AMCHP Life Course Metrics Project Indicators Proposed, Not Selected Thematic Category Indicator Name Brief Description Formula Numerator Formula Denominator Data Source 1 Childhood Experiences Adverse Childhood Experiences (ACE): Sexual Abuse Prevalence of experience of sexual abuse among adults Numerator: Weighted number of adults ages 18 and over responding to the BRFSS survey who report that they experienced sexual abuse during childhood Denominator: Weighted number of adults ages 18 and over responding to the BRFSS survey Behavioral Risk Factor Surveillance System (BRFSS) 2 Community Health Policy Medicaid / CHIP Eligibility Prevalence of states, territories, and jurisdictions with Medicaid/CHIP upper income limits at or above 200% Federal Poverty Level (FPL) Numerator: Number of states, territories, and jurisdictions with Medicaid/CHIP upper income limits at or above 200% Denominator: Total states, territories, and jurisdictions participating in Medicaid The Children’s Health Insurance Program Reauthorization Act (CHIPRA) Annual Report 3 Community Health Policy MCH in Physical Activities and Nutrition Plans Prevalence of states who have identified MCH interventions in their state-level, CDC-sponsored Physical Activity and Nutrition Plans (PANP) Numerator: Number of states that identify PANP interventions, other than breastfeeding, involving target populations that could include pregnant women, mothers and/or young children (0-5) in the “Response to Obesity” section of their PANP. Interventions that are strictly limited to post-preschool school settings are not eligible. Denominator: Number of states and territories with a PANP CDC’s Division of Nutrition, Physical Activity, and Obesity: 4 Community Health Policy Low Birth Weight Percent of all live births with birth weight < 2,500 grams Numerator: Number of resident low birth weight (<2,500 g) live births Denominator: Number of resident live births NVSS National Vital Statistics Birth Records
5 Community Health Policy Infant Mortality Infant mortality rate per 1,000 live births Numerator: Total number of infant deaths (or deaths to children less than 1 year/365 days of age) Denominator: Total live births Death and birth records from state vital statistics offices and the National Center of Health Statistics via the National Vital Statistics System 6 Community Health Policy Death Pregnancy-related death ratio per 100,000 total live births Numerator: Total resident deaths Denominator: Total resident live births Pregnancy Mortality Surveillance System (PMSS) 7 Community Health Policy Medicaid Expansion The prevalence of states implementing the 2014 Medicaid expansion Numerator: Number of states/territories implementing expansion Denominator: Total States and territories Track until 2014 – The Advisory Board Company 8 Community Health Policy Neighborhood Amenities Percent of children ages 0 to 17 years with access to neighborhood amenities (sidewalks, parks, recreation centers, libraries). Numerator: Number of neighborhood amenities (sidewalks, parks, recreation centers, or libraries) available to children ages 0-17 years Denominator: Number of children ages 0 to 17 years The National Survey of Children’s Health (NSCH) and the National Survey of Children with Special Health Care Needs (NSCSHCN) 9 Community Safety Parents Perceived Safety of Children in School Percent of adolescents 6-17 years whose parents consider them to be safe at school Numerator – Number of adolescents aged 6 to 17 years whose parents consider them to be safe at school Denominator – Number of adolescents aged 6 to 17 years enrolled in school National Survey of Children’s Health 10 Early Life Services Child Care Quality Rating and Improvement Prevalence of states implementing a child care Quality Rating System (QRS) or Quality Rating & Improvement System (QRIS) Numerator: Number of states, territories, and jurisdictions implementing one or more QRS included in the Office of Planning, Research and Evaluation (DHHS/ACF) Compendium of Quality Denominator: Total states, territories, and jurisdictions Child Care Quality Rating System (QRS) Assessment: Compendium of Quality Rating Systems and Evaluations related
14 Economic Experiences Gini Index of Income Inequality The Gini index of income inequality measures the dispersion of the household income distribution in a population. The Gini index varies from zero to 1. Here, zero corresponds to perfect income equality (i.e. everyone has the same income) and 1 correspond Numerator: Gini coefficient (0 to 1- 0 indicates no inequality, 1 indicates complete inequality) *pre-calculated by ACS Denominator: N/A (pre-calculated by ACS) U.S. Census Bureau, American Community Survey (ACS) 15 Environmental Health Air The average exposure of the general public to particulate matter of 2.5 microns or less in size (PM2.5). Numerator: The average exposure of the general public to particulate matter of 2.5 microns or less in size (PM2.5). Denominator: Exposure levels are weighted to represent the population in the specific geographical region. United Health Foundation, America’s Health Rankings 16 Family & Social Wellbeing School Absence Percent fourth-graders absent from school 5 or more days in the past month. Good predictor of academic success Numerator: 4th-graders absent 5 or more days in the past month Denominator: all 4th-graders National Center for Education Statistics 17 Family & Social Wellbeing Adult Asthma Percent adults who currently have asthma Numerator: Total current asthma cases among adult population ≥18 Denominator: Total adult population ≥18 Behavioral Risk Factor Surveillance System 18 Family & Social Wellbeing Literacy—Child Percent of children who were read to by a family member every day Numerator: Days during the previous week on which family members read stories to young children: none; 1-3 days; 4-6 days; every day Denominator: Children ages 0-5 (weighted) National Survey of Children's Health (NSCH) 19 Family & Social Wellbeing Physical Inactivity Prevalence of children and adults not meeting physical activity state policy standards per week Numerator: Number of children and adults not meeting public health policy standards for physical activity. Denominator: Number of children and adults included in the identified data systems used to measure this indicator. a. Youth Behavior Risk Surveillance (YRBSS) b. National Survey of Children’s Health (NSCH) c. Behavioral Risk Factor Surveillance System (BRFSS)
26 Health Care Access and Quality Early and Adequate Prenatal Care The proportion of pregnant women who receive early and adequate prenatal care. Numerator: 1) The number of women who initiated PNC in the 1st trimester in a calendar year and 2) the number of women who received adequate PNC based on the Kotelchuck index in a calendar year Denominator: 1) The number of live births that occurred in the calendar year and 2) the number of live births in a calendar year Vital records – certificates of live birth – NCHS. States can also use their own vital records data that may be more timely than that available via NCHS. 27 Health Care Access and Quality Preconception Health Counseling Percent of women who have discussed preconception health with a health care worker prior to pregnancy. Numerator – Number of women who reported that they obtained preconception counseling Denominator – Total number of women of childbearing age surveyed Pregnancy Risk Assessment Monitoring System (PRAMS) 28 Health Care Access and Quality Health Care Utilization - Adult Percent of adults who report they have had a preventive health visit in the past year. Numerator: Number of adults (18+ years) who reported having had a routine health checkup within the past year Denominator: Adult population (18+ years) Behavioral Risk Factor Surveillance System (BRFSS 29 Health Care Access and Quality Transition Services for Youth with Special Health Care Needs Youth with special health care needs receive services necessary for a successful transition to adult life. Numerator: CSHCN age 12-17 years whose doctors usually/always encourage increasing responsibility for 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. Denominator: All Children with special health care needs age 12-17 years National Survey of Children with Special Health Care Needs
30 Mental Health Depression (Suicide Percent of 9th-12th graders who have seriously considered or have attempted to commit suicide Numerator: Teens reporting seriously considering or attempted suicide Denominator: All teens completing the YRBS (9-12th) in states that participate in YRBS) Youth Risk Behavior Surveillance System (YRBSS) 31 Mental Health Mental Health Screening - Juvenile Facilities The proportion of juvenile residential facilities that screen admissions for mental health problems. Numerator: Number of juvenile residential facilities that screen all admitted clients for mental health problems Denominator: Number of juvenile residential facilities Juvenile Residential Facilities Census (JFRC), DOJ, OJJDP. 32 Nutrition Household Food Security - SNAP Recipients Percent of families with children receiving SNAP benefits in a given state compared to percent of families with children eligible for SNAP benefits Numerator: # of families with children receiving SNAP benefits Denominator: # of families with children below 130% Federal Poverty Line United States Department of Agriculture (USDA) Economic Research Survey (ERS) 33 Public Health Capacity Data Capacity to capture adverse childhood events Prevalence of states collecting Adverse Childhood Events (ACES) data through the Behavioral Risk Factor Surveillance System Numerator: Number of states/territories with ACES module on the annual BRFSS Denominator: 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam CDC Behavior Risk Factor Surveillance System (BRFSS) Website (Use of Multiple Questionnaire Data) : 34 Public Health Capacity Child Maltreatment (ratio of CPS investigation and alternative response workers to child population) Ratio of CPS Investigation and Alternative Response workers to child population Numerator: Number of CPS investigation and alternative response workers Denominator: Child population as defined in ACF Child Maltreatment report. Administration for Children and Families Children’s Bureau: Child Maltreatment 2011.
35 Reproductive Life Experiences Abortion Access Access to safe, legal abortions using the number of abortion care providers within each county. Numerator: # of abortion care providers Denominator: women age 15-44 by county Jones RK and Kooistra, K., 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 Reproductive Life Experiences STI-Chlamydia (all) Chlamydia rate per 100,000 total population Numerator: Total reported Chlamydia cases in the population Denominator: Total population CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) Atlas 37 Reproductive Life Experiences Preconception Risk Factor Score Percent of women with 2 or more risk factors based on at-risk drinking, smoking, obesity, diabetes and frequent mental stress (Denny et al., J. Women's Health 2012) Numerator: Weighted number of non-pregnant women age 18-44 responding to the Behavioral Risk Factor Surveillance System (BRFSS) survey that they had two or more risk factors (based on: at-risk drinking, smoking, obesity, diabetes, and frequent mental distress) Denominator: Weighted number of non-pregnant women age 18-44 responding to the BRFSS survey Behavioral Risk Factor Surveillance Survey (BRFSS)
38 Reproductive Life Experiences Birth Spacing / Inter-pregnancy Interval Percentage of live births conceived within 18 months of a previous birth Numerator: Women in states and territories who have implemented the Revised 2003 birth certificate who had less than 18 months between their previous live birth and the start of the pregnancy resulting in the most recent live birth. Denominator: All women in states and territories who have implemented the Revised 2003 birth certificate who reported having a previous live birth. Certificate of Live Birth - National Vital Statistics System (NVSS) 39 Reproductive Life Experiences Maternal Age Both maternal age and maternal age at first birth (<=19, 20-24, and 25+) were assessed for face validity, predictive power, wide availability, and malleability and inclusion in the Index. The latter maternal age variable was chosen over maternal age as “it reflects concern about delaying the first birth over the mother’s age at any given focal child’s birth”. Numerator: Median Mother’s Age (years) Denominator: Primiparous women (women who have only given birth to one child)delivering a live birth Birth data set, which is part of the National Vital Statistics System (NVSS). NVSS contains all live births reported in the United States. The birth data set is the primary data set for analyzing birth trends and patterns in the United States. Birth data sets are available from Vital Stats Online and VitalStats. 40 Social Capital & Community Engagement, Social Cohesion Residential Mobility for Children Percent of children who live in the same house as they did a year ago Numerator: Children (1 to 4 yrs., 5 - 17 yrs) who live in the same house as they did a year ago Denominator: Total children (1-4 yrs, yrs) American Community Survey, variable #B07001
41 Social Capital & Community Engagement, Social Cohesion Adolescent Social Connectedness Measure of social connectedness: Is there at least one teacher or other adult in this school that you can talk to if you have a problem?; and Can you talk with at least one of your parents or other adult family members about things that are important to you? Numerator: The number (weighted) of parents of children age 6-17 who reported being contacted by the child’s school about children’s problems at the school. 2007 - (K7Q04)- 2010/11- How often did school contact parents about children's problems at school? (S7Q04 ) Denominator: Total number (weighted) of respondents National Survey of Children’s Health 42 Social Capital & Community Engagement, Social Cohesion Percent Teens Not Attending School and Not Working Associated with poor health and economic outcomes Numerator: Youth, ages 16-19 not enrolled in school, and not employed Denominator: All youth, ages 16-19 American Community Survey (ACS), US Census 43 Social Capital & Community Engagement, Social Cohesion Arrests Arrests per 1,000 persons : all offenses Numerator: Number of global arrests reported: all offenses 1) Number of arrests (adults 18+) 2) Number of arrests (children < 18) / juvenile arrests 3) Number of children in public schools with in or out of school suspensions Denominator: population covered in arrest report and Department of Education data source 1) Total adult population 2) Total juvenile population 3) Total student population in public schools Bureau of Justice Statistics. Based on FBI’s Age, Sex, and Race Summarized Yearly Arrest Master Files (indicators 1 &2); Department of Education (DOE) Civil Rights Data Collection (indicator 3) - http://ocrdata.ed.gov/
44 Social Capital & Community Engagement, Social Cohesion Education Index of Concentration at the Extremes (ICE), by Community Percent of counties with high educational inequality, also an indicator of social capital Numerator: # of residents in a census tract with a college degree as an indicator of advantage, calculated as: ICE=(College High School) Denominator: total population x 100,000 American Community Survey 2011, U.S. Bureau of the Census