for all services used by Medicare beneficiaries; to establish all types of health insurance coverage and relate coverage to sources of payment; and to trace changes over time, such as health status, and the impacts of programmatic changes. It includes survey data on measures of health status and access to care that are linked to the physicians and hospital claims data. The survey was initiated in 1991 and is designed to support both cross-sectional and longitudinal analysis. Data are collected through interviews that take place over 4-month intervals. Each interview includes questions regarding the household composition; an accounting of the individual’s health insurance coverage; a review of an individual’s health care utilization in the period since the last interview; details about each type of service, provider characteristics, and medicines prescribed; and a detailed account of charges and payments associated with these health care events. The interview data are linked to Medicare claims.

Youth Risk and Behavior Survey

The Youth Risk Behavior Surveillance System includes national, state, and local school-based surveys of representative samples of 9th- through 12th-grade students (National Center for Chronic Disease Prevention and Health Promotion, 2005). These surveys are conducted every 2 years, usually during the spring semester. The national survey, conducted by CDC, provides data representative of high school students in public and private schools in the United States. The state and local surveys, conducted by departments of health and education, provide data representative of the state or local school district. The Risk Behavior Surveillance System was developed in 1990 to monitor priority health risk behaviors that contribute markedly to the leading causes of death, disability, and social problems among youth and adults in the United States. These behaviors, often established during childhood and early adolescence, include: tobacco use, dietary behaviors, physical activity, alcohol and other drug use, sexual behaviors, and behaviors that contribute to unintentional injuries and violence. Despite the importance of sleep deprivation and other sleep disorders in young adolescents (see Chapter 3), no questions on sleep and sleep behaviors have ever been included in the survey.

Process for Inclusion of New Components in Surveys

One impediment for the addition of greater sleep-related content in surveillance and monitoring instruments is the process required to have new components added. In addition to a high standard of scientific merit, inclusion of new components also often requires specific sponsorship. The



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