The goals were to generate a cumulative hardship index and to evaluate its association with the well-being of children 4 to 36 months of age without private health insurance.


Cross-sectional surveys were linked to anthropometric measures and medical record review at 5 urban medical centers (July 1, 2004, to December 31, 2007). Cumulative hardship index scores ranged from 0 to 6, with food, housing, and energy each contributing a possible score of 0 (secure), 1 (moderately insecure), or 2 (severely insecure) to generate scores indicating no hardship (score of 0), moderate hardship (scores of 1–3), or severe hardship (scores of 4–6). The outcome was a composite indicator of child wellness, including caregivers' reports of children's good/excellent heath, no hospitalizations, not being developmentally at risk, and anthropometric measurements within normal limits. Covariates were selected a priori and through association with predictors and outcomes.


Of 7141 participants, 37% reported no material hardship, 57% moderate hardship, and 6% severe hardship. Multivariate logistic regression analyses showed ordinal association between the cumulative hardship index and children's adjusted odds of wellness (severe versus no hardship, adjusted odds ratio [AOR]: 0.65 [95% confidence interval [CI]: 0.51–0.83]; severe versus moderate hardship, AOR: 0.73 [95% CI: 0.58–0.92]; moderate versus no hardship, AOR: 0.89 [95% CI: 0.79–0.99]).


Increasing levels of a composite measure of remediable adverse material conditions correlated with decreasing adjusted odds of wellness among young US children.

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