Adults Living in Families Experiencing Food Insecurity in the Past 30 Days: United States, 2021.

In 2021, 33.8 million people in the United States were food insecure, that is, they did not have consistent, dependable access to sufficient quality or quantity of food (1,2). Food insecurity affects health outcomes (3), increasing the risk of high cholesterol, hypertension, chronic health conditions, and changes in functional limitations (4-6), and is a social determinant of health. This report explores selected sociodemographic characteristics of adults aged 18 and over living in families experiencing food insecurity.

Critical data at the crossroads: the National Health and Nutrition Examination Survey faces growing challenges.

NHANES needs urgent attention to ensure its future, which is facing emerging challenges associated with data collection, stagnant funding that has undercut innovation, and the increased call for granular data for subpopulations and groups at risk. The concerns do not rest merely on securing more funding but focus on the need for a constructive review of the survey to explore new approaches and identify appropriate change. This white paper, developed under the auspices of the ASN's Committee on Advocacy and Science Policy (CASP), is a call to the nutrition community to advocate for and support activities to prepare NHANES for future success in a changing nutrition world. Furthermore, because NHANES is much more than a nutrition survey and serves the needs of many in health fields and even commercial arenas, effective advocacy must be grounded in alliances among the survey's diverse stakeholders so that the full range of expertise and interests can engage. This article highlights the complicated nature of the survey along with key overarching challenges to underscore the importance of a measured, thoughtful, comprehensive, and collaborative approach to considering the future of NHANES. Starting-point questions are identified for the purposes of focusing dialog, discussion forums, and research. In particular, the CASP calls for a National Academies of Sciences, Engineering, and Medicine study on NHANES to articulate an actionable framework for NHANES going forward. With a well-informed and integrated set of goals and recommendations that could be provided by such a study, a secure future for NHANES is more readily achievable.

Anxiety and Depression Signs Among Adolescents in 26 Low- and Middle-Income Countries: Prevalence and Association With Functional Difficulties.

PURPOSE: The aim of this study is to describe the occurrence of signs of depression and anxiety among adolescents from 26 low- and middle-income countries and explore the extent to which these are associated with difficulties across other functional domains. METHODS: We analyzed randomly selected, nationally representative data from 26 countries with a total sample size of 123,975 adolescents aged 10-17 years. Data on functional difficulties, including signs of depression and anxiety, were collected by the Child Functioning Module, an instrument validated to identify the population of children with disabilities through household surveys. We estimated percentages and 95% confidence intervals of adolescents with difficulties across 11 domains of functioning, and of signs of depression and/or anxiety. We used multinomial regressions to estimate the association between difficulties in the different domains and having signs of depression only, signs of anxiety only, and signs of both depression and anxiety, relative to not presenting signs of depression or anxiety. RESULTS: In total, 5.5% of adolescents were reported to have had signs of anxiety, 3.1% signs of depression, and 2.3% co-occurring signs of anxiety and depression. Compared to adolescents without functional difficulties, those with difficulties in one or more domains were three times more likely to have signs of depression and anxiety. The likelihood of presenting signs of depression only or signs of both depression and anxiety was significantly higher across all domains, and the highest among adolescent with difficulties to self-care and communicating. The likelihood of presenting signs of anxiety only was significantly higher across all domains except seeing and hearing, and the highest among adolescent with difficulties communicating and accepting changes. DISCUSSION: Adolescents with functional difficulties in all domains analyzed, across different contexts, are more likely to experience depression and anxiety signs than those without such difficulties. Increasing the availability of population-level data on adolescent functional difficulties, including those related to depression and anxiety, is important in promoting inclusivity, participation, and the right of children to equal opportunities.

Harmonizing Disability Data To Improve Disability Research And Policy.

Disability is complex and multifaceted, complicating governments' efforts to collect the high-quality, comprehensive data necessary for developing, implementing, and monitoring policies. Yet data are needed to obtain information on functioning in the population, to identify the population with disabilities, and to disaggregate indicators of well-being by disability to determine whether people with disabilities are participating in society to the same extent as those without disabilities. In this article we discuss the need for data harmonization to improve disability research and policy. We describe standard question sets on disability developed for inclusion in surveys and administrative systems, as well as the need for coordination of both statistical and administrative data systems. Until disability data become more harmonized, it will not be possible to support the development of comprehensive, evidence-based policies and programs to address the needs of the population with disabilities.

Assessing Anxiety and Depression: A Comparison of National Health Interview Survey Measures.

Objective-This report examines differences across two different sets of measures used to assess anxiety and depression in the National Health Interview Survey (NHIS).

Children Living in Households That Experienced Food Insecurity: United States, 2019-2020.

Food insecurity, which affects an estimated 15 million Americans (1), is the limited or uncertain availability of safe and nutritionally adequate foods, or the limited or uncertain ability to acquire acceptable foods in socially acceptable ways (2). Food insecurity has been consistently associated with poor health outcomes in children, including poorer overall health status, acute and chronic health problems, and limited healthcare access (3). This report describes the percentage of children aged 0-17 years living in food-insecure households during the past 30 days by selected sociodemographic and family characteristics using 2019-2020 National Health Interview Survey data.

Stressful Life Events Among Children Aged 5-17 Years by Disability Status: United States, 2019.

Children with disabilities are at increased risk of experiencing stressful life events (1,2). These events include various forms of abuse, neglect, and household instability, such as exposure to violence, parental or guardian incarceration, and living with someone with mental illness or alcohol or drug problems (3). Stressful life events experienced in childhood may have lifelong effects on physical and mental health outcomes (4-11), as well as socioeconomic outcomes, including educational attainment and employment (12). This report presents disparities in four stressful life events among children aged 5-17 years by disability status using 2019 National Health Interview Survey (NHIS) data.

Disparities in Stressful Life Events Among Children Aged 5-17 Years: United States, 2019.

Stressful life events in childhood include various forms of abuse, neglect, and household instability, such as violence exposure, parental incarceration, or living with someone with mental health, alcohol, or drug problems (1). These events are key social determinants of a child's well-being and can have lifelong impacts on physical and mental health (2-9). This report presents sociodemographic disparities in stressful life events as reported by a knowledgeable adult, usually a parent, among children aged 5-17 years using the 2019 National Health Interview Survey data.

Measuring Disability: An Examination of Differences Between the Washington Group Short Set on Functioning and the American Community Survey Disability Questions.

Objective-This report examines differences in survey reports of disability between two sets of disability questions, the Short Set on Functioning (WG-SS) developed by the Washington Group on Disability Statistics (WG) and a set of disability questions developed for the American Community Survey (ACS).

Hearing Difficulties Among Adults: United States, 2019.

Difficulty hearing is related to other functional difficulties, such as communication, and can limit participation across a range of activities including employment, education, and civic activities. While hearing loss can occur at any age, it increases with age (1,2) and has been shown to be associated with cognitive and functional decline in older adults (3-6). This report presents difficulties with hearing even when using a hearing aid among U.S. adults aged 18 and over by level of difficulty and age, sex, and race and Hispanic origin. It also presents estimates of the prevalence of hearing aid use among adults aged 45 and over to focus on the age group with higher rates of hearing difficulties.

The development and testing of a module on child functioning for identifying children with disabilities on surveys. III: Field testing.

BACKGROUND: A module on child functioning developed by UNICEF and the Washington Group on Disability Statistics (WG) for use in censuses and surveys reflects current thinking around disability measurement and is intended to produce internationally comparable data. The Child Functioning Module (CFM) was developed in response to limitations of the Ten Question Screening Instrument (TQSI) for use in surveys and builds on the WG Short Set (WG-SS) of questions that was designed to capture disability in censuses, particularly among the adult population. OBJECTIVE: This paper documents the testing of the module and summarizes its results, including a description of prevalence levels across countries using different cut-offs, and comparisons with prevalence levels obtained using the TQSI and the WG-SS. METHODS: Field tests were conducted in Samoa as part of the 2014 Demographic and Health Survey and in Mexico as part of the 2015 National Survey of Boys, Girls and Women. The module was also implemented in Serbia as part of a dedicated survey conducted in the province of Vojvodina, in February 2016. RESULTS: Using the recommended cut-offcut-off, the percentage of children reported as having functional difficulty ranges from 1.1% in Serbia to 2% in Mexico among children aged 2-4 years, and from 3.2% in Samoa to 11.2% in Mexico among children aged 5-17 years. Across all three countries, the prevalence of functional difficulty was highest in the socio-emotional domains. A comparison of the prevalence levels obtained using the WG-SS and the CFM shows that, except for the question on cognition/learning, the WG-SS and the CFM are relatively close for children aged 5-17 years for the domains that are included in both question sets, but the WG-SS excludes many children identified by the CFM in other domains. The comparison between the TQSI and the CFM shows that, while the prevalence estimates are similar for seeing and hearing, significant differences affect other domains, particularly cognition/learning and communication. CONCLUSIONS: The CFM addresses a full range of functional domains that are important for child development. The module represents an improvement on the TQSI in that it allows for scaled responses to determine the degree of difficulty, and so can separate out many potential false positives. The module is also preferred over the WG-SS for collecting data on children, first, because most of the questions in the WG-SS are not suitable for children under the age of 5 years, and second, because the WG-SS leaves out important functional domains for children aged 5-17 years, namely those related to developmental disabilities and behavioural issues.

The development and testing of a module on child functioning for identifying children with disabilities on surveys. I: Background.

This is the first of three papers that will document the development of a survey module on child functioning developed by UNICEF in collaboration with the Washington Group on Disability Statistics (WG), and demonstrate - both conceptually and through test results - the strengths of that module compared with alternative tools for identifying children with disabilities in household surveys. This first paper in the series sets the background and reviews the literature leading to the development of the UNICEF/WG Child Functioning Module (CFM) and presents the WG Short Set of questions (WG-SS) and the Ten Question Screening Instrument (TQSI) as precursors, outlining some of their shortcomings and how the UNICEF/WG CFM was designed to meet those challenges. Subsequent articles will summarize results from the cognitive and field testing of the CFM including comparisons with results derived from the TQSI and the WG-SS.

An evaluation of the American Community Survey indicators of disability.

BACKGROUND: Collection of data in the Census for implementing disability legislation has been continuous since 1970 although the questions used have changed several times. Concerns have been raised about the ability of the newest question set developed for the American Community Survey (ACS) to adequately represent the population with disabilities because it does not capture all those eligible for certain benefit programs. OBJECTIVE: Using national data, we examine how the addition of questions on the receipt of SSI/SSDI changes the composition of the population identified by the ACS measures. In ancillary materials we also examine the addition of a work limitation question to the population identified by ACS measures. METHODS: Using descriptive secondary analysis of 2011 NHIS data we compare the characteristics of those identified by the ACS questions to those identified by the ACS questions and receipt of SSI/SSDI and those only receiving SSI/SSDI. The comparison is based on conditions, specific functional limitations and severity of limitation. RESULTS: The results provide evidence ACS questions identify a population representing persons at risk for participation difficulties including those who receive SSI/SSDI. The ACS population has higher proportions with mental health and development disabilities than comparison population. The ancillary data demonstrates the work limitation question does not make a significant difference in identifying recipients of SSI/SSDI. CONCLUSION: The analysis demonstrates that the disability measures developed for the ACS produce an unbiased picture of the population with disabilities by including persons with all conditions, more severe disability or selected types of functional limitations.

A Framework for Monitoring Progress Using Summary Measures of Health.

OBJECTIVE: Initiatives designed to monitor health typically incorporate numerous specific measures of health and the health system to assess improvements, or lack thereof, for policy and program purposes. The addition of summary measures provides overarching information which is essential for determining whether the goals of such initiatives are met. METHOD: Summary measures are identified that relate to the individual indicators but that also reflect movement in the various parts of the system. RESULTS: A hierarchical framework that is conceptually consistent and which utilizes a succinct number of summary measures incorporating indicators of functioning and participation is proposed. DISCUSSION: While a large set of individual indicators can be useful for monitoring progress, these individual indicators do not provide an overall evaluation of health, defined broadly, at the population level. A hierarchical framework consisting of summary measures is important for monitoring the success of health improvement initiatives.

Harmonising summary measures of population health using global survey instruments.

measures of population health-health expectancies in particular-have become a standard for quantifying and monitoring population health. To date, cross-national comparability of health expectancies is limited, except within the European Union (EU). To advance international comparability, the European Joint Action on Healthy Life Years (JA: EHLEIS) set up an international working group. The working group discussed the conceptual basis of summary measures of population health and made suggestions for the development of comparable health expectancies to be used across the EU and Organisation for Economic Co-operation and Development (OECD) members. In this paper, which summarises the main results, we argue that harmonised health data needed for health expectancy calculation can best be obtained from 'global' survey measures, which provide a snapshot of the health situation using 1 or a few survey questions. We claim that 2 global measures of health should be pursued for their high policy relevance: a global measure of participation restriction and a global measure of functional limitation. We finally provide a blueprint for the future development and implementation of the 2 global measures. The blueprint sets the basis for subsequent international collaboration, having as a core group Member States of the EU, the USA and Japan. Other countries, in particular OECD members, are invited to join the initiative.

Comments on Sabariego et al. Measuring Disability: Comparing the Impact of Two Data Collection Approaches on Disability Rates. Int. J. Environ. Res. Public Health, 2015, 12, 10329-10351.

In the article, Measuring Disability: Comparing the Impact of Two Data Collection Approaches on Disability Rates, in Volume 12 of the Journal International Journal of Environmental Research and Public Health, Carla Sabariego et al. [1] raise several issues regarding the use of the short set of questions developed by the Washington Group on Disability Statistics (WG) as compared with the approach to disability measurement proposed through the Model Disability Survey (MDS). We address these below. [...].

Methods to improve international comparability of census and survey measures of disability.

PURPOSE: To describe the methods used by the Washington Group on Disability Statistics (WG) to develop internationally comparable questions on disability that can be used worldwide. METHOD: The WG approach to developing disability measures included careful consideration of the theoretical and conceptual issues associated with disability, translating disability concepts into measurement tools, and mixed-method evaluations of the proposed questions using both cognitive and field interviewing methodologies. RESULTS: Disability is a complex construct the measurement of which presents considerable challenges for survey methodologists. The Washington Group on Disability Statistics (WG), a UN Statistical Commission sponsored city group, was established to address the methodological and measurement challenges that have characterized disability statistics and to develop questions for use worldwide that will provide comparable, valid and reliable disability statistics. The WG used a variety of methods to meet these objectives and has finalized a short set disability measure for use in censuses worldwide. CONCLUSIONS: The methodologies adopted by the WG have resulted in question sets that greatly improve the international comparability of disability statistics and will advance our understanding of disability worldwide.

Measuring disability and monitoring the UN Convention on the Rights of Persons with Disabilities: the work of the Washington Group on Disability Statistics.

The Washington Group on Disability Statistics is a voluntary working group made up of representatives of over 100 National Statistical Offices and international, non-governmental and disability organizations that was organized under the aegis of the United Nations Statistical Division. The purpose of the Washington Group is to deal with the challenge of disability definition and measurement in a way that is culturally neutral and reasonably standardized among the UN member states. The work, which began in 2001, took on added importance with the passage and ratification of the UN Convention on the Rights of Persons with Disabilities since the Convention includes a provision for monitoring whether those with and without disabilities have equal opportunities to participate in society and this will require the identification of persons with disabilities in each nation. The International Classification of Functioning, Disability and Health (ICF) developed by the World Health Organization provided a framework for conceptualizing disability. Operationalizing an ICF-based approach to disability has required the development of new measurement tools for use in both censuses and surveys. To date, a short set of six disability-related questions suitable for use in national censuses has been developed and adopted by the Washington Group and incorporated by the United Nations in their Principles and Recommendations for Population and Housing Censuses. A series of extended sets of questions is currently under development and some of the sets have been tested in several countries. The assistance of many National and International organizations has allowed for cognitive and field testing of the disability questionnaires in multiple languages and locations. This paper will describe the work of the Washington Group and explicate the applicability of its approach and the questions developed for monitoring the UN Convention on the Rights of Persons with Disabilities.