Trends in the Well-Being of America's Children and Youth, 1997

INTRODUCTION

This is the second edition of an annual report from HHS on trends in the well-being of our nation's children and youth. The report presents the most recent and reliable estimates on more than 80 indicators of well-being. It is intended to provide the policy community, the media, and all interested citizens with an accessible overview of data describing the condition of children in the United States.

The indicators have been organized into five broad areas:

• population, family, and neighborhood;
• economic security;
• health conditions and health care;
• social development, behavioral health, and teen fertility; and
• education and achievement.

For each indicator, the report provides one or more graphics to highlight key trends and important population sub-group differences, and tables that provide more detailed information for the interested user. These are accompanied by text which briefly describes the importance of each indicator and highlights the most salient features of the data.
 

INDICATORS INCLUDED IN THE REPORT

This report presents a broad and carefully chosen collection of national estimates of child and youth well-being. It reports indicators that have been collected more than once over the last few years so that trends may be presented. Where possible, trends are presented from the 1970s through the 1990s. In a few cases, data for earlier years are also presented, as are projections into the 21st century.

Decisions regarding which indicators were to be included in the report have been guided by a combination of scientific and practical considerations. In preparation for the first edition of this report, a list of indicators were culled from over 20 papers presented at a major national conference on indicators of child well-being. At this conference, nationally recognized experts representing a broad spectrum of disciplines and research interests related to child well-being recommended key indicators that should be tracked on a regular basis by the federal statistical system.

The final list of indicators was modified based on a number of practical considerations including data availability (the data needed to be available for a nationally representative sample and available on a regular basis), timeliness (the most recent estimates had to be available for 1990 or later), and quality and consistency (the data had to be both reliable and consistently measured over time).

Other important indicators have been added for this second edition based on recommendations from the staff of statistical agencies who are participating in the Federal Interagency Forum on Child and Family Statistics, described below. Additional measures will be added to new editions of the report over time as new data become available.
 

A COMPREHENSIVE VIEW OF CHILDREN AND YOUTH

This report is intended to help readers develop a sense of how children and youth are faring overall. As an example, we offer below a selection of findings from the report that relate to the experience of teenagers.

• The teen birth rate for 15-19 year old young women has been dropping since 1991, with the largest decreases among black teens.
• Use of cigarettes, alcohol, marijuana and cocaine by high school students has increased during the 1990s, following periods of decreasing use during the previous decade.
• 17-year-old students have made modest gains in mathematics and science proficiency since the early 1980s.
• The mortality rate for black youth ages 15-19, following a sustained period of decline, increased dramatically during the late 1980s, and has remained at a very high level since 1991. During that same time period, mortality rates among white youth ages 15-19 declined.
• Receipt of early prenatal care by teen mothers has increased steadily during the 1990s.

THE NEED FOR BETTER DATA ON CHILDREN AND YOUTH

As this report demonstrates, the data available for tracking the well-being of children and youth at the national level are fairly extensive. Even so, there remain major gaps in the federal statistical system that must be filled if we are to have a complete picture of the quality of our children's lives.

We have few measures of social development and health-related behaviors for very young and pre-teenage children which are measured on a regular basis. For example, we currently lack good indicators of school readiness for young children. Measures of mental health for any age child are rare, though one such measure was recently added to the National Health Interview Survey. Positive measures of social development and related behaviors are also sparse, with the result that the current set of indicators may present a gloomier picture of our children's overall well-being than is in fact the case. New indicators which reflect the positive developments we desire for our children and youth clearly need to be developed and incorporated into the federal statistical system.

We have very few indicators available that reflect important social processes affecting child well-being that go on inside the family and within the neighborhood. Measures of parent-child interactions, critical to the social and intellectual development of children, are only now beginning to work their way into regularly repeated national surveys. Indicators related to fathering are virtually nonexistent and in need of development. We currently lack an annual measure of whether both biological parents of a child are in the household. Reliable indicators of child homelessness also need to be developed.

Other important areas in need of measurement development or improvements in the quality, consistency, and frequency of available data include child abuse and neglect, youth violent crime, day care quality, learning disabilities, and measures of children in institutionalized care.

Finally, data which can be used to track the well-being of children at the state and local levels are much less plentiful than at the national level. As state and local governments take on increasing levels of responsibility for the design and implementation of government programs of all sorts affecting children, youth, and their families, the need for such information is increasing. The federal statistical system is positioned to play a significant role in increasing the availability of such data for use at the state and local level.

FEDERAL INTERAGENCY FORUM ON CHILD AND FAMILY STATISTICS

The Federal Interagency Forum on Child and Family Statistics, an interagency group of leaders of federal agencies and departments responsible for collecting or analyzing data on children and youth, has adopted a mandate to improve the federal statistical system regarding data on children, youth, and their families. Member agencies have played a crucial role in the production of this report, providing data and carefully reviewing relevant text. This forum will continue to develop strategies for improving the federal statistical system in ways that preserve existing data in these areas while filling in the data gaps described above. As data from these efforts become available they will be incorporated into new editions of this annual report. The forum, in response to the President's Executive Order No. 13045, also publishes an annual report on key indicators of child and youth well-being, entitled America's Children: Key National Indicators of Well-Being.

USING THE DOCUMENT

In the presentation of data for this report, percents and rates were, as a rule, rounded to the nearest whole number. Estimates based on the Decennial Census, the National Vital Statistics System, and surveys with very large sample sizes were often presented to one decimal place since differences of less than one percentage point are often or always statistically significant from these sources.

Practical considerations did not allow for the use of tests of statistical significance for all cross-time and between-group differences discussed in the text, though they were used in many cases. When such tests were not available, small differences were either not reported in the text, or were reported cautiously. Often in such cases estimates were simply reported without any claims as to which were in fact higher or lower.

Finally, the user should note that, in all tables and figures, unless otherwise clearly specified, race-specific estimates (e.g., white, black, Native American, Asian) include Hispanics of those races even when a separate estimate is given for Hispanics. In cases where Hispanics have been separated out, "non-Hispanic" will follow the race designation as in "white, non-Hispanic." By contrast, in the textual descriptions of the data, races are in most cases referred to simply as white, black, Native American, or Asian, whether or not they include Hispanics. When Hispanics have been excluded, this is noted in a footnote.

ACKNOWLEDGMENTS

Members of the Federal Interagency Forum on Child and Family Statistics have given substantial support for this report through the provision of data and the careful review of relevant sections of the report. These include the National Center for Education Statistics, the Centers for Disease Control and Prevention (National Center for Health Statistics), the Bureau of the Census, the Bureau of Labor Statistics, the Department of Housing and Urban Development, the Administration for Children and Families, the Food and Nutrition Service of the Department of Agriculture, the Office of Management and Budget, the National Institute of Child Health and Human Development, and the Office of the Assistant Secretary for Planning and Evaluation at HHS.

Special thanks go to Wendell Primus, former Deputy Assistant Secretary for Human Services Policy, HHS/ASPE. It was his vision that brought the 1996 volume, and this volume, into reality. Thanks also to Matthew Stagner, HHS/ASPE, for leading the development of both the 1996 and 1997 volumes. Many others in HHS/ASPE have contributed to the development, review, and production of this report. Thanks go to Ann Rosewater, Ann Segal, Barbara Broman, Elisa Koff, Amy Nevel, Gary Hyzer, Gil Crouse, Reuben Snipper, and Bruce Gray. Chris Treston and David Peabody deserve special thanks for their creativity and dedication in completing the graphic design of this document.

Several non-Federal individuals and groups also supplied data or analyses for this report including the Survey Research Center and Institute for Social Research of the University of Michigan; the Educational Testing Service; Greg Duncan of Northwestern University; Paul Jargowski of the University of Texas at Dallas; and William Frey of the University of Michigan.

This report was produced under contract by Child Trends, Inc., of Washington, D.C. Brett Brown served as project director. Other members of the project staff included Christopher Botsko, Carla Butler, Anne Driscoll, Carol Emig, Jane Fueyo, Tawanda Greer, Charles Halla, Michelle Harper, Fanette Jones, Chisina Kapungu, Gretchen Kirby, Jennifer Manlove, Suzanne Miller, Kristin Moore, Cheryl Oakes, Angela Romano, and Richard Wertheimer.

SECTION 1 POPULATION, FAMILY, AND NEIGHBORHOOD (PF)

CHILD POPULATION CHARACTERISTICS

PF 1.1 Number of children

Though the total population of the United States has grown steadily over the last four decades, the trend in the number of children has been less steady, and the number of children has even shrunk during some periods.

Figure PF 1.1 presents trends in the total number of children under age 18 from 1950 through 1996, with projections through the year 2020. From 1950 to 1960, roughly the period of the baby boom, the number of children increased by 36 percent from 47.3 to 64.5 million. The number rose at a more modest rate in the ensuing decade to 69.8 million in 1970. The number actually declined to 63.7 million by 1980, and held steady over the next decade. Between 1990 and 1996, the number of children rose by more than five million to 69.4 million. The U.S. Census Bureau projects that the number of children will continue to rise over the next several decades, reaching 77.6 million by the year 2020.

Differences by Race and Ethnicity. Between 1996 and the year 2020, the number of children is projected to grow for all race and ethnic groups presented in the table (see Table PF 1.1). Increases will be proportionally greatest for Hispanic children, whose numbers are projected to grow from 10.0 to 17.2 million by the year 2020, an increase of more than 70 percent. Should these projections prove accurate, Hispanics could become the largest minority child population as early as 2010.
 

Figure PF 1.1  Number of Children Under Age 18 in the U.S.: 19502020

Source: U.S. Bureau of the Census, Current Population Reports, Series P-25, No. 311, Estimates of the Population of the United States by Single Years of Age, Color, and Sex, 1900 to 1959, pages 22-23, 42-43. Series P-25 No. 519, Estimates of the Population of the United States, By Age, Sex, and Race: April 1, 1960 to July 1, 1973, Table 2. Series P-25, No. 917, Preliminary Estimates of the Population of the United States by Age, Sex, and Race: 1970 to 1981, Table 2. Estimates of the Population of the United States by Age, Sex, Race, and Hispanic Origin: 1990 to 1995, Updated Tables, Appendix A. Series P-25, No. 1130, Projections of the Population of the United States by Age, Sex, Race, and Hispanic Origin: 1995 to 2050, Table 2.

Table PF 1.1  Number of Children Under 18 by Age and Race/Ethnicity: 19502020 (Number in Millions)
									Projected
			1950	1960	1970	1980	1990	1996a	2000	2010	2020
All Children			47.3	64.5	69.8	63.7	64.2	69.4	70.8	72.5	77.6
Age
	0-5		19.1	24.3	20.9	19.6	22.5	23.5	22.9	23.9	26.4
	6-11		15.3	21.8	24.6	20.8	21.6	23.2	24.3	23.6	25.8
	12-14		12.9	18.4	24.3	23.3	20.1	22.7	23.6	25	25.4
Race/Ethnicity
	White		41.3	55.7	59.3	52.5	51.3	54.9	55.4	55.2	57.9
	Non-whiteb		6	8.8	10.5
	Black			8.1	9.5	9.5	9.9	10.8	11.3	12.2	13.4
	Hispanicc					5.6	7.9	10	11	13.7	17.2
	Asian					1.1	2.2	2.9	3.3	4.3	5.4
	American Indian					0.5	0.7	0.8	0.8	0.9	1
Note: a1996 estimate is for July 1.  b"Non-white" refers to all races other than white, and includes black, Native American, Asian, and any other race except white.  cPeople of Hispanic origin can be of any race.  Source: U.S. Bureau of the Census, Current Population Reports, Series P-25, No. 311, Estimates of the Population of the United States by Single Years of Age, Color, and Sex, 1900 to 1959, pages 22-23, 42-43. Series P-25, No. 519, Estimates of the Population of the United States, By Age, Sex, and Race: April 1, 1960 to July 1, 1973, Table 2. Series P-25, No. 917, Preliminary Estimates of the Population of the United States by Age, Sex, and Race: 1970 to 1981, Table 2. Estimates of the Population of the United States by Age, Sex, Race, and Hispanic Origin: 1990 to 1995, Updated Tables, Appendix A. Series P-25, No. 1130, Projections of the Population of the United States by Age, Sex, Race, and Hispanic Origin: 1995 to 2050, Table 2.

 

PF 1.2 Children as a percentage of the population

The proportion of the total population who are children can have important consequences for the entire population, including children. On the one hand, because children are for the most part dependent and in need of investment to become productive citizens, they may present special short-term fiscal challenges to society when they constitute a relatively higher proportion of the overall population. On the other hand, as they grow up to become productive adults they will provide support for those entering retirement and for the next generation of children.

Figure PF 1.2 illustrates trends in the proportion of the population under age 18 from 1940 through 1996, with projections through the year 2020. In 1940 and 1950, children constituted 31 percent of the overall population. During the next decade, children as a proportion of the population rose rapidly to 36 percent. The rise in birthrates that produced this increase in the proportion of children in the population during the 1950s is commonly known as the baby boom. Since that peak in 1960, the percentage has been declining to its current level of 26 percent. Projections by the Bureau of the Census predict that this proportion will drop further to 24 percent by the year 2010, and will remain at approximately that level through 2020.
 

Figure PF 1.2  Children Under Age 18 as a Percentage of the Total Population: 19402020

Source: U.S. Bureau of the Census, 1990 Census of Population and Housing, Summary Population and Housing Characteristics (CPH-1-1) Table 1. U.S. Bureau of Census, 1970 Census Volume, Characteristics of the Population, U.S. Summary, Table 52. 1980 Census Volume, General Population Characteristics, U.S. Summary, Table 41. Current Population Reports, Series P-25, No. 311, Estimates of the Population of the Unites States by Single Years of Age, Color, and Sex, 1900 to 1959. Series P-25, No. 917, Preliminary Estimates of the Population of the United States by Age, Sex, and Race: 1970 to 1981, Table 2. PPL-41 Estimates of the Population of the United States by Age, Sex, Race, and Hispanic Origin: 1990 to 1995, Updated Tables, Appendix A. Series P-25, No. 1130, Projections of the Population of the United States by Age, Sex, Race, and Hispanic Origin: 1995 to 2050, Table 2.

Table PF 1.2   Children Under Age 18 as a Percentage of the Total Population:  19402020
								Projected
	1940	1950	1960	1970	1980	1990	1996	2000	2010	2020
All Children
Ages 0-17	31	31	36	34	28	26	26	26	24	24
Source: U.S. Bureau of the Census, 1990 Census of Population and Housing, Summary Population and Housing Characteristics (CPH-1-1) Table 1. U.S. Bureau of Census, 1970 Census Volume, Characteristics of the Population, U.S. Summary, Table 52. 1980 Census Volume, General Population Characteristics, U.S. Summary, Table 41. Current Population Reports, Series P-25, No. 311, Estimates of the Population of the Unites States by Single Years of Age, Color, and Sex, 1900 to 1959. Series P-25, No. 917, Preliminary Estimates of the Population of the United States by Age, Sex, and Race: 1970 to 1981, Table 2. PPL-41 Estimates of the Population of the United States by Age, Sex, Race, and Hispanic Origin: 1990 to 1995, Updated Tables, Appendix A. Series P-25, No. 1130, Projections of the Population of the United States by Age, Sex, Race, and Hispanic Origin: 1995 to 2050, Table 2.

PF 1.3 Proportion of families containing children

Since 1960, Americans have been moving toward having families with fewer children. Indeed, a growing percentage of families have no minor children of their own in their household. Between 1960 and 1996, the percentage of families with four or more own children under age 18 in the household decreased from nine percent to three percent (see Figure PF 1.3). During the same period, the proportion of families with no minor children grew from 43 percent to 51 percent.

Differences by Race and Ethnicity. These general trends are also evident when white, black, and Hispanic families are considered separately, though the levels are substantially different for each group (see Table PF 1.3). For example, between 1970 and 1996 the percentage of black families with four or more children dropped from 19 percent to five percent. The percentage for whites during that period went from nine percent to three percent. For Hispanic families, the percentage dropped from ten percent to seven percent between 1980 (the first year for which Hispanic estimates are available) and 1996.

Black and Hispanic families were considerably less likely than white families to be without any minor children, with proportions of 43 percent, 36 percent, and 52 percent, respectively in 1996. They were also both more likely than white families to have four or more children, though these differences were smaller than in previous decades.

Figure PF 1.3   Percentage of Families with No Children, and With Four or More Resident Children: 19601996

Source: Estimates for 1960 - 1996 from Household and Family Characteristics, Current Population Reports, Series P-20 for various years.
 

Table PF 1.3  Percentage Distribution of Families by Number of Own Children Under 18 Years of Age: 19601996
			1960	1970	1980	1990	1991	1992	1993	1994	1995	1996
All Families
	Without own children		43	44	48	51	51	51	51	50	51	51
	One child		19	18	21	21	20	20	20	20	20	20
	2 children		18	17	19	19	19	18	19	19	19	19
	3 children		11	11	8	7	7	7	7	8	7	7
	4 or more children		9	10	4	3	3	3	3	3	3	3
White Families
	Without own children		43	45	49	51	53	53	53	52	52	52
	One child		19	18	21	21	19	20	19	19	20	19
	2 children		18	18	19	19	18	18	19	19	19	19
	3 children		11	11	8	7	7	7	7	7	7	7
	4 or more children		9	9	4	3	3	3	2	2	2	3
Black Families
	Without own children			39	38	41	41	42	42	40	42	43
	One child			18	23	25	25	24	25	25	24	24
	2 children			15	20	19	19	19	18	20	20	18
	3 children			10	10	9	9	10	10	9	9	9
	4 or more children			19	8	6	6	5	5	5	5	5
Hispanic Families
	Without own children				31	37	36	36	37	36	36	36
	One child				23	23	22	22	23	22	23	23
	2 children				23	21	23	22	22	23	23	23
	3 children				13	12	12	13	12	13	12	12
	4 or more children				10	7	7	7	7	6	7	7
Source: Estimates for 1960 - 1996 from "Household and Family Characteristics," Current Population Reports, Series  P-20 for various years.

 

PF 1.4 Race/Ethnicity composition

The United States has become increasingly racially and culturally diverse over the last three decades, and is projected to become even more so in the decades to come. Table PF 1.4 presents the racial and ethnic composition of Americas children from 1960 to 1996, and includes projections of likely changes in that composition through the year 2020 as estimated by the Bureau of the Census. As Figure PF 1.4 illustrates, as recently as 1980, nearly three-quarters (74 percent) of all children in this country were non-Hispanic whites. This proportion diminished to 66 percent in 1996, and is expected to continue a steady downward trend until, by the year 2020, non-Hispanic whites will constitute just over one half (55 percent) of all U.S. children. The historical trend for all whites is similar though less dramatic, since Hispanics comprise an increasingly large proportion of the white population (see Table PF 1.4).

As of 1996, blacks constituted the largest minority population group at 16 percent of the total child population. (see Table PF 1.4). They were followed by Hispanics at 14 percent, Asian Americans at 4 percent, and Native Americans at 1 percent. By the year 2010, Hispanics are projected to be 19 percent of the child population, supplanting blacks as the largest minority group in the child population. By the year 2020, more than one in five American children are expected to be Hispanic, nearly double the proportion in 1990. The Asian American population is also expected to continue its rapid growth, increasing from 4 percent in 1996 to 6 percent by the year 2020.

Figure PF 1.4   Percentage Distribution of U.S. Children by Race/Ethnicity: 1980-2020

Note: Population estimates for July 1.

Sources: U.S. Bureau of the Census, Current Population Reports, Series P-25, No. 519 Estimates of the Population of the United States by Age, Sex, and Race: April, 1960 to July 1, 1973. U.S. Bureau of the Census, Current Population Reports, Series P-25, No. 1095, U.S. Population Estimates, by Age, Sex, Race, and Hispanic Origin: 1980-1991. U.S. Bureau of the Census, Population Division, release, PPL-41, United States Population Estimates by Age, Sex, Race, and Hispanic Origin 1990 to 1995 and updated tables, Appendix A. U.S. Bureau of the Census, Current Population Reports, Series P-25, No. 1130, Projections of the Population of the United States by Age, Sex, Race, and Hispanic Origin: 1995 to 2050.
 

Table PF 1.4  Percentage Distribution of U.S. Children Under 18 by Race/Ethnicity:  19602020
						Projected
	1960	1970	1980	1990	1996	2000	2010	2020
White	86	85	82	80	79	78	76	75
White, non-Hispanic	--	--	74	69	66	64	59	55
Black	13	14	15	15	16	16	17	17
Hispanic	--	--	9	12	14	16	19	22
Asian American	--	--	2	3	4	4	6	6
Native American	--	--	1	1	1	1	1	1
Note: All population estimates for July 1.   Sources: U.S. Bureau of the Census, Current Population Reports, Series P-25, No. 519 "Estimates of the Population of the United States by Age, Sex, and Race: April, 1960 to July 1, 1973. U.S. Bureau of the Census, Current Population Reports, Series P-25 No. 1095, "U.S. Population Estimates, by Age, Sex, Race, and Hispanic Origin: 1980-1991." U.S. Bureau of the Census, Population Division, release, PPL-41, "United States Population Estimates by Age, Sex, Race, and Hispanic Origin 1990 to 1995" and updated tables, Appendix A. U.S. Bureau of the Census, Current Population Reports, Series P-25, No. 1130, "Projections of the Population of the United States by Age, Sex, Race, and Hispanic Origin: 1995 to 2050.

 

PF 1.5 Immigrant children

The United States is a nation of immigrants. Rates of immigration have varied substantially over periods of our history, as have the countries and cultures from which these immigrants originate. Recently the U.S. has been experiencing a period of high immigration. Immigrant children are of particular interest, since they may have special needs that must be addressed through the education system.

The percentage of Americas children and youth who are foreign born has been increasing steadily over the last several decades, from 1.2 percent in 1970 to 3.7 percent in 1990 (see Figure PF 1.5.A).

Differences by Age. Older children are more likely than younger children to be foreign born. In 1990, 6.5 percent of youth ages 15 to 19 were foreign born, compared to only 1.4 percent of children under age five (see Table PF 1.5).

Differences by Race and Ethnicity. The percentage of children who are foreign-born varies substantially by racial and ethnic background (see Figure PF 1.5.B). In 1980, less than two percent of whites, blacks and Native Americans were foreign born, compared to 40.0 percent of Asians and 14.0 percent of Hispanics. By 1990, the percentage of foreign-born Asian children had declined from 40.0 to 33.2 percent, while the percentage of foreign-born Hispanic children increased to almost 16 percent.

Figure PF 1.5.A  Percentage of U.S. Children Ages 19 and Under Who Were Foreign Borna: 19701990

Notes: ^aIncludes both immigrants and illegal aliens.

 Source: U.S. Bureau of the Census, The Foreign-Born Population in the U.S., 1990, CP-3-1, and 1990 STF-3A census files. U.S. Bureau of the Census, Detailed Characteristics of the Population, 1980, Chapter D, U.S. Summary. U.S. Bureau of the Census, National Origin and Language, PC(2-1A), 1970.
 

Figure PF 1.5.B   Percentage of U.S. Children Ages 19 and Under Who Were Foreign Borna by Race/Ethnicity: 1980-1990

Notes: ^aIncludes both immigrants and illegal aliens.

 Source: U.S. Bureau of the Census, The Foreign-Born Population in the U.S., 1990, CP-3-1, and 1990 STF-3A census files. U.S. Bureau of the Census, Detailed Characteristics of the Population, 1980, Chapter D, U.S. Summary. U.S. Bureau of the Census, National Origin and Language, PC(2-1A), 1970.

Table PF 1.5  Percentage of U.S. Children Ages 19 and Under Who Were Foreign-Born  by Age and Race/Ethnicity: 1970-1990
				1970	1980	1990
All Children				1.2	2.9	3.7
Under 5 years				0.6	1.4	1.4
5 to 9 years				1.1	2.6	2.7
10-14 years				1.4	3.2	4.3
15-19 years				1.8	4.1	6.5
Race/Ethnicity
	White			1.2	1.7	1.8
	Black			0.5	1.8	2.2
	American Indian, Eskimo, and Aleut				1.5	1.1
	Asian and Pacific Islander				40	33.2
	Hispanic				14	15.8
Notes: aIncludes both immigrants and illegal aliens.  Source: U.S. Bureau of the Census, The Foreign-Born Population in the U.S., 1990, CP-3-1, and 1990 STF-3A census files. U.S. Bureau of the Census, Detailed Characteristics of the Population, 1980, Chapter D, U.S. Summary. U.S. Bureau of the Census, National Origin and Language, PC(2-1A), 1970.

 

PF 1.6 Children as a percentage of the dependent population

 
Children and senior citizens frequently depend on assistance from family members, friends, and government agencies. Both the young and old are less likely than other age groups to fully support themselves through participation in the labor market. Varying proportions of both the child population and the elderly population therefore receive income transfers, health care, and other services through public programs. This indicator looks at children (under age 18) as a percentage of the dependent population (children under age 18 + adults ages 65 and older).

Senior Citizen Population Grows in Relation to Child Population. The number of children in the U.S. declined after 1970, while the number of senior citizens increased (see Table PF 1.1 earlier in this volume). Children under 18 went from being 79 percent of the dependent population in 1960 to 67 percent , where it has stayed since 1990 (see Table PF1.6). Despite the fact that the child population is growing again, this slow downward trend is expected to continue, and the growth of the elderly population will continue to outpace growth in the child population.

Differences by Race and Ethnicity. The trend toward a larger senior population relative to the child population is occurring among all racial and ethnic groups. Table PF 1.6 shows that between 1980 and 1990, children declined as a percentage of the dependent population across all racial and ethnic groups. Population projections for 2010 suggest that there will be even more seniors relative to children in each group at that time.

Yet there are also considerable differences across groups in the number of children relative to senior citizens. There are far fewer white children relative to white senior citizens than there are minority children relative to minority seniors. White children are currently estimated to make up about 61 percent of the white dependent population. African-Americans are closest to whites with children making up 79 percent of the combined child and elderly population total. Among Hispanics, children outnumber seniors by the greatest margin, with children estimated to be 86 percent of the dependent population.

Figure PF 1.6   Percentage of Children in the Dependent Population (Persons Age 65 and Over and Those Under Age 18) by Race/Ethnicity

Source: U.S. Bureau of the Census, Current Population Reports, P25-1095. U.S. Bureau of the Census, Population Division, release PPL-41, United States Population Estimates by Age, Sex, Race, and Hispanic Origin 1990 to 1995" and updated tables. Day, Jennifer Cheeseman, Population Projections of the United States by Age, Race, and Hispanic Origin: 1995 to 2050. U.S. Bureau of the Census, Current Population Reports, P25-1130, U.S. Government Printing Office, Washington, D.C. 1996.
 

Table PF 1.6   Percentage of Children in the Dependent Population (Persons Age 65 and Over and Those Under Age 18) by Race/Ethnicity
											1960					1970					1980					1990					Estimate 1996					Projecteda 2010
Total											79					78					71					67					67					65
	White, non Hispanic																				68					62					61					57
	Black																				82					79					79					78
	Hispanic																				89					87					86					83
	Asian American																				88					85					81					76
	Native Americanb																				84					82					84					79
Notes: aProjection is based on the Census Bureaus middle series.  bIncludes Alaskan Natives.  Source: U.S. Bureau of the Census, Current Population Reports, P25-1095. U.S. Bureau of the Census, Population Division, release PPL-41, "United States Population Estimates by Age, Sex, Race, and Hispanic Origin 1990 to 1995" and updated tables. Day, Jennifer Cheeseman, Population Projections of the United States by Age, Race, and Hispanic Origin: 1995 to 2050. U.S. Bureau of the Census, Current Population Reports, P25-1130, U.S. Government Printing Office, Washington, D.C. 1996.

 

FAMILY STRUCTURE

PF 2.1 Family structure: number of parents in household

Family structure is correlated with many factors that contribute to child well-being such as material wealth. It is also associated with many child outcomes. For example, children from disrupted or never-married families are somewhat more likely to use alcohol and drugs, to become teen parents, and to achieve lower earnings than are children from intact families, and they are less likely to attain a high school diploma. These associations are evident even after controlling for family socioeconomic status, race, and other background factors.¹ Nevertheless, the great majority of children brought up in single-parent families do well. In particular, differences in well-being between children from divorced and intact families tend, on average, to be moderate to small.²

Between 1960 and 1996, the proportion of children in two-parent families (about three-quarters of whom were families with both biological parents present)³ decreased from 88 percent to 68 percent (see Figure PF 2.1)

Differences by Race and Ethnicity. The decrease in the proportion of children living in two-parent families is evident for both black and white children, though the descent is significantly steeper for black children. Between 1960 and 1996, the proportion of black children living in two-parent families fell by 34 percentage points, from 67 percent to 33 percent. By contrast, the drop for white children was only 16 percentage points, from 91 percent to 75 percent. For Hispanic children, the trend is also towards a smaller proportion of children in two-parent families, decreasing from 75 percent to 62 percent between 1980 (the first year for which Hispanic estimates are available) and 1996.

Table PF 2.1.B presents 1980 and 1990 census data for Asian and Native American families in addition to data on white, black, and Hispanic families. The percent of children living in two-parent families dropped for all five groups during that period. In 1990, Asian children were the most likely to live in a two-parent household at 84 percent followed closely by whites at 82 percent, then Hispanics (71 percent), Native Americans (64 percent) and blacks (47 percent).
 

Figure PF 2.1   Percentage of U.S. Children Under Age 18 Living With Two Parents, by Race/Ethnicity: 19601996

Source: 1960 data U.S. Bureau of the Census, 1960 Census of Population, PC (2) - 4B, Persons by Family Characteristics, Tables 1 and 19. 1970 Hispanic data U.S. Bureau of the Census, 1970 Census of the Population, PC (2) - 1 C, Persons of Spanish Origin, Table 4. Data from 1970 - 1995 U.S. Bureau of the Census, Current Population Reports, Series P20-491, Marital Status and Living Arrangements: March 1995, and earlier reports. 1996 data U.S. Bureau of Census Unpublished tables.

Table PF 2.1.A   Living Arrangements of Children Under 18 Years Old by Race/Ethnicity: Selected Years, 19601996 (in percents)
		1960	1970a	1975	1980a	1985	1990	1991	1992	1993	1994	1995	1996
Totals:
	Two Parents	88	85	80	77	74	73	72	71	71	69	69	68
	Mother Only	8	11	16	18	21	22	22	23	23	23	23	24
	Father Only	1	1	2	2	3	3	3	3	3	3	4	4
	No Parent	3	3	3	4	3	3	3	3	3	4	4	4
White
	Two Parents	91	90	85	83	80	79	78	77	77	76	76	75
	Mother Only	6	8	11	14	16	16	17	18	17	18	18	18
	Father Only	1	1	2	2	2	3	3	3	3	3	3	4
	No Parent	2	2	2	2	2	2	2	2	2	3	3	3
Black
	Two Parents	67	58	49	42	40	38	36	36	36	33	33	33
	Mother Only	20	30	41	44	51	51	54	54	54	53	52	53
	Father Only	2	2	2	2	3	4	4	3	3	4	4	4
	No Parent	11	10	8	12	7	8	6	7	7	10	11	9
Hispanicb
	Two Parents	--	--	--	75	68	67	66	65	65	63	63	62
	Mother Only	--	--	--	20	27	27	27	28	28	28	28	29
	Father Only	--	--	--	2	2	3	3	4	4	4	4	4
	No Parent	--	--	--	3	3	3	4	3	4	5	4	5
Note: aRevised estimate based on population from the decennial census for that year.  bHispanics may be of any race.  Source: 1960 data U.S. Bureau of the Census, 1960 Census of Population, PC (2) - 4B, "Persons by Family Characteristics," Tables 1 and 19. 1970 Hispanic data U.S. Bureau of the Census, 1970 Census of the Population, PC (2) - 1 C, "Persons of Spanish Origin," Table 4. Data from 1970 - 1995 U.S. Bureau of the Census, Current Population Reports, Series P20-491, "Marital Status and Living Arrangements: March 1995," and earlier reports. 1996 data U.S. Bureau of Census unpublished tables.

Table PF 2.1.B  Percentage Distribution of U.S. Families with Own Children Under Age 18, by Family Type and Race/Ethnicity: 1980 and 1990
			1980	1990
	Total
		Married couple	81.5	77.1
		Female head	16.1	17.7
		Male head	2.4	4.1
	White
		Married couple	85.7	82.2
		Female head	12.1	14
		Male head	2.2	3.7
	Black
		Married couple	54.3	46.9
		Female head	41.7	47.6
		Male head	4	5.5
	Hispanic
		Married couple	76.6	71.4
		Female head	20.4	22.1
		Male head	3.1	6.5
	Asian American
		Married couple	88.5	84.3
		Female head	9.4	9.8
		Male head	2.1	2.9
	Native American
		Married couple	71.5	63.6
		Female head	24.2	28.7
		Male head	4.3	7.8
Source: "The Challenge of Change: What the 1990 Census Tells Us About Children," prepared by the Population Reference Bureau for the Center for the Study of Social Policy, Table 14, with data from the Bureau of the Census, 1980 Census of Population, "General Social and Economic Characteristics," PC80-1-C1, United States Summary, tables 100,121, and 131; and Census of Population and Housing 1990, Summary Tape File 3, tables P-19, P-20, and P-21.

¹ Amato, P.R. 1993. Childrens Adjustment to Divorce: Theories, Hypotheses, and Empirical Support. Journal of Marriage and the Family. 55: 23-58.

² Zill, N., Morrison, D., and Coiro, M. 1993. Long-term Effects of Parental Divorce on Parent-Child Relationships, Adjustment and Achievement in Early Adulthood. Journal of Family Psychology. 7(1): 91-103.

PF 2.2 Percentage of all births to unmarried mothers

Children who are born to single mothers regardless of the age of the mother are considerably more likely than children born to two parents to grow up poor, to spend large portions of their childhood without two parents, and to become single parents themselves.⁴

Between 1960 and 1994, there was a considerable increase in the percentage of all births to unmarried mothers from 5.3 percent in 1960 to 32.6 percent in 1994 (see Figure PF 2.2). However, preliminary data for 1995, displayed in Table PF 2.2, indicate a small decline in the percentage of all births to unmarried mothers, to 32.0 percent.

Differences by Age of the Mother. Nonmarital childbearing increased among mothers of all ages between 1960 and 1994 (see Table PF 2.2). For mothers ages 15 to 19, nonmarital births increased from 14.8 percent in 1960 to 75.5 in 1994. For mothers ages 20 to 24, nonmarital births increased from 4.8 percent in 1960 to 44.9 percent in 1994. For mothers in all age groups over age 24, nonmarital births increased from three percent or less in 1960 to between 15 and 22 percent in 1994. Age data are not yet available for 1995, so it is unclear whether the overall decline in the percentage of nonmarital births noted for that year occurred for mothers of all ages or only among certain age groups.

Contrary to popular opinion, nonmarital childbearing does not occur primarily among teenagers. In 1994, about 31 percent of nonmarital births were to teenagers (young women under age 20), 35 percent were to women ages 20 to 24, and about 35 percent were to women ages 25 and older.⁵

Differences by Race and Ethnicity. The percentage of all births to unmarried mothers increased steadily for whites, blacks, and Hispanics between 1980 and 1994.⁶ Preliminary data indicate a slight decline for all three groups in 1995. In 1994, Asian and white women had the lowest percentage of nonmarital births at 24.1 and 25.5 percent, respectively. Hispanics were next at 43.1 percent, followed by American Indian and black women at 57.0 percent and 70.5 percent. This ordering is the same for all age groups, though the size of the difference can vary substantially by the age of the mother. For young women ages 15 to 19, for example, whites and Hispanics have very similar percentages of births to unmarried mothers 67.6 and 69.7 percent, respectively while the percentage among young black women ages 15 to 19 is much higher at 95.3 percent. By ages 25-29, however, percentages for Hispanic women move midway between white and black rates, with whites at 16.5 percent, Hispanics at 33.2 percent, and blacks at 57.3 percent (see Table PF 2.2).

Figure PF 2.2   Percentage of All Births to Unmarried Mothers by Age of Mother: 19601995

Source: 1960 - 1992 data: Ventura, S.J., 1995. Births to Unmarried Mothers: United States, 1980-92. Vital and Health Statistics Series 21, No. 53, U.S. Department of Health and Human Services, Public Health Service, June 1995. 1992 Hispanic data from unpublished tables; Stephanie Ventura: National Center for Health Statistics. 1993 data: Ventura, S.J., Martin, J.A., Taffel, S.M., et. al. Advance Report of Final Natality Statistics, 1993. Monthly Vital Statistics Report; Vol. 44, No. 3, Supp. 1, Hyattsville, Maryland: National Center for Health Statistics, 1995. 1994 data: Ventura, S.J., Martin, J.A., Matthew, T.J., Clarke, S.C. Advance Report of Final Natality Statistics, 1994. Monthly Vital Statistics Report; Vol. 44, No. 11, Supp., Hyattsville, Maryland: National Center for Health Statistics, 1996. 1995 data: Rosenberg, H.M., Ventura, S.J., Maurer, J.D., et. al. Births and Deaths: United States, 1995. Monthly Vital Statistics Report; Vol. 45, No. 3, Supp. 2, Hyattsville, Maryland: National Center for Health Statistics, 1996.

Table PF 2.2  Percentage of All Births to Unmarried Mothers, by Age of Mother and Race/Ethnicity:a 19601995
					1960	1970	1980	1985	1990	1991	1992	1993	1994	1995
All Races
	All Ages				5.3	10.7	18.4	22	28	29.5	30.1	31	32.6	32
		Ages 15-19			14.8	29.5	47.6	58	67.1	68.8	70	71.3	75.5
		Ages 20-24			4.8	8.9	19.4	26.3	36.9	39.4	40.7	42.2	44.9
		Ages 25-29			2.9	4.1	9.0	12.7	18	19.2	19.8	20.7	21.8
		Ages 30-34			2.8	4.5	7.5	9.7	13.3	14.0	14.3	14.7	15.1
		Ages 35-39			3.0	5.2	9.4	11.2	13.9	14.6	15.2	15.6	16.1
White
	All Ages				2.3	5.7	11.2	14.7	20.4	21.8	22.6	23.6	25.5	25.3
		Ages 15-19			7.2	17.1	33.1	44.8	56.4	58.8	60.4	62.3	67.6
		Ages 20-24			2.2	5.2	11.7	17.7	27.8	30.2	31.7	33.4	36.3
		Ages 25-29			1.1	2.1	5.2	8.1	12.6	13.7	14.3	15.2	16.5
		Ages 30-34			1.0	2.1	4.6	6.3	9.3	9.8	10.2	10.6	11.1
		Ages 35-39			1.3	2.7	6.4	8.1	10.3	10.9	11.4	11.7	12.3
Black
	All Ages					37.6	56.1	61.2	66.5	67.9	68.1	68.7	70.5	69.5
		Ages 15-19				62.7	85.7	90.2	92	92.3	92.6	92.9	95.3
		Ages 20-24				31.3	57	65.4	72.6	74.7	75.2	76.7	79.0
		Ages 25-29				20.3	36.8	45.2	53.3	54.7	55	55.8	57.3
		Ages 30-34				19.6	29.6	37	45.2	46.5	46.7	46.9	47.4
		Ages 35-39				18.6	28.4	35.1	42.0	43.8	44.7	44.8	45.8
Hispanic
	All Ages						23.6	29.5	36.7	38.5	39.1	40	43.1	40.8
		Ages 15-19					41.9	51.3	53.7	61.2	61.9	62.8	69.7
		Ages 20-24					23.8	30.9	35.1	41.5	42.3	43.4	47.0
		Ages 25-29					15.9	22.2	25.7	30.3	30.8	31.7	33.2
		Ages 30-34					15.2	19.6	23.0	26.6	27.2	27.5	28.6
		Ages 35-39					16.2	20.8	23.2	27.6	28.5	29.0	30.3
Asian
	All Ages												16.2
		Ages 15-19											62.7
		Ages 20-24											30.0
		Ages 25-29											11.3
		Ages 30-34											8.0
		Ages 35-39											8.8
American Indian
	All Ages												57.0
		Ages 15-19											82.9
		Ages 20-24											60.6
		Ages 25-29											45.5
		Ages 30-34											40.6
		Ages 35-39											38.5
Notes: aBirths from 1980 onwards by race of mother. Tabulations prior to 1980 are by race of child, which assigns the child to the race of the nonwhite parent, if any, or to the race of the father, if both are nonwhite.  Source: 1960 - 1992 data: Ventura, S.J., 1995. Births to Unmarried Mothers: United States, 1980-92. Vital and Health Statistics Series 21, No. 53, U.S. Department of Health and Human Services, Public Health Service, June 1995. 1992 Hispanic data from unpublished tables; Stephanie Ventura: National Center for Health Statistics. 1993 data: Ventura, S.J., Martin, J.A., Taffel, S.M., et. al. Advance Report of Final Natality Statistics, 1993. Monthly Vital Statistics Report; Vol. 44, No. 3, Supp. 1, Hyattsville, Maryland: National Center for Health Statistics, 1995. 1994 data: Ventura, S.J., Martin, J.A., Matthew, T.J., Clarke, S.C. Advance Report of Final Natality Statistics, 1994. Monthly Vital Statistics Report; Vol. 44, No. 11, Supp., Hyattsville, Maryland: National Center for Health Statistics, 1996. 1994 data for Asians and American Indians from unpublished tables; Stephanie Ventura: National Center for Health Statistics. 1995 data: Rosenberg, H.M., Ventura, S.J., Maurer, J.D., et. al. Births and Deaths: United States, 1995. Monthly Vital Statistics Report; Vol. 45, No. 3, Supp. 2, Hyattsville, Maryland: National Center for Health Statistics, 1996. Hispanic data for 1980: Ventura, S.J., Births of Hispanic parentage, 1980. Monthly Vital Statistics Report, volume 32, no. 6, Supp., Hyattsville, MD: Public Health Service. 1983. Hispanic data for 1985: Ventura, S.J. Births of Hispanic parentage, 1985. Monthly Vital Statistics Report; vol. 36, no. 11 Supp., Hyattsville, MD: Public Health Service. Hispanic data for 1990 and 1991: National Center for Health Statistics, Vital Statistics of the United States Vol. I Natality (table 1-46). Issues for 1990-91.

⁴ See Ventura, S.J., 1995. Births to Unmarried Mothers: United States, 1980-1992. NCHS Series 21, No. 53. U.S. Department of Health and Human Services; and McLanahan, S., and Sandefur, G. 1994. Growing up with a single parent: What hurts, what helps. Cambridge, Mass.: Harvard University Press.

⁵ Ventura, S.J., Martin, J.A., Matthew, T.J., Clarke, S.C. Advance Report of Final Natality Statistics, 1994. Monthly Vital Statistics Report; Vol. 44, No. 11, Supp., Hyattsville, Maryland: National Center for Health Statistics, 1996.

⁶ Data are available for whites from 1960, and for blacks from 1970, indicating that the percent of births which were nonmarital had also been increasing prior to 1980 for those races. Data for Hispanics are only available starting in 1980.
 

PF 2.3 Foster care

 
A child is placed in foster care when a court determines that his or her family cannot provide a minimally safe environment. This determination often follows an investigation by a state or county child protective services worker. Placement most commonly occurs either because a member of a household has physically or sexually abused a child or because a childs caretaker(s) has severely neglected the child. In some cases, children with severe emotional disturbances may also be put into foster care.

Since both federal and state laws discourage removal of children from their families unless necessary to ensure a childs safety, placement in foster care is an extreme step taken only when a child is in immediate danger or when attempts to help the family provide a safe environment have failed. Thus, the frequency of placements in foster care is an indicator of family dysfunction that is so severe that a child cannot remain safely with his or her family.

The number of children in foster care rose sharply from 262 thousand in 1982 to 462 thousand in 1994. As shown in Figure PF 2.3, the rate of children living in foster care (i.e., the number of children in foster care per one thousand children under age 18) also rose dramatically during the same time period, from 4.2 foster children per one thousand children under age 18 in 1982 to 6.8 in 1994 an increase of over 60 percent. Between 1990 and 1994, the rate of children in foster care continued to increase, but at a slower pace.

Figure PF 2.3  Children Living in Foster Care: 19821994 (Rate per thousand)

Note: Estimate of total is the number of children in foster care on the last day of the fiscal year. 1994 is the last year in which data on foster care was collected through the Voluntary Cooperative Information System (VCIS). The Administration on Children and Families (ACF) has implemented the Adoption and Foster are Analysis and Reporting System (AFCARS) as a replacement for VCIS. While VCIS was a voluntary reporting system, states are required to participate in AFCARS and must use uniform definitions. Most importantly, AFCARS collects case-level foster care data. Thus, the new system may bring about a significant change in estimates of children in foster care. However, the first release of data from AFCARS show no significant change in estimates of children in foster care.

Source: Tatara, Tashio. U.S. Child Substitute Care Flow Data for FY 1993 and Trends in the State Child Substitute Care Populations, VCIS Research Notes, No. 11, August 1995. U.S. Bureau of the Census, Statistical Abstract of the United States, 1995 (Washington, DC: U.S. Government Printing Office, 1995).

Table PF 2.3   Number and Rate (per thousand) of Children Living in Foster Care: 19821994
	1982	1983	1984	1985	1986	1987	1988	1989	1990	1991	1992	1993		1994
Total Number
(in thousands)	262	269	270	270	280	300	340	383	400	414	427	445		462
Rate
(per thousand)	4.2	4.3	4.3	4.3	4.5	4.8	5.4	6	6.3	6.4	6.5	6.6	6.8
Note: Estimate of total is the number of children in foster care on the last day of the fiscal year. 1994 is the last year in which data on foster care was collected through the Voluntary Cooperative Information System (VCIS). The Administration on Children and Families (ACF) has implemented the Adoption and Foster are Analysis and Reporting System (AFCARS) as a replacement for VCIS. While VCIS was a voluntary reporting system, states are required to participate in AFCARS and must use uniform definitions. Most importantly, AFCARS collects case-level foster care data. Thus, the new system may bring about a significant change in estimates of children in foster care. However, the first release of data from AFCARS show no significant change in estimates of children in foster care.  Source: Tatara, Tashio. "U.S. Child Substitute Care Flow Data for FY 1993 and Trends in the State Child Substitute Care Populations," VCIS Research Notes, No. 11, August 1995. U.S. Bureau of the Census, Statistical Abstract of the United States, 1995 (Washington, DC: U.S. Government Printing Office, 1995).

⁷ For purposes of this report "foster care" is defined as a living arrangement where a child resides outside his/her own home, under the case management and planning responsibility of a state child welfare agency. These living arrangements include relative and non-relative foster homes, group homes, child care facilities, emergency shelter care, supervised independent living, and non-finalized adoptive homes.
 
 

NEIGHBORHOODS

PF 3.1 Residential stability

Recent research has demonstrated a strong relationship between residential stability and child well-being, with frequent moves associated with such negative outcomes as dropping out of high school, delinquency, depression, and nonmarital teen births. Some researchers theorize that these negative associations may result from a lack of rootedness in a local community and its institutions on the part of frequent movers.⁸

The United States has long been a highly mobile society. In 1960, 21 percent of children under the age of 18 had moved to a new residence during the previous year. The general trend since that time has been toward somewhat lower rates of mobility, to a low of 17 percent in 1994 (see Table PF 3.1.A).

Differences by Age. Young children were the most mobile of any child age group (see Table PF 3.1.B). In 1994, 22 percent of children under the age of five had changed residences in the previous year, compared to
17 percent among children ages 5-9, 13 percent for ages 10-14, and 15 percent for youth ages 15-17.

Differences by Race and Ethnicity. For all children under age 18 in 1994, 16 percent of white children moved during the previous year compared to 20 percent of black children and 21 percent of Hispanic children. For each group, the youngest children were the most likely to move, and children ages 10-14 were the least likely to move.

Table PF 3.1.A  Percentage of Children Under Age 18 Who Have Moved Within the Last Year: 19601994
	1960	1970	1981	1990	1991	1992	1993	1994
Totala	21	19	18	18	17	18	17	17
Note: aTotal children refers to all children between the ages of 1 and 17.  Source: U.S. Bureau of the Census, March Current Population Reports, Series P-20, Geographical Mobility, various years.

Table PF 3.1.B  Percentage of Children Under Age 18 Who Have Moved Within the Last Year, by Age and Race/Ethnicity: 19901994
					1990	1991	1992	1993	1994
All Children
	Totala				18	17	18	17	17
		1-4 Years			24	23	22	23	22
		5-9 Years			19	18	18	17	17
		10-14 Years			15	14	15	14	13
		15-17 Years			15	15	14	14	15
White
	Totala				18	17	17	16	16
		1-4 Years			23	22	21	22	21
		5-9 Years			18	17	17	16	16
		10-14 Years			14	13	15	13	12
		15-17 Years			14	14	14	14	13
BLACK
	Totala				21	21	21	20	20
		1-4 Years			26	26	27	26	25
		5-9 Years			22	22	22	20	22
		10-14 Years			19	17	18	17	16
		15-17 Years			18	16	16	14	18
Hispinic
	Totala				25	21	24	23	21
		1-4 Years			32	27	27	28	26
		5-9 Years			28	20	25	24	20
		10-14 Years			18	19	21	19	15
		15-17 Years			21	19	19	20	21
Note: aTotal children refers to all children between the ages of one and 17.  Source: U.S. Bureau of the Census, March Current Population Reports, Series P-20, Geographical Mobility, various years.

⁸ Coleman, J. 1988. "Social Capital and the Creation of Human Capital." American Journal of Sociology. 94: s95-s120.
 

PF 3.2 Children in poor/very poor neighborhoods

 
Recent research has demonstrated a significant relationship between neighborhood quality and the well-being of the children and youth who live in them. Even after controlling for relevant personal and family background characteristics, residence in low income neighborhoods has been shown to have negative effects on early childhood development and to be associated with higher rates of high school drop out and teen parenthood.⁹

Overall, one in 20 American children lived in very poor neighborhoods in 1990, defined as census tracts in which 40 percent or more of the residents live in poor families. More than one in five children lived in neighborhoods in which 20 percent or more of the residents live in poor families (see Table PF 3.2).

Differences by Race and Ethnicity. Black children were the most likely to live in very poor neighborhoods, followed by Hispanic children, and at a much lower rate white children. Almost 19 percent of black children live in very poor neighborhoods, compared to 11.3 percent of Hispanic children and 1.2 percent of white children (see Figure PF 3.2).

Differences by Family Structure. Children in single-parent families were much more likely to live in a very poor neighborhood than were children in two-parent families (12.5 percent versus 2.7 percent) (see Figure PF 3.2).

Differences by Family Income. More than one in six poor children (17.5 percent) lived in very poor neighborhoods compared to 2.3 percent of nonpoor children.

Figure PF 3.2   Percentage of Children Who Live in Very Poor (40+ % Poverty) Neighborhoods: 1990.

Note: Neighborhoods are defined as census tracts and block-numbering areas. Both metropolitan and nonmetropolitan areas are included. The poverty rate is the percent of all persons in the neighborhood living in families below the poverty line in 1990.

 Source: Tabulations by Paul A. Jargowski from 1990 Census Summary Tape File 3A (CD-ROM version)
 

Table PF 3.2  Percentage of Children Who Live in Poor Neighborhoods: 1990
			Neighborhood Poverty Level
			20+ % Poor	40+ % Poor
Total			22.9	5
	Age of Child
		0-4	23.5	5.3
		5-17	22.7	4.9
	Family Structure
		Two Parent	17.3	2.7
		Single Parent	41.2	12.5
	Race/Ethnicity
		White non-Hispanic and other	12.2	1.2
		Black	56.4	18.6
		Hispanic	46.6	11.3
	Family Poverty
		In poverty	54.6	17.5
		Not in poverty	16.0	2.3
Note: Neighborhoods are defined as census tracts and block-numbering areas. Both metropolitan and nonmetropolitan areas are included. The poverty rate is the percent of all persons in the neighborhood living in families below the poverty line in 1990.   Source: Tabulations by Paul A. Jargowski from 1990 Census Summary Tape File 3A (CD-ROM version).

⁹ Brooks-Gunn, J., Duncan, G., Klebanov, P., and Sealand, N. 1994. "Do Neighborhoods Influence Child and Adolescent Behavior?" American Journal of Sociology, 99(2), 353-395. See also Crane, J., 1991. "The Epidemic Theory of Ghettos and Neighborhood Effects on Dropping Out of High School and Teenage Childbearing." American Journal of Sociology, 96(5), 1126-1159.
 

SECTION 2 ECONOMIC SECURITY (ES)

POVERTY AND INCOME

ES 1.1 Mean family income

Mean (average) income of families with children is a good starting point for assessing the economic well-being of children since it measures an average familys ability to purchase food, shelter, clothing, child care, and other basic goods and services required to raise children. When mean family income is rising, the likelihood is that children in an average family are enjoying a rising standard of living.

However, mean family income fails to capture important economic resources that may also be available to a family, such as employer-paid health benefits, Medicaid, or food stamps. Moreover, it says nothing about changes in the distribution of income across families. For a more complete picture of childrens economic well-being, it is necessary to look at several measures of economic well-being, including those in the following sections.

Accelerating Growth in Family Income Since 1992. Between 1975 and 1992, mean income of families with children (in constant 1995 dollars)¹ grew by a very modest average annual percentage rate of 0.4 percent from $42,916 to $45,747, as shown in Figure ES 1.1.A. Between 1992 and 1995, the average annual growth rate accelerated to 3.1 percent.

Growth in Family Income by Family Type. In the past, this rise was not experienced equally across all family types. Between 1975 and 1992, female-headed families enjoyed only a modest 0.3 average annual percentage increase from $18,410 to $20,354, while married-couple families with children showed an average annual increase in average incomes of 0.9 percent, from $47,572 to $55,115.² However, this difference in growth rates reversed after 1992. Family income increased at an average annual rate of 3.4 percent for married-couple families and 3.9 percent for female-headed families.

Differences in Family Income by Family Type. There has long been a substantial gap in family income between female-headed and married-couple families, and that gap has been growing since 1975 (see Figure ES 1.1.A). In 1995, children in married-couple families enjoyed a substantial income advantage over children in female-headed families, with mean family incomes over 2.8 times as large ($60,854 versus $21,905).
As Table ES 1.1 shows, this disparity is similar within white, black, and Hispanic families with ratios ranging from 2.4 for Hispanics ($38,145 versus $15,945) to 3.0 for black families ($53,078 versus $17,645).

Differences in Mean Family Income by Race and Ethnicity. Mean family incomes are substantially higher for white families with children than for black and Hispanic families with children. Table ES 1.1 shows that, in 1995, whites enjoyed family incomes that were about 65 percent higher than black families, and 71 percent higher than Hispanic families. Among married-couple families, the white-black disparity is considerably smaller, with whites enjoying incomes that are only 16 percent higher. The disparity between whites and Hispanics remains almost as large for married-couple families, however, with white families having average incomes 61 percent higher than their Hispanic counterparts.

Since 1990, the income gap between black and white married couples with children has narrowed, while the incomes of Hispanic married couples with children have lagged behind both white and black married couples with children (see Figure ES 1.1.B). Consequently, black married-couple families earn significantly more than Hispanic married-couple families, with mean family incomes of $53,078 and $38,145, respectively, in 1995.

Among female-headed families, white families with children have an average income of $23,943 in 1995, which is 36 percent higher than that for similar black families ($17,645) and 50 percent higher than that for Hispanic families ($15,945).
 

 
 

 
 
 

 
 

¹ In constructing income figures in constant 1995 dollars, we have followed the practice of the Bureau of the Census and used the CPI-U-X1 consumer price index. This index differs from the standard CPI-U index in its treatment of the costs of owner-occupied housing for years prior to 1986.

² If the CPI-U consumer price index had been used, the average annual growth rate for married-couple families would have been even lower, and the real income of female-headed families would have actually fallen.
 

ES 1.2 Income distribution

Figures ES 1.2.A and ES 1.2.B present trends in the income of the poorest and richest families with children. The poorest families are those whose income falls in the bottom 20 percent (or bottom quintile) of all families; the richest families are those whose income falls in the top 20 percent of all families. The measure shown is the income to poverty ratio, the ratio of annual family income to the poverty line. For example, families whose pretax income was half of the poverty line would have a value of 0.50 for this measure. Each figure shows results separately by type of family.

Between 1967 and 1973 the income to poverty ratio of the poorest families increased from 0.74 to 0.88 (see Figure ES 1.2.A). By 1994, the ratio had dropped to 0.66.

Differences in the Income-to-Poverty Ratio by Family Type. The poorest single-mother families fared much worse than the poorest married-couple families (see Figure ES 1.2.A). After an increase from 0.21 to 0.33 between 1967 and 1973, the ratio for the poorest single-mother families dropped and was at 0.25 in 1994. The poorest married-couple families crossed over the poverty line between 1967 and 1973 (from 0.89 to 1.16, see Figure ES 1.2.A). However, since 1979, their ratio has declined, reaching 1.06 by 1994.

Difference in the Income-to-Poverty Ratio by Income Quintile. While the poorest families with children were getting poorer, the richest families with children were getting richer (see Figure ES 1.2.B). Between 1967 and 1994, the income to poverty ratio of the richest families increased from 4.77 to 7.14.

For the richest married-couple families, the picture was even brighter (see Figure ES 1.2.B). The income to poverty ratio increased from 4.88 to 7.68 between 1967 and 1994. The richest single-parent families headed by women were also well above the poverty line throughout the entire period. Their income to poverty ratio increased from 2.78 to 4.14 between 1967 and 1989 before declining to 4.02 in 1994.

Data for all five income quintiles show that the poorest families (the bottom quintile) were the only families to lose ground between 1967 and 1994 (see Table ES 1.2). For all time periods and all income groups, families headed by single mothers had considerably less income than those headed by married couples.
 

ES 1.3 Children in poverty

Being raised in economically deprived circumstances can have far reaching negative consequences for children. Growing up at or near the poverty line ($15,569 for a family of four in 1995) means not only that a child has a much lower level of consumption than other children, but also that he or she is more likely than a nonpoor child to experience difficulties in school,³ to become a teen parent,⁴ and, as an adult, to earn less and experience greater unemployment.⁵ The effects of being raised in a family with income significantly below the poverty line are correspondingly more damaging.

Children At, Below, and Slightly Above the Poverty Level. Figures ES 1.3.A and 1.3.B illustrate trends in the proportions of children living in various degrees of poverty and near-poverty. Specifically:

• Children in families with incomes below 50 percent of the poverty line. Between 1975 and 1993, the proportion of children living in extreme poverty, that is, at or below 50 percent of the poverty line⁶ doubled from 5 percent in 1975 to 10 percent by 1993. By 1995, this percentage dropped back to 8 percent, still 60 percent higher than in 1975 (see Figure ES 1.3.A).

• Children in families with incomes at or below the poverty line. Less dramatic but still striking, the proportion of children at or below 100 percent of the poverty line increased by 29 percent from 17 percent in 1975 to 22 percent by 1993 before dropping to 20 percent by 1995. The percentage of children in poverty has remained at or above 20 percent since 1990 (see Figure ES 1.3.A).
• Children above but near the poverty line. In contrast, as shown in the lower line of figure ES1.3.B, the proportion of children at or below 150 percent of the poverty line increased only slightly from 30 percent to 32 percent between 1975 and 1995, and, as shown in the upper line of that figure, the proportion of children at or below 200 percent of the poverty line in 1995 was 43 percent the same as in 1975.

Differences by Race and Ethnicity. There are no substantial differences by race or Hispanic origin in the trends described above, even though the incidence of poverty is consistently highest for blacks and lowest for whites (see Table ES 1.3.A). The increase in the percentage of children raised in extreme poverty occurred for all three groups, while the percentage of children at or below 200 percent of the poverty line has hardly changed at all.

Table ES 1.3.B and Figure ES 1.3.C present a more detailed (but less current) look at poverty by race and Hispanic origin using data from the decennial census.⁷ They show that the incidence of poverty is lowest by far for white children and highest for black and Native American children. While the incidence of poverty grew noticeably between 1979 and 1989 for all groups, the differences between the groups remained stable:

• The poverty rate for white children was 12.1 percent in 1989.
   
• The poverty rate for Asian children was 16.7 percent in 1989, nearly a third higher than for white children.
   
• The poverty rate for Hispanic children was 31.8 percent in 1989, a rate 2.6 times as high as for white children.
   
• The poverty rate for Native American children was 38.3 percent in 1989, slightly more than three times the poverty rate for white children.
   
• The poverty rate for black children was 39.5 percent in 1989, slightly more than three times the white child poverty rate.

Child Poverty by Family Type. The chances of a child experiencing poverty are strongly influenced by the type of family in which he or she lives. Throughout the period from 1970 through 1995, about 50 percent of the children living in female-headed families were poor (see Table ES 1.3.C). In contrast, during the 1990s,⁸ only about 10 percent of children living in married-couple families were poor (see Figure ES 1.3.D).
 

³ Parker, S., Greer, S., and Zuckerman, B. 1988. "Double Jeopardy: The Impact of Povery on Early Childhood Development." Pediatric Clinics of North America, 35: 1-10.  Hill, M.S., and Duncanc, G.D. 1987. "Parental Family Income and the Socioeconomic Attainment of Children." Social Science Research, 16: 39-37

⁴ An, C., Haveman, R., and Wolfe, B. 1993. "Teen Out-of-Wedlock Births and Welfare Receipt: The Role of Childhood Events and Economic Circumstances," Review of Economics and Statistics.

⁵ Duncan, G., and Brooks-Gunn, J. 1996. "Income Effects Across the Life Span: Integration and Interpretation," in Consequences of Growing Up Poor (G. Duncan and J. Brooks-Gunn, eds.). New York: Russell Sage Press.

⁶ $7,784 for a family of four in 1995.

⁷ These poverty estimates are based on Decennial Census data rather than the Current Population Survey data presented in other tables. Estimates from the two sources differ because the Current Population has a much smaller sample than the Decennial Census.

⁸ The only period for which these statistics are published.
 
 

ES 1.4 Lifetime childhood poverty

The majority of children never experience poverty while growing up, and, among those who do, most are in poverty for only a small portion of their childhood. Many children, however, and particularly many black children, spend a large proportion of their formative years living in poverty, with correspondingly negative consequences for their development and well-being.⁹

Changes in Childhood Poverty Over Time. Although 64 percent of all children who turned age 18 between 1985 and 1987 were never poor, 10 percent were poor for six or more years through age 17 (see Figure ES 1.4.A and Table ES 1.4). Six percent were poor for eleven or more years, and 1 percent were poor for all 17 years. Children turning age 18 three years later show a similar pattern, though they were somewhat more likely to have been poor for a greater number of years, with 14 percent poor for six or more years, and 8 percent poor for eleven or more years.

Differences by Race. The risk of experiencing long-term poverty in childhood varies substantially by race (see Figure ES 1.4.B and Table ES 1.4). Of the nonblack children who turned age 18 between 1988 and 1990, 73 percent never experienced poverty while growing up, only 8 percent were poor for six or more years, and only 4 percent were poor for at least eleven years. By contrast, nearly one half (47 percent) of all black children in that cohort were poor for six or more years, 28 percent for eleven or more years, and 6 percent for all seventeen years of their childhoods.
 

⁹ Duncan, G. 1995. "Longitudinal Indicators of Children's Poverty and Dependence." Institute for Research on Poverty Special Report Series, SR#60b.
 

FINANCIAL SUPPORT

ES 2.1 Effect of government transfer programs

Although the federal system of cash and near-cash transfers (including federal income and payroll taxes)¹⁰ plays a substantial role in reducing the poverty rate of children, its collective effect has varied significantly over time. In 1979, federal cash and near-cash transfers produced a 37 percent reduction in poverty among persons in families with related children under age 18 (see Figure ES 2.1). However, by 1983, the same transfer programs produced only a 19.1 percent reduction in poverty. By 1989 the percentage poverty reduction recovered to 23.9 percent, rose again to 26.5 percent in 1993, and to 32.6 percent in 1994.

In the absence of any federal transfers and taxes, 21.4 percent of all persons living in families with children would have been poor in 1994 (see Table ES 2.1). Social insurance programs other than Social Security reduced the poverty rate to 20.6 percent. The Social Security system reduced the poverty rate further to 19.2 percent. After inclusion of means-tested cash transfers, the poverty rate fell to 17.8 percent. Food and housing benefits cut the poverty rate to 15.3 percent. Finally, the federal tax system reduced the poverty rate of all persons living in families with children to 14.4 percent.

All of the federal cash and near cash transfers considered in Table ES 2.1 except federal taxes reduced poverty among persons in families with related children under age 18 in all years. Until recently, the net impact of the federal tax system was to increase the poverty rate. By 1993, however, the impact of the tax system on the number of such persons in poverty became neutral, and in 1994, the federal tax system reduced the number of persons in poverty. This is because of the recent expansion of the Earned Income Tax Credit (EITC), which provides refundable tax credits to low-income families with children and at least one working parent whose earnings are low. Because the credit is refundable, many families eligible for the EITC receive a payment from the Treasury instead of paying federal income tax.
 

Figure ES 2.1  Percentage Reduction in the Number of Individuals in Families (with Own Children Under Age 18) Who Are Poor, Resulting from Federal Cash and Near-Cash Transfers

Table ES 2.1  Antipoverty Effectiveness of Cash and Near-Cash Transfers  (including Federal Income and Payroll Taxes) for All Individuals  in Families with Related Children Less than Age 18
		1979	1983	1989	1993	1994
Total population (in thousands)		133,435	132,123	135,430	144,551	145,814
Poverty rate (in percent):
	Cash income before transfers	16.6	21.9	18.6	22.3	21.4
	Plus social Insurance (other than Social Security)	15.8	20.4	18	21.4	20.6
	Plus Social Security	14.3	19.1	16.8	20.0	19.2
	Plus means-tested cash transfers	12.9	18.4	15.8	18.7	17.8
	Plus food and housing benefits	10.2	16.5	13.6	16.4	15.3
	Less Federal taxes	10.5	17.7	14.1	16.4	14.4
Total percentage reduction in poverty rate		36.6	19.1	23.9	26.5	32.6
Source: Congressional Budget Office computations using the CBO tax model, with data from the March Current Population Survey, 1980, 1984, 1990, 1994, and 1995. Table prepared by staff from the Department of Health and Human Services, Assistant Secretary for Planning and Evaluation.

¹⁰ Federal cash and near-cash transfers include social security, unemployment compensation, workers' compensation, all means-tested cash transfers, food and housing benefits, and federal income and payroll taxes.
 

ES 2.2 Means-tested assistance: AFDC and Food Stamps

Many poor children have depended on Aid to Families with Dependent Children (AFDC) and the Food Stamp program for basic material needs. AFDC was a federal and state cash assistance program targeted to needy children, and to certain others in the household of such a child.¹² As a result of major welfare reform enacted in August 1996, the AFDC program has now been replaced by the Temporary Assistance to Needy Families program (TANF). TANF provides a block grant to states to design and administer their own welfare and work programs.

The food stamp program provides low-income households with vouchers that can be exchanged for food. The new law includes significant new restrictions on food stamp eligibility.

Children's Receipt of AFDC and Other Welfare Benefits. Twelve percent of all children lived in families receiving AFDC or general assistance in 1979, according to survey data (see Figure ES 2.2). The rate decreased slightly to 11 percent in 1989, but by 1993 had increased to 14 percent. However, by 1995, the recipiency rate dropped back to 12 percent.

More than 7 million children lived in families receiving welfare in 1979 and 1989 (see Table ES 2.2.A). By 1994, 9.5 million children were living in families receiving welfare. In 1995, the number of children on welfare dropped sharply to 8.7 million.

Administrative data show a similar rise in the number of children receiving AFDC between 1985 and 1994 (see Table ES 2.2.C). After peaking at 9.5 million in 1994, the number dropped to 9.2 million in 1995.

Children's Receipt of Food Stamps. Food stamp receipt shows a similar pattern. In both 1979 and 1989, 15 percent of all children lived in households receiving food stamps, according to survey data (see Figure ES 2.2). The proportion increased to 20 percent by 1993. In that year 14.2 million children lived in households receiving food stamps, up from 9.7 million in 1989 (see Table ES 2.2.B). However, the recipiency rate dropped to 18 percent by 1995.

Administrative data for Food Stamps also show a rise in the number of children receiving food stamps during the late 1980s and early 1990s, followed by a recent decline (see Table ES 2.2.C). According to these data, the number of children receiving Food Stamps grew from 9.9 million in 1985 to 14.4 million in 1994. By 1995, the number declined to 13.9 million, or 20.3 percent of the child population.
 

Figure ES 2.2  Percentage of Children Under Age 18 Living in Families Receiving AFDC (or General Assistance), and in Households Receiving Food Stamps, 1979-1995

Table ES 2.2.A  Percentage and Number (in thousands) of Children Under Age 18 in Families Receiving AFDC or General Assistance, 1979-1995
	1979	1989	1993	1994	1995
Number (in thousands)	7,228	7,116	9,440	9,463	8,656
Percent	12	11	14	13	12
Source: Estimates for 1979 - 1994 calculated by Child Trends, Inc. Based on analysis of the March 1980, 1990, 1994, and 1995 Current Population Surveys. Estimates for 1995 provided by U.S. Census Bureau.

Table ES 2.2.B  Percentage and Number (in thousands) of Children Under Age 18 in Households Receiving Food Stamps, 1979-1995
	1979	1989	1993	1994	1995
Number (in thousands)	9,336	9,696	14,193	13,667	13,115
Percent	15	15	20	19	18
Source: Estimates for 1979 - 1994 calculated by Child Trends, Inc., based on analysis of the March 1980, 1990, 1994, and 1995 Current Population Surveys. Estimates for 1995 provided by U.S. Census Bureau.

Table ES 2.2.C  Percentage and Number of Children Under Age 18 Receiving AFDC or Food Stamps According to Administrative Records, 1985-1995 (number of children in thousands)
		1985	1990	1991	1992	1993	1994	1995
								(est)
AFDC
	Number (in thousands)	7,041	7,620	8,375	9,087	9,402	9,464	9,152
	Percent	11.2	11.9	12.9	13.5	13.6	13.9	13.4
Food Stamps
	Number (in thousands)	9,906	10,127	11,952	13,349	14,196	14,391	13,883
	Percent	15.8	15.8	18.4	20.2	21.2	21.2	20.3
Sources: AFDC information drawn from unpublished data, Administration for Children and Families, U.S. Department of Health and Human Services. 1995 estimate calculated by the Office of the Assistant Secretary for Planning and Evaluation. Food Stamps information drawn from calculations by the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health Services, based on unpublished data from the U.S. Department of Agriculture, Food and Consumer Service.

¹¹ Includes "General Assistance".

¹² Needy children include those "who have been deprived of parental support or care because their father or mother is absent from the home continuously, is incapacitated, is deceased or is unemployed." In Overview of Entitlement Programs: 1994 Green Book, Committee on Ways and Means, U.S. House of Representatives.
 

ES 2.3 Lifetime welfare dependence

Chronic welfare receipt is a major concern of policy makers of all political persuasions for several reasons. First, chronic welfare receipt imposes large costs on taxpayers. Second, there is some evidence suggesting that long-term welfare receipt may have a more negative impact on adult recipients and their children than short-term receipt that helps a family weather a crisis.¹⁴

Living in a family receiving welfare at some point during childhood is a common experience, affecting 40 percent of all children, 33 percent of non-black children, and 81 percent of black children who turned age 18 in 1991-93 (see Figure ES 2.3.A). Long-term welfare receipt is considerably less common: 10 percent of all children lived in families receiving welfare for 11 or more years of their childhood.

Differences by Race. For black children, however, long-term welfare receipt is considerably more common than for non-black children. Thirty-eight (38) percent of all black children born in the years 1973-1975 spent 11 or more years of their childhood living in families receiving at least some welfare. This contrasts with the experience of non-black children, of whom only 6 percent spent 11 or more years of their childhood in families receiving welfare.

Changes Over Time. Table ES 2.3.A presents data for three cohorts of children turning age 18 in 1985-87, 1988-90, and 1991-93. The data show two contrasting trends in the lifetime experience of welfare receipt among children:

• On the one hand, there appears to be a small increase in the proportion of children whose families never received welfare, from 57 percent to 61 percent across the three age cohorts. This trend is also evident for black children, where the proportion whose families never received welfare increased from 12 percent to 19 percent.
• On the other hand, there is also a small increase in the percentage of children who lived in families receiving welfare for at least 11 years, from eight percent in the cohort turning age 18 in 1985-87 to 10 percent for the cohort turning age 18 in 1991-93.

These two trends indicate some polarization of the life experience of children. A slightly greater proportion is growing up in families who are chronically dependent on welfare, even while an increasing proportion of children live in families that manage to avoid welfare altogether.

Welfare Benefits As a Portion of Total Family Income. Of the 10 percent of children in families that received welfare for at least 11 years, fewer than half lived in families in which welfare benefits were at least half of total family income for at least 11 years. Similarly, although 38 percent of black children lived in families receiving welfare for at least 11 years, only 14 percent lived in families in which welfare benefits were at least half of total family income for at least 11 years (see Table ES 2.3.A, right panel). Thus, welfare is a supplement to family income rather than the primary source of income in more than half of the families receiving welfare over the long run.

AFDC Receipt. As shown in Figure ES 2.3.B, when only AFDC benefits are taken into account, the pattern is very similar to the pattern for all welfare benefits. While living in a family receiving AFDC benefits for at least one year is fairly common (19 percent of non-black children and 67 percent of black children), chronic receipt is not. Only 4 percent of non-black children lived in families receiving AFDC benefits for at least 11 years, and only 20 percent of black children lived in such families. Moreover, as shown in Table ES 2.3.B, there is no evidence of increased polarization of children with respect to AFDC receipt.
 

Figure ES 2.3.A  Percentage of Children Receiving Welfare by Number of Years on Welfare Through Age 17: for Those Who Turned Age 18 in 19911993

Note: Welfare includes AFDC, Food Stamps, and SSI or "other welfare, which includes local General Assistance."  Source: Estimates supplied by Greg J. Duncan, Northwestern University, based on data from the Panel Study of Income Dynamics (PSID).

Figure ES 2.3.B  Percentage of Children Receiving AFDC by Number of Years on AFDC Through Age 17: for Those Who Turned Age 18 in 19911993

Source: Estimates supplied by Greg J. Duncan, Northwestern University, based on data from the Panel Study of Income Dynamics (PSID).

Table ES 2.3.A  Percentage of Children Receiving Welfare by Number of Years on Welfare  During Childhood, by Year Turned 18
				NUMBER OF YEARS FAMILY  RECEIVED ANY WELFARE  BENEFIT				NUMBER OF YEARS IN WHICH  WELFARE BENEFITS WERE  AT LEAST HALF OF TOTAL  FAMILY INCOME
				______________________________				_______________________________
					One or	Six or	11 or		One or	Six or	11 or
					More	More	More		More	More	More
				Never	Years	Years	Years	Never	Years	Years	Years
				______	______	______	______	______	______	______	______
Turned age 18 in 1985-1987
(1967-69 birth cohort)
	All children			57	43	16	8	-	-	-	-
	Black			12	88	66	35	-	-	-	-
	Non-black			64	36	8	3	-	-	-	-
Turned age 18 in 1988-1990
(1970-72 birth cohort)
	All children			58	43	21	12	-	-	-	-
	Black			19	81	67	40	-	-	-	-
	Non-black			65	35	13	7	-	-	-	-
Turned age 18 in 1991-1993
(1973-75 birth cohort)
	All children			61	40	17	10	83	17	9	4
	Black			19	81	52	38	50	50	30	14
	Non-black			67	33	12	6	88	12	5	2
Note: Welfare includes AFDC, Food Stamps and SSI or "other welfare, which includes local General Assistance."
Source: Estimates supplied by Greg J. Duncan, Northwestern University, based on data from the Panel Study of Income Dynamics (PSID).

Table ES 2.3.B  Percentage of Children Receiving AFDC by Number of Years on AFDC During Childhood, by Year Turned 18
			Number of years family  received any AFDC  benefit				Number of years in which  AFDC benefits were  at least half of  total family income
				One or	Six or	11 or		One or	Six or	11 or
				More	More	More		More	More	More
			Never	Years	Years	Years	Never	Years	Years	Years
Turned age 18 in 1985-1987  (1967-69 birth cohort)
	All children		77	23	10	5	87	13	3	1
	Black		29	71	45	19	44	56	15	6
	Non-black		85	15	4	2	94	7	2	1
Turned age 18 in 1988 -1990  (1970-72 birth cohort)
	All children		71	28	15	7	84	17	7	3
	Black		28	73	45	23	49	51	16	9
	Non-black		80	20	9	4	91	10	5	2
Turned age 18 in 1991 -1993  (1973-75 birth cohort)
	All children		76	25	11	6	85	15	6	2
	Black		34	67	39	20	54	47	23	10
	Non-black		81	19	7	4	89	11	4	1
Source: Estimates supplied by Greg J. Duncan, Northwestern University based on data from the Panel Study of Income Dynamics (PSID).

¹³ For this indicator, "welfare" has been defined to include Aid to Families with Dependent Children, Food Stamps, Supplemental Security Income, and "other welfare," which includes local General Assistance.

¹⁴ Duncan, G., and Brooks-Gunn, J. 1996. "Income Effects Across the Life Span: Integration and Interpretation," in Consequences of Growing Up Poor (G. Duncan and J. Brooks-Gunn, eds.).
 

ES 2.4 Sources of family income

Although most families with children receive most of their income from their own earnings and other private sources, federal transfer programs providing both cash and in-kind benefits are an important supplement for many families and the most important source of income for some. Thus, many children's standard of living is significantly affected by these programs. Most families with children pay taxes to the federal government to help pay for these programs.

Federal Cash Benefits. Many families receive some of their income in the form of government transfers, although the overwhelming majority of families (95 percent in 1993), had other, private sources of income as well (see Figure ES 2.4.A).

• The most common federal cash benefit was the earned Income Tax Credit (EITC)¹⁵, which the federal government paid to 29 percent of families with children.

• The federal government paid cash social insurance benefits (including Social Security, Workers' Compensation, and Unemployment Insurance benefits) to 20 percent of families with children.
• Cash benefits from the AFDC program were paid to 16 percent of families with children.
• Supplemental Security Income (SSI) benefits were provided to only 4 percent of families with children.
• A small percentage of families with children received cash benefits from other means-tested cash programs.

Single-parent families with children are less likely than married-couple families with children to have pre-transfer income (see Table ES 2.4.A). While 98 percent of married-couple families with children had pre-transfer income, only 85 percent of single-parent families had income before transfers. It is not surprising, therefore, that single-parent families with children were more likely than married-couple families with children to receive means-tested cash benefits. For example, while only 6 percent of married-couple families received AFDC benefits, 40 percent of single-parent families received these benefits.

Federal In-Kind Benefits. Many families also receive in-kind benefits from the federal government (see Figure ES 2.4.A).

• The federal government provided food stamps to 20 percent of families with children.
• Housing benefits were provided to 6 percent of families with children.

Single-parent families with children were much more likely than married-couple families to receive in-kind benefits (see Table ES 2.4.A). For example, while only 9 percent of married-couple families received food stamps, 45 percent of single-parent families did so. Similarly, only one percent of married-couple families received housing benefits, but 17 percent of single-parent families did so.

Federal Taxes. Most families with children pay both social security (FICA) taxes¹⁶ and federal income taxes (see Figure ES 2.4.B). In 1993, 91 percent of all families with children paid social security taxes, while 76 percent paid federal income taxes. Married-couple families were more likely than single-parent families to pay federal taxes. While 97 percent of married-couple families paid social security taxes, only 76 percent of single-parent families did so. Similarly, while 88 percent of married-couple families paid federal income taxes, only 48 percent of single-parent families did so.
 

¹⁵ This benefit is paid to families with children, at least one working parent, and relatively low family income. If the credit is larger than a family's federal income tax liability, the difference is refunded to the family. The 29 percent figure refers only to families that received a refund and not to families whose EITC only partially offset their federal income tax liability.

¹⁶ FICA taxes cover the Old Age, Survivors, and Disability Insurance (Social Security) program plus Medicare.
 

ES 2.5 Child support nonpayment

The issue of child support has gained in importance in recent years. As rates of divorce and non-marital birth have risen, an increasing proportion of children and their custodial parents must depend on this source of income for financial support, and suffer correspondingly when it is not forthcoming. In addition, when noncustodial parents do not support their children financially, it is often left to the government to step in and provide support in the form of AFDC, food stamps, and other forms of assistance.

In many cases, and particularly where nonmarital births are concerned, families who should be receiving child support from the noncustodial parent lack a court order establishing how much is owed. Among those who do have court orders, about half (49 percent) do not receive all of the money they are owed in a given year.¹⁷

Table ES 2.5 shows the proportion of families who had court orders for child support but received no support at all for selected years between 1978 and 1991. Estimates are presented for all eligible families, and separately for population subgroups defined by marital status (married, divorced, separated, and never married) and race/ethnicity (white, black, and Hispanic). During that time period, the proportion of all eligible families who received no support whatsoever ranged between 21 and 28 percent. Rates of nonpayment decreased somewhat from 1978 to 1985, from 28 to 21 percent, then rose to about 25 percent by the end of the decade. This general historical pattern is consistent regardless of marital status, race, or ethnicity.

Differences by Marital Status. Women who are separated or never married were substantially less likely to have court orders for child support than those who were divorced, or who had remarried.¹⁸ Once a court order is established, however, the rates of nonpayment appear to be fairly similar across all marital status groups. In 1991, for example, rates of nonpayment ranged from about 24 percent for divorced women to 28 percent for never married women.¹⁹

Differences by Race and Ethnicity. In most years, eligible white families experienced lower rates of nonpayment than either black or Hispanic families. For example, in 1991, the most recent year for which estimates are available, the percentage of eligible families receiving no payment was 23 percent for whites, 31 percent for blacks, and 35 percent for Hispanics.

Methods of Payment. Some custodial parents receive their child support payments directly from the non-custodial parent or that parent's place of employment. Other parents use the Child Support Enforcement program, authorized under Title IV-D of the Social Security Act, to establish and enforce child support orders. Families receiving AFDC and Medicaid benefits are required to cooperate with their state's child support enforcement agency. Other families may request these services. Since fiscal year 1992, collections made by child support enforcement agencies have increased by nearly 40 percent, from $8 billion in fiscal year 1992 to $11 billion in fiscal year 1995.²⁰ For the same period, paternity establishments increased more than 40 percent and child support orders increased 16 percent.
 

¹⁷ Child Support for Custodial Mothers and Fathers. Current Population Reports Series P60, No. 187.

¹⁸ Ibid.

¹⁹ In some years rates of nonpayment appear to be substantially smaller for women who were separated or never married than for those who are divorced or remarried, but estimates for the former groups are based on small samples sizes which are subject to greater error. Disparities in sample size may account for the apparent cross-group differences in those years. ( See, for example, years 1983, 1985, and 1987)

²⁰ Preliminary data from the Office of Child Support Enforcement, U.S. Department of Health and Human Services.
 

PARENTAL AND YOUTH EMPLOYMENT

ES 3.1 Parental labor force participation

Over the last three decades the proportion of single-parent families has increased, as has the proportion of mothers who work regardless of marital status.²¹ These factors have reduced the percentage of children who have a parent at home full time. Figure ES 3.1 presents data on the percentage of children who have all resident parents participating in the labor force²² at some level for the years 1985, 1990, and 1994 through 1996.

Parents in the Labor Force by Family Type. Between 1985 and 1996, the percentage of children who have all resident parents in the labor force increased from 59 percent to 66 percent (see Figure ES 3.1). Since 1990, the percentage of children who have all resident parents participating in the labor force has been similar for both married-couple families and single-mother families. In 1996, the rate was 64 percent for married-couple families and 66 percent for single-mother families. The rate for children in single-father families has remained much higher, at 88 percent.

Parents in the Labor Force by Age of Child. Children under age 6 have been less likely than older children to have all resident parents in the labor force (see Table ES 3.1). In 1996, 58 percent of younger children had all resident parents in the labor force, compared with 70 percent for older children.

Parents in the Labor Force by Race and Ethnicity. Between 1985 and 1990, white children, black children, and Hispanic children all became more likely to have all their resident parents in the labor force (see Table ES 3.1). However, between 1990 and 1996, the rates stayed virtually the same for blacks and Hispanics, and increased modestly for whites. By 1996, 66 percent of white children, 64 percent of black children, and 50 percent of Hispanic children lived in families in which all resident parents were working.
 

²¹ Bianchi, S. M. 1995. "Changing Economic Roles of Women and Men" in State of the Union: American in the 1990s: Volume I. Reynolds Farley (ed.). New York: Russell Sage Foundation, 1995.

²² Participating in the labor force means either working or looking for work.
 

ES 3.2 Maternal employment

Over the last several decades, the increasing proportion of mothers moving into employment has had substantial consequences for the everyday lives of families with children. Maternal employment adds to the financial resources available to families, and is often the only source of income for families headed by single mothers although if child care services are purchased and unsubsidized, they may offset a substantial percentage of low-wage mothers' earnings.

Maternal employment rates for all mothers with children under age 18 increased steadily from 53 percent to 63 percent between 1980 and 1990 (see Figure ES 3.2.A). From 1990 to 1995, rates increased at a slower pace from 63 percent to 66 percent. This pattern of increasing maternal employment was evident for all mothers, regardless of the age of their children.

Differences by Age of Child. The percentage of mothers who are employed increases with the age of the youngest child for all time periods presented in Table ES 3.2.A. In 1995, 54 percent of mothers with children under age 3 were employed, compared to 62 percent and 73 percent for mothers with youngest children ages 3-5 and 6-17, respectively.

Differences by Race and Ethnicity. In 1995, 67 percent of white mothers, 62 percent of black mothers, and 49 percent of Hispanic mothers were employed (see Table ES 3.2.A). Black mothers were the most likely to be employed full-time (50 percent). Although all three groups substantially increased their rates of employment between 1980 and 1990, only white mothers continued to increase their rate of employment substantially between 1990 and 1995.

Differences by Marital Status. Throughout the period between 1988 and 1995, divorced mothers had higher rates of employment than never-married or currently married mothers. Employment increased from 62 percent to 67 percent for married mothers, from 40 to 48 percent for never-married mothers, and from 75 to 77 percent for divorced mothers.

Full-Time Versus Part-Time Employment. As shown in Figure ES 3.2.B, among all employed mothers, 70 percent were working full time in 1995. Employed mothers with older children were more likely to work full time than those with young children, with rates ranging from 65 percent for mothers with children under age 3, to 73 percent for mothers with a youngest child between the ages of 6 and 17. Divorced mothers were more likely to work full time (83 percent) than never-married mothers (72 percent) and married mothers (68 percent). Black mothers who were employed were more likely to work full time (82 percent) than white mothers (68 percent).
 

ES 3.3 Parental labor force detachment

Attachment to the labor force is, for the vast majority of families, a necessary prerequisite for financial and social stability. Children who have no parents in the labor force are at considerably higher risk of poverty, which can have long-term negative consequences for their well-being.^23,24

Figure ES 3.3 presents trends in the proportion of children living in families where there were no resident parents attached to the labor force. Data are presented for 1985, 1990, and 1994 through 1996, by family type, age of child, and race/ethnicity. During that period, approximately one in 10 children lived in families in which all resident parents were detached from the labor force. The percentages fluctuated within a narrow range throughout the period.

Labor Force Detachment by Family Type and Age of Child. The rate of parental labor force detachment for children in married couple families was very low, fluctuating between 2 and 3 percent between 1985 and 1996. However, detachment rates for children in families headed by single mothers were more than ten times higher throughout the period. In 1985, 39 percent of children living in single-mother families had a nonworking mother (see Figure ES 3.3). This percentage dropped to 34 percent by 1996. For children under age 6 in single-mother families, the reduction was somewhat larger, from 51 percent in 1985 to 44 percent in 1996 (see Table ES 3.3).

In families headed by single mothers, mothers of children under age six were more likely to be detached from the labor force than mothers of older children. The gap between the two age groups has narrowed over time, however, decreasing from 26 percentage points in 1985 (59 percent versus 33 percent) to 16 percentage points in 1996 (44 percent versus 28 percent). Children living in families headed by single fathers experienced parental labor force detachment rates between 11 and 14 percent during this time period. This is substantially less than rates experienced by children in families headed by single mothers (12 percent versus 34 percent in 1996), but substantially higher than those in married-couple families (2 percent).

Labor Force Detachment by Race and Ethnicity. White children were much less likely than black or Hispanic children to have no resident parents in the labor force in 1996, with rates of 7 percent, 25 percent, and 17 percent, respectively.
 

²³ Blau, F., and Grossberg, A. 1992. "Maternal Labor Supply and Children's Cognitive Development, "Review of Economics and Statistics.

²⁴ Duncan, G., and Brooks-Gunn, J. 1996. "Income Effects Across the Life Span: Integration and Interpretation," in Consequences of Growing Up Poor (G. Duncan and J. Brooks-Gunn, eds.).
 

ES 3.4 Secure parental labor force attachment

Parents' full-time employment over the course of an entire year indicates a secure attachment to the labor force and produces a degree of financial security for their children. As shown in Table ES 3.4, the percentage of children in families with at least one securely attached parent increased from 69 percent to 74 percent over the parental attachment to the labor force by racial and ethnic groups, poverty status, age of children, and family structure.

Differences by Race and Ethnicity. The parents of children in white families consistently have the highest rates of secure attachment to the labor force. Throughout the entire 1984-1995 period, more than 70 percent of white children had at least one parent with a secure labor force attachment. In 1995, the rate for white children was 78 percent (see Figure ES 3.4). In contrast only about half of black children and about 60 percent of Hispanic children lived in families with at least one parent who was securely attached to the labor force. In 1995 the rate for black children was 53 percent, and the rate for Hispanic children was 61 percent.

Differences by Poverty Status. Secure parental labor force attachment is associated with escaping poverty (see Figure ES 3.4). In 1995, only 25 percent of poor families with children had at least one parent with a secure labor force attachment while 86 percent of nonpoor families had at least one securely attached parent. The percentage of poor families with at least one parent securely attached to the labor force has increased over the period from 20 percent in 1984 to 25 percent in 1995.

Differences by Age of Children. Secure parental labor force attachment is more common among families with older children. In 1995, 78 percent of families with children ages 12 through 17 had at least one parent who was securely attached to the labor force, compared to 69 percent of families with children younger than age six (see Figure ES 3.4).

Differences by Family Structure. Married-couple families are far more likely than other family types to have at least one parent securely attached to the labor force. In 1995, 87 percent of married-couple families had at least one securely attached parent. In contract, only 38 percent of the single-mother families and 67 percent of the single-father families had a securely attached parent (see Figure ES 3.4).
 

ES 3.5 Child care

The child care needs of American families have been increasing over the past several decades as mothers have moved into the labor force in ever greater numbers. Child care that is reliable and of high quality is especially important for infants and preschoolers because they are dependent on caregivers for their basic needs and safety. Yet the quality of care varies substantially in the United States.²⁵ Research has clearly demonstrated that child care quality can have substantial impacts on the development of a young child's personality, cognitive skills, social skills, and well-being.

Child Care Centers and Preschools. As shown in Table ES.3.5.A, working mothers with preschool children have increasingly chosen care provided in day care centers and preschools. In 1965, only 8 percent of mothers working full time chose day care centers and preschools for child care. By 1993, 34 percent did so. Similarly, for children whose mothers worked part time, use of child care centers and preschools increased from 3 percent in 1965 to 23 percent in 1993.

Child Care in a Non-Relative's Home. For children of full-time working mothers, care in a non-relative's home peaked at 27 percent in the mid-1980s, then declined to 18 percent by 1993. Similarly, for children whose mothers worked part time, care in a non-relative's home peaked at 19 percent in 1982 and has since declined to 14 percent.

Care by Fathers and Other Relatives. The fraction of children of full-time working mothers cared for by fathers or other relatives in the child's home was 28 percent in 1993 exactly the same as in 1965. The fraction of children of part-time working mothers cared for by fathers or other relatives in the child's home was 38 percent in 1993 about the same as in 1977 and slightly higher than in 1965.

Child Care Arrangements by Various Child and Family Characteristics. Table ES.3.5.B presents 1993 estimates of the distribution of child care types used by all working mothers (regardless of hours worked) by child's race/ethnicity, age, mother's marital status and educational attainment, poverty status, monthly income, and AFDC program participation status. The information in this table indicates the following:

• Prior to age 3, the most common arrangement for child care is in another home by either a relative or non-relative. Forty percent for children under age one and 37 percent of children ages 1-2 whose mothers are employed are in this kind of care arrangement.
• For children ages 3-4 whose mothers are employed, the most common arrangement for care is child care centers and preschools. Thirty-nine percent of children are in this care arrangement. Twenty-four percent are cared for by a relative or non-relative in another home. Hispanic families, however, are much less likely than white and black non-Hispanics to use day care centers and preschools.
• Children with mothers of higher socioeconomic status are the most likely to be receiving care from a day care center or preschool. For example, 20 percent of poor children under age 5 receive care from such sources, compared to 31 percent of non-poor children. Only 20 percent of children whose mothers have less than a high school diploma receive care from a day care center or preschool, compared to 36 percent of children whose mothers have a college degree. In contrast, 52 percent of children of poor mothers are cared for by relatives compared with only 40 percent of children of non-poor mothers, and 54 percent of children of mothers without a high school diploma are cared for by relatives compared with only 31 percent of children of mothers with a college degree.
• Children whose families participate in the Aid to Families with Dependent Children (AFDC) program appear somewhat less likely than other children to attend day care centers or preschools (26 percent for participants versus 30 percent for nonparticipants). They are also less likely to be cared for by their fathers (5 percent for participants versus 16 percent for nonparticipants). However, 40 percent of children in AFDC families are cared for by other relatives compared with only 24 percent for children whose families do not participate in AFDC.

²⁵ Whitebook, M., Phillips, D., and Howes, C. 1989. National Child Care Staffing Study. Oakland, CA: Child Care Employees Project; and Hayes, C.D., Palmer, J.L., and Zaslow, M.J. (Eds.). 1990. Who Cares for America's Children? Child Care Policy for the 1990s. Washington, D.C.: National Academy Press.
 

ES 3.6 Detached Youth

"Detached youth" refers to young people ages 16-19 who are neither in school nor working. This detachment, particularly if it lasts for several years, increases the risk that a young person, over time, will have lower earnings and a less stable employment history than his or her peers who stayed in school and/or secured jobs.²⁶

Since 1975, the percentage of detached youth has fluctuated between 9 and 12 percent (see Table ES 3.6). In 1994, 10 percent of all youth ages 16-19 were detached.
 

²⁶ Brett Brown. 1996. "Who are America's Disconnected Youth?," report prepared for the American Enterprise Institute.
 

HOUSING

ES 4.1 Inadequate housing

Housing is a major expense for most families. A home's physical condition, its safety, the level of crowding in a household, and the quality of the surrounding neighborhood can all affect children's well-being.²⁷

Table ES 4.1 presents recent trends in the physical quality of housing for children, reporting the percentage of families with children under age 18 living in housing units with moderate to severe physical problems as defined by the U.S. Department of Housing and Urban Development.²⁸ Data are presented for every other year from 1985 through 1993. Across this time period, the percentage of children's households with moderate to severe physical problems fluctuated slightly from 9 percent in 1985 to 7 percent in 1993.²⁹

Differences by Type of Family. Data are also presented separately for three types of households containing children: married couples, other types of households containing two or more adults (which could include, for example, cohabiting couples, adult siblings, mother and grandmother, or adult house mates), and households with one or no adult. The data consistently indicate that married-couple families with children are the least likely to experience housing with physical problems as defined here, followed by households with one or no adult, and households with two or more adults who are not married. In 1993, for example, 6 percent of married-couple households with children, 10 percent of households with one or no adult, and 11 percent of households with two or more unmarried adults lived in housing with moderate to severe physical problems (see Figure ES 4.1).
 

²⁷ U.S. Department of Health and Human Services and U.S. Department of Education. 1995. The JOBS Evaluation: How Well are They Faring? AFDC Families with Preschool-aged Children in Atlanta at the Outset of the JOBS Evaluation. Washington, D.C.: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. See also Blackman, T., Evason, E., Melaugh, M. And Woods, R. 1989. Housing and Health: a Case Study of Two Areas in West Belfast. Journal of Social Policy, 18(1): 1-26.

²⁸ Physical problems can include problems with plumbing, heating, electricity, upkeep, and/or hallways.

²⁹ It is not clear whether or not this downward trend is statistically significant. The level of fluctuation in this estimate from year to year would indicate that the contrast may be the result of random error.

SECTION 3 HEALTH CONDITIONS AND HEALTH CARE (HC)

MORTALITY

HC 1.1.a Infant mortality

Infancy is commonly divided into the neonatal period, the first 27 days of life, and the postneonatal period, 28 days to less than one year. About two-thirds of infant deaths occur during the neonatal period (although advances in neonatology in recent decades have greatly improved the chances that infants will survive this period). The three leading causes of death to infants (one year and younger) are congenital anomalies, disorders relating to a short gestation period and low birth weight, and sudden infant death syndrome (SIDS).¹ In 1995, SIDS dropped from the second to the third leading cause of infant mortality. The SIDS decline accounted for nearly one-third of the total drop in infant mortality in 1995.²

The U.S. infant mortality rate has decreased rapidly over the past three decades. Between 1960 and 1995³ the rate fell from 26.0 to 7.5 infant deaths per thousand live births (see Figure HC 1.1.A.1). There was a steep decline in the rate of neonatal deaths (from 18.7 to 4.8 infant deaths per thousand live births) and a smaller, more gradual decline in the rate of postneonatal deaths (from 7.3 to 2.7 infant deaths per thousand live births).

International Comparisons. Despite declines in recent decades, the U.S. infant mortality rate ranks among the highest of industrialized nations. For example, in 1992, the rate of infant deaths per thousand live births was 4.5 in Japan, 6.6 in the United Kingdom, 6.8 in France, and 6.2 in Germany, compared to 8.5 deaths per thousand live births in the United States in that year.⁴ The Russian Federation, in contrast, has an infant mortality rate of 18.4 deaths per thousand live births.

Differences by Race and Ethnicity. While infant mortality rates have declined for all races and ethnic groups in the United States, there is nevertheless considerable variation by race and ethnicity (see Figure HC 1.1.A.2). Specifically:³
 

• For white infants, the infant mortality rate has declined by 72 percent between 1960 and 1995 from 22.9 to 6.3 deaths per thousand live births (see Table HC 1.1.A.1).
• For black infants, the infant mortality rate has declined by 66 percent between 1960 and 1995 from 44.3 to 14.9 deaths per thousand live births (see Table HC 1.1.A.1).
• For Hispanic infants, the infant mortality rate has declined by 24 percent between 1985 and 1994 from 8.6 to 6.5 deaths per thousand live births (see Table HC 1.1.A.1).

  
  For Asian infants, the infant mortality rate has declined by 20 percent from an average of 8.3 deaths per thousand live births during the period 1983-1985 to an average of 6.6 deaths per thousand live births during the period 1989-1991⁵ (see Table HC 1.1.A.2).

• For Native American infants, the infant mortality rate declined by nine percent from an average of 13.9 deaths per thousand live births during the period 1983-1985 to an average of 12.6 deaths per thousand live births during the period 1989-1991 (see Table HC 1.1.A.2).

Figure HC 1.1.A.1  Infant, Neonatal, and Postneonatal Deaths Per Thousand Live Births, 1960-1995

Notes: Includes births and deaths of persons who were not residents of the 50 states and the District of Columbia. Data by race for 1960 are by race of child; all other years are by race of mother. Data for 1995 are preliminary.
Source: National Center for Health Statistics. Health, United States, 1995. Hyattsville, Maryland: Public Health Service. 1996. Table 23 for totals and race breaks. Data for 1994 and 1995 data from: Births and Deaths: United States, 1995. Monthly Vital Statistics Report; Vol. 45, No. 3, Supplement 2. Hyattsville, Maryland: Public Health Service, 1996.
 

Figure HC 1.1.A.2  Infant Deaths Per Thousand Live Births, by Race and Hispanic Origin,a 1960-1995

Note: ^aHispanic rates not available prior to 1985. Infant mortality by Hispanic-origin reported by 17 States and the District of Columbia in 1985; 45 States, New York State (excluding New York City), and the District of Columbia in 1990; 47 States, New York State (excluding New York City), and the District of Columbia in 1991; 48 states and the District of Columbia in 1992; and 49 States and the District of Columbia in 1993 and 1994. bIncludes births and deaths of persons who were not residents of the 50 states and the District of Columbia. cData by race for 1960 are by race of child; all other years are by race of mother. dData for 1995 are preliminary.
Source: National Center for Health Statistics. Health, United States, 1995. Hyattsville, Maryland: Public Health Service. 1996 (table 23 for totals and race breaks). 1970 data from: National Center for Health Statistics. Vital Statistics of the United States, 1992. Vol. II, Mortality, Part A. Washington: Public Health Service. 1996 (table 2-2). Hispanic data for 1985 from: National Center for Health Statistics: Vital Statistics of the United States, 1985, Vol. II, Mortality, Part A. Washington: Public Health Service. 1988 (table 2-19). 1990 Hispanic data from: Monthly Vital Statistics Report. Vol. 41, No. 7 (Supplement), January, 1993 (table 26). 1991 Hispanic data from: Monthly Vital Statistics Report, Vol. 42, No. 2 (Supplement), August, 1993 (table 25). 1992 Hispanic data from: Monthly Vital Statistics Report, Vol. 43, No. 6 (Supplement), March, 1995 (table 28). 1993 Hispanic data from: Monthly Vital Statistics Report, Vol. 44, No. 7(s), February, 1996 (table 32). 1994 Hispanic data from: Singh, G.K., Kochanek, K.D., and MacDorman, M.F. Advance Report of Final Mortality Statistics, 1994. Monthly Vital Statistics Report, Vol. 45, No. 3. Hyattsville, Maryland: Public Health Service, 1996 (table 25). Data for 1994 and 1995 from: Rosenberg, H.M., Ventura, S.J., Maurer, J.D., Heuser, R.L. and Freedman, M.A. Births and Deaths: United States, 1995. Monthly Vital Statistics Report; Vol. 45, No. 3, Supplement 2. Hyattsville, Maryland: Public Health Service, 1996 (table 13).
 
 

Table HC 1.1.A.1 nfant, Neonatal, and Postneonatal Deaths per Thousand Live Births, by Race and Hispanic Origin, 1960-1995
			1960a,b	1970	1980	1985	1990	1991	1992	1993	1994	1995c
Infant (under one year)
Death Rate			26	20	12.6	10.6	9.2	8.9	8.5	8.4	8	7.5
	White		22.9	17.6	10.9	9.2	7.6	7.3	6.9	6.8	6.6	6.3
	Black		44.3	33.3	22.2	19	18	17.6	16.8	16.5	15.8	14.9
	Hispanicd					8.6	7.8	7.5	6.8	6.7	6.5
Neonatal (under 28 days)
Death Rate			18.7	15.1	8.5	7	5.8	5.6	5.4	5.3	5.1	4.8
	White		17.2	13.7	7.4	6	4.8	4.5	4.3	4.3	4.2	4
	Black		27.8	23.2	14.6	12.6	11.6	11.2	10.8	10.7	10.2	9.6
	Hispanicd					5.4	5	4.6	4.3	4.1	4.1
Postneonatal (28 days to under one year)
Death Rate			7.3	4.9	4.1	3.7	3.4	3.4	3.1	3.1	2.9	2.7
	White		5.7	4	3.5	3.2	2.8	2.8	2.6	2.5	2.4	2.2
	Black		16.5	10.1	7.6	6.4	6.4	6.3	6	5.8	5.6	5.3
	Hispanicd					3.2	2.8	2.8	2.5	2.6	2.5
Notes: aIncludes births and deaths of persons who were not residents of the 50 states and the District of Columbia.  bData by race for 1960 are by race of child; all other years are by race of mother.   cData for 1995 are preliminary.  dInfant mortality by Hispanic-origin reported by 17 States and the District of Columbia in 1985; 45 States, New York State (excluding New York City), and the District of Columbia in 1990; 47 States, New York State (excluding New York City), and the District of Columbia in 1991; 48 States and the District of Columbia in 1992; and 49 States and the District of Columbia in 1993 and 1994.  Source: National Center for Health Statistics. Health, United States, 1995. Hyattsville, Maryland: Public Health Service. 1996 (table 23 for totals and race breaks). 1970 data from: National Center for Health Statistics. Vital Statistics of the United States, 1992. Vol. II, Mortality, Part A. Washington: Public Health Service. 1996 (table 2-2). Hispanic data for 1985 from: National Center for Health Statistics: Vital Statistics of the United States, 1985, Vol. II, Mortality, Part A. Washington: Public Health Service. 1988 (table 2-19). 1990 Hispanic data from: Monthly Vital Statistics Report. Vol. 41, No. 7 (Supplement), January, 1993 (table 26). 1991 Hispanic data from: Monthly Vital Statistics Report, Vol. 42, No. 2 (Supplement), August, 1993 (table 25). 1992 Hispanic data from: Monthly Vital Statistics Report, Vol. 43, No. 6 (Supplement), March, 1995 (table 28). 1993 Hispanic data from: Monthly Vital Statistics Report, Vol. 44, No. 7(s), February, 1996 (table 32). 1994 Hispanic data from: Singh, G.K., Kochanek, K.D., and MacDorman, M.F. "Advance Report of Final Mortality Statistics, 1994." Monthly Vital Statistics Report, Vol. 45, No. 3. Hyattsville, Maryland: Public Health Service, 1996 (table 25). Data for 1994 and 1995 from: Rosenberg, H.M., Ventura, S.J., Maurer, J.D., Heuser, R.L. and Freedman, M.A. " Births and Deaths: United States, 1995." Monthly Vital Statistics Report; Vol. 45, No. 3, Supplement 2. Hyattsville, Maryland: Public Health Service, 1996 (table 13).

 
 

Table HC 1.1.A.2  Infant, Neonatal, and Postneonatal Deaths Per Thousand Live Births for Asians and Native Americans, Combined Years: 1983-1985, 1986-1988 and 1989-1991
					1983-1985	1986-1988	1989-1991
Infant (under 1 year)
	Infant Death Rate (All Races)				10.6	9.8	9
		Asiana			8.3	7.3	6.6
		Native Americanb			13.9	13.2	12.6
Neonatal (under 28 days)
	Neonatal Death Rate (All Races)				6.9	6.3	5.7
		Asiana			5.2	4.5	3.9
		Native Americanb			6.7	5.9	5.9
Postneonatal (28 days to one year)
	Postneonatal Death Rate (All Races)				3.7	3.5	3.3
		Asiana			3.1	2.8	2.6
		Native Americanb			7.2	7.3	6.7
aIncludes Pacific Islanders.  bIncludes Alaskan Natives.   Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Data computed by the Division of Health and Utilization Analysis from data compiled by the Division of Vital Statistics for the National Linked Files of Live Births and Infant Deaths.

¹ Rosenberg, H.M., Ventura, S.J., Maurer, J.D., Heuser, R.L., and M.A. Freedman. "Births and Deaths:United States, 1995." Monthly Vital Statistics Report. Vol. 45, No. 3 (Supplement 2). Hyattsville, Md.: National Center for Health Statistics. 1996.

² Press release from the U.S. Department of Health and Human Services. "Reduction in SIDS Deaths Helps Bring Low Infant Mortality." October 9, 1996.

³ 1995 data are preliminary.

⁴ National Center for Health Statistics. "Health, United States, 1995." Hyattsville, Maryland: Public Health Service. 1996.

⁵ Infant mortality data for Asians and Native Americans are presented from the national linked birth and infant death files in Table HC 1.1.A.1. Rather than relying solely on the often inaccurate reporting of race on death certificates of infants, the linked files use race from birth certificates and, therefore, provide more accurate data for these populations. The National Linked Birth and Infant Death Files data are available from 1983-1991. The linked files will be produced on a regular basis again beginning with 1995 data.

HC 1.1.b Child and youth mortality

Injuries are a common cause of death for children of all ages.⁶ Among children ages one to four, injuries accounted for 44 percent of all deaths in 1993. Following injury, the leading causes of death in this age group were congenital anomalies, malignant neoplasm, diseases of the heart, and HIV or AIDS.⁷ Injuries accounted for 52 percent of deaths to children ages five through 14 in 1993, and 80 percent of all deaths to adolescents ages 15 through 19.⁸

Overall, child mortality rates have decreased substantially over the past several decades⁹ (see Table HC 1.1.B.1). In 1994, the latest year for which data were available, mortality rates per 100 thousand were 42.9 for one- through four-year-olds, 19.9 for five- through nine-year-olds, 25.2 for 10- through 14-year-olds, and 86.8 for 15- through 19-year-olds.

Differences by Age. The most dramatic declines in mortality occurred among children under age 15 with decreases of approximately 60 percent among children ages one to four and five to nine, and a 43 percent decrease among children ages 10 through 14 since 1960 (see Figure HC 1.1.B.1). Most of the decline in the mortality rate for these groups occurred between 1960 and 1990; mortality rates since then have been fairly constant. In contrast, mortality rates for youth ages 15 through 19 have decreased by only six percent since 1960. Moreover, unlike the fairly steady declines among the younger age groups, the adolescent mortality rate has had a variable pattern over the last thirty years (see Figure HC 1.1.B.1).

Differences by Race and Ethnicity. Multiyear data from the National Center for Health Statistics is used to examine the differences in the mortality rate of children and youth for several racial and ethnic groups across two time periods 1989-1991 and 1992-1993 (see Table HC 1.1.B.2). For both children and youth ages one to 14 and ages 15 to 24, blacks have the highest mortality rate, followed by Native Americans, Hispanics and whites. Asian children and youth consistently have the lowest mortality rate. The disparity in mortality rates by race and ethnic group is greater among youth ages 15 to 24 than among children ages one to 14 (see Table HC 1.1.B.2).

The mortality rate for children ages one to 14 decreased for all racial and ethnic groups except Native Americans between the periods 1989-1991 and 1992-1993. In contrast, the mortality rate for youth ages 15 to 24 declined only for whites and Native Americans, and increased for blacks, Hispanics and Asians across these two time periods.

Differences by Race for Younger Children. Data for earlier decades are available only for black and white children (see Table HC 1.1.B.1). These data show substantial differences between white and black children since at least 1970 for children ages one through four, five through nine, and 10 through 14. By 1994, the mortality rate for black children ages 10 through 14 was nearly 65 percent higher than the rate for white children in that age group, 81 percent higher for children ages five though nine, and twice as high for children ages one through four.

Differences by Race For Adolescents. The blackwhite disparity among adolescents ages 15 through 19 was substantial in 1970, but had declined by 1980 to the point where black youth registered lower mortality rates than white youth (see Figure HC 1.1.B.2). This reversal was short lived, however. Black mortality rates surged from a low of 85.2 per 100 thousand in 1985 to 145.0 per 100 thousand by 1994, while white mortality rates remained fairly stable. Much of this recent increase in black teen mortality reflects a substantial increase in black teen male homicide rates, which are reviewed in Section HC 1.2.B of this report.

Differences by Gender. Male child death rates are higher than female rates for all age groups, but the differences are far more pronounced for the older age groups, for whom violent and injury-related deaths disproportionately affect males¹⁰ (see Table HC 1.1.B.1).
 
 

Figure HC 1.1.B.1  Child and Youth Mortality Rates by Age Group, 1960-1994  (rates per 100,000 population in age group)

Source: National Center for Health Statistics (NCHS), unpublished data provided by the Statistical Resources Branch and Gardner, P. and Hudson, B.L. Advance Report of Final Mortality Statistics, 1993. National Center for Health Statistics. 1996.
 
 

Figure HC 1.1.B.2  Mortality Rates for White and Black Youth Ages 15 to 19, 1970-1994 (rates per 100,000 population in age group)

Source: National Center for Health Statistics (NCHS), unpublished data provided by the Statistical Resources Branch and Gardner, P. and Hudson, B.L. Advance Report of Final Mortality Statistics, 1993. National Center for Health Statistics. 1996.
 
 

Table HC 1.1.B.1  Child and Youth Mortality Rates by Age Group, Gender and Race:  Selected Years, 1060 to 1994 (rates per 100,000 population in age group)
				1960	1965	1970	1975	1980	1985	1990	1991	1992	1993	1994
1-4 years
All Children				109.1	95.9	84.5	69.9	63.9	51.8	46.8	47.4	43.6	44.8	42.9
Gender
	Male			119.5	104.3	93.2	76.7	72.6	58.5	52.4	52.0	48.0	49.5	47.3
	Female			98.4	87.1	75.4	62.7	54.7	44.8	41.0	42.7	39.0	39.9	38.2
Race
	White			95.2	83.2	75.1	63.3	57.9	46.6	41.1	41.7	38.1	38.3	36.5
	Black			__	__	140.0	106.2	97.6	80.7	76.8	79.7	73.2	79.1	77.2
5-9 years
All children				49.0	43.9	42.1	35.2	30.4	25.0	22.2	21.5	20.4	21.1	19.9
Gender
	Male			56.3	50.8	49.7	41.4	35.0	28.5	25.6	24.5	23.7	23.2	22.6
	Female			41.5	36.8	34.2	28.6	25.6	21.4	18.5	18.4	16.8	19.0	17.0
Race
	White			46.2	40.8	39.9	33.0	28.4	22.9	20.3	19.8	18.3	19.0	17.6
	Black			__	__	56.4	47.4	41.7	36.2	32.3	32.0	32.1	32.9	31.8
10-14 years
All Children				44.0	40.5	40.6	35.3	30.8	28.0	26.0	25.8	24.6	25.6	25.2
Gender
	Male			55.0	50.9	51.3	44.9	38.3	35.0	31.6	32.9	30.7	31.7	31.2
	Female			32.6	29.7	29.5	25.3	22.9	20.6	20.2	18.2	18.2	19.2	18.8
Race
	White			41.4	38.6	38.4	33.7	29.8	27.0	24.3	24.2	22.8	23.7	23.0
	Black			__	__	54.6	44.3	36.6	34.8	36.6	36.4	35.3	37.2	37.9
15-19 years
All Children				92.2	95.3	110.3	100.2	97.9	80.5	87.9	89.0	84.3	86.9	86.8
Gender
	Male			130.1	136.0	157.8	145.4	141.4	113.4	127.2	128.6	122.4	126.0	126.6
	Female			54.0	53.9	61.7	53.8	53.1	46.2	46.4	47.2	44.0	45.6	44.8
Race
	White			87.9	90.9	103.1	98.0	99.1	80.2	81.4	80.5	75.6	77.0	76.8
	Black			__	__	158.0	114.4	92.3	85.2	127.7	141.2	135.5	143.6	145.0
Source: National Center for Health Statistics (NCHS), unpublished data provided by the Statistical Resources Branch and Gardner, P. and Hudson, B.L. "Advance Report of Final Mortality Statistics, 1993." National Center for Health Statistics. 1996.

 
 

Table HC 1.1.B.2 Child and Youth Mortality Rates by Age Group, Gender, Detailed Race and Hispanic Origina for 1989-1991 and 1992-1993 (rates per 100,000 population in age group)
					Combined Years 1989-1991			Combined Years 1992-1993
					Total	Male	Female	Total	Male	Female
ONE TO 14 Years
	All Races				31.4	36.2	26.3	29.3	33.7	24.6
		White			28.4	32.8	23.8	26.1	30.3	21.7
		Black			48.3	56.1	40.3	47.1	53.4	40.7
		Asianb			22.7	25.3	20.0	20.3	23.1	17.4
		Native Americanc			37.3	45.1	29.2	38.9	47.0	30.6
		Hispanic Origin			30.2	34.7	25.5	28.4	32.4	24.2
15 TO 24 YEARS
	All Races				99.1	146.1	50.0	97.0	144.0	47.9
		White			89.3	129.5	47.0	84.2	122.3	44.1
		Black			161.9	254.9	69.8	174.8	279.5	70.6
		Asianb			50.1	70.8	28.1	56.1	80.1	31.1
		Native Americanc			142.0	208.3	71.1	129.4	184.2	71.4
		Hispanic Origin			103.3	156.5	40.9	107.5	167.3	40.2
Note: aPersons of Hispanic origin may be of any race. The four race groups listed in the table include persons of Hispanic and non-Hispanic origin. Death rates reported for white, black, and Hispanic persons are based on highly consistent information. However, persons identified as American Indian or Asian in the data from the Census Bureau (denominator of death rates) are sometimes misreported as white on the death certificate (numerator), resulting in underestimate of about 22-30 percent for death rates of American Indians and 12 percent for death rates of Asians (National Centers for Health Statistics, Health United States 1993, Table 33; Sorlie, P.D., Rogot E., and Johnson, N.J. "Validity of demographic characteristics on the death certificate," Epidemiology 3(2): 181-184, 1992).  bAsian and Pacific Islander.  cNative American or Alaskan Native.  Source: 1989-1991 data from: Centers for Disease Control and Prevention, National Center for Health Statistics (1994), Health United States 1993, Table 32; NCHS: Data computed by the Division of Analysis from data compiled by the Division of Vital Statistics and from national population for race groups from national population estimates for race groups. 1992-1993 data computed by Infant and Child Health Studies Branch, National Center for Health Statistics from Mortality Data compiled by Division of Vital Statistics.

⁶ Injury-related mortality includes death from motor vehicle crashes, fires and burns, drowning, suffocation, and accidents caused by firearms and other explosive materials, among others.

⁷ Gardner, P., and Hudson, B.L. (1996) "Advance Report of Final Mortality Statistics, 1993." Monthly Vital Statistics Report. Vol. 44, No.7 (S). Hyattsville, Maryland: National Center for Health Statistics; and, National Center for Health Statistics (1996). 1993 Detail Mortality File. Unpublished data. Cited in: Health Resources & Services Administration. Child Health USA 95. DHHS Pub. No. HRSA-M-DSEA-96-5. Public Health Service, Washington, 1996.

⁸ Discussion and data regarding motor vehicle crashes, the largest category of injury-related death for 15-19 year olds, follows in the next section [HC 1.2].

⁹ Health Resources & Services Administration. Child Health USA 95. DHHS Pub. No. HRSA-M-DSEA-96-5. Public Health Service, Washington, 1996.

¹⁰ Section HC 1.2 further highlights the differences in mortality rates between males and females ages 15-19 for violent and injury-related deaths.
 

HC 1.2.a Youth motor vehicle deaths

Motor vehicle deaths are among the leading causes of injury-related mortality¹¹ for 15- to 19-year-olds, accounting for approximately 40 percent of all teenage injury deaths in 1993.¹² However, as a fraction of all violent deaths to teens, motor vehicle crashes have declined. In 1994, motor vehicle deaths claimed 29.3 lives per 100 thousand teens ages 15 through 19, compared to 43.6 per 100 thousand teens in 1970 (see Figure HC 1.2.A). Slight increases in the rate of motor vehicle crash deaths among youths were seen in 1993 and 1994.

Differences by Gender and Race. The decrease in the rate of youth motor vehicle deaths between 1970 and 1994 has been greatest among males, falling from 67.1 to 41.7 deaths per 100 thousand among white males, and from 43.4 to 29.0 deaths per 100 thousand among black males (see Table HC 1.2.A). Among females ages 15 through 19, rates declined less dramatically over this period, from 24.4 to 21.3 per 100 thousand for whites, and from 11.1 to 10.4 per 100 thousand for blacks.

Differences by Age. Among youth ages 10 through 14, motor vehicle death rates are quite low in comparison to older youth, and have dropped from 9.6 to 6.0 per 100 thousand between 1970 and 1994. This decline was evident for both white and black males and females, with most of the decline occurring before 1990.
 

Figure HC 1.2.A  Youth Motor Vehicle Crash Deaths: 1970-1994 (rate per 100,000)

Source: National Center for Health Statistics, unpublished work tables prepared by the Mortality Statistics Branch, Division of Vital Statistics, 1995, and 1996.
 

Table HC 1.2.A Youth Motor Vehicle Crash Deaths: Selected Years, 1970-1994  (rate per 100,000)
Population
Groups		1970	1975	1980	1985	1990	1991	1992	1993	1994
All youth
	Ages 10-14	9.6	8.4	8.1	7.4	6.4	6.1	5.5	5.9	6.0
	Ages 15-19	43.6	38.4	43.0	33.5	33.1	31.2	28.2	28.6	29.3
White males
	Ages 10-14	12.6	10.9	10.9	9.8	7.7	7.8	7.0	7.1	7.5
	Ages 15-19	67.1	61.7	69.1	51.3	49.3	44.5	39.6	41.6	41.7
White females
	Ages 10-14	6.6	5.8	5.7	5.6	5.3	4.4	4.1	4.4	4.8
	Ages 15-19	24.4	20.6	25.6	22.6	22.2	23.0	21.0	20.2	21.3
Black males
	Ages 10-14	11.9	9.6	7.9	8.9	7.9	8.8	7.8	8.3	7.6
	Ages 15-19	43.4	24.6	24.4	22.1	28.7	29.5	26.2	26.7	29.0
Black females
	Ages 10-14	6.4	4.2	4.0	3.0	3.8	3.3	3.6	4.8	4.8
	Ages 15-19	11.1	7.1	6.7	7.5	9.7	9.0	9.1	8.2	10.4
Source: National Center for Health Statistics, unpublished work tables prepared by the Mortality Statistics Branch, Division of Vital Statistics, 1995 and 1996.

¹¹ Injury-related mortality is the leading cause of death for 15-19 year old teenagers, accounting for 80% of all deaths. Injury-related mortality includes death from motor vehicle crashes, fires and burns, drowning, suffocation, and accidents caused by firearms and other explosive materials, among others.

¹² National Center for Health Statistics (1996). 1993 Detail Mortality File. Unpublished data.
 
 

HC 1.2.b Youth homicides

The rate of death from homicide for teens ages 15 through 19 more than doubled between 1970 and 1994, increasing from 8.1 per 100 thousand in 1970 to 20.3 per 100 thousand in 1994 (see Table HC 1.2.B.1). Virtually all of this increase has taken place since 1985 (see Figure HC 1.2.B.1).

Male Youth Homicide Rates by Race. As large as the overall increase has been, this trend has been most alarming for males ages 15 to 19. The rate of death from homicide for this age group of black males has increased dramatically from 46.7 per 100 thousand in 1985 to 135.8 per 100 thousand in 1994, a rate nearly nine times that for white males of the same age (see Figure HC 1.2.B.2). The homicide rate for black males aged 15 to 19 actually declined nearly 30 percent from 1970 to 1985, but rose again after 1985. Even with slight declines in the homicide rate in 1992 and 1994, the rate for young black males has nearly tripled since 1985. While the homicide rate for white males of the same age group (15 through 19) is substantially less than that of black males, this rate has also doubled since 1985 (from 7.2 to 15.4 per 100 thousand), and has tripled since 1970.

Female Youth Homicide Rates by Race. Homicide rates for females ages 15 through 19 of both races are considerably lower than among males in this age group. For example, the rate for black females was 15.1 per 100 thousand in 1994, approximately one-ninth the rate for black males. The gender disparity in homicide rates is also large for whites, although it is not as great as that between black males and females. In 1994, the homicide rate for white females ages 15 through 19 was 3.4 deaths per 100 thousand, nearly a quarter of that for white males. As is the case for males, the youth homicide rate for black females is higher than the rate for white females four and one half times higher in 1994.

Homicide Rates for Younger Youth. The homicide rate for youth ages 10 through 14 was 2.2 per 100 thousand in 1994 substantially lower than the rate for older youth. Nevertheless, this rate has nearly doubled between 1970 and 1994. For whites, there is little difference in the homicide rates of males and females in this younger age group. For blacks, however, there is a disparity between males and females, although it is not as pronounced as the difference for older black males and females. In 1994, the homicide rate of 9.1 for young black males was virtually twice that of females in the same age group, with a rate of 4.6 per 100 thousand.

Homicides Involving Firearms. In examining the rate of homicides due to firearms in proportion to total homicides, it is evident that firearms have been involved in the majority of youth homicides since 1980 (see Figure HC 1.2.B.3). Deaths to youth ages 15 through 19 involving firearms accounted for 66 percent of the total deaths due to homicide in 1980 (7.0 firearm deaths per 100 thousand out of a total of 10.6 deaths per 100 thousand due to homicide). The percentage of firearm-related homicides increased to 87 percent by 1994. Homicides due to firearms are more likely among black youth than among white youth, and most particularly among black males ages 15 through 19 (see Table HC 1.2.B.2). In 1994, 93 percent of homicides among older male black youth (ages 15 through 19) involved a firearm, compared to 84 percent among white male youth. Homicides among female youth involve a firearm less often, although firearms are still the means of the majority of female homicides.
 

Figure HC 1.2.B.1  Youth Homicides: 1970-1994 (rate per 100,000)

Source: National Center for Health Statistics, unpublished work tables prepared by the Mortality Statistics Branch, Division of Vital Statistics, 1995 and 1996.
 
 

Figure HC 1.2.B.2  Male Youth Homicides Ages 15-19, by Race: 1970-1994 (rate per 100,000)

Source: National Center for Health Statistics, unpublished work tables prepared by the Mortality Statistics Branch, Division of Vital Statistics, 1995 and 1996.
 
 

Figure HC 1.2.B.3  Percentage of Homicides to Youth Ages 15-19 Due to Firearmsa: 1980-1994

Note: aIncludes assault by handguns and all other and unspecified firearms.
Source: National Center for Health Statistics, unpublished work tables prepared by the Mortality Statistics Branch, Division of Vital Statistics, 1996.
 
 

Table HC 1.2.B.1 Youth Homicidesa: Selected Years, 1970-1994 (rate per 100,000)
			1970	1975	1980	1985	1990	1991	1992	1993	1994
All Youth
	Ages 10-14		1.2	1.2	1.4	1.5	2.1	2.2	2.4	2.5	2.2
	Ages 15-19		8.1	9.6	10.6	8.6	17	19.6	19.3	20.7	20.3
White males
	Ages 10-14		0.6	1	1.1	1.4	1.7	1.8	2	1.9	1.8
	Ages 15-19		5.2	8.1	10.9	7.2	12.5	14.4	15.2	15.2	15.4
White females
	Ages 10-14		0.6	0.8	1.1	0.9	0.9	0.9	1	1.2	0.9
	Ages 15-19		2.1	3.2	3.9	2.7	3.6	3.6	3.6	3.6	3.4
Black males
	Ages 10-14		6.8	4.1	3.9	4.2	8.1	9.1	9.6	10.5	9.1
	Ages 15-19		65.2	51.4	48.8	46.7	115.7	134.6	128.5	140.7	135.8
Black females
	Ages 10-14		2.3	2.3	2.4	1.7	4.8	3.8	5.1	5.2	4.6
	Ages 15-19		10.6	15.3	11	10.4	15.6	15.6	14.2	18.4	15.1
Note: aHomicide includes death by legal intervention  Source: National Center for Health Statistics, unpublished work tables prepared by the Mortality Statistics Branch, Division of Vital Statistics, 1995 and 1996.

 
 

Table HC 1.2.B.2 Youth Homicides Due to Firearmsa: Selected Years, 1980-1994 (rate per 100,000)
			1980	1985	1990	1991	1992	1993	1994
All Youth
	Ages 10-14		0.8	0.8	1.5	1.6	1.9	1.9	1.7
	Ages 15-19		7	5.7	13.8	16.4	16.7	17.8	17.7
White Males
	Ages 10-14		0.7	0.8	1.1	1.2	1.5	1.3	1.3
	Ages 15-19		7.2	4.9	9.4	11.6	12.9	12.5	13
White Females
	Ages 10-14		0.4	0.4	0.4	0.4	0.6	0.6	0.4
	Ages 15-19		1.7	1.1	1.7	1.9	2.1	2	2.2
Black Males
	Ages 10-14		3.2	2.8	6.1	7.6	7.7	9.2	7.1
	Ages 15-19		38.4	36.7	104.4	122.5	118.7	130.1	126.6
Black Females
	Ages 10-14		1	*	2.9	2.5	3.2	3.3	3
	Ages 15-19		6.3	4.7	9.6	10.3	9.8	13.4	9.9
Note: Calculations by Child Trends, Inc., to combine rates of assault by handguns and rates of assault by all other and unspecified firearms may affect overall rates due to previous rounding.  aIncludes assault by handguns and all other and unspecified firearms.  * = Not calculated because of unreliability due to infrequency of the event.  Source: National Center for Health Statistics. Unpublished work tables prepared by the Morality Statistics Branch, Division of Vital Statistics, 1996.

 

HC 1.2.c Youth suicides

Suicide, like homicide, has come to play a proportionately larger role in teen deaths over the past several decades. Between 1970 and 1990, the suicide death rate for youth ages 15 through 19 nearly doubled, from 5.9 to 11.1 per 100 thousand (see Figure HC 1.2.C). Since 1990, the overall suicide death rate has stabilized at approximately 11 deaths per 100 thousand youth ages 15 through 19.

Differences by Gender. Male teens are more likely than females to commit suicide (see Table HC 1.2.C). The suicide rate for white males ages 15 through 19 was 18.7 per 100 thousand in 1994, more than five times the rate of 3.5 per 100 thousand for white females. The suicide rate for black males ages 15 through 19 is 16.6 deaths per 100 thousand, compared to 2.4 per 100 thousand for black females in this age group.

Differences by Race. White male youth ages 15 through 19 have long had a higher suicide rate than their black male peers (see Table HC 1.2.C). In 1970, white males ages 15 through 19 were twice as likely as black males to die from suicide (9.4 versus 4.7 per 100 thousand). However, the gap between white and black male suicide rates has narrowed in recent years, with suicide rates of 18.7 and 16.6 per 100 thousand in 1994 for white and black males, respectively. Among females ages 15 through 19, white females and black females were equally likely to commit suicide in 1970 with rates of 2.9 per 100 thousand. By 1975, white female suicide rates were twice that of their black peers ages 15 through 19. This trend held in all subsequent years in which data could be calculated for black females until 1994, when the suicide rate for ages 15 through 19 was 2.4 per 100 thousand among black females and 3.5 per 100 thousand among white females.

Suicide Rates for Younger Youth. While considerably lower, suicide rates for youth ages 10 through 14 have followed trends similar to those among older youth, with males having higher rates of suicide than females, and whites having higher suicide rates than blacks (see Table HC 1.2.C). In this age group, suicide is infrequent for both sexes and races, making gender or racial differences small as well.
 

Figure HC 1.2.C  Youth Suicides: Selected Years 1970-1994 (rate per 100,000)

Source: National Center for Health Statistics, unpublished work tables prepared by the Mortality Statistics Branch, Division of Vital Statistics, 1995 and 1996.
 
 

Table HC 1.2.C Youth Suicides: Selected Years 1970-1994 (rate per 100,000)
			1970	1975	1980	1985	1990	1991	1992	1993	1994
All Youth
	Ages 10-14		0.6	0.8	1.2	1.6	1.5	1.5	1.7	1.7	1.7
	Ages 15-19		5.9	7.5	8.5	9.9	11.1	11	10.8	10.9	11.1
White males
	Ages 10-14		1.1	1.4	1.4	2.5	2.3	2.4	2.6	2.4	2.5
	Ages 15-19		9.4	12.9	15	17.1	19.3	19.1	18.4	18.5	18.7
White females
	Ages 10-14		0.3	0.4	0.3	0.9	0.9	0.8	1.1	1	1
	Ages 15-19		2.9	3.1	3.3	4.1	4	4.2	3.7	4.2	3.5
Black males
	Ages 10-14		0.3	0.2	0.5	*	1.6	2	2	2.3	2.1
	Ages 15-19		4.7	6.1	5.6	8.2	11.5	12.2	14.8	14.4	16.6
Black females
	Ages 10-14		0.4	0.3	0.1	*	*	*	*	*	*
	Ages 15-19		2.9	1.5	1.6	1.5	1.9	*	1.9	*	2.4
* = Not calculated because of unreliability due to infrequency of the event.  Source: National Center for Health Statistics, unpublished work tables prepared by the Mortality Statistics Branch, Division of Vital Statistics, 1995 and 1996.

 

HEALTH CONDITIONS

HC 2.1 Healthy births

A healthy birth is defined here as a birth with the following characteristics: a five-minute Apgar¹³ score of nine or more out of ten, weight at birth of at least 2,500 grams (5.5 pounds), a gestational age of at least 37 weeks, and maternal receipt of prenatal care within the first trimester.

Increasing Percentages of Healthy Births. Table HC 2.1 reports the percentage of all births qualifying as healthy births for 1985, 1991 and 1994, by race and ethnic group, and by the mothers marital status and educational background. The table shows an increase in the percentage of all healthy births between 1985 and 1994, as well as increases for each population subgroup presented. The percent of all births qualifying as healthy increased from 59.1 percent to 65.9 percent during that period of time.

Continued Disparities Across Population Subgroups. While healthy births are increasing for all the subgroups presented in Table HC 2.1, there are also persistent disparities across subgroups. For example:

• In 1994, 49.7 percent of births to black women were defined as healthy, compared to 55.4 percent of births to Hispanic women and 69.8 percent of births to white women.
• In 1994, 73 percent of births to married women were healthy, compared to 50.6 percent of births to single women.
• In 1994, 70.1 percent of births to mothers with at least a high school education were healthy, compared to 48.8 percent of births to mothers with less than a high school education (see Figure HC 2.1).

Figure HC 1.2  Percentage of All Births Defined as Healthy,a by Mothers Education: 1994

Note: aHealthy birth is defined as follows: 5-minute Apgar score of 9+, birth weight 2,500+ grams, gestational age of 37+ weeks, prenatal care in the first trimester. Source: Special tabulation for 1994 birth data by Sally C. Clarke, National Center for Health Statistics.
 
 

Table HC 2.1  Percentage of All Births Defined as Healthy,a by Selected Sociodemographic Characteristics: 1985, 1991, and 1994
			1985	1991	1994
Total			59.1	61.1	65.9
Race/Ethnicity
	White		62.7	65	69.8
	Black		41.5	43.3	49.7
	Hispanic		48.6	49.8	55.4
Mothers Marital Status
	Married		65	68.6	73
	Singleb		37.9	43.1	50.6
Mothers Education
	High school or more		64	67.1	70.1
	Less than high school		40	43.3	48.8
Notes: aHealthy birth is defined as follows: 5 - minute Apgar score of 9+, birth weight 2,500+ grams, gestational age of 37+ weeks, prenatal care in the first trimester.   bSingle status includes mothers who have never been married, or are divorced or widowed.  Source: 1985 and 1991 data from: Morrison, D.R. (1994). "Healthy Birth Index". Final Report. Submitted to the Annie E. Casey Foundation, Kids Count Indicator Development Project, Child Trends, Inc., Washington, DC, 1994. Special tabulation for 1994 birth data by Sally C. Clarke, National Center for Health Statics.

¹³ The Apgar score is a numerical expression of the physical condition of an infant shortly after delivery. The infant is rated, 0, 1, or 2 on color, heart rate, reflex irritability, muscle tone and breathing. The maximum score is 10, and a score of 4 or less indicates examination and treatment are warranted. As defined in: Apgar, V., Holiday, D.A., James, L.S., Weisbrot, I.N., and C. Berrien. (1953). "Evaluation of the Newborn Infant-2nd Report." Current Research in Anesthesia and Analgesia, Vol. 32: 260-267.
 
 

HC 2.2.a Low birth weight

Low birth weight infants (babies born weighing less than 2,500 grams or 5.5 pounds) face an increased risk of physical and developmental complications and death.¹⁴ These babies account for nearly two-thirds of all neonatal deaths (deaths under 28 days of age).¹⁵

The percentage of all infants born at low birth weight declined between 1970 and 1985, from 7.9 percent to 6.8 percent (see Table HC 2.2.A). By 1995, however, that percentage had increased to 7.3 percent of all infants.¹⁶ This pattern is evident for both white and black births and across almost all age groups of mothers.

Differences by Race and Ethnicity. Low birth weight rates are consistently higher for blacks than for whites and Hispanics. In 1970, 6.9 percent of white infants and 13.9 percent of black infants born in the U.S. were low birth weight. This gap continued into the 1990s; by 1995, 13.0 percent of black infants and 6.2 percent of white infants were born at low birth weight. The rates for Hispanics have remained at or slightly below 6.3 percent between 1980 (the first year for which Hispanic data are available) and 1995.

Differences by Age of Mother. For mothers in all age groups, there was a decline in the percentage of low weight births between 1970 and 1985. Since 1985, however, that percentage increased slightly across nearly all age groups. The following trends, illustrated in Table HC 2.2.A, are particularly noteworthy:

• Mothers under age 15 consistently have the highest rates of low weight births (see Figure HC 2.2.A). While the percentage of low weight births to mothers under age 15 improved between 1970 and 1994, the trend has not been one of consistent improvement. Instead, the percentage of low weight births to these very young mothers decreased considerably between 1970 and 1985 from 16.6 percent to 12.9 percent but then increased to 13.3 percent in 1990 and to 13.7 percent in 1994.
• For mothers in all other age groups, rates of low weight births have stayed within 1.5 percentage points of their 1970 rate.
• Mothers between the ages of 25 and 29 consistently have the lowest rates of low weight births.

Figure HC 2.2.A  Percentage of All Births Born at Low Birth Weight, by Age of Mother:a 1994

Notes: aBefore 1979, low birth weight defined as: Infants weighing < 2,500 grams. 1979 and beyond, low birth weight defined as: Infants weighing < 2,500 grams.
Source: Ventura, S.J., Martin, J.A., Mathews, T.J. and Clarke S.C. Advance Report of Final Natality Statistics, 1994. Monthly Vital Statistics Report, Vol. 44, No. 11, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1996 (tables 24 and 44).
 

Table HC 2.2.A Percentage of All Births Born at Low Birth Weight,a Selected Years: 1970-1995
					1970	1975	1980	1985	1990	1992	1993	1994	1995d
Total					7.9	7.4	6.8	6.8	7	7.1	7.2	7.3	7.3
	Race/Ethnicityb,c
		Black			13.9	13.2	12.7	12.7	13.3	13.3	13.3	13.2	13
		White			6.9	6.3	5.7	5.7	5.7	5.8	6	6.1	6.2
		Hispanic			--	--	6.1	6.2	6.1	6.1	6.2	6.3	6.3
	Age of Mother
		Under 15			16.6	14.1	14.6	12.9	13.3	13.2	13.5	13.7	--
		15-19			10.5	10	9.4	9.3	9.3	9.3	9.2	9.3	--
		20-24			7.4	7.1	6.9	6.9	7.1	7.1	7.2	7.3	--
		25-29			6.9	6.1	5.8	5.9	6.2	6.2	6.4	6.4	--
		30-34			7.5	6.8	5.9	6.1	6.4	6.5	6.7	6.7	--
		35-49			8.8	8.4	7.2	7.1	7.4	7.8	8.1	8.2	--
Notes: aBefore 1979, low birth weight defined as: Infants weighing < 2,500 grams (< 5.5 pounds). 1979 and beyond, low birth weight defined as: Infants weighing < 2,500 grams (<5.5 pounds).   bPercentages are based on the race and ethnicity of the mother.   cPercentage low birth weight by ethnicity are not available before 1980. Birth figures for Hispanic infants in 1980 are based on data from 22 States which report Hispanic origin on the birth certificate; 23 States and the District of Columbia in 1985; 48 States and the District of Columbia in 1990; 49 States and the District of Columbia in 1992; and 50 States and the District of Columbia in 1993.   dData for 1995 are preliminary.  Sources: National Center for Health Statistics. Health, United States, 1995. Hyattsville, Maryland: Public Health Service. 1996. Table 11 for totals and race/ethnicity breaks for 1970-1993. 1970 data from: National Center for Health Statistics, Health, United States, 1982, Table 24; 1975 data from: Vital Statistics of the U.S., 1975, Table 1-37; 1980 data from: Monthly Vital Statistics Report, Vol. 31 No. 8 , Supplement. 1982; 1985 data from: National Center for Health Statistics: Vital Statistics of the United States, 1985, Vol. I, Natality. DHHS Pub. No. (PHS) 81-1113. Public Health Service; Washington. 1988. Table 1-81. 1990 data from: Monthly Vital Statistics Report, Vol. 41, No. 9(s), February, 1993, Tables 13 and 26; 1992 data from: Ventura, S.J., Martin, J.A., Taffel, S.M., Mathews, T.J. and Clarke S.C. Advance Report of Final Natality Statistics, 1992. Monthly Vital Statistics Report, Vol. 43, No. 5, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1994 (tables 24 and 44); 1993 data from: Ventura, S.J., Martin, J.A., Taffel, S.M., Mathews, T.J. and Clarke S.C. Advance Report of Final Natality Statistics, 1993. Monthly Vital Statistics Report, Vol. 44, No. 3, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1995 (tables 24 and 44); 1994 data from: Ventura, S.J., Martin, J.A., Mathews, T.J. and Clarke S.C. Advance Report of Final Natality Statistics, 1994. Monthly Vital Statistics Report, Vol. 44, No. 11, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1996 (tables 24 and 44). 1995 preliminary data from: Rosenberg, H.M., Ventura, S.J., Maurer, J.D., Heuser, R.L., Freedman, M.A. Births and Deaths: United States, 1995. Monthly Vital Statistics Report, Vol 45, No. 3, Supplement 2. Hyattsville, Maryland: National Center for Health Statistics. 1996.

¹⁴ Disorders relating to short gestation and unspecified low birth weight were the second leading cause of death to infants in 1995 as reported in Rosenberg, H.M., Ventura, S.J., Maurer, J.D., Heuser, R.L., and M.A. Freedman. "Births and Deaths: United States, 1995." Monthly Vital Statistics Report. Vol. 45, No. 3 (Supplement 2). Hyattsville, Maryland: National Center for Health Statistics. 1996.

¹⁵ Ventura, S.J., Martin, J.A., Mathews, T.J., Clarke, S.C. "Advance Report of Final Natality Statistics, 1994." Monthly Vital Statistics Report, Vol. 44, No. 11 (S). Hyattsville, Maryland: National Center for Health Statistics, 1996.

¹⁶ Data for 1995 are preliminary.
 
 

HC 2.2.b Very low birth weight

Very low birth weight infants (babies born weighing less than 1,500 grams, or 3.3 pounds) are at particularly high risk of severe physical and developmental complications and death. Advances in medical technology in recent years have made it possible for increasing numbers of very low weight infants to survive.

The percentage of infants born at very low birth weight has remained constant for the last 24 years (see Table HC 2.2.B). Between 1970 and 1989 (not shown), 1.2 percent of all infants were classified as very low birth weight.¹⁷ The proportion then increased slightly to 1.3 percent, where it has remained from 1990 to 1994.

Differences by Race and Ethnicity. The percentage of babies born at very low birth weight varies by race and ethnicity (see Table HC 2.2.B). For whites, the percentage of very low weight births has remained at or about 1.0 percent from 1970 through 1994. For blacks, the percentage of very low birth weight babies increased from 2.4 percent in 1970 to 3.0 percent by 1992, where it has remained through 1994. In contrast, the percentage of low birth weight babies (as distinct from "very low") decreased for both blacks and whites from 1970 to the mid-1980s, then increased (see Table HC 2.2.A in the previous discussion). The percentage of very low weight births among Hispanics was 1.0 percent for the years shown between 1980 and 1992, and 1.1 percent in 1993 and 1994.

Differences by Age of Mother. Age of mother appears to be an important factor in the likelihood of very low birth weight, particularly at the youngest ages. The percentage of very low weight infants born to mothers under age 15 has increased since 1975, reaching its highest proportion in 1993 at 3.6 percent, and then decreasing slightly to 3.4 percent by 1994. The percentage of very low weight births among mothers age 15 to 19 is lower than the proportion of such births to their younger counterparts but remains slightly higher than the proportion observed for women age 20 and older.
 
 

Table HC 2.2.B   Percentage of All Births Born at Very Low Birth Weight,a Selected Years: 1970-1994
					1970	1975	1980	1985	1990	1992	1993	1994
Total					1.2	1.2	1.2	1.2	1.3	1.3	1.3	1.3
Race/Ethnicityb,c
		White			1	0.9	0.9	0.9	1	1	1	1
		Black			2.4	2.4	2.5	2.7	2.9	3	3	3
		Hispanic					1	1	1	1	1.1	1.1
Age of Mother
		Under 15				3.1	3.4	3.1	3.2	3.1	3.6	3.4
		15-19				1.8	1.7	1.8	1.8	1.8	1.8	1.7
		20-24				1.1	1.1	1.2	1.3	1.3	1.3	1.3
		25-29				0.9	1	1	1.1	1.1	1.1	1.2
		30-34				1	1	1.1	1.2	1.2	1.2	1.2
		35-49				1.2	1.2	1.3	1.4	1.5	1.5	1.6
Notes: aBefore 1979, very low birth weight defined as: < 1,500 grams, 1979 and beyond, very low birth weight defined as: Infants Weighing < 1,500 grams.   bPercentages are based on the race and ethnicity of the mother.   cPercentage very low birth weight by ethnicity are not available before 1980. Birth figures for Hispanic infants in 1980 are based on data from 22 States which reported Hispanic origin of the mother on the birth certificate; 23 States and the District of Columbia in 1985; 48 States and the District of Columbia in 1990; 49 States and the District of Columbia in 1992; and 50 States and the District of Columbia in 1993 and 1994.   Sources: National Center for Health Statistics. Health, United States, 1995. Hyattsville, Maryland: Public Health Service. 1996. Table 11 for totals and race/ethnicity breaks for 1970-1993. 1975 data from: Vital Statistics of the U.S., 1975, Table 1-37; 1980 data from: Monthly Vital Statistics Report, Vol. 31 No. 8, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1982 (table 13); 1985 data from: Monthly Vital Statistics Report, Vol. 36 No.4, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 198 (table 17); 1990 data from: Monthly Vital Statistics Report, Vol. 41, No. 9, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1993 (table 13); 1992 data from: Ventura, S.J., Martin, J.A., Taffel, S.M., Mathews, T.J. and Clarke S.C. "Advance Report of Final Natality Statistics, 1992." Monthly Vital Statistics Report, Vol. 43, No. 5, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1994 (tables 24 and 44); 1993 data from: Ventura, S.J., Martin, J.A., Taffel, S.M., Mathews, T.J. and Clarke S.C. "Advance Report of Final Natality Statistics, 1993." Monthly Vital Statistics Report, Vol. 44, No. 3, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1995 (tables 24 and 44); 1994 data from: Ventura, S.J., Martin, J.A., Mathews, T.J. and Clarke S.C. "Advance Report of Final Natality Statistics, 1994." Monthly Vital Statistics Report, Vol. 44, No. 11, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1996 (tables 24 and 44).

¹⁷ Data for individual years indicate that the rate remained at 1.2 percent through 1989 (not shown).
 
 

HC 2.3 General health conditions

Most children in the United States are reported by their parents to be in very good or excellent health. The percentage of all children under age 18 reported to be in very good or excellent health has remained at about 80 percent since 1984. These reports vary little by gender; there are modest differences by age of child for some population subgroups (see Table HC 2.3).

Differences by Race. Parents reports of their childrens health vary by race. Between 1984 and 1994, black parents were less likely than white parents to report that their children were in very good or excellent health. In 1994, 72 percent of black children under age five were reported in very good or excellent health, compared to 83 percent of white children. Sixty-eight percent of black children ages five to 17 were reported in very good or excellent health, compared to 81 percent of white children in this age group (see Table HC 2.3).

Differences by Family Income. Parents reports of their childrens health also vary by family income, with higher-income families more likely to report that their children are in very good or excellent health. For example, in 1994, 67 percent of children under age five in families with annual incomes under $10 thousand were reported to be in very good or excellent health, compared to 90 percent of children in families with incomes of $35 thousand or more. A similar pattern exists for children ages five to 17 (see Figure HC 2.3).
 
 

Figure HC 2.3   Percentage of Children Under Age 18 Reported by Their Parents to Be in Very Good or Excellent Health, by Family Income: 1994

Source: National Center for Health Statistics. Current Estimates from the National Health Interview Survey: United States, 1994. Vital and Health Statistics, Series 10, No. 193 (table 70).
 
 

Table HC 2.3  Percentage of Children Under Age 18 Reported by Their Parents to Be in Very Good or Excellent Health: Selected Years, 1984-1994
					Age: <5							Age: 5-17
					1984		1987	1990	1992	1993	1994	1984	1987	1990	1992	1993	1994
Total					79		81	81	80	80	81	77	80	80	80	79	79
	Race
		Black			67		71	72	70	71	72	65	66	68	68	70	68
		White			81		84	83	82	82	83	80	83	83	82	81	81
	Gender
		Male			78			80	79	80	81	78		81	80	79	79
		Female			79			82	81	80	81	77		80	79	78	78
	Family Incomea
		Under $10,000									67						62
		$10,000-$19,999									74						68
		$20,000-$34,999									80						77
		$35,000 or more									90						88
Notes: aFamily income is not adjusted in the National Health Interview Survey for comparison over time, therefore family income is shown only for the most recent year.   Source: National Center for Health Statistics. "Current Estimates from the National Health Interview Survey: United States," 1984, 1987, 1990, 1992, 1993, 1994; Vital and Health Statistics, Series 10, Nos. 156, 166, 181, 189, 190, and 193, Table 70 in each.

 

HC 2.4 Chronic health conditions

Chronic health problems can cause children to miss school and often require medical assistance and follow-up. Chronic conditions can also create stress for children and their parents, cause parents to lose time from work, and increase a familys medical expenses.

Over the period from 1984 to 1994, respiratory conditions have been the most prevalent chronic health problems experienced by children under age 17, followed by skin conditions, and impairments (see Figure HC 2.4). In general, there are few pronounced patterns of improvement or deterioration among those conditions shown (see Table HC 2.4). Two exceptions, however, are asthma and chronic sinusitis. The prevalence of these two chronic conditions increased incrementally from 1984 to 1993, but declined slightly in 1994. In 1984, asthma affected 43 children per thousand, compared with 69 children per thousand in 1994; chronic sinusitis affected 47 children per thousand in 1984, and 65 children per thousand by 1994.
 
 

Figure HC 2.4   Selected Chronic Health Conditions per 1,000 Children Ages 0-17: 1994

Source: National Center for Health Statistics, Current Estimates from the National Health Interview Survey: United States 1994, Vital and Health Statistics, Series 10, No. 193, Table 70.
 
 

Table HC 2.4  Selected Chronic Health Conditionsa per 1,000 Children  Ages 0-17: Selected Years, 1984-1994
					number per 1,000
Type of Conditions					1984	1987	1990	1992	1993	1994
	Respiratory Conditions
		Hay fever, allergic rhinitis without Asthma			61	64	57	71	57	61
		Chronic bronchitis			50	62	53	54	59	55
		Chronic sinusitis			47	58	57	69	80	65
		Asthma			43	53	58	63	72	69
		Chronic diseases of tonsils or adenoids			34	30	23	28	26	23
	Skin Conditions
		Dermatitis			39	32	31	41	36	38
		Serious acne			26	26	26	25	28	29
	Impairments
		Deformity or orthopedic impairment			35	36	29	33	29	28
		Speech impairment			16	19	14	21	20	21
		Hearing impairment			24	16	21	15	17	18
		Visual impairment			9	10	9	10	7	9
	Other Conditions
		Heart disease			23	22	19	19	20	18
		Migraine headache			11	8	14	13	13	16
		Anemia			11	8	10	11	9	12
		Epilepsy			7	4	4	3	5	5
Notes: aChronic conditions as defined in the National Health Interview Survey are conditions that either a) were first noticed three months or more before the reference date of the interview; or b) belong to a group of conditions (including heart diseases, diabetes, and others) that are considered chronic regardless of when they began. The prevalence estimates are based on reports by parents or other adult respondents in response to checklists administered in household interviews.   Source: National Center for Health Statistics, "Current Estimates from the National Health Interview Survey: United States," 1984, 1987, 1990, 1992, 1993, 1994; Vital and Health Statistics, Series 10, Nos. 150, 156, 166, 181, 189, 190, and 1993, Tables 57 and 62.

 

HC 2.5 Overweight children and adolescents

Persons who are overweight in adolescence are at greater risk of being overweight as adults, and adults who are overweight are at higher risk of numerous health problems including hypertension, coronary heart disease, gallbladder disease, noninsulin dependent diabetes, and some cancers.¹⁸ Because being overweight in childhood and adolescence increases the risk of being overweight in adulthood, the trends in overweight prevalence among children and youth have become an important public health concern.

Differences by Age. Overweight prevalence was similar among children ages six to 11 years old and adolescents 12 to 17 years old (see Table HC 2.5). For both age groups and sexes, overweight prevalence has increased from 15 percent in the earliest time period to approximately 22 percent in 1988-1991.

Differences by Gender. During the time period 1988-1991, there was little difference in the overweight prevalence of male and female children and adolescents 22 percent of male children and 23 percent of female children were overweight, and 22 percent of male adolescents and 21 percent of female adolescents were overweight.

Differences by Race Among Male Children and Adolescents. In the earliest time periods (1963-1965 and 1971-1974), the percentage of black male children who were overweight was at least six percentage points lower than that of white male children. This was reversed in the most recent period (1988-1991), with black male children recording an overweight prevalence rate that is five percentage points higher than that of their white peers. Blackwhite differences were less among the older age group, but the same pattern is evident (see Figure HC 2.5).

Differences by Race for Female Children and Adolescents. With the exception of the earliest time period, the percentage of black females who were overweight was higher than that of white females for both children and adolescents. By the most recent time period 31 percent of black female children and 30 percent of black female adolescents were overweight compared with 22 percent of white female children and 20 percent of white female adolescents (see Figure HC 2.5).
 
 

Figure HC 2.5   Age-Adjusted Prevalence of Overweight Adolsecents (Ages 12-17) from National Surveys, by Sex: 1976-1980 and 1988-1991a

Note: ^aPrevalence of overweight is determined by those children and adolescents who were at or above the 85th percentile of body mass index (BMI) from the National Health and Nutrition Examination Surveys II and III. Determinations of overweight with BMI were sex- and age-specific.
Source: Troiano, Richard P. and Katherine M. Flegal, Robert J. Kuczmarski, Stephen M. Campbell, Clifford L. Johnson, 1995. Overweight Prevalence and Trends for Children and Adolescents: The National Health and Nutrition Examination Surveys, 1963-1991. Archives of Pediatrics and Adolescent Medicine. Vol. 149 (October). Estimates were calculated from National Health and Nutrition Examination Survey (NHANES); 1976 to 1980 for NHANES II, and 1988 to 1991 for NHANES III.
 
 

Table HC 2.5  Age-Adjusted Prevalence of Overweight Children and Adolescents: Selected Years, 1963-1991a
					1963-1965	1966-1970	1971-1974	1976-1980	1988-1991
Ages 6 through 11
	Maleb				15.2		18.2	19.9	22.3
		White			16		19.5	20.8	22.3
		Black			10.3		12.3	15.1	27.2
	Femaleb				15.2		13.9	15.8	22.7
		White			15.7		13.4	15.4	22
		Black			12.1		16.8	18.4	30.7
Ages 12 through 17
	Maleb					15.1	14.9	16.3	21.7
		White				15.8	15.3	16.6	22.6
		Black				10.4	12.3	14.5	23.3
	Femaleb					15.2	19.7	15.5	21.2
		White				15	19.7	15.2	20.3
		Black				16.5	20.8	18.2	29.9
Notes: aPrevalance of overweight is determined by those children and adolescents who were at or above the 85th percentile of body mass index (BMI) from the National Health Examination Surveys II and III. Determinations of overweight with BMI were sex- and age-specific.   bTotals for male and female children and adolescents include data for race groups not shown separately.   Source: Troiano, Richard P. and Katherine M. Flegal, Robert J. Kuczmarski, Stephen M. Campbell, Clifford L. Johnson, 1995. "Overweight Prevalence and Trends for Children and Adolescents: The National Health and Nutrition Examination Surveys, 1963-1991." Archives of Pediatrics and Adolescent Medicine. Vol. 149 (October). Estimates were calculated from National Health Examination Survey; 1963-1965 for ages 6 through 11, and 1966 to 1970 for ages 12 through 17 years and from the National Health and Nutrition Examination Survey (NHANES); 1971 to 1974 for NHANES I, 1976 to 1980 for NHANES II, and 1988 to 1991 for NHANES III.

¹⁸ Troiano, Richard P. and Katherine M. Flegal, Robert J. Kuczmarski, Stephen M. Campbell, Clifford L. Johnson, 1995. "Overweight Prevalence and Trends for Children and Adolescents: The National Health and Nutrition Examination Surveys, 1963-1991." Archives of Pediatrics and Adolescent Medicine. Vol. 149 (October).
 

HC 2.6 Abuse and neglect

Abuse and neglect cause physical and/or emotional harm to children. They can produce short-term psychological consequences that range from poor peer relations to violent behavior, as well as untold long-term psychological and economic consequences when children reach adulthood.¹⁹ They can result in serious injury or, in extreme cases, death.

The National Research Council distinguishes four categories of child maltreatment: (1) physical abuse, (2) sexual abuse, (3) emotional maltreatment, and (4) neglect.²⁰ The first three are commonly grouped together under the term "abuse," although there are currently no universally accepted definitions of any of these terms. (For example, the point at which corporal punishment becomes physical abuse is not agreed upon by child welfare professionals or lay people).

According to data from the most comprehensive annual data collection efforts undertaken to date, there were about 875 thousand substantiated cases²¹ of child abuse and neglect in 1994a rate of 12.9 cases per thousand children under age 18 (see Figure HC 2.6). This is a substantial increase over the roughly 720 thousand cases substantiated in 1990, when the rate was only 11.4 cases per thousand.²² Although maltreatment was about evenly split between abuse and neglect, abuse accounted for a somewhat smaller share of the total in 1994 than in 1990.

The number of substantiated cases shown in Figure HC 2.6 may substantially understate the actual number of cases of maltreatment. In order for a case to be substantiated, it must first be reported to child welfare authorities, and child protective services workers must undertake an investigation which finds sufficient evidence of abuse or neglect to proceed further with the case.

Another data source, the third National Incidence Study of Child Abuse and Neglect, yields a much higher estimate of the total number of cases of child maltreatment possibly as high as 2.8 million cases in 1993. This study includes (1) all cases reported to child protective services (regardless of whether they were investigated and substantiated)²³ and (2) cases known to community professionals but not necessarily reported to child protective services.

Differences by Race. Black children account for a disproportionate share of substantiated maltreatment cases relative to their share of the child population (see Table HC 2.6).

• Black children, who constituted only 16 percent of all children under age 18, accounted for 26 percent of the abuse and neglect cases in 1994.
• White children, who constituted 79 percent of all children under age 18, accounted for only 56 percent of abused and neglected children in 1994.
• Hispanic children, who constituted about 14 percent of all children under age 18, accounted for only nine percent of the abuse and neglect cases.

Differences by Age. No age group accounts for an obviously disproportionate share of abuse and neglect cases. In 1994, (see Table HC 2.6) infants under age one accounted for about seven percent of substantiated cases; children ages one to five accounted for about 33 percent of substantiated cases; children ages six to 12 accounted for 38 percent of substantiated cases; and children ages 13 to 17 accounted for about 20 percent of substantiated cases.
 
 

Figure HC 2.6   Substantiated Cases of Child Maltreatment, 1990-1994  (number, and rate per 1,000 children under age 18)

Note: Statistics for 1990-1992 have been revised, to obtain consistent representation of the same number of jurisdictions over the entire 1990-1994 period. Statistics are for the 50 states plus the District of Columbia.
Sources: 1994, National Center on Child Abuse and Neglect, Child Maltreatment, 1994: Reports from the States to the National Center on Child Abuse and Neglect (Washington, D.C.: U.S. Government Printing Office, 1996). 1993, National Center on Child Abuse and Neglect, Child Maltreatment, 1993: Reports from the States to the National Center on Child Abuse and Neglect (Washington, D.C.: U.S. Government Printing Office, 1995). 1992, National Center on Child Abuse and Neglect, Child Maltreatment, 1992: Reports from the States to the National Center on Child Abuse and Neglect (Washington, D.C.: U.S. Government Printing Office, 1994). 1990- 91, National Center on Child Abuse and Neglect, 1991 Summary Data Component. (Washington, DC: U.S. Government Printing Office, 1993). U.S. Bureau of the Census, Statistical Abstract of the United States, 1994 (Washington, D.C.: U.S. Government Printing Office, 1995). U.S. Bureau of the Census, Statistical Abstract of the United States, 1995 (Washington, D.C.: U.S. Government Printing Office, 1996).
 
 

Table HC 2.6  Substantiated Cases of Child Maltreatment, 1990-1994  (number, and rate per 1,000 children under age 18)
				1990	1991	1992	1993	1994
Total
	Number			722,414	741,175	849,448	903,342	875,560
	Rate per thousand			11.4	11.4	12.8	13.5	12.9
	Type of Maltreatment (% of Total Cases)
		Abuse		51	50	45	46	44
		Neglect		49	50	55	54	56
	Race/Ethnicity (% of Total Cases)
		White		55	56	55	54	56
		Black		25	27	26	25	26
		Hispanic		9	10	10	9	9
		Other		4	4	4	4	4
		Unknown		7	5	6	9	4
	Sex (% of Total Cases)
		Male		47	46	46	47	47
		Female		53	54	54	53	53
	Age (% of Total Cases)
		Under 1		8	8	7	7	7
		1 to 5		31	32	32	33	33
		6 to 12		37	38	37	38	38
		13 to 17		20	20	19	20	20
		18+/unknown		5	2	5	2	2
Note: Statistics for 1990-1992 have been revised, to obtain consistent representation of the same number of jurisdictions over the entire 1990-1994 period. Statistics are for the 50 states plus the District of Columbia.   Sources: 1994, National Center on Child Abuse and Neglect, "Child Maltreatment, 1994: Reports from the States to the National Center on Child Abuse and Neglect" (Washington, D.C.: U.S. Government Printing Office, 1996). 1993, National Center on Child Abuse and Neglect, "Child Maltreatment, 1993: Reports from the States to the National Center on Child Abuse and Neglect" (Washington, D.C.: U.S. Government Printing Office, 1995). 1992, National Center on Child Abuse and Neglect, Child Maltreatment, 1992: Reports from the States to the National Center on Child Abuse and Neglect (Washington, D.C.: U.S. Government Printing Office, 1994). 1990- 91, National Center on Child Abuse and Neglect, "1991 Summary Data Component." (Washington, DC: U.S. Government Printing Office, 1993). U.S. Bureau of the Census, "Statistical Abstract of the United States, 1994" (Washington, D.C.: U.S. Government Printing Office, 1995). U.S. Bureau of the Census, "Statistical Abstract of the United States, 1995" (Washington, D.C.: U.S. Government Printing Office, 1996).

¹⁹ Many studies have demonstrated a correlation between child abuse and neglect and serious adult problems including violence, incarceration, and mental illness. However, these studies have not been able to separate the effects of child abuse and neglect from other factors that are correlated with it including poverty, education, parenting skills, etc.

²⁰ National Research Council, Panel on Child Abuse and Neglect, Understanding Child Abuse and Neglect. Washington, DC: National Academy Press, 1993.

²¹ In most states, each reported incident is counted even if multiple incidents are reported for the same child.

²² The apparent drop between 1993 and 1994 should be viewed with caution since there are important inconsistencies in data collection methodology from year to year.

²³ According to the National Incidence Study, in 1993, only 28 percent of maltreatment cases identified by the Study were investigated--a significant decrease from the 44 percent investigated in 1986. The cause of this drop is not clear.
 

HC 2.7 Suicidal teens

Suicide is a major cause of death among American youth (see Section HC 1.2.C). Attempted suicide has been related to mental health problems including depression and adjustment or stress reactions, as well as to substance abuse.²⁴

In 1995, 24 percent of youth in grades nine through 12 report having seriously considered suicide during the previous 12 months (see Table HC 2.7.A). During the same time period, nine percent, or one in eleven, report having actually attempted suicide during the previous year (see Table HC 2.7.B). These rates are considerably higher than the proportion of youth who actually commit suicide (see Section HC 1.2.C).

Rates for contemplation of suicide range from 29 percent in 1991 to 24 percent in 1993 and 1995 (see Table HC 2.7.A). The percentage of youth who report actually attempting suicide has remained around nine percent in recent years (see Table HC 2.7.B).

Differences by Race/Ethnicity.²⁵ Black youths report somewhat lower rates of considering suicide in comparison with their white and Hispanic peers (20 percent for black youth versus 25 percent for both whites and Hispanics in 1995). Rates of reported attempted suicide are similar across the three groups, ranging from eight to ten percent.

Differences by Gender. In 1995, female youth were more likely than male youth to report having thought seriously about suicide (30 percent versus 18 percent) and having attempted suicide (12 percent versus six percent) during the previous year (see Figure HC 2.7). However, the rate of actual suicides, particularly among teens ages 15 to 19, are considerably higher for males than for females, as discussed in section HC 1.2.C.
 
 

Figure HC 2.7   Suicide: Percentage of Students in Grades 9-12 Who Report Having Seriously Considered or Attempted Suicide in the Previous 12 Months: 1995

Source: Youth Risk Behavior Surveillance - United States 1995. In: CDC Surveillance Summaries, MMWR 1996; Vol. 45 (No. 55-4): 1-85.
 

Table HC 2.7.A  Suicidal Teens: Percentage of Teens in Grades 9-12 Who Report Having Seriously Considered Suicide in the Previous 12 Months: For Selected Years 1990-1995
					1990	1991	1993	1995
Total					27	29	24	24
		Male			21	21	19	18
		Female			34	37	30	30
	Grade
		9			30	29	24	26
		10			26	30	25	25
		11			29	32	25	26
		12			33	26	23	20
	Race/Ethnic Group
		White non-Hispanic			28	30	24	25
		Black non-Hispanic			20	22	20	20
		Hispanic			30	27	26	25
Source: Data for 1990 from "1990-1991 Youth Risk Behavior Surveillance System," Morbidity and Mortality Weekly Report reprints, Centers for Disease Control and Prevention. Data for 1991 from Public Health Reports, Vol. 108, Supplement 1, U.S. Public Health Service. Data for 1993 from "Youth Risk Behavior Surveillance- United States 1993," Vol. 44, No. SS-1, U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention. Data for 1995 from Kann, L., Warren, C.W., Harris, W.A., Collins, J.L., Williams, B.I., Ross, J.G., and Kolbe, L.J. "Youth Risk Behavior Surveillance -- United States, 1995." In: CDC Surveillance Summaries, September 27, 1996. Morbidity and Mortality Weekly Report 1996; 45 (No. 55-4): 1-85. All data from Youth Risk Behavior Surveys 1990-1995.

Table HC 2.7.B  Suicidal Teens: Percentage of Teens in Grades 9-12 Who Report Having Attempted Suicide in the Previous 12 Months: Selected Years, 1990-1995
				1990	1991	1993	1995
Total				8	7	9	9
		Male		6	4	5	6
		Female		10	11	13	12
	Grade
		9		9	9	10	11
		10		9	8	9	10
		11		8	6	8	9
		12		7	6	7	6
	Race/Ethnic Group
		White non-Hispanic		8	7	8	8
		Black non-Hispanic		7	7	8	10
		Hispanic		12	8	14	13
Source: Data for 1990 from "1990-1991 Youth Risk Behavior Surveillance System," Morbidity and Mortality Weekly Report reprints, Centers for Disease Control and Prevention. Data for 1991 from Public Health Reports, Vol. 108, Supplement 1, U.S. Public Health Service. Data for 1993 from "Youth Risk Behavior Surveillance- United States 1993," Vol. 44, No. SS-1, U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention. Data for 1995 from Kann, L., Warren, C.W., Harris, W.A., Collins, J.L., Williams, B.I., Ross, J.G., and Kolbe, L.J. "Youth Risk Behavior Surveillance -- United States, 1995." In: CDC Surveillance Summaries, September 27, 1996. Morbidity and Mortality Weekly Report, 1996; 45 (No. 55-4): 1-85. All data from Youth Risk Behavior Surveys 1990-1995.

²⁴ Alcohol, Drug Abuse, and Mental Health Administration. Report of the Secretarys Task Force on Youth Suicide. Publication No. (ADM)899-1621. Washington, D.C.: U.S. Department of Health and Human Services, 1989. Cited in Healthy People 2000: National Health Promotion and Disease Prevention Objectives, Conference Edition. U.S. Department of Health and Human Services, 1990.

²⁵ Estimates for whites and blacks exclude Hispanics of those races.
 

HC 2.8 Activity limitations

Activity limitations refer to long term reductions in activities resulting from a chronic disease or impairment.²⁶ Two types of activity limitations are examined here: limitations in major activities and limitations in any activity. A person is classified as having an activity limitation if he or she reports (a) an inability to perform the major activity for a person in his or her age group, (b) being able to perform the major activity but being limited in the kind or amount of this activity, or (c) not being limited in the major activity but being limited in the kind or amount of other activities. For children under age 5, the major activity consists of ordinary play. For hildren ages five to 17, the major activity is attending school. Children are classified as being limited in a major activity if they are unable to engage in the major activity or are limited in the kind or amount of this activity.

Between 1990 and 1994 the percentage of children under age 18 with chronic conditions that limit any of their activity has risen from 4.9 percent to 6.7 percent (see Table HC 2.8.A). This trend is true for both males and females and whites and blacks, although the percentages are higher for males and for blacks. The percentage of children with limitations in major activities follows a similar upward trend since 1990 (see Table HC 2.8.B).

Differences by Gender. Males have consistently accounted for a greater percentage of youth with an activity limitation due to a chronic condition. In 1994, 7.9 percent of males compared to 5.6 percent of females had activity limitations that were caused by a chronic condition (see Figure HC 2.8.A). Looking only at limitations in major activities in 1994, 6.0 percent of males had such limitations compared to 3.8 percent of females (see Figure HC 2.8.B).

Differences by Race. Black youth are more likely than white youth to have activity limitations due to chronic conditions (see Table HC 2.8.A). In 1994, 8.8 percent of black youth had activity limitations compared to 6.4 percent of white youth. A similar gap existed for major activity limitations with 6.7 percent of black youth being limited in major activities and 4.7 percent of white youth.
 

Figure HC 2.8.A   Percentage Under Age 18 With an Activity Limitation Due to Chronic Conditions, by Gender: Selected Years, 1983-1994

Source: National Center for Health Statistics, Current Estimates from the National Health Interview Survey: United States 1983, 1985, 1990, 1991, 1992, 1993, 1994.
 
 

Figure HC 2.8.B   Percentage Under Age 18 With a Major Activity Limitation Due to Chronic Conditions, by Gender: Selected Years, 1983-1994

Source: National Center for Health Statistics, Current Estimates from the National Health Interview Survey: United States 1983, 1985, 1990, 1991, 1992, 1993, 1994.
 
 

Table HC 2.8.A  Activity Limitations:a Percentage Under Age 18 With an Activity Limitation Due to Chronic Conditionsb
					1983	1985	1990	1991	1992	1993	1994
Total					5.1	5.1	4.9	5.8	6.1	6.6	6.7
	Gender
		Males			5.9	6	5.6	6.8	7.1	7.8	7.9
		Females			4.3	4.2	4.2	4.7	5	5.3	5.6
	Race/Ethnicity
		White			5	5.1	4.8	5.7	5.9	6.5	6.4
		Black			5.7	5.8	5.5	6.8	7.5	7.7	8.8
Notes: aAn activity limitation is defined as follows: Persons are classified in terms of the major activity usually associated with their particular age group. The major activities for the age groups are a) ordinary play for children under 5 years of age, b) attending school for those 5-17 years of age. A person is classified as having an activity limitation if he or she is: a) unable to perform the major activity, b) able to perform the major activity but limited in the kind or amount of this activity, c) not limited in the major activity but limited in the kind or amount of other activities.   bA condition is considered chronic if a) the respondent indicates it was first noticed more than 3 months before the reference date of the interview or b) it is a type of condition that ordinarily has a duration of more than 3 months.   Source: National Center for Health Statistics, "Current Estimates from the National Health Interview Survey: United States" 1983, 1985, 1990, 1991, 1992, 1993, 1994.

Table HC 2.8.B  Major Activity Limitations:a Percentage Under Age 18 With an Activity Limitation In a Major Activity Due to Chronic Conditionsb
					1983	1985	1990	1991	1992	1993	1994
Total					3.5	3.7	3.6	4.2	4.4	4.6	4.9
	Gender
		Males			4.2	4.4	4.2	5	5.2	5.6	6
		Females			2.8	2.9	3	3.3	3.7	3.5	3.8
	Race/Ethnicity
		White			3.4	3.5	3.5	4.1	4.3	4.5	4.7
		Black			4.5	4.6	4.2	5.2	6	5.7	6.7
Notes:   aAn activity limitation is defined as follows: Persons are classified in terms of the major activity usually associated with their particular age group. The major activities for the age groups are a) ordinary play for children under 5 years of age, b) attending school for those 5-17 years of age. A person is classified as having an activity limitation if he or she is: a) unable to perform the major activity, b) able to perform the major activity but limited in the kind or amount of this activity, c) not limited in the major activity but limited in the kind or amount of other activities.   bA condition is considered chronic if a) the respondent indicates it was first noticed more than 3 months before the reference date of the interview or b) it is a type of condition that ordinarily has a duration of more than 3 months.   Source: National Center for Health Statistics, "Current Estimates from the National Health Interview Survey: United States" 1983, 1985, 1990, 1991, 1992, 1993, 1994.

²⁶ A disease or impairment is classified as chronic if it has been apparent for at least three months or is a new condition that will ordinarily last for more than three months.
 

HC 2.9 Lead exposure

Exposure to lead has long been recognized as a serious health hazard, particularly for infants, toddlers, and preschool-age children, whose developing nervous systems are sensitive to lead. Research during the past two decades has shown that adverse health effects can occur from blood lead levels (BLLs) that had previously been considered safe. Based on this research the Centers for Disease Control and Prevention now consider BLLs at least as low as ten micrograms per deciliter of blood as hazardous for children ages one to five.²⁷

Dramatic Decreases in Blood Lead Levels. The percentage of very young children who have been exposed to potentially dangerous levels of lead declined dramatically in the 1980s (see Table HC 2.9). Data gathered between 1976 and 1980 revealed that 88.2 percent of children between the ages of one and five had blood lead levels which have been shown to have adverse health effects. Subsequent data gathered between 1988 and 1991 found that only 8.9 percent of children had hazardous levels of lead in their blood. This dramatic decrease has been attributed primarily to the removal of lead from gasoline and from soldered food and soft drink cans. Other contributing factors have been the ban on leaded paint for residential use in 1978, the ban on lead in solder for household plumbing, and the ongoing screening of children for lead exposure. Deteriorating lead-based paint and lead-contaminated dust in older homes are the primary source of lead exposure for children in the United States today.²⁸

Differences by Race/Ethnicity,²⁹ Family Income, and Place of Residence. The decline in blood lead levels occurred among both non-Hispanic black and non-Hispanic white children.³⁰ However, non-Hispanic black children, poor and near-poor children, and children living in the central areas of large cities still faced considerably higher risks of being exposed to high levels of lead (see Figure HC 2.9 and Table HC 2.9). For many children, these higher risks were probably related to residence in older homes which contained deteriorated lead-based paint.
 
 

Figure HC 2.9   Percentage of Children Ages 1-5 With Blood Lead Levels Greater Than or Equal To Ten Micrograms per Deciliter

Source: Pirkle, James L., Brody, Debra J., Gunter, Elaine W., Kramer, Rachel A., Paschal, Daniel C., Flegal, Katherine M., and Matte, Thomas D. (1994) The Decline in Blood Lead Levels in the United States: The National Health and Nutrition Examination Surveys (NHANES) in Journal of the American Medical Association Volume 272, pp. 284-291. Brody, Debra J., Pirkle, James L., Kramer, Rachel A., Flegal, Katherine M., Matte, Thomas D., Gunter, Elaine W., and Paschal, Daniel C. (1994). Blood Lead Levels in the U.S. Population: Phase 1 of the Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1991) in Journal of the American Medical Association Volume 272, pp. 277-283.
 
 

Table HC 2.9  Percentage of Children Ages 1-5 With Blood Lead Levels Greater Than or Equal To Ten Micrograms per Deciliter
			1976-1980	1988-1991
ALL CHILDREN AGES 1-5			88.2	8.9
	Ages 1-2		88.3	11.5
	Ages 3-5		88.1	7.3
Race/Ethnicity
	White, non-Hispanic		85	5.5
	Black, non-Hispanic		97.7	20.6
Income
	0 to 129% of Poverty			16.3
	130% to 299% of Poverty			5.4
	300% of Poverty or Greater			4
Urban Status
	Central City Greater Than 1 Million			21
	Central City Less Than 1 Million			16.4
	NonCentral City			5.8
Source: Pirkle, James L., Brody, Debra J., Gunter, Elaine W., Kramer, Rachel A., Paschal, Daniel C., Flegal, Katherine M., and Matte, Thomas D. (1994) "The Decline in Blood Lead Levels in the United States: The National Health and Nutrition Examination Surveys (NHANES)" in Journal of the American Medical Association Volume 272, pp. 284-291. Brody, Debra J., Pirkle, James L., Kramer, Rachel A., Flegal, Katherine M., Matte, Thomas D., Gunter, Elaine W., and Paschal, Daniel C. (1994). "Blood Lead Levels in the U.S. Population: Phase 1 of the Third National Health and Nutrition Examination Survey (NHANES III, 1988 to 1991)" in Journal of the American Medical Association Volume 272, pp. 277-283.

²⁷ Centers for Disease Control. Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service: 1991.

²⁸ Centers for Disease Control. " Blood Lead Levels -- United States, 1988-1991. Morbidity and Mortality Weekly Report August 5, 1994, Vol. 43, No. 30; and, Pirkle, James L., Brody, Debra J., Gunter, Elaine W., Kramer, Rachel A., Paschal, Daniel C., Flegal, Katherine M., and Matte, Thomas D. (1994) "The Decline in Blood Lead Levels in the United States: The National Health and Nutrition Examination Surveys (NHANES)" in Journal of the American Medical Association Volume 272, pp. 284-291.

²⁹ Estimates for whites and blacks exclude Hispanics of those races.

³⁰ Data for Mexican-American children for 1982-1984 and 1988-1991 show a similar trend. While 61.5 percent of 4-5 year old Mexican-American children had hazardous levels of lead in their blood in 1982-1984 the total was 4.9 percent by 1988-91. Pirkle, James L., Brody, Debra J., Gunter, Elaine W., Kramer, Rachel A., Paschal, Daniel C., Flegal, Katherine M., and Matte, Thomas D. (1994) "The Decline in Blood Lead Levels in the United States: The National Health and Nutrition Examination Surveys (NHANES)" in Journal of the American Medical Association Volume 272, pp. 284-291.
 

HC 2.10 Violent victimization of teens

Violent crimes include simple and aggravated assaults, rape, and robbery (stealing by force or threat of violence). In order to keep track of the incidence of these and other crimes, the United States has been administering the National Crime Victimization Survey on an annual basis since 1972.

Among youth ages 12 to 17, rates of victimization for violent crimes rose from 79 to 99 per thousand between 1980 and 1990 (see Figure HC 2.10) Rates continued to increase to a high of 123 per thousand in 1993 before declining to 118 per thousand in 1994.

Differences by Gender. Boys are considerably more likely than girls to be victims of violent crimes. In 1994, 141 per thousand boys ages 12 to 17 were victims of violent crimes compared to 95 per thousand girls.
 

Figure HC 2.10   Violent Victimization of Youth: Rates (per 1,000) for Youth Ages 12-17

Notes: Because of changes made in the victimization survey, data prior to 1992 are adjusted to make them comparable with data collected under the redesigned methodology. Victimization rates were calculated using population estimates from the Bureau of the Census Current Population Reports. Such population estimates normally differ somewhat from population estimates derived from survey data. The rates may therefore differ marginally from rates based upon survey derived population estimates. Source: Unpublished tables, Bureau of Justice Statistics, National Crime Victimization Survey, 1980-1994.
 
 

Table HC 2.10  Violent Victimization of Youth: Rates (per 1,000) for Youth Ages 12-17
			1980	1985	1990	1991	1992	1993	1994
Age
	12-17		79.0	84.3	98.6	106.2	117.9	123.1	118.4
	12-14		70.4	81.4	102.1	97.6	119.3	121.0	118.2
	15-17		86.6	87.1	95.1	115.0	116.4	125.2	118.6
Race/Ethnicity
	White		77.7	87.7	95.4	105.1	121.4	125.7	118.4
	Black		91.1	69.3	122.1	127.6	111.8	132.9	135.8
	Other		49.7	71.7	76.1	54.2	79.2	49.4	64.7
Sex
	Male		106.4	113.0	131.0	148.9	146.2	149.3	140.5
	Female		50.4	54.3	64.4	61.2	88.1	95.5	95.1
Notes: Because of changes made in the victimization survey, data prior to 1992 are adjusted to make them comparable with data collected under the redesigned methodology. Victimization rates were calculated using population estimates from the Bureau of the Census Current Population Reports. Such population estimates normally differ somewhat from population estimates derived from survey data. The rates may therefore differ marginally from rates based upon survey-derived population estimates.   Source: Unpublished tables, Bureau of Justice Statistics, National Crime Victimization Survey, 1980-1994.

 

HC 2.11 Dental caries

"Dental caries" is a technical term referring to either treated or untreated tooth decay in one or more teeth. Proper preventive care reduces the incidence of dental caries. The presence of dental caries may indicate a lack of access to preventive care or a lack of information about preventive techniques.³¹

Racial and Ethnic Differences in Dental Caries. Mexican American children ages two through four had the highest prevalence of dental caries in their primary teeth (see Figure HC 2.11). Almost one-third of Mexican American children had dental caries compared to 22 percent of black children and 13 percent of white children. Mexican American children also had the highest prevalence of dental caries in permanent teeth, but the gap among children ages five through 17 was much smaller than it was for younger children. Black children had the lowest percentage of dental caries with 39 percent, compared to 45 percent for white children and 49 percent for Mexican American children.
 

Figure HC 2.11   Percentage of Children with Dental Caries 1988-1991

Source: Kaste, L.M., Selwitz, R.H., Oldakowski, R.J., Brunelle, J.A., Winn, D.M., & Brown, L.J. (1996) Coronal Caries in the Primary and Permanent Dentition of Children and Adolescents 1-17 Years of Age: United States, 1988-1991. Journal of Dental Research, 75, 631-641. Rockville, MD: National Institutes of Health. National Institute of Dental Research, Division of Epidemiology and Oral Disease Prevention.
 
 

Table HC 2.11  Percentage of Children with Dental Caries 1988-1991
	Non-Hispanic White	Non-Hispanic Black	Mexican-American
Percent of children ages 2-4 w/dental
caries in primary teeth	13	22	32
Percent of children ages 5-17
w/dental caries in permanent teeth	45	39	49
Source: Kaste, L.M., Selwitz, R.H., Oldakowski, R.J., Brunelle, J.A., Winn, D.M., & Brown, L.J. (1996) "Coronal Caries in the Primary and Permanent Dentition of Children and Adolescents 1-17 Years of Age: United States, 1988-1991." Journal of Dental Research, 75, 631-641. Rockville, MD: National Institutes of Health. National Institute of Dental Research, Division of Epidemiology and Oral Disease Prevention.

³¹ Kaste, L.M., R.H. Selwitz, R.J. Oldakowski, J.A. Brunelle, D.M. Winn and L.J. Brown (1996). "Coronal Caries in the Primary and Permanent Dentition of Children and Adolescents 1-17 Years of Age: United States 1988-1991." Journal of Dental Research 75: 631-641. Rockville, MD: National Institutes of Health. National Institute of Dental Research, Division of Epidemiology and Oral Disease Prevention.
 
 

HEALTH CARE

HC 3.1 Health insurance coverage

Children who are covered by health insurance are considerably more likely to have a regular source of health care.³² Regular care increases the continuity of care, which is important to the maintenance of good health.

Since 1987, the percentage of children who are not covered by health insurance has stayed stable at 13 to 14 percent (see Table HC 3.1.A). Rates of coverage vary little by age of child, though older children are slightly less likely to be covered.

Differences by Race and Ethnicity. Hispanic children are far less likely to be covered than either white or black children. In 1995, 27 percent of Hispanic children were not covered by health insurance, compared to 13 percent of whites and 15 percent of black children (see Figure HC 3.1.A).

Children Covered by Medicaid. The proportion of children who are covered by Medicaid has grown substantially over time, increasing from 15 percent in 1987 to a high of 24 percent in 1993, before declining slightly to 23 percent in 1994 and 1995 (see Figure HC 3.1.B). Young children are considerably more likely to be covered by Medicaid. In 1995, 30 percent of children under age six were covered, compared to 17 percent of children ages 12 through 17. Finally, a very large proportion of black and Hispanic children rely on Medicaid for their medical coverage. In 1995, 45 percent of black and 37 percent of Hispanic children were covered by Medicaid, compared to 18 percent of white children.
 

Figure HC 3.1.A   Percentage of Children Under Age 18 Not Covered by Health Insurance, by Race and Ethnicity Group: 1995

Source: Unpublished Tables, based on Analyses from the March Current Population Surveys. Housing and Household Economic Statistics Division, U.S. Bureau of the Census.
 
 

Figure HC 3.1.B   Percentage of Children Under Age 18 Who Were Covered by Medicaid: 1987-1995

Source: Unpublished Tables, based on Analyses from the March Current Population Surveys. Housing and Household Economic Statistics Division, U.S. Bureau of the Census.
 
 

Table HC 3.1.A  Percentage of Children Under Age 18 Not Covered by Health Insurance: 1987-1995
			1987	1988	1989	1990	1991	1992	1993	1994	1995
All Children			13	13	13	13	13	13	14	14	14
Age 0-5			12	13	13	11	11	11	12	14	13
Age 6-11			13	13	13	13	12	12	13	13	13
Age 12-17			14	14	14	15	15	15	17	15	14
Race/Ethnicity
	White		12	12	12	13	12	12	13	13	13
	Black		17	16	16	15	15	14	16	17	15
	Hispanic		28	29	30	28	27	25	26	28	27
Source: Unpublished Tables, based on Analyses from the March Current Population Surveys. Housing and Household Economic Statistics Division, U.S. Bureau of the Census.

Table HC 3.1.B  Percentage of Children Under Age 18 Covered by Medicaid: 1987-1995
					1987		1988		1989		1990		1991		1992		1993		1994		1995
All Children						15		16		16		19		20		22		24		23		23
		Age 0-5				18		19		20		24		27		30		32		30		30
		Age 6-11				15		15		15		17		19		20		22		22		23
		Age 12-17				12		12		11		14		15		15		17		16		17
Race/Ethnicity
		White			11		11		11		14		16		17		19		18		18
		Black			38		38		37		42		44		46		47		44		45
		Hispanic			26		25		25		30		34		37		39		37		37
Source: Unpublished Tables, based on Analyses from the March Current Population Surveys. Housing and Household Economic Statistics Division, U.S. Bureau of the Census.

³² National Center for Health Statistics, "Health of Our Nations Children" 1988. Vital Statistics Health Series, No. 191.
 
 

HC 3.2.a Early prenatal care

Early prenatal care (i.e., care in the first trimester of a pregnancy) allows women and their health care providers to identify and, when possible, treat or correct health problems and health-compromising behaviors that can be particularly damaging during the initial stages of fetal development. Increasing the number of women who receive prenatal care, and who do so early in their pregnancies, can improve birth outcomes and lower health care costs by reducing the likelihood of complications during pregnancy and childbirth.³³

The percentage of mothers receiving prenatal care in the first trimester has increased from 68.0 percent in 1970 to 81.2 percent in 1995 (see Table HC 3.2.A). Following a decade of essentially no change, the proportion of women receiving early prenatal care has improved incrementally throughout the 1990s.

Differences by Race and Ethnicity. The percentage of women receiving prenatal care during the first three months of pregnancy has increased over the past two decades for white, black, and Hispanic women.³⁴ While the gains have been greatest for black and Hispanic women, white women are still the most likely to receive prenatal care in their first trimester (see Figure HC 3.2.A).
 

• The percentage of black women receiving prenatal care in the first trimester increased from 44.2 percent in 1970 to 62.4 percent in 1980. Rates declined slightly to 60.6 percent in 1990, but continued to increase in subsequent years, reaching 70.3 percent by 1995.
• The percentage of Hispanic women who receive early prenatal care has increased steadily, from 60.2 percent in 1980 to 70.4 percent by 1995.
• The percentage of white women receiving early prenatal care increased from 72.3 percent to 79.2 percent between 1970 and 1980, was stable through the 1980s, then increased during the 1990s to 83.5 percent by 1995.

Differences by Age of Mother. Older women are more likely to receive early prenatal care than are younger women. Although there have been improvements in the receipt of early prenatal care by teenagers, this age group is consistently the least likely to receive prenatal care in the first trimester of pregnancy.

• Receipt of early prenatal care among women under age 15 improved considerably between 1975 and 1994, increasing from 30.9 percent to 45.7 percent.
• The percentage of women age 35 and over who received early prenatal care also improved during this time period, increasing from 68.4 percent in 1975 to 86.2 percent by 1994.
• More than 80 percent of mothers age 25 and older received early prenatal care throughout the 1990s.

Figure HC 3.2.A   Percentage of Mothers Receiving Prenatal Carea in the First Trimester, by Race/Ethnicity,b for Selected Years 1970-1995

Notes: a^The data refer to those women who had live births.
^bPercentages are based on the race and ethnicity of the mother.
^cFigures for Hispanic women in 1980 are based on data from 22 States which report Hispanic origin on the birth certificate; 23 States and the District of Columbia in 1985; 48 States and the District of Columbia in 1990; 49 States and the District of Columbia in 1992; and 50 States and the District of Columbia since 1993.
^dData for 1995 are preliminary.

Source: National Center for Health Statistics. Health, United States, 1995. Hyattsville, Maryland: Public Health Service. 1996. (table 7 for totals and race/ethnicity breaks for 1970-1993); 1975 data from: Monthly Vital Statistics Report. Vol. 25, No. 10, Supplement. 1976 (table 17); 1980 data from: Monthly Vital Statistics Report. Vol. 31, No. 8, Supplement. 1982 (table 20); 1985 data from: Monthly Vital Statistics Report. Vol. 36, No. 4, Supplement. 1987 (table 25); 1990 data from: Monthly Vital Statistics Report. Vol. 41, No. 9, Supplement. 1993 (tables 26 and 30); 1992 data from: Ventura, S.J., Martin, J.A., Taffel, S.M., Mathews, T.J. and Clarke S.C. Advance Report of Final Natality Statistics, 1992. Monthly Vital Statistics Report, Vol. 43, No. 5, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1994 (tables 24 and 33); 1993 data from: Ventura, S.J., Martin, J.A., Taffel, S.M., Mathews, T.J. and Clarke S.C. Advance Report of Final Natality Statistics, 1993. Monthly Vital Statistics Report, Vol. 44, No. 3, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1995 (tables 24 and 33); 1994 data from: Ventura, S.J., Martin, J.A., Mathews, T.J. and Clarke S.C. Advance Report of Final Natality Statistics, 1994. Monthly Vital Statistics Report, Vol. 44, No. 11, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1996 (tables 24 and 33). 1995 preliminary data from: Rosenberg, H.M., Ventura, S.J., Maurer, J.D., Heuser, R.L., Freedman, M.A. Births and Deaths: United States, 1995. Monthly Vital Statistics Report, Vol 45, No. 3, Supplement 2. Hyattsville, Maryland: National Center for Health Statistics. 1996 (table A).
 
 

Table HC 3.2.A   Percentage of Mothers Receiving Prenatal Care in the First Trimester:  Selected Years, 1970-1995a
			1970	1975	1980	1985	1990	1992	1993	1994	1995d
Total			68.0	72.4	76.3	76.2	75.8	77.7	78.9	80.2	81.2
Race/Ethnicityb,c
	White		72.3	75.8	79.2	79.3	79.2	80.8	81.8	82.8	83.5
	Black		44.2	55.5	62.4	61.5	60.6	63.9	66.0	68.3	70.3
	Hispanic				60.2	61.2	60.2	64.2	66.6	68.9	70.4
Age of Mother
	Under 15			30.9	34.5	36.0	37.9	42.9	44.8	45.7
	15-19			53.3	56.3	53.9	55.1	59.5	61.9	64.3
	20-24			73.4	74.9	71.7	68.9	71.2	72.8	74.6
	25-29			81.5	84.0	83.1	81.7	82.9	83.6	84.5
	30-34			78.9	84.4	85.5	85.3	86.4	86.9	87.7
	35 and older			68.4	76.1	81.3	83.4	84.6	85.3	86.2
Note: aThe data refer to those women who had live births.   bPercentages are based on the race and ethnicity of the mother.   cFigures for Hispanic women in 1980 are based on data from 22 States which report Hispanic origin on the birth certificate; 23 States and the District of Columbia in 1985;   48 States and the District of Columbia in 1990; 49 States and the District of Columbia in 1992; and 50 States and the District of Columbia since 1993.   dData for 1995 are preliminary.   Sources: National Center for Health Statistics. Health, United States, 1995. Hyattsville, Maryland: Public Health Service. 1996. (table 7 for totals and race/ethnicity breaks for 1970-1993); 1975 data from: Monthly Vital Statistics Report. Vol. 25, No. 10, Supplement. 1976 (table 17); 1980 data from: Monthly Vital Statistics Report. Vol. 31, No. 8, Supplement. 1982 (table 20); 1985 data from: Monthly Vital Statistics Report. Vol. 36, No. 4, Supplement. 1987 (table 25); 1990 data from: Monthly Vital Statistics Report. Vol. 41, No. 9, Supplement. 1993 (tables 26 and 30); 1992 data from: Ventura, S.J., Martin, J.A., Taffel, S.M., Mathews, T.J. and Clarke S.C. "Advance Report of Final Natality Statistics, 1992." Monthly Vital Statistics Report, Vol. 43, No. 5, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1994 (tables 24 and 33); 1993 data from: Ventura, S.J., Martin, J.A., Taffel, S.M., Mathews, T.J. and Clarke S.C. "Advance Report of Final Natality Statistics, 1993." Monthly Vital Statistics Report, Vol. 44, No. 3, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1995 (tables 24 and 33); 1994 data from: Ventura, S.J., Martin, J.A., Mathews, T.J. and Clarke S.C. "Advance Report of Final Natality Statistics, 1994." Monthly Vital Statistics Report, Vol. 44, No. 11, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1996 (tables 24 and 33). 1995 preliminary data from: Rosenberg, H.M., Ventura, S.J., Maurer, J.D., Heuser, R.L., Freedman, M.A. "Births and Deaths: United States, 1995." Monthly Vital Statistics Report, Vol 45, No. 3, Supplement 2. Hyattsville, Maryland: National Center for Health Statistics. 1996   (table A).

³³ U.S. Public Health Service. "Caring for Our Future: The Content of Prenatal Care." Washington, D.C.: U.S. Department of Health and Human Services. 1989.as increased from 68.0 percent in 1970 to 81.2 percent in 1995 (see Table HC 3.2.A). Following a decade of essentially no change, the proportion of women receiving early prenatal care has improved incrementally throughout the 1990s.

³⁴ This data includes only those women who gave birth, not all women who were pregnant.
 

HC 3.2.b Late or no prenatal care

Receiving prenatal care late in a pregnancy, or receiving no prenatal care at all can lead to negative health outcomes for mother and child. Women who receive care late in their pregnancy or who do not receive care at all are at increased risk of bearing infants who are low birth weight, who are stillborn, or who die within the first year of life.³⁵ Between 1970 and 1994, the percentage of women receiving late or no prenatal care declined from 7.9 percent to 4.4 percent (see Figure HC 3.2.B).

Differences by Race and Ethnicity. The percentage of mothers who receive late or no prenatal care has declined substantially for mothers in all race and ethnic groups (see Table HC 3.2.B):

• Black mothers have seen the most dramatic improvement, with the percentage receiving late or no prenatal care dropping by half between 1970 and 1994. In 1994, 8.2 percent of black mothers received late or no prenatal care.
• The percentage of Hispanic women receiving late or no prenatal care has decreased every year since 1990, and at 7.6 percent in 1994 was lower than the rate for black women.
• White women have consistently been least likely to receive late or no prenatal care. In 1994, 3.6 percent of white women received late or no prenatal care.

Differences by Age. In general, as the age of the mother increases, the likelihood of receiving late or no prenatal care decreases. The percentage of mothers age 15 and younger who received late or no prenatal care is nearly double that of mothers ages 15 through 19, and three to five times greater than mothers 20 years and older. Although their rates remain much higher than any other age group, the percentage of mothers age 15 and under who received late or no prenatal care has improved dramatically since 1975, decreasing to 15.9 percent by 1994. Percentages among mothers age 15 through 19 have also improved over this time period, decreasing to 8.0 percent in 1994. Less than four percent of women in each age group over 25 received late or no prenatal care during pregnancy, especially women age 30 through 34 whose rate of late or no prenatal care reached a new low of 2.7 percent in 1994.
 

Figure HC 3.2.B   Percentage of Mothers Receiving Latea or No Prenatal Care: Selected Years, 1970-1994b

Notes: ^aLate prenatal care is defined as 7th month or later. bThe data refer to those women who had live births. Source: 1970 and 1975 data from: Unpublished tabulations, National Center for Health Statistics. 1980 - 1993 data from: National Center for Health Statistics. Health United States, 1995. Hyattsville, Maryland: Public Health Service, 1996 (table 7). 1994 data from: Ventura, S.J., Martin, J.A., Mathews, T.J. and Clarke, S.C. Advance Report of Final Natality Statistics, 1994. Monthly Vital Statistics Report, Vol. 44, No. 11, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1996 (tables 24 and 33).
 
 

Table HC 3.2.B  Percentage of Mothers Receiving Latea or No Prenatal Care: Selected Years, 1970-1994b
			1970	1975	1980	1985	1990	1992	1993	1994
Total			7.9	6	5.1	5.7	6.1	5.2	4.8	4.4
Race/Ethnicityc,d
	White		6.3	5	4.3	4.8	4.9	4.2	3.9	3.6
	Black		16.6	10.5	8.9	10.2	11.3	9.9	9	8.2
	Hispanic				12	12.4	12	9.5	8.8	7.6
Age
	< 15			21.1	20	20.5	20.3	17.2	16.6	15.9
	15-19			10.8	10.3	12	11.9	9.7	8.9	8
	20-24			5.8	5.4	6.9	8	6.7	6.2	5.6
	25-29			3.6	3.1	3.8	4.4	3.9	3.7	3.4
	30-34			4.3	3	3.1	3.4	3	2.9	2.7
	35 and older			7.5	5.4	4.5	4.1	3.6	3.4	3.1
Notes:  aLate prenatal care is defined as 7th month or later.   bThe data refer to those women who had live births.   cPercentages are based on the race and ethnicity of the mother.   dFigures for Hispanic women in 1980 are based on data from 22 States which report Hispanic origin on the birth certificate; 23 States and the District of Columbia in 1985;   48 States and the District of Columbia in 1990; 49 States and the District of Columbia in 1992; and 50 States and the District of Columbia since 1993.   Sources: 1970 and 1975 data from: Unpublished tabulations, National Center for Health Statistics. Health, United States, 1995. Hyattsville, Maryland: Public Health Service. 1996. (table 7 for totals and race/ethnicity breaks for 1980-1993); 1980 data from: Monthly Vital Statistics Report. Vol. 31, No. 8, Supplement. 1982 (table 20); 1985 data from: Monthly Vital Statistics Report. Vol. 36, No. 4, Supplement. 1987 (table 25); 1990 data from: Monthly Vital Statistics Report. Vol. 41, No. 9, Supplement. 1993   (tables 26 and 30); 1992 data from: Ventura, S.J., Martin, J.A., Taffel, S.M., Mathews, T.J. and Clarke, S.C. "Advance Report of Final Natality Statistics, 1992." Monthly Vital Statistics Report, Vol. 43, No. 5, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1994 (tables 24 and 33); 1993 data from: Ventura, S.J., Martin, J.A., Taffel, S.M., Mathews, T.J. and Clarke S.C. "Advance Report of Final Natality Statistics, 1993." Monthly Vital Statistics Report, Vol. 44, No. 3, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1995 (tables 24 and 33); 1994 data from: Ventura, S.J., Martin, J.A., Mathews, T.J. and Clarke S.C. "Advance Report of Final Natality Statistics, 1994." Monthly Vital Statistics Report, Vol. 44, No. 11, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1996   (tables 24 and 33).

³⁵ U.S. Public Health Service. "Caring for Our Future: The Content of Prenatal Care." Washington, D.C.: U.S. Department of Health and Human Services. 1989.ve late or no prenatal care has declined substantially for mothers in all race and ethnic groups (see Table HC 3.2.B):
 

HC 3.2.c Inadequate prenatal care

Receiving early and consistent prenatal care increases the likelihood of a healthy birth outcome. Adequate prenatal care is determined by both the early receipt of prenatal care (within the first trimester) and the receipt of an appropriate number of prenatal care visits for each stage of a pregnancy. Women whose prenatal care fails to meet these standards are at a greater risk for pregnancy complications and negative birth outcomes. After fluctuating for the latter half of the 1980s, the percentage of mothers receiving inadequate prenatal care has decreased since 1990.

Differences by Race. While the percentages of both black and white women receiving inadequate prenatal care have declined since 1990, the percentage of black women receiving inadequate care has consistently been more than twice as high as the percentage of white women receiving inadequate care. This gap has existed since at least 1984 (see Table HC 3.2.C). For example, in 1994, 12.0 percent of black women received inadequate prenatal care, compared to 4.9 percent of white women.
 

Table HC 3.2.C  Percentage Receiving Inadequate Prenatal Care (Based on the Kessner Indexa), by Race for Selected Years: 1984-1994b
		1984		1986		1988	1990	1991		1992		1993	1994
Racec
	White	6.2		6.3		6.1	6.8	6.4		5.7		5.3	4.9
	Black	15.1		15.3		15.5	16.4	15.5		14.5		13.1	12
Notes: aThe Kessner Index provides a measure for the adequacy of prenatal care by assessing the timeliness and frequency with which prenatal care is received according to the gestational age of the baby. Using the Kessner Index standards, prenatal care is determined to be adequate, intermediate or inadequate. Adequate prenatal care must begin within the first trimester of pregnancy and follow a prescribed number of minimum prenatal visits by gestational period. Inadequate care encompasses all women who started care after the sixth month of pregnancy (3rd trimester) and all women who had a low frequency of prenatal visits that followed the pattern described in the following chart:
Gestation (Weeks)									Number of Prenatal Visits
17 - 21			and								0
22 - 29			and								1 or less
30 - 31			and								2 or less
32 - 33			and								3 or less
34 or More			and								4 or less
bBased on 49 states for 1984-1988 and all 50 states of the United States, 1989-1994. Births with period of gestation, number of prenatal visits or month pregnancy care began not stated were excluded from tabulation.   cIn 1990, 1991, 1992, 1993 and 1994 race is of mother; for 1984, 1986 and 1988, race is of child.   Source: Division of Vital Statistics, National Center for Health Statistics. Unpublished tabulations.

 

HC 3.3 Immunization

Childhood vaccinations can prevent diseases that killed or permanently impaired many children in past decades. The Centers for Disease Control and Prevention recommend that 80 percent of all routine childhood vaccinations be administered within the first two years of life. Vaccination coverage is particularly important before children enter preschool to prevent the spread of disease.

There were substantial increases in the proportion of children vaccinated between 1991 and 1994 for each of the recommended vaccines presented in Table HC 3.3.A. These improvements are observed for all children, but particularly for low-income children, minority children, and children living in urban and rural areas (see Table HC 3.3.A). Between 1991 and 1994 there was also a substantial improvement in the proportion of children receiving the combined series of DTP, OPV and MMR (4:3:1)³⁶ vaccination (see Figure HC 3.3.A).

Even with the increases of recent years, more than one million children remain unvaccinated for serious preventable diseases.³⁷ In particular, there are differences in immunization rates by income, race, and place of residence.

Differences by Income. Children in households at or above poverty are more likely to have received each of the vaccinations specified in each year from 1991 to 1994 than are children in households below poverty. However, the gap between vaccination levels of poor and non-poor children decreased from 1991 to 1994. For instance, the percentage of poor children vaccinated for polio was 38.7 percent in 1991, compared to 59.5 percent of children at or above the poverty line, nearly a 21 percentage point gap. By 1994, that gap had closed to less than one percentage point, with respective percentages at 79.4 and 79.9.

Differences by Race. White infants ages 19 to 35 months have higher percentages of vaccination receipt than do black children or children of other races. The disparity in vaccination levels between white and black infants has narrowed from 1991 to 1994, as the vaccination levels of black children have greatly improved.

Differences by Place of Residence. For many, but not all diseases, suburban children are more likely than either rural or urban children to have been vaccinated.

Provider-Adjusted Estimates. Unlike data for previous years, which were based only on parent reports, 1994-1995 immunization estimates are based on information from parents and health care providers. These newer estimates are more accurate and reflect higher rates of immunization than those based on parent reports alone. Data for 1994-1995 cannot be compared to estimates for 1991-1994, however, since an undetermined portion of the observed increase is due to this change in methodology.

The most recent provider-adjusted estimates (July 1994June 1995) indicate that 75 percent of children ages 19 to 35 months received their 4:3:1 combined series vaccinations. Fifty-one percent of all children in that age group had received their Hepatitis B vaccination (see Table HC 3.3.B).
 

Figure HC 3.3.A   Percentage of Children 19-35 Months Who Received the Combined Seriesa Immunizations:b 1991-1994

Note: ^aFour doses DTP, three doses poliovirus, one dose measles-mumps-rubella vaccine. bData are based on household interviews of a sample of the non-civilian, non- institutionalized population. Refusals and unknowns were excluded.

Source: Centers for Disease Control and Prevention. Data computed by the National Immunization Program, Center for Prevention Services from data compiled by the Division of Health Interview Statistics, National Center for Health Statistics.
 
 

Figure HC 3.3.B   Vaccination Coverage Levels Among Children Aged 19-35 Months, by Selected VaccinesNational Immunization Survey, U.S., July 1994June 1995

Note: ^a3 DTP/DT is 3 or more doses of diphtheria and tetanus toxoids and pertussis vaccine/diphtheria and tetanus toxoids.
^b4 DTP/DT is 4 or more doses of DTP/DT.
^cPoliovirus is 3 or more doses of poliovirus vaccine.
^dHib is 3 or more doses of Haemophilus influenzas type b vaccine.
^eMMR is 1 or more doses of measles-mumps-rubella vaccine.
^fHepatitis B is 3 or more doses of Hepatitis B vaccine.

Source: Morbidity and Mortality Weekly Reports. National, State and Urban Area Vaccination Coverage Levels Among Children Aged 19-35 Months - United States, July 1994 - June 1995, June 21, 1996, Vol. 45, No. 24, Table 1.
 
 

Table HC 3.3.A  Percentage of Children Aged 19-35 Months Who Have Received Vaccinations for Routinely Recommended Vaccinesa, by Selected CharacteristicsU.S.: 1991-1994
		Race			Poverty Statusb		Location of Residencec
					Below Poverty	At/Above Poverty
	Total	White	Black	Otherd			Urban	Suburban	Rural
>3 Doses DTP*
1991	68.8	73.4	50.6	58	53	75.7	64.8	72.3	67.6
1992	83.1	84.8	74.7	79.3	79.7	84.6	82.5	84.4	80.7
1993	88.2	89.4	82.6	84.5	80.6	90.8	85.8	89.8	88.5
1994	89.5	90.6	84.4	87.9	88.8	90.3	87.7	90.4	90
>4 Doses DTP*`
1991	43.3	47.3	27.9	33.1	29.9	48.6	36.4	46.4	47.5
1992	59	59.5	55	62.4	54.4	61	59.7	60	55.4
1993	72.1	73	69.2	64.7	65.3	74.6	68.5	75.6	70.6
1994	70.1	70.8	64.4	77.3	67.7	71.2	67.2	72.1	69.9
>3 Doses Poliovirus
1991	53.2	57.3	35.6	49.8	38.7	59.5	49.9	55.8	52.5
1992	72.4	74.1	62.7	75.5	66.6	74.7	74.1	72.6	69
1993	78.9	79.8	73.4	80.8	73.3	81	75.3	79.7	82.5
1994	79.2	80.3	73.2	81.7	79.4	79.9	76.4	80.9	79.5
>3 Doses Hib**
1991	1.7	1.9	1.4	0	0	2.2	0.9	2.5	1.2
1992	28.2	29.1	25.5	23	23	29.8	27.5	31.8	20.8
1993	55	56.9	44.8	56.9	43.9	59.6	47.8	60.5	55.2
1994	75	76.6	67.2	72.3	72.1	76.6	70.6	76.7	77.6
Measles
1991	82	82.9	77.4	83.8	73.4	86.6	78.4	85	81.1
1992	82.5	83.6	77.9	79.9	80.2	84.3	84.5	83.3	77.2
1993	84.1	86	76.9	72.5	78.4	86.9	84.2	86.2	79.8
1994	90.3	91.7	86	81.1	88.3	91.8	87.9	91.7	91
>3 Doses Hepatitis B
1991
1992
1993	16.3	16.3	16	16.7	11.3	18.2	17.4	19	9.3
1994	34.4	33.7	36.2	39.7	31.6	35.2	33.8	37.8	27.1
Combined Series: 4:3:1
1991	37	41.4	20.8	27.5	23.8	42.2	31.7	38.6	41.9
1992	55.3	55.9	50.9	57.5	51.4	56.7	57.7	55.4	50.5
1993	67.1	68.4	61.8	58.4	58.7	70.5	62.1	71.4	66
1994	67.5	68.4	61.2	72.4	64.9	68.8	63.5	69.7	68.3
Combined Series: 3:3:1§
1991	50	54.5	31.4	44.2	34.3	56.6	46.6	52.8	49.4
1992	68.7	70	60.2	71.9	65	70.2	72.4	68.2	63.2
1993	74.5	75.7	69.2	68	66.8	77.7	71.5	76.3	75.3
1994	77.3	78.7	70.5	76.3	76.6	78.4	72.9	79.5	78.9
*Diphtheria, tetanus toxoids, and pertussis vaccine.   **Hemophilus influenzas type b vaccine.   Any vaccination containing measles vaccine.   Four doses DTP, three doses poliovirus, one dose measles-mumps-rubella vaccine.   §Three doses DTP, three doses poliovirus, one dose measles-mumps-rubella vaccine.   aData are based on household interviews of a sample of the non-civilian, non institutionalized population. Refusals and unknowns were excluded. Exclusions included unknown vaccine type.   bPoverty status is based on family income and family size using Bureau of the Census poverty thresholds.   cRural areas were those not in a metropolitan statistical area (MSA); suburban areas were those in an MSA but outside the central city; and urban areas were the central city of the MSA.   dLimitations in sample size precluded collection of data about ethnicity and analysis of data for races other than black and white.   Source: Centers for Disease Control and Prevention. Data computed by the National Immunization Program, Center for Prevention Services from data compiled by the Division of Health Interview Statistics, National Center for Health Statistics.

 
 

Table HC 3.3.B  Percentage of Children Aged 19-35 Months Who Have Received Vaccinations for Routinely Recommended Vaccine, by Selected VaccinesNational Immunization Survey, U.S.a  July 1994June 1995
Vaccine	Dose				July 1994 - June 1995
DPT/DT*
	>3 Doses				94
	>4 Doses				78
Poliovirus
	>3Doses				86
Hib¶
	>3 Doses				91
MMR§
	>1 Dose				89
Hepatitis B
	>3 Doses				51
		19-24 Months			64
		25-30 Months			51
		31-35 Months			34
Combined Series
	4 DTP/3 Polio/1 MMR				75
	4 DTP/3 Polio/1 MMR/3 Hib				73
*Diphtheria and tetanus toxoids and pertussis vaccine/Diphtheria and tetanus toxoids.   ¶Hemophilus influenzas type b vaccine.   §Measles-mumps-rubella vaccine.   Four doses DTP/DT, three doses poliovirus vaccine, and one dose MMR.   Four doses DTP/DT, three doses poliovirus vaccine, one dose MMR, three doses Hib.   aData are based on household interviews of a sample of the non-civilian, non-institutionalized population.   Refusals and unknowns were excluded.   Note: In 1994-1995, data from the household interviews is supplemented with information from medical providers and cannot be compared to 1991-1993 data.   Source: Morbidity and Mortality Weekly Reports. "National, State and Urban Area Vaccination Coverage Levels Among Children Aged 19-35 Months," June 21, 1996, Vol. 45, No. 24, Table 1. (Data from the National Immunization Survey.)

³⁶ Four doses diphtheria, tetanus toxoids and pertussis vaccine (DTP); three doses poliovirus vaccine (OPV); and one dose measles-mumps-rubella vaccine (MMR).

³⁷ Centers for Disease Control and Prevention. "Vaccination Coverage Levels Among Children Aged 19-35 Months -- United States, April-December 1994." Morbidity and Mortality Weekly Report. Vol. 44, No. 33, August 25, 1995
 
 

SECTION 4 SOCIAL DEVELOPMENT, BEHAVIORAL HEALTH, AND TEEN FERTILITY (SD)

SOCIAL DEVELOPMENT

SD 1.1 Life goals

The personal and social life goals of high school students reflect their priorities for the future and provide insights into the positive and negative influences in their lives as they make the transition to adulthood. The percentages of high school seniors who rated selected personal and social life goals as extremely important for 1976 through 1995 are presented in Table SD 1.1. Personal goals include being successful at work, having a good marriage and family life, and having lots of money. Social goals include making a contribution to society, working to correct social and economic inequalities, and being a leader in the community.

From 1976 through 1995, high school seniors have been fairly consistent in the relative importance they assign to various life goals. Specifically:

• Having a Good Marriage and Family Life and Being Successful in My Line of Work have been cited most often by high school seniors as being extremely important. By 1995, four out of five high school seniors felt it extremely important to have a good marriage and family life (see Figure SD 1.1.A).
• Having Lots of Money and Making a Contribution to Society were the next most likely goals to be considered extremely important by high school seniors. The percentage of seniors who find these goals important is considerably lower, hovering between 20 and 30 percent in recent years (see Figures SD 1.1.A. and SD 1.1.B).
• Working to Correct Social and Economic Inequalities and Being a Leader in the Community are important goals for only small percentages of high school seniors 10 percent and 12 percent, respectively, in 1995 (see Figure SD 1.1.B).

Differences by Race. In 1995, black students were more likely than whites to view as extremely important issues such as being successful at work (72 percent versus 59 percent), having lots of money (41 percent versus 21 percent), and correcting social and economic inequalities (18 percent versus 8 percent). The two groups appeared equally likely to attach extreme importance to having a good marriage and family life, a rate that has hovered around 75 percent for both races over time.

Differences by Gender. Across the six goals, rates vary little between male students and female students with two exceptions. In 1995, females were more likely to indicate that having a good marriage and family life was extremely important (83 percent versus 73 percent), and were less likely to report that having lots of money was an extremely important goal (19 percent versus 30 percent).
 

Figure SD 1.1.A   Percentage of High School Seniors Who Rate Selected Personal Goals as Being Extremely Important, 1995

Source: Bachman, J.G., Johnston, L.D., and OMalley, P.M. Monitoring the Future: Questionnaire responses from the Nations High School Seniors, 1995. Questionnaire form 1 numbers, A007A, A007B, A007C. Data based on one of six questionnaire forms with a resulting sample size one-sixth of the total sample size for each year.
 
 

Figure SD 1.1.B   Percentage of High School Seniors Who Rate Selected Social Goals as Being Extremely Important, 1995

Source: Bachman, J.G., Johnston, L.D., and OMalley, P.M. Monitoring the Future: Questionnaire responses from the Nations High School Seniors, 1995. Questionnaire form 1 numbers, A007G, A007H, A007L. Data based on one of six questionnaire forms with a resulting sample size one-sixth of the total sample size for each year.
 
 

Table SD 1.1   Percentage of High School Seniors Who Rate Selected Life Goals as Being "Extremely Important," 1976-1995
						1976	1981	1986	1991	1992	1993	1994	1995
Personal Goals
Being Successful in My Line of Work
Total						53	57	61	62	66	65	63	62
	Gender
		Male				53	58	62	60	63	63	61	62
		Female				52	57	60	64	69	67	66	62
	Race
		White				50	55	58	59	65	62	60	59
		Black				67	71	73	75	80	74	79	72
Having a Good Marriage and Family Life
Total						73	76	75	76	78	79	76	78
	Gender
		Male				66	71	69	71	72	74	70	73
		Female				80	82	82	83	84	85	81	83
	Race
		White				72	77	76	76	79	79	76	78
		Black				75	73	76	78	75	76	72	76
Having Lots of Money
Total						15	18	27	28	29	26	26	25
	Gender
		Male				20	24	34	37	35	32	32	30
		Female				11	13	18	19	22	18	19	19
	Race
		White				12	15	24	25	24	20	22	21
		Black				33	32	38	39	46	45	47	41

 
 

Table SD 1.1 Continued  Percentage of High School Seniors Who Rate Selected Life Goals as Being "Extremely Important," 1976-1995
						1976	1981	1986	1991	1992	1993	1994	1995
Social Goals
Making a Contribution to Society
Total						18	18	17	21	22	24	24	20
	Gender
		Male				16	19	18	20	22	25	23	19
		Female				20	17	16	22	23	25	25	21
	Race
				White		18	18	16	20	22	24	23	19
				Black		23	21	20	27	27	25	29	25
Working to Correct Social and Economic Inequalities
Total						10	10	9	12	15	15	14	10
	Gender
		Male				8	9	7	11	14	14	12	9
		Female				13	10	11	13	17	16	16	10
	Race
		White				8	7	7	10	13	12	11	8
		Black				20	21	19	21	26	21	25