surement challenges, because they do not have the capacity to report on their moods or cognitions. To fully understand the relationship between children’s behaviors and health across regions and populations, optimal measurement strategies in most cases require (1) reliance on multiple informants (single-informant data on youth behavior are usually incomplete and should be used with caution), including reliable observational data about the behaviors of infants and young children; (2) combining measures of behavior across informants and settings; (3) demonstration that the behaviors are not simply normal variations; and (4) demonstration that the behavior is in fact related to adverse health consequences. Multi-informant reports are not always needed, but the validity and adequacy of single-informant data should be scrutinized during the planning and execution of studies of children’s behavioral influences. Moreover, because children’s behavior is constantly changing, measures must be sufficiently sensitive to detect such changes, as well as able to detect relevant differences in the timing, duration, and intensity of behavior influences on health.

To what extent do studies take into account these factors? Data regarding child and youth risk behaviors are gathered routinely from a number of national surveys (see examples below), some consisting of one-time investigator-initiated (even longitudinal) projects, and others consisting of programmatic efforts to collect such information regularly. However, across the broad range of studies listed in Appendixes A and B, most do not meet the requirements outlined above.

As an example, in the National Health Interview Survey (NHIS), four questions from a single informant (parent-caretaker) are asked about children’s risk behaviors. Similar limitations are found in most other national surveys, with the notable exceptions of the Youth Risk Behavior Survey (YRBS) and the current NHANES study, which devote significant time to interviewing children in major behavioral areas related to adverse outcomes (e.g., substance use). In the current NHANES survey, multi-informant interviews are conducted using a well-validated instrument (the Diagnostic Interview Schedule for Children—Shaffer et al., 1996; Jensen et al., 1995). However, for the NHANES study, valid determinations and differences within and across any single geographic policy region (such as a city, county, or state) are not possible, given the sampling frame and sample sizes for this particular survey, rendering the study inadequate for adapting regional policies to variations in regional behavioral influences on health.

The YRBS, which attempts to track 10 high-risk youth behaviors, based on representative samples of entire classrooms within schools within states, has modest promise for policy and planning purposes, although the data are self-reports. While innovative, this methodology is largely dependent on the states’ own resources to implement the surveys and, in any given year of the survey, as many as 50 percent of states may not have valid or presumably generalizable data. Moreover, rates of specific high-risk behaviors are solely dependent on youths’ self-reports (using a pencil and paper survey measure administered in classroom group settings); are often much higher than those found in more in-depth, meth-



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