Appendix C
Selected Indicators from National Children’s Data Syntheses

This appendix highlights the types of measures used in national initiatives that present indicators on various aspects of children’s health and may provide a useful reference for states and localities interested in developing state or local indicators. Details regarding specific data used to produce indicators are typically available on the web site of the data collection agency.

America’s Children and the Environment

http://www.epa.gov/envirohealth/children/

A report by the U.S. Environmental Protection Agency, produced for the first time in 2000 and updated in 2003. It presents key information on the environmental exposures, biomonitoring, and environmentally related diseases that affect children’s health and well-being. The measures in the report are based on data collected from state and federal agencies.

Measure/Indicator

Age

Frequency Measured

Level

Common air pollutants (1): percentage of children living in a county in which at least one air quality standard was exceeded during the year

Children ≤ 18 yrs

Annually: 1990–1998

County

Common air pollutants (2): percentage of children’s days that were designated as having “unhealthy” air quality

Children ≤ 18 yrs

Annually: 1990–1998

County



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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Appendix C Selected Indicators from National Children’s Data Syntheses This appendix highlights the types of measures used in national initiatives that present indicators on various aspects of children’s health and may provide a useful reference for states and localities interested in developing state or local indicators. Details regarding specific data used to produce indicators are typically available on the web site of the data collection agency. America’s Children and the Environment http://www.epa.gov/envirohealth/children/ A report by the U.S. Environmental Protection Agency, produced for the first time in 2000 and updated in 2003. It presents key information on the environmental exposures, biomonitoring, and environmentally related diseases that affect children’s health and well-being. The measures in the report are based on data collected from state and federal agencies. Measure/Indicator Age Frequency Measured Level Common air pollutants (1): percentage of children living in a county in which at least one air quality standard was exceeded during the year Children ≤ 18 yrs Annually: 1990–1998 County Common air pollutants (2): percentage of children’s days that were designated as having “unhealthy” air quality Children ≤ 18 yrs Annually: 1990–1998 County

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Measure/Indicator Age Frequency Measured Level Hazardous air pollutants: percentage of children living in counties where at least one hazardous air pollutant concentration was greater than a health benchmark Children ≤ 18 yrs 1990 County Environmental tobacco smoke: percentage of homes with children under 7 in which someone smokes on a regular basis Children < 7 yrs 1994, 1996, 1999 (total of 10 target years) National—based on national survey Drinking water standards: percentage of children served by public water systems that exceeded a maximum contaminant level or violated a treatment standard Children ≤ 18 yrs Annually: 1993–1998 Nationala Nitrates and nitrites: percentage of children living in areas served by public water systems in which the nitrate/nitrite standard was exceeded Children ≤ 18 yrs Annually: 1993–1998 Nationala Monitoring and reporting: percentage of children living in areas with major violations of drinking water monitoring and reporting requirements Children ≤ 18 yrs Annually: 1993–1998 Nationala Pesticide residues in foods: percentage of fruits, vegetables, grains, dairy, and processed foods with detectable pesticide residues   Annually: 1993–1998 Nationala Hazardous waste sites (1): percentage of children living in counties with Superfund sites Children ≤ 18 yrs Every 2 years: 1990–2000 County Hazardous waste sites (2): percentage of children living in counties that had Superfund sites in 1990 Children ≤ 18 yrs Every 2 years: 1990–2000 County Concentrations of lead in blood (1): average concentrations of lead in blood for children 5 and under Children ≤ 5 yrs 1976–1980, 1988–1991, 1992–1994 Nationala Concentrations of lead in blood (2): percentage of children ages 1–5 with concentrations of lead in blood greater than 10 micrograms per deciliter Children 1–5 yrs 1992–1994 Nationala

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Measure/Indicator Age Frequency Measured Level Respiratory diseases (1): percentage of children under 18 with asthma and chronic bronchitis Children ≤ 18 yrs Annually: 1990–1996 Nationala Respiratory diseases (2): percentage of children under 18 with asthma Children ≤ 18 yrs 1997–1998 Nationala Respiratory diseases (3): asthma hospitalization rate for children 0–14 Children 0–14 yrs Annually: 1987–1998 Nationala Childhood cancer (1): cancer incidence and mortality for children under 20 Children ≤ 20 yrs Annually: 1975–1995 Nationala Childhood cancer (2): cancer incidence for children under 20 by type Children ≤ 20 yrs Annually: 1973–1996 Nationala aBased on data reported to rather than collected by the federal government. America’s Children: Key National Indicators of Well-Being http://www.childstats.gov/americaschildren/ A report by the Federal Interagency Forum on Child and Family Statistics that includes federal and state statistics on the health and well-being of children and their families. The report includes indicators of well-being within the parameters of economic security, health, behavior, and social environment and education in addition to key contextual measures. Measure/Indicator Age Frequency Measured Level Child poverty and family income: percentage of related children under age 18 in poverty by family structure Children ≤ 18 yrs Annually: 1980–2000 National Child poverty and family income: percentage of related children under age 18 relative to the poverty line Children ≤ 18 yrs Annually: 1980–2000 National Secure parental employment: percentage of children under age 18 living parents with at least one parent employed full time all year Children ≤ 18 yrs Annually: 1980–2000 National Housing problems: percentage of households with children under age 18 that report housing problems Children ≤ 18 yrs 1978, 1983, 1989, 1993, 1995, 1997, 1999 National

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Measure/Indicator Age Frequency Measured Level Food security and diet quality (1): percentage of children under age 18 in households experiencing food insecurity reporting child hunger Children ≤ 18 yrs Annual: 1995–2000, and 1997 however 1996 omitted because not relevant for comparison National Food security and diet quality (2): percentage of children ages 2 to 5 and 6 to 9 with a good diet Children 2–5 yrs 6–9 yrs 1994–1996, 1998 National Access to health care: percentage of children under age 18 covered by health insurance Children ≤ 18 yrs Annual: 1987–2000, 1999 and 2000 not comparable with earlier years National Access to health care: percentage of children under age 18 with no usual source of health care by type of health insurance Children ≤ 18 yrs Annual: 1993–2000, 1997–2000 not comparable with earlier years National General health status: percentage of children under age 18 in very good or excellent health Children ≤ 18 yrs Annual: 1984–2000, 1997–2000 not comparable with earlier years National Activity limitation: percentage of children ages 5 to 17 with any limitation in activity resulting from chronic conditions Children 5–17 yrs 2000 National Childhood immunization: percentage of children ages 19 to 35 months who received combined series immunization coverage Children 19–35 mos Annual: 1994–2000 National Low birthweight: percentage of infants weighing less than 5.5 pounds at birth Children < 5.5 lbs Annual: 1980–2000 National Infant mortality: deaths before the first birthday per 1,000 live births Children < 1 yr Annual: 1983–1991, 1995–1999 National

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Measure/Indicator Age Frequency Measured Level Child mortality (1): deaths per 100,000 children ages 1 to 4 Children 1–4 yrs Annual: 1980–1999 National Child mortality (2): deaths per 100,000 children ages 5 to 14 by race and by cause of death Children 5–14 yrs Annual: 1980–1999 National Adolescent mortality: deaths per 100,000 adolescents 15 to 19 by cause of death Children 5–19 yrs Annual: 1980–1999 National Adolescent mortality: injury deaths per 100,000 adolescents 15 to 19 by gender, race, and type of injury Children 5–19 yrs 1999 National Adolescent births: births per 1,000 females ages 15 to 17 Females 15–17 yrs Annual: 1980–2000 National Regular cigarette smoking: percentage of 8th grade students who reported smoking daily in the previous 30 days Children 8th, 10th, and 12th grades Annual: 1980–2001 National Alcohol use: percentage of 8th grade students who reported having five or more alcoholic beverages in a row in the last 2 weeks Children 8th, 10th, and 12th grades Annual: 1980–2001 National Illicit drug use: percentage of 8th grade students who have used illicit drugs in the previous 30 days Children 8th, 10th, and 12th grades Annual: 1980–2001 National Youth victims and perpetrators of serious violent crimes: rate of serious violent crime victimization per 1,000 youth ages 12 to 17 Children 12–17 yrs Annual: 1980–2000 National Youth victims and perpetrators of serious violent crimes: serious violent crime offending rate by youth ages 12 to 17 Children 12–17 yrs Annual: 1980–2000 National Family reading to young children: percentage of children ages 3 to 5 who are read to every day by a family member Children 3–5 yrs 1993, 1995, 1996, 1999, 2001 National Early childhood care and education: percentage of children ages 3 to 5 who are enrolled in early childhood centers Children 3–5 yrs 1991, 1993 not comparable for later years 1995, 1996, 1999, 2001 National

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Measure/Indicator Age Frequency Measured Level Mathematics achievement (0–500 scale): average mathematics scale score of 9-, and 17-year-olds Children 9, 13- 13, 17 yrs 1982, 1986, 1990, 1992, 1994, 1996, 1999 National Reading achievement (0–500 scale): average reading scale score of 9-, 13- and 17-yearolds Children 9, 13, 17 yrs 1980, 1984, 1988, 1990, 1992, 1994, 1996, 1999 National High school academic course-taking: percentage of high school graduates who completed high-level coursework in mathematics, science, English, or foreign language High school graduates 1982, 1987, 1990, 1992, 1994, 1998 National High school completion: percentage of young adults ages 18 to 24 who have completed high school Young adults 18–24 yrs Annual: 1980–2000 National Youth neither enrolled in school nor working: percentage of youth ages 16 to 19 who are neither in school nor working Children 16–19 yrs Annual: 1984–2001 National Higher education: percentage of high school graduates ages 25 to 29 who have completed a bachelor’s degree or higher Young adults 25–29 yrs Annual: 1980–2001 National Children of at least one foreign-born parent: percentage of children under age 18 by nativity of child and parents Children ≤ 18 yrs Annual: 1994–2001 National Child Health USA http://www.mchirc.net/CH-USA.htm An annual report by the Health Resources and Service Administration of the U.S. Department of Health and Human Services composed of secondary data for 59 health status indicators summarized both graphically and textually, including long-term trends. Measure/Indicator Age Frequency Measured Level Related children under 18 years of age living in families below 100% of poverty level by race/ethnicity Children ≤ 18 yrs 1970, 1980, 1990, 1998, 1999 National

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Measure/Indicator Age Frequency Measured Level Related children under 18 years of age living in families below 100% of poverty level, by household status Children ≤ 18 yrs 1999 National Status school dropout rates for ages 16–24 by race/ethnicity Children 16–24 yrs Annual: 1988–1999 National Mothers in the workforce Children 6–17 yrs Every 5 years—1980–2000 National Hours per week spent in child care by children under 5 with working mothers Children < 5 yrs 1997 National Percentage distribution of births by maternal age, by race N/A 1999 National Breastfeeding by race N/A Annual: 1990–1999 National Percentage of infants born at low birthweight by race N/A Annual: 1984–1999 National Percentage of infants born at very low birthweight by race N/A Annual: 1984–1999 National Comparison of national infant mortality rates N/A 1997 International, National U.S. infant mortality rates by race of mother N/A Annual: 1980–1999 National Preliminary neonatal mortality rates by race of mother N/A 1999 National Preliminary postneonatal mortality rates by race of mother N/A 1999 National Maternal mortality rates by race of mother N/A Annual: 1975–1998 National Number of cases of reportable vaccinepreventable diseases among children under 5 Children < 5 yrs 1999 National Percentage of child abuse and neglect victims by type of maltreatment N/A 1999 National Sources of maltreatment reports N/A 1999 National

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Measure/Indicator Age Frequency Measured Level Pediatric aids by race/ethnicity and exposure category N/A 1981–2000 National Major causes of hospitalization by age Children 1–21 yrs 1999 National Discharge rate of patients 1–14 years old for selected diagnosis Children 1–14 yrs Annual: 1985–1999 National Leading causes of death in children ages 1–14 Children 1–14 yrs 1999 National Childhood deaths due to external cause, by cause and age Children 1–14 yrs 1999 National Adolescent birth rates, by age and race of mother N/A 1999 National Percentage of high school students who have ever had sexual intercourse, by grade and gender Children 9th, 10th, 11th, and 12th grades 1999 National Sexual activity and condom use in high school students Children 9th, 10th, 11th, and 12th grades 1999 National Rates of sexually transmitted disease per 100,000 adolescents by age and race Young adults 15–24 yrs 1999 National Adolescent AIDS cases, by race/ethnicity and exposure category for ages 13–19 Children 13–19 yrs 1981–1999 National Adolescent AIDS cases by gender and exposure category for ages 13–19 Children 13–19 yrs 1981–1999 National Young adult AIDS cases by gender and exposure category for ages 20–24 Young adults 20–24 yrs 1981–1999 National Percentage of high school students who carried a gun in the past 30 days, by sex and race N/A Annual: 1993–1999 National Percentage of high school students who participated in vigorous, moderate, or strengthening physical activity, by race N/A 1999 National

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Measure/Indicator Age Frequency Measured Level Percentage of high school students who participated in moderate physical activity, by grade Children 9th, 10th, and 11th grades 1999 National Long-term trend in 30-days prevalence of cigarette smoking for 8th, 10th, and 12th graders Children 8th, 10th, and 12th grades Annual: 1975–2000 National 30-day prevalence of drug use among adolescent ages 12–17 Children 12–17 yrs Annual: 1988–1999 National Leading causes of death in adolescent ages 15–19 Children 15–19 yrs 1999 National Motor vehicles crashes and firearms mortality among adolescents ages 15–19 Children 15–19 yrs 1998 National Health insurance coverage of children under 18 yrs Children ≤ 18 yrs 1999 National Health insurance coverage of children under 18 yrs in poverty Children ≤ 18 yrs 1999 National Estimated vaccination coverage among children ages 19–35 months by race/ethnicity Children 19–45 mos 2000 National Recommended childhood immunization schedule, United States, January–December 2001 Children ≤ 18 yrs 2001 National Percentage of children receiving an EPSDT preventive dental service Children > 2 yrs Annual: 1988–1998 National Percentage of children with dental care needs and those receiving dental care in the last 12 months by income Children > 2 yrs 1997 National Percentage of children with no physician visits in the past year, by age and race/ethnicity Children ≤ 19 yrs 1998 National Usual source of acute care Children ≤ 19 yrs 1998 National Physician utilization by children with chronic activity limitation, by age Children under 5 yrs, over 5 yrs 1998 National Hospital utilization by income and race N/A 1998 National

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Measure/Indicator Age Frequency Measured Level Percentage of mothers beginning prenatal care in the first trimester, by age and race N/A 1999 National Percentage of mothers receiving late or no prenatal care, by age and race of mother N/A 1999 National Percentage of infants born at low birthweight, women receiving first trimester prenatal care, and births to women under 18, by race of mother and state N/A 1999 State, national Medicaid enrollees, expenditures, and reported EPSDT utilization for children under age 21 N/A FY 1998 FY 1999 State, national State Children’s Health Insurance Program (SCHIP) aggregate enrollment statistics N/A FY 2000 State, national Health insurance status for children under age 19 N/A 1999 County Percentage of children under 19 who are uninsured N/A 1999 State, national Infant and neonatal mortality rates, by race of mother and state N/A 1998 State, national Percentage of infants born at very low birthweight in U.S. cities with populations over 100,000 N/A Annual: 1989–1999 National Percentage of infants born at very low birthweight in U.S. cities with populations over 100,000 N/A Annual: 1989–1999 National Infant mortality in U.S. cities with population over 100,000 N/A Annual: 1989–1998 National Percentage of pregnant women receiving first trimester prenatal care in U.S. cities with populations over 100,000 N/A Annual: 1989–1999 National Percentage of pregnant women receiving late or no prenatal care in U.S. cities with populations over 100,000 N/A Annual: 1989–1999 National

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health KIDS COUNT Data Book http://www.aecf.org/kidscount/kc2002/ A data book produced by the Annie E. Casey Foundation that tracks national and state-level indicators of the educational, social, economic, and physical well-being of children in the United States, with a focus on 10 core indicators. Measure/Indicator Age Frequency Measured Level Number of children under age 18 N/A 2000 State, national Race and Hispanic origin of children N/A 2000 State, national 4th grade students who scored below basic reading level Children 4th grade 1998 State, national 8th grade students who scored below basic reading level Children 8th grade 1998 State, national 8th grade students who scored below basic writing level Children 8th grade 1998 State, national Median income of families with children N/A 1998 State, national Female-headed families receiving child support or alimony N/A 1998 State, national Children in working-poor families without a telephone at home N/A 1998 State, national Children in extreme poverty (income 50% below of poverty level)   1998 State, national Children without health insurance   1998 State, national Children in working-poor families who lack health insurance   1998 State, national 2-year-olds who were immunized Children 2 yrs 1999 State, national Juvenile violent crime arrest rate Children 10–17 yrs 1998 State, national

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Measure/Indicator Age Frequency Measured Level Juvenile property crime arrest rate Children 10–17 yrs 1998 State, national Number of children under 18 in working poor families Children < 18 yrs 1998 State, national Percentage of children under age 18 in working poor families Children < 18 yrs 1998 State, national Percentage change of low-birthweight babies   1990–1998 State, national Percentage change of infant mortality rates   1990–1998 State, national Percentage change of child death rates ages 1–14 Children 1–14 yrs 1990–1998 State, national Percentage change of rate of teen deaths by accident, homicide, and suicide ages 15–19 Young adults 15–19 yrs 1990–1998 State, national Percentage change of teen birth rate of females ages 15–17 Females 15–17 yrs 1990–1998 State, national Percentage change of teens who are high school dropouts ages 16–19 Young adults 16–19 yrs 1990–1998 State, national Percentage change of teens not attending school and not working ages 16–19 Young adults 16–19 yrs 1990–1998 State, national Percentage change of children living with parents who do not have full-time, year-round employment   1990–1998 State, national Percentage change of children in poverty   1990–1998 State, national Percentage change of families with children headed by a single parent   1990–1998 State, national

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Child Trends Databank http://www.childtrendsdatabank.org/ Child Trends produces this continuously updated web-based bank of data of the latest estimates for indicators relating to child and family health and well-being. The data identifies and tracks trends and population subgroup disparities. Measure/Indicator Age Frequency Measured Level Overweight children and youth Children 6–19 yrs 1999 National Disordered eating: symptoms of bulimia Children 9th–12th grades 2001 National Children with limitations Children 5–17 yrs 1998–2000 National Learning disabilities Children 3–17 yrs 1997–2000 National Asthma Children < 18 yrs 1988–1998 National Children with AIDS Children < 13 yrs 1985–2001 National Low- and very-low-birthweight infants   1970–2001 National Suicidal teens Children 9th–12th grades 2001 National Adolescents who feel sad or hopeless Children 9th–12th grades 1999, 2001 National Parental symptoms of depression Children < 18 yrs 2000 National Vigorous physical activity by youth Children 9th–12th grades 1993–2001 National Mothers who smoke while pregnant N/A 1989–2000 National

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Children’s Health, The Nation’s Wealth: Assessing and Improving Child Health Measure/Indicator Age Frequency Measured Level Condom use Children 9th–12th grades 1993–1999 National Participation in school athletics Children 8th–12th grades 1991–2000 National Seat belt use Children 5–15 yrs 1994–2000 National Drunk driving Children 9th–12th grades 1995–2001 National Physical fighting by youth Children 9th–12th grades 1993–2001 National Students carrying weapons Children 9th–12th grades 1991–2001 National Adolescents who have ever been raped Females 9th–12th grades 2001 National Dating violence Children 9th–12th grades 1999–2001 National Child maltreatment Children < 18 yrs 1990–2000 National Youth who felt unsafe at school Children 12–18 yrs 1999 National In addition, the U.S. Department of Health and Human Services has identified in Healthy People 2010 a set of health objectives intended to improve the health of the country. Healthy People 2010 specifies 10 leading health indicators and 467 objectives within the overall goals of improving quality and years of healthy life and eliminating health disparities. Several of the objectives relate to children. The objectives are listed and can be searched at http://www.healthypeople.gov/.