DOCUMENT RESUME PS 029 018 ED 447 921 Child Health USA, 2000. TITLE Health Resources and Services Administration (DHHS/PHS), INSTITUTION Washington, DC. Maternal and Child Health Bureau. 2000-00-00 PUB DATE 83p.; For 1999 edition, see ED 438 063. NOTE U.S. Government Printing Office, Superintendent of AVAILABLE FROM Documents, Mail Stop: SSOP, Washington, DC 20402-9328. Single copies also available from: National Maternal and Child Health Clearinghouse, 2070 Chain Bridge Road, Suite 450, Vienna, VA 22182-2536; Tel: 703-356-1964. For full text: http://www.mchb.hrsa.gov. Descriptive -- Reports Numerical/Quantitative Data (110) PUB TYPE (141) MF01/PC04 Plus Postage. EDRS PRICE Adolescents; Birth Weight; *Child Health; Demography; Early DESCRIPTORS Parenthood; Employed Parents; Health Behavior; Health Care Costs; *Health Needs; *Incidence; Infant Mortality; Infants; Mortality Rate; Mothers; Municipalities; Poverty; Prenatal Care; *Social Indicators; Tables (Data) Healthy People 2010; *Indicators; Medicaid; Vaccination IDENTIFIERS ABSTRACT Intended to inform policymaking in the public and private sectors, this booklet compiles secondary data for 59 health status indicators. The book provides both graphical and textual summaries of data and addresses long-term trends where applicable. Data are presented for the target populations of Title V funding: infants, children, adolescents, women of childbearing age. In children with special health care needs, addition to health status, the book addresses health service2 ;F:nd population characteristics. Following the introduction, which discusses trends and issues in children's health, the booklet has six sections: (1) "Population Characteristics," including children in poverty, maternal age, "Health Status," discussing the working mothers, and school dropouts; (2) "Health health issues related to infants, children, and adolescents; (3) Services and Utilization," including health care financing, vaccination coverage levels, physician visits, service utilization by children with chronic conditions, hospital utilization, and prenatal care; (4) "State-Specific Data," including data tables on infant and neonatal mortality, prenatal care, low birth weight, births to women under 18, "City Data," focusing on Medicaid information, and health insurance; (5) comparisons between cities with populations over 100,000 and national data on "Healthy infant mortality, low birth weight, and prenatal care; and (6) People 2010 Objectives." (Contains 34 references.) (EV) Reproductions supplied by EDRS are the best that can be made from the original document. a ©1h uom CS U.S. DEPARTMENT OF EDUCATION Office of Educational Research and Improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) AThis document has been reproduced as received from the person or organization originating it. Minor changes have been made to improve reproduction quality. Points of view or opinions stated in this document do not necessarily represent Administration erdlililltisoujces and official OERI position or policy. latemal and Child Health Child Health USA 20 1 U.S. Department of Health and Human Services Health Resources and Services Administration Maternal and Child Health Bureau 3 3 founmwas 58 Hospital Utilization 32 Child Mortality LETTER FROM DR. VAN DYCK .. . .5 60 Prenatal Care Childhood Deaths Due to Injury 33 Adolescents 6 INTRODUCTION 62 IV. STATE-SPECIFIC DATA 34 Physical Activity and Overweight Prenatal Care, Low Birth Weight, 36 Sexual Activity and Condom Use I. POPULATION . .63 and Births to Women Under 18 . 37 10 Adolescent Childbearing CHARACTERISTICS . Medicaid Recipients, Expenditures 38 Adolescent STD s Population of Children 11 64 and EPSDT Services 39 Abortion among Adolescents 12 Children in Poverty 65 SCHIP Enrollees .40 Adolescent AIDS, by Race/Ethnicity 13 School Dropouts 66 Health Insurance Status Adolescent AIDS, by Gender 41 14 Working Mothers/Child Care 67 Uninsured Children (Map) .42 Young Adult AIDS, by Race/Ethnicity 16 Maternal Age 68 Infant and Neonatal Mortality 43 Violence 44 17 Cigarette Smoking H. HEALTH STATUS 69 V. CITY DATA 45 Infants Substance Abuse 70 Low and Very Low Birth Weight 46 Adolescent Mortality 18 Infant Feeding 71 Infant Mortality Adolescent Deaths Due to Injury 47 20 Low Birth Weight 72 Prenatal Care 21 Very Low Birth Weight III. HEALTH SERVICES 22 International Infant Mortality 48 VI. HEALTHY PEOPLE 23 UTILIZATION Infant Mortality 73 2010 OBJECTIVES 49 .24 Health Care Financing Neonatal and Postneonatal Mortality 76 References 50 25 Vaccination Coverage Maternal Mortality 79 Contributors 51 Children Immunization Schedule 52 27 Dental Health Vaccine-Preventable Diseases 54 28 Physician Visits Child Abuse and Neglect 55 29 Place of Physician Contact Pediatric AIDS Service Utilization by Children with 30 Hospitalization 56 Chronic Conditions Hospital Discharge Trends 31 5 - , t , , , 5 Please note that Child Health USA 2000 is toward the goals set out in the MCHB's strate- Dear Colleague: not copyrighted. Readers are free to duplicate gic planto eliminate barriers and health dis- and use all or part of the information con- parities, to assure quality of care, and to The Health and Services Resources tained in this publication. The book is available 'improve the health infrastructure and system. Administration's Maternal and Child Health Single online at http: / /www.mchb.hrsa.gov. Child Health USA is published to provide Bureau (MCHB) is pleased to present Child copies of this publication are also available at the most current data available for public Health USA 2000, the eleventh annual report no cost from the National Maternal and Child health professionals and other individuals in on the health status and service needs of Health Clearinghouse, 2070 Chain Bridge the private and public sectors. The book's suc- To assess the Bureau's America's children. Road, Suite 450, Vienna, VA 22182-2536, tele- cinct format is intended to facilitate the use of progress toward achieving its vision for a phone: (703) 356-1964 or (888) 434-4624. the information as a snapshot of measures of Nation where all individuals enjoy equal access I hope the information provided in Child children's health in the United States. to quality health care in a supportive, culturally Health USA 2000 is a valuable resource for Population The first section, competent, family and community setting, your efforts to plan, implement, or expand pro- Characteristics, presents statistics on factors MCHB has compiled this book of secondary grams that affect the health of children in the that influence the well-being of children. The data for 59 health status indicators. It provides United States. second section, entitled Health Status, contains both graphical and textual summaries of data vital statistics and health behavior information and addresses long-term trends where applica- for infants, children, adolescents, and women Sincerely yours, ble. of childbearing age. The third section, Health Data are presented for the target popula- Services Utilization, contains data regarding tions of Title V funding: infants, children, ado- health care financing and newly implemented lescents, children with special health care health policies. The fourth and fifth sections In needs, and women of childbearing age. contain information on selected indicators at addition to population characteristics, this Peter C. van Dyck, M.D., M.P.H. This edition also the state and city levels. book also addresses health status and health Associate Administrator for Maternal and includes a special section that lists the Healthy Child Health USA 2000 services utilization. Child Health People 2010 Objectives for Maternal, Infant, also provides insight into the Nation's progress and Child Health. 7 6 T;.-,,JP5rvAlFqt*4zk INTc., ODUCTION months of pregnancy) went up for the ninth of preventive health benefits for both mother consecutive year, with nearly 83 percent of and child. The benefits of breastfeeding Early childhood is a critical time in chil- women receiving care in the first trimester. include prevention of diarrhea and infections dren's physical, emotional, and intellectual in infants, as well as long-term preventive However, this percentage is significantly lower development, a time when children's environ- for minority women; only 73 percent of effects for the mother, including earlier return ment can have the greatest influence on their African-American mothers and 74 percent of to pre-pregnancy weight and reduced risk of In addition to the effect of future success. Hispanic mothers received early care. African- premenopausal breast cancer and osteoporosis. positive relationships with parents and care- In 1998, more than 64 percent of mothers American and Hispanic women are also more givers and the influence of early childhood likely to begin care late in pregnancy or to reported breastfeeding their babies right after education on the social and intellectual devel- delivery, the highest rate in recent years. deliver with no prenatal care at all. opment of children, many important steps Young mothers are particularly likely to However, rates of breastfeeding decline dra- taken before and soon after birth can greatly enter prenatal care late in pregnancy, and the matically after the initial months of life, and influence children's health and physical devel- children of teenage mothers are more likely to only 29 percent report that they are still breast- opment. These include early and adequate pre- face economic, health, and developmental chal- feeding their infants at 6 months of age. These natal care, breastfeeding, and immunization. Another area in which we have seen lenges. the United rates are even lower among African-American Fortunately, States has seen progress, is in the rate of births to adolescent women and young mothers; 45 percent of progress in recent years in many of these areas. women. In 1998, the birth rate among adoles- African-American women report breastfeeding However, many threats to the lives and health cents was 51 births per 1,000 women aged 15- in the hospital, and only 19 percent breastfed at of young children (as well as older children and 19, the lowest rate reported since 1987. 6 months. adolescents) remain, and significant effort is However, again, teen birth rates are much high- An early indicator of the health of infants still needed to assure the healthy development er within minority groups: for African- is their birth weight. Babies born at low birth of America's children. Americans, the adolescent birth rate in 1998 weight (less than 2500 grams, or 5.5 pounds) One of the earliest steps we can take for was 85 births per 1,000 women 15-19, and for are most susceptible to physical disabilities, to assure that pregnant children's health is Hispanics, the rate was 94 births per 1,000 and infant developmental women have access to prenatal care early in delays, death. women. Despite improvements in the use of prental pregnancy and that they receive appropriate Breastfeeding is another important contrib- care, the rate of low birth weight has actually care throughout pregnancy. In 1998, the per- utor to the health of young children, and rates risen in recent years; the rate reported in 1998 centage of births to women who received early of breastfeeding have also shown improve- prenatal care (beginning in the first three was 7.6 percent of all live births, which is sim- ment in recent years. Breast milk has a number ilar to the rates seen thirty years ago. However, 7 N'FIR 1)1 The major risks to children's health and their tance of putting infants down to sleep on the causes of these rates of low birth weight development, particularly after infancy, are in backs. appear to be changing. The recent increases largely preventable. The leading cause of death As children grow, preventive health care is the low birth weight rate, at least among white is injury, including for children over age essential for monitoring their health and devel- in the 1 women, can be attributed to increases motor vehicle crashes, firearms (including opment and assuring that they receive the rec- rate of multiple births, as twins and triplets are In 1998, injuries homicides), and drowning. ommended series of immunizations. The per- at particular risk for being small at birth. caused the deaths of 6,420 children under age centage of 19- to 35-month-old children who Another important risk factor for low birth 15. Other leading causes of death in childhood had been fully immunized in 1998 was the weight is smoking during pregnancy. neoplasms, or are birth defects and malignant highest ever recorded, with 78 percent of chil- Another sentinel indicator of the health of dren receiving all recommended vaccines. cancer. young children is the rate of infant mortality. As we focus our attention on the health and However, approximately 1 million children still In 1998, the infant mortality rate remained developmental needs of young children, we need one or more of the recommended doses steady at 7.2 deaths per 1,000 live births, the crit- must not forget that adolescence is another of vaccine to be fully protected. lowest rate ever recorded in the U.S. However, Lifetime health ical period in children's lives. Children are more likely to have access to this rate still ranks 26th among the industrial- habits, both positive and negative, are formed both preventive and acute health care, in infan- ized nations of the world. In addition, the mor- during the teenage years, and the groundwork is adolescence, cy and throughout childhood and tality rate among African-American infants is laid for the health of the next generation. if they have a source of comprehensive health still more than twice that of whites. The lead- While most adolescents are generally healthy, In 1998, nearly 16 percent of chil- coverage. ing causes of neonatal mortality, or death in the significant threats to adolescent health remain. dren, or over 11 million children, were unin- first 28 days of life, are birth defects and disor- One of the greatest of these threats is cigarette sured, a proportion that was unchanged from ders related to short gestation (preterm deliv- smoking, which, when begun in the teen years, 1997. This proportion varies across the coun- Neonatal deaths ery) and low birth weight. 1999, can have lifelong health consequences. In in try, from 6 percent in Nebraska to 26 percent make up two-thirds of all infant deaths. The the percentage of eighth-graders who smoke Arizona and Texas. However, the implementa- leading causes of postneonatal mortality, or decreased to 18 percent, while the percentage tion of the State Children's Health Insurance death between 28 days and 1 year of age, are of tenth- and twelfth-graders who smoke Program in all 50 states has improved access to Sudden Infant Death Syndrome, or SIDS, and remained steady at 26 and 35 percent, respec- health insurance for low-income children, and birth defects. The rate of SIDS has dropped tively. The prevalence of smoking among teens by the end of 1999 these programs had dramatically in the past five years, as parents has increased substantially since 1991. enrolled two million children. and caregivers have learned about the impor- 9 8 ONTR OLT= I% Other important threats to the lives and tary, and professional organizations, in 28 focus health of adolescents include injury, particular- The 23 objectives in the Maternal, areas. ly motor vehicle crashes, the leading cause of Infant, and Child Health focus area are includ- death among teens aged 15-19; sexually trans- ed here. Although the methods used to calcu- mitted diseases; substance abuse; and violence. late the specific statistics in this book may not Motor vehicle crashes caused the deaths of precisely coincide with the way these national 5,213 15- to 19-year-olds in 1998, and firearms and state-level objectives are measured, the were the cause of death for another 3,593 ado- :;-;information presented here will provide readers lescents. The number of AIDS cases reported with timely and accurate data that allows for an in adolescents and young adults has declined in overview of the current status of child health. recent years, and rates of other reportable sex- ually transmitted diseases, including chlamydia, gonorrhea, and syphilis, appear to be decreasing as well. However, STDs still affect thousands of adolescents and young adults each year and can have lasting health effects if not adequately treated. The statistics presented here paint a picture of continuing progress toward the goal of healthy children and families, but we still have a long way to go in many areas. On the National level, the U.S. Department of Health and Human Services has launched Healthy People 2010, a revised set of health objectives for the Nation that focuses on two major goals: increasing the quality and years of healthy life and eliminating health disparities. These goals 10 are reflected in 467 specific objectives, devel- oped by a consortium of government, volun- 9 ' ,--'- . - .!i.e. 1\ k