Health of Women and Children Report - America's …...AMERICA’S HEALTH RANKINGS® HEALTH OF WOMEN AND CHILDREN REPORT 5 State Rankings Figure 3 2019 state scores* listed by …

Health of Women and Children Report 2019

2 AMERICA’S HEALTH RANKINGS® HEALTH OF WOMEN AND CHILDREN REPORT www.AmericasHealthRankings.org

America’s Health Rankings® is built on the World Health Organization’s definition of health: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

The model’s behaviors, community & environment, policy and clinical care categories reflect the personal, social and environmental factors that influence the health outcomes category.

Behaviors

Policy ClinicalCare

Health Outcomes

Community &Environment

AMERICA’S HEALTH RANKINGS® HEALTH OF WOMEN AND CHILDREN REPORT www.AmericasHealthRankings.org 1

ContentsIntroduction 2

State Rankings 4

Social and Economic Factors 10

Successes and Challenges 14

Successes 16

Challenges 30

State Summaries 48

Appendix 155

Measure Definitions, Sources and Data Years 156

Women’s Health 156

Infants’ Health 158

Children’s Health 160

Supplemental Measures 162

Data Source Descriptions 163

Methodology 165

Model Development 166

Health of Women and Children Advisory Committee 168

The Team 169

References 170


IntroductionAmerica’s Health Rankings® Health of Women and Children Report

According to U.S. Census Bureau estimates, in 2018 there were more than 58 million women of reproductive age (18-44) and nearly 73.4 million children (0-17) in the United States. Women and children make up 40.2 percent of the U.S. population, and both populations are growing more diverse. According to U.S. Census, non-Hispanic white children will account for less than half of children in 2020. Figure 1 shows the change in the population of women ages 18-44 and children between 1990 and 2018 by five racial/ethnic groups. Since 1990, the proportion of the population who are non-Hispanic white has decreased in women and children, while the proportion in each racial and ethnic minority has increased.

Summary of Key Findings

• Social and economic factors, including concentrated disadvantage, continue to influence individual and population health and well-being across the country.

• Stark disparities exist in key measures of health across states and by race/ethnicity, gender and education. To achieve the highest level of health for all people, these disparities need to be addressed and eliminated.

+ Smoking and tobacco use have decreased among women of reproductive age, pregnant women and youth.

+ Advances have been made in clinical care measures such as flu vaccination among women of reproductive age and HPV vaccination among male teens.

+ The teen birth rate has decreased.

– Adverse health behaviors including excessive drinking have increased among women of reproductive age.

– No progress has been made addressing low birthweight infants.

– Troubling mortality rates reveal increases in child mortality, teen suicide and drug deaths among women of reproductive age.

Purpose and objective

America’s Health Rankings’ purpose is to create widespread awareness of where states stand on important public health measures. To achieve this, comprehensive data are necessary to assess the current health of populations across

Figure 1Change in population of women and children by race/ethnicity between 1990 and 2018

140

120

100

80

60

40

20

0

-20

PERC

ENT

CH

AN

GE

WOMEN (18-44)

CHILDREN (0-17)

White* Black* Asian/ American Indian/ Hispanic Pacific Islander* Alaska Native*

* Non-Hispanic


the nation. The 2019 America’s Health Rankings Health of Women and Children Report provides a state-by-state comparison of the health of women, infants and children. The report combines various health-related measures across categories of health determinants and health outcomes using a wealth of reputable data sources.

• Fifty-five measures of health are used to rank states. Additionally, six measures from the Pregnancy Risk Assessment Monitoring System and 12 supplemental measures that are not included in the state rankings calculation reveal current and emerging issues affecting women and children.

• Five categories of health comprise the rankings model: behaviors, community & environment, policy, clinical care and health outcomes.

• Twenty-one data sources are used including the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System and Pregnancy Risk Assessment Monitoring System, the U.S. Census Bureau’s American Community Survey and the Maternal and Child Health Bureau’s National Survey of Children’s Health.

The objective of America’s Health Rankings Health of Women and Children Report is to improve population health of women and children by:

• Providing a benchmark for states. Each year the report presents trends, strengths, challenges and highlights of every state. In addition, the website offers a visual that displays all measures in order of impact on a state’s overall rank. This enables states to zoom in on health issues that have the largest impact on population health of women and children. With America’s Health Rankings Health of Women and Children Report’s three years

Introduction

of data, community leaders, public health officials and policymakers can monitor health trends over time and compare their state with neighboring states and the nation.

• Stimulating action. The report is intended to promote data-driven discussions among individuals, community leaders, the media, policymakers and public health officials that can drive change and improve the health of women and children. States can incorporate the report into their annual review of programs, and many organizations use the report as a reference when assigning goals for health-improvement plans.

• Highlighting disparities. The state rankings show disparities in health between states and among population groups at state and national levels. The report highlights disparities in age, gender, race/ethnicity, education and income.

New This YearTwelve supplemental measures were added to the America’s Health Rankings website to highlight current and emerging issues affecting women, infants and children. For measure definitions see page 162. Additionally, state-level data for adverse childhood experiences (Page 11) and concentrated disadvantage (Page 13) components give additional context that allows users to dive deeper into these two summary measures.


The health of women and children across states

The U.S. map in Figure 2 displays the 2019 rankings shaded by quintile. The healthiest states for women, infants and children are in the Northeast, West and Midwest. The states with the most health challenges are concentrated in the South, with the exception of Nevada.

• The top five states are Northeastern states.

• Four of the bottom five states are Southern states.

The states are ranked according to a calculated score (see Methodology page 165), with the U.S. score set at zero.

State RankingsHighest ranked states

#1 Rhode Island#2 Massachusetts#3 New Hampshire#4 Vermont#5 Connecticut

Lowest ranked states

#46 Nevada#47 Louisiana#48 Oklahoma#49 Arkansas#50 Mississippi

Figure 22019 state rankings map

Metric NameOverall-HWC (overall_mch)

Edition Name2019 HWC

1–10 11–20 21–30 31–40 41–50 not ranked


State Rankings

Figure 32019 state scores* listed by ranking

-0.750 -0.250 0.250 0.750

1 Rhode Island

2 Massachusetts

3 New Hampshire

4 Vermont

5 Connecticut

6 Minnesota

7 California

8 New Jersey

9 Utah

10 Colorado

11 Iowa

12 Maryland

13 New York

14 Hawaii

15 North Dakota

16 Maine

17 Washington

18 Virginia

19 Wisconsin

20 Oregon

21 Delaware

22 Idaho

23 Pennsylvania

24 South Dakota

25 Kansas

26 Illinois

27 Montana

28 Nebraska

29 Michigan

30 North Carolina

31 Alaska

32 Ohio

33 Wyoming

34 New Mexico

35 Indiana

36 South Carolina

37 Arizona

38 Missouri

39 Florida

40 Georgia

41 Tennessee

42 West Virginia

43 Texas

44 Kentucky

45 Alabama

46 Nevada

47 Louisiana

48 Oklahoma

49 Arkansas

50 Mississippi

* Weighted standard deviation relative to U.S. value. A score of zero is equal to the U.S. value.

Figure 3 displays the states in order of rank. The green bars represent states scoring healthier than the U.S. average (above zero), while gold bars represent states scoring unhealthier than the U.S. average (below zero). The distance between bars indicate the difference between state scores. For example, California (No. 7) and Minnesota (No. 6) have a large difference in score, making it difficult for California to move up in the rankings. There is also a large gap in score between Ohio (No. 32) and the next higher state, Alaska (No. 31).

Adjust My Rank is a web tool that illustrates the changes in health needed to improve a state’s rank. Users can adjust up to eight measures to achieve the desired change in rank. The tool assumes all other state and national values remain constant. Adjust My Rank demonstrates that improving population health at the state level requires a multi-pronged approach. Focusing on one measure alone likely does not improve health enough to change a state’s rank. Adjust My Rank can be used to prioritize public health goals and interventions as well as to spark dialogue on how to improve state health.


Mississippi remains No. 50

Mississippi (Page 96) is No. 50, for the second year in a row. The state ranks last in the behaviors and community & environment categories (Table 2). Improvements were made in policy, clinical care and outcomes categories in the past year, yet declines were seen in the behaviors category. All-in-all, Mississippi ranks in the bottom 10 states across all five model categories. The state also ranks in the bottom five for all three populations of women, infants and children. Infant child care cost, excessive drinking among women ages 18-44 and cervical cancer screening have the most positive impact on Mississippi’s rank. Breastfed infants, household smoke, uninsured women and household food insecurity are the measures with the most negative impact on Mississippi’s rank.

Strengths:

• Low prevalence of excessive drinking among women ages 18-44 at 12.4 percent, compared with 19.6 percent nationally

Rhode Island moves into the top spot

Rhode Island (Page 126) is the healthiest state in this year’s report. The state’s top rank is driven by No. 1 rankings in the policy and clinical care categories (Table 1). Rhode Island also ranks in the top five across all three populations of women, infants and children. Baby-friendly facilities, uninsured women, prenatal care before the third trimester and well-baby checks have the greatest positive impact on the state’s rank. Supportive neighborhoods, infant child care cost, substance use disorder among youth and drug deaths among women have the most negative impact on Rhode Island’s rank.

Strengths:

• Low percentage of uninsured women ages 19-44 at 5.7 percent, compared with 12.4 percent nationally

• High percentage of prenatal care before the third trimester at 98.0 percent of live births, compared with 93.7 percent nationally

• Lowest child mortality rate at 16.3 deaths per 100,000, compared with 25.7 deaths per 100,000 nationally

Challenges:

• High drug death rate among females ages 15-44 at 21.3 deaths per 100,000, compared with 16.3 deaths per 100,000 nationally

• High cost of infant child care at 13.3 percent of a married couple’s median household income, compared with 12.3 percent nationally

• Low prevalence of supportive neighborhoods at 51.0 percent of children ages 0-17, compared with 55.4 percent nationally

State Rankings

Table 1Rhode Island 2019 population and model category rankings

Rank changePopulation 2019 ranking since 2018

Women 4 —Infants 2 +2Children 4 +2

Rank changeModel category 2019 ranking since 2018

Behaviors 16 +6Community & Environment 18 +7Policy 1 —Clinical Care 1 —Outcomes 9 +1State rank 1 +2


State Rankings

• Low cost of infant child care at 7.3 percent of a married couple’s median household income, compared with 12.3 nationally

• High prevalence of children with health insurance at 95.3 percent, compared with 93.9 percent nationally

Challenges:

• High percentage of uninsured women ages 19-44 at 19.1 percent, compared with 12.4 percent nationally

• Lowest percentage of infants breastfed exclusively for six months at 13.0 percent, compared with 24.9 percent nationally

• Highest prevalence of overweight or obesity among youth at 39.2 percent, compared with 31.0 percent nationally

Table 3Largest rank improvements since 2018

State 2018 ranking 2019 ranking Rank change

New York 19 13 +6Maine 21 16 +5Maryland 16 12 +4Missouri 41 37 +4New Jersey 12 8 +4

Table 4Largest rank declines since 2018

State 2018 ranking 2019 ranking Rank change

Nebraska 22 28 -6Washington 11 17 -6Florida 34 39 -5Wisconsin 14 19 -5

States with the largest changes in rank in the past year

New York (Page 112) and Maine (Page 86) made the most progress in the rankings since 2018, improving six and five ranks, respectively (Table 3). New York’s improvement was driven by progress in infants’ health measures (+11 ranks from No. 28 to No. 17) and gains in the policy (+8 ranks) and clinical care (+7 ranks) categories. Maine’s rank increase was driven by progress in women’s health measures (+7 ranks from No. 27 to No. 20) and in the behaviors (+14 ranks) category.

Nebraska (Page 102) and Washington (Page 142) experienced the largest declines in the rankings since 2018, both dropping six ranks (Table 4). Nebraska’s drop in rank was driven by declines in infants’ health measures (-17 ranks from No. 24 to No. 41) and declines in the community & environment (-11 ranks) category. Washington’s drop in rank was driven by declines in children’s health measures (-6 ranks from No. 18 to No. 24) and in the behaviors and clinical care categories (-4 ranks).

Table 2Mississippi 2019 population and model category rankings

Rank changePopulation 2019 ranking since 2018

Women 47 —Infants 50 —Children 49 +1

Rank changeModel category 2019 ranking since 2018

Behaviors 50 -2Community & Environment 50 —Policy 46 +2Clinical Care 44 +4Outcomes 48 +2State rank 50 —


The health of women, infants and children within states

When examining women, infants and children separately, variations emerge in the rankings within many states. Table 5 displays the overall and individual ranks for women, infants and children shaded by quintile of rank. For example, New Hampshire (No. 3) ranks in the top five for infants and children, but ranks No. 11 for women. Arkansas (No. 49) ranks in the bottom five for women and infants, but ranks No. 38 for children. The largest variations in rank among the three populations occur in Oregon (No. 20), South Dakota (No. 23), Montana (No. 27), Alaska (No. 31) and New Mexico (No. 34). In all five states, the rank for children’s health is dramatically lower than the ranks for infants’ and women’s health. Meanwhile, there is little variation among the ranks of the three populations in Rhode Island (No. 1), New York (No. 13), Nevada (No. 46) and Mississippi (No. 50).

A line graph displayed in the state summaries (Pages 48-153)demonstrates how each state compares with the average U.S. score for each population group (women, infants, and children) and each model category (behaviors, community & environment, policy, clinical care and outcomes) as well as overall.

Table 52019 Population group rankings sorted by overall state ranking

Rhode Island

Massachusetts

New Hampshire

Vermont

Connecticut

Minnesota

California

New Jersey

Utah

Colorado

Iowa

Maryland

New York

Hawaii

North Dakota

Maine

Washington

Virginia

Wisconsin

Oregon

Delaware

Idaho

Pennsylvania

South Dakota

Delaware

Illinois

Montana

Nebraska

Michigan

North Carolina

Alaska

Ohio

Wyoming

New Mexico

Indiana

South Carolina

Arizona

Missouri

Florida

Georgia

Tennessee

West Virginia

Texas

Kentucky

Alabama

Nevada

Louisiana

Oklahoma

Arkansas

Mississippi

State Women’s Infants’ Children’sranking ranking ranking ranking

Sorting Edition2019 HWC

Sorting MetricOverall-HWC (overall_mch)

Sorting DirectionAscending

Column 5 - Edition Name2007 Annual

Display Column

Column 5 - Metric NameNone

Column 6 - Metric NameNone

Column 6 - Edition Name2009 Annual

Display Column

TOP 10

11 TO 20

21 TO 30

31 TO 40

BOTTOM 10

State Rankings


State Rankings

Figures 4 to 6 show the geographic distribution of rankings across states for each population group. The top ranking states for women’s health are spread throughout the West, Midwest and Northeast, while the bottom ranking states are in the South, with the exception of Nevada and Indiana. For infants’ health, the top ranking states are in the West and Northeast as well as Minnesota, while the lowest ranking states are clustered in the South, as well as Nevada, Nebraska and Ohio. The top ranking states for children’s health are spread in the Northeast as well as Minnesota, Iowa, Virginia and Maryland, while the lowest ranking states are in the West and South.

1 to 10 11 to 20 21 to 30 31 to 40 41 to 50 not ranked


Figure 42019 women’s health rankings map

Metric NameOverall-Women (overall_..


Figure 52019 infants’ health rankings map

Metric NameOverall-Infants (overall_in..



Figure 62019 children’s health rankings map

Metric NameOverall-Children (overall_..



The health of women, infants and children is fundamental to the health of communities, and vice versa. Health behaviors and outcomes are heavily influenced by social and economic factors at state, community, household and individual levels. Social and economic factors continue to challenge the well-being of families in communities across the country. This year’s report finds stark disparities by gender, race/ethnicity, geography and education across key measures of health. To achieve the highest level of health for all people, more work is needed to address and eliminate these disparities.

America’s Health Rankings Health of Women and Children Report finds that:

• Nearly 14.7 million (20.5 percent) children ages 0-17 have at least two of nine adverse childhood experiences. Table 6 shows the nine components of the adverse childhood experiences measure at the state level.

According to the Child and Adolescent Health Measurement Initiative, adverse childhood experiences are stressful or traumatic events that affect children and have a lasting impact on health and well-being. Early experiences have a broad and profound impact on an individual’s

development and subsequent emotional, cognitive, social and biological functioning.

• Nearly a quarter (24.0 percent) of households are in areas of concentrated disadvantage. This means there is a higher percentage of households headed by females (who are more likely to face wage discrimination than males); a higher percentage of children; and a higher percentage of people unemployed, living in poverty and receiving public assistance. Table 7 displays the five components of the concentrated disadvantage measure at the state level.

According to the Association of Maternal and Child Health Programs, concentrated disadvantage is a measure of community well-being that helps identify community-level concentrated poverty and economic segregation. Persistent high levels of concentrated disadvantage can harm physical and mental health and is associated with: poor birth outcomes, child maltreatment, lack of access to healthy foods and recreational areas,1 poor educational outcomes,2 teen pregnancy3 and high rates of violent crime.4

Social and Economic Factors

higher in Oklahoma (28.5% of children ages 0-17)than California (14.8%)

higher in Mississippi (43.5% of households)than Vermont (2.5%)

A DV E R S E C H I L D H O O D E X P E R I E N C E S

C O N C E N T R AT E D D I SA DVA N TAG E

1.9x

17.4x

D I S PA R I T I E S


Social and Economic FactorsTable 6Nine components of adverse childhood experiences (ACEs) sorted by ACEs ranking, 2019

14.8 19.4 21.5 1.7 4.4 3.3 1.6 5.4 7.4 3.215.6 21.0 20.4 2.3 3.5 3.5 2.0 5.5 5.3 5.715.6 24.2 17.8 1.9 3.7 2.6 2.7 4.7 5.5 3.715.7 21.7 19.6 2.7 3.5 3.5 3.3 5.9 5.4 2.015.7 25.5 20.5 3.3 3.4 2.9 2.9 5.7 4.1 2.817.2 20.8 18.5 2.2 7.1 5.2 4.1 8.4 8.0 3.517.6 22.8 18.0 2.0 6.1 4.1 3.6 11.6 7.0 1.617.7 22.0 18.5 2.4 6.5 4.3 3.6 7.5 9.5 2.118.1 22.1 19.9 3.5 5.9 4.5 3.9 7.1 6.0 4.318.2 20.1 19.5 2.9 4.4 8.5 5.6 5.2 8.3 2.218.2 22.2 22.4 3.0 4.9 4.8 5.1 8.0 7.3 2.918.3 23.4 20.9 3.2 5.3 4.9 3.2 8.0 7.6 3.118.4 22.2 22.2 1.7 5.1 4.4 3.6 9.1 10.8 4.218.5 21.4 21.3 3.9 3.4 3.9 1.9 9.1 8.9 1.118.6 23.4 21.3 2.3 5.3 6.6 5.7 8.2 9.5 2.418.9 23.6 20.3 2.6 7.8 4.5 3.4 8.9 10.0 1.919.2 22.7 21.3 4.0 8.2 5.1 4.5 7.7 8.2 3.619.9 25.7 23.3 4.8 8.0 6.2 3.1 5.9 8.8 3.919.9 23.6 23.3 3.9 8.5 4.2 2.8 7.3 7.0 3.620.1 23.9 23.5 2.3 7.0 4.4 3.2 8.3 11.3 4.820.6 25.5 21.7 2.0 7.5 4.8 4.0 8.7 9.6 4.420.8 22.9 27.1 2.3 8.3 6.4 4.6 8.1 9.3 4.420.9 24.7 25.5 4.6 9.1 6.1 3.2 6.5 6.9 3.021.1 27.4 23.2 2.2 8.2 5.2 3.4 13.6 9.8 1.621.5 23.8 24.2 2.3 6.1 5.0 3.8 9.8 12.9 2.221.7 20.4 25.3 2.5 9.1 6.8 4.4 9.8 9.5 4.222.0 24.6 24.5 2.6 9.1 7.3 6.0 7.9 8.1 3.922.0 24.2 26.2 4.5 7.6 5.2 4.0 7.7 7.6 4.922.2 22.9 26.2 5.2 10.0 6.3 4.7 9.1 9.2 3.322.5 27.5 27.8 2.2 6.6 6.2 4.5 11.8 11.2 1.523.3 26.5 24.9 2.2 6.4 6.3 3.5 11.2 11.3 3.723.6 25.5 25.4 3.9 9.9 7.2 4.3 8.0 8.6 4.923.7 23.6 25.4 4.8 9.6 5.6 5.8 7.9 9.0 5.224.1 23.8 26.0 4.1 9.8 5.9 6.3 11.3 13.0 3.424.1 25.4 26.9 3.5 11.7 6.9 4.2 7.9 10.0 4.424.4 24.8 29.4 3.9 10.7 6.0 6.4 6.7 10.8 4.425.1 28.9 25.8 4.2 11.0 6.6 5.5 9.7 9.3 3.325.1 27.5 25.5 2.5 8.5 6.8 4.5 10.9 11.7 3.625.2 28.3 28.8 4.9 11.6 5.0 3.9 7.0 8.8 3.225.3 27.3 30.8 4.7 10.3 6.1 5.6 6.9 9.2 3.425.5 30.7 29.0 5.6 11.9 9.7 4.1 7.8 10.5 4.625.8 26.7 30.1 3.0 12.6 5.8 3.2 8.1 11.5 2.625.9 28.4 26.5 3.5 10.9 7.6 4.5 9.8 11.3 3.025.9 28.7 26.6 4.1 11.4 7.6 6.0 12.3 15.4 2.626.0 24.3 30.0 5.0 12.2 9.5 5.9 8.7 11.4 6.026.3 27.8 29.6 4.1 8.2 6.9 4.2 7.5 9.7 4.627.1 28.8 31.5 5.8 13.1 8.9 5.0 10.6 11.7 2.727.3 26.8 31.0 3.1 10.7 7.2 5.4 8.3 13.7 4.427.7 30.6 31.9 4.2 9.0 8.3 6.3 11.2 13.5 2.128.5 30.0 30.6 4.0 14.6 9.2 6.1 11.6 12.5 4.3

California

Maryland

New Jersey

Massachusetts

New York

Minnesota

Utah

North Dakota

Illinois

Hawaii

Rhode Island

Connecticut

Washington

New Hampshire

Iowa

Nebraska

Pennsylvania

Texas

Virginia

Colorado

South Dakota

Kansas

South Carolina

Idaho

Vermont

Wisconsin

Delaware

Michigan

Indiana

Maine

Oregon

North Carolina

Georgia

Alaska

Tennessee

Nevada

Ohio

Wyoming

Louisiana

Florida

Mississippi

Kentucky

Missouri

Montana

New Mexico

Alabama

Arkansas

Arizona

West Virginia

Oklahoma

Two or more ACEs

Economic hardship

Parent divorce or separation

Parent death

Parent in jail

Domestic violence

Neighbor-hood

violenceMental illness

Substance misuse Discrimination

TOP 10

11 TO 20

21 TO 30

31 TO 40

BOTTOM 10

Values represent percentages of children ages 0-17



• Nearly one in eight households (12.3 percent) in the nation don’t have adequate food due to lack of resources, despite improvements in food insecurity since 2016.

Food insecurity has broad effects on health due to the mental and physical stress that it places on the body. In women it is associated with obesity, anxiety, depression, risky sexual behavior, low birthweight and gestational diabetes.5 In children it is associated with anemia, asthma, anxiety, depression, cognitive and behavioral problems as well as hospitalization.6

• Nearly 55.3 million women ages 19-44 (12.4 percent) are uninsured — ranging dramatically from 3.3 percent of women in Massachusetts to 25.6 percent in Texas.

Health insurance is a critical factor in ensuring women receive needed care to achieve and maintain good health. Moreover, babies born to healthy mothers start off on a promising path to health that has the potential to last a lifetime. According to the Kaiser Family Foundation, the most common reason for being uninsured is cost.

higher in New Mexico (17.9% of households)than Hawaii (7.4%)

higher in Texas (25.6% of women ages 19-44)than Massachusetts (3.3%)

H O U S E H O L D F O O D I N S E C U R I T Y

U N I N S U R E D WO M E N

2.4x

7.8x


Social and economic factors continue to challenge the well-being of families in communities across the country. Nearly one in eight households in the nation don’t have adequate food.


Table 7Five components of concentrated disadvantage sorted by concentrated disadvantage ranking, 2019

2.5 7.3 25.1 8.9 4.4 19.23.1 6.8 15.9 7.5 2.7 22.93.8 7.3 14.6 8.2 4.7 23.74.2 5.0 17.3 9.4 4.5 19.87.2 8.4 27.5 9.2 5.3 19.38.3 9.1 23.0 8.2 4.8 22.08.4 6.6 18.6 9.3 4.3 23.48.8 7.9 15.3 9.3 4.4 30.410.3 8.9 25.5 9.3 3.7 24.710.4 7.6 23.7 9.0 4.1 23.411.6 10.0 25.4 9.1 5.4 26.211.9 8.0 19.8 9.8 3.8 24.812.6 7.8 20.1 12.1 5.5 22.312.7 7.6 18.9 9.8 5.2 23.013.5 7.0 26.1 12.1 4.9 21.613.7 8.5 19.3 10.1 4.8 24.713.7 8.0 25.5 10.0 6.0 22.513.8 8.1 24.9 9.9 4.7 22.513.9 6.9 23.6 10.7 7.7 25.216.6 10.3 26.1 11.8 5.8 22.916.8 6.6 23.0 14.2 6.1 22.517.5 7.8 22.1 12.3 6.0 20.417.9 8.9 26.9 11.8 6.5 21.018.8 7.0 20.8 12.6 7.2 21.219.9 7.9 19.9 13.3 7.0 22.320.1 10.3 25.4 12.1 6.1 23.920.4 13.0 34.0 11.4 7.2 20.520.5 9.8 32.3 10.3 6.8 21.521.2 8.2 28.6 13.5 6.4 21.621.3 11.8 28.0 12.3 5.7 24.522.5 10.9 29.4 12.4 7.4 22.323.0 9.8 27.3 12.4 7.4 23.023.2 10.8 28.3 12.7 6.5 22.624.0 13.2 29.8 13.1 6.3 23.724.4 12.4 32.2 13.3 6.6 22.725.6 11.8 29.0 13.2 7.2 22.826.6 9.5 29.0 13.5 6.8 19.926.7 11.3 27.9 14.3 6.8 21.227.7 10.3 27.0 12.8 8.0 23.227.8 11.1 32.2 13.1 7.2 20.328.3 13.8 30.9 12.5 6.8 22.930.4 13.6 32.4 14.8 7.4 22.730.6 12.3 31.6 14.6 7.2 22.331.4 11.1 26.4 13.3 7.7 23.432.4 12.4 29.0 14.0 5.8 26.333.3 12.8 30.5 15.0 7.5 24.534.3 12.3 30.3 12.4 7.1 23.834.6 14.9 33.9 16.1 7.2 23.941.4 15.6 36.5 13.8 7.7 23.943.5 16.6 37.1 17.9 8.8 24.3

Vermont

North Dakota

Wyoming

New Hampshire

Maine

Montana

Minnesota

Utah

South Dakota

Iowa

Idaho

Nebraska

Virginia

Colorado

Hawaii

Kansas

Washington

Wisconsin

Alaska

Missouri

Maryland

Massachusetts

Pennsylvania

Connecticut

New Jersey

Indiana

West Virginia

Oregon

Delaware

Oklahoma

Michigan

Illinois

Ohio

Arkansas

Tennessee

North Carolina

Rhode Island

New York

Nevada

Florida

Kentucky

Alabama

South Carolina

California

Texas

Georgia

Arizona

Louisiana

New Mexico

Mississippi

Concentrated disadvantage

(% of households)

Female-headed household

(% of households)

Below poverty threshold

(% of households)

Receiving public assistance

(% of population)

Population younger than 18 years

(% of population)

Unemployed (% of population

ages 16 and older)

TOP 10

11 TO 20

21 TO 30

31 TO 40

BOTTOM 10



National SuccessesDeclines in smoking and tobacco use

12%

12%

31%

SMOKING among women ages 18-44 decreased

TOBACCO USE among pregnant women decreased

TOBACCO USE among youth ages 12-17 decreased

since 2018 from 7.8 percent to 6.9 percent


22% since 2016 from 24.2 to 18.8 births per 1,000

TEEN BIRTHS among females ages 15-19 decreased

Declines in teen births


Advances in clinical care measures

2%

5%

DEDICATED HEALTH CARE PROVIDER among women ages 18-44 increased

FLU VACCINATION among women ages 18-44 increased



18%HPV IMMUNIZATION among males ages 13-17 increased


7%MENINGOCOCCAL IMMUNIZATION among adolescents ages 13-17 increased



National ChallengesIncreases in adverse health behaviors among women

2%

11%

6%

CHLAMYDIA among females ages 15-44 increased

EXCESSIVE DRINKING among women ages 18-44 increased

OBESITY among women ages 18-44 increased

since 2018 from 1,609.0 to 1,639.8 new cases per 100,000 females



Increases in mortality rates

6%

25%

CHILD MORTALITY ages 1-19 increased

TEEN SUICIDE ages 15-19 increased

since 2016 from 24.3 to 25.7 deaths per 100,000 children

since 2016 from 8.4 to 10.5 deaths per 100,000 teens

36%DRUG DEATHS among females ages 15-44 increased

since 2016 from 12.0 to 16.3 deaths per 100,000 females

2% since 2018 from 8.1 percent of live births to 8.3 percent

LOW BIRTHWEIGHT increased

No progress addressing low birthweight


Successes

Smoking decreasing among women of reproductive age, with widespread disparities

Smoking among women ages 18-44 decreased 12 percent since 2016 from 17.4 percent to 15.3 percent (Figure 7) — a decrease of nearly 950,000 women. Significant decreases also occurred in nine states (Figure 8). The largest decrease occurred in Rhode Island, dropping 33 percent since 2016.

Smoking is the leading cause of preventable death and disease in the United States, causing an estimated 201,773 deaths in women annually, according to the Centers for Disease Control and Prevention (CDC). Smoking affects reproductive health. According to the National Cancer Institute, women who smoke are more likely to go through menopause at a younger age and have trouble getting pregnant compared with women who do not smoke.

DEFINITION

Percentage of women ages 18-44 who reported smoking at least 100 cigarettes in their lifetime and currently smoke daily or some days (does not include e-cigarette use) (2-year estimate)

Smoking and tobacco use down, advances in clinical care measures, teen births down

State Nation

Figure 7Smoking among women, 2016-2019

S M O K I N G

higher among American Indian/Alaska Native (25.5%)than Asian (3.5%) women

higher among high school graduates (26.0%)than college graduates (6.3%)

higher in West Virginia (33.6%)than Utah (7.4%)

S M O K I N G among women ages 18-44

4.5x

4.1x

7.3x


PERC

ENTA

GE

OF

WO

MEN

AG

ES 1

8-44


SuccessesS M O K I N G

95 PERCENT CONFIDENCE INTERVAL

0 5 10 15 20 25 30PERCENTAGE OF WOMEN AGES 18–44

Colorado

Indiana

Maine

Minnesota

Nebraska

New York

Rhode Island

South Carolina

South Dakota

United States

2016 2019

Figure 8States with decreases in smoking among women between 2016 and 2019

20%

17%

20%

20%

18%

21%

33%

19%

24%

12%

Decrease since 2016


Successes

Disparities and geographic variation Disparities in smoking among women ages 18-44 are present across age group, race/ethnicity, education and income (Figure 9). American Indian/Alaska Native women have a smoking prevalence that is 7.3 times higher than Asian women. Both populations have made improvements, however, with smoking prevalence declining 23 percent (33.1 percent

to 25.5 percent) and 27 percent (4.8 percent to 3.5 percent), respectively, since 2016.

Large differences are also present across states, with smoking prevalence 4.5 times higher in West Virginia (33.6 percent) than Utah (7.4 percent). And the gap has grown: In 2016, smoking was 4.1 times higher in West Virginia (33.6 percent) than California (8.2 percent).

S M O K I N G

Figure 9Smoking among women by subpopulation

PERCENTAGE OF WOMEN AGES 18–44

0 10 20 30

Overall

Ages 18–24

Ages 25–34

Ages 35–44

American Indian/Alaska Native*

Asian*

Black*

Hawaiian/Pacific Islander*

Hispanic

Multiracial*

Other Race*

White*

Less Than High School**

High School Graduate**

Some College**

College Graduate**

Less Than $25,000**

$25,000–$49,999**

$50,000–$74,999**

$75,000 or More**

* Non-Hispanic** Women ages 25 and older


Successes

Tobacco use down among pregnant women, disparities across states

Tobacco use among pregnant women decreased 12 percent in the past year from 7.8 percent to 6.9 percent (Figure 10), or 31,535 fewer mothers. Decreases were seen in all states. The largest declines occurred in Maine and North Dakota, both decreasing 2.5 percentage points. Despite these improvements, the geographic variation is astounding; tobacco use during pregnancy is 17.6 times higher in West Virginia (24.7 percent) than California (1.4 percent). The ratio between these two states has grown wider since 2016.

According to CDC’s Division of Reproductive Health, smoking during pregnancy increases the risk of abnormal bleeding during pregnancy and delivery and health problems in infants including preterm birth, low birthweight, birth defects of the mouth and lip, sudden infant death syndrome and damage to developing lungs and brain. Other research shows it is associated with miscarriage7 and ectopic pregnancy.8

DEFINITION

Percentage of mothers who used tobacco during pregnancy (does not include e-cigarette use)

Figure 10Tobacco use during pregnancy, 2016-2019

State Nation

S M O K I N G

higher in West Virginia (24.7%)than California (1.4%)

TO B AC C O U S E among pregnant women

17.6x


Tobacco use down among youth, with disparities across states

Tobacco use among youth ages 12-17 decreased 31 percent since 2016 from 7.4 percent to 5.1 percent (Figure 11). It decreased significantly in 18 states shown in green in Figure 12. Despite these improvements, large geographic variation

DEFINITION

Percentage of children ages 12-17 who used a tobacco product in the past month (does not include e-cigarette use) (2-year estimate)


Successes

Figure 11Tobacco use among youth, 2016-2019

Figure 12Map of states with significant decreases in tobacco use among youth between 2016 and 2019

State Nation

S M O K I N G

higher in Kentucky (9.6%)than Hawaii (3.4%)

TO B AC C O U S E among youth ages 12-17

2.8x

D I S PA R I T I E SPE

RCEN

TAG

E O

F C

HIL

DR

EN A

GES

12-

17

remains; tobacco use among youth is 2.8 times higher in Kentucky (9.6 percent) than Hawaii (3.4 percent). This gap has grown. In 2016, tobacco use among youth was 2.5 times higher in West Virginia (12.5 percent) than in California (5.0 percent).

According to CDC’s Office on Smoking and Health, nearly nine in 10 cigarette smokers have their first cigarette by age 18. A report from the Surgeon General estimates that 5.6 million Americans who are 17 or younger today will die early from diseases caused by long-term tobacco use.

no significant change significant decrease


Successes

The percentage of women with a dedicated health care provider up, with widespread disparities

The percentage of women ages 18-44 with a dedicated health care provider increased 2 percent since 2016 from 71.6 percent to 73.0 percent (Figure 13), an increase of nearly 1.6 million women. Significant increases in the percentage of women who reported having a dedicated health care provider occurred in five states (Figure 14), while two states experienced significant decreases. The largest increases occurred in North Carolina and West Virginia, both increasing 8 percent. Delaware had the largest decline, dropping 10 percent.

Having a dedicated health care provider is associated with greater use of preventive services,9 lower health care costs,10 fewer hospitalizations and emergency room visits,11 and better management of chronic conditions such as high blood pressure12 and high cholesterol.13 Women ages 20-64 who have a dedicated provider are about four times more likely to receive a clinical breast exam and cervical cancer screening.9 Those without one are more likely to have unmet health care needs.14

Figure 13Dedicated health care provider among women, 2016-2019

DEFINITION

Percentage of women ages 18-44 who reported having one or more people they think of as their personal doctor or health care provider (2-year estimate)

Advances in clinical care measures

higher among white (77.8%)than Hispanic (59.7%) women

higher among college graduates (81.3%)than those with less than a high school education (58.5%)

higher in Maine (87.5%)than Nevada (60.8%)

D E D I CAT E D H E A LT H CA R E P R OV I D E R among women ages 18–44

1.4x

1.4x

1.3x


PERC

ENTA

GE

OF

WO

MEN

AG

ES 1

8-44

50

60

2016 2017 2018 2019EDITION YEAR

State Nation

PERC

ENTA

GE

OF

WO

MEN

AG

ES 1

8–44

C L I N I CA L CA R E


Successes

Figure 14States with significant increases and decreases in dedicated health care provider among women between 2016 and 2019

0 10 20 30 40 50 60 70 80 90


Colorado

Delaware

Indiana

North Carolina

Ohio

Washington

West Virginia

United States

2016 2019

6%

10%

5%

8%

6%

6%

8%

2%

Change since 2016




SuccessesC L I N I CA L CA R E

Disparities and geographic variationDisparities in the percentage of women with a dedicated health care provider are present by age group, race/ethnicity, education and income (Figure 15) as well as across states. The percentage of women ages 18-44 with a dedicated health care provider is 1.4 times

Figure 15Dedicated health care provider among women by subpopulation


0 10 20 30 40 50 60 70 80 90

Overall

Ages 18–24

Ages 25–34

Ages 35–44


Asian*

Black*


Hispanic

Multiracial*

Other Race*

White*



Some College**

College Graduate**

Less Than $25,000**

$25,000–$49,999**

$50,000–$74,999**

$75,000 or More**

higher among college graduates (81.3 percent) than those with less than a high school education (58.5 percent). This gap, however, has shrunk due to an 8 percent increase among women with less than a high school education (54.3 percent to 58.5 percent) since 2016.



Successes

Flu vaccination up among women, with widespread disparities

Flu vaccination coverage among women ages 18-44 increased 5 percent since 2016 from 32.8 percent to 34.4 percent (Figure 16), an increase of nearly 1.3 million women. Since 2016, flu vaccination coverage increased significantly in Florida from 20.7 percent to 27.4 percent and decreased significantly in Louisiana from 35.3 percent to 28.0 percent.

According to CDC, pregnant women are at greater risk of severe illness and hospitalization from the flu. Among pregnant women, the flu shot reduced risk of being hospitalized with flu by an average of 40 percent in 2018. Flu vaccination in the 2017-2018 flu season prevented an estimated 7 million illnesses and more than 100,000 influenza-related hospitalizations.

Figure 16Flu vaccination among women, 2016-2019

DEFINITION

Percentage of women ages 18-44 who received the flu vaccine in the last year (2-year estimate)


higher among Asian (43.8%)than black (29.1%) women

higher among college graduates (44.2%)than those with less than a high school education (28.5%)and high school graduates (27.8%)

higher in South Dakota (48.7%)than Nevada (26.5%)

F LU VAC C I N AT I O N among women ages 18–44

1.8x

1.6x

1.5x


State Nation

PERC

ENTA

GE

OF

WO

MEN

AG

ES 1

8–44


SuccessesC L I N I CA L CA R E

Disparities and geographic variation Disparities in flu vaccination among women ages 18-44 are present across age groups, race/ethnicity, education and income (Figure 17) and across states. Some groups have

Figure 17Flu vaccination among women by subpopulation

Overall

Ages 18–24

Ages 25–34

Ages 35–44


Asian*

Black*


Hispanic

Multiracial*

Other Race*

White*



Some College**

College Graduate**

Less Than $25,000**

$25,000–$49,999**

$50,000–$74,999**

$75,000 or More**

PERCENTAGE OF WOMEN AGES 18–440 10 20 30 40 50


made significant improvements. Since 2016, flu vaccination has increased 12 percent among women ages 18-24 (28.9 percent to 32.4 percent) and 10 percent among Hispanic women (29.1 percent to 32.0 percent).


Successes

HPV immunization up among teenage males, disparities across states and by race/ethnicity and poverty status

HPV immunization among males ages 13-17 increased 18 percent in the past year from 37.5 percent to 44.3 percent (Figure 18). Significant increases occurred in two states, Montana at 72 percent (27.9 percent to 48.1 percent) and Texas at 36 percent (26.5 percent to 36.0 percent). National male HPV immunization coverage is now within 10 percentage points of female coverage (53.1 percent).

According to CDC, human papillomavirus (HPV) is the most common sexually transmitted infection, affecting nearly all sexually active men and women. It can cause genital warts and certain cancers. HPV vaccination could prevent more than 90 percent of these cancers from developing.

Disparities and geographic variationThere are disparities in HPV immunization among males ages 13-17 across race/ethnicity, poverty

Figure 18HPV immunization among teen males, 2018-2019


DEFINITION

Percentage of males ages 13-17 who are up-to-date on all recommended doses of human papillomavirus (HPV) vaccine

higher among Hispanic (54.6%)than white (40.2%) males

higher in Rhode Island (78.4%)than Mississippi (23.4%)

H P V VAC C I N AT I O N among males ages 13–17

3.4x

1.4x


State Nation

PERC

ENTA

GE

OF

MA

LES

AG

ES 1

3–17

status (Figure 19) and across states. A higher percentage of males living below poverty (49.5 percent) received recommended doses of HPV vaccine than those above poverty (41.7 percent).

Figure 19HPV immunization among teen males by subpopulation

Black*

Hispanic

White*

Above Poverty

Below Poverty

PERCENTAGE OF MALES AGES 13–170 10 20 30 40 50 60 * Non-Hispanic



Successes

Meningococcal immunization up among teens, with no differences by race/ethnicity or poverty status

Meningococcal immunization coverage among teens ages 13-17 increased 7 percent since 2016 from 79.3 percent to 85.1 percent (Figure 20). Since 2016, significant increases occurred in 11 states shown in green in Figure 21.

Meningococcal disease is a potentially life-threatening illness caused by Neisseria meningitidis, the leading cause of bacterial meningitis in the nation. According to CDC, meningococcal disease is spread from person-to-person among those with close contact. The CDC recommends this vaccine for all children ages 11 or 12, with a booster shot at age 16 to protect against the period of increased risk from ages 16-21.

Disparities and geographic variationThere are no significant differences by race/ethnicity or poverty status (Figure 22), although differences exist across states. In Georgia, 95.3 percent of teens received the meningococcal vaccine compared with 90.7 percent in Wyoming. Meningococcal immunization increased significantly among white teens in the past year, from 81.2 percent to 84.6 percent, as well as teens living above the poverty level, from 82.0 percent to 84.8 percent.

Figure 20Meningococcal immunization among teens, 2016-2019

DEFINITION

Percentage of adolescents ages 13-17 who received one or more doses of meningococcal conjugate (MenACWY) vaccine

State Nation

PERC

ENTA

GE

OF

AD

OLE

SCEN

TS A

GES

13–

17

85.7


Figure 21Map of states with increases in meningococcal immunization between 2016 and 2019


Figure 22Meningococcal immunization among teens by subpopulation

Overall

Black*

Hispanic

White*

Above Poverty

Below Poverty

PERCENTAGE OF ADOLESCENTS AGES 13–170 10 20 30 40 50 60 70 80 90 100

* Non-Hispanic

85.7

Successes

no significant change significant increase


Successes

Figure 23Teen births among females, 2016-2019

DEFINITION

Number of births per 1,000 females ages 15-19

Teen births decreased 22 percent since 2016 from 24.2 to 18.8 births per 1,000 females ages 15-19 (Figure 23). Teen births have decreased in all states since 2016. Figure 24 shows the five states with the largest and smallest decreases. Texas had the largest drop from 37.8 to 27.6 births per 1,000 females, and Delaware had the smallest drop from 20.7 to 18.5 births per 1,000 females. States with large decreases had the highest rates. Despite improvements over the past three years, there is variation across states; teen births are 4.0 times higher in Arkansas (32.8 births per 1,000) than Massachusetts (8.1 births per 1,000).

According to Planned Parenthood, teenage mothers are more likely to experience maternal illness, miscarriage, stillbirth and neonatal death. Teen mothers are also significantly more likely to drop out of high school and face unemployment. Children born to teen mothers are more likely to have worse educational, behavioral and health outcomes than children born to older parents, according to CDC.

BIRT

HS

PER

1,00

0 A

GES

15-

19 40

30

20

10

0

Figure 24Teen births, largest and smallest state improvements between 2016 and 2019

2016 2019

States with the largest rate decreases in teen births relative to the Unites States are to the left, and states with the smallest decreases are to the right.

State Nation

BIRT

HS

PER

1,00

0

FEM

ALE

S A

GES

15-

19

30

20

10

0

Teen births down, disparities across states

T E E N B I RT H S

higher in Arkansas (32.8 births per 1,000)than Massachusetts (8.1)

T E E N B I RT H S among females ages 15-19

4.0x



Chlamydia up among women with disparities across states and by race/ethnicity

Chlamydia incidence, a proxy for risky sexual activity, increased 2 percent since 2018 among females ages 15-44 from 1,609.0 to 1,639.8 new cases per 100,000 females and increased 5 percent since 2016 (from 1,559.0) (Figure 25). There were 61,822 more cases in 2019 than in 2016. Chlamydia has increased in 40 states and D.C. since 2016. Figure 26 shows the five states with the largest increases and the seven states with the largest decreases in chlamydia incidence since 2016. Delaware had the largest increase (306.0 more new cases per 100,000 females ages 15-44) and Alabama saw the largest drop (406.4 fewer new cases per 100.000 females ages 15-44).

Chlamydia is the most commonly reported sexually transmitted infection, with more than

Challenges

DEFINITION

Number of new cases of chlamydia per 100,000 females ages 15-44

Adverse health behaviors up among women; no progress made addressing low birthweight; and child mortality, teen suicide and drug deaths among women up

B E H AV I O R S

higher among black (3,320.3 cases per 100,000)than Asian (325.8) females

higher in Alaska (2,497.4 cases per 100,000)than Utah (906.1)

C H L A M Y D I A I N C I D E N C E among females

2.8x

10.2x


Figure 25Chlamydia among women, 2016-2019

State Nation

CA

SES

PER

10

0,0

00

FEM

ALE

S A

GES

15–

44


Challenges

Figure 26Chlamydia, largest state improvements and declines between 2016 and 2019

States with the largest rate decreases in chlamydia relative to the Unites States are to the left, and states with the largest increases are to the right.

CA

SES

PER

100

,00

0 F

EMA

LES

AG

ES 1

5-44

3,000

2,500

2,000

1,500

1,000

500

0

2016 2019

Figure 27Chlamydia among females by subpopulation

Overall

American Indian/Alaska Native

Asian

Black

Hawaiian/Pacific Islander

Hispanic

White

CASES PER 100,000 FEMALES AGES 15–440 500 1,000 1,500 2,000 2,500 3,000 3,500

B E H AV I O R S

1.7 million cases of chlamydia reported to the CDC in 2017. While women usually have no symptoms, chlamydial infections can cause permanent damage to reproductive organs. According to CDC, chlamydia in pregnant women can result in negative health outcomes for the baby, including premature delivery, low birthweight, eye infection and pneumonia.

Disparities and geographic variationThere are large disparities by race/ethnicity and across states. Chlamydia incidence among females ages 15-44 is 10.2 times higher among black (3,320.3) than Asian (325.8) females (Figure 27).


Figure 28Excessive drinking among women, 2016-2019

Excessive drinking up among women, with widespread disparities

Excessive drinking increased 11 percent since 2016 from 17.7 percent to 19.6 percent of women ages 18-44, an increase of nearly 1.2 million women (Figure 28). Six states had significant increases in excessive drinking (Figure 29). The largest increase occurred in Tennessee, increasing 50 percent.

According to the National Institute on Alcohol Abuse and Alcoholism, excessive drinking is the third leading cause of preventable death in the nation; an estimated 26,000 women die annually from alcohol-related causes. Excessive alcohol consumption is associated with increased risk of liver and heart disease, breast cancer and high blood pressure,15 and it is detrimental to mother and infant health. CDC notes, however, that most who drink in excess do not have an alcohol use disorder.

DEFINITION

Percentage of women ages 18-44 who reported either binge drinking (having four or more drinks on one occasion in the past 30 days) or chronic drinking (having eight or more drinks per week) (2-year estimate)

State Nation

higher among multiracial (24.7%)than Asian (12.4%) women

higher among college graduates (21.2%)than those with less than a high school education (9.9%)

higher in Wisconsin and North Dakota (both 26.8%)than West Virginia (12.2%)

E XC E S S I V E D R I N K I N G among women ages 18–44

2.2x

2.1x

2.0x


PERC

ENTA

GE

OF

WO

MEN

AG

ES 1

8–44

B E H AV I O R S

Challenges


B E H AV I O R S

Challenges

Figure 29States with increases in excessive drinking among women between 2016 and 2019

PERCENTAGE OF WOMEN AGES 18–440 5 10 15 20 25 30

Kansas

Kentucky

North Carolina

Pennsylvania

South Carolina

Tennessee

United States

2016 2019

28%

31%

42%

29%

28%

50%

11%

Increase since 2016



Disparities and geographic variation There are significant differences in excessive drinking among women ages 18-44 by age group, race/ethnicity, education, income (Figure 30) and across states. Since 2016, excessive drinking increased significantly among women ages 35-44 (13.6 percent to 15.7 percent). Significant increases also occurred during the same time

frame among black (13.5 percent to 16.4 percent) and white (20.8 percent to 23.4 percent) women, those with some college (16.6 percent to 20.3 percent) and college graduates (19.8 percent to 21.2 percent), those with annual household incomes of $50,000-$74,999 (18.2 percent to 22.1 percent) and $75,000 or more (20.1 percent to 22.7 percent).

Figure 30Excessive drinking among women by subpopulation

Overall

Ages 18–24

Ages 25–34

Ages 35–44


Asian*

Black*


Hispanic

Multiracial*

Other Race*

White*



Some College**

College Graduate**

Less Than $25,000**

$25,000–$49,999**

$50,000–$74,999**

$75,000 or More**

PERCENTAGE OF WOMEN AGES 18–440 10 20 30


ChallengesB E H AV I O R S


B E H AV I O R S

Challenges

Obesity up among women of reproductive age, with widespread disparities

Obesity among women ages 18-44 increased 6 percent since 2016 from 25.9 percent to 27.4 percent (Figure 31). The only state with a significant change since 2016 was Nebraska, where obesity increased 16 percent (25.8 percent to 29.8 percent).

According to CDC, adults with obesity are more likely to have decreased quality of life and an increased risk of serious health conditions. Obesity impacts reproductive health; it is associated with reduced fertility and contraception effectiveness.16 Obesity can have a negative effect on mother and infant health by contributing to gestational hypertension and diabetes; birth complications (preeclampsia, C-section and postpartum hemorrhage);16 miscarriage; stillbirth; and neonatal mortality.17

Figure 31Obesity among women, 2016-2019

DEFINITION

Percentage of women ages 18-44 with a body mass index of 30.0 or higher based on reported height and weight (2-year estimate)

State Nation

higher among American Indian/Alaska Native (42.9%)than Asian (9.1%) women

higher among those with less than a high school education (41.0%) than college graduates (20.0%)

higher in Arkansas (40.2%)than Massachusetts (18.5%)

O B E S I T Y among women 18-44

2.2x

2.1x

4.7x


PERC

ENTA

GE

OF

WO

MEN

AG

ES 1

8–44


Disparities and geographic variationThere are significant differences in obesity prevalence among women ages 18-44 by age group, race/ethnicity, education, income (Figure 32) and across states. Since 2016, the prevalence of obesity increased significantly among women ages 18-24 (16.0 percent to 18.0 percent), American/Alaska Native (32.5 percent

B E H AV I O R S

to 42.9 percent) and white (23.3 percent to 25.0 percent) women, and high school (36.2 percent to 39.2 percent) and college (18.2 percent to 20.0 percent) graduates. Obesity increased significantly across all annual household income-levels except among women making less than $25,000, who have the highest prevalence of all income groups at 40.3 percent.

Figure 32Obesity among women by subpopulation

Overall

Ages 18–24

Ages 25–34

Ages 35–44


Asian*

Black*


Hispanic

Multiracial*

Other Race*

White*



Some College**

College Graduate**

Less Than $25,000**

$25,000–$49,999**

$50,000–$74,999**

$75,000 or More**

PERCENTAGE OF WOMEN AGES 18–440 10 20 30 40 50


Challenges


Challenges

Low birthweight increased 2 percent since 2018 from 8.1 percent to 8.3 percent of live births (Figure 33). Since 2016, the largest increase occurred in Nebraska (+0.9 percent points), and the greatest decreases, though not substantial, occurred in Maine and Wyoming (both -0.5 percent points).

According to CDC’s Division of Vital Statistics, low birthweight infants are at increased risk of infant mortality. Low birthweight is associated with multiple health conditions in infants and additional health problems during childhood and adulthood. The average hospital cost for a low birthweight infant is estimated to be $27,200, compared with $3,200 on average for all babies, according to the Agency for Health Care Research and Quality’s Health Care Cost Utilization Project.

DEFINITION

Percentage of infants weighing less than 2,500 grams (5 pounds, 8 ounces) at birth

Figure 33Low birthweight, 2016-2019

State Nation

No progress addressing low birthweight, with widespread disparities

LOW B I RT H W E I G H T

higher among Black (13.7%)than White (7.0%)

higher in Mississippi (11.6%)than Alaska (6.2%)


1.9x

2.0x


higher among black (13.7%)than white (7.0%) women

higher in Mississippi (11.6%)than Alaska (6.2%)



Disparities and geographic variation The percentage of mothers with a low birthweight infant differs by maternal age group, race/ethnicity, education (Figure 34) and across states. The percentage

Figure 34Low birthweight by subpopulation

PERCENTAGE OF LIVE BIRTHS0 5 10 15

Overall

Ages 15-19

Ages 20-24

Ages 25-29

Ages 30-34

Ages 35-39

Ages 40-44

Black/African American*

Hispanic

White*

Less Than High School

High School Graduate

Some College

College Graduate

* Non-Hispanic

of mothers with low birthweight babies is 1.4 times higher among mothers ages 40-44 (10.9 percent) than younger mothers (mothers ages 25-29 and 30-34, both 7.7 percent).

Challenges


Challenges

Child mortality up with disparities across states and by age group, gender and race/ethnicity

Child mortality increased 6 percent since 2016 from 24.3 to 25.7 deaths per 100,000 children (Figure 35). Eight states experienced significant increases since 2016 (Figure 36), notably Alaska with a 37 percent increase (33.1 to 45.4 deaths per 100,000).

According to Child Trends, child mortality had been declining since 1980, with rates among children ages 1-4 and 5-14 declining until 2017. Death rates for teens ages 15-19 declined from 1980 to 2013. CDC’s Division of Vital Statistics reported there were 20,337 deaths among children ages 1-19 in 2017. Among children and adolescents, motor vehicle crashes are the leading cause of death, followed by firearm-related injuries and cancer, according to a recent study.18

Figure 35Child mortality, 2016-2019

DEFINITION

Age-adjusted number of deaths per 100,000 children ages 1-19 (3-year estimate)

State Nation

Child mortality, teen suicide and drug deaths among women of reproductive age up

M O RTA L I T Y R AT E S

DEA

THS

PER

10

0,0

00

CH

ILD

REN

AG

ES 1

–19

higher among American Indian/Alaska Native (46.9 deaths per 100,000) than Asian (15.4) children

higher in Alaska (45.4 deaths per 100,000)than Connecticut (16.3)

C H I L D M O RTA L I T Y

2.8x

3.0x




Figure 36States with increases in child mortality between 2016 and 2019

0 10 20 30 40 50 60

DEATHS PER 100,000 CHILDREN AGES 1–19

Alaska

Florida

Georgia

Illinois

Kentucky

Missouri

Ohio

South Carolina

United States

2016 2019

37%

8%

12%

10%

15%

14%

16%

15%

6%

Increase since 2016

ChallengesM O RTA L I T Y R AT E S


Challenges

Figure 37Child mortality by subpopulation

Disparities and geographic variationChild mortality rates differ significantly by age group, gender and race/ethnicity (Figure 37) as well as across states. Child mortality rates are 3.8 times higher among children ages 15-19 (50.3 deaths per 100,000) than children ages 5-14 (13.4). Figure 38 shows this disparity has grown. Since 2016, there was no significant change in the rate among children ages 1-4, a 5 percent increase among children ages 5-14 (12.8 to 13.4 deaths per 100,000) and a 10 percent increase among children ages 15-19 (45.8 to 50.3 deaths per 100,000). The child mortality rate is 1.8 times higher among males than females. Both experienced significant increases since 2016, males from 30.7 to 32.6 deaths per 100,000 and females from 17.5 to 18.5 deaths per 100,000. Since 2016, child mortality increased 5 percent among white (23.5 to 24.6 deaths per 100,000) and Hispanic children (19.7 to 20.6 deaths per 100,000), and 11 percent among black children (36.1 to 40.0 deaths per 100,000) (Figure 39). Increases among Asian and American Indian/Alaska Native children were not significant due to large confidence intervals.

Overall

Female

Male

Ages 1-4

Ages 5-14

Ages 15-19


Asian*


Hispanic

White*

DEATHS PER 100,000 CHILDREN AGES 1–190 10 20 30 40 50


Figure 38Child mortality by age group, 2016-2019

DEA

THS

PER

100

,00

0 A

GES

1-1

9 50

40

30

20

10

0

2016 2017 2018 2019

2016 2017 2018 2019EDITION YEAR

Ages 1-4

Ages 5-14

Ages 15-19

Figure 39Child mortality by race/ethnicity, 2016-2019

DEA

THS

PER

100

,00

0 A

GES

1-1

9 50

40

30

20

10

0



White*Hispanic

Asian*

EDITION YEAR

* Non-Hispanic

* Non-Hispanic


Figure 40Teen suicide, 2016-2019

Teen suicide up with large disparities across states and by gender and race/ethnicity

Teen suicide increased 25 percent since 2016 from 8.4 to 10.5 deaths per 100,000 teens ages 15-19 (Figure 40). Since 2016, significant increases occurred in seven states (Figure 41). The largest increase occurred in Colorado, increasing 58 percent.

According to CDC’s Division of Violence Prevention, suicide was the second leading cause of death among teens ages 15-19 in 2016. Far more adolescents have suicidal thoughts or attempt suicide and survive than those who die by suicide. Results from the 2017 Youth Behavioral Risk Factor Surveillance System show that in the past year 17.2 percent of high school students seriously considered attempting suicide and 7.4 percent attempted suicide.

DEFINITION

Number of deaths by suicide per 100,000 adolescents ages 15-19 (3-year estimate)

State Nation

higher among American Indian/Alaska Native (30.0 deaths per 100,000) than black (6.7) teens

higher in Alaska (35.7 deaths per 100,000)than Rhode Island (4.9)

T E E N S U I C I D E R AT E

7.3x

4.5x


DEA

THS

PER

10

0,0

00

AD

OLE

SCEN

TS

AG

ES 1

5–19





Figure 41States with increases in teen suicide between 2016 and 2019

0 5 10 15 20 25DEATHS PER 100,000 ADOLESCENTS AGES 15–19

California

Colorado

Georgia

Illinois

Missouri

Ohio

Texas

United States

2016 2019

34%

58%

40%

49%

54%

46%

28%

25%

Increase since 2016


Figure 42Teen suicide by subpopulation

Disparities and geographic variationTeen suicide varies by gender, race/ethnicity (Figure 42) and across states. Teen suicide is 3.1 times higher among males (15.7 deaths per 100,000 teens) than females (5.1 deaths per 100,000 teens). Both significantly increased since 2016, with females increasing 28 percent (4.0 to 5.1 deaths per 100,000 teens) and males increasing 24 percent (12.7 to 15.7 deaths per 100,000 teens) (Figure 43). Teen suicide also increased significantly since 2016 among Hispanic (30 percent increase from 5.6 to 7.3 deaths per 100,000), black (46 percent increase from 4.6 to 6.7 deaths per 100,000) and white (37 percent increase from 9.3 to 12.7 deaths per 100,000) teens.

Overall

Female

Male


Asian/Pacific Islander*


Hispanic

White*

DEATHS PER 100,000 ADOLESCENTS AGES 15–190 10 20 30

Figure 43Teen suicide by gender, 2016-2019

DEA

THS

PER

100

,00

0 A

DO

LESC

ENTS

AG

ES 1

5-19

20

15

10

5

0

2016 2017 2018 2019EDITION YEAR

Female

Male

* Non-Hispanic



Challenges

Drug deaths up among females, disparities across states and by age group and race/ethnicity

Drug deaths increased 36 percent since 2016 from 12.0 to 16.3 deaths per 100,000 females ages 15-44 (Figure 44). During this time, drug deaths increased significantly in 27 states, shown in blue in Figure 45.

According to the U.S. Drug Enforcement Administration’s 2018 National Drug Threat Report, drug overdose deaths have risen steadily in the United States over the past two decades and have become a leading cause of injury death. The alarming rise is fueled largely by an epidemic of opioid overdoses, accounting for nearly seven in 10 drug overdose deaths in 2017, reports CDC. According to the American College of Obstetricians and Gynecologists, drug use during pregnancy can result in the child developing neonatal abstinence syndrome as well as placental growth issues, preterm labor, miscarriage and stillbirths.

Figure 44Drug deaths among females, 2016-2019

DEFINITION

Age-adjusted number of deaths due to drug injury (unintentional, suicide, homicide or undetermined) per 100,000 females ages 15-44 (3-year estimate)


State Nation

DEA

THS

PER

10

0,0

00

FEM

ALE

S A

GES

15-

44

Figure 45Map of states with increases in drug deaths among females between 2016 and 2019

no significant change significant increase


Disparities and geographic variation The drug death rate among women of reproductive age varies by age group, race/ethnicity (Figure 46) and across states. The rate is 3.3 times higher among females ages 35-44 (23.0 deaths per 100,000) than females ages 15-24 (6.9). The differences in drug death rates by race/ethnicity have increased since 2016 (Figure 47). Since 2016, drug deaths increased 69 percent among black (6.1 to 10.3 deaths per 100,000), 64 percent among white (14.1 to 23.1) and 31 percent among Hispanic (4.5 to 5.9) females.

Figure 47Drug deaths among females by race/ethnicity, 2016-2019

DEA

THS

PER

100

,00

0 A

GES

15-

44

25

20

15

10

5

02016 2017 2018 2019

EDITION YEAR

White*


Hispanic

Figure 46Drug deaths among females by subpopulation

Overall

Ages 15-24

Ages 25-34

Ages 35-44


Hispanic

White*

DEATHS PER 100,000 FEMALES AGES 15–440 5 10 15 20 25

* Non-Hispanic

* Non-Hispanic


higher among white (23.1 deaths per 100,000)than Hispanic (5.9) females

higher in West Virginia (51.3 deaths per 100,000) than Hawaii (5.3)

D RU G D E AT H R AT E among females ages 15–44

9.7x

3.9x



Maternal mortality a national concern

The United States has the highest maternal mortality rate of all developed countries and is the only industrialized nation with a rising rate.19 According to CDC’s Pregnancy Mortality Surveillance System, maternal mortality has increased dramatically in the United States since 1987, when surveillance was first implemented.

Nationally, the maternal mortality rate is 29.6 deaths per 100,000 live births. The estimates provided in this report are calculated using death certificate data. Estimates of maternal mortality released directly from states may differ.

DEFINITION

Number of deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within one year of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 births (5-year estimate)

Figure 48Maternal mortality by subpopulation

Overall

Ages 15-24

Ages 25-34

Ages 35-44


Asian/Pacific Islander*


Hispanic

White*

DEATHS PER 100,000 LIVE BIRTHS0 10 20 30 40 50 60 70 * Non-Hispanic

Disparities and geographic variation Large differences in maternal mortality rates exist by race/ethnicity, maternal age group (Figure 48) and across states. Maternal mortality is 3.2 times higher among mothers ages 35-44 (51.5 deaths per 100,000 live births) than mothers ages 15-24 (15.9), 3.8 times higher among black (63.8) than Asian/Pacific Islander (17.0) mothers and 5.8 times higher in Louisiana (72.0) than Alaska (12.4).


higher among black (63.8 deaths per 100,000 live births)than Asian/Pacific Islander (17.0) mothers

higher in Louisiana (72.0 deaths per 100,000 live births)than Alaska (12.4) mothers

M AT E R N A L M O RTA L I T Y

5.8x

3.8x


State Summaries



2019RANK State

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

45313749

710

521

394014222635102544471612

229

65037272846

38

3413

301532482023

1362341

4394

1817

421933

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal


U N I T E D H E A LT H F O U N DAT I O N | A M E R I C A’S H E A LT H R A N K I N G S ® H E A LT H O F W O M E N A N D C H I L D R E N R E P O R T 2 0 19

State Score US ScoreRating State Rank

SUMMARY

Least Healthy State Most Healthy State

OVERALLRANK:

2016 2018 2019

WomenInfantsChildrenOverall

Strengths:• Low prevalence of excessive drinking

among women• Low cost of infant child care• High percentage of high school

graduation

Challenges: • High prevalence of diabetes among

women• High infant mortality rate• High prevalence of 2+ adverse

childhood experiences

State Health Department Website: alabamapublichealth.gov

Highlights: • In the past year, the percentage of infants

exclusively breastfed for six months increased 58% from 13.0% to 20.6%

• In the past year, HPV immunization among males ages 13-17 increased 36% from 24.7% to 33.7%

• In the past year, immunizations among children ages 19-35 months decreased 8% from 77.3% to 71.2%

• In the past three years, chlamydia decreased 19% from 2,103.1 to 1,696.7 cases per 100,000 females ages 15-44

• In the past three years, excessive drinking among women ages 18-44 increased 30% from 11.3% to 14.7%

• In the past three years, tobacco use during pregnancy decreased 11% from 10.8% to 9.6% of live births

45

Annual Report Rank: 48Senior Report Rank: 44

AlabamaA

LAB

AM

A

42433042

44134440

30442

30

37444143

44492646

42473345

++++++

++++++++

++++++++++++

+++++

++++++

+++++

Community & Environment

Behaviors

Clinical Care

Outcomes

Overall

Policy

34 43 4247 48 4734 30 3344 46 45


WOMEN

INFANTS

* Measure not included in ranking calculation due to missing data in several states

NA = Data unavailable

To explore supplemental measures, visit www.AmericasHealthRankings.org

High School Graduation (% of students)Overweight or Obesity (% ages 10–17)

Substance Use Disorder (% ages 12–17)Tobacco Use (% ages 12–17)

Adverse Childhood Experiences (% ages 0–17)Neighborhood Amenities (% ages 0–17)

Protective Family Routines and Habits (% ages 0–17)Supportive Neighborhoods (% ages 0–17)

Adequate Health Insurance (% of insured ages 0–17)Children With Health Insurance (% ages 0–17)

Homeless Family Households (number per 10,000)Water Fluoridation (% served)

Adolescent Well-Visit (% ages 12–17)Developmental Screening (% ages 9 months–5 years)

Immunizations—Adolescents (mean z score)HPV Female (% ages 13–17)

HPV Male (% ages 13–17)Meningococcal (% ages 13–17)

Tdap (% ages 13–17)Immunizations—Children (% ages 19–35 months)

Medical Home for Child With Special Health Care Needs (% ages 0–17)

Child Mortality (deaths per 100,000 ages 1–19)Missed School Days (% ages 6–17)

Teen Births (births per 1,000 ages 15–19)Teen Suicide (deaths per 100,000 ages 15–19)

91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9

2019 2019 No. 1Rating Value Rank State



Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes

Chlamydia (cases per 100,000 ages 15–44)Excessive Drinking (% ages 18–44)

Obesity (% ages 18–44)Physical Inactivity (% ages 18–44)

Smoking (% ages 18–44)

Concentrated Disadvantage (% of households)Food Insecurity (% of households)

Intimate Partner Violence—Lifetime (% ages 18+)Intimate Partner Violence—Pregnancy

(% with a recent live birth)

Postpartum Visit (% with a recent live birth)Publicly-Funded Women’s Health Services (% of need met)

Uninsured (% ages 19–44)

Cervical Cancer Screening (% ages 21–44)Dedicated Health Care Provider (% ages 18–44)

Dental Visit (% ages 18–44)Flu Vaccination (% ages 18–44)

Well-Woman Visit (% ages 18–44)

Diabetes (% ages 18–44)Drug Deaths (deaths per 100,000 ages 15–44)

Maternal Mortality (deaths per 100,000 live births)Postpartum Depression (% with a recent live birth)Unintended Pregnancy (% with a recent live birth)

Breastfed (% of infants)Drinking Before Pregnancy (% with a recent live birth)

Sleep Position (% with a recent live birth)Tobacco Use During Pregnancy (% of live births)

Household Smoke (% ages 0–17)Infant Child Care Cost (% of married couple’s median income)

Baby-Friendly Facility (% of live births) mPINC (Maternity Practices in Infant

and Nutrition Care survey score)

Low-Risk Cesarean Delivery (% of singleton, term, vertex, first births)

Prenatal Care Before Third Trimester (% of live births)Well-Baby Check (% ages 0–2)

Infant Mortality (deaths per 1,000 live births) Low Birthweight (% of live births)

Neonatal Mortality (deaths per 1,000 live births)Preterm Birth (% of live births)

42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,696.714.736.126.623.1

30.416.337.53.7

88.731

15.0

80.873.163.429.865.8

5.316.034.519.940.0

20.652.972.19.6

21.57.6

16.572

28.2

92.581.1

8.7

10.34.912.0

345

484443

424627

1239

2726404329

502139

45

28

443

3246

40

4232

49484747

7431744

46483029

2207

23

373739384238302143

451

4210

89.334.34.07.9

26.319.512.157.1

81.295.52.3

78.6

76.326.6

-0.54747.233.778.388.771.240.1

36.31.8

27.09.1

ALABAMA

++++++++++

+++++

++++++

++++++++++++

++++++

+

+++

++++++

+++

++

+++

++++

+++++++++++

++++++++

+++++++++++++++++

++++++++++++++++++

++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low maternal mortality rate• Low prevalence of low birthweight • Low prevalence of overweight or

obesity among children

Challenges: • High incidence of chlamydia among

females• Low prevalence of well-baby visits• High child mortality rate

State Health Department Website: dhss.alaska.gov



• In the past year, teen births decreased 25% from 29.3 to 22.0 births per 1,000 females ages 15-19

• In the past year, tobacco use during pregnancy decreased 14% from 12.5% to 10.7% of live births

• In the past three years, child mortality increased 37% from 33.1 to 45.4 deaths per 100,000 children ages 1-19

• In the past three years, obesity among women ages 18-44 increased 24% from 26.8% to 33.1%

• In the past three years, teen suicide increased 18% from 30.3 to 35.7 deaths per 100,000 adolescents ages 15-19

31


AlaskaA

LAS

KA

455

5039

2911

3026

16344734

41194640

38

4924

30144831

+++++++++

+++++++++++++

+++++++++

++++++++

++++++++++++++

++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

31 34 304 10 1447 49 4828 33 31


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

2,497.421.033.118.019.3

13.911.643.32.9

87.66316.7

81.769.069.031.252.7

2.317.112.413.427.1

42.157.280.010.7

14.211.9

3.482

19.2

94.278.2

6.16.23.29.0

5034431233

192248

142

1643213849

7261

1

31

1522

4913

5

2344

2611114

465

5048

3435437

8484743

506

50403348503217

50353550

ALASKA

++++++++++

++++++++

++++++

+++++++++++

+++++++++++++

+++++

++

+++++++

+++++

+++++

++++

++++++++++++++++

++++++++

+++++++++++

++++++++

+++++++++++++++++++

++++++

78.225.06.58.7

24.131.818.353.6

78.591.011.549.3

67.942.3

-1.53845.739.868.478.969.547.3

45.44.2

22.035.7

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low prevalence of diabetes among

women• Low percentage of low-risk cesarean

deliveries• Low prevalence of tobacco use among

adolescents

Challenges: • Low prevalence of women with a

dedicated health care provider• Low percentage of prenatal care

before third trimester• Low prevalence of supportive

neighborhoods

State Health Department Website: azdhs.gov

Highlights: • In the past year, HPV immunization

among females ages 13-17 increased 24% from 46.6% to 57.9%


• In the past year, substance use disorder among youth decreased 14% from 5.6% to 4.8%

• In the past three years, flu vaccination among women ages 18-44 increased 16% from 25.3% to 29.4%

• In the past three years, tobacco use among youth ages 12-17 decreased 47% from 6.8% to 3.6%


37


ArizonaA

RIZ

ON

A

910229

46224745

42354747

46414447

14153821

36274737

++++++++++++++++++

++++++

+++++

++++

+++++++++++++

++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

38 36 3620 31 2749 44 4743 39 37


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,747.416.126.919.412.0

34.313.142.6NA

NA15

13.3

77.666.058.929.461.0

2.316.027.3NANA

26.3NANA4.8 ‘

13.813.9

6.879

20.6

91.079.3

5.47.53.69.3

377

23206

473347

4636

4244484541

72129

24

10

1137

4726

7

4739

16151817

489

403

48313249

35472638

463135172028474446

25443528

78.025.54.83.6

27.333.212.045.3

72.191.24.857.8

71.229.2

-0.40257.948.483.882.466.536.6

26.74.6

22.013.0

ARIZONA

+++++++++++++++++++

++++

+++

+++++

+++++++++++

+++

+++++

++++++

++++

+++++

+++

++++++++++++++++

+++++++++++++

++++++

++++++++

+++++++++++++++++++

+++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



among women• Low cost of infant child care• Low prevalence of homeless family

households


women• High prevalence of tobacco use during

pregnancy• High teen birth rate

State Health Department Website: healthy.arkansas.gov



• In the past year, HPV immunization among males ages 13-17 decreased 28% from 33.6% to 24.3%


• In the past three years, the percentage of infants exclusively breastfed for six months increased 48% from 13.8% to 20.4%

• In the past three years, meningococcal immunization among children ages 13-17 increased 42% from 64.8% to 91.7%

• In the past year, teen suicide increased 30% from 11.0 to 14.3 deaths per 100,000 adolescents ages 15-19

49


ArkansasA

RK

AN

SA

S

49472549

47384346

24491336

42483348

48464749

48493849

++++++

+++++

++++++++++

+++++

++++

+++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

46 48 4849 47 4944 38 3849 49 49


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

2,068.717.440.229.328.6

24.017.440.84.4

85.82911.6

78.073.560.336.360.1

5.015.744.521.032.4

20.448.891.913.7

26.19.7

21.767

26.6

90.076.2

7.99.34.611.4

4612504949

344941

1726

4024452242

492046

46

43

508

2149

34

4848

47424245

14272141

47393533

6355

32

442223394911113437

44345037

88.030.24.17.5

27.128.011.855.9

78.993.91.9

70.3

73.035.20.12746.624.391.792.469.442.3

35.24.1

32.814.3

ARKANSAS

++++++++

++++

+++++++

++++++++++

++++++

+

+

++++++

++++

++

++

++++

+++++++++++

+++++++

++++++++++++++

++++++++++++++++++++++

++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low prevalence of smoking among

women• Low prevalence of tobacco use during

pregnancy• Low prevalence of 2+ adverse



dedicated health care provider• High cost of infant child care• Low prevalence of supportive

neighborhoods

State Health Department Website: cdph.ca.gov


among males ages 13-17 increased 15% from 40.3% to 46.3%



• In the past three years, food insecurity decreased 17% from 13.5% to 11.2% of households

• In the past three years, infant child care cost increased 29% from 14.4% to 18.6% of married couple’s median income


7


CaliforniaC

ALI

FOR

NIA

33214

26341124

26223

36223734

2481

75187

++++++++++++++++++

++++++++++++

++++++++++++++++++

+++++++++

++++++++++++++++++++

+++++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

12 10 75 2 522 21 1810 7 7


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,483.618.223.418.57.8

31.411.234.9NA

87.5509.3

79.670.866.933.564.2

2.46.517.613.031.2

26.3NA79.71.4

11.118.6

44.885

24.4

96.279.0

4.36.92.98.7

18159152

441816

319

3638313232

1037

24

1

250

87

24

742

4856

3430342

13

3244

9234234

384834132534443939

728167

82.730.74.63.5

14.855.412.051.2

78.195.37.5

63.7

76.222.2

-0.35560.946.382.283.568.642.2

19.93.815.17.1

CALIFORNIA

++++++++++++++++++++++

+++++++++

+++++++++

++++++++++

+++++++++++++++

+++

+++++

++++++

++++++++++

+++

++++++

++++++++++++++++++++

++++++++++++

+++++++++++++

+++++++++++

+++++++++++++++++++

+++++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low prevalence of food insecurity• Low neonatal mortality rate• High prevalence of neighborhood

amenities

Challenges: • High prevalence of excessive drinking

among women• High cost of infant child care• High teen suicide rate

State Health Department Website: colorado.gov/cdphe



• In the past year, the percentage of infants exclusively breastfed for six months decreased 37% from 35.3% to 22.4%

• In the past three years, dedicated health care provider among women ages 18-44 decreased 6% from 74.5% to 69.8%


• In the past three years, smoking among women ages 18-44 decreased 20% from 18.4% to 14.7%


10


ColoradoC

OLO

RA

DO

8294124

1042310

105

398

28101516

6133114

8142310

++++++++++++

++++++++++++++++

+++++++++++++++++

++++++++++++++++

+++++++++++++++

+++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

8 7 813 10 1423 22 2314 10 10


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,495.823.220.816.514.7

12.79.2

36.81.5

91.73810.1

80.969.869.541.559.1

2.015.321.911.4

30.0

22.465.987.86.1

14.216.1

48.985

21.6

94.085.3

4.79.13.18.8

19402816

144

23

723

2640198

44

41915

38

16

1447

67

10

2513

83998

45154614

2016

25

46294127

213

25268

33312322

22221945

79.127.55.64.7

20.159.217.758.2

68.594.97.2

74.0

80.749.9

0.04553.154.482.488.671.046.2

26.03.716.120.4

COLORADO

++++++++++++++++++++

++++++++++++

++++++++

+++++++++++++++

+++++++++++++

++

++++

+++++

++++++++++

+++++

+++++++

+++++++++++++++++

++++++++++

+++++++++++++++++

++++++++

+++++++++++++++++++++++++++++

+++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• High flu vaccination coverage among

women• High prevalence of well-baby visits• Low child mortality rate

Challenges: • High drug death rate among women• High percentage of low-risk cesarean

deliveries• Low prevalence of children with

adequate health insurance

State Health Department Website: portal.ct.gov/dph



• In the past year, HPV immunization among females ages 13-17 increased 12% from 56.9% to 63.5%



• In the past three years, drug deaths increased 66% from 11.6 to 19.3 deaths per 100,000 females ages 15-44


5


ConnecticutC

ON

NE

CT

ICU

T

61657

25152218

5894

2634

191648

5625

+++++++++++++++++++

++++++++++++++

++++++++++++++++++++

++++++++++++++++++++

++++++++++++++++++

++++++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

6 6 514 13 62 2 24 6 5


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,359.920.521.621.113.2

18.812.237.71.7

93.8387.1

83.480.678.841.770.3

2.819.319.012.723.4

23.657.579.64.5

13.912.6

46.383

28.2

96.790.1

5.28.13.39.5

10295

2410

242630

78

71127

10

23348

35

7

1231

7

10

40

33

12221221

157

348

12163823

374

3915

9163713241010

12736

87.925.34.64.1

18.339.611.758.7

71.998.16.3

89.5

85.836.91.20863.552.794.994.975.349.8

16.33.88.86.7

CONNECTICUT

+++++++++++++++++++++

+++++++++

++++++++++

++++++++++++++++++++++++

++++++++++

++

+++++

++++++

++++++++++

++

++++++++++

++++++++++++++

++++++++++++++++

+++++++++++++

+++++++++++++

+++++++++++++++++++++++++++++++++++++++++++

++++++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• High prevalence of well-woman visits• High percentage of births at baby-

friendly facilities• Low prevalence of tobacco use among

adolescents

Challenges: • High prevalence of physical inactivity

among women• High infant mortality rate• Low prevalence of supportive

neighborhoods

State Health Department Website: dhss.delaware.gov



• In the past year, chlamydia increased 18% from 1,679.0 to 1,987.1 cases per 100,000 females ages 15-44

• In the past year, the percentage of infants exclusively breastfed for six months increased 15% from 20.5% to 23.6%

• In the past three years, dedicated health care provider among women ages 18-44 decreased 10% from 84.9% to 76.8%



21


DelawareD

ELA

WA

RE

47371337

23153528

152162

2314711

23441935

26161721

+++++++++

++++++++++++

++++++++++++++++++

++++++++++++++++

++++++++++

++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

20 21 2627 26 1618 13 1722 20 21


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,987.120.928.329.517.8

21.211.1

37.6NA

86.9308.1

77.676.866.337.073.0

2.427.716.911.7NA

23.655.597.59.1

16.610.9

88.190

24.9

93.387.4

8.59.04.810.2

4233265026

291728

1514

421934194

10454

35

27

2612

12

26

379

48384429

1924267

27382839

21243419

64211156122665

14382510

86.929.94.34.0

22.029.312.452.5

75.195.25.387.1

86.924.8

0.59859.656.790.589.677.151.7

23.54.418.59.1

DELAWARE

++++++++++

++++++++++

++++++++

++++++++++++++++

+++++++++++

++

+++

+++++++

++++++++++

+++

+++++++

+++++++

+++++++++++++++

++++++++++

++++++++++++

++++++++++++++++++++++++++++++++++++

++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



among women• Low prevalence of tobacco use during

pregnancy• High immunization coverage among

children

Challenges: • Low flu vaccination coverage among

women• High percentage of low-risk cesarean

deliveries• High prevalence of 2+ adverse


State Health Department Website: floridahealth.gov

Highlights: • In the past year, immunizations among

children ages 19-35 months increased 14% from 67.1% to 76.2%






39


FloridaFL

OR

IDA

18274231

30143730

48273742

45463946

31312330

37343939

++++++++++

++++++++++++

+++++++

+++++

++++++++++

++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

41 38 3736 29 3438 33 3940 34 39


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,655.217.224.326.213.5

27.811.937.9NA

NA17

19.1

77.663.062.727.469.3

3.118.828.1NANA

21.3NANA4.8

14.911.8

17.580

31.0

92.484.0

6.28.84.1

10.2

319124213

402431

4146

4247424915

313132

42

10

2021

3121

50

4318

29342929

38473312

40152846

27463724

165032423435178

49

2937248

82.336.44.54.6

25.339.912.450.4

74.291.65.677.6

81.316.0

-0.22745.339.480.291.176.230.8

27.74.418.28.4

FLORIDA

++++++++++++++++

+++++++

++

++++++++

++++++

+

+++++

+++++++

+++++

+

+++++

+++++++++++

+++++++++

++++++++++

+++++++++

++++++++++++++++++++++

+++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



among women• Low cost of infant child care• Low prevalence of substance use

disorder among adolescents

Challenges: • High percentage of uninsured women• Low percentage of prenatal care

before third trimester• Low percentage of high school

graduation

State Health Department Website: dph.georgia.gov



• In the past year, HPV immunization among females ages 13-17 decreased 19% from 55.4% to 45.0%





40


GeorgiaG

EO

RG

IA

33242429

3784133

49292340

32441935

37473641

43373140

+++++++++++

++++++++++

+++++++++

+++++++++

++++++

+++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

44 42 4348 40 3726 28 3145 37 40


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,997.715.331.725.715.0

33.313.037.41.4

91.016

20.2

81.266.068.429.670.0

2.812.366.312.433.6

22.150.273.94.8

15.410.3

31.175

27.9

91.582.8

7.69.94.811.4

436

394018

463226

4448

2144234412

231449

39

10

219

1337

39

4523

45474445

41381

23

33373542

2445146

3179

442418

5026

34403315

80.632.43.25.5

23.729.311.851.3

74.692.13.2

96.2

78.140.8

0.66245.046.495.393.365.645.5

29.24.521.99.5

GEORGIA

++++++++++++++

++++++

++

++++++++++++

++++++++

++

+++++

++++++++

++++++

++

++++

++++

+++++++++++

+++++++

+++++++++++++

++++++++++++++++++++++++++++++

++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low drug death rate among women• Low prevalence of tobacco use during

pregnancy• Low prevalence of tobacco use among

adolescents


women• High cost of infant child care• High prevalence of homeless family

households

State Health Department Website: health.hawaii.gov

Highlights: • In the past year, the percentage of

infants exclusively breastfed for six months increased 9% from 30.2% to 32.9%

• In the past year, infant mortality increased 14% from 5.1 to 5.8 deaths per 1,000 live births

• In the past year, meningococcal immunization among children ages 13-17 increased 13% from 75.8% to 85.9%




14


HawaiiH

AW

AII

20183

3

35109

14323224

15302624

21271221

9221414

+++++++++++++++++++

+++++++++++++++++

+++++++++++

+++++++++++++

+++++++++++++

++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

10 9 99 19 2213 17 147 13 14


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,615.322.522.822.713.4

13.57.4

34.7NA

NA255.5

79.781.971.535.468.0

3.95.3

22.9NANA

32.9NANA4.0

16.014.3

12.180

20.7

92.979.7

5.88.53.7

10.4

26397

2812

151

14

283

349122519

431

18

7

5

2339

4121

8

4138

21291933

3418131

1141243

12

4850

4210289

2321433129

11102729

82.728.03.93.4

18.255.315.351.3

82.998.419.411.7

74.639.1

-0.05762.747.285.984.869.844.8

22.73.119.113.2

HAWAII

+++++++++++++++++

+++++++++++++

++++++++

++++++++++++++++++

++++++++++

+++++

+++++

+++++

++++

+++++

+++

++++++++++++

+++++++++++++++

++++++++++++++

++++++++++++

++++++++++++++++++++++++++

+++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low prevalence of physical inactivity

among women• Low percentage of low-risk cesarean

deliveries• Low prevalence of overweight or


Challenges: • Low prevalence of well-woman visits• Low percentage of births at baby-

friendly facilities• High teen suicide rate

State Health Department Website: healthandwelfare.idaho.gov



• In the past year, the percentage of infants exclusively breastfed for six months decreased 16% from 33.9% to 28.4%



• In the past three years, Tdap immunization among children ages 13-17 increased 23% from 70.8% to 87.3%


22


IdahoID

AH

O

218269

84196

45354044

475

3436

27102116

29132922

+++++++++++++++++

+++++++++++++++++++

++++++

++++++++++

+++++++++++++++

+++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

29 29 296 5 1336 32 2926 25 22


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,236.917.224.315.914.8

11.611.033.03.1

94.421

16.8

74.770.465.330.152.6

2.913.032.822.427.9

28.448.584.08.8

13.410.5

9.878

18.1

95.881.4

5.37.03.48.8

8912517

11165

3543

4939374150

291637

17

24

910

4327

3

1131

1511138

433

3430

2436163

20323247

404327283912363638

323

2643

79.724.34.66.0

21.129.814.864.5

75.794.25.031.9

75.724.4

-0.03352.136.590.587.369.242.3

28.02.518.619.3

IDAHO

+++++++++++++++++++++++

+++++++++++++

+++

+++++++

+++++++++

++++

+++

++++++++++

++++

+++++

++++++

+++++++++++++++++

+++++++++++

++++++++++++++

+++++++++

+++++++++++++++++++++

+++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• High prevalence of women with a

dedicated health care provider• Low prevalence of tobacco use during

pregnancy• High prevalence of neighborhood

amenities


among women• Low percentage of infants exclusively

breastfed for six months• Low prevalence of children with


State Health Department Website: dph.illinois.gov


infants exclusively breastfed for six months decreased 24% from 25.8% to 19.5%






26


IllinoisIL

LIN

OIS

30402335

32321229

27221723

16281317

24331528

27351326

++++++++++

+++++++++++

+++++++++++++

+++++++++++++++

++++++++++++

++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

28 26 2726 30 358 11 1321 26 26


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,822.823.826.622.113.5

23.011.241.51.3

92.4209.8

83.479.370.032.666.5

3.414.121.49.332.1

19.562.481.56.4

15.514.3

22.381

25.1

94.083.0

6.28.54.410.4

3843222513

321843

3622

713173526

371713

49

18

2239

2019

28

2521

29293533

18293720

95

4224

4410203

191215311415119

35

24192212

87.030.54.75.2

18.153.710.658.2

68.996.54.0

98.5

81.137.4

0.49748.951.889.292.475.443.3

26.53.617.49.4

ILLINOIS

+++++++++++++

+++++++

+++++

++++++++++++++++++

++++++++++

+

++++

+++++

++++++++

+++

++++++

++++++++++

+++++++++++++

++++++++++++++

+++++++++++++++

+++++++++++++++++++++++++++++++++

++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



dedicated health care provider• High percentage of infants exclusively

breastfed for six months• Low prevalence of substance use


Challenges: • High maternal mortality rate• High neonatal mortality rate• Low prevalence of neighborhood

amenities

State Health Department Website: in.gov/isdh






• In the past three years, dedicated health care provider among women ages 18-44 increased 5% from 75.3% to 79.1%


35


IndianaIN

DIA

NA

35281830

39502842

34151826

31282930

47383340

41382635

++++++++++++

+++++++

+++++++++++++

+++++++++++

+++++++

++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

43 41 4133 41 3831 25 2636 35 35


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,642.919.329.924.221.3

20.113.642.5NA

NA1911.7

77.579.167.134.163.8

3.423.850.2NANA

31.7NANA13.5

21.415.2

31.080

23.4

93.781.7

7.48.34.99.8

3023323638

263746

3927

4514293034

374348

9

42

4343

1421

16

3230

43254727

30253

32

2941235

2541108

243313354382

4630

36233922

83.829.93.36.4

22.227.713.063.2

74.693.12.9

94.7

79.729.0

0.57548.433.593.195.166.344.2

30.53.7

22.811.4

INDIANA

++++++++++++

++++++

+++++

+++++++++++++

++++

+++++

+

++

+++++++

++++

+++++

++++++++

+++++++++++++

++++++++++++

++++++++++++++

++++++++++++++++++++++++++

++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



women• Low prevalence of low birthweight • High percentage of high school

graduation


among women• High prevalence of tobacco use during

pregnancy• High teen suicide rate

State Health Department Website: idph.iowa.gov








10


IowaIO

WA

32321122

9

231312

12437

22

413127

49

2912

6251010

+++++++++++

++++++++++++++++

+++++++++++++

++++++++++++++++++

+++++++++++++++++

++++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

7 5 622 22 255 9 108 9 10


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,480.824.331.518.018.2

10.410.535.32.2

94.2296.7

81.981.975.643.467.1

2.19.3

26.57.4

24.2

29.562.886.712.4

17.411.7

8.175

24.0

95.682.2

5.16.63.59.2

1746381227

101218

175

1397422

56

25

12

38

3120

4537

22

1226

1121716

1342417

1526238

13332211

1834145

29306163

21431833

91.031.54.25.0

18.636.113.062.2

77.594.24.1

92.7

81.128.40.51365.542.683.693.472.851.9

25.74.616.013.7

IOWA

++++++++++++++

+++++++++++++

+++++++++

++++++++++++++++++++++

+++++++++++++

++++

++

++++++

+++

+++

+++++++

+++++++++++++++++

++++++++++++++

+++++++++++++++

+++++++++++++

+++++++++++++++++++++++++++++++++++

++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low drug death rate among women• High percentage of prenatal care

before third trimester• Low prevalence of homeless family

households

Challenges: • High prevalence of obesity among


pregnancy• Low HPV immunization coverage

among adolescent females

State Health Department Website: kdheks.gov




• In the past year, preterm birth increased 9% from 8.8% to 9.6% of live births before 37 weeks gestation




25


KansasK

AN

SA

S

29342028

20202117

40172531

3211

4029

11242920

28192725

++++++++++++

+++++++++++++++

+++++++++++

+++++++++++

++++++++++++++

+++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

26 28 2829 23 1919 26 2725 27 25


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,527.119.1

30.822.218.4

13.713.333.92.6

89.417

13.1

78.872.868.335.462.8

2.610.826.612.430.7

26.163.380.210.1

14.713.1

41.176

23.8

96.282.9

6.07.44.19.6

2221352729

16359

4135

3727252535

171026

27

30

1733

1135

18

722

25142925

24352122

22191226

23281235

321144484745253223

29153138

86.531.54.15.4

20.837.415.358.0

74.895.03.0

63.5

77.537.8

-0.92338.530.472.189.769.546.1

27.73.421.314.5

KANSAS

++++++++++++++

+++++++++++

+++

+++++++++++++

++++++++++++

+++

+++

++++++

++++++

++++

++++++++

+++++++++++++

+++++++++++

++++++++++++++

++++++++++++

++++++++++++++++++

+++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low percentage of uninsured women• Low cost of infant child care• High percentage of high school

graduation

Challenges: • High drug death rate among women• High prevalence of tobacco use during

pregnancy• High prevalence of tobacco use

among adolescents

State Health Department Website: chfs.ky.gov/agencies/dph








44


KentuckyK

EN

TU

CK

Y

44493948

48274043

1837521

21404133

49364044

39434044

+++++

+++++++

++++++++++++++

++++++++

++++++

++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

33 36 3935 45 4335 34 4034 42 44


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,417.818.333.326.528.3

28.314.745.32.2

89.3247.1

81.776.968.331.871.6

3.834.932.414.031.8

21.148.783.917.9

23.48.2

24.573

28.3

94.581.9

6.78.83.911.1

1316444348

414350

318

161825377

404834

43

49

484

1943

43

2029

36342341

4487

50

42453914

164091

274740454531382336

38264631

89.737.03.69.6

25.821.711.3

60.0

77.093.22.5

99.9

79.322.2

-0.61744.731.183.386.471.042.5

32.13.8

29.013.4

KENTUCKY

+++++++++++

+++

+++++++

++++++++++++++++++

+++++

+

+

++++++

+++++

+

+++++++

++++++++

++++++++++++

++++++++

++++++++++++++++

+++++++++++++++++

++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• High prevalence of well-woman visits• Low cost of infant child care• Low prevalence of homeless family

households

Challenges: • High maternal mortality rate• High prevalence of low birthweight • High child mortality rate

State Health Department Website: ldh.la.gov

Highlights: • In the past year, teen births decreased

15% from 34.1 to 29.1 births per 1,000 females ages 15-19


• In the past year, infant child care cost increased 30% from 6.6% to 8.6% of married couple’s median income

• In the past three years, flu vaccination among women ages 18-44 decreased 21% from 35.3% to 28.0%



47


LouisianaLO

UIS

IAN

A

50384447

459

4541

37171928

32432839

50484250

50404247

+++++

++++++++

+++++++++++++

++++++++

++++

+++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

49 49 5045 44 4045 45 4248 48 47


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

2,376.520.334.128.825.2

34.617.335.92.9

84.915

11.3

84.372.858.228.070.0

4.819.172.015.244.7

20.253.967.96.5

18.38.6

41.676

30.4

93.980.9

7.810.74.012.7

4927464847

484820

4624

527504812

483250

47

19

375

1035

48

2833

46492549

47321337

39444921

7252

45

3346176

3016232834

47174721

78.130.93.96.9

25.223.37.6

58.9

78.995.21.5

44.2

77.322.3

0.43564.341.989.090.170.043.6

39.13.529.111.3

LOUISIANA

+++++++

++++++

++++

++++++++++++++

++++

+

++++

+++++++

+++++++

+

+++++

++++++

+++++++++

+++++++

++++++++++++++

+++++++++++++++++++++++++++

+++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



dedicated health care provider• High prevalence of well-baby visits• Low teen birth rate




among adolescents

State Health Department Website: maine.gov/dhhs

Highlights: • In the past year, tobacco use during

pregnancy decreased 16% from 15.6% to 13.1% of live births




• In the past three years, teen births decreased 21% from 16.5 to 13.1 births per 1,000 females ages 15-19


16


MaineM

AIN

E

15163220

27171621

21163520

142116

26231823

20122116

++++++++++++++

++++++++++++++

+++++++++++++

++++++++++++++++++

+++++++++++++

+++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

19 27 2012 14 1211 23 2111 21 16


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,186.124.423.716.020.4

7.2

14.439.31.8

93.733

12.0

81.287.564.636.067.9

2.4

24.523.813.423.8

34.170.989.213.1

16.711.2

18.484

23.8

96.490.6

6.27.14.58.7

547106

36

54134

1030

211

392320

104420

5

41

2714

289

18

42

2912396

19203744

3032219

36184421

2202611427421715

13419

30

86.928.84.77.9

22.532.920.259.0

71.995.710.379.3

89.435.7

0.01861.557.083.985.172.747.8

22.94.513.113.3

MAINE

++++++++++++++++++

++++++++

++++++++

+++++++++++++++++

++++++++++

+++++

+

+++++++

++++++++

++++

++++++++++

++++++++++++++

+++++++++++

++++++++++++++

++++++++++

+++++++++++++++++++++++++++++++++

+++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low prevalence of food insecurity• Low prevalence of household smoke• Low prevalence of substance use


Challenges: • High drug death rate among women• High percentage of low-risk cesarean

deliveries• High prevalence of overweight or


State Health Department Website: health.maryland.gov








12


MarylandM

AR

YLA

ND

23151413

151178

2023311

123369

34371433

1726512

+++++++++++++++

++++++++++++++++++

++++++++++++++++

++++++++++++++++

++++++++++

++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

21 16 1741 37 267 4 523 16 12


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,634.619.028.423.612.4

16.810.434.42.9

90.2258.3

81.779.869.039.670.7

3.3

22.925.012.431.5

26.251.878.25.5

12.912.7

18.282

28.2

93.187.5

6.68.94.510.5

272028328

211113

2815

161221119

343922

26

13

8

32

3013

40

398

35373936

1644511

3121034

1215265

5171818201033112

1945115

87.734.83.44.5

15.644.116.055.8

77.695.94.8

96.4

87.136.6

0.38057.548.491.888.375.253.4

25.24.714.26.5

MARYLAND

+++++++++++++++++

+++++++++++

+++++++

++++++++++++++++++++

+++++++

+++

++++

+++++++

+++++++

++

+++++++

++++++++

++++++++++++++

++++++++++++++++

++++++++++++++++

+++++++++++++++++++++++++++++++++++++

++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low maternal mortality rate• High prevalence of well-baby visits• Low teen birth rate


among women• High cost of infant child care• High prevalence of homeless family

households

State Health Department Website: mass.gov/orgs/department-of-public-health




• In the past year, tobacco use among youth ages 12-17 decreased 10% from 4.8% to 4.3%



• In the past three years, chlamydia increased 23% from 1,002.0 to 1,229.1 cases per 100,000 females ages 15-44

1


MassachusettsM

AS

SA

CH

US

ET

TS

4842

1331511

69

4312

3712

12522

3712

++++++++++++++++++++

+++++++++++++++

+++++++++++++++

++++++++++++++++++++

+++++++++++++++++++

++++++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

1 1 37 7 71 1 11 1 2


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,229.124.918.519.011.9

17.510.233.91.5

92.4253.3

81.085.476.440.573.9

2.5

22.213.710.822.9

26.663.283.74.7

11.416.8

19.087

25.7

95.090.7

4.17.52.78.9

7481

195

22109

281

2545102

14382

22

9

649

265

31

171

315311

12112610

471831

385

4931

191424114

32014

88.326.34.34.3

15.751.014.456.9

71.997.725.170.4

90.939.21.51867.463.794.096.282.151.8

17.43.68.16.4

MASSACHUSETTS

++++++++++++++++++++

+++++++++++++

++++++++

+++++++++++++++++++++++

+++++++++++

+++

+++++

++++++

++++++++

++

+++++++++

++++++++++++++++++

++++++++++++++++

++++++++++++++++

++++++++++

+++++++++++++++++++++++++++++++++++++++++++++

+++++++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low percentage of uninsured women• High prevalence of well-baby visits• High immunization coverage among

adolescents

Challenges: • High drug death rate among women• High prevalence of household smoke• Low percentage of high school

graduation

State Health Department Website: michigan.gov/mdhhs








29


MichiganM

ICH

IGA

N

39423241

28402931

2523816

17171012

32352734

31362229

++++++

++++++++++

+++++++++++++++

+++++++++++++++++

+++++++++

++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

32 31 3142 36 3624 24 2232 29 29


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,636.522.430.523.019.7

22.513.636.12.0

91.3166.7

80.082.771.332.268.6

2.723.627.612.930.2

23.962.583.311.3

19.712.3

30.378

26.6

95.185.1

6.58.84.410.2

2838343135

313721

445

316133617

194230

33

35

4028

1627

34

1614

33343529

42391323

28182727

29171913

15255141956

299

28362125

80.232.53.95.5

22.037.612.558.0

74.095.83.891.7

81.333.2

0.90860.448.593.593.469.949.9

27.44.316.412.4

MICHIGAN

+++++++++++

+++++++

++++++

+++++++++++++++++

++++++++

++

++

+++++

+++++++

++

++++++++

+++++++++

++++++++++

+++++++++++++

+++++++++++++++

++++++++++++++++++++++++++++++++++++++

+++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



women• Low prevalence of low birthweight • High prevalence of supportive

neighborhoods


among women• High cost of infant child care• Low prevalence of children with


State Health Department Website: health.state.mn.us




• In the past year, immunizations among children ages 19-35 months decreased 10% from 73.8% to 66.1%




6


MinnesotaM

INN

ES

OTA

132176

5

3517

8102710

10142212

1763

11076

++++++++++++++++++

+++++++++++++++++

++++++++++++++++++

++++++++++++++++

++++++++++++++++++++

++++++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

2 3 110 10 106 6 75 5 6


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,388.224.023.817.315.1

8.49.5

33.90.0

93.0295.4

81.171.175.744.169.6

1.911.217.311.419.8

37.266.496.38.1

14.115.5

30.682

23.4

96.279.7

5.26.73.48.9

114511919

769

172

23366314

2116

3

21

1346

1513

16

737

1241311

34102620

6974

4813402

362

2933271934486

1087

27

82.726.24.35.2

17.247.617.363.2

67.696.17.0

98.8

76.551.3

-0.06548.645.487.587.566.151.5

21.53.012.112.8

MINNESOTA

++++++++++++++++++

+++++++++++++++

+++++++++

+++++++++++++++++++

++++++++++++++

+++++

+++

+++++

++++++++

++++

+++++++

+++++++++++++++++

++++++++++++++

++++++++++++++++++++

++++++++++++

+++++++++++++++++++++++++++

++++++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



among women• Low cost of infant child care• High prevalence of children with


Challenges: • High percentage of uninsured women• Low percentage of infants exclusively

breastfed for six months• High prevalence of overweight or


State Health Department Website: msdh.ms.gov






• In the past three years, Tdap immunization among children ages 13-17 increased 31% from 70.8% to 92.4%

• In the past three years, physical inactivity among women ages 18-44 decreased 20% from 34.4% to 27.6%

50


MississippiM

ISS

ISS

IPP

I

48484750

50185050

43501346

27465044

29504848

47504950

++++

+++++++

+++++++

++++++

++++++

++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

50 47 4750 50 5050 50 4950 50 50


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

2,297.512.438.027.624.3

43.517.239.7NA

NA2819.1

85.372.166.628.166.4

3.810.427.2NANA

13.0NANA8.9

24.87.3

12.560

30.8

95.278.0

9.111.65.513.6

483

494646

504737

2246

332324727

409

28

50

25

491

4050

49

1445

50505050

33506

43

41505032

1122337

344946495049113832

48394916

83.039.23.57.6

25.515.36.1

56.3

77.895.31.6

60.0

77.018.6

-1.03334.423.463.092.468.743.8

39.84.431.09.6

MISSISSIPPI

+++++++++

++++

++++

+++++++++++++

++++++++++

+

+++

++++++

+++

+

+++++

++++

+++++++++

+++++

++++++++++++++

+++++++++++++++

++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• High percentage of high school

graduation• High percentage of infants exclusively

breastfed for six months• High flu vaccination coverage among

women

Challenges: • High prevalence of 2+ adverse

childhood experiences• High prevalence of tobacco use during

pregnancy• High maternal mortality rate

State Health Department Website: health.mo.gov

Highlights: • In the past year, meningococcal

immunization among children ages 13-17 increased 12% from 66.2% to 74.3%






37


MissouriM

ISS

OU

RI

42351532

34443339

41392338

35224336

39343236

38393237

+++++++++

+++++++

++++++++

++++++++

++++++++

++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

40 46 3838 39 3929 36 3235 41 37


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,729.021.630.323.922.0

16.612.841.83.9

87.818

13.9

80.171.561.838.264.0

2.921.540.713.934.5

31.361.581.914.5

21.312.0

13.275

23.8

94.482.1

6.58.74.010.6

3636333541

202944

4037

2935441433

293744

10

46

4223

3737

18

2127

33312538

121711

40

44243522

17382526

264148434144482112

4253739

88.327.73.77.3

25.936.211.858.8

76.393.74.676.8

79.425.7

-1.40345.234.274.380.171.248.6

33.32.8

22.514.9

MISSOURI

+++++++++

++++++++

++++

++++++++++++

++++++

+++++

+

++++

++++

++++

++++++

+++++++++

++++++++++++++

+++++++++

++++++++++++

++++++++++++++++

++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



women• High percentage of infants exclusively

breastfed for six months• Low prevalence of overweight or


Challenges: • High maternal mortality rate• High prevalence of tobacco use during


State Health Department Website: dphhs.mt.gov




• In the past year, low birthweight increased 13% from 7.1% to 8.0% of live births




27


MontanaM

ON

TAN

A

13194424

17292722

9134014

25313231

18165032

16184527

++++++++++++

+++++++++++++

+++++++++++++++

+++++++++

+++++++++++

++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

23 17 1624 17 1846 43 4531 28 27


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,548.220.823.015.320.6

8.311.437.2NA

NA41

11.3

81.971.069.837.462.3

1.9

12.940.7NANA

35.7NANA15.0

18.112.0

27.982

23.8

94.080.7

5.88.03.09.5

24318437

6

2025

524

1337181537

21544

4

47

3523

1713

18

2535

2121621

278

4946

4340316

34143346

28837292246214744

46483047

85.825.56.38.3

25.927.918.559.7

72.296.05.1

33.7

79.339.4

-0.41550.148.171.290.466.239.9

36.75.321.224.1

MONTANA

+++++++++++++++++

++++++++++++

++++++++

++++++++++++++++

++++++++++

+++++

+

+++++

++++++++

++++

+++++

++++++++++++++

++++++++++

++++++++++++

+++++++++

++++++++++++++++++++++

++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low drug death rate among women• Low prevalence of low birthweight • High immunization coverage among

children

Challenges: • Low prevalence of well-woman visits• High cost of infant child care• Low prevalence of children with


State Health Department Website: dhhs.ne.gov

Highlights: • In the past year, low birthweight

increased 6% from 7.1% to 7.5% of live births






28


NebraskaN

EB

RA

SK

A

2635719

19472527

36483642

23368

20

5

223718

23411928

++++++++++++++

+++++++++++

++++++

++++++++++++++

++++++++++++++

+++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

22 22 2311 24 4120 15 1917 22 28


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,479.922.129.818.816.4

11.913.533.7NA

NA2012.7

77.177.870.243.362.4

2.76.322.7NANA

25.4NANA9.6

18.014.4

12.871

24.9

94.679.1

5.97.53.79.9

1637311723

12368

3633

4617165

36

19216

29

28

3441

3848

26

1940

23151928

8211717

1633329

40312929

394012127

241451

20472336

89.128.94.05.0

18.932.412.061.9

70.394.54.971.6

76.125.9

0.59761.455.384.892.377.957.0

25.35.018.114.1

NEBRASKA

+++++++++++++++

+++++++++++

++++

++++++++++++++++

+++++++++++++

+++

+++

+++

+++

+++

++++++

++++++++++++++

++++++++++++++++

+++++++++++++

++++++++++

++++++++++++++++++++++++++++++++++

++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low maternal mortality rate• Low prevalence of tobacco use during

pregnancy• Low prevalence of homeless family

households

Challenges: • Low flu vaccination coverage among

women• Low prevalence of well-baby visits• Low prevalence of supportive

neighborhoods

State Health Department Website: dhhs.nv.gov








46


NevadaN

EV

AD

A

20263227

42494649

47383849

49494849

17282825

44444646

++++++++++++

++++

++++++

++++

+++++++++++++

++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

42 44 4440 38 4448 47 4647 45 46


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,668.318.525.225.612.5

27.712.443.8NA

NA10

15.5

77.860.858.826.564.7

3.316.914.0NANA

20.8NANA4.2

17.715.0

16.375

28.6

91.176.0

5.59.13.410.7

331815389

392749

4940

4150495030

34253

44

6

3342

3437

44

4650

17391340

40224112

36134650

41428

28

454443272840462050

33133332

80.929.05.24.6

24.440.89.6

39.8

69.792.62.473.7

71.724.1

-0.79552.945.377.382.571.329.5

28.33.321.913.5

NEVADA

+++++++++++++++++

++++++

+++

+++++++

++++++++++

+

+++++

+++

++++

+

++

++++++++++++

++++++++++

++++++++

++++++++++

+++++++++++++++++

++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low prevalence of food insecurity• Low infant mortality rate• Low teen birth rate

Challenges: • High prevalence of smoking among



among adolescents

State Health Department Website: dhhs.nh.gov








3


New HampshireN

EW

HA

MP

SH

IRE

2022815

21085

163

306

7425

33267

11133

++++++++++++++++

++++++++++++++++++++

+++++++++++++++++

++++++++++++++++++++

+++++++++++++++++

+++++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

11 8 111 1 13 3 33 2 3


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

935.923.825.318.923.2

4.29.434.70.8

95.1298.6

85.885.468.135.967.8

2.333.722.816.219.9

30.274.286.011.3

13.712.0

49.490

25.2

96.389.7

3.96.92.88.3

243161844

4514

1717

14272421

74717

11

35

1023

52

29

54

1842

104

2632

1428518

333

3844

32348517237

6322

24

88.924.44.36.4

18.534.317.859.2

72.298.16.2

46.6

87.535.1

1.00263.056.987.995.178.950.9

19.73.98.411.9

NEW HAMPSHIRE

+++++++++++++++

++++++++++++++

++++++++

+++++++++++++++++++

++++++++++

++++

++

++++++++

++++++++++

+++

++++++++++

++++++++++++++++++++

+++++++++++++++

++++++++++++++++

++++++++++

++++++++++++++++++++++++++++++++++++++++++

+++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low prevalence of food insecurity• Low prevalence of household smoke• Low prevalence of 2+ adverse


Challenges: • High maternal mortality rate• High percentage of low-risk cesarean

deliveries• Low prevalence of children with


State Health Department Website: state.nj.us/health








8


New JerseyN

EW

JE

RS

EY

111225

14264

31194937

9

202014

36121

10

18888

++++++++++++++++++

+++++++++++++++++++

+++++++++

+++++++++++++++++

++++++++++++++++

+++++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

15 20 1830 15 817 10 819 12 8


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,359.617.622.227.811.8

19.98.6

35.82.1

89.42211.8

82.476.278.933.173.3

2.817.346.413.225.3

24.450.775.03.7

11.310.7

18.983

29.3

94.289.2

4.47.93.09.5

9136474

25219

3228

12201

333

232747

30

4

411

2710

47

235

520621

24138

22

4411

43272949

8191625267

243547

3752

90.533.23.34.1

15.655.610.560.2

69.295.04.914.6

86.536.3

0.46553.845.593.390.069.335.2

17.42.910.35.2

NEW JERSEY

++++++++++++++++++++

++++++++++++

+++++

++++++++++++++++++++

+++++++

+++

+++++

+++++++++

++++++++

+

++++++++

+++++++++++++++++

++++++++++++++++

+++++++++++++++

++++++++

++++++++++++++++++++++++++++++

++++++++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



among women• High percentage of births at baby-

friendly facilities• High prevalence of children with


Challenges: • High prevalence of food insecurity• Low percentage of prenatal care

before third trimester• Low percentage of high school

graduation

State Health Department Website: nmhealth.org





• In the past three years, food insecurity increased 46% from 12.3% to 17.9% of households



34


New MexicoN

EW

ME

XIC

O

28124934

49244144

267119

40393138

38324639

40204334

++++++++++

++++++

+++++++++++++++++

++++++++

+++++++

+++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

39 45 4025 20 2040 42 4337 37 34


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

2,294.916.527.920.515.2

41.417.937.61.9

86.628

12.9

81.1

64.964.937.457.7

3.3

23.032.412.932.0

27.650.879.26.3

17.012.0

54.381

18.3

88.580.9

5.69.54.010.3

478

252321

495028

2234

2346381547

344034

20

17

2923

319

4

5034

18442532

50234815

45272548

4372325

121838233039411940

41294546

71.129.66.04.8

26.035.212.750.1

79.793.84.277.0

82.936.5

-0.53855.041.978.085.571.942.1

33.03.927.920.9

NEW MEXICO

+++++++++++++++

+++++

+++++

+++++++++++

++++++

++++

++++

++++++

+++++++++

+++++

+++

++++++++++

+++++++++

++++++++

+++++++++++++

+++++++++++++++++++++++++

++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low prevalence of smoking among

women• Low prevalence of household smoke• Low teen suicide rate

Challenges: • High prevalence of physical inactivity

among women• High cost of infant child care• High prevalence of homeless family

households

State Health Department Website: health.ny.gov



• In the past year, the percentage of baby-friendly facilities increased 67% from 12.9% to 21.6% of live births



• In the past three years, meningococcal immunization among youth ages 13-17 increased 12% from 79.6% to 89.3%


13


New YorkN

EW

YO

RK

17251918

18192316

10203213

17332224

151055

14171513

+++++++++++++++

+++++++++++++++

+++++++++++++++

++++++++++++

+++++++++++++++++++

++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

13 15 1423 28 1727 18 1520 19 13


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,603.720.321.427.011.7

26.710.931.71.7

89.6327.5

78.478.370.536.771.6

2.812.225.513.026.0

21.452.975.34.5

11.215.3

21.682

29.0

95.084.5

4.68.13.09.0

25274

453

38153

1112

381614217

231323

41

7

3

44

2313

46

1717

622614

3933175

58

4440

157

5030

174581616149

4228

53183

81.831.44.03.7

15.747.710.552.4

77.197.235.471.4

81.323.1

0.66858.249.189.392.967.544.8

18.03.912.55.4

NEW YORK

+++++++++++++++++

+++++++++++

++++++++

++++++++++++++++++

++++++++++

+

+++++

++++++

+++++++

+

++++++++

+++++++++++++++++

+++++++++++++

+++++++++++++

+++++++++++++

+++++++++++++++++++++++++++++++

+++++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• High prevalence of well-woman visits• High prevalence of well-baby visits• High prevalence of developmental

screenings


women• High neonatal mortality rate• Low prevalence of neighborhood

amenities

State Health Department Website: ncdhhs.gov



• In the past year, meningococcal immunization among children ages 13-17 increased 12% from 75.7% to 84.8%





30


North CarolinaN

OR

TH

CA

RO

LIN

A

35231626

31283935

44143135

1117139

40431637

34302530

++++++++++++

+++++++++

+++++++++

+++++++++++++++++

+++++++++

+++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

36 33 3431 33 3021 27 2530 30 30


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

2,020.820.032.220.116.9

25.614.435.22.1

92.820

15.9

85.374.466.538.572.7

4.119.227.611.735.1

27.053.179.98.7

18.311.6

37.678

23.2

93.584.5

7.39.44.810.5

4425402124

364117

3641

32233135

453330

21

23

3618

1227

15

3416

41434436

22317

28

32462535

32441818

20419301024152520

2714289

86.630.73.65.9

23.621.212.755.3

72.592.63.587.8

81.044.4

0.33050.053.784.891.970.946.9

27.33.3

20.68.9

NORTH CAROLINA

++++++++++++

+++++++

+++

+++++++++++++++++++

++++++

+++

+++

++++++

+++++++

++++

++++++

+++++

+++++++++++++

++++++++

+++++++++++

+++++++++++++++++++++++++++++++++++

+++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low prevalence of food insecurity• Low prevalence of low birthweight • High prevalence of supportive

neighborhoods


among women• Low prevalence of well-baby visits• Low prevalence of children with


State Health Department Website: ndhealth.gov







• In the past three years, teen suicide decreased 13% from 20.6 to 17.9 deaths per 100,000 adolescents ages 15-19

15


North DakotaN

OR

TH

DA

KO

TA

37312738

1641

23442033

25359

20

8182013

13271115

+++++++++

++++++++++++++++++++

++++++++++

++++++++++++++

+++++++++++++++++

+++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

4 12 1319 25 2725 20 1113 17 15


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,451.226.829.620.119.4

3.19.029.71.7

87.1269.6

79.873.469.442.859.4

2.79.821.79.9

30.8

29.170.483.411.9

16.19.4

13.873

22.2

94.477.8

6.86.73.88.8

1549302134

232

2521

3325206

43

19814

13

37

247

3643

12

2146

374218

17263038

822112

471914

41287

1012918419

269

2042

87.230.04.47.0

17.737.015.567.4

67.795.51.4

96.7

75.431.5

0.73562.653.291.990.678.847.1

27.03.016.217.9

NORTH DAKOTA

+++++++++++++

+++++++++++++++

++++++

+++++++++++++++

+++++++++++++

++++

++

++++++++

+++

++++

++++

+++++++++++++++

++++++++++++

+++++++++++++++++

+++++++++++++++

++++++++++++++++++++++++++++++++++++

+++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• High prevalence of well-woman visits• Low cost of infant child care• High prevalence of supportive

neighborhoods

Challenges: • High drug death rate among women• High neonatal mortality rate• Low immunization coverage among

children

State Health Department Website: odh.ohio.gov

Highlights: • In the past year, meningococcal

immunization among children ages 13-17 increased 10% from 79.6% to 87.3%






32


OhioO

HIO

46463045

34433237

29281127

12262918

42402238

33422832

++++++

+++++++

+++++++++++++

++++++++++++++

++++++++

++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

35 32 3337 42 4228 28 2833 32 32


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,847.421.330.922.823.6

23.213.738.0NA

NA147.5

82.679.173.034.970.3

3.237.224.7NANA

23.7NANA13.8

23.010.9

16.580

24.3

93.783.6

7.38.75.1

10.4

3935363045

333932

4812

1114102810

334921

34

44

4712

3221

23

3220

41314933

28361736

37174213

26301611

292422243520184527

31162919

84.232.44.06.8

25.138.710.660.0

74.694.63.492.7

79.133.30.19254.939.387.390.666.445.1

27.93.4

20.810.8

OHIO

++++++++++

++++++

+++++

+++++++++++++++++++++

++++++

++

+

+++++

+++++

+++

++++++

++++++

+++++++++++

+++++++++++

++++++++++++++

++++++++++++++++++++++++++

+++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019




households

Challenges: • High percentage of uninsured women• High prevalence of household smoke• High prevalence of 2+ adverse


State Health Department Website: ok.gov/health

Highlights: • In the past year, preterm birth increased

8% from 10.3% to 11.1% of live births before 37 weeks gestation






48


OklahomaO

KLA

HO

MA

40444646

40484948

46294441

38424542

40394443

45455048

+++++

+++++

++++++

+++++

++++++

++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

47 40 4539 43 4541 48 5046 47 48


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,906.013.535.025.821.3

21.315.040.13.5

86.731

21.7

81.969.259.534.564.4

3.817.533.915.038.9

21.650.577.611.2

22.911.4

21.778

24.8

93.078.7

7.48.14.711.1

404474138

304539

1249

1342472931

402838

40

34

4617

2127

25

4043

43224341

37463031

50494036

18491636

432945413847374321

43254841

82.635.34.46.2

28.518.410.954.2

76.389.83.4

62.6

73.530.9

-0.96345.637.571.186.767.346.4

34.93.829.716.3

OKLAHOMA

+++++++++++

++++++

+++++

+++++++++++

+++++++

++

++

+++++

++++++

+++

+++

++++++

++++++++

++++++

+++++++++++

+++++++++++++++

++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low drug death rate among women• Low percentage of preterm births• Low prevalence of overweight or


Challenges: • Low prevalence of well-woman visits• High cost of infant child care• Low percentage of high school

graduation

State Health Department Website: oregon.gov/oha/ph




• In the past year, tobacco use among youth ages 12-17 decreased 11% from 6.2% to 5.5%

• In the past three years, low birthweight increased 10% from 6.2% to 6.8% of live births



20


OregonO

RE

GO

N

96

3813

33443136

74

407

44122527

66

3311

214

3420

++++++++++++++++

+++++++

+++++++++++++++++

+++++++++++

++++++++++++++++

++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

24 23 2115 3 439 36 3427 18 20


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,435.720.226.216.015.3

20.512.939.82.2

89.5399.4

79.772.365.630.457.9

2.79.419.512.322.7

33.463.185.88.9

14.316.4

52.686

22.6

95.582.7

4.96.83.48.3

142620622

283038

620

3430354046

197

10

6

25

1648

46

13

1324

97132

491

4323

31201838

199

4548

231

3322841402745

12501434

76.721.95.35.5

23.337.414.453.3

76.096.711.022.6

79.960.0

-0.31855.154.477.086.370.338.6

22.87.4

15.013.8

OREGON

+++++++++++++++++++

++++++++

+++++++++

++++++++++

++++++++++++++

+++++

+++

+++++

++++++++++

++++

+++++++

+++++++++++++++++++

++++++++++

++++++++++++

+++++++++++

+++++++++++++++++++++++++

+++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low percentage of uninsured women• High prevalence of well-baby visits• Low prevalence of substance use


Challenges: • High drug death rate among women• High prevalence of household smoke• Low prevalence of developmental

screenings

State Health Department Website: health.pa.gov

Highlights: • In the past year, substance use disorder

among youth decreased 11% from 3.6% to 3.2%

• In the past year, teen suicide increased 15% from 8.2 to 9.4 deaths per 100,000 adolescents ages 15-19





23


PennsylvaniaP

EN

NS

YLV

AN

IA

26391121

22351725

13263218

22221719

35301027

24321223

++++++++++++

++++++++++++

+++++++++++++

++++++++++++++

+++++++++++++

++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

18 24 2443 35 3210 8 1224 23 23


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,503.923.326.318.118.9

17.912.137.12.9

90.5297.1

78.282.067.837.265.9

2.4

33.426.110.631.5

25.664.681.211.1

19.212.3

25.078

25.7

93.486.3

6.28.44.49.4

2042211432

232524

178

398

281828

104624

28

33

3928

1827

31

3511

29263519

22281

28

17231720

10393641

10391020166182624

17121212

86.630.43.25.9

19.236.414.658.9

77.993.25.5

54.6

85.726.1

0.61356.149.193.490.670.445.9

24.63.214.89.4

PENNSYLVANIA

++++++++++++++

+++++++++

+++++++++

+++++++++++++++++

+++++++++

+++

++

+++++

+++++++

++

++++++

++++++++++++

++++++++++++++

+++++++++++++++

++++++++++

+++++++++++++++++++++++++++++++++++

++++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low percentage of uninsured women• High percentage of prenatal care

before third trimester• Low child mortality rate

Challenges: • High drug death rate among women• High cost of infant child care• Low prevalence of supportive

neighborhoods

State Health Department Website: health.ri.gov








1


Rhode IslandR

HO

DE

IS

LAN

D

127

3216

21241718

4111

1341

161939

4241

+++++++++++++++

++++++++++++++

++++++++++++++++++++

++++++++++++++++++++

++++++++++++++++++

++++++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

5 4 428 4 212 6 49 3 1


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,534.218.124.723.812.2

26.612.432.61.2

92.5355.7

85.885.674.547.578.5

2.521.319.013.626.4

28.964.682.66.0

14.913.3

86.096

25.4

98.088.8

5.77.54.48.3

231414347

37274

94

13921

14368

15

15

1934

21

30

26

1915352

29423716

10101245

38

2620

730211351441

11861

84.133.64.74.9

18.246.615.351.0

79.896.84.8

84.5

86.729.71.49776.878.494.194.674.441.6

16.33.611.44.9

RHODE ISLAND

++++++++++++++++++

++++++++++

++++++++++

+++++++++++++++++++++++++

+++++++++++

++++

++++

++++++

++++++++++

+++

++++++++++

+++++++++++++++

++++++++++

+++++++++++++++

+++++++++++++++++

++++++++++++++++++++++++++++++++++++++

+++++++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019




households


women• High prevalence of low birthweight • High child mortality rate

State Health Department Website: scdhec.gov

Highlights: • In the past year, HPV immunization increased

54% from 30.8% to 47.4% among females ages 13-17 and 39% from 27.4% to 38.0% among males ages 13-17.






36


South CarolinaS

OU

TH

CA

RO

LIN

A

41333940

417

3632

35112025

39363441

46423342

46293536

+++++++

++++++++++

+++++++++++++

+++++++

+++++

++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

45 39 4632 34 2937 35 3539 36 36


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

2,033.018.433.323.718.3

30.611.7

42.3NA

NA31

16.9

81.672.362.729.461.7

4.616.139.4NANA

24.4NANA8.4

17.48.7

41.778

27.0

93.483.9

7.09.74.311.2

4517443328

432345

1244

1930424539

472343

30

22

326

927

37

3519

38463244

32402135

23474130

284369

223836373737274913

40243218

83.633.04.16.7

20.920.110.857.1

74.192.62.2

93.6

80.126.4

-0.40747.438.078.689.466.048.4

32.83.721.710.4

SOUTH CAROLINA

+++++++++++

+++++

+++++

+++++++++++

+++++

+++

+++

+++++++

++++++++

++

++++++

++++++

+++++++++

++++++++

++++++++++++++

+++++++++++++++++++++

+++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



women• Low cost of infant child care• High prevalence of supportive

neighborhoods

Challenges: • High percentage of uninsured women• High prevalence of tobacco use during


State Health Department Website: doh.sd.gov

Highlights: • In the past year, preterm birth increased

9% from 8.5% to 9.3% of live births before 37 weeks gestation






23


South DakotaS

OU

TH

DA

KO

TA

23214836

33153

31462839

8273623

13204126

12213623

+++++++++

+++++++++++++++++++

++++++++

+++++++++++++

++++++++++++

++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

14 11 1218 16 2130 39 3618 24 23


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,914.420.827.412.418.7

10.311.427.82.5

91.227

14.0

80.772.878.448.767.1

2.59.2

32.614.330.2

32.262.687.612.6

16.67.5

4.974

17.8

93.976.5

6.16.94.09.3

4131241

31

9201

2438

282731

22

145

36

8

39

252

4842

2

2847

268

2517

31144647

2125206

4911299

495

47323243491211

492

3848

83.727.55.68.4

20.636.214.262.4

66.396.44.9

93.6

68.542.4

-1.22248.840.974.579.574.749.6

42.82.3

22.630.0

SOUTH DAKOTA

+++++++++++++

++++++++++++++

+++++

+++++++++++++++++++

+++++++++++

+++++

++

++++++++

++

+++++

++++

+++++++++++++++

++++++++

+++++++++++++++

+++++++++++++

+++++++++++++++++++++

+++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



among women• High prevalence of well-baby visits• High immunization coverage among

children


women• High prevalence of household smoke• High prevalence of overweight or


State Health Department Website: tn.gov/health

Highlights: • In the past year, HPV immunization increased

29% from 36.9% to 47.7% among females ages 13-17 and decreased 12% from 35.2% to 31.1% among males ages 13-17






41


TennesseeT

EN

NE

SS

EE

38453643

36393438

28403

29

29382028

45403945

35463041

++++++

++++++++

+++++++++++++

++++++++++++

++++++

+++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

37 35 3544 46 4632 31 3042 43 41


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,636.517.232.925.021.8

24.412.939.61.9

92.726

12.5

83.474.362.830.967.1

4.023.435.816.532.4

22.752.396.712.8

21.111.3

21.172

26.9

92.385.4

7.19.24.511.1

289

423740

353036

2531

723413922

444141

37

40

4116

2446

36

4412

39413941

3491339

35423012

14121317

1313413645422728

37334125

89.837.73.97.1

24.125.412.160.1

77.296.33.1

88.1

82.537.2

-0.65247.731.175.089.479.350.4

32.04.1

26.612.4

TENNESSEE

+++++++++++++

+++++++

+++++

++++++++++++++

+++

++

++

+++++

++++

++

+++++

++++++

++++++++++++

++++++++++

++++++++++++++++

++++++++++++++++++++++++++

++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low drug death rate among women• Low prevalence of tobacco use during

pregnancy• Low prevalence of tobacco use among

adolescents

Challenges: • High percentage of uninsured women• Low percentage of prenatal care

before third trimester• High teen birth rate

State Health Department Website: dshs.state.tx.us








43


TexasT

EX

AS

3110311

435

3834

50334550

50504950

28292329

49333643

++++++++++++++++

++++++++++

+++++

++++

++++++++++++

++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

48 50 4934 31 3333 41 3641 44 43


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,723.319.131.025.613.2

32.414.040.1NA

NA10

25.6

74.661.860.132.761.9

3.17.4

39.2NANA

24.1NANA3.0

12.511.2

20.177

28.6

89.876.1

5.78.43.810.6

3521373810

454039

4950

5049463438

314

42

32

2

714

2533

44

4949

19262138

43775

19344741

39501022

482142464022454148

236

4420

89.732.43.63.7

19.932.19.051.6

71.486.52.9

79.0

69.135.2

-0.74243.536.085.183.267.835.1

26.12.827.611.1

TEXAS

++++++++++++++

+++++

++

+++++++

++++++++

++

+++++

+++++++++

+++++

+

++

++++++++++++

+++++++++++++++++

++++++++

+++++++++++

++++++++++++++

+++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



women• Low prevalence of household smoke• High prevalence of supportive

neighborhoods

Challenges: • Low prevalence of well-woman visits• Low prevalence of well-baby visits• Low prevalence of children with


State Health Department Website: health.utah.gov

Highlights: • In the past year, chlamydia increased

4% from 871.5 to 906.1 cases per 100,000 females ages 15-44




• In the past three years, physical inactivity among women ages 18-44 decreased 16% from 16.9% to 14.2%

• In the past three years, neonatal mortality increased 19% from 3.6 to 4.3 deaths per 1,000 live births

9


UtahU

TAH

1411

6122

31415045

428

3832

10201715

1011169

++++++++++++++++++++

++++++++++++++++++++

+++++

++++++++++

+++++++++++++++++

++++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

16 13 102 6 1114 16 166 8 9


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

906.112.321.314.27.4

8.810.733.61.7

91.22211.8

75.569.875.533.655.8

1.720.923.015.325.4

27.825.887.13.2

7.112.3

8.675

17.7

96.379.0

5.27.24.39.4

12321

8136

3228

484083148

13519

19

3

1

28

4437

1

541

12133219

262123

76211

50342042

472631474422164018

1841744

86.022.73.83.6

17.653.113.371.0

63.494.04.051.7

70.332.6

-0.15042.132.985.191.667.947.2

25.02.815.220.3

UTAH

+++++++++++++++++++++++++

++++++++++++++

+++++

+++++++++++

+++++++++++

++++

+++++

++++++++

+++

+++++

++++++

++++++++++++++

+++++++++++++++++

++++++++++++++++++

++++++++

+++++++++++++++++++++

++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



among women• High percentage of infants exclusively

breastfed for six months• Low teen birth rate



pregnancy• High prevalence of substance use


State Health Department Website: healthvermont.gov



• In the past year, HPV immunization increased 17% from 58.4% to 68.5% among females ages 13-17 and 15% from 53.1% to 60.8% among males ages 13-17





4


VermontV

ER

MO

NT

7202817

1141914

1

12155

5153

221114

2394

++++++++++++++++

++++++++++++++

++++++++++++++++++

++++++++++++++++++++

+++++++++++++++++

++++++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

3 2 23 8 34 5 92 4 4


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,000.023.225.614.818.6

2.59.8

39.21.7

93.7596.9

83.187.077.535.266.7

2.617.726.611.522.5

38.068.487.815.5

17.213.9

10.488

19.9

98.387.9

4.06.72.67.5

440183

30

17

33

27

10242725

172926

2

48

3037

424

6

17

2411

8124541

252917

51

4540

415623

26101516

8

424

23

89.127.25.57.5

21.533.821.962.2

79.398.411.056.3

87.437.0

0.82868.560.884.292.874.047.5

20.34.510.111.8

VERMONT

+++++++++++++++++++

++++++++++++

++++++++++

+++++++++++++++++++++

++++++++++

+++++

+

+++++

++++++

+++++

++++++++++

++++++++++++++++++++

+++++++++++

++++++++++++++++

+++++++++++++

++++++++++++++++++++++++++++++++++++++++

++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



women• High percentage of prenatal care

before third trimester• High HPV immunization coverage

among adolescent females


dedicated health care provider• High cost of infant child care• Low meningococcal immunization

coverage among adolescents

State Health Department Website: www.vdh.virginia.gov

Highlights: • In the past year, chlamydia increased

10% from 1,388.8 to 1,525.6 cases per 100,000 females ages 15-44





• In the past three years, infant mortality decreased 6% from 6.3 to 5.9 deaths per 1,000 live births

18


VirginiaV

IRG

INIA

231468

7

262313

39315

32

17161615

2526917

2223618

+++++++++++++++++

+++++++++++++++

+++++++++++

++++++++++++++++

+++++++++++++++

+++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

17 18 2217 18 239 12 612 15 18


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,525.619.628.322.115.1

12.610.133.62.8

89.6

1712.5

80.172.170.340.968.9

2.815.229.512.426.6

26.658.375.95.6

14.913.4

12.780

26.4

95.285.0

5.98.43.99.5

2124262519

1396

4131

293215916

231833

22

14

1835

3921

33

1415

23262321

1913719

18212217

2226147

2532203153629631

15111417

86.927.53.65.1

19.937.013.259.6

74.995.13.2

95.9

79.429.1

0.21068.050.480.089.377.144.2

23.63.215.09.9

VIRGINIA

++++++++++++++++

++++++++++++++

+++

++++++++++++++++++

+++++++++

+++

++++

++++++

+++++

++

++++++++

++++++++++++

+++++++++++++++++

++++++++++++++

+++++++++++++++

++++++++++++++++++++++++++++++

++++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



among women• Low neonatal mortality rate• Low prevalence of overweight or



women• High cost of infant child care• Low prevalence of supportive

neighborhoods

State Health Department Website: doh.wa.gov








17


WashingtonW

AS

HIN

GTO

N

59

2912

24212023

19202817

30212426

193136

1992417

+++++++++++++++++

+++++++++++++

+++++++++++++++

++++++++++++

++++++++++++++++++

++++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

27 18 198 9 916 18 2416 11 17


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,394.518.825.317.513.5

13.710.841.41.9

89.9268.5

79.971.968.437.461.5

3.511.419.711.324.9

29.156.385.36.8

11.315.4

18.483

23.1

93.982.5

4.66.62.68.4

1219161013

161442

2516

3234231540

391211

13

20

545

2810

14

2825

6215

4464123

1314847

306

4333

143524191032312925

9211240

79.425.05.25.5

18.440.017.250.3

73.397.49.8

63.9

81.327.7

0.10856.853.782.688.669.945.7

21.43.714.815.0

WASHINGTON

+++++++++++++++++++++

+++++++++

+++++++

+++++++++++++

++++++++++

++++

++++

++++++

++++++++

++++

++++++

++++++++++++++++++++

++++++++++

++++++++++++++

+++++++++++

++++++++++++++++++++++++++++

++++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



among women• High prevalence of well-baby visits• Low prevalence of homeless family

households

Challenges: • High drug death rate among women• High prevalence of tobacco use during


among adolescents

State Health Department Website: dhhr.wv.gov

Highlights: • In the past year, tobacco use among

youth ages 12-17 decreased 23% from 12.4% to 9.5%




• In the past three years, child mortality decreased 12% from 34.2 to 30.0 deaths per 100,000 children ages 1-19


42


West VirginiaW

ES

T V

IRG

INIA

19504344

37464847

2

461014

17311822

43454347

25484142

+++++++

+++++

+++++++++++++++

+++++++++++++

++++

++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

25 25 2546 49 4843 40 4138 40 42


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

982.712.232.522.733.6

20.414.939.41.7

88.1478.9

81.475.965.536.872.5

4.151.317.212.431.8

20.241.586.524.7

22.211.6

8.173

27.6

93.386.5

7.29.54.312.0

31

412850

274435

418

202136206

45505

47

50

4518

4543

38

3710

40443247

6453049

49434828

3121314

112730333517341214

35494312

89.434.94.49.5

27.723.37.9

57.4

72.995.41.6

90.5

85.032.0

-0.14348.639.387.987.574.747.9

30.06.027.19.4

WEST VIRGINIA

+++++++++++++++

++++++

+++++++++

++++++++++++++++++

+++++++

+

+

+++++

++

++

+++++++

++++++

++++++++++

++++++

++++++++++++++

++++++++++++++++++++++++++++

++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019



women• Low percentage of low-risk cesarean

deliveries• Low teen birth rate



pregnancy• Low prevalence of children with


State Health Department Website: dhs.wisconsin.gov








19


WisconsinW

ISC

ON

SIN

34301023

16332518

21252519

69278

9

252319

15242019

+++++++++++++

+++++++++++++

+++++++++++++

++++++++++++++++++

+++++++++++++++

+++++++++++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

9 14 1521 21 2415 14 2015 14 19


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,655.526.828.718.617.6

13.810.036.32.8

94.2227.3

84.182.772.238.768.2

2.1

18.519.911.727.3

28.369.486.211.0

16.813.6

16.082

21.6

95.982.0

6.17.74.19.6

3249291625

18822

3211

66111218

53012

18

32

2836

3513

10

1028

26192925

11162423

26301515

42162416

351421211828223642

16461034

88.627.64.25.5

21.733.715.259.8

69.695.94.5

88.9

76.937.00.19756.048.883.890.369.241.0

24.34.713.813.8

WISCONSIN

+++++++++++++

++++++++++++

++++++

++++++++++++++++++++++

++++++++++++

++++

++

+++++

++++++

+++++

++++++++

+++++++++++++

++++++++++++++

++++++++++++++

++++++++++++

+++++++++++++++++++++++++

++++++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


Strengths:• Low incidence of chlamydia among

females• Low neonatal mortality rate• High prevalence of supportive

neighborhoods

Challenges: • High percentage of uninsured women• High prevalence of tobacco use during


State Health Department Website: health.wyo.gov





• In the past three years, low birthweight decreased 5% from 9.2% to 8.7% of live births



33


WyomingW

YO

MIN

G

16413632

11

301415

38414648

47254745

30134530

32314433

+++++++++

+++++++++++++++

+++++

++++++

+++++++++++

+++++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

30 30 3216 27 3142 46 4429 31 33


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,202.720.525.717.722.9

3.813.233.90.8

92.83017.9

75.762.867.030.058.1

2.816.634.812.730.3

28.865.286.014.4

18.912.0

2.477

21.2

93.880.1

5.08.73.18.9

629191142

3349

1545

4748304245

232440

16

45

3823

5033

9

3136

1031911

25194434

3811910

45363439

303649504850381833

39304049

86.228.25.46.6

25.145.016.660.7

68.793.85.357.1

78.227.0

-1.43233.628.460.786.472.043.8

32.63.9

24.631.1

WYOMING

+++++++++++++++++

++++++++++++

+++++

+++++++

++++++++

++++

+

+++++

+++

+++++

++++

++++++++++++++++

++++++++++

++++++++++++++++

+++++++

+++++++++++++++++

++++++++

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


District of ColumbiaD

IST

RIC

T O

F C

OLU

MB

IA

42433042

44134440

30442

30

37444143

44492646

42473345

++++++

++++++++

++++++++++++

+++++

++++++

+++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

Strengths:• High HPV immunization coverage

among adolescents• Low prevalence of tobacco use during

pregnancy• Low percentage of uninsured women

Challenges: • Low percentage of high school

graduation• High neonatal mortality rate• High prevalence of excessive drinking

among women

State Health Department Website: dchealth.dc.gov








NOT RANKED


WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

2,116.532.723.521.010.5

41.711.2NANA

NA843.5

85.270.180.235.077.4

2.57.8

35.6NANA

29.1NANA2.7

14.314.6

49.082

28.7

90.989.0

8.010.55.510.6

73.234.75.13.7

21.374.718.550.9

82.095.277.4

100.0

82.631.6NA79.476.691.386.174.039.2

27.62.521.0NA

DISTRICT OF COLUMBIA

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal

WomenInfants

ChildrenTotal




SUMMARY


OVERALLRANK:

2016 2018 2019


4x

Annual Report Rank: 4xSenior Report Rank: 4x

United StatesU

NIT

ED

STA

TE

S

42433042

44134440

30442

30

37444143

44492646

42473345

++++++

++++++++

++++++++++++

+++++

++++++

+++++


Behaviors

Clinical Care

Outcomes

Overall

Policy

State Health Department Website: hhs.gov

Highlights: • In the past three years, smoking among

women ages 18-44 decreased 12% from 17.4% to 15.3%







• In the past three years, low birthweight increased 4% from 8.0% to 8.3% of live births




WOMEN

INFANTS

















91.021.93.23.4

14.859.221.971.0

82.998.41.4

99.9

90.960.01.51876.878.495.396.282.157.0

16.31.88.14.9




Behaviors


Policy

Clinical Care

Outcomes

Policy

Clinical Care

Outcomes























42.125.897.51.4

7.17.3

88.196

17.7

98.390.7

3.96.22.67.5


Policy

Clinical Care

Outcomes

906.112.218.512.47.4

2.57.4

27.80.8

95.1633.3

85.887.578.948.778.5

1.75.312.47.419.8

*

*

**

**

*

**

*

Symbol Rank+++++

+++++++

+++

1–1011–2021–3031–4041–50

RATING


Behaviors

CHILDREN

Behaviors

**

1,639.819.627.422.415.3

24.012.337.32.2

90.326

12.4

80.073.067.434.466.5

3.016.329.612.530.3

24.956.779.56.9

15.512.3

26.179

26.0

93.782.2

5.98.33.99.9

84.631.04.15.1

20.539.212.255.4

74.493.97.1

74.4

78.731.1

0.00053.144.385.188.770.443.2

25.73.718.810.5

UNITED STATES



Appendix


Concentrated Disadvantage

Food Insecurity — Household

Intimate Partner Violence — Lifetime*

Intimate Partner Violence —Pregnancy

Chlamydia

Excessive Drinking

Obesity

Physical Inactivity

Smoking

Percentage of households located in census tracts with a high level of concentrated disadvantage, calculated using five census variables: percentage below poverty line, receiving public assistance, female-headed households, unemployed, younger than 18

Percentage of households unable to provide adequate food for one or more household members due to lack of resources

Percentage of women 18 and older who experienced contact sexual violence, physical violence and/or stalking by an intimate partner

Percentage of women with a recent live birth who experienced violence by husband or partner (current or former) during most recent pregnancy

Number of new cases of chlamydia per 100,000 females ages 15-44

Percentage of women ages 18-44 who reported either binge drinking (having four or more drinks on one occasion in the past 30 days) or chronic drinking (having eight or more drinks per week)

Percentage of women ages 18-44 with a body mass index of 30.0 or higher based on reported height and weight

Percentage of women ages 18-44 who reported doing no physical activity or exercise other than their regular job in the past 30 days

Percentage of women ages 18-44 who are smokers (reported smoking at least 100 cigarettes in their lifetime and currently smoke daily or some days)

American Community Survey

U.S. Department of Agriculture, Household Food Security in the United States in 2017

National Intimate Partner and Sexual Violence Survey

Pregnancy Risk Assessment Monitoring System or equivalent

National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention Atlas

Behavioral Risk Factor Surveillance System

Behavioral Risk Factor Surveillance System Behavioral Risk Factor Surveillance System Behavioral Risk Factor Surveillance System

Table 7Data Sources and Measures of Women’s Health

Measure Description Source Data Year(s)

Appendix

Behaviors


* Data appearing in this edition are the same that appeared in the 2018 edition.

Policy

Postpartum Visit

Publicly-Funded Women’s Health Services*

Uninsured

Percentage of women with a recent live birth who reported receiving a postpartum checkup

Percentage of need met by publicly-funded providers for contraceptive services by women with a family income 250 percent below the federal poverty level and women younger than 20

Percentage of women ages 19-44 not covered by private or public health insurance


Guttmacher Institute, Contraceptive Needs and Services 2014 Update


2016

2016-2017

2016-2017

2016-2017

2016-2017

2013-2017

2015-2017

2010-2012

2017

2017

2014

2017


Cervical Cancer Screening*

Dedicated Health Care Provider

Dental Visit*

Flu Vaccination

Well-Woman Visit

Diabetes

Drug Deaths

Maternal Mortality**

Postpartum Depression

Unintended Pregnancy

Percentage of women ages 21-44 who received a Pap smear within the past three years

Percentage of women ages 18-44 who reported having one or more people they think of as their personal doctor or health care provider

Percentage of women ages 18-44 who reported visiting the dentist or dental clinic within the past year

Percentage of women ages 18-44 who received the flu vaccine in the last year

Percentage of women ages 18-44 with a preventive medical visit in the past year

Percentage of women ages 18-44 who reported being told by a health professional that they have diabetes (excluding prediabetes and gestational diabetes)

Age-adjusted number of deaths due to drug injury (unintentional, suicide, homicide or undetermined) per 100,000 females ages 15-44

Number of deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within one year of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 live births

Percentage of women with a recent live birth who reported experiencing depressive symptoms

Percentage of women with a recent live birth who did not want to become pregnant or wanted to become pregnant later







CDC WONDER Mortality data





Appendix

* Data appearing in this edition are the same that appeared in the 2018 edition. ** Calculated measure using CDC WONDER Natality data as the denominator.

Clinical Care

Outcomes

2016

2016-2017

2016

2016-2017

2016-2017

2016-2017

2015-2017

2013-2017

2017

2017


Household Smoke

Infant Child Care Cost

Breastfed

Drinking Before Pregnancy

Sleep Position

Tobacco Use During Pregnancy

Percentage of children ages 0-17 who live in households where someone uses cigarettes, cigars or pipe tobacco

Average cost for center-based infant care as a percentage of married couple’s median income

Percentage of infants exclusively breastfed for six months

Percentage of women with a recent live birth who consumed alcohol during the three months before pregnancy

Percentage of women with a recent live birth who reported their infants are usually placed on their backs to sleep

Percentage of mothers who used tobacco during pregnancy

National Survey of Children’s Health

Child Care Aware, The U.S. and the High Cost of Child Care: 2018

2018 Breastfeeding Report Card



CDC WONDER Natality data

Table 8Data Sources and Measures of Infants’ Health


Appendix

Behaviors

* Data appearing in this edition are the same that appeared in the 2018 edition.


Policy

Baby-Friendly Facility

mPINC*

Percentage of live births occurring at facilities that adhere to 10 Steps to Successful Breastfeeding and are designated baby-friendly by Baby-Friendly USA

Maternity Practices in Infant and Nutrition Care survey score based on seven birth facility policies and practices, with higher scores denoting better maternity care policies and practices



2015

2017

2017

2017

2016-2017

2017

2018

2016


Low-Risk Cesarean Delivery

Prenatal Care Before Third Trimester

Well-Baby Check

Infant Mortality

Low Birthweight

Neonatal Mortality

Preterm Birth

Percentage of singleton, head first, term (37 or more completed weeks) first births that were cesarean deliveries

Percentage of live births in which the mother began prenatal care between the first and sixth month of pregnancy

Percentage of babies ages 0-2 who had a well-baby checkup in the past 12 months

Number of infant deaths (before age 1) per 1,000 live births

Percentage of infants weighing less than 2,500 grams (5 pounds, 8 ounces) at birth

Number of deaths during first 28 days of life (0-27 days) per 1,000 live births

Percentage of live births before 37 weeks gestation




CDC WONDER Linked Birth/Infant Death data





Clinical Care

Outcomes

2017

2017

2016-2017

2015-2016

2017

2016-2017

2017

Appendix


Adverse Childhood Experiences

Neighborhood Amenities

Protective Family Routines and Habits*

Supportive Neighborhoods

High School Graduation

Overweight or Obesity

Substance Use Disorder

Tobacco Use

Percentage of children ages 0-17 who experienced two or more of the following: economic hardship; 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

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

Percentage of children ages 0-17 who meet age-specific criteria for protective family routines and habits

Percentage of children ages 0-17 who live in neighbor-hoods where people help each other, watch out for each other’s children and know where to go for help in the community

Percentage of high school students who graduate with a regular high school diploma within four years of starting ninth grade

Percentage of children ages 10-17 who are overweight or obese for their age based upon reported height and weight

Percentage of children ages 12-17 who were dependent on or abused illicit drugs or alcohol in the past year

Percentage of children ages 12-17 who used a tobacco product in the past month





National Center for Education Statistics


National Survey on Drug Use and Health

National Survey on Drug Use and Health

Table 9Data Sources and Measures of Children’s Health


Appendix

Behaviors


* Data appearing in this edition are the same that appeared in the 2018 edition. ** Calculated measure using 2017 American Community Survey population estimates as the denominator.

Policy

Adequate Health Insurance

Children With Health Insurance

Homeless Family Households**

Water Fluoridation*

Percentage of insured children ages 0-17 whose health plan has either no or reasonable out-of-pocket costs; offers benefits or covered services that meet the children’s needs; and allows them to see needed health care providers

Percentage of children ages 0-17 with health insurance of any type

Number of families sleeping outside, in an emergency shelter or in a transitional housing program per 10,000 family households

Percentage of population served by community water systems that receive fluoridated water



U.S. Department of Housing and Urban Development, 2018 Annual Homeless Assessment Report

Water Fluoridation Reporting System

2016-2017

2016-2017

2015-2016

2015-2016

2016-2017

2016-2017

2016

2016-2017

2016-2017

2016-2017

January 2018

2014


Adolescent Well-Visit

Developmental Screening

Immunizations —Adolescents

• HPV Immunization Females

• HPV Immunization Males

• Meningococcal Immunizations

• Tdap Immunizations

Immunizations —Children

Medical Home for Child With Special Health Care Needs

Child Mortality

Missed School Days

Teen Births

Teen Suicide

Percentage of children ages 12-17 who had a preventive checkup in the past 12 months

Percentage of children 9 months-5 years with a visit in the past 12 months whose parent completed a standardized developmental screening tool

Mean z score of the percentage of adolescents ages 13-17 who received the recommended doses of Tdap, meningococcal and HPV vaccines

Percentage of females ages 13-17 who are up-to-date on all recommended doses of human papillomavirus (HPV) vaccine

Percentage of males ages 13-17 who are up-to-date on all recommended doses of human papillomavirus (HPV) vaccine

Percentage of adolescents ages 13-17 who received one or more doses of meningococcal conjugate (MenACWY) vaccine

Percentage of adolescents ages 13-17 who received one or more doses of tetanus, diphtheria and acellular pertussis (Tdap) vaccine since age 10

Percentage of children ages 19-35 months who received recommended doses of diphtheria, tetanus and acellular pertussis (DTaP); measles, mumps and rubella (MMR); polio; Haemophilus influenzae type b (Hib); hepatitis B; varicella; and pneumococcal conjugate vaccines

Percentage of children ages 0-17 with special health care needs 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

Age-adjusted number of deaths per 100,000 children ages 1-19

Percentage of children ages 6-17 who missed 11 or more days of school in the past school year (excluding homeschooled children)

Number of births per 1,000 females ages 15-19

Number of deaths by suicide per 100,000 adolescents ages 15-19

National Survey of Children’s Health National Survey of Children’s Health

America’s Health Rankings composite measure

National Immunization Survey — Teen




National Immunization Survey — Child







Clinical Care

Outcomes

2016-2017

2016-2017

2019

2017

2017

2017

2017

2017

2016-2017

2015-2017

2016-2017

2017

2015-2017

Appendix


Flourishing (Ages 0-5)

Air Pollution*

Frequent Mental Distress

Severe Housing Problems

Percentage of children ages 6 months-5 years who show affection, resilience, interest and curiosity in learning, and smile and laugh a lot

Average exposure of the general public to particulate matter of 2.5 microns (PM2.5) or less in size

Percentage of women ages 18-44 years who reported their mental health was not good 14 or more days in the past 30 days

Percentage of occupied housing units with at least one of four problems: lack of complete kitchen facilities, lack of plumbing facilities, severely crowded, or severely cost-burdened occupants


U.S. Environmental Protection Agency


U.S. Department of Housing and Urban Development, Comprehensive Housing Affordability Strategy

Table 10Supplemental Measures


Appendix

Women

Infants

Children

Asthma

Children in Poverty

Detracting Neighborhood Elements

Flourishing (Ages 6-17)

Housing With Lead Risk

Mental Health Care

Preventive Dental Care

Students Experiencing Homelessness

Percentage of children ages 0-17 who currently have asthma

Percentage of children younger than 18 who live in households below the poverty threshold

Percentage of children ages 0-17 who live in a neighborhood where there is litter or garbage on the street or sidewalk, poorly kept or rundown housing, and vandalism such as broken windows and graffiti

Percentage of children ages 6-17 who show self-regulation, interest and curiosity in learning, and work to finish tasks

Percentage of housing stock with potential elevated lead risk due to age of housing

Percentage of children ages 3-17 with a mental or behavioral health condition who received treatment or counseling

Percentage of children ages 1-17 who had one or more preventive dental care visits during the past 12 months

Percentage of public school students who lack a fixed, regular and adequate nighttime residence








National Center for Education Statistics, Digest of Education Statistics 2017

2015-2017

2016-2017

2011-2015

2016-2017

2016-2017

2017

2016-2017

2016-2017

2017

2016-2017

2016-2017

2015-2016

* Calculated measure using the U.S. Census Bureau’s Annual Estimates of the Resident Population: April 1, 2010 to July 1 2017 as the denominator.


America’s Health Rankings Composite MeasureAmerica’s Health Rankings composite measures are calculated from existing measures to provide summary information for multiple measures. Data are analyzed, and a mean z score is calculated across respective measures.

American Community SurveyThe American Community Survey (ACS) is an ongoing survey conducted by the U.S. Census Bureau. ACS provides information about the nation’s population demographics and housing.

Behavioral Risk Factor Surveillance System The Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) is the nation’s largest phone-based population survey. BRFSS provides information about U.S. residents’ health-related risk behaviors, chronic health conditions and use of preventive services.

Breastfeeding Report CardCDC’s Breastfeeding Report Card is a compilation of data on breastfeeding practices that pro-vides information about our nation’s progress on achieving Healthy People 2020 goals for breast-feeding. The report is created by CDC’s Division of Nutrition, Physical Activity and Obesity.

CDC WONDERCDC WONDER (Wide-ranging Online Data for Epidemiologic Research) is a query system for the analysis of public-use health data.

Linked Birth/Infant Death Records provide death counts and rates as well as demographic information for children younger than 1 year in the United States. Information is obtained from linking death certificates to birth certificates.

Natality files are derived from birth certificates and include counts and rates of births to U.S. residents occurring within the United States.

Multiple Cause of Death files contain counts, rates and causes of death, as well as demographic information for U.S. residents based on death certificates.

Data Source DescriptionsChild Care Aware, The U.S. and the High Cost of Child CareChild Care Aware® of America is a national membership-based nonprofit organization working to advance affordability, accessibility, development and learning of children in child care. The non-profit’s annual report provides information about the cost and affordability of child care across the nation.

Guttmacher Institute, Contraceptive Needs and Services, 2014 UpdateThe Guttmacher Institute is a leading research and policy organization committed to advancing sexual and reproductive health and rights in the United States and globally. The institute’s Contraceptive Needs and Services report provides information regarding women’s needs for publicly funded contraceptive services across the nation.

National Center for Education StatisticsThe National Center for Education Statistics is the primary federal entity for collecting and analyzing data related to education in the nation. The center’s survey program — Common Core of Data — collects national, state and local data on public elementary and secondary schools and school districts.

The center also provides supplemental information on economic and population trends in addition to statistical information covering the broad field of American education in the publication Digest of Education Statistics.

National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention AtlasThe National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP) is a large branch of the CDC. The Center’s interactive atlas allows for creation of customized tables, maps and charts using more than 15 years of surveillance data on HIV/AIDS, viral hepatitis, sexually transmitted diseases, tuberculosis as well as social and economic data.

Appendix


National Immunization SurveysCDC’s National Immunization Surveys are a group of phone surveys that collect information about vaccination coverage among children 19–35 months and teens 13–17 years, and flu vaccinations for children 6 months–17 years.

National Intimate Partner and Sexual Violence SurveyThe National Intimate Partner and Sexual Violence Survey conducted by CDC collects the most current and comprehensive national- and state-level data on intimate partner violence, sexual violence and stalking victimization in the United States.

National Survey of Children’s HealthThe ongoing National Survey of Children’s Health (NSCH) is funded by the Health Resources and Services Administration’s Maternal and Child Health Bureau. NSCH provides information about children’s health and access to health care as well as children’s family, neighborhood, school and social contexts. Data are analyzed for America’s Health Rankings reports using an indicator data set available for request from the Data Resource Center for Child & Adolescent Health — a project of the Child and Adolescent Health Measurement Initiative.

National Survey on Drug Use and HealthThe ongoing National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration provides estimates of substance use and mental illness at the national, state and sub-state levels.

Pregnancy Risk Assessment Monitoring System or EquivalentThe Pregnancy Risk Assessment Monitoring System (PRAMS) is a surveillance project of the CDC and state health departments. Forty-seven states participate in PRAMS, covering about 83 percent of all U.S. births. Data are used to identify groups of women and infants at higher risk for health problems, monitor changes in health status and measure progress toward goals in improving

the health of mothers and infants. Data are also obtained directly from three states that administer a similar survey to women who have recently given birth. Data may be missing from states due to low response rates or other data collection issues.

U.S. Department of Agriculture, Household Food Security in the United States ReportThe U.S. Department of Agriculture’s (USDA)Economic Research Service analyzes data from U.S. Census Bureau’s Current Population Survey (CPS) Food Security Supplements to create the Household Food Security in the United States annual report. The report provides national statistics on food security, household food spending and the use of federal food and nutrition assistance by food-insecure households.

U.S. Department of Housing and Urban Development The department’s Annual Homeless Assessment Report (AHAR) provides point-in-time counts of people experiencing homelessness on one day in January.

The department’s Office of Policy Development and Research manages data from the U.S. Census Bureau’s ACS. These data, known as CHAS (Comprehensive Housing Affordability Strategy), demonstrate the extent of housing problems and needs, particularly for low-income households.

U.S. Environmental Protection AgencyThe U.S. Environmental Protection Agency performs a variety of federal research, monitoring, standard-setting and enforcement activities to ensure environmental protection. The agency regularly produces a wealth of public and environmental health data.

Water Fluoridation Reporting SystemCDC’s Division of Oral Health monitors community water systems receiving optimally fluoridated drinking through its Water Fluoridation Reporting System. The division regularly provides national- and state-level water fluoridation statistics.

Appendix


Appendix

MethodologyRankings Calculation

For each measure, the most recent state-level data as of July 15, 2019, are presented as the value. The ranking of each measure is the ordering of states according to value. Ties in values are assigned equal ranks.

The state value is then normalized and presented as a score. The z score for each measure is based on the following formula:

The z score indicates the number of standard deviations a state value is above or below the U.S. value. A zero indicates a state has the same value as the nation. States with higher values than the U.S. value have a positive score, while states that perform below the U.S. value have a negative score. To prevent an extreme score from exerting

excessive influence, the maximum score for a measure is capped at +/- 2.00. If a U.S. value is not available from the original data source for a measure, the mean of all state values is used.

The overall ranking is the ordering of each state according to its overall score. A state’s overall score is calculated by adding the products of the z score for each measure multiplied by its assigned weight. If a value is not available for a state for the current edition, the value for the measure from a prior edition is used. If a value is missing for a measure from the prior edition, no score is assigned to the measure and weights for the remaining measures in the model category are increased by the weight of the missing measure. Measure weights can be found at AmericasHealthRankings.org/about. It’s important to note that the rankings are a relative measure of health. Not all changes in rank translate into actual declines or improvements in health.

For a more detailed methodology, please see AmericasHealthRankings.org/about/methodology

Data Considerations

Data presented in this report are aggregated at the state level and cannot be used to make inferences at the individual level. Values and ranks from prior years are updated on our website to reflect known errors or updates from the reporting source. The error bars on subpopulation graphs represent 95 percent confidence intervals.

Score =state value – national value

standard deviation of all state values

1. Gather data. 2. Normalize state values for each measure using U.S. value (calculate z score).

3. Eliminate outliers. 4. Multiply by weights. 5. Sum weighted scores. 6. Rank states by sum of all measure scores.

Σ–2σ –1σ μ 1σ 2σ

BehaviorsCommunity & Environment

Public & Health PoliciesClinical Care

Health Outcomes


In 2016, an advisory group of maternal and child health experts developed the America’s Health Rankings Health of Women and Children Report model. The advisory group identified areas of health and well-being most pertinent to women, infants and children and established state-level indicators of population health using a three-tiered scorecard. The scorecard produces an overall state rank and a state rank for each of the three population groups.

Each year, the advisory group reviews the model to improve existing measures, integrate new data sources that enhance the model and adjust to changes in data availability.

Five primary considerations drive the selection of measures used to produce the state rankings in the Health of Women and Children Report. The measures:

1. Represent a broad range of health issues that affect the health of women and children.

2. Use common measurement criteria across the 50 states.

3. Are available at the state level.

4. Must be current and updated periodically.

5. Are amenable to change.

The advisory group is always monitoring for new survey and surveillance data sources for use in future publications. In particular, the advisory group is attentive to state-level data for neonatal abstinence syndrome, domestic violence and e-cigarette use among women and children.

Model Development2019 Model Notes and Revisions

State Ranking MeasuresFifty-five measures are used to rank states. Seven of the measures (listed below) were not updated due to lack of data availability; the values and ranks of these seven measures are the same this year as in the 2018 edition.

Cervical cancer screeningDental visitIntimate partner violence — LifetimemPINCPublicly-funded women’s health servicesProtective family routines and habitsWater fluoridation

The following measures were revised this year. See Tables 7, 8 and 9 for current definitions and source details of Women’s Health (Page 156), Infants’ Health (Page 158) and Children’s Health (Page 160) measures.

WomenUninsured, previously defined as women ages 18-44, is now defined as women ages 19-44 due to a change by the source.

Maternal mortality, previously defined as deaths in the 42 days after delivery, is now defined as deaths in the year following delivery.

Unintended pregnancy replaces intended pregnancy. Data are missing for several states, so this measure is not included in the state rankings calculation.

Appendix


Appendix

InfantsDrinking before pregnancy replaces alcohol consumption during pregnancy. Data are missing from several states, so this measure is not included in the state rankings calculation.

ChildrenChild mortality, previously defined as children ages 1-18, is now defined as children ages 1-19.

Homeless family households is not comparable to prior editions due to a methodology change by the data source.

National Survey of Children’s Health measures were adjusted from one-year to two-year estimates to improve state-level sample size.

Supplemental Measures

Twelve supplemental measures were added to the report this year. These measures are not included in the state rankings calculation. They are intended to highlight current and emerging issues affecting women and children.

Air pollutionAsthma — ChildrenChildren in povertyDetracting neighborhood elementsFlourishing — Ages (0–5)Flourishing — Ages (6–17)Frequent mental distress — WomenHousing with lead riskMental health care — ChildrenPreventive dental care — ChildrenSevere housing problemsStudents experiencing homelessness

See Table 10 for current definitions of Supplemental Measures (Page 162). To explore the measures visit www.AmericasHealthRankings.org.


Christina Bethell, Ph.D., M.P.H., M.B.A. Director of the Child and Adolescent Health

Measurement InitiativeProfessor, Bloomberg School of Public Health,

Johns Hopkins University

Carter Blakey Deputy Director, Office of Disease Prevention

and Health Promotion Director, Division of Community Strategies, U.S.

Department of Health and Human Services

Cheryl Clark, Dr.P.H., R.H.I.A.Associate Director for Epidemiology and

Evaluation, Association of Maternal & Child Health Programs

Paige Endsley, M.P.H. Senior Research Program Coordinator, Child and

Adolescent Health Measurement Initiative

Reem Ghandour, Dr.P.H., M.P.A.Director, Division of Epidemiology, Office of

Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration

Carol Gilbert, M.S. Senior Health Data Analyst, CityMatch, The

National Organization of Urban MCH Leaders

Rahul Gupta, M.D., M.P.H., M.B.A., F.A.C.P.Chief Medical and Health Officer, Senior Vice

President, March of Dimes

Wendy Hellerstedt, Ph.D., M.P.H. Retired Associate Professor, Epidemiology and

Community Health, University of Minnesota

Sarah Milder, M.P.H. Principal, Arundel Metrics, Inc.

Health of Women and Children Advisory Committee

Jane Pennington, M.P.H. Chief of Staff for the Office of Medical AffairsUnitedHealth Group

Karyl Rattay, M.D., M.S. Director, Delaware Division of Public Health, State

of Delaware

Carol Sakala, Ph.D., M.S.P.H. Director of Childbirth Connection Programs,

National Partnership for Women and Families

Anna Schenck, Ph.D., M.S.P.H. Professor and Director of the Public Health

Leadership Program, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill

Katie Sellers, Dr.P.H., C.P.H.Vice President for Impact, de Beaumont Foundation

Kristin Shaw, M.P.H. Principal, Arundel Metrics, Inc.

Holly Shulman, M.A. Statistician, Division of Reproductive Health,

National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention

Caroline Stampfel, M.P.H. Director of Programs, Association of Maternal &

Child Health Programs

Kate Taft, M.P.H. Associate Director for Child and Adolescent Health,

Association of Maternal & Child Health Programs

Mary Wahl, M.P.H. Research Program Manager, Child and Adolescent

Health Measurement Initiative

Appendix


Appendix

Aldrich DesignEmily AldrichAngela Hagen Arundel Metrics, Inc.Aaron ClarkTom EcksteinDr. Mary Ann HonorsLaura HoughtalingNatasha KataevaChristine Kim ParkAlexia MálagaSarah MilderElise ParksKristin ShawRuth Sheldon

The Glover Park GroupTeal HuttonTalia KatzAndré MalkinePeter MartinDan RichfieldDan StoneJohn TaylorWayne Walrath

The TeamAmerica’s Health Rankings Health of Women and Children Report is a team effort in which all contribute to the creation and dissemination of this report. Members of the team, listed alphabetically by organization, follow:

MirumKali BarlauNathan DentonJoshua HagenKates HartmanAnna KalscheurMichael Williams

Reservoir Communications GroupDanielle ApfelJill CourtneyDavid LumbertRobert SchoolingGretta Stone RoninWare Inc.T.J. Kellie

United Health FoundationAlyssa Malinski EricksonDr. Linda GenenDr. Janice HuckabyTracy MaloneJenifer McCormickL.D. PlattDr. Rhonda RandallAnne Yau


1. Robert J. Sampson et al. “Assessing the “Neighbor-hood Effects”: Social Processes and New Directions in Research.” Annual Review of Sociology 28, no. 1 (2002): 443-78.

2. Jennifer E.V. Lloyd et al. “Early Experiences Mat-ter: Lasting Effect of Concentrated Disadvantage on Children’s Language and Cognitive Outcomes.” Health & Place 16, no. 2 (2010): 371-80.

3. Jeanne Brooks-Gunn et al. “Do Neighborhoods Influ-ence Child and Adolescent Development?” Ameri-can Journal of Sociology 99, no. 2 (1993): 353-95.

4. Lincoln Quillian. “Segregation and Poverty Concen-tration: The Role of Three Segregations.” American Sociological Review 77, no. 3 (2012): 354-79.

5. Louise C. Ivers et al. “Food Insecurity: Special Considerations for Women.” The American Journal of Clinical Nutrition 94, no. 6 (2011): 1740S-44S.

6. Craig Gundersen et al. “Food Insecurity And Health Outcomes.” Health Affairs 34, no. 11 (2015): 1830–39

7. Beth L. Pineles et al. “Systematic Review and Meta-analysis of Miscarriage and Maternal Exposure to Tobacco Smoke During Pregnancy.” American Journal of Epidemiology 179, no. 7 (2014): 807-23.

8. Andrew W. Horne et al. “The Association between Smoking and Ectopic Pregnancy: Why Nicotine Is BAD for Your Fallopian Tube.” PloS One 9, no. 2 (2014): e89400.

9. Lynn A. Blewett et al. “When a Usual Source of Care and Usual Provider Matter: Adult Prevention and Screening Services.” Journal of General Internal Medicine 23, no. 9 (2008): 1354–60.

10. Barbara Starfield et al. “Contribution of Primary Care to Health Systems and Health.” The Milbank Quar-terly 83, no. 3 (2005): 457–502.

11. Ellen J. Weber et al. “Does Lack of a Usual Source of Care or Health Insurance Increase the Likelihood of an Emergency Department Visit? Results of a Na-tional Population-Based Study.” Annals of Emergency Medicine 45, no. 1 (2005): 4–12.

12. Erica S. Spatz et al. “Beyond Insurance Coverage: Usual Source of Care in the Treatment of Hyper-tension and Hypercholesterolemia. Data from the 2003-2006 National Health and Nutrition Exami-nation Survey.” American Heart Journal 160, no. 1 (2010): 115–21.

References

Appendix

13. Paul Winters et al. “The Role of Usual Source of Care in Cholesterol Treatment.” The Journal of the American Board of Family Medicine 23, no. 2 (2010) 179–85.

14. Willi Horner-Johnson et al. “Usual Source of Care and Unmet Health Care Needs: Interaction of Dis-ability with Race and Ethnicity.” Medical Care 52 (2014): S40-S50.

15. Sharon C. Wilsnack et al. “Focus on: Women and the Costs of Alcohol Use.” Alcohol Research: Current Reviews 35, no. 2 (2013): 219–28.

16. Teresa Kulie et al. “Obesity and Women’s Health: An Evidence-Based Review.” Journal of American Board of Family Medicine 24, no. 1 (2011): 75–85.

17. Darcy E. Broughton et al. “Obesity and Female Infertility: Potential Mediators of Obesity’s Impact.” Fertility and Sterility 107, no. 4 (2017): 840–47.

18. Rebecca M. Cunningham et al. “The Major Causes of Death in Children and Adolescents in the United States.” The New England Journal of Medicine 379, no. 25 (2018): 2468-75.

19. Nicholas J. Kassebaum et al. “Global, Regional, and National Levels of Maternal Mortality, 1990–2015: A Systematic Analysis for the Global Burden of Dis-ease Study 2015.” The Lancet 388, no. 10053 (2016): 1775–812.


Appendix

America’s Health Rankings® Health of Women and Children Report is available in its entirety at www.AmericasHealthRankings.org. Visit the site to request or download additional copies. America’s Health Rankings Health of Women and Children Report 2019 edition is funded entirely by United Health Foundation, a recognized 501(c)(3) organization.

Data contained within this report were obtained from and used with permission of:

Child Care AwareEnvironmental Protection AgencyGuttmacher InstituteDepartment of AgricultureDepartment of Commerce Census BureauDepartment of Education National Center for Education StatisticsDepartment of Health and Human Services Centers for Disease Control and Prevention Health Resources & Services Administration Substance Abuse and Mental Health Services Administration Department of Housing and Urban Development Annual Homelessness Assessment Report Comprehensive Housing Affordability Strategy

United Health Foundation encourages the distribution of information contained in this publication for non-commercial and charitable, educational or scientific purposes. Please acknowledge America’s Health Rankings Health of Women and Children Report as the source and provide the following notice: ©2019 United Health Foundation. All Rights Reserved. Please acknowledge the original source of specific data as cited.

Arundel Metrics, Inc. of Saint Paul, Minnesota, conducted this project for and in cooperation with United Health Foundation.Design by Aldrich Design, Saint Paul, Minnesota.Questions and comments on the report should be directed to United Health Foundation at [email protected] ©2019 United Health Foundation



Explore data.

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VISIT: www.AmericasHealthRankings.org

Guided by a passion to help people live healthier lives, United Health Foundation provides helpful information to support decisions that lead to better health outcomes and healthier communities. The Foundation also supports activities that expand access to quality health care services for those in challenging circumstances and partners with others to improve the well-being of communities.

SEPTEMBER 2019

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America’s Health Rankings® is available in its entirety at www.AmericasHealthRankings.org Visit the website to request or download additional copies.

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