Department of Health Policy and Management, UCLA (University of California, Los Angeles).
Department of Public Policy, UCLA.
JAMA Netw Open. 2022 Oct 3;5(10):e2238582. doi: 10.1001/jamanetworkopen.2022.38582.
Improving child and adolescent well-being is a critical public health goal, yet monitoring of this measure at the national level remains limited. Composite indices aggregate existing indicators from population data sources, but these indices currently have weaknesses that may inhibit widespread use.
To apply a novel, more child-centric index method to document changes in overall child and adolescent well-being in the US from 2000 to 2019, assess which states and racial and ethnic subpopulations experienced the greatest inequities in well-being, and identify the specific components associated with changes in the index over time.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study applied the Child and Adolescent Thriving Index 1.0 to population-level data from 2000 to 2019 from several data sources. The area-based sampling frame for each of the component data sources allowed for nationally representative estimates for every year of the study period. The indices for every state and by race and ethnicity were also calculated. Due to the scope and breadth of the index components from across the life course, the Child and Adolescent Thriving Index 1.0 is intended to approximate the well-being of persons up to age 17 years. Data were analyzed from June 7, 2021, to March 17, 2022.
Time in years.
The Child and Adolescent Thriving Index 1.0 is a weighted mean of 11 indicators intended to proxy well-being. The index comprises 11 components: non-low birth weight in neonates, preschool attendance in children aged 3 to 4 years, reading proficiency in fourth-grade students, math proficiency in eighth-grade students, food security in children younger than 18 years, general health status, nonobesity in high school students, nonsmoking in adolescents aged 12 to 17 years, non-marijuana use in adolescents aged 12 to 17 years, high school graduation in young adults aged 18 to 21 years, and nonarrest rate in children aged 10 to 17 years. The index ranges from 0 to 1, with 0 indicating minimum and 1 indicating maximum possible well-being at the population level.
The Child and Adolescent Thriving Index 1.0 was applied to data from 12 320 national, state, and racial and ethnic population-level estimates. Over the study period, the Child and Adolescent Thriving Index 1.0 score increased from 0.780 points in 2000 to 0.843 points in 2019. Despite some convergence in geographic and racial and ethnic disparities, inequities were still present in 2019 in the South (-0.021 points) compared with the Northeast and among American Indian or Alaska Native (-0.079 points), Black (-0.053 points), and Latinx (-0.047 points) children and adolescents compared with White youths. Index components most associated with the overall increases in index scores of well-being were high school graduation rate (+0.028 units) and nonsmoking in adolescents (+0.022 units), amounting to 80.6% of the total increase.
Results of this study suggest that child and adolescent well-being scores increased from 2000 to 2019, but substantial work remains to address persistent inequities across states and racial and ethnic populations. The newly developed Child and Adolescent Thriving Index 1.0 may be used in future work to evaluate which public policy types (economic, social, health care, housing, or education) are associated with higher levels of well-being.
提高儿童和青少年的幸福感是一个至关重要的公共卫生目标，但在国家层面上，对这一指标的监测仍然有限。综合指数从人口数据来源汇总现有指标，但这些指数目前存在弱点，可能会阻碍其广泛使用。
应用一种新颖的、更以儿童为中心的指数方法，记录美国从 2000 年到 2019 年儿童和青少年整体幸福感的变化，评估哪些州和种族及族裔亚人群在幸福感方面存在最大的不平等，并确定与指数随时间变化相关的具体组成部分。
设计、地点和参与者：本横断面研究应用儿童和青少年茁壮成长指数 1.0 对来自多个数据源的 2000 年至 2019 年的人口水平数据进行分析。每个组成部分数据来源的基于区域的抽样框架允许在研究期间的每一年进行全国代表性估计。还计算了每个州以及按种族和族裔划分的指数。由于跨生命周期指数组成部分的范围和广度，儿童和青少年茁壮成长指数 1.0 旨在近似 17 岁以下人群的幸福感。数据分析于 2021 年 6 月 7 日至 2022 年 3 月 17 日进行。
年数。
儿童和青少年茁壮成长指数 1.0 是一个加权平均值，有 11 个旨在代理幸福感的指标组成。该指数由 11 个组成部分组成：新生儿中非低出生体重、3 至 4 岁儿童的学前出勤率、四年级学生的阅读能力、八年级学生的数学能力、18 岁以下儿童的食品安全、一般健康状况、高中生非肥胖、12 至 17 岁青少年不吸烟、12 至 17 岁青少年不使用大麻、18 至 21 岁青年高中毕业率和 10 至 17 岁儿童的非被捕率。指数范围从 0 到 1，其中 0 表示人口水平上的最低和 1 表示最大可能的幸福感。
儿童和青少年茁壮成长指数 1.0 应用于来自 12320 个全国、州和种族及族裔人口水平估计的数据集。在研究期间，儿童和青少年茁壮成长指数 1.0 得分从 2000 年的 0.780 点上升到 2019 年的 0.843 点。尽管在地理和种族及族裔差距方面有所收敛，但在 2019 年，南方（与东北相比）仍存在不平等现象，与白人青少年相比，美国印第安人或阿拉斯加原住民、黑人和拉丁裔儿童和青少年的不平等现象仍然存在（分别为-0.079 点、-0.053 点和-0.047 点）。与整体幸福感指数得分增加最相关的指数组成部分是高中毕业率（增加 0.028 个单位）和青少年不吸烟（增加 0.022 个单位），占总增加量的 80.6%。
本研究结果表明，从 2000 年到 2019 年，儿童和青少年的幸福感得分有所提高，但在各州和种族及族裔群体中仍然存在大量工作要做，以解决持续存在的不平等问题。新开发的儿童和青少年茁壮成长指数 1.0 可用于未来的工作，以评估哪些类型的公共政策（经济、社会、医疗保健、住房或教育）与更高水平的幸福感相关。
