To support evidence-based policymaking as well as to publish data as a public good, various federal government agencies conduct surveys of the U.S. population. Many of these surveys include data relating to issues of health, either as the explicit focus of the survey (e.g., the Centers for Disease Control and Prevention’s [CDC] Behavioral Risk Factor Surveillance System [BRFSS]) or as a component of a broader survey (e.g., the Census Bureau’s Current Population Survey [CPS]). These surveys also vary in their scope of content, with some focused narrowly on particular health issues (e.g., the CDC’s National Immunization Survey [NIS]) and others more comprehensively addressing a wide variety of health topics (e.g., the National Center for Health Statistics’ [NCHS] National Health Interview Survey [NHIS]).
Another way that surveys vary is by their target populations. While some focus on nearly the entire U.S. population (e.g., the Census Bureau’s American Community Survey [ACS]), others focus just on population subsets, such as how the BRFSS survey includes only adults (i.e., those age 18 and older).
One important population subset that is covered by multiple federal health-related surveys is children, or children and adolescents, generally defined as those younger than age 18. These surveys that collect health information on children and adolescents are important for numerous reasons, including that children have particular health profiles and needs that differ from adults. Also important is the fact that the health and related issues can influence children’s lifelong trajectory in a variety of ways, including their long-term health, economic situation, and other circumstances well into adulthood. For those reasons, this blog focuses on providing an overview of federal health-related surveys pertaining—either exclusively or with a strong emphasis—on children and adolescents and acknowledging their unique importance.
Children’s Health Survey Data
Surveys that focus specifically on child and adolescent health have been fielded in the United States for over 20 years. While the National Health Interview Survey (NHIS) has a specialized child component that was established in 1997, the National Survey of Children with Special Health Care Needs (NS-CSHCN), first fielded in 2001, was the most comprehensive national-level survey to gauge the health of children in the U.S., and, more specifically, children with special health care needs.[1] The goal of the survey was to assess whether these children and their families and caregivers were able to have their unique needs met via adequate access to care, specialty services, sufficient health insurance coverage, as well as assessing their overall feelings of satisfaction with care and understanding of decision-making processes.
In 2016, the NS-CSHCN merged with the National Survey of Children’s Health (NSCH), a survey that was founded in 2003 by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB) and the aim of which was “to help states and communities better understand the health and well-being of all children.”[2] Both the NS-CSHCN and the NSCH surveys were created with the idea that monitoring the health and well-being of children is critical to better understand the impacts of childhood experiences and conditions on future health and health-related outcomes.
As exemplified in the study of adverse childhood experiences (ACEs), events that occur in childhood can have long-lasting effects on health, well-being, and opportunity that carry into adulthood. ACEs are potentially traumatic events in childhood (age 0–17) such as experiencing or witnessing neglect or abuse, housing instability or food insecurity, growing up in a household where an adult or caregiver has mental health or substance abuse issues, as well as several others. While survey data drawn from the BRFSS have shown that ACEs are common—64% of adults in 2020 reported experiencing at least one type of ACE during childhood—research has also shown that understanding and addressing the prevalence of ACEs is linked to reductions in poor health outcomes for adults, which can range from reduced diagnosis of heart disease to fewer episodes of depression.[3]
This is just one example of the way that health surveys, especially children’s health surveys such as the ones we detail below, allow public health researchers to better understand the health and health-related issues facing the U.S. population at more vulnerable times in their lives, and how survey data can be effectively used to address these concerns in both the short- and long-term.
National Survey of Children’s Health (NSCH)
As previously noted, the NSCH was first established in 2003, though only fielded sporadically until 2016 when it underwent a series of consequential changes. These changes included:
- A revised questionnaire as a result of combining with the NS-CSHCN,
- A change in survey operators (though still funded by the MCHB, the U.S. Census Bureau currently conducts the NSCH), and
- A change in periodicity to become an annual survey.[4]
The NSCH provides crucial data regarding the physical and emotional health of children age 0–17 with questions on access to and quality of health care falling under the former and questions regarding family structure (e.g., number of parents or other family in household, parental marital status), parental physical and mental health, neighborhood characteristics (e.g., safety, presence of parks and libraries, social support), and school experiences (e.g., bullying, difficulty making or keeping friends, missed days) falling under the latter.
Data are available at the state level, and includes demographic variables of age, race and ethnicity, and sex. The goal of the survey is to ensure that community workers, educators, and policymakers are able to understand and be responsive to the health needs of children and families.
For instance, according to the NSCH, we know that the rate of adolescents (age 12–17) with a diagnosed mental or behavioral health condition peaked at a high of 20.6% in 2023. This rate has been steadily increasing since 2016 when it measured at 15% and is concurrent with a rise in reported difficulty in obtaining treatment once diagnosed (up to 57.3% in 2022 from 45.3% in 2018).[5]
Many states have sought to respond to this growing need to address mental and behavioral health diagnoses among adolescents: Nearly 30 states used their 2022 legislative sessions to bolster the availability of mental and behavioral health service providers. Kentucky, for example, set aside nearly $7.5 million to fund school-based mental health providers, and Maine established a safety center that provides resources and training on behavioral health supports and strategies for schools across the state.[6]
National Immunization Survey (NIS)
Another critical survey on a more specialized health care topic is the National Immunization Survey (NIS) conducted by the CDC. Like the National Health Interview Survey, the NIS has multiple components that are geared toward specific populations. The NIS-Child (age 19–35 months) was first conducted in 1994 to monitor all routine vaccinations for this age group such as MMR, polio, influenza (flu), Hepatitis A and Hepatitis B, among others. In 2006, the NIS-Teen (age 13–17 years) was added to track routine vaccinations for adolescents such as flu and HPV, among others.
While both of these components ask about flu vaccination, a separate model called the NIS-Child Influenza Module (CIM) is also conducted each year to include children age 6–18 months and 3–12 years who are not part of the NIS-Child and NIS-Teen surveys. A component measuring COVID-19 vaccination rates in adults age 18 and older, the NIS-Adult COVID Module (ACM), was added in 2021.
The NIS provides researchers with data at the state level, and includes a plethora of demographic variables such as age, race and ethnicity, health insurance coverage status, poverty level, primary language, housing stability, and others.
Childhood vaccinations are one of the most effective methods for preventing harmful diseases that can affect children and result in serious illness, short- and long-term health complications, or even death. According to the 2023 NIS data, however, rates of standard child immunizations are decreasing at various levels, with declines ranging from 1.3 percentage points (varicella) to 7.8 percentage points (influenza).[7]
Understanding the seriousness of this decline, states are taking action to address decreases in flu vaccination rates and increases in vaccine hesitancy among residents. The Texas Department of State Health Services, for example, recently introduced a communications toolkit and guide to reach out to parents at schools, at pediatric clinics, and via social media to help underscore the importance of vaccination and dispel myths and misinformation regarding vaccines.[8]
Youth Risk Behavioral Surveillance System (YRBSS)
Another survey conducted biennially by the CDC, the Youth Risk Behavioral Surveillance System (YRBSS), provides state- and sub-state-level data on the health behaviors and well-being of adolescents in middle and high school. The YRBSS is unique in several ways: It consists of several surveys that measure different grade levels, different geographies, and are either conducted at the federal level by the CDC or directly by the state, territory, locality, or Tribal Nation. Another unique feature of the YRBSS is that the number of states or local districts who participate each year may change. Participation from states has ranged from 26 in 1991 to a high of 47 states each round between 2009-2015 to a current level of 39 states in 2023.[9]
One component of the YRBSS is the Youth Risk Behavior Survey (YRBS), conducted nationally by the CDC since 1991 includes high school students (grades 9–12) from both private and public schools within the U.S. Another component includes a version of the YRBS distributed to middle schools, which has been conducted by interested states, territories, tribal governments, and local school districts since 1995.
Several one-time surveys have also been fielded that are considered part of the YRBSS, focused on a singular issue (e.g., physical activity and nutrition-related behaviors) or on a better understanding of a related population (e.g., students enrolled in alternative high schools or undergraduate collegiate students).
Questions on the YRBS are divided into six main topic areas:
- Unintentional injuries and violence (e.g., exposure to violence or threats, bullying);
- Tobacco use (e.g., vaping and tobacco use);
- Substance use (e.g., alcohol and other drug use);
- Sexual behavior (e.g., risk of pregnancy or sexually transmitted infections);
- Dietary behaviors (e.g., obesity and weight control) and physical activity;
- Other health topics (e.g., mental health, unstable housing).
While some measures have been monitored since the survey’s beginning in 1991, providing researchers with a unique opportunity to understand trends over time, the design of the YRBSS is flexible enough to allow for data collection on emerging topics of interest and concern to be added, such as the recent addition of questions regarding mental health and adverse childhood experiences (ACEs) in 2023.[10] The YRBSS also provides demographic characteristics such as grade level, sex, race and ethnicity, and sexual identity.
The Youth Risk Behavior Surveillance System was founded, as the name suggests, in order to help public health researchers and policymakers to understand and monitor risky adolescent health behaviors that may lead to negative consequences such as serious illness, injury, diagnosis of chronic health conditions or disability, or death across demographic groups and over time.
For instance, the 2023 YRBSS data show a growing area of concern for adolescents is the experience of violence at school. From 2021 to 2023, the percentage of students who reported being bullied increased from 15% to 19%. Within that same time frame, the percentage of students who reported being threatened or injured with a weapon at school also increased from 7% to 9%. Unsurprisingly, the percentage of students who missed school due to safety concerns also increased from 2021 to 2023, rising from 9% to 13%.[11]
Multiple states are working to address this emergent issue, with Minnesota leading the way by passing several new laws in 2024 that provide funding and guidance for developing and implementing violence prevention education. All Minnesota school districts must integrate a program for violence prevention in their curriculum that will teach students, educators, and staff to recognize violent behaviors in fellow students and families as well as providing education on tactics for safe intervention, nonviolent conflict resolution, self-protection, useful coping mechanisms, and understanding and identification of supports such as local community services, agencies, and organizations that can offer family, mental health, and crisis services.[12]
Conclusion
Survey data on child and adolescent health, such as those collected via the surveys explored in this blog, are critical tools in the arsenal of public health and health workers, advocates, educators, and community organizations. These data sources can enhance their abilities to monitor the health and wellbeing of the next generation and respond to emerging concerns with targeted solutions, whether that be supports and resources to address mental health issues, improved communications strategies regarding the safety and efficacy of vaccinations to address falling rates of immunizations, or the establishment of educational programs to intervene and prevent cycles of violence that impact student safety at home and at school.
The National Survey of Children’s Health, the National Immunization Survey, and the Youth Risk Behavior Surveillance System each provide unique insight into differing facets of the health issues faced by children and adolescents. A loss or interruption of estimates from any of these sources would create a problematic data gap for monitoring long-term trends.
Should data from these surveys be seriously delayed or curtailed, states or other concerned organizations could consider alternative data sources to fill gaps in our understanding of the health and health-related concerns among specific groups of children and adolescents. Minnesota, for example, has conducted its own alternative to the YRBSS—the Minnesota Student Survey (MSS)—every three years since 1989. Students in a range of grade levels, from fifth to eleventh, are surveyed regarding health, health behaviors and risk factors, physical activity, mental health, sexual health, substance use, family and relationships, and school experiences.[13]
Others, like Washington, have more recently begun to conduct surveys of children: The Child Wellness Survey (CWS) was established in 2024, and looks to better understand the health status, access and utilization of health care services, diagnosed behaviors and conditions, caregiving and education, family and neighborhood characteristics, and demographic characteristics for two cohorts of children, those age 6 months to 5 years and those age 6 to 11 years.
While both types of these state-fielded surveys offer policy health researchers a potential alternative to obtaining specific state-level health data for monitoring the health of children and adolescents, they are unable to fully replace the national-level or local-level data available via federally funded and conducted surveys such as the NSCH, the NIS, or the YRBSS, nor could they substitute for the historical data collected since these surveys’ inceptions.
Notes and References
This blog is part of the State Alternatives for Health Data Continuity project funded by Robert Wood Johnson Foundation (RWJF). With this project, SHADAC is developing resources to help anyone involved in the health policy process consider their options for identifying and filling gaps in important measures of health. Please contact us if you would like to learn more or if you have questions.
[1] Data Resource Center for Child & Adolescent Health. About the National Survey of Children's Health. Child & Adolescent Health Measurement Initiative. https://www.childhealthdata.org/learn-about-the-nsch/NSCH
[2] Maternal and Child Health Bureau. (2025, June). National Survey of Children's Health (NSCH), Participants Frequently Asked Questions. Health Resources & Services Administration. https://mchb.hrsa.gov/data-research/national-survey-childrens-health/participants-frequently-asked-questions
[3] U.S. Centers for Disease Control and Prevention. (2024, Oct 8). About Adverse Childhood Experiences. https://www.cdc.gov/aces/about/index.html
[4] U.S. Department of Commerce. (2025, Jan 7). 2023 National Survey of Children's Health: Data Users Frequently Asked Questions (FAQs). U.S. Census Bureau. https://www2.census.gov/programs-surveys/nsch/technical-documentation/methodology/2023-NSCH-FAQs.pdf
[5] Sappenfield, O., Alberto, C., Minnaert, J., Donney, J., Lebrun-Harris, L., Ghandour, R. (2024, Oct). National Survey of Children's Health: Adolescent Mental and Behavioral Health, 2023 Data Brief. Maternal and Child Health Bureau, Health Resources & Services Administration. https://mchb.hrsa.gov/sites/default/files/mchb/data-research/nsch-data-brief-adolescent-mental-behavioral-health-2023.pdf
[6] Gould, Z. (2022, Feb 22). States Enhance Children’s Mental Health Services through Workforce Supports. National Academy for State Health Policy. https://nashp.org/states-enhance-childrens-mental-health-services-through-workforce-supports/
[7] Hill, H. A., Yankey, D., Elam-Evans, L. D., Mu, Y., Chen, M., Peacock, G., & Singleton, J. A. (2024). Decline in Vaccination Coverage by Age 24 Months and Vaccination Inequities Among Children Born in 2020 and 2021 - National Immunization Survey-Child, United States, 2021-2023. MMWR. Morbidity and mortality weekly report, 73(38), 844–853. https://pmc.ncbi.nlm.nih.gov/articles/PMC11563569/
[8] Texas Department of State Health Services. (2023). Strategies to Increase Childhood Influenza Vaccination Packet. Texas Health and Human Services. https://www.dshs.texas.gov/sites/default/files/LIDS-Immunizations/pdf/AA1_Flu_Strategies_to_Increase_ChildhoodVax_Packet_v3.pdf
[9] U.S. Centers for Disease Control and Prevention. (2024, Oct 31). YRBS Supplementary Tables. https://www.cdc.gov/yrbs/supplementary-tables/index.html
[10] Brener, N., Mpofu J., Krause, KH., et al. (2024, Oct 8). Overview and Methods for the Youth Risk Behavior Surveillance System — United States, 2023. MMWR Suppl 2024;73(Suppl-4):1–12. https://www.cdc.gov/mmwr/volumes/73/su/su7304a1.htm?s_cid=su7304a1_w
[11] U.S. Centers for Disease Control and Prevention. (2024, Sept 29). 2023 Youth Risk Behavior Survey Results. https://www.cdc.gov/yrbs/results/2023-yrbs-results.html
[12] S.F. No. 893, State of Minnesota Ninety-Fourth Session (MN 2025). https://www.revisor.mn.gov/bills/text.php?number=SF893&version=0&session=ls94&session_year=2025&session_number=0&format=pdf
[13] Minnesota Department of Health. (2024, Nov 24). Minnesota Student Survey Data. https://www.health.state.mn.us/data/mchs/surveys/mss/index.html