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Social & Economic Factors

Community and Family Safety

Weighted sum of the z-scores of ranked community and family safety measures for children.
America's Health Rankings composite measure, 2020

Child Victimization*

Number of children who were victims of maltreatment that was either substantiated or indicated per 1,000 children.
U.S. Department of Health & Human Services, Administration for Children and Families, Children’s Bureau, Child Maltreatment Report, 2018

Economic Resources - Children

Weighted sum of the z-scores of ranked economic resources measures for children.
America's Health Rankings composite measure, 2020

Children in Poverty

Percentage of children younger than 18 years who live in households below the poverty threshold.
U.S. Census Bureau, American Community Survey, 2018

Children in Poverty Racial Gap

The excess percentage of Black children who live in households below the poverty threshold compared with white children.
U.S. Census Bureau, American Community Survey, 2014–2018

High-speed Internet

Percentage of households with children under age 18 that have a broadband internet subscription and a computer, smartphone or tablet.
Steven Manson, Jonathan Schroeder, David Van Riper, and Steven Ruggles. IPUMS National Historical Geographic Information System: Version 14.0 [Database]. Minneapolis, MN: IPUMS. 2019. http://doi.org/10.18128/D050.V14.0, 2018

Students Experiencing Homelessness

Percentage of public school students who lack a fixed, regular and adequate nighttime residence.
U.S. Department of Education, National Center for Education Statistics, Digest of Education Statistics, 2016-2017 School Year

WIC Coverage

Percentage of children ages 1-4 eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) who received WIC benefits in an average month.
U.S. Department of Agriculture, WIC Eligibility and Coverage Rates, 2017

Education - Children

Weighted sum of the z-scores of ranked education measures for children.
America's Health Rankings composite measure, 2020

Early Childhood Education Enrollment

Percentage of children ages 3-4 who are enrolled in nursery school, preschool or kindergarten.
U.S. Census Bureau, American Community Survey, 2018

Fourth Grade Reading Proficiency

Percentage of fourth grade students who scored proficient or above on the reading assessment.
U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics, National Assessment of Educational Progress (NAEP), 2019

High School Graduation

Percentage of high school students who graduate with a regular high school diploma within four years of starting ninth grade.
U.S. Department of Education, National Center for Education Statistics, 2017-2018 School Year

Social Support and Engagement - Children

Sum of weighted z-scores of ranked social support and engagement measures for children.
America's Health Rankings composite measure, 2020

Adverse Childhood Experiences

Percentage of children ages 0-17 who experienced two or more of the following: parental divorce or separation; living with someone who had an alcohol or drug problem; neighborhood violence victim or witness; living with someone who was mentally ill, suicidal or severely depressed; domestic violence witness; parent served jail time; being treated or judged unfairly due to race/ethnicity; or death of parent.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

Foster Care Instability

Percentage of children in foster care with three or more placements within 12 months.
U.S. Department of Health & Human Services, Children's Bureau, Child Welfare Outcomes Report Data, 2018

Neighborhood Amenities

Percentage of children ages 0-17 with access to a park or playground; recreation center, community center or boys' and girls' club; library or bookmobile; and sidewalks or walking paths.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

Reading, Singing or Storytelling

Percentage of children ages 0-5 whose family members read, sang or told stories to them every day during the past week.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

Physical Environment

See Measures Table – Women for physical environment measures.

Clinical Care

Access to Care

Sum of weighted z-scores of ranked access to care measures for children.
America's Health Rankings composite measure, 2020

ADD/ADHD Treatment

Percentage of children ages 3-17 who currently have ADD or ADHD and are taking medication and received behavioral treatment.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

Pediatricians

Number of pediatricians per 100,000 children ages 0-21.
U.S. HHS, Centers for Medicare & Medicaid Services, National Plan and Provider Enumeration System, Sept. 2019; CDC WONDER Single Race Population Estimates 2010-2018, September, 2019

Uninsured Children

Percentage of children younger than 19 years not covered by private or public health insurance.
U.S. Census Bureau, American Community Survey, 2018

Preventive Clinical Care

Sum of weighted z-scores of ranked preventive clinical services measures for children.
America's Health Rankings composite measure, 2020

Childhood Immunizations

Percentage of children who received recommended doses of diphtheria and tetanus toxoids and acellular pertussis; poliovirus vaccine; measles-containing; Haemophilus influenzae type b conjugate; hepatitis B; varicella; and pneumococcal conjugate vaccines (combined 7-vaccine series) by age 35 months.
CDC, National Immunization Survey-Child, 2015-2016 Birth Cohort

HPV Vaccination

Percentage of adolescents ages 13-17 who have received all recommended doses of the human papillomavirus (HPV) vaccine.
CDC, National Immunization Survey-Teen, 2018

Preventive Dental Care

Percentage of children ages 1-17 who had one or more preventive dental care visits during the past 12 months.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB) , 2018–2019

Well-child Visit

Percentage of children ages 0-17 who received one or more preventive visits in the past 12 months.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2016–2017

Quality of Care

Sum of weighted z-scores of ranked quality of care measures for women.
America's Health Rankings composite measure, 2020

Adequate Insurance

Percentage of children ages 0-17 who were continuously insured in the past year with adequate coverage, based on 3 criteria: whether their children’s insurance covers needed services and providers, and reasonably covers costs.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

Developmental Screening

Percentage of children 9-35 months whose parent completed a standardized developmental screening tool in the past 12 months.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

Medical Home

Percentage of children ages 0-17 who received coordinated, ongoing and comprehensive care within a medical home, including having a personal doctor or nurse, a dedicated source for sick care, family-centered care, and referrals and effective care coordination when needed.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

Behaviors

Nutrition & Physical Activity

Weighted sum of the z-scores of ranked nutrition and physical activity measures for children.
America's Health Rankings composite measure, 2020

 Breastfed**

Percentage of infants exclusively breastfed for six months.
CDC, 2018 Breastfeeding Report Card, 2015

Food Sufficiency

Percentage of children ages 0-17 whose household could always afford to eat good nutritious meals in the past 12 months.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

Physical Activity

Percentage of children ages 6-17 who were physically active at least 60 minutes everyday in the past week.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

Soda Consumption - Youth*

Percentage of high school students who reported drinking a can, bottle or glass of soda or pop two or more times per day in the past week.
CDC, Youth Behavioral Risk Surveillance System, 2019

Sexual Health - Youth

Weighted sum of the z-scores of ranked measures for youth.
America's Health Rankings composite measure, 2020

Dual Contraceptive Nonuse - Youth*

Percentage of sexually active high school students who reported not using both a condom during last sexual intercourse and birth control pills; an intrauterine device or implant; or a shot, patch or birth control ring before last sexual intercourse.
CDC, Youth Behavioral Risk Surveillance System, 2019

Teen Births

Number of births per 1,000 females ages 15-19.
CDC WONDER Online Database, Natality public-use data; CDC WONDER Bridged-Race Population Estimates 2010-2018, 2018

Sleep Health

Weighted sum of the z-scores of ranked sleep health measures for children.
America's Health Rankings composite measure, 2020

Adequate Sleep

Percentage of children age 6-17 who sleep recommended age-appropriate hours on most weeknights.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

Sleep Position

Percentage of women with a recent live birth who reported their infants are usually placed on their backs to sleep.
CDC and States, Pregnancy Risk Assessment Monitoring System or equivalent, 2018

Tobacco Use - Youth

Weighted sum of the z-scores of ranked tobacco use measures for youth.
America's Health Rankings composite measure, 2020

Electronic Vapor Product Use - Youth*

Percentage of high school students who reported using an electronic vapor product in the past 30 days.
CDC, Youth Behavioral Risk Surveillance System, 2019

Tobacco Use - Youth

Percentage of children ages 12-17 who used a tobacco product in the past month.
National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration (SAMHSA) restricted online data analysis system (RDAS), 2017–2018

Health Outcomes

Behavioral Health

Weighted sum of the z-scores of ranked behavioral health measures for children.
America's Health Rankings composite measure, 2020

Alcohol Use - Youth

Percentage of children ages 12-17 who reported drinking alcohol in the past month.
National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration (SAMHSA) restricted online data analysis system (RDAS), 2017–2018

Anxiety

Percentage of children ages 3-17 who currently have anxiety problems.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

Depression

Percentage of children ages 3-17 who currently have depression.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

Flourishing

Percentage of children ages 6 months-5 years who show affection, resilience, interest and curiosity in learning, and smile and laugh a lot; and children ages 6-17 who show self-regulation, interest and curiosity in learning, and work to finish tasks.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

Illicit Drug Use -Youth

Percentage of children ages 12-17 who reported using illicit drugs, including marijuana, in the past month.
National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration (SAMHSA) restricted online data analysis system (RDAS), 2017–2018

Mortality

Weighted sum of the z-scores of ranked mortality measures for children.
America's Health Rankings composite measure, 2020

Child Mortality

Age-adjusted number of deaths per 100,000 children ages 1-19.
CDC WONDER Online Database, Underlying Cause of Death, Multiple Cause of Death files, 2016–2018

Infant Mortality

Number of infant deaths (before age 1) per 1,000 live births.
CDC WONDER Online Database, Linked Birth/Infant Death files, 2016–2017

Neonatal Mortality*

Number of deaths during first 28 days of life (0-27 days) per 1,000 live births.
CDC WONDER Online Database, Linked Birth/Infant Death files, 2016–2017

Teen Suicide*

Number of deaths by suicide per 100,000 adolescents ages 15-19.
CDC WONDER Online Database, Underlying Cause of Death, Multiple Cause of Death files, 2016–2018

Physical Health

Sum of weighted z-scores of ranked physical health measures for children.
America's Health Rankings composite measure, 2020

Asthma

Percentage of children ages 0-17 who currently have asthma.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

High Health Status - Children*

Percentage of children ages 0-17 whose health is very good or excellent.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019

Low Birthweight

Percentage of infants weighing less than 2,500 grams (5 pounds, 8 ounces) at birth.
CDC WONDER Online Database, Natality public-use data, 2018

Low Birthweight Racial Gap

Difference between the race/ethnicity with the highest percentage of low birthweight infants compared with white infants with low birthweight.
CDC WONDER Online Database, Natality public-use data, 2018

Overweight or Obesity - Youth

Percentage of children ages 10-17 who are overweight or obese for their age based upon reported height and weight.
National Survey of Children's Health, U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), 2018–2019
* Supplemental measure. ** Data appearing in this update are the same that appeared in the 2019 edition.

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