverty line do not have sufficient budgets to meet their basic needs independent of outside subsidies (Boushey, Brocht, et al., 2001). Families who live in poverty or near poverty continually need to make trade-offs between necessities. For example, 65 percent of families with household incomes between 100 and 200 percent of the federal poverty line experienced at least one serious hardship during the prior year, including food insecurity, lack of health insurance, or lack of adequate child care (Boushey, Brocht, et al., 2001).

Poverty is a risk factor for several MEB disorders and is associated with other developmental challenges. Poor children show difficulties with aspects of social competence, including self-regulation and impulsivity (Takeuchi, Williams, and Adair, 1991), and abilities associated with social-emotional competence (Eisenberg, Fabes, et al., 1996). Furthermore, poverty has been found to be associated with a wide range of problems in physical health, including low birth weight, asthma, lead poisoning, and accidents, as well as cognitive development. Poor children are also more likely to experience developmental delays, lower IQ, and school failure (Gershoff, 2003; Brooks-Gunn and Duncan, 1997).

Gershoff, Aber, and Raver (2003) describe three pathways by which poverty affects child development. With the parent investment pathway, the relations between poverty and children’s cognitive development is mediated by the quality of the home environment, which is represented by the amount of cognitively stimulating material in the home (e.g., books, CDs) and how often parents take their children to stimulating places, such as museums and libraries. With the parent behavior and stress pathway, the parents are considered to be under high levels of stress because of their



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