Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–June 2018

November 15, 2018

A new report from NCHS presents selected estimates of health insurance coverage for the civilian noninstitutionalized U.S. population based on data from the 2018 National Health Interview Survey, along with comparable estimates from previous calendar years. Estimates for the first 6 months of 2018 are based on data for 39,112 persons.

Key Findings:

  • In the first 6 months of 2018, 28.5 million persons of all ages (8.8%) were uninsured at the time of interview—not significantly different from 2017, but 20.1 million fewer persons than in 2010.
  • In the first 6 months of 2018, among adults aged 18–64, 12.5% were uninsured at the time of interview, 20.0% had public coverage, and 69.2% had private health insurance coverage.
  • In the first 6 months of 2018, among children aged 0–17 years, 4.4% were uninsured, 43.4% had public coverage, and 53.6% had private health insurance coverage.
  • Among adults aged 18–64, 69.2% (137.1 million) were covered by private health insurance plans at the time of interview in the first 6 months of 2018. This includes 4% (7.9 million) covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges.
  • The percentage of persons under age 65 with private health insurance enrolled in a high-deductible health plan increased, from 43.7% in 2017 to 46.0% in the first 6 months of 2018.
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Fact or Fiction: Is yoga is the fastest-growing complementary health approach among children and adults in the United States?

November 8, 2018

 


Use Of Yoga and Meditation Becoming More Popular in U.S.

November 8, 2018

The use of yoga and meditation has increased in the U.S., according to two new reports released by the CDC’s National Center for Health Statistics (NCHS).

The first report “Use of Yoga, Meditation, and Chiropractors Among U.S. Adults Aged 18 and Older” examines changes from 2012 to 2017 in the percentage of U.S. adults that used yoga, meditation and chiropractors in the past 12 months. Of the three complementary health approached presented, yoga was the most commonly among U.S. adults in 2012 (9.5%) and 2017 (14.3%). The use of meditation increased more than threefold from 4.1% in 2012 to 14.2% in 2017.

The second report released today, “Use of Yoga, Meditation and Chiropractors Among U.S. Children Aged 4–17 Years,” reveals that U.S. children aged 4-17 years who used yoga in the past 12 months increased significantly from 3.1% in 2012 to 8.4% in 2017. Further examination of 2017 data showed that girls were more likely than boys to have used yoga in the past 12 months (11.3% vs. 5.6%).

Other findings documented in the reports:

  • In 2017, the use of yoga among U.S. adults aged 18-44 (17.9%) was more than twice that of adults 65 years and older (6.7%).
  • In 2017, non-Hispanic white adults were more likely to use yoga (17.1%) and see a chiropractor (12.7%) in the past 12 months compared with Hispanic (8% and 6.6%, respectively) and non-Hispanic black (9.3% and 5.5%, respectively) adults.
  • The use of yoga, meditation and chiropractors saw a significant increase from 2012 to 2017, among U.S. adults.
  • Use of meditation increased significantly for U.S. children from 0.6% in 2012 to 5.4% in 2017.
  • Older U.S. children aged 12-17 were more likely to have used meditation (6.5%) and a chiropractor (5.1%) than younger children aged 4-11 (4.7% and 2.1% respectively) in 2017.
  • There was no significant difference in the use of a chiropractor for children from 2012 to 2017.

The two reports, “Use of Yoga, Meditation, and Chiropractors Among U.S. Adults Aged 18 and Older” and “Use of Yoga, Meditation and Chiropractors Among U.S. Children Aged 4–17 Years” are available on the NCHS web site at www.cdc.gov/nchs.


Chronic School Absenteeism Among Children With Selected Developmental Disabilities: National Health Interview Survey, 2014–2016

September 26, 2018

Lindsey Black, NCHS Health Statistician

Questions for Lindsey Black, Health Statistician and Lead Author of “Chronic School Absenteeism Among Children With Selected Developmental Disabilities: National Health Interview Survey, 2014–2016

Q: Why did you decide to focus on chronic school absenteeism among U.S. children with developmental disabilities for this report?

LB: DDs encompass a range of conditions that may have lifelong impacts on the functioning and wellbeing of children. In particular, developmental disabilities (DDs) can affect school adjustment, attendance and academic performance. Previous research has explored the relationships of DDs and school outcomes but have generally been limited in sample size and use aggregate mental health measures, rather than specific conditions.

This study aims to describe chronic school absenteeism among a nationally representative sample of children with selected DDs of autism spectrum disorder, intellectual disability, other developmental delay and attention-deficit/hyperactivity disorder (ADHD), in order to identify groups that may need additional supports.


Q: What is meant by chronic school absenteeism?

LB:  School absenteeism was categorized based on the survey question, “During the past 12 months, about how many days did (sample child) miss school because of illness or injury?” Responses of 15 or more days were categorized as chronic school absenteeism based on the U.S. Department of Education definition.


Q: How did the findings vary among the selected developmental disabilities?

LB: In this nationally representative sample of children aged 5–17 years, children with ADHD, autism spectrum disorder, and intellectual disability were more likely to have had chronic school absenteeism compared with children who did not have these conditions even after controlling for demographic and selected physical health conditions.

Similarly, as the number of DDs increased, the DDs of chronic school absenteeism increased. These findings show that both the type and number of DDs are associated with school attendance.


Q: What methods did you use to conduct this analysis?

LB: We calculated the weighted percentage of children who had chronic school absenteeism for each of the selected developmental disability groups. Next, separate unadjusted logistic regressions for each of the selected DDs as the dependent variable (and chronic absenteeism as the outcome) were calculated. Multivariate logistic regressions were also used to assess the association between children with selected DDs and chronic school absenteeism, adjusted by selected demographic characteristics and co-occurring physical health conditions.


Q: Is there any comparable trend data on this topic from previous National Health Interview Service data?

LB: This is the first report that specifically looks at chronic school absenteeism among developmental disabilities.  Data on number of school days missed due to illness or injury has been collected among children consistently since 1997.


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

LB: Children with DDs had higher chronic school absenteeism. Associations remained, controlling for demographics and co-occurring physical health conditions.


High-deductible Health Plan Enrollment Among Adults Aged 18-64 With Employment-based Insurance Coverage

August 9, 2018

Questions for Robin Cohen, Ph.D. and Lead Author of “High-deductible Health Plan Enrollment Among Adults Aged 18-64 With Employment-based Insurance Coverage

Q: What made you decide to put together a report about high and low deductible health plans for adults with employment-based coverage?

RC: We decided to produce an analysis focusing on high-deductible health plans (HDHPs) after observing how enrollment in HDHPs has increased over the past decade. In addition, HDHP enrollment growth has been faster among those with employment-based coverage than among those with directly-purchased coverage, so it also made sense to highlight employment-based insurance plans in this study. This report examines differences in the demographic characteristics for those with employment-based coverage by plan type.    


Q: Was there a finding in your new report that really surprised you?

RC: It was the dramatic increase in high-deductible health plan (HDHP) enrollment in recent years that really surprised us. We hadn’t expected to see such a large jump, which was most notable among those with a health savings account (HSA). The percentage of adults aged 18 to 64 enrolled in an HDHP with an HSA more than quadrupled in the past decade from 4.2% to 18.9%.


Q: What differences or similarities did you see between or among various demographic groups in this analysis?

RC: Both the differences among age groups and the lack of variance by sex in this study’s findings are notable. Among adults aged 18 to 64 with employment-based coverage, there were no differences in the type of health insurance plan by sex. Enrollment in a high-deductible health plan with a health savings account was higher among adults aged 30 to 44 than those aged 18 to 29 and 45 to 64.


Q: What is the significance of having a health savings account and not having one when you have a high-deductible health insurance plan?

RC: A health savings account (HSA) allows pretax income to be saved to help pay for the higher costs associated with a high-deductible health plan (HDHP). However, this report did not examine the association of having an HDHP — coupled with an HSA — on service use and financial burden for medical care.

 

Q: Is it a choice for Americans to have a health savings account? Can anyone have one?

 

RC: A health savings account (HSA) must be coupled with a high-deductible health plan (HDHP), but not everyone enrolled in an HDHP has an HSA. High-deductible health plans with HSAs are offered to individuals both by employers and in the direct-purchase health insurance market.

Q: What would you say is the take-home message of this report?

 

RC: I think the real take-home message in this Data Brief is the role that education and income play in health insurance coverage with these types of high-deductible health plans (HDHPs). More highly educated and affluent adults were more likely to enroll in an HDHP with a health savings account (HSA) and less likely to enroll in a traditional plan or an HDHP without an HSA — than their less educated and less affluent counterparts. The National Health Interview Survey will continue to monitor different types of private health insurance, and the survey can be used to examine further differences according to plan type.

Q: Do you have trend data on high-deductible health plans going back further than 2007?

RC: No, we don’t have earlier than 2007 trend data on high-deductible health plans (HDHPs). The National Health Interview Survey began to collect data on enrollment in HDHPs starting in 2007.


State Variation in Meeting the 2008 Federal Guidelines for Both Aerobic and Muscle-strengthening Activities Through Leisure-time Physical Activity Among Adults Aged 18-64: United States, 2010-2015

June 28, 2018

Questions for Lead Authors Debra L. Blackwell, Ph.D., Demographic Statistician, and Tainya C. Clarke, Ph.D., M.P.H., Health Statistician, of “State Variation in Meeting the 2008 Federal Guidelines for Both Aerobic and Muscle-strengthening Activities Through Leisure-time Physical Activity Among Adults Aged 18-64: United States, 2010-2015

Q:  Was there a result in your study that you hadn’t expected and that really surprised you?

DB/TC:  The result that we found most surprising – and it really is quite striking – is the state-level variation in  the percentages of adults who were meeting the federal physical activity guidelines through their leisure-time physical activity. We were also surprised that many of the states with the highest percentages of meeting the guidelines through leisure-time physical activity were “cold weather” states that get more snow during winter months. How are people in these states meeting these guidelines during the colder winter months? Are they participating in outdoor winter sports, do they exercise at indoor facilities, or some combination of outdoor and indoor activities? Unfortunately we can’t answer these questions with our data, but it would be interesting to know. In addition, previous research has generally shown higher rates of leisure-time physical activity for men than for women. This also includes studies that look at meeting the 2008 federal guidelines for aerobic and muscle-strengthening activities through leisure-time physical activity. While our current study also found that men were more likely than women to meet the guidelines through leisure-time physical activity, some states were exceptions – especially Colorado, but also in Massachusetts, Washington, New Hampshire, Utah, and Wyoming, where men and women had statistically comparable percentages.


Q:  What would you say is the take-home message of this report?

DB/TC:  This is a “good news” data report – for the most part. We think the real take-home message of this report is that, overall, American adults aged 18-64 are exceeding guideline targets for physical activity through their leisure-time physical activity. The Healthy People 2020 objective regarding physical activity specifies that 20.1% of all adults meet both aerobic and muscle-strengthening federal guidelines by 2020. We found that in 2010-2015, nearly 23% of adults aged 18-64 were accomplishing this through their leisure-time physical activity– a truly positive finding. But when we looked at differences by gender and work status, we found that among all women aged 18–64, 18.7% met the guidelines through their leisure-time physical activity, which is nearly two percentage points lower than the Healthy People target. While the average for working women (20.9%) was above the target, the average among all nonworking women was only 14.6%, almost six percentage points lower than the Healthy People 2020 target. Nonworking women in just five states—Colorado, Idaho, New Hampshire, Utah, and Washington—met the objective through their leisure-time physical activity. We should keep in mind though, that the National Health Interview Survey (NHIS) only collects information on leisure-time physical activity, so our study was not able to look at occupational physical activity.


Q:  What made you decide to conduct this study on physical activity among Americans?

DB/TC:  One motivation for conducting this study was that we wanted to look at state-by-state percentages.  This new report is a continuation of a previous report (https://www.cdc.gov/nchs/data/nhsr/nhsr094.pdf) that looked at occupational differences among employed adults who met federal physical activity guidelines during their leisure-time physical activity. That report focused on individuals, not states, and excluded adults who were not working. While doing that analysis, we saw that there was considerable regional variation in the outcome.  We wanted to expand that earlier research to include all adults in this same age group (working as well as nonworking), and to consider differences in meeting the guidelines by state because we had already seen this regional variation.


Q:  What differences or similarities did you see between or among various demographic groups in this analysis?

DB/TC:  We did observe some differences between men and women, as well as by work status, but we didn’t distinguish between many demographic groups since this was a state-level analysis. Men had higher percentages of meeting the guidelines through leisure-time physical activity than women overall — and within most, but not all, states. This was also true when we compared working and nonworking men and women overall and within most states.


Q:  Why do you think there is such a vast difference among the states in the percentage of adults who meet the guidelines for physical activity through their leisure-time physical activity?

DB/TC:  There are likely many factors that play a role in these state differences, as researchers are likely to suggest. We looked at just two: occupational distributions among working adults (and among working men and women), and at percentages of illness and disability among nonworking adults (and among nonworking men and women). States with higher percentages of professionals and managers — relative to production workers –generally had higher percentages of working adults meeting the federal guidelines for physical activity during their leisure time than states with more production workers and fewer professionals and managers. Similarly, states with higher percentages of nonworking adults in fair or poor health or with a disability had lower percentages of meeting the guidelines during their leisure time than states with fewer nonworking adults in fair or poor health or with a disability. Indeed, many factors are likely involved. And we only considered leisure-time physical activity in our study. Our survey doesn’t collect information on physical activity performed while at work or when commuting.


Q:  What sort of trend data do you have on this topic that will help us see how physical activity for Americans has evolved over time?

DB/TC:  There is some trend data available through various sources. The Centers for Disease Control and Prevention (CDC) has published several reports on this topic; the 2014 report is available at https://www.cdc.gov/physicalactivity/downloads/pa_state_indicator_report_2014.pdf, and a 2010 report is available at https://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2010.pdf. CDC also has mini-reports available for each state that take into account state-specific data; these are available at  https://www.cdc.gov/physicalactivity/resources/state-action-guides.html.

Also, the National Center for Health Statistics (NCHS) reports Key Health Indicators based on the National Health Interview Survey (NHIS), including person-level estimates of adults aged 18 and over who meet the 2008 federal physical activity guidelines for both aerobic and muscle-strengthening activities during leisure-time physical activity. Please see tables 7.5 through 7.8 in https://www.cdc.gov/nchs/nhis/releases/released201806.htm#7A.


Q:  Is this the most recent data you have on this topic?

DB/TC:  While we do have newer data files, those data were not available when we were carrying out our analysis. So our current report is based on 2010-2015 National Health Interview Survey (NHIS) data. However, the most recent Key Health Indicators report at the website immediately above includes results from the 2016 and 2017 National Health Interview Survey.


Q: How many people were surveyed for this report?

DB/TC:  The National Health Interview Survey, or NHIS, is a national, in-person survey conducted annually. Roughly 35,000 U.S. adults respond to the “Sample Adult” interview in any given survey year, and all of them are asked a series of questions about how often, how long, and how vigorously they spend leisure time doing exercise. This report looks at state-level variation in meeting the 2008 federal guidelines for physical activity through leisure-time physical activity among adults aged 18-64 using the 2010-2015 NHIS. The 2008 physical activity guidelines recommend muscle-strengthening activities at least twice weekly, with either moderate-intensity aerobic physical activity for at least 150 minutes per week, vigorous-intensity aerobic physical activity for at least 75 minutes per week, or an equivalent combination. For those of our readers interested in the specific sample sizes used in this analysis, here are the numbers:

Sample adults aged 18-64 years who met the guidelines for both muscle-strengthening and aerobic activities through leisure physical activity (n = 32,942) are the focus of the study. Sample adults meeting only one guideline (n = 48,810) or neither guideline (n = 70,402) are not shown separately, but are included in the denominators. Percentage estimates are based on pooled data from the 2010–2015 NHIS for all 50 states and the District of Columbia.

 


QuickStats: Percentage of Adults Aged 18 Years or Older With or Without Psychological Distress† Who Were Current Smokers, by Age Group and Level of Distress — National Health Interview Survey, 2014–2016

June 18, 2018

During 2014–2016, 37.2% of adults aged 18 years or older with serious psychological distress were current smokers, followed by 27.6% of those with mild to moderate psychological distress and 14% of those with no psychological distress.

Among adults aged 18–44 and 45–64 years, the percentage of adults who were current smokers increased with the level of psychological distress.

Among adults aged 65 years or older, the percentage who were current smokers was less among adults with no psychological distress than among adults with mild to moderate or serious psychological distress.

Source: National Health Interview Survey, 2014–2016. https://www.cdc.gov/nchs/nhis/index.htm

https://www.cdc.gov/mmwr/volumes/67/wr/mm6723a6.htm