US School-aged Children Research Articles

Beverage patterns and trends among school-aged children in the US, 1989-2008

BackgroundHigh intake of sugar-sweetened beverages in childhood is linked to increased risk of obesity and type II diabetes later in life. Using three nationally representative surveys of dietary intake, we investigated beverage patterns and trends among US school-aged children from 1989/91 to 2007/08.Methods3, 583 participants ages 6-11 y old were included. We reported per capita trends in beverage consumption, percent consuming, and amount per consumer for the following categories of beverages: sugar-sweetened beverages (SSB), caloric nutritional beverages (CNB) and low calorie beverages (LCB). Statistically significant differences were tested using the Student's t test in Stata 11.ResultsWhile per capita kcal contribution from total beverages remained constant over the study period, per capita consumption of SSBs increased and CNBs decreased in similar magnitude. The substantial increase in consumption of certain SSBs, such as fruit drinks and soda, high fat high sugar milk, and sports drinks, coupled with the decrease in consumption of high fat low sugar milk was responsible for this shift. The percent consuming SSBs as well as the amount per consumer increased significantly over time. Per capita intake of total milk declined, but the caloric contribution from high fat high sugar milk increased substantially. Among ethnicities, important differences in consumption trends of certain SSBs and 100% juice indicate the complexity in determining strategies for children's beverage calorie reduction.ConclusionsAs upward trends of SSB consumption parallel increases in childhood obesity, educational and policy interventions should be considered.

Urinary trichlorophenol levels and increased risk of attention deficit hyperactivity disorder among US school-aged children

BackgroundTrichlorophenols (TCPs) are organochlorine compounds which are ubiquitous in the environment and well known for their carcinogenic effects. However, little is known about their neurotoxicity in humans.ObjectivesOur goal was to...

Pediatric obesity epidemiology

To provide updated summary of recently published data regarding pediatric obesity epidemiology. There is a burgeoning literature of pediatric obesity epidemiology, with type 2 diabetes trends serving as the harbinger for obesity related diseases in children. The National Health and Nutrition Examination Survey and Pediatric Nutrition Surveillance System report a tripling of the prevalence of BMI at least 95% (obesity) among US school-age children and adolescents over the past three decades. Recent updates provide insight into infants and toddler obesity and explore the impact of ethnicity, socioeconomic status, school setting and geographic variations. International data confirm similar upward shifts in pediatric BMI distribution, especially in countries undergoing economic transitions favoring industrialized, western urban lifestyles. The health and financial consequences of this epidemic are a complex global public health dilemma. International efforts are underway to reverse these obesity trends. On-going analysis of obesity prevalence and exploration of potential causal associations are required to implement and assess the effectiveness of interventions and policies.

The role of culture in relational aggression: Associations with social-psychological adjustment problems in Japanese and US school-aged children

The purpose of this study was (1) to evaluate psychometric properties that assess forms of aggression (i.e., relational and physical aggression) across cultures (i.e., Japan and the United States) and (2) to investigate the role of culture in the associations between forms of aggression and social-psychological adjustment problems such as depressive symptoms and delinquency. Participants consisted of 296 fourth-graders (197 Japanese and 99 US children). It was hypothesized that relative to US children, relational aggression would be more strongly associated with depressive symptoms for Japanese children. Findings supported our hypothesis, suggesting that Japanese children may be more vulnerable to negative interpersonal experiences, including relational aggression.

Determining an Association between Having a Medical Home and Uncontrolled Asthma in US School-Aged Children: A Population-Based Study Using Data from the National Survey of Children's Health

Introduction: The American Academy of Pediatrics and the American Academy of Family Physicians believe that infants, children, and adolescents benefit from having a medical home, characterized by accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care. Several studies suggest that patients with asthma benefit from having a medical home. However, no national study has been conducted examining the relationships between having a medical home and asthma control in school-aged children with asthma. The purpose of this study was to examine the hypothesis that having an adequate medical home is protective against uncontrolled asthma in children. Methods: To test this hypothesis, cross-sectional data from the 2003–2004 National Survey of Children's Health were analyzed. Analyses entailed creating the variables “medical home” as well as “uncontrolled asthma” from multiple variables. Multivariate analysis was performed using children with uncontrolled asthma as the dependent variable. Results: The logistic regression model performed yielded that school-aged children with uncontrolled asthma were more likely to: speak a primary language other than English (OR, 1.069; 95% CI, 1.045-1.093); live in households with incomes < 100% of the federal poverty level (FPL) (OR, 1.826; 95% CI, 1.810-1.842); not have health insurance (OR, 2.296; 95% CI, 2.263-2.330); live in rural rather than metropolitan areas (OR, 1.275; 95% CI, 1.262-1.287); and be non-Caucasian (OR, 2.067; 95% CI, 2.050-2.085). Multivariate analysis also yielded that children with uncontrolled asthma were more likely to have a medical home (OR, 1.138; 95% CI, 1.128-1.148). Conclusions: After controlling for possible confounding variables, this study did not detect an association between having a medical home and asthma control for children with asthma aged 5 to 17 years. Additional research should examine the relationship between variables, such as poverty, place of residence, health insurance status, and the medical home, not only in the instance of uncontrolled asthma, but for other childhood health conditions.

Neuropsychological function in school-age children with low mercury exposures

The EPA reference dose for methylmercury (MeHg) was established using data from populations with greater exposures than those typical of the US. Few data are available on potential adverse health effects at lower levels. We examined relationships between hair mercury (Hg) levels and neuropsychological outcomes in a population of US children. This study included data from 355 children ages 6-10 enrolled in the New England Children's Amalgam Trial. Data on total hair Hg levels, sociodemographic information and neuropsychological function were collected. We evaluated associations between hair Hg and neuropsychological test scores with linear regression methods and used generalized additive models to determine the shape of associations that departed from linearity. Models controlled for relevant covariates, including the potential beneficial effects of consuming fish. In adjusted models, we observed no significant linear relationships between hair Hg level and any test score. Significant departures from linearity were identified for WIAT Math Reasoning and WRAMVA Visual-Motor Composite scores. The association was positive for hair Hg levels below 0.5 microg/g and negative for levels between 0.5 and 1.0 microg/g. Overall, test scores of children with hair Hg levels 1.0 microg/g appeared to be lower than those of children with levels < 1.0 microg/g, but few children had levels in this upper range and these differences did not reach statistical significance. Hair Hg levels below 1.0 microg/g in US school-age children were not adversely related to neuropsychological function.

Additional Visit Burden for Universal Influenza Vaccination of US School-Aged Children and Adolescents

To estimate the additional primary care visits needed for universal influenza vaccination of all US children and adolescents if all vaccinations occurred in primary care settings. Cross-sectional design. Well-child care and other visits to primary care practices from the 2003-2004 Medical Expenditure Panel Survey. Children aged 5 to 18 years (n = 3047) with a usual source of care. Main Outcome Measure Percentage of children needing 0, 1, or 2 additional visits to be immunized against influenza in a 3-, 4-, or 5-month vaccination window. In a 3-month window, if only well-child care visits were used for first immunization, 97% of 5- and 6-year-olds and 98% of 7- and 8-year-olds would need 1 or 2 additional visits for complete vaccination; 95% of 9- to 18-year-olds would need 1 visit. If instead all visits were used for immunization, 90% of 5- and 6-year-olds and 91% of 7- and 8-year-olds would need 1 or 2 visits; 78% of 9- to 18-year-olds would need 1 visit. Expanding the window to 4 or 5 months slightly reduces the need for additional visits. Nationally, using all opportunities for vaccination, 42 million additional visits would be needed in a generous 5-month window. Most children and adolescents would need additional visits for universal influenza vaccination, even if all existing visits were used as vaccination opportunities. Efficient methods for vaccinating large numbers of children and adolescents are needed if primary care practices are to provide influenza vaccine for all children.

Barriers to Care Among US School-Aged Children With Disabilities

We examined financial barriers to care experienced by US school-aged children with disabilities. Data from the 2005 National Health Interview Survey were analyzed. Children aged 5 to 17 years were classified into 4 health condition groups: children with activity limitations, disabling conditions, chronic asthma, or no health conditions. Financial barriers to care were defined as being unable to afford prescriptions, delaying medical care, and/or having forgone medical care because of concern about cost. Our study included 8870 school-aged children; 338 children had an activity limitation, 1535 had a disabling condition, 594 children had chronic asthma, and 6288 children had no health conditions. Children with activity limitations were significantly more likely than children with no health conditions to experience all 3 financial barriers to care. Uninsured children with activity limitations, disabling conditions, or no health conditions had the highest prevalence of all financial barriers to care. Of children living greater than or equal to 200% Federal Poverty Level, children with activity limitations and disabling conditions were more likely than children with no health conditions to experience all 3 financial barriers to care. Multivariate analysis showed uninsured children (odds ratio, 7.40; 95% confidence interval, 5.28-10.37) and children with an activity limitation (odds ratio, 3.70; 95% CI, 2.37-5.76) were at highest risk for financial barriers to care. Uninsured and privately insured children with activity limitations were significantly more likely to experience financial barriers. The results show that many uninsured children still experience financial barriers to care despite the creation of the State Children's Health Insurance Program.

Has the United States Population Been Adequately Vaccinated to Achieve Rubella Elimination?

Mathematical models indicate that elimination of rubella virus transmission requires maintenance of approximately 90% rubella immunity among children. To evaluate whether rubella vaccination coverage among US preschool and school-age children is at levels consistent with rubella elimination, we reviewed data from 3 sources: (1) the Biologics Surveillance, which documents the net number of vaccine doses sold (1970-2004); (2) state immunization surveys of school entrants 5-6 years of age (1980-2005); and (3) the National Immunization Survey of children 19-35 months of age (1995-2004). Vaccine biologics data show that the net number of rubella vaccine doses sold was at least equivalent to the number of children born each year during 1970-2004. The average coverage for school-entrant surveys among reporting states was >95% for 1980-2004. National coverage among children 19-35 months of age was > or =90% overall for each year during 1995-2004. Three independent surveys suggest that childhood coverage with rubella-containing vaccine has been at sufficiently high levels to achieve elimination of rubella virus transmission.

Identified Attention-Deficit/Hyperactivity Disorder and Medically Attended, Nonfatal Injuries: US School-Age Children, 1997–2002

To determine the medically attended, nonfatal injury rate among children 6-17 years of age ever and never identified with attention-deficit/hyperactivity disorder (ADHD). An analysis was performed of parentally reported injury episodes during the past 3 months and current demographic characteristics of 3,741 sample children ever identified with ADHD and 48,243 never identified with ADHD in the 1997-2002 National Health Interview Surveys. The annualized rate of injury was 204 episodes per 1,000 among children with ADHD compared with 115 episodes per 1,000 among children without ADHD. Injury episode rates were higher for children with ADHD regardless of age, sex, or health insurance. Logistic regression, which controlled for confounding risk factors, showed a robust association between ADHD and injury. The adjusted odds ratio (OR) for ADHD (OR(adj) = 1.83) was similar to the ORs for other important predictors of injury, such as male sex (OR(adj) = 1.45), older age (OR(adj) = 1.50), and private health insurance (OR(adj) = 1.44). Children with other health conditions had an increased odds for injury (OR(adj) = 1.51 for children with other developmental disorders and OR(adj) = 1.53 for children with physical disorders). Characteristics of injury episodes were generally similar for children with and without ADHD. Results from a large, nationally representative sample indicate that children ever identified with ADHD were more likely to have a medically attended, nonfatal injury than children never identified with ADHD. The increased odds of injury among children with ADHD could not be attributed to other confounding risk factors. Children with ADHD may benefit from targeted injury prevention efforts.

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National Autism Prevalence Trends From United States Special Education Data

Reports of large increases in autism prevalence have been a matter of great concern to clinicians, educators, and parents. This analysis uses a national data source to compare the prevalence of autism with that of other disabilities among successive birth cohorts of US school-aged children. Comparison of birth cohort curves constructed from administrative data. US children 6 to 17 years of age between 1992 and 2001. A disability category classification of autism, mental retardation, speech and language impairment, traumatic brain injury, or other health impairment, as documented by state departments of education and reported to the Office of Special Education Programs, US Department of Education. Prevalences of disability category classifications for annual birth cohorts from 1975 to 1995 were calculated by using denominators from US Census Bureau estimates. For the autism classification, there were birth cohort differences, with prevalences increasing among successive (younger) cohorts. The increases were greatest for annual cohorts born from 1987 to 1992. For cohorts born after 1992, the prevalence increased with each successive year but the increases did not appear to be as great, although there were fewer data points available within cohorts. No concomitant decreases in categories of mental retardation or speech/language impairment were seen. Curves for other health impairments, the category including children with attention-deficit/hyperactivity disorder, also showed strong cohort differences. Cohort curves suggest that autism prevalence has been increasing with time, as evidenced by higher prevalences among younger birth cohorts. The narrowing in vertical separation of the cohort curves in recent years may mark a slowing in the autism prevalence increase.

Attention Deficit Hyperactivity Disorder in Very Young Children

The number of children diagnosed with attention deficit hyperactivity disorder (ADHD) is rising. It is now considered the most common neuropsychiatric syndrome in US school-age children, affecting 3% to 5%, or approximately 2 million children. ADHD is a chemical imbalance in the brain resulting in inappropriate degrees of inattention, hyperactivity, and impulsivity; these symptoms must be present prior to age 7. ADHD is difficult to diagnose as it is linked to many other conditions such as learning disabilities, conduct disorders, bipolar disorders, and manic-depressive illnesses. The authors offer information on behaviors signaling the need for referral in very young children and describe the positive and negative effects of common medications. They suggest specific behavioral coping strategies for both home and group care settings.

Food insufficiency, family income, and health in US preschool and school-aged children

This study investigated associations between family income, food insufficiency, and health among US preschool and school-aged children. Data from the third National Health and Nutrition Examination Survey were analyzed. Children were classified as food insufficient if the family respondent reported that the family sometimes or often did not get enough food to eat. Regression analyses were conducted with health measures as the outcome variables. Prevalence rates of health variables were compared by family income category, with control for age and gender. Odds ratios for food insufficiency were calculated with control for family income and other potential confounding factors. Low-income children had a higher prevalence of poor/fair health status and iron deficiency than high-income children. After confounding factors, including poverty status, had been controlled, food-insufficient children were significantly more likely to have poorer health status and to experience more frequent stomachaches and headaches than food-sufficient children; preschool food-insufficient children had more frequent colds. Food insufficiency and low family income are health concerns for US preschool and school-aged children.

Low vaccination levels of US preschool and school-age children. Retrospective assessments of vaccination coverage, 1991-1992

Low vaccination levels of US preschool and school-age children. Retrospective assessments of vaccination coverage, 1991-1992

Geographic Mobility and Children's Emotional/Behavioral Adjustment and School Functioning

To evaluate the relationship of geographic mobility to children's emotional/behavioral adjustment and school functioning. Analysis of data from the 1988 National Health Interview Survey of Child Health in which multistage probability sampling was used to obtain data for nationally representative estimates of health and demographic characteristics of US children. 10,362 US school-age children and their families. The 1988 National Health Interview Survey of Child Health includes data on health and demographic characteristics, emotional/behavioral variables, school functioning, and geographic mobility for 10,362 US school-age children. This study examined the relationship of children's geographic mobility to children's reported emotional problems, use of psychological help, scores on a Behavior Problem Index, repeating a grade in school, and being suspended or expelled from school. Twenty-four percent of children have never moved, 35% of children have moved once or twice, and 39% of children aged 6 to 17 years have moved three or more times in their lifetime. Using multiple logistic regression to control for important demographic variables, children who moved three or more times were 2.3 times more likely to have received psychological help, 1.7 times more likely to have repeated a grade, and 1.9 times more likely to have been suspended or expelled from school compared with children who had never moved. Multiple regression was also used to analyze the impact of mobility in relation to scores on the Behavior Problem Index. Children who moved three or more times were 1.6 times more likely to be in the top tenth percentile of scores on the Behavior Problem Index compared with children who had never moved. Children who move three or more times are at increased risk for emotional/behavioral and school problems. Thus, pediatricians, other health professionals, and educators should be alert to the potential educational and psychological problems among children from highly mobile families.

Community-based sealant programs in the United States: results of a survey.

The appropriate use of pit and fissure sealants could reduce substantially the majority of occlusal caries among US school-aged children. The 1986-87 national oral health survey conducted by the NIDR showed that less than 8 percent of the children 5-17 years of age had sealants on their teeth. The purpose of this national study was to document the current status of community-based sealant programs and to identify general program characteristics. Data were gathered through a mail survey to all state dental directors and site visits to four selected comprehensive community-based programs. Twenty-nine states were currently conducting sealant programs. The vast majority of these programs had formal quality assurance systems and companion health education components. Eight states indicated that sealant programs had been terminated within the last two years. Medicaid reimbursement for sealants was available in 42 states, with a mean reimbursement rate of $10.71 per sealant. Reimbursement rates ranged from $3.00-$20.00 per sealant. State practice acts almost uniformly permitted the placement of sealants by dental hygienists (n = 48), but less frequently by dental assistants (n = 15). Approximately 43 percent of state practice acts did not require a dentist to be present physically when auxiliaries place sealants in public/community sealant programs. All respondents indicated that there was a need for additional programs in their state. No structural factors--for example, level of Medicaid reimbursement for sealants or state practice act requirements for auxiliary supervision--were found to be associated with the presence of community-based sealant programs. Nationally, only a small percentage of children appeared to be receiving sealants in community programs.

Impact of Family Relocation on Children's Growth, Development, School Function, and Behavior

The United States is a highly mobile society, with family relocation rates double those of Great Britain and Germany. The objective of this study was to describe the impact of frequent family moves on reported rates of delay in growth or development, learning disorders, school failure, and frequent behavioral problems in US school-age children. We analyzed data on 9915 six- to 17-year-old children of families responding to the 1988 National Health Interview Survey, a nationally representative sample of families and children. Parents were asked to report the total number of moves the index child had experienced during his or her lifetime. Total moves were adjusted for the child's age in years. Children were divided into two groups: never moved/infrequent relocation (below the 90th percentile for age-adjusted moves) and frequent relocation (above the 90th percentile for age-adjusted moves). The parent was asked if the child had ever had a learning disability or a delay in growth or development, had ever failed a grade, or had four or more frequently occurring behavioral problems as described by a behavioral problems checklist. The measures of both child dysfunction and family relocation were independently associated with multiple sociodemographic characteristics such as poverty, race, and family structure. Frequent relocation was associated with higher rates of all measures of child dysfunction; 23% of children who moved frequently had repeated a grade vs 12% of children who never or infrequently moved. Eighteen percent of children who moved frequently had four or more behavioral problems vs 7% of children who never or infrequently moved. Use of logistic regression to control for potential confounding covariates demonstrated that children who moved frequently were 77% more likely to be reported to have four or more behavioral problems (odds ratio, 1.77; 95% confidence interval, 1.37 to 2.29) and were 35% more likely to have failed a grade (odds ratio, 1.35; 95% confidence interval, 1.06 to 1.72), but no more likely to have had delays in growth or development or a learning disorder. After adjusting for other covariates, frequent family relocation was associated with an increased risk of children failing a grade in school and four or more frequently occurring behavioral problems.

The need for toothpastes with lower than conventional fluoride concentrations for preschool-aged children.

Since 1945, when community water fluoridation was first implemented in the United States, not only has the procedure grown to cover more than half of the US population, but the development and use of other fluoride methods have expanded greatly. A concomitant, dramatic decrease has occurred in the caries prevalence of US school-aged children. Recent studies indicate, however, that the prevalence and, to a lesser extent, the intensity of dental fluorosis have increased in schoolchildren in both fluoridated and fluoride-deficient areas. Several studies show that young children inadvertently ingest sizable proportions of toothpaste during toothbrushing. Although ingestion of fluoride toothpastes by preschool-aged children may not be the major contributor to the increase in fluorosis, the findings of at least four studies suggest that the use of fluoride toothpastes by young children is a risk factor. The direct dose-response relation between effectiveness and fluoride concentration of toothpastes is far from clear-cut and, at best, is weak. Thus, considering today's reduced risk of caries, it is timely to market fluoride toothpastes in the US with 400-500 ppm fluoride for preschool-aged children, who are still at risk for developing fluorosis, as has been done in several other countries. Dental public health authorities must work with toothpaste manufacturers, professional organizations, and regulatory agencies to facilitate the approval and marketing of such pediatric fluoride toothpastes.