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Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. 347-359 (doi:10.1542/peds.2007-1406)
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ARTICLE

Who is at Risk for Special Health Care Needs: Findings From the National Survey of Children's Health

Paul W. Newacheck, DrPHa,b, Sue E. Kim, PhD, MPHc, Stephen J. Blumberg, PhDd, Joshua P. Rising, MD, MPHe

a Institute for Health Policy Studies
b Departments of Pediatrics
c Medicine, University of California, San Francisco, California
d National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
e Robert Wood Johnson Clinical Scholars Program, Yale University, New Haven, Connecticut

OBJECTIVE. A conceptual model of risk factors for special health care needs in childhood was presented previously. This article uses that conceptual model to identify candidate variables for an exploratory empirical examination of the effects of factors that may increase or decrease the risk of developing a special health care need.

METHODS. The National Survey of Children's Health was used for our analysis (N = 102 353). We used multilevel and multivariate analysis methods. We examined risk factors for special health care needs generally and for specific physical, developmental, behavioral, and emotional conditions cooccurring with special health care needs. Risk factors were grouped into 6 major domains, namely, predisposing characteristics, genetic endowment, physical environment, social environment, health-influencing behavior, and health care system characteristics. We examined preschool-aged and school-aged children separately.

RESULTS. Significant associations were found in 5 of 6 domains studied (no variables in the health care systems characteristics were significant). Individual variables found to decrease or to increase significantly the odds of experiencing special health care needs were expressed at the child level (eg, age and gender), family level (eg, family structure and family conflict), and neighborhood level (eg, perception of supportiveness of the neighborhood).

CONCLUSIONS. This analysis is the first to consider empirically a range of risk factors for special health care needs, using a population health model. Although provisional, the results of our analysis can help us to begin thinking about which characteristics of the child, family, and community are worthy of further exploration. Some of the variables we found to be significantly associated with special health care needs, such as age and ethnicity, are immutable. However, we found a number of significant correlates (ie, possible risk factors) that may be amenable to public health interventions, including breastfeeding practices, exposure to secondhand smoke, family closeness, and neighborhood cohesion.

Key Words: children with special health care needs • risk factors • outcomes • epidemiology • National Survey of Children's Health

Abbreviations: CSHCN—children with special health care needs • ADHD—attention-deficit/hyperactivity disorder • NSCH—National Survey of Children's Health • OR—odds ratio

Accepted Nov 15, 2007.


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