Child Health USA 2007
 
Child Health USA 2007 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 2007. Rockville,

Maryland: U.S. Department of Health and Human Services, 2008.

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

HRSA Information Center

P.O Box 2910

Merrifield, VA 22116

1-888-ASK-HRSA or ask@hrsa.gov
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

Children with Special Health Care Needs:

Conditions and Functional Impact . . . . . . . . . . . . .18

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

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

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

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

Hospital Discharge Trends . . . . . . . . . . . . . . . . . . . . . . .34

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

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

Child Mortality Due to Injury . . . . . . . . . . . . . . . . . .37

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

Cigarette Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48

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

Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

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

Adolescent Mortality from Traffic 

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

Health Services Financing

and Utilization .................................... 53

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

Children with Special Health Care Needs:

Health Insurance and Needed Services . . . . . . . .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

Emergency Department 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 .......................................... 75

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

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

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

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

Child Health USA 2007

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

(MCHB) is pleased to present Child Health USA

2007, the 18th annual report on the health status

and service needs of America’s children. The

Bureau’s vision is that of a Nation in which the

right to grow to one’s full potential is universally

assured through attention to the comprehensive

physical, psychological, and social needs of the

maternal and child population. To assess the

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 are from the same sources as the information in the corresponding graphs (unless otherwise

noted). Data are presented for the target populations of Title V Maternal and Child Health Block

Grant funding: infants, children, adolescents,

children with special health care needs, and

women of childbearing age. Child Health USA

2007 addresses health status and health services

utilization and offers insight into the Nation’s

progress toward the goals set out in the MCHB’s

strategic plan—to assure quality of care, eliminate

barriers and health disparities, and improve the

health infrastructure and 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 utilization of

selected health services. The final sections, State

Data and City Data contain information on selected

indicators at those levels.

Child Health USA is not copyrighted and readers may duplicate and use all of the information

contained herein. This and all previous editions

of Child Health USA since 1999 are available

online at www.mchb.hrsa.gov/mchirc/chusa.

For a complimentary copy of the publication,

mail your request to HRSA Information Center,

P.O Box 2910, Merrifield, VA 22116,

1-888-ASK-HRSA or ask@hrsa.gov.

Preface

Child Health USA 2007

5

Preface
Child Health USA 2007 

Introduction 

The health of the current child population has 

important implications for the future health of 

the United States population. Many childhood 

health issues—including weight, smoking, oral 

health, and vaccination coverage—can affect 

health throughout the lifespan. In 2007, nearly 

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 

ensure that children are born healthy and maintain good health as they grow up. 

Good health begins even before birth. Timely 

prenatal care is an important preventive strategy 

that can help protect the health of both mother 

and child. Entry into prenatal care during the 

first trimester has been improving, reaching 83.9 

percent of pregnant women in 2005. A small proportion of women (3.5 percent) did not receive 

prenatal care until the third trimester or did not 

receive care at all. This was 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 

also included in Child Health USA. For instance, 

data are presented on maternal age, which can 

affect the health of both infant and mother. In 

2005, births to women aged 15–19 years reached 

another record low, while births to older women 

(35 years and older) increased slightly from the 

previous year. 

Parental employment and child care can also 

affect the health and well-being of a family. In 

2006, 70.9 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), 63.5 percent were in the labor force and 

59.7 percent were employed. In 2005, 60 percent 

of children under 6 years of age required care 

from someone other than a parent at least once a 

week. 

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 emerging evidence indicates that 

birth weight may affect children into adulthood 

as well. 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. Despite high rates of prenatal care utilization, 2005 data indicate that 8.2 percent of 

infants were born at low birth weight (less than 

2,500 grams, or 5 pounds 8 ounces), which is the 

highest rate recorded in the last 3 decades. 

Although the number of multiple births, which 

are more likely to result in low birth weight, is 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) 

represented 1.5 percent of live births in 2005. 

This represents an increase since 1980 when 

approximately 1 percent of infants were born at a 

very low birth weight. 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 (6.8 deaths per 1,000 live births in 

2004). 

Introduction 7 
Child Health USA 2007 

Introduction 

Breastfeeding can also support the health of 

infants and mothers. Breastfeeding rates have 

increased steadily since the beginning of the last 

decade. In 2005, 72.9 percent of mothers 

reported ever breastfeeding their infants. However, breastfeeding declined dramatically as infant 

age increased: 39.1 percent of mothers reported 

breastfeeding their infants at 6 months of age. 

The rate of exclusive breastfeeding at 6 months 

was even lower (13.9 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 2005, 80.8 

percent of children aged 19–35 months had 

received the recommended series of vaccines; 

76.1 percent of children in this age group 

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

Physical activity is another important protective factor in lifelong health that begins in early 

childhood. Results from the 2005 Youth Risk 

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

recommended levels of physical activity, and 54.2 

8 
Child Health USA 2007 

percent of students were enrolled in a physical 

education class on one or more days per 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 had 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 (aged 

15–19 years) and young adults (aged 20–24 

years) are at much higher risk of contracting STIs 

than are older adults. Chlamydia continues to be 

fairly common among adolescents and young 

adults, with rates of 1,621 and 1,719 cases per 

100,000, respectively, in 2005. Gonorrhea followed in prevalence with overall rates of 438 and 

507 per 100,000 adolescents and young adults, 

respectively. Genital human papillomavirus 

(HPV) is believed to be the most common STI in 

the United States. It is estimated that 24.5 percent of females aged 14–19 years and 44.8 percent aged 20–24 years had an HPV infection in 

2003–2004. In 2006, a vaccine for HPV was 

approved by the Food and Drug Administration 

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

Mental health is another issue that increasingly 

affects children as they grow older. In 2005, 

21.8 percent of youth aged 12–17 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 proportion of youth 

receiving treatment in 2005 represented a slight 

decrease from the previous year (22.5 percent). 

Depression was the leading reason reported for 

mental health treatment among this age group. 

A number of other issues are interrelated with 

mental health, including violence and substance 

abuse. Results from the 2005 Youth Risk Behavior Surveillance System 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. Among males, nonHispanic 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, 9.9 percent of 

adolescents aged 12–17 years reported using 

illicit drugs in the past month in 2005. Alcohol 

was the most commonly used drug among adolescents, with 16.5 percent reporting past-month 

use in 2005, while marijuana was the most commonly used illicit drug (6.8 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 public health professionals to 

draw upon the experiences of programs that have 

achieved success. The health of our children and 

adolescents relies on effective public health efforts 

that include providing access to knowledge, 

skills, and tools; providing drug-free alternative 

activities; identifying risk factors and linking people to appropriate services; building community 

supports; and supporting approaches that promote policy change. 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. 

Introduction 9 
Child Health USA 2007 

Population Characteristics
 

The population of the United States is becoming 

increasingly diverse, which is reflected in the sociodemographic characteristics of children and their 

families. The percentage of children who are 

Hispanic or Asian/Pacific Islander has more than 

doubled since 1980, while the percentage who are 

non-Hispanic White has declined. The percentage of 

children who are Black has remained relatively 

stable. This reflects the changes in the racial and 

ethnic makeup of the population as a whole. 

At the national, State, and local levels, 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 highrisk populations that require specific interventions. 

This section presents data on several population 

characteristics that influence maternal and child 

health program development and evaluation. 

Included are data on the age and racial and ethnic 

distribution of the U.S. population, as well as data on 

poverty status, child care arrangements, and school 

dropout rates. 

Population Characteristics 11 
–

Child Health USA 2007 

POPULATION OF CHILDREN 

In 2006, there were an estimated 73.7 million 

children under 18 years of age in the United 

States, representing nearly 25 percent of the population. Young adults aged 20–24 years composed slightly more than 7 percent of the population, while adults aged 25–64 years composed 

over 53 percent of the population and adults 

aged 65 years and older accounted for more than 

12 percent. 

Since the 2000 Census, the number of children under 5 years of age is estimated to have 

risen 6.4 percent, while the number of children 

aged 5–19 years has risen nearly 2 percent. The 

number of adults aged 65 years and older, however, has risen more than 8 percent in the same 

period. 

The ethnic makeup of the child population 

reflects the increasing diversity of the population 

over the past several decades. Hispanic children 

represented 9 percent of all children in 1980, 

compared to more than 20 percent in 2006; 

Asian/Pacific Islander children represented 2 percent of all children in 1980 and more than 4 percent in 2006. While the percentage of children 

who are Hispanic or Asian/Pacific Islander has 

more than doubled since 1980, the percentage 

who are non-Hispanic White has declined. The 

percentage of children who are Black has 

remained relatively stable. 

U.S. Resident Population, by Age Group, 2006 

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

20–24 Years
 

7.1%
 

15–19 Years
 

7.1%
 

10–14 Years
 

6.9%
 

5–9 Years
 

6.6%
 

Under 5 Years
 

6.8%
 65 Years 

and Older 

12.4% 

25 64 Years 

53.1% 

Population of Children Under Age 18, by Race/Ethnicity, 2006 

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

American Indian/
 

Alaska Native
 

0.9%
 

Two Races or More
 

2.5%
 

Asian/Pacific Islander 


4.1% 


Hispanic 

20.3% 

Non-Hispanic 

Black 

14.6% 

Non-Hispanic White 

57.6% 

12 Population Characteristics 
Child Health USA 2007 

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 2006, more than 21 percent of children living in the United States had at least one 

foreign-born parent. Of all children, 17.2 percent were born in the United States to foreignborn parents and nearly 4 percent were foreignborn. Most children were native-born and lived 

in households with one or both native parents 

(74.4 percent). 

Children’s poverty status varies with nativity. 

In 2006, foreign-born children of foreign-born 

parents were most likely to live in households 

with incomes below 100 percent of the poverty 

level (30.4 percent) and 100–199 percent of the 

poverty level (30.8 percent). Only 15.4 percent 

of native-born children of native parents lived 

below 100 percent of the poverty level, as did 

20.2 percent of native children of foreign-born 

parents.1 

Children’s health insurance coverage also varied by nativity in 2006. Native-born children 

with native parents were the most likely to be 

insured (92.1 percent), while foreign-born children of foreign-born parents were the least likely 

to be insured (66.0 percent). Just over 84 percent 

of native-born children of foreign-born parents 

had health insurance coverage (data not shown). 

1	 The U.S. Census Bureau poverty threshold was $20,444 for a 

family of four in 2006. Following the Office of Management and 

Budget’s Statistical Policy Directive 14, the Census Bureau uses a set 

of money income thresholds that vary by family size and 

composition to determine who is in poverty. 

Children Under Age 18, by Nativity of Child and Parent(s),* 2006 

Source (1.2): U.S. Census Bureau, Current Population Survey 

Other 4.8% 

Foreign-Born Child 

and Parent 

3.9% 

Native Child, 

Foreign-Born Parent 

17.2% 

Native Child 

and Parent 

74.4% 

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

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

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

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

and Parent(s),** 2006 

Source (1.2): U.S. Census Bureau, Current Population Survey 

Below 100% 100–199% 200% of Poverty 

of Poverty of Poverty and Above 

15.4 19.2 

Native Child 

and Parent 

Native Child, 

Foreign-Born Parent 

Foreign-Born 

Child and Parent 

20.2 28.0 51.9 

30.4 30.8 38.9

20 40 60 80 100 

*The U.S. Census Bureau poverty threshold for a family of four was $20,444 in 2006. **“Native parent” indicates that 

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

outside of the United States. 

Population Characteristics 13 

65.4 
Child Health USA 2007 

CHILDREN IN POVERTY 

In 2005, nearly 13 million children under 18 

years old lived in households with incomes below 

the poverty threshold ($19,971 for a family of 

four in 2005);1 this represents 17.6 percent of all 

children in the United States. Children represented more than one-third of people in poverty, 

but only about 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. In 2005, a 

much higher proportion of Black (34.5 percent) 

and Hispanic (28.3 percent) children under age 

18 were poor than were their non-Hispanic 

White counterparts (10.0 percent). 

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

living with a single mother, 52.9 percent lived in 

poverty, which was more than five times the rate 

of their counterparts in married-couple families. 

Similarly, 42.8 percent of children under 18 living with a female head of household with no 

husband present lived in poverty, compared to 

8.5 percent of children in married-couple families (data not shown). Although they compose 

only 18.2 percent of all families in the United 

States, female-headed households represent 52.8 

percent 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. 

Children Under Age 18 Living in Households with Incomes Below 

100 Percent of Poverty Level, by Race/Ethnicity:* 1976–2005 

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

50 

40 

34.5 

30 28.3 

20 17.6 

10 10.0

Total 

Non-Hispanic White 

Black 

Hispanic 

1976 1980 1984 1988 1992 1996 2004 2005 

Percent of Children 

*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. Hispanics 

may be of any race. Data not reported for American Indian/Alaska Natives or children of multiple races. 

Families Below 100 Percent of Poverty Level,* by Family Type, 

2005** 

Source (I.4): U.S. Census Bureau, Current Population Survey 

Male Householder, 

No Wife Present 

8.7% 

Married-Couple 

Families 

38.4% 

Female Householder, 

No Husband Present 

52.8% 

*The U.S. Census Bureau poverty threshold for a family of four was $19,971 in 2005. **Totals do not equal 

100 percent due to rounding. 

14 Population Characteristics 
SCHOOL DROPOUTS 

As of October 2005, there were nearly 3.5 million high school status dropouts1 in the United 

States, representing 9.4 percent of the population 

aged 16–24 years. The dropout rate has generally declined over the past several decades and, 

after a slight increase in 2004, reached a new low 

in 2005. This represents a decline in status 

dropouts of 35.6 percent since 1972. 

Historically, Hispanic students have had 

higher dropout rates than youth of other races 

and ethnicities: 22.4 percent in 2005, compared 

to 10.4 percent of non-Hispanic Blacks and 6.0 

percent of non-Hispanic Whites. The high rate 

among Hispanics, overall, is partly due to the 

Percent of Population 

high dropout rate among Hispanics born outside 

of the United States (36.5 percent). First generation Hispanics, those born in the United States 

but have at least one parent born outside of the 

country, have a much lower dropout rate (13.9 

percent), while the rate among Hispanics who 

were born in the United States to American-born 

parents is comparable to that of other racial/ethnic groups (11.6 percent). 

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. 

Child Health USA 2007 

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

high school reported worse health outcomes than 

their peers who did complete high school, as well 

as reduced access to medical care and higher rates 

of uninsurance.2 

1	 “Status dropouts” refers to 16- to 24-year-olds who are not enrolled 

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

equivalent). 

2	 National Center for Health Statistics. Health, United States, 2006 

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

MD: 2006. 

School Status Dropout* Rates Among Persons Aged 16–24, by Race/Ethnicity: 1992–2005 

Source (I.5): U.S. Department of Education, National Center for Education Statistics 

40 

35 

30 

25 

20 

15 

10 

5 

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

Population Characteristics 15 

10.4 

22.4 

6.0 

9.4 

Non-Hispanic White 

Total Non-Hispanic Black

Hispanic 

1992 1994 1996 1998 2000 2002 2004 2005 
Child Health USA 2007 

MATERNAL AGE 

In 2005, the general fertility rate rose slightly 

to 66.7 births per 1,000 women aged 15–44 

years. The birth rate among teenagers aged 

15–19 years continued to decline, reaching 

another record low (40.5 births per 1,000 

women aged 15–19). This rate was 35 percent 

lower than the most recent peak reported in 

1991 (61.8 births per 1,000). The highest birth 

rate was among women aged 25–29 (115.5 per 

1,000), followed by women aged 20–24 years 

(102.2 per 1,000). There was a 2.0 percent 

increase in birth rates among women aged 35–39 

years and 40–44 years, since 2004, to 46.3 and 

9.1 per 1,000, respectively (data not shown). 

In 2005, 10.2 percent of births were to women 

aged 19 years and younger, and 52.5 percent of 

births were to women in their twenties; more 

than one-third of births were to women in their 

thirties, and 2.7 percent were to women aged 

40–54 years (data not shown). The average age at 

first birth was 25.2 years; this is an increase of 

almost 4 years since 1970. 

Among non-Hispanic Black and Hispanic 

women, more than 56 percent of births were to 

women in their twenties, while just over half of 

births to non-Hispanic White women occurred 

in the same age group. The proportion of births 

to teenagers was higher among non-Hispanic 

Black and Hispanic women (17.0 and 14.1 percent, respectively) than to non-Hispanic White 

women (7.3 percent). Non-Hispanic White 

women giving birth were more likely to be in the 

30- to 54-year-old age range than were either 

non-Hispanic Black or Hispanic women. 

Distribution of Births, by Race/Ethnicity and Maternal Age, 2005* 

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

Non-Hispanic White Non-Hispanic Black Hispanic 

40–54 Years 

3.0% 30–39 Years 

38.9% 

20–29 Years 

50.8% 

18–19 Years 

5.3% 

17 Years and 

Under 1.9% 

30–39 Years 

23.9% 

20–29 Years 

56.8% 

18–19 Years 

10.7% 17 Years 

and Under 

17 Years 5.3% 

and Under 40–54 Years 6.3% 2.0% 

40–54 Years 

2.2% 

30–39 Years 

27.6% 

20–29 Years 

56.3% 

18–19 Years 

8.8% 

*Totals may not add to 100 percent due to rounding. 

16 Population Characteristics 
60 

70 

80 

WORKING MOTHERS AND 

CHILD CARE 

In 2006, 70.9 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, 63.5 percent 

were in the labor force and 59.7 percent were 

employed (the remainder were unemployed and 

looking for work). Of women with children aged 

6–17 years, 76.7 percent were in the labor force 

and more than 73 percent were employed. 

Employed mothers with children aged 6–17 

years were more likely than women with younger 

children to be employed full-time (77.8 versus 

72.2 percent). Married mothers with a spouse 

present were less likely than never-married, 

divorced, separated, and widowed mothers to be 

in the labor force (68.6 versus 76.6 percent); 

however, married mothers in the labor force were 

more likely to be employed than mothers of 

other marital statuses. The unemployment rate 

among married mothers was only 3.6 percent, 

compared to a rate of 8.5 percent among mothers of other marital statuses (data not shown). 

In 2005, 40 percent of children under 6 years 

of age did not require nonparental child care, 

Child Health USA 2007 

while 60 percent required at least one child care 

arrangement. Overall, 60 percent of children 

with at least one child care arrangement received 

center-based care, 22 percent received care from 

a nonrelative, and 35 percent received care from 

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

Among children who received child care, 56.9 

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

than 1 year of age. 

Mothers in the Labor Force, by Age of Child: 1975–2006 Weekly Child Care Arrangements* for Children Aged 5 Years 

Source (1.7): U.S. Department of Labor, Bureau of Labor Statistics and Younger,** by Age, 2005 

Source (1.8): U.S. Department of Education, National Center for Education Statistics 

80 

76.7 

70 

Under 1 Year 

1–2 Years 

3–5 Years 

47.0 

27.0 

58.0 

20.2 20.7 21.2

15.9 

11.0 13.9 11.8 

22.8 

60 56.9

Percent of Mothers

Percent of Children

63.5 50 

40 

30 

20 

With Children Aged 6–17 

With Children Under Age 6 

10 

No Nonparental Relative Care Nonrelative Care Center-Based 1975 1980 1985 1990 1995 2000 2006 Arrangements Care 

*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. 

Population Characteristics 17 

40 

50 
Child Health USA 2007 

CSHCN: CONDITIONS AND 

FUNCTIONAL IMPACT 

HRSA’s Maternal and Child Health Bureau 

defines children with special health care needs 

(CSHCN) as “those who have or are at increased 

risk for a chronic physical, developmental, 

behavioral, or emotional condition and who also 

require health and related services of a type or 

amount beyond that required by children generally.” The 2005–2006 National Survey of 

CSHCN provides information about the prevalence and impact of special health care needs 

among children in the United States. Children 

were considered to have special health care needs 

if their parents answered “yes” to at least one 

question in each of three categories. Based on 

this series of questions, 13.9 percent of children 

under 18 years of age in the United States, or 

approximately 10.2 million children, were estimated to have special health care needs. Overall, 

21.8 percent of U.S. households with children 

have at least one CSHCN. 

The survey asked parents of CSHCN whether 

their children had any of a list of 16 conditions 

(the list was not exhaustive and did not include 

all conditions that CSHCN might have). Overall, 91 percent of CSHCN were reported to have 

at least one condition on the list, and 57 percent 

had two or more conditions. Allergies (53 percent) were the health condition most commonly 

reported by parents of CSHCN. Other commonly reported conditions were asthma (39 percent), attention deficit disorder (30 percent), and 

emotional problems (21 percent). 

One important aspect of special health care 

needs is how those needs impact the child. Based 

on parents’ reports, nearly 38 percent of 

CSHCN were never affected in their ability to 

do things other children do because of the nature 

of their health condition or the treatment they 

receive to manage their conditions. Another 

39 percent were moderately affected some of the 

time. Nearly one quarter (24 percent) are 

affected usually, always, or a great deal by their 

conditions. 

Percentage of CSHCN with Selected Conditions, 2005–2006 Impact of Child’s Condition on Functional Ability, 2005–2006 

Source (I.9): Centers for Disease Control and Prevention, National Survey of Children Source (I.9): Centers for Disease Control and Prevention, National Survey of Children 

with Special Health Care Needs with Special Health Care Needs 

Allergies 

Asthma 

Daily Activities Affected ADD/ADHD* 

38.8 

53.0 

29.8 

21.1 

15.1 

11.4 

5.4 

Usually, Always 

Emotional Problems or a Great Deal 

24.0% 

Migraine or Frequent Headaches 

Mental Retardation 

Autism 

10 20 30 40 50 60 

Percent of CSHCN 

*Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder 

18 Population Characteristics 

Daily Activities 

Moderately Affected 

Some of the Time 

38.5% 

Daily Activities 

Never Affected 

37.6% 
Child Health USA 2007 

Health Status
 

Monitoring 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 data collection period to the next whenever 

multiple years of data are available. 

In the following section, mortality, disease, injury, 

and health behavior indicators are 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 19 
Health Status – Infants
 
BREASTFEEDING 

Breastfeeding has been shown to promote the 

health and development of infants, as well as 

their immunity to disease, and may provide a 

number of maternal health benefits. For this reason, the American Academy of Pediatrics recommends exclusive breastfeeding—without supplemental foods or liquids—through the first 6 

months of life, 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 2005, 72.9 percent of infants 

were ever breastfed. Asian/Pacific Islander infants 

were most likely to be breastfed (81.4 percent), 

followed by Hispanic and non-Hispanic White 

infants (79.0 and 74.1 percent, respectively). 

Breastfeeding rates increased with maternal age, 

higher educational achievement, and higher 

income. 

The proportion of infants who are breastfed 

decreases as infant age increases. In 2005, 39.1 

percent of infants were breastfed at 6 months, 

Child Health USA 2007 

while 20.1 percent were breastfed at 12 months. 

Exclusive breastfeeding rates have not shown the 

same improvement over time as breastfeeding 

initiation. In 2005, only 13.9 percent of infants 

were exclusively breastfed at 6 months. As with 

breastfeeding initiation, exclusive breastfeeding 

was higher among Hispanic, Asian/Pacific 

Islander, and non-Hispanic White infants, as 

well as infants whose mothers were older, more 

educated, and had higher incomes. 

Breastfed Infants,* by Duration and Race/Ethnicity, 2005 Breastfed Infants, by Recommended Duration* and Maternal 

Source (II.1): Centers for Disease Control and Prevention, National Immunization Survey Age, 2005 

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

Percent of Infants 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

American Indian/

Alaska Native

Asian/ Pacific IslanderNon-Hispanic Hispanic BlackNon-Hispanic White Total 

Percent of Intants 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Total Under 20 Years 20–29 Years 30 Years and Older 

13.9 

6.7 10.1 

17.3 20.1 

5.4 

15.8 

24.2 

Ever Breastfeeding 

Breastfeeding at 6 Months 

Exclusive** Breastfeeding at 6 Months 

Breastfeeding at 12 Months 

72.9 

67.3 

81.4 79.0 

55.4 

74.1 

39.1 33.7 

47.5 42.0 

22.8 

41.1 

*Includes exclusive and supplemental breastfeeding.	 *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. 

Health Status - Infants 21 
Child Health USA 2007 

LOW BIRTH WEIGHT 

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. 

In 2005, 8.2 percent of infants were born at 

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

pounds 8 ounces); this represents a slight increase 

(1.2 percent) from the rate recorded in 2004. 

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 2005, the low birth weight rate was much 

higher among infants born to non-Hispanic 

Black women (14.0 percent) than among infants 

of other racial/ethnic groups. The next highest 

rate, which occurred among infants born to 

Asian/Pacific Islanders, was 8.0 percent, followed 

by a rate of 7.4 percent among American 

Indian/Alaska Natives. Low birth weight 

occurred among 7.3 percent of infants born to 

non-Hispanic White women, while infants of 

Hispanic women experienced the lowest rate 

(6.9 percent). Infants born to mothers of all races 

and ethnicities, except for American Indian/ 

Alaska Native, saw an increase in low birth 

weight from 2004. 

Low Birth Weight Among Infants, by Race/Ethnicity: 1989–2005 

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

Statistics System 

14 Non-Hispanic Black 

13 

12 

11 

Asian/Pacific Islander 10

of Inf

8 

9

Percent ants 

All Races Non-Hispanic White 

Hispanic American Indian/

Alaska Native 

7 

6 

14.0 

8.2 

8.0 

7.4 

7.3 

6.9 

1989 1991 1993 1995 1997 1999 2001 2003 2005 

22 Health Status - Infants 
Child Health USA 2007 

VERY LOW BIRTH WEIGHT 

In 2005, 1.5 percent of live births were infants 

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

or 3 pounds 4 ounces). The proportion of very 

low birth weight infants has slowly climbed from 

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. 

Non-Hispanic Black newborns are more than 

two and a half times more likely than other racial 

and ethnic groups to be born at a very low birth 

weight. Among non-Hispanic Black infants, 3.3 

percent are born at a very low birth weight, compared to 1.2 percent of non-Hispanic Whites, 

Hispanics, and American Indian/Alaska Natives, 

and Asian/Pacific Islanders. This difference is a 

major contributor to the disparity in infant mortality rates between non-Hispanic Black infants 

and infants of other racial and ethnic groups. 

Very Low Birth Weight Among Infants, by Race/Ethnicity: 1989–2005 

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

Statistics System 

3.3 

1.2 

Non-Hispanic White 1.5

Non-Hispanic Black 

Hispanic 

Asian/Pacific Islander 

Percent of Infants

American Indian/

Alaska Native 

1.0 

1.5 

2.0 

2.5 

3.0 

3.5 

1989 1993 1997 2001 2005

All Races 

Health Status - Infants 23 
4 

5 

6 

7 

8 

9 

Child Health USA 2007 

NEONATAL AND 

POSTNEONATAL MORTALITY 

Neonatal. In 2005, 18,770 infants died before 

reaching 28 days of age, representing a neonatal 

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

Statistically, 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 2005, 9,670 infants between rates were highest among infants born to nonthe ages of 28 days and 1 year died, representing Hispanic Black women (9.4 and 4.9 per 1,000 

a postneonatal mortality rate of approximately live births, respectively). Both of these rates are 

2.3 deaths per 1,000 live births. This rate repre­ more than twice the respective rates of infants 

sents a 3 percent increase over the previous year. born to non-Hispanic White and Hispanic 

Postneonatal mortality is generally related to women. 

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

injuries. 

Neonatal and postneonatal mortality rates 

vary by maternal race and ethnicity; in 2005, 

Neonatal Mortality Rates, by Maternal Race/Ethnicity, 2005 Postneonatal Mortality Rates, by Maternal Race/Ethnicity, 2005 

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

Statistics, National Vital Statistics System Statistics, National Vital Statistics System 

10 10 

4.5 

3.7 

9.4 

3.9 

Total Non-Hispanic White Non-Hispanic Black Hispanic 

9 

8 

Deaths per 1,000 Live Births

7 

6 

5 

4 

3 

2 2

1 1 Deaths per 1,000 Live Births

2.3 2.0 

4.9 

1.9 

Total Non-Hispanic White Non-Hispanic Black Hispanic 

24 Health Status - Infants 

3 
MATERNAL MORTALITY 

The rate of maternal mortality in the United 

States has declined dramatically since 1950; 

however, the maternal mortality rate in 2005 

(15.1 per 100,000 live births) was nearly 70 percent higher than the rate reported in 2002 (8.9 

per 100,000). According to the National Center 

for Health Statistics, this increase may largely be 

due to changes in how pregnancy status is 

recorded on death certificates. 

In 2005, there were a total of 623 maternal 

deaths resulting from complications during pregnancy, childbirth, or up to 42 days postpartum. 

The maternal mortality rate among non-Hispanic Black women (39.2 per 100,000 live 

births) was more than 3 times the rate among 

non-Hispanic White women (11.7 per 100,000) 

and more than 4 times the rate of Hispanic 

women (9.6 per 100,000). 

Child Health USA 2007 

The risk of maternal death increases with age, 

regardless of race. In 2005, the maternal mortality rate among women aged 35 years and older 

(38.0 per 100,000 live births) was more than 3 

times the rate of women aged 20–24 years (10.7 

per 100,000) and more than 5 times that of 

women under 20 years of age (7.4 per 100,000). 

Maternal Mortality Rates, by Race/Ethnicity, 2005 Maternal Mortality Rates, by Age, 2005 

Source (II.3): Centers for Disease Control and Prevention, National Center for Health Source (II.2): Centers for Disease Control and Prevention, National Center for Health 

Statistics, National Vital Statistics System Statistics, National Vital Statistics System 

39.2 

Maternal Deaths per 100,000 Live Births

15.1 

11.7 

9.6 

Maternal Deaths per 100,000 Live Births

7.4 

10.7 11.8 12.8 

38.0 

5 

10 

15 

20 

25 

30 

35 

40 

5 

10 

15 

20 

25 

30 

35 

40 

Total Non-Hispanic White Non-Hispanic Black Hispanic Under 20 Years 20-24 Years 25-29 Years 30-34 Years 35 Years and Older 

Health Status - Infants 25 
Child Health USA 2007 

INFANT MORTALITY 

In 2005, 28,440 infants died before their first 

birthday, representing an infant mortality rate of 

6.9 deaths per 1,000 live births, a slight increase 

over the previous year (6.8 deaths per 1,000 live 

births). The leading cause of infant mortality was 

congenital malformations, deformations, and 

chromosomal abnormalities, which accounted 

for 19.5 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 

infants (5.7 and 5.8 per 1,000 live births, respectively). Although the trend in infant mortality 

rates among both non-Hispanic Blacks and nonHispanic 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 pregnant women 

and infants with the goal of improving pregnancy outcomes. 

Infant Mortality Rates,* by Maternal Race 

Source (II.2, 3): Centers for Disease Control and Preven 

Statistics System 

20
 

18
 

16
 

Non-Hispanic Wh 

All Races 

1985 1990 

include a rise in both preterm and multiple
 14 

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
 

Deaths per 1,000 Live Births

12 

10 

8 

6 

have contributed to a renewed decline during the 

1990s. 4 

In 2005, the mortality rate among non-His- 2 

panic Black infants was 14.3 deaths per 1,000 

live births. This is more than twice the rate 

among non-Hispanic White and Hispanic 

*Under 1 year of age. 

26 Health Status - Infants 
Child Health USA 2007 

INTERNATIONAL INFANT International Infant Mortality Rates, Selected Countries, 2004 

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

Although the infant mortality rate in the 

United States has declined significantly in recent 

decades, it was still ranked below that of many 

other industrialized nations in 2004 with a rate 

of 6.8 deaths per 1,000 live births. This represents a slight decline from the rate of 6.9 per 

1,000 in 2003 and considerably less than the rate 

of 26.0 per 1,000 reported in 1960. 

Differences in infant mortality rates among 

industrialized nations may reflect disparities in 

the health status of women before and during 

pregnancy, as well as the quality and accessibility 

of primary care for pregnant women and infants. 

However, some of these differences may be due, 

in part, to the international variation in the definition, reporting, and measurement of infant 

mortality. 

In 2004, the U.S. infant mortality rate was 

more than twice that of six other industrialized 

countries, including Singapore, Hong Kong, 

Japan, Sweden and Finland. Singapore had the 

lowest rate (2.0 per 1,000), followed by Hong 

Kong (2.5 per 1,000) and Japan (2.8 per 1,000). 

2.0

 2.5

 2.8

 3.1

 3.2

 3.3

 3.5

 3.7

 3.9

 4.0

 4.1

 4.1

 4.1

 4.1

 4.2

 4.3

 4.4

 4.5

 4.5

 4.7

 4.9

 4.9 

5.0

 5.3

 5.5

 5.7

 5.8

 6.6

 6.8

 6.8 

1 2 3 4 5 6 7 8 

United States 

Poland 

Hungary 

Cuba 

New Zealand 

Northern Ireland 

Canada 

England and Wales 

Scotland 

Ireland 

Australia 

Israel* 

Austria 

Denmark 

Belgium 

Switzerland 

Netherlands 

Italy 

Greece 

Germany 

Portugal 

France 

Czech Republic 

Spain 

Finland 

Norway 

Sweden 

Japan 

Hong Kong 

Singapore 

Deaths per 1,000 Live Births 

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

Health Status - Infants 27 
Health Status – Children
 
VACCINE-PREVENTABLE 

DISEASES 

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

past several decades. In 2005, there were no 

reported cases of diphtheria in the entire 

U.S. population, and no cases of tetanus or polio 

among children under 5 years of age. Only one 

case of rubella was reported among children 

under 5 years of age, the first to be reported in 

this age group since 2001. 

From 2004 to 2005, the number of reported 

cases of measles, mumps, and hepatitis A and B 

decreased among children under 5 years of age. 

Rates of hepatitis B infection have declined 

98 percent among children under 13 years of 

age since 1990, 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. The overall incidence of Hepatitis A has 

also dropped dramatically since routine vaccinaChild Health USA 2007 

tion for children living in high-risk areas was rec- of age who were too young to have received the 

ommended starting in 1996. first three doses of acellular pertussis vaccine. 

While the number of reported cases of several This age group accounted for 13 percent of all 

vaccine-preventable diseases decreased from reported pertussis cases in 2005. 

2004 to 2005, the number of reported cases of 

H. Influenzae, rubella, and pertussis, increased 

over the same period. In 2005, the incidence of 

reported pertussis among the entire U.S. population (8.7 per 100,000 people) increased just 

slightly after doubling from 2003 to 2004. This 

rate was highest among children under 6 months 

Reported Cases of Selected Vaccine-Preventable Diseases Among Children Under 

Age 5, 2005 

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

Number of Reported Cases 

0 

0 

0 

1 

5 

10 

21 

208 

358 

6,394 

200 400 600 800 1,000 6,000 6,200 6,400 6,600 6,800 7,000 

Pertussis 

H. Influenzae 

Hepatitis A 

Mumps 

Measles 

Hepatitis B 

Rubella 

Tetanus 

Polio 

Diphtheria 

Health Status - Children 31 
Child Health USA 2007 

PEDIATRIC AIDS 

Acquired immunodeficiency syndrome 

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

cells that are responsible for fighting infection. 

AIDS is diagnosed when HIV has weakened the 

immune system enough that the body has a difficult time fighting infections. Through 2005, an 

estimated 9,068 AIDS cases in children younger 

than 13 had ever been reported in the United 

States. Pediatric AIDS cases represent less than 

one percent of all AIDS cases ever reported. 

In 2005, an estimated 68 new AIDS cases were 

diagnosed among children under age 13, nearly 

all of which were attributed to transmission from 

the mother before or during birth (perinatal 

transmission), excluding one case in which the 

risk factor was not specified. The number of new 

cases of pediatric AIDS has declined substantially 

since 1992, when an estimated 894 new cases 

were reported. A major factor in this decline is 

the increasing use of antiretroviral therapy 

before, during, and after pregnancy to reduce 

perinatal transmission of HIV. In addition, the 

Centers for Disease Control and Prevention 

released new and updated materials in 2004 to 

further promote universal prenatal HIV testing. 

It is expected that the perinatal transmission rate 

will continue to decline with increased use of 

treatments and obstetric procedures. 

Racial and ethnic minorities are disproportionately represented among pediatric AIDS 

cases. Non-Hispanic Black children account for 

nearly 62 percent of all pediatric AIDS cases, but 

compose approximately 15 percent of the total 

U.S. population under age 13. 

Estimated Numbers of AIDS Cases in Children Under Age 13, 

by Year of Diagnosis: 1992–2005 

Source (II.6): Centers for Disease Control and Prevention, HIV/AIDS Surveillance System 

1,000 

894 879 

799 800 

663 

600 509 

400 329 

241 

187 200 129 121 105 71 68 50 

Number of Cases 

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

Estimated Numbers of AIDS Cases Ever Reported in Children 

Under Age 13, by Race/Ethnicity: Through 2005* 

Source (II.6): Centers for Disease Control and Prevention, HIV/AIDS Surveillance System 

Non-Hispanic White 

Non-Hispanic Black 

Hispanic 

Asian/Pacific Islander 

American Indian/ 

Alaska Native 

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

Number of Cases 

1,613 

1,738 

54 

5,631 

32 

*Includes children with a diagnosis of AIDS, from the beginning of the epidemic through 2005, but does not 

include 33 children of unknown or multiple races. 

32 Health Status - Children 
Child Health USA 2007 

HOSPITALIZATION 

In 2005, there were 3.5 million hospital discharges among youth aged 1–21 years, or 4.1 

hospital discharges per 100 children. This represents little change from 2004. 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 and adolescents older than 1 

year, this category accounted for only 9 percent 

of the hospital discharges of children aged 1–14 

years in 2005. Diseases of the respiratory system 

were the major cause of hospitalization for children 1–9 years of age, accounting for 31 percent 

of discharges. Pregnancy and childbirth 

accounted for 65 percent of hospital discharges 

of young women aged 15–21 years. Mental disorders were the leading cause of hospitalization 

among youth aged 10–14 years and the second 

leading cause among 15- to 19- and 20- to 21­

year-olds. 

Major Causes of Hospitalization, by Age, 2005 

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

Discharge Survey 1–4 Years 

Diseases of the Respiratory System
 

Endocrine, Metabolic, and Immunity*
 

Injury
 

Infectious and Parasitic Diseases
 

Diseases of the Digestive System
 

5–9 Years 

Diseases of the Respiratory System 

Diseases of the Digestive System 

Injury 

Endocrine, Metabolic, and Immunity* 

Diseases of the Genitourinary System 

Infectious and Parasitic Diseases 

10–14 Years 

Mental Disorders
 

Diseases of the Digestive System
 

Injury
 

Diseases of the Respiratory System
 

Endocrine, Metabolic, and Immunity*
 

15–19 Years 

Pregnancy/Childbirth
 

Mental Disorders
 

Injury
 

Diseases of the Digestive System
 

Diseases of the Respiratory System
 

20–21 Years 

Pregnancy/Childbirth
 

Mental Disorders
 

Injury
 

Diseases of the Digestive System
 

Diseases of the Respiratory System
 

258 

86 

50 

47 

44 

90 

52 

44 

37 

21 

22 

104 

77 

50 

46 

33 

87 

82 

44 

211 

23 

37 

33 

65 

470 

439 

50 100 150 200 250 300 350 400 450 500 

Number of Discharges (In Thousands) 

*Includes endocrine diseases, nutritional diseases, metabolic diseases, and immunity disorders. 

Health Status - Children 33 
Child Health USA 2007 

HOSPITAL DISCHARGE 

TRENDS 

Three types of health problems (respiratory 

diseases, digestive diseases, and injury) accounted 

for 44 percent of hospital discharges among children aged 1–14 years in 2005. Since 1985, overall hospital discharge rates for children in this age 

group declined by 37 percent, which is reflected 

in decreases in discharge rates for each of those 

three categories. 

Between 1990 and 2005, hospital discharge 

rates for diseases of the respiratory system 

declined 23.1 percent for children aged 1–14 

years; from 91 hospital discharges per 10,000 

children in 1990 to a new low of 70 per 10,000 

children in 2005. During this period, the rate of 

discharges due to injury also declined, from 38 to 

26 per 10,000 children, or 31.6 percent. Similarly, the hospital discharge rate among children 

for diseases of the digestive system dropped 16.2 

percent. 

34 Health Status - Children 

Discharge Rates Among Children Aged 1–14, by Selected Diagnoses: 1990–2005 

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

Hospital Discharge Survey 

100 

Diseases of the Respiratory System 90 


80 


70 
 70.0 

60 


50 


Injury Diseases of the Digestive System 40 


30 
 31.0 

26.0 

20 


10 


Hospital Discharges per 10,000 Children 

1990 1993 1996 1999 2002 2005 
CHILD ABUSE AND NEGLECT 

State child protective services (CPS) agencies 

received approximately 3.3 million referrals, 

involving an estimated 6 million children, alleging abuse or neglect in 2005. More than half of 

these reports were made by community professionals, such as teachers, other educational personnel, police officers, medical personnel, and 

daycare providers. 

Investigations determined that an estimated 

899,000 children were victims of abuse or neglect in 2005;1 this is equivalent to a rate of about 

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

Neglect was the most common type of maltreatment (7.6 per 1,000 children), followed by physical abuse (2.0 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 2005, the rate of victimization 

among children from birth to age 3 was 16.5 per 

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

steadily as age increased (data not shown). 

A majority of the perpetrators of abuse and 

neglect, almost 80 percent, were parents. Remaining types of perpetrators included other relatives 

Child Health USA 2007 

(6.8 percent), unmarried partners of parents (3.8 

percent), and professionals such as daycare workers and residential facility staff (0.9 percent). Foster parents accounted for 0.5 percent of perpetrators, while friends and neighbors accounted for 

0.6 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. 

1	 The increase of approximately 20,000 victims since 2004 is likely 

due to the inclusion of Puerto Rico and Alaska in 2005. 

Child Abuse and Neglect Among Children Under Age 18, 

by Type of Maltreatment, 2005 

Source (II.8): Administration on Children, Youth, and Families, National Child Abuse 

and Neglect Data System 

Neglect 

Physical Abuse 

Sexual Abuse 

Psychological 

Maltreatment 

Medical Neglect 

Other Abuse 

Unknown 

Rate per 1,000 Children 

2 4 6 8 

7.6 

1.1 

0.9 

0.2 

2.0 

1.7 

0.1 

Perpetrators of Child Abuse and Neglect, by Relationship 

to Victim, 2005* 

Source (II.8): Administration on Children, Youth, and Families, National Child Abuse 

and Neglect Data System 

Other 5.5% 

Unknown/Missing 3.7% 

Professionals*** 0.9%
 

Unmarried Partner
 

of Parent**
 

3.8%
 

Other Relative 

6.8% 

Parent 

79.4% 

*Based on 42 States reporting. **Defined as someone who has a relationship with the parent and lives in the 

household with the parent and maltreated child. ***Includes residential facility staff, child daycare providers, 

and other professionals. 

Health Status - Children 35 
Child Health USA 2007 

CHILD MORTALITY 

In 2005, 11,358 children between the ages of 

1 and 14 years died of various causes; this was 

261 fewer than in the previous year. The overall 

mortality rate among 1- to 4-year-olds was 29.4 

per 100,000, and the rate among 5- to 14-yearolds was 16.3 per 100,000. The leading cause of 

death among children in the younger age group 

continues to be unintentional injury, which 

accounted for 35.0 percent of all deaths in this 

age group in 2005. The next most common 

cause of death was congenital malformations 

(birth defects), followed by malignant neoplasms 

(cancer), homicide, and diseases of the heart. 

Unintentional injury was also the leading 

cause of death among older children, accounting 

for 36.6 percent of deaths among 5- to 14-yearolds. This was followed by malignant neoplasms, 

congenital malformations, homicide, suicide, 

and diseases of the heart. 

Leading Causes of Death Among Children Aged 1–14, 2005 

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

Statistics System 

1–4 Years 

Unintentional Injury 

Congenital Malformations 

Malignant Neoplasms 

Homicide 

Diseases of the Heart 

Influenza and Pneumonia 

Septicemia 

5–14 Years 

Unintentional Injury 

Malignant Neoplasms 

Congenital Malformations 

Homicide 

Suicide 

Diseases of the Heart 

Influenza and Pneumonia 

10.3 

3.2 

2.3 

2.3 

0.9 

1 2 3 4 5 6 7 8 9 10 11 

0.5 

0.7 

6.0 

2.5 

1.0 

0.8 

0.7 

0.3 

0.6 

Death Rate per 100,000 Population in Specified Age Group 

36 Health Status - Children 
Child Health USA 2007 

CHILD MORTALITY DUE 

TO INJURY 

In 2005, unintentional injuries caused the 

deaths of 1,664 children aged 1–4 years and 

2,415 children aged 5–14 years. In 2005, motor 

vehicle crashes, followed by drowning, fires and 

burns were the most common causes of unintentional injury death among children aged 1–4 and 

5–14 years. Unintentional injuries due to motor 

vehicle crashes caused 3.2 and 3.3 deaths per 

100,000 children aged 1–4 and 5–14 years, 

respectively. 

In addition, 375 children aged 1–4 years were 

the victims of homicide in 2005 and 613 children 

aged 5–14 years were the victims of homicide or 

suicide (data not shown). 

Deaths Due to Unintentional Injury Among Children Aged 1–14, 2005 

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

Statistics System 

1–4 Years 

5–14 Years 

3.0 

3.2 

0.9 

3.3 

0.7 

0.6 

1.5 

0.1 

Fires and Burns 

Suffocation 

Drowning 

Motor Vehicle Crashes 

Suffocation 

Fires and Burns 

Drowning 

Motor Vehicle Crashes 

0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 

Death Rate per 100,000 Population 

Health Status - Children 37 
Health Status – Adolescents
 
80 

100 

120 

Child Health USA 2007 

ADOLESCENT 

CHILDBEARING 

The birth rate among adolescents aged 15–19 

years decreased to 40.5 births per 1,000 females 

in 2005. This is 1.5 percent below the rate in the 

previous year and represents a 34 percent 

decrease since the most recent peak in 1991. The 

birth rate among adolescents aged 10–14 years 

remained static at 0.7 per 1,000; however, this 

rate is 50 percent lower than the 1991 rate. 

Teenage birth rates were highest among older 

adolescents, aged 18–19 years, at 69.9 per 1,000. 

Among younger adolescents aged 10–14 years, 

birth rates remained the same from 2004 among 

all races and ethnicities except non-Hispanic 

Black females who saw a 6 percent increase. 

Non-Hispanic Black females in this age group 

also had the highest birth rate (1.7 per 1,000) 

followed by Hispanic and American Indian/ 

Alaska Native females (1.3 and 0.9 per 1,000, 

respectively). The lowest birth rates were found 

among Asian/Pacific Islanders and non-Hispanic 

Whites (0.2 per 1,000 for both groups). 

Teenage birth rates have historically varied 

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

had the lowest birth rate in 2005 (17.0 per 1,000), 

followed by non-Hispanic Whites (25.9 per 

1,000). Although non-Hispanic Black teens had 

one of the highest birth rates for this age group 

(60.9 per 1,000), they have also experienced the 

largest percentage decrease since 1991 (48 percent). Comparatively, Hispanic females had the 

highest birth rate among teens aged 15–19 years 

(81.7 per 1,000), but had the lowest percentage 

decrease since 1991 (22 percent). The birth rate 

for American Indian/Alaska Native females aged 

15–19 years was 52.7 per 1,000. 

Birth Rates Among Adolescent Females, by Maternal Age Birth Rates Among Females Aged 15–19, by Maternal 

and Race/Ethnicity, 2005 Race/Ethnicity: 1990–2005 

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

Statistics, National Vital Statistics System Statistics, National Vital Statistics System 

140 140 

120 

100 

80 

10–14 Years 

15–17 Years 

18–19 Years 

21.4 

69.9 

0.7 

11.5 

48.0 

0.2 

34.9 

103.0 

1.3 

48.5 

134.6 

1.7 

8.2 

30.1 

0.2 

30.5 

87.6 

0.9 

Live Births per 1,000 Females 

American Indian/

Alaska Native

Asian/

Pacific Islander

Non-Hispanic Hispanic

Black

Non-Hispanic

White 

Total 

Non-Hispanic Black 

Non-Hispanic White 

Hispanic 

American Indian/Alaska Native 

Asian/Pacific Islander

Live Births per 1,000 Females

60 

40 

20 

1990 1995 2000 2005 

40 Health Status - Adolescents 

25.9 

60.9 

81.7 

17.0 

52.7 

20 

40 

60 
SEXUAL ACTIVITY 

In 2005, 46.8 percent of high school students 

reported ever having had sexual intercourse, representing a slight increase since 2003, while 53.2 

percent of students were abstinent (had never 

had intercourse). Nearly 13 percent of students 

were not currently sexually active (had not had 

intercourse in the past 3 months), while 12.6 

percent of students were currently sexually active 

but did not use a condom during their last intercourse. Another 21.3 percent of students were 

currently sexually active and reported using a 

condom during their last sexual encounter. 

Sexual activity and condom use varied by race 

and ethnicity in 2005. Non-Hispanic Black students were most likely to report ever having sexual intercourse (67.6 percent), and 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; data not shown). 

In 2005, sexual activity increased with grade 

level, while condom use decreased. Among 12th 

grade students, 49.4 percent reported being curChild Health USA 2007 

rently sexually active: 27.4 percent used a condom during their last intercourse, while 22.0 

percent did not. In other words, 55.5 percent of 

sexually active 12th graders used a condom during their last sexual encounter. In contrast, 21.9 

percent of 9th graders were sexually active, 74.4 

percent of whom used a condom during their last 

sexual encounter: 5.6 percent of 9th graders were 

sexually active and not using a condom, while 

16.3 percent were sexually active and used a condom during their last sexual encounter. 

Sexual Activity Among High School Students, 2005 Condom Use Among Sexually Active High School Students, 

Source (II.9): Centers for Disease Control and Prevention, Youth Risk Behavior Survey by Grade, 2005 

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

Abstinent* 

53.2% 

50 

Intercourse in Past 

3 Months, No Condom at 

Last Intercourse 40 12.6% 

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 

Percent of Students

30 Intercourse in Past 

3 Months, Used 

Condom at Last 

Intercourse 20 21.3% 

10 

No Intercourse 

in Past 3 Months 12.9% 

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

Health Status - Adolescents 41 

49.4 
Child Health USA 2007 

SEXUALLY TRANSMITTED 

INFECTIONS 

Overall, adolescents (aged 15–19 years) and 

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

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

as chlamydia, gonorrhea and genital human 

papillomavirus (HPV). Within each of these age 

groups, reported rates of chlamydia and gonorrhea infections were highest among non-Hispanic Black youth. 

Chlamydia continues to be the most common 

STI among adolescents and young adults, with 

rates of 1,621 and 1,719 cases per 100,000, 

respectively, in 2005. Rates were highest among 

non-Hispanic Blacks aged 15–19 and 20–24 

(5,503 and 5,360 per 100,000, respectively), followed by American Indian/Alaska Natives 

(2,675 and 2,980 per 100,000, respectively). 

Rates of gonorrhea were 438 and 507 per 

100,000 adolescents and young adults, respectively, and were also higher among non-Hispanic 

Blacks and American Indian/Alaska Natives. 

HPV is the most common STI in the United 

States. A recent study indicated that 24.5 percent 

of females aged 14–19 and 44.8 percent aged 

20–24 had an HPV infection in 2003–2004.1 

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 certain 

types of HPV was approved in 2006 by the Food 

and Drug Administration (FDA) for use in 

females aged 9–26 years.2 

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

Patel SS, Markowitz LE. Prevalence of HPV infection among 

females in the United States. JAMA. 2007 Feb;297(8):876-8. 

2	 Centers for Disease Control and Prevention, Division of STD 

Prevention. HPV and HPV vaccines: information for healthcare 

providers. June 2006. Available from: http://www.cdc.gov/std/hpv 

/STDFact-HPV-vaccine-hcp.htm, viewed 5/31/07. 

Reported Rates of Sexually Transmitted Infections Among Adolescents and Young Adults, by Age and Race/Ethnicity, 2005 

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

5,502.6 5,500 Total 

Non-Hispanic

White 

Non-Hispanic

Black 

Hispanic 

American Indian/

Alaska Native 

1,621.0 

769.6 

2,675.3 

1,674.9 

942.7 

2,979.8 

1,719.4 1,839.7 

5,360.0 5,500 

506.8 

161.0 

475.8 259.4 

2,452.9 

438.2 120.0 369.0 219.6 

2,106.3 

Total 

Non-Hispanic White 

Non-Hispanic Black 

Hispanic 

American Indian/

Alaska Native

Rate per 100,000 Females

4,400 

3,300 

2,200 

Rate per 100,000 Females

4,400 

3,300 

2,200 

1,100 1,100 

15–19 Years 20–24 Years	 15–19 Years 20–24 Years 

Chlamydia	 Gonorrhea 

42 Health Status - Adolescents 
ADOLESCENT AND YOUNG 

ADULT HIV/AIDS 

Acquired immunodeficiency syndrome 

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

cells that are responsible for fighting infection. 

AIDS is diagnosed when HIV has weakened the 

immune system enough that the body has a difficult time fighting infections. In 2005, there 

were an estimated 19,134 people aged 13–24 

years living with HIV/AIDS,1 representing 4.0 

percent of all cases. 

An estimated 5,132 people aged 13–24 years 

were diagnosed with HIV/AIDS in 2005, representing 13.7 percent of all new cases. While the 

13- to 14- and 15- to 19-year-old age groups 

accounted for only 43 and 1,213 new 

HIV/AIDS cases, respectively, this represents an 

increase since 2004 of 30 percent among adolescents aged 13–14 years and 16.6 percent among 

those aged 15–19. Comparatively, the age group 

with the next highest percentage increase was 50­

to 54-year-olds (11.6 percent). 

The number of AIDS cases diagnosed among 

people aged 13–24 years was 2,369 in 2005, and 

41,146 since the epidemic began in the early 

1980s (data not shown). Among people who 

died with AIDS in 2005, 1.3 percent (213 perChild Health USA 2007 

sons) were adolescents and young adults. Since 

the beginning of the epidemic, 9,887 people in 

this age group have died with the disease. While 

the estimated number of people diagnosed with 

HIV/AIDS increased 6.6 percent in 2005, the 

number of deaths of people with the disease has 

decreased in recent years due, in part, to the 

availability of effective prescription drugs to 

combat the disease. Part D of HRSA’s Ryan 

White HIV/AIDS Program provides family-centered, comprehensive care to children, youth and 

women with HIV/AIDS and their families. 

1	 Includes persons with a diagnosis of HIV infection only, a diagnosis 

of HIV infection and a later AIDS diagnosis, and concurrent 

diagnoses of HIV infection and AIDS in 33 states and dependent 

areas with confidential name-based reporting. 

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

with AIDS, by Age, 2005 

Source (II.6): Centers for Disease Control and Prevention, HIV/AIDS Surveillance System 

Diagnosed with HIV/AIDS 

Living with HIV/AIDS 

Dying with AIDS 

4,101 

13,824 

1,209 

1,213 

3,876 

43 13–14 Years 

15–19 Years 

157 

42 

14 

20–24 Years 

1,000 2,000 3,000 4,000 12,000 13,000 14,000 15,000 

Number of Persons 

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

infection and AIDS in 33 States and dependent areas with confidential name-based reporting. 

Health Status - Adolescents 43 
PHYSICAL ACTIVITY 

Results from the 2005 Youth Risk Behavior 

Surveillance System 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. 

Child Health USA 2007 

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 also 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. More 

than 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. 

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

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

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

Percent of Students 

Total 

Non-Hispanic White 

Non-Hispanic Black 

Hispanic 

35.8 32.9 29.5 

38.7 

68.7 69.4 

62.0 

70.2 

9.6 10.6 14.4 

8.1 

Met Currently Recommended Levels Met Previously Recommended Levels No Vigorous or Moderate 

of Physical Activity* of Physical Activity** Physical Activity 

*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. 


Health Status - Adolescents 45 
15 

20 

25 

Child Health USA 2007 

MENTAL HEALTH 

TREATMENT 

In 2005, 21.8 percent of youth aged 12–17 

years, or 5.5 million youth, 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 proportion of youth receiving 

treatment in 2005 represents a 3.1 percent 

decrease from 2004. Overall, there was little difference by age group or race and ethnicity; however, females were more likely than males to 

receive treatment (24.1 versus 19.6 percent). 

Males and females aged 14–15 were more likely 

to receive treatment than youth of other ages. 

Youth with lower family incomes were more 

likely to receive treatment than those with higher 

family incomes. For instance, nearly 25 percent 

of youth with family incomes of less than 

$20,000 received mental health treatment, compared to 19.9 percent of those with family 

incomes of $75,000 or more. 

Among youth who received mental health 

treatment or counseling in 2005, 28.9 percent 

also used illicit drugs in the past year. Illicit drug 

use among those receiving treatment increased 

with age. Just over 16 percent of 12- to 13-yearolds receiving treatment used illicit drugs in the 

past year, compared to 25.4 percent of those aged 

14–15 and 46.2 percent of 16- to 17-year-olds. 

Females receiving mental health treatment were 

more likely than males to report illicit drug use 

in the past year (31.4 versus 25.8 percent; data 

not shown). 

Mental Health Treatment/Counseling* in the Past Year Among Mental Health Treatment/Counseling* in the Past Year Among 

Youth Aged 12–17, by Age and Sex, 2005 Youth Aged 12–17, by Family Income, 2005 

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

Survey on Drug Use and Health Survey on Drug Use and Health 

30 30 

19.9 

21.8 22.4 20.8 

24.9 

Total Less Than $20,000 $20,000–49,999 $50,000–74,999 $75,000 or More 

25 

20 

15 

Percent of Youth 

10 

Total 12–13 Years 14–15 Years 16–17 Years 

Percent of Youth 

20.7 

24.1 

21.5 

26.9 

21.7 

23.7 

16.4 

19.6 

Female 

Male 

5 5

*Having received treatment or counseling from any of 10 specific sources for emotional or behavioral *Having received treatment or counseling from any of 10 specific sources for emotional or behavioral

problems not caused by drug or alcohol use. problems not caused by drug or alcohol use. 

46 Health Status - Adolescents 

10 
Child Health USA 2007 

Depression was the leading reason reported for 

mental health treatment among 12- to 17-yearolds (44.2 percent). Other common reasons for 

treatment included breaking rules or “acting out” 

(24.8 percent), problems at home or with family 

members (23.5 percent), and problems at school 

(22.6 percent). (Survey respondents were able to 

report more than one reason for seeking treatment.) 

The most common source of mental health 

treatment among youth receiving treatment was 

at school with a counselor, psychologist, or in 

regular meetings with a teacher (47.3 percent). 

The second most common source reported was 

with a therapist or psychologist (46.9 percent). 

Use of a partial day hospital or treatment program was reported by 7.9 percent of youth 

receiving treatment, and an overnight or longer 

stay in a residential treatment center was 

reported by 9.5 percent (data not shown). (Youth 

receiving treatment could indicate any number 

of 10 possible sources of care.) 

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

Aged 12–17 Who Received Treatment, 2005 

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

Felt Depressed 

Breaking Rules or Acting Out 

Family/Home Problems 

Problems at School 

Suicidal Thoughts or Attempts 

Felt Very Afraid or Tense 

Problems with Friends 

Trouble Controlling Anger 

Eating Problems 

Diagnosed Mental Disorder 

Other Reasons 

Percent of Youth Receiving Treatment 

44.2 

28.8 

1.9 

7.8 

13.2 

15.0 

16.6 

17.0 

22.6 

23.5 

24.8 

10 20 30 40 50 

*Among those having received treatment or counseling from any of 10 specific sources for emotional or behavioral problems not caused by drug 

or alcohol use. Respondents could indicate more than one reason for treatment. 

Health Status - Adolescents 47 
Child Health USA 2007 

CIGARETTE SMOKING 

Between 2005 and 2006, cigarette smoking 

declined slightly among 8th-, 10th- and 12thgraders, according to the annual Monitoring the 

Future Study. The largest decrease in the percentage of students who had smoked at least 

once in the previous 30 days occurred among 

12th-graders, from 23.2 percent in 2005 to 21.6 

percent in 2006. Only 8.7 percent of 8th-graders 

and 14.5 percent of 10th-graders reported pastmonth cigarette use in 2006, compared to 9.3 

and 14.9 percent, respectively, the year before. 

Since past-month use peaked among 8th and 

10th-graders in 1996, both groups have seen a 

substantial decline (58.6 and 52.3 percent, 

respectively). Among 12th-graders, the most 

recent peak occurred in 1997 (39 percent) but 

has seen a somewhat more modest decline of 

40.8 percent. Factors that appear to have contributed to the decline include increases in perceived risk and personal disapproval of smoking, 

higher cigarette prices, and anti-smoking advertising campaigns. 

The teen smoking rate increased substantially 

between 1991 and 1996. Increases occurred in 

virtually every sociodemographic group: male 

and female; those planning on attending college 

and not; those living in all four regions of the 

country; those living in rural and urban areas; 

and those of different races and ethnicities. 

Since 1996, cigarette smoking among adolescents has declined across all demographic groups 

consistently, which is likely to have important 

long-term health consequences for this generation of adolescents. Despite this decline, certain Percent of Students

subgroups were still more likely than others to 

smoke. Students who did not intend to graduate 

from a 4-year college program were more likely 

to smoke than those who did have a 4-year college plan (23.2 versus 7.1 percent). White adolescents were most likely to smoke cigarettes (9.3 

percent), followed by Hispanic (8.8 percent) and 

Black adolescents (6.0 percent). 

Any Cigarette Use Among Students in the Past 30 Days, by Grade: 1975–2006 

Source (II.12): University of Michigan, Monitoring the Future Study 

40 

35 

30 

25 

21.6 

20 

15 14.5

10 8.7 

12th Grade 

8th Grade 

10th Grade 

1975 1980 1985 1990 1995 2000 2006 

48 Health Status - Adolescents 
SUBSTANCE ABUSE 

Prevalence. In 2005, 9.9 percent of adolescents 

aged 12–17 years reported using illicit drugs in 

the past month; however, this varied with age. 

Among youth aged 12–13 years, 3.8 percent 

reported drug use in the past month, compared 

to 8.9 percent of those aged 14–15 years and 

17.0 percent of those aged 16–17 years. Illicit 

drug use did not vary widely between Hispanic, 

non-Hispanic White, and non-Hispanic Black 

adolescents (ranging from 9.4 to 11.0 percent); 

however, more than 19 percent of American 

Indian/Alaska Native adolescents and only 3.3 

percent of Asians reported past-month use (data 

not shown). 

In 2005, marijuana was the most commonly 

used illicit drug (6.8 percent), followed by the 

non-medical use of psychotherapeutic drugs, 

such as pain relievers, tranquilizers, and stimulants (3.3 percent). Males aged 12–17 years were 

slightly more likely to use marijuana than 

females (7.5 versus 6.2 percent). 

Alcohol was the most commonly used drug 

among adolescents, with 16.5 percent reporting 

past-month use in 2005. Alcohol use was more 

common among female adolescents than males 

(17.2 versus 15.9 percent). Illicit drug use among 

adolescents who smoked cigarettes in the past 

month (46.7 percent) or were heavy drinkers1 

(59.9 percent) was much higher than among 

adolescents who didn’t smoke (5.5 percent) or 

drink (5.0 percent). Among those adolescents 

who both smoked cigarettes and drank heavily in 

the past month, 70.9 percent also used an illicit 

drug. 

Perception of Risk and Access to Drugs. In 2005, 

34.0 percent of adolescents perceived smoking 

marijuana once a month to be a great risk, while 

48.8 percent perceived the same risk regarding 

cocaine use. Smoking one or more packs of cigarettes a day was considered a great risk by 68.3 

Child Health USA 2007 

percent of adolescents, which represents a significant increase since 2002 (63.1 percent). Drinking five or more drinks on one or two occasions 

per week was considered to be a great risk by 

38.4 percent of adolescents. 

While only 15.5 percent of adolescents 

reported being approached by someone selling 

drugs in the past month, 51.0 percent reported 

that marijuana would be fairly or very easy to 

obtain. The same was reported by 24.9 percent 

of teens regarding cocaine, 15.7 percent for LSD, 

and 14.0 percent for heroin. 

1	 Heavy drinking is defined as consuming 5 or more drinks on the 

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

Past Month Drug Use Among Adolescents Aged 12–17, 2005 

Source (II.13): Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health 

4 

8 

12 

16 

20 

Percent of Youth

9.9 

16.5 

6.8 

1.2 

3.3 

0.8 

Alcohol Any Illicit Drug* Marijuana/ Non-medical Use Inhalants Hallucinogens**

Hashish of Psychotherapeutics** 

*Includes marijuana/hashish, cocaine, heroin, hallucinogens, inhalants, or prescription-type psychotherapeutic drugs used non-medically. 

**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. 

Health Status - Adolescents 49 
20 

25 

30 

35 

40 

Child Health USA 2007 

VIOLENCE 

Violence among adolescents is a critical public 

health issue in the United States. In 2005, homicide was the second leading cause of death among 

persons aged 15–24 years. 

Results from the 2005 Youth Risk Behavior 

Surveillance System 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, respectively), and nonHispanic Black females were more likely than 

non-Hispanic White and Hispanic females (9.4 

versus 6.0 and 7.8 percent, respectively). 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. Nearly 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 Who Carried a Weapon in the Past High School Students Threatened or Injured with a Weapon 

30 Days, by Sex and Race/Ethnicity: 1993–2005 on School Property in the Past Year, by Race/Ethnicity: 1993–2005 

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

Hispanic Male 

Hispanic Female 

Non-Hispanic White Male 

Non-Hispanic White Female 

Non-Hispanic Black Female 

Non-Hispanic Black Male 

40 

15 

Non-Hispanic White Hispanic Non-Hispanic Black

35 

31.4 

29.8 30 

Percent of Students

23.7 

Percent of Students

25 

20 

9.4 10 8.1 7.8 

6.0 7.2 5 

1993 1995 1997 1999 2001 2003 2005 1993 1995 1997 1999 2001 2003 2005 

50 Health Status - Adolescents 

5 

10 

15 

9.8 
ADOLESCENT MORTALITY 

In 2005, 13,703 deaths were reported among 

adolescents aged 15–19 years. After a moderate 

increase for this age group in the early 1980s, 

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

death among this age group and accounted for 

48.3 percent of all deaths among adolescents in 

2005. This is equivalent to a rate of 31.4 deaths 

per 100,000 adolescents, a 5 percent decrease 

from 2004. Homicide and suicide were the next 

leading causes of death, accounting for 15.2 and 

11.8 percent, respectively, of all deaths within 

this age group. After a 12 percent increase in the 

adolescent suicide rate between 2003 and 2004, 

the rate declined about 8.5 percent to 7.7 suicides per 100,000 adolescents in 2005. 

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 2005, 

and accounted for 46 percent of injury-related 

deaths among adolescents. Alcohol is a significant contributor to these deaths: recent data sugChild Health USA 2007 

gest that nearly one-third of adolescent drivers 

killed in crashes had been drinking. Firearms 

were the next leading cause of fatal injury, 

accounting for 25 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 12.3 per 100,000 population in 2005, about half the rate of motor vehicle injury deaths (23.0 per 100,000). 

Leading Causes of Death Among Adolescents Aged 15–19, 2005 Deaths Due to Injury Among Adolescents Aged 15–19, 2005 

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

Statistics, National Vital Statistics System Statistics, National Vital Statistics System 

Unintentional Injury 

Homicide 

Suicide 

Malignant 

Neoplasms (Cancer) 

Diseases of the Heart 

31.4 

9.9 

7.7 

3.5 

1.8 

Motor Vehicle Traffic 

Firearms 

Poisoning 

Drowning 

23.0 

12.3 

4.0 

1.6 

5 10 15 20 25 30 35 5 10 15 20 25 

Death Rate per 100,000 Population Death Rate per 100,000 Population 

Health Status - Adolescents 51 
Child Health USA 2007 

ADOLESCENT MORTALITY 

FROM TRAFFIC AND 

FIREARM INJURIES 

The two leading mechanisms of injury death 

among adolescents are motor vehicle crashes and 

firearms. In 2005, the latest year for which data 

are available, motor vehicle traffic caused the 

deaths of 4,829 adolescents 15–19 years of age. 

The vast majority of those killed were in motor 

vehicle crashes 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 Surveillance System 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.1 

In 2005, 2,623 adolescents aged 15–19 years 

were killed by firearms, a rate of 12.4 per 

100,000 adolescents. Of these, homicide 

accounted for 66 percent of firearm deaths, suicide accounted for 28 percent, and 4 percent 

were considered unintentional. The 2005 Youth 

Risk Behavior Surveillance System indicated that 

5.4 percent of high school students carried a gun 

on one or more days during the past month, a 

behavior that could contribute to firearm 

mortalities.1 

1	 Centers for Disease Control and Prevention. Youth risk behavior 

surveillance: United States, 2005. MMWR, Vol. 55, No. SS-5; 

2006. 

Adolescent Mortality from Traffic Injuries and Firearm Injuries, 2005 

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

National Vital Statistics System 

Traffic Mortality by Person Injured 

Motor Vehicle Occupant
 

Pedestrian
 

Motorcyclist
 

Pedal Cyclist
 

Firearms Mortality by Intent 

Homicide
 

Suicide
 

Unintentional
 

Unknown
 

12.2 

1.2 

0.2 

8.3 

3.5 

0.5 

1.2 

0.1 

3 6 9 12 15 

Death Rate per 100,000 Population 

52 Health Status - Adolescents 
Child Health USA 2007 

Health Services Financing and Utilization
 

The availability of and access to quality health care 

directly affects the health of the population. This is 

especially true of those at high risk due to low socioeconomic status or chronic medical conditions. 

Children may receive health coverage through a 

number of sources, including private insurance, 

either employer-based or purchased directly, and 

public programs, such as 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. 

Nearly every State has SCHIP programs that help 

expand coverage to children who would otherwise 

be uninsured. Despite the progress achieved 

through public programs, approximately 8.7 million 

children remain uninsured in the United States. 

This section presents data on the utilization of health 

services within the maternal and child population. 

Data are summarized by source of payment, type of 

care, and place of service delivery. 

Health Services Financing and Utilization 53 
50 

60 

70 

Child Health USA 2007 

HEALTH CARE FINANCING 

In 2006, 8.7 million children younger than 18 

years of age had no health insurance coverage; 

this represents 11.7 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 race and ethnicity and family income. Non-Hispanic White children were 

most likely to have private insurance coverage in 

2006 (76.9 percent), while fewer than half of 

non-Hispanic Black and Hispanic children had 

private coverage during the same period (49.4 

and 40.9 percent, respectively). Non-Hispanic 

Black children were most likely to have public 

coverage (43.5 percent); Hispanic children were 

the most likely to be uninsured (22.1 percent). 

As family income increases, private health 

insurance coverage among children rises, while 

the proportion of children with public coverage 

and no coverage decreases. In 2006, children 

with family incomes below 100 percent of 

poverty were the most likely to have public coverage (67.2 percent) or be uninsured (19.3 percent), and were least likely to have private coverage (19.5 percent). The majority of children with 

family incomes of 200 to 299 percent or 300 

percent or more of poverty were privately insured 

(72.7 and 90.0 percent, respectively). 

In 1997, SCHIP was created in response to the 

growing number of uninsured children in lowincome working families. In 2006, more than 

6.6 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, Health Insurance Coverage Among Children Under Age 18, 

by Race/Ethnicity and Type of Coverage,* 2006 by Poverty Level* and Type of Coverage,** 2006 

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

Total Less Than 100% of Poverty 100 100 Non-Hispanic White 90.0 100–199% of Poverty

90 Non-Hispanic Black 90 200–299% of Poverty

Hispanic 300% of Poverty or Above 76.9 80 80 72.7 

29.8 

49.4 

22.0 22.1

Percent of ChildrenPercent of Children

67.2 64.6 70

60 

43.5 50 45.1 45.7 40.9 42.3

40 

12.1 9.4 

30 22.8 19.5 19.3 20 17.1 14.0 11.7 7.3 10 

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

*The U.S. Census Bureau poverty threshold for a family of four was $20,444 in 2006. **Totals equal 

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

54 Health Services Financing and Utilization 

10 

20 

30 

40 

5.4 
CSHCN: HEALTH INSURANCE 

AND NEEDED SERVICES 

The National Survey of Children with Special 

Health Care Needs (CSHCN) asked the parents 

of CSHCN whether their child had insurance in 

the past 12 months and what kind of insurance 

they had. Health insurance included private 

insurance provided through an employer or 

union or obtained directly from an insurance 

company; public insurance, such as Medicaid, 

the State Children’s Health Insurance Program 

(SCHIP), or military health care; or some other 

plan that pays for health services obtained from 

doctors, hospitals, or other health professionals. 

Overall, 91.2 percent of CSHCN were 

reported to have been insured for all of the previous 12 months, while the remaining 8.8 percent were uninsured for all or some part of the 

year. At the time of the interview, almost 97 percent of CSHCN were reported to have some type 

of insurance: 59.1 percent had private insurance 

and 28.1 percent had public insurance. Another 

7.4 percent of CSHCN had both private and 

public insurance, and 3.5 percent were uninsured at the time of the interview. 

CSHCN require preventive health care and 

dental services and acute care when they are sick 

in addition to a variety of other services to manChild Health USA 2007 

age their conditions, maintain their abilities, and 

promote their development. The health service 

needed most often by CSHCN is prescription 

medication: 86 percent of these children are 

reported to need prescription drugs. Just over 

half of CSHCN need the care of medical specialists, such as cardiologists or pulmonologists. 

Other services needed by a smaller proportion of 

children include eyeglasses or vision care (33 percent of CSHCN), mental health care (25 percent), dental care other than preventive care (24 

percent), and physical, occupational, or speech 

therapy (23 percent). 

Health Insurance Coverage for CSHCN,* by Type of Coverage, 

2005–2006 

Source (I.9): Centers for Disease Control and Prevention, National Survey of Children 

with Special Health Care Needs 

Comprehensive Uninsured Insurance 3.5% 

Private
 2.0%

and Public
 

7.4%
 

Public 

28.1% 

Private 

59.1% 

*Insurance coverage at the time of interview. 

Percent of CSHCN Needing Specific Health Services, 2005–2006 

Source (I.9): Centers for Disease Control and Prevention, National Survey of Children 

with Special Health Care Needs 

Prescription Drugs 

Preventive Dental Care 

Routine Preventive Care 

Specialist Care 

Eyeglasses/Vision Care 

Mental Health Care 

Other Dental Care 

Specialized Therapies* 

Disposable Medical Supplies 

Durable Medical Equipment 

20 40 60 80 100 

Percent of CSHCN 

*Types of therapies include physical, occupational or speech. 

Health Services Financing and Utilization 55 

81.1 

86.4 

77.9 

51.8 

33.3 

25.0 

24.2 

22.8 

18.6 

11.4 
Child Health USA 2007 

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 complete series of vaccines. In 2005, 80.8 percent of 

children aged 19–35 months had received the 

recommended 4:3:1:3:3 series of vaccines. This 

series comprises four doses of diphtheria, tetanus, 

and pertussis vaccine, three doses of poliovirus 

vaccine, one dose of measles-mumps-rubella vaccine, three doses of Haemophilus influenzae 

type b (Hib) vaccine, and three doses of the 

Hepatitis B vaccine. Overall, 76.1 percent had 

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

Since 2000, the greatest increases in vaccination rates have occurred with the varicella vaccine 

(added to the schedule in 1996) and the diphtheria, tetanus, and pertussis vaccine (DTP). 

These rates have risen 29.6 and 4.9 percent, 

respectively. Vaccination rates for other vaccines 

have also risen during this time period, ranging 

from 0.5 percent (Hib vaccine) to nearly 3 percent (Hepatitis B vaccine). 

While there was no difference in vaccination 

coverage by race and ethnicity regarding the 

4:3:1:3:3 series of vaccines, racial and ethnic disparities were evident regarding the coverage of 

three individual vaccines: the DTP vaccine; the 

varicella vaccine; and the pneumococcal conjugate vaccine (PCV; data not shown). Non-Hispanic Black and Hispanic children were less likely 

than non-Hispanic White children to have 

received 4 or more doses of the DTP and PCV 

vaccines, while non-Hispanic White children 

were less likely to have received the varicella 

vaccine. 

Each year, the CDC publishes an update of the 

recommended childhood immunization schedule 

(see facing page). The 2007 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 between 6 months and 5 years of age. 

Vaccination Rates Among Children Aged 19–35 Months, by Race/Ethnicity, 2005 

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

Non-Hispanic Non-Hispanic Total Hispanic Asian White Black 

Complete Series 

4:3:1:3:3:1 

(with Varicella) 

Series 4:3:1:3:3 

(without Varicella) 

4+ DTP 

3+ Polio 

1+ MMR* 

3+ Hib 

3+ HepB 

1+ Varicella 

76.1 76.0 76.3 75.6 77.1 

80.8 82.1 79.3 78.8 80.5 

85.7 87.1 84.0 83.6 88.8 

91.7 91.4 91.0 92.3 92.9 

91.5 91.4 91.9 91.1 91.9 

93.9 94.2 92.9 94.2 89.3 

92.9 93.1 92.7 92.7 92.7 

87.9 86.1 90.6 89.2 91.9 

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

vaccine. 

56 Health Services Financing and Utilization 
Child Health USA 2007 

Recommended Immunization Schedule for Children Aged 0–6 Years, United States, 2007 

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

BIRTH 1MO 2MO 4MO 6MO 12MO 15MO 18MO 19–23MO 2–3YR 4-6YR 

Hepatitis B1 HepB HepB see footnote 1 HepB HepB Series 

Rotavirus2 Rota Rota Rota 

Diphtheria, Tetanus, Pertussis 3 DTaP DTaP DTaP DTaP DTaP 

Haemophilus influenzae type b4 Hib Hib Hib4 Hib Hib 

Pneumococcal 5 PCV PCV PCV PCV PCV 

PPV 

Inactivated Poliovirus IPV IPV IPV IPV 

Influenza6 Influenza (Yearly) 

Measles, Mumps, Rubella 7 MMR MMR 

Varicella 8 Varicella Varicella 

Hepatitis A9 HepA (2 doses) HepA Series 

Meningococcal 10 MPSV4 

Range of Recommended Ages Catch-Up Immunization Certain High-risk Groups 

This schedule indicates the recommended ages for routine administration of currently licensed feasible. Additional vaccines may be licensed and recommended during the year. Licensed Committee on Immunization Practices statement for detailed recommendations. Clinically significhildhood vaccines, as of December 1, 2006, for children aged 0–6 years. Additional information combination vaccines may be used whenever any components of the combination are indicated cant adverse events that follow immunization should be reported to the Vaccine Adverse Event 

is available at http://www.cdc.gov/nip/recs/child-schedule.htm. Any dose not administered at the and other components of the vaccine are not contraindicated and if approved by the Food and Reporting System (VAERS). Guidance about how to obtain and complete a VAERS form is 

recommended age should be administered at any subsequent visit, when indicated and Drug Administration for that dose of the series. Providers should consult the respective Advisory available at http://www.vaers, hhs.gov or by telephone, 800-822-7967. 

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

At birth: • Administer monovalent HepB to all newborns before hospital discharge. • If mother is hepatitis surface antigen (HBsAg)-positive, administer HepB and 0.5 mL of hepatitis B

immune globulin (HBIG) within 12 hours of birth. • If mother’s HBsAg status is unknown,

administer HepB within 12 hours of birth. Determine the HBsAg status as soon as possible

and if HBsAg-positive, administer HBIG (no later than age 1 week). • If mother is HBsAgnegative, the birth dose can only be delayed with physician’s order and mother’s negative 

HBsAg laboratory report documented in the infant’s medical record. 

After the birth dose: • The HepB series should be completed with either monovalent HepB

or a combination vaccine containing HepB. The second dose should be administered at age

1–2 months. The final dose should be administered at age 24 weeks or older. Infants born to

HBsAg-positive mothers should be tested for HBsAg and antibody to HBsAg after completion of 3 doses or more of a licensed HepB series, at age 9–18 months (generally at the

next well-child visit). 

4-month dose: • It is permissible to administer 4 doses of HepB when combination vaccines

are administered after the birth dose. If monovalent HepB is used for doses after the birth

dose, a dose at age 4 months is not needed. 

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

• Administer the first dose at age 6–12 weeks. Do not start the series later than age 12

weeks. • Administer the final dose in the series by age 32 weeks. Do not administer a dose

later than age 32 weeks. • Data on safety and efficacy outside of these age ranges are

insufficient. 

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

age: 6 weeks) • The fourth dose of DTaP may be administered as early as age 12 months,

provided 6 months have elapsed since the third dose. • Administer the final dose in the

series at age 4–6 years. 

4. Haemophilus influenzae type b conjugate vaccine (Hib). (Minimum age: 6 weeks) • If 

PRP-OMP (PedvaxHIB® or ComVax® [Merck]) is administered at ages 2 and 4 months, a

dose at age 6 months is not required. • TriHiBit® (DTaP/Hib) combination products should

not be used for primary immunization but can be used as boosters following any Hib vaccine

in children aged 12 months or older. 

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

[PCV]; 2 years for pneumococcal polysaccharide vaccine [PPV]) • Administer PCV at ages

24–59 months in certain high-risk groups. Administer PPV to children aged 2 years or older

in certain high-risk groups. See MMWR 2000;49(No. RR-9):1–35. 

6. Influenza vaccine. (Minimum age: 6 months for trivalent inactivated influenza vaccine 

[TIV]; 5 years for live, attenuated influenza vaccine [LAIV]) • All children aged 6–59 months

and close contacts of all children aged 0–59 months are recommended to receive influenza

vaccine. • Influenza vaccine is recommended annually for children aged 59 months or older

with certain risk factors, health-care workers, and other persons (including household members) in close contact with persons in groups at high risk. See MMWR 2006;55(No. RR10):1–41. • For healthy persons aged 5–49 years, LAIV may be used as an alternative to

TIV. • Children receiving TIV should receive 0.25 mL if aged 6–35 months or 0.5 mL if aged

3 year or older. • Children aged under 9 years who are receiving influenza vaccine for the

first time should receive 2 doses (separated by 4 weeks or more for TIV and 6 weeks or

more for LAIV). 

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

the second dose of MMR at age 4–6 years. MMR may be administered before age 4–6

years, provided 4 or more weeks have elapsed since the first dose and both doses are

administered at age 12 months or older. 

8. Varicella vaccine. (Minimum age: 12 months) • Administer the second dose of varicella 

vaccine at age 4–6 years. Varicella vaccine may be administered before age 4–6 years, provided that 3 or more months have elapsed since the first dose and both doses are administered at age 12 months or older. If second dose was administered 28 days or more following

the first dose, the second dose does not need to be repeated. 

9. Hepatitis A vaccine (HepA). (Minimum age: 12 months) • HepA is recommended for all

children aged 1 year (i.e., aged 12–23 months). The 2 doses in the series should be administered at least 6 months apart. • Children not fully vaccinated by age 2 years can be vaccinated at subsequent visits. • HepA is recommended for certain other groups of children,

including in areas where vaccination programs target older children. See MMWR 

2006;55(No. RR-7):1–23. 

10. Meningococcal polysaccharide vaccine (MPSV4). (Minimum age: 2 years)

•Administer MPSV4 to children aged 2–10 years with terminal complement deficiencies or

anatomic or functional asplenia and certain other highrisk groups. See MMWR 2005;54(No.

RR-7):1–21. 

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

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

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

Physicians (http://www.aafp.org). 

Health Services Financing and Utilization 57 
26 

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 among 

children in 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 12 months of age. 

During Federal Fiscal Year 2005, only 27.6 

percent of children eligible for services under the 

Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program 

received preventive dental service. 

In 2005, 72.6 percent of children aged 1–18 

years had seen a dentist in the past year. Frequency of dental visits among children varies by 

family income and race/ethnicity. Children with 

family incomes of 200 percent or more of the 

poverty level were more likely to have seen a dentist in the past year than children living with 

Child Health USA 2007 

family incomes below 200 percent of the poverty 

level (78.2 versus 63.8 percent). 

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 (76.5 percent), while Hispanic children were least likely (63.0 percent). Approximately 70 percent of both non-Hispanic Black 

children and children of other races (including 

Asian/Pacific Islander, American Indian/Alaska 

Native and those of multiple races) visited a dentist in the past year (data not shown). 

Receipt of EPSDT Preventive Dental Service Among Children, Receipt of Dental Care Among Children Aged 1–18, by Poverty 

Birth Through Age 20: 1990–2005* Level,* 2005 

Source (III.4): Centers for Medicare and Medicaid Services	 Source (III.5): Centers for Disease Control and Prevention, National Center 

for Health Statistics, National Health Interview Survey 

30 100 

90 

28 27.6 80 

1990 1995 2000 2005 

Percent of Eligible Children

Percent of Children

70 

60 

50 

40 

10 

All Children Below 200% Poverty Level 200% Poverty Level or More

Within Past Year 

More Than 1 Year Ago or Never 

27.4 

63.8 

72.6 78.2 

36.2 

21.8 

*Not all States and Territories reported data in all years.	 *The poverty level was equal to $19,971 for a family of four in 2005. 

Health Services Financing and Utilization 59 

30 

20 20 

22 

24 
Child Health USA 2007 

TIMING OF PHYSICIAN 

VISITS 

The American Academy of Pediatrics recommends that children have eight health care visits 

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

at least one per year from middle childhood 

through adolescence. In 2005, 11.4 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 less 

Hispanic Black children had similar rates except 

among children aged 15–17 years (10.4 and 17.6 

percent, respectively). Hispanic children aged 

15–17 years were the most likely not to have seen 

a physician in the past year (27.2 percent). 

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

in the Past 12 Months, by Age and Race/Ethnicity,* 2005 

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

Interview Survey 

likely than younger children to have seen a physician. More than 15 percent of 15- to 17-year-olds 

had not had a physician visit in the previous year, 

compared to only 6.1 percent of children under 

5 years of age. 

Physician visits varied with race and ethnicity
 

across all age groups in 2005. Almost 17 percent
 

of all Hispanic children did not see a physician,
 

compared to 9.2 percent of non-Hispanic White
 

children and 10.8 percent of non-Hispanic Black 

children. In every age group, Hispanic children 

were the least likely to have seen a physician in 

the previous year, while non-Hispanic White 

children were most likely to have seen a physiPercent of Children 

3 

6 

9 

12 

15 

18 

21 

24 

27 

30 

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

Total 

Non-Hispanic White 

Non-Hispanic Black 

Hispanic 

11.4 

9.2 

10.8 

16.9 

6.1 

4.6 4.7 

9.7 

11.3 

10.1 11.1 

15.9 

14.2 

11.8 12.3 

20.5 

15.1 

10.4 

17.6 

27.2 

cian. Non-Hispanic White children and non­ *The sample of American Indian/Alaska Natives, Asian/Pacific Islanders and children of more than one race was too small to produce 

reliable results. 

60 Health Services Financing and Utilization 
RECEIPT OF PREVENTIVE 

CARE 

In 2005, nearly 73 percent of children under 

18 years of age were reported by their parents to 

have had a preventive medical visit (or “wellchild” visit) in the past year. The American Academy of Pediatrics (AAP) recommends that children have eight health care visits in their first 

year, three in their second year, and at least one 

per year from middle childhood through 

adolescence. 

Despite the recommendation that older children should have one visit per year, only 66.7 

percent of children aged 10–14 years and 64.8 

percent of children aged 15–17 years had a wellchild visit in the past year. Younger children (aged 

birth to 4 years) were the most likely to have had 

a well-child visit in the past year (85.4 percent). 

The likelihood of children receiving preventive 

care also varied by race and ethnicity. Non-Hispanic Black children were the most likely to have 

had a preventive medical visit in the past year 

Child Health USA 2007 

(77.6 percent), followed by non-Hispanic White 

children (73.7 percent). Hispanic children were 

least likely to have had a preventive visit (67.1 

percent). 

In 2005, children with family incomes above 

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

below the poverty level (73.9 versus 69.3 percent; 

data not shown). 

Receipt of Preventive Medical Care in the Past Year Among Receipt of Preventive Medical Care in the Past Year Among 

Children Under Age 18, by Age, 2005 Children Under Age 18, by Race/Ethnicity, 2005 

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

Statistics, National Health Interview Survey Statistics, National Health Interview Survey Percent of Children 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

66.7 72.8 71.2 

Percent of Children 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

69.4 73.7 

77.6 

85.4 

67.1 64.8 

Total 0–4 Years 5–9 Years 10–14 Years 15–17 Years Non-Hispanic White Non-Hispanic Black Hispanic Other* 

*Includes American Indian/Alaska Natives, Asian/Pacific Islanders and children of more than one race. 

Health Services Financing and Utilization 61 
Child Health USA 2007 

PLACE OF PHYSICIAN 

CONTACT 

In 2005, a doctor’s office or HMO was the 

usual place of sick care (not including routine or 

preventive care) for 77.5 percent of children in 

the United States, a proportion that varies by 

family income and race and ethnicity. 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 poverty level. 

Among children with family incomes below 

the poverty level, 73.2 percent of non-Hispanic 

White children received care at a doctor’s office 

or HMO, compared to 56.7 percent of non-Hispanic Black children and 43.1 percent of Hispanic children. Hispanic children were more 

likely than non-Hispanic children to receive nonroutine care at a clinic or health center when they 

were sick, with nearly 53 percent whose family 

incomes were below poverty and 27.2 percent 

above poverty receiving care at such a location. 

Comparatively, only 23.1 percent of low-income 

and 14.4 percent of higher-income non-Hispanic 

White children received care from clinics or 

health centers. 

Only a small proportion of children used a 

hospital emergency room, hospital outpatient 

department, or some other source as their primary source of sick care, but children with family incomes below the poverty level were more 

likely to do so than children with higher family 

incomes. For instance, 6.0 percent of non-Hispanic Black children and 3.9 percent of Hispanic 

children with family incomes below the poverty 

level regularly received care from these sources, 

while those with family incomes above the 

poverty level were less likely to do so (3.2 and 2.4 

percent, respectively.) 

Percent of Children 

Place of Physician Contact,* by Poverty Level** and Race/Ethnicity,*** 2005 

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

Non-Hispanic White Non-Hispanic White Non-Hispanic White 

Non-Hispanic Black Non-Hispanic Black Non-Hispanic Black 100 100 100 Hispanic Hispanic
 

90
 

Hispanic 

85.0 90 90

77.8 80 80 80 73.2 70.4 70 70 70

60 56.7 60 60 52.9
 

50
 50 50 43.1
 

40
 40 37.3 40

30 30 27.2 30 23.1 19.0 20 20 20 14.4 

10 10 10 6.0 3.7 3.9 0.6 3.2 2.4

Below Poverty Level Above Poverty Level Below Poverty Level Above Poverty Level Below Poverty Level Above Poverty Level 

Doctor’s Office or HMO Clinic or Health Center Hospital or Other Place**** 

*The place where the child usually goes when sick; does not include routine or preventive care visits. **The U.S. Census Bureau poverty threshold for a family of four was $19,971 in 2005. ***The sample of American 

Indian/Alaska Natives, Asian/Pacific Islanders and children of more than one race or “other” races was too small to produce reliable results. ****Includes hospital emergency rooms, hospital outpatient departments, 

and “some other place.” 

62 Health Services Financing and Utilization 
60 

70 

80 

EMERGENCY DEPARTMENT 

UTILIZATION 

In 2005, more than 21 percent of children 

went to a hospital emergency room or emergency 

department (ER/ED) at least once. Children 

with family incomes above the poverty level 

($19,971 for a family of four) were less likely 

than children in poverty to have visited the 

ER/ED. Nearly 27 percent of low-income children made one to three emergency room visits 

during the year, compared to 18.7 percent of 

children in higher-income families. Similarly, 2.5 

percent of low-income children and less than 1 

percent of children with family incomes above 

the poverty level made four or more visits to the 

ER/ED. 

The use of ER/EDs also varied by other demographic factors including age and race and ethnicity. Younger children used the ER/ED more 

often than older children and adolescents; 25.4 

percent of children under 5 years of age made 

1–3 visits to the emergency room compared to 

18.2 percent of 5- to 9-year-olds and fewer than 

16.5 percent of adolescents aged 10–14 and 

15–17 years. Similarly, 2.0 percent of children 

under 5 years made 4 or more visits to the 

Child Health USA 2007 

ER/ED compared to 1.1 percent of those aged 

5–9 and fewer than 1 percent each of 10- to-14­

year-olds and 15- to 17-year-olds. 

Non-Hispanic Black children were most likely 

to visit the ER/ED in 2004 (24.2 percent), followed by non-Hispanic White children (20.1 

percent), and Hispanic children (19.5 percent). 

Non-Hispanic children of other races (including 

Asian/Pacific Islanders, American Indian/Alaska 

Natives, and children of multiple races) had the 

lowest percentage of children with at least one 

ER/ED visit (18.0 percent; data not shown). 

Visits to the Emergency Room/Emergency Department Visits to the Emergency Room/Emergency Department Among 

Among Children Under Age 18, by Poverty Level,* 2005 Children Under Age 18, by Age, 2005 

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

Statistics, National Health Interview Survey Statistics, National Health Interview Survey 

100 

90 

Below Poverty Level

Above Poverty Level 

18.7 

2.5 0.9 

26.7 

70.8 

80.4 

No Visits 1–3 Visits 4 Visits or More 

*The U.S. Census Bureau poverty threshold for a family of four was $19,971 in 2005. 

100 

90 

Under 5 Years 

5–9 Years 

10–14 Years 

15–17 Years 83.1 83.0 80.7 

72.6 

2.0 1.1 0.7 0.6

16.2 16.4 18.2 

25.4 

80 

Percent of Children

Percent of Children

70 

60 

50 

40 

30 

20 

10 

No Visits 1–3 Visits 4 Visits or More 

Health Services Financing and Utilization 63 

10 

20 

30 

40 

50 
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 2005, 83.9 

percent of women in 37 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 

non-Hispanic 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 2005, 

non-Hispanic White women had the highest 

rates of early prenatal care utilization (88.7 percent), followed by Asian/Pacific Islander women 

(85.3 percent), Hispanic women (77.6 percent), 

and non-Hispanic Black women (76.5 percent); 

Child Health USA 2007 

American Indian/Alaska Native women had the 

lowest rate (69.6 percent). 

Late or No Prenatal Care. The percentage of 

women beginning prenatal care in the third 

trimester or going without prenatal care 

remained steady in 2005 at 3.5 percent. American Indian/Alaska Natives, Hispanic and nonHispanic Black women were 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, Mothers Receiving Late or No Prenatal Care, 

by Race/Ethnicity, 2005* by Race/Ethnicity, 2005* 

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

Statistics, National Vital Statistics System Statistics, National Vital Statistics System Percent of Mothers Percent of Mothers 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

83.9 88.7 

76.5 77.6 

85.3 

69.6 

10 

20 

30 

40 

50 

60 

70 

80 

90 

100 

3.5 2.2 5.6 5.1 3.0 

8.2 

Total Non-Hispanic

White 

Non-Hispanic

Black 

Hispanic American Indian/

Alaska Native

Asian/

Pacific Islander Total Non-Hispanic

White 

Non-Hispanic

Black 

Hispanic American Indian/

Alaska Native

Asian/

Pacific Islander 

*2005 data include 37 States, Washington DC, and New York City. *2005 data include 37 States, Washington DC, and New York City. 

Health Services Financing and Utilization 65 
Child Health USA 2007 

State Data 

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, preterm birth, health care financing, 

Medicaid enrollment and expenditures, and SCHIP 

enrollment. 

The following pages reveal important disparities in 

these measures across States. For instance, the 

proportion of infants born at low birth weight (less 

than 2,500 grams or 5 pounds 8 ounces) was 

highest in the District of Columbia and several 

southern States, including Alabama, Louisiana, 

Mississippi, and South Carolina. With the exception 

of Alabama, births to unmarried women were also 

highest in these states, as well as in Delaware and 

New Mexico. 

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 67 
Child Health USA 2007 

State Children’s Health Insurance Program (SCHIP) Aggregate Enrollment Statistics, FY 2006 

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

Type of Date Upper Total SCHIP Type of Date Upper Total SCHIP 

State SCHIP Program Implemented Eligibility Enrollment State SCHIP Program Implemented Eligibility Enrollment 

Alabama Separate 02/01/98 200% 84,257 Montana Separate 01/01/99 150% 17,304 

Alaska Medicaid 03/01/99 175% 22,227 Nebraska Medicaid 05/01/98 185% 44,981 

Arizona Separate 11/01/98 200% 96,669 Nevada Separate 10/01/98 200% 39,317 

Arkansas Combo 10/01/98 200% 3,440 New Hampshire Combo 05/01/98 300% 12,393 

California Combo 03/01/98 250% 1,391,405 New Jersey Combo 03/01/98 350% 120,884 

Colorado Separate 04/22/98 200% 69,997 New Mexico Medicaid 03/31/99 235% 25,155 

Connecticut Separate 07/01/98 300% 23,110 New York Separate 04/15/98 250% 688,362 

Delaware Combo 02/01/99 200% 10,751 North Carolina Combo 10/01/98 200% 247,991 

District of Columbia Medicaid 10/01/98 200% 6,332 North Dakota Combo 10/01/98 140% 6,318 

Florida Combo 04/01/98 200% 303,595 Ohio Medicaid 01/01/98 200% 218,529 

Georgia Separate 11/01/98 235% 343,690 Oklahoma Medicaid 12/01/97 185% 116,012 

Hawaii Medicaid 07/01/00 300% 22,031 Oregon Separate 07/01/98 185% 59,039 

Idaho Combo 10/01/97 185% 24,727 Pennsylvania Separate 05/28/98 200% 188,765 

Illinois Combo 01/05/98 200% 316,781 Rhode Island Combo 10/01/97 250% 25,492 

Indiana Combo 10/01/97 200% 133,696 South Carolina Medicaid 10/01/97 185% 68,870 

Iowa Combo 07/01/98 200% 49,575 South Dakota Combo 07/01/98 200% 14,584 

Kansas Separate 01/01/99 200% 48,934 Tennessee* 10/01/97 

Kentucky Combo 07/01/98 200% 64,861 Texas Separate 07/01/98 200% 585,461 

Louisiana Medicaid 11/01/98 200% 142,389 Utah Separate 08/03/98 200% 51,967 

Maine Combo 07/01/98 200% 31,114 Vermont Separate 10/01/98 300% 6,314 

Maryland Combo 07/01/98 300% 136,034 Virginia Combo 10/22/98 200% 137,182 

Massachusetts Combo 10/01/97 300% 190,640 Washington Separate 02/01/00 250% 15,000 

Michigan Combo 05/01/98 200% 118,501 West Virginia Separate 07/01/98 220% 39,855 

Minnesota Combo 10/01/98 280% 5,343 Wisconsin Medicaid 04/01/99 185% 56,627 

Mississippi Separate 07/01/98 200% 83,359 Wyoming Separate 12/01/99 200% 7,715 

Missouri Medicaid 09/01/98 300% 106,577 

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

68 State Data 
Medicaid Per Enrollee Participation

State Enrollees* Expenditure** Ratio***

Child Health USA 2007 

Medicaid Enrollees, Expenditures, and Reported EPSDT Utilization for Children Under 21, FY 2004 

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

State 

Medicaid 

Enrollees* 

Per Enrollee 

Expenditure** 

Participation 

Ratio*** State 

Medicaid 

Enrollees* 

Per Enrollee 

Expenditure** 

Participation 

Ratio*** 

Alabama 

Alaska 

Arizona 

Arkansas 

California 

Colorado 

Connecticut 

Delaware 

District of Columbia 

Florida 

Georgia 

Hawaii 

Idaho  

Illinois** ** 

Indiana 

Iowa 

Kansas 

Kentucky 

Louisiana 

Maine 

Maryland 

Massachusetts 

Michigan 

Minnesota 

Mississippi 

Missouri 

491,853 

88,347 

670,534 

379,001 

6,071,277 

303,090 

274,773 

79,449 

90,822 

1,626,835 

1,109,058 

121,477 

145,333 

1,146,996 

593,195 

228,738 

212,357 

318,008 

733,403 

NR 

493,167 

480,203 

1,006,133 

400,984 

460,033 

684,632 

$1,880.18 

$4,493.54 

$2,279.82 

$2,130.60 

$1,352.43 

$1,953.42 

$2,134.73 

$2,706.08 

$3,493.72 

$1,877.67 

$1,821.56 

$1,842.34 

$2,061.55 

$1,487.99 

$1,828.82 

$2,391.59 

$2,434.86 

$2,537.93 

$1,537.94 

$5,275.23 

$2,606.13 

$3,459.01 

$1,837.88 

$3,138.35 

$1,600.98 

$1,734.64 

47% 

51% 

61% 

25% 

39% 

48% 

61% 

32% 

73% 

56% 

50% 

67% 

33% 

73% 

54% 

100% 

87% 

44% 

64% 

NR 

54% 

74% 

42% 

100% 

32% 

63% 

Montana 

Nebraska 

Nevada 

New Hampshire 

New Jersey 

New Mexico 

New York 

North Carolina 

North Dakota 

Ohio 

Oklahoma 

Oregon 

Pennsylvania  

Rhode Island 

South Carolina 

South Dakota 

Tennessee 

Texas 

Utah 

Vermont 

Virginia 

Washington 

West Virginia** ** 

Wisconsin 

Wyoming 

65,113 

157,025 

150,620 

NR 

534,765 

329,214 

2,113,319 

858,750 

43,893 

1,154,022 

NR 

273,778 

941,719 

112,508 

640,690 

83,268 

775,232 

2,712,573 

172,342 

73,351 

494,199 

661,357 

216,516 

467,934 

52,770 

$2,536.63 

$2,201.22 

$1,617.51 

$2,483.13 

$2,223.72 

$2,415.37 

$2,708.01 

$2,348.96 

$2,144.94 

$2,005.30 

$1,672.24 

$1,971.84 

$2,603.95 

$4,034.41 

$1,818.43 

$2,282.76 

$1,864.99 

$1,876.39 

$1,986.96 

$2,993.23 

$1,785.67 

$1,515.80 

$1,916.62 

$1,585.51 

$2,124.46 

54% 

52% 

38% 

NR 

54% 

49% 

94% 

72% 

41% 

47% 

NR 

55% 

57% 

54% 

33% 

43% 

47% 

62% 

49% 

84% 

56% 

55% 

50% 

65% 

36% 

* Unduplicated number of individuals under age 21 determined to be eligible for EPSDT services (FY 2004 416 Report). 

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

***The ratio of Medicaid eligibles receiving any initial and periodic screening services to the number of eligibles who should have received such services. 

****Enrollee and Participation Ratio data are based on FY 2003 data. 

NR = Not reported. 

State Data 69 
Child Health USA 2007 

Health Insurance Status of Children Through Age 18, 2005* 

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

Percent with Percent Percent with Percent 

Private/Employer- Enrolled in Percent Private/Employer- Enrolled in Percent 

State Based Insurance Public Insurance** Uninsured*** State Based Insurance Public Insurance** Uninsured*** 

Alabama 64.1% 38.2% 4.6% Montana 56.6% 24.5% 14.0% 

Alaska 56.8% 44.6% 8.5% Nebraska 70.4% 27.7% 5.4% 

Arizona 52.5% 30.9% 17.3% Nevada 69.2% 17.5% 14.9% 

Arkansas 55.4% 39.9% 11.6% New Hampshire 77.5% 16.8% 5.5% 

California 53.0% 31.0% 13.9% New Jersey 72.1% 17.2% 10.9% 

Colorado 65.2% 20.2% 13.6% New Mexico 48.4% 38.6% 20.5% 

Connecticut 71.3% 19.7% 8.0% New York 61.4% 32.7% 8.2% 

Delaware 65.8% 26.8% 11.9% North Carolina 57.1% 30.5% 12.4% 

District of Columbia 45.7% 48.4% 6.7% North Dakota 67.0% 23.9% 9.0% 

Florida 54.6% 27.1% 18.5% Ohio 67.0% 25.9% 8.1% 

Georgia 54.3% 36.2% 11.5% Oklahoma 53.6% 39.5% 11.0% 

Hawaii 68.0% 34.4% 5.7% Oregon 59.3% 27.8% 10.5% 

Idaho 60.4% 24.3% 11.7% Pennsylvania 68.3% 26.8% 7.3% 

Illinois 67.2% 23.1% 10.3% Rhode Island 64.6% 31.9% 7.8% 

Indiana 63.3% 27.8% 10.2% South Carolina 57.1% 34.5% 10.5% 

Iowa 71.3% 24.6% 5.4% South Dakota 59.9% 28.8% 9.0% 

Kansas 65.9% 27.6% 6.1% Tennessee 60.2% 33.7% 9.2% 

Kentucky 62.4% 34.3% 7.3% Texas 50.4% 31.6% 19.0% 

Louisiana 58.4% 32.3% 9.0% Utah 64.6% 23.4% 12.7% 

Maine 59.3% 36.3% 8.0% Vermont 59.0% 42.6% 6.2% 

Maryland 68.5% 26.0% 8.2% Virginia 68.9% 27.5% 8.7% 

Massachusetts 71.7% 23.5% 4.4% Washington 62.9% 30.9% 9.0% 

Michigan 70.3% 27.3% 5.3% West Virginia 61.2% 38.9% 7.8% 

Minnesota 73.6% 17.2% 6.3% Wisconsin 70.5% 24.4% 7.1% 

Mississippi 48.3% 43.1% 12.3% Wyoming 59.8% 29.5% 10.9% 

Missouri 60.3% 29.8% 8.3% 

*Data reflect changes made to 2005 Current Population Survey estimates which were released on April 17th, 2007. 

** Includes children covered by Medicaid, SCHIP, Medicare, military health insurance and the Indian Health Service. 

*** See map on facing page. 

70 State Data 
Child Health USA 2007 

Percent of Children Through Age 18 Who Are Uninsured, by State, 2005 

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

IL 

AK 

HI 

WA 

KS 

MN 

WI 

IA 

MO 

AR 

MS AL 

SC 

KY 

IN 

MI 

OH 

PA 

NY 

VT 

NH 

ME 

MA 

CT 

RI 

NJ 

MD 

DE 

DC (7.8%) 

NE 

VA WV 

ND 

SD ID 

WY 

LA 

FL 

OR 

TN 

NC 

CO 

TX 

GA 

OK 

NV 

AZ 

UT 

CA 

MT 

NM 

< 7.5% 7.5 - 10% 10.1 - 12% 12.1 - 21% 

State Data 71 
Child Health USA 2007 

Percent of Infants Born at Low Birth Weight, Preterm Births, and Births to Unmarried Women, by State and Race of Mother, 2005 

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

Low Birth Weight Preterm Birth Births to Unmarried Women Low Birth Weight Preterm Birth Births to Unmarried Women 

Non-Hispanic Non-Hispanic Non-Hispanic Non-Hispanic Non-Hispanic Non-Hispanic 

State Total* White Black Total* White Black Total* White Black Hispanic State Total* White Black Total* White Black Total* White Black Hispanic 

United States 8.2 7.3 14.0 12.7 11.7 18.4 36.9 25.3 69.9 48.0 Missouri 8.1 7.0 14.3 13.3 12.1 19.9 37.8 30.2 76.9 48.5 

Alabama 10.7 8.8 15.5 16.7 14.6 21.9 35.7 20.9 70.4 21.5 Montana 6.6 6.3 N/A 11.4 10.9 N/A 34.6 28.0 43.1 43.7 

Alaska 6.1 5.7 15.5 10.6 9.5 16.8 36.0 23.4 51.9 37.7 Nebraska 7.0 6.5 13.1 12.2 11.6 17.1 30.9 24.3 69.7 47.1 

Arizona 6.9 6.9 13.0 13.2 12.1 20.2 43.1 26.5 61.0 54.4 Nevada 8.3 7.8 14.8 13.9 13.1 20.8 40.9 30.0 69.5 49.1 

Arkansas 8.9 7.7 14.5 13.4 12.3 18.1 40.2 29.9 77.1 44.6 New Hampshire 7.0 6.8 11.3 10.5 10.2 20.9 27.3 27.1 37.4 46.9 

California 6.9 6.5 12.6 10.7 10.0 15.5 35.7 21.3 64.0 45.8 New Jersey 8.2 7.1 13.4 12.5 11.1 17.4 31.4 14.5 66.3 55.8 

Colorado 9.2 8.9 15.3 12.3 11.7 16.5 27.1 18.3 52.6 41.2 New Mexico 8.5 8.8 14.4 13.1 12.7 17.5 50.8 30.4 57.9 56.6 

Connecticut 8.0 6.8 13.5 10.4 9.6 15.2 32.2 18.6 67.4 62.6 New York 8.3 7.0 13.2 12.1 10.5 17.2 38.7 21.3 67.8 62.9 

Delaware 9.5 7.7 14.9 14.0 12.4 18.4 44.3 30.3 70.6 62.0 North Carolina 9.2 7.9 14.6 13.7 12.2 18.8 38.4 23.0 69.1 51.9 

DC 11.2 7.1 14.1 15.9 9.4 19.5 56.0 5.9 77.2 67.5 North Dakota 6.4 6.3 N/A 11.5 10.9 N/A 32.2 25.4 25.4 35.2 

Florida 8.7 7.6 13.6 13.8 12.2 18.5 42.8 31.5 68.4 45.2 Ohio 8.7 7.8 13.9 13.0 12.1 18.0 38.9 31.3 76.2 56.1 

Georgia 9.5 7.5 14.4 13.6 12.1 18.0 40.6 23.5 67.2 46.9 Oklahoma 8.0 7.5 14.2 13.1 12.7 18.1 39.1 31.3 73.4 46.2 

Hawaii 8.2 6.6 10.8 12.2 9.8 12.0 36.3 24.6 27.1 47.4 Oregon 6.1 6.0 11.4 10.2 10.0 13.6 33.3 29.5 64.7 45.7 

Idaho 6.7 6.7 N/A 11.4 11.2 N/A 22.9 19.5 26.7 37.9 Pennsylvania 8.4 7.3 13.5 11.9 10.8 16.7 36.5 27.1 76.2 61.3 

Illinois 8.5 7.3 15.1 13.1 11.8 19.6 37.1 22.5 78.1 46.7 Rhode Island 7.8 7.1 10.3 12.1 11.0 14.0 38.5 28.3 66.5 60.7 

Indiana 8.3 7.8 13.4 13.5 12.8 18.5 40.2 33.6 77.8 54.4 South Carolina 10.2 7.8 15.3 15.6 13.3 20.4 43.3 26.3 74.1 44.7 

Iowa 7.2 7.0 12.5 11.8 11.6 17.6 32.5 29.4 73.1 47.5 South Dakota 6.6 6.6 N/A 11.5 10.9 N/A 36.2 26.2 38.5 49.5 

Kansas 7.2 6.9 13.7 12.2 11.9 16.9 34.2 28.0 72.4 48.8 Tennessee 9.5 8.4 14.9 14.7 13.7 19.8 40.2 29.3 75.0 50.4 

Kentucky 9.1 8.8 13.5 15.2 14.8 19.8 35.5 31.2 74.3 49.5 Texas 8.3 7.7 14.2 13.6 12.8 18.8 37.6 24.3 64.7 43.2 

Louisiana 11.5 8.7 16.0 16.5 13.3 21.4 48.0 29.0 76.7 37.5 Utah 6.8 6.6 10.6 11.4 11.0 17.0 17.7 12.6 44.4 40.2 

Maine 6.8 6.8 9.0 10.7 10.7 11.7 35.0 35.0 35.5 43.1 Vermont 6.2 6.2 N/A 9.0 9.0 N/A 32.3 32.4 40.8 34.7 

Maryland 9.1 7.1 13.1 13.3 11.3 17.0 37.1 22.3 60.0 51.2 Virginia 8.2 7.2 12.7 12.3 11.2 16.7 32.2 20.6 63.7 47.1 

Massachusetts 7.9 7.3 11.9 11.3 10.7 15.8 30.2 21.8 58.4 63.8 Washington 6.1 5.6 9.8 10.6 9.9 13.5 30.9 25.9 52.9 46.0 

Michigan 8.3 7.0 14.7 12.5 11.1 19.4 36.6 27.1 75.7 46.5 West Virginia 9.6 9.4 13.1 14.4 14.3 19.6 36.5 35.2 75.4 43.7 

Minnesota 6.5 6.0 11.3 10.7 10.4 13.2 29.8 23.1 59.4 50.9 Wisconsin 7.0 6.3 13.6 11.4 10.6 17.9 32.5 24.5 82.2 48.9 

Mississippi 11.8 8.7 16.1 18.8 15.6 23.1 49.4 26.2 77.1 50.4 Wyoming 8.6 8.8 N/A 13.1 13.1 N/A 32.8 28.6 61.5 48.3 

N/A: Figure does not meet standards of reliability or precision or no data is available. 

*Includes races other than White and Black. 

72 State Data 
Child Health USA 2007 

Infant and Neonatal Mortality Rates (Deaths per 1,000 Live Births), by State and Race of Mother, 2005 

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

Infant Mortality Neonatal Mortality Infant Mortality Neonatal Mortality 

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

United States 6.87 5.73 13.73 4.54 3.79 9.07 Missouri 7.50 6.36 14.63 4.72 4.00 9.33 

Alabama 9.40 7.18 14.67 5.74 4.58 8.55 Montana 6.99 6.66 N/A 4.14 4.14 N/A 

Alaska 5.93 4.74 N/A 2.96 N/A N/A Nebraska 5.62 5.17 N/A 3.29 3.06 N/A 

Arizona 6.88 6.60 12.62 4.50 4.52 5.76 Nevada 5.77 5.22 13.67 3.49 3.26 7.46 

Arkansas 7.88 6.36 14.85 4.79 3.70 9.63 New Hampshire 5.27 5.01 N/A 4.30 4.13 N/A 

California 5.34 5.01 13.64 3.63 3.47 8.34 New Jersey 5.23 4.02 11.01 3.47 2.77 6.95 

Colorado 6.44 6.03 16.33 4.77 4.52 12.17 New Mexico 6.14 5.56 N/A 3.64 3.65 N/A 

Connecticut 5.82 4.91 13.45 4.19 3.80 8.14 New York 5.81 5.03 9.33 4.03 3.59 5.96 

Delaware 9.02 5.98 18.89 6.70 4.52 13.74 North Carolina 8.80 6.52 16.35 6.13 4.32 11.99 

District of Columbia 14.05 8.75 16.95 9.91 N/A 11.92 North Dakota 5.96 5.84 N/A 4.29 4.03 N/A 

Florida 7.20 5.67 12.02 4.53 3.52 7.72 Ohio 8.26 6.71 16.92 5.58 4.47 11.77 

Georgia 8.15 5.90 12.60 5.41 3.68 8.82 Oklahoma 8.05 7.27 15.35 4.79 4.35 9.75 

Hawaii 6.47 6.26 N/A 4.18 3.91 N/A Oregon 5.86 5.85 N/A 3.79 3.80 N/A 

Idaho 6.11 6.06 N/A 4.03 3.98 N/A Pennsylvania 7.30 6.18 14.12 5.17 4.41 9.74 

Illinois 7.42 5.70 16.35 4.98 3.87 10.75 Rhode Island 6.46 5.79 N/A 5.04 4.67 N/A 

Indiana 8.01 6.95 17.01 5.46 4.61 12.45 South Carolina 9.41 7.12 13.80 5.82 4.38 8.59 

Iowa 5.34 5.05 13.93 3.46 3.22 N/A South Dakota 7.24 6.04 N/A 4.54 4.53 N/A 

Kansas 7.37 6.64 17.59 4.89 4.44 10.55 Tennessee 8.86 7.41 13.96 5.65 4.32 10.28 

Kentucky 6.64 6.01 13.15 4.00 3.67 7.66 Texas 6.57 5.72 14.07 4.13 3.61 8.83 

Louisiana 10.06 7.04 14.87 5.76 4.10 8.37 Utah 4.46 4.39 N/A 3.01 2.96 N/A 

Maine 6.87 6.88 N/A 4.82 4.74 N/A Vermont 6.67 6.39 N/A 4.13 3.94 N/A 

Maryland 7.30 5.06 11.61 5.25 3.49 8.56 Virginia 7.47 5.80 14.10 5.14 4.01 9.56 

Massachusetts 5.15 4.84 8.18 3.72 3.51 6.14 Washington 5.09 4.81 10.87 3.07 2.90 6.15 

Michigan 7.92 5.80 18.26 5.47 3.89 13.06 West Virginia 8.11 7.93 N/A 5.09 5.07 N/A 

Minnesota 5.10 4.52 10.58 3.26 2.86 7.54 Wisconsin 6.61 5.44 17.66 4.48 3.77 11.48 

Mississippi 11.35 6.64 17.20 6.70 3.08 11.20 Wyoming 6.77 6.94 N/A 4.70 4.73 N/A 

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

*Includes races other than White or Black. 

**Includes Hispanics. 

State Data 73 
Child Health USA 2007 

City Data
 

The following section presents data on the health of 

infants living in cities compared to that of infants 

nationwide. Included are data on low and very low 

birth weight for infants that were born in U.S. cities 

with over 100,000 residents and infant mortality for 

infants born in cities with more than 250,000 

residents. 

The following measures indicate that the health 

status of infants living in large U.S. cities is generally 

poorer than that of infants in the Nation as a whole. 

In 2005, the percentage of infants born at low birth 

weight was 7 percent higher in cities compared to 

the national average (8.8 versus 8.2 percent). The 

infant mortality rate was also higher in cities, which 

may be at least partly attributable to the higher rate 

of low birth weight. In 2004, the city infant mortality 

rate was 7.4 per 1,000 live births, compared to a rate 

of 6.8 per 1,000 nationwide. 

City Data 75 
6 

Child Health USA 2007 

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 2005, 118,980 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 8.8 

percent of infants in U.S. cities. The 2005 percentage of urban infants born at low birth weight 

was 7 percent higher than the percentage among 

all U.S. infants (8.2 percent), though this gap has 

decreased somewhat since 1990. 

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 2005, nearly 1.7 percent of live births 

in cities with populations over 100,000 were of 

very low birth weight. This exceeded the rate of 

very low birth weight nationwide by 12 percent. 

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

Populations over 100,000: 1990–2005 Populations over 100,000: 1990–2005 

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

Statistics, National Vital Statistics System Statistics, National Vital Statistics System 

10
 10


9
 9
 8.8 

8.2 8
 8
 

7
 7
 

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

1990 1995 2000 2005
 

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

1990 1995 2000 2005
 

Percent of Infants

Percent of Infants

6
 

5
 

4
 

3
 

2
 2
 1.7 

1.5 1
 1


76 City Data 

3 

4 

5 
Child Health USA 2007 

INFANT MORTALITY 

In 2004, 6,482 infants born to residents of 

cities in the United States with populations over 

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

mortality rate in U.S. cities was 7.4 deaths per 

1,000 live births, which was higher than the rate 

for the Nation as a whole (6.8 per 1,000). 

Although the infant mortality rate in cities has Infant Mortality Rates in U.S. Cities:* 1990–2004 

consistently been higher than the rate nation- Source (II.2): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital 

wide, it has declined over the past decade, and the Statistics System 

disparity in infant mortality rates between infants 15 

in cities and the Nation as a whole has decreased 

by 50 percent. Between 1990 and 2004, the 14 

infant mortality rate in cities has declined by 13 

nearly one-third, while the nationwide decline 12 

Total U.S. Cities 

Total U.S. Population 

1990 1992 1994 1996 1998 2000 2002 2004 

during the same period was 25.3 percent.
 

Declines in infant mortality rates since 2000,
 

however, have been relatively small for both cities
 

and the population as a whole.
 

Rate per 1,000 Live Births

11 

10 

9 

8 

7 

6 

*Data for 1990–2002 were for cities with populations over 100,000; data after 2002 reflect cities with populations over 250,000. 

City Data 77 

7.4 

6.8 
Child Health USA 2007 

References 

Population Characteristics	 Health Status 

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DC: The Bureau; 2007. 

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http://www.census.gov/population/www/socdemo/hh-fam/cps2006.html, accessed 

5/21/07. 

I.3	 U.S. Bureau of the Census, Current Population Survey, Annual Social and Economic 

Supplements. Poverty and Health Statistics Branch/HHES Division. Historical 

Poverty Tables [Table 3]. http://www.census.gov/hhes/www/poverty/histpov/ 

perindex.html, accessed 9/20/07. 

I.4	 DeNavas-Walt, Carmen, Bernadette D. Proctor, and Cheryl Hill Lee, U.S. Census 

Bureau, Current Population Reports, P60-231, Income, Poverty, and Health Insurance Coverage in the United States: 2005, U.S. Government Printing Office, Washington, DC, 2006. http://www.census.gov/prod/2006pubs/p60-231.pdf, accessed 

5/10/07. 

I.5	 U.S. Department of Education, National Center for Education Statistics. The Condition of Education 2007 (NCES 2007-064). Washington, DC: U.S. Government 

Printing Office; 2007 June. http://nces.ed.gov, accessed 5/31/07. 

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ML. Births: Final data for 2005. National vital statistics reports; vol 56 no 6. 

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

I.7	 U.S. Department of Labor, Bureau of Labor Statistics. Employment characteristics of 

families in 2006 (USDL 07-0673). Washington, DC: The Department; May 2007. 

[Table 5] http://www.bls.gov/news.release/pdf/famee.pdf, accessed 5/21/07 

I.8	 Iruka I, Carver P. Initial results from the 2005 NHES Early Childhood Program Participation Survey (NCES 2006-075). Washington, DC: U.S. Department of Education, National Center for Education Statistics; 2006. 

I.9	 U.S. Department of Health and Human Services, Health Resources and Services 

Administration, Maternal and Child Health Bureau. The National Survey of Children 

with Special Health Care Needs Chartbook 2005–2006. Rockville, Maryland: U.S. 

Department of Health and Human Services, 2007. 

78	 References 

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National Vital Statistics System. Unpublished Data. 

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vital statistics reports; vol. 56 no 10. Hyattsville, MD: National Center for Health 

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on Trends in the Health of Americans. Hyattsville, MD: 2007. 

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Vol. 17. Rev ed. Atlanta: U.S. Department of Health and Human Services, Centers 

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accessed 8/27/06. 

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National Hospital Discharge Survey, 2005. Unpublished data. 

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Office; 2006. 

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States, 2005. MMWR, Vol. 55, No. SS-5; 2006. 

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2005. Atlanta, GA: U.S. Department of Health and Human Services; 2006 Nov. 

http://www.cdc.gov/std/stats/, accessed 5/31/07. 
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II.11	 U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. NATIONAL SURVEY ON DRUG 

USE AND HEALTH, 2005 [Computer file]. ICPSR04596-v1. Research Triangle 

Park, NC: Research Triangle Institute [producer], 2006. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2006-11-16. 

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(December 21, 2006). Decline in daily smoking by younger teens has ended. University of Michigan News and Information Services: Ann Arbor, MI.[On-line]. Available: http://www.monitoringthefuture.org, accessed 5/31/07. 

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the 2005 National Survey on Drug Use and Health: National Findings (Office of 

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5/24/07. 

Health Services Financing and Utilization 

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

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(National). 1995-2005: The Centers. http://www.cms.hhs.gov/MedicaidEarlyPeriodicScrn/, accessed 5/23/07. 

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National Health Interview Survey, 2005. 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: FY 2006 annual enrollment report. Baltimore, MD: The Centers; 2007. 

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df, accessed 9/20/07. 

IV.2	 Centers for Medicare & Medicaid Services. Annual EPSDT participation report, 

FY 2004 (Form CMS-416). Baltimore, MD: The Centers. June 2006. 

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References 79 
Child Health USA 2007 

Contributors 

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, NIH 

Substance Abuse and Mental Health Services 

Administration 

Other Federal and Non-Governmental Contributors 

American Academy of Pediatrics 

U.S. Census Bureau 

U.S. Department of Education 

U.S. Department of Labor 

United Nations 

Photography Copyrights 

Cover; title page; pages 20, 29, and 39: first 

photo, Naomi Tein; second, third and fourth 

photos, iStockPhoto; fifth photo, Stacy Gleason. Pages 5 and 19, Sheryl Mathis; page 8, 

Renee Schwalberg; pages 11, 30, 64, and 67, 

iStockphoto.com; page 44, Christin Hitchcock; 

page 53, Jennifer Decker; page 58, Naomi Tein; 

page 75, Kate Lynch Machado; and page 80, 

Nanci Cartwright. 

80 Contributors