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.

Are there sociodemographic-specific associations of coping with heart disease and diabetes incidence?

OBJECTIVE: Psychological factors, including psychological distress and well-being, have been associated with cardiometabolic disease risk. Here, we examined whether a psychological process, namely how individuals cope with stressors, relates to such risk, which has been understudied. METHOD: During 2004-2006, 2,142 participants without heart disease and diabetes from the Midlife in the U.S. study completed a validated coping inventory assessing six strategies (positive reinterpretation and growth, active coping, planning, focus on and venting of emotion, denial, and behavioral disengagement) and relevant covariates. As a proxy for coping flexibility, participants were also classified as having lower, moderate, or greater variability in their use of these strategies. Heart disease and diabetes were documented in 2013-2015. Logistic regressions modeled adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of developing heart disease and diabetes, separately, with coping exposures. RESULTS: In sociodemographic-adjusted models, greater use of adaptive strategies predicted lower diabetes risk (e.g., positive reinterpretation and growth: AOR = 0.83; 95% CI [0.72, 0.96]); estimates were weaker for maladaptive strategies, and all strategies were unrelated to heart disease. All associations for coping variability were null. In secondary analyses, greater use of adaptive strategies predicted lower heart disease risk in more educated participants only (e.g., active coping: AOR = 0.71; 95% CI [0.55, 0.92]) and lower diabetes risk in females only (e.g., planning: AOR = 0.75; 95% CI [0.61, 0.91]). Results were maintained additionally adjusting for health, behavioral, and social factors. CONCLUSIONS: Findings suggest sex and education differences in coping's association with heart disease and diabetes. Future studies should recognize adaptive strategies may be more potent for health among certain populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Disparities in Screening for Adverse Childhood Experiences.

INTRODUCTION: Screening for adverse childhood experiences (ACEs) in the clinical setting is set to become more commonplace with continued efforts to reimburse clinicians for screening. However, an examination of disparities in ACEs screening and related attitudes and beliefs is needed. METHODS: Using the 2021 California Health Interview Survey (CHIS), this study examined if several measures of socioeconomic status, access to care and identities were associated with 3 outcomes: 1) getting screened for ACEs by a clinician; 2) beliefs about the importance of screening and 3) satisfaction with efforts to address the impacts of ACEs. Logistic regressions were used to estimate odds of the outcomes. RESULTS: Black, Latinx, and Asian individuals had lower odds of being screened for ACEs than non-Hispanic Whites. A recent doctor's visit, higher burden of ACEs, and serious psychological distress were associated with higher odds of being screened. Latinx individuals, women, bisexual individuals, those with a recent doctor's visit and those with serious psychological distress had higher odds of believing clinicians asking about ACEs was very important, relative to their counterparts. Latinx individuals, American Indian or Alaska native individuals, Asian individuals, those with higher educational attainment and those with serious psychological distress had lower odds of being very satisfied with providers' efforts to address the impact of ACEs, relative to their counterparts. CONCLUSIONS: Efforts to expand ACEs screening should consider the disparities in screening that currently exist. Given the wide-ranging impacts that ACEs have on health, an equitable approach to screening is necessary.

Lack of Reliable Transportation for Daily Living Among Adults: United States, 2022.

Access to transportation may be required for many daily tasks, including going to work, health care visits, and obtaining groceries. Previous research suggests that a lack of transportation, especially among adults who are older, uninsured, and have lower incomes, leads to reduced access to health care, which may then lead to adverse health outcomes (1,2). Using data from the 2022 National Health Interview Survey, this report describes the percentage of adults who lacked reliable transportation for daily living in the past 12 months by selected sociodemographic and geographic characteristics.

Demographic Differences in Life Dissatisfaction Among Adults: United States, 2021.

Objective-Previous work has established life satisfaction as an important indicator of overall health and well-being. This report describes differences in life dissatisfaction by selected characteristics, grouped by family income. Methods-Data from the 2021 National Health Interview Survey were used to examine the percentage of adults that were dissatisfied with life by selected demographic characteristics (age, sex, race and Hispanic origin, and nativity status [born in the United States or U.S. territory]), grouped by family income. Results-In 2021, 4.8% of adults were dissatisfied with life. In general, analyses showed significant differences by all selected demographic characteristics among adults with incomes of less than 200% of the federal poverty level. Among this group, men, adults ages 45-64, White non-Hispanic adults, Black non-Hispanic adults, and adults born in the United States were more likely to be dissatisfied with life compared with their counterparts. No significant differences in life dissatisfaction by selected demographic characteristics among adults with incomes greater than 200% of the federal poverty level were observed. Conclusion-This report presents estimates of life dissatisfaction among adults by demographic subgroups and family income. These results highlight the importance of monitoring life dissatisfaction among detailed subgroups grouped by income, in addition to the overall national estimate.

A window of opportunity: Adverse childhood experiences and time alone with a provider in the United States.

BACKGROUND: To date, there is limited literature on the relationship between Adverse Childhood Experiences (ACEs) and the quality of health care provider encounters. This is key, as people with a history of ACEs have a greater burden of illness. METHODS: This study uses data from the 2020-2021 National Survey of Children's Health to examine relationships between ACEs and (1) spending less than ten minutes with a health care provider, and (2) spending time alone with a health care provider. RESULTS: In general, our results suggested most ACEs were associated with higher odds of a provider spending <10 min with a child during their last preventative care visit, while ACEs were inconsistently related to spending time alone with a provider. Each additional ACE was found to be associated with higher odds of both outcomes. CONCLUSIONS: This work emphasizes the importance of ACEs screening in a health care setting and may set the groundwork for future research investigating mechanisms within these associations. Given the established link between health care quality and patient-provider trust, and health outcomes, intervention work is needed to develop healthcare practices that may encourage the length and quality of health care provider visits.

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.

Adverse Childhood Experiences and Family-Centered Care.

Adverse Childhood Experiences (ACEs) include experiences of child maltreatment and household dysfunction. Prior work has shown that children with ACEs may have suboptimal utilization of preventive health care, including annual well-visits, however little is known about the relationship between ACEs and quality of patient care. Using data from the 2020 National Survey of Children's Health (N = 22,760) a series of logistic regression models estimated associations between ACEs, both individually and cumulatively, and five components of family-centered care. Most ACEs were consistently associated with lower odds of family-centered care (e.g. financial hardship was associated with doctors always spend enough time with children, AOR = 0.53; 95% CI = 0.47, 0.61), except for having a parent or guardian die, which was associated with higher odds. Cumulative ACE score was also associated with lower odds of family-centered care (e.g. doctors always listened carefully to the parent, AOR = 0.86; 95% CI = 0.81, 0.90). These findings emphasize the importance of the consideration of ACEs in the context of family-centered care, and support the need for ACEs screening in the clinical setting. Future work should focus on mechanisms explaining the observed associations.

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.

The perceived neighborhood walking environment and self-reported sleep health in a nationally representative sample of the United States.

Neighborhood environment can influence sleep health; yet, there is a lack of data on specific environment features in nationally representative samples. We used the 2020 National Health Interview Survey to determine associations between perceived built and social environment factors related to pedestrian access (walking paths, sidewalks), amenities (shops, transit stops, entertainment/services, places to relax), and unsafe walking conditions (traffic, crime) and self-reported sleep duration and disturbances. Places to relax and pedestrian access were associated with better sleep health while unsafe walking conditions were associated with worse sleep health. Access to amenities (shops, transit stops, entertainment venues) had null associations with sleep health.

Health Conditions and Health Care Use Among American Indian and Alaska Native Adults by Tribal Land Residential Status: United States, 2019-2021.

Objective-This report presents estimates for selected health conditions and health care use among American Indian and Alaska Native (AIAN) adults by tribal land residential status.

Diagnosed Allergic Conditions in Adults: United States, 2021.

An allergy occurs when an individual's immune system misclassifies typically harmless substances as harmful and has a specific and reproducible immune response (1,2). The severity of allergy symptoms can range from itchy, watery eyes and hives to life-threatening anaphylaxis, and the presence of allergies can negatively impact an individual's quality of life (3-6). This report uses 2021 National Health Interview Survey (NHIS) data to describe the prevalence of seasonal allergies, eczema, and food allergies in adults in the United States.

Retrospective reports of socioeconomic disadvantage in childhood and mortality risk: are associations consistent across measures and sex?

Although prior research has established associations between childhood socioeconomic disadvantage and all-cause mortality, there is still limited research investigating (1) the consistency between subjective and objective reports of childhood socioeconomic status, (2) sex differences in the associations between childhood socioeconomic disadvantage and all-cause mortality, and (3) potential mediators within these associations. Drawing on data from the Midlife in the United States (MIDUS) cohort (N = 7425), we examined the associations between three distinct indicators of childhood socioeconomic disadvantage and all-cause mortality risk, and whether these associations differ for males and females. Among males only, lower perceived relative childhood financial status, lower levels of parents' education, and receipt of welfare during childhood were associated with excess mortality risk, adjusted for age and minority status, with adjusted hazard ratios ranging from 1.24 (95% confidence interval (CI): 1.02, 1.51) for perceived childhood financial status to 1.28 (95% CI: 1.11, 1.47) for welfare in childhood. When additionally adjusted for education, substance use, depression, and underlying health conditions, only childhood welfare status maintained an association with mortality (AHR, 1.17; 95% CI, 1.02-1.35). Mediation analyses among males revealed that education, substance use, depression, and underlying health conditions accounted for substantial proportions of these associations, ranging from 31.03 to 57.63%, across indicators of childhood socioeconomic disadvantage. Future research is needed to clarify the developmental mechanisms that lead to sex differences and identify effective strategies to intervene on the relation between childhood socioeconomic position and excess mortality risk among males.

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.

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.

Vitamin D status and its longitudinal association with changes in patterns of sleep among middle-aged urban adults.

OBJECTIVE: We examined relationships of vitamin D status with over time changes in patterns of sleep in a longitudinal study of Whites and African-American urban middle-aged adults, while further testing effect modification by age group, sex and race and the potential roles of dietary and supplemental vitamin D. METHODS: Data on 1,760 middle-aged participants in the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS study: Age range at v2: 33-71y, mean±SD:53.0±8.8, % women: 58.4%, % African-American:60.3%) were used, with complete baseline 25-hydroxyvitamin D [25(OH)D] serum concentration data, initial selected covariates and mediators, and initial and/or follow-up data on five sub-scales (sleep duration, daytime dysfunction, sleep disturbance, sleep latency and sleep quality) of the Pittsburgh Sleep Quality Index. Mean±SD time between initial and follow-up visits: 4.1±1.5 years. Time-interval multiple mixed-effects linear regression models were used. RESULTS: Upon multiple testing adjustment, among Whites, initial 25(OH)D was associated with better sleep duration [25(OH)D × TIME γ±SE: -0.027±0.011, P=0.017] and sleep quality [25(OH)D × TIME γ±SE: -0.026±0.010, P=0.008] over time, with heterogeneity by race found for both relationships (P<0.05 for 25(OH)D × TIME × Race in the un-stratified model). These relationships remained unaltered after further adjustment for dietary and supplemental vitamin D, indicating that this association may be largely explained by sunlight exposure. LIMITATIONS: Limitations included small sample size, selection bias, residual confounding and lack of objective sleep measures. Conclusions Vitamin D status, possibly through mechanisms involving sunlight exposure, was linked to a potential improvement in sleep duration and quality among White urban adults.

Leveraging 31 Million Google Street View Images to Characterize Built Environments and Examine County Health Outcomes.

OBJECTIVES: Built environments can affect health, but data in many geographic areas are limited. We used a big data source to create national indicators of neighborhood quality and assess their associations with health. METHODS: We leveraged computer vision and Google Street View images accessed from December 15, 2017, through July 17, 2018, to detect features of the built environment (presence of a crosswalk, non-single-family home, single-lane roads, and visible utility wires) for 2916 US counties. We used multivariate linear regression models to determine associations between features of the built environment and county-level health outcomes (prevalence of adult obesity, prevalence of diabetes, physical inactivity, frequent physical and mental distress, poor or fair self-rated health, and premature death [in years of potential life lost]). RESULTS: Compared with counties with the least number of crosswalks, counties with the most crosswalks were associated with decreases of 1.3%, 2.7%, and 1.3% of adult obesity, physical inactivity, and fair or poor self-rated health, respectively, and 477 fewer years of potential life lost before age 75 (per 100 000 population). The presence of non-single-family homes was associated with lower levels of all health outcomes except for premature death. The presence of single-lane roads was associated with an increase in physical inactivity, frequent physical distress, and fair or poor self-rated health. Visible utility wires were associated with increases in adult obesity, diabetes, physical and mental distress, and fair or poor self-rated health. CONCLUSIONS: The use of computer vision and big data image sources makes possible national studies of the built environment's effects on health, producing data and results that may inform national and local decision-making.

Insurance Types, Usual Sources of Health Care, and Perceived Discrimination.

INTRODUCTION: Discrimination can compromise access to and utilization of health care and lead to poorer health. As such, it is important to understand the factors associated with experiences of discrimination in health care. METHODS: Using data from the 2015 to 2017 California Health Interview Survey (n = 63,100), this study examined whether insurance types and sites of usual sources of care were associated with reasons for perceived discrimination in health care and whether the reasons were associated with delaying health care. Odds of study outcomes were calculated among insured adults using logistic regressions. Insurance coverage types and sites of usual sources of care were the main independent variables. Six reasons for lifetime discrimination in health care were examined: 1) dissatisfaction with the health care system, 2) race or skin color, 3) age, 4) way the participant speaks English or other barrier to communication, 5) insurance status or type, and 6) income or education. RESULTS: Adults with Medicaid perceived more discrimination due to race or skin color relative to those with employer-sponsored coverage. This association does not vary by race/ethnicity. Perceived discrimination due to 1) dissatisfaction with the health care system, 2) insurance status or type, and 3) barriers to communication were each associated with increased delays in getting needed medical care. CONCLUSIONS: Findings highlight potential insurance types and sources of care that could contribute to perceptions of being discriminated.