# 16 {#section .Chapter-# .unnumbered}

# Maternal, Infant, and Child Health

#### Fetal, Infant, Child, and Adolescent Deaths

16-1 Fetal and infant deaths

16-1a At 20 or more weeks of gestation

16-1b Perinatal deaths

16-1c Infant deaths

16-1d Neonatal deaths

16-1e Postneonatal deaths

16-1f All birth defects

16-1g Congenital heart defects

16-1h SIDS deaths

16-2 Child deaths

16-2a Children aged 1 to 4 years

16-2b Children aged 5 to 9 years

16-3 Adolescent and young adult deaths

16-3a Adolescents aged 10 to 14 years

16-3b Adolescents aged 15 to 19 years

16-3c Young adults aged 20 to 24 years

#### Maternal Deaths and Illnesses

16-4 Maternal deaths

16-5 Maternal illness and complications due to pregnancy

16-5a During labor and delivery

16-5b Ectopic pregnancies

16-5c Postpartum complications

#### Prenatal Care

16-6 Prenatal care

16-6a First trimester

16-6b Early and adequate

16-7 Childbirth classes

#### Obstetrical Care

16-8 Very low birth weight infants born at level III hospitals

16-9 Cesarean births

16-9a First-time births

16-9b Prior cesarean deliveries

#### Risk Factors

16-10 Low birth weight and very low birth weight

16-10a Low birth weight

16-10b Very low birth weight

16-11 Preterm births

16-11a Total preterm

16-11b 32 to 36 weeks of gestation

16-11c Less than 32 weeks of gestation

16-12 Weight gain during pregnancy

16-13 Infants put to sleep on their backs

#### Developmental Disabilities and Neural Tube Defects

16-14 Developmental disabilities

16-14a Mental retardation

16-14b Cerebral palsy

16-14c Autism

16-14d Epilepsy

16-15 Spina bifida and other neural tube defects

16-16 Optimum folic acid levels

16-16a Folic acid consumption

16-16b Median RBC folate levels

#### Prenatal Substance Exposure

16-17 Prenatal substance exposure

16-17a Alcohol

16-17b Binge drinking

16-17c Cigarette smoking

16-17d Illicit drugs

16-18 Fetal alcohol syndrome

#### Breastfeeding, Newborn Screening, and Service Systems

16-19 Breastfeeding

16-19a Early postpartum

16-19b At 6 months

16-19c At 1 year

16-20 Newborn bloodspot screening

16-20a Screening at birth

16-20b Followup diagnostic testing

16-20c Appropriate service interventions

16-21 Sepsis among children with sickle cell disease

16-22 Medical homes for children with special health care needs

16-23 Service systems for children with special health care needs

###   {#section-1 .unnumbered}

### Fetal, Infant, Child, and Adolescent Deaths

16-1. Reduce fetal and infant deaths.

  ---------------------- ------------------------------------------------
  16-1a. Fetal deaths at 
  20 or more weeks of    
  gestation.             

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  14.2 (Maternal and Infant Health).
  Objective**            

  **Measure**            Rate per 1,000 live births plus fetal deaths.

  **Baseline**           6.8 (1997).

  **Numerator**          Number of fetal deaths (20 or more weeks of
                         gestation).

  **Denominator**        Number of live births plus fetal deaths (20 or
                         more weeks gestation).

  **Targeted             U.S. resident live births plus fetal deaths (20
  Population**           or more weeks gestation).

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A description of the primary measurement used to
                         determine the infant's gestational age---the
                         interval between the first day of the last
                         normal menstrual period (LMP) and the
                         birth---has been published by NCHS.**^1^**

                         This objective uses the same measurement
                         protocol as the comparable Healthy People 2000
                         objective 14.2. A description of the fetal death
                         measurement has been published by NCHS.**^2^**
  ---------------------- ------------------------------------------------

  ---------------------- ------------------------------------------------
                         States are required to report fetal deaths if
                         they occur in the 20th week of pregnancy or
                         later, or if they weigh at least 350
                         grams.**^3^** The number of fetal deaths may be
                         underreported in part because of variations in
                         reporting requirements by States.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-1b. Fetal and       
  infant deaths during   
  perinatal period (28   
  weeks of gestation to  
  7 days or more after   
  birth).                

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 1,000 live births plus fetal deaths.

  **Baseline**           7.5 (1997).

  **Numerator**          Number of fetal and infant deaths (from 28 weeks
                         gestation to 7 days after birth).

  **Denominator**        Number of live births plus fetal deaths (of at
                         least 28 weeks gestation).

  **Targeted             U.S. resident live births plus fetal deaths (20
  Population**           or more weeks gestation).

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           The number of fetal deaths may be underreported
                         in part because of variations in reporting
                         requirements by States.

                         A description of the primary measurement used to
                         determine the infant's gestational age---the
                         interval between the first day of the last
                         normal menstrual period (LMP) and the
                         birth---has been published by NCHS.**^1^**

                         A description of the perinatal death measurement
                         has been published by NCHS.**^3^**

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-1c. All infant      
  deaths (within 1       
  year).                 

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  14.1 (Maternal and Infant Health).
  Objective**            

  **Measure**            Rate per 1,000 live births.

  **Baseline**           7.2 (1998).

  **Numerator**          Number of deaths to infants under age 1 year.

  **Denominator**        Number of live births.

  **Targeted             U.S. resident live births.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           This objective uses a similar measurement
                         protocol as the comparable Healthy People 2000
                         objective; however, all of the baseline data for
                         this objective come from the period-linked birth
                         and infant death data set (linked file).**^4^**
                         In the linked file, the information from the
                         death certificate is linked to information on
                         the birth certificate for each infant under 1
                         year who died during the calendar year. The
                         purpose of linkage is to use the many variables
                         and improve racial/ethnic reporting available
                         from the birth certificate. The comparable
                         Healthy People 2000 objective was tracked using
                         the annual "unlinked" file**^5^** for the total
                         and black population, and the cohort (used from
                         1983--91) or period-(used since 1995) linked
                         file for the American Indian/Alaska Native and
                         Puerto Rican populations.**^2^**

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-1d. Neonatal deaths 
  (within the first 28   
  days of life).         

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  14.1d (Maternal and Infant Health).
  Objective**            

  **Measure**            Rate per 1,000 live births.

  **Baseline**           4.8 (1998).

  **Numerator**          Number of deaths infants aged under 28 days.

  **Denominator**        Number of live births.

  **Targeted             U.S. resident live births.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided with objective 16-1c for
                         more information.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-1e. Postneonatal    
  deaths (between 28     
  days and 1 year).      

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  14.1g (Maternal and Infant Health).
  Objective**            

  **Measure**            Rate per 1,000 live births.

  **Baseline**           2.4 (1998).

  **Numerator**          Number of deaths to infants aged 28 days to 11
                         months.

  **Denominator**        Number of live births.

  **Targeted             U.S. resident live births.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided with objective 16-1c for
                         more information.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  -----------------------------------------------------------------------
  16-1f. All birth       
  defects.               
  ---------------------- ------------------------------------------------
  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 1,000 live births.

  **Baseline**           1.6 (1998).

  **Numerator**          Number of infant (under age 1 year) deaths due
                         to birth defects (ICD-9 codes 740-759).

  **Denominator**        Number of live births.

  **Targeted             U.S. resident live births.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           All of the baseline data for this objective come
                         from the period-linked birth and infant death
                         data set (linked file).**^4^** In the linked
                         file, the information from the death certificate
                         is linked to information on the birth
                         certificate for each infant under 1 year who
                         died during the calendar year. The purpose of
                         linkage is to the use the many variables and
                         improve racial/ethnic reporting available from
                         the birth certificate.

                         See Part C for a description of the NVSS and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  16-1g. Congenital      
  heart defects.         
  ---------------------- ------------------------------------------------
  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 1,000 live births.

  **Baseline**           0.53 (1998).

  **Numerator**          Number of infant (under age 1 year) deaths from
                         congenital heart and vascular defects (ICD-9
                         codes 745-747).

  **Denominator**        Number of live births.

  **Targeted             U.S. resident live births.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided with objective 16-1f for
                         more information.

                         ICD-9 codes 745-746 refer to congenital
                         anomalies of the heart, and code 747 refers to
                         other congenital anomalies of the circulatory
                         system.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

  -----------------------------------------------------------------------
  16-1h. Reduce deaths   
  from sudden infant     
  death syndrome (SIDS). 
  ---------------------- ------------------------------------------------
  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 1,000 live births.

  **Baseline**           0.72 (1998).

  **Numerator**          Number of infant (under age 1 year) deaths from
                         SIDS (ICD-9 code 798.0).

  **Denominator**        Number of live births.

  **Targeted             U.S. resident live births.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Comments provided with objective 16-1f for
                         more information.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

16-2. Reduce the rate of child death.

  ---------------------- ------------------------------------------------
  16-2a. Children aged 1 
  to 4 years.            

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 100,000 population.

  **Baseline**           34.6 (1998).

  **Numerator**          Number of deaths among children aged 1 to 4
                         years.

  **Denominator**        Number of children aged 1 to 4 years.

  **Targeted             U.S. resident population.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-2b. Children aged 5 
  to 9 years.            

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 100,000 population.

  **Baseline**           17.7 (1998).

  **Numerator**          Number of deaths among children aged 5 to 9
                         years.

  **Denominator**        Number of children aged 5 to 9 years.

  **Targeted             U.S. resident population.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

16-3. Reduce deaths of adolescents and young adults.

  ---------------------- ------------------------------------------------
  16-3a. Adolescents     
  aged 10 to 14 years.   

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 100,000 population.

  **Baseline**           22.1 (1998).

  **Numerator**          Number of deaths among adolescents aged 10 to 14
                         years.

  **Denominator**        Number of adolescents aged 10 to 14 years.

  **Targeted             U.S. resident population.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-3b. Adolescents     
  aged 15 to 19 years.   

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 100,000 population.

  **Baseline**           70.6 (1998).

  **Numerator**          Number of deaths among adolescents aged 15 to 19
                         years.

  **Denominator**        Number of adolescents aged 15 to 19 years.

  **Targeted             U.S. resident population.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-3c. Young adults    
  aged 20 to 24 years.   

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Rate per 100,000 population.

  **Baseline**           95.3 (1998).

  **Numerator**          Number of deaths among young adults aged 20 to
                         24 years.

  **Denominator**        Number of young adults aged 20 to 24 years.

  **Targeted             U.S. resident population.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

### Maternal Deaths and Illnesses

  ---------------------- ------------------------------------------------
  16-4. Reduce maternal  
  deaths.                

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  14.3 (Maternal and Infant Health).
  Objective**            

  **Measure**            Ratio per 100,000 live births.

  **Baseline**           7.1 (1998).

  **Numerator**          Number of female deaths due to obstetric causes
                         (ICD-9 codes 630 to 676) within 42 days of a
                         pregnancy.

  **Denominator**        Number of live births.

  **Targeted             U.S. resident population.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           Caution should be used when comparing these data
                         with pregnancy-related mortality rates from
                         other reports. NCHS uses the definition of
                         maternal mortality and related coding
                         conventions recommended in the ICD-9 by the
                         World Health Organization. Other definitions may
                         use different time intervals from pregnancy to
                         death and may be more inclusive with regard to
                         cause of death.

                         A description of the maternal mortality
                         measurement has been published by NCHS.**^2^**

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

16-5. Reduce maternal illness and complications due to pregnancy.

  ---------------------- ------------------------------------------------
  16-5a. Maternal        
  complications during   
  hospitalized labor and 
  delivery.              

  **National Data        National Hospital Discharge Survey (NHDS), CDC,
  Source**               NCHS.

  **State Data Source**  State hospital discharge data systems.

  **Healthy People 2000  Adapted from 14.7 (Maternal and Infant Health).
  Objective**            

  **Measure**            Rate per 100 deliveries.

  **Baseline**           31.2 (1998).

  **Numerator**          Number of hospital discharges for females with
                         any listed diagnosis of maternal complications
                         during labor/delivery (see Comments).

  **Denominator**        Number of hospital discharges for females who
                         delivered one or more infants (principal
                         diagnosis of ICD-9-CM code V27).

  **Targeted             U.S. civilian population.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           This objective was adapted from Healthy People
                         2000 objective 14.7, which measured "severe
                         complications of pregnancy," defined as
                         hospitalizations for ICD-9-CM codes 630-676
                         (excluding 635 and 650).**^2^** The data used to
                         track this Healthy People 2010 objective use any
                         listed diagnosis of selected ICD-9-CM codes
                         641-672 (see Appendix E for a detailed list of
                         codes used).

                         Principal diagnosis is the diagnosis chiefly
                         responsible for admission of the person to the
                         hospital.

                         See Part C for a description of NHDS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-5b. (Developmental) 
  Ectopic pregnancies.   

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed data source is the National Hospital
                         Discharge Survey (NHDS), CDC, NCHS.

                         See Part C for a description of NHDS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-5c. (Developmental) 
  Postpartum             
  complications,         
  including postpartum   
  depression.            

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

### Prenatal Care

16-6. Increase the proportion of pregnant women who receive early and
adequate prenatal care.

  ---------------------- ------------------------------------------------
  16-6a. Care beginning  
  in first trimester of  
  pregnancy.             

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Leading Health       Access to Care.
  Indicator**            

  **Healthy People 2000  14.11 (Maternal and Infant Health).
  Objective**            

  **Measure**            Percent of live births.

  **Baseline**           83 (1998).

  **Numerator**          Number of females receiving prenatal care in the
                         first trimester (three months) of pregnancy.

  **Denominator**        Number of live births.

  **Targeted             U.S. resident population.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A description of the primary measurement used to
                         determine the fetus's gestational age---the
                         interval between the first day of the last
                         normal menstrual period (LMP) and the
                         birth---has been published by NCHS.**^1^**

                         This objective uses the same measurement
                         protocol as the comparable Healthy People 2000
                         objective 14.11. A description of the prenatal
                         care measurement has been published by
                         NCHS.**^2^**

                         This objective is one of the measures used to
                         track the Access to Care Leading Health
                         Indicator. See Appendix H for a complete
                         listing.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-6b. Early and       
  adequate prenatal      
  care.                  

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent of live births.

  **Baseline**           74 (1998).

  **Numerator**          Number of pregnant females receiving adequate
                         prenatal care (by the Adequacy of Prenatal Care
                         Utilization Index, APNCU).

  **Denominator**        Number of live births.

  **Targeted             U.S. resident population.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           The APNCU is a measure of prenatal care
                         utilization that combines the month of pregnancy
                         prenatal care begun with the number of prenatal
                         visits. Rates can be classified as "intensive
                         use," "adequate," "intermediate," or "less than
                         adequate." For this objective, adequate prenatal
                         care is defined as a score of either "adequate"
                         or "intensive use." A discussion of the APNCU
                         has been published in a previous article.**^6^**

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-7. (Developmental)  
  Increase the           
  proportion of pregnant 
  women who attend a     
  series of prepared     
  childbirth classes.    

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         Proposed data sources include the National
                         Pregnancy and Health Survey, NIH, NICHD; the
                         National Survey of Family Growth (NSFG), CDC,
                         NCHS; and the National Health Interview Survey
                         (NHIS), CDC, NCHS.

                         See Part C for a description of NSFG and NHIS
                         and Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

### Obstetrical Care

  ---------------------- ------------------------------------------------
  16-8. Increase the     
  proportion of very low 
  birth weight (VLBW)    
  infants born at level  
  III hospitals or       
  subspecialty perinatal 
  centers.               

  **National Data        Title V Reporting System, HRSA, MCHB.
  Source**               

  **State Data Source**  Title V Reporting System, HRSA, MCHB.

  **Healthy People 2000  Adapted from 14.14 (Maternal and Infant Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           73 (1996--97).

  **Numerator**          Number of live births at VLBW in subspecialty
                         facilities (level III facilities).

  **Denominator**        Number of infants born live at VLBW.

  **Targeted             U.S. resident live births.
  Population**           

  **Questions Used To    From the Title V Reporting System (Performance
  Obtain the National    Measure 17).
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           VLBW is defined as a birth weight of less than
                         1,500 grams (3 lbs 4 ozs).

                         Data are reported by States each year as part of
                         the Maternal and Child Health Block Grant
                         application. A national weighted average is
                         calculated by summing the numerator and
                         denominator information reported by each
                         jurisdiction.

                         This objective differs from Healthy People 2000
                         objective 14.14, which proposed to track the
                         proportion of VLBW infants born in facilities
                         covered by a neonatologist 24 hours a day. No
                         data are available for Healthy People 2000
                         objective 14.14.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

16-9. Reduce cesarean births among low-risk (full-term, singleton,
vertex presentation) women.

  ---------------------- ------------------------------------------------
  16-9a. Women giving    
  birth for the first    
  time.                  

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Adapted from 14.8a (Maternal and Infant Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           18 (1998).

  **Numerator**          Number of births delivered by cesarean section
                         to low-risk females giving birth for the first
                         time.

  **Denominator**        Number of live births to low-risk females giving
                         birth for the first time.

  **Targeted             U.S. resident population.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           For this objective a low-risk female is defined
                         as one with a full-term (at least 37 weeks since
                         LMP), singleton (not a multiple pregnancy),
                         vertex fetus (head facing in a downward position
                         in the birth canal).

                         A description of the primary measurement used to
                         determine the fetus's gestational age, the
                         interval between the first day of LMP and the
                         birth has been published by NCHS.**^1^**

                         This objective uses a similar calculation
                         protocol as the comparable Healthy People 2000
                         objective (14.8). The primary differences lie in
                         the data sources used to measure the objective
                         (the Healthy People 2010 objective used data
                         from birth certificates and the Healthy People
                         2000 objective uses data obtained from hospital
                         records) and the Healthy People 2010 objective
                         focuses on low-risk women, while the Healthy
                         People 2000 objective targeted all women who
                         have not previously delivered an infant by
                         cesarean. A description of how to calculate the
                         Healthy People 2000 cesarean measurement has
                         been published by NCHS.**^2^**

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-9b. Prior cesarean  
  birth.                 

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Adapted from 14.8b (Maternal and Infant Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           72 (1998).

  **Numerator**          Number of cesarean deliveries to low-risk
                         females who previously delivered an infant by
                         cesarean.

  **Denominator**        Number of live births to low-risk females who
                         previously delivered an infant by cesarean.

  **Targeted             U.S. resident population.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           For this objective a low-risk female is defined
                         as one with a full-term (at least 37 weeks since
                         LMP), singleton (not a multiple pregnancy),
                         vertex fetus (head facing in a downward position
                         in the birth canal).

                         A description of the primary measurement used to
                         determine the fetus's gestational age, the
                         interval between the first day of LMP and the
                         birth has been published by NCHS.**^1^**

                         This objective uses a similar calculation
                         protocol as the comparable Healthy People 2000
                         objective (14.8). The primary differences lie in
                         the data sources used to measure the objective
                         (the Healthy People 2010 objective uses data
                         from birth certificates and the Healthy People
                         2000 objective used data obtained from hospital
                         records) and the Healthy People 2010 objective
                         focuses on low-risk women while the Healthy
                         People 2000 objective targets all women who
                         previously delivered an infant by cesarean. A
                         description of how the Healthy People 2000
                         cesarean measurement was calculated has been
                         published by NCHS.**^2^**

                         This measure is the complement of the vaginal
                         birth after cesarean (VBAC) rate for low-risk
                         women.

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

### Risk Factors

16-10. Reduce low birth weight (LBW) and very low birth weight (VLBW).

  ---------------------- ------------------------------------------------
  16-10a. Low birth      
  weight (LBW).          

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  14.5 (Maternal and Infant Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           7.6 (1998).

  **Numerator**          Number of live births with birth weight of less
                         than 2,500 grams (5 lbs 8 oz).

  **Denominator**        Number of live births.

  **Targeted             U.S. resident live births.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  -----------------------------------------------------------------------
  16-10b. Very low birth 
  weight (VLBW).         
  ---------------------- ------------------------------------------------
  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  14.5 (Maternal and Infant Health).
  Objective**            

  **Measure**            Percent.

  **Baseline**           1.4 (1998).

  **Numerator**          Number of live births with birth weight of less
                         than 1,500 grams (3 lbs 4 oz).

  **Denominator**        Number of live births.

  **Targeted             U.S. resident live births.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  -----------------------------------------------------------------------

  

16-11. Reduce preterm births.

  ---------------------- ------------------------------------------------
  16-11a. Total preterm  
  births.                

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent.

  **Baseline**           11.6 (1998).

  **Numerator**          Number of infants born prior to 37 completed
                         weeks of gestation.

  **Denominator**        Number of live births.

  **Targeted             U.S. resident live births.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A description of the primary measurement used to
                         determine the infant's gestational age, the
                         interval between the first day of LMP and the
                         birth has been published by NCHS.**^1^**

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-11b. Live births at 
  32 to 36 weeks of      
  gestation.             

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent.

  **Baseline**           9.6 (1998).

  **Numerator**          Number of infants born between 32 and 36
                         completed weeks of gestation.

  **Denominator**        Number of live births.

  **Targeted             U.S. resident live births.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A description of the primary measurement used to
                         determine the infant's gestational age---the
                         interval between the first day of LMP and the
                         birth has been published by NCHS.**^1^**

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

-    

  ---------------------- ------------------------------------------------
  16-11c. Live births at 
  less than 32 weeks of  
  gestation.             

  **National Data        National Vital Statistics System (NVSS), CDC,
  Source**               NCHS.

  **State Data Source**  National Vital Statistics System (NVSS), CDC,
                         NCHS.

  **Healthy People 2000  Not applicable.
  Objective**            

  **Measure**            Percent.

  **Baseline**           2.0 (1998).

  **Numerator**          Number of infants born at less than 32 completed
                         weeks of gestation.

  **Denominator**        Number of live births.

  **Targeted             U.S. resident live births.
  Population**           

  **Questions Used To    Not applicable.
  Obtain the National    
  Data**                 

  **Expected             Annual.
  Periodicity**          

  **Comments**           A description of the primary measurement used to
                         determine the infant's gestational age---the
                         interval between the first day of LMP and the
                         birth has been published by NCHS.**^1^**

                         See Part C for a description of NVSS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

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+---+-----------------+---+------------------------------------------+---+
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+---+-----------------+---+------------------------------------------+---+
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+---+-----------------+---+------------------------------------------+---+
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|   |                 | ? |                                          |   |
+---+-----------------+---+------------------------------------------+---+
|   |                 |   | \[If Yes:\]                              |   |
|   |                 |   |                                          |   |
|   |                 |   | Would that be:\                          |   |
|   |                 |   | on his/her side,\                        |   |
|   |                 |   | on his/her stomach with his/her head     |   |
|   |                 |   | face down,\                              |   |
|   |                 |   | on his/her stomach with his/her head     |   |
|   |                 |   | turned to the side,\                     |   |
|   |                 |   | on his/her back,\                        |   |
|   |                 |   | or in some other position?               |   |
+---+-----------------+---+------------------------------------------+---+
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+---+-----------------+---+------------------------------------------+---+
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+---+-----------------+---+------------------------------------------+---+
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|   |                 | . |                                          |   |
+---+-----------------+---+------------------------------------------+---+

  

### Developmental Disabilities and Neural Tube Defects

16-14. Reduce the occurrence of developmental disabilities.

+---------------------+------------------------------------------------+
| 16-14a. Mental      |                                                |
| retardation.        |                                                |
+=====================+================================================+
| **National Data     | Metropolitan Atlanta Developmental             |
| Source**            | Disabilities Surveillance Program (MADDSP),    |
|                     | CDC, NCEH.                                     |
+---------------------+------------------------------------------------+
| **State Data        | State surveillance systems.                    |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 10,000.                               |
+---------------------+------------------------------------------------+
| **Baseline**        | 131 (1991--94) (metropolitan Atlanta, GA).     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of children aged 8 years with an IQ of  |
|                     | 70 or less whose parent(s) or legal            |
|                     | guardian(s) reside in metropolitan Atlanta,    |
|                     | Georgia.                                       |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of children aged 8 years residing in    |
|                     | metropolitan Atlanta, Georgia.                 |
+---------------------+------------------------------------------------+
| **Targeted          | Resident population (selected areas---see      |
| Population**        | Comments).                                     |
+---------------------+------------------------------------------------+
| **Questions Used To | Not applicable.                                |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | IQ is an acronym for intelligence quotient.    |
+---------------------+------------------------------------------------+
|                     | If an IQ score was not available, a written    |
|                     | statement by a psychometrist that the child's  |
|                     | intellectual functioning falls within the      |
|                     | range for mental retardation was acceptable.   |
+---------------------+------------------------------------------------+
|                     | Metropolitan Atlanta, Georgia, consists of a   |
|                     | five-county area including Clayton, Cobb,      |
|                     | DeKalb, Fulton, and Gwinnett.                  |
+---------------------+------------------------------------------------+
|                     | A description of MADDSP has been published by  |
|                     | CDC.**^8^**                                    |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+
|                  |                                                |
|                     |                                                |
| 16-14b. Cerebral    |                                                |
| palsy.              |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Metropolitan Atlanta Developmental             |
| Source**            | Disabilities Surveillance Program (MADDSP),    |
|                     | CDC, NCEH.                                     |
+---------------------+------------------------------------------------+
| **State Data        | State surveillance systems.                    |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Rate per 10,000.                               |
+---------------------+------------------------------------------------+
| **Baseline**        | 32.2 (1991--94) (metropolitan Atlanta, GA).    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of children aged 8 years with cerebral  |
|                     | palsy whose parent(s) or legal guardian(s)     |
|                     | reside in metropolitan Atlanta, Georgia.       |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of children aged 8 years residing in    |
|                     | metropolitan Atlanta, Georgia.                 |
+---------------------+------------------------------------------------+
| **Targeted          | Resident population (selected areas---see      |
| Population**        | Comments).                                     |
+---------------------+------------------------------------------------+
| **Questions Used To | Not applicable.                                |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Metropolitan Atlanta, Georgia, consists of a   |
|                     | five-county area including Clayton, Cobb,      |
|                     | DeKalb, Fulton, and Gwinnett.                  |
+---------------------+------------------------------------------------+
|                     | A definition of cerebral palsy and a           |
|                     | description of MADDSP has been published by    |
|                     | CDC.**^8^**                                    |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+
|                  |                                                |
|                     |                                                |
| 16-14c.             |                                                |
| (Developmental)     |                                                |
| Autism spectrum     |                                                |
| disorder.           |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | An operational definition could not be         |
|                     | specified at the time of publication.          |
+---------------------+------------------------------------------------+
|                     | Data will be available from Metropolitan       |
|                     | Atlanta Developmental Disabilities             |
|                     | Surveillance Program (MADDSP), beginning with  |
|                     | 1997 data.                                     |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+
|                  |                                                |
|                     |                                                |
| 16-14d              |                                                |
| (Developmental)     |                                                |
| Epilepsy.           |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | An operational definition could not be         |
|                     | specified at the time of publication.          |
+---------------------+------------------------------------------------+
|                     | Data will be available from Metropolitan       |
|                     | Atlanta Developmental Disabilities             |
|                     | Surveillance Program (MADDSP), beginning with  |
|                     | 1997 data.                                     |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+
|                  |                                                |
|                     |                                                |
| 16-15. Reduce the   |                                                |
| occurrence of spina |                                                |
| bifida and other    |                                                |
| neural tube defects |                                                |
| (NTDs).             |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Birth Defects Prevention Network      |
| Source**            | (NBDPN), CDC, NCEH.                            |
+---------------------+------------------------------------------------+
| **State Data        | State birth defects monitoring systems; State  |
| Sources**           | vital statistics.                              |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 14.17 (Maternal and Infant        |
| 2000 Objective**    | Health).                                       |
+---------------------+------------------------------------------------+
| **Measure**         | Ratio per 10,000 live births.                  |
+---------------------+------------------------------------------------+
| **Baseline**        | 6 (1996) (selected States---see Comments).     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of live births and fetal deaths of 20   |
|                     | or more weeks gestation diagnosed with spina   |
|                     | bifida and other neural tube defects (ICD-9    |
|                     | codes 740-742.0).                              |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of live births.                         |
+---------------------+------------------------------------------------+
| **Targeted          | Resident live births plus fetal deaths (20 or  |
| Population**        | more weeks gestation) (selected States---see   |
|                     | Comments).                                     |
+---------------------+------------------------------------------------+
| **Questions Used To | Not applicable.                                |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | A description of the primary measurement used  |
|                     | to determine an infant's gestational age---the |
|                     | interval between the first day of LMP and the  |
|                     | birth has been published by NCHS.**^1^**       |
+---------------------+------------------------------------------------+
|                     | NCEH is collaborating with more than 30 States |
|                     | in NBDPN to systematically collect             |
|                     | population-based birth defect data in a timely |
|                     | fashion.                                       |
+---------------------+------------------------------------------------+
|                     | This objective is comparable to Healthy People |
|                     | 2000 objective 14.17, which was tracked by the |
|                     | Birth Defects Monitoring Program (BDMP)        |
|                     | through 1993. However, the BDMP system of      |
|                     | voluntary reporting by hospitals was           |
|                     | unreliable and no longer exists.               |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

16-16. Increase the proportion of pregnancies begun with an optimum
folic acid level.

+---------------------+------------------------------------------------+
| 16-16a. Consumption |                                                |
| of at least 400 μg  |                                                |
| of folic acid each  |                                                |
| day from fortified  |                                                |
| foods or dietary    |                                                |
| supplements by      |                                                |
| nonpregnant women   |                                                |
| aged 15 to 44       |                                                |
| years.              |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health and Nutrition Examination      |
| Source**            | Survey (NHANES), CDC, NCHS.                    |
+---------------------+------------------------------------------------+
| **State Data        | Behavioral Risk Factor Surveillance System     |
| Source**            | (BRFSS), CDC, NCCDPHP.                         |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 21 (1991--94).                                 |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of nonpregnant females aged 15 to 44    |
|                     | years who report consuming an average of 400   |
|                     | μg of folic acid daily over the past month.    |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of nonpregnant females aged 15 to 44    |
|                     | years.                                         |
+---------------------+------------------------------------------------+
| **Targeted          | U.S. civilian, noninstitutionalized            |
| Population**        | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1988--94 National Health and          |
| Obtain the National | Nutrition Examination Survey:                  |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | Folic acid intake is estimated from questions  |
|                     | regarding vitamin intake for specific vitamin  |
|                     | brand names and the frequency and duration of  |
|                     | use.                                           |
+---------------------+------------------------------------------------+
| **Expected          | Annual, beginning with 1999 data.              |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | For this measure only folic acid intake from   |
|                     | dietary supplements is included. Folic acid    |
|                     | intake from food was not included. In          |
|                     | 1991--94, very few women would have been       |
|                     | consuming 400 μg folic acid per day unless     |
|                     | they were taking a supplement containing folic |
|                     | acid.                                          |
+---------------------+------------------------------------------------+
|                     | The method of calculation of this objective    |
|                     | involves averaging the intake of folic acid in |
|                     | the past month. Because the number of days in  |
|                     | a month varies, the threshold consumption      |
|                     | level used in the calculation of the baseline  |
|                     | data for this objective is an average of 394   |
|                     | μg per day.                                    |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHANES and     |
|                     | BRFSS and Appendix A for focus area contact    |
|                     | information.                                   |
+---------------------+------------------------------------------------+
|                  |                                                |
|                     |                                                |
| 16-16b. Median red  |                                                |
| blood cell (RBC)    |                                                |
| folate level among  |                                                |
| nonpregnant women   |                                                |
| aged 15 to 44       |                                                |
| years.              |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Health and Nutrition Examination      |
| Source**            | Survey (NHANES), CDC, NCHS.                    |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Not applicable.                                |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Number (ng/ml).                                |
+---------------------+------------------------------------------------+
| **Baseline**        | 160 (1991--94).                                |
+---------------------+------------------------------------------------+
| **Numerator**       | Median RBC folate level.                       |
+---------------------+------------------------------------------------+
| **Denominator**     | Not applicable.                                |
+---------------------+------------------------------------------------+
| **Targeted          | U.S. civilian, noninstitutionalized            |
| Population**        | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | Not applicable.                                |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
| **Expected          | Annual beginning with 1999 data.               |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | The median RBC folate is a population-weighted |
|                     | estimate from a blood specimen collected from  |
|                     | women aged 15 to 44 years as part of the       |
|                     | standard NHANES protocol.                      |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHANES and     |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

### Prenatal Substance Exposure

16-17 Increase abstinence from alcohol, cigarettes, and illicit drugs
among pregnant women.

6-17a. Alcohol.

+---+--------------------+---+----------------------------------------------+---+
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+---+--------------------+---+----------------------------------------------+---+
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+---+--------------------+---+----------------------------------------------+---+
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|   |                    | : |                                              |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | -   Think about the last time you drank any  |   |
|   |                    |   |     type of alcoholic beverage. How long has |   |
|   |                    |   |     it been since you last drank an          |   |
|   |                    |   |     alcoholic beverage?                      |   |
|   |                    |   |                                              |   |
|   |                    |   |     If you last drank an alcoholic beverage  |   |
|   |                    |   |     within the past 30 days, mark the first  |   |
|   |                    |   |     box.\                                    |   |
|   |                    |   |     If it has been more than 30 days ago but |   |
|   |                    |   |     within the past 12 months that you last  |   |
|   |                    |   |     drank an alcoholic beverage, mark the    |   |
|   |                    |   |     second box.\                             |   |
|   |                    |   |     If it was more than 12 months ago but    |   |
|   |                    |   |     within the past 3 years, mark the third  |   |
|   |                    |   |     box.\                                    |   |
|   |                    |   |     If it has been more than 3 years since   |   |
|   |                    |   |     you last drank and alcoholic beverage,   |   |
|   |                    |   |     mark the fourth box.\                    |   |
|   |                    |   |     If you have never drunk an alcoholic     |   |
|   |                    |   |     beverage in your life, mark the last     |   |
|   |                    |   |     box.                                     |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | -   Are you currently pregnant?              |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | \[If yes:\]                                  |   |
|   |                    |   |                                              |   |
|   |                    |   | -   How many months pregnant are you?\       |   |
|   |                    |   |     Number of months pregnant \_\_\_\_\_     |   |
+---+--------------------+---+----------------------------------------------+---+
|   | **Expected         |   | Annual.                                      |   |
|   | Periodicity**      |   |                                              |   |
+---+--------------------+---+----------------------------------------------+---+
|   | **Comments**       |   | To ensure adequate precision of estimates    |   |
|   |                    |   | for pregnant women, baseline data are based  |   |
|   |                    |   | on combined data from 1996 and 1997 NHSDAs   |   |
|   |                    |   | and represent annual average estimates for   |   |
|   |                    |   | 1996 and 1997.                               |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | This objective is a measure similar to       |   |
|   |                    |   | Healthy People 2000 objective 14.10, which   |   |
|   |                    |   | used data from the National Maternal and     |   |
|   |                    |   | Infant Health Survey and the National        |   |
|   |                    |   | Pregnancy and Health Survey.                 |   |
+---+--------------------+---+----------------------------------------------+---+
|   |                    |   | See Part C for a description of NHSDA and    |   |
|   |                    |   | Appendix A for focus area contact            |   |
|   |                    |   | information.                                 |   |
+---+--------------------+---+----------------------------------------------+---+

  

+---------------------+------------------------------------------------+
| 16-17b. Binge       |                                                |
| drinking.           |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Household Survey on Drug Abuse        |
| Source**            | (NHSDA), SAMHSA.                               |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 14.10 (Maternal and Infant        |
| 2000 Objective**    | Health).                                       |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 99 (1996--97).                                 |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of nonpregnant females aged 15 to 44    |
|                     | years reporting not binge drinking at all in   |
|                     | the past month (30 days).                      |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of nonpregnant females aged 15 to 44    |
|                     | years.                                         |
+---------------------+------------------------------------------------+
| **Targeted          | U.S. civilian, noninstitutionalized            |
| Population**        | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1996--97 National Household Survey on |
| Obtain the National | Drug Abuse:                                    |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   During the past 30 days, on how many days  |
|                     |     did you have 5 or more drinks on the same  |
|                     |     occasion? By "occasion," we mean at the    |
|                     |     same time or within a couple of hours of   |
|                     |     each other.\                               |
|                     |     On the solid line, write the number of     |
|                     |     days in the past 30 days when you drank 5  |
|                     |     or more drinks of an alcoholic beverage on |
|                     |     the same occasion.                         |
|                     |                                                |
|                     |     If you never had 5 or more drinks on the   |
|                     |     same occasion on any day when you drank    |
|                     |     during the past 30 days, mark the first    |
|                     |     box.                                       |
|                     |                                                |
|                     |     If you have never drunk an alcoholic       |
|                     |     beverage in your life, mark the last box.  |
+---------------------+------------------------------------------------+
|                     | -   Are you currently pregnant?                |
+---------------------+------------------------------------------------+
|                     | \[If yes:\]                                    |
|                     |                                                |
|                     | -   How many months pregnant are you?\         |
|                     |     Number of months pregnant \_\_\_\_\_       |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Binge drinking is defined as drinking five or  |
|                     | more alcoholic drinks on the same occasion on  |
|                     | at least one day in the past 30 days. By       |
|                     | "occasion" is meant at the same time or within |
|                     | a couple of hours of each other.               |
+---------------------+------------------------------------------------+
|                     | To ensure adequate precision of estimates for  |
|                     | pregnant women, baseline data are based on     |
|                     | combined data from 1996 and 1997 NHSDAs and    |
|                     | represent annual average estimates for 1996    |
|                     | and 1997.                                      |
+---------------------+------------------------------------------------+
|                     | This objective is adapted from Healthy People  |
|                     | 2000 objective 14.10, which measured use of    |
|                     | alcohol during pregnancy data from the         |
|                     | National Maternal and Infant Health Survey and |
|                     | the National Pregnancy and Health Survey.      |
|                     | Binge drinking during pregnancy was not        |
|                     | addressed in Healthy People 2000.              |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHSDA and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

+---------------------+------------------------------------------------+
| 16-17c. Cigarette   |                                                |
| smoking.            |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Vital Statistics System (NVSS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **State Data        | National Vital Statistics System (NVSS), CDC,  |
| Source**            | NCHS.                                          |
+---------------------+------------------------------------------------+
| **Healthy People    | 14.10 (Maternal and Infant Health).            |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 87 (1998) (selected areas---see Comments).     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of women having live births reporting   |
|                     | abstaining from cigarette smoking during       |
|                     | pregnancy.                                     |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of live births.                         |
+---------------------+------------------------------------------------+
| **Targeted          | Resident population (selected areas---see      |
| Population**        | Comments).                                     |
+---------------------+------------------------------------------------+
| **Questions Used To | From the U.S. Standard Certificate of Live     |
| Obtain the National | Birth (1989 revision):                         |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Other risk factors for this pregnancy -    |
|                     |     Complete all items.\                       |
|                     |     \[A number of check boxes are provided     |
|                     |     including\...\] Tobacco use during         |
|                     |     pregnancy\...\...\..... yes  no \        |
|                     |     Average number of cigarettes per day       |
|                     |     \_\_\_\_\_\_                               |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Baseline data for smoking during pregnancy are |
|                     | for 46 States, the District of Columbia, and   |
|                     | New York City. Data on smoking during          |
|                     | pregnancy were not available for California,   |
|                     | Indiana, New York State (New York City did     |
|                     | report), and South Dakota.                     |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NVSS and       |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+

  

+---------------------+------------------------------------------------+
| 16-17d. Illicit     |                                                |
| drugs.              |                                                |
+---------------------+------------------------------------------------+
| **National Data     | National Household Survey on Drug Abuse        |
| Source**            | (NHSDA), SAMHSA.                               |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 14.10 (Maternal and Infant        |
| 2000 Objective**    | Health).                                       |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 98 (1996--97).                                 |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of nonpregnant females aged 15 to 44    |
|                     | years reporting not using any illicit drugs in |
|                     | the past month (30 days).                      |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of nonpregnant females aged 15 to 44    |
|                     | years who were pregnant.                       |
+---------------------+------------------------------------------------+
| **Targeted          | U.S. civilian, noninstitutionalized            |
| Population**        | population.                                    |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1996--97 National Household Survey on |
| Obtain the National | Drug Abuse:                                    |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | \[The following question is asked separately   |
|                     | for each illicit drug: marijuana or hashish,   |
|                     | cocaine, "crack," heroin, hallucinogens, and   |
|                     | inhalants:\]                                   |
|                     |                                                |
|                     | -   How long has it been since you last used   |
|                     |     \[marijuana or hashish, cocaine, "crack,"  |
|                     |     heroin, hallucinogens, inhalants\]?\       |
|                     |     If your answer is within the past 30 days, |
|                     |     mark the first box.\                       |
|                     |     If your answer is more than 30 days ago    |
|                     |     but within the past 12 months, mark the    |
|                     |     second box.\                               |
|                     |     If your answer is more than 12 months ago  |
|                     |     but within the past 3 years, mark the      |
|                     |     third box.\                                |
|                     |     If your answer is more than 3 years ago,   |
|                     |     mark the next-to-last box.\                |
|                     |     If you have never used (marijuana or       |
|                     |     hashish, cocaine, "crack," heroin,         |
|                     |     hallucinogens, inhalants) in your life,    |
|                     |     mark the last box.                         |
+---------------------+------------------------------------------------+
|                     | \[The following questions are asked separately |
|                     | for nonmedical use of analgesics (prescription |
|                     | pain killers), tranquilizers, stimulants, and  |
|                     | sedatives:\]                                   |
|                     |                                                |
|                     | -   As you read the following list of          |
|                     |     (prescription pain killers, tranquilizers, |
|                     |     stimulants, sedatives), please mark one    |
|                     |     box beside [each]{.underline} (pain        |
|                     |     killer, tranquilizers, stimulants,         |
|                     |     sedatives) to indicate whether you have    |
|                     |     [ever]{.underline} used that (pain killer, |
|                     |     tranquilizers, stimulants, sedatives) when |
|                     |     it was [not]{.underline} prescribed for    |
|                     |     you, or that you took only for the         |
|                     |     experience or feeling it caused. Again, we |
|                     |     are interested in [all]{.underline} kinds  |
|                     |     of (prescription pain killers,             |
|                     |     tranquilizers, stimulants, sedatives), in  |
|                     |     pill or nonpill form.                      |
|                     |                                                |
|                     |     \[This question is followed by a list of   |
|                     |     common drugs in the category specified and |
|                     |     the following additional questions:\]      |
+---------------------+------------------------------------------------+
|                     | -   Have you ever used a (pain killer,         |
|                     |     tranquilizers, stimulants, sedatives)      |
|                     |     whose name you don't know that was         |
|                     |     [not]{.underline} prescribed for you, or   |
|                     |     that you took only for the experience or   |
|                     |     feeling it caused? If "YES," mark the      |
|                     |     first box; if "NO," mark the second box.   |
+---------------------+------------------------------------------------+
|                     | -   Have you ever used any [other]{.underline} |
|                     |     (pain killer, tranquilizers, stimulants,   |
|                     |     sedatives) besides the ones listed above,  |
|                     |     that was [not]{.underline} prescribed for  |
|                     |     you, or that you took only for the         |
|                     |     experience or feeling it caused? PLEASE    |
|                     |     PRINT NAME(S) OF OTHER \[PAIN KILLERS,     |
|                     |     TRANQUILIZERS, STIMULANTS, SEDATIVES\]     |
|                     |     BELOW. If "YES," mark the first box; if    |
|                     |     "NO," mark the second box.                 |
|                     |                                                |
|                     |     \[If the respondent reported use of any    |
|                     |     (pain killer, tranquilizers, stimulants,   |
|                     |     sedatives) they are asked:\]               |
+---------------------+------------------------------------------------+
|                     | -   How long has it been since you last used   |
|                     |     (a pain killer, tranquilizers, stimulants, |
|                     |     sedatives) that was not prescribed for     |
|                     |     you, or that you took only for the         |
|                     |     experience or feeling it caused?\          |
|                     |     If your answer is within the past 30 days, |
|                     |     mark the first box.\                       |
|                     |     If your answer is more than 30 days ago    |
|                     |     but within the past 12 months, mark the    |
|                     |     second box.\                               |
|                     |     If your answer is more than 12 months ago  |
|                     |     but within the past 3 years, mark the      |
|                     |     third box.\                                |
|                     |     If your answer is more than 3 years ago,   |
|                     |     mark the next-to-last box.                 |
+---------------------+------------------------------------------------+
|                     | -   Are you currently pregnant?                |
+---------------------+------------------------------------------------+
|                     | \[If "yes":\]                                  |
|                     |                                                |
|                     | -   How many months pregnant are you?\         |
|                     |     Number of months pregnant \_\_\_\_\_       |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Illicit drugs are defined as marijuana or      |
|                     | hashish, cocaine (including crack), inhalants, |
|                     | hallucinogens (including PCP and LSD), heroin, |
|                     | and nonmedical use of psychotherapeutics.      |
+---------------------+------------------------------------------------+
|                     | To ensure adequate precision of estimates for  |
|                     | pregnant women, baseline data are based on     |
|                     | combined data from 1996 and 1997 NHSDAs and    |
|                     | represent annual average estimates for 1996    |
|                     | and 1997.                                      |
+---------------------+------------------------------------------------+
|                     | This objective is adapted from Healthy People  |
|                     | 2000 objective 14.10, which tracked abstinence |
|                     | from marijuana and cocaine use during          |
|                     | pregnancy with data from the National Maternal |
|                     | and Infant Health Survey and the National      |
|                     | Pregnancy and Health Survey. The Healthy       |
|                     | People 2010 objective measures abstinence from |
|                     | any illicit drug.                              |
+---------------------+------------------------------------------------+
|                     | See Part C for a description of NHSDS and      |
|                     | Appendix A for focus area contact information. |
+---------------------+------------------------------------------------+
|                  |                                                |
|                     |                                                |
| 16-18.              |                                                |
| (Developmental)     |                                                |
| Reduce the          |                                                |
| occurrence of fetal |                                                |
| alcohol syndrome    |                                                |
| (FAS).              |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | An operational definition could not be         |
|                     | specified at the time of publication.          |
+---------------------+------------------------------------------------+
|                     | A proposed data source is the Fetal Alcohol    |
|                     | Syndrome Network (FASNet), CDC.                |
+---------------------+------------------------------------------------+
|                     | This objective is comparable to Healthy People |
|                     | 2000 objective 14.4, which was tracked by the  |
|                     | Birth Defects Monitoring Program (BDMP)        |
|                     | through 1993. However, the BDMP system of      |
|                     | voluntary reporting by hospitals was           |
|                     | unreliable and no longer exists.               |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

### Breastfeeding, Newborn Screening, and Service Systems

16-19. Increase the proportion of mothers who breastfeed their babies.

+---------------------+------------------------------------------------+
| 16-19a. In early    |                                                |
| postpartum period.  |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Mothers' Survey, Ross Products Division,       |
| Source**            | Abbott Laboratories, Inc.                      |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | 14.9 (Maternal and Infant Health) (also 2.11). |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 64 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of mothers who indicate that breast     |
|                     | milk is at least one of the types of milk      |
|                     | their infant was fed in the hospital.          |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of mothers of infants aged 1 to 12      |
|                     | months.                                        |
+---------------------+------------------------------------------------+
| **Targeted          | U.S. resident population.                      |
| Population**        |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 Mothers' Survey:                 |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Please check the milks your youngest baby  |
|                     |     was fed in the hospital:\                  |
|                     |     Breast milk\                               |
|                     |     (List of formulas)\                        |
|                     |     Cow's milk                                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Early postpartum breastfeeding is defined as   |
|                     | breastfeeding a newborn infant before being    |
|                     | discharged from the hospital.                  |
+---------------------+------------------------------------------------+
|                     | Surveys are sent out monthly to a sample of    |
|                     | mothers with infants of every month of age     |
|                     | between 1 month and 12 months. All are asked   |
|                     | about the milk their infants were fed in the   |
|                     | hospital, so the entire sample forms the       |
|                     | denominator for this objective.                |
+---------------------+------------------------------------------------+
|                     | Respondents can check more than one type of    |
|                     | milk. If breast milk is checked, the mother is |
|                     | considered to be breastfeeding, regardless of  |
|                     | whether other milk or formulas are used.       |
+---------------------+------------------------------------------------+
|                     | A description of the Mothers' Survey has been  |
|                     | published elsewhere.**^9^**                    |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

+---------------------+------------------------------------------------+
| 16-19b. At 6        |                                                |
| months.             |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Mothers' Survey, Ross Products Division,       |
| Source**            | Abbott Laboratories, Inc.                      |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | 14.9 (Maternal and Infant Health) (also 2.11). |
| 2000 Objective**    |                                                |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 29 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of mothers who indicate that breast     |
|                     | milk is at least one of the types of milk      |
|                     | their infant was fed 6 months after delivery.  |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of mothers of infants aged 6 months.    |
+---------------------+------------------------------------------------+
| **Targeted          | U.S. resident population.                      |
| Population**        |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 Mothers' Survey:                 |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Please check the milks your youngest baby  |
|                     |     was fed most often in the last week:\      |
|                     |     Breast milk\                               |
|                     |     (List of formulas)\                        |
|                     |     Cow's milk                                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Surveys are sent out monthly to a sample of    |
|                     | mothers with infants of every month of age     |
|                     | between 1 month and 12 months.                 |
+---------------------+------------------------------------------------+
|                     | Respondents can check more than one type of    |
|                     | milk. If breast milk is checked, the mother is |
|                     | considered to be breastfeeding, regardless of  |
|                     | whether other milk or formulas are used as     |
|                     | well.                                          |
+---------------------+------------------------------------------------+
|                     | A description of the Mothers' Survey has been  |
|                     | published elsewhere.**^9^**                    |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+
| 16-19c. At 1 year.  |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Mothers' Survey, Ross Products Division,       |
| Source**            | Abbott Laboratories, Inc.                      |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 14.9 (Maternal and Infant Health) |
| 2000 Objective**    | (also 2.11).                                   |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 16 (1998).                                     |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of mothers who indicate that breast     |
|                     | milk is at least one of the types of milk      |
|                     | their infant was fed 1 year after delivery.    |
+---------------------+------------------------------------------------+
| **Denominator**     | Number of mothers of infants aged 1 year.      |
+---------------------+------------------------------------------------+
| **Targeted          | U.S. resident population.                      |
| Population**        |                                                |
+---------------------+------------------------------------------------+
| **Questions Used To | From the 1998 Mothers' Survey:                 |
| Obtain the National |                                                |
| Data**              |                                                |
+---------------------+------------------------------------------------+
|                     | -   Please check the milks your youngest baby  |
|                     |     was fed most often in the last week:\      |
|                     |     Breast milk\                               |
|                     |     (List of formulas)\                        |
|                     |     Cow's milk                                 |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Surveys are sent out monthly to a sample of    |
|                     | mothers with infants of every month of age     |
|                     | between 1 month and 12 months.                 |
+---------------------+------------------------------------------------+
|                     | Respondents can check more than one type of    |
|                     | milk. If breast milk is checked, the mother is |
|                     | considered to be breastfeeding, regardless of  |
|                     | whether other milk or formulas are used as     |
|                     | well.                                          |
+---------------------+------------------------------------------------+
|                     | A description of the Mothers' Survey has been  |
|                     | published elsewhere.**^9^**                    |
+---------------------+------------------------------------------------+
|                     | This objective is comparable to Healthy People |
|                     | 2000 objective 14.9; however, the measurement  |
|                     | of infants aged 1 year is new to Healthy       |
|                     | People 2010.                                   |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

16-20. (Developmental) Ensure appropriate newborn bloodspot screening,
followup testing, and referral to services.

  ---------------------- ------------------------------------------------
  16-20a. Ensure that    
  all newborns are       
  screened at birth for  
  conditions mandated by 
  their State-sponsored  
  newborn screening      
  programs, for example, 
  phenylketonuria and    
  hemoglobinopathies.    

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         Proposed data sources are the Title V
                         Performance Measures, HRSA, MCHB and the
                         National Newborn Screening and Genetic Resource
                         Center.

                         This objective is adapted from Healthy People
                         2000 objective 14.15, which measured newborns
                         screened by State-sponsored programs for genetic
                         disorders and referral for appropriate
                         treatment. Healthy People 2000 objective 14.15
                         was tracked with data from the Council of
                         Regional Networks for Genetic Services,
                         Association of State and Territorial Public
                         Health Laboratory Directors.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-20b. Ensure that    
  followup diagnostic    
  testing for screening  
  positives is performed 
  within an appropriate  
  time period.           

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         Proposed data sources are the Title V
                         Performance Measures, HRSA, MCHB, and the
                         National Newborn Screening and Genetic Resource
                         Center.

                         This objective is adapted from Healthy People
                         2000 objective 14.15, which measured newborns
                         screened by State-sponsored programs for genetic
                         disorders and referral for appropriate
                         treatment. Healthy People 2000 objective 14.15
                         was tracked with data from the Council of
                         Regional Networks for Genetic Services,
                         Association of State and Territorial Public
                         Health Laboratory Directors.

                         See Appendix A for focus area contact
                         information.

  16-20c. Ensure that    
  infants with diagnosed 
  disorders are enrolled 
  in appropriate service 
  interventions within   
  an appropriate time    
  period.                

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         Proposed data sources are the Title V
                         Performance Measures, HRSA, MCHB, and the
                         National Newborn Screening and Genetic Resource
                         Center.

                         This objective is Healthy People 2000 objective
                         14.15, which measured newborns screened by
                         State-sponsored programs for genetic disorders
                         and referral for appropriate treatment. Healthy
                         People 2000 objective 14.15 was tracked with
                         data from the Council of Regional Networks for
                         Genetic Services, Association of State and
                         Territorial Public Health Laboratory Directors.

                         See Appendix A for focus area contact
                         information.
  ---------------------- ------------------------------------------------

  

  ---------------------- ------------------------------------------------
  16-21. (Developmental) 
  Reduce hospitalization 
  for life-threatening   
  sepsis among children  
  aged 4 years and under 
  with sickling          
  hemoglobinopathies.    

  **Comments**           An operational definition could not be specified
                         at the time of publication.

                         A proposed data source is the National Hospital
                         Discharge Survey (NHDS), CDC, NCHS.

                         See Part C for a description of NHDS and
                         Appendix A for focus area contact information.
  ---------------------- ------------------------------------------------

  

+---------------------+------------------------------------------------+
| 16-22.              |                                                |
| (Developmental)     |                                                |
| Increase the        |                                                |
| proportion of       |                                                |
| children with       |                                                |
| special health care |                                                |
| needs who have      |                                                |
| access to a medical |                                                |
| home.               |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | An operational definition could not be         |
|                     | specified at the time of publication.          |
+---------------------+------------------------------------------------+
|                     | A proposed data source is the Title V          |
|                     | Reporting System, HRSA, MCHB.                  |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+
|                  |                                                |
|                     |                                                |
| 16-23. Increase the |                                                |
| proportion of       |                                                |
| Territories and     |                                                |
| States that have    |                                                |
| service systems for |                                                |
| children with       |                                                |
| special health care |                                                |
| needs.              |                                                |
+---------------------+------------------------------------------------+
| **National Data     | Title V Block Grant Application Form 13, HRSA, |
| Source**            | MCHB.                                          |
+---------------------+------------------------------------------------+
| **State Data        | Not identified.                                |
| Source**            |                                                |
+---------------------+------------------------------------------------+
| **Healthy People    | Adapted from 17.20 (Diabetes and Other Chronic |
| 2000 Objective**    | Disabling Conditions).                         |
+---------------------+------------------------------------------------+
| **Measure**         | Percent.                                       |
+---------------------+------------------------------------------------+
| **Baseline**        | 15.7 (1997)                                    |
+---------------------+------------------------------------------------+
| **Numerator**       | Number of States and Territories that have a   |
|                     | score of at least 10 (of a possible 12) on a   |
|                     | four-part rating of aspects of a coordinated   |
|                     | continuum of appropriate services for children |
|                     | with special health care needs (CSHCN).        |
+---------------------+------------------------------------------------+
| **Denominator**     | 59 States and Territories.                     |
+---------------------+------------------------------------------------+
| **Questions Used To | From the Title V Block Grant Application (Form |
| Obtain the National | 13), in which State Title V officials are      |
| Data**              | asked to rate their programs on the following  |
|                     | criteria:                                      |
+---------------------+------------------------------------------------+
|                     | -   State program collaboration with other     |
|                     |     State agencies and private organizations.  |
|                     |     The State has established and maintained   |
|                     |     on ongoing interagency collaborative       |
|                     |     process for the assessment of needs with   |
|                     |     respect to the development of              |
|                     |     community-based systems of services for    |
|                     |     CSHCN. State programs collaborate with     |
|                     |     other agencies and organizations in the    |
|                     |     formulation of coordinated policies,       |
|                     |     standards, data collection and analysis,   |
|                     |     financing of services, and program         |
|                     |     monitoring to assure comprehensive,        |
|                     |     coordinated services for CSHCN and their   |
|                     |     families.                                  |
+---------------------+------------------------------------------------+
|                     | -   State support for communities. State       |
|                     |     programs emphasize the development of      |
|                     |     community-based programs by establishing   |
|                     |     and maintaining a process for facilitating |
|                     |     community systems building through         |
|                     |     mechanisms such as technical assistance    |
|                     |     and consultation, education and training,  |
|                     |     common data protocols, and financial       |
|                     |     resources for communities engaged in       |
|                     |     systems development to assure that the     |
|                     |     unique needs of CSHCN are met.             |
+---------------------+------------------------------------------------+
|                     | -   Coordination of health components of       |
|                     |     community-based systems. A mechanism       |
|                     |     exists in communities across the State for |
|                     |     coordination of health services with one   |
|                     |     another. This includes coordination among  |
|                     |     providers of primary care, habilitative    |
|                     |     and rehabilitative services, other         |
|                     |     specialty medical treatment services,      |
|                     |     mental health services, and home health    |
|                     |     care.                                      |
+---------------------+------------------------------------------------+
|                     | -   Coordination of health services with other |
|                     |     services at the community level. A         |
|                     |     mechanism exists in communities across the |
|                     |     State for coordination and service         |
|                     |     integration among programs serving CSHCN,  |
|                     |     including early intervention and special   |
|                     |     education, social services, and family     |
|                     |     support services.                          |
+---------------------+------------------------------------------------+
| **Expected          | Annual.                                        |
| Periodicity**       |                                                |
+---------------------+------------------------------------------------+
| **Comments**        | Possible responses to each are 0 (not met), 1  |
|                     | (partially met), 2 (mostly met), and 3         |
|                     | (completely met). The State's score is the sum |
|                     | of the four ratings.                           |
+---------------------+------------------------------------------------+
|                     | This objective is adapted from Healthy People  |
|                     | 2000 objective 17.20, which tracked the number |
|                     | of States that had service systems for         |
|                     | children with or at risk of chronic disabling  |
|                     | conditions, as required by Public Law 101-239. |
|                     | A data source was never identified to track    |
|                     | Healthy People 2000 objective 17.20.           |
+---------------------+------------------------------------------------+
|                     | See Appendix A for focus area contact          |
|                     | information.                                   |
+---------------------+------------------------------------------------+

  

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