Appendix A: Data Source Descriptions

Air Quality System

The Air Quality System (AQS) contains ambient air pollution data collected by the U.S. Environmental Protection Agency (EPA) and by state, local, and tribal air pollution control agencies. Data on criteria pollutants (particulate matter, ozone, carbon monoxide, nitrogen dioxide, sulfur dioxide, and lead) consist of air quality measurements collected by sensitive equipment at thousands of monitoring stations in all 50 states, plus the District of Columbia, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands. Each monitor measures the concentration of a particular pollutant in the air. Monitoring data indicate the average pollutant concentration during a specified time interval, usually 1 hour or 24 hours. The AQS also contains meteorological data, descriptive information about each monitoring station (including its geographic location and operator), and data quality assurance/quality control information. Data are available from AQS dating back to 1957. The system is administered by the EPA's Office of Air Quality Planning and Standards, Outreach and Information Division, in Research Triangle Park, North Carolina.

For the Outdoor Air Quality indicator, a county is considered to have a pollutant concentration above the level of the current Primary National Ambient Air Quality Standard (NAAQS) if the measured pollutant level was greater than the level of the standard at any monitor within the county during the year. The indicator is calculated as the sum of children living in counties with pollutant concentrations above the level of a standard divided by the total number of children in the United States. This calculation differs from the method for identifying areas in violation of an air quality standard. See America's Children and the Environment at https://www.epa.gov/ace (Indicator E1) for further discussion.

Information about AQS is available online at https://www.epa.gov/aqs
Agency Contacts:
Luke Kaufman
U.S. Environmental Protection Agency
Phone: 919-541-5771
Email: kaufman.luke@epa.gov
Kristen Foley
U.S. Environmental Protection Agency
Phone: 919-541-5367
Email: foley.kristen@epa.gov

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American Housing Survey

The American Housing Survey (AHS) is sponsored by the U.S. Department of Housing and Urban Development's Office of Policy Development and Research and is conducted by the U.S. Census Bureau. The survey provides data necessary for evaluating progress toward "a decent home and a suitable living environment for every American family," a goal affirmed in 1949 and 1968 legislation. The AHS began as an annual survey in 1973 and has been conducted biennially in odd-numbered years since 1985. A longitudinal nationally representative sample of 60,000 housing units plus newly constructed units was surveyed during the period of 1985 to 2013, and a new sample was drawn in 2015. Transient accommodations, military and worker housing, and institutional quarters are excluded. AHS data detail the types, size, conditions, characteristics, costs and values, equipment, utilities, and dynamics of the housing inventory; they also provide some information about neighborhood conditions. Data include demographic, financial, and mobility characteristics of the occupants. Since 1997, the AHS has been conducted using computer-assisted personal interviewing.

Information about the AHS is available online at https://www.census.gov/programs-surveys/ahs.html.

Agency Contact:
George R. Carter III
Office of Policy Development and Research
U.S. Department of Housing and Urban Development
Phone: 202-402-5873
Email: George.R.Carter@hud.gov

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Current Population Survey

The Current Population Survey (CPS) is a nationwide survey conducted monthly for the U.S. Bureau of Labor Statistics by the U.S. Census Bureau. The survey is representative of the civilian noninstitutionalized population of the United States with a sample located in more than 2,000 counties and independent cities and coverage in every state and the District of Columbia.

The CPS sample is selected from a complete address list of geographically delineated primary sampling units, which are based on census addresses and updated using recent construction and other data. It is administered through field representatives, either in person or by telephone using computer-assisted personal interviewing (CAPI). Some CPS data also are collected through a centralized telephone operation called computer-assisted telephone interviewing (CATI). For more information about the CPS, its sampling structure, and estimation methodology, see https://www2.census.gov/programs-surveys/cps/methodology/CPS-Tech-Paper-77.pdf.

Core Survey

The CPS core survey, administered to about 60,000 households each month, is the primary source of information on employment and unemployment characteristics of the civilian noninstitutionalized population, released every month by the U.S. Bureau of Labor Statistics.

Annual Social and Economic Supplement (ASEC)

Administered since 1947, ASEC (formerly called the March Supplement) provides information that can be used to estimate the status and well-being of children.

The 2014 CPS ASEC (which refers to health insurance coverage estimates of the 2013 calendar year) is the first to use the improved measures of health insurance coverage. Following more than a decade of research, evaluation, and consultation with outside experts, the U.S. Census Bureau implemented an approach shown to improve the accuracy of health insurance coverage measurement. For a list of references, please see the U.S. Census Bureau director's statement on the improved set of health insurance coverage questions at https://www.census.gov/newsroom/archives/2014-pr/cb14-67.html. Due to these changes, data for the 2014 CPS ASEC are not comparable with data from earlier years.

The 2014 CPS ASEC included redesigned questions for income and health insurance coverage. All of the approximately 98,000 addresses were selected to receive the improved set of health insurance coverage items. The improved income questions were implemented using a split panel design. Approximately 68,000 addresses were selected to receive a set of income questions similar to those used in the 2013 CPS ASEC. The remaining 30,000 addresses were selected to receive the redesigned income questions. The source of data for tables in this volume is the CPS ASEC sample of 98,000 addresses.

There was an implementation of an updated processing system for the 2018 CPS ASEC. For more information, see technical documentation at https://www2.census.gov/programs-surveys/demo/datasets/income-poverty/time-series/data-extracts/2018/cps-asec-bridge-file/2018-asec-bridge-file-documentation.pdf and information on the updated processing system at https://www.census.gov/data/datasets/time-series/demo/income-poverty/cps-asec-design.html. Due to these changes, data for the 2018 CPS ASEC are not comparable with data from earlier years.

School Enrollment Supplement

The School Enrollment Supplement, which has also been administered since 1947, asks questions on school enrollment by grade and other school characteristics about each member of the household age 3 or over.

Food Security Supplement

Introduced in April 1995 and administered in December since 2001, the food security supplement contains a systematic set of questions validated as measures of the severity of food insecurity on a 12-month and a 30-day basis. Statistics presented in this report are based on 12-month data from the Food Security Supplement. The food security questions are based on material reported in prior research on hunger and food security and reflect the consensus of nearly 100 experts at the 1994 Food Security and Measurement Conference, convened jointly by the National Center for Health Statistics and the Food and Nutrition Service of the U.S. Department of Agriculture. The supplement was developed, tested, and refined further by the conferees, members of a Federal interagency working group, and survey methods specialists for the U.S. Census Bureau's Center for Survey Methods Research. All households interviewed in the CPS in December are eligible for the supplement. Special supplement sample weights were computed to adjust for the demographic characteristics of supplement noninterviews.

Information about food security is available online at https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/.

Information about the CPS is available online at https://www.census.gov/cps.

Agency Contacts:
Food Security
Laura J. Hales
Economic Research Service
U.S. Department of Agriculture
Phone: 816-412-7441
Email: laura.hales@usda.gov
Secure Parental Employment and Youth Neither Enrolled in School nor Working
Connor Borkowski
U.S. Bureau of Labor Statistics
Phone: 202-691-5334
Email: borkowski.connor@bls.gov

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Monitoring the Future

The Monitoring the Future (MTF) study is a continuing series of nationally representative surveys intended to assess the changing lifestyles, values, and preferences of American youth. Each year since 1975, high school seniors from a sample of public and private high schools have participated in this study. The 2024 survey is the 50th consecutive national survey of 12th-grade students and the 34th national survey of 8th- and 10th-grade students (who were added to the study in 1991). The study is conducted by the University of Michigan's Institute for Social Research under a grant from the National Institute on Drug Abuse. All grades are sampled independently, with no school representing more than one grade. The survey design currently uses a two-stage stratified random sampling procedure, where the stages include selection of schools randomly drawn from 70 grade-specific strata, and a sample of students in the target grade within each selected school. Data are collected in the spring of each year using questionnaires administered in the classroom by representatives from the University of Michigan's Survey Research Center. The 2024 survey included a total of 24,257 students from 272 schools nationwide.

In 2020, data collection was halted earlier than usual due to the COVID-19 pandemic and subsequent stay-at-home orders. This resulted in smaller samples being obtained that year, but analyses show that these samples were nationally representative.

For more information, please see the following:

Information about MTF is available online at https://www.nida.nih.gov/DrugPages/MTF.html and https://monitoringthefuture.org.

Agency Contact:
Jessica Cotto
National Institute on Drug Abuse
Phone: 301-480-2816
Email: jessicacotto@nih.gov

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National Child Abuse and Neglect Data System

The National Child Abuse and Neglect Data System (NCANDS) annually collects case-level data on reports alleging child abuse and neglect, as well as the results of these reports, from state child protective services agencies. The mandate for NCANDS is based on the Child Abuse Prevention and Treatment Act (CAPTA), as amended in 1988, which directed the Secretary of the Department of Health and Human Services (HHS) to establish a national data collection and analysis program that would make available state child abuse and neglect reporting information. HHS responded by establishing NCANDS as a voluntary national reporting system. In 1992, HHS produced its first NCANDS report based on data from 1990. The annual data report Child Maltreatment evolved from that initial report.

Every year, NCANDS data are submitted voluntarily by the 50 states, the District of Columbia, and the Commonwealth of Puerto Rico. The NCANDS reporting year is based on the Federal fiscal year calendar that spans October 1 to September 30. States submit case-level data, referred to as a Child File, by creating an electronic file of child-specific records for each report of alleged child abuse and neglect that receives a Child Protective Services (CPS) response, in the form of an investigation or alternative response. Case-level data include information about the characteristics of the reports of abuse and neglect, the children involved, the types of maltreatment, the CPS findings, the risk factors of the child and the caregivers, the services provided, and the perpetrators.

The Child File is supplemented by agency-level aggregate statistics in a separate data submission called the Agency File. The Agency File contains data that are not reportable at the child-specific level and are often gathered from agencies external to CPS. Information collected in the Agency File includes receipt of prevention and postresponse services and caseload and workforce data. States are asked to submit both the Child File and the Agency File each year.

CAPTA (42 U.S.C. §5106a), as amended by the CAPTA Reauthorization Act of 2010 (P.L.111–320), retained the existing definition of child abuse and neglect as, at a minimum:

Any recent act or failure to act on the part of a parent or caretaker that results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act, which presents an imminent risk of serious harm.

Each state defines the types of child abuse and neglect in state statute and policy. CPS agencies determine the appropriate response for the alleged maltreatment based on those statutes and policies. The most common response is an investigation. The result of an investigation response is a determination (also known as a disposition) about the alleged child maltreatment.

In NCANDS, a victim is defined as a child for whom the state determined at least one maltreatment was substantiated or indicated and for whom a disposition of substantiated or indicated was assigned. It is important to note that a child may be a victim in one report and a nonvictim in another report. "Substantiation" is a case determination that concludes that the allegation of maltreatment or risk of maltreatment is supported by state law or policy. "Indicated" is a case determination that concludes that although maltreatment cannot be substantiated by state law or policy, there is reason to suspect that the child may have been maltreated or was at risk of maltreatment.

State statutes also establish the level of evidence needed to determine a disposition of substantiated or indicated. The local CPS agencies respond to the safety needs of the children who are the subjects of child maltreatment reports based on these state definitions and requirements for levels of evidence.

NCANDS data are a critical source of information for many publications, reports, child welfare personnel, researchers, and others. NCANDS data are used as a performance measure in several Federal programs.

NCANDS data also are used for the annual Child Maltreatment report series. Each report summarizes the major national and state-by-state findings for the given fiscal year and is a key resource for thousands of people and organizations across the world. The Children's Bureau has published an annual Child Maltreatment report since 1992. Reports are available on the Children's Bureau website at https://www.acf.hhs.gov/cb/data-research/child-maltreatment.

Rates are based on the number of states submitting data to NCANDS each year; states include the District of Columbia and the Commonwealth of Puerto Rico. Information about NCANDS is available online at https://acf.gov/cb/research-data-technology/reporting-systems/ncands.

Agency Contact:
Cara Kelly, PhD
Administration on Children, Youth, and Families
Administration for Children and Families
Email: cara.kelly@acf.hhs.gov

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National Crime Victimization Survey

The National Crime Victimization Survey (NCVS) is the nation's primary source of information on criminal victimization. The NCVS is sponsored by the Bureau of Justice Statistics, and data are collected by the U.S. Census Bureau. The NCVS collects information on nonfatal victimizations, reported and not reported to the police, against persons age 12 or over from a nationally representative sample of U.S. households. Sample households are chosen using a multistage stratified sample design. All household members age 12 and over in selected households are interviewed to obtain information on the frequency, characteristics, and consequences of criminal victimization in the United States.

In 2023, there were 142,028 household interviews. Overall, 63% of eligible households completed an interview. Within participating households, 226,480 persons completed an interview in 2023, representing an 82% response rate among eligible persons from responding households.

The survey collects information on nonfatal personal crimes (rape or sexual assault, robbery, aggravated assault, simple assault, and personal larceny [purse snatching and pocket picking]) and household property crimes (burglary or trespassing, motor vehicle theft, and other types of theft). Survey respondents provide information about themselves, such as age, sex, race, Hispanic origin, and household income, and whether they experienced a victimization. Victims are also asked whether they reported the incident to the police.

In instances of personal violent crimes, victims are asked about the characteristics of the perpetrator.

In addition to providing annual-level and change estimates on criminal victimization, the NCVS is the primary source of information on the nature of criminal victimization incidents.

It has been ongoing since 1973 and was redesigned in 1992.

Due to changes in survey methodology in 2006, national-level estimates were not comparable with estimates based on NCVS data from previous years. See Criminal Victimization, 2006 (https://bjs.ojp.gov/library/publications/criminal-victimization-2006) for more information on the redesigned methodology. In 2016, the NCVS sample was redesigned, and 2016 estimates among youth are not comparable with estimates from other years.

The 2020 NCVS weights include an additional adjustment to address the impact of modified Census Bureau field operations due to the COVID-19 pandemic. For more information on the weighting adjustments applied in 2020, see the Source and Accuracy Statement for the 2020 National Crime Victimization Survey in the NCVS 2020 Codebook (https://www.icpsr.umich.edu/web/NACJD/studies/38090/summary) and Criminal Victimization, 2020 (https://bjs.ojp.gov/sites/g/files/xyckuh236/files/media/document/cv20.pdf).

Information about the NCVS is available online at https://bjs.ojp.gov/programs/ncvs.

Agency Contact:
Erin Tinney, PhD
Bureau of Justice Statistics
Phone: 202-307-0765
Email: erin.tinney@usdoj.gov

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National Health and Nutrition Examination Survey

The National Health and Nutrition Examination Survey (NHANES) is a major program of the National Center for Health Statistics (NCHS). NHANES is designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and health examinations. The NHANES interview includes demographic, socioeconomic, dietary, and health questions. The examination component consists of medical, dental, and physiological measurements, as well as laboratory tests administered by highly trained medical personnel. Findings from this survey are used to determine the prevalence of major diseases and risk factors for diseases among the civilian noninstitutionalized population of the United States and serve as the basis for national standards for such measurements as body mass index and blood pressure.

The NHANES program began in the early 1960s and has been conducted as a series of surveys focusing on different population groups or health topics. In 1999, the survey became a continuous program that, in addition to a core focus on major chronic health conditions and nutrition, has flexible content to meet emerging public health concerns. Each year, the survey examines a nationally representative sample of about 5,000 persons located in 15 counties across the country. Health interviews are conducted in respondents' homes. Health measurements are performed in specially designed and equipped mobile centers, which travel to the selected 15 counties during each survey year. The study team consists of medical and health technicians as well as dietary and health interviewers. Data collection is conducted with notebook computers. Survey information is available to NCHS staff within 24 hours of collection, which enhances quality assessment and increases the speed with which data are released to the public.

Since 1999, the sample design has consisted of multiyear stratified and clustered four-stage samples, with public-use data released in 2-year cycles. In March 2020, the 2019–2020 data collection was interrupted due to the COVID-19 pandemic. As a result, data collection for the 2019–2020 cycle was not completed, and the data collected for that period were not nationally representative. To create a nationally representative sample, the partial 2019–March 2020 data were combined with the full dataset from the previous cycle (2017–2018). The resulting files are referred to as the 2017–March 2020 prepandemic files. NHANES returned to the field in August 2021 with a 2-year sample design similar to past cycles, except that there was no oversampling by race and Hispanic origin and income. The August 2021–August 2023 cycle sampled 6,736 children and adolescents ages 1–19; interviewers collected information for 3,935 children and adolescents and completed 2,663 examinations. For children and adolescents, the unweighted response rates for interviews and examinations were 38.3% and 25.9%, respectively.

Starting with data updates for America's Children, 2017, the reliability of survey percentage estimates is assessed using the Clopper–Pearson confidence interval, which was adapted for complex surveys by Korn–Graubard, to determine if the estimate is unreliable and should be suppressed. This method has been applied to all NHANES estimates. The reliability of prior estimates for other indicators are evaluated based on relative standard error.

For more information about the survey methodology, see the following:

Information about NHANES is available online at https://www.cdc.gov/nhanes.

Agency Contact:
Lara Akinbami
National Center for Health Statistics
Phone: 301-458-4306
Email: lakinbami@cdc.gov

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National Health Interview Survey

The National Health Interview Survey (NHIS) is conducted by the National Center for Health Statistics (NCHS). NHIS monitors the health of the U.S. population by collecting and analyzing data on a broad range of topics. NHIS is a continuing nationwide sample survey of the civilian noninstitutionalized population in the United States, excluding patients in long-term care facilities, persons on active duty with the Armed Forces, prisoners, and U.S. nationals living in foreign countries. Data are collected through personal household interviews by trained interviewers. Before 1997, a paper-and-pencil questionnaire format was used. From 1997 onward, computer-assisted personal interviewing (CAPI) was used. Interviewers obtain information on personal and demographic characteristics, including race and ethnicity, through self-reports or reports by a member of the household. Interviewers also collect data on illnesses, injuries, impairments, chronic conditions, disability, utilization of health services, and other health topics. Each year, the survey is reviewed, and special topics are added or deleted. For most health topics, the survey collects data for an entire year.

The NHIS sample is designed to estimate the national prevalence of health conditions, health service utilization, and health behaviors of the civilian noninstitutionalized population of the United States. From 2006 to 2015, it included an oversample of Asian, Black, and Hispanic persons; a new sample design was introduced in 2016, and Asian, Black, and Hispanic people are no longer oversampled. The NHIS core questionnaire items are revised every 10 to 15 years. The sample for the NHIS is redesigned and redrawn about every 10 years to better measure the changing U.S. population and to meet new survey objectives.

In 2019, the NHIS questionnaire was redesigned to better meet the needs of data users, the Centers for Disease Control and Prevention, and the Department of Health and Human Services. Starting with the 2019 survey, the NHIS annual data release only includes the Sample Adult, Sample Child, Imputed Income, and Paradata files. Household, family, and person data files are no longer released. Starting with the 2019 survey, an interviewed household is defined as one where the household roster and a substantial portion of either the Sample Adult interview or the Sample Child interview is completed. Previous survey cycles defined an interviewed household as one where at least one family in the household completed a substantial portion of the family interview. Due to changes in weighting and design methodology, direct comparisons between estimates before 2019 and estimates from 2019 onward should be made with caution, as the impact of these changes has not been fully evaluated at this time.

In 2022, 7,464 children under age 18 were sampled from 8,879 eligible households for a response rate of 45.8%. In 2023, 7,692 children under age 18 were sampled from 9,202 eligible households for a response rate of 44.9%.

Starting with data updates for America's Children, 2017, the reliability of survey percentage estimates is assessed using the Clopper–Pearson confidence interval, which was adapted for complex surveys by Korn–Graubard, to determine if the estimate is unreliable and should be suppressed. This method has been applied to all NHIS estimates. The reliability of prior estimates for other indicators are evaluated based on relative standard error.

For more information about the survey methodology, see the following:

Information about NHIS is available online at https://www.cdc.gov/nchs/nhis.htm.

Summary health data for children are available online at https://www.cdc.gov/nchs/nhis/products/data-query-systems.html.

Agency Contacts:
Health Insurance and Access to Care
Robin A. Cohen
National Center for Health Statistics
Phone: 30-458-4152
Email: rcohen@cdc.gov
Disability
Julie Weeks
National Center for Health Statistics
Phone: 301-458-4562
Email: jweeks@cdc.gov
Asthma
Lara Akinbami
National Center for Health Statistics
Phone: 301-458-4306
Email: lakinbami@cdc.gov

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National Hospital Ambulatory Medical Care Survey

The National Hospital Ambulatory Medical Care Survey (NHAMCS) Emergency Department (ED) Component was conducted by the National Center for Health Statistics. NHAMCS-ED collected data on ambulatory care visits to hospital emergency departments. Data were abstracted or electronically extracted from medical records by U.S. Census Bureau field representatives. Patient characteristics collected included age, sex, race, ethnicity, and expected source of payment. Visit characteristics collected included reasons for visit, diagnoses, tests and procedures, medications, providers seen, and disposition. Data were also collected on selected hospital characteristics, such as trauma level and electronic health record capabilities. Annual data collection began in 1992 and ended in 2022.

The survey was a nationally representative sample of in-person visits to EDs in non-Federal, short-stay, and general hospitals. NHAMCS used a four-stage probability sample design, involving samples of geographic primary sampling units (PSUs); hospitals within PSUs; EDs; and patient visits to EDs.

The hospital sample consisted of almost 500 hospitals. In 2021, 16,207 ED patient record forms were completed, and the ED hospital response rate was 89.4%. In 2022, 16,025 ED patient record forms were completed, and the ED hospital response rate was 82.6%.

For background information, see https://www.cdc.gov/nchs/data/series/sr_01/sr01_034acc.pdf.

Information about NHAMCS is available on the National Hospital Ambulatory Medical Care Survey website at https://www.cdc.gov/nchs/nhamcs/about/index.html.

Agency Contact:
Julie Weeks
National Center for Health Statistics
Phone: 301-458-4562
Email: jweeks@cdc.gov

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National Immunization Surveys

The National Immunization Surveys (NIS) are a family of telephone surveys used to monitor vaccination coverage among children ages 19–35 months (NIS-Child), adolescents ages 13–17 years (NIS-Teen), and influenza vaccination coverage among children/adolescents ages 6 months to 17 years (NIS-Flu). Data collection for NIS-Child began in April 1994 to assess vaccination coverage after measles outbreaks in the early 1990s. Similar to the NIS-Child, the NIS-Teen was launched in 2006. The NIS-Flu was added during the 2009–2010 flu season.

The NIS provide population-based, state, selected local area, and territorial estimates of vaccination coverage among children and adolescents using a standard survey methodology. The surveys collect data through telephone interviews with parents or guardians in all 50 states, the District of Columbia, and some cities or counties and U.S. territories. Cell phone numbers are randomly selected and called to identify one or more age-eligible children or adolescents from the household. The parents and guardians of eligible children for NIS-Child and adolescents for NIS-Teen are asked during the interview for the names of their children's or teen's vaccination providers and permission to contact them. With this permission, a questionnaire is mailed to each child's vaccination provider(s) to collect the information on the types of vaccinations, number of doses, dates of administration, and other administrative data about the health care facility. Estimates of vaccination coverage are determined for vaccinations recommended by the CDC. Children and adolescents are classified as being up to date based on the CDC-recommended numbers of doses for each vaccine. All vaccination coverage estimates are based on provider-reported vaccination history.

Information about the NIS is available online at https://www.cdc.gov/nis/about/index.html.

Agency Contact:
Laurie D. Elam-Evans, PhD, MPH
Centers for Disease Control and Prevention
Phone: 404-718-4838
Email: LXE1@cdc.gov

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National Survey of Children's Health (NSCH)

The National Survey of Children's Health (NSCH) is a household survey that produces national and state-level data on the physical and emotional health and well-being of children ages 0–17 in the United States. The survey collects information on topics like access to and use of health care; family interactions; parental health; school and after-school experiences; and neighborhood characteristics. The NSCH is the only national and state-level survey on the health and well-being of children, their families, and their communities.

Information about the NSCH is available online at https://mchb.hrsa.gov/data-research/national-survey-childrens-health.

Agency Contact:
Reem Ghandour, DrPH, MPA
Maternal and Child Health Bureau
Health Resources and Services Administration
Email: rghandour@hrsa.gov

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National Vital Statistics System—Linked Birth/Infant Death Data Set

The National Center for Health Statistics' National Vital Statistics System collects and publishes data on births and deaths in the United States. The period-linked data set of the Linked Birth/Infant Death Data Set is used to produce the statistics presented in this report. In the period-linked data set, the numerator consists of all infant deaths occurring in a given year linked to their corresponding birth certificates from that calendar year or the previous year. The linked file includes all the variables in the national natality file, as well as medical information reported for the same infant on the death record and the age of the infant at death. The infant's race and Hispanic origin are classified based on the race and Hispanic origin of the mother reported on the birth certificate. This is preferred over race and Hispanic origin on the death certificate because information on the birth certificate is usually provided by the parents, while information on the death certificate may be completed by a third party (like the coroner or physician). Linked files are available starting with the birth cohort of 1983. Linked files were not produced for the 1992–1994 data years.

Race Reporting

The 2003 revision of the U.S. Standard Certificate of Live Birth uses revised race and ethnicity sections conforming to the 1997 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. The 2003 revision permits reporting of more than one race (multiple races). In 2003, states began adopting this new certificate on a rolling basis. Starting with the 2017 linked data set, single-race data are available for all 50 states and the District of Columbia. For data before 2017, bridged-race categories were presented to provide uniformity and comparability of data over time. Therefore, data for race groups for 2017 onward are not comparable with earlier data. The bridged population estimates can be found online at https://www.cdc.gov/nchs/nvss/bridged_race.htm.

For more information, see the following:

  • Ely, D. M., & Driscoll, A. K. (2025). Infant mortality in the United States, 2023: Data from the period linked birth/infant death file. National Vital Statistics Reports, 74(7). National Center for Health Statistics. https://dx.doi.org/10.15620/cdc/174592

Information about the Linked Birth/Infant Death file is available online at https://www.cdc.gov/nchs/nvss/linked-birth.htm.
Agency contact:
Joyce Martin
National Center for Health Statistics
Phone: 301-458-4362
Email: jamartin@cdc.gov

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National Vital Statistics System—Mortality

The National Center for Health Statistics' (NCHS's) National Vital Statistics System (NVSS) collects and publishes data on deaths in the United States. NCHS obtains information on deaths from the registration offices of all states, New York City, and the District of Columbia. Funeral directors and family members provide demographic information on death certificates. Medical certification of cause of death is provided by a physician, medical examiner, or coroner.

Cause of Death

For 1980–1998, cause of death is classified according to the International Classification of Diseases (ICD), 9th Revision. For 1999 onward, cause of death is classified according to the ICD, 10th Revision. The following ICD codes are used in the America's Children report:

Cause of Death ICD-9 ICD-10
 
Birth defects 740–759 Q00–Q99
Cancer 140–208 C00–C97
COVID-19 . . . U07.1
Heart disease 390–398, 402, 404–429 I00–I09, I11, I13, I20–I51
Homicide E960–E969 *U01–*U02, X85–Y09, 87.1
Influenza and pneumonia 480–487 J09–J18
Injuries (intentional and unintentional) E800–E869, E880–E929, E950–E999 *U01–*U03, V01–Y36, Y85–Y87, Y89
Drowning E830.0–E830.9, E832.0–E832.9, E910.0–E910.9, E954, E964, E984 W65–74, X71, X92, Y21
Fall E880.0–E886.9, E888, E957.0–E957.9, E968.1, E987.0–E987.9 W00–W19, X80, Y01, Y30
Fire and burns E890–E899, E924.0–E924.9, E958.1, E958.2, E958.7, E961, E968.0, E968.3, E988.1, E988.2, 988.7 *U01.3, X00–X19, X76–77, X97–X98, Y26–Y27, Y36.3
Firearms E922, E955.0–E955.4, E965.0–E965.4, E970, E985.0–E985.4 *U01.4, W32–W34, X72–X74, X93–X95, Y22–Y24, Y35.0
Firearm homicide E965.0–E965.4 *U01.4, X93–X95
Firearm suicide E955.0–E955.4 X72–X74
Motor vehicle traffic E810–E825 V02–V04, V09.0, V09.2, V12–V14, V19.0–V19.2, V19.4–V19.6, V20–V79, V80.3–V80.5, V81.0–V81.1, V82.0–V82.1, V83–V86, V87.0–V87.8, V88.0–V88.8, V89.0, V89.2
Pedestrian (nontraffic) E800.2, E801.2, E802.2, E803.2, E804.2, E805.2, E806.2, E807.2, E820.7, E821.7, E822.7, E823.7, E824.7, E825.7, E826.0, E827.0, E828.0, E829.0 V01.0, V02.0, V03.0, V04.0, V05, V06, V09.0, V09.1, V09.3, V09.9
Suffocation E911–E913.9, E953.0–E953.9, E963, E983.0–E983.9 W75–W84, X70, X91, Y20
Suicide E950–E959 *U03, X60–X84, Y87.0
Unintentional injuries E800–E869, E880–E929 V01–X59, Y85–Y86

 

... Category not applicable.

Population Denominators and Race Reporting

Population denominators are based on Census data. The 2003 revision of the U.S. Standard Certificate of Death uses revised race and ethnicity sections conforming to the 1997 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. The 2003 revision permits reporting of more than one race (multiple races). In 2003, states began adopting this new certificate on a rolling basis. Starting with 2018 data, all 50 states and the District of Columbia have adopted the 2003 certificate. Prior to 2018 data, to provide uniformity and comparability of data for trend comparison, bridged race categories were presented. Therefore, data for race groups for 2018 and subsequent years are not comparable with earlier data. The bridged population estimates can be found online at https://www.cdc.gov/nchs/nvss/bridged_race.htm. Prior to America's Children, 2003, rates were based on populations estimated from the 1990 Census.

For more information about these methodologies, see:

For more information on national mortality data, see the following:

Information about NVSS deaths data is available online at https://www.cdc.gov/nchs/nvss/deaths.htm.
Agency Contacts:
Child Mortality
Donna Hoyert
National Center for Health Statistics
Phone: 301-458-4279
Email: dhoyert@cdc.gov
Adolescent Mortality
Julie Weeks
National Center for Health Statistics
Phone: 301-458-4562
Email: jweeks@cdc.gov

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National Vital Statistics System—Natality

The National Center for Health Statistics' (NCHS's) National Vital Statistics System (NVSS) collects and publishes data on births in the United States. NCHS obtains information from the registration offices of all states, New York City, and the District of Columbia. The birth certificate must be filed with the local registrar of the district in which the birth occurs. Each birth must be reported promptly; the reporting requirements vary from state to state, ranging from 24 hours to as many as 10 days after the birth. Demographic information on birth certificates, such as race and ethnicity, is provided by the mother at the time of birth. Hospital records provide the base for information on birthweight.

Population Denominators and Race Reporting

Population denominators are based on Census data. The 2003 revision of the U.S. Standard Certificate of Live Birth uses revised race and ethnicity sections conforming to the 1997 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity. The 2003 revision permits reporting of more than one race (multiple races). In 2003, states began adopting this new certificate on a rolling basis. Starting with 2016 data, all 50 states and the District of Columbia have adopted the 2003 certificate. For data before 2016, bridged-race categories were presented to provide uniformity and comparability of data over time. Therefore, data for race groups for 2016 onwards are not comparable with earlier data. The bridged population estimates can be found online at https://www.cdc.gov/nchs/nvss/bridged_race.htm. Prior to America's Children, 2003, rates were based on populations estimated from the 1990 Census.

For more information about these methodologies, see the following:

  • Hamilton, B. E., Sutton, P. D., & Ventura, S. J. (2003). Revised birth and fertility rates for the 1990s and new rates for Hispanic populations, 2000 and 2001: United States. National Vital Statistics Reports, 51(12). National Center for Health Statistics. https://www.cdc.gov/nchs/data/nvsr/nvsr51/nvsr51_12.pdf
  • Ingram, D. D., Weed, J. A., Parker, J. D., Hamilton, B. E., Schenker, N., Arias, E., & Madans, J. (2003). U.S. Census 2000 population with bridged race categories. Vital and Health Statistics, 2(135). National Center for Health Statistics. https://www.cdc.gov/nchs/nvss/bridged_race.htm
  • Matthews, T. J., & Hamilton, B. E. (2019). Total fertility rates by state and race and Hispanic origin: United States, 2017. National Vital Statistics Reports, 68(1). National Center for Health Statistics. https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_01-508.pdf
  • Ventura, S. J., Hamilton, B. E., & Sutton, P. D. (2003). Revised birth and fertility rates for the United States, 2000 and 2001. National Vital Statistics Reports, 51(4). National Center for Health Statistics. https://www.cdc.gov/nchs/data/nvsr/nvsr51/nvsr51_04.pdf

For more information on national natality data, see the following:

  • Osterman, M. J. K., Hamilton, B. E., Martin, J. A., Driscoll, A. K., & Valenzuela, C. P. (2024). Births: Final data for 2022. National Vital Statistics Reports, 73(2). National Center for Health Statistics. https://dx.doi.org/10.15620/cdc:145588

Information about NVSS births data is available online at https://www.cdc.gov/nchs/nvss/births.htm.
Agency Contact:
Joyce Martin
National Center for Health Statistics
Phone: 301-458-4362
Email: jmartin@cdc.gov

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Safe Drinking Water Information System

The Safe Drinking Water Information System (SDWIS) is the national regulatory compliance database for the drinking water program of the U.S. Environmental Protection Agency (EPA). SDWIS includes information on the nation's more than 148,000 public water systems and data submitted by states and EPA regions in conformance with reporting requirements established by statute, regulation, and guidance.

The EPA sets national standards for drinking water. These requirements take three forms: maximum contaminant levels (MCLs; the maximum allowable level of a specific contaminant in drinking water), treatment techniques (specific methods that facilities must follow to remove certain contaminants), and monitoring and reporting requirements (schedules that utilities must follow to report testing results). States report any violations of these three types of standards to the EPA.

Water systems must monitor for contaminant levels on fixed schedules and report to the EPA when a maximum contaminant level has been exceeded. States also must report when systems fail to meet specified treatment techniques. More information about the maximum contaminant levels can be found online at https://www.epa.gov/ground-water-and-drinking-water/table-regulated-drinking-water-contaminants.

The EPA sets minimum monitoring schedules that drinking water systems must follow. These minimum monitoring schedules (states may require systems to monitor more frequently) vary by the type and size of the drinking water system, the source water (surface water or ground water), and contaminant. For example, at a minimum, all drinking water systems regularly monitor nitrate; community water systems that serve surface water monitor daily for turbidity; and ground water systems may monitor inorganic contaminants every 9 years.

SDWIS includes data on the total population served by each public water system and the state in which the public water system is located. However, SDWIS does not include the number of children served. In this report, the fractions of the population served by noncompliant public water systems in each state were estimated using the total population served by violating community water systems divided by the total population served by all community water systems. The numbers of children served by violating public water systems in each state were estimated by multiplying the fraction of the population served by violating public water systems by the number of children (ages 0–17) in the state.

Information about SDWIS is available online at https://www.epa.gov/enviro/sdwis-overview.

Agency Contact:
Renee Morris
Office of Ground Water and Drinking Water
U.S. Environmental Protection Agency
Phone: 202-564-8037
Email: morris.renee@epa.gov

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Youth Risk Behavior Surveillance System

The Youth Risk Behavior Surveillance System (YRBSS) was developed in 1990 to monitor health risk behaviors and experiences that contribute to the leading causes of death, disability, and social problems among youth and adults in the United States.

The YRBSS includes national, state, and local school-based surveys of representative samples of 9th- through 12th-grade students. These surveys are conducted every 2 years, usually during the spring semester. The national Youth Risk Behavior Survey (YRBS), conducted by the Centers for Disease Control and Prevention, provides data that are representative of high school students in public and private schools in the United States. The state and local surveys, conducted by departments of health and education, typically provide data that are representative of public high school students in each state or local school district. Survey procedures for the national, state, and local surveys are designed to protect students' privacy by allowing for anonymous and voluntary participation. Before survey administration, local parental permission procedures are followed. Students complete the self-administered questionnaire during one class period and record their responses directly on an electronic device, computer-scannable booklet, or answer sheet.

For the 2023 national YRBS, the sampling frame consisted of all public and private schools with students in at least one of grades 9–12 in the 50 states and the District of Columbia. A three-stage cluster sample design produced a nationally representative sample of students in grades 9–12 who attend public and private schools. All students in selected classes were eligible to participate. Schools, classes, and students that refused to participate were not replaced. In 2023, 20,103 questionnaires were completed in 155 schools. The school response rate was 73%, and the student response rate was 71%. The overall response rate (school response rate multiplied by the student response rate) was 35.4%.

Information about the YRBSS, including the 2023 national YRBS, is available online at https://www.cdc.gov/yrbs.

Agency Contact:
Mike Underwood, PhD
Chief, School-Based Surveillance Branch
Division of Adolescent and School Health
Centers for Disease Control and Prevention
Phone: 404-718-1471
Email: jmunderwood@cdc.gov

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Federal Interagency Forum on Child and Family Statistics

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