Tài liệu 2011 CHILD HEALTH STATUS REPORT pdf

Maternal HealthPregnancy Risk Assessment Tracking System: Maternal Health4 Percent Idaho mothers who drank alcohol during the third trimester* Percent Idaho mothers who smoked during

2011 CHILD HEALTH STATUS REPORT

Cassia

GoodingJerome

LincolnMinidokaTwin Falls

Bannock

Bear Lake

BinghamButte

Caribou

FranklinOneida

Idaho

Lewis

NezPerce

Latah

Clearwater

ShoshoneBenewah

KootenaiBonner

Map of Idaho Health Districts

Much of the data in this report is reported by Health District This map displays the counties that make up the seven Health Districts of Idaho

C H I L D H E A L T H S T A T U S R E P O R T 3

Maternal Health 4

Birth Outcomes 7

Immunizations: Kindergarten 10

Immunizations: First Grade 14

Immunizations: Seventh Grade 18

Health Insurance Coverage 22

Lead Exposure 27

Mortality Rates 28

Asthma 30

Mental Health 31

Substance Abuse 33

Reproductive Health 38

Weight, Nutrition, and Physical Activity 40

Reference List 42

This Idaho KIDS COUNT Child Health Status Report

at-tempts to capture the most relevant and current data related

to child health in the state In the next few years, health

reform legislation will likely change the landscape of public

health and health care This report may serve as a baseline by

which we can eventually assess areas for improvement and

identify areas where gains are yet to be realized

Idaho KIDS COUNT is grateful to Sarah Clark and Sara

Herring for diligently compiling the data for this report and

to Amanda Hundt for graphic design We are also indebted

to our colleagues at the Idaho Department of Health and

Welfare and the State Department of Education for timely

responses to data questions

This research was funded by the Annie E Casey Foundation

We thank them for their support but acknowledge that the

findings and conclusions presented here do not necessarily

reflect the opinions of the Foundation

Please visit the KIDS COUNT Data Center available at

www.idahokidscount.org for the most recent indicators on

child health and well-being

Maternal Health

Pregnancy Risk Assessment Tracking System: Maternal Health4

Percent Idaho mothers

who drank alcohol during

the third trimester*

Percent Idaho mothers

who smoked during

the third trimester

Percent Idaho mothers

who initiated prenatal care

in the first trimester

Percent Idaho mothers who

received routine dental

care during pregnancy

Notes

* Consuming one or more alcoholic beverages during the last trimester.

Maternal health and access to health care are important

fac-tors for infant health Alcohol use during pregnancy can

have severe, negative implications for unborn fetuses and

can result in Fetal Alcohol Spectrum Disorders In addition

to miscarriages and stillbirth, alcohol consumption during

pregnancy can cause a range of lifelong defects.1

Smoking during pregnancy can also cause negative

implica-tions for both mom and baby, including premature births,

low birth weight, and stillbirth.2

It is important for pregnant women to access prenatal and

dental care Studies have shown that expectant mothers are

more susceptible to dental cavities and gum disease due to the

rise in hormone levels during pregnancy, and early-initiated

prenatal care can unveil and reduce potential complications

and ensure that both mom and baby are healthy.3

In Idaho, alcohol consumption during pregnancy increased slightly from 2007 to 2009 from 3.3% of mothers to 4.1% of mothers In 2009, Health District 2 had the highest percent

of pregnant mothers consuming alcohol at 7.6% Health District 7 had the lowest percent at 1.1%.4

Smoking also increased slightly between 2007 and 2009, from 8.0% to 8.5% of pregnant women In 2009, Health District 1 had the highest percent of pregnant women smok-ing at 14.9%, and Health District 7 had the lowest percent

at 5.1% Smoking during pregnancy is more prevalent than drinking during pregnancy by a factor of about two.4

Prenatal care increased between 2007 and 2009, from 86.5%

to 89.4% of expectant mothers receiving routine prenatal care Dental care utilization during pregnancy also increased, from 45.5% to 53.9% of mothers receiving routine dental care.4

C H I L D H E A L T H S T A T U S R E P O R T 5

2009 2008

2009 2008

2009 2008

2009 2008

District 5 District 4

District 3 District 2

District 1 Idaho

C H I L D H E A L T H S T A T U S R E P O R T 7

Birth Outcomes

Low birthweight, defined as a weight of less than 2500 grams

(approximately 5.8 lbs), can be indicative of intrauterine

growth retardation, fetal growth restriction, and/or poor

maternal nutrition This type of growth delay contributes

to the risk of other health problems, including respiratory

distress and hypoglycemia, and is therefore a useful birth

outcome to track.5

Low birthweight babies, as a percent of births, has remained

fairly consistent in Idaho over the 11-year span of

1999-2009, ranging from a low of 6.2% in 1999 to a high of 6.9%

in 2006 Idaho has consistently been below the national

av-erage in percentage of low birthweight babies Nationally,

low birthweight rates ranged between 7.6% and 8.3% of all

births during the same 11-year period The percent of low

birthweight babies is calculated by dividing the number of

low birthweight babies by the total number of births.6,7

Breastfeeding in Idaho increased slightly from 2007 to 2009

from 50.5% of mothers breastfeeding for the first six months,

to 55.4% of mothers breastfeeding for the first six months

In 2009, the health district with the highest prevalence of

mothers breastfeeding for the first six months was Health

District 7 at 62.8%, and the health district with the lowest prevalence was Health District 3 at 47.3% Only mothers 18 years of age or older, whose infants were at least six months

at the time of the survey, are included in these data.4

The percent of Idaho mothers reporting that their babies hearing had been tested remained fairly constant from 2007

to 2009, increasing slightly from 94.2% to 94.8% In 2009, the health district with the highest reported frequency of newborn hearing tests was Health District 6 at 98.1%, and the health district with the lowest reported frequency of new-born hearing tests was Health District 2 at 91.7%.4

Routine well-baby care is essential to ensuring that newborns are developing normally and identifying potential health problems early Between 2007 and 2009 the percent of Idaho mothers who took their child for routine well-baby care visits increased slightly from 96.9% to 98.1% In 2009, the health districts with the highest percent of routine well-baby visits were Health Districts 1 and 7 at 99.0% The health district with the lowest percent of routine well-baby care was Health District 5 at 96.3%.4

Pregnancy Risk Assessment Tracking System: Infant Care4

Percent of Idaho mothers

who breastfed for at

least six months*

Percent of Idaho mothers

who reported their baby's

hearing was tested

Percent of Idaho mothers

who took their baby for

routine well-baby care

Idaho US

2007 2006

2005 2004

2003 2002

2001 2000

1999

2009 2008

2007

0%

District 7 District 6

District 5 District 4

District 3 District 2

District 1 Idaho

C H I L D H E A L T H S T A T U S R E P O R T 9

2009 2008

District 5 District 4

District 3 District 2

District 1 Idaho

2009 2008

Idaho seventh-graders have complete immunization rates of 94.8% for DTaP, 95.8% for polio, 95.2% for MMR, and 95.2% for Hepatitis B Idaho seventh-graders are above the herd immunity thresholds for all of these communicable diseases.10

Exemption rates were 4.3% for kindergarten, 4.2% for first grade and 2.8% for seventh grade immunizations Person-

al exemptions were the most common type of exemption Incomplete records decreased over the grades with rates of 8.5% in kindergartners, 4.5% in first-graders, and 2.9% in seventh-graders.10

It is helpful to examine immunization rates in the context of

herd immunity Herd immunity refers to the portion of the

population that should be vaccinated against a

communi-cable disease in order to stop the spread of that disease Note

that although the herd immunity threshold for a

communi-cable disease may be reached, outbreaks can and do occur

on a smaller scale Estimated herd immunity thresholds for

reported immunizations are listed below.8

Idaho kindergartners have complete immunization rates of

87.7% for DTaP (diphtheria, tetanus and acellular pertussis),

93.1% for polio, 87.7% for MMR (measles, mumps and

rubella), and 93.0% for Hepatitis B Idaho kindergartners

are above the threshold for herd immunity for these

com-municable diseases except pertussis (whooping cough) and

are below the upper end of the measles threshold.10

Idaho first-graders have plete immunization rates of 92.1% for DTaP, 94.8% for polio, 92.0% for MMR, and 94.4% for Hepatitis B Like kindergartners, Idaho first graders are above the thresh-old for herd immunity for these communicable diseases except pertussis (whooping cough) and are below the upper end of the measles threshold.10

District 5 District 4

District 3 District 2

District 1 Idaho

District 5 District 4

District 3 District 2

District 1 Idaho

District 5 District 4

District 3 District 2

District 1 Idaho

District 5 District 4

District 3 District 2

District 1 Idaho

District 5 District 4

District 3 District 2

District 1 Idaho

Immunizations: First Grade

First Grade Immunization Rates Overall10

District 5 District 4

District 3 District 2

District 1 Idaho

District 5 District 4

District 3 District 2

District 1 Idaho

0

District 5 District 4

District 3 District 2

District 1 Idaho

District 5 District 4

District 3 District 2

District 1 Idaho

District 5 District 4

District 3 District 2

District 1 Idaho

Immunizations: Seventh Grade

Seventh Grade Immunization Rates Overall10

District 5 District 4

District 3 District 2

District 1 Idaho

District 5 District 4

District 3 District 2

District 1 Idaho

District 5 District 4

District 3 District 2

District 1 Idaho

District 5 District 4

District 3 District 2

District 1 Idaho

District 5 District 4

District 3 District 2

District 1 Idaho

Health Insurance Coverage

Between 2000 and 2009, the percent of children in Idaho

without health insurance decreased significantly from 16%

to 9% The uninsurance rates of children in the United States

also decreased, from 12% to 10%.11

Over the same ten year period, children receiving health

in-surance through a parent’s employer decreased from 54% to

46% in Idaho and from 58% to 49% in the United States

Children with private health insurance (not associated with

an employer) increased in Idaho from 7% to 12%, but

remained at 5% in the United States Children with only

public health insurance (Medicaid, CHIP, military, etc.)

in-creased in Idaho from 15% to 24% and in the United States

from 18% to 29% Children with both public and private

insurance remained constant at 8% of Idaho children, and

increased slightly from 6% to 7% in the United States The

overall trend over these years was an increase in insurance

coverage for children.11

Children’s Medicaid and the Children’s Health Insurance

Program (CHIP) are both largely federally funded programs

that provide health insurance benefits CHIP premiums are based on a sliding income scale Children’s Medicaid does not have premiums Between 2000 and 2011 enrollment

in the Children’s Medicaid and CHIP programs has more than doubled In 2000, the number of Idaho children en-rolled in Medicaid was 66,837 This increased to 140,773

in 2011 Over that period, CHIP enrollment also increased from 7,203 to 24,226 Total enrollment in these programs increased from 74,040 to 164,999.12

Insurance coverage during pregnancy can mean access to natal care Between 2007 and 2009, Idaho mothers who had health insurance (Medicaid or other) increased from 95%

pre-to 96.6% The percent of Idaho mothers with health ance prior to pregnancy (excluding Medicaid) also increased slightly during this time, from 62.7% to 64% The overall trend is a decrease in uninsured pregnant women from 5%

insur-to 3.4%.4

Idaho Medicaid Program Enrollment (CHIP/Medicaid)12

Total 74040 93970 103763 111610 118510 122465 121979 132791 135043 141059 152772 164999 Medicaid 66837 82674 91595 100789 106623 109152 107439 113844 108093 115673 128152 140773

Public Only: CHIP,

Medicaid, Miltary, etc.

C H I L D H E A L T H S T A T U S R E P O R T 2 3

Idaho Public Insurance

US Public Insurance Idaho Uninsured

2007 2006

2005 2003

2002 2001

CHIP Medicaid

Total 0

2009 2008

2007 2006

2005 2004

2003 2002

2001 2000

Maternal Health Insurance4

Idaho mothers with

health insurance coverage

Idaho mothers with Medicaid

coverage during pregnancy

Idaho mothers insured prior

to and/or during pregnancy

(Medicaid or other)

Idaho mothers uninsured prior

to and/or during pregnancy

2009 2008

C H I L D H E A L T H S T A T U S R E P O R T 2 5

2009 2008

dation Report, Uninsured Children: Who Are They and Where

Do They Live?, using data from the Urban Institute analysis

of American Community Survey (ACS) 2008 data from the Integrated Public Use Microdata Series (IPUMS)

Uninsured Rate Among Children (0–18) in Idaho by Area, 2008 13

5–9 µg/dL

10 µg/dL or above

Lead is a highly toxic, naturally occurring metal that can

enter the body when swallowed or inhaled It has been used

in paints, ceramics, pipes, gasoline, batteries, cosmetics,

jew-elry, children’s toys, and other household products Exposure

to lead can cause irreversible damage, and children under

age six are especially vulnerable High levels of exposure can

lead to hyperactivity, aggressive behavior, learning

disabili-ties, lowered IQ, speech delay and hearing impairment Even

low to moderate exposure can cause long-term cognitive and

behavioral problems.14

Blood testing is necessary to determine a child’s lead level

An elevated blood lead level is defined as greater than 10

micrograms per deciliter (µg/dL), subclinical lead exposure

levels are 5 to 9 µg/dL, and moderate exposures are 3 to 4

µg/dL; however, there is no safe level of lead in the body.14

Many children in Idaho are never tested for lead and the

state does not have comprehensive surveillance data A study

of lead tests in children in Head Start (ages 4-5) and Early

Head Start (ages birth to 3) programs reveals some alarming

trends between the 2007-2008 and 2010-2011 school years

and includes over 8,600 test results Clinical exposures (at

or above 10 µg/dL) remained rare, at less than 1 percent of

children screened The prevalence of subclinical lead

expo-sures between 5 and 9 increased dramatically, from 0.32% of children screened to 4.90% of children screened Likewise, the prevalence of moderate exposure (3 to 4 µg/dL) increased from 1.94% of children screened to 20.63%.14

The overall incidence of children with detectable lead levels (at or greater than 3 µg/dL) increased from 2.78% of chil-dren tested to 25.81% of children tested This is concern-ing because even at low levels lead can be damaging, and a detectable lead level signals that lead is present in the child’s environment In January 2012, an advisory committee to the Centers for Disease Control and Prevention (CDC) recom-mended lowering the action level from 10 µg/dL to 5 µg/dL.14