substance use, diet, or exercise or to their compliance with health care interventions. According to findings from the Global Burden of Disease study, these behavioral aspects of health are likely to exert even greater influence in coming decades, as behavioral and life-style-related health conditions (e.g., auto accident injuries, consequences of smoking, depression) become predominant in their overall impact on children’s health and illness (Murray and Lopez, 1996).

Another area with significant measurement gaps concerns infant and young children’s behavior. Some data are gathered on a recurring basis through the National Household Education Surveys Program to address a wide range of education-related child behaviors, including emerging literacy and numeracy in very young children. These surveys assess, from the perspective of the parent and teacher, aspects of school readiness, children’s experiences in early childhood programs, and school adjustment, but they do not generate state or local estimates of differences in behavioral influences on health outcomes. However, other data pertaining to developmental milestones for cognition, behavior or social development are not assessed. An important exception to this rule is the Early Childhood Longitudinal Study—Birth Cohort (ECLS-B), a large-scale (N = 12,500), nationally representative, and longitudinal study that follows a single cohort of children from birth to entry into 1st grade. Because of its longitudinal design, this study will enable researchers to examine children’s cognitive, social, behavioral, and emotional growth and to relate their growth and change to their experiences in early child care programs. While this study is likely to yield important findings concerning children’s behavioral development, it is time-limited and cannot be used for ongoing monitoring of behavioral influences of U.S. infants and young children. A similar study of the 1998 kindergarten cohort (ECLS-K) also contains rich data on some aspects of behavior in a large cohort over time.

Challenges in Measuring Behavioral Influences

There are many special challenges in assessing children’s behavioral, emotional, and cognitive influences on health because information may be highly stigmatizing, raise fears that the child will be “labeled,” or may concern illegal activity, such as criminal acts or substance abuse. It has been well established in behavioral research that large variations in observers’ reports exist (e.g., see Achenbach, McConaughy, and Howell, 1987; Jensen et al., 1999), sometimes because there are differences in how different persons perceive the same behavior (perhaps as a function of different ethnic or cultural backgrounds), and sometimes because different persons do not always witness the same behavior, since behavior may vary from setting to setting.

For all of these reasons, measurement of behavioral influences calls for obtaining multiple sources of information, ensuring that the measures of behavior do not rely on single items, and including measures of functional impairment

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