Child Health USA

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Child Health USA

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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

Child Health USA 2007

Table of Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Population Characteristics . . . . . . . . . . . . . . . . . . . . . . . 11
Population of Children . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Children of Foreign-Born Parents . . . . . . . . . . . . . .13
Children in Poverty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
School Dropouts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Maternal Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Working Mothers and Child Care . . . . . . . . . . . . . .17
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

Preface
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 read-

ers 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

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 main
tain 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 pro
portion 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 moth
ers 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 uti
lization, 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 single
ton 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 indus
trialized world (6.8 deaths per 1,000 live births in
2004).

Introduction

Child Health USA 2007

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. How
ever, 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 vari
cella (chicken pox) vaccine.
Physical activity is another important protec
tive factor in lifelong health that begins in early
childhood. Results from the 2005 Youth Risk
Behavior Surveillance System show that 35.8 per
cent of high school students met the currently
recommended levels of physical activity, and 54.2
8

Introduction

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 per
cent of 12th-graders).
The period of adolescence introduces addi
tional 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 per
cent) than females (19.5 percent). However, by
12th grade, females were more likely to be cur
rently 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 fol
lowed 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 per
cent of females aged 14–19 years and 44.8 per
cent 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 Behav
ior 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 dur
ing 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 ado
lescents, with 16.5 percent reporting past-month
use in 2005, while marijuana was the most com
monly used illicit drug (6.8 percent).
The health status and health services utiliza
tion indicators reported in Child Health USA can
help policymakers and public health officials ana
lyze 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 peo
ple to appropriate services; building community
supports; and supporting approaches that pro
mote policy change. Such preventive efforts and
health promotion activities are vital to the con
tinued improvement of the health and well-being
of America’s children and families.
Introduction

Child Health USA 2007

Population Characteristics

The population of the United States is becoming
increasingly diverse, which is reflected in the socio
demographic characteristics of children and their
families. The percentage of children who are
Hispanic or Asian/Pacific Islander has more than
doubled since 1980, while the percentage who are
non-Hispanic White has declined. The percentage of
children who are Black has remained relatively
stable. This 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

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 pop
ulation. Young adults aged 20–24 years com
posed slightly more than 7 percent of the popu
lation, 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 chil
dren 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, how
ever, 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 per
cent of all children in 1980 and more than 4 per

cent 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

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

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

20–24 Years

7.1%

15–19 Years

7.1%

10–14 Years

6.9%

25–64 Years
53.1%

5–9 Years

6.6%

Under 5 Years

6.8%

Population Characteristics

65 Years
and Older
12.4%

American Indian/

Alaska Native

0.9%

Two Races or More

2.5%

Asian/Pacific Islander

4.1%

Non-Hispanic White
57.6%

Hispanic
20.3%
Non-Hispanic
Black
14.6%

Child Health USA 2007

CHILDREN OF FOREIGN
BORN PARENTS
The foreign-born population in the United
States has increased substantially since the 1970s,
largely due to immigration from Asia and Latin
America. In 2006, more than 21 percent of chil
dren living in the United States had at least one
foreign-born parent. Of all children, 17.2 per
cent 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 Under Age 18, by Nativity of Child and Parent(s),* 2006
Source (1.2): U.S. Census Bureau, Current Population Survey

Children’s health insurance coverage also var
ied by nativity in 2006. Native-born children
with native parents were the most likely to be
insured (92.1 percent), while foreign-born chil
dren 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 Poverty Level* and Nativity of Child
and Parent(s),** 2006
Source (1.2): U.S. Census Bureau, Current Population Survey
Below 100%
of Poverty

100–199%
of Poverty

200% of Poverty
and Above

Other 4.8%
19.2

15.4
Foreign-Born Child
and Parent
3.9%
Native Child,
Foreign-Born Parent
17.2%

65.4

Native Child
and Parent
Native Child
and Parent
74.4%

20.2

28.0

51.9

Native Child,
Foreign-Born Parent
30.4

30.8

38.9

Foreign-Born
Child and Parent
20
*“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.

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

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 repre
sented 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 particu
larly 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 liv
ing with a female head of household with no

husband present lived in poverty, compared to
8.5 percent of children in married-couple fami
lies (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

Families Below 100 Percent of Poverty Level,* by Family Type,
2005**

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

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

Percent of Children

Black
Hispanic
34.5

28.3

Total
20
Non-Hispanic White

Male Householder,
No Wife Present
8.7%

17.6
10.0

Female Householder,
No Husband Present
52.8%
1976

1980

1984

1988

1992

1996

2004

2005

*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.

Married-Couple
Families
38.4%

Population Characteristics

*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.

Child Health USA 2007

In addition, the National Center for Health Sta
tistics 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
Hispanic

30
Percent of Population

SCHOOL DROPOUTS
As of October 2005, there were nearly 3.5 mil
lion high school status dropouts1 in the United
States, representing 9.4 percent of the population
aged 16–24 years. The dropout rate has gener
ally 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
high dropout rate among Hispanics born outside
of the United States (36.5 percent). First genera
tion 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/eth
nic groups (11.6 percent).
According to the U.S. Department of Com
merce, high school dropouts are more likely to
be unemployed and, when they are employed,
earn less than those who completed high school.

25
22.4

Non-Hispanic Black

Total
20
Non-Hispanic White
15

10.4
9.4

6.0

1992

1994

1996

1998

2000

2002

2004

2005

*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

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 per
cent, 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 Black

Non-Hispanic White

20–29 Years
50.8%

17 Years and
Under 1.9%

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

18–19 Years
8.8%

18–19 Years
10.7%

30–39 Years
38.9%

Population Characteristics

20–29 Years
56.3%

20–29 Years
56.8%

18–19 Years
5.3%

40–54 Years
3.0%

Hispanic

17 Years
and Under
6.3%
40–54 Years
2.2%

17 Years
and Under
5.3%
30–39 Years
23.9%

40–54 Years
2.0%

30–39 Years
27.6%

Child Health USA 2007

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 moth
ers of other marital statuses (data not shown).
In 2005, 40 percent of children under 6 years
of age did not require nonparental child care,

while 60 percent required at least one child care
arrangement. Overall, 60 percent of children
with at least one child care arrangement received
center-based care, 22 percent received care from
a nonrelative, and 35 percent received care from
a relative other than a parent (data not shown).
Among children who received child care, 56.9
percent of children aged 3–5 years received cen
ter-based care compared to 22.8 percent of chil
dren aged 1–2 and 11.8 percent of children less
than 1 year of age.

Weekly Child Care Arrangements* for Children Aged 5 Years
and Younger,** by Age, 2005

Mothers in the Labor Force, by Age of Child: 1975–2006
Source (1.7): U.S. Department of Labor, Bureau of Labor Statistics

Source (1.8): U.S. Department of Education, National Center for Education Statistics
80

With Children Aged 6–17

Under 1 Year
1–2 Years
3–5 Years

76.7

70
With Children Under Age 6
63.5
60

Percent of Children

Percent of Mothers

60
50

58.0

56.9
47.0

40
30

27.0
13.9

10
1975

1980

1985

1990

1995

2000

2006

22.8

20.2 20.7 21.2

No Nonparental
Arrangements

Relative Care

15.9
11.0

Nonrelative Care

11.8

Center-Based
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

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 gener
ally.” The 2005–2006 National Survey of
CSHCN provides information about the preva
lence 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 esti
mated 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). Over
all, 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 per
cent) were the health condition most commonly

reported by parents of CSHCN. Other com
monly reported conditions were asthma (39 per
cent), 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
with Special Health Care Needs

53.0

Allergies
38.8

Asthma

21.1

Emotional Problems
15.1

Migraine or Frequent Headaches

11.4

Mental Retardation
Autism

5.4
10

30
40
Percent of CSHCN

*Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder

Population Characteristics

Daily Activities Affected
Usually, Always
or a Great Deal
24.0%

29.8

ADD/ADHD*

Daily Activities
Never Affected
37.6%
Daily Activities
Moderately Affected
Some of the Time
38.5%

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

Health Status – Infants

Child Health USA 2007

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 rea
son, the American Academy of Pediatrics recom
mends exclusive breastfeeding—without supple
mental 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,

Breastfed Infants,* by Duration and Race/Ethnicity, 2005
Source (II.1): Centers for Disease Control and Prevention, National Immunization Survey

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

Percent of Infants

100

Ever Breastfeeding
Breastfeeding at 6 Months

79.0

74.1

72.9

80
67.3

70
60

55.4
47.5

50
40

39.1

42.0

41.1

33.7

22.8

70
60
50
40
30

10
Total

Non-Hispanic Non-Hispanic
White
Black

*Includes exclusive and supplemental breastfeeding.

Exclusive** Breastfeeding at 6 Months
Breastfeeding at 12 Months

81.4
Percent of Intants

100

Hispanic

Asian/
American Indian/
Pacific Islander Alaska Native

24.2

20.1

15.8

13.9
6.7
Total

5.4

Under 20 Years

17.3

10.1
20–29 Years

30 Years and Older

*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

Child Health USA 2007

Health Status - Infants

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

14.0

Non-Hispanic Black

11
Percent of Infants

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 per
cent 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

Asian/Pacific Islander

Hispanic
All Races

American Indian/
Alaska Native

Non-Hispanic White

8.2
8.0

7.4
7.3
6.9

1989

1991

1993

1995

1997

1999

2001

2003

2005

Child Health USA 2007

tality 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
3.5
Non-Hispanic Black
3.3

3.0

2.5
Percent of Infants

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 sig
nificantly increased risk of severe problems,
including physical and visual difficulties, devel
opmental delays, and cognitive impairment,
requiring increased levels of medical, educa
tional, 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, com
pared 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 mor

American Indian/
Alaska Native

2.0
All Races
Asian/Pacific Islander
Non-Hispanic White

1.5

Hispanic

1.2
1.0

1989

1993

1997

2001

Health Status - Infants

2005

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 mal
formations, and conditions occurring in the
perinatal period.

Postneonatal. In 2005, 9,670 infants between

the ages of 28 days and 1 year died, representing
a postneonatal mortality rate of approximately
2.3 deaths per 1,000 live births. This rate repre
sents a 3 percent increase over the previous year.
Postneonatal mortality is generally related to
Sudden Infant Death Syndrome (SIDS), con
genital malformations, and unintentional
injuries.
Neonatal and postneonatal mortality rates
vary by maternal race and ethnicity; in 2005,

rates were highest among infants born to nonHispanic Black women (9.4 and 4.9 per 1,000
live births, respectively). Both of these rates are
more than twice the respective rates of infants
born to non-Hispanic White and Hispanic
women.

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
Statistics, National Vital Statistics System

Source (II.2): Centers for Disease Control and Prevention, National Center for Health
Statistics, National Vital Statistics System
10

10
9.4

9
8

7
6
5

4.5

4
3

7
6
5

3
2.3
2

Health Status - Infants

Non-Hispanic White

Non-Hispanic Black

Hispanic

4.9

Total

3.9

3.7

Deaths per 1,000 Live Births

1.9

2.0

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

Child Health USA 2007

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 per
cent 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 preg
nancy, childbirth, or up to 42 days postpartum.
The maternal mortality rate among non-His
panic 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).

The risk of maternal death increases with age,
regardless of race. In 2005, the maternal mortal
ity 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
Statistics, National Vital Statistics System

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

39.2

35
30
25
20
15

15.1
11.7
9.6

10
5

Total

Non-Hispanic White

Non-Hispanic Black

Hispanic

Maternal Deaths per 100,000 Live Births

38.0

35
30
25
20
15
10

10.7

11.8

20-24 Years

25-29 Years

12.8

7.4

Under 20 Years

30-34 Years

35 Years and Older

Health Status - Infants

Child Health USA 2007

infants (5.7 and 5.8 per 1,000 live births, respec
tively). 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 propor
tional 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 preg
nancy outcomes.
Infant Mortality Rates,* by Maternal Race
Source (II.2, 3): Centers for Disease Control and Preven
Statistics System
20

14
Deaths per 1,000 Live Births

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
include a rise in both preterm and multiple

births. The rapid decline in infant mortality that

began in the mid-1960s slowed among both

Blacks and Whites during the 1980s. Major

advances, including the approval of synthetic

surfactants and the recommendation that infants

be placed on their backs when sleeping, may

have contributed to a renewed decline during the
1990s.
In 2005, the mortality rate among non-Hispanic Black infants was 14.3 deaths per 1,000
live births. This is more than twice the rate
among non-Hispanic White and Hispanic

All Races

12
10
8
6

Non-Hispanic Wh

4
2

1985
*Under 1 year of age.

Health Status - Infants

1990

Child Health USA 2007

INTERNATIONAL INFANT
MORTALITY
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 repre
sents 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 def
inition, 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).

International Infant Mortality Rates, Selected Countries, 2004
Source (II.4): Centers for Disease Control and Prevention, National Center for Health Statistics
Singapore

2.0

Hong Kong

2.5

Japan

2.8

Sweden

3.1

Norway

3.2

Finland

3.3

Spain

3.5

Czech Republic

3.7

France

3.9

Portugal

4.0

Germany

4.1

Greece

4.1

Italy

4.1

Netherlands

4.1

Switzerland

4.2

Belgium

4.3

Denmark

4.4

Austria

4.5

Israel*

4.5

Australia

4.7

Ireland

4.9

Scotland

4.9

England and Wales

5.0

Canada

5.3

Northern Ireland

5.5

New Zealand

5.7

Cuba

5.8

Hungary

6.6

Poland

6.8

United States

6.8
1

4
5
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

Health Status – Children

Child Health USA 2007

VACCINE-PREVENTABLE
tion for children living in high-risk areas was rec- of age who were too young to have received the
DISEASES
ommended starting in 1996.
first three doses of acellular pertussis vaccine.
The number of reported cases of vaccine-pre
While the number of reported cases of several This age group accounted for 13 percent of all
ventable diseases has generally decreased over the vaccine-preventable diseases decreased from reported pertussis cases in 2005.
past several decades. In 2005, there were no 2004 to 2005, the number of reported cases of
reported cases of diphtheria in the entire H. Influenzae, rubella, and pertussis, increased
U.S. population, and no cases of tetanus or polio over the same period. In 2005, the incidence of
among children under 5 years of age. Only one reported pertussis among the entire U.S. popu
case of rubella was reported among children lation (8.7 per 100,000 people) increased just
under 5 years of age, the first to be reported in slightly after doubling from 2003 to 2004. This
this age group since 2001.
rate was highest among children under 6 months
From 2004 to 2005, the number of reported
Reported Cases of Selected Vaccine-Preventable Diseases Among Children Under
cases of measles, mumps, and hepatitis A and B
Age 5, 2005
decreased among children under 5 years of age. Source (II.5): Centers for Disease Control and Prevention
Rates of hepatitis B infection have declined
Diphtheria 0
98 percent among children under 13 years of
Polio 0
age since 1990, with the implementation of a
Tetanus 0
national strategy to eliminate the disease. This
Rubella 1
strategy includes routine screening of pregnant
Hepatitis B 5
women for the hepatitis B virus and routine vac
Measles 10
cination of infants and children. It is important
Mumps 21
to note that since most hepatitis B infections
208
Hepatitis A
among infants and young children are asympto
H. Influenzae
358
matic, the reported number of cases likely
Pertussis
6,394
underestimates the incidence in these age
groups. The overall incidence of Hepatitis A has
200
400
600
800 1,000
6,000 6,200 6,400 6,600 6,800 7,000
Number of Reported Cases
also dropped dramatically since routine vaccinaHealth Status - Children

Child Health USA 2007

PEDIATRIC AIDS
Acquired immunodeficiency syndrome
(AIDS) is caused by the human immunodefi
ciency 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 dif
ficult 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 dispropor
tionately 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

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

1,000
894

Number of Cases

800

879

1,613

Non-Hispanic White
799

5,631

Non-Hispanic Black
663

600

Hispanic

509

400

Asian/Pacific Islander 54

329
241

American Indian/
Alaska Native 32

187

200

1,738

129

121

105

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

1,000

2,000

3,000
4,000
Number of Cases

5,000

6,000

*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.

Health Status - Children

Child Health USA 2007

HOSPITALIZATION
In 2005, there were 3.5 million hospital dis
charges among youth aged 1–21 years, or 4.1
hospital discharges per 100 children. This repre
sents little change from 2004. Hospital dis
charge 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 chil
dren 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 dis
orders 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

258

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

52
44

Injury
Endocrine, Metabolic, and Immunity*
Diseases of the Genitourinary System
Infectious and Parasitic Diseases

37
22
21

10–14 Years
Mental Disorders

104

Diseases of the Digestive System

Injury

50
46

Diseases of the Respiratory System

Endocrine, Metabolic, and Immunity*

15–19 Years
Pregnancy/Childbirth

470

Mental Disorders

211

Injury

Diseases of the Digestive System

Diseases of the Respiratory System

20–21 Years
Pregnancy/Childbirth

439

Mental Disorders

Injury

Diseases of the Digestive System

Diseases of the Respiratory System

65
33
37
23
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

Child Health USA 2007

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

Hospital Discharges per 10,000 Children

HOSPITAL DISCHARGE
TRENDS
Three types of health problems (respiratory
diseases, digestive diseases, and injury) accounted
for 44 percent of hospital discharges among chil
dren aged 1–14 years in 2005. Since 1985, over
all 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. Simi
larly, the hospital discharge rate among children
for diseases of the digestive system dropped 16.2
percent.

70.0

Diseases of the Digestive System

Injury

31.0
26.0

1990

Health Status - Children

1993

1996

1999

2002

2005

Child Health USA 2007

CHILD ABUSE AND NEGLECT
State child protective services (CPS) agencies
received approximately 3.3 million referrals,
involving an estimated 6 million children, alleg
ing abuse or neglect in 2005. More than half of
these reports were made by community profes
sionals, such as teachers, other educational per
sonnel, police officers, medical personnel, and
daycare providers.
Investigations determined that an estimated
899,000 children were victims of abuse or neg
lect 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 maltreat

ment (7.6 per 1,000 children), followed by phys
ical abuse (2.0 per 1,000). Other types of abuse
included sexual abuse, psychological maltreat
ment, 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. Remain
ing types of perpetrators included other relatives

(6.8 percent), unmarried partners of parents (3.8
percent), and professionals such as daycare work
ers and residential facility staff (0.9 percent). Fos
ter parents accounted for 0.5 percent of perpetra
tors, 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

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

Neglect

7.6

Physical Abuse
Sexual Abuse

1.1

Psychological
Maltreatment
Medical Neglect

Professionals*** 0.9%

Unmarried Partner

of Parent**

3.8%

0.9
0.2

Parent
79.4%

Other Relative
6.8%

1.7

Other Abuse
Unknown

Other 5.5%
Unknown/Missing 3.7%

2.0

0.1
2

4
Rate per 1,000 Children

*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

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-year
olds was 16.3 per 100,000. The leading cause of
death among children in the younger age group
continues to be unintentional injury, which Leading Causes of Death Among Children Aged 1–14, 2005
accounted for 35.0 percent of all deaths in this Source (II.3): Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital
age group in 2005. The next most common Statistics System
1–4 Years
cause of death was congenital malformations
Unintentional Injury
10.3
(birth defects), followed by malignant neoplasms
Congenital Malformations
3.2
(cancer), homicide, and diseases of the heart.
Malignant Neoplasms
2.3
Unintentional injury was also the leading
Homicide
2.3
cause of death among older children, accounting
Diseases of the Heart
0.9
0.7
for 36.6 percent of deaths among 5- to 14-year Influenza and Pneumonia
Septicemia 0.5
olds. This was followed by malignant neoplasms,
congenital malformations, homicide, suicide,
5–14 Years
Unintentional Injury
and diseases of the heart.
6.0
Malignant Neoplasms

2.5
1.0

Congenital Malformations
Homicide

0.8

Suicide
Diseases of the Heart
Influenza and Pneumonia

0.7
0.6
0.3

Death Rate per 100,000 Population in Specified Age Group

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 uninten
tional 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
Motor Vehicle Crashes

3.2

Drowning

3.0

Fires and Burns

1.5

Suffocation

0.9

5–14 Years
Motor Vehicle Crashes

3.3

Drowning

0.7

Fires and Burns
Suffocation

0.6

0.1

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

Health Status – Adolescents

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.

lescents 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 per
cent). 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.

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 ado

Birth Rates Among Adolescent Females, by Maternal Age
and Race/Ethnicity, 2005

Birth Rates Among Females Aged 15–19, by Maternal
Race/Ethnicity: 1990–2005

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

120

120
103.0

100
87.6
80

69.9

48.5

48.0
34.9

30.1

30.5

21.4
20

11.5
0.7
Total

140

134.6
10–14 Years
15 –17 Years
18–19 Years

0.2
Non-Hispanic
White

Health Status - Adolescents

8.2
1.7
Non-Hispanic
Black

1.3
Hispanic

0.2

Live Births per 1,000 Females

140

Hispanic
100

American Indian/Alaska
Native

Non-Hispanic Black
Non-Hispanic White

60
40

81.7
60.9
52.7

Asian/Pacific Islander
25.9
17.0

0.9

Asian/
American Indian/
Pacific Islander Alaska Native

1990

1995

2000

2005

Child Health USA 2007

SEXUAL ACTIVITY
In 2005, 46.8 percent of high school students
reported ever having had sexual intercourse, rep
resenting 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 inter
course. 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 stu
dents were most likely to report ever having sex
ual intercourse (67.6 percent), and also most
likely to report condom use during their last sex
ual encounter (68.9 percent of sexually active
students). Hispanic students were second most
likely to report ever having had sexual inter
course (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 cur-

Sexual Activity Among High School Students, 2005
Source (II.9): Centers for Disease Control and Prevention, Youth Risk Behavior Survey

rently sexually active: 27.4 percent used a con
dom during their last intercourse, while 22.0
percent did not. In other words, 55.5 percent of
sexually active 12th graders used a condom dur
ing 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 con
dom during their last sexual encounter.

Condom Use Among Sexually Active High School Students,
by Grade, 2005
Source (II.9): Centers for Disease Control and Prevention, Youth Risk Behavior Survey
50

Intercourse in Past
3 Months, No Condom at
Last Intercourse
12.6%

Abstinent*
53.2%

Percent of Students

Intercourse in Past
3 Months, Used
Condom at Last
Intercourse
21.3%

Total Sexually Active*
Condom Use at Last Intercourse
No Condom Use at Last Intercourse

39.4
22.0
15.1

29.2

10.0

21.9
20
5.6

27.4

24.3

19.2

10
16.3

No Intercourse
in Past 3 Months
12.9%
9th Grade
*Have never had intercourse.

49.4

10th Grade

11th Grade

12th Grade

*Had sexual intercourse during the 3 months preceding the survey.

Health Status - Adolescents

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 cer
tain sexually transmitted infections (STIs), such
as chlamydia, gonorrhea and genital human
papillomavirus (HPV). Within each of these age
groups, reported rates of chlamydia and gonor
rhea infections were highest among non-His
panic 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), fol
lowed 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, respec
tively, 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

5,360.0

Total

5,500

Non-Hispanic
White

4,400

Non-Hispanic
Black
Hispanic

3,300

2,979.8

2,675.3 American Indian/
Alaska Native
2,200
1,674.9

1,621.0
1,100

1,839.7

1,719.4
942.7

769.6

Rate per 100,000 Females

5,500

Total
Non-Hispanic White

4,400

Non-Hispanic Black
Hispanic

3,300

American Indian/
Alaska Native
2,200

1,100
438.2
120.0

15–19 Years

20–24 Years

Chlamydia
42

Health Status - Adolescents

2,452.9

2,106.3

219.6 369.0

506.8

15–19 Years

161.0

259.4

20–24 Years

Gonorrhea

475.8

Child Health USA 2007

ADOLESCENT AND YOUNG
sons) were adolescents and young adults. Since combat the disease. Part D of HRSA’s Ryan
ADULT HIV/AIDS
the beginning of the epidemic, 9,887 people in White HIV/AIDS Program provides family-cen
Acquired immunodeficiency syndrome this age group have died with the disease. While tered, comprehensive care to children, youth and
(AIDS) is caused by the human immunodefi the estimated number of people diagnosed with women with HIV/AIDS and their families.
ciency virus (HIV), which damages or kills the HIV/AIDS increased 6.6 percent in 2005, the 1 Includes persons with a diagnosis of HIV infection only, a diagnosis
of HIV infection and a later AIDS diagnosis, and concurrent
cells that are responsible for fighting infection. number of deaths of people with the disease has
diagnoses of HIV infection and AIDS in 33 states and dependent
AIDS is diagnosed when HIV has weakened the decreased in recent years due, in part, to the
areas with confidential name-based reporting.
immune system enough that the body has a dif availability of effective prescription drugs to
ficult time fighting infections. In 2005, there Number of Persons Aged 13–24 Diagnosed with and Living with HIV/AIDS,* and Dying
were an estimated 19,134 people aged 13–24 with AIDS, by Age, 2005
years living with HIV/AIDS,1 representing 4.0 Source (II.6): Centers for Disease Control and Prevention, HIV/AIDS Surveillance System
percent of all cases.
43
13–14 Years
An estimated 5,132 people aged 13–24 years
1,213
15–19 Years
were diagnosed with HIV/AIDS in 2005, repre Diagnosed with HIV/AIDS
20–24 Years
3,876
senting 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
1,209
HIV/AIDS cases, respectively, this represents an
4,101
Living with HIV/AIDS
increase since 2004 of 30 percent among adoles
13,824
cents aged 13–14 years and 16.6 percent among
those aged 15–19. Comparatively, the age group
14
with the next highest percentage increase was 50
to 54-year-olds (11.6 percent).
Dying with AIDS 42
The number of AIDS cases diagnosed among
157
people aged 13–24 years was 2,369 in 2005, and
3,000
12,000
13,000
14,000
15,000
1,000
2,000
4,000
41,146 since the epidemic began in the early
Number of Persons
1980s (data not shown). Among people who
*Includes persons with a diagnosis of HIV infection only, a diagnosis of HIV infection and a later AIDS diagnosis, and concurrent diagnoses of HIV
died with AIDS in 2005, 1.3 percent (213 per- infection and AIDS in 33 States and dependent areas with confidential name-based reporting.
Health Status - Adolescents

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 com
mon among children in younger grades (60.4
percent of 9th-graders) than in the older grades
(49.2 percent of 12th-graders). High school stu
dents 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 stu
dents reported watching television for 3 or more
hours on an average school day.
The HealthierUS Initiative—available online at
www.healthierus.gov—provides credible, accu
rate 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
100

Total
Non-Hispanic White
Non-Hispanic Black
Hispanic
68.7

90
80
Percent of Students

PHYSICAL ACTIVITY
Results from the 2005 Youth Risk Behavior
Surveillance System show that 35.8 percent of
high school students met the currently recom
mended levels of physical activity and 68.7 per
cent of students met the previously recom
mended standard for physical activity in the
previous week. Current physical activity stan
dards 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 mod
erate physical activity.
Nationwide, 54.2 percent of high school stu
dents were enrolled in a physical education class
on one or more days a week, although the per
centage 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 per
centage of students attending daily physical edu
cation classes has dropped from 42 percent in
1991 to 33.0 percent in 2005. Among those stu
dents who attended physical education classes,
84.0 percent reported exercising or playing
sports for more than 20 minutes during an
average class.

70.2

69.4
62.0

60
50
40
30

35.8

38.7
29.5

32.9

14.4
9.6

10
Met Currently Recommended Levels
of Physical Activity*

Met Previously Recommended Levels
of Physical Activity**

8.1

10.6

No Vigorous or Moderate
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

Child Health USA 2007

MENTAL HEALT H
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 emo
tional 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 dif
ference by age group or race and ethnicity; how
ever, 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, com
pared 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-year
olds 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
Youth Aged 12–17, by Age and Sex, 2005

Mental Health Treatment/Counseling* in the Past Year Among
Youth Aged 12–17, by Family Income, 2005

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

Female
Male
24.1

Percent of Youth

21.5
19.6

20.7

21.8
16.4

15
10

22.4
20.8

19.9

15
10
5

Total

12–13 Years

14–15 Years

16–17 Years

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

24.9

23.7
21.7
Percent of Youth

30
26.9

Health Status - Adolescents

Total

Less Than $20,000 $20,000–49,999 $50,000–74,999

$75,000 or More

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

Child Health USA 2007

Depression was the leading reason reported for
mental health treatment among 12- to 17-year
olds (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 treat
ment.)
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 pro
gram 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.)

Treatment/Counseling*

Reasons for Mental Health
Aged 12–17 Who Received Treatment, 2005

in the Past Year Among Youth

Source (II.11): Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health
44.2

Felt Depressed

24.8

Breaking Rules or Acting Out

Family/Home Problems

23.5

22.6

Problems at School

Suicidal Thoughts or Attempts

17.0

Felt Very Afraid or Tense

16.6

Problems with Friends

15.0

13.2

Trouble Controlling Anger

Eating Problems

Diagnosed Mental Disorder

7.8

1.9

28.8

Other Reasons

20
30
Percent of Youth Receiving Treatment

*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

Child Health USA 2007

Health Status - Adolescents

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 adoles
cents has declined across all demographic groups
consistently, which is likely to have important
long-term health consequences for this genera
tion of adolescents. Despite this decline, certain

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 col
lege plan (23.2 versus 7.1 percent). White ado
lescents 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
12th Grade
10th Grade
30
Percent of Students

CIGARETTE SMOKING
Between 2005 and 2006, cigarette smoking
declined slightly among 8th-, 10th- and 12th
graders, according to the annual Monitoring the
Future Study. The largest decrease in the per
centage 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 con
tributed to the decline include increases in per
ceived risk and personal disapproval of smoking,
higher cigarette prices, and anti-smoking adver
tising 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

25
21.6

8th Grade
20

14.5

8.7

1975

1980

1985

1990

1995

2000

2006

Child Health USA 2007

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 cig
arettes a day was considered a great risk by 68.3

percent of adolescents, which represents a signif
icant increase since 2002 (63.1 percent). Drink
ing 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
20
16.5
16
Percent of Youth

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 stimu
lants (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

12
9.9
8

6.8
3.3

1.2
Alcohol

Any Illicit Drug*

Marijuana/
Hashish

Non-medical Use
of Psychotherapeutics**

Inhalants

0.8
Hallucinogens**

*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

Child Health USA 2007

VIOLENCE
Violence among adolescents is a critical public
health issue in the United States. In 2005, homi
cide 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-His
panic 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 signifi
cantly 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
30 Days, by Sex and Race/Ethnicity: 1993–2005

High School Students Threatened or Injured with a Weapon
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

Hispanic Male
Non-Hispanic White Male

35
31.4
29.8

Non-Hispanic Black Male

23.7

20
Hispanic Female
15

Non-Hispanic Black Female

9.4
7.8
6.0

Non-Hispanic White Female
5

1993

1995

1997

Health Status - Adolescents

1999

2001

2003

2005

30
Percent of Students

Percent of Students

25
20

Non-Hispanic Black

Hispanic

Non-Hispanic White

15
9.8
8.1
7.2

10
5

1993

1995

1997

1999

2001

2003

2005

Child Health USA 2007

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. Unin
tentional 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 sui
cides 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 signifi
cant contributor to these deaths: recent data sug-

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 popu
lation in 2005, about half the rate of motor vehi
cle 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
Statistics, National Vital Statistics System

31.4

Unintentional Injury

23.0

Motor Vehicle Traffic

9.9

Homicide

Firearms

12.3

7.7

Suicide

4.0

Poisoning
3.5

Malignant
Neoplasms (Cancer)

Diseases of the Heart

Drowning

1.8

10
15
20
25
Death Rate per 100,000 Population

1.6

10
15
Death Rate per 100,000 Population

Health Status - Adolescents

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 Sur
veillance 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, sui
cide accounted for 28 percent, and 4 percent
were considered unintentional. The 2005 Youth
52

Health Status - Adolescents

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
12.2

Motor Vehicle Occupant

Pedestrian

1.2

Motorcyclist

1.2

Pedal Cyclist

0.2

Firearms Mortality by Intent
8.3

Homicide

Suicide

Unintentional

3.5
0.5

Unknown
0.1
3

6
9
Death Rate per 100,000 Population

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 socio
economic 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

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 popula
tion. 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 fam
ily 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 cov
erage (67.2 percent) or be uninsured (19.3 per

cent), and were least likely to have private cover
age (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,
by Race/Ethnicity and Type of Coverage,* 2006

Health Insurance Coverage Among Children Under Age 18,
by Poverty Level* and Type of Coverage,** 2006

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

Total
Non-Hispanic White
Non-Hispanic Black
Hispanic

90
76.9

Percent of Children

80
70

100

64.6

60
50

49.4

43.5 42.3

40.9

40
29.8

22.1

22.0

11.7

10
Private Coverage

Public Coverage

14.0
7.3
No Coverage

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

Health Services Financing and Utilization

Less Than 100% of Poverty
100–199% of Poverty
200–299% of Poverty
300% of Poverty or Above

90.0

90
Percent of Children

100

72.7
67.2

70
60
50

45.1

45.7

40
30
20

19.5

22.8

19.3 17.1
9.4

10
Private Coverage

Public Coverage

12.1
5.4
No Coverage

*The U.S. Census Bureau poverty threshold for a family of four was $20,444 in 2006. **Totals equal
more than 100 percent because children may have more than one type of coverage.

Child Health USA 2007

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 pre
vious 12 months, while the remaining 8.8 per
cent were uninsured for all or some part of the
year. At the time of the interview, almost 97 per
cent 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 unin
sured 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 man-

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
Insurance
2.0%

Uninsured
3.5%
Private

and Public

7.4%

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 spe
cialists, such as cardiologists or pulmonologists.
Other services needed by a smaller proportion of
children include eyeglasses or vision care (33 per
cent of CSHCN), mental health care (25 per
cent), dental care other than preventive care (24
percent), and physical, occupational, or speech
therapy (23 percent).

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

86.4

Prescription Drugs
Preventive Dental Care

81.1

Routine Preventive Care

77.9
51.8

Specialist Care
33.3

Eyeglasses/Vision Care
Public
28.1%

Private
59.1%

Mental Health Care

25.0
24.2

Other Dental Care

22.8

Specialized Therapies*
Disposable Medical Supplies
Durable Medical Equipment

18.6
11.4
20

*Insurance coverage at the time of interview.

40
60
Percent of CSHCN

100

*Types of therapies include physical, occupational or speech.

Health Services Financing and Utilization

Child Health USA 2007

VACCINATION COVERAGE
The Healthy People 2010 objective for the
complete series of routinely recommended child
hood vaccinations is immunization of at least 90
percent of 19- to 35-month-olds with the com
plete 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 vac
cine, 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 vari
cella (chicken pox) vaccine.
Since 2000, the greatest increases in vaccina
tion rates have occurred with the varicella vaccine
(added to the schedule in 1996) and the diph
theria, 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 per
cent (Hepatitis B vaccine).
While there was no difference in vaccination
coverage by race and ethnicity regarding the
56

Health Services Financing and Utilization

4:3:1:3:3 series of vaccines, racial and ethnic dis
parities were evident regarding the coverage of
three individual vaccines: the DTP vaccine; the
varicella vaccine; and the pneumococcal conju
gate vaccine (PCV; data not shown). Non-His
panic 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 vac
cines for all infants before hospital discharge and
the use of annual influenza vaccines for all chil
dren 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
Total

Non-Hispanic
White

Non-Hispanic
Black

Hispanic

Asian

76.1

76.0

76.3

75.6

77.1

80.8

82.1

79.3

78.8

80.5

4+ DTP

85.7

87.1

84.0

83.6

88.8

3+ Polio

91.7

91.4

91.0

92.3

92.9

1+ MMR*

91.5

91.4

91.9

91.1

91.9

3+ Hib

93.9

94.2

92.9

94.2

89.3

3+ HepB

92.9

93.1

92.7

1+ Varicella

87.9

86.1

90.6

89.2

91.9

Complete Series
4:3:1:3:3:1
(with Varicella)

Series 4:3:1:3:3
(without Varicella)

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

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
Hepatitis B1

1MO

2MO
HepB

HepB

4MO

6MO

12MO

15MO

Rotavirus2

Rota

Diphtheria, Tetanus, Pertussis 3

DTaP

Haemophilus influenzae type b 4

Hib

Hib4

Hib

Pneumococcal 5

PCV

Inactivated Poliovirus

IPV

19–23MO
2–3YR
HepB Series

4-6YR

DTaP

DTaP
Hib
PCV
PPV

IPV

IPV
Influenza (Yearly)

Influenza 6
Measles, Mumps, Rubella 7
Varicella 8

MMR

Varicella

Varicella
HepA (2 doses)

Hepatitis A 9

HepA Series
MPSV4

Meningococcal 10
Range of Recommended Ages

18MO

HepB

see footnote 1

Catch-Up Immunization

Certain High-risk Groups

This schedule indicates the recommended ages for routine administration of currently licensed
childhood vaccines, as of December 1, 2006, for children aged 0–6 years. Additional information
is available at http://www.cdc.gov/nip/recs/child-schedule.htm. Any dose not administered at the
recommended age should be administered at any subsequent visit, when indicated and

feasible. Additional vaccines may be licensed and recommended during the year. Licensed
combination vaccines may be used whenever any components of the combination are indicated
and other components of the vaccine are not contraindicated and if approved by the Food and
Drug Administration for that dose of the series. Providers should consult the respective Advisory

Committee on Immunization Practices statement for detailed recommendations. Clinically signifi
cant adverse events that follow immunization should be reported to the Vaccine Adverse Event
Reporting System (VAERS). Guidance about how to obtain and complete a VAERS form is
available at http://www.vaers, hhs.gov or by telephone, 800-822-7967.

1. Hepatitis B vaccine (HepB). (Minimum age: birth)
At birth: • Administer monovalent HepB to all newborns before hospital discharge. • If moth
er 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 HBsAg
negative, 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 comple
tion 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 mem
bers) in close contact with persons in groups at high risk. See MMWR 2006;55(No. RR
10):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, pro
vided that 3 or more months have elapsed since the first dose and both doses are adminis
tered 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 admin
istered at least 6 months apart. • Children not fully vaccinated by age 2 years can be vacci
nated 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

Child Health USA 2007

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 preventa
ble 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 Associ
ation recommends that children have their first
dental checkup within 6 months of the eruption
of their first tooth and 12 months of age.

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 chil
dren were least likely (63.0 percent). Approxi
mately 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 den
tist in the past year (data not shown).

During Federal Fiscal Year 2005, only 27.6
percent of children eligible for services under the
Medicaid Early and Periodic Screening, Diag
nostic, 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. Fre
quency 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 den
tist in the past year than children living with

Receipt of EPSDT Preventive Dental Service Among Children,
Birth Through Age 20: 1990–2005*

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

100

Within Past Year
More Than 1 Year Ago or Never

27.6

80
Percent of Children

Percent of Eligible Children

26
24
22

78.2

72.6

63.8

60
50
36.2

40
30

27.4
21.8

10
1990

1995

*Not all States and Territories reported data in all years.

2000

2005

All Children

Below 200% Poverty Level

200% Poverty Level or More

*The poverty level was equal to $19,971 for a family of four in 2005.

Health Services Financing and Utilization

Child Health USA 2007

Health Services Financing and Utilization

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
30

Total
Non-Hispanic White

27.2

Non-Hispanic Black
Hispanic

20.5

21
Percent of Children

TIMING OF PHYSICIAN
VISITS
The American Academy of Pediatrics recom
mends 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 hospital
ization, trips to the emergency room, home vis
its, or dental visits). Older children were less
likely than younger children to have seen a physi
cian. 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 physician. Non-Hispanic White children and non

17.6

16.9
15.9

15
12

15.1

14.2
11.4

11.3

10.8
9.7

9.2

10.1

11.1

11.8 12.3
10.4

9
6.1

4.6 4.7

Total

0–4 Years

5–9 Years

10–14 Years

15–17 Years

*The sample of American Indian/Alaska Natives, Asian/Pacific Islanders and children of more than one race was too small to produce
reliable results.

Child Health USA 2007

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 “well
child” visit) in the past year. The American Acad
emy of Pediatrics (AAP) recommends that chil
dren 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 chil
dren 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-His
panic Black children were the most likely to have
had a preventive medical visit in the past year

(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 pre
ventive 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
Children Under Age 18, by Age, 2005

Receipt of Preventive Medical Care in the Past Year Among
Children Under Age 18, by Race/Ethnicity, 2005

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

Source (III.5): Centers for Disease Control and Prevention, National Center for Health
Statistics, National Health Interview Survey
100

100
90

72.8

71.2

80
66.7
64.8

60
50
40
30

Percent of Children

85.4

50
40
30
20
10

5–9 Years

10–14 Years

15–17 Years

67.1

10
0–4 Years

69.4

Total

77.6
73.7

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

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-His
panic Black children and 43.1 percent of His
panic 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 pri
mary source of sick care, but children with fam
ily incomes below the poverty level were more
likely to do so than children with higher family
incomes. For instance, 6.0 percent of non-His
panic 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.)

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 Black
Hispanic
85.0
77.8

100

Percent of Children

73.2

70.4

70
60
50

Non-Hispanic White
Non-Hispanic Black
Hispanic

100

56.7

80
70

70
60

10
Below Poverty Level

52.9

43.1

Above Poverty Level

Doctor’s Office or HMO

Non-Hispanic White
Non-Hispanic Black
Hispanic

100

37.3

40
27.2

23.1
14.4

19.0

30
20
10

Below Poverty Level

Above Poverty Level

Clinic or Health Center

3.7

6.0

3.9

Below Poverty Level

0.6

3.2

2.4

Above Poverty Level

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.”

Health Services Financing and Utilization

Child Health USA 2007

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 chil
dren 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 demo
graphic factors including age and race and eth
nicity. 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

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), fol
lowed 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
Among Children Under Age 18, by Poverty Level,* 2005

Visits to the Emergency Room/Emergency Department Among
Children Under Age 18, by Age, 2005

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

Below Poverty Level
Above Poverty Level

100

90
80.4

70.8

Percent of Children

60
50
40
26.7

18.7

20
10

1–3 Visits

80.7 83.1 83.0
72.6

70
60
50
40
30

25.4
18.2 16.2 16.4

20
2.5

No Visits

Under 5 Years
5–9 Years
10–14 Years
15–17 Years

100

2.0 1.1

0.9

4 Visits or More

No Visits

1–3 Visits

0.7

0.6

4 Visits or More

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

Health Services Financing and Utilization

Child Health USA 2007

PRENATAL CARE
Timely Prenatal Care. Prenatal care — especially
care beginning in the first trimester — improves
pregnancy outcomes by identifying and manag
ing chronic and pregnancy-related conditions
and providing expectant parents with relevant
health care advice. The rate of first trimester pre
natal 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.

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. Ameri
can 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 edu
cational attainment.

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 pre
natal 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 per
cent), followed by Asian/Pacific Islander women
(85.3 percent), Hispanic women (77.6 percent),
and non-Hispanic Black women (76.5 percent);

Mothers Beginning Prenatal Care in the First Trimester,
by Race/Ethnicity, 2005*

Mothers Receiving Late or No Prenatal Care,
by Race/Ethnicity, 2005*

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

Source (I.6): Centers for Disease Control and Prevention, National Center for Health
Statistics, National Vital Statistics System
100

100
83.9

85.3
76.5

80
Percent of Mothers

88.7
77.6

80
69.6

70
60
50
40
30

Percent of Mothers

70
60
50
40
30

10
Total

Non-Hispanic Non-Hispanic
White
Black

Hispanic

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

Asian/
American Indian/
Pacific Islander Alaska Native

3.5
Total

2.2

5.6

Non-Hispanic Non-Hispanic
White
Black

5.1
Hispanic

8.2
3.0
Asian/
American Indian/
Pacific Islander Alaska Native

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

Health Services Financing and Utilization

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

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
SCHIP Program

Date
Implemented

Upper
Eligibility

Alabama

Separate

02/01/98

200%

84,257

Alaska

Medicaid

03/01/99

175%

22,227

Arizona

Separate

11/01/98

200%

96,669

Combo

10/01/98

200%

3,440

State

Arkansas

Total SCHIP
Enrollment

Type of
SCHIP Program

Date
Implemented

Upper
Eligibility

Montana

Separate

01/01/99

150%

17,304

Nebraska

Medicaid

05/01/98

185%

44,981

Nevada

Separate

10/01/98

200%

39,317

Combo

05/01/98

300%

12,393
120,884

State

New Hampshire

Total SCHIP
Enrollment

California

Combo

03/01/98

250%

1,391,405

New Jersey

Combo

03/01/98

350%

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
247,991

Delaware

Combo

02/01/99

200%

10,751

North Carolina

Combo

10/01/98

200%

Medicaid

10/01/98

200%

6,332

North Dakota

Combo

10/01/98

140%

6,318

Florida

Combo

04/01/98

200%

303,595

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

District of Columbia

Ohio

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

Combo

07/01/98

200%

14,584

Iowa

Combo

07/01/98

200%

49,575

South Dakota

Separate

01/01/99

200%

48,934

Tennessee*

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
15,000

Kansas

10/01/97

Massachusetts

Combo

10/01/97

300%

190,640

Washington

Separate

02/01/00

250%

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.

State Data

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*

Alabama

Per Enrollee
Expenditure**

Participation
Ratio***

State

Medicaid
Enrollees*

Per Enrollee
Expenditure**

Participation
Ratio***

491,853

$1,880.18

47%

Montana

65,113

$2,536.63

54%

Alaska

88,347

$4,493.54

51%

Nebraska

157,025

$2,201.22

52%

Arizona

670,534

$2,279.82

61%

Nevada

150,620

$1,617.51

38%

Arkansas

379,001

$2,130.60

25%

New Hampshire

$2,483.13

California

6,071,277

$1,352.43

39%

New Jersey

534,765

$2,223.72

54%

Colorado

303,090

$1,953.42

48%

New Mexico

49%

Connecticut

274,773

$2,134.73

61%

New York

79,449

$2,706.08

32%

North Carolina

Delaware
District of Columbia

90,822

$3,493.72

73%

North Dakota

Florida

1,626,835

$1,877.67

56%

Ohio

Georgia

1,109,058

$1,821.56

50%

Oklahoma

121,477

$1,842.34

67%

Idaho****

145,333

$2,061.55

Illinois****

1,146,996

$1,487.99

Indiana

593,195

Iowa

329,214

$2,415.37

2,113,319

$2,708.01

94%

858,750

$2,348.96

72%

43,893

$2,144.94

41%

1,154,022

$2,005.30

47%

$1,672.24

Oregon

273,778

$1,971.84

55%

33%

Pennsylvania****

941,719

$2,603.95

57%

73%

Rhode Island

112,508

$4,034.41

54%

$1,828.82

54%

South Carolina

640,690

$1,818.43

33%

228,738

$2,391.59

100%

South Dakota

83,268

$2,282.76

43%

Kansas

212,357

$2,434.86

87%

Tennessee

775,232

$1,864.99

47%

Kentucky

318,008

$2,537.93

44%

Texas

2,712,573

$1,876.39

62%

Louisiana

733,403

$1,537.94

64%

Utah

172,342

$1,986.96

49%

$5,275.23

Vermont

73,351

$2,993.23

84%

493,167

$2,606.13

54%

Virginia

494,199

$1,785.67

56%

Hawaii

Maine
Maryland
Massachusetts

480,203

$3,459.01

74%

Washington

661,357

$1,515.80

55%

1,006,133

$1,837.88

42%

West Virginia****

216,516

$1,916.62

50%

Minnesota

400,984

$3,138.35

100%

Wisconsin

467,934

$1,585.51

65%

Mississippi

460,033

$1,600.98

32%

Wyoming

52,770

$2,124.46

36%

Missouri

684,632

$1,734.64

63%

Michigan

* Unduplicated number of individuals under age 21 determined to be eligible for EPSDT services (FY 2004 416 Report).
Medicaid
Per Enrollee
Participation
** Represents total Medicaid vendor payments divided by Medicaid eligibles under 21 (FY 2004 MSIS Report).
State
Enrollees*
Expenditure**
Ratio***
***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

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
Private/EmployerBased Insurance

Percent
Enrolled in
Public Insurance**

Percent
Uninsured***

Percent with
Private/EmployerBased Insurance

Percent
Enrolled in
Public Insurance**

Percent
Uninsured***

Alabama

64.1%

38.2%

4.6%

Alaska

56.8%

44.6%

8.5%

Montana

56.6%

24.5%

14.0%

Nebraska

70.4%

27.7%

Arizona

52.5%

30.9%

5.4%

17.3%

Nevada

69.2%

17.5%

14.9%

Arkansas

55.4%

California

53.0%

39.9%

11.6%

New Hampshire

77.5%

16.8%

5.5%

31.0%

13.9%

New Jersey

72.1%

17.2%

10.9%

Colorado
Connecticut

65.2%

20.2%

13.6%

New Mexico

48.4%

38.6%

20.5%

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%

State

*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.

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

NH
VT

MA
ID

MI
NE

IA
IL

DE
WV

VA
MD

DC (7.8%)

OK
AR

MS
AK

CO
CA

RI
CT

< 7.5%

7.5 - 10%

10.1 - 12%

12.1 - 21%

State Data

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
Non-Hispanic
Total* White Black

State

Preterm Birth
Non-Hispanic
Total* White Black

Births to Unmarried Women
Non-Hispanic
Total* White
Black Hispanic

State

Low Birth Weight
Non-Hispanic
Total* White Black

Preterm Birth
Non-Hispanic
Total* White Black

Births to Unmarried Women
Non-Hispanic
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

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

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

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

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

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

9.0

10.7

11.7

35.0

35.5

43.1

Vermont

6.2

N/A

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

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.

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

State

Total*

Infant Mortality
White**
Black**

Total*

Neonatal Mortality
White
Black

State

Total*

Infant Mortality
White**
Black**

Total*

Neonatal Mortality
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

N/A

Alaska

5.93

4.74

N/A

2.96

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
11.99

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

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
9.75

Georgia

8.15

5.90

12.60

5.41

3.68

8.82

Oklahoma

8.05

7.27

15.35

4.79

4.35

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
6.15

Massachusetts

5.15

4.84

8.18

3.72

3.51

6.14

Washington

5.09

4.81

10.87

3.07

2.90

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

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

Child Health USA 2007

BIRTH WEIGHT
Low Birth Weight. Disorders related to short ges
tation and low birth weight are the second lead
ing 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 per
centage 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 out
comes. 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
Populations over 100,000: 1990–2005

Infants Born at Very Low Birth Weight in U.S. Cities with
Populations over 100,000: 1990–2005

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

Source (II.2): Centers for Disease Control and Prevention, National Center for Health
Statistics, National Vital Statistics System
10

6
Total U.S. Population

Percent of Infants

Total U.S. Cities

4
3

1990

8.8
8.2

City Data

1995

2000

2005

Total U.S. Cities

Total U.S. Population

1.7
1.5
1990

1995

2000

2005

Child Health USA 2007

Rate per 1,000 Live Births

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
14
by 50 percent. Between 1990 and 2004, the
infant mortality rate in cities has declined by
13
nearly one-third, while the nationwide decline
12
during the same period was 25.3 percent.

Declines in infant mortality rates since 2000,

11
however, have been relatively small for both cities

10
and the population as a whole.

Total U.S. Cities

9
8

7.4

Total U.S. Population

6.8

1990

1992

1994

1996

1998

2000

2002

2004

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

City Data

Child Health USA 2007

References
Population Characteristics

Health Status

I.1

U.S. Census Bureau, Population Division. Annual population estimates. Washington,
DC: The Bureau; 2007.

II.1

I.2

U.S. Census Bureau, America’s Families & Living Arrangements, 2006.
http://www.census.gov/population/www/socdemo/hh-fam/cps2006.html, accessed
5/21/07.

Centers for Disease Control and Prevention. 2005 National Immunization Survey —
Table 1. Breastfeeding rates by socio-demographic factors. http://www.cdc.gov/breast
feeding/data/NIS_data/data_2005.htm, accessed 5/14/07.

II.2

Centers for Disease Control and Prevention, National Center for Health Statistics,
National Vital Statistics System. Unpublished Data.

II.3

Kung HC, Hoyert DL, Xu JQ, Murphy SL. Deaths: Final data for 2005. National
vital statistics reports; vol. 56 no 10. Hyattsville, MD: National Center for Health
Statistics. 2008.

II.4

National Center for Health Statistics. Health, United States, 2007 With Chartbook
on Trends in the Health of Americans. Hyattsville, MD: 2007.

II.5

Centers for Disease Control and Prevention. Summary of notifiable diseases—United
States, 2005. Published March 30, 2007, for MMWR 2005;54(No. 53).
http://www.cdc.gov/mmwr/summary.html, accessed 5/16/07.

II.6

Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2005.
Vol. 17. Rev ed. Atlanta: U.S. Department of Health and Human Services, Centers
for Disease Control and Prevention; 2007:[Tables 1, 3, 4, 7, 8 and Figure 1].
Also available at: http://www.cdc.gov/hiv/topics/surveillance/resources/reports,
accessed 8/27/06.

II.7

Centers for Disease Control and Prevention, National Center for Health Statistics.
National Hospital Discharge Survey, 2005. Unpublished data.

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 Insur
ance Coverage in the United States: 2005, U.S. Government Printing Office, Wash
ington, 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 Condi
tion of Education 2007 (NCES 2007-064). Washington, DC: U.S. Government
Printing Office; 2007 June. http://nces.ed.gov, accessed 5/31/07.

I.6

Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Kirmeyer S, Munson
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

II.8

U.S. Department of Health and Human Services, Administration on Children, Youth,
and Families. Child maltreatment 2005. Washington, DC: U.S. Government Printing
Office; 2006.

I.8

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

II.9

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

II.10

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.

Centers for Disease Control and Prevention. Sexually transmitted disease surveillance,
2005. Atlanta, GA: U.S. Department of Health and Human Services; 2006 Nov.
http://www.cdc.gov/std/stats/, accessed 5/31/07.

References

Child Health USA 2007

II.11

II.12

II.13

U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Ser
vices 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-uni
versity Consortium for Political and Social Research [distributor], 2006-11-16.
Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. Monitoring
the Future national results on adolescent drug use: Overview of key findings, 2006.
[NIH Publication No. 07-6202] Bethesda, MD: National Institute on Drug Abuse,
2007. Johnston, L. D., O’Malley, P. M., Bachman, J. G. & Schulenberg, J. E.
(December 21, 2006). Decline in daily smoking by younger teens has ended. Univer
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able: 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
Applied Studies, NSDUH Series H-30, DHHS Publication No. SMA 06-4194).
Rockville, MD. http://oas.samhsa.gov/nsduh/2k5nsduh/2k5results.pdf, accessed
5/24/07.

Health Services Financing and Utilization

III.1

U.S. Census Bureau, Current Population Survey, 2007. Current Population Survey
Table Creator. Available online at http://www.census.gov/hhes/www/cpstc/
cps_table_creator.html, accessed 4/28/08.

III.2

Centers for Disease Control and Prevention, National Immunization Program.
National Immunization Survey, Jan – Dec 2005. http://www.cdc.gov/nip/
coverage/default.htm#NIS, accessed 5/17/07.

III.3

Department of Health and Human Services, Centers for Disease Control and Preven
tion. Recommended Immunization Schedules, United States, 2007.
http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2007/child-schedule
bw-press.pdf, accessed 9/20/07.

III.4

Centers for Medicare and Medicaid Services. Annual EPSDT Participation Reports
(National). 1995-2005: The Centers. http://www.cms.hhs.gov/MedicaidEarlyPeriod
icScrn/, accessed 5/23/07.

III.5

Centers for Disease Control and Prevention, National Center for Health Statistics.
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 Pro
gram: FY 2006 annual enrollment report. Baltimore, MD: The Centers; 2007.
http://www.cms.hhs.gov/NationalSCHIPPolicy/downloads/FY2006StateTotalTable.p
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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IV.3

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tions. Fiscal Year 2004 National MSIS Tables. Rev. 6/22/07. [Tables 5 & 19]
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References

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

Contributors

Photography Copyrights

Cover; title page; pages 20, 29, and 39: first
photo, Naomi Tein; second, third and fourth
photos, iStockPhoto; fifth photo, Stacy Glea
son. 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.

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