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.

Sample Design and Estimation Structures for the National Health Interview Survey, 2016-2025.

This report presents operating characteristics of the NHIS 2016-2025 sample design. The general sampling structure is presented, along with a discussion of weighting and variance estimation techniques primarily for 2016-2018. This report is organized into four major sections. The first section presents a general overview of NHIS and its sample design. The second section describes the redesign process, updates for 2016-2025, and includes general frame and sample design considerations. The third section provides a more detailed description of the sample design and how the sample was selected. The last two sections present a description of the estimators used in NHIS for analyzing and summarizing survey results. Documentation for subsequent changes to the sampling and weighting procedures is available on the NCHS website as separate reports and through each year's survey description document. This report is intended for general users of NHIS data.

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.

The Co-Occurrence of Autism Spectrum Disorder in Children With ADHD.

Objective: Children with ADHD frequently present with autism spectrum disorder (ASD) symptomatology, yet there is a notable gap in the treatment needs of this subpopulation, including whether the presence of ASD may be associated with more severe ADHD symptoms. Method: Data from the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (n = 2,464) were used to compare children diagnosed with ADHD and ASD with children with ADHD, but not ASD. Children were classified as needing treatment if it was received or their parents reported it was needed, but not received. Results: Approximately one in eight children currently diagnosed with ADHD was also diagnosed with ASD. Children diagnosed with both disorders had greater treatment needs, more co-occurring conditions, and were more likely to have a combined hyperactive/impulsive and inattentive ADHD subtype. Conclusion: These findings highlight the complexity of children diagnosed with both ADHD and ASD.

Latent Class Analysis of ADHD Neurodevelopmental and Mental Health Comorbidities.

OBJECTIVE: Many children diagnosed with attention-deficit/hyperactivity disorder (ADHD) experience co-occurring neurodevelopmental and psychiatric disorders, and those who do often exhibit higher levels of impairment than children with ADHD alone. This study provides a latent class analysis (LCA) approach to categorizing children with ADHD into comorbidity groups, evaluating condition expression and treatment patterns in each group. METHODS: Parent-reported data from a large probability-based national sample of children diagnosed with ADHD (2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome) were used for an LCA to identify groups of children with similar groupings of neurodevelopmental and psychiatric comorbidities among children with current ADHD (n = 2495). Differences between classes were compared using multivariate logistic regressions. RESULTS: LCA placed children who were indicated to have ADHD into 4 classes: (low comorbidity [LCM] [64.5%], predominantly developmental disorders [PDD] [13.7%], predominantly internalizing disorders [PID] [18.5%], and high comorbidity [HCM] [3.3%]). Children belonging to the HCM class were most likely to have a combined ADHD subtype and the highest number of impaired domains. Children belonging to the PDD class were most likely to be receiving school services, whereas children in the PID class were more likely to be taking medication than those belonging to the LCM class who were least likely to receive psychosocial treatments. CONCLUSION: Latent classes based on co-occurring psychiatric conditions predicted use of varied treatments. These findings contribute to the characterization of the ADHD phenotype and may help clinicians identify how services could be best organized and coordinated in treating ADHD.

Design and Operation of the National Survey of Children's Health, 2011-2012.

Objectives This report presents the development, plan, and operation of the 2011-2012 National Survey of Children's Health, a module of the State and Local Area Integrated Telephone Survey, conducted by the National Center for Health Statistics. Funding was provided by the Maternal and Child Health Bureau, Health Resources and Services Administration. The survey was designed to produce national and state prevalence estimates of the physical and emotional health of children aged 0-17 years, as well as factors that may relate to child well-being including medical homes, family interactions, parental health, school and after-school experiences, and neighborhood characteristics.

Factors Associated with Adoption and Adoption Intentions of Nonparental Caregivers.

Data from the 2011-2012 National Survey of Children's Health and the 2013 National Survey of Children in Nonparental Care were used to fit a multinomial logistic model comparing three groups to those who never considered adoption: those who ever considered, but are not currently planning adoption; those planning adoption; and those who adopted. Adoption may be more likely when the caregiver is a nonkin foster parent, a foster care agency was involved, and/or financial assistance is available. Those with plans to adopt but who have not adopted may face adoption barriers such as extreme poverty, lower education and being unmarried.

Health and Well-Being of Children in Kinship Care: Findings from the National Survey of Children in Nonparental Care.

This study uses nationally representative survey data to describe differences in characteristics, adverse family experiences, and child well-being among children in kinship care with varying levels of involvement with the child welfare system. Well-being is examined in the domains of physical and mental health, education, and permanency. Comparisons provide insight on kinship care arrangements inside and outside the child welfare system, as well as the variability among nonfoster kinship care arrangements.

Design and operation of the National Survey of Children with Special Health Care Needs, 2009-2010.

OBJECTIVES: This report presents the development, plan, and operation of the 2009-2010 National Survey of Children with Special Health Care Needs, a module of the State and Local Area Integrated Telephone Survey. The survey is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. This survey was designed to produce national and state-specific prevalence estimates of children with special health care needs (CSHCN), to describe the types of services that they need and use, and to assess aspects of the system of care for CSHCN. METHODS: A random-digit-dial sample of households with children under age 18 years was constructed for each of the 50 states and the District of Columbia. The sampling frame consisted of landline phone numbers and cellular(cell) phone numbers of households that reported a cell-phone-only or cell-phone-mainly status. Children in identified households were screened for special health care needs. If CSHCN were identified in the household, a detailed interview was conducted for one randomly selected child with special health care needs. Respondents were parents or guardians who knew about the children's health and health care. RESULTS: A total of 196,159 household screening interviews were completed from July 2009 through March 2011, resulting in 40,242 completed special-needs interviews, including 2,991 from cell-phone interviews. The weighted overall response rate was 43.7% for the landline sample, 15.2% for the cell-phone sample, and 25.5% overall.

Adverse family experiences among children in nonparental care, 2011-2012.

OBJECTIVE: This report presents estimates of the proportion of children who have experienced selected adverse family events by the number of biological parents in the household, with a focus on comparisons among subgroups of children in nonparental care defined by caregiver type. DATA SOURCES: Data were drawn from the 2011-2012 National Survey of Children's Health, a nationally representative telephone survey of households with children conducted by the National Center for Health Statistics. RESULTS: Children in nonparental care were 2.7 times as likely as children living with two biological parents to have had at least one adverse experience, and more than 2 times as likely as children living with one biological parent and about 30 times as likely as children living with two biological parents to have had four or more adverse experiences. More than one-half of children in foster care had experienced caregiver violence or caregiver incarceration and almost two-thirds had lived with someone with an alcohol or drug problem. Estimates for children in other nonparental care subgroups were lower than for foster care, but still elevated above those of children living with biological parents. CONCLUSIONS: Children in nonparental care, especially those in foster care, are particularly likely to have experienced adverse family events. These events could have occurred at any time in the child's life and could have preceded or contributed to the child's current living situation. Nevertheless, children in nonparental care may be vulnerable to poorer health and well-being outcomes that are often associated with having had adverse experiences.

Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007 to 2011-2012.

OBJECTIVES: This report presents data on the prevalence of diagnosed autism spectrum disorder (ASD) as reported by parents of school-aged children (ages 6-17 years) in 2011-2012. Prevalence changes from 2007 to 2011-2012 were evaluated using cohort analyses that examine the consistency in the 2007 and 2011-2012 estimates for children whose diagnoses could have been reported in both surveys (i.e., those born in 1994-2005 and diagnosed in or before 2007). DATA SOURCES: Data were drawn from the 2007 and 2011-2012 National Survey of Children's Health (NSCH), which are independent nationally representative telephone surveys of households with children. The surveys were conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics with funding and direction from the Health Resources and Services Administration's Maternal and Child Health Bureau. RESULTS: The prevalence of parent-reported ASD among children aged 6-17 was 2.00% in 2011-2012, a significant increase from 2007 (1.16%). The magnitude of the increase was greatest for boys and for adolescents aged 14-17. Cohort analyses revealed consistent estimates of both the prevalence of parent-reported ASD and autism severity ratings over time. Children who were first diagnosed in or after 2008 accounted for much of the observed prevalence increase among school-aged children (those aged 6-17). School-aged children diagnosed in or after 2008 were more likely to have milder ASD and less likely to have severe ASD than those diagnosed in or before 2007. CONCLUSIONS: The results of the cohort analyses increase confidence that differential survey measurement error over time was not a major contributor to observed changes in the prevalence of parent-reported ASD. Rather, much of the prevalence increase from 2007 to 2011-2012 for school-aged children was the result of diagnoses of children with previously unrecognized ASD.

Language and immigrant status effects on disparities in Hispanic children's health status and access to health care.

The objective of this study is to estimate Hispanic/non-Hispanic (nH)-white health disparities and assess the extent to which disparities can be explained by immigrant status and household primary language. The 2007 National Survey of Children's Health was funded by the Maternal and Child Health Bureau, and conducted by Centers for Disease Control and Prevention's National Center for Health Statistics as a module of the State and Local Area Integrated Telephone Survey. We calculated disparities for various health indicators between Hispanic and nH-white children, and used logistic regression to adjust them for socio-economic and demographic characteristics, primary language spoken in the household, and the child's immigrant status. Controlling for language and immigrant status greatly reduces health disparities, although it does not completely eliminate all disparities showing poorer outcomes for Hispanic children. English-speaking and nonimmigrant Hispanic children are more similar to nH-white children than are Hispanic children in non-English speaking households or immigrant children. Hispanic/nH-white health disparities among children are largely driven by that portion of the Hispanic population that is either newly-arrived to this country or does not speak primarily English in the household.

Design and operation of the National Survey of Adoptive Parents, 2007.

OBJECTIVE: This report presents the development, plan, and operation of the National Survey of Adoptive Parents (NSAP), a module of the State and Local Area Integrated Telephone Survey conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. NSAP was designed to produce national estimates of the characteristics, health, and well-being of adopted children and their families, the preadoption experiences of the adoptive parents, and their access to and utilization of postadoption supports and services. Funding for the survey was provided by the Office of the Assistant Secretary for Planning and Evaluation and the Administration for Children and Families, both of the Department of Health and Human Services. METHODS: The National Survey of Children's Health, 2007 (NSCH) was a random-digit-dial telephone survey of households with children under age 18 years. In households with more than one child, one child was randomly selected to be the subject of the interview. Children identified as adopted, who did not live with a biological parent and who lived in households where English was spoken, were eligible for the NSAP follow-up interview. The NSAP interview was a call-back scheduled at the end of the NSCH telephone interview. Sampled children included those adopted from other countries, from the U.S. foster care system, and from private domestic sources. Respondents were either the adoptive mother or the adoptive father. RESULTS: A total of 2,089 NSAP interviews were completed from April 2007 to July 2008. The interview completion rate (i.e., cooperation rate) for eligible respondents was 74.4%. The overall response rate, taking into account nonresponse to NSCH, was 34.6%.

Design and operation of the National Survey of Adoptive Parents of Children With Special Health Care Needs, 2008.

OBJECTIVE: This report presents the development, plan, and operation of the National Survey of Adoptive Parents of Children with Special Health Care Needs (NSAP-SN), a module of the State and Local Area Integrated Telephone Survey conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. The survey was designed to produce national estimates of the characteristics, health, and well-being of adopted children with special health care needs (CSHCN) and their families, the preadoption experiences of the adoptive parents, and their access to and utilization of postadoption services. Funding was provided by the Office of the Assistant Secretary for Planning and Evaluation and the Administration for Children and Families, both of the U.S. Department of Health and Human Services. METHODS: The National Survey of Children with Special Health Care Needs 2005-2006 (NS-CSHCN), a random-digit-dial telephone survey of households with children, included questions that identified whether the sampled child was adopted. Adopted CSHCN under age 18 in 2008 who lived in households where English was spoken were eligible for the NSAP-SN follow-up interview. The NSAP-SN interview was a follow-back telephone call 1 to 3 years after the original NS-CSHCN interview. Sampled children included CSHCN adopted from other countries, from the U.S. foster care system, and from private domestic sources. Respondents were either the adoptive mother or the adoptive father. RESULTS: A total of 1,007 NSAP-SN interviews were completed from February 2008 to July 2008. The interview completion rate (i.e., cooperation rate) for eligible respondents was 67.3%. The overall response rate, taking account of nonresponse to NS-CSHCN, was 37.7%.

Assessing a multilevel model of young children's oral health with national survey data.

OBJECTIVES: To empirically test a multilevel conceptual model of children's oral health incorporating 22 domains of children's oral health across four levels: child, family, neighborhood and state. DATA SOURCE: The 2003 National Survey of Children's Health, a module of the State and Local Area Integrated Telephone Survey conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, is a nationally representative telephone survey of caregivers of children. STUDY DESIGN: We examined child-, family-, neighborhood-, and state-level factors influencing parent's report of children's oral health using a multilevel logistic regression model, estimated for 26 736 children ages 1-5 years. PRINCIPAL FINDINGS: Factors operating at all four levels were associated with the likelihood that parents rated their children's oral health as fair or poor, although most significant correlates are represented at the child or family level. Of 22 domains identified in our conceptual model, 15 domains contained factors significantly associated with young children's oral health. At the state level, access to fluoridated water was significantly associated with favorable oral health for children. CONCLUSIONS: Our results suggest that efforts to understand or improve children's oral health should consider a multilevel approach that goes beyond solely child-level factors.

Differentiating subgroups of children with special health care needs by health status and complexity of health care needs.

OBJECTIVES: Our objective is to use the Children with Special Health Care Needs (CSHCN) Screener to identify subgroups of CSHCN differentiated by health status and complexity of need. METHODS: Data are from the National Survey of Children with Special Health Care Needs, 2001 and the National Survey of Children's Health, 2003 (conducted by the Maternal and Child Health Bureau and the National Center for Health Statistics); and the 2001 and 2002 Medical Expenditure Panel Survey, conducted by the Agency for Healthcare Research and Quality. A broad array of variables measuring health status, complexity of need, and related issues are examined by subgroupings of CSHCN. RESULTS: Relative to other CSHCN, CSHCN with functional limitations or who qualify on more CSHCN Screener items have poorer health status and more complex health care needs. They more often experience a variety of health issues; their insurance is more often inadequate; the impact of their conditions on their families is higher; and their medical costs are higher. CONCLUSION: In the absence of information on specific conditions, health status, or complexity of need, the CSHCN Screener alone can be used to create useful analytic subgroups that differ on these dimensions. The proposed subgroups, based on the type or number of CSHCN screening criteria, differentiate CSHCN by health status and complexity of health care needs, and also show differences in the impact of their conditions on their families, costs of their medical care, and prevalence of various health problems.

The impact of gaps in health insurance coverage on immunization status for young children.

OBJECTIVE: To examine the impact of full-year versus intermittent public and private health insurance coverage on the immunization status of children aged 19-35 months. DATA SOURCE: 2001 State and Local Area Integrated Telephone Survey's National Survey of Children with Special Health Care Needs (NS-CSHCN) and the 2000-2002 National Immunization Survey (NIS). STUDY DESIGN: Linked health insurance data from 2001 NS-CSHCN with verified immunization status from the 2000-2002 NIS for a nationally representative sample of 8,861 nonspecial health care needs children. Estimated adjusted rates of up-to-date (UTD) immunization status using multivariate logistic regressions for seven recommended immunizations and three series. PRINCIPAL FINDINGS: Children with public full-year coverage were significantly more likely to be UTD for two series of recommended vaccines, (4:3:1:3) and (4:3:1:3:3), compared with children with private full-year coverage. For three out of 10 immunizations and series tested, children with private part-year coverage were significantly less likely to be UTD than children with private full-year coverage. CONCLUSIONS: Our findings raise concerns about access to needed immunizations for children with gaps in private health insurance coverage and challenge the prevailing belief that private health insurance represents the gold standard with regard to UTD status for young children.

Vaccination coverage by special health care needs status in young children.

OBJECTIVE: The purpose of this study was to compare vaccination coverage among children 19 to 35 months of age with and without special health care needs overall and among demographic subgroups. METHODS: Data are from the National Survey of Children With Special Health Care Needs, a module of the State and Local Area Integrated Telephone Survey, which was sponsored by the Health Resources and Services Administration Maternal and Child Health Bureau and conducted in 2000-2002 by the Centers for Disease Control and Prevention National Center for Health Statistics. We used data from the National Immunization Survey and the National Survey of Children With Special Health Care Needs to examine immunization coverage rates for individual vaccines and an array of combined series vaccinations. The relationship between special needs and immunization status was analyzed by age, gender, and race or ethnicity of the child; the child's health insurance type; the mother's educational attainment and presence in the household; and household income relative to the federal poverty level. RESULTS: Overall, there were no significant differences between children with and without special needs for any of the individual antigens or combined immunization series. Some significant differences by special needs status were found within certain demographic subgroups. CONCLUSIONS: Our results suggest that, generally children with special health care needs have immunization rates that are very similar to typically developing children. There is some evidence that children with special health care needs are at risk for underimmunization if they are non-Hispanic white or live in an affluent household and are more likely to be immunized if they are Hispanic, poor, publicly insured, or if their mothers did not complete high school. These findings may be due to outreach or support programs that target disadvantaged children. However, it is important to note that the majority of comparisons within demographic subgroups show no significant differences between children with special health care needs and children without special health care needs.

Prevalence of children with special health care needs in metropolitan and micropolitan statistical areas in the United States.

OBJECTIVES: We estimate the prevalence of children with special health care needs (CSHCN) in 70 metropolitan and four micropolitan statistical areas across the United States. METHODS: The data are from the 2001 National Survey of CSHCN, which was sponsored by the Maternal and Child Health Bureau and conducted by the National Center for Health Statistics. Prevalence estimates were generated for 74 metropolitan and micropolitan statistical areas (M/MSAs) and 45 individual counties that were represented by at least 1,000 children in the sample. To generate the estimates, the child-level sample weights (representative at the national and state level) were recalibrated within each M/MSA and county to match Census 2000 counts of the child population by age, sex, and Hispanic ethnicity. RESULTS: M/MSA-level and county-level prevalence of CSHCN are compared with national- and state-level prevalence, and within M/MSAs and counties, prevalence is reported by age, sex and race/ethnicity. Most, but not all, M/MSA- or county-level prevalence estimates did not differ significantly from state-level estimates. Some M/MSAs and counties that did not differ from their states in overall prevalence of CSHCN did show some differences in prevalence for certain demographic subgroups. CONCLUSIONS: Metropolitan health departments and Maternal and Child Health agencies that serve urban areas may find these new small area estimates useful for program planning purposes. This study demonstrates the importance of assessing whether state estimates may approximate local area estimates of the prevalence of CSHCN.