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Children in Poverty

Children in poverty and mental health providers were featured as successes in the 2018 Annual Report, and these two measures continue to improve.
The percentage of children living in poverty continues to improve, significantly decreasing 2% in the past year (18.4% to 18.0%) and down 20% since the peak in 2013 (22.6%) (Figure 5).
Exposure to chronic stress — including unreliable access to food, health care and stable housing — may impair child development and affect health throughout the lifespan. One estimate of the social cost of childhood poverty, including lost potential earnings and costs of poor health, totaled $1.03 trillion annually in the United States, or around 5.5% of gross domestic product.
Geographic variation
The disparity between the states with the highest and lowest prevalence has improved over time. The percentage of children in poverty is 2.9 times higher in Mississippi (27.8%) than Utah (9.5%); this disparity is smaller than in 2009 when children in poverty was 3.4 times higher in Mississippi (30.4%) than New Hampshire (9.0%).

Mental Health Providers

The number of mental health providers per 100,000 population increased 5% in the past year (234.7 to 247.4) and improved 13% since the measure was added in 2017 (218.0) (Figure 6).
An analysis by the Kaiser Family Foundation found that more than 115 million Americans live in mental health shortage areas, and only 26.1 of the need is being met. Additionally, the National Council of Behavioral Health reported that 77% of counties in the United States experience a severe shortage of psychiatrists. The National Center for Health Workforce Analysis projected that by 2025 there will be a 45,000 to 250,000 shortage in mental health professionals.
Geographic variation
Mental health providers is 6.2 times higher in Massachusetts (626.6 providers per 100,000) than Alabama (100.7).

Long-term successes in smoking, infant mortality, violent crime and air pollution


Smoking among adults decreased 45% since the first Annual Report in 1990* (from 29.5%) and 6% in the past year (from 17.1%). Today, 16.1% of adults smoke, well above the Healthy People 2020 national goal to reduce smoking to 12.0% of adults.
In the past year, smoking among males significantly decreased 5% from 18.6% to 17.6%, 8% among 18 to 44 year-olds from 18.5% to 17.1% and 5% among white adults from 17.1% to 16.3%.
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While no significant decreases occurred at the state-level in the past year, since 2012 smoking prevalence significantly decreased in the District of Columbia and all states except Alaska, Idaho, North Dakota and Tennessee.
According to the Centers for Disease Control and Prevention (CDC), smoking is the leading cause of preventable death in the nation. More than 480,000 people die annually from smoking-related causes, including more than 41,000 deaths from secondhand smoke. Additionally, over 16 million Americans live with a disease caused by smoking, and smokers, on average, live 10 years less than non-smokers.
Concerns Over Vaping Products: E-cigarette Use
Despite declines in smoking, e-cigaette use is an emerging issue. The nation needs more data on the use of e-cigarettes and vaping products. Supllemental data on adult e-cigarette use has been added to this year's report. Among 36 states with data, adult e-cigarette use varies from 4.3% in Maryland to 7.5% in Colorado.
While e-cigarette prevalence is lower than traditional smoking among adults, it is an emerging problem among youth, with use increasing 78% between 2017 to 2018 among high school students (11.7% to 20.8%), and a 49% increase among middle school students (3.3% to 4.9%), accordin
Disparities and geographic variation
Disparities in smoking are present across states and by gender, age, race/ethnicity, education and income groups (Figure 7). Smoking tends to be lowest among women, adults ages 65 and older, Asian adults, college graduates ages 25 and older and adults ages 25 and older with incomes of $75,000 or more. Populations with the highest smoking prevalences over time include men, American Indian/Alaska Native adults, adults ages 25 and older with less than a high school education and adults ages 25 and older with incomes less than $25,000. With each increase in education level or income, smoking prevalence is significantly lower. Smoking among adults is 2.8 times higher in West Virginia (25.2%) than Utah (9.0%).

Infant Mortality

Since 1990, infant mortality decreased 43% (10.2 to 5.8 deaths per 1,000 live births), the lowest value in Annual Report history. The greatest decline occurred during the 1990s and was largely driven by reductions in sudden infant death syndrome (SIDS) and in vaccine-preventable diseases as well as advances in medical care. With the progress made in the last decade, the Healthy People 2020 goal of reducing the infant mortality rate to 6.0 deaths per 1,000 live births has been achieved.
Since 1990, infant mortality decreased in all states. Figure 8 displays states with the largest and smallest decreases since 1990. The largest improvements occurred in South Carolina (13.0 to 6.7 deaths per 1,000 live births), New York (10.7 to 4.5 deaths per 1,000 live births), Illinois (11.9 to 6.2 deaths per 1,000 live births) and Washington (9.7 to 4.1 deaths per 1,000 live births). States with the smallest improvements since 1990 include Arkansas 10.3 to 8.1 deaths per 1,000 live births), Oklahoma (10.0 to 7.6 deaths per 1,000 live births) and Wisconsin (8.9 to 6.4 deaths per 1,000 live births).
Progress is still being made; nearly 1,200 fewer infant deaths have occurred since the 2017 Annual Report. Still, more than 45,000 infants died since then. Furthermore, the U.S. infant mortality rate is higher than comparable countries (see International Comparison). Out of 36 Organization for Economic Co-operation and Development member countries, the United States ranks No. 33 in infant mortality.
Losing an infant is devastating for parents, families and communities. According to CDC, significant disparities persist in infant mortality, particularly between babies born to black women and babies born to white women. The leading causes of infant mortality include low birthweight, birth defects, preterm birth, maternal pregnancy complications, SIDS and unintentional injuries.
Geographic variation
The disparity between the states with the highest and lowest infant mortality rate has worsened over time. Infant mortality is 2.3 times higher in Mississippi (8.6 deaths per 1,000) than Massachusetts (3.8); this is a larger disparity than in 1990 when infant mortality was 1.7 times higher in South Carolina and Mississippi (13.0) than Massachusetts (7.8).

Violent Crime

Since peaking in 1993, the violent crime rate decreased 50% from 758 to 381 offenses per 100,000 and fell in 40 states. The largest improvements occurred in New York (1164 to 351 offenses per 100,000), Florida (1184 to 385), California (1090 to 447) and Illinois (1039 to 404). Ten states, however, experienced increases in violent crime since 1993, with the largest increases in Alaska (614 to 885 offenses per 100,000), Montana (140 to 374), South Dakota (182 to 405) and North Dakota (65 to 281).
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According to FBI data, there were more than 1.2 million acts of violent crime in 2017. Violent crimes cause physical harm as well as social and emotional distress and contribute to injury, disability, premature death, depression, anxiety and post-traumatic stress disorder. Exposure to violent crime can have both an immediate and lasting impact on health and well-being.
Geographic variation
The rate of violent crime is 7.9 times higher in Alaska, the state with the highest rate (885 offenses per 100,000), than Maine, the state with the lowest rate (112). Since 1990, Alaska’s rate increased 95% (455 to 885 offenses per 100,000), while Maine’s already low rate decreased 27% (153 to 112 offenses per 100,000) as shown in Figure 9. This geographic disparity has improved over time. In 1990, the violent crime rate was 18 times higher in Florida (1,024 offenses per 100,000) than North Dakota (57).

Air Pollution

Air pollution decreased 36% since 2003 (13.2 to 8.4 micrograms per cubic meter [μg/m3]) and 6% since 2016 (from 8.9 μg/m3) as shown in Figure 10. The largest improvements in air pollution since 2003 occurred in Georgia (16.5 to 8.3 μg/m3), Alabama (15.6 to 8.1 μg/m3), Tennessee (14.9 to 7.4 μg/m3) and Ohio (15.7 to 8.5 μg/m3). While the United States has made great strides in reducing air pollution over the past decade and a half, a National Bureau of Economic Research report using single-year estimates suggests signs of a reversal in this trend.
According to the Environmental Protection Agency, air pollution is associated with heart and lung problems and premature death. CDC reports that large pollutant particles in the air can cause irritation and discomfort, while small, fine pollutant particles including PM2.5 (i.e., tiny particles in the air that are two and one half microns or less in width) from sources such as auto exhaust or power plants can penetrate deeply into lung tissue and enter the bloodstream. An estimated 200,000 premature deaths occur annually in the United States from combustion emissions alone.
Geographic variation
The disparity between the states with the highest and lowest value has improved over time. Air pollution is 2.9 times higher in California (12.8 μg/m3) than New Hampshire (4.4 μg/m3); this disparity is smaller than in 2003 when air pollution was 3.3 times higher in California (17.2 μg/m3) than Wyoming (5.2 μg/m3).

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