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Health and Safety

Chapter 4: Health and Safety

FACTORS AFFECTING CHILDREN'S HEALTH
DISEASES OF CHILDHOOD
MENTAL HEALTH ISSUES IN YOUNG PEOPLE
CHILDHOOD DEATHS

FACTORS AFFECTING CHILDREN'S HEALTH

A variety of factors affect children's health. These range from prenatal influences; access to and quality of health care; poverty, homelessness, and hunger; childhood diseases; and diet and exercise. This chapter discusses these factors and looks at the leading causes of death among infants, children, and adolescents.

Birth Defects

In Birth Defects: Frequently Asked Questions (December 12, 2006, http://www.cdc.gov/ncbddd/bd/faq1.htm), the Centers for Disease Control and Prevention (CDC) indicates that birth defects affect one out of every 33 babies born. Birth defects are the leading cause of infant deaths. In addition, these babies have a greater chance of illness and disability than do babies without birth defects. Two major birth defects, neural tube defects and fetal alcohol syndrome, are in large part preventable.

NEURAL TUBE DEFECTS. Major defects of the brain and spine are called neural tube defects. Each year, as many as 3,000 infants are born in the United States with neural tube defects caused by the incomplete closing of the spine and skull. Another estimated 1,500 pregnancies are either stillborn or terminated because of these defects. The occurrence of these defects can be greatly reduced by adequate folic acid consumption before and during early pregnancy.

FETAL ALCOHOL SYNDROME. Alcohol consumption by pregnant women can cause fetal alcohol syndrome (FAS), a birth defect characterized by a low birth weight, facial abnormalities such as small eye openings, growth retardation, and central nervous system deficits, including learning and developmental disabilities. The condition is a lifelong, disabling condition that puts these affected children at risk for secondary conditions, such as mental health problems, criminal behavior, alcohol and drug abuse, and inappropriate sexual behavior. Not all children affected by prenatal alcohol use are born with the full syndrome, but they may have selected abnormalities.

According to the CDC, in Tracking Fetal Alcohol Syndrome (December 5, 2006, http://www.cdc.gov/ncbddd/fas/fassurv.htm), estimates of the prevalence of FAS vary from 0.2 to 1.5 per 1,000 births in different areas of the United States. Other alcohol-related birth defects are thought to occur three times as often as FAS. In Alcohol Consumption among Women Who Are Pregnant or Who Might Become PregnantUnited States, 2002 (Morbidity and Mortality Weekly Report, vol. 53, no. 50, December 2004), the CDC finds that in 2002, 10.1% of pregnant women drank alcohol, putting their babies at risk for FAS. As many as one out of 50 (1.9%) pregnant women frequently drank alcohol. According to James Tsai et al., in Patterns and Average Volume of Alcohol Use among Women of Child-bearing Age (Maternal and Child Health Journal, vol. 11, no. 5, September 2007), 2% of pregnant women and 13% of nonpregnant women of childbearing age are estimated to engage in binge drinking, and 21.5% reported drinking at least 45 drinks per month.

Health Care

IMMUNIZATIONS. In America's Children in Brief: Key National Indicators of Well-Being, 2008 (2008, http://www.childstats.gov/americaschildren/index.asp), the Federal Interagency Forum on Child and Family Statistics explains that the proportion of preschool-age children immunized against communicable and potentially dangerous childhood diseasesincluding diphtheria, tetanus, and pertussis (whooping cough), known collectively as DTP, polio, and measlesdropped during the 1980s but rose significantly during the 1990s. By 2006, 85.2% of all children had received four doses of DTP, 92.8% had received three doses of poliovirus vaccine, 93.4% had received haemophilus influenzae type b vaccine, 93.3% had received three doses of hepatitis B vaccine, 92.3% had received measles

TABLE 4.1 Percentage of children vaccinated for selected diseases, by poverty statusa, raceb, and Hispanic originc, 1996 and 2006
Characteristic Total Below poverty At or above
1996 2006 1996 2006 1996 2006
   Total
Combined series (4:3:1:3:3:1)d 76.9 73.4 78.3
Combined series (4:3:1:3:3)e 67.7 80.5 61.4 76.3 69.9 82.2
Combined series (4:3:1:3)f 76.4 82.1 68.9 77.8 79.2 83.9
Combined series (4:3:1)g 78.4 83.1 71.6 79.0 80.8 84.8
DTP (4 doses or more)h 81.1 85.2 73.9 80.8 83.6 86.9
Polio (3 doses or more)i 91.0 92.8 87.7 91.9 92.0 93.1
MMR (1 dose or more)j 90.6 92.3 87.2 90.9 91.9 93.0
Hib (3 doses or more)k 91.4 93.4 86.9 91.1 93.1 94.2
Hepatitis B (3 doses or more)l 81.8 93.3 78.0 92.7 83.2 93.5
Varicella (1 dose or more)m 12.2 89.2 5.4 88.3 15.3 90.0
PCV (3 doses or more)n 86.9 84.1 88.0
White, non-Hispanic
Combined series (4:3:1:3:3:1)d 77.8 69.0 78.9
Combined series (4:3:1:3:3)e 68.9 82.2 59.3 74.1 70.5 83.1
Combined series (4:3:1:3)f 78.5 83.9 68.0 75.2 80.4 84.9
Combined series (4:3:1)g 80.1 84.7 70.3 76.7 81.9 85.7
DTP (4 doses or more)h 82.7 86.6 72.4 78.0 84.7 87.6
Polio (3 doses or more)i 91.9 93.3 88.2 90.1 92.5 93.6
MMR (1 dose or more)j 91.4 92.8 85.1 87.7 92.5 93.5
Hib (3 doses or more)k 92.8 94.1 87.4 87.9 93.7 94.8
Hepatitis B (3 doses or more)l 82.1 93.8 76.4 91.7 83.3 94.0
Varicella (1 dose or more)m 14.5 88.7 6.4 83.2 16.3 89.4
PCV (3 doses or more)n 87.2 79.5 88.4
Black, non-Hispanic
Combined series (4:3:1:3:3:1)d 73.8 71.7 76.8
Combined series (4:3:1:3:3)e 66.8 76.7 61.3 74.0 71.9 80.4
Combined series (4:3:1:3)f 74.2 78.4 69.3 75.8 79.1 81.9
Combined series (4:3:1)g 76.6 78.9 72.5 76.5 80.9 82.4
DTP (4 doses or more)h 79.0 81.2 74.3 78.8 83.3 84.8
Polio (3 doses or more)i 90.1 90.4 86.8 90.4 92.6 91.4
MMR (1 dose or more)j 89.7 90.9 88.3 90.8 90.8 91.6
Hib (3 doses or more)k 89.4 91.0 85.9 89.9 92.8 93.4
Hepatitis B (3 doses or more)l 81.9 91.5 77.8 91.6 85.0 92.5
Varicella (1 dose or more)m 8.6 89.1 89.2 12.9 89.8
PCV (3 doses or more)n 82.9 82.2 84.5

vaccines, and 89.2% had received varicella (chickenpox) vaccine. (See Table 4.1.) More than four out of five of these children received the vaccinations in combined series. Children living below the poverty line and African-American children were slightly less likely than the general child population to be immunized.

In 1994 the U.S. Department of Health and Human Services (HHS) implemented the Vaccines for Children (VFC) program, which provides free or low-cost vaccines to children at participating private and public health care provider sites. Eligible children, including children on Medicaid, children without insurance or whose insurance does not cover vaccinations, and Native American or Alaskan Native children can receive the vaccinations through their primary care physician. Children not covered under the program but whose parents cannot afford vaccinations can receive free vaccines at public clinics under local programs. The HHS states in Budget in Brief, Fiscal Year 2009 (2008, http://www.hhs.gov/budget/09budget/2009BudgetInBrief.pdf) that the VFC program and Section 317 (the supporting vaccine infrastructure) had a budget of $3.2 billion for fiscal year 2009. Vaccines provided through the program represented about 40% of all childhood vaccines purchased in the country.

The World Health Organization (WHO) and the United Nations Children's Fund report in Global Immunization Vision and Strategy, 20062015 (October 2005, http://www.who.int/vaccines-documents/DocsPDF05/GIVS_Final_EN.pdf) that developed nations, including the United States, generally have among the highest immunization rates in the world. The global immunization rate for DTP in 2003 was 78%, up from only 20% in 1980. Immunization rates for the developed world for the same time period were 10 to 20 percentage points higher than the global average, reflecting the low immunization rates in many developing nations. The WHO notes in Global Immunization Data (January 2008, http://www.who.int/immunization/newsroom/Global_Immunization_Data.pdf) that in 2006 immunization coverage exceeded 90% in Europe and the Americas, 92% in the western Pacific, and 86% in the eastern Mediterranean.

PHYSICIAN VISITS. Children's health depends on access to and usage of medical care. Based on household interviews of a sample of the civilian noninstitutionalized population, the National Center for Health Statistics (NCHS) finds that in 2006, 57.2% of children under the age of 18 visited the doctor between one and three times, 24.6% saw the doctor between four and nine times, and 7.3% saw the

 
TABLE 4.1 Percentage of children vaccinated for selected diseases, by poverty statusa, raceb, and Hispanic originc, 1996 and 2006 [CONTINUED]
Characteristic Total Below poverty At or above
1996 2006 1996 2006 1996 2006
Not available.
aBased on family income and household size using US Bureau of Census poverty thresholds for the year of data collection.
bFrom 1996 to 2000, the 1977 OMB Standards for Data on Race and Ethnicity were used. Beginning in 2002, the 1997 OMB Standards for Data on Race and Ethnicity were used.
cPersons of Hispanic origin may be of any race.
dThe 4:3:1:3:3:1 series consists of 4 doses (or more) of diphtheria, tetanus toxoids and pertussis (DTP) vaccines, diphtheria and tetanus toxoids (DT), or diphtheria, tetanus toxoids and any acellular pertussis (DTaP) vaccines; 3 doses (or more) of poliovirus vaccines; 1 dose (or more) of any measles-containing vaccine; 3 doses (or more) of Haemophilus influenzae type b (Hib) vaccines; 3 doses (or more) of hepatitis B vaccines; and 1 dose (or more) of varicella vaccine. The collection of coverage rate estimates for this series began in 2002.
eThe 4:3:1:3:3 series consists of 4 doses (or more) of diphtheria, tetanus toxoids and pertussis (DTP) vaccines, diphtheria and tetanus toxoids (DT), or diphtheria, tetanus toxoids and any acellular pertussis (DTaP) vaccines; 3 doses (or more) of poliovirus vaccines; 1 dose (or more) of any measles-containing vaccine; 3 doses (or more) of Haemophilus influenzae type b (Hib) vaccines; and 3 doses (or more) of hepatitis B vaccines.
fThe 4:3:1:3 series consists of 4 doses (or more) of diphtheria, tetanus toxoids and pertussis (DTP) vaccines, diphtheria and tetanus toxoids (DT), or diphtheria, tetanus toxoids and any acellular pertussis (DTaP) vaccines; 3 doses (or more) of poliovirus vaccines; 1 dose (or more) of any measles-containing vaccine; and 3 doses (or more) of Haemophilus influenzae type b (Hib) vaccines.
gThe 4:3:1 series consists of 4 doses (or more) of diphtheria, tetanus toxoids and pertussis (DTP) vaccines, diphtheria and tetanus toxoids (DT), or diphtheria, tetanus toxoids and any acellular pertussis (DTaP) vaccines, 3 doses (or more) of poliovirus vaccines; and 1 dose (or more) of any measles-containing vaccine.
hDiphtheria, tetanus toxoids, and pertussis vaccine (4 doses or more of any diphtheria, tetanus toxoids, and pertussis vaccines, including diphtheria and tetanus toxoids and any acellular pertussis vaccine).
iPoliovirus vaccine (3 doses or more).
jMeasles-mumps-rubella (MMR) vaccine (1 dose or more) was used beginning in 2005. The previous coverage years reported measles-containing vaccines.
kHaemophilus influenzae type b (Hib) vaccine (3 doses or more).
lHepatitis B vaccine (3 doses or more).
mVaricella vaccine (1 dose or more) is recommended at any visit at or after age 12 months for susceptible children (i.e., those who lack a reliable history of chickenpox).
nThe heptavalent pneumococcal conjugate vaccine (PCV) is recommended for all children ages 223 months and for certain children ages 2459 months. The series consists of doses at ages 2, 4 and 6 months, and a booster dose at ages 1215 months.
SOURCE: Adapted from Table HC3. Childhood Immunization: Percentage of Children Ages 1935 Months Vaccinated for Selected Diseases by Poverty Status, and Race and Hispanic Origin, 19962006, in America's Children in Brief: Key National Indicators of Well-Being, 2008, Federal Interagency Forum on Child and Family Statistics, 2008, http://www.childstats.gov/americaschildren/tables.asp (accessed November 2, 2008)
Hispanicc
Combined series (4:3:1:3:3:1)d 77.0 76.4 78.3
Combined series (4:3:1:3:3)e 63.7 79.7 62.4 78.3 64.1 81.6
Combined series (4:3:1:3)f 71.1 81.3 68.2 80.1 72.7 83.2
Combined series (4:3:1)g 74.1 82.0 70.9 80.9 74.6 83.9
DTP (4 doses or more)h 77.2 84.5 74.0 82.7 77.5 86.3
Polio (3 doses or more)i 89.4 93.3 88.0 93.0 89.8 93.4
MMR (1 dose or more)j 88.2 92.0 87.4 92.8 89.0 91.9
Hib (3 doses or more)k 88.5 93.9 87.1 93.5 90.3 93.9
Hepatitis B (3 doses or more)l 80.8 93.6 79.9 93.2 81.1 93.9
Varicella (1 dose or more)m 7.6 89.6 6.3 90.5 11.2 90.5
PCV (3 doses or more)n 88.9 87.7 89.8

doctor 10 or more times. (See Table 4.2.) However, 10.9% of children did not see a doctor at all. Poor children have less access to health care than nonpoor children.

HEALTH INSURANCE. One reason some children do not have access to medical care is their lack of health insurance. According to the U.S. Census Bureau, 11% (8.1 million) of American children had no health insurance coverage in 2007. (See Figure 4.1.) Factors affecting children's access to coverage included their age, race, and ethnicity, and their family's economic status. Children between the ages of 12 and 17 were more likely to be uninsured (12%) than six- to 11-year-olds (10.3%) and children under the age of six (10.5%). Poor children were proportionately more likely to be uninsured than all children (17.6% versus 11%), and those of Hispanic origin were the least likely racial or ethnic group to receive health insurance coverageone out of five (20%) Hispanic children were uninsured, compared to 12.2% of African-American children, 11.7% of Asian-American children, and 7.3% of non-Hispanic white children.

Child health insurance coverage increased slightly among all age groups, races, and ethnicities from 2000 to 2004, but then declined from 2004 to 2006. Overall, the percent of children covered by private health insurance declined from 70.2% in 2000 to 64.7% in 2006. (See Table 4.3.) In the press release HHS Issues New Report Showing More American Children Received Health Insurance in Early 2002 (December 31, 2002, http://www.hhs.gov/news/press/2002pres/20021231.html), the NCHS states that Tommy G. Thompson, the HHS secretary, attributed ongoing increases to a push to provide more government coverage, particularly under the State Children's Health Insurance Program. This trend, however, leveled off in 2005 and 2006.

According to Carmen DeNavas-Walt, Bernadette D. Proctor, and Cheryl Hill Lee of the Census Bureau, in Income, Poverty, and Health Insurance Coverage in the United States: 2005 (August 2006, http://www.census.gov/prod/2006pubs/p60-231.pdf), in 2005 government programs, such as Medicare, Medicaid, and military insurance, covered a greater proportion of African-American and Hispanic children than other children. Almost half (44.9%) of African-American children and 39.3% of Hispanic

 
TABLE 4.2 Health care visits to doctor's offices, emergency departments, and home visits over a 12-month period, by selected characteristics, 1997, 2005, and 2006
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]
Characteristic Number of health care visitsa
None 13 visits 49 visits 10 or more visits
1997 2005 2006 1997 2005 2006 1997 2005 2006 1997 2005 2006
  Percent distribution
18 years and over, age-adjustedb, c 16.5 15.6 17.2 46.2 46.2 46.9 23.6 24.6 23.1 13.7 13.7 12.8
18 years and over, crudeb 16.5 15.5 17.2 46.5 46.2 46.8 23.5 24.6 23.1 13.5 13.7 12.9
Age
Under 18 years 11.8 10.2 10.9 54.1 56.3 57.2 25.2 26.1 24.6 8.9 7.4 7.3
      Under 6 years 5.0 5.1 4.9 44.9 47.9 50.6 37.0 37.5 34.8 13.0 9.5 9.7
      617 years 15.3 12.7 13.8 58.7 60.4 60.5 19.3 20.6 19.6 6.8 6.4 6.1
1844 years 21.7 23.1 25.3 46.7 46.0 45.8 19.0 18.8 17.8 12.6 12.1 11.0
      1824 years 22.0 24.3 25.3 46.8 44.7 47.2 20.0 19.2 17.4 11.2 11.8 10.2
      2544 years 21.6 22.6 25.4 46.7 46.5 45.3 18.7 18.7 17.9 13.0 12.2 11.4
4564 years 16.9 14.1 16.4 42.9 43.1 44.3 24.7 26.4 23.6 15.5 16.4 15.7
      4554 years 17.9 15.9 18.5 43.9 45.1 46.1 23.4 23.9 21.8 14.8 15.1 13.6
      5564 years 15.3 11.5 13.5 41.3 40.5 41.9 26.7 29.8 26.1 16.7 18.2 18.5
65 years and over 8.9 5.7 6.0 34.7 31.1 33.2 32.5 36.7 36.2 23.8 26.5 24.6
      6574 years 9.8 6.0 6.7 36.9 34.8 34.6 31.6 35.1 36.6 21.6 24.1 22.1
      75 years and over 7.7 5.3 5.3 31.8 26.9 31.5 33.8 38.5 35.7 26.6 29.2 27.6
Sexc
Male 21.3 20.4 22.8 47.1 46.9 46.8 20.6 21.9 20.0 11.0 10.8 10.4
Female 11.8 10.8 11.8 45.4 45.5 46.8 26.5 27.3 26.2 16.3 16.4 15.2
Racec, d
White only 16.0 15.2 17.2 46.1 46.0 46.2 23.9 24.9 23.4 14.0 14.0 13.2
Black or African American only 16.8 16.0 16.0 46.1 47.5 49.2 23.2 23.6 23.3 13.9 12.9 11.5
American Indian or Alaska Native only 17.1 20.5 13.5 38.0 36.6 44.2 24.2 29.4 27.6 20.7 13.4 14.7
Asian only 22.8 21.6 21.9 49.1 49.5 51.3 19.7 20.5 18.1 8.3 8.5 8.7
Native Hawaiian or other Pacific Islander only * * * * * * * *
2 or more races 15.6 16.3 37.9 44.8 26.7 21.3 19.9 17.6
Hispanic origin and racec, d
Hispanic or Latino 24.9 24.0 27.1 42.3 42.4 43.0 20.3 21.7 19.6 12.5 11.9 10.3
      Mexican 28.9 26.7 31.1 40.8 41.7 40.8 18.5 20.5 18.3 11.8 11.1 9.8
Not Hispanic or Latino 15.4 13.9 15.4 46.7 46.8 47.6 24.0 25.2 23.7 13.9 14.0 13.2
      White only 14.7 13.1 15.0 46.6 46.7 46.9 24.4 25.7 24.2 14.3 14.6 13.9
      Black or African American only 16.9 16.0 15.7 46.1 47.5 49.5 23.1 23.6 23.4 13.8 12.9 11.4
Respondent-assessed health statusc
Fair or poor 7.8 9.2 12.2 23.3 21.9 21.2 29.0 27.1 28.1 39.9 41.9 38.6
Good to excellent 17.2 16.2 17.8 48.4 48.5 49.3 23.3 24.4 22.8 11.1 10.9 10.1
Percent of poverty levelc, e
Below 100% 20.6 20.8 21.0 37.8 37.5 39.5 22.7 24.3 22.3 18.9 17.4 17.2
100%less than 200% 20.1 20.4 21.6 43.3 42.3 43.5 21.7 22.8 21.5 14.9 14.5 13.3
200% or more 14.5 13.3 15.2 48.7 48.7 49.3 24.2 25.2 23.7 12.6 12.8 11.9
Hispanic origin and race and percent of poverty levelc, d, e
Hispanic or Latino
      Below 100% 30.2 28.1 32.8 34.8 37.4 35.3 19.9 19.8 19.2 15.0 14.7 12.7
      100%less than 200% 28.7 27.8 29.9 39.7 39.0 42.0 20.4 22.2 19.3 11.2 11.1 8.8
      200% or more 18.9 19.4 22.2 48.8 47.1 47.4 20.4 22.7 20.4 11.9 10.8 10.1
Not Hispanic or Latino
      White only
            Below 100% 17.0 16.6 16.3 38.3 36.4 38.7 23.9 27.4 24.2 20.9 19.7 20.8
            100%less than 200% 17.3 17.6 18.8 44.1 42.2 43.7 22.2 23.2 22.2 16.3 17.0 15.4
            200% or more 13.8 11.8 14.0 48.2 48.7 48.6 24.9 26.0 24.6 13.1 13.6 12.7
      Black or African American only
            Below 100% 17.4 17.9 18.1 38.5 40.2 45.0 23.4 24.5 21.9 20.7 17.4 15.0
            100%less than 200% 18.8 16.2 17.9 43.7 47.1 45.5 22.9 24.0 24.2 14.5 12.7 12.5
            200% or more 15.6 15.2 13.5 51.7 50.4 53.6 22.7 23.4 23.5 10.0 11.0 9.3

children had government insurance, compared to only 18% of non-Hispanic white children and 15.9% of Asian-American children.

To remain in the Medicaid program, families must have their eligibility reassessed at least every six months. If the family income or other circumstances change even

TABLE 4.2 Health care visits to doctor's offices, emergency departments, and home visits over a 12-month period, by selected characteristics, 1997, 2005, and 2006 [CONTINUED]
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]
Characteristic Number of health care visitsa
None 13 visits 49 visits 10 or more visits
1997 2005 2006 1997 2005 2006 1997 2005 2006 1997 2005 2006
  Percent distribution
Health insurance status at the time of interviewf, g
Under 65 years
      Insured 14.3 12.5 14.3 49.0 49.9 50.4 23.6 24.5 23.1 13.1 13.1 12.3
            Private 14.7 12.9 14.7 50.6 51.8 52.6 23.1 24.1 22.4 11.6 11.3 10.3
            Medicaid 9.8 10.0 11.3 35.5 38.3 37.4 26.5 25.8 25.5 28.2 25.9 25.8
      Uninsured 33.7 37.6 39.2 42.8 42.1 42.2 15.3 14.4 12.5 8.2 5.9 6.1
Health insurance status prior to interviewf, g
Under 65 years
      Insured continuously all 12 months 14.1 12.4 14.3 49.2 50.1 50.8 23.6 24.5 23.1 13.0 12.9 11.9
      Uninsured for any period up to 12 months. 18.9 18.9 19.1 46.0 45.1 46.3 20.8 22.1 20.9 14.4 13.8 13.7
      Uninsured more than 12 months 39.0 43.6 45.6 41.4 40.1 40.2 13.2 12.1 9.6 6.4 4.2 4.5
Percent of poverty level and health insurance status prior to interviewe, f, g
Under 65 years
      Below 100%
            Insured continuously all 12 months 13.8 12.7 12.6 39.7 40.7 43.1 25.2 25.7 24.2 21.4 21.0 20.1
            Uninsured for any period up to 12 months 19.7 19.0 17.8 37.6 37.6 39.3 21.9 23.2 23.4 20.9 20.2 19.5
            Uninsured more than 12 months 41.2 46.2 50.1 39.9 35.3 35.3 12.2 14.2 9.9 6.6 4.4 4.8
100less than 200%
      Insured continuously all 12 months 16.0 14.9 16.3 46.4 46.1 45.9 21.9 23.6 23.0 15.8 15.4 14.8
      Uninsured for any period up to 12 months 18.8 19.3 20.6 45.1 44.9 49.8 21.0 21.7 18.7 15.0 14.1 10.9
      Uninsured more than 12 months 38.7 43.6 44.3 41.0 39.4 42.1 14.0 12.5 10.2 6.3 4.5 3.4
200% or more
      Insured continuously all 12 months 13.7 11.8 14.1 51.0 51.8 52.6 23.6 24.6 22.9 11.7 11.7 10.4
      Uninsured for any period up to 12 months 17.8 18.6 18.6 50.3 48.1 48.0 20.4 22.1 20.7 11.5 11.2 12.7
      Uninsured more than 12 months 36.6 41.1 42.8 43.8 44.8 42.4 13.2 10.2 9.3 6.4 3.9 *5.5
Geographic regionc
Northeast 13.2 11.4 12.1 45.9 47.1 47.6 26.0 26.5 25.1 14.9 15.0 15.2
Midwest 15.9 13.8 15.2 47.7 47.4 48.4 22.8 24.7 23.6 13.6 14.0 12.7
South 17.2 16.1 18.3 46.1 46.0 45.6 23.3 24.6 23.5 13.5 13.3 12.6
West 19.1 20.1 21.7 44.8 44.4 46.7 22.8 22.8 20.2 13.3 12.6 11.3

slightly, the family can lose its eligibility for the Medic-aid program, disrupting health care coverage.

From the late 1980s through the mid-1990s the numbers of uninsured American children rose as coverage rates for employer-sponsored health insurance declined, even though the proportion of children covered by Medicaid also rose. In 1997, as part of the Balanced Budget Act, Congress created the State Children's Health Insurance Program (SCHIP) to expand health insurance to children whose families earned too much money to be eligible for Medicaid but not enough money to pay for private insurance. SCHIP provides funding to states to insure children, offering three alternatives: states may use SCHIP funds to establish separate coverage programs, expand their Medicaid coverage, or use a combination of both. By September 1999 all 50 states had SCHIP plans in place. By September 4, 2003, the program had been expanded to enroll even more children at higher income levels. According to the Centers for Medicare and Medicaid Services, in FY 2008 Number of Children Ever Enrolled YearSCHIP by Program Type (January 20, 2009, http://www.cms.hhs.gov/NationalSCHIPPolicy/downloads/FY2008StateTotalTable012309FINAL.pdf), in fiscal year 2008, 7.4 million children were enrolled in SCHIP, up from 7.1 million the year before.

Homelessness

Under the McKinney-Vento Homeless Assistance Act, the U.S. Department of Education is required to file a report on homeless children served by the act. The Department of Education obtains the data from school districts, which use

TABLE 4.2 Health care visits to doctor's offices, emergency departments, and home visits over a 12-month period, by selected characteristics, 1997, 2005, and 2006 [CONTINUED]
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]
Characteristic Number of health care visitsa
None 13 visits 49 visits 10 or more visits
1997 2005 2006 1997 2005 2006 1997 2005 2006 1997 2005 2006
*Estimates are considered unreliable. Data preceded by an asterisk have a relative standard error (RSE) of 20%30%. Data not shown have an RSE greater than 30%.
Data not available.
aThis table presents a summary measure of health care visits to doctor offices, emergency departments, and home visits during a 12-month period.
bIncludes all other races not shown separately and unknown health insurance status.
cEstimates are age-adjusted to the year 2000 standard population using six age groups: Under 18 years, 1844 years, 4554 years, 5564 years, 6574 years, and 75 years and over.
dThe race groups, white, black, American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and 2 or more races, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Starting with 1999 data, race-specific estimates are tabulated according to the 1997 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity and are not strictly comparable with estimates for earlier years. The five single-race categories plus multiple-race categories shown in the table conform to the 1997 Standards. Starting with 1999 data, race-specific estimates are for persons who reported only one racial group; the category 2 or more races includes persons who reported more than one racial group. Prior to 1999, data were tabulated according to the 1977 Standards with four racial groups and the Asian only category included Native Hawaiian or other Pacific Islander. Estimates for single-race categories prior to 1999 included persons who reported one race or, if they reported more than one race, identified one race as best representing their race. Starting with 2003 data, race responses of other race and unspecified multiple race were treated as missing, and then race was imputed if these were the only race responses. Almost all persons with a race response of other race were of Hispanic origin.
ePercent of poverty level is based on family income and family size and composition using U.S. Census Bureau poverty thresholds. Missing family income data were imputed for 25%29% of persons in 19971998 and 32%35% in 19992006.
fEstimates for persons under 65 years of age are age-adjusted to the year 2000 standard population using four age groups: Under 18 years, 1844 years, 4554 years, and 5564 years of age.
gHealth insurance categories are mutually exclusive. Persons who reported both Medicaid and private coverage are classified as having private coverage. Starting in 1997, Medicaid includes state-sponsored health plans and State Children's Health Insurance Program (SCHIP). In addition to private and Medicaid, the insured category also includes military plans, other government-sponsored health plans, and Medicare, not shown separately. Persons not covered by private insurance, Medicaid, SCHIP, public assistance (through 1996), state-sponsored or other government-sponsored health plans (starting in 1997), Medicare, or military plans are considered to have no health insurance coverage. Persons with only Indian Health Service coverage are considered to have no health insurance coverage.
hMSA is metropolitan statistical area. Starting with 2006 data, MSA status is determined using 2000 census data and the 2000 standards for defining MSAs.
Notes: In 1997, the National Health Interview Survey questionnaire was redesigned.
SOURCE: Table 82. Health Care Visits to Doctor Offices, Emergency Departments, and Home Visits within the Past 12 Months, by Selected Characteristics: United States, 1997, 2005, and 2006, in Health, United States, 2007. With Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, 2007, http://www.cdc.gov/nchs/data/hus/hus07.pdf (accessed September 15, 2008)
  Percent distribution
Location of residencec
Within MSAh 16.2 15.6 16.8 46.4 46.5 47.5 23.7 24.5 23.1 13.7 13.4 12.6
Outside MSAh 17.3 15.4 19.2 45.4 44.7 43.7 23.3 25.2 23.3 13.9 14.7 13.8

different methods of estimation. In Report to the President and Congress on the Implementation of the Education for Homeless Children and Youth Program under the McKinney-Vento Homeless Assistance Act (2006, http://www.ed.gov/programs/homeless/rpt2006.doc), the Department of Education states that 602,568 children who experienced homeless-ness at some point during the year were enrolled in school during the 200304 school year. Of these children, half (50.3%) lived doubled-up with relatives or friends, a quarter (25.3%) lived in shelters, 9.9% lived in hotels or motels, and 2.6% were unshelteredin other words, sleeping outside, in vehicles, or in abandoned buildings. This number is almost certainly much lower than the number of children who actually experienced homelessness during this period, as the homeless status of children does not always come to the attention of school officials and many homeless children are not enrolled in school.

The U.S. Conference of Mayors find in Hunger and Homelessness Survey: A Status Report on Hunger and Homelessness in America's Cities, a 23-City Survey (December 2007, http://www.usmayors.org/HHSurvey2007/hhsurvey07.pdf) that 23% of homeless people were in families with children, 76% were single men or women, and 1% were unaccompanied youthusually runaways. According to the Conference of Mayors, between 1994 and 2007 the proportion of families among the homeless generally declined, as did the proportion of unaccompanied youth among the homeless population. Data from this survey show city-by-city estimates of children as a percent of homeless family members. In Mayors Examine Causes of Hunger, Homelessness: The U.S. Conference of Mayors Release 2008 Hunger and Homelessness Survey Results (December 12, 2008, http://www.usmayors.org/pressreleases/documents/hungerhomelessness_121208.pdf), the Conference of Mayors announces that the homeless rate among cities, in general, grew about 12% from 2007 to 2008, and 16 cities cited an increase in homeless families.

Nearly nine out of 10 (87%) mayors surveyed in the 2007 report said the lack of affordable housing was a principal cause of homelessness among families with children, and 57% cited poverty. Another major cause of family homelessness was domestic violence: 39% of mayors cited such violence as a principal cause of homelessness among families with children. In contrast, 65% of mayors said mental illness and 61% said substance abuse were the principal causes of homelessness among single people and

 

unaccompanied youth. In Mayors Examine Causes of Hunger, Homelessness: The U.S. Conference of Mayors Release 2008 Hunger and Homelessness Survey Results twelve cities (63 percent) reported an increase in homelessness because of the foreclosure crisis.

The poverty and lack of stability that homelessness brings have a very negative impact on children. An example of the poor educational achievement of homeless youths is shown in Homeless Census and Homeless Youth/Foster Teen Study (2002, http://www.appliedsurveyresearch.org/www/products/MC_Homeless02_report.pdf), a study of unaccompanied homeless youths conducted in Monterey County, California. According to the survey's findings, 21% of 16-year-olds, 22% of 17-year-olds, 33% of 18-year-olds, 51% of 19-year-olds, 59% of 20-year-olds, and 70% of 21-year-olds were below grade level. Only 13% of the homeless youths in the study had a high school diploma or general equivalency diploma. The remaining 87% were performing below grade level.

Homelessness also has a negative impact on children's health. Catherine Karr of the National Health Care for the Homeless Council argues in Homeless Children: What Every Health Care Provider Should Know (December 29, 2003, http://www.nhchc.org/Children/index.htm) that these children suffer from frequent health problems. They are seen in emergency rooms and are hospitalized more often than other poor children. The often crowded and unsanitary conditions they live in lead to a higher rate of infectious diseases, such as upper respiratory infections, diarrhea, and scabies. Homeless children live in less structured and often unsafe environments, leaving them more vulnerable to accidents and injury. They tend not to have access to nutritious food, and are often malnourished or obese. Homeless children tend to lag behind their housed peers developmentally, and school-age homeless children often have academic problems. The greater likelihood that homeless children come from families plagued by mental illness, drug use, and domestic violence negatively affects their own mental health. Homelessness results in serious negative consequences for the children's health.

Hunger

Food insecurity is defined as the lack of access to enough food to meet basic needs. Mark Nord, Margaret Andrews, and Steven Carlson of the U.S. Department of Agriculture report in Household Food Security in the United States, 2006 (November 2007, http://www.ers.usda.gov/Publications/ERR49/ERR49.pdf) that in 2006, 89.1% of U.S. households were food secure, which remained essentially unchanged from the year before. However, the remaining 10.9% (12.6 million) of U.S. households experienced food insecurity at some time during the year. Most of these households used a variety of coping strategies to obtain adequate food, such as eating less varied diets, participating in food assistance programs, or getting food from community food pantries or soup kitchens. Regardless, 4% (4.6 million) of all households experienced very low food securityin other words, some household members reduced or otherwise altered their normal food intake because of a lack of money.

Nord, Andrews, and Carlson find that a higher percentage of children than adults were food insecure17.2% of children were food insecure, and 15.6% of households with children were insecure. Households experiencing food insecurity tend to go through a sequence of steps as food insecurity increases: first, families begin to worry about having enough food, then they begin to decrease other necessities, then they reduce the quality and quantity of all household members diets, then they decrease the frequency of meals and quantity of adult members food, and finally they decrease the frequency of meals and the quantity of children's food. Even though children are usually protected from being hungry, an estimated one out of every 200 children (0.6%) experienced very low food security on one or more days during the year. Households with incomes below the poverty line,

 
TABLE 4.3 Percentage of children under age 18 covered by health insurance, by type of insurance, age, race, and Hispanic origin, 19872006
Characteristic 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Not available.
Notes: Children are considered to be covered by health insurance if they had public or private coverage at any time during the year. Some children are covered by both types of insurance; hence, the sum of public and private is greater than the total. The data from 1996 to 2004 have been revised since initially published.
aFor race and Hispanic-origin data in this table: From 1987 to 2002, following the 1977 OMB standards for collecting and presenting data on race, the Current Population Survey (CPS) asked respondents to choose one race from the following: white, black, American Indian or Alaskan Native, or Asian or Pacific Islander. The Census Bureau also offered an other category. Beginning in 2003, following the 1997 OMB standards for collecting and presenting data on race, the CPS asked respondents to choose one or more races from the following: white, black, Asian, American Indian or Alaska Native, and Native Hawaiian or other Pacific Islander. All race groups discussed in this table from 2002 onward refer to people who indicated only one racial identity within the racial categories presented. People who responded to the question on race by indicating only one race are referred to as the race-alone population. The use of the race-alone population in this table does not imply that it is the preferred method of presenting or analyzing data. Data from 2002 onward are not directly comparable with data from earlier years. Data on race and Hispanic origin are collected separately. Persons of Hispanic origin may be of any race.
bPersons of Hispanic origin may be of any race.
cPublic health insurance for children consists mostly of Medicaid, but also includes Medicare, the State Children's Health Insurance Programs (SCHIP), and the Civilian Health and Medical Care Program of the Uniformed Services (CHAMPUS/Tricare).
SOURCE: Adapted from Table HC1. Health Insurance Coverage: Percentage of Children Ages 017 Covered by Health Insurance by Selected Characteristics, 19872006, in America's Children in Brief: Key National Indicators of Well-Being, 2008, Federal Interagency Forum on Child and Family Statistics, 2008, http://www.childstats.gov/americaschildren/tables.asp (accessed November 2, 2008)
Any health insurance
      Total 87.1 86.9 86.7 87.0 87.3 87.3 86.3 85.8 86.2 85.3 85.3 85.0 87.5 88.4 88.7 88.8 89.0 89.5 89.1 88.3
Age
      Ages 05 87.6 87.4 87.2 88.5 88.7 89.3 88.5 86.2 86.7 86.4 86.0 84.9 87.6 88.8 89.6 89.5 89.9 90.7 89.6 88.7
      Ages 611 87.3 87.1 87.1 87.0 87.7 87.6 87.0 86.5 86.5 85.6 86.3 85.6 87.9 88.7 89.1 89.4 89.3 89.8 90.1 88.9
      Ages 1217 86.4 86.3 85.8 85.2 85.4 84.8 83.1 84.8 85.5 84.1 83.6 84.4 87.0 87.7 87.4 87.5 87.8 88.2 87.8 87.4
Race and Hispanic origina
      White, non-Hispanic 90.3 90.3 90.3 90.0 90.4 90.2 89.4 89.4 89.5 89.6 89.5 89.6 92.5 92.8 93.0
      White-alone, non-Hispanic 92.6 92.9 93.0 93.0 92.7
      Black 83.1 84.0 83.5 85.4 84.7 86.3 84.4 83.4 84.7 81.4 81.5 81.0 84.2 86.3 86.8
      Black-alone 86.5 86.1 88.2 88.2 85.9
      Hispanicb 71.5 70.9 69.8 71.6 73.4 74.5 74.3 71.5 73.2 71.4 71.6 70.5 74.1 75.1 76.2 77.8 79.3 79.7 78.5 77.9
Private health insurance
      Total 73.6 73.5 73.6 71.1 69.7 68.7 67.4 65.6 66.1 66.5 67.3 67.9 70.0 70.2 68.8 67.9 66.3 66.4 65.8 64.7
Age
      Ages 05 71.7 71.0 70.6 68.2 66.1 64.6 63.4 59.7 60.4 62.4 63.6 64.3 66.4 66.5 64.9 63.9 62.3 62.3 61.4 60.5
      Ages 611 74.3 74.1 74.9 72.5 71.2 70.8 70.0 67.3 67.2 67.1 68.4 68.5 70.2 70.4 69.0 68.5 66.6 67.3 66.6 65.4
      Ages 1217 75.1 75.5 75.7 73.0 72.1 70.9 69.0 70.3 71.0 70.2 69.8 70.9 73.2 73.5 72.4 71.2 69.7 69.5 69.2 67.9
Race and Hispanic origina
      White, non-Hispanic 83.2 83.2 83.1 80.8 79.9 79.5 77.8 77.1 78.0 77.9 78.0 79.3 81.6 81.4 80.2
      White-alone, non-Hispanic 79.6 78.6 77.9 78.1 76.9
      Black 49.2 49.9 51.5 48.5 45.4 46.1 45.5 43.0 43.9 45.4 48.2 47.6 52.2 53.9 53.1
      Black-alone 50.8 48.0 49.3 48.7 49.0
      Hispanicb 47.9 48.3 48.2 44.9 42.8 41.9 41.8 37.7 38.3 39.9 41.8 43.2 46.3 45.2 43.9 43.5 42.4 43.8 42.0 40.9
Public health insurancec
      Total 19.0 19.2 19.2 21.9 23.9 25.2 26.8 26.3 26.4 24.9 23.4 22.8 23.2 24.4 25.9 26.8 29.1 29.9 29.7 29.8
Age
      Ages5 22.1 22.9 23.7 27.6 30.0 32.8 35.1 33.3 32.6 30.8 28.6 26.8 27.3 29.2 31.3 32.1 34.4 35.5 34.7 34.7
      Ages 611 18.6 18.2 18.0 20.0 22.3 22.9 24.8 25.2 25.6 24.7 23.1 23.0 23.4 24.5 26.4 26.8 28.8 29.5 29.8 29.5
      Ages 1217 16.1 16.2 15.3 17.5 18.6 19.1 19.8 19.9 20.5 19.2 18.6 18.6 19.2 19.8 20.3 21.9 24.4 25.0 24.7 25.5
Race and Hispanic origina
      White, non-Hispanic 12.1 12.5 12.7 14.7 16.1 16.7 18.5 18.1 17.5 17.6 17.0 15.8 16.3 17.2 18.7
      White-alone, non-Hispanic 18.5 20.5 21.2 21.2 22.0
      Black 42.1 41.9 41.0 45.5 47.5 49.3 49.5 48.5 48.8 44.8 39.6 41.6 39.8 41.9 41.6
      Black-alone 44.2 46.5 48.4 48.0 44.0
      Hispanicb 28.2 27.4 27.0 31.9 36.5 38.3 40.8 38.4 39.0 35.3 33.9 31.5 32.9 34.6 37.0 39.6 42.0 42.2 41.4 42.3

households with children headed by a single woman, and African-American and Hispanic households were the most likely to experience food insecurity.

EMERGENCY FOOD ASSISTANCE . Feeding America (formerly America's Second Harvest), the nation's largest charitable hunger-relief organization, reports in Hunger Study, 2006 (2006, http://www.hungerinamerica.org/key_findings/) that in 2005, 25.3 million Americans sought emergency food assistance. In Hunger and Homelessness Survey, the Conference of Mayors states that 80% of mayors reported that requests for emergency food assistance had increased in 2007, and that the total number of emergency food assistance requests increased by 12% during that year. The Conference of Mayors note, Overall, it appears that the need for emergency food assistance programs is continuing to increase and that cities are facing many challenges in responding to the demand for assistance. The most frequent reasons for hunger cited by city officials were poverty (90% of mayors), high housing costs (57% of mayors), and unemployment (52% of mayors). Other causes included high medical, utility, and transportation costs, substance abuse, and a lack of education. In the 2008 report Mayors Examine Causes of Hunger, Homelessness, the Conference of Mayors observes that requests for emergency food assistance had continued to increase in most cities. The organization states that an estimated 59 percent of requests for food assistance were coming from familiesmany for the first-time.

Exposure to Toxins

Another threat to children's health is exposure to environmental toxins. Two toxins that children are most frequently exposed to are lead and second-hand smoke.

LEAD POISONING. Because they have smaller bodies and are growing, children suffer the effects of lead exposure more acutely than adults do. Lead poisoning causes nervous system disorders, reduction in intelligence, fatigue, inhibited infant growth, and hearing loss. Toxic levels of lead in a parent can also affect unborn children.

In Toys and Childhood Lead Exposure (August 31, 2007, http://www.cdc.gov/nceh/lead/faq/toys.htm), the CDC indicates that children are primarily exposed to lead in paint and plastics. Leaded paint was banned in the United States in 1978, although children may be exposed to leaded paint in older homes. Even though leaded paint is not used on toys manufactured in the United States, it is still widely used on toys manufactured in other countries. Therefore, children may be exposed to lead when playing with imported toys. In addition, the use of lead in plastic, which makes it more flexible and able to return to its original shape, has not been banned. The CDC explains that when the plastic is exposed to substances such as sunlight, air, and detergents the chemical bond between the lead and plastics breaks down and forms a dust.

David Barboza reports in Why Lead in Toy Paint? It's Cheaper (New York Times, September 11, 2007) that in 2007 nearly two dozen toys were recalled because they contained toxic levels of lead paint. Dozens of children's jewelry products, most of them made in China, had also been recalled in 2006 and 2007. In September 2007 Mattel, the world's largest toy maker, announced its third recall in six weeks, asking people to return certain toys made in China that contained high levels of lead paint. Lead paint is sometimes used in manufacturing products for children because it is less expensive than nonleaded paint. Ashland University randomly tested plastic toys and children's jewelry and found high lead levels in many of them, most of which had not been recalled. According to the article China Bans Lead Paint in Toys Exported to U.S. (Associated Press, September 11, 2007), China signed an agreement on September 11, 2007, to prohibit the use of lead paint on toys for export to the United States. However, Barboza states that enforcement of the regulations in China is lax.

In CDC Surveillance Data, 19972006 (November 29, 2007, http://www.cdc.gov/nceh/lead/surv/stats.htm), the CDC states that in 2006, 39,526 children in the United States aged five and under had confirmed blood lead levels greater than the CDC's recommended level of 10 micrograms per deciliter of blood. This was 1.2% of all children tested. According to the Commission for Environmental Cooperation, in Children's Health and the Environment in North America: A First Report on Available Indicators and Measures (January 2006, http://www.cec.org/files/PDF/POLLUTANTS/CEH-Indicators-fin_en.pdf), this number had dropped substantially since the early 1970s, due largely to the phasing out of lead in gasoline between 1973 and 1995. Even though children from all social and economic levels can be affected by lead poisoning, children in families with low incomes who live in older, deteriorated housing are at higher risk. Paint produced before 1978 frequently contained lead, so federal legislation now requires owners to disclose any information they may have about lead-based paint before renting or selling a home built earlier than 1978. Lead is also found in lead plumbing and is emitted by factory smokestacks.

SECONDHAND SMOKE AND CHILDREN. Environmental tobacco smoke is a major hazard for children, whose respiratory, immune, and other systems are not as well developed as those of adults. According to the CDC, in Disparities in Secondhand Smoke ExposureUnited States, 19881994 and 19992004 (Morbidity and Mortality Weekly Report, vol. 57, no. 27, July 11, 2008), secondhand or passive smoke (smoke produced by other people's cigarettes) increases the number of attacks and severity of symptoms in children with asthma and can even cause asthma in preschool-age children. It also causes lower respiratory tract infections, middle-ear disease, and a reduction in lung function in children, and it increases the risk of sudden infant death syndrome. The CDC

finds the percentage of children aged four to 11 who were regularly exposed to secondhand smoke in their homes decreased from 38.2% in the 198894 period to 23.8% in the 19992004 period, a reduction of 37.7%. The percentage of children aged 12 to 19 exposed to secondhand smoke decreased from 35.4% in the 198894 period to 19.5% in the 19992004 period, for an even larger decline of 44.9%.

DISEASES OF CHILDHOOD

Overweight and Obese Children

The number of overweight and obese Americans has reached epidemic proportions and has become a national concern. The percentage of overweight children and adolescents has grown significantly since the 1970s. Between 1976 and 1980, 6.7% of boys and 6.4% of girls aged six to 11 years were overweight. (See Table 4.4.) For boys, this percentage hit a high of 19.9%, or one in five boys, in the 200304 period, before dropping to a still high of 16.2% in 200506. Girls also hit a high of 17.6% in 200304, before it dropped to 14.1% in 200506.

An upward trend was also seen in the rates of overweight adolescents; 4.5% of boys and 5.4% of girls aged 12 to 17 were overweight in the period from 1976 to 1980, but 18.1% of adolescent boys and 17.5% of adolescent girls were overweight in the 200506 periodand these figures had not dropped from the previous two-year period. (See Table 4.4.) The proportion of overweight children overall between the ages of six and 17 tripled (from 5.7% to 16.5%) between 1976 and 2006.

The percentages of overweight children (in the 85th percentile or above for body mass index) and obese children (in the 95th percentile or above for body mass index) vary by race and ethnicity. In 2007 African-American adolescents were more likely to be overweight (19%) or obese (18.3%) than non-Hispanic white adolescents (14.3% were overweight and 10.8% were obese) or Hispanic adolescents (18.1% were overweight and 16.6% were obese). (See Table 4.5.) Younger students were more likely than older students to be either overweight or obese.

Medical professionals are concerned about this trend, because overweight children have an increased risk for premature death in adulthood as well as for many chronic diseases, including coronary heart disease, hypertension, diabetes mellitus (type 2), gallbladder disease, respiratory disease, some cancers, and arthritis. Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents. Being overweight or obese can also lead to poor self-esteem and depression in children.

Weight problems in children are thought to be caused by a lack of physical activity, unhealthy eating habits, or a combination of these factors, with genetics and lifestyle playing important roles in determining a child's weight. Watching television and playing computer and video games contribute to the inactive lifestyles of some children. According to Danice K. Eaton et al. of the CDC, in Youth Risk Behavior SurveillanceUnited States, 2007 (Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008), a quarter (24.9%) of high school students spent three or more hours per school day on the computer and more than a third (35.4%) spent three or more hours per school day watching television, often not getting a sufficient amount of physical exercise as a consequence.

Physical activity patterns established during youth may extend into adulthood and may affect the risk of illnesses such as coronary heart disease, diabetes, and cancer. Mental health experts correlate increased physical activity with improved mental health and overall improvement in life satisfaction. Eaton et al. report that only 43.7% of high school boys and 25.6% of high school girls met recommended levels of physical activity. (See Table 4.6.) White students were somewhat more likely to meet recommended levels of physical activity (37%) than African-American (31.1%) or Hispanic (30.2%) students. Only about half (53.6%) of high school students attended physical education classes, 56.3% played on a sports team, and only

 
TABLE 4.4 Percentage of children 617 who are overweight, by gender and age group, selected years 19762006
Age group Total Male Female
19761980 19881994 19992000 20012002 20032004 20052006 19761980 19881994 19992000 20012002 20032004 20052006 19761980 19881994 19992000 20012002 20032004 20052006
Note: Overweight is defined as body mass index (BMI) at or above the 95th percentile of the 2000 Centers for Disease Control and Prevention sex specific BMI-for-age growth charts.
SOURCE: Table HEALTH5. Overweight: Percentage of Children Ages 617 Who Are Overweight by Gender and Age Group, 19761980, 19881994, and 19992000, 20012002, 20032004, and 20052006, in America's Children in Brief: Key National Indicators of Well-Being, 2008, Federal Interagency Forum on Child and Family Statistics, 2008, http://www.childstats.gov/americaschildren/tables.asp (accessed November 2, 2008)
Ages 617
    Total 5.7 11.2 15.0 16.5 18.0 16.5 5.5 11.8 15.7 18.0 19.1 17.2 5.8 10.6 14.3 15.1 16.8 15.9
Ages 611
    Total 6.5 11.3 15.1 16.3 18.8 15.1 6.7 11.6 15.7 17.5 19.9 16.2 6.4 11.0 14.3 14.9 17.6 14.1
Ages 1217
    Total 5.0 11.1 14.9 16.8 17.2 17.8 4.5 12.0 15.6 18.4 18.3 18.1 5.4 10.2 14.2 15.2 16.0 17.5
 
TABLE 4.5 Percentage of high school students who were obese and who were overweight, by sex, race/ethnicity, and grade, 2007
Category Obese Overweight
Female Male Total Female Male Total
% % % % % % %
*Non-Hispanic.
Notes: Students who were 95th percentile for body mass index (BMI), by age and sex, based on reference data. Previous Youth Risk Behavior Survey reports used the term overweight to describe youth with a BMI 95th percentile for age and sex and at risk for overweight for those with a BMI 85th percentile and <95th percentile. However, this report uses the terms obese and overweight in accordance with the 2007 recommendations from the Expert Committee on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity convened by the American Medical Association (AMA) and cofunded by AMA in collaboration with the Health Resources and Services Administration and CDC.
Students who were 85th percentile but <95th percentile for body mass index, by age and sex, based on reference data.
SOURCE: Danice K. Eaton, Table 82. Percentage of High School Students Who Were Obese and Who Were Overweight, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White* 6.8 14.6 10.3 12.8 15.7 14.3
Black* 17.8 18.9 18.8 21.4 16.6 19.0
Hispanic 12.7 20.3 16.6 17.9 18.3 18.1
Grade
  9 8.1 17.3 12.7 14.2 17.7 15.1
10 10.7 16.6 13.8 18.3 17.0 17.6
11 9.8 16.4 13.2 14.2 15.9 16.0
12 9.3 14.7 12.0 13.1 14.9 14.0
       Total 9.6  
 
TABLE 4.6 High school participation in physical activity, by demographic characteristics, 2007
Category Met recommended levels of physical activity Did not participate in 60 or more minutes of physical activity on any day
Female Male Total Female Male Total
% % % % % %
Notes: Were physically active doing any kind of physical activity that increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes/day on 5 or more days during the 7 days before the survey.
Did not participate in 60 or more minutes of any kind of physical activity that increased their heart rate and made them breathe hard some of the time on at least 1 day during the 7 days before the survey.
*Non-Hispanic.
SOURCE: Danice K. Eaton, Table 52. Percentage of High School Students Who Met Recommended Levels of Physical Activity and Who Did Not Participate in 60 or More Minutes of Physical Activity on Any Day, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White* 27.9 46.1 37.0 28.2 16.7 22.4
Black* 21.0 41.3 31.1 42.1 21.8 32.0
Hispanic 21.9 38.6 30.2 35.2 18.8 27.1
Grade
  9 31.5 44.4 38.1 26.1 17.1 21.5
10 24.4 45.1 34.8 31.7 16.3 24.0
11 24.6 45.2 34.8 34.3 18.0 26.2
12 20.6 38.7 29.5 36.2 21.5 28.9
   Total 25.6 43.7 34.7 31.8 18.0 24.9

30.3% attended physical education classes daily. (See Table 4.7.) Rigorous activity among high school students also generally declined with age.

Asthma

Another serious disease affecting children is asthma, a chronic respiratory disease that causes attacks of difficulty breathing. In The State of Childhood Asthma, United States, 19802005 (December 12, 2006, http://www.cdc.gov/nchs/data/ad/ad381.pdf), Lara J. Akinbami of the CDC indicates that millions of children in the United States have asthma. In 2005, 8.9% (6.5 million) of children were currently suffering from asthma, and 12.7% (9 million) of children had suffered with it at some point in their lifetime. Childhood asthma

 
TABLE 4.7 Percentage of high school students who attended physical education classes and who played on at least one sports team, 2007
Category Attended PE classesa Attended PE classes dailyb Played on at least one sports team
Female Male Total Female Male Total Female Male Total
% % % % % % % % %
aOn 1 or more days in an average week when they were in school.
b5 days in an average week when they were in school.
cNon-Hispanic.
Notes: Run by their school or community groups during the 12 months before the survey. PE is physical education. During the 30 days before the survey, among the 79.6% of students nationwide who exercised or played sports.
SOURCE: Adapted from Danice K. Eaton, Table 78. Percentage of High School Students Who Attended Physical Education (PE) Classes, by Sex, Race/ Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, and Table 80. Percentage of High School Students Who Played on at Least One Sports Team and Who Saw a Doctor or Nurse for an Injury That Happened While Exercising or Playing Sports, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
Whitec 46.8 54.0 50.4 25.6 32.2 28.9 54.8 63.0 58.9
Blackc 50.6 61.0 55.9 27.8 35.8 31.9 44.7 65.1 54.9
Hispanic 57.3 64.7 61.0 35.5 36.4 36.0 41.8 58.1 50.0
Grade
  9 65.1 68.3 66.8 40.4 39.7 40.1 54.7 63.4 59.2
10 51.2 62.3 56.8 26.1 35.7 30.9 50.8 64.7 57.8
11 38.8 51.4 45.1 19.8 27.9 23.9 52.5 63.0 57.7
12 38.5 44.6 41.5 20.2 27.5 23.8 41.9 56.2 49.0
    Total 49.4 57.7 53.6 27.3 33.2 30.3 50.4 62.1 56.3

caused 27 hospitalizations per 10,000 children in 2004, and caused 12.8 million missed days of school in 2003. The American Lung Association estimates that up to a million asthmatic children are exposed to secondhand smoke, worsening their condition.

According to Akinbami, African-American children suffer from asthma at a rate 60% higher than that of non-Hispanic white children, and Puerto Rican children suffer from asthma at a rate 140% higher than non-Hispanic white children. In addition, she finds that African-American children's asthma is apparently much less well controlled than that of non-Hispanic white children. African-American children have a 250% higher hospitalization rate, a 260% higher emergency department visit rate, and a 500% higher death rate from asthma. Akinbami speculates that this is due to the lower level and quality of health care received by African-American children.

HIV/AIDS

Acquired immune deficiency syndrome (AIDS) was identified as a new disease in 1981, and, according to the CDC, in HIV/AIDS SurveillanceReport: Cases of HIV Infection and AIDS in the United States and Dependent Areas, 2006 (2008, http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006report/pdf/2006SurveillanceReport.pdf), an estimated one million cases had been diagnosed in the United States through 2006. AIDS is caused by the human immunodeficiency virus (HIV), which weakens the victim's immune system, making it vulnerable to other opportunistic infections. Young children with AIDS usually have the virus transmitted to them either by an infected parent or through contaminated transfusions of blood or blood products. Adolescents who are sexually active or experimenting with drugs are also vulnerable to HIV infection, which can be spread through sexual intercourse without the use of a condom or through shared hypodermic needles.

In adults the most common opportunistic infections of AIDS are Kaposi's sarcoma (a rare skin cancer) and pneumocystis carinii pneumonia. In infants and children, a failure to thrive and unusually severe bacterial infections characterize the disease. Except for pneumocystis carinii pneumonia, children with symptomatic HIV infection seldom develop opportunistic infections as adults do. More often, they are plagued by recurrent bacterial infections, persistent oral thrush (a common fungal infection of the mouth or throat), and chronic and recurrent diarrhea. They may also suffer from enlarged lymph nodes, chronic pneumonia, developmental delays, and neurological abnormalities.

HOW MANY ARE INFECTED? According to the CDC, in HIV/AIDS Surveillance Report, by the end of 2006 there were a cumulative total of 9,144 AIDS cases in children under the age of 13 since record-keeping began in 1981. (See Table 4.8.) African-American children made up the overwhelming majority of these cases (5,654 cases), followed by Hispanic children (1,748 cases), non-Hispanic white children (1,599 cases), Asians or Pacific Islanders (54 cases), and Native Americans or Alaskan Natives (31 cases). By the end of 2006, 5,165 children aged 14 and under had died from the disease.

 
TABLE 4.8 Diagnoses of AIDS in children younger than 13, by year of diagnosis, race and Hispanic origin, and transmission category, 200206
  Year of diagnosis Cumulativea
2002 2003 2004 2005 2006
Notes: These numbers do not represent reported case counts. Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts have been adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk factor, but not for incomplete reporting.
aFrom the beginning of the epidemic through 2006.
bIncludes children of unknown race or multiple races. Cumulative total includes 58 children of unknown race or multiple races. Because column totals were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.
SOURCE: Table 4. Estimated Numbers of AIDS Cases in Children <13 Years of Age, by Year of Diagnosis and Selected Characteristics, 20022006 and Cumulative50 States and the District of Columbia, in HIV/AIDS Surveillance Report: Cases of HIV Infection and AIDS in the United States and Dependent Areas, 2006, vol. 18, Centers for Disease Control and Prevention, 2008, http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2006report/pdf/2006SurveillanceReport.pdf (accessed November 5, 2008)
Race/ethnicity
White, not Hispanic 14 12 7 4 4 1,599
Black, not Hispanic 70 46 33 38 30 5,654
Hispanic 18 10 9 8 3 1,748
Asian/Pacific Islander 1 0 1 1 1 54
American Indian/Alaska Native 1 0 1 0 0 31
Transmission category
Hemophilia/coagulation disorder 0 0 0 0 0 226
Mother with documented HIV infection or 1 of the following risk factors 104 70 53 52 37 8,508
      Injection drug use 12 8 5 3 4 3,220
      Sex with injection drug user 4 6 3 2 1 1,397
      Sex with bisexual male 2 0 3 1 1 209
      Sex with person with hemophilia 0 0 0 0 0 35
      Sex with HIV-infected transfusion recipient 0 0 0 0 0 22
      Sex with HIV-infected person, risk factor not specified 36 20 20 25 13 1,530
      Receipt of blood transfusion, blood components, or tissue 2 1 0 0 0 144
      Has HIV infection, risk factor not specified 47 34 21 21 17 1,951
Receipt of blood transfusion, blood components, or tissue 2 0 0 0 0 374
Other/risk factor not reported or identified 0 0 0 0 0 36
      Totalb 106 70 53 53 38 9,144

MEANS OF TRANSMITTAL. Most babies of HIV-infected mothers do not develop HIV. HIV-positive mothers can reduce the risk of transmission by taking antiretroviral drugs during the last two trimesters of pregnancy and during labor; giving birth by caesarean section; giving the infant a short course of antiretroviral drugs after birth; and not breast feeding. With these interventions, the transmission rate can be reduced to as low as 2%.

Even though interventions are effective in preventing HIV transmission from pregnant mothers to babies, the overwhelming majority of children with AIDS contracted it from mothers either infected with HIV or at risk for AIDS (8,508 of 9,144 cases, or 93%). (See Table 4.8.) Another way HIV/AIDS has been transmitted to children was through blood transfusions contaminated with the virus, although this means of transmission has been all but eliminated in the twenty-first century.

ADOLESCENTS WITH AIDS . The number of AIDS cases among adolescents is comparatively low. In HIV/AIDS Surveillance Report, the CDC states that by the end of 2006, 6,704 adolescents aged 13 to 19 had been diagnosed with AIDS since the beginning of the epidemic in the early 1980s. However, because of the long incubation period between the time of infection and the onset of symptoms, it is highly probable that many people who develop AIDS in their early twenties became infected with HIV during their adolescence; 36,225 young adults, 20- to 24-year-olds, had been diagnosed since the beginning of the epidemic by the end of 2006.

MENTAL HEALTH ISSUES IN YOUNG PEOPLE

Marital Conflict and Divorce

Marital conflict hurts children whether it results in the breakup of marriages or not. Nearly all the studies on children of divorce have focused on the period after the parents separated. However, recent studies suggest that the negative effects children experience may not come so much from divorce itself as from marital discord between parents before divorce. In fact, some research suggests that many problems reported with troubled teens not only began during the marriage but may have contributed to the breakup of the marriage. According to the article Children of Divorce (Journal of the American Board of Family Practice, vol. 14, no. 3, 2001), children raised in discord and marital instability often experience a variety of social, emotional, and psychological problems. Amy L. Baker reports in The Long-Term Effects of Parental Alienation on Adult Children: A Qualitative Research Study (American Journal of Family Therapy, vol. 33, no. 4, JulySeptember 2005) that negative effects, such as low self-esteem, depression, drug and/or alcohol abuse, lack of trust, alienation from

own children, and an elevated risk of divorce, persist among these children into adulthood.

Divorce can cause stressful situations for children in several ways. One or both parents may have to move to a new home, removing the children from family and friends who could have given them support. Custody issues can generate hostility between parents. If one or both parents remarry, children are faced with yet another adjustment in their living arrangements.

Eating Disorders

Even though young people who are overweight increase their risk for certain diseases in adulthood, an overemphasis on thinness during childhood may contribute to eating disorders such as anorexia nervosa (a disorder characterized by voluntary starvation) and bulimia nervosa (a disorder in which a person eats large amounts of food then forces vomiting or uses laxatives to prevent weight gain). Girls are both more likely to have a distorted view of their weight and more likely to have eating disorders than boys.

Eaton et al. report that in 2007 students as a whole had a fairly accurate view of their weight: 15.8% of students were overweight (having a body mass index between the 85th and 95th percentile for their age and sex) and 13% were obese (having a body mass index equal to or greater than the 95th percentile for their age and sex). (See Table 4.5.) Approximately 29.3% said they were slightly or very overweight. (See Table 4.9.) However, girls were much more likely than boys to have a skewed perception of their body size. Even though 32.7% of male students were obese or overweight, 24.2% perceived themselves as overweight and 30.4% were trying to lose weight. Among female students, 24.7% of students were obese or overweight, 34.5% described themselves as overweight, and fully 60.3% were trying to lose weight.

Most students used healthy ways to lose weight, such as diet and exercise. However, a significant proportion used unhealthy methods such as extended periods of not eating, taking diet pills or laxatives, or inducing vomiting. Over half (53.2%) of female students and a quarter (28.3%) of male students ate less food, fewer calories, or low-fat foods to control their weight. (See Table 4.10.) Another two-thirds (67%) of female students and over half (55%) of male students exercised to control their weight. However, 16.3% of female students and 7.3% of male students had not eaten for 24 hours or more to lose weight; 7.5% of female students and 4.2% of male students had taken diet pills, powders, or liquids to control their weight; and 6.4% of female students and 2.2% of male students had vomited or taken laxatives to control their weight. (See Table 4.11.) A greater proportion of female students than male students used both healthy and unhealthy behaviors for weight control. In addition, Hispanic and non-Hispanic white students were in general more likely than African-American students to use unhealthy methods of weight control and the use of these methods increased somewhat with age.

Hyperactivity

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders to appear in childhood. No one knows what causes ADHD, although research has focused on biological causes and the role of genetics. Symptoms include restlessness, inability to concentrate, aggressiveness, and impulsivity; and the lack of treatment can lead to problems in school, at work, and in making friends. Methylphenidate, a stimulant, is frequently

 
TABLE 4.9 Percentage of high school students who thought they had a problem with weight and were trying to lose weight, by sex, race/ethnicity, and grade, 2007
Category Described themselves as overweight Were trying to lose weight
Female Male Total Female Male Total
% % % % % %
*Non-Hispanic.
SOURCE: Danice K. Eaton, Table 84. Percentage of High School Students Who Described Themselves As Slightly or Very Overweight and Who Were Trying to Lose Weight, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White* 34.0 23.6 28.8 62.3 29.0 45.6
Black* 30.1 19.1 24.6 49.5 24.9 37.1
Hispanic 39.3 28.3 33.8 62.1 38.5 50.2
Grade
  9 33.6 24.3 28.8 58.6 31.0 44.4
10 33.8 24.8 29.2 60.2 31.6 45.8
11 36.2 25.8 31.0 61.3 30.1 45.8
12 34.9 21.6 28.3 61.6 28.7 45.3
      Total 34.5 24.2 29.3 60.3 30.4 45.2
 
TABLE 4.10 Percentage of high school students who ate less food, fewer calories, or low-fat foods and who exercised, by sex, race, ethnicity, and grade, 2007
Category Ate less food, fewer calories, or low-fat foods to lose weight or to keep from gaining weight Exercised to lose weight or to keep from gaining weight
Female Male Total Female Male Total
% % % % % %
Note: To lose weight or to keep from gaining weight during the 30 days before the survey.
*Non-Hispanic.
SOURCE: Danice K. Eaton, Table 86. Percentage of High School Students Who Ate Less Food, Fewer Calories, or Low-Fat Foods and Who Exercised, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White* 58.4 28.3 43.3 71.5 53.3 62.4
Black* 34.6 21.0 27.8 50.7 53.7 52.2
Hispanic 52.0 32.3 42.1 66.4 60.1 63.2
Grade
  9 50.5 27.3 38.6 70.6 58.7 64.5
10 53.0 29.1 40.9 67.7 54.2 60.9
11 54.0 29.8 42.0 65.0 54.9 59.9
12 56.4 27.4 42.0 63.7 51.1 57.5
      Total 53.2 28.3 40.6 67.0 55.0 60.9
 
TABLE 4.11 Percentage of high school students who engaged in unhealthy behaviors in an effort to lose weight, by sex, race, Hispanic origin, and grade, 2007
Category Did not eat for 24 or more hours to lose weight or to keep from gaining weight Took diet pills, powders or liquids to lose weight or to keep from gaining weighta Vomited or took laxatives to lose weight or to keep from gaining weight
Female Male Total Female Male Total Female Male Total
% % % % % % % % %
Notes: To lose weight or to keep from gaining weight during the 30 days before the survey.
aWithout a doctor's advice.
bNon-Hispanic.
SOURCE: Adapted from Danice K. Eaton et al., Table 88. Percentage of High School Students Who Did Not Eat for 24 or More Hours and Who Took Diet Pills, Powders, or Liquids, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, and Table 90. Percentage of High School Students Who Vomited or Took Laxatives, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
whiteb 16.7 5.7 11.2 8.3 3.7 6.0 6.9 1.3 4.1
Blackb 13.2 7.4 10.3 3.9 3.6 3.7 3.5 2.5 3.0
Hispanic 17.4 10.7 14.1 7.8 5.1 6.4 7.0 3.7 5.3
Grade
9 16.8 6.5 11.6 6.1 2.9 4.4 5.5 2.1 3.8
10 19.1 6.5 12.7 6.9 3.8 5.3 7.6 1.8 4.7
11 14.8 8.1 11.5 7.4 5.0 6.2 5.7 2.1 4.0
12 13.6 8.0 10.9 10.2 5.7 8.0 6.6 2.6 4.6
Total 16.3 7.3 11.8 7.5 4.2 5.9 6.4 2.2 4.3

used to treat hyperactive children. In Summary Health Statistics for U.S. Children: National Health Interview Survey, 2006 (September 2007, http://www.cdc.gov/nchs/data/series/sr_10/sr10_234.pdf), Barbara Bloom and Robin A. Cohen of the CDC explain that boys are more likely to be diagnosed with ADHD than girls; 10.7% of boys aged three to 17 have been diagnosed at some point, compared to 4% of girls.

Drug and Alcohol Use

Few factors negatively influence the health and well-being of young people more than the use of drugs, alcohol, and tobacco. Monitoring the Future, a long-term study on the use of drugs, alcohol, and tobacco conducted by the University of Michigan's Institute for Social Research, annually surveys eighth, 10th, and 12th graders on their use of these substances. According to Lloyd D.

 
TABLE 4.12 Percentage of high school students who drank alcohol and used marijuana, by sex, race, ethnicity, and grade, 2007
Category Lifetime alcohol usea Current alcohol useb Lifetime marijuana used Current marijuana usee
Female Male Total Female Male Total Female Male Total Female Male Total
% % % % % % % % % % % %
aHad at least one drink of alcohol on at least 1 day during their life.
bHad at least one drink of alcohol on at least 1 day during the 30 days before the survey.
cNon-Hispanic.
dUsed marijuana one or more times during their life.
eUsed marijuana one or more times during the 30 days before the survey.
SOURCE: Adapted from Danice K. Eaton, Table 35. Percentage of High School Students Who Drank Alcohol, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, and Table 39. Percentage of High School Students Who Used Marijuana, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
Whitec 76.4 75.8 76.1 47.1 47.4 47.3 34.1 41.8 38.0 17.0 22.7 19.9
Blackc 70.0 68.4 69.1 34.9 34.1 34.5 35.0 44.5 39.6 17.1 26.0 21.5
Hispanic 79.3 76.5 77.9 47.5 47.7 47.6 35.9 42.0 38.9 16.4 20.5 18.5
Grade
9 66.1 65.0 65.5 37.2 34.3 35.7 21.7 33.0 27.5 12.5 16.9 14.7
10 74.6 74.9 74.7 42.3 41.4 41.8 34.5 39.2 36.9 16.5 22.0 19.3
11 79.1 79.7 79.4 46.5 51.5 49.0 36.6 48.3 42.4 17.5 25.2 21.4
12 85.2 80.2 82.8 54.2 55.6 54.9 48.3 49.9 49.1 22.6 27.8 25.1
Total 75.7 74.3 75.0 44.6 44.7 44.7 34.5 41.6 38.1 17.0 22.4 19.7

Johnston et al. of the Institute for Social Research, in Monitoring the Future: National Results on Adolescent Drug Use, Overview of Key Findings, 2007 (2008, http://www.monitoringthefuture.org/pubs/monographs/overview 2007.pdf), the percentage of high school students who had used an illicit drug during that past year declined between 1997 and 2007, after sharp increases during the early 1990s. Johnston et al. find that in 2007, 35.9% of seniors (who were more likely than eighth or 10th graders to use an illicit drug) had used an illicit drug in the previous 12 months. Concerning the lifetime prevalence rate, 46.8% of 12th graders had tried an illicit drug. Alcohol (72.7% of seniors) and marijuana (41.8% of seniors) were the most commonly used drugs. Eaton et al. find that in 2007, 75% of all high school students had tried alcohol and 44.7% had used it in the past month. (See Table 4.12.) The researchers also note that 38.1% of high school students reported they had tried marijuana, and 19.7% reported they had used it at least once in the 30 days before the survey.

TOBACCO. Most states prohibit the sale of cigarettes to anyone under the age of 18, but the laws are often ignored and may carry no penalties for youths who buy cigarettes or smoke in public. In fact, 16% of high school students reported in 2007 that they had bought cigarettes in a store or gas station. (See Table 4.13.) The American Lung Association reports in Smoking and Teens Fact Sheet (August 2008, http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=39871) that each day 4,000 children smoke their first cigaretteand almost 1,300 of them will become regular smokers. According to Eaton et al., half (50.3%) of all high school students in 2007 said they had tried cigarettes at some point in their lives. (See Table 4.14.) One out of five (20%) high school

 
TABLE 4.13 Percentage of high school students who bought cigarettes in a store or gas station, by sex, race, Hispanic origin, and grade, 2007
Category Bought cigarettes in a store or gas station
Female Male Total
% % %
Not available.
*Non-Hispanic.
Note: During the 30 days before the survey, among the 16.1% of students nationwide who were aged <18 years and who currently smoked cigarettes.
SOURCE: Adapted from Danice K. Eaton, Table 31. Percentage of High School Students Who Usually Obtained Their Own Cigarettes by Buying Them in a Store or Gas Station and Who Currently Used Smokeless Tobacco, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White* 10.9 20.4 15.9
Black*   22.6 19.3
Hispanic 9 9 17.1 13.8
Grade
9 7.0 11.8 9.7
10 9.4 20.2 15.0
11 13.6 20.9 17.8
12 17.0 34.8 25.6
Total 11.3 20.0 16.0

students had smoked at least one cigarette in the month before the survey and 8.1% had smoked at least 20 days in the past month. (See Table 4.15.) Almost twice as many male students smoked heavily than did female students:

 
TABLE 4.14 Percentage of high school students who ever smoked cigarettes, by sex, race, ethnicity, and grade, 2007
Category Lifetime cigarette usea Lifetime daily cigarette useb
Female Male Total Female Male Total
% % % % % %
aEver tried cigarette smoking, even one or two puffs.
bEver smoked at least one cigarette every day for 30 days.
cNon-Hispanic.
SOURCE: Danice K. Eaton, Table 25. Percentage of High School Students Who Ever Smoked Cigarettes, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
Whitec 48.3 51.7 50.0 14.9 15.8 15.4
Blackc 48.8 52.0 50.3 5.0 7.3 6.2
Hispanic 52.1 54.5 53.3 7.1 8.9 8.0
Grade
9 39.2 46.0 42.7 6.3 10.3 8.3
10 48.7 48.8 48.8 12.4 11.7 12.0
11 51.4 55.4 53.4 14.0 13.4 13.8
12 58.5 60.1 59.3 15.8 18.0 16.8
Total 48.8 51.8 50.3 11.8 13.0 12.4
 
TABLE 4.15 Percentage of high school students who currently smoked cigarettes, frequently smoked cigarettes, or smoked more than ten cigarettes per day, by sex, race, ethnicity, and grade, 2007
Category Current cigarette usea Current frequent cigarette useb Smoked more than 10 cigarettes/day
Female Male Total Female Male Total Female Male Total
% % % % % % % % %
aSmoked cigarettes on at least 1 day during the 30 days before the survey.
bSmoked cigarettes on 20 or more days during the 30 days before the survey.
cNon-Hispanic.
Notes: On the days they smoked during the 30 days before the survey, among the 20.0% of students nationwide who currently smoked cigarettes. During the 12 months before the survey, among the 20.0% of students nationwide who currently smoked cigarettes.
SOURCE: Adapted from Danice K. Eaton, Table 27. Percentage of High School Students Who Currently Smoked Cigarettes, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, and Table 29. Percentage of High School Students Who Currently Smoked More Than 10 Cigarettes and Who Tried to Quit Smoking Cigarettes, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
Whitec 22.5 23.8 23.2 10.2 10.6 10.4 8.0 15.7 11.9
Blacka 8.4 14.9 11.6 2.1 5.8 3.9 1.7 8.6 6.1
Hispanic 14.6 18.7 16.7 3.3 5.1 4.2 4.8 8.4 6.8
Grade
9 12.3 16.2 14.3 3.3 5.4 4.3 6.7 12.6 10.1
10 19.1 20.0 19.6 6.8 7.2 7.0 5.3 12.6 9.0
11 19.6 23.4 21.6 9.7 10.5 10.1 8.1 9.9 9.0
12 25.5 27.4 26.5 11.3 13.1 12.2 7.8 19.2 13.6
Total 18.7 21.3 20.0 7.4 8.7 8.1 7.1 13.8 10.7

13.8% of male adolescents and 7.1% of female adolescents smoked more than 10 cigarettes per day.

Teens say they smoke for a variety of reasonsthey just like it, it's a social thing, and many young women who are worried about their weight report that they smoke because it burns calories. Many of them note they have seen their parents smoke. The ALA indicates that youth who have two parents who smoke are more than twice as likely to become smokers than youth whose parents do not smoke. Children in smoking households are at risk not only from secondhand smoke but also from this greater likelihood to take up smoking themselves.

CHILDHOOD DEATHS

Infant Mortality

The NCHS defines the infant mortality rate as the number of deaths of babies younger than one year per 1,000 live births. Neonatal deaths occur within 28 days

 
TABLE 4.16 Infant mortality rate among selected groups by race and Hispanic origin of mother, selected years 19832004
[Data are based on linked birth and death certificates for infants]
Race and Hispanic origin of mother 19831985a, g 19861988a, g 19891991a, g 19951997b, g 19992001b, g 20022004b, g
Data not available.
aRates based on unweighted birth cohort data.
bRates based on a period file using weighted data.
cInfant (under 1 year of age), neonatal (under 28 days), and postneonatal (28 days11 months).
dStarting with 2003 data, estimates are not shown for Asian or Pacific Islander subgroups during the transition from single race to multiple race reporting.
eePersons of Hispanic origin may be of any race.
fPrior to 1995, data shown only for states with an Hispanic-origin item on their birth certificates.
gAverage annual mortality rate.
Notes: The race groups white, black, American Indian or Alaska Native, and Asian or Pacific Islander include persons of Hispanic and non-Hispanic origin. Starting with 2003 data, some states reported multiple-race data. The multiple-race data for these states were bridged to the single-race categories of the 1977 Office of Management and Budget standards for comparability with other states. National linked files do not exist for 19921994. Data for additional years are available.
SOURCE: Adapted from Table 19. Infant, Neonatal, Postneonatal Mortality Rates, by Detailed Race and Hispanic Origin of Mother: United States, Selected Years 19832004, in Health, United States, 2007. With Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, 2007, http://www.cdc.gov/nchs/data/hus/hus07.pdf (accessed September 15, 2008
Infant c deaths per 1,000 live births
All mothers 10.6 9.8 9.0 7.4 6.9 6.9
White 9.0 8.2 7.4 6.1 5.7 5.7
Black or African American 18.7 17.9 17.1 14.1 13.6 13.5
American Indian or Alaska Native 13.9 13.2 12.6 9.2 9.1 8.6
Asian or Pacific Islanderd 8.3 7.3 6.6 5.1 4.8 4.8
Chinese 7.4 5.8 5.1 3.3 3.2
Japanese 6.0 6.9 5.3 4.9 4.0
Filipino 8.2 6.9 6.4 5.7 5.7
Hawaiian 11.3 11.1 9.0 7.0 7.8
Other Asian or Pacific Islander 8.6 7.6 7.0 5.4 4.9
Hispanic or Latinoe, f 9.2 8.3 7.5 6.1 5.6 5.6
Mexican 8.8 7.9 7.2 5.9 5.4 5.5
Puerto Rican 12.3 11.1 10.4 8.5 8.4 8.1
Cuban 8.0 7.3 6.2 5.3 4.5 4.3
Central and South American 8.2 7.5 6.6 5.3 4.8 4.9
Other and unknown Hispanic or Latino 9.8 9.0 8.2 7.1 6.7 6.8
Not Hispanic or Latino
Whitef 8.8 8.1 7.3 6.1 5.7 5.7
Black or African Americanf 18.5 17.9 17.2 14.2 13.7 13.7
Neonatal c deaths per 1,000 live births
All mothers 6.9 6.3 5.7 4.8 4.6 4.6
White 5.9 5.2 4.7 4.0 3.8 3.8
Black or African American 12.2 11.7 11.1 9.4 9.2 9.2
American Indian or Alaska Native 6.7 5.9 5.9 4.4 4.5 4.5
Asian or Pacific Islanderd 5.2 4.5 3.9 3.3 3.2 3.3
Chinese 4.3 3.3 2.7 2.1 2.1
Japanese 3.4 4.4 3.0 2.8 2.6
Filipino 5.3 4.5 4.0 3.7 4.0
Hawaiian 7.4 7.1 4.8 4.5 4.9
Other Asian or Pacific Islander 5.5 4.7 4.2 3.5 3.3
Hispanic or Latinoe, f 6.0 5.3 4.8 4.0 3.8 3.9
Mexican 5.7 5.0 4.5 3.8 3.6 3.7
Puerto Rican 8.3 7.2 7.0 5.7 5.9 5.6
Cuban 5.9 5.3 4.6 3.7 3.1 3.1
Central and South American 5.7 4.9 4.4 3.7 3.3 3.5
Other and unknown Hispanic or Latino 6.1 5.8 5.2 4.6 4.4 4.9
Not Hispanic or Latino
Whitef 5.7 5.1 4.6 4.0 3.8 3.8
Black or African Americanf 11.8 11.4 11.1 9.4 9.2 9.2

after birth and postneonatal deaths occur 28 to 365 days after birth. The U.S. infant mortality rate declined from 165 per 1,000 live births in 1900 to a low of 6.9 per 1,000 live births in between 2002 and 2004. (See Table 4.16.) In Health, United States, 2007 (2007, http://www.cdc.gov/nchs/data/hus/hus07.pdf), the CDC notes that several factorsincluding improved access to health care, advances in neonatal medicine, and educational campaignscontributed to the overall decline in infant mortality in the twentieth century.

Not all racial and ethnic groups have reached that record-low infant mortality rate. Between 2002 and 2004 the infant mortality rate for non-Hispanic white infants was 5.7 deaths per 1,000 live births, less than half the rate of 13.5 for African-American infants. (See Table 4.16.) Rates for Native American or Alaskan Native, Hispanic, and Asian or Pacific Islander babies were 8.6, 5.6, and 4.8, respectively.

The NCHS lists the 10 leading causes of infant mortality in the United States in 2006. (See Table 4.17.) Birth

 
TABLE 4.17 Ten leading causes of infant death, by race and Hispanic origin, 2006
[Data are based on a continuous file of records received from the states. Rates are per 100,000 live births. Figures are based on weighted data rounded to the nearest individual, so categories may not add to totals or subtotals. Race and Hispanic origin are reported separately on both the birth and death certificate. Rates for Hispanic origin should be interpreted with caution because of inconsistencies between reporting Hispanic origin on birth and death certificates. Race categories are consistent with the 1977 Office of Management and Budget (OMB) standards. Multiple-race data were reported for deaths by 25 states and the District of Columbia and for births by 23 states. The multiple-race data for these states were bridged to the single-race categories of the 1977 OMB standards for comparability with other states. Data for persons of Hispanic origin are included in the data for each race group, according to the decedent's reported race.]
Ranka Cause of death, race and Hispanic origin Number Rate
Category not applicable.
aRank based on number of deaths.
bIncludes races other than white and black.
cIncludes all persons of Hispanic origin of any race. Because of a misclassification error in New Mexico, statistics for Hispanic decedents of all ages were underestimated by about 3.0 percent, and statistics for Hispanic decedents under 1 year of age were underestimated by about 1.0 percent.
Notes: For certain causes of death such as unintentional injuries, homicides, suicides, and sudden infant death syndrome, preliminary and final data may differ because of the truncated nature of the preliminary file. Data are subject to sampling or random variation.
SOURCE: Adapted from Melonie P. Heron et al., Table 8. Infant Deaths and Infant Mortality Rates for the 10 Leading Causes of Infant Death, by Race and Hispanic Origin: United States, Preliminary 2006, in Deaths: Preliminary Data for 2006, National Vital Statistics Report, vol. 56, no. 16, June 11, 2008, http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_16.pdf (accessed November 5, 2008)
  All racesb    
All causes 28,609 670.6
1 Congenital malformations, deformations and chromosomal abnormalities 5,827 136.6
2 Disorders related to short gestation and low birth weight, not elsewhere classified 4,841 113.5
3 Sudden infant death syndrome 2,145 50.3
4 Newborn affected by maternal complications of pregnancy 1,694 39.7
5 Newborn affected by complications of placenta, cord and membranes 1,123 26.3
6 Accidents (unintentional injuries) 1,119 26.2
7 Respiratory distress of newborn 801 18.8
8 Bacterial sepsis of newborn 786 18.4
9 Neonatal hemorrhage 598 14.0
10 Diseases of the circulatory system 539 12.6
All other causes 9,136 214.2
  Non-Hispanic white    
All causes 13,019 563.6
1 Congenital malformations, deformations and chromosomal abnormalities 2,989 129.4
2 Disorders related to short gestation and low birth weight, not elsewhere classified 1,805 78.1
3 Sudden infant death syndrome 1,171 50.7
4 Newborn affected by maternal complications of pregnancy 751 32.5
5 Accidents (unintentional injuries) 547 23.7
6 Newborn affected by complications of placenta, cord and membranes 472 20.4
7 Respiratory distress of newborn 353 15.3
8 Bacterial sepsis of newborn 331 14.3
9 Neonatal hemorrhage 299 12.9
10 Diseases of the circulatory system 239 10.3
All other causes 4,062 175.9
  Total black    
All causes 8,842 1,335.2
1 Disorders related to short gestation and low birth weight, not elsewhere classified 1,978 298.7
2 Congenital malformations, deformations and chromosomal abnormalities 1,157 174.7
3 Sudden infant death syndrome 656 99.1
4 Newborn affected by maternal complications of pregnancy 595 89.9
5 Newborn affected by complications of placenta, cord and membranes 378 57.1
6 Accidents (unintentional injuries) 351 53.0
7 Bacterial sepsis of newborn 272 41.1
8 Respiratory distress of newborn 267 40.3
9 Necrotizing enterocolitis of newborn 204 30.8
10 Diseases of the circulatory system 175 26.4
All other causes 2,809 424.2
  Hispanicc    
All causes 5,706 549.2
1 Congenital malformations, deformations and chromosomal abnormalities 1,442 138.8
2 Disorders related to short gestation and low birth weight, not elsewhere classified 919 88.4
3 Newborn affected by maternal complications of pregnancy 299 28.8
4 Sudden infant death syndrome 244 23.5
5 Newborn affected by complications of placenta, cord and membranes 227 21.8
6 Accidents (unintentional injuries) 178 17.1
7 Respiratory distress of newborn 159 15.3
8 Bacterial sepsis of newborn 152 14.6
9 Neonatal hemorrhage 113 10.9
10 Diseases of the circulatory system 99 9.5
All other causes 1,874 180.4

defects (congenital malformations) were the primary cause of infant mortality (136.6 deaths per 100,000 live births). Premature delivery or low birth weight was the second-leading cause of infant mortality (113.5 per 100,000 live births). Sudden infant death syndrome (50.3), complications of pregnancy (39.7), complications in the placenta or umbilical cord (26.3), accidents (26.2), respiratory distress (18.8), bacterial sepsis (18.4), neonatal hemorrhage (14), and diseases of the circulatory system (12.6) complete the list.

SUDDEN INFANT DEATH SYNDROME. Sudden infant death syndrome (SIDS; sometimes called crib death), the unexplained death of a previously healthy infant, was the third-leading cause of infant mortality in the United States in 2006. Moreover, according to the CDC, in Safe Sleep for Your Baby: Ten Ways to Reduce the Risk of Sudden Infant Death Syndrome (August 2003, http://www.nichd.nih.gov/publications/pubs/safe_sleep_gen.cfm), SIDS is the leading cause of death among infants aged one to 12 months. In 1992 the American Academy of Pediatrics recommended that babies sleep on their back to reduce the risk of SIDS and launched its Back to Sleep campaign to educate parents. It had been a long-held belief that the best position for babies to sleep was on their stomach. Other risk factors for SIDS include maternal use of drugs or tobacco during pregnancy, low birth weight, and poor prenatal care. For reasons not yet understood, even though the overall rate of SIDS has declined since the beginning of the Back to Sleep campaign, it has declined less among African-Americans and Native Americans than among other groups. The CDC indicates that African-American babies are more than twice as likely to die of SIDS and Native American babies are nearly three times as likely to die of SIDS than white babies.

A number of studies have considered the possible causes of and risk factors for SIDS. For example, the article SIDS Risk Prevention Research Begins to Define Physical Abnormalities in Brainstem, Points to Possible Diagnostic/Screening Tools (PR Newswire, October 18, 1999) reports that one study, ongoing since 1985, conducted by Hannah Kinney of Harvard Medical School in Boston, Massachusetts, found a brain defect believed to affect breathing in babies who died of SIDS. Researchers suggest that as carbon dioxide levels rise and oxygen levels fall during sleep, the brains of some babies do not get the signal to regulate breathing or blood pressure accordingly to make up for the change. This condition is particularly dangerous for infants sleeping on their stomachs or on soft bedding. According to the National Institutes of Health, in SIDS Infants Show Brain Abnormalities, (November 10, 2006, http://www.nih.gov/news/research_matters/november2006/11102006sids.htm), this project found that this type of brain abnormality might be linked to higher levels of serotonin in the brainstem. Duane Alexander stated, This finding lends credence to the view that SIDS risk may greatly increase when an underlying predisposition combines with an environmental risksuch as sleeping face downat a developmentally sensitive time in early life.

Mortality among Older Children

In the second half of the twentieth century, childhood death rates declined dramatically. Most childhood deaths are from injuries and violence. Even though death rates for all ages decreased, the largest declines were among children.

In 2005 three of the leading causes of death of one- to four-year-olds were unintentional injuries, congenital anomalies (birth defects), and malignant neoplasms (cancers). (See Table 4.18.) The remaining deaths were spread across a variety of diseases, including heart disease, pneumonia, influenza, HIV/AIDS, homicide, and suicide.

MOTOR VEHICLE INJURIES. The National Highway Traffic Safety Administration notes in Determine Why There Are Fewer Young Alcohol-Impaired Drivers (September 2001, http://www.nhtsa.dot.gov/people/injury/research/FewerYoungDrivers/) that even though motor vehicle fatalities decreased by 25% between 1982 and 2000 for 15- to 19-year-olds, traffic accidents were still the leading cause of death for this age group. During the 1980s and early 1990s, traffic fatalities linked to teenage drinking fell. This decline was due in large part to stricter enforcement of drinking age laws and driving while intoxicated or driving under the influence laws. Nevertheless, motor vehicle crashes were the leading cause of death among 15- to 20-year-olds in 2003. In the fact sheet Mortality: Adolescents and Young Adults (2006, http://nahic.ucsf.edu/downloads/Mortality.pdf), the National Adolescent Health Information Center reports that in 2003, 25.2 of every 100,000 teenagers in this age group were killed in traffic accidents. Many of those killed had been drinking alcohol and were not wearing their seatbelts. Timothy M. Pickrell of the U.S. Department of Transportation reports in Driver Alcohol Involvement in Fatal Crashes by Age Group and Vehicle Type (June 2006, http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2006/810598.pdf) that 20% of all young drivers aged 15 to 20 who were killed in crashes were intoxicated.

Eaton et al. find that in 2007, in the month before the survey, 18.3% of high school seniors (those most likely to have their driver's licenses) reported they had driven a vehicle after drinking alcohol. (See Table 4.19.) Male seniors (23.6%) were more likely than female seniors (13.1%) to drive after drinking. Another 29.1% of high school students admitted they had ridden with a driver who had been drinking.

SUICIDE. In 2005 suicide was the fifth-leading cause of death among five- to 14-year-olds and the third-leading cause of death in 15- to 24-year-olds. (See Table 4.18.) Debra L. Karch et al. of the CDC report in Surveillance for Violent

 
TABLE 4.18 Leading causes of death and numbers of deaths, by age, 1980 and 2005
[Data are based on death certificates]
Age andrank order 1980 2005
Cause of death Deaths Cause of death Deaths
Under 1 year
Category not applicable.
SOURCE: Adapted from Table 32. Leading Causes of Death and Numbers of Deaths, by Age: United States, 1980 and 2005, in Health, United States, 2007. With Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, 2007, http://www.cdc.gov/nchs/data/hus/hus07.pdf (accessed September 15, 2008)
  All causes 45,526 All causes 28,440
1 Congenital anomalies 9,220 Congenital malformations, deformations and chromosomal abnormalities 5,552
2 Sudden infant death syndrome 5,510 Disorders related to short gestatiion and low birth weight, not elsewhere classified 4,714
3 Respiratory distress syndrome 4,989 Sudden infant death syndrome 2,230
4 Disorders relating to short gestation and unspecified low birthweight 3,648 Newborn affected by maternal complications of pregnancy 1,776
5 Newborn affected by maternal complications of pregnancy 1,572 Newborn affected by complications of placenta, cord and membranes 1,110
6 Intrauterine hypoxia and birth asphyxia 1,497 Unintentional injuries 1,083
7 Unintentional injuries 1,166 Respiratory distress of newborn 860
8 Birth trauma 1,058 Bacterial sepsis of newborn 834
9 Pneumonia and influenza 1,012 Neonatal hemorrhage 665
10 Newborn affected by complications of placenta, cord, and membranes 985 Necrotizing enterocolitis of newborn 546
14 years
  All causes 8,187 All causes 4,756
1 Unintentional injuries 3,313 Unintentional injuries 1,664
2 Congenital anomalies 1,026 Congenital malformations, deformations and chromosomal abnormalities 522
3 Malignant neoplasms 573 Malignant neoplasms 377
4 Diseases of heart 338 Homicide 375
5 Homicide 319 Diseases of heart 151
6 Pneumonia and influenza 267 Influenza and pneumonia 110
7 Meningitis 223 Septicemia 85
8 Meningococcal infection 110 Cerebrovascular dieases 62
9 Certain conditions originating in the perinatal period 84 Certain conditions originating in the perinatal period 58
10 Septicemia 71 Chronic lower respiratory diseases 56
514 years
  All causes 10,689 All causes 6,602
1 Unintentional injuries 5,224 Unintentional injuries 2,415
2 Malignant neoplasms 1,497 Malignant neoplasms 1,000
3 Congenital anomalies 561 Congenital malformations, deformations and chromosomal abnormalities 396
4 Homicide 415 Homicide 341
5 Diseases of heart 330 Suicide 272
6 Pneumonia and influenza 194 Diseases of heart 252
7 Suicide 142 Influenza and pneumonia 106
8 Benign neoplasms 104 Chronic lower respiratory diseases 104
9 Cerebrovascular diseases 95 Cerebrovascular dieases 95
10 Chronic obstructive pulmonary diseases 85 Septicemia 81
1524 years
  All causes 49,027 All causes 34,234
1 Unintentional injuries 26,206 Unintentional injuries 15,753
2 Homicide 6,537 Homicide 5,466
3 Suicide 5,239 Suicide 4,212
4 Malignant neoplasms 2,683 Malignant neoplasms 1,717
5 Diseases of heart 1,223 Diseases of heart 1,119
6 Congenital anomalies 600 Congenital malformations, deformations and chromosomal abnormalities 504
7 Cerebrovascular diseases 418 Diabetes mellitus 202
8 Pneumonia and influenza 348 Cerebrovascular dieases 196
9 Chronic obstructive pulmonary diseases 141 Pregnancy, childbirth and puerperuim 183
10 Anemias 133 Influenza and pneumonia 172

DeathsNational Violent Death Reporting System, 16 States, 2005 (Morbidity and Mortality Weekly Report, vol. 57, no. SS-03, April 11, 2008) that the male suicide rate (18.4 per 100,000) was more than three times higher than the female suicide rate (4.8 per 100,000). According to Melonie Heron of the CDC, in Deaths: Leading Causes for 2004

 
TABLE 4.19 Percentage of high school students who rode with a driver who had been drinking alcohol and who drove when they had been drinking alcohol, by sex, race, ethnicity, and grade, 2007
Category Rode with a driver who had been drinking alcohol Drove when drinking alcohol
Female Male Total Female Male Total
% % % % % %
Note: One or more times during the 30 days before the survey.
*Non-Hispanic.
SOURCE: Danice K. Eaton, Table 5. Percentage of High School Students Who Rode in a Car or Other Vehicle Driven by Someone Who Had Been Drinking Alcohol and Who Drove a Car or Other Vehicle When They Had Been Drinking Alcohol, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White* 28.0 27.8 27.9 9.3 13.9 11.6
Black* 26.9 28.1 27.4 3.9 7.5 5.7
Hispanic 35.1 36.0 35.5 7.7 13.0 10.3
Grade
9 27.6 27.6 27.6 4.1 6.8 5.5
10 30.4 27.1 28.7 7.3 10.0 8.7
11 26.8 31.4 29.2 9.1 13.7 11.5
12 30.5 32.5 31.5 13.1 23.6 18.3
Total 28.8 29.5 29.1 8.1 12.8 10.5
 
TABLE 4.20 Percentage of high school students who felt sad or hopeless, who seriously considered attempting suicide, and who made a suicide plan, by sex, race, ethnicity, and grade, 2007
Category Felt sad or hopeless Seriously considered attempting suicide Made a suicide plan
Female Male Total Female Male Total Female Male Total
% % % % % % % % %
*Non-Hispanic.
Notes: Almost every day for 2 or more weeks in a row so that they stopped doing some usual activities. During the 12 months before the survey.
SOURCE: Adapted from Danice K. Eaton et al., Table 19. Percentage of High School Students Who Felt Sad or Hopeless, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, and Table 21. Percentage of High School Students Who Seriously Considered Attempting Suicide, and Who Made a Plan about How They Would Attempt Suicide, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White* 34.6 17.8 26.2 17.8 10.2 14.0 12.8 8.8 10.8
Black* 34.5 24.0 29.2 18.0 8.5 13.2 12.0 7.1 9.5
Hispanic 42.3 30.4 36.3 21.1 10.7 15.9 15.2 10.4 12.8
Grade
9 34.8 22.1 28.2 19.0 10.8 14.8 13.4 9.2 11.2
10 37.7 20.3 28.9 22.0 9.3 15.6 16.1 8.9 12.5
11 34.5 19.5 27.1 16.3 10.7 13.5 11.6 9.2 10.4
12 35.9 22.6 29.4 16.7 10.2 13.5 11.7 9.5 10.6
Total 35.8 21.2 28.5 18.7 10.3 14.5 13.4 9.2 11.3

(National Vital Statistics Reports, vol. 56, no. 5, November 20, 2007), in 2004, the latest year for which detailed statistics were available, white males aged 15 to 19 had twice the suicide rate (13.6 per 100,000) of African-American males (7.4 per 100,000) or Hispanic male youth (9.9 per 100,000). Among females aged 15 to 19, the rate for whites (3.7 per 100,000) was considerably higher than that for Hispanics (2.7 per 100,000) or African-Americans (1.9 per 100,000).

Eaton et al. questioned high school students regarding their thoughts about suicide. Almost one out of seven (14.5%) students surveyed in 2007 claimed that they had seriously thought about attempting suicide in the previous 12 months. (See Table 4.20.) Even though the suicide death rate was much higher among males than females, females (18.7%) were more likely to have considered suicide than males (10.3%). Of all students,

 
TABLE 4.21 Percentage of high school students who attempted suicide and whose suicide attempt resulted in an injury that required medical treatment, by sex, race, ethnicity, and grade, 2007
Category Attempted suicide Suicide attempt treated by a doctor or nurse
Female Male Total Female Male Total
% % % % % %
*Non-Hispanic.
Notes: During the 12 months before the survey. One or more times.
SOURCE: Danice K. Eaton, Table 23. Percentage of High School Students Who Attempted Suicide and Whose Suicide Attempt Resulted in an Injury, Poisoning, or Overdose That Had to Be Treated by a Doctor or Nurse, by Sex, Race/Ethnicity, and GradeUnited States, Youth Risk Behavior Survey, 2007, in Youth Risk Behavior SurveillanceUnited States, 2007, Morbidity and Mortality Weekly Report, vol. 57, no. SS-4, June 6, 2008, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf (accessed November 5, 2008)
Race/ethnicity
White* 7.7 3.4 5.6 2.1 0.9 1.5
Black* 9.9 5.5 7.7 2.1 2.5 2.3
Hispanic 14.0 6.3 10.2 3.9 1.8 2.9
Grade
9 10.5 5.3 7.9 2.6 1.9 2.3
10 11.2 4.9 8.0 3.1 1.0 2.0
11 7.8 3.7 5.8 1.7 1.4 1.6
12 6.5 4.2 5.4 1.8 1.5 1.7
Total 9.3 4.6 6.9 2.4 1.5 2.0

11.3% (13.4% of females and 9.2% of males) had made a specific plan to attempt suicide. Approximately 6.9% of students (9.3% of females and 4.6% of males) said they had attempted suicide in the previous year, and 2% of high school students (2.4% of females and 1.5% of males) said they had suffered injuries from the attempt that required medical attention. (See Table 4.21.) These numbers reflect the fact that females of all ages tend to choose less fatal methods of attempting suicide, such as overdosing and cutting veins, than males, who tend to choose more deadly methods, such as shooting or hanging.

These rates reflect the fact that a large proportion of students, particularly female students, feel sad or hopeless. In 2007, 35.8% of female students and 21.2% of male students reported these feelings. (See Table 4.20.) The likelihood that a child will commit suicide increases with the presence of certain risk factors. According to the CDC, in Homicides and SuicidesNational Violent Death Reporting System, United States, 20032004 (Morbidity and Mortality Weekly Report, vol. 55, no. 26, July 7, 2006), among the factors whose presence may indicate heightened risk are depression, mental health problems, relationship conflicts, a history of previous suicide attempts, and alcohol dependence.

In addition, the suicide rate among male homosexual teens is believed to be extremely high. Gary Remafedi of the University of Minnesota notes in Suicidality in a Venue-Based Sample of Young Men Who Have Sex with Men (Journal of Adolescent Health, vol. 31, no. 4, 2002) that 20% to 42% of teens and young men who have sex with other males attempt suicide. Suicidal gay adolescents are not only coping with stressors but also have few coping resources. In Gay Adolescents and Suicide: Understanding the Association (Adolescence, vol. 40, no. 159, fall 2005), Robert Li Kitts of Oregon Health and Science University states that the process of realizing that one is gay and having to accept it is not just an immediate stressor and can actually narrow one's options further by taking away coping resources, such as friends and family. Gay adolescents who come out (disclose their sexuality) may experience great family discord, rejection, and even failure from the disappointment they elicit. It would make sense to conclude that homosexuality is an important risk factor for adolescent suicide.

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Health and Safety

Health and Safety

FACTORS AFFECTING CHILDREN'S HEALTH

A variety of factors affect children's health. These range from prenatal influences; access to and quality of health care; poverty, homelessness, and hunger; childhood diseases; and diet and exercise. This chapter discusses these factors and looks at leading causes of death among infants, children, and adolescents.

Birth Defects

According to the Centers for Disease Control and Prevention (CDC), in "Birth Defects: Frequently Asked Questions" (December 12, 2006, http://www.cdc.gov/ncbddd/bd/faq1.htm), birth defects affect one out of every thirty-three babies born. Birth defects are the leading cause of infant deaths; in addition, these babies have a greater chance of illness and disability than do babies without birth defects. Two major birth defects, neural tube defects and fetal alcohol syndrome, are in large part preventable.

NEURAL TUBE DEFECTS

Major defects of the brain and spine are called neural tube defects. The CDC notes in "Medical Progress in the Prevention of Neural Tube Defects" (June 17, 2005, http://www.cdc.gov/ncbddd/bd/mp.htm) that each year as many as one out of every one thousand pregnancies is affected by a neural tube defect. Infants born with neural tube defects suffer from an incomplete closing of the spine and skull. The occurrence of these defects can be greatly reduced by adequate folic acid consumption before and during early pregnancy.

FETAL ALCOHOL SYNDROME

Alcohol consumption by pregnant women can cause fetal alcohol syndrome (FAS), a birth defect characterized by a low birth weight, facial abnormalities such as small eye openings, growth retardation, and central nervous system deficits, including learning and developmental disabilities. The condition is a lifelong, disabling condition that puts those children affected at risk for secondary conditions, such as mental health problems, criminal behavior, alcohol and drug abuse, and inappropriate sexual behavior. Not all children affected by prenatal alcohol use are born with the full syndrome, but they may have selected abnormalities.

According to the CDC, in "Fetal Alcohol Spectrum Disorders" (December 5, 2006, http://www.cdc.gov/ncbddd/fas/fassurv.htm), estimates of the prevalence of FAS vary from 0.2 to 1.5 per 1,000 births in different areas of the United States. Other alcohol-related birth defects are thought to occur three times as often as FAS. In "Alcohol Consumption among Women Who Are Pregnant or Who Might Become Pregnant—United States, 2002" (Morbidity and Mortality Weekly Report, December 24, 2004, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5350a4.htm), the CDC finds that in 2002, 10.1% of pregnant women drank alcohol, putting their babies at risk for FAS. As many as one out of fifty pregnant women (1.9%) frequently drank alcohol.

Health Care

IMMUNIZATIONS

The proportion of preschool-age children immunized against communicable and potentially dangerous childhood diseases—including diphtheria, tetanus, and pertussis (whooping cough), known collectively as DTP; polio; and measles—dropped during the 1980s but rose significantly during the 1990s. By 2004, 87% of all children had received four doses of DTP, 92% had received three doses of the poliovirus vaccine, 94% had received the haemophilus influenzae type b vaccine, 94% had received the measles vaccine, 93% had received three doses of the hepatitis B vaccine, and 88% had received the varicella (chickenpox) vaccine. (See Table 4.1.) More than four out of five of these children received the vaccinations in combined series. Children living below the poverty line and African-American children were slightly less likely than the general child population to be immunized.

TABLE 4.1
Percentage of children vaccinated for selected diseases, by poverty statusa, race, and Hispanic originb, 1996–2004
Characteristic Total Below poverty At or above poverty
1996 1997 1998 1999 2000 2001 2002 2003 2004 1996 1997 1998 1999 2000 2001 2002 2003 2004 1996 1997 1998 1999 2000 2001 2002 2003 2004
Total
Combined series (4:3:1:3)c767679787677788183697174737172727678807982817879798385
Combined series (4:3:1)d787881807879798284727276757273737779818083827980808486
DTP (4 doses or more)e818284838282828586747680797677758081848486858484848787
Polio (3 doses or more)919191909089909292888990878787888990929292919090919392
Measles-containing (MCV)f919092929191929393878690908989909291929293929192929394
Hib (3 doses or more)g919393949393939494879091919090909192939495959594949594
Hepatitis B (3 doses or more)828487889089909292788185878787889191838588899190909393
Varicellah12264358687681858851741556474798486152944586977818588
PCV (3 doses or more)i416873336269437175
White, non-Hispanic
Combined series (4:3:1:3)c797982817979808485687277767371727978808083828080818586
Combined series (4:3:1)d808083828080818586707379777472738078828284838181828687
DTP (4 doses or more)e838487868484848888727682817875758281858588868585868889
Polio (3 doses or more)929292909190919392889091888887889188939293919191929393
Measles-containing (MCV)f919193929292939494858490908887919090939394939292939494
Hib (3 doses or more)g939495959594949595879092939289889192949596959595959695
Hepatitis B (3 doses or more)828588899190919393768087888886869192838588899290929493
Varicellah15284256667579848761738515867758084162943576876808587
PCV (3 doses or more)i447175315666467377
Black, non-Hispanic
Combined series (4:3:1:3)c747373747171717576697172726969687074797774777274727980
Combined series (4:3:1)d777474757273727778737274747071697276817876787375738081
DTP (4 doses or more)e797777797676768080747677787574747578838079837878778483
Polio (3 doses or more)908988878785878990878988868584878690939187888786879191
Measles-containing (MCV)f908989908889909291888789908888909190919190918790909391
Hib (3 doses or more)g899190929390929391869190919287889090939490949391949592
Hepatitis B (3 doses or more)828284878985889291788286868985899289858483909085889292
Varicellah92142586775838586*1640576071808485132744607277848687
PCV (3 doses or more)i346268306167386470
American Indian and Alaska Native
Combined series (4:3:1:3)c827378756976*7775***********8779*84***
Combined series (4:3:1)d837879787076*7976***********8781*84***
DTP (4 doses or more)e858083807577*8077***********92837684***
Polio (3 doses or more)909085889088*91879293**82*878996*8893949696*92*
Measles-containing (MCV)f8992919287948492898794*938396*93**9296929293909089
Hib (3 doses or more)g918690919091*89909593**82**929089*97979795**89
Hepatitis B (3 doses or more)798382*9186*9091****85**9295*8287*9791*8889
Varicellah*2028*6269708184**22***********76*8285
PCV (3 doses or more)i336075******
TABLE 4.1
Percentage of children vaccinated for selected diseases, by poverty statusa, race, and Hispanic originb, 1996–2004 [continued]
Characteristic Total Below poverty At or above poverty
1996 1997 1998 1999 2000 2001 2002 2003 2004 1996 1997 1998 1999 2000 2001 2002 2003 2004 1996 1997 1998 1999 2000 2001 2002 2003 2004
—=Not available.
*Estimates are considered unreliable.
aBased on family income and household size using US Bureau of Census poverty thresholds for the year prior to each year of data collection.
bFrom 1996 to 2000, the 1977 Office of Management and Budget (OMB) Standards for Data on Race and Ethnicity were used. From 2002 onward, the 1997 OMB Standards for Data on Race and Ethnicity were used. Persons of Hispanic origin may be of any race. Included in the total, but not shown separately, are Native Hawaiian and other Pacific Islanders, and two or more races.
cThe 4:3:1:3 series consists of ≥4 doses of diphtheria, tetanus toxoids and pertussis vaccines, diphtheria and tetanus toxoids, and diphtheria, tetanus toxoids and any acellular pertussis vaccine (DTP/DT/DTaP); ≥3 doses of poliovirus vaccine; ≥1 doses of any measles-containing vaccine; and ≥3 doses of haemophilus influenzae type b (Hib) vaccine.
dThe 4:3:1 series consists of ≥4 doses of diphtheria, tetanus toxoids and pertussis vaccines, diphtheria and tetanus toxoids, and diphtheria, tetanus toxoids and any acellular pertussis vaccine (DTP/DT/DTaP); ≥3 doses of poliovirus vaccine; and ≥1 doses of any measles-containing vaccine.
eDiphtheria, tetanus toxoids, and pertussis vaccine (≥4 doses of any diphtheria, tetanus toxoids and pertussis vaccines, including diphtheria and tetanus toxoids, and any acellular pertussis vaccine).
fProviders were asked about measles-containing vaccine, including MMR (measles-mumps-rubella) vaccines.
gHaemophilus influenzae type b (Hib) vaccine (three or more doses).
hRecommended in July 1996. Administered on or after the first birthday, unadjusted for history of varicella illness (chicken pox). (One or more doses of varicella at or after child's first birthday, unadjusted for history of varicella illness).
iPneumococcal conjugate vaccine (three or more doses); the percentage of children ages 19-35 months who received 3 (or more) doses of pneumococcal conjugate vaccine was low in 2002, because universal infant vaccination was not recommended until October 2000.
Source: "Table HEALTH5. Childhood Immunization: Percentage of Children Ages 19-35 Months Vaccinated for Selected Diseases by Poverty Status, Race and Hispanic Origin, Selected Years 1996–2004," in America's Children in Brief: Key National Indicators of Well-Being, 2006, Federal Interagency Forum on Child and Family Statistics, 2006, http://childstats.gov/americaschildren/tables/health5.asp (accessed February 25, 2007)
Asian
Combined series (4:3:1:3)c787179777577838184*********777081807777848083
Combined series (4:3:1)d817683827980858487**80******797484858179868487
DTP (4 doses or more)e858089878584888990**85**85**91847991908785909089
Polio (3 doses or more)908993909390929193*9092**90939292898893919390919092
Measles-containing (MCV)f93909293909095969494929586*93989294939094949289959693
Hib (3 doses or more)g928992909292959192*****95939296949094939392959090
Hepatitis B (3 doses or more)858889889190949493*94*84*95959396868690889289949392
Varicellah183653647782879191******909391204155668081879090
PCV (3 doses or more)i557176***557377
Hispanic
Combined series (4:3:1:3)c717375757377767981687073737073757880737779787479768184
Combined series (4:3:1)d747577777579777982717176767376767980757780807580778184
DTP (4 doses or more)e777881807983798284747579787679788183788183828083808486
Polio (3 doses or more)899089898891909091888890898890898990909090908791919292
Measles-containing (MCV)f888891909092919393878590909091919392899092919093899394
Hib (3 doses or more)g899092929193929393878992918891939292909294959394929594
Hepatitis B (3 doses or more)818186898890909192807983878788899191818488889091899393
Varicellah8224761708082868961844597081828888112549627082818589
PCV (3 doses or more)i376670356571386771

In 1994 the U.S. Department of Health and Human Services (HHS) implemented the Vaccines for Children (VFC) program, which provides free or low-cost vaccines to children at participating private and public health care provider sites. Eligible children, including children on Medicaid, children without insurance or whose insurance does not cover vaccinations, and Native American or Alaskan Native children can receive the vaccinations through their primary care physician. Children not covered under the program but whose parents cannot afford vaccinations can receive free vaccines at public clinics under local programs. The HHS reports in FY 2007 Budget in Brief: Centers for Disease Control and Prevention (February 20, 2006, http://www.hhs.gov/budget/07budget/cdc.html#infectious) that the VFC program had a budget of $2.6 billion for fiscal year 2007. Vaccines provided through the program represented about 40% of all childhood vaccines purchased in the country.

The World Health Organization and the United Nations Children's Fund report in Global Immunization Vision and Strategy, 2006–2015 (October 2005, http://www.who.int/vaccines-documents/DocsPDF05/GIVS_Final_EN.pdf) that developed nations, including the United States, generally have among the highest immunization rates in the world. The global immunization rate for DTP in 2003 was 78%, up from 72% in 1999. Immunization rates for the developed world for the same time period were ten to twenty percentage points higher than the global average, reflecting the low immunization rates in many developing nations. In 2003 only 28% of developing countries reported that their immunization rate for DTP was 80% or higher.

PHYSICIAN VISITS

Children's health depends on access to and usage of medical care. Based on household interviews of a sample of the civilian noninstitutionalized population, the CDC's National Center for Health Statistics (NCHS) finds that in 2004, 55.3% of children under age eighteen visited the doctor between one and three times, 26.2% saw the doctor between four and nine times, and 8% saw the doctor ten or more times. (See Table 4.2.) However, 10.6% of children did not see a doctor at all. Poor children have less access to health care than nonpoor children.

HEALTH INSURANCE

One reason some children do not have access to medical care is their lack of health insurance. According to Carmen DeNavas-Walt, Bernadette D. Proctor, and Cheryl Hill Lee of the U.S. Census Bureau, in Income, Poverty, and Health Insurance Coverage in the United States: 2005 (August 2006, http://www.census.gov/prod/2006pubs/p60-231.pdf), 11.2% of American children (or 8.3 million) had no health insurance coverage in 2005. Factors affecting children's access to coverage included their age, race and ethnicity, and their family's economic status. Children between the ages of twelve and seventeen were more likely to be uninsured than those under age twelve (12.6% versus 10.5%). Poor children were proportionately more likely to be uninsured than all children (19% versus 11.2%) because of government programs such as Medicaid, and those of Hispanic origin were the least likely racial or ethnic group to receive health insurance coverage, with 21.9% of them being uninsured. Uninsured rates for other racial and ethnic groups were 7.2% for non-Hispanic white children, 12.2% for Asian-American children, and 12.5% for African-American children. Robin A. Cohen and Michael E. Martinez of the NCHS estimate in Health Insurance Coverage: Early Release Estimates from the National Health Interview Survey, January-June 2006 (December 2006, http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur200612.pdf) that 9.2% of all children were uninsured for at least part of 2006.

Child health insurance coverage increased slightly among all age groups, races, and ethnicities from 2000 to 2004, although the percent of children covered by private health insurance declined from 70% in 2000 to 66% in 2004. (See Table 4.3 and Figure 4.1.) In the press release "HHS Issues New Report Showing More American Children Received Health Insurance in Early 2002" (December 31, 2002, http://www.hhs.gov/news/press/2002pres/20021231.html), the HHS secretary Tommy G. Thompson attributes ongoing increases to a push to provide more government coverage, particularly under the State Children's Health Insurance Program. This trend, however, may be leveling off. Cohen and Martinez find that there was no significant change in the number of uninsured children between 2005 and 2006. (See Figure 4.1.)

DeNavas-Walt, Proctor, and Hill Lee note that in 2005 government programs, such as Medicare, Medicaid, and military insurance, covered a greater proportion of African-American children and Hispanic children than other children. Almost half (44.9%) of African-American children and 39.3% of Hispanic children had government insurance, compared with only 18% of non-Hispanic white children and 15.9% of Asian children.

To remain in the Medicaid program, families must have their eligibility reassessed at least every six months. If family income or other circumstances change even slightly, the family can lose its eligibility for the Medicaid program, disrupting health care coverage.

From the late 1980s through the mid-1990s the numbers of uninsured American children rose as coverage rates for employer-sponsored health insurance declined, even though the proportion of children covered by Medicaid also rose. In 1997, as part of the Balanced Budget Act, Congress created the State Children's Health Insurance Program (SCHIP) to expand health insurance to children whose families earned too much money to be eligible for Medicaid but not enough money to pay for private insurance. SCHIP provides funding to states to insure children, offering three alternatives: states may use SCHIP funds to establish separate coverage programs, expand their Medicaid coverage, or use a combination of both. By September 1999 all fifty states had SCHIP plans in place. By September 4, 2003, the program had been expanded to enroll even more children at higher income levels. According to the Centers for Medicare and Medicaid Services, in FY 2005 Annual Enrollment Report (July 12, 2006, http://www.cms.hhs.gov/NationalSCHIPPolicy/downloads/FY2005AnnualEnrollmentReport.pdf), in fiscal year 2005, 6.1 million children were enrolled in SCHIP.

TABLE 4.2
Health care visits to doctor's offices, emergency departments, and home visits over a 12-month period, by selected characteristics, selected years 1997–2004
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]
Characteristic Number of health care visitsa
None 1-3 visits 4-9 visits 10 or more visits
1997 2003 2004 1997 2003 2004 1997 2003 2004 1997 2003 2004
Percent distribution
All personsb, c 16.515.816.146.245.845.823.624.824.613.713.613.5
Age
Under 18 years11.811.310.654.154.555.325.226.726.28.97.58.0
   Under 6 years5.05.55.344.946.047.537.039.036.913.09.410.3
   6-17 years15.314.013.158.758.759.019.320.821.16.86.66.8
18-44 years21.722.423.846.746.745.619.019.119.212.611.811.5
   18-24 years22.023.625.746.847.245.020.018.219.211.211.010.1
   25-44 years21.622.023.146.746.645.818.719.419.213.012.012.0
45-64 years16.914.715.042.942.243.324.726.625.315.516.516.3
   45-54 years17.916.916.943.944.245.023.424.522.914.814.315.2
   55-64 years15.311.412.341.339.240.926.729.828.916.719.618.0
65 years and over8.96.35.634.731.531.632.535.836.823.826.426.1
   65-74 years9.87.16.836.934.036.031.635.734.521.623.322.6
   75 years and over7.75.44.131.828.626.433.836.039.526.630.030.0
Sexc
Male21.320.620.947.146.846.620.621.921.611.010.710.9
Female11.811.111.545.444.945.026.527.727.516.316.316.0
Racec, d
White only16.015.716.046.145.645.423.925.124.814.013.613.8
Black or African American only16.814.715.846.145.847.023.225.224.613.914.312.6
American Indian or Alaska Native only17.123.317.738.041.441.724.220.625.020.714.715.5
Asian only22.822.620.849.147.851.519.720.719.78.38.98.1
Native Hawaiian or other Pacific
  Islander only
2 or more races11.113.644.942.923.026.221.017.3
Hispanic origin and racec, d
Hispanic or Latino24.925.326.742.342.941.820.320.320.612.511.510.9
    Mexican28.927.829.740.842.541.018.518.818.911.811.010.4
Not Hispanic or Latino15.414.114.246.746.346.524.025.625.213.914.014.14
    White only14.713.513.546.646.246.124.426.125.714.314.214.7
    Black or African American only16.914.615.646.145.947.323.125.324.613.814.212.5
Respondent-assessed health statusc
Fair or poor7.88.78.123.323.222.029.028.828.039.939.341.9
Good to excellent17.216.416.948.448.148.023.324.524.411.110.910.7
Percent of poverty levelc, e
Below 100%20.620.921.137.837.837.722.723.723.518.917.617.7
100%-less than 200%20.119.820.943.341.542.521.723.622.314.915.114.4
200% or more14.513.713.848.748.448.124.225.425.312.612.612.8
Hispanic origin and race and percent of poverty levelc, d, e
Hispanic or Latino:
    Below 100%30.229.931.634.837.035.019.918.519.615.014.613.9
    100%-less than 200%28.728.630.539.740.239.320.420.619.411.210.510.9
    200% or more18.920.721.548.847.747.020.421.222.211.910.39.2
Not Hispanic or Latino:
    White only:
        Below 100%17.017.016.238.337.537.523.925.925.420.919.520.9
        100%-less than 200%17.316.616.744.141.043.222.224.923.416.317.416.7
        200% or more13.812.512.748.248.147.424.926.326.113.113.113.8
    Black or African American only:
         Below 100%17.415.715.938.538.140.923.426.525.720.719.617.5
        100%-less than 200%18.815.418.143.744.244.522.925.923.814.514.513.7
        200% or more15.613.714.351.750.651.322.724.324.410.011.410.0
TABLE 4.2
Health care visits to doctor's offices, emergency departments, and home visits over a 12-month period, by selected characteristics, selected years 1997–2004 [continued]
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]
Characteristic Number of health care visitsa
None 1-3 visits 4-9 visits 10 or more visits
1997 2003 2004 1997 2003 2004 1997 2003 2004 1997 2003 2004
*Estimates are considered unreliable.
—Data not available.
aThis table presents a summary measure of health care visits to doctor's offices, emergency departments, and home visits during a 12-month period.
bIncludes all other races not shown separately and unknown health insurance status.
cEstimates are age adjusted to the year 2000 standard population using six age groups: Under 18 years, 18-44 years, 45-54 years, 55-64 years, 65-74 years, and 75 years and over.
dThe race groups, white, black, American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and 2 or more races, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Starting with 1999 data, race-specific estimates are tabulated according to the 1997 Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity and are not strictly comparable with estimates for earlier years. The five single race categories plus multiple race categories shown in the table conform to the 1997 standards. Starting with 1999 data, race-specific estimates are for persons who reported only one racial group; the category 2 or more races includes persons who reported more than one racial group. Prior to 1999, data were tabulated according to the 1977 Standards with four racial groups and the Asian only category included Native Hawaiian or other Pacific Islander. Estimates for single race categories prior to 1999 included persons who reported one race or, if they reported more than one race, identified one race as best representing their race. Starting with 2003 data, race responses of other race and unspecified multiple race were treated as missing, and then race was imputed if these were the only race responses. Almost all persons with a race response of other race were of Hispanic origin.
ePercent of poverty level is based on family income and family size and composition using U.S. Census Bureau poverty thresholds. Missing family income data were imputed for 25%-29% of persons in 1997–1998 and 32%-35% in 1999–2004.
fEstimates for persons under 65 years of age are age adjusted to the year 2000 standard population using four age groups: Under 18 years, 18-44 years, 45-54 years, and 55-64 years of age.
gHealth insurance categories are mutually exclusive. Persons who reported both Medicaid and private coverage are classified as having private coverage. Starting in 1997 Medicaid includes state-sponsored health plans and State Children's Health Insurance Program (SCHIP).
hMSA is metropolitan statistical area.
Source: "Table 80. Health Care Visits to Doctor's Offices, Emergency Departments, and Home Visits within the Past 12 Months, by Selected Characteristics, United States, Selected Years 1997–2004," in Health, United States, 2006, with Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, 2006, http://0-www.cdc.gov.mill1.sjlibrary.org/nchs/data/hus/hus06.pdf (accessed February 6, 2007)
Health insurance status at the time of interviewf, g
Under 65 years of age:
   Insured14.312.813.449.049.149.123.625.224.613.112.912.8
       Private14.713.213.650.651.151.423.124.623.911.611.111.2
       Medicaid9.89.911.835.535.235.126.528.128.228.226.824.9
   Uninsured33.738.137.842.842.442.515.313.413.68.26.16.1
Health insurance status prior to interviewf, g
Under 65 years of age:
   Insured continuously all 12 months14.112.713.449.249.349.423.625.224.613.012.812.7
   Uninsured for any period up to 12 months18.920.420.046.046.245.720.821.221.914.412.212.3
   Uninsured more than 12 months39.044.343.941.439.841.313.211.210.06.44.74.8
Percent of poverty level and insurance status prior to interviewe, f, g
Under 65 years of age:
   Below 100%:
       Insured continuously all 12 months13.812.714.339.740.939.625.225.825.721.420.520.4
       Uninsured for any period up to 12 months19.718.417.637.643.942.021.921.624.620.916.115.7
       Uninsured more than 12 months41.247.747.139.935.738.612.211.79.46.64.95.0
   100%-less than 200%:
       Insured continuously all 12 months16.013.815.746.445.045.421.924.423.515.816.815.5
      Uninsured for any period up to 12 months18.820.221.745.142.045.121.024.822.115.012.911.1
       Uninsured more than 12 months38.743.445.041.039.139.414.012.19.96.35.45.7
   200% or more:
       Insured continuously all 12 months13.712.412.651.051.151.323.625.324.711.711.311.5
       Uninsured for any period up to 12 months17.820.420.350.349.647.520.419.120.411.510.911.9
       Uninsured more than 12 months36.641.839.743.844.745.413.29.610.96.44.04.1
Geographic regionc
Northeast13.210.411.645.947.645.526.027.027.514.915.015.4
Midwest15.914.213.947.747.247.522.825.425.113.613.213.5
South17.216.516.746.145.146.223.324.823.813.513.613.3
West19.121.021.344.844.243.822.822.222.713.312.612.2
Location of residencec
Within MSAh16.216.016.346.445.945.923.724.824.413.713.313.4
Outside MSAh17.315.015.345.445.645.423.324.925.313.914.514.0
TABLE 4.3
Percentage of children under age 18 covered by health insurance, by type of insurance, age, race, and Hispanic origin, 1987–2004
Characteristic 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
All health insurance
    Total 87 87 87 87 87 87 86 86 86 85 85 85 87 88 88 88 89 89
Gender
    Male878787878788878686858585878888888989
    Female878787878887868686858585878888898989
Age
    Ages 0-5888787898989888687868684878989899090
    Ages 6-11878787878888878787858685888889898989
    Ages 12-17868686858585838586848384878787878788
Race and Hispanic originb
    White, non-Hispanic909090909090898990898989929393929392
    Black838484858586848385818180848686868687
    Hispanicc727170727375747273717170747576777979
Region
    Northeast929391929291908889888889929292919191
    Midwest929392919291919191919089919292929292
    South828182838384838383828282848686868687
    West858584848586848384838382848686878888
Private health insurance
    Total 74 74 74 71 70 69 67 66 66 66 67 68 70 70 68 67 66 66
Gender
    Male737474717069686666676768707069676665
    Female747374716968676566666767707068686666
Age
    Ages 0-5727171686665636060626364666664636261
    Ages 6-11747475737171706767676868707069686667
    Ages 12-17757676737271697071706970737372716969
Race and Hispanic originb
    White, non-Hispanic838383818080787778787879818180797877
    Black495052494546464344454847525352504748
    Hispanicc484848454342423838404243464544434243
Region
    Northeast797878777573717071696970737472717171
    Midwest798080767574737474757675777877767473
    South686869666564636261616264666664636161
    West717070686667656061626363656564656263
Government health insuranced
    Total 19 19 19 22 24 25 27 26 26 25 23 23 23 24 26 27 29 30
Gender
    Male191919222425272626252322242526272930
    Female191919222426272727252423232426272929
Age
    Ages 0-5222324283033353333312927272931323435
    Ages 6-11191818202223252526252323232526272929
    Ages 12-17161615181919202021191919192020222425
Race and Hispanic originb
    White, non-Hispanic121313151617191818181716161719182121
    Black424241454849504849454042404242444748
    Hispanicc282727323738413839353431333537404242

Homelessness

Under the McKinney-Vento Homeless Assistance Act, the U.S. Department of Education is required to file a report on homeless children served by the act. The Department of Education obtains the data from school districts; school districts use different methods of estimation. In the Report to the President and Congress on the Implementation of the Education for Homeless Children and Youth Program under the McKinney-Vento Homeless Assistance Act (2006, http://www.ed.gov/programs/homeless/rpt2006.doc), the Department of Education states that 602,568 children who experienced homelessness at some point during the year were enrolled in school during the 2003–04 school year. Of these children, about half (50.3%) lived doubled-up with relatives or friends; 25.3% lived in shelters, 10% stayed in hotels or motels, and 2.6% were unsheltered—in other words, sleeping outside, in vehicles, or in abandoned buildings. This number is almost certainly much lower than the number of children who actually experienced homelessness during that period, as the homeless status of children does not always come to the attention of school officials and many homeless children are not enrolled in school.

The U.S. Conference of Mayors, in the Hunger and Homelessness Survey: A Status Report on Hunger and Homelessness in America's Cities, a 23-City Survey (December 2006, http://www.usmayors.org/uscm/hungersurvey/2006/report06.pdf), finds that 30% of homeless people were in families with children, 51% were single men, 17% were single women, and 2% were unaccompanied youth—usually runaways. Since 1994 the proportion of families among the homeless has generally declined, as has the proportion of unaccompanied youth among the homeless population. Data from the Conference of Mayors survey show city-by-city estimates of children as a percent of homeless family members. Values range from 20% of family members in Charleston, South Carolina, and Los Angeles, California, to 83% in Santa Monica, California, and Trenton, New Jersey.

TABLE 4.3
Percentage of children under age 18 covered by health insurance, by type of insurance, age, race, and Hispanic origin, 1987–2004 [continued]
Characteristic 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
aChildren are considered to be covered by health insurance if they had government or private coverage at any time during the year. Some children are covered by both types of insurance; hence, the sum of government and private is greater than the total.
bFor race and Hispanic-origin data in this table: From 1987 to 2002, following the 1977 Office of Management and Budget (OMB) standards for collecting and presenting data on race, the Current Population Survey (CPS) asked respondents to choose one race from the following: white, black, American Indian or Alaskan Native, or Asian or Pacific Islander. The Census Bureau also offered an "other" category. Beginning in 2003, following the 1997 OMB standards for collecting and presenting data on race, the CPS asked respondents to choose one or more races from the following: white, black, Asian, American Indian or Alaska Native, or Native Hawaiian or other Pacific Islander. All race groups discussed in this table from 2002 onward refer to people who indicated only one racial identity within the racial categories presented. People who responded to the question on race by indicating only one race are referred to as the race-alone population. The use of the race-alone population in this table does not imply that it is the preferred method of presenting or analyzing data. Data from 2002 onward are not directly comparable with data from earlier years. Data on race and Hispanic origin are collected separately; Hispanics may be any race.
cPersons of Hispanic origin may be of any race.
dGovernment health insurance for children consists mostly of Medicaid, but also includes Medicare, the State Children's Health Insurance Programs (SCHIP), and the Civilian Health and Medical Care Program of the Uniformed Services (CHAMPUS/Tricare).
Note: Estimates beginning in 1999 include follow-up questions to verify health insurance status and use the Census 2000-based weights. Estimates for 1999 through 2004 are not directly comparable with estimates for earlier years, before the verification questions were added.
Source: "Table ECON5.A. Access to Health Care: Percentage of Children Ages 0-17 Covered by Health Insurance by Selected Characteristics, Selected Years 1987–2004," in America's Children in Brief: Key National Indicators of Well-Being, 2006, Federal Interagency Forum on Child and Family Statistics, 2006, http://childstats.gov/americaschildren/tables/econ5a.asp (accessed February 25, 2007)
Region
   Northeast181918212222252323242324242425252626
   Midwest181717202223242423211919201921222526
   South201920232528292928272524242629303232
   West202222232727282930272524252727283132

The poverty and lack of stability that homelessness brings has a negative impact on children. An example of the poor educational achievement of homeless youths is shown in the Homeless Census and Homeless Youth/Foster Teen Study (2002, http://www.appliedsurveyresearch.org/www/products/MC_Homeless02_report.pdf), a study of unaccompanied homeless youths conducted in Monterey County, California. Twenty-one percent of sixteen-year-olds, 22% of seventeen-year-olds, 33% of eighteen-year-olds, 51% of nineteen-year-olds, 59% of twenty-year-olds, and 70% of twenty-one-year-olds were below grade level, according to its findings. Only 13% of the homeless youths in the study had a high school diploma or general equivalency diploma (GED). The remaining 87% were performing below grade level.

Homelessness also has a negative impact on children's health. Catherine Karr of the National Health Care for the Homeless Council, in Homeless Children: What Every Health Care Provider Should Know (2006, http://www.nhchc.org/Children/), argues that these children suffer from frequent health problems. They are seen in emergency rooms and hospitalized more often than other poor children. The often crowded and unsanitary conditions they live in lead to a higher rate of infectious diseases, such as upper respiratory infections, diarrhea, and scabies. Homeless children live in less structured and often unsafe environments, leaving them more vulnerable to accidents and injury. They tend not to have access to nutritious food and are often malnourished or obese. Homeless children tend to lag behind their housed peers developmentally, and school-age homeless children often have academic problems. The greater likelihood that homeless children come from families plagued by mental illness, drug use, and domestic violence negatively impacts their own mental health. Homelessness results in serious negative consequences for children's health.

Hunger

Food insecurity is defined as the lack of access to enough food to meet basic needs. Mark Nord, Margaret Andrews, and Steven Carlson of the U.S. Department of Agriculture report in Household Food Security in the United States, 2005 (November 2006, http://www.ers.usda.gov/Publications/ERR29/ERR29.pdf), that in 2005, 89% of U.S. households were food secure. However, the remaining 11% (12.6 million U.S. households) experienced food insecurity at some time during the year. Most of these households used a variety of coping strategies to obtain adequate food, such as eating less varied diets, participating in food assistance programs, or getting food from community food pantries or soup kitchens. However, 3.9% of all households (4.4 million households) experienced very low food security—in other words, some household members reduced or otherwise altered their normal food intake because of a lack of money.

Nord, Andrews, and Carlson find that in 2005 a higher percentage of children than adults were food insecure (16.9% and 11%, respectively). Households that are experiencing food insecurity tend to go through a sequence of steps as food insecurity increases: first, families begin to worry about having enough food, then they begin to decrease other necessities, then they reduce the quality and quantity of all household members' diets, then they decrease the frequency of meals and quantity of adult members' food, and finally they decrease the frequency of meals and the quantity of children's food. Even though children are usually protected from being hungry, almost one out of every one hundred children (0.7%) experienced very low food security on one or more days during 2005. Households with incomes below the poverty line, households with children headed by a single woman, and African-American and Hispanic households were the most likely to experience food insecurity.

EMERGENCY FOOD ASSISTANCE

America's Second Harvest, the nation's largest charitable hunger-relief organization, reports in the Hunger Study, 2006 (http://www.hungerinamerica.org/key_findings/) that in 2005, 25.3 million Americans sought emergency food assistance. In the Hunger and Homelessness Survey, the Conference of Mayors finds that requests for emergency food assistance increased by 7% in 2006, and requests for food assistance by families with children increased by an average of 5% in the surveyed cities. Almost half (48%) of those requesting assistance were members of families with children; 18% of requests by families were estimated to have gone unmet because of lack of resources. The most frequent reasons for hunger cited by city officials were unemployment and low-paying jobs. Other causes included high housing and medical costs, substance abuse, high utility and transportation costs, and a lack of education.

Exposure to Toxins

Another threat to children's health is exposure to environmental toxins. Two toxins that children are most frequently exposed to are lead and secondhand smoke.

LEAD POISONING

Lead exposure now comes primarily from leaded paints that have worn off or been scraped from older homes. Lead is also found in lead plumbing and emitted by factory smokestacks. Because they have smaller bodies and are growing, children suffer the effects of lead exposure more acutely than adults do. Lead poisoning causes nervous system disorders, reduction in intelligence, fatigue, inhibited infant growth, and hearing loss. Toxic levels of lead in a parent can also affect unborn children.

In "CDC Surveillance Data, 1997–2005" (February 16, 2007, http://www.cdc.gov/nceh/lead/surv/stats.htm), the CDC indicates that in 2005 approximately 46,770 children from age five and under had confirmed blood lead levels greater than the center's recommended level of ten micrograms per deciliter of blood. This was about 1.6% of all children tested. According to the U.S. Environmental Protection Agency (EPA), in Children's Health and the Environment in North America, United States (December 2005, http://www.cec.org/files/PDF/POLLU TANTS/CountryReport-US-CHE_en.pdf), this number has dropped substantially since the early 1970s, due largely to the phasing out of lead in gasoline between 1973 and 1995. Although children from all social and economic levels can be affected by lead poisoning, children in families with low incomes who live in older, deteriorated housing are at higher risk. Paint produced before 1978 frequently contains lead, so federal legislation now requires owners to disclose any information they may have about lead-based paint before renting or selling a home built earlier than 1978.

SECONDHAND SMOKE AND CHILDREN

In Children's Health and the Environment in North America, United States, the EPA reports that environmental tobacco smoke (ETS) is a major hazard for children, whose respiratory, immune, and other systems are not as well developed as those of adults. Secondhand or passive smoke—smoke produced by other people's cigarettes—increases the number of attacks and severity of symptoms in children with asthma and can even cause asthma in preschool-age children. As noted in the American Lung Association's Secondhand Smoke and Children Fact Sheet (August 2006), "Exposure to secondhand smoke causes 150,000 and 300,000 acute lower respiratory tract infections (pneumonia and bronchitis) annually in children 18 months and younger; these infections result in 7,500 to 15,000 hospitalizations each year." Passive smoking can also cause middle-ear disease and a reduction in lung function in children, and is considered a risk factor in sudden infant death syndrome. The EPA finds in Children's Health and the Environment in North America, United States that the percentage of children under age six who were regularly exposed to secondhand smoke in their homes decreased substantially from 27% in 1994 to 11% in 2003.

DISEASES OF CHILDHOOD

Overweight and Obese Children

The number of overweight and obese Americans has reached epidemic proportions and has become a national concern. The percentage of overweight children and adolescents has grown significantly since the 1970s. Between 1976 and 1980, 6.7% of boys and 6.4% of girls aged six to eleven years were overweight. (See Table 4.4.) In the 2003–04 period those percentages had almost tripled for boys (19.9%) and more than doubled for girls (17.6%). An even more alarming upward trend was seen in the rates of overweight adolescents; 4.5% of boys and 5.4% of girls aged twelve to seventeen were overweight in the 1976–80 period, but 18.3% of adolescent boys and 16% of adolescent girls were overweight in the 2003–04 period. The proportion of overweight children overall between the ages of six and eighteen more than tripled (from 5.7% to 18%) between 1976 and 2004.

Percentages of overweight children vary by race and ethnicity. In the 2003–04 period African-American adolescents (21.5%) were more likely to be overweight than white, non-Hispanic adolescents (16.9%) or Mexican-American adolescents (16.3%). (See Table 4.4.) Among children aged six to eleven, white, non-Hispanic children were the least likely to be overweight (17.7%), compared with African-American (22%) and Mexican-American (22.5%) children of the same age.

Medical professionals are concerned about this trend, because overweight children are at increased risk for premature death in adulthood, as well as for many chronic diseases, including coronary heart disease, hypertension, diabetes mellitus (type 2), gallbladder disease, respiratory disease, some cancers, and arthritis. Type 2 diabetes, previously considered an adult disease, has increased dramatically in children and adolescents. Being overweight or obese can also lead to poor self-esteem and depression in children. According to the CDC, in 2005, 15.7% of high school students were at risk for becoming overweight and 13.1% were already overweight. (See Table 4.5.)

Weight problems in children are thought to be caused by a lack of physical activity, unhealthy eating habits, or a combination of these factors, with genetics and lifestyle playing important roles in determining a child's weight. Television watching and playing computer and video games contribute to the inactive lifestyles of children. According to the CDC, in "Youth Risk Behavior Surveillance—United States, 2005" (Morbidity and Mortality Weekly Report, June 6, 2006), 21.1% of high school students spent three or more hours per school day on the computer, and 37.2% spent three or more hours per school day watching television, often not getting a sufficient amount of physical exercise as a consequence.

Physical activity patterns established during youth may extend into adulthood and affect the risk of illnesses such as coronary heart disease, diabetes, and cancer. Mental health experts correlate increased physical activity with improved mental health and overall improvement in life satisfaction. The CDC reports that less than half of students in high school participated in vigorous physical activity, exercise, and physical education classes, and this percentage was even lower for females than for males. (See Table 4.6.) Only 43.8% of male high school students engaged in sufficient vigorous physical activity, whereas only 27.8% of female high school students did. White students were somewhat more likely to meet recommended levels of physical activity (38.7%) than Hispanic (32.9%) or African-American (29.5%) students. Rigorous activity among high school students also generally declined with age.

Asthma

Another serious disease affecting children is asthma, a chronic respiratory disease that causes attacks of difficulty breathing. In The State of Childhood Asthma, United States, 1980–2005 (December 12, 2006, http://www.cdc.gov/nchs/data/ad/ad381.pdf), Lara J. Akinbami of the CDC reports that millions of children in the United States have asthma. In 2005, 8.9% of children (6.5 million) were currently suffering from asthma, and 12.7% of children (9 million) had suffered with it at some point in their lifetime. Childhood asthma caused 27 hospitalizations per 10,000 children in 2004, and caused 12.8 million missed days of school in 2003. The American Lung Association (ALA) estimates that up to a million asthmatic children are exposed to secondhand smoke, worsening their condition.

Akinbami notes that African-American children suffer from asthma at a rate 60% higher than that of non-Hispanic white children, whereas Puerto Rican children

TABLE 4.4
Percentage of children 6-17 who are overweight, by gender, race, and Hispanic origin, selected years 1976–2004
Total Male Female
1976–1980 1988–1994 1999–2000 2001–2002 2003–2004 1976–1980 1988–1994 1999–2000 2001–2002 2003–2004 1976–1980 1988–1994 1999–2000 2001–2002 2003–2004
—=Not available.
*Estimates are considered unreliable.
aFrom 1976 to 1994, the 1977 Office of Management and Budget (OMB) Standards for Data on Race and Ethnicity were used to classify persons into one of the following four racial groups: white, black, American Indian or Alaskan Native, or Asian or Pacific Islander. For data from 1999 to 2004, the revised 1997 OMB standards were used. Persons could select one or more of five racial groups: white, black or African American, American Indian or Alaska Native, Asian, and Native Hawaiian or other Pacific Islander. Data on race and Hispanic origin are collected separately but are combined for reporting. Persons of Mexican origin may be of any race. Included in the total but not shown separately are American Indian or Alaska Native, Asian, or Native Hawaiian or other Pacific Islander race due to the small sample size for each of these groups. Data from 1999 onward are not directly comparable with data from earlier years. The National Health and Nutrition Examination Survey (NHANES) sample was designed to provide estimates specifically for persons of Mexican-origin and not for all Hispanic-origin persons.
bEstimates are unstable because they are based on a small number of persons.
Notes: Overweight is defined as body mass index (BMI) at or above the 95th percentile of the 2000 Centers for Disease Control and Prevention BMI-for-age growth charts (http://www.cdc.gov/growthcharts). BMI is calculated as weight in kilograms divided by the square of height in meters.
Source: "Table HEALTH4. Overweight: Percentage of Children Ages 6-17 Who Are Overweight by Gender, Race, and Hispanic Origin, 1976–1980, 1988–1994, 1999–2000, 2001–2002, and 2003–2004," in America's Children in Brief: Key National Indicators of Well-Being, 2006, Federal Interagency Forum on Child and Family Statistics, 2006, http://childstats.gov/americaschildren/tables/health4.asp (accessed February 25, 2007)
Ages 6-17
   Total 5.7 11.2 15.0 16.5 18.0 5.5 11.8 15.7 18.0 19.1 5.8 10.6 14.3 15.1 16.8
Race and Hispanic origina
   White, non-Hispanic4.910.511.214.617.34.711.311.916.018.85.19.610.513.215.7
   Black, non-Hispanic8.214.021.120.421.75.8b11.519.217.718.310.716.523.123.325.3
   Mexican American15.424.121.519.616.128.025.222.314.720.017.616.6
Ages 6-11
   Total 6.5 11.3 15.1 16.3 18.8 6.7 11.6 15.7 17.5 19.9 6.4 11.0 14.3 14.9 17.6
Race and Hispanic origina
   White, non-Hispanic5.710.211.714.817.76.110.711.915.518.55.29.811.614.116.9
   Black, non-Hispanic9.014.619.619.922.06.8b12.317.116.917.511.217.022.423.126.5
   Mexican American16.423.420.122.517.526.726.025.315.319.813.619.4
Ages 12-17
   Total 5.0 11.1 14.9 16.8 17.2 4.5 12.0 15.6 18.4 18.3 5.4 10.2 14.2 15.2 16.0
Race and Hispanic origina
   White, non-Hispanic4.310.810.714.416.93.612.012.016.519.05.09.59.312.414.6
   Black, non-Hispanic7.513.322.721.021.5  *10.721.618.619.110.316.023.523.424.1
   Mexican American14.224.923.116.314.429.824.218.814.020.322.013.4
TABLE 4.5
Percentage of high school students who had or perceived they had a problem with weight, by sex, race/ethnicity, and grade, 2005
aStudents who were ≥85th percentile but <95th percentile for body mass index, by age and sex, based on reference data.
bStudents who were ≥95th percentile for body mass index, by age and sex, on the basis of reference data.
cNon-Hispanic.
Source: Adapted from "Table 60. Percentage of High School Students Who Were at Risk for Becoming or Were Overweight, by Sex, Race/Ethnicity, and Grade," and "Table 62. Percentage of High School Students Who Described Themselves as Slightly or Very Overweight and Who Were Trying to Lose Weight, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2005," Morbidity and Mortality Weekly Report, vol. 55, no. SS-5, June 9, 2006, http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf (accessed February 25, 2007)
Category At risk for becoming overweighta Overweightb
Female Male Total Female Male Total
%%%%%%
Race/ethnicity
Whitec13.815.214.58.215.211.8
Blackc22.616.719.816.115.916.0
Hispanic16.816.516.712.121.316.8
Grade
 915.918.317.110.415.012.7
1015.414.514.910.616.513.6
1115.215.915.69.417.213.3
1215.614.114.89.715.512.6
   Total 15.5 15.8 15.7 10.0 16.0 13.1
Described themselves as overweight Were trying to lose weight
Female Male Total Female Male Total
%%%%%%
Race/ethnicity
Whitec37.724.731.163.528.845.9
Blackc36.317.627.252.724.438.9
Hispanic42.432.037.164.138.651.2
Grade
 936.224.330.260.131.945.8
1036.224.530.261.528.244.4
1139.126.032.661.730.546.2
1241.825.633.764.028.746.4
   Total 38.1 25.1 31.5 61.7 29.9 45.6
TABLE 4.6
High school participation in physical activity by sex, race/ethnicity, and grade, 2005
Category Met currently recommended levels of physical activitya Met previously recommended levels of physical activityb No vigorous or moderate physical activityc
Female Male Total Female Male Total Female Male Total
aWere physically active doing any kind of physical activity that increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes/day on ≥5 of the 7 days preceding the survey.
bParticipated in at least 20 minutes of vigorous physical activity (i.e., physical activity that made them sweat and breathe hard) on ≥3 of the 7 days preceding the survey and/or at least 30 minutes of moderate physical activity (i.e., physical activity that did not make them sweat and breathe hard) on ≥5 of the 7 days preceding the survey.
cDuring the 7 days preceding the survey.
dNon-Hispanic.
Source: "Table 52. Percentage of High School Students Who Met Currently Recommended Levels of Physical Activity, Who Met Previously Recommended Levels of Physical Activity, and Who Participated in No Vigorous or Moderate Physical Activity, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2005," Morbidity and Mortality Weekly Report, vol. 55, no. SS-5, June 9, 2006, http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf (accessed February 25, 2007)
%%%%%%%%%
Race/ethnicity
Whited30.246.938.763.377.070.29.36.91.1
Blackd21.338.229.553.171.762.018.210.21.8
Hispanic26.539.032.962.676.069.412.38.92.0
Grade
 930.842.836.968.478.473.58.27.21.4
1030.046.838.563.077.870.510.37.51.4
1125.143.834.460.774.267.412.48.41.7
1224.041.932.951.771.961.815.28.42.0
   Total 27.8 43.8 35.8 61.5 75.8 68.7 11.3 7.9 0.9

suffer from asthma at a rate 140% higher than non-Hispanic white children. Akinbami finds that besides their higher prevalence rates, African-American children's asthma is apparently much less well controlled than non-Hispanic white children's asthma. African-American children have a 260% higher emergency department visit rate, a 250% higher hospitalization rate, and a 500% higher death rate from asthma. She speculates that this is because of the lower level and quality of health care received by African-American children.

HIV/AIDS

Acquired immunodeficiency syndrome (AIDS) was identified as a new disease in 1981, and, according to the CDC, in the HIV/AIDS Surveillance Report (2006, http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2005report/pdf/2005SurveillanceReport.pdf), an estimated 988,376 cases had been diagnosed in the United States through 2005. AIDS is caused by the human immunodeficiency virus (HIV), which weakens the victim's immune system, making it vulnerable to other opportunistic infections. Young children with AIDS usually have the virus transmitted to them either by an infected parent or through contaminated transfusions of blood or blood products. Adolescents who are sexually active or experimenting with drugs are also vulnerable to HIV infection, which can be spread through sexual intercourse without the use of a condom or through shared hypodermic needles.

In adults the most common opportunistic infections of AIDS are Kaposi's sarcoma—a rare skin cancer—and pneumocystis carinii pneumonia. In infants and children a failure to thrive and unusually severe bacterial infections characterize the disease. Except for pneumocystis carinii pneumonia, children with symptomatic HIV infection seldom develop opportunistic infections as adults do. More often, they are plagued by recurrent bacterial infections, persistent oral thrush (a common fungal infection of the mouth or throat), and chronic and recurrent diarrhea. They may also suffer from enlarged lymph nodes, chronic pneumonia, developmental delays, and neurological abnormalities.

HOW MANY ARE INFECTED?

By the end of 2005 the CDC reported a cumulative total of 9,078 AIDS cases in children under the age of thirteen since record keeping began in 1981. (See Table 4.7.) African-American children made up the overwhelming majority of these cases (5,614 cases), followed by Hispanic children (1,732 cases), non-Hispanic white children (1,613 cases), Asians and Pacific Islanders (54 cases), and Native Americans or Alaskan Natives (32 cases). By the end of 2005, 5,136 children aged fourteen and under had died from the disease.

MEANS OF TRANSMITTAL

Most babies of HIV-infected mothers do not develop HIV. HIV-positive mothers can reduce the risk of transmission by taking antiretroviral drugs during the last two trimesters of pregnancy and during labor; giving birth by caesarean section; giving the infant a short course of antiretroviral drugs after birth; and not breastfeeding. With these interventions, the transmission rate can be reduced to as low as 2%.

Although interventions are effective in preventing HIV transmission from pregnant mothers to babies, the overwhelming majority of children with AIDS contracted it from mothers who were either infected with HIV or at risk for AIDS (8,438 of 9,078 cases, or 93%). (See Table 4.7.) Another way HIV/AIDS has been transmitted to children was through blood transfusions contaminated with the virus, although this means of transmission has been all but eliminated in the twenty-first century.

ADOLESCENTS WITH AIDS

The number of AIDS cases among adolescents is comparatively low. The CDC reports that by the end of 2005, 6,324 adolescents aged thirteen to nineteen had been diagnosed with AIDS since the beginning of the epidemic in the early 1980s. However, because of the long incubation period between the time of infection and the onset of symptoms, it is highly probable that many people who develop AIDS in their early twenties became infected with HIV during their adolescence; by 2005, 34,987 twenty- to twenty-four-year-olds had been diagnosed.

MENTAL HEALTH ISSUES IN YOUNG PEOPLE

Marital Conflict and Divorce

Marital conflict hurts children whether it results in the breakup of marriages or not. Nearly all the studies on children of divorce focus on the period after the parents separated. However, some recent studies suggest that the negative effects children experience may not come so much from divorce itself as from the marital discord between parents before divorce. In fact, some research suggests that many problems reported with troubled teens not only began during the marriage but may have contributed to the breakup of the marriage. According to the article "Children of Divorce" (Journal of the American Board of Family Practice, 2001), children raised in discord and marital instability often experience a variety of social, emotional, and psychological problems.

Divorce can cause stressful situations for children in several ways. One or both parents may have to move to a new home, removing the children from family and friends who can give them support. Custody issues can generate hostility between parents. If one or both parents remarry, children are faced with yet another adjustment in their living arrangements.

Eating Disorders

Even though young people who are overweight increase their risk for certain diseases in adulthood, an overemphasis on thinness during childhood may contribute to eating disorders such as anorexia nervosa (extreme and often fatal weight loss) and bulimia ("binging and purging"). Girls are both more likely to have a distorted view of their weight and more likely to have eating disorders than boys.

TABLE 4.7
Diagnoses of AIDS in children younger than 13, by year of diagnosis, race/ethnicity, and transmission category, 2001–05
Year of diagnosis Cumulativea
2001 2002 2003 2004 2005
Note: These numbers do not represent reported case counts. Rather, these numbers are point estimates, which result from adjustments of reported case counts. The reported case counts have been adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk factor, but not for incomplete reporting.
aFrom the beginning of the epidemic through 2005.
bIncludes children of unknown race or multiple races. Cumulative total includes 33 children of unknown race or multiple races. Because column totals were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.
Source: "Table 4. Estimated Numbers of AIDS Cases in Children <13 Years of Age, by Year of Diagnosis and Selected Characteristics, 2001–2005 and Cumulative—50 States and the District of Columbia," in HIV/AIDS Surveillance Report, vol. 17, Centers for Disease Control and Prevention, 2006, http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2005report/pdf/2005SurveillanceReport.pdf (accessed February 25, 2007)
Race/ethnicity
White, not Hispanic121411781,613
Black, not Hispanic83724329395,614
Hispanic221610991,732
Asian/Pacific Islander1101154
American Indian/Alaska Native0101032
Transmission category
Hemophilia/coagulation disorder00000226
Mother with documented HIV infection or 1 of the following
  risk factors1151026747578,438
    Injection drug use13117643,196
    Sex with injection drug user1046211,388
    Sex with bisexual male32021202
    Sex with person with hemophilia1000036
    Sex with HIV-infected transfusion recipient0000022
    Sex with HIV-infected person, risk factor not specified39361919251,501
    Receipt of blood transfusion, blood components, or tissue12100143
    Has HIV infection, risk factor not specified47473218251,949
Receipt of blood transfusion, blood components, or tissue02000372
Other/risk factor not reported or identified3000042
    Totalb 118 104 67 47 58 9,078

The CDC reports that although 13.1% of students were overweight in 2005, a much higher proportion thought they were overweight (31.5%). (See Table 4.5.) Girls (38.1%) were much more likely than boys (25.1%) to believe they were overweight. Non-Hispanic white (31.1%) and especially Hispanic (37.1%) youths were more likely than African-American youths (27.2%) to think of themselves as overweight.

In 2005 nearly half (45.6%) of high school students nationwide were trying to lose weight by a variety of methods. (See Table 4.5.) Almost one out of twenty (4.5%) high school students had taken laxatives or induced vomiting to lose weight, 12.3% went without eating for twenty-four hours or more, and 6.3% took diet pills. (See Table 4.8.) Hispanic and non-Hispanic white students were more likely to resort to these unhealthy behaviors than were African-American students. Many more females than males engaged in risky weight-loss methods.

Many more high school students engaged in healthier methods of losing weight. Well over half of high school females dieted or exercised to lose weight (54.8% and 67.4%, respectively); among males, only 26.8% dieted and 52.9% exercised to lose weight. (See Table 4.8.) Once again, among females these behaviors varied by race: Far more white and Hispanic female students engaged in these weight-loss activities than did African-American female students.

Hyperactivity

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders to appear in childhood. No one knows what causes ADHD, although recent research reported by the National Institute of Mental Health finds a link between a person's ability to pay attention and the body's use of glucose in the brain. Symptoms include restlessness, inability to concentrate, aggressiveness, and impulsivity; lack of treatment can lead to problems in school, at work, and in making friends. In "Attention Deficit Hyperactivity Disorder" (2001, http://www.nimh.nih.gov/publicat/helpchild.cfm), the National Institute of Mental Health estimates that 4.1% of youths aged nine to seventeen are affected in any six-month period by ADHD. Boys are two to three times more likely to be affected by ADHD than girls. Methylphenidate, a stimulant, is frequently used to treat hyperactive children.

TABLE 4.8
Percentage of high school students who engaged in healthy and unhealthy behaviors associated with weight controla, by sex, race/ethnicity, and grade, 2005
Category Ate less food, fewer calories, or foods low in fat to lose weight or to keep from gaining weight Exercised to lose weight or to keep from gaining weight Went without eating for ≥24 hours to lose weight or to keep from gaining weight Took diet pills, powders, or liquids to lose weight or to keep from gaining weightc Vomited or took laxatives to lose weight or to keep from gaining weight
Female Male Total Female Male Total Female Male Total Female Male Total Female Male Total
aDuring the 30 days preceding the survey.
bNon-Hispanic.
cWithout a doctor's advice.
Source: Adapted from "Table 64. Percentage of High School Students Who Engaged in Healthy Behaviors to Lose Weight or to Keep from Gaining Weight, by Sex, Race/Ethnicity, and Grade," and "Table 66. Percentage of High School Students Who Engaged in Unhealthy Behaviors to Lose Weight or to Keep from Gaining Weight, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2005," Morbidity and Mortality Weekly Report, vol. 55, no. SS-5, June 9, 2006, http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf (accessed February 25, 2007)
%%%%%%%%%%%%%%%
Race/ethnicity
Whiteb58.826.442.469.851.217.67.512.59.24.26.66.72.34.4
Blackb39.622.031.156.551.654.114.08.611.44.95.15.04.02.83.4
Hispanic53.231.542.268.963.065.917.77.412.67.55.76.66.83.95.4
Grade
 950.827.138.868.357.762.918.48.113.36.04.35.25.52.74.1
1055.325.740.169.052.160.316.27.411.77.74.46.07.23.05.1
1155.626.841.466.349.458.017.26.812.19.24.87.06.12.54.3
1258.427.643.065.551.258.316.07.811.910.24.47.35.92.64.3
   Total 54.8 26.8 40.7 67.4 52.9 60.0 17.0 7.6 12.3 8.1 4.6 6.3 6.2 2.8 4.5

Drug and Alcohol Use

Few factors negatively influence the health and well-being of young people more than the use of drugs, alcohol, and tobacco. Monitoring the Future, a long-term study on the use of drugs, alcohol, and tobacco conducted by the University of Michigan's Institute for Social Research, annually surveys eighth, tenth, and twelfth graders on their use of these substances. According to the Monitoring the Future: National Results on Adolescent Drug Use, Overview of Key Findings, 2005 (April 2006, http://www.drugabuse.gov/PDF/overview2005.pdf), University of Michigan researchers Lloyd D. Johnston et al. indicate that the percentage of high school students who have ever tried any illicit drug either remained steady or decreased slightly from the mid-1990s to 2005. This plateau followed sharp increases during the early 1990s. Johnston et al. find that by the time they neared high school graduation, half (50%) of American students had tried an illicit drug. Between 1975 and 2005, 83% to 90% of high school seniors reported that they could easily obtain marijuana, more than any other illicit drug. A third of twelfth graders had used marijuana in the previous twelve months. The CDC finds that in 2005, 38.4% of high school students reported they had tried marijuana, and 20.2% reported they had used it at least once in the thirty days before the survey. (See Table 4.9.)

TOBACCO

Most states prohibit the sale of cigarettes to anyone under the age of eighteen, but the laws are often ignored and may carry no penalties for youths who buy cigarettes or smoke in public. The ALA reports in "Smoking and Teens Fact Sheet" (April 2006, http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=39871) that each day six thousand children smoke their first cigarette and that almost two thousand of them will become regular smokers. The CDC indicates that in 2005, 23% of high school students had smoked at least one cigarette in the month prior to being surveyed and 9.4% had smoked at least twenty days in the past month. (See Table 4.10.) Almost twice as many male students smoked heavily than did female students: 7.2% of female adolescents and 14.2% of male adolescents smoked more than ten cigarettes per day.

Teens say they smoke for a variety of reasons—they "just like it," "it's a social thing," and many young women who are worried about their weight report that they smoke because "it burns calories." Many of them note they have seen their parents smoke. The ALA indicates that youth who have two parents who smoke are more than twice as likely to become smokers than youth whose parents do not smoke. Children in smoking households are at risk not only from secondhand smoke but also from this greater likelihood to take up smoking themselves.

ALCOHOL

According to Johnston et al., alcohol remained the drug of choice for teenagers in 2005. (See Table 4.11.) Almost seven out of ten (68.6%) high school seniors had used alcohol in the twelve months prior to the survey, and 47% had used alcohol in the previous thirty days. Although there was some decline in drinking among students in the 1980s, alcohol use remained generally stable among young people between 1995 and 2005. The CDC finds that in 2005, 74.3% of all high school students had had at least one alcoholic drink in their lifetime, 43.3% had taken a drink in the thirty days prior to being surveyed, and 25.5% had had five or more drinks on one occasion at least once in the previous thirty days. (See Table 4.9.) African-American youth were less likely than either non-Hispanic white or Hispanic high schoolers to have ever had a drink, to have had a drink in the previous thirty days, or to engage in episodic heavy drinking.

CHILDHOOD DEATHS

Infant Mortality

The NCHS defines the infant mortality rate as the number of deaths of babies younger than one year per 1,000 live births. Neonatal deaths occur within 28 days after birth and postneonatal deaths occur 28 to 365 days after birth. The U.S. infant mortality rate declined from 165 per 1,000 live births in 1900 to a low of 6.8 per 1,000 live births in 2003, after increasing in 2002 for the first time in decades. (See Table 4.12.) In Health, United States, 2003 (http://www.cdc.gov/nchs/data/hus/hus03.pdf), the CDC notes that several factors—including improved access to health care, advances in neonatal medicine, and educational campaigns—contributed to the overall decline in infant mortality in the twentieth century.

Not all racial and ethnic groups have reached that record-low infant mortality rate. In 2003 the infant mortality rate for non-Hispanic white infants was 5.7 deaths per 1,000 live births, less than half the rate of 13.5 for African-American infants. (See Table 4.12.) Rates for Native American or Alaskan Native, Hispanic, and Asian and Pacific Islander babies were 8.7, 5.6, and 4.8, respectively.

The NCHS lists the ten leading causes of infant mortality in the United States in 2004. (See Table 4.13.) Birth defects (congenital malformations) were the primary cause of infant mortality (136.6 deaths per 100,000 live births). Premature delivery or low birth weight was the second-leading cause of infant mortality (113.8 per 100,000 live births). Sudden infant death syndrome (51.2), complications of pregnancy (41.4), complications in the placenta or umbilical cord (24.2), respiratory distress (21.3), bacterial sepsis (19.4), neonatal hemorrhage (14.4), and intrauterine hypoxia/birth asphyxia (12.2) completed the list.

SUDDEN INFANT DEATH SYNDROME

Sudden infant death syndrome (SIDS; sometimes called crib death), the unexplained death of a previously healthy infant, was the third-leading cause of infant mortality in the United States in 2004. Moreover, it was the leading cause of death for infants older than one month. In 1992 the

TABLE 4.9
Percentage of high school students who drank alcohol and used marijuana, by sex, race/ethnicity, and grade, 2005
Category Lifetime alcohol usea Current alcohol useb Episodic heavy drinkingc Lifetime marijuana usee Current marijuana usef
Female Male Total Female Male Total Female Male Total Female Male Total Female Male Total
aHad at least one drink of alcohol on ≥1 day during their life.
bHad at least one drink of alcohol on ≥1 of the 30 days preceding the survey.
cHad ≥5 drinks of alcohol in a row (i.e., within a couple of hours) on ≥1 of the 30 days preceding the survey.
dNon-Hispanic.
eUsed marijuana one or more times during their life.
fUsed marijuana one or more times during the 30 days preceding the survey.
Source: Adapted from "Table 28. Percentage of High School Students Who Drank Alcohol, by Sex, Race/Ethnicity, and Grade," and "Table 30. Percentage of High School Students Who Used Marijuana, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2005," Morbidity and Mortality Weekly Report, vol. 55, no. SS-5, June 9, 2006, http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf (accessed February 25, 2007)
%%%%%%%%%%%%%%%
Race/ethnicity
Whited75.775.075.345.947.046.428.131.829.936.040.038.019.221.320.3
Blackd71.466.569.032.529.631.210.411.911.137.843.840.718.822.120.4
Hispanic79.079.979.444.848.946.821.928.725.337.547.742.618.028.123.0
Grade
 966.566.666.536.236.336.217.320.719.027.830.929.316.218.617.4
1075.673.274.442.741.442.024.125.124.635.739.037.418.921.520.2
1177.175.576.344.247.846.025.030.427.639.445.142.318.523.521.0
1281.881.581.749.652.050.829.236.232.842.852.447.619.526.122.8
   Total 74.8 73.8 74.3 42.8 43.8 43.3 23.5 27.5 25.5 35.9 40.9 38.4 18.2 22.1 20.2
TABLE 4.10
Percentage of high school students who used tobacco, by sex, race/ethnicity, and grade, 2005
Lifetime cigarette usea Lifetime daily cigarette useb Current cigarette used
Category Female Male Total Female Male Total Female Male Total
aEver tried cigarette smoking, even one or two puffs.
bEver smoked at least one cigarette every day for 30 days.
cNon-Hispanic.
dSmoked cigarettes on ≥1 of the 30 days preceding the survey.
eSmoked cigarettes on ≥20 of the 30 days preceding the survey.
fOn the days they smoked during the 30 days preceding the survey, among the 23.0% of students nation wide who reported current cigarette use.
gDuring the 30 days preceding the survey, among the 19.1% of students nationwide who were aged <18 years and who reported current cigarette use.
Source: Adapted from "Table 20. Percentage of High School Students Who Ever Smoked Cigarettes, by Sex, Race/Ethnicity, and Grade," and "Table 22. Percentage of High School Students Who Currently Smoked Cigarettes, by Sex, Race/Ethnicity, and Grade," and "Table 24. Percentage of High School Students Who Tried to Quit Smoking Cigarettes, Who Usually Got Their Own Cigarettes by Buying Them in a Store or Gas Station, and Who Were Not Asked to Show Proof of Age When They Bought or Tried to Buy Cigarettes in a Store, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2005," Morbidity and Mortality Weekly Report, vol. 55, no. SS-5, June 9, 2006, http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf (accessed February 25, 2007)
%%%%%%%%%
Race/ethnicity
Whitec53.254.954.017.015.116.127.024.925.9
Blackc53.256.354.73.27.55.211.914.012.9
Hispanic52.062.157.19.211.510.419.224.822.0
Grade
 947.749.848.710.29.910.020.518.919.7
1050.854.152.511.511.611.521.921.121.4
1155.359.657.516.014.515.324.324.224.3
1258.362.260.317.418.117.826.029.127.6
   Total 52.7 55.9 54.3 13.5 13.3 13.4 23.0 22.9 23.0
Current frequent cigarette usee Smoked >10 cigarettes/dayf Bought cigarettes in a store or gas stationg
Category Female Male Total Female Male Total Female Male Total
%%%%%%%%%
Race/ethnicity
Whitec11.710.611.27.516.211.711.117.414.1
Blackc2.45.13.72.54.43.518.624.621.6
Hispanic4.78.16.56.110.48.512.221.317.4
Grade
 97.06.76.94.612.88.65.011.68.2
108.47.07.76.56.76.67.813.410.6
1110.010.510.38.617.913.114.825.820.3
1212.513.913.29.216.913.227.734.030.8
   Total 9.3 9.3 9.4 7.2 14.2 10.7 11.7 18.8 15.2

American Academy of Pediatrics recommended that babies sleep on their backs to reduce the risk of SIDS and launched its Back to Sleep campaign to educate parents. It had been a long-held belief that the best position for babies to sleep was on their stomachs. The American SIDS Institute (2005, http://www.sids.org/) reports that the Back to Sleep campaign has resulted in the reduction of SIDS cases by over 50% since 1983. Other risk factors for SIDS include maternal use of drugs or tobacco during pregnancy, low birth weight, and poor prenatal care. For reasons not yet understood, the CDC notes in "Sudden Infant Death Syndrome" (November 13, 2006, http://www.cdc.gov/SIDS/index.htm) that even though the overall rate of SIDS has declined since the beginning of the Back to Sleep campaign, it has declined less among African-Americans and Native Americans than among other groups.

A number of recent studies consider the possible causes of and risk factors for SIDS. One study, "SIDS Risk Prevention Research Begins to Define Physical Abnormalities in Brainstem, Points to Possible Diagnostic/Screening Tools" (PRNewswire, October 18, 1999), which has been ongoing since 1985 and is being conducted by Hannah Kinney of Harvard Medical School in Boston, Massachusetts, finds a brain defect believed to affect breathing in babies who die of SIDS. Researchers suggest that as carbon dioxide levels rise and oxygen levels fall during sleep, the brains of some babies do not get the signal to regulate breathing or blood pressure accordingly to make up for the change. This condition is particularly dangerous for infants sleeping on their stomachs or on soft bedding. According to the article "SIDS Infants Show Brain Abnormalities" (NIH Research Matters, November 10, 2006), the project finds that this brain abnormality might be linked to higher levels of serotonin in the brainstem. Duane Alexander, the director of the National Institute of Child Health and Human Development, states that "this finding lends credence to the view that SIDS risk may greatly increase when an underlying predisposition combines with an environmental risk—such as sleeping face down—at a developmentally sensitive time in early life."

TABLE 4.11
Percent of high school seniors who reported drug and alcohol use during 12-month period and 30-day period, 2005
Used in past 12 months Used in past 30 days
Source: Adapted from Lloyd D. Johnston et al., "Table 2. Trends in Annual Prevalence of Use of Various Drugs for Eighth, Tenth, and Twelfth Graders," and "Table 3. Trends in 30-Day Prevalence of Use of Various Drugs for Eighth, Tenth, and Twelfth Graders," in Monitoring the Future: National Results on Adolescent Drug Use, Overview of Key Findings, 2005, U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, April 2006, http://www.drugabuse.gov/PDF/overview2005.pdf (accessed February 25, 2007)
Marijuana/hashish33.619.8
Inhalants5.02.0
PCP1.30.7
MDMA (ecstasy)3.01.0
Cocaine5.12.3
Crack1.91.0
Heroin0.80.5
Other narcotics9.03.9
Amphetamines8.63.9
Methamphetamine2.50.9
Sedatives (barbiturates)7.23.3
Tranquilizers6.82.9
Alcohol68.647.0
Steroids1.50.9

Mortality among Older Children

In the second half of the twentieth century childhood death rates declined dramatically. Most childhood deaths are from injuries and violence. Even though death rates for all ages decreased, the largest declines were among children.

In 2004 three of the leading causes of childhood death were unintentional injuries, congenital anomalies (birth defects), and malignant neoplasms (cancers). (See Table 4.14.) The remaining deaths were spread across a variety of diseases, including heart disease, pneumonia, influenza, HIV/AIDS, homicide, and suicide.

MOTOR VEHICLE INJURIES

According to the National Highway Traffic Safety Administration (NHTSA), in "Determine Why There Are Fewer Young Alcohol-Impaired Drivers" (September 2001, http://www.nhtsa.dot.gov/people/injury/research/FewerYoungDrivers/), during the 1980s and early 1990s traffic fatalities linked to teenage drinking fell. This decline was due in large part to stricter enforcement of drinking age laws and driving while intoxicated or driving under the influence laws. Nevertheless, motor vehicle crashes were the leading cause of death among fifteen- to nineteen-year-olds in 2003. In the fact sheet "Mortality: Adolescents and Young Adults" (2006, http://nahic.ucsf.edu/downloads/Mortality.pdf), the National Adolescent Health Information Center reports that 25.2 of every 100,000 teenagers in that age group were killed in traffic accidents in 2003. Many of those killed had been drinking alcohol and were not wearing their seatbelts. Timothy M. Pickrell of the U.S. Department of Transportation reports in "Driver Alcohol Involvement in Fatal Crashes by Age Group and Vehicle Type" (June 2006, http://www-nrd.nhtsa.dot.gov/pdf/nrd-30/NCSA/RNotes/2006/810598.pdf) that 20% of all young drivers aged fifteen to twenty who were killed in crashes were intoxicated.

The CDC's 2005 "Youth Risk Behavior Surveillance" finds that in the month before the survey 17.1% of high school seniors (those most likely to have their driver's licenses) reported they had driven a vehicle after drinking alcohol. (See Table 4.15.) Male seniors (19.2%) were more likely than female seniors (15%) to drive after drinking. Another 28.5% of high school students admitted they had ridden with a driver who had been drinking. Females were slightly more likely to ride with a driver who had been drinking (29.6%) than were males (27.2%).

SUICIDE

In 2004 suicide was the seventh-leading cause of death among five- to fourteen-year-olds and the third-leading cause of death in fifteen- to twenty-four-year-olds. (See Table 4.14.) The CDC reports in "Homicides and Suicides—National Violent Death Reporting System, United States, 2003–2004" (Morbidity and Mortality Weekly Report, July 7, 2006) that the male suicide rate is more than four times higher than the female suicide rate. Robert N. Anderson and Betty L. Smith of the CDC's Division of Vital Statistics note in "Deaths: Leading Causes for 2001" (National Vital Statistics Reports, November 7, 2003) that in 2001, the most recent year for which detailed statistics are available, white males aged fifteen to nineteen had twice the suicide rate (14 per 100,000) of African-American males (7.3 per 100,000) or Hispanic male youth (7.8 per 100,000). Among females aged fifteen to nineteen, the rate for whites (2.9 per 100,000) was considerably higher than that for Hispanics (2.5 per 100,000) or African-Americans (1.3 per 100,000).

The CDC's "Youth Risk Behavior Surveillance" questioned high school students regarding their thoughts about suicide. In 2005 almost one out of six students (16.9%) surveyed claimed that they had seriously thought about attempting suicide in the previous twelve months. (See Table 4.16.) Although the suicide death rate was much higher among males than among females, females (21.8%) were more likely to have considered suicide than males (12%). Of all students, 13% (16.2% of females and 9.9% of males) had made a specific plan to attempt suicide, 8.4% of students (10.8% of females and 6% of males) said they had attempted suicide in the previous year, and 2.3% of high school students (2.9% of females and 1.8% of males) said they had suffered injuries from the attempt that required medical attention. These numbers reflect the fact that females of all ages tend to choose less fatal methods of attempting suicide, such as overdosing and cutting veins, than males, who tend to choose more deadly methods, such as shooting or hanging.

TABLE 4.12
Infant mortality rate among selected groups, by race and Hispanic origin of mother, selected years 1983–2003
[Data are based on linked birth and death certificates for infants]
Race and Hispanic origin of mother 1983a 1985a 1990a 1995b 1999b 2000b 2001b 2002b 2003b
*Estimates are considered unreliable. Rates preceded by an asterisk are based on fewer than 50 deaths in the numerator. Rates not shown are based on fewer than 20 deaths in the numerator.
aRates based on unweighted birth cohort data.
bRates based on a period file using weighted data.
cInfant (under 1 year of age), neonatal (under 28 days), and postneonatal (28 days-11 months).
dStarting with 2003 data, estimates are not shown for Asian or Pacific Islander subgroups during the transition from single race to multiple race reporting.
ePersons of Hispanic origin may be of any race.
fPrior to 1995, data shown only for states with an Hispanic-origin item on their birth certificates.
Notes: The race groups white, black, American Indian or Alaska Native, and Asian or Pacific Islander include persons of Hispanic and non-Hispanic origin. Starting with 2003 data, some states reported multiple-race data. The multiple-race data for these states were bridged to the single race categories of the 1977 Office of Management and Budget standards for comparability with other states. National linked files do not exist for 1992–1994. Data for additional years are available.
Source: Adapted from "Table 19. Infant, Neonatal, and Postneonatal Mortality Rates, by Detailed Race and Hispanic Origin of Mother: United States, Selected Years 1983–2003," in Health: United States, 2006, with Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, 2006, http://www.cdc.gov/nchs/data/hus/hus06.pdf (accessed February 25, 2007)
Infantc deaths per 1,000 live births
All mothers 10.910.4 8.9 7.6 7.0 6.9 6.8 7.06.8
White 9.3 8.9 7.3 6.3 5.8 5.7 5.7 5.85.7
Black or African American19.218.616.914.614.013.513.313.813.5
American Indian or Alaska Native15.213.113.1 9.0 9.3 8.3 9.7 8.68.7
Asian or Pacific Islanderd 8.3 7.8 6.6 5.3 4.8 4.9 4.7 4.84.8
    Chinese 9.5 5.8 4.3 3.8 2.9 3.5 3.2 3.0
    Japanese 5.6* 6.0* 5.5* 5.3* 3.5* 4.5* 4.0* 4.9*
    Filipino 8.4 7.7 6.0 5.6 5.8 5.7 5.5 5.7
    Hawaiian11.2 9.9* 8.0* 6.5* 7.0* 9.0 7.3*9.6
    Other Asian or Pacific Islander 8.1 8.5 7.4 5.5 5.1 4.8 4.8 4.7
Hispanic or Latinoe, f 9.5 8.8 7.5 6.3 5.7 5.6 5.4 5.65.6
    Mexican 9.1 8.5 7.2 6.0 5.5 5.4 5.2 5.45.5
    Puerto Rican12.911.2 9.9 8.9 8.3 8.2 8.5 8.28.2
    Cuban 7.5 8.5 7.2 5.3 4.6 4.6 4.2 3.74.6
    Central and South American 8.5 8.0 6.8 5.5 4.7 4.6 5.0 5.15.0
    Other and unknown Hispanic or Latino10.6 9.5 8.0 7.4 7.2 6.9 6.0 7.16.7
Not Hispanic or Latino:
    Whitef 9.2 8.6 7.2 6.3 5.8 5.7 5.7 5.85.7
    Black or African Americanf19.118.316.914.714.113.613.513.913.6
Neonatalc deaths per 1,000 live births
All mothers  7.1 6.8 5.7 4.9 4.7 4.6 4.5 4.74.6
White 6.1 5.8 4.6 4.1 3.9 3.8 3.8 3.93.9
Black or African American12.512.311.1 9.6 9.5 9.1 8.9 9.39.2
American Indian or Alaska Native 7.5 6.1 6.1 4.0 5.0 4.4 4.2 4.64.5
Asian or Pacific Islanderd 5.2 4.8 3.9 3.4 3.2 3.4 3.1 3.43.4
    Chinese 5.5 3.3 2.3 2.3 1.8 2.5 1.9 2.4
    Japanese 3.7* 3.1* 3.5* 3.3* 2.8* 2.6* 2.5* 3.7*
    Filipino 5.6 5.1 3.5 3.4 3.9 4.1 4.0 4.1
    Hawaiian 7.0* 5.7* 4.3* 4.0* 4.9* 6.2* 3.6* 5.6*
    Other Asian or Pacific Islander 5.0 5.4 4.4 3.7 3.3 3.4 3.2 3.3
Hispanic or Latinoe, f 6.2 5.7 4.8 4.1 3.9 3.8 3.6 3.83.9
    Mexican 5.9 5.4 4.5 3.9 3.7 3.6 3.5 3.63.8
    Puerto Rican 8.7 7.6 6.9 6.1 5.9 5.8 6.0 5.85.7
    Cuban 5.0* 6.2 5.3 3.6* 3.5* 3.2* 2.5* 3.2*3.4
    Central and South American 5.8 5.6 4.4 3.7 3.3 3.3 3.4 3.53.6
    Other and unknown Hispanic or Latino 6.4 5.6 5.0 4.8 4.8 4.6 3.9 5.14.7
Not Hispanic or Latino:
    Whitef 5.9 5.6 4.5 4.0 3.8 3.8 3.8 3.93.8
    Black or African Americanf12.011.911.0 9.6 9.6 9.2 9.0 9.39.3

In "Homicides and Suicides" the CDC reports that the likelihood that a child will commit suicide increases with the presence of certain risk factors. Among the factors whose presence may indicate heightened risk are depression, mental health problems, relationship conflicts, a history of previous suicide attempts, and alcohol dependence. In addition, the suicide rate among male homosexual teens is believed to be extremely high. Gary Remafedi of the University of Minnesota's Youth and AIDS Projects, in "Suicidality in a Venue-Based Sample of Young Men Who Have Sex with Men" (Journal of Adolescent Health, October 2002), corroborates previous estimates that 20% to 42% of teens and young men who have sex with other males attempt suicide.

TABLE 4.13
Ten leading causes of infant death by race and Hispanic origin, 2004
[Data are based on a continuous file of records received from the states. Rates are per 100,000 live births. Figures are based on weighted data rounded to the nearest individual, so categories may not add to totals or subtotals Rates for Hispanic origin should be interpreted with caution because of inconsistencies between reporting Hispanic origin on birth and death certificates]
Ranka Cause of death and age Number Rate
All racesb
All causes27,835676.3
 1Congenital malformations, deformations and chromosomal abnormalities5,623136.6
 2Disorders related to short gestation and low birth weight, not elsewhere classified4,685113.8
 3Sudden infant death syndrome2,10951.2
 4Newborn affected by maternal complications of pregnancy1,70541.4
 5Newborn affected by complications of placenta, cord and membranes99824.2
 6Accidents (unintentional injuries)99524.2
 7Respiratory distress of newborn87721.3
 8Bacterial sepsis of new born79819.4
 9Neonatal hemorrhage59314.4
10Intrauterine hypoxia and birth asphyxia50212.2
All other causes8,950217.5
Non-Hispanic white
All causes13,084567.8
 1Congenital malformations, deformations and chromosomal abnormalities3,002130.3
 2Disorders related to short gestation and low birth weight, not elsewhere classified1,89582.3
 3Sudden infant death syndrome1,12348.8
 4Newborn affected by maternal complications of pregnancy75332.7
 5Accidents (unintentional injuries)53423.2
 6Newborn affected by complications of placenta, cord and membranes48220.9
 7Respiratory distress of newborn39817.3
 8Bacterial sepsis of new born34414.9
 9Neonatal hemorrhage27712.0
10Intrauterine hypoxia and birth asphyxia26411.4
All other causes4,013174.2
Total blackc
All causes8,3471,362.8
 1Disorders related to short gestation and low birth weight, not elsewhere classified1,766288.4
 2Congenital malformations, deformations and chromosomal abnormalities1,049171.3
 3Sudden infant death syndrome683111.5
 4Newborn affected by maternal complications of pregnancy624101.9
 5Newborn affected by complications of placenta, cord and membranes30649.9
 6Respiratory distress of newborn30249.4
 7Accidents (unintentional injuries)30049.0
 8Bacterial sepsis of new born26843.7
 9Neonatal hemorrhage15725.6
10Necrotizing enterocolitis of newborn15124.6
All other causes2,741447.5
TABLE 4.13
Ten leading causes of infant death by race and Hispanic origin, 2004 [continued]
[Data are based on a continuous file of records received from the states. Rates are per 100,000 live births. Figures are based on weighted data rounded to the nearest individuals, so categories may not add to totals or subtotals Rates for Hispanic origin should be interpreted with caution because of inconsistencies between reporting Hispanic origin on birth and death certificates]
Ranka Cause of death and age Number Rate
—Category not applicable.
aRank based on number of deaths.
bIncludes races other than black and white.
cRace and Hispanic origin are reported separately on both the birth and death certificate. Race categories are consistent with the 1977 Office of Management and Budget (OMB) standards. California, Hawaii, Idaho, Maine, Michigan, Minnesota, Montana, New Hampshire, New Jersey, New York, Oklahoma, South Dakota, Washington, Wisconsin, and Wyoming reported multiple-race data in 2004. The multiple-race data for these states were bridged to the single race categories of the 1977 OMB standards for comparability with other states. Data for persons of Hispanic origin are included in the data for each race group, according to the decedent's reported race.
dIncludes all persons of Hispanic origin of any race.
Notes: For certain causes of death such as unintentional injuries, homicides, suicides, and respiratory diseases, preliminary and final data differ because of the truncated nature of the preliminary file. Data are subject to sampling and/or random variation. Although the infant mortality rate is the preferred indicator of the risk of dying during the first year of life, another measure of infant mortality, the infant death rate, is shown elsewhere in this report. The two measures typically are similar yet they can differ because the denominators used for these measures are different.
Source: Adapted from Arialdi M. Miniño, Melonie P. Heron, and Betty L. Smith, "Table 8. Infant Deaths and Infant Mortality Rates for the 10 Leading Causes of Infant Death, by Race and Hispanic Origin: United States, Preliminary 2004," in "Deaths: Preliminary Data for 2004," National Vital Statistics Reports, vol. 54, no. 19, June 28, 2006, http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_19.pdf (accessed February 25, 2007)
Hispanicd
All causes3,782400.2
 1Congenital malformations, deformations and chromosomal abnormalities1,288136.3
 2Disorders related to short gestation and low birth weight, not elsewhere classified82887.7
 3Newborn affected by maternal complications of pregnancy26828.3
 4Sudden infant death syndrome24125.5
 5Newborn affected by complications of placenta, cord and membranes17418.4
 6Bacterial sepsis of new born16317.2
 7Respiratory distress of newborn16016.9
 8Accidents (unintentional injuries)13214.0
 9Neonatal hemorrhage12713.5
10Atelectasis10811.4
All other causes29431.1
TABLE 4.14
Leading causes of death and numbers of deaths, by age, 1980 and 2004
[Data are based on death certificates]
Age and rank order 1980 2004
Cause of death Deaths Cause of death Deaths
Under 1 year
All causes45,526All causes27,936
 1Congenital anomalies9,220Congenital malformations, deformations and chromosomal abnormalities5,622
 2Sudden infant death syndrome5,510Disorders related to short gestation and low birth weight, not elsewhere classified4,642
 3Respiratory distress syndrome4,989Sudden infant death syndrome2,246
 4Disorders relating to short gestation and unspecified low birth weight3,648Newborn affected by maternal complications of pregnancy1,715
 5Newborn affected by maternal complications of pregnancy1,572Unintentional injuries1,052
 6Intrauterine hypoxia and birth asphyxia1,497Newborn affected by complications of placenta, cord and membranes1,042
 7Unintentional injuries1,166Respiratory distress of newborn875
 8Birth trauma1,058Bacterial sepsis of newborn827
 9Pneumonia and influenza1,012Neonatal hemorrhage616
10Newborn affected by complications of placenta, cord, and membranes985Diseases of circulatory system593
1-4 years
All causes8,187All causes4,785
 1Unintentional injuries3,313Unintentional injuries1,641
 2Congenital anomalies1,026Congenital malformations, deformations and chromosomal abnormalities569
 3Malignant neoplasms573Malignant neoplasms399
 4Diseases of heart338Homicide377
 5Homicide319Diseases of heart187
 6Pneumonia and influenza267Influenza and pneumonia119
 7Meningitis223Septicemia84
 8Meningococcal infection110Certain conditions originating in the perinatal period61
 9Certain conditions originating in the perinatal period84In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior53
10Septicemia71Chronic lower respiratory diseases48
5-14 years
All causes10,689All causes6,834
 1Unintentional injuries5,224Unintentional injuries2,666
 2Malignant neoplasms1,497Malignant neoplasms1,019
 3Congenital anomalies561Congenital malformations, deformations and chromosomal abnormalities389
 4Homicide415Homicide329
 5Diseases of heart330Suicide285
 6Pneumonia and influenza194Diseases of heart245
 7Suicide142Chronic lower respiratory diseases120
 8Benign neoplasms104In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior84
 9Cerebrovascular diseases95Influenza and pneumonia82
10Chronic obstructive pulmonary diseases85Cerebrovascular diseases77
TABLE 4.14
Leading causes of death and numbers of deaths, by age, 1980 and 2004 [continued]
[Data are based on death certificates]
Age and rank order 1980 2004
Cause of death Deaths Cause of death Deaths
—Category not applicable.
Source: Adapted from "Table 32. Leading Causes of Death and Numbers of Deaths, by Age: United States, 1980 and 2004," in Health: United States, 2006, with Chartbook on Trends in the Health of Americans, Centers for Disease Control and Prevention, National Center for Health Statistics, 2006, http://www.cdc.gov/nchs/data/hus/hus06.pdf (accessed February 25, 2007)
15-24 years
All causes49,027All causes33,421
 1Unintentional injuries26,206Unintentional injuries15,449
 2Homicide6,537Homicide5,085
 3Suicide5,239Suicide4,316
 4Malignant neoplasms2,683Malignant neoplasms1,709
 5Diseases of heart1,223Diseases of heart1,038
 6Congenital anomalies600Congenital malformations, deformations and chromosomal abnormalities483
 7Cerebrovascular diseases418Cerebrovascular diseases211
 8Pneumonia and influenza348Human immunodeficiency virus (HIV) disease191
 9Chronic obstructive pulmonary diseases141Influenza and pneumonia185
10Anemias133Chronic lower respiratory diseases179
TABLE 4.15
Percentage of high school students who rode with a driver who had been drinking alcohol and who drove when they had been drinking alcohol, by sex, race/ethnicity, and grade, 2005
Category Rode with a driver who had been drinking alcohola Drove when drinking alcohola
Female Male Total Female Male Total
aOne or more times during the 30 days preceding the survey.
bNon-Hispanic.
Source: "Table 4. Percentage of High School Students Who Rode in a Car or Other Vehicle Driven by Someone Who Had Been Drinking Alcohol and Who Drove a Car or Other Vehicle When They Had Been Drinking Alcohol, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2005," Morbidity and Mortality Weekly Report, vol. 55, no. SS-5, June 9, 2006, http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf (accessed February 25, 2007)
%%%%%%
Race/ethnicity
Whiteb30.426.228.310.112.411.3
Blackb24.024.324.13.56.54.9
Hispanic34.737.436.16.414.610.5
Grade
 930.125.827.94.56.55.5
1029.526.227.84.88.36.6
1128.127.728.09.514.712.1
1230.729.530.115.019.217.1
   Total 29.6 27.2 28.5 8.1 11.7 9.9
TABLE 4.16
Percentage of high school students who felt sad or hopeless, who seriously considered attempting suicide, who made a suicide plan, and who attempted suicide, by sex, race/ethnicity, and grade, 2005
Category Felt sad or hopelessa, b Seriously considered attempting suicideb Made a suicide planb Attempted suicidea, d Suicide attempt treated by a doctor or nursea
Female Male Total Female Male Total Female Male Total Female Male Total Female Male Total
aAlmost every day for ≥2 weeks in a row so that they stopped doing some usual activities.
bDuring the 12 months preceding the survey.
cNon-Hispanic.
dOne or more times.
Source: Adapted from "Table 16. Percentage of High School Students Who Felt Sad or Hopeless, Who Seriously Considered Attempting Suicide, and Who Made a Plan about How They Would Attempt Suicide, by Sex, Race/Ethnicity, and Grade," and "Table 18. Percentage of High School Students Who Actually Attempted Suicide and Whose Suicide Attempt Resulted in an Injury, Poisoning, or Overdose That Had to Be Treated by a Doctor or Nurse, by Sex, Race/Ethnicity, and Grade," in "Youth Risk Behavior Surveillance—United States, 2005," Morbidity and Mortality Weekly Report, vol. 55, no. SS-5, June 9, 2006, http://www.cdc.gov/mmwr/PDF/SS/SS5505.pdf (accessed February 25, 2007)
%%%%%%%%%%%%%%%
Race/ethnicity
Whitec33.418.425.821.512.416.915.49.712.59.35.27.32.71.52.1
Blackc36.919.528.417.17.012.213.55.59.69.85.27.62.61.42.0
Hispanic46.726.036.224.211.917.918.510.714.514.97.811.33.72.83.2
Grade
 938.519.929.023.912.217.917.610.213.914.16.810.44.02.13.0
1037.021.328.923.011.917.318.110.314.110.87.69.12.42.22.3
1138.019.428.821.611.916.816.39.512.911.04.57.82.91.42.2
1232.620.226.418.011.614.812.09.010.56.54.35.42.21.01.6
   Total 36.7 20.4 28.5 21.8 12.0 16.9 16.2 9.9 13.0 10.8 6.0 8.4 2.9 1.8 2.3

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