Family structure and child well-being: dads make a difference.

Objectives:* Review current trends in family structure.* Identify research and demographic findings that link child well-being to family structure.* Recognize the health benefits of fathers.* Examine the role of physicians and community organizations in addressing family environments.Many of social concerns are associated with personal and familial patterns. Educational attainment, obesity, cardiovascular disease, mental health problems, substance abuse and violence have all been recognized for their strong links to family experiences and routines. A number of years ago a clinic noted that there were significant "dropouts" from their obesity program. On closer evaluation, some similarities were noted with the "drop-out" group: they we likely to have experienced a difficult childhood, and often abuse.The Adverse Childhood Experiences Study (ACE) developed out of the obesity clinic observation. Kaiser Permanente and the Centers for Disease Control began a study that followed 17,000 patients. The information obtained is enlightening but not surprising. Seventeen risk areas associated with abuse, neglect and household dysfunction were identified. The more risks, or adverse childhood experiences, experienced by a person, the greater the possibility that they would have social, emotional or cognitive impairment. The impairments often led to high risk behaviors (drugs, sex, school failure, etc.) which increased the incidence of significant illness or disability.The information about this progression is not new. All of us have watched neighbors, friends and loved ones endure abuse or dysfunction, then succumb to social or mental health problems leading to poor choices and disease. The connections are "official research findings" now.Health Promotion: the next big question is: "how can we intervene?" or "how can we improve health?" For years health promotion believed that the cure to smoking or asthma or diabetes or drug use was through education. If we just let people know "this is your brain" and "this is your brain on drugs," people are smart enough that they will just do what is right.When education failed to modify health behaviors, we thought the magic bullet was motivation. If we align the messaging with the values of the person, or we scare them, or we promise good things as a result of good decisions, surely people will make good choices.Education and motivation can change a few patterns, but short-term behavioral changes in around 10-15% or the population are considered a good outcome. Health promotion advocates recognized that promoting health skills might improve outcomes. But even with the combined efforts of education, motivation and skills, condom education programs were failing to significantly modify patterns, even when the issue is potentially life and death, as noted in many of the HIV/condom programs.Support Systems: What does determine health behaviors? The root of most personal patterns is the family. The routines of sleep, the patterns of tooth care, the choice of foods, daily activity patterns, and models of communicating and coping with stress are all "caught" not "taught." When a society fails to support the support system that creates health patterns, it should not be surprised that health patterns fail.Health Interventions Do Not Predict Wellness: Relationships Predict Wellness Because Relationships Support Sustained Behaviors.The Paradigms of Baby Boomers:* Marriage is old fashioned and confining.* Open relationships are healthier and more conducive to personal development.* Fathers are nice but not necessary* It is better to live with a single mother than with unhappy married parents.* The kids will be okay; they are flexible.* Financial disparities are the reason for differences in health and school achievement.In other words, Baby Boomers created skepticism regarding relationships. …