Differences in Health Care Among Children Aged 2–8 Years in Rural and Urban Areas

Mental health is a critical component of physical health and development. The onset of mental, behavioral, and developmental disorders (MBDDs) often occurs in childhood. Nationally representative data suggest that 15% of U.S. children aged 2–8 years (i.e., early childhood, as defined by Healthy People 2020 [HP2020]) ( 1 ) have a parent-reported MBDD diagnosis ( 2 ). Treating these conditions early is important; an HP2020 objective sets a national target for 76% of all children with mental health problems to receive treatment ( 1 ). Factors associated with having a parent-reported MBDD diagnosis in early childhood include inadequate insurance coverage, lacking a medical home (patient-centered, coordinated primary care model), fair or poor parental mental health, financial difficulties (i.e., “very hard to get by on your family’s income—hard to cover the basics like food or housing”), employment difficulties because of child care issues, living in a neighborhood lacking social support (i.e., neighbors who “help each other out,” “watch out for each other’s children,” and can be “count[ed] on” and “trusted to help my child”), and living in a neighborhood with limited amenities (i.e., no sidewalks, parks or playgrounds, recreation or community centers, or libraries) or in poor condition (i.e., with litter or garbage on the street or sidewalk, poorly kept housing, or vandalism ( 2 ). Understanding how these factors are associated with mental health among young children in different types of communities might help those who are developing prevention and intervention programs.

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