National Survey of Children’s Health: Insights & Trends

1. An overview of the SLAITS National Survey of Children’s Health Kathleen S. O’Connor, MPH National Center for Health Statistics Division of Health Interview Statistics Special Populations Survey Branch State and Local Area Integrated Telephone Survey (SLAITS) July 13, 2004

2. Background • Sponsored by Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration (HRSA) • Describes condition and offers a status report of the physical and emotional health of 0 – 17 year old children in households in all 50 states & DC • Basis for Federal and State program planning efforts (set goals) • MCHB Strategic Plan goals and National Performance Measures (monitor outcomes) • Measures public health organizations’ progress toward better serving children and families (monitor outcomes)

3. Methodology • Random-Digit-Dial (RDD) telephone survey • National Immunization Survey (NIS) sampling frame • 20 to 25 minutes in length excluding the NIS interview (NSCH after the NIS) • Fielded January 2003 – February 2004 • Sample = 102,000 children (2,000 per state and DC) • Detailed questionnaire administered to MKP re: one randomly selected child per HH

4. Methodology • Sampling weights permit national and state-specific estimates of health and well-being characteristics • Adjusted weights (non-response bias, non-coverage of non-telephone households)

5. Unique features • Comprehensive detailed snapshot; the data cover various dimensions regarding child – family – neighborhood • Contains a variety of positive indicators to track youth development: • family strengths • family relationships and behavior • family processes • household routines • Will be able to monitor trends in the future (pending future $$) • Large sample size permits calculation of State level estimates

6. Unique features • Examines various parent measures: parental health (mental and physical), behavior, resources, concerns, coping • Attempts to characterize all persons in a parental role living inside and outside the household • Address developmental stages • Early childhood (0 – 5 years of age) • Middle childhood and adolescence (6 – 17 years of age) • Indicators are consistent across all states and DC

7. Many interesting questions, not much interview time…. • Indicators carefully chosen • Technical Expert Panel participants represented Federal agencies, foundations, academic researchers, health care providers, State and local service providers • Long process (Summer 2001 – Winter 2002) • Experts recommended measures; final decision made by HRSA

8. Conceptualization • Objective and perceived (subjective) measures • Demonstrated measures • Balanced so no single area dominates • Parsimonious • Population size & other cell size considerations • Newly developed questions address emergent topics • Focus on policy relevant topics

9. Survey Domains Child Characteristics Child Outcomes Family Level Influences Neighborhood and Community Influences

10. Ambling through the questionnaire: select indicators by section (+ indicates multiple questions on that topic)

11. Health and functional status • Child’s general health status • Height, weight to calculate BMI • FACCT CSHCN screener (+) • Ever told: learning disability (MD, HCP, teacher) • Selected conditions from NHIS • Severity of most severe condition • Asthma (+) • Child’s general dental health status • Length of time since last dental care visit • Mental and emotional health

12. Health insurance coverage • Any kind of health care coverage • Medicaid/SCHIP • Any time (last 12 months) not covered • Last 12 months—had health coverage • Dental insurance

13. Health care access and utilization • Medical care (sick-child, well-child, physical exam, ER, any kind of care) (+) • Did you see HCP • Any time needed care last 12 months? • ER visits—how many? How many visits due to accident, injury, or poisoning? • Did child receive all needed care? • Why did child not receive all medical care needed? • (similar sub-battery of questions listed above asked for dental care and prescription medications) • Dental care (+) • Prescription medications (+) • Mental health care or counseling • Hepatitis A vaccination (+)

14. Medical Home • Personal doctor or nurse • (How often) spend enough time with child • (How often) explain things in a way you can understand • Advice from HCP over the phone (+) • Needed care right away for illness/injury (+) • Preventive care (+) • Specialist care (+) • Care coordination (+) • Special services, equipment (+) • Language interpreter to talk to HCP (+)

15. Early childhood (0 – 5 years old) • Parental concerns (learning, development, behavior, Glascoe scale) (+) • Child care (+) • Injury (+) • Poisoning (+) • Breastfeeding (+) • How many days past week: read stories to child

16. Middle childhood & adolescence (6 – 17 years old) • Type of school (public, private, home) • Illness/injury: days missed from school • School problems, repeated grade • After school activities (sports, clubs and activities, organized events) • Parent attendance at activities • Relative number of child’s friends parent has met • Child self-care (+)

17. Middle childhood & adolescence (continued) • Community service/volunteer work • Hours of paid work • How many nights: enough sleep for child that age • Exercise/physical activity, helmet use • Time spent reading for pleasure • Time spent using a computer for purposes other than schoolwork • Time spent watching TV, videos, videogames • Family rules regarding TV programs • Parental concerns about the child (+) • Descriptions of the child (positive/negative behaviors) (+)

18. Family Functioning • Number of outings • Eat a meal together as a family (# days) • Religious service attendance (how often) • Closeness of parent to child • How well can parent and child share ideas or talk about things that really matter • Coping with day-to-day demands of parenthood • Parent aggravation scale (+) • Does parent have someone to turn to for day-to-day emotional help with parenting • How are serious disagreements in the family settled

19. Parental health • Parents in and out of the household and relationship with child (biological, step, etc.) • Interaction with non-custodial parent • Parents general health , mental and emotional health status • Parental exercise habits • Insurance coverage of all parents • Anyone in HH use cigarettes, cigars, pipes

20. Neighborhood characteristics • Neighborhood / community cohesion (+) • Perception of safety in community / neighborhood, school, and home

21. Demographics • Highest level of education of anyone in HH • Primary language spoken at home • Natality in US—child and parents • How long in US • Number of moves to a new address (stability) • Employment status • Income • Participation in TANF, Food Stamps, free or reduced-cost breakfasts or lunches, WIC

22. Sample research questions • What is the prevalence of selected conditions for school-aged children? • Do parental health habits and status impact the health and functional status of school-aged children? If so, how? • Do parental concerns and aspirations impact the health and well-being of school-aged children? If so, how?

23. Sample research questions • Do characteristics of family functioning and family stressors impact the health and functional status of school-aged children? If so, how? • Do neighborhood and community characteristics impact the health and functional status of school-aged children? If so, how? • Do school-aged children have a ‘Medical Home’? If so, how can it be characterized?

24. Timeline • Data cleaning and review: Summer & Fall 2004 • Public Use data files will be released as soon as they have been prepared and the necessary reviews and approvals have been obtained, including review by the NCHS Disclosure Review Board • Public Use File release: Anticipated Late 2004 or Early 2005

25. For more information • www.cdc.gov/nchs/slaits.htm • SLAITS listserve (directions on website) • slaits@cdc.gov • 301-458-4181 Thank you for your interest!