Overview of the 2019 National Health Interview Survey Questionnaire Redesign.

Data System. Federal health surveys, like the National Health Interview Survey (NHIS), represent important surveillance mechanisms for collecting timely, representative data that can be used to monitor the health and health care of the US population. Data Collection/Processing. Conducted by the National Center for Health Statistics (NCHS), NHIS uses an address-based, complex clustered sample of housing units, yielding data representative of the civilian noninstitutionalized US population. Survey redesigns that reduce survey length and eliminate proxy reporting may reduce respondent burden and increase participation. Such were goals in 2019, when NCHS implemented a redesigned NHIS questionnaire that also focused on topics most relevant and appropriate for surveillance of child and adult health. Data Analysis/Dissemination. Public-use microdata files and selected health estimates and detailed documentation are released online annually. Public Health Implications. Declining response rates may lead to biased estimates and weaken users' ability to make valid conclusions from the data, hindering public health efforts. The 2019 NHIS questionnaire redesign was associated with improvements in the survey's response rate, declines in respondent burden, and increases in data quality and survey relevancy. (Am J Public Health. 2023;113(4):408-415. https://doi.org/10.2105/AJPH.2022.307197).

The association between air pollution and childhood asthma: United States, 2010-2015.

OBJECTIVE: The current population-based study examines the association between county-level ambient air pollution and childhood asthma. METHODS: Data from the nationally representative 2010-2015 National Health Interview Survey were linked to nationwide fine particulate matter (PM2.5) air pollution data at the county-level from the National Environmental Public Health Tracking Network which utilizes air quality monitoring stations and modeled PM2.5 measurements (Downscaler model data) and adjusted by county-level socioeconomic characteristics data from the 2010-2015 American Community Survey. Multilevel modeling techniques were used to assess the association between PM2.5 annual concentrations (quartiles < 8.11, 8.11-9.50, 9.51-10.59, ≥ 10.60 µg/m3) and current childhood asthma along with two asthma outcomes (episode in the past year, emergency room (ER) visit due to asthma). RESULTS: From 2010 to 2015, there were significant declines in PM2.5 concentrations and asthma outcomes. In unadjusted models, children living in areas with higher PM2.5 concentrations were more likely to have current asthma, ≥1 asthma episode in the past year, and ≥1 ER visit due to asthma compared with children living in areas with the lowest quartile (< 8.11 µg/m3). After adjusting for characteristics at the county, geographic, and child and family-level, significant associations remained for asthma episode, and ER visit among children living in areas with PM2.5 annual concentrations between 9.51 and 10.59 µg/m3 (3rd quartile) compared with children living in areas with the lowest quartile. CONCLUSIONS: This study adds to the limited literature by incorporating nationally representative county-, child-, and family-level data to provide a multi-level analysis of the associations between air pollution and childhood asthma in the U.S.

Correction to: Health Care Transition Planning Among Youth with ASD and Other Mental, Behavioral, and Developmental Disorders.

In the original publication of the article, Figure 1 included footnotes which duplicated information appearing in the figure caption. Therefore the notes of "NOTES: ASD = autism spectrum disorder; MBDD = mental, behavioral, or developmental disorder. Indicators presented are unadjusted estimates. x Significantly different than youth with autism spectrum disorder based on adjusted odds ratio (p < .05). y Significantly different than youth with other mental, behavioral, or developmental disorders based on adjusted odds ratio (p < .05)." have been removed. The figure 1 appearing in the original version of the article has been corrected.

Health Care Transition Planning Among Youth with ASD and Other Mental, Behavioral, and Developmental Disorders.

OBJECTIVE: To estimate the prevalence of health care transition components among youth with autism spectrum disorder (ASD) aged 12-17 using the 2016 National Survey of Children's Health (NSCH), compared to youth with other mental, behavioral, or developmental disorders (MBDDs) or youth without MBDDs. METHODS: The 2016 NSCH is a nationally and state representative survey that explores issues of health and well-being among children ages 0-17. Within the NSCH, parents of a subset of youth, ages 12-17, are asked a series of questions about their youth's eventual transition into the adult health care system. The current study explores components of this transition, comparing youth diagnosed with ASD, youth with other mental, behavioral, or developmental disorders (MBDDs), and youth without MBDDs. RESULTS: Approximately 1-in-4 youth with ASD had actively worked with their doctor to understand future changes to their health care, significantly less than youth with other MBDDs and youth without MBDDs. Fewer than 2-in-5 youth with ASD had met with their doctor privately or had a parent who knew how their youth would be insured when they reached adulthood. CONCLUSIONS: The current analysis of a nationally representative sample of youth reveals discrepancies in the proportion of youth with ASD receiving appropriate health care transition planning compared to youth with other MBDDs and youth without MBDDs. These findings suggest the potential for barriers among youth with ASD to effectively transitioning into the adult health care system.

Concordance between survey reported childhood asthma and linked Medicaid administrative records.

OBJECTIVE: Agreement between administrative and survey data has been shown to vary by the condition of interest and there is limited research dedicated to parental report of asthma among children. The current study assesses the concordance between parent-reported asthma from the National Health Interview Survey (NHIS) with Medicaid administrative claims data among linkage eligible children from the NHIS. METHODS: Medicaid Analytic eXtract (MAX) files from the Centers for Medicare & Medicaid Services (CMS) (years 2000-2005) were linked to participants of the NHIS (years 2001-2005). Concordance measures were calculated to assess overall agreement between a claims-based asthma diagnosis and a survey-based asthma diagnosis. Structural equation modeling was used to assess the association between demographic, service utilization, and co-occurring conditions factors and agreement. RESULTS: Percent agreement between the two data sources was high (90%) with a prevalence-adjusted bias-adjusted kappa of 0.80 and Cohen's kappa of 0.55. Agreement varied by demographic characteristics, service utilization characteristics, and the presence of allergies and other health conditions. Structural equation modeling results found the presence of a series of co-occurring conditions, namely allergies, resulted in significantly lower agreement after controlling for demographics and service utilization. CONCLUSIONS: There was general agreement between asthma diagnoses reported in the NHIS when compared to medical claims. Discordance was greatest among children with co-occurring conditions.

Reported Wandering Behavior among Children with Autism Spectrum Disorder and/or Intellectual Disability.

OBJECTIVE: To characterize wandering, or elopement, among children with autism spectrum disorder (ASD) and intellectual disability. STUDY DESIGN: Questions on wandering in the previous year were asked of parents of children with ASD with and without intellectual disability and children with intellectual disability without ASD as part of the 2011 Survey of Pathways to Diagnosis and Services. The Pathways study sample was drawn from the much larger National Survey of Children with Special Health Care Needs conducted in 2009-2010. RESULTS: For children with special healthcare needs diagnosed with either ASD, intellectual disability, or both, wandering or becoming lost during the previous year was reported for more than 1 in 4 children. Wandering was highest among children with ASD with intellectual disability (37.7%) followed by children with ASD without intellectual disability (32.7%), and then children with intellectual disability without ASD (23.7%), though the differences between these groups were not statistically significant. CONCLUSIONS: This study affirms that wandering among children with ASD, regardless of intellectual disability status, is relatively common. However, wandering or becoming lost in the past year was also reported for many children with intellectual disability, indicating the need to broaden our understanding of this safety issue to other developmental disabilities.

The association between early family social stressors and emotional well-being among infants and toddlers.

OBJECTIVE: Early childhood behavioral and emotional disorders are linked to diagnosable mental health problems both later in childhood and into adulthood. However, little work has examined the association between family social stressors and emotional well-being among children under two years of age, including whether differences exist between infancy and toddlerhood. METHODS: Data come from the nationally representative 2019-2022 National Health Interview Survey, an annual, cross-sectional survey conducted by the National Center for Health Statistics. Separate multivariate logistic regression models estimated associations between family social stressors (stressful life events, family food insecurity, family difficulty paying medical bills) and having a Baby Pediatric Symptom Checklist (BPSC) subscale score of 3 or more ("above the BPSC cutoff") for poorer emotional well-being among children 2-23 months. Models were additionally stratified by age group (infants, 2-11 months; toddlers, 12-23 months), and adjusted for child and family sociodemographic and geographical characteristics. RESULTS: Children who had experienced a stressful life event (AOR=3.83, 95% CI: 2.48-5.92), family food insecurity (AOR=1.69, 95% CI: 1.13-2.51), or family difficulty paying medical bills (AOR=2.10, 95% CI: 1.54-2.87) had higher odds of being above the BPSC cutoff, adjusted for all relevant covariates. Toddlers who experienced a stressful life event (66.5% vs. 41.0%) or family difficulty paying medical bills (53.1% vs. 29.8%) had higher odds of being above the BPSC cutoff compared with infants. CONCLUSIONS: Family social stressors were linked to poorer emotional well-being among young children. Future research may benefit from the exploration of additional predictors of emotional well-being among this age group.

Developing Sampling Weights for Statistical Analysis of Parent-Child Pair Data From the National Health Interview Survey.

The National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics since 1957, is the principal source of information on the health of the U.S. civilian noninstitutionalized population. NHIS selects one adult (Sample Adult) and, when applicable, one child (Sample Child) randomly within a family (through 2018) or a household (2019 and forward). Sampling weights for the separate analysis of data from Sample Adults and Sample Children are provided annually by the National Center for Health Statistics. A growing interest in analysis of parent-child pair data using NHIS has been observed, which necessitated the development of appropriate analytic weights. Objective This report explains how dyad weights were created such that data users can analyze NHIS data from both Sample Children and their mothers or fathers, respectively. Methods Using data from the 2019 NHIS, adult-child pair-level sampling weights were developed by combining each pair's conditional selection probability with their household-level sampling weight. The calculated pair weights were then adjusted for pair-level nonresponse, and large sampling weights were trimmed at the 99th percentile of the derived sampling weights. Examples of analyzing parent-child pair data by means of domain estimation methods (that is, statistical analysis for subpopulations or subgroups) are included in this report. Conclusions The National Center for Health Statistics has created dyad or pair weights that can be used for studies using parent-child pairs in NHIS. This method could potentially be adapted to other surveys with similar sampling design and statistical needs.

Mental Health Treatment Among Children Aged 5-17 Years: United States, 2021.

Mental health disorders, such as attention-deficit/hyperactivity disorder, anxiety, and behavioral conditions, are common in school-aged children in the United States (1). Frontline treatments for mental health disorders can include medication, counseling or therapy, or both, depending on the condition and the age of the child (2). This report describes the percentage of children aged 5-17 years who have received mental health treatment in the past 12 months by selected characteristics, based on data from the 2021 National Health Interview Survey. Mental health treatment is defined as having taken medication for mental health, received counseling or therapy from a mental health professional, or both in the past 12 months.

Stressful Life Events and Healthcare Utilization Among U.S. Children Aged 2-17 Years.

Objective-Associations between stressful life events (SLEs) during childhood and suboptimal healthcare access and use has been documented. Recent changes to the National Health Interview Survey's questionnaire enabled the inclusion of SLEs in the child sample, resulting in an additional national data source where SLEs can be tracked. In this report, the latest SLE estimates are examined for children aged 2-17 years in the United States and their associations with healthcare utilization. Methods-Data from the 2021 National Health Interview Survey were used to examine the percentage of children who experienced one or more SLEs-emotional abuse, unmet basic needs, experiences of racism, household mental illness, household substance abuse, parental incarceration, and exposure to neighborhood violence-and describe the association between SLEs and selected healthcare utilization indicators over the past 12 months (as in no well-child visit, emergency room visits, urgent care visits, unmet medical care needs due to cost, use of prescription medications for mental health, and use of any mental health therapy). Multivariate logistic regression models were fit to produce prevalence ratios for selected healthcare utilization indicators by SLEs, after adjusting for child and family sociodemographic characteristics. Results-In 2021, one in five children aged 2-17 years had ever experienced an SLE. In general, all SLEs were related to higher healthcare utilization (as in emergency department visits or mental health therapy) and unmet medical care needs. In general, no significant associations were found between experiencing SLEs and not receiving preventive health care. After adjusting for demographic characteristics, higher rates of healthcare utilization, unmet medical care needs, and mental healthcare utilization generally persisted for children with SLEs. Conclusion-This report expands knowledge on the relationship between childhood SLEs and the use of preventive care, healthcare utilization, and mental health care. National Health Interview Survey data can be used to monitor trends in these associations over time.

Diagnosed Allergic Conditions in Children Aged 0-17 Years: United States, 2021.

The percentage of children with certain allergic conditions has increased over previous decades (1,2). Seasonal allergies, which includes hay fever, allergic rhinitis, and allergic conjunctivitis, causes sneezing, cough, runny nose, and itchy eyes. Eczema, also known as atopic dermatitis, causes itchy, bumpy rashes and thickened skin that can appear anywhere on the body. Food allergies can cause hives, vomiting, trouble breathing, or throat tightening. Children with allergic conditions may have increased healthcare use and decreased quality of life (3). Food allergies can be life threatening (4). This report describes the percentage of children who had diagnosed seasonal allergy, eczema, or food allergy by sex, age, and race and Hispanic origin from the 2021 National Health Interview Survey (NHIS).

Diagnosed Developmental Disabilities in Children Aged 3-17 Years: United States, 2019-2021.

Developmental disabilities are common in children in the United States, and the prevalence has increased in recent years (1). Timely estimates are necessary to assess the adequacy of services and interventions that children with developmental disabilities typically need (2). This report provides updated prevalence estimates for diagnosed autism spectrum disorder, intellectual disability, and other developmental delay among children aged 3-17 years from the 2019-2021 National Health Interview Survey (NHIS), with differences in prevalence examined between years and by sex, age group, and race and Hispanic origin. Estimates are also presented for any developmental disability, defined as having had one or more of these three diagnoses.

Assessing the Validity of the Baby Pediatric Symptom Checklist Using a Nationally Representative Household Survey.

OBJECTIVE: The Baby Pediatric Symptom Checklist (BPSC) is a screening tool developed for detecting behavioral or emotional concerns among parents of children younger than 18 months. Nationally representative survey data have not yet been used to assess the validity of the BPSC, nor to evaluate its appropriateness for use among children between 18 and 23 months old. The current study assesses the validity of the BPSC using data from the National Health Interview Survey (NHIS). METHODS: Data from the 2019 NHIS were used to evaluate the 12-item BPSC screening tool among a nationally representative sample of children 2 to 23 months. Confirmatory factor analysis (CFA) and differential item functioning (DIF) were used to assess construct and predictive validity and test how response items differed by selected sociodemographics. Quantile regression was used to calculate 50th, 70th, and 90th percentiles for age-based normative curves of the previously established domains of irritability, inflexibility, and difficulty with routines. RESULTS: A 3-factor CFA produced comparable results to the original study. Tests of DIF did not reveal any significant effects for the child's sex, race and Hispanic origin, household urbanization level, number of children in family, or respondent type (mother, father, other). In addition, DIF was not found between children aged 2 to 17 months and 18 to 23 months. Age-based normative data were calculated for each subscale. CONCLUSIONS: The use of the BPSC in a nationally representative survey produced findings comparable to those of the original-validation study. The NHIS can be used to track BPSC scores over time at the population-level.

Psychiatric-related emergency department visits among children with an autism spectrum disorder.

OBJECTIVE: This study aimed to examine the prevalence and characteristics of psychiatry-related emergency department (ED) visits among children with an autism spectrum disorder (ASD), including the specific reason for visit, as well as the influence of insurance type. METHODS: Data used for this cross-sectional, observational study were obtained from the 2008 National Emergency Department Sample, the largest all-payer ED database in the United States. Psychiatry-related visits to the ED among children with ASD were identified using International Classification of Diseases, Ninth Revision, billing codes. A total of 3,974,332 visits (unweighted) were present for youth 3-17 years, of which 13,191 involved a child with ASD. RESULTS: Thirteen percent of visits among children with ASD were due to a psychiatric problem, as compared with 2% of all visits by youths without ASD. Results from the multivariate analyses revealed that the likelihood for a psychiatric ED visit was increased 9-fold (odds ratio [OR], 9.13; 95% confidence interval [CI], 8.61-9.70) among pediatric ASD visits, compared with non-ASD visits. Children with ASD who were covered by private insurance, compared with those with medical assistance, were at even greater risk for a psychiatric ED visit (OR, 1.58; 95% CI, 1.53-1.63). Visits among children with ASD were more likely to be due to externalizing (OR, 1.62; 95% CI, 1.44-1.83) and psychotic (OR, 1.93; 95% CI, 1.58-2.35) disorders compared with visits among non-ASD children. CONCLUSIONS: This study highlights the need for improving community-based psychiatric systems of care for youths with ASD to divert psychiatry-related ED visits, particularly for those children with private insurance.

Dental health of children with autism spectrum disorders: a population-based study.

Data from the 2007 National Survey of Children's Health were used to investigate how autism spectrum disorder (ASD) symptom severity and comorbidity are associated with the dental health needs of children. The results of this study help provide insights into the greater oral needs of the increasing population of children with ASD that reside in our communities and their dependency upon local practitioners for treatment.

Healthcare Access and Utilization for Young Adults With Disability: U.S., 2014-2018.

PURPOSE: Young adults with disability experience barriers to healthcare access and are at risk for not receiving needed services as they transition from pediatric to adult health systems. This study examined patterns of healthcare utilization for young adults with disability and potential barriers to receipt of care. METHODS: Data from the 2014 to 2018 National Health Interview Survey were analyzed to examine differences in service utilization, unmet need, care satisfaction, and financial worry between young adults (18-30 years) with and without disability (unweighted n = 15,710). Odds ratios were adjusted for individual, family, and interview characteristics. RESULTS: Compared to those without disability, young adults with disability were more likely to have had an emergency room visit in the past year (39.2% vs. 19.5%). They were also more likely to have a usual source of care when sick (82.2% vs. 75%). Among young adults who affirmed they had a usual place of care, those with disability were more likely to use the emergency room as their usual place of care (5.3% vs. 1.8%). A greater percentage of young adults with disability delayed medical care due to cost (19.1% vs. 8.9%) and reported an unmet medical need (21% vs. 10.2%). CONCLUSIONS: Findings highlight gaps in healthcare access for young adults with disability. Differences in healthcare utilization patterns for young adults with disability and factors that may negatively influence health outcomes for this population were found. Further research focused on the continuity of healthcare services in this age group through the healthcare transition period may provide additional insight into these discrepancies.

Assessing Anxiety and Depression: A Comparison of National Health Interview Survey Measures.

Objective-This report examines differences across two different sets of measures used to assess anxiety and depression in the National Health Interview Survey (NHIS).

Anxiety and depression symptoms among children before and during the COVID-19 pandemic.

PURPOSE: The COVID-19 pandemic caused disruptions to children's daily lives due in part to stay-at-home orders and school closures, reducing interactions with both peers and extended family. Yet, few studies with nationally representative data have explored the potential association of the COVID-19 pandemic and children's mental health. METHODS: The current study analyzed data from the 2019 and 2020 National Health Interview Survey (NHIS) to describe changes in the prevalence of symptoms of anxiety and depression before and during the first year of the pandemic among children aged 5-17 years. Changes in prevalence by child- and family-level characteristics were also examined. RESULTS: During the COVID-19 pandemic, nearly one in six children aged 5-17 years had daily or weekly symptoms of anxiety or depression, a significant increase from before the COVID-pandemic (16.7% (95% CI:15.0-18.6) versus 14.4% (95% CI:13.4-15.3)). Males, children 5-11 years, non-Hispanic children, children living in families in large metropolitan areas, incomes at or below the federal poverty level, and whose highest educated parent had more than a HS education, also showed statistically significant increases in anxiety and depression symptoms. CONCLUSIONS: NHIS data may be used to monitor this increase in mental health symptomatology and assist in identifying children at risk.

Concussions and Brain Injuries in Children: United States, 2020.

A concussion is a mild type of traumatic brain injury (1). Previous studies using national data have shown that concussion prevalence can differ by survey methodology and question wording (2). The 2020 National Health Interview Survey (NHIS) included questions on concussion to measure both symptoms and diagnosis from a health care provider to provide a more complete understanding of the public health burden, because children with mild injuries may not see a doctor or receive a diagnosis. This report presents national estimates of lifetime symptomatology and health care professional diagnoses of concussions or brain injuries as reported by a knowledgeable adult, usually a parent, in children aged 0-17 years using data from the 2020 NHIS.

Influenza Vaccination in the Past 12 Months Among Children Aged 6 Months-17 Years: United States, 2019.

Increasing the proportion of persons, including children, who are vaccinated annually against seasonal influenza is a Healthy People 2030 Leading Health Indicator (1). Vaccination is effective in preventing influenza (2), and the Advisory Committee on Immunization Practices recommends an annual influenza vaccination for children aged 6 months and over (3). This report examines the percentage of children aged 6 months through 17 years who had an influenza vaccination in the past 12 months using data from the 2019 National Health Interview Survey.