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The Health and Economic Well-Being of US Mothers with Intellectual Impairments

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Title: The Health and Economic Well-Being of US Mothers with Intellectual Impairments
Language: English
Authors: Powell, Robyn M. (ORCID 0000-0001-7898-2268), Parish, Susan L., Akobirshoev, Ilhom
Source: Journal of Applied Research in Intellectual Disabilities. May 2017 30(3):456-468.
Availability: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA
Peer Reviewed: Y
Page Count: 13
Publication Date: 2017
Document Type: Journal Articles
Reports - Research
Descriptors: Health, Well Being, Mothers, Toddlers, Intellectual Disability, Poverty, Public Policy, Health Needs, Economic Factors, Disabilities, Parent Child Relationship, Welfare Services
DOI: 10.1111/jar.12308
ISSN: 1360-2322
Abstract: Background: While the United States has seen increased attention by policymakers on the rights of parents with disabilities, there is limited understanding of the health and economic well-being of parents with intellectual impairments. This study compares the health and economic well-being of mothers with and without intellectual impairments. Methods: This descriptive, exploratory study is a secondary analysis of the Fragile Families and Child Wellbeing Study. This study includes a subsample of mothers of three-year-old children (n = 1561), including mothers with intellectual impairments (n = 263) and without intellectual impairments (n = 1298). Results: US Mothers with intellectual impairments are more likely to report serious health conditions, have less instrumental support, live in poverty, receive public benefits and experience certain material hardships. Conclusion: Findings from this study indicate the need for policies and programmes to support parents with intellectual impairments by addressing their health and economic needs.
Abstractor: As Provided
Entry Date: 2017
Accession Number: EJ1137032
Database: ERIC
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  Value: <anid>AN0122405678;e0301may.17;2018Jul02.12:39;v2.2.500</anid> <title id="AN0122405678-1">The Health and Economic Well-Being of US Mothers with Intellectual Impairments. </title> <p>Background: While the United States has seen increased attention by policymakers on the rights of parents with disabilities, there is limited understanding of the health and economic well‐being of parents with intellectual impairments. This study compares the health and economic well‐being of mothers with and without intellectual impairments. Methods: This descriptive, exploratory study is a secondary analysis of the Fragile Families and Child Wellbeing Study. This study includes a subsample of mothers of three‐year‐old children (n = 1561), including mothers with intellectual impairments (n = 263) and without intellectual impairments (n = 1298). Results: US Mothers with intellectual impairments are more likely to report serious health conditions, have less instrumental support, live in poverty, receive public benefits and experience certain material hardships. Conclusion: Findings from this study indicate the need for policies and programmes to support parents with intellectual impairments by addressing their health and economic needs.</p> <p>economic well‐being; Fragile Families and Child Wellbeing Study; health; income; parents with intellectual impairments</p> <p>Despite increased attention by US policymakers on the rights of parents with intellectual impairments and their children (e.g. National Council on Disability [<reflink idref="bib57" id="ref1">57</reflink>] ), particularly in relation to their disproportionate involvement with the child welfare system (LaLiberte & Lightfoot [<reflink idref="bib41" id="ref2">41</reflink>] ; Lightfoot & Slayter [<reflink idref="bib47" id="ref3">47</reflink>] ; Lightfoot & DeZalar [<reflink idref="bib44" id="ref4">44</reflink>] ), there is still very limited knowledge of the health and economic well‐being of these parents. The extant research suggests families headed by parents with intellectual impairments experience disparities related to poor health, lack of social supports and low socio‐economic status (International Association for the Scientific Study of Intellectual Disabilities, Special Interest Research Group [IASSID SIRG] on Parents and Parenting with Intellectual Disabilities [<reflink idref="bib38" id="ref5">38</reflink>] ). Nonetheless, the existing research has mostly been conducted outside of the United States in the UK, Canada and Australia. Hence, there is an urgent need for empirical research on US parents with intellectual impairments so that appropriate supports and policies can be implemented.</p> <p>Past studies have found that mothers with intellectual impairments experience poorer physical health compared to other mothers (Aunos et al. [<reflink idref="bib4" id="ref6">4</reflink>] ; Emerson et al. [<reflink idref="bib27" id="ref7">27</reflink>] ). Mothers with intellectual impairments also have heightened rates of mental health disorders (McGaw et al. [<reflink idref="bib52" id="ref8">52</reflink>] ; Aunos et al. [<reflink idref="bib4" id="ref9">4</reflink>] ; O'Keeffe & O'Hara [<reflink idref="bib58" id="ref10">58</reflink>] ; Darbyshire & Stenfert Kroese [<reflink idref="bib21" id="ref11">21</reflink>] ; Emerson & Brigham [<reflink idref="bib25" id="ref12">25</reflink>] ; Emerson et al. [<reflink idref="bib27" id="ref13">27</reflink>] ). Likewise, newborns and infants born to mothers with impairments also experience worse health outcomes, particularly during birth (McConnell et al. [<reflink idref="bib50" id="ref14">50</reflink>] ; Höglund et al. [<reflink idref="bib37" id="ref15">37</reflink>] ; Hindmarsh et al. [<reflink idref="bib36" id="ref16">36</reflink>] ; Parish et al. [<reflink idref="bib61" id="ref17">61</reflink>] ).</p> <p>Researchers have also examined the social context in which mothers with intellectual impairments and their children live. These families have high rates of poverty and material hardships, low educational attainment and employment, and are more likely to be single parents compared to other parents (Höglund et al. [<reflink idref="bib37" id="ref18">37</reflink>] ; Emerson & Brigham [<reflink idref="bib25" id="ref19">25</reflink>] ; Hindmarsh et al. [<reflink idref="bib36" id="ref20">36</reflink>] ). Additionally, mothers with intellectual impairments experience elevated rates of stress and limited social supports (McGaw et al. [<reflink idref="bib52" id="ref21">52</reflink>] ; Aunos et al. [<reflink idref="bib4" id="ref22">4</reflink>] ; McConnell et al. [<reflink idref="bib51" id="ref23">51</reflink>] ; Darbyshire & Stenfert Kroese [<reflink idref="bib21" id="ref24">21</reflink>] ; Feldman et al. [<reflink idref="bib31" id="ref25">31</reflink>] ; Emerson & Brigham [<reflink idref="bib26" id="ref26">26</reflink>] ; Meppelder et al. [<reflink idref="bib54" id="ref27">54</reflink>] ).</p> <p>Although there is a general understanding of how these families fare, particularly with respect to health and economic well‐being, the existing studies have important limitations. Most of the existing research has been conducted with smaller samples usually drawn from clinical or child welfare populations (e.g. Aunos et al. [<reflink idref="bib3" id="ref28">3</reflink>] , [<reflink idref="bib4" id="ref29">4</reflink>] ; Booth & Booth [<reflink idref="bib13" id="ref30">13</reflink>] ; Booth et al. [<reflink idref="bib14" id="ref31">14</reflink>] ; McGaw et al. [<reflink idref="bib52" id="ref32">52</reflink>] , [<reflink idref="bib53" id="ref33">53</reflink>] ; Feldman et al. [<reflink idref="bib31" id="ref34">31</reflink>] ; Granqvist et al. [<reflink idref="bib32" id="ref35">32</reflink>] Meppelder et al. [<reflink idref="bib54" id="ref36">54</reflink>] ), and few studies have used population‐based samples (e.g. Emerson & Brigham [<reflink idref="bib25" id="ref37">25</reflink>] , [<reflink idref="bib26" id="ref38">26</reflink>] ; Hindmarsh et al. [<reflink idref="bib36" id="ref39">36</reflink>] ). Thus, the lack of robust population‐based data about parents with intellectual impairments is a significant concern (Llewellyn & Hindmarsh [<reflink idref="bib48" id="ref40">48</reflink>] ). Indeed, without population‐based data, generalizability, a fair examination of differences between these parents and others, and hypothesis testing on key variables cannot occur.</p> <p>The aim of this study was to describe and compare the health and economic well‐being of US mothers with and without intellectual impairments who have young children. Health and economic well‐being were chosen as outcomes because both impact parenting capabilities in mothers with and without intellectual impairments. To conduct this study, we analysed data on mothers of 3‐year‐old children using a large population‐based data set, the Fragile Families and Child Wellbeing Study (hereafter, Fragile Families). The study's overarching research question was as follows: Does health and economic well‐being differ for US mothers with and without intellectual impairments?</p> <hd id="AN0122405678-2">Methods</hd> <hd id="AN0122405678-3">Data source</hd> <p>This study is a secondary analysis of publicly available data from Fragile Families, a longitudinal study of 4898 births that occurred in US cities between 1998 and 2000 (Reichman et al. [<reflink idref="bib64" id="ref41">64</reflink>] ; Brooks‐Gunn et al. [<reflink idref="bib15" id="ref42">15</reflink>] ). Fragile Families was designed to provide longitudinal information about new parents and their biological children in urban areas. It offers rich data on family socio‐economic and demographic characteristics, parent and child physical and psychological health, child developmental outcomes and parent–child relationships (Reichman et al. [<reflink idref="bib64" id="ref43">64</reflink>] ).</p> <p>Employing stratified random sampling, data were collected from families living in 16 US cities with populations over 200 000 (Reichman et al. [<reflink idref="bib64" id="ref44">64</reflink>] ). Four additional large cities were sampled based on funders' interest. Due to some hospitals' Institutional Review Board restrictions, the majority of the parents who were interviewed were 18 years and older at the time of the focal child's birth. Additionally, mothers who intended to place their child for adoption, those for whom the baby's father was not alive at the time of the birth, those who could not speak English or Spanish well enough to complete the interview and those who were seriously ill following their child's birth were excluded (Reichman et al. [<reflink idref="bib64" id="ref45">64</reflink>] ). When weighted, Fragile Families is representative of all mothers who gave birth in large US cities (cities with populations over 200 000) between 1998 and 2000 (Reichman et al. [<reflink idref="bib64" id="ref46">64</reflink>] ; Bendheim‐Thoman Center for Research on Child Wellbeing [<reflink idref="bib6" id="ref47">6</reflink>] ).</p> <p>Fragile Families currently includes six waves (Bendheim‐Thoman Center for Research on Child Wellbeing [<reflink idref="bib8" id="ref48">8</reflink>] ). Baseline interviews were conducted shortly following the focal child's birth. Follow‐up interviews were conducted when the focal child was approximately one, three, five and nine years of age. In 2014, researchers began the sixth wave of data collection (age 15). Comprehensive information about the Fragile Families' design and sample is available elsewhere (Reichman et al. [<reflink idref="bib64" id="ref49">64</reflink>] ). This study analysed data from the baseline and child's age‐three data collection waves. During the age‐three data collection wave, trained interviewers completed in‐home assessments. All data were collected verbally.</p> <hd id="AN0122405678-4">Sample</hd> <p>This study draws on a subsample of mothers of young children from the Fragile Families (n = 1561), including mothers with intellectual impairments (n = 263) and without intellectual impairments (n = 1298). This study analyses data from the baseline survey as well as the follow‐up interview conducted when the focal child was age 3. As discussed below, identification of maternal intellectual impairments was based on the mother's performance on the Peabody Picture Vocabulary Test‐Revised edition (PPVT‐R), which was conducted during the three‐year assessment. Hence, we excluded mothers who did not take the PPVT‐R. In addition, because the PPVT‐R was only conducted in English, this study's sample excluded mothers who did not speak English well enough to complete the instrument. Moreover, we weighted the data so that it is nationally representative of mothers in large cities. Thus, we excluded respondents who were not in the national sample (Bendheim‐Thoman Center for Research on Child Wellbeing [<reflink idref="bib7" id="ref50">7</reflink>] ).</p> <hd id="AN0122405678-5">Measures</hd> <hd id="AN0122405678-6">Intellectual impairment</hd> <p>We identified mothers with intellectual impairments based on their PPVT‐R performance. The PPVT‐R is a widely‐used, reliable assessment of receptive vocabulary among people with intellectual impairments (Dunn & Dunn [<reflink idref="bib24" id="ref51">24</reflink>] ), and tests of its validity indicate that PPVT‐R scores are highly correlated with IQ test scores (Naglieri [<reflink idref="bib55" id="ref52">55</reflink>] ; Naglieri & Pfeiffer [<reflink idref="bib56" id="ref53">56</reflink>] ; Prout & Schwartz [<reflink idref="bib62" id="ref54">62</reflink>] ; Bell et al. [<reflink idref="bib5" id="ref55">5</reflink>] ; Dickson et al. [<reflink idref="bib22" id="ref56">22</reflink>] ). For this study, mothers with a PPVT‐R score below 80 were determined to have intellectual impairments; mothers above this cut‐off were determined not to have intellectual impairments. Several past studies concerning parents with intellectual impairments have included parents with IQ scores marginally above 70, the traditional cut‐off for an intellectual disability diagnosis (e.g. Feldman et al. [<reflink idref="bib31" id="ref57">31</reflink>] ). For example, Meppelder et al. ([<reflink idref="bib54" id="ref58">54</reflink>] ) used an IQ cut‐off of 85 and McGaw et al. ([<reflink idref="bib52" id="ref59">52</reflink>] ) included parents with IQs below 80. As most parents with intellectual impairments labels have mild to borderline cognitive impairments (IASSID Special Interest Research Group on Parents and Parenting with Intellectual Disabilities [<reflink idref="bib38" id="ref60">38</reflink>] ), using a cut‐off point of 80 to define parents with intellectual impairments is appropriate.</p> <hd id="AN0122405678-7">Socio‐demographics</hd> <p>This study included numerous descriptive variables. Mother's race or ethnicity was measured with categories for Non‐Hispanic Black; Non‐Hispanic White; Hispanic; and Non‐Hispanic Other. We constructed a binary variable to measure whether the mother was married to the focal child's biological father during the age‐three wave. Mother's age at the time of the focal child's birth was measured in years. Mother's education at the focal child's birth was measured with four categories: less than a high school diploma; high school diploma or general equivalency degree (GED); some college or technical school; or a college degree or more. We constructed a variable to measure the mother's insurance status when the child was three years old with categories for private, Medicaid and uninsured.</p> <p>Consistent with previous studies (e.g. Page et al. [<reflink idref="bib59" id="ref61">59</reflink>] ), we constructed a binary measure of high parenting stress that identified mothers who reported that they ‘strongly agree’ that being a parent is harder than they thought it would be; they feel trapped by their responsibilities as a parent; they find that taking care of their children is much more work than pleasure; or they often feel tired, worn out, or exhausted from raising a family. Two of the four items were drawn from the well‐established, validated Parenting Stress Index (Abidin [<reflink idref="bib1" id="ref62">1</reflink>] ), which has also been used in prior studies to examine parenting stress among mothers with intellectual impairments (e.g. Feldman et al. [<reflink idref="bib30" id="ref63">30</reflink>] ; Aunos et al. [<reflink idref="bib4" id="ref64">4</reflink>] ).</p> <p>Lastly, similar to prior studies, we included two measures of social support, instrumental and partner support, which were assessed during the age‐three wave (e.g. Manuel et al. [<reflink idref="bib49" id="ref65">49</reflink>] ). We measured instrumental support using an index of summed responses to items about the mothers' perception of whether her social networks would provide support across three dimensions (financial, housing and childcare) if needed. We used three dichotomous social support items to generate the scale: During the next year, if you needed help, could you count on someone (i) to loan you $200? (ii) to provide a place to live? or (iii) to help with emergency childcare? Items were summed to an index, ranging from 0 (no perceived supports) to 3 (all perceived supports), with higher scores indicating greater instrumental support. Partner support was measured based on the mother's response to six items covering the quality of the relationship between mothers and their children's birth fathers (including single mothers or those still married, cohabiting or romantically involved with the birth father) or current partner. Mothers were asked how frequently the birth partner or their current partner (i) ‘is fair and willing to compromise when you have a disagreement’, (ii) ‘expresses affection or love for you’, (iii) ‘insults or criticizes you or your ideas’, (iv) ‘encourages or helps you to do things that are important to you’, (v) ‘listens to you when you need someone to talk to’ and (vi) ‘really understands your hurts and joys’. The response options for each individual item ranged from never (i) to often (iii). We reverse coded each of these, except for the third one, so that higher scores indicate a more supportive relationship. The items were averaged to obtain an overall partner support score. Past studies have used similar outcomes to measure social support (Ciabattari [<reflink idref="bib18" id="ref66">18</reflink>] ; Harknett & Knab [<reflink idref="bib34" id="ref67">34</reflink>] ).</p> <hd id="AN0122405678-8">Health outcomes</hd> <p>This study examined eight outcomes related to mothers' physical and emotional health. Overall health was measured based on the mothers' rating of their health status (poor, fair, good, very good or excellent). We collapsed these response categories into a single binary variable (poor or fair versus good, very good or excellent). Self‐reported health status is a reliably robust predictor of actual health status (Benyamini & Idler [<reflink idref="bib9" id="ref68">9</reflink>] ; Idler & Benyamini [<reflink idref="bib39" id="ref69">39</reflink>] ). Self‐reported health status has also been used in previous studies to examine the health of mothers with intellectual impairments (e.g. Hindmarsh et al. [<reflink idref="bib36" id="ref70">36</reflink>] ). During the three‐year in‐home assessments, a trained interviewer measured and weighed the mothers. A mother with a body mass index (BMI) at or above 25 was considered overweight or obese, in accordance with the Centers for Disease Control and Prevention guidelines. BMI has been identified as a key indicator of health for adults with intellectual impairments (Van Schrojenstein Lantman‐de Valk et al. [<reflink idref="bib69" id="ref71">69</reflink>] ). In addition, single binary variables measured whether the mother had been hospitalized or visited the emergency room within the past year; whether she had a serious physical or mental condition that limited her ability to work; whether she regularly took medication for any physical or mental problems; or whether she smoked cigarettes in the past month.</p> <p>This study examined two indicators of mothers' emotional health. Major depression and generalized anxiety disorder were binary variables measured by assessments using the Composite International Diagnostic Interview (CIDI), a standardized instrument for assessment of mental disorders (World Health Organization [<reflink idref="bib77" id="ref72">77</reflink>] ). The CIDI questions were part of the three‐year survey, and the mother's responses were scored according to the definitions and criteria of the International Statistical Classification of Diseases and Related Health Problems, tenth edition (ICD‐10; World Health Organization [<reflink idref="bib76" id="ref73">76</reflink>] ) and the Diagnostic and Statistical Manual, fourth edition (DSM‐IV; American Psychiatric Association [<reflink idref="bib2" id="ref74">2</reflink>] ). Such measures have been used in previous studies to measure major depression and generalized anxiety disorder among adults with intellectual impairments (e.g. White et al. [<reflink idref="bib74" id="ref75">74</reflink>] ).</p> <hd id="AN0122405678-9">Economic outcomes</hd> <p>This study investigated six indicators of economic well‐being. First, we constructed a variable to measure family income when the focal child was three years old (<99% of the federal poverty level, between 100% and 199% of the federal poverty level and below 200% of the federal poverty level). Mother's employment status was based on a binary variable indicating whether she had worked for pay in the last week. Next, binary variables measured whether the mother had received public benefits vis‐à‐vis Temporary Assistance to Needy Families (welfare), Food Stamps/Supplemental Nutrition Assistance Program,[<reflink idref="bib1" id="ref76">1</reflink>] Supplemental Nutrition Program for Women, Infants and Children,[<reflink idref="bib2" id="ref77">2</reflink>] or Supplemental Security Income[<reflink idref="bib3" id="ref78">3</reflink>] within the past year. Thereafter, consistent with prior studies (e.g. Heflin & Iceland [<reflink idref="bib35" id="ref79">35</reflink>] ), we constructed binary variables to measure whether or not the mother had experienced material hardships in the past 12 months, based on receipt of free food or meals; difficulty paying bills; lack of medical care, disconnected telephone or unstable housing. In addition, we constructed a categorical variable to measure how many material hardships were experienced (none; one; two; or three or more). Finally, our measure of food insecurity was based on the 10 household‐ and adult‐referenced questions in the US Household Food Security Survey Module (Bickel et al. [<reflink idref="bib14" id="ref80">14</reflink>] ; Carlson [<reflink idref="bib16" id="ref81">16</reflink>] ). The items ask about the prior year and assess food security along a continuum by asking about a range of conditions and behaviours experienced when the quality or amount of available food is inhibited as a result of lack of money or other resources. Consistent with prior studies, mothers with three or more positive items were considered ‘food insecure’ (Whitaker et al. [<reflink idref="bib73" id="ref82">73</reflink>] ). Notably, existing studies have used similar self‐reported items to measure material hardship among mothers with intellectual impairments (e.g. Emerson & Brigham [<reflink idref="bib25" id="ref83">25</reflink>] ; Wade et al. [<reflink idref="bib71" id="ref84">71</reflink>] ).</p> <hd id="AN0122405678-10">Analytic strategy</hd> <p>Descriptive statistical analyses characterize the sample of US mothers with and without intellectual impairments. For continuous variables, independent sample t‐tests compared each sample on the means of characteristics. For dichotomous variables, the Pearson Chi‐squared statistic was corrected for the survey design with the second‐order correction of Rao & Scott ([<reflink idref="bib63" id="ref85">63</reflink>] ) and converted into an F statistic to obtain a proper P value from the design‐based F statistic. In addition, magnitude of effects for analyses were assessed for bivariate analysis using Cohen's effect size guidelines, such that odds ratios of 1.44, 2.47, and 4.25 and Cohen's d of 0.2, 0.5, and 0.8, indicate small, medium and large effects, respectively (Cohen [<reflink idref="bib19" id="ref86">19</reflink>] , [<reflink idref="bib20" id="ref87">20</reflink>] ). Data were cleaned and analysed using Stata/SE 14.0 for Mac (Stata Corporation, College Station, TX, USA).</p> <p>We used the Fragile Families weights to make the sample nationally representative of all mothers who gave birth in large US cities (cities with populations over 200 000) between 1998 and 2000. Jackknifing, a replication sampling variance estimation technique was applied using a set of replicate weights to estimate variance (Wolter [<reflink idref="bib75" id="ref88">75</reflink>] ). Replicate weights are a series of variables that contain the information necessary for correctly computing the standard errors of point estimates when analysing complex survey data. The replicate weights in Fragile Families account for the strata and the differential sampling rates characteristic of the primary sampling unit (Carlson [<reflink idref="bib16" id="ref89">16</reflink>] ).</p> <hd id="AN0122405678-11">Results</hd> <p>Table [NaN] describes the sample and provides weighted statistics comparing mothers with and without intellectual impairments. Statistically significant differences in race and ethnicity with small effect sizes were found between mothers with and without intellectual impairments (F = 4.36, P < 0.001). Mothers with intellectual impairments were more likely to identify as Non‐Hispanic Black (46.2% versus 24.1%, OR = 2.06) or Hispanic (40.2% versus 24.5%, OR = 1.48). Mothers with intellectual impairments were also significantly less likely to be married to the focal child's birth father when the child was three years old (31.7% versus 59.7%, F = 5.42, P < 0.5, OR = 0.43). Statistically significant differences in educational attainment also existed between mothers with and without intellectual impairments (F = 17.24, P < 0.001). Mothers with intellectual impairments were significantly more likely, with a medium effect size, not to graduate high school (55.5% versus 20.0%, OR = 3.51) and less likely to attend some college (6.4% versus 31.7%, OR = 0.26) or earn a college degree (1.4% versus 23.7%, OR = 0.22). Statistically significant differences also existed with respect to mothers' health insurance status (F = 4.17, P < 0.05). Mothers with intellectual impairments were more likely, with a medium effect size, to receive Medicaid (57.2% versus 29.8%, OR = 2.95) and less likely to have private insurance (36.5% versus 62.3) or be uninsured (6.3% versus 7.9%). In comparison to other mothers, those with intellectual impairments were significantly younger at the time they gave birth to the focal child (M = 24.7 versus M = 27.1, P < 0.01, d = 0.12). Finally, while not statistically significant, a small effect size indicated that mothers with intellectual impairments had less instrumental support (M = 2.5 versus 2.7, d = 0.46).</p> <p>Description of the sample of mothers with and without intellectual impairments</p> <p> <ephtml> <table><tr><th align="left">Mother's characteristic</th><th align="char">Mothers with intellectual impairments (n = 263)</th><th align="char">Mothers without intellectual impairments (n = 1298)</th><th align="char">Test statistic</th><th align="char">Effect size</th></tr><tr><th align="char">n</th><th align="char">%</th><th align="char">n</th><th align="char">%</th><th align="char">F</th><th align="char">OR (95% CI)</th></tr><tr><td align="left">Race or ethnicity</td></tr><tr><td align="left">Non‐Hispanic White</td><td align="char" char=" ">10</td><td align="char" char=".">11.1</td><td align="char" char=".">365</td><td align="char" char=".">43.2</td><td align="char" char=".">4.36</td><td align="char" char=".">0.10 (0.05, 0.19)</td></tr><tr><td align="left">Non‐Hispanic Black</td><td align="char" char=" ">169</td><td align="char" char=".">46.2</td><td align="char" char=".">608</td><td align="char" char=".">24.1</td><td align="char" char=".">2.06 (1.56, 2.71)</td></tr><tr><td align="left">Hispanic</td><td align="char" char=" ">76</td><td align="char" char=".">40.2</td><td align="char" char=".">281</td><td align="char" char=".">24.5</td><td align="char" char=".">1.48 (1.10, 1.99)</td></tr><tr><td align="left">Other</td><td align="char" char=" ">7</td><td align="char" char=".">2.5</td><td align="char" char=".">42</td><td align="char" char=".">8.1</td><td align="char" char=".">0.82 (0.36, 1.84)</td></tr><tr><td align="left">Married to child's birth father at age 3</td><td align="char" char=" ">44</td><td align="char" char=".">31.7</td><td align="char" char=".">412</td><td align="char" char=".">59.7</td><td align="char" char=".">5.42</td><td align="char" char=".">0.43 (0.31, 0.61)</td></tr><tr><td align="left">Educational attainment at child's birth</td></tr><tr><td align="left">Less than high school</td><td align="char" char=" ">161</td><td align="char" char=".">55.5</td><td align="char" char=".">408</td><td align="char" char=".">20.0</td><td align="char" char=".">17.24</td><td align="char" char=".">3.51 (2.66, 4.62)</td></tr><tr><td align="left">High school diploma</td><td align="char" char=" ">66</td><td align="char" char=".">36.7</td><td align="char" char=".">344</td><td align="char" char=".">31.7</td><td align="char" char=".">0.94 (0.69, 1.27)</td></tr><tr><td align="left">Some college</td><td align="char" char=" ">26</td><td align="char" char=".">6.4</td><td align="char" char=".">385</td><td align="char" char=".">24.7</td><td align="char" char=".">0.26 (0.17, 0.40)</td></tr><tr><td align="left">College degree</td><td align="char" char=" ">8</td><td align="char" char=".">1.4</td><td align="char" char=".">160</td><td align="char" char=".">23.7</td><td align="char" char=".">0.22 (0.11, 0.46)</td></tr><tr><td align="left">Health insurance status at child's age 3</td></tr><tr><td align="left">Private</td><td align="char" char=" ">43</td><td align="char" char=".">36.5</td><td align="char" char=".">513</td><td align="char" char=".">62.3</td><td align="char" char=".">4.17</td><td align="char" char=".">0.27 (0.19, 0.38)</td></tr><tr><td align="left">Medicaid</td><td align="char" char=" ">150</td><td align="char" char=".">57.2</td><td align="char" char=".">469</td><td align="char" char=".">29.8</td><td align="char" char=".">2.95 (2.15, 4.05)</td></tr><tr><td align="left">Uninsured</td><td align="char" char=" ">21</td><td align="char" char=".">6.3</td><td align="char" char=".">77</td><td align="char" char=".">7.9</td><td align="char" char=".">1.39 (0.84, 2.30)</td></tr><tr><td align="left">High parenting stress</td><td align="char" char=" ">133</td><td align="char" char=".">44.6</td><td align="char" char=".">566</td><td align="char" char=".">41.4</td><td align="char" char=".">0.08</td><td align="char" char=".">1.32 (1.01, 1.73)</td></tr></table> </ephtml> </p> <p></p> <p> <ephtml> <table><tr><th align="left" /><th align="char" char=" ">Mean</th><th align="char">SD</th><th align="char">Mean</th><th align="char">SD</th><th align="char">t</th><th align="char">d (95% CI)</th></tr><tr><td align="left">Mean age at child's birth</td><td align="char" char=".">24.7</td><td align="char" char=".">6.20</td><td align="char" char=".">27.1</td><td align="char" char=".">6.05</td><td align="char" char=".">−2.77</td><td align="char" char=".">0.12 (−0.01, 0.26)</td></tr><tr><td align="left">Mean PPVT‐R score</td><td align="char" char=".">74.6</td><td align="char" char=".">0.90</td><td align="char" char=".">95.7</td><td align="char" char=".">0.44</td><td align="char" char=".">−21.67</td><td align="char" char=".">2.14 (1.98, 2.29)</td></tr><tr><td align="left">Instrumental support</td><td align="char" char=".">2.5</td><td align="char" char=".">0.13</td><td align="char" char=".">2.7</td><td align="char" char=".">0.05</td><td align="char" char=".">−1.79</td><td align="char" char=".">0.46 (0.33, 0.59)</td></tr><tr><td align="left">Partner support</td><td align="char" char=".">2.7</td><td align="char" char=".">0.04</td><td align="char" char=".">2.7</td><td align="char" char=".">0.03</td><td align="char" char=".">1.17</td><td align="char" char=".">0.00 (−0.16, 0.160)</td></tr></table> </ephtml> </p> <p>1 All variables are weighted to represent mothers who gave birth in large US cities with population of 200 000 or more between 1998 and 2000. Number of observations (n) is unweighted. SD, standard deviation; OR, odds ratio; CI, confidence intervals.</p> <p>2 *P < 0.05, **P < 0.01, ***P < 0.001.</p> <p>Table [NaN] presents the weighted, unadjusted physical and emotional health outcomes, stratified by whether or not the mother had intellectual impairments. As these bivariate comparisons show, mothers with intellectual impairments were more likely, with a small effect size, to report having a serious health condition that limited their ability to work (21.2% versus 7.2%, P < 0.05, OR = 2.33). While not statistically significant, a small effect size showed that mothers intellectual impairments were also more likely to rate their health as fair or poor (4.9% versus 2.9%, OR = 1.59) as well as be overweight or obese (21.0% versus 22.3%, OR = 1.55).</p> <p>Unadjusted, weighted physical and emotional health of mothers with and without intellectual impairments at child's age 3</p> <p> <ephtml> <table><tr><th align="left">Health characteristics</th><th align="left">Mothers with intellectual impairments</th><th align="char">Mothers without intellectual impairments</th><th align="char">Test statistic</th><th align="char">Effect size</th></tr><tr><th align="left">n</th><th align="char">%</th><th align="char">n</th><th align="char">%</th><th align="char">F</th><th align="char">OR (95% CI)</th></tr><tr><td align="left">Fair or poor self‐rated health</td><td align="left">43</td><td align="char" char=".">14.1</td><td align="char" char=".">142</td><td align="char" char=".">9.2</td><td align="char" char=".">1.02</td><td align="char" char=".">1.59 (1.10, 2.30)</td></tr><tr><td align="left">Overweight or obese (BMI ≥ 25)</td><td align="left">15</td><td align="char" char=".">4.9</td><td align="char" char=".">49</td><td align="char" char=".">2.9</td><td align="char" char=".">0.71</td><td align="char" char=".">1.55 (0.85, 2.81)</td></tr><tr><td align="left">Hospitalized or visited emergency room in the past year</td><td align="left">54</td><td align="char" char=".">21.0</td><td align="char" char=".">284</td><td align="char" char=".">22.3</td><td align="char" char=".">0.02</td><td align="char" char=".">0.92 (0.66, 1.28)</td></tr><tr><td align="left">Serious health condition that limits work</td><td align="left">37</td><td align="char" char=".">21.2</td><td align="char" char=".">85</td><td align="char" char=".">7.2</td><td align="char" char=".">4.17</td><td align="char" char=".">2.33 (1.55, 3.52)</td></tr><tr><td align="left">Regularly takes medication</td><td align="left">37</td><td align="char" char=".">25.3</td><td align="char" char=".">170</td><td align="char" char=".">18.8</td><td align="char" char=".">0.32</td><td align="char" char=".">1.09 (0.74, 1.61)</td></tr><tr><td align="left">Tobacco use</td><td align="left">67</td><td align="char" char=".">38.5</td><td align="char" char=".">343</td><td align="char" char=".">67.8</td><td align="char" char=".">3.11</td><td align="char" char=".">0.83 (0.54, 1.28)</td></tr><tr><td align="left">Major depression</td><td align="left">56</td><td align="char" char=".">23.7</td><td align="char" char=".">276</td><td align="char" char=".">17.0</td><td align="char" char=".">0.51</td><td align="char" char=".">1.01 (0.73, 1.39)</td></tr><tr><td align="left">Generalized anxiety disorder</td><td align="left">13</td><td align="char" char=".">6.1</td><td align="char" char=".">66.0</td><td align="char" char=".">4.9</td><td align="char" char=".">0.08</td><td align="char" char=".">0.97 (0.53, 1.79)</td></tr></table> </ephtml> </p> <ulist> <item>3 All variables are weighted to represent mothers who gave birth in large US cities with population of 200 000 or more between 1998 and 2000. Number of observations (n) is unweighted. OR, odds ratio; CI, confidence intervals.</item> <item>4 *P < 0.05, **P < 0.01, ***P < 0.001.</item> </ulist> <p>Weighted, unadjusted economic well‐being outcomes, comparing mother with and without intellectual impairments, are presented in Table [NaN] . Statistically significant differences, with small effect size, indicate that mothers with intellectual impairments had lower incomes (F = 7.15, P < 0.001); mothers with intellectual impairments were more likely to be living below 99% of the federal poverty level (44.9% versus 27.0%, OR = 3.07). Mothers with intellectual impairments were significantly more likely to receive Supplemental Nutrition Program for Women, Infants and Children (WIC) benefits (63.8% versus 39.6%, F = 4.78, P < 0.05, OR = 1.82).</p> <p>Unadjusted, weighted economic well‐being of mothers with and without intellectual impairments at child's age 3</p> <p> <ephtml> <table><tr><th align="left">Financial characteristics</th><th align="char">Mothers with intellectual impairments</th><th align="char">Mothers without intellectual impairments</th><th align="char">Test statistic</th><th align="char">Effect size</th></tr><tr><th align="char">n</th><th align="char">%</th><th align="char">n</th><th align="char">%</th><th align="char">F</th><th align="char">OR (95% CI)</th></tr><tr><td align="left">Income</td></tr><tr><td align="left">Less than 99% of FPL</td><td align="char" char=" ">170</td><td align="char" char=".">44.9</td><td align="char" char=".">484</td><td align="char" char=".">27.0</td><td align="char" char=".">7.15</td><td align="char" char=".">3.07 (2.33, 4.05)</td></tr><tr><td align="left">100–199% of FPL</td><td align="char" char=" ">81</td><td align="char" char=".">51.9</td><td align="char" char=".">518</td><td align="char" char=".">37.2</td><td align="char" char=".">0.67 (0.01, 0.50)</td></tr><tr><td align="left">200% of FPL and above</td><td align="char" char=" ">12</td><td align="char" char=".">3.3</td><td align="char" char=".">296</td><td align="char" char=".">35.8</td><td align="char" char=".">0.16 (0.09, 0.29)</td></tr><tr><td align="left">Unemployed</td><td align="char" char=" ">147</td><td align="char" char=".">33.2</td><td align="char" char=".">512</td><td align="char" char=".">40.7</td><td align="char" char=".">0.69</td><td align="char" char=".">1.98 (1.51, 2.59)</td></tr><tr><td align="left">Receives public benefits</td></tr><tr><td align="left">TANF/welfare</td><td align="char" char=" ">103</td><td align="char" char=".">18.3</td><td align="char" char=".">287</td><td align="char" char=".">11.6</td><td align="char" char=".">2.60</td><td align="char" char=".">2.28 (1.72, 3.01)</td></tr><tr><td align="left">Food stamps/SNAP</td><td align="char" char=" ">155</td><td align="char" char=".">39.2</td><td align="char" char=".">542</td><td align="char" char=".">24.4</td><td align="char" char=".">2.89</td><td align="char" char=".">2.02 (1.54, 2.65)</td></tr><tr><td align="left">Supplemental security income</td><td align="char" char=" ">23</td><td align="char" char=".">4.9</td><td align="char" char=".">44</td><td align="char" char=".">3.6</td><td align="char" char=".">0.48</td><td align="char" char=".">2.72 (1.62, 4.60)</td></tr><tr><td align="left">Supplemental Nutrition Program for women, infants and children</td><td align="char" char=" ">149</td><td align="char" char=".">63.8</td><td align="char" char=".">566</td><td align="char" char=".">39.6</td><td align="char" char=".">4.78</td><td align="char" char=".">1.82 (1.37, 2.42)</td></tr><tr><td align="left">Material hardships in the past year</td></tr><tr><td align="left">Received free food or meals</td><td align="char" char=" ">22</td><td align="char" char=".">4.5</td><td align="char" char=".">122</td><td align="char" char=".">8.4</td><td align="char" char=".">1.42</td><td align="char" char=".">0.88 (0.55, 1.41)</td></tr><tr><td align="left">Difficulty paying bills</td><td align="char" char=" ">84</td><td align="char" char=".">26.4</td><td align="char" char=".">576</td><td align="char" char=".">36.7</td><td align="char" char=".">1.09</td><td align="char" char=".">0.59 (0.44, 0.78)</td></tr><tr><td align="left">Lack of medical care</td><td align="char" char=" ">10</td><td align="char" char=".">2.7</td><td align="char" char=".">89</td><td align="char" char=".">3.7</td><td align="char" char=".">0.32</td><td align="char" char=".">0.54 (0.28, 1.05)</td></tr><tr><td align="left">Telephone disconnected</td><td align="char" char=" ">81</td><td align="char" char=".">21.6</td><td align="char" char=".">306</td><td align="char" char=".">13.4</td><td align="char" char=".">1.45</td><td align="char" char=".">2.52 (1.08, 1.93)</td></tr><tr><td align="left">Unstable housing</td><td align="char" char=" ">37</td><td align="char" char=".">10.7</td><td align="char" char=".">129</td><td align="char" char=".">6.3</td><td align="char" char=".">1.24</td><td align="char" char=".">1.71 (1.02, 2.86)</td></tr><tr><td align="left">Number of material hardships in the past year</td></tr><tr><td align="left">None</td><td align="char" char=" ">123</td><td align="char" char=".">50.7</td><td align="char" char=".">580</td><td align="char" char=".">56.2</td><td align="char" char=".">0.84</td><td align="char" char=".">1.09 (0.83, 1.42)</td></tr><tr><td align="left">One</td><td align="char" char=" ">71</td><td align="char" char=".">35.6</td><td align="char" char=".">370</td><td align="char" char=".">26.6</td><td align="char" char=".">0.93 (0.69, 1.25)</td></tr><tr><td align="left">Two</td><td align="char" char=" ">47</td><td align="char" char=".">11.7</td><td align="char" char=".">230</td><td align="char" char=".">11.8</td><td align="char" char=".">1.01 (0.71, 1.43)</td></tr><tr><td align="left">Three or more</td><td align="char" char=" ">22</td><td align="char" char=".">2.10</td><td align="char" char=".">118</td><td align="char" char=".">5.4</td><td align="char" char=".">0.91 (0.57, 1.47)</td></tr><tr><td align="left">Food insecure</td><td align="char" char=" ">48</td><td align="char" char=".">10.4</td><td align="char" char=".">145</td><td align="char" char=".">10.5</td><td align="char" char=".">0.00</td><td align="char" char=".">1.78 (1.24, 2.54)</td></tr></table> </ephtml> </p> <ulist> <item>5 All variables are weighted to represent mothers who gave birth in large US cities with population of 200 000 or more between 1998 and 2000. Number of observations (n) is unweighted. OR, odds ratio; CI, confidence intervals; FPL, federal poverty level; TANF, temporary assistance for needy families; SNAP, Supplemental Nutrition Assistance Program.</item> <item>6 *P < 0.05, **P < 0.01, ***P < 0.001.</item> </ulist> <p>Furthermore, although not statistically significant, small to medium effect sizes indicate several other economic disparities between mothers with and without intellectual impairments. Mothers with intellectual impairments were more likely to be unemployed (33.2% versus 40.7%, OR = 1.98) as well as receive Temporary Assistance For Needy Families (welfare) (18.3% versus 11.6%, OR = 2.28), Food Stamps/Supplemental Nutrition Assistance Program (39.2% versus 24.4%, OR = 2.02) and Supplemental Security Income (4.9% versus 3.6%, OR = 2.72). Lastly, mothers with intellectual disabilities were more likely to have had their phone disconnected (21.6% versus 13.4%, OR = 2.52), face unstable housing (10.7% versus 6.3%, OR = 1.71) and experience food insecurity (10.4% versus 10.5%, OR = 1.78).</p> <hd id="AN0122405678-12">Discussion</hd> <p>Using data from Fragile Families, a large population‐based study, we compared the health and economic well‐being of US mothers with and without intellectual impairments. The core findings of the present study suggest that compared with other US mothers, those with intellectual impairments experience health and economic disadvantages. These findings are noteworthy because although it has long been established that there is no systematic association between parenting ability and intelligence (Tymchuk & Feldman [<reflink idref="bib66" id="ref90">66</reflink>] ; Booth & Booth [<reflink idref="bib12" id="ref91">12</reflink>] ; Dowdney & Skuse [<reflink idref="bib23" id="ref92">23</reflink>] ), parents with intellectual impairments and their children face heightened risk of multiple disadvantages related to poor health, lack of social supports and low socio‐economic status which can impact their parenting capabilities and result in deleterious child outcomes (IASSID Special Interest Research Group on Parents and Parenting with Intellectual Disabilities [<reflink idref="bib38" id="ref93">38</reflink>] ). Thus, findings from the present study have important policy and practice implications.</p> <p>Our study found several socio‐demographic differences between mothers with and without intellectual impairments. Previous research has found that mothers with intellectual impairments are often single parents who experience decreased social support and elevated parenting stress (Emerson & Brigham [<reflink idref="bib26" id="ref94">26</reflink>] ; Emerson et al. [<reflink idref="bib27" id="ref95">27</reflink>] ; Feldman et al. [<reflink idref="bib31" id="ref96">31</reflink>] ; Höglund et al. [<reflink idref="bib37" id="ref97">37</reflink>] ; Wade et al. [<reflink idref="bib71" id="ref98">71</reflink>] ). Corroborating these findings, in our study, mothers with intellectual impairments were less likely to be married to the focal child's birth father. They also had less instrumental support. However, there were no differences with parenting stress or partner support. The latter is possibly attributed to the lower marital rates of mothers with intellectual impairments. These disparities may also be a result of instrumentation. Future research should investigate these contradictory findings. Further, consistent with previous research (e.g. Hindmarsh et al. [<reflink idref="bib36" id="ref99">36</reflink>] ; Höglund et al. [<reflink idref="bib37" id="ref100">37</reflink>] ), we found that mothers with intellectual impairments were younger and had less education than other mothers. Significant differences in race and ethnicity were found in the present study.</p> <p>Studies from other countries have also found that mothers with intellectual impairments experience higher rates of poor physical and emotional health (Aunos et al. [<reflink idref="bib4" id="ref101">4</reflink>] ; Feldman et al. [<reflink idref="bib31" id="ref102">31</reflink>] ; Höglund et al. [<reflink idref="bib37" id="ref103">37</reflink>] ; Emerson & Brigham [<reflink idref="bib26" id="ref104">26</reflink>] ; Emerson et al. [<reflink idref="bib27" id="ref105">27</reflink>] ). In the present study, we found that mothers with intellectual impairments were more likely to report having a serious health condition and fair or poor overall health. Additionally, mothers with intellectual impairments were more likely to be overweight or obese. Findings from the present study corroborate prior research that indicates that mothers with intellectual impairments have worse health outcomes (Höglund et al. [<reflink idref="bib37" id="ref106">37</reflink>] ). Further, the poor health outcomes experienced by the mothers in the present study are consistent with earlier research that found adults with intellectual impairments face numerous health disparities (Krahn et al. [<reflink idref="bib40" id="ref107">40</reflink>] ). These results are important because past studies have shown that families headed by mothers with intellectual impairments may be at increased risk of parenting difficulties if they have additional impairments or health conditions (McGaw et al. [<reflink idref="bib53" id="ref108">53</reflink>] ).</p> <p>Notably, parents with intellectual impairments were more likely to be Black or Hispanic compared to parents without such impairments. In the United States, individuals from racial or ethnic minority backgrounds have been found to be more likely to experience material hardships than non‐Hispanic Whites (Beverly [<reflink idref="bib10" id="ref109">10</reflink>] ). However, the evidence on this point is equivocal, and when income, health and disability status are accounted, some research does not find racial and ethnic differences (Levy [<reflink idref="bib43" id="ref110">43</reflink>] ). Further inquiry is needed to disentangle the relationships between hardship and race for parents with intellectual impairments. Remarkably, our study found no differences with respect to emotional health between mothers with and without intellectual impairments. This is at odds with other published studies which have found that parents with intellectual impairments experience greater psychopathology than their peers (Aunos et al. [<reflink idref="bib4" id="ref111">4</reflink>] ; Emerson & Brigham [<reflink idref="bib26" id="ref112">26</reflink>] ; Emerson et al. [<reflink idref="bib27" id="ref113">27</reflink>] ; Feldman et al. [<reflink idref="bib31" id="ref114">31</reflink>] ; McGaw et al. [<reflink idref="bib52" id="ref115">52</reflink>] ; Meppelder et al. [<reflink idref="bib54" id="ref116">54</reflink>] ; Wade et al. [<reflink idref="bib71" id="ref117">71</reflink>] ). This contradictory finding may be attributed to sampling or instrumentation differences and warrants further research.</p> <p>Finally, findings from the present study indicate mothers with intellectual impairments were more likely to experience economic disadvantage. Past studies have found that compared to other mothers, those with intellectual impairments experience higher rates of poverty and face a wide range of environmental adversities, such as poverty, material hardships and poor housing (Emerson & Brigham [<reflink idref="bib26" id="ref118">26</reflink>] ; Emerson et al. [<reflink idref="bib27" id="ref119">27</reflink>] ; Feldman et al. [<reflink idref="bib31" id="ref120">31</reflink>] ; Höglund et al. [<reflink idref="bib37" id="ref121">37</reflink>] ; Wade et al. [<reflink idref="bib71" id="ref122">71</reflink>] ). Consistent with previous research, our study found that mothers with intellectual impairments were more likely to be living below the federal poverty level as well as receive public benefits and be unemployed. Mothers with intellectual impairments also had an increased likelihood of experiencing certain material hardships. The poverty and disadvantage these mothers experience is notable because economic hardship is associated with poorer developmental outcomes for children (Grantham‐McGregor et al. [<reflink idref="bib33" id="ref123">33</reflink>] ; Lefmann & Combs‐Orme [<reflink idref="bib42" id="ref124">42</reflink>] ; Walker et al. [<reflink idref="bib72" id="ref125">72</reflink>] ). Thus, children of parents with intellectual impairments are at increased risk of deleterious developmental outcomes due to socio‐economic disadvantage and other environmental adversities (Feldman et al. [<reflink idref="bib31" id="ref126">31</reflink>] ; Emerson & Brigham [<reflink idref="bib25" id="ref127">25</reflink>] ).</p> <hd id="AN0122405678-13">Limitations</hd> <p>While our findings have important implications for practice as well as future research, they must be cautiously interpreted in the light of the study's limitations. First, the exploratory, descriptive nature of this study prevented us from ascertaining whether the deleterious health and economic outcomes of mothers with intellectual impairments experienced were predicted by their disability or contextual factors. Next, most of the variables were measured by maternal report, which is vulnerable to recall bias and social desirability bias. Nevertheless, many existing studies have used self‐reported measures to examine the health and economic well‐being of parents with intellectual impairments (e.g. Aunos et al. [<reflink idref="bib4" id="ref128">4</reflink>] ; Emerson & Brigham [<reflink idref="bib25" id="ref129">25</reflink>] ; Feldman et al. [<reflink idref="bib30" id="ref130">30</reflink>] ; Hindmarsh et al. [<reflink idref="bib36" id="ref131">36</reflink>] ; Wade et al. [<reflink idref="bib71" id="ref132">71</reflink>] ). Similarly, while the majority of the measures are well established for the general population, some have not been validated with adults with intellectual impairments. Likewise, owing to limitations imposed by Fragile Families, our measure of social supports differs from the existing research on parents with intellectual impairments. Additionally, because this study was a secondary data analysis, causality cannot be inferred from these observational data. Thus, health and economic outcomes may be attributable to other factors that were not analysed here. Attrition is an inherent problem with all longitudinal research. However, the response rate for the age‐three wave was 86%, which is fairly high for these types of studies. Further, because of sampling limitations imposed by the Fragile Families' survey design (e.g. parents planning to place their children for adoption were excluded), this study presumably excluded some mothers with intellectual impairments.</p> <p>Moreover, the binary measure of intellectual impairments prevented a consideration of the nature and severity of the mother's impairment. Nevertheless, our approach is consistent with past studies that used the PPVT‐R instrument to identify intellectual impairments. Tests of its validity indicate the PPVT‐R correlates well with other measures of intellectual impairments (Dunn & Dunn [<reflink idref="bib24" id="ref133">24</reflink>] ; Naglieri [<reflink idref="bib55" id="ref134">55</reflink>] ; Prout & Schwartz [<reflink idref="bib62" id="ref135">62</reflink>] ; Bell et al. [<reflink idref="bib5" id="ref136">5</reflink>] ; Dickson et al. [<reflink idref="bib22" id="ref137">22</reflink>] ). Finally, generalizability is somewhat limited because the findings are representative of births in large US cities. Therefore, the findings cannot be extrapolated to other families. However, because 81% of the US population lives in urban areas (US Census Bureau [<reflink idref="bib67" id="ref138">67</reflink>] ), this study captured the experiences of the majority of mothers with intellectual impairments.</p> <hd id="AN0122405678-14">Strengths and implications</hd> <p>Notwithstanding the study's limitations, it has important implications for the development and implementation of programmes and policies that affect these families as well as future research on US mothers with intellectual impairments and their families. To the best of our knowledge, this is the first nationally representative study to compare the health and economic well‐being of US mothers with and without intellectual impairments who have young children. Moreover, in contrast to most of the existing research in this area, this study's sample was not derived from parents who are involved with child protection services, receiving disability services or on disability registries. Accordingly, our study addresses selection bias and other gaps in the existing research and thus makes a novel contribution to the research.</p> <p>In this study, we found US mothers with intellectual impairments were more likely to experience worse health outcomes than other mothers. Our study also found that compared with other mothers, those with intellectual impairments were younger, less educated and experienced less instrumental support. These findings suggest supports and services for families with parents with intellectual impairments must be comprehensive to meet their health and socio‐economic needs. Interventions for parents with intellectual impairments should also improve parents' social support networks, including peer supports. Access to social support has been shown to improve outcomes for families headed by parents with intellectual impairments (Meppelder et al. [<reflink idref="bib54" id="ref139">54</reflink>] ; Wade et al. [<reflink idref="bib71" id="ref140">71</reflink>] ).</p> <p>Further, our study found that mothers with intellectual impairments experienced socio‐economic disadvantage. Certainly, the economic hardships incurred by these families could be lessened although the expansion of existing public benefit programmes, such as Supplemental Security Income. Although adults with intellectual impairments generally qualify for Supplemental Security Income, parents with disabilities do not receive increased benefits if they are caring for non‐disabled children (Parish et al. [<reflink idref="bib60" id="ref141">60</reflink>] ; National Council on Disability [<reflink idref="bib57" id="ref142">57</reflink>] ). In other words, receipt of public benefits may not be enough to support the entire family. For example, the present Supplemental Security Income benefit for one adult provides an income transfer that is approximately 25% below the current federal poverty level (US Department of Health & Human Services, [<reflink idref="bib68" id="ref143">68</reflink>] ). In this study, mothers with intellectual impairments had worse economic outcomes. Therefore, the present benefit levels appear insufficient in the light of the hardships faced by these families. A second possible contributor to the markedly high rates of hardship in these families is the low employment rates and low wages typically earned by adults with intellectual impairments (Siperstein et al. [<reflink idref="bib65" id="ref144">65</reflink>] ). Indeed, in our study, mothers with intellectual impairments were more likely to be unemployed. Thus, policy efforts to improve both employment and wages would likely reduce material hardship in these families.</p> <p>Therefore, there is a need to increase the availability of support services for parents with intellectual impairments and their children (Lightfoot & LaLiberte [<reflink idref="bib45" id="ref145">45</reflink>] ; National Council on Disability [<reflink idref="bib57" id="ref146">57</reflink>] ). Although evidence‐based interventions to support these families have existed since the 1980s (Feldman [<reflink idref="bib29" id="ref147">29</reflink>] ), these interventions are not widely used (Lightfoot & LaLiberte [<reflink idref="bib45" id="ref148">45</reflink>] , [<reflink idref="bib46" id="ref149">46</reflink>] ; National Council on Disability [<reflink idref="bib57" id="ref150">57</reflink>] ). This gap in service availability is particularly noteworthy because appropriate interventions can increase parenting capabilities of parents with intellectual impairments (Feldman [<reflink idref="bib28" id="ref151">28</reflink>] ; Wade et al. [<reflink idref="bib70" id="ref152">70</reflink>] ). Hence, funding and implementing evidence‐based interventions for these families must be a priority for policymakers.</p> <p>Finally, findings from this study have important implications for future research. To the best of our knowledge, this is the first US study to use population‐based data to compare the health and economic well‐being of mothers with and without intellectual impairments. Moreover, as an exploratory, descriptive study, it provides direction for future research. For example, future studies should analyse population‐based data to determine whether the deleterious outcomes these mothers face is a result of their disability or the context in which they live. Moreover, future research should cross‐reference administrative data to limit recall and social desirability bias. Future studies should also seek to use measures for parents with intellectual impairments that have been tested for validity and reliability, particularly those related to social supports and stress. Additionally, future research should explore how experiences of disadvantage for racial and ethnic minority parents with intellectual impairments differ from that of their White counterparts. Finally, a more comprehensive and detailed measure of intellectual impairments should be utilized in future research.</p> <hd id="AN0122405678-15">Conclusion</hd> <p>Our study provides new evidence comparing the health and economic well‐being of US mothers with and without intellectual impairments. Findings from this study indicate the need for policies and programmes to support parents with intellectual impairments and their children by addressing their health and economic needs. Moreover, further research, using population‐based data, is needed to better understand the context in which US mothers with intellectual impairments and their families live.</p> <hd id="AN0122405678-16">Acknowledgments</hd> <p>Funding for this study was provided by the Lurie Institute for Disability Policy, the Heller School for Social Policy and Management at Brandeis University.</p> <ref id="AN0122405678-17"> <title>Footnotes</title> <blist> <bibl id="bib1" idref="ref62" type="bt">1</bibl> <bibtext>The Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, is a federal programme that provides food‐purchasing assistance for low‐income people living in the United States. </bibtext> </blist> <blist> <bibl id="bib2" idref="ref74" type="bt">2</bibl> <bibtext>The Supplemental Nutrition Program for Women, Infants and Children (WIC) is a federal assistance programme for health care and nutrition of low‐income pregnant women, breastfeeding women, and infants and children under the age of five. </bibtext> </blist> <blist> <bibl id="bib3" idref="ref28" type="bt">3</bibl> <bibtext>Supplemental Security Income is a means‐tested income transfer program for people with severe disabilities. </bibtext> </blist> </ref> <ref id="AN0122405678-18"> <title>References</title> <blist> <bibtext>Abidin R. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Health and Economic Well-Being of US Mothers with Intellectual Impairments
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Powell%2C+Robyn+M%2E%22">Powell, Robyn M.</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-7898-2268">0000-0001-7898-2268</externalLink>)<br /><searchLink fieldCode="AR" term="%22Parish%2C+Susan+L%2E%22">Parish, Susan L.</searchLink><br /><searchLink fieldCode="AR" term="%22Akobirshoev%2C+Ilhom%22">Akobirshoev, Ilhom</searchLink>
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  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Applied+Research+in+Intellectual+Disabilities%22"><i>Journal of Applied Research in Intellectual Disabilities</i></searchLink>. May 2017 30(3):456-468.
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  Label: Availability
  Group: Avail
  Data: Wiley-Blackwell. 350 Main Street, Malden, MA 02148. Tel: 800-835-6770; Tel: 781-388-8598; Fax: 781-388-8232; e-mail: cs-journals@wiley.com; Web site: http://www.wiley.com/WileyCDA
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 13
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2017
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Health%22">Health</searchLink><br /><searchLink fieldCode="DE" term="%22Well+Being%22">Well Being</searchLink><br /><searchLink fieldCode="DE" term="%22Mothers%22">Mothers</searchLink><br /><searchLink fieldCode="DE" term="%22Toddlers%22">Toddlers</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Poverty%22">Poverty</searchLink><br /><searchLink fieldCode="DE" term="%22Public+Policy%22">Public Policy</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Needs%22">Health Needs</searchLink><br /><searchLink fieldCode="DE" term="%22Economic+Factors%22">Economic Factors</searchLink><br /><searchLink fieldCode="DE" term="%22Disabilities%22">Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Welfare+Services%22">Welfare Services</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/jar.12308
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1360-2322
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: While the United States has seen increased attention by policymakers on the rights of parents with disabilities, there is limited understanding of the health and economic well-being of parents with intellectual impairments. This study compares the health and economic well-being of mothers with and without intellectual impairments. Methods: This descriptive, exploratory study is a secondary analysis of the Fragile Families and Child Wellbeing Study. This study includes a subsample of mothers of three-year-old children (n = 1561), including mothers with intellectual impairments (n = 263) and without intellectual impairments (n = 1298). Results: US Mothers with intellectual impairments are more likely to report serious health conditions, have less instrumental support, live in poverty, receive public benefits and experience certain material hardships. Conclusion: Findings from this study indicate the need for policies and programmes to support parents with intellectual impairments by addressing their health and economic needs.
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2017
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  Label: Accession Number
  Group: ID
  Data: EJ1137032
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1137032
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        Value: 10.1111/jar.12308
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 13
        StartPage: 456
    Subjects:
      – SubjectFull: Health
        Type: general
      – SubjectFull: Well Being
        Type: general
      – SubjectFull: Mothers
        Type: general
      – SubjectFull: Toddlers
        Type: general
      – SubjectFull: Intellectual Disability
        Type: general
      – SubjectFull: Poverty
        Type: general
      – SubjectFull: Public Policy
        Type: general
      – SubjectFull: Health Needs
        Type: general
      – SubjectFull: Economic Factors
        Type: general
      – SubjectFull: Disabilities
        Type: general
      – SubjectFull: Parent Child Relationship
        Type: general
      – SubjectFull: Welfare Services
        Type: general
    Titles:
      – TitleFull: The Health and Economic Well-Being of US Mothers with Intellectual Impairments
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          Name:
            NameFull: Powell, Robyn M.
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            NameFull: Parish, Susan L.
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            NameFull: Akobirshoev, Ilhom
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            – D: 01
              M: 05
              Type: published
              Y: 2017
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              Value: 1360-2322
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              Value: 30
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              Value: 3
          Titles:
            – TitleFull: Journal of Applied Research in Intellectual Disabilities
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