Child 

Health 

USA 

2008-2009

September 2009

U.S. Department of Health and Human Services

Health Resources and Services Administration
Child Health USA 2008-2009 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. 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 2008-2009. 

Rockville, Maryland: U.S. Department of Health and Human Services, 2009.

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 2008-2009

Table of Contents 3

Table of Contents

Preface ........................................................................................................5

Introduction....................................................................................................7

Population Characteristics...............................................................................11

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

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

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

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

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

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

Neighborhood Characteristics .................................................................18

Health Status..................................................................................................19

Health Status - Infants.....................................................................................20

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

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

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

Maternal Mortality....................................................................................24 

Neonatal and Postneonatal Mortality ......................................................25

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

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

Health Status - Children .................................................................................29

Health Status.. ........................................................................................30

Vaccine-Preventable Diseases ...............................................................31

Pediatric AIDS .........................................................................................32

Hospitalization.........................................................................................33

Hospitalization Trends .............................................................................34

Abuse and Neglect..................................................................................35

Child Mortality..........................................................................................36

Childhood Deaths Due to Injury ..............................................................37

Health Status - Adolescents ...........................................................................39

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

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

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

Adolescent and Young Adult HIV/AIDS ...................................................43

Physical Activity.......................................................................................45

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

Cigarette Smoking...................................................................................47

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

Violence.......... ........................................................................................49

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

Adolescent Mortality from Traffic and Firearm Injuries ............................51

Health Services Financing and Utilization .................................................53

Health Care Financing.............................................................................54

Adequacy of Health Insurance Coverage................................................55

Vaccination Coverage .............................................................................56

Immunization Coverage ..........................................................................57

Mental Health Treatment.........................................................................58

Dental Care .............................................................................................59

Timing of Health Care Visits ....................................................................60

Preventive Health Care Visits..................................................................61

Usual Place for Sick Care .......................................................................62

Emergency Department Utilization..........................................................63

Prenatal Care ..........................................................................................65

State Data.......................................................................................................67

SCHIP Enrollment ..................................................................................68

Medicaid Enrollment and EPSDT Utilization ...........................................69

Health Insurance Status ..........................................................................70

Health Insurance Status (Map)................................................................71

Low Birth Weight, Preterm Birth, and Births to Unmarried Women.........72

Infant and Neonatal Mortality ..................................................................73

City Data ........................................................................................................75

Birth Weight.............................................................................................76

Infant Mortality.........................................................................................77

References .....................................................................................................78

Contributors...................................................................................................80

Child Health USA 2008-2009

Preface 5

Preface

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

(MCHB) is pleased to present Child Health USA 

2008-2009, the 19th annual report on the health 

status and service needs of America’s children. 

MCHB’s vision is that of 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 long-term trends 

where applicable and feasible. 

This edition of Child Health USA combines 

2 calendar years in order to provide more timely data for public use. All of the data discussed 

within the text of these pages are from the same 

sources as the information in the corresponding 

graphs, unless otherwise noted. Data are presented for the target populations of Title V Maternal 

and Child Health Block Grant funding: infants, 

children, adolescents, children with special health 

care needs, and women of childbearing age. Child 

Health USA 2008-2009 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 published 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 information 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 2008-2009

Introduction 7

Introduction

The health of the current child population 

reflects the overall health of the Nation and has 

important implications for the future as these 

children grow into adults. Many childhood issues—including weight, smoking, oral health, and 

vaccination coverage—can affect health throughout the lifespan. In 2008, nearly 25 percent of 

the United States population was under 18 years 

of age. Overall, the parents of 84.4 percent of 

children reported their children to be in excellent 

or very good health in 2007, but that percentage was lower for older children. The health and 

well-being of these children, and that of the entire Nation, depends on preventive services, such 

as prenatal care and immunization, as well as the 

promotion of healthy life choices. These measures 

help ensure that children are born healthy and 

maintain good health as they grow up.

Good health begins even before birth. Timely 

prenatal care is an important preventive strategy 

that can help protect the health of both mother 

and child. Entry into prenatal care during the 

first trimester has been increasing, reaching 83.2 

percent of pregnant women in 2005 (this is according to data from areas using the “unrevised” 

birth certificate—for more information, please 

see page 65). A small proportion of women (3.6 

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. 

Several other indicators of maternal health are 

included in Child Health USA. For instance, data 

are presented on maternal age, which can affect 

the health of both infant and mother. In 2006, 

births to women aged 15-19 years increased for 

the first time in 15 years to 41.9 births per 1,000 

females in this age group; this is still significantly 

lower than the most recent peak (61.8 per 1,000 

in 1991). The average age at first birth among 

women in the United States was 25.0 years. 

A number of family and neighborhood factors can also affect the health and well-being of 

children and the larger community. In 2007, 71.0 

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 

(63.3 percent). In 2005, 60 percent of children 

under 6 years of age required care from someone 

other than a parent at least once a week. The 2007 

National Survey of Children’s Health measured a 

number of neighborhood amenities available to 

children: 46.7 percent of children were reported 

to have all four of the listed amenities (sidewalks 

or walking paths, a park or playground, a community or recreation center, and a library or 

bookmobile), while 4.5 percent of children had 

none of those neighborhood amenities. Additionally, 28.6 percent of children were reported to live 

in neighborhoods with at least one of three specific indicators of poor neighborhood conditions, 

such as litter, vandalism, or dilapidated housing. 
Child Health USA 2008-2009

8 Introduction

Child Health USA also provides information 

regarding the health of infants and young children. Healthy birth weight is an important indicator of infant health, and emerging evidence indicates that birth weight may affect children into 

adulthood. Children born very low birth weight 

are significantly more likely to die in the first year 

of life than children of healthy birth weight, and 

those who survive are at particularly high risk 

for health complications. In 2006, 8.3 percent 

of infants were born low birth weight (less than 

2,500 grams, or 5 pounds 8 ounces). Although 

the number of multiple births, which are more 

likely to result in low birth weight, are on the 

rise, the low birth weight rate among singletons 

is rising as well. Very low birth weight (less than 

1,500 grams, or 3 pounds 4 ounces) represented 

1.5 percent of live births in 2006. Although maternal and infant mortality rates have dropped 

dramatically in the last century, the United States 

still has one of the highest rates of infant death 

in the industrialized world (6.7 deaths per 1,000 

live births). 

Breastfeeding can support the health of infants and mothers, 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. 

Vaccination is a preventive health measure 

that protects children into adulthood. Vaccines are available for a number of public health 

threats, including measles, mumps, rubella (German measles), polio, diphtheria, tetanus, pertussis (whooping cough), and H. Influenzae type b 

(a meningitis bacterium). In 2006, 80.5 percent 

of children aged 19-35 months had received this 

recommended series of vaccines; 76.9 percent of 

children received the recommended series plus 

the varicella (chicken pox) vaccine.

Physical activity is another important protective factor in lifelong health, with habits that can 

be formed early in childhood. Results from the 

2007 Youth Risk Behavior Surveillance System 

indicate that 34.7 percent of high school students 

met the levels of physical activity recommended 

at the time, and 24.9 percent of students did not 

participate in 1 hour or more of physical activity 

in the past week.

Mental health is another important health issue among children. In 2005-2006, the parents 

of 11.2 percent of girls aged 4-17 years and 17.6 

percent of boys in that age group had talked to a 

health care provider or school staff about emotional or behavioral difficulties. Overall, 4.2 

percent of girls and 6.4 percent of boys received 

treatment for these difficulties (not including 

children who received medication only). 

The period of adolescence brings age-specific 

health issues that need to be monitored and addressed. In 2007, 47.8 percent of high school 

students reported ever having had sexual intercourse. Although sexual activity increased with 
Child Health USA 2008-2009

Introduction 9

grade level, condom use decreased: among 9th 

grade students, 20.1 percent were sexually active, 

two-thirds of whom used condoms, while 52.6 

percent of 12th grade students were sexually active, half of whom used condoms. 

With sexual activity comes the risk of sexually 

transmitted infections (STIs). Adolescents (aged 

15-19) and young adults (aged 20-24 years) are 

at much higher risk of contracting STIs than are 

older adults. Chlamydia continues to be one of 

the most common STIs among adolescents and 

young adults, with rates of 1,674 and 1,796 per 

100,000, respectively, in 2006. Gonorrhea followed in prevalence with overall rates of 459 and 

528 per 100,000 among adolescents and young 

adults, respectively. Cases of genital human papillomavirus (HPV) are not currently tracked by the 

Centers for Disease Control and Prevention, but 

it is believed to be the most common STI in the 

United States. It is estimated that 24.5 percent 

of females aged 14-19 years and 44.8 percent of 

females aged 20-24 years had an HPV infection 

in 2003-2004. 

Violence also threatens the health of adolescents. The 2007 Youth Risk Behavior Surveillance indicates that 18.0 percent of high school 

students had carried a weapon at some point during the month preceding the survey. Males were 

about four times as likely as females to carry a 

weapon (28.5 versus 7.5 percent), with nonHispanic White males being the most likely to 

do so (30.3 percent). The survey also showed that 

12.4 percent of students had been in a fight on 

school property in the past year; this was most 

common among non-Hispanic Black males (20.0 

percent). 

With regard to substance use, 9.5 percent of 

adolescents aged 12-17 years reported using illicit drugs in the past month. Rates were highest among children aged 16-17 years (16.0 percent). Alcohol was the most commonly used drug 

among adolescents, with 15.9 percent reporting 

past month use. 

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 drugfree 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 2008-2009

Population Characteristics 11

Population Characteristics

The population of the United States is be-

coming increasingly diverse, which 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 non-Hispanic 

White has declined. The percentage of chil-

dren 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, pol-

icymakers use population information to ad-

dress health-related issues that affect mothers, 

children, and families. By carefully analyzing 

and comparing available data, public health 

professionals can often identify high-risk pop-

ulations that require specific interventions.

This section presents data on several popu-

lation characteristics that influence maternal 

and child health program development and 

evaluation. Included are data on the age and 

racial and ethnic distribution of the U.S. pop-

ulation, as well as data on the poverty status of 

children and their families, child care arrange-

ments, and school dropout rates.
Child Health USA 2008-2009

12 Population Characteristics

Population of Children

In 2007, there were an estimated 75.2 million children under 18 years of age in the United 

States, representing nearly 25 percent of the population. Young adults aged 20-24 years composed 

7 percent of the population, while adults aged 

25-64 years composed over 53 percent of the 

population, and adults aged 65 years and older 

composed over 12 percent.

Since the 2000 Census, the number of children under 5 years of age has risen 8 percent, 

while the numbers of children aged 5-9 and 10-

14 years have fallen 3.4 percent and 1.0 percent, 

respectively. The number of adolescents aged 15-

19 years of age has risen just over 6 percent, while 

the number of young adults aged 20-24 years has 

risen nearly 11 percent. The number of adults 

aged 25-64 years has risen over 9 percent since 

the 2000 Census, and the number of adults aged 

65 years and older has risen more than 8 percent 

in the same period (data not shown). 

The racial/ethnic makeup of the child population reflects the increasing diversity of the population over the past several decades. Hispanic 

children represented 9 percent of all children 

in 1980, compared to more than 20 percent in 

2007; Asian/Pacific Islander children represented 

2 percent of all children in 1980, but more than 

4 percent in 2007. While the percentage of children who are Hispanic or Asian/Pacific Islander 

has more than doubled since 1980, the percentage who are non-Hispanic White has declined, 

and the percentage who are Black has remained 

relatively stable. 

Population of Children Under Age 18, by Race/Ethnicity, 2007

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

U.S. Population, by Age Group, 2007

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

65 Years 

and Older

12.6%

25–64 Years

53.2%

20–24 Years 7.0%

15–19 Years 7.1%

10–14 Years 6.7%

5–9 Years 6.6%

Under 5 Years 6.9%

Non-Hispanic

White 56.0%

Black 

15.2%

Hispanic

 20.5%

American Indian/

Alaska Native 1.1%

Asian/Pacific Islander 4.3%

Two or More Races 2.9%
Child Health USA 2008-2009

Population Characteristics 13

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 2007, nearly 22 percent of children 

living in the United States had at least one foreign-born parent. Of all children, 18.3 percent 

were U.S.-born with a foreign-born parent or 

parents, and 3.6 percent of children were themselves foreign-born. Most children (74.4 percent) 

were native-born with native-born parents. 

Children’s poverty status varies noticeably 

with nativity. In 2007, foreign-born children of 

foreign-born parents were most likely to live in 

households with incomes below 100 percent of 

the poverty threshold (25.6 percent) and 100-199 

percent of the poverty threshold (31.8 percent). 

In comparison, only 15.8 percent of native-born 

children of native-born parents lived below 100 

percent of the poverty threshold.

A number of other sociodemographic indicators vary by children’s nativity. For instance, 

native-born children with native-born parents 

were the most likely to have health insurance in 

2007 (91.7 percent), while foreign-born children 

of foreign-born parents were the least likely to be 

insured (59.1 percent). Just over 83 percent of native-born children with foreign-born parents had 

health insurance coverage (data not shown).1

1 The U.S. Census Bureau poverty threshold was $21,203 for 

a family of four in 2007. Following the Office of Management and Budget’s Statistical Policy Directive 14, the Census 

Bureau uses a set of money income thresholds that vary by 

family size and composition to determine who is in poverty.

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

and Parent(s),** 2007

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

*The U.S. Census Bureau poverty threshold for a family of four was $21,203 in 2007. **“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),* 2007

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

25.6 31.8 42.6

15.8 18.9 65.3

19.9 29.6 50.5

Other 3.7%

Foreign-Born Child

and Parent

3.6%

Native Child,

Foreign-Born Parent

18.3%

Native Child 

and Parent

74.4% 

Foreign-Born

Child and Parent

Native Child,

Foreign-Born Parent

Native Child

and Parent

Below 100% 

of Poverty

100–199% 

of Poverty

200% of Poverty 

and Above

Percent of Children
Child Health USA 2008-2009

14 Population Characteristics

CHILDREN IN POVERTY

In 2006, nearly 13 million children under 18 

years of age lived in households with incomes below the poverty threshold ($20,614 for a family 

of 4 in 2006); this represents 17.4 percent of all 

children in the United States. 

Poverty affects many aspects of a child’s life, 

including living conditions, access to health care, 

and adequate nutrition, all of which contribute 

to health status. Black and Hispanic children are 

particularly vulnerable to poverty. In 2006, 33.4 

percent of Black children and 26.9 percent of Hispanic children lived in households with incomes 

below the poverty threshold, compared to 10.0 

percent of non-Hispanic White children. Over 

the past two decades, the percentage of children 

in poverty has dropped noticeably among the 

Black population, while it has remained relatively 

constant among Whites.

Single-parent families are also particularly vulnerable to poverty: of children living in households with incomes below 100 percent of the 

poverty threshold in 2006, 59.6 percent lived in 

a female-headed household. However, children 

living in a female-headed household made up 

only 24.1 percent of the overall child population. 

Overall, 42.0 percent of children living with a female householder and 20.3 percent of children 

living with a male householder were living in poverty in 2006 (data not shown).

Children Under Age 18 Living in Households with Incomes Below

100 Percent of Poverty Threshold,* by Race/Ethnicity,** 1976–2006

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

Total

*The U.S. Census Bureau poverty threshold for a family of four was $20,614 in 2006. 

**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 Households with Incomes

Below 100 Percent of Poverty Threshold,* by Family Type, 2006

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

1976 1980 1984 1988 1992 1996 2004 2006

33.4

26.9

10.0

17.4

Non-Hispanic White

Black

Hispanic

*The U.S. Census Bureau poverty threshold for a family of four was $20,614 in 2006.

Married-Couple 

Families

33.9%

Female Householder,

No Husband Present

59.6%

Male Householder,

No Wife Present

6.5%

50

40

30

20

10
Child Health USA 2008-2009

Population Characteristics 15

SCHOOL DROPOUTS

As of October 2006, there were nearly 3.5 million high school status dropouts1

 in the United 

States, representing 9.3 percent of the population 

aged 16-24 years. The dropout rate has generally 

declined over the past several decades, and after 

a slight increase in 2004, reached a new low in 

2006. This represents a decline in status dropouts 

of over 35 percent since 1972.

Historically, Hispanic students have had higher dropout rates than youth of other races and 

ethnicities: in 2006, 22.1 percent of Hispanics 

aged 16-24 years were status dropouts compared 

to 5.8 percent of non-Hispanic Whites and 10.7 

percent of non-Hispanic Blacks. The high rate 

among Hispanics, overall, is partly due to the 

high dropout rate among Hispanics born outside 

of the United States (36.2 percent). First generation Hispanics—those born in the United States 

but having at least one parent born outside of the 

country—have a much lower dropout rate (12.3 

percent) than do Hispanics who were born in the 

United States to American-born parents (12.1 

percent; data not shown).

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

unemployed and, when they are employed, earn 

less than those who completed high school. In 

addition, the National Center for Education Statistics indicates that those who did not complete 

high school reported worse health outcomes than 

their peers who did complete high school, as well 

as reduced access to medical care and higher rates 

of uninsurance.2

1 “Status dropouts” refer to 16- to 24-year-olds who are not enrolled in school and have not earned high school credentials 

(diploma or equivalent). 

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

2006 with Chartbook on Trends in the Health of Americans. Hyattsville, MD: 2006.

10.7

22.1

Percent of Population School Status Dropout* Rates Among Persons Aged 16–24, by Race/Ethnicity, 1992–2006

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

5.8

9.3

Non-Hispanic White

To Non-Hispanic Black tal

Hispanic

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

1992 1994 1996 1998 2000 2002 2004 2006

40

35

30

25

20

15

10

5
Child Health USA 2008-2009

16 Population Characteristics

Maternal age

According to preliminary data, the general fertility rate rose to 69.5 live births per 1,000 women 

aged 15-44 years in 2007. The birth rate among 

teenagers aged 15-19 years rose for the second year 

in a row, to 42.5 births per 1,000 females in this age 

group. This rate is still 31 percent lower than the 

most recent peak, reported in 1991 (61.8 births per 

1,000). In 2007, the highest birth rate was among 

women aged 25-29 years (117.5 births per 1,000), 

followed by women aged 20-24 years (106.4 births 

per 1,000). Birth rates for women aged 30-34 years 

(99.9 births per 1,000) and 35-39 years (47.5 per 

1,000) were the highest reported in over four decades. The birth rate for women aged 40-44 years 

was 9.5 births per 1,000, an increase of more than 

70 percent since 1990 (data not shown).

In 2007, 3.4 percent of births were to minors 

under 18 years of age, and another 7.1 percent 

were to teenagers aged 18-19 years. Just over onequarter of births occurred among young adults 

aged 20-24 years, and exactly one-half were to 

women aged 25-34 years. Another 11.6 percent of 

births were to women aged 35-39 years, and 2.6 

percent of births were to women aged 40-54 years. 

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). 

Age distribution of births varies by race/ethnicity. Among non-Hispanic Black and Hispanic 

women, 17.4 percent and 14.2 percent of births, 

respectively, were to teenagers, compared to 7.5 

percent among non-Hispanic Whites. The percentage of births to young adults aged 20-24 years 

was also higher among non-Hispanic Black and 

Hispanic women (31.9 percent and 28.7 percent, 

respectively) than among non-Hispanic White 

women (22.8 percent). However, non-Hispanic 

White women had higher birth rates than nonHispanic Black and Hispanic women in each of 

the older age categories. 

Distribution of Births, by Race/Ethnicity and Maternal Age, 2007*

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

40-54 Years

 2.9% 35-39 Years

 13.0%

25-34 Years

 53.7%

20-24 Years

 22.8%

18-19 Years

 5.5%

Under 18

Years 2.0%

Non-Hispanic White Non-Hispanic Black Hispanic

40-54 Years

 2.1%

35-39

 Years

 8.1%

25-34 Years

 40.6%

20-24 Years

 31.9%

18-19 Years

11.2%

Under

 18 Years

 6.2% 40-45 Years

 2.0% 35-39

 Years

 9.0%

25-34 Years

 46.0%

20-24 Years

 28.7%

18-19 Years

 8.9%

Under 18

 Years

 5.3%

*Preliminary data
Child Health USA 2008-2009

Population Characteristics 17

working mothers and

child care

In 2007, 71.0 percent of women with children under 18 years of age were in the labor force 

(either employed or looking for work) and 67.8 

percent were employed. Of mothers with children under 6 years of age, 63.3 percent were in 

the labor force and 59.6 percent were employed. 

Of women with children aged 6-17 years, 77.2 

percent were in the labor force and 74.3 percent 

were employed.

Employed mothers with children aged 6-17 

years were more likely to be employed full-time 

than women with younger children (77.8 percent versus 72.5 percent). Married mothers with 

a spouse present were less likely to be in the labor 

force than women of other marital statuses (68.8 

percent versus 76.5 percent). Married mothers 

who were in the labor force, however, were more 

likely than mothers of other marital statuses to be 

employed: the unemployment rate among married mothers was only 3.0 percent, compared to a 

rate of 8.0 percent among mothers of other marital statuses (data not shown). 

In 2005, 40 percent of children under 6 years 

of age did not require nonparental child care, 

while 60 percent required at least one child care 

arrangement. Overall, 60 percent of children 

with at least one child care arrangement received 

center-based care, 22 percent received care from 

a nonrelative, and 35 percent received care from 

a relative other than a parent (data not shown). 

Among children who received child care, 56.9 

percent of children aged 3-5 years received center-based care compared to 22.8 percent of children aged 1-2 years and 11.8 percent of children 

under 1 year of age.

Weekly Child Care Arrangements* for Children Under Age 6,**

by Age, 2005

Source (1.7): U.S. Department of Education, National Center for Education Statistics

63.3

77.2 With Children Aged 6–17

Percent of Mothers Mothers in the Labor Force,* by Age of Child, 1975−2007

Source (1.6): U.S. Department of Labor, Bureau of Labor Statistics

Percent of Children

10

20

30

40

50

60

70

80 Under 1 Year

1–2 Years

3–5 Years

47.0

27.0

58.0

20.2 20.7 21.2

15.9

11.0 13.9 11.8

22.8

56.9 With Children Under Age 6

*Percents may equal more than 100 because children may have more than one type of nonparental

care arrangement. **Includes only children not yet enrolled in kindergarten.

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

employment.

No Nonparental

Arrangements Relative Care Nonrelative Care Center-BasedCare

10

40

50

60

70

80

1975 1980 1985 1990 1995 2000 2005 2007
Child Health USA 2008-2009

18 Population Characteristics

NEIGHBORHOOD 

CHARACTERISTICS

The environment in which a child grows up 

can affect his or her physical health, social and 

emotional functioning, and cognitive development. The availability of neighborhood amenities, such as playgrounds, community centers, and 

libraries provides children with opportunities to 

be active and engaged in the broader community. 

Poor conditions, however, such as dilapidated 

housing, vandalism, and litter or garbage on the 

street may have an adverse impact, either directly 

or indirectly, on a child’s overall well-being.

In 2007, 46.7 percent of children lived in 

neighborhoods that had four neighborhood amenities, including sidewalks, parks or playgrounds, 

recreation or community centers, and a library, 

while 28.6 percent of children lived in neighborhoods with at least one indicator of poor conditions, such as vandalism, litter on the street, or 

dilapidated housing. 

The percentage of children living in neighborhoods with amenities and poor conditions varied 

significantly by poverty status. Among children 

with household incomes of 100 percent or less 

of the Federal Poverty Level (FPL), 39.5 percent 

lived in neighborhoods with four neighborhood 

amenities, compared to 46.7 percent of children 

with household incomes of 201-400 percent FPL 

and 54.2 percent of children with incomes of 

more than 400 percent FPL.

Non-Hispanic Black children were most likely 

to live in neighborhoods with one or more poor 

conditions (37.0 percent), and Hispanic children 

were second most likely (33.5 percent). Non-Hispanic White children were least likely to live in 

neighborhoods with one or more poor conditions 

(24.4 percent).

Children Under Age 18 with Four Neighborhood Amenities,* 

by Poverty Status,** 2007

Source (I.8): 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

46.7

39.5 42.7 46.7

54.2

Children Under Age 18 with One or More Poor Neighborhood 

Conditions,* by Race/Ethnicity, 2007

Source (I.8): 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

24.4

37.0 33.5

28.6 28.2

10

20

30

40

50

60

More than 

400% FPL

201-400% 

FPL

101-200% 

FPL

100% or

Less FPL

Total

10

20

30

40

50

60

Non-Hispanic 

Other

Non-Hispanic Hispanic

Black

Non-Hispanic 

White

Total

*Conditions include litter or garbage on the street or sidewalk; poorly kept or dilapidated housing;

and vandalism. 

*Amenities include sidewalks or walking paths; park or playground area; recreation center, 

community center or boys’ or girls’ club; and library or bookmobile. **Federal Poverty Level (FPL) 

was equal to $20,650 for a family of four in 2007; FPL is set by the U.S. Department of Health and 

Human Services for determining income eligibility in public assistance programs.
Child Health USA 2008-2009

Health Status 19

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 ba-

sis, some surveillance systems collect data at 

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

can be identified by examining and compar-

ing 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 

maternal and child populations that are affected by, or in need of, specific health services 

or interventions.
Health Status - Infants
Child Health USA 2008-2009

Health Status - Infants 21

Breastfeeding

Breastfeeding has been shown to promote the 

health and development of infants, as well as their 

immunity to disease, and may provide a number 

of maternal health benefits. For this reason, 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 of life. 

Breastfeeding initiation rates in the United 

States have increased steadily since the early 

1990s. In 2007, the parents of 75.5 percent of 

children aged newborn to 5 years reported that 

the child had ever been breastfed. Hispanic children were most likely to have been breastfed 

(82.4 percent), followed by children of other races, including Asian/Pacific Islanders and Native 

Americans/Alaska Natives (82.2 percent). NonHispanic Black children were the least likely to be 

breastfed (55.5 percent). Breastfeeding rates tend 

to increase with maternal age, higher educational 

achievement, and higher income. 

Rates of exclusive breastfeeding are significantly lower than rates of breastfeeding initiation. 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 the first 6 

months of life. The rate of exclusive breastfeeding varied by family income, with 10.6 percent of 

children with family incomes below 100 percent 

of the Federal Poverty Level (FPL) being exclusively breastfed through 6 months, compared to 

14.7 percent of children with family incomes of 

400 percent FPL or above. Exclusive breastfeeding rates have not shown the same improvement 

over time as have breastfeeding initiation rates, 

and as with breastfeeding initiation, exclusive 

breastfeeding varies by a number of demographic 

and socioeconomic factors, such as maternal age 

and education.

Breastfeeding* among Children Under Age 6, by Race/Ethnicity,

2007

Source (I.8): 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

70

80

90

100

Non-Hispanic

Other Races**

Non-Hispanic

Multiple Races

Non-Hispanic Hispanic

 Black

Non-Hispanic

 White

Total

*Ever breastfed. **Includes Asian/Pacific Islanders, American Indian/Alaska Natives, and children of other races.

Exclusive* Breastfeeding among Children Aged 6 Months to

5 Years, by Income, 2007

Source (I.8): 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

70

80

90

100

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

*Fed only breast milk for the first 6 months of life. **The Federal Poverty Level, as determined by the 

U.S. Department of Health and Human Services, was $20,650 for a family of four in 2007.

12.4 10.6 10.9 12.8 14.7

75.5

82.2

74.0

82.4

55.5

76.7
Child Health USA 2008-2009

22 Health Status - Infants

Low birth weight

Low birth weight is one of the leading causes of 

neonatal mortality (death before 28 days of age). 

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

year of life than are infants of normal weight.

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 2007; this 

represents a slight decrease from the rate recorded 

in 2006 (8.3 percent), which was the sixth consecutive year of increase and the highest rate recorded 

in four decades. 

The increase in multiple births, more than half 

of which are delivered at less than 2,500 grams, 

has strongly influenced the increase in low birth 

weight; however, rates of low birth weight are also 

on the rise for singleton births. 

In 2007, the low birth weight rate was much 

higher among infants born to non-Hispanic Black 

women (13.8 percent) than among infants of other 

racial/ethnic groups. The next highest rate, which 

occurred among infants born to Asian/Pacific Islanders, was 8.1 percent, followed by a rate of 7.5 

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 (6.9 percent). The low birth weight 

rate remained steady or decreased for infants born 

to mothers of all racial/ethnic groups in 2007. 

Low birth weight also varied by maternal age. 

In 2006 (the latest year for which data are available), the rate of low birth weight was highest 

Low Birth Weight Among Infants, by Maternal Race/Ethnicity, 1990−2007*

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

Statistics System

13.8

8.1

8.2

7.5

7.2

Non-Hispanic Black

Non-Hispanic White

Percent of Infants

6.9

Asian/Pacific Islander

American Indian/

Alaska Native

Hispanic

5

6

7

8

9

10

11

12

13

14

15

1990 1992 1994 1996 1998 2000 2002 2004 2006

All Races

*Data for 2007 are preliminary.

among babies born to women aged 40-54 years 

(20.3 percent), followed by babies born to women 

under 15 years of age (13.4 percent.) The lowest 

rates occured among babies born to mothers aged 

25-29 years and 30-34 years (7.5 and 7.6 percent, 

respectively; data not shown).
Child Health USA 2008-2009

Health Status - Infants 23

Very low birth weight

According to preliminary data, 1.5 percent of 

live births were among very low birth weight infants (less than 1,500 grams, or 3 pounds 4 ounces) in 2007. The proportion of very low birth 

weight infants has slowly climbed from just over 

one percent in 1980.

Infants born at such low birth weights are approximately 100 times more likely to die in the 

first year of life than are infants of normal birth 

weight (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 and a half times more likely 

than infants born to mothers of other racial/

ethnic groups to be born very low birth weight. 

Among infants born to non-Hispanic Black 

women, 3.2 percent were very low birth weight in 

2006, compared to 1.1 percent of infants born to 

Asian/Pacific Islander women, 1.2 percent of infants born to non-Hispanic Whites and Hispanics, and 1.3 percent of infants born to 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.

In 2006 (the latest year for which data are are 

available), the rate of very low birth weight was 

highest among babies born to mothers aged 45-

Very Low Birth Weight Among Infants, by Race/Ethnicity, 1990−2007*

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

Statistics System

3.2

1.2

1.1

1.3

Non-Hispanic White 1.5

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

All Races

*Data for 2007 are preliminary.

54 years (3.5 percent). Mothers under 15 years of 

age also had high rates of very low birth weight 

(3.1 percent.) The rate was lowest among mothers 

aged 25-29 years (1.3 percent; data not shown).
Child Health USA 2008-2009

24 Health Status - Infants

Maternal Mortality

The rate of maternal mortality in the United 

States declined dramatically over the last century; 

however, an increase in the rate has become evident in the past several decades. In 2006, the maternal mortality rate was 13.3 deaths per 100,000 

live births, compared to a low of 6.6 in 1987. 

Some of this increase may be due to changes in 

the coding and classification of maternal deaths. 

In 2006, there were a total of 569 maternal 

deaths (those resulting from complications during pregnancy, childbirth, or direct or indirect 

obstetric causes up to 42 days after delivery or 

termination of pregnancy). The maternal mortality rate among non-Hispanic Black women was 

more than 3 times the rate among non-Hispanic 

White women (34.8 versus 9.1 per 100,000). 

The risk of maternal death increases with 

age, regardless of race or ethnicity. In 2006, the 

maternal mortality rate of women aged 35 years 

and over (29.3 per 100,000) was nearly 3 times 

the rate of women aged 20-24 years (10.2 per 

100,000) and nearly 6 times the rate of women 

under 20 years of age (5.0 per 100,000). 

Maternal Mortality Rates, by Race/Ethnicity, 2006

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

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

13.3

9.1

34.8

10.2

Maternal Mortality Rates, by Age, 2006

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

5.0

10.2 11.7 12.6

29.3

5

10

15

20

25

30

35

40

Total Non-Hispanic White Non-Hispanic Black Hispanic 

5

10

15

20

25

30

35

40

Under 20 Years 20-24 Years 25-29 Years 30-34 Years 35 Years and Older

Causes of maternal death are classified as direct, indirect, or unspecified. Some of the most 

common direct causes include complications related to the puerperium, or period immediately 

after delivery (2.6 per 100,000), eclampsia and 

preclampsia (1.3 per 100,000), and hemorrhage 

(0.9 per 100,000). Indirect causes occured at a 

rate of 3.0 per 100,000 in 2006, and comprised 

deaths from pre-exiting conditions complicated 

by pregnancy.
Neonatal and

Postneonatal Mortality

Neonatal. In 2006, 18,989 infants died before 

reaching 28 days of age, representing a neonatal 

mortality rate of 4.5 deaths per 1,000 live births. 

This rate remains unchanged from the previous 

year.

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.

Child Health USA 2008-2009

Health Status - Infants 25

Neonatal mortality rates vary by race and 

ethnicity. In 2006, the neonatal mortality rate 

among non-Hispanic Black infants was 9.1 per 

1,000 live births, more than twice the rate among 

non-Hispanic White and Hispanic infants (3.7 

and 3.8 per 1,000, respectively).

Postneonatal. In 2006, 9,538 infants died 

between the ages of 28 days and 1 year, representing a postneonatal mortality rate of 2.2 deaths 

per 1,000 live births. This rate is slightly lower 

than the rate of 2.3 deaths per 1,000 live births 

reported in 2005.

Postneonatal mortality is generally related to 

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

Postneonatal mortality varies by race and ethnicity. In 2006, the highest rate of postneonatal mortality was reported among non-Hispanic Black 

infants (4.7 per 1,000). Non-Hispanic White 

and Hispanic infants had rates of 1.9 and 1.7 per 

1,000, respectively. 

Neonatal Mortality Rates, by Maternal Race/Ethnicity, 2006

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

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

4.5

3.7

9.1

3.8

Postneonatal Mortality Rates, by Maternal Race/Ethnicity, 2006

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

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

2.2 1.9

4.7

1.7 2

4

6

8

10

Total Non-Hispanic White Non-Hispanic Black Hispanic

2

4

6

8

10

Total Non-Hispanic White Non-Hispanic Black Hispanic
Child Health USA 2008-2009

26 Health Status - Infants

Infant Mortality

In 2006, 28,527 infants died before their first 

birthday, representing an infant mortality rate 

of 6.7 deaths per 1,000 live births. The leading 

cause of infant mortality was congenital anomalies, which accounted for 20 percent of deaths, 

followed by disorders related to short gestation, which accounted for another 17 percent of 

deaths.

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. However, the decades-long decline 

in infant mortality began to level off in 2000, and 

the rate has remained relatively steady in the years 

since.

In 2006, the mortality rate among non-Hispanic Black infants was 13.8 deaths per 1,000 

live births. This is two and one-half times the rate 

among non-Hispanic White and Hispanic infants 

(5.6 and 5.5 per 1,000, respectively). Although 

the infant mortality rates among both non-Hispanic 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 Healthy 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, 1985–2006

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

Vital Statistics System

13.8

6.7

5.6

5.5

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 2006
International Infant 

Mortality

In 2005, the United States infant mortality 

rate ranked below that of many other industrialized nations, with a rate of 6.9 deaths per 1,000 

live births. This represents a slight increase from 

the rate of 6.8 per 1,000 in 2004, but is still 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. However, some of these differences may be 

due, in part, to the international variation in the 

definition, reporting, and measurement of infant 

mortality.

In 2005, the U.S. infant mortality rate was 

more than twice that of seven other industrialized countries, including Singapore, Hong Kong, 

Sweden, Japan, Finland, Norway, and the Czech 

Republic. Singapore had the lowest rate (2.1 per 

1,000), followed by Hong Kong and Sweden (2.4 

per 1,000).

Child Health USA 2008-2009

Health Status - Infants 27

International Infant Mortality Rates, Selected Countries, 2005

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

Deaths per 1,000 Live Births

 2.1

 2.4

 2.4

 2.8

 3.0

 3.1

 3.4

 3.5

 3.6

 3.7

 3.8

 3.9

 4.0

 4.1

 4.2

 4.2

 4.4

 4.6

 4.7

 4.9

 5.0

 5.0 

 5.1

 5.2

 5.4

 6.2

 6.2

 6.3

 6.9

12345678

United States

Northern Ireland

Hungary

Cuba

Canada

Scotland

New Zealand

England and Wales

Australia

Netherlands

Italy

Israel

Denmark

Austria

Switzerland

Spain

Ireland

Germany

Greece

Belgium

France

Portugal

Czech Republic

Norway

Finland

Japan

Sweden

Hong Kong

Singapore

Health Status - Children 
Child Health USA 2008-2009

30 Health Status - Children

HEALTH STATUS

The general state of a child’s health as perceived by their parents is a useful measure of the 

child’s overall health and ability to function. The 

2007 National Survey of Children’s Health asked 

parents to rate their child’s health status as excellent, very good, good, fair, or poor. Overall, the 

parents of 84.4 percent of children under 18 years 

of age reported that their child’s health was excellent or very good. This varied, however, by the 

child’s race and ethnicity.

Non-Hispanic White children and non-Hispanic children of multiple races were most likely 

to be reported in excellent or very good health 

(91.0 and 87.9 percent, respectively), followed by 

non-Hispanic children of other races (85.3 percent). Hispanic children were least likely to be 

reported in excellent or very good health (68.4 

percent). Slightly more than 80 percent of nonHispanic Black children were reported in excellent or very good health.

Parents were also asked to rate the condition 

of their child’s teeth as excellent, very good, good, 

fair, or poor. Overall, the parents of 70.7 percent 

of children aged 1-17 reported that their child’s 

teeth were in excellent or very good condition 

(the question was not asked of children under 1 

year of age). 

The child’s oral health status also varied with 

race and ethnicity. More than 80 percent of nonHispanic White children and 76.9 percent of 

non-Hispanic children of multiple races were reported to have excellent or very good oral health, 

compared to 62.5 percent of non-Hispanic Black 

children and 49.3 percent of Hispanic children.

Children Under Age 18 in Excellent or Very Good Health, 

by Race/Ethnicity, 2007

Source (I.8): 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

84.4 91.0

80.4

68.4

87.9 85.3

Children Under Age 18 in Excellent or Very Good Oral Health, 

by Race/Ethnicity, 2007

Source (I.8): 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

80.5

62.5

49.3

76.9

68.6

70.7

20

40

60

80

100

Non-Hispanic 

Other Races*

Non-Hispanic 

Multiple Races

Non-Hispanic Hispanic

Black

Non-Hispanic 

White

Total

20

40

60

80

100

Non-Hispanic 

Other Races*

Non-Hispanic 

Multiple Races

Non-Hispanic Hispanic

Black

Non-Hispanic

 White

Total

*Includes Asian/Pacific Islander, American Indian/Alaska Natives, and children of other races. *Includes Asian/Pacific Islander, American Indian/Alaska Natives, and children of other races.
Child Health USA 2008-2009

Health Status - Children 31

VACCINE-PREVENTABLE

DISEASES

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

past several decades. In 2006, there were no reported cases of diphtheria or polio in the United 

States population, and no cases of tetanus among 

children under 5 years of age. Among children in 

this age group, there were also no reported cases 

of acquired rubella and only one case of congenital rubella.

From 2005 to 2006, the number of reported cases of hepatitis A and pertussis 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 October of 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 for 

children. With regard to pertussis, the number of 

cases among young children decreased by nearly 

50 percent over the previous year, although the 

CDC reports that this is likely due to the cyclical 

nature of the disease and not an increase in immunization. The highest reported rate occurred 

among infants under 6 months of age, a population that is too young to be fully vaccinated. 

While the number of reported cases of several 

vaccine-preventable diseases decreased between 

2005 and 2006, the number of reported cases of 

measles and H. Influenzae increased slightly. The 

number of reported cases of mumps increased 

by a factor of 17 due to an outbreak, which was 

largely focused in six contiguous Midwestern 

States. In response, the CDC updated criteria for 

mumps immunity and vaccination recommendations. Reported cases of hepatitis B remained virtually unchanged.

Reported Cases of Selected Vaccine-Preventable Diseases Among Children 

Under Age 5, 2006

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

Number of Reported Cases

0 

0 

0

1

6

16

146

369

383

3,344

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

Pertussis 

H. Influenzae 

Mumps

Hepatitis A

Measles

Hepatitis B

Rubella*

Tetanus

Polio 

Diphtheria 

*Congenital Rubella
Child Health USA 2008-2009

32 Health Status - Children

PEDIATRIC AIDS

Acquired immunodeficiency syndrome 

(AIDS) is caused by the human immunodeficiency virus (HIV), which damages or kills the cells 

that are responsible for fighting infection. AIDS is 

diagnosed when HIV has weakened the immune 

system enough that the body has a difficult time 

fighting infections. Through 2007, an estimated 

9,209 AIDS cases in children younger than 13 

had ever been reported in the United States. Pediatric AIDS cases represent less than one percent 

of all AIDS cases ever reported. 

In 2007, an estimated 28 new AIDS cases 

were diagnosed among children under age 13. 

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 and updated materials in 2004 to 

further promote universal prenatal HIV testing. 

It is expected that the perinatal transmission rate 

will continue to decline with increased use of 

treatments and obstetric procedures. 

Racial and ethnic minorities are disproportionately represented among pediatric AIDS 

cases. Non-Hispanic Black children account for 

over 60 percent of all pediatric AIDS cases ever 

reported, but compose only about 15 percent of 

the total U.S. population in this age group.

Estimated Numbers of AIDS Cases Ever Reported in Children

Under Age 13, by Race/Ethnicity, Through 2007*

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

Number of Cases

1,602

1,757

54

1,000 2,000 3,000 4,000 5,000 6,000

American Indian/

Alaska Native

Asian/Pacific Islander

Hispanic

Non-Hispanic Black

Non-Hispanic White

5,699

*Includes children with a diagnosis of AIDS from the beginning of the epidemic through 2007, but does not

include 58 children of unknown or multiple races.

Estimated Numbers of AIDS Cases in Children Under Age 13,

by Year of Diagnosis, 1992–2007

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

32

106 70 53 28 38

241

121

663

894

187

509

879

129

329

799

200

400

600

800

1000

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

53
Child Health USA 2008-2009

Health Status - Children 33

Hospitalization

In 2006, there were nearly 3.5 million hospital discharges among youth aged 1–21 years, 

equaling 4.0 hospital discharges per 100 children. 

Hospital discharge rates generally decrease with 

age until early adolescence, and then begin to increase. 

While injuries are the leading cause of death 

among children and adolescents older than 1 year 

of age, they were not the most common cause 

of hospitalization for any age group of children. 

In 2005-2006, diseases of the respiratory system 

were the most common cause of hospitalization 

for 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, 

accounting for 24 percent of discharges. Among 

adolescents and young adults aged 15-19 and 20-

21 years, pregnancy and childbirth was the most 

common cause of hospitalization, accounting for 

42 and 64 percent of discharges, respectively. 

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
Child Health USA 2008-2009

34 Health Status - Children

Hospitalization Trends

Four types of health problems—respiratory 

diseases, digestive diseases, injuries, and endrocrine, metabolic, and immunity diseases and 

disorders—accounted for 51 percent of hospital 

discharges among children aged 1-14 years in 

2006. Since 1985, overall hospital discharge rates 

for children in this age group have declined by 

38 percent, which is reflected in decreases in discharge rates for each of those three categories.

Between 1990 and 2006, hospital discharge 

rates for diseases of the respiratory system declined 26.4 percent for children aged 1-14 years 

(from 91 per 10,000 to a low of 67 per 10,000). 

During this period, the rate of discharges due to 

injury also declined, from 38 to 25 per 10,000, 

or 34.2 percent. Similarly, the hospital discharge 

rate among children for diseases of the digestive 

system dropped from 37 to 30 per 10,000, or 

19.0 percent. The rate of discharges due to endrocrine, metabolic, and immunity diseases and 

disorders, however, increased 36.8 percent, from 

19 to 26 per 10,000. This category of diseases 

and conditions includes thyroid gland disorders, 

diabetes, nutritional deficiencies, and overweight 

and obesity.

67.0

Hospital Discharges per 10,000 Children

Hospitalization Rates Among Children Aged 1–14, by Selected Diagnosis, 1990–2006

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

Hospital Discharge Survey

25.0

26.3

30.0

Diseases of the Digestive System

Injury

Diseases of the Respiratory System

10

20

30

40

50

60

70

80

90

100

1990 1992 1994 1996 1998 2000 2002 2004 2006

Endrocrine, Metabolic, and Immunity 

Diseases and Disorders
Child Health USA 2008-2009

Health Status - Children 35

ABUSE AND NEGLECT

State child protective services (CPS) agencies 

received approximately 3.3 million referrals, involving an estimated 6.0 million children, alleging abuse or neglect in 2006. More than half of 

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

personnel, police officers, medical personnel, and 

daycare providers.

Investigations determined that an estimated 

905,000 children were victims of abuse or neglect 

in 2006, equaling a victimization rate of 12.1 per 

1,000 children in the population. Neglect was the 

most common type of maltreatment (experienced 

by 64.1 percent of victims), followed by physical 

abuse (16.0 percent). Other types of abuse included sexual abuse, psychological maltreatment, 

medical neglect, and categories of abuse based on 

specific State laws and policies. Some children 

suffered multiple types of maltreatment.

Victimization rates were highest among 

young children. In 2006, the rate of victimization 

among children under 1 year of age was 24.4 per 

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

steadily as age increased (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. 

Almost 80 percent of perpetrators of abuse or 

neglect were parents of the victim. Remaining 

types of perpetrators included other relatives (6.7 

percent), unmarried partners of parents (3.8 percent), and professionals such as daycare workers 

and residential facility staff (0.9 percent). Foster 

parents accounted for 0.4 percent of perpetrators, 

while friends and neighbors accounted for 0.5 

percent.

Abuse and Neglect Among Children Under Age 18, by Type of

Maltreatment, 2006

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

and Neglect Data System

Percent of Victims*

64.1

8.8

6.6

15.1

16.0

2.2

1.2

Perpetrators of Child Abuse and Neglect, by Relationship 

to Victim, 2006*

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

and Neglect Data System

Other 5.3%

Unknown/Missing 3.5%

Professionals*** 0.9%

Unmarried Partner

of Parent** 3.8%

Other Relative 6.7%

Parent

79.9%

*Based on 47 states reporting. **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. 

0 10 20 30 40 50 60 70 80

Unknown

Other Abuse**

Medical Neglect

Psychological

Maltreatment

Sexual Abuse

Physical Abuse

Neglect

*Percentages equal more than 100 because some children were victims of more than one type of abuse 

or neglect. **Includes abandonment, threats of harm, and congenital drug addiction.
Child Health USA 2008-2009

36 Health Status - Children

Child Mortality

In 2006, 10,780 children between the ages of 

1 and 14 years died of various causes; this was 

nearly 600 fewer than the previous year. The 

overall mortality rate among 1- to 4-year-olds 

was 28.4 per 100,000 children in that age group, 

and the rate among 5- to 14-year-old children 

was 15.2 per 100,000. Each of these rates is approximately one percentage point lower than the 

previous year.

Unintentional injury continued to be the 

leading cause of death among both 1- to 4-yearolds and 5- to 14-year-olds, accounting for 35 

percent and 37 percent of all deaths, respectively. 

Among the younger group, the next leading cause 

of death was congenital anomalies (birth defects), 

followed by malignant neoplasms (cancer), homicide, and diseases of the heart. Among the older 

group, the second leading cause of death was 

malignant neoplasms, followed by homicide and 

congenital anomalies. 

Mortality rates were higher among males than 

females for both the 1- to 4-year-old and 5- to 

14-year-old age groups (30.5 versus 26.3 and 

17.6 versus 12.8 per 100,000, respectively, in 

2006; data not shown). For both age groups, nonHispanic Black children had the highest mortality rates (44.3 per 100,000 for 1- to 4-year-olds 

and 21.9 for 5- to 14-year-olds). Non-Hispanic 

Leading Causes of Death Among Children Aged 1–14, 2006

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

9.9

3.2

2.3

2.2

1.0

1–4 Years

5–14 Years

0.3

0.4

0.4

0.5

0.8

5.6

2.3

1.0

0.9

0.6

0.2

0.2

0.2

0.3

0.5

123456789 10 11

Benign Neoplasms

Speticemia

Cerebrovascular Diseases

Chronic Lower

Respiratory Diseases

Suicide

Diseases of the Heart 

Congenital Anomalies

Homicide

Malignant Neoplasms (cancer)

Unintentional Injury

Cerebrovascular Diseases

Benign Neoplasms

Conditions Originating in

the Perinatal Period

Septicemia

Influenza and Pneumonia

Diseases of the Heart

Homicide

Malignant Neoplasms (cancer)

Congenital Anomalies

Unintentional Injury

White and Hispanic children had much lower 

mortality rates. Among Hispanics, rates were 

26.4 per 100,000 for 1- to 4-year olds and 14.2 

per 100,000 for 5- to 14-year-olds. Among nonHispanic Whites, rates were 25.0 and 14.0 per 

100,000, respectively (data not shown).
Child Health USA 2008-2009

Health Status - Children 37

Child Mortality Due to 

Injury

In 2006, unintentional injuries were the cause 

of death for 1,610 children aged 1-4 years and 

2,258 children aged 5-14 years. Motor vehicle 

traffic, drowning, and fires and burns were the 

most common causes of unintentional injury 

death among children in both age groups. Unintentional injury due to motor vehicle traffic 

caused 2.9 and 3.0 deaths per 100,000 children 

aged 1-4 and 5-14 years, respectively.

In addition, 366 children aged 1-4 years were 

victims of homicide in 2006, while 609 children 

aged 5-14 years were victims of homicide or suicide (data not shown).

Deaths Due to Unintentional Injury Among Children Aged 1–14, 2006

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

1–4 Years

2.8

2.9

0.8

3.0

1.2

0.6

0.7

0.3

0.3

0.5

0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Suffocation

Land Transport,

 Other than Motor Vehicle

Fires and Burns

Drowning

Motor Vehicle Traffic

5-14 Years

Pedestrian,

 Other than Motor Vehicle

Suffocation

Fires and Burns

Drowning

Motor Vehicle Traffic

Health Status - Adolescents 
Child Health USA 2008-2009

40 Health Status - Adolescents

Adolescent Childbearing

According to preliminary data, the birth rate 

among adolescents aged 15-19 years increased to 

42.5 births per 1,000 females in 2007, from 41.9 

per 1,000 the previous year. This was the first increase since the most recent peak in 1991 (61.8 

births per 1,000), but still represents an overall decrease of 31 percent since that year. The birth rate 

among adolescents aged 10-14 years decreased to 

0.6 per 1,000, which represents a decline of more 

than 50 percent since 1991. Teenage birth rates 

were highest among older adolescents, aged 18-

19 years, at 73.9 per 1,000. 

Teenage birth rates have historically varied 

considerably by race/ethnicity. Among adolescents aged 15-19 years, Asian/Pacific Islanders had the lowest birth rate in 2006 (17.3 per 

1,000), followed by non-Hispanic Whites (27.2 

per 1,000). Hispanic females had the highest 

birth rate in this age group (81.7 per 1,000), and 

also the lowest percentage decline since 1991 

(21.9 percent). Non-Hispanic Black females had 

the second highest birth rate among those aged 

15-19 years (64.3 per 1,000), but the highest percentage decline since 1991 (45.8 percent).

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

(1.5 per 1,000), followed by Hispanic females 

(1.2 per 1,000) and American Indian/Alaska 

Native females (0.9 per 1,000). Non-Hispanic 

White and Asian/Pacific Islander females had the 

lowest birth rates among those aged 10-14 years 

(0.2 per 1,000). 

Birth Rates Among Adolescent Females Aged 10-19, by

Age and Race/Ethnicity, 2007*

Source (I.5): 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

22.2

73.9

0.6

11.8

50.5

0.2

35.8

109.3

1.2

47.8

137.1

1.5 8.4

30.7

0.2

31.7

101.3

0.9

Birth Rates Among Adolescent Females Aged 15–19, by 

Race/Ethnicity, 1990–2007*

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

Statistics, National Vital Statistics System

27.2

64.3

81.7 Non-Hispanic Black

Non-Hispanic White

Hispanic

Live Births per 1,000 Females

17.3

59.0

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 1994 1998 2002 2006

*Preliminary data *Preliminary data
Child Health USA 2008-2009

Health Status - Adolescents 41

SEXUAL ACTIVITY

In 2007, 47.8 percent of high school students 

reported ever having had sexual intercourse, representing a slight increase from the previous year, 

while the remaining 52.2 percent were abstinent. 

Overall, 35 percent of students reported that they 

were currently sexually active (had intercourse 

at least once in the 3 months before the survey): 

21.5 percent were currently sexually active and 

reported using a condom during their last sexual 

intercourse, while 13.5 percent were currently 

sexually active and reported not using a condom 

during their last encounter (i.e., 61 percent of 

sexually active students used a condom during 

their last encounter). 

Sexual activity and condom use vary by race 

and ethnicity. In 2007, non-Hispanic Black students were most likely to report ever having sexual intercourse (66.5 percent), and most likely to 

report using a condom during their last sexual encounter (67.3 percent of currently sexually active 

students). Hispanic students were second most 

likely to report ever having had sexual intercourse 

(52.0 percent), followed by non-Hispanic White 

students (43.7 percent; data not shown).

In 2007, sexual activity increased with grade 

level, while condom use decreased. Among 12th 

grade students, 52.6 percent reported being currently sexually active: 28.5 percent were currently 

sexually active and used a condom during their 

last intercourse, while 24.1 percent were sexually 

active and did not use a condom (i.e., just over 

half of sexually active 12th graders used a condom 

during their last encounter). In contrast, 20.1 

percent of 9th graders were sexually active: 6.2 

percent of 9th graders were sexually active and not 

using a condom, while 13.9 percent were sexually 

active and used a condom during their last sexual 

encounter (i.e., almost 70 percent of sexually active 9th graders used a condom during their last 

encounter).

Sexually Active, but No Intercourse

in Past 3 Months

12.8%

Intercourse in Past

3 Months, No condom

at Last Intercourse

13.5%

Intercourse in Past

3 Months, Used condom

at Last Intercourse

21.5%

Abstinent* 

52.2%

Sexual Activity Among High School Students, 2007

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

Youth Risk Behavior Survey

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

Condom Use Among Sexually Active High School Students,

by Grade, 2007

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

10

20

30

40

50

60

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

Total Sexually Active*

Condom Use at Last Intercourse

No Condom Use at Last Intercourse

13.9

6.2

20.2

10.4

25.9

15.9

28.5

24.1

20.1

30.6

41.8

52.6
Child Health USA 2008-2009

42 Health Status - Adolescents

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 STI among adolescents and young adults, 

with rates of 1,674 and 1,796 cases per 100,000, 

respectively, in 2006. Rates were highest among 

non-Hispanic Blacks, followed by American Indian/Alaska Natives. Rates of gonorrhea were 

459 and 528 per 100,000 adolescents and young 

adults, respectively, and were also highest among 

non-Hispanic Blacks 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 24.5 percent of females aged 14-19 years and 44.8 percent 

of those aged 20-24 years had an HPV infection 

in 2003-2004.1

 There are many different types 

of HPV, some of which can cause cancer. Although cervical cancer in women is the most serious health problem caused by HPV, it is highly 

preventable with routine Pap tests and follow-up 

care. 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 2007, 25 percent of females aged 13-17 

years initiated 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, 

viewed 9/3/08.

3 Centers for Disease Control and Prevention. Vaccination coverage among adolescents aged 13-17 years - limited states, 

2007. MMWR 2008; 57:1100.

Total

Non-Hispanic

White

Non-Hispanic

Black

Hispanic

American Indian/

Alaska Native

Reported Rates of Sexually Transmitted Infections Among Adolescents and Young Adults, by Age and Race/Ethnicity, 2006

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

Rate per 100,000 

Chlamydia Gonorrhea

528

165

481 277

2,561

459 121 381 233

2,192

1,674

751

2,760

1,725

5,618

942

3,113

1,796 1,978

5,477

1,250

2,500

3,750

5,000

6,250

15–19 Years 20–24 Years

1,250

2,500

3,750

5,000

6,250

15–19 Years 20–24 Years

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

American Indian/

Alaska Native
Child Health USA 2008-2009

43

ADOLESCENT AND YOUNG 

ADULT HIV/AIDS

Acquired immunodeficiency syndrome 

(AIDS) is caused by the human immunodeficiency virus (HIV), which damages or kills the cells 

that are responsible for fighting infection. AIDS 

is diagnosed when HIV has weakened the immune system enough that the body has a difficult 

time fighting infections. 

An estimated 5,259 people aged 13-24 years 

were diagnosed with HIV/AIDS1 in 2006, representing 14.3 percent of all new cases. While the 

number of diagnoses among children aged 13-14 

years fluctuates from year to year, the number of 

diagnoses among the older age groups have increased steadily over the past few years. Diagnoses of HIV/AIDS among adolescents aged 15-19 

years and young adults aged 20-24 years have 

increased 34 and 23 percent, respectively, since 

2003.

In 2006, there were 211 deaths of adolescents 

and young adults with AIDS, representing 1.4 

percent of all deaths of persons with AIDS. Since 

the beginning of the epidemic, an estimated 

10,096 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. 

With an increase in diagnoses and a decrease 

in deaths, the number of people living with HIV/

AIDS has increased. In 2006, there were an estimated 19,979 people aged 13-24 years living with 

HIV/AIDS, representing 3.9 percent of all cases. 

Overall, the number of adolescents and young 

adults living with HIV/AIDS has increased 19 

percent since 2003.

1 Includes persons with a diagnosis of HIV infection only, 

a diagnosis of HIV infection and a later AIDS diagnosis, 

and concurrent diagnoses of HIV infection and AIDS in 33 

states and 5 dependent areas with confidential name-based 

reporting.

number of Persons Aged 13-24 Diagnosed with and living with HIV/AIDS* 

and Dying with AIDS, by Age, 2006

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

*Includes persons with a diagnosis of HIV infection only, a diagnosis of HIV infection and a later AIDS diagnosis, and concurrent diagnoses of 

HIV infection and AIDS in 33 states and 5 dependent areas with confidential name-based reporting.

4,539

14,301

1,139

1,332

3,886

41

Number of Persons

13–14 Years

15–19 Years

3,000 12,000 13,000 14,000 15,000

162

44

5

Diagnosed with HIV/AIDS

Living with HIV/AIDS

Dying with AIDS

20–24 Years

1,000 2,000 4,000

Child Health USA 2008-2009

Health Status - Adolescents 45

PHYSICAL ACTIVITY

Results from the Youth Risk Behavior Surveillance System show that 34.7 percent of high 

school students met currently recommended levels of physical activity in 2007. At that time, the 

recommendation for this age group was any kind 

of physical activity that increases heart rate and 

causes the child to breathe hard for some of the 

time for a total of at least 60 minutes per day, 

5 or more days per week. Non-Hispanic White 

students were the most likely to meet the recommended levels of physical activity (37.0 percent), 

followed by non-Hispanic Black students (31.1 

percent); Hispanic students were least likely to 

meet recommended levels (30.2 percent). Overall, 24.9 percent of students did not participate 

in 60 or more minutes of physical activity on any 

day in the week before the survey.

Nationwide, 53.6 percent of high school students attended physical education classes on 1 or 

more days a week in 2007. This rate drops dramatically with increasing grade: 66.8 percent of 

9th grade students attended PE class, compared to 

41.5 percent of 12th grade students. The percentage of students attending daily physical education 

classes has dropped from 42 percent in 1991 to 

30.3 percent in 2007. Again, younger students 

were much more likely to attend daily classes 

than older students (40.1 percent of 9th graders 

compared to 23.8 percent of 12th graders; data 

not shown). 

In 2007, 56.3 percent of high school students 

reported playing on at least one sports team in 

the past year. This was also more common among 

children in younger grades (59.2 percent of 9th

graders) than in the older grades (49.0 percent of 

12th graders; data not shown). 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 35.4 percent of students reported watching television for 3 or more hours on an average 

school day.

The HealthierUS Initiative—available online 

at www.healthierus.gov—provides accurate information about physical fitness, nutrition, and 

disease prevention to help Americans of all ages 

make healthy decisions.

Physical Activity Among High School Students, by Race/Ethnicity, 2007

Source: (II.9): Centers for Disease Control and Prevention, Youth Risk Behavior Survey 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 5 or more days during the preceding 7 days.

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

34.7 31.1 30.2

37.0

Met Recommended Levels of

Physical Activity*

Did not Participate in 60+ Minutes of

Physical Activity on Any Day in Past Week

24.9 27.1 32.0

22.4

100

90

80

70

60

50

40

30

20

10
Child Health USA 2008-2009

46 Health Status - Adolescents

Mental Health

In 2007, 8.2 percent of adolescents aged 12 to 

17 years experienced a major depressive episode 

(MDE), which is defined as at least 2 weeks of 

depressed mood or loss of 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 an MDE (11.9 

versus 4.6 percent; data not shown). For both 

sexes, occurrence of MDE peaked at 16 years of 

age; of females in that age group, 17.3 percent 

experienced at least one MDE in the past year. 

Adolescents of two or more races were most likely 

to experience an MDE (10.0 percent), followed 

by non-Hispanic White and non-Hispanic Black 

adolescents (8.7 and 7.8 percent, respectively); 

American Indian/Alaska Native adolescents were 

least likely to experience an MDE (4.6 percent; 

data not shown).

Among adolescents who received treatment or 

counseling for an emotional or behavioral problem (not including drug or alcohol use), depression was the most commonly reported problem 

(50.0 percent). Adolescents also commonly reported receiving treatment for problems with 

home or family (28.8 percent), breaking rules or 

acting out (25.1 percent), and contemplating or 

attempting suicide (20.2 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.

Percent of Children Receiving Treatment

12.1

16.8

Occurrence of Major Depressive Episode (MDE)* in the Past Year 

Among Adolescents Aged 12-17 Years, by Age and Gender, 2007

Source (II.13): Substance Abuse and Mental Health Service Administration, National 

Survey of Drug Use and Health Percent of Children

6.7

1.9

3.7 3.0

11.0

*MDE is defined as a period of at least two weeks when a person experienced a depressed mood or loss 

of pleasure in daily activities and had a majority of specific depression symptoms. 

6.2

13.8

17.3

2.7

8.7

5

10

15

20

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

6.6

15.9 Female

Male

Commonly Reported Reasons for Receiving Mental Health

Treatment* in the Past Year Among Adolescents Aged

12-17 Years Who Received Treatment, 2007

Source (II.13): 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 Afraid or Tense

Contemplated/ Attempted Suicide

Breaking Rules/Acting

 Out

Problems at Home/

Family

Felt Depressed

17.2

17.9

20.2

25.1

28.8

50.0
Child Health USA 2008-2009

Health Status - Adolescents 47

CIGARETTE SMOKING

In 2007, cigarette smoking among adolescents 

continued to decline, according to the annual 

Monitoring the Future Study. The largest decrease 

occurred among 8th graders, with the percentage 

of students who had smoked any cigarettes in the 

past 30 days falling from 8.7 to 7.1 percent since 

the previous year. Cigarette smoking in the past 30 

days showed a smaller decline among 10th graders, 

dropping from 14.5 to 14.0 percent, while smoking among 12th graders remained steady at 21.6 

percent. 

The percent of teens smoking in the past month 

began a rapid increase in the early 1990s, with the 

rates among 8th and 10th graders reaching a peak 

in 1996 (at 21.0 and 30.4 percent, respectively), 

and the rate among 12th graders peaking in 1997 at 

36.5 percent. These increases occurred in virtually 

every sociodemographic group: male and female, 

those planning on attending a four-year college 

and those without such plans, those living in all 

four regions of the country, those living in rural 

and urban areas, and those of different racial and 

ethnic groups. Since the mid-1990s, overall rates 

of smoking in the past month have dropped 66 

percent among 8th graders, 54 percent among 10th

graders, and 41 percent among 12th graders. 

Despite this decline, certain subgroups of adolescents are still more likely than others to smoke. 

With regard to race and ethnicity, non-Hispanic 

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 fouryear 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,

1991–2007

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

the Future Study

7.1

8.1

5.1

8.0

16.2

7.1

10.5

24.9

10.8

15.3

Percent of Student

14.0

s

21.6

12th Grade

8th Grade

10th Grade

5

10

15

20

25

30

35

40

1991 1993 1995 1997 1999 2001 2003 2005 2007

5

10

15

20

25

30

35

40

Any Cigarette Use Among Students in the Past 30 Days, by

Grade and Race/Ethnicity,* 2007

Source (II.12): National Insitutes 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 *Data for race represents a two-year average (2006 and 2007) to increase sample size and thus

provide a more stable estimate.
Child Health USA 2008-2009

48 Health Status - Adolescents

SUBSTANCE ABUSE

In 2007, 9.5 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 

use in the past month, compared to 8.9 percent 

of youth aged 14-15 years and 16.0 percent of 

youth aged 16-17 years. There was also variation 

by race/ethnicity, with rates ranging from 6.0 percent among Asian youth to 18.7 percent1

 among 

American Indian/Alaska Native youth. Rates for 

non-Hispanic White, non-Hispanic Black, and 

Hispanic youth were 10.2 percent, 9.4 percent, 

and 8.1 percent, respectively (data not shown).

Marijuana was the most commonly used illicit 

drug among adolescents in 2007 (6.7 percent), 

followed by non-medical use of prescription-type 

psychotherapeutics, such as pain relievers, tranquilizers, and stimulants (3.3 percent). Adolescent males were slightly more likely than their 

female counterparts to report using illicit drugs 

in the past month (10.0 versus 9.1 percent, respectively). Illicit drug use is associated with other health risk behaviors. In 2007, 47.3 percent of 

adolescents who reported cigarette use in the past 

month also reported illicit drug use, compared to 

only 5.4 percent of adolescents who did not report smoking. Adolescents who reported heavy2

alcohol use in the past month were also more 

likely to use illicit drugs than adolescents who did 

not report alcohol use (60.1 versus 5.0 percent, 

respectively; data not shown).

Alcohol continues to be the most commonly 

used drug among adolescents, with 15.9 percent 

reporting past-month use in 2007. There was 

little difference in alcohol use among males and 

females (15.9 and 16.0 percent, respectively). 

Greater variation was evident by race, with rates 

ranging from 8.1 percent among Asian youth to 

20.5 percent1

 among American Indian/Alaska 

Native youth; the rate for non-Hispanic White 

youth was 18.2 percent. 

In 2007, 34.5 percent of adolescents perceived 

smoking marijuana once a month to be a great 

risk, while 49.6 percent perceived the same level 

of risk with cocaine use. Smoking one or more 

packs of cigarettes a day was considered a great 

risk by 68.8 percent of youth. Drinking five or 

more drinks once or twice per week was considered a great risk by 39.4 percent of adolescents.

While fewer than 15 percent of adolescents 

reported being approached by someone selling 

drugs in the past month, 49.1 percent reported 

that marijuana would be fairly or very easy to obtain; the same was reported by 25.3 percent of 

youth regarding crack, 24.5 percent regarding 

cocaine, 14.4 percent regarding LSD, and 14.1 

percent regarding heroin (data not shown).

1 2006; no estimate was reported for 2007 due to low precision. 

2 Heavy drinking is defined as drinking 5 or more drinks on the 

same occasion on each of 5 or more days in the past 30 days.

Past Month Drug Use Among Adolescents Aged 12–17 Years, by Drug Type, 2007

Source (II.13): 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.

4

8

12

16

20

Non-medical Use Inhalants Hallucinogens* of Psychotherapeutics*Marijuana/

Hashish

Alcohol Any Illicit Drug

Percent of Youth

9.5

15.9

6.7

1.2

3.3

0.7
Child Health USA 2008-2009

Health Status - Adolescents 49

VIOLENCE

Violence among adolescents is a critical public 

health issue in the United States. In 2006, homicide was the second leading cause of death among 

persons aged 15-24 years.

Results from the Youth Risk Behavior Surveillance System show that 18.0 percent of high 

school students had carried a weapon (such as a 

gun, club, or knife) at some point during the preceding 30 days in 2007. Males were about four 

times as likely as females to carry a weapon (28.5 

versus 7.5 percent). Among male students, nonHispanic Whites were the most likely to carry 

a weapon (30.3 percent) followed by Hispanics 

(28.2 percent), while non-Hispanic Blacks were 

least likely to carry a weapon (24.6 percent). The 

opposite was true among females: non-Hispanic 

Blacks were the most likely to carry a weapon 

(10.0 percent), followed by Hispanics (9.0 percent), while non-Hispanic White females were 

least likely to carry a weapon (6.1 percent). Just 

over 5 percent of students reported carrying a gun 

in the preceding 30 days, and males were more 

than 7 times as likely as females to do so. 

In 2007, 12.4 percent of high school students 

reported being in a physical fight on school property during the 12 months preceding the survey. 

Males were 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, non-Hispanic Black students were 

the most likely to be in a physical fight on school 

property (17.6 percent), followed by Hispanic 

students (15.5 percent); non-Hispanic White 

students were least likely to be in a fight (10.2 

percent). 

High School Students Who Carried a Weapon in the Past

30 Days, by Sex and Race/Ethnicity, 1993–2007

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

Percent of Students

1993 1995 1997 1999 2001 2003 2005 2007

12.4

16.3

8.5

10.2

14.5

5.9

17.6

20.0

15.2 15.5

18.5

12.4

24.6

28.2

30.3

10.0

6.1

9.0

Hispanic Male 

Hispanic Female 

Non-Hispanic White Male

Non-Hispanic White Female 

Non-Hispanic Black Female

Non-Hispanic Black Male

40

35

30

25

20

15

10

5

10

20

30

40

All Races Non-Hispanic White Non-Hispanic Black Hispanic

Total

Male

Female

High School Students in a Physical Fight on School Property 

in the Past 12 Months, by Sex and Race/Ethnicity, 2007

Source (II.9): Centers for Disease Control and Prevention, Youth Risk Behavior Survey
Child Health USA 2008-2009

50 Health Status - Adolescents

Adolescent Mortality

In 2006, 13,739 deaths were reported among 

adolescents aged 15-19 years, representing a rate 

of 64.4 per 100,000. The rate for males in this age 

group was notably higher than that for females 

(90.7 versus 36.8 per 100,000; data not shown). 

Unintentional injury remains the leading cause 

of death among this age group and accounted 

for nearly half of all deaths among adolescents in 

2006, representing a rate of 31.3 per 100,000. The 

second and third leading causes of death among 

adolescents aged 15-19 years were homicide and 

suicide, with rates of 10.8 and 7.3 per 100,000, 

respectively. These causes accounted for 17 and 

11 percent of deaths within this age group.

Within the general category of deaths due to 

injury or other external causes (including intentional injury), motor vehicle traffic was the leading 

cause of mortality among 15- to 19-year-olds in 

2006, accounting for 45 percent of injury-related 

deaths among adolescents. Alcohol is a significant 

contributor to these deaths; recent data suggest 

that nearly one-third of adolescent drivers killed 

in crashes had been drinking (data not shown). 

Firearms were the next leading cause of fatal injury, accounting for 26 percent of injury-related 

deaths in this age group, followed by poisoning, 

suffocation, and drowning. Within the category 

of unintentional injuries, firearm injury falls to 

the fifth leading cause of death (data not shown).

Leading Causes of Death Among Adolescents Aged 15–19, 2006

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

Statistics, National Vital Statistics System

Death Rate per 100,000 Population

31.3

10.8

7.3

3.2

1.7

5 10 15 20 25 30 35

Diseases of

 the Heart

Malignant

 Neoplasms

 (cancer)

Suicide

Homicide

Unintentional

 Injury

Deaths Due to Injury* Among Adolescents Aged 15–19, 2006

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

Statistics, National Vital Statistics System

Death Rate per 100,000 Population

22.6

13.2

4.3

1.6

3.7

5 10 15 20 25 30 35

Drowning

Suffocation

Poisoning

Firearms

Motor Vehicle

Traffic

*Includes intentional injury, such as homicide and suicide
Child Health USA 2008-2009

Health Status - Adolescents 51

Adolescent Mortality

from Traffic and Firearm

injuries

The two leading mechanisms of injury death 

among adolescents are motor vehicle traffic and 

firearms. In 2006, 4,814 adolescents aged 15 to 

19 years were killed by motor vehicle traffic. Most 

of those were either involved as driver or passenger in the vehicle, while the remaining deaths 

occurred among pedestrians, motorcyclists, and 

pedal cyclists. The 2007 Youth Risk Behavior 

Survey revealed that 11.1 percent of high school 

students had rarely or never worn seat belts when 

riding in a car driven by someone else. Additionally, 29.1 percent of students had ridden at least 

once in the 30 days preceding the survey with a 

driver who had been drinking (data not shown).

Firearms were the second leading mechanism 

of injury death among adolescents in 2006. Overall, 2,809 adolescents were killed by firearms, representing a rate of 13.2 per 100,000 adolescents. 

Of these, homicide accounted for 70 percent and 

suicide accounted for 25 percent; the remainder 

were unintentional or of unknown intent. The 

2007 Youth Risk Behavior Survey indicated that 

5.2 percent of high school students carried a gun 

at least once in the month preceding the survey. 

Adolescent Mortality from Traffic and Firearm Injuries, 2006

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

National Vital Statistics System

Death Rate per 100,000 Population

Traffic Mortality by Person Injured

11.5

1.3

0.2

9.1

3.3

0.5

1.0

0.2

2 4 6 8 10 12

Unknown

Unintentional

Suicide

Homicide

Pedal Cyclist

Motorcyclist

Pedestrian

Motor Vehicle Occupant

Firearms Mortality by Intent

Health Services Financing and Utilization Child Health USA 2008-2009

Health Services Financing and Utilization 53

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 

Medicaid or the State Children’s Health Insurance Program (SCHIP; changed to CHIP in 

2009). Eligibility for public programs is based 

on a family’s income compared to the Federal 

poverty level. Nearly every State has SCHIP 

programs that help expand coverage to children who would otherwise be uninsured. 

Despite the progress achieved through public 

programs, approximately 8.1 million children 

remain uninsured in the United States.

This section presents data on the 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 2008-2009

54 Health Services Financing and Utilization

HEALTH CARE FINANCING

In 2007, 8.1 million children younger than 18 

years of age had no health insurance coverage, representing 11.0 percent of the population. This was 

a slight drop from the rate of 11.7 percent the previous year. More than 30 percent of children were 

insured through public programs such as Medicaid and the State Children’s Health Insurance Program (SCHIP; changed to CHIP in 2009).

Children’s insurance status varies by a number 

of factors, including race and ethnicity and poverty 

status. Non-Hispanic White children were more 

likely than children of other racial/ethnic groups 

to have private insurance coverage in 2007 (76.9 

percent), while fewer than half of non-Hispanic 

Black and Hispanic children had private coverage 

during the same period (48.7 and 40.4 percent, 

respectively). Non-Hispanic Black children were 

most likely to have public coverage (47.1 percent), 

and Hispanic children were the most likely to be 

uninsured (20.0 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 2007, children with family incomes below 100 percent of the poverty 

threshold ($21,203 for a family of four in 2007) 

were most likely to have public coverage (70.1 

percent) or be uninsured (17.6 percent), and were 

least likely to have private coverage (17.2 percent). 

The majority of children with family incomes of 

200 to 299 percent and 300 percent or more of 

poverty were privately insured (72.7 and 90.2 percent, respectively). 

In 1997, SCHIP was created in response to 

the growing number of uninsured children in 

low-income working families. In 2007, more than 

7.1 million children were enrolled in SCHIP. 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,* 2007

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

Percent of Children

10

20

30

40

50

60

70

80

90

100

31.0

64.2

12.2

22.0

76.9

7.3

47.1 48.7

11.0

44.2 40.4

20.0

Health Insurance Coverage Among Children Under Age 18,

by Poverty Status* and Type of Coverage,** 2007

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

10

20

30

40

50

60

70

80

90

100

Private Coverage Public Coverage No Coverage

45.2

17.2

72.7

90.2

46.1

70.1

23.7

9.7

17.6 16.9 11.2

5.0

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

Private Coverage Public Coverage No Coverage

Less Than 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 poverty threshold for a family of four was $21,203 in 2007.

** Totals equal more than 100 percent because children may have more than one type of coverage.
Child Health USA 2008-2009

Health Services Financing and Utilization 55

ADEQUACY OF HEALTH 

INSURANCE COVERAGE

While the majority of children in the United 

States have health insurance coverage, it may not 

always be adequate to meet their health and medical needs. The 2007 National Survey of Children’s 

Health asked parents of insured children three 

questions about the services and costs associated 

with their child’s health insurance. Parents were 

asked whether out-of-pocket costs were reasonable, whether the child’s health insurance covered 

services that met the child’s needs, and whether 

their health insurance allowed them to see the 

health care providers they needed.

Children were considered to have adequate 

health insurance coverage if their parent answered 

“usually” or “always” to each of these three questions. Overall, 23.5 percent of currently insured 

children lacked adequate insurance. Older children 

were more likely than younger children to lack adequate coverage: 26.3 percent of children aged 12-

17 and 25.2 percent of those aged 6-11 years were 

reported to lack adequate insurance, compared to 

19.2 percent of children aged 0-5 years.

The percentage of children lacking adequate 

health insurance coverage also varied by household income. Currently insured children with incomes below the Federal Poverty Level (FPL) and 

more than 400 percent of FPL were least likely 

to lack adequate coverage (20.1 and 21.1 percent, respectively). In comparison, 26.9 percent 

of children with household incomes of 201-400 

percent of FPL and 25.1 percent of those with incomes of 101-200 percent of FPL lacked adequate 

insurance.

Currently Insured Children Under Age 18 Whose Health Insurance 

Was Not Adequate, by Age, 2007

Source (I.8): 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

Currently Insured Children Under Age 18 Whose Health Insurance

Was Not Adequate, by Poverty Status,* 2007

Source (I.8): 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 with Health Insurance

20.1

25.1

26.9

21.1

5

10

15

20

25

30

100% or Less FPL 101-200% FPL 201-400% FPL More than 400% FPL

*Federal Poverty Level (FPL) was equal to $20,650 for a family of four in 2007; FPL is set by

the U.S. Department of Health and Human Services for determining income eligibility in public

assistance programs.

Percent of Children with Health Insurance

23.5

19.2

25.2 26.3

5

10

15

20

25

30

Total 0-5 Years 6-11 Years 12-17 Years
Child Health USA 2008-2009

56 Health Services Financing and Utilization

VACCINATION COVERAGE

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

of the universally recommended vaccines among 

young children. In 2007, 77.4 percent of children 

19-35 months of age had received each of the vaccines in the recommended 4:3:1:3:3:1 series. This 

series comprises 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 influenzae 

type b (Hib) vaccine; three doses of the Hepatitis 

B vaccine; and one dose of varicella (chicken pox) 

vaccine. Overall, 80.1 percent of young children 

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

the varicella vaccine.

In recent years, the greatest increase in vaccination rates has occurred with the varicella vaccine, 

which was added to the recommended schedule 

in 1996. Since 2000, coverage of varicella vaccine 

has increased approximately 30 percent. Coverage 

for most other vaccines has also risen during this 

time period, generally between 2 and 4 percent. 

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

Black children have the lowest rates of vaccination with the overall 4:3:1:3:3:1 series, as well as 

the lowest rates of vaccination with each of the 

individual vaccines, except varicella.

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 schedule in 2009; 

however, there were a number of changes in the 

catch-up recommendations for several vaccines 

and the vaccination guidelines for certain populations of children.

Vaccination Rates among Children Aged 19-35 Months, by Race/Ethnicity, 2007

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

Total Non-Hispanic 

White

Non-Hispanic 

Black

Hispanic Asian

Complete Series 4:3:1:3:3:1 

(includes Varicella) 77.4 77.5 75.3 78.0 79.4

Series 4:3:1:3:3 

(excludes Varicella) 80.1 81.0 77.5 79.8 80.7

4+ DTaP 84.5 85.3 82.3 83.8 87.5

3+ Polio 92.6 92.6 91.1 93.0 95.0

1+ MMR 92.3 92.3 91.5 92.6 93.9

3+ Hib 92.6 92.6 90.8 93.5 91.0

3+ HepB 92.7 92.5 91.2 93.6 93.8

1+ Varicella 90.0 89.2 89.8 90.6 93.7
Child Health USA 2008-2009

Health Services Financing and Utilization 57

Recommended Immunization Schedule for Children Aged 0-6 Years, United States, 2009

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 see footnote 1 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 Poliovirus IPV IPV IVP IVP

Influenza6 Influenza (yearly)

Measles, Mumps, Rubella7 MMR see footnote 7 MMR

Varicella8 Varicella see footnote 8 Varicella

Hepatitis A9 HepA (2 doses) HepA Series

Meningococcal10 MCV

Range of recommended ages Certain high-risk groups

This schedule indicates the recommended ages for routine administration 

of currently licensed vaccines, as of December 1, 2008, for children aged 

0 through 6 years. Any dose not administered at the recommended age 

should be administered at a subsequent visit, when indicated and feasible. 

Licensed combination vaccines may be used whenever any component of the 

combination is indicated and other components are not contraindicated and 

if approved by the Food and Drug Administration for that dose of the series. 

Providers should consult the relevant Advisory Committee on Immunization 

Practices statement for detailed recommendations, including high-risk conditions: 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). Guidance about how to obtain 

and complete a VAERS form is available 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. 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 (anti-HBs) after completion of at least 3 doses of the HepB series, at 

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

4-month dose:

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

vaccines containing HepB are administered after the birth dose.

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 or older (i.e., 15 weeks 0 days or older).

• Administer the final dose in the series by age 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) should not be used for doses at ages 2, 4, or 6 months but 

can be used as the final dose in children aged 12 months or older.

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 to children aged 2 years or older with certain underlying medical conditions (see MMWR 2000;49[No. RR-9]), including a cochlear implant.

6. Influenza vaccine. (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 nonpregnant persons (i.e., those who do not have underlying medical 

conditions that predispose them to influenza complications) aged 2 through 49 

years, either LAIV or TIV may be used.

• 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.

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

• Administer the second dose 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.

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

• Administer the second dose 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.

9. 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 children older than 1 year who live in areas 

where vaccination programs target older children or who are at increased risk of 

infection. See MMWR 2006;55(No. RR-7).

10. Meningococcal vaccine. (Minimum age: 2 years for meningococcal conju

 gate vaccine [MCV] and for meningococcal polysaccharide vaccine [MPSV])

• Administer MCV to children aged 2 through 10 years with terminal complement 

component deficiency, anatomic or functional asplenia, and certain other high-risk 

groups. See MMWR 2005;54(No. RR-7).

• Persons who received MPSV 3 or more years previously and who remain at 

increased risk for meningococcal disease should be revaccinated with MCV.

The Recommended Immunization Schedules for Persons Aged 0 Through 18 Years 

are approved by the Advisory Committee on Immunization Practices (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).
Child Health USA 2008-2009

58 Health Services Financing and Utilization

MENTAL HEALTH 

TREATMENT

According to parents’ reports, 5.3 percent of 

children aged 4-17 years received treatment for 

emotional or behavioral difficulties in the past 

year. This includes treatment, alone or in conjunction with medication, for difficulties with 

emotions, concentration, behavior, or being able 

to get along with others. Boys were more likely 

than girls to have received treatment (6.4 versus 4.2 percent), and older children (aged 12-17 

years) were more likely than younger children 

(aged 4-11 years) to have received treatment (6.5 

versus 4.4 percent; data not shown). Among 

those children who received treatment for emotional or behavioral difficulties, almost 60 percent 

were seen at a private practice, clinic, or mental 

health care center, while nearly 40 percent received treatment through their school. Another 

one-quarter of children who received treatment 

did so through a primary care provider, and fewer 

than 10 percent of children received treatment at 

some other type of place. (Parents could report 

more than one place of treatment.)

In 2005-2006, 5.1 percent of children aged 

4-17 years were prescribed medication for emotional or behavioral difficulties in the past year. 

That includes the 4.4 percent of children who 

were reported to have been prescribed medication 

for the symptoms of attention deficit hyperactivity disorder (ADHD). Again, boys were more 

likely than girls to have been prescribed medication (6.6 versus 3.4 percent), and 12- to 17-yearolds were more likely to be prescribed medication 

than younger children (6.0 versus 4.3 percent; 

data not shown). 

Receipt of Treatment* for Emotional or Behavioral Difficulties in the 

Past 12 Months among Children Aged 4-17 Years, by Sex and Age,

2005-2006

Source (II.11): Centers for Disease Control and Prevention, National Center for Health 

Statistics, National Health Interview Survey Percent of Children

5.2 4.2 3.4

*Received treatment, other than or in addition to medication, in the past 12 months for difficulties with emotions,

concentration, behavior, or being able to get along with others; this includes children who have been prescribed 

medication and are receiving other types of treatment, but does not include children who have been prescribed 

medication only. 

5.3 6.4

5

10

15

20

Total 4-11 Years 12-17 Years

7.8

Female

Male

*Treatment, other than or in addition to medication, in the past 12 months for difficulties with emotions, 

concentration, behavior, or being able to get along with others; this includes children who have been 

prescribed medication and are receiving other types of treatment, but does not include children who 

have been prescribed medication only. Parents could report more than one place of treatment.

Percent of Children Receiving Treatment

9.1

Place of Treatment* for Emotional or Behavioral Difficulties 

among Children Aged 4-17 Years who Received Treatment 

in the Past 12 Months, 2005-2006

Source (II.11): Centers for Disease Control and Prevention, National Center for

Health Statistics, National Health Interview Survey

0 10 20 30 40 50 60

Other Place

Pediatric

or General

Medical Practice

Child's School

Mental Health

Private Practice,

Clinic or Center

27.1

39.0

58.7
Child Health USA 2008-2009

Health Services Financing and Utilization 59

Dental Care

According to the Centers for Disease Control 

and Prevention, dental caries (tooth decay) is the 

single 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, are 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 their first tooth or at 12 months of age, 

whichever comes first.

In 2006, only 27.7 percent of children eligible 

for services under the Medicaid Early and Periodic 

Screening, Diagnostic, and Treatment (EPSDT) 

program received preventive dental services.

In 2007, 73.0 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 income. 

Children with family incomes of 200 percent or 

more of the poverty threshold were more likely 

to have received dental care than children living 

with family incomes below 200 percent of the 

poverty threshold (78.9 versus 64.8 percent, respectively). 

Non-Hispanic White children aged 1-18 years 

were more likely than children of other racial/ethnic groups to have received dental care in the past 

year (76.0 percent), followed by non-Hispanic 

Black children (71.0 percent) and Hispanic children (67.5 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 26 November, 2008.

Receipt of Dental Care* among Children Aged 1–18 Years,

by Poverty Level,** 2007

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

for Health Statistics, National Health Interview Survey

27.7

Percent of Eligible Children 

Receipt of EPSDT Preventive Dental Service among Eligible

Children,* Aged Birth–20 Years, 1990–2006**

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

Annual EPSDT Report

Percent of Children

Within Past Year

More Than 1 Year Ago or Never

27.0

64.8

73.0

78.9

35.2

21.1

*All children on Medicaid are eligible for EPSDT services. **Not all States and Territories reported 

data in all years.

*Includes visits to specialists and dental hygienists. **The poverty threshold, as determined by the Census

Bureau, was equal to $21,203 for a family of four in 2007.

20

22

24

26

28

30

1990 1994 1998 2002 2006

10

20

30

40

50

60

70

80

90

100

All Children Below 200% Poverty Level 200% Poverty Level or More
Child Health USA 2008-2009

60 Health Services Financing and Utilization

timing of Health Care 

visits

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 2007, 11.4 percent 

of children under 18 years of age had not seen a 

physician or other health care professional in the 

past year (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 

7.4 percent of children under 5 years of age.

Health care visits also varied by race/ethnicity: 

in 2007, nearly 17 percent of Hispanic children 

had not seen a physician or other health professional in the past year, compared to 9.7 percent 

of non-Hispanic White children and 9.6 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 Black children were the most likely to have 

seen one, except for within the 15- to 17-year-old 

age group. Across all racial/ethnic and age groups, 

Hispanic children aged 15-17 years were the most 

likely to have gone without a health care visit in 

the past year (29.2 percent).

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

in the Past 12 Months, by Age and Race/Ethnicity, 2007

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

Interview Survey Percent of Children

0

3

6

9

12

15

18

21

24

27

30

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

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

11.4

9.6

16.6

7.4 7.4

4.5

8.9

10.4 9.5

8.4

14.5 13.7

11.6 10.8

21.2

15.5

10.6

17.4

29.2

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

9.7
Child Health USA 2008-2009

Health Services Financing and Utilization 61

preventive health care 

visits

In 2007, nearly 74 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. 

Young children were more likely than children 

of other ages to have a well-child visit: 82.7 percent of children aged 4 years and younger had a 

visit in the past year, compared to 75.8 percent of 

children aged 5-9 years, 69.1 percent of children 

aged 10-14 years, and only 63.3 percent of children aged 15-17 years. 

The proportion of children receiving preventive medical care also varies by race and ethnicity. 

In 2007, non-Hispanic Black children were the 

most likely to have had a well-child visit in the 

past year (79.8 percent), followed by non-Hispanic White children (74.1 percent). Hispanic 

children were least likely to have had preventive 

care (68.5 percent).

Receipt of preventive medical care also varies by poverty status. In 2007, 74.3 percent of 

children with family incomes above the poverty 

threshold ($21,203 for a family of four in 2007) 

had a well-child visit in the past year, compared 

to 70.7 percent of children with family incomes 

below the poverty threshold (data not shown). 

Receipt of Preventive Health Care in the Past Year Among 

Children Under Age 18, by Age, 2007

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

Statistics, National Health Interview Survey Percent of Children

10

20

30

40

50

60

70

80

90

100

69.1 73.7 75.8

Receipt of Preventive Health Care in the Past Year Among 

Children Under Age 18, by Race/Ethnicity, 2007

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

Statistics, National Health Interview Survey Percent of Children

10

20

30

40

50

60

70

80

90

100

74.1

79.8 82.7

68.5

63.3

Total 0–4 Years 5–9 Years 10–14 Years 15–17 Years Non-Hispanic White Non-Hispanic Black Hispanic
Child Health USA 2008-2009

62 Health Services Financing and Utilization

usual place for sick 

care

In 2007, a doctor’s office or health maintenance organization (HMO) was the usual place 

for sick care (not including routine or preventive 

care) for 74.8 percent of children in the United 

States, a proportion that varies by poverty status 

and race/ethnicity. Children with family incomes 

above the poverty threshold ($21,203 for a family 

of four in 2007) were more likely to visit a doctor’s 

office or HMO for sick care than children with 

family incomes below the poverty threshold. 

Among children with family incomes below 

the poverty threshold, 71.2 percent of non-HisPlace of Physician Contact,* by Poverty Status** and Race/Ethnicity, 2007

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 poverty threshold for a family of four was $21,203 in 2007.

Doctor’s Office or HMO

84.3

67.1

77.1

45.9

61.8

71.2

Non-Hispanic White

Non-Hispanic Black

Hispanic

0

10

20

30

40

50

60

70

80

90

100

Below Poverty Level Above Poverty Level

Clinic or Health Center

13.9

31.6

20.4

50.4

35.6

25.4

Non-Hispanic White

Non-Hispanic Black

Hispanic

0

10

20

30

40

50

60

70

80

90

100

Below Poverty Level Above Poverty Level

Hospital or Other Place

1.8 2.5 1.4 3.8 3.4 2.6

Non-Hispanic White

Non-Hispanic Black

Hispanic

0

10

20

30

40

50

60

70

80

90

100

Below Poverty Level Above Poverty Level

panic White children received sick care at a doctor’s office or HMO, compared to 61.8 percent of 

non-Hispanic Black children and 45.9 percent of 

Hispanic children. Hispanic children were more 

likely than non-Hispanic children to receive sick 

care at a clinic or health center, with over 50 

percent whose family incomes were below poverty and more than 30 percent whose family incomes were above poverty receiving care at such 

a location. Comparatively, only 25.4 percent of 

low-income and 13.9 percent of higher-income 

non-Hispanic White children received care from 

clinics or health centers. 

Only a small proportion of children used a 

hospital emergency room, hospital outpatient 

department, or some other source as their primary source of sick care. Children with family 

incomes below the poverty threshold were more 

likely than children with family incomes above 

the poverty threshold to do so. For instance, 3.8 

percent of Hispanic children and 3.4 percent of 

non-Hispanic White children with family incomes below the poverty threshold received sick 

care from these sources, compared to 1.4 percent 

and 1.8 percent, respectively, of those with family 

incomes above the poverty threshold.
Child Health USA 2008-2009

Health Services Financing and Utilization 63

Visits to the Emergency Room/Emergency Department 

Among Children Under Age 18, by Poverty Status,* 2007

Source (III.5): 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

17.7

1.4 2.8 1.1

19.2

26.1

79.4

71.2

81.3

Visits to the Emergency Room/Emergency Department Among 

Children Under Age 18, by Age, 2007

Source (III.5): 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 82.9 79.1 82.1

74.9

1.0 0.8 0.6 2.7

16.3 20.3 16.9

22.4

10

20

30

40

50

60

70

80

90

100

No Visits 1-3 Visits 4 or More Visits

*The U.S. Census Bureau poverty threshold for a family of four was $21,203 in 2007.

10

20

30

40

50

60

70

80

90

100

No Visits 1-3 Visits 4 or More Visits

Emergency Department 

Utilization

In 2007, more than 20 percent of children had 

at least one visit to a hospital emergency department (ED). Children with family incomes below 

the poverty threshold ($21,203 for a family of 

four in 2007) were more likely than children with 

family incomes above the poverty threshold to 

have visited the ED. Just over 26 percent of children from low-income families made one to three 

ED visits during the year, compared to fewer than 

18 percent of children from higher-income families. Similarly, 2.8 percent of children from lowincome families made four or more visits to the 

ED, compared to 1.1 percent of children from 

higher-income families.

Emergency department utilization also varies 

by age: 22.4 percent of children under 5 years of 

age made 1-3 visits to the ED in 2007, followed 

by children aged 15-17 years (20.3 percent). Children under 5 years of age were also the most likely 

to make 4 or more visits to the ED (2.7 percent), 

followed by children aged 5-9 years (1.0 percent). 

Racial/ethnic differences in utilization were also 

apparent, with non-Hispanic Black children most 

likely to make 1-3 and 4 or more visits to the ED 

(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 as the result of 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 2008-2009

Health Services Financing and Utilization 65

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 2006, in the 18 reporting areas (States and 

territories) that use the revised birth certificate, 

69.0 percent of women giving birth were determined to have received prenatal care in the first 

trimester. In the 34 areas using the unrevised 

birth certificate, 83.2 percent of women were reported to have entered prenatal care in the first 

trimester. 

Early prenatal care utilization differs by race/

ethnicity. In 2006, 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 

88.1 percent, respectively). Non-Hispanic Black 

and Hispanic women are less likely to receive first 

trimester prenatal care. 

In 2006, 7.9 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 3.6 percent. In both the 

unrevised and revised reporting areas, non-Hispanic Black and Hispanic women were more than 

twice as likely as non-Hispanic White women to 

receive late or no prenatal care. 

Receipt of First Trimester Prenatal Care, by Race/Ethnicity 

and Birth Certificate Revision*, 2006

Source (I.5): 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**, 2006

Source (I.5): 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

83.2

69.0

88.1

76.2 76.1

58.4

77.3

57.7

20

40

60

80

100

Total Non-Hispanic White Non-Hispanic Black Hispanic

3.6 2.3

7.9 5.2 5.7 5.0

11.8 12.2

*“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 2006, including California (which had implemented a partial revision); 

“Revised” data are for all reporting areas that had implemented the 2003 Revision, not including California.

*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 2006, including California (which had implemented a partial revision); 

“Revised” data are for all reporting areas that had implemented the 2003 Revision, not including California.

Unrevised

Revised

Unrevised

Revised

State Data

Child Health USA 2008-2009

State Data 67

While the indicators presented in the 

previous sections are representative of the 

United States population as a whole, the fol-

lowing 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 interven-

tion to specific populations. Included are data 

on infant, neonatal, and perinatal mortality, 

low birth weight, preterm birth, health care 

financing, Medicaid enrollment and expendi-

tures, and SCHIP enrollment.

The following pages reveal important 

disparities 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 Missis-

sippi, followed by the District of Columbia, 

and several other southern States, including 

Alabama and Louisiana. With the exception 

of Alabama, births to unmarried women were 

also highest in these States, as well as in New 

Mexico. 

All of the issues presented here have geo-

graphic program and policy implications. 

State and local leaders can use this informa-

tion to better serve their maternal and child 

populations in need.
Child Health USA 2008-2009

68 State Data

State Children’s Health Insurance Program (SCHIP) Aggregate Enrollment, FY 2007

Source (IV.1): Centers for Medicare and Medicaid Services, Medicaid Statistical Information System

*Programs may be an expansion of Medicaid, a separate SCHIP program, or a combination of the two. **Presumptive eligibility 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 populations (e.g., infants). For States with a combination plan, information for the Medicaid plan is listed first, followed by information for the separate SCHIP plan.

State Type of SCHIP 

Program*

Upper 

Eligibility

Total SCHIP 

Enrollment

Presumptive 

Eligibility?**

Alabama Separate 200% 106,691 N

Alaska Medicaid 175% 17,558 N

Arizona Separate 200% 104,209 N

Arkansas Combo 200% 89,642 N/N

California Combo 250% 1,538,416 Y/Y

Colorado Separate 200% 84,649 N

Connecticut Separate 300% 23,632 N

Delaware Combo 200% 11,143 N/N

District of Columbia Medicaid 300% 6,566 N

Florida Combo 200% 323,529 Y/N

Georgia Separate 235% 356,285 N

Hawaii Medicaid 300% 23,958 N

Idaho Combo 185% 33,060 N/N

Illinois Combo 200% 345,576 Y/Y

Indiana Combo 200% 130,368 N/N

Iowa Combo 200% 50,238 N/N

Kansas Separate 200% 49,536 Y

Kentucky Combo 200% 68,776 N/N

Louisiana Combo 200% 153,663 N/N

Maine Combo 200% 31,037 N/N

Maryland Medicaid 200% 132,887 N

Massachusetts Combo 300% 184,483 Y/Y

Michigan Combo 200% 114,025 Y/Y

Minnesota Combo 280% 5,408 N/N

Mississippi Separate 200% 81,565 N

Missouri Combo 300% 81,764 Y/N 

State Type of SCHIP 

Program*

Upper 

Eligibility

Total SCHIP 

Enrollment

Presumptive 

Eligibility?**

Montana Separate 175% 20,115 N

Nebraska Medicaid 185% 46,199 N

Nevada Separate 200% 41,862 N

New Hampshire Combo 300% 12,088 Y/N

New Jersey Combo 350% 150,277 Y/Y

New Mexico Medicaid 234% 16,525 Y

New York Separate 250% 651,853 Y

North Carolina Combo 200% 240,152 N/N

North Dakota Combo 140% 5,469 N/N

Ohio Medicaid 200% 231,538 N

Oklahoma Medicaid 185% 117,084 N

Oregon Separate 185% 63,090 N

Pennsylvania Separate 300% 227,367 N

Rhode Island Combo 250% 26,067 N/N

South Carolina Medicaid 150% 59,920 N

South Dakota Combo 200% 14,982 N/N

Tennessee Combo 250% 41,363 Y/Y

Texas Separate 200% 710,690 N

Utah Separate 200% 44,785 N

Vermont Separate 300% 6,132 N

Virginia Combo 200% 144,163 N/N

Washington Separate 250% 14,734 N

West Virginia Separate 220% 38,582 N

Wisconsin Combo 200% 62,523 N/N

Wyoming Separate 200% 8,570 N
Child Health USA 2008-2009

State Data 69

Medicaid Enrollment and EPSDT Utilization for Children under 21, FY 2007

Source (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 initial and periodic screening services to the number of eligibles who should have received such services.

***Represents total Medicaid vendor payments divided by Medicaid eligibles under 21 (FY 2004 Medicaid Statistical Information System Report).

****Enrollee and Participation Ratio data are from FY 2005.

N/R: Not reported.

State Medicaid Enrollees* 

EPSDT

Participation 

Ratio** 

Medicaid 

Expenditures 

(Per Enrollee)***

Alabama 503,051 57% $1,880.18

Alaska 84,203 50% $4,493.54

Arizona 644,688 70% $2,279.82

Arkansas 387,393 25% $2,130.60

California 4,547,735 43% $1,352.43

Colorado 338,186 59% $1,953.42

Connecticut 278,677 65% $2,134.73

Delaware 87,502 60% $2,706.08

District of Columbia 91,236 73% $3,493.72

Florida 1,611,397 68% $1,877.67

Georgia 1,069,682 54% $1,821.56

Hawaii 146,692 68% $1,842.34

Idaho 157,656 45% $2,061.55

Illinois 1,392,361 69% $1,487.99

Indiana 607,468 100% $1,828.82

Iowa**** 248,169 68% $2,391.59

Kansas 218,498 65% $2,434.86

Kentucky 348,376 58% $2,537.93

Louisiana 770,726 65% $1,537.94

Maine 136,617 59% $5,275.23

Maryland 514,777 58% $2,606.13

Massachusetts 530,197 78% $3,459.01

Michigan 1,103,459 52% $1,837.88

Minnesota 410,610 65% $3,138.35

Mississippi 400,507 42% $1,600.98

State Medicaid Enrollees* 

EPSDT

Participation 

Ratio** 

Medicaid 

Expenditures 

(Per Enrollee)***

Missouri 643,491 69% $1,734.64

Montana 64,620 58% $2,536.63

Nebraska 161,329 56% $2,201.22

Nevada 154,025 63% $1,617.51

New Hampshire 90,678 61% $2,483.13

New Jersey 589,415 58% $2,223.72

New Mexico 324,178 47% $2,415.37

New York 2,021,928 56% $2,708.01

North Carolina 973,650 79% $2,348.96

North Dakota 44,470 46% $2,144.94

Ohio 1,227,384 50% $2,005.30

Oklahoma 504,458 50% $1,672.24

Oregon 271,889 61% $1,971.84

Pennsylvania 1,120,184 49% $2,603.95

Rhode Island 113,005 55% $4,034.41

South Carolina 528,336 48% $1,818.43

South Dakota 88,107 49% $2,282.76

Tennessee 816,486 57% $1,864.99

Texas 2,904,790 65% $1,876.39

Utah 167,691 59% $1,986.96

Vermont 57,307 55% $2,993.23

Virginia 548,732 67% $1,785.67

Washington 646,521 58% $1,515.80

West Virginia 207,606 45% $1,916.62

Wisconsin 499,965 68% $1,585.51

Wyoming 53,642 38% $2,124.46
Child Health USA 2008-2009

70 State Data

Health Insurance Status of Children Under 18,* 2008

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

*Children may have more than one type of coverage. **Includes children covered by Medicaid, SCHIP, 

Medicare, military health insurance, and the Indian Health Service. 

State Percent with 

Private Insurance

Percent with 

Public Insurance**

Percent 

Uninsured

Alabama 67% 31% 7%

Alaska 64% 36% 11%

Arizona 60% 33% 14%

Arkansas 52% 49% 6%

California 60% 34% 11%

Colorado 71% 19% 13%

Connecticut 76% 25% 5%

Delaware 70% 28% 7%

District of Columbia 56% 41% 6%

Florida 62% 27% 19%

Georgia 61% 35% 11%

Hawaii 70% 37% 5%

Idaho 71% 24% 11%

Illinois 70% 31% 7%

Indiana 70% 31% 5%

Iowa 77% 27% 5%

Kansas 68% 32% 8%

Kentucky 63% 36% 8%

Louisiana 58% 39% 12%

Maine 67% 40% 5%

Maryland 72% 24% 11%

Massachusetts 72% 30% 3%

Michigan 69% 31% 6%

Minnesota 78% 22% 6%

Mississippi 47% 49% 12%

Missouri 63% 32% 10%

State Percent with 

Private Insurance

Percent with 

Public Insurance**

Percent 

Uninsured

Montana 59% 35% 13%

Nebraska 72% 25% 10%

Nevada 72% 16% 14%

New Hampshire 82% 18% 6%

New Jersey 73% 17% 13%

New Mexico 50% 42% 15%

New York 62% 34% 9%

North Carolina 58% 34% 12%

North Dakota 72% 26% 8%

Ohio 69% 29% 9%

Oklahoma 56% 41% 13%

Oregon 68% 26% 11%

Pennsylvania 74% 26% 7%

Rhode Island 70% 30% 9%

South Carolina 61% 31% 14%

South Dakota 72% 27% 8%

Tennessee 58% 39% 9%

Texas 51% 32% 21%

Utah 75% 19% 10%

Vermont 66% 38% 9%

Virginia 65% 33% 10%

Washington 71% 30% 7%

West Virginia 60% 41% 5%

Wisconsin 75% 27% 6%

Wyoming 72% 29% 10%
Health Insurance Status: Percent of Children Aged 18 and Younger Who Are Uninsured, by State, 2008

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

Child Health USA 2008-2009

State Data 71

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 (7.8%)

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
Child Health USA 2008-2009

72 State Data

Low Birth Weight, Preterm Birth, and Births to Unmarried Women (Percent), by State and Maternal Race/Ethnicity, 2006

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

N/A: Figure does not meet standards of reliability or precision. *All races/ethnicities.

State

Low Birth Weight Preterm Birth Births to Unmarried Women

Total* Non-Hispanic 

White Black Total* Non-Hispanic 

White Black Total* Non-Hispanic 

White Black Hispanic

United States 8.3 7.3 14.0 12.8 11.7 18.5 38.5 26.6 70.7 49.9

Alabama 10.5 8.5 15.5 17.1 14.8 22.1 36.6 22.2 69.9 21.4

Alaska 6.0 6.0 9.6 11.2 10.5 13.6 36.8 24.4 44.3 36.8

Arizona 7.1 6.8 12.8 13.2 12.1 17.6 44.0 27.9 62.3 55.5

Arkansas 9.2 7.9 15.0 13.7 12.5 19.0 41.8 31.2 78.4 46.5

California 6.8 6.4 12.0 10.7 9.8 15.1 37.6 22.4 65.0 48.2

Colorado 8.9 8.7 15.7 12.2 11.4 18.5 27.6 18.9 53.4 41.4

Connecticut 8.1 6.9 12.5 10.4 9.6 14.2 34.0 19.8 68.0 63.1

Delaware 9.3 7.7 14.8 13.7 11.9 17.8 45.5 31.8 71.5 61.5

District of 

Columbia 11.5 7.3 14.5 16.0 10.8 19.0 57.6 5.9 79.3 67.5

Florida 8.7 7.6 13.4 13.8 12.0 19.0 44.4 32.6 68.5 47.8

Georgia 9.6 7.5 14.4 14.1 12.5 18.5 42.4 25.0 67.8 48.6

Hawaii 8.1 5.9 10.2 12.1 9.0 13.9 36.0 23.7 25.1 47.4

Idaho 6.9 7.0 N/A 11.6 11.4 23.3 24.3 20.6 40.8 39.9

Illinois 8.6 7.4 14.3 13.3 12.0 19.1 38.7 24.0 78.7 48.9

Indiana 8.2 7.6 14.1 13.2 12.5 18.7 41.4 34.8 78.2 55.0

Iowa 6.9 6.8 10.6 11.6 11.3 14.9 33.8 30.7 72.4 49.1

Kansas 7.2 6.9 12.4 11.8 11.5 15.7 35.2 28.8 72.9 49.6

Kentucky 9.1 8.7 14.6 15.1 14.7 20.3 35.3 30.9 72.6 48.4

Louisiana 11.4 8.5 16.2 16.4 13.3 21.5 49.8 31.6 77.3 49.7

Maine 6.8 6.8 7.5 11.1 11.1 13.0 37.1 37.2 34.6 42.7

Maryland 9.4 7.6 13.4 13.5 11.7 17.0 39.7 24.4 62.0 53.9

Massachusetts 7.9 7.2 12.1 11.3 10.7 15.7 32.2 23.5 60.1 65.9

Michigan 8.4 7.1 14.2 12.5 11.1 18.8 38.3 28.7 76.9 48.2

Minnesota 6.5 6.0 10.3 10.5 10.3 13.1 31.7 24.6 60.1 55.9

Mississippi 12.4 8.9 16.7 18.8 15.0 22.9 52.8 28.4 79.1 56.1

State

Low Birth Weight Preterm Birth Births to Unmarried Women

Total* Non-Hispanic 

White Black Total* Non-Hispanic 

White Black Total* Non-Hispanic 

White Black Hispanic

Missouri 8.1 7.1 13.6 12.8 11.7 18.9 39.3 31.6 77.6 50.3

Montana 7.3 7.3 N/A 11.9 11.3 N/A 36.0 29.4 N/A 48.4

Nebraska 7.1 6.6 14.0 12.5 11.8 18.1 32.3 25.4 69.4 48.8

Nevada 8.3 8.3 14.1 14.4 13.8 20.2 41.3 29.8 69.6 49.3

New Hampshire 6.9 6.8 10.8 10.4 10.2 15.0 29.4 29.2 41.8 45.8

New Jersey 8.6 7.4 14.1 12.9 11.7 18.8 33.0 15.5 67.1 57.1

New Mexico 8.9 8.7 15.0 14.1 13.0 19.3 51.2 30.4 56.0 57.2

New York 8.3 7.1 12.6 12.4 11.0 16.7 40.0 22.6 69.0 64.2

North Carolina 9.1 7.8 14.2 13.6 11.9 19.0 40.1 24.5 70.4 53.2

North Dakota 6.7 6.7 N/A 12.1 11.6 N/A 31.7 25.1 34.2 46.6

Ohio 8.8 7.7 14.5 13.3 12.2 18.7 40.5 32.6 77.2 56.9

Oklahoma 8.3 7.9 15.4 13.9 13.4 20.1 40.9 33.1 75.7 48.5

Oregon 6.1 6.0 8.5 10.3 10.1 11.4 34.3 30.5 62.8 46.5

Pennsylvania 8.5 7.4 14.0 11.8 10.8 16.8 38.3 28.6 76.9 63.3

Rhode Island 8.0 7.7 11.6 12.6 11.9 15.0 40.5 30.1 63.6 61.5

South Carolina 10.1 7.8 15.2 15.4 13.0 20.4 45.6 28.5 75.5 45.9

South Dakota 7.0 6.7 11.2 12.7 11.5 16.8 37.1 26.7 47.2 47.4

Tennessee 9.6 8.4 14.8 14.8 13.7 19.6 41.4 30.4 74.9 52.3

Texas 8.4 7.6 14.2 13.7 12.6 18.6 39.4 25.5 65.9 45.1

Utah 6.9 6.6 11.0 11.5 10.9 16.4 18.8 13.0 49.0 43.2

Vermont 6.9 6.7 N/A 9.6 9.5 N/A 34.5 34.6 35.1 36.5

Virginia 8.3 7.1 13.0 12.0 10.6 16.7 33.8 21.7 63.9 50.2

Washington 6.5 6.0 10.7 11.0 10.3 13.6 31.9 26.8 52.8 47.4

West Virginia 9.7 9.5 16.3 14.0 13.9 19.0 37.9 36.7 73.6 45.7

Wisconsin 6.9 6.2 13.4 11.4 10.4 18.1 34.1 25.7 83.4 50.2

Wyoming 8.9 9.1 N/A 12.8 12.8 N/A 33.0 28.6 60.0 49.3
Child Health USA 2008-2009

State Data 73

Infant and Neonatal Mortality,* by State and Maternal Race, 2006

Source (II.2): 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.

**All races/ethnicities. ***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***

Rate Rate Rate Rate Rate Rate

United States 6.69 5.56 13.29 4.45 3.72 8.82

Alabama 9.03 6.73 14.17 5.77 4.11 9.58

Alaska 6.91 4.46 N/A 3.73 N/A N/A

Arizona 6.36 6.04 16.93 4.35 4.27 9.57

Arkansas 8.54 6.86 15.72 4.93 3.74 9.68

California 5.04 4.78 12.05 3.48 3.33 8.20

Colorado 5.71 5.48 12.39 4.37 4.26 7.94

Connecticut 6.22 4.86 14.77 4.76 3.67 11.75

Delaware 8.26 6.20 14.30 6.01 4.29 10.73

District of Columbia 11.26 N/A 14.46 7.04 N/A 9.06

Florida 7.25 5.91 11.91 4.75 3.81 7.96

Georgia 8.11 5.76 12.93 5.29 3.82 8.33

Hawaii 5.64 N/A N/A 4.43 N/A N/A

Idaho 6.82 6.70 N/A 4.63 4.68 N/A

Illinois 7.25 6.00 13.68 4.90 4.37 7.76

Indiana 7.99 6.67 18.66 4.94 3.98 12.63

Iowa 5.12 4.90 N/A 3.25 3.15 N/A

Kansas 7.13 6.05 19.25 4.27 3.86 9.78

Kentucky 7.52 6.79 15.00 4.43 4.10 7.87

Louisiana 9.92 6.21 15.82 6.12 3.54 10.17

Maine 6.29 6.21 N/A 4.24 4.14 N/A

Maryland 7.95 5.98 11.75 5.78 4.37 8.55

Massachusetts 4.76 4.57 7.99 3.60 3.46 6.18

Michigan 7.37 5.78 14.94 5.18 4.03 10.48

Minnesota 5.18 4.70 8.32 3.28 3.11 4.89

Mississippi 10.60 7.11 14.60 6.60 4.34 9.25

State

Infant deaths Neonatal Deaths

Total** White*** Black*** Total** White*** Black***

Rate Rate Rate Rate Rate Rate

Missouri 7.41 6.10 14.92 4.90 3.95 10.10

Montana 5.84 4.95 N/A 2.64 2.15 N/A

Nebraska 5.57 5.22 10.61 3.52 3.27 N/A

Nevada 6.42 5.77 15.70 4.17 3.84 8.97

New Hampshire 6.05 5.68 N/A 3.96 3.54 N/A

New Jersey 5.49 4.40 11.53 3.91 3.35 7.38

New Mexico 5.78 5.68 N/A 3.64 3.47 N/A

New York 5.63 4.90 9.18 3.79 3.37 5.89

North Carolina 8.08 5.95 15.05 5.56 4.08 10.31

North Dakota 5.80 4.89 N/A 3.60 3.40 N/A

Ohio 7.77 6.05 16.87 5.21 4.02 11.52

Oklahoma 8.00 6.79 15.39 4.41 3.80 8.40

Oregon 5.48 5.31 N/A 3.70 3.71 N/A

Pennsylvania 7.63 6.19 15.21 5.47 4.31 11.54

Rhode Island 6.14 5.65 N/A 5.01 4.50 N/A

South Carolina 8.40 5.67 13.76 5.53 3.55 9.44

South Dakota 6.88 5.26 N/A 3.61 3.15 N/A

Tennessee 8.69 6.77 16.01 5.81 4.21 11.65

Texas 6.22 5.49 11.97 3.97 3.54 7.34

Utah 5.10 5.10 N/A 3.53 3.63 N/A

Vermont 5.53 5.55 N/A 3.07 N/A N/A

Virginia 7.10 5.37 13.32 4.91 3.71 9.26

Washington 4.68 4.38 7.37 2.99 2.78 5.06

West Virginia 7.41 6.74 28.57 3.87 3.44 N/A

Wisconsin 6.39 5.03 18.28 4.30 3.38 12.94

Wyoming 7.04 6.57 N/A 4.43 3.91 N/A

City Data

Child Health USA 2008-2009

City Data 75

The following section compares urban 

health to the national average for several 

health 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 generally poorer than that of infants in 

the Nation as a whole. In 2006, 8.8 percent of 

infants living in cities were born at low birth 

weight, compared to a national average of 8.5 

percent. The infant mortality rate showed an 

even greater disparity, with a rate of 7.5 per 

1,000 live births among infants in cities compared to a national average of 6.9 per 1,000. 
Child Health USA 2008-2009

76 City Data

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 2006, 123,230 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 8.8 percent of infants in U.S. cities. The 

2006 percentage of urban infants born low birth 

weight was 6 percent higher than the percentage 

among all U.S. infants (8.3 percent), though this 

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 2006, nearly 1.7 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 by 13 percent.

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

Populations over 100,000, 1990–2006

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

Statistics, National Vital Statistics System

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

Percent of Infants

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

Populations over 100,000, 1990–2006

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

Statistics, National Vital Statistics System Percent of Infants

8.3

8.8

1.7

1.5

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

1

2

3

4

5

6

7

8

9

10

1990 1994 1998 2002 2006

1

2

3

4

5

6

7

8

9

10

1990 1994 1998 2002 2006
Child Health USA 2008-2009

City Data 77

Infant Mortality

In 2005, 6,623 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 United States cities was 7.5 

deaths per 1,000 live births, which was higher 

than the rate for the Nation as a whole (6.9 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 2005, the infant 

mortality rate in cities declined by nearly onethird, 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,* 1990–2005

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

Statistics System

7.5

6.9

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 1993 1996 1999 2002 2005
Child Health USA 2008-2009

78 References

Population Characteristics

(I.1): U.S. Census Bureau, Population Division. Annual population estimates 

(2007). Available online: http://www.census.gov/popest/national/asrh/. 

Accessed April, 2009.

(I.2): U.S. Census Bureau, Housing and Household Statistics Branch. America’s families and living arrangements: 2007. Available online: http://www.

census.gov/population/www/socdemo/hh-fam.html. Accessed April, 2009.

(I.3): U.S. Census Bureau, Housing and Household Economic Statistics Division. 2006 detailed poverty tables. Available online: http://www.census.

gov/hhes/www/macro/032007/pov/toc.htm. Accessed April, 2009. 

(I.4): U.S. Department of Education, National Center for Education Statistics. The condition of education 2008. Available online: http://nces.ed.gov/

programs/coe/. Accessed April, 2009.

(I.5): Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Kirmeyer S, Mathews TJ. Births: Final data for 2006. National vital statistics 

reports, vol 57, no 7. Hyattsville, MD: National Center for Health Statistics, 2007 Jan. Hamilton BE, Martum JA, Ventura SJ. Births: Preliminary 

Data for 2007. Hyattsville, MD: National Center for Health Statistics, 

2009 March.

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

characteristics of families in 2007 (USDL 08-0731). Washington, DC: the 

Department, 2008 May.

(I.7): Iruka I, Carver P. Initial results from the 2005 NHES Early Childhood 

Program Participation Survey (NCES 2006-075). Washington, DC: U.S. 

Department of Education, National Center for Education Statistics, 2006.

(I.8): Health Resources and Services Administration, Maternal and Child 

Health Bureau and Centers for Diease Control and Prevention, National 

Center for Health Statistics. 2007 National Survey of Children’s Health. 

Data Resource Center for Child and Adolescent Health website. http://

www.nschdata.org. Accessed June, 2009.

Health Status

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

Health Statistics, National Vital Statistics System. Unpublished data. 

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

Health Statistics. Deaths: final data for 2006. National Vital Statistics 

Reports, vol. 57, no. 14. April 2009. 

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

Health Statistics. Health, United States, 2008, with chartbook. Hyattsville, 

MD: 2009. 

(II.4): Centers for Disease Control and Prevention. Summary of notifiable 

diseases—United States, 2006. MMWR, 2008;55(53): 33-34.

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

Report, 2006. Volume 18. Atlanta, GA: U.S. Department of Health and 

Human Services, Centers for Disease Control and Prevention, 2008.

(II.6): Centers for Disease Control and Prevention, National Center for 

Health Statistics. National Hospital Discharge Survey, 2006. Unpublished 

data.

(II.7): U.S. Department of Health and Human Services, Administration for 

Children and Families. Child maltreatment 2006. Washington, DC: U.S. 

Government Printing Office, 2008.

References
Child Health USA 2008-2009

References 79

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

Health Statistics, National Vital Statistics System. Generated using the 

National Center for Injury Prevention and Control’s Web-based Injury 

Statistics Query and Reporting System (WISQARS). http://www.cdc.gov/

injury/wisqars/index.html. Accessed June, 2009.

(II.9): Centers for Disease Control and Prevention. Youth risk behavior surveillance: United States, 2007. MMWR, 2008;57(SS-4).

(II.10): Centers for Disease Control and Prevention, Division of STD Prevention. Sexually transmitted disease surveillance, 2006. Atlanta, GA: U.S. 

Department of Health and Human Services, 2007 Nov.

(II.11): Simpson GA, Cohen RA, Pastor PN, Reuben CA. Use of mental 

health services in the past 12 months by children aged 4-17 years: United 

States, 2005-2006. NCHS Data Brief, No. 8. September 2008.

(II.12): Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future national survey results on drug use, 1975-2007: Volume 

I, secondary school students. (NIH Pub. No. 08-6418A). Bethesda, MD: 

National Institute on Drug Abuse, 2008.

(II.13): Substance Abuse and Mental Health Services Administration. Results 

from the 2007 National Survey on Drug Use and Health: national findings. (NSDUH Series H-34, DHHS Pub. No. SMA 08-4343). Rockville, 

MD. 2008.

Health Services Financing and Utilization

(III.1): U.S. Census Bureau, Current Population Survey, 2007. CPS table 

creator. http://www.census.gov/hhes/www/cpstc/cps_table_creator.html. 

Accessed March 2009.

(III.2): Centers for Disease Control and Prevention. 2006 National Immunization Survey. http://www.cdc.gov/vaccines/stats-surv/imz-coverage.htm. 

Accessed April, 2009.

(III.3): Centers for Disease Control and Prevention. 2009 childhood immunization schedule. http://www.cdc.gov/vaccines/recs/schedules/default.htm. 

Accessed June, 2009.

(III.4): Centers for Medicare and Medicaid Services. 2006 Annual EPSDT Report (Form 416). http://www.cms.hhs.gov/

MedicaidEarlyPeriodicScrn/03_StateAgencyResponsibilities.asp. Accessed 

May, 2009.

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

Health Statistics. 2007 National Health Interview Survey. Unpublished 

data. Analysis by the Maternal and Child Health Information Resource 

Center.

State Data

(IV.1): Centers for Medicare and Medicaid Services. CHIP annual enrollment 

report, 2007. http://www.cms.hhs.gov/NationalCHIPPolicy/CHIPER/list.

asp. Accessed April, 2009.

(IV.2): Centers for Medicare and Medicaid Services. EPSDT annual report 

(Form 416). http://www.cms.hhs.gov/MedicaidEarlyPeriodicScrn/03_

StateAgencyResponsibilities.asp. Accessed June, 2009. 
Child Health USA 2008-2009

80 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

Contributors

Photography Credits

Cover and title page, clockwise from top left: first, second, fourth, sixth, seventh and eighth 

photos, iStockPhoto; third photo, Gretchen Noonan; fifth photo, Valerie Gwinner. Pages 

5, 7, 9, 11, 19, 20, 29, 39, 44, 53, 58, 64, 75 and 80: iStockPhoto. Page 20: Kathi Pewitt. 

Page 29: Jennifer Decker. Pages 8 and 39: Valerie Gwinner. Page 67: Renee Schwalberg.