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

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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.

Adverse Childhood Experiences By Experience, Demographic Group and State

Samantha Liv
2025 Council of State and Territorial Epidemiologists (CSTE) Annual Conference

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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 2025 Annual Conference

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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.