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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

Adverse Childhood Experiences

Adverse experiences during childhood can negatively affect future development and subsequent emotional, cognitive, social, and biological functioning, in addition to adult health outcomes. Children who experience more adverse events have reduced mental and physical health, higher risk of chronic disease, and are more likely to engage in unsafe behaviors, such as smoking, drinking, and risky sexual behaviors. The more adverse experiences a person has during childhood, the greater the likelihood of having negative physical or health outcomes, and partaking in health risk behaviors in the long-term. Increasing awareness and increasing the capacity of communities to respond to these experiences are important in reducing the effects.

Percentage of children aged 0 to 17 who experienced two or more of the following: Socioeconomic hardship, divorce/parental separation, lived with someone who had an alcohol or drug problem, victim or witness of neighborhood violence, lived with someone who was mentally ill or suicidal, domestic violence witness, parent served time in jail, treated or judged unfairly due to race/ethnicity, death of parent

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




Neighborhood Amenities

Neighborhood amenities, such as playgrounds, sidewalks, walking paths, libraries, and community centers, offer opportunities for recreation, social interaction, and education without traveling far from home. Access to playgrounds, sidewalks, and walking paths can promote physical activity in adults and children. The odds of being obese are 44% higher for children who grow up in neighborhoods with the lowest index of neighborhood amenities relative to those with the highest index of neighborhood amenities, even after adjusting for individual socioeconomic characteristics. Urban neighborhoods are more likely to have more amenities than rural neighborhoods.

Percentage of children aged 0 to 17 with access to parks or playgrounds, recreation or community centers, libraries or book mobiles, and sidewalk or walking paths

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



Protective Home Environment (0–5)

The early home environment of children has long-term effects on their development and well-being. Sharing family meals, reading and singing, breastfeeding, and limiting television watching and secondhand smoke exposure all positively influence a child’s development and are not dependent on a family’s income. Young children with a protective home environment have better language development, problem solving and social skills, as well as lower risk of chronic diseases, such as obesity and asthma.

Percentage of children aged 0 to 5 who have four or more family meals per week, are read or sung to every day, were ever breastfed, watch two hours of television or less per day (children 1 year or older), and experience no household tobacco smoke exposure

Data source: National Survey of Children’s Health, 2011–2012 For details: www.americashealthrankings.org/ ALL/prot_env_0to5



Protective Home Environment (6–17)

The home environment of children and adolescents is an essential factor in their growth and development as they prepare to leave home and enter young adulthood. Sharing family meals, meeting a child’s friends, completing homework, and limiting television watching and secondhand smoke exposure all positively influence a child’s physical and personal development and are not dependent on a family’s income. Children and adolescents with a protective home environment have better social skills, as well as lower risk of chronic diseases, such as obesity and asthma. In addition, parents who know their child’s friends can help them create positive friendships and can be more responsive if their peers introduce risky behaviors.

Percentage of children aged 6 to 17 who have four or more family meals per week, no television in their bedroom and watch two hours of television or less per day, parents have met all or most of their friends, usually or always do required homework, and experience no household tobacco smoke exposure

Data source: National Survey of Children’s Health, 2011–2012 For details: www.americashealthrankings.org/ALL/ prot_env_6to17



Supportive Neighborhoods

Living in a supportive neighborhood impacts healthy child development. Neighborhoods that support parents and their children offer role models, social connections, and improve trust. Children with high levels of perceived neighborhood support have more prosocial skills and fewer negative behaviors. Unsafe neighborhoods are linked to increased rates of low birthweight, infant mortality, child abuse and neglect, juvenile delinquency, and high school dropout. Children in unsafe neighborhoods also have increased rates of poor motor and social development. High levels of support are associated with higher incomes and rural locations, though many low-income individuals report high levels of support.

Percentage of children aged 0 to 17 whose parents report their child is usually safe in their neighborhood and they 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, there are trusted adults nearby to help my child if they got hurt or scared while playing outside

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




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