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Executive SummaryIntroductionExplore the Health of Women, Children and InfantsFindingsThe Health of Women and Children between StatesThe Health of Women and Children within StatesHealthy Communities for ChildrenClinical Preventive Services for ChildrenRacial Disparities in Measures of MortalityVariations in SmokingMeasures of Women's HealthBehaviors | Measures of Women’s HealthCommunity & Environment | Measures of Women’s HealthPolicy | Measures of Women’s HealthClinical Care | Measures of Women’s HealthOutcomes | Measures of Women’s HealthMeasures of Infants' HealthBehaviors | Measures of Infants’ HealthCommunity & Environment | Measures of Infants’ HealthPolicy | Measures of Infants’ HealthClinical Care | Measures of Infants’ HealthOutcomes | Measures of Infants’ HealthMeasures of Children's HealthBehaviors | Measures of Children’s HealthCommunity & Environment | Measures of Children’s HealthPolicy | Measures of Children’s HealthClinical Care | Measures of Children’s HealthOutcomes | Measures of Children’s HealthState SummariesAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDistrict of ColumbiaUnited StatesAppendixData Sources and Measures of Women’s HealthData Sources and Measures of Infants’ HealthData Sources and Measures of Children’s HealthMethodologyModel DevelopmentAmerica’s Health Rankings® Health of Women and Children Steering GroupThe Team
Across the United States, the health of children is strongly influenced by healthy, safe, and supportive home environments and communities. This report looks at five measures in this area from the National Survey of Children’s Health: Supportive neighborhoods, neighborhood amenities, adverse childhood experiences (ACEs), protective home environment ages 0 to 5, and protective home environment ages 6 to 17.
A supportive neighborhood is defined as the percentage of children whose parents responded that their child is “usually” or “always” safe in their community or neighborhood, and they “strongly agree” or “somewhat agree” with at least three of the following: In my neighborhood people help each other out, we watch out for each other’s children, there are people I can count on in this neighborhood, if my child were outside playing and got hurt or scared, there are adults nearby who I trust to help my child. Three out of four children aged 0 to 17 live in such a neighborhood.
The percentage of children aged 0 to 17 living in supportive neighborhoods varies by levels of household income (relative to the federal poverty level (FPL)), increasing in a linear fashion with increasing household income (% FPL) across the three race/ethnicity groups studied with the exception of the <100% FPL group and the 100-199% FPL income groups for Hispanics (Figure 6).
Neighborhood amenities is the percentage of children aged 0 to 17 with access to sidewalks or walking paths, parks or playgrounds, recreation or community centers, and libraries or book mobiles. More than one-half (54.1%) of children aged 0 to 17 live in neighborhoods with all four amenities. As household income increases relative to the FPL, the percentage of children with all four neighborhood amenities increases in a linear fashion across the three race/ethnicity groups studied, with less variation by income among non-Hispanic blacks and non-Hispanic whites compared with Hispanics (Figure 7).
A pattern similar to supportive neighborhoods and neighborhood amenities holds true for both measures of protective home environment; the percentage of children living in a protective home environment increases with each increasing income level across all three race/ethnicity groups studied with the exception of non-Hispanic blacks aged 6 to 17.

Figure 6 - Percentage of Children Living in Supportive Neighborhoods by Race/Ethnicity and Household Income

Figure 7 - Percentage of Children with Neighborhood Amenities by Race/Ethnicity and Household Income

Nationally 22.6% of children aged 0 to 17 experience two or more ACEs. There are nine possible adverse events, which range from parental divorce to witnessing a violent crime to having an imprisoned parent. Research has shown that experiencing these adverse events can affect the health of a child over his or her lifetime.
The prevalence of ACEs is inversely related to household income, however, this relationship does not hold across all race/ethnicity groups (Figure 8). The percentage of Hispanic children reporting two or more ACEs is significantly [†] greater in the lowest income group (<100% FPL) compared with the highest income group (≥400% FPL), but there is no significant† difference between the middle income groups. This differs from non-Hispanic white children where there is a significant† difference between each income group and a clear decrease in ACEs with each increase in income level. For non-Hispanic black children, there is no significant† difference between the lowest two income groups. Across all three race/ethnicity groups, the percentage of two or more ACEs is lowest among those households with the highest income levels (≥400% of FPL).
† Significance based on non-overlapping 95% confidence intervals, ∝= 0.05

FIGURE 8 Percentage of Children with Multiple* Adverse Childhood Experiences by Race/Ethnicity and Household Income

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