Who is at risk for special health care needs: findings from the National Survey of Children's Health.
OBJECTIVE
A conceptual model of risk factors for special health care needs in childhood was presented previously. This article uses that conceptual model to identify candidate variables for an exploratory empirical examination of the effects of factors that may increase or decrease the risk of developing a special health care need.


METHODS
The National Survey of Children's Health was used for our analysis (N = 102 353). We used multilevel and multivariate analysis methods. We examined risk factors for special health care needs generally and for specific physical, developmental, behavioral, and emotional conditions cooccurring with special health care needs. Risk factors were grouped into 6 major domains, namely, predisposing characteristics, genetic endowment, physical environment, social environment, health-influencing behavior, and health care system characteristics. We examined preschool-aged and school-aged children separately.


RESULTS
Significant associations were found in 5 of 6 domains studied (no variables in the health care systems characteristics were significant). Individual variables found to decrease or to increase significantly the odds of experiencing special health care needs were expressed at the child level (eg, age and gender), family level (eg, family structure and family conflict), and neighborhood level (eg, perception of supportiveness of the neighborhood).


CONCLUSIONS
This analysis is the first to consider empirically a range of risk factors for special health care needs, using a population health model. Although provisional, the results of our analysis can help us to begin thinking about which characteristics of the child, family, and community are worthy of further exploration. Some of the variables we found to be significantly associated with special health care needs, such as age and ethnicity, are immutable. However, we found a number of significant correlates (ie, possible risk factors) that may be amenable to public health interventions, including breastfeeding practices, exposure to secondhand smoke, family closeness, and neighborhood cohesion.
Newacheck
Paul W
PW
Institute for Health Policy Studies, University of California, San Francisco, 3333 California St, Suite 265, San Francisco, CA 94118, USA. paul.newacheck@ucsf.edu
Kim
Sue E
SE
Blumberg
Stephen J
SJ
Rising
Joshua P
JP
D017677:Age Distribution; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002669:Child Welfare; D002675:Child, Preschool; D002908:Chronic Disease; D002658:Developmental Disabilities / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D017146:Models, Organizational; D016017:Odds Ratio; D011787:Quality of Health Care; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012959:Socioeconomic Factors