National Survey Of Children Research Articles

Parental Perceived Need for Counseling for Adolescents’ Anxiety and Depression Symptoms: A Cross-Sectional Study

Objective This study examined the association between parental perceived need for counseling or mental health care services and adolescents’ subgroups of anxiety and depression symptoms (Anxiety-only, Depression-only, Anxiety-Depression, and None). Method Adolescent sample (N = 20,486, M = 14.69 years old, SD = 1.69) was drawn from the National Survey of Children’s Health 2017–2018 (NSCH 2017–2018). A chi-square test was used to analyze the association between two categorical variables. Results The Chi-square test was statistically significant, Χ 2(6) = 7,914.33, p < .01, V = .44. Adolescents from the Anxiety-Depression group received counseling or mental health care the most (80.94%), while 69.03% of those in the depression-only group and 44.86% in the Anxiety-only group received mental health services. Conclusions Caregivers of adolescents with Anxiety-only tended to perceive the least need for counseling or mental health care, compared with those with depression or both, suggesting the need to enhance mental health awareness.

A Causal Model of Children’s Vicarious Traumatization

Children may be vicariously traumatized from learning about the trauma of family and friends. To date, a causal model of children’s vicarious traumatization has not been empirically validated in the literature. This paper fills the gap in the literature by reporting on the direct effect of vicarious trauma on children independent of caregiving impairment. Data for the study came from the National Survey of Children’s Exposure to Violence I (NATSCEV I). This unique dataset features two indicators of vicarious trauma exposure: (1) family victimization and (2) community violence. Hierarchical multiple regression was conducted in order to control for nuisance variables such as caregiver impairment, defined as the degree of warmth or hostility; time elapsed since the trauma occurred and the study taking place; and other trauma exposure (i.e. direct and witnessed trauma). As expected, the study found evidence of a direct and positive relationship between learning about the trauma of close friends and family and children’s trauma symptomatology. Both adolescents and young children were found to be vulnerable to experience vicarious traumatization, with gender and ethnicity being contributing factors. Chronological age was not found to be significant in children’s vicarious traumatization. These findings support the causal model of vicarious traumatization. They demonstrate that children may be traumatized by exposure to the trauma material of others above and beyond the influence of caregiver impairment. As such, attention should be given to interventions, practices, and policies that intervene in the lives of children exposed to violence.

Testing a Tailored Social-Ecological Model for Autism Spectrum Disorders

To propose a tailored social ecological model for Autism Spectrum Disorders and explore relationships between variables in a large nationally-representative dataset. A tailored social-ecological model was developed and examined across variables in the 2016/2017 National Survey of Children's Health. A series of iterative multivariable logistic regressions were performed including individual, family, and community/neighborhood variables. A multivariable logistic regression using state-level fixed effects was performed to understand dynamics related to macro-level policies. In the full model, gender, disability severity, certain types of insurance coverage and household income were significantly related to ASD diagnosis. Females had lower odds of a diagnosis compared to males (aOR: 0.27; CI:0.18-0.41). Children with at least one other moderate/severe disability had odds 7.61 higher (CI:5.36-10.82) of a diagnosis than children without moderate/severe disabilities. Children with public insurance only (aOR:1.66; CI:1.14-2.41) or both private and public insurance coverage (aOR: 2.62; CI:1.6-4.16) had higher odds of a diagnosis compared to children with private insurance only. For those who reported it was "somewhat" or "very often" hard to cover basics with their income, odds of a diagnosis were higher compared to those who reported it was "never" or "hardly ever" hard to cover basics (aOR: 1.676; CI:0.21-2.56). Patterns of ASD diagnosis are related to individual and family characteristics. There is some evidence that a child's environment has some relationship to reported ASD diagnosis. Professionals should be aware of an individual's environmental factors or context when assessing for ASD.

Neighborhood Conditions and Recurrent Emergency Department Utilization by Children in the United States

To determine the associations of social and physical neighborhood conditions with recurrent emergency department (ED) utilization by children in the US. This cross-sectional study was conducted with the National Survey of Children's Health from 2016 to 2018 to determine the associations of neighborhood characteristics of cohesion, safety, amenities, and detractors with the proportions of children aged 1-17years with recurrent ED utilization, defined as 2 or more ED visits during the past 12months. A multivariable regression model was used to determine the independent association of each neighborhood characteristic with recurrent ED utilization controlling for individual-level characteristics. In this study of 98 711 children weighted to a population of 70 million nationally, children had significantly greater rates of recurrent ED utilization if they lived in neighborhoods that were not cohesive, were not safe, or had detractors present (all P<.001). With adjustment for individual-level covariates and the other neighborhood characteristics, only neighborhood detractors were independently associated with recurrent ED utilization (1 detractor: aOR 1.32, 95% CI 1.03-1.68; 2 or 3 detractors: aOR 1.37, 95% CI 1.04-1.81). Among neighborhood characteristics, the presence of physical detractors such as rundown housing and vandalism was most strongly associated with recurrent ED utilization by children. Negative attributes of the built environment may be a potential target for neighborhood-level, place-based interventions to alleviate disparities in child healthcare utilization.

Free open access data sources for dermatology researchers

Free open access data sources are a valuable tool for dermatology researchers and may uncover crucial information about dermatological diseases and delivery of dermatological care. This short review discusses six open access data sources including: National Health and Nutrition Examination Survey (NHANES), National Health Interview Survey (NHIS), National Survey of Children's Health (NSCH), National Ambulatory Medical Care Survey (NAMCS)/National Hospital Ambulatory Medical Care Survey (NHAMCS), Centers for Medicare and Medicaid Services (CMS), and Gene Expression Omnibus (GEO). We explain the role of each data source in dermatology and provide examples of past studies, which have used these data repositories.

Defining the role of exposure to ACEs in ADHD: Examination in a national sample of US children

BackgroundClinical presentations of ADHD vary according to biological and environmental developmental influences. An emerging field of research has demonstrated relationships between exposure to adverse childhood experiences (ACEs) and ADHD prevalence, particularly in high-risk samples. However, research examining the combined role of traditional risk factors of ADHD and ACEs is limited, and reliance on high-risk samples introduces sampling bias. ObjectiveTo examine the influence of ACEs on ADHD diagnosis using a large, nationally representative sample of US children. Participants and settingNationally representative samples (2017 and 2018) of 40,075 parents from the National Survey of Children’s Health (NSCH). MethodsWe conducted logistic regression models to examine the association of ACEs and ADHD diagnosis, controlling for child and parent demographic variables and other risk factors. ResultsExposure to ACEs was significantly associated with parent-reported ADHD diagnosis, controlling for known parental and child-risk factors of ADHD. The association followed a gradient pattern of increased ADHD prevalence with additional exposures. Compared to children with no ACEs, the odds of an ADHD diagnosis were 1.39, 1.92, and 2.72 times higher among children with one, two and three or more ACEs. The ACE most strongly associated with the odds of ADHD was having lived with someone with mental illness closely followed by parent/guardian incarceration. ConclusionsResults further strengthen the evidence that ACEs exposure is associated with increased ADHD prevalence. Clinicians should assess ACEs in the diagnosis of ADHD. Furthermore, results of the study lend support to the efforts of agencies (both institutional and state-level) promoting routine screening of ACEs in children.

The burden of oral health problems in children with mental health disorders in the United States

Mental health disorders (MHDs) are major public health concerns with increasing risk of morbidity and mortality among children. Oral health problems (OHPs) are receiving attention as associated comorbidities. This study assessed the burden of oral health problems in children aged 3-17 years with MHD in the United States. Cross sectional analyses was performed using the National Survey of Children's Health database 2016-2017 containing information of 60,655,439 children. Weighted survey binomial logistic regression generating odds ratio for association between MHD and OHP were calculated. Weighted dose-response models captured incremental effects of MHD severity on oral health conditions. Population attributable risk (PAR) to quantify proportions of potentially avertable OHP as a result of intervention targeted at different levels of MHD severity were estimated. Prevalence of OHP among those with any MHD was 22.5percent. Children with MHD were more likely to be non-Hispanic White, living in poorer households, and having private health insurance P< 0.001. Dose-response analyses showed children with mild MHD were 85 percent more likely [OR=1.85 (95% CI: 1.47-2.32)], and those with moderate/severe MHD 93 percent more likely (OR=1.93, 95% CI: 1.50-2.49) to experience OHP, compared to children without MHD. Population attributable risk (PAR) revealed that if mild and moderate/severe MHD were improved by 75 percent, OHP would be averted in 152,206 children with mild and 255,851 with moderate/severe MHD, respectively. Our results suggest that disparities persist among the pediatric population with MHD who suffer OHP in the United States.

The Arkansas Active Kids Study: Identifying contributing factors to metabolic health and obesity status in prepubertal school-age children.

We report the design, protocol and statistical analysis plan for the Arkansas Active Kids (AAK) Study. The study investigates the complex relationships between factors that contribute to metabolic health and obesity status in prepubertal school-age children in the state of Arkansas. We aim to identify modifiable behavioral and environmental factors and phenotypes related to metabolic health that are associated with obesity status that, if addressed effectively, can aid in designing effective intervention strategies to improve fitness and reduce obesity in children. We analyzed dietary and physical activity data from two national surveys (National Survey of Children's Health and Youth Risk Behavior Surveillance System). We then conducted detailed surveys to collect dietary, physical activity, socio-demographic, and environmental data from a sample of 226 prepubertal Arkansas children. In the same sample of prepubertal children, we also collected extensive physiologic data to further study associations between physical activity and metabolic health. All study visits included detailed measures of vital signs, energy expenditure, components of physical fitness, body composition and the collection of biological samples for determination of metabolic analytes. The observational, environmental and physiological results will be used to craft multivariate statistical models to identify which variables define 'phenotype signatures' that associate with fitness level and obesity status.

Assessing Cardiometabolic Health Risk Among U.S. Children Who Live in Grandparent-Headed Households

Many interventions have been designed to leverage parent-caregivers as change agents for improving children’s cardiometabolic health (CMH), however very few have been designed to leverage grandparent-caregivers for that purpose. This is surprising since there has been a steady increase in children living in grandparent-headed households. As a first step in assessing the potential impact of interventions with grandparent-caregivers, we used data from the National Survey of Children’s Health (2018) to compare CMH measures in children living in grandparent-headed households with CMH measures in children living in parent-headed households. Our hypothesis was that CMH risk might be higher in grandparent households – given that research shows that grandparents taking over caregiving from parents is associated with worse overall health outcomes for both grandparents and their grandchildren. Additionally, since research indicates that children who experience ≥ 4 adverse childhood experiences (ACEs) have significantly worse health outcomes, we assessed levels of ACEs. Our analytic sample included children aged 10-17 years (n=14,941). Adjusting for age, sex, race/ethnicity, and health insurance coverage status, children living in grandparent households were more likely to be obese (Adjusted Odds Ratio [95% confidence interval]= 2.04 [1.02, 4.09]), exposed to secondhand smoke (2.32 [1.49, 3.59]), and less likely to meet recommended age-appropriate standards for sleep (0.42 [0.27, 0.67]). The children living in grandparent households were more likely to experience ≥ 4 ACEs (8.59 [5.42, 13.62]). Our results provide indirect evidence that interventions with grandparent-caregivers may be particularly critical for improving CMH risk in families.

Variability in Prevalence Estimates of Disability Among Children in the National Survey of Children’s Health

Variability in Prevalence Estimates of Disability Among Children in the National Survey of Children’s Health

A comparison study: caregiver functioning and family resilience among families of children with cystic fibrosis, asthma, and healthy controls

ABSTRACT Caregivers of children with cystic fibrosis (CF) are at risk for psychosocial difficulties, which has been related to poorer child well-being and medical adherence. The present study utilized the National Survey of Children’s Health (NSCH) to examine self-reported differences in caregiver functioning among a matched sample of caregivers of youth with CF, asthma, and healthy controls (N = 114). CF caregivers reported poorer mental health and more parenting aggravation. Among CF caregivers, poorer caregiver mental health predicted less family resilience, which in turn, predicted more parenting aggravation. Findings have implications for prevention screening and brief interventions within pulmonary medicine.

Impact of medical home-consistent care and child condition on select health, community, and family level outcomes among children with special health care needs

ABSTRACT Using the 2009/2010 National Survey of Children with Special Health Care Needs (CSHCN), we investigated the impact of medical home-consistent care and child condition on five outcomes for CSHCN (n = 32,299). Models suggested that medical home-consistent care predicted increased odds of preventive services receipt, no unmet health or family support needs, ease of use of community-based services, and shared decision-making. Despite these positive effects, disparities persisted based on insurance, condition complexity, and household income. These findings illustrate the positive impacts of medical home-consistent care on children yet remind health professionals of the unique family circumstances that ultimately impact health and wellbeing.

Timing of Introduction of Complementary Foods - United States, 2016-2018.

The American Academy of Pediatrics (AAP) recommends introducing complementary foods (i.e., any solid or liquid other than breast milk or infant formula) to infants at approximately age 6 months (1). Although a consensus on ideal timing is lacking, most experts agree that introduction of complementary foods before age 4 months is too early because of infant gastrointestinal and motor immaturity (1,2). In addition, early introduction prevents exclusively breastfed infants from reaching the recommended 6 months of exclusive breastfeeding (1) and might be associated with increased risk for overweight and obesity (3). Nationally representative data on complementary feeding are limited; state-level estimates have been previously unavailable. CDC analyzed 2016-2018 data from the National Survey of Children's Health (NSCH) (N = 23,927) to describe timing of complementary feeding introduction and prevalence of early introduction of complementary foods before age 4 months (early introduction) among children aged 1-5 years. Prevalence of early introduction was 31.9% nationally and varied geographically and across sociodemographic and infant feeding characteristics. These estimates suggest that many infants are introduced to complementary foods before they are developmentally ready. Efforts by health care providers and others who might influence infant feeding practices could help decrease the number of infants who are introduced to complementary foods too early.

What’s missing from the nation’s report card

This study re-envisions the Nation’s Report Card from a “whole child” perspective that considers not just students’ academic achievement, but also their physical and mental health. Jaekyung Lee’s integrated analysis of the National Assessment of Educational Progress and the National Survey of Children’s Health datasets reveals that many of our children and youth are not in good shape, getting the average grade of C, with grades of B+ for physical health, C for socioemotional wellness, and D for academic proficiency. The analysis also shows that better health and wellness measures are associated with higher achievement. In addition, the states with stronger “whole community” scores, which measure protective and nurturing family-school-neighborhood environments, produce students who do better on all measures.

Mediating effects of early childhood programs and high quality home environments on the cognitive development of poor children involved in the child welfare system

Abstract The current study used the data from the National Survey of Children and Adolescents (NSCAW II) to examine the effects of early childhood program (ECE) participation and high-quality home environments on the cognitive outcomes of 16–46 months children (N = 342) living in poverty and investigated by the child welfare system (CWS) for possible child maltreatment. Structural equation modeling was used to examine the direct and indirect pathways from family income to children’s early cognitive development as well as the role of ECE participation and the quality of home environments in mediating the negative effects of poverty on children’s outcomes. The results of the study suggest that poverty affects children’s cognitive development indirectly via the quality of the home environment. Also, poverty was directly linked to the ECE participation of CWS involved children, however the effect of ECE attendance on cognitive development of young children was not confirmed. The findings also show that maternal education is the strongest determinant of the quality of children’s home environment as well as children’s cognitive outcomes. The study findings point to the salience of early home interventions and opportunities for low-income mothers to further their educational attainment.

Factors Associated with Resilience in Families of Children with Autism Spectrum Disorder.

Families of children with autism spectrum disorder (ASD) report high levels of stress and poor psychological functioning. Resilience serves to buffer these challenges. Little is known about the factors associated with resilience in these families. Data from the National Survey of Children's Health (NSCH) 2016 were used to investigate independent child, parent, and health care factors associated with resilience in families of children with ASD. We used the NSCH's family resilience composite derived from 4 survey questions focused on (1) communication, (2) working together to solve problems, (3) drawing on strengths, and (4) staying hopeful during difficult times. We defined family resilience as high or low based on the number of questions answered "all of the time" or "most of the time" versus "some of the time" or "none," respectively. Using survey weights, univariate and multivariate logistic regression analyses identified associations of child, parent, and health care factors with low family resilience. We analyzed data representing 1151 children with ASD. Low resilience was reported in 32% of families. Low family resilience was significantly associated with parent factors such as not having someone to turn to for support, cutting work hours, and feeling "child hard to care for"; child ASD-related factors such as moderate ASD severity; and health care factors such as lack of satisfaction in communications with providers. The findings highlight specific vulnerabilities in families of children with ASD that are associated with low family resilience. Intervention approaches that have the ability to improve overall family resilience should be carefully considered.

Breastfeeding Is Associated with a Reduced Risk of Attention-Deficit/Hyperactivity Disorder Among Preschool Children.

Breastfeeding has been associated with a lower risk of attention-deficit/hyperactivity disorder (ADHD). However, most studies examining this association have focused on small samples outside the United States or were likely subject to substantial residual confounding. Our objectives were to investigate, in a nationally representative sample of preschool children in the United States, the associations between ADHD and both age of breastfeeding cessation and age of formula introduction, as well as associations between ADHD and exclusive breastfeeding duration. Analysis of data from children aged 3 to 5 years in the 2011/12 National Survey of Children's Health (n = 12,793). Logistic regressions were used to model current medical diagnosis of preschool ADHD as a function of breastfeeding duration, breastfeeding exclusivity, and the timing of formula introduction with adjustment for 12 potential confounders using propensity scores, including sex, age, race, household income, prematurity, insurance, and medical home. After adjustment for potential confounders, exclusive breastfeeding for at least 6 months was associated with substantially reduced odds of ADHD (adjusted prevalence odds ratio [aPOR] = 0.38; 95% confidence interval [CI], 0.15-0.99). Breastfeeding duration was also associated with ADHD, with 8% reduced odds of ADHD for each additional month of breastfeeding (aPOR = 0.92; 95% CI, 0.86-0.99). The results for exclusive breastfeeding duration were similar, but the confidence interval included the null (aPOR = 0.92; 95% CI, 0.85-1.00). The age of formula introduction was not associated with ADHD (aPOR = 0.92; 95% CI, 0.81-1.05). In a nationally representative sample of preschool children, breastfeeding was associated with a lower prevalence of ADHD. These findings provide evidence in support of the neurodevelopmental benefits of breastfeeding.

Employment and well-being among caregivers of children with autism spectrum disorder

ABSTRACT We used the 2016–2018 National Survey of Children’s Health to assess restricted work participation among caregivers of children with autism spectrum disorder (ASD) and special health care needs (SHCN). Caregivers of children with ASD (N = 2,041) were especially likely to avoid changing jobs to keep health insurance coverage (20%; 95% CI: 16%, 24%), compared to either caregivers of children with other SHCN (N = 18,189) or children without SHCN (N = 68,499). Identifying effective strategies to mitigate the effects of a child’s ASD diagnosis on parents’ withdrawal from the workforce would add an important piece to comprehensive, family-centered care for this at-risk population.

Betrayal Trauma and Gender: An Examination of the Victim-Offender Overlap.

Empirical research has demonstrated widespread support for the association between violent victimization and offending, or the "victim-offender overlap." This study adds to this body of research by applying the betrayal trauma framework to investigate whether the relationship between the victim and perpetrator impacts the presence of the victim-offender overlap and whether these effects differ across gender. Specifically, this study utilizes a series of binary logistic regressions to investigate (a) whether violent victimization is associated with violent offending, (b) whether this relationship varies by victim-perpetrator relationship (familial vs. nonfamilial vs. both), and (c) whether the impact of this relationship varies across gender. Data come from the third and most recent wave of the National Survey of Children's Exposure to Violence (NatSCEV III; n = 1,949). Results indicate that violent victimization is associated with violent offending. When disaggregated by perpetrator-type, the results show that experiencing familial-only perpetrated violence and experiencing both familial and nonfamilial perpetrated violence are significantly associated with violent offending while experiencing nonfamilial-only perpetrated violence is not significantly associated with violent offending. Furthermore, the results indicate that the effects of the perpetrator-victim relationship vary across gender, such that the impacts of familial- and nonfamilial-only perpetrated violence were significantly weaker for males compared with females. The effects of experiencing violent victimization from both familial and nonfamilial perpetrators does not vary across genders. These findings lend support to a gender-specific betrayal trauma framework as well as research on the effects of cumulative victimization. Directions for future research and clinical implications are identified.

Impact of Social Capital on the Availability of Health Care Services.

Children with special health care needs (CSHCN) and their families experience many structural, financial, psychosocial, and physical obstacles to accessing and fully utilizing a continuum of health care services, including a myriad of contextual barriers that are unique to their local communities. Social capital is one contextual barrier hypothesized in the literature to reduce access to health care services. To better understand the role of social capital in accessing health care services for this vulnerable population, a study was constructed using data from a large representative sample of CSHCNs. The analysis was conducted on data collected through the National Survey of Children's Health, a cross-sectional study of child health that includes information on physical and mental health; access to health care; and neighborhood, school, and social context. Logistic regression analyses were performed on a reduced, complete data set containing only CSHCN (n = 32,496) using 5 medical home variables and an investigator-constructed social capital composite score. Social capital was not found to be a complete mediator of individual medical home characteristics; however, each increase in the social capital scale reduced the odds of experiencing a delay in care of overall health care services by 12.5% (P = .006). The effects of social capital on the accessibility of health care services is significant and focusing on strengthening social capital within communities will improve overall health outcomes for this vulnerable group of children.