Physician Office Visits for ADHD in Children and Adolescents Aged 4–17 Years: United States, 2012–2013

January 25, 2017

Questions for Michael Albert, Medical Officer and Lead Author on “Physician Office Visits for Attention-deficit/Hyperactivity Disorder in Children and Adolescents Aged 4–17 Years: United States, 2012–2013

Q: Did we learn anything new from this new report about the problem of Attention-deficit/Hyperactivity Disorder (ADHD) among children?

MA: Yes, this report provides a snapshot of health care utilization related to ADHD among children aged 4-17 years. Specifically, it looks at visits to physician offices and uses nationally representative data from the 2012-13 National Ambulatory Medical Care Survey.  Based on a sample of 946 visits by children aged 4-17 years with a primary diagnosis of ADHD, an estimated annual average of 6.1 million physician office visits were made by this age group during 2012-13, corresponding to a visit rate of 105 visits per 1,000 children.

Q:  Does your research back up the notion that boys are more commonly afflicted with ADHD than girls?

MA: Our analysis did find that among children aged 4-17 years with a primary diagnosis of ADHD, the visit rate was more than twice as high for boys as girls.

Q: Is it true that medication is very often involved in the treatment of ADHD?

MA: Central nervous system stimulant medications were provided, prescribed, or continued at approximately 80% of these ADHD visits.  A total of 29% of ADHD visits included a diagnostic code for an additional mental health disorder.  In terms of what specialty of physician provided care at these visits, it was a pediatrician at 48%, psychiatrist at 36%, and general and family medicine physician at 12%.

Q: Was it surprising that 80% of office visits for ADHD involve medication?

MA: It is important to interpret this finding carefully.  Because the National Ambulatory Medical Care Survey is a visit-based survey, as opposed to population based, estimates of persons cannot be made.  Thus, the finding should not be interpreted as indicating that 80% of children aged 4-17 years with ADHD are taking CNS stimulant medications. It is possible that patients taking CNS stimulant medications tend to make more physician office visits than those not taking these medications.  This might be in order to monitor the medication, or for other reasons such as differences in the severity of disease between those who take medication and those who do not.  Although the use of medication in children with ADHD in our survey cannot be directly compared with population-based surveys, there is evidence from the latter that medication is frequently used.  An analysis of parent-reported data from the National Survey of Children’s Health found that among children aged 4-17 years, 69% of children with current ADHD were taking medication for their ADHD (the specific medication was not identified).

Q: Anything else you’d like to address about the report?

MA: Again, we think the significance of this report lies in providing a snapshot of health care utilization related to ADHD in children that is nationally representative.  We chose to investigate several variables to in our analysis that are of interest and provide important information.

QuickStats: Prevalence of Untreated Dental Caries in Permanent Teeth Among Children and Adolescents Aged 6–19 Years, by Age Group

January 17, 2017


During 2011–2014, 13.3% of children and adolescents aged 6–19 years had untreated dental caries in their permanent teeth.

The percentage of children and adolescents with untreated dental caries increased with age: 6.1% among those aged 6–11 years, 14.5% among those aged 12–15 years, and 22.6% among those aged 16–19 years.


The Association of Marital Status and Offers of Employer-based Health Insurance for Employed Women Aged 27–64: United States, 2014–2015

January 12, 2017

Questions for Robin Cohen, Ph.D., Health Statistician and Lead Author on “The Association of Marital Status and Offers of Employer-based Health Insurance for Employed Women Aged 27–64: United States, 2014–2015

Q: Why did you decide to do a report comparing the marital status and offers of employer-based health insurance for employed women?

RC: A recent study found that women were less likely than men to have been insured through own employer and more likely to have been covered as a dependent. This report describes the association of marital status and the presence of employment-based insurance offers among employed women in the United States. It is important to note, that the presence of an offer does not necessarily indicated take-up.

Q: Is this the first time the National Health Interview Survey (NHIS) has released a report on this topic? If not, where is trend data available?

RC: This is the first time that NHIS has released a report on the association of marital status and of offers of employer-based private health insurance coverage for employed women.

Q: In general, how do offers of employer-based health insurance for employed women vary by marital status?

RC: Marital status is an important predictor of having an offer of health insurance through employment for employed women aged 27-64. Married women may gain an additional opportunity for an offer of health insurance coverage through their spouse’s employer. Therefore, taking all offers of health insurance into account, employed married women aged 27-64 were more likely than employed unmarried women to have an employer offer of health insurance.

Q: How do offers of employer-based health insurance vary by marital status for employed women within categories of educational attainment?

RC: Regardless of educational attainment, employed married women aged 27-64 were more likely than employed unmarried women to have been offered health insurance by their employer or their spouse’s employer. For both married and unmarried women, total health insurance offers increased as levels of educational attainment increased.

Q: Do offers of employer-based health insurance vary by marital status for employed women aged within categories of race and ethnicity?

RC: Employed non-Hispanic white and non-Hispanic Asian unmarried women were more likely than their married counterparts to have an offer of coverage from their own employer. However unmarried Hispanic and non-Hispanic black women were about as likely to have an offer of coverage from their own employer.

Healthy People 2020 Midcourse Review

January 11, 2017
David Huang, Health Promotion Statistics Branch Chief

David Huang, Health Promotion Statistics Branch Chief

Questions for David Huang, Health Promotion Statistics Branch Chief and Corresponding Author on “Healthy People 2020 Midcourse Review

Q: What exactly is “Healthy People 2020”?

DH: For nearly four decades, the U.S. Department of Health and Human Services (HHS) has developed and maintained national health promotion and disease prevention objectives with targets every 10 years through the Healthy People Initiative. The latest phase of the initiative, Healthy People 2020 (HP2020), is by far the largest and most far-reaching, spanning well over 1,200 measures across 42 Topic Areas and about 200 federal and non-federal data sources.

Q: How did this initiative begin?

DH: The initiative began in 1979 with the publication of the first national public health agenda in Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention, followed in 1980 by an HHS companion piece outlining the first set of ten-year objectives with targets in Promoting Health/Preventing Disease: Objectives for the Nation. Since then, a new iteration of national health objectives has been released by HHS every ten years, so we are now in our fourth decade – a remarkable feat for a federal initiative.

Q: What is a Midcourse Review, and what data years are examined?

DH: The “Healthy People 2020 Midcourse Review” reports the status of the objectives at the midpoint of the decade and provides a roadmap for achieving the Healthy People 2020 objectives by 2020. The term “midcourse” is used to refer to the approximate half-way point of the decade spanning 2010 to 2020. The exact year or years of both the baseline (initial) and midcourse data vary by data source and by specific objective. For example, many objectives with the National Health Interview Survey (NHIS) as their data source have 2008 as the baseline year and 2014 as the midcourse year. Note that there may be more recent data available than those used in the report.

Q: What are the sources of data are used in the report?

DH: The data used in Healthy People 2020 come from about 200 data sources, sponsored by numerous entities including the federal government and private and global agencies and organizations. In each case, the sponsoring agency or organization collected data using its own methods and procedures. Therefore, data in this report vary with respect to source, method of collection, definitions, and reference period.

Q: How is the country doing at this mid-point?

DH: The country has met or exceeded more than a quarter (27.3%) of its ten-year targets for 828 trackable HP2020 objectives, which compares quite favorably to the three previous Healthy People Midcourse Reviews. One-quarter (23.9%) of its targets were improving; one-third (34.4%) had demonstrated little or no detectable change; and about fourteen percent (14.4%) were getting worse.

QuickStats: Rates of Drug Overdose Deaths Involving Heroin by Selected Age Groups — United States, 2006–2015

January 9, 2017

The rate of drug overdose deaths involving heroin increased slightly during 2006–2010 but more than tripled during 2010–2015 for all age groups shown.

During 2010–2015, the rates increased from 1.2 to 3.8 per 100,000 for persons aged 15–24 years, from 2.2 to 9.7 for persons aged 25–34 years, from 1.6 to 7.4 for persons aged 35–44 years, from 1.4 to 5.6 for persons aged 45–54 years, and from 0.7 to 3.4 for persons aged 55–64 years.

In 2015, the rate of drug overdose deaths involving heroin was highest for persons aged 25–34.


Number of Deaths from Cervical Cancer, 1999-2015

January 6, 2017

Number of Deaths from Cervical Cancer, 1999-2015


Year Deaths
1999 4,205
2000 4,200
2001 4,092
2002 3,952
2003 3,919
2004 3,850
2005 3,924
2006 3,976
2007 4,021
2008 4,008
2009 3,909
2010 3,939
2011 4,092
2012 4,074
2013 4,217
2014 4,115
2015 4,175
TOTAL 68,668

Births: Final Data for 2015

January 5, 2017

Questions for Joyce A. Martin, M.P.H., Demographer, Statistician, and Lead Author on “Births: Final Data for 2015

Q: Was there a result in your study’s analysis of births in the United States that you hadn’t expected and that really surprised you?

JM: Although small, (from 9.57% to 9.63%) the rise in the preterm birth rate (births of less than 37 completed weeks of gestation) was unexpected. This rate had been declining steadily since 2007.

Also of note is the decline in the triplet and higher-order multiple birth rate, down 9% from 2014 to 2015, and a decrease of 46% since 1998. The year 2015 also is the third straight year of declines in the rate of cesarean delivery (rate of 32.0% in 2015).

The continued, large decline in the teen birth rate (down 8% from 2014 to 2015) was also somewhat surprising, although not unprecedented. From 2007 through 2014, the teen birth rates had declined 7% annually.

Q: What is the difference between this new births report and the other reports your office produced on 2015 birth data, like the preliminary data report on 2015 births and the Data Brief on teen births?

JM: The annual report “Births: Final Data for 2015” offers substantially more detail (e.g., age, race and Hispanic origin of mother, state) on key topics, than does the report on preliminary birth statistics (“Births: Preliminary Data for 2015”). The final report also includes information on topics not included in the preliminary reports such as multiple births, attendant and place of birth, birth order and birth rates for fathers.

Q: How has the number of births in the United States changed in 2015 from previous years?

JM: The number of births in the United States declined slightly in 2015 (by 9,579 births to 3,978,497) from 2014. The decline for 2015 followed an increase in births for 2014, which was the first increase since 2007.

Q: What differences, if any, did you see among race and ethnic groups, and among various ages?

JM: Of continued concern are the higher risks of poor birth outcomes as measured by levels of preterm birth and low birthweight among non-Hispanic black mothers compared with total births and other race and Hispanic origin groups. For example, in 2015 the preterm birth rate for births to non-Hispanic black mothers was more than 50% higher at 13.41% than for non-Hispanic white women (8.88%) and nearly 50% higher than the rate for births to Hispanic mothers (9.14%).

Q: Did you observe any regional or state differences in this study on births?

JM: Differences by state were observed for many of the demographic and medical/health items included in the 2015 final birth report. For example, from 2014 to 2015, the general fertility rate–which is the number of births per 1,000 women aged 15–44–declined in eight states and was essentially unchanged in the 42 states and the District of Columbia (DC). In 2015, the general fertility rate ranged among states from 51.1 births per 1,000 women aged 15–44 in Vermont to 78.2 in South Dakota.

Also, increases in preterm birth rates were limited to four states from 2014 to 2015: Arkansas, California, Nebraska, and North Carolina. Rates declined in four states: Montana, New York, Texas and Wyoming. Nonsignificant differences were reported for the remaining states and DC.