Benjamin Zablotsky

IntroductionChildhood asthma is a chronic condition characterized by repeated episodes of wheezing, breathlessness, chest tightness and coughing and can result in acute episodes of asthma attacks t...

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

Objective: Promoting health during adolescence can support long-term well-being, especially for teens diagnosed with attention-deficit/hyperactivity disorder (ADHD), who face increased risks due to the disorder's impact on development and health behaviors. ADHD is often associated with difficulties in social interactions, a higher likelihood of bullying involvement, and co-occurring mental health conditions. These factors may also be influenced by health factors such as physical activity, sleep quality, and screen time usage. Nationally representative teen self-reports provide a novel perspective on ADHD-related health outcomes compared with relying on parent reports. Method: We used nationally representative data from the National Health Interview Survey (NHIS) and NHIS-Teen from July 2021 to December 2022, to examine teen-reported health and well-being factors, stratified by parent-reported ADHD diagnoses among teens aged 12 to 17 years. Weighted prevalence estimates and adjusted prevalence ratios (aPR) adjusting for teen age, sex, and family income, all with 95% confidence intervals (CIs), were calculated. Results: Just over 10% of teens had ADHD and they reported higher prevalence of bullying victimization (aPR = 1.64, CI = 1.27–2.11), difficulties making friends (aPR = 1.83, CI = 1.15–2.90), difficulty getting out of bed (aPR = 1.29, CI = 1.02–1.64), irregular wake times (aPR = 2.17, CI = 1.45–3.25), and >4 hours daily screen time (aPR = 1.26, CI = 1.05–1.52) than teens without ADHD; teens with ADHD reported a lower prevalence of lacking peer support (aPR = 0.70, CI = 0.51–0.96). Conclusion: Teens with ADHD face distinct challenges related to social-emotional well-being and health behaviors that support overall wellness. Findings may inform opportunities for health promotion among teens with ADHD.

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. 2023;113(4):408–415. https://doi.org/10.2105/AJPH.2022.307197 )

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 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/m³). 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/m³ (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.