circumstances, at the census tract level. In cases in which administrative records are not sufficient to provide the needed data for policy development or planning of interventions, states and communities should consider conducting targeted surveys. Of most value would be surveys that model national surveys, thus allowing comparisons with a national standard, or state- or local-level application of national surveys, such as the Behavioral Risk Factor Surveillance Survey. When feasible, strategies to link data at the individual level and then aggregate to community levels should be a goal.


Recommendation 11: The U.S. Department of Health and Human Services and the Environmental Protection Agency should prioritize research and training on emerging methods for characterizing children’s health and understanding influences on it, including research on:

  • creation of improved measures of functioning and health potential;

  • the relative importance of and interactions among the range of influences;

  • biopsychosocial pathways of development;

  • assessment of children’s exposures to environmental toxins and other environmental health hazards;

  • reasons and remedies for health disparities;

  • longitudinal methods that can identify causal relationships between developmental and functional levels and the health status of children;

  • development of profiles and integrative measures of children’s health; and

  • construction of trajectories for each domain of children’s health.

Great strides have been made in conceptualizing the dynamic process by which many external influences interact with individuals’ biology and behaviors over the course of childhood to determine health. However, empirical studies of the nature and importance of these processes are suggestive but far from definitive.

The research literature provides strong empirical evidence that children’s health results from developmental processes involving continuously changing and iterative time frames with differentially sensitive and critical periods of development for prevention and health promotion. At each developmental phase, children experience multiple influences, and their experiences in a given phase will in turn shape their response to influences in later stages of development. Yet current measures of children’s health capture neither the iterative nature of these factors nor their interdependence. Furthermore, the measures are generally not robust

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