Child Health USA 2006

Maternal and Child Health Bureau
Child Health USA 2006 is not copyrighted. Readers are free to duplicate and use all or part of the 

information contained in this publication. 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 2006. Rockville,

Maryland: U.S. Department of Health and Human Services, 2006.

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

HRSA Information Center

2070 Chain Bridge Road, Suite 450

Vienna, VA 22182-2536

703-442-9051 or 1-888-ASK-HRSA
Preface 5

Introduction 7

Population Characteristics 11

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

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

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

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

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

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

Health Status 19

Health Status - Infants

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

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

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

Neonatal and Postneonatal Mortality . . . . . .24

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

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

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

Health Status - Children

Oral Health . . . . . . . . . . . . . . . . . . . . . . . . . .29

Overweight . . . . . . . . . . . . . . . . . . . . . . . . . .30

Pediatric AIDS . . . . . . . . . . . . . . . . . . . . . . .31

Vaccine-Preventable Diseases . . . . . . . . . . . . .33

Hospitalization . . . . . . . . . . . . . . . . . . . . . . .34

Hospital Discharge Trends . . . . . . . . . . . . . . .35

Child Abuse and Neglect . . . . . . . . . . . . . . . .36

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

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

Health Status - Adolescents

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

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

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

Adolescent and Young Adult

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

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

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

Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . .48

Substance Abuse . . . . . . . . . . . . . . . . . . . . . .49

Cigarette Smoking . . . . . . . . . . . . . . . . . . . .50

Adolescent Mortality . . . . . . . . . . . . . . . . . . .51

Adolescent Mortality from Traffic 

and Firearm Injuries . . . . . . . . . . . . . . . . . . .52

Health Services Financing

and Utilization 54

Health Care Financing . . . . . . . . . . . . . . . . .55

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

Immunization Schedule . . . . . . . . . . . . . . . .57

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

Timing of Physician Visits . . . . . . . . . . . . . . .60

Receipt of Preventive Care . . . . . . . . . . . . . . .61

Place of Physician Contact . . . . . . . . . . . . . .62

Hospital Utilization . . . . . . . . . . . . . . . . . . . .63

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

State Data 67

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

Medicaid Enrollees, Expenditures,

and Reported EPDST Utilization . . . . . . . . .69

Health Insurance Status of Children . . . . . . .70

Uninsured Children . . . . . . . . . . . . . . . . . . .71

Low Birth Weight, Prenatal Care,

Births to Unmarried Women . . . . . . . . . . . . .72

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

City Data 74

Birth Weight . . . . . . . . . . . . . . . . . . . . . . . . .75

Infant Mortality . . . . . . . . . . . . . . . . . . . . . .76

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

References 78

Contributors 80

Child Health USA 2006

3

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

(MCHB) is pleased to present Child Health USA

2006, the 17th annual report on the health status

and service needs of America’s children. The

Bureau’s vision is that of a future 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

Bureau’s progress toward achieving this vision,

MCHB has compiled this book of secondary data

for more than 50 health status and health care

indicators. It provides both graphical and textual

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

All of the data discussed within the text of these

pages is from the same sources as the information

in the corresponding graphs (unless otherwise

noted). Data are presented for the target populations of Title V funding: infants, children, adolescents, children with special health care needs, and

women of childbearing age. Child Health USA

2006 addresses health status and health services

utilization, as well as 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 systems of care.

Child Health USA is published to provide the

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

public sectors. The book’s succinct format is

intended to facilitate the use of the information as

a snapshot of measures of children’s health in the

United States.

Population Characteristics is the first section, and

presents statistics on factors that influence the

well-being of children, including poverty, education, and child care. The second section, entitled

Health Status, contains vital statistics and health

behavior information for the maternal and child

health population. Health Services Financing and

Utilization, the third section, includes data regarding health care financing and newly implemented

health policies. The final sections, State Data and

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

Please note that Child Health USA is not copyrighted. Readers are free to duplicate and use all

or part of the information contained herein. This

book, as well as previous editions, is available in

both HTML and PDF formats online at

www.mchb.hrsa.gov. 

For a complimentary copy of the publication,

mail your request to HRSA Information Center,

2070 Chain Bridge Road, Suite 450, Vienna, VA

22182-2536, or call 703-442-9051 or 1-888-

ASK-HRSA.

Preface

Child Health USA 2006

5

Preface
The health of the current child population has

important implications for the future health of

the overall United States population as today’s

children grow into adults. A number of childhood health issues—including weight, smoking,

oral health, and vaccination coverage—can affect

health throughout the lifespan. In 2005, approximately 25 percent of the United States population was under 18 years of age. The health and

well-being of these children, as well as that of our

country, depend on preventive services such as

prenatal care and immunization, as well as the

promotion of healthy life choices. These measures

help assure that children are born healthy and

maintain good health as they 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 improving, reaching 83.9

percent of pregnant women in 2004. A small proportion of women (3.6 percent) goes without

prenatal care until the third trimester, or forgoes

it entirely. This is more common among Black

and Hispanic women, as well as those who are

younger, unmarried, and less educated.

Several other indicators of maternal health are

presented in Child Health USA. One of these is

maternal age, which can affect the health of both

infant and mother. In 2004, births to 15- to 19-

year old women reached a record low, while

births to older women (35 years and older)

increased. Parental employment and child care

can also affect the health and well-being of a family. In 2005, 70.5 percent of women with children under 18 years of age were in the labor force

(either employed or looking for work). Of mothers with preschool-aged children (younger than 6

years), 62.8 percent were in the labor force and

58.5 percent were employed. In the same year, 60

percent of children under 6 years of age required

at least one weekly nonparental child care

arrangement.

After the health of the mother and the family,

Child Health USA presents data regarding the

health of infants and young children. Healthy

birth weight is an important indicator of infant

health, and evidence is currently emerging that

birth weight affects children into adulthood, as

well. Despite high rates of prenatal care utilization, preliminary data in 2004 indicate that 8.1

percent of infants were born at low birth weight

(less than 2,500 grams, or 5 pounds 8 ounces)

that year, which is the highest rate recorded in the

last 3 decades. Although the increase in multiple

births, which are more likely to result in low birth

weight, are on the rise, the low birth weight rate

among singleton births is rising as well. Very low

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

4 ounces) is also on the rise, representing 1.5 percent of live births in 2004. This has increased

from a rate of approximately 1 percent in 1980.

Children born at very low birth weight are significantly more likely to die in the first year of life

than babies of normal birth weight, and those

who survive are at particularly high risk for severe

physical, developmental, and cognitive problems.

Although rates of maternal and infant mortality

have dropped dramatically in the past century,

the United States still has one of the highest rates

of infant death in the industrialized world

(6.9 deaths per 1,000 live births in 2004).

Breastfeeding can also support the health of

infants and mothers. Breastfeeding rates have

increased steadily since the beginning of the last

Introduction

Child Health USA 2006

7

Introduction
decade. In 2004, 70.3 percent of mothers

reported ever breastfeeding their infant. However, the rate declined dramatically as infant age

increased: 36.2 percent of mothers reported

breastfeeding their infant at 6 months of age. The

rate of exclusive breastfeeding at 6 months was

even lower (14.1 percent).

Vaccination is a preventive health measure that

protects the health of 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 2004, 80.9

percent of children aged 19 to 35 months had

received the recommended series of vaccines;

76.0 percent of children in this age group

received the recommended series plus the varicella (chicken pox) vaccine. 

Oral health becomes an important factor in

overall child health status as soon as the first

tooth appears. In 2003, the parents of 68.4 percent of children reported that their children’s

teeth were in excellent or very good condition.

Non-Hispanic White children were most likely

to have teeth in excellent or very good condition,

while Hispanic children were least likely. In

2004, 72.3 percent of children had seen a dentist

in the past year.

Physical activity and healthy weight are other

important factors in overall health that begin in

early childhood. In 2003, 14.8 percent of children aged 10 to 17 years were classified as overweight. Results from the 2005 National Youth

Risk Behavior Surveillance show that 35.8 percent of high school students met the currently

recommended levels of physical activity, and 54.2

percent of students were enrolled in a physical

education class on one or more days a week.

Enrollment in weekly physical activity classes was

higher in the younger grades (71.5 percent of 9th

graders) than in the older grades (38.8 percent of

12th graders).

The period of adolescence introduces additional health issues that need to be monitored and

addressed. In 2005, 46.8 percent of high school

students reported ever having sexual intercourse.

Among 9th grade students, more males were currently sexually active (24.5 percent) than females

(19.5 percent). However, by 12th grade, females

were more likely to be currently sexually active

(51.7 percent) than males (47.0 percent). With

sexual activity comes the risk of sexually transmitted infections (STIs). Adolescents (ages 15 to 19

years) and young adults (ages 20 to 24 years) are

at much higher risk of contracting STIs than are

older adults. Chlamydia continues to be the most

common STI in adolescents and young adults,

with rates of 1,579 and 1,660 cases per 100,000,

respectively, in 2004. Gonorrhea followed in

Introduction

Child Health USA 2006

8
Introduction

prevalence with overall rates of 427 and 498 per

100,000 adolescents and young adults, respectively. Although specific statistics are yet unavailable, genital human papillomavirus (HPV) is

believed to be the most common STI in the

United States. A vaccine for HPV was recently

approved by the Food and Drug Administration

(FDA) for use in females aged 9 to 26 years.

Mental health is another issue that increasingly

affects children as they grow older. In 2004, 22.5

percent of youth aged 12 to 17 years received

mental health treatment or counseling in the past

year, which includes treatment or counseling for

emotional or behavioral problems not caused by

drug or alcohol use. The rate in 2004 represented

a significant increase over the previous year (20.6

percent). Depression was the leading reason

reported for mental health treatment among this

age group.

A number of other issues are interconnected

with mental health, including violence and substance abuse. Results from the 2005 Youth Risk

Behavior Surveillance indicate that 18.5 percent

of high school students had carried a weapon

(such as a gun, knife, or club) at some point during preceding 30 days. Among males, non-Hispanic Whites and Hispanics were more likely

than non-Hispanic Blacks to carry a weapon.

Among females, non-Hispanic Blacks were more

likely to carry a weapon than their non-Hispanic

White and Hispanic counterparts. With regard

to substance abuse, 10.6 percent of adolescents

aged 12 to 17 years reported using illicit drugs in

the past month in 2004. Alcohol was the most

commonly used drug among adolescents, with

17.6 percent reporting past-month use in 2004,

while marijuana was the most commonly used

illicit drug (7.6 percent).

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

can help policymakers and public health officials

analyze the current health climate 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 lessons to be learned from the

experiences of programs that have achieved success. The health of our children and adolescents

relies on effective public health efforts that

include providing access to knowledge, skills, and

tools; providing drug-free alternative activities;

identifying risk factors and linking people to

appropriate services; building community supports; and supporting approaches that promote

policy change. 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 2006

9
The population of the United States is becoming increasingly diverse, which is reflected by the

socio-demographic 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 children who are Black has remained relatively stable. This largely demonstrates the

changes in the racial and ethnic makeup of the

population as a whole.

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

health-related issues that affect mothers, children,

and families. By carefully analyzing and comparing available data, public health professionals can

often isolate high-risk populations that require

specific interventions.

This section presents data on several population characteristics that have an impact on maternal and child health program development and

evaluation. Included are data on the age and racial

and ethnic distribution of the U.S. population, as

well as data displaying poverty status, child care

arrangements, and school dropout rates.

Population Characteristics

Child Health USA 2006

11

Population Characteristics
POPULATION OF CHILDREN

In 2005, there were an estimated 73.4 million

children under 18 years of age in the United

States, representing approximately 25 percent of

the population. Young adults aged 20 to 24 years

composed just over 7 percent of the population,

while adults aged 25 to 64 years composed nearly

53 percent of the population and adults aged 65

years and older composed more than 12 percent. 

Since the 2000 Census, the number of children under 5 years of age has risen 5.8 percent,

and the number of children aged 5 to 19 years

has risen just over 2 percent. The number of

adults aged 65 years and older has risen over

5 percent in the same period.

The population of children reflects the

increase in the diversity of the population over

the past several decades. Hispanic children represented 9 percent of all children in 1980, compared to over 19 percent in 2005; Asian/Pacific

Islander children represented 2 percent of all

children in 1980 and over 4 percent in 2005.

While the percentage of children who are Hispanic or Asian/Pacific Islander has more than

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

children who are Black has remained relatively

stable.

Population Characteristics

Child Health USA 2006

12

Population of Children Under Age 18, by Race/Ethnicity: 2005

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

U.S. Resident Population, by Age Group: 2005

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

65 Years 

and Older

12.4%

25 to 64 Years

52.9%

20 to 24 Years

7.1%

15 to 19 Years

7.1%

10 to 14 Years

7.0%

5 to 9 Years

6.6%

Under 5 Years

6.9%

American

Indian/Alaska Native

1.1%

Two or More Races

2.8%

Asian/Pacific Islander

4.1%

Hispanic

19.4%

Non-Hispanic

Black

15.2%

Non-Hispanic White

57.4%
Population Characteristics

CHILDREN OF FOREIGNBORN PARENTS

The foreign-born population in the United

States has increased substantially since the 1970s,

largely due to immigration from Asia and Latin

America. In 2003, over 20 percent of children

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

were born in the United States to atleast one foreign-born parent and 4 percent were themselves 

foreign-born. Most children (76.2 percent) were

native-born and lived in households with nativeborn parents.

Children with foreign-born parents were more

likely than children with native-born parents to

have family incomes below 100 percent of the

Federal poverty level. Health insurance coverage

also varies by nativity: native-born children with

foreign-born parents were the most likely to have

public insurance, while foreign-born children 

with foreign-born parents were the most likely to

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

insurance.

Child Health USA 2006

13

Children Under Age 18, by Health Insurance Status and Nativity

of Child and Parent(s):* 2003

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

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

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

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

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

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

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

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

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

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

Statistics, National Survey of Children’s Health

0

10

20

30

40

50

60

70

80

Publicly Insured Privately Insured No Insurance

24.6 25.8

37.7

6.2

43.1

12.8

31.1

49.6

69.2

Native Child and Parent

Native Child, Foreign-Born Parent

Foreign-Born Child and Parent

Other

3.3%

Foreign-Born Child

and Parent

4.0%

Native Child,

Foreign-Born Parent

16.5%

Native Child

and Parent

76.2%
Population Characteristics

CHILDREN IN POVERTY

In 2004, just over 13 million children under

18 years of age lived in households with incomes

below the Federal poverty threshold ($19,307 for

a family of four);1 this represents 17.8 percent of

all children in the United States. Children represented over one-third of people in poverty, but

only one-quarter of the population.

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. A much

higher proportion of Black (33.6 percent) and

Hispanic (28.9 percent) children under age 18

were poor than were their non-Hispanic White

counterparts (10.5 percent).

Children in single-parent families are particularly likely to be poor: of children under age 6 living with a single mother, 52.6 percent lived in

poverty, approximately five times the rate of 

their counterparts in married-couple families.

Although they compose only 18 percent of all

families in the United States, female-headed

households represent about half of all families in

poverty.

1 Following the Office of Management and Budget’s Statistical

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

income thresholds that vary by family size and composition to

determine who is in poverty.

Child Health USA 2006

14

Children Under Age 18 Living in Households with Incomes Below

100 Percent of Poverty Level, by Race/Ethnicity:* 1976-2004

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

Total

*The Current Population Survey currently allows respondents to choose more than one race; however, prior 

to 2002, only one race was reported. Figures reported here are for respondents who chose one race; 

however, Hispanics may be of any race.

Married-Couple

Families

41.0% Male Householder,

No Wife Present

8.4%

Female Householder,

No Husband Present

50.6%

Families Below 100 Percent of Poverty Level, by Family Type: 2004

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

0

10

20

30

40

50

1976 1980 1984 1988 1992 1996 2004

33.6

28.9

10.5

Non-Hispanic White 17.8

Black

Hispanic
SCHOOL DROPOUTS

As of October 2004, there were approximately

3,766,000 high school dropouts* in the United

States. This represents a dropout rate of 10.3 percent. The rate has generally declined over the

past several decades; however, 2004 saw the first

increase since 1998. 

Since 1970, Hispanic students have had the

highest dropout rates; the dropout rate among

this group was 23.8 percent in 2004. The high

Hispanic dropout rate is partly due to the high

dropout rate among Hispanics born outside of

the United States (38.4 percent). First generation

Hispanics, those who were born in the United

States but have at least one parent born outside

of the country, have a much lower dropout rate

(14.7 percent), and the rate among second-generation or more Hispanics, those who were born

in the United States to American-born parents, is

comparable to that of other racial/ethnic groups

(13.7 percent). The dropout rates among nonHispanic Whites and non-Hispanic Blacks were

6.8 and 11.8 percent, respectively, in 2004.

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

be unemployed and, when they are employed,

earn less than those who completed high school.

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

report worse health than their peers who did

complete high school, regardless of income.

*Status dropouts refers to 16- to 24-year-olds who are not enrolled

in school and have not earned high school credentials (diploma or

equivalent).

Population Characteristics

Child Health USA 2006

15

11.8

23.8

Percent

Status School Dropout Rates* for Children Aged 16-24, by Race/Ethnicity: 1990-2004

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

0

5

10

15

20

25

30

35

40

1990 1992 1994 1996 1998 2000 2002 2004

6.8

10.3

Non-Hispanic White

Non-Hispanic Black

Total

Hispanic

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

MATERNAL AGE

In 2004, the general fertility rate rose to 66.3

births per 1,000 women aged 15 to 44 years. The

birth rate among teenagers 15 to 19 years continued to decline, reaching another record low.

This rate was 33 percent lower than the recent

peak of 41.2 births per 1,000 women in this age

group reported in 1991. The rate among women

aged 20 to 24 years also reached a record low

(101.7 per 1,000). Conversely, the birth rate

among women aged 30 to 34 years rose slightly

(less than 1 percent), while the rates among

women aged 35 to 39 and 40 to 44 years rose

more notably (4 and 3 percent, respectively).

In 2004, just over 10 percent of births were to

women aged 19 years and younger and 52 percent were to women in their twenties; just over

one-third of births were to women in their thirties, and 2.7 percent were to women in their forties and early fifties.

Among non-Hispanic Black and Hispanic

women, over half of births were to women in

their twenties; exactly half of births to non-Hispanic White women occurred in the same age

group. The proportion of births that were to

teenagers was higher among non-Hispanic Black

and Hispanic women (17.2 and 14.3 percent,

respectively) than to non-Hispanic White women

(7.4 percent). Non-Hispanic White women were

more likely than non-Hispanic Black and Hispanic women to give birth in their thirties, forties,

and early fifties.

Child Health USA 2006

16

Distribution of Births, by Maternal Age and Race/Ethnicity: 2004

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

40-54 Years

3.0% 30-39 Years

39.6%

20-29 Years

50.0%

18-19 Years

5.4%

17 Years

and Under

2.0%

Non-Hispanic White Non-Hispanic Black Hispanic

40-54 Years

2.1%

30-39 Years

24.1%

20-29 Years

56.5%

18-19 Years

10.8%

17 Years

and Under

6.4% 40-54 Years

1.9% 30-39 Years

27.3%

20-29 Years

56.5%

18-19 Years

8.9%

17 Years

and Under

5.4%
Population Characteristics

WORKING MOTHERS AND

CHILD CARE

In 2005, 70.5 percent of women with children

under 18 years of age were in the labor force

(employed or looking for work). Of mothers with

children younger than 6 years, 62.8 percent were

in the labor force and 58.5 percent were

employed. Of women with children aged 6 to 17

years, 76.5 percent were in the labor force and

over 73 percent were employed.

Employed mothers with children aged 6 to 17

years were more likely than women with younger

children to be employed full-time (77.0 versus

70.9 percent). Married mothers with a spouse

present were less likely than never-married,

divorced, separated, and widowed women to be

in the labor force (68.2 versus 76.1 percent);

however, married mothers in the labor force were

more likely to be employed than women in other

marital situations. The unemployment rate

among married mothers was only 3.6 percent,

compared to a rate of 9.2 percent among mothers in other marital situations.

In 2005, 40 percent of children under 6 years

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. Nonparental child

care was more common among older than

younger children. Among children who received

child care, older children were more likely than

young children to receive center-based care.

Child Health USA 2006

17

Weekly Child Care Arrangements* for Children Aged 5 Years 

and Younger,** by Age: 2005

Source (I.7): Department of Education, National Center for Education Statistics

62.8

76.5 With Children Ages 6-17

Percent of Mothers

Mothers in the Work Force: 1975-2005

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

Percent of Children

0

10

20

30

40

50

60 Less Than 1 Year

1-2 Years

3-5 Years 47.0

27.0

58.0

31.3 25.4 23.9

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.

30

40

50

60

70

80

1975 1980 1985 1990 1995* 2000 2005

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

survey and estimation process.

No Nonparental

Arrangements

Relative Care Nonrelative Care Center-Based

Care
Assessing the health status of infants, children,

and adolescents allows health professionals, 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 population. Although indicators of child health and well-being are often

assessed on an annual basis, some surveillance

systems collect data at intervals, such as every 2,

3, or 5 years. Trends can be identified by examining and comparing data from one year to the

next wherever multiple years of data are available.

In the following section, mortality, disease,

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

in this section are based on vital statistics and

national surveys 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.

Health Status

Child Health USA 2006

19

Health Status
Health Status - Infants
BREASTFEEDING

Breastfeeding has been shown to promote the

health and development of infants, as well as their

immunity to disease; it has also been shown to

have a number of benefits to maternal health. For

this reason, the American Academy of Pediatrics

recommends exclusive breastfeeding—without

supplemental foods or liquids—through the first

6 months of age, and continued supplemental

breastfeeding through at least the first year.

Breastfeeding initiation rates in the United

States have fluctuated over the past several

decades, but have increased steadily since the

early 1990s. In 2004, 70.3 percent of mothers

ever breastfed their infants. Hispanic women

were most likely to breastfeed their infants (79.2

percent), followed by Asian/Pacific Islander and

non-Hispanic White women (74.9 and 71.0 percent, respectively). Breastfeeding rates increased

with maternal age, higher educational achievement, and higher income.

Breastfeeding rates decrease as infant age

increases. In 2004, 36.2 percent of mothers

breastfed their infants at 6 months, and 17.8 percent breastfed at 12 months. Exclusive breastfeeding rates have not shown the same improvement over time as breastfeeding initiation. In

2004, only 14.1 percent of women practiced

exclusive breastfeeding at 6 months. As with

breastfeeding initiation, exclusive breastfeeding

rates were higher among Hispanic, Asian/Pacific

Islander, and non-Hispanic White women, as

well as women who were older, educated, and

had higher incomes.

Health Status - Infants

Child Health USA 2006

21

Breastfeeding* Rates, by Race/Ethnicity: 2004

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

0

20

40

60

80

100

Ever Breastfed Breastfeeding at 6 Months

*Includes exclusive and supplemental breastfeeding.

Breastfeeding Rates, by Recommended Duration* and Maternal

Age: 2004

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

0

10

20

30

40

50

Exclusive Breastfeeding** at 6 Months Breastfeeding at 12 Months

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

and continued supplemental breastfeeding through 1 year.

**Defined as breast milk only—no solids, water or other liquids.

14.1

6.8

11.5

16.9 17.8

5.0

13.8

22.2

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

Asian/Pacific Islander

American Indian/Alaska Native

70.3 65.5 74.9 79.2

50.4

71.0

36.2 29.2 34.8 39.9

21.1

37.7

Total

20 Years and Younger

20-29 Years

30 Years and Older
LOW BIRTH WEIGHT

In 2004, 8.1 percent of infants were born at

low birth weight (less than 2,500 grams, or

5 pounds 8 ounces); this represents an increase

from the rate recorded the previous year (7.9 percent). The percentage of infants born at low birth

weight has risen steadily from a low of 6.7 percent in 1984 and is currently at the highest level

recorded in the past three decades.

The increase in multiple births, which are at

high risk of being born preterm and of low

weight, has strongly influenced the increase in

low birth weight; however, rates are also on the

rise for singleton births.

In 2004, the low birth weight rate was much

higher among non-Hispanic Black infants

(13.7 percent) than among infants of other

racial/ethnic groups. The next highest rate,

which occurred among Asian/Pacific Islander

infants, was 7.9 percent, followed by a rate of 7.5

percent among American Indian/Alaska Native

infants. Low birth weight occurred among 7.2

percent of non-Hispanic White infants, and Hispanic infants experienced the lowest rate

(6.8 percent). Although low birth weight rates

were lowest among non-Hispanic White and

Hispanic infants, these were also the only two

racial/ethnic groups to experience a significant

increase over the previous year.

Low birth weight is one of the leading causes

of neonatal mortality. Low birth weight infants

are more likely to experience long-term disability

or to die during the first year of life than are

infants of normal weight.

Health Status - Infants

Child Health USA 2006

22

Low Birth Weight Among Infants, by Race/Ethnicity: 1985-2004*

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

Statistics System

5

6

7

8

9

10

11

12

13

14

1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2004

13.7

7.9

7.5

7.2

Non-Hispanic Black

Non-Hispanic White

Percent of Live Births

*1985-88 data are based on the race of the infant; data from following years are based on the race of the mother.

6.8

Asian/Pacific Islander

American Indian/Alaska Native

Hispanic
Health Status - Infants

VERY LOW BIRTH WEIGHT

In 2004, 1.5 percent of live births were infants

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

or 3 pounds 4 ounces). This has slowly climbed

from a rate of just over one percent in 1980.

Because the chance of survival increases as

birth weight increases, very low birth weight

infants have the lowest survival rates. Infants

born at such low birth weights are approximately

100 times more likely to die in the first year of

life than are infants of normal birth weight. Very

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

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

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

The overall rate of very low birth weight

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

rate among most other racial and ethnic groups,

including non-Hispanic Whites (1.2 percent),

Hispanics (1.2 percent), and Asian/Pacific

Islanders (1.1 percent). This difference is a major

contributor to the disparity in infant mortality

rates between non-Hispanic Black infants and

infants of other racial/ethnic groups.

Child Health USA 2006

23

Very Low Birth Weight Among Infants, by Race/Ethnicity: 1985-2004*

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

Statistics System

3.1

1.3

1.2

1.1

Non-Hispanic White

Non-Hispanic Black

Hispanic

Asian/Pacific Islander

Percent of Live Births

American Indian/Alaska Native

0.5

1.0

1.5

2.0

2.5

3.0

3.5

1985 1990 1995 2000 2004

*1985-88 data are based on the race of the infant; data from following years are based on the race of the mother.
NEONATAL AND

POSTNEONATAL MORTALITY

Neonatal. In 2004, 18,593 infants died before

reaching 28 days of age, representing a neonatal

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

This rate is unchanged from the previous year.

Neonatal mortality is generally related to short

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

perinatal period. 

Postneonatal. In 2004, 9,343 infants died

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

deaths per 1,000 live births. This rate is

unchanged from the previous year.

Postneonatal mortality is generally related to

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

injuries.

Neonatal Mortality Rates, by Maternal Race/Ethnicity: 2004

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

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

0

1

2

3

4

5

6

7

8

9

10

Total Non-Hispanic White Non-Hispanic Black Hispanic

4.5

3.8

9.4

3.8

Postneonatal Mortality Rates, by Maternal Race/Ethnicity: 2004

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

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

0

1

2

3

4

5

6

7

8

9

10

Total Non-Hispanic White Non-Hispanic Black Hispanic

2.3 1.9

4.8

1.8

Health Status - Infants

Child Health USA 2006

24
MATERNAL MORTALITY

During the past several decades, the rate of

maternal mortality in the United States has

declined dramatically. However, the rate in 2004

(13.1 per 100,000 live births) was significantly

different from the rate reported in 2002 (8.9 per

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

how pregnancy is recorded on death certificates.

Overall, there were 540 maternal deaths resulting from complications during pregnancy, childbirth, or up to 42 days postpartum in 2004. The

maternal mortality rate among non-Hispanic

Black women (36.1 per 100,000 live births) is

about four times the rate among non-Hispanic

White women (9.8 per 100,000 live births). This

disparity has widened since 2000. 

According to the National Center for Health

Statistics, the risk of maternal death increases for

women over age 30, regardless of race. Women

aged 35 to 39 years have over three times the risk

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

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

2004. Hyattsville, Maryland: 2004.

Child Health USA 2006

Health Status - Infants 25

Maternal Mortality Rates, by Race/Ethnicity: 2004

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

Statistics System

0

5

10

15

20

25

30

35

Total Non-Hispanic White Non-Hispanic Black Hispanic

Deaths per 100,000 Live Births

9.8

36.1

8.5

13.1
Health Status - Infants

INFANT MORTALITY

In 2004, 27,936 infants died before their first

birthday, representing an infant mortality rate of

6.8 deaths per 1,000 live births. The leading

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

infant deaths. 

The infant mortality rate declined from the

1960s into this century, but increased slightly

between 2001 and 2002. This was largely due to

an increase in the percentage of infants born

weighing less than 750 grams, reasons for which

include a rise in both preterm and multiple

births. The rapid decline in infant mortality that

began in the mid-1960s slowed among both

Blacks and Whites during the 1980s. Major

advances, including the approval of synthetic surfactants and the recommendation that infants be

placed on their backs when sleeping, may have

contributed to a renewed decline during the

1990s. 

In 2004, the mortality rate among non-Hispanic Black infants was 14.2 deaths per 1,000

live births. This is more than twice the rate

among non-Hispanic White infants (5.7 per

1,000 live births). Although the trend in infant

mortality rates among both Blacks and non-Hispanic Whites has generally been one of decline

throughout the last century, the proportional discrepancy in rates between the two races remains

largely unchanged.

The Maternal and Child Health Block Grant

and the MCHB’s Healthy Start Program provide

health and support services to pregnancy women

and infants with the goal of improving 

pregnancy outcomes.

Child Health USA 2006

26

U.S. Mortality Rates Among Infants,* by Maternal Race/Ethnicity: 1983-2004

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

Statistics System

14.2

6.8

5.7

5.6

Non-Hispanic White

Hispanic

Non-Hispanic Black

All Races

Deaths per 1,000 Live Births

*Under 1 year of age.

0

2

4

6

8

10

12

14

16

18

20

1983 1985 1990 1995 2000 2004
Child Health USA 2006

INTERNATIONAL INFANT

MORTALITY

Although the infant mortality rate in the

United States has declined significantly in recent

decades, it was still ranked below many other

industrialized nations in 2003 with a rate of 6.9

deaths per 1,000 live births. This represents a

slight decline from the rate of 7.0 in 2002, and

is equal to the rate from 2001; however, it is considerably below the rate of 26.0 per 1,000

reported in 1960. Differences in infant mortality

rates among industrialized nations may reflect

disparities in the health status of women before

and during pregnancy, as well as the quality and

accessibility of primary care for pregnant women

and infants. However, some of these differences

may be due, in part, to the international variation in the definition, reporting, and measurement of infant mortality.

According to data reported by individual

countries, six countries or territories had infant

mortality rates that were half the rate of the

United States or less. Hong Kong had the lowest

rate (2.3 per 1,000), followed by Singapore

(2.5 per 1,000). Overall, the United States was

ranked 28th.

International Infant Mortality Rates:* 2003

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

Deaths per 1,000 Live Births

012345678

Poland

United States

Cuba

England and Wales

Canada

New Zealand

Northern Ireland

Scotland

Ireland

Israel**

Netherlands

Greece

Australia

Austria

Denmark

Switzerland

Italy

Belgium

Germany

Spain

Portugal

Czech Republic

France

Norway

Sweden

Finland

Japan

Singapore

Hong Kong

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

deaths according to the United Nations Demographic Yearbook. 

**Includes data for East Jerusalem and Israeli residents in certain other territories under occupation by Israeli military forces since June 1967.

2.3

 2.5

 3.0

 3.1

 3.1

 3.4

 3.9

 3.9

 4.1

 4.1

 4.2

 4.3

 4.3

 4.3

 4.4

 4.5

 4.8

 4.8

 4.8

 4.9

 5.1

 5.1

 5.2

 5.2

 5.3

 5.3

 6.3

 6.9

 7.0

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

ORAL HEALTH

For the National Survey of Children’s Health,

parents were asked to rate the condition of their

children’s teeth as excellent, very good, good, fair,

or poor. Overall, the parents of 68.4 percent of

children reported that their children’s teeth were

in excellent or very good condition.

The condition of children’s teeth varies by a

number of factors, including race and ethnicity.

In 2003, 76.4 percent of non-Hispanic White

children had teeth that were in excellent or very

good condition, as reported by their parents, as

did 69.9 percent of multiracial children. The parents of non-Hispanic Black and Hispanic children were less likely to report that their children’s

teeth were in excellent or very good condition:

61.1 percent of non-Hispanic Black children and

only 46.7 percent of Hispanic children had teeth

that were in excellent or very good condition, as

did 67.2 percent of children of other races.

Parents who reported that their child’s teeth

were in fair or poor condition were asked to identify the specific dental health issues experienced

by their child. More than half of children whose

teeth were in fair or poor condition (54.6 percent) were reported to have cavities. Other commonly reported problems included crooked

teeth, or teeth that need braces (33.5 percent);

broken front tooth or teeth that need repair

(11.8 percent); teeth problems such as grinding,

soft teeth, or teeth falling out (6.1 percent); and

pain (4.6 percent).

Child Health USA 2006

29

Children Whose Teeth Are in Excellent or Very Good Condition,

by Race/Ethnicity: 2003

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

Statistics, National Survey of Children’s Health Percent of Children *Includes Asian/Pacific Islander and American Indian/Alaska Native children.

Condition of Children’s Teeth: 2003

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

Statistics, National Survey of Children’s Health

76.4

69.9 67.2

46.7

61.1

Non-Hispanic

White

Poor 2.1%

Fair 7.5%

Good

21.9%

Very Good

25.9%

Excellent

42.5%

0

10

20

30

40

50

60

70

80

90

100

Non-Hispanic

Black

Hispanic Multiracial Other*
Health Status - Children

OVERWEIGHT

The National Survey of Children’s Health

asked parents to give the height and weight of

their children in order to determine their Body

Mass Index (BMI). Overweight means that the

child’s BMI, calculated from the parent-reported

height and weight, is at or above the 95th percentile for sex and age. Overall, 14.8 percent of

children aged 10 to 17 years were classified as

overweight in 2003.

The prevalence of overweight varies by a number of factors, including race and ethnicity, age,

and family income. Of children with family

incomes below 100 percent of the Federal

poverty level (FPL), almost one-quarter (22.4

percent) were overweight, compared to 19.0 percent of children with family incomes between

100 and 199 percent FPL, 13.7 percent of children with family incomes between 200 and 399

percent FPL, and 9.1 percent of children with

family incomes of 400 percent FPL or more.

With regard to race and ethnicity, Non-Hispanic

Black children were most likely to be overweight

(23.5 percent) based on parent-reported height

and weight, followed by Hispanic children (18.9

percent); White children were least likely to be

overweight (12.0 percent). Multiracial children

and children of other races have rates of overweight that are approximately equal (15.3 and

15.2 percent, respectively).

Child Health USA 2006

30

Children Aged 10-17 Years Who Are Overweight, 

by Race/Ethnicity: 2003

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

Statistics, National Survey of Children’s Health Percent

0

5

10

15

20

25

30

14.8

18.9

15.2

23.5

12.0

15.3

Children Aged 10-17 Years Who Are Overweight, by Family

Income: 2003

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

Statistics, National Survey of Children’s Health Percent

0

5

10

15

20

25

30

22.4

19.0

13.7

9.1

0-99% FPL* 100-199% FPL 200-399% FPL 400% or More FPL

*Includes Asian/Pacific Islander and American Indian/Alaska Native children. *Federal poverty level, equal to $18,400 for a family of four in 2003.

Total Non-Hispanic

White

Non-Hispanic

Black

Hispanic Multiracial Other*
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. An AIDS diagnosis is received when an HIV infection becomes

advanced and meets certain criteria determined by

the Centers for Disease Control and Prevention

(CDC). By 2004, 9,443 cases of AIDS in children

younger than 13 had ever been reported in the

United States. Pediatric AIDS represents approximately one percent of all cases ever reported.

In 2004, an estimated 48 new AIDS cases were

diagnosed among children, all of which were

attributed to transmission through the mother

before or during birth (perinatal transmission).

The number of new cases of pediatric AIDS has

declined substantially since 1992, when 945 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, the virus that causes AIDS.

In 1994, the U.S. Public Health Service recommended this treatment for all HIV-positive pregnant women, and in 1995 routine HIV counseling and voluntary testing for all pregnant women

was recommended. It is expected that the perinatal transmission rate will continue to decline 

with increased use of treatments and obstetric 

procedures.

Racial and ethnic minorities are disproportionately represented among pediatric AIDS cases.

Non-Hispanic Blacks compose approximately

15 percent of the child population but represent

almost 60 percent of all pediatric AIDS cases.

Health Status - Children

Child Health USA 2006

31

Estimated Numbers of AIDS Cases in Children Under Age 13, 

by Race/Ethnicity: Through 2004*

Source (II.4): Centers for Disease Control and Prevention, 

HIV/AIDS Surveillance System

Number of Cases

1,612

2,128

53

0 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

5,590

*Includes children with a diagnosis of AIDS, from the beginning of the epidemic through 2004.

Estimated Numbers of AIDS Cases in Children Under Age 13,

by Year of Diagnosis: 1992-2004

Source (II.4): Centers for Disease Control and Prevention, HIV/AIDS Surveillance System Number of Cases

0

200

400

600

800

1000

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

34 109 69 48

247

115

684

945

190

526

919

124

339

823
Health Status - Children

VACCINE-PREVENTABLE

DISEASES

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

past several decades. In 2004, there were no

reported cases of diphtheria, rubella, or polio in

the entire U.S. population and no cases of tetanus

among children under 5 years of age. 

From 2003 to 2004, the number of reported

cases of H. Influenzae and hepatitis B decreased

among children under 5 years of age. Rates of

hepatitis B infection have steadily declined with

the implementation of a national strategy to eliminate the disease. This strategy includes routine

screening of pregnant women for the hepatitis B

virus, and routine vaccination of infants and children. It is important to note that since most hepatitis B infections among infants and young children are asymptomatic, the reported number of

cases likely underestimates the incidence in these

age groups. 

While the number of reported cases of several

vaccine-preventable diseases decreased from 2003

to 2004, the number of reported cases of measles,

mumps, hepatitis A, and pertussis increased over

the same period. In 2004, the incidence of

reported pertussis among the entire U.S. population increased for the third year in a row, and the

number of cases was the highest reported since

1959. Of cases for which age was reported, 10 percent occurred among children under 6 months of

age who were too young to have received the full

schedule of acellular pertussis vaccine. The highest

reported rate of the disease (136.5 per 100,000)

occurred among this age group. With regard to

hepatitis A, although the number of cases among

children under 5 years increased from 2003 to

2004, the overall incidence of the disease has

dropped dramatically since routine vaccination for

children living in high-risk areas was recommended starting in 1996. 

Child Health USA 2006

33

Incidence of Select Vaccine-Preventable Diseases Among Children Under Age 5: 2004

Source (II.5): Centers for Disease Control and Prevention

Number of Reported Cases

0

0

0

0

10

23

44

291

331 5,795

Pertussis

H. Influenzae

Hepatitis A

Mumps

Measles

Hepatitis B

Polio

Rubella

Diphtheria

Tetanus

0 100 200 300 400 500 600 700 800 900 1000 6000
Health Status - Children

Major Causes of Hospitalization, by Age: 2004

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

Discharge Survey

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

269

86

58

56

51

104

61

45

32

30

98

76

52

48

33

88

77

43

181

20

20

40

43

62

505

440

Ages 1-4

Diseases of the Respiratory System

Injury

Endocrine, Nutritional, and Metabolic

Diseases and Immunity Disorders

Diseases of the Digestive System

Infectious and Parasitic Diseases

Ages 5-9

Diseases of the Respiratory System

Diseases of the Digestive System

Injury

Endocrine, Nutritional, and Metabolic

Diseases and Immunity Disorders

Infectious and Parasitic Diseases

Ages 10-14

Mental Disorders

Diseases of the Digestive System

Injury

Diseases of the Respiratory System

Endocrine, Nutritional, and Metabolic

Diseases and Immunity Disorders

Ages 15-19

Pregnancy/Childbirth

Mental Disorders

Injury

Diseases of the Digestive System

Diseases of the Respiratory System

Ages 20-21

Pregnancy/Childbirth

Mental Disorders

Injury

Diseases of the Digestive System

Diseases of the Genitourinary System

Diseases of the Respiratory System

Number of Discharges (In Thousands)

HOSPITALIZATION

In 2004, there were 3.6 million hospital discharges among children aged 1 through 21, or

4.2 discharges per 100 children that year. This

represents little change from 2003. Hospital discharge rates generally decrease with age until

about age 9 and then increase during later 

adolescence. 

While injuries are the leading cause of death

among children older than 1 year, this category

accounted for only 9 percent of hospital discharges

of children 1 to 14 years old in 2004. Diseases of

the respiratory system were the major cause of hospitalization for children 1 to 9 years of age,

accounting for 31 percent of discharges. Pregnancy and childbirth accounted for 67 percent of

discharges of young women aged 15 to 21. Mental disorders were the second leading cause of hospitalization for 15- to 21-year-olds.

Overall, there has been a significant decrease

in hospital discharge rates among children over

the past 20 years. From 1985 to 2004, there was

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

systems declined 44 percent for children in this

age group.

Child Health USA 2006

34
Health Status - Children

HOSPITAL DISCHARGE

TRENDS

Since 1985, overall hospital discharge rates for

children aged 1 to 14 have declined by 33 percent.

Between 1985 and 2004, hospital discharge

rates for diseases of the respiratory system

declined 44 percent for children in this age group.

Three diagnostic categories (respiratory diseases, digestive diseases, and injury) accounted for

44 percent of discharges among children aged

1 to 14 years in 2004.

Child Health USA 2006

35

74.1

Rate per 100,000 Children

Discharge Rates Among Children Aged 1-14, by Selected Diagnoses: 1985-2003

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

Hospital Discharge Survey

27.0

34.4

Diseases of the Digestive System

Injury

Diseases of the Respiratory System

0

40

80

120

160

200

1985 1987 1989 1991 1993 1995 1997 1999 2001 2003
CHILD ABUSE AND NEGLECT

State child protective services (CPS) agencies

received approximately 3 million referrals, involving an estimated 5.5 million children, alleging

abuse or neglect in 2004. Over half of these

reports were made by community professionals,

such as teachers and other educational personnel,

medical personnel, and daycare providers.

Investigations determined that an estimated

872,000 children were victims of abuse or neglect

in 2004; this is equivalent to a rate of about

11.9 per 1,000 children under 18 years of age.

Neglect was the most common type of maltreatment (7.4 per 1,000 children), followed by physical abuse (2.1 per 1,000). Other types of abuse

included sexual abuse, psychological maltreatment, medical neglect, and categories of abuse

based on specific State laws and policies. Some

children suffer multiple types of maltreatment.

Victimization rates were highest among young

children. In 2004, the rate of victimization among

children from birth to age 3 was 16.1 per 1,000

children of the same age; the rate declined steadily

as age increased. A majority of perpetrators of

abuse and neglect, almost 80 percent, were parents. Remaining types of perpetrators included

other relatives (6.5 percent), unmarried partners

of parents (4.1 percent), and professionals such as

daycare workers and residential facility staff

(1.1 percent). Foster parents account for 0.4 percent of perpetrators, while friends and neighbors

account for 0.3 percent.

Data were obtained from the National Child

Abuse and Neglect Data System, the primary

source of national information on abused and

neglected children known to State CPS agencies.

Health Status - Children

Child Health USA 2006

36

Child Abuse and Neglect Among Children Under Age 18,

by Type of Maltreatment: 2004

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

and Neglect Data System

Rate per 1,000 Children

0 2 4 6 8

7.4

2.1

1.2

0.9

0.3

3.2

0.1

Perpetrators of Child Abuse and Neglect, by Relationship 

to Victim: 2004

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

and Neglect Data System

Psychological

Maltreatment

Sexual Abuse

Other Abuse

Unknown

Physical Abuse

Neglect

Medical Neglect

Other 5.9%

Unknown/Missing 3.9%

Professionals** 1.1%

Unmarried Partner

of Parent* 4.1%

Other Relative 6.5%

Parent 78.5%

*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.
Health Status - Children

CHILD MORTALITY

In 2004, 11,619 children between the ages of

1 and 14 years died of various causes; this was

222 fewer than the previous year. The overall

death rate among 1- to 4-year-olds was 29.9 per

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

was 16.8 per 100,000. The leading cause of

death among the younger age group continues to

be unintentional injury, which accounted for

34.3 percent of all deaths in this age group in

2004. The next most common cause of death

was congenital malformations (birth defects),

followed by malignant neoplasms (cancer),

homicide, and major cardiovascular diseases.

Unintentional injury was also the leading cause

of death among older children, accounting for

39.0 percent of deaths among 5- to 14-year-olds.

This was followed by malignant neoplasms, congenital malformations, homicide, major cardiovascular diseases, and suicide.

Child Health USA 2006

37

Leading Causes of Death Among Children Aged 1-14: 2004

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

Statistics System

Death Rate per 100,000 Population in Specified Age Group

10.3

3.6

2.5

2.4

1.5

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

Major Cardiovascular Diseases

Chronic Lower Respiratory

Diseases

Suicide

Homicide

Congenital Malformations

Malignant Neoplasms

Unintentional Injury

Septicemia

Influenza and Pneumonia

Major Cardiovascular Diseases

Homicide

Malignant Neoplasms

Congenital Malformations

Unintentional Injury

Ages 1-4 Years

Ages 5-14 Years

0.5

0.7

6.5

2.5

1.0

0.8

0.7

0.3

0.8
Health Status - Children

CHILDHOOD DEATHS DUE

TO INJURY

In 2004, unintentional injuries caused the

deaths of 1,641 children aged 1 to 4 years and

2,666 children aged 5 to 14 years. In 2004, motor

vehicle crashes, drowning, and fires and burns

were the most common causes of unintentional

injury death among children aged 1 to 4 years.

Motor vehicle crashes were the most common

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

to drowning, fires and burns, and suffocation.

In addition, 377 children aged 1 to 4 years

were the victims of homicide in 2004, and 614

children aged 5 to 14 years were the victims of

homicide or suicide (data not shown).

Child Health USA 2006

38

Deaths Due to Unintentional Injury Among Children Aged 1-14: 2004

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

Statistics System

Death Rate per 100,000 Population

Ages 1-4 Years

Ages 5-14 Years

3.3

2.7

0.8

3.7

0.7

0.6

1.4

0.3

0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Fires and Burns

Suffocation

Drowning

Motor Vehicle Traffic

Suffocation

Fires and Burns

Drowning

Motor Vehicle Traffic
Health Status - Adolescents
Health Status - Adolescents

ADOLESCENT

CHILDBEARING

The birth rate among adolescents aged 15 to

19 years decreased to 41.1 births per 1,000

females in 2004. This is 1 percent below the rate

in the previous year, and represents a 33 percent

decrease since the most recent peak in 1991. The

birth rate among the youngest adolescents, aged

10 to 14 years, increased slightly to 0.7 per

1,000. Teenage birth rates were highest among

the oldest adolescents, aged 18 to 19 years, at

70.0 per 1,000. 

Teenage birth rates have historically varied

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

Islanders had the lowest birth rate in 2004 (17.3

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

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

teens had one of the highest birth rates for this

age group (63.1 per 1,000), they have also experienced the largest percentage drop since 1991

(47 percent). Hispanic females had the highest

birth rate among teens aged 15 to 19 years (82.6

per 1,000) and the lowest percentage drop since

1991 (21 percent). Among the youngest teens,

aged 10 to 14 years, non-Hispanic Black females

had the highest birth rate (1.6 per 1,000), followed by Hispanic females (1.3 per 1,000); the

lowest birth rates were again found among

Asian/Pacific Islanders and non-Hispanic Whites

(0.2 per 1,000 for both groups).

Child Health USA 2006

40

Birth Rates Among Adolescent Females, by Age and Maternal

Race/Ethnicity: 2004

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

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

0

20

40

60

80

100

120

140

Total Non-Hispanic White Non-Hispanic Black Hispanic

10-14 Years

15-17 Years

18-19 Years

22.1

70.0

0.7

12.0

48.7

0.2

37.1

103.9

1.6

49.7

133.5

1.3

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

1990-2004

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

Statistics, National Vital Statistics System

0

20

40

60

80

100

120

1990 1992 1994 1996 1998 2000 2002 2004

26.7

63.1

82.6

Non-Hispanic Black

Non-Hispanic White

Hispanic

Live Births per 1,000 Females

17.3

52.5

American Indian/

Alaska Native

Asian/Pacific Islander
Health Status - Adolescents

SEXUAL ACTIVITY

In 2005, 46.8 percent of high school students

reported ever having had sexual intercourse, representing a slight increase since 2003. Although

non-Hispanic Black students were most likely to

report ever having sexual intercourse (67.6 percent), they were also most likely to report condom use during their last sexual encounter (68.9

percent of sexually active students). Hispanic students were second most likely to report ever having had sexual intercourse (51.0 percent), followed by non-Hispanic White students (41.8

percent), and non-Hispanic students of other

races (36.4 percent).

Almost half of all 12th grade students reported

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

more males were currently sexually active than

females (24.5 percent versus 19.5 percent).

However, by 12th grade, females were more

likely to be currently sexually active than males

(51.7 percent versus 47.0 percent). More than

half of all high school students reported that they

had never had sexual intercourse.

In 2005, 62.8 percent of sexually active students reported using a condom during their last

sexual encounter, representing a slight decrease

since 2003. Males were more likely to report

using condoms than females in every grade, and

younger students were more likely than older

students (74.5 and 65.3 percent of 9th and 10th

graders, compared to 61.7 and 55.4 percent of

11th and 12th graders, respectively).

Sexual Activity Among High School Students: 2005

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

*Have never had intercourse. *Had sexual intercourse during the 3 months preceding the survey.

No Intercourse

in Past 3 Months

12.9%

Intercourse in Past 

3 Months, No Condom at

Last Intercourse

12.6%

Intercourse in Past

3 Months, Used

Condom at Last

Intercourse

21.3%

Abstinent*

53.2%

Condom Use Among Sexually Active High School Students,

by Grade: 2005

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

0

10

20

30

40

50

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

Total Sexually Active*

Condom Use at Last Intercourse 

No Condom Use at Last Intercourse

16.3

5.6

19.2

10.0

24.3

15.1

27.4

22.0

21.9

29.2

39.4

49.4

Child Health USA 2006

41
Health Status - Adolescents

SEXUALLY TRANSMITTED

INFECTIONS

Adolescents (ages 15 to 19 years) and young

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

of contracting sexually transmitted infections

(STIs) than are older adults. Within each of these

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

among non-Hispanic Black youth than youth of

all other reported racial and ethnic categories.

Chlamydia continues to be the most common

STI in adolescents and young adults, with rates

of 1,579 and 1,660 cases per 100,000, respectively, in 2004. Gonorrhea followed in prevalence with overall rates of 427 and 498 per

100,000 adolescents and young adults, respectively. Syphilis is far less common among young

people and the population as a whole, with a rate

of 1.7 per 100,000 adolescents and a rate of 5.0

per 100,000 young adults.

Another STI, genital human papillomavirus

(HPV), is the most common STI in the United

States. It is estimated that as many as half of

those who are infected with HPV are adolescents

and young adults. There are many different types

of HPV, and some, which are referred to as

“high-risk,” can cause cancer. Although cervical

cancer in women is the most serious health problem caused by HPV, it is highly preventable with

regular Pap tests and follow-up care. A vaccine

for HPV was recently approved by the Food and

Drug Administration (FDA) for use in females

aged 9 to 26 years.1

1 Centers for Disease Control and Prevention, Division of STD

Prevention. HPV and HPV vaccines: information for healthcare

providers. June 2006. Available from:

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

Child Health USA 2006

42

Prevalence of Sexually Transmitted Infections Among Adolescents and Young Adults, by Age and Race/Ethnicity: 2004

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

0

1,300

2,600

3,900

5,200

6,500

15-19 Years 20-24 Years

Rate per 100,000

760.6 886.4

1,604.1

5,336.1 5,301.3

1,685.4

Chlamydia Gonorrhea Syphilis

0

700

1,400

2,100

2,800

3,500

15-19 Years 20-24 Years

117.5 149.0 212.7

2,079.8

2,487.2

237.3

0

4

8

12

16

20

15-19 Years 20-24 Years

Non-Hispanic White

Non-Hispanic Black

Hispanic

0.4

1.7 1.9

6.9

19.5

5.0

Non-Hispanic White

Non-Hispanic Black

Hispanic

Non-Hispanic White

Non-Hispanic Black

Hispanic
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 an HIV infection becomes advanced

and meets certain criteria determined by the Centers for Disease Control and Prevention (CDC).

In 2004, 4,883 people aged 13 to 24 years were

diagnosed with HIV/AIDS,* representing

approximately 12.5 percent of all diagnoses. The

number of AIDS cases diagnosed among this age

group was 2,174 in 2004, and 40,059 since the

epidemic began in the early 1980s.

There were 18,293 people aged 13 to 24 years

living with HIV/AIDS in 2004, representing

approximately 4 percent of all cases. Among people who died with AIDS in 2004, just over 1 percent (232 persons) were adolescents and young

adults. Since the beginning of the epidemic, just

over 10,000 people in this age group have died

with the disease. While the number of people living with HIV/AIDS has increased in recent years,

the number of deaths of people with the disease

has decreased due in part to the availability of

effective prescription drugs to combat the disease.

Health Status - Adolescents

Child Health USA 2006

43

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

and Dying with AIDS: 2004

Source (II.4): Centers for Disease Control and Prevention, HIV/AIDS Surveillance System

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

diagnoses of HIV infection and AIDS.

3,683

13,371

1,239

1,080

3,762

41

Number of Persons

13-14 Years

15-19 Years

0 3,000 12,000 15,000

184

32

16

Diagnosed with HIV/AIDS

Living with HIV/AIDS

Dying with AIDS

20-24 Years
Health Status - Adolescents

PHYSICAL ACTIVITY

Results from the 2005 Youth Risk Behavior

Survey show that 35.8 percent of high school

students met the currently recommended levels

of physical activity and 68.7 percent of students

met the previously recommended standard for

physical activity in the previous week. Current

physical activity standards for this age group recommend 60 minutes of physical activity five

days per week; previous standards recommended

at least 20 minutes of vigorous activity or 30

minutes of moderate activity five days per week.

Only 9.6 percent of students did not engage in

any vigorous or moderate physical activity.

Nationwide, 54.2 percent of high school students were enrolled in a physical education class

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

(71.5 percent of 9th graders) than in the older

grades (38.8 percent of 12th graders). The percentage of students attending daily physical education classes has dropped from 42 percent in

1991 to 33.0 percent in 2005. Among those students who attended physical education classes,

84.0 percent reported exercising or playing

sports for more than 20 minutes during an average class.

In 2005, a total of 56.0 percent of high school

students reported playing on one or more sports

teams in the past year. This was more common

among children in younger grades (60.4 percent

of 9th graders) than in the older grades (49.2

percent of 12th graders). High school students

also reported sedentary activities, such as using a

computer or watching television. Over one-fifth

(21.1 percent) 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 37.2 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 credible, accurate information about physical fitness, nutrition,

and prevention to help Americans of all ages to

make healthy decisions.

Child Health USA 2006

45

Physical Activity Among High School Students, by Race/Ethnicity: 2005

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

0

10

20

30

40

50

60

70

80

90

100

Percent

*Participation in physical activity for a total of 60 minutes or more per day on 5 or more of the past 7 days.

**Participation in at least 20 minutes of vigorous physical activity on 3 or more of the past 7 days and/or at least 30 minutes of moderate physical 

activity on 5 or more of the past 7 days.

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

35.8 32.9 29.5

38.7

Met Currently Recommended Levels

of Physical Activity*

Met Previously Recommended Levels

of Physical Activity**

No Vigorous or Moderate

Physical Activity

68.7 69.4

62.0

70.2

9.6 10.6 14.4

8.1
Health Status - Adolescents

Child Health USA 2006

46

MENTAL HEALTH

TREATMENT

In 2004, 22.5 percent of youth aged 12 to 17

years received mental health treatment or counseling in the past year, which includes treatment

or counseling for emotional or behavioral problems not caused by drug or alcohol use. The rate

in 2004 represented an increase over the previous

year’s rate of 20.6 percent. Overall, there was little difference by age group or race and ethnicity;

however, females were more likely than males to

receive treatment (25.0 versus 20.1 percent). The

treatment rate among males declined with age,

while the rate among females increased with age.

Youth with lower family incomes were more

likely to receive treatment that those with higher

family incomes. 

Among youth who received mental health treatment or counseling, 33.6 percent used illicit drugs

in the past year. Illicit drug use among those

receiving treatment was most common among 12-

to 13-year-olds (38.5 percent), and least common

among 16- to 17-year-olds (31.4 percent).

Females receiving mental health treatment were

far more likely than males to report past year illicit

drug use (41.6 versus 25.6 percent).

Mental Health Treatment/Counseling* in the Past Year Among

Children Aged 12-17, by Age and Sex: 2004

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

Survey on Drug Use and Health Percent

0

5

10

15

20

25

30

Mental Health Treatment/Counseling* in the Past Year Among

Children Aged 12-17, by Family Income: 2004

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

Survey on Drug Use and Health Percent

0

5

10

15

20

25

30

$75,000

or More

$50,000-

74,999

$20,000-

49,999

Less than

$20,000

Total

20.1

22.5 23.3

*Treatment or counseling from any of 10 specific sources for emotional or behavioral

problems not caused by drug or alcohol use.

*Treatment or counseling from any of 10 specific sources for emotional or behavioral 

problems not caused by drug or alcohol use.

22.1

25.0

22.4

25.3

21.4

27.3

16.8

20.1 20.9

26.4

Female

Male

Total 12-13 Years 14-15 Years 16-17 Years
Health Status - Adolescents

Child Health USA 2006

47

MENTAL HEALTH

TREATMENT, CONTINUED

Depression was the leading reason reported for

mental health treatment among 12- to 17-yearolds. Other common reasons for treatment

included breaking rules or “acting out” (27.5

percent), feeling very afraid or tense (20.9 percent), and suicidal thoughts or attempts (18.5

percent). Survey respondents were able to report

more than one reason for seeking treatment.

The most common source of mental health

treatment among those youth receiving treatment was a school counselor or psychologist, or

regular teacher meetings (46.7 percent). Also

common was a private source, such as a therapist

or psychologist (45.0 percent). Use of a partial

day hospital or treatment program was reported

by 7.8 percent of youth receiving treatment, and

an overnight or longer stay in a residential treatment center was reported by 5.3 percent. Youth

receiving treatment could indicate any number

of 10 possible sources of care.

Reasons for Mental Health Treatment/Counseling* in the Past Year Among Children 

Aged 12-17 Who Received Treatment: 2004

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

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

**Respondents could indicate more than one reason for treatment.

Percent Receiving Treatment**

0 5 10 15 20 25 50 55

Other Reasons

Other Mental/Neurological

Disorder

Social/Friend Problems

Eating Problems

School-Related Issues

Family/Home Problems

Suicidal Thoughts or Attempts

Felt Very Afraid or Tense

Breaking Rules or “Acting Out”

Felt Depressed 51.7

20.2

3.2

8.2

8.8

11.3

13.1

18.5

20.9

27.5
Health Status - Adolescents

Child Health USA 2006

48

VIOLENCE

Violence among adolescents is a critical public

health issue in the United States. In 2004, the latest year for which data are available, homicide was

the second leading cause of death among persons

aged 15 to 24 years.

Results from the 2005 Youth Risk Behavior

Survey (YRBS) indicate that 18.5 percent of high

school students had carried a weapon (such as a

gun, knife, or club) at some point during the preceding 30 days. Males were more than four times

as likely as females to carry a weapon (29.8 versus

7.1 percent). Non-Hispanic White and Hispanic

males were more likely than non-Hispanic Black

males to carry a weapon (31.4 and 29.8 versus

23.7 percent), and non-Hispanic Black females

were more likely than non-Hispanic White and

Hispanic females (9.4 versus 6.0 and 7.8 percent).

Just over 5 percent of students reported carrying a

gun in the preceding 30 days, and males were

more than 11 times as likely as females to do so.

Almost 36 percent of students had been in a physical fight at least once in the preceding 12 months.

In 2005, 6.5 percent of students carried a

weapon on school property on at least one of the

preceding 30 days, which did not vary significantly by grade Almost 8 percent of students

were threatened or injured with a weapon on

school property in the preceding 30 days; this

was relatively consistent across grades. Almost 14

percent of high school students had been in a

fight on school property in the preceding 12

months, and 6 percent of students missed school

on at least one of the 30 preceding days because

of safety concerns.

High School Students Threatened or Injured with a Weapon

on School Property in Past Year, by Race/Ethnicity: 1993-2005

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

Non-Hispanic White Hispanic Non-Hispanic Black

Percent of Students

High School Students Who Carried a Weapon in the Past

30 Days, by Sex and Race/Ethnicity: 1993-2005

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

0

5

10

15

20

25

30

35

40

1993 1995 1997 1999 2001 2003 2005

31.4

23.7

29.8

9.4

6.0

7.8

Hispanic Male

Hispanic Female

Non-Hispanic White Male

Non-Hispanic White Female

Non-Hispanic Black Female

Non-Hispanic Black Male

9.8

8.1

7.2

0

5

10

15

20

25

30

35

40

1993 1995 1997 1999 2001 2003 2005
Health Status - Adolescents

Child Health USA 2006

49

SUBSTANCE ABUSE

Prevalence. In 2004, 10.6 percent of adolescents aged 12 to 17 years reported using illicit

drugs in the past month. The use of illicit drugs

within the past month increased with age.

Among those aged 12 to 13 years, 3.8 percent

reported past-month use, compared to 10.9 percent of those aged 14 to 15 years and 17.3 percent of those aged 16 to 17 years. Rates of pastmonth illicit drug use were similar among

non-Hispanic White, non-Hispanic Black, and

Hispanic adolescents (ranging from 9.3 to 11.1

percent); American Indian/Alaska Native adolescents had the highest rate of past-month use

(26.0 percent), while Asian adolescents had the

lowest (6.0 percent).

Alcohol is the most commonly used drug

among adolescents, with 17.6 percent reporting

past-month use in 2004. Marijuana is the most

commonly used illicit drug (7.6 percent), followed by the nonmedical use of psychotherapeutic drugs, such as pain relievers, tranquilizers, and

stimulants (3.6 percent). Marijuana use is more

common among male adolescents than their

female counterparts (8.1 versus 7.1 percent),

while prescription drug abuse is more common

among females (4.1 versus 3.2 percent).

In 2004, 47.5 percent of adolescents who

smoked cigarettes in the past month also used an

illicit drug, compared to only 5.6 percent of

those who didn’t smoke. Among those adolescents who both smoked cigarettes and used alcohol, 58.8 percent also used an illicit drug.

Perception of Risk and Access to Drugs. In 2004,

35.0 percent of adolescents perceived smoking

marijuana once a month to be a great risk, while

49.6 percent perceived the same risk regarding

cocaine use. Smoking one or more packs of cigarettes a day was considered a great risk by

67.5 percent of adolescents, which represented a

significant increase over the past year (from 64.2

percent). Drinking five or more drinks on one or

two occasions per week was considered to be a

great risk by 40.9 percent of adolescents. 

In 2004, 52.2 percent of adolescents reported

that marijuana would be fairly or very easy to

obtain. The same was reported by 24.4 percent

of teens regarding cocaine, 16.9 percent for LSD,

and 14.0 percent for heroin. Just over 16 percent

of adolescents reported being approached by

someone selling drugs in the past month.

Past Month Drug Use Among Adolescents Aged 12-17: 2004

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

*Does not include alcohol.

**Psychotherapeutics include prescription-type pain relievers, tranquilizers, stimulants (including methamphetamine), and sedatives but do

not include over-the-counter drugs; hallucinogens include LSD, PCP, and Ecstasy.

0

4

8

12

16

20

Percent

10.6

17.6

7.6

1.2

3.6

0.8

Alcohol Any Illicit Drug* Marijuana Non-Medical Use Inhalants

 of Psychotherapeutics**

Hallucinogens**
Health Status - Adolescents

Child Health USA 2006

50

CIGARETTE SMOKING

As reported in the Monitoring the Future

Study, cigarette smoking declined among 10th

and 12th graders but remained stable for 8th

graders between 2004 and 2005. Among 10th

graders, 14.9 percent reported smoking at least

once during the previous 30 days in 2005, compared to 16.0 percent the year before. The rate

among 12th graders dropped from 25.0 to 23.2

percent over the same period. Overall, there has

been a 56 percent decline among 8th graders and

a 51 percent decline among 10th graders since

use peaked among those grades in 1996. Among

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

more modest decline of 36 percent. Factors that

appear to have contributed to this decline

include increases in perceived risk and disapproval of smoking, high cigarette prices, and

anti-smoking advertising campaigns.

The teen smoking rate increased substantially

between 1991 and 1996. Increases occurred in

virtually every sociodemographic group: both

sexes, those planning on attending college and

not, those living in all four regions of the country, those living in rural and urban areas, and

among Whites, Black, and Hispanics. Since

1996, rates have declined across all demographic

groups consistently. Although absolute rates of

smoking have declined among adolescents, certain subgroups are less likely to smoke than others. Students who are not college-bound are

more likely to smoke than their college-bound

peers, and Black adolescents are less likely to

smoke cigarettes than White adolescents. The

decline in rates of cigarette smoking since 1996

is likely to have important long-term health consequences for this generation of adolescents.

Any Cigarette Use Among High School Students in the Past 30 Days, by Grade: 1975-2005

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

9.3

Percent of Students

14.9

23.2

12th Grade

8th Grade

10th Grade

5

10

15

20

25

30

35

40

1975 1980 1985 1990 1995 2000 2005
Health Status - Adolescents

Child Health USA 2006

51

ADOLESCENT MORTALITY

In 2004, 13,706 deaths were reported of adolescents aged 15 to 19 years. After a moderate

increase for this age group in the early 1980s,

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

death among this age group and accounted for

49.8 percent of all deaths among adolescents in

2004. Homicide and suicide were the next leading causes of death, accounting for 14.1 and 12.4

percent, respectively, of all deaths within this 

age group.

Deaths Due to Injury. Within the classification of

deaths due to injury or other external causes,

motor vehicle crashes were the leading cause of

mortality among 15- to 19-year-olds in 2004,

and accounted for 48 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. Firearms

were the next leading cause of injury death,

accounting for 23 percent of injury-related

deaths in this age group. Adolescent death rates

due to motor vehicle injuries and firearms were

similar in the early 1990s until 1994, when they

began to diverge. The rate of adolescent firearm

deaths was recorded at 12.0 per 100,000 population in 2004, less than half the rate of motor

vehicle injury deaths (24.7 per 100,000).

Leading Causes of Death Among Adolescents Aged 15-19: 2004

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

Statistics, National Vital Statistics System

Death Rate per 100,000 Population

0 5 10 15 20 25 30 35 40

Diseases

of the Heart

Malignant

Neoplasms (Cancer)

Suicide

Homicide

Unintentional

Injury 32.9

9.3

8.2

3.5

1.8

Deaths Due to Injury Among Adolescents Aged 15-19: 2004

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

Statistics, National Vital Statistics System

Death Rate per 100,000 Population

0 5 10 15 20 25 30 35 40

Drowning

Poisoning 

Firearms

Motor Vehicle Traffic 24.7

12.0

4.2

1.6
ADOLESCENT MORTALITY

FROM TRAFFIC AND

FIREARM INJURIES

The two leading mechanisms of injury deaths

among adolescents are motor vehicle crashes and

firearms. In 2004, motor vehicle traffic caused

the deaths of 5,113 adolescents 15 to 19 years of

age. The vast majority of those killed were in

motor vehicle accidents as either a passenger or

driver. Deaths of pedestrians, motorcyclists, and

others accounted for the remainder of motor

vehicle mortality among adolescents.

Results of the 2005 Youth Risk Behavior Survey

revealed that 10.2 percent of high school students

had rarely or never worn seat belts when riding in

a car driven by someone else. Additionally, in the

30 days preceding the survey, 28.5 percent of students had ridden on one or more occasions with a

driver who had been drinking alcohol.

In 2004, 2,494 adolescents aged 15 to 19 years

were killed by firearms. Of these, homicide

accounted for 65 percent of firearm deaths, suicide accounted for 32 percent, and 3 percent

were considered unintentional.

Health Status - Adolescents

Child Health USA 2006

52

Adolescent Mortality from Traffic and Firearm Injuries: 2004

Source (II.2): 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

13.4

1.2

0.2

7.6

3.8

0.4

1.1

0.1

0 2 4 6 8 10 12 14 16

Unknown

Unintentional

Suicide

Homicide

Pedal Cyclist

Motorcyclist

Pedestrian

Motor Vehicle Occupant

Firearms Mortality by Intent
Health Services Financing and Utilization

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54

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 chronic medical conditions or low

socio-economic status.

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).

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

Every State has SCHIP programs that help expand

coverage to children who would otherwise be

uninsured. Despite the progress achieved through

public programs, approximately 8.3 million children remain uninsured in the United States.

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

and child population. Data are summarized by

source of payment, type of care, and place of

service delivery.

Health Services Financing and Utilization
Health Services Financing and Utilization

Child Health USA 2006

55

HEALTH CARE FINANCING

In 2004, 8.3 million children younger than 18

years of age had no health insurance coverage; this

represents 11.2 percent of the child population.

Almost 30 percent of children were publicly

insured by sources such as Medicaid and the State

Children’s Health Insurance Program (SCHIP).

Children’s insurance status varies by a number

of factors, including family income and race and

ethnicity. Non-Hispanic White children had

high rates of private insurance coverage in 2004

(77.3 percent), while fewer than half of Black

and Hispanic children had private coverage during the same period (48.0 and 42.9 percent,

respectively). Black children were the most likely

to have public coverage (48.0 percent), while

Hispanic children were the most likely to be

uninsured (21.1 percent). Rates of private coverage rise and rates of public coverage and no coverage fall with increasing family income. Children with family incomes below 100 percent of

the poverty level were the most likely to have

public coverage (66.8 percent) or be uninsured

(19.4 percent), while they were the least likely to

have private coverage (20.2 percent); the majority (85.7 percent) of children with family

incomes of 200 percent of the poverty level or

more were privately insured.

In 1997, SCHIP was created in response to the

growing number of uninsured children in lowincome working families. In 2004, over 6 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:* 2004

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

0

10

20

30

40

50

60

70

80

29.7

65.6

11.2

21.0

77.3

7.6

48.0 48.0

13.0

42.9 42.0

21.1

Health Insurance Coverage Among Children Under Age 18,

by Poverty Level and Type of Coverage:* 2004

Source (III.2): Employee Benefit Research Institute, Analysis of Current Population Survey Percent

0

10

20

30

40

50

60

70

80

90

100

38.7

20.2

56.9

85.7

53.7

66.8

35.9

13.1 16.3 19.4 16.2

6.9

Total

Non-Hispanic White

Black

Hispanic

Private Coverage Public Coverage No Coverage Private Coverage Public Coverage No Coverage

<100% FPL**

100-149% FPL

150-199% FPL

200% or More FPL

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

**Federal poverty level.
Health Services Financing and Utilization

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VACCINATION COVERAGE

The Healthy People 2010 objective for the

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

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

series of vaccines. Data released from the CDC’s

2004 National Immunization Survey show that

80.9 percent of children aged 19 to 35 months

had received the recommended 4:3:1:3:3 series of

vaccines. This series comprises 4 doses of diphtheria, tetanus, and pertussis vaccine, 3 doses of

poliovirus vaccine, 1 dose of measles-mumpsrubella vaccine, and 3 doses of Haemophilus

influenzae type b vaccine. Overall, 76.0 percent

had received that series plus the varicella (chicken

pox) vaccine. 

Since 2000, the greatest increases in vaccination

rates have occurred with the diphtheria, tetanus,

and pertussis vaccine and the varicella vaccine

(which was added to the schedule in 1996.) They

have risen 4.7 and 29 percent, respectively. Vaccination rates for other vaccines have generally risen

about 2 percent over the same period. Racial and

ethnic disparities in vaccination rates persist, with

non-Hispanic Black children and American

Indian/Alaska Native children (data not shown)

having the lowest rates for each of the major vaccines. Non-Hispanic White children experience

the highest vaccination rates.

Each year, the CDC publishes an updated version of the recommended childhood immunization schedule (see facing page). The 2006 schedule continues to encourage the routine use of

hepatitis B vaccines for all infants before hospital

discharge and the use of annual influenza vaccines

for all children starting at 6 months of age.

Estimated Vaccination Rates Among Children Aged 19-35 Months, 

by Race/Ethnicity: 2004

Source: (III.3): Centers for Disease Control and Prevention, National Immunization Survey

93.5 94.7 92.6

92.4 93.0 91.9

90.9

87.5 86.5 86.3 89.1

85.5 87.7 79.5 84.1

93.0 93.5 90.7 93.2

91.6 92.1 90.4 91.2

90.8

1+ Varicella

Non-Hispanic

White

Non-Hispanic

Black Total Hispanic

4+ DTP

3+ Polio

1+ MMR*

3+ HepB

3+ Hib

Complete Series 76.0 77.2 70.9 75.9

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

(MMR) vaccine shown above.
Health Services Financing and Utilization

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Recommended Childhood and Adolescent Immunization Schedule, United States, 2006

Source (III.4): Department of Health and Human Services, Centers for Disease Control and Prevention

This schedule indicates the recommended ages for routine administration of currently licensed

childhood vaccines, as of December 1, 2005, for children through age 18 years. Any dose not

administered at the recommended age should be administered at any subsequent visit when

indicated and feasible. The graphic indicates age groups that warrant special effort to administer

those vaccines not previously administered. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and other components of the vaccine are not contraindicated and if approved by the Food and Drug Administration for that does of the series. Providers

should consult the respective ACIP statement for detailed recommendations. Clinically significant

adverse events that follow immunization should be reported to the Vaccine Adverse Event

Reporting System (VAERS). Guidance about how to obtain and complete a VAERS form is available at www.vaers.hhs.gov or by telephone, 800-822-7967.

1. Hepatitis B vaccine (HepB). AT BIRTH: All newborns should receive monovalent HepB soon after

birth and before hospital discharge. Infants born to mothers who are HBsAg-positive should receive

HepB and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth. Infants born to mothers whose HBsAg status is unknown should receive HepB within 12 hours of birth. The mother should

have blood drawn as soon as possible to determine her HBsAg status; if HBsAg-positive, the infant

should receive HBIG as soon as possible (no later than age 1 week). For infants born to HBsAg-negative mothers, the birth dose can be delayed in rare circumstances but only if a physician’s order to

withhold the vaccine and a copy of the mother’s original HBsAg-negative laboratory report are documented in the infant’s medical record. FOLLOWING THE BIRTHDOSE: The HepB series should be

completed with either monovalent HepB or a combination vaccine containing HepB. The second dose

should be administered at age 1-2 months. The final dose should be administered at age 24 weeks or

younger. It is permissible to administer 4 doses of HepB (e.g., when combination vaccines are given

after the birth dose); however, if monovalent HepB is used, a dose at age 4 months is not needed.

Infants born to HBsAgpositive mothers should be tested for HBsAg and antibody to HBsAg after completion of the HepB series, at age 9-18 months (generally at the next well-child visit after completion

of the vaccine series).

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

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

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

be given at age 4 years or younger. Tetanus and diphtheria toxoids and acellular pertussis vaccine

(Tdap - adolescent preparation) is recommended at age 11-12 years for those who have completed

the recommended childhood DTP/DTaP vaccination series and have not received a Td booster dose.

Adolescents 13-18 years who missed the 11-12-year Td/Tdap booster dose should also receive a single dose of Tdap if they have completed the recommended childhood DTP/DTaP vaccination series.

Subsequent tetanus and diphtheria toxoids (Td) are recommended every 10 years. 

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

licensed for infant use. If PRP-OMP (PedvaxHIB® or ComVax® [Merck]) is administered at ages 2

and 4 months, a dose at age 6 months is not required. DTaP/Hib combination products should not be

used for primary immunization in infants at ages 2, 4 or 6 months but can be used as boosters after

any Hib vaccine. The final dose in the series should be administered at age 12 months or younger.

4. Measles, mumps, and rubella vaccine (MMR). The second dose of MMR is recommended routinely at age 4-6 years but may be administered during any visit, provided at least 4 weeks have

elapsed since the first dose and both doses are administered beginning at or after age 12 months.

Those who have not previously received the second dose should complete the schedule by age 11-12

years. 

5. Varicella vaccine. Varicella vaccine is recommended at any visit at or after age 12 months for susceptible children (i.e., those who lack a reliable history of chickenpox). Susceptible persons aged 13

years or younger should receive 2 doses administered at least 4 weeks apart.

6. Meningococcal vaccine (MCV4). Meningococcal conjugate vaccine (MCV4) should be given to all

children at the 11-12 year old visit as well as to unvaccinated adolescents at high school entry (15

years of age). Other adolescents who wish to decrease their risk for meningococcal disease may also

be vaccinated. All college freshmen living in dormitories should also be vaccinated, preferably with

MCV4, although meningococcal polysaccharide vaccine (MPSV4) is an acceptable alternative.

Vaccination against invasive meningococcal disease is recommended for children and adolescents

aged 2 years or younger with terminal complement deficiencies or anatomic or functional asplenia

and certain other high risk groups (see MMWR 2005;54 [RR-7]:1-21); use MPSV4 for children aged

2-10 years and MCV4 for older children, although MPSV4 is an acceptable alternative. 

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

series should be given at age 12 months or younger. Pneumococcal polysaccharide vaccine (PPV) is

recommended in addition to PCV for certain high-risk groups. See MMWR 2000; 49(RR-9):1-35.

8. Influenza vaccine. Influenza vaccine is recommended annually for children aged 6 months or

younger with certain risk factors (including, but not limited to, asthma, cardiac disease, sickle cell disease, human immunodeficiency virus [HIV], diabetes, and conditions that can compromise respiratory

function or handling of respiratory secretions or that can increase the risk for aspiration), healthcare

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

high risk (see MMWR 2005;54[RR-8]:1-55). In addition, healthy children aged 6-23 months and close

contacts of healthy children aged 0-5 months are recommended to receive influenza vaccine because

children in this age group are at substantially increased risk for influenza-related hospitalizations. For

healthy persons aged 5-49 years, the intranasally administered, live, attenuated influenza vaccine

(LAIV) is an acceptable alternative to the intramuscular trivalent inactivated influenza vaccine (TIV).

See MMWR 2005;54(RR-8):1-55. Children receiving TIV should be administered a dosage appropriate for their age (0.25 mL if aged 6-35 months or 0.5 mL if aged 3 years or younger). Children aged 8

years or younger who are receiving influenza vaccine for the first time should receive 2 doses (separated by at least 4 weeks for TIV and at least 6 weeks for LAIV). 

9. Hepatitis A vaccine (HepA). HepA is recommended for all children at 1 year of age (i.e.,12-23

months). The 2 doses in the series should be administered at least 6 months apart. States, counties,

and communities with existing HepA vaccination programs for children 2-18 years of age are encouraged to maintain these programs. In these areas, new efforts focused on routine vaccination of 1-

year-old children should enhance, not replace, ongoing programs directed at a broader population of

children. HepA is also recommended for certain high risk groups (see MMWR 1999; 48[RR-12]1-37).

PCV

Vaccines within dotted line

are for selected populations

Range of Recommended Ages Catch-Up Immunization 11-12 Year Old Assessment

BIRTH 1MO 2MO 4MO 6MO 12MO 15MO 18MO 24MO 4-6YR 11-12YR 13-14YR 15YR 16-18YR

Hepatitis B1 Hep B Hep B Hep B1 Hep B Hep B series

Diphtheria, Tetanus, Pertussis 2 DTaP DTaP DTaP DTaP DTaP Tdap Tdap

Haemophilus influenzae type b3 Hib Hib Hib3 Hib

Inactivated Poliovirus IPV IPV IPV IPV

Measles, Mumps, Rubella4 MMR MMR MMR

Varicella 5 Varicella Varicella

Meningococcal 6 MCV4 MCV4

MPSV4 MPSV4

Pneumococcal 7 PCV PCV PCV PCV PPV

Influenza8 Influenza (Yearly) Influenza (Yearly)

Hepatitis A9 HepA Series

The Childhood and Adolescent Immunization Schedule is approved by: 

Advisory Committee on Immunization Practices www.cdc.gov/nip/acip, American Academy of

Pediatrics www.aap.org, and American Academy of Family Physicians www.aafp.org
Health Services Financing and Utilization

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DENTAL CARE

In a 2000 report on oral health, the Surgeon

General identified dental caries (tooth decay) as

the single most common chronic disease among

children in the United States. This is a preventable health problem that can significantly affect

children’s health, ability to concentrate in school,

and quality of life, and is more common in children of low-income families.

To promote good oral hygiene, the American

Dental Association recommends that children

have their first dental checkup within 6 months

of the eruption of their first tooth and no later

than 12 months of age. In Federal Fiscal Year

2004, only 26.5 percent of children eligible for

services under the Medicaid Early and Periodic

Screening, Diagnostic, and Treatment (EPSDT)

program received a preventive dental service.

In 2004, 72.3 percent of children had seen a

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

race and ethnicity. Non-Hispanic White children

between the ages of 1 and 18 years were most

likely to have visited a dentist or other dental 

specialist within the past year (76.9 percent),

while Hispanic children were least likely (62.3

percent). Children with family incomes at or

above 200 percent of the poverty level were more

likely (78.1 percent) to have seen a dentist in the

past year than children living with family

incomes below 200 percent of the poverty level 

(63.3 percent).

Children’s Receipt of Dental Care, by Family Income: 2004

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

for Health Statistics, National Health Interview Survey

26.5

Percent of Eligible Children

Children Receiving an EPSDT Preventive Dental Service:

1990-2004

Source (III.5): Centers for Medicare and Medicaid Services

Percent

0

10

20

30

40

50

60

70

80

90

100

All Children Below 200% FPL* At or Above 200% FPL

Within Past Year

More Than 1 Year Ago or Never

27.7

63.3

72.3 78.1

36.7

21.9

*Includes data from 42 States. *Federal poverty level.

15

20

25

30

1990 1992 1994 1996 1998 2000 2002 2004*
Health Services Financing and Utilization

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60

In 2004, 11.8 percent of children under 18

years of age had not seen a physician or other

health care professional in the previous year (not

including overnight hospitalization, trips to the

emergency room, home visits, or dental visits).

Older children were more likely than younger

children to go without a physician visit. More

than 15 percent of 15- to 17-year-olds had not

had a physician visit in the previous year, compared to only 5.9 percent of children under 5

years of age.

Across all age groups, Hispanic children were

the least likely to have seen a physician in the

prior year; non-Hispanic White children were

most likely to have seen a physician, except

among children under 5 years of age, among

whom non-Hispanic Black children were the

most likely. At all ages, Hispanic children were

approximately twice as likely as non-Hispanic

White children to have had no physician 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.

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

Year, by Age and Race/Ethnicity: 2004

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

Interview Survey Percent

0

5

10

15

20

25

30

35

40

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

Non-Hispanic White

Non-Hispanic Black

Hispanic

9.1

12.3

18.7

4.9 3.6

9.7 9.6

12.9

19.0

10.5

17.6

27.7

11.4

16.9

24.1

TIMING OF PHYSICIAN VISITS
Health Services Financing and Utilization

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61

RECEIPT OF PREVENTIVE

CARE

In 2004, 73 percent of children under 18 years

of age were reported by parents to have had a preventive medical visit (or “well-child” visit) in the

past year. The American Academy of Pediatrics

(AAP) recommends that children have eight such

visits in their first year, three in their second year,

and at least one per year from middle childhood

through adolescence. 

Despite the recommendation that older children should have one preventive visit per year,

only 68.3 percent of children aged 10 to 14 years

and 63.8 percent of children aged 15 to 17 years

received a well-child visit in the past year.

Younger children (ages birth to 4 years) were the

most likely to have received a well-child visit in

the past year (85.3 percent).

The rate of preventive visits for children also

varied by racial and ethnic group. Non-Hispanic

Black children were the most likely to have

received a preventive visit in the past year (79.4

percent), followed by non-Hispanic White children (73.9 percent). Hispanic children were least

likely to receive a preventive visit (64.9 percent).

Children with family incomes above the Federal

poverty level were more likely to receive a preventive visit than those children with family

incomes below the poverty level (74.5 versus 68.9

percent; data not shown).

Children Under Age 18 Who Have Received Preventive 

Medical Care in the Past Year, by Age: 2004

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

Statistics, National Health Interview Survey Percent

0

10

20

30

40

50

60

70

80

90

100

68.3 73.0 71.3

Children Under Age 18 Who Have Received

Preventive Medical Care in the Past Year, by Race/Ethnicity: 2004

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

Statistics, National Health Interview Survey Percent

0

10

20

30

40

50

60

70

80

90

100

73.9 73.5

79.4

85.3

64.9

*Includes American Indian/Alaska Native and those of more than one race.

63.8

Total 0-4 Years 5-9 Years 10-14 Years 15-17 Years Non-Hispanic White Non-Hispanic Black Hispanic Other*
Health Services Financing and Utilization

Child Health USA 2006

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PLACE OF PHYSICIAN

CONTACT

In 2004, a doctor’s office or HMO was the

usual place of sick care (not including routine or

preventive care) for nearly 79 percent of children

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

family income. Children with family incomes

above the poverty level were more likely to visit a

doctor’s office or HMO for sick care than children with family incomes below the Federal

poverty level. While this discrepancy was evident 

within all age groups, it was most pronounced

among children aged 5 to 12 years. Within this

age group, 82.1 percent of children with family

incomes above the poverty level went to a doctor’s

office or HMO compared to 58.4 percent of children in poverty. Moreover, poor children were

more likely to visit a clinic or health center for

sick care (38.3 percent versus 16.4 percent of 

5- to 12-year-olds). Only a small proportion of

children used a hospital emergency room or outpatient department as a source of sick care, but 

children in all age groups with family incomes

below the poverty level were more likely to do so

than children with higher family incomes.

Younger children were more likely than older

children to visit clinics or health centers, hospital

emergency rooms, and hospital outpatient

departments when sick. Use of a doctor’s office or

HMO as a source of sick care increased with age.

Place of Physician Contact,* by Age and Poverty Level: 2004

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

0

10

20

30

40

50

60

70

80

90

100

Below Poverty Level Above Poverty Level

Percent

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

Under 5 Years

0

10

20

30

40

50

60

70

80

90

100

Below Poverty Level Above Poverty Level

5-12 Years

Doctor’s Office or HMO

Clinic or Health Center

Hospital Emergency Room

Hospital Outpatient Department

0

10

20

30

40

50

60

70

80

90

100

Below Poverty Level Above Poverty Level

13-17 Years

82.0

0.5 0.7

16.6

2.1 1.4

37.9

59.5

82.1

0.5 0.8

16.4

1.0 2.0

38.3

58.4

82.0

0.4 0.9

16.5

1.7 2.4

32.7

63.2

Doctor’s Office or HMO

Clinic or Health Center

Hospital Emergency Room

Hospital Outpatient Department

Doctor’s Office or HMO

Clinic or Health Center

Hospital Emergency Room

Hospital Outpatient Department
Health Services Financing and Utilization

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HOSPITAL UTILIZATION

In 2004, over 20 percent of children went to a

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

less likely than children with family incomes

below the Federal poverty level to have visited the

ER/ED. Children in low-income families were

more likely than their peers in higher-incomes

families to have gone one to three times

(25.5 versus 19.1 percent) and four or more

times (3.3 versus 1.0 percent).

The rate of ER/ED visits varied by other factors, including age, race and ethnicity. Children

under 5 years of age were more likely than children in other age groups to have visited the

ER/ED at least once. The rate of visits among this

group was 24.3 percent, compared to 18.4 percent

among children aged 5 to 9 years, 16.5 percent

among children aged 10 to 14 years, and 18.8 percent among children aged 15 to 17 years. NonHispanic Black children had the highest rate of

ER/ED visits in 2004 (23.4 percent), followed by

Hispanic children (20.8 percent), and nonHispanic White children (20.6 percent); non-Hispanic children of other races (including Asian) had

the lowest rate (16.7 percent).

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

by Poverty Level: 2004

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

Statistics, National Health Interview Survey

0

10

20

30

40

50

60

70

80

90

100

No Trips 1-3 Trips 4 or More Trips

Percent

Below Poverty Level

Above Poverty Level

25.5

1.0 3.3

19.1

79.9

71.2

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

by Age: 2004

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

Statistics, National Health Interview Survey

0

10

20

30

40

50

60

70

80

90

100

No Trips 1-3 Trips 4 or More Trips

Percent

< 5 Years

5-9 Years

10-14 Years

15-17 Years 82.6 80.5 79.6

73.5

1.1 0.9 1.6 2.2

16.5

18.8 18.4

24.3
Health Services Financing and Utilization

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PRENATAL CARE

Timely Prenatal Care. Prenatal care—especially

care beginning in the first trimester—improves

pregnancy outcomes by identifying and managing

chronic and pregnancy-related conditions and

providing expectant parents with relevant health

care advice. The rate of first trimester prenatal care

utilization has been increasing fairly steadily since

the early 1990s, and in 2004, 83.9 percent of

women in 41 States, Washington DC, and New

York City received prenatal care during the first

trimester of pregnancy. 

The increase in prenatal care utilization over the

past 15 years has been especially remarkable

among racial and ethnic groups with historically

low rates of prenatal care. The proportion of nonHispanic Black, Hispanic, and American

Indian/Alaska Native women receiving early prenatal care increased by 20 percent or more since

1990; however, disparities still exist. In 2004, nonHispanic White women had the highest rates of

early prenatal care utilization (88.9 percent), followed by Asian/Pacific Islander women (85.6 percent), Hispanic women (77.5 percent), and nonHispanic Black women (76.5 percent); American

Indian women had the lowest rate (69.9 percent).

Late or No Prenatal Care. The percentage of

women beginning prenatal care in the third

trimester or going without prenatal remained

steady in 2004 at 3.6 percent. Hispanic and nonHispanic Black women are more than twice as

likely as non-Hispanic White women to receive

late or no prenatal care. Risk factors for late or no

prenatal care include being younger than 20

years old, being unmarried, and having low educational attainment.

Mothers Beginning Prenatal Care in the First Trimester, 

by Race/Ethnicity: 2004*

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

Statistics, National Vital Statistics System Percent

Mothers Receiving Late or No Prenatal Care, by Race/Ethnicity: 2004*

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

Statistics, National Vital Statistics System Percent

0

10

20

30

40

50

60

70

80

90

100

American Indian/

Alaska Native

Asian/Pacific

 Islander

Non-Hispanic Hispanic

 Black

Non-Hispanic

White

Total

83.9 88.9

76.5 77.5

85.6

69.9

0

10

20

30

40

50

60

70

80

90

100

American Indian/

Alaska Native

Asian/Pacific

Islander

Non-Hispanic Hispanic

Black

Non-Hispanic

White

Total

3.6 2.2 5.7 5.4 3.0

7.9

*2004 data includes 41 States, Washington DC and New York City. *2004 data includes 41 States, Washington DC and New York City.
State Data

Child Health USA 2006

67

While the indicators presented in previous sections are representative of the United States population as a whole, the following section presents

data at the State level. Geographic differences in

health status and health care utilization play an

important role in tailoring health programs and

interventions to specific populations. Included

are data regarding infant, neonatal, and perinatal

mortality, low birth weight, early prenatal care,

health care financing, Medicaid enrollment and

expenditures, and SCHIP enrollment.

The following pages reveal important disparities in these measures across States. For instance,

the rates of low birth weight births (less than

2,500 grams or 5 pounds 8 ounces) were highest

in the District of Columbia and several southern

States, including Alabama, Louisiana, Mississippi, and South Carolina. These States, in addition to New Mexico and Texas, were also among

those with the highest rates of births to women

under 18 years of age.

All of these issues have geographic program

and policy implications, and State and local leaders can use this information to better serve their

maternal and child populations in need.

State Data
State Data

Child Health USA 2006

68

Type of Date Upper Total SCHIP

State SCHIP Program Implemented Eligibility Enrollment

Alabama Separate 02/01/98 200% 81,856

Alaska Medicaid 03/01/99 175% 22,322

Arizona Separate 11/01/98 200% 88,005

Arkansas Combo 10/01/98 200% 1,214

California Combo 03/01/98 250% 1,223,475

Colorado Separate 04/22/98 185% 59,530

Connecticut Separate 07/01/98 300% 22,289

Delaware Combo 02/01/99 200% 10,354

District Of Columbia Medicaid 10/01/98 200% 6,631

Florida Combo 04/01/98 200% 384,801

Georgia Separate 11/01/98 235% 306,733

Hawaii Medicaid 07/01/00 200% 20,602

Idaho Combo 10/01/97 185% 21,839

Illinois Combo 01/05/98 200% 281,432

Indiana Combo 10/01/97 200% 129,544

Iowa Combo 07/01/98 200% 46,562

Kansas Separate 01/01/99 200% 47,323

Kentucky Combo 07/01/98 200% 63,728

Louisiana Medicaid 11/01/98 200% 109,150

Maine Combo 07/01/98 200% 30,654

Maryland Combo 07/01/98 300% 120,316

Massachusetts Combo 10/01/97 200% 162,679

Michigan Combo 05/01/98 200% 89,257

Minnesota Combo 10/01/98 280% 5,076

Mississippi Separate 07/01/98 200% 79,352

Missouri Medicaid 09/01/98 300% 115,355

Type of Date Upper Total SCHIP

State SCHIP Program Implemented Eligibility Enrollment

Montana Separate 01/01/99 150% 15,841

Nebraska Medicaid 05/01/98 185% 44,706

Nevada Separate 10/01/98 200% 39,316

New Hampshire Combo 05/01/98 300% 11,892

New Jersey Combo 03/01/98 350% 129,591

New Mexico Medicaid 03/31/99 235% 24,310

New York Separate 04/15/98 250% 618,973

North Carolina Separate 10/01/98 200% 196,181

North Dakota Combo 10/01/98 140% 5,725

Ohio Medicaid 01/01/98 200% 216,495

Oklahoma Medicaid 12/01/97 185% 108,100

Oregon Separate 07/01/98 185% 52,722

Pennsylvania Separate 05/28/98 200% 179,807

Rhode Island Combo 10/01/97 250% 27,144

South Carolina Medicaid 10/01/97 150% 80,646

South Dakota Combo 07/01/98 200% 14,038

Tennessee* 10/01/97

Texas Separate 07/01/98 200% 526,406

Utah Separate 08/03/98 200% 43,931

Vermont Separate 10/01/98 300% 6,614

Virginia Combo 10/22/98 200% 124,055

Washington Separate 02/01/00 250% 15,547

West Virginia Separate 07/01/98 200% 38,614

Wisconsin Medicaid 04/01/99 185% 57,165

Wyoming Separate 12/01/99 200% 6,120

State Children’s Health Insurance Program (SCHIP) Aggregate Enrollment Statistics: FY 2005

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

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

Child Health USA 2006

69

Medicaid Per Enrollee Participation

State Enrollees* Expenditure** Ratio***

Alabama 481,845 $1,836.40 48%

Alaska 87,286 $4,110.60 50%

Arizona 579,640 $2,342.56 56%

Arkansas 346,665 $2,301.14 27%

California 3,558,434 $1,851.14 41%

Colorado 262,321 $2,221.69 50%

Connecticut 269,073 $1,927.66 56%

Delaware 75,829 $2,928.68 70%

D.C. 89,993 $3,379.62 69%

Florida 1,570,711 $1,745.87 55%

Georgia 1,022,908 $1,634.63 100%

Hawaii  107,259 $1,699.68 70%

Idaho 145,333 $1,846.51 33%

Illinois 1,146,996 $1,611.20 73%

Indiana 572,672 $1,728.27 56%

Iowa 214,993 $2,277.59 98%

Kansas 202,917 $1,982.79 61%

Kentucky 340,350 $3,090.63 48%

Louisiana 694,224 $1,361.64 60%

Maine** ** 120,844 $5,087.43 59%

Maryland 482,276 $2,510.09 52%

Massachusetts 497,400 $2,189.83 92%

Michigan 958,135 $1,456.38 46%

Minnesota 391,447 $3,148.38 81%

Mississippi**** 434,327 $1,564.49 29%

Missouri 654,873 $1,674.01 61%

Medicaid Per Enrollee Participation

State Enrollees* Expenditure** Ratio***

Montana 62,629 $2,392.37 55%

Nebraska 166,725 $2,130.85 53%

Nevada 146,198 $1,844.22 99%

New Hampshire  73,975 $2,639.16 54%

New Jersey 500,141 $2,418.08 51%

New Mexico** ** 303,439 $2,386.92 49%

New York 2,015,608 $2,775.83 89%

North Carolina 819,202 $2,180.26 69%

North Dakota 38,494 $1,960.10 49%

Ohio 1,103,858 $1,785.62 45%

Oklahoma**** 420,165 $1,635.03 45%

Oregon 272,298 $2,073.06 51%

Pennsylvania 941,719 $2,720.48 57%

Rhode Island 109,989 $2,989.72 53%

South Carolina 641,797 $1,482.73 31%

South Dakota 80,188 $2,113.05 41%

Tennessee 782,057 $1,336.41 39%

Texas 2,445,943 $1,819.75 60%

Utah 163,122 $2,016.50 47%

Vermont 72,160 $2,798.91 88%

Virginia 466,705 $1,657.28 56%

Washington 659,843 $1,363.56 50%

West Virginia 216,516 $1,794.02 50%

Wisconsin 436,630 $1,642.08 55%

Wyoming 50,993 $1,866.49 38%

Medicaid Enrollees, Expenditures, and Reported EPDST Utilization for Children Under 21: FY 2003

Source (IV.2, IV.3): Centers for Medicare and Medicaid Services, Fiscal Year 2003 National MSIS Tables and Annual EPSDT Participation Report

*Unduplicated number of individuals under age 21 determined to be eligible for EPSDT services.

**Total Medicaid vendor payments divided by Medicaid eligibles under 21.

***The percent of Medicaid eligibles under age 21 who received any initial and periodic screening services during FY 2003.

****Based on FY 2002 data.
Health Insurance Status of Children Through Age 18: 2004*

Source (IV.4): Analysis of 2005 Current Population Survey, American Academy of Pediatrics

State Data

Child Health USA 2006

70

Percent with Percent

Private/Employer- Enrolled in Percent

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

Alabama 60.5 32.1 7.4

Alaska 52.6 38.9 8.5

Arizona 53.6 31.3 15.1

Arkansas 51.5 40.9 7.6

California 55.1 31.8 13.1

Colorado 70.7 14.2 15.1

Connecticut 70.8 20.1 9.0

Delaware 67.9 19.3 12.8

District of Columbia 49.6 42.6 7.8

Florida 57.7 26.3 15.9

Georgia 53.7 34.0 12.4

Hawaii 72.8 21.7 5.5

Idaho 63.6 27.1 9.3

Illinois 67.7 20.4 12.0

Indiana 63.5 27.3 9.3

Iowa 68.9 24.2 7.0

Kansas 71.3 21.6 7.2

Kentucky 61.6 30.0 8.4

Louisiana 52.5 39.3 8.2

Maine 60.3 33.7 6.0

Maryland 71.7 18.6 9.8

Massachusetts 71.2 22.2 6.7

Michigan 65.9 27.0 7.1

Minnesota 76.9 16.5 6.6

Mississippi 46.4 39.3 14.4

Missouri 62.8 28.5 8.7

Percent with Percent

Private/Employer- Enrolled in Percent

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

Montana 54.2 33.2 12.6

Nebraska 67.7 26.1 6.1

Nevada 70.3 13.3 16.4

New Hampshire 77.0 15.2 7.8

New Jersey 72.4 15.9 11.7

New Mexico 42.5 43.5 14.0

New York 59.3 31.9 8.8

North Carolina 64.1 24.8 11.2

North Dakota 71.4 22.4 6.2

Ohio 68.6 23.7 7.7

Oklahoma 52.5 33.6 13.9

Oregon 66.4 23.6 10.0

Pennsylvania 67.2 22.0 10.8

Rhode Island 62.4 30.3 7.3

South Carolina 58.1 33.8 8.1

South Dakota 61.3 33.2 5.5

Tennessee 59.1 30.5 10.4

Texas 51.9 26.5 21.7

Utah 71.2 17.8 11.0

Vermont 56.2 38.3 5.5

Virginia 72.9 18.2 9.0

Washington 63.0 30.5 6.5

West Virginia 59.8 31.1 9.2

Wisconsin 68.2 26.0 5.8

Wyoming 65.3 25.0 9.7

*Estimates for 2004 should not be compared directly to estimates prior to 2000 due to changes in survey design. 

**Includes children covered by Medicare and the Indian Health Service.

***See map on facing page.
State Data

Child Health USA 2006

71

IL

Alaska

HI

Washington

California

Kansas

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%)

Nebraska

VA WV

North

Dakota

South

Dakota

Utah

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

Idaho

Wyoming

LA

FL

Oregon

TN

NC

New Mexico

Colorado

Texas

GA

Oklahoma

Nevada

Arizona

Montana

Percent of Children Through Age 18 Who Are Uninsured: 2004

Source (IV.4): American Academy of Pediatrics
State Data

Child Health USA 2006

72

Percent of Infants Born at Low Birth Weight, Women Receiving First Trimester Prenatal Care, and Births to Unmarried Women, 

by State and Race of Mother: 2004

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

Low Birth Weight Early Prenatal Care Births to Unmarried Women

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

United States 8.1 7.2 13.7 83.9 88.9 76.5 35.8 24.5 69.3 46.4

Alabama 10.4 8.5 15.1 84.0 90.1 77.2 36.2 21.1 70.6 25.1

Alaska 6.0 5.1 9.3 80.7 85.4 85.2 34.6 22.4 39.3 34.9

Arizona 7.2 7.3 12.0 76.3 87.2 77.8 42.2 25.2 61.2 54.0

Arkansas 9.3 8.1 15.5 82.3 85.4 76.1 38.8 28.4 77.0 42.4

California 6.7 6.3 12.4 87.1 90.7 83.5 34.4 20.5 63.3 44.5

Colorado 9.0 8.7 14.6 80.2 86.2 72.0 27.5 18.9 52.8 41.6

Connecticut 7.8 6.7 12.7 87.2 92.3 77.4 30.6 17.0 66.7 62.2

Delaware 9.0 7.4 13.8 85.1 90.0 81.7 42.3 27.9 71.2 58.1

D.C. 11.1 5.6 14.1 77.8 91.8 72.8 55.9 6.3 77.5 62.9

Florida 8.5 7.3 13.1 N/A N/A N/A 41.4 30.4 67.4 43.1

Georgia 9.3 7.4 14.0 83.9 90.3 79.4 39.2 22.6 66.5 45.2

Hawaii 7.9 6.2 10.2 81.8 85.2 87.4 33.4 23.6 28.4 44.6

Idaho 6.8 6.6 N/A N/A N/A N/A 22.6 19.2 37.8 37.2

Illinois 8.4 7.3 14.6 85.5 90.8 74.2 36.3 22.1 77.5 45.4

Indiana 8.1 7.5 13.6 80.8 84.3 68.5 38.8 32.5 77.9 52.7

Iowa 7.0 6.9 11.0 88.4 90.0 76.3 31.0 28.1 72.9 44.4

Kansas 7.3 7.0 13.7 86.5 89.8 78.3 33.0 27.8 71.2 45.3

Kentucky 8.8 8.4 13.3 N/A N/A N/A 35.0 30.7 75.7 48.9

Louisiana 10.9 8.0 15.2 85.5 91.5 77.4 49.1 29.7 76.7 40.7

Maine 6.4 6.4 N/A 88.5 88.9 80.2 34.1 34.0 35.5 31.7

Maryland 9.3 7.4 13.2 82.3 90.2 74.7 35.7 21.2 59.6 48.9

Massachusetts 7.8 7.2 11.8 89.6 92.2 80.4 28.5 20.4 57.1 63.1

Michigan 8.3 7.1 14.5 85.9 89.8 71.9 35.7 26.6 74.0 45.7

Minnesota 6.5 6.0 10.5 86.3 90.4 74.0 29.0 22.4 57.7 51.6

Mississippi 11.6 8.7 15.5 84.4 90.6 77.6 48.3 25.5 76.7 46.8

Low Birth Weight Early Prenatal Care Births to Unmarried Women

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

Missouri 8.3 7.3 14.0 88.2 90.2 80.4 37.0 29.4 77.0 47.5

Montana 7.6 7.6 N/A 83.2 86.4 93.6 34.3 27.8 51.1 40.8

Nebraska 7.0 7.0 11.8 82.9 86.0 72.5 30.2 24.2 69.5 43.9

Nevada 8.0 7.8 13.8 75.0 83.8 68.8 39.7 29.3 68.8 47.8

New Hampshire 6.8 6.9 N/A N/A N/A N/A 26.4 25.9 40.0 40.4

New Jersey 8.3 7.2 13.7 79.1 88.4 63.3 30.1 13.6 64.8 54.4

New Mexico 8.1 8.0 14.7 69.4 76.5 66.9 48.8 28.3 54.3 55.8

New York 8.2 6.9 13.0 N/A N/A N/A 37.8 20.7 67.3 61.6

North Carolina 9.0 7.7 14.2 84.0 90.4 76.5 36.9 22.0 68.1 50.1

North Dakota 6.6 6.4 N/A 85.7 88.7 81.1 29.9 22.9 26.4 35.3

Ohio 8.5 7.5 14.0 87.8 89.9 78.6 37.4 29.8 76.0 52.4

Oklahoma 8.0 7.8 13.0 78.1 82.3 72.2 38.4 31.3 71.7 46.1

Oregon 6.0 6.0 10.6 80.5 84.0 73.6 32.5 28.8 65.4 44.5

Pennsylvania 8.2 7.1 13.5 N/A N/A N/A 35.2 26.0 74.8 61.0

Rhode Island 8.0 7.3 11.0 90.0 92.5 82.4 37.3 27.0 64.1 60.7

South Carolina 10.2 7.9 15.3 N/A N/A N/A 41.9 24.9 73.2 43.8

South Dakota 6.9 6.9 N/A 77.9 83.4 63.6 35.1 25.4 42.1 46.8

Tennessee 9.2 8.2 13.8 N/A N/A N/A 38.2 27.5 74.4 48.8

Texas 8.0 7.4 13.9 81.8 88.2 78.4 36.0 23.6 64.2 40.7

Utah 6.7 6.3 10.8 80.0 83.7 60.5 17.5 12.6 45.6 40.5

Vermont 6.4 6.3 N/A 90.0 90.4 71.7 32.3 32.5 49.1 34.7

Virginia 8.3 7.0 12.8 85.6 90.5 79.0 31.0 20.0 62.4 44.0

Washington 6.2 5.7 11.1 N/A N/A N/A 30.4 25.7 55.2 44.1

West Virginia 9.3 9.1 14.3 86.0 86.4 76.2 34.8 33.6 76.7 34.4

Wisconsin 7.0 6.2 13.6 85.3 88.7 76.9 31.3 23.5 81.9 47.8

Wyoming 8.6 8.5 N/A 85.2 87.0 83.3 31.7 27.9 46.3 49.0

N/A: Figure does not meet standards of reliability or precision or the State did not report this indicator.

*Includes races other than White and Black.

**Includes Hispanics.
State Data

Child Health USA 2006

73

Infant and Neonatal Mortality Rates, by State and Race of Mother: 2004

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

Infant Mortality Neonatal Mortality

State Total* White Black Total* White Black

United States 6.79 5.66 13.79 4.52 3.78 9.13

Alabama 8.67 6.79 13.25 5.07 3.78 8.26

Alaska 6.67 5.47 N/A 3.48 3.04 N/A

Arizona 6.73 6.54 11.96 4.54 4.55 7.58

Arkansas 8.27 7.12 13.40 4.93 4.35 7.45

California 5.16 4.89 12.39 3.49 3.36 7.96

Colorado 6.34 5.98 14.68 4.47 4.22 9.22

Connecticut 5.54 4.50 12.88 4.11 3.37 10.04

Delaware 8.62 6.52 15.48 5.63 4.26 9.98

D.C. 11.98 N/A 14.65 8.70 N/A 10.20

Florida 7.05 5.60 11.81 4.54 3.60 7.62

Georgia 8.51 6.07 13.93 5.72 3.94 9.73

Hawaii 5.69 5.21 N/A 4.27 4.05 N/A

Idaho 6.17 6.13 N/A 3.91 3.96 N/A

Illinois 7.46 5.95 15.73 4.97 4.13 9.73

Indiana 8.03 6.96 16.92 5.45 4.77 11.00

Iowa 5.07 4.84 N/A 3.20 3.19 N/A

Kansas 7.16 6.48 16.54 4.46 4.21 8.09

Kentucky 6.78 6.26 12.59 3.91 3.57 7.72

Louisiana 10.46 7.65 14.78 6.29 4.20 9.43

Maine 5.67 5.46 N/A 4.23 4.11 N/A

Maryland 8.44 5.74 13.96 6.02 3.98 10.11

Massachusetts 4.84 4.44 9.18 3.76 3.49 6.77

Michigan 7.58 5.50 17.51 5.35 3.87 12.25

Minnesota 4.70 4.21 9.21 3.19 3.05 5.13

Mississippi 9.81 6.21 14.58 6.00 3.57 9.13

Infant Mortality Neonatal Mortality

State Total* White Black Total* White Black

Missouri 7.51 6.38 14.66 4.81 4.15 8.99

Montana 4.51 4.17 N/A 2.60 2.24 N/A

Nebraska 6.57 5.91 16.53 4.22 3.88 N/A

Nevada 6.39 5.27 18.56 4.26 3.58 11.81

New Hampshire 5.56 5.30 N/A 4.46 4.21 N/A

New Jersey 5.65 4.75 10.66 3.99 3.33 7.78

New Mexico 6.31 5.79 N/A 3.77 3.56 N/A

New York 6.07 5.00 10.90 4.28 3.66 7.35

North Carolina 8.79 6.26 16.76 6.02 4.13 11.84

North Dakota 5.62 5.13 N/A 4.52 4.13 N/A

Ohio 7.67 6.09 16.34 5.02 3.96 10.72

Oklahoma 8.01 7.06 17.21 4.68 4.09 11.26

Oregon 5.49 5.34 N/A 3.87 3.78 N/A

Pennsylvania 7.25 6.16 13.47 4.90 4.12 9.26

Rhode Island 5.32 4.97 N/A 3.99 3.86 N/A

South Carolina 9.28 6.79 14.12 6.43 4.72 9.84

South Dakota 8.20 6.96 N/A 5.03 4.89 N/A

Tennessee 8.63 6.65 15.97 5.40 4.01 10.52

Texas 6.31 5.60 12.73 4.14 3.69 8.15

Utah 5.21 5.21 N/A 3.41 3.46 N/A

Vermont 4.55 4.68 N/A 3.03 3.12 N/A

Virginia 7.47 5.81 14.19 5.07 3.93 9.52

Washington 5.52 5.35 10.60 3.34 3.29 6.66

West Virginia 7.57 7.44 N/A 4.79 4.75 N/A

Wisconsin 5.99 4.57 19.39 3.99 3.13 12.27

Wyoming 8.81 8.34 N/A 5.88 5.98 N/A

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

*Includes races other than White or Black.
City Data

Child Health USA 2006

74

The following section presents data on the

health of infants and children living in cities

compared to that of children nationwide.

Included are data on infant mortality, low birth

weight, and prenatal care for those women and

children who reside in U.S. cities with over

100,000 residents.

The following measures indicate that the

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

is generally poorer than that of children in the

nation as a whole. In 2004, the percentage of

infants born at low birth weight was 8 percent

higher in cities compared to the national average

(8.6 versus 8.1 percent). Infant mortality was

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

the higher rate of low birth weight. In 2003, the

city infant mortality rate was 7.5 per 1,000 live

births, compared to a rate of 6.8 nationwide. The

percentage of pregnant women receiving first

trimester prenatal care was lower in cities (81.7

percent) than it was in the 42 jurisdictions that

reported these data (83.4 percent).

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 2004, 116,651 babies born to residents

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

of low birth weight (weighing less than 2,500

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

rate of 8.6 percent. The 2004 percentage of

urban infants born at low birth weight was 6 percent higher than the national rate of 8.1 percent. 

Very Low Birth Weight. Infants born at very low

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

4 ounces) are at highest risk for poor health outcomes. In 2004, 1.63 percent of live births in

cities with populations over 100,000 were of very

low birth weight. This exceeded the national very

low birth weight rate by 10 percent.

City Data

Child Health USA 2006

75

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

Populations over 100,000: 1990-2004

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

Statistics, National Vital Statistics System

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

Percent

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

Populations over 100,000: 1990-2004

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

Statistics, National Vital Statistics System Percent

8.1

8.6

1.6

1.4

0

1

2

3

4

5

6

7

8

9

10

1990 1992 1994 1996 1998 2000 2002 2004

Total U.S. Population

Total U.S. Cities

0

1

2

3

4

5

6

7

8

9

10

1990 1992 1994 1996 1998 2000 2002 2004
INFANT MORTALITY

In 2003, 6,620 infants born to residents of

cities in the United States with populations over

250,000 died in the first year of life. The city

infant mortality rate was 7.5 deaths per 1,000 live

births, higher than the rate of 6.8 for the nation

as a whole. Although the infant mortality rate in

cities has routinely been higher than the rate

nationwide, it has declined over the past decade.

Between 1990 and 2000, infant mortality in

cities declined by roughly one-third; the decline

nationwide in the same period was 25 percent.

Between 2001 and 2002 there was an increase of

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

City Data

Child Health USA 2006

76

Infant Mortality Rates in U.S. Cities:* 1990-2003

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

Statistics System

7.5

6.8

Total U.S. Cities

Percent of Live Births

Total U.S. Population

1990 1992 1994 1996 1998 2000 2002 2003 5

6

7

8

9

10

11

12

13

14

15

*Data for 1990-2002 were for cities with populations over 100,000; data for 2003 were for cities with populations over 250,000.
City Data

Child Health USA 2006

77

PRENATAL CARE

Early Prenatal Care. Women living in cities with

a population of over 100,000 are less likely to

begin prenatal care in the first 3 months of pregnancy than women nationwide. The gap in early

entry into prenatal care between urban women

and the Nation as a whole has narrowed 

since 1991.

In 2004, 83.2 percent of pregnant women living in cities in 41 States, Washington DC, and

New York City began prenatal care in the first

trimester of pregnancy, compared to 83.9 percent

of the overall population in the reporting jurisdictions. The percentage of women receiving prenatal care has increased steadily in the past decade

at both the city and nationwide levels. The

Healthy People 2010 objective is for 90 percent

of pregnant women to begin prenatal care in the

first trimester.

Late or No Prenatal Care. In 2004, 3.8 percent of

pregnant women living in U.S. cities with a population over 100,000 in 41 States, Washington

DC, and New York City either began prenatal

care in the third trimester or received no prenatal

care. The percentage of women receiving late or

no prenatal care is 6 percent higher among

women living in cities than among the overall

population in the 41 reporting jurisdictions.

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

with Populations over 100,000: 1990-2004*

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

National Vital Statistics System

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

Percent

Pregnant Women Receiving First Trimester Prenatal Care in

U.S. Cities with Populations over 100,000: 1990-2004*

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

Statistics, National Vital Statistics System Percent

83.2

83.9

3.8

3.6

Total U.S. Cities

Total U.S. Population

*2004 data includes 41 States, Washington DC and New York City. *2004 data includes 41 States, Washington DC, and New York City.

0

10

20

30

40

50

60

70

80

90

100

1990 1992 1994 1996 1998 2000 2002 2004 0

10

20

30

40

50

60

70

80

90

100

1990 1992 1994 1996 1998 2000 2002 2004
Child Health USA 2006

78

Population Characteristics

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

Washington, DC: The Bureau; 2006.

I.2 Centers for Disease Control and Prevention, National Center for Health Statistics. National Survey of Children’s Health, 2003. Analysis conducted by

the Maternal and Child Health Information Resource Center. 

I.3 DeNavas-Walt C, Proctor B, Hill Lee C. Income, poverty, and health insurance coverage in the United States: 2004. Current Population Reports, P60-

229. Washington, DC: U.S. Government Printing Office; 2005.

I.4 U.S. Department of Education, National Center for Education Statistics.

The condition of education 2006 (NCES 2006-071). Washington, DC:

U.S. Government Printing Office; 2006. 

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

Births: final data for 2004. National Vital Statistics Reports, Vol. 55, No. 1;

2006 Sep.

I.6 U.S. Department of Labor, Bureau of Labor Statistics. Employment characteristics of families in 2005 (USDL 06-731). Washington, DC: The Department; Apr 2006. 

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.

Health Status

II.1 Centers for Disease Control and Prevention. 2004 National Immunization

Survey—breastfeeding rates by socio-demographic factors. Available from:

http://www.cdc.gov/breastfeeding/data/NIS_data/2004/socio-demographic.htm

II.2 Centers for Disease Control and Prevention, National Center for Health Statistics. Unpublished data.

II.3 Centers for Disease Control and Prevention, National Center for Health Statistics. Health, United States, 2006. Hyattsville, MD: 2006.

II.4 Centers for Disease Control and Prevention. HIV/AIDS Surveillance

Report, 2004 (Vol. 15). Atlanta, GA: US Department of Health and

Human Services; 2005.

II.5 Centers for Disease Control and Prevention. Summary of notifiable diseases:

United States, 2004. MMWR, Vol. 53, No. 53; 2006.

II.6 Centers for Disease Control and Prevention, National Center for Health Statistics. National Hospital Discharge Survey, 2004. Unpublished data.

II.7 U.S. Department of Health and Human Services, Administration on Children, Youth, and Families. Child maltreatment 2004. Washington, DC:

U.S. Government Printing Office; 2006.

II.8 Centers for Disease Control and Prevention. Youth risk behavior surveillance: United States, 2005. MMWR, Vol. 55, No. SS-5; 2006.

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

surveillance, 2004. Atlanta, GA: U.S. Department of Health and Human

Services; 2005 Sep.

References

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

the 2004 National Survey on Drug Use and Health: national findings.

Rockville, MD: SAMHSA, Office of Applied Studies; 2005.

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

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

2005. Bethesda, MD: National Institute on Drug Abuse; 2006.

Health Services Financing and Utilization

III.1 U.S. Census Bureau. Annual Demographic Survey, March 

Supplement, 2004.

III.2 Fronstin P. Sources of health insurance and characteristics of the uninsured:

analysis of the March 2005 Current Population Survey. EBRI Issue Brief

No. 287; 2005 Nov.

III.3 Centers for Disease Control and Prevention, National Immunization Program. National Immunization Survey, Jan-Dec 2004. Available from:

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

III.4 Centers for Disease Control and Prevention, National Immunization Program. Recommended childhood and adolescent immunization schedule,

United States, 2006. http://www.cdc.gov/nip/recs/childschedule.htm#printable

III.5 Centers for Medicare and Medicaid Services. FY 2004 416 Report. Baltimore, MD: The Centers; 2006.

III.6 Centers for Disease Control and Prevention, National Center for Health

Statistics. National Health Interview Survey, 2004. Analysis conducted by

the Maternal and Child Health Information Resource Center.

State Data

IV.1 Centers for Medicare and Medicaid Services. State Children’s Health Insurance Program annual enrollment report, 2005. Baltimore, MD: The Centers; 2006 Jul.

IV.2 Centers for Medicare and Medicaid Services. Annual EPSDT participation

report, FY 2003 (Form 416). Baltimore, MD: The Centers.

IV.3 Centers for Medicare and Medicaid Services. Medicaid program statistics,

FY 2002 (MSIS state summary). Baltimore, MD: The Centers.

IV.4 American Academy of Pediatrics, Division of Health Policy Research. Children’s health insurance status and Medicaid/SCHIP eligibility and enrollment, 2004. Elk Grove Village, IL: The Academy; 2005 Sep.

References

Child Health USA 2006

79
Child Health USA 2006

80

This publication was prepared for the Maternal

and Child Health Bureau (MCHB) of the

Health Resources and Services Administration.

It was produced by the Maternal and Child

Health Information Resource Center 

of the MCHB.

Federal Contributors within the U.S. Department

of Health and Human Services

Administration on Children, Youth,

and Families

Centers for Disease Control and Prevention

Centers for Medicare and Medicaid Services

National Institute on Drug Abuse

Substance Abuse and Mental Health Services

Administration

Other Federal and Non-Governmental Contributors

American Academy of Pediatrics

Employee Benefit Research Institute

U.S. Census Bureau

U.S. Department of Education

U.S. Department of Labor

Urban Institute

Contributors

Contributors

Photography Copyrights 

Daniel Armijo, page 8; Cheryl Bell, cover, title page (1st); Gerald Bragg, cover, title page (2nd); Kathy Cooper, page

80; Getty Images, pages 58, 64; iStockphoto.com, cover, title page (3rd and 5th), pages 11, 20, 32, 39, 44 (1st and

2nd), 54, 67, 74; Min Lee, cover, title page (4th); Kate Lynch Machado, page 28; Sheryl Mathis, page 9; RaQeeba

Milner, page 5; Photos.com, page 44 (3rd); Renee Schwalberg, page 19.