Increases in Reported Frequent Mental Distress by Disability Group Between 2016 and 2024

Zoe Portlas
2026 Council of State and Territorial Epidemiologists (CSTE) Annual Conference • Boston, MA

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Background

Adults with disabilities experience frequent mental distress at higher rates than adults without disabilities. Frequent mental distress, defined as reporting/having not good mental health at least 14 of the last 30 days, has increased in recent years, and understanding the way these changes affect adults with and without disabilities is important for improving mental health outcomes.

Methods

Frequent mental distress was evaluated using 2016-2024 BRFSS data. Data were stratified by disability group, including difficulty with hearing, seeing, cognition, mobility, self-care, and independent living, and without a disability. Statistical significance was determined using nonoverlapping 95% confidence intervals. Analysis was performed in R.

Results

From 2016 to 2024, frequent mental distress remained higher among all disability groups compared with those without a disability in the United States. The prevalence of frequent mental distress was 5.2 times higher among those with cognitive difficulty compared with no disability, the largest disparity in 2024. At the state level, the highest disparities were: 13.6 times higher among those with self-care difficulty (69.5%) compared with no disability (5.1%) in South Dakota, 11.4 times higher among those with cognitive difficulty (51.3%) compared with no disability (4.5%) in Minnesota, and 10.9 times higher among those with independent living difficulty (52.3%) compared with no disability (4.8%) in North Dakota.

Between 2016 and 2024, there were significant increases in reported frequent mental distress among several of these groups, led by: 44% among those without a disability (6.4% to 9.2%), 10% among those with difficulty hearing (19.4% to 21.4%), 7% among those with independent living difficulty (42.2% to 45.2%), and 5% among those with cognitive difficulty (45.4% to 47.7%).

Between 2016 and 2024, 35 states and D.C. saw increases between 27% and 170% in at least one group, most often those without disabilities. The most significant increases among disability groups at the state level were: 170% among those with difficulty hearing (8.1% to 21.9%) and 148% among those with self-care difficulty (28.0% to 69.5%) in South Dakota and 94% among those with difficulty hearing (13.1% to 25.4%) in Virginia. 

Conclusions and Public Health Impact

These findings identify significant disparities in frequent mental distress across disability status and states. Understanding the rate at which mental distress affects adults with disabilities can help address disparities and promote inclusion in mental health advocacy and treatment.

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Using Disaggregated Data to Uncover Asian American Breastfeeding Initiation Gaps

Samantha Liv
2026 Council of State and Territorial Epidemiologists (CSTE) Annual Conference • Boston, MA

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Background

Asian Americans are frequently aggregated in public health research, creating a skewed narrative of uniform maternal health success. Recognizing that current surveillance data leaves some populations invisible, this study used disaggregated data to uncover hidden breastfeeding initiation gaps.

Methods

Breastfeeding initiation (defined as receiving breast milk prior to hospital discharge) was analyzed using 2024 CDC WONDER natality data. The aggregated Asian category was compared against seven disaggregated subgroups. Results were stratified by state, metropolitan status, maternal education, and age. Analyses were performed using R, with statistical significance determined via 95% confidence intervals.

Results

National baseline data show that the high Asian aggregate initiation rate (89.9%) masks subgroups. Asian Indian (93.9%) and Korean (93.5%) mothers significantly led initiation, while Chinese (85.3%) and Other Asian (85.9%) subgroups fell significantly below the aggregate. 

These disparities vary significantly by state. In Virginia, the highest-rate state, all subgroups exceeded the national aggregate, led by Asian Indian (97.7%) and Korean (97.6%) mothers. Conversely, Wisconsin, the lowest-rate state, exposed widened disparities, revealing a severe 33-point gap between Asian Indian (92.5%) and Other Asian (59.5%) mothers. 

Metropolitan status revealed further gaps. Nonmetropolitan Vietnamese (79.5%) and Other Asian (76.0%) mothers had notably lower rates than their metropolitan counterparts (86.2% and 89.4%). Conversely, Korean mothers maintained high rates across both nonmetropolitan (92.6%) and metropolitan (93.5%) settings. 

Stratification by maternal education showed that while advanced degrees were associated with higher rates, disparities persisted. Asian Indian mothers consistently had higher rates than the aggregate across all levels. Chinese mothers fell significantly below the aggregate, with rates dropping to 54.2% among those with a ninth through 12th grade education and no diploma, over 23% less than the aggregate for that level (77.4%). 

Analysis by maternal age shows initiation peaked among mothers in their 30s. However, the aggregate baseline hid significant subgroup disparities, particularly within the 25–29 age group, where nearly every subgroup differed significantly from the aggregate.

Conclusions and Public Health Impact

Aggregating Asian American maternal health data masks systemic disparities across geography, metropolitan status, education, and age. Disaggregated surveillance is essential to accurately identify and allocate resources to high-risk subpopulations.

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Comparing Multiple Relative Inequality Summary Measure Methods for Data Exploration Across States

Aaron Clark
2026 Behavioral Risk Factor Surveillance System (BRFSS) Annual Meeting

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Background

The BRFSS dataset offers wide-ranging health indicators at the state level. Finding indicators that have high or low inequality among states can help guide decision-makers when evaluating policy, setting goals, or allocating resources. This presentation compares the following relative inequality summary measures: coefficient of variation (CoV), quartile coefficient of dispersion (QCD), index of disparity (IDIS), and mean log deviation (MLD).

Objectives

To observe the performance of different relative inequality summary measures on BRFSS estimates and develop guidance.

Methods

The BRFSS 2024 dataset was used to calculate prevalence estimates for 27 health indicators at the state and national levels. Indicator estimates were used to calculate CoV, QCD, IDIS, and MLD. The three highest-inequality and three lowest-inequality indicators identified by each method were selected for comparison, along with three indicators from the midpoint.

Results

The indicators selected using CoV, QCD, IDIS, and MLD were highly similar to each other, with QCD, IDIS, and MLD each having one unique selection among the six indicators with the highest and lowest inequality. Almost all measures from the middle were unique.

Conclusions

CoV, QCD, IDIS, and MLD all performed similarly. This suggests that whichever summary measure is easiest to explain to the intended audience is likely the best choice, as none performed notably better in this sample. Modern computational capabilities also make it possible to perform all four summaries to compare the outcomes.

Tender Topics: Stories of Real Conversations on Vaccinations, Racism, and Identity

Alexia Málaga
2026 Minnesota Public Health Association (MPHA) Annual Conference • St. Cloud, MN

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Description

The key topic of this presentation is communications, with the main message being: tough conversations are inevitable, and how we navigate them can either deepen connection or create distance in relationships. Change begins with an idea, often acted on in coordination with others, and learning whether and how to engage in difficult dialogue—especially with people we appear to disagree with—is a skill. My hope is for attendees to be inspired by these success stories to speak their truth with honesty, compassion, and curiosity. This presentation aligns with the conference theme, Reimagining the Future of Public Health, by showing how skillfully engaging in tough conversations about tender public health topics can build healthier relationships and open new opportunities for collaboration, bold ideas, and real solutions.

Learning Objectives

1. Determine whether or not to engage in a difficult dialogue—especially with someone you appear to disagree with—after assessing personal safety needs and boundaries.

2. Evaluate potential consequences of sharing your truth versus remaining silent, including possible impacts on the relationship (deepening or creating distance).

3. Apply this demonstrated approach for communicating with honesty, compassion and curiosity around tender public health topics.

Digital Accessibility in the Age of the Dynamic Data Visualization: A Practicum

Rivers Laraque-Ho
2025 American Medical Writers Association (AMWA) Medical Writing & Communication Conference • Phoenix, AZ

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While dynamic and innovative presentations of scientific data advance across the internet, digital accessibility lags behind. Short alt-text image descriptions, even when provided, rarely communicate the details and data points of a complex graph. Data visualizations present unique challenges for writing and encoding image descriptions, but as an increasing amount of scientific research and public health information take on dynamic visual web elements, it is our critical responsibility as writers and analysts to make our work accessible to our colleagues and readers. Learn how to write full descriptions of charts, graphs, and dashboards, and walk away with the resources and technical background to have informed conversations about web accessibility. Participants will have time to practice writing accessible descriptions for example visualizations and discuss the process.

Use of Psychedelic Substances in the United States, 2024: Results from the National Survey Investigating Hallucinogenic Trends (NSIHT)

Prepared by Data Maven in collaboration with Rocky Mountain Poison & Drug Safety (RMPDS) and the Substance Abuse and Mental Health Services Administration (SAMHSA)
2025

Data Maven team members included Aaron Clark, Rivers Laraque-Ho, Alexia Málaga, Zoe Portlas, and Kristin Shaw.

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Data Maven is proud to announce the release of the Use of Psychedelic Substances in the United States report showcasing results from the 2024 National Survey Investigating Hallucinogenic Trends (NSIHT). This report was prepared in collaboration with Rocky Mountain Poison & Drug Safety (RMPDS) and the Substance Abuse and Mental Health Services Administration (SAMHSA). This landmark study provides one of the most comprehensive looks at psychedelic substance use among adults in the United States, offering critical insights to inform safety, research, and policy.

Explore the full report and more on the RMPDS website, or download the PDF to the right.

Adverse Childhood Experiences By Experience, Demographic Group and State

Samantha Liv
2025 Council of State and Territorial Epidemiologists (CSTE) Annual Conference • Grand Rapids, MI

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Background

Adverse childhood experiences (ACEs) are potentially traumatic events linked to negative health outcomes in adulthood. The National Survey of Children's Health (NSCH) expanded its ACEs measure to include discrimination based on sexual orientation and gender identity and discrimination based on health conditions in 2020 and 2021, respectively.

Methods

This study analyzed 2022-2023 data from NSCH. Prevalence estimates, state disparity ratios and 95% confidence intervals were calculated for children aged 0-17 experiencing two or more ACEs. Prevalence estimates were stratified by state, gender, race/ethnicity, and caregiver education, and individual ACEs were analyzed separately without stratification. Analyses were conducted using R 4.3.1.

Results

In 2022-2023, 14.5% of U.S. children (approximately 10,108,000) experienced two or more ACEs. Significant disparities occurred across demographic groups. American Indian/Alaska Native children had the highest prevalence at 32.3%, which was 8.7 times higher than the lowest prevalence found among Asian children (3.7%). Children of caregivers with a high school diploma/GED had a prevalence of two or more ACEs that was 2.1 times higher than children of college-educated caregivers (21.1% vs. 10.0%). Geographically, the prevalence was 2.3 times higher in Montana (22.5%) than in New Jersey (9.6%).

The discrimination-based ACEs had lower prevalences but notable state disparities. Race/ethnicity discrimination affected 4.4% of children (3,036,600), health condition or disability discrimination affected 2.8% of children (1,914,200) and sexual orientation or gender identity discrimination affected 1.9% of children ages 12-17 (902,800). Discrimination based on health conditions or disability was 3.0 times higher in West Virginia and Maine (both 4.5%) than in Hawaii (1.5%); discrimination based on race or ethnicity was 3.4 times higher in Mississippi (6.4%) than in Utah (1.9%); and sexual orientation or gender identity discrimination among children ages 12-17 had the highest state disparity ratio, which was 5.8 times higher in Oregon (4.6%) than in New Jersey (0.8%).

Parental divorce or separation was the most prevalent individual ACE, affecting 21.6% of children (14,955,400). Mental illness in the household impacted 8.6% of children (5,945,300), substance misuse in the household affected 8.2% of children (5,649,600) and parental incarceration impacted 6.0% of children (4,164,900) and had the second highest state disparity ratio, at 5.3 times higher in Arkansas (12.3%) than Massachusetts (2.3%).

Conclusion

This analysis reveals disparities in overall ACE prevalence across racial and ethnic, educational, and geographic lines in the United States. The inclusion of discrimination-based ACEs provides a more comprehensive picture of childhood adversity, highlighting the need for targeted interventions to address ACEs.

Mental Health Conditions Among Children — Trends and Demographic Disparities at National and State Levels

Alexia Málaga
2025 Council of State and Territorial Epidemiologists (CSTE) Annual Conference • Grand Rapids, MI

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Background

Early diagnosis of mental health conditions among children is vital to provide adequate care and support and reduce problems at home, school and socially. Understanding demographic trends and disparities can illuminate populations needing support for timely diagnosis and treatment.

Methods

Prevalence estimates, 95% confidence intervals and disparity ratios were calculated using 2-year estimates of National Survey of Children’s Health data. Mental health conditions (MHCs) is defined as the percentage of children ages 3-17 with a current, diagnosed mental or behavioral health condition such as ADHD, anxiety, behavioral problems or depression. Estimates were broken down by state, sex, race/ethnicity and caregiver educational attainment. All statistical analyses were performed using R-4.3.1. 

Results

Nearly 12.1 million children in the U.S., or 1 in 5, had MHCs in 2022-2023, approximately 1.4 million more than in 2020-2021. The prevalence of MHCs significantly increased 12% since 2020-2021 and 28% since 2016-2017.

In 2022-2023, the most prevalent MHCs were anxiety (10.7%) and ADHD (10.5%) followed by behavioral problems (7.5%) and depression (4.4%). Since 2020-2021, anxiety significantly increased 18% and ADHD increased 12%. Since 2016-2017, depression, anxiety and ADHD significantly increased 47%, 45%, and 21%, respectively.

In 2022-2023, the prevalence of MHCs was 3.8 times higher among American Indian/Alaska Native (24.9%) than Hawaiian/Pacific Islander (6.6%) children, 2.1 times higher in Maine (28.9%) than Hawaii (14.0%), 1.6 times higher among children whose caregiver has some post-high school education (22.8%) than children whose caregiver has less than a high school education (14.2%), and 1.2 times higher among males (21.5%) than females (18.2%).

Between 2020-2021 and 2022-2023, the prevalence of MHCs significantly increased 16% among females, 10% among males, 15% among white children and 14% among children whose caregiver is a college graduate. These same populations experienced significant prevalence increases since 2016-2017, with the addition of children whose caregiver has some post-high school education or is a high school graduate, and Hispanic and multiracial children.

Conclusions

More children are being diagnosed with MHCs each year, and anxiety and ADHD are the most prevalent. ADHD increased the most since 2020-2021, while depression increased the most since 2016-2017. Children whose caregiver has less than a high school education had the highest prevalence of MHCs in 2016-2017 and lowest in 2022-2023. This group didn’t experience significant changes, rather prevalences among higher education groups have increased. While the prevalence of MHCs remains significantly higher among males than females, the disparity ratio has been narrowing. 

Limitations

It is possible that the rise in diagnosed mental health conditions reflects an increase in diagnoses rather than the underlying conditions. NSCH data are reported by a parent or guardian. While a caregiver is likely to be aware of diagnoses, it is possible that the caregiver responding to the survey is unaware or unwilling to report a diagnosis. Anxiety, depression, and ADHD are as diagnosed by a doctor, while behavioral problems include those diagnosed by an educator. 

Health Equity in Injury Data: Approaches for Injury Data Communication and Dissemination With a Health Equity Lens

Aaron Clark, Natasha Kataeva, Rivers Laraque-Ho, Sarah Milder, Samantha Sanvik, and Kristin Shaw
Developed in collaboration with the Council of State and Territorial Epidemiologists (CSTE) and produced with support from the Centers for Disease Control and Prevention (CDC)
2024

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Health Equity in Injury Data offers practical strategies for communicating injury data through a health equity lens. The guide underscores a key idea: data visualizations are more than displays of information — they are stories that shape understanding, influence decisions, and can validate or challenge inequities. As the report describes, public health professionals have a responsibility to pair quantitative results with context, ensuring data on disparities does not unintentionally reinforce stigma or misinterpretation. Through clear examples, practical guidance, and accessible design, the resource offers tools for creating injury data visualizations that are equitable, inclusive, and impactful.

Data Maven’s role in this collaboration included writing, research, and technical expertise in data communication, health equity and accessibility. The guide was designed by Emily Aldrich of Aldrich Design and reviewed for accessibility and usability by Data Maven’s Zoe Portlas and Alexia Málaga. Members of the CSTE Injury Surveillance Workgroup and Health Equity Subcommittee provided valuable insight throughout the development process, shaping a resource that reflects the shared expertise and priorities of the applied epidemiology community.

Syphilis Resurgence in the United States (2017-2022): An Analysis of Trends, Geographic Variations and Disparities

Samantha Liv
2024 Council of State and Territorial Epidemiologists (CSTE) Annual Conference • Pittsburgh, PA

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Background

The rising incidence of primary, secondary and congenital syphilis across the United States presents significant public health challenges. This study analyzed syphilis cases and rates from 2017 to 2021, aiming to provide an understanding of the temporal trends, geographical variations and population disparities associated with the resurgence in sexually transmitted infections.

Methods

U.S. state-level temporal trends were analyzed from 2017 to 2021 via percent change calculations and geographic variations were assessed for the year 2021. Primary and secondary syphilis rates were analyzed by age, race/ethnicity and sex at the national level. Data was obtained from the CDC NCHHSTP AtlasPlus and analysis was performed using R statistical software.

Results

Temporal trends from 2017 to 2021 showed primary and secondary syphilis rate changes across the nation, the highest occurring in Alaska with a 1372% increase (1.8 to 26.5 per 100,000) and a decrease in two states and the District of Columbia (-3%; 39.4 to 38.4 per 100,000): Vermont (-33%; 2.1 to 1.4 per 100,000) and Maine (-10%; 4.9 to 4.4 per 100,000). Congenital syphilis rates increased in nearly all states. The highest increase was in Mississippi (6641%, 2.7 to 182.0 per 100,000) while the lowest increase occurred in Nebraska (5.1%; 3.9 to 4.1 per 100,000). 

In 2021, South Dakota reported the highest rate of primary/secondary syphilis (48.7 per 100,000, 436 cases), while Vermont reported the lowest (1.4 per 100,000, 9 cases), highlighting regional variability. For congenital syphilis, Arizona faced the highest rate (232.3 per 100,000, 181 cases), while Maine, New Hampshire, and Wyoming reported zero cases, and Nebraska, Delaware and Vermont each reported 1 case (4.1, 9.5 and 18.6 per 100,000, respectively) in 2021.

Between 2017 and 2021, rates of primary and secondary syphilis across the U.S. have increased in all populations, notably for American Indians/Alaska Natives (325%; 11.0 to 46.7 per 100,000), females (217%; 2.3 to 7.3 per 100,000) and adults ages 65+ (114%; 0.7 to 1.5 per 100,000).

Conclusions

This study highlights syphilis trends in the United States from 2017 to 2021. Alarming increases in primary and secondary syphilis, particularly in Alaska, contrast with declines in Vermont, Maine, and D.C., necessitating targeted interventions. The surge in congenital syphilis, notably in Mississippi, underscores maternal and child health challenges, urging focused preventive measures. These findings emphasize the need for continued surveillance and targeted strategies to mitigate syphilis impact across diverse populations nationwide.

Examining Subgroup Differences in the Three Leading Causes of Death Among Minnesota Children and Teens During 2018-2022

Natasha Kataeva
2024 Minnesota Public Health Association (MPHA) Annual Conference

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Death rates were accessed using CDC WONDER Provisional Mortality Statistics files. In 2018-2022, 1,315 MN children ages 1-19 died. The three leading causes of death were accidents (535), suicide (258), and homicide (150). Each cause of death was analyzed by age group, sex, race/ethnicity, and mechanism of death.

The accidental death rate was 7.8 per 100,000. Motor vehicle traffic accidents were the most common mechanism. The rate was highest among 15-19 year olds (18.5), males (10.0), and American Indian/Alaska Native children.

The suicide rate was 3.7 per 100,000. Suffocation was the most common mechanism. The death rate was highest among 15-19 year olds, males (5.2), and American Indian/Alaska Native children (23.6).

The homicide rate was 2.2 per 100,000. Firearms were the most common mechanism. The death rate was highest among 15-19 year olds (5.2), males (3.3), and Black children (9.9).

Maternity Care Deserts and Their Associations With Infant, Child and Maternal Mortality at the State Level

Natasha Kataeva
2023 American Public Health Association (APHA) Annual Meeting and Expo

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Background

U.S. maternal mortality rates are rising and many women have no access to care. Maternity care deserts are typically measured at the county-level, however, many states have initiatives to reduce maternal mortality. The associations between state-level infant, child and maternal mortality rates and the proportion of females living in a maternity care desert were examined.

Methods

The state-level proportion of females ages 15-44 living in a maternity care desert (county with no hospitals providing obstetric care, no birth centers, no OB/GYN and no certified nurse midwives) was calculated using 2020 March of Dimes and CDC WONDER Single-Race Population Estimates data. State-level children (deaths per 100,000 ages 1-19), infant (deaths before age 1 per 1,000 live births) and maternal (deaths related to or aggravated by pregnancy, excluding accidental or incidental causes occurring within 42 days of the end of a pregnancy per 100,000 live births) mortality rates were calculated from 2018-2020 CDC WONDER, Multiple Cause of Death Files; 2019-2020 Linked Birth/Infant Death Files; and 2016-2020 Federally Available Data, Maternal and Child Health Bureau, respectively. 

Results 

Maternity care deserts had a low positive correlation with maternal mortality (r=0.49), a moderate positive correlation with infant mortality (r=0.55) and a high positive correlation with child mortality (r=0.71).

Conclusion

States with a higher percentage of females living in maternity care deserts tended to have higher rates of maternal, infant and child mortality. More research is needed to unpack the relationship between maternity care deserts and mortality.