OBJECTIVES: To estimate the proportions of US infants who were breastfed exclusively for 6 months, according to characteristics of the mother, child, and household environment, and to compare associations between those characteristics and exclusive breastfeeding with associations between those characteristics and breastfeeding initiation. METHODS: Data were obtained from the 2007 National Survey of Children's Health, a nationally representative, cross-sectional survey. Multivariate logistic regression was used to calculate the adjusted odds ratios for breastfeeding among all infants and for breastfeeding exclusively for 6 months among infants who had initiated breastfeeding. All analyses were limited to children aged 6 months through 5 years for whom breastfeeding data were available (N = 25 197). RESULTS: Of the nearly 75% of children in the study who had ever been breastfed, 16.8% had been breastfed exclusively for 6 months. Non-Hispanic black children were significantly less likely to have ever been breastfed compared with their non-Hispanic white counterparts (adjusted odds ratio: 0.54 [95% confidence interval: 0.44–0.66]). However, no significant differences in the odds of exclusive breastfeeding according to race were observed. Children with birth weights of <1500 g were most likely to have ever been breastfed and least likely to have been breastfed exclusively. Maternal age was significantly associated with exclusive breastfeeding; however, maternal age was not associated with breastfeeding initiation. CONCLUSIONS: In the United States, the prevalence of exclusive breastfeeding for 6 months remains low among those who initiate breastfeeding. Factors associated with breastfeeding exclusively for 6 months differ from those associated with breastfeeding initiation.

OBJECTIVE: The medical home concept encompasses the elements of pediatric care considered essential for all children. We describe here the characteristics of children with medical homes and the relationship between presence of a medical home and selected health care outcomes by using new data from the 2007 National Survey of Children's Health (NSCH). METHODS: We used a medical home measure comprising 5 components: having a usual source of care; having a personal physician or nurse; receiving all needed referrals for specialty care; receiving help as needed in coordinating health and health-related care; and receiving family-centered care. A total of 83 448 children aged 1 to 17 years had valid data for all applicable medical home components. The NSCH is a random-digit-dial population-based telephone survey. RESULTS: In 2007, 56.9% of US children aged 1 to 17 years received care in medical homes. Younger children were more likely to have a medical home than their older counterparts. Substantial racial/ethnic, socioeconomic, and health-related disparities were present. Children who received care in medical homes were less likely to have unmet medical and dental needs and were more likely to have annual preventive medical visits. CONCLUSIONS: Approximately half of the children in the United States have access to all components of a pediatric medical home. Because the medical home is increasingly promoted as the standard for provision of high-quality comprehensive health care, these findings reinforce the need to continue and expand federal, state, and community efforts to ensure that all children have access to this model of care.

Introduction Since 2001, the Health Resources and Services Administration's Maternal and Child Health Bureau (HRSA MCHB) has funded and directed the National Survey of Children's Health (NSCH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN), unique sources of national and state-level data on child health and health care. Between 2012 and 2015, HRSA MCHB redesigned the surveys, combining content into a single survey, and shifting from a periodic interviewer-assisted telephone survey to an annual self-administered web/paper-based survey utilizing an address-based sampling frame. Methods The U.S. Census Bureau fielded the redesigned NSCH using a random sample of addresses drawn from the Census Master Address File, supplemented with a unique administrative flag to identify households most likely to include children. Data were collected June 2016-February 2017 using a multi-mode design, encouraging web-based responses while allowing for paper mail-in responses. A parent/caregiver knowledgeable about the child's health completed an age-appropriate questionnaire. Experiments on incentives, branding, and contact strategies were conducted. Results Data were released in September 2017. The final sample size was 50,212 children; the overall weighted response rate was 40.7%. Comparison of 2016 estimates to those from previous survey iterations are not appropriate due to sampling and mode changes. Discussion The NSCH remains an invaluable data source for key measures of child health and attendant health care system, family, and community factors. The redesigned survey extended the utility of this resource while seeking a balance between previous strengths and innovations now possible.

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To provide a national, population-based assessment of the quality of the health care system for children and youth with special health care needs using a framework of six health care system quality indicators. 49,242 interviews with parents of children with special health care needs from the 2009–10 National Survey of Children with Special Health Care Needs (NS-CSHCN) were examined to determine the extent to which CSHCN had access to six quality indicators of a well-functioning system of services. Criteria for determining access to each indicator were established and applied to the survey data to estimate the proportion of CSHCN meeting each quality indicator by socio-demographic status and functional limitations. 17.6 % of CSHCN received care consistent with all six quality indicators. Results for each component of the system quality framework ranged from a high of 70.3 % of parents reporting that they shared decision-making with healthcare providers to a low of 40 % of parents reporting receipt of services needed for transition to adult health care. Attainment rates were lower for CSHCN of minority racial and ethnic groups, those residing in households where English was not the primary language, those in lower income households, and those most impacted by their health condition. Only a small proportion of CSHCN receive all identified attributes of a high-quality system of services. Moreover, significant disparities exist whereby those most impacted by their conditions and those in traditionally disadvantaged groups are served least well by the current system. A small proportion of CSHCN appear to remain essentially outside of the system, having met few if any of the elements studied.

Objective Children with special health care needs (CSHCN) are at risk for decreased participation which can negatively impact their lives. The objectives of this study were to document the presence of participation restrictions for CSHCN compared to other children and to determine how personal and environmental factors are associated with participation restrictions for CSHCN. Methods The 2007 National Survey of Children’s Health (NSCH) was analyzed to evaluate two participation outcomes for children aged 6–17 years: school attendance and participation in organized activities, and two participation outcomes for children aged 12–17 years: working for pay and volunteering. Adjusted prevalences of participation restrictions were calculated for children with and without special health care needs. Logistic regression was used to identify factors independently associated with participation restrictions for CSHCN. Results After adjustment for sociodemographic characteristics, a larger proportion of CSHCN (27.9%) reported missing more than 5 days of school than other children (15.1%). In contrast, no differences were found for participation in organized activities, working for pay or volunteering. CSHCN with functional limitations were more likely to experience all four types of participation restrictions compared to other CSHCN and non-CSHCN. For CSHCN, the odds of certain participation restrictions were higher for those with functional limitations, in fair/poor health, with depressed mood, living at or near the federal poverty level and living in homes not headed by two parents. Conclusions CSHCN with functional limitations and those with worse health status are at elevated risk of experiencing participation restrictions than other children. Social disadvantage furthers the likelihood that CSHCN will experience participation restrictions.

A recently proposed modal-based method that captures the geometric nonlinear effects in the regime of large deformations is applied to the modeling of University of Michigan's X-HALE UAV. The method is an extension of the classical modal approach towards large geometric deflections and uses higher-order stiffness terms and mode components to account for nonlinear force-displacement relationships and geometrically nonlinear displacement fields. In this paper, the method is further extended to enable rigid body motions of an aircraft in free flight. The verification of this extension is done using the X-HALE model which is considered as a challenging test case due to pronounced nonlinearities in steady and unsteady flight conditions. A structural and an aerodynamic model of the X-HALE UAV were built and aeroelastic simulations of the model were done and validated with UM/NAST results.

IntroductionColorectal cancer screening rates have increased significantly in Kentucky, from 35% in 1999 to 66% in 2012. A continued improvement in screening requires identification of existing barriers and implementation of interventions to address barriers.MethodsThe state of Kentucky added a question to the 2012 Kentucky Behavioral Risk Factor Surveillance System survey for respondents aged 50 years or older who answered no to ever having been screened for colorectal cancer by colonoscopy or sigmoidoscopy to assess the reasons why respondents had not been screened. Combined responses constituted 4 categories: attitudes and beliefs, health care provider and health care systems barriers, cost, and other. Prevalence estimates for barriers were calculated by using raking weights and were stratified by race/ethnicity, sex, education, income, and health insurance coverage. Logistic regression estimated odds ratios for barriers to screening.ResultsThe most common barriers in all areas were related to attitudes and beliefs, followed by health care provider and systems, and cost. Non-Hispanic whites and respondents with more than a high school education were more likely to choose attitudes and beliefs as a barrier than were non-Hispanic blacks and those with less than a high school education. Respondents with low incomes and with no insurance were significantly more likely to select cost as a barrier. No significant associations were observed between demographic variables and the selection of a health care provider and a health care system.ConclusionBarriers related to education, race/ethnicity, income, and insurance coverage should be considered when designing interventions. Expansion of Medicaid and implementation of the Affordable Care Act in Kentucky could have an impact on reducing these barriers.