ED 198 955

TITLE

INSTITUTION

T72?ORT NO

EVe DATE

NOTE

AVAILABLE FRCM

DOCUMENT RESUME

PS 012 111

Better Health for Our Children: A National Strategy.

The Report of the Select Panel for the Promotion of

Child Health to the United States Congress and the

Secretary of Health and Human Services. Volume III: A

Statistical Profile.

?ublic Health Service (DHHS), Rockville, Md.

DHSS-PHS-79-55071

al

333p.: For other volumes of

1G9-112 and PS 012 137.

Superintendent of Documents,

Office, Washington, DC 20402

017-002-00142-9, $7.50).

this report, see PS 012

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EDES PRICE MF01/PC14 Plus Postage.

DESCRIPTORS *Background: Firth: *Children:

Influences: Health Conditions:

Services; *Mothers: Pregnancy:

Tables (Data)

IDENTIFIERS *Health Status

Environmental

Health Needs: *Health

Social Influences;

ABSTRACT

This third volume of the 19B1 Report of the Select

Panel for the Promotion of Child Health presents a compendium of

background data on various aspects of maternal and child health in

the United States. The volume is divided into two sections. Section I

consists of six chapters of text and Section II consists of 120

tables. The text is designed to facilitate interpretation of the

tables, to highlight the data, and to provide references to recent

analytic studies and major sources of data. Section I discusses the

following topics: the changes which have occurred in children's

living conditions: the conditions influencing and surrounding ;.be

beginning of life, including fertility, family planning, parental And

hospital care, and the health status of the newborn: the

environmental and social facts influencing family health: the health

status and needy of children and youth: the resources available for

health care of children: and the use of health services. Selection of

the tabular data presented in Section II is based on five criteria:

population coverage (national or large subgroups of the U.S.

population), statistical reliability And validity, timeliness,

importance to public health or social medicine, and relevance to

social policy. An index of tables relevant to each chapter in Section

I is provided in order to facilitate use of the tables.

(Author/MP)

***********************************************************************

* Reproductions supplied by EDRS are the best that can be made

from the original document.

*****************.:4**************************************************
BETTER HEALTH

FOR OUR CHILDREN:

A NATIONAL STRATEGY

S DEPARTMENT OF NEALTm

EDUCATION &WELFARE

NATIONAL INSTITUTE OF

EDUCATION

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TpiE PERSON OR OIRGANiZATfIDN OQ iGINAT 'NO iT POINTS OC u+,A, OR OPINIONS

STATE 0 00 NOT NECES5Arti..v 14E04ESENT Ogg sC:AL "..&Ti0r4A6 945T I u TE OF

EDUCATION POS. 'ION OP POLICY

The Report

Of The Select Panel

For The Promotion

Of Child Health

To The United

States Congress

And The Secretary Of Health

And Human Services

1981

Volume Ill

A Statistical Profile

THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health SerYice

Office of the Assistant Secretary for Health

and Surgeon General

DHHS (PHS) Publication No. 79-55071
DEPARTMENT OF HEALTH AND HUMAN SERVICES

OFFICE OF THE SECRETARY

SELECT PANEL. FOR THE OROMOT1074

OF CmILD HEAL? Pi 1832 M STREET. N.W. - RM. 711 WRS141144GTON, D.C. 20036 202-634-4805

December 2, 1980

Honorable Patricia R. Harris

Secretary

Department of Health and Human Services

Honorable Edward M. Kennedy

Chairman, Subcommittee on Health and Scientific Research

Senate Committee on Labor and Human Resources

Honorable Henry A. Waxman

Chairman. Subcommittee on Health and the Environment

House Committee on Interstate and Foreign Commerce

Dear Secretary Harris, Senator Kennedy, and Congressman Waxman:

I am proud to transmit to you the report of the Select Panel

for the Promotion of Child Health, in accordance with Public Law 95-626 which created the Panel.

The 17 members of the Panel and our staff have devoted an

extraordinary amount of time, energy, and--we hope--wisdom to our task. Our commitment has reflected how seriously 14%0 have all come to take the opportunity offered us by the breadth a--if mandate Congress assigned to us. The chance to design the foumtations of a national effort to improve the health of our children has infused

our work with excitement and zest. It has also permitted us to

mobilize the contributions of hundreds of individuals and

organizations throughout the country, engaged in large ways and

small in understanding and serving the health needs of this

country's children and families. The Panel, and the Nation, are profoundly in their debt.

We were impressed with the richness and diversity of available

FILlenta,coimetenc.e and commitment, reflected in the accomplishments of a great variety of public programs and private efforts in

communities throughout the country. We also became starkly aware

of the extent of the unsolved problems that remain.

Our recommendations reflect a hardheaded analysis of serious

unmet needs in child and maternal health, a recognition of past

successes and future opportunities for effectively meeting these

needs, careful consideration of the weaknesses and strengths of current Federal programs and policies, and a sober and pragmatic

assessment of the capacity of our institutions to provide parents, professionals, and others working to improve child health with the scientific, financial, and organizational support they need.
Honorable Patricia R. Harris

Honorable Edward M. Kennedy

Honorable Henry A. Waxman

Page Two

Volume I of our report presents our major findings and

recommendations.

Volume II contains specific recommendations for improving five major Federal programs with significant impact on child health:

-- Title V of the Social Security Act

-- The Special Supplemental Food Program for Women, Infants and

Children

P.L. 94-142: The Education for All Handicapped Children Act

Medicaid and EPSDT

- - Community Mental Health Centers and Services Systems

Volume III consists of what we believe to be the most

comprehensive compilation of data on child health in the U.S. yet

to be published.

We also submit a collection of background papers, listed at the

end of Volume I, which were prepared for the Panel, and which we

believe will be extremely useful to those who wish to become

familiar in greater depth with selected aspects of the issues %re

have analyzed.

Some of our recommendations should be acted on immediately.

Others are designed to be considered and implemented over a period

of years. All of our recommendations are practical, and as

specific and concrete as we have been able to make them.

The goals we set out encompass an extremely broad sweep of

issues. In accordance with our congressional mandate we have

addressed and analyzed issues and policies pertaining to the

physical environment, health behavior, health services organization

and financing, and health research. 'de did not try to go beyond

these, although we are fully aware that other aspects of the social

environment exercise a powerful influence on health. It is true

that if we could eliminate poverty and racism in this country, if

high quality preschool programs and community supports for families

were more available, if teachers and schools were more effective,

if we had full employment and every young person could look forward

to productive work, our health indicators would improve

significantly. Nevertheless, we have not focused on these issues,

both because they are outside the Panel's mandate, and because we

wish to help direct public attention to the extensive opportunities

to improve child health by improvier health policies and programs.
Honorable Patricia R. Harris

Honorable Edward M. Kennedy

Honorable Henry A. Waxman

Page Three

The Panel has asked me to call your attention to an additional problem we faced in defining our mandate. As you know, the legislation that establisised the Panel asked us to look at the health of -children and expectant mothers.- Child health is obviously inseparable from maternal health. The health of the mother during pregnancy is unquestionably a major determinant of child health. But as we looked beyond purely physiological factors in child health, we found that our concerns must include fathers as well as mothers, both in relation to their role in the decision to conceive a child, and to their continuing role in providing nurturance, support, protection,

they grow. and guidance to their children J$ Not only is the family the primary unit for the delivery of health services to infants and children, but the family environment is probably the greatest influence on a child's health. We wish to be clear that our use of the term -maternal and child health,- when we describe and analyze both needs and interventions, is in no way inconsistent with our conviction that fathers as well as mothers are central to raising healthy children.

We are grateful for the opportunity you have given us to en.;age in this work, and thank you for the help and support we have received from you and your associates in the course of our deliberations. We trust that the value of our efforts will prove to have justified the investment

in the creation of that the American public has mde this report.

I am sure you share with us the conviction that public policy, no matter how well conceived and carried out, can contribute only modestly to the vigor, grace, and joy we wish to See in our children's lives. But as our report makes clear, public policy and programs can mean the crucial difference, especially Iii thcr lives of the most vulnerable of our children.

We hope most profoundly that this report will contribute to shaping public policy in ways that will help all American families and communities to protect and promote the health of all of our nation's children.

RespectfuILy and sincerely yours,

LsLa os sue,.,.

Lisbeth Bambeeger Scharr.

Chairperson
MEMBERS OF THE SELECT PANEL

FOR THE PROMOTION OF CHILD HEALTH

Lisbeth Bamberger Schorr, Chairperson Washington, D.C.

John C. Mac Queen, M.D., Vice Chairperson Professor of Pediatrics

University of Iowa

Director, State Services for Crippled Children. Iowa City, Iowa

Jo Anne Brasel, M.D.

Professor of Pediatrics

UCLA School of Medicine

Director, Clinical Research Center

Harbor-UCLA Medical Center

Los Angeles, California

Mitchell I. Ginsberg, L.H.D.

Dean, Columbia University School of Social Work New York, New York

Frank Hardart, Jr., M.D.

Obstetrician and Gynecologist New York, New York

Roger C. Herdman, M.D.

Vice President for Administration and Academic Affairs,

Sloan Kettering Memorial Institute New York, New York

Nicholas Hobbs, Ph.D.

Professor of Psychology and Preventive Medicine Vanderbilt University Nashville, Tennessee

George I. Lythcott, M.D. Assistant Surgeon General and Administrator Health Services Administration

Public Health Service, DHHS

Howard Newman, J.D.-1-

Administrator, Health Care Financing Administration, DHHS

(Mr. Newman served from June 1980 to December 1980; he replaced Leonard D. Schaeffer who served from March 1979 to June 1980.)

vii
Katherine B. Nuckolls, Ph.D.

Professor of Nursing, School of Nursing University of North Carolina Chapel Hill, North Carolina

John Palmer, Ph.D. .1*

Assistant Secretary for Planning and Evaluation, DHHS (Dr. Palmer served from November 1979 to December 1980; he replaced Benjamin W. Heineman, Jr. who served from March 1979 to November 1979.)

Cesar A. Peralest

Assistant Secretary for Human Development Services, DHHS

(Mr. Perales served from February 1980 to December 1980; he replaced Blandina Cardenas Ramirez, Ed.D., Commissioner, Administration for Children, Youth, and Families, Office of Human Development Services, DHHS, who served from March 1979 to February 1980.)

Julius B. Richmond, M.D. st

Assistant Secretary for Health and Surgeon General of the Public Health Service, DHHS

Aaron Shirley, M.D. Project Director. Jackson- .Hinds Comprehensive Health Center, Jackson, Mississippi

Jeanne C. Sinkford, D.D.S., Ph.D.

Dean, School of Dentistry Howard University College of Dentistry Washington, D.C.

George Tarjan, M.D. Professor of Psychiatry Director, Division of Mental Retardation Program and Child Psychiatry Neuropsychiatric Institute, UCLA School of Medicine

Los Angeles, California

Charlotte Wilen

Founding Chairperson. Council on Maternal and Infant Health, State of Georgia

'Ex Officio voting members

tThe Panel members who are representatives of the Department of Health and Human Services wish to

commend the Pane: as a whole for its thorough information gathering and careful analysis of child health problems. They believe the Panel's report is an extremely useful document.- However. the specific programmatic and budget recommendations contained in the report have not yet been formally

considered by the Department or by the Executive Ofrice of the President Thus, participation by Czpartinent representatives in the Panel's activities cannot be construed as an Administration

endorsenszni of the recommendations.

Ali
STAFF REPRESENTATIVES FROM THE

DEPARTMENT OF

HEALTH AND HUMAN SERVICES

For the Assistant Secretary for Health and Surgeon General:

Susanne Stoiber

Deputy Assistant Secretary Office of Planning and Evaluation

Juel Janis, Ph.D.

Special Assistant to the Assistant Secretary for Health and Surgeon General

Samuel Kessell, M.D.

Special Assistant to the Assistant Secretary for Health and Surgeon General

Patricia Mullen, Dr. P. H.

Special Assistant to the Director, Office of Health Information and Health Promotion

For the Assistant Secretary for Planning and Evaluation:

Bonnie Lefkowitz

Director, Division of Health Services and Resources

For the Administrator. Health Care Fina;lcing Administration:

Mary Tierney, M.D.

Director, Office of Child Health

For the Assistant Secretary for Humqn Development Services:

Linda Randolph, M.D. Director, Health Services Branch, i -!ministration for Children, Youth, and Families

Margaret A. Siegel Special Assistant to the Assistant Secretary for Human Development Services

o ix
For the Assistant Surgeon General and Administrator, Health Ser- vices Administration:

Vince L. Hutchins, M.D.

Associate Bureau Director, Office for Maternal and Child Health, Bureau of Community Health Services

x 9
SELECT PANEL FOR THE PROMOTION OF

CHILD HEALTH

Professional Staff

John A. Butler. Staff Directo.-

Sarah S. Brown. Associate Staff Director

Harriette B. Fox, Senior Program Analyst and Project Director. Volume II Mary Grace Kovar, Senior Statistician and Project Director. Volume HI

Martha Angle, Senior Editor. Volume I K. C. Cole. Writing Consultant Elizabeth des Cognets. Research Assistant Barbara G. Furst, Editor. Volume IV

Jeanne G. Holzgrefe. Consulting Policy Analyst Ruth J. Katz. Associate Program Analyst and Staff Attorney Lorraine V. Merman. Senior Research Associate

Jessica K. Laufer. Research Associate

Wendy Lazarus. Consulting Pr>licy Analyst Amanda F. MacKenzie. Public Liaison

Denise J. Merry. Demographer

Ellen Opper-Weiner. Coordinator. Public Hearings Charlotte L. Tsoucalas. Law Clerk

Vicki Kalmar Weisfeld, Editor. Volumes II and III

Support Staff

Dorothy K. Cavanaugh. Senior Staff Assistant and Office Manager

Isabelle E. Duke. Administrative Assistant to the Staff Director

David James Dyr.r. Secretary

Constance Johnston. Administrative Assistant to the Panel Chairperson Vb endy Klaich, Secretarial Assistant

Michelle Miles, Secretary Gail Milner. Administrative Secretary Catherine Waller, Staff Assistant

xi
SELECT PANEL STAFF

VOLUME III

Mary Grace Kovar, Senior Statistician and Project Director Denise J. Meny, Demographer
FOREWORD

The mandate of the Select Panel for the Promotion of Child Health to

develop "a comprehensive plan to promote the health of children and

pregnant women" has necessitated an evaluation of the health-related

data for women of childbearing age and for children. What do we know about the Nation's children and pregnant women: their health status, living conditions, and health-related behavior? What

are their patterns of family living and are these associated with health

status? What health care do they receive, and what health resources are

available to them? These are some of the broad questions that this volume

attempts to answer. through tables and text, in order to support the Panel's work in developing the comprehensive plan. The information has

been used by the Panel during its deliberations and in preparation of its

recommendations, which are in volumes I and IL

The volume is divided into two sections. Section I consists of text and

section II of 120 tables.

The text is designed to facilitate interpretation of the tables, to highlight

the data, and to provide references to important or recent analytic studies and to major sources of data. It is not designed to analyze all of the data

in this volume or in all epidemiological studies. The hope is that it will

serve as an introduction to readers who will browse through the tables and

find the information they need to make their own interpretations. An

index of tables relevant to each chapter is provided at the end of the text

and a subject index at the end of the tables to facilitate such use.

Chapter 1 is an overview of changes in the conditions in which children

live in the United States and provides some indication of the changes that are projected.

Chapter 2 is devoted to the conditions influencing and surrounding the

beginning of life, including fertility. family planning, prenatal and hospital care, and the health status of the newbornusing infant mortality as an

indicator. Concern for the child's well-being must start here, as this is the

time when the child is at the greatest risk of long-term damage or death.

Chapter 3 is a return to some of the conditions discussed in chapter 1.

The focus is on characteristics of families and adults with whom children

live and the relationship of these characteristics with the health and health

care of children.. Data are included on other factors believed to influence

health or health behavior, such as immunization, sanitation and water

supply, nutrition and diet, and health education. There is a discussion of

the data on child abuse.

Chapter 4 is a description of the health status of children and youths. Data on death rates, institutionalized children, and children with life- threatening or limiting chronic conditions are included.. However, the
greater part of the chapter is spent on health status indicators for the vast majority of children who are living in the community. Chapter 5 concerns the resources available for the health care of

childrenmedical personnel, facilities, and financing. Data on changes in

the supply and cost are included. Chapter 6 contains a discussion of the use of medical and dental care, places where children receive medical care, and differentials among

children in the amount of care and the places where care is received- Data on diagnoses for visits to office-based physicians and for hospitalizations are discussed, as are some of the characteristics of the visits to office-based

physicians. Unless there is a specific reference in the text, the data and the

references are in the ables in section II. The tables are not referenced in

the text. Instead, an index to the tables relevant to each chapter (many of which are not explicitly discussed) follows the text. The index should

enable the reader t.) examine the data and make additional or different

interpretations.

The tables follow the same order as that used in Health United States to

facilitate comparison of data on pregnant women and children with data

for the entire population. Some of the tables are identical to those in

Health United States, which, since that volume is published annually, will enable the user to find comparable information in years to come. Despite the large number of tables, they are only a selection from the

vast amount of data available- The selection was based on five criteria:

population coverage (national or large subgroups of the U.S. population), statistical reliability and validity, timeliness, importance to public health

or social medicine, and relevance to social policy_ The approach taken to select and present the information imposes

restrictions. There are no data from clinical trials, local area studies, studies of special population groups, or studies of rare conditions even

though such studies are of great importance. Many were used for the

background papers in volume IV and as the basis for recommendations in

volume I.

The tables were designed for an easy-to-use presentation of numbers, rates, and percentages_ They were not designed to present cross-classification of many simultaneous variables, and there is no multivariate analysis. For example, differences in the proportion of children who have visited a

doctor are shown according to income and education separately, as if each

were independent of the other, rather than considering them simulta- neously. The reader should not conclude that increasing income or

increasing education would all by itsef increase the proportion of children

receiving care. The data are cross-sectional, not longitudinal. Thus, one should be wary of inferring that low parental education or living in a particular geographic area is the cause of a child's ill health. The most that can be

said is that children in specific circumstances are more likely to be in poor health.

Every effort has been made to include only data of known statistical reliability or validity. In general, this means that the data are from

national probability surveys, the decennial census, and the national vital

xvi
registration system. All of these are subject to reporting and measurement

error and to the possibility of the accuracy of reporting changing over

time. but errors and changes have been studied and there are estimates of

their magnitude_ Samples are also subject to sampling error. For a

probability sample, sampling errors can be calculated so that the user

knows how much confidence to place in the estimate. Sampling errors are

computed for all U.S. Bureau of the Census and Nationa! Center for Health Statistics surveys and are available in the source documents, but they are not shown in the tables in this volume. Instead, the tables are

designed so that estimates with a large sampling error are not usually presented; in some cases where such estimates are shown, they are

flagged. Insofar as possible, data were selected so that the tables on all subjects would refer to the same point in timeapproximately the mid- 1 970's_ Older data were used when nothing was available for the later time; newer

data were used when there was reason to believe that there had been a

change. All time trends and text references include the latest information

available when this volume went to press_ Finally, there are restrictions imposed by the lack of data. Little

information is available about Hispanic children for example. The lack of data should not be the basis for judging that an issue is not important. Many people prodded leads to sources of data. furnished published and unpublished data, and reviewed portions of the text or tables. The names

of some are known, while others are unknown. Those whose names are

known are acknowledged in volume I. To everyone, known and unknown, without whose help the data presented in this volume could not have been

brought together, thank you_ Three agencies of the Public Health Service made such extensive

contributions that the volume could not be what it is without their help. The National Center f...)r Health Statistics loaned the author to the Panel

and made the NCHS data freely available. The Bureau of Community Health Services funded two special sets of tabulations. These agencies made the inclusion of previously unpublished data possible. The Centers

for Disease Control provided extensive background material. To these

agencies and to all of the others which provided publications, results of

funded research, and other help, thank you_ Despite the generous help of many people and organizations, error in

presentation or interpretation may remain. The responsibility for them, of course, is the author's.

Mary Grace Kovar

xvii
CONTENTS

Letter of Transmittal lii

W:embers of the Select Panel for the Promotion of Child Health .... vii

Staff Repre...entatives from the Department of Health and Human Services ix

Select Panel for the Promotion of Child Health xi

Select Panel Staff for Volume III xiii

Foreword xv

Section I. Discussion 1

Chapter 1. The Changing World of Children 3

The Number of Children 3

Mothers in the I abor Force 4

Single-Parent Families 5

Low-Income Families 6 Other Changes 7

Chapter 2. Pregnancy and Childbirth 9

Fertility Rates 9 Family Planning 10

Use and Sources of Medical Care 13

Physician Supply and Distribution 16

Cost an ci Funding of Maternity Care 17 Newborns at Risk 19

Children Born to Unmarried Mothers 20 Mortality Rates 21

Chapter 3. Environmental and Social Factors Influencing Health 25

Income and Poverty 25

Children Without Fathers 29 Race and Ethnicity 32

Parents' Level of Educatirm 33

Other Factors Affecting Health 35
Chapter 4. Health Status and Needs 41

Mortality Rates 41

Assessments of Health 43

Risk-Taking Behavior 50

Chapter 5. Resources for Health Care 53

Supply of Health Care Personnel 54

Geographic Distribution of Health Care Personnel 57

Satisfaction With Health Care Facilities 58

The Increasing Cost of Health Care 59

Private and Public Coverage and Expenditures

for Health Care 60

Chapter 6. Use of Health Services 65

Contacts With a Physician 66

Place of Visit 69

Regular Sources of Health Care 70

Visits to Office-Based Physicians 71

Dental Care 74

Inpatient Care in Hospitals 74

Long-Term Institutional Care 76

Mental Health Care 76

Guide to Tables Relevant to Chapters 78

References and Notes 81

Bibliography 88

Section II. Tabular Presentation of Data 89

Symbols 89

List of Detailed Tables 91

Detailed Tables 102

Guide to Tables 314

1 G
Volume III

A Statistical Profile

17
SECTION I

DISCUSSION

.18
CHAPTER 1

THE CHANGING WORLD OF

CHILDREN

THE NUMBER OF CHILDREN

The best estimate, before the results of the decennial census are

released, is that there are 62 million children and youths under 18 years of age in the United Statesabout 7.7 million fewer than there were in 1970. This decade has seen the children of the baby boom grow up and reach

adulthood. In 1980 the children born in 1954 (the rust year that there were 4 million or more births) became 26 and the children born in 1964 (the last year thp.: here were 4 million or more births in this country) became 16

years of age. The small number of children born during the 1970's does not mean

that the number of children will continue to decline. It only means that we

do not now have, and do not expect to have again in this century, the large number of children we have had in the recent past If women have an

average 2.1 births during their lifetime (the number used by the U.S. Bureau of the Census for the midlevel fertility estimates), there will be a

gradual but steady increase to 65 million children by 1990. and to 69 million by the year 2000approximately the same number as in 1970. If, on the other hand, the average number of births is 2.7 per woman (the number used for the high fertility estimate), there will be about 88 million

children by the year 2000. If there are only 1.7 births per woman (the number used for the low fertility projection), there will be about 57 million

children then ( 1).

It is impossible to know how many children will be born during the next

20 years. Based on the responses of young married women in their early

twenties, we can predict them to have an average of 2.1 children. Although

an individual woman may have more or fewer children than she expects when she is young, the projections based on women's own expectations are remarkably accurate (2). However, the birth rate is influenced by many factors: for example, availability of effective contraception and

abortion, unemployment rates, rates of women's participation in the labor force and of inflation, availability of housing, and divorce and marriage

rates.

3
MOTHERS IN THE LABOR FORCE

One of the most striking changes during the past few years has been the

increase in women's participation in the labor force. Unprecedented numbers of women entered the labor force during the 1970's; more women entered or reentered the work force during that decade than

during any other decade of this century (3). The greatest increase was for women 25-34 years of age: 62 percent were employed in 1978 compared with 45 percent in 1970. In the past, many of these women would have

stopped working when they married or had children. One result of this change is that a higher proportion of children have mothers who work. While the number of children decreased, the number

of children with working mothers increased by 33 million from 1970 to 1977 (4). Younger children are less likely than older children to have working mothers. Nevertheless, in 1977, 38 percent of the children who were under 6 years of age had mothers who worked, and by 1990 that proportion is projected to be 45 percent (table A). On the average, black children are more likely than white children to

have working mothers (55 vs. 46 percent in 1977), and children living with

their mothers only are more likely than children in two-parent families to

have working mothers (58 vs. 46 percent in 1977) (4). However, there are

interesting variations by family type. In 1977, about 60 percent of black

children in husband-wife families had mothers who worked in contrast to

45 percent of white children. On the other hand, 63 percent of the white

children but only 51 percent of the black children living with their mother only had a working mother. In the mother-only families, the proportion with working mothers was greater for white children of every age. The planning for small families and the increasing participation of wives in the labor force may be motivated by economics. A recent study

estimated that in 1977 the total direct cost of raising a child from birth

through- college ranged from $44,200 for families whose after-tax income was $10,500-$13,500 to $64,200 for families whose after-tax income was $16.500-$20,000 (6). According to the study, a mother would, on the

average, forego about $100,000 in earnings if she stayed out of the labor force until her child was 14 years of age. If the mother had only an

elementary school education she would forego $75,000; if she had a postgraduate education, $155,000. Regardless of the mother's level of education, her lost earnings were greater than the direct cost of raising the

child. Because the Tax Reform Act of 1976 instituted a tax credit for child

care expenses for all parents who meet the requirements, mothers of young

children, especially those mothers with higher levels of education, may be encouraged to remain in the labor force while their children are still

young. A mother in the labor force can make a significant contribution to

family income when fathers are unemployed, not in the labor force, or

absent. In 1977, 133 million children had a father in one of those

circumstances. In each category, the family income was considerably

higher if the mother worked (table B).

4
TABLE A. Children Under 6 Veers of Age and Number and Percent of Children Under 6 Years at Age With Mothers in OW Labor Foram Untied Stales, 1970-60 Selected Years

Year

Children tinder 6 Years of Alp

Total Mother in Labor Force

Number in thousands Percent

1970 19,606 5,590 28.5 1975 18,134 6,512 35.9 1977 17.117 6,431 37.6 1950 23,331 10,453 44.8

SOURCE: Reference 5.

TABLE B. Family Income by Father's and Mother's Work Status: UMW States, 1977

Mother

Father In Labor Force Not in Labor Force

Median family income in dollars

Unemployed 13,900 8,800 Not in labor force 11,600 7.100 Absent 7,800 4.200

SOURCE: Reference 4.

SINGLE-PARENT FAMILIES

There is no numerical reason why children today should not be well cared for. There are two adults 18-64 years of age for every child under 18 years of age. Not since 1950 have there been so many adults of working age relative to the number of children. However, the proportion of children who are living with only one parent (or no parent) has been

increasing steadily. That proportion increased from 9 percent in 1960 to 13 percent in 1970 to 19 percent in 1978, and Glick has projected that, in 1990, 25 percent of all children will be living with only one parent (7). Thus, while the proportion of children relative to adults has been decreasing, the proportion of children having only one adult to provide daily support and care has been increasing. Despite the widespread media attention to v.hildren living with their fathers, most children living with one parent live with their mothersliving only with a father is rare. In 1978, less than 2 percent of the children in the United States lived only with their fathers in contrast to 17 percent who lived only with their mothers. The comparable figures for 1990 are projected to be 2 and 23 percent, respectively. Being raised by one parent is not a new phenomenon in this country. At the turn of the century about 29 percent of the children had only one

5
parent during some part of their childhood (8). By the mid-I970's, it was estimated that 45 pert-ent of the children would spend some part of their childhood with only one parent and that 26 percent of the children would

have been involved in a divorce ( 7. 9). It is projected that by 1990 about 50 percent of the children will spend some part of their childhood with

only one parent and that 32 percent will have been involved in a divorce. Thus the increase over the 90-year period will be about 30-50 percent. The reasons for living with only one parent are vastly different today

from the reasons in 1900. and the household arrangements are also

different. In 1900. a child with only one parent had usually lest a parent through death and the lost parent was about as likely to be the mother. who perhaps died in childbirth, as the father. When this happened, children were often raised by relatives or were sent to orphanages. Today. death rates for young adults are much lower but divorce rates are higher. as are birth rates to unmarried women. Single parents are more

likely to maintain separate households for them.celves and their children. The increase in the proportion of children in one-parent homes is due primarily to the increasing number of divorces. Each year beginning in 1972. more than 1 million children under 18 years of age have been

involved in a divorce and. although the number of children per divorce has been decreasing due to falling birth rates. the total number of children

affected has been increasing and reached 1.147,000 in 1978 (10). In

contrast. 544.000 children-16 percent of all birthswere born to

unmarried women that year ( 1 I ). About half of 111 marital disruptions in the early 1970's occurred to

children under 6 years of age (12). Black children were more likely than white children to experience marital disruption, were younger when the disruption occurred (5.0 vs. 6.5 years of age), and were more likely to

remain with their mothers in single-parent families for substantial periods of time. Five years after the disruption. over one-third (35 percent) of the white children and four-fifths (82 percent) of the black children were still under 18 years of age and their mothers had not remarried. Bumpass and Rindfuss estimated that if the divorce experience of 1970-73 holds throughout the children's lifetimes, one out of three (33

percent) white children and three out of five (59 percent) black children

born after their mother's first marriage will experience marital disruption

through divorce. separation. or death of a parent before the child reaches 16 years of age ( 12).

LOW-INCOME FAMILIES

Because on the average women earn less than men and because a single adult earns less than two adults, households headed by women frequently

are low-income households. The reduced economic circumstances of

families headed by separated or divorced women in the years immediately

following the marital disruption have been amply documented (13). According to the U.S. Bureau of the Census, in 1978, children in families headed by women were about six times as likely as children in families headed by men to be living below the poverty level.

6

9
The increasing proportion of children living with a mother only, coupled with the differential in family income between husband-wife and woman-only families, is one reason that the proportion of children living in poverty has remained high.. From 1970 to 1978 the proportion of children living in poverty actually increased somewhat from 15 to 16 percent For those children in a family with a man as head, the proportion

declined from 9 to F.: pf-rcent. For those living in a family with a woman as head, the proportion declined from 53 to 51 percent. However, at the same time, the proportion of children living without a father in the household increased from 11 to 17 percent ( 14). Children were shifted from the

relatively more to the relatively less affluent family situation. Similarly, the income differential between black and white people, coupled with the higher proportion of black children living with a mother only. accounts for the much higher proportion of black than of white children who live in poverty (41 vs. 11 percent in 1978).

OTHER CHANGES

Other changes have occurred that affect children, and may have had an influeaxe on their health. Increasing proportions of children are in school at younger ages. In 1940, only 43 percent of all children 5-6 years of age were attending school; by 1970, 90 percent were enrolled in school; and by 1977 the proportion had risen to 96 percent. The proportion of children 3-4 years of age enrolled in school increased from 13 to 32 percent in the 11 years from 1966 to 1977. The proportion of older children (14-17 years of age) attending school had increased earlier, from 79 percent in 1940 to 94 percent in 1967. and has remained at about that level. Unlike children of earlier times, most children today grow up in an urban environment. In 1940, 50 percent of the children under 18 years of age lived in urban areas. By 1970, 72 percent of the children lived in urban areas, and the slow movement back to more rural areas which is occurring today has not caused that proportion to decrease significantly. Television, which was relatively uncommon when many of today's parents were children, has become a major factor in children's lives. By the time they reach the age at which they should be graduating from high school, most children have spent more time in front of a television set than in school (15).

The number of families with cars and the number of cars per family have increased, and in many jurisdictions the driving age has been lowered to 16 years. Many children are driven to school or other activities when they are young and as soon as they are legally permitted, they or their friends drive themselves wherever they go. The children of 30-40 years ago may have been isolated if they grew up on farms with no companions their own ages but the movement to metropolitan areas may not have meant an end to isolation- Children in small families where the adults work, and where the television is all consuming, may also be isolated. In many States, the drinking age has been lowered. Alcohol and

nicotine are more widely and openly used by adolescents, and marihuana,

7

23
which was unknown to most of the parents of today's children, has become a commonly used drug. Finally, there is the increasing level of sexual activity among young women who are themselves still legally children. Data prior to the 1970's are scarce, but certainly during the 1970's the proportion of school-age

adolescent females who were sexually active increased (data on males

were not collected until 1979) (16, 17). A significant number of these young women became mothers (213,000 in 1978).

8

4) .4 A.. II
CHAPTER 2

PREGNANCY AND CHILDBIRTH

FERTILITY RATES

The birth rate and the number of babies born have both declined steadily since 1961 when 4,268,000 babies were born. Although demogra- phers had been predicting a rise when the baby boom children themselves reached adulthood, the decline continued until there was a minor upturn in the number of births in 1976 and in the birth rate in 1977. The increase has continued into 1980. During the 12-month period ending with July 1980, there were 3,544,000 live births, 4 percent more than during the comparable 12 months a year earlier. The birth rate was 3 percent higher than it had been during the previous 12 months (18). The decline was due to women having fewer babies on the average and postponing having the first child. An examination of age-birth-order specific rates suggests that women having previously postponed births accounts for the increase. The rate of first births has been rising among women ages 25-34 while rates among young women and rates of higher order births among older women have been declining. If that is indeed the case, the number of children born may increase over the next 10-15 years as large numbers of women move into their late twenties and early thirties. There will, however, be no enormous upturn as the number of births married women expected to have was lower in 1978 than in any year since data were first collected in 1967.

Adolescent fertility rates have been declining since 1972 and the number of births to adolescents under 18 years of age has been declining since 1973. The number of births to young women under 18 years of age was still higher in 1978 than it had been 10 years earlier, but if the downward trend in the rates continues, the number in 1979 will be lower than the number in 1969. As the number of adolescent women declines, as it will over the next decade, the number of births to adolescents will continue to decline even if the decline in the birth rate does not continue. At the same time the proportion of births to adolescents (and the proportion of births to all young women under 25 years) who are unmarried increased. By 1978, a quarter of all births to women 15-24 years of age and 57 percent of the births to adolescents 15-17 years of age were to unmarried women. A decade earlier the comparable percentages were 14 and 40. There is no indication of a downturn in this trend. At

9
present. the proportion of young pregnant women who marry before the

child is born is still decreasing. Both birth rates and the proportion of births to very young women and

to unmarried women vary enormously by population subgroups and

among different areas of the country. Birth rates and the proportion of

births to unmarried women are still higher among black women than white women. and the difference is especially large among adolescents even though fertility rates have declined more rapidly among black

adolescents than among white adolescents. Birth rates are generally lowest in the Northeastern States and highest in the Mountain States while the highest proportions of out-of-wedlock births were in the South. Over half of all births in the District of Columbia in 1976 were to unmarried women.

The births to very young women and to unmarried women are particularly worrisome from a health standpoint because the child is at greater than average risk of getting a poor start in life. In 1977. when 7.1

percent of the babies weighed 2.500 grams or less at birth. 11.0 percent of

the babies born to adolescents under 18 years were low-birth-weight babies. Even for those young women who began prenatal care during the

first trimester of pregnancy (which relatively few did), 10.4 percent of their babies weighed 2.500 grams or less at birth (in contrast to 6.1 percent of

the babies born to women 18-39 years of age and 8.4 percent of the babies born to women 40 years of age or older who began care that early). The number of young women receiving early prenatal care would probably be higher if first pregnancies of low-income women were universally covered under Medicaid. Women pregnant for the first time

a group that includes disproportionately large numbers of teenagers and unmarried womenare not universally eligible for Aid to Families with Dependent Children or Medicaid's medically needy program because they

have no dependent children. In 1978. 19 States had no Medicaid coverage

for prenatal care for these women. In 30 States and the District of Columbia they were eligible if they met criteria of need. (Arizona has no

Medicaid program.)

FAMILY PLANNING

Family planning services are defined as contraceptive. sterilization, and

infertility services. Women needing contraception or sterilization include

all fecund women of childbearing age who are sexually active and are not pregnant or seeking to become pregnant_ In 1977. an estimated 6.9 million women with incomes below 150 percent of poverty fit the definition of need: about 4.9 million (71 percent) of them received family planning

services from organized providers or private physicians ( 1 9). No information is available on need or receipt of infertility services. Improved family planning should reduce fertility as the number of unwanted and unplanned births decreases. If the births prevented are to women whose offspring are at increased risk of death as newborns or

infants. increased risk of birth defects. or increased risk of living in a poor environment. then child health should also improve.

10
An area analysis of the 1969 U.S. family planning program revealed that, independent of other factors, the program had a significant impact, lowering the fertility of lower socioeconomic status women (20). Similar results were shown by Darney in a study of Georgia from 1965 to 1971. Counties with high levels of contraceptive acceptance by black women had twice the fertility decline among black women than did counties with low acceptance rates (21). A finding of both the 1965 and the 1970 National Fertility Studies was that the rapid decline in the fertility of U.S. married women in the 1960's was due almost entirely to increased control over unplanned fertility. Data from the 1973 and the 1976 National Surveys of Family Growth suggest that the trend toward improved planning of births continued in the early 1970's but that significant social differentials in fertility remained. In particular, women who were low on the Federal Poverty Index tended to have less control over their recent fertility (22). From 1965 to 1976, the proportion of married couples in the United States using the most effective methods of birth controloral contracep- tives, the intrauterine device, contraceptive surgical sterilizationhas steadily increased (23). In 1976, approximately halfof all married couples (48 percent) were using one of these methods. When the less effective methods are added (diaphragm, condom, foam, rhythm, withdrawal, douche, and other), approximately 68 percent of married women were using a contraceptive method both in 1973 and 1976. In addition, about 7 percent of the couples were sterile in 1973 and 11 percent in 1976 primarily because of noncontraceptive surgery. Thus, only 21 percent of the married women were fecund and not using some form of contracep- tion in 1976. Of these, 13 percent were seeking to become pregnant, were pregnant, or had just had a baby; 8 percent were nonusers at risk of an unplanned pregnancy. In 1976, black married women and low-income married women of both races (those below 150 percent of poverty) were less likely to use contraception than white and higher income wives. Although black wives in low-income families had an increase of contraceptive use from 1973 to 1976, they were the least likely to use one of the three most effective methods, had an increase ofuse of the least effective methods, and had the highest proportion of nonusers in 1976 (24). Use of oral contraceptives by currently married women decreased from 1973 to 1976 (from 25 to 22 percent of all married women 15-44 years of age), a reversal of the increasing oral contraceptive use from 1960 to 1973. This decrease was consistent for all age, race, and i-7,:-.ome groups, except for a slight nonsignificant increase among high-income black wives ages 25-44 and low-income white wives less than 25 years of age. The highest prevalence (48 percut) of oral contraceptive use in 1976 was among low- income white wives less than 25 years of age (24). Women not currently married reported an increase in the use of oral and intrauterine contraception between 1973 and 1976 (24). Sexually experienced women younger than 20 years of age who had never been married were more likely to use some form of contraception in 1976 than in 1971 (25).

I1
The prevalence of surgical sterilization among currently married women

increased from 1973 to 1976, primarily due to an increase from 17 to 20 percent in the proportion of white couples who were sterilized for contraceptive reasons; the prevalence for black couples declined from 15

to 13 percent. The greater proportion of sterilized white couples in 1976 is partly a

result of a more rapid increase in the rate of tubal sterilization for white

than black women (26) and greater utilization of vasectomy by white than black men (24). Surgical sterilization was the most popular method of contraception for white couples married 10 years or more, and by 1975

nearly half (47 percent) of these couples had been sterilized. White couples choose about evenly between male and female procedures while among black couples sterilization of males was rare. White couples who had

chosen sterilization were disproportionately of high parity; of high fertility during the first 5 years of marriagc; prone to have unwanted births; non- Catholic; and from the Western part of the country. The sterilized men

tended to be more from the middle class and the women more from the

lower socioeconomic level (27). By 1975. tubal sterilizations had become the third most frequently

performed surgical procedure on reproductive age women (following

elective abortion and diagnostic dilation and curettage). The majority (62 percent) of the women undergoing tubal sterilization in 1975 were ages 25-34. Nine-tenths (89 percent) of the white women who obtained tubal sterilizations in 1975 were currently married, whereas only 66 percent of black women in 1975 were married at the time of the operation. The trend

in both racial groups was toward sterilization between rather than

immediately following pregnancies (26). However, women who have had

a cesarean birth were three times as likely as other women to be sterilized

in the hospital after the pregnancy (28). If the cesarean birth rate

continues to increase as it has during the 1970's, both the rate of sterilization and the proportion immediately following pregnancy will

increase.

From 1967 through 1978, 6.3 million women obtained 7.9 million legal abortions; about one in eight U.S. women of reproductive age has had a

legal abortion. Since the 1973 Supreme Court decisions that declared

restrictive abortion laws unconstitutional, the annual number of legal abortions has increased by 85 percent, but the rate of increase has been

smaller each year (29). In every year since 1972. women who obtained legal abortions were mainly young, white, unmarried, and childless; for many this was their first abortion. Teenagers have nearly one-third of all abortions, but the percentage decreased slightly between 1972 and 1977. In each year since 1973, women obtained abortions at earlier, and thus safer, gestational

ages. Married women are less likely than unmarried women to obtain family planning services from an organized family planning program. In 1976, approximately 13 million currently married fecund women ages 15-44 had made at least one visit for family planning services within the previous 3 years. Four-fifths (84 percent) had gone to their own physician. Even

among married women, a relatively high proportion of teenage women (36

12
percent). black women (37 percent). and Hispanic women (33 percent) had made their most recent visit to an organized program. In 1977, an estimated 4.2 million women in the United States were served by organized family planning programsmore than four times the number served in 1968 when substantial Federal funding for contraceptive services began. The annual rate of growth increased steadily from 24

percent in 1969 to 38 percent in 1972 and then decreased as the growth rate in funding decreased. By 1977 the growth rate was 3 percent, th lowest since 1968 (30-32).

Approximately three-quarters of all patients served by organized family planning programs had low incomes (150 percent of the poverty index) and nine-tenths had low or marginal incomes (200 percent of the poverty index). Over the last decade, patients of family planning clinics have become younger. of lower parity, and better educated (30).

USE AND SOURCES OF MEDICAL CARE

It has often been noted that women are more likely to receive medical care than men and that women of childbearing ages have a great deal of contact with the medical care system. For example, in 1975, 69 percent of the women 25-44 years of age had had one or more contacts with a physician within 6 months and 85 percent had had one or more contacts within a year. The comparable figures for men of the same age were 48 and 67 percent and for children under age 17, 57 and 74 percent (33 and table C). Despite their having so many contacts with physicians, women in this age gt-oup still had problems obtaining medical care. In 1977, adults age 20 or older were asked on the National Health Interview Survey whether they had problems getting medical care and if so what the problems were. Thu: group most likely to have encountered problems were women 20-44

TABLE C. Contacts With Physicians by Children and Adults Under 45 Years of Age: United States, 1975

Contacts With Physicians

Alift

Under 17

Years

17-24

Years

25-44

Years

With at least one contact Percentage of population

Both sexes 74 76 76 Male 74 68 67

Female 73 84 85

Number per person per year Number of contacts

Both sexes 4.2 4.8 5.1 Male 4.5 3.4 3.6 Female 4.0 6.0 6.4

SOURCE: Reference 34.

9

13
years of age. Problems were reported for 13 percent of these women, in

contrast with 8 percent of the women ages 45 and older. For 7 percent cost was the problem and for 4 percent the hours were not good. Eight percent of women 20-44 years of age were prevented from obtaining the care they

thought they needed by access problems (35). In 1978, about 12 percent of the women ages 17-44 had no regular source of medical care. In addition, 29 percent had a regular source of care but did not have a regular physician. Women were less likely to have a regular source if they had no third-party coverage to help pay the cost; about 90 percent of the women with public or private coverage in contrast with 79 percent of those with no coverage had a regular source of medical care. However, 77 percent of the women with private or military coverage but only 59 percent of those with Medicaid and 61 percent of those with

no coverage relied on a private physician as a reguiar source of care. The

reason the women on Medicaid were as likely as women with private

insurance to have a regular source of care is that they relied on outpatient departments (15 percent) or health centers or clinics (8 percent). The American College of Obstetricians and Gynecologists (36) has published standards for the timing and frequency of visits for prenatal

care. Inequalities in the receipt of prenatal care have been well documented against such standards by information recorded on the

certificate of live birth.

Despite public and professional agreement that women should begin

prenatal care early in pregnancy, only three-quarters (74 percent) of all babies born alive in 1977 were born to women who made their first visit

for prenatal care during the first trimester of pregnancy. The situation has been improving; 5 years earlier the comparable figure was 69 percent (37). Nevertheless, those women whose need for care (as measured by the

likelihood of a low-birth-weight baby) was greatestvery young women, older women, unmarried women, black women, and poorly educated womenwere still least likely to receive early care. In 1977, only 32

percent of the 10,000 babies born to mothers under 15 years of age were born to mothers who had made a visit for prenatal care during the first

trimester of pregnancy; 21 percent had not made even one visit by the end of the second trimester. The proportion receiving early prenatal care was higher in each succeeding age group to a maximum of 83 percent of the women 25-29 years of age and then lower again to 63 percent of the women 40 years of age or older. Only 56 percent of the black women 40 years of age or older when the child was born had any prenatal care during the first trimester. Only 45 percent of the women who were unmarried when the baby was born made their first visit during the first trimester. Half of the mothers with no education beyond eighth grade and only 44 percent of the mothers who were under 18 years of age when the child was born made a first visit that early. Young unmarried or undereducated mothers were at a double disadvantage. Only 37 percent of the mothers who were under age 18 and unmarried at the time of the child's birth and 40 percent of those who had not gone beyond the eighth grade received any prenatal care during the

first trimester.

14
While a number of studies have demonstrated that many factors other than prenatal care affect the chance of having a low-birth-weight baby (38. 39). it is worth noting that in each age by race, education, or birth- order category. the proportion of mothers of infants weighing 2.501 grams or more at birth who began care during the first trimester was usually higher and never lower than the proportion of mothers of infants weighing 2,500 grams or less who began care that early. An analysis of 140,000 births in New York City in 1968 suggests that infant mortality can be substantially reduced by identifying women at risk through relatively simple social and medical information collected early in the pregnancy and providing them with appropriate care. "The overall infant mortality rate would have been reduced 16 percent if mothers in each risk category had had the same pregnancy outcome as the other mothers in their ethnic group who had adequate care" (38). Yet the New York City data documented the same misallocation of resources as the national data. Those women at greater than average risk were less likely to receive adequate prenatal care than those women at less than average risk. National data on where women receive prenatal care and who provides the care are scarce. According to the 1975 National Health Interview Survey, there were 32 million contacts (including telephone contacts) during the preceding 12 months (33). According to the National Ambulatory Medical Care Survey, there were 20.9 million visits to office- based physicians for prenatal care and 2.4 million visits for post partum observations in 1975 (40). Thus, approximately three-quarters of all contacts for prenatal and postnatal care were visits to office-based physicians and, assuming that 10 percent of the contacts were by telephone. about four-fifths of the visits were to office-based physicians. That four-fifths of the visits were to office-based physicians does not mean that four-fifths of the pregnant women received care from such physicians. Women who make relatively few visits for prenatal care are also women who are unlikely to rely on a private physician for their care. About three-quarters (73 percent) of the visits to office-based physicians for prenatal care were to obstetrician-gynecologists; three-fifths (60 percent) of the visits for post partum observation were to such specialists. Visits for prenatal care were short-32 percent involved 5 minutes or less with the physician and 69 percent involved 10 minutes or less. There was some diet counseling during 14 percent of the visits and medical counseling during 25 percent. If the data from the National Ambulatory Care Survey are any indication of the amount of time a woman spends with a physician during pregnancy, the total is low. According to that survey on which physicians in office-based practice reported for themselves, the average visit for prenatal care involved 10.7 minutes of direct contact with the physician (41). If the American College of Obstetricians and Gynecologists' recommendations of 10 prenatal care visits were met, the physician spent only 107 minutes over the course of the pregnancy. For the woman who made fewer than 10 visits, there would have been even less time. No data were collected in that survey on whether other health professionals in the office spent time with the pregnant woman.

15
PHYSICIAN SUPPLY AND DISTRIBUTION

Physicians and other health professionals, hospitals and other health

care facilities, are not equally distributed across the United States. It is

important to bear in mind, however, that there can be an oversupply as well as an undersupply of health care resources. Oversupply of resources has been cited as one of the possible reasons for rising cesarean birth rates, for example. Thus, an area that is below the national average for a particular resource is not necessarily at a disadvantage nor is an area that

is above the national average necessarily at an advantage.

It is interesting to examine the relationship between the physician

supply in an area and the timing of women's first visit for prenatal care. In 1975. there were about 40,000 professionally active physicians in the United States including 5.000 in general or family practice and 22,000 in obstetrics and gynecology. Physicians, particularly specialists, were heavily concentrated in metropolitan areas with the heaviest concentration in the large metropolitan areas of the Northeast (42). Overall, in 1975 there were 610 physicians for every 100,000 women of

the childbearing ages 15-44. including 107 physicians in general or family practice and 42 in obstetrics and gynecology. During the 3-year period

1975-77, 6 percent of all babies (5 percent of white aad 9 percent of black) were born to women who received no care or who received their first care

during the last trimester of pregnancy. In the core counties of the large metropolitan areas of the Northeast, there were 1,047 physicians including 69 specialists in obstetrics-gynecolo- gy per 100,000 women 15-44 years of age. However I l percent of all babies and 18 percent of the babies born to black women in this region were born to women who had no prenatal care during the first two

trimesters of pregnancy. In general, women in large metropolitan areas where there were 56

obstetrician-gynecologists per 100,000 women were no more likely to

receive prenatal care during the first trimester than women in medium- sized metropolitan areas where there were only 43. Women in New York State, which had the highest physician-to-population ratio of any State, were less likely to begin care during the first trimester than women in many other States such as Iowa, Ohio, North Carolina, and California where the physician-to-population ratios were much lower. In the North Central region outside the metropolitan areas where there were 328 physicians including 15 specialists in obstetrics-gynecology per 100,000 women, only 4 percent of the white and 9 percent of the black women failed to receive any care during the first two trimesters of pregnancy. In the comparable areas of the South where there were only

286 physicians including 18 specialists in obstetrics-gynecology for every 100,000 women of childbearing age. the proportion of women failing to

receive any care during the first two trimesters of pregnancy was similar- 5 percent of the white and 10 percent of the black women. In part, the lack of a relationship between the physician-to-population

ratio and the timing of the first visit for prenatal cas-f.. #-:nay be a function of

the fact that some physicians in large metropoli,tan areas devote large

16 v,0
amounts of their time to teaching, research, or administration and relatively little to direct patient care. Even allowing for that possibility. however, it is clear that the mere presence of physicians in an area is not a guarantee that women will receive early prenatal care or that there will be equity of access. The large differences that exist in every geographic area in the proportions of white and black women who begin care during. the first trimester are evidence of the lack of equity.

COST AND FUNDING OF MATERNITY CARE

Third-party payment plans for medical care, like all insurance, are designed to pay for the unexpected or unusual event and frequently do not provide much coverage for the "routine" care of pregnant women. (Medicaid programs in 19 States do not pay for the prenatal care of women pregnant for the first time on the grounds that they are not mothers.) The public programs that are designed to provide accessibility

to medical care for low-income people only partly fill the need. Of the married women who had a live birth in 1972, 52 percent had health insurance to help pay for prenatal care and 65 percent had insurance for hospital care (43). Both proportions were substantially

higher than the respective 36 and 59 percents in 1964-66. However, only 27 percent of the married women in 1972 had coverage that paid more than three-fourths of the bill for prenatal care and 40 percent had coverage that paid for more than three-fourths of the hospital bill. Only one-fifth (21 percent) of the married women in families with incomes under $5,000 had any insurance coverage for prenatal care compared with two-thirds (67 percent) of the women in families with incomes of $10,000 or more. Young mothers and poorly educated mothers were extremely unlikely to have health insurance for prenatal care. Although unmarried mothers were not included in this survey, it can be assumed that they were also unlikely to have coverage for prenatal care. In 1975. Muller estimated that between 4.4 and 8.4 million women were not covered for prenatal care and that even among those who were, "more than two-thirds of the covered employees have benefits of under $500" (44).

Although the use of a different data source means that the estimates are

not strictly comparable, data from the 1977 National Hospital Discharge Survey indicate that there has been little change between 1972 and 1977 in the proportion of women who had private insurance to pay for childbirth. Of the 3.3 million patients hospitalized for deliveries in the United States in 1977. 62 percent (2.1 million) listed a private insurance plan as the principal expected source of payment (45). Medicaid was expected to pay for 12 percent and other Government programs for 4 percent. Still, 18 percent of the women hospitalized for deliveries expected that they or their families would be the principal source of payment. The passage of P.L. 95-555 in late 1978 that amended Title VII of the Civil Rights Act to prohibit sex discrimination on the basis of pregnancy means that the proportion of women who have private health insurance to

17
help pay for childbirth should increase as health insurance contracts are

renegotiated. That change in law is not reflected in these data. Adequate prenatal and hospital care can be expensive. If there are

complications, costs increase. The direct monetary cost of normal delivery

in Jacksonville, Fla.. in 1972 was estimated to be $792 in the private sector and $546 in the public sector (46). Of the total, $350 was for physician

services in the private sector and $122 in the public sector. A cesarean

birth, which at that time was relatively rare, added $687 to the cost in the private sector and $498 in the public sector. The average cost of a delivery

in Jacksonville in 1972 was $750. Five years later the Health Insurance

Institute estimated that the cost of having a baby was over $1,400

including normal newborn care, which was not included in the earlier study (table D). The rise in maternity care expenditures is due to rising prices and a

change in the services. In general, close to 70 percent of the increase in all medical care expenditures for all ages over the past few years has been due

to rising prices. 7 percent to population changes, and the rest to the

increasing intensity of services (48). Muller's 1972 estimate of $750 for the average cost of having a baby assumed that 5 percent of all deliveries were cesarean births. Nationally. the proportion at that time was 7 percent, but by 1978 the national proportion had risen to 15 percent. Simply changing

the proportion of cesarean births from 5 to 15 percent and assuming no

change in prices would increase the estimate of the private sector cost by $70 to $910. Fetal monitoring and increased use of laboratory and

diagnostic tests would also add to costs even in the absence of a price

increase.

At the same time, prices have risen. While the Consumer Price Index

increased by 87 percent from 1970 to 1979, the price of medical care

TABLE D. Tho Cost of Having a Baby: 1977

Hospital Room and board

(3.3 days @ $102.00 /day) $336.60 Nursery

(3.3 days @ $60.00/ day) 217.80

Labor room 79.00

Delivery -oom 153.00

Circumcision setup 10.00

Pharmacy (mother and baby) 39.00

Laboratory (mother and baby) 53.00

Subtotal $888.40

Medical

Attending physician's complete obstetrical charge 5351.00

Circumcision 29.00

Anesthesia 100.00-150.00

Pediatrician's newborn care 38.00

Subtotal $518.00-$568.00

GRAND TOTAL $1.406.40-S1.456.40

SOURCE: Reference 47.

18 3.1
increased by 99 percent. Physicians' fees were twice as high and the price of a hospital room two and a half times as high in 1979 as in 1970. The hospital room a nd board that cost $336.60 in the table above would have cost $416.17 " '7. the physician's charge would have been $415 instead of $351. Thc . ; Iceases were relatively less, however, than they were in the mid- 'n.: t1 physicians' fees and hospital prices were rising more rapidly '. ....crc in the late 1970's. Even the rate of increase in the fees of obstetricians, which have increased more rapidly since 1970 than the fees of other physicians providing primary care, has slowed. In 1970-73. the average annual increase was 11.4 percent; in 1975-78, it was 8.2 percent. By 1978. the average fee for an initial visit to an obstetrician- gynecologist was $29.85 and the fee for a followup visit was $18.23.

NEWBORNS AT RISK

From 1950 to the mid- 1960's, there was a gradual increase in the proportion of low-birth-weight babies, followed by a general decline to a proportion just below the 1950 level. During the entire period 1950-76, the proportion of low-birth-weight babies was consistently higher among nonwhite infants and the difference increased with time. By 1976, the proportion of low-birth-weight babies was 6.1 percent for white infants, 13.0 percent for black infants, and 6.9 percent for infants of other races (39). While age of the mother and birth order are associated with low birth weight, the decline in the proportion of low-birth-weight babies from 1966 to 1976 was not due to a change in the maternal age-birth-order distribution.

Black babies were far more likely than white babies to be of low birth weight when born at full term (6.3 vs. 2.8 percent), but at gestation ages before 36 weeks, black babies were less likely to be low birth weight (39). Children of mothers who smoke dur'ng pregnancy are at increased risk. The evaluation and review of the literature in the chapter "Pregnancy and Infant Health" in Smoking and Health document the adverse effect of smoking during pregnancy on survival, birth weight, health, and develop- ment of the newborn (49). The adverse effects of cigarette smoking are the best documented but other aspects of the mother's behavior during pregnancy such as patterns of food and alcohol intake are increasingly being studied as they are suspected contributing factors in increasing the risk to the child.

The incidence rates of certain severe birth defects, particularly chromo- somal abnormalities, increase with advancing maternal age. Many of these can be diagnosed prenatally. In one analysis, the effect of using prenatal diagnosis and elective abortion for severe chromosomal anomalies and neural tube defects was found to reduce the risk of women 35-44 years of age having deformed children to a level comparable with that for younger women. For women 45 years of age and older the risk was substantially reduced but remained two times greater than that for women 34 years of age and younger (50). A decline in the incidence at birth of babies with neural tube defects in England and Wales between 1974 and 1977 was

19

aTh

it:.)
partly attributed to antenatal diagnosis and the availability' of abortion

(51).

CHILDREN BORN TO UNMARRIED MOTHERS

New unmarried mothers are in many ways at a disadvantage with

respect to raising a child. First, in the majority of cases the unmarried women giving birth are very young: in 1975, more than 52 percent were 20 years of age or under. and 29 percent were 17 years of age or under (52). They may not be fully mature physically or emotionally. More likely than not they have not completed high school, and the chances of their doing

so after the birth of a child are slim, particularly if they keep the child. A

1971 study of a national sample of teenage women showed that, among

those with an illegitimate first birth, 86 percent had kept the babies and were still living with them at the time of the survey (53). Such women are

less prepared to provide for a child's growth and development than are married mothers. Of the married women who gave birth in 1975, only 13

percent were teenagers (52). Data from other studies indicate that "there are indeed differences in

the life chances of legitimate and illegitimate children" (54). Using data

from California. Berkov and Sklar found a declining level of adoption of children born out-of-wedlock, a pattern of fewer subsequent marriages among unmarried mothers, and fewer stable marriages among those who

did marry. They also found a higher risk of an illegitimate child's dying in

the first year of life. Although mortality rates for infants under 28 days

(neonatal period) were higher than rates for infants of 28 days to I year of age (postneonatal period), the differential by legitimacy status was considerably greater in the postneonatal period, indicating that "once outside the hospital, the children are exposed to economic and social conditions that negate advances (in parental. obstetrical, and neonatal

intensive care) and reduce their life chances." There was also evidence

that childbearing by unmarried women was more likely among poverty

than among higher income populations. The disadvantage to the child appears to be greatest early in life. While

a sizable reduction in the levels of fetal death has occurred for babies born

to both married and unmarried women and the differential between the

two groups has declined, the ratio of fetal deaths to live births was still 56 percent higher for unmarried than married women (15.9 vs. 10.2 fetal deaths at 20 weeks or more gestation per 1,000 live births) in 1975 (55). Overall, in 1975. the proportion of low-birth-weight infants among babies born to unmarried women was about twice as high as the proportion among babies born to married women (12.9 vs. 6.5 percent). The unmarried mothers were younger, were less likely to have received

early prenatal care, and had fewer visits for care (7.4 vs. 10.0) (55). Each of these factors independently contributed to the risk of the infant's having low birth weight. However the differences in the incidence of low

birth weight between infants born to married and unmarried women

persisted even after the data were controlled for race, age of mother, educational attainment of mother, month prenatal care began, and live

20 366
birth order. although the magnitude of the difference was reduced. The high overall difference is due to the multiple risk of women who are unmarried. young, and undereducated.

Because half of all births to unmarried women are to teenagers ( II), the focus of concern is on these young women and their babies. Adolescents and older teenagers arc the only age group to show a consistent rise in illegitimacy rates during the 1970's. Unmarried women giving birth especially adolescentsare likely to need not o ply special medical care but also social support. Areas of the country where a high proportion of the births are to unmarried mothers face a heavy burden if they are to provide the necessary financial and social supports. In 6 of the 39 reporting areas that indicated marital status on the birth certificate in

1976. 20 percent or more of the births were to unmarried women.

MORTALITY RATES

In 1978. there were 3.333.279 live births, 45.945 infant deaths, and 321 maternal deaths reported (11. 56). The conditions surrounding childbirth have greatly improved over the past 50 years. In 1930. 65 out of 1.000 babies born alive died before their first birthday (57). Twenty years later, in 1950. the rate was less than half that-29 per 1.000. During the following 20 years, the rate of decline was much slower; in 1970. the infant mortality rate was still 20 deaths per 1,000 live births. For reasons only partly understood, the rate again began

to decline rapidly, until by 1978 the inh.nt mortality rate was 13.8 deaths under 1 year of age per 1.000 live births. The decline is continuing; the provisional infant mortality rate was 13.0 in 1979 (58). Data for the 12 months ending in July 1980 show the rate to be 12.8-3 percent lower than

the rate of 13.2 for the comparable period ending July 1979 (18). In 8 years. the infant mortality rate dropped 32 percent. More than

21.000 babies survived in 1978 who would have died if the 1970 rate had

prevailed; about 52,000 babies lived who would have died according to the 1950 infant mortality rate, and 171,000 survived who would have died had the 1930 rate prevailed. The recent decline in deaths (1970-78) has been phenomenal (38 percent) for the first 7 days after birththe time when the risk of death is greatest; 58 percent of all infants who died in 1978 died during the first 7 days (56). These are deaths that can often be prevented by good prenatal care, by appropriate care for the woman at high -risk of having her child die, and by first-rate care during delivery and immediately after birth. Part of the improvement is due to relatively fewer births to women who are at high risk because of age or parity; part is due to technical improvements

in medical care and to regionalization of maternal and neonatal services.

The decline in deaths in the postneonatal period (28 days to I year), when the environment in which the child lives is more important. has not been as greatonly 14 percent from 1970 to 1978. Equally striking has been the decline in maternal mortality. In 1950, 83.3 women for every 100,000 live births died from complications of

21

3
pregnancy. childbirth. and the puerperium (39); in 1978. 9.6 women died. The rate for 1978 is 54 percent lower than the rate for 1970. There is. however, no reason to believe that infant and maternal mortality rates in the United States arc as low as they can be. For example. the infant mortality rate for black infants was 93 percent higher

than for white infants in 1978; the rate during the first 7 days was 89

percent higher. If the infant mortality rate for black infants had been as

low as that for white infants. 6.129 of the 12.747 black infants who died

that year would have lived. Analyses of infant mortality rates for different areas of the country

reveal how much variation there is within the United States and give

further indication of the possibility for improvement. In 1978 the infant mortality rate in the South was 26 percent higher than the rate in the West

and the neonatality rate was 35 percent higher. Even within regions. there was great variation among rates in neighboring States. Data being collected as part of an evaluation of the efficacy of regionalization of services to ensure that all pregnant woman and their newborn children have rapid sure access to an appropriate level of care

indicate that not oil , mortality but morbidity can be prevented. Neonatal intensive care units, the most complex component of a regionalized

system. are expensive the cost per patient day averages over $500 and bills for a high-risk pregnancy and birth in the $20,000 range are

considered normalwhich is one reason the approach is being so

carefully evaluated (60). The data published so far show that the magnitude of significant morbidity is substantial among all infants

including those of normal birth weight but that there is an important parallelism between the risk factors for death and those for morbidity in

surviving infants (61). Reducing the risk of mortality should also reduce

the risk of morbidity. Some of the variation in rates may be due to the uneven distribution of

medical resources and access t.:,) them. However, the data cited above in

this report do not reveal an association between physician-to-population

ratios and the timing of a woman's first visit for prenatal care. Such data give no indication of the quality of care provided even for those women

who did receive care. Similarly, the ratio of hospital beds to population

gives no indication of the quality of care received in the hospital. Currently. about 99 percent of all births occur in hospitals in contrast to

56 percent in 1940. However, in 1976. 28 percent of all hospital deliveries were in hospitals with no premature nursery and 17 percent were in

hospitals with no blood bank. Urban hospitals were much more likely to

have these facilities; 80 percent of the babies born in urban hospitals but only 48 percent of those born in hospitals outside metropolitan areas were born in a facility with a premature nursery (62). While there has been a great increase in the proportion of women

receiving prenatal care and a shift toward earlier care, an increase in the proportion of births in hospitals. and improvement in the technical capability for safer childbirth, many mothers do not receive adequate

prenatal care and children are still born in hospitals that are not equipped

for emergencies during delivery or for care of a premature newborn.

22

-) r}

......: %...)
Factors Associated With the Decline

in Infant Mortality

One of the objectives of maternal and child health programs and of

family planning programs has been to reduce the proportion of births to

women in high-risk categories and to help women have children when it is best for mother and child. Approximately 27 percent of the decline in

infant mortality from 1964 through 1974 can be accounted for simply

because of changes in the age and live-birth-order distribution assuming no change in the specific mortality rates (63). During this period, 30

percent of the decline in mortality rates for white infants but only 19

percent of the decline for black infants was due to a change in the age and

live-birth-order distribution (64). Estimates by Lee et al. (65) indicate that 14 percent of the decline in neonatal mortality between 1950 and 1975 can

be attributed to changes in age -parity distributions. Estimates have also been made of the potential reduction in the U.S. infant mortality through family planning (66). Under family limitation

assumptions alone, the potential direct reduction through family planning

services is about 10 percent, with postneonatal mortality more responsive

than neonatal. Under optimal assumptions of family size, spacing of births, timing of the first birth, and termination of the reproductive period, infant mortality might be further reduced by as much as 30 percent. A relationship between family planning services and postneonatal mortality was shown in North Carolina in 1974. Family planning patients had a 50 percent lower postneonatal mortality rate compared with

controls matched for maternal age, race, marital status, education, number of living children, and number of dead siblings (67). Burnett's

findings are consistent with the hypothesis that children of family

planning patients may be desired more and better timed and consequently mothers and children may receive better care. There are conflicting reports on the contribution of abortion to the decline in infant and maternal mortality. From 1969 to 1975, liberalized

abortion was found to be associated with decreases in prematurity rates, fetal mortality rates, and birth rates in Oregon (68). Similar trends were

demonstrated in New York City following legalized abortion (65). Bauman et aL (69) found no significant association between levels of abortion-to-birth ratios and trends of fetal and infant mortality rates in

the United States from 1967 to 1973.

Medical care and appropriate facilities to care for mother and child can make a difference in the child's chance of survival, and their contributions

are extremely important. Low-birth-weight (2,500 grams or less) babies are a group at far greater risk of death than babies who weigh more at birth. Prompt attention for these children so that they survive the first few days after birth can do much to reduce infant mortality. In a collaborative study of seven countries in which the United States was represented by five States, the United States ranked third in the proportion of low-birth-weight babies and sixth in perinatal mortality

rates (70). After the perinatal rates were standardized for birth weight, the United States had the lowest perinatal mortality rate of the seven

39

23
countries. Standardization for duration of gestation for the five countries

for which data were available also yielded the lowest rate for the United

States (table E). Assuming that the States included in the study were

representative, if the United States had had the same distribution of birth

weights as Sweden, the perinatal mortality rates would have been lower in

the United States.

Early neonatal mortality rates (deaths under 7 days per 1.000 live births). which are one component of the perinatal rate. for low-birthweight infants had been fairly stable from 1950 to 1964 but then decreased

sharply by 1973-74. In an analysis of data from the same five States, it was found that 15 percent of the reduction was due to a change in the age and

live-birth-order distribution (71). Seventeen percent of the decline for white babies but only 3 percent of the decline for other babies could be

attributed to changes in birth weight. The decline in mortality among low- birth-weight infants accounted for 53 percent of the decline in early neonatal mortality for white infants and 64 percent for other infants over

that timc. Improved survival during the early neonatal period was not merely a postponement of death to later infancy; rates declined for older infants as well.

TABLE E. Cross-Nation& Comparison of Birth Weight and Pertsatal Mortality Rates

Country

Observed

Perinatal

Mortality Rank

Rats Order

Percerd of

Wants weights,.

Lees Than

Z000 Grams

Perinetel

MerleMy RIND Standaedlasid tor Rook

SIM Weight Order

Hungary 29.1 1 10.8 16.6 5 Cuba 26.9 2 10.8 20.1 1 Austria 21.4 3 5.7 18.2 3 New Zealand 17.3 4 5.2 17.3 4

Japan 17.0 5 5.3 18.9 2 United States (part) 14.9 6 6.0 11.7 7 Sweden 12.6 7 3.9 14.5 6

SOURCE Reference 7O

24 11
CHAPTER 3

ENVIRONMENTAL AND SOCIAL

FACTORS INFLUENCING HEALTH

This chapter provides an introduction to the extrinsic influences on

child healthenvironmental and social factors that are gaining increasing

attention. Almost regardless of the child's health status at birth, the physical environment and social milieu in which he lives can serve either

to enhance or reduce his potential. A child's health is determined by many factors including heredity, the mother'sand to a lesser extent the father'sbehavior patterns and

health status, the intrauterine environment and conditions of delivery, as well as other factors that influence children directly. Children in the United States are not born equally healthy or with equal opportunity to achieve and maintain good health. Infants born with a major malformation, prematurely, or at a low birth weight, those injured

at birth, and those born to a mother with a sexually transmissible disease

or a drug addiction come into the world with a distinct disadvantage. Children born to parents who are poor or who are poorly educated are also at a distinct disadvantage. There are many more of these children

than there are children born with a physical disadvantage. In 1975 for example, 7 percent of the children born were low-birth-weight babies (39); 17 percent of the children under 18 years of age (10.7 million) were living

in families classified as being below the poverty level (72). There were 7.7 million children and youths living in families with incomes below $5,000

and one-third (22.5 million) were living in families whose head had not completed high school.

INCOME AND POVERTY

Children are more likely to be living in poverty than people of any other age. In 1978, 16 percent of all children, including 11 percent of white children, 41 percent of black children, and 27 percent of Hispanic

children, were in families below the poverty level. Knowledge about the health of these children and their use of health services is vital if public programs are to operate effectively since the public programs designed to

improve health by increasing access to medical care are heavily oriented

toward low-inconie 'populations.

25
In general, children are in families with relatively low incomes simply because children are born to young parents who have not vet achieved

their full income potential. Half of all births (51 percent) in 1978 were to women under 25 years of age, and married women 25-29 years of age had already had two-thirds of the births they expected to have. Income levels are low and poverty rates are high when the family head is young. In 1977 for example, when 9 percent of all families were below the poverty level, 20 percent of the families with a family head under 25 years of age were below the poverty level (73). Relatively little is known about how many children are born into poor families. Probably the most recent national data were obtained from the 1972 National Natality Survey. While the survey undoubtedly underesti- mates the extent of poverty because births to unmarried women were excluded, it does furnish information on the relationship between the family's income and health and medical care at the beginning of the child's life. Approximately 30 percent of the married women whose babies were born in hospitals that year were from families whose incomes were under $7,000 the year before the baby was born; 11 percent were from families with incomes under $4,000. Mothers in the lowest income category were no more likely than other mothers to have underlying medical conditions or complications of pregnancy; they were more likely to have complications of labor (74). They were significantly less likely to begin care during the first trimester of pregnancy and had, on the average, fewer visits for prenatal care (46 percent had 1-9 visits), although they were no more likely to have no prenatal care (75). Their children were more likely to be born prematurelybefore the 37th week of gestation and, if born at or near term, were more likely to weigh 2,500 grams or less. In 1972, 7 percent of all babies born in hospitals to married women were low birth weight, but 11 percent of those born into families with yearly incomes under $4,000 were low birth weight (76). In a study of women in their late twenties, Hofferth and Moore (77) found a significantly lower income among women who began childbearing early. The difference amounted to about $1,000 a year less income for each year of decreased age at birth of the first child. Considerably more is known about children than about infants. The income distributions derived from the 1975-76 National Health Interview Survey, the source of much of the data on children's health and use of health services that follow, are shown in table F. Sixty-one percent of all children and youths whose family incomes were known lived in families with incomes under $15,000 at that time; 13 percent (about 8 million

children) lived in families with incomes below $5,000. Preschool children were much more likely to live in low-income families than older "hildren. Parents in poor families perceive their children's health as being Children in low-income families (under $5,000 in 1975-76) were 3.5 times as likely as children in high-income farnilic, ($15,000 or more) to be judged as only being in fair or poor health. They were also 1.5 times as likely to be limited in activities such as playing or going to school because of a chronic condition. On the average, the low-income children had 3 more days of restricted activity and lost 2 more days of school (i.e., 40

26 42
TABLE F. Children and Youths Under 18 Years of Age, According to Age and Family Income: United States, 1975 -76 Annual Average

A911

Total

Under Under 6 6-11 12-17 Family Income 18 Years Years Yearn Years

Percent distribution

All incomes 100.0 100.0 100.0 100.0 Under $5.000 12.7 15.3 12.4 10.9 55,000-59.999 22.4 25.4 22.5 20.0 S10.000-514,999 25.7 28.6 25.8 23.5 $15.000-$24.999 27.5 23.9 27.8 30.0 325.000 or more 11.7 6.8 11.4 15.7

SOURCE: Reference 35.

percent more school days) each year than children in families with $15,000 income or more.

Half of the low-income children examined as part of the National Health and Nutrition Examination Survey in 1971-74 had decayed teeth needing treatment (78). The need for dental care, however, was high for all children. The examining dentists estimated that 53 percent of all children and youths ages 1-17 and 68 percent of those who were adolescents needed dental care; 59 percent of the low-income children

and youths and 78 percent of the low-income adolescents needed dental care. In the same survey almost a quarter of the people 6-19 years of age were found to have significant eye abnormalities (excluding refraction errors) and about 5 percent needed treatment. Income differentials for eye problems. while they did exist, were not large (78). In analyzing data from the National Health Examination Survey from the late 1960's, Grossman (79) found that, while low income was associated with some of the measures of poor health in children, the magnitude of the difference was reduced when other related socioeconom- ic variables were held constant. For four of the six health measures studied. differences in the parents' level of education accounted for as much of the difference as did income itself. Such a finding is consistent with other data reviewed ir. this report. In general, chikiren in low-income families are less likely to have a

regular source of medical care, less likely to have received any medical care during the year and much less likely to have received care from a private physician. They are, however, more likely to have been hospitalized and, if hospitalized, to have remained in the hospital longer. Only 80 percent of the low-income children in contrast to 93 percent of the high-income children were reported by their parents to have a regular source of care in 1974 (table G). Eighty-seven percent of the children in families with incomes of $1 5,000 or more had a private physician as a

regular source of care; 61 percent of the children in families with incomes of $5,000 or less had such a source. Of those children and youths who had

27

'13
actually made a visit for medical care during the year, 73 percent of the high-income but only 47 percent of the low-income children had received

all their medical care from a private physician; 4 percent of the highincome but 22 percent of the low-income children and youths received all of their care in an institutional setting. While a visit to a physician means that the child actually went to the physician (home visits are negligible), a contact with a physician is defined

in these data to include telephone contacts. It is interesting that 20 percent of all contacts for high-income children were by telephone compared with

I 1 percent for the low-income children (table 0). Even though they were younger on the average, children in relatively

low-income families (under $10,000) were less likely to have had a medical contact of any kind during the year than children in higher income

families. About 70 percent of the children in families with incomes under $5,000 or $5.000-$9,999 had had a medical contact during the year compared with 78 percent in families with incomes of $15,000 or more in 1975-76. If they did have at least one contact, the children in the lowincome families had, on the average, more contacts than children in

families with incomes of 55,000 59,999.

The low-income children were also more likely than other children to be hospitalized and, if hospitalized, to remain in the hospital longer. In

TABLE G. Source of Medical Care for Children and Youths

Under 18 Years of Age, According to Family

Income: United States, 1974

Source of Medical Care

Family Income

Under

$5,000

$15,000 or More

Percent of children and youths

With regular source of care 80 93

Private office 61 87

Regular physician 61 85

Regular pediatrician 15 36

With no visit for care 36 26

Total with a visit for care 100 100

To private physician only 47 73

To institutional setting only 22 4

To both 31 23

With no contact for care 29 22

Percent of contacts

Total 100 100

In doctor's office 56 67

In hospital clinic or

emergency room 23 9

In other place 10 4

By telephone 11 20

SOURCE: Reference 35.

28
1975-76, 7 percent of the children and youths in families with incomes under $5.000 had been hospitalized during the year; there were 6.1

hospital days for each 100 children in this income group or 83 days for each child hospitalized. Five percent of the children and youths in families with incomes of $15,000 or more had been hospitalized; there were 1.9 hospital days for each 100 children in this income group or 3.9 days for each hospitalized child. Children and youths in low-income families are far more likely to be

living in housing with structural deficiencies or incomplete plumbing than

those in families with more income. In 1977, 13 percent of the children in

families with incomes of $5,000 or less lived in housing where the roof

leaked, 17 percent lived in housing where there were cracks or holes in the

walls or ceilings. Eight percent lived in housing with incomplete plumbing, and 4 percent had no _piped-in water. Leaky roofs, holes in walls, and

incomplete plumbing were rare in the housing of children in families with

incomes of $15,000 or more.

The poor children were also more likely to be living in neighborhoods where traffic was heavy, streets needed repair, and there were rundown housing and abandoned structures. Inadequate housing, incomplete plumbing, and crowding contribute to the spread of contagion and infection. Infection rates of measles and

rubella, for example, are higher in poverty areas than in nonpoverty areas. Heavy traffic and rundown or abandoned structures contribute to

accidents and injuries. The poor quality of housing and neighborhoods is

an environmental risk for poor children.

CHILDREN WITHOUT FATHERS

In the national data collection systems of the Federal statistical agencies

(and in the tables in this volume), children are classified as living "with both parents," "with mother only," or "other." The implication is that the

children with both parents are with their own biological parents but that is not true for all these children. Many are with two biological parents but others are with one biological parent and one step parent and some are adopted. For example, data from the National Health Interview Survey show

that in 1975-76, 80 percent of the children 6-11 years of age were in two- parent families. However, data from an independent non-Federal survey

show that more than one-fourth of elementary school-age children were

not living with their biological fathers in 1976 (the proportion was more

than half for black children). Less than cane -third of the children whose parents were divorced or separated saw their fathers regularly (80). Similarly, children living with a mother only may have been born to a woman who never married or they may be living with a mother whose marriage was disrupted through divorce, separation, or death, and there may or may not be other adults in the household in addition to the mother. Finally, as adults marry and divorce, the child is moved from one family structure to another and may make several transitions before

reaching age 18. Most divorced mothers of young children do remarry;

29
thus the same child may be in a two-parent, mother-only, or a different

two-parent family depending on the point in time. The transitional nature of family structures that a child may live in while growing up. coupled with the lack of distinction among the family

structures as they are defined, may partially explain why differences between children of married and unmarried mothers which were so

evident at birth are much less evideni in childhood and adolescence.

Although there is little evidence that going through a divorce or living with only one parent affects the physical health of the child per se, there is evidence that the child's emotional well-being is affected. Elementary

school-age children whose parents were separated were more likely than others to have gotten into a fight at school (80). Children in one-parent families were, according to administrative records of 14 schools, more

likely to be low achievers. late to school, truant, or subject to disciplinary

action than children in two-parent families (81). A study of children who were first observed soon after their parents divorced, then 1.5 years later, and again 6.5 years later found that many of them were still in various degrees of turmoil the third time they were observed (82). Utilization of mental health facilities is higher among children of divorced or separated parents than among children of married parents. However, it is not

possible from the utilization data to determine whether divorce created the need for mental health care or was the occasion for seeking and receiving

care. Utilization data are, at best, an indirect measure of health and at

worst a biased one.

In contrast, in a 1978 study examining the effects of the presence of a man on mothers and their 2.5-4-year-old children in a sample of black

and Hispanic people in New York City, Philliber and Rothenberg (83) found little to indicate that the presence or absence of a man had any

important effect on child-related outcomes. The emotional and verbal responsiveneF., of the mother to the child, the opportunities of the child for stimulation, and the measures of child health and development were all unaffected.

Childrer and youths without fathers in the household were twice as

likely as children with both parents (7.9 vs. 3.6 percent) to be reported as being in fair or poor health in the 1975-76 National Health Interview

Survey. Possibly, an emotional component exists in this measure of health

status: differences between the two groups of children were not as great for other measures of health status. For example, children living without fathers were somewhat more likely than children living with two parents

to be limited in their ability to carry on their major activity (2.9 vs. 1.7 percent), but the difference is small enough to be accounted for by the older ages of the children without fathers. Children and youths without fathers in the household also had, on the average, 2 more days of

restricted activity and I more day lost from school per year than children with two parents. It is important to remember that children in households without fathers are more likely than other children to be in families that are poor. Women

earn less than men on the average and women raising children alone have

an additional disadvantage trying to achieve an adequate income. In 1978,

30
51 percent of the children in families headed by women in contrast with 8

rercent in families headed by men were living below the poverty level. The measures of health status are all negatively associated with income, and the slightly lower levels of health for these children cannot be attributed simply to the absence ofa father.

The proportion of children who had seen a doctor during the year and the number of visits during the year were about the same for both groups of children. Children without fathers are as likely to receive medical care as children with fathers even though the former are poorer, because in many States Medicaid covers poor children without fathers but not those with father s.

Dental care, however, is associated with family income, and children without fathers were less likely to have received dental care during the year. Only 56 percent of the children 4-17 years of age who did not have fathers in the household in 1975-76 had made a visit to a dentist during the year compared with 64 percent of those with fathers. Dental care is not as well covered under public programs as medical care is. It often has to be paid for out-of-pocket and may be foregone. Fmally, the children without fathers present were more likely to have been hospitalized and to have spent, on the average, twice as many days in the hospital as children with two parents. The probability of being

hospitalized is negatively associated with income; that is, poor children are more likely to be hospitalized and have longer stays than wealthier children. However there may be an additional factor: doctors may be more likely to hospitalize a child and mothers may be more likely to have the child remain hospitalized when conditions for caring for the child at home are poor. Children without fathers are less likely to be cared for by a parent during the day. While 83 percent of the 3-13-year-old children whose mothers were married with a husband present were cared for by a parent in 1974-75, only 68 percent of the children of formerly married and 70 percent of the children of never-married mothers were cared for by a parent during the day. The housing conditions for children in families with a woman as head of the househ."Id arc more likely to be inadequate than the conditions for children in husband-wife families. In 1977, children in families with a woman as head were more likely to live with peeling paint, broken plaster, cracks in walls or ceilings, holes in the floor, or leaking roofs than children

living in husband-wife families. A third of the former and about a fifth of

the latter group (33 vs. 22 percent) lived in housing with one or more such deficiencies.

Conditions outside the home were also likely to be worse. Heavy traffic and street noise, for example, were reported more frequently, and the desire to move because of those and other neighborhood conditions were reported twice as frequently for children in households with a woman as the head as for husband-wife households (84).

Conversely, services such as public transportation, schools, shopping, police, hospitals, and health clinics were not perceived as being worse when the household had a woman as a head. For example, 16 percent of

31
the children in families with a woman as head and 18 percent of the

children in husband-wife families lived in neighborhoods where hospitals and health clinics were felt to be inadequate. The evidence is mixed for children and youths who are not living with

fathers. Differences in physical and emotional health status and in

cognitive development are small if they exist at all and may largely be attributed to the relatively low economic and educational levels of the mothers and to the poor housing and neighborhood conditions in which

the children live.

RACE AND ETHNICITY

In the United States, black children as a group are still at a

disadvantage. From the limited amount of data available it appears that Hispanic children are also disadvantaged. American Indian children are not at a disadvantage early in life as measured by the proportion of low- birth-weight babies and infant mortality rates but mortality rates are high

in childhood. Children of Oriental background have extremely low infant mortality rates, but little is documented about how they fare later in life. Because black children are the largest racial minority group of children

(Hispanic children are rapidly becoming the largest ethnic minority), every effort has been made in this volume to show them as a separate

category. With double the chance of weighing 2,500 grams or less at birth

and almost double the chance of dying in infancy (39), black infants start

life at a disadvantage. They are less likely to receive the health benefits of breast feeding. They are, in addition, more likely to be born to mothers under 18 years of age, to unmarried mothers, and/or to mothers who have not completed high school (11). Such mothers may have more difficulty

caring for their children especially since they are also more likely to be

poor. Black children and youths are less likely to have received medical care within a year, and if they received care, it was more likely to be received in a hospital outpatient clinic. Just over half (55 percent) of the black

children and youths had a regular physician and only 19 percent had a pediatrician as a regular physician in 1974. The comparable numbers for white children were 82 percent and 29 percent. Only 4 out of 10 black

children ages 4-17 had visited a dentist within a year compared with more

than 6 out of 10 white children. Black preschool children were less likely

than white children to have received the recommended series of

immunizations.

Although black children were more likely to be perceived as being in

fair or poor health than white children, they were no more likely than white children to be reported as limited in activity because of health or to have had days when their activity was restricted, they stayed in bed, or

they missed school because of illness. On the average, they had about the

same number of missing, decayed, or filled teeth as white children at elementary school age and fewer at adolescence. If they did have decayed

3

32
teeth, however, the proportion that had been filled was lower for black children and youths. Black children and youths are more likely to live in housing with

incomplete plumbing, leaky roofs, cracks, or peeling paint and are more likely to live where there is street crime, litter, rundown housing, or abandoned buildings. They are more likely to be behind in school or to drop out altogether (85, 86). At the end of adolescence, if examined for the draft in 1972, black youths were more likely to be rejected. Data on Hispanic children were not available when this volume was prepared. There have been problems in defusing who should be included as Hispanic and there has been a lack of population controls to be used in generating national estimates. Data from the 1975-76 survey carried out by the Center for Health Administration Studies of the University of Chicago indicate that people of Spanish heritage living in the Southwest were less likely than the total population to have health insurance or a regular source of care and were less likely to have seen a doctor or a dentist (87). Data from the 1976-78 National Health Interview Survey indicate that Hispanic people in general were less likely to have contacted a physician or visited a dentist within 12 months (88). Although these data are not specifically about children, there is no reason to assume that differentials in access that exist for people of all ages do not also exist for children.

PARENTS' LEVEL OF EDUCATION

Among the important socioeconomic variables is education. Neverthe- less, far less attention has been paid to associations between the parents' education and the health and care of the child than to the associations between the parents' income, marital status, or race and the child's health and health care. The question of whether there are associations between parental education and the health of children is important because there are more children with parents who have not completed 12 years of education than there are children below the poverty level, in one-parent families, or of racial minorities.

In the mid-1970's, 22.5 million childrena third of the children under 18 years of agewere in families whose head had not completed high school. Just about half of these children and youths, 10.9 million, were in families whose head had not gone beyond the eighth grade (table H). Children in poor families, single-parent families, and black families are more likely to have poorly educated parents (orjust a mother) than other children. There is an interaction among these factors, but parental education is not just a surrogate for other measures of socioeconomic status; it exerts an independent effect. For example, a cross-tabulation from the 1975-76 National Health Interview Survey (which is the source of data for many of the tables in this volume) showed that children of highly educated mothers were more likely to receive medical or dental care than children of mothers with little education regardless of the

33
TABLE FL Children and Youths Under 18 Years of Age, According to Age and Education of Household Head: Wailed States, 1975-76 Annual Average

Education of

Household Heed

Age

Total

Under

18 Years

Under 6 6-11

Years Years

12-17

Years

Percent distribution

Total 100.0 100.0 100.0 100.0

0-8 years 16.8 13.0 16.7 19.9

9-11 years 17.6 17.0 17.6 18.0

12 years 35.4 36.7 35.2 34.7

13-15 years 13.7 15.8 13.9 12.1

16 years or more 16.3 17.5 16.5 15.1

SOURCE: Reference 35.

family's income or whether the child lived with a mother only. A child with a poorly educated mother in a high-income family was no more likely

to have received care than a child with a poorly educated mother in a lowincome family. Such cross-tabulations are not presented in this volume. However, all of

the tables in section H. which were prepared especially for this volume, present data by both family incorr (or poverty status) and education of

the family head. The differential b.....ween the lowest and highest education

category is larger than the differential between the lowest and highest

income category on all measures that relate directly to children but one

the quality of housing, for which the income differential is larger. In part

the smaller differential by income could be considered as evidence that the public programs designed to reduce income differentials are effective. A special tabulation ranking the predictive value of six control variables

(education_ ethnicity, family size, income, sex, and age) for nine outcome measures for the child was prepared from the 1976 National Survey of Children by Child Trends, Inc. (80). For seven of the nine outcome measures (vocabulary, school performance, practical skills, misbehavior according to the child, the child's feeling of rejection by parents and

rejection by peers, and the child's level of fears and worries), parental education ranked higher than family income and in most cases it was either the best predictor of all the control variables or was a much better predictor than income. Only for the parental reporting of the child's misbehavior and the child's self-esteem was income more important. The importance of parental education to the physical and emotional health of the child and the receipt of health services for pregnant women

and children does not mean that we must demand high levels of education

for all parents. It does mean that providing special outreach and support services, not just financing medical care or putting clinics or medical care personnel in an area. may be necessary to help parents with little

education make appropriate decisions about caring for their children and

themselves.

34
OTHER FACTORS AFFECTING HEALTH

Immunization

The best estimates available are that 9 out of 10 children who entered

kindergarten or first grade in 1978 had been immunized for measles, rubella, mumps, diphtheria, and tetanus. Only a few States reportedly had

immunization levels below 90 percent for these diseases. Immunization

levels for school-age children appear to be higher than they were in 1976, although because the reporting system for children entering school was only introduced in 1978, data are not really comparable with those from

earlier years.

Achieving high levels of immunization for preschool children appears to

remain a major problem. In 1978, of the 12.2 million children 1-4 years of age, only about 6 out of 10 had received full protection for measles, rubella, and polio: the proportion for diphtheria was somewhat higher; for mumps, somewhat lower. The best estimates available indicate that preschool minority children and those in poverty areas of central cities are the least likely to be immunized; even though those children, often living

in crowded housing, are at great risk of contagion. Problems of access may partially account for the low levels of immunization for these children but

parental beliefs are also important. In 1978-79, 22 percent of the minority parents in contrast with 12 percent of all parents believed that most children's diseases had been conquered and there was no need to

immunize against them: 44 percent of the minority parents in contrast with 28 percent of all parents believed that it was the responsibility of the Government and the schoolsas opposed to the parentsto immunize

children against eL ldhood diseases (89).

Sanitation and Quality of the Water Supply

Sanitation and pure water have been major public health concerns at least since Snow's classic study demonstrated the relationship between cholera and the use of public pumps to supply Londoners with water (90). Almost all children in the United States today live in housing with piped- in water (99 percent) and with complete plumbing facilities for the household's exclusive use (98 percent). The majority of children and youths live in housing where water is obtained from public or private

systems connected to a public sewer (66 percent), as opposed to individual sources (78 percent).

There are, however, sizable numbers of children who do not have this protection and, as usual, they are children whose families are poor or are poorly educated, children in large families, or children who live outside

metropolitan areas or in the South. The quality of the sewage disposal system and the water supply

probably varies from one area to another and possibly from one season to another. Purity of public water supplies has been assumed to be adequate

35
and there has been, until recently, little review. One aspect of the water supply that has been evaluated is fluoridation. By 1975, about half of the people in the United States lived in areas where the water contained

fluoride either naturally or through adjustment. In general. the proportion was low in States where the population was widely dispersed and higher in densely populated States where people were more likely to obtain water

from public systems. The proportion of the population with fluoridated water has not

increased since 1975 despite fluoride's demonstrated effectiveness in reducing tooth decay in children. It has been well documented that children living in communities with fluoridated water have less tooth

decay than children in communities without fluoride (91-94) and that the

cost of dental care in tax-supported programs per child was much lower in areas with fluoridated water than in areas without (95-98). Adding

fluoride to the water is one action that can improve health at a

demonstrable cost savings.

Nutrition and Diet

The nutritional status of the U.S. population and the relationship of nutrition to child health are still matters of cortroversy. Few children in

the United States suffer from undernutrition of the kind that cripples and kills large numbers of children in parts of the developing world. As determined by height and weight, U.S. children are rarely stunted in

growth. Of the children under 18 years of age who were screened in 1978

(primarily low-income children eligible for public programs), only 9

percent were below height for age and only 6 percent were below weight for age. The only nutritional deficiency that appears to affect any sizable number of children is anemia; 14 percent of the children screened in the nutrition surveillance program were judged to have a low hemoglobin

level and 18 percent a low hematocrit (99). However, the relationship

between disease and low hemoglobin lei 71 is not clear.

A special study of Indochinese refugees seen in four clinics revealed that both anemia and stunting appear to be significant nutrition-related

problems among young Southeast Asian refugee children who entered the United States since July I. 1979 and the possibility of acute undernutrition

for children under 2 years of age (100). This documents the possibility of pockets of undernutrition in a country where undernutrition is not a major public health problem. Despite the absence of widespread nutritional deficiency, there is reason for concern about some of the feeding and eating patterns of children. In

the not-too-distant past. the majority of newborn infants were breast fed. Even in 1950 about one-third of the newborn children were breast fed for 3 months or more. The proportion then declined rapidly; only about 7

percent of the children born in the early 1970's were breast fed that long. Though there is some evidence of an upturn in the proportion of breastfed children in the late 1970's. the increase appears to have been primarily

among women whose children are least at risk. Children who, because of

36
the parents' educational or income level, were more likely to be at

nutritional risk than others were also less likely to be breast fed (101). Pregnant women and children in low-income families who are at

nutritional risk are eligible for food through the Supplemental Food Program for Women. Infants. ar.d Children (WIC). However, in 1980, fewer than half of those eligible were being served in anv State except Vermont; in many States, including some with large eligible populations, fewer than one-fifth of those eligible were being served by the program. In the National Health and Nutrition Survey in 1971-74, it was found

that most children ages I-11 drank whole milk and ate meat or poultry

and fruits or vegetables one or more times daily. Most also had dessert at

least once a day and one-fifth reportedly had dessert at least twice a day. The eating patterns of young childrenwhether boys or girls, above or below the poverty level, white or blackwere similar with one except:on. The likelihood of eating salty snacks at least once a day was higher among

elementary school-age children than among preschool-age children and was higher among black children regardless of age. This last is of particular concern as high-sodium diets have been implicated in hyperten- sion which is more prevalent among black than among white adults. Adolescents' eating patterns differed from those of younger children

and differed between white and black youths. Black youths were more likely than white youths to eat candy and salty snacks and to drink

sweetened beverages: they were less likely to drink coffee or tea or to eat

bread.

Health Education

Very few States require that health education be taught in the schools, and even when they do. it may be only one course of a few hours during

the 12 years of schooling. In 1978-79, only 10 States required that nutrition be taught; in 14 States such a course was optional. Small wonder

that when asked a series of health-related questions, most 17-year-olds could answer general questions but could not answer specific questions

such as which food group was the best immediate source of energy ( 102). They also knew little about child development, some aspects of their own

health. or about the kinds of illnesses for which they should seek medical

care.

They did not appear to be aware that accidents are a major threat to

their lives. Responses indicated that almost half of them did not know that

accidents are the leading cause of death for people 1-38 years of age. About one-fourth of the respondents did not ktiow that motor vehicle

accidents account for approximately half of all accic al deaths (102). The consultants who reviewed that report pointed that there were

gaps in knowledge and that the report did not assess behavior to see how it related to knowledge. This last is important because many other studies have shown that adolescents know that smoking and drinking alcoholic beverages, for example, can be health hazards (103. 104). Nevertheless, many continue to smoke tobacco and marihuana and to drink.

37
Television

The amount of time children spend watc'..ing television has been of particular concern because of the possibility of adverse effects on health

or behavior. In late 1976, elementary school-age children spent more time watching television than they spent with friends or parents and much more time than they spent reading or doing homework or chores. However. when time spent watching television or engaging in the other activities and a number of demographic characteristics of the family were

related to measures of self-esteem and behavior, television watching per se appeared to be of relatively little importance (80). The potential for health

education through television has been considered but information will have to be presented very carefully if it is to have the desired results (105).

Child Abuse and Neglect

The problem of child abuse and neglect has received increasing

attention in recent years. Despite the attention, valid and reliable data have been extremely difficult to obtain, no comparable data are available

to make reliable estimates of time trends, and the only thing that is absolutely certain is that some children are abused and that for a few

death is the result.

There are many forms of child abuse and neglect including psychologi- cal. sexual, and physical abuse and physical, emotional, and care-taking

neglect.

One approach to estimating the incidence of physical abuse is to look at

the deaths from external causes. In 1976. about 19,000 children and

youths under age 18 died of accidents or violence. The majority of these deaths were reported as accidents but 819 were reported as suicides, and

1.635 as homicides. Of the homicides, 170 were children under age 1, 340 were children ages 1-5, and 162 were children ages 6-1! (the other 963 were adolescents ages 12-17). The reported homicide rates were 5.6, 2.1, and 0.8 per 100.000 children of the specified ages (106). While this could

indicate that physical abuse of young children is more common, it must be

remembered that very young children are more fragile than older ones and

could more easily die of a comparable assault. Unknown proportions of

the accidental deaths could also have been due to abuse, neglect, or

suicide but not reported as such. During the late 1960's, all States enacted legislation that mandated

reporting of child abuse and neglect; the legislation did not include uniform definitions of either abuse or neglect. Beginning in 1974, the Children's Division of the American Humane Association has operated a

Clearinghouse on Child Abuse and Neglect. In 1976, 416,000 cases of

abused or neglected children were reported. There were approximately

twice as many cases of neglect as there were of abuse and, of all cases

reported. approximately 1 percent were severe, although the proportion of

the validated reports that were severe was about 5 percent. Eighty-five percent of the perpetrators of abuse and neglect were the child's natural parents ( 107).

38
The number of cases reported has risen each year to 507,000 in 1977

and 614.000 in 1978, in part because of increased reporting ofsexual abuse

( 108. 109). Nevertheless, it is generally recognized that the actual

incidence of abuse is greater than the reported incidence because many incidents go unreported. The magnitude of underreporting obviously varies from State to State. as the number of reports in five States in 1978

ranged from 6 to 23 per 1,000 children (110). In a 1976 survey of families consisting of a couple who identified

themselves as married or being a "couple" and one or more children ages 3-17 living at home. 63 percent of the respondents reported at least one

violent episode toward the child during the previous year and 73 percent reported at least one violent episode in the course of raising the child

(111).

Most of the episodes were the milder forms of violence such as pushing

or slapping. However, hitting w;:li something during the year was reported

by 13 percent; throwing sorr.;:thing by 5 percent; kicking, biting, or hitting the child by 3 percent; and 'eating by 1 percent. There were rare reports of either threatening or using gun or knife. Using an index combining

the forms of violence thought to have the highest probability of injuring

the child. Gelles estimated that 3.6 percent of the children or 1.4-1.9

million children were vulnerable to physical injury from violence in 1975.

Gelles thought the estimate should be considered low because the data

were obtained from self-reporting, the response rate was low, and only

children with both adult males and females in the household were included. On the other hand. since no information on whether the child

was injured was collected, the estimates must be considered as indicating

potential injuries only. Although data on the incidence of child abuse are faulty, there is no

doubt that physical or sexual abuse or severe neglect can be a-significai:t problem for some children. Abused children are almost always mistreated

in their own homes: they are betrayed by the very people whom they must depend upon.

39
CHAPTER 4

HEALTH STATUS AND NEEDS

Overall, the health of children and youths in the United States is good

compared to adults or compared to children in the past. Although the

incidence of acute illness is high, relatively few children suffer from

chronic conditions or from long-term limitation of activity and death rates

are low. There are major problem areas, however. Children in low-income

families, and especially children in families with little income and only one

parent. are in poorer health and are more likely to have limitations than

other children. Accidents now account for half of the deaths of children

and youths ages 1-17 and motor vehicle accidents are the leading cause of

death. Use of alcohol, cigarettes, or marihuana is common among

adolescents and the proportion of unmarried adolescent girls who have had intercourse is increasing. Children in inner-city slums, in the hills of Appalachia. or in the

families of migrant workers may be in extreme poverty and ill health. Special surveys and individual studies which are not included in this volume document the health conditions and special needs of these

children (112-116).

MORTALITY RATES

The decline in death rates for young children has been dramatic. Of every 100.000 children 1-4 years of age, 564 died in 1930, 290 in 1940, 139

in 1950, 109 in 1960, 84 in 1970, and 69 in 1978. The infectious and

communicable diseases that used to leave thousands of children dead or

damaged are no longer leading cause.; cf death. Some, such as diphtheria and polio, are now rarely reported. Others, such as pneumonia, are still major causes of illness and hospitalization but are rarely kiliers and are

less likely to leave children damaged because better treatment helps them

zo survive in good health. Accidents are now the leading cause of death for

this age group. accounting for 42 percent of the deaths in 1978. Older children have never had the high del h rates of infants and young

children. In fact. death rates in late childhc are !ower than at any other age. Even for these children, however, the death rate in 1978 was only a

third of what it was in 1940 (34 vs. 104 per 100,000 children 5-14 years of age). Accidents were the cause of 51 percent of the deaths of children 5-14

41
years old in 1978; 26 percent of the deaths were caused by motor vehicle

accidents in 1978.

At every single year of age, death rates are higher for boys than for girls. They are higher for "disease causes" and they are much higher for "external causes." In 1976 the differential for external causesaccidents,

poisoning, and violencewas smallest at the beginning of life and then

increased. Young boys under 6 years were 41 percent more likely to die of poisoning, accidents, or violence than young girls of the same age; young men 16-17 years of age were almost 200 percent more likely to die from

accidents or violence than young women the same age. Overall, death rates are higher for black children than for white

children. In 1976 the differential was largest at the beginning of life and

decreased through the school years until for a brief period in adolescence

(ages 16-17) black youths had lower death rates. After that, the rates diverged again. Young black children were more likely than white

children to die of accidents, poisoning, or violence (death rates of 5.4 and

2.9 per 10.000. respectively, for preschool, and of 2.4 and 1.4, respectively, for elementary school-age children). Black adolescents were less likely than white adolescents to die of these external causes (3.7 and 4.2 per 10.000, respectively) because black youths were not killed as frequently in

automobile accidents; they were less likely to have access to cars and to

have a driver's license.

Death rates among children and youths under 18 years of age would be

reduced by one-quarter if no child died in an automobile accident. The use of restraining devices in back seats would keep small children from

being thrown forward and perhaps killed_ Some European countries have

found that changing school hours so that they do not coincide with rush

hours helps to reduce automobile accidents involving children. However, the greatest potential for reducing the number of deaths lies in reducing

the number of deaths of adolescents. Raising the legal minimum age for both drinking and driving has been suggested as a way of saving the lives not only of young drivers but also of other children who may be passengers or pedestrians. This is a very controversial issue, however

(117-119). Designing and building safer vehicles and roadways would

reduce the risk of death for people of all ages as well as adolescents.

Although data on socioeconomic differentials in childhood mortality

are scarce, the existing data indicate that there are socioeconomic differentials and such differentials are greatest for mortality due to

accidents. In England and Wales where occupational class of the father is

reported on children's death certificates, the standardized mortality ratio

in 1970-72 for boys ages 1-14 in the lowest class was 2.2 times that of boys

in the highest class for all causes of death but 4.7 times as high for accidents. poisonings and violence. For girls the same age, the comparable numbers were 1.8 and 3_4 (120). Such information is not available in the United States. However, an

analysis of data from the June 1975 Current Population Survey revealed

that there were significant socioeconomic differentials in the mortality of people under 20 years of age and that a primary source of the

socioeconomic variation was variation in mortality due to accidents 121).

42
The author pointed out that the results indicate that accident prevention has the potential of not only reducing the number of early deaths but also reducing inequality in life chances.

ASSESSMENTS OF HEALTH

More useful for assessing health status than mortality rates are the measures of the incidence and prevalence of diseases, physical and

emotional impairments, and reductions in physical, intellectual, and social functioning. Unfortunately, these measures are more difficult to obtain and to interpret. Physical illness, disability, and death are not independent of one

another nor are they independent of emotional illness and disability or the child's environment Emotional and behavioral problems can both cause, and result from, physical problems. The physical and social environment affects both physical and emotional health. Crowded and dilapidated housing, poor schools and teachers, poverty, and discrimination all

increase the risk of physical and emotional illness and impairment. Strong relationships exist between family income and certain health

indicators. The proportion of children reported to be in "fair" or "poor" health drops significantly as income rises. About 9 percent of the children

and youths in families with incomes of less than $5,000 per year compar-d with 2 percent in families with incomes of $15,000 or more were reported

to be in "fair" or "poor" health in 1975-76. Children and youths in low- income families are likely to have more days when their activity is restricted, they are confined to bed, or they are out of school. For example, low-income school-age children lost, on the average, 6.6 days of school per year in 1975-76 because of acute illnesses while high-income

children lost 4.7 days.

There are geographic variations in the health of children. During the last year of the draft, 1972, young men from the East South Central division were more likely to be rejected than young men from any other area. In Alabama, Kentucky, Mississippi, and Tennessee, 51 percent of the white and 71 percent of the black men were rejected compared with 45 percent of the white and 63 percent of the black men overall.

In general, children in the South are more likely than children in other parts of the country to be reported by their parents as being in poor health, although they are no more likely to be reported as having a long

term limitation of activity and the average number of days spent in bed or out of school because of illness is no higher than in the rest of the country. Most of the measures of the health of children and youths which have been obtained from the National Health Interview Survey since 1957 show remarkable stability (34, 122-124). The short-term measures of

disability reflect flu epidemics but show no time trends. There is possibly a

trend in the proportion of children who are limited in activity by a chronic condition: this proportion appears to have increased from about 2 percent in the early 1960's to about 4 percent in the mid-1970's. The apparent

increase is not due to the increased proportion ofchildren and youths who

43
are adolescents and, being older, are more likely to be limited. Among other things, it could be due to increased parental awareness, better diagnosis through greater access to medical care, or decreased institution- alization of handicapped children. In any case, based on household

interviews, 3.8 percent of the children and youths under 18 years of age were limited in activity in 1975-76. Other measures from the National Health "Examination Survey (now the National Health and Nutrition Examination Survey) exhibit the same kind of relative stability. The proportion of elementary school-age

children in need of special services in 1963-65, for example, was almost

identical to that found when the survey was replicated by the Foundation

for Child Development in 1976. Special resources were recommended for about 21 percent of the children both times. In general. rates for communicable notifiable diseases are very low. Rates for those diseases for which immunization is available have declined

over the years although not all of the decline can be attributed to

immunization. Rates for diphtheria, for example, had been declining

before the immunization was developed. On the other hand, rates for some diseases for which immunization is not available have increased. In

particular, although gonorrhea is still rarely reported for children under 15 years of age, the rate in the second half of the 1970's was higher than in

previous years.

Major Diseases

There are major diseases and conditions that affect few children but make it difficult or impossible for them to live full lives in the community. Those children afflicted with a serious chronic condition have very special additional needs for care.

The probability of survival has been improving for children diagnosed

as having cancer especially for acute lymphatic leukemia which is the most common childhood cancer ( 125). Nevertheless, cancer causes more deaths of children 1-17 years of age than any other disease. Malignant neoplasms caused the deaths of 3,214 children in 1976; leukemia was

responsible for 1,359 of these deaths ( 106). A special survey in late 1978 of children under 18 years of age receiving Supplemental Security Income Benefits who were not living in Medicaid

institutions revealed that an unexpectedly high proportion (15 percent) of

them were in foster care settings. These children, on the a--,erage, had lived

away from their parents for 7.5 years and had little or no contact with

their parents although in almost all cases the parents were still living ( 126). Of the children living with their families, more than expected were minority children (56 percent), with only the mother as the parent (57 percent), and poor_ Although the families have to be poor to meet program requirements, they were in very poor households. In fact, 42

percent reported receiving income from AFDC or General Assistance during the previous years.

44 59
The majority (53 percent) of the children were multiply handicapped. The most frequently reported main disability was mental retardation (27 percent) with 15 percent reporting "other diseases of the nervous system" and an equal proportion "other mental conditions." When information on main and secondary disabilities was combined, these were still the most frequent conditions. The same pattern of multiple handicapping conditions (with mental retardation the most common medical reason for admission followed by nervous disorders and mental illness) was found among children and youth under 18 years of ago who were in institutions in 1976 (127). Over half (55 percent) of the institutionalized children had a speech, walking, visual or hearing disorder, and a third (34 percent) had two or more such disorders.

About 4 percent of all children under age 18 living in the community were reported by their parents to be limited in amount or kind of activity in 1975-76. Asthma was the condition most frequently reported as causing the child to be limit ..tcl (20 percent). About 10 percent of the children with

a limitation were limited because of orthopedic impairments, 7 percent because of mental or nervous conditions, 5 percent because of hearing

impairments. 4 percent because of visual impairments, and 2 percent because of heart conditions. In the national survey, as in the Supplemental Security Income survey. children in poor families or with a mother only were more likely to be limited than children in families with more money or both parents.

Accidents and Injuries

As the infectious diseases disappeared as the leading causes of death, injuries, which were always among the leading causes, took over first place. In 1976. half of the 32,000 U.S. children past infancy who died died

from accidents. Of these children and youths, over a quarter (27 percent) died because of motor vehicle accidents. 7 percent drowned, and 4 percent died from fires. In addition. 5 percent of the deaths were reported as homicides and 3 percent as suicides (106). The epidemiology of injuries is different from that of the common acute

illnesses of childhood. While diseases occur more frequently in preschool children than in school children and at about the same frequency among boys anti ,;irls, the incidence of injuries is about the same for school-age and preschool-age children and much more frequent among boys than girls.

Injuries are the only acute condition affecting children and youths that show a pronounced se difference. During the 1975-76 school year, for every 100 boys of school age, there were 51 injuries and 50 days lost from school, while for every 100 girls there were 29 injuries and 22 days lost from school (128). One estimate shows that, for both boys and girls, a school injury usually occurs during physical education class; for boys in senior high school. the second most frequent occasion of injuries is

45

6 0
interscholastic sports. No health professional of any kind was available to

care for a quarter (24 percent) of the athletic injuries that occurred in

public secondary schools in 1975-76 ( 129). However. prevention of injuries should begin with an evaluation of conditions in and around the home, because over half of all injuries of children and youths under 18 years of age in 1975 that resulted in

restricted activity or medical attention occurred at home; 26 percent inside the house and 28 percent on the adjacent property. About 17 percent of the injuries occurred at school, 10 percent at places of

recreation including school. 8 percent on streets and highways, and 12

percent "somewhere else" (including farms and the work place) ( 78). For injuries resulting in visits to emergency rooms, questions have been

asked about consumer products involved. In 1976. among children under 6 years of age, the five leading products. which accounted for 382,000

emergency room visits, were tables, stairs or ramps, bicycles, swings, and beds (130). Among children 6-11 years of age, the top five, which

accounted for 498.000 visits, were bicycles, glass of unspecified origin, swings. skateboards, and nails and tacks. Among youths 12-17 years of age. the top five categories were all recreational: football , basketball , bicycles, baseball. and skateboards accounted for 773,000 emergency

room visits.

More recent data fron the surveillance system show that in 1979-80 the

five leading products involved in product-related injuries of children under 5 years of age were tables, stairs, chairs and sofas, beds, and

playground equipment. For children 5-14 years of age, they were bicycles. football, baseball, playground equipment. and ice and roller skating.

Respiratory Conditions

Of all diseases affecting children, respiratory conditions cause more disability and use of medical services than any other type of condition. Children and youths have more days of restricted activity, spend more

time in bed, and lose more days of school because of acute respiratory

conditions than for any other reason. In 1975-76. respiratory conditions accounted for 61 percent of the school days children missed because of an

acute illness. Asthma caused more long-term limitation of activity than

any other chronic disease in children: only chronic bronchitis was more prevalent. A quarter (26 percent) of all visits children under 18 years of age made

to office-based physicians in 1975-76 were for respiratory conditions-33 million visits a year. Over half (58 percent) of these visits were fc acutc

upper respiratory conditions: 15 percent were for bronchitis or asthma. A fifth ( i percent) of the days children spent in short-stay hospitals in 1975-76 were due to respiratory conditions-4.9 million days a year. A

third (30 percent) of these days were due to pneumonia. In 1976. 5 percent of the deaths of children and youths past infancy were due to respiratory conditions. That year, pneumonia caused the deaths of over 900 children ages 1-17 and almost 2.000 infants,

46
Tooth Decay

Tooth decay probably affects more children than any other single health problem except upper respiratory conditions and injuries. However, while most upper respiratory conditions and injuries have only transitory

effects, tooth decay is permanent. At the time of the first National Health and Nutrition Examination Survey in the early 1970's, 44 percent ef all children ar..i youths and 54

percent of those who were adolescents were found on examination to have

one or more decayed unfilled teeth; 53 percent of all children and youths and 68 percent of the 12-17-year-old adolescents needed dental care. Tooth decay is a problem from early childhood into adulthood. Although evidence of decay was rare among children under 4 years of age, the average 5-year-old had 2.2 decayed, nonfunctional carious, or filled primary teeth; most often these were decayed teeth. Half (55 percent) of the primary school-age children had one or more decayed, missing, or filled (DMF) permanent teeth. The average 11-year-old had 2.7 affected teeth (131).

By the time they are 12-17 years of age, only 10 percent of the children have no decayed, missing, or filled teeth. A fourth (26 percent) of the

adolescents examined had one or more teeth missing (they were not necessarily missing because of decay); half(54 percent) had one or more decayed teeth needing repair. The average 17-year-old had 8.7 decayed, missing, or filled teeth-2 decayed, 1 missing, and 5 filled-30 percent of their teeth were affected.

Girls were more likely than boys to have decayed, missing, or filled teeth. And there was some evidence that by adolescence white children were more likely than black children to have DMF teeth, although the difference was not significant. However, 60 percent of the DMF teeth of white adolescents had been filled in contrast with 23 percent of the teeth of black adolescents.

Family income and parental education were not determining factors in tooth decay. Differences in the average number of affected teeth among income or education groups were not significant. However, family income was associated with whether white children had their teeth filled; four- fifths of the affected teeth had satisfactory fillings if a white adolescent lived in a family with an income of $15,000 or more but only two-fifths if the family income was $3,000 or less. Only one-fifth of the affected teeth of black children had satisfactory fillings regardless of family income. (The comparison is complicated because black adolescents were twice as likely to have teeth missing; 47 percent of the black adolescents compared with 22 percent of the white adolescents had one or more teeth missing. Information on why they were missing was not reported.) The impact of untreated dental problems on many of the children is probably permanent. Among the adults examined in 1971-74 at the same time the children were, one-fifth of those 35-44 years of age already had lost all of their teeth from one or both arches; 9 percent had no natural

teeth. The average 35-44-year-old adult had nine teeth missing. The incidence of decay throughout childhood is high. Children zed

47
both better education in how to care for their own teeth and more care

from dental professionals.

Visual and Eye Problems

In the same survey, eye abnormalities and the need for eye care were evaluated. Few children had significant eye abnormalities needing

treatment-4 percent of the children 1-5 years of age and 5 percent of

those 6-19 years of age. Of these needing treatment, 71 percent of the younger children and 47 percent of the older children were not receiving

treatment ( 78). National data on visual acuity are not available for the 1970's but there

is no reason to believe that the prevalence of defective visual acuity has changed since adolescents 12-17 years of age were examined in 1966-70. At that time slightly more than 40 percent were unable to see well enough

to read at the 20/20 level at the standard distance without correction; only

about a third wore corrective lenses. Even so, nearly a third of those who wore lenses failed to reach the 20/20 level even when wearing their own

lenses ( 132).

Skin Disorders

An interesting example of the need for care along with information on whether the person tried to get care is provided by the dermatological evaluations in the 1971-74 National Health and Nutrition Examination

Survey. Over one-third (36 percent) of adolescents 12-17 years of age were

found to have significant skin conditionsconditions that in the opinion

of the trained survey dermatologists should be seen by a physician at least once for assessment or care (133). Only 15 percent of the adolescents had conditions that they were

concerned about, but of those who were concerned, only half (51 percent) had sought any care and only a quarter (23 percent) had sought care from

a physician. Not surprisingly then, only about a sixth (16 percent) of the concerned adolescents were receiving what the survey dermatologists considered to be the best possible care, although 70 percent had

conditions that could be improved with expert care. Clearly, when people have conditions that could be improved with

expert care but only a fraction are receiving that care, there is an unmet need. It cannot be brushed off as a lack of concern among adolescents about a trivial problem. Of those adolescents who considered their skin

condition a social handicap, the survey dermatologists rated 95 percent as being disfigured. Of those who considered their skin condition an

employment handicap, 90 percent were rated as disfigured (133).

Mental and Emotional Disorders

The lack of agreement in classiillza.tion and of measuring instruments has retarded the development of knowledge about the incidence and

48
prevalence of psychiatric disorders among children. Existing research fills in only parts of the puzzle. National data on the incidence of psychiatric disorders are not available for children. Gould et al. (134) recently

reviewed prevalence studies of mental disorder among children, summa- rizing 25 studies that had estimated the prevalence of "clinical maladjust- ment** among children in the United States between 1928 and 1975. These studies are characterized by a variety of methods and concepts; this fact partially accounts for the rate of maladjustment per 100,000 population ranging from 8,000 to 25.000. with a median rate of 18,000 per 100.000 (i.e.. 18 percent). If this estimate is interpreted to mean children in need of clinical

treatment. it appears to be high. The Stanford Research Institute, in reviewing studies and reanalyzing data collected through the Health Examination Survey in the 1960's, found much lower prevalence rates of emotionally disturbed children. In nine studies published from 1954 to 1974 the prevalence rate was 2 percent of the school-age noninstitutionalized population. Teachers reporting on the Health Examination Survey

estimated 3.4 percent of the elementary school-age and 1.2 percent of the

secondary school-age population in need ofspecial services for emotional- ly disturbed (135 ). When parental reporting of problems which may be indicative of emotional disturbance was added, an additional 3.7 percent of the elementary school-age population were identified. fcr a prevalence of 7.1 percent. It is noteworthy that of each 100 children identified, only

seven (0.5 percent of all children) were identified by both parents and teachers. Children identified by parents tended to have health-related problems such as late walking or hearing problems; children identified by teachers tended to be less attentive and more restless, to require more discipline and to be less popular with school playmates. Gould et al. (134) pointed out that the most severely disturbed or psychotic children are not likely to be found in schools which is where

many of the studies referred to were done. Psychotic disorders are rare in

childhood and adolescence. but studies indicate that the rate of "psychotic disorders" among children is on the order of 45 per 100,000 population. The auth..)rs also observed that most children with "psychotic disorders" receive treatment, in contrast to children with "clinical maladjustment," which suggested to them that the majority of children with "clinical maladjustment" were not receiving treatment.

The rates of utilization of the specialty mental health and health sectors by children are considerably lower than the estimated prevalence rates, thus supporting the suggestion that most children with a clinical maladjustment are not receiving care in the specialty mental health sector or the general health sector. Based on the limited data available, it appears about 1 percent of the children are treated by the specialty mental health

sector and 1- 10 percent are treated by the general health care sector (136). Health services research may help us discover the factors that contribute

to children's being underserved with respect to mental health services. These observations on the lack of care of "clinically maladjusted" children in the medical care sector are confirmed by estimates of the proportion of emotionally disturbed children who are not being served in

schools. Using a prevalence rate of 2 percent, it was estimated that there

49
were a million emotionally disturbed children ages 5-17 in 1977-78 (137). Of these, 288,000 were receiving services, leaving 725,000 potentially unserved children. Thus, only 28 percent of the emotionally disturbed

children who potentially should be receiving special education services v, ere receiving them. Emotionally disturbed children were less likely to be

receiving special education services than any other category of handi- capped children and accounted for the largest number of children not

receiving the services to which they were entitled.

RISK-TAKING BEHAVIOR

The risk-taking behavior of adolescents can result in being injured or killed in an automobile accidentthe leading cause of death among

adolescents. Risk-taking sexual behavior can result in acquiring a sexually

transmissible disease and for girls ....an result in becoming pregnant with unwanted children. Smoking and drinking are associated with shortened

life expectancy and the development of certain diseases, and alcohol is

frequently a factor in motor vehicle accidents. Crime and violence can result in injury or death or in a criminal record that can curtail

educational or work opportunities. Failure to seek medical care when

indicated is another behavior by which adolescents increase their own risk

of ili health.

Tobacco, Marihuana, and Alcohol Use

In 1979. 72 percent of the high school seniors had drunk alcohol, 34

percent had smoked a cigarette, and 37 percent had smoked marihuana within the 30 days prior to the survey. The proportion of adolescents ages 12-18 who currently smoke

cigarettes increased until about 1974 and then began to decrease. The decrease is due primarily to a decrease in cigarette smoking among boys, who were more likely to smoke cigarettes than girls until the mid 1970's. However, by 1979 boys were less likely than girls to smoke. The

proportion of adolescents who have ever tried cigarettes does not show the

same downward trend as the proportion who are regular smokers. Over half of the adolescents and four out of five young adults 18-25 years of age in 1979 had at least tried smoking tobacco. However, the majority had

smoked less than five packs of cigarettes (138). Of those adolescents who

had tried IL 28 percent had smoked 100 cigarettes or more. While a higher proportion of adolescents had tried smoking tobacco than had tried marihuana (54 vs. 31 percent), the proportion of those who had tried it and smoked 100 or more cigarettes was close to the same (28 or 24

percent). Between 1972 (when data were first collected on a national sample) and 1979 the proportion of adolescents who had tried marihuana more than doubled, from 14 to 31 percent. The rapid increase came early in the decade: the slight increase between 1977 and 1979 was not significant.

50
In the adolescent's world in the late 1970's, smoking marihuana was still

not as common as smoking tobacco or drinking alcohol-54 percent of the adolescents in 1979 had tried tobacco and 70 percent had tried alcohol. Nevertheless, marihuana use was very much a part of the youth culture. Even in rural areas and in the South, where marihuana use was relatively

low, about a quarter of all adolescents and half of those 16-17 years of age had tried it at least once, while more than a quarter had used it within a

month of the survey ( 138). Of those who had tried marihuana, about a quarter had only used it once or twice but an equal number had used it 100 times or more. Probably included among those who had tried it only once or twice were

younger adolescents and older ones who were just beginning to use

marihuana; only 8 percent of the 12-13-year-olds had ever tried the drug, and 8 percent of all adolescents who had tried it had first used it during

the 6 months preceding the survey (138). The drug of choice is still alcohol-70 percent of all adolescents and 95 percent of all young adults in 1979 had at least tried it. Over a third (37

percent) of the adolescents in 1979 were current drinkers; that is, they had had a drink within the month preceding the survey; this figure includes 9 percent who had consumed alcohol five or more times during the month. For the most part they had only one or two drinks, but 11 percent had, on

at least one occasion, five or more drinks during the preceding month

(138).

Sexual Behavior

Increasing proportions of unmarried adolescent girls have had inter- course and the increase has occurred at all ages. In 1971, 27 percent, and

in 1976. 41 percent of the unmarried 17-year-old women reported that

they had had sexual intercourse at least once. The comparable figures for 15-year-olds are 14 and 18 percent (25). The proportion of women 15-19 years of age residintz metropolitan areas of the United States who have had premarital experience

increased from 30 percent in 1971 to 43 percent in 1976 to 50 percent in 1976). About half (49 percent) of the unmarried 17-year-old women in

metropolitan areas had had intercourse in 1979 compared to 43 percent in 1976 and 26 percent in 1971 The comparable figures for unmarried 15- year -olds are 23. 19. and 14 percent. While the proportion of unmarried

adolescent women who have ever had intercourse was still much lower for

white than black women in 1979, virtually all of the increase between 1976

and 1979 is accounted for by the increase in the proportion of unmarried white adolescent women who have had intercourse ( 1 7). The proportion of all teenage women who have ever been premaritally

pregnant also increased from 9 percent in 1971 to 13 percent in 1976 to 16 percent in 1979. These increases have been accompanied by a decline in

the likelihood that premaritally pregnant teenagers will marry and, among

those who remain unmarried, an increase in the proportion of the

pregnancies that are terminated by abortion (17).

51
These trends have been noted by a number of observers. The decreased

likelihood of a teenager marrying is especially well-documented. Even in

the short time between 1974 and 1978, first marriage rates for women 14-17 years of age decreased from 25 to 17 per 1.000 never-married women and for women 18-19 years of age they decreased from 134 to 96. In 1974, 43 percent of all brides marrying for the first time were under 20

years of age; in 1978. only 34 percent were that young (139. 140). There was evidence in 1979 of an increased and more consistent use of

contraception but there was a decline in the use of the pill and the IUD

and a rise in the use of the least effective methods, especially withdrawal.

Because information was collected from young men for the first time in 1979. no data on time trends are available for young men. However, in 1979 over half (56 percent) of the unmarried I 7-year-old men had had

intercourse at least once (17). Of the unmarried 17-year-olds, white men

were more likely than white women and black men were less likely than

black women to have had intercourse.

The young women are at risk of pregnancy and both sexes are at risk of

contracting a sexually transmissible disease. Sexually transmissible dis- eases have been rare among adolescents under age 15 and somewhat more

common among 16-17-year-olds but historically the incidence of sexually

transmissible diseases has been much higher among young adults (141). It

is certainly possible that the incidence of these diseases among adolescents will increase with increasing levels of sexual activity.

Crime and Disruption

School crime and disruption can be si3nificant problems. During a

typical month, a secondary school student has about I chance in 9 of having something stolen. I chance in 80 of being attacked, and I chance in 200 of being robbed by force. Personal violence is most pronounced in

junior high schools (142). The arrest rate of adolescents for violent crimes and, to some extent, for property crimes has been increasing. In 1977, 150 youths per 100,000 were arrested for robbery compared with 93 youths in 1967 and 59 youths in

1964, the first year that comparable records were kept. The comparable

figures for aggravated assault were 136. 90. and 65, respectively.

52
CHAFFER 5

RESOURCES FOR HEALTH CARE

Counting the supply of health care resources available to children

appears to be simple but is in fact extraordinarily difficult. A physician may be licensed to practice and a hospital authorized to have a specified number of beds but the physician may be engaged in research or

administration instead of patient care and the hospital may not have

constructed a new wing or may have closed an old one even though the beds are authorized. A registered nurse may not be currently in the labor force but is thinking of returning someday or may be only working part time. In addition, scale professionals are licensed in more than one

j urisdiction.

Hospitals may be licensed to have a specified numbei of beds but the

actual number staffed and available may be lower. A clitlIc with satellites or a clinic open in different places on different days of the week may be

counted once or several times.

It is difficult to evaluate the adequacy of the supply of resources

persorme!, funds, facilities --for children in different areas of the country. First, the resources for children overlap with those for other populations

in an area. Second, there is some question as to whether a high ratio of physicians (or other health personnel) to population is good in itself. (There is evidence that some children receive unneeded caresuch as required school and camp physical examinationsand unneeded and

possibly harmful surgerysuch as tonsillectomies.) Third, an area may

have a relatively small supply of a health resource but people there have

access to an adjacent area with a large supply of that resource. A county

that is short on resources may be next to a county with an abundance of

easily accessible resources. Fourth, an area that is low on one type of medical professional could be well supplied with other professionals who

are able provide effectively many of the needed services. Finally, when the desire is to estimate the resources available to one population group. in this case children, the task becomes almost

impossible. Pediatricians care for children but they also care for older people if needed and many children, especially adolescents, receive care from physicians with other specialties. Dentists, nurses, and other practitioners provide care to people of all ages, not only children. Children's hospitals and pediatric units in community hospitals provide

care for children but the number of beds may not be constant and a sick

53

es
child will be put in another unit if accessary. Determining expenditures

for the care of children suffers from the same difficulty. Much of the data for this chapter are based on informed estimates using

careful methodology and multiple sources of information. They are the Test available, but the users should be aware that different assumptions or more inforrmItion could have produced different estimates- For example, different assumptions about the nctriber of hours physicians or nurses spend in patient care produce different estimates of the number of "fulltime equivalent" physicians and nurses. Different assumptions about the number of conditions requiring care and the kind ofcare required produce different estimates of the number of physicians and other health personnel required to care for children.

SUPPLY OF HEALTH CARE PERSONNEL

Data on the number of primary care physicians indicate that ther has been a great decline since the 1930's in the number of thee physicians and

t'..: number relative to the population. In 193 there were 112,116 general practitioners, 3.567 general internists, and 1.396 general pediatricians altogether 117.000 providers of primary care for the entire population. In 1963. there were 68.091 general practitioners, 21,114 general internists, and 9.225 general pediatricians (98.000 in all); by 1971 there were 49.528 general practitioners. 23.829 general internists, and 10,742 general pediatricians (84.000 in all). Over this 40-year period the ratio of the primary care providers to the population declined, from 94 physicians per 100.000 population to 41 per 100.000 ( 143). The Harvarc Child Health Task Force report stated that in 1931 there were 18.6 physicians (full-time equivalents) per 100,000 people who devoted time to the primary care of children but that the ratio had

declined to 11.3 per 100.000 by 1973 (144). This estimate depends on the premise that general practitioners and family practitioners give most if not all of their tir--° providing primary care, and that internists see children

infrequently. The estimated number of primary care physicians declined from 94 ;1- 100.000 in 1931 to 65 per 100,000 in 1973. Acco -ing to the Bureau of Health Professions, there were 124,000 primary care physicians (defined as general practice and now including

family practice. general internal medicine, and pediatrics) in 1973 or 57.7 per 100.000 population (145). These are the primary care physicians designated under the Health Professions Educational Assistance Act of 1976 ( P.L. 94-484).

Regardless of how one counts. there is no question that there was for many years a decline in primary care physicians resulting largely from an increase in specialization. In 1930. 75 percent of the physicians were engaged in primary care. By 1970 only 38 percent of the professionally

active physicians were engaged in primary care and the proportion has

remained relatively constant since then ( 145). However, since 1968 the supply of primary care physicians has been increasing more rapidly than the population so that the physician to

54
population ratio has increased and is projected to continue increasing at

least until 1990. In 1969, there were 55.0 and in 1976 there were 61.9

professionally activ.... primary care physicians per 100,000 population. According to the Bureau of Health Professions (BHP) projections, there will be 74.9 in 1980 and 97.9 per 100,000 in 1990 (145). The proportion of first-year residencies in primary care specialties has increased from 25 percent of all residencic.5 in 1968 to 43 percent in 1976. Most of the

increase is accounted for by family practice, which did not exist as a

specialty in 1968 but accounted for 12 percent of the first-year residencies

in 1976 (145).

The concern about an undersupply of physicians has now changed to a

concern about oversupply. If the Bureau of Health Professions projections are correc l. there will be 567,000 active physicians including 240,000

primary care physicians by 1990 or 231.3 and 97.9 per 100,000 population, respectively (145). According to the Graduate Medical Education Nation- al Advisory Committee (GMENAC), there will be 536,000 active physicians including 176,000 in primary care but only 441,000 to 490,000 physicians including 175,000 to 194,000 -imary care physicians will be required (146). Instead of a shortage. t,,ere will be a surplus of 70,000

physicians by 1990 and 145.000 by the year 2000. However, little of the

excess will be in primary care. The supply of physicians in those specialties will be in near balance with the need if the projections and estimates made

the Graduate Medical Education Advisory Committee are correct but

there will be a surplus if the BHP projections and the GMENAC estimates of need are correct (table I).

Because of the projected surplus of physicians, the Advisory Committee

made several recommendations that could affect Lhe provision of health care to children. One was that "although the Models estimate a small

surplus in the three primary care disciplines. GMENAC recommends that

a larger surplus be created deliberately in the 1980's as an interim measure

TABLE I. Estimated and Projected Number of Physicians, According to Specialty: United States, 1978 and 1990

Specialty

GUENAC

Near.-.Zrew of

Physicians Percent

increase

1978 1990 1978-90

Ratio of

Projected Supply to Estimated

Requirements

In 1990

BHP

Number of

Physicians 1990

General family practice 54.350 64,400 18 1.05 82,830 General pediatrics 23.800 37,750 59 1.15 48,470 General internal

medicine 48,950 73,800 51 1.05 108,530 Primary care total 127.100 175,950 38 239.830 Obstetricsgynecology 23.100 34.450 49 1.45 33,230

SOURCES: References 145. 146.

55
until an ag.,regate balance can be achieved in the 1990's." A second was

that until studies have been completed, "the numbers of PA's, NP's, and N MW's in training for child medical care, adult medical care, and

obstetrical/gynecological care should remain stable at their present numbers" (146).

There is evidence of a conflict in these recommendations. The estimate

of need for primary care physicians was lower than it would have been if

there were no delegation to nonphysician providers, thus GMENAC

recognized the contribution of these providers. The report included a delegation level for 1990 of "not more than 46 million ambulatory visits

(16 percent or the child ambulatory case load)." However, the committee estimated that the supply of nonphysician providers would dout..3e between 1978 and 1980. thus addin^ their contribution to the physician

surplus. The force of these recommendations, ther,..fcre, would be to

continue training physicians but to shift those in .raining from other specialties where the surplus is projected to be much greater into primary

care specialties and to restrict the expansion of the supply of personnel who are not physicians. The total number of personnel available for primary care would continue to grow but the ratio of physicians to

nonphysicians would increase. The GMENAC recommendations were submitted just before this was

written. The methodology has not yet been subjected to outside criticism

and, since much of it was developed for this report, may be disputed and

revised. The recommendations may be accepted in whole, in part, or not at all. If they are accepted, they could alter the availability of health care

to children and to pregnant women. It is also important to remember that some physicians in office-based

practice who are not designated as primary care physicians and physicians

in institutional settings are also providing primary care to children. Children are actually receiving more medical care than they used to, although it is possible that a smaller proportion of the care is from the designated primary care physicians. Of all children who made a visit for medical care in 1974, 10 percent received all their care in institutionalized

settings and 35 percent received some of their care in such places. Only

two-thirds received all their care from private physicians. Of the visits children and youths made to office-based physicians in 1975-76, onefourth were not to designated primary care physicians. In 1976, 65 percent of the professionally active primary care physicians whose major activity was patient care were in office-based practice and 60 percent of the office- based physicians were not primary care physicians. It is also important to recognize that the Bureau of Health Professions projects that the supply of other health personnel whose services are

important for children, such as dentists and optometrists, will not increase

as much as the supply of physicians will (table J). In general, the supply of professional resources has grovil and will continue to grow for all level-: and areas of training. The numbers of physicians, dentists. registered n rses, optometrists, and podiatrists are all

expected to increase. The supp:v of dietitians, medical technologists,

56
TABLE J. Estimated and Projected Number of Active Health Personnel and Percent Increase In Supply: December 1965-90, Selected Years

Arthr Health

Personnel

Humber of Personnel Percent lemmas*

1965 1979 1990

1965-

1979

1979-

1990

Total

personnel 1.1 57.965 1,914,720 2,530,400 65.4 32.2

Physicians 288.675 433.550 598,340 50.2 38.0 M.D.'s 277,575 416,680 568.500 50.1 36.4 D.O.'s 11 .1 00 16,870 29.840 52.0 76.9 Dentists 95,990 123,500 156,290 28.7 26.5 Optometrists 17.300 21,560 26,450 24.6 22.7 Pharmacists 104.100 140.360 175.040 34.8 24.7 Podiatrists 7,600 8.340 12.460 9.7 49.4 Veterinarians 23,300 35.410 52,820 52.0 49.2 Registered nurses 621,000 1.152,000 1.509,000 85.5 31 Total population

(thousands) 195.539 221,195 244,503 13.1 10.5

SOURCE: Reference 42.

occupational therapists, physical therapists, and speech pathologists

(personnel requiring baccalaureates only) will also grow. The supply of personnel requiring less training (baccalaureate not necessary) will also expand; this includes lab assistants, licensed practical nurses, and

radiologic technologists. Emphasis on the growth of physician extender personnel has also led to the emergence of a supply of physician's assistants and nurse practitioners. In 1979 there were 16,000 graduates of nurse practitioner programs of whom 61 were child health associates; 89 percent of those with certificates and 64 percent of those with masters degrees were in primary care. Approximately 70-80 percent of the physician's assistants were employed by primary care physicians (147).

GEOGRAPHIC DISTRIBUTION OF HEALTH CARE

PERSONNEL

The number of people available to provide health care to children is

only one of the factors affecting availability of services. Whether health

care providers are located where they are needed is another. In 1977 there were 16 million people living in critical health manpower shortage areas designated under Section 329(b) of the PHS Act (148). One report stated

that "there are not enough of the right kind of doctors and other medical personnel in the right places to adequately respond to the health care

needs of children" ( 144). Physicians are heavily concentrated in metropolitan areas, especially

the metropolitan areas of the Northeast. For example, in 1976 when there were 162 physicians for every 100,000 people, there were 254 physicians

57
per 100,000 people in the large metropolitan areas of the Northeast (290 per 100,000 in the core counties) in contrast to 75 per 100,000 outside metropolitan areas in the North Central region and 72 per 100,000 outside metropolitan areas in the South. There were about 98,000 active non-Federal dentists in the United States in 1976 or 46 dentists per 100,000 persons. The concentration of dentists was also heaviest in the large metropolitan areas. Within standard

metropolitan statistical areas there were 51 per 100,000 persons; outside

these areas there were 32.

Although programs for physician's assistants (PA's) and nurse practitioners (NP's) were originally perceived as rovicling services in areas where there was a shortage of physicianN, the distribution of these practitioners has not, to date. been significantly different than that of physicians. Available data on NP's and PA's in 1977 indicate that

approximately 70 percent of them were practicing in nonshortage areas, while the remaining 30 percent were in shortag 1.rea:y. (149). Two factors have an impact on the geographic distribution of NP's and PA's. The first involves the restrictions placed on their services under

various professional practice acts in the States, such as supervision

requirements and the range of permitted activities including prescribing

drugs. The second is whether reimbursement is made for their services by

third-party insurers. including Medicare and Medicaid (149). The counts of physicians (or other resources) do not seem to provide useful indicators of their availability when evaluated by utilization rates. Apparently, there are barriers that make resources inaccessible even

though they are theoretically available. The ratio of pediatricians to children, of obstetricians to women of

childbearing age, and of all physicians to the general population is higher

in metropolitan areas than outside them and is highest in the core counties

of large metropolitan areas (52). Nevertheless, children in central cities are

less likely to receive care from an office-based physician than children

outside metropolitan areas. A study of utilization rates in nonmetropolitan designated Medically Underserved Areas showed that the use of medical

services was as high in these areas as in other nonmetropolitan areas although children were less likely to have had a routine physical examination in the medically underserved areas (150).

SATISFACTION WITH HEALTH CARE FACILITIES

On the A --nual Housing Survey in 1977 people were asked whether the

local hospitals and health clinics were satisfactory. Eighteen percent of the children and youths under 18 years of age lived in households where the

answer was no. About 6 percent of the children lived in households where

the adult respondent was bothered very much by the unsatisfactory

facilities and another 5 percent lived in households where the respondent was bothered somewhat. Thus, in 1977, 11.5 million children and youths

lived in households where an adult found the health facilities unsatisfactory, and the adult respondents for 3.9 million of the children were bothered very much. A higher proportion of white than of black children and

58
youths lived in households where an adult found the facilities unsatisfactoryLack of satisfaction with health facilities was more common outside than inside standard metropolitan statistical areas (SMSA's): 22 percent of the children and Youths outside SMSA's lived in households in which the respondent expre.- ed dissatisfaction while 16 percent inside SMSA's lived in households where dissatisfaction was expressed. Somewhat surprising was the finding that the proportion expressing dissatisfaction was lowest in the households of 12 million children and youths living in the central cities of large SMSA's: 1I percent of the children lived in households where dissatisfaction was expressed. Family income o; education of the householder did not appear to be associated with whether people-were satisfied with health facilities.

THE INCREASING COST OF HEALTH CARE

While the Consumer Price Index increased by 87 percent from 1970 to 1979. the price of medical care increased by 99 percent. Physicians' fees were twice as high and the price of a hospital room two and a half times as high in 1979 as in 1970. The increases were relatively less, however, in the later part of the 1970's than in the early 1970's. For example, fees for pediatricians increased at an average annual rate of 7.0 percent from 1970

to 1973, at 15.2 percent from 1973 to 1975. and at 5.6 percent from 1975 to 1978. By 1978 the average fee for an initial office visit to a pediatrician was $19.03 and the fee for a subsequent office visit was $13.72. From 1970 to 1978. expenditures for the health care of children under 19 years of age increased from $10.4 million to $19.9 million. Per capita expenditures increased at an average annual rate of 9.6 percentfrom $137.68 to $286.07 per child. Thus, the amount spent per child just about kept pace with the increase in medical care prices. The distribution of funds. that is the proportion spent on specified

services was relatively steady: changes were minor. The proportion spent on hospital care increased from 33.2 to 35.6 percent and the proportion

spent on dentists' care increased from 11.5 to 14.0 percent.. The proportion

spent on drugs and drug sundries decreased from 18.2 to 14.2 percent. All other changes were less than one percentage point. Adequate care for most children is relatively inexpensive. If there are medical complications. costs increase and they can skyrocket for a child requiring intensive care. Third-party payment plans. which, like all

insurance, are designed to pay for the unexpected or unusual event, do not provide much coverage for the "routine" care of children. The public programs that are designed to provide accessibility to medical care for

low-income people only partly fill the need. In the face of general inflation and the greater inflation of medical care prices. children's medical care will be increasingly difficult to pay for. Children remain the only population group in which a substantial proportion are below the officially designated poverty level, and families with young children in general have less money than other families if only because people have their children when they are young and have less

P.,41 59
money. Nevertheless, public programs pay for about the same proportion

of the care of children as of adults of working age (29 percent in 1978) and

a much lower proportion than for elderly people (63 percent in 1978).

PRIVATE AND PUBLIC COVERAGE

AND EXPEND' T1URES FOR HEALTH CARE

Most children live in families that have private health insurance coverage. In the mid-1970's about three-quarters of the children and

youths were reported as covered by some form of private health insurance. Children in families with relatively high incomes, high levels of education, and both parents present were more likely to be covered by health

insurance than other children. Half of the black children and half of the children with no father in the household had no coverage, and about a quarter (27 percent) of the children in families with incomes under $5,000

had no coverage. If public programs are working as desired, they will compensate for the absence of private insurance. In 1976 a series of questions were asked in

the National Health Interview Survey to determine how many people had no coverage under any public or private program. At that time, 48.2 million children and youths who were not in institutions were reported to have some form of private health insurance coverage, 6.7 million to have Medicaid coverage, 2.0 million had coverage under other programs, and 7.6 million one out of ninewere not covered by any of the specified

forms of coverage. One-quarter of the children in families with incomes under $5.000 and one-quarter of the farm children were not covered. Clearly, public programs did not compensate for the lack of private insurance. In addition, continuing coverage under Medicaid is not assured People may have coverage at one point in time but lose it because of changes in family iiicoine or structure. Analysis of the National Medical Care Expenditures Survey data confirms what has always been suspected: although 4.6 million children under 18 years of age were

covered by Medicaid at some time during 1977, only 4.1 million children were enrolled at any one point in time that year (151). Preliminary data

from that survey a.so confirm that many children (8.1 million in 1977) were not covered by either public programs or private insurance (152). The Medicaid program was designed to reduce or eliminate differentials

in accessibility, availability, and quality of medical care by reducing the financial barriers for low-income families. Although it has not been completely successful in achieving its goals, it is the public program providing the largest amount of money for the medical care of children. Therefore, it is worthwhile to examine it in detail. Of the $5. 0 million from public funds spent on the health care of children under 19 years of age in fiscal year 1978, 55 percent or $3,142 million was from Medicaid, with $1,751 million from the Federal Government and $1,391 million from State and local governments. The next largest dollar amount spent from public funds for personal health

care of children and youths was $823 million spent by the Department of Defense for minor dependents of military personnel. Other programs

60
provided about $1,731 million: this includes the Medicare program, which paid $30 million, and State and local public hospitals, which spent $85

Although most of the money spent on the medical care of children and youths (71 percent) is from private rather than public funds, the

proportion from public funds has increased from 16 percent in 1965 to 24

percent in 1970 to 29 percent in 1978, reflecting primarily the increase in Medicaid spending during the early years of its implementation. That the great increase in public relative to private financing o.:.-curred during the early years of the program can be seen by considenng the average annual percentage rate of change in per capita expenditures. From 1965 to 1970 the average annual change in expenditures for children

and youths under 19 years of age was 21 percent for public expenditures and 8 percent for private expenditures. From 1970 to 1976 the comparable public and private expenditures were 13 and 8 percent and from 1976 to

1978 they were 10 and 11 percent. The growth rate for public expenditures has been declining (the dollar amount is still increasing) while the growth

rate for private expenditures. which remained fairly stable for a decade, is now increasing. There appears to be little question that Medicaid, along with other public programs at the Federal. State, and local levels, has made it possible for many children to receive medical care who otherwise would

not. The programs have succeeded in reducing but nor eliminating

differentials in use of medical care. However, equity, that is equal use

according to need, has not been achieved. When the people living in a State are poor, there are many conflicting demands for relatively little money. One of the consequences is that the

services provided under Medicaid, which is a State program, may be at the minimum level. Poor children in poor States will then receive fewer benefits than poor children in wealthier States. For example, of the 17 States where the income standard for all basic needs for a family of four was under $300 per month, 14 States or 82 percent either had no coverage under Medicaid or restrictions on coverage for vision or dental services; of

the 33 States and the District of Columbia where the income standard was $300 or more. 21 or 62 percent, had such restrictions. Also, one study has shown that, although people enrolled in Medicaid

appreciated the help that Medicaid offered in paying for care, Medicaid did not change their health care pattern. To some extent this was because

the enrollees did not try to find a private doctor or change their source of care. but another reason was the refusal of many private physicians to care

for Medicaid enrollees after Medicaid reimbursement was changed from

the customary fee to a fee set lower than the customary one (153). There are gaps in eligibility due to the design of the programs and the

lack of coordination among them and there is inequality in the services provided because of the ways in which the programs are funded. (See

volume 11.)

In some cases, the rigidity of the regulations also makes it difficult to

provide needed services to children. Auxiliary medical personnel can often

screen children to determine whether a doctor should see the child and

can provide many of the ambulatory care services which are the mainstay

61
of medical care for children. Pediatric nurse practitioners can serve in

isolated areas, referring children when nec.....sary. They can spend time with Cae parent or child explaining the treatment and the reason for

continuing the medicine even after the child appears to have recovered;

they can often speak in words understood by parent and child better than

the doctor can. Despite these and other advantages, the services of nurse practitioners may not be covered by either public or private third-party

insurance.

Knowing whether a person has private health insurance or is covered

under a public program is only a partial answer to the question, Who pays

for care? There are restrictions and limitations on what public programs and private insurance will pay for. In general, they are designed to pay for

inpatient care that is used by relatively few children. Although in 1978, 46 percent of the hospital care was paid for out of public funds, only 6

percent of all children and youths are hospitalized during a year. In

contrast, only 16 percent of the bill for physicians' ..ervices was paid out of public funds, although 75 percent of the children and youths receive ambulatory care. As a result, neither private health insurance nor

Medicaid pays for much of the routine care of children.

Some children probably fail to receive care when there is no third-party financing. In 1978, only 86 percent of the children and youths with no third-party coverage even had a regular source of care in contrast to 92

percent of those with Medicaid and 94 percent of those with private or

military coverage. The differential remained even when poverty status was controlled.

Of the 50.1 million children and youths who actually received

ambulatory care in 1974, 27 percent had all or part of the bill paid by

private insurance and 15 percent by public funds. For 6 percent the method of payment was uncertain, and for 79 percent all or part of the

care was paid out-of-pocket. The impact of Medicaid can clearly be seen here. While children and youths in families with incomes under $5,000 were less likely to receive ambulatory care than children in relatively high

income families, these families were far less likely to make out-of-pocket payments if the children did receive care. Only 42 percent of the lowest

income children compared with 89 pev:ent of the highest income children

had out-of-pocket payments; 52 percent 0' the lowest income children had bills that were covered wholly or in part by Medicaid and 6 percent by private health insurance while only 35 percent of the highest income

children had bills for ambulatory care covered wholly or in part by private health insurance. Medicaid does help children in low-income families {although paying any out-of-pocket medical expense for a child in a family with iess than $5,000 yearly income is bound to be difficult), but it does not provide much help to children in geographic areas where the

proportion with health insurance coverage is low, such as farm children or

children in the South.

Dental care is not well covered under private health insurance or Medicaid. Often it is not covered at all unless the need results from an accident or injury. In 1978. for example, of the 17 southern States, 7

provided no coverage for dental services and 8 provided services in case of emergency only. Preliminary data from the National Medical Care

62
Expenditure Survey indicate that the average charge for a dental visit for a child under age 12 was 522.71, of which 67 percent was paid by the family, 14 percent by private health insurance, and 20 percent by public sources (154). The same is true for visual disorders. Significant eye abnormalities requiring special treatment are unusual in children but nearsightedness is common by the time children reach adolescence (155). However, in 1978 Medicaid did not cover vision exams at all in 10 States and covered examinations after surgery only in 4 States. Of the 36 States (including the District of Columbia) that did cover vision examinations, 9 had a restriction of 1 pair of glasses per year and 8 had other limits. Private health insurance does not cover routine eye care. Coverage for dental examinations and care is improving for children in both the public and private sector and for vision testing in the public sector. A change in the regulations in 1978 permits direct referral under the Early and Periodic Screening, Diagnosis, and Treatment Program if the child's par..;nt or guardian requests it. Thus, even if dental examination or vision testing is not covered under Medicaid, either can be obtained if requested. Enrollment in rrivate dental ins'rance plans has been increasing. There were only 12 million enrollees in 1970 but by 1975 there were 34 million. The estimate for 1978 is 40 million (156). There are many reasons for the differential proportions of care paid for by public programs among age groups including program eligibility and the fact that children, who are more likely to be in good health than adults. are less likely to require lor!g periods of expensive inpatient care. The mixture of services needed by children is quite different from that needed by adults. Young people receive far more of their medical care as ambulatory patients and, in general, ambulatory care is less likely than inpatient care to be covered by either private or public coverage. There are factors other than supply and need that determine utilization. Some people cannot afford the services they need for themselves or their children. Some people are not aware of a need for health services and would not use them if they were available. Forty-eight percent of the families in 1978 had cut back on one or more health-related items in order to cope with inflation with higher proportions among low-income families (56 percent). minorities (60 percent). and single-parent families (72 percent). Major health items that they were cutting back on included dental work and checkups of all kinds (89). There was also evidence of denial. Over half (54 percent) did not want to think that serious illness could happen to anyone in their family; 43 percent agreed that it can be very frightening to go for a checkup because you never know what you will find out: and 73 percent agreed that checkups cost too much for the average family to afford. In such cases, education and support resources may be needed as much as medical health care resources.

ok-m-f( 63
CHAFFER 6

USE OF HEALTH SERVICES

The previous chapters addressed the health status and need for health care of children and youths and the availability and accessibility ofhealth services for children; this chapter addresses whether or not these services are used, how frequently they are used, and differentials in use. While national data show that differentials between "poor" and s`nonpoor" children in use of ambulatory care have decreased, they have by no means been eliminated (157). Differentials in both the proportion of children and youth receiving care and the place of care still exist Care in institutional settings is not inherently better or worse than private care (158). However, relying on hospital outpatient departments and emergency rooms for care or failing to have any regular source of medical care can present problems. One probler : 4s that there may not be continuity of care. A related problem is that them may be a lack of certain kinds of preventive c- such as the recommended series of inoculations. Another problem, witich is seldom considered, is that people have to physically go to the outpatient department for care or consultation. When one is unsure about the need for medical care and the cost in time, money, or energy is excessive, there may be a tendency to delay or avoid care. Differentials in the use of dental care are still large. In 1975-76, children and youths ages 4-17 were 1.6 times as likely to have received dental care within a year if the family income was $15,000 or more than they were if the family income was $5,000 or less. Private insurance and public programs are still less likely to cover cliental care than medical care although the situation is changing. Differentials in the use of inpatient care are the opposite direction from those for ambulatory care: children in poor families are more likely to be hospitalized and to remain in the hospital longer than children in families with more income. It can be assumed that children in poor families are less likely to receive good preventive care than children in families with more money.' Certainly they are less likely to have received the recommended immunizations. They are also more likely to live in crowded and deficient housing with incomplete plumbing. Such factors are likely to contribute to more frequent and severe illness and, consequently, to more hospitalization. The factors that contribute to differentials in the use of medical care are complex. Income is only one. Evidence presented in this chapter suggests that knowledge is another, if level of education is considered as a proxy.

65

If 3
The child's own needs for preventive or illness care are a third. The

availability of appropriate resources is essential. It is too simplistic to speak of the need for medical care as if all children needed the same kind of care or that the same child always had the same needs. Children need, and to varying degrees, many different kinds of health care. There will always be differentials in the utilization rates for

physicians. dentists. hospitals. and psychiatric facilities because of

differentials in the need for them. Such differentials are shown in this

chapter. However, there are other differentials in use which are not associated with need. Those differentials a- e also shown.

CONTACTS WITH A PHYSICIAN

Most of the care children receive is ambulatory. In 1975-76, children

and youths had about 12 times as many ambulatory medical contacts of

ali kinds and 5.5 times as many visits to office-based physicians as they had days in a hospital. Nevertheless, children and youths received less ambulatory medical care than adults. They had. on the average. 4.1

physician contacts (including telephone) while people 18-64 years of age had 5.2 and people 65 years of age and older had 6.7 physician contacts

per person per year (34. 122). In recent years. over half of the children and youths have had a contact with a physician within 6 months and about three quarters have had a

contact during a year. Almost 90 percent have had a contact within 2

years and 97 percent within 5 years (34. 122. 123). In 1975-76, those with

at least one contact had, on the average. 5.6 contacts during the year. Children in families where the head had less than 8 years of education and

children in families with six or more people were less likely to have had

anv medical contact and had fewer contacts than other children. Only 63 percent of the children and youths in f t n lies with either of these

characteristics had any reported contact with a physician during the year. Young chi!dren and children in highly educated families were more likely

than other children to have had a physician contact during the year. About 88 percent of the children under age 6 and 84 percent of the

children and youths in families whose head had 16 or more years of education had had at least one contact with a physician during the year_ Most of the contacts were because the child was, or was thought to be, sick. According to the parents, 80 percent of the contacts were for

diagnosis or treatment while 13 percent were for general checkups and 5 percent were for immunization. In general. those groups of children who

had fewer medical contacts during the year had a smaller fraction of their

contacts for preventive care. The American Academy of Pediatrics (159) has published guidelines and recommendations for the frequency with which children should visit a

physician for routine preventive care and developmental evaluation. In

each State. the Early and Periodic Screening, Diagnosis. and Treatment

Program (EPSDT) also has i schedule for the ages and frequency at which

children should be screened. It was not possible to obtain data to evaluate precisely what proportion of the children in the United States are being

66
seen according to either set of guidelines but an approximation was made using information collected through the 1975-76 National Health Inter- view Survey on the interval since the last contact with a physician. If a

child under 2 years of age had not had any contact with a physician within 6 months, a child 2-5 years of age had not had any contact within 1 year. or a child 6-17 years of age had not had any contact within 2 years. the child was classified as needing medical care- By these criteria, 14 percent of the children and youths under 18 years of age who were not in institutions needed medical care in the mid-1970's (35): excluded of course are those children who needed care for a particular condition even though they had seen a physician within the specified time frame. Including those children would raise the percentages. The children most likely to have failed to receive care were the 11 million children living in households where the head had 8 years or less of education: one-quarter (25 percent) of those children had not had a contact wit;: a physician within the specified interval. The 12 million children living in households where the head had 9-11 years of education were also at risk of failing to receive care: one-fifth of those children (20 percent) had not received care within the specified interval. Also at high risk were children in large families and black children. In both categories ab, one-fifth of the children (21 and 19 percent. respectively) should have seen a physician more recently than they had if recommended evaluation and prevention schedules were to be main- tained.

The large income differentials in children's receipt of medical care that existed prior t-) the implementation of Medicaid have diminished ( 157). Nevertheless. differentials by family income still exist and there are differentials by other characteristics of the family; the proportion of children who have had a physician contact during the year is 20 percentage points lower when the family head has not gone beyond eighth grade than when the family head is a college graduate or when there are six or more persons in the family in contrast with three or fewer. As Anderson ( 160) pointed out, the poor improved their position relative to the rest of the population between 1963 and 1976 and currently have high levels of access if the measure is number of visits per person, but they may still receive less care relative to need. The use-disability ratio is one way of examining differences among population groups in the use of medical care relative to need. Two use- disability ratios are shown in table K. D'rrerences by income are much greater when either of the need measures is taken to account than when they are not: differences between white and black children and youths are relatively smaller. Differences in the number of physician contacts between children of parents with little education and those with above average education are large regardless of whether need is taken into account or not. One reason for the large differential by education is that the proport;on of all contacts which were reported by the parents as being for a -general checkup" was twice as great when the family head was a college graduo-- as when he or she had not gone beyond eighth grade (15 vs. 7 percent;. -"once a limitation of using disability for estimating need is that the need for preventive care is not taken into account, the high use of

67
TAME K. Physician Cotes per Person and per 100 Clisnimithly Day= United litoise, 1975 -75 Anima Avenge

Variable

Physician Contacts Per Year

Per

Person

Per 100 Days et:

Restricted tied

Activity Disabi

Family income Under 55.000 4.2 33 72

S5.000-$9.999 3.7 33 74

510.000-$14.999 4.1 38 95

$15.000 or more 4.4 43 98

Education of family head 8 years or less 2.8 26 58

9-11 years 3.6 31 75

12 years 4.1 38 86

13-15 years 4.8 44 101

16 years or more 5.4 49 120

Race

White 4.3 38 88

Black 3.2 37 76

SOURCE Tablets 54 and 74.

services by children of highly educated parents relative to reed as defined may reflect appropriate use of preventive care. On the other hand, it may

reflect overuse if many of the general checkups are not really nececsary. A contact does not necessarily mean a visit to the physician. Many

private physicians, especially pediatricians, can be reached by telephone

at specified times and can almost always be reached through an answering

service. Thus. when the parent is in doubt about whether the child needs

to see a physician. advice can be obtained by telephone and many minor

problems may be managed without an office visit. This option is seldom

available except through private physicians, where there is usually no

charge. About 17 percent of all contacts of children and youths are

telephone contacts. In 1974. only 6 percent of the black children and 12 percent of the

children in families with incomes of less than $5,000 had a telephone

contact during the year compared with 25 percent of the white children or

27 percent in families with incomes of $15,000 or more. The low-income

child or the black child had to be taken to the physician with the resultant problems of cost, transportation, and time. In 1975. children and youths under 18 years of age had about 22 million

episodes of injury which received some medical attention. The first medical attention for 15 percent of those injuries was by telephone. However. only 5 percent of the injury episodes of children in low-income

families compared with 19 percent in high-income families were first medically attended through a telephone call. Whether those for whom the telephone was the first medical contact were later seen by a physician is not known. It seems reasonable to
speculate, however, that there would be savings in time and money if telephoning a physician for advice were an option equally available to

everyone. Certainly pediatricians have learned that many problems can be adequately handled via the telephone by trained aides (161). Children who rely on institutional settings for their carc might be better served if

these facilities also offered telephone consultation as a service.

PLACE OF VISIT

A specit supplement to the National Health Interview Surrey in 1974 provided data about the different places where people. go for ambulatory medical care over the course of a year. During that year, 69 percent of the children and youths made at least one visit for medical care: 62 percent went to a private physician in their office, 5 percent to a free-standing

clinic. and 21 percent to a hospital outpatient department or emergency

room. (These amount to more than 69 percent because the categories are not mutually exclusive.) About half (45 percent) saw a private physician

only, 7 percent received care in a hospital or free-standing clinic only, and 17 percent had ambulatory care in both private and institutional settings. About 31 perc...mt of all children under 18 years of age did not go to any

of these three places for medical care. Not seeing a physician at all during

the year was highly related to :age; 16 percent of the children under 6 years of age. 36 percent of those 6-1 i years of age, and 39 percent of youths 12-17 years of age had not seen a physician during the previous 12 months. Seeing a physician was also highly associated with race; 42 percent of the black children compared with 29 percent of the white

children had not seen a physician for ambulatory care during the year. To a lesser degree not seeing a physician was associated with family

income (36 percent of those in families with income under $5,000 but 26 percent of those in families with incomes of $15,004 or more), residence

(33 percent in central cities of standard metropolitan statistical areas

(SMSA's) and 35 percent outside SMSA's but 27 percent in the suburban

areas of SMSA's). and region (33 percent in the South and West but 27

percent in the Northeast) had not made a visit for medical care during the year. Race, residence in a central city, and income were major determinants

for the setting in which ambulatory care was received. Only 58 percent of

the black children under 18 years of age received medical care in any of

the three settings: 26 percent saw a private physician only, 18 percent received all their care in institutional settings, and i4 percent in both. In

contrast. 71 percent of the white children received medical care in one of the three settings: 48 percent from a private physician only. 5 percent in

institutional settings only, and 18 percent in both. Overall, 66 percent of the white children compared with 40 percent of the black children

received some care in a private setting; 18 percent of the black children

compared with 5 percent of the white children received all their care in an institutional setting. Children who lived in the central city were also more likely to receive

care in an institutional setting than those who lived outside the central city

r 69
of a metropolitan area. In the central city, 38 percent of the children and youths saw a private physician only, 12 percent received care in

institutional settings only, and 18 percent in both. In the suburban areas. 50 percent received care from a private physician only, 5 percent in

institutional settings only, and 18 percent in both. Thus, 68 percent of the

suburban compared with 55 percent of the central city children and

youths received some care in a private setting. Poor children were also more likely than those in families with more

income to receive their med: in institutional settings. Among

children in families with inco- k.. $5,000, 64 percent saw a physician

in one of the three settings; . received care in a private setting only, 14 percent in an institu, -Ling only, and 19 percent in both. Among children in families with incomes of $15,000 or more, 74 percent saw a physician during the year; 54 percent received all their care in a private setting. 3 percent in an institutional setting only, and 17 percent in both. Thirteen percent of the children and youths in the low-income

families received some of their care in free-standing clinics; about 9 percent had some care in a public health clinic and 5 percent in a

neighborhood health center. Black children, children in central cities, and poor children were more

likely than their counterparts to receive care in institutional settings, but

the amount of such care did not compensate for the lack of care in private

settings. They were still less likely to have received any medical attention

during th, year despite the likelihood of being in poorer health. Use of hospitals for ambulatory care has increased greatly. In 1956, only about 6 percent of the children under 14 years of age received

ambulatory care in a hospital (162). In 1974. 21 percent of the children under 18 years of age had made at least one visit during the year for ambulatory care at a hospital; 16 percent were seen in an emergency room

and 8 percent in an outpatient department (some were seen in both

departments). Even among upper income families, 18 percent of the

children and youths received some care in hospital outpatient departments and emergency rooms, and 21 percent of the suburban children used

hospitals for some of their ambulatory care. Children in poor (under $5,000) families were more likely to be seen in hospital outpatient departments than those in families with incomes of $15.000 or more (14 cent vs. 6 percent), but children in higher income

families were seen in emergency rooms almost as frequently as those in

lower income families (15 vs. 19 percent). The same relationships hold

h, ,ck -:hiidren are compared with white children or children in

ce .e.s with those in suburbs. Emergency rooms are used by all

w . _ecled but outpatient departments are used by the poor, the black.

2:1d central city child_

REGULAR SOURCES OF HEALTH CARE

Obviously. many children do not need to see a physician every year especially older children. In other cases, no one realizes that the child

70
needs medical care or, realizing it, does not seek care. However, for 8 percent of the children and youths in 1974, the need was recognized but there were problems obtaining care (35). Problems in obtaining care were reported most frequently for the groups of children most likely to need a physician. For example, problems were reported for almost one-fifth (18 percent) of the children in fair or poor health (35). Difficulty in getting an appointment when needed was cited as the most common problem. One reason for the difficulty in getting an appointment may be that there is no source of care where the child is already known. In 1974, one- tenth (6.5 million) of the children and youths did not have a usual place of care; one-sixth of the black children and the children in families with incomes under $5,000 did not have a usual place to receive care. Forty- five percent of the black children and youths and 39 percent of children and youths in families with incomes under $5,000 did not have a regular physician regardless of whether they had a usual place ofcare. More recent data indicate that the proportion of children and youths without a usual source of care may have shown a small decrease, but the proportion of children and youths without a regular physician nrly have shown a small increase (a difference in definition and the restrictic.n of he age to 'Alder 17 years in 1978 account for part of the ot;served differences). For the 45.0 million children under 17 years of age with private or military coverage in 1978, 94 percent had a usual source of care: it was a private physician's office for 84 percent; 79 percent had a regular physician. Of the 6.8 million children and youths with Medicaid coverage 92 percent had a usual source of care: however, the usual source was a physician's office for only 59 percent; only 62 percent had a regular physician. For the 6.4 million uninsured children and youths. 86 percent had a usual source of care: it was a private physician's office for 65 percent; 64 percent had a regular physician. The children covered by Medicaid and the children with no health insurance were about equally unlikely to have a regular physicianthe former because of reliance on outpatient departments and clinics for their usual care and the latter because of not having a usual source of care. Even controlling for health insurance coverage, black children and children below the poverty level were less likely to have a usual source of care or a regular physician and were more likely to rely on institutional sources for care than white children or children in families above the poverty level.

VISITS TO OFFICE-BASED PHYSICIANS

The distribution by settings is different when the number of visits made by children as opposed to the proportion of children who made at least one visit during the year is examined. Although only 69 percent of the children and youth visited a physician's office and 21 percent a hospital for ambulatory care in 1975-76. 77 percent of all visits were to physicians' offices and only 17 percent to hospitals (The remainder were to other

71
places.) Thus children receiving care in private physicians' offices made

more visits, on the average, than children receiving ambulatory care

through hospitals. Data from the National Ambulatory Medical Care Survey provide useful information on the kinds of physicians providing care and the

characteristics of the visits. However, this information applies only to

visits to private physicians' offices. It is important to keep in mind that

private physicians provide only part of the ambulatory medical care of

children and youths. Children under 6 years of age, children in upper

income families, white children, and suburban children are much more

likely than their counterparts to have received care, from a private

physician. and injuries are frequitly treated in emergency rooms

regardless of demographic characteristics of the injured person. Pediatricians, general practitioners, and family practitioners provide the major part of the private care of children. In 1975-76, 40 percent of the

visits children under 18 years of age made to office-based physicians were

to pediatricians; 34 percent were to general practitioners and specialists in

family practice. Among ,:hiluren under 6 years of age, 57 percent of the visits were to

pediatricians. Among elementary school children 41 percent of the visits

were to pediatricians. However, with adolescence there was a definite shift

away from using pediatricians. Only 23 percent of the visits of adolescents 12-15 years of age and 7 percent of the visits of those 16-17 years of age were to pediatricians. The older adolescents made about 44 percent of

their visits to general or family practitioners.

Reasons for the Visits

Routine care. that is. -care not involving an illness, accounted for onequarter (25 percent) of the office visits made by children and youths in

1975-76. Respiratory conditions, the major Hine' for which children were

taken to the physician's office, accounted for another quarter (26 percent), infectious and parasitic conditions (8 percent), skin conditions (7 percent), conditions affecting the nervcus system 1 percent) and injuries (8

percent) accounted for most of the rem... ...Lig The average number of visits per child and the reasons for the visit

change as children move from infancy through adolescence. Babies, those

not yet a year old. were taken to a physician's office 5.9 times a year on

the average. Half of those visits (49 percent) were for routine care, 13

percent for treatment of an acute upper respiratory condition, 7 percent

for infectious and parasitic conditions, and 6 percent for ear conditions.

Injuries accounted for 2 percent of the visits. Older preschool children were taken to a physician's office 2.4 times a

year. Only a quarter (24 percent) of the visits were for routine care.

Injuries accounted for 6 percent of the visits. Acute upper respiratory

conditions were paramount amo..g illnesses (21 percent). and ear

conditions were also important reasons (12 percent). From the start of elementary school at age 6 through 15, children visited

a private physician on the average 1_5 times a year during 1975-76. Most

72
of these visits were for illness or injury: routine care accounted or less than a fifth of the visits. Injuries were a major reason for taking a school- age boy to the physician. Eleven percent of the visits elementary school- age boys made to a physician's office and 16 percent of the visits boys 12-15 years cf age made were for injuries. Around 16 years of age, there is a change in reasons for seeing an office- based physician. Through all the years of childhood and early adoles- cence. boys make more visits to physicians than girls mostly because

they have more injuries. In later adolescence, 16-17 years of age, girls make more visits than boys. Some girls at this age are receiving prenatal care (about II percent of all visits by girls 16-17 years of age made to

private physicians in 1975-76 were for prenatal care), and it is likely that some of the visits for examination and observation are for suspected

pregnancy. These data reflect only the visits to private physicians in office-based practice. They also reflect only the first of three diagnoses that the physician can report if there are multiple diagnoses. Thus. they may not accurately reflect the proportion of children who have specific problems. It appears likely that psychosocial problems. for example, are underreported. Only 1 percent of the first-listed diagnoses by pediatricians in the

National Ambulatory Medical Care Survey were psychosocial in contrast with 2 percent of the second-listed and 3.5 percent of the third-listed

diagnoses (163). Goldberg et al. (164) found that 2 percent of the visits of children to office-based physicians in Monroe County. N.Y., were for

mental health problems. although for another 3 percent of the children the physician reported a mental health problem when asked. In a study of seven primary care facilities. Starfield et aL found that the percent of visits associated with psychosocial diagnosis was consistently less than half the percent of children recorded as having these problems and that both

percentages varied widely according to the kind of facility and service

(163).

Characteristic of the Visits

Very fey, of the visits (15 percent) of children under 15 years of age were

first-time visits and about half (51 percent) were for patients who had

already been seen at least once for the current problem. The physicians' judgment for over half (57 percent) of the visits was that the problem was not serious. This is a reflection of the continuity of care for children in

private care. the high proportion of visits (especially ofyoung children) for non-illness-related care, and the greater number of visits made by young

children. About a quarter (26 percent) of these visits involved injections, imr71:_tai-ation. or desensitization and 13 percent involved medical counseling. Blood pressure was checked on only 8 percent of the visits. Even when the visit was for a medical or special examination, the child's blood

pressure was checked only 15 percent of the time. Most of the visits were short. Only 14 percent involved more than 15

minutes of contact with the physician and 57 percent lasted 10 minutes or

less. In general. the visits for illness care involved less time spent with the physician the *t the visits for special examinations.

S

73
DENTAL CARE

The often noted differences in children's receipt of medical care and

their receipt of dental care are somewhat misleading due to two factor.. First, the comparisons are oft =n made for children of all ages although very young children receive a great deal of medical attention and almost no dental attention. Almost none of the children under age 4 and only 56 percent of those 4-5 years of age in 1975-76 hat! ever had a dental visit, while virtually all had visited a physician. Seoncl. the commonly quoted numbers for medical care include telephone contacts; 17 percent of all contacts for medical care of children and youths under age 18 in 1975-76 were telephone contacts. When those are excluded, there were 5.1 doctor visits per child under age 6 per year and 2.7 visits per person 6-17 years of age reported in the National Health Interview Survey. At the same time, there were 1 dental visits per year for children 4-5 years of age, 1.6 visits

for children 6-11, and 2.3 visits for youths 6-17 years of age. Of the

children and youths 4-17 years of age, 62 percent had at least one dental visit during 1975-76. School-age children 6-17 years of age were just about as likely to have visited a dentist as a physician. However, 14

percent of the children 6-11 years of age and 7 percent of the youths 12-17 years of age had never visited a dentist. Even when the population is restricted to people 4-"' years of age to

avoid the inclusion of very young children, there populations of children and youths who are receiving little dental car.... In 1975-76 less

than half of the black children, children in families whose head had less

than 8 years of education, and children in families with incomes under 55,000 had visited a dentist within a year. and about one-fourth of the

children in each of these groups had never visited a dentist.

The differentials among socioeconomic categories are much more

pronounced for dental care than for medical care. Neither private health

insurance nor public programs are as likely to pay for dental care as medical care although the situation is changing. The number of people

enrolled in private dental insurance plans has increased greatly from 12 million in 1970 to 35 million in 1975 to an estimated 4.0 million in 1978

(156) Changes in the guidelines in 1978 permit the immediate referral of a

child to a dentist under EPSDT even when Medicaid does not cover

dental care.

INPATIENT CARE IN HOSPITALS

Data from the National Hospital Discharge Survey show that children

and youths use far less inpatient medical care than adults. The average child spent only 29 percent as many days in the hospital in 1975-76 as a

working-age adult and 8 percent as many days as an adult 65 years of age or older (62).

In 1975-76. there were 352 days of short-stay hospital care per year for every 1.000 children under 18 years of age. Of these 352 days, 274 were for diseases and conditions. 65 for injuries. 14 for deliveries, and only 3 for arninations and observation without illness.

74
On the average, infants spend more time in the hospital than older children. Excluding the routine hospitalization at the time of birth, there were 1.266 hospital days per year for every 1,000 infants in 1975-76. The

rate of utilization is high because of the long hospitalizations of infants in distress at birth. The average length of stay of infants hospitalized for perinatal morbidity resulting from maternal conditions, difficult labor, birth injuries, etc., was 14.2 days, and it is not unusual for such infants to

be hospitalized for a month or more. Pneumonia, however, accounted for more hospital care for infants than any other single condition-540,000 days each year; and all respiratory conditions together accounted for 1.265 million days each year. Among preschool children as among infants, respiratory conditions were the most common reason for the child being in the hospital; 35 percent of all the days preschool children spent in the hospital were

because of a respiratory condition and about a third of those days were

due to pneumonia (11 percent of the total). At this age, however, injuries were the second most common ref- on for the child t3eing in the hospital, accounting for 16 percent of th.: days preschool children spent in

hospitals. Children hospitalized for injuries stayed longer than other childrenon the average 5.1 days. Among elementary school children and young adolescents injuries were

the most common reason for the child being hospitalized. About a quarter of the children in the hospital on any given day were there because of an injury (25 and 23 percent for children 6-11 and 12-15 years of age, respectively). Respiratory conditions were still a major reason for elementary school children being in the hospital (19 percent of the days) but were less important for those 12-15 years of age (10 percent). In later adolescence, injuries and childbirth were the most common

reasons for the young person being in the hospital. Injuries accounted for 22 percent and childbirth for 16 percent of the days youths 16-17 years of age spent in the hospital. On any given day, 38 percent of the boys that age who were in the hospital were there because of an injury and 27

percent of the girls were there because of childbirth (62). Most hospitalization for pneumonia in children, childbirth for adoles- cent girls, and perinatal conditions resulting from poor intrauterine or

delivery circumstances for newborns should be avoidable in this country if present knowledge and preventive care were equitably and energetically

applied. One important change in the hospitalization of children should be noted. In 1966-67, there were 15 hospitalizations for tonsillectomies for every 1.000 children under age 15. Ten year, later, there were only 8 such

hospitalizations (165). Data from the National Health Interview Survey for the same time

period reveal the differentials in hospitalization rates between children in

low-income families and those in high-income families. About 7 percent of the children and youths in families with incomes under $5,000 and 5

percent of those in families with incomes of $15,000 or more had been

hospitalized during the year. However, there were 610 days of hospitalization for every 1.000 children and youths in the low-income families, but only 190 days for every 1.000 children in the high-income .. The

75
large differential is due to the average length-of-stay being longer for the poor children-8.5 days if the family income was under $5,000 in

comparison to 3.9 days if the family income was $13,000 or more.

LONG-TERM INSTITUTIONAL CARE

Very few children are residents of long-term health care institutions, although the estimate of 152,000 in 1976 is almost certainly an underesti- mate (127). However, the data are included here as they do indicate the multiple needs of these children, the long stays in institutions, and the

apparent lack of treatment. The largest proportion of the children were admitted for medical reasons (38 percent) and family reasons (31 percent). Almost a third (31 percent) had been in the facility for 5 years or more; almost half (48

percent) for 3 years or more. For 80 percent no discharge was expected in

the next 12 months. They were long-term residents of institutions with multiple handicaps (1.27). According to repo: .ing by the facilities, these young people were less

likely than adults to be receiving treatment. They needed educational. social. medical. nursing, and other services; 98 percent needed at least one

such service (127). Despite the need, 30 percent were receiving no

treatment. The only conditions for which significant proportions of the

children and youths were receiving treatment were mental retardation (29 percent) and mental illness (19 percent). Information on number of visits or interval since last visit by health professionals such as physicians, dentists, and nurses was not collected. Thus, although these children were

in medical care facilities, little is known about whether they actually

received medical care.

MENTAL HEALTH CARE

Children with psychiatric disorders receive care in specialty mental health settings such as psychiatric hospitals, general hospital psychiatric units. commt; :lay mental health centers, free-standing outpatient psychiat- ric clinics. residential treatment centers for children, private practices, and other settings. They also receive care through a number of general health

care settings. including pediatricians' office-based practices, Health Maintenance Organizations, prepaid group practices, and other organized

health care settings, and through general hospital nonpsychiatric services. Outside of the health and mental health settings, care is also provided within the school system, the social service system, and the correctional system. The exact number of children receiving care in each of these

sectors, the nature and type of their problems, and the types of treatment provided are not known. Data based on national probability samples of all specialty menial health facilities in the United States indicate that care received by children and youths within the specialty mental health sector is primarily

76
outpatient care. During 1975, there were 358,000 admissions of persons under 18 years of age to outpatient settings compared with only 83.000 to inpatient psychiatric services. There were app. -Nxima tely 214.000 admis- sions to federally funded community mental health centers that provide both inpatient and outpatient care. Therefore, in 1975, the estimated overall rate of admissions for children and youths under 18 years of age to the specialty mental health sector was 989 per 100.n00 population, or about 1 percent.

The diagnostic compo- tion of inpatient and outpatient admissions was different. Inpatient admissions reflected more heavily the "severe" mental disorders such as depressive disorders and schizophrenia. These two categories accounted for over 30 percent of the inpatient admissions but only 4 percent of the outpatient admissions. Caution should be xercised in using these data, however, because for a large number of child.-en either no diagnosis or some general category was assigned. Some recent studies provide estimates of children and youths with mental disorders seen in organized health care settings that are not mental health specialty facilities. A study of four organized health care settings with mental health services cornpa: 1 data on the extent. nature. and impact of diagnosed mental disorder mong children wider 18 years of age seen in the pediatrics departments uring 1975 1166). Acrt-ss settings. between 3.3 percent and 10.1 percer t of ti e childreii seen were diagnosed

as having a mental disorder in the study yearrepresentinz an annual treated prevalence of between 2.2 percent ad 8.2 percent of the child populations registered in the health care plans. Transient situational disturbances, behavior disorders, and special symptoms were the most common disorders. The more severe disorders accounted for less t'-an 4 percent of all diagnosed mental disorders. As has been found in studies of adults, patients with diagnosed mental disorders used nonmental services appreciably more often than did patients without such a diagnosis. However, this greater use of health services was accounted for primarily by visits to specialistis other than pediatricians. A pilot study in Monroe County. N.Y., on the role of the pediatrician in the delivery of mental health services to children showed that 5 percent of 3.742 patients seen by nine pediatricians were reported to have an emotional, behavioral, or school problem (164). The recognized preva- lence rate ranged from 1.4 percent to 7.8 percent for the different study pediatricians. The most frequently reported problems were adaptation reaction, specific learning disorder, hyperkinetic disorder. psychosomatic disorder, and conduct disorder. Frequency of mental health problems observed by the pediatricians was about five times the annual rate of Monroe County children contacting a psychiatric inpatient or outpatient setting. If this ratio holds for the United States, perhaps five times as many children with mental health problems are seen in pediatricians' offices as in psychiatric ; cilities. In a study by Starfield et al. (163) conducted in

seven primary care facilities, there was great variation among facilities but in all but the hospital teaching facilities, 5-15 percent of the chilcIre7. peen in one year were diagnosed as having behavioral, educational, or social problems. These problems, however, engendered fewer visits for their management than might have been expected from their frequency.

77
Quids lo Taft Mount lo CharAsis a

Health Status and Determinants

A, Population

DelffoOmPhic

Social and economic

B. Fertility

General 7, 8, 9

Expciad births 10

Adolesc t 11, 12, 13

UnmarrieL 13,14

Contraceptio and abortion 15, 16, 67

C. Mortality

Infant, fetal, and perinatal 17,18

Children and youths by cause

D. Determinants

Medical carelee Utilization

Immunization by disease

Usual Ace of care 29, 31

11./MMIIIMalMENOWNIMI,I.

I,

IMM.P1M.M11.0,0=.

20 21, 22

Breast feeding

Food consumption by food group

Special diet 35

Substance use by type of substance 36, 37, 39, 40

Cigarette 3 6, 3

, 3 88, 39 , 9

40

26, 27, 28, 29,

301 31

Fluoridation

Housing conditions

School health programs by type

Activities

E. Measures of health

low bill weight

Height, weight, and hemoglobin 49 50, 59
51

52, 53

54

55

55,57

58

Ks, 61, 62

63, 64

66

Parental assessment of health

Limitation of activity

habil IfY days by tYlm

Acute Condltiors by type

Injuries

Notifiable disuses

Dental decay

Handicap. by tYPe

Arrests by type of crime

Preinduction disqualification

11. Utilization of Health Resources

A, Ambulatory

Family planning

Prenatal care

Contacts with physicians

Inter/al and number

Source or place

Resson

Injuries

Visits

Place

Office visits

Office visits by diagnosis

Dental visits

Interval and number

Psychiatric services

B. Inpatient

Hospital zation and days

Diagnosis

Surgical procedures

67

68, 69,70, 71

72, 73

93

N.

V

88, 89
b TAW Wont lo CMOs (CA)

0001011%111600.N.INIMINIMIMINIMMIMINIMMINO=WININMwellmMINOMMNISmonellftlw 001,

NI, Health Care Resource

A. Personnel and facilities

Satisfaction

Physicians

71 72, 73

Dentists

Nurses

Practical nurses

Dental hygienists

Community hospital beds

Accessible schools

V. Health Care Costs and Financing

A. Expenditures

National

Personal

Type of expenditure

Source of funds

B Financing

Public programs

AFDC

Medicaid

WIC

Health insurance

Source of payment

C. Cost

Consumer Price Ir6ex by type

Fees by Physician specialty

109

115, 117

119, 120

114
REFERENCES AND NOTES

f U.S Bureau of the Cassis:. -Population Estimates and Ptojections." Current Population Reports. Senor P-25. Number 800. Washington. D.C.: U.S. Government Printing Office, April 1979. 42) U.S. Bureau of the Census. -Perspectives on American Fertility." Current Population Reports. Series P-23. Number 70. Washington. D.C.: U.S. Government Printing Office. 1978. 13) Bureau of Labor Statistics. Women in the Labor Force: Some New Data Series. by J. L. Norwood and E. Waldnsan. Report 575. Washington. D.C.: U.S Government Printing Office. 1979. (4) Bureau of Labor Statistics. "Children of Working Mothers. March 1977," by A. S. Grossman. Special Labor Force Report .217. Washington. D.C.: U.S. Government Printing Office. 1979. (5) Moore, K. A. and S. L. Hofferth. "Women and Their Children." In The Subtle Revolution.R. E. Smith. ed. Washington. D.C.: The Urban Institute, 1979. (6) Espenahade. T. J. "The Value and Cost of Children." Population Bulletin. Volume 2. Number 1. Washington, D.C.: Populaitica. Reference Bureau, Inc.. 1977. 17) Glick. P. -Children of Divorced Pare.its in Demographic Perspective.' Journal of Social Issues 35(4): 170-182. 1979.

(8) Bane. M. J. Here to Stay: American Families in the Twentieth Century. New York: Basic Books. Inc.. 1976.

(U) Glick. P C. and A. J. Norton. -Marrying. Divorcing and Living Together in the U.S. Today.- Population Bulletin. Volume 32. Number 5. Washington. D.C.: Population Reference Bureau, Inc.. 1977.

(10) National Center for Health Statists.a. -Final Divorce Statistics. 1978." Monthly Vital Statistics Report. Advance Report. Volume 29. Number 4. DHHS Publication Number (PHS) 80-1120. Public Health Service. Hyattsville. Md.. July 31, 1980.

( 7? National Center for Health Statistics. "Final Natality Statistics. 1978." Monthly Vital Statistics Report. Advance Report. Volume 29. Number 1. DHHS Publication Number (PHS) 80-1120. Public Health Service. Hyettsvilte, Md.. April 28. 1980. ( /2) Bumpass. L. and R. R. Rindfuss. -Children's Expe-ience of Marital Disruption." American Journal ctf5ociology 85(1): 49-65. 1979. (13) Espenshade. T. J. -The Economic Cc. cs of Divorce.'" Journal of Marriage and the Family 41(3): 615-625, August 1979. (14) U.S. Bureau of the Census. "Marital a tams and Living Arrangements." Current Population Reports. Series P-20. Number 323. Washington. D.C.: US. Government Printing Office. April 1978.

(15) Action for Children's Television. General Information Pamphlet. Newtonville. Mass.. undated (16) Zelnik. M. and .1. F. Kantner. "First Pregnancies to Women Aged 15-19: 1976 and 1971." Family Ptaritung Perspectives 10( 0: 11-20. January-February 1978.

( - M. and J. F. Kantner. -Sexual Activity. Contraceptive Use. and Pregnancy Among Metropolitan-Area Teenagers: 1971 1979,- Family Planning Perspectives 12(5): 230-237. Septem- ber-October 1980.

(18) National Center for Health Statistics. " Births. Marriages. Divorces, and Deaths for July 1980." .Monthly Vital Statistics Report. Volume 29. Number 7. DHHS Publication Number (PHS) 80-1120. Public Health Service. Hyattsville. Md.. October 6, 1980. (19) Alan Guttmacher Institute. Data and Analyses for 1978 Revision DREW Five Year Plan on Family Planning Services. New York, December 1979. (20) Cutright. P. and F. S. Jaffe. Impact of Family Planning Programs on Fertility. The U.S. Experience. New York: Praeger Publishers. Inc.. 1977. (21) Darney. P. 1) "Fertility Decline and Participation in Georgia's Family Planning Program: Temporal and Real Associations." Studies In Family Planning 6: 156-165. 1975. (22 , -knderson. J. E. -Planning Status of Marital Births in the U.S.. 1975-1976." Family Planning Evaluation Division, Center for Disease Contra:. May 1980. unpublished paper. (23) Weston'. C. F. and E. F. Jones. -C-ontraception and Sterilization in the United States." Family Planning Perspectives 9: 153-157. 1979.

(24) Nat..mal Center for Health Statistics. -Contraceptive Utilization in the United States: 1973 and 1976." by K. Ford. Advance Data from Vital and Health Surtist:cs. Number 36. DHEW Publication Number (PHS) 78-1250. Public Health Service. Hyattsville, Md.. August 18. 1978.

81
(25) Ze Inds- M. and J. F. Kantner. "Seaual and Contraceptive Eaperunsce of Young Unmarried WORMS

in the United States. 1976 and 1971." Finlay Planning Pltrapereives 9: 5S-71.1977.

(J4) Center far Disease Control. Surveillance: Tribal Sierilamat.n 1070-1915. DHEW Putsbcation

Number (CDC) 74-8378. Atlanta. Ga.. 1979.

(27) Westeaff, C F. and J. McCarthy, **Sank:awn in the United States.' Family Planning Perspectives

I I : 147-152.1979.

(;:8) Taffel. S. M. and P. .1. Meek. "Post-Parturn SttirdilatI011 in Cesarean Section and Non-Cesarean

Section Deliveries: 1970-1975. United States." Paper presented to the Southern Repoetal

Demographic Group. Tallahassee, Fla.. October 1980.

(29) Forrest. J. D.. E. Sullivan. and C. Tieter. "Abortion in the United States. 1977-1978... Family

Planning Perspectives 1 I: 329-341.1979.

(30) Totes. A. "Organized Family Planning Services in the United SUMS. 19611-1976.- Fasnily Planning

Perspectives 10: 83-1111.1978.

(31) 'ores. A. -Organized Family Planning Services in the United States. 1976-1977.** Family Planning

eierspectives II: 342-347.1979.

(32) Morns.. L.. -Family Planning Services in the United Slates." Bulletin of die Pan American Health

,..)rgansmation 9: 124-128.1975.

r 1*1 National Cornier for Health Statistics. "Physician Visits. Volume and Interval Since Last Visit:

United States. 1975.- by A. Gentile. Vital and Health Statist Series 10. Number 128. DHEW

Publication Number (PHS) 79-1556. Public Health Service. Washington. D.C.: U.S. Government

Printing Office, April 1979.

(34) National Center for Health Statistics. -Current Estimates Born the Health Interview Survey: United

States. 1975.- by T. F. Drury. Vital And Health Statistics. Series MX Number 115. DHEW

Publication Number (PHS) 77-1543. Public Health Service. Washington, D.C.: U.S. Government

Printing Office. March 1977.

(35) National Center for Health Statistics. Special tabulations from the National Health Interview

Survey prepared by M. G. Kovar.

( 36) American College of Obstetricians and Gynecologists. Standards for Obstetric and Gynecologic

Service. Washington, D.C., 1974.

(37) National Center for Health Statistics. "Prenatal Care. United States. 1969-1975.- by S. Taffel. Vital

and Health Statistics. Series 21. Number 33. DHEW Publication Number (PHS) 78-1911. Public

Health Service. Washington. DC.: U.S. Government Printing Office. September 1978.

(38) institute of Medicine. -Infant Death, an Analysis by Maternal Risk and Health Care.- Contrasts in

Health Status, Volume I. Washington. D.C.: National Academy of Sciences. 1973.

(39) National Center for Health Statistics. -Factors Associated with Low Bir.12 Weight: United States,

1976.- by S. Taffel. Vital and Health Statistics. Series 21. Number 37. DHHS Publication Number

(PHS) 80-1915. Public Health Service. Washington. D.C.: U.S. Government Printing Office, April

1980

(40) National Center for Health Statistics. "The National Ambulatory Medical Care Survey. 1975

Summary. United States. January-December 1975:- by H. Koch and T. McLemore. Vital and

Health Statistics. Series 13. Number 33. DHEW Publication Number (PHS) 78-1784. Public Health

Service. Washington. D.C.: U.S. Government Printing Office. January 1978.

(41) Notional Center for Health Statistics. -Office Visits by Women: The National Ambulatory Medical

Care Survey." by B. K. Cspress. Vital and Health Statistics. Series 13. Number 45. DHHS

Publication Number (PHS) S0-1796. Public Health Serves. Washington, D.C.: U.S. Government

Printing Office. March 1980.

(42) US. Department of Health and Human Services- Supply of Manpower in Selected Health

Occupations: 1950-1990. DHHS Publication Number (HRA) 80-35. Health Resources Administration. Washington. D.C.: U.S. Government Printing Office. September 1980.

(43) Cynamon. M. L. and P. J. Meek. -Insurance Coverage for Prenatal Care. Hospital Stay. and

Physician Care United States, 1964-66 and 1972 National Natality Surveys.** Paper presented to

the annual meeting of the American Public Health Association. New York. November 1979.

(44) Muller. C. -Financial Assurance for Reproductive Health Services:* The Mount Sinai Journal of

Nfechcine 42(4): 316-325. July-August 1975.

(45) National Center for Health Statistics. -Expected Principle Source of Payment, for Hospital

Discharges: United States 1977.- by R. Pokras and G. Gardocki. Advance Data from Vital And

Health Statistics. Number 62. DHEW Publication Number (PHS) 81-1250. Public Health Service.

Hyattsville. Md.. October 31.1980.

82
(46) Muller. C., M. Krasner. F. S. Jaffe, D. Carson, and J. Whalen. Financing Fertility Related Health

SerViCOS in Jacksonville. Florida. 1973-1978. Center for Family Planning Program Development.

Division of Planned Parentbood-World Population, New York, 1979.

(47) Health Insurance Institute. Source Book of Health Insurance Data 1978-1979. Washington. D.C.,

1960.

(48) Health Care Financing .Adininistiatiosi. Health Care Financing Trends. Spring. 1980. by D. P.. Waldo. Volume 1, Number 3. HCFA Publication Number 03013. Office of Research. Demonstrations, and Statistics. Spring 1980.

(49) Office on Smoking and Health. Smoking and Health. A Report cf the Surgeon General. DHEW

Publication Number (PHS) 79-50066. Public Health Service. Washington. D.C.: US. Government Printing Office, 1979

(St) Goldberg, M. F., L. D. Emonds, and G. P. Oakley. 'Reducing Birth Defect Risk in Advanced

Maternal Age." Journal of :he Amerie an Medical Association 242: 2292-2294, 1979. (Si) Bradshaw. .1.. J. Weak. and J. Weatherall. "Congenital Malformations of the Central Nervous

eystesn." Population Trends. pp. 13-1L Spring 1980.

(52) National Center for Health Statistics.. Health United Stater, 1976-197Z DHEW Publication

Nutiber (HRA) 77-1232. Health Resources Achninistration. Washington. D.C.: U.S. Government Printing Office, 1977.

(53) Zebtik. M. and J. F. Kammer. "The Resolution of Teenage First Pregnancies." Family Planning Perspectivess 6(2): 744-80, Sowing 1974.

(St) Bearkov, B. and J. Sta:ar. -Does Illegitimacy Make a Difference? A Study of the Life Chances of

Illegitimate Childreal in Califoenia2" Population and Development Review 2(2): 201-217, June 1976. (.$5) National Center for Health Statistics. "Trend's and Differentials in Births to Unmarried Women:

United Sams. 1970-76," by S. J. Ventura- Vital and Health Statistics. Series 21. Number 36. DHHS

Publication Number (PHS) 80-1914. Public Health Service. Washington,. D.C.: US. Government Printing Office, Mar 1980.

(56) National C.enter (07 Health Statistics. "Thal Mortality Statistics. 1978." Monthly Vital Statistics

Report Volume 29. Number 6, Supplement (2). DHHS Publication Number (PHS) 80-11120. Public

Health Service. Hyattsville. Md.., September 17. 1980.

($7) U.S. Bureau of the Cigars. Vital Stasis' tics Rates in the United Swett. 190)-19414 Washington. D.C.: U.S. Government Printing Office. 1943.

(5.I) National Censer for Health Statham. 'Births. Marriages, Divorces, and Deaths foi 1979." Monthly

Vital Statistics Report Provisional Statistics- Volume 28, Number 12. DHHS Publication Number

(PHS) 80-1129. Public Health Service. Hyattsville, Md, March 14, 1980.

(59) NrSonal Censer for Health Statistics. Vita Stalin tics Reim in the United States 1940-1964 by R.. D. crave 47. id N. M. Hemel. DREW Publication Number (PHS) 61677. Public Health Service.

Washington, D.C.: US. Government Printing Office, 1968.

(60) The Robert-Woo-t-Johnson Foundation. Special Rep-art: Regionalized Prenatal Services. Number 2. Office of Information Service, Princeton, NJ., 1978-

(61) Shapiro. S., M. C. McCormick, B. IL Starfield, J. P. Kriecher, and D. Bross. "Relevance of Correlates of Infant Deaths on Scent Morbidity at I Year of Age." American Journal of Obstetrics andOynecology36(3): 363-373, February 1980.

(62) Komar. M. G. "Ouldren and Youth: Health Status and Use of Health Services." In Health United

States. 197*. DREW Publication Number (PHS) 78-1232. Public Health Service. Washington. D.C. US. Government Printing Office. December 1978.

(63) Morris. N. M., J. R. Udry, and C. I.. Chase. "Shifting Ago-Parity Distribution of Births and

Decrease in Infant Mortalit' American Journal of Ptsblic Health 65(4): 353-358, April 1975. (64) K.ovar. 111. G. "Mortality of Black Infants in the United States." Phylon 38(4): 370-397, 1977. (65) Lee. R... S.. N. Faz....:-.1 L. M. Gartner., M. A. Pearlman. and L. Gross. "Neonatal Mortality: An

Analysis of the Recent Improvement in the United States." American Journal of Public Health 80: 15-21. 1960.

(66) Wright. N. H. "Some Estimates of the Potential Reduction in the United States infant Mortality

Rate by Family Ptomains." American Journal orPublic Heafth 62: 1130-1134, 1972

(67) Burnett. C., R. Lkhy T. Vitaglione. and E. Seigel. "ninny Planning in North Carolina: Has It Lowered Infant Mortality?' Paper Pres=sed the South Carolina Petinstal Association. January

25, 1978.

(68) Quick. I_ D. "tesalined Abortion in Oregon: Effects on Fertility. Prematurity, Fetal Death. and

Infant Death." American Journal of Public Health 68: 1003-1008, 1978.

83
(69) Bauman. K. E. and fr. E. Anderson "Legal Abortions and Trends in Fetal and Infant Marta thy

Rates in the United States." Anse:sic:an Journal of Obstetrics and Gysiecoloay 136: 194-202. 1980.

(70) World Health Organization. A WHO Report on Social and Biological Effects on Perinatal

Aderodity. Volume 2. Budapest, Hungary: Statistical Publishing House, 1978.

(71) Kleiman. J. C.. M. G. ',Cover. J. J. Feldman. and C. A. Young. "A Comparison of 1960 and

1973-74 Early Neonatal Mortality in Selected States." Amman Journal of Epidemiology 108(6):

454-469, July 1978. (72) US. Bin-eau of the Census. "Characteristics of the Population Below the Poverty Level." Current

Pepedation Reports. Series P-60. Number 119. Washington. D.C.: U.S. Government Printing

Office. March 1979.

(73) U.S. Bureau of the CCUSUIL "Money Income and Poverty Status of Families and Persons in the

United States.' Current Population Reports. Series P-60. Number DM Washington. D.C.: U.S.

Government Printing Office. November 1979.

(74) Macs*. P. J. "Underlying Medical Conditions, Complications of Pregnancy and Complication of

Labor to 'Wadies* of Lqeitimate Live Hospital Births in the United States." Paper presented to the

annual meeting of the Population Association of America. Atlanta. Ga., Apra 1978.

(75) Jones, A. E. and P. J. Placek. "Prenatal Care and Its Relationship to Maternal and Infant Health."

Paper presented to the annual meeting of the Southern Regional Demographic Group. Myrtle

Beach, S.C. October 1979.

(76) Mock.. P. 3. "Maternal and Infant Health Factors Associated with Low Birth Weight: Findings

from the 1972 National Natality Survey." In Epidemiology of Prernaussity. D. N1 Reed and F. J.

Stanley, eds. Baltimore. Md.: Urban and Schwarnzberg, September 1977.

(77) Hofferth. S. L.. and K. A. Moore. "Early Chddbearing and Later Economic Well-Being." American

Sociological Reviev44: 784-815. October 1979.

( 7S) National Center for Health Statistics. Health United States. 1978. DHEW Publication Number

(PBS) 78- 1232. Public Health Service. Hyattsville. Md, December 1978.

(79) Grossman. M.. D. Coate, I... N. Edwards. R. A. Shakota. and D. Chernichovsky. Determinants of

ms's Health. Final Report, Gratis Number 1 1R01 HS 02917, National Center for Health

Statistics Research. New York: National Bureau of Economic Research. February 1980.

(SO) Child Trends. Inc. Special tabulations from the 1976 National Survey of Children, Washington.

D.C.. 1980.

(8t) National Association of Elementary School Principals- The Most Significant Minority-One-Parent

Children in the Schools. Arlington. Va.. 1980.

(82) Wademein. 3- S. and 3. B. Kelly. "California's Children of Divorce." Psychology Today, pp. 67-72.

January 1980_

(83) Phiildser. S.C. and P. B. Rothenberg. "The Impact of Single Parenthood on Mothers and Their

Children." Paper presented to the annual meeting of the Population Association of America.

Denver. Cob.. April 1980. (84) U.S. Bureau of the Census. Data from the 1977 Annual Housing Survey; special tabulations

prepared by the US. Bureau of the Census. Centerfor Demographic Studies. 1980.

(85) U.S. Bureau of The Census. "Relative Progress of Children in School: 1976." Ckssrent Population

Reports. Series P-20. Number 337- Washington. D.C.: US. Government Printing Office, April

1979.

(86) National Center for Education Statistics. Digest of Education Statistics 1979, by W. V. Grant and

C. G. Lind. Publication Number (NC ES) 79-401_ Washington. D.C.: US. Government

Printing Office. January 1979. (87) The Robert Wood Johnson Foundation. SpecialReport: A New Survey on Access to Medical Care.

Number 1. Office of Information Services. Princeton. NJ., 1978-

(88) Feller. B. and T. Drury. "Using National Health Statistics for All Persons of Hispanic Ancestry as

Surrogate Estimates for Persons of Specific Types of Hispanic Ancestry: A Preliminary Assessment

of Problems of Bias." Paper presented to the annual meeting of the American Statistical

Association. Houston. Tex.. August 1980.

(89) General Mills. Inc. The General Mills American Family Report.. 1978-79: Family Health in an Era

ofStrcsa. Minneapolis. Minn.. 1979_

(90) Snow. J. "On the Mode of Communication of Cholera." In Snow on Q-- -Zara. 3 ea New

York: The Commonwealth Fund. 1936.

(91) Crooks. E. L. W... Jr. and A. B. Konilsoff. Twmty-Year Study of the Effectiveness of Fluoride in

the Richmond Water Supply." Vsrgiais Dental Journal49(6): 24-26, December 1972.

84
(92) Kodiak. L. 'Dental Health Survey of New Haven School Claildren after Seven Years of Fluoridation.' Connecticut Health Bulletin. Spring 1977.

(93) Schultz. W. E. "Results *tithe City of Milwaukee Dental Surinys, 1950,1959,1965." The Wisconsin

Dental Society 45(5): 195-196. May 1969. (94) Yacavonsie, .1. A. and A. M. Parente. 'Twenty Years of Community Water Fluoridation: The

Prevalence of Dental Carnes Among Providence. Rhode Island School Children." Rhode Island

Dental Journal 18: 3-7.1974.

(95) Brewster: L. L. "Tuscan Had Start Dental Care Project." American Journal of Public Health 58:

881-891. May 1968.

(96) California Dental Service Corporation. "The Relationship of Fluoridaian and Operation Head Start Expenditures.' California Dental Service Newslener. San Francisco. June 1967.

(97) Hagan. J. H. Annual Report to the Membership o trite Missouri Dental Service Corporation. 1970.

Missouri Dental Service Corporation. Crystal City. Mo.. 1970.

(98) Ohio Dental Association. Council on Legislation. Tar Savings from Fluoridation in Ohio Head

Start and Other Anti-%Poverty Dental Programs. Columbus. Ohio: Ohio Dental Association, April

1966.

(99) Canter for Disease Control. Special background materials compiled for the Select Panel for the

Promotion of Child Health. Atlanta. Ga.. 1980.

(100) Center for Disease Control. Surveillant = Nutrition. Annual Sennmary, 1978. Atlanta. Ga.. 1980.

(101) National Censer for Health Statistics. 'Trends in Breast Feeding Among American Mothers," by C. Hirschman and G. E. Hendershot Vital and Health Statistics. Series 23, Number 3. DHEW

Publication Number (PEES) 79-1979. Public rvice. Washington. D.C.: U.S. Government

Printing Office. November 1979

(102) National Assessment of Educational Progress. Chet-cap: A National Assessment of Health Awareness Among 17-Year-Olds and Young Adults. C:ontract NO. OEC -O-74 -0506. National

Center for Education Statistics. Washington. D.C.: U.S. Government Printing Office. September

1978.

(103) National Institute of Education. Teenage Smoking: Immediate and Lorg-Term Patterns. by D. E.

Green. Washington. D.C.: U.S. Government Printing Office. November 1979_

(104) National Institutes of Health. Teenage Smoking: National Patterns of Cigarette Smoking. Ages 12

Through 111. in 1972 and 1974. DHEW Publication Number (NIH) 76-391. Washington, D.C.: U.S.

Government Printing Office. 1974.

(105) Institute of Medicine. Adolescent Behavior and Health: A Conference Surnmar3r. Washington.

National Academy of Sciences. 19'78-

(106) Mortality Division. National Center for Healils%snistiai. Data from the National Vital Registration

System. 1976. (107) American Humane Association. Children's Division. -National Analysis of Official Child Abuse

and Neglect Reporting, 1976:' Denver. Colo., 1977.

(!tom) National Center for Child Abuse and Neglect. National Analysis of Of Child Abuse and

Neglect Reporting. 1977. DHEW Publication Number (OHMS) 79-3=2. Office of Human

Development Services. Washington. D.C.: US. Government Printing Office. 1979. (109) National Center for Child Abuse and Neglect. National Analysis of Official Child Abase and Neglect Reporting, 1978. DHEW Publication Number (OHDS) 80-30271_ Office of Human

Development Service& Washings:In, D.C.: U.S. Government Printing Office. 1980.

(110) Camptroller General of the United U.S. General Accounting Office. Report to the Congress,

Increased Federal Efforts Needed to Better Identify, Treat, and Prevent Child Abuse and Neglect.

Washington. D.C.: U.S. Government Printing Office, April 29.1980. (Ill) Gilles, R.. 'Violence Towards Children in the United States." Paper presented to the annual meeting of the American Associatio' n for the Advaneemeni of Science, Denver, Cob.. February

1977.

(112) Brunswick. A_ F. and E. JoipeOson- 'Adolescent Health in Harlem." Americana Journal of Public

Health. Supplement. October 1972.

(113) Brunswick. A. F. and P. Collate. "Psychophyrical Correlates of Elevated Blood Pressure: A Study

of Urban Black Adolescents." learns, of Human Stress 3(4): 19-31. December 1977.

(114) Brinenvick. A. F. "Indicators of Health Status in AdoICIONI0e-" International Journal of Health

Services 6(3): 475-491.1976.

(115) Brunswick. A. F.. J. M. Boyle. and C. Marina. "Who Sees the Doctor? A Study of Urban Black

Adolescents:* Social Science and Medicine 13A: 45-56.1979.

85
MO Coles. R. C7 ea of Canis. Volumes 1-4. Boston: Little. Brown. and Company, 1967. 1972-73,

19711.

(117) Whitehead, P. C Alcohol and Young DriVeri. Inspect and Implications of Lowering the Drinking

A. Department of National Health and Welfare, Canada.November 1977.

-MS) Robertson, L. 'Crash Involvement of :sea -seed Drivers When Drivers Education is Eliminated

Erma lash SehooL" American Journe of Public Health70(6): 599-603. June 1980.

(119) Greene, L. "To Educate or Not tr Educate: Is that the Question?' American Journal of Public

Health 70(6): 425-626, Jam 1950.

(l20) Office of Population Censuses and Surveys. Occupations/ Mortality. Series DS. Number 1. Her

Majesty's Stationery Office. 1.0m1011. 1977.

(121) Mare, R. D. "SociSeconomic Effects of Cad Mortality in the UnitedSWIM" Institute for Research

on Poverty. Center for Demography and Ecology. University of Wiscoosin. Madison. unpublished

PaPer- (122) National Cramer far Health Statistics. ""Current Estimates from the Health Interview Survey: United

Stases. 1976." by E. R. Black. Vital and Health Statistics. Series 10, Number 119. DHEW

Publication Number (PIES) 73-1547. Public Health Service. Washington. D.C: U.S. Government

Printing Office. November 1977.

(123) National Center for Health Statistics. 'Current Estimates from the Health Interview Survey: United

States. 1977.' by L. J. Howie and T. F. Drury. Vital and Health Statistics. Series 10. Number 126.

DHEW Publication Number (PHS) 73-1554. Public Health Service. Washington. D.C.: U.S.

Government Priming Office. September 1978.

(124) Health Services Administration. Health Status of Children: A Review of Survey"' l963-ter.-

DHEW Publication Number (BSA) 71-5744. Washington. D.C.: U.S. Government Printing Office.

19711.

(123) Myers. M. H. and B. F. Harkey. 'Cancer Patient Survival in the United States- In Coma"

Epidemiology and Prevention. D. Schottenfeld and J. F. Fraumen. Jr., eds. Philadelphia: W.B.

Saundra:. in press. (126) U.S. Departmeet of Health. Education. and Welfare. Social Security istration. Surrey of

Blind and Disabled Children Remitting Supplemental Security Income (SSD Benefits SSA

Publication' Number 13-11725. Washington, D.C.: U.S. Government Printing Office. January 1980.

(127) U.S. Bureau of the Census. "1976 Surveyof institutionalised Persons, a Study of Persons Receiving

Long-Tenn Care." COMM Population Reports. Series P-23. Number 69. WasLington, D.C.: U.S.

Government Printing Office. June 1973.

(128) National Center for Health Statistics. 'Acute Conditions. Incidence, and Aspeciated Disability.

United States. July 1975-June 1976," by J. W. Choi. Vital and Health SialtiMiCS. Series 10, Number

120. DHEW PublicataSea Number (P115) 73-1548. Public Health Service. Washington. D.C.: U.S.

Government Printing Office, January 1973.

(129) National Center for Education Statist' ice. Athletic Injuries and Deaths in Secondary Schools and

Colleges, by R. Calvert, Jr. Publication Number (LACES) 79-339X. Washington, D.C.: U.S.

Government Printing Office, November 1979.

(130) Consumer Product Safety Commission. Data from the National Electronic Injury Surveillance

Syssens. (I3l) National Censer for Health Statistics. -Decayed. being. and Filled Teeth among Persons 1-74

Years: United States. 1971-74,- by J. Kelly and C. Harvey. Vital and Health Statistics. Series 11, in

preperation. (132) Kovar. M. G "Adolescent Americans: What of Their Medical and Health Problems?" The

Sciences, 18-21. April 1979_

(133) National Center for Health Statistics -Skin Conditions and Related Need for Medical Care Among

Persons 1-74 Years: United States. 1971-74." by M. T. Johnson and J. Roberts. Viral and Health

Statistics. Series 11, Number 212. DREW Publication Number (PHS) 79-1660. Public Health

Service. Washington, D.C..: U.S. Government Printing Office. November 1978.

(134) Gould. M. S.. R. Wonsch-Ffttrig, and B. P. Dobsenwend. -Formulation of Hypotheses about the

Prevalence, TEL and Prognostic Spat-sconce of Psychiatric Disorders in Children isa the

United States- In Mental illness in the United States, Epid esniological Estimates. B. P.

Dohrenwmad. ed. New York: Praeger Publishers. Inc.. 1930.

(135) Stanford Research Institute. Educational Policy Research Center. Studies of Handicapped

Students. Volume I. Whom do Teachers Identify as Handicapped? and, Volume 11, Teacher

Identification of Handicapped Pupils (Ages 6-11) Compared with Identification Using Other

Indicators. Menlo Park, Calif., 1975, 1978.

86
Mtn Tombs. C. Specie& beclqwound asakrials compiled Itor the Select Panel the the Promotion of child

Health, National meat... of Mental He 1980.

(137) U.S. Office of Education. Bureau of Education Ibr the Handicapped. Progress Towards a Free and Appropriate Edanstion: A Repast to the Conran on the Pro em of P.L. 94-142: Education for

AI Handicapped Children Act. DHEW Publication Number (OE) 79-051303. WashiSpon, D.C.:

U.S. Government Printing Oftioe. January 1979. (13S) National Institute on Drug Abuse; Alcohol. Do j Abuse. and Mental Health Administration. National Survey on Drug Ahem: Main Mediae& 1979. by P. M. Fiabburne, H. L Abelson, and 1.

Ciao. COMM% No. 27-78-4508. /toekvilla. Md.. 19801

(139) National Censer tier Health Statistics "Final Marriage Statistics. 1974." M indsfy Vital Statistics

Report. Volume 25. Number 2 Supplement. Public Health Service. Rockville. Md.. May 5. 1976. (Mt) National Center for Health Statistics. lir-mal Martine Statistics: 1978." Mandily Vital Sadistic.

Report. Volume 29. Number 6 Supplement (2). DHHS 'Publication Number (PHS) 80-1120. Public

Health Service. Hyattsvilk, Md., September 12. 1980. (141) Kann. M. G. "Some Indicators of Healtb-Related Behavior Among Adolescents in the United

States.' Phiblic Health Reports 94(2): 109-11a. March-April 1979. (142) National Institute of Education. Violeta Selsoas--Safit Schoch. The Safe School Study Report to

the Congress. Volume L Washings". D.C.: U.S. Government Printing Office. 197$.

(143) Children's Defame Fund. Doctors and Dollars Are Not Enough. How to Improve Health Services

for Children and Their Families. Washington. D.C.: Washington Research Project. Inc.. April 1976.

(144) Harvard Child Health Project. Report of the Harvard Chad Health Project Task .Foroc. Volumes

1-111.Cambridge: Ballinger Publishing Co.. 1977.

(145) U.S. Department of Health and Human Services Health Resources Administration. The CUI7eZit

and Fissure Supply of Physicians and Physician 4toecralists. DHHS Publication Number (HRA)

80-60. Washington. D.C.: U.S. Government Printing Office. September 1980. (146) U.S. Department of Health and Human Services Office of Graduate Medical Education. Report of

the Graduate Medical Education National Advisory Committee. Washington. D.C.: U.S.

Government 1Priating, Office, September 1980. (147) Wallets. J. "Current Status and Future Prospects of Non-physician Health Care Providers- In

Health United Scrum. 1979. DHEW Publication Number (PHS) 80-1232. Public Health Service.

Washington. D.C.: U.S. Government Printing Office. 1980. (14$) U.S. Department of Health. Education. and Welfare, Health Resources Ad axzn' istration. A Report

to the Prestid eat and Congress on the Status of Health Professions Personnel in the United States.

DHEW Publication Number (HRA) 78-93. Washington. D.C.: U.S. Government Printing Office.

August 1979. (149) Weston-I. L -The Distribution of Nurse Practitioners and Physician its, Implications of Legal COVIStraiiiila and Reimbussernesm- .Pubiic Health Reports 95(3): 253-258. May-June 1980.

(150) lUeiniman..1. C. and R. W. Wilson. Are 'Medically Underscrved Areas Medically Underserveerr

Health Services Research 12(2): 147-162, Summer 1977.

(151) Wileasky. G. R.. D. C. Walden. and 3. A. K.asper. The Changing Medicaid Population.

Unpublished document. (352) National Censer for Health Services Research. "Who Are the Uninsured?' Data Preview 1. by J. A.

Kasper. D. C. Wadden, and G. R. VI-do:sky. National Health Care Expenditures Study. DHHS

Publication Number (PHS) 80-3276. Public Health Service. Hyattsville. Md.. 1980.

(153) Haggerty. R.. 3.. IC. J. Roghmann. and I. B. Pleas. Chad Health and the Oxernunir' y. New York:

John Wiley and Sons. 1975.

(154) National Center for Health Services Resouch. -Charges and Sources of Payment for Dental Visits

weal SeParate Charges." Data Preview 2. by L. F. Rassiter and W. R Lawson. National Health Care JEspencrmares Study. DIMS Publication Number (PHS) 80-3275. Public Health Service.

Hyattsville. Md.. 1910.

(155) National Censer for Health Statistics. "Monocular Visual Activity of Persons 4-74 Years,. United

Stales. 1571-1972.- by J. Roberts and .1. F. Ludford. Vital and Health Statistics. Series 11. Number

201- DHEW Publication Number (PHS) 77-1646. Public Health Service. Washington. D.C.: U.S.

Government Printing Office. March 1977.

(156) U.S. Dttortment of Health. Education. and Welfare, Health Resources Administration. A Survey

of Denzil ante& Plana 0/JEW Pi:Weal:ion Number (HRA) 79-29. Washita" gton: U.S. Govern -

ment Printing Office. 1979.

(157) Wilma. R. W. and E. L White. "'Changes in Morbidity, Disability, and Utilization Differentials Between the Poor and the Nonpoor: Data from -Ne Health Interview Survey. 1964 and 1973.1-

Modell Owe 15tak 636-646. August 1977.

sr7
(1311) Institut* of Medicine. "Asennenent of Medical Care for Children.' Contrasts an Meth Status.

Volume 3. Waehingtoo. D.C.: National Academy of Sciences, 1974.

(159) American Academy of Pediatrics. Standards of Child Maids Cum Committee on Standards of

amid Health Caere. Evanson. EL. 1977.

(160) Anshmeces, R "Hey ids Status bodices and Aeons to Medical Care." American Journal of Public

Menhir 611(5): 4511-463, May 19711.

(161) Katz. H. P.. 3. Panes. and A. L Medan "Quality AINCOMIllint of a Telephone Care System Utilizing

Noe-Physician PeisconeL" Anissicen Journal ofPublic Health 68(1): 31-311. January 1973.

(162) Odoroft. M. E. and L.. M. Abbe. 'Use of General Hospitals. Factors in Outpatient Visits.' Public

Health Reports 72(6): 4711-4113, June 1957.

(163) StarnekL B.. E. Orem M. Wood. R.. Panama, C. Allen. L. B. Gordon, P. Moffatt, P.. Drachmas. and

H. Kate:. "Psydsosockd and Pitychosonsatic Diagnoses in Primary Care of Children." Pediatrics

63(2): 59-1filt. Ample 1980. (164) Goldberg. L. D.. D. A. Raper. T. K. Winery. L B. Plass. and K. J. Roglimana. "The Role of the

Pediatrician in the Delivery of Mental Health Services for Children." Pediatrics 63: 3911-909. 1979.

(165) National Center for Health Statistics. Health Unised Stares. 1979. DHEW Publication Number

(PHS)110-1232. Public HeoL:s Service. Hyattsville. 11 .d.. 1900.

(166) Jacobsen. A. M.. I. D. Goldberg. 11. 3.. Burns. E. W. Hoeper. T Harkin. and K. Hewitt.

'Diagnosed Mental Decreer in Children and Use of Health Ser . wes in Four Organized Health

Care Settings.' American Journal of ftychiatty 137(5): 599-565. May 1980.

BIBLIOGRAPHY

Chadreses Defense Fund. EPSDT. Does it Spell Health Case for Poor Children? Washington. D.C.:

Washiegtoo Research Project. June 1977.

National Research CounciL Toward a National Policy for Children and Families. Washington. D.C.:

National Academy of Sciences. 1976. Saver. G. A. Child Health, America's Future. Germantown. Md.: Aspen Systems Corp.. 1973.

The Carnegie Council on Children. AU Our Cladren: The American Family Under Pressure, by K.

Keniston. New York: Harcourt BraciJovanovich. 1977_

U.S. Deparunent of Health. Education. and Welfare. Healthy People. The Surgeon General's Report on

Health Proasodon and Disease Prevention. DHEW Publication Number (PHS) 79-55071. Public

Health Service- Washington. D.C.: U.S. Government Printing Office. July 1979.

88
SECTION H

TABULAR PRESENTATION

OF DATA

SYMBOLS

Data not available 1=1

Category applicable .00

Quantity zero =1

Quantity more than 0 but less than 0.05 0.0

Figure does not meet stand^ -ds of

reliability or precision

Q3
LIST OF DETAILED TABLES

L Health Status and Determinants

A. Population

TABLE 1.

TABLE 2.

TABLE 3.

TABLE 4.

TABLE 5.

B. Fertility

TABLE

TABLE

TABLE

TABLE

Children and Youths Under 18 Years of Age, According to Race, Sex, and Age: United States, July 1, 1978 Children and Youths Under 18 Years of Age, According to Region and Residence by County Chazacteristic: United States, 1975-76 Annual Average Women 15-44 Years of Age and Children and Youths Under 18 Years of Age 1960-1978, and Population Projections for 1980-2000 Under Three Fertility Assumptions, According to Age, and Child and Aged Dependency Ratios: United

States, 1960-2000 Selected Years Daytime Care of Children 3-13 Years of Age, According to Labor Force Status of Mother by Age of Child and Marital Status of Mother: United States, October 1974 and February 1975 Children and Youths Under 18 Years of Age in Poverty, According to Race, Spanish Origin, and Sex of Family Head: United States, 1960-78

Selected Years

Selected Demographic Measures Related to Chil- dren and Youths Under 18 Years of Age, According to Race: United States, 1940-78 Selected Years

7. Live Births, Crude Birth Rates, and Age-Specific Birth Rates, According to Race: United States, 1950-78 Selected Years

8. Live Births and Birth Rates, According to Region, Division, and State: United States, 1978 9. Birth Rates, According to Age of Mother and Live Birth Order: United States, 1950-78 Selected Years

10. Lifetime Births Expected by Married Women and Percent of Expected Births Already Born, According to Age and Race: United States, 1967-78

Selected Years

1 94

91
92

TABLE

TABLE

TABLE

TABLE

TABLE

TABLE

11. Live Births, and Age-Specific Birth Rates for

Women Under 25 Years of Age, According to Age

of Mother and Race: United States, 1966-78

12. Cumulative Percent of Births to Women Under 25

Years of Age, According to Age of Mother and

Race: United States, 1966-78

13. Live Births and Birth Rates for Unmarried Women

and Ratios of Births to Unmarried Women to

Total Live Births, for Women Under 25 Years of

Age, According to Age and Race: United States,

1966-78

14. Ratios of Births to Unmarried Women to Total

Live Births, According to Region, Division, State,

and Race: United States, 1976

15. Contraceptive Status of Currently Married Women

5-44 Years of Age, According to Race and

Hispanic Origin: United States, 1973 and 1976

16. Legal Abortions, According to Selected Characteristics of the Patient and of the Procedure: United

States, 1972-77

C. Mortality

TABLE 17.

TABLE 18.

TABLE 19.

TABLE 20.

TABLE 21.

TABLE 22.

Infant, Late Fetal, and Perinatal Mortality Rates

and Late Fetal and Perinatal Deaths, According to

Race: United States, 1940-78 Selected Years

Perinatal Death Rates, According to Birth Weight and Age at Death: Hawaii, Oklahoma, Rhode

Island, Utah, Vermont, and Washington, 1973

Total, Infant, and Neonatal Deaths and Rates,

According to Color, Sex, Region, Division, and

State: United States, 1978 Deatkt Rates for Selected Causes for Children 1-4

Years of Ayr, According to Color: United States,

1925-78 Selected Years

Death Rates for Selected Causes for Children and

Youths 5-14 Years of Age, According to Color:

United States, 1925-78 Selected Years Death Rates Due to Diseases and Conditions and

to External Causes for Persons Under 25 Years of

Age, According to Race, Sex, and Age: United

States, 1976

D. Determinants

TABLE 23. Immunization and Infection Status of Children

1-4 Years of Age According to Specified Disease:

United States, 1970-78 TABLE 24. Immunization and Infection Status of Children

1-9 Years of Age, According to Specified Disease,

Age, Metropolitan Status, Color, and Poverty

Level: United States, 1976

105
TABLE 25. Immunization Status of Children Entering Kinder- garten and First Grade, According to Specified Disease, State, and Selected Cities: United States, 1978-79

TABLE 26. Regular Source of Care for Children and Youths Under 18 Years of Age, According to Place of Usual Care, and Selected Characteristics: United States, 1974 TABLE 27. Regular Physician at Place of Usual Care for Children and Youths Under 18 Years of Age, According to Specialty of Physician, and Selected Characteristics: United States, 1974 TABLE 28. Regular Source of Care for Children and Youths Under 17 Years of Age, According to Regular Physician and Travel Time, Type of Health Insur- ance Coverage, and Selected Characteristics: Unit- ed States, 1978

TABLE 29. Regular Source of Care for Women 17-44 Years of

Age. According to Regular Physician and Travel Time, Type of Health Insurance Coverage, and

Selected Characteristics: United States, 1978 TABLE 30. Regular Source of Care for Children and Youths Under 17 Years of Age, According to Place of

Usual Care, Type of Health Insurance Coverage, and Selected Characteristics: United States, 1978 TABLE 31. Usual Sources of Care of Women 17-44 Years of

Age, According to Place of Usual Care, Type of Health Insurance Coverage, and Selected Characteristics: United States, 1978 TABLE 32. Ever-Married Mothers 15-44 Years of Age in 1973 Who Breast Fed Their First Child for 3 Months or More, According to Year of Birth of First Child

and Selected Characteristics of the Mother: United

States, 1973 TABLE 33. Consumption of Selected Food Groups by Chil- dren and Youths Under 18 Years of Age, According to Frequency of Intake, Race, Age, and Sex: United States, 1971-74 TABLE 34. Consumption of Selected Food Groups by Women 18-44 Years of Age, According to Frequency of

Intake and Race: United States, 1971-74 TABLE 35. Youths 12-17 Years of Age According to Sex and Women 15-44 Years of Age on a Special Diet, by Reason for Diet, Kind of Diet, Sex, and Age: United States, 1971-74 TABLE 36. Ever Use of Specified Substances by Youths 12-17 Years of Age, According to Type of Substance: United States, 1972-79 Selected Years TABLE 37. Ever Use and Recency of Use of Specified Substances by Persons 12-25 Years of Age, According

to Age and Type of Substance: United States, 1979

93
TABLE

TABLE

TABLE

38.

39.

40.

TABLE 41.

TABLE 42.

TABLE 43.

TABLE 44.

TABLE 45.

TABLE 46.

Current Cigarette Smoking by Youths 12-18 Years

of Age, According to Age and Sex: United States,

1968-79 Selected Years

Use of Specified Substances in the Past 30 Days by

High School Seniors, According to Type of Substance: United States, 1975-79

Ever Use and Recency of Use of Specified Sub- stances by High School Seniors, According to

Type of Substance: United States, 1979

Population Served With Fluoridated Water, According to Type of Fluoridation, Division, and

State: United States, 1975 Children and Youths Under 18 Years of Age

-lying in Structures With Specified Interior or

-Structural Deficiencies, According to Selected Characteristics: United States, 1977 Children and Youths Under 18 Years of Age Living in Structures With Specified Plumbing

Deficiencies and with Specified Water and Sewage

Disposal Facilities, According to Selected Characteristics: United States, 1977 Children and Youths Under 18 Years of Age Living in Households that Reported Specified

Conditions Existing in the Neighborhood, According to Selected Characteristics: United States, 1977

Subject Areas Included in State School Health

Education Programs, According to State: United

States, 1978-79 Average Hours per Day Spent in Specified Activities and With Specified Companions by Children

6-12 Years of Age, According to Selected Characteristics: United States, 1976

E. Measures of Health

TABLE

TABLE

TABLE

TABLE

94

47. Infants Weighing 2,500 Grams or Less at Birth,

According to Color or Race, Division, and State:

United States, 1965-67, 1970-72, and 1975-77

Annual Averages 48. Infants Weighing 2,500 Grams or Less at Birth,

According to Age, Race, and Education of Mother

and Trimester Prenatal Care Began: United States,

Reporting Areas, 1977 49. Height or Children and Youths 2-17 Years of Age

at Selected Percentiles of the Height Distribution, According to Sex and Age: United States

50. Weight of Children and Youths 2-17 Years of Age

at Selected Percentiles of the Weight Distribution, According to Sex and Age: United States

_I 7
TABLE

TABLE

TABLE

TABLE

TABLE

TABLE

TABLE

TABLE

TABLE

TABLE

TABLE

51. Parental Assessment of Health of Children and

Youths Under 18 Years of Age, According to Selected Characteristics: United States, 1975-76 Annual Averagpe 52. Limitation of Activity Among Children and Youths Under 18 Years of Age, According to Deree of Limitation and Selected Characteristics:

United States, 1975-76 Annual Average 53. Selected Chronic Conditions Causing Limitation

of Activity Among Children and Youths Under 17 Years of Age, According to Degree of Limitation: United Stater, 1976 54, Disability Days Among Children and Youths Under 18 Years of Age, According to Type of Disability Day and Selected Characteristics: Unit- ed States, 1975-76 Annual Average 55. Incidence of Acute Conditions Among Children

and Youths Under 17 Years of Age, According to Condition, Sex, Usual Activity, and Family In- come: United States, 1976 56. Ranking of Top 10 Consumer Products Associated With Injuries to Children and Youths Treated in Hospital Emergency Rooms and Estimated Num- ber of Such Product-Related Injuries per 100,000 Children and Youths Under 15 Years of Age, According to Age and Product: United States, 1979-80

57. Student Accident Rates and School Days Lost from School per Injury for Students in Grades K-12, According to Grade, Sex, and Location and Activity: United States, 1977-78 School Year 58. Selected Notifiable Disease Rates per 100,000 Children and Youths Under 15 Years of Age, According to Availability of Immunization and Disease: United States, 1960-78 Selected Years 59. Mean Hemoglobin Levels of Children and Youths Under 18 Years of Age and of Women 15-44 Years of Age and Hemoglobin at Selected Percentiles, According to Age and Sex of Children and Youths: United States, 1971-74 60. Children and Youths 1-18 Years of Age With Decayed Teeth and Those Needing Dental Care, According to Age and Family Income: United

States, 1971-74 61. Decayed, Nonfunctional Carious, and Filled Pri- mary Teeth Among Children 2-5 Years of Age, According to Race and Sex: United States, 1971-74

1 LOS 95
TABLE

TABLE

63.

64.

TABLE 65.

TABLE 66.

Decayed, Missing, and Filled Teeth Among Children and Youths 6-17 Years of Age, According to Race, Sex, and Age: United States, 1971-74

Need, Availability, and Use of Special School Resources for Children 6-12 Years of Age With

Specific Handicaps, According to Type of Handicap: United States, 1963-65 (Ages 6-11) and 1976

(Ages 6-12) Children and Youths 5-17 Years of Age With

Handicapping Conditions, Served in Educational Facilities and Potentially Unserved in the United

States and Number Potentially Unserved According to Handicapping Condition, Region, Division,

and State: United States, 1977-78 School Year Adjusted National Arrest Rates per 100,000

Youths 11-17 Years of Age, According to Type of

Crime: United States, 1964-77 Results of Preinduction Examination of Draftees,

According to Race, Region, Division, and State:

United States, 1972

IL Utilization of Health Resources

A. Ambulatory

TABLE 67.

TABLE

TABLE

TABLE

TABLE

96

Place of Most Recent Family Planning Visit by

Currently Married Fecund Women 15-44 Years of

Age With a Family Planning Visit in Last 3 Years,

According to Race or Ethnicity and Age: United

States, 1973 and 1976

68_ Live Births, According to Month of Pregnancy Prenatal Care Began and Race and Age of

Mother: United States, Reporting Areas, 1977

69_ Number of Births and Percent for Which Prenatal

Care Began in Specified Trimesters, According to Race and Selected Characteristics of the Mother:

United States, Reporting Areas, 1977 70_ Births for Which Prenatal Care Began in the First

Trimester, According to Race, Birth Weight, and

Selected Characteristics of the Mother: United

-States, Reporting Areas, 1977

71. Non-Federal Physicians in Direct Patient Care per

100,000 Population, Number of Births and Percent

for Which Prenatal Care Began in Specified

Trimesters, According to Region, Residence by

County Characteristics, and Race: United States,

Reporting Areas, 1975 (Physicians) and 1975-77

(Births and Prenatal Care)

102
TABLE 72. Non-Federal Physicians in Direct Patient Care per 10%000 Population, Number. of Births and Percent for Whidi Prenatal Care Began in Specified Trimesters, According to State and Race: United States, Reporting Areas, 1975 (Physicians) and

1975-77 (Births and Prenatal Care)

TABLE 73_ Number of Births, Non-Federal Physicians in Direct Patient Care per 100,000 Women 1544 Years of Age and Percent of Births for Which Prenatal Care Did Not Begin Before the Third Trimester, According to Region, Residence by County Characteristics, and Race: United States, Reporting Areas, 1975 (Physicians) and 1975-77

(Births and Prenatal Care)

TABLE 74. Interval Since Last Contact with a Physician amid Number of Contacts per Person per Year by Children and Youths Under 18 Years of Age, According to Selected Characteristics: United

States, 1975-76 Amival Average

TABLE 75. Source or Place of Last Contact with Physicians by Children and Youths Under 18 Years of Age, According to Age, Family Income, and Race: United States, 1975-76 Annual Average

TABLE 76. Reason for Last Contact With a Physician by Children and Youths Under 18 Years of Age, According to Selected Characteristics: United

States, 1975

TABLE 77. Source or Place of First Contact for Medical

Attention for Injuries of Children and Youths Under 18 Years of Age, According to Sex and Family Income: United States, 1975

TABLE 78. Sources or Places of Physician Contacts by

tThildren and Youths Under 18 Years of Age During the Past 12 Months, According to Selected Characteristics: United State- 1974

TABLE 79- Places Where Children and Youths Under 18

Years of Age Had Seen a Physician Within the Past 12 Months, According to Type of Place and Selected Characteristics: United States, 1974

TABLE 80. Office Visits to Physicians per Person per Year and Percent Distribution of Office Visits by Children

and Youths Under 18 Years of Age, According to Physician Specialty and Sex and Agc. of Patient: United States, 1975-76 Annual Average

1 re 97
TABLE 81_ Office Visits to Physicians per Person per Year and Percent Distribution of Office Visits by Children

and Youths Under 18 Years of Age, According to

Whether Principal Diagnosis was Disease, Injury,

or Examination Without Diagnosis and Sex and

Age of Patient: United States, 1975-76 Annual

Average TABLE 82. Office Visits to Physicians by Children and Youths Under 15 Years of Age, According to Physician

Specialty and Most Common Principal Diagnosis:

United States, 1975-76 Annual Average

TABLE 83. Office Visits to Physicians by Children and Youths Under 15 Years of Age, According to Prior Visit

Status, Seriousness of Problem, and Most

Common Principal Diagnosis: United States,

1975-76 Annual Average TABLE 84. Office Visits to Physicians by Children and Youths Under 15 Years of Age, According to Length of

Time With Physician and Most Common Principal

Diagnosis: United States, 1975-76 Annual

Average TABLE 85- Office Visits to Physicians by Children and Youths Under 15 Years of Age, According to Selected

Diagnostic and Therapeutic Service Provided and

Most Common Principal Diagnosis: United States,

1975-76 Annual Average TABLE 86. Office Visits to Physicians by Children and Youths Under 15 Years of Age, According to Selected

Disposition of Visit and Most Common Principal

Diagnosis: United States, 1975-76 Annual

Average TABLE 87. Interval Since Last Visit to a Dentist and Number

of Visits per Person per Year by Children and Youths 4-17 Years of Age, According to Selected Characteristics: United States, 1975-76 Annual

Average TABLE 88. Admissions of Children and Youths Under 18

Years of Age to Selected Inpatient and Outpatient

Psychiatric Services and Admission Rate per

100,000 Population, According to Type of Service,

Age, Sex, Race, and Ethnicity: United States, 1975

B. Inpatient

TABLE 89- Admissions of Children and Youths Under 18

Years of /age to Selected Inpatient and Outpatient

Psychiatric Sm-vices, According to Type of Service

and Primary Psychiatric Diagnosis: United States,

19.5
TABLE

TABLE

TABLE

TABLE

90- Whether Hospitalized During the Past Year and Hospital Days per Person per Year for Children

and Youths Under 18 Years of Age, According to

Selected Characteristics: United States, 1975-76 Annual Average 9L Discharges and Days of Care per 1,000 Population, and Average Length of Stay for Children and Youths Under 15 Years of Age Discharged From

Non-Federal Short-Stay Hospitals, According to Sex and Leading Diagnostic Category: United States, 1975-76 Amnia Average 92 Operations per 1,000 Inpatients Under 15 Years of Age Discharged From Non-Federal Short-Stay Hospitals, According to Sex, and Surgical Procedure: United States, 1965-66 and 1975-76 Annual Averages 93. Cesarean. Sections as a Percent of All Deliveries in

Non-Federal Short-Stay Hospitals, According to Region and Age of Mother: United States, 1965-78 Selected Years

M. Health Care Resources

A. Personnel and facilities

TABLE 94.

TABLE 95.

TABLE 96.

TABLE 97.

TABLE 98.

TABLE 99.

Children and Youths Under 18 Years of Age Living in Households Dissatisfied with Neighborhood Services and Degree of

Dissatisfaction With Hospitals and Health Clinics, According to Type of Service and Selected Characteristics: United States, 1977 Medical Personnel per 10,000 Resident Population, According to Profession, Region, and Location by County Characteristics: United States, 1972-76 Selected Years

Professionally Active Physicians (144.D.-s), According to Major Activity and Primary Specialty: United States, 1976 Active Non-Federal Dentists and Employed Registered Nurses and Number per 100,000 Population, According to Division and State: United States, 1976 (Dentists) and 1977-78 (Nurses) Community Hospital Beds per 1,000 Population

and Average Annual Rate of Change, According

to Division and State: United States, 1970-76 Elementary and Secondary Schools With Doors, Toilets, and Classrooms Accessible to Handicapped Pupils, According to Region, Division, and State: United States, 1978

9 99
IV. Health Care Cc3ts and Financing

A. Expenditures

TABLE ZOO.

TABLE 101.

TABLE 102.

TABLE 103.

TABLE 104.

TABLE 105.

TABLE 106.

B. Financing

TABLE 107.

TABLE 108.

TABLE 109.

TABLE 110.

100

Gross National Product and National Health

Expenditures: United States, 1929-78 Selected

Years

Personal Consumption Expenditures for Medical Care, According to Type of Expenditure: United

States, 1950-78 Selected Years Average Annual Percent Change in per Capita

Personal Health Care Expenditures, According to

Source of Funds and Age: United States, 1965-78

Selected Years

Aggregate Personal Health Care Expenditures for

Children and Youths Under 19 Years of Age, According to Source of Funds and Type of Expenditure: United States, 1965-78 Selected

Years

Personal Health Care Expenditures for Children

and Youths Under 19 Years of Age, According to

Source of Funds and Type of Expenditure: United

States, 1965-78 Selected Years Estimated Personal Health Care Expenditures

Under Public Programs for Children and Youths

Under 19 Years of Age, According to Program and Source of Funding: United States, 1965-78

Selected Years

Per Capita Personal Health Care Expenditures,

According to Source of Funds, Age and Type of

Expenditure: United States, 1978

Amount for All Basic Needs as Defined by the

State Need Standard and Amount of Monthly AFDC Payment to a Family With No Countable

Income After Application by State of Any Method

of Limiting Payment Used, According to Family

Size and State: United States, April 1,1978

Aid to Families with Dependent Children (AFDC)

and Medicaid Recipients Under 18 Years of Age

and Average Monthly AFDC Payments per Family and per Recipient, According to State:

United States, 1975 (AFDC Recipients), 1978

(Payments), and 1980 (MedicaidRecipients)

Medicaid Coverage for Prenatal Care to LowIncome Women Who are Pregnant for the First

Time, According to State: United States, 1978

Medicaid Coverage for Vision and Dental

Services, According to State: United States, 1978

113
TABLE 111. Children Under 5 Years of Age and Pregnant Women who are Financially Eg-igible for, and Percent Served by the Special Supplemental Food Program for Women, Infants, and Children, According to State: United States, 1975 (Eligible) and January 1980 (Percent Served) TABLE 112. Health Insurance Coverage of Children and Youths Under 18 Years of Age. According to Selected Characteristics: United States, 1975-76 Annual Average TABLE 113. Health Care Coverage of Children and Youths Und.er ts Years of Age, According to Type of Coverage and Selected Characteristics: United

States, 1976 TABLE 114. Sources of Payment for Ambulatory Care for Children and Youths Under 18 Years of Age With Ambulatory Care in the Past Year, According to Selected Characteristics: United States, 1974

C Cost

TABLE 115.

TABLE 116.

TABLE 117.

TABLE 118.

TABLE 119.

TABLE 120.

Consumer Price Index, According to Expenditure Category: United States, 1935-79 Selected Years Consumer Price Index for All Items and Selected

Medical Care Components: United States 1950-79 Selected Years

Consumer Price Index for Medical Care Items, According to Expenditure Category: United

States, 1947-79 Selected Years Annual Percent Change in the Consumer Price

Index, According to Expenditure Category: United States, 1947-79 Selected Years Average Fee for Initial and Followup Office Visits and for Periodic Examinations, According to Physician Specialty, Type of Visit, and Division: United States, 1978

Average Fee for Initial and Followup Office Visits and Average Annual Percent Change in Fee, According to Type of Visit and Physician

Specialty: United States, 1970-78 Selected Years

114 101
1 

peso alp* VCCoNVIKIAS 1.104101M i*n oiswwwioe folupd :301039 Nal1911 .4110 issit3 Mfigrotd ems togisktii 

4100 ungral RAW mum POO wo4 *Au leux4 

%el es at cct 03 sz pa 8 Selt 191'Z !.!11Z an hal 

Stt RC 64 L6Z ?6? XI I It I 099 91 Z9I't 1'Z ?Z 047 96VC 

OCC Z6S We CR 9CC 

... 

. 

, 

. . 

1111 tZ07 KO Cal 'I SI 9ClIt 

in 610 Ss 19t's tooiz zuYI as tll't 1111 vs( £S5/1 09 zg'9 en'ol 

OM NS IOC 96Z 91t'£ SKI 0/911 199 t1 990st S901 0007 

61C 9!£ 999 ta CI oat s61 Lon SNII tal 

919 OIC SOC DS C2 ER Cif LOO'C &Z9'£ Pt I ?I 

Z6Z 68Z OIS 92 tS? OM sail JOS 96tt lin S161 

909 90C IOC L9Z 09? Ol 49'1 LZe? 66t'l 

Cta *II I V3S'L tO 11S'91 CLV6 9011 CLVSI 0I611 smA 

NCI 9/1 06? 98e SOS 02 12 6 6CfC S11911 C99/ t91,11 

tOS CV 12 ZOn 011 91,1 91S 16? /9? 9 6LVC SOL'I 

60c Its Ca taz I Rs tqc I09'C 9?S'1 

90S 92 ?S? Wir, 921 91CII 16S /6? tie 9 SOVC PIA ZI9'1 

S 9 9 ? 9 9 R O D I Z C 6 WIC 1 kV LOCI ire 9211 LEI 

119 gest 9110 ail sesiz sal cell 919'91 Loll ele 104 6C11 61 lig 

%el al PPS 92 69? 19t LC? IC? ? UPI San 

VI al DS t2 99? t9t SCZ 6ZZ tit' 96t/ NV I 9COIC 

KS 02 1/9? £S, EZZ tZZ wiz tal at/ I tte tell 

L95 Liz ce let tit al94 ses'z SZCII 

OSS 62 12 99t 1St' 06e1 Ltia I Mill I L6IIC 9C91 19V1 

sa gel ess'I net 19111 9911 1091 teTe ortes rs119 spun 9 smi 19c's1 

00L101 LOS DVS 68C'6 tett 199It 96S1S 906'9? IS? tcolc 

uommod smincv 

sPoi NM NrN 11101 NS NM *mei 0018 IN NMI lug INN III 

W4 W4 

9103 SIC/C 

Iol spun 

II! 4010 

Ft sail MIA 

M m PNNn s a r o run '1 Np Pa PPA am 11 P v 3 o c to titia 

TABLE & Wow 1544 Yuri of* and Children ad VA kW 18 Yen of A, 1960-19789 me Population Projections for

1910400 Under Throe Ferliti Assombs, Acceding to Air, tad Chid and Apd *gam Mot UMW Stales,

1N0-2000, Sided Yon

AP ind DIPondeci Ala

Vex

1910 1970 1978 1078 1980

Seas 0 (2.1 births /woman)

Women, 15-44 years

15-19

20-24

25-29

30-34

35-39

40-44

To under 18 years

Under 6

Under 1

1-5

6-11

12-17

Alternate projections for

children and youths

under 18 years

Series I (2.7 births /woman)

Series III (1.7 births /woman)

Population in thousands

36,145 42,607 48,136 50,061 51,878

6,640 9,500 10,442 10,362 10,141

5,566 8,519 9,749 10,150 10,398

5,512 6,902 8,941 9,058 9,492

6,079 5,864 7,196 8,016 8,687

6,403 5,677 6,099 6,675 7,164

5,946 6,145 5,709 5,800 5,996

64,525 69,664 65,198 63,378 61,983

24,300 20,902 18,914 18,442 19,110

4,094 3,503 3,027 3,197 3,478

20,206 17,399 15,887 15,245 15,632

21,815 24,540 21,316 20,833 20,136

18,411 24,222 24,968 24,103 22,737

1985 1990 1995 2000

Projected population in thousands

55,085

8,857

10,192

10,331

9,703

8,788

7,214

62,293

22,297

3,887

18,410

19

20,909

It

56,440 56,237 56,428

8,231 8,284 9,658

8,920 8,294 8,360

10,123 8,870 8,257

10,540 10,326 9,069

9,790 10,627 10,411

8,836 9,836 10,673

64,775 68,394 68,979

23,332 22,675 21,550

3, 3,N1/4! 3,563

19,437 18,986 17,987

22,203 23,7e3 23,363

19,240 21,956 24,066

::..

- -- 63,889 68,292 75,978 84,774 68,061

- -- 60,555 58,293 57,528 57,763 56,904

Number per 100 population Number per 100 projected population

Chid dependency ratiol 64.9 62.2 51.3 48.3 45.8 43.5 43.5 44.7 432

Aged dependency ratio2 16.8 17,9 18.1 18.4 18.4 19.1 20.0 20.5 19.9

' P o l i t i c o under 18 pars of age per 100 population 18-64 years°, age.

2Pcpuladcri 65 years of age and over per 100 population 18-64 years of age.

N O T E S : Data are based on decennia) cerases and on upoates and projections of decennial MUSS. Dependency ratios von calculated byusing figures for Series II

Roidcal

SOURCES U.S. Bureau of the Census; Population estimates and projections. Currant Population Report Scrim P-25, Nos. 519, 704, 721, and 800. Washirgton, U.S.

Government Printing Office, Apr. 1974, July 1977, Apr. 1978, Apr, 1979.
TARE 4. kilo Cis %Ado 1-13 Yam id Apt Accsodko lo Libor Face Stars of Pats tq Aged Child, end Milli Stirs of Mir. lad 8bM1, Wok" 1974 and Mary 1175

Libor Fat c4 NOM

Mather by ko of Chid sad In

Mel OW of Mohr Thaw* TotaP

Co t Same

Can in emi Norm Ws Home

Chid

Day Chits Can OW No No Can Paid fa Sell ROW ROW Reidy Maths Corder

Labor lace status of mother

Tobi 3-13 years' 40,765 100.0 80.5 4,5 5.1 1.4 2.9 3.1 0.8 3-6 years 13,758 100.0 80,9 0.1 3.5 1.3 5.1 6.1 1.6 7.13 years

M labor force

27,007 100.0 80.3 6.7 5.9 1.5 1.8 1.6 0.4

17,555 100.0 0.6 9.2 8.7 2.7 5.5 6.8 1.6 3-6 years 5,308 100.0 58.0 0.4 6.8 2.8 11.3 14,9 3.7 7-13 years 12,247 100.0 66.1 13.1 9.5 2.6 3,0 32 0.7 Employed 1111 be 10,323 100.0 50.1 12.9 12.3 3.6 7.3 9.1 2.4 3-6 years 2,917 100.0 41.4 0.7 9.0 4.0 15.2 21.0 6.0 7-13 pm 7,406 100,0 53.5 17.7 13.7 3.4 4.2 4.4 1,0 Not In labor force 22,4% 100.0 94.3 0.7 2.0 0.3 0.8 0.2 0.1 3-6 years 8,255 100.0 96.1 1.3 0.2 1.0 0.4 0.1 7-13 years 14,243 100.0 93.3 1.1 2.4 0.4 0.6 02 0,1

Marti status of mother

husband present 33,467 100.0 0.4 3.9 4.0 1.2 2.5 2.8 0.6 *sod, dice*, dr.

atom! 5,960 100.0 67.7 7.4 9.6 2.2 4.2 4.6 1.7 New married 625 100.0 eat 3.8 112 1.3 7.8 2.6 1.3

Percent distribution

VilitImpoS4refros Ftnary1975,mi data for vs 7-13 are from CO* 1974.

:lecke* the chickea et othertpee daythe we and tipdare not repatel, net thcwnle a verde category. 'cid* dean rah no moth,mak hott pin al a sole *gory.

NOTE Data are bowl co how** interviste ote sem* al the Mienroninetleikeellzed population.

SOURCE U.S. Bureau of the Con DION care of *fon: Weber 174 and Febno 1975. CUrrla bond Printing Me, 1978, Population Reports SON P-20, No. 298, Washington. U.S.

118
11 1;;O:i; 0AI*.04 rr 0047Pyi 00".*M0 rr°74=1 tiltftst 1111,Q1R0 CONOIghV Man M4441 0"1"1041"lat lOgSSIg rrrrrrr NOM Pf rbq CI)
Tan Sidi My* awn Mid to Ctehe and On)* 18 Yew of Ape, Acceding b Ram Unlhd Sisk

11404 tided Yon

Calm

and Yoh

InMolwd 440 In kw

Under 18 Cal par 1,000

bx Yon at Ap Dependency Chliton

sad Yw h Thousands Rio end Yolk

Clildron

Ew Born

pr

Evoratiiini

Wow 15.44

Yon of

Tod

1940 40,359

1950 47,278

1955 55,739

1910 64,525

1965 6,731

1970 U4

1915 6,295

1976 e6,191

1977 64,250

1976 63,316

WNba

1940 35,459

160 41,289

1955 4479

1960 55,745

1965 6,721

1970 59,192

1975 55,510

1976 54,434

19711 53,475

1918 52,596

Out d

Plant d Web*

Woman 11-24 6klh thlo

You al hp par 1,61

Who An Ural*

110 spool Woman 15-44

WAIN Yon d Apt

418 ... 1,859 452 71

511 6.3 1,859 54.1 14,1

58.3 6.3 2,031 . 19.3

64.9 72 2,314 622 21,6

65.7 8.9 2,471 102 23,5

64.6 12.5 2,357 76.0 26.4

Si 16.9 2,140 78.5 248

51.3 17.1 2,082 79.0 24.7

50.0 17.0 2,061 782 26.0

48.5 18.1 2,040 ... 262

47.5 ..

... 48,9 3.6

49.6 . 1:e,: 57,8 6.1

565 ... ... 7.9

62.7 ". 2,253 ... 292

632 ... 2,398 73,0 11.6

58.1 2,281 78.4 13,9

50.6 . 2,069 033 12.6

48.9 .. 2,017 80.6 127

47.5 .. 1 ...: ; KO 13.7

46.1

"

1,962 ... 13.9
Tall WWI Mop* bone Mid b Chlkkee end Yak Under 11 Yews d App, Acardkig b Rat UM Nest

11041 Sided Yen (at)

Out

and Ye* Wm PEW ol Wedlock

Ingffid Ear Sorg Wow 1144 I* Me

Poplin In boa pr 1,000 Yam el hp per 11000

Under 11 *Ad per 1,000 Earilenled Who An Urn*

Rya Yew d Ap Da.* Children Women 1544 HO !gaol Wow 1$44

ad Yw b ThoiMM Ruth and Yak Yew cd hp Nobs Yew, Apo

M diet

1940 4,893 612

1950 5,989 619

1955 7,259 73.1

1980 8,180 82.8

1965 10,010 86.5

1970 10,502 79.8

1915 10,785 10.8

1916 10,751 69.7

1977 10,775 672

1918 10,780 65.3

Back

1910 9,531 81.5

1975 9,554 12.5

1916 9,418 10.3

1971 9,432 88.6

1978 9,389 68.6

Li

16.1 35.6

2,098 26.8 71.2

IMO POO 872

2,788 98,3

3,085 50.3 97.6

2,903 60.5 89.9

2 652 68.3 80.4

2,552 Cal 78.1

2,585 63.0 79.4

zei duo 78.7

2,974 59.9 95.5

2,714 66.6 85.6

2,616 CV 83.2

Z720 67.4 84.5

2,805 SOU 83.1 .:.
Eardsd In WI b Filo b WIN b Mk Nolhon Ili w lbx $4 $i41 7-13 14-17 Onsihrsal hi lake Pout, In Ws aid Wu Yon Yarn Yon Val Was Form Log lass

Total Paint of cNIdto and putts

1940 ... 40 95.0 79.3 Sao

49.5 19N . 74.4 17 814 ..

57.5 1955 ... 78.1 992 86.9 ... 1910 40.7 N.5 9003 26.5 672

OOP 1 1965 2125 84.4 14 93.2 ... ... 20.7 1910 20.5 89.5 992 941 12.1 38.8 14.9 71.5 1975 31.5 94.7 993 93.6 17,1 44.1 16,8 ..

1976 31,3 95.5 992 93.7 172 45.6 15.8 1977 320 95.8 99.4 93.7 17.8 47.7 16.0 ..

1978 34.2 95.3 99.1 93.7 18.7 49.8 15.7 ... *in

1940 ... 44.0 95.5 90.7 Una 1050 SOO 389.0 *0 84,4 ... 4509

... 1965 ... 58.1 792 13 87.5 ... ... .. 1 ... 82.0 16 90.8 SOO 20.0 67.0

... 195 212.3 85.3 99.4 93.4 ... .

1970 w 19.9 90.3 N2 94.5 8.8

14.4

372 10.5 1975 30.9 70.2 94.8 99.3 918 12.8 42.8 12.5 1976 Z4 95.8 99.2 916 13.1 44.6 11.3 1977 31.1 95,6 99.5 93,5 13.4 4a4 11.4 .. 1978 X7 95.4 99.2 93.5 14.1 48.4 11.0 .. AI nth,

1940 . 36.6 91.2 66.2 ... 1950 ... 19

3136)3 266.8 754

,1 ..

... 1955 .... 71.1 59 N.1 829 2

19N ... 713 99.1 86.8 SAO

GIRO 1965 213.7 N.7 19.3 99.2 91.1 ...

11150 1970 23,1 NA 99.4 92,1 30.1 49.1 ... 1975 33.5 78$ 94,4 11 926 39.7 51,6 ..

1976 34.3 94.2 59.1 94,1 38.3 51.8 ... 1977 362 963 992 95.7 39i 54.8

1978 41.3 94.5 99.0 95.1 41.6 58.1 DSO I 122
0

TAU 1, Dolor* lo ChIlOn alit YO*4 Undo 11 Yon d Pik Amoning b Rice UMW Mk

0341 WOW Vim (41,)

Mkt k Idol In Fobs In Fobs

In WI* llolho ;slow

ha $4 64 7-13 14-17 Ons.Pont In Labor Poet In Nan

id hi Von Min Yon Vol Folks Fon WI kw

Batt

1970 22.7 84.9 99.3 94.8 32,0 49.o

1975 33,5 94,4 992 921 432 51.9

1976 34.5 94,0 99.0 95.3 42.0 52.7

1977 35,2 98.5 99.1 94.8 43.6 55.2

1978 41.3 93.9 992 94.8 45.2 58,3

41.5 79.8

41.4

40.4

41.6

412

liturfoatich turn include/4*a Hawaii

tett atoll*

Vatafoaps5.13,

41) Ka *Igo mdsr20,

N O M O d a a r e t e a l o n * * o b i c u m ;doted by data from multiple sour* on umOu of the civilian ncoiretitudcealizeci population, and on the national vital

*Idol system.

SOURCES; Ocean 1 and 2-- National Calor for Health Statistict tier Urdtei &ft 1978. DHEW Put No, (PHS) 78-123Z Pak Palth Servict Washirgton.

U.S, Gounsunt Pitsg OffIct 1978; U.S, Bureau of the Wax Population stints and injections. Current Population Repots. Series P.25, No. 800.

WaeMrpiar.U.S.GovernmentPdn ic oft Pg. Ire.

Coble 3- floral Center for Hub Stitt Noe Unitsd States, 1978, DHEW Pub. No, (PHS) 78.1232. Public Health Seim Washington. U.S. Government

Pe* Offa, Deo, 197t Vital Stdrics *f* NMI Sato &port. OHHS Pub. No. (PHS) 79.1120 anc183.1120. Pubic Health Service. Hyattsville, Md. May 1979

and ))/ 1990.

Caton 4-U.S. Bureau of the C4410X Fertility of American women. ArrantF*viation Reports Series P-20, Na. 325, 341. Washington, U.S. Government Printing

019:1, SO 1978 sot Oct, 1979,

CoNNm5. -U.S. Bureau rite Cereut Nue otPopt4a8ort 1940, U.S. Summary,Vol IV, Characteristics In Age, Pat 1, Washington, U.S. Government Printing Office,

1043'4ns 0/Pollelort-1142, Edo:ationlaiingion.114Gamut Pride; Offia, 1953; CartaolPoxlatke, 1960, Educational attainment. Washington, U.S.

Gourmet Pedrg EducationalWont, 1903. Current Popuitn Rept Series P.20 Not 158, 207, 295 and 314, Washington, U.S. Government Printing

Oite, Du. 1984, Not 1970, Jut 19761ard Oio. 1977.

Colo lo- National Center Health Statists: Vital Statists of the U.S. Vol. 1, Nalty DREW Pub. No. (PHS)784 113. hitt Health Scott Washington, U.S.

Gowned Pedro Oki; Ststallot 197t Final Nat*/ 19n; ind Rml Neti4Statieti, 1978. Mcothk VitsiStiflatta Report DH HS Pub, No.

(RS) 44120, 794131 antl 844120. Pubk Hulls Soviet lOttnie, IN. U.S. Gemmel Prating Office, Mu, 1978, Feb. 1979, and Aix, 1984

Columns 7-10 -U.S. Bureau of the Cog School enrolment. Dort Poptistion &pork Wes P-20, Noe. 167, 222, 303, 319, 333 and 335, Ration, U.S.

karma P101406* Aug, 19671,10o 1971, Doc, 197t F0.1 978, Fe. lit and ,1919.

Olem 11-U.S. knee di)). Com MIN elba ascl king arrangements, Current Repot Sales P-20, Not 212,287, 308, 323, anc1338. Washircton.

U 4 G a l o r e P r i n t i n g O l O c e , F o b. 1971, D e l 1 9 7 5, J a r t 1 9 7 7, Apr, 1918, and M a y 1 , Cenul of Poolation, 1St U.S. Surreal, Wiled Character*, DC(1)

1 Column

Vialington, u,S.GovarnmentPdntl gOffloe,1911

12-US. Depaturd c4 Ulm Ikettiy Lsbtx %IOW, Vol. 102, WA and Vol, 1021 No. 10. Waleigton, U.S. GovernmentPrinting Office, Apr. 1979 and Aug.

19791 Bunted Labor bigot Chic* cl everteg fathers. **Leta FOC. Report Not 205 and 217, Wulington. U.S, Government Printing Office, June 1977

led Me 1978.

0:to 13-118, Bureau c4 the Corn Ilcoey access end catty status of folio lot perm In the United States. Corot Poultices Aeporb. Series P-60, No,

120; and dariteeelke of the population below tlw pouty 1,41, Serie P-9), No. 1194 WuNngton. US, Government Pdritirg G.fla, Nov. 1971 and Mar. 1979.

Swirl, Ginn Chwacteralkt %Opt% D.C.: U.S Gamiest RON 192; Census of PopLan 1970. U.S. bran General Population

Chtstedetts, PC(1)B1. Wash4co, U.S airing Pinto OfIct11972.

C 11)3 F4
TARR Lb kb, Cads NM hi% Md kpipsdk Mdh Ate, Andkig lo Unad SW 334 doh* Yam

Aped Mob! In Yvan

ha lift of Cot kth

and Yost the kb 1014 5-3 2024 5-3 3034 369 4044 45-49

Live bids per 1,000 wan !di

1960 3,632,000 241 1,0 81,6 196.13 186.1 1017 52.9 15.1 1.2

1960

1965 gem

4,257,850

10 0.9 23 241,6 1902 116.0 58,6 16.1 1.0

1966 3,760,356

23.7 0.8 89.1 258.1 197,4 112.7 56.2 15.5 0.9

1970 3,731,386

19.4 0.8 70,5 195,3 161.6 94.4 46,2 12.8 0.8

1915 3,144,198

18,4 1.2 23 167.8 145,1 73.3 31.7 11 0.5

1978 3167,7813

14.8 1,3 56.3 114.7 110.3 53.1 19.4 4,6 0.3

1977 132032

14,8 1.2 515 112.1 1088 54.5 19.0 4.3 0.2

1978 31333,279

15A 1,2 53.7 115.2 114,2 57,5 192 4.2 0.2 15.3 12 52.4 1123 112.0 59.1 18.9 3.9 0.2

Wits

1960

1955

3,108,000

3,485,000

23.0 0.4 70.0 1114 1661 102.6 51.4 14,5 1.0

1965 3,123,860

23.8 0.3 79.1 235.8 188,6 114.0 56,7 15.4 0.9

1970 1091,264

18,3 0.3 116 189.0 158.4 91.6 44.0 12.0 0.7 17,4 0.5 57,4 163.4 145.9 1975 2,551,996 71,9 30.0 7.5 0.4 13,8 0,6 48.8 109.7 110.0 52.1 18.1 4.1 0.2 1976 2,567,814 13.8 0.6 44.6 107.0

1977 2,641,070

108,4 53.5 17.7 3.8 0.2

1978 2,6811118

14,4

14.2

0,6 44.6 1213 113.8 56.3 17.8 3.8 02 0.6 43.6 106.3 111.1 57.9 17.6 3.5 02 AP, .,

1950

195 613,000

524,000 33.3 5.1 10.5 242,6 173,8 112.6 64.3 21.2 2.6

1960 667,106

34.5 4.8 1672 281.6 2182 132.6 74.9 220 2.1

195 636,498

32.1 4,0 1582 294.2 214,6 135.6 742 22.0 1.7 27.6 4.0 138.4 2392 183.5

1970 640,122

113.0 62.7 19.3 1,5

1975

25.1 4.8 133.4 198,8 140.1 82,5 42,2 12.6 0.9

1976

592,202 21.2 43 108.6 143.5 1121 59.7 27.6 7.6 0.5

1977

600,174 21.1 4,3 102.4 141,7 111.6 NI 27.0 7.0 0.5

1978

835,582 21.9 4.3 102.4 145.7 116.5 64.8 27.5 6.9 0.5 662,163 22.1 4.1 99.1 145.7 117,3 66.7 27.0 15 0.4
MILE 1. LIve NM, Crude DI Rise and Age4piclIc Nth Rik According b Rom Untied tales, 1950-11 Selected Years

(Cot)

Age of kW In Years

Race Number ol Crude NM

and Year LIve MAN Rill 11-14 15-11 20-24 25-29 3044 35-39 40-44 4541

Live births per 1,000 women

Black

1950

1955

1960 0,264 31.9 4.3 156.1 295,4 218.6 137.1 73.9 21.9 1.1

1965 581,126 21.5 4.3 144,6 243.1 180.4 111.3 61.9 18.7 1,4

1910 512,362 25.3 5.2 147.7 202,7 136.3 79.6 41.9 12.5 1.0

1915 511,581 20.9 5.1 113.8 145.1 105.4 54.1 25.4 7.5 0.5

1976 514,419 20.8 4,7 107.0 143.4 105.5 54.7 24.6 6,8 0,5

1977 544,221 21.7 4,7 107.3 147.7 111.1 58.8 25.1 6.6 0.5

1978 551,540 21.6 4.4 103.1 147.5 110,6 59.6 24.0 6.0 0.4

the Ientsper1,003popthtion.

NOTES: Data we breed on the ream& 011 bon system, on bets adjusted for undregistabon In 1950 and 1955, and on registered birth' for all other years.

Rom ay 1980,1986, and tin are based on r t'Lapisof births; in 1975-77, they are based on 100 percent of bats in selected States and on a 50.percent

sgrcie of Oh In s.9 other States. Data fa 1978 are proVeional and based on 100 percent of baths, Beginning in 1970 (except fa 1918),N/trait, nonresidents of the

UnbiStits emexcluded.

souRcEs: No* Center tor Hew Statisics: Hearth United States, 1979. DREW Ft. No. (PHS) 80.1232. Public Health Service. Hyattsville, Md 1980: and Final

&telly Staberks, 1978, Monthly VW Stattsla Report, Vd. 29, No. 1. DHBV Pub. No. (P16)93-1120. Nblic Health Service. ItAtaville, Md., Apr. 28,1980.
1111111111(iiilliiiii ii1111 (1111111 li" ill ii 11 a 1 11 1 11 111 11 gAllIsmOtingiWipp; F44.4rips01400A "044;m0 taittiME9tralig ttgligifiliiti Pixfomq01:09)09)91,"`Pchca444 m.4 m4i0444m4.4mLacoumLcob01 .1poppipopaommum tocamwaimph.Asibpp wobtambk)inbik) aeif
114

TAME S. Live ifildhs find IWO Miss, Accomding to weeks%

Ellelsioa, and WNW Untied 116108, 197'1 (ConL)

Mirth Rai*

nisi*" 011111810/4 and WM*

Plumber of

Uwe Births

per 1,000 Population

West

Mountain

ATIZOria

Colorado

Idaho

Montana

Novae, Nowt Mexico

Utah

Wyoming

Pacific

Alaska

CaNfornia

Hawaii

Oregon Washington

202.546

43,112

44,107

19,391

13,545

10,990

23.932

38,808

8.661

479,624

8.861

356,310

16,753

39.974

58.726

19.5

18.2

16.3

22.0

17.4

16.5

19.7

29.5

20.4

16.1

21.6

16.0

18.6

15.9

15.5

NOTE: Data are based on the national vital registration system.

SOURCE National Center tor Health Statistics: Rnal Natality Statistics.

1978. Afonthiy Vital Statistics Report Advance Report. Vol. 29. No. 1. OHHS

Pub.- No...(PHS)80-1120. Public Health Service. Hyattsville, PAO_ Apr. 28,

1980.

1 27
TABLE IL 111111111 Illathmi, As/amine b Aga al Mother and Live NOM Order: Milled

11111.108, 16110-76 Illeisellad Yampa

Age of lillothar In Yams

TOW

Vow 15-441 10-14 15-19 20.64 25-29 30-34 35-39 40-44 45-49

First-ardor birth* pot 1,000 woman

1950 33.3 0.9 57.7 802 37.1 14.5 5.7 1.2 0.1

1955 32.9 0.9 63.7 90.5 33.0 11.5 4.5 1.1 0.1

1960 31.1 0.8 61.4 87.9 26.6 8.6 3.2 0.8 0.0

1965 29.7 0.8 51.6 75.4 24.6 7.2 2.7 0.6 0.0

1970 34.2 1.1 53.7 78.2 31.2 7.3 2.1 0.4 0.0

1971 32.1 1.1 50.8 69.2 30.3 7.0 1.9 0.4 0.0

1972 29.9 1.1 49.4 61.0 29.4 7.0 1.8 0.3 0.0

1973 28.8 1.2 47.6 56.5 30.1 7.3 1.7 0.3 0.0

1974 28.9 12 46.0 56.5 32.0 7.8 1.8 0.3 0.0

1975 28.4 1.2 44.4 54.8 32.1 8.1 1.8 0.3 0.0

1976 27.9 1.2 42.0 53.8 32.5 8.9 1.9 0.3 0.0

1977 28.6 1.2 42.0 55.2 35.2 9.9 2.0 0.3 0.0

1978 28.3 1.1 40.9 54.3 35.9 11.1 2.2 0.3 0.0

Third-ardor births per 1.000 women

1950 18.4 0.0 3.9 30.7 35.4 23.6 10.0 1.9 0.1

1955 23.1 0.0 4.6 42.3 47.2 29.0 11.9 2.4 0.1

1960 22.8 0.0 5.0 49.9 51.0 25.3 10.0 2.1 0.1

1965 16.6 0.0 3.3 33.0 40.0 19.7 7.2 1.5 0.1

1970 13.6 0.0 2.1 21.6 35.1 17.2 5.1 0.9 0.0

1971 12.5 0.0 1.9 19.5 31.8 15.8 4.6 0.8 0.0

1972 10.7 0.0 1.7 16.0 26.0 14.2 4.1 0.7 0.0

1973 9.8 0.0 1.6 14.2 23.5 13.6 3.8 0.6 0.0

1974 9.6 0.0 1.5 13.5 22.6 13.4 3.6 0.5 0.0

1975 9.5 0.0 1.5 13.1 22.1 13.3 3.6 0.5 0.0

1976 9.6 0.0 1.4 12.9 21.8 13.8 3.7 0.5 0.0

1977 10.1 0.0 1.5 13.4 22.9 14.8 3.9 0.5 0.0

1978 10.0 0.0 1.5 13.4 22.0 15.0 4.1 0.5 0.0

Rates computed by relating total live births. regardless of age of mother. to women 15-44 years of

age.

NOTE Data are based ac trio national vital registration aystern.

SOURCES: National Center for Health Statistic= Health United States. 7978. DHEW Pub. No.

(PHS) 78-1232_ Public Health Service. Hyattsville. Dec. 1978: Final Natality Sbetistics. 1977 and 1978, liontitly Vita, Statistics Report Vol. 27, No. 11 and Vol. 29, No. 1. OHMS Pub. Noe. (PHS) 79-1120 and (PHS) 80-1120. Public Health Service. Hyattsville, Md.. Feb. 5. 1979 and Apr. 28, 1990-

1

I

115
TAMS 10. Lilo Num Mem Rapeoted by flersiod Women and Percent of lExpected M.M. Alisady an Aceording to Age and Moe: United

Shreee, 111147-79 Seloolied Years

neve

and Year

Ass of Mae lid Women In Years

Total

14-39 14-17 19-19 20-21 22-24 2S-29 30-34

Toter Lifetime births expected per 1.000 married WOmen

1967 3,115 2,719 2,916 2,856 3,037 3.288 3,300

1971 2,776 2,491 2,256 2,373 2.404 2.619 2.989 3.257

1972 22.678 40 2.229 2.210 2,282 2,452 2,915 3,218

1973 22,638 2,264 2,274 2,254 2,386 2.804 3.233

1974 2,546 2,1 09 2.189 2,142 2.170 2,335 2.724 3,090

1975 2,495 1,961 2.189 2,183 2,163 2,260 2,610 3.058

1976 2,442 2,033 2,163 2,122 2,145 2.202 2.536 2,994

1977 2,424 2.257 2,174 2,120 2,137 2.197 2,468 2,948

1978 32,273 2.157 2,085 2.108 2,210 2,215 2,424

White

1967 23,068 2,707 2.964 2,849 3.001 3.200 3.215

1971 2,732 2,417 2,264 2,368 2,367 2.577 2.936 3,189

1972 22,633 2.240 2.188 2,268 2.420 2.842 3,155

1973 22,807 se im gm. 2,254 2,282 2,255 2.352 2.761 3.180

1974 2.515 2.150 2,161 2,146 2,156 2,304 2.689 3.040

1975 2.455 1.979 2,18o 2,144 2,141 2,233 2,564 2,989

1976 2,415 2,028 2,164 2,115 2.123 2,176 2.514 2,949

1977 2,393 2.257 2,192 2.142 2.127 2,183 2.424 2,876

1978 32,246 2,174 2,080 2.086 2,177 2,188 2.395

Bleck

1967

1971

23,657 3.304

2,522

2.444

2,969

2.787

3.407

3,112

4257

3.714

4.226

4,223

1972 23.209 w 2,409 2.469 2,830 3,749 3.986

1973

1974

23.024

2,913 2,432

2.194

2,100

2,243 2,197 2,.99

2,779

3,332 3.2383.945

3.642

1975 3.013 2,579 2.497 2,587 3,212 3.962

1976 2.794 2,228 2,413 2.508 2.923 3.579

1977 2.785 2,250 1,741 1,889 2.232 2,304 2,990 3,867

1978 32.618 1,833 2,209 2,469 2,510 2.604 2,789 .= IMP OW Total, Percent of expected births already born

1967 77.5 26.9 332 47.8 76.1 92.7 97.4

1971 76.7 16.3 25.3 32.5 46.7 74.4 93.7 98.6

1972 278.0 27.3 32.6 48.1 73.7 94.3 98.6

1973 277.5 26.0 32.7 46.5 73.6 93.5 98.6

1974 76.9 18.6 25.5 31.2 47.1 72.4 93.2 99.1

1975 76.5 24.7 27.5 30.7 43.9 70.9 93.0 99.0

1976 76.8 18.7 26.8 32.1 43.9 71.3 93.1 98.7

1977 76.4 30.8 24.5 34.2 41.9 67.9 92.1 98.6

1978 67.5 25.8 24.5 32.7 43.7 67.1 91.1 _

o

116
HEM WAIN TAM ty,44$404 041(11(141001tel ii;;;;Fa 'J.1048184' 1,%10c10401 aaaaraaaW Minn; Vii0M66808 aililrqN0.0.01N Lig000P0,10 MOMOONOCIp4 ggagiSgig MUMMA' ItR0.41rplelo.:g 1* of a a 17410022aP emectoomoRN
TAMA 11. Live 1910114e, and Ase-Elpeallaa 91ew Mane for Women Under 25 Years of Poet Aeoardkee to Age at 11/111her and Ream Untied 111 Wee,

111011-711

Race

and Year

Aged Mother lei Years

Taal 10-4 10-14 15-17 14-19 20-24

Total, Numbs, of Wee births

1966 1,927,544 8.128 186,704 434.722 1,297,990

1967 1,915,626 8,593 188,234 406,211 1,310,588

1968 1.907.668 9.504 192,970 396,342 1,306,872

1969 1,971,570 10,466 201,770 402,884 1,356.448

1970 2,075.334 11,752 223,590 421.118 1,418,874

1971 1,994,500 11,578 226,296 401,644 1,354,980

1972 1,802,545 12,082 236,641 379,639 1,174,183

1973 1,718,070 12,861 238,403 365.693 1,101,113

1974 1,716,029 12,529 234,177 361,272 1,108,051

1975 1,688.556 12,642 227,270 354,968 1,093,676

1976 1,662,274 11,928 215.493 343,251 1,091,602

1977 1,717,100 11,455 213,788 345,366 1,146,491

1978 1,693,703 10,772 202,661 340,746 1,139,524

White

1966 1,568,898 2,666 119,800 345,312 1,101,120

1967 1,554,686 2,761 118.035 317.204 1,116,686

1968 1,542.812 3,114 121,166 305.336 1,113.296

1969 1,590,042 3,684 128,156 306,118 1,152,084

1970 1,667,806 4,320 143,646 319,962 1,199.880

1971 1,585,200 4,130 143,806 302.920 1,134,344

1972 1,408,764 4,573 150,897 283.089 970,205

1973 1,333,569 4,907 153,416 271,417 903,829

1974 1,336,658 5,053 152,257 267,895 911,453

1975 1.309,878 5,073 148,344 261.785 894,676

1976 1,286,548 5,054 139,901 253,374 888,219

1977 1,326,116 4,671 138,223 253,960 929,262

1978 1,299,344 4,512 130,957 249,103 914,772

Black

1966 335.596 5,370 64,922 84.818 180.486

1967 337,682 5,742 66.133 88,410 177,397

1968 339.286 6,312 69,594 87,986 175,394

1969 352,928 6.650 71,020 90,918 184,340

1970 376,648 7,274 76,882 94.944 197,548

1971 376,702 7,264 79.238 92.446 197,754

1972 361,049 7,363 62.217 90,132 181,337

1973 351,290 7.778 81.158 87,615 174,739

1974 345,581 7,291 77.947 86,483 173,860

1975 344,274 7,315 74,946 86.098 175,915

1976 339,499 6,661 71,429 82.507 178,902

1977 352.952 6,582 71,182 84.006 191,180

1978 353,800 6,068 67.317 83.684 196,731

Total' Live births per 1.000 WOMON7

1966 0.8 35.7 120.3 185.6

1967 0.9 35.3 1167 172.9

1968 1.0 35.1 113.5 166.5

1969 1.0 35_7 112.4 165.7

1970 12 38.8 114.7 167.8

1971 1.1 38.3 105.6 150.6

1972 12 39.2 97.3 131.0

118 1 3j
TAME 11. Uwe MUNN and Agoapoofflo SIM Rolm for Women Under 26 Yours ON Ass, Amman. o Age 1111olher and noose WNW. inaloo, 1966-78 (Co.) o

Rom and War

Aso 01 Modsor In Vipers

TrANI

10- 4 10-14 15-17 1819 20-24

1973 - 1.3 38.9 91.8 120.7 197 _ 1.2 37.7 89.3 119.0

1975 - 1.3 36.6 85.7 114.7

1976 - 12 34.6 81.3 112.1

1977 12 34.5 81.9 115.2

1978 -. 12 32.9 81.0 112.3

1Vhito

1966 - 0.3 26.6 108.2 180.0

1967 - 0.3 25.7 104.0 167.9

1968 __ 0.4 25.6 100.5 162.1

1969 - 0.4 26.4 99.2 161.3

1970 - 0.5 29.2 101.5 163.4

1971 - 0.5 28.6 92.4 145.4

1972 - 0.5 29.4 84.5 125.6

1973 -- 0.6 29.5 79.6 115.4

1974 - 0.6 29.0 77.7 114.2

1975 - 0.8 28.3 74.4 109.7

1976 - 0.6 26.7 70.7 107.0

1977 - 0.6 26.5 71.1 109.8

1978 - 0.8 25.4 70.1 106.3

Mack

1966 - 4.2 97.9 2192 227.9

1967 - 4.4 99.5 213.4 211.9

1968 YEND 4.7 98.2 206.1 199.8

1989 - 4.8 96.9 2025 198.0

1970 5.2 101.4 204.9 202.7

1971 - 5.1 99.7 193.8 187.3

1972 - 5.1 99.9 181.7 166.2

1973 - 5.4 96.8 169.5 154.6

1974 - 5.0 91.0 162.0 148.7

1975 ..... 5.1 86.6 156.0 145.1

1976 _. 4.7 81.5 146.8 143.4

1977 - 4.7 312 147.6 147.7

1978 - 4,4 76.6 145.0 147.5

'includes ail other races not shown asIL separate category. *Base at percent includes births to all women. regsrdless of age.

NOTE: Data are based on the national vital registration system

SOURCE Radom! Center for Health Statistics: Hasid% United States. 1978. DHEW Pub. No.

(PFD 79-1232. Public Ifealth Service. Washington. U.S. dowwrwrwont Printing Office. Dec. 1978; Statistios, 1977 and 1978. Monthly Vital Statistics Report.Vol. 27, No. 11 and Vol. 29. No. 11.4 =Pub. N. (PHS) 79-1120 and (PHS) 80-1120. Public Health Service. Hyattsville. Md. Feb. 5,1979 and Apr. 28, 1960.

132 119
120

TAIMIA 12. Conadoeso liorood of I lirlho to women Under

25 Tom of As According to Ago ol llolhor

and Nom Undid ffldar, 1980-78

Aga of Ilikillsow In Wore

Row Under Under Under Under

and Year 15 1 20 25

Toter Parent of total MI blithe

1966 0.2 5.4 17.5 53.4

1967 0.2 5.6 17.2 54.4

1968 0.3 5.8 17.2 54.5

1969 0.3 5.9 17.1 54.8

1970 0.3 6.3 17.6 55.6

1971 0.3 6.7 18.0 56.1

1972 0.4 7.8 19.3 55.3

1973 0.4 8.0 19.7 54.8

1974 0.4 7.8 19.2 54.3

1975 0.4 7.6 18.9 53.7

1976 0.4 7.2 18.0 52.5

1977 0.3 6.8 17.2 51.0

1978 0.3 6.4 16.6 50.8

Whits

1968 0.1 4.1 15.6 52.4

1967 0.1 4.1 15.0 53.2

1968 0.1 4.3 14.8 53.0

1969 0.1 4.4 14.6 53.1

1970 0.1 4.8 15.1 54.0

1971 0.1 5.1 15.4 54.3

1972 0.2 5.9 16.5 53.0

1973 0.2 62 16.8 52.3

1974 0.2 6.1 16.5 51.9

1975 0.2 6.0 16.3 51.3

1976 02 5.6 15.5 50.1

1977 0.2 5.3 14.8 49.3

1978 02 5.1 14.3 48.5

Block

1966 1.0 12.6 27.8 60.1

1967 1.1 13.6 29.5 62.1

1968 12 14.3 30.9 63.9

1969 1.2 14.3 31.0 65.0

1970 1.3 14.7 31.3 65.8

1971 1.3 15.3 31.7 68.7

1972 1.4 16.9 33.8 68.0

1973 1.5 17.4 34.4 68.5

1974 1.4 16.8 33.9 68.1

1975 1.4 16.1 32.9 67.3

1976 1.3 152 312 66.0

1977 12 14.3 29.7 64.9

1978 1.1 13.3 28.5 642

'Includes all other races not shown as a separate category.

NOTE: Data are based on eve national vitth registration system.

SOURCE: National Center for Health Statisticm Health. United States.

197a CHEW Pub. No. (PHS) 78-1232. Public Health Service. Hyattsville, Md., Dee. 1978; anal Natality Statistics. 1977 and 1978. Monthly Vital Statelier Report. Vol. 27, No. 11 and Vol. 29, No. 1. DWG Pub. Nos. (PHS)

79-1120 and (PHS) 80 -1120. Public Medd' Service. HyattsvNle. Md. Feb. 5,

1979 and Apr. 28.1980.

133
TAMS 18. Lem Sifts and II In.. Reese for Umeraeried Women and Ratios of Mike le Unmarried WON11181 ID To U Write, for Women Under 25 Years of Asa, Il000rding is Age and Room United ilaise, 19116-7111

Race

and Year

Age of Unmarried Women In Yaws

Tolle

15-24 15-17 11A-19 20-24

Number of M births to unmarried women ToteP

1966 228,300 65.900 69.800 92,500 1967 246.000 70,900 73,500 101,600 1968 265,900 77.900 80,200 107,900 1969 285,100 83,300 84,900 116,900 1970 317.100 96,100 94,300 126.700 1971 319,200 100,800 93.200 125,200 1972 321,900 108,500 93,700 119,600 1973 -323,900 111,300 93,500 119,100

1 4, '4 333,400 113,000 97,700 122,700 19.3 356,600 116,800 105,800 134,000 1976 370,300 116,400 108,500 145,400 1977 408,300 120,900 118,700 168,600 1978 426,200 116,500 123,200 186,500

White

1966 103,200 23,400 34,100 45.800 1967 112,900 24,800 35.500 52,500 1968 124,200 28,400 38.900 56,800 1989 131,000 30,800 39.500 60,700 1970 141.500 36,200 43,200 62,100 1971 131,400 39.900 55.300 1972 128,100 39,900 38,700 49,500 1973 129,400 42.400 38,700 48,300 1974 134,600 44.800 40.200 49,600 1975 148,400 48,900 45.000 54,500 1976 156,500 50,000 47,600 58,900 1977 176,400 53.800 53,200 69.300 1978 185,500 52.500 55.900 77,000

Mack

1966

1967

1968

... _

. ...

......

.. WO M .....

. __

M M, _ .. - -- M. ..

....._ 1966 148,500 51,200 43,900 53,500

1970 169,700 58.400 49,500 61,800

1971 181,900 63,100 51,800 67,000

1972 186,900 66.600 53200 67,000

1973 187,400 67,000 52,900 67.500

1974 191.000 66.100 55,200 69,700

1975 199,300 65,500 58,200 75,800

1976 205.000 64,100 58.500 82.400

1977 221,800 64,400 62,700 94.600

1978 228.700 61,200 64,000 103,500

1 34 121
4 4 4 4 4 4 4 4 4 4 4 .4 ma 11 4 4 4 4 4 4 ma eve e4 melee 4 4 VA 4 4 4 4 4 4 4 4 4 4 4 WWWWWWOOM41 0000WOOWWVW/i 00000000WW ZilYilikqW*611H1 ;m714111v=ing J re .4 mil i .11 re ::,488888981 1 QD iNa in .4 LA ip is 8VV:142481;1111 io b.) 44 p RO 4) D i0 me we me me me me mi V tg ;i V tit8 g t3 ia i1D in co co b to (4 !/* -'' ' ' 4.4 will 4 4 .4 4 46 ma 41 rei J re il J J il il me me ilwpmmmp4wwp-, :11Wcainiotn.-4 :6:49)50F0PPPYIP RniNNNMIN 7488888-011ail NVCOVW0-14O MPOMA il il il me il il me me me il me il pcn:4pcboopq.sicnos. ocno01's.bLawinb0Ds.4 iA0=1,40V3tiniN 0.404tom4miAbboi ggfaci8nnt81:114 14.061.4inb:liobibioto $WW418t8gPI`Int
TAIRA 13. Lito Mame and SIM ilnins far Unnonmed leknono and Poem of

WM* 10 lUlnincrvind Women in TOW Live 111411M, tor Woomen Under 28 Venni et Age. According lo Ago and Miaow Wind 82105, 1966-78 Mont)

Ram

and Yaw

Age of Unninevind Wornen Iw Yews

Total

16-341 18-17 18-10 20-24

LAMP births to unmentsci warier, per 1.000 total iv* births Toter

1966 118.9 363.0 160.6 71.3 1967 129.0 376.7 180.1 77.5 1968 140.1 403.7 201.3 82.6 1969 145.4 412.8 210.7 86.2 1970 153.7 429.8 223.9 89.3 1971 161.0 445.4 232.0 92.4 1972 179.8 468.6 248.8 101.9 1973 189.9 466.9 256.7 106,2 1974 196.7 482 5 270.4 110.7 1975 212.8 Si 39 298.1 122.5 1976 224.4 540.2 316.1 133.2 1977 239.4 565.5 343.7 147.1 1978 253.2 574.9 361.6 163.7

White

1966 65.9 195.3 98.8 41.6 1967 72.7 210.1 111.9 47.0 1968 80.7 234.4 127.4 51.0 1969 82.6 240.3 129.0 52.7 1970 85.1 252.0 135.0 51.8 1971 83.1 251.7 131.7 48.8 1972 91.2 264.4 136.7 51.0 1973 97.4 276.4 142.6 53.4 1974 101.1 294.2 150.1 54.4 1975 1137 329.6 171.9 60.9 1976 122.1 357.4 187.9 66.3 1977 133.5 389.2 209.5 74.6 1978 143.3 400.9 224.4 84.2

Block

1966

1967

1968

__ NA

.._ OP

.......

. .

oft M. dl. ___

- --

NM MM M. ....... - --

41. MN M .6 OW 1969 428.8 720.9 482.9 290.2 1970 459.4 759.6 521.4 312.8 1971 492.4 796.3 560.3 338.8 1972 528.4 810.1 590.2 309.5 1973 545.5 825.6 603.8 386.3 1974 564.6 848.0 638.3 400.9 1975 591.5 874.0 676.0 429.8 1976 615.9 897.4 709.0 460.6 1977 640.4 904.7 746.4 494.8 1978 657.7 909.1 764.8 526.1

'Includes aii other races not shown as a separate

NOTE: Data are based on die national vital registration system.

SOURCE: Pietionel Center for Health Statisticir }fit. Unthrd Stator. 1978 DREW Pub. No (PHS) 78-1232. Public 1.lealth Service. Washington. U.S. Government Printing 0111011. CIc, 19713: Fires Ststieecs. 1977 and 1978. Monthly Mai Shatatice Report Vol. 27. No. 11 and Vol. 29. No. 1. Pub. Nos. (PHS) 79-1120 and (PHS) 80-1120. Public Health Service. Hyattsville. Md.. Feb. 5.1979 and Apr. 28.1990.

136 123
TABLE 14. Ratios at Mirth* to Unnuorried Worms's to Total Live Births, According is Auglion, Division, Stele, and Rae= United Steles, 1976

Ratio Ratio

per 1,000 Region, Division, per 1,000

Live Births Stall, and Race Live Mess Region,. Division, Sita, and Race

Northeast

New England Connecticut

White

AN other

Black

- Mir M.

.1=1,110-1M Maine 100.9

White 100.2

All other 149.6

Black 147.5

Massachusetts

White

All other MM. Black

New Hampshire 93.1

White 92.7

AN other 113_9

Black *202.5

Rhode Island 129.0

White 103.7

All other 457.4

Black 548.3

Vermont

White =1 AU other MID M. Black

Middle Atlantic

New Jersey 170.3

White 80.5

All other 517.6

Black 544.4

New York

White =. All other

Black

Pennsylvania 143_5

White 74.9

All other 557.0

Black 586.1

North Central

East North Central

trances 194.6

White 79.3

Al other 79.3

Black 619.0

Indiana 126.6

White 79.3

All other 518.4

Black 541_5

Michigan 151.8

White 82_4

other 464.9

Black 489.2

124

Ohio

White

All other

Black

1044-sconsin

White

All other

Black

West North Central

Iowa

White

All other

Black

Kansas

White

AU other

Black

Minnesota

White

All other

Black

Missouri

White

All other

Black

Nebraska

White

All other

Black

North Dakota

White

All other

Black

South Dakota

White

All other

Black

South

South Atlantic

DelawareWhite

All other

Black

District of Columbia

White

AR other

Black

Florida

White

All other

Black

137

Ml-

...M. 1092

78.6

489.6

573.0

83.0

72.8

390.6

519.8

98.8

66.9

399.1

491.3

94.8

79.0

426.0

549.4

154.2

75.6

564.4

596.9

91.5

67.9

461.4

536.8

82.5

58.5

348.1

*72.7

117.5

69.2 4142

*33.9

206.9

85.7

593.8

617.0

515.9

155.8

572.9

576.0

203.5

77.9

540.8

562.0
MOLE 14., Ratios of DIM, to Unmarried 'Women to Total Live Births, According lio Region, Olvialion,.. Mate, and Ream United States, 1978 (Cont.)

Region,' Division, Ilises, and Race

Radio

per 1,000 Live Mae Region, Division, State, and Race

Ratio

per 1,000 Lire Mess

Georgia

'White Al other

egad( Maryland White.

AY other

MID I= M

.1M1. ANN

1M. Texas

White

All other

Black

123.6

72.2

406.1

428.7

Black West North Carolina 1622 Mountain

White. 47_0 Arizona 142.4 AI other 410.8 White 102_2 Black 434.5 An other 365.0 South Carolina 2012 Black 445_4 Whits 51.9 Colorado 100.9 Al other 422.9 White 88.4 Black 430.4 AO other 276.0 Virginia 153.6 Black 362.1 White 61.8 Idaho .11. AU other 427.8 White

Black 459.8 AN other

West' Virginia 107.2 Black Whits 91.1 Montana ma. dm AU other 460.4 White

Stack 505.1 All other 1

East South Central Black

Alabama 195.8 Nevada IM 010 White 44.1 White AN other 471.0 All other AIM Black 475.6 Black Kentucky 123.9 New Mexico -1=1. White 82.9 White AU other 514.9 All other Black 541.9 Black Mississippi We 237.3 Litah 32.0

42_2 White 29_2 AU other 458.9 All other 116.7 Black 463.9 Black 245.2 Tennessee 1652 Wyoming 71.2 White 61.3 White 63.8 AU other 532.8 AU other 219.7 Black 546.6 Black 315.8 West South Central Pacific Arkansas 174.0 Alaska 106.5 Virhite 59.5 White 55.8 All other 499.3 All other 244.2 Black 510.6 Black 178.3 Louisiana 215.1 California White 58.9 White IM1 AU other 449.1 All other MM. Black 457.9 Black MO. Oldahonla 118.6 Hawaii 96.0 White 66.6 White 87.9 AU other 335.9 AU other 98.9 Black 483.5 Black 71.4

125 138
TAME 141. Philicw GUINAN' 10 Unonsirtiod Mamma 10) Total Uwe Births, Acoor+diro 00 flogOom6 Division, 0111116 and Roc= thriftmd Mitidos, 10715 {Cant.)

Ratio Rollo

0410106126%. Per 1,000 awn, Ohdolon, per 1,000

and Roos Uwe eirthe Stodo, and Race Uwe EarlItes

Oregon 110.0 Washington 102.9

White 100.5 White 87.7

AB other 276.7 Ai/ other 248.0

Black 478_7 Black 393.6

NOTES: Oats are based on the national vital registration system_ Ratios are out-of-wedlock live

births per 1.000 total awe births in special' ed group; refer only to out-of-wedlock births occurring

within the reporting area to residents of the area.

SOURCE: National Center for Health Statistics: Trends and differentials in births to unmarried

worherr. United States. 1970-1976. by S. J. Ventura. Vital and Health Statistics. Series 21, No. 36.

OHM Pub. No. (PHS) 80-1914. Public Health Service. Washington. U.S. Government Printing

Office. May 1980.

126 1 39
Al statuses 100.0 100.0 100.0 Sterile couples Al sterile couples 23.8 24.0 22.7 Ncesurgical 0.9 0.8 1.9 Sur 9icat 22.9 23.1 20.8 Noncontraceptive 6.5 6.6 62 Female 6.3 6.3 6.1 Male 0.2 0.3 0.0 Contraceptive 16.4 16.5 14.6 Female 8.6 8213.6 Liale 7.8 8.4 1.0 Fecund couples Noncontraceptors Praf Part PAP. seeking pregnancy 142 14.2 14.0 Other nonusers 8.7 7.8 17.9 Cordraceptces Ali methods 53.2 54.0 45.3 Oral contraceptive pill 25.1 25.1 26.3 intrauterine device 6.7 6.6 7.6 plaPtira9m 2.4 2.5 12 Condom 9.4 9.9 32 Foam Rhythm Viithdrawal Douche Other 3.5 3.5 3.0 2.8 2.9 0-.7 1.5 1.6 0.4 0.6 0.5 1.8 1.3 1.3 1.0 lin. 1973, catraceptive status was implied for those vranen for whom itwas not aecerbiirm 2Includes all other races not shown asaaspirate category. 'Women ot Hispanic origin aretincismied inthe figures for black and white wain ifthey we NOTE: Dela bend onhousehold interviews of asample of ever-married, civiian, non same Nations! Center for Health Statistics: Contraceptive utilzation inthe United SNo. ,31!L DHBVPub. No. (PHS) 78-1750. Pubic Health Service. Hyattsville, Md., Aug. 1978. was those waffle' for whom itwas not ascertairm 2Includes all other races not shown asaseparate category. %Vanua ot Hispanic origin are Inc:Aided inthe figures for black and white waren ifthey we. NOTE: Dsta are based onhousehold interviews of asampled ever-am-Tied, civiian, non source National Center for Health Statistics: Contraceptive utilization inthe United SNo. ,31L OHEW Pub. No. (PHS) 78-1750. Pubic Hoer Service. Hyattsville, Md., Aug. 1978.
TABLE 16. Legal Abortions, According to Seiecied Characteristics of the Pa lined and of the Proceduric United Stales, 1972-77

Year

Cisarecessisbc 1972 1973 1974 1975 1976 1977

Center for Disease Number of legal abortions reported

Control 586,760 615,831 763,476 854,853 988,267 1,079,430

Alan Gutbnacher bate 744,600 898,600 1,034,200 1,179.300 1,320,000

Percent distribution

Total 100.0 100.0 100.0 100.0 100.0 100.0

AgeUnder 20 years 32.6 32.7 327 33.1 32.1 30.8

20-24 years 325 32.0 31.8 31.9 33.3 34.5

25 years and over 34.9 35.3 35.6 35.0 34.6 34.7

Color we 77.0 72.5 69.7 67.8 66.6 66.4

AR other 23.0 27.5 30.3 32.2 33.4 33.6

Marital status

Married 29.7 27.4 27.4 26.1 24.6 24.3

Unmarried 70.3 72.6 72.6 73.9 75.4 75.7

Number of Hying

children

0 49.4 48.6 47.8 47.1 47.7 53.4

1 18_2 18.8 19.6 20.2 20.7 19.1

13_3 14.2 14.8 1*.5 15.4 14.4

3 8.7 8.7 8.7 8.7 8.3 7.0

4 5.0 4.8 4.5 4.4 4.1 3.3

5 or more 5.4 4.9 4.5 4.2 3.8 2.9

Location of abortion

facility

In State of

residence 562 74.8 86.6 89.2 90.0 90.0

Out of State of

residence 43.8 25.2 13.4 10.8 10.0 10.0

Procedure

Curretage 88.6 88.4 89.7 90.9 92.8 93.8

Intrauterine

instillation 10.4 10.4 7.8 6.2 6.0 5.4

Hysterotorny or hysterectomy 0.6 0.7 0.6 0.4 0.2 0.2

Other,- 0.5 0.6 1.9 24 0.9 0.7

Period of gestation Under 9 weeks 34.0 36.1 42.6 44..6 47.0 512

9-10 weeks 30-7 29.4 28.7 28.4 28.0 27.2

11-12 weeks 17.5 17.9 15.4 14.9 14.4 13.1

13-15 weeks 8.4 6.9 5.5 5.0 4.5 3.4

16-20 weeks 82 8.0 6.5 6_1 5.1 4.3

21 weeks and over 1.3 1.7 12 1.0 0.9 0.9

NOTE& Data are based on reporting by State health departments and by facilities. Percent distributions exclude cases for which selected characteristic was unknown and are based on

abortions reported to the Center for Dimes* Control.

SOURCE: National Center for Health Statistic= Health, United States. 1979. MEW Pub. No-

(PHS)80-123. Public Health Service. Hyattsville,P4d., 1980.

1 4 1
TABLE -17.. Intent; Lido Fetal, and Perinatal Mortality Rates and Late Fetid and Perinatal Ouriallse, According to Rao= Untied Mains, 1940-78 8s acted Years

Inland Mortality Raley

Neonatal Late Fatal

Mortality

Parkratal

Mortality

Race

and Year To Total

tinder

7 Days

Postnolonatal

Number

of

Deaths Rebel

Number

of

Deallos Rake

Total

1940 47.0 28.8 ---- MD M. 1950 29.2 20.5 17.8 8.7 53,806 14.9 117,223 32.5 1955 26.4 19-1 17.0 7.3 52,940 12.9 121,594 29.7 1960 26.0 18.7 16.7 7.3 51,984 12.1 123,109 28.6 1965 24_7 17_7 15.9 7.0 45,476 11.9 105,154 27.6 1970 20.0 15.1 13.6 4.9 35,791 9.5 86,612 23.0 1975 16.1 11_6 10.0 4.5 24,801 7.8 56,197 17.7 1976 152 10.9 9.3 4.3 23,911 7.5 53,408 16.7 1977 14.1 9.9 8.4 4.2 7.1 15.4 1978 13.8 9.5 8.0 4.3 23,654 fM-116 57.493 1979 13.0 8.7 MP 4.2 MEP 411. White

1940 43.2 27.2 MI-M. Mt. OM M. 1950 26.8 19.4 17.1 7.4 41,337 13.3 93,592 30.1 1955 23-6 17.7 15.9 5.9 40.630 11.6 95,770 27.3 1960 22.9 172 15.6 5.7 39.165 10.8 95,262 26.2 1965 21.5 16.1 14.6 5.4 33.234 10.5 78.840 25.0 1970 17.8 13.8 12.5 4.0 26,782 8.6 65,370 21.1 1975 142 10.4 9.0 3.8 18.340 7.1 41,220 16.0 1976 13.3 9.7 8.2 3.6 17,822 6.9 38,969 15.1 1977 123 8.7 7.4 3.6 6.5 13.9 1978 12.0 8.4 7.0 3.6 17,548 ...M. Mil 37,586 IM AI other

1940 73.8 39.7 - -- AD IMO 1M MP . 1950 44.5 27.5 228 16.9 12,472 24.8 23,634 47.0 1955 42.8 27.2 22.9 15.6 12,323 20.5 25.837 43.0 1960 43.2 26.9 22.9 16.4 12,838 19.2 27,866 41.6 1965 40.3 25.4 22.1 14.9 12,222 18.8 26,294 40.5 1970 30.9 21.4 19.1 9.5 8.993 13.9 21,226 32_7 1975 24.2 16.8 14.4 7.5 6,467 10.8 14,983 25.0 1976 23.5 16.3 13.9 72 6.099 10.1 14,449 23.8 1977 21.7 14.7 123 7.0 9.5 Mb IM 21.7 1978 21.1 14.0 11.9 7.0 6,120 13.921 M. 11. han. Black

1940

1950

1955

1960

1965

1970

1975

1976

1977

1978

43.9

43.1

44.3

41.7

32.6 262

25.5

23.6

23.1

MD M. Mb WPM* OM 27.8 23.0

27.8 23.5

27.8 23.7

26.5 23.1

22.8 20.3

18.3 15.7

17.9 15_3

16.1 13.5

15.5 13.2

16.1

15.3

16.5 152

9.9

7.9

7.6

7.6

7.6

1111.M.

MMO

1-M. MD M. MI OM M.

'Deaths per 1,000 Ova births.

NOTE Data are based on the national vital registration system. SOUROM Health Unita:, State% 1978, for data years 1950-76, DHEVV Pub. No. (PHS) 78-1232. PubOc Health Service. Hyattsville, IPA& Dec_ 1978; WM18011130=of United Slates, Vol. II, for data yaws 1977-79. Public Health Service. Hyattsville, Md. To be 9
TABLE 1$. Perinetel Death Raise, Accordhp to WM Weight and Age at Misfit Hama, Oklahoma, Rhode Island, Utah, Vermont, and

Washington, 1973

Birth Weight In Grams

AN 911th Less Than 1,000- 1.000- 2.000- 2,500- 3.000- 3,500- 4,000- 4,500

Age at Death Weights' 1,000 1,499 1,999 2,499 2,999 3,499 3,999 4,499 or Mom

Number

All perinatal deaths 2,152 459 278 244 241 226 196 126 56 14

Deaths per 100,000 births in birth weight category

Age at death

All ages 1,487 80,245 39,943 15,865 4,109 915 348 310 417 5,385

Late fetal deaths 666 14,510 12,500 7,282 1,671 462 190 174 245 3,462

Under 24 hours2 301 30,679 11,207 2,731 887 134 41 27 60 1,538

timer 1 hour 57 6,993 1,149 260 68 12 14 10 7 0

1-11 hours 123 14,685 4,454 650 324 24 14 12 0 0

12-23 hours 25 1,049 1,006 325 119 12 0 5 0 385

24-47 hours 113 4,196 3.879 1,625 529 73 34 22 45 0

48-71 hours 96 4,021 3,448 1,560 153 109 21 20 30 0

72-95 hours 50 2,098 1,437 650 119 53 12 12 7 0

96-119 hours 28 1,224 144 455 85 16 7 15 15 0

120-143 hours 17 524 287 130 102 16 7 5 7 0

144-167 hours 10 175 431 195 51 4 2 7 0 0

'Includes only those deaths for which no detailed ages were available. 2Inc ludas unkncivm birth weights not shown as a separate category.

NOTE Data we based on the national vital registration system.

SOURCE World Health Organization: A WHO Report on Social and Biological Effects on Perinatal Mortality. Vol. 2. Budapest. Hungary. Statistical Publishing House,

1978.

14
TABLE 19. Total, Iniont, and Neonate! DMri.s and Reiss, According to Color, Olvlsion, and Malec United Stales, 1978

Color, illem6 Revlon OPrIslon, and Illishe

Total Cleellm

Infant Downie

(under 1 year) Neonatal Meths

(under 28 days)

Plmodter Raley Number Raft" Number Rail=

Anibal States 1.927,788 8.8 45,945 13.8 31,618 9.5 thole 1.055290 9.9 26,088 15.3 18.014 10.5 Female 872,498 7.8 19,857 12.2 13,604 8.4 White 1.68%722 9.0 32,213 12.0 22,482 8.4 Male 920,123 10.0 18,423 13.4 12.867 9.3 Farad. 769.599 8.0 13,789 10.6 9.615 7.4 Al other 23%066 8.1 13,733 21.1 9,136 14.0 Male 135,167 9.6 7.665 23.1 5,147 15.5 Female 102,895 6.6 6.068 18.9 3.989 12.4

Northeast 463,263 9.4 8,314 13.1 6,115 9.7 New England 109.624 8.9 1,741 11.4 1,290 8.4 Connecticut 26,078 8.4 433 11.6 348 9.3 Maine 10,179 9.3 165 10.4 97 6.1 Massachusetts 52,660 9.1 760 11.1 558 8.1 New Hampshire 7.408 8.5 129 10.4 100 8.0 Rhode island 8.873 9.5 157 13.6 122 10.6 Vermont 4,426 9.1 97 13.6 65 9.1 Middle Attantic 353.639 9.6 6,573 13_7 4,825 10.1 New Jersey 65,993 9.0 1.216 13.0 873 9.3 New York 167.572 9.4 3,268 14.0 2.355 10.1 Pennsylvania 120,074 102 2,089 13.7 1,597 10.5

North Central 520,734 3.9 12,161 13.6 8,380 9.4 East No Central 362.435 8.8 8.676 13.8 5,916 9.4 Rinob 103,026 9.2 2,744 15.7 1,909 10.9 Indiana 47.548 8.8 1,094 13.1 722 8.6 Michigan 74.968 8.2 1,923 13.8 1,275 9.2 Ohio 96,569 9.0 2,147 13.3 1,486 9.2 Wisconsin 40.324 8.6 768 112 524 7.6 West No Central 158,229 9.3 3.485 132 2,464 9.3

Iowa 27,450 9.4 562 12.6 397 8.9 Kansas 21.665 92 458 12.5 318 8.7 Minnesota 33,316 8.3 741 12_0 513 8.3 Missouri 49.442 10.2 1,080 14.8 785 10.3 Nebraska 14,443 9.2 327 13.0 228 9.1 North Dakota 5,491 8.4 152 13.5 108 9.6 South Dakota 6.492 9.4 165 13.5 115 9.4

South 635,104 9.0 17,235 15.3 11,777 10.5 South Atlantic 315.892 9.1 7,822 15.5 5,374 10.6 Delaware 4.957 8.5 115 13.2 83 9.6 District of Columbia 7.065 10.5 256 27.3 190 20.2 Florida 95,595 11.0 1.598 14.1 1,054 9.3 Georgia 43,298 8.5 1,297 15.4 869 10.3 Maryland 33,130 8.0 814 14.7 613 11 .1 North Carolina 47,322 8.5 1.367 16.6 938 11.4 South Carolina 24,112 8.3 922 18.6 616 12.4 Virginia 40,767 7.9 1.010 13.8 710 9.7 west Virginia 19,646 10.6 443 15.1 301 10.3 East South Central 130.196 9.3 3,514 15.4 2,398 10.5

Alabama 34.680 9_3 969 16.1 660 11.0 Kentucky 33,421 9.6 729 12.7 494 8.6 Mississippi 23,350 9.7 829 18.7 546 12.3 Tennessee 38,745 8.9 987 14.8 698 10.5

1: 4 131
ii I 4§A1U gilAPIWPOIM r r r co(lmai F.030)WhhWMhMholit Nqoqm (c!qqatc1(100.0.rolvsoNm a 4 1-7 e a war: 4* NNeil-r cremoq v-cyroiriorvo.oltcor-min mckitiv:r:oici viIliii§ rrrrr rrrrrrrrrrrrrrrr r ri mommo (ProAR r cool 41aWliFOMO tri v hNWWNONhOhtqh:WCOM Nq7C11*qq00q(13ra""11°. IsO&M gWidddd"rg*Rg Mai WfMkiiliM r Is 1 , 1111; ,IlliIIIIIIIiiii
TAME 20. Death Raise for Selected Causes for Children 1-4 Years of

Years

Color and Cause of Deaths 1925 1930 1935 1940 1945 1950

Total

AN causes' 641.0 563.6 440.9 289.6 203.0 139.4

Diseases and conditions

Congenital anomalies 8.6 9.0 8.3 10.3 11.6 11.1

Malignant neoplasms 6.0 6.9 7.5 9.5 10.3 11.1

Leukemia 2.6 2.8 3.5 4.7 5.1 5.C. Of brain and other

parts of nervous

system 1.4 1.5 2.1

Diseases of heart 9.3 6.9 5.7 3.6 2.9 1..1 Accidents and violence

Motor vehicle

accidents" 12.0 14.5 13.7 12.4 11.2 11.5

All other accidents' 58.4 46.7 43.0 36.3 35.5 25.3

Homicide 0.6 0.9 0.5 0.6 0.7 0.6

Deaths psi

White

AN causes* 592.2 516.7 4092 261.6 185.8 124.1

Diseases and conditions

Congenital anomalies 8.5 92 8.4 10.7 11.8 112

MaNgnent now 18M11 6.3 72 7.9 10.1 11.0 12.2

Leukemia 2.8 3.0 3.8 5.1 5.6 6.4

Of brain and other

parts of nervous

system 1.5 1.6 2.1

Diseases of heart 9.2 6.6 5.5 3.5 2.7 1.1

Accidents and violence

Motor vehicle

;#1 accidents' 12.6 152 14.1 12.9 11.6 11.7

1.4 AN other accidents' 54.8 43.7 41.1 34.4 33.0 21.7

Homicide 0.6 0.8 0.5 0.6 0.7 0.5

C 1
z4i' TAIL! N. Mk Ribs for So Isdid Csuses far Chldron 1-4 Um of Aga, According b Color United %tat 1925-78 Si*

Yon (Cat)

Cola and C81111 cd Doff 1925 1930 1935 1910 1915 1150 1155 1160 1965 1970 1975 1976 1971 1978

Deaths per 103,000 resident population

M other

All maw 1102 932,3 670.3 484.6 326.9 250.8 198.9 190.8 153.6 134.1 101.0 96.9 97.6 99.0

Disease and condition

Congenital anomaies 9.6 7.3 7.4 7,8 10.1 10.3 13.5 15.6 12.1 11.9 9.5 10.1 10.0 8.5

Malignant neoplasms 3.8 3.8 4.0 4.7 5.6 7.7 6.5 7.6 5.0 6.3 4.9 4.1 4.5 3.8

Leukemia 0.7 1.0 1.3 2.0 1.9 2.4 2.2 2.5 2.1 2.0 1.8 1.6 1.4 1.3

Of brain and other

parts of nervous

system e 0.7 0.8 1,8 1.3 1.7 1.2 1.7 1.3 1.4 1.8 1.3

Diseases of heart 10.6 9.8 7.1 4.7 4.1 2.5 3.3 3.3 2.7 3.8 3.0 2.8 3.3 4.3

Accident and violence

Motor vehicle

accidents' 7.2 9.2 10.5 8.6 8.8 10.6 12.3 11.2 13.1 14.7 13.8 13.1 12.3 13.8

All other accidents' no 69.9 56.8 49.8 53.6 51.1 47.6 44.5 38.9 32.5 26.0 24.0 24.5 26.9

Homicide 1.0 1.1 0.4 0.7 0.7 1,2 1.2 1.7 2.4 5.2 6.8 6.4 72 7,1

'Bozo, cd donna, revisions of the Intematicoallist of Causes of Death and changes in rules of caoss-of.deatti selection, there is lack of comparability to a varying dqu for some caws fri mi one ration to the next. The beginningdates of the revisionare 1921, 1930, 149, 1949,1958, and 19E4.1n some instances, data are omitted for eft yew because appropriate subcategoriesare not available by age of the decedent. Except fa diseasea that are epidemic in nature, abrupt changes at the NOON ci the redaion period are indicative of Mks in comparability. The catookealt titles we based on the Eighth Revision International Classification of Mews Adapted for *in the Urged States and insome instances have been consideratly shonened.

:population ollusted for age bias in races other than white,

alncludse Ober causes not shown as a separate category.

,The "motor vehicle szident" rate can be added to the "other accident" rate to provide the singlecategory "all accidents."

NOTE.Dataarebasedonthenaticn al viaireotiatansystem.

SOURCE. National Center for Hilith Statistics: Nati) United States, 1976-77, for data 192545, caiEw Pub. No. (HRA) 77 -1232. New Resources

frcistratico, Hyattsville, Md. 1977: Vital Stu da d the United Spits, Vol. II, fa data yti ),1-7, Public Health Service, Hyattsville, Md. To be published.
TAKE 21. kb Rio Mr slated CNN ter Chidren * Yob 5-14 Yours of Ap, ActxrdIng to Color. LIM Odes,WWI

Ido:lid Yoe

Caw Ind Cause of MOP 1925

Total

Al causal 1962

Diseases and codtions

*ant neoplasms 2.8

Luken* 12

Of Nain other parts

of net systom -- 031grital auras 1.4

Diereses of heart 16.5

Accidents and Wan

Motor vehicle accidents, 15,0

other accidents, 26.9

Suldde 02

Ftetide 0.6

Write

Al cowl 185.3

Diseases and odors

Maltent neoplasms 3.0

Loukeria 1.3

. Of brain and other pads

of nervous system -

Capital =make 1.4

Diseases of heart 16.7

Accidents and violence

Motor *Me oxidate 15.6

Ap other amide& 25.7

Suicide 02

Homicide 0.5

1930 1935 1940 1945 11501 1855 1960 1965 1970 1975 1876 1977 1978

Deaths per 100,000 resident population

171.7 152.9 103.7 902 03.1 48.8 46.6 422 41.3 35.7 34.7 34,6 33.9

3.7 4.1 5.0 5.3 6.7 7.0 6.8 6,5 6.0 4.8 5.0 4.8 4.2

1.7 2.0 2.0 22 2.8 3.0 3.2 2.9 2.7 2.1 2.3 2.2 2.0 . 0.9 0.9 1.5 1.6 1.5 1.4 1.3 1.3 1.5 1.2 1.0

14 1.8 2,1 2.3 2.4 2.7 3.6 2.8 2.2 2.0 2.0 1.9 1.8

121 10.1 8.0 5.9 21 0.8 1,3 0.9 0.8 0.9 0.9 0.9 1.0

14,7 12.3 11.5 11.0 8.8 8.0 7.9 8.9 10.2 8.7 8.5 8.6 8.8

21.4 19.9 17.1 20.5 13.8 12.2 11.3 9.8 9.9 9.4 8.4 8.7 8.4

0.2 0.2 02 0.2 0.2 0.1 0.3 0.3 0.3 0.5 0.4 0.5 0.4

0.9 0.6 0.6 0.6 0.5 0.4 0.5 0.6 0.9 1.0 1.1 12 1.3

1607 145.3 96.6 85.6 56.4 46.4 43.9 39.6 39.1 33.9 332 33.1 32.2

3.9 4.3 5.3 5.7 7.0 7.3 7.1 6.8 6.2 4.9 5.1 4.9 4.2

1.8 2.1 2.2 2.4 3.0 3.2 3.5 3,1 2.9 2.3 2.5 23 2.0

1.0 1.0 1.5 1,7 1.6 1.5

1.4 1.9 2.2 2.4 2.4 2.8 3.7 2.8

12,0 9.9 705 5.4 1.8 0.7 1.0 0.7

151 128 11.8 11.5 8.9 8.0 7.9 8.8

20.3 18.7 162 19.7 12.6 11.1 9.9 8.6

02 0.2 02 0.3 0.2 0.1 0.3 0.3

0.7 0,5 0.5 0.5 0.4 0.4 0.4 0.5

113

1.4 1.3 1.3 1.2 1.0

2.2 2.0 2.0 1.8 1.8

0.7 0.8 0.8 0.8 0.9

9.8 8.5 8.5 8.5 8.9

9.0 8.5 7.7 7.9 7.7

0.3 0.5 0.5 0.6 0.5

0.5 0.8 0.8 0.9 0.9
TANI 21. DO for Selected CIAO lot Children and Youts 5-14 Yam of Apt cti According b Color. UMW St p, 1125-78 Sided Um (Cot)

Cols sad Com c4 DOI 1125 1930 1135 1140 1145 19502 1155 1160 1905 1970 1175 1971 1077 1071

61110=1=111MNIMIN

All other

AN cause& 301.6

OileaStS and conditions

leant neoplasm 2,0

leukemia 0.7

Of brain and other parts

of nervous system --- Cogenital unties 1.6

Diseases of heart 14,7

Accidents and violence

Motor vehicle acciderts,

All other accidents,

Suicide

Hcrricide

8.9

38.4

0.1

1.8

Deaths per 100,000 resident population

260.9 210.9 154.0 121.0 86.0 66.0 64,3 58.0 53.7

2.1 2.6 2.4 2.5 4.9 5.0 4.8 4.7 4.5

0.6 1.0 0.7 1,1 1.6 1.6 1.8 1.6 1.6

0.4 0.1 1,3 0.9 1.3 1.2 1.2

1.0 1.4 1.6 1.9 2,2 1.8 3.2 2.9 2.1

12.2 11.5 11.5 9.1 3.9 1.6 3.0 2.0 1.5

10.1 8.3

30.3 28.6

0.1 0.2

2.2 1.6

9,8 8.0 8,6 7.9 8.3 9.8 12.4

24.1 25.8 22.5 20.1 20.9 16.9 14.9

0.2 --- 0.1 0.1 0.1 0.1 0.2

1.4 1,3 1,5 1.0 1.2 1.6 2.9

45.4 42.2 42.0 41.9

4,4 4.3 4.3 4.1

1.6 1.6 1.6 1.7

.

1,2 1.3 1.1 0.9

1.9 2.1 2.0 2.2

1,4 1,4 1.3 1.6

9.8 8.8

13.7 11.9

0.1 0.4

2.2 2.2

9.2 8.4

12.4 12.0

0.3 0.3

2.6 2.9

'Because of *emit revisions of the InternationalList of Causes of Death and changes in rules of caus.of.death selection, there is lad of comparability to a varying degree for some CAMS from one redion to the net The beginning dztes of the revtions are 1921,1930, :939, 1949, 1958, and 1968. In some irstsices omitted for earl* rem *sum data we ascreviatesubcatepries art not avaikle by age of the decedent. Except for teases that are vide* in nature, abrupt changes at the *ionic of the revision penal are indtatve ci breaks in corroarability. The cause.of.death titles are based on the Eighth Revision international Ossification Diseamsditiaptecl kg Us in the ailed &Wand of income instme have been comiieratlytatened.

1Poptiatice acted for age Ms in races other than whits.

dudes caw causes not Wooa *prate category,

411* "Nor Wile accident" rateor be Oded to the "other imident" rate to provide the imgle category "all accidents."

NOTE: Data are baud an the national vital Verdict, system.

SOURCE: Natonal Cents for Health Statmlics: Hatt bolted States, 1976-77, for data mars 1925-75. DHEW Pub. No, ORA) 77-123Z Health Resources Adminit1671 HOS*, Md., IV: Vital Statistics of the United States, Vol, II, for data years 1976-78. Public Health Servo. Hyattsville, Md, To be published.
nal a Dii RIP Dqo lo Mims ad Cobilkes ard b Wird CMS br MOM Mr 25 Yam ol As kadlog to

Nos, Med So UMW Ibla,101

Ohms ad Cordons

M Comae ICQA Coder COM

M 4Mrer M Ober M Olw

AI AM

la ad Ale Ram Ilk Tooi Beds Rua Ns VA Is less Whib Tri Ps

Des per 10,001 residentwit*

btu WE Wilk

Polardmil Mid Noe

ICOA CodN E163

Eta ire

Unit 25 yen 12.4 11.3 18.7 19.5 7,3 6,4 125 13.2 5.1 4.9 6.2 6.3

War 6 30.9 26.8 S2 54.0 27,6 zu 41 48.6 3.3 2.9 5.1 54

Under 1 159.5 135.6 2711 301,4 154.5 131.4 238.9 211.6 5.0 42 9.3 9.8

14 6.4 58 8.8 9.3 34 3.2 4.4 4.1 2.9 2.6 4.4 4.6

6-11 3.1 19 19 4.0 1.5 1,5 1.6 1.6 1.6 1.4 2.3 2.4

12-17 6.0 5.9 6.4 62 1.8 1.7 24 2.5 4.2 42 3.9 3.1

12-15 4,4 4.3 4.9 4.8 1.6 1.5 U 2.3 2.7 2,7 2.7 2.5

16-17 9.1 9.1 9.4 9.0 2.1 20 2,9 31 7.0 7,1 6.5 6.1

18.24 12.9 12.0 17,9 18.6 30 2.7 52 5.6 9.8 9.4 12.7 13.0

Mil

UN* 25 yaks 158 14.5 210 24,0 8,3 72 13.9 14.7 7.5 7.2 9.2 9.3

Under 6 34.3 310 54.9 592 30.5 236 42 532 3.8 3.4 5.1 6.0

Under 1 176.3 151.2 301,2 3213 170.8 1418 VA 311,8 5.5 4.6 9.9 10.5

14 7.1 6.8 9.8 10.4 3.7 3,4 4.9 5.1 3.5 3.1 5.0 5.2

641 3.7 35 4,9 5,0 1,6 1,6 1,7 1,7 2.1 1.9 3.2 3.3

12-47 8.1 10 8.1 8,4 2,1 2.0 26 28 6.1 6,1 6.1 5.8

12-15 5.7 5.5 62 6,1 1.8 1.8 2.3 2.3 3,9 3.8 3.9 3."

16017 12.9 12.8 13.6 132 2.5 2.3 13 3.2 10.4 10.4 10.3 19

1144 19.4 18.2 26.8 27.9 3.7 3.3 6,1 16 15.1 14.9 20.7 21.4
TAKE 22. Deelh Me Dui b Ohms and Condthom and to bog Ceuta for Persons Undo 25 Years of Age, According to

c o Race, 8ex, Ind Age: NW Mittel 1978 (Cont.)

All Causes

All Other

Diem and Condition

ICDA Codes 000-196,

Elliott Caw Accident,

Poisoning and Violence

ICDA Codes E800-13911

All 01Iw All Other

All All All

Sex and Age Races White Total Black Races RIM Total Black Races Vihlth Total Black

Deaths per 10,000 resident population

Female

Under 25 years 9.0 8.0 14.4 15,1 6.4 5,5 11.2 11.8 2.6 2.5 3.3 3,3

Under 6 27.3 23.5 45.3 48.7 24.6 21.1 40.8 43.9 2,7 2.3 4.5 4.8

Under 1 141.9 119.2 254.2 273.8 137.3 115.5 245.5 264.7 4.6 3.7 8.7 9.2

1-5 5.5 5.1 7.7 82 3.2 3.0 3,9 4.2 2.4 2." 3.8 4.0

6-11 2.5 2.4 3.0 3.1 1.4 1.4 1.5 1.6 1.1 1.0 1.5 1.5

12-17 3.7 3.7 4.0 3.9 1.5 1.4 2.3 2.3 2.2 2,3 1.8 1.6

12-15 3.0 2.9 3.5 3,4 1.4 1.3 2.1 2.2 1.6 1.6 1.4 1.3

16-17 5.2 5.2 5.2 4.9 1.7 1.6 2.6 2.7 3.5 3.7 2.6 2.2

18-24 6.4 5.8 9.6 10.0 2.4 2.1 4.4 41 4.0 3.8 5.2 5.3

Tette ate ooded according tothe Eighth Revision International Oasification ot Diseases, Adapted tor Use in the United States.

NOTE Data are based on the national vital regishtion *tem.

SOURCE: National Center for Hob Statistics: Nei* United States, 1978, DHEW Pub. No. (P4)711.1222, Public Health Service.
TABLE 23, Irounketion end Inlectbn Steles ol Children 14 Yews of Age, According to Specified Divest United Steles, 1970-78

MEID=MINIMEMEIEW ilistri ot

AMEEMEDEMMEDIEEMEDMEDEEI

DTP' Pop** Polio Moils Robek Innunintion M.M.M.NNI1111 bronlation

of Age Idea Muni. Info inenont. 3 Doses 0 Yee in Thousands ton lib Ion don or More Doses

3 Dons

of MOM

Plump

0 Imrani

Dons sato*

.,

1970 14,123 8.1 57.2

1971 14,112 8.7 61.0

1972 13,906 7.4 622

1973 13,874 6.3 61.2

1974 13,210 5.1 64.5

1975 12,729 4.8 65.5

19761 12,276 43 65.9

1977 Am 3.8 63.1

1978 12,187 3.3 628

Percent of children

14.4 37.2 76.1 7,0 65.9 10.8

13.9 51.2 78.7 5.8 67.3 8.6

12.3 56.9 75.6 6.9 62.9 10.7 IDES 12.8 55.6 72.6 6.2 60,4 13.9 34.7 12.2 59.8 73.9 5.2 63.1 11.7 4.4 11,3 $1.9 75.2 4.5 64.8 10.3 44.4 10,0 61,7 71.4 3.7 61.6 9.5 48.3 10.0 59.4 69.5 3.3 6C.1 8.7 481 7.8 61.7 14.0 3.8 61.4 7.9 51.1

'Dip4itheris-tetawitoi

Nov kroximicowas first rotted in 1973.

allegesirq in 1978, the categorrdon't Morels addedto response categories. Wm 1978, the laic of the "don't Imo" option arseermitichwe peticulartyapparent for those immunizative resulted in some forced positk that re*e nit* doseschedules, i.e s poUo and OW, NOTES; Data are based on hotethdd inter*, of a sample of the civilian nceinstitutionalized population, Infecton at SOURCE National Center for immunization are not mutually exclusive. Health Stabstics Health United States, 1979. CHEW Pub. No. (PHS) 80- 1232. Public Health Service, Washington, U,S, Government PrintligOffice,1910.

0 152
24. kilmakial lad Minion Iles of Or Odin 14 Yeas d Ape, According b Spelled Mu, Apt Metropolitan Ste Mk

Owl aril Poverty Lot Urged Mel 1176

Mobs

DTP, Polio

;mmunkellon Imunkallon

Population 3 a 3 a Mumps

Ape, liccollat 8b1u1, M Inhc- km* Info Inftel. Mom 0 Mon 0 Immo*

Coke, aid Pouts Ls* Thousands Ion don Ion zdion Dom Doses Doses Doses Won

Percent of children

1-4 years

Central cities of SMSA 3,523 5.8 62.5 9,4 59.5 68.1 4.4 53.8 10.7 45.6

Rite 2,334 6.0 66.8 9.1 614 71.5 4.4 61.7 8.4 47.9

All other 1,189 5.4 54.0 10.1 51.7 49.4 4.4 38.4 15.4 41.0

Poverty areas 948 7.2 50.7 10.7 51.5 44,6 7.1 38.0 15.6 37.9

Nonpoverty areas 2,575 5.2 66.8 9.0 62.4 71.2 3.5 59.6 9.0 48.4

Remaining areas of 4,549 3.4 67.2 9.2 e3.5 75.7 2.9 65.3 7.7 50.7

SMSA

Poverty areas 314 6.2 56.4 17.5 51.2 72.0 10.1 61.5 14,7 35.2

Nonpoverty areas 4,235 3.2 68.1 8.6 64.5 75.9 2.4 65.6 7.2 51.8

Outside SMSA 4,205 4.0 67.3 11.3 61.5 72.9 4.0 63,9 10.5 47.9

5-9 years

Central cites of SMSA 4,712 13.2 71,4 18.3 68.3 72.8 1.8 66.3 5.5 46.4

Mite 3,159 12.5 76,3 19.3 70.0 18.4 1.6 73.3 3.7 49.3

All other 1,552 14.6 61.4 16.3 64,9 61.2 2.2 52.1 9.3 40.7

Poverty areas 1,149 18.7 61.2 18.6 63.1 58.0 2.7 54.4 9.2 38.1

Nonpoverty areas 1,562 11.4 74.7 18.2 70.0 77.5 1.6 70,2 4.3 49.1

Remaining areas of 6,776 9.3 77.3 17.4 71.9 80.6 1.0 74.1 3.9 55.3

NSA

Poverty areas 417 19.0 70.5 22.0 61.5 783 1.1 71,4 5.0 39.1

Nonpoverly areas 6,360 &6 77.8 17.1 72.5 80.7 1.0 74,3 3.8 56.4

Outside NSA 5,809 11.3 74.4 24.0 67.7 80.2 2.2 73.5 6.1 48.6

iDiormork4staxe-Ptdosis.

NOTES: Do we bowl on tousehcid Wm*" of a samob of the chilan norinstituticoakzed popdation. Infection andimmunisation are not mutually excitsiw,

SOURCE; Now cow for Hoe &bits: Hoge United States, 1971 Dei P4 P. (ItHS) 78-1232, Public Health Service. Washington, U.S. Government

FitirpOlitt Doc. irta .:
TAME 25. Immunizellon Statue of Children Entering fandergprien and First Grade, According to Specified Disease. Stale, and Selected CI Ow Un Had States, 11175-79

Region, Division. and State riundser in Type of hamuntradon

Semple Measles Rubella Mumps Polio DPT/Td1

United States2 3,272.090

Northeast

New England Connecticut 5.069 Maine 16,000 Massachusetts 74,851 New Hampshire 15,019 Rhode and 10,382 Vermont 8,197 Middle Atlantic

New Jersey 92.398 New Yorks 121,263 New York City 112.273 Pennsylvania 183,920 Allegheny City 16,015 Philadelphia 21,440

No Central

East North Central

Rlinois 125.668 Chicago 2,636 Indiana 78.699 Marion City 9,247 Michigan 137,925 Ohio 151,202 Wisconsin 51,972 West North Central

Iowa 41,282 Kansas 33.258 Minnesota 55,301 Missouri 70.000

Nebraska 23,461 No Dakota 11,896 South Dakota 9,450

South

South Atlantic

Delaware 13.294 District of Columbia 10,379 Florida 248,326 Georgia 111,620 Maryland 35,153 North Carolina 82,332 South Carolina 81,774 Virginia 74,971 West Virginia 23,098

Percent of children

93 91 83

94 92

92 91

99 93

96 96

93 92

94 80

99 99

97 97

95 96

94 93

93 93

83 81

89 87

83 81

96 96

95 93

90 90

98 98

93 93

96 96

96 96

97 97

95 93

97 96

97 96

88 88

95

97

93

82

100

94

95

98

71

93

94

52

78

96

94

81

57

88

83

73

IMO86

92

95

69

90

95

86

59

95

93

82

94

92

96 96

91 91 98 97 96 96 93 93 96 96

97 96

97 97 5.4 93 94 94 93 94

82 84

86 88 77 81

95 97

94 95

90 91

97 96

85 85

95 94

95 92

92 88

97 97

97 97

97 97

88 88

141
1

i

S8R2 Mg; MUM 88SRP

ms ssai RPMUS gSg2P

Un P..Afi §§gig0A1 ME

titgar: gig g;;Wrvig4 4g7:7:a

v- 1- o

1 1

111011111 lillilill101111 
2 'ilif 11111 To :II 11, 011 i hill I nia PO PJA Uti Biagi P:q 0 oor34 IIRM$ 0)43i4k) ulv '4LAtoio inbitog (71409) 04 10i044 0/OW4O ?&Pr4N OCONN PPPb!...1 0M4O 9140 miom-4 PSIS mioibb 04301 4W00 PPma) :JOC0471 M044 OM 44MW 141. 71PPP 040M :49) 4,4 46*IA FIR 0)4 4:14 0.74P st-iwN.A0F4 PM82 mmioWco 0000$ 4.4(1140 moomp 444tom 1to NNMP N P omN44
TAKE 27. RN* Pbyidm d Pio al MI Can tot arm and Ms Mr 1e Yen d Age, kordIng b Spsclity d

Ng* and laleded Chodedets: INIMId 1hihi 1974

WMh Pap* Source ol Can

400111t1 01 111Pbr Pkt11040

Without

Poplikei kris NNW

In Source RIPlif moral

Charadsdelc Thouunds d Carel Tole Phydclen Tool PracIllomr Podskiclii Wrist

Percent of population

Total under 18 years' 67,247 9.7 88.3 10.5 71.8 45,9 27,8 1.2

AP

Under 6 years 19,649 6.9 91.8 11.4 80.4 34.2 43.5

611 years 22,155 9.1 89.2 9.9 79.3 4E5 29.4

12-17 years 25,443 12.3 84.9 10.3 74.6 54.3 14.4 2.4

12-15 years 16,126 11.1 87.5 10.6 77.0 53.4 18.4

1E-17 years 8,716 14.7 79.8 9.7 70.1 56.2 6.8

Race

White 56,493 8.4 89.8 8,1 81.7 482 29.2 1.3

Black 9,628 17.3 80.1 24.7 55.4 332 18.6

Health slats

Bullent and good 63,159 9.6 88.4 10.3 78.1 45.9 28.1 1.2

Fair and poor 3,129 10.6 81.1 13.3 73.8 45.6 233
rely lovas

Under 18,000 8,029 18.1 80.0 18.6 61,4 41,8 14.9 0.7 15,0034104 15,392 12.5 85.6 12,9 72.8 46.8 22.2 0.6 110400414X 18,829 72 909 8.5 82,4 48.8 29.6 1.1 8151000 or mom 21,287 5,8 925 7,4 85.1 44,4 36.3 2.1

Mira

816A 46,097 9.1 88.7 12.3 76,4 402 32.2 1.4 Ca lot dty 19,227 122 85.3 17.6 67.8 36.1 28.1 1.2 Ou Skis centri dty 26,811 7.0 911 8,6 82.5 43.1 35.1 1.6 tkelds NSA 21,150 10.9 87.5 6,4 81.1 58.2 18.4 0.7

taut 15,187 9.1 892 99 79,3 40.8 313 2.2 Nod Central 18,351 14 91,3 7.8 83.4 54.4 24,4 1.0 Sou II 21,446 11,8 M 12.2 744 43.9 27,4 0.7

12,263 11,6 85,8 121 73.1 42,8 27.0 1.2

NINIMPINIMINIMINw

ircktio Oft d of*we rd minx fret Own, *Ominmate atigoist lbAes Oft lo *to *tonon on cd an hash*

NOTE DO on tab on Ittekid Inbriftidsarrolidthecivilianrailtituttaindpoxigion.

SOURCE Dion d Hob Wievirdtablia, Mont WV for Her Statitict CO front* iisith Inter* Survey.
TAKE a kr* Sourced Can for Children and Undv 11 Yule ol keg, Accoing to Rept Physician and Treel NA

T y p o of Hoolth Iwo Coo* and kb* Chnderlicy United Niel WI

WM Regular Sono ol Can

To ol Hodh Irmo

Comp and Ow**

Total under 17 pars

Private or military only

Medicaid with or without other

magi

Medicaid onty

Vire*

Race

White

Private or military only

Medicaid with or without other

coverage

Warred

Bitek

Private or military any

Medicaid with or without other

coverage

Uninsured

PI:arty level

150 percent or less of poverty level

Private or military only

Medicaid with or without other

coverage

Uninsured

Without

Anulor

Sours

ol Core

Without

RR*

TN Physician

Percent of population

59,012 7.0 93.0 24.7

44,954 56 94,4 20.8

6,795

5,638

6,409

8.3

8.2

14.2

91,7

91.8

85.8

37.8

38.7

36.0

48,945 6.5 93.5 21.5

39,760 5,2 94.8 19.4

3,587

4,955

9,148

4,544

8,1

14,4

9,7

9.0

3,074 8,4

1,337 12.1

91.9

85.6

90.3

91.0

30.0

31.3

4045

31.6

91.6 47,1

87.9 52.6

16,557 9.6 90.4 34.2

7,207 8.7 91.3 28.9

5,374 7.9 92.1 37.5

3,669 14.2 85.8 38.9

With Vol

Thad

30 Wes

or Mom

15.9

14.7

20.6

21.1

19.3

15.1

14.5

18.9

16.5

20.3

16.8

22,6

28.0

20.0

19.5

20.1

211
15041 port cl gook M 11,00 6.7 931 210 162

Fitts a illy atly 9,487 5.1 0,3 21.5 162

MOM le tx %tat car

MINI 437 11.0 KO 34.7 14.5 Urtial 1,021 13,3 86.7 31.8 16.9

200 pronto ma c4 ;alert/ Nil 21,134 131 86.9 18.0 13.3

RAI at met/ any 24,618 12.8 812 11.7 12.9

littiki Otto wirout other

ono 247 6.7 93.3 26.4 252 Lift* 1,017 18.2 81.8 23.0 16.8

MOiccdir Oft

lisk.:4161 39,977 7.3 92.7 26.4 144

PIMis or ear/ ail XX 5,8 942 21.7 132

Ihicid dti Ix vitot Ow

comp 5,206 8,4 91.6 41.5 20.4

Urirend 3,593 16.9 83,1 43.3 15.7

keitcollan 19,026 6.5 93.5 21.0 192

Molt cc allay only 14,348 5.3 94.7 19.1 18.1

Msticil *Is a *out other

coop 1,587 7.9 921 25.6 21,1 Wire* 2,810 10.7 89.3 26.6 23.9

MN

Urdi 8 pm 18,411 6.0 94.0 24.0 17.8 Pdelt a itiry xi/ 131399 4,3 95,7 19.4 16.8

kW* lb or *tout dor

cam 2,485 7.6 92.4 36.5 21.5 Met 2,251 12,8 812 35.6 19.0

6.17 yin 40,0 7.5 92.5 25.0 15.1

Firtaii a Miry any 31,596 62 93.8 21.5 13.9

Ilsdkold st a *tat of*

comp 4,310 8,7 91,3 38.6 20.1

Iiirand 4,158 14.9 85.1 36.2 19,5

fatilisalltinixabskteNta conexcica Usable.

tokateolontookiikamiseds surfkolaschillirairdtuttakt**ion.

80Ul t :arMbnd Ida* Saks, Weil Ceriv for WO %Ott DO*I* HO In** Sum/.

16
its TM 11, Isphr eaeol ol Cis for Wow 1744 ran d Acolky lo Roplir Physklaund TWIN, Typo of Hit

Imarince CAVIM., end Selected Chocitilsect Unlisd Nss,18n

1)ps ol Hob Nuance

Corm end

ChIrmlidelc

*al

ROI

Scarce

al Caro'

Vfilh ter 80111M ol Cars

WNW

AV*

TOW Physicist,

WIC Travel

The el

30 Wm*

or More

Total women 17-44 years

Private a !Mang only

Medicaid with or igioul other

coverage

Medicaid only

Uninsured

Race

WNte

Private or rotary only

MOW with or without other

coverage

Unkind

Bildt

Private or military only

Medicaid with or without other

coverage

thirsted

Poverty level

150 potent cc less of poverty level

Private or mart' cd

Medicaid with or About other

coigne

Uninsured

Percent of population

45,676 12.1 87.9 29.0

36,557 10.6 89.4 26.4

3,362

2,751

5,138

9.6

9,5

21.5

39,112 12.0

32,535 10.6

1,835

4,267

5,818

3,438

11.3

21.2

11.3

9.9

1,452 7.4

789 19.3

9,896 14,0

4,745 12.7

2,577 9.2

2,416 21.2

90.4

78.5

38.1

39.6

40.0

15.8

15,0

22,7

23.1

17,4

88.0 273 15.0

89.4 25.6 14,6

88.7

78.8

88.7

90.1

32.7

37.1

39.0

32.4

19,7

16.3

20.9

18,1

92.6 44.8 28,4

80.7 52.4 23.9

86.0 38.3

87.3 34.0

19.8

18.3

90,8 39.5 23.1

78.8 45.2 19.5
150.1. Facet 01 plarti loll 7,151 122 87,8 21.9 15.7

a Nifty ct 5,871 10.5 89.5 26.5 15.1

lirtid ON or west *sr

Gump 251 9.6 90,4 25,9 181 Wend 956 22,3 77.7 31.5 14,4

200 wart a mon of poirty Iml 25,074 10.7 89.3 25.1 14.3

1444 ft fillby Or4 23.396 10.1 89.9 24,7 14,2

MPS* le a wikutolhor

amp 229 11.8 88.2 22.2 219 Ills* 1,278 11 79,9 30.7 16.0

141.ccollm sits Ili** 32216 12.8 87.2 31.2 14.7

Phis tx wary a* 25,889 11.3 88.7 27.9 13.9

Ilidlcsid with a wilhad *sr

OM* 21610 9.9 901 428 21.8

IWilitfut 3,280 24.3 75.7 45.6 16.4

Ikaracixam 13,40 10,4 89.6 23.8 18.3

Prints a !diary ony 10,64 9.1 90,9 22.6 17.6

Moikaki * at *auto*

*rap 757 8.7 91.3 21.1 25.8 Mad 1,857 10 83.5 30.0 19.1

toblesomn otos Inlontativ coma olcaro lowegiblo.

IVE: Dili w bowl co houitid InlonirasoloswOrithodvionreirdtutivolizodrouitiz

Mt Nob, d Hoith lotortiodtollicoMibralColor tor HalthStolitico: Dots frcethefisit
aqiw d Cm for Ma and Yak Mir 17 Yos d A Akodk0 Mox ConiTgo d 0 India Camp, ad 1191Kia Ctaididike u rd 1111

Pisa of 1.111a1 Con

wNh

Tors Nalk

Immo Cam Iowa

ad *wild* d Cie Oia

Toti odor 17 pos

Pdva a *ay my

Mid* Oh a *out

Mr cam

kW* ati

LINK*

RICO

Whip

P*46 or fatly only

sdlcid OM or without

oIw wasp

Uriwed

FYats coriby only

laid we or without

*or compp

Uri**

Peaty Ma

150 want or las d

FairlY INg

Peals or dart onty

Oti a *tali

odor mop

Uriani

MIPM

OL4pisd

Diadood caMr

Plant d papuktion

MOW

Wpm In Um

Nam Oa Plea

93,0 716 5,6 2.9 1.0

94.4 818 3,9 1.4 0.6

91.7 59.2 13.8 10,2 2.4

91.8 57.8 14,2 11.3 2.2

05.8 64.9 8.8 5.6 2.3

93,5 82.8 3.9 1.7 0.7

94.8 85,7 3.3 0.9 0.5

91,9 618 8.8 6.7 1.5

85.6 70.5 5,6 4.0 1.3

90.3 519 14.4 9.7 3.1

KO 613 9,0 5,8 1.9

91.6 417 19.9 14.6 3.4

87.9 44.4 20.6 11,7 6.1

90,4 66.3

911 74.3

92.1 59.0

851 61.9

10.5 6.2

7.5 3.0

14.1 10,4

11.1 6.1

2.0

1.3

2.3

1.4

1.4

1.4

1.5

1.2

1.3

1.3

1.6

0.9

1.6

1.6

1.1

2.6

12

1.0

1.6

2.8 1,1
OM past d poly Iml 933 14 10 11 0,1 1,7

Nilo a still v4 id CS 4,6 1.3 0.7 1.7

Mit NIM i IONA

di camp 0,0 ill 11.5 U 0,6 . WWI 117 17,3 61 3.1 2,1 2.8

ZO pm* a mat

ci lost INS 611 Si 27 1,1 0.3 1.3

PAO a dirt only 613 872 2,7 1.0 0.3 1,3

IA** dh a OM

mw coop 113 74,7 7,0 17 17 1.6

Iftvid 914 81.8 2,5 2,1 0.4 0.9

Ilegdim Os

klecsdial 17 713 10 11 12 1.4

Pia a tilri (AV 942 II 4.1 11 0.1 1.4

MOM will a dhoti

ti or camp 91,1 54,0 1,2 11,4 29 1.5

tkireii IV 515 12.2 7,5 11 1.5

ktimarcolbi 915 15 3,6 1.5 0,7 1.3

NO a may or4 94,7 619 3.1 0$ OM 13

Mid OA a IOW

cihr mop 11 714 II 14 0.5 01

bud 103 715 4.4 3,1 12 0.9

fr.

Ur& 6 yun Sok 712 6.5 4.0 0,8 1,1

Nall a milk arty 25.7 64,7 4,7 1.9 0.5 1.0

'Mild db a litai

dr comp 14 57.9 14.1 11.4 1.9 1.5

anal 872 64x3 19 16 1,2 0.9

6.17 yam 112.5 71f 5,3 24 1.2 1,5

Pita a day ore/ Ile 613 3,1 13 01 1,5

Ilstkil sts vest

allot COMO 91,3 KO 116 9.6 2.. 1,3

Urimaid IV $2 17 3,9 LC 1.5

vs StidoctibitntoWolinon Km al me Is orakii

112 taintsvicti WON tarsiasdi is* Mho ddlr rairstkobreed p;dsita

EOM Mica ol IrAmisr Nord Cartels% Nat Ca IN to Hs. hipiadmv.
rm6 TAILS 31. Usual Somas ol Care cif Women 17.44 Years of Age, According to Place of Usual Care, Type of Health insurance

Cover* ond Selecisd Charatedstice: UMW Shies, 1978

Type of Mt

Immo Coin"

and Choc:led*

With

%der

Sawa

of Care,

Place of Usual Care

HeePliel Hoerlitel

Outpatient Health Emergency More Than

Nee Department Center Room One Place

Percent of population

Total women 17-44 years 87.9 73.2 5.1 2.5 1,0 3,4

Private or military 89 4 76.5 4.0 1.8 0.7 3.6

Medicaid with or without

other coverage 9L4 59.0 15.4 7.9 2.7 2,7

Medicaid only 90.5 561 16.8 9.0 3.0 2.7

Uninsured 78.5 61.0 6.6 4.2 1.8 2.4

Race

White 88.0 75.5 4.0 1.9 0.6 3,4

Private or military 89.4 77.6 3.5 1.5 0.5 3,6

Medicaid with or without

other coverage 88.7 67.6 9.5 4,1 2.5 2.9

Uninsured 78.8 64.5 5.4 3.6 0.9 2.2

Black 88.7 59.2 12.7 6.6 3.2 3.6

Private or military 90.1 68.0 8.2 4,1 2.7 4.0

Medicaid with or without

other coverage 92.6 48.2 23.2 12.4 2.9 2.7

Uninsured 80.7 45.7 13.2 7.5 6.8 3.8

Poverty level

150 pennant or less of

Povert level 86.0 61.1 10.0 5.6 2.1 2.8

Private or military 87.3 66.0 7.0 4.3 1.2 2.7

Medicaid with or without

other coverage 90.8 57.5 16.0 8.5 3.2 3.0

Uninsured 78.8 55.9 9.1 5,2 3.0 2.9
159-15. porta of poverty level 87.8 73.8 6.0 1.9 0.9 2.8

Private a Nary 89.5 75.8 5.6 1.7 1.0 2.9

MtAloid with a *out

dig coverage 90.4 70.9 121 1.6 - 3.2

Unbued 77.7 626 6.3 33 0.8 2.1

200 percent a more of

poverty MI 89.3 78.4 3.0 1.3 0.4 3.9

Private a meaty 89.9 78.9 3.0 1.3 0.4 4.0

Medicaid * or without

other wage 88.2 712 8.3 3.6 0.8 1.3

Unbind 79.9 71.7 2.2 1,4 0.3 2.4

**pc& status

Matra:dad 872 71.0 5.8 2.8 1.0 3.8

Private a rattail/ 88.7 75.1 4.0 1.9 0.7 4.0

Medtaid with or without

other coverage 90.1 53.3 19.3 8.9 32 2.9

Untitled 751 54.8 8.7 4.7 2.3 2.5

kreetroditan 89.6 78.6 3.6 1.9 0.8 2.5

Private a rilitary 90.9 80.0 18 1.4 0.7 2.6

Medicaid with or without

other coverage 91.3 78.5 21 4.5 1.0 2.1

Wised 83.5 721 3.0 3.2 1.0 2.3

lixdadre viono for ardor radon on SOWS of care is unavailable.

NOTE DM 3IX toed co toehold interview of a sup* of the civilian wiratitutionalized population.

SOME; Mite c4 Haiti Intel* Statistics. National Ceder fa Health Sttistior Data from the NO Interview Survey.

w

106
TAKE 32 Ewibrriol Mdhin 1$44 Years of Age In 1973 Who areall Fir thelr Rmt Child for 3 Months or Morel According to

A

Year of 11111 of FM Chid and Sided Characierldlcs ol the Mr UnItti Wok 1973

Year of likth of FInt Child

All

Years

1950 or

Before 1951-55 135141 195145 1985-70 1971-73

Total ever-married mothers

15.44 years

Percent of evemanial mothers who breast fed first child

13.e 32.0 18.1 13.4 12.3 8.2 7.1

Re4On

CIO* 10.8 16.3 14.8 13.4 10.9 7.6 5.9

Protestant 13.8 352 19.8 13.4 11.8 8.2 7.0

Jetiiiih 1C 8: .... '6.8 '4.1 118 *12.6 .. Othr or we 17.2 48.8 '16.7 18.4 22.6 9.7 15.6

Race and Spanish origin

White 12.5 28.0 16.7 12.7 12.4 8.5 7.6

Black 16.7 45.4 28.4 18.0 9.5 '3,9 '1.5

Spanish origin' 20.1 37.7 314 31.7 16,3 11.2 *V

Farm backpround

Farm 19.0 42.7 26.9 20.4 12.8 8.3 6.3

Nonfarm 10.9 23.8 13.8 10.5 12.1 8.1 7.3

Geographic region

Northeast 10.1 26.5 10.5 7.6 9.8 11.0 6.9

North Central 10.0 26.4 11.0 11,3 11.2 5.0 6.3

South 15.4 40.3 28.2 17.2 12.3 6.1 4.7

West 16.1 25.6 19.0 16.6 16.4 12.0 13.6

Education

8 years or 25.0 39.6 38.3 27.0 15.1 12.2 'V

9-11 years 13.3 31.2 22.6 15.5 7,5 21 5.5

12 years 8.6 22.2 11.9 8.6 9.5 5,7 4.9

13-15 years 14.4 54.6 12.6 13.6 19.9 9.8 9,4

16 years or more 21.6 '18.6 127 19.1 26,4 25.4 19,1

fl' 1 1:' 7
Occgatioi

Nrar worked 16,4 41,9 21.2 21,9 17.4

Pro 'animals and 8.9 '5,3 wagers 19.2 33.4 20.9 16,9 17.6 20.2 17.2 end clod woken 9.1 26.8 11.0 9.8 10.3 Mix mien 5.8 5.2 14.3 36.2 24.1 13.1 11.1 NU* operators, 6.3 7.0

and tamwatis 14.2 30.0 22.6 16.1 12.2 5.9 '2.8

karty

Below platy Oaf 21.1 452 34.5 27.2 13.7 10.9 100-199 *percent tow '5.8

200.209 percent above

13.5 38.4 210 14.9 14.4 3.6 5.7 10.3 30.3 15.7

330 plant 10.5 10.3 5.9 7.1 a more above 12.3 23.8 132 10.8 12.0 12.1 8.5

ErrOdyment between first

and second Nth

No second birth 7.8 36.0 17,8 12.6 10.9 6.5 &obit Mom births 5.6 12.2 26.0 15.5 13.8

Not stc4risi between births 9.0 7.8 '13.5

16.0 35.3 192 13.2 14.9 9.9 17.6

'ken al Sot* alcan goy be cloy rte.

KIM DM we Wel on lash* into**, of a vole ofevtpmerriei women.

SOURCE: Mini Cots for Heath Stabstiot Trends In Mat feeding among kneraan gathers, by C. Hirschman and G. E. Se* 23, No. 3. DiEw Pub. No. (PRS) 79-179. Public Hendershot. Vital and Haab Statistics, **Seat Wasting*. U.S. Government Printing Me, Nov. 1979.
VS1222 1111;11: 11141111111h11111111iTiliMilllil 8 11 If 11 i 01 B PP$PPW 00:0444.A44) fati45414 ROmISEL, kobioinbio 4 ppomoom mpto4-48c48 ) ^ P 1.PP91 93P 4P roNcolvtotecomt.Atri4 PANtMooS8 SWAMmmVS8.4 bmirp4m6.-Lmm iltgNtnin4at 0..combinio..44,4io6 R844M4T-4:q to V co Ca io L.4 ia co 'co io 8to-44800Nto., .0.. m .4 .m.. .44 ppppmootnwpw OUPOAWM-AON400) o-gooi.'441Wcob4m iobirC-4641:4bibia
1113111 1 111111i 1 111 q 11 '1 11 I 11 oonr) P:401 8-MIppg "0494"840$ "P1144815,cM P4918 iolAbw -LoWaioWiriwthobb ...liocamcoLA.4inwobm io46-44omboObem N(Q)O -& paNo o'N,W4h ""N"ONNO thqmo4-AvIN:4-A:491 inioL4ko:Cobw4bom .."411).-4W.ANW 4A 474moopmo74opp '4uul'ob.4mio4)-4tomo .4.4NN4NNN p-kmotbto-mcopm,4 mbiv't461-4mio.4 ..."ANNW 4- pules ,-44)%iaik et41 snIM.,psig; StatMOpSt4it S0)tgnom(11::m T84481 ObiniobWhmWtocow :4bb,44mblioim4) b)0)ivici0.tokoW bL)-4irlio 8(-20:1 .I .l :-.1W1919P0V4PP a:64N9)941tPP 13$4 -ab34(447C-4w-441404 minqmoloWsholWoo wbw4m4wrotho AC04:001 1;
TAME 33- Coneumplion at Seiecked Food Groups by Children and Youths Un- der 1$ Years al/ Age, According b Frequency of Intake, Race, Age, and Se= Uraled $tallfra. 11071-74 (Coat)

Rare,' Age, Sex, end Food Group

AU fruit and vegetables Breads

Cereals

Desserts

Candy Sviteetened beveeages2 Coffee and tea

Salty snacks

Black. both sexes

1-5 years Whole milk

Meat and poultry Fish and shellfish

Eggs All fruit and vegetables Breads

Cereals

Desserts

Candy Sweetened beverages2 Coffee and tea

Salty smacks 6-11 years Whole milk

Meat and poultry Fish and shellfish

Eggs AA fruit and vegetables Breads

Cereals

Desserts

Candy Sweetened beverages2 Coffee and tea

Salty snacks 12-17 years Whole milk

Meat and poultry Fish and shellfish

Eggs All fruit and vegetables Breads

Cereals

Desserts

Candy Sweetened beverages2 Coffee and tea

Salty snacks

158

Frequency During Preceding 3 Months

2 or Move

Times Once

per Day per Day

61.7

53.1

0.3

13.1

5.1

13.1

9.5

1.2

68.0

38.3

0.0

0.0

52.4

61.6

2.3

14.3

6.7

9.4

1.4

2.0

50.7

41.7

0.0

1.0

55.4

77.2

1.7

13.1

8.6

9.4

2.8

4.9

36.0

43.2

0.0

0.4

48.7

70.8

3.3

17.1

16.4

25.3

3.2

7.5

1 7

1-6

Times Seldom or

per Week Never

Percent distribution

28.8 9.4 0.1

33.0 13.7 0.2

11.5 48.4 39.7

32.0 48.4 6.4

18.1 58.1 18.7

28.5 44.3 14.0

17.1 30.1 43.4

13.3 66.1 19.4

15.2 11.9 4.9

45.7 15.9 0.2

1.0 60.0 39.0

18.5 71.0 9.7

34.1 13.4 0.0

252 12.2 1.0

35.2 o5.9 6.6

43.4 36.9 5.4

28.6 49.2 15.5

30.4 45.8 14.4

11.7 22.6 64.3

Z4.0 67.3 6.7

28.9 17.3 3.2

48.3 9.8 0.3

1.6 64.3 34.1

16.2 68.5 14.2

34.2 10.4 0.0

18.1 4.1 0.6

26.1 63.8 8.4

46.6 39.2 1.1

37.6 48.5 5.3

34.3 49.1 7.2

6.7 30.9 59.6

26.1 62.6 6.4

33.3 24.5 6.1

422 14.0 0.7

1.1 54.4 44.5

14.9 63.7 21.0

31.8 18.9 0.6

19.5 9.5 02

12.2 58.4 26.1

29.9 49.5 3.5

29.1 36.1 18.4

27.5 44.4 2.9

10.8 34.4 51.6

24.0 63.4 5.2
TABLE 33. on of Selociled Food Groups by Children and Voiding Un- der 1$ Year* of Age., AcicordIng to Frequency of Intake, Race, Age, irctd ilsoc LWOW defies, 11171-74 (Cont.)

Race,' Poe, Sim. and Food Group

Frequency During Preceding 3 Months

2 or More

Tinges

per 011Y

Once

per Day

1-4

Times

pzr Week Seldom, or Hever

12-17 years, male

Percent distribution

Whole mMk 40.8 35.4 20.0 3.7 Meat and poultry 37.5 43.8 18.2 0.5 Fish and shellfish 0.0 1.9 54.5 43.6 Egfl3 0.2 13-2 71.7 15.0 Al fruit and vegetables 44.6 31.9 22.2 1,3 Breads 76.2 17.7 5.8 Corona 5.8 13.7 56.9 23.5 Desserts 19.7 30.7 45.4 4_2 Candy 16.5 2rs..8 33.3 19.5 Sweetened beveracies2 24.8 30.8 41.7 2.7 Coffee and tea 2.7 12.3 32_2 52.7 Salty snacks 8.7 23.5 60.9 6.9 12-17 years, female

Whole mint 31.3 31.3 28.9 8.5 Meat and poultry 48.7 40.6 9.9 0.8 Rah and shellfish 0.0 0.3 54_4 45.3 Eggs 0.7 16.5 55.8 27.0 AR fruit and vegetables 52.7 31.6 15.7 0.0 13reacis 69.1 18.8 12.0 0.0 Cereals 0.8 10.6 59.8 28.7 Desserts 14.5 29.1 53.6 2.8 Candy 16.3 32.5 33.9 17.3 SP4veetened beverages.? 25-.7 24.2 47.1 3.0 Coffee and tea 3.7 9.3 36.6 50.4 Salty snacks 6-2 24.5 65.8 3.5

1F-3i:dudes children of other races.

=Doss not include alcoholic beverages.

NOTE: Data are based on dietary interviews of a sample of the population.

SOURCE: National Center for Health Statist= Food consumption persons aged 1-74 Years. United States 1971-74. by C. M. Dresser. Series 11-No. 210. DHEW Pub. No. (PHS) 79-16513. Public Health Government Printing Office. May 1979.

1 '710 .

civilian noninstitutionalizedl

profiles of black and White Vital and Health Statistics. Service. Washington. U.S.

159
TAKE St CossumfAim ol Seise* Food Grupe by Women 1144 Yam d Ap, According 10 Frequency ol end Rece:

Slit 1$71-74

Race' rid Food Croup Tot

..1,0101ditIM

Fromm Doing Preceding 3 Mods

4 no

Plr DIY

a Mom

1.4 Seldom

3 Timm 2 Thu Once Times or PO* Per DIN per DIY Per Week Never

Percent distribution Writ

Whole * 00.0 1.8 6.7 13,7 22.2 27.2 28.4

Skim milk 100.0 0.3 1.3 3.2 4 4 7.9 82 9

Meat and poultry 100.0 0.1 0.6 26.6 .! 2 15.0 0 5

Fish and shellfish 100.0 0.0 0.0 0.0 0.9 55.2 43.3

Eggs 100.0 0.0 0.0 0.2 14.9 66.1 18.8

Cheese 100.0 0.1 0.1 0.9 12.4 71.8 14.7

!Apples, seeds, and nuts 103,0 0.0 0.0 0.5 4.5 53.8 41.1

Fnits and vegetables,

SI kinds 130.0 3.7 18.1 361 34.3 7.5 0.3

Fruits and vegetables

rich in vitamin A 100.0 0.0 0.0 0.2 3.3 58.9 37.6

Foils and vegetables

rich in vitamin C 100.0 0.3 12 5.9 32.0 48.2 12.4

Bread 103.0 0.4 12.4 30.9 38.1 16.8 1.4

Cereals 100.0 0.0 0.0 0.1 7.5 392 53.1

Fats and oils 1010 0.4 8.0 21.6 40.7 21.0 8.2

Desserts 100.0 0.2 0.7 6.3 24.2 52.9 15.7

WO 103.0 0.1 0.2 0.8 9.9 45.0 43.9

Sweetened beverages? 100.0 1.9 3.5 8.5 21.5 34.9 29.7

Add*

**toned beverages2 100.0 02 0.7 2.8 6.7 13.0 76.6

Coffee arod tea 100.0 19.3 152 19.5 22.2 12.0 11.8

Salty snacks 1010 0.1 0.1 0.4 7,4 54.5 37.5
Back

Witis mit

8141 *

100.0 0.9 3.8 5.9 18.1 35.7 35.5

1010 0.0 0.4 0,8 1,7 9.4 87.7 lied and pity 100.0 0.3 3,9 34.0 45.1 16.0 0.7 Fib and gird 100.0 0.0 0.0 0.2 0.9 Cats 35.0 EP 100.0 0.1 0.1 02 20.6 58.1 20.8 Chose 100.0 0.0 0.0 0.5 3.9 59.8 35.8 legumes, sleds, and nuts 100.0 0.0 0.5 0.0 5.4 57.3 36.8 Fnits and vegetables,

d kinds 100.0 3.2 11.3 28.5 39.1 17.0 1.0 Fruit and opts*

rich in twin A 100.0 0.0 0.3 1.3 6.9 09.2 22.2 Nis and vegetables

rich inviturin C 1010 0.3 1.5 5.4 25.8 52.5 14.6 Bread

NM*

100.0 1.2 18.9 31.3 27.3 20.3 1.0

100.0 0.1 0.1 0.0 6.0 35.5 58.3 Fab and cis

Netts

100.0 0.0 5.7 10,3 39.3 31.3 13.4

100.0 0.1 1,1 6.1 23.4 50.7 18.6 Candy 100.0 0.8 1,3 2.3 10.7 36.5 48.4 Stoked tong*

Wolf

100.0 2.9 93 15.3 28.0 33.4 11.1

sweltered boo* 100.0 10 02 1.2 3.4 7.3 88.0 CO* and tea 100.0 4,8 6,6 13.4 30.9 21.6 22.6 Sit/ snacks 100.0 0.0 0.5 0.9 10.1 472 412

'BO* own aloharaw

:Das* Wadi *oh* Imrirsgs

KR: Oda ire boldat distil/ SION d smootedthecivin nairatItudalizad pit&

SOURCE 14tlawlCenbrfa Huth &static& Food constan* profits of tack and Oita won aged 1-74 years, United States, 1971-74, andiftsillitikt Sol 11, No. an NS by C. M. Dresser. Vital Rib. (PHS) Vs% RA* Health SOM.Visiting* U.S. Govimment Printing Office, May 1919.
TAILS 35. Yottis 12-17 Yews ci Ape, ActordIng b Bert and Wow 15-44 Ws of hp on a Spulal DIA by Reason WOK Kind

DIN, lon, Ind lot UMW Nis, 1171-74

Amon tor DIN land ol Did

Pcodolon On I

In lipschl Wad AR Low Carta Low Low NI

Sox Mk* Thousands Did Los Mobilo Prowl OW Cis* hydras Fal Solt 011wr

Percent of population Percent of population

ode

12-17 years 12,422 0.9 0.2 0.0 ... 0.6 02 0.2 0.3 0.1 0.7

Female

12-17 years 12,043 52 3.1 0.6 0.4 1.5 2.8 0.9 1.5 0.4 1,7

15.44 years 44,532 102 6.4 0.4 0.6 3.6 5.5 22 3.0 1.2 3.5

1519 poi 9,790 7.8 5.4 0.3 0.5 1.9 4.6 12 2.6 0.4 2.4

2344 years 9,215 8.6 5.8 0.3 1.2 2.0 5.0 1.9 2.0 12 2.7

25-34 years 13,933 10.9 7.1 0.3 0.9 3.5 6.4 2.5 3.4 1.3 3.5

35-44 pars 11,593 12.7 6,7 03 0.1 6,7 5.8 2.8 3.7 1.9 5.2

NonDataaretnrsedaninterviewsof a sampledthecivi nra instituticsdad ppulatico,

Sr ACE: 006:41 KWh Eurridtico Steaks, Natiorll Cider for Huth Statistics: Des front the Hee andNutrition Examination Survey.
TAKE 3i,. Ever Uwe of Spectillad Illisbaismoss by Youllbs 13-17 Items of Agit. Amanita. to Type of

littleslonose I Nsd Sealise, 1972-7*, ilelecbsd Yeats

Type of Ilubstaaos Ever Used

Year

1972 1974 1979 1977 1979

Licit substances Percent of youths

Alcohol 54-0 53.6 52.6 70.3

Cigarettes 520 45.5 47.3 54.1

Nlicit substances

Marihuana 14_0 23.0 22.4 28.0 30.9

inhalants 6.4 8.5 8.1 9.0 9.8

Hallucinogens 4.8 6.0 5.1 4.6 7.1 Cocain 1.5 3.6 3.4 4,0 5.4

Heroin 0.6 1.0 0.5 1.1 0.5

Nonmedical we of

per-Jootropic drugs Stimulants 4.0 5.0 4.4 52 3.4

Sedatives 3.0 5.0 2.8 3.1 1.2

Tranquilizers 3.0 3.0 3.3 3.8 4.1

Analgesics M IM - -- MM.. 3.

NOTE` Dta are based on household interviews of a sample of the civilian

noninsetutionsilzed population.

SOURCE: Fihburne. P. M. H. 1. Abelson. and 1. Clain. National' on

Diva Abuser Math Finding.. /979.Contract No. 27-78-3508. Alcohol. Crug Atxwa. and Mental liseith Administration. National institute on Drug Abusa Rockville. W., 1980.

163
h:oick1c3 *ONO WONt- ",(4 Nrr Gorr. 0q(1) 9 Ir` 64Ar cdui AM iNoo wth.ro rr ,c4Wo 000rs W4uiv 000q rZoiclio cnoors ONN". NONV, (17 q(017I g3 8"' -r0 °Pi? IN4t(1 O PV mm.tm It,NrN gg Celn mo NI11179 mNoir _1304,
TAME 311. Currents elgrell Sinoldiag by 'Ionise 12-1* Years of Ass, Aociairding b Asia and Seic United

1111111-79 Ihrlealad Yams

Age and Sex

Year

19811 IWO 1972 1974 1979

Total. 12-18

years

Percent of youths who are cgsrent sabers

Male 14.7 18.5 15.7 15.8 10.7

Fenn*: 8.4 11.9 13.3 15.3 12.7

12-14 years

lrtale 2.9 5.7 4.6 4.2 32

Female 0.6 3.0 2.8 4.9 4.3

15-16 years Male 17.0 19.5 17.8 18.1 13.5

Female 9.6 14.4 15.3 202 11.8

17-18 years Male 302 37.3 302 31.0 19.3

Female 1&6 22.8 25.3 25.9 26.2

'Glossal smokers are defined as those who smoke one cigarette or more Par week.

NOTE Date are based on telephone interviews.

SOURCE: National institute of Education Teenage Smoking: Immediate and Long Tenn Pattern& Washington. U.S. Government Printing Office. Nov. 1279.

165
TAME 39. Ues al Spiel lied Substances inthe Past 30 DM* by 141901 School Seniors, According to Type of Substance: United Stare, 1975-79 rses of Type of Substance 1975 1976 1977 1978 1979 Percent of seniors reporting use in past 30days Licit substances Alcohol 68.2 68.3 71.2 72.1 71.8 Cigarettes 36.7 38.8 38.4 36.7 34.4 Illicit substances Marihuana 27.1 32.2 35.4 37.1 36.5 Cocaine 1.9 2.0 2.9 3.9 5.7 Inhalants' --- 0.9 1.3 1.5 1.7 Hallucinogens2 4.7 3.4 4.1 3.9 4.0 Heroin 0.4 0.2 0.3 0.3 0.2 Other opiates* 2.1 2.0 2.8 2.1 2.4 Nonmedical use of Psychotropic &ug Stimulants 8.5 7.7 8.8 8.7 9.9 Sedatives 5.4 4.5 5.1 4.2 4.4 Tranquilizers 4.1 4.0 4.6 3.4 3.7 'When the percent of students reporting use of inhalants isadjusted for underreporting of amyl and butyl nitrites, the 1979 figure is3.1. 2When the percent of student, reporting use V.' hallucinogens isadjusted for underreporting of PCP. the 1979 figure is5.5. 'includes only drug use that was not under

aphysician's orders. NOTE: Data are based on questionnaires administered inschool toa sample of high school seniors. SOURCE: Johnston. L. D., Bachman. J. G.. and O'Malley. P. M.: 1979 Highlights. Drugs and the Nation's High School Students. DHHS Pub. No. (A0.40) 80-930. Alcohol. Drug Abuse, and Mental Health Administration. Rockville, Md.. 1980.

17J 166
TAME 40. Ever Use and Recency of Use of Speci lied Substances by High School Seniors, According to Type of Substance: United States,

11170

Type of Substance

Recency of Use

TOW

Past

Month

Past Veer, Not

Not Past

Past Month Veer

Mertes

Used

Licit substances Percent distribution

Alcohol J 100.0 71.8 16.3 4.9 7.0

Cigarettes 74.0 100.0 34.4 1(39.6) 26.0

Illicit substances

Marihuana 60.4 100.0 36.5 14.3 9.6 39.6

Cocaine 15.4 100.0 5.7 6.3 3.4 84.6

Inhalants 12.7 100.0 1.7 3.7 7.3 87.3

Adjusted? 18.7 100.0 3.1 6.1 9.5 81.3

Hallucinogens 14.1 100.0 4.0 5.9 4.2 85.9

Adjusted' 18.6 100.0 5.5 7.3 5.8 81.4

Heroin 1.1 100.0 0.2 0.3 0.6 98.9

Other opiates.* 10.1 1 oo. 0 2.4 3.8 3.9 89.9

Nonmedical use of

psychotropic drugs', Stimulants 24.2 100.0 9.9 8.4 5.9 75.8

Sedatives 14.6 100.0 4.4 5.5 4.7 85.4

Tranquilizers 16.3 100.0 3.7 5.9 6.7 83.7

'The combined total for the two columns is shown because the question asked did not distinguish

between the two answer categories. Vidiusted for underreporting ofarnyl and butyl nitrites.

;adjusted for underreporting for PCP. 4Includes only drug use that was not under a physician's orders.

NOTE: Data are based on questionnaires administered in school to a sample of high school seniors.

SOURCE: Johnston. L. D.. Bachman. J. G.. and O'Malley. P. M.: 1979 Highlights, Drugs and the All's High School Students. DHHS Pub. No. (ADM) 80-930. Alcohol. Drug Abuse. and Mental Health Administration. Rockville. NW.. 1980.

167
11111111111111111i 111111111g11111 ;40

.A .44 W

lP$444NYW874$INP14!"3 -14WNNM400$11"p P:Lw

4 t0§410111STt'el""a 81tvieN4.17) %owu4,12T0Q=L

Cr, .10 0 ti -100 -Am-A2-AhA66 ?1,1121301-Aw'RIS V4M1.4N468

giaNORMAStalM?88,1

L4Wobiaslinh)b.1.66.,W4ininbK)44

28tAllalin9t(i ISS 01ST-MO

L4 4.4 La i) k) i) b in in .4 "4 Li LA IU1.Iinia .16 LA in G

!V.2".0110g108t8tAtR8N8tit 4ttiOtSSW8Vriol tSFAMIM

c n 'A 1 . 4 L4 CD b i n 4 4 LA h ) 'A h ) b 4 4 b b b 44 b 44 thin in b tab LL NNtD4D4IAWQIfD

r840(1 N00000N-L000D OM

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PriP ri 

1-40411M110
TAME 41. Pepsis lion Saivad WiM Fluoiridodad Waller. According 10 Typo of Illuorkislioss, Division, and DIM= UnlSsd *tabs, 1975 (Cont.)

Division and SW* Popuisdon

in Thousands

Type of Fluorkhdian

Does

Typos

Adiusiod

Water

Natural

Water

West

Mountain 9,625 41.5 22.1 19.4

Arizona 2212 29.3 6.7 22.6

Colorado 2.541 81.4 54.2 27.2

Idaho 813 32.1 5.9 26.1

Nevada 590 2.9 0.8 2.0

New Mexico 1,144 61.4 35.7 25.7

Utah 1,203 2.3 2.1 0.2

Wyoming 376 20.0 14.9 5.3

Pacific 28,274 22.5 18.2 4.3

Alawica 365 42.8 42.5 0.3

Camlomia 21,198 21.5 16.1 5.4

Hawaii 868 6.3 6.3 - Oregon 2,284 10.5 9.3 1.2

Washington 3,559 38.4 37.2 12

Nom Data are based on reporting by State health officials. Water systems are considered to have derdaNy significant natural fluoridation If they have 0.7 parts per million or more naturally occurring fluoride. Adjusted water systems are fluoridated at the optimal level according to the

average maximum local daily air temperature.

SOURCES: Center for Disease Control: Fluoridation Census, 1975. Public Health Service. DHEW. Atlanta. Ga. Apr. 1977; D:vision of Dental Health, Bureau of Health Manpower F7uoridation Census, 1967, DHEW Pub. No. (PUll) 66-428. National institutes of Health. Bethesda. Md.. 1968; U.S. Bureau of Comm Population estimates and pro Current Population Reports. Series P-25. Nos. 460

and 646- Waaflinfation. U.S. Government Office. June 1971 and Feb. 1977.

1 c: 169
Pi TANI 4 Children and Youms Under 1$ Yen of Age Living in tutees With SOW In or Shuctursi Ws*

o Acceding to lauded Chestrisics: United Mess, 1977

Inerict or *Arai Daisy

Craft/Mots Pealing ids

Populdion Issont in Point In Piaster In Holes In

Chaste's* In Thousa nds Luke Roof Leeks Weistellep Weep Weis/COW Floors

Percent of population

Total under 18 years 64,291 12.8 7.5 7.3 5.1 4.6 2.8

Age

'Met 6 years 18,583 12.3 8.0 8.4 5.6 4.7 3,4

6-11 years 21,451 12.9 7.3 7,3 5.1 4.6 2.8

12-17 years 24,276 13.2 7.3 6.4 4,7 4.5 2.3

Sex

Male 32,6 12.9 7,5 7.3 4.9 4.5 2.6

Female 31,653 12.9 7.5 73 5.3 4.7 2.9

Race . White 53,873 13.6 6.6 5,5 4.1 3.6 1.9

Al other 10,441 9.1 12.0 16.2 10.3 9.6 7.4

Black 9,125 9.3 12,9 17.1 10.5 10.2 8.0

Family income

Under $5,000 6,594 10.2 13.2 16.8 11.3 9.6 8,2

$5,01049,999 10,696 9.6 12.4 13.8 8.9 7.7 5.9

$10,00414,999 12,528 13.1 7.6 7.6 5.0 5.6 2.5

515,000424,999 20,550 13.9 5.2 3.9 2.8 2.5 1.0

$25,030 or more 13,566 14.8 4.4 2.4 2.5 2.0 0.6

Sex of householder

Male head, wife pr !nt 52,321 13.1 6.8 5.5 4.0 3.6 2.0

Other male head 1,558 13.8 8.8 11.3 6.0 7.2 4,5

Female head 10,437 11.3 10.8 15.6 10.3 8.9 6.5

Ok 153
Eclectic(' of howohckier

8 pie a Nen 8,785 9.5 12.8 14.7 10.2 9.9 6.8 9.11 yore 10,504 9.9 9.2 10.9 6.9 7,3 4,4 12 years 23,513 13.9 6.3 6.1 4.3 3.7 2,1 13.15 yews 10,062 12.9 6,1 5.1 3.3 2.3 1.3 16 years or more 11,4 15.9 5.5 2.6 2.7 1.9 0.9

Farisi tie

2 priors 1,587 10.9 7.8 9.9 5.7 5,0 3.F 3 parlors 9,648 11.0 6.1 6.4 4.4 3,3 1,4 4 persons 19,492 12.8 6.1 5.1 3.3 2.9 2.0 5 woo 15,484 13.5 7.1 6.1 4,4 4.0 2.3 B peaces of more 18,117 13.5 10.1 10.8 7.8 7.5 4.2

Reside*

Inside SU 44,411 12.7 6.8 7.0 4.9 4.3 2.3 Cereal title(' of

large SMSA 12,472 11.8 8.8 11.5 8.6 7.5 4.4 Sate of large

SMSA 18,366 12,8 5.2 4.8 3.4 2.9 1.0 Whit SMSA 19,904 13.2 9.0 7.9 5.5 5.2 3.8

RIO

Northeast 13,818 23.3 8.3 8.9 7.1 6,0 2.6 North Central 17,10 20.3 6.4 5,9 4.3 4,3 1.5 South 21,756 5.0 8.6 8.2 5.2 4.8 4.5 Welt 11,589 4.0 6.1 5.7 3.6 3.0 1.5

Ike* any ths50 lugest

Malradaiydthosseithboomantsbut pont isbasedontotal populabco,

0311:00sare boadon toulebSd

inteNewaolammleolthecivIllannonlnablulionalizad population.

SOME: U.S. Bureau of It* Caw Data from the 1977 Annual Housing Survey, Spada' tabulations prepared by the US. Now* SM. Bureau of the Census, Center for

154
TABLE 43. Children and Youths Linder 1$ Years of Age Living in =ruction's With Specified Plumbing Deficiencies and With Specilled Wido and Sewage Disposal Reclining, According lo Selected Characteristic:1:r

United Stable, 1977

Cfteracteristic

Population

in

Thousands

Plumbing Deficiencies

Water and Sewage Facilities

Toted

Without

Piped-in Water

Water Not

Obtained

Freon

a System

Not Como:-

fed to a

Public

Sewer

Percent of population

Total under 18 years 64,291 2.1 0.9 21.8 34.0

AgeUnder 6 years 18,583 2.0 0.9 20.0 31 4

6-11 years 21,451 2.1 0.9 21.8 34.;

12-17 years 24.276 2.1 1.0 23.1 35.7

Sex

Male 32.650 2.0 0.9 21.9 34.3

Female 31,653 2.1 1.0 21.5 33.5

Race

White 53.873 1.3 0.5 23.9 37.0

All other 10,441 6.1 3.4 11.1 18.1

Black 9,125 7.0 3.9 11.7 19.0

Family income Under $5,000 6,594 7.6 3.9 21.1 31.8

$5.000-39.999 10.696 4.9 2.2 23.0 34.7

$10.000-$14.993 12.528 1.7 0.5 23.4 35.5

315.000-324,999 20.550 0.4 0.2 22.1 34.9

$25.000 or more 13,566 0.1 0.1 19.0 31.4

Sex of householder

Male head. wife present 52,321 1.7 0.7 23.9 36.9

Other male head 1,558 4.1 2.5 19.7 32.5

Female head 10,437 3.7 1.9 11.3 19.3

Education of householder

8 years or less 8.785 9.0 4.2 28.5 40.9

9-11 years 10.504 3.1 1.4 23.9 36.1

12 years 23.513 0.8 0.3 23.3 35.6

13-15 years 10,062 0.3 0.1 18.2 30.3

16 years or more 11.466 0.1 0.0 14.5 26.5

Family size 2 persons 1,587 1.6 0.5 11.1 18.8

3 persons 9,648 1.3 0.4 17.8 29.2

4 persons 19,492 1.2 0.6 20.8 34.0

5 persons 15,484 1.6 0.6 23.6 36.6

6 persons or more 18.117 3.9 1.9 24.3 35.5

172
TABLE 43. Ch Odeon and Youths Linder 7 i VOWS at Age Living In Binactures Wv: Spooned Insoluble's. Dsliciencise and Wills Specified Water and Illetwage Disposal Faclilless According to Selected Characteristic= United Ilistss, 1177 (Cont.)

Plumbing Waller and Sewage Delicienciss Facilities

Characteristic

Population

Thousands Total

Without

Plped-In Water

Waksr Not

Obtelnod

From

a System

Not Cone

led to a

Public

Bowser

Residence

Percent of population

Inside SMSA' 44.411 0.8 0.3 14.1 24.3 Central cities of

large SMSA 12.472 0.3 0.0 0.7 2.2 Suburbs

large 18,366 0.9 0.3 13.8 27.3 Outside SMSA 19,904 4.8 2.3 38.7 55.4

Region Northeast 13,818 0.7 0.1 20.6 34.0 No Central 17,163 0.9 0.3 27.1 .22.8 South 21.756 4.9 2.4 24.4 41.4 West 11,589 0.1 0.1 10.1 21.7

Includes only the 50 largest SPASA's.

NOTE: Data are based on household interviews of a sample of the civilian nortinstitutionalized population.

SOURCE: U.S. Bureau of the Census: Data from Me 1977 Annual Housing Survey. Special tabulations prepared by the U.S. Bureau of the Census, Center for Demographic Studies.

v

173
71 TAKE 41, Chit* and Youths Und er 11 Years O Ago Mg In Households that Repo* Speed Condition FAIN In the

ar Neighborhood, According io fleiscio" Characteristics: United Ste% 107

Coidition

Population Al Lot Poor

In One Shot Shit

Charactoistic Thousands Condition Lighting Noise

Total under 18 years

Age

Under 6 yws

6-11 years

12-17 years

Sex

Male

Female

Race

White

M other

Black

Family income

Under $5,000

$5,00049,999

$15,034424,999

$25,000 or more

Sex of householder

Male head, wife present

Other male head

Female head

*Os

Hon Needing

Traffic Rep*

Percent of

64,291 73.4 30.8 30.0 25.3 22.0

Aber).

Street iundowv bed

Crime UM r Housing Odors Sbuctures

population

17.0 16.9 11.2 9.4 8.2

18,583 75.1 31.0 32.0 25.0 21.6 17.1 18,1 12.5 10.0 8.9

21,451 72.7 31.2 29.2 25.4 21.8 17.1 17.0 11.0 9.9 8.2

24,276 72.7 X.3 29.2 25.6 22.5 16.9 15.9 10.4 8.5 7.7

32,650 73.7 31.0 30.3 25,8 22.4 17.3 16.9 11.4 9.5 8.2

31 453 73.1 30.6 29.8 24,8 21.6 16.8 16.9 11.1 9.3 8.3

53,873 72 7 31.8 29.7 24.1 21.7 16.2 15.1 9.8 9.2 6.3

10,441 77.3 25.7 31.8 31.7 23.4 21.6 26.1 18.6 10.4 18.5

9,125 78.8 26.4 32.1 331 24.9 22.7 27.9 20.2 10.9 20.3

6,594 76.4 28.6 32.7 30.7 24.0 19.9 23,7 16.5 10.8 15.1

10,696 76.1 28.2 32.1 28.8 24.4 19.1 22.1 13.4 9.5 11.9

20,550 70.4 31.2 29.5 24.7 21.7 15,4 14.9 9.9 9.4 6.3

13,566 68.4 32.5 25.4 19.4 17.5 16,4 11.4 7.7 7.8 4.5

52,321 72.8 32.0 29.6 24.3 22.1

1,558 75.0 27.0 30.1 25,4 22.9

10,437 76.2 25.2 32,2 30.3 21,3

1

16,0

18.0

22.3

15.5

17.1

23,9

10.3

9,9

15.8

9,4

8.6

9,5

7.0

9.5

14.4
Edo**, d host Odor

311 yen

pa of low 8,785 719 31,9 29.0 30.0 269 14.5 20.0 12.4 8.7 9.9

10,504 78.1 30,3 32.3 30.6 26.6 18,9 21.4 14.6 11.3 12.3 12 pors

1315 pro

23,513 73,8 29.8 31.0 26.4 22.6 17.1 17,1 11.8 9.6 8.3 10,082 72.7 31,9 30.2 22.2 19.8 18.4 14.9 10,4 9.0 7.3 1$ pin or more 11,466 66,4 31,6 267 17.5 14,8 15.9 11.7 6.7 8.0 4,0

Folly

2 NM 1,587 74 8 24.1 34.2 31.0 19.3 21,5 3 we 9,648 74.4 29,7 13.0 26.8 20.7 18.8 4 pan 19,492 73,2 321 29.0 23.6 21,0 16.1

5 wris 15,484 71.8 30,4 28.6 23.4 22.0 16.0 6 ;on oi mon 18,117 74.3 30.9 30.4 27.6 23.9 17.6

Rosidonco

SMSA' 44,411 718 29.9 31.1 25,5 19.6 20.3

Centro! o ot

SMSA 12,472 75.5 18.9 35.0 31.1 19.0 26.6

&Woo d

lip SUSA 18,366 71.1 32.1 29.5 22.6 17.3 17.8

Outido SMSA 19,904 72.6 32.8 27.7 25.0 27,4 9.7

ROcin

taut 13,818 72.0 26.7 30.0 25.7 20.8

Nat Coral 17,163 73.4 30.7 30.0 25.9 21.1

South 21,756 75.1 14.8 28.9 25.8 27,1

Mho 11,589 72,1 264 32,4 23.2 15.0

21.3 12.9

18.6 11.8

15,9 10.8

15,7 11.1

17.7 11.4

17.6 12.0

24.7 16,8

13.2 9.5

15.4 9.5

18.1 16.1 11.7

I:. 9 151 10.7

;4 19.0 11.

20.5 16.3 11.6

9.1 10.5

9.5 7,8

9,3 7.2

8.9 7.5

9.8 10.0

9.8 8.6

11.9 15.3

8.6 4.9

8,5 7.4

9.2 11.2

9.4 8.9

9.1 7.6

10.1 5.0

Inciditati the 501vp,

NOTE: Mt ars tadon rousehal inotArs of a so* of t.) dvlUennonabtubonslizedpopuiatlon

SOURCE: U.S. Bureau of the Cosa DO from the 1977 Annual Housing Survey Special Ibuiati,ls preps* by the U.S. Bureau of Docciporic Stu* the Census, Center for
41, Mkt Anse Included In We School NO !Edon Proirm, Accoting b UM lies, 1111.

Mild kw

Folk Vs/ Dogs, Dental Noah

M. in Venni Totem WIN end Growl and

bde kW* Mob Diem Alcohol Neil Nutedon Orel Hygiene Milepost

Northeut

New England

Connecticut lit III .0 M

Mins, G III .11 111 ill Ili

MUISChatt 114 I41 ill lii M M ,

New Hampshire .14 PA M M 414 Ili

Rhode islandl 4.1 oil ill PA 111 Vermont III 411 ill M 1,4 til III

MO Mantic

New Jersey G 0 0 M'S 0 0 0 0

New York C-E ... ... M 0 0 0 .., Penneytvania "1 111 ki 411 11 ill

North Central

Est North Central

Bois C ... ... M M M M M

Indiana ,.. ,.. M .ii ... Michigan G M 0 M M ki M 0

aOhio ... ... M M ... ... ... Mon* G . ... 0 a Oil Ili 10 West Nortn Central

lora .., 10 M M ... .., Kanewf I.. 111 111 11. I11 111 ... Minnesota ill 0 0 /1 0 0 .0 0

Mini - 0 0 0 0 .,. 111 Nebraska G ... ... 1.11 II. It. 141 ... Wit Dakota .4, Pill Ill M 1.1 11 191 South Dakota'

O. .19
ecte

WI Ai*

Dikil c4 Ccieti

Dim 0 0 0 M 0

,.. M I I M M 0

Reda C 0 M M M

ell

Osatit

... 0 0 M 0

IA

kW 0 0 It M

16111 cam, GiE 0 0 m

Sough Carobs 0 C 0 C WO* 0 M 0 0 . YAM %NM M M m

061 Ent South Colral

160

111 116 666 III

A /61 NI

111 IA

Ilt 0

... M 0 3

... 11111*0 ...

11 TIMM M 106 Wilt SOUth 1,1 OH IA

010 WiTil

Mall

... M M M

610 ictisirg 661 6 0 0 MNS 0 0 0

ONItaril

060

004

011

0I0N

111

111

006 0

111 0 0 0

05

so 0 0 G

4.1 511 000 0 0

061 0 0 0 142 600 11 0

11N

615

411

666 0 0 0 0

666 N

111

111

141

811

1.

141

111 0 0 0

21

011

114 0 0 0 0

141 811

110

111 111

110 0 0 0

MI NI 0 M

01 001/

110
1.14 TOM 411, Sub led Arent included in Stele School *eh bob horn, According to Stew United Slates, 1911-79 (Cod)

Subic! AN

Feerik UN/ Drug, Dental Hub

Neelth Six Wiwi Takao, Metal end Growth and

Education Edialicei Dime *ON *Rh Won Orel Hygiene Development

Pe*

Alice G 111 .11 Callomia G 0 M M 0 0 0

G M M M 0 M M

Oregon 11m 11* 111 WaShingtOn 111 111 111 .11.416PMVAinl1111111MMINi 111

I 1 / KEY; M f+ tad; 0 Optional/Pero* S Secondary School Level; E Elementary School Level; G General (local option for whin oh*); C selection of content and Comprehensive; specified content arso for eich grade

'Subject offerings are option of kcal district.

One Wilted mfotos of inetructicn in health rd physical education per week is required for all students, K-12.

NalfhKtoatOn not required; one unit of physical education required to graduate of which onhalf unit maybe health education, 1f Ind ppm at State level.

linituction In phyla' legation and mental health required at jurior high and high school levels.

tremor of heith riation required la *aeon,

;Ho irshdon NO, 40'; 'ft gra* 1-12; no pcific requirements

%MI dation U*4 ',anjunction other subiect areas; roi special program exists.

lOrie half Hof holm 4licatic4 required fa graduation.

'Mir legation two 1t to loci education mandates,

"HMO *ton IV req.*: coe unit of Myicsloducatico required to valuate of Mich onehalt may be health education.

NOTES: Data are based On rooting by Stites, Unkaa otherwise noted, programs referto both elementary and secondary levels.

SOURCE: Castle, A. S., and Jerrick, S, J.: School Her in America, 2nd ed., A Survey of State School Health Programs, Ohio. Center for Diem Coital. Manta, Ga., A. 1979, American School Health As,sociaton, Kent,
Trni bap Now pet Day Iwo hi*Mal Addeo and WM *Mod Cerreolow by Chlbran IA Yam d Ap, Am*, b NNW Chembrbicee Utled Ois, 1171

asibtialc

Vining Rolm lot

Teloisket Nand Plena Chas Mode Pa*

Icial 6-12 ywi

Average hours per day

2.1 0.8 0.6 0.5

AP

lib 6 yen 1,6

7 yea 2.1

yes 2.1

9 yen 2.0

10 yen

11 on 2.2

Eaty 12 yen 2.4

0.4

0.5

0.7

0.8

0.9

1.0

1.0

0.6

0.6

0.7

0.6

0.7

0.6

0.8

0.5

0.4

0.4

0.5

0.6

0.6

0.5

SuI* 2.1 0.7 0.6 0.5

Female 2.1 0.8 0.7 0.6

Race

Vito 2.1 0.7 0.6 0.5

Black 2.2 1.0 0.7 0.7

Other 2.4 0.8 0.8 0.6

Fen* income

Under $5,000 2.3 0.7 0.7 0.6

$5,00049,999 2,1 0.7 0,6 0.5 k $10 00C414 999 q " 2.0 0.8 0.6 0.5 4 $15,000 or more 2.1 0.8 0.6 0.5

19 2

1.6 1.2

1,5 1.4

1.6 1,1

1.6 1.2

1,5 1.2

1.5 1,1

1.5 1.2

1.5 1.0

1,6 1.2

1.5 1.1

1.6 1.2

1.4 1.2

1.1 1.1

1.7 1.3

1.6 1.0

1.6 1.2

1.5 1.2

06

0.7

0.6

0.6

06

0.6

0.5

0.5

0.6

0.6

0.6

0.6

0,7

0.7

0.6

0.6

0.6
TAKE 41 Au* Hours per Day Spent In Swilled WIN and With Spedfled Camillus by Children I-12 Years of Age,

o

According lo Sided Ctiveciedelia:' United Sliest 19Y6 (Cont)

Conpolon3

Wooing Ruding for

Clouted* Teloision Hound( Plenum Chose Friends Parents Sift

Average hours per day

Education of most educatid

Pannt

8 yaws or less 2.3 0.8 0.5 0.6

9-11 years 2.1 0,8 0.6 0.5

12 years 2.2 0.8 0.6 0.5

13-15 years 2.1 0,8 0.7 0.5

16 years or more 1,9 0.7 0.7 0.4

Number of children in *lily

1 child 2.2 0.9 0.6 0.5

2 thidren 2.2 0.8 0.7 0.5

3 children 2.1 0.8 0.6 0.5

4 chldren or more 2.0 0.8 0.6 0.5

Community type and

population size

Within NSA

Central city

1100(,31:0 or more 2.1 0.9 0,6 0.6

250,000-49,999 2.0 0.7 0.6 0.5

5010004491999 2.1 0.7 0.5 0,4

Suburbs

Affluent 2.0 0,7 0.5 0.4

Nonaffluent 2.1 0.8 0.7 0.5

Outside SMSA

Cities and towns 2.2 0.8 0 0.5

Rural 2.2 0,7 0:1 13 3 0.6

1.6 1.1

1,7 1.1

1.5 1.2

1,5 1,2

1.5 1.1

1.5 1,3

1.5 1.3

1.5 1.1

1.6 1.1

1,7 1.2

1,5 1.1

2.0 0.9

1,7 1.1

1.7 1,3

1.6 1.1

1.0 4,2

0.6

0.6

0.6

0.6

0.6

1.0

0.7

0.6

0.5

0.6

0.6

0.3

0.6

0,6

0.5

0.6
140011

Notheist 2.1 0.8 0.1 0.5 1.5 1.2 0.6

North Central 2.0 0.9 0,5 0.5 1.6 1.1 0.6

South 22 0.1 0.7 0.6 1,5 1.1 0.6

West 2.2 0.6 0.6 0.6 1.8 1.2 0.5

1E00E* fa each charlotte's/Joare adjustei to eifultanecosi partial out the effects of all other charactilstics.

McfStes ire not muluily Wok

3TIme speot with ocrepArs maybe We savaged In any of the spelled activities,

%Ws*/ han sot* spent Wks NOM% sot hairs tOrrtion set Is tool on.

NOTE Data are bold on tosuseld:1 Interviews of a samcie of prints of elerhentartethoolle cNIdren.

SOURCE; The 1976 Nadal SUrvey of Cl rem; Special tabulatices Roared by Chid Trends, Inc., Washirgton, H., 1980,

1911
TARE 41. WM Weighing 2,500 Ora ns or La at M, According to Nor or Race, Division, and St* United Stalest 196547,

1970-72, and 1975-77 Annul Averages

1N5-17 1910.12 1915-11

Al

Diviskei and Stab Tolii Whits Other' Totali *Me link Tole White Slack

Percent of he births

United States 8.3 7.2 13.1 7.8 6.6 13.6 1.2 6.1 13.3

Nalheast

Now Engird 7.9 7.6 14.2 7.2 6.8 14,1 6.6 6.2 12.3

Connecticut 8.4 7.7 15.1 7.6 6.8 14.3 7.0 6.2 13.7

Maine 7.4 7.4 13.2 6.8 6.7 '9.3 5.7 5.7 '6,7

Massachusetts 7.8 7,5 13.3 7,2 6.8 13.6 6.5 6,2 11.1

New Hamlin) 7.6 7.5 '9.3 6.8 6,7 '10.0 6.2 6.2 '7.7

Rhode Island 8.3 7.9 14.7 7.3 6.7 17.2 6.8 6.4 13.2

Vermont 7.8 71 '2.7 7,1 7.0 ,14.5 6.5 6.5 '12,5

Me Atlantic 8.6 7.4 15.5 b 2 6.9 14,4 7,7 6.4 13.4

New Jersey 8.4 7.1 15.0 81 6.7 14.6 7.6 62 13.6

New York 9.0 7,7 15,2 8.' 7.2 142 8.0 6.6 13.2

Pennsylvania 8.1 7.0 16,6 7.7 6.7 14.8 7.2 6.2 13.9

North Central

East North Central 7.8 6.9 14.5 7.5 6.4 13.9 7.0 5.9 13,4

Minois 8 2 6.8 14,4 8.0 6.4 14.2 7.6 5.9 13.8

!Ana 7.6 6.9 14,0 6.9 6.4 12,1 6.5 5.8 11.9

Michigan 7.9 6,9 14.6 7.8 6.5 14.4 7,4 6.1 13.7

Ohio 7.9 7.1 15.0 7.5 6.6 13.8 7.0 6.1 13.2

Wit0118i11 6,9 6,5 13.5 6.4 6.1 12.5 5.8 5.3 12.6

West North Central 6,9 6.4 13.1 6.6 6.1 13.3 6.1 5.6 13.2

Iowa 62 6.1 13.3 6.1 5.9 129 5.6 5.5 10.8

Karns 7,0 6.6 12.9 E8 6.3 12.7 6.5 5.9 13.4

Minnesota 6.3 6.2 9.7 6,1 5.9 12.5 5,4 5,2 12.0
*mull 1,9 6.6 14,7 7.5 6.4 13.5 7.1 5,9 13.7 *mks 6.8 6.5 12,8 6.6 6,3 12.8 5,8 5.5 11.9 Nat Dakota 6,4 6.4 7.0 5.7 5.7 10,1 5,2 5.0 11,8 South Dakota 6.3 6.1 7.4 6.0 5,9 '9.4 5.5 5.3 '8.7

South

South Nark 9,4 7.5 133 8,7 6.9 13,5 8.2 6.3 12,9 Delaware 9.0 7.3 15.7 8.3 6.4 15.5 7.9 6.2 13.8 District of Columbia 13,0 7,4 14,5 12.6 7.1 13.5 12.6 6,6 13.8 Florida 9.2 7.5 13.7 8,4 6.8 13,1 7,9 6.3 12.7 keg la 9.6 7.3 13.7 9,1 7.0 13,5 8.7 6.4 12.9 Ma* 92 7.5 15.1 8.1 6.5 13.4 7.9 5.9 13,2 North Cardin 9,4 7.7 13,3 8.9 7,0 13.9 8.3 6.3 12,9 South Cat* 9,7 7.6 12.7 9.1 6.8 12,9 9.0 6.3 13.0

8.9 7.4 13.4 8.3 6.8 13.6 7.5 6.1 12.4 West VI Oa 8,4 8,2 13.7 7,8 7.5 13.2 7.1 7,0 10.8 East Scut Centri 9.0 7.4 13.0 8.5 6.9 128 8.0 6.4 12.3 Alabama 9.0 7.1 12.4 8,7 6,7 12.7 8.2 6.2 11.9 Kentucky 8,3 7.7 14,2 7,8 7.2 13.4 7,2 6.6 12.6

9,7 6.8 12,3 9.3 6.6 12.4 9.1 6.3 12.3 Tennessee 9.1 7.5 14.9 8.3 6.9 13.6 ri, 6.5 12.9 West South Central 8.7 7,3 13,8 82 6,8 13.6 7 6.5 132 Arkansas 8,8 7.4 12.1 7,9 6.6 12.0 ¶ Win .) 6.4 12.7

10,1 7.1 14.6 9.3 6.7 13.6 d.9 6,3 12.8 Oklahoma 7.7 7.0 11,4 7.7 7.0 14,9 7.6 6.8 13,3 Texas 8.4 1.4 14.0 8.0 6.9 13.9 7.5 6.5 13.5

West

Mu* 8.8 8.5 11,1 7.9 7.7 14.3 7.1 6.9 13,3 ArIzona 7.8 7.4 9.9 7.0 6.8 11.9 6.4 6.2 11.7

Colorado 10.4 10.1 15.8 9,4 9.1 15.2 8.7 8.4 14.6 Idaho

WAN

7.2 72 10,0 6.5 6.5 '5.7 5.7 5.7 '6.9

10 8.0 8.5 7.5 7.5 14.9 6.7 6.5 '10.0

Nevada 9.5 8.9 13.0 9.1 8.1 16.8 1.5 6.7 13.8

03 New 141mdco 10.1 10.0 11.0 92 9.2 15.4 8.4 8.5 12.5

196
; TAKE 47, WitIMIghIng UN Grins ct Uri 11 AccordIrc b Color or ka, Nib% and Stir. UMW 11118, 111544

1176.72, Ind 117647 brig karIall (Cod)

116647 1170-72 117547

Al

OMsion and Slals Tatrl WMs Wm' TotiP Ole lid Tote Oh Black

Percent of Ii, births

Utah 7,1 7.0 10.6 6.4 6.3 10.8 5.4 5.4 15,1

W011 9.2 9.0 12.9 9.1 8.9 18.8 8.7 8.5 16.4

PadBC 7,4 6.7 11.3 6.6 6.0 12,3 6.1 5.4 11.5

Alaska 7,1 6,3 6,7 6.3 6.0 10,3 5,4 5,0 9,1

California 7,5 6.8 12.0 6.7 6.0 12,2 6.1 5.5 116

Hawaii 9.0 7.5 9.6 8.1 6.4 11.6 7.6 6.0 9.3

Oregon 6,3 6.1 10.8 5.9 5.7 14.0 5,4 5.3 11.6

Washington 6.8 6.5 10.9 6.4 6.1 12.6 5.6 5.3 9.8

Vats by Nrth *41 for tt'd black pop** not avalahle for these years. Overall, 91 percant of the births for the 3.year period in the"all ow" color category we

tisk to the MO* Atlantic, Ent Nat COW, South Malec, Ent Soath Central, and West Soutgentral OMiers, we 01095 percent of the lams in the "all ether"

mkt atop:cows back. Pamir, in rhea:10101nd Attic States malt of the births in the "ell other" odor category ore rat Neck. In recent perste proportion or

int* other than black who were Ickirilmvight Infants hes been similar to that or white infant' Theriot all other may not be ccoparabke to bleclonakin a trend

drain* infInnt

lack* el other races rVt shown es a separate cowry.

NOTE: Deli are Wed on the national vital *station system,

SOURCE National Center for Health %team Health United States, 1979. OND Pub. No. (PHS) 80-1232. Public Health Service. Washington. U.S. Government

Printing 015ce, 1$90.
TAU 41, MuMnls IN16h11 2,600 Ora or Les of Ildh, Awing b AIS, Rol and !Won el Mob and Tdmeir Prenabl

Can Wad ilk 1111.14 Palk

Aloe and Educion

Ilote, and DImseli

Prenil Cie hp

TotaP

Race

White

Back

ol Mohr

Al Apse

Psromt

NON ci WsIOhMup

Ms In 2A00 Or=

Thousands or last

3,327 7.1

2,691 5,9

544 12.8

Eduction'

8 years or less 126

9-12 years 1,697

13 years or more 741

Trio* prenatal

care begoi12

Fist 2,152

Second 592

Third and no care 583

9.6

7.8

5.3

6,3

8.2

8.7

Ur* 11 YIN1 1149 Yews

Rstant PEW

Nudsr d Walgikig Nwesr d Welpro

Ilrbt In 2,100 Own NW In 2,503 Oro

Thom* or La Thousands or Las

225 11.0 3,076 6.8

143 8.8 2,528 5,7

78 15.2 462 12.4

25 12.6

148 11,1

S

90

79

56

10.4

10.5

12.7

98 8.8

1,538 7,5

736 5.3

2,048

507

521

6.1

7.9

8.3

40 Years or More

Poet

Nur& ol Weighk1

Ibht In 2,600 Gram

Thousands Co

25 9.0

20 8.1

5 13.1

3 9,9

11 9.7

5 6.6

14

6

6

8.4

9.3

10.2

'MOAN OW rub not gal as a sprats category and 16,485 MN for *tech Nit weights wort not rebated.

tindudn 12,786 births to women who molds In States that did not quirt worth; of month vents) are top, but *NO occurred In Stites**, reporbove

rKe.01,1077,44States and the Mitt of Cobs& %tired rwating of month prenatal care began. States tat requiringwere Matt, Mans* Idaho, New MIXiCO,

ind

NOTE Dili art MEI co Ile noticoai viral rocisttabai systbm.

SOURCE Diviim of vital Mks, Nab* Center for Heel %Rift Selected dots. Special *data mod by Intonation Science, Research Institute, %it Spina, It., WOE

vA
NOVOON0001..N0 *Meh *14444541gliggigIM6 NOWOONOV0001-*I-V, rrrrrrrr
rigeopmtAsswg 610=IMIPPOPtM1 missniase:01Tu85. 00f0i0$0$$PP011 Oast Istanstss.8
1 sh;110611,04gti galiita §§§§§§§g§ 000000000 T4$4$$$T68 64.16.(0:16:A 14 in tggggggtg Lhb-4b6.4W4k4 91####0H6# -,4m-atni*)m-im §i 1 iTil IN "Ili Illi q 1141 1111 nig' I 14 I / lill ( I 1 le 60A-16 oig Nlill At git Ma h'g Mg, PA ig §§§§§ gg§ 00000 000 aMtt WS bNtoi;11 4:44k) Vitt(.1 Att I 0 00W4.4 WOW PPPP*4 clo...4o4 NN P mem .... ... 8888 888 0000 000 Best 4te WWii0.4 4340! :ittt ps8 Ww4o, (AL.... 1! ! 00OW MPYIP PNP 44 NW( M ...IMM iiii.4 ii
TAKE SI. Pereeisi Areestivarset of Nelda of Children and Youths Under 111

Teem ell Age, According to Selected Characteristics: United Stries, 11175 -711 Annual Average (Cont.)

Perceived Level of Neeith

Pepuestion let Fair or Characteristic Thousands Tots. Ezosi lent Good Poor

Region Northeast 14.700 100.0 60.9 35.4 3.7

North Central 17,545 100.0 60.7 35.5 3.7

South 21.644 100.0 55.0 39.5 5.4

Ws 11.833 100.0 63.7 32.0 4.3

'Includes children living with father or*y. and with unknown family income and sducatlon of heed. not shown an separate categories.

NOTE: Data ars based on household interviews of a sample of the civilian noninstitutionalized population.

SOURCE: Division of Health Interview Statistics. National Canter for Health Statistics: Data from

the Health Interview Survey.

2"2 189
TAKE IL MIN c4 AO, Amon Chit* old Yogi. Under 11 Yon ol Age, Acordroj ki Dip* ol Unilloico and licind

Ctondollei Mid NM 1117141 Annul Avv*

Dopy ol Mktg Mintz

Wed

MA In Mount Webb

Population Nd but not at IOW lo Carly

In Mind In In Itior of 114or on Nor

Thconds Tool Adhlts Actdy Aort Adm

Total Or 18 yowl, 65,722

As

Peron' *Mon

nu N.2 1.9 1.7 0.2

Ng 6 yews 19,217 100.0 97.6 0.0 2.0 0.4

6.11 yews 21,471 100.0 950 2.3 1.6 0.0

12-17 years 25,034 10.0 953 3.0 1.6 0.1

Nit 33,436 1010 NJ 2.1 1.9 02

*ale 32,286 1010 96.5 1.7 1.6 0.2

Race

VSt6 54,967 100,0 961 2.0 1.7 0.2 Bit 9,831 100.0 96.4 1.4 2.0 0.2

Other 924 1010 97J 1,1 1.0 0.1

Frt/ Name

Under woo 7,707 1010 94.8 2.1 2.8 0.3

$5,00049,999 13,04 1010 95.9 1.9 1.9 0.3

$10,000414 15,647 100,0 96.3 1.9 1,6 0.1

$15030 or more 23,776 1010 956 1.9 1.4 0.1

Ponta, Fromce

Both persnis present 52,732 100.0 96.5 1.9 1.5 0.2

Mother cosy prised 10,126 100,0 94,9 2.2 2.7 0.2

New poet present 2,204 100,0 ),0 2.0 2.5 0.5
itbstlon of 1674 NI

8 pro cc Ion 10,945 10110 950 1,8 1,9 0.3 9.11 pis 11,862 100.0 95.9 2,1 1.9 0.2 12 yen 23,053 1010 951 1.9 1.8 0,2 1$15 yin 8,946 100.0 952 2.0 1.6 0.2 11 yon c; we 10,578 100.0 97,0 1.7 1.3 0.1

Fmk El

3 pro' Or Ivor 11,.4.< 100.0 NA 2.1 2.3 0.2 4 pan 18,842 100.0 953 1,8 1,8 0.2 5 prow 15,228 100.0 953 1,9 11 02 I a oil proxis 20,059 %n 955 1.9 1.4 0.2

RsolOsra

MAI NA 47,907 100.0 ,952 1.8 1.8 0,2 lap MA 2632 100.0 952 1.8 1,9 0.2 Coo ado 17,203 100.0 96,0 1.8 2,1 0,2 Fetos coo* us 10ao 961 1.8 1.5 0.2 lido SW 15,198 100.0 951 11 1,9 0.2

Othsr ASA 6,519 100.0 961 1.9 1.4 0,2

Outollo SliSA 17,815 100.0 96.2 22 1,4 0.2

A4scont to $14A 11,795 100.0 962 2.1 1.5 02 Not klant to NSA 6,02O 105.0 962 2.2 1.3 02

RIO

Northost 14,700 100,0 95,9 2.1 1.9 02

Norm Cotral 17,545 1010 954 1.8 1.6 0.1

Souk 21,644 1010 96,5 1.6 1.6 0.3

W111 11,833 100.0 95,6 2.3 1,9 02

VicktectiOreht se Iseorak, artitir*nownIrtikcetrilskitecl hod, nottomisegestscatgale,

KITE Do antodon Nuestcldlrim4esclisinOecitachillinranhatioiblgotta.

SOIJEICi: Chislai of liNNI Mr* Stab, tittal Cawfor Net Stalks Dots frce to HO Intel* Sort
TABLE 53. Selected Chronic Conditions Causing U11116110011 of Activity Amc4g Children and Youths Under 17Years at Age, According toDegree of Limitation: United States, 1976 Degree of Activity Limitation limited in Limited, Amount or Unable to but Not inKind of Carry on Chronic Condition Total Limited Major Activity Major Activity Major Activity Total under 17years limited inactivity 2,266.695 1,087,587 1,058,928 Number of persons 120,180 Arthritis and Percent of population inlimitation category limited because of specified condition rheumatism *1.0 '1.3 *0.7 *1.7 Heart conditions 2.4 *3.0 *1.9 *1.4 Hypertension without heart involvement *0.3 *0.5 *0.2 *- Diabetes *1.0 *1.4 *0.7 *- Mental and nervous conditions 6.7 6.1 7.5 '5.7 Asthma 20.1 19.1 22.6 *7.1 Impairments of back or spine 3.2 5.4 *0.7 042 Impairments of lower extremities and hips 6.9 9.3 4.2 *9.0 Visual impairments 3.7 4.3 *1.7 *15.1 Heariag impairments 5.2 5.64.9 *3.2 NOTE: Data are based on household interviews ofasample of the civil a.1 noninstitutionalized population. SOURCE: National Center for Health Statistic= Health United States, 1978. DHEW Pub. No. (PHS) 78-1232. Public Health Service. Washington. U.S. Government Printing Office. Dec. 1978. 192
:10 co In* wv* q0141 a vi VWNu?r: alto aloOt Oqo mr.o. mom coN INN 6idd Or rojoi rrr rr r rrrr dloyy (0011 rrr dciN NWN VOW 11101(0. wain Reici OrOrr 411qt*Iqr vvva. n001010o , wow,* qt1RNA do, 00.000 loy cgRulmitt, rrr MNOM Nrc104 oloo VNONM0000 invio*Itto*.t* qcgroiqqc4I9 wolooloontv* it.01q01t0.99I r;El UR Rik §Elia WRIF101 NN gd icidd NKitod 41:d4 gtp.Olo$4:.:Kci rirr Zkg d °Ing siM iaf fR§H PRIMA Kdidd CiON dr:goid 1-r.1-cm r1 rr
TABLE 54. Disability Days Among Children and Youths Undw 18 Tamara of Age, According 10 Type of Disability Day and Selected Characteristics: United Males, 1975-78 Annual Average (Cont.)

Population

Population a-18

Type of Disability Day

In Years in Restricted School

Characteristic Thousands Thousands ActivIty Bed Loss'

Region Northeast 14,700 9,661 11.5 5.0 5.8

North Central 17,545 11,202 10.2 4.5 4.6

South 21,644 13,848 9.6 42 4.5

West 11,833 7,490 14.1 6.0 6.4

'School-loss days Mate cidy to children and youths 6-16 years of age. 2Incl-xise children 'sieving with father only, and with unknown family income szmd education of head. not shown as sepereste categories.

Dry are based on household interviews of a sample of the civilian noninstitutionalized pop.

SOURCE: Division of Health Interview Statistics. National Center for Health Statistics: Data from

*ow Health Interview Survey_

194
TABLE 55. *Idea of AO WWI Among Children and Youths Under 17 Years of Aga, According to CondMon, Sex, Usual Activity, and ki Man Untied SI*, 1970

All

8u, Usual Acthlty, Acute

and Family Callbone Total Upper Monza OW Iii n,

kin CondMon

RuPITaloo

Total under 117 years2

Sex and usual activity

Male

Waking or going to school

All other activities'

Female

Working or going to school

All other activities

Family income

Les than 55,000

55,00049,999

$10,000414,999

515,000 or more

Infective

and MOW

Parasitic System All

Mew Conditions Other

Acute conditions per 100 persons per year

307.8 169.8 98.2 61.1 10.4 37.0 45,4 15.1 40.5

304.8 159.1 91.2 57.5 10.4 44.5 47.4 15.4 38,4

268.8 140.1 73.7 2.8 7.7 43 5 40.6 17.4 27.2

381.6 199.8 128.7 54.8 16.2 46.6 61.8 11.1 62.3

310.9 180.9 105.5 64.9 10.5 29.2 43.4 14.7 42.7

283.2 169,1 91.2 67.9 10.0 26.4 36.0 15.8 35.8

370.4 2061 136.1 58.5 11.6 35.1 59.3 12.4 57,5

316.1 179,8 112.2 56,3

291.9 156,1 92.4 56,2

311.6 173.3 92.2 66,4

321.8 175.1 103.1 62.1

11,4 30.9 48.1 15.6 41.7

7.5 35.3 46.7 17,4 36.5

14,7 37,6 46.4 11.9 42.5

9.8 41,1 48,3 15.1 422

'Includes promoria, bronchitis, and other respiatayconditice not shownas separate categcnes.

14ties thilten with unknown familyincome and unknown usual activity, not shown as separate categories.

Includes persons keeping house(women only), persons with other activities not spedfidd (both sexes), and persons under 6 years of age for whom no activity Is specified.

NOTE: Data are based on household interviews of a sample of the civilian noninstitutionalized population,

SOURCE National Center for Health Statistics: Health United Slates, 1971 DHEW Pub, No. (PHS) 78 -1232. ; Printing Office, Dec. 1971 Public Health Service. Washington, U.S. Government
TABLE 586 Ranidng of Top 10 Consumer Products Associated With Mudge to Cid Mien and Youths Tnisted In Hosp. tail Emergency Rooms and Est imallsd Number of Such Product-Reisted injuries per 100,000 Children and Youths Under 15 Veers of Age, According to Age and Product Untied Mabee, 19710-00

Age

0-4 Years 5-14 Yews

Rank Product and Cods

Injuries per 100,000

Popadation

Injuries per 100,000 Product and Code Population

1 Tables all types (4001, 6, 7, 12, 31. 44, 46)

2 Stairs (inclucrmg folding), steps, ramps, and landings

(40. 42-43)

3 Chairs, sofas, and sofa beds (79, 80, 4017-4124, 4052-4053)

Bicycles and accessories 666.3 (02) 876.7

470.4

441.4

4 Beds (excluding water beds) (01. 61, 94) 392.6

5 Playground equipment (34, 42-44, 3219, 3246, 3273)

6 Bicycles and accessories

(02)

7 Desks, cabinets, shelves,

racks, and footlockers

(04, 30-31, 64, M. 92-93,

40218-4029)

318.0

Football, activity and

related ec;uipment (3227. 3244, 3269)

Baseball, activity and

related equipment 3228. 3240, 3270)

424.6

330.4

Playground equipment (34, 42-44, 3219. 3246, 3273) 287.1

Ice and roller skating

and Skating not specified

(excluding ice hockey)

(3216-3211c 3255)

Basketball, activity and

262.8 related equipment (3226. 3244 3267)

180.4

8 Nails, carpet tacks, screws. and thumb tacks (19) 112.0

9 Bathtub and nonglass shower structures (10, 11, 4030)

Stairs (including folding)

stem ramps, and landings

(40. 42-43)

267.7

237.9

215.3

Nails, carpet tacks, screws, and thumb tacks (19) 180.8

Glass doors, windows, and panels (23, 25-26, 36, 67, 107.7 69, 73, 75, 82-88, 0609) 103.6

10 Glass doors. windows, and panels

(23. 25-26, 36, 67 69, 73, 75, 82-83. 0609) 1032

Fences, nonelectric or unspecified (34. 51, 56) 101.7

NOTE: Data are based on reporting by a sample of hospital emergency rooms.

SOURCE: National Electronic Injury Surveillance System: NEISS Data Highlights, Vol. 4, No. 1. U.S. Consumer Product Safety Commission. Washington. Jan.Mar. 1980.

196
TAU IL kidiriFliss and 161631 Goys Wit MI Sclexi per Injury for 8bients M big K-12, Amordng b Oak

144 id Lotion el Ades Unbl Skint 1177-71 bed Year

Sal

ard Witt

Grade

DaYs Lot

roam bivalent Grades 1-3 Grades 44 Grades 14 Grades 10-12 pc Injwy

Bois Acddents per 100,000 student days DaYs

Al stod itriedictions 9.39 6.29 5.82 8.96

Slops and lets 0.64 0.00 0.00 0.06

Bulingieneral grounds 1.86 2.01 1.32 1.77

Unorganked sides 1.94 2.80 3.01 3.90

Other 0.37 0.30 0.38 0.40

education 2.92 0.47 0.81 2.33

BPolts

triers:al sports 0,12 0.00 0.00 0.05

Interscholastic sports 1.15 0.00 0.00 0.07

Special actides 0.05 0.04 0,03 0,07

Travel to school

Motor vehicle 0.18 0.37 0.11 0.11

Ncanotor vehicle 0.16 0.30 0.16 0.20

Gies

Al school jurisdictions Liu 4.01 4,16 6.04

Shop and labs 0.14 0.00 0.00 0.04

Suildiroiential grounds 1.23 0,99 0.89 1.08

Unorganized activities 1.19 1.97 2.24 2.33

Other 0.22 022 020 0.25

Physical education 2.14 0.34 0.64 2.08

BP*

Interval sports 0.04 0.00 0.00 0.02

Interscholastic sports 0.23 0.00 0,03 0.02

Special activities 0.05 0.09 0.03 0.06

Travel to school

Motor vehicle 0,16 0.22 0.09 0.07

Nortnotor vehicle 0.08 0.18 0.07 0.09

12.12 12.26 1.09

1.05 1.56 0.64

2.67 1.72 0.91

0.88 0.20 1.04

0.39 0.34 131

4.93 4.36 1.19

0,21 0,27 1.12

1.51 3.40 1.15

0.07 0,05 0.85

0,21 026 1.98

0.20 0,10 1.59

7.85 4.65 1.13

0.32 0,19 0.62

1.85 1.18 1.02

0.28 0.09 1.20

0.21 0.23 1.64

4.25 2.05 1.05

0.11 0.04 0.81

0.44 0.51 1.10

0.07 0.05 1,43

0,20 0.27 1.98

0.12 0.04 1.18

'Accidents re those causirogl) the loss d one if day or more of school Me, (2) the loss of onehalf day or we of activity during nonwhaol time, and /or (3) any

petty damage as a result ofa Owl jurisdictiana1 accident.

ITots1 ides amiest mt shag as a *prate category,

itOntrgarten rata afiitel one.half day,

NOTE Data am based on reporirg by ackols.

SOURCE Nalkoal Safety Council: Amidst Fact, 1979 Edit). Ckago, 1979.

2i

11
TABLE 5111. Selected 111111011able Mimes Roles per 100,000 Children and Youths Under 15 Yeses of Aare. According lo of Immunize lion

and Inseam thrilled Steles, 1900-7S Selected Veers

Availability of Inummizallon

and Meissen

Year

1900 1905 1970 1975 1976 1977 1978

Reported cases per 100.000 population Diseases with

inanunization available

Measles - -- --- 38.2 37.7 68.9 27.1

hturnP's ___ --- - -- --- 18.0 162

Rubella ..... - -- ...... 11.8 52 9.5 6.8

Pact ussis - -- '.. --- 3.6 3.1

Diphtheria 1.2 0.2 0.6 0.1 0.0 0.0 0.0

Poliomyelitis, total 4.2 0.1 0.1 0.0 0.0 0.0 0.0

Poliomyelitis. paralytic 3.4 0.1 0.1 0.0 0.0 0.0 0.0

Diseases with no

immunization available

Venereal diseases

Gonorrhea 8.7 7.6 13.0 23.2 22.6 23.4 23.5

Syphirm. Primary and secondary 0.3 0.5 0.4 0.5 0.4 0.3 0.3

Saknonehosis - ......... ___ 25.9 26.2

Shigelosis --- - -- - -- - -- 19.0 220

Hepatitis A 138.7 1222 26.3 14.9 120 10.5 10.9

Hepatitis B '38.7 1222 0.2 0.7 0.6 0.6 0.5

Tuberculosis 7.9 9.8 5.7 3.7 3.4 3.0 29

lln 1980 and 1965. data on hepatitis A and hepatitis B were not collected separately.

NOTES: Data are based on reporting by State health departments. The total resident population under 15 years of age was used to calculate all rates except that for primary and secondary syphilis

for which the civilian resident population was used.

SOURCES: Center for Disease Control: Reported morbidity and mortality in the United States Morbidity and Mortality Weekly Report (Annual Summary) 9(53). 1960: 14(53). 1965: 19(53). 1970: 24(54), 1975; 25(53). 1976: 26(53), 1977; 27(54), 1978. Tuberculosis data from the Tuberculosis Control Division, Bureau of State Services~ venereal disease data from the Venereal Disease Control Division. Bureau of State Services.

2

198
TABLE SI Mean Hmgegaglobki Levels of Children and Youths Under 18 Years of Age mad of Women 15-44 Years of Age and Hemoglobin at Seim: led Percennies, According to Age and Sex of Children and Youths: IMliud Sloles, 1971-74

Sex and Age

Mean Hemoglobin Level

Percentile

5th 101h 25th 50th 75th 90th 95th

Under 18 years Males Grams per deciliter at percentile shown

1 year 11.9 7.9 9.8 11.2 121 13.0 13.6 13.9

2 years 12.3 10.6 10.7 11.6 12.4 13.0 13.7 14.0

3 years 12.6 11.0 11.3 11.9 12.5 13.1 13.8 14.3 4-5 years 12.7 11.2 11.5 12.1 12.7 13.3 14.0 14.4

6-11 years 13.2 11.7 120 126 13_3 13.9 14.4 14.8

12-17 years 14.6 12.5 13.0 13.7 14.5 15.5 16.4 16.7

Females

1 year 12.0 9.5 10.5 11.4 12.1 12.6 13.3 13.7

2 years 12.4 10.7 11.0 11.6 12.5 13.1 13.5 14.2

3 years 12.4 10.8 112 11.8 12.4 13.1 13.9 14.0

4-5 years 12.8 112 11.5 12.0 12.7 13.5 14.0 14.6

6-11 years 13.2 11.6 11.9 12.5 13.1 13.8 14.2 14.8

12-17 years 13.6 12.0 12.3 12.9 13.6 14.3 14.9 15.4

Women 18-44 years 18-19 years 13.6 11.8 123 13.0 13.6 14.3 15.0 15.3

20-24 years 13.6 11_9 12.3 129 13.6 14.3 14.9 15.3

25-34 years 13.7 11.9 12.3 13.0 13.7 14.5 152 15.6

35-44 years 13.7 11.7 122 13.0 13.7 14.4 152 15.7

NOTE: Data are based on physical examinations of a sample of the civilian noninstituborsalized

population.

SOURCE: National Center for Health Statistics: Hemoglobin and selected iron-related finding of persons 1-74 years of age: United States. 1971-74. by C. L Johnson. Advance Data from Vital and Health Statistics. No. 46. DHEIN Pub. No. (PHS) 79-1250. Public Health Service. Hyattsville. Md.. Jan. 1979.

2 2

199

TABLE It Dayed, Ikelvedoni Carlow, and FlIti Mewl NM bong MT 14 Veers of Age, Aoxeing to Rea and Ser

UMW Mk, 1971-14

AI lims, Meck

ke loth A

Noir al Tod Saes Male Fri kw Me Foie Sae Male Folio

Domed, nonfunctional Average nurnbe at age 5

cake, and Med teeth 2.2 2.2 2,1 2,1 2.2 2.1 2.3 2.0 2.5

Number of decard,

moiffictialt cancut

and MaC teeth

0

12

3 a we

Percent distribution of children ages 1-5

100.0 100.0 100.0 100.0 100.0

75.7 74.5 76.9 75.8 74.8

6.0 6.3 5.6 6.1 6.3

5.6 5.8 5.4 5.8 6.1

12,7 13.4 121 12.3 12.8

100.0 100.0 100.0 100.0

17.0 75.7 74,4 11.0

6.0 4.5 6.0 3.0

5.6 4.3 3.7 4.8

11.4 15.5 15.9 15.2

%%Woo* no not shown as a mots category,

NOM Dili are bold on dental ausinations of a sample of the cAfiliet nolindutimalized poodattit Fled teeth include oily Me with satisfactory Mit%

Diu* tot hide not co* teeth with al* but also SW tit with *cos loin or defective Ski Nonfunctional carious *NIare tliceekbticil cannot be saved baud Oink *a

SOURCE Mal Center for NtiNi Statists: Decayed, mitairc and Mad teeth among peons 144 yea United Stated, 197144, by J. Kelly and C. Hervey. Vital and

Health Stab Sties 11.1n prat
14 TARE 12 kept Misoing, aid FINS Tee bog Chlkhn awlouthe 147 Yore cd Ape, Accord4 to Ram Su, and Age:

UMW OA 1171.14

Ap raises

of NM

Teeth decayed,

mist" or fled

Robe( of decayed teeth

0 69,7 68,4 69.1 70,8 70.1 71.5 58.4 60.8 56.0

1 11.9 10.5 13.4 11.6 10.9 12.5 13.3 8.4 18.2

2 9.7 11.5 7.8 8.8 102 7.2 14.4 17.1 11.6

3 a we 91 9.6 9.7 8.8 8.8 8.8 13.9 13.7 14.2

Newts of missing teeth

0 91.6 90.7 92.5 92.5 91.6 93.4 87.1 86.5 87.6

1 5.6 5.7 5.4 5.2 5.6 4.7 7.4 5.3 9.5

2 or more 28 3.6 2.1 2.3 2,8 1.9 5.5 8.2 2.9

Number of fled teeth

0 69.3 73.1 65.2 66.5 70.2 62.5 84.5 89.4 79.6

1 8.7 7.7 9.7 9.7 8.6 10.9 3.6 2.9 4.3

2 7.3 6.4 8.2 7.9 72 8.6 3.5 2.4 4.5

3 Cf more 14,7 12.8 16.9 15.9 14.0 18.0 8.4 5,3 11,6

Rae Sack

Bole 1c4k 60 h

Sexes Me Female Sexes Mole Fen* Sues Male Foie

Average number at age 11

2.7 2.5 3.0 2.7 2.6 2.9 2.8 2.4 3.1

Percent distribution of children ages 6-11

Teeth decayed,

*sing, or aped

Average number at age 17

8.7 8.1 9.4 8.8 8.2 9.6 7.7 7.3 8.2

Number of decayed teeth Percent distribution of children ages 12-17

0 46.0 47.5 44.4 49.4 50.4 48,4 24.9 28.3 21.5

1 162 15.8 16.6 16.5 16.0 17.0 13.4 13.0 13.7

2 10,0 10.4 9.7 9.5 10.4 8.6 12.9 10.7 15.2

14.9 13.9 16.0 13,8 12,8 14.8 222 21.5 23.0

5 or more 12.9 12.4 13.3 10.8 10.4 112 26,5 26.5 26.6

n. 4 I.
Wetly cf risil teeth

0 742 78.0 70.3 78.0 81 0 74.9

1 9.4 8.2 10.8 8.2 7,4 8.9

2 , 8.5 7.6 9.3 7.5 6.4 8.6

3 Or more 7.9 62 9.6 6.3 52 7.6

Number of Med tub

0 32.3 34,0 30.6 26.5 28.5 24.4

1 6,7 6.1 7.3 6.8 6.4 7.1

2 8.4 82 8.6 8.9 82 9.6 3.4 19.2 21.0 17.2 20.8 23.2 18.3

5-9 24.4 22.9 25.9 26.7 25.2 28.5

10 or more 9.0 7.8 10.4 10,3 8.5 12.1

53.0 61.4 44.6

15.9 112 20.5

14.1 14.8 13.4

17.0 12.6 21.5

69.8 702 69,3

5.8 4.6 7.1

5.4 92 1.6

7.7 4,8 10.6

9.7 9,5 9,7

1.6 1.7 1,7

leatise *emend alteamp* Wept/.

NOIEt Ditenbodtedrititeriratoscf a so* c4 the Odlerairstittimalized totabcd. Red teeinclude only teeth vitt satisfactory filinp. tit irda act gift** Decayed cites tuteleolled teeth vath *co Minct defecthCilito. NOV* imitate 1* trisirg and nontational teeth.

SOURCE: %Dont Crier WO Nth: Decayed, mixings and Ned ter among persons 1-74

Mid Hoe Stsligict Series 11. In yrst Unitedatet 1971-74, by J. Kelly and C. Harvey. Vital pws.
TAME el. NIsed. Avalliablilly, and Use of Special School Pissources for Children 6-12 Yaws of Age WW2 Specific Handicap., According lo Type ot ilandicasx United Sla1.s. 1913-65 Ogee 6-11) and 1971

(Agin 6-12)

Type of Handicap

Childless

for Whom

fleameroe Was

Racoamovended

1963-16 1971

Availability and Use of Reemerces

Resource.

Available

and Used

Resources

Available, Resources

Not Med Not Available

1963 -15 1976 1913-45 1971 1963-65 1971

Percent of

children

Percent of

thOSO recommended

Slow learners 13 13 29 60 14 13 57 27

Speech impearmenta 6 6 47 75 19 13 33 12

Emotionally clielturbsd 3 4 22 26 23 26 55 48

Mentally retarded 1 2 65 78 16 10 19 12

Hearing handicaps 1 1 34 53 14 21 52 26

Moult hometown 1 1 35 52 14 50 48

Orthopedic handicaps 0 1 44 35 23 15 33 50

Toted identified as

needling one or more

special resources 21.4 20.6 .0 0-8 NOTE: Data WO based on teachers' amassment* of a sample of the civilian noninstitastionalized

population.

SOURCES: National Center for Health Statiaticir Data from the National Health Survey. Series 11. No. 113. DHEW Pub. No. (1-1SM) 72-1040. Health Services and Manta= Health Administration. Hyattsville. tad. U.S. Government Printing Office. Feb. 1972: The 1976 Nsaionall Survey of Children. special tabulations prepared by Child Trends. Inc.. Washington. D.C.

2

204
TAU M. Cam led Yoh 547 Yon ol Age We Nedisphig

Um* b b Med SIN SI* In Medal WIN sod kW* and Nate Watt bad Wing b Needkelig Conlon, lob Dhi and skel, eit Untied 111748 kb* Yes

Ibliont Dm*

eed Bale

Linked States

in need

Served

Potelially urns*

AN

Wks

Nrodkeing Cordial

Speech Eldon* Ned*

N ohl Diluted ROAM 01*

Number in daunts

6,0E0 1,513 1,764 1,013 1,168 607

3,766 967 1,224 a.,. 943 346

2293 547 540 725 225 261

Number potentially imserivd

Northeast 549,523 182,484 122,551 126,074 81,187 37,239 New England 4918 21,219 37,E00 16,931 11,772 5,400 Connectkut 27,023 -972 10,289 5,318 6,483 5,905 e 9,310 1,444 3,382 2,382 577 1,527 lAassachusetb 25 N : 15,850 12,707 740 -238 -3,452 New Hampshire 13,219 2,646 5,460 3204 1,650 Rhode Island 261 11,4E8 1,640 3,826 3,098 Vront 2100 206 6,289 612 1,936 2,189

Middle Atlantic 600 953

456,611 161,265 84,951 109,143 69,415 New Just/ 31,84

57,314 12,210 -6,124 21,454 18,133 11,642 New York 259,337 95,506 74,974 44,462 42,03 1,7E2 PenrisOvania 139,903 53,549 16,101 43,227 8,649 18,435

Not Centel 660,209 173,339 124,643 207,881 49,674 104,682 East North Central 480,824 142,196 90,902 142,673 31,766 73,291 Illinois 79,798 17,666 18,632 21,909 11,181 10,412 Indira 69,801 31,525 983 24,276 1,654 11,364 Mickel 120,112 35,631 16,64 30,372 18,560 18,882

N

Ohio 133,148 40,282 28,692 49,127 -8227 23,274 0

0 Wisconsin 77,965 17,092 25,927 161 8,598 9,359

213
1 TABLE 14 Chile* aid Ms 5-11 Years d Age WMh Ho limping Conditions, Served In Educational FM* and Po IWO

Uwe* in the UMW Stake and Number Po Wally Unload According lo Handicapping Condition, kW, Division,

and bit UMW Stabs, 1977-78 School Yaw (Cod)

Dhisicm, All Learning

aid Ws Conditions Mild

West Ned Central 119,381 31,143

Iowa 30,515 1,760

Kansas 26,197 6,684

Minnesota 43,753 2,420

Missouri 41,060 10,701

Nebraska 16,357 3,675

North Dakota 9,956 2,340

South Dakota 10,943 3,563

South

South Mantic

Delaware

District of Columbia

Florida

GeorgM

kirliand

North Carolina

South Carolina

Virginia

West Virginia

East South Central

Alabama

Kentucky

Mississippi

Tennessee

West South Central

Arkansas

635,233 122,451

338,924 83,333

2,867 -779

11,918 3,966

84,334 14,789

58,710 18,061

33,685 -2,049

55,614 17,910

1Z857 9,093

59,192 16,468

19,087 5,868

143,196 42,262

45,456 18,139

37,611 15,473

40,467 14,143

19,662 -6,093

153,113 -3,144

24,779 7,236

Handicapping Codlion

Spich Emoticalk MonWly

impoimd MAW Rotor* Other

33,741 65,208 17X8 31,391

7,348 11,710 3,069 6,629

4,605 8,290 2,774 4,446

11,476 15,871 6,774 7,213

4,463 17,209 1,692 6,997

2,796 6,046 559 3,283

1,748 2,950 1,489 1,430

1,305 3,132 1,551 1,393

165,299 262,506 -12,219 97,201

88,792 118,171 -9,553 58,185

2,120 2 -21 946

3,184 2,280 1,687 802

22,965 25 ;1; 6,361 14,612

20,309 14,063 -2,648 8,919

4,654 16,050 1,943 7,087

20,483 22,744 -15,245 9,782

53 9,727 -111160 5,144

9,491 20,109 5,705 8,020

4,933 1,588 -2,175 2,873

40,112 59,527 -22,163 23,998

15,611 15,843 -111727 6,990

6,094 14,691 -4,554 5,906

10,492 12,067 -2,404 6,169

7,975 16,926 .4,078 4,933

36,335 84,808 20,007 15,018

8,508 9,606 -5,081 4,510

Ni

ri

Ni A.
Wins 31,286 16,118 4,841 14,677 -1,675 6,007 OWN 23,076 543 4,786 11,745 881 5,122 Teo 73,972 47,041 26,882 48,780 25,972 -621

West 448,282 88,402 127,740 123,430 106,657 22,065

Mountain 101,524 -2,442 40,288 26,097 21,037 16,553 Arizona 23,296 -2,358 9,804 6,951 4,564 4,336 Cando 28,070 681 9 ; ;,.. 7,306 5,726 4,492

Idaho 6,984 419 1,812 3,472 1,028 234

Montana 11,876 1,786 3,197 3,304 2,112 1,479

Needs 6,661 311 1,150 2,564 1,717 920

New Mexico 20,114 1,647 8,276 4,817 2,831 2,545

Utah 1,512 -41242 5,025 4,581 1,941 2,369

WyomIng 3,031 -686 1,158 1,264 1,118 118 Ps* 346,758 70,844 87,452 91,333 85,620 5,512

Alaska 2,502 -1,049 1,813 1,720 1,052 -1,035 Cada 254,744 59,031 56,174 72,919 70,346 -3,724 NW 13,955 552 5,267 3,947 2,306 1,883 Oregon 25,965 1 ;,A 71594 8,272 4,930 3,287

Wu NnOtco 49,592 10,427 16,604 10,475 6 At 5,101

NOTE Wife tad on cetirnikl Wets of those in need end child oounts and Annual Program No admitted by States.

SOURCE Dm of Elation for the Nendlospod: Progress Towada Free andAppropia0 Education: A Repot to the Congress on the Progress of Pi. 94-142, Edit*, fa Ai Hmdlcaged CS Act MY ht. No. (OE) 7945003. U.S. Offlce of Rob. Washington, U.S. Government Printing Office, Jan. 1979.

2
TAOISM $6. Arline lad Nations' Anent Raise 'per 100,000 Youths 11-17 Years of *fie. According 1 Type of Grieve: Welled titedas, 1064-77 Itiolerd Crimea

Violent Citrons Property Crimes

Aggro- Motor

voted Larceny- Vehicle

Year Murder Rape Assault Robbery eurglary Theft Theft

Arrests per 100,000 youths 11-17 years of age

1964 3 10 65 59 506 1,011 357

1965 3 13 71 75 532 1.089 360

1966 4 11 85 76 529 1,094 357

1967 4 12 90 93 599 1,136 369

1968 5 13 85 112 652 1,149 379

1969 6 14 90 126 650 1.265 367

1970 7 15 96 136 664 1,381 338

1971 7 16 110 149 698 1.472 319

1972 7 17 118 152 677 1,412 290

1973 7 18 118 155 744 1,347 307

1974 8 19 138 189 940 1.829 320

1975 6 16 142 179 926 1,668 267

1976 6 16 134 155 852 1,603 245

1977 6 16 136 150 867 1,580 275

frequency 'Rates- calculated arrest by x acliusbnent factor.

population ages 11-17

The adiustment factor was applied to compensate for jurisdictions not included in the Uniform Crime Reports.

NOTE: Data were Weed on mexicana by jurisdictions and updates of decennial census.

SOURCE: U.S. Department of Jumbos. Law Enforcement Assistance Administration: Reports the

National Juvenile Justice Amassment Centers. A National Assessment of Serious Juvenile Crime and the Juvenile Justice System: The Need for a Rational Response. Vol. IL Washington. U.S. Governmerr. Printing Office. Apr- 1960.

208
N, ANUNi d hairdo:ft Lambs ol Dnlba, According lo Rice, DMion, and Nit UMW Mita, 1972

Rom for

Mal*

AM RI* NNW Found Tohl

Otile* and I 6xamlr sd Total Acapbbb DbquillOsd Only

Al races

UMW States 46012 100.0

Nord** 108,532 100.0

Nee Engird 26,035 100.0

Connecticut 6,821 103,0

Milne 2531 100.0

Masucleaetts 12,260 100.0

New Hoxeldre 1,447 100k

Rhode lit 2,093 100.0

Vormnt 877 100.0

Middle Mantic 82,491 100.0

New Jersey 15,132 100.0

New York 39,543 100,0

PertirAvaria 21,822 100.0

North Central 121,949 100.0

East North Central 88,793 103.0

Illinois 23,153 100.0

Indiana 11,823 100.0

Michigan 21,014 100.0

Ohio 22,E36 100.0

Vile:crein 10,162 100.0

West North Central 39,156 103.0

Iowa 1,349 100.0

Kansas 4,821 100.0

*nook 9,676 100.2

Misouri

Nebraska

9,817 100.0

4,110 100.0

North Dakota 1,477 100.0

South Dakota 1,906 100.0

48.1

50.1

50.7

53,3

49.6

45.2

57.3

52,5

48,1

49.1

432

54,5

60.3

58.7

60,2

59.9

58.1

57,7

56.3

63.9

62.6

64.3

64.8

63.8

14.2

58.6

59.2

Percent *tau*

47,0 35.8

51.3 43.6

49.3

49,3

46.7

50.4

54.8

42,7

47,5

51.9

50,9

so

45,5

39.7

41.3

39.8

40.1

41.3

42.3

43.1

36,1

31.4

36.7

35.2

362

30,8

41.4

418

43,5

44.3

39,3

44.8

48.1

34.6

42.4

43.6

42.5

47.2

39,0

33,5

34.1

32.1

32.4

35,3

34.8

37.1

322

32.9

32.1

321

31.7

27.2

37.9

37.2

and Nimbly AdmInktri

Wolk DboiMsd live

Dhquallbd Only Reasons

32

2.4

1.8

2.3

2,0

1.6

2.3

0.9

2.2

2.6

2.0

3.3

2.0

1.8

2.1

1.7

1.9

2.2

2.6

1,7

1.1

1.2

0.8

0,8

1.1

0.7

1.4

1.1

6,7

4,3

2.5

2.1

2.9

2.4

2.0

5.1

2.1

4.8

5.8

53

3.1

3.4

4,1

4,8

4.6

3.2

4.2

32

1.8

2.1

1.7

1.1

22

1.8

2.1

1.6

1.3

1,0

1.5

0.6

2.5

1.6

2.4

2.1

0.8

0.9

0.6

1.0

0.8

1.0

1.0

1.2

1.2

0.6

0.7

1.7

1.0

1.2

1.5

1.2

0.6

1.1

0.9
TAILI IS. aseuNs ol Pro Intudbn Exininid d MAK According b Rom Region, DM* and Slit UM btu, 1072

o (C010

Fact Reglok Nig

DM* and Wird

Amon for Disqus Dilution

IMMO

Ihdlcily and liontily Adffilnists.

Found Total DOM

TOO Acceptable Disquillloi Only Disqualki Only Woo

South 152,0 IMO 48.8 51.2 31.8 5.5 12.8 1.1

South Ale* 75,453 100.0 49.8 50.2 31.0 4.8 13.1 1.3

Dies 1,029 100.0 54.1 45.9 15.3 3.1 6,5 1.0

Diatict of Columbia 1,233 100.0 41.6 58.4 362 7,9 12.5 1.8

Florida 15,877 100.0 41.5 52.5 39.9 3.3 8.0 1.3

Georgia 12,262 100.0 47.7 52.3 26.1 5.0 19.8 1,4

**Kt UN 160.0 49.2 50.8 41.2 2.5 4.8 2.3

Not Carolina 13,631 100.0 55.4 44,6 22.8 5.2 15.2 1,4

South Croke 6,632 1004 16 60.4 26.4 8.3 25.5 0,2

Virginia 11,134 100.0 58.0 42.0 24.4 4.5 11.5 1.6

We Virginia 4,887 100.0 44,9 55.1 37.1 7.9 9,4 0.1

Eat South Central 32,734 100.0 44,7 55.3 30.0 8.2 16.2 0.9

Attu 7,835 1004 42.5 51.5 27.6 10.3 18.3 1.3

Kentucky 8,7643 1004 45.9 54.1 35.8 7.5 10.0 0.8

6,221 103.0 41.1 58.9 23.1 8.6 26.6 0.6

Tennessee 9,910 100.0 47.8 522 31,0 6.8 13.5 0.9

%tit South Central 44,482 100.0 50.1 49.9 34,4 4.9 9.7 0.9

Arta sass 4,378 1004 49.4 50.6 32.8 5.6 10.8 14

Latina 7,251 100.0 42.0 58.0 33.5 6.5 17.2 0.8

Oklahoma 6,509 100.0 54.6 45,4 34.9 3,5 6.3 0.7

Tens 26,344 look 51.3 48.7 34.9 4.6 8.3 0.9

West 75,462 100.0 55.2 44.8 36.5 2 0 3.8 2.5

Moulain 22,221 100,0 517 46.3 38.5 2.1 3.1 2.0

Arizona 5,199 100.0 46.8 532 43.2 3.4 4.4 2.2

Colorado 5,616 160.0 54.6 45.4 39,4 1.5 3.0 1.5

Idaho 2,060 1004 52.7 47.3 41.3 1.3 23 2,4

Montana 1,874 11:0.0 66.8 34.2 29.4 0.8 1.2 2.8

Nevada 1,160 loao 50.1 49.9 39.5 2.9 4.1 3.4

2'21
Inisv Ndir eg DO use 2,908 100.0 55.1 44,9 39.1 1.2 2.9 1,7

813 100.0 59.7 40.3 35.9 0.6 1.8 2.0

53,241 103.0 55.8 44.2 35,5 2.0 4.0 2.7

101 1010 48.4 516 41.1 6.0 18 2.7

37,715 100,0 54,8 452 36.2 1.9 44 2.7

1,776 100.0 50.3 49,7 33.2 4.1 10.6 1.8

5,000 100.0 13,8 362 291 0.7 2.0 4.3

8,049 100.0 57.3 42.7 36.7 2.2 1.8 2.0

Whits

Wild Slats 4151., 1 1010 54.8 452 37.9 2.2 3.8 1.3 *Most 100,905 1010 49,4 50.6 44.7 1.9 3.0 1.0

N0 England 25249 ICAO 51.0 49.0 43.6 1.6 2.3 1.5

Coticut 8,449 1010 52.0 48.0 44.2 1.6 1.7 0.5 Illr4 ZOO ICAO 53.3 46.7 39.2 2.1 2.9 2.5 klauctotts 11,94 100.0 49.5 50.5 45,3 1.5 2.1 1.6 No No** 1,435 ICAO 45.1 54.9 48.2 2,3 2.0 2.4

Photo Wild 2,057 1010 57.4 42.6 35.0 0.8 4.8 2.0 Vault 875 1010 52.6 47.4 42.3 2.2 2.1 0.8

Middle Atli* 75 1010 48.8 51.2 45.1 2.0 3.3 0.8

No Jersey 13,194 100,0 49.9 50.1 44.6 1.4 3.6 0.5

New York 35,790 1010 43.9 511 49.3 2.4 3.5 0.9 PritilOil 26,102 1010 55.0 45.0 39.7 1.7 2.8 0.8

North Central 120,112 1010 61.2 38.8 34.4 1.3 2.2 0.9

East North Until 82,275 1010 59.8 40.2 35.2 1.5 2.6 0.9

Illktis 21,031 1010 61.7 38.3 33.4 1.2 2.6 1,1

Cana 11,088 1010 60.6 39.4 33.0 1.7 3.5 1.2

Ikhlgan 19,353 100,0 59.9 40.1 362 1.3 2.0 0.6

Ohio 20,.( 1010 581 412 35,7 1.9 3.0 0.6

liestroin 9,910 1010 57.2 42.8 37,5 1,4 2.3 1.6

West North Central 37,837 1010 64.2 35.8 32.4 0.9 1.5 1.0

Iowa 7,266 1010 18 37.2 33.1 1.1 1.9 1.1 Kiwi 4,650 100.0 0.8 362 33.0 0.6 1.3 1.3 NNW 9,596 ICAO 64,9 35.1 32.1 0.8 1,0 1.2

Illottel 8, 100.0 64.5 35.5 32.2 1.2 1.5 0.6

la

Utak 4,017 ICAO 69.5 30.5 27.4 0.6 1,4 1.1

North Dakota 1,412 100.0 58,6 41.4 37.9 1,4 2.1

South Dakota 1,897 ICAO 59.3 40,7 37,1 1.1 1.6 0.9

224
Tai of holnducdon Bornholm ol Dransw, Aocordkp lo Rao, RION Dh lolon, and 841r. Nod go* 1972

(Col*

Noon lor Dbquallncatlon

Myhlly

Modloolly and lly Ade**

Rploni *Or Found Uhl DION Mdcoly Dboolliod bw

Dl ton, uad Ii bald Tool Accoplablo *Mod Only MOM Onty Mon

Scot 122,103 100,0 52,5 47,5 36.5 3.6 6.3 1.1

Sote Antic $3,034 103.0 54.0 46.0 35.8 2.9, 5.9 1.4

Woo 858 1010 54,1 45.9 39.0 2.3 3.6 1.0

Diobiot ci Columbia Si 1010 34.1 65.9 $3.3 1.9 3.7

Flo* 13,422 1010 49.3 50.1 444 2.0 3.4 1.3

Go* 8,872 1010 54,4 45,6 32.6 2.9 8.5 1.6

11141114 7,336 1010 491 50,3 44.5 1.5 2.3 2.0

North Carolina 10,18e loao 622 31.8 26,3 2.1 1.3 1.5

South Carolina 4,108 1010 49.6 50.4 37.0 4.0 9.2 0.2

kirk 8,831 1010 62.1 37.9 21.9 2.8 5.4 1.8

VAd VIrglria 4,668 100,0 45,4 54.6 37.5 7.4 9.1 0.6

Ent South Conti 25,465 100.0 49,3 501 35.2 5.6 8.9 1.0

Nen 5,434 100.0 49.9 50.1 36.1 5.0 7.5 1.5

Korgoly 8,199 1010 48.5 53.5 36.4 7.0 9.3 0.8

3,476 1010 52.9 47.1 35.1 4.8 6,6 0.6

Tomo 81353 100.0 50.1 49.9 33.7 5.0 10.3 0.9

West South Control 38,034 1010 52.5 47.5 38.0 3.3 5.3 0.9

3,461 100.0 51,8 48,2 39.0 3.5 42 1.5

Win 5,014 1010 46.7 53.3 42.8 3.6 10 0.9

Mho 6,052 1010 514 44.6 314 2.8 4,8 0.6

Tau 23,481 1010 53.1 47.0 37.2 3.4 5.4 0.9

%it 72,740 ioao 55.6 44.4 36,9 1.8 3,3 2,4

Mom* 21,771 100,0 519 48.1 38.9 1.9 3.4 1,9

Arizona 5,045 1010 47,0 53.0 43.8 3.2 3.9 2.1

Colorado 5,478 100.0 54,7 45,3 39,7 1.3 2.8 1.5

Idaho 2,05 1010 52.1 47.3 41.5 12 2.3 2.3

Whoa 1,872 1010 65.8 342 29.5 0.8 1.1 28

0 225
Nevada

New Moico

Utah

VOir0

Pict

Caul

*al

Witinc Itta

Sick

Ned Stets

textheed

New Wind

Cortockut

kik

kikolastis

No Hirohito)

Rhode Mod

Verret

klidle Aldo

Now Joey

New York

Permit,*

North Central

Est North Central

Inca

lofts

ONo

Moo

Woo*

Wet North Central

bwa

Kok

IWO

Mend

Nebula

421h Mote

Sod Dakota

1,00 1004 51.5 48,5 40.9 2.3 2,2 3,1

2,318 100,0 55,6 444 31,7 3.5 8,3 0.9

2,977 100.0 55,3 44.7 39.1 1.1 2.8 1,7

873 1034 599 40.1 35.7 0.6 1.7 2.1

50,969 100.0 56.3 43.7 36.1 1.7 3,3 2.6

SO 14.0 44.4 53,6 41.3 5.9 3.6 2.8

35,841 14.0 55.5 44.5 36.9 1,6 3,4 2,6

1,771 100.0 50.3 49.7 33.3 4.0 10,6 1.8

4,941 103.0 64.0 36.0 29.2 0.7 1.8 4.3

7,926 1004 57.6 42.4 30,9 1.9 1.7 1.9

48,722 14.0 37.5 62.5 174 11.8 31,7 1.4

7,597 103.0 40.4 59.6 27.0 9.8 21,3 1.5

786 1010 41.3 58.7 35.4 9.1 12,2 *A

372 1010 28.8 71,2 45,6 14.0 103 1,1 7 1010 57.1 42.9 28.6 14,3

357 100.0 52.4 41.6 262 6.2 13.5 1.7

12 100.0 58.3 41.7 33,4 8.3

36 100.0 55.6 44.4 16.6 2.8 42 2.8 2 1000 100.0 1004

6,811 14.0 40.2 594 26.2 9.8 22.3 1.5

1,48 1010 41.3 58.7 20.1 8.2 29.3 1,1

3,153 103 36,5 13.5 282 11.6 222 1.5

1,720 1010 47.6 52.4 26.5 7.2 17.1 1.6

7,837 100.0 46.2 53.8 22.8 8.7 20.4 1.9

6,518 100.0 44.6 55.4 22.4 9.0 22.2 1.8

2,121 1001 45.0 55.0 19.9 6.3 26.4 2.4

135 100.0 502 49.8 20.6 5.7 212 2.3

1,41 1010 45.0 55.0 24.6 11.6 18.3 0.5

1,143 100.0 44.5 55.5 24.1 10,8 18.8 1.8

252 100.0 23.8 76.2 20.7 11.5 39.6 4.4

1,319 100.0 54.1 45.9 252 7,1 11.3 2.3

83 1010 41.0 59.0 22.9 10.8 18.1 7.2

171 100,0 50.9 49.1 22.2 7.0 15.8 4.1

80 100.0 52.5 47.5 4.0 7.5 7.5 25

878 1010 562 43.8 25.6 7.1 9.8 1.3

93 100.0 54.8 452 19.3 5.4 16.2 4.3 5 1010 03.0 40.0 40.0 9 1010 33.3 661 66.7

226
tfle TAU 11, hub Pt."' don fandmion ol Ors* Wig lo Ram, Neg4m, 0htion, and 11i UMW MO 972

Noon tar Disquallkdon

Modally and MAW Adrrinlein.

REA As NON Found Tahl Dlaquallid ModlcsHy Dlamifikd dw

MOS% and Mali IMMO Tali WO Dliquilkd Orel DhquIMd Ont %Ion

Scut 3563 1010 34.0 66.0 13.3 134 38.3 1.0

South Manic 16,849 100.0 35.0 64.6 14,1 11.4 37,9 1.2

Dino 171 1010 54.4 45.6 119 7.0 21.1 0.6

Diet cd Cants 910 103.0 44.3 55.7 21.1 10.0 15.6 2.4

2,455 1010 37.6 62.4 17.8 10.5 32.8 1.3

Nola 3,390 100.0 30,1 69.9 9.6 10.4 49.3 0.6

Hartland 1,432 1010 46.7 53.3 24.0 7,4 17.8 4.1

Nat Cook 3,445 100.0 35,3 64.7 12.4 12.6 38.6 1.1

Sett Celina 2,524 100.0 213 76.7 9.4 152 52.0 0.1

V*4 2,333 1010 42.3 57.7 10.9 10.9 34.9 1.0

Wilt W101 219 100.0 34.2 65.8 28.4 18.3 16.4 2.7

Est Scut Central 7,269 look 28.8 71.2 11.4 17.1 42.0 0.7

Attu 2,401 1010 25,7 74.3 8.6 22.4 42.5 0.8

Kentucky 569 100.0 36.7 69,3 26.2 14,1 21.8 1.2

1111101 2,745 1010 28,2 73,8 7.0 13.5 51.9 0.5

Tom 1,554 1010 35.6 64.4 16.7 16,5 30.4 0.8

Mot South Central 6,448 100.0 36.1 49 13.4 14.1 35.6 0.8

Aaneaa 917 100,0 40.1 59.9 10.1 13.6 35.4 0.8

Louli 2,217 1010 31.3 e8.7 12,4 13.3 42.3 0.7

Okahona 457 1010 43.8 56.2 14.9 12,7 273 1.3

Tam 2,857 1010 37.2 62.8 15.0 15.1 31.8 0.9

Mat 2,722 1010 43.6 56.4 25,0 8.3 19.2 3.9

Mom* 450 100.0 43,1 56,9 23.3 9.8 18,9 4.9

At= 154 look 422 57.8 20,8 11.7 162 7.1

Colorado 138 100.0 50.0 50.0 28.1 9.4 12,3 22

Idaho 5 100.0 e0.0 40.0 20.0 20.0

2:'7
2 100,0 50,0 504 . .

50.0 -

77 1090 291 701 44 11,7 299 6.5

43 1034 512 48,8 20.9 .

25,6 2.3

21 1010 33,3 617 28.6 14.3 19.0 4,8

10 1010 40.0 604 500 .

10.0 -

2,212 1090 43.7 513 25.3 8.0 19.3 3.1

11 1010 45,5 54,5 36.3 9.1 9,1 -

2,014 1034 439 56,1 25.5 7.3 19.7 3.6

5 1110 610 40.0 20.0 20.0 -

59 100.0 50.8 49.2 22.1 . 201 6.8

123 100.0 *6 63,4 24,3 220 13,0 4.1

NOTEOlintationrip*Okr4dForossEntrousawinigStadora.

SOURCE; *brawl Mn T "Sony Foram Exiratiors for Win" (Rots Cotrol Symbol DCSPER-324
TAW It PM of Most kW Pup Ploalroi Id by Wady IWO Wad WOW 16x44 his al kis IlfIllu Pity

P l y * V l d In 1 4 3 Yw s, A c e * la pas or d i a l * U M W I 1173 and WI

Ilbs ChM*

DJ Pp

Tote

I* ow 1544 pars

154 yen

15.19 yin

2544 pm

35-44 pus

Writs

Tc411 1$44 yws

1524 pars

16.19 yeas

2,534 years

35-44 pars

Mack

Toti 15.44 yews

15.24 pars

15-19 pars

25-34 res

3544 yips

1)73 1171

IiIkt al Id

Oak of lIwt4r al

Wow VI Ctipted WOW WM

VIIII In AN Own liNeal We

Thomends Mao PhysIdm Micas lewd,

12,211

ON

716

6,889

1,833

Perot disfribution

103.0

100,0

100.0

100,0

100,0

82.5

77,5

72.6

86,1

83,3

17.5

15

27,4

13.9

16,7

13,262

4,520

797

6,674

2,069

Race of Visit

01Pind

All Own Ihdlcal

Plow Ph** lents

Percent distribution

103.0 84.1

100.0 76,8

100.0 63.8

103,0 88.1

100,0 86.9

11,268 100.0 84.5 15.5 12,164 100,0 85,9

4,122 100,0 79.4 20.6 4,152 100.0 79.2

657 1004 75.4 24.6 711 100.0 664

5,469 1004 87,6 12.4 6,139 100.0 89.4

1,676 100.0 86.7 13.3 1,873 100.0 88,7

$24 101.0 57.8 42.2

338 1010 54.0 460

45 100.0 '33.9 66.1

364 100.0 66.0 34.0

122 100.0 439 561

875 103.0 63.0

300 100,0 52,4

69 100.0 64.4

408 100.0 69,0

167 100.0 66.8

15.9

232

36,2

11.9

13.1

14,1

20.8

34.6

10.6

11,3

37.0

47,6

'35,6

31.0

33.2
NIIPINC

T 11044 yNN

16.24 yNrI

724 103.0 84.2 35.8 782 1000 87.3 32.7 275 loao 72.7 27.3

11019 ylirl 266 100.0 57.3 42.7 47 100.0 82.9 *37.1 38 100.0 '22.5 26.34pn 77.5 304 1000 82,1 37,9 401 100,0 3544 pin 89.7 30.3 145 IMO 52.3 47.7 115 103.0 82.9 017.1

%MN Or us, ratotei is a spa atirty. VAteshatergattmfOnhat4fl,*Om WK. ci**Ithricatirepted. WIDa1ntoolonhouiftkMlurrrdavle dmrNdwomahthwchYdbwNpiga

Wirt, Hat MINA Ws al Iv*/ Oaringwits pray marred wee 1544 pars ce age: kW Stes, 1173 and 19/0, by G, Iliad hot,Atka Da from WirdHar &gifts Pt, 45. DIEW Pub. No, (P14)N-1250, KWh Soma It/IOW's, 41., F. 1979.
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TABLE 70. Mike for Which Prenehd Core Began in the Fine Triangle of Ihe Meier: Unlied Slam, 1911,016111 Are" 1977

Ape and Charaderietic

Rarer

AN

Birth

Weighiss

Lees Then

2,501

Cirame

2,501

Grans

or More

A

111 Wei

Percent of birth

AI ages 71.4 63.6 72.0 74

Under 18 years 44.2 41.7 44.5 46 Wedlock status's

In wedlock 53.0 50.2 53.4 53 Out of wedlock 37.1 36.8 37.2 35 Educations

8 years or less 39.5 362 39.9 43 9-12 years 45.0 43.3 45.2 47 Live birth order

Fast birth 45.4 43.2 45.7 47. Second or third birth 39.5 38.4 39.8 42.

18-39 years 73.4 66.2 74.0 76. Wedlock status'

In wedlock 76.7 71.5 77.0 78. Out of wedlock 48.2 46.0 48.5 46. Educations

8 years or less 9-12 years

52.7

70.8

49.6

63.4

53.0

71.4

54.,

13 years or more 84.1 80.0 84.3 86. Live birth order

First birth 762 69.2 76.7 78.1 Second or third birth 75.0 67.7 75.5 78.1 Fourth or later birth 64.3 59.0 64.8 68.1

2"
TABLE 70. Mars Ice Which Prenatal Care Began In the First Trimester,' According to Race, Birth Wight end Selected Characteristics

of the Mother Untied Stales, %meg Area, 1977 (Cont)

Race

Ras, White Bleck

Age and Characteristic

Al Loss Than 2501 All Less Than 2501 All Less Than 2,501

Birth 2,501 Grams BA 2,501 Grants BIM 2,501 Grams

NON Grams or More Weights Grams or More Weights Grams or More

Percent of births with prenatal care in the first trimester

40 years or cider 60.6

Wedlcck stake

In mxIlock 62.3

Out of wedlock 4t6

Educatlon8

8 years or less 45.3

$42 years 61.1

13 years or more 74.8

Live tirth ader

First through tNrd birth 71.8

Rath or later birth 57.3

56.5 61.1 62.7 58.9 3.1 52.3 51.0

58.8 621 64.6 61.0 64.9 53.5 54.0

42.1 41.7 32.4 32.5 32.5

44.7 45.5 45.7 46.6 45.7

51,5 61.5 64.5 61.5 64.8 50.9

65.4 75.3 76.0 70.0 76.4

66.7 72.4 73.0 EV 73.3

52.9 57.8 59.5 54.6 60.0

52.6

53.5

S

10 51.4 50.7

«

$ $

51.1 52.0 51.3

'Includes 12763 Nest° *men etici reside in States that do not cclect data on prenatal cars which occurred in States where then data are collected.In 1977, reporting

of month of prlancydudng *Id prenatal are began was required by 44 States and the Delia of Columbia. States not requiring reporting were Alaska, kkanss,

Idaho, *limo, Prosylvenie end VITOria

Ilrcludes as c4hti races not shwas a spate categgy.

dude 6,485 Nth fcntidthirth v4ight was not repot*.

%blab is opted by 37 Slates Wt. Dishict of °labia

s E l b a t i c e of m o t h e r Is reported tf144 States and the District of Columbia

NOTE: Osta are based cm the nitro! Oaf registation system.

SOURCES: Division of Vital Stabotia, National Wier for Health Statistics Selected data. Special tabulations prepared by the Information Sciences Research Institute,

Stier Spring, Ite Mar. 1960.
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TABLE 71- Non-Federal Physicians in Direct Patient Cars per 100,000 Population, Number of Births and Percent for Whit-th Prenatal Care

Began In Specified Trimesters, According to Region, Residence by County Characteristics, and Roc= United States, Reporting Areas, 1975 (Physicians) and 1975-77 (Births and Prenatal Cam) (Cont)

Trimester Prenatal Care Began

Region, Residence by County Characteristic, and Race

Physicians per 100,000 Population

Average Annual

Number of

Live !WOW

First

Trimester

Thirds

Trimester, No Care, and Not Reported

Percent of births

South 113.1 978.966 66.1 12.4

White 715.624 71.0 11.2

Black 250.064 52.5 15_7

Within SMSA 142.5 617,472 67.3 12.6

White 452,611 72.2 11.1

Black 156,727 53.3 16.6

Large SMSA 163.4 224.652 69.0 13.3

White 155,731 75.0 11.3

Black 66,153 55.1 17.8

Core counties 200.8 150,747 66.6 13.3

White 93.460 73.9 10_8

Black 55.625 54.4 17.5

Fringe Counties 89.9 73.905 74.0 13.2

White 62.271 76.7 12.2

Black 10.528 58.3 19.6

Medium SMSA 134.3 258,017 66.6 12.3

White 193,424 71.7 10.8

Black 61 .123 71.7 10.8

Other SMSA 119.8 134.804 65.7 12.0

White 103,456 69.0 11.8

Black 29,451 54.3 13.3

Outside SMSA 60.9 361.494 64.1 11_9

White 263,013 68.8 11.0

Black 93.337 51.1 14.0

Adjacent 56.6 181.838 64.0 12.3

White 133,345 69.1 11.1

Black 45.352 49.9 15.4

Urbanized 77.0 54.379 63.4 13.6

White 40.075 68.2 12.6

Black 12,716 48.8 16.5

Less Urbanized 50.9 107,315 64.5 11.6

White 78,047 69.7 10.5

Black 27.935 50.7 14.7

Thinly populated 32.8 20,144 63.1 11.8

White 15,222 67.9 10.7

Black 4,700 48.0 15.6

Not adjacent 65.4 179,656 64.1 11.5

White 129.668 68.6 11.0

Black 47.985 52.3 12.7

Urbanized 93.3 60,717 66.8 9.5

White 42,064 72.9 8.4

Black 17,876 52.7 11.7

Less urbanized 57.5 92,245 62.6 12.7

White 66,951 66.7 12.2

Black 24,420 51.9 13.4

Thinly populated 33.7 26.694 62.9 12.E

White 20.653 65.8 12.-s

Black 5.689 53.0 13.4
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TABLE 72. Non-Foderad Physicians inDirect Padnt Cape per 100.000 Papule don. Number ddirlhe and Percent for Which Prenatal Cam lieges hi Specified Trionesters, According toStabs and Ram= United Matas, Negev ling Areas, 1975 (Physicians) and 1975-77 (Births and PIMMOM& Care) Stabs and Race Physicians per 100,000 Population' Average Annual Nosonbsr of Uwe Mew United States3 133.9 3.212.873 White 2,603560 Black 523,427 NortheaSi New England Connecticut 175.9 36,060 White 31.486 Black 4.195 Maine 105.7 15,479 White 15.256 Black 65 Massachusetts 181.5 67.431 White 62.342 Black 4,285 New Hampshire 131.2 11,454 White 11.294 Black 73 Rhode Island 159.7 11,052 White 10.275 Black 617 Vermont 155.3 6,835 White 6,783 Black 19 Middle Atlantic New Jersey 138.8 92.258 White 73.592 Black 17,497 New York 201_8 237,375 White 183.783 Black 48,526 Pennsylvania 138.0 150.357 White 129.659 Black 19,574 No Central East North Central Illinois 130.5 172,357 White 132.834 Black 36.658 Indiana 96.2 82,781 White 73.629 Black 8,715 Michigan 1192 134,602 White 110.358 Black 22.930 Trinsestar Prisnebil Care Began Third* Trknseilsr, First No Cam, and Triunseber Not Reported Percent of births 70.5 74.1 54.3 77.9 80.8 56.5 74.6 74.6 68.0 84.3 85.2 71.8 80.2 80.2 70.4 85.2 86.1 742 72.6 72.7 49.1 67.2 72.4 45.4 66.4 72.7 43.0 - 9.3 8.2 15.1 11.5 10.1 22.8 6-2 6.2 3.7 4.6 4.2 10.8 3.7 3.7 4.7 3.6 3.4 6.9 5.4 5.4 10.5 13.1 10.5 24.0 11.9 9.0 23.1 OBI AI. ob. 71.6 75.9 562 62.4 65.3 38_2 74.6 77.8 59.6 2-#! 2 6.1 4.8 10.5 21.3 19.3 38.4 5.4 4.3 11.1 229
11 111111111111111) 1111141111111111111'11111e ao o o Os w w Moilq1=W900.4P"Pco 8; :8:8:410SMR4IM Ibitt PPSS$$ gMMAg [apmegunMggp§t§ Wan TM002t8g8V0P4rTSS U M V W 4 4 10SPFS glizs1 6 co VI L., Vo th a aw 4in iob C) aa o io a be )/ lo 4 4aK) io to b o io inmin cr-6 in to crl ka ;i4 ko 408&1100,1084:4m omi.N3=mL)ipoihmAcri-col M400)40040041414040144NNN MNO*4414 :liob6-kbOW6Winiaio6WistobL4to 6)4=kbq
TABLE 72. Non-Federal Physkdans in Direct Patient Care per 100,000 Population, Number of Earths and Percent for Which Prenatal Care lieges in Specilled Trimesters, According to Stale and Ream United ulna, Repoeling Areas, 1975 (Physicians) and 1975-77 (itirths and Prenatal Care) (Cont)

Trimester

Prenatal Care Began

State and Race

Physicians per 100,000 Population'

Average Annual

Plumber of

Uwe Births

First

Trimester

Third=

Trimester, No Care, and Not Reported

Percent of births

More) Carolina 103.6 82,039 72.4 4.9 White 55,896 79.9 3.1

Black 24,045 55.3 8.9 South Carolina 91.0 48.134 66.9 7.5 White 28,784 76_1 5.0 Black 18,999 53.0 11.3 Virginia 115.6 71,485 White 53,575 Black 16.583 West Virginia 99.9 28.922 61.2 9.7 White 27,704 62.0 9_2 Black 1.108 43.3 19.4 East South Central

Alabama 85.5 59,343 69.4 7_1 White 38,533 78.9 4.6

Black 20.614 51.9 11.9 Kentucky 100.0 56,178 64.4 14.7 White 50.993 65.7 14.5

Black 4.885 51.4 16.6

Mississippi 79.9 44,078 69.0 7_3 White 22,989 79.7 5.0 Black 20.784 57.4 9.8 Tennessee 112.7 63,901 =r-a_9 11 9

White 49,865 70.5 11.1

Black 13,679 54.0 15.5 West South Central

Arkansas 85.1 34,785 White 25.766 - - - Black 8,722 - -- Louisiana 104.9 70,901 68.1 12.3 White 42,548 76.8 11.4

Black 27,806 55.0 13.4

Oklahoma 93.9 43.952 66.0 9.9 White 35,664 70.0 8.1 Black 4,315 49.4 15.2 Texas 109.3 221202 68.2 10.8 White 186,694 70.4 10.5 Black 32,544 55.2 12.5

West

Mountain

Arizona 137.7 40,465 59.6 14.9

White 34,066 63.3 12.5

Black 1,592 49.4 17.1

Colorado 147.5 41.428 74.2 6.6 White 38,616 74.8 6.3 Black 1,864 66.2 9.4

231

2.14
TAME 72- Niono4Fedieral Physicians in Direct Patient Cate per 100,000 Population, Number of a.0 and Percent for Which Prenatal Care

Began In Specified TrIntsellers, According to Male and Ream United

Staler, Repotting Areas, 1975 (Physicians) and 1975-77 Meths and

Prenatal Cam) (Cont.)

Male and Rees

Physicians per 100,000

1Populatton's

Average Annual

Number of

Live Births

Trimester

Prenatal Care Began

Find

Trimester

Thirds'

Trimester, No Care, and Not Reported

Percent of births

Idaho 88.3 17,488 .m........ - --

White 17.088 --- - -- Black 58 ___ _ _ _ Montana 100.0 12.658 77.0 4.6

White 11,324 79.2 3.5

Black 60 782 5.6

Nevada 107.7 9,635 723 7.1

White 8,152 74.9 6.1

Black 984 56.6 12.6

New Mexico 99.8 22,052 - -- White 18,405 ....... - - - Black 574 --- IM. MV Utah 129.7 34.939 80.7 6.6

White 33.801 81.4 6.3

Black 163 65.1 15.2

Wyoming 88.2 7,544 74.9 5.6

White 7,208 75.6 5.2

Black 83 57.7 10.2

Pacific

Alaska 75.7 7,933 - -- AM Ow White 5,709 IM. M. Black 257 - -- - --

California 170.4 332,499 72.0 7.2

White 278.205 72.4 7.3

Black 34,924 69.1 6.6

Hawaii 137.0 16,336 69.6 6.1

White 4,326 70.5 5.4

Black 366 62.8 7.9

Oregon 137.8 35,258 74.8 5.9

White 33,344 75.4 5.6

Black 794 62_3 10.3

Washington 1 34.7 53.669 75.4 6.2

White 48.588 76.9 5.6

Black 1,979 59.5 11.8

'Physician data not available according to race. =Includes births for which information on the beginning trimester of prenatal care not reportec

3Total for each State includes other races not shown as a separate category.

NOTE: Data are based on reporting by physicians. estimated population counts. ,.and the nations

vital registration system. SOURCES: Bureau of Health Manpower. Department of Health. Education. and Welfare: Selects

data; National Cancer Institute: Selected data; Division of Vital Statistics. National Center for Healt

Statistics Selected data. Special tabulations prepared by the information Sciences Researc

Institute. Silver Spring, Md.. Mar. 1980.

232
TAME 73.- M mbar. al Ition-fradatall Pitysicilmna iA Cilnect Pallant Case Orr ,IINPAIM _Illtanuan 111.44 Tease at Asa and Parosnit NOM. for

Walk Pinsielint :Cow Oki Nat illasin Illoilisea_1111111 Third TrIoneellar, Aeossallas. Itenidense Cauniky Clisseacterkillics and 1111Mfts lielosable Aim, 1675 011brikzelens) and

7r (111,11as and Pranstail Carer

itasien6 Ployaician ItipecikiNty alleldelece IMF AWNING* No Pvui a'

Comae, Amount Obstetrics Cars illetove

Citaincandolkm Number of AM oaf MONS Teams ma Raps Live Ilerlas Physicias Pamlico Gynsoollosy Trtoneller

Physiciares per 100.000 twxnen 15-44 years of age Percent of births

Lk fitmfflas3 2.908.771 609.9 106.9 41.7 9-3

White 2.353.359 8.2

Mick 477.659 15_1

1010Whin SMSA 2.096.862 702.7 99.6 49.6 9_5

Witte 1.664.904 8.1

;Shack 375.724 15.5

Urge SMSA 1,141.194 790.7 1012 55_7 9.4

Witt* 872.314 7.8

Black 237,627 15_5

C:10,0 counties 823.174 905.4 1102 628 10.3

White 586,674 8.3

Black 210.811 15.8

Fringe counties 318,019 516.4 79.9 38.6 7_2

White 285,640 6.6

Black 26,816 13.5

Medium SMSA 669,772 600.9 98.9 43.3 9.9

Wilt* 550,189 8.7

Oetser

Bieck

SMSA

99.370

285.897 556.5 93.8 38.0

16.7

8.3

White 242.400 7.5

Bleck 38.728 12_4 Outside SMSA 811.909 334.9 128.3 18,4 9.3

White 688.456 8.3

Black 101,935 13.9

Adjacent 411,576 323_8 126.1 185 9.4

MIN* 354.070 8.5

'Black 50.864 14_9 Not adjacent

White

400.333

334.386

347.0 130.7 18_0 9_2

8.1

Shack 51.071 12_9

Plicmitsammt 477.945 814-3 96.8 55.1 10.7

White 394,811 8.3

Within

Bieck

SMSA

75,276 41Z551 858.0 93.8 58.4

22_6

11.5

White 331.436 8.9

Bieck 73.910 22_8

Large $300114A 264,011 956_6 95.6 64.4 13.9

199,476 10.5

Back 58.915 25.3

Core 4:ourdiett 183,594 1.047-3 98.4 69.3 16.6

white 127.022 12.4

EMiscit 52,148 26.8

Frkmple counties 80,417 775.2 94.0 54.5 7.7

White 72,454 7.2

Black 6.767 13.5

2-,G 233
TABLE 73. Number of Births, Non-Federal Physicians In Direct Patient Cars

per 100.000 Women 15-44 Years of Age and Percent of Births for

Which Prenatal Cars Did Not Begin Before the Third Trimester, According to Region, Residence by County Characteristics, and Race: Unified States, Reporting Areas, 1975 (Physicians) and 1975-77 (Births and Pr natal Carer (Cont.)

Region, Residence by County Characteristic

and Race

Average Annual

Number of

Live Births

Physician Spacialty No Prenatal

Care Before Third

Trimester Ail

Physicians

General

Practice

Obstecrics

and

Gynecology

Medium SMSA 126,586 685.9 90.1 49.0 7.3

White 111.956 6.5

Black 13,246 13.0

Other SMSA 21,954 60P.2 92.8 36.5 6.4

White 20.004 5.9

Black 1.750 14.4

Outside SMSA 65.394 497.8 118.7 30.8 5.9

White 63.376 5.8

Black 1.366 12.7

Adjacent 43.645 459.4 117.2 32.3 6.2

White 42.069 5.9

Not adjacent 21,748 577.8 121.9 27.7 5.5

White 21,307 5.4

Black 186 9.8

North Central 867.431 537.9 110.8 35.2 6.7

White 745.293 5.9

Black 109.511 12.0

Within SMSA 591.701 625.5 99.0 43.6 6.6

white 480,619 5.5

Black 103,471 11.9

Large SZvISA 352,433 578.5 94.4 49.2 6.0

White 267,944 4.7

Black 79,272 10.0

Core counties 232.925 835.6 107.1 58.8 6.9

White 156.844 5.2

Black 72,124 10.3

Fringe counties 119,508 377.8 70.0 30.7 4.2

White 111,101 3.9

Black 7,148 7.0

Medium SMSA 155,872 514.8 111.0 35.1 9.4

White 136,341 7.9

Black 18,055 20.7

Other SMSA 83,396 602,7 96.8 35.5 4.4

White 76,333 4.0

Black 6,143 8.9

Outside SMSA 275,730 328.0 139.1 15.2 6.9

White 264,674 6.6

Black 6,040 12.6

Adjacent 138,381 327.6 137.8 16.2 6.9

White 133,64? 6.7

Black 3,511 12.0

Not adjacent 137,349 328.4 140.5 14.1 6.9

White 131.032 6.4

Black 2,529 13.6
TABLE 73. Number of Births, Non-Fedsral Physkaans in Direct Patient Cars per 100,000 Women 15-44 Years of Age and Percent of Births for Which Prenatal Care Did Not Begin Before the Third Trimester, According to Region, Residence by County Characteristics, and Roam Untied Stsfies, Reporting Armes, 1975 (Physicians) and 1975-77 (Births and Prenatal Care)'(CoreL)

Region, Residence by County Characieristic

and Race

Average Annual

Number of Use Births

Physician Specialty -No Prenatal

Cams Before

Third

Trimester

All

Physicians

General

Practice

Obstetrics

and

Gynecology

South 978.966 506.9 95.7 38.7 12.4 White 715,624 11.2 Black 250.064 15.7 Within SMSA 617.472 622.9 85.9 49.6 12.6 White 452,611 11.1 Black 1 56,727 16.6 Large SMSA 224.652 712.7 85.4 59.4 13.3 White 155,731 11_3 Black 66. a53 17.8 Core counties 150,747 882.8 94.1 73.3 13.3 White 93.460 10.8 Black 55.625 17.5 Fringe counties 73,905 385.9 68.7 32.7 13.2 White 62,271 12.2 Black 10.528 19.6 Medium SMSA 258,017 587.3 87.3 44.6 12.3 White 193,424 10.8 Black 61,123 16.8 Other SMSA 134,804 524.9 83.9 41.5 12.0 White 103,456 11.8 Black 29,451 13.3 Outside SMSA 361,494 286.1 11-:.4 17.8 11.9 White 263,013 11.0 Black 93,337 14.0

Adj2,.1.ent 181,838 266.6 114.7 15.9 12.3 White 133,345 11.1 Black 45,352 15.4 Not adjacent 179,656 306.5 114.2 19.9 11..5 White 129,668 11.0 Black 47,985 12.7

West 584,430 687.5 129.7 43.5 7.5 white 497,631 7.1 Black 42.809 7.6 Within SMSA 475.138 743.8 124.8 48.2 7.0 White 400,238 6.9 Black 41,616 7.5 Large SMSA 300.098 809.8 127.3 51.5 7.0 White 249,163 6.8 Black 33,287 6.8 Core counties 255,908 866.1 134.0 54.9 7.4 White 209,348 7.4 Black 30,915 6.9 Fringe counties 44,190 518.9 92.6 33.9 4.5 White 39,814 4.3 Black 2,:172 5.8

235
TABLE 73. Number of Births, Non-Federal Physicians in Direct Patient Care

per 100,000 Women 15-44 Years of Ago and Percent of Births for Which Prenatal Care Did Not Begin Before the Third Trimester,

According to Region. Residence by County Characteristics, and

Room United States, Reporting Areas, 1975 (Physicians) and

1975-77 (Births and Prenatal Care)1(Cont.)

Raglan, Residence by County Characteristic and Race

Average Annual

Number of

Live Births

Physician Specialty No Prenatal

Cars Before

Third

Trimester

Obstetrics

All General and

Physicians Prac:lice Gynecology

Medium SMSA 129,297 639.2 120.2 44.2 8.1

White 108.467 7.7

Black 6.946 10.7

Other SMSA 45.743 521.9 118.8 33.7 5.2

White 42,608 4.9

Black 1.383 6.7

Outside SMSA 109.292 403.6 154.2 19.9 - 8.8

White 97,393 7.5

Black 1,192 12.5

Adjacent 47.712 386.9 144.7 23.1 8.8

White 45.014 8.4

Black 821 11.2

Not adjacent 61.580 417.3 162.1 17.3 8.8

White 52,379 6.7

Black 371 15.6

Excludes data for those States which did not require reporting on the month prenatal care began. These States were Alaska. Arkansas. Idaho. New Mexico. Pennsylvania. and Virginia.

2Physician data not applicable according to race. 3The total for each area includes other races not shown as a separate category_

NOTES: Data are based on reporting by physicians. estimated population counts, and the national

vital registration system. Data on month of pregnancy prenatal care began are for 2 years only for

Alabama and Massachusetts.

SOURCES: Bureau of Health Manpower, Department of Health, Education, and Welfare: selected

data; National Cancer Institute: Selected data; Division of Vital Statistics, National Center for Health

Statistics; selected data. Special tabulations prepared by the Information Sciences Research

Institute. Silver Sprang. Md.. Mar. 1980.

2

236
TAILE74. Mod Slra Lid Wad IS a Priddy and biker of WW1 per Peon par Yew by Chlldren and Youths Under 18 Yon of IA Accaing b Skied Chncloildot Untied 1$75-78 Annual Amp

PoplatIon

In

rounds

Ince List WWI Contacts per Year

Total

Per

Panora

Under 1 14 5 or Wm Per With

Year Yon Apo Yon Apo New Parson Contact

Percent distribution of population Total under 18 yeast 65,722 100.0 73.7 234 2.2 0.4 4,1 5.6

A9e

Under 6 years 19,217 100.0 88,4 10.1 0.8 0,4 6,4 7.2 6-11 years 21,471 100.0 69.4 27.1 2.3 0.4 3.3 4.8 12-17 years 25,034 100.0 66.0 29.3 3.7 0.4 3.0 4.6

Sex

Male 33,436 100.0 73.7 23.0 2.1 0.4 4.2 Female 5.8

32,286 100.0 73.6 23.0 2.3 0.4 4.0 5.4

Race

White

Black

54,967 100.0 74,9 22.1 1.9 0.3 4.3 5.7

9,831

Other

100.0 66.3 28.1 3.7 0.7 3.2 4.8 924 100.0 75.3 18.7 3.0 1.1 *42 '5.6

Farri4 income

Under $5,000 7,707 100,0 70.6 24.0 3.3 0.8 4.3 6.1 $500049,!4 13,634 100.0 69.7 25.7 3.3 0.7 3.7 5.3 $10,000414919 15,647 100.0 74.0 23.2 1.8 0.3 4.1 5.5 $15,000 or more 23,776 100.0 77.6 20.4 1.4 0.1 4.4 5,7

Parental pretence

Both parents present

Mother only present

62,732 100.0 74.5 23.0 2.1 0.4 4.1 5.5

10,126 100.0 74.0 23.2 2.3 0.5 4.2 5,7 Neither parent present 2,204 100.0 72.3 24.1 3.3 0.4 4.3 6.0

Matto of holy head

8 years or 10,945 100.0 62.6 30.9 5.3 1.3 2.8 4.4 9-11 years 11,552 100.0 69.8 27.0 2.8 0.4 3.7 5.3
N

14

pi Per

Population Mon

In Ng 1 1.4 5 or More Per YAM

Thousands Tdal Yarn Yen Po Years Apo Never Person Contact

Vial It MINI Shoo tat Witt AI a Plwidm and NNW of Co** per Peon per Year by Children and Youths Under

11 Yen of PIA Accoing blink! Chem*** UMW SW 197$41 Annual Average (Cod)

Inlwal Sin Lad Canted Contact per Year

Percent distribution of population

12 years 23,053 100.0 75.2 23.0 1.6 0.2 4.1 5.5

13-15 years 8,946 100.0 80.6 18.4 0.9 0,2 4.8 6.0

16 years or more 10,518 100.0 84.3 14.9 0.7 0.1 5.4 6.4

FgrdlY ske

3 persons or few 11,593 100.0 83.6 14.3 1.2 0.2 5.9 7,1

4 persona 18,842 100,0 79,7 18,3 1.1 0.2 4.8 6.0

5 perms 15,228 100,0 73.0 242 1.8 0.4 3.8 52

6 or more persona 20,059 100.0 627 31,5 4,1 0.7 2.7 4,3

Residence

Within SMSA 47,907 100,0 75.3 21.7 1.8 0.4 4,4 5.8

Large SMSA 26,192 100,0 76.7 20.7 1,5 0.3 4,4 5.8

Core counties 11,203 100.0 76.0 21.0 1.7 0.4 4,3 5.6

Fringe counties 8,, 100.0 78.0 20.2 1.1 0.2 4.8 6.1

Medium SMSA 15,196 100.0 74.5 22.1 2.2 0.5 4.3 5.8

Other SMSA 6,519 100,0 71.3 25.1 2.5 0.3 4.1 5.8

Outside SMSA 17,815 100.0 69.3 26.3 3.2 0.5 3,5 5.0

Adjacent to SMSA 11,795 100,0 70.1 25.4 3.2 0,4 3.6 5.1

Not adjacent to 6,020 100,0 67,7 28.0 3.2 0.6 3.4 4,9

*SA

ROn

Northeast 14,700 100,0 782 19.6 1.4 6.2 4,5 5,7

:Na t Central 17,545 100.0 74.4 23.0 1,7 0.3 4.1 5.5

South 21,644 100.0 51.) , 25.6 3.1 0.6 3.7 5.3

West 11,833 100.0 73.9.,/, 1 22.3 2.4 0.5 4.5 6.1

lkdois clam *with father coy, and Aran ?wily hvome and dationof head, not shoat as ',grata cativo*

NOTED as based on houlehOl irtevieva of a sample of the Ws nooloatitulionalized population.

SOURCE: Nob ci Het Nein Statistiz, Naticai Cater fa Health kirks Data km the Health Into*/ Survey,
TABLE 75. Boum. or Piave of Last Contact with Physicians by Children and Youths Under 1$ Years of Age, "molding lo Age, Family income, and Room United ,tales, 1975-78 Annuli Amoorneli

Bounce or Piece or Contact

Age, Family income, and Race Total

Hospital Oulpslient Clinic or Physician's Emergency Mice Room Telephone Home Other

Percent distribution of contacts

Total under 18 years* 100.0 63.4 14.2 16.9 0.6 4.9

AgeUnder 6 years 100.0 59.7 13.4 21.0 0.5 5.4 6-11 years 100.0 64.4 14.4 16.7 0.6 3.9 12-17 years 100.0 68.4 15.2 10.5 0.9 5.0

Family income Under $5.000 100.0 55.8 23.0 11.1 0.2 9.9 $5.000-$9..999 100.0 57.4 20.7 13.3 0.4 8.2 $10.000-$14,999 100.0 65.1 12.5 18.3 0.3 3.8 $15,000 or more 100.0 67.1 9.3 20.0 0.9 2.7

Color

White 100.0 65.3 11.9 18.2 0.7 3.9 All other 100.0 50.9 29.1 8.5 0.3 11.2

'Includes children with unlusown family income. not shown as a separate category. NOTE: Data are based on household interviews of a sample of the civilian ized population. Health Statistics: Data from the Health Interview Survey.

SOURCE: Division of Health Interview Statistics. National Center for Health Statistics: Data from the Health Interview Survey.

2...; 0-...... 239
PI TAU 11, Noce for LW Contad VIM PhysIdan by CPA* al Youths Undo( a Yen ol Age, According to Sikted

Cherectedift United PAK 1975

Raaon la Contact

Wpm* Eye kohl or

OMNI Ira* Ea* Postal

Chancier* To %WI Cho* Wm Mc. Cm Other

Percent distribuVon of contacts

Total under 18 years' 100.0 80.4 13.0 4.8 0.6 0.5 0.8

Aile

Under 6 years 100.0 75.4 15.9 7.6 0.3 0.0 0.8

6.11 years 100.0 87.5 8.1 3.3 1.0 0.0 0.1

12-17 years 100.0 81.5 13.1 1.7 0.7 1.6 1.5

Set

Male 100.0 80.6 13.6 4.7 0.6 0.0 0.6

Female 100.0 80.1 12,4 4.8 0.6 0.9 1.0

Race

White 100.0 80.8 13,1 4.5 0.6 0.3 0.8

Black 100.0 78.4 12.6 5.2 0.5 1.3 1.0

OM 100.0 73.9 14.6 10.3 0.0 0.0 1.1

Fan* Income

Under $5000 100.0 81.8 10.1 6.1 0.0 1.1 0.9

$5,00049,999 100.0 79.5 12.8 5.3 0.8 0.6 1.0

$10400414,999 100.0 80.6 12.4 6.2 0.3 0.3 0.3

$15,000 or more 100.0 80.5 14.2 3.4 0,8 0.2 1.0

Parental presence

Both parents present 100.0 84.3 10.9 2.9 1.0 0.3 0.6

Mother only present 100.0 84.6 ,03.3 9.- ..)3.3 0.3 0.8 0.7

Neither parent present 100.0 73.0 .7 40 ,.; J32 0.0 7.7 2.4
Ertalica 44 fink head

I pars or 1010 84.2 71 5.9 1.1 0.9 0,8 9.11 pars 1010 82.0 10,8 5.6 0.0 0.9 0.8

12 years 1010 79,4 13.8 4.9 0.6 0.4 1.0

13.15 pen 103.0 79,8 15,5 3,1 0.5 0.1 0.3

16 years or more 1010 78.8 15.4 3.8 0.8 0,2 1.0

Funk is

3 persons or fret tap 78,3 14,4 4.9 0.6 0.8 1.0

4 persons 100.0 80.7 13.6 4.0 0.6 0,2 0.9 5 peons 100.0 79.8 13.0 6,1 0,6 0,1 0.4

6 or more persons 1010 82.6 10.8 4.3 0.7 0.8 0.8

Reline

*in SMSA 120 84.5 13.4 4.4 0.6 0.4 0.8

Urge SMSA 100,0 80.1 14.0 4.0 0.6 0.3 1.0

Core counties 1010 80.3 13.9 3.6 0.7 0.5 1.0

Fringe counties 1010 79.6 14.1 4.9 0,5 0.0 0.9

Medium SMSA 120 81.5 12.6 4.4 0.5 0.5 0.5

Other SMSA 1010 80.0 12.6 5.4 0.6 0.6 0.8

Outside SMSA 1010 80.0 11.9 6.2 0.6 0.6 0.7

Adjacent to SMSA 1010 800 12.4 4.9 0.9 0.8 1.0

Not adjacent to SMSA 100.0 79.9 11.1 8.5 0.0 0.2 0.3

Northeast 1010 79.6 14.9 3.7 0.8 0.3 0.8

North Central 100.0 78,4 14.5 5.2 0.9 0.5 0.6

South 100.0 80.9 11.2 5.9 0.3 0.7 1.1

West 100.0 83,3 11.5 3.9 0.5 0.2 0.6

In-** clidan Nog fither* end *it unkran fan* into art!'dation Mud, not tomas swats coterie

NO11: Data are Wei on housekid into** of a sample of the civilian nonlostitutkinitad population.

S O U R C E % l i on ofNe i th Int r i o e w S t at ists,NiticaalCotedethealth Statistics: Oatfrom the Hutt Intetview Suriey.

251
ildillesi HD libl' 0 0 00000 00000 00000 00000 WillA io44F04 V1481! 666t.io Ettog Oh0i...00 PAS$S mktiokoto rie4V gio:16(.0. .4_.-A -4 :4:49 41 yomi4 ig§ii 00000 f449) P491 no00 ,...40:4m %mow°

b 'adorn
TAM 71. kayo Pius of Ph)** Corkds by Chiba and Yalta Under 11 Mrs of Aga During ihs Pad 11 Nook Ant. 1) laisded Chocked* UMW Nisi 1174

Privals

Pollion Physician's

in Olb GroLo

Charicisedc Thom* or Clic Prides

Same or Pio of Cars

110101 NOW.

Public hood

Outmlard Empty Hs* HMI

telephone Clinic Room Clinic Cs*

COMM

or

htaby

Home Clinic

Number tiling specified source or place in thousands

Total under 18 years, 67,241 37,205 12,996 14,815 5,543 10,895 2,432 915 858 176

Total under 18 years'

Age

Under 6 years

6-11 years

12-17 years

Race

White

Sack

67,247 55,3

Percent of population

19.3 22.0 8.2 16.2 3.6 1,4 1,3 0.3

19,649 65.8 26.6 38.1 10.9 22.1 7.1 2.6 1.8 0.3

22,155 52.1 18.0 19.2 6.7 12.7 2.6 0.9 1.2 0.1

25,443 50,0 14,9 12.1 7,5 14,7 1.9 0.8 0.9 0.4

56,493 58.8 20.5 24.8 6.9 16.3 3.1 0.9 1.3 0.2

9,628 35.4 11.8 6.4 16.1 16.2 7.0 4.1 1.1 0.4

Health status

Exallent and good 63,759 54.9 19.3

Fork and poor 3,129 64.4 20.9

Family income

Less than $5,000

$5,030-$9,999

$101000-$14,999

$15,000 or more

21,7 7.7 15.7 3.5 1.2 1.2 0.3

30.2 18.3 27.6 6.7 3.7 3.0 0.2

8,029 43.8 13.9 12,0 14,3 18.5 8.9 4.5 1,1 0.6

15,392 49.0 15,6 17.9 9.3 16.9 5.0 1.7 0.8 0.2

18,829 57,4 20.3 25.4 1.7 16.7 3.0 1.1 1.0 0.2

21,287 63.2 23.9 27.2 5.9 14,8 1.5 0.3 1.9 0.2
TANS 71 law or Pike ol Ph)** WM by Min and huts Until Vows 04 Dying b Pot 12 Monk

Au* b Wind Osindreda: Untbd Iblist 1174 (Cot)

Iwo or Pico OW

Pthis

Poplin's NOM

In CON Orcnp

Thom* cab: Pub

, MOW ,..... Niptor. Comm

Pubic hood or

QOM Brow, NW Noe Indust,

Wham Mirk Room CI* Cons Ham Chic

Reba

%ISA

Conti city

006 antral city

NIA SVSA

Pgico

Hottest

No Conti

Scut

YMlet

461097 562 20.0

19,227 49.0 18.1

26,871 61.3 21,4

21,150 53.5 17.8

Number Wog specified source or place in thousands

23.9 9.3

19.6 12.6

27.0 6.8

17.9 6.0

17.3

18.1

16.1

13,9

3.4 1.6

5.0 2.8

2.3 0,7

4.1 0.9

1.5

1.6

1,4

0,8

0.3

0.5

0,2

0.1

15,187 61.8 152 24.1 9,4 19.3 2.7 1.5 2.4 0.4

18,351 55,5 20.8 25.3 6.7 15.8 2,7 1,0 1,2 0,2

21,446 518 17.6 192 8.6 15.8 5.1 1.6 0.8 0.3

12,263 49.7 25.3 19.5 8.4 13.6 3.6 1,1 0.8 0.3

keel*dOberracesendwimeWIincome ,ndshownaeseparatec ateptiet

MOM CO sA NW on haishcii hots of s ogle d the civilin nairtituticeilzel *attn. Pircents add to more Own 100 because some children

wind an slants ces pia OA them.

SOURCE %lion ci Holts Interie Statitics, fittai Cater fa He* Statitict Date from the Her Interview &my.
TAKE N FINN Roe CNN and Yea Ur* 1 Yen of Of Nad 8aen Ohpidm MI* the Pot 12 Mho, Andkl

Type of Paoa end Chincidct Mid Mimi 1174

PrMnM Phyddan

No Choi* Thmats Teti Vld

Fltale

Wit

F*

Muhl standing,

Mb a

P111140 Nudist Without

Toll Only Only *phi

NNW Only

Fr*

*WA;

With or

110101 linthout

Toil Ontl 110101

Percent der/Minn of population

Total Mr 18 years' 67,247 100,0 31.2 62.0 44.6 14.3 3.2 6.8 5.1 1.8

AP

Under 6 years 19,649 100.0 16.4 75.2 49,2 19.5 6.5 8.4 5.4 3,0

6.11 years 22,155 100.0 35.7 58.1 45,1 11.0 2.0 6.2 4.8 1.3

1217 years 25,443 100.0 38.6 56,2 40.4 13.2 1.6 6.1 5.0 1,1

12 -15 years 16,726 100.0 38.8 55.3 40.7 13.2 1.5 5.9 4,9 1.0

18.17 years 8,116 100.0 38.3 55.1 40.0 13.2 2.0 6.6 5,2 1.4

Race

Vitt 56,493 100.0 29.3 65.8 41.7 15.2 2.9 4.9 3.8 1.1

9,628 100.0 42.0 40.1 26.2 9.0 4.9 11.8 12.3 5.5

HO status

Excellent and good 63,159 100.0 31.6 61.7 441 13.8 3.0 6.7 5,0 1.7

Fair at pa 3,129 100.0 21.0 70.2 38.4 24.9 6.9 8.7 5.8 2.9

Fady income

Under $5,000 8,0e9 100.0 36.4 49.5 30.0 12.2 7,2 14.1 8.8 5.3

$5,0004,999 15,392 100.0 35.6 54.7 31.4 13.6 3.7 9.7 6.8 2.9

$10,000414 18,829 101.0 29.4 64.8 46,5 15.3 2.9 5.8 4.6 1.2

$15,000 or more 21,281 1004 26.4 701 53,8 15.1 1.7 2.9 2.6 0.3

tik
F

7I, Mice Po Cat* and Youths Under 11 Yen AN Had Seen a Physician Within IN Pot 12 Wets, According to F Toe ol Plea and kit* Chem:ham tided Nis 104 (Colt)

PI* Physician

Private

With

Fro

MOW Only

Fro

RI*, Wept deeding, Populace Peale With Wither With or

le No Phislcian *Nei Without

Chiseled* HoOliel WNW

Thousands Total Via Tail Only Only Hos* Totel Onty ilapital

Nitro

$14 46,097 100.0 29.3 62,9 44.9 14.9 3.1 7.8 5.9 1.9 Central city 19,227 1004 32.7 55.3 37.5 13.6 4.2 12.0 8.6 3.4

Outside central city 26,871 100.0 26.9 68.2 50 15.9 2.3 4.8 4.0 0.8 Outs* SW 21,150 100.0 35.3 60.1 43.9 12.8 3.4 4.6 3.5 1,4

Reiion

Northeast 15,187 100,0 26.8 65.8 462 17.2 2.3 7.4 5.6 1.8 North Central 18,351 1060 30,7 64.9 47.3 15.0 2.6 4.4 3,3 1.0 South 21,446 100.0 33.4 564 41.5 12.6 4.3 8.2 5.8 2.3

West 12,263 100.0 33.3 59.4 43.8 12.5 3.1 7.3 5.5 1,7

Percent diatribution of population

'Mats Olean ol to race NI unknoe tan* incces, not shown as separate catepriet

NOTE: Data are teed on boob* interview' of um* of to civilian riminstitutionalizedpopulation,

SOURCE. l'iiv'z'on of Health Interview Statistics, Nib* Colter for Health Stahstios: Data from the Health Interview Survey.

M.E.MINIom
`=IIMMINWiitn. Tel I MIN Vigil° Millis per kw rot Yet on Pirard Ma ndon d Olb I* by CM* and YovIta Undo 9

Yin d *, Aosallai b Nib ip* aid So and A. of Pik Unlhd Ills, 17641 Aral Amp

ItPkim sPeot

Gavel

0110 hub

VI* and Otdirdcd

Ion pi Paw Fat, *mil and All

and Op pr %sr TOM Pedlilles lied era kiddy Oradlog Otor

TOW under 18

pro 2.0 10.0 40.3 33.8 2.4 2.1 21,4

Under 6 years 2,9 100.0 56.8 29.8 0.9 1.0 11.5

Unto 1 yor 5.9 1010 59.8 30.1 0.8 1.4 7.9

14 ywn 2.4 101.0 56.5 29.1 0.9 0.1 13,2 6.11 yen 1.5 100.0 41.0 31.8 1.9 0.8 24.5

12 -11 years 1,6 1010 16.9 40.1 5.0 4.5 32.9

12-15 yew 1.5 101.0 23.1 38.1 4.1 2.2 31.9

16.11 pus 1.9 1010 1.2 43.8 6.4 8.2 34.4

Perant distribution of visits

Milo, odor 18

PS 2.0 100,0 41.3 13.7 2.2 0,6 22/ kr 6 pm 3.0 100.0 56.6 29.2 1.0 0,8 12.4

Under 1 yir 6.0 1010 58,1 30.9 0.7 1.0 9.3

1-5 years 2.5 101,0 55.9 28,5 1.1 0.7 13,8 6.11 prs 1.5 1010 40.0 331 2.1 0.6 24.2

12 -11 pus 1.5 100.0 19.0 41.2 4, 0 3 35.2

12-15 years 1.5 1010 24.0 39.4 31 1,3 32.6

16-17 years 1.5 100.0 9.4 44.6 5.4 0.2 40.4

Fink undo( 18

years 1.9 100.0 39.3 33,8 2.6 3.6 20,7

Under 6 yews 2.8 1010 51.1 30.5 0.7 1.1 10.6

1.4 Undr 1 pr 5.8 1010 61.5 29.3 0.9 2.0 6.3 14 prs 2.3 100.0 55.0 31.1 0.6 0,7 12.6
NI

4

TULE it Oft Mb to Physicians per Person pr Year and Percent Distribution of °ChM: by Children and Youths Under 18

Years of Age, According to Physician Specialty and Sex and Age al Patient: United States, 1915.76 Annual keep (Cont.)

Physician SPeclatf

General

Office Practice

Visits and Obstetrics

Sex per Person Family Internal and All

and Age per Year Total Pediatrics Medicine Medicine Gynecology Other

Percent distribution of visits

6-11 years 1,4 100,0 42.1 30.4 1.6 1.1 24.8

12-17 years 1.7 100.0 15,0 40,3 5.7 8.4 30.6

12.15 years 1,5 100,0 22.2 38.0 4,5 4.2 31.1

16-17 years 2.2 100,0 5.7 42.3 7.1 13.8 301

N O T E : Data are based on reporting bya sample of offickased physiciars.

SOURCE Division of Health Resources Utilization Statistics, National Center for Health Statistics: Data from the National Ambulate l'Aedical Care Survey.
TABLE 61. Office Visits to Physicians per Person per Year and Percent Disiribsdion of Office Visits by Chikhen and Youths Under 10 Yews of Age, According to Whether Principal Diagnosis was Disease,

injury, or Examination Without Diagnosis and Sex and Age of Patient United States, 1975-11 Annual Average

Examination and

Obstwvation

Sex and Age

Office

Visits

per Person

per Year Total'

Diseases

and

Conditions

ICDA Nos.

000-7962

External

Causes

ICDA iNios.

E1100-E0992

Total

ICDA Nos.

793, YOO-Y13

Prenatal

Care

ICDA No

Y06

Total under 18 Percent distribution of visits

years 2.0 100.0 65.6 8.2 25.4 s0.8

Under 6 years 2.9 100.0 62.5 4_6 32.4

Under 1 year 5.9 100.0 48.0 1.9 49.4

1-5 years 2.4 100.0 69.3 5.8 24.4

6-11 years 1.5 100.0 71.8 9.5 18.0

12-17 years 1.6 100.0 65.1 12.3 21.3 3.3

12-15 years 1.5 100.0 66.4 12.8 19.6 1.5

16-17 years 1.9 100.0 63.1 11.6 23.9 6.2

Male, under 1E,

years 2.0 100.0 64.5 10.0 24.6

Under 6 years 3.0 100.0 62.9 5.2 31.4

Under 1 year 6.0 100.0 49.8 2.5 46.9

1-5 years 2.5 100.0 69.0 6.4 24.2

6-11 years 1.5 100.0 71.7 10.9 16.5

12-17 years 1.5 100.0 60.6 16.8 21.5

12-15 years 1.5 100.0 61.9 16.3 20.7

16-17 years 1.5 100.0 58.3 17.7 23.0

Female. under 18

years 1.9 100.0 66.7 6.3 25.8 *1.2

Under 6 years 2.8 100.0 61.9 3.9 33.5

Under 1 year 5.8 100.0 46.1 1.2 52.1

1-5 years 2.3 100.0 69.6 5.2 24.5

6-11 years 1.4 100.0 71.8 7_9 19.7

12-17 years 1.7 100.0 69.1 8.2 21.1 6.3

12-15 years 1.5 100.0 71.2 9.0 18.5 3.0

16-17 years 2.2 100.0 66.5 7.2 24.5 10.5

I'm:ludas unknown diagnoses, not shown as a separate category. 2Diagnoses are coded according to the Eighth Revision International Classification of Diseases, Adapted for Use in the United States.

NOTE: Data are based on reporting by a sample of office-based physicians.

SOURCE: Division of Health Utilization Statistics, National Center for Health Statistics: Data from

the National Ambulatory Medical Care Survey.

249
TAKE 82. 01110 We Ile to Phyekiins by Children and Youths Under 15 Yew of Aiel According to Physician *deity and Most

Common Principe, Digo* United Stets; 1975-78 Annual Average

kin* Diagnosis

Offka

Vette

per 1,*

Population

ICDA Code per Year

Physician *My

Mete.

Goner& trIcs

All and and

ik,A11. Family Irdemel Mat- One. Other Other

des Practice Medicine rice ology Medical Surgical Other

To visits by population

under 15 years

Medical or spacial exams Acute URt3except influenza

Diseases of ear and mastoid

proces

Infective and parasitic diseases

Infect= and inflammations of skin

Brom*, emphysema, asthma

Hay fever

YO0

460-465

380-389

000-136

680498

490-493

507

21,982,1

360.2

326.6

169.1

151,8

91.9

83.9

47::

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

31.6

23,7

42.5

28.5

36,1

39.2

292

19.5

Percent distribution of visits

1.7

'0.7

2.0

'0.7

'2.3

'1.8

'2.2

*4,4

47,1

70.1

49.8

54.8

43,7

43,3

58.1

48.8

1.0

0.7

0.6

0.3

0.8

1.4

0.5

0.2

2,9

'0.1

'0.0

'0.6

7,3

10.9

7.7

21.7

13.8 2.0

3.5 '1.3

3.3 1.8

14.2 *1.0

'3.4 '1.3

'2.8 '0.6

'1.3 '1,1

'5.3 'u.2

,Diaptic cravings and code number inclasions are based on the Eighth Revision International Classification of Diseases, Adapted for Use in the United States. 2Includes office *is to physicians tor all other diagnoses not shown as a separate category.

'Upper respirtoq infections.

KITES: Data are based an reporting by a sample of offke-based physicians, Rates are based on the average annual civilian noninstitutionik!;:ed population, excluding

Wm and Hawaii.

SOURCE National Center for Health Statistics: Heigh. United Sties, 1978. OHEW Pub. No. (PHS) 78-1232. Public Health Service, Washington, U.S, Government Printing Office, Dec. 1978.
TABLE N. Offlcs Visits to Physldsns by Children end Youths Under 15 Years of Age, Accorting to Prior Visit Status, Protient, and Most Seriousness of Common Principal Diagnosis: United States, 1915 -76 Annual Amp

Prior Visit Status Seriousness of Problem

Office

Visits Patient Seen Before

per 1,000 Patient Serious

Principal Diagnosis

Population Never Seen Current Another or Very Slightly Not ICU Code' Per Year Before Problem kbrem Serious Serious Serious

Total visits by population

under 15 years

Medical or special exams Acute URP except influenza

Diseases of ear and mastoid process

Infective and parasitic teases

Infections and inflammations of skin

Bronchitis, emphysema, asthma

Hay fever

Percent distribution of visits Percent distribution of visits

21,9821 14.5 51.4 34.1 11.3 31.6 57.1

Y00 360.2 10.9 65.0 24.1 0.8 2.8 96.5 460.465 326.6 12.5 42.0 45.5 8.8 43.8 47.4

380 -389 169.1 12.7 53.7 33.6 14.7 52.1 33.2

000-136 151.8 18.3 30.7 51.1 11.5 39.0 49.4

680-698 91,9 17.5 41,0 41,5 10.5 31.9 57.6 490-493 63.9 C.9 66.3 26.8 16.5 55.0 28.5

507 47.1 '5.5 '85.6 8.9 '6.8 34.7 58.5

'Diagnostic groupings and code number inclusions are based on the Eighth Revision International Classification of 2Inclodes dice visits tophysicians for all other diagnoses Diseases, Adapted for Use in the United States. not shown as a separate category. kip resoratoly inactions.

NOTES: Data are based on reporting by a sample of ofnckased physicks. Rates are based on the average annual civilian noniretitutionalited population, excluding Mika and Harrah,

SOURCE: National Center for Health Statistics: Health United States, 1978. CHEW Pub. No, (PHS) 78-1232. Public Health Service. Panting Office, Dec. 1978. Washington, U.S. Government
TABLE it Officeleits b Physidens by CNition end Yoldhs 0* 15 Yew of Age, Actording to Length of Time With Physician

end Most Common Principe' Diapiosis: United MK 915-76 Anntsl Ming*

Length of linen Physidan

Viels 31

Por 1-5 6-10 11-15 MO Minutes

Prindps.---CDABlesseis Cody' Popes Totalt Ian, Minds Minutes Mims to or More

Percent distribution of visit

Total visits by population

undi 15 years 31,982,1 100.0 18,2 39.1 26.2 11.9 1.9

Medcal or special exams Y0f0 360.2 100.0 8.9 33.6 40.9 14.6 '1,2

Acute URI' except influenza 460-465 326.6 100.0 19.6 50.3 22.9 6,6 '0.3

Dissass of ear and mastoid process 38:489 169.1 100.0 23.9 46.8 21.0 7.1 *0.4

Infective and parasitic diseases 000 -136 151.8 100.0 17.7 42.0 25.4 11.8 '1,0

infections and intonations of skin 680-698 91.9 100.0 30.0 37.7 18,7 6.4 9.5

Bronchitis, emphysema, asthma 490493 83.9 100.0 15.9 43.9 23.1 9,8 '2.7

Hay 47.1 100.0 19.9 26.4 17.1 1.9 '5.2

,Oisposfic

may

arxi ode number inclisiora are based on the Eight Revision International Classification of Diseases, Adapted for Use in the United States.

:Raab may not add to100.0 coing to exclutn ot visits with urine rktation.

alrickviesoltlet*Itophricianstor to diagnoses not Wm as a separate category,

AUger regiratory '11.1.'ections.

NOTES: Del are bis4 on reporting by a sampb ot ollice.based physician Sates are based on the average annual civilian noninstitutionalized population, excluding

A* and Hawaii.

SOURCE National Center for Health Statistics: Health United States, 1978 De Pub. No. (PHS) 78-1232, Public Health Service, Washington, U.S. Government

Printing Ohio, Dec.1978.
TABLE 85. Of ice Visits k iholcial by Children and Youths Under 15 Years of Age, According to S;Aeciqd Diagnostic and

Therapeutic Service Provided and Most Common Principle' Dlignoels: United States, 1975-76 Annual Average

Principal Dillnois

%Wed Diascoslic Woe, Selected Therapeutic Service'

Office *dor

Visits

bro. diza

per 1,000 Genral Blood t:11, or

Population Wog Pressure Clinical Drug Medical Donnell'.

ICDA Code' per Year, or Exam Chock Lab Test Prescribed Counseling *ion

Total tits by population

under 15 years

Medical or special exams Acute URIs except influenza

D4aases of ear and mastoid proms

Infective and parasitic diseases

Infections and inflammations of skin

enditis. emphysema, asthma

Hay fever

Y00

460-465

380-389

000 -136

680498

490-493

507

Percent of visits

41,9821 22.6 7.8 16.8 41.4 13.1 26.2

360.2 59.8 15,2 23.6 6,1 17.9 51.5

326.6 14.1 4,8 23.6 78.2 7.7 22.2

169.1 13.0 '2.2 6.6 72.3 9.7 14.4

151.8 17.6 6.8 27.1 54.6 14,0 14.2

91.9 7.7 '2,6 6.7 60.1 13,1 31.6

83.9 11.9 '2.8 8.1 63,0 11.8 45.1

47,1 '7.7 '1.2 '4,3 27.5 '10.6 67.8

' Diagnostic groupings and code number inclusions are based on the Eighth Revision International Classification

lndudes all services not storm of Diseases, Adapted for Use in the United States. as a separate category,

'More than one service was possible.

4Includes office Veils to physicians for all other diagnoses not shown as a separate category.

5t1tVef regiratcfY Nedra

NOTES: Data are based on reporting by a sample of office-based physicians. Rates are based on the average annual civilian noninstutionalized Alaska and population, excluding

SOURCE National Center for Health Statistics: Health United States, 1978. DHEW Pub. No. 78-1232. Public Health

Office, Dec.1978. Service. Washington. U.S. Government Printing
TAKE Olks Mlle b Ptryeldis by =me end ods Under 15 Yore ol Ape, According to Sided Disposition of and

Most Common Pidpol Clop* Mid St* 1975-78 Aral Average

PlindP11 MP*

ON

Vblla

per 1INO

Poputele

ar Yw

Wooled DigtelIcei

Rein at Return

Wiled 1 Woe

The Needed Follow

Total Oita by population

Liter 15 years 1,982.1

MOW or special tams Y00 3602

Acute URI, except inters 460-465 326.6

MN* of ear and mastoid process 380 -389 169.1

Ink* and parasitic bases 000-136 151.8

Infeckm and inter dons of skin E80-698 91.9

Bo*, emphysema, astma 490-493 83.9

Nay fever 507 47.1

19.9

24,6

20.6

15.8

20.5

17.1

7,7

,6.0

Percent of visits

47.6

64.9

26.3

54.6

320

43,7

53.5

77.6

26.0

11,0

42.9

24.6

33.9

36.5

33.2

19.0

6,1

'1.1

11.9

14.3

7.1

16.6

Sal

grooirrar at4 rtimber inclusive are based on the Sghth Rev* International Clestficltion of Disuses, Adapted to Use in the United Sites.

Nathan one *lbw patio.

NOTES: Data are based on roping by a samae of offiagased Alban Rates are based on the average annual civilian mninstitutionalized population, exdueing

Moat Hawaii.

SOURCE National Ca* for Health Statistics: Health Urited States, 1978. MEW Pub. No. (PHS) 78 -1232. Public Health Service. Washington. U.S. Government

Printing Moe, Dec. 1978.

2i. v7
TAKE 11. Mod Sin Lad VMIt lo A Dwist elld keibi d Vids plr Mon per Year by Children kiss *Whig b srefouths 4-17 Yam of 8AMdsd Cheri:Mkt nut MIK 1975-7I Ausi Awsp

Inisral Skim Lai 1st Visits per Year

Potation Under 1-2 2-4 5 or More

Choctsristic Mhos* Pet Pet Person Total 1 Year Yam Um Yam New Person With Visits

Percent distribution d population

Total 4-17 years, 53,541 100.0 61.9 12.9 8.6 2.3 14.4 1.9 3.0

4-5 years

6.11 years

7,036 100.0 47.5 6.9 1.8 C.0 43.7 1.1 2,4

12-17 years

21,434 100,0 64.6 12.9 7.7 1:0 13.8 1.6 2.5 24,972 100.0 63,9 14.5 11.2 3.f; 6.5 2.3 3.6

Sex

Male 27,149

Female

100,0 60,5 13.2 9.0 2.4 14,9 1.7 2.9 26,240 100.0 63.6 12.5 8.1 21 13.7 2.0 3.1

Race

White 44,697 100.0 66,4 12.3

Black

8.0 2.0 12.3 2.0 3.1 1,951 100.0 42,8 16.2 11.6

Other 3.5 26.0 0.9 2,0 670 100.0 59.7 12.1 10.4 2,6 15.3 '1.9 '32

FNrily income

Utter $sa

$5,00049,999

5,871 100,0 46.6 13.6 10.7 3.3 25.8 1.2 2.6 10,645 100.0 49.5 14.2 11.3

510,000414,999

3.3 21.7 1.3 2.6 12,363

215,003 or more 100.0 59.6 13.7 9.6 2,4 14.7 1,7 2.8 20,525 100.0 75.1 11,3 5.7 1.2 6.7 2.5 3.4

Parental presence

Both pare* present

Mother only present

42,657 103,0 63.9 12.3 8.0 2.1 13.7 1.9 3.0

Nit* parent present

8,358 100.0 55.7 15.0 10.4 2.7 162 1.6 2.9 1,890 100.0 46.7 15.0 12.7 3.5 22.1 1.3 2.9

Rucatico of fat* head

8 years or less

9-11 years

9,378 100.0 42.2 14.4 12,4 4.5 26.6 12 2.9 9,482 100.0 53.9 15.0 10.9 2.9 17.3 1.4 2.6
TABLE 17. hong Since Last Yblt lo bid and Nurber of Wits per Pow per Year tl Children and Youths 4-17 Yes of

Apo Accodng b Sided Chmachrldcs: WNW Sties, 197548 bull Average (Cont)

Mini SI* Lad VIA %lb per Year

POO Under 1-2 2-4 5 or More Per Per Person

Chao** In Naiads Total 1 Year Years Years Years Never Person With Was

12 pars

13-15 years

16 years or more

Percent distribution of population

18,626 100.0 64.0 13.2 8.7

7,039 1010 70.8 11.9 6.4

8,459 101.0 82.2 8.8 3.2

Fedsl size

3 persona or fewer :,786

4 prom 14

5 persons 13,150

6 or we persons 17,923

Resklence

VA* SMSA

Urge SMSA 21,454

On county 13,956

Fringe county 7,469

Medlin SMSA 12,291

Other SMSA 5,243

Outside NSA 14,522

Adjacent to SMSA 9,646

Not adjacent t0 SMSA 4,906

Raft

Went

North Central

Soh

Wed

100.0 65.3

100,0 61

100.0 65.1

100,0 54.1

64.1

64.3

64.3

71.2

62.2

58.3

56.3

57,4

54.0

12.1

11.3

13,1

14.2

12.8

12.9

12.9

12.1

12.8

13.2

13.1

12.3

14.7

1.8 12,3 1.8

L6 9.4 2.3

0.5 5.3 2,9

8.2 2.3

6.8 1.5

7.6 1.9

10.9 3.1

82

8.2

82

6.8

8.4

9.6

9.7

9.8

9.4

2.0

2.0

2.0

1.1

2.6

2.3

2.8

2.7

3.0

12,1

13.3

12.3

171

12.9

12.7

12.7

8.8

14.1

16.6

18.1

11.3

18.8

2.1

2.0

2.0

1.6

2.0

2.2

2.0

2.4

1.9

1,6

1.5

1.6

1.3

2.8

3.3

3.5

3.2

3.0

3.1

2.9

3.1

3.4

3.1

3,4

3.1

2.7

2,7

2.8

2.4

12,144 100.0 70.0 11.9 6.9 1.3 9.9 2.1 2.9

14,316 lou 66.4 12,7 8.0 1.9 11.0 2.0 3.1

17,547 103.0 52.4 13.3 10.2 3.2 20.9 1.4 2.7

9,528 loao 62.8 13.5 8.5 2.3 13.1 2.2 3.5

ado Oak* bin; with fa* ark, and unkxte family income and elation of hod, not shown as sprats categories.

KOTE: Danbamd on hue* interviews of a sample of the cidan winstilutimalized population.

SOURCE: DWdion of He Int,* Statistics, Nalmi Coter for He* Statistias: Data fromthe Health Interview Survey,

0 2V-1
TAU II Whin41 arm id Youths Unit II Yeas d Ap b risIM Irodard Ind Oulpstisnt AN& Nis per 100,000 katistalqccating POO* Sobs and

b Too ci thrticol Pik floAte, sod Moldy: UMW Stilitlin

Vs al Soria

hided Psychistdc Mini

Al

Irfivi Stab

Arik Sea, Roe, Walt Gni *Ms Oulpisot sod

rid Etholcity Sonia PI* Psydiddc Cots Tobl Public No** Mos

Number of clients

Total under 18 years eue 15,426 25,252 42,690 11,067 31,623 358,061

Age

Under 5 years 416 $ $ $

$

5-9 years 17,734 2,470 550 1,187 733 551 $

14-14 years 111,743 25,44 4,639 9,974 11,221 2,530 8,691 15-17 years 134,202 54,648 10,231 13,966 30,451 7,701 22,750 94,382

So

Male 43,891 7,611 16,318 19,962 6,606 13,356 Female 227,411 39,477 7,815 8,934 22,728 4,461 18,267 130,650

Race

White 65,928 13,853 17,548 34,527 7,599 26,928 Bkick 280,501 16,548 1,417 7,427 7,704 3,414 4,290 Other 58,294 892 156 277 459 « * 9,266

Ethni:ity

*Panic origin 5,304 533 742 4,029 1,840 2,189 15,731

Percent distribution

CACA Tott under 18 years 100.0 100.0 100.0 100,0 100.0 100,0 100.0 g
TAM $1. Admission of Children and Youths Under 18 Tiers of Age to Selected Inpetiont and Outpatient Psychiatric Services and

Admission Rale per 100,000 Population,' According to Type of Servke, Age, Sex, Rm., Ind Ethnic:14! United States, 1975

ao (Cont.)

1 ipe of Service

Inpatlent POW* Services

All

*bed State General Hospitals Outpatient

Apt Sil RAM PAriliiic and Psychletric

and Ethnicity Services Private County Total Public Nonpublic Services

Number of clients

Age

Under 5 years 0.5 * 5.0

5-9 years 3.0 3.6 4.7 1.7 5,0 31.2

10-14 years 3t0 30.1 39.5 26.3 22.9 27.5 37.5

15-17 years 65.6 66.3 55.3 71,3 69.6 71.9 26.4

Sex

Male 52.6 49.3 64.6 46.8 59.7 42.2 63,5

Female 47.4 50.7 35.4 53.2 40.3 57,8

Race

Mite 79.1 89.8 69.5 801 68.7 85.2 78.3

Black 19.8 92 29.4 18.0 30.8 13.6 19.1

Other 1.1 1.0 1.1 1.1 $

2.6

Ethnicity

Hispanic origin 6.4 3.5 2.9 9,4 16.6 6.9 4.4

Rate per 100,000 population2

Total under 18 years 125.8 23.3 38.1 64.4 16.7 47 7 540.4

Age

Under 5 years 2.6

4 I

111.6

5.9 years 142 32 6.8 4.2 3.2 644.6
10-14 ma 126.5 22.7 48.8 55.0 12.4 42.6 657.3 15-17 years 433.4 81.1 110.8 241.5 61.1 180.4 748.5

Sex

Male 130.0 4,5 48.3 59.1 19.6 39.6 673.5 Fence 121,5 24,1 27.5 70.0 13.7 56.2 402,1

Race

White

Sack

Oew

Ethnicity

Paric telgin

118,8 25.0 31.6 62.2 13.7 48.5 173.3 505.6 14.8 77.8 80,7 35.8 44,9 715.2 72.5 12.7 22.5 37.3

752.7

106.8 10.7 14.9 81.1 37.1 44,1 316.8

Itlie les acitsixssto the inpatient stabsci State and county end privets mental hospitais, Warpsfrom ncn.Federal general hospitals with separate psychiatric

*of watt 61:1 atkrissixs freestanding outpatient psychatric clinics and cutpatiert services affiliated et other mental hob facildes, Wading federally

ariehalC110.

Rogation estimates und as *animators in ratecomputations atefrom the Grant Pepin on Repats of the Bureau of the teas, Series P-25, No, 614; and Series

P-20, Ho. 290.

NOTE Data are toedon repoting by swim

SOURCE NatalInstitute of Mental Health, Driii011 of Biometry and Etidernidor Unpublished data
TABLE $9. Admissions of Children and Youths Under 18

Veers ot Ago to Selected inpellent and OuNslimd Psychiatric Ilervloss: According to

Typo of Service and Primary Psychiatric

Olegnoele: United Steles, 1876

Number of Clads and

Primary PerivistrIc Diegnoels

Type of Service

Inpetierd Dulpetieni

Number of assorts 83.368 358.061

Percent disbibution

Total 100.0 100.0

Mental retardation 2.4 4.2

Alcohol an drug

disorders 4.3

Depressive disorders 13.5 2.0

Sctizophrenia 16.8 2.1

Neuroses 5.5 1.7

Personably disorders 9.1 3.7

Adsustrnent reactions 30.5 45.4

Behavior disorders 12.9 14.8

Other diagnoses 5.0 25.8

'Includes admissions to the inpatient services of State and county and

private mental hospitals, discharges from non-Federal general hospitals with separate psychiatric inpatient units, and admissions of freestanding

outpatient psychiatric clinics and outpatient services affiliated with °the, mental health facilities. excluding federally assisted community mental

health clklcs.

NOTE: Data are based on reporting by specialty mental health facilities.

SOURCE: rotational Institute of Mental Health. Division of Biometry and

Epidemiology: Unpublished data.

2 L.

260
8 8ET ?i $4141 1418 °Mln SE112 alSr$As 164(6 66 k ai cduiviri trit:co cdo346 64;666r.: MI AR ;WI 2280. mol RUM 000 00 00 0000 odd 00000 0000 000000 0(00 NNA (DNTT g ggg II AAS HIS NAN. (DANT**. qq*.(0. $88 1811$ US$ SIAM N q*.0 0* omN Nelget (1011 **(00)m (0(1qme10 6 (*to 06 mitdm hWOV 0001 W60W4 wingty ininooloW q 000 00 000 0.0.0.0. 0.0.0. 0.0.00.0. 0.0.0.0. 8 888 88 888 8888 888 88888 8888 888888 rrr 0 4g &k EA ME 01 HOP, WA MUIP $.&g P6 1(4'11 ° °;Rm° ;yin mr4 CO
TABLE 90. Wits Ilior tiospltalbed During the Past Year and Hospital Days per Person per Year for Children and Youths tinder 18 Years of Ago,

According to selected Characteristics: Untied Steam, 1975-78

Annual Average (Cont.)

ChareCterhitiC

Ptppulation

in

Whether

Hospitalised

In Past Year

Thcusands Total

Hospital Days per Year

Par Person

With

Per HospitalYee No Person IzatIon

Percent distribution

Outside SMSA 17,815 100.0 6.0 94.0 0.37 6.08

Adjacent to SMSA 11,795 100.0 6.2 93.8 0.41 6.63

Not adjacent to SMSA 6.020 100.0 5.6 94.4 0.27 4.90

Region Northeast 14.700 100.0 5.3 94.7 0.38 7.17

North Central 17.545 100.0 6.2 93.8 0.33 5.37

South 21,644 100.0 6.0 94.0 0.34 5.67

West 11.833 100.0 4.9 95.1 0.25 5.07

'Includes children living with father only. and unknown family income and education of head, not

shown as separate categories.

NOTE: Data are based on household interviews of a sample of the civilian noninstitutionalized

population. SOURCE: Division of Health Interview Statistics, National Center for Health Statistics: Data from

the Health Interview Survey.

262
TABLE 91. Disc:hewn and Days of Care per 1,000 Population, and Avi Age Discharged From Non- Federal Shod -Sky Hospitsis, Acr 1975-76 Annual Average

Sex, Fksi-lUserd Diagnosis, and ICDA Cods'

Total under 15 years

All diagnose&

Diseases of the heart 4r 410-414, 420-429 lechemic heart disease 410-414 Malignant neoplasms 140-209 Fracture

Delivery 800-829

650-662 Neuroses and nonpsychotic disorders 300-309 Cerebrovascular disease 430-438 Pneumonia 480-486 Psychoses 290-299 Diabetes mellitus 250 Arthritis and rheumatism 710-718 Diseases of arteries, arterioles. capillaries 440-448 Benign neoplasms 210-228 Bronchitis, emphysema, asthma 490-493 Diseases of central nervous system 320-349 Ulcer 531-534 Sprains and strains 840-848 Eye diseases and conditions 360-379 Inguinal hernia 550,552 Congenital anomalies 740-759 Disorders of menstruation 626 Intercranial injury 850-854 Appendicitis 540-543 Lacerations 870-907 Gastritis and duodenitis 535 Hypertension 400, 401, 403

2'a
TABLE II. Disdarps and Days of Ors pm 1,000 Popidon, sod Ammo WO of gay for Children mid Youths Under 15 Yaws of

Age Discharged From NonFsdemi ShorkStay Nankai% According to Sex and Lading Diagnostic Cigar United Stales,

117541 Annual Average (Cont)

Sul Fliskilted Diagnosis, and ICDA Code'

Amp Length

Discharges Days of Can of Stay

Male under 15 years

Ail diagnoses2

Diseases of the heart

LIchemic heart disease

Malkinvt neoplasms

Fracture

Neuroses and noripsyciV4c ,!iseff.i.ers

Cerebrovescular disease

Pneumonia

Diseases of arteries, arterioles, capillaries

inguinal hernia

Psychoses

Ulcer

Diabetes mellitus

Bronchitis, emphysema, asthma

Diseases of central nervous system

Minh and rheumatism

Sprains and strains

Lacerations

Intercranial injury

Eye diseases and conditions

Congenital anomalies

390-498. 402, 404, 410414, 420429

410-414

140-209

800-829

300 -309

430-438

480-486

440-448

550,552

290-299

531-534

250

490-493

320-349

710-718

840-848

870-907

850-854

360-379

740-759

(

Number per 1,000 population In days

78.5 354.7 4.5

0.5 '3.0 '6.3

'0.1 *0.9 *11.2

0.5 *41 *9.4

4.5 28.3 6.3

0.7 7.0 9.6

*01 *0.8 *11.5

5.0 28.9 5.8

'0.0 '0.3 '6.2

3.0 8.3 2.7

*0.1 '11 '34.2

*0.1 *0,4 '5.0

0.4 '2.5 '6.6

3.0 13.9 4.7

1.2 10.2 8.6

'02 '2.1 '7.7

*0.2 '0.9 '4.2

1.5 *5.8 '4.0

21 8.0 3.0

1.5 *43 '2.8

1

23.7 6.1
Foils tender 15 yews

AN *Pees

Oleos* of the heart 390-398, 402, 404,

Inherit heart disease

Delivery

kitiont neoPlan

Recto

Neuroses and nonpsychotic disorders

Cerebrovasular disease

Arthritis and rheumatism

Psychoses

Diabetes mellitus

Benign neoplasms

Pneumonia

Disorders of menstruation

Bronchitis, emphysem? asthma

Dirac of arteries, arterioles, capillaries

Disease of central nervous system

Sprains and strains

Er divan and conditions

Ulcer

Congenital anomalies

Itypetension

410 -414, 420429

410.'414

650.42

140409

800-829

300-309

430438

710-718

290-299

250

210-228

480-486

626

490493

440-448

320-349

840.848

360479

531-534

740-759

400, 401, 403

63.9 288.2

'0.4 '3.6

'0.1 '1.5

0.6

0,4 '3.8

2.7 16.2

0.8 7.1

'0.1 '0.9

'0.2 *1,4

'0.0 '1,1

0.4 '2.9

0.8 1.1

3,9 23.7

'0.2

2.0 8.3

'0.3

1.0 9.2

'0,1 '3.9

1.3 '3.0

'0,1 '0.6

2.5 14.1

'0.0 '0.5

4.5

'10.4

'21,4

"4,5

6.1

8.5

*10,2

'7,4

'25.0

'7,3

13.9

60

1,4

4.2

'6.9

8.8

*26.2

2.3

"7.2

5.7

1 1,5

'Diego:tic groupings and code number inclusions are based on the Eighth Revision International Classification of Diseases, Adapted fa Use in the United States. Codes 7E0471, 773, and 779are not used in the HcepitalDischarge Sot/. 21ncludee diagnoses not shown as a separatecategory,

NOTES O i t a ate basedon a sample of hospital records.Rates are basedon the average annual civilian winstitutionalized population. SOURCE: National Center for Health Statistics: Health United States, 1978. CHEW Pub, No, (PHS) 78-1232. Public Health Service. Washington, U.S. Government Printing Office, D. 1978.

278
TAKE 12, °prelims par 1* Inpetionts Under 15 Yam of Age Dlitharged Fron tkroFidersi SliodsStay Hospitals, According to

So, and Surgical Promise United Stets, 196541 and .375-71 Annual Awrages

ICDA Coda' Both Seas Yale Wile

4.INWNWNEY ilusIn Soot Eighth 1915-11 1076-76 106541 1915.16 196546 1075-76

Surgical Produre Revision Revision Avarage Averigs Abwrap Averags Au,;is Arm

Operations per 1,000 population under age 15

All operations3 411 40.7 47.3 46.4 34,5 34.7

4 Tonsillectomy with or without

adenoidectomy 27.1-27.2 21.1-21.2 16,2 8.5 16.3 8.5 16,0 8.6

NYillgtornY 17.0 .4 3.9 ... 4,5 0 i 3,4

Repair of inguinal hernia 40,0-401 38.2-38.3 2.3 2.0 4,0 3.4 0,6 0,6

Closed reduction of fracture

without tation 482,0 '82.0 2.2 1.9 2.9 2,4 1,5 1.4

Appendectomy s 45.1 41,1 2,3 1,8 2,5 2.0 2,1 1.7

Adenoidectomy without

tonsillectomy 27.3 21.3 0.6 1.5 0,7 1.7 0,5 1,4

Resection and recession of

eye muscle 112-11.3 10.5-10.6 1,1 1.0 1.2 1.0 1,1 1.0

Dilation of urethra 64.5 51,5 0.5 0.9 '0.2 '0.3 0,8 1.5

Excision of lesion of skin

and subcutaneous tissue 89.1 92.1-92.2 1.0 0.9 1.0 0.9 1,0 0.8

'Surgical goupings and code number inclusions are based on the Seventh Revision and Eighth Revision International Classification of Diseases, Adapted for Use in the

United States,

IncluJes data foryttich sex was not stated,

Incbieopentions not listed in taNe, Including operations applicable to one sex.

(These codes are mcdifications of ICDA codes for use in the Hospital Discharge Survey.

' imited to estimated number of appendectomies, excluding those performed incidental to other abdominalsurgery.

NOTES: Data are based on a sample of hospital records, gates are based on the civilian nonirstitutionalized population, excludirg newborn infants,

SOURCE: National Center fa Health Statistics: Heat tad Stales, 1978, DHEW Pub, No. (PHS) 78-1232. Public Health Service. Washington. U.S, Government

Printing Of Dec. 1978,
TABLE 93. Coasters Sections ea a Percent of AU Deliveries In Non-Federal

Shorl-Stay H plWs. Amon:Oro to Region and Age of Mother: United Stales, 1965-78 Selected Veers

Region and Age

Year

1965 1970 1971 1972 1973 1974 1975 1916 1977 1978

United States

Percent of deliveries

All ages 4.5 5.5 5.8 7 0 7.9 9.1 10.4 12.1 13.7 15.2

Under 25 years 3.3 4.6 4.4 5.e* 6.8 7.8 8.9 11.1 12.1 12.7

25-29 years 4.3 5.9 6.5 7.7 8.1 9.6 11.1 12.3 14.8 16.4

30 years and ovei 7.0 7.8 8.9 10.0 11.2 12.1 13.9 14.5 16.0 19.8

Northeast

All ages 4.6 6.2 7.4 7.3 9.0 10.8 11.8 14.6 15.9 17.6

Under 25 years 3.3 4.7 5.7 5.2 7.2 9.7 9.4 13.2 12.8 13.9

25-29 years 4.3 6.5 7.0 7.8 9.4 10.2 12.4 14.8 16.7 19.2

30 years and

over 6.8 9.0 11.7 10.9 12.7 13.9 16.3 16.9 20.9 22.0

North Central

All ages 4.1 4.7 5.2 5.7 7.0 8.3 9.3 10.6 12.3 13

Under 25 years 2.6 4.0 4.0 4.9 5.8 6.8 7.8 10.0 11.1 12

25-29 years 3.9 5.4 6.5 5.5 7.1 9.9 10.1 10.9 13.2 13 -

30 years and

over 7.8 5.5 7.2 8.4 10.1 10.3 13.0 11.6 14.1 19.3

South

All ages 3.5 5.8 5.1 7.4 8.0 9.2 10.5 12.1 13.6 15.2

Under 25 years 2.9 5.0 3.7 5.8 6.9 8.1 9.0 11.6 -2.5 12.9

25-29 years *3.8 6.4 6.1 9.6 8.7 9.9 12.0 12.1 15 3 17.7

30 years and

over 5.0 7.6 9.0 9.6 11.2 12.7 13.5 14.5 14.3 18.5

West

All ages 6.5 5.7 5.6 8.3 8.0 8.1 10.4 11.3 13.3 14.6

Under 25 years 5.5 4.5 4.9 7.0 7.9 7.1 10.2 9.8 12.1 12.2

25-29 years *6.0 *4.7 6.2 8.2 6.8 7.9 9.8 11.7 14.4 15.0

30 years and

over 8.7 10.5 *7.1 12.2 10.2 11.6 12.1 15.0 14.7 19.4

NOTE: Data are based on a sample of hospital records.

SOURCES: National Center for Health Statistics: Health United States. 1978, for data years 1965- 76. DHEW Pub. No. (PHS) 78-1232. Public Health Service. Washington. U.S. "lovernrnent Printing Office. Dec. 1978: data for years 1977-78 aggregated from P. J. Ptacek and S. M. Taffel: Trends in

cesarean section delivery rates. Public Health Reports. To be published.

267
TARE it Children aid %Ms kW 18 Yore 0:4 Age thing in Households Dialled wNh Whorl,* Solos end Degree of

Damon Oh Hospitals and HO ghrks, ico3rdIng to Tie ol Sento and Selected Chnderhict Untied Steles,

11/7

Type of Beaks

Dope ol Dissolindon

With Hospiti and Clinks

Hal** Italy

Public and Bothersome and

Popullon Tromp %sit No( Somewhat to !Whereon,

161mMMIINMI10.

Chao** ls Tinsonde KW School Shopping Police Clinks Bolhersome lotorsane Wish lo Moo

Percent or population in households Percent of population in households with

dissatislioe with specified service specified degree of dissatisfaction

Total under 18 years 64,291 40.2 6.9 14.9 11.6 17.9 6.5 5.1 6.0

Age

Under 6 years 18583 37.3 5.8 14.8 11.3 17.9

Aol

5.0 6.3

6-11 years 21,451 39.9 6.9 15.3 12.1 1t: 6.5 5.3 6,2

12-17 years 24,276 42.5 7.8 14.6 11.3 17.5 6.6 5.1 5.5

Sex

Male 32,650 40.2 6.8 15.2 11.7 18.0 6.6 5.1 6.0

Female 31,663 40.0 7.1 14.6 11.4 17.7 6,3 5.1 6.0

Race

White 53,873 43.5 6.9 14.3 10.9 18.3 6.9 5.3 5.8

All other 10,441 22.9 7.1 18.2 15.1 15.8 4.1 4.2 7.2

Black 9,125 22.9 7.3 19.1 16.0 15.5 3.8 4.1 7.3

Family income

Under $5,090 6,594 31.9 6.8 17.0 14.4 17.6 5.2 4.8 7.3

$5,00049,999 10,696 34.1 6.2 16.4 13,9 18.7 6.0 4.7 7.5

$10,000414,999 12,528 39.0 7.1 15.4 12.1 19.4 7.6 5.0 6.5

$15,000424,999 20,550 42.7 6.6 14.4 10.6 18.6 6.9 5.6 5.7

$25,000 or more 13,566 46.2 7.8 12.8 9. 14.9 5.8 4.9 3.9

je.
Sex d timeholiv

Mile 41 Ole

Oh* male hod

;resent 52,321

101

42S 6.0 14.6 11.1 16.2 6.9 5.3 5,7 36.9 7.5 15.6 9.1 21.3 6.3 7.2 Fr* held 10,437 7.4 218 7.4 16,1 14.2 15.8 4.5 3,9 7.0

Education at householder

8 pin or less 8,785 34.5 5,7 15.2 13.9 18.3 6.9 4.9 6.0 9.11 years 10,504 34.3 6,5 16.7 12.5 18.5 6.5 4.7 6.9 12 years 23,513 40.5 6.6 15.4 12.1 18.6 6.6 5.5 6.2 13-15 years 10,062 42.7 8.3 142 12,4 17,9 6.2 5.2 6.2 16 ms or more 11,466 46.8 7,8 12,7 7.2 15.5 6.0 4,8 4.4 Fa size

2 person 1,587 29.0 7.9 12.7 11.3 14,9 4,9 4.2 5.5 3 persons 9,648 37,9 6.6 14,5 11.0 18.4 5.9 5.6 6,5 4 perms 19,492 41,8 6,9 14.8 11.0 18.2 6.7 5,2 6.0 5 persons 15,484 41,4 6.7 14.3 11.8 18.0 6.8 5.0 6 perms or more 18,117 5,9 39,4 7.2 15.9 12.4 17.4 6.4 5.0 5,7

Residence

Inside SO 44,411 34,9 7,2 13.7 11.1 16.1 6.0 4.7 Central city of 5.1

Iwo SMSA 12,472 15,5 8,5 12.8 13.6 11,4 3.0 3.0 Suburb of large 5.2

SSA 18,366 39.7 6.4 11.9 8,7 15,5 6.1 4.5 Outside SMSA 19,904 4,6 51,9 6.4 17.6 12.6 21.9 7.5 6.1 8.0

/Icon

Northeast 13,818 392 6.6 14.6 10,8 14.4 4.4 4.1 5.5 North Central 17,163 43.5 5.9 13.8 10.8 18.0 6.9 5.6 5.2 South 21,756 41.8 7.3 16.2 12.4 20.2 7.2 5.5 West 11,589 7,1 33.3 8.1 14.4 12.0 17.5 6.7 5.0 5.6

ilndudesonly the 50iargot

NOTE Data am boil on repot% by a earn0 of the civiliannoninstitutichalized ;quieten.

SOURCE U.S. beau of the Census: Data from the 1977 Annual Housing Survey. Special tabulations prepared by the U.S Bureau of Me CVO, Center for P.4 Detv9IPticSwot

, 252
TABU IL Medical Personnel per 10,000 Resident PopulM10, According to Profession, Region, and Location by County

Cluischristia: 0 United Nisei 1972-7I Waled hers

Prelusion

Licensed

Registered Practical

Geographic Region Ado Adel Licensed Nurses Nunes

and Lomb Norrideral Peanstidsral Dental Employed In Employers In

Cow4 Physicians, Mist Ityglenhte Nursingi Nursing

Chiseled* 1971 1971 1974 1912 1974

Pemonnelorer 10,000 resident population

United States 16.2 4,6 1.9 38.2 9.2

Within SMSA 19.3 5,1 2.2 38.0 18.9

Large SMSA 22.0 5.5 2.2 37,8 16.7

Core counties 25.5 5.7 2.2 40.2 18.2

Fringe counties 1 4 5.3 2.3 32.4 13.2

Medium SMSA 1( 4.6 2.2 38.5 20.8

Other SMSA It 4,3 2.0 37.8 24,1

Outside NSA 8. 3.2 1.2 27.0 20.0

Adjacent to SMSA 7.8 3.2 1.3 26.8 19.2

Urbanized 9.9 3.8 1.6 34.9 19.7

Less urbanized 6.4 2.7 1.0 21.4 20.0

Thinly populated 3.7 1.8 0.5 13.0 11.4

Not adjacent to SMSA 8.4 3.3 1,1 27.2 21.0

Urbanized 12.4 4.0 1,7 35.5 23.8

Less urbanized 7.2 3.2 0.9 25.3 21.9

Thinly populated 4.2 2.3 0.7 17,3 12.8

Northeast 20.6 5.5 2.4 51.4 19.9

Within SMSA 22.2 5.8 2.4 46.7 19.8

Large SMSA 25.4 6.2 2.1 44,8 18,3

Core counties 29.0 5.9 2.0 46.2 19.4

Fringe counties 19.1 6.6 2.4 42,2 16,2

Medium SMSA 16.8 5.0 2.9 49.6 22.6

Other SMSA 14.6 4.9 2.8 55.5 22.5

0 2J3
Midi SMSA 10.9 3,9 2,5 47,7 20.9

Mont to SSA 9,9 3.9 2.2 46.7 201

Uttariad 9,6 4,1 2,2 47.9 20,2

Lev Amid 11.4 3.2 2.3 44.5 20,7

Thinly populated 6.7 3,3 1.1 24,1 9,3

Not adlicsitto SMSA 13.5 3.9 3.2 50.3 23.0

Urterized 18,0 4,1 3,7 58,8 26.3

Um urttrizsd 9.6 3.8 2.4 43.5 20.3

Thinly Paid 10.6 4,0 4,5 39.9 19.8

North Central 14,2 4.4 1,7 38.4 18.2

Within SMSA 17.3 4.8 2,0 36,7 18.4

Lap srA 18.9 5.1 2.1 34.6 16.1

Core co', IS 23.4 5.5 2,! 38.7 18.8

Fringe court ; 10.4 4.3 2,1 25.9 10.7

*km SIAM 13.8 4,4 1,9 38.5 20.5

Other SMSA 16.6 4.4 to 42.6 24,3

Outside SMSA 1.5 3.5 1,0 29.6 17.9

Adjacent to SMSA 7.1 3.4 1,1 28.4 16.9

Urbarized 10.1 3.9 1,6 35.9 18.6

Lees urbanized 5.1 3.1 0.9 23.6 16.2

Thirty populated 3.3 2.5 0.4 16.8 10.1

Not went to SMSA 7.3 3.7 0.9 301 18.9

Urbanized 11.2 42 1,4 41.0 21,1

LI. urbanized 6.9 3.8 0.9 29.8 20.1

Thinly Mutated 3.6 2,5 0,5 20.3 12.6

South 13.8 3.6 1.6 28.8 20.1

WIMil SMSA 17.6 4.3 2.0 32.2 19.9

Large SMSA 20.4 4.7 2.1 32.7 15.7

Core countiee 25.5 5.1 2.2 37.0 17.5

Fringe cantles 12.1 4.0 1,8 25.2 12,6

Medium SMSA 16.6 4.2 2.0 32.2 21.0

Other SMSA 14.5 3.6 2.0 31. 25.5

Outside SMSA 72 2.5 1.0 16.7 21.9

P.1 Adizent to SMSA 6.5 2.4 1.0 17,4 20.9 v

Oil Urbanized 8.9 3.2 1.3 23.9 21,1

Lees uterized 5.9 2.2 0.9 15.7 22,8

Ttinty populated 3.5 1.3 0.5 9.9 11,7

2 sl
ti TAM N, Medical Mono per 10100 Resident Molding to Prolseslon, Region, and Location by County

Chsocloistics: United x, 1912.19 kis* Yam (Cont,)

Profession

Ucosnesd

Rallstervi Priclical

OW* Region Ade Active Wood Nunes Nunes

aid Lemke Non.Fidsmi NonFiderel Denbl Employed In Employed In

by County Physician' Dentish, itigionistes Nursing' Nursing

NNW* 1171 1119 1974 1912 1974

Personnel per 10,000 resident population

Not adjacent to SMSA 7.9 2.6 0.9 20.0 23.0

Urbanized 12.2 3.4 1.5 28,4 25.6

Less urbanized 6.6 2.4 0.7 17.6 24.6

Thinly populated 3.9 1.7 0,5 11.5 130

West 17.9 5.5 2.1 36.5 17.0

Within SMSA 20.2 5.8 2.3 35.3 16.8

Large SMSA 22.3 5.9 25 36.0 16.0

Core counties 23.8 5.9 2.4 31.0 16.9

Fringe counties 14.0 6.0 3.3 30.3 11.4

Medium SMSA 17.2 5.3 1.8 32.9 17,5

Other NSA 11,6 5.8 2.0 36.5 20.3

Outside Sif,A 9.5 4.3 1.2 28.8 18.2

Adjacent to SMSA 9.7 4,2 1,2 26.3 17,3

Urbanized 10.7 4.3 1.2 27.3 17.9

Leo urbanized 8.2 4.3 1,2 24.9 161

Thinly populated 5.8 3.1 1.3 21.6 12.0

Not adjacent to SMSA 9.4 4.4 1.2 30.6 18.8

Urbanized 11.9 5M 15 32,6 22,1

1.16 urbanized 8.4 4,2 1.1 30.6 18.2

Thinly populated 5.6 3.2 1,1 24,3 11.0
loci* 21,691 physicians riot clue* in 1971,

includes *tit and dental hygolts licensed in State of residence, Excludes Pennsylvania from the licensed drntsl hygienists Dental register wen not ivelat4e for 1114. data for Pennsylvania

ixcludes motored hunts with addresses unknown from the tato utopia. These nurses are included in the region totals and the United States total

NOTES: Oita VI 0110 on reporting by meld pommel or on 'OM: Counties are grouped accoroing to the Apr 1973 Office of Management and Budget rnotrcodktewionmeropatin dosignstiore. Al ska is excluded from 0 location categories; however, the Al nit& State tail is included in the West totaland the United Stites toll for all profesiors except dentists,

SOURCES: Moe Center for Health Statistics: Computed by the Division of Anslysis from Goodman, L. 1976, Otago. Amman Medical J.: Physician Distribution and Medical Lam in the U.S., Aucciation, 19/7. (Copyright 1117: Used with the permission of the American Medial Association.); Information Institute: Computed from data from Sciences Research the Division of Dentistry, Bureau of Health Minperwer, Roth, A. V., and Walden, A. R,: The Nation's Nurses: 1972 Nurses Kansas City, Mo. American Inventoq of Registered Nurses' Aseociation, 1974. (Copyright 1974: Used with the permission of the Amer' Schmitting, G. T. LPN': 1974 Nurses' Association); Roth, A. V , and Invintay of Licensed Practical Nurses Kansas City, Mo. American Nurses' Association, 1911 4pyrght 1917: Used with the permission of the American Nurses' Aiscciation); U:S. New of the Census: Estimates of the population of States with Senn P.25, No 640, components of change, 1970-75, Current PopulationRepot. Washington, U.S Government Printing Office, Nov. 19/6. p. 21.
TAME M. Probetniaaally Active Phye keens (11111J:Ve), According to Meier

Acite 1p sad Primary spookier tinned Slat se, 1117111

Maury Spec:Wily

Major Proles, lonal Activity

Patient Care

Noepital-Iniesed Pieciloe

01111oeSewed Rye Meats Full-Teams Number Total PIIIIKNOla All Years' Physicians Others

Profeseionany active

Percent distribution of physicians

physicians 343.876 100.0 62.5 18.1 10.8 8.6

Primary care 134.051 100.0 64.8 20.3 8.0 6.4

General practices 54,631 100.0 84.2 8.0 5.7 2.1

Internal medicine 57.312 100.0 48.9 31.6 9.8 9.7

Pediatrics 22.108 100.0 58.1 24.0 9.1 8.8

Other medical specialties 18.702 100.0 70.1 4.1 122 13.6

Dermatology 4,755 100.0 75.1 13.5 6.0 5.4

Pediatric energy 469 100.0 70.2 15.6 5.5 8.7

Pediabic cardiology 537 100.0 42 3 10.6 21.0 26.1

Internal medicine

subspecialties', 12.941 100.0 45/.4 0.0 14.4 16.2

Surgical specialties 97,416 100.0 70.0 19.4 7.0 3.6

General surgery 31.899 100.0 62.0 26.5 8.0 3.6

Neurological surgery 2.959 100.0 68.6 18.0 8.3 5.0

Obstetrics and gynecology 21.908 100.0 72.3 17.2 6.2 4.3

Opthalmoiev2y 11.326 100.0 78.4 14.1 4.3 3.2

Orthopedic surgery 11.689 100.0 71.8 17.5 7.8 2.9

Otolaryngology 5,788 100.0 75.1 14.4 7.3 3.2

Plastic surgery 2.337 100.0 77.3 14.6 5.3 2.9

Colon and rectal surgery 667 100.0 89.5 4.8 4.0 1.7

Thoracic surgery 2.020 100.0 69.9 13.7 10.9 5.5

Uro levy 6.823 100.0 75.4 14.5 7.3 2.8

Other specialties 93,707 100.0 49.7 16.0 18.4 16.0

Anesthesiology 13,074 100.0 69.1 13.2 11.4 6.3

Neurology 4.374 100.0 44.7 25.9 13.1 16.3

Pathology 11,815 100.0 36.0 21.5 24.8 17.7

Forensic pathology 203 100.0 43.4 3.9 4.9 47.8

Psychiatry 24.196 100.0 51.1 16.2 20.5 12.1

Child psychiatry 2.618 100.0 56.9 11.6 14.1 17.4

Physical medicine and

rehabilitation 1.665 100.0 36.9 17.4 35.7 10.1

Radiology 11.627 100.0 60.2 15.6 18.0 6.2

Diagnostic radiology 3,794 100.0 592 14.5 19.1 7.3

Therapeutic radiology 1.202 100.0 58.3 17.5 19.3 4.9

Nriecellaneouss 19.139 100.0 35.5 13.0 17.0 34.6

*Includes interns and residents.

alroch.rdes medical typo-ling. administration. research. anC other professional activities.

'Includes general practice and farnity practice. 4trocludes gastroenteroiogy. pulmonary diseases. allergy. and cardiOvascular diseases.

strides occupational medicine, general preventive medicine, aerospace medicine, public health,

other specialties root listed. and unspecified sPecialbesNOTE: Data are based on reporting by physicians.

SOURCE: Goodman. L. J.: Physician Distribution and Medical Licensure in the US.. 1976.

Chicago. American Medical ASSOCietiOn. 1977. (Copyright 1977: Used with the permission of the

American Medical Association.)

S
11

I

11

1

niarRiran M,4in§§giM HEAMMIW

iFIMARii

o SRW144"491VDT SM/1002::g0"

1

WEI.Wk

OdviWitv-7

Icromqvcloir Nolep-00.01I91 03410.00v0.01(

SBASV4113284) 13g41;21;13gSni 28(4241ggR8

a *IgiivcTA AgNIMPH PRigEI

K m a 
TABLE 97. Active Non-Federal Dentists and Employed Registered Nurses and Number per 100,000 Population, According to Division and State: United States, 1976 (Dentists) and 197T-78 (Nurses) (Cord.)

Division and State

Dentists' Employed Registered Nurses2

Number Per 100,000 Population3 Number Per 100,000 Population's . West

Mountain 4,668 48.4 50,144 492

Arizona 963 43.3 13,794 590

Colorado 1,389 54.6 15,495 583

Idaho 385 47.3 3,515 404

Montana 380 50.9 3,956 510

Nevada 271 45.9 2,709 422

New Mexico 395 34.5 4,472 368

Utah 721 59.9 4,350 340

Wyoming 164 43.6 1,823 440

Pacific 15,850 .56.8 128,524 437

Alaska - -- - -- 1,776 422

California 11,732 55.3 89,756 408

Hawaii 483 55.6 3,979 440

Oregon 1,433 62.7 12,793 532

Washington 2,202 62.0 20,220 547

',Excludes Alaska. 2Adjusted for nonresponse to questions on employment status and county of employment. Population figures are based on 1975 population estimates.

'Population figures are based on 1977 population estimates, market statistics.

NOTE: Data are based on a registry of dentists and an inventory of registered nurses.

SOURCE: National Cancer Institute: selected data; Bureau of Health Professionals, Health ReseJrces Administration: selected data; Special tabulations prepared by the Information Sciences Re* earch Institute, Silver Spring, Md.. Mar. 1980; American Nurses Association, Research and Policy Analysis Department, Sti.:.tistics Unit: 1977-78 Inventory of Registered Nurses. Prepublication data. Used with the permission of the American Nurses Association. Kansas City, Mo., Oct. 1980.

276
TABLE 91 Community Hospital Beds pe' 1,000 Population and Average Annual Rate of

United States, 1970.70 Change, According to Division and State;

Year

Period

Division and State 1970 1971 1972 1973 1914 1975 1916 1960-701 1970-78

Average annual rate

Community hospital beds per 1,000 population? of change

lilted States 4.3 4.4 4.4 4.5 4,5 4.6 4.6 1,8 1.1

Northeast

New England 4.1 4,2 4.2 4.2 4,2 4.2 4.2 0.5 0.4 Connecticut 3.4 3.4 3.5 3.5 3.5 3.5 3,5 Maine 0.5

Massachusetts

4.7 4.7 4.6 4.7 4,6 4.7 4.7 3.2 0,0

New Hampshire

4,4 4,5 4.6 4.6 4.6 4,6 4,6 0.5 0.7 4.0 4.1 4.1 4.1 4,0 4,2 4.1 -1.0 0.4 4.1 Rhode Island

Vermont

4,0 3.7 3,8 3.8 3.8 3.8 3.7 0.8 -1,3 4,5 4.3 4.7 4,8 4.8 4,8 4.7 Middle Atlantic 0.7

New Jersey

4.4 4,4 4.5 4.5 4.6 4.6 4.6 1.0 0.7

New York

3.6 3.7 3.8 3.8 4.0 4.0 4,1 1.5 2.2 4.6 4,5 4.6 4.7 4.7 4.7 4.7 0.7 0,4 Pennsylvank 4.7 4.7 4,7 4.7 4.7 4.7 4,8 1.4 0.4

Noah Central

East Noah Central 4.4 4.5 4.5 4.6 4.6 4,7 4.7 2.0 1,1 Illinois 4,7 4.7 4.7 4.8 4.9 4.9 5.0 1.6 1,0 Indiana

Michigz,^.

4.0 4.1 4.1 4.2 4.4 4,4 4,4 2.5 1.6

Ohio

4.3 4.3 4.4 4.4 4.4 4.5 4.4 2.6 0.4

Wisconsin

4.2 43 4.3 4.4 4,5 4.6 4.6 2.1 1.5

West Noah Central

5 2 5.1 5.1 5.2 5.2 5.1 5.3 1.9 0,3

5.7 5.6 5.6 5.7 5.8 5.8 5.8 2.8 0.3 Iowa

Kansas

5.0 5,8 5.7 5.8 5.9 6,0 5.9 3.6 0.9

Minnebota

5.4 5.6 5.6 5.6 5.7 5.7 5.8 2.5 1.2

6.1 5.8 5.8 5.9 6.0 6.0 6.0 2.4 -0.3 Missouri 5.1 5.1 5.2 5.2 5.4 5.5 5,6 21 1.6 Nebraska 6.2 6.3 6.0 6.0 6.1 6.1 6.2 3.4 North Dakota 6.8 6.5 6.4 6.7 6.9 6.7 6.7 2,7 -0.2 South Dakota 5,6 5,6 5,4 5.5 5.6 5.5 5.6 2.2
t4 TABLE 98. Community Hospital Beds per 1,000 Populatfo and Average Annual Rate of Change, According to Division and State;

united States, 1970-78 (Cont.)

Division and State

Year

1970 1971 1972 11173

Mod

1974 1975 1978 1960 -70' 1970-78

Community hospital becki per 1,000 population2

Average annual rate

of change

South

South Atlantic 4,0 4.1 4,1 4,2 4.2 4,3 4.4 1.9 1.6

Delaware 3.7 3.7 3.6 3.6 3.5 3.5 3.6 -0.5

District of Columbia 7.4 7.3 7.4 7.2 7.0 7.1 7.3 2.3 -0.2

Florida 4.4 4.5 4.5 4,6 4.5 4.9 5.1 3.5 2.5

[Georgia 3.8 4.0 4.0 4.2 4.3 4.4 4.5 3.1 2.8

Maryland 3.1 3.1 3.1 3.1 3.2 , 3.2 3.3 -0.6 1.0

North Carolina 3.8 3.8 3.8 3.9 4.0 4.0 4.1 1.1 1.3

South Carolina 3.7 3.8 3.9 3.9 4,0 3.9 3.9 2.4 0.9

Virginia 3.7 3.8 3.8 4.1 4.0 4.1 4.1 2.1 1.7

West Virginia 5.4 5.4 5.5 5.7 5.8 5,5 5.8 2.8 1.2

East South Central 4.4 4.4 4,5 4.7 4.8 4.9 5.0 3,8 2,1

Alabama 4.3 4.2 4.4 4,6 4.8 4.9 4.9 4.3 2.2

Kentucky 4,0 4,1 4.1 4.3 4.3 4.3 4.4 2.9 1.6

Mississippi 4.4 4.6 4,5 4.7 4.7 4.9 5.0 4.2 2.1

Tennessee 4.7 4.8 4.8 5.0 5.1 5.4 5.5 3.2 2.6

West South Central 4.3 4.4 4.5 4.5 4.6 4.7 4.7 2.6 1.5.

Arkansas 4.2 4.3 4,3 4.4 4.5 4.6 4.8 3.7 2.2

Louisiana 4.2 4.4 4,4 4.5 4,5 4.7 4.6 0.7 1.5

Oklahoma 4.5 4.6 4,5 4.5 4.6 4.6 4.6 3.4 0,4

Texas 4.3 4.4 4.5 4.5 4.6 4.7 4.7 2.6 1.5

West

Mountain 4.3 4.2 4.1 4,0 4,0 4,0 4.0 2.1 -1.2

Arizona 4,1 4.0 3,9 3.9 3.9 3.8 3.8 3.1 -1.3

Colorado ,4.6 4.6 4.3 4,2 4.1 4.4 4,4 1.9 -0.7

Idaho 4.0 4.0 4.0

t

.41 3.9 3.8 2.2 -0.9 J ti 1
Montana

Nevada

,New Mexico

Utah

Wyoming

Pacific

Alaska

California

Hawaii

Oregon

Washington

5.8 5.7 5,5 5.3 5,3 5.2 5.2 1,3 -1.8 4,2 4.0 4.1 4.6 4.4 4.3 4.3 0.7 0.4 3.5 3.7 3.4 3.4 3,4 3,4 3,3 1,9 -1.0 3.6 3.5 3.3 3.2 3,2 3.2 3.2 2,5 -2.0 5.5 5.0 5.0 4.8 4,7 4.5 4.4 1.8 -3.7 3,7 3.8 3.8 3.8 3.9 3.9 3.8 1.8 0.4 2.3 2.4 2.3 2.2 2.2 2.2

3.8 3.8 3,8 3.9 4,0 4.0 3.9 2.4 0.4 3.4 3.4 3,3 3.2 3.3 3.1 -1.5 4.0 4.1 4.0 3,9 4.0 3.9 3.9 1.3 -0.4 3.5 3.4 3.5 3.5 3,4 3.4 3.4 0.6 -0,5

1960 includes hospital units of institutions.

2Civi Ilan noninstitutionalizedpopulation of all ages.

NOTES; Data are based on reporting by facilities. Community hospitals include all nortFederal shorstayhospitals classified by the American Hospital Association to one

of the following services: general medical and surgical; obstetrics and gynecology; eye, ear, nose, and throat; rehabilitation; orthopedic; other specialty; children's general; children's eye, ear,nose, and throat; children's rehabilitation; children's orthopedic; andchildren's other specialty.

SOURCE: National Center for Health Statistics: Health United States, 1978 CHEW Pub, No. (PHS) 78-1232. Public Health Service, Washington, U.S. Government Printing Office, Dec. 1978.

2`J2
TABLE 99. Elementary and Secondary Schools With Doors, Toilets, and Classrooms Accessible to Handicapped Pupils, According to Region, Division, and State: United States, 1978

Architectural Features Accessible

to Handicapped Pupils

Region, Division, and State Building Entrances

Toilet

Stalls

Classroom

Entrances

Percent of

schools

Percent of schools

with accessible

entrances

United States 60.0 26.6 58.8

Northeast 45.9 21.1 56.4

New England 45.9 22.9 62.7

Connecticut 50.6 26.7 66.4

Maine 43.0 16.2 67.3

Massachusetts 41.9 21.3 58.6

New Hampshire 49.7 22.2 58.0

Rhode Island 44.6 20.9 66.0

Vermont 62.6 42.2 69.6

Middle Atlantic 46.0 20.3 53.5

New Jersey 44.1 17.2 52.1

New York 41.1 15.7 51.5

Pennsylvania 52.0 26.8 56.4

North Central 59.2 25.3 59.8

East North Central 56.8 24.9 59.3

Illinois 46.1 16.0 57.1

Indiana 60.4 27.4 58.2

Michigan 61.3 29.1 64.2

Ohio 54.5 20.9 55.2

Wisconsin 68.5 38.5 60.9

West North Central 64.4 26.2 61.1

Iowa 58.9 23.6 57.9

Kansas 66.9 25.1 56.0

Minnesota 70.7 32.0 63.8

Missouri 60.9 23.7 61.6

Nebraska 74.1 28.2 65.9

North Dakota 81.2 39.3 68.3

South Dakota 46.3 19.1 53.3

South 61.6 29.3 53.5

South Atlantic 61.1 28.2 52.6

Delaware 45.4 20.6 56.5

District of Columbia 14.0 4.5 50.6

Florida 74.5 41.2 42.2

Georgia 58.1 22.5 58.9

Maryland 64.3 26.1 68.0

North Carolina 65.6 34.0 50.2

South Carolina 58.2 29.3 50.7

Virginia 58.0 22.1 56.2

West Virginia 44.9 17.6 49.0

East South Central 60.3 29.3 50.7

Alabama 68.2 42.9 51.2

Kentucky 57.8 24.9 47.2

Mississippi 62.1 27.6 52.2

Tennessee 55.5 23.3 52.4

280 29 3
TABLE 99. Elementary and Secondary Schools With Doors, Toilets, and Classrooms Accessible to Handicapped Pupils, According to Region, Division, and State: United States, 1978 (Cont.)

Architectural Features Accessible

__to Handicapped Pupils

Region, Division, and State Building Entrances

Toilet

Stalls Classroom

Entrances

Percent of

schools

Percent of schools

with accessible

'entrances

Wift.t South Central 63.0 30.9 56.2 At kansas 76.1 42.5 61.5 Louisiana 51.2 12.2 44.5 Oklahoma 71.4 30.4 61.2 Texas 61.8 34.2 56.9

West 73.4 25.6 68.6 Mountain 70.0 33.2 65.4 Arizona 80.8 48.5 73.7 Colorado 68.3 30.6 65.2 Idaho 65.6 23.3 :55.7

Montana 65.5 28.7 58.5 Nevada 72.7 24.5 24.4 New Mexico 79.7 45.2 74.3 Utah 58.5 27.6 70.4 Wyoming 61.8 21.5 67.4 Pacific 74.9 28.0 70.0 Alaska 47.1 36.0 66.1 California 77.2 27.1 69.9 Hawaii 50.4 26.6 48.2 Oregon 75.4 27.2 75.2 Washington 74.1 31.1 71.1

NOTE: Data are based on reporting by school districts.

SOURCE: U.S. Department of Education. Office of Civil Rights: 1978 Oernentary and Secondary School Civil Rights Survey, State, regional, and national 34.Immaries of data

2 9

281
TABLE 100. Gross National 'Product and National Health

Expenditures : United States, 1929-78 Selected Years

Year

Gross

National

Product

in Billions

National Health 'Expenditures

Amount

In

Billions

Percent of

Gross

National

Product

Amount

per Capita

1929 $103.1 $3.6 3.5 $29.49

1935 72.2 2.9 4.0 22.65

1940 99.7 4.0 4.0 29.62

1950 284.8 12.7 4.5 81.86

1955 398.0 17.7 4.4 105.38

1960 503.7 26.9 5.3 146.30

1965 688.1 43.0 6.2 217.42

1966 753.0 47.3 6.3 236.51

1967 796.3 52.7 6.6 260.35

1968 868.5 58.9 6.8 288.17

1969 935.5 66.2 7.1 320.70

1 F.)7 0 982.4 74.7 7.6 358.63

1971 1,063.4 82.8 7.8 393.09

1972 1,171.1 92.7 7.9 436.47

1973 1,306.6 102.3 7.8 478.38

1974 1,412.9 115.6 8.2 535.99

1975 1,528.8 131.5 8.6 604.57

1976 1,700.1 148.9 8.8 678.79

1977 1,887.2 170.0 9.0 768.77

1978' 2,107.6 192.4 9.1 863.01

1Preliminary estimates.

NOTE: Data were compiled by the Health Care Financing Administration.

SOURCES: Gibson, R. M.: National health expenditures. 1978. Health Care Financing Review 1(1):1-36, Summer 1979; Office of Research.

Demonstrations and Statistics, Health Care Financing Administration: Selected data.

282
TABLE 101. Personal Consumption Expenditures for Medical Care, Accor ilng

to Type of Expenditure: United States, 19E0-78 Selected Years

Year

Type of Expenditure

All

Medical

Care Hospital Services

Physi- clans'

Services

Medicines

and

Appliances Dentists

Net Cost

of Health

Insurance

All Other

Medical

Care

Billions of dollars

1950 $8.8 $2.0 $2.6 $2.2 $1.0 $0.3 $0.7 1955 12.8 3.2 3.5 3.0 1.5 0.6 1.0 1960 19.5 5.3 5.2 4.6 2.0 0.8 1.6 1965 29.4 8.4 8.0 6.2 2.8 1.3 2.8 1966 31.8 9.4 8.5 6.5 2.9 1.4 3.1 1967 34.2 10.7 9.4 6.7 3.2 1.4 2.8 1968 37.8 12.4 10.0 7.3 3.5 1.6 2.9 1969 43.4 15.2 11.4 7.8 4.1 1.8 3.0 1970 48.7 17.9 12.9 8.4 4.7 1.7 3.2 1971 53.4 20.4 14.2 8.5 4.9 2.0 3.3 1972 59.6 23.3 15.5 9.1 5.4 2.6 3.8 1973 66.6 25.9 17.2 9.8 6.4 3.2 4.2 1974 75.2 :".4.1.1 19.1 10.7 7.0 3.3 4.9 1975 87.0 35.4 22.1 11.4 7.9 4.6 5.5 1976 99.1 41.5 24.9 12.3 9.8 4.3 6.3 1977 114.2 48.4 28.3 13.4 11.0 5.7 7.4

1978 128.3 54.6 31.2 14.9 12.2 6.7 8.7

NOTES: Data are based on reporting by hospitals, physicians, dentists, and other health care facilities: the Health Care Financing Administration; the American Hospital Association; and other

trade sources. Data are revised and exclude private expenditures in Federal, State, city. and other government hospitals and nursing homes.

SOURCE: Health Insurance Institute: Source Book of Health Insurance Data: 1979-1980. Washington. 1980.

283
TABLE 102. Average Annual Percent Change in per C.'spita Personal Health Care Expenditures. According

to Source ol Funds and Age: United States, 1905-78 Selected Years

Age and Year

Source of Funds

Total Private Public

All ages Average annual percent change

1965-78 11.2 7.1 16.6

1965-70 10.9 6.9 22.0

1970-76 11.4 10.0 -13.9

1976-77 12.0 12.1 11.7

1977-78 11.6 12.0 11.0

Under 19 years 1965-78 10.0 8.6 15.3

1965-70 10.7 8.4 20.6

1970-76 9.1 7.9 12.6

1976-77 11.4 12.1 9.7

1977-78 10.6 10.3 11.1

19-64 years 1965-78 10.2 9.2 13.6

1965-70 9.4 7.9 14.9

1970-76 10.8 9.7 13.8

1976-77 10.6 10.8 10.2

1977-78 10.6 10.9 9.8

65 years and older 1965-78 11.9 6.5 18.5

1965-70 12.6 0.0 29.9

1970-76 11.3 9.7 12.3

1976-77 12.2 13.9 11.2

1977-78 11.3 13.7 9.9

NOTE: Data are compiled by the Health Care Financing Administration.

SOURCE: Fisher, C. R.: Differences by age groups in health care

spending. Health Care Financing Review, 1(4):65-90, Spring 1980.

2

284
TABLE 103. Aggregate POWS0111111 Irlesith Care Expenditures for Children and Youths Under 19 Years of Ags, According to 80411111:0 of Funds and Type of Expenditure: United States, 1965-79 Selected Years

Source of Funds

Year and

Type of Expenditure

Total

ASPOreliete Amount In

Millions of

Dollars Total Private

Public

Total Federal

State

and

Local

1965 Percent distribution

Total 36.383 100.0 84.5 15.5 9.5 6.1 Hospital care 1.731 100.0 64.2 35.8 21.0 14.8 Physicians' services 1.712 100.0 97.7 2.3 1.5 0,8 Dentists' services 772 100.0 97.5 2.5 1.6 0.9 Other professional services 135 100.0 95.6 4.4 2.2 2.2 Drugs and drug sundries 1,397 100.0 98.9 1.1 0.7 0.4 Eyeglasses and appliances 306 100.0 98.7 1.3 0.7 0.7 Nursing home care --- 100.0 --- --- - -- Other health services 330 100.0 12.4 87.6 56.7 30.9

1970

Total 10.356 100.0 76.1 23.9 14.2 9.7 Hospital care 3.439 100.0 58.2 41.8 24.3 17.5 Physicians' services 2.737 100.0 89.6 10.5 5.7 4.7 Dentists* services 1,188 100.0 93.5 6.5 3.5 3.0 Other professional services 183 100.13 78.7 21.3 13.1 8.2 Drugs and drug sundries 1,883 100.0 96.4 3.6 1.9 1.7 Eyeglasses and appliances 309 100.0 96.1 3.9 2.3 1.6 Nursing home care 61 100.0 --- 100.0 45.9 54.1 Other health services 556 100.0 10.3 89.8 61.3 28.4

1976

Total 16,590 100.0 71.1 28.9 19.3 9.7 Hospital care 5,992 100.0 54.4 45.6 32.7 12.9 Physicians' s4rvices 4,252 100.0 82.9 17.1 9.9 7.2 C-tntists' services 0.209 100.0 90.4 9.6 5.2 4.4 Other profes.-aonal services 4;14 100.0 63.1 36.9 22.6 14.3 Drugs and drug sundries 2,47k. 100.0 93.7 6.4 3.5 2.8 Eyeglasses and appliances 416 100.0 95.4 4.6 3.1 1.4 Nursing home care 55 100.0 --- 100.0 52.7 47.3 Other health services 880 100.0 10.7 89.3 56.5 32.8

1977

Total 18,259 100.0 71.5 28.5 18.7 9.8 Hospital care 6,551 100.0 54.6 45.4 32.2 13.1 Physicians' services 4,771 100.0 84.4 15.6 9.1 6.5 Dentists' services 2,493 100.0 91.4 8.6 4.7 3.9 Other professional services 352 100.0 48.9 51.1 29.8 21.3 Drugs and drug sundries 2,624 100.0 94.3 5.8 3.2 2.6 Eyeglasses and appliances 439 100.0 95.2 4.8 3.2 1.6 Nursing home care 61 100.0 3.3 96.7 50.8 45.9 Other health services 968 100.0 10.6 89.4 53.2 36.2

1978

Total 19.875 100.0 71.4 28.7 18.9 9.8 Hospital care 7,070 100.0 54.2 45.8 32.4 13.3 Physicians' services 5.215 100.0 84.0 16.0 9.3 6.7 Dentists' services 2,780 100.0 91.6 8.4 4.5 3.9 Other professional services 398 100.0 48.5 51.5 29.7 21.9 Drugs and drug sundries 2.823 100.0 93.9 6.1 3.4 2.7 Eyeglasses and appliances 481 100.0 95.4 4.6 3.1 1.5 Nursing home care 68 100.0 1.5 98.5 51.5 47.1 Other health services 1,040 100.0 10.9 89.1 56.6 32.5

NOTE: Data vA-ve compiled by the Health Care Financing Administration.

SOURCE: Fisher. C. G.: Differences by age groups in health care spending. Health Care Financing Review l(4):65-90, Spring 1980.

285
TABLE 104. Personal Health Care Expenditures for Children and Youths Under

Selected Years

Year and Source of Funds

Type of Expenditure

1965 1970

Total Private Public Total Private Public

Aggregate amount in millions of dollars

Total $6,383 $5,391 $992 $10.356 $7,878 $2,475.

Hospital care 1,731 1.111 620 3.439 2,001 1,43E

Physicians' services 1,712 1.673 39 2.737 2,451 28

Dentists' services 772 753 19 1.188 1,111 7'.

Other professional services 135 129 6 183 144 3!

Drugs and drug

sundries 1,397 1,382 15 1,883 1.816 6"

Eyeglasses and

appliances 306 302 4 309 297 1:

Nursing-home care - -- '' ... 61 6.

Other hearth

services 330 41 289 556 57 49!

Per capita amount

Total $83.02 $70.12 $1 2.90 $137.68 $104.73 $32.9

Hospital care 22.91 14.45 8.06 45.72 26.60 19.1

Physicians' services 22.27 21.76 0.51 36.39 32.58 3.8-

Dentists' services 10.04 9.79 0.25 15.80 14.77 1.0.

Other professional services 1.76 1.68 0.08 2.43 1.91 6.5.

Drugs and drug

sundries 18.17 17.98 0.20 25.03 24.14 0.8

Eyeglassrss and

appNances 3.98 3.93 0.05 4.11 3.95 0.1

Nursing-home care --- 0.81 0.8

Other health

services 4.29 0.53 3.76 7.39 0.76 6.E

Percent distribution

Total 100.0 100.0 100.0 100.0 100.0 100.

Hospital care 27.1 20.6 62.5 33.2 25.4 58_

Physicians' services 26.8 31.0 4.0 26.4 31.1 11

Dentists' services 12.1 14.0 1.9 11.5 14.1 3

Other professional services 2.1 2.4 0.6 1.8 1.8 1

Drugs and drug

sundries 21.9 25.6 1.6 18.2 23.1 2

Eyeglasses and

appliances 4.8 5.6 0.4 3.0 3.8 01

Nursing-home care --- 0.6 2

Other health

services 5.2 0.8 29.1 5.4 0.7 20

NOTE: Data were compiled by the Health Care Finance Administration.

SOURCE: Fisher, C. FL: Differences by age groups in health care spending. Health Care Flnancin!

Reviewl(4):65-90, Spring 1980.

286
airs of Age, According to Source of Fund* and Type of Expenditure: United Slates, 1965-78

Year and Source of Funds

1976 1977 1978

Total Private Public Tdtal Private Public Total Private Public

Aggregate amount in million..ir of dollars

116,590 $11,789 $4,801 518,259 $13,053 $5,206 $19,875 $14,180 $5,696 5,992 3,261 2.731 '6,551 3,578 2,973 7,070 3,835 3,235 4,252 3,526 726 4,771 4,027 744 5,215 4,382 833 2,209 1,997 212 2,493 2,279 214 2,780 2,546 234

314 198 116 352 172 180 398 193 205

2,472 2,315 157 2,624 2,472 151 2,823 2,650 173

416 397 19 439 418 21 481 459 22 55 55 'at 2 59 68 1 67

880 94 786 968 103 865 1,040 113 927

Per capita amount 232.34 $165.10 $67.24 $258.77 $184.99 $73.78 $286.07 $204.10 $81.99 83.92 45.67 38.25 92.84 50.71 42.13 101.76 55.20 46.56 59.55 49.38 10.17 67.61 57.07 10.54 75.06 63.07 11.99 30.94 27.97 2.97 35.33 32.30 2.55 40.01 36.65 3.37

4.40 2.77 1.62 4.98 2.44 3.03 5.73 2.78 2.95

34.62 32.42 2.20 37.19 35.05 2.14 40.63 38.14 2.49

5.83 5.56 0.27 6.22 5.92 0.30 6.92 6.61 0.32 0.77 - -- 0.77 0.86 0.03 0.84 1.00 0.01 0.96

12.32 1.32 11.00 13.72 1.46 12.30 14.97 1.63 13.34

Percent distribution

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 36.1 27.7 56.9 35.9 27.4 56.9 35.6 27.0 56.8 25.6 29.9 15.1 26.1 30.8 14.2 26.2 30.9 14.6 13.3 16.9 4.4 13,6 17.5 4.1 14.0 18.0 4.1

1.9 1.7 2.4 1.9 1.3 3.5 2.0 1.4 3.6

14.9 19.6 3,3 14.4 18.9 2.8 14.2 18.7 3.0

2.5 3.4 0.4 2.4 3.2 0.4 2.4 3.2 0.4 0.3 ........ 1.1 0.3 ........ 1.1 0.3 0.0 1.2

5.3 0.8 16.4 5.3 0.8 16.7 5.2 0.8 16.3

287
TABLE 105. Estimated Personal Health Care Expenditures Under Public

Programs for =didn't's and Youths Under 19 Years of Age, According to Program and Source of Funding: United States,

1965-78 Selected Yews

Year

Program and Funding 1965 1970 1976 1977 1978

Expenditures in millions of dollars

All public programs $922 $2,492 $4,801 $5,206 $5,696

Federal 603 1,484 3,194 3.413 3,757

State and local 389 1.008 1,607 1,793 1,939

Major program areas Medicare 17 25 30

Medicaid, total M 913 2.534 2,849 3,142

Federal OW M. 41. 500 1,432 1,605 1,751

State and local 413 1,102 1,244 1,391

Other public medical assistance, total 217 82 83 93 100

Federal 140

State and local 77 72 83 93 100

Veterans Administration

Department of Defense 354 656 811 788 823

Workers compensation medical benefits, total Federal employees am. State and local

employees State and local

hospitals (net) 185 316 23 88 85

Other public expenditures

for personal health

care, total 237 534 1,273 1,363 1,515

Federal 109 327 935 995 1,151

State and local 128 207 338 368 364

NOTE: Data were compiled by the Health Care Finance Administration.

SOURCE: Fisher, C. G.: Differences by age groups in health care spending. Health Care Financing

Review 1(4):65-90, Spring 1980.

288
TABLE 1O IL Per Capita P04110C11111 Heatth Cere Expenditures, According to Source of Funds, Age, and Type of Expenditure: United States,

19711

Source of Funds

Ago and Type 44 Expenditure

Per Capita Amount in

Dollars

and Cents Total Private

Public

Total Federal

State

and

Local

AH ages Percent distribution of dollars

Total expenditures $752.98 100.0 61.3 38.7 27.7 11.0

Hospital care 340.93 100.0 46.2 53.8 39.9 13.9

Physicians' services 158.08 100.0 73.2 26.8 20.1 6.7

Dentists' services 59.64 100.0 96.0 4.1 2.3 1.7

Other professional services 19.17 100.0 77.3 22.7 15.8 6.9

Drugs and drug sundries 67.70 100.0 91.4 8.6 4.4 4.2

Eyeglasses and appliances 17.40 100.0 90.8 9.2 7.4 1.9

Nursing home care 70.64 100.0 46.9 53.1 29.9 23.1 Other health services 19.43 100.0 27.1 72.9 56.3 16.6

Under 19 years Total expenditures $286.07 100.0 71.4 28.7 18.9 9.8

Hospital care 101.76 100.0 54.3 45.8 32.4 13.3

Physicians' services 75.06 100.0 84.0 16.0 9.3 6.7

Dentists' services 40.01 100.0 91.6 8.4 4.5 3.9

Other professional services 5.73 100.0 48.5 51.5 29.7 21.9

Drugs and drug sundries 40.63 100.0 93.9 6.1 3.4 2.7

Eyeglasses and appliances 6.92 100.0 95.5 4.6 3.1 1.5

Nursing home care 1.00 100.0 1.0 96.0 51.5 47.1

Other health services 14.97 100.0 10.9 89.1 56.6 32.5

19-64 years Total expenditures $753.96 100.0 71.5 28.6 16.2 12.4

Hospital care 369.98 100.0 59.9 40.1 22.8 17.3

Physicians' services 163.56 100.0 84.3 15.7 6.9 8.8

Dentists' services 70.75 100.0 97.1 2.9 1.7 1.2

Other professional services 21.58 100.0 89.0 11.0 5.0 6.1

Drugs and drug sundries 70.02 100.0 93.1 6.9 3.4 3.5

Eyeglasses and appliances 21.62 100.0 95.2 4.8 2.5 2.3

Nursing home care 23.67 100.0 19.7 80.4 44.0 36.4

Other health services 22.72 100.0 35.0 65.0 54.6 10.5

65 years and over Total expenditures $2,026.19 100.0 36.9 63.2 54.3 8.9

Hospital care 868.86 100.0 12.5 87.5 81.1 6.4

Physicians' services 365.70 100.0 40.6 59.4 57.5 1.9

Dentists' services 56.76 100.0 96.8 2.9 2.0 1.2

Other professional services 44.74 100.0 57.9 42.1 38.6 3.5

Drugs and drug sundries 132.61 100.0 84.4 15.6 8.2 7.4

Eyeglasses and appliances 24.83 100.0 66.9 33.2 32.9 0.3

Nursing home care 518.14 100.0 53.8 46.2 26.4 19.8

Other health services 14.53 100.0 9.9 90.2 69.8 20.3

NOTE: Data are compiled by the Health Care Financing Administration.

SOURCE: Fisher. C. R.: Differences by age groups in health care spending. Health Care Financing Reviaw. 1(0:65-90, Spring 1930.

30,E 289
TABLE 107. Amount for All Basic Needs as Defined by the State Need Standard and Amount of Monthly AFDC Payment to a Family With No Countable income After Application by State of Any Method of Limiting Payment Used, According to Family Size and State: United States, April 1, 1978

State

Two - Person Family' Four-Person Family

State Need

Standard

for All

Basic Needs

Assistance

Payment to a Family With No income

State Need

Standard

for All

Bilslc Needs

Assistance

Payment to a Family With No income

Northeast

New England

Amount in dollars

Connecticut $266 $266 $384 $384

Maine 205 185 349 314

Massachusetts 251 251 358 358

New Hampshire 263 263 346 346

Rhode Island 255 255 359 359

Vermont 412 311 560 423

Middle Atlantic

New Jersey 235 235 356 356

New York 333 333 476 476

Pennsylvania 260 260 373 373

North Central

East North Central

Illinois 204 204 300 300

Indiana 247 175 363 275

Michigan 319 319 459 459

Ohio 284 176 431 267

Wisconsin 371 315 520 442

West North Central

Iowa -257 257 369 369

Kansas 216 216 306 306

Minnesota 286 286 404 404

Missouri 250 163 365 237

Nebraska 250 250 370 370

North Dakota 247 247 389 389

South Dakota 252 252 333 333

South

South Atlantic

Delaware 181 181 287 287

District of Zolumbia 226 203 349 314

Florida 150 125 230 191

Georgia 161 105 227 148

Maryland 203 162 314 251

North Carolina 159 159 200 200

South Carolina 138 75 217 117

Virginia 174 157 272 245

West Virginia 219 164 332 249

East South Central

Alabama 144 89 240 148

Kentucky 135 135 235 235

Mississippi 188 330 252 360

Tennessee 142 91 217 139

West South Central

Arkansas 193 133 273 188

Louisiana 240 496 410 41 64

290 3 j3
TABLE 107. Amount for All Basic Needs as Defined by the State Need StmrJard and Amount of Monthly AFDC Payment to a Family With No Countable Income After Application by State of Any Method of Umltin.2 Payment Used, According to Family ri:mc and State: United States, April 1, 1978 (ConL)

Two-Person Family* Four-Person Family2

State

State Need

Standard fix All

Basic Needs

Assistance

Payment to a Family With No income

State Need

Standard

for All

Basic Needs

Assistance

Payment to a Family With No Income

Amount in dollars

Oklahoma 198 198 309 309

Texas 115 86 187 140

West

Mountain

Arizona 180 126 282 197

Colorado 189 189 290 290

Idaho 289 251 395 344

Montana 163 163 252 252

Nevada 229 185 341 276

New Mexico 160 147 239 220

Utah 297 229 457 352

Wyoming 210 210 270 270

Pacific

Alaska 300 300 400 400

California 297 287 444 423

Hawaii 382 382 533 533

Oregon 304 277 470 428

Washington 292 292 416 416

TA two-person family consists of one needy adult and one child. 2A four-person family consists of one needy adult and three children. 3Mississippi increased its payments to 360 for a two-person 4Louisiana increased its payments to 3101 for a two-person family and 5172 for a four-person family

in May 1978.

NOTE: Data are based on reporting by States.

SOURCE: Office of Family Assistance, Social Security Administration: Characteristics of State Plans

for Aid to Families with Dependent Children. DHEW Pub. No. (FSA) 78-21235. Washington. U.S. Government Printing Office, 1978.

291
TABLE 108. Odd to Families with Dependent Children (AFDC) and Medicaid

Recipients Under 18 Years of Age and Average Monthly AFDC

Payments per Family and per Recipient, According to State: United

States, 1975 (AFDC Recipients), 1973 (Payments), and 1980

(Medicaid Recipients)

State

Poor children' Average Monthly

Receiving AFDC Payment

Per Per

AFDC Medicaid Family Recipient

Percent of

poor children Payment in dollars

United States 44 48 $252 $84

Northeast

New England Connecticut 52 54 315 104

Maine 50 48 213 71

Massachusetts 74 72 323 109

New Hampshire 41 51 234 81

Rhode Island 62 61 286 95

Vermont 48 49 282 92

Middle Atlantic

New Jersey 54 60 287 89

New York 57 66 375 120

Pennsylvania 50 60 285 93

North Central -, East North Central

Illinois 64 62 266 81

Indiana 36 34 191 64

Michigan 59 65 332 107

Ohio 54 57 213 72

Wisconsin 36 43 318 113

West North Central

Iowa 35 37 281 97

Kansas 37 43 235. 88

Minnesota 30 39 297 107

Missouri 50 45 178 60

Nebraska 24 23 263 90

North Dakota 22 22 248 88

South Dakota 19 21 203 70

South

South Atlantic

Delaware 52 56 215 74

District of Columbia 69 74 239 81

Florida 25 34 145 51

Georgia 44 43 107 39

Maryland 53 60 193 67

North Carolina 32 39 157 58

South Carolina 34 37 87 30

Virginia 32 37 195 69

West Virginia 38 43 193 67

East South Central

-Alabama 42 39 112 37

Kentucky 30 33 168 60

Mississippi 47 40 52 16

Tennessee 37 44 109 39

292
TABLE 108. Aid to Families with Dependant Children (AFDC) and Medicaid Recipients Under 18 Years of Ago and Average Monthly AFDC

Payments per Family and per Recipient, According to State: United States, 1975 (AFDC Recipients), 1978 (Payments), and 1980

(Medicaid Recipients) (Cont.)

State

Poor Children' Average Monthly Receiving AFDC Payment

Per Per

AFDC Medicaid Family Recipient

West South Central

Percent of

poor children Payment in dollars

Arkansas 26 31 148 49 Louisiana 43 41 128 39 Oklahoma 27 33 214 70 Texas 24 25 108 34

West

Mountain

Arizona 28 ... 114 45:: Colorado 45 46 208 74 Idaho 28 30 253 90 Montana 19 26 187 67 Nevada 31 29 184 66 New Mexico 30 33 161 52 Utah 35 36 263 90 Wyoming 19 20 205 78 Pacific

Alaska 32 34 306 117 Caltornia 58 61 319 107 Hawaii 46 54 380 119 Oregon 36 47 282 102 Washington 48 51 301 105

'Poor children are defined as thr: .r,!. under 18 years of age living in families with incomes (excluding Federal cash assistance payr-ic..-!-.,.1 vaiow the national poverty standard.

NOTES: Data arts based on household interviews of a sample of the civilian noninstitutionalized population and on reporting by States. The percent of poor children receiving AFDC is the 1975 actual percent. The percent of poir children receiving Medicaid is based on 1975 poverty data projected to 1980 leveds and 1980 estimates of Medicaid recipients. The average monthly AFDC payments are actual FY 1978 data.

SOURCES: U.S. Bureau of the CGrisus: 1975 Survey of Income and Education. Selected data; Office of Child Health, Health Care Financing Administration: 1978 reportingby States.

293
TABLE 109. Medicaid Coverage for Prenatal Care to Low-Income Women Who

are Pregnant for the First Time; According to State: United States,

197$

State

Medicaid

Coverage of Prenatal Care State

Medicaid

Coverage of Prenatal Caro

Northeast South Atlantic

New England Georgia 0

Connecticut 0 Maryland 2

Maine North Carolina 0

Massachusetts 3 South Carolina 1

New Hampshire 0 Virginia 1

Rhode Island 2 West Virginia 2

Vermont 3 East South Central

Middle Atlantic Alabama 0

New Jersey 0 Kentucky 2

New York 3 Mississippi 0

Pennsylvania 3 Tennessee 2

West South Central

North Central Arkansas 0

East North Central Louisiana 2

Illinois O Oklahoma 0

Indiana 0 Texas 0

Michigan 0

Ohio 1 West

Wisconsin 3 Mountain

West North Central Arizona

Iowa 0 Colorado 1

Kansas 2 Idaho 0

Minnesota 3 Montana 2

Missouri 0 Nevada 1

Nebraska 2 New Mexico 1

North Dakota 2 Utah 3

South Dakota 1 Wyoming 0

Pacific

South Alaska 1

South Atlantic California 3

Delaware 1 Hawaii 3

District of Columbia 2 Oregon 1

Florida 0 Washington 3

KEY: 0 A. no coverage; 1 coverage of categorically needy women only; 2 coverage of

categorically needy and medically needy women; 3 coverage of categorically and medically

needy women and women in low-income, two-parent families.

1These women are not yet eligible for Aid to Families with Dependent Children or Medicaid's

medically needy program because they have no dependent children.

NOTE: Data are based on reporting by States.

SOURCE: Office of Child Health, Health Care Financing Administration: 1978 Medicaid State Plan

data.

294
TABLE 110, Medicaid Coverage for Vision and Dental Services, According to State: United States, 1978

Comp of Annual Limits Coverage of Umib on Optometry and on Pairs of Dental Mote Dental Vision Exams' Eyeglasses Services' Coverage

Northeast

New. England

Connecticut yes 1 pair yes Maine no after surgery no, under EPSDT

yes Massachuseits no, under EPSDT

yes no

yes New Hampshire no

yes no

yes Rhode island emergency only yes no Vermont yes not no

10 no Middle Atlantic ... New Jersey

yes no ew York .yes no

yes no

yes Pennsylvania no

yes yes yes not

North Central

East North Central

Illinois

yes no yes Indiana no

yes no yes Michigan not

yes 1 pair yes Ohio no

yes no Wisconsin yes no

yes no West North Central yes no

Iowa

yes no

yes Kansas not

yes no

yes Minnesota yes

Yes no Missouri PG no

yes no ye Nebraska not yes no North Dakota yes no yes 1 pair yes South Dakota not no

yes

no2

14 South

4:

South Atlantic ch

Delaware

no 1 pair, under EPSDT

no District of Columbia yes 1 pair yes emergency only
TABLE 110, Medicaid Coverage for Vision and Dental Services, According to State: United States, 1978 (Cont.)

Coverage of Annual Limits Coverage of Limits on

Optometry and on Pairs of Dental Dental

State Vision Exams' Eyeglasses Services' Coverage

Florida no no Georgia no 1 pair, under EPSDT yes emergency only

Maryland yes 1 pair yes emergency only

North Carolina yes no yes no South Carolina yes no yes emergency only

Virginia yes 1 pair no ... West Virginia yes 1 pair yes emergency only

East South Central

Alabama yes 1 pair no Kentucky no 1 pair, under EPSDT no Mississippi after surgery yes yes emergency only

Tennessee no .. yes emergency only

West South Central

Arkansas yes no yes no Louisiana yes no no ,

Oklahoma no .. yes emergency only

Texas after surgery yes no West

Mountain

Arizona ...

Oss

SOO

11.

Colorado

Idaho

Montana

Nevada

New Mexico

Utah

Wyoming

Pacific

Alaska

California

after surgery no Yes

Yes

Yes no Yes

Yes

Yes

110 Yes yes surgery only no 1 pair yes no,

Yes yes emergency only

Yes Yes not

Yes emergency only

Yes no

ho no Yes nog

110

111
Hawaii

Oregon

Washington

yes

Yes

Yes

Yes nono

Yes no Yes

no

tti

'Changes In regulations in 1978 made children eligiblefor direct referral underEPSDT if servicewas requested by parent or guardian. 2Slate has reportedno limits.

NOTE: Data are based on reporting by States. EPSDT is the Early and Periodic Screening, Diagnosisand Treatment program. SOURCE: Office of Child Health, Health Care FinancingAdministration: 1978 Medicaid State Plan data,

31J
TABLE 111. Children Under 5 Years of Age and Pregnant Women who are Financially Eligible for, and Percent Served by the Special Supplemental Food Program for Women, Infants, and Children, According to State: United States, 1975 (Eligible) and January 1980 (Percent Served)

Children under 5

Total Years of Age Pregnant Women

State

Number

Eligible

Percent

Served

Number

Eligible

Percent

Served

Number

Eligible

Percent

Served

United States 8;696,085 20.3 7,246,454 18.9 1,449,631 27.1

Northeast . Now England Connecticut 83,472 38.6 69,560 38.5 13,912 38.9

Maine 45,908 26.1 38,757 24.9 7,151 32.3

Massachusetts 191,604 16.0 159,670 15.0 31,934 20.8

New Hampshire 28,404 15.7 23,670 15.5 4.734 16.6

Rhode Island 28,200 24.7 23,500 23.5 4,700 30.4

Vermont 22,428 71.7 18,690 68.2 3,738 89.5

Middle Atlantic

New Jersey 237,000 18.9 197,500 18.4 39,500 21.6

New York 541,822 22.3 451,518 21.0 90,304 28.5

Pennsylvania 406,924 15.0 335,770 14.9 71,154 15.5

North Central

East North Central

Illinois 386,340 17.7 321,950 14.5 64,390 18.2

Indiana 205,056 11.4 170,880 10.5 34,176 15.8

Michigan 323,860 17.8 271,550 17.4 54,310 19.3

Ohio 435,492 19.3 362,916 18.7 72,582 22.1

Wisconsin 137,988 22.5 114,990 21.5 22,998 27.4

West North Central

Iowa 90,780 20.5 75,650 19.7 15,130 24.3

Kansas 76,596 17.1 63,830 15.0 12,766 20.8

Minnesota 139,152 18.5 115,960 17.8 23,192 22.0

Missouri 161,064 20.1 134,220 18.2 26,844 30.0

Nebraska 54,800 18.0 45.667 17.5 9,133 21.3

North Dakota2 24,050 29.0 20,042 28.9 4,008 29.3

South Dakota 29,910 17.7 24,925 13.4 4,985 19.0

South

South Atlantic

Delaware 18,564 22.3 15,470 22.7 3,094 20.2

District of Columbia

Florida 338,190 17.8 281,826 15.5 56,364 28.9

Georgia 250,152 23.2 208,460 22.0 41,692 28.9

Maryland 122,604 29.1 102,170 27.6 20,434 41.5

North Carolina 236,393 32.1 196,994 30.6 39,399 39.5

South Carolina 145,364 34.9 121,120 34.3 24,244 38.0

Virginia 151,676 28.6 127,230 26.5 24,446 39.8

West Virginia 81,372 20.5 67.810 20.0 13,562 23.3

East South Central

Alabama 186,432 25.6 155,360 26.1 31.072 22.7

Kentucky 158,416 28.0 132,080 19.3 26,416 33.4

Mississippi 144,280 35.4 120,233 36.5 24,047 29.4

Tennessee 195,024 24.3 162,520 23.8 32.504 26.7

3 1 I

298
TABLE 111. Children Under 5 Years of Age and Pregnant Women who are Financially Eligible for, and Percent Served by the Special Supplemental Food Program for Women, Infants, and Children, According to State: United States, 1975 (Eligible) and January 1980 (Percent Served) (Cont.)

State

Total

Children under 5

Years of Age Pregnant Women

Number

Eligible

Percent

Served

Number

Eligible

Percent

Served

Number

Eligible

Percent

Served

West South Central

Arkansas 121,992 13.4 101,660 12.8 20,332 15.7 Louisiana 198,708 27.9 165,590 26.9 33,118 33.1 Oklahoma 109,831 19.5 91,526 16.6 18,305 34.2 Texas 702.180 15.3 585.150 14.3 117,030 20.1

West

Mountain

Arizona 121,140 30.8 100.950 28.8 20,190 45,5 Colorado 94,380 19.4 78,650 18.0 15,730 26.1

Idaho 44,520 19.2 37,100 18.6 7.420 22.2

Montana 31,428 40.0 26,190 37.2 5,238 53.8

Nevada 24.290 33.3 20,242 30.8 4,048 45.6

New Mexico2 69,662 14.1 57,968 10.8 11,594 30.5

Utah 82,824 18.4 69,020 17.3 13,804 23.5

Wyoming ... Pacific

Alaska 10,866 8.9 9,055 8.1 1,811 12.9 California 765,072 16.3 637,560 13.7 127,512 29.1

Hawaii 33,948 11.5 28.290 11.7 5,658 10.4 Oregon 83,256 24.2 69,380 19.8 13,876 45.8

Washington 127,404 20.7 106,170 18.5 21,234 32.1

Indian Nations 29,776 56.8 23.677 57.1 6,099 55.4

'Under 200 percent poverty. 2For North Dakota and New Mexico, the percent served isas of February, 1980.

NOTES: Data are based on updates of the decennial census and reporting by States. The number of eligibles does not take into account nutritional risks,, which, along with low income, qualify a

person to receive program benefits. Persons who are nutritional risks are included in the percent served, however.

SOURCE: Supplemental Food Programs Division, Food and Nutrition Service: Data tabulated from

reporting by State programs.

3 I r)

299
TABLE 112. Health insurance Coverage of Children and Youths Under 18 Years

of Age, According to Selected Characteristics: United States,

1975-76 Annual Average

. Characteristic Population

in Thousands Total

He th insurance

Coverage

Covered

Not

Covered

Total under Percent distribution of popAlaton

18 years of age, 65,722 100.0 76.0 24.0

AgeUnder 6 years 19,217 100.0 70.8 29.2

6-11 years 21,471 100.0 75.3 24.7

12-17 years 25,034 100.0 77.5 22.5

Sex

Male 33,436 100.0 75.1 24.9

Female 32.286 100.0 74.5 25.5

Race

White 54,967 100.0 79.3 20.7

Black 9,831 100.0 50.2 49.8

Other 924 100.0 67.1 33.0

Family income Under $5,000 7,707 100.0 27.2 72.8

55,000-59,999 13.634 100.0 60..4 39.6

$1 0,0M-41 4,999 15,647 100.0 85.7 14.3

$15,000 or more 23,776 100.0 92.5 7.5

Parental presence Both parents present 52.732 100.0 83.0 17.0

Mother only present 10,126 100.0 47.7 52.3

Neither parent present 2,204 100.0 46.2 53.8

Education of family head 8 years or less 10,945 100.0 52.3 47.8

9-11 years 11.552 100.0 61.4 38.6

12 years 23.053 100.0 80.2 19.9

13-15 years 8,946 100.0 84.3 15.7

16 or more years 10,578 100.0 93.9 6.1

Family size 3 or fewer persons 11.593 100.0 71.8 28.4

4 persons 18,842 100.0 80.2 19.8

5 persons 15,228 100.0 79.2 20.8

6 or more persons 20,059 100.0 68.2 31.8

Residence

Within SMSA 47,907 100.0 76.1 23.9

Large SMSA 26,192 100.0 76.8 23.2

Core counties 17,203 100.0 72.0 28.0

Fringe counties 8,989 100.0 86.1 13.9

Medium SMSA 15,196 100.0 75.8 24.2

Other SMSA 6.519 100.0 73.8 26.2

Outside SMSA 17,815 100.0 71.4 28.6

Adjacent to SMSA 11.795 100.0 72.2 27.8

Not adjacent to SMSA 6,020 100.0 70.0 30.0

300

3 3
TABLE 112. Health Insurance Coverage of Children and Youths Under 18 Years of Age, According to Selected Characteristics: United States, 1975-76 Annual Average ,(Cont)

Characteristic

Health Insurance

Coverage

Population Not in Thousands Total Covered Covered

Region

Percent distribution of population

Northeast 14,700 100.0 79.0 21.0 North Central 17,545 100.0 82.8 17.2 South 21,644 100.0 67.8 32.2 West 11.833 100.0 70.6 29.4

'Includes children living with father only and unknown family income and education of head, not shown as separate categories. noninstitutionalized population.

NOTE: Data are based on household interviews of a sample of the civilian noninstitutionalized

population.

SOURCE: Division of Health Interview Statistics. National. Center for Health Statistics: Data from the Health Interview Survey.

31

301
TAM 113. HO Care Coverage of Children and Youths Under 18 Years of Age, According to Type of Coverage and Selected

Characteristics; United States, 1916

Type of Coverage'

Private Insurance'

or Medicare' Medicaid' Other Programs' No Insurance

Number of Percent timber of Percent Number of Percent Number of Percent

Persons In of Persons In of Persons In of Persons In of

Chwactedstic Thousands Population Thousands Population Thousands Population Thousands Population

Total under 18 yearso 48,197 73.9 6,662 10.2 2,004 3.1 7,577 11.6

Age

Under 6 years 13,237 70.0 2,373 12.5 631 3.3

6-11 years 15,906 74.6 2,259 10.6 596 2.8

12-17 years 19,054 76.4 2,030 8.1 777 3.1

2,469

2,317

2,791

13.1

10.9

11.2

Sex

Male 24,708 74,5 3,361 10.1 1,005 3.0 3,751 11,3

Female 23,489 73.4 3,301 10.3 999 3.1 3,826 12.0

Color

Mite 42

All other 5,498

78.5 3,547 6.5 1,718 3.2 5,845 10.7

51.0 3,115 28.9 286 2.7 1,732 16.1

Family income

Under $5,000 1,734 24.8 3,293 47.1 61 0.9 1,801 25.8

$5,00049,999 7,536 58.2 2,006 15.5 500 3.9 2,751 212

$10,000- 514,999 12,634 84.3 429 2.9 587 3.9 1,192 7.9

$15,000 or more 22,381 91.9 n. 672 2.8 848 3.5
Residence

Within SMSA

Central city 11,769 65.4 3,333 18.5 528 2.9 2,192 Outside central city 12,2 21,371 81,8 1,629 6.2 794 3.0 Outside SMSA 1,996 7.6

Nonfarm 13,594 71.6 1,637 8.6

Farm 646 3.4 2,869 15,1 1,463 69.9 62 3.0 36 1,7 521 24.9

w

Region

Northeast 11,317 78,2 1,933 13.4 120 0.8 North Central 941 6,5 14,257

Sou lh 144

81,9 1,573 9.0 142 0.8 1,292 7,4 66.9 1,921 9.0 1 I; ; 5.1 3,781 West 17.6 8;267 69.7 1,235 10.4 653 5.5 1,563 13,2

Includes 432,944 childrenand youths who had hospital insurance, but the kind of coverage was unknown, and 311,817 who did not know if they were covered by health Insurance.

Includes all persons withprivate hospital insurance coverage whether or not they have other coverage (e.g., Medicaid) as well, Includes those who haveMedicare with no other public or private coverage,

Include* those who did not have private insurance or Medicare, and reported either (1) receipt of Medicaid services in the previous year, (2) eligibility for Medicaid as a

reason for not having other coverage, or (3) receipt of benett payments under Aid to Families with Dependent Children or Supplemental Security Income in the past year. Includis military (Civilian Health and Medical Program of the Uniformed Services), Veterans Administration, private surgical coverage only, and professional courtesy as reasons for holding no other type ofpublic or privatecoverage.

Includes unknown familyIncome, not shorn as a separate category,

?Pers= with high incomes can qualify for Medicaid in at least two ways: (1) previous year's income was high, yet family dissolution or catastrophic Illness during the current year could result inMedicaid eligibility; (2) in certainStates, large families*Incomes In excess of S15,000 could qualify for Medicaid coverage. NOTES: Data are based on household Interviews of a sample of the civilian noninstitutIonalized population. To avoid multiple counting of Individuals, these estimates were derived by assigning each individual to one coverage category only. Persons with both private Insurance and Medicare, for example, were placed in the private Insurance category, As a result, Medicare and Medicaid estimates do not correspond to counts available fromthose programs.

SOURCE: Division of Health Interview Statistics, National Centerfor Health Statistics: Datafrom the Health Interview Survey.

316
TABLE 114, Sources of Payment for Ambulatory Cue tor Children and Youths Under 18 Yen of Age With Ambulatory Care In the

Put Year, According to Selected Characteristics: United States, 1974

CharectrIstIc

Source of Payment,

Population Public Payment

With

Ambulatory Private Other

Care In Health Medicaid or Public Direct Other and

Population Past Year Insurance Total WIN germs Payment Unknown

In titOusands Percent of population with ambulatory care

Total under 18 years2 67,247 50,1: 27,2 14.8 11.0 3.9 78.5 6.0

Age

Under 6 years 19,649 17,517 26.7 17.0 12.8 4.3 79.5 4.8

6-11 years 22,155 15,257 27.1 13.9 10.7 3.2 79.4 5,4

12-17 years 25,443 17,312 27.8 13.5 9.6 4.0 76.6 7.7

Sex

Male

Female

Race

White

Black

Other

34,239 25,550 29,6 14.1 10.3 3.9 78.4 6.1

33,008 24,536 24.7 15.6 11.8 3.9 78.5 5.8

56,493 42,764 28.9 11,2 7.3 4.0 82.5 5.3

9,628 6,451 14.5 38.9 36.1 3.2 51.9 9,9

1,125 870 , 36.1 15,0 10.0 5.0 74,9 10.5

Health status

Excellent or good 63,759 47,170 27.0 13.9 10.1 3.9 79.2 5.9

Fair or poor 3,129 2,655 30.8 12 27.7 3.7 66.1 6.2

"1

.L1
Family Income

Under $5,000

15,004,999

8,029 5,719 6.3 55.2 51.9 3.5 42.4 8.8 15,392

$10,000-$14,999

10,819 22,2 20.5 15.4 5.3 73.8 6.2 18,829 14,229 31.0 7.3

$15,000 or more 3.5 3.9 85,1 5,4 21,287 16,713 35.2 3.9 0.9 3.1 89.0 4.5

Residence

Wit* SMSA 46,097 35,423 28.0 15,3 11,6 3.7 Central city 77.7 5.9 19,227

Outside central city

14,365 24.0 23.8 20.5 3.6 68.4 6.8 26,871 21,058 30,7 9.4

Outside SMSA 5.6 3.8 84.0 5,3 21,150 14,663

Nonfarm

25.3 13.8 9.6 4.2 80.4 6.1 18,669

Farm

13,041 25.6 14.9 10.3 4.6 79.0 6.4 2,481 1,622 22.8 4.8 4.1 0.7 91,9 3.9

Region

Northeast

North Central

South

West

15,187

18,351

21,446

12,263

11,956

13,651

15,560

8,920

26.6

28.0

21.2

37.2

15.2

11.3

16.1

17.6

13.8 1.5

9.6 1.7

10.1 6.1

11.1 6.5

71.2 5.1

81.8 5.5

19.3 6.6

73.6 6.8

iNumbers may not add to 100 because more than one source of payment was possible,

:Includes unknown family Income, not shown as a separate category.

NOTE: Data are based on household interviews ofa sample of the civilian noninstitutionalizedpopulation.

SOURCE: Division of Healthinterview Statistics, National Center for Health Statistics: Data from the Health interview Survey,
TABLE 115. Consumer Price Index,' According to Expenditure Category: United States, 1935-79 Selected Years

Expenditure Category

Year2

All

Items Food

Other

Goods

Trans- Medical Enter- and

Apparel Housing portatlon Care tainment Services

Consumer Price Index

1935 41.1 36.5 40.8 49.3 42.6 36.1 41.8 44.6

1940 42.0 3.5.2 42.8 52.4 42.7 36.8 46.1 48.3

1945 53.9 50.7 61.5 59.1 47.8 42.1 62.4 56.9

1950 72.1 74.5 79.0 72.8 68.2 53.7 74.4 60.9

1955 80.2 81.6 84.1 82.3 77.4 64.8 76.7 79.8

1960 88.7 88.0 89.6 90.2 89.6 79.1 87.3 87.8

1965 94.5 94.4 93.7 94.9 95.9 89.5 95.9 94.2

1966 97.2 99.1 96.1 97.2 97.2 93.4 97.5 97.2

1967 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

1968 104.2 103.6 105.4 104.2 103.2 106.1 104.7 104.6

1969 109.8 108.9 111.5 110.8 107.2 113.4 108.7 109.1

1970 116.3 114.9 116.1 118.9 112.7 120.6 113.4 116.0

1971 121.3 118.4 119.8 124.3 118.6 128.4 119.3 120.9

1972 125.3 123.5 -122.3 129.2 119.9 132.5 122.8 125.5

1973 133.1 141.4 126.8 135.0 123.8 137.7 125.9 129.0

1974 147.7 161.7 136.2 150.6 137.7 150.5 133.8 137.2

1975 161.2 175.4 142.3 166.8 150.6 168.6 144.4 147.4

1976 170.5 180.8 147.6 177.2 165.5 184.7 151.2 153.3

1977 181.5 192.2 154.2 189.6 177.2 202.4 157.9 159.2

1978 195.3 206.2 159.5 202.6 185.8 219.4 176.2 183.2

1978 195.4 211.4 159.6 202.8 185.5 219.4 176.6 183.3

1979 217.4 234.5 166.6 227.6 212.0 239.7 188.5 196.7

'1967 =100.

'Data for 1935-78 are for urban wage and clerical workers. Data for 1978 are repeated for all urban

consumers, a new index introduced by the Bureau of Labor Statistics in January 1978. Data for 1979

are for all urban consumers.

NOTE: Data are based on reporting by samples of providers and other retail outlets.

SOURCE: Health Insurance Institute: Source Book of Health Insurance Data: 1979-1980.

Washington, 1980.

306
TABLE 116, Consumer Price Indell for All Items and Selected Medical Care Components; United States 1984491 Selected Years

Item and Medical

Cam Component

Year

1950 1955 1960 1965 1970 1975 1976 1977 1978 1979

CPI, all items

Less medical care

Consumer Price Index

72.1

11

80.2 88.7 94,5 116.3 161.2 170.5 181.5 195,4 217.4 89.4 94.9 116.1 160,9 169.7 180.3 190 216.1

CPI, 'Al services 58.7 70.9 83.5 92,2 121.6 166.6 180.4 194.3 210.9 234.2

All medical care 53.7 64.8 79.1 89.5 120.6 168.6 184.7 202.4 219.4 239.7

Medical care services 49.2 60.4 74.9 87.3 124.2 179.1 197.1 216.7 235.4 258.3 Professional services

Physicians' fees

General physician, office visit

55.2

54.9

65.4 77.0 88,3 121,4 169.4 188.5 206.0 223,1 243.6

General physician,

65.4 75.9 87.3 122.6 173,9 193,8 212.1 house visit

Tonsillectomy and

52.9 61.2 75.0 87.6 122.4 170.5 189.8 205.7

Obstetrical

adenoldectomy 60.7 69.0 80.3 91.0 117.1 163.3 179.2 200.2 cases

Pediatric care, office visits

51.2 68.6 79.4 89.0 121,8 167.2 192.1 207.8

Dentists' tees

65,8 122.7 172,5 192,7 213,1 63.9 73.0 821 92.2 119.4 161.9 172.2 185.1 198.1 2143 Other professional services

Examination, prescription

and dispensing eyeglasses 73.5 77.0 85,1 92.8 113.5 149.6 158.9 168,2 -

11 1.

e1N 6 6

61.

/16 614

Medical care commodities

Prescription drugs

Supplements, cough and

cold preparations, and

respiratory agents)

92.6 101.6 115.3 102.0 101.2 109.3 115.2 122,1 131.6 141.8

UM. 616 6611 66

103.4 109.6
w TABLE 115, Consumer Price Index' for All Items and Selected Medical Care Components; United States 1950 -19, Selected Years

oo (Conti) gillMilmIM1111111.1w

Rim and Medical

Year2

Care. Component 1950 1955 1960 1965 1910 1975 1976 1977 1918 1979

Selected nonmedical items

Gasoline

Food

Consumer Price Index

117,9 170.8 177,9 188.2 196.3 265.6

108.8 132.4 175.4 180.8 192.2 211.4 234,5

i1967 a 100.

!Data for 1950-77 are for urban wage and clerical workers. Data for 1978 and 1979 are for alt urban consumers, a new index Introduced by the Bureau of Labor Statistics,

Jan, 1978.

3Dec, 1977 100,

NOTE: Data are based on reporting by samples of providers and other retail outlets.

SOURCE: Bureau of Labor Statistics, U.S. Department of Labor: Consumer Price Index. Various releases,

3
TABLE 117. Consumer Price index' for Medical Care Items, According to Expenditure Category: United States, 1947-79 Selected Years

Expenditure Category

Yeara

All

Medical

Care

Hems

Physi- cians`

Fees

Dentists'

Fees Hospital Room

Prescription Drugs

Over the

Counter

Drugs

Consumer Price Index

1947 48.1 51.4 56.9 23.1 ... Ma 1950 53.7 55.2 63.9 30.3 92.6 1955 64.8 65.4 73.0 42.3 101.6 --- 1960 79.1 77.0 82.1 57.3 115.3 1965 89.5 88.3 92.2 75.9 102.0 98.0 1966 93.4 93.4 95.2 83.5 101.8 99.0 1967 100.0 100.0 100.0 100.0 100.0 100.0 1968 106.1 105.6 105.5 113.6 98.3 102.5 1969 113.4 112.9 112.9 128.8 99.6 103.2 1970 120.6 121.4 119.4 145.4 101.2 106.2 1971 128.4 129.8 127.0 163.1 101.3 110.3 1972 132.5 133.8 132.3 173.9 100.9 111.3 1973 137.7 138.2 136.4 182.1 100.5 112.4 1974 150.5 150.9 146.8 201.5 102.9 117.5 1975 168.6 169.4 161.9 236.1 109.3 130.1 1976 184.7 188.5 172.2 268.6 115.2 138.9 1977 202.4 206.0 185.1 299.5 122.1 148.5 1978 219.4 223.3 199.3 331.6 132.1 159.1 1978 219.4 223.1 198.1 332.4 131.6 159.0 1979 239.7 243.6 214.8 370.3 141.8 170.7

11967 - 100.

Mats for 1935-78 are for urban wage and clerical workers. Data for 1978 are repeated for all urban consumers, a new index introduced by the Bureau of Labor Statistics in January 1978. Data for 1979 are for all urban consumers.

NOTE: Data are based on reporting by samples of providers and other retail outlets.

SOURCE: Health insurance Institute: Source Book of Health Insurance Data: 1979-1980. Washington, 1980.

2 ) 0

...0 *10

309
TABLE 118. Annual Percent Change In the Consumer Price Indox,lAccordIng to Expenditure Category: United States, 1947-79 Selected Years

Expenditure Category

Year

All

Items

All

Medical

Care

Items

Physi- clans'

Fees

Dentists'

Fees Hospital Room

Pressed p- don

Drugs

Over

the

Counter

Drugs

Annual percent change

1947 14.4 8.3 6.4 8.4 17.3 9.9

1950 11.0 1.9 1.5 2.4 3.4 2.7 - -- 1955 -0.4 2.2 3.5 1.0 4.2 1.4

1960 1.6 3.5 2.5 2.0 6.9 -0.3

1965 1.7 2.5 3.6 3.1 5.6 -1.1 0.7

1966 2.9 4.4 5.8 3.3 10.0 -0.2 1.0

1967 2.9 7.1 7.1 5.0 19.8 -1.8 1.0

1968 ,;$.2 6.1 5.6 5.5 13.6 -1.7 2.5

1969 5.4 '6.9 6.9 7.0 13.4 1.3 0.7

1970 5.9 6.3 7.5 5.8 12.9 1.6 2.9

1971 4.3 6.5 6.9 6.4 12.2 0.1 3.9

1972 3.3 3.2 3.1 4.2 6.6 -0.4 0.9

1973 6.2 3.9 3.3 3.1 4.7 -0.4 1.0

1974 11.0 9.3 9.2 7.6 10.7 2.4 4.5

1975 9.1 12.0 12.3 10.3 17.2 6.2 10.7

1976 5.8 9.5 11.3 6.4 13.8 5.4 6.8

1977 6.5 9.6 9.3 7.5 11.5 6.0 6.9

1978 7.6 8.4 8.4 7.7 10.7 8.2 7.1

1979 11.3 9.3 9.2 8.4 11.4 7.8 7.4

11967 -100. 2Data for 1947-78 are for urban wage and clerical workers. Data for 1979 are for all urban

consumers, a new index introduced by the Bureau of Labor Statistics in January 1978.

NOTE: Data are based on reporting by samples of providers and other retail outlets.

SOURCE: Health Insurance institute: Source Book of Health Insurance Data: 1979-1980.

Washington, 1980.

310
TABLE 119. Average Fee for initial and Follow:1p /Mice Visits and for Periodic Examinations, Aeciording to Physician Specialty, Type of Visit, and Division: United States, 1978

Type of Visit and Division

Specialty

All

Specialties Pediatrics

General

and Family Practice internal

Medicine

Obstetrics and

Gynecology

Initial office visit Average lee In dollars

All divisions $27.60 $19.03 $16.55 $32.53 $29.85 New England 26.13 16.08 15.03 26.45 28.24 Middle Atlantic 31.31 19.93 15.88 34.96 33.96 East North Central 24.91 17.22 15.86 31.88 25.58 West North Central 20.95 15.00 13.72 29.51 23.18 South Atlantic 28.40 19.65 16.50 31.37 32.70 East South Central 23.74 17.75 15.48 33.91 29.43 West South Central 25.95 19.13 15.67 36.50 25.61 Mountain 24.28 17.75 14.00 28.63 26.58 Pacific 31.78 22.36 21.09 35.01 32.17

Foliowup office visit All divisions 17.74 13.72 12.15 16.83 18.23 New England 17.79 13.58 12.03 15.87 18.85 Middle Atlantic 21.23 15.28 11.93 19.14 21.20 East North Central 15.76 12.40 11.47 15.44 15.39 West North Central 13.11 11.67 9.87 14.11 13.00 South Atlantic 18.06 13.70 12.28 16.61 19.57 East South Central 14.60 12.75 10.51 14.79 17.00 West South Central 15.23 12.47 11.28 15.70 14.23 Mountain 16.07 12.75 11.26 15.17 16.42 Pacific 20.13 15.19 15.36 18.93 20.06

Periodic examination

All divisions 31.40 18.73 30.88 43.18 24.94 New England 26.47 15.00 24.41 33.98 23.67 Middle Atlantic 30.81 18.57 30.12 41.10 25.35 East North Central 27.17 17.70 24.33 40.08 22.56 West North Central 28.32 14.17 27.08 45.37 21.09 South Atlantic 34.64 15.11 35.34 50.21 27.70 East South Central 27.13 16.00 24.59 36.75 21.14 West South Central 26.44 14.57 22.62 38.02 22.61 Mountain 30.70 * 31.08 40.67 18.92 Pacific 40.41 26.59 44.71 50.19 28.96

NOTE: Data are based on reporting by physicians.

SOURCE: American Academy of Pediatrics: Demographic and Socioeconomic Fact Book on Child Health Cara. Chicago, 1980. (Copyright 1980: Used with the permission of the American Academy of Pediatrics and the American Medical Association.)

3"

311
TABLE 120, Avery Fos for MIMI and Foliate*: Moo Visits and Average Annual Percent Change In Fee, According to Type of Visit

and Nekton Specialty: United Metes, 1970 -78 Selected Years

Type, of VIM and

PhYsklin SPKIINY

Year Change in Fee

1970 1073 1975 1918 1970-78 1970-73 1073-76 1975-78

Initial visit

Pediatrics

General and family practice

Internal medicine

Obstetrics-gynecology,

Folio; visit

Pediatrics

General and family practice

Internal medicine

Obstetrics- gynecology

Average fee In dollars and cents Average annual percent change

$9.95 $12.20 $16.18 $19.03 8.4 7,0 15.2 5.6

8.46 10.74 13,11 16.55 8.8 8.3 10.5 8.1

17.81 20,51 26.11 32.53 7,8 4.8 12.8 7,6

14.23 19.68 23,57 29.85 9.7 11.4 9.4 8.2

8.65

7.52

11,13

11.53

11.07

9.29

13.56

13,73

13.72

12.15

16.83

18,23

39,7

310,1

1.6

39,6

wad 004 0.

13.1 7,4

11,2 9.4

10.4 7.5

Q.1 9.9

'An initial office visit is defined as "office visit, new patient, brief evaluation, history, examination, and/or treatment,"

foliowup office visit is defined as "office visit, established patient, brief examination, evaluation, and/or treatment, same or new illness,"

'Average annual percent change for 1973-78.

NOTE: Data are based on reporting by physicians,

SOURCE; American Academy of Pediatrics: Demographic and Socioeconomic Fact Book on Child Health Care. Chicago, 1980, (Copyright 1980: Used with the

permission of the American Academy of Pediatrics and the American Medical Association.)
Guide lo Tables

Time

Trend Age

I. Health status and

determinants

A. Population Demographic Social and

economic

B. Fertility

1, 3 4

General 7, 9

Expected births 10

Adolescent 11, 12, 13

Unmarried 13

Contraception and

C.

abortion

Mortality

16, 67

Infant, fetal,

and perinatal Children and youth

18, 19

by cause 22

D. Determinants

Medical care-See

Utilization

Immunization by

disease 24

Usual place of care 26, 27, 28,

Breast feeding

29, 30, 31

Food consumption by

food group 33, 34

Special diet 35

Substance use by

type of substance 36, 37, 39,

40

Cigarette smoking 38

Fluoridation

Housing conditions School health

programs, by type

42, 43, 44

Activities 46

E. Measures of health

Low birth weight Height, weight, and

48, 70

hemoglobin Parental assessment

49, 50, 59

of health 51

Limitation of

activity

iisiebility days by=re.

52

54

314

Sex

Family Color/ income/

Race/ Poverty Eitudeity Status 1

5, 6 7

10

11, 12, 13

13, 14

15, 16, 67

17, 19

20, 21, 22

24

26, 27, 28,

29, 30, 31

32

33, 34

42, 43, 44

46

47, 48, 70

51

52

54
Geographic Variables

Location

Family Education Size Residence

16

42, 43, 44

46

70

51

52

54

Region State Other

2

26,

32

27

4,

9

16,

18

20,

23,

58

26,

29,

32

6

67

21,

24,

27,

30,

22

25,

28,

31

42, 43, 44 94

99

46

48, 18

51 78, 79,

114,

26, 27

52 53

54

31) 315
ankle to Tables (Cord.)

Acute conditions,

by type

Injuries Notifiable diseases

Dental decay Handicaps by type Arrests by type of

crime

Pre-induction

disqualification

316

Family Color/ Income/

Tim. Race/ Poverty

Trend Ag. Sex Ethnicity Status
Parental

oresence,

Sex of

Head, Marital

Status

Geographic Variables

Location

Family or

Size Residence

3

317
Guide to Tables (Cont.)

IL Utilization of Health

Resoilrces

Ambulatory Family-Planning Prenatal care

Contacts with

physicians

Interval and

number

Source or place Reason

Injuries Visits

Place

Office visits

Office visits

by diagnosis

Dental visits

Interval and

number

Psychiatric

services

B. Inpatient Hospitalization and days Diagnosis Surgical procedures

Ill. Health Care Resources

A. Personnel and

facilities

Satisfaction

Physicians Dentists

Nurses

Practical

Dental hygienists Community hospital beds

Accessible schools

318

Family Color/ Income/

Place or Race/ Poverty

Specialty Age Sex Ethnicity Status 3
Parental

Presence, Sea of

Heed,

Marital

Status

Geographic Variables

Location

Fondly or

Size Residence

319
Guide to Tables (Cont.)

IV. Health Care Costs

and Financing A. Expenditures National

Personal

Type of expenditure Source of funds

B. Financing Public programs AFDC

Medicaid

WIC

Health insurance

Source of payment C. Cost

Consumer Price

Index by type

Fees by physician

specialty

320

Social and

Time Demographic

Trends AA. Characteristics

3 '1 9
Rogion or Dhasion

113, 114, 28,

29, 30, 31

112, 113, 28,

29, 30, 31

114

28. 29, 30,

31

28, 29, 30,

31

321

* U.S. GOVERNMENT PRINTING OFFICE.: 1981 0 - 339-243 (Vol. III)