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Introduction | Population
The health of children is one of our Nation's highest priorities. Children under age 21 represent about one-third of the total U.S. population, and the child population has become increasingly racially and ethnically diverse. Largely due to immigration from Asia and Latin America, the foreign-born population has increased in the past several decades. (All of the statistics cited here are discussed in more detail elsewhere in this book.) In 2002, approximately 20 percent of children had at least one parent who was born outside of the United States, and 3.7 percent were themselves foreign-born. These families are particularly likely to have low incomes and to experience barriers to health care access. Another particularly vulnerable population is children with special health care needs. This population represents 12.8 percent of children in the United States, according to estimates from the National Survey of Children with Special Health Care Needs, or as many as 16.2 percent of children, according to the Medical Expenditure Panel Survey.
When identifying ways to improve overall child well-being, the issue of health coverage is of critical importance. Health insurance status is often a determinant of access to and use of health care services among children. In 2001, 11.9 percent or 8.5 million children remained uninsured. Based on an analysis of census data, the rise in the percentage of children with insurance is attributable to both the strong economy of the late 1990s and the Children’s Health Insurance Program (CHIP) implemented in 1997.1 The CHIP was established as part of the Balanced Budget Act of 1997, to expand medical coverage to low-income children ineligible for Medicaid. In 2002, 22.8 percent of children were enrolled in CHIP and Medicaid nationwide.
Children's health depends on a wide range of factors, including the family's economic circumstances, access to health care, and knowledge of children's health care needs and how to address them. The correlation between a family's socioeconomic status and child health and development is well documented; although the 2001 childhood poverty rate is the lowest it has been in the past two decades, 11 million children under 18 still live in families with incomes below the Federal poverty level. Black and Hispanic children are more likely to live in poverty than are White children. In 2001, 30 percent and 27.4 percent of Black and Hispanic children, respectively, were living in families with incomes below the Federal poverty level, compared to 12.8 percent of White children.
Child health begins before birth, with adequate and high quality prenatal care during pregnancy. Inadequate prenatal care utilization is associated with a reduced number of well-child visits and less than complete immunizations.2 This suggests that the pattern of health care during the prenatal period may be a predictor of the use of adequate pediatric services during childhood. In 2001, over 83 percent of pregnant women began prenatal care in the first trimester, reflecting a significant increase in the use of early prenatal care over the past ten years. However, this percentage is significantly lower for minority women; only 74.5 percent of Black mothers received early care compared to 85.2 percent of White women. To improve low-income women’s access to prenatal care, States may expand their CHIP programs to cover pregnant women, an option that several states have taken.
In the United States, low birth weight (less than 2,500 grams or 5 pounds 8 ounces) is a strong predictor of infant mortality and morbidity. Preterm birth, occurring before 37 weeks of gestation, is one of the predominant proximate causes of low birth weight. Risk factors for preterm delivery include low socioeconomic status, low pre- pregnancy weight, inadequate weight gain during the pregnancy, history of infertility problems, smoking, and multiple gestation. Infants who are born at low birth weight are at a greater risk of developing other problems later in life, such as physical disabilities and developmental delays. Despite improvements in the use of prenatal care, the rate of low birth weight has actually risen in recent years, partly due to an increase in the number of multiple births, which are more likely to produce low birth weight babies.
In 2001, 7.7 percent of all live births nationwide were low birth weight. This represented a slight increase from the prior year. Several maternal risk factors have been associated with delivering low birth weight infants. Women who are demographically at risk include those who are Black, have a low level of education, and are low-income. The Black low birth weight rate of 13 percent is considerably higher than the rate for White (6.7 percent) and Hispanic (6.5 percent) births.
Low birth weight is one of the leading causes of neonatal mortality. The preliminary rate of neonatal mortality, or the death of infants during the first 28 days after birth, was 4.6 deaths per 1,000 live births in 2001 and represents no change from the 2000 rate. Also remaining unchanged was the rate of postneonatal mortality, or death between 28 days and 1 year of age. In 2001, the preliminary rate was 2.3 deaths per 1,000 live births. The leading causes of postneonatal mortality are Sudden Infant Death Syndrome (SIDS) and birth defects. The rate of SIDS has dropped dramatically in the past 5 years, as parents and caregivers have learned about the importance of putting infants down to sleep on their backs.
The rate of infant mortality or death of children in the first year has consistently declined in the United States. In 2000, the preliminary infant mortality rate was 6.9 deaths per 1,000 live births. However, the rate of death among Black infants of 14.2 deaths per 1,000 live births is still 2.5 times the rate among White infants, and this disparity has not decreased. The United States ranks 26th among developed nations in its rate of infant mortality, reflecting the progress that remains to be made.
Infant health and development can be greatly enhanced through breastfeeding. Healthy People 2010 set the target of 75 percent for new mothers breastfeeding in the hospital, 50 percent maintaining breastfeeding for at least 6 months, and 25 percent continuing for 1 year.3 In 2001, breastfeeding rates were the highest recorded since national breastfeeding data have been collected. The initiation rate or in-hospital breastfeeding rate was 69.5 percent for all women. This rate increased most among groups of mothers that have traditionally been the least likely to breastfeed, Black and Hispanic women. In 2001, 52.9 percent of Black women and 73 percent of Hispanic women initiated breastfeeding in the hospital. In fact, 2001 was the first year that the highest in-hospital breastfeeding rates were among Hispanic women. The American Academy of Pediatrics reports that infants who are breastfed have fewer bacterial and viral infections, such as ear infections and pneumonia. There is research supporting that breastfeeding has long-term benefits such as improving a child's immune system and even enhancing cognitive functioning.
Another indicator of child health is the percentage of children who are adequately immunized. Children who are not fully immunized are at higher risk for serious, preventable diseases and are most likely not receiving adequate preventive health care. The percentage of children who receive a full series of immunizations-including those for measles, mumps, rubella (German measles), polio, diphtheria, tetanus, pertussis (whooping cough), and Haemophilus influenzae type b (the bacterium that causes meningitis)-was reported to be 74.8 percent in 2002, a slight increase from the rate reported in 2001. Although the number of reported cases of vaccine-preventable diseases has decreased steadily in the past decade, significant progress is still needed to reach the goal of immunizing at least 90 percent of children by their second birthday.
Childhood mortality rates have generally declined over the past several decades. In 2001, there were 12,249 deaths among children ages 1-14. Injuries are the leading cause of death for children in this age group. Injuries accounted for 33.2 percent of all deaths among children ages 1-4 and 39.4 percent of all deaths among children ages 5-14. The leading cause of injury death among children ages 1-14 was motor vehicle crashes. Unintentional injury was also the leading cause of death among adolescents ages 15-19, which accounted for 48 percent of deaths in 2001. Of deaths due to injury, motor vehicle crashes were the most common cause of death (77 percent), followed by deaths due to firearms (38 percent).
Reducing violence among adolescents is another approach to reducing the rate of death and disability due to injury. In this area, we are making significant progress; between 1993 and 2001, the percentage of high school students carrying weapons declined by 21 percent and the percentage of high school students bringing weapons to school declined by 46 percent. However, violence among adolescents remains a problem. Nearly 9 percent of students reported being threatened or injured with a weapon on school property in 2001, and this rate has increased 22 percent since 1993.
Finally, as many of the statistics shown here make clear, mental health is a critical component of children’s overall health. Mental disorders are a leading cause of hospitalizations for adolescents, and suicide is the third leading cause of death for this age group. Certain high-risk factors, such as poverty and maternal depression, also affect a child’s well-being and overall health. Screening for mental health problems and providing access and linkages to needed services and supports can help to prevent the tragic consequences of mental health problems and/or mental disorders.
The data presented here paint a picture of continued progress toward the goal of healthy children and families, but we still have a long way to go in many areas. By monitoring the health of children throughout their lives, we can identify opportunities for the prevention of disease and injury. It is expected that the data in this book will be one source of the information needed by policymakers, program planners, and the public to improve the health and well-being of children in America.
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Introduction | Population