Abstract
Persistent unmet preventive and developmental health care needs of children in low-income families are a national concern. Recently, there have been efforts to promote developmental services as part of primary care for all young children. However, there is limited research to determine whether the neediest families are well in universal interventions. In our study, we assessed if disparities persist in utilization of developmental services, well child care, and satisfaction with care among low-, middle-, and high-income families participating in Healthy Steps for Young Children. Healthy Steps is a national experiment that incorporated developmental services into primary care for children from birth to 3 years of age. In the United States, 15 pediatric practices participated in this prospective study. At birth, 2,963 children were enrolled between September 1996 and November 1998 and followed through 33 months of age. The utilization of developmental services, satisfaction with care, and receipt of age-appropriate well child visits were measured at 30–33 months and adjusted for demographic and economic covariates. We found that the adjusted odds of low-income families did not differ from high-income families in receipt of four or more Healthy Steps services, a home visit, or discussing five or more child rearing topics. Low- and middle-income families had reduced adjusted odds of receiving a developmental assessment and books to read. The adjusted odds of low- and middle-income families did not differ from high-income families in being very satisfied with care provided or receiving age-appropriate well child visits. A universal practice-based intervention such as Healthy Steps has the potential to reduce income disparities in the utilization of preventive services, timely well child care, and satisfaction with care.
Similar content being viewed by others
References
Green M, Palfrey JS, editors. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 2nd ed. Arlington, VA: National Center for Education in Maternal and Child Health: 2002.
American Academy of Pediatrics. Guidelines for Health Supervision III. Elk Grove Village, IL: American Academy of Pediatrics; 1997.
American Academy of Pediatrics, Committee on Psychosocial Aspects of Child and Family Health. The new morbidity revisited: a renewed commitment to the psychosocial aspects of pediatric care. Pediatrics. 2001;108:1227–1230.
American Academy of Pediatrics, Committee on Children with Disabilities. Developmental surveillance and screening of infants and young children. Pediatrics. 2001;108:192–195.
Young KT, Davis K, Schoen C, Parker S. Listening to parents: a national survey of parents with young children. Arch Pediatr Adolesc Med. 1998;152:255–262.
Ronsaville DS, Hakim RB. Well child care in the United States: racial differences in compliance with guidelines. Am J Public Health. 2000;90:1436–1443.
Dinkevich EI, Cunningham SJ, Crain EF. Parental perceptions of access to care and quality of care for inner-city children with asthma. J Asthma. 1998;35:63–71.
Newacheck PW, Hughes DC, Hung Y, Wong S, Stoddard JJ. The unmet health needs of America’s children. Pediatrics. 2000;105:989–997.
Newacheck PW, Halfon N. Preventive care use by school-aged children: differences by socioeconomic status. Pediatrics. 1988;82(part 2):462–468.
St. Peter RF, Newacheck PW, Halfon N. Access to care for poor children: separate and unequal? JAMA. 1992;267:2760–2764.
Janicke DM, Finney JW, Riley AW. Children’s health care use: a prospective investigation of factors related to care-seeking. Med Care. 2001;39:990–1001.
Newacheck PW, Hughes DC, Stoddard JJ. Children’s access to primary care: differences by race, income, and insurance status. Pediatrics. 1996;97:26–32.
Schuster MA, Duan N, Regalado M, Klein DJ. Anticipatory guidance: what information do parents receive? What information do they want? Arch Pediatr Adolesc Med. 2000; 154:1191–1198.
Newacheck PW, Hochstein M, Marchi KS, Halfon N. Access to health care for young children in the United States. In: Halfon N, McLearn KT, Schuster MA, eds. Child Rearing in America: Challenges Facing Parents with Young Children. New York, NY: Cambridge University Press; 2002;293–319.
American Academy of Pediatrics Task Force on the Family. Family pediatrics report on the Task Force on the Family. Pediatrics. 2003;111:1541–1571.
McLearn KT, Zuckerman BS, Parker S, Yellowitz M, Kaplan-Sanoff M. Child development and pediatrics for the 21st century: the Healthy Steps approach. J Urban Health. 1998;75:704–723.
Minkovitz C, Strobino D, Hughart N, Scharfstein D, Guyer B, the Healthy Steps Evaluation Team. Early effects of the Healthy Steps for Young Children program. Arch Pediatr Adolesc. Med. 2001;155:470–479.
Minkovitz CS, Hughart N, Strobino D, et al., A practice-based intervention to enhance quality of care in the first 3 years of life: the Healthy Steps for Young Children program. JAMA. 2003;290:3081–3091.
Upshur C. Early intervention as preventive intervention. In: Meisels S, Shonkoff J, eds. Handbook of Early Intervention. New York, NY: Cambridge University Press; 1990:633–650.
Schonkoff J, Phillips D. From Neurons to Neighborhoods: the Science of Early Childhood Development. Washington, DC: National Academy Press; 2000.
Karoly LA, Greenwood PW, Everingham SS, et al.: Investing in Our Children. Santa Monica, CA: RAND; 1998.
Brooks-Gunn J, Fuligni A, Barth M, Young KT. Helping Children Take Healthy Steps: Abstracts of Selected Articles on Early Childhood Interventions. New York, NY: The Commonwealth Fund; 1997.
Victora CG, Vaughan JP, Barros FC, Silva AC, Tomasi E. Explaining trends in inequities: evidence from Brazilian child health studies. Lancet. 2000;356:1093–1098.
Guyer B, Hughart N, Strobino DM, Jones A, Scharfstein D. Healthy Steps Evaluation Team. Assessing the impact of pediatric-based developmental services on infants, families, and clinicians: challenges to evaluating the Healthy Steps Program. Pediatrics. 2000;105:e33.
Street RL. Physicians’ communication and parents’ evaluations of pediatric consultations. Med Care. 1991;29:1146–1152.
Busey S, Schum TR, Meurer JR. Parental perceptions of well-child care visits in an innercity clinic. Arch Pediatr Adolesc Med. 2002;156:62–66.
Hall JA, Dornan MC. Patient sociodemographic characteristics as predictors of satisfaction with medical care: a meta-analysis. Soc Sci Med. 1990;30:811–818.
Davis K, Collins KS, Schoen C, Morris C. Choice matters: enrollees’ views of their health plans. Health Aff (Millwood). 1995;14:99–112.
Bates AS, Wolinsky FD. Personal, financial, and structural barriers to immunization in socioeconomically disadvantaged urban children. Pediatrics 1998;101:591–596.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
McLearn, K.T., Strobino, D.M., Minkovitz, C.S. et al. Narrowing the income gaps in preventive care for young children: Families in healthy steps. J Urban Health 81, 556–567 (2004). https://doi.org/10.1093/jurban/jth140
Issue Date:
DOI: https://doi.org/10.1093/jurban/jth140