PODCAST: Children and Mental Health: Part One

May 14, 2021



HOST:  May is Mental Health Month in the United States.  In recent years, mental health awareness has grown as a major public health issue, with suicide being one of the leading causes of death in the country.  The arrival of the COVID-19 pandemic in 2020 placed even more of a spotlight on the subject, and NCHS collects data on topics such as anxiety and depression as well as mental health treatment in the U.S. during the pandemic, all part of the new national Household Pulse Survey.  During the period April 14-26, Pulse data showed that over 27 percent of adults suffered from anxiety in the past week, and that almost 23 percent suffered from depression.  A third, or 32 percent of adults, suffered from both. 

These numbers are the lowest in over a year, but still pose a significant impact on American society and on the American health care system.  21 percent of adults used prescription drugs for mental health problems in the past four weeks, and nearly 10 percent received mental health counseling.  However, the number of suicides and the rate of suicide in the U.S. declined in 2019 and appeared to also decline in 2020, which runs somewhat counter to the fact that 1 in 4 adults either used prescription drugs or received counseling for mental health issues, while another 10 percent needed mental health treatment but did not receive it.

Mental health concerns are also significant among children, and last week the country observed “Children’s Mental Health Awareness Week.”  Suicide is the 2nd leading cause of death among children between ages 10 and 14, and there is a great deal of concern about the impact of the pandemic on children’s mental health.

NCHS has several measures that provide insight into children’s mental health in the U.S.  And joining us today is Benjamin Zablotsky, a health statistician for the Division of Health Interview Statistics at NCHS.

HOST: What did the data tell us about the scope of mental health concerns among children in the U.S.? 

BEN ZABLOTSKY: Sure, I think when we are talking about mental health concerns, we can break that down into two separate things – two different bins if you will.  The first would be the prevalence of mental health disorders in the United States.  And this includes developmental disabilities like autism spectrum disorder and intellectual disabilities, but it also includes behavioral and mental disorders like ADHD, anxiety, and depression.  And when we look at the prevalence of conditions we see about one in five or one in six, depending on what you look at, that seems to be about the prevalence of mental health concerns.  But I think we need to look beyond just the prevalence of these disorders.  The other “bin” I would talk about as it relates to mental health concerns is also what percentage of children are receiving treatment for mental health.  And when we’re talking about mental health treatment, we talk about whether a child is on a pharmaceutical medication or receiving counseling or therapy – and we look at those two things to get a sense of what percentage of the child population is on mental health treatment.  And the report I wrote in 2019 found that about 14% of children have received either a therapy or a mental health-related medication in the past 12 months. 

HOST:  So there’s a lot of information out there.  Now, are teenagers at particular risk of mental health problems compared to adults, given all the changes they’re going through?

BEN ZABLOTSKY: I would say that older children are more likely to be diagnosed with anxiety and depression, and they’re typically along the same lines in terms of prevalence as adults.  And a lot of this just has to do with the stresses of being a teenager – it’s a challenging time.  Teenagers tend to experience a lot of transitions during that time period as it relates to school and their own development. So yeah, I would say certainly teenagers are more likely to experience the mental health conditions than their younger peers, and sometimes comparable to those of adults.

HOST:  Is there any sense that these issues have worsened or become more prevalent over time?

BEN ZABLOTSKY:  You know, people have looked at things like the prevalence of developmental disabilities over time and we have seen an increase in the prevalence of some of those disorders.  As it relates to teenagers and mental health, as it relates to both anxiety and depression, I believe there are some findings that have found higher rates of those two conditions – depression and anxiety – and some of it might be tied to the introduction of social media and the prevalence of bullying generally, including the kind of the more present cyber-bullying that wasn’t something that necessarily existed, you know, a few decades ago.

HOST:  So the social media and the cyber-bullying – is that something you’ve done any research on yourself?

BEN ZABLOTSKY: I haven’t looked at that personally but we actually are now including some questions on the National Health Interview Survey on bullying to get a sense of that from the parent perspective, and interestingly enough later this year as part of a CDC data modernization initiative, the Division of Health Interview Statistics is going to be launching a survey of adolescents.  These are actually people who were the subjects at the National Health Interview Survey, and we are going to be including some questions on cyber-bullying and bullying in general. This should be really great to look at to get a sense of that from the adolescent perspective.

HOST: You mentioned some of your research – could you talk a little bit more about some of the studies you’ve been involved in and what you found?

BEN ZABLOTSKY: Sure.  So as I was mentioning I kind of think of two different domains that my research lies in.  The first part is looking at the prevalence of mental health conditions generally, and most of that work has been focused around developmental disabilities.  And using the NHIS we explored how there might have been changes in the prevalence over time in children in the United States between (ages) 3 and 17.  And we actually did find a significant increase in the prevalence of developmental disabilities over time, with the current prevalence being about one in six children in the United States.  And then some of the other work that I do which focuses on the treatment side of things – which I think is really important just to make the point that even though we’re talking about the prevalence of these disorders, we’re really only talking for the most part about the prevalence “diagnosed” disorders.  And so it’s quite possible that children could be receiving treatment for their mental health that’s not affiliated or to a specific disorder.  So that mental health treatment side, we are finding in a report that used data from 2019 that about 14% of children are receiving mental health treatment, either in the form of taking a medication for their mental health or receiving counseling or therapy from a mental health professional in the past 12 months.

HOST:  So often times mental health is something that’s viewed as kind of a silent problem, and therefore it’s assumed that people who need treatment aren’t getting it.  Would you say that your data support that or does it show that on contrary kids are actually getting treatment for some of these problems?

BEN ZABLOTSKY: Right.  So there are situations where if you were to kind of do a crosstab of children who have a diagnosed condition and a child who has received mental health treatment, it’s not a one-to-one match.  So there are certainly situations where children who don’t have a diagnosis are still receiving mental health treatment, and a lot of times it might be a situation where the child doesn’t have access to services to get a diagnosis but they certainly can find resources in the community to get treatment of some sort to help in the treatment of the diagnosis that just might be not actually diagnosed by a professional.

HOST:  Next week we will continue our discussion with Ben Zablotsky about his research on mental health issues facing children in the U.S.

This week, NCHS released the latest quarterly data on infant mortality in the U.S., showing a rate of an estimated 5.50 infant deaths per 1,000 live births in the one-year period ending in mid-year 2020, the lowest rate on record. 

NCHS also released the latest monthly data on drug overdose deaths in the country, for the one-year period ending in October 2020.  Over 91,000 Americans died from drug overdoses during this period, a 30% increase from the same period a year ago.

Finally, NCHS released an analysis of total fertility rates by educational attainment, which showed that women with no high school diploma are giving birth at above-replacement levels whereas women with the highest educational attainment are giving birth at levels considerably below replacement. 

Influenza Vaccination in the Past 12 Months Among Children Aged 6 Months–17 Years: United States, 2019

April 15, 2021

21-323150-visual-abstract-db407-child-flu-vacQuestions for Lindsey Black, Health Statistician and Lead Author of “Influenza Vaccination in the Past 12 Months Among Children Aged 6 Months–17 Years: United States, 2019.”

Q: Is this the most recent data you have on this topic?  If so, when will you release 2020 vaccination data?

LB: Yes, this is the most recent data. 2020 data will be released in the fall of 2021.

Q: Do you have influenza vaccination data for adults?

LB: Yes, some information on adults is available in the interactive summary health statistics for adults, located at : https://www.cdc.gov/nchs/nhis/shs.htm

Q: Do you have trend data that goes further back than 2019?

LB: Influenza vaccination has been collected as part of the sample child on NHIS since about 2005. However, in 2019, there were significant changes to the survey and we have not yet evaluated how that may result in a break in the trend, or the appropriateness of assessing trends across survey period (2019 vs earlier than 2019).

Q: Was there a specific finding in the data that surprised you from this report?

LB: I found it surprising that the amount of regional differences observed. It is so interesting that starting at the East South Central states, and moving North, we see a gradual improvement to 65.3% of children lving in New England that had a vaccination.

Q: Where can I get COVID vaccination data?  Will this be included in future NHIS data?

NHIS began collecting that and it will be included in the 2021 data release in the fall of 2022. In the meantime, Covid-19 vaccinations in the United States provided by CDC are located at:  https://covid.cdc.gov/covid-data-tracker/#vaccinations


March 26, 2021


The CDC National Center for Health Statistics web page “Stats of the States” has been updated to include the latest state-based final data on selected vital statistics topics, including:

  • General fertility rates
  • Teen birth rates
  • Selected other maternal and infant health measures
  • Marriage & divorce rates
  • Leading causes of death
  • Other high profile causes of death.

The site’s map pages allow users to rank states from highest to lowest or vice versa.  This latest version of “Stats of the States” also includes two new topics:  Life expectancy by state and COVID-19 death rates by state (provisional data on a quarterly basis, through Q3 of 2020).  All death rates are adjusted for age.  Rates are featured in the maps because they best illustrate the impact of a specific measure on a particular state.

The main “Stats of the States” page can be accessed at:  https://www.cdc.gov/nchs/pressroom/stats_of_the_states.htm

QuickStats: Rate of Unintentional Traumatic Brain Injury (TBI)–Related Deaths Among Persons Aged 24 Years and Under, by Age Group

October 16, 2020

From 1999 to 2018, death rates for unintentional TBI among persons aged 24 years and under declined across all age groups.

During the 20-year period, TBI-related death rates declined from 3.7 per 100,000 to 1.5 among children aged 0–4 years, from 3.0 to 0.9 for children and adolescents aged 5–14 years, from 14.7 to 4.4 for adolescents and young adults aged 15–19 years, and from 14.1 to 6.9 for young adults aged 20–24 years.

For most of the period, rates were highest for persons aged 20–24 years followed by those aged 15–19, 0–4, and 5–14 years.

Source: National Center for Health Statistics, National Vital Statistics System, Mortality Data. https://www.cdc.gov/nchs/deaths.htm.


Fast Food Intake Among Children and Adolescents in the United States, 2015–2018

August 14, 2020

Questions for Cheryl Fryar, Health Statistician and Lead Author of “Fast Food Intake Among Children and Adolescents in the United States, 2015–2018.”

Q: Why does NCHS conduct studies on fast food consumption among children and adolescents?

CF: We focus on fast food for this report because fast food continues to play an important role in the American diet. Fast food has been associated with poor diet and increased risk of obesity. In a previous report, we described the percentage of calories consumed from fast food among children and adolescents during 201-2012. This report provides an update on the daily percentage of calories consumed from fast food by children and adolescents aged 2-19 years during 2015-2018 and trends since 2003.

Q: How did the data vary by age groups, sex and race?

CF: There were some demographic differences in the daily percentage of calories consumed from fast food. Adolescents aged 12–19 consumed a higher percentage of calories (16.7%) from fast food than younger children (11.4%) aged 2-11 years. Girls consumed a higher percentage than boys and non-Hispanic white adolescents consumed a lower percentage than the other race and Hispanic origin groups. This brief report did not examine confounders that may possibly explain demographic differences.

Q: Was there a specific finding in the data that surprised you from this report?

CF: While there really wasn’t anything in this report that I hadn’t expected to see or that was surprising to me, this report’s trends analysis is of interest. The daily percentage of calories from fast food in children and adolescents decreased from 14.1% in 2003–2004 to 10.6% in 2009–2010, and then increased to 14.4% in 2017-2018.

Q: How did you obtain this data for this report?

CF: The National Health and Nutrition Examination Survey (NHANES) is the source of the data.  Since 1999, NHANES has been conducted on a continuous basis, and visits approximately 15 counties each year of various population size.  The survey conducts at home health interviews and health examinations in mobile examination centers (MEC) with nearly 5000 people each year.   Information on nutrient intake was obtained from one 24-hour dietary recall interview administered in-person at the MEC.  Specifically, anyone who reported obtaining any food or beverage from “restaurant fast food/pizza” was someone who consumed fast food on a given day.  Dietary recalls cover intake for any given day, specifically the 24-hour period prior to the dietary recall interview (midnight to midnight).

For survey participants < 6 years of age a proxy was used (who was generally the person most knowledgeable about the child’s food intake). For children ages 6- 8, interviews were conducted with a proxy and with the child present to assist in reporting intake information. Interviews of children ages 9-11, were conducted with the child and the assistance of an adult familiar with the child’s intake. Adolescents 12 years or older answered for themselves.

Q: What is the take home message for this report?

CF: The take-home message for this report is that more than one-third (36.3%) of U.S. children and adolescents consume fast food on a given day. Overall, children and adolescents consume, on average, 13.8% of their daily calories from fast food.  And, on a given day, over 11% of children and adolescents consume more than 45% of their daily calories from fast food.

Diet and exercise play important roles in helping individuals achieve and maintain their health.  The USDA/HHS’ Dietary Guidelines for Americans 2015 provides guidance in healthy food choices.  In addition, HHS’ 2018 Physical Activity Guidelines for Americans provides guidance for all ages in improving health through physical activity.

QuickStats: Prevalence of Obesity and Severe Obesity Among Persons Aged 2–19 Years — National Health and Nutrition Examination Survey, 1999–2000 through 2017–2018

April 3, 2020

From 1999–2000 to 2017–2018, the prevalence of obesity among persons aged 2–19 years increased from 13.9% to 19.3%, and the prevalence of severe obesity increased from 3.6% to 6.1%.

Source: National Center for Health Statistics, National Health and Nutrition Examination Survey, 1999–2000 to 2017–2018. https://www.cdc.gov/nchs/nhanes.htm.

QuickStats: Percentage of Children and Adolescents Aged 4–17 Years with Serious Emotional or Behavioral Difficulties by Sex and Urbanization Level

March 13, 2020

During 2016–2018, the percentage of children and adolescents aged 4–17 years with serious emotional or behavioral difficulties was higher among those living in nonmetropolitan areas (6.7%) than among those living in metropolitan areas (5.3%).

Among boys, those living in nonmetropolitan areas (8.5%) were more likely to have serious emotional or behavioral difficulties than those living in metropolitan areas (6.6%), but the difference among girls was smaller and not significant.

Among children and adolescents living in either metropolitan or nonmetropolitan areas, boys were more likely than girls to have serious emotional or behavioral difficulties.

Source: National Health Interview Survey, 2016–2018. https://www.cdc.gov/nchs/nhis/index.htm.


Racial and Ethnic Differences in the Prevalence of Attention-deficit/Hyperactivity Disorder and Learning Disabilities Among U.S. Children Aged 3–17 Years

March 4, 2020

Attention-deficit/hyperactivity disorder (ADHD) and learning disabilities are the most commonly diagnosed neurodevelopmental disorders in children and often coexist.

Previous research has suggested that the prevalence of these conditions may differ by race and Hispanic origin.

Using timely, nationally representative data, this report examines the reported prevalence of ADHD and learning disabilities by race and ethnicity and select demographic characteristics that are associated with the diagnosis of these conditions.


  • In 2016–2018, nearly 14% of children aged 3–17 years were reported as ever having been diagnosed with either attention-deficit/hyperactivity disorder (ADHD) or a learning disability; non-Hispanic black children were the most likely to be diagnosed (16.9%).
  • Among children aged 3–10 years, non-Hispanic black children were more likely to have ever been diagnosed with ADHD or a learning disability compared with non-Hispanic white or Hispanic children.
  • Diagnosis of ADHD or a learning disability differed by federal poverty level for children in all racial and ethnic groups.
  • Diagnosis of ADHD or a learning disability differed by parental education among non-Hispanic white children only.

Prevalence of Children Aged 3–17 Years With Developmental Disabilities, by Urbanicity: United States, 2015–2018

February 19, 2020

Questions for Ben Zablotsky, Ph.D., Health Statistician and Lead Author of “Prevalence of Children Aged 3–17 Years With Developmental Disabilities, by Urbanicity: United States, 2015–2018.”

Q: Why did you decide to focus on urbanicity among children with developmental disabilities?

BZ: Thanks to previous research, we know that children with developmental disabilities typically require more health care and educational services than their typically developing peers, and we also know that children living in rural areas have greater unmet medical needs when compared to children living in urban areas.  For these two reasons, it is possible, that children with developmental disabilities living in rural areas could represent some of the most vulnerable when it comes to receiving a variety of health care services.  This report attempts to answer this question, by exploring the prevalence of selected developmental disability conditions and use of related services in rural and urban areas.  It serves as a follow-up to a previous Pediatrics article written by myself and Lindsey Black, along with colleagues from the National Center for Health Statistics, National Center on Birth Defects and Developmental Disabilities, and the Maternal and Child Health Bureau, titled “Prevalence and Trends of Developmental Disabilities among Children in the United States: 2009-2017

Q: How did you obtain this data for this report and what is considered a developmental disability?

BZ: Data come from the 2015-2018 National Health Interview Survey, a timely and nationally representative survey.  Developmental disabilities examined in this report were attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, blindness, cerebral palsy, moderate to profound hearing loss, learning disability, intellectual disability, seizures in the past 12 months, stuttering or stammering in the past 12 months, or any other developmental delay. Children whose parents answered that their child had one or more of these conditions were classified as having any “developmental disability.”

Q: Can you summarize how the data varied by types of developmental disabilities and service utilization in rural and urban areas?

BZ: During 2015-2018, children were more likely to be diagnosed with ADHD and cerebral palsy in rural areas than urban areas.  Meanwhile, children with developmental disabilities living in rural areas were less likely to have seen a mental health professional, therapist, or had a well-child check-up in the past 12 months than their urban peers.  Children with developmental disabilities in rural areas were also less likely to be receiving Special Education or Early Intervention Services.

Q: Was there a specific finding in the data that surprised you?

BZ: Children with developmental disabilities often need specialty and mental health services.  It was surprising to see that approximately half of children with developmental disabilities living in rural areas had not seen a mental health professional, specialist, or therapist in the past year.

Q: What is the take home message for this report?

BZ: There was a higher prevalence of children with developmental disabilities in rural areas compared with urban areas. Furthermore, among children with developmental disabilities, those living in rural areas were less likely to use a range of health care and educational services compared with their urban peers.  Additional research exploring the pathways to the diagnosis and treatment of developmental disabilities in both urban and rural areas, with a focus on the availability of resources to pay for services as well as access to trained specialty providers, could provide insight into the disparities seen in this report.

Births: Final Data for 2018

November 27, 2019

Questions for Joyce Martin, Health Statistician and Lead Author of “Births: Final Data for 2018

Q: What is new in this report from the 2018 provisional birth report?

JM: In addition to providing final numbers and rates for numerous birth characteristics such as fertility rates, teen childbearing, cesarean delivery and preterm and low birthweight, this report presents final information on  teen childbearing by race and Hispanic origin and by state, births to unmarried women, tobacco use during pregnancy, source of payment for the delivery and twin and triplet childbearing.

Q: Was there a specific finding in the 2018 final birth data that surprised you?

JM: The continued decline in birth rates to unmarried women (down 2% for 2017-2018 to 40.1 births per 1,000 unmarried women), the fairly steep decline in tobacco smoking among pregnant women (down 6% to 6.5% of all women) and the continued declines in twin (down 2%) and triplet (down 8%) birth rates.  Also of note is the decline in the percentage of births covered by Medicaid between 2017 and 2018 (down 2% to 42.3%) and the small rise in the percentage covered by private insurance (49.6% in 2018).

Q: How did you obtain this data for this report?

JM: These data are based on information for all birth certificates registered in the United States for 2018.

Q: What is the take home message for this report?

JM: Birth certificate data provide a wealth of important current and trend information on demographic and maternal and infant health characteristics for the United States.

Q: Why do you think the birth has dropped in the U.S.?

JM: The factors associated with family formation and childbearing are numerous and complex, involving psychological, cultural, demographic, and socio-economic influences. The data on which the report is based come from all birth certificates registered in the U.S. While the data provide a wealth of information on topics such as the number of births occurring in small areas, to small population groups, and for rare health outcomes, the data do not provide information on the attitudes and behavior of the parents regarding family formation and childbearing. Accordingly, the data in and of itself cannot answer the question of why births have dropped in the U.S.