Physician Office Visits by Children for Well and Problem-focused Care: United States, 2012.

KEY FINDINGS: Data from the National Ambulatory Medical Care Survey, 2012 •Physician office visit rates for well care were lower for school-aged (those aged 6-11 years) children (31 per 100 population) and adolescents aged 12-17 years (29 per 100 population) than for younger children (349 and 74 per 100 population for children under age 1 year and 1-5 years, respectively). •Visit rates for well and problem-focused care were highest for general pediatricians (59 and 173 per 100 population) compared with other primary (7 and 25 per 100 population) and specialty care providers (1 and 24 per 100 population) across all age groups. •Among school-aged and adolescent children, a higher percentage of well-care visits had recommended height, weight, and blood pressure measurements recorded, compared with visits for problem-focused care.

Parents' mood and the content of pediatric care for young children.

OBJECTIVE: To assess the relationship between parents' mood and the provision of anticipatory guidance by pediatric health care providers. DATA SOURCE: Data analyzed were from the National Survey of Early Childhood Health, a cross-sectional nationally representative survey concerning young children 4-35 months of age (n = 2068). KEY VARIABLES: Parents were asked whether the children's health care providers had discussed 10-12 age-appropriate health promotion topics and 5 psychosocial issues during the past 12 months. Parents also identified missed opportunities for guidance (ie, topics not discussed for which discussion would have been helpful) and reported whether providers should discuss psychosocial issues. Parents' mood was assessed using factor scores derived from the Mental Health Inventory. ANALYSES: Log-linear regression analyses determined if parents' mood was a significant predictor of the number of topics and issues discussed, the number of missed opportunities, and the reported number of issues that providers should discuss. RESULTS: Parents who were more often in a positive mood discussed more health promotion topics (B =.06, P <.001) and psychosocial issues (B =.10, P <.01) with their child's health care providers. Parents who were more often in a negative mood identified more missed opportunities (B =.08, P =.02) and more issues that providers should discuss (B =.04, P <.001). CONCLUSIONS: Increased attention to parents' mood and emotional well-being may help pediatricians identify parents who desire additional anticipatory guidance and ensure that opportunities for the provision of guidance are not inadvertently missed.

Design and operation of the National Survey of Children's Health, 2007.

OBJECTIVES: This report presents the development, plan, and operation of the 2007 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. This survey was designed to produce national and state-specific prevalence estimates for a variety of physical, emotional, and behavioral health indicators and measures of children's experiences with the health care system. The survey also includes questions about the family (for example, parents' health status, stress and coping behaviors, family activities) and about respondents' perceptions of the neighborhoods where their children live. Funding and direction for this survey was provided by the Maternal and Child Health Bureau of the Health Resources and Services Administration. METHODS: A random-digit-dialed sample of households with children under age 18 years was selected from each of the 50 states and the District of Columbia. One child was randomly selected from all children in each identified household to be the subject of the survey. The respondent was a parent or guardian who knew about the child's health and health care. RESULTS: A total of 91,642 interviews were completed from April 2007 to July 2008. Nearly 80% of the interviews were completed in 2007. Interviews were completed in 66.0% of identified households with children. The weighted overall response rate was 46.7%. A data file has been released that contains demographic information on the selected child, substantive health and well-being data for the child and his or her family, and sampling weights. Estimates based on the sampling weights generalize to the noninstitutionalized population of children in each state and nationwide.

Design and operation of the Survey of Adult Transition and Health, 2007.

OBJECTIVES: This report documents the survey design and operating procedures for the 2007 Survey of Adult Transition and Health (SATH). Sponsored by the Maternal and Child Health Bureau of the Health Resources and Services Administration, SATH was conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics as a module of the State and Local Area Integrated Telephone Survey program. A follow-back survey design was used to attempt to locate and contact 10,933 eligible cases originally identified in the 2001 National Survey of Children with Special Health Care Needs (NS-CSHCN). These data examine the transition experience of adolescents as they switched from pediatric health care providers to those that treat adults only. Eligible persons were aged 14-17 years as of 2001, had at least one special health care need, and lived in English-speaking households. In 2007, these cases involved young adults aged 19-23. State estimates cannot be obtained from SATH. METHODS: Telephone numbers sampled in 2001 were dialed to locate the 2001 NS-CSHCN respondent. This person was asked for current contact information for the eligible SATH young adult to be contacted directly. Data were collected from June 12 through August 26, 2007. RESULTS: Although we were unable to contact 7409 (68%) of the 2001 parent/guardian respondents, almost all of the young adults we were able to contact participated (98%). The SATH public-use microdata file contains interview data collected in 2007 from 1,865 young adults, along with variables from the 2001 NS-CSHCN public-use file. The unweighted interview completion rate was 17.5%.

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.

Design and operation of the National Asthma Survey.

OBJECTIVES: This report presents detailed information on the National Asthma Survey (NAS), a module of the State and Local Area Integrated Survey program conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics. NAS, sponsored by the CDC's National Center for Environmental Health, was designed to produce national prevalence estimates of adults and children with asthma; to describe the health, socioeconomic, behavioral, and environmental predictors that relate to controlling asthma better; and to characterize the content of care and limitations of persons with asthma. National prevalence estimates were constructed to be consistent with those produced from the CDC's National Health Interview Survey (NHIS), although prevalence estimates for subpopulations may or may not be consistent with NHIS. METHODS: Two separate random-digit-dial telephone studies were fielded: a national study and a four-state study in Alabama, California, Illinois, and Texas. Children aged 0-17 years and adults aged 18 years and over were included in both studies. The screening procedure differed between the studies. Percentages can be generated for the four states combined or for each state separately. A substudy was conducted in the national study to examine the accuracy of proxy reports of asthma. RESULTS: Data were collected from February 2003 to March 2004. A total of 955 detailed asthma interviews were completed in the national study and 5,741 in the four-state study. A data file has been released for each study that contains asthma, health, and demographic data, as well as sampling weights. The weighted overall response rates were 47.2% for the national sample and 48.5% for the four-state sample.

Unworried parents of well children: a look at uninsured children who reportedly do not need health insurance.

OBJECTIVES: We examined the characteristics of uninsured children from low-income households whose parents reported that health insurance coverage was not needed. METHODS: With data from the 2001 National Survey of Children With Special Health Care Needs, we used logistic-regression analyses to investigate the odds of reporting that uninsured children do not need insurance for various sociodemographic groups and children of varying health status. We also explored the odds of health care use, awareness of Medicaid and the State Children's Health Insurance Program (SCHIP), and desire to enroll according to the reported need for insurance. RESULTS: Parents of 6.8% of uninsured children from low-income households reported that their children did not need insurance. Rates were highest for American Indian/Alaska Native children (15.2%) and children whose parents completed the interview in a non-English language (10.6%). Rates were lowest for children with special health care needs (2.8%) and children with > or =7 school absences attributable to illness or injury in the past year (2.6%). Relative to children with another reason for lacking insurance, children who reportedly did not need insurance were less likely to have needed (adjusted odds ratio: 0.49) or used (adjusted odds ratio: 0.45) health care services in the past year and their parents were less likely to have heard of Medicaid or SCHIP (adjusted odds ratio: 0.58) or to have a desire to enroll their children if their children were eligible for Medicaid or SCHIP (adjusted odds ratio: 0.25). CONCLUSIONS: Increasing participation among uninsured children whose parents do not perceive a need for insurance coverage may require more than simply increasing knowledge about the availability of public insurance programs.