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26 Hardships in America
apply our criteria to both in-home and center-based care.
There are two ways to measure child care quality. The first is to measure the
child care process through the observation of the child care setting. The second
is through examining structural measures that are related to the quality of care,
such as the child-to-adult ratio, the group size, and caregiver education and
training. These structural measures of quality have been shown to be correlated
with process measures of quality and have been shown to be related to concurrent
(short-term) and long-term child outcomes (Vandell and Wolfe 2000). Due to
the limitations of the data, we are able to use only structural measures of child
care quality. The structural measures provide an indication of the adequacy of
the family’s child care, but are not sufficient to truly measure child care quality.
The structural measure of child care quality we use is child-to-adult ratio.
We measure child care quality (reported in the NSAF) by the child-to-adult
ratio in the child care setting, based on the recommendations of the American
Academy of Pediatrics and the American Public Health Association. These
recommendations range from three children to one adult for children one year
or younger to 12 children for every adult for 9- to 12-year-olds.
For school-age children, we look at the type of non-school care a child
receives, which has been shown to influence a variety of aspects of a child’s
well-being (Capizzano, Adams, and Tout 2000). We use two measures of quality:
whether the child cares for himself or herself and whether the child is involved
in activities. Children who care for themselves during non-school hours are
placed at a greater risk for physical and psychological harm and are at a greater
risk for being victims of crime. Self-care has also been linked to poor school
performance, behavioral problems, and an increased chance of engaging in
risky behaviors such as smoking, alcohol and drug use, sexual activity, and
crime. Children involved in extracurricular activities and enrichment programs
have been shown to perform better in school and to adjust better socially.
The variables used to determine if a family is experiencing a serious child
care hardship include:
• whether the child-to-adult ratio is less than that recommended by the
American Academy of Pediatrics and the American Public Health
Association (American Public Health Association and American Academy
of Pediatrics 1992) (NSAF).
• whether a child has cared for himself or herself in the past month or stayed
alone with a sibling under 13 years old (NSAF).
• whether a child was involved in any enrichment activities (NSAF).
2.3.5 Hardships indices
To compare the proportion of families experiencing hardships, we construct
two hardship indices. The index of critical hardships includes:
• whether anyone in the family goes without necessary medical care (NSAF