Child Health USA 2005

Maternal and Child Health Bureau
Child Health USA 2005 is not copyrighted. R

of the information contained in this publicatioSuggested Citation: U.S. Department of HealServices Administration, Maternal and Child Rockville, Maryland: U.S. Department of HeSingle copies of this publication are also avaiHRSA Information Center P.O. Box 2910 Merrifield, VA 22116 703-442-9051 or 1-888-ASK-HRSA 
Preface 5

Introduction 7

Population Characteristics 11

Population of Children . . . . . . . . . . . . . . . . .12

Children of Foreign-Born Parents . . . . . . . . .13

Children in Poverty . . . . . . . . . . . . . . . . . . . .14

School Dropouts . . . . . . . . . . . . . . . . . . . . . .15

Maternal Age . . . . . . . . . . . . . . . . . . . . . . . .16

Working Mothers and Child Care . . . . . . . . .17

Health Status 19

Health Status - Infants

Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . .21

Low Birth Weight . . . . . . . . . . . . . . . . . . . . .22

Very Low Birth Weight . . . . . . . . . . . . . . . . .23

Neonatal and Postneonatal Mortality . . . . . .24

Maternal Mortality . . . . . . . . . . . . . . . . . . . .25

Infant Mortality . . . . . . . . . . . . . . . . . . . . . .26

International Infant Mortality Rates . . . . . . .27

Health Status - Children

Health Status of Children . . . . . . . . . . . . . . .29

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Mental Health . . . . . . . . . . . . . . . . . . . . . . .31

Child Abuse and Neglect . . . . . . . . . . . . . . . .32

Pediatric AIDS . . . . . . . . . . . . . . . . . . . . . . .33

Vaccine-Preventable Diseases . . . . . . . . . . . . .35

Hospitalization . . . . . . . . . . . . . . . . . . . . . . .36

Child Mortality . . . . . . . . . . . . . . . . . . . . . . .37

Childhood Deaths Due to Injury . . . . . . . . .38

Health Status - Adolescents

Adolescent Childbearing . . . . . . . . . . . . . . . .40

Sexual Activity . . . . . . . . . . . . . . . . . . . . . . .41

Sexually Transmitted Infections . . . . . . . . . . .42

Adolescent and Young Adult

HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . .43

Physical Activity and Overweight . . . . . . . . .45

Mental Health Treatment . . . . . . . . . . . . . . .46

Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

Substance Abuse . . . . . . . . . . . . . . . . . . . . . .48

Cigarette Smoking . . . . . . . . . . . . . . . . . . . .49

Adolescent Mortality . . . . . . . . . . . . . . . . . . .50

Adolescent Mortality from Traffic 

and Firearm Injuries . . . . . . . . . . . . . . . . . . .51

Health Services Financing

and Utilization 53

Vaccination Coverage . . . . . . . . . . . . . . . . . .54

Immunization Schedule . . . . . . . . . . . . . . . .55

Timing of Dental Care . . . . . . . . . . . . . . . . .57

Timing of Physician Visits . . . . . . . . . . . . . . .58

Receipt of Preventive Care . . . . . . . . . . . . . . .59

Place of Physician Contact . . . . . . . . . . . . . .60

Hospital Utilization . . . . . . . . . . . . . . . . . . . .61

Health Care Financing . . . . . . . . . . . . . . . . .62

Prenatal Care . . . . . . . . . . . . . . . . . . . . . . . . .63

State Data 65

SCHIP Enrollment Statistics . . . . . . . . . . . . .66

Medicaid Enrollees, Expenditures,

and Reported EPDST Utilization . . . . . . . . .67

Health Insurance Status of Children . . . . . . .68

Children Who Are Uninsured . . . . . . . . . . . .69

Low Birth Weight, Prenatal Care,

Births to Women Under Age 18 . . . . . . . . . .70

Infant and Neonatal Mortality Rates . . . . . . .71

City Data 73

Birth Weight . . . . . . . . . . . . . . . . . . . . . . . . .74

Infant Mortality . . . . . . . . . . . . . . . . . . . . . .75

Prenatal Care . . . . . . . . . . . . . . . . . . . . . . . . .77

References 78

Contributors 80

Child Health USA 2005

3

Table of Contents
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The Health Resources and Services Administration’s Maternal and Child Health Bureau

(MCHB) is pleased to present Child Health USA

2005, the 16th annual report on the health status

and service needs of America’s children. To assess

the Bureau’s progress toward achieving its vision

for a Nation where all individuals enjoy equal

access to quality health care in a supportive, culturally competent family and community setting,

the MCHB has compiled this book of secondary

data for more than 50 health and health care indicators. It provides both graphical and textual

summaries of data and addresses long-term trends

where applicable.

All of the data discussed in this book came

from the same sources as the information in the

graphs (unless otherwise noted). Data are presented for the target populations of Title V funding: infants, children, adolescents, children with

special health care needs, and women of childbearing age. In addition to population characteristics, this book also addresses health status and

health services utilization. Child Health USA

2005 also provides insight into the Nation’s

progress toward the goals set out in the MCHB’s

strategic plan—to assure quality of care, to eliminate barriers and health disparities, and to

improve the health infrastructure and system.

Child Health USA is published to provide the

most current data available for public health professionals and other individuals in the private and

public sectors. The book’s succinct format is

intended to facilitate the use of the information as

a snapshot of measures of children’s health in the

United States.

Population Characteristics is the first section and

presents statistics on factors that influence the

well-being of children. The second section, entitled Health Status, contains vital statistics and

health behavior information for infants, children,

adolescents, and women of childbearing age.

Health Services Financing and Utilization, the third

section, includes data regarding health care

financing and newly implemented health policies. The fourth and fifth sections, State Data and

City Data, contain information on selected indicators at the those levels.

Please note that Child Health USA 2005 is not

copyrighted. Readers are free to duplicate and use

all or part of the information contained in this

publication. The book and previous editions of it

are also available online at www.mchb.hrsa.gov in

HTML and PDF formats.

For a complimentary copy of the publication,

mail your request to: HRSA Information Center,

2070 Chain Bridge Road, Suite 450, Vienna, VA

22182-2536. To make a request by phone, call

703-442-9051 or 1-888-ASK-HRSA.

Preface

Child Health USA 2005

5

Preface
This page left intentionally blank.
In 2004, approximately 25 percent of the

United States population was under the age of 18.

The racial and ethnic distribution of these 73

million children demonstrates the growing diversity of this population: 58 percent were non-Hispanic White, 19 percent were Hispanic, 15 percent were Black, 4 percent were Asian or Pacific

Islander, and the remaining 4 percent were of

other races (including more than one race). The

health of these children depends on preventive

services such as prenatal care and immunization,

as well as the promotion of healthy life choices.

These measures help assure that children are born

healthy and maintain good health as they age,

and to be successful requires the continuing effort

of individuals, families, communities, and health

care providers.

Preventive care for children begins even before

they are born. Timely prenatal care is an important preventive strategy that can help protect the

health of both mother and child. Entry into prenatal care during the first trimester has been

improving, reaching 84.1 percent of pregnant

women in 2003. This rate is lower for younger

women and Black and Hispanic women. A small

number of pregnant women (3.5 percent in

2003) go without prenatal care until the third

trimester, or forgo it entirely. This is more common among Black and Hispanic women, as well

as younger women, unmarried women, and

women with low levels of education.

Healthy birth weight is an important indicator

of young children’s health. Despite high rates of

prenatal care utilization, the rate of low birth

weight (LBW)—less than 2,500 grams (5 pounds

8 ounces)—is currently at the highest level

recorded in the past 3 decades. In 2003, 7.9 percent of all births were considered low birth

weight. Very low birth weight (VLBW)—less

than 1,500 grams (3 pounds 4 ounces)—is also

on the rise, representing 1.4 percent of all live

births in 2003, compared to approximately 1 percent in 1980. These babies are significantly more

likely to die in the first year of life than babies of

normal birth weight, and those who survive are at

particularly high risk for severe physical, developmental, and cognitive problems. Although rates

of maternal and infant mortality have dropped

dramatically in the past century, the United States

still has one of the highest rates of infant death in

the industrialized world. Of every 1,000 infants

born alive in 2003, seven died in their first year.

Breastfeeding can also support the health of

infants and mothers. Breastfeeding rates have

increased steadily since the beginning of the

1990s. In 2003, the breastfeeding initiation rate

reached 70.9 percent, the highest yet recorded.

However, the rate declines dramatically as infant

age increases, and only 36.2 percent of mothers

were still breastfeeding their infants at 6 months.

The exclusive breastfeeding at 6 months rate was

even lower (14.2 percent).

The preventive health measure that is probably

most recognized among the public is childhood

immunization. Vaccines are available for public

health threats such as measles, mumps, rubella

(German measles), polio, diphtheria, tetanus,

pertussis (whooping cough), and H. influenzae

type b (a bacterium that causes meningitis).

The Healthy People 2010 objective is to immunize at least 90 percent of 19- to 35-month-olds

with the full series of recommended childhood

vaccines. A 2002-03 survey from the Centers for

Disease Control and Prevention shows that 80.5

percent of children 19 to 35 months of age had

Introduction

Child Health USA 2005

7

Introduction
received the recommended series of vaccines. As

a result of the increasing success of immunization, the number of reported cases of vaccine-preventable diseases continues to decrease. In 2003,

there were no reported cases of diphtheria,

tetanus, rubella, or polio among children under 5

years of age, and very few cases of hepatitis B,

measles, and mumps.

Dental care is another important preventive

service for children—one that is too often overlooked. In 2003, 70.8 percent of children visited

a dentist within the past year, but among children

living in families with incomes below 200 percent of the poverty level the rate was only 60.5

percent. To promote good oral hygiene, the

American Academy of Pediatrics recommends

that children begin annual dental visits within

6 months of the eruption of their first tooth and

no later than 12 months of age.

Despite our best preventive efforts, children

are still vulnerable to a number of diseases, conditions, and other risks to their health and wellbeing. Asthma, for instance, is a disease that

causes wheezing, chest tightness, and shortness of

breath, and can lead to school absences, hospitalization, and even death. In 2003, almost 8 percent of children under 18 years of age were

reported by parents to be affected by asthma.

This includes all children whose parents reported

that a doctor ever told them the child had asthma

and that the child still has asthma, and children

who, in the past year, used asthma medication,

had moderate or severe difficulties combined

with an attack, or had been hospitalized for

asthma. It was most often reported among nonHispanic Black children and children living in

families with incomes below the poverty level.

According to the Youth Risk Behavior Survey,

13.5 percent of high school students were overweight in 2003, and almost one-third described

themselves as overweight. Childhood overweight

is associated with significant health problems; for

instance, high cholesterol and high blood pressure, which are risk factors for heart disease,

occur more frequently among overweight children than those with a healthier weight. Overweight is also closely linked to type 2 diabetes,

and can have emotional effects such as poor selfesteem and depression.1 Regular exercise helps to

regulate weight, and in 2003, over 60 percent of

high school students engaged in sufficient vigorous activity and over half of high school students

performed regular strengthening exercises.

Mental health issues are also a risk to the health

of children and adolescents. In 2003, approximately 10 percent of children were reported by

their parents to have moderate to severe socioemotional problems; this includes children who

Introduction

Child Health USA 2005

8
Introduction

have difficulties with emotions, concentration,

behavior, or getting along with other people.

Socio-emotional problems were most common

among males and non-Hispanic Black children.

Over 20 percent of children ages 12 to 17 years

received mental health treatment or counseling,

most commonly for feeling depressed, breaking

rules or acting out, feeling afraid or tense, having

suicidal thoughts or attempts, and having problems at home. Most who received treatment did

so from a private therapist or counselor, or from

school sources; 9 percent were hospitalized for

treatment of their mental health problems.

Unfortunately, the health of children and adolescents can also be affected by HIV/AIDS. At

the end of 2003, 9,419 cases of AIDS had been

reported in children younger than 13 since the

epidemic began in the early 1980s. Pediatric

AIDS cases represent just over 1 percent of all

AIDS cases ever reported. Cases of HIV/AIDS

among adolescents and young adults 13 to 24

years of age represented 12 percent of all diagnoses in 2003. Adolescents and young adults represented approximately 4 percent of all people

living with HIV/AIDS in 2003, and 1 percent of

people who died with the disease.

Adolescents and young adults are also vulnerable to sexually transmitted infections (STIs) such

as chlamydia, gonorrhea, and syphilis. These can

lead to pelvic inflammatory disease and infertility if left untreated, while increasing the risk of

contracting other STIs. Young adults ages 20 to

24 years generally have higher rates of infection

than teens, and non-Hispanic Black youth have

higher rates than their non-Hispanic White and

Hispanic peers. 

Many of the decisions that adolescents and

young adults make affect their future health and

success in life. Some adolescents and young

adults never complete high school, which can

lead to unemployment and decreased health status. In 2002, there were over 3.7 million high

school dropouts in the United States (this comprises 16- to 24-year-olds who have not earned a

diploma and are not enrolled in school). Some

teens also become parents, although the rate of

adolescent childbearing has dropped considerably in the past decade. The birth rate among

adolescent females ages 15 to 17 years was

41.7 per 1,000 in 2003, a 33 percent decrease

since the most recent peak in 1991. Rates are

highest among older teens and Hispanic youth. 

The health and well-being of adolescents can

also be threatened by the use of alcohol and

drugs. In 2003, 18 percent of 12- to 17-year-olds

reported using alcohol, and over 11 percent

reported using illicit drugs in the past month.

The most commonly reported drug is marijuana,

followed by the nonmedical use of prescription

drugs, such as pain relievers and tranquilizers.

Over half of teens reported that marijuana would

be fairly or very easy to obtain, and 16 percent of

adolescents reported being approached by someone selling drugs in the past month.

Data presented in Child Health USA 2005 are

important for both appreciating America’s public

health achievements and recognizing the challenges that we still face. The health of our children and adolescents relies on effective public

health efforts that include providing access to

knowledge, skills, and tools; providing drug-free

alternative activities; identifying risk factors and

linking people to appropriate services; building

community supports; and supporting approaches

that promote policy change. Such preventive

efforts and health promotion activities are vital to

the continued improvement of the health and

well-being of America’s children and families.

1 Office of the Surgeon General. The Surgeon General’s call to

action to prevent and decrease overweight and obesity. Washington, DC: U.S. Department of Health and Human Services; 2001.

Child Health USA 2005

9
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The United States has an increasingly diverse

population, which is demonstrated by the sociodemographic characteristics of children and their

families. Over one-quarter of the population is

under 20 years of age.

At the National, State, and local levels, policymakers use population information to address

health-related issues that affect mothers and children. By carefully analyzing and comparing data,

workers in the health field can often isolate highrisk populations that require specific interventions. Policymakers can then tailor programs to

meet the needs of these children and their 

families.

The following section presents data on several

population characteristics that have an impact on

maternal and child health program development

and evaluation. Included are data on the age distribution of the population of the United States,

the racial and ethnic makeup of the child population, poverty status, child care arrangements,

and school dropout rates.

Population Characteristics

Child Health USA 2005

11

Population Characteristics
POPULATION OF CHILDREN

In 2004, there were over 73 million children

under the age of 18 in the United States, representing approximately 25 percent of the total

population. Young adults 20 to 24 years of age

represented just over 7 percent of the population,

while adults 25 to 64 years of age represented

nearly 53 percent, and adults 65 years of age and

over represented more than 12 percent. The

median age in the United States for all races was

36 years.

Since 2000, the number of children under

5 years of age has risen 4.6 percent, and the number of children ages 5 to 19 years has risen 2 percent. The number of adults ages 65 and older has

risen approximately 3.5 percent over the same

period.

Reflecting the trends in the general population, the population of children has become

increasingly diverse over the past several decades.

Since 1980, the percentage of children who are

Hispanic or Asian/Pacific Islander has more than

doubled, while the percentage who are nonHispanic White has declined. Hispanic children

represented 9 percent of all children in 1980 and

almost 19 percent in 2004; likewise, Asian/

Pacific Islander children represented 2 percent in

1980 and 4 percent in 2004. In the same period,

the percentage of children who are White

dropped by approximately 18 percent to represent 58 percent of the child population in 2004,

while the percentage of children who are Black

remained relatively stable. In addition, nearly

3 percent of children were of more than one

racial group in 2004.

Population Characteristics

Child Health USA 2005

12

Population of Children Under Age 18, by Race/Ethnicity: 2004

Source (I.1): U.S. Census Bureau 

U.S. Resident Population, by Age Group: 2004

Source (I.1): U.S. Census Bureau

65 Years 

and Older

12.4%

25 to 64 Years

52.7%

20 to 24 Years

7.1%

15 to 19 Years

7.1%

10 to 14 Years

7.2%

5 to 9 Years

6.7%

Under 5 Years

6.8%

American

Indian/Alaska Native

1.1%

Two or More Races

2.7%

Asian/Pacific Islander

4.0%

Hispanic

18.9%

Non-Hispanic

Black

15.3%

Non-Hispanic White

58.0%
Population Characteristics

CHILDREN OF FOREIGNBORN PARENTS

The foreign-born population in the United

States has increased substantially since the 1970s,

largely due to immigration from Asia and Latin

America. In 2003, over 20 percent of children

living in the United States had at least one foreign-born parent. Of all children, 16.5 percent

were born in the United States to foreign-born

parents and 4 percent were themselves foreignborn. Most children (76.2 percent) were nativeborn and lived in households with native-born

parents.

Children with foreign-born parents were more

likely than children with native-born parents to

have family incomes below 100 percent of the

Federal poverty level. Health insurance coverage

also varies by nativity: native-born children with

foreign-born parents were the most likely to have

public insurance, while foreign-born children 

with foreign-born parents were the most likely to

be uninsured. Native-born children with nativeborn parents were most likely to have private

insurance.

Child Health USA 2005

13

Children Under Age 18, by Health Insurance Status and Nativity

of Child and Parent(s):* 2003

Source (I.2): Centers for Disease Control and Prevention, National Center for Health

Statistics, National Survey of Children’s Health Percent of Children

*The term “native parent” indicates that both parents who live with the child were born in the U.S., while “foreign-born

parent” indicates that one or both parents were born outside of the U.S.; “other” includes children with parents whose

nativity status is unknown and foreign-born children with native parents.

Children Under Age 18, by Nativity of Child and Parent(s):* 2003

Source (I.2): Centers for Disease Control and Prevention, National Center for Health

Statistics, National Survey of Children’s Health

0

10

20

30

40

50

60

70

80

Publicly Insured Privately Insured No Insurance

24.6 25.8

37.7

6.2

43.1

12.8

31.1

49.6

69.2

Native Child and Parent

Native Child, Foreign-Born Parent

Foreign-Born Child and Parent

Other

3.3%

Foreign-Born Child

and Parent

4.0%

Native Child,

Foreign-Born Parent

16.5%

Native Child

and Parent

76.2%
Population Characteristics

CHILDREN IN POVERTY

In 2003, more than 12.8 million children

under 18 years of age lived in families with

incomes below the Federal poverty threshold

($18,400 for a family of four).1 Of all children

living in the United States, 17.2 percent lived in

families with incomes below the poverty level.

Children represented 36 percent of people in

poverty but only 25 percent of the population as

a whole.

Poverty affects living conditions and access to

health care and nutrition, all of which contribute

to health status. Black and Hispanic children

were particularly vulnerable. A much higher proportion of Black (33.6 percent) and Hispanic

(29.5 percent) related children* under age 18

were poor than were related non-Hispanic White

children (9.3 percent).

Children in single-parent families are particularly likely to be poor: of children under age 6

living with a single mother, 52.9 percent lived in

poverty, compared to 9.6 percent of children of

the same age in married-couple families.

1 Following the Office of Management and Budget’s Statistical

Policy Directive 14, the Census Bureau uses a set of money

income thresholds that vary by family size and composition to

determine who is in poverty.

Child Health USA 2005

14

Related Children* Under Age 18 Living in Families Below

100 Percent of Poverty Level, by Race/Ethnicity:** 1970-2003

Source (I.3): U.S. Census Bureau, Current Population Survey Percent of Children

Total

Non-Hispanic White

Black

Hispanic

*Related children are those under 18 who are related to the householder by birth, marriage, or adoption.

**The CPS currently allows respondents to choose more than one race. Prior to 2002, only one race was reported.

Figures reported here are for respondents who chose one race; however, Hispanics may be of any race.

***Hispanic ethnicity was not reported until 1973.

Married Couple

40.9%

Male Householder,

No Wife Present

8.4%

Female Householder,

No Husband Present

50.7%

Families Below 100 Percent of Poverty Level, by Family Type: 2003

Source (I.3): U.S. Census Bureau, Current Population Survey

0

10

20

30

40

50

60

1970*** 1980 1990 2003

37.7

44.2

11.6

33.0

42.1

17.9

41.5

14.9

29.5

33.6

9.3 10.5 11.3

19.9 17.2
SCHOOL DROPOUTS

As of October 2002, the latest year for which

data are available, there were approximately

3,721,000 high school dropouts* in the United

States. This translates into a total dropout rate of

10.5 percent among people in this age group, a

rate that has been in decline over the past several

decades.

Since 1970, Hispanic students have had the

highest dropout rates, representing 25.7 percent

of Hispanic young adults in 2003. The high Hispanic dropout rate is partly due to the high

dropout rate among Hispanics born outside of

the United States (41.4 percent). First generation

Hispanics, those who were born in the U.S. but

have at least one parent born elsewhere, have a

much lower dropout rate (14.4 percent), and the

rate among second generation or higher Hispanics, those who were born in the U.S. to American-born parents, is comparable to that of other

racial/ethnic groups (11.3 percent). The dropout

rates among non-Hispanic Whites and non-Hispanic Blacks in 2002 were 6.5 and 11.3 percent,

respectively. 

According to the U.S. Department of Commerce, high school dropouts are more likely to

be unemployed and, when they are employed,

earn less than those who completed high school.

According to the National Center for Health Statistics, those who did not complete high school

report worse health than their peers who did

complete high school, regardless of income.

Population Characteristics

Child Health USA 2005

15

11.3

25.7

Percent

Status School Dropout Rates* for Ages 16-24, by Race/Ethnicity: 1990-2002

Source (I.4): U.S Department of Education, National Center for Education Statistics

0

5

10

15

20

25

30

35

40

1990 1992 1994 1996 1998 2000 2002

6.5

10.5

Non-Hispanic White

Non-Hispanic Black

Total

Hispanic

*Status dropouts refers to 16- to 24-year-olds who are not enrolled in school and have not earned high school credentials (diploma or equivalent.)
Population Characteristics

MATERNAL AGE

The general fertility rate rose to 66.1 births per

1,000 women ages 15 to 44 years in 2003. The

birth rate among mothers ages 35 to 44 years continued to increase; rates for women in their mid

twenties to early thirties also increased, but to a

lesser extent. The birth rates among teenagers and

women in their early twenties declined. The rate

among 15- to 17-year-olds was 42 percent lower

than a recent peak in 1991, and the rate among

18- and 19-year-olds dclined 25 percent during

the same period.

In 2003, 10 percent of births were to women

under 20, over half were to women in their twenties, just over one third were to women in their

thirties, and almost 3 percent were to women in

their forties and early fifties. The average age at

first birth in 2003 was 25.2 years, the highest yet

recorded. The average age at first birth has risen

from 21.4 years in 1970.

Among non-Hispanic Black and Hispanic

women, over half of births in 2003 were to

women in their twenties. Among non-Hispanic

White women, a smaller proportion of births

were to women in that age group (49.5 percent).

The proportion of births that were to women

under 20 years of age was higher among nonHispanic Black and Hispanic women (17.4 and

14.3 percent, respectively) than non-Hispanic

White women (7.5 percent). Births to non-Hispanic White women were more likely to be to

women in their thirties, forties, and early fifties.

Child Health USA 2005

16

Distribution of Births, by Maternal Age and Race/Ethnicity: 2003

Source (I.5): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System

40-54 Years

2.9% 30-39 Years

40.0%

20-29 Years

49.5%

18-19 Years

5.4%

17 Years

and Under

2.1%

Non-Hispanic White Non-Hispanic Black Hispanic

40-54 Years

2.1%

30-39 Years

24.5%

20-29 Years

56.0%

18-19 Years

10.8%

17 Years

and Under

6.6% 40-54 Years

1.9% 30-39 Years

26.8%

20-29 Years

57.0%

18-19 Years

8.9%

17 Years

and Under

5.4%
Population Characteristics

WORKING MOTHERS AND

CHILD CARE

In 2004, 70.4 percent of women with children

under 18 years of age were in the labor force

(either employed or looking for work). Of mothers with preschool-aged children (younger than

6 years), 61.8 percent were in the labor force and

over 57 percent were actually employed. Of

women with children ages 6 to 17 years, 77.3

percent were in the labor force and almost 74

percent were employed. Employed mothers of

children in the older age group were more likely

to work full time than mothers of children under

6 years of age (76.7 versus 69.8 percent). Married

mothers with a present spouse were less likely

than mothers in other marital situations to be in

the labor force (67.8 versus 77.1 percent); however, almost all married women in the labor force

were employed, while women in other situations

were more likely to be looking for work. The

unemployment rate among married mothers was

3.7 percent, compared to a rate of 9.7 percent

among mothers of other marital statuses.

Among children under age 5 with employed

mothers, child care arrangements varied by family

income. In 2002, children with family incomes of

less than 200 percent of the Federal poverty level

(FPL) were most likely to be in relative or parent/other care, while children with family incomes

of 200 percent FPL or more were most likely to be

in center-based care. Family child care and

nanny/babysitter care were the least common

types of care among children of both income

groups, although each was more common among

children with higher family incomes.

Child Health USA 2005

17

Child Care Arrangements for Children Under Age 5 with Employed 

Mothers, by Family Income: 2002

Source (I.7): Urban Institute, National Survey of America’s Families

61.8

77.3 Mothers with Children Ages 6-17

Percent of Mothers

Mothers in the Work Force: 1975-2004

Source (I.6): U.S. Department of Labor

Percent of Children

0

8

16

24

32

40

Nanny/

 Babysitter***

Family

Child Care**

Center-Based Relative Parent/Other

< 200% FPL*

200% or More FPL

31.2 29.5

24.9

31.3

25.4 23.9

14.2

3.5

10.7

5.3

Mothers with Children Under Age 6

*Federal poverty level, equal to $18,100 for a family of four in 2002.

**Care by a non-relative in the provider’s home.

***Care by a non-relative in the child’s home.

30

40

50

60

70

80

1975 1980 1985 1990 1995* 2000 2004

*Data for 1995 and later are not strictly comparable with data for earlier years due to changes in the

survey and estimation process.
This page left intentionally blank.
Health Status

The systematic assessment of the health status

of infants, children, and adolescents allows

health professionals to gauge the impact of past

and current health intervention and prevention

programs. Program planners and policymakers

can identify trends by examining and comparing

data from one year to the next. Although indicators are often assessed on an annual basis, some

surveillance systems collect data at intervals, such

as every 2, 3, or 5 years.

In the following section, mortality, disease,

injury, and health behavior indicators are presented by age group. The health status indicators

in this section are based on vital statistics and

National surveys. Population-based samples are

designed to yield information that is representative of the maternal and child populations that

are affected by, or in need of, specific health 

services.

Child Health USA 2005

19

Health Status
Health Status - Infants
BREASTFEEDING

Breastfeeding has been shown to promote the

health and development of infants, as well as

their immunity to disease; it has also been shown

to have a number of benefits to maternal health.

For this reason, the American Academy of Pediatrics (AAP) recommends exclusive breastfeeding—without supplemental foods or liquids—

through the first 6 months of age and continued

breastfeeding through at least the first year. 

Breastfeeding initiation rates in the United

States have fluctuated over the past several

decades but have increased steadily since the

beginning of the 1990s. In 2003, 70.9 percent

of mothers ever breastfed their infants. Asian

women were most likely to breastfeed their

infants (79.3 percent), followed by Hispanic and

non-Hispanic White women (77.8 and 72.2 percent, respectively). Breastfeeding rates increased

with maternal age, higher educational achievement and higher income. Married women were

more likely than unmarried women to breastfeed

(76.8 versus 57.8 percent, respectively).

Breastfeeding rates decrease as infant age

increases. In 2003, 36.2 percent of mothers

breastfed their infants at 6 months, and 17.2 percent breastfed at 12 months. Exclusive breastfeeding rates have not shown the same improvement over time as breastfeeding initiation. In

2003, only 14.2 percent of women practiced

exclusive breastfeeding at 6 months. As with

breastfeeding initiation, exclusive breastfeeding

rates were higher among Asian, Hispanic, and

non-Hispanic White women, and women who

were older, educated, and of higher income.

Health Status - Infants

Child Health USA 2005

21

Breastfeeding* Rates, by Race/Ethnicity: 2003

Source (II.1): Centers for Disease Control and Prevention, National Immunization Survey Percent

0

20

40

60

80

100

Ever Breastfeeding Breastfeeding at 6 Months

*Includes exclusive and supplemental breastfeeding.

Breastfeeding Rates, by Recommended Duration* and Maternal

Education: 2003

Source (II.1): Centers for Disease Control and Prevention, National Immunization Survey Percent

0

20

40

60

80

100

120

140

160

Exclusive Breastfeeding at 6 Months Breastfeeding at 12 Months

*The American Academy of Pediatrics recommends exclusive breastfeeding through 6 months of age,

and continued supplemental breastfeeding through 1 year.

14.2 10.5 11.8 15.1 19.9 17.2 15.2 13.0 17.0 24.8

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

Asian/Pacific Islander

American Indian/Alaska Native

70.9 68.6 77.8 79.3

51.1

72.2

36.2 32.0

44.1 38.2

21.9

38.5

Total

< High School

High School

Some College

College Graduate
LOW BIRTH WEIGHT

In 2003, 324,064 infants were born at low

birth weight (less than 2,500 grams, or 5 pounds

8 ounces); this represented 7.9 percent of all live

births. The percentage of newborns born at low

birth weight has risen steadily from a low of 6.7

percent in 1984 and is currently at the highest

level recorded in the past three decades.

Low birth weight rates differ by maternal age,

with mothers younger than 15 and older than 45

years of age most likely to deliver low birth

weight infants. Much of the incidence of low

birth weight among older mothers is due to an

increase in the proportion of multiple births.

Multiple births are much more likely to be low

birth weight than are singletons: in 2003, 58.2

percent of all multiple births were low birth

weight. The increased frequency of multiple

births among older mothers is largely due to the

increasing use of assisted reproductive technologies and the fact that older mothers are also more

likely than younger mothers to conceive multiples naturally. Although the increase in multiple

births is a contributing factor to the increase in

low birth weight rates, low birth weight also

increased among singleton deliveries.

The low birth weight rate among non-Hispanic

Black infants (13.6 percent) has not declined significantly since 1991. The rates among non-Hispanic White and Hispanic infants were considerably lower in 2003 (7.0 and 6.7 percent,

respectively). The rate of low birth weight among

infants born to smokers was substantially higher

than among nonsmokers (12.4 versus 7.7 percent)

in 2003. This significant differential has been consistently observed among both non-Hispanic

Black and non-Hispanic White infants. Other factors associated with increased risk of low birth

weight include maternal poverty and low levels of

educational attainment.

Low birth weight is one of the leading causes

of neonatal mortality. Low birth weight infants

are more likely to experience long-term disability

or to die during the first year of life than are

infants of normal weight.

Health Status - Infants

Child Health USA 2005

22

Low Birth Weight Among Infants, by Race/Ethnicity: 1985-2003*

Source (I.5): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics

System

5

6

7

8

9

10

11

12

13

14

1985 1987 1989 1991 1993 1995 1997 1999 2001 2003

13.6

7.8

7.4

7.0

Non-Hispanic Black

Non-Hispanic White

Percent of Live Births

*1985-88 data are based on the race of the infant; data after 1989 are based on the race of the mother.

6.7

Asian/Pacific Islander

American Indian/Alaska Native

Hispanic
Health Status - Infants

VERY LOW BIRTH WEIGHT

In 2003, 1.4 percent of live births were infants

of very low birth weight (less than 1,500 grams,

or 3 pounds 4 ounces). This has slowly climbed

from a rate of just over one percent in 1980.

Because the chance of survival increases as

birth weight increases, very low birth weight

infants have the lowest survival rates. Infants

born at such low birth weights are approximately

100 times more likely to die in the first year of

life than are infants of normal birth weight. Very

low birth weight infants who survive are at a significantly increased risk of severe problems,

including physical and visual difficulties, developmental delays, and cognitive impairment

requiring increased levels of medical, educational, and parental care.

The overall rate of very low birth weight

among non-Hispanic Black newborns (3.1 percent) is over two and a half times greater than the

rate among most other racial and ethnic groups,

including non-Hispanic Whites (1.2 percent),

Hispanics (1.2 percent), and Asian/Pacific

Islanders (1.1 percent). This difference is a major

contributor to the disparity in infant mortality

rates between non-Hispanic Black infants and

infants of other racial and ethnic groups.

Child Health USA 2005

23

Very Low Birth Weight Among Infants, by Race/Ethnicity: 1985-2003

Source (I.5): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics 

System

0.5

1.0

1.5

2.5

3.0

3.5

1985 1990 1995 2000 2003

3.1

1.3

1.2

1.1

Non-Hispanic White

Non-Hispanic Black

Hispanic

Asian/Pacific Islander

Percent of Live Births

American Indian/Alaska Native
NEONATAL AND

POSTNEONATAL MORTALITY

Neonatal. In 2003, 19,108 infants died before

reaching 28 days of age, representing a neonatal

mortality rate of 4.7 deaths per 1,000 live births.

This rate is unchanged from the previous year.

Neonatal mortality is generally related to short

gestation and low birth weight, congenital malformations, and conditions occurring in the 

perinatal period. 

Postneonatal. In 2003, 9,320 infants died

between the ages of 28 days and 1 year, representing a postneonatal mortality rate of 2.3

deaths per 1,000 live births. This rate is

unchanged from the previous year.

Postneonatal mortality is generally related to

Sudden Infant Death Syndrome (SIDS), congenital malformations, and unintentional

injuries.

Neonatal Mortality Rates, by Maternal Race/Ethnicity: 2003

Source (II.2): Centers for Disease Control and Prevention, National Center for Health

Statistics, National Vital Statistics System Deaths per 1,000 Live Births

0

1

2

3

4

5

6

7

8

9

10

Total Non-Hispanic White Non-Hispanic Black Hispanic

4.7

3.9

9.4

4.0

Postneonatal Mortality Rates, by Maternal Race/Ethnicity: 2003

Source (II.2): Centers for Disease Control and Prevention, National Center for Health

Statistics, National Vital Statistics System Deaths per 1,000 Live Births

0

1

2

3

4

5

6

7

8

9

10

Total Non-Hispanic White Non-Hispanic Black Hispanic

2.3 1.9

4.7

1.9

Health Status - Infants

Child Health USA 2005

24
MATERNAL MORTALITY

During the past several decades, the rate of

maternal mortality in the United States has

declined dramatically. However, the rate in 2003

(12.1 per 100,000 live births) was significantly

different from the rate reported in 2002 (8.9 per

100,000). This may partly be due to a change in

how pregnancy is recorded on death certificates.

Overall, there were 495 maternal deaths resulting from complications during pregnancy, childbirth, or up to 42 days postpartum in 2003. The

maternal mortality rate among non-Hispanic

Black women (31.2 per 100,000 live births) is

about four times the rate among non-Hispanic

White women (8.1 per 100,000 live births). This

disparity has widened since 2000. 

According to the National Center for Health

Statistics, the risk of maternal death increases for

women over age 30, regardless of race. Women

ages 35 to 39 years have over three times the risk

of maternal death as women ages 20 to 24 years.1

1 National Center for Health Statistics. Health, United States,

2004. Hyattsville, Maryland: 2004.

Child Health USA 2005

Health Status - Infants 25

Maternal Mortality Rates, by Race/Ethnicity: 2003

Source: (II.2): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital

Statistics System

0

5

10

15

20

25

30

35

Total Non-Hispanic White Non-Hispanic Black Hispanic

Percent

8.1

31.2

10.1

12.1
Health Status - Infants

INFANT MORTALITY

In 2003, 28,428 infants died before their first

birthday, representing an infant mortality rate of

6.9 deaths per 1,000 live births. The leading

cause of infant mortality was congenital malformations, deformations and chromosomal abnormalities, which accounted for 20 percent of

infant deaths.

The infant mortality rate declined from the

1960s into this century, but increased slightly

between 2001 and 2002. This was largely due to

an increase in the percentage of infants born

weighing less than 750 grams, reasons for which

include a rise in both preterm and multiple

births. The rapid decline in infant mortality that

began in the mid-1960s slowed among both

Blacks and Whites during the 1980s. Major

advances, including the approval of synthetic

surfactants and the recommendation that infants

be placed on their backs when sleeping, may

have contributed to a renewed decline during the

1990s. 

Based on preliminary data, the mortality rate

among Black infants was 14.1 infant deaths per

1,000 live births in 2003. This is almost two and

one-half times the rate among non-Hispanic

White infants (5.8 per 1,000 live births).

Although the trend in infant mortality rates

among both Blacks and non-Hispanic Whites

has generally declined throughout the last century, the proportional discrepancy in rates

between the two races remains largely

unchanged.

The Maternal and Child Health Block Grant

and the MCHB’s Healthy Start Program provide

health and support services to pregnant women

and infants with the goal of reducing infant mortality rates.

Child Health USA 2005

26

U.S. Mortality Rates Among Infants,* by Maternal Race/Ethnicity: 1997-2003

Source (II.2): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital

Statistics System

0

2

4

6

8

10

12

14

16

18

20

1983 1985 1990 1995 2000 2003

14.1

6.9

5.9

Non-Hispanic White 5.8 Hispanic

Black

All Races

Deaths per 1,000 Live Births

*Under 1 year of age.
Child Health USA 2005

INTERNATIONAL INFANT

MORTALITY RATES

Although the United States has substantially

reduced its infant mortality rate in recent

decades, it was still ranked below many industrialized nations in 2002 with a rate of 7.0 deaths

per 1,000 live births. This represents a slight

increase from the rates of 6.9 and 6.8 per 1,000

in 2000 and 2001, respectively, but is well below

the rate of 26.0 per 1,000 reported in 1960. Differences in infant mortality rates among industrialized nations may reflect disparities in the

health status of women before and during pregnancy, as well as the quality and accessibility of

primary care for pregnant women and their

infants. However, some of these differences may,

in part, be the result of international variation in

the definition, reporting, and measurement of

infant mortality.

According to data reported by individual

countries, seven industrialized countries or territories had infant mortality rates that were half

the rate of the United States or less. Hong Kong

had the lowest rate (2.3 per 1,000), followed by

Sweden (2.8 per 1,000). Overall, the United

States was ranked 28th in the world.

International Infant Mortality Rates:* 2002

Source (II.3): Centers for Disease Control and Prevention, National Center for Health Statistics

Deaths per 1,000 Live Births

012345678

2.3

2.8

2.9

3.0

3.0

3.4

3.5

4.1

4.1

4.2

4.3

4.4

4.5

4.7

4.7

4.9

5.0

5.0

5.0

5.1

5.2

7.0

6.2

5.4

5.9

5.4

5.3

*Includes countries, territories, cities, or geographic areas with at least 1 million population and with “complete” counts of live births and infant 

deaths as indicated in the United Nations Demographic Yearbook. Some of the variation in infant mortality rates is due to differences among 

countries in distinguishing between fetal and infant deaths.**Includes data for East Jerusalem and Israeli residents in certain other territories 

under occupation by Israeli military forces since June 1967.

Hong Kong

Sweden

Singapore

Finland

Japan

Spain

Norway

Austria

France

Czech Republic

Germany

Denmark

Switzerland

Italy

Northern Ireland

Belgium

Australia

Netherlands

Portugal

Ireland

England and Wales

Scotland

Canada

Israel**

Greece

New Zealand

Cuba

United States

Hungary

Poland

6.5

7.5

7.2

Health Status - Infants 27
Health Status - Children
Health Status - Children

HEALTH STATUS OF

CHILDREN

In 2003, 84.1 percent of children were in

excellent or very good health, according to parent reports. Males were slightly less likely to be in

excellent or very good health than females (83.5

versus 84.7 percent). The percent of children in

excellent or very good health decreases with

increased age: 86.0 percent of children under age

5 were in excellent or very good health, compared to 83.8 percent of 6- to 11-year-olds and

82.6 percent of 12- to 17-year-olds. 

The rate of children in excellent or very good

health varies by several other factors, including

family income and race and ethnicity. Non-Hispanic White children were the most likely to be

in excellent or very good health (90.7 percent)

while Hispanic children were the least likely

(64.4 percent). Children with family incomes

below 100 percent of the Federal poverty level

(FPL) were least likely to be reported by parents

to be in excellent or very good health (66.8 percent), followed by those with family incomes of

100 to 199 percent of FPL (80.9 percent), and

those with family incomes of 200 to 399 percent

of FPL (90.2 percent); children with family

incomes of 400 percent of FPL or above were the

most likely to be in excellent or very good health

(93.8 percent).

Child Health USA 2005

29

Children Aged 0-17 Years in Excellent or Very Good Health, 

by Race/Ethnicity: 2003

Source (I.2): Centers for Disease Control and Prevention, National Center for Health 

Statistics, National Survey of Children’s Health

Children Aged 0-17 Years in Excellent or Very Good Health, 

by Family Income: 2003

Source (I.2): Centers for Disease Control and Prevention, National Center for Health 

Statistics, National Survey of Children’s Health

*Federal poverty level, equal to $18,400 for a family of four in 2003.

0

10

20

30

40

50

60

70

80

90

100

Non-Hispanic Hispanic

Black

Non-Hispanic

White

Total

84.1

90.7

78.9

64.4

0

10

20

30

40

50

60

70

80

90

100

<100% FPL* 100-199% FPL 200-399% FPL 400% or More FPL

66.8

93.8

80.9

90.2

Percent

Percent
Health Status - Children

ASTHMA

Asthma is a disease in which the airways

become blocked or narrowed. It is triggered by

allergies or other factors, and symptoms include

wheezing, chest tightness, and shortness of

breath. In 2003, almost 8 percent of children in

the United States were affected by asthma. This

includes all children whose parents reported that

a doctor ever told them the child had asthma and

that the child still has asthma, and children who,

in the past year, used asthma medication, had 

moderate or severe difficulties combined with an

attack, or had been hospitalized for asthma.

In 2003, males were more likely to be affected

by asthma than females (9.2 versus 6.6 percent).

A greater proportion of children ages 6 to 11

years and 12 to 17 years were affected by asthma

(8.8 and 8.7 percent, respectively) than children

from birth to age 5 (6.2 percent). Non-Hispanic

Black children were most likely to be affected by

asthma, while Hispanic children were least likely

to be affected. Children with lower family 

incomes were more likely to be affected than

children with higher family incomes.

The effects of asthma also vary by insurance

status. Children with public insurance were more

likely to be affected by asthma than children with

private insurance (10.6 versus 7.2 percent); of

children with no insurance, 5.0 percent were

affected in the ways described above. It is important to note that uninsured children may be less

likely to have access to doctors and prescription

drugs, which may affect whether parents report

that their child has been affected by asthma.

Child Health USA 2005

30

Children Aged 0-17 Years Affected by Asthma,* 

by Race/Ethnicity: 2003

Source (I.2): Centers for Disease Control and Prevention, National Center 

for Health Statistics, National Survey of Children’s Health Percent

0

2

4

6

8

10

12

14

16

Total Non-Hispanic White Non-Hispanic Black Hispanic

6.4

12.4

7.9 7.2

Children Aged 0-17 Years Affected by Asthma,* by Family 

Income: 2003

Source (I.2): Centers for Disease Control and Prevention, National Center 

for Health Statistics, National Survey of Children’s Health Percent

0

2

4

6

8

10

12

14

16

<100% FPL** 100-199% FPL 200-399% FPL 400% or More FPL

6.8 7.7

10.0

8.6

*Includes all children whose parents reported that a doctor ever told them the child had asthma and that the child still has asthma, and children who, in the past year, used asthma medication, had moderate

or severe difficulties combined with an attack, or had been hospitalized for asthma. **Federal poverty level, equal to $18,400 for a family of four in 2003.
Health Status - Children

MENTAL HEALTH 

In 2003, almost 10 percent of children in the

United States had moderate to severe socio-emotional problems. This includes children whose

parents reported that they have moderate to

severe difficulties with emotions, concentration,

behavior, or getting along with others.

Rates of socio-emotional difficulties vary by a

number of factors, including sex, age, race/ethnicity, family income, and insurance type. In

2003, a greater proportion of males under age 18

experienced socio-emotional difficulties than

their female counterparts (11.3 versus 6.9 percent). Children of multiple races had the highest

rate of socio-emotional problems (12.7 percent)

followed by non-Hispanic Black children

(11.6 percent), and non-Hispanic White children (9.0 percent); Hispanic children had the

lowest rate (8.3 percent).

Older children were more likely to experience

socio-emotional difficulties than younger children, with 12- to 17-year-olds experiencing the

highest rate (10.9 percent) and 3- to 5-year olds

experiencing the lowest rate (4.9 percent). Rates

declined consistently with increased family

income: children with family incomes below 100

percent of the poverty level experienced the highest rate (14.0 percent), while children with family incomes at or above 400 percent of the

poverty level experienced the lowest rate (6.1

percent). Children with public insurance had a

higher rate of socio-emotional problems than

children with private insurance (14.9 versus 7.0

percent); they also had a higher rate than children without insurance (8.0 percent).

Child Health USA 2005

31

Children Aged 3-17 Years with Socio-Emotional Difficulties,* 

by Race/Ethnicity: 2003

Source (I.2): Centers for Disease Control and Prevention, National Center for Health

Statistics, National Survey of Children’s Health Percent

0

2

4

6

8

10

12

14

More Than

One Race

Non-Hispanic Hispanic

Black

Non-Hispanic

White

Total

Children with Socio-Emotional Difficulties,* by Age: 2003

Source (I.2): Centers for Disease Control and Prevention, National Center

for Health Statistics, National Survey of Children’s Health Percent

0

2

4

6

8

10

12

14

3-5 Years 6-11 Years 12-17 Years

10.9

4.9

9.6

*Includes all children whose parents said that they have moderate to severe difficulties with emotions, concentration, behavior, or getting along with other people.

8.3

9.2

11.6

12.7

9.0
CHILD ABUSE AND NEGLECT

State child protective services (CPS) agencies

received 2.9 million referrals alleging child abuse

or neglect in 2003. Over half of these reports

were received from community professionals,

while the remainder were received from family,

friends, relatives, or neighbors of these children.

In 2003, investigations by State CPS agencies

determined that an estimated 906,000 children

were victims of abuse or neglect, equivalent to a

rate of 12.4 per 1,000 children under 18 years of

age. Approximately 63 percent of all victims 

suffered neglect or medical neglect, 19 percent

physical abuse, 10 percent sexual abuse, 5 percent psychological maltreatment, and 17 percent

other forms of maltreatment. Some children suffered multiple types of maltreatment.

Victimization was highest among the youngest

children. In 2003, the rate of victimization

among children from birth to age 3 was 16.4 per

1,000 children of the same age; the rates declined

steadily as age increased. Among the estimated

1,500 children who died of abuse and neglect,

children under 1 year of age accounted for nearly

44 percent, and children under 7 years

accounted for 90 percent. Of the child fatalities

that occurred in 2003, 78 percent were caused

by a parent.

The data were obtained from the National

Child Abuse and Neglect Data System, the primary source of National information on abused

and neglected children known to State CPS

agencies.

Health Status - Children

Child Health USA 2005

32

Child Abuse and Neglect Among Children Under Age 18,

by Type of Maltreatment: 2003

Source (II.4): Administration on Children, Youth, and Families, National Child Abuse

and Neglect Data System

*Percentages total more than 100 because some children are victims of more than one type of maltreatment.

Percent of Abused/Neglected Children*

0 10 20 30 40 50 60 70

Psychological

Maltreatment

Sexual Abuse

Other

Physical Abuse

Neglect/Medical

Neglect 63.2

18.9

16.9

9.9

4.9

Sources of Maltreatment Reports: 2003

Source (II.4): Administration on Children, Youth, and Families, National Child Abuse

and Neglect Data System

Percent of Reports

0 3 6 9 12 15 18

Alleged Perpetrator

Alleged Victim

Child Daycare/Foster Care Providers

Friends/Neighbors

Parents

Relatives (Excluding Parents)

Medical Personnel

Anonymous

Other/Unknown

Social Service/Mental Health Personnel

Legal/Law Enforcement Personnel

Educators 16.3

16.0

14.6

12.1

9.1

8.2

8.1

7.3

5.6

1.7

0.7

0.1
PEDIATRIC AIDS

At the end of 2003, 9,419 cases of Acquired

Immunodeficiency Syndrome (AIDS) in children younger than 13 had been reported in the

United States since the beginning of the epidemic. Pediatric AIDS cases represented just over

one percent of all cases ever reported.

In 2003, an estimated 59 new AIDS cases were

diagnosed among children, almost 100 percent

of which were transmitted before or during birth

(perinatal transmission). Since 1993, the number of new cases of pediatric AIDS due to 

perinatal transmission has declined substantially,

and from 1999 to 2003 the number of new cases

among children under 13 years of age, regardless

of transmission method, decreased 68 percent. A

major factor in this decline is the increasing use

of treatment before, during, and after pregnancy

to reduce perinatal transmission of the Human

Immunodeficiency Virus (HIV), the virus that

causes AIDS. In 1994, the U.S. Public Health

Service recommended this treatment for all HIVpositive pregnant women, and in 1995 routine

HIV counseling and voluntary testing for all

pregnant women was recommended. It is

expected that the perinatal transmission rate will

continue to decline with increased use of aggressive treatments and obstetric procedures, such as

elective cesarean section.

Racial and ethnic minorities are disproportionately represented among pediatric AIDS

cases. As of 2003, the number of pediatric AIDS

cases ever reported among non-Hispanic White

children was less than one-third the number

among non-Hispanic Black children, and 25

percent less than that among Hispanic children.

Health Status - Children

Child Health USA 2005

33

AIDS Cases Among Children Under Age 13, by Race/Ethnicity:

Through 2003*

Source (II.5): Centers for Disease Control and Prevention, HIV/AIDS Surveillance

System

Number of Cases

1,620

2,128

56

0 1000 2000 3000 4000 5000 6000

American Indian/

Alaska Native

Asian/Pacific Islander

Hispanic 

Non-Hispanic Black

Non-Hispanic White

5,562

*Includes children with a diagnosis of AIDS, from the beginning of the epidemic through 2003.

Estimated Numbers of AIDS Cases in Children Under Age 13,

by Year of Diagnosis: 1993-2003

Source (II.5): Centers for Disease Control and Prevention, HIV/AIDS Surveillance System Number of Cases

0

200

400

600

800

1000

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

30

59

187

105

522

926

117

335

826

119

246

688

Health Status - Children

VACCINE-PREVENTABLE

DISEASES

The number of reported cases of vaccine-preventable diseases has decreased steadily over the

past decade. The number of cases of H. Influenzae among children under 5 years of age increased

from 2002 to 2003, but the number of cases of

measles, mumps, pertussis, and Hepatitis A and B

decreased over the same period. It is important to

note that since most Hepatitis B infections

among infants and young children are asymptomatic, the reported number of cases likely underestimates the incidence of Hepatitis B in these age

groups. In 2003, the highest number of cases of

pertussis (3,700) was reported since 1964; however, the number of cases among children under

5 decreased by almost 10 percent. Of all pertussis

cases, 17 percent were among infants under 6

months of age who are too young to have received

the full schedule of pertussis vaccine. 

Although much progress has been made in

reducing the number of reported cases of vaccine-preventable diseases, several of these diseases

are still common. The number of cases of pertussis, Hepatitis A, and H. Influenzae remain

substantial and indicate a continuing need to

promote immunization efforts. Since childhood

vaccination for Hepatitis A was recommended in

1996 for children living in high-risk areas, the

number of cases has decreased; in 2003, it

reached the lowest rate ever recorded (2.7 cases

per 100,000). Rates of Hepatitis A have shown

the greatest decline among children in States

where routine vaccination was recommended,

suggesting that immunization policies are having

a positive impact on the incidence of the disease.

Child Health USA 2005

35

Vaccine-Preventable Diseases Among Children Under Age 5: 2003

Source (II.6): Centers for Disease Control and Prevention

Number of Reported Cases

0 200 400 600 800 1000 3200 3400

Pertussis

H. Influenzae

Hepatitis A

Mumps

Measles

Hepatitis B

Polio

Rubella

Diptheria and Tetanus 0

0

0

13

19

32

231

376

3,355
Health Status - Children

Major Causes of Hospitalization, by Age: 2003

Source (II.7): Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital

Discharge Survey

0 50 100 150 200 250 300 350 400 450 500 550

309

83

56

49

107

52

44

35

33

97

71

56

34

103

89

54

192

18

33

39

61

520

460

Ages 1-4

Diseases of the Respiratory System

Endocrine, Nutritional, and Metabolic

Diseases and Immunity Disorders

Injury

Diseases of the Digestive System

Infectious and Parasitic Diseases

Ages 5-9

Diseases of the Respiratory System

Injury

Diseases of the Digestive System

Endocrine, Nutritional, and Metabolic

Diseases and Immunity Disorders

Infectious and Parasitic Diseases

Ages 10-14

Mental Disorders

Diseases of the Digestive System

Diseases of the Respiratory System

Injury

Endocrine, Nutritional, and Metabolic

Diseases and Immunity Disorders

Ages 15-19

Pregnancy/Childbirth

Mental Disorders

Injury

Diseases of the Digestive System

Diseases of the Respiratory System

Ages 20-21

Pregnancy/Childbirth

Mental Disorders

Injury

Diseases of the Digestive System

Diseases of the Genitourinary System

Diseases of the Respiratory System

Number of Discharges in Thousands

HOSPITALIZATION

In 2003, there were 3.7 million hospital discharges among children ages 1 to 21, or 4.4 discharges per 100 children. This represents little

change from 2002. Hospital discharge rates generally decrease until about age 7 and increase

during later adolescence. 

While injuries are the leading cause of death

among children older than 1 year, they

accounted for only 9 percent of hospital discharges among children 1 to 14 years old in

2003. Diseases of the respiratory system were

the major cause of hospitalization for children 

1 to 9 years of age, accounting for 34 percent of

discharges. Pregnancy and childbirth accounted

for 67 percent of discharges of young women

ages 15 to 21. Mental disorders were the second

leading cause of hospitalization for adolescents.

Overall, there has been a significant decrease

in hospital discharge rates among children over

the past 20 years. From 1985 to 2003, there was

a 33 percent decrease in discharge rates for children ages 1 to 14 years. During this period, hospital discharge rates for diseases of the respiratory system declined 35 percent for children in

this age group.

Child Health USA 2005

36
Health Status - Children

CHILD MORTALITY

In 2003, 11,841 children between the ages of

1 and 14 years died of various causes; this was

190 fewer than the previous year. The overall

death rate among 1- to 4-year-olds was 31.1 per

100,000, and the rate among 5- to 14-year-olds

was 16.9 per 100,000. The leading cause of

death among 1- to 4-year-olds continues to be

unintentional injury, which accounted for 34.2

percent of all deaths in this age group in 2003.

The next most common cause of death was congenital malformations (birth defects), followed

by malignant neoplasms (cancer), homicide, and

diseases of the heart. Unintentional injury was

also the leading cause of death among 5- to 14-

year-olds in 2003, accounting for 37.0 percent

of deaths among this age group. This was followed by malignant neoplasms, congenital malformations, homicide, suicide, and diseases of

the heart.

Child Health USA 2005

37

Leading Causes of Death Among Children Ages 1-14: 2003

Source (II.2): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital 

Statistics System

Death Rate per 100,000 Population in Specified Age Group

10.6

3.3

2.4

2.2

1.2

0 1 2 3 4 5 6 7 8 9 10 11

Influenza and Pneumonia

Diseases of the Heart

Suicide

Homicide

Congenital Malformations

Malignant Neoplasms

Unintentional Injury

Septicemia

Influenza and Pneumonia

Diseases of the Heart

Homicide

Malignant Neoplasms

Congenital Malformations

Unintentional Injury

Ages 1-4 Years

Ages 5-14 Years

0.05

1.0

6.3

2.6

0.9

0.8

0.6

0.3

0.6
Health Status - Children

CHILDHOOD DEATHS DUE

TO INJURY

In 2003, unintentional injuries caused the

deaths of 1,679 children aged 1-4 years and

2,562 children aged 5-14 years. In 2003, motor

vehicle crashes, drowning, and fires and burns

were the most common causes of unintentional

injury death among children aged 1-4 years.

Motor vehicle crashes were the most common

cause of unintentional injury death among children aged 5-14 years, followed by deaths due to

drowning, suffocation, and fires and burns.

In addition, 342 children aged 1-4 years were

the victims of homicide in 2003, and 565 children aged 5-14 years were the victims of homicide or suicide (data not shown).

Child Health USA 2005

38

Deaths Due to Unintentional Injury Among Children Ages 1-14: 2003

Source (II.2): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital 

Statistics System

Death Rate per 100,000 Population

Ages 1-4 Years

Ages 5-14 Years

3.2

3.0

1.1

3.7

0.7

0.7

1.6

0.6

0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Fires and Burns

Suffocation

Drowning

Motor Vehicle Crashes

Suffocation

Fires and Burns

Drowning

Motor Vehicle Crashes
Health Status - Adolescents
Health Status - Adolescents

ADOLESCENT

CHILDBEARING

The birth rate among adolescents ages 15 to

19 decreased to 41.6 births per 1,000 females in

2003. This is 3 percent below the rate in 2002

and represents a 33 percent decrease since the

most recent peak in 1991. The birth rate among

the youngest adolescents, those ages 10 to 14

years, declined to 0.6 per 1,000. The number of

births to this age group dropped to 6,661—the

fewest reported in 45 years. Teenage birth rates 

were highest among the oldest adolescents, 18 to

19 years, at 70.7 per 1,000.

Teenage birth rates have historically differed

considerably by race and ethnicity. Among adolescents ages 15 to 19 years, Asian/Pacific

Islanders had the lowest birth rate in 2003 (17.4

per 1,000), followed by non-Hispanic Whites

(27.4 per 1,000). Although non-Hispanic Black

teens had one of the highest birth rates for this

age group (64.7 per 1,000), they have also experienced the largest percentage drop since 1991 

(45 percent). Hispanic females had the highest

birth rate among 15- to 19-year-olds (82.3 per

1,000) and the lowest percentage drop since

1991 (21 percent). Among 10- to 14-year-olds,

non-Hispanic Black females had the highest

birth rate (1.6 per 1,000), followed by Hispanic

females (1.3 per 1,000).

Child Health USA 2005

40

Birth Rates Among Adolescent Females, by Age and Maternal

Race/Ethnicity: 2003

Source (I.5): Centers for Disease Control and Prevention, National Center for Health

Statistics, National Vital Statistics System Live Births per 1,000 Females

0

20

40

60

80

100

120

140

Total Non-Hispanic White Non-Hispanic Black Hispanic

10-14 Years

15-17 Years

18-19 Years

22.4

70.8

0.6

12.4

50.1

0.2

38.8

105.3

1.6

49.7

131.9

1.3

Birth Rates Among Females Ages 15-19, by Maternal Race/Ethnicity:

1990-2003

Source (I.5): Centers for Disease Control and Prevention, National Center for Health

Statistics, National Vital Statistics System

0

20

40

60

80

100

120

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

27.5

64.8

82.2

Non-Hispanic Black

Non-Hispanic White

Hispanic

Live Births per 1,000 Females

17.6

52.6

American Indian/

Alaska Native

Asian/Pacific Islander
Health Status - Adolescents

SEXUAL ACTIVITY

In 2003, 46.7 percent of high school students

reported ever having sexual intercourse, representing a slight increase since 2001. Although

non-Hispanic Black students were most likely to

report ever having sexual intercourse (67.3 percent), they were also most likely to report condom use during their last sexual encounter (72.8

percent of sexually active students). Hispanic students were second most likely to report ever having intercourse (51.4 percent), followed by nonHispanic White students (41.8 percent).

Almost half of all 12th grade students reported

having sexual intercourse in the 3 months preceding the survey. Among 9th grade students,

more males were currently sexually active (24

percent) than females (18.3 percent). By 12th

grade, however, females were more likely to be

currently sexually active (51 percent) than males

(46.5 percent). More than half of all high school

students reported that they have never had sexual

intercourse. Abstinence Education Programs

provide funding for education, mentoring, counseling, and adult supervision to promote abstinence from sexual activity.

In 2003, 63 percent of sexually active students

reported using a condom during their last sexual

intercourse. Condom use by male students is

reportedly higher than condom use by females in

every grade, and younger students reported more

condom use during their last sexual intercourse

(69 percent of 9th and 10th graders) than older

students (57.4 percent of 12th graders).

Sexual Activity Among High School Students: 2003

Source (II.8): Centers for Disease Control and Prevention, Youth Risk Behavior Survey

*Have never had intercourse.

No Intercourse

in Past 3 Months

12.4%

Intercourse in Past 

3 Months, No Condom at

Last Intercourse

12.7%

Intercourse in Past

3 Months, Used Condom

at Last Intercourse

21.6%

Abstinent*

53.3%

Condom Use Among Sexually Active High School Students,

by Grade: 2003

Source (II.8): Centers for Disease Control and Prevention, Youth Risk Behavior Survey

*Had sexual intercourse during the 3 months preceding the survey. Percent of Students

0

10

20

30

40

50

9th Grade 10th Grade 11th Grade 12th Grade

Total Sexually Active*

Condom Use at Last Intercourse 

No Condom Use at Last Intercourse

14.6

6.6

21.1

9.5

25.0

16.1

28.1

20.8

21.2

30.6

41.1

48.9

Child Health USA 2005

41
Health Status - Adolescents

SEXUALLY TRANSMITTED

INFECTIONS

Adolescents (ages 15 to 19 years) and young

adults (ages 20 to 24 years) are at much higher

risk of contracting sexually transmitted infections (STIs) than are older adults. Within these

age groups, reported rates of chlamydia, gonorrhea, and syphilis are significantly higher among

non-Hispanic Black youth than youth of all

other reported racial and ethnic categories. Rates

of STIs among Hispanic adolescent and young 

adults are about twice those of non-Hispanic

Whites.

Chlamydia continues to be the most common

STI in adolescents and young adults, with a rate

of 1,524 cases per 100,000 adolescents and

1,605 per 100,000 young adults. Gonorrhea followed in prevalence with an overall rate of 443

cases per 100,000 adolescents and 529 cases per

100,000 young adults. Syphilis is less common

among young people and the population as a

whole. In 2003, the rate of syphilis was 1.6 cases 

per 100,000 adolescents and 4.3 cases per

100,000 young adults. For each of these conditions, rates are slightly higher among 20- to 24-

year-olds than among adolescents.

Although these conditions are treatable with

antibiotics, STIs can have serious health consequences. Active infections can increase the likelihood of contracting HIV and untreated STIs can

lead to pelvic inflammatory disease and infertility in women.

Child Health USA 2005

42

Sexually Transmitted Infections Among Adolescents and Young Adults, by Age and Race/Ethnicity: 2003

Source (II.9): Centers for Disease Control and Prevention, STD Surveillance System

0

650

1,300

1,950

2,600

3,250

3,900

4,550

5,200

5,850

6,500

15-19 Years 20-24 Years

Rate per 100,000 of Same Age Group

748.1 852.5

1,611.0

5,071.3 5,056.9

1,725.7

Chlamydia Gonorrhea Syphilis

0

350

700

1,050

1,400

1,750

2,100

2,450

2,800

3,150

3,500

15-19 Years 20-24 Years

118.9 152.0 219.3

2,193.8

2,683.1

251.8

0

2

4

6

8

10

12

14

16

18

20

15-19 Years 20-24 Years

Non-Hispanic White

Non-Hispanic Black

Hispanic

0.4

1.5 2.0

6.8

16.4

4.9

Non-Hispanic White

Non-Hispanic Black

Hispanic

Non-Hispanic White

Non-Hispanic Black

Hispanic
Health Status - Adolescents

ADOLESCENT AND YOUNG

ADULT HIV/AIDS

In 2003, 3,897 people between 13 and 24

years of age were diagnosed with HIV/AIDS,*

representing 12 percent of all diagnoses. The

number of AIDS cases diagnosed among this age

group was 2,050 in 2003, and 38,490 since the

epidemic began in the early 1980s. 

There were 13,752 people 13 to 24 years of

age living with HIV/AIDS in 2003, representing

approximately 4 percent of all cases. Among people who died with AIDS in 2003, just over 1 percent (237 persons) were 13 to 24 years of age.

Since the beginning of the epidemic, over 10,000

adolescents and young adults have died with the

disease. While the number of people living with

HIV/AIDS has increased in recent years, the

number dying with the disease has decreased due

in part to the availability of effective prescription

drugs to combat the disease.

Child Health USA 2005

43

Number of Persons Ages 13-24 Diagnosed with and Living with HIV/AIDS,*

and Dying with AIDS, by Age: 2003

Source (II.5): Centers for Disease Control and Prevention, HIV/AIDS Surveillance System

0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 4,500 13,250 13,750

Dying with AIDS

237

Living with HIV/AIDS

13,752

New Diagnoses of HIV/AIDS

3,897

*This includes persons with a diagnosis of HIV infection only, a diagnosis of HIV infection and a later AIDS diagnosis, and concurrent 

diagnoses of HIV infection and AIDS.

3,847

13,134

229

50

618

8

Number of Persons

13-14 Years 15-24 Years

Health Status - Adolescents

PHYSICAL ACTIVITY AND

OVERWEIGHT

Results from the 2003 National Youth Risk

Behavior Survey show that 62.6 percent of high

school students regularly participated in sufficient vigorous physical activity, and almost 25

percent participated in sufficient moderate physical activity. Just over half (51.9 percent) performed regular strengthening exercises, while

57.6 percent played on one or more sports teams.

Nationwide, 55.7 percent of high school students were enrolled in a physical education class

on one or more days a week, although the percentage is far higher in the younger grades (71

percent of 9th graders) than in the older grades

(39.5 percent of 12th graders). The percentage

of students attending daily physical education

classes has dropped from 42 percent in 1991 to

28.4 percent in 2003.

While 12.1 percent of high school students

were overweight in 2003, 29.6 percent described

themselves as overweight and 43.8 percent were

trying to lose weight. Among all racial and ethnic

groups, males were more likely to be overweight

than females (17.4 versus 9.4 percent), while

females were more likely than males to perceive

themselves as such (36.1 versus 23.5 percent).

In an attempt to lose weight or to prevent

themselves from gaining weight, 42.2 percent of

students engaged in healthy behaviors such as

eating less food, fewer calories, or foods lower in

fat. In addition, 57.1 percent of students exercised for the same purpose. Females were more

likely to engage in such weight control behaviors

than males; 56.2 percent of females used food as

a way to control weight compared to 28.9 percent of males, and 65.7 percent used exercise

compared to 49 percent of males. In contrast to

these healthy behaviors, 13.3 percent of students

went without eating for more than 24 hours in

an attempt to lose weight, 9.2 percent took diet

pills, powders, or liquids without the advice of a

doctor, and 6.0 percent vomited or took laxatives. Again, such behaviors are more common

among female students than males.

The HealthierUS Initiative—available online

at www.healthierus.gov—provides credible,

accurate information about physical fitness,

nutrition, and prevention to help Americans of

all ages to make healthy choices.

Child Health USA 2005

45

Physical Activity Among High School Students, by Race/Ethnicity: 2003

Source: (II.8): Centers for Disease Control and Prevention, Youth Risk Behavior Survey

0

10

20

30

40

50

60

70

80

90

100

Vigorous* Moderate** Strength***

Percent

* Activities that caused sweating and hard breathing for at least 20 minutes on 3 of the 7 preceding days.

** Activities that did not cause sweating or hard breathing for at least 30 minutes on 5 of the 7 preceding days.

*** Activities such as push-ups, sit-ups, or weightlifting on 3 of the 7 preceding days.

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

62.6 59.3 54.8

65.2

24.7 21.7 22.0 26.2

51.9 51.5

45.4

53.6
MENTAL HEALTH

TREATMENT

In 2003, 20.6 percent of youth 12 to 17 years

of age received mental health treatment or counseling. The most commonly reported reasons for

seeking counseling were feeling depressed (50.2

percent), breaking rules or “acting out” (25.7

percent), feeling afraid or tense (21.4 percent),

and suicidal thoughts or attempts (18.9 percent).

There was little variation in mental health

treatment rates among youth by age group or

race and ethnicity in 2003. Females ages 12 to

17 years were more likely to receive treatment or

counseling than males of the same age (22.4 versus 19.0 percent). Treatment rates also varied by

family income, with the highest rate among

youths with family incomes of less than $20,000

(24.8 percent). Rates decrease as income

increases, and youths with family incomes of

$75,000 or more had the lowest treatment rate

(18.7 percent).

Among youth receiving mental health treatment/counseling, 48 percent went to a private

therapist, psychologist, psychiatrist, social

worker, or counselor. The second most common

source of treatment was school counselors,

school psychologists, or regular meetings with

teachers (46 percent). Of youths receiving treatment, 9 percent were hospitalized for treatment

of mental health problems. 

Health Status - Adolescents

Child Health USA 2005

46

Reasons for Mental Health Treatment/Counseling* Among Children Ages 12-17 Who

Received Treatment: 2003

Source (II.10): Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health

*Having received treatment or counseling from any of 10 specific sources for emotional or behavioral problems not caused by alcohol or drug use.

**Total is equal to more than 100% because respondents could indicate more than one reason for treatment.

Percent of Youth Receiving Treatment**

0 5 10 15 20 25 50 55

Other Problems

Other Mental Disorders

Social/Friend Problems

Eating Problems

School Problems

Family/Home Problems

Suicidal Thoughts or Attempts

Feeling Afraid or Tense

Breaking Rules or “Acting Out”

Felt Depressed 50.2

21.9

2.9

8.8

9.4

10.4

14.3

18.9

21.4

25.7
VIOLENCE

Violence among adolescents is a critical public

health issue in the United States. In 2003, homicide was the second leading cause of death

among persons ages 15 to 24 years. 

The Youth Risk Behavior Survey (YRBS) asks

adolescents about their exposure to violence both

in general and on school property. The 2003 survey found that 17.1 percent of high school students had carried a weapon (such as a gun, knife,

or club) at some point during the 30 days preceding the survey. Males were four times as likely

as females to carry a weapon (26.9 versus 6.7 percent); however, there was little difference among

grades or racial and ethnic groups in likelihood

of carrying weapons. Just over 6 percent of students admitted to carrying a gun in the preceding 30 days, and males were more than six times

as likely as females to do so. Thirty percent of

students had been in a physical fight at least once

in the 12 months preceding the survey, and

4.2 percent had been injured in such a fight.

According to the YRBS, violence reaches high

school students during school time. In 2003,

over 6 percent of students carried a weapon on

school property on at least one of the preceding

30 days. Older students were slightly more likely

than ninth graders to do so. Over 9 percent of

students were threatened or injured with a

weapon on school property in the preceding 30

days, a rate that consistently declined with

increased grade level. Almost 13 percent of high

school students had engaged in a fight on school

property in the preceding 12 months, over 5 percent of students missed school on at least one of

the 30 preceding days because of safety concerns.

Health Status - Adolescents

Child Health USA 2005

47

High School Students Threatened or Injured with a Weapon

on School Property in Past 12 Months, by Race/Ethnicity: 1993-2003

Source (II.8): Centers for Disease Control and Prevention, Youth Risk Behavior Survey

Non-Hispanic Black

Non-Hispanic White Hispanic

Percent of Students

High School Students Who Carried a Weapon in the Past

30 Days, by Sex and Race/Ethnicity: 1993-2003

Source (II.8): Centers for Disease Control and Prevention, Youth Risk Behavior Survey Percent of Students

0

5

10

15

20

25

30

35

40

1993 1995 1997 1999 2001 2003

27.1

24.3

24.9

9.8

5.5

8.5

Hispanic Male

Hispanic Female

Non-Hispanic White Male

Non-Hispanic White Female

Non-Hispanic Black Female

Non-Hispanic Black Male

10.9

9.4

7.8

0

5

10

15

20

25

30

35

40

1993 1995 1997 1999 2001 2003
Health Status - Adolescents

SUBSTANCE ABUSE

Prevalence and Incidence. In 2003, 11.2 percent

of adolescents ages 12 to 17 years reported using

illicit drugs in the past month. The use of illicit

drugs within the past month increased with age.

Among 12- to 13-year-olds, 3.8 percent reported

past-month use, compared to 19.2 percent of 16-

to-17-year-olds. Rates of past-month illicit drug

use were similar among non-Hispanic White,

non-Hispanic Black, and Hispanic adolescents

(ranging from 9.6 to 11.8 percent); American

Indian/Alaska Native adolescents had the highest

rate of past-month use among 12- to 17-yearolds (19.6 percent), while Asian adolescents had

the lowest (6.5 percent).

Alcohol is the most commonly used drug

among adolescents, with almost 18 percent of

12- to 17-year-olds reporting past-month use in

2003. Marijuana is the most commonly used

illicit drug (7.9 percent), followed by the nonmedical use of prescription psychotherapeutic

drugs, such as pain relievers, tranquilizers, and

stimulants (4.0 percent). Marijuana use is more

common among male adolescents than their

female counterparts (8.6 versus 7.2 percent),

while prescription drug abuse is more common

among females (4.2 versus 3.7 percent).

In 2003, 48.4 percent of 12- to 17-year-olds

who smoked cigarettes in the past month also

used an illicit drug, compared to only 6.1 percent of adolescents who didn’t smoke.

Perception of Risk and Access to Drugs. In 2003,

34.9 percent of adolescents perceived smoking

marijuana once a month as a great risk, while

51.4 percent perceived the same risk regarding

cocaine use. Smoking one pack of cigarettes a day

was considered a great risk by 64.2 percent of

adolescents. Among those youths who perceived

marijuana as a great risk, 1.8 percent admitted to

using the drug within the past month; however,

among youths who perceived it as a moderate,

slight, or nonexistent risk, 11.2 percent reported

marijuana use in the past 30 days.

In 2003, almost 54 percent of teens reported

that marijuana would be fairly or very easy to

obtain. The same was reported by 25.0 percent

of youths for cocaine, 17.6 percent for LSD, and

15.3 percent for heroin. Just over 16 percent of

adolescents reported being approached by someone selling drugs in the past month.

Child Health USA 2005

48

Past Month Drug Use Among Adolescents Ages 12-17: 2003

Source: (II.10): Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health

*Does not include alcohol.

**Psychotherapeutics include prescription-type pain relievers, tranquilizers, stimulants, and sedatives; hallucinogens include

LSD, PCP, and Ecstasy.

0

2

4

6

8

10

12

14

16

18

20

Non-Medical Use of Hallucinogens**

 Psychotherapeutics**

Any Illicit Drug* Alcohol Marijuana

Percent

17.7

7.9

4.0

1.0

11.2
Health Status - Adolescents

CIGARETTE SMOKING

As reported in the Monitoring the Future

Study by the University of Michigan, cigarette

smoking declined among 8th and 10th graders

but increased slightly among 12th graders from

2003 to 2004. Among 8th graders, 9.2 percent

reported smoking at least one time during the

30 days preceding the survey in 2004, compared

to 10.2 percent during the previous year. The

rate among 10th graders in 2004 was 16.0 percent, and the rate among 12th graders was 25.0

percent; this is compared to 16.7 and 24.4 percent, respectively, in 2003. These figures represent a 56 percent decline for 8th graders and a

47 percent decline for 10th graders since use

peaked among those grades in 1996. Among

12th graders, use peaked in 1997 and has seen a

more modest decline of 33 percent. Factors that

appear to have contributed to the decline include

increases in perceived risk and disapproval of

smoking, high cigarette prices, and anti-smoking

advertising campaigns.

The prevalence of smoking among teens

increased substantially between 1991 and 1996.

These increases occurred in virtually every sociodemographic group: both sexes, those planning

on attending college and not, those living in all

four regions of the country, those living in rural

and urban areas, and among Whites, Blacks, and

Hispanics. Since 1996, rates have declined across

all demographic groups consistently. Although

absolute rates of smoking have declined among

adolescents, certain subgroups are less likely to

smoke than others. Students who are not 

college-bound are more likely to smoke than college-bound high school students, and Black adolescents are less likely to smoke cigarettes than

their White counterparts. The decline in rates of

cigarette smoking since 1996 is likely to have

important long-term health consequences for

this generation of adolescents.

Child Health USA 2005

49

Any Cigarette Use Among High School Students in the Past 30 Days, by Grade: 1975-2004

Source (II.11): University of Michigan, Monitoring the Future Study

9.2

Percent of Students

16.0

25.0

12th Grade

8th Grade

10th Grade

5

10

15

20

25

30

35

40

1975 1980 1985 1990 1995 2000 2004
Health Status - Adolescents

Child Health USA 2005

50

ADOLESCENT MORTALITY

In 2003, 13,595 deaths were reported of adolescents aged 15-19 years. After a moderate

increase for this age group in the early 1980s,

death rates have since gradually declined. Unintentional injury remains the leading cause of

death among this age group and accounted for

approximately 50 percent of all deaths among

adolescents 15-19 years of age in 2003. Homicide and suicide were the next leading causes of

death, accounting for 14 and 11 percent, respectively, of all deaths within this age group.

Deaths Due to Injury. Within the classification of

deaths due to injury or other external causes,

motor vehicle crashes were the leading cause of

mortality among 15- to 19-year-olds in 2003,

and accounted for 50 percent of injury-related

deaths among adolescents. Alcohol is a significant contributor to these deaths; nearly one-third

of adolescent drivers killed in crashes had been

drinking. Firearms were the next leading cause of

injury death, accounting for 29 percent of

injury-related deaths in this age group. Adolescent death rates due to motor vehicle injuries and

firearms were similar in the early 1990s until

1994, when they began to diverge. The rate of

adolescent firearm deaths was recorded at 12.1

per 100,000 population in 2003, less than half

the rate of motor vehicle injury deaths of 25.2

per 100,000.

Leading Causes of Death Among Adolescents Ages 15-19: 2003

Source (II.2): Centers for Disease Control and Prevention, National Center for Health

Statistics, National Vital Statistics System

Death Rate per 100,000 Population

0 5 10 15 20 25 30 35 40

Diseases

of the Heart

Malignant

Neoplasms (Cancer)

Suicide

Homicide

Unintentional

Injury 33.0

9.5

7.3

3.4

1.9

Deaths Due to Injury Among Adolescents Ages 15-19: 2003

Source (II.2): Centers for Disease Control and Prevention, National Center for Health

Statistics, National Vital Statistics System

Death Rate per 100,000 Population

0 5 10 15 20 25 30 35 40

Drowning

Poisoning 

Firearms

Motor Vehicle Traffic 25.2

12.1

3.5

1.5
Health Status - Adolescents

Child Health USA 2005

51

ADOLESCENT MORTALITY

FROM TRAFFIC AND

FIREARM INJURIES

The two leading mechanisms of injury deaths

among adolescents are motor vehicle crashes and

firearms. In 2003, motor vehicle traffic caused

the deaths of 5,169 adolescents 15-19 years of

age. The vast majority of those killed were in

motor vehicle accidents either as a passenger or

driver. Deaths of pedestrians, motorcyclists, and

others accounted for the remainder of motor

vehicle mortality among adolescents.

Results of the 2003 Youth Risk Behavior Survey revealed that 18.2 percent of high school students had rarely or never worn seat belts when

riding in a car driven by someone else. Additionally, 30.2 percent of students had ridden on one

or more occasions with a driver who had been

drinking alcohol in the 30 days preceding the

survey.

In 2003, 2,469 adolescents aged 15-19 were

killed by firearms. Of these, homicide accounted

for 65 percent of firearms deaths, suicide

accounted for 30 percent, and 4 percent were

considered to be unintentional.

Adolescent Mortality from Traffic and Firearm Injuries: 2003

Source (II.2): Centers for Disease Control and Prevention, National Center for Health Statistics, 

National Vital Statistics System

Death Rate per 100,000 Population in Specified Age Group

Traffic Mortality by Person Injured

14.0

1.5

0.3

7.9

3.6

0.5

1.0

0.2

0 2 4 6 8 10 12 14 16

Unknown

Unintentional

Suicide

Homicide

Pedal Cyclist

Motorcyclist

Pedestrian

Motor Vehicle Occupant

Firearms Mortality by Intent
This page left intentionally blank.
The availability of, and access to, quality

health care directly affects the health of mothers

and children. This is especially true of those populations at high risk due to chronic medical conditions or low socio-economic status.

Children may receive health coverage through

a number of sources, including private insurance

or public programs such as Medicaid or the State

Children’s Health Insurance Program (SCHIP).

Eligibility for public programs is based on a family’s income compared to the Federal poverty

level. Every State has SCHIP programs that help

expand coverage to many uninsured children.

Outreach and consumer education are also key

components in that expansion. Despite the

progress achieved through public programs,

approximately 8.5 million children remain uninsured in the United States. 

The following section presents data on the utilization of health services within the maternal

and child population. The most recent data are

summarized by source of payment, type of care,

and place of service delivery and are presented by

age, income, and race and ethnicity.

Health Services Financing and Utilization

Child Health USA 2005

53

Health Services Financing and Utilization
Health Services Financing and Utilization

Child Health USA 2005

54

VACCINATION COVERAGE

The Healthy People 2010 objective for the

complete series of routinely recommended childhood vaccinations is immunization of at least 90

percent of 19- to 35-month-olds with the full

series of vaccines. Data released from the CDC’s

2003-04 National Immunization Survey show

that 80.5 percent of children 19 to 35 months of

age had received the recommended 4:3:1:3:3

series of vaccines (4 DTP, 3 polio, 1 MCV, 3 Hib,

3 HepB); 74.5 percent of 19- to 35-month-olds

had received the 4:3:1:3:3:1 series, which

includes the varicella (chicken pox) vaccine. In

the past 5 years, the greatest increases in vaccination rates have occurred with the hepatitis B and

varicella vaccines (varicella was added to the

schedule in 1996). Since the 1998-99 survey, the

vaccination rate for hepatitis B has increased 5

percent to 92.3 percent, while the varicella vaccination rate has risen over 60 percent, from

52.1 percent in 1998-99 to 86.2 percent in

2003-04. Racial and ethnic disparities exist in

vaccination rates, and non-Hispanic Black children and American Indian/Alaska Native children (data not shown) have the lowest vaccination rates for each of the major vaccines.

Each year, the CDC publishes an update of the

recommended childhood immunization schedule

(see facing page). The 2005 schedule continues

to encourage the routine use of hepatitis B vaccines for all infants before hospital discharge and

the use of yearly influenza vaccines for all children 6 to 23 months of age.

Estimated Vaccination Rates Among Children Aged 19-35 Months, by Race/Ethnicity:

2003-04

Source: (III.1): Centers for Disease Control and Prevention, National Immunization Survey

*The immunization schedule calls for one dose of measles-containing vaccine (MCV), which can include the measles-mumps-rubella

(MMR) vaccine shown above.

93.8 94.9 93.3

92.3 93.1 91.5

91.5

86.2 85.1 86.1 87.4

85.6 87.9 79.2 84.3

92.9 93.3 90.5 92.9

91.6 92.7 89.0 91.0

90.2

1+ Varicella

Non-Hispanic

White

Non-Hispanic

Black

Total Hispanic

4+ DTP

3+ Polio

1+ MMR*

3+ HepB

3+ Hib
Health Services Financing and Utilization

Child Health USA 2005

55

This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of

December 1, 2004, for children through age 18 years. Any dose not administered at the recommended age should be administered at any subsequent visit when indicated and feasible.

The graphic indicates age groups that warrant special effort to administer those vaccines not previously administered. Additional

vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and other components of the vaccine are not contraindicated. Providers should consult

the manufacturers' package inserts for detailed recommendations. Clinically significant adverse events that follow immunization

should be reported to the Vaccine Adverse Event Reporting System (VAERS). Guidance about how to obtain and complete a

VAERS form is available at www.vaers.org or by telephone, 800-822-7967.

1. Hepatitis B (HepB) vaccine. All infants should receive the first dose of HepB vaccine soon

after birth and before hospital discharge; the first dose may also be administered by age 2

months if the mother is hepatitis B surface antigen (HBsAg) negative. Only monovalent

HepB may be used for the birth dose. Monovalent or combination vaccine containing

HepB may be used to complete the series. Four doses of vaccine may be administered when

a birth dose is given. The second dose should be administered at least 4 weeks after the first

dose, except for combination vaccines which cannot be administered before age 6 weeks.

The third dose should be given at least 16 weeks after the first dose and at least 8 weeks

after the second dose. The last dose in the vaccination series (third or fourth dose) should

not be administered before age 24 weeks.

Infants born to HBsAg-positive mothers should receive HepB and 0.5 mL of hepatitis B

immune globulin (HBIG) at separate sites within 12 hours of birth. The second dose is recommended at age 1-2 months. The final dose in the immunization series should not be

administered before age 24 weeks. These infants should be tested for HBsAg and antibody

to HBsAg (anti-HBs) at age 9-15 months.

Infants born to mothers whose HBsAg status is unknown should receive the first dose of

the HepB series within 12 hours of birth. Maternal blood should be drawn as soon as possible to determine the mother’s HBsAg status; if the HBsAg test is positive, the infant should

receive HBIG as soon as possible (no later than age 1 week). The second dose is recommended at age 1-2 months. The last dose in the immunization series should not be administered before age 24 weeks.

2. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. The fourth dose of

DTaP may be administered as early as age 12 months, provided 6 months have elapsed

since the third dose and the child is unlikely to return at age 15-18 months. The final dose

in the series should be given at age >4 years. Tetanus and diphtheria toxoids (Td) is recommended at age 11–12 years if at least 5 years have elapsed since the last dose of tetanus and

diphtheria toxoid-containing vaccine. Subsequent routine Td boosters are recommended

every 10 years.

3. Haemophilus influenzae type b (Hib) conjugate vaccine. Three Hib conjugate vaccines are

licensed for infant use. If PRP-OMP (PedvaxHIB® or ComVax® [Merck]) is administered at

ages 2 and 4 months, a dose at age 6 months is not required. DTaP/Hib combination products should not be used for primary immunization in infants at ages 2, 4 or 6 months but

can be used as boosters after any Hib vaccine. The final dose in the series should be administered at age>12 months.

4. Measles, mumps, and rubella vaccine (MMR). The second dose of MMR is recommended

routinely at age 4-6 years but may be administered during any visit, provided at least 4

weeks have elapsed since the first dose and both doses are administered beginning at or after

age 12 months. Those who have not previously received the second dose should complete

the schedule by age 11-12 years.

5. Varicella vaccine. Varicella vaccine is recommended at any visit at or after age 12 months for

susceptible children (i.e., those who lack a reliable history of chickenpox). Susceptible persons aged >13 years should receive 2 doses administered at least 4 weeks apart.

6. Pneumococcal vaccine. The heptavalent pneumococcal conjugate vaccine (PCV) is recommended for all children aged 2-23 months and for certain children aged 24-59 months. The

final dose in the series should be given at age >12 months. Pneumococcal polysaccharide

vaccine (PPV) is recommended in addition to PCV for certain high-risk groups. See

MMWR 2000;49(RR-9):1-35.

7. Influenza vaccine. Influenza vaccine is recommended annually for children aged >6 months

with certain risk factors (including, but not limited to, asthma, cardiac disease, sickle cell

disease, human immunodeficiency virus [HIV], and diabetes), healthcare workers, and

other persons (including household members) in close contact with persons in groups at

high risk (see MMWR 2004;53[RR-6]:1-40). In addition, healthy children aged 6-23

months and close contacts of healthy children aged 0-23 months are recommended to

receive influenza vaccine because children in this age group are at substantially increased

risk for influenza-related hospitalizations. For healthy persons aged 5-49 years, the

intranasally administered, live, attenuated influenza vaccine (LAIV) is an acceptable alternative to the intramuscular trivalent inactivated influenza vaccine (TIV). See MMWR

2004;53(RR-6):1-40. Children receiving TIV should be administered a dosage appropriate

for their age (0.25 mL if aged 6-35 months or 0.5 mL if aged >3 years). Children aged >8

years who are receiving influenza vaccine for the first time should receive 2 doses (separated

by at least 4 weeks for TIV and at least 6 weeks for LAIV).

8. Hepatitis A vaccine. Hepatitis A vaccine is recommended for children and adolescents in

selected states and regions and for certain high-risk groups; consult your local public health

authority. Children and adolescents in these states, regions, and high-risk groups who have

not been immunized against hepatitis A can begin the hepatitis A immunization series during any visit. The 2 doses in the series should be administered at least 6 months apart. See

MMWR 1999;48(RR-12):1-37.

Footnote: Recommended Childhood and Adolescent Immunization Schedule United States,

2005

Recommended Childhood and Adolescent Immunization Schedule, United States, 2005

Source (III.2): Centers for Disease Control and Prevention

Range of Recommended Ages Preadolescent Assessment Catch-Up Immunization Only if Mother HBsAg(-)

AT BIRTH 1MO 2MO 4MO 6MO 12MO 15MO 18MO 24MO 4-6YR 11-12YR 13-18YR

Hepatitis B1 Hep B #1

Hep B #2 Hep B #3 Hep B series

Diphtheria, Tetanus, Pertussis2 DTaP DTaP DTaP DTaP DTaP Td Td

H. influenzae type b3 Hib Hib Hib Hib

Inactivated Poliovirus IPV IPV IPV IPV

Measles, Mumps, Rubella4 MMR #1 MMR #2 MMR #2

Varicella5 Varicella Varicella

Pneumococcal Conjugate6 PCV PCV PCV PCV PCV PPV

Influenza7 Influenza (Yearly) Influenza (Yearly)

Hepatitis A8 Hepatitis A Series

Vaccines below line are for selected populations

Health Services Financing and Utilization

TIMING OF DENTAL CARE

In a 2000 report on oral health, the Surgeon

General identified dental caries (tooth decay) as

the single most common chronic disease among

children in the United States, a condition even

more common among children living in families

with low incomes. This is a preventable health

problem that can significantly affect children’s

health, ability to concentrate in school, and quality of life. 

To promote good oral hygiene, the American

Academy of Pediatrics recommends that all 

children receive an oral health risk assessment by

6 months of age and a dental referral by 3 years;

earlier referrals are appropriate for children

found to be at risk. In Federal Fiscal Year 2002,

only 23 percent of children eligible for services

under the Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program received a preventive dental service.

In 2003, 70.8 percent of children had seen a

dentist in the past year. Frequency of dental visits among children varies by family income and

race and ethnicity. Non-Hispanic White children

between the ages of 1 and 18 years were most

likely to have visited a dentist or other dental specialist within the past year (75.6 percent), while

Hispanic children were least likely (61.3 percent). Children with family incomes at or above

200 percent of the poverty level were almost 30

percent more likely to have seen a dentist in the

past year than children living with family

incomes below 200 percent of the poverty level.

Child Health USA 2005

57

Children Receiving Dental Care in the Past 12 Months, by Family

Income: 2003

Source (III.4): Centers for Disease Control and Prevention, National Center 

for Health Statistics, National Health Interview Survey

23.0

Percent of Eligible Children

Children Receiving an EPSDT Preventive Dental Service:

1990-2002

Source (III.3): Centers for Medicare and Medicaid Services

Percent

0

10

20

30

40

50

60

70

80

90

100

All Children <200% FPL* 200% or More FPL

Within Past Year

Over 1 Year Ago or Never

39.2

60.5

70.8

77.3

39.5

22.7

*Includes data from 49 States. *Federal poverty level, equal to $18,400 for a family of four in 2003.

0

5

10

15

20

25

30

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002*
In 2003, 12.2 percent of children under

18 years of age had not seen a physician or other

health care professional in the previous year (not

including overnight hospitalization, trips to the

emergency room, home visits, or dental visits).

Older children were more likely than younger

children to go without a physician visit. Nearly

16 percent of 15- to 17-year-olds had not had a

physician visit in the previous year, compared to

only 5.8 percent of children under 5 years of age.

Across all age groups, Hispanic children were

the least likely to have seen a physician in the

prior year; non-Hispanic White children were

most likely to have seen a physician, except

among 10- to 14-year-olds where non-Hispanic

Black children were the most likely. At all ages,

Hispanic children were at least 45 percent more

likely than non-Hispanic White children to have

had no physician visits.

Child Health USA 2005

58 Health Services Financing and Utilization

Children Reported Not to Have Seen a Physician or Other Health Professional in the Past

12 Months, by Age and Race/Ethnicity: 2003

Source (III.4): Centers for Disease Control and Prevention, National Center for Health Statistics, National Health 

Interview Survey Percent of Children

0

5

10

15

20

25

30

35

40

Total 0-4 Years 5-9 Years 10-14 Years 15-17 Years

Non-Hispanic White

Non-Hispanic Black

Hispanic

9.9

11.2

19.5

4.2

6.8

10.1 10.4

12.0

19.0

12.1

15.9

29.2

13.2 12.1

25.5

TIMING OF PHYSICIAN VISITS
Health Services Financing and Utilization

Child Health USA 2005

59

RECEIPT OF PREVENTIVE

CARE

In 2003, 58.8 percent of children were

reported by parents to have had both a preventive

medical and dental visit in the past year. The

American Academy of Pediatrics (AAP) recommends that children have eight health care visits

in their first year, three in their second year, and

at least one per year from middle childhood

through adolescence. The AAP also recommends

that all children receive an oral health risk assessment by 6 months of age and a dental referral by

3 years; earlier referrals are appropriate for children found to be at risk. The traditional recommendation for oral health supervision is every

6 months thereafter; however, this should also be

adjusted based on each child’s individual risk.

Males and females were equally as likely to

have had both a preventive medical and dental

visit in the past year; however, the rate of preventive visits varied by age, race and ethnicity, and

family income. Children ages 6 to 11 years are

most likely to have received both preventive and

dental visits (63.0 percent), followed by children

ages 12 to 17 years (61.9 percent). Receipt of regular preventive care rose with family income:

children with family incomes below 100 percent

of the Federal poverty level (FPL) were least likely

to have received care in the past year (48.3 percent), while children with family incomes at

400 percent of the FPL or higher were most

likely (69.8 percent). By race and ethnicity, Hispanic children were least likely to have received

both types of care in the past year (48.8 percent)

while non-Hispanic White children were most

likely (62.4 percent).

Children Aged 0-17 Years Who Have Received Preventive Medical 

and Dental Care in the Past Year, by Race/Ethnicity: 2003

Source (I.2): Centers for Disease Control, National Center for Health Statistics, National 

Survey of Children’s Health Percent

0

10

20

30

40

50

60

70

80

Total Non-Hispanic White Non-Hispanic Black Hispanic

48.8

58.8 57.7

Children Aged 0-17 Years Who Have Received Preventive Medical

and Dental Care in the Past Year, by Family Income: 2003

Source (I.2): Centers for Disease Control, National Center for Health Statistics, National 

Survey of Children’s Health Percent

0

10

20

30

40

50

60

70

80

<100% FPL* 100-199% FPL 200-399% FPL 400% or More FPL

69.8

48.3 52.1

62.4 61.3

*Federal Poverty Level, equal to $18,400 for a family of four in 2003.
PLACE OF PHYSICIAN

CONTACT

In 2003, a doctor’s office or HMO was the

usual place of sick care (not including routine or

preventive care) for nearly 79 percent of children

in the United States, a rate that varies by age and

family income. Children with family incomes

above the poverty level were more likely to visit a

doctor’s office or HMO for sick care than children in poverty (82.3 versus 58.9 percent), and

were less likely to visit a clinic or health center

(16.2 versus 36.7 percent). Only a small 

proportion of children used a hospital emergency

room or outpatient department as a source of sick

care, but children with family incomes below the

poverty level were more likely to do so than children from families with higher incomes.

Younger children were more likely than older

children to visit clinics or health centers, hospital

emergency rooms, and hospital outpatient

departments when sick. Children ages 5 to 12

years were more likely than their older and

younger counterparts to use a doctor’s office or

HMO as a source of care.

Health Services Financing and Utilization

Child Health USA 2005

60

Place of Physician Contact,* by Age and Poverty Level: 2003

Source (III.4): Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey

0

10

20

30

40

50

60

70

80

90

100

Below Poverty Level Above Poverty Level

Percent

*The place where the child usually goes when sick; does not include routine or preventive care visits.

Under 5 Years

0

10

20

30

40

50

60

70

80

90

100

Below Poverty Level Above Poverty Level

5-12 Years

Doctor’s Office or HMO

Clinic or Health Center

Hospital Emergency Room

Hospital Outpatient Department

0

10

20

30

40

50

60

70

80

90

100

Below Poverty Level Above Poverty Level

13-17 Years

81.1

0.4 1.2

17.1

2.1 1.5

42.2

54.1

83.4

0.5 0.6

15.1

1.8 2.7

32.5

62.8

81.8

0.2 0.7

17.0

2.0 2.9

36.7

58.4

Doctor’s Office or HMO

Clinic or Health Center

Hospital Emergency Room

Hospital Outpatient Department

Doctor’s Office or HMO

Clinic or Health Center

Hospital Emergency Room

Hospital Outpatient Department
Health Services Financing and Utilization

Children’s Trips to the Emergency Room/Emergency Department,

by Poverty Level: 2003

Source (III.4): Centers for Disease Control and Prevention, National Center for Health 

Statistics, National Health Interview Survey

0

10

20

30

40

50

60

70

80

90

100

Percent

Below Poverty Level

Above Poverty Level

24.0

1.0 3.0

19.2

79.8

73.0

Children’s Trips to the Emergency Room/Emergency Department,

by Age: 2003

Source (III.4): Centers for Disease Control and Prevention, National Center for Health 

Statistics, National Health Interview Survey

0

10

20

30

40

50

60

70

80

90

100

Percent

< 5 Years

5-9 Years

10-14 Years

15-17 Years 83.6 80.6 79.2

72.8

0.9 1.1 1.2 2.1

15.3

19.6 18.5

25.2

Child Health USA 2005

61

HOSPITAL UTILIZATION

In 2003, over 20 percent of children went to a

hospital emergency room or emergency department (ER/ED) at least once. Children with family incomes above the Federal poverty level (FPL)

were less likely than children living below the FPL

to have visited the ER/ED. Children in lowincome families were more likely to have gone one

to three times (24.0 versus 19.2 percent) and four

or more times (3.0 versus 1.0 percent). Despite

this difference, there was little disparity in the

number of nights spent in the hospital by FPL.

The rate of ER/ED visits also varied by a number of other factors, including sex, age, and race

and ethnicity. Males under 18 years of age were

more likely than their female counterparts to

have made any trips to the ER/ED (22.4 versus

19.3 percent). More specifically, males were

more likely than females to have gone one to

three times, while both sexes were equally likely

to have made four or more visits. By age, children under 5 years had the highest rate of

ER/ED visits (27.3 percent), followed by children 15 to 17 years (20.8 percent). Non-Hispanic Black children had the highest rate of

ER/ED visits (24.1 percent), followed by Hispanic and non-Hispanic White children (20.3

and 20.6 percent, respectively).

Children’s Trips to the Emergency Room/Emergency Department,

by Poverty Level: 2003

Source (III.4): Centers for Disease Control and Prevention, National Center for Health 

Statistics, National Health Interview Survey

0

10

20

30

40

50

60

70

80

90

100

No Trips 1-3 Trips 4 or More Trips

Percent

Below Poverty Level

Above Poverty Level

24.0

1.0 3.0

19.2

79.8

73.0

Children’s Trips to the Emergency Room/Emergency Department,

by Age: 2003

Source (III.4): Centers for Disease Control and Prevention, National Center for Health 

Statistics, National Health Interview Survey

0

10

20

30

40

50

60

70

80

90

100

No Trips 1-3 Trips 4 or More Trips

Percent

< 5 Years

5-9 Years

10-14 Years

15-17 Years 83.6 80.6 79.2

72.8

0.9 1.1 1.2 2.1

15.3

19.6 18.5

25.2
Health Services Financing and Utilization

HEALTH CARE FINANCING

In 2003, 8.4 million children younger than 18

years of age (11.4 percent) had no health insurance coverage, and almost one-third of children

were publicly insured. 

Children with family incomes below the Federal poverty level (FPL) were more likely than

children with family incomes of 200 percent of

FPL or above to have public insurance (66.8 versus 12.6 percent) or be uninsured (19.5 versus

6.7 percent). Only 12.4 percent of children with

family incomes below the FPL had employmentbased coverage, compared to 78.6 percent with

family incomes of 200 percent of FPL or above.

Although over 90 percent of privately insured

children received insurance that was employment-based, children of employed adults may

not receive coverage because it is not offered by

the employer or it is prohibitively expensive. In

2003, almost two-thirds of uninsured children

lived in families whose head was employed yearround on a full-time basis.

In 1997, the State Children’s Health Insurance

Program (SCHIP) was created in response to the

growing number of uninsured children in lowincome working families. In 2003, 5.8 million

children were enrolled in SCHIP. Although

designed to cover children with a family income

of below 200 percent of FPL, many States have

expanded eligibility to children with higher family income; as of September 2003, 39 States and

the District of Columbia had SCHIP coverage

for children living at 200 percent of FPL and

higher.

Child Health USA 2005

62

Health Insurance Coverage* Among Children Under Age 18: 2003

Source (I.3): U.S. Census Bureau, Current Population Survey Percent

0

10

20

30

40

50

60

70

80

Private Coverage Public Coverage No Coverage

29.1

65.9

11.4

Health Insurance Coverage* Among Children Living in Families 

Below 100 Percent of Poverty Level: 2003

Source (III.5): Employee Benefit Research Institute, Analysis of Current Population Survey Percent

0

10

20

30

40

50

60

70

80

Private Coverage Public Coverage No Coverage

66.8

19.8 19.5

*Total equals more than 100% because children may have more than one source of coverage.
PRENATAL CARE

Timely Prenatal Care. Prenatal care—especially

care beginning in the first trimester—improves

pregnancy outcomes by identifying and managing chronic and pregnancy-related conditions

and providing expectant parents with relevant

health care advice. The rate of first trimester prenatal care utilization has been increasing fairly

steadily since the early 1990s, and in 2003, 84.1

percent of women received prenatal care during

the first trimester of pregnancy.

The increase in prenatal care utilization over

the past decade has been especially remarkable

among racial and ethnic groups with historically

low rates of prenatal care. The proportion of

non-Hispanic Black, Hispanic, and American

Indian women receiving early prenatal care

increased by 20 percent or more since 1990;

however, disparities still exist. In 2003, non-Hispanic White women had the highest rates of

early prenatal care utilization (89.0 percent), followed by Asian/Pacific Islander women (85.4

percent), non-Hispanic Black women (75.9 percent), and Hispanic women (77.5 percent);

American Indian women had the lowest rate of

early prenatal care utilization (70.8 percent).

Late or No Prenatal Care. The percentage of

women beginning prenatal care in the third

trimester or going without prenatal care

decreased slightly to 3.5 percent in 2003. Hispanic and non-Hispanic Black women are more

than twice as likely than non-Hispanic White

women to receive late or no prenatal care. Other

risk factors for late or no prenatal care include

being younger than 20 years old, being unmarried, and having low educational attainment.

Health Services Financing and Utilization

Child Health USA 2005

63

Mothers Beginning Prenatal Care in the First Trimester, by Age 

and Race: 2003

Source (I.5): Centers for Disease Control and Prevention, National Center for Health

Statistics, National Vital Statistics System Percent

Mothers Receiving Late or No Prenatal Care, by Age and Race: 2003

Source (I.5): Centers for Disease Control and Prevention, National Center for Health

Statistics, National Vital Statistics System Percent

0

10

20

30

40

50

60

70

80

90

100

40 Years

and Older

35-39

Years

30-34

Years

25-29

Years

20-24

Years

15-19

Years

Total <15 Years

83.5

89.0

76.3

90.8

56.2

93.3 89.9 92.7

74.1 75.9

65.8

80.1

43.2

82.2 78.3 81.0

Non-Hispanic White

Non-Hispanic Black

0

10

20

30

40

50

60

70

80

90

100

40 Years

and Older

35-39

Years

30-34

Years

25-29

Years

20-24

Years

15-19

Years

Total <15 Years

2.1 4.4 3.2 1.8

13.7

1.3 1.5 2.2 6.0 6.0 7.7 5.1

16.9

5.1 5.8 6.8

Non-Hispanic White

Non-Hispanic Black
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While the indicators presented in previous sections are representative of the United States as a

whole, the next section presents data on a number of health indicators at the State level.

Included are data on infant, neonatal, and perinatal mortality, low birth weight, early prenatal

care, births to women under 18, health care

financing for children, Medicaid enrollment and

expenditures, and SCHIP enrollment.

The following pages reveal stark differences in

these measures across States. For instance, the

rates of low birth weight births (less than 2,500

grams or 5 pounds 8 ounces) were highest in the

District of Columbia and the southern States of

Alabama, Louisiana, Mississippi, and South Carolina (all greater than 10 percent). These States,

in addition to New Mexico and Texas, were

among those with the highest rates of births to

women under 18 years of age.

Poverty in the United States has risen over the

past several years. Poverty affects living conditions and access to health care and nutrition, all

of which contribute to health status. Medicaid

and the State Children’s Health Insurance Program (SCHIP) were designed to assure that 

children living in low-income families have

access to insurance coverage and receive adequate

health care services. Alaska, New Mexico, and

the District of Columbia had the greatest proportion of children with Medicaid/SCHIP coverage (over 40 percent), followed closely by 

Mississippi (39.9 percent), while New Jersey and

Utah had the smallest proportions (16 percent or

less). Vermont had the lowest proportion of

uninsured children (5.2 percent) while Texas led

the Nation with the highest proportion of uninsured children (20.2 percent).

State Data

Child Health USA 2005

65

State Data
Type of Date Upper Total SCHIP

State SCHIP Program Implemented Eligibility Enrollment

Alabama Separate 02/01/98 200% 79,407

Alaska Medicaid 03/01/99 175% 21,966

Arizona Separate 11/01/98 200% 87,681

Arkansas Combo 10/01/98 200% 799

California Combo 03/01/98 250% 1,035,752

Colorado Separate 04/22/98 185% 57,244*

Connecticut Separate 07/01/98 300% 21,438

Delaware Combo 02/01/99 200% 10,250

District of Columbia Medicaid 10/01/98 200% 6,093

Florida Combo 04/01/98 200% 419,707

Georgia Separate 11/01/98 235% 280,083

Hawaii Medicaid 07/01/00 200% 19,237

Idaho Combo 10/01/97 185% 19,054

Illinois Combo 01/05/98 200% 234,027

Indiana Combo 10/01/97 200% 80,698

Iowa Combo 07/01/98 200% 41,636

Kansas Separate 01/01/99 200% 44,350

Kentucky Combo 07/01/98 200% 94,500

Louisiana Medicaid 11/01/98 200% 105,580

Maine Combo 07/01/98 200% 29,171

Maryland Combo 07/01/98 300% 111,488

Massachusetts Combo 10/01/97 200% 166,508

Michigan Combo 05/01/98 200% 87,563

Minnesota Combo 10/01/98 275% 4,784

Mississippi Separate 07/01/98 200% 82,900

Missouri Medicaid 09/01/98 300% 176,014

Type of Date Upper Total SCHIP

State SCHIP Program Implemented Eligibility Enrollment

Montana Separate 01/01/99 150% 15,281

Nebraska Medicaid 05/01/98 185% 33,314

Nevada Separate 10/01/98 200% 38,519

New Hampshire Combo 05/01/98 300% 10,969

New Jersey Combo 03/01/98 350% 127,244

New Mexico Medicaid 03/31/99 235% 20,804

New York Combo 04/15/98 250% 826,611

North Carolina Separate 10/01/98 200% 174,434

North Dakota Combo 10/01/98 140% 5,137

Ohio Medicaid 01/01/98 200% 220,190

Oklahoma Medicaid 12/01/97 185% 100,761

Oregon Separate 07/01/98 185% 46,720

Pennsylvania Separate 05/28/98 200% 177,415

Rhode Island Combo 10/01/97 250% 25,573

South Carolina Medicaid 10/01/97 150% 75,597

South Dakota Combo 07/01/98 200% 13,397

Tennessee* Medicaid 10/01/97

Texas Separate 07/01/98 200% 650,856

Utah Separate 08/03/98 200% 38,693

Vermont Separate 10/01/98 300% 6,693

Virginia Combo 10/22/98 200% 99,569

Washington Separate 02/01/00 250% 17,002

West Virginia Separate 07/01/98 200% 36,906

Wisconsin Medicaid 04/01/99 185% 67,893

Wyoming Separate 12/01/99 185% 5,525

Child Health USA 2005

66 State Data

State Children’s Health Insurance Program (SCHIP) Aggregate Enrollment Statistics: FY 2004

Source (IV.1): Centers for Medicare and Medicaid Services

*Enrollment data is only available for 10.5 months of the year.

**Tennessee does not currently cover any children in an SCHIP program.
State Data

Medicaid Per Enrollee Participation

State Enrollees* Expenditure** Ratio***

Alabama 459,844 $1,706.53 48%

Alaska 83,976 $3,511.01 45%

Arizona 490,898 $2,397.82 60%

Arkansas 316,411 $2,327.45 26%

California 3,401,740 $1,765.72 37%

Colorado 257,877 $2,152.11 53%

Connecticut N/R N/R N/R

Delaware 72,630 $2,410.62 63%

District of Columbia 85,160 $3,252.16 63%

Florida 1,475,561 $1,624.44 53%

Georgia 1,174,535 $1,230.73 39%

Hawaii 107,259 $1,419.54 70%

Idaho 133,479 $1,718.58 16%

Illinois 1,133,694 $1,679.00 70%

Indiana 549,454 $1,670.62 51%

Iowa 72,052 $6,271.97 49%

Kansas 190,069 $1,814.12 56%

Kentucky 391,167 $2,610.66 46%

Louisiana 637,653 $1,430.47 55%

Maine 120,844 $4,213.02 59%

Maryland 458,543 $2,309.87 50%

Massachusetts 495,114 $2,184.56 61%

Michigan 909,148 $1,334.01 46%

Minnesota 365,352 $3,099.79 59%

Mississippi 434,327 $1,522.04 27%

Missouri 624,852 $1,641.88 60%

Medicaid Per Enrollee Participation

State Enrollees* Expenditure** Ratio***

Montana 59,968 $2,520.95 51%

Nebraska 160,967 $2,038.89 52%

Nevada 130,486 $1,579.71 78%

New Hampshire 73,974 $2,417.12 54%

New Jersey 530,508 $1,985.07 48%

New Mexico 303,439 $589.93 49%

New York 1,770,911 $2,803.83 92%

North Carolina 780,846 $2,048.18 75%

North Dakota 35,328 $1,905.72 26%

Ohio 1,033,705 $1,710.91 42%

Oklahoma 420,165 $1,561.63 45%

Oregon 279,936 $1,909.36 50%

Pennsylvania 903,940 $2,504.14 53%

Rhode Island 107,847 $2,833.95 56%

South Carolina 545,012 $1,592.83 33%

South Dakota 76,408 $2,087.94 41%

Tennessee 806,397 $1,237.42 39%

Texas 2,104,436 $1,796.71 55%

Utah 145,036 $2,244.43 50%

Vermont 70,293 $2,808.56 85%

Virginia 438,806 $1,669.81 55%

Washington 700,065 $1,209.00 24%

West Virginia 208,997 $1,707.80 50%

Wisconsin 391,584 $1,736.83 53%

Wyoming 44,892 $1,706.37 38%

Medicaid Enrollees, Expenditures, and Reported EPDST Utilization for Children Under 21: FY 2001

Source (IV.2, IV.3): Centers for Medicare and Medicaid Services

*Unduplicated number of individuals under age 21 determined to be eligible for EPSDT services (FY 2002 416 Report).

**Represents total Medicaid vendor payments (FY 2002 MSIS Report) divided by Medicaid eligibles under 21.

***This ratio indicates the extent to which Medicaid eligibles received any initial and periodic screening services during FY 2002.

Child Health USA 2005

67
State Data

Percent with Percent

Private/Employer- Enrolled in Percent

State Based Insurance Medicaid/SCHIP** Uninsured***

Alabama 61.9 28.7 9.4

Alaska 51.8 40.6 7.6

Arizona 57.8 26.9 15.3

Arkansas 50.6 38.5 11.0

California 57.5 29.5 13.0

Colorado 68.6 17.1 14.3

Connecticut 72.5 19.1 8.3

Delaware 66.9 24.2 8.9

District of Columbia 44.8 43.5 11.7

Florida 57.5 26.4 16.1

Georgia 59.6 26.8 13.6

Hawaii 70.8 21.8 7.5

Idaho 56.7 29.6 13.7

Illinois 69.4 20.3 10.3

Indiana 69.6 20.8 9.6

Iowa 73.6 18.0 8.4

Kansas 74.4 19.2 6.4

Kentucky 61.8 27.3 10.9

Louisiana 53.1 31.5 15.4

Maine 58.5 35.2 6.3

Maryland 72.2 19.2 8.5

Massachusetts 71.1 20.3 8.6

Michigan 66.6 27.0 6.3

Minnesota 75.2 18.6 6.2

Mississippi 48.5 39.9 11.7

Missouri 65.7 26.9 7.4

Percent with Percent

Private/Employer- Enrolled in Percent

State Based Insurance Medicaid/SCHIP** Uninsured***

Montana 51.7 33.0 15.3

Nebraska 71.5 21.2 7.3

Nevada 62.7 19.9 17.4

New Hampshire 77.5 17.1 5.4

New Jersey 72.5 15.9 11.5

New Mexico 38.1 50.8 11.0

New York 59.1 31.1 9.8

North Carolina 56.4 31.0 12.6

North Dakota 72.9 21.5 5.7

Ohio 68.3 23.0 8.7

Oklahoma 51.7 31.5 16.9

Oregon 61.3 25.1 13.6

Pennsylvania 69.3 21.9 8.9

Rhode Island 68.4 25.8 5.8

South Carolina 62.3 28.2 9.4

South Dakota 65.1 28.5 6.4

Tennessee 64.3 24.8 10.8

Texas 49.4 30.4 20.2

Utah 74.8 16.0 9.2

Vermont 57.0 37.8 5.2

Virginia 73.4 17.9 8.6

Washington 58.5 32.9 8.6

West Virginia 53.4 37.7 8.9

Wisconsin 65.9 25.9 8.1

Wyoming 57.9 30.0 12.1

Child Health USA 2005

68

Health Insurance Status of Children Through Age 18: 2003*

Source (IV.4): American Academy of Pediatrics

*Estimates for 2003 should not be compared directly to estimates prior to 2000 due to changes in survey design. 

**Includes children covered by Medicare and Indian Health Services.

***See map on facing page.
IL

Alaska

HI

Washington

California

Kansas

Nevada

MN

WI

IA

MO

AR

MS AL

SC

KY

IN

MI

OH

PA

NY

VT

NH

ME

MA

CT

RI

NJ

MD

DE

DC (11.7%)

Nebraska

VA WV

Montana North

Dakota

South

Dakota

Utah

< 7.5% 7.5 - 10% 10.1 - 12% 12.1 - 23%

Idaho

Wyoming

Arizona Oklahoma

LA

FL

Oregon

TN

NC

New Mexico

Colorado

Texas

GA

State Data

Percent of Children Under the Age of 19 Who Are Uninsured: 2003

Source (IV.4): American Academy of Pediatrics

Child Health USA 2005

69
Percent of Infants Born at Low Birth Weight, Women Receiving First Trimester Prenatal Care, and Births to Women Under Age 18, 

by State and Race of Mother: 2003

Source (I.5): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System

Low Birth Weight Early Prenatal Care Births Under 18

Non-Hispanic Non-Hispanic State Total* White Black Total White Black Total White** Black** Hispanic

United States 7.9 7.0 13.6 84.1 89.0 75.9 3.4 3.0 6.6 5.4

Alabama 10.0 8.1 14.5 83.8 90.0 75.7 4.8 3.5 7.8 5.6

Alaska 6.0 5.2 9.1 79.8 82.9 81.0 3.3 2.0 5.7 5.1

Arizona 7.1 6.9 12.1 76.6 88.0 79.5 4.8 4.5 6.7 7.0

Arkansas 8.9 7.7 14.6 81.3 84.6 73.4 4.9 3.9 9.0 4.9

California 6.6 6.1 12.4 87.3 90.8 84.1 3.1 3.3 4.8 4.7

Colorado 9.0 8.8 15.7 79.3 86.1 70.7 3.5 3.4 5.9 7.0

Connecticut 7.5 6.4 12.5 88.7 92.7 81.4 2.2 1.9 4.9 6.2

Delaware 9.4 7.8 14.3 84.4 88.8 79.6 3.6 2.6 6.7 5.1

D.C. 10.9 6.1 13.7 76.1 89.6 71.0 4.2 N/A 5.9 4.5

Florida 8.5 7.2 13.2 85.8 90.1 77.8 3.6 2.9 6.1 3.8

Georgia 9.0 7.4 13.0 84.0 90.5 79.1 4.1 3.2 6.2 4.5

Hawaii 8.6 6.5 13.3 82.4 86.3 89.1 2.6 1.7 N/A 4.3

Idaho 6.5 6.5 N/A 81.4 83.9 87.4 2.6 2.5 N/A 6.4

Illinois 8.3 7.1 14.4 85.4 91.0 74.1 3.4 2.5 8.4 4.6

Indiana 7.9 7.3 13.3 81.5 84.7 69.3 3.4 3.0 7.0 4.9

Iowa 6.6 6.3 13.3 88.9 90.6 76.8 2.5 2.3 9.2 5.1

Kansas 7.4 7.1 12.8 87.8 90.5 80.2 3.1 2.8 7.3 6.0

Kentucky 8.7 8.3 13.7 87.0 88.2 80.7 3.8 3.6 6.8 4.6

Louisiana 10.7 7.7 14.9 84.1 90.3 75.5 4.9 2.8 8.0 3.9

Maine 6.5 6.6 N/A 87.5 87.9 75.6 2.5 2.5 N/A N/A

Maryland 9.1 7.1 13.0 83.7 91.0 75.3 3.0 1.9 5.2 3.8

Massachusetts 7.6 7.0 11.8 90.0 92.4 80.3 1.9 1.7 3.7 6.3

Michigan 8.2 6.9 14.1 86.1 89.8 72.7 3.1 2.3 7.2 5.2

Minnesota 6.2 5.8 10.3 86.5 90.5 72.3 2.2 1.6 4.9 5.4

Mississippi 11.4 8.6 15.2 84.9 91.0 77.8 5.6 3.6 8.2 N/A

Low Birth Weight Early Prenatal Care Births Under 18

Non-Hispanic Non-Hispanic State Total* White Black Total White Black Total White** Black** Hispanic

Missouri 8.0 7.2 13.4 88.4 90.2 80.9 3.5 2.8 7.8 5.1

Montana 6.8 6.5 N/A 84.4 87.4 87.8 3.0 2.2 N/A 5.5

Nebraska 6.9 6.8 11.5 83.4 86.9 72.8 2.8 2.4 8.0 5.5

Nevada 8.1 7.7 13.3 75.8 84.6 70.6 3.9 3.8 6.7 6.1

New Hampshire 6.2 6.1 12.2 92.8 93.4 85.5 1.4 1.4 N/A 3.8

New Jersey 8.1 7.0 13.3 80.2 89.2 63.5 2.1 1.6 5.1 4.3

New Mexico 8.5 8.2 16.0 68.9 77.0 69.1 6.1 6.2 4.5 8.4

New York 7.9 6.6 12.2 82.4 88.6 72.8 2.3 2.0 4.3 4.3

North Carolina 9.0 7.6 14.2 84.5 90.8 76.8 3.9 2.9 7.2 5.1

North Dakota 6.5 6.4 N/A 87.3 90.0 84.8 2.1 1.7 N/A N/A

Ohio 8.3 7.4 13.6 87.7 89.8 78.8 3.4 2.6 8.0 5.3

Oklahoma 7.8 7.5 13.6 77.8 82.0 69.8 4.3 3.8 7.4 6.4

Oregon 6.1 6.1 11.6 81.2 84.5 77.6 2.8 2.7 5.0 5.6

Pennsylvania 8.1 6.9 14.0 76.0 80.4 57.4 3.2 2.2 8.5 8.2

Rhode Island 8.5 7.8 12.3 90.9 93.5 82.1 3.0 2.5 5.8 6.0

South Carolina 10.1 7.8 15.0 77.5 83.6 70.6 4.6 3.3 7.5 4.9

South Dakota 6.6 6.4 N/A 78.4 83.4 65.5 2.8 1.8 N/A 8.2

Tennessee 9.4 8.1 14.8 83.4 88.1 73.0 4.3 3.4 8.0 5.5

Texas 7.9 7.3 13.7 80.9 88.4 77.0 5.1 5.1 6.8 6.9

Utah 6.5 6.4 15.3 80.3 83.9 61.8 1.9 1.8 5.5 4.9

Vermont 7.0 7.1 N/A 90.6 90.8 73.5 2.7 1.4 N/A N/A

Virginia 8.2 6.9 13.0 85.3 90.4 77.3 1.4 2.0 5.6 3.6

Washington 6.0 5.6 11.1 74.0 77.6 68.9 2.6 2.5 3.9 5.7

West Virginia 8.6 8.5 12.1 85.8 86.4 73.5 3.6 3.5 6.8 N/A

Wisconsin 6.8 6.0 13.6 84.9 88.5 73.7 2.8 1.8 9.9 5.8

Wyoming 8.9 8.9 N/A 86.4 87.9 96.2 3.4 3.2 N/A 7.5

State Data

Child Health USA 2005

70

N/A Figure does not meet standards of reliability or precision.

*Includes races other than White and Black.

**Includes Hispanics.
State Data

Child Health USA 2005

71

Infant and Neonatal Mortality Rates, by Race of Mother and State: 2002

Source (IV.5): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System

Infant Mortality*** Neonatal Mortality****

State All* White** Black** All* White** Black**

Alabama 9.1 7.1 13.9 5.9 4.6 8.9

Alaska 5.5 4.2 N/A 2.0 N/A N/A

Arizona 6.4 6.2 13.0 4.1 4.1 N/A

Arkansas 8.3 6.9 13.9 5.1 4.2 8.3

California 5.5 5.2 12.9 3.7 3.5 8.0

Colorado 6.1 5.5 21.1 4.0 3.6 13.6

Connecticut 6.5 5.5 14.2 4.7 4.2 9.0

Delaware 8.7 7.3 12.9 7.0 6.1 10.3

District of Columbia 11.3 N/A 14.5 7.6 N/A 9.3

Florida 7.5 5.8 13.6 5.0 3.9 9.1

Georgia 8.9 6.6 13.7 5.9 4.2 9.4

Hawaii 7.3 N/A N/A 4.7 N/A N/A

Idaho 6.1 6.1 N/A 4.0 4.1 N/A

Illinois 7.4 5.6 16.3 5.0 4.0 10.2

Indiana 7.7 6.8 15.3 5.3 4.7 9.6

Iowa 5.3 5.1 N/A 3.6 3.5 N/A

Kansas 7.1 6.5 15.2 4.8 4.4 10.0

Kentucky 7.2 6.6 14.2 4.2 4.0 6.7

Louisiana 10.3 6.9 15.0 6.6 4.4 9.7

Maine 4.4 4.3 N/A 3.2 3.1 N/A

Maryland 7.5 5.3 12.3 5.4 3.9 8.5

Massachusetts 4.9 4.5 9.1 3.7 3.5 6.1

Michigan 8.1 6.0 18.5 5.5 4.2 12.1

Minnesota 5.4 5.0 10.3 3.5 3.5 4.9

Mississippi 10.3 6.9 14.8 6.8 4.4 9.8

Infant Mortality*** Neonatal Mortality****

State All* White** Black** All* White** Black**

Missouri 8.5 7.1 17.1 5.5 4.7 11.0

Montana 7.5 7.1 N/A 4.9 4.7 N/A

Nebraska 7.0 6.1 20.8 4.8 4.2 15.3

Nevada 6.0 5.1 18.4 3.9 3.3 10.7

New Hampshire 5.0 5.3 N/A 3.5 3.7 N/A

New Jersey 5.7 4.5 12.8 4.1 3.2 9.2

New Mexico 6.3 5.7 N/A 4.3 4.0 N/A

New York 6.0 5.4 9.9 4.3 3.9 6.7

North Carolina 8.2 5.9 15.6 5.6 3.8 11.5

North Dakota 6.3 5.6 N/A 4.1 3.7 N/A

Ohio 7.9 6.2 17.7 5.4 4.2 12.1

Oklahoma 8.1 7.1 17.2 5.1 4.4 11.1

Oregon 5.8 5.6 N/A 3.8 3.8 N/A

Pennsylvania 7.6 6.6 15.1 5.6 4.9 10.2

Rhode Island 7.0 6.4 N/A 4.8 4.3 N/A

South Carolina 9.3 6.0 15.8 6.3 3.9 11.2

South Dakota 6.5 4.9 N/A 3.6 2.9 N/A

Tennessee 9.4 7.0 18.3 5.9 4.2 12.5

Texas 6.4 5.6 13.5 3.9 3.4 8.3

Utah 5.6 5.5 N/A 3.8 3.8 N/A

Vermont 4.4 4.5 N/A N/A N/A N/A

Virginia 7.4 5.5 14.6 5.1 3.6 10.8

Washington 5.8 5.5 12.7 3.7 3.5 8.8

West Virginia 9.1 8.5 N/A 5.3 5.0 N/A

Wisconsin 6.9 5.6 18.9 4.8 4.0 12.9

Wyoming 6.7 6.8 N/A 3.8 3.9 N/A

N/A Figure does not meet standards of reliability or precision.

* Includes races other than White or Black.

** Includes Hispanics.

*** Rates are deaths less than one year per 1,000 live births in specified group.

**** Rates are deaths under 28 days per 1,000 live births in specified group.
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City Data

The following section presents data on the

health of infants and children living in cities

compared to that of children nationwide.

Included are data on infant mortality, low birth

weight, and prenatal care for those women and

children who reside in U.S. cities with over

100,000 residents.

The following measures indicate that the

health status of children living in large U.S. cities

is generally poorer than that of children in the

Nation as a whole. In 2003, the percentage of

infants born at low birth weight was 8 percent

higher in cities compared to the National average

(8.5 versus 7.9 percent). Infant mortality was

also higher in cities, likely due at least in part to

the higher rate of low birth weight. In 2002, the

city infant mortality rate was 7.5 per 1,000 live

births, compared to a rate of 7.0 nationwide. The

percentage of pregnant women receiving first

trimester prenatal care was lower in cities (81.7

percent) than it was nationwide (84.1 percent).

Child Health USA 2005

73

City Data
City Data

Child Health USA 2005

74

BIRTH WEIGHT

Low Birth Weight. Disorders related to short 

gestation and low birth weight are the second

leading cause of neonatal mortality in the United

States. In 2003, 114,085 babies born to residents

of U.S. cities with populations over 100,000 were

of low birth weight (weighing less than 2,500

grams, or 5 pounds 8 ounces); this represents a

rate of 8.5 percent. The 2003 percentage of

urban infants born at low birth weight was 8 percent higher than the National rate of 7.9 percent.

Very Low Birth Weight. Infants born at very low

birth weight (less than 1,500 grams, or 3 pounds

4 ounces) are at highest risk for poor health outcomes. In 2003, 1.6 percent of live births in cities

with populations over 100,000 were of very low

birth weight. This exceeded the National very

low birth weight rate by 14 percent.

Infants Born at Very Low Birth Weight in U.S. Cities with 

Populations over 100,000: 1990-2003

Source (V.1): Centers for Disease Control and Prevention, National Center for Health

Statistics, National Vital Statistics System

Total U.S. Population Total U.S. Cities

Percent

Infants Born at Low Birth Weight in U.S. Cities with

Populations over 100,000: 1990-2003

Source (V.1): Centers for Disease Control and Prevention, National Center for Health 

Statistics, National Vital Statistics System Percent

7.9

8.5

1.6

1.4

0

1

2

3

4

5

6

7

8

9

10

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Total U.S. Population

Total U.S. Cities

0

1

2

3

4

5

6

7

8

9

10

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
City Data

Child Health USA 2005

75

INFANT MORTALITY

In 2002, 9,204 infants born to residents of

cities in the United States with populations over

100,000 died in the first year of life. The city

infant mortality rate was 7.5 deaths per 1,000 live

births, higher than the rate of 7.0 for the Nation

as a whole. Although the infant mortality rate in

cities has routinely been higher than the rate

nationwide, it has declined over the past decade.

Between 1990 and 2000, infant mortality in

cities declined by roughly one-third; the decline

nationwide in the same period was 25 percent.

Between 2001 and 2002, there was an increase of

0.1 and 0.2 deaths per 1,000 live births, respectively, in cities and nationwide.

Infant Mortality Rates in U.S. Cities with Populations over 100,000: 1990-2002

Source (V.1): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital 

Statistics System

7.5

7.0

Total U.S. Cities

Percent of Live Births

Total U.S. Population

0

2

4

6

8

10

12

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

City Data

Child Health USA 2005

77

PRENATAL CARE

Early Prenatal Care. Women living in U.S. cities

with a population of over 100,000 are less likely

to begin prenatal care in the first 3 months of

pregnancy than women nationwide. The gap in

early entry into prenatal care between urban

women and the Nation as a whole has narrowed

since 1991.

In 2003, 81.7 percent of pregnant women living in U.S. cities began prenatal care in the first

trimester of pregnancy, compared to 84.1 percent 

nationwide. The percentage of women receiving

prenatal care has increased steadily in the past

decade at both the city and nationwide levels.

The Healthy People 2010 objective is for 90 percent of pregnant women to begin prenatal care in

the first trimester.

Late or No Prenatal Care. In 2003, 4.4 percent of

pregnant women living in U.S. cities with a population over 100,000 either began prenatal care

in the third trimester or received no prenatal care.

The percentage of women receiving late or no 

prenatal care is 26 percent higher among women

living in cities than among the overall population

of the United States.

Pregnant Women Receiving Late or No Prenatal Care in U.S. Cities 

with Populations Over 100,000: 1990-2003*

Source (V.1): Centers for Disease Control and Prevention, National Center for Health Statistics

National Vital Statistics System

Total U.S. Cities Total U.S. Population

Percent

Pregnant Women Receiving First Trimester Prenatal Care in

U.S. Cities with Populations Over 100,000: 1990-2003*

Source (V.1): Centers for Disease Control and Prevention, National Center for Health

Statistics, National Vital Statistics System Percent

81.7

84.1

4.4

3.5 0

10

20

30

40

50

60

70

80

90

100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Total U.S. Cities

Total U.S. Population

0

10

20

30

40

50

60

70

80

90

100

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

*2003 data includes 48 states and the District of Columbia.
Child Health USA 2005

78

Population Characteristics

I.1 U.S. Census Bureau, Population Division. Annual estimates of the 

population by selected age groups. Washington, DC: The Bureau; 2005.

I.2 Centers for Disease Control and Prevention, National Center for Health 

Statistics. National Survey of Children’s Health, 2003. Analysis conducted

by the Maternal and Child Health Information Resource Center.

I.3 DeNavas-Walt C, Proctor B, Mills R. Income, poverty, and health insurance

coverage in the United States: 2003. Current Population Reports, P60-226.

Washington, DC: U.S. Government Printing Office; 2004.

I.4 Laird J, Lew S, Chapman C. Dropout rates in the United States: 2002.

Washington, DC: National Center for Education Statistics; 2005. 

I.5 Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson

ML. Births: final data for 2003. National Vital Statistics Reports, Vol. 54,

No. 2; 2005 Sep.

I.6 U.S. Department of Labor, Bureau of Labor Statistics. Employment 

characteristics of families in 2004. Washington, DC: The Department;

2005.

I.7 Capizzano J, Adams G. Snapshots of America’s Families, No. 16—Children

in low-income families are less likely to be in center-based child care. 

Washington, DC: Urban Institute; 2004.

Health Status

II.1 Centers for Disease Control and Prevention. 2003 National Immunization

Survey, breastfeeding data. Available from: http://www.cdc.gov/

breastfeeding/NIS_data/index.htm

II.2 Hoyert DL, Kung HC, Smith, BL. Deaths: preliminary data for 2003.

National Vital Statistics Reports, Vol. 53, No. 15; 2005 Feb.

II.3 Centers for Disease Control and Prevention, National Center for Health 

Statistics. Health, United States, 2005. Hyattsville, MD: 2005

II.4 U.S. Department of Health and Human Services, Administration on 

Children, Youth, and Families. Child maltreatment 2003. Washington, DC:

U.S. Government Printing Office; 2005.

II.5 Centers for Disease Control and Prevention. HIV/AIDS Surveillance

Report, 2003 (Vol. 15). Atlanta, GA: US Department of Health and

Human Services; 2004.

II.6 Centers for Disease Control and Prevention. Summary of notifiable diseases:

United States, 2003. MMWR, Vol. 52, No. 54; 2005 Apr.

II.7 Centers for Disease Control and Prevention, National Center for Health 

Statistics. National Hospital Discharge Survey, 2003. Unpublished data.

II.8 Centers for Disease Control and Prevention. Youth risk behavior surveillance:

United States, 2003. MMWR, Vol. 53, No. SS-2; 2004 May.

II.9 Centers for Disease Control and Prevention. Sexually transmitted disease

surveillance, 2003. Atlanta, GA: U.S. Department of Health and Human

Services; 2004 Sep.

References

References
II.10 Substance Abuse and Mental Health Services Administration. Results from

the 2003 National Survey on Drug Use and Health: national findings.

Rockville, MD: SAMHSA, Office of Applied Studies; 2004.

II.11 Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the

future national results on adolescent drug use: overview of key findings,

2004. Bethesda, MD: National Institute on Drug Abuse; 2005. 

Health Services Financing and Utilization

III.1 Centers for Disease Control and Prevention, National Immunization 

Program. National Immunization Survey, July 2003-June 2004. Available

from: http://www.cdc.gov/nip/coverage/default.htm#

III.2 Centers for Disease Control and Prevention, National Immunization 

Program. Recommended childhood and adolescent immunization schedule,

United States, 2005. Available from: http://www.cdc.gov/nip/recs/

child-schedule.htm

III.3 Centers for Medicare and Medicaid Services. FY 2002 416 Report. 

Baltimore, MD: The Centers; 2005.

III.4 Centers for Disease Control and Prevention, National Center for Health

Statistics. National Health Interview Survey, 2003. Analysis conducted by

the Maternal and Child Health Information Resource Center.

III.5 Fronstin P. Sources of health insurance and characteristics of the uninsured:

analysis of the March 2004 Current Population Survey. EBRI Issue Brief

No. 276; 2004 Dec.

State Data

IV.1 Centers for Medicare and Medicaid Services. State Children’s Health 

Insurance Program annual enrollment report, 2004. Baltimore, MD: 

The Centers; 2005 May.

IV.2 Centers for Medicare and Medicaid Services. Annual EPSDT participation

report, FY 2002 (Form 416). Baltimore, MD: The Centers.

IV.3 Centers for Medicare and Medicaid Services. Medicaid program 

statistics, FY 2002 (MSIS state summary). Baltimore, MD: 

The Centers.

IV.4 American Academy of Pediatrics, Division of Health Policy Research. 

Children’s health insurance status and Medicaid/SCHIP eligibility and

enrollment, 2003. Elk Grove Village, IL: The Academy; 2004 Sep.

IV.5 Kochanek KD, Murphy SL, Anderson RN. Deaths: final data for 2002.

National Vital Statistics Reports 2004; 53(5).

City Data

V.1 Centers for Disease Control and Prevention, National Center for Health 

Statistics. Unpublished data.

References

Child Health USA 2005

79
Child Health USA 2005

80

This publication was prepared for the Maternal

and Child Health Bureau (MCHB) of the

Health Resources and Services Administration.

It was produced by the Maternal and Child

Health Information Resource Center of the

MCHB.

Federal Contributors within the U.S. Department

of Health and Human Services

Administration on Children, Youth,

and Families

Centers for Disease Control and Prevention

Centers for Medicare and Medicaid Services

National Institute on Drug Abuse

Substance Abuse and Mental Health Services

Administration

Other Federal and Non-Governmental Contributors

American Academy of Pediatrics

Employee Benefit Research Institute

U.S. Census Bureau

U.S. Department of Education

U.S. Department of Labor

Urban Institute

Photography Copyrights

David C. Arendt, courtesy of La Leche League

International: page 20; Cheryl Bell: page 73;

Holly Doggett: cover, title and pages 19, 28;

Judith Gallagher: page 53; Keith Brofsky, Photodisc Green, Getty Images: page 76; Valerie

Gwinner: cover, title and pages 8, 80; iStockphoto.com: cover, title and pages 11, 39, 44,

65; Renee Schwalberg: page 5; Veer Incorporated: page 34; Beth Zimmerman: page 56.

Contributors

Contributors