Well-being of Children and Parents: Highlights from the KFF Survey on Racism, Discrimination, and Health

In recent years, there have been growing concerns about children’s mental health and well-being, particularly since the COVID-19 pandemic and with a rise in awareness and exposure to racism and discrimination amid instances of racial injustice, including the killings of George Floyd and Breonna Taylor, and growth in anti-Asian sentiment. Previous reporting from KFF’s Racism, Discrimination, and Health Survey examined experiences with and impacts of unfair treatment and discrimination, access to and use of mental health care, and loneliness and social support networks among adults. Based on responses from parents, this analysis examines parents’ assessments of their children’s mental health and well-being, children’s use of mental health care, children’s experiences with unfair treatment, and parents’ worries about their children as well as their hopes for their future.

The analysis reveals some areas of shared challenges across parents, as well as several areas where experiences differ across race and ethnicity. For example, while similar shares of parents across racial and ethnic groups say their children’s mental health is fair or poor, a larger share of White parents (32%) compared to Black (20%), Hispanic (23%), and Asian (14%) parents report that their children have received mental health care services in the past three years. Moreover, while about half of parents of school-aged children overall say any of their children have ever been treated differently or unfairly in one of several ways, larger shares of Black (40%), Hispanic (23%), and Asian parents (26%) say such treatment occurred specifically because of their child’s race or ethnicity compared to White parents (16%). The survey further shows a strong association between these negative experiences, and parent’s reported mental health status of their children. More broadly, Black, Hispanic, and Asian parents are more worried about their children and families compared to White parents, including worries about violence and experiences with racism and discrimination. At the same time, they remain more confident that life will be better for the next generation.

The findings highlight the importance of efforts to address racial disparities in mental health care use among children, as well as the importance of addressing other factors that influence children’s health and well-being, including unfair treatment and underlying structural inequities in social and economic factors.

Parents’ Perceptions of Children’s Mental Health and Use of Mental Health Care

Black, Hispanic, and Asian parents are less likely than White parents to say their children received mental health services in the past three years. About nine in ten (88%) parents overall say their children’s mental health is excellent, very good, or good, while about one in ten (12%) report their children’s mental health as fair or poor, shares that do not differ significantly across racial and ethnic groups. White parents (32%) are more likely to say that any of their children have received mental health services in the past three years than are Hispanic (23%), Black (20%), and Asian parents (14%). Among parents overall, three-quarters (75%) of those who describe their children’s mental health as fair or poor say at least one of their children received mental health services compared to about one in five (21%) of those who say their children’s mental health is excellent, very good, or good.

About one in seven parents (14%) say there was a time in the past three years when they thought their children might need mental health services or medication but did not receive them, a share that rises to more than four in ten (45%) among parents who say their children’s mental health is fair or poor. Similar shares of Hispanic, Black, Asian, and White parents say there was a time in the past three years when their children went without needed mental health services or medication. Among all parents who say their child went without needed care, seven in ten (70%) say they tried to find a provider for their children, while three in ten (30%) did not. Overall, adults identify scheduling delays, cost concerns, difficulty finding a provider who could understand their background and experiences, lack of information, and fear and embarrassment as challenges to getting mental health care for themselves or their children.² 

Children’s Experiences with Unfair and Negative Treatment

About half of parents of school-aged children³  say any of their children have ever been treated unfairly or negatively, with larger shares of Black, Hispanic, and Asian parents than White parents attributing this treatment to their child’s race or ethnicity. The types of treatment asked about in the survey include being called names or racial slurs (32%), being treated unfairly by a teacher or other adult (31%), being hurt, threatened, or harassed in person or online (30%), or having a teacher or other adult assume something bad about them (25%). Over half of White (57%) and Black (52%) parents and nearly four in ten Asian (39%) and Hispanic (36%) parents say their children have ever had at least one of these negative experiences. Notably, four in ten Black parents (40%) and about a quarter of Asian (26%) and Hispanic (23%) parents say their child had at least one of these negative experiences and that their race or ethnicity was a major or minor reason for this treatment, compared to a smaller share of White parents (16%).

There is a strong association between reported negative experiences among children and parents’ perceptions of their children’s mental health and well-being. Parents who say their child had at least one of the negative experiences asked about in the survey are more likely to say their children’s mental health is fair or poor compared with those who say their child did not have one of these experiences (20% vs. 6%), a pattern that is consistent across racial and ethnic groups.

Many (45%) parents of school-aged children who had a negative experience say their child received mental health care in the past three years, but among these parents, Black parents are less likely than White parents to say their child received care. Perhaps reflecting greater health care access, White parents whose children who had at least one negative experience are more likely to report that their children have received mental health care services in the past three years compared to their Black counterparts (50% vs. 32%). While about four in ten (45%) parents of children who had a negative experience say their child saw a mental health care provider in the past three years, some also report unmet mental health care needs among their children. One-quarter (25%) of these parents say there was a time in the past three years when they thought their child might need mental health services or medication but didn’t get them, a share that is similar across racial and ethnic groups.

Parents’ Worries, Challenges, and Optimism

While one in five parents across racial and ethnic backgrounds say they worry about their children’s health and well-being daily or almost daily, Black and Hispanic parents are more likely than White parents to say they worry about a range of other issues affecting their families. Black (18%) and Hispanic (18%) parents are more likely to say they experience worry or stress “every day” or “almost every day” about their child being the victim of violence at their school compared to White parents (11%). Similarly, Black (16%) and Hispanic (11%) parents are more likely to say they frequently worry about the possibility of them or someone in their family being the victim of gun violence than are White (3%) parents. In addition, larger shares of Black (15%), Asian (12%), and Hispanic (7%) parents worry about experiences with racism and discrimination than do White parents (2%).

Beyond these worries, parents also express financial concerns. Overall, parents’ top worries are about work and employment (23% worry daily or almost daily), followed by providing for their family’s basic needs (21%). Likely reflecting lower household incomes, three in ten (30%) Black parents say they frequently worry about providing for their family’s basic needs, higher than the shares of Asian (20%), White (20%), and Hispanic (18%) parents who say the same.

Many parents report financial challenges that can have implications for their children’s well-being, including higher shares of Black parents. Overall, at least one in five parents across racial and ethnic backgrounds say they have had problems paying for necessities, health care, and childcare in the past year. Reflecting lower incomes and an array of underlying structural inequities, Black parents are more likely than White parents to report these challenges. For example, larger shares of Black parents (61%) say they had problems paying for food, housing, transportation, or other necessities in the past year compared to White parents (36%). Paying for health care also is a concern among parents, with at least one in four parents across racial and ethnic groups saying this has been a problem in the past year for them and their families. Moreover, at least one in five parents say they had problems finding or affording childcare, including larger shares of Black (31%) and Asian parents (29%) relative to White (21%) parents, and about one in five parents say they have had problems getting or keeping a job, with higher shares of Black (36%) and Hispanic (27%) parents reporting this than White parents (18%).

Black, Hispanic, and Asian parents are more confident than White parents that life for the next generation will be better. Six in ten or more Asian (71%), Black (64%), and Hispanic (60%) parents say they are either “very confident” or “somewhat confident” that life overall for the next generation will be better than it has been for their generation, compared to about one in three (34%) White parents who say the same. The differences in the shares of parents who say they are “very” confident are especially stark, with only 6% of White parents saying this, compared to about one in five Black (27%), Asian (26%) and Hispanic (22%) parents.

The Survey on Racism, Discrimination, and Health was designed and analyzed by researchers at KFF. The survey was conducted June 6 – August 14, 2023, online and by telephone among a nationally representative sample of 6,292 U.S. adults in English (5,706), Spanish (520), Chinese (37), Korean (16), and Vietnamese (13).

The sample includes 5,073 adults who were reached through an address-based sample (ABS) and completed the survey online (4,529) or over the phone (544). An additional 1,219 adults were reached through a random digit dial telephone (RDD) sample of prepaid (pay-as-you-go) cell phone numbers. Marketing Systems Groups (MSG) provided both the ABS and RDD sample. All fieldwork was managed by SSRS of Glen Mills, PA; sampling design and weighting was done in collaboration with KFF.

Sampling strategy:The project was designed to reach a large sample of Black adults, Hispanic adults, and Asian adults. To accomplish this, the sampling strategy included increased efforts to reach geographic areas with larger shares of the population having less than a college education and larger shares of households with a Hispanic, Black, and/or Asian resident within the ABS sample, and geographic areas with larger shares of Hispanic and non-Hispanic Black adults within the RDD sample.

The ABS was divided into areas (strata) based on the share of households with a Hispanic, Black, and/or Asian resident, as well as the share of the population with a college degree within each Census block group. To increase the likelihood of reaching the populations of interest, strata with higher incidence of Hispanic, Black, and Asian households, and with lower educational attainment, were oversampled in the ABS design. The RDD sample of prepaid (pay-as-you-go) cell phone numbers was disproportionately stratified to reach Hispanic and non-Hispanic Black respondents based on incidence of these populations at the county level.

Incentives:Respondents received a $10 incentive for their participation, with interviews completed by phone receiving a mailed check and web respondents receiving a $10 electronic gift card incentive to their choice of six companies, a Visa gift card, or a CharityChoice donation.

Community and expert input:Input from organizations and individuals that directly serve or have expertise in issues facing historically underserved or marginalized populations helped shape the questionnaire and reporting. These community representatives were offered a modest honorarium for their time and effort to provide input, attend meetings, and offer their expertise on dissemination of findings.

Translation:After the content of the questionnaire was largely finalized, SSRS conducted a telephone pretest in English and adjustments were made to the questionnaire. Following the English pretest, Cetra Language Solutions translated the survey instrument from English into the four languages outlined above and checked the CATI and web programming to ensure translations were properly overlayed. Additionally, phone interviewing supervisors fluent in each language reviewed the final programmed survey to ensure all translations were accurate and reflected the same meaning as the English version of the survey.

Data quality check:A series of data quality checks were run on the final data. The online questionnaire included two questions designed to establish that respondents were paying attention and cases were monitored for data quality including item non-response, mean length, and straight lining. Cases were removed from the data if they failed two or more of these quality checks. Based on this criterion, 4 cases were removed.

Weighting:The combined cell phone and ABS samples were weighted to match the sample’s demographics to the national U.S. adult population using data from the Census Bureau’s 2021 Current Population Survey (CPS). The combined sample was divided into five groups based on race or ethnicity (White alone, non-Hispanic; Hispanic; Black alone, non-Hispanic; Asian alone, non-Hispanic; and other race or multi-racial, non-Hispanic) and each group was weighted separately. Within each group, the weighting parameters included sex, age, education, nativity, citizenship, census region, urbanicity, and household tenure. For the Hispanic and Asian groups, English language proficiency and country of origin were also included in the weighting adjustment. The general population weight combines the five groups and weights them proportionally to their population size.

A separate weight was created for the American Indian and Alaska Native (AIAN) sample using data from the Census Bureau’s 2022 American Community Survey (ACS). The weighting parameters for this group included sex, education, race and ethnicity, region, nativity, and citizenship. For more information on the AIAN sample including some limitations, adjustments made to make the sample more representative, and considerations for data interpretation, see Appendix 2.

All weights also take into account differences in the probability of selection for each sample type (ABS and prepaid cell phone). This includes adjustment for the sample design and geographic stratification of the samples, and within household probability of selection.

The margin of sampling error including the design effect for the full sample is plus or minus 2 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. Appendix 1 provides more detail on how race and ethnicity was measured in this survey and the coding of the analysis groups. For results based on other subgroups, the margin of sampling error may be higher. All tests of statistical significance account for the design effect due to weighting. Dependent t-tests were used to test for statistical significance across the overlapping groups.

Sample sizes and margins of sampling error for other subgroups are available by request. Sampling error is only one of many potential sources of error and there may be other unmeasured error in this or any other public opinion poll. KFF public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.

1. Many surveys and data analyses classify individuals into non-overlapping racial and ethnic categories using single-race and Hispanic ethnicity categories and grouping those who identify as more than one race into a “multiracial” or “other” category. To allow for better representation of experiences of the growing shares of people who identify as multiracial, this report uses an “alone or in combination” approach for classifying individuals so that they are represented within each racial and ethnic group with which they identify, resulting in overlapping racial and ethnic categories. For example, responses from someone who identifies as both Black and Asian are included in the results for both Black adults and Asian adults. The exception is reporting on White adults, who in this report are defined as those who identify as non-Hispanic and select White as their only race. ↩︎
2. This question was asked among those who thought they or their child needed mental health care services but did not try to find a mental health care provider. See topline for full question wording. ↩︎
3. Parents of school-aged children refers to adults who said they are the parent or guardian of any child under age 18 living with them and said that at least one of their children is between the ages of 5 and 17 and currently enrolled in school. See topline for full question wording. ↩︎