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Introduction
The health of the current child population has important implications for the future health of the United States population. Many childhood health issues—including weight, smoking, oral health, and vaccination coverage—can affect health throughout the lifespan. In 2007, nearly 25 percent of the United States population was under 18 years of age. The health and well-being of these children, as well as that of our country, depend on preventive services, such as prenatal care and immunization, as well as the promotion of healthy life choices. These measures help ensure that children are born healthy and maintain good health as they grow up.
Good health begins even before birth. Timely prenatal care is an important preventive strategy that can help protect the health of both mother and child. Entry into prenatal care during the first trimester has been improving, reaching 83.9 percent of pregnant women in 2005. A small proportion of women (3.5 percent) did not receive prenatal care until the third trimester or did not receive care at all. This was more common among Black and Hispanic women, as well as those who are younger, unmarried, and less educated.
Several other indicators of maternal health are also included in Child Health USA. For instance, data are presented on maternal age, which can affect the health of both infant and mother. In 2005, births to women aged 15–19 years reached another record low, while births to older women (35 years and older) increased slightly from the previous year.
Parental employment and child care can also affect the health and well-being of a family. In 2006, 70.9 percent of women with children under 18 years of age were in the labor force (either employed or looking for work). Of mothers with preschool-aged children (younger than 6 years), 63.5 percent were in the labor force and 59.7 percent were employed. In 2005, 60 percent of children under 6 years of age required care from someone other than a parent at least once a week.
After the health of the mother and the family, Child Health USA presents data regarding the health of infants and young children. Healthy birth weight is an important indicator of infant health, and emerging evidence indicates that birth weight may affect children into adulthood as well. Children born at very low birth weight are significantly more likely to die in the first year of life than babies of normal birth weight, and those who survive are at particularly high risk for severe physical, developmental, and cognitive problems. Despite high rates of prenatal care utilization, 2005 data indicate that 8.2 percent of infants were born at low birth weight (less than 2,500 grams, or 5 pounds 8 ounces), which is the highest rate recorded in the last 3 decades. Although the number of multiple births, which are more likely to result in low birth weight, is on the rise, the low birth weight rate among singleton births is rising as well. Very low birth weight (less than 1,500 grams, or 3 pounds 4 ounces) represented 1.5 percent of live births in 2005. This represents an increase since 1980 when approximately 1 percent of infants were born at a very low birth weight. Although rates of maternal and infant mortality have dropped dramatically in the past century, the United States still has one of the highest rates of infant death in the industrialized world (6.8 deaths per 1,000 live births in 2004).
Breastfeeding can also support the health of infants and mothers. Breastfeeding rates have increased steadily since the beginning of the last decade. In 2005, 72.9 percent of mothers reported ever breastfeeding their infants. However, breastfeeding declined dramatically as infant age increased: 39.1 percent of mothers reported breastfeeding their infants at 6 months of age. The rate of exclusive breastfeeding at 6 months was even lower (13.9 percent).
Vaccination is a preventive health measure that protects the health of children into adulthood. Vaccines are available for a number of public health threats, including measles, mumps, rubella (German measles), polio, diphtheria, tetanus, pertussis (whooping cough), and H. Influenzae type b (a meningitis bacterium). In 2005, 80.8 percent of children aged 19–35 months had received the recommended series of vaccines; 76.1 percent of children in this age group received the recommended series plus the varicella (chicken pox) vaccine.
Physical activity is another important protective factor in lifelong health that begins in early childhood. Results from the 2005 Youth Risk Behavior Surveillance System show that 35.8 percent of high school students met the currently recommended levels of physical activity, and 54.2 percent of students were enrolled in a physical education class on one or more days per week. Enrollment in weekly physical activity classes was higher in the younger grades (71.5 percent of 9th-graders) than in the older grades (38.8 percent of 12th-graders).
The period of adolescence introduces additional health issues that need to be monitored and addressed. In 2005, 46.8 percent of high school students reported ever having had sexual intercourse. Among 9th grade students, more males were currently sexually active (24.5 percent) than females (19.5 percent). However, by 12th grade, females were more likely to be currently sexually active (51.7 percent) than males (47.0 percent).
With sexual activity comes the risk of sexually transmitted infections (STIs). Adolescents (aged 15–19 years) and young adults (aged 20–24 years) are at much higher risk of contracting STIs than are older adults. Chlamydia continues to be fairly common among adolescents and young adults, with rates of 1,621 and 1,719 cases per 100,000, respectively, in 2005. Gonorrhea followed in prevalence with overall rates of 438 and 507 per 100,000 adolescents and young adults, respectively. Genital human papillomavirus (HPV) is believed to be the most common STI in the United States. It is estimated that 24.5 percent of females aged 14–19 years and 44.8 percent aged 20–24 years had an HPV infection in 2003–2004. In 2006, a vaccine for HPV was approved by the Food and Drug Administration (FDA) for use in females aged 9–26 years.
Mental health is another issue that increasingly affects children as they grow older. In 2005, 21.8 percent of youth aged 12–17 years received mental health treatment or counseling in the past year, which includes treatment or counseling for emotional or behavioral problems not caused by drug or alcohol use. The proportion of youth receiving treatment in 2005 represented a slight decrease from the previous year (22.5 percent). Depression was the leading reason reported for mental health treatment among this age group.
A number of other issues are interrelated with mental health, including violence and substance abuse. Results from the 2005 Youth Risk Behavior Surveillance System indicate that 18.5 percent of high school students had carried a weapon (such as a gun, knife, or club) at some point during the preceding 30 days. Among males, non- Hispanic Whites and Hispanics were more likely than non-Hispanic Blacks to carry a weapon. Among females, non-Hispanic Blacks were more likely to carry a weapon than their non-Hispanic White and Hispanic counterparts.
With regard to substance abuse, 9.9 percent of adolescents aged 12–17 years reported using illicit drugs in the past month in 2005. Alcohol was the most commonly used drug among adolescents, with 16.5 percent reporting past-month use in 2005, while marijuana was the most commonly used illicit drug (6.8 percent).
The health status and health services utilization indicators reported in Child Health USA can help policymakers and public health officials analyze the current health climate and determine what programs might be needed to further improve the public’s health. These indicators can also help identify positive health outcomes, which may allow public health professionals to draw upon the experiences of programs that have achieved success. The health of our children and adolescents relies on effective public health efforts that include providing access to knowledge, skills, and tools; providing drug-free alternative activities; identifying risk factors and linking people to appropriate services; building community supports; and supporting approaches that promote policy change. Such preventive efforts and health promotion activities are vital to the continued improvement of the health and well-being of America’s children and families.
