Health and Safety

views updated May 14 2018

Chapter 4: Health and Safety

FACTORS AFFECTING CHILDREN'S HEALTH
DISEASES OF CHILDHOOD
MENTAL HEALTH ISSUES IN YOUNG PEOPLE
CHILDHOOD DEATHS

FACTORS AFFECTING CHILDREN'S HEALTH

A variety of factors affect children's health. These range from prenatal influences; access to and quality of health care; poverty, homelessness, and hunger; childhood diseases; and diet and exercise. This chapter discusses these factors and looks at the leading causes of death among infants, children, and adolescents.

Birth Defects

In Birth Defects: Frequently Asked Questions (December 12, 2006, http://www.cdc.gov/ncbddd/bd/faq1.htm), the Centers for Disease Control and Prevention (CDC) indicates that birth defects affect one out of every 33 babies born. Birth defects are the leading cause of infant deaths. In addition, these babies have a greater chance of illness and disability than do babies without birth defects. Two major birth defects, neural tube defects and fetal alcohol syndrome, are in large part preventable.

NEURAL TUBE DEFECTS. Major defects of the brain and spine are called neural tube defects. Each year, as many as 3,000 infants are born in the United States with neural tube defects caused by the incomplete closing of the spine and skull. Another estimated 1,500 pregnancies are either stillborn or terminated because of these defects. The occurrence of these defects can be greatly reduced by adequate folic acid consumption before and during early pregnancy.

FETAL ALCOHOL SYNDROME. Alcohol consumption by pregnant women can cause fetal alcohol syndrome (FAS), a birth defect characterized by a low birth weight, facial abnormalities such as small eye openings, growth retardation, and central nervous system deficits, including learning and developmental disabilities. The condition is a lifelong, disabling condition that puts these affected children at risk for secondary conditions, such as mental health problems, criminal behavior, alcohol and drug abuse, and inappropriate sexual behavior. Not all children affected by prenatal alcohol use are born with the full syndrome, but they may have selected abnormalities.

According to the CDC, in Tracking Fetal Alcohol Syndrome (December 5, 2006, http://www.cdc.gov/ncbddd/fas/fassurv.htm), estimates of the prevalence of FAS vary from 0.2 to 1.5 per 1,000 births in different areas of the United States. Other alcohol-related birth defects are thought to occur three times as often as FAS. In Alcohol Consumption among Women Who Are Pregnant or Who Might Become PregnantUnited States, 2002 (Morbidity and Mortality Weekly Report, vol. 53, no. 50, December 2004), the CDC finds that in 2002, 10.1% of pregnant women drank alcohol, putting their babies at risk for FAS. As many as one out of 50 (1.9%) pregnant women frequently drank alcohol. According to James Tsai et al., in Patterns and Average Volume of Alcohol Use among Women of Child-bearing Age (Maternal and Child Health Journal, vol. 11, no. 5, September 2007), 2% of pregnant women and 13% of nonpregnant women of childbearing age are estimated to engage in binge drinking, and 21.5% reported drinking at least 45 drinks per month.

Health Care

IMMUNIZATIONS. In America's Children in Brief: Key National Indicators of Well-Being, 2008 (2008, http://www.childstats.gov/americaschildren/index.asp), the Federal Interagency Forum on Child and Family Statistics explains that the proportion of preschool-age children immunized against communicable and potentially dangerous childhood diseasesincluding diphtheria, tetanus, and pertussis (whooping cough), known collectively as DTP, polio, and measlesdropped during the 1980s but rose significantly during the 1990s. By 2006, 85.2% of all children had received four doses of DTP, 92.8% had received three doses of poliovirus vaccine, 93.4% had received haemophilus influenzae type b vaccine, 93.3% had received three doses of hepatitis B vaccine, 92.3% had received measles

TABLE 4.1 Percentage of children vaccinated for selected diseases, by poverty statusa, raceb, and Hispanic originc, 1996 and 2006
CharacteristicTotalBelow povertyAt or above
199620061996200619962006
   Total
Combined series (4:3:1:3:3:1)d76.973.478.3
Combined series (4:3:1:3:3)e67.780.561.476.369.982.2
Combined series (4:3:1:3)f76.482.168.977.879.283.9
Combined series (4:3:1)g78.483.171.679.080.884.8
DTP (4 doses or more)h81.185.273.980.883.686.9
Polio (3 doses or more)i91.092.887.791.992.093.1
MMR (1 dose or more)j90.692.387.290.991.993.0
Hib (3 doses or more)k91.493.486.991.193.194.2
Hepatitis B (3 doses or more)l81.893.378.092.783.293.5
Varicella (1 dose or more)m12.289.25.488.315.390.0
PCV (3 doses or more)n86.984.188.0
White, non-Hispanic
Combined series (4:3:1:3:3:1)d77.869.078.9
Combined series (4:3:1:3:3)e68.982.259.374.170.583.1
Combined series (4:3:1:3)f78.583.968.075.280.484.9
Combined series (4:3:1)g80.184.770.376.781.985.7
DTP (4 doses or more)h82.786.672.478.084.787.6
Polio (3 doses or more)i91.993.388.290.192.593.6
MMR (1 dose or more)j91.492.885.187.792.593.5
Hib (3 doses or more)k92.894.187.487.993.794.8
Hepatitis B (3 doses or more)l82.193.876.491.783.394.0
Varicella (1 dose or more)m14.588.76.483.216.389.4
PCV (3 doses or more)n87.279.588.4
Black, non-Hispanic
Combined series (4:3:1:3:3:1)d73.871.776.8
Combined series (4:3:1:3:3)e66.876.761.374.071.980.4
Combined series (4:3:1:3)f74.278.469.375.879.181.9
Combined series (4:3:1)g76.678.972.576.580.982.4
DTP (4 doses or more)h79.081.274.378.883.384.8
Polio (3 doses or more)i90.190.486.890.492.691.4
MMR (1 dose or more)j89.790.988.390.890.891.6
Hib (3 doses or more)k89.491.085.989.992.893.4
Hepatitis B (3 doses or more)l81.991.577.891.685.092.5
Varicella (1 dose or more)m8.689.189.212.989.8
PCV (3 doses or more)n82.982.284.5

vaccines, and 89.2% had received varicella (chickenpox) vaccine. (See Table 4.1.) More than four out of five of these children received the vaccinations in combined series. Children living below the poverty line and African-American children were slightly less likely than the general child population to be immunized.

In 1994 the U.S. Department of Health and Human Services (HHS) implemented the Vaccines for Children (VFC) program, which provides free or low-cost vaccines to children at participating private and public health care provider sites. Eligible children, including children on Medicaid, children without insurance or whose insurance does not cover vaccinations, and Native American or Alaskan Native children can receive the vaccinations through their primary care physician. Children not covered under the program but whose parents cannot afford vaccinations can receive free vaccines at public clinics under local programs. The HHS states in Budget in Brief, Fiscal Year 2009 (2008, http://www.hhs.gov/budget/09budget/2009BudgetInBrief.pdf) that the VFC program and Section 317 (the supporting vaccine infrastructure) had a budget of $3.2 billion for fiscal year 2009. Vaccines provided through the program represented about 40% of all childhood vaccines purchased in the country.

The World Health Organization (WHO) and the United Nations Children's Fund report in Global Immunization Vision and Strategy, 20062015 (October 2005, http://www.who.int/vaccines-documents/DocsPDF05/GIVS_Final_EN.pdf) that developed nations, including the United States, generally have among the highest immunization rates in the world. The global immunization rate for DTP in 2003 was 78%, up from only 20% in 1980. Immunization rates for the developed world for the same time period were 10 to 20 percentage points higher than the global average, reflecting the low immunization rates in many developing nations. The WHO notes in Global Immunization Data (January 2008, http://www.who.int/immunization/newsroom/Global_Immunization_Data.pdf) that in 2006 immunization coverage exceeded 90% in Europe and the Americas, 92% in the western Pacific, and 86% in the eastern Mediterranean.

PHYSICIAN VISITS. Children's health depends on access to and usage of medical care. Based on household interviews of a sample of the civilian noninstitutionalized population, the National Center for Health Statistics (NCHS) finds that in 2006, 57.2% of children under the age of 18 visited the doctor between one and three times, 24.6% saw the doctor between four and nine times, and 7.3% saw the

 
TABLE 4.1 Percentage of children vaccinated for selected diseases, by poverty statusa, raceb, and Hispanic originc, 1996 and 2006 [CONTINUED]
CharacteristicTotalBelow povertyAt or above
199620061996200619962006
Not available.
aBased on family income and household size using US Bureau of Census poverty thresholds for the year of data collection.
bFrom 1996 to 2000, the 1977 OMB Standards for Data on Race and Ethnicity were used. Beginning in 2002, the 1997 OMB Standards for Data on Race and Ethnicity were used.
cPersons of Hispanic origin may be of any race.
dThe 4:3:1:3:3:1 series consists of 4 doses (or more) of diphtheria, tetanus toxoids and pertussis (DTP) vaccines, diphtheria and tetanus toxoids (DT), or diphtheria, tetanus toxoids and any acellular pertussis (DTaP) vaccines; 3 doses (or more) of poliovirus vaccines; 1 dose (or more) of any measles-containing vaccine; 3 doses (or more) of Haemophilus influenzae type b (Hib) vaccines; 3 doses (or more) of hepatitis B vaccines; and 1 dose (or more) of varicella vaccine. The collection of coverage rate estimates for this series began in 2002.
eThe 4:3:1:3:3 series consists of 4 doses (or more) of diphtheria, tetanus toxoids and pertussis (DTP) vaccines, diphtheria and tetanus toxoids (DT), or diphtheria, tetanus toxoids and any acellular pertussis (DTaP) vaccines; 3 doses (or more) of poliovirus vaccines; 1 dose (or more) of any measles-containing vaccine; 3 doses (or more) of Haemophilus influenzae type b (Hib) vaccines; and 3 doses (or more) of hepatitis B vaccines.
fThe 4:3:1:3 series consists of 4 doses (or more) of diphtheria, tetanus toxoids and pertussis (DTP) vaccines, diphtheria and tetanus toxoids (DT), or diphtheria, tetanus toxoids and any acellular pertussis (DTaP) vaccines; 3 doses (or more) of poliovirus vaccines; 1 dose (or more) of any measles-containing vaccine; and 3 doses (or more) of Haemophilus influenzae type b (Hib) vaccines.
gThe 4:3:1 series consists of 4 doses (or more) of diphtheria, tetanus toxoids and pertussis (DTP) vaccines, diphtheria and tetanus toxoids (DT), or diphtheria, tetanus toxoids and any acellular pertussis (DTaP) vaccines, 3 doses (or more) of poliovirus vaccines; and 1 dose (or more) of any measles-containing vaccine.
hDiphtheria, tetanus toxoids, and pertussis vaccine (4 doses or more of any diphtheria, tetanus toxoids, and pertussis vaccines, including diphtheria and tetanus toxoids and any acellular pertussis vaccine).
iPoliovirus vaccine (3 doses or more).
jMeasles-mumps-rubella (MMR) vaccine (1 dose or more) was used beginning in 2005. The previous coverage years reported measles-containing vaccines.
kHaemophilus influenzae type b (Hib) vaccine (3 doses or more).
lHepatitis B vaccine (3 doses or more).
mVaricella vaccine (1 dose or more) is recommended at any visit at or after age 12 months for susceptible children (i.e., those who lack a reliable history of chickenpox).
nThe heptavalent pneumococcal conjugate vaccine (PCV) is recommended for all children ages 223 months and for certain children ages 2459 months. The series consists of doses at ages 2, 4 and 6 months, and a booster dose at ages 1215 months.
SOURCE: Adapted from Table HC3. Childhood Immunization: Percentage of Children Ages 1935 Months Vaccinated for Selected Diseases by Poverty Status, and Race and Hispanic Origin, 19962006, in America's Children in Brief: Key National Indicators of Well-Being, 2008, Federal Interagency Forum on Child and Family Statistics, 2008, http://www.childstats.gov/americaschildren/tables.asp (accessed November 2, 2008)
Hispanicc
Combined series (4:3:1:3:3:1)d77.076.478.3
Combined series (4:3:1:3:3)e63.779.762.478.364.181.6
Combined series (4:3:1:3)f71.181.368.280.172.783.2
Combined series (4:3:1)g74.182.070.980.974.683.9
DTP (4 doses or more)h77.284.574.082.777.586.3
Polio (3 doses or more)i89.493.388.093.089.893.4
MMR (1 dose or more)j88.292.087.492.889.091.9
Hib (3 doses or more)k88.593.987.193.590.393.9
Hepatitis B (3 doses or more)l80.893.679.993.281.193.9
Varicella (1 dose or more)m7.689.66.390.511.290.5
PCV (3 doses or more)n88.987.789.8

doctor 10 or more times. (See Table 4.2.) However, 10.9% of children did not see a doctor at all. Poor children have less access to health care than nonpoor children.

HEALTH INSURANCE. One reason some children do not have access to medical care is their lack of health insurance. According to the U.S. Census Bureau, 11% (8.1 million) of American children had no health insurance coverage in 2007. (See Figure 4.1.) Factors affecting children's access to coverage included their age, race, and ethnicity, and their family's economic status. Children between the ages of 12 and 17 were more likely to be uninsured (12%) than six- to 11-year-olds (10.3%) and children under the age of six (10.5%). Poor children were proportionately more likely to be uninsured than all children (17.6% versus 11%), and those of Hispanic origin were the least likely racial or ethnic group to receive health insurance coverageone out of five (20%) Hispanic children were uninsured, compared to 12.2% of African-American children, 11.7% of Asian-American children, and 7.3% of non-Hispanic white children.

Child health insurance coverage increased slightly among all age groups, races, and ethnicities from 2000 to 2004, but then declined from 2004 to 2006. Overall, the percent of children covered by private health insurance declined from 70.2% in 2000 to 64.7% in 2006. (See Table 4.3.) In the press release HHS Issues New Report Showing More American Children Received Health Insurance in Early 2002 (December 31, 2002, http://www.hhs.gov/news/press/2002pres/20021231.html), the NCHS states that Tommy G. Thompson, the HHS secretary, attributed ongoing increases to a push to provide more government coverage, particularly under the State Children's Health Insurance Program. This trend, however, leveled off in 2005 and 2006.

According to Carmen DeNavas-Walt, Bernadette D. Proctor, and Cheryl Hill Lee of the Census Bureau, in Income, Poverty, and Health Insurance Coverage in the United States: 2005 (August 2006, http://www.census.gov/prod/2006pubs/p60-231.pdf), in 2005 government programs, such as Medicare, Medicaid, and military insurance, covered a greater proportion of African-American and Hispanic children than other children. Almost half (44.9%) of African-American children and 39.3% of Hispanic

 
TABLE 4.2 Health care visits to doctor's offices, emergency departments, and home visits over a 12-month period, by selected characteristics, 1997, 2005, and 2006
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]
CharacteristicNumber of health care visitsa
None13 visits49 visits10 or more visits
199720052006199720052006199720052006199720052006
 Percent distribution
18 years and over, age-adjustedb, c16.515.617.246.246.246.923.624.623.113.713.712.8
18 years and over, crudeb16.515.517.246.546.246.823.524.623.113.513.712.9
Age
Under 18 years11.810.210.954.156.357.225.226.124.68.97.47.3
      Under 6 years5.05.14.944.947.950.637.037.534.813.09.59.7
      617 years15.312.713.858.760.460.519.320.619.66.86.46.1
1844 years21.723.125.346.746.045.819.018.817.812.612.111.0
      1824 years22.024.325.346.844.747.220.019.217.411.211.810.2
      2544 years21.622.625.446.746.545.318.718.717.913.012.211.4
4564 years16.914.116.442.943.144.324.726.423.615.516.415.7
      4554 years17.915.918.543.945.146.123.423.921.814.815.113.6
      5564 years15.311.513.541.340.541.926.729.826.116.718.218.5
65 years and over8.95.76.034.731.133.232.536.736.223.826.524.6
      6574 years9.86.06.736.934.834.631.635.136.621.624.122.1
      75 years and over7.75.35.331.826.931.533.838.535.726.629.227.6
Sexc
Male21.320.422.847.146.946.820.621.920.011.010.810.4
Female11.810.811.845.445.546.826.527.326.216.316.415.2
Racec, d
White only16.015.217.246.146.046.223.924.923.414.014.013.2
Black or African American only16.816.016.046.147.549.223.223.623.313.912.911.5
American Indian or Alaska Native only17.120.513.538.036.644.224.229.427.620.713.414.7
Asian only22.821.621.949.149.551.319.720.518.18.38.58.7
Native Hawaiian or other Pacific Islander only********
2 or more races15.616.337.944.826.721.319.917.6
Hispanic origin and racec, d
Hispanic or Latino24.924.027.142.342.443.020.321.719.612.511.910.3
      Mexican28.926.731.140.841.740.818.520.518.311.811.19.8
Not Hispanic or Latino15.413.915.446.746.847.624.025.223.713.914.013.2
      White only14.713.115.046.646.746.924.425.724.214.314.613.9
      Black or African American only16.916.015.746.147.549.523.123.623.413.812.911.4
Respondent-assessed health statusc
Fair or poor7.89.212.223.321.921.229.027.128.139.941.938.6
Good to excellent17.216.217.848.448.549.323.324.422.811.110.910.1
Percent of poverty levelc, e
Below 100%20.620.821.037.837.539.522.724.322.318.917.417.2
100%less than 200%20.120.421.643.342.343.521.722.821.514.914.513.3
200% or more14.513.315.248.748.749.324.225.223.712.612.811.9
Hispanic origin and race and percent of poverty levelc, d, e
Hispanic or Latino
      Below 100%30.228.132.834.837.435.319.919.819.215.014.712.7
      100%less than 200%28.727.829.939.739.042.020.422.219.311.211.18.8
      200% or more18.919.422.248.847.147.420.422.720.411.910.810.1
Not Hispanic or Latino
      White only
            Below 100%17.016.616.338.336.438.723.927.424.220.919.720.8
            100%less than 200%17.317.618.844.142.243.722.223.222.216.317.015.4
            200% or more13.811.814.048.248.748.624.926.024.613.113.612.7
      Black or African American only
            Below 100%17.417.918.138.540.245.023.424.521.920.717.415.0
            100%less than 200%18.816.217.943.747.145.522.924.024.214.512.712.5
            200% or more15.615.213.551.750.453.622.723.423.510.011.09.3

children had government insurance, compared to only 18% of non-Hispanic white children and 15.9% of Asian-American children.

To remain in the Medicaid program, families must have their eligibility reassessed at least every six months. If the family income or other circumstances change even

TABLE 4.2 Health care visits to doctor's offices, emergency departments, and home visits over a 12-month period, by selected characteristics, 1997, 2005, and 2006 [CONTINUED]
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]
CharacteristicNumber of health care visitsa
None13 visits49 visits10 or more visits
199720052006199720052006199720052006199720052006
 Percent distribution
Health insurance status at the time of interviewf, g
Under 65 years
      Insured14.312.514.349.049.950.423.624.523.113.113.112.3
            Private14.712.914.750.651.852.623.124.122.411.611.310.3
            Medicaid9.810.011.335.538.337.426.525.825.528.225.925.8
      Uninsured33.737.639.242.842.142.215.314.412.58.25.96.1
Health insurance status prior to interviewf, g
Under 65 years
      Insured continuously all 12 months14.112.414.349.250.150.823.624.523.113.012.911.9
      Uninsured for any period up to 12 months.18.918.919.146.045.146.320.822.120.914.413.813.7
      Uninsured more than 12 months39.043.645.641.440.140.213.212.19.66.44.24.5
Percent of poverty level and health insurance status prior to interviewe, f, g
Under 65 years
      Below 100%
            Insured continuously all 12 months13.812.712.639.740.743.125.225.724.221.421.020.1
            Uninsured for any period up to 12 months19.719.017.837.637.639.321.923.223.420.920.219.5
            Uninsured more than 12 months41.246.250.139.935.335.312.214.29.96.64.44.8
100less than 200%
      Insured continuously all 12 months16.014.916.346.446.145.921.923.623.015.815.414.8
      Uninsured for any period up to 12 months18.819.320.645.144.949.821.021.718.715.014.110.9
      Uninsured more than 12 months38.743.644.341.039.442.114.012.510.26.34.53.4
200% or more
      Insured continuously all 12 months13.711.814.151.051.852.623.624.622.911.711.710.4
      Uninsured for any period up to 12 months17.818.618.650.348.148.020.422.120.711.511.212.7
      Uninsured more than 12 months36.641.142.843.844.842.413.210.29.36.43.9*5.5
Geographic regionc
Northeast13.211.412.145.947.147.626.026.525.114.915.015.2
Midwest15.913.815.247.747.448.422.824.723.613.614.012.7
South17.216.118.346.146.045.623.324.623.513.513.312.6
West19.120.121.744.844.446.722.822.820.213.312.611.3

slightly, the family can lose its eligibility for the Medic-aid program, disrupting health care coverage.

From the late 1980s through the mid-1990s the numbers of uninsured American children rose as coverage rates for employer-sponsored health insurance declined, even though the proportion of children covered by Medicaid also rose. In 1997, as part of the Balanced Budget Act, Congress created the State Children's Health Insurance Program (SCHIP) to expand health insurance to children whose families earned too much money to be eligible for Medicaid but not enough money to pay for private insurance. SCHIP provides funding to states to insure children, offering three alternatives: states may use SCHIP funds to establish separate coverage programs, expand their Medicaid coverage, or use a combination of both. By September 1999 all 50 states had SCHIP plans in place. By September 4, 2003, the program had been expanded to enroll even more children at higher income levels. According to the Centers for Medicare and Medicaid Services, in FY 2008 Number of Children Ever Enrolled YearSCHIP by Program Type (January 20, 2009, http://www.cms.hhs.gov/NationalSCHIPPolicy/downloads/FY2008StateTotalTable012309FINAL.pdf), in fiscal year 2008, 7.4 million children were enrolled in SCHIP, up from 7.1 million the year before.

Homelessness

Under the McKinney-Vento Homeless Assistance Act, the U.S. Department of Education is required to file a report on homeless children served by the act. The Department of Education obtains the data from school districts, which use

TABLE 4.2 Health care visits to doctor's offices, emergency departments, and home visits over a 12-month period, by selected characteristics, 1997, 2005, and 2006 [CONTINUED]
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]
CharacteristicNumber of health care visitsa
None13 visits49 visits10 or more visits
199720052006199720052006199720052006199720052006
*Estimates are considered unreliable. Data preceded by an asterisk have a relative standard error (RSE) of 20%30%. Data not shown have an RSE greater than 30%.
Data not available.
aThis table presents a summary measure of health care visits to doctor offices, emergency departments, and home visits during a 12-month period.
bIncludes all other races not shown separately and unknown health insurance status.
cEstimates are age-adjusted to the year 2000 standard population using six age groups: Under 18 years, 1844 years, 4554 years, 5564 years, 6574 years, and 75 years and over.
dThe race groups, white, black, American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and 2 or more races, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Starting with 1999 data, race-specific estimates are tabulated according to the 1997 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity and are not strictly comparable with estimates for earlier years. The five single-race categories plus multiple-race categories shown in the table conform to the 1997 Standards. Starting with 1999 data, race-specific estimates are for persons who reported only one racial group; the category 2 or more races includes persons who reported more than one racial group. Prior to 1999, data were tabulated according to the 1977 Standards with four racial groups and the Asian only category included Native Hawaiian or other Pacific Islander. Estimates for single-race categories prior to 1999 included persons who reported one race or, if they reported more than one race, identified one race as best representing their race. Starting with 2003 data, race responses of other race and unspecified multiple race were treated as missing, and then race was imputed if these were the only race responses. Almost all persons with a race response of other race were of Hispanic origin.
ePercent of poverty level is based on family income and family size and composition using U.S. Census Bureau poverty thresholds. Missing family income data were imputed for 25%29% of persons in 19971998 and 32%35% in 19992006.
fEstimates for persons under 65 years of age are age-adjusted to the year 2000 standard population using four age groups: Under 18 years, 1844 years, 4554 years, and 5564 years of age.
gHealth insurance categories are mutually exclusive. Persons who reported both Medicaid and private coverage are classified as having private coverage. Starting in 1997, Medicaid includes state-sponsored health plans and State Children's Health Insurance Program (SCHIP). In addition to private and Medicaid, the insured category also includes military plans, other government-sponsored health plans, and Medicare, not shown separately. Persons not covered by private insurance, Medicaid, SCHIP, public assistance (through 1996), state-sponsored or other government-sponsored health plans (starting in 1997), Medicare, or military plans are considered to have no health insurance coverage. Persons with only Indian Health Service coverage are considered to have no health insurance coverage.
hMSA is metropolitan statistical area. Starting with 2006 data, MSA status is determined using 2000 census data and the 2000 standards for defining MSAs.
Notes: In 1997, the National Health Interview Survey questionnaire was redesigned.
SOURCE: Table 82. Health Care Visits to Doctor Offices, Emergency Departments, and Home Visits within the Past 12 Months, by Selected Characteristics: United States, 1997, 2005, and 2006, in Health, United States, 2007. With Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, 2007, http://www.cdc.gov/nchs/data/hus/hus07.pdf (accessed September 15, 2008)
 Percent distribution
Location of residencec
Within MSAh16.215.616.846.446.547.523.724.523.113.713.412.6
Outside MSAh17.315.419.245.444.743.723.325.223.313.914.713.8

different methods of estimation. In Report to the President and Congress on the Implementation of the Education for Homeless Children and Youth Program under the McKinney-Vento Homeless Assistance Act (2006, http://www.ed.gov/programs/homeless/rpt2006.doc), the Department of Education states that 602,568 children who experienced homeless-ness at some point during the year were enrolled in school during the 200304 school year. Of these children, half (50.3%) lived doubled-up with relatives or friends, a quarter (25.3%) lived in shelters, 9.9% lived in hotels or motels, and 2.6% were unshelteredin other words, sleeping outside, in vehicles, or in abandoned buildings. This number is almost certainly much lower than the number of children who actually experienced homelessness during this period, as the homeless status of children does not always come to the attention of school officials and many homeless children are not enrolled in school.

The U.S. Conference of Mayors find in Hunger and Homelessness Survey: A Status Report on Hunger and Homelessness in America's Cities, a 23-City Survey (December 2007, http://www.usmayors.org/HHSurvey2007/hhsurvey07.pdf) that 23% of homeless people were in families with children, 76% were single men or women, and 1% were unaccompanied youthusually runaways. According to the Conference of Mayors, between 1994 and 2007 the proportion of families among the homeless generally declined, as did the proportion of unaccompanied youth among the homeless population. Data from this survey show city-by-city estimates of children as a percent of homeless family members. In Mayors Examine Causes of Hunger, Homelessness: The U.S. Conference of Mayors Release 2008 Hunger and Homelessness Survey Results (December 12, 2008, http://www.usmayors.org/pressreleases/documents/hungerhomelessness_121208.pdf), the Conference of Mayors announces that the homeless rate among cities, in general, grew about 12% from 2007 to 2008, and 16 cities cited an increase in homeless families.

Nearly nine out of 10 (87%) mayors surveyed in the 2007 report said the lack of affordable housing was a principal cause of homelessness among families with children, and 57% cited poverty. Another major cause of family homelessness was domestic violence: 39% of mayors cited such violence as a principal cause of homelessness among families with children. In contrast, 65% of mayors said mental illness and 61% said substance abuse were the principal causes of homelessness among single people and

 

unaccompanied youth. In Mayors Examine Causes of Hunger, Homelessness: The U.S. Conference of Mayors Release 2008 Hunger and Homelessness Survey Results twelve cities (63 percent) reported an increase in homelessness because of the foreclosure crisis.

The poverty and lack of stability that homelessness brings have a very negative impact on children. An example of the poor educational achievement of homeless youths is shown in Homeless Census and Homeless Youth/Foster Teen Study (2002, http://www.appliedsurveyresearch.org/www/products/MC_Homeless02_report.pdf), a study of unaccompanied homeless youths conducted in Monterey County, California. According to the survey's findings, 21% of 16-year-olds, 22% of 17-year-olds, 33% of 18-year-olds, 51% of 19-year-olds, 59% of 20-year-olds, and 70% of 21-year-olds were below grade level. Only 13% of the homeless youths in the study had a high school diploma or general equivalency diploma. The remaining 87% were performing below grade level.

Homelessness also has a negative impact on children's health. Catherine Karr of the National Health Care for the Homeless Council argues in Homeless Children: What Every Health Care Provider Should Know (December 29, 2003, http://www.nhchc.org/Children/index.htm) that these children suffer from frequent health problems. They are seen in emergency rooms and are hospitalized more often than other poor children. The often crowded and unsanitary conditions they live in lead to a higher rate of infectious diseases, such as upper respiratory infections, diarrhea, and scabies. Homeless children live in less structured and often unsafe environments, leaving them more vulnerable to accidents and injury. They tend not to have access to nutritious food, and are often malnourished or obese. Homeless children tend to lag behind their housed peers developmentally, and school-age homeless children often have academic problems. The greater likelihood that homeless children come from families plagued by mental illness, drug use, and domestic violence negatively affects their own mental health. Homelessness results in serious negative consequences for the children's health.

Hunger

Food insecurity is defined as the lack of access to enough food to meet basic needs. Mark Nord, Margaret Andrews, and Steven Carlson of the U.S. Department of Agriculture report in Household Food Security in the United States, 2006 (November 2007, http://www.ers.usda.gov/Publications/ERR49/ERR49.pdf) that in 2006, 89.1% of U.S. households were food secure, which remained essentially unchanged from the year before. However, the remaining 10.9% (12.6 million) of U.S. households experienced food insecurity at some time during the year. Most of these households used a variety of coping strategies to obtain adequate food, such as eating less varied diets, participating in food assistance programs, or getting food from community food pantries or soup kitchens. Regardless, 4% (4.6 million) of all households experienced very low food securityin other words, some household members reduced or otherwise altered their normal food intake because of a lack of money.

Nord, Andrews, and Carlson find that a higher percentage of children than adults were food insecure17.2% of children were food insecure, and 15.6% of households with children were insecure. Households experiencing food insecurity tend to go through a sequence of steps as food insecurity increases: first, families begin to worry about having enough food, then they begin to decrease other necessities, then they reduce the quality and quantity of all household members diets, then they decrease the frequency of meals and quantity of adult members food, and finally they decrease the frequency of meals and the quantity of children's food. Even though children are usually protected from being hungry, an estimated one out of every 200 children (0.6%) experienced very low food security on one or more days during the year. Households with incomes below the poverty line,

 
TABLE 4.3 Percentage of children under age 18 covered by health insurance, by type of insurance, age, race, and Hispanic origin, 19872006
Characteristic19871988198919901991199219931994199519961997199819992000200120022003200420052006
Not available.
Notes: Children are considered to be covered by health insurance if they had public or private coverage at any time during the year. Some children are covered by both types of insurance; hence, the sum of public and private is greater than the total. The data from 1996 to 2004 have been revised since initially published.
aFor race and Hispanic-origin data in this table: From 1987 to 2002, following the 1977 OMB standards for collecting and presenting data on race, the Current Population Survey (CPS) asked respondents to choose one race from the following: white, black, American Indian or Alaskan Native, or Asian or Pacific Islander. The Census Bureau also offered an other category. Beginning in 2003, following the 1997 OMB standards for collecting and presenting data on race, the CPS asked respondents to choose one or more races from the following: white, black, Asian, American Indian or Alaska Native, and Native Hawaiian or other Pacific Islander. All race groups discussed in this table from 2002 onward refer to people who indicated only one racial identity within the racial categories presented. People who responded to the question on race by indicating only one race are referred to as the race-alone population. The use of the race-alone population in this table does not imply that it is the preferred method of presenting or analyzing data. Data from 2002 onward are not directly comparable with data from earlier years. Data on race and Hispanic origin are collected separately. Persons of Hispanic origin may be of any race.
bPersons of Hispanic origin may be of any race.
cPublic health insurance for children consists mostly of Medicaid, but also includes Medicare, the State Children's Health Insurance Programs (SCHIP), and the Civilian Health and Medical Care Program of the Uniformed Services (CHAMPUS/Tricare).
SOURCE: Adapted from Table HC1. Health Insurance Coverage: Percentage of Children Ages 017 Covered by Health Insurance by Selected Characteristics, 19872006, in America's Children in Brief: Key National Indicators of Well-Being, 2008, Federal Interagency Forum on Child and Family Statistics, 2008, http://www.childstats.gov/americaschildren/tables.asp (accessed November 2, 2008)
Any health insurance
      Total87.186.986.787.087.387.386.385.886.285.385.385.087.588.488.788.889.089.589.188.3
Age
      Ages 0587.687.487.288.588.789.388.586.286.786.486.084.987.688.889.689.589.990.789.688.7
      Ages 61187.387.187.187.087.787.687.086.586.585.686.385.687.988.789.189.489.389.890.188.9
      Ages 121786.486.385.885.285.484.883.184.885.584.183.684.487.087.787.487.587.888.287.887.4
Race and Hispanic origina
      White, non-Hispanic90.390.390.390.090.490.289.489.489.589.689.589.692.592.893.0
      White-alone, non-Hispanic92.692.993.093.092.7
      Black83.184.083.585.484.786.384.483.484.781.481.581.084.286.386.8
      Black-alone86.586.188.288.285.9
      Hispanicb71.570.969.871.673.474.574.371.573.271.471.670.574.175.176.277.879.379.778.577.9
Private health insurance
      Total73.673.573.671.169.768.767.465.666.166.567.367.970.070.268.867.966.366.465.864.7
Age
      Ages 0571.771.070.668.266.164.663.459.760.462.463.664.366.466.564.963.962.362.361.460.5
      Ages 61174.374.174.972.571.270.870.067.367.267.168.468.570.270.469.068.566.667.366.665.4
      Ages 121775.175.575.773.072.170.969.070.371.070.269.870.973.273.572.471.269.769.569.267.9
Race and Hispanic origina
      White, non-Hispanic83.283.283.180.879.979.577.877.178.077.978.079.381.681.480.2
      White-alone, non-Hispanic79.678.677.978.176.9
      Black49.249.951.548.545.446.145.543.043.945.448.247.652.253.953.1
      Black-alone50.848.049.348.749.0
      Hispanicb47.948.348.244.942.841.941.837.738.339.941.843.246.345.243.943.542.443.842.040.9
Public health insurancec
      Total19.019.219.221.923.925.226.826.326.424.923.422.823.224.425.926.829.129.929.729.8
Age
      Ages522.122.923.727.630.032.835.133.332.630.828.626.827.329.231.332.134.435.534.734.7
      Ages 61118.618.218.020.022.322.924.825.225.624.723.123.023.424.526.426.828.829.529.829.5
      Ages 121716.116.215.317.518.619.119.819.920.519.218.618.619.219.820.321.924.425.024.725.5
Race and Hispanic origina
      White, non-Hispanic12.112.512.714.716.116.718.518.117.517.617.015.816.317.218.7
      White-alone, non-Hispanic18.520.521.221.222.0
      Black42.141.941.045.547.549.349.548.548.844.839.641.639.841.941.6
      Black-alone44.246.548.448.044.0
      Hispanicb28.227.427.031.936.538.340.838.439.035.333.931.532.934.637.039.642.042.241.442.3

households with children headed by a single woman, and African-American and Hispanic households were the most likely to experience food insecurity.

EMERGENCY FOOD ASSISTANCE . Feeding America (formerly America's Second Harvest), the nation's largest charitable hunger-relief organization, reports in Hunger Study, 2006 (2006, http://www.hungerinamerica.org/key_findings/) that in 2005, 25.3 million Americans sought emergency food assistance. In Hunger and Homelessness Survey, the Conference of Mayors states that 80% of mayors reported that requests for emergency food assistance had increased in 2007, and that the total number of emergency food assistance requests increased by 12% during that year. The Conference of Mayors note, Overall, it appears that the need for emergency food assistance programs is continuing to increase and that cities are facing many challenges in responding to the demand for assistance. The most frequent reasons for hunger cited by city officials were poverty (90% of mayors), high housing costs (57% of mayors), and unemployment (52% of mayors). Other causes included high medical, utility, and transportation costs, substance abuse, and a lack of education. In the 2008 report Mayors Examine Causes of Hunger, Homelessness, the Conference of Mayors observes that requests for emergency food assistance had continued to increase in most cities. The organization states that an estimated 59 percent of requests for food assistance were coming from familiesmany for the first-time.

Exposure to Toxins

Another threat to children's health is exposure to environmental toxins. Two toxins that children are most frequently exposed to are lead and second-hand smoke.

LEAD POISONING. Because they have smaller bodies and are growing, children suffer the effects of lead exposure more acutely than adults do. Lead poisoning causes nervous system disorders, reduction in intelligence, fatigue, inhibited infant growth, and hearing loss. Toxic levels of lead in a parent can also affect unborn children.

In Toys and Childhood Lead Exposure (August 31, 2007, http://www.cdc.gov/nceh/lead/faq/toys.htm), the CDC indicates that children are primarily exposed to lead in paint and plastics. Leaded paint was banned in the United States in 1978, although children may be exposed to leaded paint in older homes. Even though leaded paint is not used on toys manufactured in the United States, it is still widely used on toys manufactured in other countries. Therefore, children may be exposed to lead when playing with imported toys. In addition, the use of lead in plastic, which makes it more flexible and able to return to its original shape, has not been banned. The CDC explains that when the plastic is exposed to substances such as sunlight, air, and detergents the chemical bond between the lead and plastics breaks down and forms a dust.

David Barboza reports in Why Lead in Toy Paint? It's Cheaper (New York Times, September 11, 2007) that in 2007 nearly two dozen toys were recalled because they contained toxic levels of lead paint. Dozens of children's jewelry products, most of them made in China, had also been recalled in 2006 and 2007. In September 2007 Mattel, the world's largest toy maker, announced its third recall in six weeks, asking people to return certain toys made in China that contained high levels of lead paint. Lead paint is sometimes used in manufacturing products for children because it is less expensive than nonleaded paint. Ashland University randomly tested plastic toys and children's jewelry and found high lead levels in many of them, most of which had not been recalled. According to the article China Bans Lead Paint in Toys Exported to U.S. (Associated Press, September 11, 2007), China signed an agreement on September 11, 2007, to prohibit the use of lead paint on toys for export to the United States. However, Barboza states that enforcement of the regulations in China is lax.

In CDC Surveillance Data, 19972006 (November 29, 2007, http://www.cdc.gov/nceh/lead/surv/stats.htm), the CDC states that in 2006, 39,526 children in the United States aged five and under had confirmed blood lead levels greater than the CDC's recommended level of 10 micrograms per deciliter of blood. This was 1.2% of all children tested. According to the Commission for Environmental Cooperation, in Children's Health and the Environment in North America: A First Report on Available Indicators and Measures (January 2006, http://www.cec.org/files/PDF/POLLUTANTS/CEH-Indicators-fin_en.pdf), this number had dropped substantially since the early 1970s, due largely to the phasing out of lead in gasoline between 1973 and 1995. Even though children from all social and economic levels can be affected by lead poisoning, children in families with low incomes who live in older, deteriorated housing are at higher risk. Paint produced before 1978 frequently contained lead, so federal legislation now requires owners to disclose any information they may have about lead-based paint before renting or selling a home built earlier than 1978. Lead is also found in lead plumbing and is emitted by factory smokestacks.

SECONDHAND SMOKE AND CHILDREN. Environmental tobacco smoke is a major hazard for children, whose respiratory, immune, and other systems are not as well developed as those of adults. According to the CDC, in Disparities in Secondhand Smoke ExposureUnited States, 19881994 and 19992004 (Morbidity and Mortality Weekly Report, vol. 57, no. 27, July 11, 2008), secondhand or passive smoke (smoke produced by other people's cigarettes) increases the number of attacks and severity of symptoms in children with asthma and can even cause asthma in preschool-age children. It also causes lower respiratory tract infections, middle-ear disease, and a reduction in lung function in children, and it increases the risk of sudden infant death syndrome. The CDC

finds the percentage of children aged four to 11 who were regularly exposed to secondhand smoke in their homes decreased from 38.2% in the 198894 period to 23.8% in the 19992004 period, a reduction of 37.7%. The percentage of children aged 12 to 19 exposed to secondhand smoke decreased from 35.4% in the 198894 period to 19.5% in the 19992004 period, for an even larger decline of 44.9%.

DISEASES OF CHILDHOOD

Overweight and Obese Children

The number of overweight and obese Americans has reached epidemic proportions and has become a national concern. The percentage of overweight children and adolescents has grown significantly since the 1970s. Between 1976 and 1980, 6.7% of boys and 6.4% of girls aged six to 11 years were overweight. (See Table 4.4.) For boys, this percentage hit a high of 19.9%, or one in five boys, in the 200304 period, before dropping to a still high of 16.2% in 200506. Girls also hit a high of 17.6% in 200304, before it dropped to 14.1% in 200506.

An upward trend was also seen in the rates of overweight adolescents; 4.5% of boys and 5.4% of girls aged 12 to 17 were overweight in the period from 1976 to 1980, but 18.1% of adolescent boys and 17.5% of adolescent girls were overweight in the 200506 periodand these figures had not dropped from the previous two-year period. (See Table 4.4.) The proportion of overweight children overall between the ages of six and 17 tripled (from 5.7% to 16.5%) between 1976 and 2006.

The percentages of overweight children (in the 85th percentile or above for body mass index) and obese children (in the 95th percentile or above for body mass index) vary by race and ethnicity. In 2007 African-American adolescents were more likely to be overweight (19%) or obese (18.3%) than non-Hispanic white adolescents (14.3% were overweight and 10.8% were obese) or Hispanic adolescents (18.1% were overweight and 16.6% were obese). (See Table 4.5.) Younger students were more likely than older students to be either overweight or obese.

Medical professionals are concerned about this trend, because overweight children have an increased risk for premature death in adulthood as well as for many chronic diseases, including coronary heart disease, hypertension, diabetes mellitus (type 2), gallbladder disease, respiratory disease, some cancers, and arthritis. Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents. Being overweight or obese can also lead to poor self-esteem and depression in children.

Weight problems in children are thought to be caused by a lack of physical activity, unhealthy eating habits, or a combination of these factors, with genetics and lifestyle playing important roles in determining a child's weight. Watching television and playing computer and video games contribute to the inactive lifestyles of some children. According to Danice K. Eaton et al. of the CDC, in Youth Risk Behavior SurveillanceUnited States, 2007 (Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008), a quarter (24.9%) of high school students spent three or more hours per school day on the computer and more than a third (35.4%) spent three or more hours per school day watching television, often not getting a sufficient amount of physical exercise as a consequence.

Physical activity patterns established during youth may extend into adulthood and may affect the risk of illnesses such as coronary heart disease, diabetes, and cancer. Mental health experts correlate increased physical activity with improved mental health and overall improvement in life satisfaction. Eaton et al. report that only 43.7% of high school boys and 25.6% of high school girls met recommended levels of physical activity. (See Table 4.6.) White students were somewhat more likely to meet recommended levels of physical activity (37%) than African-American (31.1%) or Hispanic (30.2%) students. Only about half (53.6%) of high school students attended physical education classes, 56.3% played on a sports team, and only

 
TABLE 4.4 Percentage of children 617 who are overweight, by gender and age group, selected years 19762006
Age groupTotalMaleFemale
197619801988199419992000200120022003200420052006197619801988199419992000200120022003200420052006197619801988199419992000200120022003200420052006
Note: Overweight is defined as body mass index (BMI) at or above the 95th percentile of the 2000 Centers for Disease Control and Prevention sex specific BMI-for-age growth charts.
SOURCE: Table HEALTH5. Overweight: Percentage of Children Ages 617 Who Are Overweight by Gender and Age Group, 19761980, 19881994, and 19992000, 20012002, 20032004, and 20052006, in America's Children in Brief: Key National Indicators of Well-Being, 2008, Federal Interagency Forum on Child and Family Statistics, 2008, http://www.childstats.gov/americaschildren/tables.asp (accessed November 2, 2008)
Ages 617
    Total5.711.215.016.518.016.55.511.815.718.019.117.25.810.614.315.116.815.9
Ages 611
    Total6.511.315.116.318.815.16.711.615.717.519.916.26.411.014.314.917.614.1
Ages 1217
    Total5.011.114.916.817.217.84.512.015.618.418.318.15.410.214.215.216.017.5
 
TABLE 4.5 Percentage of high school students who were obese and who were overweight, by sex, race/ethnicity, and grade, 2007
CategoryObeseOverweight
FemaleMaleTotalFemaleMaleTotal
%%%%%%%
*Non-Hispanic.
Notes: Students who were 95th percentile for body mass index (BMI), by age and sex, based on reference data. Previous Youth Risk Behavior Survey reports used the term overweight to describe youth with a BMI 95th percentile for age and sex and at risk for overweight for those with a BMI 85th percentile and <95th percentile. However, this report uses the terms obese and overweight in accordance with the 2007 recommendations from the Expert Committee on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity convened by the American Medical Association (AMA) and cofunded by AMA in collaboration with the Health Resources and Services Administration and CDC.
Students who were 85th percentile but <95th percentile for body mass index, by age and sex, based on reference data.
SOURCE: Danice K. Eaton, Table 82. Percentage of High School Students Who Were Obese and Who Were Overweight, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White*6.814.610.312.815.714.3
Black*17.818.918.821.416.619.0
Hispanic12.720.316.617.918.318.1
Grade
  98.117.312.714.217.715.1
1010.716.613.818.317.017.6
119.816.413.214.215.916.0
129.314.712.013.114.914.0
       Total9.6 
 
TABLE 4.6 High school participation in physical activity, by demographic characteristics, 2007
CategoryMet recommended levels of physical activityDid not participate in 60 or more minutes of physical activity on any day
FemaleMaleTotalFemaleMaleTotal
%%%%%%
Notes: Were physically active doing any kind of physical activity that increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes/day on 5 or more days during the 7 days before the survey.
Did not participate in 60 or more minutes of any kind of physical activity that increased their heart rate and made them breathe hard some of the time on at least 1 day during the 7 days before the survey.
*Non-Hispanic.
SOURCE: Danice K. Eaton, Table 52. Percentage of High School Students Who Met Recommended Levels of Physical Activity and Who Did Not Participate in 60 or More Minutes of Physical Activity on Any Day, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White*27.946.137.028.216.722.4
Black*21.041.331.142.121.832.0
Hispanic21.938.630.235.218.827.1
Grade
  931.544.438.126.117.121.5
1024.445.134.831.716.324.0
1124.645.234.834.318.026.2
1220.638.729.536.221.528.9
   Total25.643.734.731.818.024.9

30.3% attended physical education classes daily. (See Table 4.7.) Rigorous activity among high school students also generally declined with age.

Asthma

Another serious disease affecting children is asthma, a chronic respiratory disease that causes attacks of difficulty breathing. In The State of Childhood Asthma, United States, 19802005 (December 12, 2006, http://www.cdc.gov/nchs/data/ad/ad381.pdf), Lara J. Akinbami of the CDC indicates that millions of children in the United States have asthma. In 2005, 8.9% (6.5 million) of children were currently suffering from asthma, and 12.7% (9 million) of children had suffered with it at some point in their lifetime. Childhood asthma

 
TABLE 4.7 Percentage of high school students who attended physical education classes and who played on at least one sports team, 2007
CategoryAttended PE classesaAttended PE classes dailybPlayed on at least one sports team
FemaleMaleTotalFemaleMaleTotalFemaleMaleTotal
%%%%%%%%%
aOn 1 or more days in an average week when they were in school.
b5 days in an average week when they were in school.
cNon-Hispanic.
Notes: Run by their school or community groups during the 12 months before the survey. PE is physical education. During the 30 days before the survey, among the 79.6% of students nationwide who exercised or played sports.
SOURCE: Adapted from Danice K. Eaton, Table 78. Percentage of High School Students Who Attended Physical Education (PE) Classes, by Sex, Race/ Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, and Table 80. Percentage of High School Students Who Played on at Least One Sports Team and Who Saw a Doctor or Nurse for an Injury That Happened While Exercising or Playing Sports, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
Whitec46.854.050.425.632.228.954.863.058.9
Blackc50.661.055.927.835.831.944.765.154.9
Hispanic57.364.761.035.536.436.041.858.150.0
Grade
  965.168.366.840.439.740.154.763.459.2
1051.262.356.826.135.730.950.864.757.8
1138.851.445.119.827.923.952.563.057.7
1238.544.641.520.227.523.841.956.249.0
    Total49.457.753.627.333.230.350.462.156.3

caused 27 hospitalizations per 10,000 children in 2004, and caused 12.8 million missed days of school in 2003. The American Lung Association estimates that up to a million asthmatic children are exposed to secondhand smoke, worsening their condition.

According to Akinbami, African-American children suffer from asthma at a rate 60% higher than that of non-Hispanic white children, and Puerto Rican children suffer from asthma at a rate 140% higher than non-Hispanic white children. In addition, she finds that African-American children's asthma is apparently much less well controlled than that of non-Hispanic white children. African-American children have a 250% higher hospitalization rate, a 260% higher emergency department visit rate, and a 500% higher death rate from asthma. Akinbami speculates that this is due to the lower level and quality of health care received by African-American children.

HIV/AIDS

Acquired immune deficiency syndrome (AIDS) was identified as a new disease in 1981, and, according to the CDC, in HIV/AIDS SurveillanceReport: Cases of HIV Infection and AIDS in the United States and Dependent Areas, 2006 (2008, http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006report/pdf/2006SurveillanceReport.pdf), an estimated one million cases had been diagnosed in the United States through 2006. AIDS is caused by the human immunodeficiency virus (HIV), which weakens the victim's immune system, making it vulnerable to other opportunistic infections. Young children with AIDS usually have the virus transmitted to them either by an infected parent or through contaminated transfusions of blood or blood products. Adolescents who are sexually active or experimenting with drugs are also vulnerable to HIV infection, which can be spread through sexual intercourse without the use of a condom or through shared hypodermic needles.

In adults the most common opportunistic infections of AIDS are Kaposi's sarcoma (a rare skin cancer) and pneumocystis carinii pneumonia. In infants and children, a failure to thrive and unusually severe bacterial infections characterize the disease. Except for pneumocystis carinii pneumonia, children with symptomatic HIV infection seldom develop opportunistic infections as adults do. More often, they are plagued by recurrent bacterial infections, persistent oral thrush (a common fungal infection of the mouth or throat), and chronic and recurrent diarrhea. They may also suffer from enlarged lymph nodes, chronic pneumonia, developmental delays, and neurological abnormalities.

HOW MANY ARE INFECTED? According to the CDC, in HIV/AIDS Surveillance Report, by the end of 2006 there were a cumulative total of 9,144 AIDS cases in children under the age of 13 since record-keeping began in 1981. (See Table 4.8.) African-American children made up the overwhelming majority of these cases (5,654 cases), followed by Hispanic children (1,748 cases), non-Hispanic white children (1,599 cases), Asians or Pacific Islanders (54 cases), and Native Americans or Alaskan Natives (31 cases). By the end of 2006, 5,165 children aged 14 and under had died from the disease.

 
TABLE 4.8 Diagnoses of AIDS in children younger than 13, by year of diagnosis, race and Hispanic origin, and transmission category, 200206
 Year of diagnosisCumulativea
20022003200420052006
Notes: These numbers do not represent reported case counts. Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts have been adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk factor, but not for incomplete reporting.
aFrom the beginning of the epidemic through 2006.
bIncludes children of unknown race or multiple races. Cumulative total includes 58 children of unknown race or multiple races. Because column totals were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.
SOURCE: Table 4. Estimated Numbers of AIDS Cases in Children <13 Years of Age, by Year of Diagnosis and Selected Characteristics, 20022006 and Cumulative50 States and the District of Columbia, in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States and Dependent Areas, 2006, vol. 18, Centers for Disease Control and Prevention, 2008, http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006report/pdf/2006SurveillanceReport.pdf (accessed November 5, 2008)
Race/ethnicity
White, not Hispanic14127441,599
Black, not Hispanic70463338305,654
Hispanic18109831,748
Asian/Pacific Islander1011154
American Indian/Alaska Native1010031
Transmission category
Hemophilia/coagulation disorder00000226
Mother with documented HIV infection or 1 of the following risk factors104705352378,508
      Injection drug use1285343,220
      Sex with injection drug user463211,397
      Sex with bisexual male20311209
      Sex with person with hemophilia0000035
      Sex with HIV-infected transfusion recipient0000022
      Sex with HIV-infected person, risk factor not specified36202025131,530
      Receipt of blood transfusion, blood components, or tissue21000144
      Has HIV infection, risk factor not specified47342121171,951
Receipt of blood transfusion, blood components, or tissue20000374
Other/risk factor not reported or identified0000036
      Totalb106705353389,144

MEANS OF TRANSMITTAL. Most babies of HIV-infected mothers do not develop HIV. HIV-positive mothers can reduce the risk of transmission by taking antiretroviral drugs during the last two trimesters of pregnancy and during labor; giving birth by caesarean section; giving the infant a short course of antiretroviral drugs after birth; and not breast feeding. With these interventions, the transmission rate can be reduced to as low as 2%.

Even though interventions are effective in preventing HIV transmission from pregnant mothers to babies, the overwhelming majority of children with AIDS contracted it from mothers either infected with HIV or at risk for AIDS (8,508 of 9,144 cases, or 93%). (See Table 4.8.) Another way HIV/AIDS has been transmitted to children was through blood transfusions contaminated with the virus, although this means of transmission has been all but eliminated in the twenty-first century.

ADOLESCENTS WITH AIDS . The number of AIDS cases among adolescents is comparatively low. In HIV/AIDS Surveillance Report, the CDC states that by the end of 2006, 6,704 adolescents aged 13 to 19 had been diagnosed with AIDS since the beginning of the epidemic in the early 1980s. However, because of the long incubation period between the time of infection and the onset of symptoms, it is highly probable that many people who develop AIDS in their early twenties became infected with HIV during their adolescence; 36,225 young adults, 20- to 24-year-olds, had been diagnosed since the beginning of the epidemic by the end of 2006.

MENTAL HEALTH ISSUES IN YOUNG PEOPLE

Marital Conflict and Divorce

Marital conflict hurts children whether it results in the breakup of marriages or not. Nearly all the studies on children of divorce have focused on the period after the parents separated. However, recent studies suggest that the negative effects children experience may not come so much from divorce itself as from marital discord between parents before divorce. In fact, some research suggests that many problems reported with troubled teens not only began during the marriage but may have contributed to the breakup of the marriage. According to the article Children of Divorce (Journal of the American Board of Family Practice, vol. 14, no. 3, 2001), children raised in discord and marital instability often experience a variety of social, emotional, and psychological problems. Amy L. Baker reports in The Long-Term Effects of Parental Alienation on Adult Children: A Qualitative Research Study (American Journal of Family Therapy, vol. 33, no. 4, JulySeptember 2005) that negative effects, such as low self-esteem, depression, drug and/or alcohol abuse, lack of trust, alienation from

own children, and an elevated risk of divorce, persist among these children into adulthood.

Divorce can cause stressful situations for children in several ways. One or both parents may have to move to a new home, removing the children from family and friends who could have given them support. Custody issues can generate hostility between parents. If one or both parents remarry, children are faced with yet another adjustment in their living arrangements.

Eating Disorders

Even though young people who are overweight increase their risk for certain diseases in adulthood, an overemphasis on thinness during childhood may contribute to eating disorders such as anorexia nervosa (a disorder characterized by voluntary starvation) and bulimia nervosa (a disorder in which a person eats large amounts of food then forces vomiting or uses laxatives to prevent weight gain). Girls are both more likely to have a distorted view of their weight and more likely to have eating disorders than boys.

Eaton et al. report that in 2007 students as a whole had a fairly accurate view of their weight: 15.8% of students were overweight (having a body mass index between the 85th and 95th percentile for their age and sex) and 13% were obese (having a body mass index equal to or greater than the 95th percentile for their age and sex). (See Table 4.5.) Approximately 29.3% said they were slightly or very overweight. (See Table 4.9.) However, girls were much more likely than boys to have a skewed perception of their body size. Even though 32.7% of male students were obese or overweight, 24.2% perceived themselves as overweight and 30.4% were trying to lose weight. Among female students, 24.7% of students were obese or overweight, 34.5% described themselves as overweight, and fully 60.3% were trying to lose weight.

Most students used healthy ways to lose weight, such as diet and exercise. However, a significant proportion used unhealthy methods such as extended periods of not eating, taking diet pills or laxatives, or inducing vomiting. Over half (53.2%) of female students and a quarter (28.3%) of male students ate less food, fewer calories, or low-fat foods to control their weight. (See Table 4.10.) Another two-thirds (67%) of female students and over half (55%) of male students exercised to control their weight. However, 16.3% of female students and 7.3% of male students had not eaten for 24 hours or more to lose weight; 7.5% of female students and 4.2% of male students had taken diet pills, powders, or liquids to control their weight; and 6.4% of female students and 2.2% of male students had vomited or taken laxatives to control their weight. (See Table 4.11.) A greater proportion of female students than male students used both healthy and unhealthy behaviors for weight control. In addition, Hispanic and non-Hispanic white students were in general more likely than African-American students to use unhealthy methods of weight control and the use of these methods increased somewhat with age.

Hyperactivity

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders to appear in childhood. No one knows what causes ADHD, although research has focused on biological causes and the role of genetics. Symptoms include restlessness, inability to concentrate, aggressiveness, and impulsivity; and the lack of treatment can lead to problems in school, at work, and in making friends. Methylphenidate, a stimulant, is frequently

 
TABLE 4.9 Percentage of high school students who thought they had a problem with weight and were trying to lose weight, by sex, race/ethnicity, and grade, 2007
CategoryDescribed themselves as overweightWere trying to lose weight
FemaleMaleTotalFemaleMaleTotal
%%%%%%
*Non-Hispanic.
SOURCE: Danice K. Eaton, Table 84. Percentage of High School Students Who Described Themselves As Slightly or Very Overweight and Who Were Trying to Lose Weight, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White*34.023.628.862.329.045.6
Black*30.119.124.649.524.937.1
Hispanic39.328.333.862.138.550.2
Grade
  933.624.328.858.631.044.4
1033.824.829.260.231.645.8
1136.225.831.061.330.145.8
1234.921.628.361.628.745.3
      Total34.524.229.360.330.445.2
 
TABLE 4.10 Percentage of high school students who ate less food, fewer calories, or low-fat foods and who exercised, by sex, race, ethnicity, and grade, 2007
CategoryAte less food, fewer calories, or low-fat foods to lose weight or to keep from gaining weightExercised to lose weight or to keep from gaining weight
FemaleMaleTotalFemaleMaleTotal
%%%%%%
Note: To lose weight or to keep from gaining weight during the 30 days before the survey.
*Non-Hispanic.
SOURCE: Danice K. Eaton, Table 86. Percentage of High School Students Who Ate Less Food, Fewer Calories, or Low-Fat Foods and Who Exercised, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White*58.428.343.371.553.362.4
Black*34.621.027.850.753.752.2
Hispanic52.032.342.166.460.163.2
Grade
  950.527.338.670.658.764.5
1053.029.140.967.754.260.9
1154.029.842.065.054.959.9
1256.427.442.063.751.157.5
      Total53.228.340.667.055.060.9
 
TABLE 4.11 Percentage of high school students who engaged in unhealthy behaviors in an effort to lose weight, by sex, race, Hispanic origin, and grade, 2007
CategoryDid not eat for 24 or more hours to lose weight or to keep from gaining weightTook diet pills, powders or liquids to lose weight or to keep from gaining weightaVomited or took laxatives to lose weight or to keep from gaining weight
FemaleMaleTotalFemaleMaleTotalFemaleMaleTotal
%%%%%%%%%
Notes: To lose weight or to keep from gaining weight during the 30 days before the survey.
aWithout a doctor's advice.
bNon-Hispanic.
SOURCE: Adapted from Danice K. Eaton et al., Table 88. Percentage of High School Students Who Did Not Eat for 24 or More Hours and Who Took Diet Pills, Powders, or Liquids, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, and Table 90. Percentage of High School Students Who Vomited or Took Laxatives, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
whiteb16.75.711.28.33.76.06.91.34.1
Blackb13.27.410.33.93.63.73.52.53.0
Hispanic17.410.714.17.85.16.47.03.75.3
Grade
916.86.511.66.12.94.45.52.13.8
1019.16.512.76.93.85.37.61.84.7
1114.88.111.57.45.06.25.72.14.0
1213.68.010.910.25.78.06.62.64.6
Total16.37.311.87.54.25.96.42.24.3

used to treat hyperactive children. In Summary Health Statistics for U.S. Children: National Health Interview Survey, 2006 (September 2007, http://www.cdc.gov/nchs/data/series/sr_10/sr10_234.pdf), Barbara Bloom and Robin A. Cohen of the CDC explain that boys are more likely to be diagnosed with ADHD than girls; 10.7% of boys aged three to 17 have been diagnosed at some point, compared to 4% of girls.

Drug and Alcohol Use

Few factors negatively influence the health and well-being of young people more than the use of drugs, alcohol, and tobacco. Monitoring the Future, a long-term study on the use of drugs, alcohol, and tobacco conducted by the University of Michigan's Institute for Social Research, annually surveys eighth, 10th, and 12th graders on their use of these substances. According to Lloyd D.

 
TABLE 4.12 Percentage of high school students who drank alcohol and used marijuana, by sex, race, ethnicity, and grade, 2007
CategoryLifetime alcohol useaCurrent alcohol usebLifetime marijuana usedCurrent marijuana usee
FemaleMaleTotalFemaleMaleTotalFemaleMaleTotalFemaleMaleTotal
%%%%%%%%%%%%
aHad at least one drink of alcohol on at least 1 day during their life.
bHad at least one drink of alcohol on at least 1 day during the 30 days before the survey.
cNon-Hispanic.
dUsed marijuana one or more times during their life.
eUsed marijuana one or more times during the 30 days before the survey.
SOURCE: Adapted from Danice K. Eaton, Table 35. Percentage of High School Students Who Drank Alcohol, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, and Table 39. Percentage of High School Students Who Used Marijuana, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
Whitec76.475.876.147.147.447.334.141.838.017.022.719.9
Blackc70.068.469.134.934.134.535.044.539.617.126.021.5
Hispanic79.376.577.947.547.747.635.942.038.916.420.518.5
Grade
966.165.065.537.234.335.721.733.027.512.516.914.7
1074.674.974.742.341.441.834.539.236.916.522.019.3
1179.179.779.446.551.549.036.648.342.417.525.221.4
1285.280.282.854.255.654.948.349.949.122.627.825.1
Total75.774.375.044.644.744.734.541.638.117.022.419.7

Johnston et al. of the Institute for Social Research, in Monitoring the Future: National Results on Adolescent Drug Use, Overview of Key Findings, 2007 (2008, http://www.monitoringthefuture.org/pubs/monographs/overview 2007.pdf), the percentage of high school students who had used an illicit drug during that past year declined between 1997 and 2007, after sharp increases during the early 1990s. Johnston et al. find that in 2007, 35.9% of seniors (who were more likely than eighth or 10th graders to use an illicit drug) had used an illicit drug in the previous 12 months. Concerning the lifetime prevalence rate, 46.8% of 12th graders had tried an illicit drug. Alcohol (72.7% of seniors) and marijuana (41.8% of seniors) were the most commonly used drugs. Eaton et al. find that in 2007, 75% of all high school students had tried alcohol and 44.7% had used it in the past month. (See Table 4.12.) The researchers also note that 38.1% of high school students reported they had tried marijuana, and 19.7% reported they had used it at least once in the 30 days before the survey.

TOBACCO. Most states prohibit the sale of cigarettes to anyone under the age of 18, but the laws are often ignored and may carry no penalties for youths who buy cigarettes or smoke in public. In fact, 16% of high school students reported in 2007 that they had bought cigarettes in a store or gas station. (See Table 4.13.) The American Lung Association reports in Smoking and Teens Fact Sheet (August 2008, http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=39871) that each day 4,000 children smoke their first cigaretteand almost 1,300 of them will become regular smokers. According to Eaton et al., half (50.3%) of all high school students in 2007 said they had tried cigarettes at some point in their lives. (See Table 4.14.) One out of five (20%) high school

 
TABLE 4.13 Percentage of high school students who bought cigarettes in a store or gas station, by sex, race, Hispanic origin, and grade, 2007
CategoryBought cigarettes in a store or gas station
FemaleMaleTotal
%%%
Not available.
*Non-Hispanic.
Note: During the 30 days before the survey, among the 16.1% of students nationwide who were aged <18 years and who currently smoked cigarettes.
SOURCE: Adapted from Danice K. Eaton, Table 31. Percentage of High School Students Who Usually Obtained Their Own Cigarettes by Buying Them in a Store or Gas Station and Who Currently Used Smokeless Tobacco, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White*10.920.415.9
Black* 22.619.3
Hispanic9 917.113.8
Grade
97.011.89.7
109.420.215.0
1113.620.917.8
1217.034.825.6
Total11.320.016.0

students had smoked at least one cigarette in the month before the survey and 8.1% had smoked at least 20 days in the past month. (See Table 4.15.) Almost twice as many male students smoked heavily than did female students:

 
TABLE 4.14 Percentage of high school students who ever smoked cigarettes, by sex, race, ethnicity, and grade, 2007
CategoryLifetime cigarette useaLifetime daily cigarette useb
FemaleMaleTotalFemaleMaleTotal
%%%%%%
aEver tried cigarette smoking, even one or two puffs.
bEver smoked at least one cigarette every day for 30 days.
cNon-Hispanic.
SOURCE: Danice K. Eaton, Table 25. Percentage of High School Students Who Ever Smoked Cigarettes, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
Whitec48.351.750.014.915.815.4
Blackc48.852.050.35.07.36.2
Hispanic52.154.553.37.18.98.0
Grade
939.246.042.76.310.38.3
1048.748.848.812.411.712.0
1151.455.453.414.013.413.8
1258.560.159.315.818.016.8
Total48.851.850.311.813.012.4
 
TABLE 4.15 Percentage of high school students who currently smoked cigarettes, frequently smoked cigarettes, or smoked more than ten cigarettes per day, by sex, race, ethnicity, and grade, 2007
CategoryCurrent cigarette useaCurrent frequent cigarette usebSmoked more than 10 cigarettes/day
FemaleMaleTotalFemaleMaleTotalFemaleMaleTotal
%%%%%%%%%
aSmoked cigarettes on at least 1 day during the 30 days before the survey.
bSmoked cigarettes on 20 or more days during the 30 days before the survey.
cNon-Hispanic.
Notes: On the days they smoked during the 30 days before the survey, among the 20.0% of students nationwide who currently smoked cigarettes. During the 12 months before the survey, among the 20.0% of students nationwide who currently smoked cigarettes.
SOURCE: Adapted from Danice K. Eaton, Table 27. Percentage of High School Students Who Currently Smoked Cigarettes, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, and Table 29. Percentage of High School Students Who Currently Smoked More Than 10 Cigarettes and Who Tried to Quit Smoking Cigarettes, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
Whitec22.523.823.210.210.610.48.015.711.9
Blacka8.414.911.62.15.83.91.78.66.1
Hispanic14.618.716.73.35.14.24.88.46.8
Grade
912.316.214.33.35.44.36.712.610.1
1019.120.019.66.87.27.05.312.69.0
1119.623.421.69.710.510.18.19.99.0
1225.527.426.511.313.112.27.819.213.6
Total18.721.320.07.48.78.17.113.810.7

13.8% of male adolescents and 7.1% of female adolescents smoked more than 10 cigarettes per day.

Teens say they smoke for a variety of reasonsthey just like it, it's a social thing, and many young women who are worried about their weight report that they smoke because it burns calories. Many of them note they have seen their parents smoke. The ALA indicates that youth who have two parents who smoke are more than twice as likely to become smokers than youth whose parents do not smoke. Children in smoking households are at risk not only from secondhand smoke but also from this greater likelihood to take up smoking themselves.

CHILDHOOD DEATHS

Infant Mortality

The NCHS defines the infant mortality rate as the number of deaths of babies younger than one year per 1,000 live births. Neonatal deaths occur within 28 days

 
TABLE 4.16 Infant mortality rate among selected groups by race and Hispanic origin of mother, selected years 19832004
[Data are based on linked birth and death certificates for infants]
Race and Hispanic origin of mother19831985a, g19861988a, g19891991a, g19951997b, g19992001b, g20022004b, g
Data not available.
aRates based on unweighted birth cohort data.
bRates based on a period file using weighted data.
cInfant (under 1 year of age), neonatal (under 28 days), and postneonatal (28 days11 months).
dStarting with 2003 data, estimates are not shown for Asian or Pacific Islander subgroups during the transition from single race to multiple race reporting.
eePersons of Hispanic origin may be of any race.
fPrior to 1995, data shown only for states with an Hispanic-origin item on their birth certificates.
gAverage annual mortality rate.
Notes: The race groups white, black, American Indian or Alaska Native, and Asian or Pacific Islander include persons of Hispanic and non-Hispanic origin. Starting with 2003 data, some states reported multiple-race data. The multiple-race data for these states were bridged to the single-race categories of the 1977 Office of Management and Budget standards for comparability with other states. National linked files do not exist for 19921994. Data for additional years are available.
SOURCE: Adapted from Table 19. Infant, Neonatal, Postneonatal Mortality Rates, by Detailed Race and Hispanic Origin of Mother: United States, Selected Years 19832004, in Health, United States, 2007. With Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, 2007, http://www.cdc.gov/nchs/data/hus/hus07.pdf (accessed September 15, 2008
Infant c deaths per 1,000 live births
All mothers10.69.89.07.46.96.9
White9.08.27.46.15.75.7
Black or African American18.717.917.114.113.613.5
American Indian or Alaska Native13.913.212.69.29.18.6
Asian or Pacific Islanderd8.37.36.65.14.84.8
Chinese7.45.85.13.33.2
Japanese6.06.95.34.94.0
Filipino8.26.96.45.75.7
Hawaiian11.311.19.07.07.8
Other Asian or Pacific Islander8.67.67.05.44.9
Hispanic or Latinoe, f9.28.37.56.15.65.6
Mexican8.87.97.25.95.45.5
Puerto Rican12.311.110.48.58.48.1
Cuban8.07.36.25.34.54.3
Central and South American8.27.56.65.34.84.9
Other and unknown Hispanic or Latino9.89.08.27.16.76.8
Not Hispanic or Latino
Whitef8.88.17.36.15.75.7
Black or African Americanf18.517.917.214.213.713.7
Neonatal c deaths per 1,000 live births
All mothers6.96.35.74.84.64.6
White5.95.24.74.03.83.8
Black or African American12.211.711.19.49.29.2
American Indian or Alaska Native6.75.95.94.44.54.5
Asian or Pacific Islanderd5.24.53.93.33.23.3
Chinese4.33.32.72.12.1
Japanese3.44.43.02.82.6
Filipino5.34.54.03.74.0
Hawaiian7.47.14.84.54.9
Other Asian or Pacific Islander5.54.74.23.53.3
Hispanic or Latinoe, f6.05.34.84.03.83.9
Mexican5.75.04.53.83.63.7
Puerto Rican8.37.27.05.75.95.6
Cuban5.95.34.63.73.13.1
Central and South American5.74.94.43.73.33.5
Other and unknown Hispanic or Latino6.15.85.24.64.44.9
Not Hispanic or Latino
Whitef5.75.14.64.03.83.8
Black or African Americanf11.811.411.19.49.29.2

after birth and postneonatal deaths occur 28 to 365 days after birth. The U.S. infant mortality rate declined from 165 per 1,000 live births in 1900 to a low of 6.9 per 1,000 live births in between 2002 and 2004. (See Table 4.16.) In Health, United States, 2007 (2007, http://www.cdc.gov/nchs/data/hus/hus07.pdf), the CDC notes that several factorsincluding improved access to health care, advances in neonatal medicine, and educational campaignscontributed to the overall decline in infant mortality in the twentieth century.

Not all racial and ethnic groups have reached that record-low infant mortality rate. Between 2002 and 2004 the infant mortality rate for non-Hispanic white infants was 5.7 deaths per 1,000 live births, less than half the rate of 13.5 for African-American infants. (See Table 4.16.) Rates for Native American or Alaskan Native, Hispanic, and Asian or Pacific Islander babies were 8.6, 5.6, and 4.8, respectively.

The NCHS lists the 10 leading causes of infant mortality in the United States in 2006. (See Table 4.17.) Birth

 
TABLE 4.17 Ten leading causes of infant death, by race and Hispanic origin, 2006
[Data are based on a continuous file of records received from the states. Rates are per 100,000 live births. Figures are based on weighted data rounded to the nearest individual, so categories may not add to totals or subtotals. Race and Hispanic origin are reported separately on both the birth and death certificate. Rates for Hispanic origin should be interpreted with caution because of inconsistencies between reporting Hispanic origin on birth and death certificates. Race categories are consistent with the 1977 Office of Management and Budget (OMB) standards. Multiple-race data were reported for deaths by 25 states and the District of Columbia and for births by 23 states. The multiple-race data for these states were bridged to the single-race categories of the 1977 OMB standards for comparability with other states. Data for persons of Hispanic origin are included in the data for each race group, according to the decedent's reported race.]
RankaCause of death, race and Hispanic originNumberRate
Category not applicable.
aRank based on number of deaths.
bIncludes races other than white and black.
cIncludes all persons of Hispanic origin of any race. Because of a misclassification error in New Mexico, statistics for Hispanic decedents of all ages were underestimated by about 3.0 percent, and statistics for Hispanic decedents under 1 year of age were underestimated by about 1.0 percent.
Notes: For certain causes of death such as unintentional injuries, homicides, suicides, and sudden infant death syndrome, preliminary and final data may differ because of the truncated nature of the preliminary file. Data are subject to sampling or random variation.
SOURCE: Adapted from Melonie P. Heron et al., Table 8. Infant Deaths and Infant Mortality Rates for the 10 Leading Causes of Infant Death, by Race and Hispanic Origin: United States, Preliminary 2006, in Deaths: Preliminary Data for 2006, National Vital Statistics Report, vol. 56, no. 16, June 11, 2008, http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_16.pdf (accessed November 5, 2008)
 All racesb  
All causes28,609670.6
1Congenital malformations, deformations and chromosomal abnormalities5,827136.6
2Disorders related to short gestation and low birth weight, not elsewhere classified4,841113.5
3Sudden infant death syndrome2,14550.3
4Newborn affected by maternal complications of pregnancy1,69439.7
5Newborn affected by complications of placenta, cord and membranes1,12326.3
6Accidents (unintentional injuries)1,11926.2
7Respiratory distress of newborn80118.8
8Bacterial sepsis of newborn78618.4
9Neonatal hemorrhage59814.0
10Diseases of the circulatory system53912.6
All other causes9,136214.2
 Non-Hispanic white  
All causes13,019563.6
1Congenital malformations, deformations and chromosomal abnormalities2,989129.4
2Disorders related to short gestation and low birth weight, not elsewhere classified1,80578.1
3Sudden infant death syndrome1,17150.7
4Newborn affected by maternal complications of pregnancy75132.5
5Accidents (unintentional injuries)54723.7
6Newborn affected by complications of placenta, cord and membranes47220.4
7Respiratory distress of newborn35315.3
8Bacterial sepsis of newborn33114.3
9Neonatal hemorrhage29912.9
10Diseases of the circulatory system23910.3
All other causes4,062175.9
 Total black  
All causes8,8421,335.2
1Disorders related to short gestation and low birth weight, not elsewhere classified1,978298.7
2Congenital malformations, deformations and chromosomal abnormalities1,157174.7
3Sudden infant death syndrome65699.1
4Newborn affected by maternal complications of pregnancy59589.9
5Newborn affected by complications of placenta, cord and membranes37857.1
6Accidents (unintentional injuries)35153.0
7Bacterial sepsis of newborn27241.1
8Respiratory distress of newborn26740.3
9Necrotizing enterocolitis of newborn20430.8
10Diseases of the circulatory system17526.4
All other causes2,809424.2
 Hispanicc  
All causes5,706549.2
1Congenital malformations, deformations and chromosomal abnormalities1,442138.8
2Disorders related to short gestation and low birth weight, not elsewhere classified91988.4
3Newborn affected by maternal complications of pregnancy29928.8
4Sudden infant death syndrome24423.5
5Newborn affected by complications of placenta, cord and membranes22721.8
6Accidents (unintentional injuries)17817.1
7Respiratory distress of newborn15915.3
8Bacterial sepsis of newborn15214.6
9Neonatal hemorrhage11310.9
10Diseases of the circulatory system999.5
All other causes1,874180.4

defects (congenital malformations) were the primary cause of infant mortality (136.6 deaths per 100,000 live births). Premature delivery or low birth weight was the second-leading cause of infant mortality (113.5 per 100,000 live births). Sudden infant death syndrome (50.3), complications of pregnancy (39.7), complications in the placenta or umbilical cord (26.3), accidents (26.2), respiratory distress (18.8), bacterial sepsis (18.4), neonatal hemorrhage (14), and diseases of the circulatory system (12.6) complete the list.

SUDDEN INFANT DEATH SYNDROME. Sudden infant death syndrome (SIDS; sometimes called crib death), the unexplained death of a previously healthy infant, was the third-leading cause of infant mortality in the United States in 2006. Moreover, according to the CDC, in Safe Sleep for Your Baby: Ten Ways to Reduce the Risk of Sudden Infant Death Syndrome (August 2003, http://www.nichd.nih.gov/publications/pubs/safe_sleep_gen.cfm), SIDS is the leading cause of death among infants aged one to 12 months. In 1992 the American Academy of Pediatrics recommended that babies sleep on their back to reduce the risk of SIDS and launched its Back to Sleep campaign to educate parents. It had been a long-held belief that the best position for babies to sleep was on their stomach. Other risk factors for SIDS include maternal use of drugs or tobacco during pregnancy, low birth weight, and poor prenatal care. For reasons not yet understood, even though the overall rate of SIDS has declined since the beginning of the Back to Sleep campaign, it has declined less among African-Americans and Native Americans than among other groups. The CDC indicates that African-American babies are more than twice as likely to die of SIDS and Native American babies are nearly three times as likely to die of SIDS than white babies.

A number of studies have considered the possible causes of and risk factors for SIDS. For example, the article SIDS Risk Prevention Research Begins to Define Physical Abnormalities in Brainstem, Points to Possible Diagnostic/Screening Tools (PR Newswire, October 18, 1999) reports that one study, ongoing since 1985, conducted by Hannah Kinney of Harvard Medical School in Boston, Massachusetts, found a brain defect believed to affect breathing in babies who died of SIDS. Researchers suggest that as carbon dioxide levels rise and oxygen levels fall during sleep, the brains of some babies do not get the signal to regulate breathing or blood pressure accordingly to make up for the change. This condition is particularly dangerous for infants sleeping on their stomachs or on soft bedding. According to the National Institutes of Health, in SIDS Infants Show Brain Abnormalities, (November 10, 2006, http://www.nih.gov/news/research_matters/november2006/11102006sids.htm), this project found that this type of brain abnormality might be linked to higher levels of serotonin in the brainstem. Duane Alexander stated, This finding lends credence to the view that SIDS risk may greatly increase when an underlying predisposition combines with an environmental risksuch as sleeping face downat a developmentally sensitive time in early life.

Mortality among Older Children

In the second half of the twentieth century, childhood death rates declined dramatically. Most childhood deaths are from injuries and violence. Even though death rates for all ages decreased, the largest declines were among children.

In 2005 three of the leading causes of death of one- to four-year-olds were unintentional injuries, congenital anomalies (birth defects), and malignant neoplasms (cancers). (See Table 4.18.) The remaining deaths were spread across a variety of diseases, including heart disease, pneumonia, influenza, HIV/AIDS, homicide, and suicide.

MOTOR VEHICLE INJURIES. The National Highway Traffic Safety Administration notes in Determine Why There Are Fewer Young Alcohol-Impaired Drivers (September 2001, http://www.nhtsa.dot.gov/people/injury/research/FewerYoungDrivers/) that even though motor vehicle fatalities decreased by 25% between 1982 and 2000 for 15- to 19-year-olds, traffic accidents were still the leading cause of death for this age group. During the 1980s and early 1990s, traffic fatalities linked to teenage drinking fell. This decline was due in large part to stricter enforcement of drinking age laws and driving while intoxicated or driving under the influence laws. Nevertheless, motor vehicle crashes were the leading cause of death among 15- to 20-year-olds in 2003. In the fact sheet Mortality: Adolescents and Young Adults (2006, http://nahic.ucsf.edu/downloads/Mortality.pdf), the National Adolescent Health Information Center reports that in 2003, 25.2 of every 100,000 teenagers in this age group were killed in traffic accidents. Many of those killed had been drinking alcohol and were not wearing their seatbelts. Timothy M. Pickrell of the U.S. Department of Transportation reports in Driver Alcohol Involvement in Fatal Crashes by Age Group and Vehicle Type (June 2006, http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2006/810598.pdf) that 20% of all young drivers aged 15 to 20 who were killed in crashes were intoxicated.

Eaton et al. find that in 2007, in the month before the survey, 18.3% of high school seniors (those most likely to have their driver's licenses) reported they had driven a vehicle after drinking alcohol. (See Table 4.19.) Male seniors (23.6%) were more likely than female seniors (13.1%) to drive after drinking. Another 29.1% of high school students admitted they had ridden with a driver who had been drinking.

SUICIDE. In 2005 suicide was the fifth-leading cause of death among five- to 14-year-olds and the third-leading cause of death in 15- to 24-year-olds. (See Table 4.18.) Debra L. Karch et al. of the CDC report in Surveillance for Violent

 
TABLE 4.18 Leading causes of death and numbers of deaths, by age, 1980 and 2005
[Data are based on death certificates]
Age andrank order19802005
Cause of deathDeathsCause of deathDeaths
Under 1 year
Category not applicable.
SOURCE: Adapted from Table 32. Leading Causes of Death and Numbers of Deaths, by Age: United States, 1980 and 2005, in Health, United States, 2007. With Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, 2007, http://www.cdc.gov/nchs/data/hus/hus07.pdf (accessed September 15, 2008)
 All causes45,526All causes28,440
1Congenital anomalies9,220Congenital malformations, deformations and chromosomal abnormalities5,552
2Sudden infant death syndrome5,510Disorders related to short gestatiion and low birth weight, not elsewhere classified4,714
3Respiratory distress syndrome4,989Sudden infant death syndrome2,230
4Disorders relating to short gestation and unspecified low birthweight3,648Newborn affected by maternal complications of pregnancy1,776
5Newborn affected by maternal complications of pregnancy1,572Newborn affected by complications of placenta, cord and membranes1,110
6Intrauterine hypoxia and birth asphyxia1,497Unintentional injuries1,083
7Unintentional injuries1,166Respiratory distress of newborn860
8Birth trauma1,058Bacterial sepsis of newborn834
9Pneumonia and influenza1,012Neonatal hemorrhage665
10Newborn affected by complications of placenta, cord, and membranes985Necrotizing enterocolitis of newborn546
14 years
 All causes8,187All causes4,756
1Unintentional injuries3,313Unintentional injuries1,664
2Congenital anomalies1,026Congenital malformations, deformations and chromosomal abnormalities522
3Malignant neoplasms573Malignant neoplasms377
4Diseases of heart338Homicide375
5Homicide319Diseases of heart151
6Pneumonia and influenza267Influenza and pneumonia110
7Meningitis223Septicemia85
8Meningococcal infection110Cerebrovascular dieases62
9Certain conditions originating in the perinatal period84Certain conditions originating in the perinatal period58
10Septicemia71Chronic lower respiratory diseases56
514 years
 All causes10,689All causes6,602
1Unintentional injuries5,224Unintentional injuries2,415
2Malignant neoplasms1,497Malignant neoplasms1,000
3Congenital anomalies561Congenital malformations, deformations and chromosomal abnormalities396
4Homicide415Homicide341
5Diseases of heart330Suicide272
6Pneumonia and influenza194Diseases of heart252
7Suicide142Influenza and pneumonia106
8Benign neoplasms104Chronic lower respiratory diseases104
9Cerebrovascular diseases95Cerebrovascular dieases95
10Chronic obstructive pulmonary diseases85Septicemia81
1524 years
 All causes49,027All causes34,234
1Unintentional injuries26,206Unintentional injuries15,753
2Homicide6,537Homicide5,466
3Suicide5,239Suicide4,212
4Malignant neoplasms2,683Malignant neoplasms1,717
5Diseases of heart1,223Diseases of heart1,119
6Congenital anomalies600Congenital malformations, deformations and chromosomal abnormalities504
7Cerebrovascular diseases418Diabetes mellitus202
8Pneumonia and influenza348Cerebrovascular dieases196
9Chronic obstructive pulmonary diseases141Pregnancy, childbirth and puerperuim183
10Anemias133Influenza and pneumonia172

DeathsNational Violent Death Reporting System, 16 States, 2005 (Morbidity and Mortality Weekly Report, vol. 57, no. SS-03, April 11, 2008) that the male suicide rate (18.4 per 100,000) was more than three times higher than the female suicide rate (4.8 per 100,000). According to Melonie Heron of the CDC, in Deaths: Leading Causes for 2004

 
TABLE 4.19 Percentage of high school students who rode with a driver who had been drinking alcohol and who drove when they had been drinking alcohol, by sex, race, ethnicity, and grade, 2007
CategoryRode with a driver who had been drinking alcoholDrove when drinking alcohol
FemaleMaleTotalFemaleMaleTotal
%%%%%%
Note: One or more times during the 30 days before the survey.
*Non-Hispanic.
SOURCE: Danice K. Eaton, Table 5. Percentage of High School Students Who Rode in a Car or Other Vehicle Driven by Someone Who Had Been Drinking Alcohol and Who Drove a Car or Other Vehicle When They Had Been Drinking Alcohol, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White*28.027.827.99.313.911.6
Black*26.928.127.43.97.55.7
Hispanic35.136.035.57.713.010.3
Grade
927.627.627.64.16.85.5
1030.427.128.77.310.08.7
1126.831.429.29.113.711.5
1230.532.531.513.123.618.3
Total28.829.529.18.112.810.5
 
TABLE 4.20 Percentage of high school students who felt sad or hopeless, who seriously considered attempting suicide, and who made a suicide plan, by sex, race, ethnicity, and grade, 2007
CategoryFelt sad or hopelessSeriously considered attempting suicideMade a suicide plan
FemaleMaleTotalFemaleMaleTotalFemaleMaleTotal
%%%%%%%%%
*Non-Hispanic.
Notes: Almost every day for 2 or more weeks in a row so that they stopped doing some usual activities. During the 12 months before the survey.
SOURCE: Adapted from Danice K. Eaton et al., Table 19. Percentage of High School Students Who Felt Sad or Hopeless, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, and Table 21. Percentage of High School Students Who Seriously Considered Attempting Suicide, and Who Made a Plan about How They Would Attempt Suicide, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White*34.617.826.217.810.214.012.88.810.8
Black*34.524.029.218.08.513.212.07.19.5
Hispanic42.330.436.321.110.715.915.210.412.8
Grade
934.822.128.219.010.814.813.49.211.2
1037.720.328.922.09.315.616.18.912.5
1134.519.527.116.310.713.511.69.210.4
1235.922.629.416.710.213.511.79.510.6
Total35.821.228.518.710.314.513.49.211.3

(National Vital Statistics Reports, vol. 56, no. 5, November 20, 2007), in 2004, the latest year for which detailed statistics were available, white males aged 15 to 19 had twice the suicide rate (13.6 per 100,000) of African-American males (7.4 per 100,000) or Hispanic male youth (9.9 per 100,000). Among females aged 15 to 19, the rate for whites (3.7 per 100,000) was considerably higher than that for Hispanics (2.7 per 100,000) or African-Americans (1.9 per 100,000).

Eaton et al. questioned high school students regarding their thoughts about suicide. Almost one out of seven (14.5%) students surveyed in 2007 claimed that they had seriously thought about attempting suicide in the previous 12 months. (See Table 4.20.) Even though the suicide death rate was much higher among males than females, females (18.7%) were more likely to have considered suicide than males (10.3%). Of all students,

 
TABLE 4.21 Percentage of high school students who attempted suicide and whose suicide attempt resulted in an injury that required medical treatment, by sex, race, ethnicity, and grade, 2007
CategoryAttempted suicideSuicide attempt treated by a doctor or nurse
FemaleMaleTotalFemaleMaleTotal
%%%%%%
*Non-Hispanic.
Notes: During the 12 months before the survey. One or more times.
SOURCE: Danice K. Eaton, Table 23. Percentage of High School Students Who Attempted Suicide and Whose Suicide Attempt Resulted in an Injury, Poisoning, or Overdose That Had to Be Treated by a Doctor or Nurse, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White*7.73.45.62.10.91.5
Black*9.95.57.72.12.52.3
Hispanic14.06.310.23.91.82.9
Grade
910.55.37.92.61.92.3
1011.24.98.03.11.02.0
117.83.75.81.71.41.6
126.54.25.41.81.51.7
Total9.34.66.92.41.52.0

11.3% (13.4% of females and 9.2% of males) had made a specific plan to attempt suicide. Approximately 6.9% of students (9.3% of females and 4.6% of males) said they had attempted suicide in the previous year, and 2% of high school students (2.4% of females and 1.5% of males) said they had suffered injuries from the attempt that required medical attention. (See Table 4.21.) These numbers reflect the fact that females of all ages tend to choose less fatal methods of attempting suicide, such as overdosing and cutting veins, than males, who tend to choose more deadly methods, such as shooting or hanging.

These rates reflect the fact that a large proportion of students, particularly female students, feel sad or hopeless. In 2007, 35.8% of female students and 21.2% of male students reported these feelings. (See Table 4.20.) The likelihood that a child will commit suicide increases with the presence of certain risk factors. According to the CDC, in Homicides and SuicidesNational Violent Death Reporting System, United States, 20032004 (Morbidity and Mortality Weekly Report, vol. 55, no. 26, July 7, 2006), among the factors whose presence may indicate heightened risk are depression, mental health problems, relationship conflicts, a history of previous suicide attempts, and alcohol dependence.

In addition, the suicide rate among male homosexual teens is believed to be extremely high. Gary Remafedi of the University of Minnesota notes in Suicidality in a Venue-Based Sample of Young Men Who Have Sex with Men (Journal of Adolescent Health, vol. 31, no. 4, 2002) that 20% to 42% of teens and young men who have sex with other males attempt suicide. Suicidal gay adolescents are not only coping with stressors but also have few coping resources. In Gay Adolescents and Suicide: Understanding the Association (Adolescence, vol. 40, no. 159, fall 2005), Robert Li Kitts of Oregon Health and Science University states that the process of realizing that one is gay and having to accept it is not just an immediate stressor and can actually narrow one's options further by taking away coping resources, such as friends and family. Gay adolescents who come out (disclose their sexuality) may experience great family discord, rejection, and even failure from the disappointment they elicit. It would make sense to conclude that homosexuality is an important risk factor for adolescent suicide.

Health and Safety

views updated May 11 2018

Health and Safety

FACTORS AFFECTING CHILDREN'S HEALTH

A variety of factors affect children's health. These range from prenatal influences; access to and quality of health care; poverty, homelessness, and hunger; childhood diseases; and diet and exercise. This chapter discusses these factors and looks at leading causes of death among infants, children, and adolescents.

Birth Defects

According to the Centers for Disease Control and Prevention (CDC), in "Birth Defects: Frequently Asked Questions" (December 12, 2006, http://www.cdc.gov/ncbddd/bd/faq1.htm), birth defects affect one out of every thirty-three babies born. Birth defects are the leading cause of infant deaths; in addition, these babies have a greater chance of illness and disability than do babies without birth defects. Two major birth defects, neural tube defects and fetal alcohol syndrome, are in large part preventable.

NEURAL TUBE DEFECTS

Major defects of the brain and spine are called neural tube defects. The CDC notes in "Medical Progress in the Prevention of Neural Tube Defects" (June 17, 2005, http://www.cdc.gov/ncbddd/bd/mp.htm) that each year as many as one out of every one thousand pregnancies is affected by a neural tube defect. Infants born with neural tube defects suffer from an incomplete closing of the spine and skull. The occurrence of these defects can be greatly reduced by adequate folic acid consumption before and during early pregnancy.

FETAL ALCOHOL SYNDROME

Alcohol consumption by pregnant women can cause fetal alcohol syndrome (FAS), a birth defect characterized by a low birth weight, facial abnormalities such as small eye openings, growth retardation, and central nervous system deficits, including learning and developmental disabilities. The condition is a lifelong, disabling condition that puts those children affected at risk for secondary conditions, such as mental health problems, criminal behavior, alcohol and drug abuse, and inappropriate sexual behavior. Not all children affected by prenatal alcohol use are born with the full syndrome, but they may have selected abnormalities.

According to the CDC, in "Fetal Alcohol Spectrum Disorders" (December 5, 2006, http://www.cdc.gov/ncbddd/fas/fassurv.htm), estimates of the prevalence of FAS vary from 0.2 to 1.5 per 1,000 births in different areas of the United States. Other alcohol-related birth defects are thought to occur three times as often as FAS. In "Alcohol Consumption among Women Who Are Pregnant or Who Might Become Pregnant—United States, 2002" (Morbidity and Mortality Weekly Report, December 24, 2004, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5350a4.htm), the CDC finds that in 2002, 10.1% of pregnant women drank alcohol, putting their babies at risk for FAS. As many as one out of fifty pregnant women (1.9%) frequently drank alcohol.

Health Care

IMMUNIZATIONS

The proportion of preschool-age children immunized against communicable and potentially dangerous childhood diseases—including diphtheria, tetanus, and pertussis (whooping cough), known collectively as DTP; polio; and measles—dropped during the 1980s but rose significantly during the 1990s. By 2004, 87% of all children had received four doses of DTP, 92% had received three doses of the poliovirus vaccine, 94% had received the haemophilus influenzae type b vaccine, 94% had received the measles vaccine, 93% had received three doses of the hepatitis B vaccine, and 88% had received the varicella (chickenpox) vaccine. (See Table 4.1.) More than four out of five of these children received the vaccinations in combined series. Children living below the poverty line and African-American children were slightly less likely than the general child population to be immunized.

TABLE 4.1
Percentage of children vaccinated for selected diseases, by poverty statusa, race, and Hispanic originb, 1996–2004
CharacteristicTotalBelow povertyAt or above poverty
199619971998199920002001200220032004199619971998199920002001200220032004199619971998199920002001200220032004
Total
Combined series (4:3:1:3)c767679787677788183697174737172727678807982817879798385
Combined series (4:3:1)d787881807879798284727276757273737779818083827980808486
DTP (4 doses or more)e818284838282828586747680797677758081848486858484848787
Polio (3 doses or more)919191909089909292888990878787888990929292919090919392
Measles-containing (MCV)f919092929191929393878690908989909291929293929192929394
Hib (3 doses or more)g919393949393939494879091919090909192939495959594949594
Hepatitis B (3 doses or more)828487889089909292788185878787889191838588899190909393
Varicellah12264358687681858851741556474798486152944586977818588
PCV (3 doses or more)i416873336269437175
White, non-Hispanic
Combined series (4:3:1:3)c797982817979808485687277767371727978808083828080818586
Combined series (4:3:1)d808083828080818586707379777472738078828284838181828687
DTP (4 doses or more)e838487868484848888727682817875758281858588868585868889
Polio (3 doses or more)929292909190919392889091888887889188939293919191929393
Measles-containing (MCV)f919193929292939494858490908887919090939394939292939494
Hib (3 doses or more)g939495959594949595879092939289889192949596959595959695
Hepatitis B (3 doses or more)828588899190919393768087888886869192838588899290929493
Varicellah15284256667579848761738515867758084162943576876808587
PCV (3 doses or more)i447175315666467377
Black, non-Hispanic
Combined series (4:3:1:3)c747373747171717576697172726969687074797774777274727980
Combined series (4:3:1)d777474757273727778737274747071697276817876787375738081
DTP (4 doses or more)e797777797676768080747677787574747578838079837878778483
Polio (3 doses or more)908988878785878990878988868584878690939187888786879191
Measles-containing (MCV)f908989908889909291888789908888909190919190918790909391
Hib (3 doses or more)g899190929390929391869190919287889090939490949391949592
Hepatitis B (3 doses or more)828284878985889291788286868985899289858483909085889292
Varicellah92142586775838586*1640576071808485132744607277848687
PCV (3 doses or more)i346268306167386470
American Indian and Alaska Native
Combined series (4:3:1:3)c827378756976*7775***********8779*84***
Combined series (4:3:1)d837879787076*7976***********8781*84***
DTP (4 doses or more)e858083807577*8077***********92837684***
Polio (3 doses or more)909085889088*91879293**82*878996*8893949696*92*
Measles-containing (MCV)f8992919287948492898794*938396*93**9296929293909089
Hib (3 doses or more)g918690919091*89909593**82**929089*97979795**89
Hepatitis B (3 doses or more)798382*9186*9091****85**9295*8287*9791*8889
Varicellah*2028*6269708184**22***********76*8285
PCV (3 doses or more)i336075******
TABLE 4.1
Percentage of children vaccinated for selected diseases, by poverty statusa, race, and Hispanic originb, 1996–2004 [continued]
CharacteristicTotalBelow povertyAt or above poverty
199619971998199920002001200220032004199619971998199920002001200220032004199619971998199920002001200220032004
—=Not available.
*Estimates are considered unreliable.
aBased on family income and household size using US Bureau of Census poverty thresholds for the year prior to each year of data collection.
bFrom 1996 to 2000, the 1977 Office of Management and Budget (OMB) Standards for Data on Race and Ethnicity were used. From 2002 onward, the 1997 OMB Standards for Data on Race and Ethnicity were used. Persons of Hispanic origin may be of any race. Included in the total, but not shown separately, are Native Hawaiian and other Pacific Islanders, and two or more races.
cThe 4:3:1:3 series consists of ≥4 doses of diphtheria, tetanus toxoids and pertussis vaccines, diphtheria and tetanus toxoids, and diphtheria, tetanus toxoids and any acellular pertussis vaccine (DTP/DT/DTaP); ≥3 doses of poliovirus vaccine; ≥1 doses of any measles-containing vaccine; and ≥3 doses of haemophilus influenzae type b (Hib) vaccine.
dThe 4:3:1 series consists of ≥4 doses of diphtheria, tetanus toxoids and pertussis vaccines, diphtheria and tetanus toxoids, and diphtheria, tetanus toxoids and any acellular pertussis vaccine (DTP/DT/DTaP); ≥3 doses of poliovirus vaccine; and ≥1 doses of any measles-containing vaccine.
eDiphtheria, tetanus toxoids, and pertussis vaccine (≥4 doses of any diphtheria, tetanus toxoids and pertussis vaccines, including diphtheria and tetanus toxoids, and any acellular pertussis vaccine).
fProviders were asked about measles-containing vaccine, including MMR (measles-mumps-rubella) vaccines.
gHaemophilus influenzae type b (Hib) vaccine (three or more doses).
hRecommended in July 1996. Administered on or after the first birthday, unadjusted for history of varicella illness (chicken pox). (One or more doses of varicella at or after child's first birthday, unadjusted for history of varicella illness).
iPneumococcal conjugate vaccine (three or more doses); the percentage of children ages 19-35 months who received 3 (or more) doses of pneumococcal conjugate vaccine was low in 2002, because universal infant vaccination was not recommended until October 2000.
Source: "Table HEALTH5. Childhood Immunization: Percentage of Children Ages 19-35 Months Vaccinated for Selected Diseases by Poverty Status, Race and Hispanic Origin, Selected Years 1996–2004," in America's Children in Brief: Key National Indicators of Well-Being, 2006, Federal Interagency Forum on Child and Family Statistics, 2006, http://childstats.gov/americaschildren/tables/health5.asp (accessed February 25, 2007)
Asian
Combined series (4:3:1:3)c787179777577838184*********777081807777848083
Combined series (4:3:1)d817683827980858487**80******797484858179868487
DTP (4 doses or more)e858089878584888990**85**85**91847991908785909089
Polio (3 doses or more)908993909390929193*9092**90939292898893919390919092
Measles-containing (MCV)f93909293909095969494929586*93989294939094949289959693
Hib (3 doses or more)g928992909292959192*****95939296949094939392959090
Hepatitis B (3 doses or more)858889889190949493*94*84*95959396868690889289949392
Varicellah183653647782879191******909391204155668081879090
PCV (3 doses or more)i557176***557377
Hispanic
Combined series (4:3:1:3)c717375757377767981687073737073757880737779787479768184
Combined series (4:3:1)d747577777579777982717176767376767980757780807580778184
DTP (4 doses or more)e777881807983798284747579787679788183788183828083808486
Polio (3 doses or more)899089898891909091888890898890898990909090908791919292
Measles-containing (MCV)f888891909092919393878590909091919392899092919093899394
Hib (3 doses or more)g899092929193929393878992918891939292909294959394929594
Hepatitis B (3 doses or more)818186898890909192807983878788899191818488889091899393
Varicellah8224761708082868961844597081828888112549627082818589
PCV (3 doses or more)i376670356571386771

In 1994 the U.S. Department of Health and Human Services (HHS) implemented the Vaccines for Children (VFC) program, which provides free or low-cost vaccines to children at participating private and public health care provider sites. Eligible children, including children on Medicaid, children without insurance or whose insurance does not cover vaccinations, and Native American or Alaskan Native children can receive the vaccinations through their primary care physician. Children not covered under the program but whose parents cannot afford vaccinations can receive free vaccines at public clinics under local programs. The HHS reports in FY 2007 Budget in Brief: Centers for Disease Control and Prevention (February 20, 2006, http://www.hhs.gov/budget/07budget/cdc.html#infectious) that the VFC program had a budget of $2.6 billion for fiscal year 2007. Vaccines provided through the program represented about 40% of all childhood vaccines purchased in the country.

The World Health Organization and the United Nations Children's Fund report in Global Immunization Vision and Strategy, 2006–2015 (October 2005, http://www.who.int/vaccines-documents/DocsPDF05/GIVS_Final_EN.pdf) that developed nations, including the United States, generally have among the highest immunization rates in the world. The global immunization rate for DTP in 2003 was 78%, up from 72% in 1999. Immunization rates for the developed world for the same time period were ten to twenty percentage points higher than the global average, reflecting the low immunization rates in many developing nations. In 2003 only 28% of developing countries reported that their immunization rate for DTP was 80% or higher.

PHYSICIAN VISITS

Children's health depends on access to and usage of medical care. Based on household interviews of a sample of the civilian noninstitutionalized population, the CDC's National Center for Health Statistics (NCHS) finds that in 2004, 55.3% of children under age eighteen visited the doctor between one and three times, 26.2% saw the doctor between four and nine times, and 8% saw the doctor ten or more times. (See Table 4.2.) However, 10.6% of children did not see a doctor at all. Poor children have less access to health care than nonpoor children.

HEALTH INSURANCE

One reason some children do not have access to medical care is their lack of health insurance. According to Carmen DeNavas-Walt, Bernadette D. Proctor, and Cheryl Hill Lee of the U.S. Census Bureau, in Income, Poverty, and Health Insurance Coverage in the United States: 2005 (August 2006, http://www.census.gov/prod/2006pubs/p60-231.pdf), 11.2% of American children (or 8.3 million) had no health insurance coverage in 2005. Factors affecting children's access to coverage included their age, race and ethnicity, and their family's economic status. Children between the ages of twelve and seventeen were more likely to be uninsured than those under age twelve (12.6% versus 10.5%). Poor children were proportionately more likely to be uninsured than all children (19% versus 11.2%) because of government programs such as Medicaid, and those of Hispanic origin were the least likely racial or ethnic group to receive health insurance coverage, with 21.9% of them being uninsured. Uninsured rates for other racial and ethnic groups were 7.2% for non-Hispanic white children, 12.2% for Asian-American children, and 12.5% for African-American children. Robin A. Cohen and Michael E. Martinez of the NCHS estimate in Health Insurance Coverage: Early Release Estimates from the National Health Interview Survey, January-June 2006 (December 2006, http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur200612.pdf) that 9.2% of all children were uninsured for at least part of 2006.

Child health insurance coverage increased slightly among all age groups, races, and ethnicities from 2000 to 2004, although the percent of children covered by private health insurance declined from 70% in 2000 to 66% in 2004. (See Table 4.3 and Figure 4.1.) In the press release "HHS Issues New Report Showing More American Children Received Health Insurance in Early 2002" (December 31, 2002, http://www.hhs.gov/news/press/2002pres/20021231.html), the HHS secretary Tommy G. Thompson attributes ongoing increases to a push to provide more government coverage, particularly under the State Children's Health Insurance Program. This trend, however, may be leveling off. Cohen and Martinez find that there was no significant change in the number of uninsured children between 2005 and 2006. (See Figure 4.1.)

DeNavas-Walt, Proctor, and Hill Lee note that in 2005 government programs, such as Medicare, Medicaid, and military insurance, covered a greater proportion of African-American children and Hispanic children than other children. Almost half (44.9%) of African-American children and 39.3% of Hispanic children had government insurance, compared with only 18% of non-Hispanic white children and 15.9% of Asian children.

To remain in the Medicaid program, families must have their eligibility reassessed at least every six months. If family income or other circumstances change even slightly, the family can lose its eligibility for the Medicaid program, disrupting health care coverage.

From the late 1980s through the mid-1990s the numbers of uninsured American children rose as coverage rates for employer-sponsored health insurance declined, even though the proportion of children covered by Medicaid also rose. In 1997, as part of the Balanced Budget Act, Congress created the State Children's Health Insurance Program (SCHIP) to expand health insurance to children whose families earned too much money to be eligible for Medicaid but not enough money to pay for private insurance. SCHIP provides funding to states to insure children, offering three alternatives: states may use SCHIP funds to establish separate coverage programs, expand their Medicaid coverage, or use a combination of both. By September 1999 all fifty states had SCHIP plans in place. By September 4, 2003, the program had been expanded to enroll even more children at higher income levels. According to the Centers for Medicare and Medicaid Services, in FY 2005 Annual Enrollment Report (July 12, 2006, http://www.cms.hhs.gov/NationalSCHIPPolicy/downloads/FY2005AnnualEnrollmentReport.pdf), in fiscal year 2005, 6.1 million children were enrolled in SCHIP.

TABLE 4.2
Health care visits to doctor's offices, emergency departments, and home visits over a 12-month period, by selected characteristics, selected years 1997–2004
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]
CharacteristicNumber of health care visitsa
None1-3 visits4-9 visits10 or more visits
199720032004199720032004199720032004199720032004
Percent distribution
All personsb, c16.515.816.146.245.845.823.624.824.613.713.613.5
Age
Under 18 years11.811.310.654.154.555.325.226.726.28.97.58.0
   Under 6 years5.05.55.344.946.047.537.039.036.913.09.410.3
   6-17 years15.314.013.158.758.759.019.320.821.16.86.66.8
18-44 years21.722.423.846.746.745.619.019.119.212.611.811.5
   18-24 years22.023.625.746.847.245.020.018.219.211.211.010.1
   25-44 years21.622.023.146.746.645.818.719.419.213.012.012.0
45-64 years16.914.715.042.942.243.324.726.625.315.516.516.3
   45-54 years17.916.916.943.944.245.023.424.522.914.814.315.2
   55-64 years15.311.412.341.339.240.926.729.828.916.719.618.0
65 years and over8.96.35.634.731.531.632.535.836.823.826.426.1
   65-74 years9.87.16.836.934.036.031.635.734.521.623.322.6
   75 years and over7.75.44.131.828.626.433.836.039.526.630.030.0
Sexc
Male21.320.620.947.146.846.620.621.921.611.010.710.9
Female11.811.111.545.444.945.026.527.727.516.316.316.0
Racec, d
White only16.015.716.046.145.645.423.925.124.814.013.613.8
Black or African American only16.814.715.846.145.847.023.225.224.613.914.312.6
American Indian or Alaska Native only17.123.317.738.041.441.724.220.625.020.714.715.5
Asian only22.822.620.849.147.851.519.720.719.78.38.98.1
Native Hawaiian or other Pacific
  Islander only
2 or more races11.113.644.942.923.026.221.017.3
Hispanic origin and racec, d
Hispanic or Latino24.925.326.742.342.941.820.320.320.612.511.510.9
    Mexican28.927.829.740.842.541.018.518.818.911.811.010.4
Not Hispanic or Latino15.414.114.246.746.346.524.025.625.213.914.014.14
    White only14.713.513.546.646.246.124.426.125.714.314.214.7
    Black or African American only16.914.615.646.145.947.323.125.324.613.814.212.5
Respondent-assessed health statusc
Fair or poor7.88.78.123.323.222.029.028.828.039.939.341.9
Good to excellent17.216.416.948.448.148.023.324.524.411.110.910.7
Percent of poverty levelc, e
Below 100%20.620.921.137.837.837.722.723.723.518.917.617.7
100%-less than 200%20.119.820.943.341.542.521.723.622.314.915.114.4
200% or more14.513.713.848.748.448.124.225.425.312.612.612.8
Hispanic origin and race and percent of poverty levelc, d, e
Hispanic or Latino:
    Below 100%30.229.931.634.837.035.019.918.519.615.014.613.9
    100%-less than 200%28.728.630.539.740.239.320.420.619.411.210.510.9
    200% or more18.920.721.548.847.747.020.421.222.211.910.39.2
Not Hispanic or Latino:
    White only:
        Below 100%17.017.016.238.337.537.523.925.925.420.919.520.9
        100%-less than 200%17.316.616.744.141.043.222.224.923.416.317.416.7
        200% or more13.812.512.748.248.147.424.926.326.113.113.113.8
    Black or African American only:
         Below 100%17.415.715.938.538.140.923.426.525.720.719.617.5
        100%-less than 200%18.815.418.143.744.244.522.925.923.814.514.513.7
        200% or more15.613.714.351.750.651.322.724.324.410.011.410.0
TABLE 4.2
Health care visits to doctor's offices, emergency departments, and home visits over a 12-month period, by selected characteristics, selected years 1997–2004 [continued]
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]
CharacteristicNumber of health care visitsa
None1-3 visits4-9 visits10 or more visits
199720032004199720032004199720032004199720032004
*Estimates are considered unreliable.
—Data not available.
aThis table presents a summary measure of health care visits to doctor's offices, emergency departments, and home visits during a 12-month period.
bIncludes all other races not shown separately and unknown health insurance status.
cEstimates are age adjusted to the year 2000 standard population using six age groups: Under 18 years, 18-44 years, 45-54 years, 55-64 years, 65-74 years, and 75 years and over.
dThe race groups, white, black, American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and 2 or more races, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Starting with 1999 data, race-specific estimates are tabulated according to the 1997 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity and are not strictly comparable with estimates for earlier years. The five single race categories plus multiple race categories shown in the table conform to the 1997 standards. Starting with 1999 data, race-specific estimates are for persons who reported only one racial group; the category 2 or more races includes persons who reported more than one racial group. Prior to 1999, data were tabulated according to the 1977 Standards with four racial groups and the Asian only category included Native Hawaiian or other Pacific Islander. Estimates for single race categories prior to 1999 included persons who reported one race or, if they reported more than one race, identified one race as best representing their race. Starting with 2003 data, race responses of other race and unspecified multiple race were treated as missing, and then race was imputed if these were the only race responses. Almost all persons with a race response of other race were of Hispanic origin.
ePercent of poverty level is based on family income and family size and composition using U.S. Census Bureau poverty thresholds. Missing family income data were imputed for 25%-29% of persons in 1997–1998 and 32%-35% in 1999–2004.
fEstimates for persons under 65 years of age are age adjusted to the year 2000 standard population using four age groups: Under 18 years, 18-44 years, 45-54 years, and 55-64 years of age.
gHealth insurance categories are mutually exclusive. Persons who reported both Medicaid and private coverage are classified as having private coverage. Starting in 1997 Medicaid includes state-sponsored health plans and State Children's Health Insurance Program (SCHIP).
hMSA is metropolitan statistical area.
Source: "Table 80. Health Care Visits to Doctor's Offices, Emergency Departments, and Home Visits within the Past 12 Months, by Selected Characteristics, United States, Selected Years 1997–2004," in Health, United States, 2006, with Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, 2006, http://0-www.cdc.gov.mill1.sjlibrary.org/nchs/data/hus/hus06.pdf (accessed February 6, 2007)
Health insurance status at the time of interviewf, g
Under 65 years of age:
   Insured14.312.813.449.049.149.123.625.224.613.112.912.8
       Private14.713.213.650.651.151.423.124.623.911.611.111.2
       Medicaid9.89.911.835.535.235.126.528.128.228.226.824.9
   Uninsured33.738.137.842.842.442.515.313.413.68.26.16.1
Health insurance status prior to interviewf, g
Under 65 years of age:
   Insured continuously all 12 months14.112.713.449.249.349.423.625.224.613.012.812.7
   Uninsured for any period up to 12 months18.920.420.046.046.245.720.821.221.914.412.212.3
   Uninsured more than 12 months39.044.343.941.439.841.313.211.210.06.44.74.8
Percent of poverty level and insurance status prior to interviewe, f, g
Under 65 years of age:
   Below 100%:
       Insured continuously all 12 months13.812.714.339.740.939.625.225.825.721.420.520.4
       Uninsured for any period up to 12 months19.718.417.637.643.942.021.921.624.620.916.115.7
       Uninsured more than 12 months41.247.747.139.935.738.612.211.79.46.64.95.0
   100%-less than 200%:
       Insured continuously all 12 months16.013.815.746.445.045.421.924.423.515.816.815.5
      Uninsured for any period up to 12 months18.820.221.745.142.045.121.024.822.115.012.911.1
       Uninsured more than 12 months38.743.445.041.039.139.414.012.19.96.35.45.7
   200% or more:
       Insured continuously all 12 months13.712.412.651.051.151.323.625.324.711.711.311.5
       Uninsured for any period up to 12 months17.820.420.350.349.647.520.419.120.411.510.911.9
       Uninsured more than 12 months36.641.839.743.844.745.413.29.610.96.44.04.1
Geographic regionc
Northeast13.210.411.645.947.645.526.027.027.514.915.015.4
Midwest15.914.213.947.747.247.522.825.425.113.613.213.5
South17.216.516.746.145.146.223.324.823.813.513.613.3
West19.121.021.344.844.243.822.822.222.713.312.612.2
Location of residencec
Within MSAh16.216.016.346.445.945.923.724.824.413.713.313.4
Outside MSAh17.315.015.345.445.645.423.324.925.313.914.514.0
TABLE 4.3
Percentage of children under age 18 covered by health insurance, by type of insurance, age, race, and Hispanic origin, 1987–2004
Characteristic198719881989199019911992199319941995199619971998199920002001200220032004
All health insurance
    Total878787878787868686858585878888888989
Gender
    Male878787878788878686858585878888888989
    Female878787878887868686858585878888898989
Age
    Ages 0-5888787898989888687868684878989899090
    Ages 6-11878787878888878787858685888889898989
    Ages 12-17868686858585838586848384878787878788
Race and Hispanic originb
    White, non-Hispanic909090909090898990898989929393929392
    Black838484858586848385818180848686868687
    Hispanicc727170727375747273717170747576777979
Region
    Northeast929391929291908889888889929292919191
    Midwest929392919291919191919089919292929292
    South828182838384838383828282848686868687
    West858584848586848384838382848686878888
Private health insurance
    Total747474717069676666666768707068676666
Gender
    Male737474717069686666676768707069676665
    Female747374716968676566666767707068686666
Age
    Ages 0-5727171686665636060626364666664636261
    Ages 6-11747475737171706767676868707069686667
    Ages 12-17757676737271697071706970737372716969
Race and Hispanic originb
    White, non-Hispanic838383818080787778787879818180797877
    Black495052494546464344454847525352504748
    Hispanicc484848454342423838404243464544434243
Region
    Northeast797878777573717071696970737472717171
    Midwest798080767574737474757675777877767473
    South686869666564636261616264666664636161
    West717070686667656061626363656564656263
Government health insuranced
    Total191919222425272626252323232426272930
Gender
    Male191919222425272626252322242526272930
    Female191919222426272727252423232426272929
Age
    Ages 0-5222324283033353333312927272931323435
    Ages 6-11191818202223252526252323232526272929
    Ages 12-17161615181919202021191919192020222425
Race and Hispanic originb
    White, non-Hispanic121313151617191818181716161719182121
    Black424241454849504849454042404242444748
    Hispanicc282727323738413839353431333537404242

Homelessness

Under the McKinney-Vento Homeless Assistance Act, the U.S. Department of Education is required to file a report on homeless children served by the act. The Department of Education obtains the data from school districts; school districts use different methods of estimation. In the Report to the President and Congress on the Implementation of the Education for Homeless Children and Youth Program under the McKinney-Vento Homeless Assistance Act (2006, http://www.ed.gov/programs/homeless/rpt2006.doc), the Department of Education states that 602,568 children who experienced homelessness at some point during the year were enrolled in school during the 2003–04 school year. Of these children, about half (50.3%) lived doubled-up with relatives or friends; 25.3% lived in shelters, 10% stayed in hotels or motels, and 2.6% were unsheltered—in other words, sleeping outside, in vehicles, or in abandoned buildings. This number is almost certainly much lower than the number of children who actually experienced homelessness during that period, as the homeless status of children does not always come to the attention of school officials and many homeless children are not enrolled in school.

The U.S. Conference of Mayors, in the Hunger and Homelessness Survey: A Status Report on Hunger and Homelessness in America's Cities, a 23-City Survey (December 2006, http://www.usmayors.org/uscm/hungersurvey/2006/report06.pdf), finds that 30% of homeless people were in families with children, 51% were single men, 17% were single women, and 2% were unaccompanied youth—usually runaways. Since 1994 the proportion of families among the homeless has generally declined, as has the proportion of unaccompanied youth among the homeless population. Data from the Conference of Mayors survey show city-by-city estimates of children as a percent of homeless family members. Values range from 20% of family members in Charleston, South Carolina, and Los Angeles, California, to 83% in Santa Monica, California, and Trenton, New Jersey.

TABLE 4.3
Percentage of children under age 18 covered by health insurance, by type of insurance, age, race, and Hispanic origin, 1987–2004 [continued]
Characteristic198719881989199019911992199319941995199619971998199920002001200220032004
aChildren are considered to be covered by health insurance if they had government or private coverage at any time during the year. Some children are covered by both types of insurance; hence, the sum of government and private is greater than the total.
bFor race and Hispanic-origin data in this table: From 1987 to 2002, following the 1977 Office of Management and Budget (OMB) standards for collecting and presenting data on race, the Current Population Survey (CPS) asked respondents to choose one race from the following: white, black, American Indian or Alaskan Native, or Asian or Pacific Islander. The Census Bureau also offered an "other" category. Beginning in 2003, following the 1997 OMB standards for collecting and presenting data on race, the CPS asked respondents to choose one or more races from the following: white, black, Asian, American Indian or Alaska Native, or Native Hawaiian or other Pacific Islander. All race groups discussed in this table from 2002 onward refer to people who indicated only one racial identity within the racial categories presented. People who responded to the question on race by indicating only one race are referred to as the race-alone population. The use of the race-alone population in this table does not imply that it is the preferred method of presenting or analyzing data. Data from 2002 onward are not directly comparable with data from earlier years. Data on race and Hispanic origin are collected separately; Hispanics may be any race.
cPersons of Hispanic origin may be of any race.
dGovernment health insurance for children consists mostly of Medicaid, but also includes Medicare, the State Children's Health Insurance Programs (SCHIP), and the Civilian Health and Medical Care Program of the Uniformed Services (CHAMPUS/Tricare).
Note: Estimates beginning in 1999 include follow-up questions to verify health insurance status and use the Census 2000-based weights. Estimates for 1999 through 2004 are not directly comparable with estimates for earlier years, before the verification questions were added.
Source: "Table ECON5.A. Access to Health Care: Percentage of Children Ages 0-17 Covered by Health Insurance by Selected Characteristics, Selected Years 1987–2004," in America's Children in Brief: Key National Indicators of Well-Being, 2006, Federal Interagency Forum on Child and Family Statistics, 2006, http://childstats.gov/americaschildren/tables/econ5a.asp (accessed February 25, 2007)
Region
   Northeast181918212222252323242324242425252626
   Midwest181717202223242423211919201921222526
   South201920232528292928272524242629303232
   West202222232727282930272524252727283132

The poverty and lack of stability that homelessness brings has a negative impact on children. An example of the poor educational achievement of homeless youths is shown in the Homeless Census and Homeless Youth/Foster Teen Study (2002, http://www.appliedsurveyresearch.org/www/products/MC_Homeless02_report.pdf), a study of unaccompanied homeless youths conducted in Monterey County, California. Twenty-one percent of sixteen-year-olds, 22% of seventeen-year-olds, 33% of eighteen-year-olds, 51% of nineteen-year-olds, 59% of twenty-year-olds, and 70% of twenty-one-year-olds were below grade level, according to its findings. Only 13% of the homeless youths in the study had a high school diploma or general equivalency diploma (GED). The remaining 87% were performing below grade level.

Homelessness also has a negative impact on children's health. Catherine Karr of the National Health Care for the Homeless Council, in Homeless Children: What Every Health Care Provider Should Know (2006, http://www.nhchc.org/Children/), argues that these children suffer from frequent health problems. They are seen in emergency rooms and hospitalized more often than other poor children. The often crowded and unsanitary conditions they live in lead to a higher rate of infectious diseases, such as upper respiratory infections, diarrhea, and scabies. Homeless children live in less structured and often unsafe environments, leaving them more vulnerable to accidents and injury. They tend not to have access to nutritious food and are often malnourished or obese. Homeless children tend to lag behind their housed peers developmentally, and school-age homeless children often have academic problems. The greater likelihood that homeless children come from families plagued by mental illness, drug use, and domestic violence negatively impacts their own mental health. Homelessness results in serious negative consequences for children's health.

Hunger

Food insecurity is defined as the lack of access to enough food to meet basic needs. Mark Nord, Margaret Andrews, and Steven Carlson of the U.S. Department of Agriculture report in Household Food Security in the United States, 2005 (November 2006, http://www.ers.usda.gov/Publications/ERR29/ERR29.pdf), that in 2005, 89% of U.S. households were food secure. However, the remaining 11% (12.6 million U.S. households) experienced food insecurity at some time during the year. Most of these households used a variety of coping strategies to obtain adequate food, such as eating less varied diets, participating in food assistance programs, or getting food from community food pantries or soup kitchens. However, 3.9% of all households (4.4 million households) experienced very low food security—in other words, some household members reduced or otherwise altered their normal food intake because of a lack of money.

Nord, Andrews, and Carlson find that in 2005 a higher percentage of children than adults were food insecure (16.9% and 11%, respectively). Households that are experiencing food insecurity tend to go through a sequence of steps as food insecurity increases: first, families begin to worry about having enough food, then they begin to decrease other necessities, then they reduce the quality and quantity of all household members' diets, then they decrease the frequency of meals and quantity of adult members' food, and finally they decrease the frequency of meals and the quantity of children's food. Even though children are usually protected from being hungry, almost one out of every one hundred children (0.7%) experienced very low food security on one or more days during 2005. Households with incomes below the poverty line, households with children headed by a single woman, and African-American and Hispanic households were the most likely to experience food insecurity.

EMERGENCY FOOD ASSISTANCE

America's Second Harvest, the nation's largest charitable hunger-relief organization, reports in the Hunger Study, 2006 (http://www.hungerinamerica.org/key_findings/) that in 2005, 25.3 million Americans sought emergency food assistance. In the Hunger and Homelessness Survey, the Conference of Mayors finds that requests for emergency food assistance increased by 7% in 2006, and requests for food assistance by families with children increased by an average of 5% in the surveyed cities. Almost half (48%) of those requesting assistance were members of families with children; 18% of requests by families were estimated to have gone unmet because of lack of resources. The most frequent reasons for hunger cited by city officials were unemployment and low-paying jobs. Other causes included high housing and medical costs, substance abuse, high utility and transportation costs, and a lack of education.

Exposure to Toxins

Another threat to children's health is exposure to environmental toxins. Two toxins that children are most frequently exposed to are lead and secondhand smoke.

LEAD POISONING

Lead exposure now comes primarily from leaded paints that have worn off or been scraped from older homes. Lead is also found in lead plumbing and emitted by factory smokestacks. Because they have smaller bodies and are growing, children suffer the effects of lead exposure more acutely than adults do. Lead poisoning causes nervous system disorders, reduction in intelligence, fatigue, inhibited infant growth, and hearing loss. Toxic levels of lead in a parent can also affect unborn children.

In "CDC Surveillance Data, 1997–2005" (February 16, 2007, http://www.cdc.gov/nceh/lead/surv/stats.htm), the CDC indicates that in 2005 approximately 46,770 children from age five and under had confirmed blood lead levels greater than the center's recommended level of ten micrograms per deciliter of blood. This was about 1.6% of all children tested. According to the U.S. Environmental Protection Agency (EPA), in Children's Health and the Environment in North America, United States (December 2005, http://www.cec.org/files/PDF/POLLU TANTS/CountryReport-US-CHE_en.pdf), this number has dropped substantially since the early 1970s, due largely to the phasing out of lead in gasoline between 1973 and 1995. Although children from all social and economic levels can be affected by lead poisoning, children in families with low incomes who live in older, deteriorated housing are at higher risk. Paint produced before 1978 frequently contains lead, so federal legislation now requires owners to disclose any information they may have about lead-based paint before renting or selling a home built earlier than 1978.

SECONDHAND SMOKE AND CHILDREN

In Children's Health and the Environment in North America, United States, the EPA reports that environmental tobacco smoke (ETS) is a major hazard for children, whose respiratory, immune, and other systems are not as well developed as those of adults. Secondhand or passive smoke—smoke produced by other people's cigarettes—increases the number of attacks and severity of symptoms in children with asthma and can even cause asthma in preschool-age children. As noted in the American Lung Association's Secondhand Smoke and Children Fact Sheet (August 2006), "Exposure to secondhand smoke causes 150,000 and 300,000 acute lower respiratory tract infections (pneumonia and bronchitis) annually in children 18 months and younger; these infections result in 7,500 to 15,000 hospitalizations each year." Passive smoking can also cause middle-ear disease and a reduction in lung function in children, and is considered a risk factor in sudden infant death syndrome. The EPA finds in Children's Health and the Environment in North America, United States that the percentage of children under age six who were regularly exposed to secondhand smoke in their homes decreased substantially from 27% in 1994 to 11% in 2003.

DISEASES OF CHILDHOOD

Overweight and Obese Children

The number of overweight and obese Americans has reached epidemic proportions and has become a national concern. The percentage of overweight children and adolescents has grown significantly since the 1970s. Between 1976 and 1980, 6.7% of boys and 6.4% of girls aged six to eleven years were overweight. (See Table 4.4.) In the 2003–04 period those percentages had almost tripled for boys (19.9%) and more than doubled for girls (17.6%). An even more alarming upward trend was seen in the rates of overweight adolescents; 4.5% of boys and 5.4% of girls aged twelve to seventeen were overweight in the 1976–80 period, but 18.3% of adolescent boys and 16% of adolescent girls were overweight in the 2003–04 period. The proportion of overweight children overall between the ages of six and eighteen more than tripled (from 5.7% to 18%) between 1976 and 2004.

Percentages of overweight children vary by race and ethnicity. In the 2003–04 period African-American adolescents (21.5%) were more likely to be overweight than white, non-Hispanic adolescents (16.9%) or Mexican-American adolescents (16.3%). (See Table 4.4.) Among children aged six to eleven, white, non-Hispanic children were the least likely to be overweight (17.7%), compared with African-American (22%) and Mexican-American (22.5%) children of the same age.

Medical professionals are concerned about this trend, because overweight children are at increased risk for premature death in adulthood, as well as for many chronic diseases, including coronary heart disease, hypertension, diabetes mellitus (type 2), gallbladder disease, respiratory disease, some cancers, and arthritis. Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents. Being overweight or obese can also lead to poor self-esteem and depression in children. According to the CDC, in 2005, 15.7% of high school students were at risk for becoming overweight and 13.1% were already overweight. (See Table 4.5.)

Weight problems in children are thought to be caused by a lack of physical activity, unhealthy eating habits, or a combination of these factors, with genetics and lifestyle playing important roles in determining a child's weight. Television watching and playing computer and video games contribute to the inactive lifestyles of children. According to the CDC, in "Youth Risk Behavior Surveillance—United States, 2005" (Morbidity and Mortality Weekly Report, June 6, 2006), 21.1% of high school students spent three or more hours per school day on the computer, and 37.2% spent three or more hours per school day watching television, often not getting a sufficient amount of physical exercise as a consequence.

Physical activity patterns established during youth may extend into adulthood and affect the risk of illnesses such as coronary heart disease, diabetes, and cancer. Mental health experts correlate increased physical activity with improved mental health and overall improvement in life satisfaction. The CDC reports that less than half of students in high school participated in vigorous physical activity, exercise, and physical education classes, and this percentage was even lower for females than for males. (See Table 4.6.) Only 43.8% of male high school students engaged in sufficient vigorous physical activity, whereas only 27.8% of female high school students did. White students were somewhat more likely to meet recommended levels of physical activity (38.7%) than Hispanic (32.9%) or African-American (29.5%) students. Rigorous activity among high school students also generally declined with age.

Asthma

Another serious disease affecting children is asthma, a chronic respiratory disease that causes attacks of difficulty breathing. In The State of Childhood Asthma, United States, 1980–2005 (December 12, 2006, http://www.cdc.gov/nchs/data/ad/ad381.pdf), Lara J. Akinbami of the CDC reports that millions of children in the United States have asthma. In 2005, 8.9% of children (6.5 million) were currently suffering from asthma, and 12.7% of children (9 million) had suffered with it at some point in their lifetime. Childhood asthma caused 27 hospitalizations per 10,000 children in 2004, and caused 12.8 million missed days of school in 2003. The American Lung Association (ALA) estimates that up to a million asthmatic children are exposed to secondhand smoke, worsening their condition.

Akinbami notes that African-American children suffer from asthma at a rate 60% higher than that of non-Hispanic white children, whereas Puerto Rican children

TABLE 4.4
Percentage of children 6-17 who are overweight, by gender, race, and Hispanic origin, selected years 1976–2004
TotalMaleFemale
1976–19801988–19941999–20002001–20022003–20041976–19801988–19941999–20002001–20022003–20041976–19801988–19941999–20002001–20022003–2004
—=Not available.
*Estimates are considered unreliable.
aFrom 1976 to 1994, the 1977 Office of Management and Budget (OMB) Standards for Data on Race and Ethnicity were used to classify persons into one of the following four racial groups: white, black, American Indian or Alaskan Native, or Asian or Pacific Islander. For data from 1999 to 2004, the revised 1997 OMB standards were used. Persons could select one or more of five racial groups: white, black or African American, American Indian or Alaska Native, Asian, and Native Hawaiian or other Pacific Islander. Data on race and Hispanic origin are collected separately but are combined for reporting. Persons of Mexican origin may be of any race. Included in the total but not shown separately are American Indian or Alaska Native, Asian, or Native Hawaiian or other Pacific Islander race due to the small sample size for each of these groups. Data from 1999 onward are not directly comparable with data from earlier years. The National Health and Nutrition Examination Survey (NHANES) sample was designed to provide estimates specifically for persons of Mexican-origin and not for all Hispanic-origin persons.
bEstimates are unstable because they are based on a small number of persons.
Notes: Overweight is defined as body mass index (BMI) at or above the 95th percentile of the 2000 Centers for Disease Control and Prevention BMI-for-age growth charts (http://www.cdc.gov/growthcharts). BMI is calculated as weight in kilograms divided by the square of height in meters.
Source: "Table HEALTH4. Overweight: Percentage of Children Ages 6-17 Who Are Overweight by Gender, Race, and Hispanic Origin, 1976–1980, 1988–1994, 1999–2000, 2001–2002, and 2003–2004," in America's Children in Brief: Key National Indicators of Well-Being, 2006, Federal Interagency Forum on Child and Family Statistics, 2006, http://childstats.gov/americaschildren/tables/health4.asp (accessed February 25, 2007)
Ages 6-17
   Total5.711.215.016.518.05.511.815.718.019.15.810.614.315.116.8
Race and Hispanic origina
   White, non-Hispanic4.910.511.214.617.34.711.311.916.018.85.19.610.513.215.7
   Black, non-Hispanic8.214.021.120.421.75.8b11.519.217.718.310.716.523.123.325.3
   Mexican American15.424.121.519.616.128.025.222.314.720.017.616.6
Ages 6-11
   Total6.511.315.116.318.86.711.615.717.519.96.411.014.314.917.6
Race and Hispanic origina
   White, non-Hispanic5.710.211.714.817.76.110.711.915.518.55.29.811.614.116.9
   Black, non-Hispanic9.014.619.619.922.06.8b12.317.116.917.511.217.022.423.126.5
   Mexican American16.423.420.122.517.526.726.025.315.319.813.619.4
Ages 12-17
   Total5.011.114.916.817.24.512.015.618.418.35.410.214.215.216.0
Race and Hispanic origina
   White, non-Hispanic4.310.810.714.416.93.612.012.016.519.05.09.59.312.414.6
   Black, non-Hispanic7.513.322.721.021.5  *10.721.618.619.110.316.023.523.424.1
   Mexican American14.224.923.116.314.429.824.218.814.020.322.013.4
TABLE 4.5
Percentage of high school students who had or perceived they had a problem with weight, by sex, race/ethnicity, and grade, 2005
aStudents who were ≥85th percentile but <95th percentile for body mass index, by age and sex, based on reference data.
bStudents who were ≥95th percentile for body mass index, by age and sex, on the basis of reference data.
cNon-Hispanic.
Source: Adapted from "Table 60. Percentage of High School Students Who Were at Risk for Becoming or Were Overweight, by Sex, Race/Ethnicity, and Grade," and "Table 62. Percentage of High School Students Who Described Themselves as Slightly or Very Overweight and Who Were Trying to Lose Weight, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2005," Morbidity and Mortality Weekly Report, vol. 55, no. SS-5, June 9, 2006, http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf (accessed February 25, 2007)
CategoryAt risk for becoming overweightaOverweightb
FemaleMaleTotalFemaleMaleTotal
%%%%%%
Race/ethnicity
Whitec13.815.214.58.215.211.8
Blackc22.616.719.816.115.916.0
Hispanic16.816.516.712.121.316.8
Grade
 915.918.317.110.415.012.7
1015.414.514.910.616.513.6
1115.215.915.69.417.213.3
1215.614.114.89.715.512.6
   Total15.515.815.710.016.013.1
Described themselves as overweightWere trying to lose weight
FemaleMaleTotalFemaleMaleTotal
%%%%%%
Race/ethnicity
Whitec37.724.731.163.528.845.9
Blackc36.317.627.252.724.438.9
Hispanic42.432.037.164.138.651.2
Grade
 936.224.330.260.131.945.8
1036.224.530.261.528.244.4
1139.126.032.661.730.546.2
1241.825.633.764.028.746.4
   Total38.125.131.561.729.945.6
TABLE 4.6
High school participation in physical activity by sex, race/ethnicity, and grade, 2005
CategoryMet currently recommended levels of physical activityaMet previously recommended levels of physical activitybNo vigorous or moderate physical activityc
FemaleMaleTotalFemaleMaleTotalFemaleMaleTotal
aWere physically active doing any kind of physical activity that increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes/day on ≥5 of the 7 days preceding the survey.
bParticipated in at least 20 minutes of vigorous physical activity (i.e., physical activity that made them sweat and breathe hard) on ≥3 of the 7 days preceding the survey and/or at least 30 minutes of moderate physical activity (i.e., physical activity that did not make them sweat and breathe hard) on ≥5 of the 7 days preceding the survey.
cDuring the 7 days preceding the survey.
dNon-Hispanic.
Source: "Table 52. Percentage of High School Students Who Met Currently Recommended Levels of Physical Activity, Who Met Previously Recommended Levels of Physical Activity, and Who Participated in No Vigorous or Moderate Physical Activity, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2005," Morbidity and Mortality Weekly Report, vol. 55, no. SS-5, June 9, 2006, http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf (accessed February 25, 2007)
%%%%%%%%%
Race/ethnicity
Whited30.246.938.763.377.070.29.36.91.1
Blackd21.338.229.553.171.762.018.210.21.8
Hispanic26.539.032.962.676.069.412.38.92.0
Grade
 930.842.836.968.478.473.58.27.21.4
1030.046.838.563.077.870.510.37.51.4
1125.143.834.460.774.267.412.48.41.7
1224.041.932.951.771.961.815.28.42.0
   Total27.843.835.861.575.868.711.37.90.9

suffer from asthma at a rate 140% higher than non-Hispanic white children. Akinbami finds that besides their higher prevalence rates, African-American children's asthma is apparently much less well controlled than non-Hispanic white children's asthma. African-American children have a 260% higher emergency department visit rate, a 250% higher hospitalization rate, and a 500% higher death rate from asthma. She speculates that this is because of the lower level and quality of health care received by African-American children.

HIV/AIDS

Acquired immunodeficiency syndrome (AIDS) was identified as a new disease in 1981, and, according to the CDC, in the HIV/AIDS Surveillance Report (2006, http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2005report/pdf/2005SurveillanceReport.pdf), an estimated 988,376 cases had been diagnosed in the United States through 2005. AIDS is caused by the human immunodeficiency virus (HIV), which weakens the victim's immune system, making it vulnerable to other opportunistic infections. Young children with AIDS usually have the virus transmitted to them either by an infected parent or through contaminated transfusions of blood or blood products. Adolescents who are sexually active or experimenting with drugs are also vulnerable to HIV infection, which can be spread through sexual intercourse without the use of a condom or through shared hypodermic needles.

In adults the most common opportunistic infections of AIDS are Kaposi's sarcoma—a rare skin cancer—and pneumocystis carinii pneumonia. In infants and children a failure to thrive and unusually severe bacterial infections characterize the disease. Except for pneumocystis carinii pneumonia, children with symptomatic HIV infection seldom develop opportunistic infections as adults do. More often, they are plagued by recurrent bacterial infections, persistent oral thrush (a common fungal infection of the mouth or throat), and chronic and recurrent diarrhea. They may also suffer from enlarged lymph nodes, chronic pneumonia, developmental delays, and neurological abnormalities.

HOW MANY ARE INFECTED?

By the end of 2005 the CDC reported a cumulative total of 9,078 AIDS cases in children under the age of thirteen since record keeping began in 1981. (See Table 4.7.) African-American children made up the overwhelming majority of these cases (5,614 cases), followed by Hispanic children (1,732 cases), non-Hispanic white children (1,613 cases), Asians and Pacific Islanders (54 cases), and Native Americans or Alaskan Natives (32 cases). By the end of 2005, 5,136 children aged fourteen and under had died from the disease.

MEANS OF TRANSMITTAL

Most babies of HIV-infected mothers do not develop HIV. HIV-positive mothers can reduce the risk of transmission by taking antiretroviral drugs during the last two trimesters of pregnancy and during labor; giving birth by caesarean section; giving the infant a short course of antiretroviral drugs after birth; and not breastfeeding. With these interventions, the transmission rate can be reduced to as low as 2%.

Although interventions are effective in preventing HIV transmission from pregnant mothers to babies, the overwhelming majority of children with AIDS contracted it from mothers who were either infected with HIV or at risk for AIDS (8,438 of 9,078 cases, or 93%). (See Table 4.7.) Another way HIV/AIDS has been transmitted to children was through blood transfusions contaminated with the virus, although this means of transmission has been all but eliminated in the twenty-first century.

ADOLESCENTS WITH AIDS

The number of AIDS cases among adolescents is comparatively low. The CDC reports that by the end of 2005, 6,324 adolescents aged thirteen to nineteen had been diagnosed with AIDS since the beginning of the epidemic in the early 1980s. However, because of the long incubation period between the time of infection and the onset of symptoms, it is highly probable that many people who develop AIDS in their early twenties became infected with HIV during their adolescence; by 2005, 34,987 twenty- to twenty-four-year-olds had been diagnosed.

MENTAL HEALTH ISSUES IN YOUNG PEOPLE

Marital Conflict and Divorce

Marital conflict hurts children whether it results in the breakup of marriages or not. Nearly all the studies on children of divorce focus on the period after the parents separated. However, some recent studies suggest that the negative effects children experience may not come so much from divorce itself as from the marital discord between parents before divorce. In fact, some research suggests that many problems reported with troubled teens not only began during the marriage but may have contributed to the breakup of the marriage. According to the article "Children of Divorce" (Journal of the American Board of Family Practice, 2001), children raised in discord and marital instability often experience a variety of social, emotional, and psychological problems.

Divorce can cause stressful situations for children in several ways. One or both parents may have to move to a new home, removing the children from family and friends who can give them support. Custody issues can generate hostility between parents. If one or both parents remarry, children are faced with yet another adjustment in their living arrangements.

Eating Disorders

Even though young people who are overweight increase their risk for certain diseases in adulthood, an overemphasis on thinness during childhood may contribute to eating disorders such as anorexia nervosa (extreme and often fatal weight loss) and bulimia ("binging and purging"). Girls are both more likely to have a distorted view of their weight and more likely to have eating disorders than boys.

TABLE 4.7
Diagnoses of AIDS in children younger than 13, by year of diagnosis, race/ethnicity, and transmission category, 2001–05
Year of diagnosisCumulativea
20012002200320042005
Note: These numbers do not represent reported case counts. Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts have been adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk factor, but not for incomplete reporting.
aFrom the beginning of the epidemic through 2005.
bIncludes children of unknown race or multiple races. Cumulative total includes 33 children of unknown race or multiple races. Because column totals were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.
Source: "Table 4. Estimated Numbers of AIDS Cases in Children <13 Years of Age, by Year of Diagnosis and Selected Characteristics, 2001–2005 and Cumulative—50 States and the District of Columbia," in HIV/AIDS Surveillance Report, vol. 17, Centers for Disease Control and Prevention, 2006, http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2005report/pdf/2005SurveillanceReport.pdf (accessed February 25, 2007)
Race/ethnicity
White, not Hispanic121411781,613
Black, not Hispanic83724329395,614
Hispanic221610991,732
Asian/Pacific Islander1101154
American Indian/Alaska Native0101032
Transmission category
Hemophilia/coagulation disorder00000226
Mother with documented HIV infection or 1 of the following
  risk factors1151026747578,438
    Injection drug use13117643,196
    Sex with injection drug user1046211,388
    Sex with bisexual male32021202
    Sex with person with hemophilia1000036
    Sex with HIV-infected transfusion recipient0000022
    Sex with HIV-infected person, risk factor not specified39361919251,501
    Receipt of blood transfusion, blood components, or tissue12100143
    Has HIV infection, risk factor not specified47473218251,949
Receipt of blood transfusion, blood components, or tissue02000372
Other/risk factor not reported or identified3000042
    Totalb1181046747589,078

The CDC reports that although 13.1% of students were overweight in 2005, a much higher proportion thought they were overweight (31.5%). (See Table 4.5.) Girls (38.1%) were much more likely than boys (25.1%) to believe they were overweight. Non-Hispanic white (31.1%) and especially Hispanic (37.1%) youths were more likely than African-American youths (27.2%) to think of themselves as overweight.

In 2005 nearly half (45.6%) of high school students nationwide were trying to lose weight by a variety of methods. (See Table 4.5.) Almost one out of twenty (4.5%) high school students had taken laxatives or induced vomiting to lose weight, 12.3% went without eating for twenty-four hours or more, and 6.3% took diet pills. (See Table 4.8.) Hispanic and non-Hispanic white students were more likely to resort to these unhealthy behaviors than were African-American students. Many more females than males engaged in risky weight-loss methods.

Many more high school students engaged in healthier methods of losing weight. Well over half of high school females dieted or exercised to lose weight (54.8% and 67.4%, respectively); among males, only 26.8% dieted and 52.9% exercised to lose weight. (See Table 4.8.) Once again, among females these behaviors varied by race: Far more white and Hispanic female students engaged in these weight-loss activities than did African-American female students.

Hyperactivity

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders to appear in childhood. No one knows what causes ADHD, although recent research reported by the National Institute of Mental Health finds a link between a person's ability to pay attention and the body's use of glucose in the brain. Symptoms include restlessness, inability to concentrate, aggressiveness, and impulsivity; lack of treatment can lead to problems in school, at work, and in making friends. In "Attention Deficit Hyperactivity Disorder" (2001, http://www.nimh.nih.gov/publicat/helpchild.cfm), the National Institute of Mental Health estimates that 4.1% of youths aged nine to seventeen are affected in any six-month period by ADHD. Boys are two to three times more likely to be affected by ADHD than girls. Methylphenidate, a stimulant, is frequently used to treat hyperactive children.

TABLE 4.8
Percentage of high school students who engaged in healthy and unhealthy behaviors associated with weight controla, by sex, race/ethnicity, and grade, 2005
CategoryAte less food, fewer calories, or foods low in fat to lose weight or to keep from gaining weightExercised to lose weight or to keep from gaining weightWent without eating for ≥24 hours to lose weight or to keep from gaining weightTook diet pills, powders, or liquids to lose weight or to keep from gaining weightcVomited or took laxatives to lose weight or to keep from gaining weight
FemaleMaleTotalFemaleMaleTotalFemaleMaleTotalFemaleMaleTotalFemaleMaleTotal
aDuring the 30 days preceding the survey.
bNon-Hispanic.
cWithout a doctor's advice.
Source: Adapted from "Table 64. Percentage of High School Students Who Engaged in Healthy Behaviors to Lose Weight or to Keep from Gaining Weight, by Sex, Race/Ethnicity, and Grade," and "Table 66. Percentage of High School Students Who Engaged in Unhealthy Behaviors to Lose Weight or to Keep from Gaining Weight, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2005," Morbidity and Mortality Weekly Report, vol. 55, no. SS-5, June 9, 2006, http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf (accessed February 25, 2007)
%%%%%%%%%%%%%%%
Race/ethnicity
Whiteb58.826.442.469.851.217.67.512.59.24.26.66.72.34.4
Blackb39.622.031.156.551.654.114.08.611.44.95.15.04.02.83.4
Hispanic53.231.542.268.963.065.917.77.412.67.55.76.66.83.95.4
Grade
 950.827.138.868.357.762.918.48.113.36.04.35.25.52.74.1
1055.325.740.169.052.160.316.27.411.77.74.46.07.23.05.1
1155.626.841.466.349.458.017.26.812.19.24.87.06.12.54.3
1258.427.643.065.551.258.316.07.811.910.24.47.35.92.64.3
   Total54.826.840.767.452.960.017.07.612.38.14.66.36.22.84.5

Drug and Alcohol Use

Few factors negatively influence the health and well-being of young people more than the use of drugs, alcohol, and tobacco. Monitoring the Future, a long-term study on the use of drugs, alcohol, and tobacco conducted by the University of Michigan's Institute for Social Research, annually surveys eighth, tenth, and twelfth graders on their use of these substances. According to the Monitoring the Future: National Results on Adolescent Drug Use, Overview of Key Findings, 2005 (April 2006, http://www.drugabuse.gov/PDF/overview2005.pdf), University of Michigan researchers Lloyd D. Johnston et al. indicate that the percentage of high school students who have ever tried any illicit drug either remained steady or decreased slightly from the mid-1990s to 2005. This plateau followed sharp increases during the early 1990s. Johnston et al. find that by the time they neared high school graduation, half (50%) of American students had tried an illicit drug. Between 1975 and 2005, 83% to 90% of high school seniors reported that they could easily obtain marijuana, more than any other illicit drug. A third of twelfth graders had used marijuana in the previous twelve months. The CDC finds that in 2005, 38.4% of high school students reported they had tried marijuana, and 20.2% reported they had used it at least once in the thirty days before the survey. (See Table 4.9.)

TOBACCO

Most states prohibit the sale of cigarettes to anyone under the age of eighteen, but the laws are often ignored and may carry no penalties for youths who buy cigarettes or smoke in public. The ALA reports in "Smoking and Teens Fact Sheet" (April 2006, http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=39871) that each day six thousand children smoke their first cigarette and that almost two thousand of them will become regular smokers. The CDC indicates that in 2005, 23% of high school students had smoked at least one cigarette in the month prior to being surveyed and 9.4% had smoked at least twenty days in the past month. (See Table 4.10.) Almost twice as many male students smoked heavily than did female students: 7.2% of female adolescents and 14.2% of male adolescents smoked more than ten cigarettes per day.

Teens say they smoke for a variety of reasons—they "just like it," "it's a social thing," and many young women who are worried about their weight report that they smoke because "it burns calories." Many of them note they have seen their parents smoke. The ALA indicates that youth who have two parents who smoke are more than twice as likely to become smokers than youth whose parents do not smoke. Children in smoking households are at risk not only from secondhand smoke but also from this greater likelihood to take up smoking themselves.

ALCOHOL

According to Johnston et al., alcohol remained the drug of choice for teenagers in 2005. (See Table 4.11.) Almost seven out of ten (68.6%) high school seniors had used alcohol in the twelve months prior to the survey, and 47% had used alcohol in the previous thirty days. Although there was some decline in drinking among students in the 1980s, alcohol use remained generally stable among young people between 1995 and 2005. The CDC finds that in 2005, 74.3% of all high school students had had at least one alcoholic drink in their lifetime, 43.3% had taken a drink in the thirty days prior to being surveyed, and 25.5% had had five or more drinks on one occasion at least once in the previous thirty days. (See Table 4.9.) African-American youth were less likely than either non-Hispanic white or Hispanic high schoolers to have ever had a drink, to have had a drink in the previous thirty days, or to engage in episodic heavy drinking.

CHILDHOOD DEATHS

Infant Mortality

The NCHS defines the infant mortality rate as the number of deaths of babies younger than one year per 1,000 live births. Neonatal deaths occur within 28 days after birth and postneonatal deaths occur 28 to 365 days after birth. The U.S. infant mortality rate declined from 165 per 1,000 live births in 1900 to a low of 6.8 per 1,000 live births in 2003, after increasing in 2002 for the first time in decades. (See Table 4.12.) In Health, United States, 2003 (http://www.cdc.gov/nchs/data/hus/hus03.pdf), the CDC notes that several factors—including improved access to health care, advances in neonatal medicine, and educational campaigns—contributed to the overall decline in infant mortality in the twentieth century.

Not all racial and ethnic groups have reached that record-low infant mortality rate. In 2003 the infant mortality rate for non-Hispanic white infants was 5.7 deaths per 1,000 live births, less than half the rate of 13.5 for African-American infants. (See Table 4.12.) Rates for Native American or Alaskan Native, Hispanic, and Asian and Pacific Islander babies were 8.7, 5.6, and 4.8, respectively.

The NCHS lists the ten leading causes of infant mortality in the United States in 2004. (See Table 4.13.) Birth defects (congenital malformations) were the primary cause of infant mortality (136.6 deaths per 100,000 live births). Premature delivery or low birth weight was the second-leading cause of infant mortality (113.8 per 100,000 live births). Sudden infant death syndrome (51.2), complications of pregnancy (41.4), complications in the placenta or umbilical cord (24.2), respiratory distress (21.3), bacterial sepsis (19.4), neonatal hemorrhage (14.4), and intrauterine hypoxia/birth asphyxia (12.2) completed the list.

SUDDEN INFANT DEATH SYNDROME

Sudden infant death syndrome (SIDS; sometimes called crib death), the unexplained death of a previously healthy infant, was the third-leading cause of infant mortality in the United States in 2004. Moreover, it was the leading cause of death for infants older than one month. In 1992 the

TABLE 4.9
Percentage of high school students who drank alcohol and used marijuana, by sex, race/ethnicity, and grade, 2005
CategoryLifetime alcohol useaCurrent alcohol usebEpisodic heavy drinkingcLifetime marijuana useeCurrent marijuana usef
FemaleMaleTotalFemaleMaleTotalFemaleMaleTotalFemaleMaleTotalFemaleMaleTotal
aHad at least one drink of alcohol on ≥1 day during their life.
bHad at least one drink of alcohol on ≥1 of the 30 days preceding the survey.
cHad ≥5 drinks of alcohol in a row (i.e., within a couple of hours) on ≥1 of the 30 days preceding the survey.
dNon-Hispanic.
eUsed marijuana one or more times during their life.
fUsed marijuana one or more times during the 30 days preceding the survey.
Source: Adapted from "Table 28. Percentage of High School Students Who Drank Alcohol, by Sex, Race/Ethnicity, and Grade," and "Table 30. Percentage of High School Students Who Used Marijuana, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2005," Morbidity and Mortality Weekly Report, vol. 55, no. SS-5, June 9, 2006, http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf (accessed February 25, 2007)
%%%%%%%%%%%%%%%
Race/ethnicity
Whited75.775.075.345.947.046.428.131.829.936.040.038.019.221.320.3
Blackd71.466.569.032.529.631.210.411.911.137.843.840.718.822.120.4
Hispanic79.079.979.444.848.946.821.928.725.337.547.742.618.028.123.0
Grade
 966.566.666.536.236.336.217.320.719.027.830.929.316.218.617.4
1075.673.274.442.741.442.024.125.124.635.739.037.418.921.520.2
1177.175.576.344.247.846.025.030.427.639.445.142.318.523.521.0
1281.881.581.749.652.050.829.236.232.842.852.447.619.526.122.8
   Total74.873.874.342.843.843.323.527.525.535.940.938.418.222.120.2
TABLE 4.10
Percentage of high school students who used tobacco, by sex, race/ethnicity, and grade, 2005
Lifetime cigarette useaLifetime daily cigarette usebCurrent cigarette used
CategoryFemaleMaleTotalFemaleMaleTotalFemaleMaleTotal
aEver tried cigarette smoking, even one or two puffs.
bEver smoked at least one cigarette every day for 30 days.
cNon-Hispanic.
dSmoked cigarettes on ≥1 of the 30 days preceding the survey.
eSmoked cigarettes on ≥20 of the 30 days preceding the survey.
fOn the days they smoked during the 30 days preceding the survey, among the 23.0% of students nation wide who reported current cigarette use.
gDuring the 30 days preceding the survey, among the 19.1% of students nationwide who were aged <18 years and who reported current cigarette use.
Source: Adapted from "Table 20. Percentage of High School Students Who Ever Smoked Cigarettes, by Sex, Race/Ethnicity, and Grade," and "Table 22. Percentage of High School Students Who Currently Smoked Cigarettes, by Sex, Race/Ethnicity, and Grade," and "Table 24. Percentage of High School Students Who Tried to Quit Smoking Cigarettes, Who Usually Got Their Own Cigarettes by Buying Them in a Store or Gas Station, and Who Were Not Asked to Show Proof of Age When They Bought or Tried to Buy Cigarettes in a Store, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2005," Morbidity and Mortality Weekly Report, vol. 55, no. SS-5, June 9, 2006, http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf (accessed February 25, 2007)
%%%%%%%%%
Race/ethnicity
Whitec53.254.954.017.015.116.127.024.925.9
Blackc53.256.354.73.27.55.211.914.012.9
Hispanic52.062.157.19.211.510.419.224.822.0
Grade
 947.749.848.710.29.910.020.518.919.7
1050.854.152.511.511.611.521.921.121.4
1155.359.657.516.014.515.324.324.224.3
1258.362.260.317.418.117.826.029.127.6
   Total52.755.954.313.513.313.423.022.923.0
Current frequent cigarette useeSmoked >10 cigarettes/dayfBought cigarettes in a store or gas stationg
CategoryFemaleMaleTotalFemaleMaleTotalFemaleMaleTotal
%%%%%%%%%
Race/ethnicity
Whitec11.710.611.27.516.211.711.117.414.1
Blackc2.45.13.72.54.43.518.624.621.6
Hispanic4.78.16.56.110.48.512.221.317.4
Grade
 97.06.76.94.612.88.65.011.68.2
108.47.07.76.56.76.67.813.410.6
1110.010.510.38.617.913.114.825.820.3
1212.513.913.29.216.913.227.734.030.8
   Total9.39.39.47.214.210.711.718.815.2

American Academy of Pediatrics recommended that babies sleep on their backs to reduce the risk of SIDS and launched its Back to Sleep campaign to educate parents. It had been a long-held belief that the best position for babies to sleep was on their stomachs. The American SIDS Institute (2005, http://www.sids.org/) reports that the Back to Sleep campaign has resulted in the reduction of SIDS cases by over 50% since 1983. Other risk factors for SIDS include maternal use of drugs or tobacco during pregnancy, low birth weight, and poor prenatal care. For reasons not yet understood, the CDC notes in "Sudden Infant Death Syndrome" (November 13, 2006, http://www.cdc.gov/SIDS/index.htm) that even though the overall rate of SIDS has declined since the beginning of the Back to Sleep campaign, it has declined less among African-Americans and Native Americans than among other groups.

A number of recent studies consider the possible causes of and risk factors for SIDS. One study, "SIDS Risk Prevention Research Begins to Define Physical Abnormalities in Brainstem, Points to Possible Diagnostic/Screening Tools" (PRNewswire, October 18, 1999), which has been ongoing since 1985 and is being conducted by Hannah Kinney of Harvard Medical School in Boston, Massachusetts, finds a brain defect believed to affect breathing in babies who die of SIDS. Researchers suggest that as carbon dioxide levels rise and oxygen levels fall during sleep, the brains of some babies do not get the signal to regulate breathing or blood pressure accordingly to make up for the change. This condition is particularly dangerous for infants sleeping on their stomachs or on soft bedding. According to the article "SIDS Infants Show Brain Abnormalities" (NIH Research Matters, November 10, 2006), the project finds that this brain abnormality might be linked to higher levels of serotonin in the brainstem. Duane Alexander, the director of the National Institute of Child Health and Human Development, states that "this finding lends credence to the view that SIDS risk may greatly increase when an underlying predisposition combines with an environmental risk—such as sleeping face down—at a developmentally sensitive time in early life."

TABLE 4.11
Percent of high school seniors who reported drug and alcohol use during 12-month period and 30-day period, 2005
Used in past 12 monthsUsed in past 30 days
Source: Adapted from Lloyd D. Johnston et al., "Table 2. Trends in Annual Prevalence of Use of Various Drugs for Eighth, Tenth, and Twelfth Graders," and "Table 3. Trends in 30-Day Prevalence of Use of Various Drugs for Eighth, Tenth, and Twelfth Graders," in Monitoring the Future: National Results on Adolescent Drug Use, Overview of Key Findings, 2005, U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, April 2006, http://www.drugabuse.gov/PDF/overview2005.pdf (accessed February 25, 2007)
Marijuana/hashish33.619.8
Inhalants5.02.0
PCP1.30.7
MDMA (ecstasy)3.01.0
Cocaine5.12.3
Crack1.91.0
Heroin0.80.5
Other narcotics9.03.9
Amphetamines8.63.9
Methamphetamine2.50.9
Sedatives (barbiturates)7.23.3
Tranquilizers6.82.9
Alcohol68.647.0
Steroids1.50.9

Mortality among Older Children

In the second half of the twentieth century childhood death rates declined dramatically. Most childhood deaths are from injuries and violence. Even though death rates for all ages decreased, the largest declines were among children.

In 2004 three of the leading causes of childhood death were unintentional injuries, congenital anomalies (birth defects), and malignant neoplasms (cancers). (See Table 4.14.) The remaining deaths were spread across a variety of diseases, including heart disease, pneumonia, influenza, HIV/AIDS, homicide, and suicide.

MOTOR VEHICLE INJURIES

According to the National Highway Traffic Safety Administration (NHTSA), in "Determine Why There Are Fewer Young Alcohol-Impaired Drivers" (September 2001, http://www.nhtsa.dot.gov/people/injury/research/FewerYoungDrivers/), during the 1980s and early 1990s traffic fatalities linked to teenage drinking fell. This decline was due in large part to stricter enforcement of drinking age laws and driving while intoxicated or driving under the influence laws. Nevertheless, motor vehicle crashes were the leading cause of death among fifteen- to nineteen-year-olds in 2003. In the fact sheet "Mortality: Adolescents and Young Adults" (2006, http://nahic.ucsf.edu/downloads/Mortality.pdf), the National Adolescent Health Information Center reports that 25.2 of every 100,000 teenagers in that age group were killed in traffic accidents in 2003. Many of those killed had been drinking alcohol and were not wearing their seatbelts. Timothy M. Pickrell of the U.S. Department of Transportation reports in "Driver Alcohol Involvement in Fatal Crashes by Age Group and Vehicle Type" (June 2006, http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2006/810598.pdf) that 20% of all young drivers aged fifteen to twenty who were killed in crashes were intoxicated.

The CDC's 2005 "Youth Risk Behavior Surveillance" finds that in the month before the survey 17.1% of high school seniors (those most likely to have their driver's licenses) reported they had driven a vehicle after drinking alcohol. (See Table 4.15.) Male seniors (19.2%) were more likely than female seniors (15%) to drive after drinking. Another 28.5% of high school students admitted they had ridden with a driver who had been drinking. Females were slightly more likely to ride with a driver who had been drinking (29.6%) than were males (27.2%).

SUICIDE

In 2004 suicide was the seventh-leading cause of death among five- to fourteen-year-olds and the third-leading cause of death in fifteen- to twenty-four-year-olds. (See Table 4.14.) The CDC reports in "Homicides and Suicides—National Violent Death Reporting System, United States, 2003–2004" (Morbidity and Mortality Weekly Report, July 7, 2006) that the male suicide rate is more than four times higher than the female suicide rate. Robert N. Anderson and Betty L. Smith of the CDC's Division of Vital Statistics note in "Deaths: Leading Causes for 2001" (National Vital Statistics Reports, November 7, 2003) that in 2001, the most recent year for which detailed statistics are available, white males aged fifteen to nineteen had twice the suicide rate (14 per 100,000) of African-American males (7.3 per 100,000) or Hispanic male youth (7.8 per 100,000). Among females aged fifteen to nineteen, the rate for whites (2.9 per 100,000) was considerably higher than that for Hispanics (2.5 per 100,000) or African-Americans (1.3 per 100,000).

The CDC's "Youth Risk Behavior Surveillance" questioned high school students regarding their thoughts about suicide. In 2005 almost one out of six students (16.9%) surveyed claimed that they had seriously thought about attempting suicide in the previous twelve months. (See Table 4.16.) Although the suicide death rate was much higher among males than among females, females (21.8%) were more likely to have considered suicide than males (12%). Of all students, 13% (16.2% of females and 9.9% of males) had made a specific plan to attempt suicide, 8.4% of students (10.8% of females and 6% of males) said they had attempted suicide in the previous year, and 2.3% of high school students (2.9% of females and 1.8% of males) said they had suffered injuries from the attempt that required medical attention. These numbers reflect the fact that females of all ages tend to choose less fatal methods of attempting suicide, such as overdosing and cutting veins, than males, who tend to choose more deadly methods, such as shooting or hanging.

TABLE 4.12
Infant mortality rate among selected groups, by race and Hispanic origin of mother, selected years 1983–2003
[Data are based on linked birth and death certificates for infants]
Race and Hispanic origin of mother1983a1985a1990a1995b1999b2000b2001b2002b2003b
*Estimates are considered unreliable. Rates preceded by an asterisk are based on fewer than 50 deaths in the numerator. Rates not shown are based on fewer than 20 deaths in the numerator.
aRates based on unweighted birth cohort data.
bRates based on a period file using weighted data.
cInfant (under 1 year of age), neonatal (under 28 days), and postneonatal (28 days-11 months).
dStarting with 2003 data, estimates are not shown for Asian or Pacific Islander subgroups during the transition from single race to multiple race reporting.
ePersons of Hispanic origin may be of any race.
fPrior to 1995, data shown only for states with an Hispanic-origin item on their birth certificates.
Notes: The race groups white, black, American Indian or Alaska Native, and Asian or Pacific Islander include persons of Hispanic and non-Hispanic origin. Starting with 2003 data, some states reported multiple-race data. The multiple-race data for these states were bridged to the single race categories of the 1977 Office of Management and Budget standards for comparability with other states. National linked files do not exist for 1992–1994. Data for additional years are available.
Source: Adapted from "Table 19. Infant, Neonatal, and Postneonatal Mortality Rates, by Detailed Race and Hispanic Origin of Mother: United States, Selected Years 1983–2003," in Health: United States, 2006, with Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, 2006, http://www.cdc.gov/nchs/data/hus/hus06.pdf (accessed February 25, 2007)
Infantc deaths per 1,000 live births
All mothers10.910.4 8.9 7.6 7.0 6.9 6.8 7.06.8
White 9.3 8.9 7.3 6.3 5.8 5.7 5.7 5.85.7
Black or African American19.218.616.914.614.013.513.313.813.5
American Indian or Alaska Native15.213.113.1 9.0 9.3 8.3 9.7 8.68.7
Asian or Pacific Islanderd 8.3 7.8 6.6 5.3 4.8 4.9 4.7 4.84.8
    Chinese 9.5 5.8 4.3 3.8 2.9 3.5 3.2 3.0
    Japanese 5.6* 6.0* 5.5* 5.3* 3.5* 4.5* 4.0* 4.9*
    Filipino 8.4 7.7 6.0 5.6 5.8 5.7 5.5 5.7
    Hawaiian11.2 9.9* 8.0* 6.5* 7.0* 9.0 7.3*9.6
    Other Asian or Pacific Islander 8.1 8.5 7.4 5.5 5.1 4.8 4.8 4.7
Hispanic or Latinoe, f 9.5 8.8 7.5 6.3 5.7 5.6 5.4 5.65.6
    Mexican 9.1 8.5 7.2 6.0 5.5 5.4 5.2 5.45.5
    Puerto Rican12.911.2 9.9 8.9 8.3 8.2 8.5 8.28.2
    Cuban 7.5 8.5 7.2 5.3 4.6 4.6 4.2 3.74.6
    Central and South American 8.5 8.0 6.8 5.5 4.7 4.6 5.0 5.15.0
    Other and unknown Hispanic or Latino10.6 9.5 8.0 7.4 7.2 6.9 6.0 7.16.7
Not Hispanic or Latino:
    Whitef 9.2 8.6 7.2 6.3 5.8 5.7 5.7 5.85.7
    Black or African Americanf19.118.316.914.714.113.613.513.913.6
Neonatalc deaths per 1,000 live births
All mothers 7.1 6.8 5.7 4.9 4.7 4.6 4.5 4.74.6
White 6.1 5.8 4.6 4.1 3.9 3.8 3.8 3.93.9
Black or African American12.512.311.1 9.6 9.5 9.1 8.9 9.39.2
American Indian or Alaska Native 7.5 6.1 6.1 4.0 5.0 4.4 4.2 4.64.5
Asian or Pacific Islanderd 5.2 4.8 3.9 3.4 3.2 3.4 3.1 3.43.4
    Chinese 5.5 3.3 2.3 2.3 1.8 2.5 1.9 2.4
    Japanese 3.7* 3.1* 3.5* 3.3* 2.8* 2.6* 2.5* 3.7*
    Filipino 5.6 5.1 3.5 3.4 3.9 4.1 4.0 4.1
    Hawaiian 7.0* 5.7* 4.3* 4.0* 4.9* 6.2* 3.6* 5.6*
    Other Asian or Pacific Islander 5.0 5.4 4.4 3.7 3.3 3.4 3.2 3.3
Hispanic or Latinoe, f 6.2 5.7 4.8 4.1 3.9 3.8 3.6 3.83.9
    Mexican 5.9 5.4 4.5 3.9 3.7 3.6 3.5 3.63.8
    Puerto Rican 8.7 7.6 6.9 6.1 5.9 5.8 6.0 5.85.7
    Cuban 5.0* 6.2 5.3 3.6* 3.5* 3.2* 2.5* 3.2*3.4
    Central and South American 5.8 5.6 4.4 3.7 3.3 3.3 3.4 3.53.6
    Other and unknown Hispanic or Latino 6.4 5.6 5.0 4.8 4.8 4.6 3.9 5.14.7
Not Hispanic or Latino:
    Whitef 5.9 5.6 4.5 4.0 3.8 3.8 3.8 3.93.8
    Black or African Americanf12.011.911.0 9.6 9.6 9.2 9.0 9.39.3

In "Homicides and Suicides" the CDC reports that the likelihood that a child will commit suicide increases with the presence of certain risk factors. Among the factors whose presence may indicate heightened risk are depression, mental health problems, relationship conflicts, a history of previous suicide attempts, and alcohol dependence. In addition, the suicide rate among male homosexual teens is believed to be extremely high. Gary Remafedi of the University of Minnesota's Youth and AIDS Projects, in "Suicidality in a Venue-Based Sample of Young Men Who Have Sex with Men" (Journal of Adolescent Health, October 2002), corroborates previous estimates that 20% to 42% of teens and young men who have sex with other males attempt suicide.

TABLE 4.13
Ten leading causes of infant death by race and Hispanic origin, 2004
[Data are based on a continuous file of records received from the states. Rates are per 100,000 live births. Figures are based on weighted data rounded to the nearest individual, so categories may not add to totals or subtotals Rates for Hispanic origin should be interpreted with caution because of inconsistencies between reporting Hispanic origin on birth and death certificates]
RankaCause of death and ageNumberRate
All racesb
All causes27,835676.3
 1Congenital malformations, deformations and chromosomal abnormalities5,623136.6
 2Disorders related to short gestation and low birth weight, not elsewhere classified4,685113.8
 3Sudden infant death syndrome2,10951.2
 4Newborn affected by maternal complications of pregnancy1,70541.4
 5Newborn affected by complications of placenta, cord and membranes99824.2
 6Accidents (unintentional injuries)99524.2
 7Respiratory distress of newborn87721.3
 8Bacterial sepsis of new born79819.4
 9Neonatal hemorrhage59314.4
10Intrauterine hypoxia and birth asphyxia50212.2
All other causes8,950217.5
Non-Hispanic white
All causes13,084567.8
 1Congenital malformations, deformations and chromosomal abnormalities3,002130.3
 2Disorders related to short gestation and low birth weight, not elsewhere classified1,89582.3
 3Sudden infant death syndrome1,12348.8
 4Newborn affected by maternal complications of pregnancy75332.7
 5Accidents (unintentional injuries)53423.2
 6Newborn affected by complications of placenta, cord and membranes48220.9
 7Respiratory distress of newborn39817.3
 8Bacterial sepsis of new born34414.9
 9Neonatal hemorrhage27712.0
10Intrauterine hypoxia and birth asphyxia26411.4
All other causes4,013174.2
Total blackc
All causes8,3471,362.8
 1Disorders related to short gestation and low birth weight, not elsewhere classified1,766288.4
 2Congenital malformations, deformations and chromosomal abnormalities1,049171.3
 3Sudden infant death syndrome683111.5
 4Newborn affected by maternal complications of pregnancy624101.9
 5Newborn affected by complications of placenta, cord and membranes30649.9
 6Respiratory distress of newborn30249.4
 7Accidents (unintentional injuries)30049.0
 8Bacterial sepsis of new born26843.7
 9Neonatal hemorrhage15725.6
10Necrotizing enterocolitis of newborn15124.6
All other causes2,741447.5
TABLE 4.13
Ten leading causes of infant death by race and Hispanic origin, 2004 [continued]
[Data are based on a continuous file of records received from the states. Rates are per 100,000 live births. Figures are based on weighted data rounded to the nearest individuals, so categories may not add to totals or subtotals Rates for Hispanic origin should be interpreted with caution because of inconsistencies between reporting Hispanic origin on birth and death certificates]
RankaCause of death and ageNumberRate
—Category not applicable.
aRank based on number of deaths.
bIncludes races other than black and white.
cRace and Hispanic origin are reported separately on both the birth and death certificate. Race categories are consistent with the 1977 Office of Management and Budget (OMB) standards. California, Hawaii, Idaho, Maine, Michigan, Minnesota, Montana, New Hampshire, New Jersey, New York, Oklahoma, South Dakota, Washington, Wisconsin, and Wyoming reported multiple-race data in 2004. The multiple-race data for these states were bridged to the single race categories of the 1977 OMB standards for comparability with other states. Data for persons of Hispanic origin are included in the data for each race group, according to the decedent's reported race.
dIncludes all persons of Hispanic origin of any race.
Notes: For certain causes of death such as unintentional injuries, homicides, suicides, and respiratory diseases, preliminary and final data differ because of the truncated nature of the preliminary file. Data are subject to sampling and/or random variation. Although the infant mortality rate is the preferred indicator of the risk of dying during the first year of life, another measure of infant mortality, the infant death rate, is shown elsewhere in this report. The two measures typically are similar yet they can differ because the denominators used for these measures are different.
Source: Adapted from Arialdi M. Miniño, Melonie P. Heron, and Betty L. Smith, "Table 8. Infant Deaths and Infant Mortality Rates for the 10 Leading Causes of Infant Death, by Race and Hispanic Origin: United States, Preliminary 2004," in "Deaths: Preliminary Data for 2004," National Vital Statistics Reports, vol. 54, no. 19, June 28, 2006, http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_19.pdf (accessed February 25, 2007)
Hispanicd
All causes3,782400.2
 1Congenital malformations, deformations and chromosomal abnormalities1,288136.3
 2Disorders related to short gestation and low birth weight, not elsewhere classified82887.7
 3Newborn affected by maternal complications of pregnancy26828.3
 4Sudden infant death syndrome24125.5
 5Newborn affected by complications of placenta, cord and membranes17418.4
 6Bacterial sepsis of new born16317.2
 7Respiratory distress of newborn16016.9
 8Accidents (unintentional injuries)13214.0
 9Neonatal hemorrhage12713.5
10Atelectasis10811.4
All other causes29431.1
TABLE 4.14
Leading causes of death and numbers of deaths, by age, 1980 and 2004
[Data are based on death certificates]
Age and rank order19802004
Cause of deathDeathsCause of deathDeaths
Under 1 year
All causes45,526All causes27,936
 1Congenital anomalies9,220Congenital malformations, deformations and chromosomal abnormalities5,622
 2Sudden infant death syndrome5,510Disorders related to short gestation and low birth weight, not elsewhere classified4,642
 3Respiratory distress syndrome4,989Sudden infant death syndrome2,246
 4Disorders relating to short gestation and unspecified low birth weight3,648Newborn affected by maternal complications of pregnancy1,715
 5Newborn affected by maternal complications of pregnancy1,572Unintentional injuries1,052
 6Intrauterine hypoxia and birth asphyxia1,497Newborn affected by complications of placenta, cord and membranes1,042
 7Unintentional injuries1,166Respiratory distress of newborn875
 8Birth trauma1,058Bacterial sepsis of newborn827
 9Pneumonia and influenza1,012Neonatal hemorrhage616
10Newborn affected by complications of placenta, cord, and membranes985Diseases of circulatory system593
1-4 years
All causes8,187All causes4,785
 1Unintentional injuries3,313Unintentional injuries1,641
 2Congenital anomalies1,026Congenital malformations, deformations and chromosomal abnormalities569
 3Malignant neoplasms573Malignant neoplasms399
 4Diseases of heart338Homicide377
 5Homicide319Diseases of heart187
 6Pneumonia and influenza267Influenza and pneumonia119
 7Meningitis223Septicemia84
 8Meningococcal infection110Certain conditions originating in the perinatal period61
 9Certain conditions originating in the perinatal period84In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior53
10Septicemia71Chronic lower respiratory diseases48
5-14 years
All causes10,689All causes6,834
 1Unintentional injuries5,224Unintentional injuries2,666
 2Malignant neoplasms1,497Malignant neoplasms1,019
 3Congenital anomalies561Congenital malformations, deformations and chromosomal abnormalities389
 4Homicide415Homicide329
 5Diseases of heart330Suicide285
 6Pneumonia and influenza194Diseases of heart245
 7Suicide142Chronic lower respiratory diseases120
 8Benign neoplasms104In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior84
 9Cerebrovascular diseases95Influenza and pneumonia82
10Chronic obstructive pulmonary diseases85Cerebrovascular diseases77
TABLE 4.14
Leading causes of death and numbers of deaths, by age, 1980 and 2004 [continued]
[Data are based on death certificates]
Age and rank order19802004
Cause of deathDeathsCause of deathDeaths
—Category not applicable.
Source: Adapted from "Table 32. Leading Causes of Death and Numbers of Deaths, by Age: United States, 1980 and 2004," in Health: United States, 2006, with Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, 2006, http://www.cdc.gov/nchs/data/hus/hus06.pdf (accessed February 25, 2007)
15-24 years
All causes49,027All causes33,421
 1Unintentional injuries26,206Unintentional injuries15,449
 2Homicide6,537Homicide5,085
 3Suicide5,239Suicide4,316
 4Malignant neoplasms2,683Malignant neoplasms1,709
 5Diseases of heart1,223Diseases of heart1,038
 6Congenital anomalies600Congenital malformations, deformations and chromosomal abnormalities483
 7Cerebrovascular diseases418Cerebrovascular diseases211
 8Pneumonia and influenza348Human immunodeficiency virus (HIV) disease191
 9Chronic obstructive pulmonary diseases141Influenza and pneumonia185
10Anemias133Chronic lower respiratory diseases179
TABLE 4.15
Percentage of high school students who rode with a driver who had been drinking alcohol and who drove when they had been drinking alcohol, by sex, race/ethnicity, and grade, 2005
CategoryRode with a driver who had been drinking alcoholaDrove when drinking alcohola
FemaleMaleTotalFemaleMaleTotal
aOne or more times during the 30 days preceding the survey.
bNon-Hispanic.
Source: "Table 4. Percentage of High School Students Who Rode in a Car or Other Vehicle Driven by Someone Who Had Been Drinking Alcohol and Who Drove a Car or Other Vehicle When They Had Been Drinking Alcohol, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2005," Morbidity and Mortality Weekly Report, vol. 55, no. SS-5, June 9, 2006, http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf (accessed February 25, 2007)
%%%%%%
Race/ethnicity
Whiteb30.426.228.310.112.411.3
Blackb24.024.324.13.56.54.9
Hispanic34.737.436.16.414.610.5
Grade
 930.125.827.94.56.55.5
1029.526.227.84.88.36.6
1128.127.728.09.514.712.1
1230.729.530.115.019.217.1
   Total29.627.228.58.111.79.9
TABLE 4.16
Percentage of high school students who felt sad or hopeless, who seriously considered attempting suicide, who made a suicide plan, and who attempted suicide, by sex, race/ethnicity, and grade, 2005
CategoryFelt sad or hopelessa, bSeriously considered attempting suicidebMade a suicide planbAttempted suicidea, dSuicide attempt treated by a doctor or nursea
FemaleMaleTotalFemaleMaleTotalFemaleMaleTotalFemaleMaleTotalFemaleMaleTotal
aAlmost every day for ≥2 weeks in a row so that they stopped doing some usual activities.
bDuring the 12 months preceding the survey.
cNon-Hispanic.
dOne or more times.
Source: Adapted from "Table 16. Percentage of High School Students Who Felt Sad or Hopeless, Who Seriously Considered Attempting Suicide, and Who Made a Plan about How They Would Attempt Suicide, by Sex, Race/Ethnicity, and Grade," and "Table 18. Percentage of High School Students Who Actually Attempted Suicide and Whose Suicide Attempt Resulted in an Injury, Poisoning, or Overdose That Had to Be Treated by a Doctor or Nurse, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2005," Morbidity and Mortality Weekly Report, vol. 55, no. SS-5, June 9, 2006, http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf (accessed February 25, 2007)
%%%%%%%%%%%%%%%
Race/ethnicity
Whitec33.418.425.821.512.416.915.49.712.59.35.27.32.71.52.1
Blackc36.919.528.417.17.012.213.55.59.69.85.27.62.61.42.0
Hispanic46.726.036.224.211.917.918.510.714.514.97.811.33.72.83.2
Grade
 938.519.929.023.912.217.917.610.213.914.16.810.44.02.13.0
1037.021.328.923.011.917.318.110.314.110.87.69.12.42.22.3
1138.019.428.821.611.916.816.39.512.911.04.57.82.91.42.2
1232.620.226.418.011.614.812.09.010.56.54.35.42.21.01.6
   Total36.720.428.521.812.016.916.29.913.010.86.08.42.91.82.3

Health and Safety

views updated May 21 2018

chapter 5
HEALTH AND SAFETY

LIFE EXPECTANCY

In the early twenty-first century America's young people could look forward to living longer than the generations before them had. The average life expectancy for both sexes of all races born in 2001 was 77.2 years, although individual expectations varied considerably according to race and gender. (See Table 5.1.) Average life expectancy for white males born in 2001 was seventy-five years, up from 66.5 in 1950. The average life expectancy for African-American males born in 2001 was 68.6 years, up from 59.1 in 1950. Average life expectancy for white females born in 2001 was 80.2 years, up from 72.2 in 1950, while the average life expectancy for African-American females born in 2001 was 75.5 years, up from 62.9 in 1950.

While the life expectancy for whites and African-Americans differs at birth, statistics show that the gap narrows with age. (See Figure 5.1.) By age sixty-five there is a difference of approximately two years between life expectancies of whites and African-Americans. By age seventy-five there is almost no difference. This may be because African-Americans have a higher rate of deaths from accidents or injuries in their younger years. Women of both races have a slightly longer life expectancy than men do.

INFANT MORTALITY

The National Center for Health Statistics (NCHS) defines the infant mortality rate as the number of deaths of babies younger than one year per one thousand live births. Neonatal deaths occur within twenty-eight days after birth and post-neonatal deaths twenty-eight to 365 days after birth. The U.S. infant mortality rate declined from 165 per one thousand live births in 1900 to a record low of 6.8 per one thousand live births in 2001. (See Table 5.2.) In Health, United States, 2003, the Centers for Disease Control and Prevention (CDC) noted that several factors—including improved access to health care, advances in neonatal medicine, and educational campaigns—contributed to the over-all decline in infant mortality in the twentieth century.

Unfortunately, not all racial and ethnic groups have reached that record-low infant mortality rate. In 2001 the infant mortality rate for white infants was 5.7 deaths per one thousand live births, less than half the rate of 13.3 for African-American infants. Rates for Native American/Alaska Native, Hispanic, and Asian/Pacific Islander babies were 9.7, 5.4, and 4.7, respectively. The infant mortality rate for Native Americans/Alaska Natives went up from the previous year. (See Table 5.2.)

The National Center for Health Statistics listed the ten leading causes of infant mortality in the United States in 2002. (See Table 5.3.) Birth defects were the primary cause of infant mortality (140.7 deaths per one hundred thousand live births). Premature delivery or low birth weight was the second leading cause of infant mortality (114.4). Sudden Infant Death Syndrome (SIDS) (50.6), complications of pregnancy (42.9), complications in the placenta or umbilical cord (25.3), respiratory distress (23.8), accidents (22.2), bacterial sepsis (18.3), circulatory system diseases (16.1), and intrauterine hypoxia/birth asphyxia (14.4) completed the list.

Although infant mortality rates are decreasing for the African-American population, the CDC reported that infant mortality rates in 2002 were more than twice as high for African-American infants than for non-Hispanic white infants. (See Table 5.4.) Premature birth/low birth weight was the leading cause of death for African-American infants (310.9 per one thousand live births) and was particularly high compared with the rate for white infants (135 per one thousand live births). For unknown reasons, African-American infants are also at a much higher risk of SIDS than white infants.

Sudden Infant Death Syndrome (SIDS)

Sudden Infant Death Syndrome (SIDS; sometimes called crib death), the unexplained death of a previously

TABLE 5.1

Life expectancy at birth according to race and sex, selected years 1900–2001
[Data are based on death certificates]
All racesWhiteBlack or African American1
Specified age and yearBoth sexesMaleFemaleBoth sexesMaleFemaleBoth sexesMaleFemale
1Data shown for 1900–60 are for the nonwhite population.
2Death registration area only. The death registration area increased from 10 states and the District of Columbia in 1900 to the coterminous United States in 1933.
3Includes deaths of persons who were not residents of the 50 states and the District of Columbia.
4Life expectancies (LEs) for 2000 were revised and may differ from those shown previously. LEs for 2000 were computed using population counts from Census 2000 and replace LEs for 2000 using 1990-based postcensal estimates.
5Life expectancies for 2001 were computed using 2000-based postcensal estimates.
Notes: Populations used for computing life expectancy and other life table values for 1991–1999 are postcensal estimates of U.S. resident population, based on the 1990 census.
source: Adapted from "Table 27. Life Expectancy at Birth, at 65 Years of Age, and at 75 Years of Age, according to Race and Sex: United States, Selected Years 1900–2001," in Health, United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, 2003, http://www.cdc.gov/nchs/data/hus/tables/2003/03hus027.pdf (accessed September 3, 2004)
At birthRemaining life expectancy in years
19002,347.346.348.347.646.648.733.032.533.5
1950368.265.671.169.166.572.260.859.162.9
1960369.766.673.170.667.474.163.661.166.3
197070.867.174.771.768.075.664.160.068.3
198073.770.077.474.470.778.168.163.872.5
198574.771.178.275.371.878.769.365.073.4
199075.471.878.876.172.779.469.164.573.6
199175.572.078.976.372.979.669.364.673.8
199275.872.379.176.573.279.869.665.073.9
199375.572.278.876.373.179.569.264.673.7
199475.772.479.076.573.379.669.564.973.9
199575.872.578.976.573.479.669.665.273.9
199676.173.179.176.873.979.770.266.174.2
199776.573.679.477.174.379.971.167.274.7
199876.773.879.577.374.580.071.367.674.8
199976.773.979.477.374.679.971.467.874.7
2000477.074.379.777.674.980.171.968.375.2
2001577.274.479.877.775.080.272.268.675.5

healthy infant, was the third leading cause of infant mortality in the United States in 2002 and the leading cause of death of infants one month to one year of age. In 1992 the American Academy of Pediatrics recommended that babies sleep on their backs to reduce the risk of SIDS and launched its "Back to Sleep" campaign to educate parents. It had been a long-held belief that the best position for babies to sleep was on their stomachs. The American SIDS Institute reported that the Back to Sleep campaign had resulted in the reduction of SIDS cases by 52% between 1990 and 2000. Other risk factors for SIDS include maternal use of drugs or tobacco during pregnancy, low birth weight, and poor prenatal care.

studies on the causes of and risk factors for sids. A number of recent studies have considered the possible causes of and risk factors for SIDS. One study, ongoing since 1985, conducted by Dr. Hannah Kinney of Harvard Medical School in Boston, Massachusetts, found a brain defect believed to affect breathing in babies who died of SIDS ("SIDS Risk Prevention Research Begins to Define Physical Abnormalities in Brainstem, Points to Possible Diagnostic/Screening Tools," PR Newswire, October 18, 1999). Researchers suggest that as carbon dioxide levels rise and oxygen levels fall during sleep, the brains of some babies do not get the signal to regulate breathing or blood pressure accordingly to make up for the change. This condition is particularly dangerous for infants sleeping on their stomachs or on soft bedding. According to a May 2002 article in Clinical Psychiatry News ("Brainstem Abnormality May Be Culprit in SIDS Subset: Maternal Smoking Tied to Abnormality"), the study had shifted its focus to maternal cigarette smoking in the first trimester of pregnancy as a possible cause of the brain abnormality.

FETAL ALCOHOL SYNDROME (FAS)

Alcohol consumption by pregnant women can cause Fetal Alcohol Syndrome (FAS), a birth defect characterized by a low birth weight, facial abnormalities such as small eye openings, growth retardation, and central nervous system deficits, including learning and development disabilities. The condition is a lifelong, disabling condition that puts those children affected at risk for secondary conditions, such as mental health problems, criminal behavior, alcohol and drug abuse, and inappropriate sexual behavior. Not all children affected by prenatal alcohol use are born with the full syndrome, but they may only have selected abnormalities.

According to the CDC, estimates of the prevalence of FAS vary from 0.2 to 1.5 per one thousand births. Other

TABLE 5.2

Infant mortality rate among selected groups by race and Hispanic origin of mother, selected years 1983–2001
(Data are based on linked birth and death certificates for infants)
Race and Hispanic origin of mother1983219852199021995319983199932000320013
1Estimates are considered unreliable. Rates preceded by an asterisk are based on fewer than 50 events. Rates not shown are based on fewer than 20 events.
2Rates based on unweighted birth cohort data.
3Rates based on a period file using weighted data.
4Infant (under 1 year of age) and neonatal (under 28 days).
5Persons of Hispanic origin may be of any race.
6Prior to 1995, data shown only for states with an Hispanic-origin item on their birth certificates.
Notes: The race groups white, black, American Indian or Alaska Native, and Asian or Pacific Islander include persons of Hispanic and non-Hispanic origin. National linked files do not exist for 1992–94.
source: Adapted from "Table 19 (page 1 of 2). Infant, Neonatal, Postneonatal Mortality Rates, according to Detailed Race and Hispanic Origin of Mother: United States, Selected Years 1983–2001," in Health: United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, 2003, http://www.cdc.gov/nchs/data/hus/tables/2003/03hus019.pdf (accessed September 3, 2004)
Infant4 deaths per 1,000 live births
All mothers10.910.48.97.67.27.06.96.8
White9.38.97.36.36.05.85.75.7
Black or African American19.218.616.914.613.814.013.513.3
American Indian or Alaska Native15.213.113.19.09.39.38.39.7
Asian or Pacific Islander8.37.86.65.35.54.84.94.7
Chinese9.55.84.33.84.02.93.53.2
Japanese5.616.015.515.313.413.514.514.01
Filipino8.47.76.05.66.25.85.75.5
Hawaiian11.29.918.016.519.97.019.07.31
Other Asian or Pacific Islander8.18.57.45.55.75.14.84.8
Hispanic or Latino5,69.58.87.56.35.85.75.65.4
Mexican9.18.57.26.05.65.55.45.2
Puerto Rican12.911.29.98.97.88.38.28.5
Cuban7.58.57.25.33.714.64.64.2
Central and South American8.58.06.85.55.34.74.65.0
Other and unknown Hispanic or Latino10.69.58.07.46.57.26.96.0
Not Hispanic or Latino:
White69.28.67.26.36.05.85.75.7
Black or African American619.118.316.914.713.914.113.613.5
Neonatal4 deaths per 1,000 live births
All mothers7.16.85.74.94.84.74.64.5
White6.15.84.64.14.03.93.83.8
Black or African American12.512.311.19.69.49.59.18.9
American Indian or Alaska Native7.56.16.14.05.05.04.44.2
Asian or Pacific Islander5.24.83.93.43.93.23.43.1
Chinese5.53.32.32.32.71.82.51.9
Japanese3.713.113.513.312.512.812.612.51
Filipino5.65.13.53.44.63.94.14.0
Hawaiian7.015.714.314.017.214.916.213.61
Other Asian or Pacific Islander5.05.44.43.73.93.33.43.2
Hispanic or Latino5,66.25.74.84.13.93.93.83.6
Mexican5.95.44.53.93.73.73.63.5
Puerto Rican8.77.66.96.15.25.95.86.0
Cuban5.016.25.33.612.713.513.212.51
Central and South American5.85.64.43.73.63.33.33.4
Other and unknown Hispanic or Latino6.45.65.04.84.54.84.63.9
Not Hispanic or Latino:
White65.95.64.54.03.93.83.83.8
Black or African American612.011.911.09.69.49.69.29.0

alcohol-related birth defects are thought to occur three times as often as FAS. As many as 130,000 pregnant women each year drink alcohol at levels known to put their babies at risk for alcohol-related birth defects.

MORTALITY AMONG CHILDREN

In the second half of the twentieth century, childhood death rates declined dramatically. The majority of childhood deaths are from injuries and violence. While death rates for all ages decreased, the largest declines were among children.

In 2001 three of the leading causes of childhood death were unintentional injuries, congenital anomalies (birth defects), and malignant neoplasms (cancers). (See Table 5.5.) The remaining deaths were spread across a variety of diseases, including heart disease, pneumonia, influenza, HIV/AIDS, homicide, and suicide.

Motor Vehicle Injuries

Although motor vehicle fatalities decreased by 25% between 1982 and 2000 for fifteen- to twenty-year-olds,

FIGURE 5.1

traffic accidents were still the leading cause of death for that age group in 2002. That year, 3,827 young people were killed in traffic accidents. Many of those killed had been drinking alcohol and were not wearing their seat belts.

Suicide

In 2001 suicide was the fifth leading cause of death among people five to fourteen years old and the third leading cause of death in fifteen- to twenty-four-year-olds. (See Table 5.5.) In 2001 white males ages fifteen to nineteen had twice the suicide rate (fourteen per one hundred thousand) of African-American males (7.3 per one hundred thousand) or Hispanic male youth (7.8 per one hundred thousand). Among females ages fifteen to nineteen, the rate for whites (2.9 per one hundred thousand) was considerably higher than that for Hispanics (2.5 per one hundred thousand) or African-Americans (1.3 per one hundred thousand) (National Vital Statistics Reports, vol. 52, no. 9, November 7, 2003).

The 2003 Youth Risk Behavior Survey questioned high school students regarding their thoughts about suicide. Almost one in six students surveyed (16.9%)

TABLE 5.3

Ten leading causes of infant mortality by race and Hispanic origin, 2002
Rate per 100,000 live births
source: Adapted from "Table 8. Infant Deaths and Infant Mortality Rates for the 10 Leading Causes of Infant Death, by Race and Hispanic Origin: United States, Preliminary 2002," in "Deaths: Preliminary Data for 2002," National Vital Statistics Report, vol. 52, no. 13, February 11, 2004, http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_13.pdf (accessed September 3, 2004)
Birth defects140.7
Preterm/low birth weight114.4
SIDS50.6
Maternal pregnancy complications42.9
Placenta, cord complications25.3
Respiratory distress23.8
Accidents22.2
Bacterial sepsis18.3
Circulatory system diseases16.1
Intrauterine hypoxia/birth asphyxia14.4

claimed that they had thought about attempting suicide in the previous twelve months. (See Table 5.6.) Although the suicide death rate was much higher among males than females, females (21.3%) were more likely to have considered suicide than males (12.8%). Of all students, 16.5% (18.9% of females and 14.1% of males) had made a specific plan to attempt suicide, 8.5% of students (11.5% of females and 5.4% of males) claimed they had attempted suicide in the previous year, and 2.9% of high school students (3.2% of females and 2.4% of males) said they had suffered injuries from the attempt that required medical attention. These numbers reflect the fact that females of all ages tend to choose less fatal methods of attempting suicide, such as overdosing and cutting veins, than males, who tend to choose more deadly methods, such as shooting or hanging.

The likelihood that a child will commit suicide increases with the presence of certain factors in his or her profile. Among the factors whose presence may indicate heightened risk are depression, substance abuse, behavioral disorders, accessibility of handguns, and a tendency toward perfectionism. The suicide rate among male homosexual teens is believed to be extremely high. A 2002 study corroborated previous estimates that 20% to 42% of teens and young men who have sex with other males attempt suicide (Gary Remafedi, "Suicidality in a Venue-Based Sample of Young Men Who Have Sex with Men," Journal of Adolescent Health, vol. 31, October 2002).

HIV/AIDS

Acquired Immune Deficiency Syndrome (AIDS) was identified as a new disease in 1981, and, according to the CDC, an estimated 886,575 cases had been diagnosed in the United States through 2002. AIDS is caused by the human immunodeficiency virus (HIV), which weakens the victim's immune system, making it vulnerable to other

TABLE 5.4

Infant mortality rates for the 10 leading causes of infant death, by race and Hispanic origin, 2002
Rank1Non-Hispanic whiteNumberRate per 100,000 live births
— Category not applicable.
1Rank based on number of deaths.
2Race and Hispanic origin are reported separately on both the birth and death certificate. Data for persons of Hispanic origin are included in the data for each race group, according to the decedent's reported race.
source: Adapted from "Table 8. Infant Deaths and Infant Mortality Rates for the 10 Leading Causes of Infant Death, by Race and Hispanic Origin: United States, Preliminary 2002," in "Deaths: Preliminary Data for 2002," National Vital Statistics Report, vol. 52, no. 13, February 11, 2004, http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_13.pdf (accessed September 16, 2004)
All causes13,542587.9
1Congenital malformations, deformations and chromosomal abnormalities3,110135.0
2Disorders related to short gestation and low birth weight, not elsewhere classified1,8118.6
3Sudden infant death syndrome1,11248.3
4Newborn affected by maternal complications of pregnancy82135.6
5Newborn affected by complications of placenta, cord and membranes49321.4
6Respiratory distress of newborn44619.4
7Accidents (unintentional injuries)43719.0
8Bacterial sepsis of newborn36115.7
9Diseases of the circulatory system32013.9
10Intrauterinehypoxia and birth asphyxia31113.5
All other causes4,321187.6
Total black2
All causes8,3801,419.0
1Disorders related to short gestation and low birth weight, not elsewhere classified1,836310.9
2Congenital malformations, deformations and chromosomal abnormalities1,023173.2
3Sudden infant death syndrome603102.1
4Newborn affected by maternal complications of pregnancy57597.3
5Respiratory distress of newborn33657.0
6Newborn affected by complications of placenta, cord and membranes31553.3
7Accidents (unintentional injuries)30351.4
8Bacterial sepsis of newborn23139.1
9Diseases of the circulatory system18932.1
10Intrauterinehypoxia and birth asphyxia14724.8
All other causes2,822477.8

opportunistic infections. Young children with AIDS usually have the virus transmitted to them either by an infected parent or through contaminated transfusions of blood or blood products. Adolescents who are exploring their sexuality or experimenting with drugs are also vulnerable to HIV infection, which can be spread through sexual inter-course without the use of a condom or through shared hypodermic needles.

In adults the most common opportunistic infections of AIDS are Kaposi's sarcoma—a rare skin cancer—and pneumocystis carinii pneumonia. In infants and children a failure to thrive and unusually severe bacterial infections characterize the disease. With the exception of pneumocystis carinii pneumonia, children with symptomatic HIV infection seldom develop opportunistic infections as adults do. More often they are plagued by recurrent bacterial infections, persistent oral thrush (a common fungal infection of the mouth or throat), and chronic and recurrent diarrhea. They may also suffer from enlarged lymph nodes, chronic pneumonia, developmental delays, and neurological abnormalities.

how many are infected? As of December 2002 the CDC reported a cumulative total of 9,300 AIDS cases in children under the age of thirteen since record-keeping began in 1981. (See Table 5.7.) African-American children made up the overwhelming majority with 5,476 cases, followed by Hispanic children (2,111 cases), non-Hispanic white children (1,606 cases), Asian/Pacific Islanders (59 cases), and Native American/Alaska Natives (31 cases). By the end of 2002, 5,315 children ages fourteen and under had died from the disease.

means of transmittal. Most babies of HIV-infected mothers do not develop HIV. HIV-positive mothers can reduce the risk of transmission by taking antiretroviral drugs during the last two trimesters of pregnancy and during labor; giving birth by caesarean section; giving the infant a short course of antiretroviral drugs after birth; and not breast feeding. With these interventions, the transmission rate can be reduced to as low as 2%.

The overwhelming majority of children with AIDS, however, contracted it from mothers either infected with HIV or at risk for AIDS (93%). (See Table 5.7.) Other means of transmission were a blood transfusion contaminated with the virus and regular receipt of blood products because of a hemophilia/coagulation disorder.

adolescents with aids. The number of AIDS cases among adolescents is comparatively low. The CDC reported that, as of December 31, 2002, 5,108 adolescents ages

TABLE 5.5

Leading causes of death and numbers of deaths, by age, 1980 and 2001
(Data are based on death certificates)
Age and rank order19802001*
Cause of deathDeathsCause of deathDeaths
— Category not applicable.
*Figures for homicide and suicide include September 11, 2001 related deaths for which death certificates were filed as of October 24, 2002.
source: Adapted from "Table 32. Leading Causes of Death and Numbers of Deaths, according to Age: United States, 1980 and 2001," in Health: United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, 2003, http://www.cdc.gov/nchs/data/hus/tables/2003/03hus032.pdf (accessed September 16, 2004)
1–4 years
All causes8,187All causes5,107
1Unintentional injuries3,313Unintentional injuries1,714
2Congenital anomalies1026Congenital malformations, deformations and chromosomal abnormalaties557
3Malignant neoplasms573Malignant neoplasms420
4Diseases of heart338Homicide415
5Homicide319Diseases of heart225
6Pneumonia and influenza267Influenza and pneumonia112
7Meningitis223Septicemia108
8Meningococcal infection110Certain conditions originating in the perinatal period72
9Certain conditions originating in the perinatal period84In situ neoplasms, benign neoplasms and neoplasms of unknown behavior58
10Septicemia71Cerebrovascular diseases54
5–14 years
All causes10,689All causes7,095
1Unintentional injuries5,224Unintentional injuries2,836
2Malignant neoplasms1,497Malignant neoplasms1,008
3Congenital anomalies561Congenital malformations, deformations and chromosomal abnormalities376
4Homicide415Homicide326
5Diseases of heart330Suicide279
6Pneumonia and influenza194Diseases of heart272
7Suicide142In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior105
8Benign neoplasms104Chronic lower respiratory diseases104
9Cerebrovascular diseases95Influenza and pneumonia92
10Chronic obstructive pulmonary diseases85Cerebrovascular diseases80
15–24 years
All causes49,027All causes32,252
1Unintentional injuries26,206Unintentional injuries14,411
2Homicide6,537Homicide5,297
3Suicide5,239Suicide3,971
4Malignant neoplasms2,683Malignant neoplasms1,704
5Diseases of heart1,223Diseases of heart999
6Congenital anomalies600Congenital malformations, deformations and chromosal abnormalites505
7Cerebrovas cular diseases418Human immunodeficiency virus (HIV) disease225
8Pneumonia and influenza348Cerebrovascular diseases196
9Chronic obstructive pulmonary diseases141Influenza and pneumonia181
10Anemias133Chronic lower respiratory diseases171

thirteen to nineteen had been diagnosed with AIDS since the beginning of the epidemic in the early 1980s. But because of the lengthy incubation period between the time of infection and the onset of symptoms, it is highly probable that many people who develop AIDS in their early twenties became infected with HIV in their teenage years.

HEALTH CARE

Immunizations

The proportion of preschool-age children immunized against communicable and potentially dangerous childhood diseases—including diphtheria, tetanus, and pertussis (whooping cough), known collectively as DTP; polio; and measles—dropped during the 1980s but rose significantly during the 1990s. By 2002 82% had received four doses of DTP, 90% had received three doses of poliovirus vaccine, 93% had received haemophilus influenzae type b vaccine (Hib), 92% had received measles vaccines, 90% had received three doses of hepatitis B vaccine, and 81% had received varicella (chickenpox) vaccine. More than three quarters of these children received the vaccinations in combined series. Children living below the poverty line and African-American children are slightly less likely than the general child population to be immunized. (See Table 5.8.)

In 1994 the U.S. Department of Health and Human Services (HHS) implemented the Vaccines for Children (VFC) program, which provides free or low-cost vaccines

TABLE 5.6

Percentage of high school students who felt sad or hopeless, who seriously considered attempting suicide, who made a suicide plan, and who attempted suicide, by sex, race, ethnicity, and grade, 2003
Felt sad or hopeless*Seriously considered attempting suicied†Made a suicide plan†Attempted suicide†¶Suicide attempt required medical attention
CategoryFemale
%
Male
%
Total
%
Female
%
Male
%
Total
%
Female
%
Male
%
Total
%
Female
%
Male
%
Total
%
Female
%
Male
%
Total
%
* Felt so sad or hopeless almost every day for 2 weeks in a row that they stopped doing some usual activities.
† During the 12 months preceding the survey.
§ Non-Hispanic.
¶ One or more times.
source: Adapted from "Table 16. Percentage of High School Students Who Felt Sad or Hopeless, Who Seriously Considered Attempting Suicide, and Who Made a Suicide Plan, by Sex, Race/Ethnicity, and Grade," and "Table 18. Percentage of High School Students Who Actually Attempted Suicide and Whose Suicide Attempt Required Medical Attention, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2003," Centers for Disease Control and Prevention Surveillance Summaries: Morbidity and Mortality Weekly Report, vol. 53, no. SS–02, May 21, 2004, http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf (accessed September 16, 2004)
Race/ethnicity
White§33.319.626.221.212.016.518.613.916.210.33.76.92.41.11.7
Black§30.821.726.314.710.312.512.48.410.49.07.78.42.25.23.7
Hispanic44.925.935.423.412.918.120.714.617.615.06.110.65.74.25.0
Grade
935.721.028.022.211.916.920.914.817.714.75.810.13.93.13.5
1036.922.729.723.813.218.319.513.116.312.75.59.13.22.12.6
1135.922.128.920.012.916.417.914.416.210.04.67.32.92.02.4
1232.622.027.418.013.215.516.213.714.96.95.26.12.21.82.1
Total35.521.928.621.312.816.918.914.116.511.55.48.53.22.42.9

to children at participating private and public health-care provider sites. Eligible children, including children on Medicaid, children without insurance or whose insurance does not cover vaccinations, and Native American or Alaskan Native children can receive the vaccinations through their primary care physician. Children not covered under the program but whose parents cannot afford vaccinations can receive free vaccines at public clinics under local programs. According to the CDC, in fiscal year 2003 the VFC program spent $975 million on vaccines. The program served about 41% of the childhood population in 2002.

The World Health Organization reported in State of the World's Vaccines and Immunizations, Geneva, Switzerland, 2002) that developed nations, including the United States, generally have among the highest immunization rates in the world. Global immunization rates for DTP hovered around 70% from the mid-1990s through 2001. Immunization rates for the developed world for the same time period were ten to twenty percentage points higher. Only about 50% of children in Sub-Saharan Africa received the DTP immunizations, the lowest rate in the world.

Physician Visits

Children's health depends upon access to and usage of medical care. Based on household interviews of a sample of the civilian noninstitutionalized population, the National Center for Health Statistics found that in 2001 54.6% of children under age eighteen visited the doctor between one and three times, 26.1% saw the doctor between four and nine times, and 7.6% saw the doctor ten or more times. (See Table 5.9.) But 11.6% of children did not see a doctor at all. Poor children have less access to health care than nonpoor children. In 2001 only 78.3% of children from poor families were treated in a doctor's office, compared with 86% of children from nonpoor families.

HEALTH INSURANCE

Coverage Levels

According to the U.S. Census Bureau, 11.4% of American children—8.4 million—had no health insurance coverage in 2003. Factors affecting children's access to coverage included their age, race and ethnicity, and family's economic status. Children between the ages of twelve and seventeen were less likely to receive coverage than those under twelve (12.7% versus 10.6%). Poor children were more likely to be uninsured than their wealthier counterparts (19.2% versus 11.4%), and those of Hispanic origin were the least likely racial or ethnic group to receive health insurance coverage, with 21% of them being uninsured. Uninsured rates for other racial and ethnic groups were 7.4% for non-Hispanic white children, 12.4% for Asian-American children, and 14.5% for African-American children (U.S. Bureau of the Census, Income, Poverty, and Health Insurance Coverage in the United States: 2003, 2004). The National Center for Health Statistics estimates that 13.7% of all children were uninsured for at least part of 2003 (Robin A. Cohen and Zakia Coriaty-Nelson, Health Insurance Coverage: Estimates from the National Health Interview Survey, 2003, June 30, 2004, http://www.cdc.gov/nchs/nhis.htm [accessed July 30, 2004]).

TABLE 5.7

Diagnoses of AIDS in children younger than 13, by year of diagnosis and exposure category, 1998–2002
Year of diagnosisCumulative through 2002
19981999200020012002
Note: These numbers do not represent actual cases in persons with a diagnosis of AIDS. Rather, these numbers are point estimates of cases diagnosed that have been adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk. The estimates have not been adjusted for incomplete reporting.
aIncludes children with a diagnosis of AIDS, from the beginning of the epidemic through 2002.
bIncludes children of unknown or multiple race. Cumulative total includes 17 children of unknown or multiple race. Because column totals were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.
source: "Table 4. Estimated Numbers of Diagnoses of AIDS in Children < 13 Years of Age, by Year of Diagnosis and Exposure Category, 1998–2002," in HIV/AIDS Surveillance Report, vol. 14, Centers for Disease Control and Prevention, 2003, http://www.cdc.gov/hiv/stats/hasr1402/table4.htm (accessed September 3, 2004)
Race/ethnicity
White, not Hispanic3319131671,606
Black, not Hispanic1561298570585,476
Hispanic47331822242,111
Asian/Pacific Islander0122159
American Indian/Alaska Native1000031
Exposure category
Hemophilia coagulation disorder00000236
Mother with, or at risk for, HIV infection236181115106908,629
Injection drug use4643201393,309
Sex with injection drug user312415551,526
Sex with bisexual male66234202
Sex with person with hemophilia1201035
Sex with HIV-infected transfusion recipient1000026
Sex with HIV-infected person, risk not specified62503632321,453
Receipt of blood transfusion, blood components, or tissue01223159
Has HIV infection, risk not specified89554050371,920
Receipt of blood transfusion, blood components, or tissue10101390
Other/risk not reported or identified0223045
Totalb238183118110929,300

In 2002 government programs, such as Medicare, Medicaid, and military insurance, covered 27% of all children. Forty-four percent of African-American children and 40% of Hispanic children had government insurance, compared with only 18% of white, non-Hispanic children.

Child health insurance coverage increased among all age groups, races, and ethnicities from 1998 to 2002 by about 3%. (See Table 5.10.) In a December 31, 2002, press release ("HHS Issues New Report Showing More American Children Received Health Insurance in Early 2002," National Center for Health Statistics), Health and Human Services Secretary Tommy G. Thompson attributed ongoing increases to a push to provide more government coverage, particularly under the State Children's Health Insurance Program (SCHIP). This trend, however, may be leveling off. The National Center for Health Statistics stated that the decrease in uninsured children from 2002 to 2003 was not statistically significant, and the U.S. Census Bureau reported no change in the number of covered children from 2002 to 2003. (See Figure 5.2.)

Medicaid Coverage

In 2002 Medicaid covered 23.9% of children younger than eighteen. (See Figure 5.3.) More than two out of five African-American children (41.2%) and 37.3% of Hispanic children were covered by Medicaid, compared with 15.5% of non-Hispanic white children, and 18.1% of Asian children. In 2000 51% of all those served by Medicaid were children.

To remain in the Medicaid program, families must have their eligibility reassessed at least every six months. If family income or other circumstances change even slightly, the family can lose its eligibility for the Medicaid program, disrupting health care coverage.

The State Children's Health Insurance Program (SCHIP)

From the late 1980s through the mid-1990s, the numbers of uninsured American children rose as coverage rates for employer-sponsored health insurance declined, even though the proportion of children covered by Medic-aid also rose. In 1997, as part of the Balanced Budget Act, Congress created the State Children's Health Insurance Program (SCHIP) to expand health insurance to children whose families earned too much money to be eligible for Medicaid but not enough money to pay for private insurance. SCHIP provides funding to states to insure children, offering three alternatives: states may use SCHIP funds to establish separate coverage programs, expand their Medicaid coverage, or use a combination of both. By September 1999 all fifty states had SCHIP plans in place. By September 4, 2003, the program had been expanded to enroll even more children at higher income levels.

TABLE 5.8

Percentage of children vaccinated for selected diseases, by poverty status, race, and Hispanic origin, 1996–2002
TotalBelow povertyAt or above poverty
Characteristic199619971998199920002001200219961997199819992000200120021996199719981999200020012002
— = not available
Note: ( ) is the NIS Web site's footnote.
aThe 4:3:1:3 combined series consists of 4 (or more) doses of diphtheria and tetanus toxoids and pertussis vaccine (DTP), 3 (or more) doses of polio vaccine, 1 (or more) dose of a measles-containing vaccine (MCV), and 3 (or more) doses of Haemophilus influenzae type b (Hib) vaccine.
bThe 4:3:1 combined series consists of 4 (or more) doses of diphtheria and tetanus toxoids and pertussis vaccine (DTP), 3 (or more) doses of polio vaccine, and 1 (or more) dose of a measles containing vaccine (MCV).
c(Four or more doses of any diphtheria and tetanus toxoids and pertussis vaccines including diphtheria and tetanus toxoids, and any acellular pertussis vaccine (DTP/DTaP/DT)) Diphtheria and tetanus toxoids and pertussis vaccine.
d(One or more doses of measles-mumps-rubella vaccine; previous reports of vaccination coverage were for measles-containing vaccine (MCV). Immunization providers respondents were asked about measles-containing vaccine, including MMR (measles mumps rubella) vaccines.
e(Three or more doses of) Haemophilus influenzae type b (Hib) vaccine.
fThe percentage of children 19 to 35 months of age who received 3 (or more) doses of hepatitis B vaccine was low in 1994, because universal infant vaccination with a 3-dose series was not recommended until November 1991.
g(One or more doses of varicella at or after child's first birthday, unadjusted for history of varicella illness). Recommended in July 1996. Administered on or after the first birthday, unadjusted for history of varicella illness (chicken pox).
hPersons of Hispanic origin may be of any race.
source: "Childhood Immunization: Percentage of Children Ages 19 to 35 Months Vaccinated for Selected Diseases by Poverty Status, Race, and Hispanic Origin, 1996–2002," in America's Children in Brief: KeyNational Indicators of Well-Being, 2004, Federal Interagency Forum on Child and Family Statistics, 2004, http://www.childstats.gov/ac2003/tbl.asp?iid123&id4&indcode HEALTH4 (accessed August 24, 2004)
Total
Combined series (4:3:1:3)a767679787677786971747371727280798281787979
Combined series (4:3:1)b787881807879797272767572737381808382798080
DTP (4 doses or more)c818284838282827476807976777584848685848484
Polio (3 doses or more)919191909089908889908787878892929291909091
Measles-containing (MCV)d919092929191928786909089899092929392919292
Hib (3 doses or more)e919393949393938790919190909093949595959494
Hepatitis B (3 doses or more)f828487889089907881858787878883858889919090
Varicellag12264358687681517415564747915294458697781
White, non-Hispanic
Combined series (4:3:1:3)a797982817979806872777673717280808382808081
Combined series (4:3:1)b808083828080817073797774727382828483818182
DTP (4 doses or more)c838487868484847276828178757585858886858586
Polio (3 doses or more)929292909190918890918888878893929391919192
Measles-containing (MCV)d919193929292938584909088879193939493929293
Hib (3 doses or more)e939495959594948790929392898894959695959595
Hepatitis B (3 doses or more)f828588899190917680878888868683858889929092
Varicellag15284256667579617385158677516294357687680
Black, non-Hispanic
Combined series (4:3:1:3)a747373747171716971727269696879777477727472
Combined series (4:3:1)b777474757273727372747470716981787678737573
DTP (4 doses or more)c797777797676767476777875747483807983787877
Polio (3 doses or more)908988878785878789888685848793918788878687
Measles-containing (MCV)d908989908889908887899088889091919091879090
Hib (3 doses or more)e899190929390928691909192878893949094939194
Hepatitis B (3 doses or more)f828284878985887882868689858985848390908588
Varicellag9214258677583N/A16405760718013274460727784
Hispanich
Combined series (4:3:1:3)a717375757377766870737370737573777978747976
Combined series (4:3:1)b747577777579777171767673767675778080758077
DTP (4 doses or more)c777881807983797475797876797878818382808380
Polio (3 doses or more)899089898891908888908988908990909090879191
Measles-containing (MCV)d888891909092918785909090919189909291909389
Hib (3 doses or more)e899092929193928789929188919390929495939492
Hepatitis B (3 doses or more)f818186898890908079838787888981848888909189
Varicellag8224761708082618445970818211254962708281

TABLE 5.9

Health care visits to doctor's offices, emergency departments, and home visits over a 12-month period, according to selected characteristics, selected years, 1997–2001
(Data are based on household interviews of a sample of the civilian noninstitutionalized population)
Number of health care visits1
None1–3 visits4–9 visits10 or more visits
Characteristic199719992001199719992001199719992001199719992001
Percent distribution
All persons2,316.517.516.546.245.845.823.623.324.413.713.413.3
Age
Under 18 years11.812.411.654.154.454.625.225.026.18.98.27.6
Under 6 years5.05.95.544.945.945.837.036.837.913.011.310.8
6–17 years15.315.514.658.758.558.919.319.420.56.86.76.1
18–44 years21.724.223.346.745.846.119.017.818.912.612.311.8
18–24 years22.024.825.446.846.144.720.017.819.511.211.410.5
25–44 years21.624.022.646.745.746.518.717.818.713.012.612.2
45–64 years16.916.915.642.942.442.924.725.025.715.515.715.9
45–54 years17.918.417.143.943.244.923.422.823.614.815.714.4
55–64 years15.314.713.341.341.139.626.728.428.916.715.818.2
65 years and over8.97.97.134.734.332.332.534.135.623.823.725.0
65–74 years9.88.68.136.936.935.831.633.233.521.621.322.6
75 years and over7.77.25.831.831.128.233.835.138.126.626.627.9
Sex3
Male21.323.121.347.145.546.520.620.621.611.010.810.7
Female11.812.011.945.446.145.126.525.927.116.315.915.9
Race3,4
White only16.016.915.946.145.745.723.923.824.814.013.613.5
Black or African American only16.818.416.446.146.246.423.221.924.013.913.513.2
American Indian and Alaska Native only17.120.6*21.438.034.336.424.227.825.420.717.216.9
Asian only22.823.120.849.147.348.319.719.422.38.310.28.6
Native Hawaiian and Other Pacific Islander only********
2 or more races15.218.040.841.222.223.521.817.3
Hispanic Origin and race3,4
Hispanic or Latino24.926.227.042.344.340.220.319.220.712.510.312.0
Mexican28.930.231.440.843.039.218.518.219.611.88.79.8
Not Hispanic or Latino15.416.215.046.746.046.524.023.925.013.913.913.5
White only14.715.514.346.646.046.424.424.525.414.314.113.9
Black or African American only16.918.416.446.146.246.423.121.924.013.813.513.1
Respondent-assessed health status3
Fair or poor7.89.89.023.325.922.129.024.327.739.940.141.3
Good to excellent17.218.117.348.447.748.023.323.224.311.111.010.5
Poverty status3,5
Poor20.321.521.737.139.237.222.721.323.419.918.017.7
Near poor19.922.220.442.841.641.421.821.522.915.514.715.3
Nonpoor14.014.914.048.047.047.425.025.025.813.013.112.8
Hispanic origin and race and poverty status3,4,5
Hispanic or Latino:
Poor30.631.234.333.838.232.720.018.718.115.611.814.9
Near poor29.130.228.939.042.139.320.917.520.211.010.111.6
Nonpoor18.721.019.948.646.844.620.321.924.712.310.210.8
Not Hispanic or Latino:
White only:16.317.216.237.738.938.724.023.326.422.120.718.8
Poor17.119.817.143.740.841.322.323.324.117.016.117.6
Near poor13.214.013.147.646.947.525.725.526.113.413.613.3
Nonpoor
Black or African American only:
Poor17.818.017.337.439.938.123.323.124.021.519.020.5
Near poor18.919.918.143.044.044.923.420.523.414.715.613.6
Nonpoor15.616.314.650.548.247.423.323.726.610.611.811.4

According to the Centers for Medicare and Medicaid Services, in the first quarter of fiscal year 2004 about 4.1 million children were enrolled in SCHIP.

HEALTH OF HOMELESS CHILDREN

The Urban Institute suggests that as many as 2% of American children are homeless in the course of one year. Doctor Catherine Karr, in Homeless Children: What Every Health Care Provider Should Know (National Health Care for the Homeless Council, December 29, 2003, http://www.nhchc.org/Children/index.htm [accessed July 28, 2004]), argues that these children suffer from frequent health problems. They are seen in emergency rooms and hospitalized more often than other poor children. The often crowded and unsanitary conditions they live in lead to a higher rate of infectious diseases, like upper respiratory infections, diarrhea, and scabies. Homeless children live in

TABLE 5.9

*Estimates are considered unreliable.
— Data not available.
1This table presents a summary measure of ambulatory and home health care visits during a 12-month period.
2Includes all other races not shown separately, unknown poverty status, and unknown health insurance status.
3Estimates are age adjusted to the year 2000 standard population using six age groups: Under 18 years, 18–44 years, 45–54 years, 55–64 years, 65–74 years, and 75 years and over.
4The race groups, white, black, American Indian and Alaska Native (AI/AN), Asian, Native Hawaiian and Other Pacific Islander, and 2 or more races, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Starting with data year 1999 race-specific estimates are tabulated according to 1997 Standards for Federal data on Race and Ethnicity and are not strictly comparable with estimates for earlier years. The five single race categories plus multiple race categories shown in the table conform to 1997 Standards. The 1999 race-specific estimates are for persons who reported only one racial group; the category "2 or more races" includes persons who reported more than one racial group. Prior to data year 1999, data were tabulated according to 1977 Standards with four racial groups and the category "Asian only" included Native Hawaiian and Other Pacific Islander. Estimates for single race categories prior to 1999 included persons who reported one race or, if they reported more than one race, identified one race as best representing their race. The effect of the 1997 Standard on the 1999 estimates can be seen by comparing 1999 data tabulated according to the two Standards: Age-adjusted estimates based on the 1977 Standard of the percent of persons with a specified number of health care contacts are: (no visits) identical for white and black persons; 0.1 percentage points higher for AI/AN persons; 0.4 percentage points lower for Asian and Pacific Islander persons; (1–3 visits) identical for white persons; 0.1 percentage points lower for black persons; 1.3 percentage points higher for AI/AN persons; 0.1 percentage points lower for Asian and Pacific Islander persons; (4–9 visits) identical for white persons; 0.2 percentage points higher for black persons; 2.2 percentage points lower for AI/AN persons; 0.4 percentage points higher for Asian and Pacific Islander persons; (10 or more visits) identical for white and black persons; 0.9 percentage points higher for AI/AN persons; and 0.1 percentage points higher for Asian and Pacific Islander persons than estimates based on the 1997 Standards.
5Poor persons are defined as below the poverty threshold. Near poor persons have incomes of 100 per cent to less than 200 percent of poverty threshold. Nonpoor persons have incomes of 200 percent or greater than the poverty threshold. Poverty status was unknown for 20 percent of persons in the sample in 1997, 25 percent in 1998, 28 percent in 1999, 27 percent in 2000, and 28 percent in 2001.
6Estimates for persons under 65 years of age are age adjusted to the year 2000 standard using four age groups: Under 18 years, 18–44 years, years, and 55–64 years of age. Estimates for persons 65 years of age and over are age adjusted to the year 2000 standard using two age groups: 65–74 years and 75 years and over.
7Health insurance categories are mutually exclusive. Persons who reported both Medical and private coverage are classified as having private coverage. Persons 65 years of age and over who reported Medicare HMO (health maintenance organization) and some other type of health insurance coverage are classified as having Medicare HMO. Starting in 1997 Medical includes state-sponsored health plans and State Children's Health Insurance Program (SCHIP). The category "insured" also includes military, other State, and Medicare coverage.
8MSA is a metropolitan statistical area.
Notes: Some numbers is this table for health insurance estimates were revised and differ from previous editions of Health, United States. In 1997 the National Health Interview Survey questionnaire was redesigned. Data for additional years are available.
source: "Table 70. Health Care Visits to Doctors' Offices, Emergency Departments, and Home Visits within the Past 12 Months, according to Selected Characteristics, Selected Years 1997–2001," in Health: United States, 2003, Centers for Disease Control and Prevention, National Center for Health Statistics, 2003, http://www.cdc.gov/nchs/data/hus/tables/2003/03hus070.pdf (accessed September 3, 2004)
Health insurance status6,7
Under 65 years of age:
Insured14.315.414.149.048.649.123.623.224.213.112.712.6
Private14.715.914.450.649.950.623.122.924.011.611.311.0
Medicaid9.810.710.435.535.635.426.526.026.328.227.627.8
Uninsured33.737.337.542.841.641.415.313.214.68.27.96.5
65 years of age and over:
Medicare HMO8.95.75.035.834.230.033.134.641.122.325.523.9
Private7.36.75.535.934.934.634.034.935.222.723.524.8
Medicaid9.3*7.36.119.221.418.727.934.831.643.736.543.5
Medicare fee-for-service only15.514.014.134.035.830.528.131.034.222.419.221.2
Poverty status and health insurance status5,6,7
Under 65 years of age:
Poor:
Insured13.714.614.038.841.441.124.523.224.922.920.720.0
Uninsured36.739.843.238.839.334.614.912.615.39.58.36.9
Near poor:
Insured15.617.015.845.544.944.722.322.622.716.615.516.8
Uninsured34.538.035.341.840.240.915.613.416.68.18.47.2
Nonpoor:
Insured13.414.713.650.349.149.824.224.225.012.112.011.6
Uninsured29.132.931.945.443.746.017.014.615.58.48.86.6
Geographic region3
Northeast13.212.811.845.946.447.226.025.626.614.915.214.3
Midwest15.916.214.947.746.747.222.823.824.013.613.313.9
South17.218.917.746.145.545.223.322.524.413.513.212.8
West19.120.920.544.844.844.122.821.922.813.312.412.7
Location of residence3
Within MSA816.217.416.446.445.945.723.723.424.613.713.213.2
Outside MSA817.317.716.745.445.146.123.322.923.613.914.413.6

less structured and often unsafe environments, leaving them more vulnerable to accidents and injury. They tend not to have access to nutritious food, and are often malnourished or obese. Homeless children tend to lag behind their housed peers developmentally, and school-age homeless children often have academic problems. The greater likelihood that

TABLE 5.10

Percentage of children under age 18 covered by health insurance, by type of insurance, age, race, and Hispanic origin, 1987–200 2
Characteristic1987198819891990199119921993199419951996199719981999b2000b2001b2002
aChildren are considered to be covered by health insurance if they had government or private coverage at any time during the year. Some children are covered by both types of insurance; hence, the sum of government and private is greater than the total.
bEstimates beginning in 1999 include follow-up questions to verify health insurance status and use the Census 2000–based weights. Estimates for 1999 through 2001 are not directly comparable with earlier years, before the verification questions were added.
cPersons of Hispanic origin may be of any race.
dGovernment health insurance for children consists mostly of Medicaid, but also includes Medicare, the State Children's Health Insurance Programs (SCHIP), and Civilian Health and Medical Care Program of the Uniformed Services (CHAMPUS/Tricare).
source: "Access to Health Care: Percentage of Children under Age 18 Covered by Health Insurance by Type of Insurance, Age, Race, and Hispanic Origin, 1987–2002," in America's Children in Brief: Key National Indicators of Well-Being, 2004, Federal Interagency Forum on Child and Family Statistics, 2004, http://www.childstats.gov/ac2003/tbl.asp?iid=118&id=3&indcode=ECON5A (accessed August 24, 2004)
All health insurance
Total87878787878786868685858587888888
Age
Ages 0–588878789898988868786868487898989
Ages 6–1187878787888887878785868588888989
Ages 12–1786868685858583858684838487878787
Race and Hispanic origin
White, non-Hispanic90909090909089899089898992939392
Black83848485858684838581818084868686
Hispanicc72717072737574727371717074757677
Private health insuranced
Total74747471706967666666676870706867
Age
Ages 0–572717168666563606062636466666463
Ages 6–1174747573717170676767686870706968
Ages 12–1775767673727169707170697073737271
Race and Hispanic origin
White, non-Hispanic83838381808078777878787981818079
Black49505249454646434445484752535250
Hispanicc48484845434242383840424346454443
Government health insuranced
Total19191922242527262625232323242627
Age
Ages 0–522232428303335333331292727293132
Ages 6–1119181820222325252625232323252627
Ages 12–1716161518191920202119191919202022
Race and Hispanic origin
White, non-Hispanic12131315161719181818171616171718
Black42424145484950484945404240424244
Hispanicc28272732373841383935343133353740

FIGURE 5.2

homeless children come from families plagued by mental illness, drug use, and domestic violence negatively impacts their own mental health. Homelessness results in serious negative consequences for children's health.

OVERWEIGHT AND OBESE CHILDREN

The increasing numbers of overweight and obese Americans has become a national concern. The percentage of overweight children and adolescents has grown significantly since the 1970s. Between 1976 and 1980 6.2% of boys and 6% of girls ages six to eleven years were over-weight. (See Table 5.11.) From 1999 to 2002 those percentages had almost tripled for boys (16.9%) and more than doubled for girls (14.7%). An even more alarming upward trend was seen in the rates of overweight adolescents; 3.7% of boys and 5.7% of girls ages twelve to eighteen were overweight in the period from 1976 to 1980, but 17.5% of adolescent boys and 13.8% of adolescent girls were overweight between 1999 and 2002. The proportion of overweight children overall between the ages of six and eighteen almost tripled between 1976 and 2002.

Percentages of overweight children vary by race and ethnicity. In 2002 non-Hispanic white adolescents were less likely to be overweight (14.8%) than were non-Hispanic African-American (23.7%) and Mexican-American adolescents (21.5%). White children aged 6–11 were also less

FIGURE 5.3

likely to be overweight (13.5%) than Mexican-American (21.8%) or African-American children (19.8%).

Medical professionals are concerned about this trend, because overweight children are at increased risk for premature death in adulthood, as well as for many chronic diseases, including coronary heart disease, hypertension, diabetes mellitus (type 2), gallbladder disease, respiratory disease, some cancers, and arthritis. Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents. Being overweight or obese also can lead to poor self-esteem and depression in children. According to the CDC, in 2003 15.4% of high school students were at risk for becoming overweight and 13.5% were already overweight (Youth Risk Behavior Surveillance—United States, 2003). (See Table 5.12.)

Weight problems in children are thought to be caused by lack of physical activity, unhealthy eating habits, or a combination of these factors, with genetics and lifestyle playing important roles in determining a child's weight. Television watching and playing computer and video games also contribute to inactive lifestyles of children. According to the 2003 Youth Risk Behavior Surveillance, 38.2% of high school students spent three or more hours

TABLE 5.11

Percentage of children 6–18 who are overweight, by gender, race, and Hispanic origin, selected years 1976–2002
TotalMaleFemal
1976–19801988–19941999–20021976–19801988–19941999–20021976–19801988–19941999–2002
—= not available
*= Estimates are considered unreliable (relative standard error greater than 40 percent)
aTotals include data for racial/ethnic groups not shown separately.
bEstimates are unstable because they are based on a small number of persons (relative standard error greater than 30 percent).
Note: Overweight is defined as body mass index (BMI) at or above the 95th percentile of the 2000 Centers for Disease Control and Prevention BMI-for-age growth charts (http://www.cdc.gov/growthcharts). BMI is calculated as weight in kilograms divided by the square of height in meters.
source: "Table HEALTH3. Percentage of Children Ages 6 to 18 Who Are Overweight by Gender, Race, and Hispanic Origin, 1976–1980, 1988–1994, and 1999–2002," in "Federal Interagency Forum on Child and Family Statistics," America's Children in Brief: Key National Indicators of Well-Being, 2004, Federal Interagency Forum on Child and Family Statistics, U.S. Government Printing Office, 2004, http://childstats.gov/ac2004/tables/health3.asp (accessed September 16, 2004)
Children ages 6–18
Totala5.711.2165.511.817.25.810.614.8
Race and Hispanic origin
White, non-Hispanic4.910.513.24.711.314.35.19.612.1
Black, non-Hispanic8.21420.75.8b11.518.410.716.523.2
Mexican American15.423.116.126.914.719
Children ages 6–11
Totala6.111.315.86.211.616.961114.7
Race and Hispanic origin
White, non-Hispanic5.610.213.56.110.7145.29.813.1
Black, non-Hispanic914.619.86.8b12.31711.21722.8
Mexican American16.421.8−17.526.5−15.317.1
Children ages 12–18
Totala4.711.116.23.71217.55.710.214.8
Race and Hispanic origin
White, non-Hispanic4.310.812.93.61214.759.511.1
Black, non-Hispanic7.513.321.8*10.719.910.31623.7
Mexican American14.224.614.427.3−1421.5

TABLE 5.12

Percentage of high school students who had or thought they had a problem with weight, by demographic characteristics, 2003
At risk for becoming overweightaOverweightbDescribed themselves as overweightWere trying to lose weight
FemaleMaleTotalFemaleMaleTotalFemaleMaleTotalFemaleMaleTotal
Category%%%%%%%%%%%%
aStudents who were 85th percentile but 95th percentile for body mass index, by age and sex, based on reference data.
bStudents who were 95th percentile for body mass index, by age and sex, based on reference data.
cNon-Hispanic
source: Adapted from "Table 58. Percentage of High School Students Who Were at Risk for Becoming or Were Overweight, by Sex, Race/Ethnicity, and Grade," and "Table 60. Percentage of High School Students Who Described Themselves as Slightly or Very Overweight and Who Were Trying to Lose Weight, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2003," Centers for Disease Control and Prevention Surveillance Summaries: Morbidity and Mortality Weekly Report, vol. 53, no. SS–02, May 21, 2004, http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf (accessed September 3, 2004)
Race/ethnicity
Whitec13.814.314.17.816.212.238.523.530.862.627.944.8
Blackc21.215.518.315.619.517.626.417.922.346.722.734.7
Hispanic15.719.017.311.821.716.836.127.131.661.737.449.4
Grade
915.615.315.411.219.015.333.122.627.754.131.242.2
1015.314.715.09.317.913.736.123.229.662.228.345.1
1116.916.616.88.617.012.936.924.330.560.428.344.1
1213.215.614.48.014.711.438.724.131.461.728.044.6
Total15.315.515.49.417.413.536.123.529.659.329.143.8

per school day watching television, often not getting a sufficient amount of physical exercise as a consequence.

Physical Activity

Physical activity patterns established during youth may extend into adulthood and affect the risk of illnesses such as coronary heart disease, diabetes, and cancer. Mental health experts correlate increased physical activity with improved mental health and overall improvement in life satisfaction. The CDC's Youth Risk Behavior Surveillance—United States, 2003 reported that the percentage of students in high school who participated in vigorous physical activity, exercise, and physical education classes varied. (See Table 5.13.) Almost three out of four males engaged in sufficient vigorous physical activity (70%), but only slightly more than half of high school females did (55%). White students were somewhat more likely to engage in vigorous activity (65.2%) than African-American (54.8%) or Hispanic students (59.3%). Rigorous activity among high school students also generally declined with age.

ASTHMA

The July 2003 American Lung Association fact sheet "Asthma in Children" reported that asthma was the leading chronic illness in children. Childhood asthma was the third leading cause of hospitalization among children younger than fifteen, and caused 14.6 million missed days of school in 2002. A National Center for Health Statistics (NCHS) survey found that in 2001 8.7% of children from infancy to seventeen years, or 6.3 million, suffered from asthma. The American Lung Association estimated that

TABLE 5.13

High school participation in physical activity, by demographic characteristics, 2003
Participated in sufficient vigorous physical activityaParticipated in sufficient moderate physical activityb
FemaleMaleTotalFemaleMaleTotal
Category%%%%%%
aExercised or participated in physical activities that made students sweat and breathe hard for 20 minutes on 3 of the 7 days preceding the survey (e.g., basketball, soccer, running, swimming laps, fast bicycling, fast dancing, or similar aerobic activities).
bPhysical activities that did not make students sweat and breathe hard for 30 minutes on 5 of the 7 days preceding the survey (e.g., fast walking, slow bicycling, skating, pushing a lawn mower, or mopping floors).
cNon-Hispanic.
source: "Table 50. Percentage of High School Students Who Participated in Sufficient Vigorous Physical Activity and Sufficient Moderate Physical Activity, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2003," Centers for Disease Control and Prevention Surveillance Summaries: Morbidity and Mortality Weekly Report, vol. 53, no. SS–02, May 21, 2004, http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf (accessed September 4, 2003)
Race/ethnicity
Whitec58.171.965.223.328.926.2
Blackc44.965.054.817.525.821.7
Hispanic51.866.759.320.623.322.0
Grade
963.673.168.522.328.325.4
1058.271.564.925.326.225.7
1149.470.460.120.028.124.2
1246.463.755.020.026.323.2
Total55.070.062.622.127.224.7

up to a million asthmatic children are exposed to secondhand smoke, worsening their condition. In 2000 223 children died from complications of asthma.

A study published in the August 2002 issue of Pediatrics ("Residential Exposures Associated with Asthma in U.S. Children") concluded from a 1988 to 1994 survey that a higher percentage of African-American children (8.9%) than white children (5.2%) have asthma. Experts suggest that because a higher number of African-Americans than other racial and ethnic groups lack health insurance and live in poverty they are more likely to postpone treatment and rely on emergency room care rather than preventive medications and treatment. A 2003 University of Rochester Medical Center Study found that white children with asthma were 1.7 to two times more likely than African-American children to use medication to prevent sudden asthma attacks (Pediatric Academic Societies, News Release, "Race Plays Role in Children's Care in Emergency Department," released May 3, 2004, http://www.newswise.com/articles/view/504300 [accessed August 3, 2004]).

HUNGER

Food insecurity is defined as the lack of access to enough food to meet basic needs. According to the U.S. Department of Agriculture, in 2002 88.9% of U.S. households were food secure (Household Food Security in the United States, 2002). However, the remaining twelve million U.S. households (11.1%) experienced food insecurity at some time during the year. A higher percentage of children than adults were food insecure (18.1% and 10.5%, respectively), and almost one out of every hundred children were hungry on one or more days during the year. Households with incomes below the poverty line, households with children headed by a single woman, and African-American and Hispanic households were the most likely to experience food insecurity.

Households that are experiencing food insecurity tend to go through a sequence of steps as food insecurity increases: first, families begin to worry about having enough food, then they begin to decrease other necessities, then they reduce the quality and quantity of all household members' diets, then decrease the frequency of meals and quantity of adult members' food, and finally they decrease the frequency of meals and the quantity of children's food.

Emergency Food Assistance

Second Harvest, the nation's largest charitable hunger-relief organization, reported that in 2001 23.3 million Americans sought emergency food assistance. According to the USDA, in 2002 3% of all households used food pantries and 0.5% ate meals in emergency food centers (soup kitchens). A family with children headed by a single woman was most likely to receive this kind of food assistance. A December 2003 study by the U.S. Conference of Mayors and Sodexho (Hunger and Homelessness Survey: A Status Report on Hunger and Homelessness in America's Cities 2003) found that requests for emergency food assistance increased by 17% throughout 2002, continuing a rapid increase in these requests; the 2002 requests had increased 19% over those in 2001. More than half (59%) of the people who requested food assistance were members of families with children. An average of 14% of the demand for such assistance was unmet. The most frequent reasons for hunger cited by city officials were unemployment, low-paying jobs, high housing and medical costs, homelessness, substance abuse and mental health problems, reduced public benefits, high childcare costs, and the weakening of the economy.

LEAD POISONING

Lead exposure comes primarily from leaded paints that have worn off or been scraped from older homes. Lead is also found in lead plumbing and emitted by factory smokestacks. Because they have smaller bodies and are growing, children suffer the effects of lead exposure more acutely than adults do. Lead poisoning causes nervous system disorders, reduction in intelligence, fatigue, inhibited infant growth, and hearing loss. Toxic levels of lead in a parent can also affect unborn children.

According to the CDC fact sheet "About Childhood Lead Poisoning," in 2000 approximately 434,000 children in the United States between the ages of one and five, or about 2.2% of all children in that age group, had blood lead levels greater than the CDC's recommended level of ten micrograms per deciliter of blood. This number has dropped substantially from 1976 to 1980, when 88.2% of children under age five showed high blood lead levels. Although children from all social and economic levels can be affected by lead poisoning, children in families with low incomes, those who live in older, deteriorated housing, and African-American and Hispanic children are at higher risk. Paint produced prior to 1978 frequently contained lead, so federal legislation now requires owners to disclose any information they may have about lead-based paint before renting or selling a home built earlier than 1978.

MENTAL HEALTH ISSUES IN YOUNG PEOPLE

Marital Conflict and Divorce

Marital conflict hurts children whether it results in the breakup of marriages or not. Nearly all the studies on children of divorce have focused on the period after the parents separated. But some recent studies suggest that the negative effects children experience may not come so much from divorce itself as from marital discord between parents prior to divorce. In fact, some research suggests that many problems reported with troubled teens not only began during the marriage but may have contributed to the breakup of the marriage. Children raised in discord and marital instability often experience a variety of social, emotional, and psychological problems.

TABLE 5.14

Percentage of high school students who engaged in healthy and unhealthy behaviors associated with weight control1, by sex, race, ethnicity, and grade, 2003
Ate less food, fewer calories, or foods low in fat to lose weight or to keep from gaining weightExercised to lose weight or to keep from gaining weightWent without eating for≥24 hours to lose weight or to keep from gaining weightTook diet pills, powders, or liquids to lose weight3 or to keep from gaining weightVomited or took laxatives to lose weight or to keep from gaining weight
CategoryFemale
%
Male
%
Total
%
Female
%
Male
%
Total
%
Female
%
Male
%
Total
%
Female
%
Male
%
Total
%
Female
%
Male
%
Total
%
1During the 30 days preceding the survey
2Non-Hispanic
3Without a doctor's advice
source: Adapted from "Table 62. Percentage of High School Students Who Engaged in Healthy Behaviors Associated with Weight Control to Lose Weight or to Keep from Gaining Weight, by Sex, Race/Ethnicity, and Grade," and "Table 64. Percentage of High School Students Who Engaged in Unhealthy Behaviors Associated with Weight Control, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2003," Centers for Disease Control and Prevention Surveillance Summaries: Morbidity and Mortality Weekly Report, vol. 53, no. SS–02, May 21, 2004, http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf (accessed September 3, 2004)
Race/ethnicity
White261.129.144.669.648.158.518.47.112.513.06.89.88.52.75.5
Black239.021.830.549.246.147.514.510.512.55.14.95.05.65.05.3
Hispanic54.933.744.264.153.758.918.29.213.711.79.210.59.75.17.4
Grade
953.028.840.465.750.257.618.810.714.69.27.08.07.94.66.2
1058.127.842.768.949.859.218.57.012.710.95.88.39.33.56.4
1156.429.442.864.549.456.819.68.213.812.67.710.18.32.65.7
1257.929.843.763.246.454.615.76.911.213.08.510.87.33.85.5
Total56.228.942.265.749.057.118.38.513.311.37.19.28.43.76.0

Divorce can cause stressful situations for children in several ways. One or both parents may have to move to a new home, removing the children from family and friends who could have given them support. Custody issues can generate hostility between parents. And if one or both parents remarry, children are faced with yet another adjustment in their living arrangements.

Eating Disorders

While young people who are overweight increase their risk for certain diseases in adulthood, an over-emphasis on thinness during childhood may contribute to eating disorders such as anorexia nervosa (extreme and often fatal weight loss) and bulimia ("binging and purging"). Girls are both more likely to have a distorted view of their weight and more likely to have eating disorders than boys.

The CDC reported that although 13.5% of students were overweight, a much higher proportion thought they were overweight (29.6%) (Youth Risk Behavior Survey, 2003). (See Table 5.12.) Girls (36.1%) are much more likely than boys (23.5%) to believe they are overweight. White (30.8%) and Hispanic (31.6%) youths are more likely than African-American youths (22.3%) to think of themselves as overweight.

In 2003 nearly half (43.8%) of high school students nationwide were trying to lose weight by a variety of methods. (See Table 5.12.) Six percent of high school students had taken laxatives or induced vomiting to lose weight, 13.3% went without eating for twenty-four hours or more, and 9.2% took diet pills. (See Table 5.14.) Hispanic and white students were more likely to resort to these unhealthy behaviors than African-American students. Many more females than males engaged in risky weight-loss methods.

Well over half of high school females dieted or exercised to lose weight (56.2% and 65.7%, respectively); among males, only 28.9% dieted and 49% exercised to lose weight. (See Table 5.14.) Once again, among females these behaviors varied by race: far more white and Hispanic female students engaged in these weight loss activities than did African-American female students.

Hyperactivity (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders to appear in childhood. No one knows what causes ADHD, although recent research reported by the National Institute of Mental Health has found a link between a person's ability to pay attention and the body's use of glucose in the brain. Symptoms include restlessness, inability to concentrate, aggressiveness, and impulsivity; lack of treatment can lead to problems in school, at work, and in making friends. The National Institute of Mental Health estimated that 4.1% of youths ages nine to seventeen are affected in any six-month period by ADHD. Boys are two or three times more likely to be affected by ADHD than girls. Ritalin, a stimulant, is frequently used to treat hyperactive children.

DRUGS, ALCOHOL, AND SMOKING

Drug Use

Few factors negatively influence the health and well-being of young people more than the use of drugs, alcohol, and tobacco. Monitoring the Future (MTF), a long-term study on the use of drugs, alcohol, and tobacco conducted by the University of Michigan's Institute for Social Research, annually surveys eighth, tenth, and twelfth graders on their use of these substances. According to the institute's Overview of Key Findings 2003, the percentage of high school students who have ever tried any illicit drug either remained steady or decreased slightly from the mid-1990s to 2003. This plateau followed sharp increases during the early 1990s. The survey showed a decrease in the use of LSD, tranquilizers, amphetamines, and methamphetamines in 2002 and 2003. The use of heroin, other narcotics, crack, cocaine, and hallucinogens other than LSD remained steady. Only inhalants showed signs of increasing use, and then only among eighth graders. Still, half (51%) of American youths have tried an illicit drug by the time they leave high school.

Each year MTF asks twelfth graders, "How much do you think people risk harming themselves by using the following drugs?" The results show that from 1975 to 2003 the majority of students consistently perceived cocaine, LSD, and heroin as high-risk drugs in terms of overdose, addiction, and death. According to the MTF report in 2004, marijuana remained the only drug that barely half of all twelfth graders (54.9%) surveyed in 2003 believed had high-risk factors if used regularly. Between 1975 and 2003 83–90% of high school seniors reported that they could easily obtain marijuana, more than any other drug.

Table 5.15 shows reported drug and alcohol use by twelfth graders in 2003, according to the MTF. Alcohol remained teenagers' drug of choice; 70.1% of high school seniors had used alcohol in the twelve months prior to the survey and 47.5% had used alcohol in the prior thirty days. Marijuana was a distant second; 34.9% of twelfth graders had used marijuana in the prior twelve months and 21.2% had used it in the prior thirty days. The 2003 Youth Risk Behavior Survey found that 40.2% of high school students reported they had tried marijuana, and 22.4% reported they had used it at least once in the thirty days before the survey. (See Table 5.16.)

Alcohol Use Still High

Alcohol use remains high among high school students. Although there was some decline in drinking among students in the 1980s, it remained generally stable among young people between 1993 and 2003.

The 2003 Youth Risk Behavior Survey found that nationwide 74.9% of all high school students had had at least one alcoholic drink in their lifetime, 44.9% had taken a drink in the thirty days prior to the survey, and 28.3% had had five or more drinks on one occasion at least once in the thirty days prior to the survey. (See Table 5.16.) African-American youth were less likely than

TABLE 5.15

Reported drug and alcohol use during 12-month period and 30-day period, by high school seniors, 2003
Used in past 12 monthsUsed in past 30 days
source: Adapted from "Table 2. Trends in Annual and 30-Day Prevalence of Use of Various Drugs for Eighth, Tenth, and Twelfth Graders," in Monitoring the Future: National Results on Adolescent Drug Use, Overview of Key Findings, 2003, NIH Publication No. 04-5506, National Institute on Drug Abuse, 2004, http://www.monitoringthefuture.org/data/03data/pr03t2.pdf (accessed September 16, 2004)
Marijuana/Hashish34.921.2
Inhalants3.91.5
PCP1.30.6
MDMA (Ecstasy)4.51.3
Cocaine4.82.1
Crack2.20.9
Heroin0.80.4
Other Narcotics9.34.1
Amphetamines9.95
Methamphetamine3.21.7
Sedatives (Barbituates)62.9
Tranquilizers6.72.8
Alcohol70.147.5
Steroids2.11.3

either white or Hispanic high schoolers to have ever had a drink, to have had a drink in the previous thirty days, or to engage in episodic heavy drinking.

teenage drinking and driving. According to Determine Why There Are Fewer Young Alcohol-Impaired Drivers by the National Highway Traffic Safety Administration (September 2001), traffic fatalities linked to teenage drinking fell from 1982 to 1993 and remained fairly steady from 1993 to 1998. This decline was due in large part to stricter enforcement of drinking age laws and driving while intoxicated (DWI) or driving under the influence (DUI) laws. Motor vehicle crashes were the leading cause of death among fifteen- to twenty-year-olds in 2002. In that year 24% of all young drivers ages fifteen to twenty who were killed in crashes were intoxicated.

The 2003 Youth Risk Behavior Survey found that in the month before the survey, 12.1% of students reported they had driven a vehicle after drinking alcohol. (See Table 5.17.) Males (15%) were more likely than females (8.9%) to drive after drinking. Another 30.2% admitted they had ridden with a driver who had been drinking. Females were slightly more likely to ride with a driver who had been drinking (31.1%) than were males (29.2%).

Tobacco

Most states prohibit the sale of cigarettes to anyone under eighteen but the laws are often ignored and may carry no penalties for youths who buy cigarettes or smoke in public. According to the American Lung Association, nearly six thousand children start smoking each day, and 4.5 million adolescents are smokers. The Youth Risk Behavior Survey reported that in 2003

TABLE 5.16

Percentage of high school students who drank alcohol and used marijuana, by sex, race, ethnicity, and grade, 2003
Lifetime alcohol use*Current alcohol useEpisodic heavy drinking§Lifetime marijuana useCurrent marijuana useΔΔ
CategoryFemale
%
Male
%
Total
%
Female
%
Male
%
Total
%
Female
%
Male
%
Total
%
Female
%
Male
%
Total
%
Female
%
Male
%
Total
%
*Ever had one or more drinks of alcohol on ≥1 day.
Drank one or more drinks of alcohol on≥1 of the 30 days preceding the survey.
§Drank≥ 5 drinks of alcohol in a row on ≥ 1 of the 30 days preceding the survey.
95% confidence interval.
**Non-Hispanic.
Used marijuana one or more times during their lifetime.
ΔΔUsed marijuana one or more times during the 30 days preceding the survey.
source: Adapted from "Table 26. Percentage of High School Students Who Drank Alcohol, by Sex, Race/Ethnicity, and Grade," and "Table 28. Percentage of High School Students Who Used Marijuana, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2003," Centers for Disease Control and Prevention Surveillance Summaries: Morbidity and Mortality Weekly Report, vol. 53, no. SS-02, May 21, 2004, http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf (accessed September 16, 2004)
Race/ethnicity
White**76.674.375.448.445.947.131.532.131.838.940.539.819.923.321.7
Black**74.068.671.437.037.537.412.717.915.337.649.043.318.129.823.9
Hispanic81.477.579.548.442.745.629.827.928.938.546.742.720.427.123.8
Grade
966.264.065.038.533.936.220.918.819.828.133.130.717.219.618.5
1076.574.975.744.942.243.527.227.727.436.444.240.418.225.722.0
1180.976.478.646.847.347.029.434.131.843.545.444.520.927.324.1
1283.382.683.055.556.055.934.539.537.244.951.748.521.330.025.8
Total76.173.774.945.843.844.927.529.028.337.642.740.219.325.122.4

TABLE 5.17

Percentage of high school students who rode with a driver who had been drinking alcohol and who drove after drinking alcohol, by sex, race, ethnicity, and grade, 2003
Rode with a driver who had been drinking alcohol*Drove after drinking alcohol*
CategoryFemale
%
Male
%
Total
%
Female
%
Male
%
Total
%
*In a car or other vehicle one or more times during the 30 days preceding the survey.
§Non-Hispanic.
source: Adapted from "Table 4. Percentage of High School Students Who Rode with a Driver Who Had Been Drinking Alcohol and Who Drove after Drinking Alcohol, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2003," Centers for Disease Control and Prevention Surveillance Summaries: Morbidity and Mortality Weekly Report, vol. 53, no. SS-02, May 21, 2004, http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf (accessed September 16, 2004)
Race/ethnicity
White§29.827.328.510.315.212.9
Black§29.831.830.94.613.49.1
Hispanic40.032.836.48.614.911.7
Grade
930.226.428.25.17.26.2
1031.027.629.36.911.39.2
1130.730.330.511.119.515.3
1232.634.033.313.625.619.8
Total31.129.230.28.915.012.1

21.9% of high school students had smoked at least one cigarette in the month prior to the survey and 9.7% had smoked at least twenty days in the past month. (See Table 5.18.) The percentage of female and male heavy smokers was almost equal: 2.4% of female adolescents and 3.6% of male adolescents smoked more than ten cigarettes per day.

Teens say they smoke for a variety of reasons—they "just like it," "it's a social thing," and many young women who are worried about their weight report that they smoke because "it burns calories." Many of them report they have seen their parents smoke. A 1995 Los Angeles study, "The Influence of Parental Smoking on Youth Smoking: Is the Recent Downplaying Justified?" by Mike Males of the University of California at Irvine, found that parental smoking is a significant influence on youth smoking, especially among boys and among youth who began smoking at a young age.

smokeless tobacco. Smokeless tobacco use—chewing tobacco, snuff, or dip—among adolescents is a predominantly white male activity, according to the 2003 Youth Risk Behavior Survey. Of high school students, 11% of males and 2.2% of females had used smokeless tobacco at least once in the thirty days preceding the survey; 7.6% of white and 3% of African-American students had used smokeless tobacco in that time. White male students had the highest proportion of users (13.3%); only 4.1% of African-American males and 6.1% of Hispanic males used smokeless tobacco.

secondhand smoke and children. The Environmental Protection Agency reported that environmental tobacco smoke (ETS) is a major hazard for children, whose respiratory, immune, and other systems are not as well developed as those of adults. According to the EPA's Web site, secondhand or passive smoke—smoke produced by other people's cigarettes—increases the number of attacks and severity of symptoms in children with asthma and can even cause asthma in preschool-age children.

TABLE 5.18

Percentage of high school students who used tobacco, by sex, race, ethnicity, and grade, 2003
Lifetime cigarette use*Lifetime daily cigarette useCurrent cigarette use§Current frequent cigarette useSmoked >10 cigarettes/day**Purchased cigarettes at a store or gas station
CategoryFemale
%
Male
%
Total
%
Female
%
Male
%
Total
%
Female
%
Male
%
Total
%
Female
%
Male
%
Total
%
Female
%
Male
%
Total
%
Female
%
Male
%
Total
%
*Ever tried cigarette smoking, even one or two puffs.
Ever smoked one or more cigarettes every day for 30 days.
§Smoked cigarettes on ≥1 of the 30 days preceding the survey.
Non-Hispanic.
Smoked cigarettes on >20 of the 30 days preceding the survey.
**Smoked >10 cigarettes per day on the days they smoked during the 30 days preceding the survey.
††Among the 20.8% of students who were aged <18 years who smoked cigarettes on >1 of the 30 days preceding the survey.
§§During the 30 days preceding the survey.
source: Adapted from "Table 20. Percentage of High School Students Who Smoked Cigarettes, by Sex, Race/Ethnicity, and Grade," and "Table 22. Percentage of High School Students Who Smoked Cigarettes and Who Purchased Cigarettes in a Store or Gas Station, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2003," Centers for Disease Control and Prevention Surveillance Summaries: Morbidity and Mortality Weekly Report, vol. 53, no. SS-02, May 21, 2004, http://www.cdc.gov/mmwr/PDF/SS/SS5302.pdf (accessed September 16, 2004)
Race/Ethnicity
White58.757.458.120.917.118.926.623.324.913.210.411.83.13.63.412.024.117.5
Black56.959.858.45.210.98.210.819.315.13.17.95.50.82.11.423.720.921.8
Hispanic59.863.961.99.112.210.717.719.118.44.46.65.51.42.01.719.227.223.8
Grade
950.953.052.011.611.411.518.916.017.46.95.76.31.32.41.910.413.812.0
1057.759.058.315.814.315.021.921.721.89.09.59.22.42.42.47.819.313.6
1159.860.160.018.417.818.124.023.223.611.810.511.23.13.53.321.234.527.9
1265.964.765.418.321.019.823.329.026.211.414.513.12.66.84.818.933.626.1
Total58.158.758.415.615.715.821.921.821.99.79.69.72.43.63.113.824.218.9

According to the agency, secondhand smoke causes between 150,000 and 300,000 lower respiratory tract infections each year in children under eighteen months of age, and those infections result in between 7,500 and 15,000 hospitalizations each year. Passive smoking can also cause middle-ear disease and reduction in lung function in children, and is considered a risk factor in SIDS. The 2000 National Youth Tobacco Survey, a survey of more than 35,000 students in grades six through twelve conducted by the American Legacy Foundation, found that 42.1% of the students surveyed lived in homes where others smoked, and 69.7% were exposed to others who smoked outside the home.

"Not My Kid"

Recent surveys show that parental denial of their children's substance use is rampant among baby boomer parents. According to the Partnership for a Drug-Free America (Partnership Attitude Tracking Study: Parents, 2002), teens reported smoking marijuana three times more often than their parents reported they had. Almost all parents surveyed (91%) said they had talked to their children about the dangers of drugs. About half of parents (48%) agreed with the statement, "My child and I regularly sit down together and have open discussions about important issues like drugs," but only 19% of teens agreed. By 2003 the percentage of teens who reported their parents frequently talked to them about the risks of drugs decreased further.

Experts contend the key for parents who want to prevent their children's experimentation from turning into abuse is to stop sending ambivalent messages about drug use and not to abuse substances themselves. Nonetheless, even if parents strongly oppose drugs, do not abuse them, and talk to their child about the danger of drug abuse, children may still choose to use drugs.

CHILD ABUSE AND NEGLECT

It is impossible to determine how many children suffer abuse. All observers can do is count the number of reported cases—which include only those known to public authorities—or they can survey families, in which case parents may deny or downplay abuse. As a result, most estimates of child abuse are generally considered low. The National Child Abuse and Neglect Data System (NCANDS) and its annual report, Child Maltreatment, is the primary source of national information on abused and neglected children that has been reported to state child protective services agencies.

In 2002 1.8 million referrals alleging child abuse or neglect of more than three million children were sent to state child protective services agencies. Approximately 896,000 children were found to be victims of child maltreatment. Reports most often came from professional

FIGURE 5.4

sources, such as educators, the legal system, social service employees, and medical professionals, and less often from nonprofessional sources, such as relatives, friends, neighbors, parents, the victims themselves, and a small percentage of perpetrators. (See Figure 5.4.)

In 2002 60.5% of reported victims suffered neglect; 18.6% were physically abused; 9.9% were sexually abused; and 6.5% were emotionally or psychologically maltreated. (Figure 5.5 shows victimization rates for each group per one thousand children.) The highest rate of victims was among children three years or younger (sixteen per one thousand), followed by children four to seven years of age (13.7 per one thousand). (See Figure 5.6.) The rate of occurrence decreased as the child's age increased.

The most tragic result of child maltreatment is death. In 2002 an estimated fourteen hundred children died as a result of abuse or neglect. Children in the youngest age groups were most likely to die of maltreatment; three-quarters of the children who died were three years old or younger.

FIGURE 5.5

The largest group of abusers were mothers acting alone (40.3%) followed by fathers acting alone (19.1%). (See Figure 5.7.) Abuse of children was overwhelmingly perpetrated by parents; only 13% of perpetrators were not parents.

MISSING CHILDREN

In the 1980s, as a result of several prominent abductions and tragedies, the media focused public attention on the problem of missing children. Citizens became concerned and demanded action to address what appeared to be a national crisis. Attempting to discover the nature and dimension of the problem, Congress passed the 1984 Missing Children's Assistance Act (PL 98–473). The legislation mandated the Office of Juvenile Justice and Delinquency Prevention (OJJDP) to conduct national incidence studies to determine the number of juveniles who were "victims of abduction by strangers" and the number of children who were victims of "parental kidnapping." The result was the National Incidence Studies of Missing, Abducted, Runaway, and Thrownaway Children (NISMART), the first of which was conducted in 1988, with the results published in 1990. The second, more recent NISMART was conducted mainly in 1999, with many of the data published in a series of October 2002 reports.

Family Abductions

According to Children Abducted by Family Members: National Estimates and Characteristics (Heather Hammer et al., OJJDP, Washington, DC, October 2002), a family abduction is "the taking or keeping of a child by a family member in violation of a custody order, a decree, or other legitimate custodial rights, where the taking or keeping involved some element of concealment, flight, or intent to

FIGURE 5.6

deprive a lawful custodian indefinitely of custodial privileges." In 1999 203,900 children were victims of a family abduction. About half of these (53%) were abducted by biological fathers, and 25% by biological mothers. Most family-abducted children were not missing for long—46% were gone less than a week, and only 21% were away a month or more. Nearly half (42%) were abducted from a single-parent family. At the time the survey was done, 91% of the children had been returned, 6% had been located but not returned, and less than 1% had not been located or returned (there was no information on outcomes for 2% of cases).

FIGURE 5.7

Nonfamily Abductions

Although far fewer children are abducted by strangers than by family members, the consequences are often far worse. Violence, the use of force or weapons, sexual assault, and murder are more prevalent in nonfamily abductions. According to Nonfamily Abducted Children: National Estimates and Characteristics (David Finkelhor et al., OJJDP, Washington, DC, October 2002), 58,200 children were abducted by nonfamily members in 1999. Nearly half (46%) of these were sexually assaulted by their abductors. Only 115 of the abductions were "stereotypical kidnappings," in which a child was abducted by a slight acquaintance or stranger, detained overnight, transported fifty miles or more, held for ransom or with intention to keep permanently, or killed. Most nonfamily abducted children (59%) were 15–17 years old and 65% were female. The perpetrators were strangers 37% of the time and were three times as likely to be male as female. Most perpetrators (67%) were ages thirteen to twenty-nine. Most nonfamily abducted children (91%) were away for twenty-four hours or less, and 99% returned alive. The remaining 1% were either killed or had not been located at the time of the survey.

Runaways and Thrownaways

According to the OJJDP (Heather Hammer et al., Runaway/Thrownaway Children: National Estimates and Characteristics, Washington, DC, October 2002), runaways are children who meet at least one of the following criteria:

  • A child who leaves home without permission and stays away overnight
  • A child fourteen years old (or older and mentally incompetent) who is away from home who chooses not to come home when expected to and who stays away overnight
  • A child fifteen years old or older who is away from home who chooses not to come home and stays away two nights

In the 1970s the label "throwaways" or "thrownaways" was given by researchers to juveniles who were made to leave home or were abandoned. A thrownaway child meets one of the following criteria:

  • A child who is asked or told to leave home by a parent or other household adult, with no adequate alternative care arranged for the child by a household adult, and who is out of the household overnight
  • A child who is away from home who is prevented from returning home by a parent or other household adult, with no adequate alternative care arranged for by a household adult, and who is out of the household overnight

The OJJDP now combines its estimates of runaways and thrownaways. In 1999 1.7 million youths had a runaway/thrownaway episode. The runaway episode was thought to indicate that 1.2 million of these children were endangered in the following ways:

  • The child had been physically or sexually abused at home in the year prior to the episode or was afraid of abuse upon return (21%).
  • The child was substance dependent (19%).
  • The child was thirteen years old or younger (18%).
  • The child was in the company of someone known to be abusing drugs (18%).
  • The child was using hard drugs (17%).

Most runaway/thrownaway youth (68%) were fifteen years old or older; half were females and half were males. Most runaways (77%) were away less than one week, and more than 99% returned. An estimated 38,600 of the runaways were at risk of sexual endangerment—assault, attempted assault, or prostitution—while away from home.

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