Abstract Body: Background. Household economic stability may alleviate life stressors, allowing children to develop healthy behaviors which in turn will delay the decline of cardiovascular health (CVH) in the life course. Here, we aimed to quantify the associations between household economic stability and behavioral CVH in childhood.

Methods. Analyses used data from participants ages 0-18y in the Young Hearts study, an ongoing Chicago-based cohort. Guardians completed surveys on household economic stability and CVH behaviors. Household economic stability encompassed self-reported food security, perceived financial stability (based on difficulty paying for food, heating, or medical care), and having ≥6 months of savings. We calculated behavioral CVH scores by averaging scores on the behavioral components of the AHA Life’s Essential 8 (diet, physical activity, nicotine exposure, and sleep) and body mass index (BMI) score; component scores were 0-100 points each, with higher implying better CVH. Linear regression estimated associations between household economic stability and CVH adjusting for child age, sex, race, ethnicity, insurance, and household income.

Results. Of 6,892 included children and adolescents, 47.6% were female, average age was 8.7 [SD 5.5] years, 46.0% were non-Hispanic White, 65.8% were food secure, 50.6% were financially stable, and 19.1% had ≥6 months of savings. Holding household income constant, food security, perceived financial stability, and ≥6 months of savings were associated with a 3.2 (95% CI 2.4, 4.0), 2.3 (1.5, 3.0), and 2.4 (1.7, 3.2) point higher behavioral CVH score, respectively. Additionally, BMI score was higher (more favorable) across all 3 metrics (food security 9.4 [7.1, 11.6]; financial security 10.7 [8.6, 12.8]; ≥6 months of savings 6.9 [4.9, 9.0] points).

Conclusion. Household economic stability is associated with more ideal behavioral CVH and BMI in children and adolescents. Policies directed towards improving household financial stability could catalyze improvements in behavioral CVH habits that have long-term cascading impacts on lifetime CVH risk.