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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

Adolescent Well-Visit

An annual well-visit is recommended for all adolescents and should include a physical exam, immunizations, and guidance on a wide array of topics, including oral health, body image, healthy eating, physical activity, interpersonal relationships, school performance, mental health, sexuality, injury and violence prevention, tobacco, alcohol, pregnancy, and sexually transmitted infections. These visits provide an opportunity to discuss disease risk factors and to develop a trusting provider-patient relationship that fosters discussion of sensitive issues. Social factors and behaviors that lead to morbidity and mortality are often initiated in adolescence, which makes it a critical time for prevention and early intervention.

Percentage of children aged 12 to 17 who had a well-visit in the past 12 months

Data source: National Survey of Children’s Health, 2011–2012 For details: www.americashealthrankings.org/ ALL/adol_well_visit



Developmental Screening

Early screening and detection of developmental delays, including motor, social, and cognitive delays, allows for early intervention and counseling, which can greatly improve development and help children do better in social and educational settings. In the past, many developmental delays in children were not identified until they entered school, which is beyond the most effective period for early intervention. It is now recommended that all children receive developmental screenings during wellchild visits. During these visits, doctors can monitor and screen for delays or problems in a child’s development, including the child’s basic skills and abilities, and how the child plays, learns, speaks, behaves, and moves.

Percentage of children aged 10 months to 5 years whose parents report that they received a standardized developmental screening during a well-child visit

Data source: National Survey of Children’s Health, 2011–2012 For details: www.americashealthrankings.org/ ALL/devscreen



Immunizations — Adolescents

As children age, protection from some childhood vaccines begins to diminish, putting school-aged children at risk for diseases like pertussis. A Tdap booster at age 11 or 12 is needed to maintain protection against tetanus, diphtheria, and pertussis. The booster also protects those who come in contact with schoolaged children, most importantly infants and the elderly. Additional recommended vaccines are the meningococcal conjugate vaccine (MCV4) that protects against meningococcal disease in teens and young adults and the human papillomavirus (HPV) vaccine that protects against cervical, genital, and oropharyngeal cancers into adulthood. Yearly administration of the flu vaccine is also recommended to protect against seasonal influenza.

Combined average z score of the percentage of children aged 13 to 17 years who received ≥1 dose of Tdap since age 10 years, ≥1 dose of meningococcal conjugate vaccine, and ≥3 doses of HPV vaccine (females and males)

Data source: National Immunization Survey, 2014 For details: www.americashealthrankings.org/ALL/ immunize_teens_b_MCH



Immunizations, HPV Female

Percentage of females aged 13 to 17 years who received ≥3 doses of human papillomavirus (HPV) vaccine, either quadrivalent or bivalent

Data source: National Immunization Survey, 2014 For details: www.americashealthrankings.org/ALL/immunize_HPVfemale_MCH



Immunizations, HPV Male

Percentage of males aged 13 to 17 years who received ≥3 doses of human papillomavirus (HPV) vaccine, either quadrivalent or bivalent

Data source: National Immunization Survey, 2014 For details: www.americashealthrankings.org/ALL/immunize_HPVmale_MCH



Immunizations, MCV4

Percentage of adolescents aged 13 to 17 years who received ≥1 dose of meningococcal conjugate vaccine or meningococcal-unknown type vaccine

Data source: National Immunization Survey, 2014 For details: www.americashealthrankings.org/ALL/immunize_mcv4_MCH



Immunizations, Tdap

Percentage of adolescents aged 13 to 17 years who received ≥1 dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) since age 10 years

Data source: National Immunization Survey, 2014 For details: www.americashealthrankings.org/ALL/immunize_tdap_mch



Immunizations—Children

Early childhood immunization is a safe and cost-effective means of protecting infants and children from potentially life-threatening diseases early in life when children are most vulnerable. Infants receiving recommended immunizations by age two are protected from 14 diseases. Among all children born between 1994 and 2013, routine childhood vaccinations will prevent 322 million cases of disease and about 732,000 early deaths, saving society a total of $1.38 trillion. There is significant geographic, racial, and socioeconomic variation in US childhood vaccination coverage levels. Non-Hispanic black children and children from households living below the federal poverty level had the lowest immunization coverage in 2014.

Percentage of children aged 19 to 35 months who received recommended doses of DTaP, polio, MMR, Hib, hepatitis B, varicella, and PCV vaccines

Data source: National Immunization Survey, 2014 For details: www.americashealthrankings.org/ALL/ Immunize_child_MCH



Medical Home for Special Care Child

Nearly 20% of US children younger than 18 years have a special health need and can benefit from receiving ongoing care within a medical home. A medical home model is family-centered and provides community-based care that is accessible, continuous, comprehensive, coordinated, compassionate, and culturally effective. Children without a medical home are more likely to have delayed or forgone care, to have unmet health care needs, and to have unmet needs for family support. Some of the most challenging aspects of a medical home include easy access to needed referrals, care coordination, and family-centered care.

Percentage of children aged 0 to 17 with special health care needs that meet medical home criteria (have a personal doctor or nurse, a usual source of care, family-centered care, and receive referrals and effective care coordination when needed)

Data source: National Survey of Children with Special Health Care Needs, 2009–2010 For details: www.americashealthrankings.org/ ALL/medical_home




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