Moderating or mediating effects of family characteristics on socioeconomic inequalities in child health in high-income countries - a scoping review

Abstract

Background: By explaining the development of health inequalities, eco-social theories highlight the importance of social environments that children are embedded in. The most important environment during early childhood is the family, as it profoundly influences children's health through various characteristics. These include family processes, family structure/size, and living conditions, and are closely linked to the socioeconomic position (SEP) of the family. Although it is known that the SEP contributes to health inequalities in early childhood, the effects of family characteristics on health inequalities remain unclear. The objective of this scoping review is to synthesise existing research on the mediating and moderating effects of family characteristics on socioeconomic health inequalities (HI) during early childhood in high-income countries.

Methods: This review followed the methodology of "Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews". To identify German and English scientific peer-reviewed literature published from January 1^st, 2000, to December 19^th, 2019, the following search term blocks were linked with the logical operator "AND": (1) family structure/size, processes, living conditions, (2) inequalities, disparities, diversities, (3) income, education, occupation, (4) health and (5) young children. The search covered the electronic databases PubMed, PsycINFO, and Scopus.

Results: The search yielded 7,089 records. After title/abstract and full-text screening, only ten peer-reviewed articles were included in the synthesis, which analysed the effects of family characteristics on HI in early childhood. Family processes (i.e., rules /descriptive norms, stress, parental screen time, parent-child conflicts) are identified to have mediating or moderating effects. While families' living conditions (i.e., TVs in children's bedrooms) are suggested as mediating factors, family structure/size (i.e., single parenthood, number of children in the household) appear to moderate health inequalities.

Conclusion: Family characteristics contribute to health inequalities in early childhood. The results provide overall support of models of family stress and family investment. However, knowledge gaps remain regarding the role of family health literacy, regarding a wide range of children's health outcomes (e.g., oral health, inflammation parameters, weight, and height), and the development of health inequalities over the life course starting at birth.

Keywords: Child; Family; Health; Health status disparities; Infant; Socioeconomic factors; Socioeconomic health inequalities.

Fig. 1

Conceptual Framework of the Scoping Review

Fig. 2

Flowchart of Study Selection Following PRISMA Extension for Scoping Reviews

Fig. 3

Overview of Studies Examining the Pathways Underlying Health Inequalities with Family Characteristics

Fig. 4

Mediating Effects of Family Characteristics in SEP-Related Health Inequalities in Early Childhood (Objective 1) [46, 47, 50], [49, 51, 52], [49], [47], [44], [49], [49], [44, 46, 47], [–52], [ 47], [49, 52], [50], [44], [51]

Fig. 5

Moderating Effects of Family Characteristics on Health Inequalities in Early Childhood (Objective 2) [45, 51], [51], [43], [48], [48, 49], [43, 48, 49], [45], [51], [43], [49], [45, 51], [48]