2011 CHILD HEALTH STATUS REPORT 2 IDAHO KIDS COUNT Adams Canyon Gem Owyhee Payette Washington Ada Boise Elmore Valley Blaine Camas Cassia Gooding Jerome Lincoln Minidoka Twin Falls Bannock Bear Lake Bingham Butte Caribou Franklin Oneida Power Bonneville Clark Custer Fremont Jefferson Lemhi Madison Teton Idaho Lewis Nez Perce Latah Clearwater Shoshone Benewah Kootenai Bonner Boundary Panhandle North Central Southwest Central South Central Southeastern Eastern (District 1) (District 2) (District 3) (District 5) (District 6) (District 4) (District 7) Map of Idaho Health Districts Much of the data in this report is reported by Health District. is map displays the counties that make up the seven Health Districts of Idaho. CHILD HEALTH STATUS REPORT 3 Introduction Contents Maternal Health 4 Birth Outcomes 7 Immunizations: Kindergarten 10 Immunizations: First Grade 14 Immunizations: Seventh Grade 18 Health Insurance Coverage 22 Lead Exposure 27 Mortality Rates 28 Asthma 30 Mental Health 31 Substance Abuse 33 Reproductive Health 38 Weight, Nutrition, and Physical Activity 40 Reference List 42 is Idaho KIDS COUNT Child Health Status Report at- tempts to capture the most relevant and current data related to child health in the state. In the next few years, health reform legislation will likely change the landscape of public health and health care. is report may serve as a baseline by which we can eventually assess areas for improvement and identify areas where gains are yet to be realized. Idaho KIDS COUNT is grateful to Sarah Clark and Sara Herring for diligently compiling the data for this report and to Amanda Hundt for graphic design. We are also indebted to our colleagues at the Idaho Department of Health and Welfare and the State Department of Education for timely responses to data questions. is research was funded by the Annie E. Casey Foundation. We thank them for their support but acknowledge that the ndings and conclusions presented here do not necessarily reect the opinions of the Foundation. Please visit the KIDS COUNT Data Center available at www.idahokidscount.org for the most recent indicators on child health and well-being. 4 IDAHO KIDS COUNT Maternal Health Pregnancy Risk Assessment Tracking System: Maternal Health 4 Indicator Year Idaho HD 1 HD 2 HD 3 HD 4 HD 5 HD 6 HD 7 Percent Idaho mothers who drank alcohol during the third trimester* 2007 3.3% 4.6% 4.9% 2.4% 4.6% 4.2% 1.5% 1.5% 2008 2.9% 4.0% 4.5% 2.5% 3.5% 3.9% 2.1% 1.0% 2009 4.1% 6.1% 7.6% 1.9% 6.7% 4.8% 2.1% 1.1% Percent Idaho mothers who smoked during the third trimester 2007 8.0% 12.1% 7.9% 8.4% 8.1% 8.8% 6.3% 5.9% 2008 8.1% 11.9% 13.0% 10.5% 6.4% 5.8% 9.5% 5.5% 2009 8.5% 14.9% 11.1% 10.1% 6.2% 8.0% 10.2% 5.1% Percent Idaho mothers who initiated prenatal care in the rst trimester 2007 86.5% 84.6% 87.3% 82.1% 89.7% 84.3% 86.0% 88.6% 2008 88.9% 86.5% 88.8% 86.0% 89.9% 87.1% 89.3% 92.5% 2009 89.4% 88.5% 89.4% 88.6% 89.5% 84.3% 89.8% 94.1% Percent Idaho mothers who received routine dental care during pregnancy 2007 45.5% 39.8% 45.9% 39.5% 55.7% 37.5% 45.7% 44.4% 2008 50.4% 42.6% 48.7% 47.2% 61.5% 43.3% 47.6% 48.4% 2009 53.9% 50.8% 48.8% 47.2% 65.8% 43.8% 53.7% 53.4% Notes * Consuming one or more alcoholic beverages during the last trimester. Maternal health and access to health care are important fac- tors for infant health. Alcohol use during pregnancy can have severe, negative implications for unborn fetuses and can result in Fetal Alcohol Spectrum Disorders. In addition to miscarriages and stillbirth, alcohol consumption during pregnancy can cause a range of lifelong defects. 1 Smoking during pregnancy can also cause negative implica- tions for both mom and baby, including premature births, low birth weight, and stillbirth. 2 It is important for pregnant women to access prenatal and dental care. Studies have shown that expectant mothers are more susceptible to dental cavities and gum disease due to the rise in hormone levels during pregnancy, and early-initiated prenatal care can unveil and reduce potential complications and ensure that both mom and baby are healthy. 3 In Idaho, alcohol consumption during pregnancy increased slightly from 2007 to 2009 from 3.3% of mothers to 4.1% of mothers. In 2009, Health District 2 had the highest percent of pregnant mothers consuming alcohol at 7.6%. Health District 7 had the lowest percent at 1.1%. 4 Smoking also increased slightly between 2007 and 2009, from 8.0% to 8.5% of pregnant women. In 2009, Health District 1 had the highest percent of pregnant women smok- ing at 14.9%, and Health District 7 had the lowest percent at 5.1%. Smoking during pregnancy is more prevalent than drinking during pregnancy by a factor of about two. 4 Prenatal care increased between 2007 and 2009, from 86.5% to 89.4% of expectant mothers receiving routine prenatal care. Dental care utilization during pregnancy also increased, from 45.5% to 53.9% of mothers receiving routine dental care. 4 CHILD HEALTH STATUS REPORT 5 200920082007 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% HD 7HD 6HD 5HD 4HD 3HD 2HD 1Idaho 200920082007 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% HD 7HD 6HD 5HD 4HD 3HD 2HD 1Idaho 6 IDAHO KIDS COUNT 200920082007 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% HD 7HD 6HD 5HD 4HD 3HD 2HD 1Idaho 200920082007 0% 20% 40% 60% 80% 100% District 7District 6District 5District 4District 3District 2District 1Idaho 10% 30% 50% 70% 90% CHILD HEALTH STATUS REPORT 7 Birth Outcomes Low birthweight, dened as a weight of less than 2500 grams (approximately 5.8 lbs), can be indicative of intrauterine growth retardation, fetal growth restriction, and/or poor maternal nutrition. is type of growth delay contributes to the risk of other health problems, including respiratory distress and hypoglycemia, and is therefore a useful birth outcome to track. 5 Low birthweight babies, as a percent of births, has remained fairly consistent in Idaho over the 11-year span of 1999- 2009, ranging from a low of 6.2% in 1999 to a high of 6.9% in 2006. Idaho has consistently been below the national av- erage in percentage of low birthweight babies. Nationally, low birthweight rates ranged between 7.6% and 8.3% of all births during the same 11-year period. e percent of low birthweight babies is calculated by dividing the number of low birthweight babies by the total number of births. 6,7 Breastfeeding in Idaho increased slightly from 2007 to 2009 from 50.5% of mothers breastfeeding for the rst six months, to 55.4% of mothers breastfeeding for the rst six months. In 2009, the health district with the highest prevalence of mothers breastfeeding for the rst six months was Health District 7 at 62.8%, and the health district with the lowest prevalence was Health District 3 at 47.3%. Only mothers 18 years of age or older, whose infants were at least six months at the time of the survey, are included in these data. 4 e percent of Idaho mothers reporting that their babies hearing had been tested remained fairly constant from 2007 to 2009, increasing slightly from 94.2% to 94.8%. In 2009, the health district with the highest reported frequency of newborn hearing tests was Health District 6 at 98.1%, and the health district with the lowest reported frequency of new- born hearing tests was Health District 2 at 91.7%. 4 Routine well-baby care is essential to ensuring that newborns are developing normally and identifying potential health problems early. Between 2007 and 2009 the percent of Idaho mothers who took their child for routine well-baby care visits increased slightly from 96.9% to 98.1%. In 2009, the health districts with the highest percent of routine well-baby visits were Health Districts 1 and 7 at 99.0%. e health district with the lowest percent of routine well-baby care was Health District 5 at 96.3%. 4 Pregnancy Risk Assessment Tracking System: Infant Care 4 Indicator Year Idaho HD 1 HD 2 HD 3 HD 4 HD 5 HD 6 HD 7 Percent of Idaho mothers who breastfed for at least six months* 2007 50.5% 54.3% 54.2% 41.4% 53.1% 48.0% 49.8% 55.0% 2008 55.2% 58.7% 54.7% 45.5% 58.2% 53.6% 52.9% 60.4% 2009 55.4% 55.9% 60.9% 47.3% 58.6% 48.3% 53.5% 62.8% Percent of Idaho mothers who reported their baby's hearing was tested 2007 94.2% 92.1% 88.4% 92.4% 96.4% 96.3% 95.5% 92.6% 2008 93.7% 89.5% 89.2% 90.1% 95.8% 97.1% 94.0% 94.9% 2009 94.8% 93.1% 91.7% 92.5% 96.9% 93.8% 98.1% 94.2% Percent of Idaho mothers who took their baby for routine well-baby care 2007 96.9% 95.8% 98.1% 95.5% 98.0% 96.2% 97. 5% 96.8% 2008 97.1% 95.7% 97.7% 94.8% 98.2% 97.0% 98.2% 97.8 % 2009 98.1% 99.0% 97.4% 97.9% 98.4% 96.3% 97.6% 99.0% Low Birthweight Babies (Percentage of Births) 6,7 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 United States 7.6% 7.6% 7.7% 7.8% 7.9% 8.1% 8.2% 8.3% 8.2% 8.2% 8.2% Idaho 6.2% 6.7% 6.4% 6.2% 6.5% 6.8% 6.7% 6.9% 6.5% 6.5% 6.6% Notes * Babies who were not at least six months old at the time of the survey were excluded from analysis. 8 IDAHO KIDS COUNT IdahoUS 0 1% 2% 3% 4% 5% 6% 7% 8% 9% 20092008200720062005200420032002200120001999 200920082007 0% District 7District 6District 5District 4District 3District 2District 1Idaho 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% CHILD HEALTH STATUS REPORT 9 200920082007 0% 20% 40% 60% 80% 100% 10% 30% 50% 70% 90% District 7District 6District 5District 4District 3District 2District 1Idaho 200920082007 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% HD 7HD 6HD 5HD 4HD 3HD 2HD 1Idaho 10 IDAHO KIDS COUNT Idaho seventh-graders have complete immunization rates of 94.8% for DTaP, 95.8% for polio, 95.2% for MMR, and 95.2% for Hepatitis B. Idaho seventh-graders are above the herd immunity thresholds for all of these communicable diseases. 10 Exemption rates were 4.3% for kindergarten, 4.2% for rst grade and 2.8% for seventh grade immunizations. Person- al exemptions were the most common type of exemption. Incomplete records decreased over the grades with rates of 8.5% in kindergartners, 4.5% in rst-graders, and 2.9% in seventh-graders. 10 Immunizations: Kindergarten Kindergarten Immunization Rates Overall 10 Idaho HD 1 HD 2 HD 3 HD 4 HD 5 HD 6 HD 7 % Complete 85.8% 75.8% 80.3% 89.5% 89.5% 79.6% 87.1% 87.4% % Exempt 4.3% 8.8% 6.4% 4.3% 3.7% 3.5% 2.5% 3.9% % Medical Exemption 0.2% 0.1% 0.2% 0.2% 0.3% 0.2% 0.2% 0.2% % Religious Exemption 0.3% 0.5% 0.1% 0.8% 0.2% 0.1% 0.2% 0.2% % Personal Exemption 3.8% 8.1% 6.2% 3.3% 3.2% 3.2% 2.2% 3.5% % No Records 1.4% 3.5% 0.7% 0.6% 0.6% 2.7% 1.6% 1.5% % Incomplete Records 8.5% 11.9% 12.5% 5.5% 6.1% 14.2% 8.8% 7. 3% It is helpful to examine immunization rates in the context of herd immunity. Herd immunity refers to the portion of the population that should be vaccinated against a communi- cable disease in order to stop the spread of that disease. Note that although the herd immunity threshold for a communi- cable disease may be reached, outbreaks can and do occur on a smaller scale. Estimated herd immunity thresholds for reported immunizations are listed below. 8 Idaho kindergartners have complete immunization rates of 87.7% for DTaP (diphtheria, tetanus and acellular pertussis), 93.1% for polio, 87.7% for MMR (measles, mumps and rubella), and 93.0% for Hepatitis B. Idaho kindergartners are above the threshold for herd immunity for these com- municable diseases except pertussis (whooping cough) and are below the upper end of the measles threshold. 10 Idaho rst-graders have com- plete immunization rates of 92.1% for DTaP, 94.8% for polio, 92.0% for MMR, and 94.4% for Hepatitis B. Like kindergartners, Idaho first graders are above the thresh- old for herd immunity for these communicable diseases except pertussis (whooping cough) and are below the upper end of the measles threshold. 10 Notes *An estimated herd immunity threshhold is not listed for Hepatitis B due to the complexity of the disease and the various modes of transmission. One study conducted outside of the U.S. reported an estimated herd immunity threshold of 63-77% for Hepatitis B. 9 Estimated Herd Immunity Thresholds 8 Disease* Herd Immunity Diphtheria 85% Pertussis 92-94% Polio 80-86% Measles 83-94% Mumps 75-86% Rubella 83-85% [...]... teens in 2008.17,18 Child death rates, defined as deaths to children ages 1 to 14, also decreased between 1999 and 2008 In 1999, the child death rate was 32.3 per 100,000 children in Idaho and 22.9 per 100,000 children in the United States In 2008, the child death rate decreased to 19.4 per 100,000 in Idaho and 18.3 per 100,000 children in the United States.17,18 Overall, the infant, child, and teen mortality... Record 21 Health Insurance Coverage Between 2000 and 2009, the percent of children in Idaho without health insurance decreased significantly from 16% to 9% The uninsurance rates of children in the United States also decreased, from 12% to 10%.11 that provide health insurance benefits CHIP premiums are based on a sliding income scale Children’s Medicaid does not have premiums Between 2000 and 2011 enrollment... 2009 2011 Total 18.2% 18.5% 17.6% 19.7% Female 19.2% 19.4% 19.2% 20.0% Male 17.1% 17.6% 16.1% 19.2% 50% 40% 30% 20% 10% 0% 2005 2007 Total 30 2009 Female 2011 Male IDAHO KIDS COUNT Mental Health The Youth Risk Behavior Survey is given to high school students every other year and collects a variety of behavioral health information, including reports of mental health In the past 11 years, the mental health. .. United States Children with private health insurance (not associated with an employer) increased in Idaho from 7% to 12%, but remained at 5% in the United States Children with only public health insurance (Medicaid, CHIP, military, etc.) increased in Idaho from 15% to 24% and in the United States from 18% to 29% Children with both public and private insurance remained constant at 8% of Idaho children,... also play a role in the mental health of teenagers Overall, females are more likely to report feeling sad or hopeless and more likely to consider, make a plan for, and actually attempt suicide, than their male counterparts In 2011, 33.6% of teenage females reported feeling sad or hopeless, compared to 21.3% of males Likewise, 8.1% of females reported attempting suicide in 2011, compared to 5.1% of males.20... females reported attempting suicide in 2011, compared to 5.1% of males.20 The National Survey of Children’s Health also collects data on emotional and mental health and is administered every four years The most recent data are from 2007 and show how the mental health care of Idaho children compares to that of children in the United States For the indicators where the confidence intervals overlap, Idaho’s... 2009 2011 0% Depression Suicide thoughts Suicide plans Attempted suicide Female Suicide attempt Male Mental Health and Access to Care21 Percent of Idaho Children (95% Confidence Interval) Percent of Children Nationwide (95% Confidence Interval) 92.9% (90.7 – 95.1%) 93.6% (93.2 – 94.1%%) Children ages 6–17 who consistently exhibit problematic social behaviors 7.0% (4.9 – 9.0%) 8.8% (8.3 – 9.4%) Children... 2010 -2011 school years and includes over 8,600 test results Clinical exposures (at or above 10 µg/dL) remained rare, at less than 1 percent of children screened The prevalence of subclinical lead expo- sures between 5 and 9 increased dramatically, from 0.32% of children screened to 4.90% of children screened Likewise, the prevalence of moderate exposure (3 to 4 µg/dL) increased from 1.94% of children... 2011 enrollment in the Children’s Medicaid and CHIP programs has more than doubled In 2000, the number of Idaho children enrolled in Medicaid was 66,837 This increased to 140,773 in 2011 Over that period, CHIP enrollment also increased from 7,203 to 24,226 Total enrollment in these programs increased from 74,040 to 164,999.12 Over the same ten year period, children receiving health insurance through... 2001 and 34.6% in 2011 The percentage of students who used marijuana one or more times in the past 30 days slightly increased from 17.5% in 2001 to 18.8% in 2011. 19,20 In 2001, 54.4 % of students reported ever trying a cigarette, compared to 39.0% in 2011 The use of any tobacco in the past 30 days, including cigarettes, cigars, chew, snuff, etc., decreased from 23.4% in 2001 to 19.7% in 2011, reaching . COUNT Child Health Status Report at- tempts to capture the most relevant and current data related to child health in the state. In the next few years, health. of Idaho Health Districts Much of the data in this report is reported by Health District. is map displays the counties that make up the seven Health Districts