December 5, 2023
Questions and Answers
General Survey Questions
- Is the NSCH data both nationally and state representative?
Yes - How often do you conduct the survey, and how long does data collection take?
The NSCH is an annual survey and data are typically collected over 6 months in the latter half of the year. - Does the survey account for children who speak another language?
The survey can be completed in English or Spanish with additional assistance for other languages offered through a help line. - What is the reading literacy level required to complete the survey? Are there any accommodations for parents with disabilities?
The survey content is tested with respondents from a variety of backgrounds. Although we do not recruit for parents/caregivers with disabilities, we believe this diversity has allowed us to ensure wide acceptability of the survey content and format. Additionally, respondents can always utilize a help line to complete the questionnaire. - What is the smallest enumeration area used to draw the sample for the survey?
As an address-based survey, the smallest enumeration is the household. Approximately equal samples of addresses are randomly drawn in each state using the master address file. However, states may also oversample geographically to increase responses across regions, counties, or cities. Oversamples for racial/ethnic groups are typically drawn at the census tract level. - What are the NSCH guidelines regarding the required minimum number of respondents in a particular group to report, and when there is a flag for reliability issues?
To minimize misinterpretation, we recommend only presenting statistics with a sample size or unweighted denominator of 30 or more. Additionally, if the 95% confidence interval width exceeds 20 percentage points or 1.2 times the estimate (≈ relative standard error>30%), we recommend flagging for poor reliability and/or presenting a measure of statistical reliability (e.g., confidence intervals or statistical significance testing) to promote appropriate interpretation.
State/Local Data Questions
- The presentation indicates that estimates are available at national and state level. Does this mean that estimates at a lower geographical level (e.g. county, census tract, etc.) will NOT be released to the public?
Sub-state identifiers can only be accessed with an approved project through a Research Data Center (RDC). To protect confidentiality, any sub-state estimates produced in an RDC must be approved by the Census Bureau’s Disclosure Review Board prior to public release. - In the slide showing state level comparisons relative to overall US data, were data also collected for US Territories (Puerto Rico, Virgin Islands, Guam, American Samoa, Northern Mariana Islands)?
Data on the health and well-being of mothers and children in the five U.S. territories and three freely associated states in the Pacific are collected through the Maternal and Child Health Jurisdictional Survey (MCH-JS). - Does the survey oversample and report on geographies smaller than states? What is the plan and potential for disaggregation to small geographies like census tracts?
States that have oversampled geographically are interested in producing regional, county, or metro area estimates. Census tract level estimates would generally require both significant oversampling and reliance on model-based estimates. See the following examples for county-level estimates:- Zgodic A, Eberth JM, Breneman CB, Wende ME, Kaczynski AT, Liese AD, McLain AC. Estimates of Childhood Overweight and Obesity at the Region, State, and County Levels: A Multilevel Small-Area Estimation Approach. Am J Epidemiol. 2021 Dec 1;190(12):2618-2629. doi: 10.1093/aje/kwab176. PMID: 34132329; PMCID: PMC8796862.
- Zgodic A, McLain AC, Eberth JM, Federico A, Bradshaw J, Flory K. County-level prevalence estimates of ADHD in children in the United States. Ann Epidemiol. 2023 Mar;79:56-64. doi: 10.1016/j.annepidem.2023.01.006. Epub 2023 Jan 16. PMID: 36657694; PMCID: PMC10099151.Bradshaw J, Eberth JM, Zgodic A, Federico A, Flory K, McLain AC. County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States. J Autism Dev Disord. 2023 May 4. doi: 10.1007/s10803-023-05920-z. Epub ahead of print. PMID: 37142898.
- For the states that have over-sampled, is the oversampling for the entire NSCH or just the HRTL component?
Household addresses are oversampled and the entire survey is administered for a randomly selected child. - How would a family get access/information about the survey (e.g. through a doctors office or school)?
Households are randomly selected to participate and receive a mailed invitation from the U.S. Census Bureau with options to respond by paper or web. The invitation includes basic information about the survey and where to find more.
Data Access/Availability
- Are the data publicly available, and what are the requirements for accessing the data?
Data are publicly available from the U.S. Census Bureau in both SAS and STATA formats. The Data Resource Center also produces data sets with additional recodes that are available in SPSS, SAS, and STATA. For those who do not regularly analyze data, precalculated estimates on a range of indicators at both national and state levels are available on the Data Resource Center’s Interactive Data Query.
For all NSCH resources, please visit our MCHB NSCH webpage - When will the data on the new Healthy and Ready to Learn NOM be available?
Overall 2022 estimates of Healthy and Ready to Learn are now available in a data brief (PDF - 75 KB). A forthcoming publication will highlight many of the detailed estimates presented on the webinar. State-level data on the new NOM will be provided with the Federally Available Data released in April, 2024. This will include SAS code to produce estimates from the 2022 NSCH data set. - Are non-mutually exclusive race/ethnicity responses available for analysis?
Yes, separate single race and ethnicity data are available for analysis. And additional flags to incorporate those reporting any Asian, American Indian/Alaska Native, or Native Hawaiian/Other Pacific Islander race (alone or in combination with other races) are also available. However, producing Native Hawaiian/Other Pacific Islander estimates that include the Hispanic population is not recommended due to known over-reporting of “Other Pacific Islander” race (the last available response option) among Hispanic respondents who may not identify with any racial category. For more information, please see the Weighting and Imputation Enhancement Brief (PDF) or the 2022 NSCH Methodology Report (PDF) (pages 44-45). - Is there a more specific update on when the combined file for 2021-2022 data will be available this spring?
The 2021 and 2022 data sets are available to combine now (see Guide to Multi-Year Estimates (PDF) for example code). The Data Resource Center is planning to have a combined data set with various recodes available this spring.
General Content Questions
- What programs comprise the “receipt of federal benefits” indicator, in addition to SSI?
Other individual items ask about cash assistance/welfare, SNAP, free or reduced cost school breakfast/lunch, school meal debit cards, and WIC. - What are the new items on the eating and weight-related behaviors/concerns?
The survey has a new question that asks: DURING THE PAST 12 MONTHS, did this child engage in any of the following? Mark (X) Yes or No for EACH item.
- Skipping meals or fasting (Do NOT include skipping meals or fasting for religious reasons)
- Having low interest in food
- Extremely picky eating
- Binge eating
- Purging or vomiting after eating
- Using diet pills, laxatives, or diuretics (water pills) to lose or maintain weight without a doctor’s orders
- Over-exercising
- Not eating due to fear of vomiting or choking
- What is the Washington Group?
This refers to the Washington Group on Disability Statistics. See: WG/UNICEF Child Functioning Module (CFM) - The Washington Group on Disability Statistics (washingtongroup-disability.com) for more information on the Child Functioning Module references. - Does the survey collect positive childhood experience information?
A variety of positive experience content is collected on the survey, including: flourishing, family resiliency, neighborhood amenities, etc. - Are there any items on the survey asking if the child was born prematurely?
Yes, preterm birth and low birth weight are included on the survey.
Healthy and Ready to Learn
Please note: Many of these questions may be answered by a recent NSCH data brief on Healthy and Ready to Learn (PDF - 75 KB)
- Are parents scoring their children on these measures?
Yes. All data on the NSCH are collected from parents/caregivers knowledgeable about the child’s health and healthcare. - At this time, do you see any utility for the HRTL measure for individual children by clinicians/early childhood educators/parents/etc.?
The HRTL questions were not designed for use in a clinical or educational setting. Rather, they are designed to provide a population-level assessment of young children’s overall health and readiness to succeed in school at the state and national levels. - How should the HRTL scores be interpreted? For example, do we know that those who score emerging would not benefit from support? And is it demonstrated that those who score emerging are highly likely to "catch up" without intervention?
The framing of the three levels, “On Track”, “Emerging” and “Needs Support” is descriptive and is not intended to suggest that benefits cannot be realized by all children. The framing is designed to support policy and programmatic deliberations within the context of limited resources. - When were the HRTL domains included in the survey?
Domains were available in both the pilot measure from the 2016 NSCH and the finalized measure to be collected in 2022 forward. The primary changes include additional content in the following areas: mathematics items within Early Learning Skills, motor development which helped to distinguish two unique domains (Motor Development and Health which were previously combined), and items that better differentiate skills by age. - Have these questions been asked for children with an identified special health care needs? And are there any specific HRTL measures for CYSHCN?
The summary HRTL measure as well as the domain specific measures can all be analyzed by special health care need status and type, as well as by specific conditions captured within the survey. - What are your thoughts about the large % of CYSHCN who are needing support compared to non-CYSHCN?
This is an area where more work needs to be done. We are excited about the opportunity to explore this further. - Was ADHD or dyslexia considered a special healthcare need?
The presence of Special Health Care Needs is determined based on parent/caregiver response to five questions related to the impacts of any conditions that have lasted or are expected to last 12 months or longer. - Is the data stratified by race/ethnicity for the 5 domains?
Yes, our forthcoming publication will include domain-level detail by various child, family, and community characteristics. - Can this data be analyzed by insurance type?
Yes, insurance type/status can be examined in relation to school readiness. We did not find an independent association in our analyses. - Are there plans to create a similar measure for school-age children. Some of the factors maybe the same, others different. This may be of interest given chronic absenteeism and school concerns related to mental health and home/family factors?
Not at this time, but this is something that could be considered. - Have you thought about using Item Response Theory for each item? You can get a lot of data about the participants?
We have not done this to date. - Are you open to connecting with state level partners doing similar work?
We always welcome the opportunity to work more closely with state partners. - Is there possibility of layering in families that participate in the Nurse-Family Partnership versus not?
Prior iterations of the NSCH have included an item on participation in home visiting, generally, but the lack of specificity about the nature and quality/quantity of the services received meant that the data were not actionable. Unfortunately, while parents/caregivers can report on participation in programs generally, they cannot usually report on the specific type of program, e.g., Nurse-Family Partnership v. some other model of home visitation.
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