Neighborhood Environments and Flourishing in Children: A Focused Look at Three Age Groups by Special Healthcare Need Status from the National Survey of Children's Health

background:

Existing research establishes an association between the built environment and various health outcomes in children; however, few studies examine its association with overall wellbeing. This study evaluated the association between the built environment and child flourishing across developmental age groups and special health care needs (CSHCN) status.

methods:

This was a cross-sectional study using a nationally-representative sample from the 2011-12 National Survey of Children’s Health (n=88,288). The outcome was flourishing (yes/no), and exposures were neighborhood amenities and detractors, and unsafe neighborhoods.  Adjusted odds ratios (aOR) were estimated using logistic regression accounting for the sampling design and adjusting for demographic and neighborhood covariates. Model results were stratified by age group (6mo-5yr, 6-11yr, 12-17yr) and CSHCN status.

results:

The prevalence of flourishing in the youngest, middle and oldest age groups was respectively 95.2%, 80.6% and 79.3% among non-CSHCN and 87.8%, 56.7% and 59.2% among CSHCN. After adjustment, living in an unsafe neighborhood was associated with 30-50% lower odds of flourishing across age groups regardless of CSHCN status.  Neighborhood amenities were associated with 40-50% greater odds of flourishing among non-CSHCN ages 6-11 years (aOR=1.5 [95%CI: 1.2-1.8]) and 12-17 years (aOR=1.4 [1.2-1.6]) and 70% greater odds of flourishing among CSHCN ages 6 months-5 years (aOR=1.7 [1.1-2.7]). Neighborhood detractors were not significantly associated with odds of flourishing in any sub-group.

conclusions:

The association between the built environment and flourishing differs by age and CSHCN status. Interventions targeted at children should focus on neighborhood safety and amenities; evaluators should anticipate differential impacts across child sub-groups.