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.
HOST: We’re joined today by Merianne Spencer, the author of a new study on accidental drowning deaths among children in the United States.
HOST: So briefly describe to us the scope of the problem.
MERIANNE SPENCER: Sure. So unintentional drowning deaths are the second leading cause of injury death among children, those aged zero to 17, and is also the leading cause of unintentional injury deaths for those ages one to four, so for this study we wanted to look at national trends from 1999 to 2019 by demographic characteristics and also by urban-rural status to see what the patterns were over the past two decades among children.
HOST: So you say that drowning deaths are the second leading cause of unintentional death among kids – what was the leading cause of unintentional injury deaths in that age group?
MERIANNE SPENCER: The leading cause of death for unintentional injuries is motor vehicle traffic deaths, followed by drowning and then poisoning and then suffocation. But it’s important to note that motor vehicle traffic deaths are much higher. In 2019, there were almost 2000 deaths whereas for drowning there were pretty much half the amount. Motor vehicle traffic deaths is much higher.
HOST: How has this problem changed over time?
MERIANNE SPENCER: So over the past two decades drowning deaths have decreased – roughly a 38 percent decline over the past two decades.
HOST: Do we have any idea why drowning deaths have declined over the past two decades? Are there any CDC programs that are targeting this problem?
MERIANNE SPENCER: Looking at prevention programs, the National Center for Injury Prevention and Control – they provide a lot of information about the prevention of drowning, including pool safety, swimming safety tips and other considerations for water safety within the home. I would also look to prevention resources such as “Safe Kids Worldwide” and the “World Safety USA Network” but there are various programs that have been looking at improving safety for drowning among children and targeting that public health issue.
HOST: Now one would assume that drowning deaths tend to spike during the summer months – is that an accurate assumption? What did the data tell us about seasonality?
MERIANNE SPENCER: There’s definitely a seasonality with respect to driving death. So typically, the number of unintentional drowning deaths are lowest during colder months such as January or December, as well as in the Fall. The number of deaths tend to rise sometime in April and they peak around June and July and decrease as it goes towards September. So yes, it is an accurate assumption that there is a spike in around the warmer months when children might be swimming or going to the pool.
HOST: So which groups are more at risk for drowning deaths?
MERIANNE SPENCER: Our study found that males are definitely at greater risk for unintentional drownings – they had higher rates of unintentional drowning deaths over the past two decades compared to females. We also saw that those aged one to four had the highest rates of drowning compared to other age groups. So much higher among those aged one to four years of age. We also saw that rates were higher among non-Hispanic black children compared to non-Hispanic white children and Hispanics over the study period. And also we saw children were at higher risk for unintentional drownings in rural areas compared to urban areas.
HOST: And what did the data tell us about places that are most risky for kids in terms of being a potential drowning risk?
MERIANNE SPENCER: Our study found that death varied by age groups. So those that were less than a year of age had a higher percentage that died in a bathtub, whereas those that at age 1 to four or five to 13 had the greatest percentage of deaths in swimming pools and those aged 14 to 17 were more likely to die in natural water such as lakes, rivers, streams, or oceans. So there is definitely a difference by age group in the places where drowning deaths occurred.
HOST: Are there any plans for further studies on this topic?
MERIANNE SPENCER: We are interested in looking at those places of drowning by looking at the literal text or the written information on the death certificate records to see if we can get a little bit more information. Currently the study is focused on using the ICD-10 codes to look at places of drowning but maybe we can get some more insight about this finding in a future study.
HOST: You mentioned the literal text – that’s the same kind of technique that’s been used on some studies looking at the types of drugs involved in overdose deaths is that correct?
MERIANNE SPENCER: Yes that’s correct. So by looking at the written information by medical examiners and coroners we might be able to tease out some information beyond the coding on ICD-10 codes or get more specificity on the place of drowning or some context around the drowning deaths so that’s something we might be looking into for a future study for this topic.
MUSICAL BRIDGE
HOST: This week, NCHS released the first, full-year provisional data from 2020 on drug overdose deaths in America. The new release shows a nearly 30% increase in deaths, from over 72,000 estimated deaths in 2019 to more than 93,000 deaths in 2020.
Three-quarters of all overdose deaths involve opioids – or nearly 70,000 deaths. Much of the 2020 spike was the result of increases in deaths from synthetic opioids, primarily fentanyl. Deaths from psychostimulants such as methamphetamine also continued to increase in 2020, as did deaths from cocaine and from natural and semi-synthetic opioids such as prescription pain medication.
The first 2021 data on overdose deaths will be released in August of this year.
In 2019, 25.3% of children aged 2–17 years wore glasses or contact lenses, and the percentage increased with age among both boys and girls.
Among boys, 3% wore glasses among those aged 2–5 years, 20.0% among those aged 6–11 years, and 35.3% among those aged 12–17 years. Among girls, the corresponding percentages are 3.1, 26.4, and 48.2.
The percentage was higher among girls than boys overall and among those aged 6–11 years and 12–17 years, but not in the youngest age group.
HOST: We now continue our conversation with Ben Zablotsky, health statistician with the Division of Health Interview Statistics on children’s mental health in the United States.
HOST: You mentioned social media and the Internet – what about more traditional environmental issues that might contribute to mental health issues among children, such as family structure. Does NCHS have any data on how family structure, including maybe divorce, might impact mental health?
BEN ZABLOTSKY: So in the past, the National Survey of Children’s Health was run out of our center, and we did have some questions about family structure as it relates to whether a parent had divorced or separated. And we looked at this within kind of the lens of “stressful life event.” And we do know generally that, yes, children who experience the stressful life events which can include changes to the family structure have been associated with higher rates of mental health conditions. But other things that we can look at now right within the NHIS have to do with general adversity that a child might be dealing with as it relates to food security or the availability of health resources. And so those items are also associated with mental health and actually in 2021, we have a longer list of stressful life events that are being asked of parents that can then be looked at in the lens of health. And that could be something that is worth exploring further.
HOST: In a general sense, are there any groups of children at higher risk than others at developing mental illness?
BEN ZABLOTSKY: So I would certainly say again that older children are more likely to experience some of these internalizing mental health disorders that talked about in terms of depression and anxiety. Certainly there are children who are dealing with a more adverse living situation who have a higher chance of developing a mental health disorder, but some conditions genetically are actually more likely to occur in boys than girls. So you see that autism spectrum disorder is an example of that, you see higher rates of ADHD among boys versus girls. And generally when someone has accessibility to services, you might see higher rates of diagnosis because they are able to see someone who can actually say “Oh yes, that is what this child has. Here’s a treatment plan we can move forward with.”
HOST: You mentioned autism and ADHD. Thirty, forty years ago you didn’t really hear about these conditions. There’s some that might think that this might be over-diagnosed since they’re relatively new conditions. Do you have any data about that?
BEN ZABLOTSKY: So the prevalence of autism spectrum disorder has changed over the years because the criteria for defining the condition itself has changed. So a lot of the increase you saw in some more recent years have actually been just that – that it wasn’t necessarily as difficult to get a diagnosis based on the criteria of the DSM – but I think there’s also a lot to be said about the awareness of these conditions. And there have been campaigns within the CDC itself to increase awareness of developmental disabilities generally, and I think that also attributes quite a bit to the increased rate that we’ve seen.
HOST: And we can certainly have a whole separate podcast on those topics alone – maybe we’ll wait till your next publication on that. Are there any other topics you’d like to discuss before we sign off?
BEN ZABLOTSKY: When we’re talking about mental health I think it’s certainly worth talking about mental health within the context of COVID-19 and how the NHIS can capture that. I think one of the challenges of the NHIS is that it is a very large survey, but it’s also cross-sectional so it’s not possible to follow children longitudinally. But what we can do is look at estimates that come out of 2019 and come out of 2020 and start to get a picture of how things might be changing for children in this age of COVID-19. And some things we can look at or just access to care and potentially the use of telemedicine to receive services. You know, I’ve talked a lot about treatment generally – a lot of the treatment in 2019, you know looking at the 2019 data, was face-to-face treatment that these individuals were receiving. But a lot of times, you know, a lot of treatment is received through the schools and with schools being virtual, it’s quite likely that some children have lost out in some of the care they normally receive. So I want to certainly look at that avenue of research moving forward because there’s a lot that’s happened obviously and one thing we don’t want to lose sight of is how children’s mental health have been affected.
HOST: Well you raise a good point, because with the shuttering of schools and the isolation felt by some children and the disadvantages some children have, are you planning to directly look at the correlation between virtual learning and mental health issues that were tied to the pandemic?
BEN ZABLOTSKY: So that’s one thing that’s tricky to look at within our survey ’cause we don’t have a lot of data on the specific schools the children are attending and the resources they had prior to COVID and receiving. But I certainly think that understanding various services – and we ask questions about special education-related services – we have to understand how those might have changed and certainly will have changed when we are dealing with something like virtual schooling.
HOST: Well that also would be a great topic for its own podcast so thanks very much Ben.
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.
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
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.
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.
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.
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.
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New NCHS report measures the financial burden of medical care among veterans aged 25–64 and examines how that burde… twitter.com/i/web/status/1…1 day ago
NCHS 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.
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HOST: We’re joined today by Merianne Spencer, the author of a new 
HOST: We now continue our conversation with Ben Zablotsky, health statistician with the Division of Health Interview Statistics on children’s mental health in the United States.
Questions for Lindsey Black, Health Statistician and Lead Author of “
NCHStats 