Browsing by Author "Kimbro, Rachel T"

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    Collateral Damage? How Household Debt Impacts Child Health and Development
    (2018-04-20) Brewer, Mackenzie; Kimbro, Rachel T
    Debt has increased dramatically over the past few decades among American households. Specifically, unsecured debt, such as debt incurred from credit cards and medical bills, has increased across the socioeconomic spectrum and has risen most rapidly among lower socioeconomic status (SES) households. Yet, very little research has examined whether household indebtedness, as a dimension of SES, is associated with child well-being. To fill this gap, the current study examines whether household debt, by type and amount of debt, is an emerging form of economic stratification associated with children’s health and development. Using data from the Panel Study of Income Dynamics (PSID), the first empirical chapter examines the prevalence of unsecured debt and the profile of borrowers. Results indicate that although households across the socioeconomic spectrum have unsecured debt, the profile of borrowers depends on the specific type of debt accrued. Households with medical debt and higher debt burden are, on average, disadvantaged across a range of social and economic markers. The second empirical chapter uses data from the 2014 Child Development Supplement (CDS-2014) of the PSID and tests whether unsecured debt contributes to food insecurity among lower-income households with children. Medical debt, in particular, emerges as a significant risk factor for food insecurity, while no relationship exists between credit card debt and food insecurity. Moreover, although liquid assets buffer against the harmful effects of medical debt, few households have enough assets to attenuate the risks associated with unpaid medical bills. The third empirical chapter examines whether debt functions as a financial stressor that increases family conflict and children’s behavioral problems. While I find some evidence that debt is related to higher levels of family conflict and child behavior issues, the associations are relatively weak. More research is needed to establish the conditions under which debt influences family relationships and children’s socioemotional well-being. Overall, the findings suggest that debt is an important contributor to child health and development, although the nature of the relationship between debt and child well-being depends on the type of debt accrued, the specific outcome considered, and a household’s broader financial circumstances.
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    Creating Space for Care: Enhancing Patient-Centered Performance Outcomes Through Organizational Change
    (2020-07-24) Dinh, Julie Vy; Salas, Eduardo; King, Eden; Kimbro, Rachel T
    Hospitals present serious challenges to the development of patient-provider relationships, particularly in the pediatric intensive care unit (PICU), where stakes, stress, and entropy are high. However, episodic change, particularly at the environmental and structural levels, can create space for more positive interpersonal dynamics. This series of studies triangulates mixed-methods data, collected in the field, to identify how one such intervention influenced patient-centered performance (PCP) outcomes, including patient trust and satisfaction. Overall, this research seeks to answer the question: how do the supportive design and departmentalization of hospital units impact PCP outcomes? Accordingly, this dissertation draws upon organizational change, supportive design, and classical organization theories, centering them around an intervention. A PICU (a) developed a new, larger, and improved physical space and (b) implemented departmentalization, geographically grouping patients and provider teams by subspecialty disease groups. Study 1 uses qualitative data to describe the psychologically supportive design aspects of the intervention. Study 2 quantitatively examines how this design-based intervention ultimately enhanced PCP outcomes, including patient trust and satisfaction. Study 3 uses numeric indices derived from archival data to investigate the effects of departmentalization on health care team volume and outcomes. This research also involves the validation of a parent satisfaction scale and the development of a novel, quantitative, group-level volume index. Theoretical contributions and practical implications are discussed.
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    Cumulative Inequality and Race/Ethnic Disparities in Low Birthweight: Differences by Early Life SES
    (2015-04-15) Freeman Cenegy, Laura; Kimbro, Rachel T; Gorman, Bridget K; Bratter, Jenifer
    The current study applies Cumulative Inequality theory to investigate whether differences in black, white, and Hispanics mothers’ early life socioeconomic status (SES) account for disparities in infants’ risk of low birthweight (LBW). This study uses three-generation linked data that come from the National Longitudinal Survey of Youth 1979 (1979-1995) and the NLSY Young Adult sample (1994-2010) and contain information on the mothers and grandmothers of 2,332 singleton infants. Controlling for mothers’ health and adult SES, I assess the unique association between childhood low SES, in terms of both cumulative economic hardship (i.e., household poverty status from ages 0 to 14) and social status (i.e., grandmothers’ education and marital status), and LBW probability. I also examine differences in LBW probability between black, white, and Hispanic women from similar childhood socioeconomic backgrounds. Overall, results indicate that childhood socioeconomic factors do not account for race/ethnic disparities in LBW. Rather, childhood low SES increases the probability of LBW for whites but is not significantly predictive of LBW for blacks or Hispanics. In fact, pairwise comparisons indicate the greatest LBW disparities exist between black and white women who experienced the least socioeconomic disadvantage during early life.
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    Exploring the relationship between maternal nativity, food insecurity, and young children’s experiences at school.
    (2022-08-11) Fern, Simon E; Kimbro, Rachel T; Chavez, Sergio
    Children growing up in food insecure households experience serious challenges in their day-to-day lives, wellbeing, and development which understandably affect them at school. While food insecurity and maternal nativity, and food insecurity and school outcomes have been explored substantially by other scholars – there is a scarcity of work which interacts the three together. Using nationally representative data from the period 2010-2016 for 4,250 children in the Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011, with household incomes at or below 400 percent of the federal poverty level, this study explores whether maternal nativity affects the relationship between household food insecurity and children’s academic achievement and teacher-assessed behaviour. This analysis demonstrates a substantial food insecurity gap between households headed by US or foreign-born mothers, and a diversity of relationships between food insecurity and school outcomes. This paper provides evidence for the importance of disaggregating the ‘foreign-born mother’ category to think about the relationship between different places of origin and later trajectories in the United States.
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    Life Course Contexts and Racial Birth Outcome Disparities
    (2021-12-03) Freeman Cenegy, Laura; Kimbro, Rachel T
    ABSTRACT Life Course Contexts and Racial Birth Outcome Disparities by Laura Freeman Cenegy This dissertation investigates one of the most heavily researched, yet poorly understood, manifestations of racial health inequality in the U.S., the black-white gap in infant health at birth. I examine the ways in which life course family and contextual circumstances come together to produce far reaching negative influences on African American women’s reproductive health and the life chances of their children. In three separate, but related chapters, I pose different questions about how the contextual environments in which African American women grow up contributes to their infants’ disproportionate risk of poor health, as indicated by their weight at birth (< 5 ½ lbs.). The history and present day realities of racial residential segregation mean that, by and large, African American and white women have grown up in different neighborhoods with different resources and advantages in ways that have not been accounted for in the research to date. To address this, I use longitudinal data from the Panel Study of Income Dynamics linked with tract-level data from the U.S. Census Bureau to examine the life course contextual precursors to this important intergenerational health problem. The results indicate that the two-fold excess incidence of low birth weight among African Americans is largely attributable to their cumulative life course exposure to high poverty and majority black neighborhoods. Poor neighborhoods pose similar risks to white mothers’ infant birth weight outcomes, but their overall exposure to neighborhood poverty is quite limited compared to African American mothers. In fact, one important insight from this research is that white women coming of age from the 1970s to the present have had very little exposure to neighborhoods that were not overwhelming white and nonpoor, whereas black women’s experiences prior to childbearing have been far more diverse and characterized by a range of exposures to different racial and poverty contexts. These findings collectively underscore the need to longitudinally examine the lifecourse origins of maternal and infant health and racial inequalities in health more broadly.
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    Returning to Work, Breastfeeding, and Family Structure: A Portrait of Working Mothers in the U.S.
    (2015-01-08) Brewer, Mackenzie; Kimbro, Rachel T; Bratter, Jenifer; Augustine, Jennifer
    Using data from the Early Childhood Longitudinal Study (Birth Cohort 2001), this study investigates how the amount of time off from work after childbirth is associated with breastfeeding behavior, and how this association differs by maternal relationship status. Specifically, I observe how a delayed return to work after childbirth is associated with breastfeeding among a nationally representative sample of single, cohabiting and married working mothers. Using logistic regression and predicted probabilities, I find that returning to work after 12 weeks is associated with higher odds of breastfeeding beyond 3 months for married mothers. The amount of leave from work is not significantly associated with the breastfeeding behaviors of single or cohabiting mothers. These findings raise serious concerns about the design of current maternal leave policies, barriers in the workplace that discourage breastfeeding, and the ability of unmarried women to utilize benefits from a delayed to return to work after childbirth.