TABLE 1. Questions and methods for the National Survey of Children’s Health related to mental, behavioral, and developmental disorders; rurality; and health care, family, and community factors — United States, 2011–2012.

Variable	Questions and methods
MBDDs	Parent responded yes to at least one question: “Has a doctor or other health care provider ever told you that [child] had [specified MBDD]?” Specified MBDDs included ADHD, depression, anxiety problems, behavioral or conduct problems such as oppositional defiant disorder or conduct disorder, Tourette syndrome, autism spectrum disorder, learning disability, intellectual disability, developmental delay, or speech or other language problems.
Urban or rural residence	Urban and rural designations were determined using the four-category classification of the 2006 RUCAs, a census tract–based classification system.* Urban areas (RUCA codes 1.0, 1.1, 2.0, 2.1, 3.0, 4.1, 5.1, 7.1, 8.1, and 10.1) include metropolitan areas and surrounding towns from which commuters flow to an urban area; large rural areas (RUCA codes 4.0, 4.2, 5.0, 5.2, 6.0, and 6.1) include large towns (micropolitan areas) with populations of 10,000–49,999 and their surrounding areas; small rural areas (RUCA codes 7.0, 7.2, 7.3, 7.4, 8.0, 8.2, 8.3, 8.4, 9.0, 9.1, and 9.2) include small towns with populations of 2,500–9,999 and their surrounding areas; isolated areas (RUCA codes 10.0, 10.2, 10.3, 10.4, 10.5, and 10.6) are not near towns with a population of ≥2,500.
Health care
Inadequate insurance	Parent responded “no” to at least one of five survey items included in four variables: 1) whether the child has current health insurance coverage; 2) whether the child had gaps in coverage in the past 12 months; 3) whether the coverage is sufficient to meet the child’s needs; 4a) whether the family pays out-of-pocket expenses, 4b) and if yes, whether these expenses are usually or always reasonable; and 5) whether insurance allows the child to see needed health care providers.
No medical home	This variable was assessed through 19 survey items coded into five variables and based on the parent reporting the child not having at least one of the following components of a medical home: having a personal doctor or nurse, having a usual place of care, receiving family-centered care and care coordination, and for children who need them, getting needed referrals.
Family
At least one parent with fair or poor mental health	Parent responded “fair” or “poor” (compared with “excellent,” “very good,” or “good”) to one of two questions: “In general, what is the status of [child name]’s [mother’s/your] mental and emotional health?” and “In general, what is the status of [child name]’s [father’s/your] mental and emotional health?”
Financial difficulties	Parent responded “very often” or “somewhat often” (compared with “rarely” or “never”) when asked “Since [the child] was born, how often has it been very hard to get by on your family’s income, for example, was it hard to cover the basics like food or housing?”
Community
Neighborhood with limited amenities	Parent responded “no” to at least one of the following statements: “Please tell me if the following places and things are available to children in your neighborhood, even if [the child] does not actually use them”: 1) sidewalks or walking paths; 2) a park or playground area; 3) a recreation center, community center, or boys’ or girls’ club; 4) a library or bookmobile.
Neighborhood in poor condition	Parent responded “yes” to any of the following three questions: “In your neighborhood, is there litter or garbage on the street or sidewalk? How about poorly kept or rundown housing? How about vandalism such as broken windows or graffiti?”
Neighborhood with little social support	Parents responded they “definitely agree,” “somewhat agree,” “somewhat disagree,” or “definitely disagree” to each of four statements about their neighborhood or community: “People in this neighborhood help each other out; we watch out for each other’s children in this neighborhood; there are people I can count on in this neighborhood; if my child were outside playing and got hurt or scared, there are adults nearby who I trust to help my child.” Responses were scored 1–4 (ranging from “definitely agree” through “definitely disagree”), and an average score was calculated; averages ≥2.25† indicated a lack of social support.
Neighborhood unsafe	Parent reported “never” or “sometimes” (compared with “usually” or “always”) to the question, “How often do you feel [the child] is safe in your community or neighborhood?”

Abbreviations: ADHD = attention-deficit hyperactivity disorder; MBDD = mental, behavioral, and developmental disorder; RUCA = rural-urban commuting area.

* Source: US Department of Health and Human Services, Health Resources and Services Administration. The health and well-being of children in rural areas: a portrait of the nation 2011–2012. Rockville, MD: US Department of Health and Human Services; 2015. https://mchb.hrsa.gov/nsch/2011-12/rural-health/pdf/rh_2015_book.pdf

^† Source: Data Resource Center for Child and Adolescent Health, Child and Adolescent Health Measurement Initiative, Maternal and Child Health Bureau. 2011–2012 National Survey of Children’s Health. Child health indicator and subgroups. SAS codebook, Version 1.0. Baltimore, MD: Child and Adolescent Health Measurement Initiative; 2013. http://www.childhealthdata.org/docs/nsch-docs/sas-codebook_-2011-2012-nsch-v1_05-10-13.pdf