Child

Health

USA

2010

October 2010

U.S. Department of Health and Human Services

Health Resources and Services Administration
Child Health USA 2010 is not copyrighted. Readers are free to duplicate and use all or part of the 

information contained in this publication; however, the photographs are copyrighted and permission may be required to reproduce them. It is available online: www.mchb.hrsa.gov

Suggested Citation: U.S. Department of Health and Human Services, Health Resources and 

Services Administration, Maternal and Child Health Bureau. Child Health USA 2010.

Rockville, Maryland: U.S. Department of Health and Human Services, 2010.

Single copies of this publication are also available at no cost from:

HRSA Information Center

P.O. Box 2910

Merrifield, VA 22116

1-888-ASK-HRSA or ask@hrsa.gov
 CHILD HEALTH USA 2010 CONTENTS 3

PREFACE 4

INTRODUCTION 5

POPULATION CHARACTERISTICS 9

Population of Children 10

Children in Poverty 11

Children of Foreign-Born Parents 12

Adopted Children 13

Rural and Urban Children 14

School Engagement 15

Perceived Neighborhood Saftey 16

Child-Family Connectedness 17

Maternal Age 18

Working Mothers and Child Care 19

HEALTH STATUS 21

Health Status-Infants

Breastfeeding 23

Low Birth Weight 24

Very Low Birth Weight 25

Preterm Birth 26

Maternal Mortality 27

Infant Mortality 28

Neonatal and Postneonatal Mortality 29

International Infant Mortality 30

Health Status-Children

Vaccine-Preventable Diseases 32

Pediatric HIV and AIDS 33

Hospitalization 34

Autism Spectrum Disorder 35

Abuse and Neglect 36

Child Mortality 37

Health Status-Adolescents

Sexual Activity 39

Adolescent Childbearing 40

Sexually Transmitted Infections 41

Adolescent and Young Adult HIV and AIDS 42

Overweight and Obesity 43

Physical Activity 44

Mental Health 46

Cigarette Smoking 47

Substance Abuse 48

Violence 49

Bullying 50

Adolescent Mortality 51

HEALTH SERVICES FINANCING 

AND UTILIZATION 53

Health Care Financing 54

Adequacy of Insurance 55

Vaccination Coverage 56

Vaccination Schedule 57

Mental Health Treatment 58

Dental Care 59

Preventive Health Care Visits 60

Lack of Health Care 61

Usual Place for Sick Care 62

Medical Home 63

Emergency Department Utilization 64

Prenatal Care 65

STATE DATA 67

CITY DATA 75

REFERENCES 78

CONTRIBUTORS 80
4 CHILD HEALTH USA 2010

Preface and Reader’s Guide

The Health Resources and Services Administration’s Maternal and Child Health Bureau 

(MCHB) is pleased to present Child Health 

USA 2010, the 20th annual report on the health 

status and service needs of America’s children. 

MCHB envisions a Nation in which the right 

to grow to one’s full potential is universally assured through attention to the comprehensive 

physical, psychological, and social needs of the 

maternal and child population. To assess the 

progress toward achieving this vision, MCHB 

has compiled this book of secondary data for 

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

summaries of relevant data, and addresses longterm trends where applicable and feasible. 

All of the data discussed within the text of 

Child Health USA are from the same sources as 

the information in the corresponding graphs, 

unless otherwise noted. Data are presented for 

the target population of the Title V Maternal 

and Child Health Block Grant: infants, children, adolescents, children with special health 

care needs, and women of childbearing age. 

Child Health USA 2010 addresses health status 

and health services utilization within this population, and offers insight into the Nation’s progress toward the goals set out in the MCHB’s 

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

the health infrastructure and system of care for 

women, infants, children, and families.

Child Health USA is designed to provide the 

most current data available for public health 

professionals and other individuals in the public 

and private sectors. The book’s succinct format 

is intended to facilitate the use of the information as a snapshot 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, including 

poverty, education, and child care. The second 

section, entitled Health Status, contains vital 

statistics and health behavior data for the maternal and child population. Health Services 

Financing and Utilization, the third section, 

includes data regarding health care financing 

and utilization of selected health services. The 

final sections, State Data and City Data, contain information on selected indicators at those 

levels.

Child Health USA is not copyrighted and 

readers may duplicate and use all of the information contained herein; however, the photographs are copyrighted and permission may be 

required to reproduce. This and all editions of 

Child Health USA since 1999 are available online at www.mchb.hrsa.gov/mchirc/chusa. 

For a complimentary copy of this publication, mail your request to HRSA Information 

Center, P.O. Box 2910, Merrifield, VA 22116. 

You may also call 1-888-ASK-HRSA or email 

ask@hrsa.gov.
 CHILD HEALTH USA 2010 5

INTRODUCTION

The health of the child population is reflective of the overall health of a Nation, and has 

many implications for the Nation’s future as 

these children grow into adults. Physical, mental, and emotional health affect virtually every 

facet of life, such as learning, participation in 

leisure activities, and employment. Health 

habits established in childhood often continue 

throughout the lifespan, and many health problems in childhood, such as obesity and poor oral 

health, influence health into adulthood. Effective policies and programs are important to the 

establishment of healthy habits and the mitigation of risk factors for disease. However, the 

health and health care needs of children change 

over time, and current data on these issues is 

critically important as policy makers and program planners seek to maximize the health of 

children, now and into the future. 

In 2009, nearly 25 percent of the U.S. population was under 18 years of age. The racial and 

ethnic composition of the child population is 

shifting, with a growing population of Hispanics and Asian/Pacific Islanders and a decline in 

the representation of non-Hispanic Whites. In 

addition to race and ethnicity, the demographic 

composition of a population can also be characterized by factors such as nativity and poverty. 

In 2008, 22 percent of children in the United 

States had at least one foreign-born parent. Of 

all children, 18.6 percent were U.S.-born with 

a foreign-born parent or parents, and 3.4 percent were themselves foreign-born. In the same 

year, over 14 million children under 18 years 

of age lived in households with incomes below 

100 percent of the U.S. Census Bureau’s poverty threshold ($22,025 for a family of four in 

2008), representing 19 percent of all children in 

the United States.

Good health begins before birth. Timely prenatal care is an important preventive strategy 

that can help protect the health of both mother 

and child. In 2007, 70.8 percent of women began prenatal care during the first trimester (according to data from areas using the “revised” 

birth certificate - for more information, please 

see page 65). A small proportion of women (7.1 

percent) did not receive prenatal care until the 

third trimester, or did not receive any at all. This 

was more common among non-Hispanic Black 

and Hispanic women, as well as those who were 

younger, unmarried, and less educated. 

Following birth, there are a variety of preventive or protective factors that can affect a 

child’s health. Vaccination is a preventive health 

measure that begins immediately after birth and 

protects into adulthood. Vaccines are available 

for a number of public health threats, including measles, mumps, rubella (German measles), 

polio, diphtheria, tetanus, pertussis (whooping 

cough), hepatitis B, and H. Influenzae type b (a 

meningitis bacterium). In 2008, 78.2 percent of 

children aged 19-35 months had received this 

recommended series of vaccines; 68.4 percent 

had received this series plus the varicella (chicken pox) and pneumococcal conjugate vaccines. 

Breastfeeding is also an important protective 

factor, and rates have increased steadily since 

the beginning of the last decade. In 2007, 75.5 

percent of children through age 5 had been 

breastfed for some period of time. Although 

recommended by the American Academy of 

pediatrics, only 12.4 percent of children were 

breastfed exclusively (without supplemental 

food or liquids) for the first 6 months of life. 

Family and neighborhood characteristics can 

also play a role in the health and well-being of 

children. In 2008, 71.4 percent of women with 

children under 18 years of age were in the labor 

force (either employed or looking for work). 

Mothers with children under 6 years of age were 

less likely to be in the labor force (64.0 percent). 

In 2007, 54.2 percent of children from birth 

through age 5 were in child care for 10 or more 

hours per week. Frequency of family activities 

and bonding can affect health and well-being, 

and in 2007, 45.8 percent of children under 18 

years of age ate a meal every day with all other 

members of their household. The rate of sharing 
6 CHILD HEALTH USA 2010

meals decreased with age, from 57.7 percent of 

children from birth through age 5 to 32.9 percent of children 12‒17 years of age. In addition, 

47.8 percent of children from birth to age five 

were read to every day by family members. 

Physical activity is another factor that can affect health through the lifespan. Results from 

the Youth Risk Behavior Surveillance System 

show that 18.4 percent of high school students 

met currently recommended levels of physical 

activity in 2009 (one hour or more of physical activity every day, most of which should be 

moderate- to vigorous-intensity aerobic activity). Nearly one-quarter of students did not participate in 60 or more minutes of physical activity on any day in the preceding week. Physical 

activity can be affected by a number of factors, 

including a child’s surroundings. In 2007, the 

parents of 2.6 percent of children reported that 

their child was never safe in their neighborhood 

or community, while an additional 11.4 percent 

of children had parents who felt that their child 

was only sometimes safe. The remaining 86.1 

percent of children had parents who felt that 

their child was usually or always safe in their 

neighborhood.

Child Health USA also presents information 

on risk factors for adverse health outcomes. 

According to preliminary data, 8.2 percent of 

infants were born low birth weight (less than 

2,500 grams or 5 pounds 8 ounces) in 2008, 

and 1.5 percent of infants were born very 

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

pounds 4 ounces). Children born underweight 

are more likely to suffer from long-term disability and have higher rates of mortality than 

children born of normal weight. 

Violence and neglect are also risk factors for 

poor health, and in 2007, investigations determined that an estimated 794,000 children were 

victims of abuse or neglect, equaling a victimization rate of 10.6 per 1,000 children in the 

population. Victimization rates were highest 

among young children. Among older children, 

peer violence is also of concern. In 2007, the 

parents of 12.9 percent of children aged 6‒17 

years reported that their child “sometimes” bullied or was cruel to others in the past month, 

while the parents of 2.3 percent of children reported that their child “usually/always” bullied 

or was cruel to others. According to the Youth 

Risk Behavior Surveillance System, in 2009, 5.0 

percent of high school students reported that 

they did not go to school on at least one day 

during the past month because they felt unsafe 

at school or on their way to or from school.

Information on the prevalence of various diseases and conditions in childhood is also important in the effort to improve health in the child 

population. For instance, obesity is a serious 

health concern for children—obese children 

are more likely to have risk factors for cardiovascular disease, such as high blood pressure, 

high cholesterol, and Type 2 diabetes. Obese 

children are also at increased risk of obesity 

in adulthood, which is associated with a host 

of serious health consequences. In 2007, 15.3 

percent of children aged 10‒17 years were overweight and 16.4 percent were obese, based on 

parent-reported height and weight.

HIV/AIDS and other sexually transmitted 

infections (STIs) are also of concern. In 2008, 

an estimated 182 children younger than 13 

years of age and an estimated 6,524 people aged 

13‒24 years were diagnosed with HIV. Chlamydia continues to be the most common STI 

among adolescents and young adults. Based 

on the number of cases reported to the Centers for Disease Control and Prevention, there 

were 1,956 chlamydial infections per 100,000 

adolescents and 2,084 infections per 100,000 

young adults in 2008. Rates of gonorrhea were 

453 and 518 per 100,000 adolescents and 

young adults, respectively. 

In 2006, there were nearly 3.5 million hospital discharges among people aged 1‒21 

years. While injuries are the leading cause of 

death among this age group, they were not 

the most common cause of hospitalization. In 

2005‒2006, diseases of the respiratory system 
 CHILD HEALTH USA 2010 INTRODUCTION 7

were the most common cause of hospitalization among children aged 1‒4 and 5‒9 years, 

while mental disorders were the most common 

cause of hospitalization among children aged 

10‒14 years, and pregnancy and childbirth was 

the most common cause of hospitalization for 

adolescents aged 15‒19 years and young adults 

aged 20‒21 years. 

The health status and health services utilization indicators reported in Child Health USA 

can help policymakers and public health officials better understand current trends in pediatric health and wellness and determine what programs might be needed to further improve the 

public’s health. These indicators can also help 

identify positive health outcomes which may 

allow public health professionals to draw upon 

the experiences of programs that have achieved 

success. 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, as needed. 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.

 CHILD HEALTH USA 2010

9

Population 

Characteristics

The increasing diversity of the United States 

population is reflected in the sociodemographic 

characteristics of children and their families. 

The percentage of children who are Hispanic or 

Asian/Pacific Islander has more than doubled 

since 1980, while the percentage who are nonHispanic White has declined. The percentage of 

children who are Black has remained relatively 

stable. This reflects the changes in the racial and 

ethnic makeup of the population as a whole.

At the national, State, and local levels, poli-

cymakers use population information to address 

health-related issues that affect mothers, chil-

dren, and families. By carefully analyzing and 

comparing available data, public health profes-

sionals can often identify high-risk populations 

that could benefit from specific interventions. 

This section presents data on several popula-

tion characteristics that influence maternal and 

child health program development and evalu-

ation. Included are data on the age and racial 

and ethnic distribution of the U.S. population, 

as well as data on the poverty status of children 

and their families, child care arrangements, and 

school engagement.
Population of Children Under Age 18, by Race/Ethnicity,

1980 and 2008

Source (I.1): U.S. Census Bureau, Annual Population Estimates

U.S. Population, by Age Group, 1980 and 2008

Source (I.1): U.S. Census Bureau, Annual Population Estimates

10

20

30

40

50

60

70

80

Two or

More Races*

Asian/Pacific 

Islander*

American 

Indian/Alaska

Native*

Non-Hispanic Black* Hispanic

 White

*May include Hispanics; 1980 data is not available for two or more races. Percent of Children

56.2

15.2

21.8

1.3 4.4 3.3 0.9 1.8

8.7

14.8

74.3

1980

2008

25-64 Years

47.3%

65 Years

and Older

11.3%

Under 5 Years

7.2%

5-13 Years

13.8% 14-17 Years

7.2%

18-24 Years

13.3%

1980 2008

25-64 Years

53.1%

65 Years

and Older

12.8%

Under 5 Years

6.9%

5-13 Years

11.8%

14-17 Years

5.6%

18-24 Years

9.8%

10 POPULATION CHARACTERISTICS CHILD HEALTH USA 2010

POPULATION of children

In 2008, there were nearly 74 million children under 18 years of age in the United States, 

representing nearly 25 percent of the population. Young adults aged 18–24 years made up 

another 9.8 percent of the population, while 

adults aged 25–64 years composed 53.1 percent 

of the population, and adults aged 65 years and 

older composed 12.8 percent. 

The age distribution of the population has 

shifted significantly in the past several decades. 

The percentage of the population that is under 18 fell from 28.2 percent in 1980 to 24.3 

percent in 2008. The representation of young 

adults (aged 18–24 years) has also fallen, from 

13.3 percent to 9.8 percent. During this time 

period, the percentage of the population that is 

aged 25–64 years has increased from 47.3 percent to 53.1 percent, and the percentage that is 

over 65 years has increased from 11.3 percent 

to 12.8 percent. The median age in the United 

States has increased from 30.0 years in 1980 to 

36.8 years in 2008.

The shifting racial/ethnic makeup of the child 

population (under 18 years) reflects the increasing diversity of the population as a whole. Hispanic children represented fewer than 9 percent 

of children in 1980, compared to nearly 22 

percent in 2008, and the proportion of children 

who are Asian/Pacific Islander increased from 

less than 2 percent to 4.4 percent during the 

same period. The percentage of children who 

are Black has remained relatively steady over the 

same period, around 15 percent. However, the 

percentage of children who are non-Hispanic 

White has fallen significantly, from 74.3 percent 

in 1980 to 56.2 percent in 2008.
 CHILD HEALTH USA 2010 POPULATION CHARACTERISTICS 11

children in poverty

In 2008, more than 14 million children under 18 years of age lived in households with incomes below 100 percent of the U.S. Census 

Bureau’s poverty threshold ($22,025 for a family of four in 2008); this represents 19.0 percent 

of all children in the United States. Poverty affects many aspects of a child’s life, including living conditions, nutrition, and access to health 

care. A number of factors affect poverty status, 

and a significant racial/ethnic disparity exists. In 

2008, 34.7 percent of Black children and 30.6 

percent of Hispanic children lived in households with incomes below 100 percent of the 

poverty threshold, compared to 10.6 percent of 

non-Hispanic White children. 

Single-parent families are particularly vulnerable to poverty. In 2008, 43.4 percent of 

children living in a female-headed household 

experienced poverty, as did 20.5 percent of children living in a male-headed household. Only 

9.9 percent of children living in married-couple 

families lived in poverty (data not shown). Also, 

younger children are more likely than older 

children to experience poverty. In 2008, 21.8 

percent of children under 5 years of age lived in 

households with incomes below 100 percent of 

the poverty threshold, while the same was true 

of 17.2 percent of children aged 5–17 years.

A number of Federal programs work to protect the health and well-being of children living in low-income families. One of these is the 

National School Lunch Program, administered 

by the U.S. Department of Agriculture’s Food 

and Nutrition Service. The program provides 

nutritionally-balanced low-cost or free lunches 

to children based on household poverty level. 

In 2008, the program served free lunch to 15.4 

million children and reduced-price lunch to another 3.1 million children. This represents 60.1 

percent of all lunches served in participating 

schools.1

1. United States Department of Agriculture, Food and Nutrition Service. Child nutrition tables: National-level annual summary tables. Available online: http://www.fns.

usda.gov/pd/cnpmain. Accessed November, 2009.

Children Under Age 18 Living in Households with Incomes 

Below 100 Percent of the Poverty Threshold,* by Race/

Ethnicity,** 1976–2008

Source (I.2): U.S. Census Bureau, Current Population Survey Percent of Children

Total

*The U.S. Census Bureau uses a set of money income thresholds to determine who is in poverty; the 

poverty threshold for a family of four was $22,025 in 2008. **The Current Population Survey currently 

allows respondents to choose more than one race; however, prior to 2002, only one race was reported. 

For consistency, figures reported here are only for respondents who chose one race. 

Children Under Age 18 Living in Families* with Incomes 

Below 100 Percent of the Poverty Threshold,** by Age 

and Family Type, 2008

Source (I.2): U.S. Census Bureau, Current Population Survey

10

20

30

40

50

60

1976 1980 1984 1988 1992 1996 2004 2008

34.7

30.6

10.6

19.0

Non-Hispanic White

Black Hispanic

*Includes only children who are related to the head of household by birth, marriage, or adoption.

**The U.S. Census Bureau uses a set of money income thresholds to determine who is in poverty; 

the poverty threshold for a family of four was $22,025 in 2008.

10

20

30

40

50

60

Male Householder, 

no Wife Present

Female Householder, 

no Husband Present

Married-Couple 

Families

Total

Percent of Children

21.8 17.2

11.2 9.3

54.7

39.2

23.0 19.5

Under 5 

Years 5-17 

Years
12 POPULATION CHARACTERISTICS CHILD HEALTH USA 2010

Children Under Age 18, by Poverty Status* and Nativity of 

Child and Parent(s),** 2008

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

*The U.S. Census Bureau poverty threshold for a family of four was $22,025 in 2008. **“Native parent” indicates that

both of the child’s parents were U.S. citizens at birth, “foreign-born parent” indicates that one or both parents were 

born outside of the U.S.

*“Native parent” indicates that both of the child’s parents were U.S. citizens at birth, “foreign-born parent” 

indicates that one or both parents were born outside of the United States, and “other” includes children

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

Children Under Age 18, by Nativity of Child and 

Parent(s),* 2008

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

30.1 27.8 42.1

15.9 18.7 65.5

21.3 29.2 49.5

Other 4.1%

Foreign-Born Child

and Parent

3.4%

Native Child,

Foreign-Born Parent

18.6%

Native Child

and Parent

73.9%

Foreign-Born

Child and Parent

Native Child,

Foreign-Born Parent

Native Child

and Parent

<100%

of Poverty

Threshold

100–199%

of Poverty

Threshold

200% or More

of Poverty 

Threshold

Percent of Children

Children of ForEIgn-Born 

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 2008, 22.0 percent of 

children in the United States had at least one 

foreign-born parent. Of all children, 18.6 percent were U.S.-born with a foreign-born parent 

or parents, and 3.4 percent were themselves foreign-born. Most children (73.9 percent) were 

native-born with native-born parents. 

Children’s poverty status varies with their 

nativity. In 2008, foreign-born children with 

foreign-born parents were most likely to live 

in poverty, with 30.1 percent living in households with incomes below 100 percent of 

the U.S. Census Bureau’s poverty threshold 

($22, 025 for a family of four in 2008). Another 

27.8 percent of these children lived in households with family incomes of 100–199 percent 

of the poverty threshold. Native-born children 

with native parents were the least likely to experience poverty, with 15.9 percent living in 

households with incomes below 100 percent of 

the poverty threshold, and another 18.7 percent 

living in households with incomes of 100–199 

percent of the poverty threshold.

A number of other sociodemographic factors vary by the nativity of children and their 

parents. For instance, native-born children with 

native parents were most likely to have health 

insurance in 2008 (92.2 percent), while foreignborn children with foreign-born parents were 

least likely (68.7 percent). Almost 85 percent 

of native-born children with foreign-born parents had health insurance in 2008 (data not 

shown).
adopted children

In 2007, there were approximately 1.8 million adopted children living in the United 

States. Of all adopted children, 38 percent were 

placed with families through private domestic 

adoption, meaning the child was voluntarily 

placed for adoption by his or her biological parents. Another 37 percent of adopted children 

were placed with their families through foster 

care adoption, and the remaining 25 percent of 

adopted children came to their families through 

international adoption. 

The racial/ethnic distribution of adopted 

children differs from that of the general child 

population. While non-Hispanic White children represented 56 percent of the overall child 

population in 2007, they represented only 37 

 CHILD HEALTH USA 2010 POPULATION CHARACTERISTICS 13

percent of adopted children. Conversely, nonHispanic Black children composed 14 percent 

of the overall child population but 23 percent 

of the adopted child population, and Asian 

children composed 4 percent of the overall 

population but 15 percent of the adopted child 

population. Hispanic children represented 20 

percent of the overall child population and 15 

percent of the adopted child population (data 

not shown). The racial/ethnic distribution of 

adopted children also varies across adoption 

types, with private adoptions most likely to involve non-Hispanic White children and international adoptions most likely to involve Asian 

children. The racial/ethnic profile of children 

placed through foster care adoptions is less disparate: in 2007, 37 percent were non-Hispanic 

White, 35 percent were non-Hispanic Black, 

and 16 percent were Hispanic. 

The population of adopted children is older 

than the general child population. In 2007, 16 

percent of the general child population was 0–2 

years of age, but only 6 percent of adopted children were in that age group. Conversely, 23 percent of the adopted child population was 15–17 

years of age, while only 17 percent of the general child population was in that age group. Adopted children were more likely than children 

in the general population to have at least one 

parent with more than a high school diploma, 

to live in a household with income above 400 

percent of the Federal poverty threshold, to live 

in a safe neighborhood, and to have consistent 

insurance coverage (data not shown).

Adopted Children, by Race/Ethnicity and Adoption Type, 2007*

Source (I.4): Office of the Assistant Secretary for Planning and Evaluation and the 

Administration for Children and Families, National Survey of Adoptive Parents

Adopted Children, by Adoption Type, 2007*

Source (I.4): Office of the Assistant Secretary for Planning and Evaluation and 

the Administration for Children and Families, National Survey of Adoptive Parents

10

20

30

40

50

60

70

Private Domestic Foster Care International

*Published analyses of this data source round all estimates to the nearest whole number. **The number of 

Asian children adopted through private domestic adoption and foster care, and the number of children of 

other races adopted through international adoption, is too small to produce reliable estimates. Percent of Children

Private 

Domestic 

38% Foster Care 

37%

International

25%

50

37

19

25

35

3

13 16 17

59

12 10

Non-Hispanic Black

Hispanic

Asian**

Non-Hispanic White

Other 

Races**

*Published analyses of this data source round all estimates to the nearest whole number. 
14 POPULATION CHARACTERISTICS CHILD HEALTH USA 2010

rural and urban children

The health risks facing children often vary by 

the child’s geographic location. Children living in 

rural areas are more likely to live in poor families,1

are more vulnerable to death from injuries,2 and 

are more likely to use tobacco than their counterparts in urban areas.3

 Rural families also face 

particular challenges in gaining access to health 

care, as they often have to travel greater distances 

to use health services.4 These discrepancies in 

health status and health risks are not necessarily 

attributable to children’s geographic location, but 

rather are related to the demographic characteristics of the children and families who live in rural 

areas. Understanding these health risks provides 

program planners and policymakers important 

information with which to target services and 

interventions.

In 2007, more than 81 percent of children 

lived in urban areas, 9 percent lived in large rural areas, and another 9 percent lived in small 

or isolated rural areas (data not shown). For the 

National Survey of Children’s Health, these areas were classified based on zip code, the size of 

the city or town, and the commuting pattern 

in the area. Urban areas include metropolitan 

areas and surrounding towns from which commuters flow into an urban area. Large rural areas 

include large towns with populations of 10,000 

to 49,999 persons and their surrounding areas. 

Small or isolated rural areas include small towns 

with populations of 2,500 to 9,999 persons and 

their surrounding areas. 

In 2007, approximately 35 percent of children 

aged 10–17 years living in small rural areas were 

overweight or obese, compared to 30.9 percent 

of children living in urban areas. Children were 

defined as overweight if their Body Mass Index 

(BMI), based on parent-reported height and 

weight, fell between the 85th and 95th percentiles 

for their age and sex. Those with a BMI at or 

above the 95th percentile were considered obese. 

Children living in small rural areas were also 

more likely to live with a smoker than their urban 

counterparts (35.0 percent versus 24.4 percent). 

1 U.S. Census Bureau, 2008 American Community Survey. 

Table C17001, accessed through American Factfinder.

2 Cherry DC, Huggins B, Gilmore K. Children’s health in 

the rural environment. Pediatric Clinics of North America 54 (2007):121-133.

3 Johnston LD, O’Malley PM, Bachman JG, Schulenberg 

JE. (2009) Monitoring the Future: National Survey Results on Drug Use, 1975-2008. (NIH Publication No. 

09-7402.) Bethesda, MD: National Institute on Drug 

Abuse.

4 Probst JC, Laditka SH, Wang J-Y, Johnson AO. Effects of 

residence and race on burden of travel for care: cross sectional analysis of the 2001 US National Household Travel 

Survey. BMC Health Serv Res 2007 Mar 9;7-40.

Overweight and Obesity among Children Aged 10-17, 

by Location, 2007

Source (I.5): Health Resources and Services Administration, Maternal and Child Health 

Bureau and Centers for Disease Control and Prevention, National Center for Health 

Statistics, National Survey of Children’s Health

Children Under Age 18 Who Live in Households with a 

Smoker, by Location, 2007

Source (I.5): Health Resources and Services Administration, Maternal and Child Health 

Bureau and Centers for Disease Control and Prevention, National Center for Health 

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

26.2 24.4

33.1 35.0

10

20

30

40

50

Total Urban Large Rural Small Rural

Percent of Children

31.6 30.9 34.6 35.2

10

20

30

40

50

Total Urban Large Rural Small Rural
 CHILD HEALTH USA 2010 POPULATION CHARACTERISTICS 15

school engagement

In 2007, there were nearly 3.6 million high 

school status dropouts1 in the United States, 

representing a status dropout rate of 8.7 percent. 

This rate has declined steadily over the past several decades, with a decrease of 38 percent since 

1980 (when the rate was 14.1 percent). 

Historically, Hispanic students have had 

the highest dropout rates among youth of all 

racial/ethnic groups. In 2007, 21.4 percent of 

Hispanics 16–24 years of age were status dropouts, compared to 8.4 percent of non-Hispanic 

Blacks and 5.3 percent of non-Hispanic Whites. 

Nativity is one factor in this disparity: the status dropout rate among Hispanics born in the 

United States (11.2 percent) was much lower 

than the overall rate for this ethnic group (data 

not shown). 

The 2007 National Survey of Children’s 

Health measured youth engagement in school. 

For this measure, parents were asked how often the child cared about doing well in school 

and how often the child completed all required 

homework assignments. Children were considered engaged in school if the parent answered 

“usually” or “always” to both of these questions. 

Overall, 75.4 percent of children were considered engaged in school. This varied by race/

ethnicity, with non-Hispanic White children 

having the highest level of school engagement 

(82.6 percent), and non-Hispanic Black children having the lowest level of engagement 

(71.6 percent).

1 Status dropout refers to those 16–24 years of age who are 

not enrolled in school and have not earned high school 

credentials (diploma or equivalent).

School Status Dropout* Rates Among Persons Aged 

16-24 Years, by Race/Ethnicity, 1980-2007

Source (I.6): U.S. Department of Education, National Center for

Education Statistics

21.4

8.7

5.3

8.4

Non-Hispanic

 White

Hispanic

Non-Hispanic

 Black

Percent of Population *“Status dropout” refers to those 16-24 years of age who are not enrolled in school and have not 

earned high school credentials (diploma or equivalent).

10

20

30

40

50

60

70

80

90

1980 1985 1990 1995 2000 2005 2007

Total

Children Aged 6-17 Years Engaged in School,* by Race/

Ethnicity, 2007

Source (I.7): Health Resources and Services Administration, Maternal and Child 

Health Bureau and Centers for Disease Control and Prevention, National Center for 

Health Statistics, National Survey of Children’s Health

75.4

82.6 80.5

71.6

Percent of Children

*Children are considered engaged in school if they “usually” or “always” care about doing well in 

school and do all required homework, according to parent report.

10

20

30

40

50

60

70

80

90

Non-Hispanic Hispanic

Black

Non-Hispanic 

White

Total
16 POPULATION CHARACTERISTICS CHILD HEALTH USA 2010

perceived neighborhood 

safety

An unsafe neighborhood can have negative 

effects on a child’s health, from limiting physical activity to risking injury. In 2007, the parents of 2.6 percent of children reported that 

their child was never safe in their neighborhood 

or community, while an additional 11.4 percent of children had parents who felt that they 

were only sometimes safe. The parents of the 

remaining 86.1 percent of children felt that 

their child was usually or always safe in their 

neighborhood.

Perceived neighborhood safety varies by a 

number of factors. Children living in households with incomes of 400 percent or more of 

the Federal poverty level ($20,650 for a family 

of four in 2007) were significantly more likely 

than children living in households with incomes 

below 100 percent of the Federal poverty level 

to have parents report that their child was usually or always safe in their neighborhood (94.0 

versus 72.3 percent). 

Neighborhood safety, as reported by parents, 

varies by the geographic setting of the neighborhood or community. In 2007, the parents 

of 84.1 percent of children who lived in urban 

areas reported that their child was usually or 

always safe, compared to 93.0 of children who 

lived in suburban areas. Perceived safety also 

varies by race/ethnicity and family structure: 

the parents of non-Hispanic White children 

were most likely to report that they are usually or always safe, while non-Hispanic Black 

children were least likely, and children living in 

households with two biological or adoptive parents were most likely to be usually or always safe 

while children living in single-mother households were least likely to be usually or always 

safe (data not shown).

Neighborhood Safety* Among Children Under 18 Years,

by Poverty Level,** 2007

Source (I.7): Health Resources and Services Administration, Maternal and Child Health 

Bureau and Centers for Disease Control and Prevention, National Center for Health 

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

86.1

2.6

11.4

21.8

5.9

72.3

81.6

3.3

15.1

89.7

1.7

8.6

94.0

0.8 5.1

Neighborhood Safety* Among Children Under 18 Years, 

by Rural-Urban Area,** 2007

Source (I.7): Health Resources and Services Administration, Maternal and Child Health 

Bureau and Centers for Disease Control and Prevention, National Center for Health 

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

1.4 5.6

93.0

1.5

9.8

88.8

7.5

91.2

1.3

28.2

3.0

12.9

84.1

20

40

60

80

100

400% or More 

of Poverty

200-399%

of Poverty

100-199%

of Poverty

<100%

of Poverty

Total

20

40

60

80

100

Small Town/

Rural

Urban Core Suburban Large Town

*As determined by asking parents, “How often do you feel [child] is safe in your community or 

neighborhood?” **Rural-Urban areas are determined using the Rural-Urban Commuting Area 

(RUCA) system, which uses a combination of Census Bureau place definitions and work 

commuting information to determine the rural-urban status of an area.

*As determined by asking parents, “How often do you feel [child] is safe in your community or 

neighborhood?” **The U.S. Department of Health and Human Services establishes poverty 

guidelines for determining financial eligibility for Federal programs; the poverty level for a family 

of four was $20,650 in 2007.

Never

Safe

Sometimes

Safe

Usually or Always Safe

Never

Safe

Sometimes

Safe

Usually or Always Safe
 CHILD HEALTH USA 2010 POPULATION CHARACTERISTICS 17

Child-Family 

Connectedness

There are a number of family activities that 

can promote family bonding and help children lay the groundwork for future health and 

well-being. Sharing meals is a bonding activity 

that can also encourage good nutritional habits. In 2007, 45.8 percent of children under 18 

years of age ate a meal every day with all other 

members of their household. The rate of sharing meals decreased with age, from 57.7 percent 

of children from birth through age 5 to 32.9 

percent of children 12–17 years of age. Sharing a meal every day was more common among 

Hispanic children (53.8 percent) than non-Hispanic White and non-Hispanic Black children 

(42.0 and 42.6 percent, respectively). Sharing 

of meals also varied by family income, with 58.3 

percent of children living in households with 

incomes below 100 percent of the Federal poverty level ($20,650 for a family of four in 2007) 

sharing meals daily, while the same was true for 

only 38.8 percent of children with household 

incomes of 400 percent or more of the Federal 

poverty level (data not shown).

In 2007, 47.8 percent of children from birth 

to age five were read to every day by family 

members. This varied by household income, 

with 36.1 percent of children living in households with incomes below 100 percent of the 

Federal poverty level ($20,650 for a family of 

four in 2007) being read to every day, compared 

to 60.0 percent of children with household incomes of 400 percent or more of the Federal 

poverty level. Fewer than 10 percent of children 

with household incomes of 400 percent or more 

of the Federal poverty level were read to on two 

or fewer days in the past week, compared to 

nearly one-third of children with household incomes below 100 percent of the Federal poverty 

level. 

Frequency of Being Read to by a Family Member* Among 

Children Aged 0−5 Years, by Poverty Level,** 2007

Source (1.7): Health Resources and Services Administration, Maternal and Child 

Health Bureau and Centers for Disease Control and Prevention, National Center for 

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

10

20

30

40

50

60

400% or More of Poverty200-399% 

of Poverty

100-199% 

of Poverty

<100% 

of Poverty 

0-2 Days

32.0

36.1

31.8

23.3

37.6 39.1

16.9

31.9

51.1

*Number of days that the child was read aloud to during the past week. **The U.S. Department of

Health and Human Services establishes poverty guidelines for determining financial eligibility for 

Federal programs; the poverty level for a family of four was $20,650 in 2007.

3-6 Days

Every Day

Frequency of Family Meals* Among Children, 

by Age, 2007

Source (1.7): Health Resources and Services Administration, Maternal and Child 

Health Bureau and Centers for Disease Control and Prevention, National Center 

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

10

20

30

40

50

60

0-5 Years 6-11 Years 12-17 Years

0-5 Days

24.4

57.7

17.9 20.4

32.3

47.3

30.7

36.4

32.9

*Number of days that the child ate a meal with all other family members living in the household.

4-6 Days

Every Day

9.7

30.2

60.0
18 POPULATION CHARACTERISTICS CHILD HEALTH USA 2010

maternal age

According to preliminary data, the general 

fertility rate fell slightly to 68.7 live births per 

1,000 women aged 15–44 years in 2008 (from 

a rate of 69.5 in 2007). Birth rates for nearly 

every age and racial/ethnic group also declined. 

The rate for teenagers aged 15–19 years decreased to 41.5 per 1,000 females in this age 

group, which continues the general decline in 

teenage birthrates since 1991, when the rate was 

61.8 births per 1,000. Although the birth rate 

for women aged 25–29 years fell in 2008, this 

group still experienced the highest birth rate of 

all age groups (115.1 births per 1,000). This was 

followed by women aged 20–24 years (103.1 

births per 1,000). Birth rates for women aged 

30–34 (99.3 births per 1,000) and 35–39 years 

(46.9 births per 1,000) also declined slightly; 

the previous year saw the highest reported rates 

in over four decades for these age groups. Birth 

rates for women aged 40–44 years (9.9 births 

per 1,000) and 45–49 years (0.7 births per 

1,000) increased slightly over the previous year.

In 2008, 3.3 percent of births were to females under 18 years of age, and another 7.0 

percent were to teens aged 18–19 years. Just 

under one-quarter (24.8 percent) of births occurred among young adults aged 20–24 years, 

while 28.2 percent were to women aged 25–29 

years and 22.5 percent were to women aged 30–

34 years. Another 11.5 percent of births were 

to women aged 35–39 years, and the remaining 

2.7 percent of births were to women aged 40 

and over. Average age at first birth fell to 25.0 

years in 2006 (the latest year for which data are 

available), the first such decline since the measure became available in 1968 (data not shown). 

The age distribution of births varies by race/

ethnicity. Among non-Hispanic Black and Hispanic women, 17.1 percent and 14.1 percent of 

births, respectively, were to teenagers, compared 

to 7.4 percent of births to non-Hispanic White 

females. The percentage of births to young 

adults aged 20–24 years was higher among nonHispanic Black and Hispanic women (31.8 percent and 28.2 percent, respectively) than among 

non-Hispanic White women (22.5 percent). 

However, births to women aged 35 and older 

represented a higher proportion of births among 

non-Hispanic White women than among nonHispanic Black and Hispanic women.

Distribution of Births, by Race/Ethnicity and Maternal Age, 2008*

Source (I.8): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System

40-54 Years

 2.9% 35-39 Years 

12.7%

30-34 Years 

24.8%

25-29 Years 

29.6%

20-24 Years 

22.5%

18-19 Years

 5.5%

Under 18 Years

 1.9%

Non-Hispanic White Non-Hispanic Black Hispanic

40-54 Years

 2.1%

35-39 

Years

 8.1%

30-34 Years

 15.8%

25-29 Years 

25.1%

20-24 Years

 31.8%

18-19 Years

11.2%

Under 18

 Years

 5.9% 40-45 Years

 2.1% 35-39 Years

 9.3% 30-34 Years

 19.2%

25-29 Years 

27.0%

20-24 Years

 28.2%

18-19 Years

 8.8%

Under 18

 Years

 5.3%

*Preliminary data
 CHILD HEALTH USA 2010 HEALTH STATUS 19

working mothers and child 

care

In 2008, 71.4 percent of women with children under 18 years of age were in the labor 

force (either employed or looking for work), 

and 67.5 percent were employed. Employment 

varied by a number of factors, including the age 

of the youngest child. Of mothers with children 

from birth through age 5, 64.0 percent were in 

the labor force and 59.5 percent were employed. 

Of women whose youngest child was aged 6–17 

years, 77.3 percent were in the labor force and 

73.8 percent were employed. Employed mothers 

with children birth to age five were more likely 

to be employed part time than mothers with older children (27.9 versus 22.2 percent, data not 

shown). Employment also varied by marital status: 69.5 percent of married mothers were in the 

labor force, compared to 76.0 percent of mothers 

of other marital statuses (data not shown).

In 2007, 54.2 percent of children from birth 

through age 5 were in childcare for 10 or more 

hours per week. Overall, 29.1 percent of children 

were in the care of a non-relative, while 14.7 percent were cared for by a relative and 10.4 percent received both relative and non-relative care. 

Childcare arrangements varied by household income: 32.4 percent of children living in households with incomes of 400 percent or more of 

the Federal poverty level ($20,650 for a family of 

four in 2007) did not receive 10 or more hours 

of childcare per week while the same was true of 

57.8 percent of children with household incomes 

under 100 percent of the Federal poverty level. 

Difficulty with childcare can affect the ability 

of parents to maintain steady employment. In 

2007, approximately 37 percent of parents who 

needed child care in the past month reported that 

they had to change their arrangements because 

of circumstances beyond their control (such as 

a sick child or change in their provider’s schedule). Among all parents with children from birth 

through age five, 12.4 percent reported that 

childcare issues caused them to quit their job, pass 

a job offer, or greatly change their job because of 

problems with childcare (data not shown). 

Childcare Arrangements* for Children Aged 0-5 Years, by

Poverty Level,** 2007

Source (1.7): Health Resources and Services Administration, Maternal and Child Health 

Bureau and Centers for Disease Control and Prevention, National Center for Health Statistics, 

National Survey of Children’s Health

64.0

77.3

With Children Aged 6–17 Years

Percent of Mothers Mothers in the Labor Force,* by Age of Child,** 

1975-2008

Source (1.9): U.S. Department of Labor, Bureau of Labor Statistics

Percent of Children

10

20

30

40

50

60

70

80

Both Relative and 

Non-Relative Care

No Childcare Non-Relative Care Relative Care

Total

<100% FPL

100-199% FPL

200-399% FPL

400% or More FPL

57.8

50.746.4

32.4

45.8

20.6

46.0

29.1

17.8 14.7 15.0 10.4 9.7 10.910.2 10.6

With Children Aged 0-5 Years

*10 or more hours of childcare per week. **The U.S. Department of Health and Human Services establishes 

poverty guidelines for determining financial eligibility for Federal programs; the poverty level for a family of 

four was $20,650 in 2007.

*The labor force comprises people who are employed and people who are actively seeking 

employment. **Women with two or more children are categorized by the age of their 

youngest child.

10

20

30

40

50

60

70

80

1975 1980 1985 1990 1995 2000 2005 2008

16.5

28.4

15.9 11.0

 CHILD HEALTH USA 2010 HEALTH STATUS 21 health status

Monitoring the health status of infants, 

children, and adolescents allows health profes-

sionals, program planners, and policymakers 

to assess the impact of past and current health 

intervention and prevention programs and 

identify areas of need within the child popula-

tion. Although indicators of child health and 

well-being are often assessed on an annual basis, 

some surveillance systems collect data at regular 

intervals, such as every 2, 3, or 5 years. Trends 

can be identified by examining and comparing 

data from one data collection period to the next 

whenever multiple years of data are available.

In the following section, mortality, disease, 

injury, and health behavior indicators are pre-

sented by age group. The health status indica-

tors in this section are based on vital statistics 

and national surveys and surveillance systems. 

Population-based samples are designed to yield 

information that is representative of the mater-

nal and child populations that are affected by, or 

in need of, specific health services or interven-

tions. 
22 CHILD HEALTH USA 2010

Health Status - Infants
 CHILD HEALTH USA 2010 HEALTH STATUS-INFANTS 23

breastfeeding

Breastfeeding has been shown to promote 

the health and development of infants, as well 

as their immunity to disease. It also confers a 

number of maternal, societal, and even environmental benefits.1

 The American Academy 

of Pediatrics recommends exclusive breastfeeding—with no supplemental food or liquids—

through the first 6 months of life, and continued supplemental breastfeeding through at least 

the first year.2

Breastfeeding initiation rates have increased 

steadily since the early 1990s. In 2007, the parents of 75.5 percent of children from birth to 

5 years of age reported that the child had ever 

been breastfed (including being fed expressed 

breast milk). Children living in households 

with incomes of 400 percent of more of the 

Federal poverty level ($20,650 for a family of 

four in 2007) were most likely to have been 

breastfed (83.2 percent), while children living 

in households with incomes below 100 percent 

of the Federal poverty level were least likely to 

have been breastfed (65.7 percent). Initiation of 

breastfeeding also varies by race/ethnicity, and 

maternal age and educational achievement.

The percentage of children who are exclusively breastfed for six months is considerably 

lower than the percent who are ever breastfed. 

In 2007, the parents of only 12.4 percent of 

children aged 6 months to 5 years reported that 

their child was exclusively breastfed for at least 

the first 6 months of life. The rate of exclusive 

breastfeeding also varied by family income, with 

10.6 percent of children with family incomes 

below 100 percent of the Federal poverty level 

being exclusively breastfed through 6 months, 

compared to 14.7 percent of children with family incomes of 400 percent or more of the Federal poverty level. 

1 U.S. Department of Health and Humans Services. Benefits of breastfeeding. Available online:http://www.womenshealth.gov/breastfeeding/benefits/; accessed July, 2010.

2 American Academy of Pediatrics. Breastfeeding and the use 

of human milk. Pediatrics 2005 Feb;115(2):496-506.

Breastfeeding* Among Children Aged 0−5 Years, by

Poverty Level,** 2007

Source (I.7): Health Resources and Services Administration, Maternal and Child Health 

Bureau and Centers for Disease Control and Prevention, National Center for Health 

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

20

40

60

80

100

400% or More 

of Poverty

200-399%

of Poverty

100-199%

of Poverty

<100%

of Poverty

Total

*Ever fed breast milk. ** The U.S. Department of Health and Human Services establishes poverty 

guidelines for determining financial eligibility for Federal programs; the poverty level for a family 

of four was $20,650 in 2007.

Exclusive* Breastfeeding Among Children Aged 6 Months 

to 5 Years, by Poverty Level,** 2007

Source (I.7): Health Resources and Services Administration, Maternal and Child Health 

Bureau and Centers for Disease Control and Prevention, National Center for Health 

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

20

40

60

80

100

400% or More 

of Poverty

200-399% 

of Poverty

100-199%

of Poverty

<100%

of Poverty

Total

*Fed only breast milk for the first 6 months of life. ** The U.S. Department of Health and Human 

Services establishes poverty guidelines for determining financial eligibility for Federal programs; 

the poverty level for a family of four was $20,650 in 2007.

12.4 10.6 10.9 12.8 14.7

75.5

83.2

77.4 72.6

65.7
24 HEALTH STATUS – INFANTS CHILD HEALTH USA 2010

low birth weight

Low birth weight is a leading cause of neonatal mortality (death before 28 days of age). Low 

birth weight infants are more likely to experience long-term disability or die during the first 

year of life than are infants of normal weight.

According to preliminary data, 8.2 percent 

of infants were born low birth weight (less than 

2,500 grams or 5 pounds 8 ounces) in 2008; 

this rate was unchanged from the previous year. 

In 2006, the rate of low birth weight was the 

highest recorded in four decades (8.3 percent). 

The increase in multiple births, which are at 

high risk of low birth weight, strongly influenced this increase; however, rates of low birth 

weight also rose for singleton births. 

In 2008, the rate of low birth weight was 

much higher among infants born to non-Hispanic Black women (13.7 percent) than infants 

born to mothers of other racial/ethnic groups. 

The second highest rate, which occurred among 

Asian/Pacific Islanders, was 8.2 percent, followed by a rate of 7.4 percent among American Indian/Alaska Natives. Low birth weight 

occurred among 7.2 percent of infants born to 

non-Hispanic White women, while infants of 

Hispanic women experienced the lowest rate 

(7.0 percent). The low birth weight rate remained unchanged over the previous year for 

infants born to non-Hispanic White mothers, 

while the rate declined for infants born to nonLow Birth Weight Among Infants, by Maternal Race/Ethnicity, 1990−2008*

Source (I.8): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital

Statistics System

13.7

8.2

7.4

7.2

Non-Hispanic Black

Non-Hispanic White

Percent of Infants

7.0

Asian/Pacific Islander

American Indian/

Alaska Native

Hispanic

All Races

*Data for 2008 are preliminary.

5

6

7

8

9

10

11

12

13

14

15

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

Hispanic Black and American Indian/Alaska 

Native mothers and increased for infants born 

to Hispanic and Asian/Pacific Islander mothers. 

Low birth weight also varied by maternal age. 

In 2007 (the latest year for which data are available), the rate of low birth weight was highest 

among babies born to women younger than 15 

years of age (12.4 percent), followed by babies 

born to women aged 40–54 years (11.5 percent). The lowest rates occurred among babies 

born to mothers aged 25–29 years and 30–34 

years (7.4 and 7.6 percent, respectively; data not 

shown). 
very low birth weight

According to preliminary data, 1.5 percent 

of infants were born very low birth weight (less 

than 1,500 grams, or 3 pounds 4 ounces) in 

2008. The proportion of very low birth weight 

infants has slowly climbed from just over 1 percent in 1980. 

Infants born at such low weight are approximately 100 times more likely to die in 

the first year of life than are infants of normal 

birth weight (above 5 pounds 8 ounces). 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.

Infants born to non-Hispanic black women 

are more than two times more likely than infants born to mothers of other racial/ethnic 

groups to be very low birth weight. Among infants born to non-Hispanic Black women, 3.0 

percent were very low birth weight in 2008, 

compared to 1.2 percent of infants born to nonHispanic White, Hispanic, and Asian/Pacific 

Islander women and 1.3 percent of American 

Indian/Alaska Native women. This difference is 

a major contributor to the disparity in infant 

mortality rates between non-Hispanic Black infants and infants of other racial/ethnic groups. 

However, non-Hispanic Black infants were the 

Very Low Birth Weight Among Infants, by Race/Ethnicity, 1990−2008*

Source (I.8): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital 

Statistics System

3.0

1.2

1.3

1.5

Non-Hispanic

 White

Non-Hispanic Black

Hispanic Asian/Pacific Islander

Percent of Infants

American Indian/

Alaska Native

0.5

1.0

1.5

2.0

2.5

3.0

3.5

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

All Races

*Data for 2008 are preliminary.

only racial/ethnic group to see a drop in very 

low birth weight between 2007 and 2008; the 

rates for all other racial/ethnic groups remained 

largely unchanged. 

In 2007 (the latest year for which data are 

available), the rate of very low birth weight was 

highest among babies born to mothers under 15 

years of age (2.8 percent), followed by mothers aged 45–54 years (2.2 percent). The rate was 

lowest among mothers aged 25–29 years (1.3 

percent; data not shown).

 CHILD HEALTH USA 2010 HEALTH STATUS-INFANTS 25
26 HEALTH STATUS – INFANTS CHILD HEALTH USA 2010

preterm birth

Babies born preterm, before 37 completed 

weeks of gestation, are at increased risk of immediate and long-term complications, as well as 

mortality. Complications that occur during the 

newborn period can include respiratory distress, 

jaundice, anemia, and infection, while longterm complications can include learning and 

behavioral problems, cerebral palsy, lung problems, and vision and hearing loss. Although the 

risk of complications is greatest among those 

babies who are born the earliest, even those babies born “late preterm” (34 to 36 weeks’ gestation) are more likely than full-term babies to 

experience complications.1

According to preliminary data, 12.3 percent 

of infants were born preterm in 2008. Overall, 8.8 percent of babies were born at 34 to 

36 weeks’ gestation, 1.6 percent were born at 

32–33 weeks, and 2.0 percent were “very preterm” (less than 32 weeks). The preterm birth 

rate increased more than 20 percent from 1990 

to 2006, and has declined in the two years since 

(data not shown). 

The preterm birth rate varies by race/ethnicity. In 2008, 17.5 percent of babies born to 

non-Hispanic Black women were born preterm, 

compared to 10.7 percent of babies born to 

Asian/Pacific Islander women. Among babies 

born to non-Hispanic White women, 11.1 

percent were born preterm, while the same was 

true of 12.1 percent of babies born to Hispanic women and 13.6 percent of babies born to 

American Indian/Alaska native women.

1 Centers for Disease Control and Prevention, National 

Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health. Prematurity. 

November 2009. Available online: http://www.cdc.gov/

Features/PrematureBirth/; accessed September 2010. 

Preterm Birth Among Infants, by Completed Weeks 

of Gestation, 2008*

Source (I.8): Centers for Disease Control and Prevention, National Center for

Health Statistics, National Vital Statistics System

8.8

1.6

12.3

2.0

Percent of Live Births

*Preliminary data.

Preterm Birth Among Infants, by Maternal Race/Ethnicity, 

2008*

Source (I.8): Centers for Disease Control and Prevention, National Center for

Health Statistics, National Vital Statistics System

11.1

17.5

13.6

10.7

12.1

Percent of Live Births

*Preliminary data.

5

10

15

20

Less than 32-33 Weeks 34-36 Weeks

 32 Weeks

Total

5

10

15

20

Asian/Pacific

 Islander

American Indian/

Alaska Native

Non-Hispanic Hispanic

 Black

Non-Hispanic

 White
 CHILD HEALTH USA 2010 HEALTH STATUS-INFANTS 27

maternal mortality

The rate of maternal mortality in the United 

States declined dramatically over the last century; however, there has been some reversal of 

this trend in the last several decades. In 2007, 

the maternal mortality rate was 12.7 deaths per 

100,000 live births, compared to a low of 6.6 

per 100,000 in 1987. Some of this increase may 

be due to changes in the coding and classification of maternal deaths.

In 2007, a total of 548 women were reported 

to have died of maternal causes. This includes 

only those deaths due to causes related to or 

aggravated by pregnancy or pregnancy management, and excludes deaths occurring more 

than 42 days after the end of the pregnancy 

and deaths of pregnant women due to external 

causes (such as injury). The maternal mortality 

rate among non-Hispanic Black women was 2.7 

times the rate for non-Hispanic White women 

(28.4 versus 10.5 per 100,000). 

 Causes of maternal death are classified as 

direct, indirect, or unspecified. Some of the 

most common direct causes are complications 

related to the puerperium, or period immediately after delivery (2.2 per 100,000), eclampsia 

and pre-eclampsia (1.5 per 100,000), hemorrhage of pregnancy, childbirth, and placenta 

previa (0.9 per 100,000), and pregnancy with 

abortive outcome (0.5 per 100,000). Indirect 

causes occurred at a rate of 3.1 per 100,000, and 

comprised deaths from pre-existing conditions 

complicated by pregnancy. The rate of maternal deaths from unspecified causes was 0.5 per 

100,000. 

Maternal Mortality Rates, by Race/Ethnicity, 2007

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

Statistics, National Vital Statistics System Maternal Deaths per 100,000 Live Births

12.7

10.5

28.4

8.9

Leading Causes of Maternal Mortality, 2007

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

Statistics, National Vital Statistics System

Maternal Deaths per 100,000 Live Births

2.2

0.5

3.1

3.8

0.7

5

10

15

20

25

30

35

Non-Hispanic Hispanic 

 Black

Non-Hispanic

 White

Total 1 2 3 4 5

Unspecified Cause

Indirect Causes**

Other direct causes

Pregnancy with abortive outcome

Hemorrhage of 

pregnancy, childbirth,

 and placenta previa

Eclampsia and

 pre-eclampsia

Complications related

 to the puerperium*

*Deaths occurring in the period immediately after delivery. **Deaths from pre-existing conditions 

complicated by pregnancy. 

0.9

1.5

Direct Causes
28 HEALTH STATUS – INFANTS CHILD HEALTH USA 2010

infant mortality

In 2007, 29,138 infants died before their 

first birthday, representing an infant mortality 

rate of 6.8 deaths per 1,000 live births; this is essentially unchanged from the previous year. The 

leading cause of infant mortality was congenital 

malformations, which accounted for approximately 20 percent of deaths, followed by disorders related to short gestation and low birth 

weight, which accounted for almost 17 percent 

of deaths (data not shown). 

The infant mortality rate began a substantial 

decline in the late 19th and early 20th century. 

Some factors in this early decline included economic growth, improved nutrition, new sanitary measures, and advances in knowledge about 

infant care. More recent advances in knowledge 

that contributed to a continued decline included the approval of synthetic surfactants and the 

recommendation that infants be placed on their 

backs to sleep. 

In 2007, the mortality rate among infants 

born to non-Hispanic Black women was 13.8 

deaths per 1,000 live births. This is nearly two 

and one-half times the rate among infants born 

to non-Hispanic White and Hispanic women 

(5.6 and 5.7 per 1,000, respectively). Although 

the infant mortality rates among both nonHispanic Whites and non-Hispanic Blacks have 

declined over the last century, the disparity between the two races remains largely unchanged. 

The Maternal and Child Health Block Grant 

and MCHB’s Health Start program provide 

health and support services to pregnant women 

and infants with the goal of improving children’s health outcomes and reducing infant and 

child mortality.

Infant Mortality Rates,* by Maternal Race/Ethnicity, 1985–2007

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

National Vital Statistics System

13.8

6.8

5.7

5.6

Non-Hispanic White

Hispanic

Non-Hispanic Black

All Races

Deaths per 1,000 Live Births

*Under 1 year of age.

2

4

6

8

10

12

14

16

18

20

1985 1990 1995 2000 2005 2007
neonatal and 

postneonatal mortality 

Neonatal. In 2007, 19,058 infants died before reaching 28 days of age, representing a neonatal mortality rate of 4.4 deaths per 1,000 live 

births. Although this is a slightly lower rate than 

the previous year (4.5 per 1,000), the change 

was not statistically significant. 

Neonatal mortality is generally related to 

short gestation and low birth weight, congenital malformations, and conditions originating 

in the perinatal period, such as birth trauma or 

infection.

Neonatal mortality rates vary by race and 

ethnicity. In 2007, the neonatal mortality rate 

among infants born to non-Hispanic Black 

women was 9.0 per 1,000 live births, more than 

twice the rate among infants born to non-Hispanic White and Hispanic women (3.6 and 3.8 

per 1,000, respectively).

Postneonatal. In 2007, 10,080 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 is slightly 

higher than the rate of 2.2 deaths per 1,000 reported in 2006.

Postneonatal mortality is generally related 

to Sudden Infant Death Syndrome (SIDS), 

congenital malformations, and unintentional 

injuries. Postneonatal mortality varies by race 

and ethnicity. In 2007, the highest rate of postneonatal mortality was reported among infants 

born to non-Hispanic Black women (4.8 per 

1,000). Rates for infants born to non-Hispanic 

White and Hispanic women were 2.0 and 1.9 

per 1,000, respectively. 

 CHILD HEALTH USA 2010 HEALTH STATUS – HEALTH INDICATORS 29

Neonatal Mortality Rates, by Maternal Race/Ethnicity, 

2007

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

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

4.4

3.6

9.0

3.8

Postneonatal Mortality Rates, by Maternal Race/Ethnicity, 

2007

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

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

2.3 2.0

4.8

1.9 2

4

6

8

10

Non-Hispanic Hispanic

 Black

Non-Hispanic

 White

Total

2

4

6

8

10

Non-Hispanic Hispanic

 Black

Non-Hispanic

 White

Total
30 HEALTH STATUS – INFANTS CHILD HEALTH USA 2010

international infant

mortality

In 2006, the U.S. infant mortality rate (6.7 

infant deaths per 1,000 live births) was higher 

than that of many other industialized nations.

This represents a slight decrease from the rate 

of 6.9 per 1,000 in 2005, and is considerably 

less than 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 

infants and the medical technology available 

to infants after birth. However, some of these 

differences may be due, in part, to the international variation in the definition, reporting, and 

measurement of fetal and infant deaths.

In 2006, the U.S. infant mortality rate was 

more than twice that of eight other industrialized countries (Hong Kong, Japan, Singapore, 

Sweden, Finland, Norway, Portugal, and Czech 

Republic). Hong Kong had the lowest rate (1.8 

per 1,000), followed by Japan and Singapore 

(2.6 per 1,000). 

International Infant Mortality Rates, Selected Countries, 2006

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

Deaths per 1,000 Live Births

 1.8

1 2 3 4 5 6 7 8

United States

Slovakia

Poland

Hungary

Cuba

New Zealand

Northern Ireland

England and Wales

Australia

Scotland

Netherlands

Switzerland

Israel

Spain

Germany

France

Denmark

Ireland

Greece

Austria

Czech Republic

Portugal 

Norway

Finland

Sweden

Singapore

Japan

Hong Kong

 2.6

 2.6

2.8

 2.8

 3.2

 3.3

 3.3

 3.6

 3.7

 3.7

 3.8

 3.8

 3.8

 3.8

 4.4

 4.3

 4.4

 4.5

 4.7

 5.0

 5.1

 5.2

 5.3

 5.7

 6.0

 6.6

 6.7
 CHILD HEALTH USA 2010 31

Health Status - children
32 HEALTH STATUS – CHILDREN CHILD HEALTH USA 2010

vaccine-preventable 

diseases

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

the past several decades. In 2007, there were 

no reported cases of diphtheria or polio in the 

United States, and no cases of tetanus among 

children under 5 years of age. Among children 

in this age group, there were no reported cases 

of acquired rubella and only one case of congenital rubella. 

From 2006 to 2007, the number of reported 

cases of hepatitis A, pertussis, and mumps decreased among children under 5 years of age. 

The overall incidence of hepatitis A began dropping dramatically once routine vaccination for 

children living in high-risk areas was recommended beginning in 1996, and in 2005, the 

Centers for Disease Control and Prevention 

(CDC) instituted the recommendation that all 

children be immunized for hepatitis A starting 

at 1 year of age. The latter recommendation was 

made because two-thirds of cases were occurring in States where the vaccine was not currently recommended. With regard to pertussis, 

the number of cases among young children decreased nearly 50 percent from 2005 to 2006, 

with a smaller increase of 18 percent from 2006 

to 2007. According to the CDC, pertussis occurs cyclically and decreases in the incidence 

of the disease may not be due to increases in 

immunization rates. The highest reported rate 

occurred among infants under 6 months of age, 

a population that is too young to be fully vaccinated. Following a 2006 outbreak in Midwestern states - the largest in more than 20 years - 

reported cases of mumps decreased 72 percent. 

In response to the outbreak, the CDC updated 

criteria for mumps immunity and vaccination 

recommendations. Reported cases of hepatitis 

B and H. Influenzae remained relatively unchanged from 2006 to 2007.

Reported Cases of Selected Vaccine-Preventable Diseases Among Children

Aged 0−4 Years, 2007

Source (II.4): Centers for Disease Control and Prevention, National Notifiable Diseases Surveillance System

Number of Reported Cases

0

0

0

1

7

11

102

110

401

2,746

200 400 600 800 1,000 2,600 2,800 3,000

Pertussis

H. Influenzae

Hepatitis A

Mumps

Measles

Hepatitis B

Rubella*

Tetanus

Polio

Diphtheria

*Congenital Rubella
 CHILD HEALTH USA 2010 HEALTH STATUS – CHILDREN 33

pediatric HIV and aids

Human immunodeficiency virus (HIV) is a 

disease that destroys cells that are critical to a 

healthy immune system. Acquired immunodeficiency syndrome (AIDS) is diagnosed when 

HIV has weakened the immune system enough 

that the body has difficulty fighting disease and 

infections. In 2008, an estimated 182 children 

younger than 13 years of age were diagnosed 

with HIV1, and 41 were reported to have AIDS.

Racial and ethnic minorities are disproportionately affected by HIV. In 2008, four times 

as many HIV cases were reported among nonHispanic Black children as among non-Hispanic White Children (121 and 32 cases, respectively). Non-Hispanic Black children accounted 

for over 65 percent of cases, but represent only 

about 15 percent of the total U.S. population in 

this age group. 

The number of new pediatric AIDS cases 

has declined substantially since 1992, when an 

estimated 894 new cases were reported. A major factor in this decline is the increasing use of 

antiretroviral therapy before, during, and after 

pregnancy to reduce perinatal transmission of 

HIV. In addition, the Centers for Disease Control and Prevention released new educational 

materials and other resources in 2004 to promote universal prenatal HIV testing. Through 

2008, an estimated 9,349 AIDS cases have occurred in children younger than 13 years of age 

in the United States. Pediatric AIDS cases represent less than one percent of the more than one 

million U.S. cases ever reported.

1 Includes persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis; therefore, this includes 

persons who are first diagnosed with HIV at the same time 

they are diagnosed with AIDS.

Estimated Number of Diagnoses of HIV Among Children 

Under Age 13, by Race/Ethnicity, 2008

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

Number of Diagnoses

182

121

*The total was estimated independently of the values for each subpopulation; therefore, the sum of all 

races/ethnicities does not equal the overall total. 

Estimated Number of AIDS Cases in Children Under Age 13,

by Year of Diagnosis, 1992–2008

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

32

22

2

1

3

106 70 53 40 30

241

121

663

894

187

509

879

129

329

799

55 41

50 100 150 200

Multiple Races

American Indian/

Alaska Native

Asian/Pacific

 Islander

Hispanic

Non-Hispanic

 Black

Non-Hispanic

 White

Total*

200

400

600

800

1000

1992 1994 1996 1998 2000 2002 2004 2006 2008
34 HEALTH STATUS – CHILDREN CHILD HEALTH USA 2010

hospitalization

In 2006, there were nearly 3.5 million hospital 

discharges among people aged 1‒21 years, equaling 4.0 hospital discharges per 100 children. 

While injuries are the leading cause of death 

among this age group, they were not the most 

common cause of hospitalization. In 2005‒2006, 

diseases of the respiratory system were the most 

common cause of hospitalization among children aged 1‒4 and 5‒9 years, accounting for 39 

and 24 percent of discharges, respectively. Mental 

disorders were the most common cause of hospitalization among children aged 10‒14 years (24 

percent of discharges), and pregnancy and childbirth was the most common cause of hospitalization for adolescents aged 15‒19 years and young 

adults aged 20‒21 years (42 and 64 percent of 

discharges, respectively). 

Between 1990 and 2006, hospital discharge 

rates for children aged 1‒14 years declined by 

almost 14 percent, which reflects decreases in 

several of the most common causes of hospitalization. Discharge rates for diseases of the respiratory system declined 26.4 percent, discharges due 

to injury declined 34.2 percent, and discharges 

for diseases of the digestive system declined 19.0 

percent. The rate of discharges due to endocrine, 

metabolic, and immunity diseases and disorders, 

however, increased 36.8 percent. This category of 

diseases and conditions includes thyroid gland 

disorders, diabetes, nutritional deficiencies, and 

overweight and obesity (data not shown).

Major Causes of Hospitalization, by Age, 2005-2006

Source (II.6): Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital

Discharge Survey

251

79

52

52

47

92

52

41

32

21

107

74

50

44

29

92

84

43

216

19

36

39

67

475

433

Average Number of Discharges per Year (in thousands)

50 100 150 200 250 300 350 400 450 500

Diseases of the Respiratory System

Diseases of the Digestive System

Injury

Mental Disorders

Pregnancy/Childbirth

Ages 20-21

Diseases of the Respiratory System

Diseases of the Digestive System

Injury

Mental Disorders

Pregnancy/Childbirth

Ages 15-19

Endocrine, Metabolic, and Immunity Diseases and Disorders

Diseases of the Respiratory System

Injury

Diseases of the Digestive System

Mental Disorders

Ages 10-14

Infectious and Parasitic Diseases

Endocrine, Metabolic, and Immunity

Diseases and Disorders

Injury

Diseases of the Digestive System

Diseases of the Respiratory System

Ages 5-9

Diseases of the Digestive System

Injury

Infectious and Parasitic Diseases

Endocrine, Metabolic, and Immunity

Diseases and Disorders

Diseases of the Respiratory System

Ages 1-4
autism spectrum disorder

In 2007, the parents of 1.0 percent of children reported that their child had been diagnosed with an autism spectrum disorder (ASD) 

and that they currently had the disorder. ASD 

includes a range of diagnoses, including Asperger’s Syndrome, autism, and Pervasive Developmental Disorder (PDD). Children with autism 

have delays in language, communication, and 

social skills, while children with Asperger’s disorder have impaired social skills but do not have 

speech or language delays. They often have an 

intense interest in a single subject or topic as 

well. Children with PDD have severe and persistent delays in language, communication, and 

social skills. 

Autism spectrum disorders are four times 

more common among males than females. In 

2007, 1.7 percent of male children were reported by parents to have an ASD, compared to 0.4 

percent of female children. There is also a racial/

ethnic disparity in the prevalence of ASD. The 

parents of 1.2 percent of non-Hispanic White 

children reported that their child had an ASD 

in 2007, compared to 1.0 percent of Hispanic 

children, and 0.6 percent of non-Hispanic Black 

children. 

In 2007, the parents of 0.6 percent of children reported that their child had been diagnosed with an ASD in the past but that the 

child did not currently have the condition. 

This varied by race/ethnicity, with 0.3 percent 

of Hispanic children, 0.6 percent of non-Hispanic White children, and 1.2 percent of nonHispanic Black children having a previous, but 

not current, ASD diagnosis (data not shown).

 CHILD HEALTH USA 2010 HEALTH STATUS – CHILDREN 35

Prevalence of Autism Spectrum Disorders Among 

Children Aged 2-17 Years, by Sex, 2007

Source (I.7): Health Resources and Services Administration, Maternal and Child 

Health Bureau and Centers for Disease Control and Prevention, National Center 

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

1.7

0.4

Prevalence of Autism Spectrum Disorders Among 

Children Aged 2-17 Years, by Race/Ethnicity, 2007

Source (I.7): Health Resources and Services Administration, Maternal and Child 

Health Bureau and Centers for Disease Control and Prevention, National Center 

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

0.5

1.0

1.5

2.0

Male Female

0.5

1.0

1.5

2.0

Non-Hispanic White Non-Hispanic Black Hispanic

1.2

0.6

1.0
36 HEALTH STATUS – CHILDREN CHILD HEALTH USA 2010

abuse and neglect

State child protective services (CPS) agencies 

received approximately 3.2 million referrals, involving an estimated 5.8 million children, alleging abuse or neglect in 2007. More than half of 

these reports were made by community professionals, such as teachers and other educational 

personnel, police officers, medical personnel, 

and childcare providers. 

Investigations determined that an estimated 

794,000 children were victims of abuse or neglect in 2007, equaling a victimization rate of 

10.6 per 1,000 children in the population. Neglect was the most common type of maltreatment (experienced by 59.0 percent of victims), 

followed by physical abuse (10.8 percent), and 

sexual abuse (7.6 percent). Less common types 

of documented abuse included psychological 

maltreatment, medical neglect, and categories 

of abuse defined by specific State laws and policies. Multiple types of maltreatment were suffered by 13.1 percent of victims. 

Victimization rates were highest among 

young children. In 2007, the rate of victimization among children under 1 year of age was 

22.2 per 1,000 among boys and 21.5 per 1,000 

among girls; the rate declined steadily with increasing age (data not shown). Younger children were more likely than older children to 

be victims of neglect, while older children were 

more likely to be physically or sexually abused. 

Overall, 80 percent of perpetrators of abuse or 

neglect were parents of the victim (either alone 

or in conjunction with another person). Additional categories of perpetrators included other 

relatives (4.8 percent), unmarried partners of 

parents (2.6 percent), and professionals such as 

childcare workers and residential facility staff 

(0.8 percent). Other types of perpetrators included foster parents, friends and neighbors, 

and legal guardians. 

Abuse and Neglect Among Children Under Age 18, by 

Type of Maltreatment, 2007

Source (II.7): Administration for Children and Families, National Child Abuse and

Neglect Data System

Percent of Victims

59.0

7.6

4.2

13.1

10.8

0.9

4.2

Perpetrators of Child Abuse and Neglect, by Relationship to 

Victim, 2007

Source (II.7): Administration for Children and Families, National Child Abuse and Neglect 

Data System

Other*** 2.0%

Unknown/Missing 9.8%

Professional** 0.8%

Partner of Parent* 2.6%

Other Relative 4.8%

Parent(s)

80.0%

*Defined as someone who has a relationship with the parent and lives in the household with the parent 

and maltreated child. **Includes residential facility staff, child daycare providers, and other professionals. 

***Includes foster parents, friends or neighbors, legal guardians, and multiple nonparental perpetrators.

10 20 30 40 50 60 70

Other Abuse*

Multiple

 Maltreatments

Medical Neglect

Psychological

 Maltreatment

Sexual Abuse

Physical Abuse

Neglect

*Any maltreatment type that does not fall into one of the first five categories; can include abandonment, 

threats of harm, and congenital drug addiction.
 CHILD HEALTH USA 2010 HEALTH STATUS – CHILDREN 37

CHILD MORTALITY

In 2007, 10,850 children aged 1 to 14 years 

died of various causes, which was an increase of 

70 cases over the previous year. The overall mortality rate among children aged 1 to 4 years was 

28.6 per 100,000 children in that age group, 

and the rate among children aged 5 to 14 years 

was 15.3 per 100,000 (data not shown). 

Unintentional injury continued to be the 

leading cause of death among children in both 

age groups, accounting for 34 percent of all 

deaths among 1- to 4-year-olds and 36 percent 

of deaths among 5- to 14-year-olds. Among 1- 

to 4-year-olds, drowning was the leading cause 

of unintentional injury death (accounting for 

29 percent), followed by motor vehicle traffic 

(27 percent), fires or burns (13 percent), suffocation (9 percent), and pedestrian injuries (8 

percent; data not shown). Among 5- to 14-yearolds, motor vehicle traffic was the leading cause 

of unintentional injury death (53 percent), followed by drowning (10 percent), fires or burns 

(10 percent), land transport crashes (such as 

off-road vehicles, 6 percent), and suffocation (5 

percent; data not shown). Congenital anomalies 

(birth defects), homicide, malignant neoplasms 

(cancer), and heart disease rounded out the top 

five leading causes of death for each age group, 

though in a different order for each. 

Mortality rates were higher among males 

than females in each age group. There are also 

racial/ethnic disparities in child mortality, with 

non-Hispanic Black children experiencing 

higher mortality rates than children of other 

racial/ethnic groups. Among children aged 1 

to 4 years, the rate was 43.7 per 100,000 for 

non-Hispanic Blacks, compared to rates of 26.0 

and 25.5 per 100,000 for Hispanics and nonHispanic Whites, respectively. Among children 

aged 5 to 9 years, rates were 18.6 per 100,000 

for non-Hispanic Blacks, 13.4 per 100,000 for 

Hispanics, and 12.7 for non-Hispanic Whites. 

Among children aged 10 to 14 years, rates were 

24.6, 14.9, and 15.7 per 100,000, respectively 

(data not shown).

Leading Causes of Death Among Children Aged 1–14, 2007

Source (II.8): 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

9.6

3.3

2.4

2.2

1.1

1–4 Years

5–14 Years

0.3

0.4

0.4

0.5

0.7

5.5

2.4

0.9

0.9

0.6

0.2

0.2

0.3

0.3

0.5

1 2 3 4 5 6 7 8 9 10 11

Cerebrovascular Diseases

In situ, Benign, or Other Neoplasms

Influenza & Pneumonia

Chronic Lower Respiratory Diseases

Suicide

Heart Disease

Homicide

Congenital Anomalies

Malignant Neoplasms (Cancer)

Unintentional Injury

Chronic Lower Respiratory Diseases

In situ, Benign, or Other Neoplasms

Conditions Originating in Perinatal

 Period

Septicemia

Influenza & Pneumonia

Heart Disease

Malignant Neoplasms (Cancer)

Homicide

Congenital Anomalies

Unintentional Injury
38 CHILD HEALTH USA 2010

Health Status - adolescents
 CHILD HEALTH USA 2010 HEALTH STATUS – ADOLESCENTS 39

sexual activity

In 2009, 46.0 percent of high school students reported ever having had sexual intercourse, while the remaining 54.0 percent were 

abstinent. Overall, 34.2 percent of students 

reported that they were currently sexually active (had intercourse during the three months 

preceding the survey): 20.9 percent of students 

were currently sexually active and used a condom during their last intercourse, while 13.3 

percent of students were sexually active and did 

not use a condom during their last encounter. 

Sexual activity and condom use vary by race 

and ethnicity. In 2009, non-Hispanic Black 

students were most likely to report ever having 

sexual intercourse (65.2 percent), followed by 

Hispanic students (46.0 percent). Non-Hispanic White students were most likely to report using a condom during their last sexual encounter 

(63.3 percent of those currently sexually active), 

followed by non-Hispanic Black students (62.4 

percent; data not shown). 

Sexual activity increases with grade level 

while condom use decreases. In 2009, 49.1 

percent of 12th grade students reported being 

currently sexually active: 27.0 percent of students were sexually active and used a condom 

during their last intercourse, while 22.1 percent 

were sexually active and did not use a condom. 

In contrast, 13.7 percent of 9th grade students 

were currently sexually active and used a condom during last intercourse, while 7.7 percent 

of students were sexually active and did not use 

a condom during their last encounter.

According to the School Health Policies and 

Programs Study, 58.8 percent of states required 

middle schools and 58.0 percent of states required high school to teach about pregnancy 

prevention in 2006. Of all schools, 75.8 percent of middle schools and 86.6 percent of high 

schools taught abstinence as the most effective 

method to avoid pregnancy, HIV, and other 

STDS, while 42.0 percent of middle schools 

and 65.4 percent of high schools taught about 

the efficacy of condoms. Only 21.0 percent of 

middle schools and 38.5 percent of high schools 

taught students about the correct use of a condom (data not shown).

Sexually Active, No Intercourse

 in Past 3 Months

 11.8%

Intercourse in Past 3 Months,

 No Condom at Last Intercourse

 13.3%

Intercourse in Past 3 Months,

 Used Condom at Last Intercourse

 20.9%

Abstinent* 

54.0%

Sexual Activity Among High School Students, 2009

Source (II.9): Centers for Disease Control and Prevention, Youth Risk Behavior 

Surveillance System

*Have never had sexual intercourse. *Had sexual intercourse during the three months preceding the survey.

Condom Use Among Currently Sexually Active* High School 

Students, by Grade, 2009

Source (II.9): Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance System Percent of Students

10

20

30

40

50

60

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

Currently Sexually Active, Total

Condom Use at Last Intercourse

No Condom Use at Last Intercourse

13.7

7.7

19.7

9.4

24.7

15.6

27.0

22.1

21.4

29.1

40.3

49.1
40 HEALTH STATUS – ADOLESCENTS CHILD HEALTH USA 2010

adolescent childbearing

According to preliminary data, the birth rate 

among adolescent females aged 15–19 years 

decreased to 41.5 per 1,000 females in this age 

group in 2008. This continues the general decline in teen birth rates since the most recent 

peak in 1991, when the rate was 61.8 per 1,000 

females, and represents a decline of nearly 33 

percent over that period. The birth rate among 

adolescents aged 10–14 years was 0.6 births per 

1,000 females in this age group, representing 

a decrease of 57 percent since 1991. Teenage 

birth rates were highest among adolescents aged 

18-19 years (70.7 per 1,000), and this age group 

experienced the smallest decline since 1991 (25 

percent; data not shown).

Teenage birth rates have historically varied 

considerably by race/ethnicity. Among adolescents aged 15–19 years, Asian/Pacific Islander 

females had the lowest birth rate in 2008 (16.2 

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

females (26.7 per 1,000). Birth rates for these 

groups have decreased 41 percent and 38 percent, respectively, since 1991. Hispanic females 

had the highest birth rate in this age group (77.4 

per 1,000) in 2008, and the smallest decline 

since 1991 (26 percent). Non-Hispanic Black 

females had the second highest birth rate among 

those aged 15–19 years (62.9 per 1,000), but 

the greatest decline since 1991 (47 percent). 

Among adolescents aged 10–14 years, nonHispanic Black females had the highest birth 

rate in 2008 (1.4 per 1,000), followed by Hispanic females (1.2 per 1,000). Non-Hispanic 

White and Asian/Pacific Islander females had 

the lowest birth rates among those aged 10–14 

years (both 0.2 per 1,000). 

Birth Rates Among Adolescent Females Aged 10-19, by 

Age and Race/Ethnicity, 2008*

Source (I.8): Centers for Disease Control and Prevention, National Center for Health

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

10–14 Years

15–17 Years

18–19 Years

21.7

70.7

0.6

11.6

48.6

0.2

34.9

104.7

1.2

46.1

127.0 

1.4

8.0

28.4

0.2

32.5

96.7

0.9

Birth Rates Among Adolescent Females Aged 15–19, by 

Race/Ethnicity, 1990−2008*

Source (I.8): Centers for Disease Control and Prevention, National Center for Health

Statistics, National Vital Statistics System

26.7

62.9

Non-Hispanic Black 77.4

Non-Hispanic White

Hispanic

Live Births per 1,000 Females

16.2

58.4

American Indian/

Alaska Native

Asian/Pacific Islander

20

40

60

80

100

120

140

American Indian/

Alaska Native

Asian/Pacific

 Islander 

Non-Hispanic Hispanic

 Black

Non-Hispanic

 White

Total

20

40

60

80

100

120

140

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

*Preliminary data *Preliminary data
 CHILD HEALTH USA 2010 HEALTH STATUS – ADOLESCENTS 41

Sexually transmitted

infections

In general, adolescents (aged 15–19 years) 

and young adults (aged 20–24 years) are at 

much higher risk than older adults of contracting sexually transmitted infections (STIs), such 

as chlamydia, gonorrhea, and genital human 

papillomavirus (HPV). 

Chlamydia continues to be the most common reportable STI among adolescents and 

young adults. Based on the number of cases 

reported to the Centers for Disease Control 

and Prevention (CDC), there were 1,956 chlamydial infections per 100,000 adolescents and 

2,084 infections per 100,000 young adults in 

2008. Rates were highest among non-Hispanic 

Blacks, followed by American Indian/Alaska 

Natives. Rates of gonorrhea were 453 and 518 

per 100,000 adolescents and young adults, respectively, and were also highest among nonHispanic Black and American Indian/Alaska 

Natives. 

HPV is the most common STI in the United 

States. Unlike chlamydia and gonorrhea, cases 

of HPV are not required to be reported to the 

CDC. However, a recent study indicated that 

approximately one-quarter of females aged 

14–19 years and nearly 45 percent of those aged 

20–24 years are infected with HPV.1

 There are 

many types of HPV, some of which can cause 

cancer. Although cervical cancer in women 

is the most serious health problem caused by 

HPV, routine Pap tests and follow-up care have 

greatly reduced the incidence of and mortality 

rate from cervical cancer. A vaccine for certain 

types of HPV was first approved in 2006 by the 

Food and Drug Administration (FDA) for use 

in females aged 9–26 years.2

 In 2008, 37.2 percent of females aged 13–17 years had received at 

least one dose of the three-dose series.3

1 Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan 

DC, Patel SS, Markowitz LE. Prevalence of HPV infection among females in the United States. JAMA. 2007 

Feb;297(8):876-8.

2 Centers for Disease Control and Prevention, Division 

of STD Prevention. HPV and HPV vaccines: information for healthcare providers. June 2006. Available from: 

http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine-hcp.

htm, accessed 12/09.

3 Centers for Disease Control and Prevention. National, 

state, and local area vaccination coverage among adolescents aged 13–17 years—United States, 2008. MMWR 

2009;58:997-8.

Non-Hispanic White

Total

Non-Hispanic

Black

Hispanic

American Indian/

Alaska Native

Reported Sexually Transmitted Infections Among Adolescents and Young Adults, by Age and Race/Ethnicity, 2008

Source (II.10): Centers for Disease Control and Prevention, STD Surveillance System Rate per 100,000

Rate per 100,000 

Chlamydia Gonorrhea

518

149 261 407

2,556

453 107 204 294

2,202 1,956

849

2,809

1,874

6,651

1,052

3,164

2,084 2,239

6,568

1,000

2,000

3,000

4,000

5,000

6,000

7,000

15-19 Years 20-24 Years

1,000

2,000

3,000

4,000

5,000

6,000

7,000

15-19 Years 20-24 Years

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

American Indian/

Alaska Native
42 HEALTH STATUS – ADOLESCENTS CHILD HEALTH USA 2010

adolescent and young

adult hiv and aids

Human immunodeficiency virus (HIV) is a 

disease that destroys cells that are critical to a 

healthy immune system. Acquired immunodeficiency syndrome (AIDS) is diagnosed when 

HIV has weakened the immune system enough 

that the body has difficulty fighting disease and 

infections. In 2007, an estimated 6,524 people 

aged 13–24 years were diagnosed with HIV,1

representing 16 percent of all cases. While the 

number of HIV diagnoses among children aged 

13–14 years fluctuates from year to year, the 

number of diagnoses in the older age groups 

has increased steadily over the past several 

years. Between 2005 and 2007, estimated cases 

among adolescents aged 15–19 years increased 

by 35 percent and cases among young adults 

aged 20–24 years increased 18 percent.

In 2007, an estimated 226 adolescents and 

young adults died with an AIDS diagnosis, 

representing 1.3 percent of all deaths among 

persons with AIDS. Since the beginning of the 

epidemic, an estimated 10,450 persons aged 

13–24 years have died with the disease. Deaths 

of persons with AIDS have generally decreased 

in recent years, due in part to the availability 

of effective prescription drugs to combat the 

disease.

Given the increase in diagnoses of HIV and 

the decrease in deaths, the number of people 

living with HIV has increased. In 2007, an estimated 24,358 people aged 13–24 years were 

living with HIV, representing 4.2 percent of all 

cases. Overall, the number of adolescents and 

young adults living with HIV has increased 15 

percent since 2005. 

1 Includes persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis; therefore, this includes 

persons who are first diagnosed with HIV at the same time 

they are diagnosed with AIDS. 

Selected Data on HIV and AIDS among Adolescents and Young Adults,

by Age, 2007

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

1,712

Number of Persons

13–14 Years

15–19 Years

34

20–24 Years

1,000 2,000 3,000 4,000 5,000 6,000 16,000 17,000 18,000

Died with AIDS

 Diagnosis

Living with AIDS

Living with HIV

Diagnosed

 with HIV

4,778

1,248

5,624

17,486

664

2,653

5,900

11

40

175
 CHILD HEALTH USA 2010 HEALTH STATUS – ADOLESCENTS 43

Overweight and OBESITY

Body mass index (BMI) is the ratio of weight 

to height, which is used to define overweight 

and obesity. In children, BMI is used in conjunction with age and sex, since both of these 

factors affect body composition. Children who 

fall between the 85th and 94th percentile of 

BMI-for-age are considered overweight, while 

children who are in the 95th percentile or above 

are considered obese. In 2007, 15.3 percent 

of children aged 10–17 years were overweight 

and 16.4 percent were obese, based on parentreported height and weight. Obesity is a serious 

health concern for children—obese children 

are more likely to have risk factors for cardiovascular disease, such as high blood pressure, 

high cholesterol, and Type 2 diabetes. Obese 

children are also at increased risk of obesity in 

adulthood, which is associated with a host of 

serious health consequences.1

Overweight and obesity among children varies by a number of factors. Non-Hispanic White 

children experience obesity at almost half the 

rate of non-Hispanic Black and Hispanic children. In 2007, 12.9 percent of non-Hispanic 

White children aged 10–17 years were obese, 

compared to 23.4 percent of Hispanic children 

and 23.8 percent of non-Hispanic Black children. Rates of overweight were more comparable among the three groups, between 14 and 

18 percent. 

Low family income is also strongly associated 

with overweight and obesity. In 2007, 27.2 percent of children living with household incomes 

below 100 percent of the Federal poverty level 

($20,650 for a family of four in 2007) were 

obese, compared to only 9.8 percent of children 

living in households with incomes of 400 percent or more of the Federal poverty level. The 

pattern was similar, though not as dramatic, for 

overweight: 17.6 percent of children living in 

households with incomes below 100 percent 

of poverty were overweight, compared to 12.3 

percent of children living in households with 

incomes of 400 percent of poverty or above. 

1 Centers for Disease Control and Prevention. Childhood 

overweight and obesity. Available online: http://www.cdc.

gov/obesity/childhood/index.html; accessed February 2010. 

Overweight and Obesity* Among Children Aged 10−17 

Years, by Race/Ethnicity, 2007

Source (I.7): Health Resources and Services Administration, Maternal and Child Health 

Bureau and Centers for Disease Control and Prevention, National Center for Health 

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

15.3 16.4

14.0 12.9

23.8

17.3 17.5

23.4

Overweight and Obesity* Among Children Aged 10−17 

Years, by Poverty Level,** 2007

Source (I.7): Health Resources and Services Administration, Maternal and Child Health 

Bureau and Centers for Disease Control and Prevention, National Center for Health 

Statistics, National Survey of Children’s Health

5

10

15

20

25

30

Total Non-Hispanic White Non-Hispanic Black Hispanic 

*Overweight is a BMI-for-age between the 85th and 94th percentile, and obesity is a BMI-for-age in 

the 95th percentile or above; based on parent-reported height and weight. **The U.S. Department 

of Health and Human Services establishes poverty guidelines for determining financial eligibility for 

Federal programs; the poverty level for a family of four was $20,650 in 2007.

*Overweight is a BMI-for-age between the 85th and 94th percentile, and obesity is a BMI-for-age in 

the 95th percentile or above; based on parent-reported height and weight.

Obese

Overweight

Percent of Children

17.6

27.2

17.0

20.9

14.9 15.9

12.3

9.8

5

10

15

20

25

30

400% or More 

of Poverty

200-399%

of Poverty

100-199%

of Poverty

<100%

of Poverty 

Obese

Overweight
44 HEALTH STATUS – ADOLESCENTS CHILD HEALTH USA 2010

physical activity

Results from the Youth Risk Behavior Surveillance System show that 18.4 percent of high 

school students met currently recommended 

levels of physical activity in 2009. The U.S. 

Department of Health and Human Services 

updated its physical activity guidelines in 2008, 

recommending that children and adolescents 

get one hour or more of physical activity every 

day, most of which should be moderate- to vigorous-intensity aerobic activity. Non-Hispanic 

White students were the most likely to report 

60 minutes of physical activity that increased 

heart rate and made them breathe hard on each 

of the previous 7 days (19.7 percent), followed 

by non-Hispanic Black students (17.2 percent); 

Hispanic students were least likely to meet 

recommended levels (15.6 percent). Students 

were more likely to report being active on five 

or more days in the past week (39.9 percent). 

Overall, 23.1 percent of students did not participate in 60 or more minutes of physical activity on any day in the preceding week. 

Nationwide, 56.4 percent of high school students attended physical education (PE) classes at 

least one day per week in 2009. The rate drops 

dramatically with increasing grade: 72.4 percent 

of 9th grade students attended PE class, compared to 43.8 percent of 12th grade students. 

The percentage of students attending daily PE 

classes has dropped from 42.0 percent in 1991 

to 33.3 percent in 2009. Hispanic students were 

most likely to attend daily PE classes (40.5 percent), followed by non-Hispanic Black students 

(37.0 percent); non-Hispanic White students 

were least likely to attend daily PE classes (30.6 

percent; data not shown). 

In 2009, 58.3 percent of high school students reported playing on at least one sports 

team in the past year. This was also more common among younger children than older children (61.6 percent of 9th graders compared to 

51.1 percent of 12th graders). High school students were also asked about sedentary activities, 

such as using a computer or watching television. 

One-quarter of students reported using a computer for something other than school work for 

3 or more hours per day on an average school 

day, while 32.8 percent reported watching television for 3 or more hours on an average school 

day (data not shown).

The Let’s Move! campaign is working to combat childhood obesity through a comprehensive 

approach that provides schools, families and 

communities with simple tools to help kids be 

more active, eat better, and get healthy (http://

www.letsmove.gov).

Physical Activity Among High School Students, by Race/Ethnicity, 2009

Source: (II.9): Centers for Disease Control and Prevention, Youth Risk Behavior Survey

10

20

30

40

50

60

70

80

90

100

Percent of Students *Any kind of physical activity that increases heart rate and makes the child breathe hard some of the time for a total of at least 60 minutes 

on each of the preceding 7 days.

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

18.4 15.6 17.2 19.7

Met Recommended Levels of 

Physical Activity*

Did not Participate in 60+ Minutes of 

Physical Activity on Any Day in Past Week

23.1 23.9

32.1

20.3
 CHILD HEALTH USA 2010 HEALTH STATUS – ADOLESCENTS 45
46 HEALTH STATUS – ADOLESCENTS CHILD HEALTH USA 2010

mental health

In 2008, 8.3 percent of adolescents aged 

12–17 years experienced at least one major depressive episode (MDE), which is defined as 

having at least 2 weeks of a depressed mood 

or loss of interest or pleasure in daily activities, 

plus a majority of specific depression symptoms, 

such as altered sleeping patterns, fatigue, and 

feelings of worthlessness. Females were more 

likely than males to experience MDE (12.4 

percent versus 4.3 percent). For both sexes, occurrence of MDE generally increased with age, 

with the rate for males peaking at 17 years of age 

(6.3 percent), and the rate for females peaking 

at 16 years of age (17.6 percent). Adolescents of 

two or more races were most likely to experience 

MDE (12.0 percent), followed by American 

Indian/Alaska Natives (10.1 percent). Among 

adolescents with MDE in the past year, 37.7 

percent received treatment (data not shown).

In 2008, 12.7 percent of adolescents aged 

12–17 years received treatment or counseling 

for an emotional or behavioral problem (not including drug or alcohol use). Among those who 

received treatment, depression was the most 

commonly reported problem (48.6 percent). 

Adolescents also commonly reported receiving treatment for problems with home or family (28.9 percent), breaking rules or acting out 

(25.7 percent), and feeling very afraid or tense 

(20.4 percent). 

*Data are for most recent visit, and respondents could list more than one reason for treatment. 

Does not include treatment for problems caused by drug or alcohol use.

*MDE is defined as at least 2 weeks of depressed mood or loss of interest in daily activities, plus a 

majority of specified depression symptoms.

Percent of Children Receiving Treatment

14.0

16.3

Experience of at Least One Major Depressive Episode 

(MDE)* in the Past Year Among Adolescents Aged 12−17 

Years, by Age and Gender, 2008

Source (II.11): Substance Abuse and Mental Health Service Administration, National 

Survey of Drug Use and Health Percent of Children

14.9

2.8

4.3 5.0

3.8 3.9

5.6

11.9

17.6

3.2

8.5

6.3

15.1

Female

Male

Commonly Reported Reasons for Receiving Mental Health 

Treatment* Among Adolescents Aged 12−17 Years Who 

Received Treatment, 2008

Source (II.11): Substance Abuse and Mental Health Service Administration, National 

Survey of Drug Use and Health 

10 20 30 40 50

Problems with

 Friends

Trouble Controlling Anger

Problems at School

Felt Very Afraid or Tense

Contemplated/

Attempted Suicide

Breaking Rules/

Acting Out

Problems at Home/

Family

Felt Depressed

18.9

19.6

20.4

25.7

28.9

48.6

5

10

15

20

Total Age 12 Age 13 Age 14 Age 15 Age 16 Age 17

12.4
 CHILD HEALTH USA 2010 HEALTH STATUS – ADOLESCENTS 47

cigarette smoking

Cigarette smoking among adolescents declined between 2007 and 2008, according to 

the annual Monitoring the Future study. The 

largest decrease occurred among students in 

10th grade, with the percentage of students 

who had smoked any cigarettes in the past 30 

days falling from 14.0 in 2007 to 12.3 percent 

in 2008. Cigarette smoking in the past 30 days 

also decreased among 12th grade students, falling from 21.6 to 20.4 percent, and among 8th 

grade students, falling from 7.1 to 6.8 percent. 

The percent of teens reporting smoking in 

the past month began a rapid increase in the 

early 1990s, with the rates among 8th and 10th 

grade students reaching a peak in 1996 (at 21.0 

and 30.4 percent, respectively), and the rate 

among 12th grade students peaking a year later 

at 36.5 percent. These increases occurred in virtually every sociodemographic group: male and 

female, those with and without plans for college attendance, those living in all four regions 

of the country, and those of different racial and 

ethnic groups. Since peaking in the mid-1990s, 

overall rates of smoking in the past month have 

dropped 68 percent among 8th grade students, 

60 percent among 10th grade students, and 44 

percent among 12th grade students. 

Despite this decline, certain subgroups of 

adolescents are still more likely than others to 

smoke. With regard to race and ethnicity, nonHispanic White students are most likely to report smoking in the past month, followed by 

Hispanic students. Also, males are more likely 

than females to smoke, and adolescents without 

plans to attend a four-year college program are 

more likely to smoke than their college-bound 

peers (data not shown).

Any Cigarette Use Among Students in the Past 30 Days, 

by Grade, 1991–2008

Source (II.12): National Institutes of Health, National Institute on Drug Abuse, 

Monitoring the Future Study

6.8 7.2

4.6

7.0

15.1

6.5

11.1

24.7

11.1

15.0

12.3

Percent of Students

20.4

12th Grade

8th Grade

10th Grade

5

10

15

20

25

30

35

40

1991 1993 1995 1997 1999 2001 2003 2005 20072008

5

10

15

20

25

30

35

40

Any Cigarette Use Among Students in the Past 30 Days, 

by Grade and Race/Ethnicity, 2008

Source (II.12): National Institutes of Health, National Institute on Drug Abuse, 

Monitoring the Future Study

8th Grade 10th Grade 12th Grade

Non-Hispanic White

Non-Hispanic Black

Hispanic

Percent of Students
48 HEALTH STATUS – ADOLESCENTS CHILD HEALTH USA 2010

substance abuse

In 2008, 9.3 percent of adolescents aged 

12–17 years reported using illicit drugs in the 

past month. Illicit drug use varied by age, with 

3.3 percent of youth aged 12–13 years reporting drug use in the past month, compared to 

8.6 percent of youth aged 14–15 years and 

15.2 percent of youth aged 16–17 years. There 

was also variation by race/ethnicity, with rates 

ranging from 2.7 percent among Asian youth 

to 18.2 percent among American Indian/Alaska 

Native youth. Rates for non-Hispanic White, 

non-Hispanic Black, and Hispanic youth were 

9.8 percent, 8.2 percent, and 8.9 percent, respectively (data not shown).

Marijuana is consistently the most commonly used illicit drug among adolescents, 

with 6.7 percent reporting past-month use in 

2008. This was followed by nonmedical use of 

prescription-type psychotherapeutics, such as 

pain relievers, tranquilizers, and stimulants (2.9 

percent). Adolescent males were slightly more 

likely than females to report using illicit drugs 

in the past month (9.5 versus 9.1 percent; data 

not shown). 

Illicit drug use is associated with other health 

risk behaviors. In 2008, 49.0 percent of adolescents who reported cigarette use in the past 

month also reported illicit drug use, compared 

to only 5.3 percent of adolescents who did not 

report smoking. Adolescents who reported alcohol use in the past month were also more likely 

to use illicit drugs than adolescents who did not 

report alcohol use, with rates rising with the 

amount of alcohol used (data not shown). 

Alcohol continues to be the most commonly 

used drug among adolescents, with 14.6 percent reporting past-month use in 2008. There 

was little difference in alcohol use among males 

and females (14.2 versus 15.0 percent, respectively). Greater variation was evident by race/

ethnicity, with rates ranging from 5.7 percent 

among Asian youth to 17.2 percent among 

American Indian/Alaska Native youth; the rate 

for non-Hispanic White youth was 16.3 percent 

(data not shown). 

In 2008, 33.9 percent of adolescents perceived smoking marijuana once a month to be 

a great risk, while 49.7 percent perceived the 

same risk regarding cocaine use. Smoking one 

or more packs of cigarettes a day was considered a great risk by 69.7 percent of adolescents. 

Drinking five or more drinks once or twice per 

week was considered a great risk by 40.5 percent 

of adolescents (data not shown). 

While 13.7 percent of adolescents were approached by someone selling drugs in the past 

month, nearly 50 percent reported that marijuana would be fairly or very easy to obtain; 

23.2 percent reported the same for crack, 22.1 

percent for cocaine, 13.8 percent for LSD, and 

13.0 percent for heroin (data not shown). 

Past Month Drug Use Among Adolescents Aged 12–17 Years, by Drug Type, 2008

Source (II.11): Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health

*Psychotherapeutics include prescription-type pain relievers, tranquilizers, stimulants (including methamphetamine), and sedatives, but do not 

include over-the-counter drugs. **Hallucinogens include LSD, PCP, and Ecstasy. Percent of Youth

9.3

14.6

6.7

1.1

2.9

1.0

4

8

12

16

Nonmedical Use of Inhalants Hallucinogens**

Psychotherapeutics*

Alcohol Any Illicit Drug Marijuana
 CHILD HEALTH USA 2010 HEALTH STATUS – ADOLESCENTS 49

violence

Violence among adolescents is a critical public health issue in the United States. In 2007 

(the latest year for which data are available), 

homicide was the second leading cause of death 

among persons aged 15–24 years. 

Results from the Youth Risk Behavior Surveillance System show that, in 2009, 17.5 percent of high school students had carried a weapon (such as a gun, knife, or club) at some point 

during the preceding 30 days. Males were nearly 

four times as likely as females to carry a weapon 

(27.1 versus 7.1 percent). Among male students, non-Hispanic Whites were the most likely to carry a weapon (29.3 percent), followed by 

Hispanics (26.5 percent), while non-Hispanic 

Blacks were least likely to carry a weapon (21.0 

percent). Among females, non-Hispanic Whites 

were least likely to carry a weapon (6.5 percent) 

while Hispanics were most likely (7.9 percent).

Nearly 6 percent of students reported carrying 

a gun in the preceding 7 days, and males were 

nearly six times more likely than females to do 

so (data not shown). 

In 2009, 11.1 percent of high school students reported being in a physical fight on 

school property during the preceding 12 

months. Males were more than twice as likely 

as females to be in a fight; this sex disparity 

was most pronounced among non-Hispanic 

Whites, where males were almost three times as 

likely as females to be in a fight. Overall, nonHispanic Black students were most likely to 

be in a physical fight on school property (17.4 

percent), followed by Hispanic students (13.5 

percent); Asian students were least likely to be 

in a fight (7.7 percent). 

High School Students Who Carried a Weapon in the Past

30 Days, by Sex and Race/Ethnicity, 1993–2009

Source (II.9): Centers for Disease Control and Prevention, Youth Risk Behavior 

Surveillance System Percent of Students

Percent of Students

5

10

15

20

25

30

35

40

1993 1995 1997 1999 2001 2003 2005 2007 2009

11.1

15.1

6.7

8.6

12.4

4.3

17.4

22.2

12.5 13.5

17.7

9.3

21.0

26.5

29.3

7.9

6.5

7.8

Hispanic Male

Hispanic Female

Non-Hispanic White Male

Non-Hispanic White Female

Non-Hispanic Black Female

Non-Hispanic Black Male

High School Students in a Physical Fight on School Property 

in the Past 12 Months, by Sex and Race/Ethnicity,* 2009

Source (II.9): Centers for Disease Control and Prevention, Youth Risk Behavior

Surveillance System

5

10

15

20

25

30

35

40

Non-Hispanic Hispanic Asian

 Black

Non-Hispanic

 White

All Races

*Data for American Indian/Alaska Natives and Native Hawaiian/Other Pacific Islanders do not meet 

standards for reliability or precision.

Total

Male

Female

11.4

7.7

4.1
50 HEALTH STATUS – ADOLESCENTS CHILD HEALTH USA 2010

Children Aged 6-17 Years Who Bullied or Were Cruel 

to Others During the Past Month, by Frequency and 

Race/Ethnicity, 2007

Source (I.7): Health Resources and Services Administration, Maternal and Child 

Health Bureau and Centers for Disease Control and Prevention, National Center 

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

12.9

2.3

High School Students Who Felt Unsafe at School,* 

by Race/Ethnicity, 2009

Source (II.9): Centers for Disease Control and Prevention, Youth Risk 

Behavior Survey Percent of Children

5

10

15

20

Non-Hispanic Hispanic 

Black

Non-Hispanic 

White

Total

5

10

15

20

Non-Hispanic Hispanic

Black

Non-Hispanic 

White

Total

5.0 3.5

6.3

8.1

*Did not go to school on at least 1 day during the preceding 30 days because he/she felt unsafe 

at school or on the way to or from school. 

10.8

1.5

18.1

4.6

15.7

2.9

Sometimes

Usually/

Always

bullying

Bullying is defined as aggressive behavior that 

is intentional, repeated over time, and involves 

an imbalance of power or strength. Bullying 

may damage children’s self-esteem, cause higher 

rates of loneliness and depression, and affect academic success. Bullying can also have physical 

effects, such as an increase in headaches, sleeping problems, and stomach ailments. Children 

who engage in bullying may be more likely to 

get into physical altercations, use drugs and alcohol, and get into trouble with the law. Even 

children who witness bullying can be negatively 

affected.1

 In 2007, the parents of 12.9 percent 

of children aged 6–17 years reported that their 

child “sometimes” bullied or was cruel to others 

in the past month, while the parents of 2.3 percent of children reported that their child “usually or always” bullied or was cruel to others. 

The likelihood of a child engaging in bullying or cruelty to others varied by a number of 

factors. Non-Hispanic Black children were most 

likely to bully others sometimes (18.1 percent) 

and usually or always (4.6 percent) in the past 

month. Non-Hispanic White children were 

the least likely to sometimes (10.8 percent) and 

usually or always (1.5 percent) bully others, as 

reported by their parents. Bullying also varied 

by poverty level, with parent-reported bullying 

decreasing with increased income. It also varied 

by family structure, with children living with 

both of their parents being least likely to engage 

in bullying (data not shown). 

Violence, such as bullying, can prevent children from attending school, for fear of their 

safety. In 2009, 5.0 percent of high school students reported that they did not go to school on 

at least on day during the past month because 

they felt unsafe at school or on their way to or 

from school. Hispanic students were more than 

twice as likely to miss school because of safety 

concerns as non-Hispanic White children (8.1 

percent versus 3.5 percent). 

1 Health Resources and Services Administration, Maternal and Child Health Bureau. Stop bullying now—all 

about bullying. Available online: http://www.stopbullyingnow.hrsa.gov/adults/why-should-adults-care.aspx;

accessed February 2010.
 CHILD HEALTH USA 2010 HEALTH STATUS – ADOLESCENTS 51

adolescent mortality

In 2007, 13,299 adolescents aged 15 to 19 

years died of various causes, representing a rate 

of 61.9 per 100,000. Unintentional injury remains the leading cause of death among this age 

group, accounting for nearly half of all deaths 

among adolescents. The mortality rate for unintentional injury was 30.3 per 100,000. Homicide was the second leading cause of death, 

with a rate of 10.4 per 100,000, followed by 

suicide, with a rate of 6.9 per 100,000. The 

mortality rate of males in this age group was 

notably higher than that of females (86.9 versus 35.7 per 100,000, respectively). Racial and 

ethnic disparities also exist, with non-Hispanic 

Leading Causes of Death Among Adolescents Aged 15−19, 

2007

Source (II.8): Centers for Disease Control and Prevention, National Center for Health 

Statistics, National Vital Statistics System

Death Rate per 100,000 Population

30.3

10.4

6.9

3.2

1.6

5 10 15 20 25 30 35

Heart

Disease

Malignant

 Neoplasms

 (cancer)

Suicide

Homicide

Unintentional

 Injury

Deaths Due to Injury* Among Adolescents Aged 15−19, 

2007

Source (II.8): Centers for Disease Control and Prevention, National Center for Health 

Statistics, National Vital Statistics System

Death Rate per 100,000 Population

21.4

12.5

4.9

0.7

1.6

5 10 15 20 25 30 35

Land

Transport,

 Other**

Drowning

Poisoning

Firearms

Motor

Vehicle

Traffic

*Includes intentional injury, such as homicide and suicide, and injury deaths of undetermined intent.

**Includes off-road vehicles crashes and incidents where the motor vehicle was not classified.

Black adolescents experiencing a mortality rate 

of 85.7 per 100,000, compared to rates of 58.0 

and 57.9 per 100,000 among non-Hispanic 

Whites and Hispanics, respectively (data not 

shown).

Motor vehicle traffic was the leading cause of 

unintentional injury death among adolescents 

in 2007. Nearly half of deaths due to motor 

vehicle accidents occurred among vehicle occupants, while in 40 percent of the deaths the 

situation was not specified; a small percentage 

of motor vehicle deaths occurred among motorcyclists, pedestrians, and bicyclists. The second leading cause of unintentional injury death 

among adolescents was poisoning, followed by 

drowning, other land transport (such as allterrain vehicle crashes), and fires/burns. However, when intentional injuries such as homicide 

and suicide are included, firearms becomes the 

second leading cause of injury death. Nearly 

three-quarters (71 percent) of firearm deaths 

were homicides, while 23 percent were suicides 

(the remainder were unintentional, unknown, 

or due to legal intervention). Firearms accounted for 85 percent of homicide deaths and 43 

percent of suicide deaths (suffocation, such as 

hanging, was the second leading cause of suicide 

death, accounting for another 42 percent; data 

not shown).

h

ealthservices financing

and utilization

The availability of and access to quality health 

care directly affects the health of the population. 

This is especially true of those at high risk due 

to low socioeconomic status or chronic medical 

conditions. 

Children may receive health coverage 

through a number of sources, including private 

insurance, either employer-based or purchased 

directly, and public programs, such as Medic-

aid or the Children’s Health Insurance Program 

(CHIP). Eligibility for public programs is based 

on a family’s income compared to the Federal 

poverty level. Nearly every state has CHIP pro-

grams that help to expand coverage to children 

who would otherwise be uninsured. Despite the 

progress achieved through public programs, ap-

proximately 7.4 million children remain unin-

sured in the United States.

This section presents data on the health in-

surance status and utilization of health services 

within the maternal and child population. Data 

are summarized by source of payment, type of 

care, and place of service delivery. 

 CHILD HEALTH USA 2010 HEALTH SERVICES FINANCING AND UTILIZATION 53
54 HEALTH SERVICES FINANCING AND UTILIZATION CHILD HEALTH USA 2010

health care financing

In 2008, approximately 7.4 million U.S. 

children under 18 years of age had no health 

insurance coverage, representing 9.9 percent of 

the population. This was a decrease from the 

previous year, when the rate was 11.0 percent. 

One-third of children were insured through 

public programs such as Medicaid and the 

Children’s Health Insurance Program, and 63.5 

percent were covered by private insurance. The 

percentage of children covered by public insurance increased over the previous year, while the 

percentage of children with private insurance 

decreased. 

Children’s insurance status varies by race 

and ethnicity. In 2008, 76.5 percent of nonHispanic White children had private coverage, 

while the same was true of only 47.2 percent of 

non-Hispanic Black children and 40.6 percent 

of Hispanic children. Non-Hispanic Black children were the most likely to have public coverage (50.7 percent), and Hispanic children were 

the most likely to be uninsured (17.2 percent). 

As family income increases, private health 

insurance coverage among children rises and 

the proportions of children with public coverage and no coverage decrease. In 2008, children 

living in households with incomes below 100 

percent of the U.S. Census Bureau’s poverty 

threshold ($22,025 for a family of four in 2008) 

were most likely to have public coverage (71.5 

percent) and to be uninsured (15.7 percent). 

Children with family incomes of 300 percent or 

more of the poverty threshold were most likely 

to have private coverage (90.5 percent), and 

least likely to have public coverage (10.8 percent) or to be uninsured (4.3 percent).

In 1997, the Children’s Health Insurance 

Program was created in response to the growing 

number of uninsured children in low-income 

working families. Although designed to cover 

children with family incomes below 200 percent of the poverty level, many States have expanded eligibility to children with higher family 

incomes. 

Health Insurance Coverage Among Children Under Age 

18, by Race/Ethnicity and Type of Coverage,* 2008

Source (III.1): U.S. Census Bureau, Current Population Survey Percent of Children

Percent of Children

20

40

60

80

100

33.2

63.5

10.6

23.1

76.5

6.7

50.7 47.2

9.9

47.9

40.6

17.2

Health Insurance Coverage Among Children Under Age 

18, by Poverty Status* and Type of Coverage,** 2008

Source (III.1): U.S. Census Bureau, Current Population Survey

20

40

60

80

100

Private Coverage Public Coverage No Coverage

43.6

18.5

73.8

90.5

50.1

71.5

23.6

10.8 15.7 14.8 10.1

4.3

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

Private Coverage Public Coverage No Coverage

<100% of Poverty

100–199% of Poverty

200–299% of Poverty

300% of Poverty or Above

*Totals equal more than 100 percent because children may have more than one type of coverage.

*The U.S. Census Bureau uses a set of money income thresholds to determine who is in poverty; the 

poverty threshold for a family of four was $22,025 in 2008. **Totals equal more than 100 percent

because children may have more than one type of coverage.
 CHILD HEALTH USA 2010 HEALTH SERVICES FINANCING AND UTILIZATION 55

adequacy of insurance

While most children have some type of 

health insurance, it may not always be adequate 

to meet their needs. The 2007 National Survey 

of Children’s Health asked parents of insured 

children three questions regarding the services 

and costs associated with their child’s health insurance. Insurance was considered adequate if 

parents answered that it “usually” or “always” 

met the following criteria: 1) out-of-pocket 

costs are reasonable; 2) the benefits that are included and the services that are covered meet 

the child’s needs; and 3) the family’s preferred 

providers are covered. Overall, 23.5 percent 

of insured children had insurance that did not 

meet at least one of these three criteria, and 

therefore were determined to have insurance 

that was not adequate. 

The frequency with which parents reported 

problems with insurance adequacy differed for 

the three criteria. Problems with out-of-pocket 

costs were most commonly cited, with the parents of 18.3 percent of children reporting that 

out-of-pocket costs were not usually or always 

reasonable. The parents of 7.2 percent of children reported that insurance does not usually or 

always include benefits and services that meet 

the child’s needs, and the parents of 5.1 percent 

of children reported that insurance did not usually or always allow the child to see necessary 

providers. Older children were more likely than 

younger children to lack adequate coverage, 

with 26.3 percent of children aged 12–17 years 

and 25.1 percent of children aged 6–11 years 

lacking adequate coverage, compared to 19.2 

percent of children aged 0–5 years.

Children Lacking Adequate Health Insurance,* by 

Individual Adequacy Criteria, 2007

Source (I.7): Health Resources and Services Administration, Maternal and Child Health 

Bureau and Centers for Disease Control and Prevention, National Center for Health 

Statistics, National Survey of Children’s Health

Children Lacking Adequate Insurance Coverage,* 

by Age, 2007

Source (I.7): Health Resources and Services Administration, Maternal and Child Health 

Bureau and Centers for Disease Control and Prevention, National Center for Health 

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

19.2

25.1 26.3

5

10

15

20

25

30

0-5 Years 6-11 Years 12-17 Years

*Insurance was considered adequate if parents reported that it “usually” or “always” met each 

of the three criteria. **Among those who reported having out-of-pocket expenses.

23.5

18.3

7.2

5.1

*Insurance was considered adequate if parents reported that it “usually” or “always” had reasonable

out-of-pocket costs, included benefits and services that met the child’s needs, and allowed the child

to see necessary providers. 

5 10 15 20 25 30

Insurance Doesn’t Usually/

Always Allow Child to See

 Necessary Providers

Insurance Doesn’t Usually/

Always Provide Necessary

 Benefits or Services

Out-of-Pocket Costs Are

 Not Usually/Always

 Reasonable**

Total without

 Adequate Insurance

Percent of Children
56 HEALTH SERVICES FINANCING AND UTILIZATION CHILD HEALTH USA 2010

vaccination coverage

The Healthy People 2010 objective for childhood immunization is to achieve 90 percent 

coverage for each of the universally recommended vaccines among young children. In 

2008, 68.4 percent of children 19–35 months of 

age received each of the vaccines in the recommended 4:3:1:3:3:1:4 series. This series includes 

four doses of diphtheria, tetanus, and pertussis 

vaccine; three doses of poliovirus vaccine; one 

dose of measles, mumps, and rubella vaccine; 

three doses of Haemophilus influenza type b vaccine; three doses of the Hepatitis B vaccine; one 

dose of the varicella (chicken pox) vaccine; and 

four doses of the pneumococcal conjugate vaccine. Overall, 76.1 percent of young children 

received the 4:3:1:3:3:1 series (which does not 

include the pneumococcal vaccine), and 78.2 

percent received the 4:3:1:3:3 series (which 

does not include the pneumococcal or varicella 

vaccines). 

In recent years, the greatest increases in vaccination rates have occurred with the pneumococcal and varicella vaccines. Pneumococcal 

conjugate vaccine was added to the immunization schedule in 2001, and vaccination coverage 

was first measured in 2005. Since 2005, coverage among young children has increased 50 percent. Varicella vaccine was added to the schedule in the mid-1990s, and since 2000 coverage 

has increased by 34 percent. 

Racial/ethnic differences in coverage are apparent for most vaccine types. Non-Hispanic 

Blacks have the lowest rate of coverage with 

the complete 4:3:1:3:3:1:4 series, as well as the 

lowest rates of vaccination with each of the individual vaccines, except for the varicella and 

measles, mumps, and rubella vaccines. 

Each year, the Centers for Disease Control 

and Prevention publishes an update of the 

childhood immunization schedule (see next 

page). No new vaccines were added to the 2010 

schedule.

Vaccination Rates Among Children Aged 19-35 Months, by Race/Ethnicity, 2008

Source (III.2): Centers for Disease Control and Prevention, National Immunization Survey

Total Non-Hispanic 

White

Non-Hispanic 

Black Hispanic Non-Hispanic Asian

Complete Series 4:3:1:3:3:1:4 68.4 68.2 65.9 68.5 73.5

Series 4:3:1:3:3:1 76.1 75.3 72.7 77.7 82.2

Series 4:3:1:3:3 78.2 77.8 74.2 79.4 84.2

4+DTaP 84.6 85.0 80.1 84.9 92.3

3+ Polio 93.6 93.6 91.5 94.3 96.5

1+ MMR 92.1 91.3 92.0 92.8 94.7

3+ Hib 90.9 90.8 88.6 91.9 92.6

3+ HepB 93.5 93.4 92.1 93.7 97.5

1+ Varicella 90.7 89.8 90.4 91.8 94.2

4+ PCV 80.1 81.4 76.4 78.6 82.3
 CHILD HEALTH USA 2010 HEALTH SERVICES FINANCING AND UTILIZATION 57

Recommended Immunization Schedule for Children Aged 0-6 Years, United States, 2010

Source (III.3): Department of Health and Human Services, Centers for Disease Control and Prevention

Birth 1mo 2mo 4mo 6mo 12mo 15mo 18mo 19-23mo 2-3yr 4-6yr

Hepatitis B1 HepB HepB HepB

Rotavirus2 RV RV RV2

Diphtheria, Tetanus, Pertussis3 DTaP DTaP DTaP see footnote 3 DTaP DTaP

Haemophilus influenzae tybe b4 Hib Hib Hib4 Hib

Pneumococcal5 PCV PCV PCV PCV PPSV

Inactivated Poliovirus6 IPV IPV IPV IPV

Influenza7 Influenza (yearly)

Measles, Mumps, Rubella8 MMR see footnote 8 MMR

Varicella9 Varicella see footnote 9 Varicella

Hepatitis A10 HepA (2 doses) HepA Series

Meningococcal11 MCV

Range of recommended ages Certain high-risk groups

This schedule includes recommendations in effect as of December 15, 2009. Any dose not administered at the recommended age 

should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred 

over separate injections of its equivalent component vaccines. Considerations should include provider assessment, patient preference, and the potential for adverse events. Providers should consult the relevant Advisory Committee on Immunization Practices 

statement for detailed recommendations: http://www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse events 

that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS) at 

http://www.vaers.hhs.gov or by telephone, 800-822-7967.

1. Hepatitis B vaccine (HepB). (Minimum age: birth)

 At birth:

• Administer monovalent HepB to all newborns before hospital discharge.

• If mother is hepatitis B surface antigen (HBsAg)-positive, administer HepB and 

0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth.

• If mother’s HBsAg status is unknown, administer HepB within 12 hours of birth. 

Determine mother’s HBsAg status as soon as possible and, if HBsAg-positive, 

administer HBIG (no later than age 1 week).

 After the birth dose:

• The HepB series should be completed with either monovalent HepB or a combination vaccine containing HepB. The second dose should be administered at age 

1 or 2 months. Monovalent HepB vaccine should be used for doses administered 

before age 6 weeks. The final dose should be administered no earlier than age 

24 weeks.

• Infants born to HBsAg-positive mothers should be tested for HBsAg and antibody 

to HBsAg 1 to 2 months after completion of at least 3 doses of the HepB series, at 

age 9 through 18 months (generally at the next well-child visit).

• Administration of 4 doses of HepB to infants is permissible when a combination

vaccine containing HepB is administered after the birth dose. The fourth dose 

should be administered no earlier than age 24 weeks.

2. Rotavirus vaccine (RV). (Minimum age: 6 weeks)

• Administer the first dose at age 6 through 14 weeks (maximum age: 14 weeks 

6 days). Vaccination should not be initiated for infants aged 15 weeks 0 days or 

older.

• The maximum age for the final dose in the series is 8 months 0 days

• If Rotarix is administered at ages 2 and 4 months, a dose at 6 months is not 

indicated.

3. Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP).

(Minimum age: 6 weeks)

• The fourth dose may be administered as early as age 12 months, provided at 

least 6 months have elapsed since the third dose.

• Administer the final dose in the series at age 4 through 6 years.

4. Haemophilus influenzae type b conjugate vaccine (Hib).

(Minimum age: 6 weeks)

• If PRP-OMP (PedvaxHIB or Comvax [HepB-Hib]) is administered at ages 2 and 4 

months, a dose at age 6 months is not indicated.

• TriHiBit (DTaP/Hib) and Hiberix (PRP-T) should not be used for doses at ages 2, 

4, or 6 months for the primary series but can be used as the final dose in children 

aged 12 months through 4 years.

5. Pneumococcal vaccine. (Minimum age: 6 weeks for pneumococcal conjugate

 vaccine [PCV]; 2 years for pneumococcal polysaccharide vaccine [PPSV])

• PCV is recommended for all children aged younger than 5 years. Administer 

1 dose of PCV to all healthy children aged 24 through 59 months who are not 

completely vaccinated for their age.

• Administer PPSV 2 or more months after last dose of PCV to children aged 2 

years or older with certain underlying medical conditions, including a cochlear 

implant. See MMWR 1997;46(No. RR-8).

6. Inactivated poliovirus vaccine (IPV) (Minimum age: 6 weeks)

• The final dose in the series should be administered on or after the fourth birthday 

and at least 6 months following the previous dose.

• If 4 doses are administered prior to age 4 years a fifth dose should be administered at age 4 through 6 years. See MMWR 2009;58(30):829–30.

7. Influenza vaccine (seasonal). (Minimum age: 6 months for trivalent inactivated

influenza vaccine [TIV]; 2 years for live, attenuated influenza vaccine [LAIV])

• Administer annually to children aged 6 months through 18 years.

• For healthy children aged 2 through 6 years (i.e., those who do not have underlying medical conditions that predispose them to influenza complications), either 

LAIV or TIV may be used, except LAIV should not be given to children aged 2 

through 4 years who have had wheezing in the past 12 months.

• Children receiving TIV should receive 0.25 mL if aged 6 through 35 months or 

0.5 mL if aged 3 years or older.

• Administer 2 doses (separated by at least 4 weeks) to children aged younger 

than 9 years who are receiving influenza vaccine for the first time or who were 

vaccinated for the first time during the previous influenza season but only received 

1 dose.

• For recommendations for use of influenza A (H1N1) 2009 monovalent vaccine 

see MMWR 2009;58(No. RR-10).

8. Measles, mumps, and rubella vaccine (MMR). (Minimum age: 12 months)

• Administer the second dose routinely at age 4 through 6 years. However, the 

second dose may be administered before age 4, provided at least 28 days have 

elapsed since the first dose.

9. Varicella vaccine. (Minimum age: 12 months)

• Administer the second dose routinely at age 4 through 6 years. However, the 

second dose may be administered before age 4, provided at least 3 months have 

elapsed since the first dose.

• For children aged 12 months through 12 years the minimum interval between 

doses is 3 months. However, if the second dose was administered at least 28 days 

after the first dose, it can be accepted as valid.

10. Hepatitis A vaccine (HepA). (Minimum age: 12 months)

• Administer to all children aged 1 year (i.e., aged 12 through 23 months). 

Administer 2 doses at least 6 months apart.

• Children not fully vaccinated by age 2 years can be vaccinated at subsequent 

visits

• HepA also is recommended for older children who live in areas where vaccination

programs target older children, who are at increased risk for infection, or for whom 

immunity against hepatitis A is desired.

11. Meningococcal vaccine. (Minimum age: 2 years for meningococcal conjugate

 vaccine [MCV4] and for meningococcal polysaccharide vaccine [MPSV4])

• Administer MCV4 to children aged 2 through 10 years with persistent complement component deficiency, anatomic or functional asplenia, and certain other 

conditions placing tham at high risk.

• Administer MCV4 to children previously vaccinated with MCV4 or MPSV4 after 

3 years if first dose administered at age 2 through 6 years. See MMWR 2009; 

58:1042–3.

The Recommended Immunization Schedules for Persons Aged 0 through 18 Years are approved 

by the Advisory Committee on Immunization Practices (http://www.cdc.gov/vaccines/recs/acip), 

the American Academy of Pediatrics (http://www.aap.org), and the American Academy of Family 

Physicians (http://www.aafp.org).
58 HEALTH SERVICES FINANCING AND UTILIZATION WOMEN’S HEALTH USA 2009

mental health treatment

Some children rely on medication for the 

treatment of mental or emotional health problems. However, these services may not be accessible to all children who need them. In 2007, 

the parents of 40 percent of children who needed treatment reported that it was not received. 

Unmet need for mental health treatment varied by age, with younger children having higher 

rates of unmet needs. In 2007, 57.8 percent of 

children aged 2–5 years who needed mental 

health care did not receive it, compared to 42.2 

percent of children aged 6–11 years and 33.7 

percent of children aged 12–17 years. Hispanic 

Children Aged 2−17 Years Who Needed but Did Not 

Receive* Mental Healthcare/Counseling in the Past Year, 

by Age, 2007

Source (I.7): Health Resources and Services Administration, Maternal and Child 

Health Bureau and Centers for Disease Control and Prevention, National Center for 

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

40.0

*Both need for treatment and receipt of treatment are based on parent report. 

42.2

57.8

10

20

30

40

50

60

Total 2-5 Years 6-11 Years 12-17 Years 

33.7

*Includes Asian/Pacific Islanders and American Indian/Alaska Natives.

Children Aged 2−17 Years Currently Taking Medication for 

Attention Deficit Hyperactivity Disorder (ADHD), Emotions, 

Concentration, or Behavior, by Race/Ethnicity, 2007

Source (I.7): Health Resources and Services Administration, Maternal and Child 

Health Bureau and Centers for Disease Control and Prevention, National Center for 

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

6.2 6.3 8.3

2.5

10 7.3

20

30

40

50

60

Other 

Races*

Non-Hispanic Hispanic Multiracial

 Black

Non-Hispanic

 White

Total

3.3

children who needed treatment had the highest rates of unmet need (49.4 percent), followed 

by non-Hispanic Black children (46.0 percent). 

More than half of uninsured children who 

needed treatment did not receive it, compared 

to 36.6 percent of children with private insurance who needed treatment (data not shown). 

Some children rely on medication for mental 

or emotional health problems. In 2007, 6.2 percent of children received medication for Attention Deficit Hyperactivity Disorder (ADHD) 

or other problems with emotions, concentration, or behavior. Multiracial children were 

most likely to receive medication (8.3 percent), 

followed by non-Hispanic White children (7.3 

percent); children of other races, such as Asian/

Pacific Islanders and American Indian/Alaska 

Natives, were least likely to receive medication 

(2.5 percent). The use of medication also varies 

by insurance status. Children with public insurance were two times more likely than children 

with private insurance and almost four times 

more likely than children with no insurance to 

receive medication for ADHD, emotions, concentration, or behavior (data not shown). 
 CHILD HEALTH USA 2010 HEALTH SERVICES FINANCING AND UTILIZATION 59

dental care

According to the Centers for Disease Control and Prevention, dental caries (tooth decay) 

is the most common chronic disease among 

children in the United States. Untreated tooth 

decay causes pain and infections, which may 

affect children’s ability to eat, speak, play, and 

learn.1 Dental caries, however, is preventable 

with proper dental care. For this reason, the 

American Dental Association recommends that 

children have their first dental checkup within 

6 months of the eruption of the first tooth or at 

12 months of age, whichever comes first. 

In 2008, only 31.7 percent of children eligible for services under the Medicaid Early and 

Periodic Screening, Diagnosis, and Treatment 

(EPSDT) program received preventive dental 

services. This is similar to the previous year’s 

rate, but an improvement over the rate of 27.7 

percent in 2006.

In 2008, 73.9 percent of children aged 1–18 

years received dental care, including care from 

dental specialists and dental hygienists, in the 

past year. Receipt of dental care varied by a 

number of factors, including race/ethnicity and 

poverty level. Children living in households 

with incomes above 200 percent of the U.S. 

Census Bureau’s poverty threshold ($22,025 

for a family of four in 2008) were more likely 

than children living in households with incomes 

below 200 percent of the poverty threshold to 

have received dental care in the past year (78.9 

percent versus 66.8 percent).

Non-Hispanic White children were more 

likely than children of other racial/ethnic groups 

to have received dental care in the past year 

(76.4 percent), followed by non-Hispanic Black 

children (73.9 percent) and Hispanic children 

(66.7 percent; data not shown).

1 Centers for Disease Control and Prevention, Division of 

Oral Health. Children’s Oral Health. http://www.cdc.

gov/OralHealth/topics/child.htm; accessed February 2010.

Receipt of Dental Care* Among Children Aged 1−18 Years,

by Poverty Level,** 2008

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

for Health Statistics, National Health Interview Survey

31.7

Percent of Eligible Children

Receipt of EPSDT Preventive Dental Service Among 

Eligible Children,* Aged Birth−20 Years, 1990−2008

Source (III.4): Centers for Medicare and Medicaid Services, Annual EPSDT 

Report

Percent of Children

Within Past Year

More Than 1 Year Ago (including never)

26.1

66.8

73.9

78.9

33.2

21.1

*All children on Medicaid are eligible for EPSDT services.

*Includes visits to specialists and dental hygienists. **The U.S. Census Bureau uses a set of money income 

thresholds to determine who is in poverty; the poverty threshold for a family of four was $22,025 in 2008.

5

10

15

20

25

30

35

1990 1992 1994 1996 1998 2000 2002 2004 2006 2008

20

40

60

80

100

Total <200% of Poverty 200% or More of Poverty
60 HEALTH SERVICES FINANCING AND UTILIZATION CHILD HEALTH USA 2010

Receipt of Preventive Health Care in the Past Year Among 

Children Under Age 18, by Age, 2008

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

Statistics, National Health Interview Survey Percent of Children

70.1

75.8 76.0

Receipt of Preventive Health Care in the Past Year Among 

Children Under Age 18, by Race/Ethnicity, 2008

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

Statistics, National Health Interview Survey

86.7

66.5

20

40

60

80

100

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

Percent of Children

73.7 75.7 72.6

81.1

20

40

60

80

100

Non-Hispanic

Asian

Non-Hispanic Hispanic

 Black

Non-Hispanic

 White

preventive health care 

visits

In 2008, 75.8 percent of children under 18 

years of age were reported by their parents to 

have had a preventive, or “well-child”, medical 

visit in the past year. The American Academy of 

Pediatrics recommends that children have eight 

preventive health care visits in their first year, 

three in their second year, and at least one per 

year from middle childhood through adolescence. Well-child visits offer an opportunity not 

only to monitor children’s health and provide 

immunizations, but also to assess a child’s behavior and development, discuss nutrition, and 

answer parents’ questions. 

The proportion of children receiving wellchild visits declines with age. In 2008, 86.7 

percent of children 4 years of age and younger 

received a preventive visit in the past year, compared to 76.0 percent of children 5–9 years of 

age, 70.1 percent of children 10–14 years of 

age, and 66.5 percent of children 15–17 years 

of age. 

Receipt of preventive medical care also varies 

by race and ethnicity. In 2008, non-Hispanic 

Black children were the most likely to have received a well-child visit in the past year (81.1 

percent), followed by non-Hispanic White children (75.7 percent). Hispanic children were 

least likely to have received preventive care in 

the past year (72.6 percent). 
 CHILD HEALTH USA 2010 HEALTH SERVICES FINANCING AND UTILIZATION 61

LACK of health care 

 The American Academy of Pediatrics recommends that children have eight preventive health 

care visits in their first year, three in their second year, and at least one per year from middle 

childhood through adolescence. In 2008, 10.9 

percent of children under 18 years of age had 

not seen a physician or other health care professional in the past year for either sick or routine 

care (not including overnight hospitalization, 

emergency department visits, home health care, 

or dental care). Older children were more likely 

than younger children to go 12 months without 

seeing a health care provider. More than 15 percent of children aged 15–17 years had not seen 

a health care provider in the past year, compared 

to 5.0 percent of children under 5 years of age.

Health care visits also varied by race/ethnicity. In 2008, over 16 percent of Hispanic children had not seen a physician or other health 

professional in the past year, compared to 8.5 

percent of non-Hispanic White children and 

12.2 percent of non-Hispanic Black children. 

Within every age group, Hispanic children were 

the least likely to have seen a health care provider, and non-Hispanic White children were 

the most likely to have seen one. 

The proportion of children going without health care also varied by poverty level. 

In 2008, 13.3 percent of children living in 

households with incomes below 100 percent 

of the U.S. Census Bureau’s poverty threshold 

($22,025 for a family of four in 2008) had not 

seen a physician or other health professional in 

the past year, compared to 5.1 percent of children living in households with incomes of 400 

percent or more of the poverty threshold (data 

not shown). 

Child Reported to Have Not Seen a Physician or Other Health Care Professional* 

in the Past 12 Months, by Age and Race/Ethnicity, 2008

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

Interview Survey Percent of Children

5

10

15

20

25

30

35

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

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

10.9 12.2

16.2

5.0 4.1

6.5 6.5

10.7 10.0 10.1

14.5 14.5

10.7

18.6

20.8

15.3

9.5

14.7

32.0

*Does not include overnight hospitalizations, emergency department visits, home health care, and dental care. 

8.5
62 HEALTH SERVICES FINANCING AND UTILIZATION CHILD HEALTH USA 2010

Place of Physician Contact,* by Poverty Status** and Race/Ethnicity, 2008

Source (III.5): Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey Percent of Children

*The place where the child usually goes when sick; does not include routine or preventive care visits. **The U.S. Census Bureau uses a set of money income thresholds to determine who is in poverty; the poverty

threshold for a family of four was $22,025 in 2008.

Doctor’s Office or HMO

78.3

66.0

73.3

82.5

41.7

60.4 65.7

55.6

20

40

60

80

100

Below Poverty Threshold Above Poverty Threshold

Clinic or Health Center

20.3 24.2

31.6

16.6

34.4

54.1

32.9

40.8

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

20

40

60

80

100

Below Poverty Threshold Above Poverty Threshold

Hospital or Other Place

1.4 1.0 2.5 2.4 4.2 5.2 1.5 3.6

20

40

60

80

100

Below Poverty Threshold Above Poverty Threshold

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

usual place for sick care

In 2008, a doctor’s office or health maintenance organization (HMO) was the usual place 

for sick care (not including routine or preventive care) for 72.7 percent of children in the 

United States, a proportion that varies by poverty status and race/ethnicity. Children living in 

households with incomes above the U.S. Census Bureau’s poverty threshold ($22,025 for a 

family of four in 2008) were more likely to visit 

a doctor’s office or HMO for sick care than children living in households with incomes below 

the poverty threshold (78.3 percent versus 55.6 

percent). Children living in households with incomes below the poverty threshold were more 

likely than children living in households with 

higher incomes to go to a clinic or health center 

(40.8 percent versus 20.3 percent). 

Among children living in poverty, 65.7 percent of non-Hispanic White children received 

sick care at a doctor’s office or HMO, compared 

to 60.4 of non-Hispanic Black children and 

41.7 percent of Hispanic children. Regardless 

of income, Hispanic children were more likely 

than non-Hispanic children to receive sick care 

at a clinic or health center. Among Hispanic 

children living in poverty, 54.1 percent received 

care at a clinic or health center, compared to 

34.4 percent of their non-Hispanic Black counterparts and 32.9 percent of their non-Hispanic 

White counterparts. Among children living in 

families with incomes above the poverty threshold, 31.6 percent of Hispanics, 24.2 percent of 

non-Hispanic Blacks, and 16.6 percent of nonHispanic Whites received sick care at a clinic or 

health center.

Although only a small proportion of children 

used a hospital emergency room, hospital outpatient department, or other place as their primary 

source of sick care, it was more common among 

children living in families with incomes below 

the poverty threshold than among children with 

family incomes above the poverty threshold (3.6 

percent versus 1.4 percent). Regardless of income, this was generally more common among 

non-Hispanic Black and Hispanic children than 

among non-Hispanic Whites. 
 CHILD HEALTH USA 2010 HEALTH SERVICES FINANCING AND UTILIZATION 63

Children with a Medical Home, by Race/Ethnicity, 

2007

Source (III.5): Health Resources and Services Administration, Maternal and Child 

Health Bureau and Centers for Disease Control and Prevention, National Center 

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

68.0

*Includes Asian/Pacific Islanders and American Indian/Alaska Natives.

63.0

44.2

38.5

10

20

30

40

50

60

70

80

Other 

Races*

Non-Hispanic Hispanic Multi-racial

 Black

Non-Hispanic

 White

Total

48.6

Children with a Medical Home, by Type of Insurance, 

2007

Source (III.5): Health Resources and Services Administration, Maternal and Child 

Health Bureau and Centers for Disease Control and Prevention, National Center 

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

66.5

45.4

10

20

30

40

50

60

70

80

Private Insurance Public Insurance Uninsured

35.7

57.5

medical home

According to the American Academy of Pediatrics, children’s medical care should be accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally 

effective. These characteristics of high-quality 

health care can be combined into the concept 

of the medical home. The 2007 National Survey 

of Children’s Health made an effort to measure 

whether children’s health care is meeting the 

medical home standard. For this purpose, the 

survey included questions on the following: 1) 

whether the child has at least one personal doctor or nurse and a usual source of sick care; 2) 

whether the child has no problems gaining referrals to specialty care and access to therapies 

or other services or equipment; 3) whether the 

family is very satisfied with the level of communication among their child’s doctors and other 

programs; 4) whether the family usually or always gets sufficient help coordinating care when 

needed, and receives effective care coordination; 

5) whether the child’s providers usually or always spend enough time with the family, listen 

carefully to concerns, are sensitive to values and 

customs, provide needed information, and make 

the family feel like a partner in the child’s care; 

and 6) whether an interpreter is usually or always available when needed. If a child’s care met 

all of these criteria, according to the parent, then 

the child was defined as having a medical home.

Overall, the care received by 57.5 percent of 

children met this medical home standard. This 

varied substantially by race and ethnicity: 68.0 

percent of non-Hispanic White children received care from a medical home, compared to 

63.0 percent of multiracial children, 44.2 percent of non-Hispanic Black children, 38.5 percent of Hispanic children, and 48.6 percent of 

children of other races. 

Receipt of care from a medical home also varied by insurance status. Children with private 

insurance were most likely to receive care from a 

medical home (66.5 percent), followed by children with public insurance (45.4 percent). Children who were not currently insured were least 

likely to have a medical home (35.7 percent). 
64 HEALTH SERVICES FINANCING AND UTILIZATION CHILD HEALTH USA 2010

Visits to the Emergency Department Among Children

Under Age 18, by Poverty Status,* 2008

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

Statistics, National Health Interview Survey Percent of Children

Total 

Below Poverty Threshold

Above Poverty Threshold

18.5

3.0 1.3 1.0

19.8

25.7

78.8

71.2

80.6

Visits to the Emergency Department Among Children Under 

Age 18, by Age, 2008

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

Statistics, National Health Interview Survey Percent of Children

Under 5 Years

5–9 Years

10–14 Years

15–17 Years

83.7 81.3 81.4

71.3

2.1 1.1 0.9 1.1

15.4 17.6 17.5

26.6

20

40

60

80

100

No Visits 1-3 Visits 4 or More Visits

*The U.S. Census Bureau uses a set of money income thresholds to determine who is in poverty; 

the poverty threshold for a family of four was $22,025 in 2008.

20

40

60

80

100

No Visits 1-3 Visits 4 or More Visits

emergency department

utilization

In 2008, more than 20 percent of children 

had at least one visit to a hospital emergency department (ED). Children living in households 

with incomes below the U.S. Census Bureau’s 

poverty threshold ($22,025 for a family of four 

in 2008) were more likely than children living 

in households with incomes above the poverty 

threshold to have visited the ED. Just over onequarter of children living in poverty made one 

to three ED visits during the year, compared 

to fewer than 20 percent of children living in 

households with incomes above poverty. Similarly, 3.0 percent of children from lower-income 

households made four or more visits to the ED, 

compared to 1.0 percent of children from higher-income households.

Emergency department utilization also varies 

by age: 26.6 percent of children under 5 years 

of age made 1–3 visits to the ED in 2008, compared to 15.4 percent of children aged 10–14 

years. Children under 5 years of age were also 

the most likely to make four or more ED visits (2.1 percent). There were also racial/ethnic 

differences in ED utilization: 23.3 percent of 

non-Hispanic Black children made 1–3 visits 

to the ED in 2008, compared to 19.8 percent 

of Hispanic children and 18.9 percent of nonHispanic White children (data not shown). 

According to the 2006 National Hospital 

Ambulatory Medical Care Survey, the most 

common reason for a visit to the emergency department among children under 15 years of age 

was fever (15.1 percent), followed by cough (6.6 

percent), and vomiting (5.5 percent). The most 

common primary diagnoses treated in ED visits were acute upper respiratory infections (9.2 

percent), otitis media (middle ear infection) and 

Eustachian tube disorders (6.6 percent), and fever of unknown origin (5.8 percent; data not 

shown).1

1 Pitts SR, Niska RW, Xu J, Burt CW. National Hospital 

Ambulatory Medical Care Survey: 2006 emergency department summary. National Health Statistics Reports, 

No. 7; 2008 Aug.
 CHILD HEALTH USA 2010 HEALTH SERVICES FINANCING AND UTILIZATION 65

Receipt of First Trimester Prenatal Care, by Race/Ethnicity 

and Birth Certificate Revision*, 2007

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

Statistics, National Vital Statistics System Percent of Mothers

Receipt of Late* or No Prenatal Care, by Race/Ethnicity 

and Birth Certificate Revision**, 2007

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

Statistics, National Vital Statistics System Percent of Mothers

20

40

60

80

100

Total Non-Hispanic White Non-Hispanic Black Hispanic

82.0

70.8

87.7

76.2 75.0

59.2

72.4

64.7

20

40

60

80

100

Total Non-Hispanic White Non-Hispanic Black Hispanic

3.9 2.3 7.1 5.0 6.0 6.2 11.7 9.3

*“Unrevised” data are for all reporting areas that had not implemented the 2003 Revision of the 

U.S. Certificate of Live Birth as of January 1, 2007; “Revised” data are for the 23 reporting areas 

that had implemented the 2003 Revision.

*Care beginning in the third trimester of pregnancy. **“Unrevised” data are for all reporting areas that had 

not implemented the 2003 Revision of the U.S. Certificate of Live Birth as of January 1, 2007; “Revised” 

data are for the 23 reporting areas that had implemented the 2003 Revision.

Unrevised

Revised

Unrevised

Revised

prenatal care

Prenatal care—especially care beginning in 

the first trimester—allows health care providers 

to identify and manage a woman’s risk factors 

and health conditions and to provide expectant 

parents with relevant health care advice. The 

reported rate of first trimester prenatal care utilization has been increasing fairly steadily since 

the early 1990s; however, changes made to the 

standard birth certificate, which are gradually 

being adopted by the states, make comparisons 

over time impossible.

In 2007, in the 23 reporting areas (States and 

territories) that used the revised birth certificate, 

70.8 percent of women giving birth were determined to have received prenatal care in the 

first trimester. In the areas using the unrevised 

birth certificate, 82.0 percent of women were 

reported to have entered prenatal care in the 

first trimester. 

Early prenatal care utilization differs by race/

ethnicity. In 2007, non-Hispanic White women 

were most likely to receive first trimester prenatal care—this is the case using both revised and 

unrevised birth certificate data (76.2 percent 

and 87.7 percent, respectively). Non-Hispanic 

Black and Hispanic women are less likely to receive first trimester prenatal care.

In 2007, 7.1 percent of women in the areas 

using the revised birth certificate began prenatal care in the third trimester or did not receive 

any prenatal care; in areas using the unrevised 

birth certificate, the rate was 3.9 percent. In 

both the unrevised and revised reporting areas, 

non-Hispanic Black and Hispanic women were 

more likely than non-Hispanic White women 

to receive late or no prenatal care. 

 CHILD HEALTH USA 2010 STATE DATA 67

state data

While the indicators presented in the previ-

ous sections are representative of the U.S. popu-

lation as a whole, the following section presents 

data at the State level. Geographic differences 

in health status and health care utilization play 

an important role in tailoring health programs 

and interventions to specific populations. In-

cluded are data on infant, neonatal, and peri-

natal mortality, low birth weight, preterm birth, 

health care financing, Medicaid enrollment and 

expenditures, and CHIP enrollment.

The following pages reveal important dispari-

ties in these measures across States. For instance, 

the proportion of infants born low birth weight 

(less than 2,500 grams, or 5 pounds 8 ounces) 

was highest in Mississippi, followed by Louisi-

ana and several other southern States. Births to 

unmarried women tended to be highest in these 

States, as well.

All of the issues presented here have geo-

graphic program and policy implications. State 

and local leaders can use this information to 

better serve their maternal and child popula-

tions in need. 
68 STATE DATA CHILD HEALTH USA 2010

Children’s Health Insurance Program (CHIP) Program Design and Aggregate Enrollment, FY 2008

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

*Programs may be an expansion of Medicaid, a separate CHIP program, or a combination of the two. **Presumptive eligiblity provides immediate but temporary 

benefits for applicants who appear to meet eligibility requirements but have not yet been officially approved; in some States, this is only available for certain 

population (e.g., infants). For States with a combination plan, information for the Medicaid plan is listed first, followed by information for the separate CHIP plan. 

***Eligibility information is from FY 2007.

State Type of CHIP 

Program*

Upper 

Eligibility

Total CHIP 

Enrollment

Presumptive 

Eligibility?**

Alabama Separate 200% 110,821 N

Alaska Medicaid 175% 18,707 N

Arizona Separate 200% 112,072 N

Arkansas Combo 200% 93,446 N/N

California Combo 300% 1,692,087 Y/Y

Colorado Separate 200% 99,555 Y

Connecticut Separate 300% 22,270 N

Delaware Combo 200% 11,192 N/N

District of Columbia Medicaid 300% 8,746 N

Florida Combo 200% 354,385 Y/N

Georgia*** Separate 235% 311,234 N

Hawaii Medicaid 300% 28,803 N

Idaho Combo 185% 43,526 N/N

Illinois Combo 200% 356,460 Y/Y

Indiana Combo 200% 124,954 N/N

Iowa Combo 200% 50,390 N/N

Kansas Separate 200% 51,162 Y

Kentucky Combo 200% 67,717 N/N

Louisiana Combo 250% 147,863 N/N

Maine Combo 200% 30,947 N/N

Maryland*** Medicaid 200% 132,864 N

Massachusetts Combo 300% 200,950 Y/Y

Michigan Combo 200% 67,763 Y/Y

Minnesota Combo 280% 5,621 N/N

Mississippi Separate 200% 84,370 N

Missouri Combo 200% 136,135 Y/N

State Type of CHIP 

Program*

Upper 

Eligibility

Total CHIP 

Enrollment

Presumptive 

Eligibility?**

Montana Separate 175% 22,679 N

Nebraska Medicaid 185% 48,827 N

Nevada Separate 200% 38,592 N

New Hampshire Combo 300% 12,236 Y/N

New Jersey Combo 350% 151,805 Y/Y

New Mexico Medicaid 234% 14,944 Y

New York Separate 250% 517,256 Y

North Carolina*** Combo 200% 251,653 N/N

North Dakota*** Combo 140% 7,617 N/N

Ohio Medicaid 200% 251,278 N

Oklahoma Combo 185% 117,507 N/N

Oregon Separate 184% 73,686 N

Pennsylvania Separate 300% 256,627 N

Rhode Island Combo 250% 26,031 N/N

South Carolina Combo 200% 73,620 N/N

South Dakota Combo 200% 15,277 N/N

Tennessee*** Combo 250% 63,619 Y/Y

Texas Separate 200% 731,916 N

Utah Separate 200% 51,092 N

Vermont Separate 300% 6,496 N

Virginia Combo 200% 155,289 N/N

Washington Separate 250% 16,831 N

West Virginia Separate 220% 37,645 N

Wisconsin Combo 250% 52,940 Y/N

Wyoming Separate 200% 8,976 N
 CHILD HEALTH USA 2010 STATE DATA 69

Medicaid Enrollment and EPSDT Utilization for Children under 21, FY 2008

Source (III.4, IV.2): Centers for Medicare and Medicaid Services

*Unduplicated number of individuals under age 21 determined to be eligible for EPSDT services.

**The ratio of Medicaid eligibles receiving any EPSDT services to the number of eligibles who should have received such services. 

***Represents total Medicaid vendor payments divided by Medicaid eligibles under 21 (Medicaid Statistical Information System Report)

◊All data are from FY 2007.

♦Expenditure data are from FY 2007.

State Medicaid Enrollees* 

EPSDT 

Participation 

Ratio** 

Medicaid 

Expenditures 

(per enrollee)***

Alabama♦ 489,049 52% $1,880 

Alaska 83,617 53% $4,767 

Arizona♦ 681,537 76% $2,280 

Arkansas♦ 415,411 38% $2,131 

California 4,665,571 78% $1,761 

Colorado 343,032 56% $2,372 

Connecticut 285,538 68% $1,629 

Delaware 90,731 90% $3,815 

District of Columbia♦ 98,550 70% $3,494 

Florida 1,654,843 70% $2,183 

Georgia 1,059,612 60% $2,303 

Hawaii♦ 132,459 72% $1,842 

Idaho 163,765 45% $2,726 

Illinois 1,472,021 67% $1,747 

Indiana 679,769 100% $1,987 

Iowa 255,061 72% $2,811 

Kansas 219,175 61% $2,990 

Kentucky 491,961 57% $3,186 

Louisiana 753,992 67% $1,977 

Maine◊ 136,617 59% $5,275 

Maryland 523,789 59% $3,154 

Massachusetts♦ 543,090 78% $3,459 

Michigan♦ 1,126,951 54% $1,838 

Minnesota 416,629 68% $4,439 

Mississippi♦ 391,852 41% $1,601 

State Medicaid Enrollees* 

EPSDT 

Participation 

Ratio** 

Medicaid 

Expenditures 

(per enrollee)***

Missouri 643,125 70% $2,456 

Montana 64,071 61% $3,214 

Nebraska 163,672 52% $3,119 

Nevada♦ 163,407 59% $1,618 

New Hampshire 92,694 63% $2,872 

New Jersey 605,041 61% $2,769 

New Mexico 331,109 67% $3,164 

New York 2,006,098 63% $3,323 

North Carolina♦ 1,010,922 78% $2,349 

North Dakota♦ 45,755 48% $2,145 

Ohio♦ 1,250,115 51% $2,005 

Oklahoma 517,679 52% $2,407 

Oregon 271,889 61% $2,610 

Pennsylvania♦ 1,137,248 52% $2,604 

Rhode Island♦ 110,354 55% $4,034 

South Carolina 529,255 57% $2,479 

South Dakota 94,157 44% $2,557 

Tennessee 824,415 59% $2,259 

Texas♦ 2,943,128 60% $1,876 

Utah♦ 169,498 61% $1,987 

Vermont♦ 59,170 51% $2,993 

Virginia 563,092 66% $2,527 

Washington 663,501 59% $2,245 

West Virginia◊ 206,729 44% $1,917 

Wisconsin◊ 499,965 68% $1,586 

Wyoming 53,211 42% $3,074 
70 STATE DATA CHILD HEALTH USA 2010

Health Insurance Status of Children Under 18,* 2009

Source (III.1): U.S. Census Bureau, Current Population Survey

*Children may have more than one type of coverage. **Includes children covered by Medicaid, CHIP, 

Medicare, military health insurance, and the Indian Health Service. 

State Percent with 

Private Insurance

Percent with 

Public Insurance**

Percent 

Uninsured

Alabama 63.7% 37.3% 3.7%

Alaska 60.0% 36.7% 14.4%

Arizona 49.2% 38.1% 16.0%

Arkansas 49.2% 47.2% 9.2%

California 58.7% 36.6% 10.5%

Colorado 68.5% 22.6% 12.3%

Connecticut 74.8% 26.9% 5.4%

Delaware 70.8% 27.3% 9.1%

District of Columbia 57.3% 45.5% 6.4%

Florida 60.5% 28.3% 16.7%

Georgia 61.0% 35.3% 10.5%

Hawaii 64.2% 42.7% 5.2%

Idaho 69.5% 28.9% 8.8%

Illinois 67.8% 32.6% 6.4%

Indiana 64.7% 34.7% 6.0%

Iowa 75.1% 28.1% 5.3%

Kansas 63.4% 30.1% 11.0%

Kentucky 59.2% 37.1% 10.0%

Louisiana 58.9% 35.6% 11.3%

Maine 66.2% 36.4% 5.8%

Maryland 74.0% 27.6% 6.0%

Massachusetts 75.5% 27.1% 3.4%

Michigan 71.3% 31.8% 4.7%

Minnesota 73.5% 24.7% 6.6%

Mississippi 49.4% 43.8% 13.3%

Missouri 69.9% 31.3% 6.8%

State Percent with 

Private Insurance

Percent with 

Public Insurance**

Percent 

Uninsured

Montana 63.9% 31.5% 10.5%

Nebraska 67.4% 29.7% 10.1%

Nevada 65.3% 19.1% 19.1%

New Hampshire 79.5% 23.6% 3.7%

New Jersey 69.8% 22.3% 11.3%

New Mexico 49.1% 39.7% 16.1%

New York 63.3% 37.2% 7.1%

North Carolina 60.9% 36.8% 9.3%

North Dakota 73.3% 24.0% 8.2%

Ohio 69.7% 31.1% 5.8%

Oklahoma 59.9% 43.2% 7.2%

Oregon 66.2% 29.5% 11.6%

Pennsylvania 69.9% 29.9% 6.7%

Rhode Island 66.9% 33.5% 8.1%

South Carolina 61.4% 30.9% 12.8%

South Dakota 64.3% 33.2% 10.1%

Tennessee 56.1% 42.7% 9.4%

Texas 50.8% 37.5% 17.9%

Utah 83.3% 13.4% 9.6%

Vermont 69.0% 41.9% 3.9%

Virginia 73.3% 29.1% 6.9%

Washington 64.3% 36.7% 6.9%

West Virginia 62.0% 41.3% 6.2%

Wisconsin 74.7% 28.8% 5.8%

Wyoming 70.7% 29.3% 9.0%
 CHILD HEALTH USA 2010 STATE DATA 71

Health Insurance Status: Percent of Children Under 18 Who Are Uninsured, by State, 2009

Source (III.1): U.S. Census Bureau, Current Population Survey

IL

AK

HI

WA

KS

MN

WI

IA

MO

AR 

MS AL

SC

KY

IN

MI

OH 

PA

NY

VT

NH

ME 

MA

CT

RI

NJ

MD 

DE 

DC (6.4%)

NE

VA WV 

ND

SD

< 7.5% 7.5 - 10% 10.1 - 12% 12.1 - 21%

ID

WY

LA

FL

OR

TN

NC

CO

TX

GA

OK

NV

AZ

UT

CA

MT

NM
72 STATE DATA CHILD HEALTH USA 2010

Low Birth Weight, Preterm Birth, and Births to Unmarried Women (Percent), by State and Maternal Race/Ethnicity, 2007

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

*Low birth weight is less than 2,500 grams or 5 pounds 8 ounces; preterm birth is less than 37 completed weeks of gestation. 

N/A: Figure does not meet standards of reliability or precision; based on fewer than 20 births in the numerator.

State

Low Birth Weight* Preterm Birth* Births to Unmarried Women

Total* Non-Hispanic 

White Black

Hispanic Total* Non-Hispanic 

White Black

Hispanic Total* Non-Hispanic 

White Black

Hispanic

United States 8.2 7.3 13.9 6.9 12.7 11.5 18.3 12.3 39.7 27.8 71.6 51.3

Alabama 10.4 8.4 15.4 7.0 16.6 14.6 21.3 14.4 38.3 23.9 71.4 24.5

Alaska 5.7 5.6 11.3 6.2 10.4 9.2 14.2 11.2 37.3 23.4 46.0 34.7

Arizona 7.1 7.0 13.1 6.6 12.7 11.8 18.4 12.8 45.2 28.7 62.0 56.8

Arkansas 9.1 8.0 14.8 6.6 13.9 12.7 19.1 12.9 43.4 32.6 78.9 49.7

California 6.9 6.4 11.9 6.3 10.9 9.9 15.2 11.0 38.9 23.5 67.1 49.8

Colorado 9.0 8.7 14.8 8.6 12.2 11.3 18.4 12.9 25.4 17.3 49.4 38.2

Connecticut 8.1 7.1 12.2 8.3 10.5 9.6 14.3 10.9 35.1 20.9 68.1 63.5

Delaware 9.3 7.3 13.9 8.2 14.3 12.0 18.3 15.7 46.8 32.9 71.5 63.7

D.C. 11.1 6.2 14.6 7.3 15.6 9.6 18.8 15.2 58.5 6.9 80.0 72.0

Florida 8.7 7.4 13.6 7.1 13.8 11.8 19.0 13.1 46.1 34.5 69.8 49.6

Georgia 9.5 7.5 14.3 6.0 13.9 12.0 18.4 10.7 43.6 25.7 68.9 49.6

Hawaii 8.0 5.6 10.4 8.4 12.4 9.6 12.8 11.3 36.9 26.3 24.7 49.3

Idaho 6.5 6.5 N/A 6.3 10.5 10.3 N/A 10.9 25.5 21.8 33.1 42.0

Illinois 8.5 7.3 14.6 6.8 13.0 11.8 18.6 12.5 40.1 25.3 79.6 50.8

Indiana 8.5 7.9 14.1 7.2 12.9 12.1 19.5 12.3 42.4 36.0 78.5 56.2

Iowa 6.8 6.6 11.9 5.8 11.6 11.3 15.8 12.4 34.3 30.8 77.3 50.1

Kansas 7.1 6.8 13.2 5.6 11.6 11.1 16.6 11.4 36.5 30.2 72.2 51.6

Kentucky 9.3 8.8 15.4 7.1 15.2 14.6 21.2 14.8 39.3 34.9 76.3 51.8

Louisiana 11.2 8.5 15.8 6.6 16.6 13.7 21.4 12.4 51.4 32.8 78.5 53.6

Maine 6.3 6.2 9.5 N/A 10.6 10.4 16.3 14.4 39.1 39.1 36.8 41.6

Maryland 9.1 7.0 12.9 7.3 13.4 11.1 17.5 12.8 40.9 25.5 62.9 54.8

Massachusetts 7.9 7.3 10.8 8.0 11.2 10.9 13.9 11.4 33.4 25.1 58.4 66.9

Michigan 8.4 7.3 13.6 7.2 12.5 11.3 18.3 11.4 39.4 29.7 78.1 50.0

Minnesota 6.7 6.2 10.8 5.7 10.4 10.1 13.1 9.9 32.7 25.5 61.2 56.9

Mississippi 12.3 9.1 16.4 7.2 18.3 14.8 22.7 14.9 53.7 30.6 79.6 56.0

State

Low Birth Weight* Preterm Birth* Births to Unmarried Women

Total* Non-Hispanic 

White Black

Hispanic Total* Non-Hispanic 

White Black

Hispanic Total* Non-Hispanic 

White Black

Hispanic

Missouri 7.9 6.9 13.5 5.7 12.5 11.4 18.6 11.4 40.5 32.5 79.0 52.6

Montana 7.2 6.7 N/A 8.9 11.9 11.0 N/A 12.1 35.9 29.1 45.2 43.9

Nebraska 7.0 6.5 13.6 6.4 11.9 11.5 17.1 11.8 33.4 26.3 72.1 49.5

Nevada 8.2 7.9 14.5 6.6 14.3 13.2 20.1 13.8 42.0 30.1 70.0 50.1

New Hampshire 6.3 6.3 N/A 6.1 9.4 9.4 15.2 9.6 31.4 31.5 38.7 47.7

New Jersey 8.5 7.4 13.4 7.5 12.7 11.2 17.9 13.2 34.4 16.8 68.1 58.6

New Mexico 8.7 8.7 14.9 8.7 12.8 12.2 17.7 12.8 51.8 31.6 57.4 57.8

New York 8.1 6.9 12.6 7.7 12.3 10.8 16.8 13.1 40.7 23.7 69.5 64.7

North Carolina 9.2 7.8 14.6 6.5 13.3 11.6 18.2 12.4 41.2 25.6 71.2 53.7

North Dakota 6.3 6.2 N/A N/A 11.6 10.8 N/A 10.1 32.6 26.3 30.2 42.1

Ohio 8.8 7.6 14.2 8.2 13.2 12.0 18.6 14.1 42.2 34.4 78.5 58.9

Oklahoma 8.2 7.9 14.7 6.2 13.5 13.0 19.2 12.2 41.3 33.6 74.3 48.0

Oregon 6.1 5.9 9.8 5.9 10.3 10.1 13.5 10.2 35.1 31.0 65.2 47.7

Pennsylvania 8.4 7.1 13.8 8.9 11.8 10.5 17.2 13.1 39.7 30.1 77.7 64.1

Rhode Island 8.0 7.5 10.9 7.7 12.0 11.2 16.6 12.9 44.0 33.0 71.9 64.6

South Carolina 10.1 7.8 15.2 6.7 15.5 13.3 20.1 13.1 46.6 29.3 76.5 48.1

South Dakota 7.0 6.7 10.8 6.6 12.6 11.2 18.9 12.7 38.4 27.8 48.6 56.3

Tennessee 9.4 8.3 14.6 6.3 14.2 13.2 18.5 12.7 42.8 31.7 77.1 53.2

Texas 8.4 7.7 14.3 7.5 13.6 12.5 18.2 13.6 40.7 26.3 65.8 47.3

Utah 6.7 6.4 10.7 7.3 10.9 10.2 19.6 12.5 19.7 13.4 50.4 44.1

Vermont 6.2 6.1 N/A N/A 9.1 9.0 N/A N/A 36.6 36.6 46.3 32.5

Virginia 8.6 7.2 13.7 6.4 12.1 10.5 17.3 11.2 35.2 22.9 65.4 52.1

Washington 6.3 6.0 9.8 5.7 10.6 10.0 13.8 11.0 33.2 27.7 56.3 49.4

West Virginia 9.5 9.4 15.0 N/A 13.9 13.8 18.0 12.3 40.3 39.2 73.5 47.0

Wisconsin 7.0 6.1 13.5 6.4 11.1 10.3 17.2 11.2 35.4 26.8 84.3 53.6

Wyoming 9.1 9.3 N/A 7.1 12.7 12.4 N/A 12.2 34.7 29.7 57.0 54.3
 CHILD HEALTH USA 2010 STATE DATA 73

Infant and Neonatal Mortality,* by State and Maternal Race, 2007

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

*Mortality figures are presented as number of deaths per 1,000 live births. Infant mortality is defined as death 

during the first year of life; neonatal mortality is death during the first 28 days of life.

**Includes all races. ***Includes Hispanics. N/A: Figure does not meet the standards of reliability or precision.

State Infant Deaths Neonatal Deaths

Total** White*** Black*** Total** White*** Black***

Alabama 9.89 7.98 14.35 6.27 4.90 9.5

Alaska 6.51 5.20 n/a 3.17 3.03 n/a

Arizona 6.83 6.49 14.95 4.69 4.53 10.12

Arkansas 7.66 6.47 13.17 4.33 3.38 8.61

California 5.20 4.89 12.35 3.55 3.34 7.98

Colorado 6.12 5.85 13.16 4.17 4.01 8.19

Connecticut 6.63 5.90 12.07 5.06 4.46 9.41

Delaware 7.48 6.12 11.84 5.34 4.32 8.80

District of Columbia 13.09 8.52 16.61 9.70 5.87 12.60

Florida 7.05 5.52 12.21 4.42 3.53 7.47

Georgia 7.98 5.56 12.77 5.07 3.58 7.90

Hawaii 6.48 6.11 n/a 4.23 3.59 n/a

Idaho 6.75 6.59 n/a 4.52 4.46 n/a

Illinois 6.73 5.22 14.16 4.78 3.84 9.46

Indiana 7.58 6.61 15.99 4.79 4.13 10.40

Iowa 5.50 5.34 11.58 3.30 3.27 n/a

Kansas 7.93 7.03 18.98 5.00 4.49 11.63

Kentucky 6.69 6.01 12.69 4.06 3.73 7.58

Louisiana 9.17 6.14 14.08 5.35 3.49 8.37

Maine 6.30 6.33 n/a 4.46 4.54 n/a

Maryland 8.00 4.79 13.63 5.80 3.54 9.67

Massachusetts 4.93 4.54 8.76 3.42 3.11 6.12

Michigan 7.94 6.11 16.39 5.56 4.37 11.12

Minnesota 5.55 4.69 11.70 3.80 3.28 7.13

Mississippi 10.04 6.65 13.87 5.89 3.83 8.37

Missouri 7.48 5.89 16.48 4.99 3.77 11.69

State Infant Deaths Neonatal Deaths

Total** White*** Black*** Total** White*** Black***

Montana 6.35 5.94 n/a 3.62 3.49 n/a

Nebraska 6.76 6.12 14.04 4.86 4.38 10.53

Nevada 6.36 6.03 12.35 4.03 3.81 8.15

New Hampshire 5.36 5.34 n/a 3.25 3.31 n/a

New Jersey 5.18 4.13 11.02 3.44 2.86 6.87

New Mexico 6.27 5.99 n/a 3.89 3.88 n/a

New York 5.57 4.95 8.82 3.70 3.27 5.95

North Carolina 8.49 6.35 15.14 5.70 4.24 10.28

North Dakota 7.47 6.80 n/a 4.86 5.07 n/a

Ohio 7.69 6.34 14.81 5.18 4.21 10.20

Oklahoma 8.52 7.25 18.03 4.78 4.16 10.82

Oregon 5.75 5.70 n/a 3.95 3.93 n/a

Pennsylvania 7.56 6.12 15.07 4.98 4.12 9.45

Rhode Island 7.35 6.52 16.00 5.41 4.79 n/a

South Carolina 8.57 6.03 13.69 5.66 3.93 9.13

South Dakota 6.44 5.55 n/a 4.16 4.01 n/a

Tennessee 8.31 6.44 15.74 5.19 3.91 10.19

Texas 6.29 5.68 11.51 3.86 3.43 7.37

Utah 5.08 4.98 n/a 3.39 3.35 n/a

Vermont 5.07 4.76 n/a 3.07 n/a n/a

Virginia 7.79 5.80 15.41 5.35 3.76 11.26

Washington 4.82 4.33 10.28 2.85 2.63 5.55

West Virginia 7.46 6.95 n/a 4.68 4.33 n/a

Wisconsin 6.46 5.37 15.18 4.03 3.56 8.34

Wyoming 7.35 6.65 n/a 3.67 3.66 n/a

 CHILD HEALTH USA 2010 75 city DATA

The following section compares urban health 

to the national average for several indicators. 

Included are data on low and very low birth 

weight for infants born in U.S. cities with over 

100,000 residents, and infant mortality among 

infants born in cities with more than 250,000 

residents.

These comparisons indicate that the health 

status of infants living in large U.S. cities is gen-

erally poorer than that of infants in the Nation 

as a whole. In 2007, 8.7 percent of infants living 

in cities were born at low birth weight, com-

pared to a national average of 8.2 percent. The 

infant mortality rate showed a similar disparity, 

with a rate of 7.2 per 1,000 live births among 

infants in cities compared to a national average 

of 6.7 per 1,000 in 2006. 
76 CITY DATA CHILD HEALTH USA 2010

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 2007, 122,299 babies born to 

residents of U.S. cities with populations over 

100,000 were low birth weight (weighing less 

than 2,500 grams, or 5 pounds 8 ounces); this 

represents 8.7 percent of infants in U.S. cities. 

The rate of low birth weight among urban infants was 6 percent higher than the rate nationwide (8.2 percent). Although this has been a 

persistent disparity, the gap has decreased somewhat since 1990. 

Very Low Birth Weight. Infants born very 

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

pounds 4 ounces) are at highest risk for poor 

health outcomes. In 2007, 1.6 percent of live 

births in cities with populations over 100,000 

were very low birth weight. This exceeded the 

rate of very low birth weight nationwide (1.5 

percent) by 7 percent.

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

Populations over 100,000, 1990−2007

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

Statistics, National Vital Statistics System

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

Percent of Infants

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

Populations over 100,000, 1990−2007

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

Statistics, National Vital Statistics System Percent of Infants

8.2

8.7

1.6

1.5

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

1

2

3

4

5

6

7

8

9

10

1990 1995 2000 2005 2007

1

2

3

4

5

6

7

8

9

10

1990 1995 2000 2005 2007
 CHILD HEALTH USA 2010 CITY DATA 77

INFANT MORTALITY

In 2006, 6,582 infants born to residents of 

cities in the United States with populations over 

250,000 died in the first year of life. The infant 

mortality rate in U.S. cities was 7.2 deaths per 

1,000 live births, which was higher than the 

rate for the Nation as a whole (6.7 per 1,000). 

Although the infant mortality rate in cities 

has consistently been higher than the rate nationwide, it declined over the past decade, and 

the disparity in infant mortality rates between 

infants in cities and the Nation as a whole decreased by 50 percent. Between 1990 and 2006, 

the infant mortality rate in cities declined by 

one-third, while the nationwide decline during 

the same period was approximately 25 percent. 

Declines in infant mortality rates since 2000, 

however, have been relatively small for both cities and the population as a whole.

Infant Mortality Rates in U.S. Cities,* 1990−2006

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

Statistics System

7.2

6.7

Total U.S. Cities

Rate per 1,000 Live Births

Total U.S. Population

*Data for 1990–2002 were for cities with populations over 100,000; data after 2002 reflect cities with populations over 250,000.

5

6

7

8

9

10

11

12

13

14

15

1990 1992 1994 1996 1998 2000 2002 2004 2006
78 REFERENCES CHILD HEALTH USA 2010

REFERENCES

Population Characteristics

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Health Services Financing and Utilization

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State Data

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 CHILD HEALTH USA 2010 REFERENCES 79
80 CHILD HEALTH USA 2010

contributors

This publication was prepared for the U.S. 

Department of Health and Human Services, 

Health Resources and Services Administration, 

Maternal and Child Health Bureau (MCHB).

It was produced for MCHB by the Maternal 

and Child Health Information Resource Center under contract.

Federal Contributors within the U.S. 

Department of Health and Human 

Services

Administration for Children and Families

Centers for Disease Control and Prevention

Centers for Medicare and Medicaid Services

National Institute of Health, National Institute on Drug Abuse

Substance Abuse and Mental Health Services 

Administration

Other Federal and Non-Governmental 

Contributors

American Academy of Pediatrics

Child and Adolescent Health Measurement 

Initiative, Data Resource Center

U.S. Census Bureau

U.S. Department of Education

U.S. Department of Labor

United Nations

Photography Credits

Cover and title page, clockwise from top left: first, third, fourth, and sixth photos, iStockPhoto; 

second photo, Durrell Gray; fifth photo, Brandy Utterback; seventh photo, Gloria Aponte Clarke. 

Pages 4, 7, 9, 21, 22, 31 top, 38, 45, 67, and 74: iStockPhoto. Page 31 bottom: Janice Schuster. 

Page 53: Kate Lynch Machado. Page 80: Amy Sheon.