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.

An Expanded Approach to the Ascertainment of Children and Youth With Special Health Care Needs.

OBJECTIVE: To describe the prevalence, characteristics, and health-related outcomes of children with diagnosed health conditions and functional difficulties who do not meet criteria for having a special health care need based on the traditional scoring of the Children with Special Health Care Needs (CSHCN) Screener. METHODS: Data come from the 2016 to 2021 National Survey of Children's Health (n = 225 443). Child characteristics and health-related outcomes were compared among 4 mutually exclusive groups defined by CSHCN Screener criteria and the presence of both conditions and difficulties. RESULTS: Among children who do not qualify as children and youth with special health care needs (CYSHCN) on the CSHCN Screener, 6.8% had ≥1 condition and ≥1 difficulty. These children were more likely than CYSHCN to be younger, female, Hispanic, uninsured, privately insured, living in a household with low educational attainment, have families with more children and a primary household language other than English. After adjustment, non-CYSHCN with ≥1 conditions and ≥1 difficulty were less likely than CYSHCN, but significantly more likely than other non-CYSHCN, to have ≥2 emergency department visits, have unmet health care needs, not meet flourishing criteria, live in families that experienced child health-related employment impacts and frustration accessing services. Including these children in the calculation of CYSHCN prevalence increases the national estimate from 19.1% to 24.6%. CONCLUSIONS: Approximately 4 million children have both a diagnosed health condition and functional difficulties but are not identified as CYSHCN. An expanded approach to identify CYSHCN may better align program and policy with population needs.

Chronic School Absenteeism for Health-related Reasons Among Children Ages 5‒17 Years: United States, 2022.

Chronic school absenteeism can lead to poorer academic performance and school engagement for students (1). It is also a risk factor for school dropout (2,3), which is associated with many long-term health impacts (4,5). This report uses data from the 2022 National Health Interview Survey (NHIS) to describe the percentage of children ages 5‒17 who experienced chronic school absenteeism due to illness, injury, or disability by sociodemographic and health factors.

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 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.

Sleep Medication Use in Adults Aged 18 and Over: United States, 2020.

Sleep medications are a common treatment option for insomnia (1). Insufficient sleep is associated with many negative mental and physical health outcomes, including type 2 diabetes, heart disease, obesity, depression, and an increased risk of injury (2). The prevalence of sleep difficulties and use of sleep medication has differed between men and women (3-5). This report uses 2020 National Health Interview Survey (NHIS) data to describe the percentage of men and women who used medication for sleep, defined here as taking any medication to help fall or stay asleep most days or every day in the past 30 days, by selected sociodemographic characteristics.

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).

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.

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.

Organized Sports Participation Among Children Aged 6-17 Years: United States, 2020.

Sports team participation has been associated with increased levels of physical activity (1) and improved physical and mental health among children and adolescents (2,3). Disparities in sports participation have been found across age, sex, race, disability, and socioeconomic subgroups (4-6). This report describes national estimates of parent-reported organized sports participation during the past 12 months among children aged 6-17 years. Data from the 2020 National Health Interview Survey (NHIS) are analyzed by sociodemographic characteristics.

Sleep Difficulties in Adults: United States, 2020.

The American Academy of Sleep Medicine and the Sleep Research Society recommend adults sleep at least 7 hours a night (1); over one-quarter of adults do not meet this recommendation (2). Signs of good sleep quality include taking less time to fall asleep and not waking up often or for long periods (3). This report uses 2020 National Health Interview Survey (NHIS) data to describe the prevalence of sleep difficulties, defined here as trouble falling or staying asleep most days or every day in the past 30 days, among adults in the United States by sociodemographic and geographic characteristics.

Regular Bedtimes Among Children Aged 5-17 Years: United States, 2020.

The American Academy of Sleep Medicine recommends 9-12 hours of sleep for children aged 6-12 years and 8-10 hours for those aged 13-18 (1), yet only two-thirds of children meet these recommendations (2). This report uses 2020 National Health Interview Survey (NHIS) data to describe regular bedtimes, defined as going to sleep at the same time most days or every day in a typical school week, among children aged 5-17 years. Estimates are presented by sociodemographic characteristics, family type, Social Vulnerability Index (SVI), family income, and urbanicity of residence.

Mental Health Surveillance Among Children - United States, 2013-2019.

Mental health encompasses a range of mental, emotional, social, and behavioral functioning and occurs along a continuum from good to poor. Previous research has documented that mental health among children and adolescents is associated with immediate and long-term physical health and chronic disease, health risk behaviors, social relationships, education, and employment. Public health surveillance of children's mental health can be used to monitor trends in prevalence across populations, increase knowledge about demographic and geographic differences, and support decision-making about prevention and intervention. Numerous federal data systems collect data on various indicators of children's mental health, particularly mental disorders. The 2013-2019 data from these data systems show that mental disorders begin in early childhood and affect children with a range of sociodemographic characteristics. During this period, the most prevalent disorders diagnosed among U.S. children and adolescents aged 3-17 years were attention-deficit/hyperactivity disorder and anxiety, each affecting approximately one in 11 (9.4%-9.8%) children. Among children and adolescents aged 12-17 years, one fifth (20.9%) had ever experienced a major depressive episode. Among high school students in 2019, 36.7% reported persistently feeling sad or hopeless in the past year, and 18.8% had seriously considered attempting suicide. Approximately seven in 100,000 persons aged 10-19 years died by suicide in 2018 and 2019. Among children and adolescents aged 3-17 years, 9.6%-10.1% had received mental health services, and 7.8% of all children and adolescents aged 3-17 years had taken medication for mental health problems during the past year, based on parent report. Approximately one in four children and adolescents aged 12-17 years reported having received mental health services during the past year. In federal data systems, data on positive indicators of mental health (e.g., resilience) are limited. Although no comprehensive surveillance system for children's mental health exists and no single indicator can be used to define the mental health of children or to identify the overall number of children with mental disorders, these data confirm that mental disorders among children continue to be a substantial public health concern. These findings can be used by public health professionals, health care providers, state health officials, policymakers, and educators to understand the prevalence of specific mental disorders and other indicators of mental health and the challenges related to mental health surveillance.

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.

Dental Care Utilization Among Children Aged 1-17 Years: United States, 2019 and 2020.

The American Academy of Pediatric Dentistry recommends regular preventive dental examinations and cleanings for children starting from the time their first tooth appears or by age 1 year (1). In 2020, dental practices adjusted their services in response to the COVID-19 pandemic, and access to dental care was disrupted for many Americans (2,3). This report uses data from the 2019 and 2020 National Health Interview Survey (NHIS) to describe recent changes in the prevalence of dental examinations or cleanings in the past 12 months among children aged 1-17 years by selected sociodemographic characteristics.

Urgent Care Center and Retail Health Clinic Utilization Among Adults: United States, 2019.

Urgent care centers and health clinics within grocery or retail stores can provide acute health care services for nonemergencies, and they can also provide preventive care services, such as routine vaccinations (1). The availability and utilization of urgent care has risen dramatically in recent years (1,2). This report examines urgent care center and retail health clinic visits among adults in the past 12 months by sex and selected characteristics.

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.

Comparing prevalence estimates of concussion/head injury in U.S. children and adolescents in national surveys.

BACKGROUND AND OBJECTIVES: Reports on pediatric lifetime concussions/head injuries (LCHI) from national surveys have offered estimates on prevalence that range from 2.5% to 18% in the general population. The purpose of this study is to examine national surveys to compare methodologies and limitations pertaining to LCHI data collection. METHODS: Three nationally representative surveys that measure LCHI in children, including the National Survey of Children's Health, the National Health Interview Survey, and the Monitoring the Future Survey were examined. Children were grouped by ages 3-17 years and adolescent ages 13-17 years, stratified by selected demographic characteristics. Participants in the surveys included parents (NSCH and NHIS) and adolescents (MTF survey). The primary outcome measure is an estimate of LCHI in children. RESULTS: Estimates of prevalence of LCHI ranged from 3.6% to 7.0% for children ages 3-17 years and from 6.5% to 18.3% for adolescents 13-17 years. Survey modality, question wording, and respondent may contribute to differing estimates. Prevalence showed consistent variation by age, sex, and race/ethnicity across surveys. Associations were inconsistent between LCHI and insurance status, parental education, and household primary language. CONCLUSIONS: Although there are methodological differences in capturing pediatric LCHI across surveys, the prevalence estimates and correlational associations generated can offer awareness about the burden of these injuries and insights to research and clinical care.

Urgent Care Center and Retail Health Clinic Utilization Among Children: United States, 2019.

In recent years, urgent care centers and health clinics within grocery or retail stores have been delivering health care services to an increasing number of children and adults (1-3). Urgent care centers and retail health clinics may be able to deliver preventive care, such as routine vaccinations, and nonemergency acute or after-hours care (3-5). This report describes the utilization of urgent care centers or retail health clinics in 2019 among children aged 0-17 years in the past 12 months by selected characteristics.

Prevalence of Multiple Chronic Conditions Among US Adults, 2018.

This analysis provides prevalence estimates of diagnosed single and multiple (≥2) chronic conditions among the noninstitutionalized, civilian US adult population. Data from the 2018 National Health Interview Survey (NHIS) were used to estimate percentages for US adults by selected demographic characteristics. More than half (51.8%) of adults had at least 1 of 10 selected diagnosed chronic conditions (arthritis, cancer, chronic obstructive pulmonary disease, coronary heart disease, current asthma, diabetes, hepatitis, hypertension, stroke, and weak or failing kidneys), and 27.2% of US adults had multiple chronic conditions.