1. A module on health of children
Agenda item 3.3
Paul Camenzind
ESTAT Unit F-4
6-7 July 2017
Task Force EHIS

2. Outline
Background information → Needs, criteria for development, work done
Discussion in TG HIS 02/2017
Content of the module: 2 versions A & B
Conclusions and next steps
6-7 July 2017
Task Force EHIS

3. Why data on children in EHIS?
Envisaged in the current framework regulation /2008 (Annex I, Scope)
Part of the modernisation of social statistics → DSS broad agreement to develop measures of disability prevalence, including children → EHIS identified as a possible appropriate source by GALI TF
Commission Policy DGs consultation → Various needs
Consultation of TG HIS → Broad support to consider for future EHIS
6-7 July 2017
Task Force EHIS

4. Selection of topics questions /variables
Policy relevance/importance
Appropriateness in survey:
→ Feasible to be collected via survey & provide reliable estimates
→ Suitable for proxy respondents & different data collection modes
Take into account existing instruments and data sources → CSHCN, UNICEF/WG, HBSC, ESPAD, national surveys (Annex)
Alignment with EHIS adults and harmonization with SILC children variables
Reasonable size → Number of variables / questions
6-7 July 2017
Task Force EHIS

5. Work done
Consultation of TG HIS on the list of issues regarding the EHIS (April 2016)
Eurostat study: a proposal for a possible module on health of children
Discussions with TF EHIS (May and October 2016)
Consultation of TG HIS on health of children modules in national HIS (January 2017) & Discussion (February 2017)
ESTAT analysis of some methodological aspects (sample size, proxy interviews; January 2017)
ESTAT first draft: Module on health of children (June 2017)
6-7 July 2017
Task Force EHIS

6. Discussion in TG HIS (February 2017)
Statistical methodology aspects → Statistical population: 0–14 years; different instruments for different ages depending on content of the module → Sample size & sampling method: minimum sample size for children; sample 1 or more children in HH? Sampling method? → Use of proxy respondents: Legal issues; exclude some topics? Who can be proxy to obtain reliable data? How feasible is to involve only appropriate proxies? → Modes of data collection; special weights for children
Sample size → Sample size should be sufficient for all countries (Annex)
Proxy respondents & relationship proxy – children → SILC 2014: Proxy would be on of parents: 91% (70% to 99%) → EHIS W2: Proxy would be on of parents: 59% (29% to 70%)
6-7 July 2017
Task Force EHIS

7. Discussion in TG HIS (February 2017)
• Content – identified needs for data
EU needs/policies
National interest
Eurostat study
Disability of children
Health outcomes, incl. mental health
Weight and height
Eating behaviours: fruit, vegetables, sugar- sweetened beverages
Physical activity and sedentary activities
Tobacco use, Alcohol use, Cannabis use,
Sexual behaviour
Fighting, Being bullied and bullying others
MEHM, diseases, injuries
Phys. health: headache, stomach problems
Mental health
Disability
Lifestyles: physical activity, obesity, eating habits, breastfeeding
Violence (bullism) and psychological aspects
Behaviour (anger, hyperactivity, isolation)
Use of health services & medicines
General health
Oral health
Diseases and chronic conditions
Health potential and mental wellbeing
Special health care needs incl. funct. limit.
Physical activity/exercise
Consumption of fruits and vegetables
Curative services
Preventive services
6-7 July 2017
Task Force EHIS

8. Discussion in TG HIS (February 2017)
• Content – available "material" from ESTAT study
Topic
Short
Long
Background information (age, sex, proxy) 3
Health status and functioning
MEHM for children
Perceived oral health
Physical and sensory functional limit.
Cognitive limitations
Social and mental health difficulties
Mobility and participation
(15) 7 2 4
(20)
Health determinants and potential
Height and weight
Physical activity
Consumption of fruit and vegetables
Sweetened beverages
Breastfeeding
(0)
(11) 1
6-7 July 2017
Task Force EHIS

9. Health of children (ESTAT draft, Jun 2017)
Sub-module in adult questionnaire (not stand-alone) → Legal (child protection / privacy) → Organisational (data collection process) → Methodological (sufficient sample in small countries)
Answers only given by proxy respondents → Who could be the proxy respondents?
Respondents burden & limitation of questions → Limit to 20 health-related questions (+5 background)
Propose 2 versions of children module → Version A: Clear focus on disability & participation restrictions → Version B: Focus on disability & participation restriction and on some prevention issues
6-7 July 2017
Task Force EHIS

10. Health of children (ESTAT draft, Jun 2017)
Dimension
Number of questions: Version A
Number of questions: Version B
Height and weight 2
Minimum Europ. Health Module 3
Physical & sensory funct. limit. 6
Cognitive limitations
Social & mental health difficult.
Mobility & participations restr. 5 -
Physical activity & excercise
Consumption of fruit & veget.
Consumption of soft-drinks 1
Total
20 (+5)
6-7 July 2017
Task Force EHIS

11. Health of children (ESTAT draft, Jun 2017)
Dimension
Number of questions: Version A
Number of questions: Version B
Height and weight 2
Minimum Europ. Health Module 3
Physical & sensory funct. limit. 6
Cognitive limitations
Social & mental health difficult.
Mobility & participations restr. 5 -
Physical activity & excercise
Consumption of fruit & veget.
Consumption of soft-drinks 1
Total
20 (+5)
6-7 July 2017
Task Force EHIS

12. Health of children (ESTAT draft, Jun 2017)
General information (2)
→ Presence of any children aged 0-14 in the HH
→ Names of the children
Proxy respondent’s characteristics (1)
→ Respondent’s relationship with (each?) child
Demographic data on each child (2)
→ Child’s sex
→ Child’s age
6-7 July 2017
Task Force EHIS

13. Health of children (ESTAT draft, Jun 2017)
Weight and height (2)
→ Height of child without shoes
→ Weight of child without shoes or clothes
Minimum European Health Module (3)
→ Respondent-perceived general health of child
→ Longstanding health problem of child
→ General activity limitation of child (routed version)
6-7 July 2017
Task Force EHIS

14. Health of children (ESTAT draft, Jun 2017)
Physical and sensory functional limitations (6)
→ Child wearing glasses or contact lenses
→ Difficulty of child in seeing – even when wearing glasses or contact lenses
→ Child using hearing aids
→ Difficulty of child in hearing – even when using hearing aid
→ Child using equipment or receiving assistance for walking
→ Difficulty of child in walking without any aid or support
6-7 July 2017
Task Force EHIS

15. Health of children (ESTAT draft, Jun 2017)
Cognitive limitations of children (2)
→ Difficulty of child in learning new things
→ Difficulty of child in remembering things
Social and mental health difficulties of children (2)
→ Behavioural difficulty of child
→ Mental health difficulty of child
6-7 July 2017
Task Force EHIS

16. Health of children (ESTAT draft, Jun 2017)
Mobility and participation restrictions of children in major life domains (3)
→ Difficulty of child in leaving his/her home*
→ Difficulty of child in accessing buildings*
→ Difficulty of child in moving about in buildings*
Participation of children in compulsory education (1)
→ Difficulty of child in participating in compulsory education*
Participation of children in leisure activities (1)
→ Difficulty of child in pursuing leisure activities*
* (he/she wants to use) because of a longstanding health problem
6-7 July 2017
Task Force EHIS

17. Health of children (ESTAT draft, Jun 2017)
Mobility and participation restrictions of children in major life domains (3)
→ Difficulty of child in leaving his/her home*
→ Difficulty of child in accessing buildings*
→ Difficulty of child in moving about in buildings*
Participation of children in compulsory education (1)
→ Difficulty of child in participating in compulsory education*
Participation of children in leisure activities
→ Difficulty of child in pursuing leisure activities* (1)
* (he/she wants to use) because of a longstanding health problem
Version A
6-7 July 2017
Task Force EHIS

18. Health of children (ESTAT draft, Jun 2017)
Physical activity / exercise of children (2)
→ Number of days carrying out sports, fitness, or recreational physical activities that cause child to get out of breath or sweat
→ Time spent on carrying out sports, fitness, or recreational physical activities that cause child to get out of breath or sweat
Child consumption of fruit and vegetables (2)
→ Frequency of child eating fruit, excluding juices a week
→ Frequency of child eating vegetables and salad a week, excluding potatoes and juices
Child consumption of sugar-sweetend beverages (1)
→ Frequency of child drinking sugar-sweetened soft-drinks a week
6-7 July 2017
Task Force EHIS

19. Health of children (ESTAT draft, Jun 2017)
Physical activity / exercise of children (2)
→ Number of days carrying out sports, fitness, or recreational physical activities that cause child to get out of breath or sweat
→ Time spent on carrying out sports, fitness, or recreational physical activities that cause child to get out of breath or sweat
Child consumption of fruit and vegetables (2)
→ Frequency of child eating fruit, excluding juices a week
→ Frequency of child eating vegetables and salad a week, excluding potatoes and juices
Child consumption of sugar-sweetend beverages (1)
→ Frequency of child drinking sugar-sweetened soft-drinks a week
Version B
6-7 July 2017
Task Force EHIS

20. How to continue?
Data on health of children important, currently missing; EHIS could complement other sources of data
ESTAT believes in feasibility to include a module on health of children in EHIS (see experience in countries)
Is concrete ESTAT proposal (Versions A & B) including questionnaire & methodology useful for further steps?
Favoured version? Other proposals: adding & removing variables; changing variables, answer categories, guidelines?
Informing TG HIS / WG PHS about developments and possible consultation on a draft module (Autumn 2017)
Pretesting and pilot testing within EHIS -> Grants 2017
Further discussion about introducing a module on children in future EHIS
6-7 July 2017
Task Force EHIS

21. Annex: Other international sources of children data
Name
Health Behavior in School-Aged Children (HBSC)
European School Survey Project on Alcohol and Other Drugs (ESPAD)
Countries
EU 27 + NO + IS + other countries
EU 23 + NO + IS + other countries
Periodicity
Every four years
Target population
11-, 13-, and 16-year old students
16-year old students
Collection method
Self-administered questionnaire to students
Sample size
Approximately 1,500 students, per age group, per country
Net sample of at least 2,400 students, per country
Topics
health outcomes (self-rated health, injuries, obesity)
health behaviours (dieting, physical activity)
risk behaviours (smoking, alcohol cannabis, sexual behaviour, bullying)
use of psychoactive substances (smoking, alcohol, illegal drugs)
use of the internet for various activities in the lifetime
6-7 July 2017
Task Force EHIS

22. Annex: Estimation of sample sizes of children (data EHIS wave 2)
Variable
avg
min
max
Number of HHs with children 0-13
1,915
505
5,445
% of HHs with children 0-13
23%
15%
28%
Number of children 0-13
2,968
738
8,084
Number of children 0-4
1,380
247
3,591
Number of children 5-13
2,428
653
6,545
No. ch (max 1 child per HH)
No. ch (max 2 children per HH)
2,382
645
7,159
No. ch (max 2 children per HH)
2,330
634
6,417
6-7 July 2017
Task Force EHIS

23. Annex: Alignment with SILC children variables
Financial burden (3): all ages
→ Financial burden of medical examinations/treatments last 12 mths
→ Financial burden of dental examinations/treatments last 12 mths
→ Financial burden of medicines (pre-& non-prescribed) last 12 mths
General health and limitation in activities (2): 0-15 yrs.
→ Respondent-perceived general health of child(ren)
→ Limitation (>6 months) in activities because of health problem (routed version)
6-7 July 2017
Task Force EHIS

24. Annex: Alignment with SILC children variables
Unmet needs (4): 0-15 years
→ Unmet need for medical examination or treatment last months
→ Main reason for unmet need for medical examination or treatment last 12 months
→ Unmet need for dental examinations or treatments last months
→ Main reason for unmet need for dental examination or treatment last 12 months
6-7 July 2017
Task Force EHIS