Number 74 n May 7, 2014

Adverse Family Experiences Among Children in
 

Nonparental Care, 2011–2012
 by Matthew D. Bramlett, Ph.D., National Center for Health Statistics; Laura F. Radel, M.P.P., Department of Health

and Human Services, Office of the Assistant Secretary for Planning and Evaluation

Abstract

Objective—This report presents estimates of the proportion of children who

have experienced selected adverse family events by the number of biological

parents in the household, with a focus on comparisons among subgroups of

children in nonparental care defined by caregiver type.

Data sources—Data were drawn from the 2011–2012 National Survey of

Children’s Health, a nationally representative telephone survey of households

with children conducted by the National Center for Health Statistics.

Results—Children in nonparental care were 2.7 times as likely as children

living with two biological parents to have had at least one adverse experience,

and more than 2 times as likely as children living with one biological parent and

about 30 times as likely as children living with two biological parents to have

had four or more adverse experiences. More than one-half of children in foster

care had experienced caregiver violence or caregiver incarceration and almost

two-thirds had lived with someone with an alcohol or drug problem. Estimates

for children in other nonparental care subgroups were lower than for foster care,

but still elevated above those of children living with biological parents.

Conclusions—Children in nonparental care, especially those in foster care,

are particularly likely to have experienced adverse family events. These events

could have occurred at any time in the child’s life and could have preceded or

contributed to the child’s current living situation. Nevertheless, children in

nonparental care may be vulnerable to poorer health and well-being outcomes

that are often associated with having had adverse experiences.

Keywords: foster care • grandparent care • relative care • State and Local Area
 

Integrated Telephone Survey
 

experienced that can have lasting Introduction

negative consequences into adulthood

Adverse family experiences are (1,2). Adverse family experiences have

potentially traumatic events or been linked to poor adult health

circumstances that children may have

outcomes (1), risk of illicit drug abuse

(3), and risk of suicide (4).

The 2011–2012 National Survey of

Children’s Health (NSCH) included

questions about nine adverse family

experiences: whether the child had

experienced 1) divorce or separation, 2)

death, or 3) incarceration of a parent or

guardian; whether the child had ever

lived with anyone who 4) was mentally

ill or suicidal or severely depressed or

5) had an alcohol or drug problem;

whether the child 6) ever witnessed any

violence in the household, 7) was the

victim of violence or witnessed violence

in the neighborhood, or 8) ever suffered

racial discrimination; and 9) whether the

child’s caregiver had often found it hard

to get by on the family’s income.

A data brief based on NSCH data

describing adverse family experiences

for the population of all children was

published online by the Child and

Adolescent Health Measurement

Initiative (5). An ASPE Research Brief

by the current authors examined adverse

family experiences, among other

measures of health and well-being, for

children living with two biological

parents, children living with one

biological parent and no other parents,

and children living with no biological,

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 2 National Health Statistics Reports n Number 74 n May 7, 2014

step, or adoptive parents—i.e., children

in nonparental care (6). This report

extends that comparative analysis to

include data on the cumulative number

of different types of adverse family

events experienced, as well as

comparisons among subgroups of

children in nonparental care defined by

caregiver type, including children in

foster care, grandparent care, and other

nonparental care.

There are several reasons why a focus

on adverse experiences among children in

nonparental care is warranted. The

extensive literature documenting that

children of single parents have poorer

well-being than children living with both of

their parents (7) suggests that children

living without at least one parent present

may be further disadvantaged. In addition,

caregiving transitions are problematic for

children’s well-being (8) and most children

living apart from their parents have already

experienced at least one change in

caregiver. The cumulative effect of multiple

traumas can be serious; research has shown

that the more adverse events experienced,

the higher the risk of serious health

conditions or negative health outcomes (9).

It is possible that the caregiving

situation is the result of having experienced

adverse events or neglect that necessitated

the removal of the child from their parents’

household. These adverse events and

circumstances could have occurred at any

time in the child’s life, and may have

preceded or even contributed to the child’s

current living situation. Regardless of when

the adverse events occurred, however, it

remains the case that these children are

particularly vulnerable to poor well-being.

Most data sources either do not

have the sample size to make

examination of children in nonparental

care subgroups feasible, do not identify

the living arrangements of children

sufficiently to enable such an analysis,

or do not include data on child wellbeing outcomes. The NSCH meets all of

these requirements.

Methods

The data are drawn from the

2011–2012 NSCH, which is a nationally

representative survey sponsored by the

Health Resources and Services

Administration’s Maternal and Child

Health Bureau and conducted by the

Centers for Disease Control and

Prevention’s (CDC) National Center for

Health Statistics (NCHS) as a module of

the State and Local Area Integrated

Telephone Survey (10,11). In 2011–

2012, the NSCH was fielded as a

random-digit-dial telephone survey of

households with children aged 0–17

years in the United States; the sample

included both landlines and cell phones.

Contacted households were screened

for the presence of children, and one

child was randomly selected from

identified households with children to be

the subject of the survey. A total of

95,677 interviews were completed from

February 2011 to June 2012. The

respondent was a parent or guardian in

the household who was knowledgeable

about the child’s health. The

relationships of all adults in the

household to the sample child were

captured. If there were no parents

identified in the household, an

additional question was asked to

determine if the child was currently in

foster care to identify those children in

relative foster care whose foster parents

were identified as ‘‘grandmother’’ or

other relative.

Comparisons are made by the

number of biological parents living in

the child’s household (two, one, or zero)

and among subgroups of children in

nonparental care. Adopted children have

been shown to have poorer health

outcomes but better health care access

than biological children (12) and

stepchildren have been shown to have

poorer well-being than biological

children, although this relationship can

differ by whether the stepparent has

adopted the child or not (13). Thus,

children living with adoptive or

stepparents have been excluded from the

comparative analysis to avoid

confounding the comparison or

outcomes by number of parents.

A sampling weight was provided by

NCHS with the data record for each

child. This weight is based on the

probability of selection of the child’s

telephone number, with adjustments for

known survey response biases and

further adjustments to ensure that

weighted estimates match demographic

control totals from the Census Bureau’s

American Community Survey. Estimates

based on these weights, including all

national estimates produced for this

report, are representative of the

noninstitutionalized population of U.S.

children aged 0–17 years.

Weighted point estimates and

variances were calculated in SUDAAN

to account for the complex sample

design. Comparisons described in the

text are statistically significant at the

0.05 level, unless otherwise noted.

The overall NSCH response rate

was 23.0%. When only noncooperation

among eligible households was

examined, more than one-half of eligible

parents and guardians who were

contacted to participate in the survey did

so. Nonresponse bias analyses suggest

that, although the potential for bias

cannot be ruled out, nonresponse bias in

weighted estimates is likely smaller than

sampling error (10,11). Please see

Technical Notes for details.

For more information about NSCH,

including its sample design, data

collection procedures, and questionnaire

content, please visit: http://www.cdc.

gov/nchs/slaits/nsch.htm.

Results

Table 1 shows the sample sizes,

population estimates, and percent

distributions of children by the number

of biological parents in the household

and, for children in nonparental care, by

caregiver type. Only 3.1% of all

children, or nearly 2.25 million children,

lived in nonparental care in 2011–2012.

Among children in nonparental care,

almost 15% were in foster care; 25.2%

lived with their grandparent(s) only

while 37.9% lived with grandparent(s)

and others; and almost one-quarter lived

without foster parents or grandparents,

and were being raised by other relatives

or nonrelatives.

Table 2 presents prevalence

estimates for each of the nine adverse

family experiences by the number of

biological parents in the household and,

for children in nonparental care, by

caregiver type. Selected findings from
Two biological parents One biological parent No biological parents 

in household in household in household 

0 

10 

20 

30 

40 

50 

4.0 

18.9 

42.2 

4.7 

13.6 

24.4 

1.9 

15.3 

29.2 

1.9 

13.3 

33.5 

3.9 

16.2 

24.8 

Percent 

Neighborhood Caregiver Caregiver Mentally ill Alcohol/ drug 

violence violence incarceration caregiver problem 

NOTE: Children living with step or adoptive parents were excluded.
 

SOURCE: CDC/NCHS, State and Local Area Integrated Telephone Survey, National Sur vey of Children’s Health, 2011–2012.
 

100 

0 AFEs 

1 AFE 

2 AFEs 

3 AFEs 

29.9 4 or more AFEs 

11.9 

16.8 

22.6 

18.7 

13.6 

21.0 

12.5 

31.2 

21.7 

22.2 

70.0 

5.2 1.8 

0.9 

80 

60 

40 

Percent 

20 

0 

Two biological One biological No biological 

parents in parent in parents in 

household household household 

NOTES: Children living with step or adoptive parents were excluded. AFE is adverse family experience.
 

SOURCE: CDC/NCHS, State and Local Area Integrated Telephone Sur vey, National Sur vey of Children’s Health, 2011–2012.
 

National Health Statistics Reports n Number 74 n May 7, 2014 Page 3

this table are highlighted in the figures

and described in the text.

The number of biological parents in

the household was inversely associated

with the likelihood of having had an

adverse family experience (Figure 1).

Children living with one biological

parent were between 3 and 8 times as

likely as children living with two

biological parents to have experienced

neighborhood violence, caregiver

violence, or caregiver incarceration or to

have lived with a caregiver with mental

illness or an alcohol or drug problem.

Children in nonparental care, in turn,

were about 1.5 to 2.5 times as likely as

those living with one biological parent

to have experienced each of these five

adverse experiences. Thus, children in

nonparental care were between 5 and 17

Figure 1. Percentage of children aged 0–17 years with selected types of adverse family

experiences, by number of biological parents living in the household: United States,

2011–2012

times as likely as children living with

two biological parents to have

experienced each of these five adverse

experiences.

The cumulative number of different

types of adverse family experiences varied

by the number of biological parents in the

household (Figure 2). Seventy percent of

children living with both biological parents

had experienced none of the adverse

experiences assessed in the survey,

compared with about 20% of children

and less than 1% of children living with

both biological parents.

living with one biological parent or no

parents. Thus, children living with no

parents were 2.7 times as likely to have

experienced at least one adverse

experience, compared with children living

with both biological parents (81.3% versus

30.0%). Almost one-third (29.9%) of

children in nonparental care had

experienced four or more adverse

experiences, compared with only 13.6% of

children living with one biological parent

When examining the prevalence of

Figure 2. Percent distribution of number of different types of adverse family experiences

for children aged 0–17 years, by number of biological parents living in the household:

United States, 2011–2012

children with no adverse experiences

versus any adverse experiences, the

difference between children in

nonparental care and children living

with one biological parent was quite

small. However, as the number of

cumulative experiences compared

increased, the differences between

children in nonparental care and

children living with one biological

parent grew. Children in nonparental
0 

20 

40 

60 

80 

100 

48.3 

9.7 

13.5 

12.8 

15.7 

26.0 

11.1 

20.9 

19.7 

22.3 

25.2 

12.7 

15.0 

30.2 

16.9 

30.1 

13.0 

17.7 

19.3 

19.9 0 AFEs 

1 AFE 

2 AFEs 

3 AFEs 

4 or more AFEs 

Percent 

Foster care Grandparent(s) Grandparent(s) Nonfoster, 

only and others nongrandparent 

NOTE: AFE is adverse family experience.
 

SOURCE: CDC/NCHS, State and Local Area Integrated Telephone Sur vey, National Sur vey of Children’s Health, 2011–2012.
 

Page 4 National Health Statistics Reports n Number 74 n May 7, 2014

Figure 3. Percent distribution of number of different types of adverse family experiences

for children aged 0–17 years in nonparental care, by type of nonparental caregiver:

United States, 2011–2012

care were about twice as likely as

children living with one biological

parent to have experienced four or more

adverse events.

The number of different types of

adverse family experiences for children

in nonparental care varied among

caregiver-type subgroups (Figure 3).

About 80% of children in each subgroup

had had at least one adverse experience

and more than one-half of children in

each subgroup had had at least two

adverse experiences. Nearly one-half of

children in foster care (48.3%) had had

four or more adverse experiences,

compared with 25%–30% of children in

each of the other three caregiver

subgroups. Among those other

nonparental care subgroups, differences

were smaller and mostly nonsignificant.

Some adverse family experiences

were particularly prevalent among

children in foster care (Figure 4).

Children in foster care were

significantly more likely than other

children in nonparental care to have

ever witnessed or experienced

neighborhood violence, caregiver

violence, or caregiver incarceration or to

have lived with someone with mental

illness or an alcohol or drug problem.

More than one-half of children in foster

care had ever experienced caregiver

violence or caregiver incarceration and

almost two-thirds had lived with

someone who had an alcohol or drug

problem. Differences among the

nonfoster subgroups were not

significant.

Summary and

Discussion

Children in nonparental care were

2.7 times as likely as children living

with two biological parents to have had

at least one of the adverse experiences

assessed in NSCH, and were more than

2 times as likely as children living with

one biological parent and about 30 times

as likely as children living with two

biological parents to have had four or

more different types of adverse

experiences. Children in foster care were

particularly likely to have had multiple

types of adverse experiences; almost

one-half of them had had four or more.

More than one-half of children in foster

care had ever experienced caregiver

violence or caregiver incarceration and

almost two-thirds had lived with

someone who had an alcohol or drug

problem.

It is likely that some children in

nonparental care find themselves in that

situation because they had experienced

certain adverse family circumstances

that necessitated the removal of the

child from the birth family—that is, the

adverse experience preceded and

perhaps even contributed to the

nonparental care status rather than being

merely associated with it. For example,

more than one-half of children entering

foster care in 2007 had experienced

severe parental neglect and nearly 30%

had experienced parental alcohol or drug

abuse as contributing reasons for

entering foster care (14). Among

children whose families were

investigated for child abuse and neglect

in 2008–2009, children living in foster

or nonparental relative care 4 months

after the investigation were much more

likely to have a history of child

maltreatment, caregiver incarceration,

caregiver mental illness, caregiver

alcohol abuse, caregiver drug abuse, and

familial financial deprivation, compared

with children still living with the

investigated family (15). The

comparisons in this report are not

intended to suggest that being in

nonparental care necessarily causes or is

caused by adverse family experiences.

As a cross-sectional survey, NSCH is

not appropriate to use to draw causal

inferences of this sort.

Nevertheless, children in

nonparental care are particularly

vulnerable to poor well-being outcomes.

The cumulative effect of multiple

traumas can be serious; research has

shown that the more adverse

experiences suffered, the higher the risk

of serious health conditions or negative

health outcomes (9). The very high

prevalence of several adverse

experiences among children in foster

care may indicate that the child welfare

system has stepped in to care for

children in the worst circumstances.

Households in NSCH with children

who were identified as living in

nonparental care were asked to

participate in a follow-up survey, the

2013 National Survey of Children in
Foster care Grandparent(s) only Grandparent(s) and others Nonfoster, nongrandparent 

70 

42.2 

34.6 

41.4 

64.7 

25.4 

20.7 19.3 

43.3 

36.2 

29.3 28.0 

51.1 

Caregiver 

incarceration 

27.5 

24.1 24.9 

53.1 

26.3 

20.1 21.1 

43.2 

Percent 

60 

50 

40 

30 

20 

10 

0 

Neighborhood Caregiver Mentally ill Alcohol/ drug 

violence violence caregiver problem 

SOURCE: CDC/NCHS, State and Local Area Integrated Telephone Sur vey, National Sur vey of Children’s Health, 2011–2012. 

National Health Statistics Reports n Number 74 n May 7, 2014	 Page 5

Figure 4. Percentage of children aged 0–17 years with selected types of adverse family experiences, by type of nonparental caregiver:

United States, 2011–2012

Nonparental Care (NSCNC). The

NSCNC was sponsored by the

Department of Health and Human

Services’ Office of the Assistant

Secretary for Planning and Evaluation,

with supplemental funding from the

Annie E. Casey Foundation. Data

collection for the NSCNC is now

complete and data from the survey have

just been released. The survey collected

information on the health and well-being

of the children and their caregivers and

the children’s living arrangements,

custody issues, contact with parents, and

service accessibility. More information

about NSCNC, including public-use

microdata, questionnaire content, sample

design, and sample size, can be found at

http://www.cdc.gov/nchs/slaits/

nscnc.htm.

References

1.	 Felitti VJ, Anda RF, Nordenberg D,

Williamson DF, Spitz AM, Edwards

V, et al. Relationship of childhood

abuse and household dysfunction to

many of the leading causes of death

in adults. The Adverse Childhood

Experiences (ACE) Study. Am J Prev

Med 14(4):245–58. 1998.

2. Anda RF, Felitti VJ, Bremner JD, 6. Radel LF, Bramlett MD. Children in

Walker JD, Whitfield C, Perry BD, et nonparental care: Findings from the

al. The enduring effects of abuse and 2011–2012 National Survey of

related adverse experiences in Children’s Health. ASPE research

childhood. A convergence of brief. Washington, DC: U.S.

evidence from neurobiology and Department of Health and Human

epidemiology. Eur Arch Psychiatry Services, Office of the Assistant

Clin Neurosci 256(3):174–86. 2006. Secretary for Planning and

3. Dube SR, Felitti VJ, Dong M, Evaluation. Washington, DC. 2014.

Chapman DP, Giles WH, Anda RF. Available from: http://aspe.hhs.gov/

Childhood abuse, neglect, and hsp/14/ChildrenNonparentalCare/

household dysfunction and the risk of rb_nonparentalcare.pdf.

illicit drug use: The Adverse 7. Dunifon R. Single parenthood and

Childhood Experiences Study. child well-being: Trends, theories,

Pediatrics 111(3):564–72. 2003. and evidence. In: Peters HE, Dush

4. Dube SR, Anda RF, Felitti VJ, CK (eds.). Marriage and Family:

5.

Chapman DP, Williamson DF, Giles

WH. Childhood abuse, household

dysfunction, and the risk of

attempted suicide throughout the life

span: Findings from the Adverse

Childhood Experiences Study. JAMA

286(24):3089–96. 2001.

Child and Adolescent Health

Measurement Initiative. Overview of

adverse child and family experiences

among U.S. children. Data Resource

Center for Child & Adolescent

Health. Available from: http://

www.childhealthdata.org/docs/drc/

aces-data-brief_version-1­

8.

9.

10.

Perspectives and Complexities. New

York, NY: Columbia University

Press. 93–113. 2009.

Fomby P, Cherlin AJ. Family

instability and child well-being. Am

Sociol Rev 72(2):181–204. 2007.

Robert Wood Johnson Foundation.

The truth about ACEs. Infographic.

2013. Available from: http://

www.rwjf.org/en/about-rwjf/

newsroom/newsroom-content/2013/

05/Infographic-The-Truth-AboutACEs.html.

Centers for Disease Control and

Prevention, National Center for

0.pdf?Status=Master. Health Statistics, State and Local
Page 6 National Health Statistics Reports n Number 74 n May 7, 2014

Area Integrated Telephone Survey.

2011–2012 National Survey of

Children’s Health Frequently Asked

Questions. April 2013. Available

from: http://www.cdc.gov/nchs/slaits/

nsch.htm.

11. O’Connor KS, Bramlett MD, George

JM, et al. Design and operation of

the National Survey of Children’s

Health, 2011–2012. National Center

for Health Statistics. Vital Health Stat

1. [Forthcoming].

12. Bramlett MD, Radel LF, Blumberg

SJ. The health and well-being of

adopted children. Pediatrics

119(S1):S54–60. 2007.

13. Bramlett MD. When stepparents

adopt: Demographic, health, and

health care characteristics of adopted

children, stepchildren, and adopted

stepchildren. Adopt Q 13(3–4):248–

67. 2010.

14. Committee on Ways and Means, U.S.

House of Representatives. Chapter

11: Child welfare. In: Background

Material and Data on the Programs

within the Jurisdiction of the

Committee on Ways and Means

(‘‘Green Book’’). Washington, DC:

U.S. Government Printing Office.

2009.

15. Committee on Ways and Means, U.S.

House of Representatives. Chapter

11: Child welfare. In: Background

Material and Data on the Programs

within the Jurisdiction of the

Committee on Ways and Means

(‘‘Green Book’’). Washington, DC:

U.S. Government Printing Office.

2012. Available from: http://

greenbook.waysandmeans.house.gov/

2012-green-book/chapter-11-childwelfare.
National Health Statistics Reports n Number 74 n May 7, 2014 Page 7

Table 1. Sample sizes, population estimates, and percentage distribution by caregiver type living in the household: Children aged 0–17

years, 2011–2012

Caregiver type living in the household

Nonparental care

Two One

biological biological Nonparental Foster Grandparent(s) Grandparent(s) Nonfoster,

Item parents parent only care total care only and others1 nongrandparent

Count

Unweighted sample size .................. 63,776 17,752 3,617 461 1,287 1,234 635

Weighted population estimate2

............... 46,502 16,311 2,290 336 578 867 510

Percent

All children aged 0–17 years3 ............... 63.1 22.1 3.1 0.5 0.8 1.2 0.7

Children in nonparental care4 ............... – – 100.0 14.7 25.2 37.9 22.3

– Quantity zero.
 1Includes aunts, uncles, guardians, siblings, cousins, in-laws, other relatives, and nonrelatives.
 2Rounded to thousands.
 3Percentages do not sum to 100 because the ‘‘other’’ group is omitted; this group, with 11.7% of all children, includes those living in households that include nonbiological parents such as step or
 

adoptive parents.
 4Percentages do not sum to 100 due to rounding.
 

SOURCE: National Survey of Children’s Health, 2011–2012.

Table 2. Percentages and mean number of adverse family experiences by caregiver type: Children aged 0–17 years, 2011–2012

Caregiver type living in the household

Nonparental care

Two One

biological biological Nonparental Foster Grandparent(s) Grandparent(s) Nonfoster,

AFEs parents parent only care total care only and others1 nongrandparent

Percent (standard error)

Often hard for household to afford basics ......... 20.0 (0.39) *38.9 (0.80) *±33.0 (1.87) *32.9 (4.72) ±22.9 (2.68) *§37.9 (3.09) *§36.1 (4.68)
 

Ever experienced racial discrimination ........... 2.8 (0.16) *5.7 (0.37) *5.5 (0.83) 4.6 (1.10) ±3.4 (0.99) y5.3 (1.61) *§8.6 (2.06)
 

Ever experienced death of caregiver............ 0.4 (0.05) *6.6 (0.36) *±18.1 (1.63) *±13.2 (3.21) *±20.0 (3.19) *±18.1 (3.09) *±19.1 (2.80)
 

Ever experienced separation or divorce .......... 2.2 (0.15) *47.9 (0.82) *47.7 (1.97) *53.5 (5.09) *46.0 (3.58) *48.1 (3.25) *45.4 (4.48)
 

Ever witnessed caregiver violence ............. 1.9 (0.14) *15.3 (0.63) *±29.2 (1.83) *±53.1 (5.15) *±†24.1 (3.35) *±†24.9 (2.72) *±†27.5 (3.84)
 

Ever witnessed neighborhood violence .......... 3.9 (0.17) *16.2 (0.64) *±24.8 (1.61) *±43.2 (4.54) *†21.2 (2.91) *†20.1 (2.39) *±†26.3 (3.88)
 

Ever lived with mentally ill caregiver ............ 4.7 (0.19) *13.6 (0.51) *±24.4 (1.71) *±43.3 (5.26) *19.3 (2.99) *±†20.7 (2.51) *±†25.4 (3.75)
 

Ever experienced caregiver incarceration ......... 1.9 (0.14) *13.3 (0.56) *±33.5 (1.88) *±51.1 (5.03) *±†28.0 (3.27) *±†29.3 (2.86) *±†36.2 (4.39)
 

Ever lived with anyone with alcohol or drug problem . . 4.0 (0.19) *18.9 (0.65) *±42.2 (1.92) *±64.7 (4.52) *±†41.4 (3.50) *±†34.6 (2.88) *±†42.2 (4.37)
 

Cumulative number of AFEs (0–9)

0 .................................. 70.0 (0.43) *21.7 (0.70) *18.7 (1.59) *15.7 (3.77) *22.3 (3.13) *±16.9 (2.23) *19.9 (4.17)
 

1 .................................. 22.2 (0.40) *31.2 (0.75) ±22.6 (1.75) *±12.8 (2.61) ±†19.7 (2.46) *†§30.2 (3.38) ±∫19.3 (3.64)
 

2 .................................. 5.2 (0.20) *21.0 (0.66) *±16.8 (1.44) *±13.5 (3.22) *20.9 (3.08) *±15.0 (2.04) *17.7 (3.59)
 

3 .................................. 1.8 (0.14) *12.5 (0.57) *11.9 (1.09) *9.7 (2.18) *11.1 (1.76) *12.7 (1.97) *13.0 (2.53)
 

4 or more ............................ 0.9 (0.09) *13.6 (0.56) *±29.9 (1.75) *±48.3 (4.92) *±†26.0 (3.29) *±†25.2 (2.59) *±†30.1 (3.81)
 

Mean (standard error)

Number of AFEs ........................ 0.4 (0.01) 1.8 (0.03) *±2.5 (0.09) *±3.2 (0.22) *±2.2 (0.14) *±2.4 (0.14) *±2.6 (0.21)
 

y Indicates unreliable estimate (relative standard error > 0.3).

* Estimate differs at 0.05 level from that of two biological parents.
 

± Estimate differs at 0.05 level from that of one biological parent.
 † Estimate differs at 0.05 level from that of foster care.
 

§ Estimate differs at 0.05 level from that of grandparent(s) only.
 

∫ Estimate differs at 0.05 level from that of grandparent(s) and others.
 1Includes aunts, uncles, guardians, siblings, cousins, in-laws, other relatives, and nonrelatives.
 

NOTES: Children living with step or adoptive parents were excluded. AFE is adverse family experience.

SOURCE: National Survey of Children’s Health, 2011–2012.
Page 8 National Health Statistics Reports n Number 74 n May 7, 2014

Technical Notes

Response rate and analysis

of nonresponse

The 2011–2012 National Survey of

Children’s Health (NSCH) overall response

rate was 23.0%. The low response rate was

largely due to the inclusion of cell phone

interviews, which was necessary to provide

good coverage of the population of

children, but resulted in lower response

rates compared with previous iterations of

the survey that only included landline

numbers in the sample. The lower response

rates for cell phone interviews largely

resulted from the higher proportion of

telephone numbers that were not answered

and therefore provided no indication of

whether the number belonged to an eligible

household. When only noncooperation

among eligible households was examined,

more than one-half of eligible parents and

guardians who were contacted to participate

in the survey did so.

To reduce the potential for bias, the

sampling weights were adjusted for

nonresponse and further adjusted to

match external demographic control

totals. As summarized in the online

documentation (10) and detailed in the

methodology report (11), nonresponse

bias analyses were conducted using

several recommended approaches to

examine estimates before and after the

nonresponse weighting adjustment. Bias

was found to greatly decrease after the

weighting adjustment, and estimated

biases using the final weights were

small—in each case, the maximum

estimated bias was within the 95%

confidence interval for the survey

estimate, indicating that nonresponse

bias was consistently smaller than

potential sampling error. Bias estimates

were so small that, for most of the key

survey variables examined, changing the

method used to estimate bias changed

the estimated direction of the bias.

Definition of terms

Adverse family experiences—NSCH

included questions about the following

adverse family experiences: whether the

child had ever lived with a parent or

guardian who 1) got divorced or

separated after the child was born, 2) Grandparent-only care—Children

died, or 3) served time in jail or prison living in grandparent-only care had one

after the child was born; whether the or more grandparents but no other

child ever lived with anyone who 4) people living in the household. Because

was mentally ill or suicidal or severely it was unknown whether a child’s

depressed for more than a couple of sibling was another child being cared

weeks or 5) had a problem with alcohol for by grandparents or an adult who was

or drugs; whether the child 6) ever providing care for the child, children

heard or saw any parents, guardians, or living with grandparents plus siblings

other adults in the household slap, hit, were grouped with ‘‘grandparents and

kick, punch, or beat each other up, 7) others.’’

was the victim of violence or witnessed Grandparent(s) and others—

any violence in the neighborhood, or 8) Children living with grandparent(s) and

was ever treated or judged unfairly others had one or more grandparents

because of his or her race or ethnic plus one or more of the following

group; and 9) how often it had been relations living in the household: aunts,

very hard for the child’s caregiver to get uncles, guardians, siblings, cousins,

by on the family’s income (e.g., it was in-laws, other relatives, or nonrelatives.

hard to cover the basics like food or Nonfoster nongrandparent—

housing). This measure of financial Children in nonfoster nongrandparent

deprivation was considered an adverse care were those in nonparental care who

experience if the response was ‘‘very did not meet the criteria for foster care

often’’ or ‘‘somewhat often’’ rather than and had no grandparents living in the

‘‘rarely’’ or ‘‘never.’’ With one household. Their caregivers included

exception, these adverse family aunts, uncles, guardians, siblings,

experiences could have occurred at any cousins, in-laws, other relatives, or

time in the child’s life, and the caregiver nonrelatives.

who may have been incarcerated,

mentally ill, or violent (for example)

may have been the child’s parent,

current nonparental caregiver, or another

caregiver the child had previously lived

with. The exception was the measure of

financial deprivation, which asked about

the current caregiver’s family rather

than all the families that the child may

have lived with in his or her lifetime.

Number of parents in household—

Children were categorized as living with

both biological parents, living with one

biological parent, or living with no

biological parents. Children living with

step or adoptive parents were excluded.

Foster care—Children in foster care

were either a) those with a reported

foster mother and/or foster father living

in the household, or b) those with no

biological, step, adoptive, or foster

parents living in the household but

whose caregiver reported that the child

was currently in foster care. Because the

NSCH sample represents

noninstitutionalized children only, the

foster care sample includes only

children in household foster care; foster

children in group homes or institutions

were not represented.
U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road, Room 5419

Hyattsville, MD 20782

FIRST CLASS MAIL
 

POSTAGE & FEES PAID
 

CDC/NCHS
 

PERMIT NO. G-284
 

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

National Health Statistics Reports n Number 74 n May 7, 2014

Suggested citation

Bramlett MD, Radel LF. Adverse family

experiences among children in nonparental

care, 2011–2012. National health statistics

reports; no 74. Hyattsville, MD: National

Center for Health Statistics. 2014.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate Director

for Science

Division of Health Interview Statistics

Jane F. Gentleman, Ph.D., Director

For e-mail updates on NCHS publication releases, subscribe online at: http://www.cdc.gov/nchs/govdelivery.htm.
 

For questions or general information about NCHS: Tel: 1–800–CDC–INFO (1–800–232–4636) • TTY: 1–888–232–6348
 

Internet: http://www.cdc.gov/nchs • Online request form: http://www.cdc.gov/cdc-info/requestform.html
 

DHHS Publication No. 2014–1250 • CS246433