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Forthcoming in the Journal for the Scientific Study of Religion
https://doi.org/10.1111/jssr.12521
Religion and Disability: Variation in Religious Service Attendance Rates for Children with
Chronic Health Conditions
ANDREW L. WHITEHEAD
Department of Sociology, Anthropology, & Criminal Justice
Clemson University
Prior research consistently demonstrates greater religious involvement is associated with
improved health outcomes for those with chronic health conditions. Fewer studies focus on how
chronic health conditions influence religious service attendance rates and most focus on older
Americans. Using three waves of a nationally representative sample of children in the United
States, I test whether children with a chronic health condition never attend religious worship
services at rates significantly higher than children without a condition. I also investigate variation
in attendance rates across a broad range of conditions, something previously overlooked.
Children with chronic health conditions are more likely to never attend religious worship
services. Specifically, children with chronic health conditions that impede communication and
social interaction are most likely to never attend. Despite shifts in prevalence these findings are
stable over time. Implications for researchers, religious communities, families with children with
chronic health conditions, and healthcare providers are discussed.
Keywords: Chronic health condition, Disability, Health, Children, Religion, Congregations,
United States
Acknowledgements: The author would like to thank the editor of JSSR, three anonymous
reviewers, Ye Luo, and Joseph Baker for their insightful comments on previous drafts. Any
error(s) or omissions remain the author’s alone. Special thanks to Kelly, Joel, Natalie, and Theo
Whitehead for their enduring inspiration and commitment to flourish regardless of disability.
Please direct all correspondence to Andrew L. Whitehead, 132 Brackett Hall, Clemson
University, Clemson, SC 29634. Email: alw6@clemson.edu.
CHILDHOOD DISABILITY AND RELIGION
INTRODUCTION
Religious Service Attendance and Chronic Health Conditions
Up to twenty percent of Americans report a chronic health condition or disability of some
kind (CDC 2015; Erickson, Lee, von Schrader 2017).
1
These chronic health conditions include
motor difficulties, visual or hearing complications, self-care limitations, or cognitive
impairments. While the passage of the Americans with Disabilities Act (ADA) in 1990 improved
the lives and welfare of Americans living with chronic health conditions in a few areas,
significant progress remains elusive. Americans with chronic health conditions continue to face
higher levels of poverty, much lower employment rates, lower annual income, lower life
satisfaction, reduced access to necessary healthcare, and lower educational attainment than
Americans with no reported chronic health conditions (Erickson et al. 2017; Kessler 2010).
Participation in various aspects of social life, like going to restaurants or socializing with friends,
neighbors, or relatives is rarer for those with chronic health conditions. Chronic health conditions
also significantly influence Americans’ participation in religious activities such as attendance at
worship services.
Individuals with disabilities consider faith to be important to them at rates similar to the
population with no reported disabilities (Carter 2007). Despite this, 50 percent of people with a
chronic health condition report attending religious services at least once per month, while 57
percent of people without a chronic health condition report the same – a seven percent gap.
1
Throughout the manuscript I use the term “chronic health condition” as it is more inclusive of a broad range of
health problems than is the term “disability” (Bernell and Howard 2016). As Bernell and Howard (2016) state,
chronic health condition refers to conditions, disabilities, or diseases that have a long development and duration,
have a complex causality, have a prolonged course of illness, and may include associated functional impairment or
disability. My use of chronic health condition also follows the terminology adopted by the agencies collecting the
data used in these analyses (Centers for Disease Control and Prevention, National Center for Health Statistics, U.S.
Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child
Health Bureau).
CHILDHOOD DISABILITY AND RELIGION
Thirty-five percent of people with a chronic health condition report never attending religious
services while only 26 percent of people without a disability report the same – a nine percent gap
(Kessler 2010). Several studies find that among older Americans attendance at religious services
wanes as chronic health conditions, disability, and functional limitations increase (Barusch 1999;
Gillum and Trulear 2008). Another study demonstrates that disability due to various physical
injuries is significantly associated with less frequent attendance at religious services (Campbell,
Yoon, and Johnstone 2010). Demonstrating variation in attendance at religious services for those
with chronic health conditions is important given attendance has a stable association with long-
term health trajectories (Koenig, King, and Carson 2012) and is linked to a number of beneficial
outcomes such as lower rates of mortality, slowing functional decline, reducing depression, and
improving mental health (Ellison and Levin 1998; Hayward and Krause 2013; Hill et al. 2005;
Hummer et al. 2010; Idler and Kasl 1997a, 1997b; Koenig et al. 1997; Koenig et al. 1999; Levin
and Chatters 1998; Vogel, Polloway, and Smith 2006).
One limitation of the aforementioned studies regarding chronic health conditions and
religious service attendance is that a majority focus on adults and especially older Americans.
This is unfortunate given about one in six children report at least one developmental disability, a
17 percent increase in prevalence from 1997 to 2008 (Boyle et al. 2011). Furthermore, a handful
of studies of children with chronic health conditions highlight the beneficial effects of religious
service attendance. Consistent attendance at religious services among children and adolescents
with various chronic health conditions is generally associated with improved mental and
emotional health, higher self-esteem, and overall well-being (Abbotts et al. 2004; Ault 2010;
Kleinert et al. 2007; Meltzer et al. 2011; Swinton 2001). Prior research also demonstrates a range
of positive outcomes for family members of children with chronic health conditions who attend
CHILDHOOD DISABILITY AND RELIGION
religious services: increased social support, improved physical health, and better
mental/emotional health (Bayat 2007; Bennett et al. 1995; Coulthard and Fitzgerald 1999;
O’Hanlon 2013; Phelps et al. 2009; Poston and Turnbull 2004; Tarakeshwar and Pargament
2001; White 2009; Whitehead 2016; Yatchmenoff et al. 1998).
To date there are no large-scale, multiple time point, quantitative analyses of the
association between chronic health conditions and children’s religious service attendance in the
United States. The current analysis aims to fill this void. Using three waves of nationally
representative samples of children in the United States, this study tests two hypotheses
concerning the association between reported chronic health conditions and children’s religious
service attendance across multiple years. A number of implications for children with chronic
health conditions, their families, as well as organized religion emerge from these findings.
Multiple avenues for future research are also apparent in the understudied area of health and
religion among children.
Explaining Variation in Religious Service Attendance Rates among Children with Chronic
Health Conditions
There are a number of possible explanations why children with chronic health conditions
struggle to attend worship services at rates similar to those without chronic health conditions.
Generally, most religious congregations have been slow to respond to the needs of families with
chronically disabled children. The 2001 U.S. Congregational Life Survey found that only ten
percent of congregations report offering some form of care for people with disabilities
(Woolever and Bruce 2002). Carter (2007) identified several aspects of congregations that can
create barriers to inclusion for those with chronic health conditions and their families. These
congregational hurdles include architectural, attitudinal, communication, programmatic, and
CHILDHOOD DISABILITY AND RELIGION
liturgical barriers. Ault, Collins, and Carter (2013b) demonstrate that due to these and other
barriers, 33 percent of parents of children with chronic health conditions changed their place of
worship because they felt their child was not included. Fifty-six percent reported keeping their
child from participating in religious activities due to lack of support, and about half stated that
they had never been asked by their congregation how to best include their child. More than half
of these parents recount having been expected to stay with their child throughout worship
services in order for their child to participate (Ault, Collins, Carter 2013a). Congregational
barriers limit parents’ ability to participate and integrate into a worship community.
Due to various congregational barriers, negative mental and emotional outcomes are
commonly associated with religious activity among parents – like attending religious worship
services – while more positive mental and emotional outcomes are associated with religious
belief and spirituality (Ekas et al. 2009; Poston and Turnbull 2004; Shu 2009; Tarakeshwar and
Pargament 2001). Parents of children with chronic health conditions consistently share how
attendance at religious services creates opportunities for negative interactions and general
unresponsiveness from congregations and their members. Many parents of children with chronic
health conditions suffer from fatigue due to advocating for their child in various other spheres of
social life. The effort required to attend religious services is viewed as too much additional labor.
As one mother shares, “We wish we had a community to belong to, however . . . we have not had
the time or energy to seek-out and prepare (educate) a new spiritual home for ourselves” (Ault et
al. 2013b: 200). Attending religious services can have divergent effects from offering much
needed social and emotional support to being a cause of additional stress and distress for children
with chronic health conditions and their families (Tarakeshwar and Pargament 2001). A few
prior studies focus on children with chronic health conditions and demonstrate variation in their
CHILDHOOD DISABILITY AND RELIGION
religious service attendance rates compared to children without a chronic health condition. For
instance, among adults and adolescents with autism spectrum disorders, 44 percent attend
religious services less than yearly (Orsmond, Krauss, and Seltzer 2004).
2
Less than one-third
attend at least once per week. Two studies of adolescents and children in Great Britain found that
those with conduct disorders and depression were less likely to attend religious services regularly
(Abbotts et al. 2004; Meltzer et al. 2011). Congregational barriers and their effects on parents
and families of children with chronic health conditions may be one reason why these children
attend religious services less often than their peers leading to the first hypothesis of this study:
H1: Compared to children with no reported health conditions, children with any reported
chronic health condition will be more likely to never attend religious worship services.
In addition to the clear organizational barriers that exist within congregations, the
behavioral features of each child with a chronic health condition can significantly influence their
integration into congregational life and their frequency of worship service attendance (Ault et al.
2013b). This suggests that differences in religious service attendance might exist across a range
of childhood chronic health conditions. For example, a child with a chronic health condition
where the limitations tend to be more physical in nature – like asthma or diabetes – may be able
to attend religious services more easily than a child with a chronic health condition that limits
their capacity to communicate and interact socially, such as a child who is non-verbal and on the
autism spectrum. Of the few studies discussed above that examine religious service attendance
rates for various childhood chronic health conditions, even fewer focus on more than one and
even then the investigation is limited to only a small number of chronic health conditions. While
prior work in this area suggests that there are indeed differences in attendance rates across
2
By way of comparison, in 2004 22.7 percent of American adults report attending “less than once per year” or
“never” (General Social Survey, 2004).
CHILDHOOD DISABILITY AND RELIGION
various childhood chronic health conditions, to date there are no studies that examine a broad
range of childhood chronic health conditions and their association with attendance at worship
services.
Using data collected in 2003, Lee and colleagues (2008) find that children and
adolescents with autism spectrum disorders are less likely to attend religious services at least
once per week compared to those with ADD/ADHD or no intellectual disability. They also find
in bivariate analyses that significantly fewer children and adolescents with ADD/ADHD attend
religious services on a regular basis compared to children and adolescents with no disability.
Wagner and colleagues (2003) find some variation across chronic health condition categories
regarding participation in religious services. The proportion of children and adolescents with a
chronic health condition who participated in religious activities in the last year range from a low
of 44 percent for those with deaf-blindness to a high of 54 percent for those with an orthopedic
impairment. Because different chronic health conditions present a range of possible difficulties,
there is likely variation across chronic health conditions in the probability of never attending
religious services leading to a second hypothesis:
H2: The likelihood of never attending religious services will vary depending on
children’s particular chronic health condition.
Finally, it is important to document the association between children’s religious service
attendance and chronic health conditions across time because of shifts in the prevalence of some
conditions. From 2002 to 2008, there was a 78 percent increase in prevalence of autism spectrum
disorders where an estimated 1 in 88 children were identified with an autism spectrum disorder
in 2008, which then increased to 1 in 68 children by 2010 (Baio 2014). The prevalence of ever-
diagnosed ADHD increased 42 percent from 2003 to 2011 (Visser et al. 2014). Other
CHILDHOOD DISABILITY AND RELIGION
developmental delays, broadly defined, also increased from the late 1990s until 2008 (Boyle et
al. 2011). Hearing loss, however, shows signs of decreasing prevalence over the same time
period (Boyle et al. 2011). The following analyses tests these hypotheses using three waves of
data to determine if the association between particular chronic health conditions and never
attending religious services is consistent over time.
DATA AND METHODS
This analysis draws on data from three waves of the National Survey of Children’s
Health (2003, 2007, 2011-2012) conducted by the Centers for Disease Control and Prevention
(CDC), National Center for Health Statistics. This survey is sponsored by the U.S. Department of
Health and Human Services, Health Resources and Services Administration, and Maternal and
Child Health Bureau (2005, 2009, 2012). The NSCH gathered a broad range of information
including demographics, health insurance coverage, health and functional status, health care
access, parental health status, family functioning, and community characteristics.
The 2003, 2007, and 2011-2012 NSCH are each nationally representative samples of
non-institutionalized children and youth aged 0-17 living in all 50 states and the District of
Columbia. Each wave uses a complex survey design stratified by state, and in the case of the
2011-2012 wave, sample type as well. The NSCH uses random-digit dialing techniques to
contact households to then screen for presence of a child in the home. The interviews are
completed by parents/caregivers of children. In the 2011-2012 wave 95,677 phone interviews,
using both landline and cell phone numbers, were completed by parents/caregivers. Completed
interviews per state ranged from 1,811 to 2,200. The cell phone sample was new for the 2011-
2012 wave of the survey and the completion rate – proportion of households known to include
CHILDHOOD DISABILITY AND RELIGION
children that completed all sections – was 51.05 percent
3
overall. For the 2007 NSCH, 91,642
interviews were completed, between 1,725 and 1,932 per state. The overall completion rate was
66.0 percent. A total of 102,353 surveys were completed in the 2003 wave, between 1,483 and
2,241 per state. The completion rate was 68.8 percent. Please see Blumberg et al. (2005),
Blumberg et al. (2012), and Blumberg et al. (2013) for additional information about each wave
of the NSCH. All three waves of the NSCH public use data files and additional documentation
are available through www.childhealthdata.org.
When possible, the following analyses draw on each of the three available waves to
determine if there are changes regarding which chronic health conditions are significantly
associated with never attending religious services across the intervening decade. It also allows
for tests of whether the association between particular chronic health conditions and never
attending religious services is different depending on survey year.
Measures
Dependent Variable. Each wave of the NSCH asks, “About how often does [child name] attend
religious service?” In all three waves the possible response categories were, “None”, “At least
once per year, but less than once per month”, “At least once per month, but less than once per
week”, “At least once per week”, and “More than once per week”. This measure was
dichotomized such that 1 = never attends a religious service. In 2003, 21.4 percent of children in
the US never attended a religious service. In 2007, 20.7 percent reported the same about their
child’s religious service attendance. In 2011-2012, 23.5 percent of children never attended a
religious service (see Table 1). Focusing on never attending religious services provides the most
clarity regarding the influence of the various chronic health conditions. The overly general nature
3
54.1 percent for the landline sample (N=63,705) and 41.2 percent for the cell-phone sample (N=31,972).
CHILDHOOD DISABILITY AND RELIGION
of the other response categories limits clear interpretation of exactly how often these children are
attending.
[Table 1 about here]
Chronic Health Conditions. In all three waves of the NSCH respondents were read a list of
conditions and asked: “Has a doctor or other health care provider ever told you that [child’s
name] had [particular chronic health condition].” In 2003 there were 10 possible chronic
conditions. This list expanded to 16 in 2007 with two additional chronic conditions added in
2011-2012 to bring the total to 18. There are eight chronic conditions that were consistently
measured across all three waves. The conditions and the waves on which they appear include
autism spectrum disorder (2003, 2007, 2011-2012), attention deficit disorder (2003, 2007, 2011-
2012), developmental delay (2003, 2007, 2011-2012), learning disability (2003, 2007, 2011-
2012), oppositional defiant disorder/conduct disorder (2003, 2007, 2011-2012), asthma (2003,
2007, 2011-2012), diabetes (2003, 2007, 2011-2012), bone/joint/muscle problems (2003, 2007,
2011-2012), depression (2007, 2011-2012), anxiety (2007, 2011-2012), speech problems (2007,
2011-2012), Tourette Syndrome (2007, 2011-2012), brain injury/concussion (2007, 2011-2012),
epilepsy (2007, 2011-2012), hearing problems (2007, 2011-2012), vision problems (2007, 2011-
2012), intellectual disability (2011-2012), cerebral palsy (2011-2012), hearing or vision
problems (2003), and depression or anxiety (2003).
4
The NSCH also designates age ranges for
certain conditions to account for the fact that some chronic health conditions may not manifest in
full until a later age. For instance, while vision problems may clearly manifest before age 2,
intellectual or conduct disorders can be much more difficult to diagnose until after age 2.
4
In 2003, the NSCH combined depression and anxiety into one question. These were later separated in the 2007 and
2011-2012 surveys. The 2003 version also combined hearing and vision problems into one question. The 2007 and
2011-2012 surveys asked these separately as well.
CHILDHOOD DISABILITY AND RELIGION
In order to compare each chronic health condition to children with no reported conditions
in the multivariate models, I created three groups for each health condition: Those with the
condition (Condition Present), those with any other reported chronic health condition but not the
condition in question (Condition Absent – Other Condition(s) Present), and those with no
reported chronic health conditions (No Condition(s) Present). In all of the multivariate models,
the No Condition(s) Present group is used as the contrast category. This allows us to assess if
each reported health condition significantly raises children’s probability of never attending
religious services compared to children with no reported health conditions. Creating the
Condition Absent – Other Condition(s) Present category helps maintain the clarity of the
Condition Present and No Condition(s) Present groups. It also allows us to preserve cases. While
the results from this group are presented below I refrain from drawing any substantive
conclusions given that it is a conceptual catch-all category.
Table 2 displays each of these chronic conditions and their prevalence rates across all
three waves with significance tests. It also includes children with no reported chronic health
conditions. The most common chronic health condition within each of these three waves is
asthma with 8.6 percent of children affected in 2011-2012. Attention deficit disorder/attention
deficit hyperactivity disorder (ADD/ADHD) is the second most common condition in 2011-2012
wave – 7.9 percent of children affected, but third-most in the 2007 and 2003 waves. Learning
disability is the third most common in 2011-2012 – 7.8 percent of children affected – but second
most common on the 2007 and 2003 waves.
[Table 2 about here]
Control Variables. In addition to chronic health conditions influencing children’s religious
service attendance, a variety of social and demographic indicators are included as control
CHILDHOOD DISABILITY AND RELIGION
variables in the following analyses.
5
Age (in years, 0-17), child’s health (5 = excellent to 1 =
poor), race/ethnicity (white, Hispanic, black, multiple or other race), gender (1 = female), family
structure (two biological/adoptive parents, two parent stepfamily, single mother, other family
type), parents’ income (1 = <100% FPL to 4 = 400% or more FPL), parents’ education (highest
level attained by any parent, 1 = less than HS, 2 = HS graduate, 3 = More than HS), size of place
(1 = Urban), region (Northeast, Midwest, South, West), and survey year (where applicable) are
all included as controls (see Table 1).
Methods
Each wave of the NSCH uses a complex sampling design. For the 2003 and 2007 waves,
the survey is designed to provide independent data sets for each state. In the 2011-2012 wave,
the complex design accounts for state and for sample type. A specific program within SAS V 9.3
(PROC SURVEY) has the capacity to account for complex sampling design and was used
throughout this analysis in order to properly calculate variances, standard errors, and confidence
intervals. Every record in each wave of the NSCH is assigned a single sampling weight. These
weights are used throughout the analysis in order to provide accurate point estimates. This
analysis uses binary logistic multivariate modeling, due to the coding of the dependent variable,
while simultaneously employing the necessary complex sampling design procedures.
6
Table 3 displays the results for 21 separate binary logistic regression models for all of the
chronic health conditions for which data was collected in the 2011-2012, 2007, and 2003 waves
5
The severity of certain chronic health conditions can moderate the influence these conditions have on a child’s life.
In the 2011-2012 and 2007 NSCH, parents/guardians were asked to rate the severity of a handful of chronic health
conditions. In 2003, respondents were not asked about the severity of any chronic health condition. Due to this lack
of consistent measurement of severity, the following analyses cannot control for it in a comprehensive manner.
6
Ancillary analyses examined OLS regression models and a dependent variable (attend) that ranged from 0 (Never
attend) to 3 (Attend once per week or more) and the results did not differ from those presented below. All chronic
health conditions exhibited significant effects in an identical direction with the exception of brain injury which was
non-significant.
CHILDHOOD DISABILITY AND RELIGION
of the NSCH.
7
Controlling for survey year (where applicable), the analyses depicted in Table 3
allow us to determine if the association between the various chronic health conditions and never
attending religious services is consistent across time. In ancillary analyses (not shown but
available upon request) interaction terms for survey year and each chronic health condition were
estimated to determine if any effects were moderated by survey year (see footnote 9 for more
information). In each table, each row displays the coefficients for the Condition Present and the
Condition Absent – Other Condition(s) Present categories which are being compared to the No
Condition(s) Present group which serves as the contrast category. Again, I refrain from drawing
any substantive conclusions regarding the coefficients for the Condition Absent – Other
Condition(s) Present category since it is a conceptual catch-all category. In the interest of space
the coefficients for the various control variables are not displayed in the table. Full results are
available upon request. Please see footnote 8 for general information about the number of models
in which particular control variables were non-significant.
RESULTS
Table 2 provides the percent of children affected by each chronic health condition – with
notations to designate if the prevalence rate in 2011-2012 is significantly higher than in 2007 or
2003 – and the percent within each of these groups that never attend religious services.
Additional notations designate if the percent of children with each chronic health condition who
7
I also examined the full collection of chronic health conditions for each wave separately (see online supplementary
tables). The findings from the merged models (Table 3) are identical to those models across separate survey waves
except in four instances where there is slight variation. ADD/ADHD is significant in the merged models (as it is in
2007 and 2003) while in 2011-2012 it is non-significant. Hearing problems is non-significant in the merged models
(as it is in 2007) while in 2011-2012 it is significant (it was not asked in 2003). Bone/joint/muscle problems is
significant in the merged models (as it is in 2003) while in 2011-2012 and 2007 it is non-significant. Brain injury is
significant in the merged models (as it is in 2011-2012) while in 2007 it is non-significant (it was not asked in
2003). There are no instances where a chronic health condition exhibits a significant association in one direction in
the merged models but is significantly associated in the opposite direction in any of the separate survey wave
models.
CHILDHOOD DISABILITY AND RELIGION
never attend is significantly different than the percent of children with no health condition who
never attend. Within each wave of the NSCH, children with autism spectrum disorders have the
highest reported frequency of never attending religious services. Furthermore, the percent of
children with autism spectrum disorders who never attend is consistently significantly higher
than children with no chronic health conditions. In 2011-2012, 32.1 percent of children with an
autism spectrum disorder report never attending religious services. In the same survey year, 24.4
percent of children without a chronic health condition report never attending.
Other chronic health conditions asked across all three waves where significantly more
children with that particular chronic health condition report never attending religious services
include (with the 2011-2012 percent who never attend in parentheses): ADD/ADHD (23.6),
developmental delay (29.3), learning disability (27.1), and oppositional defiant disorder (29.2).
Significantly more children with depression (29.9), anxiety (27.7) and speech problems (29.8)
never attend in both the 2007 and 2011-2012 surveys when compared to children with no
reported conditions.
Several chronic health conditions show a less consistent relationship with never attending
religious services. In 2011-2012, significantly more children with hearing problems (26.0) or a
brain injury (31.0) report never attending religious services while there are no significant
differences between those with these conditions and children with no health conditions in 2007.
While these findings give clear evidence that various chronic health conditions are
significantly related to children’s never attending religious services, multivariate models are
necessary to ensure the relationship is robust. Table 3 displays the results of 21 separate logistic
regression models (20 chronic health condition models and one model for children with no
reported health conditions) using all three waves the NSCH data (where applicable). Each row
CHILDHOOD DISABILITY AND RELIGION
displays the coefficients for each chronic health condition from separate models, and the second
through fourth columns contain the coefficients and odds ratios for the Condition Present and
Condition Absent – Other Condition(s) Present categories which are being compared to the
contrast category, No Condition(s) Present. Each model contains all of the control variables
discussed in the data section. The final column provides the sample size for each model along
with a notation designating the particular waves of the NSCH included in the analyses. The
online supplementary models display the results from each individual survey wave.
Net of all other effects, children with no reported health conditions are significantly less
likely (b = -.127) to report never attending religious services across all three waves, even when
controlling for survey year. Conversely, the odds of never attending religious services are 1.84
times higher for a child with an autism spectrum disorder compared to children with no
conditions. Likewise, for those chronic health conditions present on all three waves, the odds of
never attending religious services are higher for children with ADD/ADHD (1.19),
developmental delays (1.36), learning disabilities (1.36), oppositional defiant disorder (1.48), and
bone/joint/muscle problems (1.15). However, across all three waves, children with asthma and
diabetes are not significantly more likely to never attend compared to children with no chronic
health conditions.
Several chronic health conditions present on both the 2011-2012 and 2007 waves of the
NSCH also show consistent effects. Children with depression (1.73), anxiety (1.45), speech
problems (1.42), and brain injury (1.71) all report higher odds of never attending religious
services than those children with no reported health conditions. Conversely, children who report
having Tourette Syndrome, epilepsy, hearing problems, or vision problems are no more or less
likely to never attend compared to children with no reported health conditions. Finally, on the
CHILDHOOD DISABILITY AND RELIGION
2011-2012 wave children with intellectual disability and Cerebral Palsy are not significantly
more likely to never attend than children with no health conditions. In the 2003 wave,
respondents were simultaneously asked if their child had “hearing or vision problems”, or
“depression or anxiety”. Similar to when depression and anxiety were asked separately on both
the 2007 and 2011-2012 waves, children who reported having depression or anxiety in 2003
were significantly more likely to never attend religious services. The findings for hearing or
vision problems when asked simultaneously in 2003 mirror those for hearing problems and
vision problems when they were asked separately in the 2007 and 2011-2012 waves: no
significant differences.
8
[Table 3 about here]
DISCUSSION AND CONCLUSION
Across three waves of a nationally representative survey of children in the United States,
it is clear that a number of chronic health conditions are significantly associated with never
attending religious worship services. In support of the first hypothesis, children with chronic
health conditions are more likely to never attend religious services compared to children with no
reported health conditions. Furthermore, consistently since 2003, children with autism spectrum
disorders, ADD/ADHD, developmental delays, learning disabilities, oppositional defiant
disorder/conduct disorders, and bone/joint/muscle problems are all more likely to never attend
religious services. Since first asked in 2007, children with speech problems, depression, anxiety,
or brain injuries are significantly more likely to never attend religious services compared to
children with no reported conditions. Children with asthma, diabetes, Tourette Syndrome,
8
Across all models, all of the control variables were consistently significantly associated with never attending
except parents’ income (non-significant in 17 models), Midwest (non-significant in four models), and child’s health
(non-significant in all models). Full model results available upon request.
CHILDHOOD DISABILITY AND RELIGION
epilepsy, hearing problems, vision problems, intellectual disabilities, or Cerebral Palsy are no
more or less likely to never attend religious services compared to children with no reported
chronic health conditions. This variation across various disabilities and chronic health conditions
supports the second hypothesis.
Taken together, these analyses unveil a number of important findings. It appears that
across a range of chronic health conditions, those that are primarily characterized by deficiencies
in social interaction or might impede communication are most consistently and significantly
associated with disengagement with attendance at religious worship services. Furthermore, these
results strongly suggest that the higher probability of children with particular health conditions
never attending religious services has been stable over time.
9
Prior research signals that this is
likely due to factors attributable to barriers within congregations as well as the characteristics of
the children’s disability. As Ault and colleagues (2013b) point out, the behavioral characteristics
of children with various chronic health conditions play an important role in structuring if and
how they will be integrated into congregational life. Children with autism spectrum disorders,
developmental delays, and conduct disorders all manifest a range of social and behavioral
characteristics that routinely result in strained social encounters and interactions. Likewise,
children with speech problems might not be able to communicate as easily as their peers. The
particular behavioral characteristics or physical limitations associated with these health
conditions appear to limit these children’s ability to attend religious services.
9
In ancillary models I estimated interactions between each chronic health condition and survey year. Out of the 16
possible interactions between each chronic health condition and survey year in Table 3 only two were significant:
ADD/ADHD and hearing problems. The majority of non-significant interaction terms suggests that the associations
between each chronic health condition and never attending religious services are consistent across survey years with
few substantial differences across time. Results available upon request.
CHILDHOOD DISABILITY AND RELIGION
Carter’s (2007) five congregational barriers – architectural, attitudinal, communication,
programmatic, and liturgical – may also be influential in limiting the integration of children with
communication and social interaction deficiencies due to various chronic health conditions.
Attitudinal, communication, and programmatic barriers might be particularly important
regarding never attending religious services. Attitudinal barriers many times include patronizing,
disparaging, or paternalistic comments or behaviors, such as questioning whether those with
particular chronic health conditions “really get anything out of participating” (Carter 2007:12).
Communication barriers include failing to present doctrines and information in new ways so that
those who learn using different techniques are not excluded. Programmatic barriers refer to the
additional supports that are sometimes necessary for those with chronic health conditions to
participate. Many children with developmental disabilities, like those who are on the autism
spectrum or have a learning disability, require extra support from a peer or adult. Children with
speech limitations may not be able to participate in the same games, songs, or lessons as their
peers. Alongside the behavioral characteristics of each child with a chronic health condition,
congregational barriers may also explain why children with deficiencies in communication and
social interaction are much more likely to never attend religious services.
These analyses also demonstrate the necessity of considering various childhood heath
conditions separately as well as including a broad spectrum of conditions. The few previous
studies that examined religious service attendance among children with chronic health conditions
tend to focus on just one or two chronic health conditions. There are virtually no studies that
consider children’s religiosity alongside conditions related to anxiety, learning disabilities, or
speech problems. Moreover, while a majority of the current literature on chronic health
conditions and religion focuses on older adults, it is vital that future research focus on children.
CHILDHOOD DISABILITY AND RELIGION
This is especially important given that some chronic health conditions among children, like
autism spectrum disorders, continue to grow in prevalence both in the United States and abroad
(Blumberg et al. 2013; Parner, Schendel, and Thorsen 2008). Increasing rates of prevalence will
have implications for places of worship as well as the families who are now faced with a
diagnosis of an autism spectrum disorder or some other health condition.
It is also important that future research on particular chronic health conditions consider
the possibility of multi-morbidity. Multi-morbidity of chronic health conditions limit functional
ability, constrain social participation, and decrease quality of life (Boyd and Fortin 2010; Griffith
et al. 2017; Marventano et al. 2014). However, much of this research focuses on the influence of
multi-morbidity within older adult populations. While an in-depth examination of each chronic
health condition and its co-morbidity with one or more other health conditions is beyond the
purview of this analysis, researchers could comprehensively examine each chronic health
condition and determine which specific ones are most likely to co-occur and if this influences the
ability of children to participate in religious services.
While children with chronic health conditions that are primarily physical in nature face
many difficulties in day-to-day life, the health conditions examined across the three waves of the
NSCH reveal no consistent associations with never attending religious services once various
controls are taken into account. Children with chronic asthma, diabetes, epilepsy, vision
problems, or hearing problems appear to never attend religious services at rates similar to
children with no health conditions. However, one particular chronic health condition that is
primarily physical – bone/joint/muscle problems – was significantly associated with never
attending. It could be that congregations are better at overcoming the barriers that might exclude
children with health conditions that are more physical in nature. It could also be that children
CHILDHOOD DISABILITY AND RELIGION
with chronic health conditions that are primarily physical do not exhibit behavioral
characteristics that might hinder their participation at religious services. A final explanation
might be that the collection of health conditions that are more physical in nature in the NSCH is
limited and a broader assortment might uncover consistent associations between chronic health
conditions that are primarily physical and religious service attendance.
Given the consistency with which children with chronic health conditions attend religious
services at lower rates, it is important to continue to explore not only why this is so, but the
consequences – both positive and negative – of these associations. There are a number of
possibilities. First, continuing to examine religious organizations for how they respond to
children with chronic health conditions and disabilities will uncover whether these lower rates of
attendance are a “supply-side” issue. It could be there are many families and children who would
like to attend religious services at least periodically throughout the year, but cannot find a
congregation in their religious tradition near them that will provide the necessary supports. The
similar findings since 2003 suggest that there have been no systemic changes made across
congregations to eliminate the barriers faced by children with a health condition. It is also
important to compare across religious traditions concerning congregational responses to children
with chronic health conditions and their families. Future analyses could draw on one aspect of
Carter’s (2007) attitudinal barriers. Such studies could examine how religious traditions and
congregations have different explanations about the causes and implications of children’s
chronic health conditions and the effects these have on children and their families. Are various
theodicies of disability or suffering influential in whether children with chronic health conditions
and their families attend?
CHILDHOOD DISABILITY AND RELIGION
Second, given the higher likelihood of children with chronic health conditions never
attending religious services, it is important to investigate how this influences the rest of the
family. Prior research shows that greater involvement in religious activities and organizations
can have a detrimental effect on the mental and emotional health of parents of children with
disabilities while private religiosity appears to be more beneficial (Ekas et al. 2009; Tarakeshwar
and Pargament 2001). Perhaps the families and parents of the children who never attend are
actually better off in some ways. There is evidence, though, that children with various chronic
health conditions and their families can benefit from religious service attendance (Abbotts et al.
2004; Ault 2010; Kleinert et al. 2007; Meltzer et al. 2011; Swinton 2001). The complex
influence of religious activity for children with chronic health conditions and their families
warrants further examination.
Ongoing investigations of religious socialization and the rise of the unaffiliated might
benefit from considering the influence of childhood chronic health conditions. The variation in
religious socialization across family types and the influence of family disruption is under
increased scrutiny (Denton 2012; Denton and Culver 2015; Petts 2015; Sullivan 2008; Zhai et al.
2007). However, the disruptions of divorce and alternative family structures on children’s
religious socialization receive the bulk of the attention. It is important to broaden the scope of
possible family disruptions. Chronic health conditions, especially within children, can be
significant family disruptions. Disability in children may also moderate the “upward influence”
children tend to have on parental and family religiosity. Given the congregational barriers
children with health conditions and their families face, it might be that caring for a child with a
chronic health condition significantly influences decisions to leave one’s faith. Regrettably, the
NSCH does not ask parents (or siblings) for their level of religious service attendance. This
CHILDHOOD DISABILITY AND RELIGION
analysis establishes that children with various chronic health conditions are much more likely to
never attend religious services. These findings are only suggestive, though, concerning whether
the rest of the family is more likely to never attend as well. If future studies were able to gather
data on parental, sibling, or familial religious service attendance alongside the children with
health conditions, various mechanisms of religious socialization and disengagement with
organized religion could be considered.
Future research should also begin to explore interactions across various socio-
demographic statuses and disability. Race, family structure, parental education, income, and
child’s age, to name a few, could possibly moderate the association between a number of these
chronic health conditions and never attending religious services.
Fifth, it is important to realize that while children with various chronic health conditions
are much more likely to never attend compared to their peers without a health condition, it does
not necessarily mean that these families or children are not religious in other ways. Gathering
data on the other avenues through which these families and children may be practicing their
religion would tell us much about lived religion and the ways in which religiosity can flourish
outside the walls of a church or synagogue (Bender et al. 2012). As congregations continue to
struggle to include children with chronic health conditions and their families into the life of the
organization, are the religious needs of families with a child with a chronic health condition
being met elsewhere or in other ways? How are these families creatively addressing the barriers
they face within organized religion?
Conclusion
Various chronic health conditions are significantly associated with children’s reported
religious service attendance. Across several waves of a nationally representative survey of
CHILDHOOD DISABILITY AND RELIGION
children, those with autism spectrum disorders, developmental delays, learning disabilities,
depression, anxiety, speech problems, and conduct disorders are consistently more likely to
never attend religious services. Religious organizations are yet another sector of social life within
which these children and perhaps their families struggle to integrate. Continuing to identify
where in society children with chronic health conditions face deficits in participation is vital.
While congregations influence more Americans than any other form of voluntary association
(Chaves 2011), it is apparent that children with chronic health conditions are not as actively
engaged as their counterparts who report no chronic health conditions. The decision for some of
these children to never attend may be made irrespective of their condition. For others, though,
the congregational and behavioral barriers are significant enough to make them much more
likely to never attend religious services. Social scientists, congregational leaders, and mental
health professionals interested in investigating and serving this population must continue to
explore not only who is least likely to attend but why.
CHILDHOOD DISABILITY AND RELIGION
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CHILDHOOD DISABILITY AND RELIGION
Table 1: Descriptive Statistics for National Survey of Children’s Health, 2003-2012
Description
2003
2007
2011-2012
Never Attend
1 = Never Attend
Religious Services
21.41
20.68
23.53
Age
In years, 0-17
8.61
8.57
8.59
Child’s Health
5 = Excellent
60.87
61.28
60.51
4 = Very Good
23.21
23.08
23.65
3 = Good
12.70
12.16
12.69
2 = Fair
2.85
3.03
2.73
1 = Poor
.37
.45
.43
White†
1 = White, non-Hispanic
60.74
56.20
52.91
Hispanic
1 = Hispanic
17.57
20.48
23.48
Black
1 = Black, non-Hispanic
14.39
14.22
13.64
Multiple race/Other
race
1 = Multiple race or
Other race
7.29
9.10
10.34
Female
1 = Child is Female
48.88
48.87
48.85
Total children in
home
1 = 1 Child to 4 = 4 or
more Children
2.32
2.26
2.27
Biological/Adoptive
Parents†
1 = Two Biological/
Adoptive Parents
61.87
67.79
64.63
Step-Parents
1 = Two Parent
Stepfamily
8.34
7.60
8.64
Single Mother
1 = Single Mother, no
Father Present
22.83
18.71
18.68
Other Type
1 = Other family type
4.34
5.90
6.60
Parents’ Income
4 = 400% or more FPL
26.68
29.34
27.82
3 = 200-399% FPL
32.63
31.10
28.19
2 = 100-199% FPL
22.84
20.99
21.54
1 = <100% FPL to
17.85
18.57
22.45
Parents’ Education
3 = More than HS
65.70
52.46
53.58
2 = HS Grad
26.45
30.68
27.61
1 = Less than HS
7.86
16.86
18.80
Urban
1 = Urban
77.37
81.29
79.71
Northeast
1 = Northeast
17.77
17.16
16.76
Midwest
1 = Midwest
22.39
21.90
21.57
South†
1 = South
35.94
36.76
37.44
West
1 = West
23.90
24.18
24.26
Survey year
Total N
102,353
91,642
95,677
Note: Weighted data
†Contrast category
Table 2: Prevalence of Chronic Health Conditions among US Children and Percent of Children with Each Chronic Health Condition Who Report Never
Attending Religious Services, 2003-2012 (Percentages)
Condition
Description
Prevalence Rates
(Percent)
Percent of Children Who Never Attend
Religious Services
2003
2007
2011-2012
2003
2007
2011-2012
Children w/ No Condition
Child (0-17) has no condition
73.39
77.54
76.66ᵃᵇ
22.46
20.87
24.36ᵃᵇ
Autism Spectrum Disorder
Child (2-17) currently has
ASD
.54
1.12
1.90ᵃᵇ
35.79ᶜ
32.72ᶜ
32.10ᶜ
Attention Deficit
Disorder/Attention Deficit
Hyperactivity Disorder
Child (2-17) currently has
ADD or ADHD
7.27
6.73
7.92ᵃᵇ
24.43ᶜ
19.97ᶜ
23.56ᶜ
Developmental Delay
Child (2-17) currently has a
Developmental Delay
3.77
2.99
3.64ᵃ
26.01ᶜ
27.01ᶜ
29.25ᵇᶜ
Learning Disability
Child (3-17) currently has a
Learning Disability
9.71
7.50
7.84ᵃᵇ
25.69ᶜ
22.72ᶜ
27.09ᵃᶜ
Oppositional Defiant
Disorder/Conduct Disorder
Child (2-17) currently has
ODD
4.88
2.91
2.84ᵇ
29.51ᶜ
25.86ᶜ
29.19ᵃᶜ
Asthma
Child (0-17) currently has
Asthma
11.95
8.67
8.62ᵇ
21.60
18.84
20.89ᵃ
Diabetes
Child (0-17) currently has
Diabetes
.34
.39
.39
21.71
19.60ᵈ
23.18
Bone/Joint/Muscle Problems
Child (0-17) currently has
bone, joint, or muscle
problems
3.47
2.30
2.36ᵇ
22.98
20.98
23.65ᵃᵈ
Depression
Child (2-17) currently has
Depression
---
2.06
2.08
---
27.40ᶜ
29.92ᶜ
Anxiety
Child (2-17) currently has
Anxiety
---
3.26
3.84ᵃ
---
25.26ᶜ
27.71ᵃᶜ
Speech Problems
Child (2-17) currently has
stuttering, stammering, or
other speech problems
---
3.28
4.54ᵃ
---
25.04ᶜ
29.75ᵃᶜ
Tourette Syndrome
Child (2-17) currently has
Tourette Syndrome
---
.18
.19
---
22.60
22.93
Brain Injury
Child (0-17) currently has a
brain injury or concussion
---
.28
.34ᵃ
---
26.21
30.98ᶜ
Epilepsy
Child (0-17) currently has
Epilepsy
---
.57
.64
---
23.90
27.14
Hearing Problems
Child (0-17) currently has
Hearing Problems
---
1.34
1.28
---
21.15
25.98ᵃᶜ
CHILDHOOD DISABILITY AND RELIGION
Vision Problems
Child (0-17) currently has
vision problems that cannot be
corrected with glasses/contact
lenses
---
1.13
1.30ᵃ
---
20.64
26.09ᵃ
Intellectual Disability
Child (2-17) currently has an
Intellectual Disability
---
---
1.06
---
---
26.13
Cerebral Palsy
Child (0-17) currently has
Cerebral Palsy
---
---
.22
---
---
25.57
Hearing or Vision Problems
Child (0-17) currently has
Hearing or Vision Problems
that cannot be corrected with
glasses/contact lenses
2.47
---
---
21.84
---
---
Depression or Anxiety
Child (2-17) currently has
Depression or Anxiety
4.18
---
---
29.16ᶜ
---
---
Sources: 2003, 2007, 2011-2012 NSCH (Weighted data)
ᵃSignificant difference compared to 2007 (p<.05).
ᵇSignificant difference compared to 2003 (p<.05).
ᶜPercent is significantly higher than children with no reported chronic health conditions in that survey year (p<.05).
ᵈPercent is significantly lower than children with no reported chronic health conditions in that survey year (p<.05).
Table 3: Logistic Regression Models of Children’s Chronic Health Conditions and Never
Attending Religious Services (2011-2012, 2007, and 2003 NSCH - Weighted)
Condition Present
Condition Absent –
Other Condition(s)
Present
b
OR
N
No condition
-.127***
.881
---
---
273,528ᵃ
Autism Spectrum Disorder
.610***
1.841
.131***
1.139
243,346ᵃ
ADD/ADHD
.177***
1.193
.140***
1.150
242,808ᵃ
Developmental Delay
.310***
1.363
.130***
1.139
243,283ᵃ
Learning Disability
.311***
1.364
.099**
1.104
230,834ᵃ
Oppositional Defiant
Disorder/Conduct Disorder
.436***
1.546
.106***
1.112
243,433ᵃ
Asthma
.022
---
.194***
1.214
272,924ᵃ
Diabetes
-.012
---
.129***
1.137
273,383ᵃ
Bone/Joint/Muscle Problems
.142*
1.153
.125***
1.133
273,253ᵃ
Depression
.546***
1.727
.129***
1.137
162,319ᵇ
Anxiety
.370***
1.447
.136***
1.145
162,305ᵇ
Speech Problems
.351***
1.421
.116**
1.124
162,405ᵇ
Tourette Syndrome
.055
---
.162***
1.176
162,447ᵇ
Brain Injury
.534*
1.705
.128***
1.137
181,527ᵇ
Epilepsy
.141
---
.134***
1.143
181,547ᵇ
Hearing Problems
.132
---
.131***
1.140
181,439ᵇ
Vision Problems
.180
---
.132***
1.141
181,398ᵇ
Intellectual Disability
.360
---
.141**
1.151
82,640ᶜ
Cerebral Palsy
.215
---
.147**
1.158
82,681ᶜ
Hearing or Vision Problems
-.126
---
.124***
1.132
91,784ᵈ
Depression or Anxiety
.419***
1.521
.077*
1.080
81,015ᵈ
*p<0.05; **p<0.01; ***p<0.001
ᵃ2011-2012, 2007, 2003 NSCH
ᵇ2011-2012, 2007 NSCH
ᶜ2011-2012 NSCH
ᵈ2003 NSCH
Note: Every row represents a separate binary logistic regression model. No Condition(s) Present is the
contrast category to which each column, Condition Present and Condition Absent – Other Condition(s)
Present, is compared. The first row (“No condition”), however, compares all children with no reported
chronic health conditions to all children who report a chronic health condition. Each model controls for
child’s age, child’s health, white (contrast), Hispanic, black, multiple/other race, female,
biological/adoptive parents (contrast), step-parents, single mother, other type, parents’ income, parents’
education, urban, Northeast, Midwest, South (contrast), West, and survey year (where applicable).
CHILDHOOD DISABILITY AND RELIGION
Supplementary Table 1: Logistic Regression Models of 18 Children’s Chronic Health
Conditions and Never Attending Religious Services (2011-2012 NSCH - Weighted)
Condition Present
Condition Absent –
Other Condition(s)
Present
b
OR
N
No condition
-.125**
0.883
---
---
92,408
Autism Spectrum Disorder
.567***
1.763
.116*
1.123
82,574
ADD/ADHD
.057
---
.173***
1.189
82,426
Developmental Delay
.323**
1.381
.119*
1.126
82,583
Learning Disability
.316***
1.371
.069
---
78,533
Depression
.523***
1.687
.112*
1.119
82,604
Anxiety
.379***
1.461
.114*
1.121
82,593
Oppositional Defiant
Disorder/Conduct Disorder
.391***
1.479
.115*
1.122
82,620
Intellectual Disability
.360
---
.141**
1.151
82,640
Cerebral Palsy
.215
---
.147**
1.158
82,681
Speech Problems
.468***
1.597
.062
---
82,633
Tourette Syndrome
-.153
---
.145**
1.157
82,654
Asthma
.049
---
.167**
1.181
92,216
Diabetes
.308
---
.123**
1.131
92,374
Epilepsy
.074
---
.126**
1.134
92,365
Hearing Problems
.377**
1.458
.108*
1.114
92,322
Vision Problems
.277
---
.117**
1.124
92,293
Bone/Joint/Muscle Problems
-.024
---
.137**
1.146
92,314
Brain Injury
.723**
2.060
.116**
1.123
92,359
*p<0.05; **p<0.01; ***p<0.001
Note: Every row represents a separate binary logistic regression model. No Condition(s) Present is the
contrast category to which each column, Condition Present and Condition Absent – Other Condition(s)
Present, is compared. The first row (“No condition”), however, compares all children with no reported
chronic health conditions to all children who report a chronic health condition. Each model controls for
child’s age, child’s health, white (contrast), Hispanic, black, multiple/other race, female, total children
in home, biological/adoptive parents (contrast), step-parents, single mother, other type, parents’
income, parents’ education, urban, Northeast, Midwest, South (contrast), West.
CHILDHOOD DISABILITY AND RELIGION
Supplementary Table 2: Logistic Regression Models of 16 Children’s Chronic Health
Conditions and Never Attending Religious Services (2007 NSCH - Weighted)
Condition Present
Condition Absent –
Other Condition(s)
Present
b
OR
b
OR
N
No condition
-.149**
0.861
---
---
89,226
Autism Spectrum Disorder
.645***
1.905
.158**
1.171
79,710
ADD/ADHD
.297**
1.346
.131
1.140
79,529
Developmental Delay
.435**
1.545
.145*
1.156
79,654
Learning Disability
.300*
1.349
.157*
1.169
75,669
Depression
.573***
1.773
.150*
1.162
79,715
Anxiety
.333**
1.395
.166**
1.180
79,712
Oppositional Defiant
Disorder/Conduct Disorder
.490***
1.633
.134*
1.144
79,743
Speech Problems
.233*
1.263
.170**
1.185
79,772
Tourette Syndrome
.186
---
.184**
1.201
79,793
Asthma
.020
---
.228***
1.256
88,995
Diabetes
-.194
---
.153**
1.166
89,173
Epilepsy
.220
---
.149**
1.161
89,182
Hearing Problems
-.127
---
.162**
1.176
89,117
Vision Problems
.034
---
.156**
1.169
89,105
Bone/Joint/Muscle Problems
.232
---
.140*
1.150
89,137
Brain Injury
.381
---
.148**
1.160
89,168
*p<0.05; **p<0.01; ***p<0.001
Note: Every row represents a separate binary logistic regression model. No Condition(s) Present is the
contrast category to which each column, Condition Present and Condition Absent – Other Condition(s)
Present, is compared. The first row (“No condition”), however, compares all children with no reported
chronic health conditions to all children who report a chronic health condition. Each model controls for
child’s age, child’s health, white (contrast), Hispanic, black, multiple/other race, female, total children
in home, biological/adoptive parents (contrast), step-parents, single mother, other type, parents’
income, parents’ education, urban, Northeast, Midwest, South (contrast), West.
CHILDHOOD DISABILITY AND RELIGION
Supplementary Table 3: Logistic Regression Models of 10 Children’s Chronic Health
Conditions and Never Attending Religious Services (2003 NSCH - Weighted)
Condition Present
Condition Absent –
Other Condition(s)
Present
b
OR
b
OR
N
No condition
-.102**
0.903
---
---
91,894
Autism Spectrum Disorder
.784***
2.191
.109**
1.116
81,062
ADD/ADHD
.222***
1.248
.100*
1.105
80,853
Developmental Delay
.164*
1.178
.118**
1.125
81,046
Learning Disability
.273***
1.314
.079
---
76,632
Depression or Anxiety
.419***
1.521
.077*
1.080
81,015
Oppositional Defiant
Disorder/Conduct Disorder
.424***
1.528
.058
---
81,070
Asthma
-.015
---
.198***
1.219
91,713
Diabetes
-.158
---
.106**
1.111
91,836
Hearing or Vision Problems
-.126
---
.124***
1.132
91,784
Bone/Joint/Muscle Problems
.167*
1.182
.097**
1.102
91,802
*p<0.05; **p<0.01; ***p<0.001
Note: Every row represents a separate binary logistic regression model. No Condition(s) Present is the
contrast category to which each column, Condition Present and Condition Absent – Other Condition(s)
Present, is compared. The first row (“No condition”), however, compares all children with no reported
chronic health conditions to all children who report a chronic health condition. Each model controls for
child’s age, child’s health, white (contrast), Hispanic, black, multiple/other race, female, total children
in home, biological/adoptive parents (contrast), step-parents, single mother, other type, parents’
income, parents’ education, urban, Northeast, Midwest, South (contrast), West.
