Federal Report Shows Slight Declines in Preterm Birth & Low Birthweight

Children More Likely to Live in Poverty, Less Likely to Have Parent Employed Year Round, Full Time

American infants were less likely to be born preterm or of low birthweight, when compared to the previous year, according to the federal government’s annual statistical report on the well-being of the nation’s children. However, the report also showed economic setbacks for the nation’s children. Children were more likely to live in poverty, and less likely to have at least one parent employed year round, full time.

This and other information has been compiled in America’s Children: Key National Indicators of Well-Being, 2009. The report, issued by the Federal Interagency Forum on Child and Family Statistics, is a statistical compendium of the status of the nation’s children and youth. The report is compiled by a number of federal agencies and provides a broad overview of the following key areas of child well-being: family and social environment, economic circumstances, heath care, physical environment and safety, behavior, education, and health.

“The slight declines in preterm birth and low birthweight give us reason for hope,” said Duane Alexander M.D., director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health. Infants born preterm and those of low birthweight (less than 5 lbs 8 oz) are at increased risk for infant death and such lifelong disabilities as blindness, deafness and cerebral palsy. This year’s report marks the first time in decades that the indicators have not increased, he added.

“Unfortunately, at this point we don’t know if they are the beginning of a trend, or a minor fluctuation,” Dr. Alexander said.

Other changes highlighted in the report include an increase in the proportion of children with health insurance coverage, increases in the proportion of high school graduates who had taken advanced course work in mathematics and foreign languages, and decreases in 10th graders’ reports of regular smoking and heavy drinking. The report also indicates an increase in the birth rate among unmarried women and an increase in the birth rate among adolescent girls. The proportion of all births that were to unmarried women also reached the highest level ever recorded.

“We are watching the increase in teen births with some concern because women who give birth so early in life often suffer economic and health disadvantages,” said Edward Sondik, Ph.D., director of the Centers for Disease Control and Prevention’s National Center for Health Statistics. “The well-being of these adolescents is critical for their future as well as their children’s future.”

This year’s report also includes a special feature on children with special health care needs--defined as those children who have a chronic physical, developmental, behavioral, or emotional condition who also require health and related services of a type or amount beyond that required by children generally. These children are identified through parents’ reports that their child has a health problem expected to last at least 12 months and which requires prescription medication, more services than most children, special therapies, or which limits his or her ability to do things most children can do.

“These data highlight the diversity of children affected by chronic health conditions,” said Peter van Dyck, M.D., M.P.H., Associate Administrator for Maternal and Child Health at the Health Resources and Services Administration. “It is important that we share these data to help inform health, social, and educational service providers in their decision-making as they work to support children with special health care needs.”

An estimated 14 percent of children ages birth to 17 years old had a special health care need in 2005–2006. Overall, 22 percent of all U.S. households with children had at least one child with special health care needs. The proportion of children with special health care needs increased from 13 percent in 2001 to 14 percent in 2005–2006.

These and other findings on the nation’s children and youth are described in the report’s content areas:

As in previous years, not all statistics are collected on an annual basis, and therefore, some data in the Report may be unchanged from last year’s report. Members of the public may access the report on-line at https://www.childstats.gov/ on July 10. Alternatively, members of the public also may obtain printed copies from the Health Resources and Services Administration, Information Center, P.O. Box 2910, Merrifield, VA 22116, by calling 1-888-Ask-HRSA (1-888-275-4772), or by e-mailing ask@hrsa.gov.

Demographic Background

America’s Children: Key National Indicators of Well-Being, 2009, the U.S. government’s annual monitoring report on the well-being of the Nation’s children and youth.

The child population of the United States was 73.9 million in 2008, unchanged from 2007. In 2008, there were approximately equal numbers of children in three age groups: birth to five years old (25 million), 6–11 (24 million), and 12–17 (25 million) years of age.

The proportion of children in relation to the overall U.S. population declined slightly, from 24.5 percent in 2007, to 24.3 percent in 2008. The proportion of children in the population is expected to remain stable in the coming decade, anticipated to be about 24 percent in 2021.

The population is projected to become even more diverse in the decades to come. In 2008, 56 percent of U.S. children were White, non-Hispanic; 22 percent were Hispanic; 15 percent were Black; 4 percent were Asian; and 5 percent were “All other races.” The percentage of children who are Hispanic has increased faster than that of any other racial or ethnic group, growing from 9 percent of the child population in 1980 to 22 percent in 2008. By 2021, it is projected that 1 in 4 children in the United States will be of Hispanic origin.

Family and Social Environment

America’s Children: Key National Indicators of Well-Being, 2009, the U.S. government’s annual monitoring report on the well-being of the Nation’s children and youth.

In 2008, 67 percent of children ages birth to 17 years old lived with two married parents, down from 68 percent in 2007. In 2008, 23 percent of children lived with only their mothers, 4 percent lived with only their fathers, and 4 percent lived with neither of their parents. Three percent of all children lived with two unmarried parents in 2008.

Births to unmarried women ages 15-44 increased, from 51 births per 1,000 unmarried women in 2006, to 53 for every 1,000 in 2007. Similarly, the proportion of all births that were to unmarried women also increased, from 38 percent in 2006 to 40 percent in 2007, the highest percentage ever recorded. From 1994 to 2002, the percentage ranged from 32 to 34 percent. The report noted that children of unmarried mothers are at higher risk of adverse birth outcomes such as low birthweight and infant mortality than are children of married mothers. They are also more likely to live in poverty than children of married mothers.

The adolescent birth rate (which includes both married and unmarried adolescents) also increased, from 22.0 births per 1,000 teenage girls ages 15-17 in 2006, to 22.2 births per 1,000 girls in 2007. The report noted that this was the second consecutive increase in this measure since the long-term decline beginning 1991–1992.

“Compared with babies born to older mothers, babies born to adolescent mothers, particularly young adolescent mothers, are at higher risk of low birthweight and infant mortality,” the report stated. “They are more likely to grow up in homes that offer lower levels of emotional support and cognitive stimulation and they are less likely to earn high school diplomas.”

The report added that for the mothers, giving birth during adolescence is associated with limited educational attainment, which, in turn, can reduce employment prospects and earnings potential.

This year’s report added data on the rate of child maltreatment among infants, who have higher rates compared to other children. Child maltreatment includes physical, sexual, and psychological abuse, as well as neglect (including medical neglect). In 2007, there were 22 substantiated child maltreatment reports per 1,000 children under age one, compared with 13 for children ages one to three, 12 for children ages four to seven, nine for children ages eight to 11, nine for children ages 12–15 and five for adolescents ages 16–17.

“Events occurring by age one set the stage for a child’s later development,” said Naomi Goldstein, Ph.D., director of the Office of Planning, Research and Evaluation at HHS’ Administration for Children and Families. “This closer look at the data can help us to target our prevention efforts.”

Economic Circumstances

America’s Children: Key National Indicators of Well-Being, 2009, the U.S. government’s annual monitoring report on the well-being of the Nation’s children and youth.

In 2007, 18 percent of all children ages birth to 17 years old lived in poverty, an increase from 17 percent in 2006. The report noted that, compared with children living in families that are not in poverty, children living in poverty are more likely to have difficulty in school, to become teen parents, and, as adults, to earn less and be unemployed more frequently. The poverty rate was higher for Black children and for Hispanic children than for White, non-Hispanic children. In 2007, 10 percent of White, non-Hispanic children, 35 percent of Black children, and 29 percent of Hispanic children lived in poverty.

The percentage of children who had at least one parent working year round, full time also declined, to 77 percent in 2007, from 78 percent in 2006. The peak was 80 percent in 2000.

“This proportion has remained relatively high, given its historical context; in the early 1990s, the proportion was 72 percent,” the report stated.

The report stated that secure parental employment reduces the incidence of poverty and its risks to children. Secure parental employment may enhance children’s psychological well-being by reducing stress and other negative effects that unemployment and underemployment can have on parents.

The percentage of children living in food-insecure households in 2007 (17 percent) was essentially unchanged from 2005 and 2006 and was lower than the 19 percent observed in 2004. The report defined food security as a family’s access at all times to adequate food for an active, healthy life. However, the percentage of children in the most food insecure households—those classified as having very low food security among children—increased from 0.6 percent in 2006 to 0.9 percent in 2007.

“In these households, eating patterns of one or more children were disrupted and food intake was reduced below a level considered adequate by caregivers,” the report stated.

Health Care

America’s Children: Key National Indicators of Well-Being, 2009, the U.S. government’s annual monitoring report on the well-being of the Nation’s children and youth.

The proportion of children with health insurance for at least some time during the year increased in 2007, to 89 percent, up from 88 percent in 2006. The report noted that in each year since 1987, between 85 and 90 percent of children have had health insurance. In 2007, 64 percent of children were covered by private health insurance at some time during the year and 31 percent were covered by public health insurance at some time during the year. The total of these two estimates exceeds 89 percent, because both estimates include children covered by both public and private insurance at some time during the year.

In recent years, a vaccine for varicella (chicken pox) was added to the combined series of vaccines recommended for children to receive by 19-35 months of age. This year’s report includes data on this combined six-vaccine series for children for the first time. In 2007, 77 percent of children ages 19–35 months had received the recommended combined six-vaccine series. Reporting for the combined six-vaccine series began in 2002, and percentages have steadily increased from 66 percent.

Physical Environment and Safety

America’s Children: Key National Indicators of Well-Being, 2009, the U.S. government’s annual monitoring report on the well-being of the Nation’s children and youth.

In 2007, 43 percent of households with children reported one or more housing problems: shelter cost burden, crowding, and/or physically inadequate housing, up from 40 percent in 2005. The report noted that this proportion has increased over the long term from 30 percent in 1978. Shelter cost burden refers to housing that costs more than 30 percent of household income.

Physically inadequate housing, defined as housing with severe or moderate physical problems, has continued to decrease: from 9 percent in 1978, to 5 percent in 2007. Improvements in housing conditions, however, have been accompanied by rising housing costs.

“Between 1978 and 2007, the incidence of cost burdens among households with children more than doubled, from 15 percent to 37 percent,” the report stated. “The proportion with severe cost burdens, paying more than half of their income for housing, rose from 6 percent to 16 percent over the same period.”

Children’s exposure to secondhand smoke dropped between 1988–1994 and 2005–2006. Exposure to secondhand smoke is measured through the presence of a tobacco byproduct, cotinine, in the blood. In 2005-2006, cotinine was present in 51 percent of children ages 4–11, down from 88 percent in 1988–1994. In 2005, 8 percent of children ages 6 and younger lived in homes where someone smoked regularly, down from 27 percent in 1994.

Injury deaths of children ages 5-14 declined to 7 per 100,000 in 2006, down from 8 per 100,000 in 2005. Injury deaths of children ages 1-4 did not change significantly from the previous year, with 12 deaths per every 100,000 children in that age group. The report noted that although injury death rates have declined over the past two decades, unintentional injuries (accidents) remain the leading cause of death for children ages 1–4 and ages 5–14: 10 deaths per 100,000 children ages 1–4 and 6 deaths per 100,000 children ages 5–14.

Nearly 80 percent of deaths among adolescents ages 15-19 were from injuries (50 injury deaths per 100,000 adolescents in 2006). This rate remained unchanged from the previous year. However, the homicide rate increased from 10 homicides per 100,000 adolescents ages 15–19 in 2005, to 11 per 100,000 in 2006. Suicides remained unchanged in this age group in 2006.

“We were pleased to note the decrease in injury death for children 5 to 14,” said Dr. Edward Sondik, director of the Centers for Disease Control and Prevention’s National Center for Health Statistics. “However, the upward trend in the homicide death rate for teens shows that intentional injury deaths are still a considerable threat to America’s youth.”

Behavior

America’s Children: Key National Indicators of Well-Being, 2009, the U.S. government’s annual monitoring report on the well-being of the Nation’s children and youth.

The proportion of 10th graders who reported smoking cigarettes daily during the past 30 days declined, from 7 percent in 2007, to 6 percent in 2008. Smoking among 8th, 10th, and 12th graders peaked in 1996 and 1997 and has declined among all three groups since then. The most dramatic declines were seen among the youngest students. In 2008, 3 percent of 8th-grade students, 6 percent of 10th-grade students, and 11 percent of 12th-grade students reported smoking cigarettes daily, compared with the respective peaks of 10, 18, and 25 percent.

The percentage of 10th graders who reported heavy drinking of alcoholic beverages in the past two weeks declined, from 20 percent in 2007 to 16 percent in 2008. The report defined heavy drinking as five or more alcoholic beverages in a row or during a single occasion in the previous 2 weeks. The report noted that heavy drinking increases the chances of motor vehicle accidents, injuries, and deaths; problems in school and in the workplace; and fighting, crime, and other serious consequences.

Education

America’s Children: Key National Indicators of Well-Being, 2009, the U.S. government’s annual monitoring report on the well-being of the Nation’s children and youth.

The report states that education shapes children’s personal development and life chances, as well as the economic and social progress of the Nation. The report’s education section presents key indicators of how well children are learning and progressing from early childhood through postsecondary school.

"Reading to young children promotes language acquisition and is linked with literacy development and, later on, with achievement in reading comprehension and overall success in school," the report stated. "The percentage of young children read to daily by a family member is one indicator of how well young children are being prepared for school."

The percentage of children ages 3-5 who were read to every day in the last week by a family member declined, from 60 percent in 2005, to 55 percent in 2007. The report noted that this percentage is slightly higher than the proportion of 53 percent in 1993, but the rate has fluctuated in intervening years.

The percentage of students who had taken at least one advanced course in mathematics by the time they had graduated high school increased, from 45 percent in 2000 to 49 percent in 2005. The report defined advanced coursework in mathematics as a course above Algebra II. This was higher than the percentage in 1982 (26 percent).

The proportion of students who had taken advanced coursework in foreign languages also increased, from 30 percent in 2000 to 33 percent in 2005. This proportion was double that in 1982 (15 percent). In 2005, 16 percent of high school graduates had not taken any foreign language course, compared with 46 percent of graduates in 1982.

In 2007, 89 percent of young adults ages 18-24 had completed high school with a diploma or an alternative credential such as a General Education Development (GED) certificate, up from 88 percent in 2006. The high school completion rate has increased slightly since 1980, when it was 84 percent.

Health

America’s Children: Key National Indicators of Well-Being, 2009, the U.S. government’s annual monitoring report on the well-being of the Nation’s children and youth.

After several decades of increases, the percentage of births that were preterm or low birthweight declined slightly in 2007. The percentage of preterm births declined from 2006 to 2007, from 12.8 percent to 12.7 percent. The percentage of infants born with low birthweight also declined, from 8.3 percent in 2006 to 8.2 percent in 2007. Preterm birth and low birthweight predispose infants toward death in the first year of life, to a variety of developmental disorders, and to chronic health problems in childhood and in adult life. Many preterm infants are of low birthweight and many low birthweight infants are preterm.

African American infants were more likely than other racial and ethnic groups to be low birthweight and born prematurely. In 2007, 18 percent of Black, non-Hispanic infants were born preterm, compared with 11 percent of White non-Hispanic infants, and 12 percent of Hispanic infants. In 2007, 13.8 percent of Black, non-Hispanic infants were low birthweight, compared with 7.2 percent of White, non-Hispanic infants, and 6.9 percent of Hispanic infants. The percentage of Black, non-Hispanic infants of low birthweight declined to a low of 13.1 percent in 1996 and 1997 then rose to 14.0 percent in 2006 before declining to 13.8 percent in 2007.

The infant mortality rate also declined, from 6.9 deaths per every 1,000 live births in 2005 to 6.7 in 2006. Infant mortality is defined as the death of an infant in the first year of life. About two-thirds of infant deaths occur in the first month after birth and are due mostly to health problems of the infant, such as birth defects, or problems related to the pregnancy, such as preterm delivery.

This year’s report added a new indicator on adolescent depression. “Depressive episodes often persist, recur, or continue into adulthood,” the report stated. “Youth who have had a Major Depressive Episode (MDE) in the past year are at greater risk for suicide and are more likely than other youth to initiate alcohol and other drug use, experience concurrent substance use disorders, and smoke daily.” The proportion of youth ages 12-17 that had a major depressive episode decreased from 9 percent in 2004 to 8 percent in 2007.

This section’s other indicators were unchanged from the previous year.

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