Telemedicine Use in Children Aged 0–17 Years: United States, July–December 2020

May 10, 2022

Questions for Maria Villarroel, Health Statistician and Lead Author of “Telemedicine Use in Children Aged 0–17 Years: United States, July–December 2020.”

Q: Why did you decide to look at telemedicine among U.S. children during the pandemic?

MV: We know that telemedicine use expanded during the COVID-19 pandemic. Telemedicine became a key practice in health care that supports social distancing and decreases contact between health care staff and other patients for the receipt of health care services and reduce the spread of infection. However, there are limited estimates of telemedicine use, especially in children, and this report aims to address that gap.


Q: How did the data vary by age groups, income level and region?

MV: We examined telemedicine use in two ways: 1) telemedicine use in the past 12 months from the time of interview in July-December 2020, so this included both pre-pandemic and pandemic periods; and 2) telemedicine use because of reasons related to the coronavirus pandemic during the first year of the pandemic – 2020.

We found that telemedicine use in the past 12 months varied by age of the child and family income. Telemedicine use in the past 12 months was highest for younger children (aged 4 years and under) and older children (12 to 17 years), and lowest for children aged 5 to 11 years.  Telemedicine use in the past 12 months was highest for children with family incomes below the federal poverty level and at or above 400% of the federal poverty level, and lowest for children with family incomes at 100%–199% of the federal poverty level.  Although not statistically significant, a similar pattern by age was observed for telemedicine use due the pandemic, while telemedicine use due to the pandemic was highest for children with family income at or above 400% of the federal poverty level.

Telemedicine use in the past 12 months and telemedicine use because of the pandemic varied by region. Children living in the Northeast were more likely to have used telemedicine than children living in the Midwest and South regions, and similarly as likely to have used telemedicine as children living in the West region. 


Q: How did telemedicine use vary between urban and rural areas?

MV: In this study, we used the NCHS Urban–Rural Classification Scheme for Counties to classify urbanization level, and we compared telemedicine use in children living in large metropolitan areas, medium and small metropolitan areas, and nonmetropolitan areas.

We found that both telemedicine use in the past 12 months and telemedicine use because of the pandemic were lower in nonmetropolitan areas compared with metropolitan areas. But we also observed that the percentage point difference between metropolitan and nonmetropolitan areas was wider for the use of telemedicine because of the pandemic than for telemedicine use in the past 12 months. For example, we observed that children residing in metropolitan areas were more than two times as likely to have use of telemedicine because of the pandemic compared with children residing nonmetropolitan areas, but children in metropolitan areas were only about 1.3 to 1.4 more likely than children in nonmetropolitan areas to have used telemedicine in the past 12 months.   


Q: Do you have comparative trend data that goes further back than the second half of 2020?

MV: No. Telemedicine questions were introduced into the NHIS survey in July 2020 as one of the emerging public health topics affecting the United States related to the COVID-19 pandemic, which was declared in March 2020 by the World Health Organization.

Trend data on telemedicine use in children is limited.  Since April 2020, the experimental data system called the Household Pulse Survey, which is a collaboration between multiple federal agencies, began collecting data on telemedicine use in the past 4 weeks in households with at least one child under 18 years of age, among other social and economic impacts of the COVID-19 pandemic. 


Q: What is the main takeaway message here?

MV: Approximately 12.6 million children in the U.S.—corresponding to 17.5% of children aged 0–17 years—used telemedicine in the past 12 months from the time of interview in July-December 2020 (a period that included time before and during the coronavirus pandemic).  

Telemedicine use in the past 12 months varied by age of the child, family income, and region of the country.

Approximately 10.2 million U.S. children—corresponding to 14.1% of children aged 0–17 years—used telemedicine in 2020 because of the pandemic.

Telemedicine use because of the pandemic varied by education of the parents living with the child and region of the country and urbanization level of residence.

Telemedicine use in the past 12 months and because of the pandemic was higher for children with current asthma, a developmental condition, and disability.


QuickStats: Percentage of Children and Adolescents Aged 5–17 Years Who Reported Being Tired Most Days or Every Day, by Age Group and Hours of Screen Time

February 11, 2022

In 2020, 3.5% of children aged 5–11 years and 10.9% of adolescents aged 12–17 years reported being tired on most days or every day.

Among adolescents aged 12–17, the percentage reporting being tired was higher (12.0%) for those who reported >2 hours of screen time (in addition to that for schoolwork) per weekday than for those who reported ≤2 hours of screen time each day (6.5%). In children aged 5–11 years, the percentage reporting being tired did not differ by hours of screen time (3.6% for >2 hours versus 3.5% for ≤2 hours).

Regardless of the amount of screen time reported, adolescents aged 12–17 years were more likely to report being tired on most days or every day than were children aged 5–11 years.

Source: National Center for Health Statistics, National Health Interview Survey, 2020. https://www.cdc.gov/nchs/nhis.htm

https://www.cdc.gov/mmwr/volumes/71/wr/mm7106a5.htm


Stressful Life Events Among Children Aged 5–17 Years by Disability Status: United States, 2019

January 26, 2022

Questions for Heidi Ullman, Health Statistician and Lead Author of “Stressful Life Events Among Children Aged 5–17 Years by Disability Status: United States, 2019.”

Q: Why did you decide to do a report on stressful life events for children with a disability?

HU: Children with disabilities are an important population group that has experienced disadvantage in many domains.  We were interested in seeing if children with disabilities were at increased risk of experiencing stressful life events as these events have been linked to adverse physical and mental health outcomes.  Identifying the extent to which children with disabilities are at increased risk will inform policy to support these children and promote their health and full inclusion in society.


Q: What is considered a disability for this report?

HU: We adopt a functional approach to disability consistent with international standards for disability measurement. Disability in children aged 5-17 years is defined by the reported level of difficulty (no difficulty, some difficulty, a lot of difficulty, or cannot do at all/unable to do) in thirteen core functioning domains: seeing, hearing, mobility, self-care, communication, learning, remembering, concentrating, accepting change, controlling behavior, making friends, anxiety and depression. Children reported to have “a lot of difficulty” or “cannot do at all” to at least one domain of functioning or with “daily” anxiety or depression are considered to have disability.


Q: Can you describe what the four stressful life events that are examined in the report?

HU: Four stressful life events are considered: 1) ever been the victim of, or witnessed, violence in the neighborhood, 2) ever lived with a parent or guardian who served time in jail or prison (after the child was born), 3) ever lived with someone who was mentally ill or severely depressed, and 4) ever lived with someone who had a problem with alcohol or drugs. It should be noted that these four stressful life events represent a subset of a larger set called Adverse Childhood Experiences (ACEs).


Q: How does the data vary by disability status when looking at the four stressful life events examined in this report?

HU: Among children aged 5-17 years, those with a disability were more likely than those without a disability to have experienced each of the four stressful life events examined in this report. The differences by disability status were greatest  for violence exposure in the neighborhood and having lived with someone who was mentally ill or severely depressed. Moreover, disability status was associated with experiencing multiple stressful life events in children.


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

HU: The take home message is that children with a disability are more vulnerable to experiencing stressful life events, the impacts of which may curtail their full participation and inclusion in society. More generally, our results point to the importance of considering disability status when analyzing health disparities.


QuickStats: Percentage of Children Aged 2–17 Years With >2 Hours of Screen Time Per Weekday, by Sex and Age Group — National Health Interview Survey, United States, 2020

January 21, 2022

Overall, 65.7% of boys and 64.6% of girls aged 2–17 years spent >2 hours of screen time per weekday, in addition to screen time spent for schoolwork.

Among both boys and girls, the percentage of children who spent >2 hours of screen time increased with increasing age group from 47.5% for those aged 2–5 years to 80.2% for those aged 12–17 years.

Source: National Center for Health Statistics, National Health Interview Survey, 2020. https://www.cdc.gov/nchs/nhis/index.htm

https://www.cdc.gov/mmwr/volumes/71/wr/mm7103a6.htm


Q & A with Author: Dental Care Utilization Among Children Aged 1–17 Years: United States, 2019 and 2020

December 2, 2021

Questions for Dzifa Adjaye-Gbewonyo, Health Statistician and Lead Author of “Dental Care Utilization Among Children Aged 1–17 Years: United States, 2019 and 2020.”

Q: Why did you decide to look at children’s dental examinations and cleanings during the pandemic?

DAG: We know that the COVID-19 pandemic required dental providers to make changes to their services, and this affected access to dental care. There have also not been many recent estimates from National Health Interview Survey (NHIS) data on preventive dental care in children, especially covering such a broad age range. So, looking at child dental care and how it changed between 2019 and 2020 was a priority research topic for the Division of Health Interview Statistics, which is responsible for the NHIS.

Q: How did the data vary by age groups, income level and region?

DAG: By age group, children aged 1-4 years had the lowest rate of dental examinations and cleanings in the past 12 months in both 2019 and 2020. They also experienced the largest decrease between the two years, from almost 59% to 51%. This contrasts with older children where the percentage ranged between 88% and 92% across age groups for the two years. By income level, fewer children living in families with lower incomes had a dental examination or cleaning in 2020 compared to 2019, while there was no significant difference between 2019 and 2020 for children with family incomes of at least 400% of the federal poverty level. Regional estimates showed that annual preventive dental visits were highest in the West and Northeast in 2019 and remained high in the West in 2020 but decreased significantly in the Northeast and in the South.

Q: What is the main takeaway message here?

DAG: I think the big takeaway is that overall, fewer children in the U.S. had an annual dental examination or cleaning in 2020 than in 2019, but the change was not the same in all segments of the child population. Some subpopulations were affected more than others, especially young children, children from lower income families, and children living in the Northeast and South. It is also important to note that we can’t fully attribute the changes to the COVID-19 pandemic because the data refer to preventive dental care in the past 12 months. So, some of this time frame took place before the pandemic.

Q: Do you plan to have adult data available for the same years?

DAG: Yes, adult data on dental care were collected and are available for 2019 and 2020. Some estimates of these data are already accessible on the NHIS website, including a data brief on urban-rural differences in dental care in 2019 and interactive quarterly and biannual estimates released through the NHIS Early Release Program. Additional analyses are also planned.

Q: Do you think the downward trend will continue into 2021?

DAG: It’s difficult to say what the trend will be in 2021 since a number of conditions have changed. Though the dental care questions rotated off the NHIS in 2021, they will return in 2022 so it will be possible to look at these data again in future years.


Concussions and Brain Injuries in Children: United States, 2020

December 1, 2021

A new NCHS report presents national estimates of lifetime symptomatology and health care professional diagnoses of concussions or brain injuries as reported by a knowledgeable adult, usually a parent, in children aged 0–17 years using data from the 2020 National Health Interview Survey.

Key Findings:

  • In 2020, 6.8% of children aged 17 years and under had ever had symptoms of a concussion or brain injury.
  • Non-Hispanic White children were more likely than children of other race and Hispanic-origin groups to have ever had symptoms of a concussion or brain injury.
  • The percentage of children aged 17 years and under who had ever had a diagnosis of a concussion or brain injury by a health care provider was 3.9%.
  • Compared with their peers, boys (4.7%) and non-Hispanic White children (5.2%) were more likely to have ever had a diagnosis of a concussion or brain injury.

Q & A with Author: Rural-urban Differences in Unintentional Injury Death Rates Among Children Aged 0-17: United States, 2018-2019

October 27, 2021

DB421_fig1Questions for Matthew Garnett, Health Statistician and Lead Author of “Rural-urban Differences in Unintentional Injury Death Rates Among Children Aged 0-17: United States, 2018-2019.”

Q: Can you describe what unintentional injury deaths are?

MG: Unintentional injury deaths include fatal injuries that were unintended, unplanned, and did not occur on purpose. In contrast, intentional injuries include homicide or assault and suicide or self-harm. Unintentional injury deaths include a wide array of mechanisms, with the four most common being: poisoning, motor vehicle crashes, drowning, and falls.


Q: How did the data vary by age groups?

MG: Rates of unintentional injury deaths differ across age groups. In both urban and rural areas, unintentional injury death rates were highest among children aged under 1 year, followed by a decline in the 1–4 and 5–13 age groups, and then increasing in the 14–17 group. Although this pattern was seen in both urban and rural areas, rural rates were consistently higher than urban rates for all age groups.

The high rates experienced among children under the age of 1 year were driven by high rates of suffocation (includes choking, asphyxiation, and strangulation). Among children aged 1-4 years, the leading mechanisms diverged based on urban-rural status, with drowning being the leading mechanism in urban areas, and with both drowning and motor vehicle traffic being the leading mechanism among in rural areas. In the older age groups, including those aged 5-13 and 14-17, motor vehicle traffic was the leading mechanism.

The decrease in overall rates from the under 1 year group to the 1-4 age group can be explained by a lower suffocation rates, which decreased from 24.9 in urban areas and 42.1 in rural areas among children under 1, to 0.7 and 1.1, respectively, in the 1-4 age group. The increase in overall rates between the 5-13 and 14-17 age groups is partially due to the increase in motor vehicle traffic rates, which increased from 1.5 in urban areas and 3.1 in rural areas among the 3-13 age group to 5.1 and 12.5, respectively, in the 14-17 age group.


Q: Do you have trend data that goes further back than 2018?

MG: This information is not presented in the report, but additional national data is available through CDC’s query system – CDC WONDER. Since 1999, rates of unintentional injury death among children aged 0-17 years have decreased from a high of 12.7 (per 100,000 population) in 1999 to 7.2 in 2019, a 43% decrease. Decreases were seen both in urban and rural areas. In urban areas the rate decreased from 11.0 in 1999 to 6.4 in 2019, a 42% decrease. In rural areas, the rate decreased from 21.5 in 1999 to 12.7 in 2019, a decrease of 41%. The unintentional injury death rate has decreased among children in both areas between 1999 and 2019; however, the gap between urban and rural rates has been maintained over time.

Rates of Unintentional Injury Death Among Children Aged 0-17 Years by Urban-rural Status, United States, 1999-2019

Year

Total

Rate per 100,000

Urban

Rate per 100,000

Rural

Rate per 100,000

1999

12.7

11.0

21.5

2000

12.3

10.7

21.1

2001

11.9

10.4

20.3

2002

11.9

10.6

19.7

2003

11.5

10.0

20.2

2004

11.7

10.2

20.3

2005

11.1

9.7

19.4

2006

10.8

9.4

18.6

2007

10.7

9.5

17.6

2008

9.3

8.1

16.6

2009

8.6

7.5

14.9

2010

8.1

7.0

14.4

2011

8.0

6.9

14.2

2012

7.7

6.7

13.8

2013

7.4

6.4

13.2

2014

7.2

6.3

12.9

2015

7.6

6.7

13.6

2016

7.8

7.0

13.2

2017

7.7

6.8

13.4

2018

7.1

6.3

12.2

2019

7.2

6.4

12.7

NOTES: Unintentional injury deaths are identified using International Classification of Diseases, 10th Revision underlying cause-of-death codes V01–X59 or Y85–Y86. The decedent’s county of residence was classified as urban or rural based on the 2013 NCHS Urban–Rural Classification Scheme for Counties. Rates shown are crude rates (deaths per 100,000).

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.


Q: What is the main takeaway message here?

MG: There are two main takeaways here. The first is that when discussing unintentional injury deaths, there are disparities for children between urban and rural areas. These disparities are found across age groups, and across multiple injury mechanisms.

The second takeaway is that the reasons for unintentional injury deaths change with age. Among the youngest children, under 1 year of age, suffocation is the leading mechanism of death, with the highest rate of any mechanism for both urban and rural children across all age groups. Among slightly older children aged 1-4 years, the leading mechanism becomes motor vehicle traffic and drowning. After this age group, the mechanism with the highest rates is motor vehicle traffic for children aged 5-13 and 14-17. For all of these leading mechanisms, rates were higher for children in rural areas.


Q: What are the reasons why unintentional injury death rates are higher in rural vs. urban areas?

MG: Data from this report suggests that different mechanisms drive the overall unintentional injury rate for each age group. Urban-rural disparities between mechanisms provide insight into the larger disparities seen in the overall unintentional rates. For example, among children under the age of 1, the rural rate of deaths involving suffocation were significantly higher (42.1 per 100,000 population) than urban rates (24.9). For that age group, suffocation was a major driver of disparity seen in the total unintentional injury death rate, which was 48.8 for rural areas and 29.3 for urban areas.

Among children aged 1-4, all reportable mechanisms show significantly higher rates among children in rural areas compared to children in urban areas. For some mechanisms, these disparities are smaller, such as natural or environmental deaths where the rural rate was 0.5 compared to the urban rate of 0.3. In other mechanisms the disparity is larger, such as for deaths involving fire or flames, where the rural rate was 1.7 compared to the urban rate of 0.4, more than 4 times higher.  

Among children aged 5-13 and 14-17, not all mechanisms show a significant disparity. However, some of the largest drivers of the overall unintentional death rate (that is, mechanisms with a larger number of deaths) for each group did. For example, motor vehicle traffic death rates were twice as high in rural areas compared to urban areas for both age groups. 

This data brief does not get into the specific reasons for disparities within specific mechanisms. However, there is a wide body of research that has associated urban-rural differences in injury mortality to a variety of factors. These include differences in types of activities undertaken by children living in rural and urban areas and the built environments that they undertake these activities in. Studies have also suggested that differences in patterns of safety equipment use and the practice of safety-related behaviors may play a role in differing mortality rates. Access to care has also been pointed to as an issue, when considering first responder response times in rural settings compared to urban settings, and access to medical facilities, including high level trauma care. The introduction to the report cites several of these studies.

Additional information on unintentional injuries, and strategies to address unintentional injuries are available from the CDC’s National Center for Injury Prevention and Control.


FACT OR FICTION VIDEO: Stressful Life Events Among Children

September 16, 2021

https://www.cdc.gov/nchs/pressroom/videos/2021/september2021/fof_Sept2021.htm


QuickStats: Percentage of Children and Adolescents Aged 0–17 Years Who Have Experienced a Specified Stressful Life Event, by Type of Event and Poverty Status

August 27, 2021

mm7034a7-f

In 2019, 20.7% of children and adolescents in families with incomes <200% of the poverty threshold and 12.6% of children and adolescents in families with incomes ≥200% of the poverty threshold had experienced at least one specified stressful life event.

Children and adolescents in families with incomes <200% of the poverty threshold were more likely than children and adolescents in families with incomes ≥200% of the poverty threshold to have been the victim or witnessed violence (8.1% versus 3.5%); lived with someone who had been in jail (8.7% versus 3.5%); lived with a person with problems with mental health or depression (10.1% versus 6.4%); or lived with a person with problems with alcohol or drugs (10.2% versus 6.5%).

Source: National Health Interview Survey, 2019. https://www.cdc.gov/nchs/nhis.htm

https://www.cdc.gov/mmwr/volumes/70/wr/mm7034a7.htm


New Report on Children and Adolescent Body Measurements

August 4, 2021

NHSR160_Cover1NCHS releases a new report, “Mean Body Weight, Height, Waist Circumference, and Body Mass Index Among Children and Adolescents: United States, 1999–2018” that presents trends in mean weight, recumbent length, height, waist circumference, and body mass index (BMI) among children and adolescents in the United States from 1999 through 2018.

Key Findings:

  • No significant trends over time were observed in any of the body measures for children aged 2–5 years, except for an increase in mean BMI among girls.
  • Among girls aged 6–11, mean height and waist circumference significantly increased from 1999–2000 through 2003–2004, and then significantly decreased for height but remained stable for waist circumference through 2017–2018.
  • Among those aged 12–15, mean body weight and waist circumference increased over time among boys, and BMI increased among both boys and girls.
  • Among adolescent boys aged 16–19, body weight significantly increased from 1999–2000 through 2009–2010 and
    then significantly decreased through 2017–2018. In addition, height remained stable through 2009–2010 and then significantly decreased through 2017–2018.
  • Among adolescent girls aged 16–19, mean body weight, waist circumference, and BMI significantly increased from 1999–2000 through 2017–2018.