RESEARCH AND PRACTICE
Intergenerational Social Networks and Health Behaviors
Among Children Living in Public Housing
Alene Kennedy-Hendricks, BA, Heather Schwartz, PhD, Rachel Johnson Thornton, MD, PhD, Beth Ann Griffin, PhD, Harold D. Green Jr., PhD, David P.
Kennedy, PhD, Susan Burkhauser, MPhil, and Craig Evan Pollack, MD, MHS
Health inequalities often endure across several
generations.1,2 Studies have linked grandpa-
rental and parental childhood exposures,3,4
social class,5 educational attainment,6,7 and
health behaviors8 to offspring health. Neigh-
borhood environments have been postulated
to play an important role in the persistence of
intergenerational inequalities. Research con-
ducted by Sharkey has shown that children
whose parents grew up in disadvantaged,
segregated neighborhoods are highly likely to
themselves live in disenfranchised neighbor-
hoods as adults.1 Although social scientists have
noted the important contributions of neighbor-
hood social processes to health outcomes,9 the
question of whether social networks play a role
in connecting neighborhood environments to
intergenerational inequality remains unresolved.
Understanding how social networks influ-
ence health behaviors and outcomes is an
evolving area of research in public health.10,11
Studies have linked the likelihood of particular
health-related behaviors and attributes among
adults, such as smoking, alcohol consumption,
obesity, and poor mental health, to the char-
acteristics of their friends and relations.11---14
Research also has shown associations between
children’s peer networks and aspects of their
health, including physical activity, weight, and
substance use.15---21 Despite growing interest in
social networks and health, little is known
about intergenerational social networks or how
the social networks of one generation may
affect the health and well-being of the next.
Caretaker social networks may be related to
child health through at least 2 mechanisms.
First, the adults in a caretaker’s social network
may shape a child’s health directly by serving
as adult role models, modeling behaviors and
conveying social norms.22 Second, a care-
taker’s social network may have an indirect
effect, mediated by the caretaker, on a child’s
health.22 In this formulation, the caretaker may
select network members with similar health
November 2015, Vol 105, No. 11 | American Journal of Public Health
Objectives. In a survey of families living in public housing, we investigated
whether caretakers’ social networks are linked with children’s health status.
Methods. In 2011, 209 children and their caretakers living in public housing in
suburban Montgomery County, Maryland, were surveyed regarding their health
and social networks. We used logistic regression models to examine the
associations between the perceived health composition of caretaker social
networks and corresponding child health characteristics (e.g., exercise, diet).
Results. With each 10% increase in the proportion of the caretaker’s social
network that exercised regularly, the child’s odds of exercising increased by 34%
(adjusted odds ratio = 1.34; 95% confidence interval = 1.07, 1.69) after the care-
taker’s own exercise behavior and the composition of the child’s peer network
had been taken into account. Although children’s overweight or obese status
was associated with caretakers’ social networks, the results were no longer
significant after adjustment for caretakers’ own weight status.
Conclusions. We found that caretaker social networks are independently
associated with certain aspects of child health, suggesting the importance of
the broader social environment for low-income children’s health. (Am J Public
Health. 2015;105:2291–2297. doi:10.2105/AJPH.2015.302663)
beliefs and behaviors, given the tendency for We focused on suburban families living in
individuals with shared characteristics to estab- subsidized housing for several reasons. First,
lish ties (a phenomenon known as homophily),23 although subsidized housing programs provide
or social network members with different char- important benefits to residents,29---31 the phys-
acteristics may influence caretakers to express ical and mental health of these populations is
new norms or behaviors (termed induction).13 By often poor.32---35 Second, suburban neighbor-
reinforcing or shaping the caretaker’s attitudes hoods, on average, now house more poor
and behaviors, caretaker social networks may, in residents than do central US cities, and the
turn, influence children. It is widely recognized number of families in suburban public housing
that caretakers play a critical role in their continues to grow.36,37 Third, families receiv-
children’s health by providing food, shelter, and ing housing assistance are at the bottom of the
care; teaching children about healthy eating; income distribution, with most such house-
creating opportunities for physical activity; and holds earning less than $20 000 annually.38
molding children’s understanding of health Fourth, caretakers’ social networks may play
and related behavioral norms.24---28 important roles among families living in certain
We examined associations between care- types of public housing in which friends and
givers’ social ties and children’s health among neighbors serve as informal caretakers by
families living in suburban subsidized housing. watching one another’s children.39 This may
Specifically, we assessed whether relationships be particularly important in single-parent
exist between caregivers’ social networks and households, which made up the majority of
their children’s health and whether these households in our study.
associations are independent of caretakers’ Studies of public housing residents have
own health characteristics. shown that their social networks may be
Kennedy-Hendricks et al. | Peer Reviewed | Social Issues | 2291

affected by neighborhood context.39---42 Using
data from Montgomery County, Maryland, we
previously found that adults living in wealthier
communities had more socioeconomically
diverse and, to a limited extent, healthier social
networks.41,43 Similarly, research from the
Moving to Opportunity experiment revealed
that participants who received housing vouchers
to move to low-poverty neighborhoods (from
high-poverty neighborhoods) were more likely
to have at least 1 college-educated friend than
those who remained in public housing devel-
opments in high-poverty neighborhoods.44
Given the well-documented relationship
between income and health and the evidence
of limited intergenerational mobility among
children who grow up in poor households and
neighborhoods,45,46 determining the extent to
which associations exist between caretakers’
social networks and children’s health allows
consideration of whether caretakers’ relation-
ships may maintain or disrupt intergenerational
inequalities known to affect factors critical to
health.
METHODS
In 2011, we conducted an in-person,
computer-assisted survey of public housing
heads of households and their children in
Montgomery County, an affluent Maryland
suburb of Washington, DC. This survey has
been described in detail elsewhere.41,43 We
supplemented the data from the 2011 survey
with household-level administrative records
obtained from the county’s public housing
authority.
A total of 801 heads of households living in
public housing were eligible for recruitment
into the study. Of these individuals, 453 agreed
to participate in the survey (a 57% response
rate). In households with 1 or more children
between the ages of 8 and 18 years, a single
child was randomly selected to complete a
separate in-person, computer-assisted inter-
view. In the 272 households with an age-
eligible child, we interviewed 209 children
(a 77% participation rate). In the 209 house-
holds in which we interviewed children, heads
of households also completed a caretaker sup-
plement to the survey. Fifty-six percent of the
children were adolescents aged 13 to 18 years,
and the remaining 46% were aged 8 to 12
2292 | Social Issues | Peer Reviewed | Kennedy-Hendricks et al.
RESEARCH AND PRACTICE
years. Among the younger children (8---12
years), information on child health was pro-
vided by the caretaker rather than directly by
the children themselves.
Independent Variables
We used an egocentric approach to describe
caretakers’ and children’s social networks; this
approach focuses on a central individual (the
“ego”) and identifies people with whom she or
he is connected (“alters”). We asked caretakers
(egos) to name up to 20 people (alters) whom
they knew and had had contact with in the
preceding year, beginning with those closest to
them. Because we were interested in neigh-
borhood determinants of health, caretakers
who listed less than 5 neighbors were asked
to name up to 5 additional alters who were
neighbors. The same process of eliciting alters
was used with children, although children were
limited to naming only other children (£ 18
years).
Respondents provided information on their
perceptions of alters’ health characteristics, in-
cluding whether the alter exercised regularly,
ate a healthy diet, was overweight, or drank
alcohol socially (among caretakers and adoles-
cents only). We focused on these attributes
because egos might reasonably observe
whether their network members had such
characteristics. To construct our primary in-
dependent variable, the health composition of
the caretaker’s social network, we calculated
the proportion of all alters the caretaker identi-
fied as having each of the health characteristics.
Dependent Variables
The key dependent variables in this study
were binary measures of children’s health
characteristics. We used questionnaire items
from existing survey instruments, including the
Centers for Disease Control and Prevention’s
Youth Risk Behavior Surveillance System
instrument,47,48 the Child Health Assessment
and Monitoring Program’s survey,49 and the
RAND Corporation’s Los Angeles Family and
Neighborhood Survey.50 Caretakers provided
health-related information for younger children
(8---12 years), whereas older children (13---18
years) provided information for themselves.
We coded children as engaging in exercise
if they reported either vigorous or moderate
physical activity for at least 20 minutes every
American Journal of Public Health | November 2015, Vol 105, No. 11
day during the preceding week.50,51 Children
were coded as having adequate fruit and
vegetable intake if they reported consuming at
least 4 servings of fruits or vegetables on an
average day (in line with US Department of
Agriculture recommendations52). Body mass
indexes (BMIs; weight in kilograms divided by
the square of height in meters) were calculated,
and the Centers for Disease Control and
Prevention growth reference53 was used to
categorize children as overweight or obese for
their age and gender. Adolescents were asked
whether they had ever consumed an alcoholic
drink, excluding sips of other people’s alcoholic
beverages.50,54
Control Variables
We included a number of covariates to
account for potential confounding of the re-
lationship between caretakers’ social networks
and children’s health and to increase the pre-
cision of our model estimates. Child-level
covariates included age, gender, and race/
ethnicity (African American, Hispanic, Asian,
White). We also controlled for the health
composition of the child’s social network to
ensure that any potential association observed
between caretaker social network and child
health was above and beyond the child’s own
network. As with the measures of the health
composition of caretakers’ social networks,
we assessed the health composition of the
child’s social networks by calculating the pro-
portions of the child’s friends with each health
characteristic.
Potential caretaker-level confounders in-
cluded gender, educational attainment (< high
school; vocational training; high school degree,
some college, or associate’s degree; bachelor’s
or graduate degree), whether the caretaker had
been born in the United States, and the care-
taker’s social network density. Caretaker social
network density was calculated as the pro-
portion of alters who, according to the care-
taker, knew one another and had been in
contact within the preceding year.55,56 Thus,
higher values represent denser social networks
and lower values represent less dense net-
works; social network density may be an
important factor in the diffusion of shared
norms and behaviors and may confound the
relationship between social network health
composition and child outcomes.13,57

Potential household- and family-level con-
founders included the type of public housing
in which the family lived (whether it was
scattered among market-rate developments or
clustered together with other public housing
units),41 the number of years that the child had
lived in the home, family structure (whether
the child lived with both parents, with 1 parent,
or in an alternate family arrangement), and
the household’s income-to-poverty ratio.
Given the hypothesis that the health com-
position of caretaker social networks may
be related indirectly to children’s health char-
acteristics via the caretakers’ own health, we
also considered measures of caretaker health
characteristics. We classified those caretakers
who reported vigorous or moderate physical
activity for an average of 20 minutes daily as
engaging in regular exercise.51 Adults who
reported consuming 4 or more servings of
fruits and vegetables on a typical day52 were
coded as having adequate fruit and vegetable
intake. We also used caretakers’ self-reported
height and weight to calculate their BMIs, and
we classified those with BMIs above 25 as
overweight or obese. Finally, caretakers who
reported drinking 1 or more alcohol beverages
in the preceding month were categorized as
consuming alcohol.
Statistical Analysis
Our primary research question was whether
the health composition of caretakers’ social
networks (proportion of alters with particular
health characteristics) is associated with chil-
dren’s corresponding health characteristics.
In a bivariate analysis, we used the t test to
examine whether the average proportions
of caretaker alters with particular health char-
acteristics were different among children with
and without the corresponding characteristic.
We then estimated logistic regression models
for each child outcome, with the corresponding
caretaker social network composition measure
as the independent variable of interest.
Model 1 regressed the outcome onto the
measures of caretaker social network composi-
tion with no additional covariates (unadjusted
model). Model 2 included covariates controlling
for potential child-, caretaker-, and household-
or family-level confounders. In model 3, we
added measures of the caretaker’s own health
characteristics to assess whether accounting for
November 2015, Vol 105, No. 11 | American Journal of Public Health
RESEARCH AND PRACTICE
caretaker health reduced the magnitude or
significance of the association between caretaker
social network characteristics and child health.
All estimates were population weighted so that
we could generalize findings to the broader
Montgomery County public housing population.
RESULTS
The mean age of the 209 children in the
study sample was 13 years, and slightly less
than half were female (Table 1). The majority
of the children (63%) lived in single-parent
(primarily single-mother) households; only
15% lived in households in which 2 parents
were present. The large majority of caretakers
we surveyed were the children’s mothers
(69%). The remaining caretakers were fathers
(8%), grandparents (4%), or those with some
other familial relationship with the child.
A large proportion of caretakers had less than
a high school education (40%). Caretakers
reported having an average of 17.7 alters, with
a maximum of 25 (as capped by the design
of the survey). About 17% of alters lived in
the same neighborhood as the caretaker and
child. Caretakers identified an average of 33%
of alters as relatives and 51% as friends.
Caretakers reported that 20% of their alters
exercised regularly. More than a third of alters
ate healthy diets (35%) and drank socially
(39%). Caretakers perceived relatively few of
their alters (14.2%) to be overweight.
Seventy-one percent of children exercised,
and 30% consumed adequate amounts of
fruits and vegetables. Thirty-nine percent of
children were overweight or obese, and 16%
of adolescents reported drinking alcohol.
Table 2 presents the results of bivariate
analyses assessing whether the proportions of
caretakers’ social network members with par-
ticular health characteristics differed among
children with and without the corresponding
health characteristic. Children who exercised at
least 20 minutes each day had caretakers with
significantly larger proportions of alters who
exercised regularly than did children who did
not exercise (22.5% vs 16.4%; P = .037). In
addition, the proportion of the caretaker social
network perceived to be overweight was
significantly higher among children who were
overweight or obese than among children
who were not (18.1% vs 12.3%; P = .026).
Kennedy-Hendricks et al. | Peer Reviewed | Social Issues | 2293
The analyses did not suggest any significant
differences in the proportions of caretaker
alters who ate healthy diets or drank alcohol
among children with and without the corre-
sponding behaviors.
Odds ratios (ORs) generated from logistic
regression models are presented in Table 3.
In the unadjusted model, we found no associ-
ation between the proportion of the caretaker’s
alters who exercise and the child’s odds of
exercising. However, after accounting for po-
tential confounders, we found that with each
10-percentage-point increase in the proportion
of the caretaker’s alters who exercised regu-
larly, the child’s odds of exercising at least 20
minutes per day increased by 35% (OR = 1.35;
95% confidence interval [CI] = 1.07, 1.71).
Controlling for the caretaker’s own exercise
behavior did not change the magnitude or
significance of the association between the
caretaker’s social network and the child’s odds
of engaging in exercise (OR = 1.34; 95%
CI = 1.07, 1.69). To put this finding in per-
spective, a 10-percentage-point change in the
proportion of caretaker alters who exercised
regularly corresponded to a difference of about
2 alters. There was no significant association
between the caretaker’s own exercise behavior
and the child’s likelihood of engaging in exercise.
The unadjusted model also revealed that,
with each 10-percentage-point increase in the
proportion of alters the caretaker perceived
as being overweight, the child’s odds of being
overweight or obese increased by 32%
(OR = 1.32; 95% CI = 1.06, 1.64). This rela-
tionship remained after adjustment for poten-
tial confounders in model 2. However, after
adjustment for the caretaker’s own overweight
status, the association was no longer significant
(OR = 1.30; 95% CI = 0.96, 1.76). Caretaker
overweight or obese status was significantly
associated with the child’s likelihood of being
overweight or obese (OR = 4.48; 95%
CI = 1.67, 12.03).
Caretaker social network composition was
not associated with child fruit and vegetable
intake or adolescent alcohol consumption. The
caretaker’s own reported fruit and vegetable
consumption was significantly associated with
the child’s reported intake (OR = 6.41; 95%
CI = 2.41, 17.07), whereas caretaker alcohol
consumption was not associated with adoles-
cents having tried alcohol.
 RESEARCH AND PRACTICE

was associated with the child’s odds of being

TABLE 1—Sociodemographic and Social Network Characteristics of Public Housing overweight or obese. However, this association
Residents: Montgomery County, MD, 2011 was no longer significant after the caretaker’s
Characteristic Sample own weight had been taken into account, raising
the possibility that caretaker weight mediates
Children this relationship. Other child health outcomes—
Age, y, mean (SE) 13.0 (0.2) including fruit and vegetable intake and alcohol
Female, % (SE) 48.2 (3.7) consumption—were not significantly associated
Race/ethnicity, % (SE) with caretaker social networks and might be
African American 65.2 (3.5) more affected by caretaker behavior directly,
Hispanic 21.3 (2.9) by peers, or by other factors.
White 10.8 (2.2) After the caretaker’s own health had been
Asian 2.7 (1.2) taken into account, the association between
Lives in scattered public housing, % (SE) 55.0 (3.8) caregiver social networks and child health
Years of child’s life lived in neighborhood, mean (SE) 5.8 (0.3) behaviors was significant for only 1 of the 4
Exercises at least 20 min/d, % (SE) 71.0 (3.6) behaviors tested. It is unclear why caretaker
Eats adequate fruits and vegetables, % (SE) 29.6 (3.5) alters’ exercise behavior was more strongly
Is overweight or obese, % (SE) 38.9 (3.9) related to children’s exercise behavior than
Drinks alcohol socially (adolescents only), % (SE) 16.2 (3.5) the other behaviors and health characteristics
Households we explored. Our study may not have had
Household income-to-poverty ratio (SE) 1.0 (0.1) sufficient power to detect a significant associa-
Household family structure, % (SE) tion, although the point estimates for these
1 parent 62.9 (3.5) other outcomes were close to 1. It is possible
2 parents 15.0 (2.7) that fruit and vegetable consumption is out of
Other 22.1 (3.0) children’s direct control because they typically
Caretakers do not purchase their own food and thus are
Born in US, % (SE) 65.2 (3.5) less likely to be influenced by caretaker social
Educational attainment, % (SE) networks. Supporting this possibility, and
< high school 39.7 (3.6) consistent with earlier research,24 we found
Vocational school 30.1 (3.3) a strong, statistically significant association
High school/some college/associate’s degree 19.7 (3.0) between the caretaker’s and child’s consump-
Bachelor’s or graduate/professional degree 10.6 (2.2) tion of fruits and vegetables, suggesting care-
Female, % (SE) 88.8 (2.4) takers’ high level of influence on children’s diet.
Health characteristic, % (SE) In addition, it is possible that alcohol con-
Adequate physical activity 43.3 (3.7) sumption among adolescents is more likely to
Adequate fruit and vegetable consumption 24.9 (3.2) be influenced by peer networks than by caretaker
Overweight or obese 76.1 (3.1) social networks, an issue on which the literature
Any alcohol consumption in past month 46.2 (3.7) has been mixed.62 Also, different health behav-
Social network densitya (SE) 0.3 (0.0) iors may be more or less influenced by social
Note. All estimates are weighted to produce values representative of the Montgomery County public housing population. The network effects more broadly.11 Exercise may be
sample size was n = 209. more visible in people’s neighborhoods, for in-
a
Proportion of caretaker’s social network members who knew one another and had been in contact within the preceding year. stance, whereas eating behaviors may be con-
fined mostly to the home and thus less susceptible
to social influences beyond the family.
Although we did not have sufficient statisti-
DISCUSSION among children is associated with better cal power or the longitudinal data necessary to
physical and mental health outcomes.58,59 This conduct a formal mediation analysis, including
Among children living in suburban public is particularly the case among children from the caretaker’s own health status as a covariate
housing, we found that the exercise behavior of low-income families living in public hous- did not alter the relationship between caretaker
caretakers’ alters was associated with the chil- ing,60,61 who may have less access than other social network and child exercise. However,
dren’s probability of exercising, independent of children to recreational facilities. it did alter the association between caretaker
the caretakers’ exercise regularity and the We also found that the proportion of care- social network and child obesity. This suggests
children’s own peer networks. Physical activity taker alters the caretaker perceived as overweight that caretakers’ own health behaviors are likely

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 RESEARCH AND PRACTICE

caretakers’ behaviors regardless of the extent to

TABLE 2—Mean Percentages of Caretaker Alters With Particular Health Characteristics which their perceptions accurately describe
Among Children With and Without the Corresponding Characteristic: Montgomery County, alters’ actual behaviors.65 In other words, in
MD, 2011 keeping with this theory, we assumed that the
Total, Children With Corresponding Health Children Without Corresponding Health meaning that caretakers ascribe to their alter
Network Characteristic Mean % Characteristic, Mean % Characteristic, Mean % P relationships is important in understanding the
processes by which social networks influence
Exercises regularly 20.8 22.5 16.4 .037
health and behaviors.
Has healthy eating 34.7 32.4 34.7 .678
A second limitation is that the health char-
habits
acteristics of children were not observed
Is overweight 14.2 18.1 12.3 .026
directly. As a means of reducing potential
Drinks alcohol socially 39.3 42.6 33.0 .222
measurement bias among children aged 8 to
Note. All estimates are weighted to produce values representative of the Montgomery County public housing population. 12 years, caretakers provided information on
these younger children’s health. Given that
research on weight and height measurements
among children indicates that parents may
to be important factors connecting caretaker this chain—housing policies and neighborhood overestimate children’s BMIs owing to under-
social networks and children’s health status in environments linked with caretaker social estimations of height, we may have overesti-
the case of some health outcomes. Future networks, which are in turn linked with child mated the extent to which the study children
research is critical to further disentangle the health—contributes to existing patterns of per- were overweight or obese.66 Furthermore,
potential pathways through which caretaker sistent intergenerational inequality. we assessed a limited number of health in-
social networks may be related to specific dicators; in future studies, researchers should
health outcomes. Limitations use additional measures of health characteris-
In our earlier work in Montgomery County, This study is subject to several limitations. tics and behaviors to examine the same ques-
we observed that caretakers’ social networks First, the caretaker social network measures tions. For instance, our outcome measure of
were associated with the type of public housing were based on the survey respondents’ self- adequate fruit and vegetable intake among
in which they lived.41 Geographic proximity reports and may not have reflected the actual children assessed only a single aspect of dietary
and social distance (e.g., differences in wealth health behaviors of their network members, habits and quality and did not align exactly
or educational level between residents of the although recent research suggests that egos with the defined social network characteristic
same community) can influence the develop- often provide accurate information on observ- (healthy eating).
ment of social ties.63 Our current work raises able alter behaviors.64 Nevertheless, symbolic Third, the study’s setting in Montgomery
the possibility that these social networks di- interactionist theory would argue that care- County limits its generalizability. Although
rectly and indirectly influence certain health takers’ perceptions of alters’ behaviors are Montgomery County is an affluent county,
outcomes among children. It is plausible that meaningful and have implications for understanding the factors that shape the health

TABLE 3—Associations Between Caretaker Social Network Composition and Child Health Characteristics: Montgomery County, MD, 2011

Model 1, Model 2, Model 3,

Child Health Characteristic (Outcome) Caretaker Social Network Composition (Exposure) Unadjusted ORa (95% CI) AORb (95% CI) AORc (95% CI)

Exercises every day % of caretaker’s alters who exercise regularly 1.19 (0.99, 1.44) 1.35* (1.07, 1.71) 1.34* (1.07, 1.69)
Eats adequate fruits/vegetables % of caretaker’s alters with healthy eating habits 0.98 (0.87, 1.09) 1.00 (0.89, 1.14) 0.99 (0.87, 1.13)
Is overweight or obese % of caretaker’s alters who are overweight or obese 1.32* (1.06, 1.64) 1.31* (1.00, 1.71) 1.30 (0.96, 1.76)
Drinks alcohol (adolescents only) % of caretaker’s alters who drink socially 1.10 (0.95, 1.28) 0.96 (0.70, 1.31) 0.92 (0.68, 1.23)

Note. AOR = adjusted odds ratio; CI = confidence interval; OR = odds ratio. All estimates are weighted to produce values representative of the Montgomery County public housing population. Odds ratios
estimated differences in the odds of children having a particular health characteristic with a 10% change in the percentage of caretaker alters (about 2 alters) with the corresponding health characteristic.
a
Unadjusted odds ratios regressed the outcome variable onto the percentage of caretaker alters with particular health characteristics.
b
Adjusted for child’s age, gender, race/ethnicity, and social network composition (the proportion of the child’s alters who exercise regularly, have a healthy diet, are overweight or obese, and drink alcohol
socially); the head of household’s nativity, gender, educational attainment, and social network density; and the number of years the family has lived in the neighborhood, household income-to-poverty ratio,
and family structure. In model 2, the total number ranged from 92 (in the model estimating the odds of drinking alcohol among adolescents only) to 167 (in the model estimating the odds of the child
exercising every day).
c
Adjusted control for all of the model 2 covariates along with the caretaker’s corresponding health behavior or health characteristic. In model 3, the total number ranged from 92 (in the model estimating the
odds of drinking alcohol among adolescents only) to 164 (in the model estimating the odds of the child exercising every day).
*P < .05.

November 2015, Vol 105, No. 11 | American Journal of Public Health Kennedy-Hendricks et al. | Peer Reviewed | Social Issues | 2295

of public housing residents in suburban com-
munities is critical as a result of recent trends
related to the areas where low-income residents
live.37 However, the significance of social
networks and ecologically structured social norms
in perpetuating intergenerational inequality may
be more salient among residents of isolated
neighborhoods with a greater intensity of con-
centrated poverty than among suburban public
housing residents.67,68 Finally, our study was
cross sectional, limiting our ability to assess
caretaker characteristics as mediators or to
assess causality.
Conclusions
We believe our findings raise intriguing
questions about the interconnections between
neighborhood social environments and the
health of vulnerable children. In particular, our
research suggests that caretaker social networks
might be associated with certain aspects of
children’s health independent of both caretakers’
behaviors and children’s social network compo-
sition. To the extent that social networks may be
shaped by neighborhood environments, our
work draws attention to the potentially important
influence of intergenerational social networks on
health behaviors. Interventions targeting chil-
dren’s health behaviors perhaps should consider
the larger social environment in which these
children live and learn, not only from their peers
and caretakers but also from the other adults
with whom their caretakers interact. j
About the Authors
At the time of the study, Alene Kennedy-Hendricks was
a PhD candidate at the Bloomberg School of Public Health,
Johns Hopkins University, Baltimore, MD. Heather
Schwartz, Beth Ann Griffin, Harold D. Green Jr, David
P. Kennedy, and Susan Burkhauser are with the RAND
Corporation, Santa Monica, CA. Rachel Johnson Thornton
and Craig Evan Pollack are with the School of Medicine,
Johns Hopkins University.
Correspondence should be sent to Alene Kennedy-
Hendricks, Department of Health Policy and Management,
Johns Hopkins Bloomberg School of Public Health, 624 N
Broadway St, Room 331, Baltimore, MD 21205
(e-mail: akenne27@jhu.edu). Reprints can be ordered at
http://www.ajph.org by clicking the “Reprints” link.
This article was accepted March 2, 2015.
Contributors
A. Kennedy-Hendricks and C. E. Pollack conceptualized
and designed the study and co-drafted the article. A.
Kennedy-Hendricks conducted the statistical analyses.
H. Schwartz and C. E. Pollack designed the data collec-
tion instruments and oversaw the statistical analyses.
2296 | Social Issues | Peer Reviewed | Kennedy-Hendricks et al.
RESEARCH AND PRACTICE
R. J. Thornton contributed to the conceptualization of the
study, the drafting of the article, and critical revisions
of the article. B. A. Griffin helped conceptualize and
design the study, oversaw the statistical analyses, and
provided critical revisions of the article. H. D. Green
and D. P. Kennedy helped to design the data collection
instruments and provided critical revisions of the article.
S. Burkhauser contributed to the statistical analyses and
provided critical revisions of the article.
Acknowledgments
This work was supported by the MacArthur Foundation
(grant 96241-0). C. E. Pollack was supported by the
National Cancer Institute and the Office of Behavioral
and Social Sciences of the National Institutes of Health
(grant K07 CA151910).
We thank Rachel Kleit for her advice and Matthew
Hoover for his research assistance.
Human Participant Protection
This study was approved by the institutional review
boards of the Johns Hopkins School of Medicine and the
RAND Corporation. Study participants provided written
informed consent.
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