) Rh-factor Is Associated With

[Karoline Oum]

Thesedata support the Institute of Medicine recommendation that resources directed toward improving health care and supporting families and communities are needed to promote healthy development among all young children. Collaborative, multidisciplinary strategies including public health and pediatric clinical partners might have the greatest impact given the broad types of factors associated with early childhood MBDDs and the large number of agencies working to support optimal child development.

The District of Columbia had the highest prevalence of living in a neighborhood in poor condition (46.2%) but the lowest prevalence of living in a neighborhood without all of the reported amenities (26.7%); the lowest prevalence of living in a neighborhood in poor condition was 20% in Maryland, whereas the highest prevalence of living in a neighborhood without all of the reported amenities was 67.5% in Mississippi (67.5%). Finally, reported prevalence of lack of neighborhood support was highest in Arizona (32.9%) and lowest in North Dakota (7.9%).

Mental, behavioral, and developmental disorders identified in childhood often persist into adulthood and are associated with increased risk for poorer school outcomes and employment opportunities, other adverse health conditions, earlier mortality, and considerable costs for persons with the disorders, their families, and society (2). Children are more likely to outgrow speech or language problems or certain developmental delays than other MBDDs, particularly if they receive early intervention. In other disorders such as Tourette syndrome, some children might outgrow the condition by late adolescence but remain at increased risk for other disorders that are more likely to persist, including ADHD and obsessive-compulsive disorder. MBDDs can substantially affect health care, families, and communities. Children with MBDDs often require more health and therapy services than children without MBDDs. Families might face stress associated with the disorder itself or financial stress associated with treatment of the disorder. Communities might need to provide additional services and support for both children and families and might face lower productivity if the parent or guardian is unable to work (2). Thus, efforts to prevent the onset of MBDDs and to improve their identification and treatment in early childhood might improve health and well-being throughout the lifespan, with the potential to translate into cost savings and overall population health improvements (2).

The data in this report included a number of sociodemographic factors associated with MBDDs, including poverty and living in a primarily English-speaking household. Household language might be reflective of increased access to health care (and thus increased likelihood of being diagnosed) or the level of acculturation, a factor that has been associated with risk behaviors and poorer health outcomes in some domains (5). The identified health care, family, and community factors associated with child MBDDs in this report have each previously been documented to be associated with poverty (6). Each significant factor might reflect the effect of insufficient parental and community resources to support optimal child development and might contribute to chronic stress. Chronic stress in early childhood can impact lifelong health. A chronically activated physiologic stress response impacts the sympathetic nervous system, metabolism, and the brain, resulting in increased risk for high blood pressure, obesity, inflammatory diseases, and mental and behavioral disorders (1). The prevalences of both poverty and MBDDs have been increasing among U.S. children, underscoring the need for public health strategies to prevent and treat MBDDs (7).

Because a large percentage of children were reported to receive preventive care, pediatric clinical settings might be one venue for identifying and possibly delivering services to children and families in need. For example, the American Academy of Pediatrics has published policy statements on screening for postpartum depression (e.g., one way to address poor maternal mental health), the medical home, recognizing social determinants of health, and partnering with public health to address child health from a population perspective (3). Increased awareness of the association of these factors with MBDDs by agencies serving children, (e.g., health departments, schools, and community organizations) might improve referrals and stimulate partnerships to address early childhood health within established community settings (3).

The findings in this report are subject to at least five limitations. First, the presence of MBDDs was based on parent report and might be subject to recall error or bias. Second, children with undiagnosed disorders were not included, and therefore, state estimates of these disorders might vary both by presence of disorders and likelihood of identification. Similarly, state data on health care, family, and community factors might be influenced by prevalence of MBDDs. Third, the cross-sectional nature of the data and reliance on parent report prevented drawing conclusions about the direction of the associations or about causality. Fourth, although the data were weighted for nonresponse, bias related to nonresponse might remain given the low response rate. Finally, a wide range of disorders were included and might be differentially related to health care, family, and community factors, and also likely vary in the extent to which they can be prevented.

These data support the Institute of Medicine recommendation that resources directed toward improving health care and supporting families and communities are needed to prevent mental, emotional, and behavioral disorders, and promote healthy development among all young children (2). Such investments would require substantial collaboration across public health, pediatric, and other agencies responsible for providing services to children, but could yield widespread benefits for early childhood and lifelong health (8).

1Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC; 2Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration; 3Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, CDC.

MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services.

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version ( ) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.

Parent-reported data from 2016 showed that a higher percentage of children in lower-income households had ever received a diagnosis of an MBDD and a lower percentage had seen a health care provider in the previous year, compared with children in higher-income households. Most children in lower-income households were in families receiving public assistance benefits.

Public assistance programs might offer collaboration opportunities for public health and pediatrics to provide information, implement co-located screening programs or services, or facilitate connection to care.

Consistent with previous studies (3,5,7), this study found that children living in lower-income households had higher prevalences of a parent-reported diagnosis of an MBDD and other health care, family, and community risk factors associated with MBDDs than did children living in higher-income households. Most children had seen a health care provider in the past year regardless of income level; therefore, the American Academy of Pediatrics recommendation to screen for MBDDs (8) and family and socioeconomic risk factors (4) during primary care visits appears to be theoretically feasible.

The findings in this report are subject to at least three limitations. First, data are cross-sectional, so it was not possible to ascertain temporal associations or causality. Second, the sampling weights used to calculate nationally representative estimates might not completely compensate for nonresponse bias. Finally, indicators rely on parental report and might be subject to recall or social desirability bias.

1Epidemic Intelligence Service, CDC; 2Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC; 3Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, CDC; 4Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland.

3a8082e126