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What can state and national data show us about childhood obesity, health care, access and neighborhood conditions? Our next guest has done some significant research into compiling that data, research that helped officials at all levels of government develop policy. She’s the director of the Division of Epidemiology and the Maternal and Child Health Bureau at the Health Resources and Services Administration, and a finalist in this year’s Service to America Medals program. Dr. Reem Ghandour spoke with Federal Drive with Tom Temin.

Interview transcript:

Dr. Reem Ghandour: I have the very good fortune of working in the Health Resources and Services Administration. And in that capacity, I get to direct the National Survey of Children’s Health, which is the largest source of state and national data related to kids health. And we cover all range of topics, everything from child weight and obesity levels, like you just mentioned, to their experiences at home — adverse childhood experiences, their neighborhood conditions, and of course, they’re accessing utilization of health care.

Tom Temin: And I’m imagining that weight or the presence of obesity is probably a indicator of a lot of other issues, or maybe causes some other issues.

Dr. Reem Ghandour: Sure. I think that’s one of the strengths of the survey is that we’re able to look at outcomes like health status, if you will, whether it’s obesity or some other condition, and look at whether or not it’s associated with health care access, with other family factors, with health behaviors. So for example, do kids who spend more time with screen time or have less sort of time doing family meals or less physical activity, do they have higher rates of obesity? And those are some of the kinds of research that can be done with our data. Certainly, there’s a lot of other I would say even deeper exploration that can go on related to kids health. So for example, what do adverse childhood experiences, what does growing up in an unsafe neighborhood, how might that be correlated with other health outcomes? So we can kind of look at a wide range of factors. And there’s folks at the state level in particular, and researchers at the state level, because we have state level data are able to also look at the effects of policy at the state level to health care outcomes among kids.

Tom Temin: And just give us a sense of the scope of the research the size of the sample, the frequency, and what are on the survey forms, what are some of the questions you ask?

Dr. Reem Ghandour: So we are an annual survey, which is something that I’m personally very proud of, it’s one of the ways that we redesigned the survey in 2016. We used to be every four years, and we realized that folks just weren’t getting the data that they needed in order to make timely decisions. So we are now annual. We’re in the field usually from about June all the way to January. And then we process the data, we clean it up, and we get it out to folks the following October. […] We have data for about 30,000 to 40,000 kids between the ages of zero to 17. And the data are actually all collected from parents. So to make this super simple, basically households get a letter in the mail, and they are asked to participate in the survey. Most of our families participate online. So they get a letter that says here, go online, and you can answer these questions about one of the kids in your households. The questions ranged from pretty sort of simple, basic, how would you rate your kids health? Or has your healthcare provider ever told you that your child has a particular condition? And we kind of run through a list of conditions. All the way to questions about the parent satisfaction with their care, whether or not their different health care providers talk to each other. We asked parents to talk about their experiences providing for their kids care. So for example, something that I think a lot of us can relate to in the pandemic, did you ever have to take time off or step away from a job in order to care for your child? So things like that. And we do ask questions about the effect of the pandemic as well. We’ve added those questions in, so, asking parents about disruptions in child care and telehealth and things like that. So, really trying to keep our finger on the pulse of what American families are going through.

Tom Temin: And you also ask height and weight.

Dr. Reem Ghandour: Height and weight. So, we do. We ask parents to report their best estimate of their child’s height and weight, and then that’s used to calculate volume index, and that’s how we determine whether or not a child is normal weight, underweight, overweight or obese.

Tom Temin: We’re speaking with Dr. Reem Ghandour. She is the director of the Division of Epidemiology in the Maternal and Child Health Bureau at the Health Resources and Services Administration, also a finalist in this year’s Service to America Medals program. And in looking at this in terms of racial disparities or ethnic disparities, are you finding that there are disparities because of race or ethnicity? Or is it simply that bad health or excessive weight comes to children under certain conditions, regardless of what race or ethnicity they are?

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Dr. Reem Ghandour: So that’s a great question. I am not one of our central researchers who focuses on obesity. So I’m probably not the expert on this subject. But I would say that a lot of times we do try to look at health conditions, whether it’s obesity or asthma or anything else. And we try to look for patterns. So, do kids have certain racial or ethnic groups experience more of that condition? Do older kids, younger kids, poorer kids? It’s helpful for us from a policy and program standpoint to try to understand who is at greater risk for certain conditions. I think we do see, certainly racial and ethnic patterns present in terms of overweight and obesity, I think, and we’re not the only data source that shows that. I think non-white kids, unfortunately, do have some higher rates of obesity. But I don’t know that that has anything to do necessarily with race. I think that is really a much bigger picture. We know that kids health is rarely affected by a single factor. It’s neighborhood factors. It’s quality and availability of food. It’s whether or not there’s adequate, safe environment for kids to play outside and sports opportunities. And then I think there’s a whole other range of factors related to special health care needs. Not every kid can participate in your local soccer team, if there is a local soccer team. And so I think it’s kind of, I understand the instinct to want to kind of throw up a particular statistic about kids of a certain group, but what I think is most important about kids health is that kids like all of us are the sum of their parts. And we really need to use, I would say, multifaceted data, with data like what we have in the National Survey of Children’s Health, to understand the complexities, all the pieces that fit together to help kids thrive and be healthy or be at risk for adverse health outcomes.

Tom Temin: By the way, what was the pandemic effect on children’s health? Do we know yet?

Dr. Reem Ghandour: That’s an interesting question. So we don’t know yet from our data, because we are just fielding the questions now, in 2021. I think you can look at a variety of sources, though, and we’ve seen increases in mental health concerns among kids, we’ve certainly seen increases in some forms of hospitalizations related to mental health. So, I think we are going to be learning for a long time what the impacts were, and as a parent with two kids — I have a preschooler and an elementary school child — I can say that there have been ways that the pandemic has, I think, allowed kids to slow down a little bit and spend a little more time at home and with close friends and family. It’s also had a tremendous impact on learning, on social development, emotional development. So I think we’re going to be studying that for a long time, unfortunately.

Tom Temin: And as the master of the survey, the data goes out to various entities in different levels of government, and I guess in private health care also, are you aware of how this data tends to get used? And are you excited about any of the ways that it ends up being applied?

Dr. Reem Ghandour: Yeah, so that’s a great point. In fact, we work really hard to make sure that our data are entirely in the public domain. Meaning that we collect the data and we put it up for everyone to use. And it always goes out on Child Health Day. So that’s the first Monday in October. And we pride ourselves on that, because we really, it sounds corny, but you really want to set the data free, let people use it to make their own decisions. So yeah, there are times when we get to work very closely with folks who analyze the data. So like I mentioned with the Robert Wood Johnson Foundation that puts out state of obesity report every year, our analysts work very closely with theirs to kind of work through the data, double check all the estimates, make sure that we’re presenting it in a way that is factually as accurate and as sort of clear as possible. Other times, we learn about it along with everybody else. So for example, we know that Starbucks used our data in 2016, looking at the parenting burden and sort of what parents sometimes go through in terms of providing care for their children. And we know that they use the data to actually inform some changes to their personnel policy. And we found out about it on CNN along with the rest of the world. So, sometimes we know a lot about what’s happening. And sometimes we know nothing. And I think what is great about the data is that because we cover such a waterfront of content, and we have such a large sample, at the national level and at the state level, folks can do all manner of research. So, I’m thrilled at any point when folks are kind of using the data, getting it out there. And we always welcome folks to contact us if they have questions or want to think through how they make use of that.

Tom Temin: And just a final question. HHS, largely through NIH and some other components, has done studies in recent years where they’re looking at a million people, a million veterans or a million people to look at cancer, what the case might be, you mentioned that you have data on 30,000 to 40,000 children, do you ever dream of saying, gosh, if we had a million children database? Or would that really make any more statistical relevance or accuracy than what you get with 40,000?

Dr. Reem Ghandour: That’s a great question. I mean, yes, more data is almost always better. But I do think there’s a trade off between sort of statistical significance and in burden. And the reality is, we want to be as efficient and as sort of tight as we can be, only collecting the data that we absolutely have to have in order to produce these estimates. So we’re pretty cautious about making sure that we spend our money wisely. I think over time, one of the other great things about surveys that you can pool data across years. So we’re now going to be able, with the release of the 2020 data, to pull data across five years. And then you have well over 100,000 kids, that’s actually enough to make some pretty important statements about kids.

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Jared Serbu: Dr. Reem Ghandour is the director of the Division of Epidemiology in the Material and Child Health Bureau at the Health Resources and Services Administration, and a finalist in this year’s Service to America Medals.

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