AMCHP Life Course Metrics Project

AMCHP Life Course Metrics Project Indicators Proposed, Not Selected

Indicator Name Brief Description Formula Numerator Formula Denominator Data Source

1 Adverse Prevalence of experience of sexual Numerator: Weighted Denominator: Weighted Behavioral Risk Childhood abuse among adults number of adults ages 18 number of adults ages Factor Surveillance Experiences and over responding to 18 and over responding System (BRFSS) (ACE): Sexual the BRFSS survey who to the BRFSS survey Abuse report that they experienced sexual abuse during childhood 2 Medicaid / CHIP Prevalence of states, territories, and Numerator: Number of Denominator: Total The Children’s Eligibility jurisdictions with Medicaid/CHIP states, territories, and states, territories, and Health Insurance upper income limits at or above jurisdictions with jurisdictions Program 200% Federal Poverty Level (FPL) Medicaid/CHIP upper participating in Reauthorization Act income limits at or above Medicaid (CHIPRA) Annual 200% Report http://www.insureki dsnow.gov/chipraan nualreport.pdf 3 MCH in Physical Prevalence of states who have Numerator: Number of Denominator: Number CDC’s Division of Activities and identified MCH interventions in their states that identify PANP of states and territories Nutrition, Physical Nutrition Plans state-level, CDC-sponsored Physical interventions, other than with a PANP Activity, and Activity and Nutrition Plans (PANP) breastfeeding, involving Obesity: target populations that http://www.cdc.gov could include pregnant /obesity/stateprogra women, mothers and/or ms/fundedstates.ht young children (0-5) in ml the “Response to Obesity” section of their PANP. Interventions that are strictly limited to post-preschool school settings are not eligible.

1 Indicator Name Brief Description Formula Numerator Formula Denominator Data Source

4 Low Birth Weight Percent of all live births with birth Numerator: Number of Denominator: Number NVSS National Vital weight < 2,500 grams resident low birth weight of resident live births Statistics Birth (<2,500 g) live births Records

5 Infant Mortality Infant mortality rate per 1,000 live Numerator: Total Denominator: Total live Death and birth births number of infant deaths births records from state (or deaths to children less vital statistics offices than 1 year/365 days of and the National age) Center of Health Statistics via the National Vital Statistics System 6 Pregnancy- Pregnancy-related death ratio per Numerator: Total Denominator: Total Pregnancy Mortality Related Death 100,000 total live births resident pregnancy- resident live births Surveillance System related deaths (PMSS) 7 Medicaid The prevalence of states Numerator: Number of Denominator: Total Track until 2014 – Expansion implementing the 2014 Medicaid states/territories States and territories The Advisory Board expansion implementing expansion Company http://www.advisor y.com/Daily- Briefing/2012/11/09 /MedicaidMap 8 Neighborhood Percent of children ages 0 to 17 years Numerator: Number of Denominator: Number The National Survey Amenities with access to neighborhood neighborhood amenities of children ages 0 to 17 of Children’s Health amenities (sidewalks, parks, (sidewalks, parks, years (NSCH) and the recreation centers, libraries). recreation centers, or National Survey of libraries) available to Children with children ages 0-17 years Special Health Care Needs (NSCSHCN) 9 Parents Percent of adolescents 6-17 years Numerator – Number of Denominator – Number National Survey of Perceived Safety whose parents consider them to be adolescents aged 6 to 17 of adolescents aged 6 to Children’s Health of Children in safe at school years whose parents 17 years enrolled in School consider them to be safe school at school

10 Child Care Prevalence of states implementing a Numerator: Number of Denominator: Total Child Care Quality Quality Rating child care Quality Rating System states, territories, and states, territories, and Rating System (QRS) and (QRS) or Quality Rating & jurisdictions jurisdictions Assessment: Improvement Improvement System (QRIS) implementing one or Compendium of more QRS included in the Quality Rating Office of Planning, Systems and Research and Evaluation Evaluations (DHHS/ACF) https://www.acf.hhs Compendium of Quality .gov/sites/default/fil Rating Systems and es/opre/qrs_compe Evaluations ndium_final.pdf 11 Children are Percent of children with special Numerator: Children 0-17 Denominator: all National Survey of Screened Early health care needs (CSHCN) who years who had at least 1 children 0-17 years Children with and Continuously received at least one preventive preventive medical visit Special Health Care for Special Health medical and dental visit in the past and at least 1 preventive Needs Care Needs year dental visit in the past 12 months. Children under 1 year old were excluded from needing preventive dental care. Therefore, any child under 12 months of age only needed to respond with 1 or more preventive medical visits to meet this indicator. Respondents with answers of don't know or refused to either item were set to missing

12 Early Childhood Percentage of early childhood Numerator: Number of Denominator: Total Numerator: National Accreditation centers that are accredited Early Childhood programs licensed childcare Association for the accredited by the centers Education of Young National Association for Children the Education of Young http://oldweb.naeyc Children (NAEYC) .org/academy/sum mary/center_summ ary.asp or search by city, state, address, program name at: http://www.naeyc.o rg/academy/accredit ation/search

Denominator: Child Care Aware of America (formally NACCRA National Association of Child Care Resources and Referrals Agencies) http://www.naccrra. org/node/2495 State data are available by clicking on individual states, then referencing the state Fact Sheet.

13 Housing Cost Percent of households paying more Numerator: # of Denominator: total # of American Burden than 50% of their income towards households that are households Community Survey housing costs paying more than 50% of (ACS), US Census their household income on housing costs (severe housing cost burden) ***Note some team members suggested keeping 30% or more (vs. 50%) 14 Gini Index of The Gini index of income inequality Numerator: Gini Denominator: N/A (pre- U.S. Census Bureau, Income measures the dispersion of the coefficient (0 to 1- 0 calculated by ACS) American Inequality household income distribution in a indicates no inequality, 1 Community Survey population. The Gini index varies indicates complete (ACS) from zero to 1. Here, zero inequality) corresponds to perfect income *pre-calculated by ACS equality (i.e. everyone has the same income) and 1 correspond 15 Air Pollution- The average exposure of the general Numerator: The average Denominator: Exposure United Health Particulates public to particulate matter of 2.5 exposure of the general levels are weighted to Foundation, microns or less in size (PM2.5). public to particulate represent the America’s Health matter of 2.5 microns or population in the Rankings less in size (PM2.5). specific geographical http://www.america region. shealthrankings.org/ ALL/air/2012 16 School Absence Percent fourth-graders absent from Numerator: 4th-graders Denominator: all 4th- National Center for school 5 or more days in the past absent 5 or more days in graders Education Statistics month. Good predictor of academic the past month success 17 Adult Asthma Percent adults who currently have Numerator: Total current Denominator: Total Behavioral Risk asthma asthma cases among adult population ≥18 Factor Surveillance adult population ≥18 System

18 Literacy—Child Percent of children who were read to Numerator: Days during Denominator: Children National Survey of by a family member every day the previous week on ages 0-5 (weighted) Children's Health which family members (NSCH) read stories to young children: none; 1-3 days; 4-6 days; every day 19 Physical Inactivity Prevalence of children and adults not Numerator: Number of Denominator: Number a. Youth Behavior meeting physical activity state policy children and adults not of children and adults Risk Surveillance standards per week meeting public health included in the (YRBSS) policy standards for identified data systems b. National Survey of physical activity. used to measure this Children’s Health indicator. (NSCH) c. Behavioral Risk Factor Surveillance System (BRFSS) 20 Chronic Regions and metropolitan area Numerator: Denominator: Total Building Resilient Stress/Resilience capacity for resilience, measure by Regions/Metros with number of Regions (BRR) the Resilience Capacity Index very high resilience regions/metros Institute of capacity Government Studies, The University of California Berkley http://brr.berkeley.e du/rci/ 21 Pregnancy- Percent of adult women with Numerator: Total number Denominator: Total Vital Stats, National Induced diagnosed hypertension during of women diagnosed number of pregnant Vital Statistics Hypertension pregnancy with hypertension during women System (NVSS), and pregnancy the Pregnancy Risk Assessment Monitoring System (PRAMS) 22 Injury Number of rapes or sexual assaults Numerator: Number of Denominator: Per 1,000 Bureau of Justice Physical/Sexual per 1,000 females age 12 and older females age 12 and older females age 12 and Statistics (BJS) Abuse who reported being older National Crime and raped or sexually Victimization Survey assaulted (NCVS)

23 Single Parent- Percentage of children that live in Numerator: Single Denominator: Total American Headed household headed by single parent parent households with household that have Community Survey Households (by race/ethnicity, child's age [<6 and related children under 18 related children under (ACS) 6-17 years]) years of age (<6 and 6- 18 years of age (<6 and http://www.census. 17) 6-17) gov/acs/www/ 24 Foster Care Rate of children 0 to 17 in foster care Numerator: Number of Denominator: Number Adoption and Foster per 1,000 children 0 to 17 in foster of children age 0 to 17 Care Analysis and care included in the data in the state or Reporting System system used to measure geographical unit of (AFCARS) this indicator. interest 25 Children With Percent of children who have Numerator: Child has Denominator: Children National Survey of Adequate Health adequate insurance coverage adequate health age 0-17 years Children’s Health Insurance insurance coverage; (NSCH) Coverage (Alternatively, look at inadequate: Child has inadequate health insurance coverage or currently uninsured) 26 Early and The proportion of pregnant women Numerator: 1) The Denominator: 1) The Vital records – Adequate who receive early and adequate number of women who number of live births certificates of live Prenatal Care prenatal care. initiated PNC in the 1st that occurred in the birth – NCHS. States trimester in a calendar calendar year and 2) the can also use their year and 2) the number number of live births in own vital records of women who received a calendar year data that may be adequate PNC based on more timely than the Kotelchuck index in a that available via calendar year NCHS. 27 Preconception Percent of women who have Numerator – Number of Denominator – Total Pregnancy Risk Health discussed preconception health with women who reported number of women of Assessment Counseling a health care worker prior to that they obtained childbearing age Monitoring System pregnancy. preconception counseling surveyed (PRAMS) 28 Health Care Percent of adults who report they Numerator: Number of Denominator: Adult Behavioral Risk Utilization - Adult have had a preventive health visit in adults (18+ years) who population (18+ years) Factor Surveillance the past year. reported having had a System (BRFSS routine health checkup within the past year

29 Transition Youth with special health care needs Numerator: CSHCN age Denominator: All National Survey of Services for receive services necessary for a 12-17 years whose Children with special Children with Youth with successful transition to adult life. doctors usually/always health care needs age Special Health Care Special Health encourage increasing 12-17 years Needs Care Needs responsibility for self- care and (when needed) have discussed transitioning to adult health care, changing health care needs, and how to maintain insurance coverage; CSHCN age 12-17 who did not achieve this outcome. 30 Depression Percent of 9th-12th graders who Numerator: Teens Denominator: All teens Youth Risk Behavior (Suicide Attempt- have seriously considered or have reporting seriously completing the YRBS (9- Surveillance System Teen) attempted to commit suicide considering or attempted 12th) in states that (YRBSS) suicide participate in YRBS) 31 Mental Health The proportion of juvenile residential Numerator: Number of Denominator: Number Juvenile Residential Screening - facilities that screen admissions for juvenile residential of juvenile residential Facilities Census Juvenile Facilities mental health problems. facilities that screen all facilities (JFRC), DOJ, OJJDP. admitted clients for mental health problems 32 Household Food Percent of families with children Numerator: # of families Denominator: # of United States Security - SNAP receiving SNAP benefits in a given with children receiving families with children Department of Recipients state compared to percent of families SNAP benefits below 130% Federal Agriculture (USDA) with children eligible for SNAP Poverty Line Economic Research benefits Survey (ERS)

33 Data Capacity to Prevalence of states collecting Numerator: Number of Denominator: 50 CDC Behavior Risk capture adverse Adverse Childhood Events (ACES) states/territories with states, the District of Factor Surveillance childhood events data through the Behavioral Risk ACES module on the Columbia, Puerto Rico, System (BRFSS) Factor Surveillance System annual BRFSS the U.S. Virgin Islands, Website (Use of and Guam Multiple Questionnaire Data) : http://www.cdc.gov /brfss/technical_info data/surveydata/20 10/2010_multiple.ht m 34 Child Ratio of CPS Investigation and Numerator: Number of Denominator: Child Administration for Maltreatment Alternative Response workers to CPS investigation and population as defined in Children and (ratio of CPS child population alternative response ACF Child Maltreatment Families Children’s investigation and workers report. Bureau: Child alternative Maltreatment 2011. response workers to child http://www.acf.hhs. population) gov/programs/cb/re search-data- technology/statistics -research/child- maltreatment 35 Abortion Access Access to safe, legal abortions using Numerator: # of abortion Denominator: women Jones RK and the number of abortion care care providers age 15-44 by county Kooistra, K., providers within each county. Abortion Incidence and Access to Services in the United States, 2008, Perspectives on Sexual and Reproductive Health, 2011, 43(1). Guttmacher Institute (data collected every 4

years), planned parenthood, National Abortion Federation Population data from: Census

36 STI-Chlamydia Chlamydia rate per 100,000 total Numerator: Total Denominator: Total CDC's National (all) population reported Chlamydia cases population Center for HIV/AIDS, in the population Viral Hepatitis, STD, and TB Prevention (NCHHSTP) Atlas 37 Preconception Percent of women with 2 or more Numerator: Weighted Denominator: Weighted Behavioral Risk Risk Factor Score risk factors based on at-risk drinking, number of non-pregnant number of non- Factor Surveillance smoking, obesity, diabetes and women age 18-44 pregnant women age Survey (BRFSS) frequent mental stress (Denny et al., responding to the 18-44 responding to the J. Women's Health 2012) Behavioral Risk Factor BRFSS survey Surveillance System (BRFSS) survey that they had two or more risk factors (based on: at-risk drinking, smoking, obesity, diabetes, and frequent mental distress)

38 Birth Spacing / Percentage of live births conceived Numerator: Women in Denominator: All Certificate of Live Inter-pregnancy within 18 months of a previous birth states and territories who women in states and Birth - National Vital Interval have implemented the territories who have Statistics System Revised 2003 birth implemented the (NVSS) certificate who had less Revised 2003 birth than 18 months between certificate who reported their previous live birth having a previous live and the start of the birth. pregnancy resulting in the most recent live birth. 39 Maternal Age Both maternal age and maternal age Numerator: Median Denominator: Birth data set, which at first birth (<=19, 20-24, and 25+) Mother’s Age (years) Primiparous women is part of the were assessed for face validity, (women who have only National Vital predictive power, wide availability, given birth to one Statistics System and malleability and inclusion in the child)delivering a live (NVSS). NVSS Index. The latter maternal age birth contains all live variable was chosen over maternal births reported in age as “it reflects concern about the United States. delaying the first birth over the The birth data set is mother’s age at any given focal the primary data set child’s birth”. for analyzing birth trends and patterns in the United States. Birth data sets are available from Vital Stats Online and VitalStats. 40 Residential Percent of children who live in the Numerator: Children (1 Denominator: Total American Mobility for same house as they did a year ago to 4 yrs., 5 - 17 yrs) who children (1-4 yrs, 5-17 Community Survey, Children live in the same house as yrs) variable #B07001 they did a year ago

41 Adolescent Social Measure of social connectedness: Is Numerator: The number Denominator: Total National Survey of Connectedness there at least one teacher or other (weighted) of parents of number (weighted) of Children’s Health adult in this school that you can talk children age 6-17 who respondents http://www.childhe to if you have a problem?; and Can reported being contacted althdata.org/browse you talk with at least one of your by the child’s school /survey/results? parents or other adult family about children’s q=641 members about things that are problems at the school. important to you? 2007 - (K7Q04)- http://www.childhealthd ata.org/browse/survey/r esults?q=939 2010/11- How often did school contact parents about children's problems at school? (S7Q04 ) http://www.childhealthd ata.org/browse/survey/r esults?q=641 42 Percent Teens Associated with poor health and Numerator: Youth, ages Denominator: All youth, American Not Attending economic outcomes 16-19 not enrolled in ages 16-19 Community Survey School and Not school, and not (ACS), US Census Working employed 43 Arrests Arrests per 1,000 persons : all Numerator: Number of Denominator: Bureau of Justice offenses global arrests reported: population covered in Statistics. Based on all offenses arrest report and FBI’s Age, Sex, and 1) Number of arrests Department of Race Summarized (adults 18+) Education data source Yearly Arrest Master 2) Number of arrests 1) Total adult Files (indicators 1 (children < 18) / juvenile population &2); Department of arrests 2) Total juvenile Education (DOE) 3) Number of children in population Civil Rights Data public schools with in or 3) Total student Collection (indicator out of school suspensions population in public 3) - schools http://ocrdata.ed.go v/

44 Education Index Percent of counties with high Numerator: # of residents Denominator: total American of Concentration educational inequality, also an in a census tract with a population x 100,000 Community Survey at the Extremes indicator of social capital college degree as an 2011, U.S. Bureau of (ICE), by indicator of advantage, the Census Community calculated as: ICE=(College graduates– No High School)