The survey is representative of the non-institutionalized, civilian population of persons under age 65.

1997 Survey:
Detailed information was obtained on 75,437 adults and 34,439 children in 44,461 households. Data collected Feb — Nov 1997.

1999 Survey:
Almost 46,000 households interviewed, with similar counts of adults and children. Data collected Feb-Oct 1999.

2002 Survey:
Planned at about 40,000 households. Broadly similar to earlier rounds.

Information about the children and the household was obtained from the adult in the household who was most knowledgeable about the health care and education of the children on whom the survey questions focused. In some households with children, adults under age 65 who had no children were also surveyed. In households without children, one or two nonelderly adults were selected randomly for interviewing.

Data were collected from February to November using computer-assisted telephone interviewing (CATI) technology. The sample consists of households with and without telephones. In households without telephones, cellular phones were provided to complete interviews.

Information about the children and the household was obtained from the adult in the household who was most knowledgeable about the health care and education of the children on whom the survey questions focused. In some households with children, adults under age 65 who had no children were also surveyed. In households without children, one or two nonelderly adults were selected randomly for interviewing.

Data were collected from February to November using computer-assisted telephone interviewing (CATI) technology. The sample consists of households with and without telephones. In households without telephones, cellular phones were provided to complete interviews.

Information about the children and the household to be obtained from the adult in the household who is most knowledgeable about the health care and education of the children on whom the survey questions are focused. In some households with children, adults under age 65 who have no children will also be surveyed. In households without children, one or two nonelderly adults will be selected randomly for interviewing.

Data to be collected from February to November using computer-assisted telephone interviewing (CATI) technology. The sample consists of households with and without telephones. In households without telephones, cellular phones will be provided to complete interviews.

Income and Hardship

Poverty among Nonelderly Americans
Children were more likely to be poor than adults: The poverty rate reached 20 percent for children, compared to 12 percent for adults. Furthermore, 43 percent of children lived in low-income families, whereas 29 percent of adults did. The poverty rate varied widely across the 13 states surveyed.

Poverty among Children
Children living with one parent were much more likely to be poor than children living with two parents-44 percent compared to 11 percent-because one-parent families typically rely on a lone adult for economic support. Even with support from the noncustodial parent, some children in one-parent families remain poor.

Employment
Employment rates varied by family situation and were particularly uneven among parents with children living at home. Married mothers were the least likely parents to work (68 percent did), whereas married fathers were the most likely (94 percent). Among unmarried parents, 74 percent worked. Although 83 percent of all childless adults had jobs, only 57 percent of low-income childless adults worked.

Affordability of Housing
Nationally, 16 percent of parents had experienced housing hardship. Among families with low incomes (under 200 percent of the poverty level), 28 percent had experienced housing hardship, as opposed to 9 percent of families with higher incomes, a statistically significant difference.

Food Concerns and Affordability
Most Americans eat regularly, without fear of running out of food because they lack money. In some households, however, limited buying power produces uncertainty about-and interruptions in-the availability of food. These situations heighten stress and can cause hunger or even poor nutrition.

Health

Health Insurance Coverage of Children
While private plans are the leading source of health insurance coverage for all Americans, public insurance plays an important role, particularly for low-income children. Public coverage for these children varied from a high of 53 percent in Washington to lows of 27 percent and 28 percent in Wisconsin and Colorado, respectively. In some states, broad public coverage offset low rates of private coverage.

Health Insurance Coverage of Nonelderly Adults
Nationally, 17 percent of nonelderly adults lacked health insurance coverage. In families with low incomes (below 200 percent of the federal poverty level), 37 percent of adults were uninsured. In contrast, 9 percent of adults with higher family incomes were uninsured, a statistically significant difference.

Confidence in the Ability to Get Children Medical Care
At the national level, 8 percent of children under age 18 had parents who were not confident that they could get necessary medical care. However, there was a considerable difference in confidence between families with low incomes (below 200 percent of the federal poverty level) and those with higher incomes.

Children and Nonelderly Adults with No Usual Source of Health Care
Nationally, adults were much more likely than children to have no usual source of care: 18 percent versus 6 percent, a statistically significant difference. This pattern held regardless of family income. However, there were large differences among adults and children across income groups.

Health Status of Nonelderly Adults and Children
Nationally, 12 percent of adults and 5 percent of children under age 18 were in fair or poor health, a statistically significant difference. This discrepancy in health status was consistent both in families with low incomes (below 200 percent of the poverty level) and in those with higher incomes. However, health status among adults and among children varied widely across income groups.

Children's environment and Behavior

Family Structure
On the national level, 63 percent of children lived in two-parent families, and the vast majority of those parents were married-only 3 percent of children lived with two unmarried biological or adoptive parents.

Children Born Outside of Marriage
Between 1978 and 1996, the number of babies born to unmarried women doubled, from just over 500,000 to over 1.2 million.

High Engagement in School
Nationally, 41 percent of all children were described as being highly engaged in school. In low-income families (below 200 percent of the poverty level), 34 percent of children were highly engaged, compared to 45 percent of children in higher-income families, a statistically significant difference.

Reading and Telling Stories to Young Children
Under welfare reform, some low-income parents may find it more difficult to find time to read to young children because of the additional demands of job training and employment. However, for other parents, less worry about money and a more structured lifestyle may make daily reading more feasible.

Participation in Extracurricular Activities
Nationally, 83 percent of all children age 6 to 17 participated in at least one extracurricular activity, including clubs, sports, or lessons. Of children in families with low incomes (under 200 percent of the poverty level), 73 percent participated, compared to 90 percent of children in higher-income families, a statistically significant difference.

Behavioral and Emotional Problems in Children
If welfare reform results in low-income families living in improved communities and reduces parental stress and depression, behavioral and emotional problems in children may decline. However, if long or erratic hours of work reduce parental supervision and control or increase parental aggravation and stress, then children's problems may increase.

Adults' environment and Behavior

Parental Participation in Volunteer or Religious Activities
Nationally, 59 percent of children lived with a parent who reported participating in religious activities at least a few times a month. Thirty-eight percent of all children lived with a parent who volunteered a few times a month.

Parental Aggravation
Nationally, 9 percent of all children lived with a parent who felt highly aggravated. Of children in families with low incomes (below 200 percent of the poverty level), 14 percent lived with such a parent, compared to 6 percent of children in families with higher incomes, a statistically significant difference. Children of parents who did not have a spouse were significantly more likely than other children (16 percent versus 7 percent) to be living with a highly aggravated parent.

Mental Health of Parents
Nationally, 17 percent of children lived with a parent whose survey responses suggested poor mental health. Of children in families with low incomes (below 200 percent of the poverty level), 25 percent lived with a parent who had symptoms of poor mental health, compared to only 10 percent of children in families with higher incomes, a statistically significant difference. Children of parents without a spouse were significantly more likely than other children to be living with a parent in poor mental health-28 percent versus 13 percent.

Attitudes Toward Welfare and Working Mothers
Nationally, 78 percent of parents agreed or strongly agreed that welfare provides a disincentive to work. Variation among the 13 states surveyed was slight: The greatest agreement was 81 percent, in Florida, while the least was 72 percent, in Massachusetts.

INCOME AND HARDSHIP.

• Food problems: Nearly half of lower-income families reported worrying about or having difficulty affording food, compared to one out of seven higher-income families. Families in Wisconsin reported the lowest rate of food problems—consistent with their substantially lower poverty rates and high employment rates. Families in California, Florida, Texas and Mississippi, on the other hand, reported significantly higher rates of food problems than does the nation as a whole.
• Housing affordability: Nearly three in ten lower-income families reported being unable to pay the mortgage, rent, or utility bills at some point in the prior year. Among higher-income families, only one in ten reported experiencing such hardship.
• Living conditions in general: Living conditions vary considerably across states. Compared to the nation, for example, California has lower employment rates among low-income parents, more children in families having difficulty affording food, and more children with no usual source of health care. Texas has more parents with housing problems, more children in families having trouble affording food, more residents in poor health, and more children and adults with no health insurance.

• Twelve percent of all children lacked health insurance at the time of the survey, with 69 percent covered by private insurance and 20 percent by a public program, most often Medicaid. Despite high rates of public coverage, 21 percent of low-income children were uninsured.
• Nationwide, among low-income families, 8 percent of children were in poor or fair health and 10 percent had no usual source of care.
• Adults fared worse. Although 44 percent of low-income adults had private insurance, 37 percent remained uninsured at the time of the survey. Twenty-three percent, nationally, were in fair or poor health, and adults were much more likely than children to lack a usual source of care.
• The national figures mask extensive variation in uninsurance rates across states—that in turn are driven largely by differences in the extent of private coverage. Massachusetts, Michigan, Minnesota and Wisconsin, for instance, have only 5 to 6 percent of their children uninsured, compared to the 19 to 21 percent uninsured in Mississippi and Texas. Such variation indicates that some states are likely to have a harder time closing their gaps in health care coverage than others.

• Parents: Parents in low-income families were much more likely than other parents to report symptoms of poor mental health (25 percent vs. 10 percent) and to experience frequent high levels of aggravation (14 percent vs. 6 percent). These problems were also more pronounced among parents who are not married. Among low-income parents, 32 percent of parents who are not married reported symptoms of poor mental health, compared with 21 percent of married parents. Among higher-income families, parents who are not married were twice as likely as married parents to report these symptoms.
• Children: Children in lower-income families are more likely to have behavioral and emotional problems and are less likely to be highly engaged in school than children in upper- income families. Even though lower-income children are less likely than higher-income children to participate in clubs, sports, or lessons outside the classroom (73 percent compared to 90 percent), they still participate at a very high rate.

ECONOMIC WELL-BEING.

• Nationally, the employment rate for low-income single parents increased from 63 percent in 1997 to 67 percent in 1999.
• The national poverty rates for adults and children declined from 13 percent and 21 percent respectively in 1997 to 11 percent and 18 percent respectively in 1999.
• The gap between the proportion of black and white adults with low incomes grew by 3 percentage points, from a 24-percentage point gap to a 27-percentage point gap.
• California, Florida, Massachusetts, Mississippi, Washington, and Wisconsin saw significant movement of families from low-income to higher-income brackets.

• The rate of employer-sponsored insurance increased for low-income adults, especially among whites, young adults (ages 19 to 34), and those in fair or poor health.
• More children in families with incomes between 100 and 200 percent of poverty—the group primarily targeted by the State Children's Health Insurance Program—had public coverage.
• Although changes in patterns of insurance coverage between 1997 and 1999 varied by state, states' relative positions did not change dramatically. Only three of the 13 states studied—Alabama, Colorado, and Massachusetts—saw significant reductions in the number of uninsured adults and children.

• The percentage of children in two-parent families increased by about 1 percentage point to 64 percent in 1999, while the percentage in single-parent families decreased from 27 percent to 25 percent. The proportion of low-income children in single-parent families dropped from 44 percent in 1997 to 41 percent in 1999.
• The well-being of higher-income children and families declined in several respects. The proportion of higher-income young children whose parents read or told stories to them fewer than three days per week increased by about 2 percentage points. The proportion of higher-income children with highly aggravated parents—parents who reported frequently feeling frustrated and stressed by the experience of caring for their child—increased, especially in two-parent households. Higher-income children ages 6 to 17 became less likely to be highly engaged in school. Despite these declines, higher-income children fare significantly better than their low-income counterparts.
• The only significant national improvements in child well-being occurred among low-income 12- to 17-year-olds. A somewhat larger share of these children was highly engaged in school (30 percent in 1997 and 34 percent in 1999) and a smaller proportion exhibited high levels of emotional and behavioral problems (15 percent in 1997 and 10 percent in 1999).