3.1 Quantitative Findings
Of the 299 caregiver-child dyads in the cohort, field observations were completed at 283 family homes. Compared to families with complete observation data, the proportion of families missing field observations was higher among those who had the lowest household income, lowest educational attainment, were food insecure, and whose primary respondent identified as non-Hispanic Black (data not shown).
The scree plot suggested two to four factors would optimally fit our data. We examined the factor loadings for each of the three structures and determined a two-factor solution was best. Eight items were assigned to the first factor. Factor one was labeled household disorganization and included items describing interior household conditions and household dynamics, such as interior noise, clutter, commotion, overcrowding with furniture, excessive telephone use, communication between household members, and overall preparedness for the study visit. Our second factor, labeled neighborhood noise, consisted of four items describing the types and amount of noise heard outside participants’ homes (Table 2).
Table 2
Factor loadings from exploratory factor analysis of environmental and household chaos indicators
|
|
Factor 1:
|
Factor 2:
|
Item No.
|
Item Name
|
Household Disorganization
|
Neighborhood Noise
|
1
|
Interior Noise Rating
|
-0.79
|
0.16
|
13
|
Cluttered Interior (Y/N)
|
0.51
|
-0.31
|
15
|
Commotion (Y/N)
|
0.84
|
-0.04
|
16
|
Interruptions (Y/N)
|
0.61
|
-0.05
|
17
|
Preparedness Rating
|
0.78
|
-0.11
|
18
|
Loud Speaking (Y/N)
|
-0.61
|
0.09
|
14
|
Crowded with Furniture (Y/N)
|
-0.40
|
0.06
|
19
|
Excessive Telephone Use (Y/N)
|
-0.47
|
0.30
|
2
|
Hear Exterior Noise Inside (Y/N)
|
0.08
|
0.75
|
3
|
Rating of Exterior Noise Audible Inside
|
-0.05
|
0.84
|
5
|
Exterior Noise Rating
|
-0.26
|
0.65
|
4
|
Noise Pollution (Y/N)
|
-0.13
|
0.45
|
6
|
Number of Changes to Household Roster
|
-0.20
|
0.05
|
7
|
Regular Mealtime Routine
|
0.23
|
-0.02
|
8
|
Number of Adults in the Household
|
0.07
|
-0.03
|
9
|
Number of Children in the Household
|
-0.26
|
-0.06
|
10
|
Caregiver Marital Status Change
|
-0.31
|
-0.11
|
11
|
Total Residential Moves
|
-0.31
|
0.06
|
12
|
Regular Bedtime Routine
|
0.34
|
-0.06
|
Note: N = 283; Exploratory factor analysis using unweighted least squares and Promax rotation; Inter-factor correlations are as follows: factors 1 & 2 = 0.17, p = 0.005; Cronbach’s Alpha 0.73 and 0.67 for household disorganization and neighborhood noise, respectively.
|
Scores were generated by summing the items assigned to each factor and internal consistency estimates were calculated (Cronbach’s Alpha = 0.73 and 0.67, respectively). Observed scores for household disorganization ranged from 8–18 and the mean score was 11.37 (SD = 2.58). Observed scores for neighborhood noise ranged from 4–12 and the mean score was 6.93 (SD = 1.89). Characteristics of the cohort were provided in Table 3.
Table 3
Descriptive statistics for child, household, and primary respondent characteristics and measures of chaos
|
Overall
|
Household Disorganization
(Range: 8–18)
|
Neighborhood
Noise
(Range: 4–12)
|
|
n
|
%
|
Mean
|
(SD)
|
P Value
|
Mean
|
(SD)
|
P Value
|
Overall
|
283
|
-
|
11.37
|
(2.58)
|
|
6.93
|
(1.89)
|
|
Child Characteristics
|
|
|
|
|
|
|
|
|
Sex
|
|
|
|
|
|
|
|
|
Boy
|
162
|
57.2
|
11.29
|
(2.46)
|
0.52
|
6.94
|
(1.88)
|
0.90
|
Girl
|
121
|
42.8
|
11.49
|
(2.73)
|
|
6.91
|
(1.91)
|
|
Household Characteristics
|
|
|
|
|
|
|
|
|
Housing Type
|
|
|
|
|
|
|
|
|
Single Family Home
|
194
|
68.6
|
10.87
|
(2.41)
|
< 0.0001
|
6.60
|
(1.83)
|
< 0.0001
|
Duplex or Condo
|
26
|
9.2
|
12.73
|
(2.49)
|
|
7.92
|
(2.02)
|
|
Apartment or Other
|
63
|
22.3
|
12.37
|
(2.66)
|
|
7.51
|
(1.76)
|
|
Number of Household Members
|
|
|
|
|
|
|
|
|
2 members
|
17
|
6.0
|
11.82
|
(2.51)
|
< 0.0001
|
7.60
|
(1.85)
|
0.43
|
3 members
|
93
|
32.9
|
10.74
|
(2.36)
|
|
7.17
|
(1.90)
|
|
4 members
|
83
|
29.3
|
10.81
|
(2.13)
|
|
6.82
|
(1.98)
|
|
5 or more members
|
90
|
31.8
|
12.47
|
(2.83)
|
|
6.74
|
(1.80)
|
|
Food Insecurity
|
|
|
|
|
|
|
|
|
Food Secure
|
239
|
84.5
|
11.18
|
(2.53)
|
< 0.01
|
6.84
|
(1.84)
|
0.03
|
Food Insecure
|
44
|
15.6
|
12.43
|
(2.59)
|
|
7.45
|
(2.06)
|
|
Income-to-Poverty Ratio
|
|
|
|
|
|
|
|
|
Less than 0.50
|
41
|
14.6
|
13.24
|
(2.60)
|
< 0.0001
|
8.07
|
(2.05)
|
< 0.0001
|
0.50–0.99
|
48
|
17.1
|
12.91
|
(2.67)
|
|
7.10
|
(1.39)
|
|
1.00-1.84
|
50
|
17.8
|
11.52
|
(2.43)
|
|
7.08
|
(1.98)
|
|
1.85–2.99
|
60
|
21.4
|
10.98
|
(2.19)
|
|
6.32
|
(1.71)
|
|
3.00 or greater
|
82
|
29.2
|
9.67
|
(1.45)
|
|
6.55
|
(1.84)
|
|
Missing
|
2
|
0.7
|
-
|
|
|
-
|
|
|
Primary Respondent Characteristics
|
|
|
|
|
|
|
|
|
Race/Ethnicity
|
|
|
|
|
|
|
|
|
Non-Hispanic white
|
149
|
52.7
|
10.58
|
(2.28)
|
< 0.0001
|
6.56
|
(1.82)
|
< 0.001
|
Non-Hispanic Black
|
104
|
36.8
|
12.48
|
(2.64)
|
|
7.48
|
(1.98)
|
|
Non-Hispanic other (includes multiple races)
|
17
|
6.0
|
11.94
|
(2.33)
|
|
7.24
|
(1.20)
|
|
Hispanic
|
13
|
4.6
|
10.92
|
(2.33)
|
|
6.23
|
(1.48)
|
|
Educational Attainment
|
|
|
|
|
|
|
|
|
High school diploma/GED or less
|
50
|
17.7
|
12.66
|
(2.41)
|
< 0.0001
|
7.96
|
(1.78)
|
< 0.0001
|
Some college
|
93
|
32.9
|
12.51
|
(2.73)
|
|
7.06
|
(1.92)
|
|
Bachelor's degree
|
66
|
23.3
|
10.23
|
(1.73)
|
|
6.29
|
(1.74)
|
|
Post-graduate degree
|
69
|
24.4
|
10.00
|
(2.01)
|
|
6.55
|
(1.75)
|
|
Missing
|
5
|
1.8
|
-
|
|
|
-
|
|
|
Endorsed Symptoms of Depression
|
|
|
|
|
|
|
|
|
No
|
257
|
90.8
|
11.27
|
(2.57)
|
0.03
|
6.89
|
(1.86)
|
0.28
|
Yes
|
26
|
9.2
|
12.42
|
(2.48)
|
|
7.31
|
(2.19)
|
|
Table 3
|
Overall
|
Household Disorganization
|
Neighborhood
Noise
|
|
n
|
%
|
Mean
|
(SD)
|
P Value
|
Mean
|
(SD)
|
P Value
|
Self-reported general health
|
|
|
|
|
|
|
|
|
Excellent
|
40
|
14.1
|
11.25
|
(2.48)
|
0.03
|
7.30
|
(2.00)
|
0.21
|
Very Good
|
104
|
36.8
|
11.06
|
(2.49)
|
|
6.81
|
(1.89)
|
|
Good
|
99
|
35.0
|
11.23
|
(2.63)
|
|
6.76
|
(1.78)
|
|
Fair/Poor
|
39
|
13.8
|
12.46
|
(2.60)
|
|
7.33
|
(2.00)
|
|
Missing
|
1
|
0.4
|
-
|
|
|
-
|
|
|
Note: Description of disorganization and neighborhood noise were derived from assessments in family homes when children were approximately 24-months of age. Higher scores are indicative of higher levels of chaos. SD = standard deviation; Household disorganization scores summarizes ratings assigned to eight items: (1) interior noise rating, (2) cluttered interior (y/n), (3) commotion (y/n), (4) interruptions (y/n), (5) preparedness rating, (6) loud speaking (y/n), (7) crowded with furniture (y/n), (8) excessive telephone use (y/n). Neighborhood noise scores summarized ratings from four items: (1) exterior noises heard from inside the home (yes/no), (2) the volume of exterior noises heard from inside the home, (3) the rating of noise heard while outside the home, and noise pollution (y/n). Food insecurity was assessed using the U.S. Department of Agriculture Food and Nutrition Service’s guidelines for measuring food security. We coded families as having food insecurity if they indicated experiencing any level food insecurity in the 12-months prior to them completing our surveys. Income-to-poverty ratio was calculated using the 2018 U.S. poverty guidelines according to household size. Depression symptomology was determined using the Center for Epidemiological Studies Depression Survey, with a score ≥ 16 indicated symptoms of depression.
|
3.2 Qualitative Findings
Household Disorganization. Concurrent with our quantitative ratings of disorganization, family homes with the highest levels of disorganization were described by researchers as environments where household members often spoke loudly or over one another or households were ill-prepared for the study visit (e.g. families were late for the visit, did not follow instructions for visit preparation, or it was apparent participating caregivers did not communicate with household members that the study visit had been scheduled to occur). Furthermore, home interiors were often cluttered, and households were tumultuous, which was often attributed to crowding (i.e., more people that the space appeared to accommodate) and heavy foot traffic in and out of the home. Example passages from ethnographies include,
“… [It] took a lot of coaxing from study staff to get any confirmations and survey/[food] orders from mom [prior to the visit]. Grandma answered the door and seemed surprised we were there. [She] spent at least 3 minutes wrangling the dogs to get them out of the way while we waited outside. There were friends of the family (according to [grandma, the friends were] 2 or 3 new moms [they were helping out ]…) making noise upstairs… Grandma [said] they were either living… there temporarily… During measurements and study activities, grandma ran in and out of the room multiple times- seemingly multitasking at opposite ends of the house. Grandma would sometimes interrupt mom during measurements or had many questions for staff. Mom and grandma yelled at each other from opposite ends of the house about changing target child's diaper for measurements...”
“The first thing I noticed upon walking in the front door was…how cluttered everything was… There were boxes of diapers, laundry, miscellaneous papers… crammed against walls and made it very difficult to get around… There were several sofas crammed into the small space, one of which was overflowing with laundry and blankets. We had to step around several kid's toys scattered across the living room floor. The kitchen… counter surfaces were completely covered in dishes, food, papers, laundry…”
Brief ethnographies also revealed themes that helped contextualize the social and material environments observed in both disorganized and organized homes (Table 4). In nearly all ethnographies from homes with high disorganization, staff wrote about children’s behaviors or energy levels. In many cases, researchers described children as being “very active” or having “a lot of energy”. Sometimes study staff noted children “running around the home” or climbing on study materials or furniture. Some children were described as “crying/screaming out of excitement…” or “demand[ing] a lot of attention from [study] staff and [caregivers]”. Such descriptions of child behavior were often coupled with staff observations of situations when caregivers attempted to bring order to the home environment unsuccessfully using approaches, such as speaking at elevated volumes or yelling across rooms to get a child’s attention. In contrast, descriptions of child behavior were mostly absent from ethnographies from homes with the lowest disorganization. However, among the most organized homes, researchers portrayed moments when caregivers were observed using specific behaviors or strategies to successfully mitigate potential disorganization within the home. This was often noted when caregivers were described as “encouraging” and “supportive” of their children as they worked through study tasks or when they responded to energetic or uncooperative children in ways that successfully calmed the child without introducing additional sources of disorganization. In one household, a mother was described as asking her excited daughter to “pause, take a deep breath, and then speak…” so she could better understand her needs.
In homes with high disorganization, staff frequently described caregivers as passive towards other household members or unengaged in visit activities. For example, one caregiver was described as “mostly passive” when she did not intervene when one child in the household was “throwing things or picking up and swinging around… three young [household] pets”. Another caregiver was described as only directly engaged with the participating child when “[complying] with the visit activities,” but not during other points of the study visit, such as transitions between activities or during preparation for mealtime. Furthermore, ethnographies from the most disorganized homes illustrated strained interactions between caregivers and children. Specifically, caregivers visibly, or audibly, expressing frustration towards their child’s actions (e.g., “mom shout[ed] ‘why?!’ several times… when [child] was crying and refusing to be measured on the stadiometer”). Other study staff wrote that caregivers “seemed to be stressed” or were “visibly frustrated” when their child struggled during the visit. These descriptions from highly disorganized homes directly contrasted with descriptions of interactions between parents and children in organized homes. In the most organized homes, staff described interactions between caregivers and children using language that was mostly positive in sentiment. For instance, one dyad seemed to enjoy shared activities as the “child giggled, or mom laughed in response to something… the child was doing”. Another family was observed “communicat[ing] a lot with one another and happily discuss[ing] their many shared interests.” One dad made comments to research staff about “how [he and the mother] were proud of the kids”. Research staff suggested that such interactions made homes feel “calm and relaxing”.
Competing caregiver responsibilities were noted in households described as highly disorganized. In such cases, caregivers shared with study staff they were rushing to get to or come from places like work, school, doctor’s visits, or were balancing other family priorities, such as medical challenges. For example, one mother shared that she “scheduled a far-away appointment 90 minutes after the set visit start time and asked [staff] at the start of the visit how long it would take to complete [the visit]”. In comparison, staff ethnographies from the most organized homes often contained passages describing preparation and prioritization of the study visit. On staff member wrote, “[the] family was very prepared for the study visit. All family members were aware we were coming and greeted us upon first interaction…. [the family] dog was put away upstairs as we had asked.” Finally, staff noted clearly defined play spaces for children within some of the homes that had the lowest ratings of disorganization. Such spaces included separate playrooms or designated spaces within a family room that was clearly marked by child play-structures, such as a small table, or a soft padded mat or rug distinguishing a space for toys and play.
Neighborhood Noise. Qualitative descriptions of neighborhood noise paralleled the quantitative scale derived from the EFA. To illustrate,
“[The] neighborhood and [the participant’s home] was very close to a very busy highway that was very loud [throughout our observation]. There was also a construction site nearby, contributing to the noise with their dump trucks that drove by-at least 3 large dump trucks went past in the 15 mins that we sat there… [While inside the home,] We could also hear noise from the highway and construction outside, especially the large trucks going by.”
“Though no cars drove through the lot during our observation, there was a constant stream of traffic down that main road and accompanying sounds of traffic. Police and ambulance sirens persisted for a few minutes and were intermittently present throughout the entire observation.”
Sources of neighborhood noise were similar across households, despite the ratings of neighborhood noise assigned by researchers. Sources included car traffic, such as distant highway noise or engines, sirens (e.g., ambulance or police sirens) and alarms (e.g., beeping from construction vehicles), air traffic, speech from people in the neighborhood, and other noises, such as dogs barking. However, among homes described as having the lowest neighborhood noise, researchers more frequently described noise as being noticeable to a lesser degree. They did this by conditioning their descriptions using words like “faint” or “muffled” or described noise as being “sporadic”, rather than persistent.
We noted two themes that were unique to households in the loudest neighborhoods (assigned to the highest quartile of neighborhood noise) (Table 4). First, in especially noisy neighborhoods, researchers more frequently described being able to hear loud ambient noises from the surrounding neighborhood while inside the participant’s home. These descriptions often included noises such as vehicles driving by, airplanes, and sirens from emergency response vehicles. In fewer instances staff described hearing neighbors talking or yelling outside. The second theme, unique to the noisiest neighborhoods, was the presence of loud music from passing vehicles. Researchers described neighborhood environments where drivers’ music was so loud, they could “feel the vibrations” from the music being played. Loud music from cars was observed when researchers were outside homes and inside homes.
We also noted two themes that were unique to the quietest neighborhoods (assigned to the lowest quartile of neighborhood noise). Researchers described neighborhood settings where geography appeared to play a role in attenuating environmental noise. Examples of geographic features include trees surrounding the neighborhood which buffered against noise, distance from the metropolitan airport, or a large parking lot or dead-end street separating the participant’s home from major sources of traffic noise. Finally, in homes that were describe as being the quietest, research staff described an overall lack of loud ambient noise. In such cases, researchers often noted the inability to hear exterior noise while inside the home.
Table 4
Codes and supporting excerpts describing social and material conditions observed during rapid participant observation
Factor
|
Parent Code
|
Supporting Excerpts
|
High Disorganization
|
|
|
|
Child Behavior
|
I endorsed commotion in the home because the [target child] had a LOT of energy and was running around the home from one end to the other, grabbing toys, riding his truck, and crying/screaming out of excitement/motioning for staff or parent to do things for him.
|
|
Passive or Unengaged Caregivers
|
Mom and children were still in pajamas and there was clutter on the floor making it difficult to navigate our things inside... Children's faces were dirty, and they went back and forth from living room to kitchen and were occasionally shouting. Mom spent most of our visit looking at her phone and playing with the youngest baby. She called the oldest over once or twice, but for the most part, he was interested in and getting into our materials. Mom did not pay much attention to what was going on in her home. She provided minimal engagement with the children and even less with us.
|
|
Strained Parent-Child Activities
|
Even when the non-preferred activities stopped, child continued to want to run around or sit in the puzzle box and resisted when we tried to direct his attention elsewhere. Mom became even more visibly frustrated during the meal but would quickly get over it and laugh it off at times. The more mom reacted to the child's outbursts, the more chaotic the environment felt.
|
|
Unsuccessful Strategies to Create Order
|
For book, child was very interested in the measurement tools still and our suitcase in the kitchen. He became very upset when Mom would not let him come to the kitchen. She became louder and louder in her requests to sit and look at the book. She sent Dad to the kitchen for a piece of candy in hopes that child would calm down. He did not. Eventually she gave in and let him come to the kitchen to see. She brought him back but was not able to get him to focus on the book much. The puzzles were a similar scenario. Mom got louder and louder to try to keep him engaged in the activity, but he still ran to the kitchen several times and she would yell for him to come back.
|
|
Competing Caregiver Responsibilities
|
Dad was very difficult to get a hold of due to his crazy work hours. Mom tried to reschedule and cancel the visit on his behalf multiple times. After some prompting and a few Saturday calls, dad confirmed a date and did the survey before the visit.
|
Low Disorganization
|
|
|
|
Positive Parent-Child Interactions
|
The home feels extremely inviting and a nurturing place for young children to grow. Mom listened to child throughout their meal and asked child questions as if they were engaged in a discussion. Mom genuinely laughed with child and genuinely seems to enjoy her time with child- and child with mom. Mom calmly redirected behaviors when child behaved less favorably. All interactions were positive and in a respectable tone.
|
|
Successful Strategies to Create Order
|
[The target child] was still asleep from the car ride home. Dad and Mom chatted a bit and Dad held [target child] until he had to get ready to leave. [Target child] was hard to measure, but Mom was very persistent in trying to get him to be cooperative. She calmly talked to him and encouraged him, while also responding to his desires and frustrations.
|
|
Visit Preparation
|
Mom did everything ahead of time and even prepped a supplementary meal… The cat was also put away before we got there… Mom remembered [staff] from their first visit… dad greeted [staff]…and introduced himself.
|
|
Designated Space for Children
|
[The] house has front playroom for kids, lots of toys but very organized - toys were in colored bins, stacked on bookshelves, arranged in specific areas. Small teepee the child received for her birthday recently, small child's table & tea-set.
|
Table 4. Continued…
|
Factor
|
Parent Code
|
Supporting Excerpts
|
High Noise
|
|
|
|
Neighborhood Noise Heard while Inside the Home
|
Some noise from the freeway was persistently audible throughout the visit. It got slightly more noticeable towards the end and I could feel the vibrations from the cars from inside the home
|
|
Loud Music from Passenger Vehicles
|
Two cars pulled in at different times that had their music turned up very loud so that we could hear it out of the vehicle and feel the bass.
|
Low Noise
|
|
|
|
Geographic Barriers to Noise
|
Since the home was in a cul-de-sac, there were no cars that had to drive by unless they were from that street and coming/going. I felt like this really contributed to the fact that it was very quiet.
|
|
Lack of Loud Ambient Noises
|
…cars [could not] be heard from the back of the home or the front where we were seated during mealtime. No outdoor sounds whatsoever [were] noticeable.
|