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Health Aff (Millwood). 2019 May;38(5):729-737. doi: 10.1377/hlthaff.2018.05425.

Family Resilience And Connection Promote Flourishing Among US Children, Even Amid Adversity.

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Christina D. Bethell ( ) is a professor in the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland.
Narangerel Gombojav is an assistant scientist in the Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health.
Robert C. Whitaker is director of research and research education at the Columbia-Bassett Program of the Columbia University Vagelos College of Physicians and Surgeons, in New York, New York, and the Bassett Medical Center, in Cooperstown, New York. He is also affiliated with the Bassett Research Institute at the Bassett Medical Center, in Cooperstown.


The outcome of flourishing and its predictors have not been well documented among US children, especially those who face adversity. Using data for 2016 and 2017 from the National Survey of Children's Health, we determined the prevalence and predictors of flourishing among US children ages 6-17. A three-item index included indicators of flourishing: children's interest and curiosity in learning new things, persistence in completing tasks, and capacity to regulate emotions. The national prevalence of flourishing was 40.3 percent (29.9-45.0 percent across states). At each level of adverse childhood experiences, household income, and special health care needs, the prevalence of flourishing increased in a graded fashion with increasing levels of family resilience and connection. Across the sectors of health care, education, and human services, evidence-based programs and policies to increase family resilience and connection could increase flourishing in US children, even as society addresses remediable causes of childhood adversity.


Adverse Childhood Experiences (ACEs); Children With Special Health Care Needs (CSHCN); National Survey of Children’s Health (NSCH); child flourishing; child healt; family resilience and connection; parent coping; parent-child connection; school engagement


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