Last data update: May 06, 2024. (Total: 46732 publications since 2009)
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Query Trace: Zablotsky B[original query] |
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QuickStats: Percentage* of children and adolescents aged 5-17 years who took medication for their mental health or received counseling or therapy from a mental health professional during the past 12 months,(†) by year - National Health Interview Survey,(§) United States, 2019 and 2022
Zablotsky B , Ng AE , Terlizzi EP . MMWR Morb Mortal Wkly Rep 2023 72 (43) 1171 The percentage of children and adolescents aged 5–17 years who took medication for their mental health during the past 12 months did not change significantly from 2019 (8.4%) to 2022 (9.3%). The percentage of children and adolescents who received counseling or therapy during the past 12 months increased from 10.0% in 2019 to 13.8% in 2022. In both 2019 and 2022, the percentage of children and adolescents who received counseling or therapy was higher than the percentage of those who took medication for their mental health. |
Quickstats: Percentage* of children and adolescents aged 17 years who have experienced a specified stressful life event,(†) by type of event and family income(¶) - National Health Interview Survey,() United States, 2021
Ng AE , Arockiaraj B , Zablotsky B . MMWR Morb Mortal Wkly Rep 2023 72 (29) 807 Abbreviation: FPL = federal poverty level. | | * With 95% CIs indicated by error bars. | | † Percentages for the specified stressful life events are based on the following questions: 1) “Has child ever been the victim of violence or witnessed violence in their neighborhood?”; 2) “Has child ever been separated from a parent or guardian because the parent or guardian went to jail, prison, or a detention center?”; 3) “Did child ever live with anyone who was mentally ill or severely depressed?”; 4) Did child ever live with anyone who had a problem with alcohol or drugs?” Having any stressful event was based on having answered “yes” to any of these four questions. The four stressful life event questions come from a larger battery of questions on adverse childhood experiences. | | § As a percentage of FPL, which is based on family income and family size, using the U.S. Census Bureau’s poverty thresholds. Family income was imputed when missing. | | ¶ Estimates are based on household interviews of a sample of the civilian, noninstitutionalized U.S. population. | | In 2021, 20.2% of children and adolescents in families with incomes <200% of FPL and 12.0% of those in families with incomes ≥200% of FPL had experienced at least one specified stressful life event. Children and adolescents in families with incomes <200% of FPL were more likely than those in families with incomes ≥200% of FPL to have had the following experiences: lived with someone with alcohol or drug problems (9.1% versus 5.8%); lived with someone who was mentally ill or severely depressed (8.8% versus 6.5%); lived with someone who had been in jail (8.8% versus 2.9%); or been the victim of or witnessed violence in their neighborhood (7.2% versus 3.1%). |
Preliminary incidence and trends of infections caused by pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2022
Delahoy MJ , Shah HJ , Weller DL , Ray LC , Smith K , McGuire S , Trevejo RT , Scallan Walter E , Wymore K , Rissman T , McMillian M , Lathrop S , LaClair B , Boyle MM , Harris S , Zablotsky-Kufel J , Houck K , Devine CJ , Lau CE , Tauxe RV , Bruce BB , Griffin PM , Payne DC . MMWR Morb Mortal Wkly Rep 2023 72 (26) 701-706 Each year, infections from major foodborne pathogens are responsible for an estimated 9.4 million illnesses, 56,000 hospitalizations, and 1,350 deaths in the United States (1). To evaluate progress toward prevention of enteric infections in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) conducts surveillance for laboratory-diagnosed infections caused by eight pathogens transmitted commonly through food at 10 U.S. sites. During 2020-2021, FoodNet detected decreases in many infections that were due to behavioral modifications, public health interventions, and changes in health care-seeking and testing practices during the COVID-19 pandemic. This report presents preliminary estimates of pathogen-specific annual incidences during 2022, compared with average annual incidences during 2016-2018, the reference period for the U.S. Department of Health and Human Services' Healthy People 2030 targets (2). Many pandemic interventions ended by 2022, resulting in a resumption of outbreaks, international travel, and other factors leading to enteric infections. During 2022, annual incidences of illnesses caused by the pathogens Campylobacter, Salmonella, Shigella, and Listeria were similar to average annual incidences during 2016-2018; however, incidences of Shiga toxin-producing Escherichia coli (STEC), Yersinia, Vibrio, and Cyclospora illnesses were higher. Increasing culture-independent diagnostic test (CIDT) usage likely contributed to increased detection by identifying infections that would have remained undetected before widespread CIDT usage. Reducing pathogen contamination during poultry slaughter and processing of leafy greens requires collaboration among food growers and processors, retail stores, restaurants, and regulators. |
Overview of the 2019 National Health Interview Survey Questionnaire redesign
Zablotsky B , Lessem SE , Gindi RM , Maitland AK , Dahlhamer JM , Blumberg SJ . Am J Public Health 2023 113 (4) e1-e8 Data System. Federal health surveys, like the National Health Interview Survey (NHIS), represent important surveillance mechanisms for collecting timely, representative data that can be used to monitor the health and health care of the US population. Data Collection/Processing. Conducted by the National Center for Health Statistics (NCHS), NHIS uses an address-based, complex clustered sample of housing units, yielding data representative of the civilian noninstitutionalized US population. Survey redesigns that reduce survey length and eliminate proxy reporting may reduce respondent burden and increase participation. Such were goals in 2019, when NCHS implemented a redesigned NHIS questionnaire that also focused on topics most relevant and appropriate for surveillance of child and adult health. Data Analysis/Dissemination. Public-use microdata files and selected health estimates and detailed documentation are released online annually. Public Health Implications. Declining response rates may lead to biased estimates and weaken users' ability to make valid conclusions from the data, hindering public health efforts. The 2019 NHIS questionnaire redesign was associated with improvements in the survey's response rate, declines in respondent burden, and increases in data quality and survey relevancy. (Am J Public Health. Published online ahead of print February 9, 2023:e1-e8. https://doi.org/10.2105/AJPH.2022.307197). |
Assessing the validity of the Baby Pediatric Symptom Checklist using a nationally representative household survey
Zablotsky B , Black LI , Sheldrick RC , Perrin EC , Blumberg SJ . Acad Pediatr 2022 OBJECTIVE: The Baby Pediatric Symptom Checklist (BPSC) is a screening tool developed for detecting behavioral or emotional concerns among parents of children younger than 18 months. Nationally representative survey data have not yet been used to assess the validity of the BPSC, nor to evaluate its appropriateness for use among children between 18 and 23 months old. The current study assesses the validity of the BPSC using data from the National Health Interview Survey (NHIS). METHODS: Data from the 2019 NHIS were used to evaluate the 12-item BPSC screening tool among a nationally representative sample of children 2-23 months. Confirmatory factor analysis (CFA) and differential item functioning (DIF) were used to assess construct and predictive validity and test how response items differed by selected sociodemographics. Quantile regression was used to calculate 50(th), 70(th), and 90(th) percentiles for age-based normative curves of the previously established domains of irritability, inflexibility, and difficulty with routines. RESULTS: A three-factor CFA produced comparable results to the original study. Tests of DIF did not reveal any significant effects for the child's sex, race and Hispanic origin, household urbanization level, number of children in family, or respondent type (mother, father, other). In addition, DIF was not found between children aged 2-17 months and 18-23 months. Age-based normative data were calculated for each subscale. CONCLUSIONS: The use of the BPSC in a nationally representative survey produced findings comparable to those of the original-validation study. The NHIS can be used to track BPSC scores over time at the population-level. |
Anxiety and depression symptoms among children before and during the COVID-19 pandemic.
Zablotsky B , Black LI , Terlizzi EP , Vahratian A , Blumberg SJ . Ann Epidemiol 2022 75 53-56 PURPOSE: The COVID-19 pandemic caused disruptions to children's daily lives due in part to stay-at-home orders and school closures, reducing interactions with both peers and extended family. Yet, few studies with nationally representative data have explored the potential association of the COVID-19 pandemic and children's mental health. METHODS: The current study analyzed data from the 2019 and 2020 National Health Interview Survey (NHIS) to describe changes in the prevalence of symptoms of anxiety and depression before and during the first year of the pandemic among children aged 5-17 years. Changes in prevalence by child- and family-level characteristics were also examined. RESULTS: During the COVID-19 pandemic, nearly one in six children aged 5-17 years had daily or weekly symptoms of anxiety or depression, a significant increase from before the COVID-pandemic (16.7% (95% CI:15.0-18.6) vs. 14.4% (95% CI:13.4-15.3)). Males, children 5-11 years, non-Hispanic children, children living in families in large metropolitan areas, incomes at or below the federal poverty level, and whose highest educated parent had more than a HS education, also showed statistically significant increases in anxiety and depression symptoms. CONCLUSIONS: NHIS data may be used to monitor this increase in mental health symptomatology and assist in identifying children at risk. |
Healthcare Access and Utilization for Young Adults With Disability: U.S., 2014-2018
Verlenden JV , Zablotsky B , Yeargin-Allsopp M , Peacock G . J Adolesc Health 2021 70 (2) 241-248 PURPOSE: Young adults with disability experience barriers to healthcare access and are at risk for not receiving needed services as they transition from pediatric to adult health systems. This study examined patterns of healthcare utilization for young adults with disability and potential barriers to receipt of care. METHODS: Data from the 2014 to 2018 National Health Interview Survey were analyzed to examine differences in service utilization, unmet need, care satisfaction, and financial worry between young adults (18-30 years) with and without disability (unweighted n = 15,710). Odds ratios were adjusted for individual, family, and interview characteristics. RESULTS: Compared to those without disability, young adults with disability were more likely to have had an emergency room visit in the past year (39.2% vs. 19.5%). They were also more likely to have a usual source of care when sick (82.2% vs. 75%). Among young adults who affirmed they had a usual place of care, those with disability were more likely to use the emergency room as their usual place of care (5.3% vs. 1.8%). A greater percentage of young adults with disability delayed medical care due to cost (19.1% vs. 8.9%) and reported an unmet medical need (21% vs. 10.2%). CONCLUSIONS: Findings highlight gaps in healthcare access for young adults with disability. Differences in healthcare utilization patterns for young adults with disability and factors that may negatively influence health outcomes for this population were found. Further research focused on the continuity of healthcare services in this age group through the healthcare transition period may provide additional insight into these discrepancies. |
The association between air pollution and childhood asthma: United States, 2010-2015
Connor EM , Zablotsky B . J Asthma 2021 59 (10) 1-16 Objective: The current population-based study examines the association between county-level ambient air pollution and childhood asthma.Methods: Data from the nationally representative 2010-2015 National Health Interview Survey were linked to nationwide fine particulate matter (PM(2.5)) air pollution data at the county-level from the National Environmental Public Health Tracking Network which utilizes air quality monitoring stations and modeled PM(2.5) measurements (Downscaler model data) and adjusted by county-level socioeconomic characteristics data from the 2010-2015 American Community Survey. Multilevel modeling techniques were used to assess the association between PM(2.5) annual concentrations (quartiles <8.11, 8.11-9.50, 9.51-10.59, ≥ 10.60 µg/m(3)) and current childhood asthma along with two asthma outcomes (episode in the past year, emergency room (ER) visit due to asthma).Results: From 2010-2015, there were significant declines in PM(2.5) concentrations and asthma outcomes. In unadjusted models, children living in areas with higher PM(2.5) concentrations were more likely to have current asthma, ≥1 asthma episode in the past year, and ≥1 ER visit due to asthma compared with children living in areas with the lowest quartile (< 8.11 µg/m(3)). After adjusting for characteristics at the county, geographic, and child and family-level, significant associations remained for asthma episode, and ER visit among children living in areas with PM(2.5) annual concentrations between 9.51-10.59 µg/m(3) (3rd quartile) compared with children living in areas with the lowest quartile.Conclusions: This study adds to the limited literature by incorporating nationally representative county-, child-, and family-level data to provide a multi-level analysis of the associations between air pollution and childhood asthma in the U.S. |
Treatment use among children with Tourette syndrome living in the United States, 2014
Wolicki SB , Bitsko RH , Holbrook JR , Danielson ML , Zablotsky B , Scahill L , Walkup JT , Woods DW , Mink JW . Psychiatry Res 2020 293 113400 Treatment of Tourette syndrome (TS) can be complicated by changes over time in tic expression, severity, and co-occurring disorders. Using the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome, this study provides descriptive estimates of the use of behavioral interventions and medication among children living with TS. Parent-reported data on 115 children aged 5-17 years ever diagnosed with TS were analyzed to provide descriptive, unweighted results. Overall, 77.4% of children had current or past use of any TS treatment; 59.1% ever used behavioral interventions and 56.1% had ever taken TS medication. Children with "moderate" or "severe" versus "mild" TS, ≥1 co-occurring disorders, and tics that interfered with functioning were significantly more likely to have used one or more TS treatments. Side effects were reported for 84.4% of children who took TS medication. Most parents of children with current TS (87.2%) were satisfied with the management of their child's TS. However, parents of children with "moderate" or "severe" current TS were significantly more dissatisfied compared to parents of children with "mild" TS. Findings from this study could be used to inform efforts to support children living with TS and their families. |
Preliminary incidence and trends of infections with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2016-2019
Tack DM , Ray L , Griffin PM , Cieslak PR , Dunn J , Rissman T , Jervis R , Lathrop S , Muse A , Duwell M , Smith K , Tobin-D'Angelo M , Vugia DJ , Zablotsky Kufel J , Wolpert BJ , Tauxe R , Payne DC . MMWR Morb Mortal Wkly Rep 2020 69 (17) 509-514 To evaluate progress toward prevention of enteric illnesses, the Foodborne Diseases Active Surveillance Network (FoodNet) of CDC's Emerging Infections Program monitors the incidence of laboratory-diagnosed infections caused by eight pathogens transmitted commonly through food at 10 U.S. sites.* This report summarizes preliminary 2019 data and describes changes in incidence compared with that during 2016-2018. The incidence of enteric infections caused by these eight pathogens reported by FoodNet sites in 2019 continued to increase or remained unchanged, indicating progress in controlling major foodborne pathogens in the United States has stalled. Campylobacter and Salmonella caused the largest proportion of illnesses; trends in incidence varied by Salmonella serotype. Widespread adoption of whole genome sequencing (WGS) of bacteria has improved the ability to identify outbreaks, emerging strains, and sources of pathogens. To maximize the potential of WGS to link illnesses to particular sources, testing of isolates by clinical and public health laboratories is needed. Reductions in Salmonella serotype Typhimurium suggest that targeted interventions (e.g., vaccinating chickens and other food animals) might decrease human infections. Reducing contamination during food production, processing, and preparation will require more widespread implementation of known prevention measures and of new strategies that target particular pathogens and serotypes. |
Health care transition planning among youth with ASD and other mental, behavioral, and developmental disorders
Zablotsky B , Rast J , Bramlett MD , Shattuck PT . Matern Child Health J 2020 24 (6) 796-804 OBJECTIVE: To estimate the prevalence of health care transition components among youth with autism spectrum disorder (ASD) aged 12-17 using the 2016 National Survey of Children's Health (NSCH), compared to youth with other mental, behavioral, or developmental disorders (MBDDs) or youth without MBDDs. METHODS: The 2016 NSCH is a nationally and state representative survey that explores issues of health and well-being among children ages 0-17. Within the NSCH, parents of a subset of youth, ages 12-17, are asked a series of questions about their youth's eventual transition into the adult health care system. The current study explores components of this transition, comparing youth diagnosed with ASD, youth with other mental, behavioral, or developmental disorders (MBDDs), and youth without MBDDs. RESULTS: Approximately 1-in-4 youth with ASD had actively worked with their doctor to understand future changes to their health care, significantly less than youth with other MBDDs and youth without MBDDs. Fewer than 2-in-5 youth with ASD had met with their doctor privately or had a parent who knew how their youth would be insured when they reached adulthood. CONCLUSIONS: The current analysis of a nationally representative sample of youth reveals discrepancies in the proportion of youth with ASD receiving appropriate health care transition planning compared to youth with other MBDDs and youth without MBDDs. These findings suggest the potential for barriers among youth with ASD to effectively transitioning into the adult health care system. |
Prevalence and trends of developmental disabilities among children in the United States: 2009-2017
Zablotsky B , Black LI , Maenner MJ , Schieve LA , Danielson ML , Bitsko RH , Blumberg SJ , Kogan MD , Boyle CA . Pediatrics 2019 144 (4) OBJECTIVES: To study the national prevalence of 10 developmental disabilities in US children aged 3 to 17 years and explore changes over time by associated demographic and socioeconomic characteristics, using the National Health Interview Survey. METHODS: Data come from the 2009 to 2017 National Health Interview Survey, a nationally representative survey of the civilian noninstitutionalized population. Parents reported physician or other health care professional diagnoses of attention-deficit/hyperactivity disorder; autism spectrum disorder; blindness; cerebral palsy; moderate to profound hearing loss; learning disability; intellectual disability; seizures; stuttering or stammering; and other developmental delays. Weighted percentages for each of the selected developmental disabilities and any developmental disability were calculated and stratified by demographic and socioeconomic characteristics. RESULTS: From 2009 to 2011 and 2015 to 2017, there were overall significant increases in the prevalence of any developmental disability (16.2%-17.8%, P < .001), attention-deficit/hyperactivity disorder (8.5%-9.5%, P < .01), autism spectrum disorder (1.1%-2.5%, P < .001), and intellectual disability (0.9%-1.2%, P < .05), but a significant decrease for any other developmental delay (4.7%-4.1%, P < .05). The prevalence of any developmental disability increased among boys, older children, non-Hispanic white and Hispanic children, children with private insurance only, children with birth weight >/=2500 g, and children living in urban areas and with less-educated mothers. CONCLUSIONS: The prevalence of developmental disability among US children aged 3 to 17 years increased between 2009 and 2017. Changes by demographic and socioeconomic subgroups may be related to improvements in awareness and access to health care. |
Children with Tourette Syndrome in the United States: Parent-reported diagnosis, co-occurring disorders, severity, and influence of activities on tics
Wolicki SB , Bitsko RH , Danielson ML , Holbrook JR , Zablotsky B , Walkup JT , Woods DW , Mink JW . J Dev Behav Pediatr 2019 40 (6) 407-414 OBJECTIVE: Describe the diagnostic process for Tourette syndrome (TS) based on parent report, as well as TS severity and associated impairment; the influence of common daily activities on tics; and the presence of co-occurring mental, behavioral, and developmental disorders among children in the United States. METHODS: Parent-report data from the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome on 115 children ever diagnosed with TS were analyzed. Descriptive, unweighted analyses included frequencies and percentages, and means and standard deviations. Fisher's exact test and t-tests were calculated to determine statistically significant differences. RESULTS: The mean age that tics were first noticed was 6.3 years, and, on average, TS was diagnosed at 7.7 years. The time from initially noticing tics to TS diagnosis averaged 1.7 years. The mean age when TS symptoms were most severe was 9.3 years. Tic severity was associated with impaired child functioning but not tic noticeability. Almost 70% of parents reported that fatigue and major transitions made their child's tics worse. Children with ever-diagnosed TS had a mean of 3.2 ever-diagnosed co-occurring mental, behavioral, or developmental disorders; a quarter (26.9%) had 5 or more co-occurring disorders. DISCUSSION: In this sample of children with TS, the time to diagnosis averaged less than 2 years from when tics were initially noticed. More severe TS was associated with greater functional impairment, and co-occurring disorders were common among children with TS. This study provides insight into the current experiences of children with TS in the United States and their families. |
Geographic disparities in treatment for children with autism spectrum disorder
Zablotsky B , Maenner MJ , Blumberg SJ . Acad Pediatr 2019 19 (7) 740-747 OBJECTIVE: Geographic differences may provide insight into what factors influence the likelihood that a child is diagnosed with ASD in the US, yet there have been few nationally representative surveys that have explored this topic. The current study expands the limited literature by analyzing regional differences in ASD prevalence, service utilization, and the presence of unmet needs within a nationally representative sample of children. METHODS: Data were drawn from the 2014-2016 National Health Interview Survey (NHIS), a nationally representative household survey of the noninstitutionalized US population. Children 3-17 were included in the analytic sample. Prevalence estimates accounted for the complex survey design of the NHIS, and differences between geographic regions were compared using logistic/linear regressions with and without adjustment for child/family characteristics. RESULTS: The prevalence of ASD was highest in the Northeast (3.0%), followed by the Midwest (2.4%), South (2.4%), and West (2.3%). A significant difference was found between the Northeast and West (p<.05). However, after accounting for child and family characteristics, this difference was no longer significant. Children with ASD in the Northeast were the most likely to have seen a specialist in the past year. Approximately 1 in 8 children with ASD experienced at least one unmet need, but there were no differences found by geographic region. CONCLUSIONS: Although differences in prevalence were not significant after adjustment, service utilization differences remained. It appears children with ASD in the Northeast utilize the greatest number of specialty services when compared to children with ASD from other parts of the country. |
The prevalence of parent-reported autism spectrum disorder among US children
Kogan MD , Vladutiu CJ , Schieve LA , Ghandour RM , Blumberg SJ , Zablotsky B , Perrin JM , Shattuck P , Kuhlthau KA , Harwood RL , Lu MC . Pediatrics 2018 142 (6) Abstract OBJECTIVES: To estimate the national prevalence of parent-reported autism spectrum disorder (ASD) diagnosis among US children aged 3 to 17 years as well as their treatment and health care experiences using the 2016 National Survey of Children's Health (NSCH). METHODS: The 2016 NSCH is a nationally representative survey of 50 212 children focused on the health and well-being of children aged 0 to 17 years. The NSCH collected parent-reported information on whether children ever received an ASD diagnosis by a care provider, current ASD status, health care use, access and challenges, and methods of treatment. We calculated weighted prevalence estimates of ASD, compared health care experiences of children with ASD to other children, and examined factors associated with increased likelihood of medication and behavioral treatment. RESULTS: Parents of an estimated 1.5 million US children aged 3 to 17 years (2.50%) reported that their child had ever received an ASD diagnosis and currently had the condition. Children with parent-reported ASD diagnosis were more likely to have greater health care needs and difficulties accessing health care than children with other emotional or behavioral disorders (attention-deficit/hyperactivity disorder, anxiety, behavioral or conduct problems, depression, developmental delay, Down syndrome, intellectual disability, learning disability, Tourette syndrome) and children without these conditions. Of children with current ASD, 27% were taking medication for ASD-related symptoms, whereas 64% received behavioral treatments in the last 12 months, with variations by sociodemographic characteristics and co-occurring conditions. CONCLUSIONS: The estimated prevalence of US children with a parent-reported ASD diagnosis is now 1 in 40, with rates of ASD-specific treatment usage varying by children's sociodemographic and co-occurring conditions. |
Concordance between survey reported childhood asthma and linked Medicaid administrative records
Zablotsky B , Black LI . J Asthma 2018 56 (3) 1-11 OBJECTIVE: Agreement between administrative and survey data has been shown to vary by the condition of interest and there is limited research dedicated to parental report of asthma among children. The current study assesses the concordance between parent-reported asthma from the National Health Interview Survey (NHIS) with Medicaid administrative claims data among linkage eligible children from the NHIS. METHODS: Medicaid Analytic eXtract (MAX) files from the Centers for Medicare & Medicaid Services (CMS) (years 2000-2005) were linked to participants of the NHIS (years 2001-2005). Concordance measures were calculated to assess overall agreement between a claims-based asthma diagnosis and a survey-based asthma diagnosis. Structural equation modeling was used to assess the association between demographic, service utilization, and co-occurring conditions factors and agreement. RESULTS: Percent agreement between the two data sources was high (90%) with a prevalence-adjusted bias-adjusted kappa of 0.80 and Cohen's kappa of 0.55. Agreement varied by demographic characteristics, service utilization characteristics, and the presence of allergies and other health conditions. Structural equation modeling results found the presence of a series of co-occurring conditions, namely allergies, resulted in significantly lower agreement after controlling for demographics and service utilization. CONCLUSIONS: There was general agreement between asthma diagnoses reported in the NHIS when compared to medical claims. Discordance was greatest among children with co-occurring conditions. |
An updated scheme for categorizing foods implicated in foodborne disease outbreaks: A tri-agency collaboration
Richardson LC , Bazaco MC , Parker CC , Dewey-Mattia D , Golden N , Jones K , Klontz K , Travis C , Zablotsky Kufel J , Cole D . Foodborne Pathog Dis 2017 14 (12) 701-710 BACKGROUND: Foodborne disease data collected during outbreak investigations are used to estimate the percentage of foodborne illnesses attributable to specific food categories. Current food categories do not reflect whether or how the food has been processed and exclude many multiple-ingredient foods. MATERIALS AND METHODS: Representatives from three federal agencies worked collaboratively in the Interagency Food Safety Analytics Collaboration (IFSAC) to develop a hierarchical scheme for categorizing foods implicated in outbreaks, which accounts for the type of processing and provides more specific food categories for regulatory purposes. IFSAC also developed standard assumptions for assigning foods to specific food categories, including some multiple-ingredient foods. The number and percentage of outbreaks assignable to each level of the hierarchy were summarized. RESULTS: The IFSAC scheme is a five-level hierarchy for categorizing implicated foods with increasingly specific subcategories at each level, resulting in a total of 234 food categories. Subcategories allow distinguishing features of implicated foods to be reported, such as pasteurized versus unpasteurized fluid milk, shell eggs versus liquid egg products, ready-to-eat versus raw meats, and five different varieties of fruit categories. Twenty-four aggregate food categories contained a sufficient number of outbreaks for source attribution analyses. Among 9791 outbreaks reported from 1998 to 2014 with an identified food vehicle, 4607 (47%) were assignable to food categories using this scheme. Among these, 4218 (92%) were assigned to one of the 24 aggregate food categories, and 840 (18%) were assigned to the most specific category possible. CONCLUSIONS: Updates to the food categorization scheme and new methods for assigning implicated foods to specific food categories can help increase the number of outbreaks attributed to a single food category. The increased specificity of food categories in this scheme may help improve source attribution analyses, eventually leading to improved foodborne illness source attribution estimates and enhanced food safety and regulatory efforts. |
Latent class analysis of ADHD neurodevelopmental and mental health comorbidities
Zablotsky B , Bramlett MD , Visser SN , Danielson ML , Blumberg SJ . J Dev Behav Pediatr 2017 39 (1) 10-19 OBJECTIVE: Many children diagnosed with attention-deficit/hyperactivity disorder (ADHD) experience co-occurring neurodevelopmental and psychiatric disorders, and those who do often exhibit higher levels of impairment than children with ADHD alone. This study provides a latent class analysis (LCA) approach to categorizing children with ADHD into comorbidity groups, evaluating condition expression and treatment patterns in each group. METHODS: Parent-reported data from a large probability-based national sample of children diagnosed with ADHD (2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome) were used for an LCA to identify groups of children with similar groupings of neurodevelopmental and psychiatric comorbidities among children with current ADHD (n = 2495). Differences between classes were compared using multivariate logistic regressions. RESULTS: LCA placed children who were indicated to have ADHD into 4 classes: (low comorbidity [LCM] [64.5%], predominantly developmental disorders [PDD] [13.7%], predominantly internalizing disorders [PID] [18.5%], and high comorbidity [HCM] [3.3%]). Children belonging to the HCM class were most likely to have a combined ADHD subtype and the highest number of impaired domains. Children belonging to the PDD class were most likely to be receiving school services, whereas children in the PID class were more likely to be taking medication than those belonging to the LCM class who were least likely to receive psychosocial treatments. CONCLUSION: Latent classes based on co-occurring psychiatric conditions predicted use of varied. These findings contribute to the characterization of the ADHD phenotype and may help clinicians identify how services could be best organized and coordinated in treating ADHD. |
The co-occurrence of autism spectrum disorder in children with ADHD
Zablotsky B , Bramlett MD , Blumberg SJ . J Atten Disord 2017 24 (1) 1087054717713638 OBJECTIVE: Children with ADHD frequently present with autism spectrum disorder (ASD) symptomatology, yet there is a notable gap in the treatment needs of this subpopulation, including whether the presence of ASD may be associated with more severe ADHD symptoms. METHOD: Data from the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome ( n = 2,464) were used to compare children diagnosed with ADHD and ASD with children with ADHD, but not ASD. Children were classified as needing treatment if it was received or their parents reported it was needed, but not received. RESULTS: Approximately one in eight children currently diagnosed with ADHD was also diagnosed with ASD. Children diagnosed with both disorders had greater treatment needs, more co-occurring conditions, and were more likely to have a combined hyperactive/impulsive and inattentive ADHD subtype. CONCLUSION: These findings highlight the complexity of children diagnosed with both ADHD and ASD. |
The transition to the adult health care system among youths with autism spectrum disorder
Nathenson RA , Zablotsky B . Psychiatr Serv 2017 68 (7) appips201600239 OBJECTIVE: The study examined how health care utilization patterns among youths with autism spectrum disorder (ASD) change as they transition into the adult health care system. METHODS: Data came from the Clinformatics Data Mart Database, a nationally diverse, clinically rich, private insurance claims database. The analytic sample consisted of youths ages 16 to 23 who were diagnosed as having ASD (N=16,338). Cross-sectional multivariate linear regressions determined whether service usage in home, office or outpatient, inpatient, and emergency department (ED) settings differed by age. RESULTS: The proportion of youths with ASD who received services declined with age in each setting except the ED. A similar reduction existed in number of visits to office or outpatient settings and inpatient settings, while home and ED visits remained stable. Service utilization declined faster among youths with co-occurring intellectual disability. CONCLUSIONS: There is a notable decline in service utilization across multiple settings as youths with ASD transition from pediatric to adult health care. |
Age of parental concern, diagnosis, and service initiation among children with autism spectrum disorder
Zablotsky B , Colpe LJ , Pringle BA , Kogan MD , Rice C , Blumberg SJ . Am J Intellect Dev Disabil 2017 122 (1) 49-61 Children with autism spectrum disorder (ASD) require substantial support to address the core symptoms of ASD and co-occurring behavioral/developmental conditions. This study explores the early diagnostic experiences of school-aged children with ASD using survey data from a large probability-based national sample. Multivariate linear regressions were used to examine age when parent reported developmental concern to doctor, received ASD diagnosis, and first obtained services. Children whose parents had concerns about their child's verbal communication reported earlier ages for all outcomes when compared to children of parents who did not have verbal communication concerns. Children whose parents had concerns about their child's nonverbal communication or unusual gestures/movements received an earlier diagnosis than children whose parents did not have these specific concerns. |
Reported wandering behavior among children with autism spectrum disorder and/or intellectual disability
Rice CE , Zablotsky B , Avila RM , Colpe LJ , Schieve LA , Pringle B , Blumberg SJ . J Pediatr 2016 174 232-239.e2 OBJECTIVE: To characterize wandering, or elopement, among children with autism spectrum disorder (ASD) and intellectual disability. STUDY DESIGN: Questions on wandering in the previous year were asked of parents of children with ASD with and without intellectual disability and children with intellectual disability without ASD as part of the 2011 Survey of Pathways to Diagnosis and Services. The Pathways study sample was drawn from the much larger National Survey of Children with Special Health Care Needs conducted in 2009-2010. RESULTS: For children with special healthcare needs diagnosed with either ASD, intellectual disability, or both, wandering or becoming lost during the previous year was reported for more than 1 in 4 children. Wandering was highest among children with ASD with intellectual disability (37.7%) followed by children with ASD without intellectual disability (32.7%), and then children with intellectual disability without ASD (23.7%), though the differences between these groups were not statistically significant. CONCLUSIONS: This study affirms that wandering among children with ASD, regardless of intellectual disability status, is relatively common. However, wandering or becoming lost in the past year was also reported for many children with intellectual disability, indicating the need to broaden our understanding of this safety issue to other developmental disabilities. |
Estimated prevalence of autism and other developmental disabilities following questionnaire changes in the 2014 National Health Interview Survey
Zablotsky B , Black LI , Maenner MJ , Schieve LA , Blumberg SJ . Natl Health Stat Report 2015 (87) 1-21 The developmental disabilities questions in the 2014 National Health Interview Survey (NHIS) were changed from previous years, including question reordering and a new approach to asking about autism spectrum disorder (ASD). This report examines survey-based estimates of the lifetime prevalence of ASD, intellectual disability (ID), and any other developmental delay (other DD) following the inclusion of a standalone ASD question, the inclusion of specific diagnoses in the ASD question, and the ASD question preceding the other DD question, and compares them with estimates from previous years. |
Factors associated with parental ratings of condition severity for children with autism spectrum disorder
Zablotsky B , Bramlett M , Blumberg SJ . Disabil Health J 2015 8 (4) 626-34 BACKGROUND: There is currently little consensus on how the severity of a child's autism spectrum disorder (ASD) should be measured, and yet despite the lack of a standardized definition, parents were readily able to answer a question asking them to describe the severity of his/her child's ASD in a national survey. OBJECTIVE: The current study examined factors associated with a parent's judgment of ASD severity, by identifying child and household characteristics that were associated with a parent's severity rating of his/her child's ASD, including child ASD symptomatology, child impact, and family impact. METHODS: Data came from the 2011 Survey of Pathways to Diagnosis and Services ("Pathways"). A total of 967 parents in households with a child diagnosed with ASD between the ages of 6-17 were eligible for the current study. A measurement model was used to create latent factors of child symptoms, child impact, and family impact; multivariate logistic regression models examined the relationship between these latent factors and the parent's severity rating of their child's ASD. RESULTS: Children with higher family impact factor scores were more likely to have parents who rated their child's ASD as the most severe. Surprisingly, symptomatology and impact on the child were less predictive of severe ratings. CONCLUSIONS: A parent's conceptualization of their child's ASD severity may vary more as a function of the impact of the child's condition on the family and less as a function of the symptoms exhibited by the child or the impact directly felt by the child. |
Diagnosis lost: differences between children who had and who currently have an autism spectrum disorder diagnosis
Blumberg SJ , Zablotsky B , Avila RM , Colpe LJ , Pringle BA , Kogan MD . Autism 2015 20 (7) 783-95 Autism spectrum disorder diagnoses sometimes change due to misdiagnosis, maturation, or treatment. This study uses a probability-based national survey-the Survey of Pathways to Diagnosis and Services-to compare currently diagnosed (n = 1420) and previously diagnosed (n = 187) children aged 6-17 years based on retrospective parental reports of early concerns about their children's development, responses to those concerns by doctors and other healthcare providers, the type of provider who made the first autism spectrum disorder diagnosis, and the autism spectrum disorder subtype diagnoses received (if any). Propensity score matching was used to control for differences between the groups on children's current level of functioning and other current characteristics that may have been related to diagnosis loss. Approximately 13% of the children ever diagnosed with autism spectrum disorder were estimated to have lost the diagnosis, and parents of 74% of them believed it was changed due to new information. Previously diagnosed children were less likely to have parents with early concerns about verbal skills, nonverbal communication, learning, and unusual gestures or movements. They were also less likely to have been referred to and diagnosed by a specialist. Previously diagnosed children were less likely to have ever received a diagnosis of Asperger's disorder or autistic disorder. |
Service and treatment use among children diagnosed with autism spectrum disorders
Zablotsky B , Pringle BA , Colpe LJ , Kogan MD , Rice C , Blumberg SJ . J Dev Behav Pediatr 2015 36 (2) 98-105 OBJECTIVE: Children diagnosed with autism spectrum disorder (ASD) require substantial support to address not only core ASD symptoms but also a range of co-occurring conditions. This study explores treatment and service use among children with ASD with and without intellectual disability (ID) and parents' perception of unmet needs from these treatments. METHODS: Data were retrieved from a probability-based national sample of 2077 children diagnosed with ASD, ID, or both (ASD and ID). Weighted multivariate logistic regressions examined differences between diagnostic groups for current medication and service utilization with a subanalysis exploring differences among those with co-occurring psychiatric conditions. Additional modeling examined parents' perception of unmet needs. RESULTS: Children diagnosed with ASD and ID were significantly more likely to be receiving current medication and services when compared with children with ID only or ASD only. Children with a co-occurring psychiatric diagnosis, from all 3 diagnostic groups, were more likely to be receiving a current medication, but not more likely to be receiving a current service when compared with children without a co-occurring psychiatric diagnosis. Children with ASD and a co-occurring psychiatric diagnosis were significantly more likely to have parents who reported unmet needs when compared with parents of children with ASD without a co-occurring psychiatric diagnosis. CONCLUSIONS: Children diagnosed with ASD and ID, especially those with a comorbid psychiatric condition, represent a vulnerable population with substantial rates of current service (98%) and medication (67%) usage, but despite these high rates, approximately 30% of parents report that their child's developmental needs are still not being met by their current treatment and services. |
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