Objective Early childhood behavioral and emotional disorders are linked to diagnosable mental health problems both later in childhood and into adulthood. However, little work has examined the association between family social stressors and emotional well-being among children under two years of age, including whether differences exist between infancy and toddlerhood. Methods Data come from the nationally representative 2019-2022 National Health Interview Survey, an annual, cross-sectional survey conducted by the National Center for Health Statistics. Separate multivariate logistic regression models estimated associations between family social stressors (stressful life events, family food insecurity, family difficulty paying medical bills) and having a Baby Pediatric Symptom Checklist (BPSC) subscale score of 3 or more (“above the BPSC cutoff”) for poorer emotional well-being among children 2-23 months. Models were additionally stratified by age group (infants, 2-11 months; toddlers, 12-23 months), and adjusted for child and family sociodemographic and geographical characteristics. Results Children who had experienced a stressful life event (AOR=3.83, 95% CI: 2.48-5.92), family food insecurity (AOR=1.69, 95% CI: 1.13-2.51), or family difficulty paying medical bills (AOR=2.10, 95% CI: 1.54-2.87) had higher odds of being above the BPSC cutoff, adjusted for all relevant covariates. Toddlers who experienced a stressful life event (66.5% vs. 41.0%) or family difficulty paying medical bills (53.1% vs. 29.8%) had higher odds of being above the BPSC cutoff compared with infants. Conclusions Family social stressors were linked to poorer emotional well-being among young children. Future research may benefit from the exploration of additional predictors of emotional well-being among this age group.

OBJECTIVE:Although growing evidence indicates that distinct affect regulation strategies (eg, positive reappraisal, anger suppression) predict mortality risk, the biological processes involved remain understudied. We investigated the association of various affect regulation exposures with mortality risk while examining the role of allostatic load. METHODS:From 2004 to 2006, 1941 participants from the Midlife in the United States longitudinal study completed validated scales assessing the use of 9 general and emotion-specific regulatory strategies (eg, denial, anger expression). An SD-based algorithm was also used to characterize how flexibly participants regulate their affect (lower, moderate, or greater variability). Participants further provided data on relevant covariates and 24 allostatic load biomarkers (eg, cortisol, glucose). Cox regressions modeled hazard ratios (HRs) and 95% CIs examined associations of affect regulation variables and all-cause mortality risk until 2022. The confounding, mediating, and moderating role of allostatic load was examined in subsequent models. RESULTS:In fully adjusted models, only greater versus lower affect regulation variability (HR=1.54; 95% CI=1.11-2.14) significantly predicted a higher mortality risk. Associations were relatively unchanged with further inclusion of allostatic load in models and allostatic load did not mediate affect regulation-mortality relationships. Yet, when evaluating moderation effects, greater versus lower and moderate variability, as well as denial, were marginally or significantly related to higher mortality risk among adults with lower allostatic load only. CONCLUSIONS:Allostatic load may modify rather than confound or mediate the association between some dimensions of affect regulation and mortality risk. Future work should evaluate the potential roles of allostatic load among diverse samples.

BACKGROUND:Parent-reported surveys are commonly used in child health research. However, few national surveys have examined concordance between parent- and teen-reported Adverse Childhood Experiences (ACEs). OBJECTIVE:To examine concordance between parent- and teen-reported ACEs among a nationally representative sample of teens and understand sociodemographic correlates of concordance. PARTICIPANTS AND SETTING:Data were collected as part of the National Health Interview Survey (NHIS), an annual nationally representative survey of the United States, with parent-reported interviews and its follow-back survey, the National Health Interview Survey-Teen (NHIS-Teen), a self-administered web survey of youth aged 12-17 years. METHODS:Parent- and teen-reported ACEs, and several measures of concordance (e.g. weighted Cohen's kappa, prevalence adjusted bias adjusted kappa (PABAK)) are presented. Unadjusted logistic regressions tested associations between sociodemographic characteristics and likelihood of concordance for each ACE. RESULTS:ACEs prevalence based on parent report were lower compared to teen report (e.g. victim of or witnessed violence in the neighborhood, 6.5 % parent-reported vs. 15.5 %, teen-reported). Weighted Cohen's kappa statistics showed fair to moderate agreement (ks ranging from 0.27 to 0.53), with PABAK statistics showing slightly higher levels (ks ranging from 0.41 to 0.88). CONCLUSIONS:There is discordance in ACEs reporting between teens and their parents, with parents less likely to report that their teen experience an ACE than teens are. This emphasizes the importance of collecting information directly from teenagers, which may help inform intervention work.

OBJECTIVE:Emerging work suggests that affect regulation strategies (e.g., active coping, anger expression) predict disease and mortality risk, with sometimes divergent estimates by sex or education levels. However, few studies have examined potential underlying biological mechanisms. This study assessed the longitudinal association of affect regulation with future allostatic load. METHOD:In 2004-2006, 574 participants from the Midlife in the United States study completed validated scales assessing use of nine general and emotion-specific regulatory strategies (e.g., denial, anger expression). As a proxy for how flexibly participants regulate their affect, variability in the use of regulatory strategies was operationalized using a standard deviation-based algorithm and considered categorically (i.e., lower, moderate, greater variability) to assess non-linear effects. Participants also provided data on relevant covariates and 24 allostatic load biomarkers (e.g., cortisol, blood pressure). In 2017-2021, these biomarkers were again collected. Linear regressions modeled betas (β) and 95 % confidence intervals (CI) examining associations of affect regulatory constructs with future allostatic load. RESULTS:In fully-adjusted models including initial allostatic load, general regulatory strategies were unrelated to future allostatic load. Yet, greater versus moderate affect regulation variability levels predicted lower allostatic load (β=-0.14; 95 %CI: -0.27, -0.01). Only among more educated participants, greater use of anger expression predicted lower allostatic load, while the reverse was noted with anger control (βexpression=-0.12; 95 %CI: -0.20, -0.05; βcontrol=0.14; 95 %CI: 0.05, 0.24). CONCLUSIONS:While general regulatory strategies appeared unrelated to allostatic load, greater variability in their use and anger-related strategies showed predictive value. Subsequent studies should examine these associations in larger, more diverse samples.

This report provides health data from the National Center for Health Statistics.

PURPOSE:To investigate differences in teen-reported and parent-reported lifetime prevalence estimates of traumatic brain injury (TBI) symptoms, TBI evaluation, and TBI diagnosis among a nationally representative sample of teenagers aged 12-17 years old and their parents. METHODS:Parent-reported data from the 2021 to 2022 National Health Interview Survey linked with teen-reported data from the National Health Interview Survey-Teen July 2021-December 2022 (n = 1,153) were analyzed. Lifetime prevalence estimates for TBI symptoms (e.g., selected symptoms as a result of a blow or jolt to the head), history of evaluation by health professional for TBI (i.e., TBI evaluation), and TBI diagnosis stratified by sociodemographic characteristics and reporter type were produced, and z-tests were conducted to test for differences. Concordance measures were calculated to assess agreement between teen and parent survey responses to TBI measures. RESULTS:Lifetime prevalence of TBI symptoms varied by reporter type across all sociodemographic characteristics with teen-report consistently producing higher estimates. Estimates of TBI evaluation varied by reporter type only among older teens, non-Hispanic teens, and teens who participated in sports; there was no difference for TBI diagnosis. Percent agreement between the 2 reporters ranged from 73% to 95%, prevalence-adjusted bias-adjusted kappa ranged from 0.45 to 0.90, and Cohen's kappa ranged from 0.22 to 0.63. DISCUSSION:There was general agreement for observable outcomes TBI evaluation and TBI diagnosis, but discordance existed in reports of TBI symptoms. These findings suggest that youth self-report of TBI symptoms may enhance surveillance efforts.

Introduction:This report describes the percentage of teenagers ages 12â17 who self-reported that they were bullied in the past 12 months, by selected characteristics. Methods:Data between July 2021 and December 2023 from the National Health Interview SurveyâTeen were used for this analysis. Point estimates and the corresponding confidence intervals were calculated using SAS-callable SUDAAN software to account for the complex sample design of NHISâTeen. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. Key findings:During July 2021 to December 2023, 34.0% of teenagers were bullied in the last 12 months. Sexual and gender minority teenagers were more likely to be bullied (47.1%) than teenagers who are not a sexual or gender minority (30.0%). White non-Hispanic teenagers were more likely to be bullied compared with teenagers in other race and Hispanic-origin groups. Teenagers with a developmental disability were more likely to be bullied than teenagers without a developmental disability. Teenagers who were bullied were nearly twice as likely to experience symptoms of anxiety (29.8%) or depression (28.5%) in the last 2 weeks when compared with teenagers who were not bullied.

Objective:Nonfinancial access barriers to care describe various reasons why adults may delay or not get medical care, beyond cost. This report focuses on five access barriers to care and describes the percentage of U.S. adults who delayed or did not get medical care in the past 12 months because of 1) being too busy with work or other commitments; 2) an appointment not being available when needed; 3) not being able to get to the doctor's office or clinic when open; 4) difficulty finding a doctor, clinic, or hospital that would accept their health insurance; and 5) it taking too long to get to the doctor's office or clinic from their house or work. Methods:Data from the 2022 National Health Interview Survey were used to produce estimates of the percentage of adults who delayed or did not get medical care in the past 12 months because of those access barriers to care, overall and by selected sociodemographic characteristics. Results:Among U.S. adults in 2022, 12.5% delayed or did not get medical care in the past 12 months because they were too busy to go to a provider, 10.6% could not find an available appointment when needed, 4.6% were unable to get to a provider when open, 4.4% had difficulty finding a doctor compatible with their health insurance, and 2.4% responded that it takes too long to get to a provider. Percentages varied by sociodemographic characteristics. Conclusion:This study provides nationally representative estimates of selected nonfinancial access barriers to medical care, both overall and for selected sociodemographic groups. Findings suggest that nonfinancial access barriers to care are widespread in the United States, and ongoing monitoring may help to address inequities in access to care.

Introduction:This report describes the self-reported prevalence of daily screen time among teenagers ages 12-17 years and explores whether differences exist by selected characteristics and demographics. Methods:Data from the July 2021-December 2023 National Health Interview Survey-Teen were used for this analysis. Point estimates and the corresponding confidence intervals were calculated using SAS-callable SUDAAN software to account for the complex sample design of NHIS-Teen. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. Key findings:During July 2021-December 2023, about one-half of teenagers had 4 hours or more of daily screen time (50.4%). Black non-Hispanic teenagers (60.4%) were most likely to have 4 hours or more of daily screen time compared with teenagers in other race and Hispanic origin groups. About 1 in 4 teenagers with 4 hours or more of daily screen time have experienced anxiety (27.1%) or depression symptoms (25.9%) in the past 2 weeks.

Access to transportation may be required for many daily tasks, including going to work, health care visits, and obtaining groceries. Previous research suggests that a lack of transportation, especially among adults who are older, uninsured, and have lower incomes, leads to reduced access to health care, which may then lead to adverse health outcomes (1,2). Using data from the 2022 National Health Interview Survey, this report describes the percentage of adults who lacked reliable transportation for daily living in the past 12 months by selected sociodemographic and geographic characteristics. Key findings Data from the National Health Interview Survey ● In 2022, 5.7% of adults lacked reliable transportation for daily living in the past 12 months. Women (6.1%) were more likely than men (5.3%) to lack reliable transportation. ● The percentage of adults who lacked reliable transportation was lowest among Asian non-Hispanic adults (3.6%) compared with other race and Hispanic origin groups. ● Lack of reliable transportation decreased with increasing education level and family income. ● Adults living in the West North Central region of the United States (7.5%) were more likely to lack reliable transportation than the national average (5.7%), while adults in New England (4.1%) were less likely

INTRODUCTION:Screening for adverse childhood experiences (ACEs) in the clinical setting is set to become more commonplace with continued efforts to reimburse clinicians for screening. However, an examination of disparities in ACEs screening and related attitudes and beliefs is needed.METHODS:Using the 2021 California Health Interview Survey (CHIS), this study examined if several measures of socioeconomic status, access to care and identities were associated with 3 outcomes: 1) getting screened for ACEs by a clinician; 2) beliefs about the importance of screening and 3) satisfaction with efforts to address the impacts of ACEs. Logistic regressions were used to estimate odds of the outcomes.RESULTS:Black, Latinx, and Asian individuals had lower odds of being screened for ACEs than non-Hispanic Whites. A recent doctor's visit, higher burden of ACEs, and serious psychological distress were associated with higher odds of being screened. Latinx individuals, women, bisexual individuals, those with a recent doctor's visit and those with serious psychological distress had higher odds of believing clinicians asking about ACEs was very important, relative to their counterparts. Latinx individuals, American Indian or Alaska native individuals, Asian individuals, those with higher educational attainment and those with serious psychological distress had lower odds of being very satisfied with providers' efforts to address the impact of ACEs, relative to their counterparts.CONCLUSIONS:Efforts to expand ACEs screening should consider the disparities in screening that currently exist. Given the wide-ranging impacts that ACEs have on health, an equitable approach to screening is necessary.

Objective: Psychological factors, including psychological distress and well-being, have been associated with cardiometabolic disease risk. Here, we examined whether a psychological process, namely how individuals cope with stressors, relates to such risk, which has been understudied. Method: During 2004-2006, 2,142 participants without heart disease and diabetes from the Midlife in the U.S. study completed a validated coping inventory assessing six strategies (positive reinterpretation and growth, active coping, planning, focus on and venting of emotion, denial, and behavioral disengagement) and relevant covariates. As a proxy for coping flexibility, participants were also classified as having lower, moderate, or greater variability in their use of these strategies. Heart disease and diabetes were documented in 2013-2015. Logistic regressions modeled adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of developing heart disease and diabetes, separately, with coping exposures. Results: In sociodemographic-adjusted models, greater use of adaptive strategies predicted lower diabetes risk (e.g., positive reinterpretation and growth: AOR = 0.83; 95% CI [0.72, 0.96]); estimates were weaker for maladaptive strategies, and all strategies were unrelated to heart disease. All associations for coping variability were null. In secondary analyses, greater use of adaptive strategies predicted lower heart disease risk in more educated participants only (e.g., active coping: AOR = 0.71; 95% CI [0.55, 0.92]) and lower diabetes risk in females only (e.g., planning: AOR = 0.75; 95% CI [0.61, 0.91]). Results were maintained additionally adjusting for health, behavioral, and social factors. Conclusions: Findings suggest sex and education differences in coping's association with heart disease and diabetes. Future studies should recognize adaptive strategies may be more potent for health among certain populations. Public Significance Statement Despite convincing evidence linking stressors and psychological distress to cardiometabolic disease risk, this is the first study examining the role of stress-related coping strategies and variability in their use in the onset of heart disease and diabetes. Results suggest the associations of coping with these conditions vary by sex and education levels, which underscores the importance of evaluating psychosocial interventions that are sociodemographic-specific to possibly prevent heart disease and diabetes.

Little is known about the impact of adverse childhood experiences (ACEs) on delaying health care. Using data from the 2016-2017 National Survey of Children's Health (n = 64,103), we examined the association between ACEs and forgoing: medical care, hearing care, vision care, mental health care, and use of health services. In logistic regression models, cumulative ACEs were associated with increases in forgoing most types of care. ACEs were associated with increased odds of using emergency department services and preventative health care. Efforts must be undertaken to reduce delays in care among children with a history of ACEs.

An allergy occurs when an individual's immune system misclassifies typically harmless substances as harmful and has a specific and reproducible immune response (1,2). The severity of allergy symptoms can range from itchy, watery eyes and hives to life-threatening anaphylaxis, and the presence of allergies can negatively impact an individual's quality of life (3-6). This report uses 2021 National Health Interview Survey (NHIS) data to describe the prevalence of seasonal allergies, eczema, and food allergies in adults in the United States.

Developmental disabilities are common in children in the United States, and the prevalence has increased in recent years (1). Timely estimates are necessary to assess the adequacy of services and interventions that children with developmental disabilities typically need (2). This report provides updated prevalence estimates for diagnosed autism spectrum disorder, intellectual disability, and other developmental delay among children aged 3-17 years from the 2019-2021 National Health Interview Survey (NHIS), with differences in prevalence examined between years and by sex, age group, and race and Hispanic origin. Estimates are also presented for any developmental disability, defined as having had one or more of these three diagnoses.