The Child and Adolescent Thriving Index 1.0: Developing a Measure of the Outcome Indicators of Well-Being for Population Health Assessment

Abstract

The well-being of children and adolescents is emerging as an area of interest for population health measurement. Previous approaches assessing national and state trends in well-being have relied on composite indices. However, these methodologies suffer from several weaknesses. This paper develops an improved index for the United States that is measurable with existing population-data resources. It derives the appropriate weights for items in this index using a longitudinal panel of 2,942 children in the Panel Study of Income Dynamics. Candidate component measures are selected for the index based on their demonstrated association with several subjective scales assessed during young adulthood. The final index demonstrates that a broad range of measures indicate higher levels of population-level well-being. The predictive validity of the index for outcomes during young adulthood is also assessed: a one-standard-deviation increase in the index score is associated with a 7.9-percentage-point decrease [95% CI: 5.9 – 9.8] in ever reporting fair or poor health, a 6.3-percentage-point decrease [95% CI: 4.6 – 8.0] in ever reporting depression, and a 17.2% [95% CI: 13.7% – 20.5%] increase in peak earnings. These values for predictive validity are slightly higher than those of existing methodologies. We also find that incorporating contextual indicators from childhood and adolescence does not substantively improve predictive validity. Policy-makers and government agencies interested in population-level well-being of children and adolescents can continue to use existing indices as reasonable proxies, but should also commit to upgrading data systems to make them more child-centric in the future.

Trends in Measures of Child and Adolescent Well-being in the US From 2000 to 2019

“…More information about the Child and Adolescent Thriving Index 1.0 can be found in previously published work. 25 Within the panel, the index shows strong predictive validity with future health and economic outcomes and performs similarly to a version of the KIDS COUNT index.…”

“…The resulting index more accurately proxies the latent construct of well-being while still relying on indicators already collected in population-level data sources. More information about the Child and Adolescent Thriving Index 1.0 can be found in previously published work . Within the panel, the index shows strong predictive validity with future health and economic outcomes and performs similarly to a version of the KIDS COUNT index.…”

“…The choice of component measures for a composite index required some subjective decisions even when assisted with a data-driven process. For example, we did not directly include measures of mental health or subjective well-being as components because doing so would place those measures on both the left and right sides of a regression in the original method analysis . The approach we used assumed that these constructs should be well reflected by the weights assigned to the objective components through those models, but they were still imperfect proxies at best.…”

“…We calculated the value of each component (z) for each geographic or racial and ethnic group (i) in each year (t) as the proportion of the population with the favorable outcome. Each component had a corresponding weight (W), which was identified through a data-driven process in a previous article 25 (eTable 9 in the Supplement). We summed the weighted component scores for a given geographic location or race and ethnicity in a single year.…”

“…For example, we did not directly include measures of mental health or subjective well-being as components because doing so would place those measures on both the left and right sides of a regression in the original method analysis. 25 The approach we used assumed that these constructs should be well reflected by the weights assigned to the objective components through those models, but they were still imperfect proxies at best. Other objective measures that may be important to well-being, such as immunization rates, bullying, socioemotional health, and relationship quality, were not included because estimates were unavailable at the national and/or state levels or they were not collected in the original study used to derive the index methods.…”