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INTRODUCTION
In 2004, approximately 25 percent of the United
States population was under the age of 18. The racial and ethnic
distribution of these 73 million children demonstrates the growing
diversity of this population: 58 percent were non-Hispanic White,
19 percent were Hispanic, 15 percent were Black, 4 percent were
Asian or Pacific Islander, and the remaining 4 percent were of other
races (including more than one race). The health of these children
depends on preventive services such as prenatal care and immunization,
as well as the promotion of healthy life choices. These measures
help assure that children are born healthy and maintain good health
as they age, and to be successful requires the continuing effort
of individuals, families, communities, and health care providers.
Preventive care for children begins even before
they are born. Timely prenatal care is an important preventive strategy
that can help protect the health of both mother and child. Entry
into prenatal care during the first trimester has been improving,
reaching 84.1 percent of pregnant women in 2003. This rate is lower
for younger women and Black and Hispanic women. A small number of
pregnant women (3.5 percent in 2003) go without prenatal care until
the third trimester, or forgo it entirely. This is more common among
Black and Hispanic women, as well as younger women, unmarried women,
and women with low levels of education.
Healthy birth weight is an important indicator
of young children’s health. Despite high rates of prenatal care
utilization, the rate of low birth weight (LBW)—less than 2,500
grams (5 pounds 8 ounces)—is currently at the highest level recorded
in the past 3 decades. In 2003, 7.9 percent of all births were considered
low birth weight. Very low birth weight (VLBW)—less than 1,500 grams
(3 pounds 4 ounces)—is also on the rise, representing 1.4 percent
of all live births in 2003, compared to approximately 1 percent
in 1980. These babies are significantly more likely to die in the
first year of life than babies of normal birth weight, and those
who survive are at particularly high risk for severe physical, developmental,
and cognitive problems. Although rates of maternal and infant mortality
have dropped dramatically in the past century, the United States
still has one of the highest rates of infant death in the industrialized
world. Of every 1,000 infants born alive in 2003, seven died in
their first year.
Breastfeeding can also support the health of infants
and mothers. Breastfeeding rates have increased steadily since the
beginning of the 1990s. In 2003, the breastfeeding initiation rate
reached 70.9 percent, the highest yet recorded. However, the rate
declines dramatically as infant age increases, and only 36.2 percent
of mothers were still breastfeeding their infants at 6 months. The
exclusive breastfeeding at 6 months rate was even lower (14.2 percent).
The preventive health measure that is probably
most recognized among the public is childhood immunization. Vaccines
are available for public health threats such as measles, mumps,
rubella (German measles), polio, diphtheria, tetanus, pertussis
(whooping cough), and H. influenzae type b (a bacterium that causes
meningitis). The Healthy People 2010 objective is to immunize at
least 90 percent of 19- to 35-month olds with the full series of
recommended childhood vaccines. A 2002-03 survey from the Centers
for Disease Control and Prevention shows that 80.5 percent of children
19 to 35 months of age had received the recommended series of vaccines.
As a result of the increasing success of immunization, the number
of reported cases of vaccine-preventable diseases continues to decrease.
In 2003, there were no reported cases of diphtheria, tetanus, rubella,
or polio among children under 5 years of age, and very few cases
of hepatitis B, measles, and mumps.
Dental care is another important preventive service
for children—one that is too often overlooked. In 2003, 70.8 percent
of children visited a dentist within the past year, but among children
living in families with incomes below 200 percent of the poverty
level the rate was only 60.5 percent. To promote good oral hygiene,
the American Academy of Pediatrics recommends that children begin
annual dental visits within 6 months of the eruption of their first
tooth and no later than 12 months of age.
Despite our best preventive efforts, children
are still vulnerable to a number of diseases, conditions, and other
risks to their health and well-being. Asthma, for instance, is a
disease that causes wheezing, chest tightness, and shortness of
breath, and can lead to school absences, hospitalization, and even
death. In 2003, almost 8 percent of children under 18 years of age
were reported by parents to be affected by asthma. This includes
all children whose parents reported that a doctor ever told them
the child had asthma and that the child still has asthma, and children
who, in the past year, used asthma medication, had moderate or severe
difficulties combined with an attack, or had been hospitalized for
asthma. It was most often reported among non-Hispanic Black children
and children living in families with incomes below the poverty level.
According to the Youth Risk Behavior Survey,
13.5 percent of high school students were overweight in 2003, and
almost one-third described themselves as overweight. Childhood overweight
is associated with significant health problems; for instance, high
cholesterol and high blood pressure, which are risk factors for
heart disease, occur more frequently among overweight children than
those with a healthier weight. Overweight is also closely linked
to type 2 diabetes, and can have emotional effects such as poor
self esteem and depression.1 Regular
exercise helps to regulate weight, and in 2003, over 60 percent
of high school students engaged in sufficient vigorous activity
and over half of high school students performed regular strengthening
exercises.
Mental health issues are also a risk to the health
of children and adolescents. In 2003, approximately 10 percent of
children were reported by their parents to have moderate to severe
socio-emotional problems; this includes children who have difficulties
with emotions, concentration, behavior, or getting along with other
people. Socio-emotional problems were most common among males and
non-Hispanic Black children. Over 20 percent of children ages 12
to 17 years received mental health treatment or counseling, most
commonly for feeling depressed, breaking rules or acting out, feeling
afraid or tense, having suicidal thoughts or attempts, and having
problems at home. Most who received treatment did so from a private
therapist or counselor, or from school sources; 9 percent were hospitalized
for treatment of their mental health problems.
Unfortunately, the health of children and adolescents
can also be affected by HIV/AIDS. At the end of 2003, 9,419 cases
of AIDS had been reported in children younger than 13 since the
epidemic began in the early 1980s. Pediatric AIDS cases represent
just over 1 percent of all AIDS cases ever reported. Cases of HIV/AIDS
among adolescents and young adults 13 to 24 years of age represented
12 percent of all diagnoses in 2003. Adolescents and young adults
represented approximately 4 percent of all people living with HIV/AIDS
in 2003, and 1 percent of people who died with the disease.
Adolescents and young adults are also vulnerable
to sexually transmitted infections (STIs) such as chlamydia, gonorrhea,
and syphilis. These can lead to pelvic inflammatory disease and
infertility if left untreated, while increasing the risk of contracting
other STIs. Young adults ages 20 to 24 years generally have higher
rates of infection than teens, and non-Hispanic Black youth have
higher rates than their non-Hispanic White and Hispanic peers.
Many of the decisions that adolescents and young
adults make affect their future health and success in life. Some
adolescents and young adults never complete high school, which can
lead to unemployment and decreased health status. In 2002, there
were over 3.7 million high school dropouts in the United States
(this comprises 16- to 24-year-olds who have not earned a diploma
and are not enrolled in school). Some teens also become parents,
although the rate of adolescent childbearing has dropped considerably
in the past decade. The birth rate among adolescent females ages
15 to 17 years was 41.7 per 1,000 in 2003, a 33 percent decrease
since the most recent peak in 1991. Rates are highest among older
teens and Hispanic youth.
The health and well-being of adolescents can also
be threatened by the use of alcohol and drugs. In 2003, 18 percent
of 12- to 17-year-olds reported using alcohol, and over 11 percent
reported using illicit drugs in the past month. The most commonly
reported drug is marijuana, followed by the nonmedical use of prescription
drugs, such as pain relievers and tranquilizers. Over half of teens
reported that marijuana would be fairly or very easy to obtain,
and 16 percent of adolescents reported being approached by someone
selling drugs in the past month.
Data presented in Child Health USA 2005
are important for both appreciating America’s public health achievements
and recognizing the challenges that we still face. The health of
our children and adolescents relies on effective public health efforts
that include providing access to knowledge, skills, and tools; providing
drug-free alternative activities; identifying risk factors and linking
people to appropriate services; building community supports; and
supporting approaches that promote policy change. Such preventive
efforts and health promotion activities are vital to the continued
improvement of the health and well-being of America’s children and
families.
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