3 - CHA Healthy Children

CHA Children Ages 4-11 | 1

Healthy Children

COMMUNITY HEALTH ASSESSMENT

Prepared by:

HealtheConnectionsHealthPlanning

November 2013


Overarching Goal Statement

Healthy People in Every Stage of Life:

All people, and especially those at greater risk of health disparities, can achieve their

optimal lifespan if they have the best possible quality of health in every stage of life.

Strategic Goal Statement

Healthy children:

Increase the number of children who grow up healthy, safe,

and ready to learn. (Children, aged 4–11 years.)

Healthy Children

TABLE OF CONTENTS

Introduction ....................................................................................................................... 1

Key Findings ....................................................................................................................... 2

Demographics and Social Determinants ....................................................................... 3

Morbidity and Mortality.................................................................................................... 4

Economic Stability ............................................................................................................. 6

Food Insecurity................................................................................................................... 7

Educational Attainment .................................................................................................. 9

Child Abuse/Mistreatment ............................................................................................ 11

Foster Care ....................................................................................................................... 12

Healthy Care ................................................................................................................... 13

Mental and Emotional Well-Being ............................................................................... 13

Lead-Free Living .............................................................................................................. 13

Health Insurance ............................................................................................................. 14

Chronic Disease Management .................................................................................... 15

Healthy Behavior ............................................................................................................. 16

Healthy Eating/Healthy Weight .................................................................................... 16

Oral Health ....................................................................................................................... 17

Injury Free Living .............................................................................................................. 18

Data Tables ...................................................................................................................... 19

References ....................................................................................................................... 22


INTRODUCTION Children ages 4 to 11 are both vulnerable and dependent as a population and highly influenced by a range of factors, including parents, caregivers, schools, media, and public policies. During early and middle childhood, developmental advances establish children’s sense of identity and allow them to make strides toward adolescence and eventually adulthood by becoming competent, independent, self-aware, and involved in the world beyond their families. It is a time of dramatic biological and cogni-tive change, as well a time when children develop skills for building healthy social relationships and habits, laying the groundwork for a healthy adulthood. These ages, more than any other developmen-tal period, set the stage for future health behavior as children develop health literacy, acquire self-discipline, and learn how to make good decisions about risky situations, eating habits, and negotiating conflict. To date, public health has played a vital role in the health of this age group, making such notable ad-vances as implementing successful immunization programs, contributing to reductions in blood lead levels, and helping to reduce the rates of dental caries through water fluoridation. Any strategic focus should address the whole child and recognize the developmental nature of children’s health and how the interdependence of health conditions can improve children’s health status and the future health and well-being of the entire population. While children aged 4 to 11 have the lowest mortality rate of any life stage, these children experience conditions and illnesses that can severely limit their ability to learn, grow, and play. An approach to early and middle childhood health must cover more than the leading causes of death. There are im-portant health conditions in this age group that have high morbidity: child maltreatment, asthma, obe-sity, dental caries, and developmental and behavioral disorders. While not typically fatal, these condi-tions still occur at rates that greatly affect children and the adolescents and adults that they will be-come. Improving child health lays the groundwork for optimal health during childhood and throughout the lifespan. Many of the leading causes of death for adults can be linked to childhood health, behaviors, and environments. Health risk behaviors related to the use of tobacco, alcohol, and other drugs are often initiated in childhood and contribute to poor health and the premature death of adults. Health promotion behaviors begun in childhood such as physical activity, good nutrition, self-regulation, safe-ty practices, and hygiene including hand washing to prevent infectious disease contribute to short- and long-term health.

“It is in the national interest to

have healthy children. Healthy

children are more ready and

able to learn and, in the long-

er term, are more likely to be-

come healthy adults who will

contribute as a productive citi-

zenry and workforce to the

continued vitality of society.”

- National Research Council, 2004


KEY FINDINGS

Healthy Care Mortality rates for children ages 5 to 14 years in Madison County increased from 7.7 per 100,000 to 8.3 per 100,000 between 2004-2006 and 2008-2010 whereas NYS as a whole decreased from 12.5 per 100,000 to 11.7 per 100,000 during the same time period.

The asthma hospitalization rate for children ages 5 to 14 years in Madison County increased from 5.8 per 10,000 (2004-2006) to 9.9 per 10,000 (2008-2010) but is less than NYS (23.4 to 20.9).

The percent of third grade children with at least one dental visit in the last year decreased from 86.0% to 81.2% between 2002-2004 and 2008-2010 whereas NYS as a whole increased from 73.4% to 83.4% during the same time period.

Healthy Behaviors

The percent of third grade children that reported taking fluoride tablets on a regular basis in-creased from 48.4% to 79.8% between 2002-2004 and 2008-2010 which is greater than NYS as whole (19.1% to 41.9%) during the same time period. The percent of third grade children with dental caries experience increased from 46.0% to 74.4% between 2002-2004 and 2008-2010 whereas NYS as a whole decreased from 54.1% to 45.4%.

The percent of third grade children receiving dental sealants increased from 38.4% to 71.1% be-tween 2002-2004 and 2008-2010 whereas NYS as a whole increased from 27.0% to 41.9%.

The percent of third grade children with untreated caries increased from 10.5% to 24.6% be-tween 2002-2004 and 2008-2010 whereas NYS as a whole decreased from 33.1% to 24.0%.

The unintentional injury mortality rates for ages 0 to 19 years in Madison County decreased from 12.2 per 100,000 to 10.4 per 100,000 between 2004-2006 and 2008-2010 but it is greater than NYS as a whole (7.5 per 100,000 to 6.1 per 100,000 during the same time period).

Healthy Environment Incidence of children less than 6 years old with confirmed blood lead levels greater or equal to 10 decreased from 10.5 per 1,000 to 8.4 per 1,000 in Madison County and is less than NYS as a whole.

Key

Indicates a favorable status compared to New York State

and/or when compared to Madison County’s previous data.

Indicates an unfavorable but similar status compared to

New York State and/or when compared to Madison County’s

previous data (difference within 10%).

Indicates an unfavorable and worse status compared to New

York State and/or when compared to Madison County’s pre-

vious data (difference greater than 10%).


7,126

6,816

6,076

5,200

5,600

6,000

6,400

6,800

7,200

7,600

1990 2000 2010

Year

Madison County Population for ages 5 to 11 years

Figure 1

Source: U.S. Census Bureau, 1980, 1990, 2000, 2010. http://www.census.gov/. Accessed: June 3, 2013.

DEMOGRAPHICS AND SOCIAL DETERMINANTS OF HEALTH

Children ages 4 to 11 years represent 9.4% of the population in Madison County. The population of Madison County’s children declined over the past 20 years. The population for children ages 5-11* years in 1990 was 7,126, representing 10.3% of the county’s population. In 2010 there were 6,880 chil-dren (9.4% of population). This represents a 3.5% decrease in the number of children ages 4-11 years.1

TABLE 1 Total Percent of Population Male Female

Total 73,442 100.0% 36,064 37,378

0-18 17,645 24.0% 8,923 8,722

4 to 11 6,880 9.4% 3,475 3,405

4 years 808 1.1% 419 389

5 years 777 1.1% 403 374

6 years 798 1.1% 415 383

7 years 827 1.1% 393 434

8 years 840 1.1% 412 428

9 years 925 1.3% 481 444

10 years 930 1.3% 474 456

11 years 975 1.3% 478 497

Madison County Children, 2010

Source: U.S. Census Bureau, 2010, Accessed 6/3/13

http://www.census.gov/


16.9

12.8

7.4

0.0

4.0

8.0

12.0

16.0

20.0

US NYS Madison County

Child Mortality Rate for children 10 to 14 years (per 100,000 population), 2008-2010

Figure 3

Source: Healthy People 2020, U.S. Department of Health & Human Services; Vital Statistics, New York State Department of Health, http://www.health.ny.gov/statistics/chac/indicators/cah.htm.

Mortality and Morbidity

The top five leading causes of death for chil-dren ages 1 to 9 years in Upstate New York are unintentional injury, malignant neoplasms, con-genital anomalies, homicide and diseases of the heart. Most injuries are predictable and poten-tially preventable. Healthy People 2020 objec-tives call for a national reduction in the child and adolescent mortality rate to no more than 12.3 per 1,000 live births for the age group 5 to 9. Nationally, motor vehicle injury remains the leading killer of children in this age group, ac-counting for 25% of deaths.2

13.7

10.2

17.2

0.0

4.0

8.0

12.0

16.0

20.0

US NYS Madison County

Child Mortality Rate for children 5 to 9 years (per 100,000 population), 2008-2010

Figure 2

Source: Healthy People 2020, U.S. Department of Health & Human Services; Vital Statistics, New York State Department of Health, http://www.health.ny.gov/statistics/chac/indicators/cah.htm. February 5, 2013

Mortality rates for children ages 5 to 14 years in Madison County increased 7.7 per 100,000 to 8.3 per 100,000 be-tween 2004-2006 and 2008-2010 whereas NYS as a whole decreased from 12.5 per 100,000 to 11.7 per 100,000 during the same time period.

Key Health Issues in Childhood

Mental and Emotional

Well-Being

Asthma

Overweight

Oral health

Unintentional injuries


Leading Causes of Death, Ages 5-14, New York State, 2009-2011

TABLE 3 2011 2010 2009

Total 266 254 276

Cancer 64 59 52

Unintentional Injury 43 64 60

Birth Defects 22 17 15

Heart Disease 17 NA 13

Suicide 13 NA NA

Homicide and Legal Intervention 13 14 14

Chronic Lower Respiratory Disease NA 15 NA

Source: Vital Statistics. New York State Department of Health - Bureau of Biometrics and Health Statistics. http://www.health.ny.gov/statistics/leadingcauses_death/gender.htm. Accessed: November 27, 2013

ED Utilization that Involved Injuries, Ages 5-14 Years, Madison County, 2009

TABLE 2 Number Rate per 1000

population

Total 1077 123.0

Treat and Release 1064 121.5

Superficial injury; contusion 337 38.5

Sprains and strains 216 24.7

Open wounds 202 23.1

Fracture of limb 141 16.1

Other injuries and conditions due to external causes 110 12.6

Intracranial injury 24 2.7

Poisoning by nonmedicinal substances 12 1.4

Skull and face fractures 12 1.4

Burns 10 1.1

Hospitalized 13 1.5

Fracture of limb 5 0.6

Open wounds of extremities 1 0.1

Other injuries and conditions due to external causes 2 0.2

Other fractures 1 0.1

Skin and subcutaneous tissue infections 1 0.1

Crushing injury or internal injury 1 0.1

Skull and face fractures 1 0.1

Source: NYSDOH SPARCS, 2009

Most (83%) Madison County children

0 to 4 years seen in the Emergency

Department for injuries are treated

and released. The majority (84%) of

which are superficial injuries, sprains

and strains, open wounds, and frac-

tured limbs.3

http://www.health.ny.gov/statistics/leadingcauses_death/gender.htm



Figure 5

Source: Council on Children and Families, Kids’ Wellbeing Indica-tors Clearinghouse (KWIC), www.nyskwic.org

Economic Stability The poverty rate measures the percentage of children living in families considered to have too little income to meet basic needs. Poverty in childhood is associated with a wide range of social, educa-tional, health and future employment problems. Research has documented that children from low-income families are more likely than others to go without necessary food; less likely to be in good

preschool programs; more likely to be retained in grade; and more likely to drop out of school.14

The percent of children and youth living below poverty has increased from 13.8% in 2007 to 17.5% in 2011.

Figure 4

Source: US Census, American Community Survey, 2011. Accessed: February 6, 2013.

The percent of children receiving public assistance is a measure of the extent to which children are dependent on govern-ment aid to meet their basic economic needs. The percent of children receiving food stamps measures the extent to which children live in families that require gov-ernmental assistance to purchase a mini-mally adequate diet.15 Supplemental Se-curity Income (SSI) benefits are intended to meet the basic economic requirements of children with special needs, not to pro-vide specialized services that may be re-quired by disabled children.16

The per-centage of students participating in the School Lunch Program is an indicator of student poverty and its concentration in public schools. It provides low-income chil-dren with access to nutrition and, in turn, promotes learning readiness and healthy eating habits.

The percentage of children receiving public assistance increased from 1.4% in 2007 to 2.7% in 2011.


Food Insecurity

Food insecurity is described as “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways”. Households are considered to be food insecure if their members ex-perience three or more indications of food insecurity

in the last 12 months.17

The percent of food insecure households in Madi-son County has increased by 38.5% from 1999-2001 to 2009-2011.

The percentage of children and youth receiving food stamps increased from 13.6% in 2007 to 21.4% between 2008-2010 but is less than NYS as a whole (48.9% to 52.4%) during the same time period.

The percentage of children receiving free or re-duced price school lunches in Madison County increased from 34.4% during the 2006-2007 school year to 39.8% during the 2009-2010 school years but is less than NYS as a whole (48.9% to 52.4%) during the same time period.

Although food insecurity has the potential to lead to negative health and other outcomes for individuals across the age spectrum, food insecurity can be par-ticularly devastating among children due to their in-creased vulnerability and the potential for long-term consequences.

Children who are food insecure are more likely to:

require hospitalization.17

have poorer physical health, which may prevent them from fully engaging in dai-ly activities such as school.18

be at risk for chronic health conditions such as anemia and asthma. 19

have oral health problems.19

be at greater risk of truancy and school tardiness.20

exhibit behavior problems including: fighting, hyperactivity, aggression, anxie-ty, mood swings, and bullying.21

Source: Feeding America, Map the Gap, www.feddingamerica.org/mapthegap, 2010. Accessed: June 12, 2013

19.1%

of the county’s children

Figure 6

Source: USDA Economic Research Service (ERS) Food Environment Atlas, 2011, http://maps.ers.usda.gov/Food Atlas. Accessed: June 12, 2013

Figure 7


Source: USDA Economic Research Service (ERS) Food Environment Atlas, 2011, http://maps.ers.usda.gov/Food Atlas. Accessed June 12, 2013.

Figure 8

SNAP participation has increased as well as benefits per capita. Howev-er the WIC program has stable en-rollment but reduced benefits per capita. A growing body of research suggests a protective effect of SNAP participation on obesity risk. It indirectly protects health by re-ducing food insecurity, improving dietary quality, and lowering rates of nutritional deficiencies as com-pared to low-income persons that do not participate in SNAP.23

SNAP and WIC Profile for Madison County, 2011

TABLE 4 2008 2011

Percent Change

SNAP

SNAP participants (% of pop) 11.9 15.4 4%

SNAP-authorized stores 41 50 22%

SNAP benefits per capita $9.44 $15.37 63%

SNAP redemptions/SNAP-authorized stores $163,594 $276,496 69%

WIC

WIC participants (% of pop) 2.7 2.6 -0.02%

WIC-authorized stores 13 12 -8%

WIC redemptions per capita $15.55 $12.71 -18%

WIC redemptions/WIC-authorized stores $83,860 $77,728 -7%

Source: Council on Children and Families, Kids’ Wellbeing Indicators Clearinghouse (KWIC), www.nyskwic.org. Accessed: February 10, 2013.

http://www.nyskwic.org


Educational Attainment There is a clear association between education and health even after controlling for job characteristics, income, and family background. Better educated individuals are less likely to self-report a past diag-nosis of an acute or chronic disease, to die from the most common acute and chronic diseases, and to report anxiety or depression. Education levels have been linked to a reduced risk of heart disease and diabetes. An additional four years of education low-ers the probability of reporting being in fair or poor health and reduces lost days of work to sickness by 2.3 days per year.

Achievement is very sensitive to attendance, and even two weeks (10 days) during one school year matters. Attendance also strongly affects standardized test scores, academic performance, gradua-tion rates, and dropout rates. In poor rural areas, one in four students miss at least a month’s worth of school. Chronic absenteeism is most prevalent in low-income students and widens achievement gaps.24 Preschool: Studies have found the long-term benefits of quality preschool to include: reduction in grade repetition and special education placement, increased achievement scores and graduation rates, increased adult economic and social success, less frequent smoking and drug use, and reduced participation in crime and delinquency. While these findings are most pronounced among disadvan-taged populations, benefits in math and language learning are found in children across all races and income brackets.25 Research has shown returns between $10 and $16 for each dollar invested in ear-ly childhood education. Local and state costs related to schooling, crime and health care are de-creased by addressing child and family needs before students fall too far behind.26

Figure 9

Source: New York State Department of Education, School Report Cards, 2010-2011, https://reportcards.nysed.gov; Council on Children and Families, Kids’ Wellbeing Indicators Clearinghouse (KWIC), www.nyskwic.org. Accessed February 12, 2013


Assessments are offered in English Language Arts (ELA) and in math at the elementary and middle-school levels. Tests are used to determine accountability for schools and districts. The assessments are based on state learning standards. Students are considered to be proficient if they are achieving at a level 3.

Although Madison County children are performing above NYS as a whole, performance for English Language Arts and Math has decreased for all grade levels since 2006-2007.

Figure 10

Source: Council on Children and Families, Kids’ Wellbeing Indicators Clearinghouse (KWIC), www.nyskwic.org. Accessed: February 12, 2013

Figure 11

Source: Council on Children and Families, KWIC, www.nyskwic.org. Accessed February 12, 2013


Figure 12

Child Abuse/Maltreatment Children may suffer from child abuse and maltreatment regardless of their socioeconomic status, race or ethnic backgrounds. There are short-term and long-term negative consequences related to child abuse and maltreatment, including adverse health effects, lower educational attainment, and delayed social and behavioral development. Persistent stress resulting from child maltreatment for young children can disrupt early brain development and impair development of the nervous and im-mune response systems. Incidents of abuse and maltreatment most frequently occur in the victims' own home and are perpe-trated by someone they know. In addition to the immediate trauma of abuse and neglect on chil-dren, some of the long-term consequences for the children, families, and society, include:

Physical: Chronic health problems, broken bones, brain trauma or even death. Psychological: Emotional effects including fear, inability to trust, depression, anxiety, and diffi-culties in forming relationships. Behavioral: Increased risk of delinquency, teen pregnancy, low academic achievement, sub-stance abuse, to be arrested as a juvenile and involved in adult or violent crime, and to eventual-ly victimize their own children. Societal: The direct costs (e.g. law enforcement, child welfare system and healthcare costs) and indirect costs (e.g. juvenile and adult criminal activity) were estimated at more than $94 billion per year for the United States and more than $2.4 billion per year for New York State.27

The number of indicated reports of child abuse and maltreatment is an important measure of its inci-dence. However, it should be noted that the rate of indicated reports is affected by a number of fac-tors other than the actual incidence of abuse and maltreatment. Therefore, some caution is required in drawing conclusions.

Rates of child abuse/maltreatment decreased from 27.5 per 1,000 in 2007 to 21.4 per 1,000 from 2008-2010 which remains greater than NYS as a whole during the same time period (16.2 per 1,000 to 18.6 per 1,000).

The percent of child abuse/maltreatment indicated on reports of child abuse / maltreatment decreased from 29.6% in 2007 to 23.0% from 2008-2010 whereas NYS as a whole decreased from 32.4% to 30.4% during the same time period.

Source: Council on Children and Families, Kids’ Wellbeing Indicators Clearinghouse (KWIC), www.nyskwic.org. Accessed: February 12, 2013


Foster Care Children are placed into foster care for a wide variety of reasons includ-ing: safety issues, families that are at least temporarily unable to care for them, a need for specialized care or treatment behavioral problems that lead to a placement. Regardless of the type of placement a child is in, placement in foster care presents children with change and loss (e.g. loss of parents, siblings, school, friends and community). Many chil-dren face multiple placements, which force children to enter and leave multiple relationships at a time in their development when consistency and stability are paramount. Many children entering the child welfare system have been exposed to developmental and health risk factors, including, poverty and substance abuse, and parental neglect and abuse. Societal and familial risk factors, including parental incarceration and HIV/AIDS, are also related to children enter-ing the system.28 These risk factors tend to coexist and interact, presenting a complex family dynamic and a complicated set of service needs. Compared to the general child population, children involved in the child welfare system are more likely to have physical, learning and mental health conditions that limit their daily activities, to be living in high-risk parental care and to be living in households with incomes below poverty.29

Figure 13

Source: Council on Children and Families, Kids’ Wellbeing Indicators Clearinghouse (KWIC), www.nyskwic.org. Accessed February 12, 2013


HEALTHY CARE

Mental and Emotional Well-Being Mental health is a key component in a child’s healthy development. The onset of major mental illness may occur as early as 7 to 11 years old, and roughly half of all life-time mental health disorders start by the mid-teens. Risk factors that increase the likelihood of mental health problems in-clude receiving public assistance, having unemployed or teenage parents, or being in the foster care system. Children with mental health problems have lower educational achievement, greater involvement with the criminal justice system, and fewer sta-ble and longer-term placements in the child welfare system than their peers. Children with mental health problems are more likely to experience problems at school, be absent, or be suspended or ex-pelled than are children with other disabilities. When treated, children with mental health problems fare better at home, in schools, and in their communities.6

According to Madison County Department of Mental Health utilization da-ta, 9.9% of those receiving services are between the ages of 6 to 10 years, and 14.1% are between the ages of 11 to 14 years of age. Of children under the age of 18 seeing a psychiatrist, 39.7% are younger than 12 years old.

Children in Madison County represent 19.9% of the Medicaid mental health consumer population. All of these children (32) were diagnosed with severe emotional disturbance. All receive supportive services. Twenty-nine per-cent (29%) of these children are on 3 or more psychotropic medications for more than 90 days.

Medicaid expenditures in Madison County are mostly for outpatient services (64%), but also in-clude residential services (23%), and case management (13%).

Figure 14

Source: County Profiles, New York State Office of Mental Health, http://bi.omh.ny.gov/cmhp/mh-services. Accessed February 5, 2013

Lead-Free Living Lead is a highly toxic metal that was used for many years in products found in and around our homes. Most children who have elevated levels of lead in the blood do not have any symptoms. When symp-toms, such as stomach ache, poor appetite, and irritability appear they are often confused with other childhood illnesses. The long-term effects of elevated blood lead levels in children may include slow de-velopment, reduced IQ scores, learning disabilities, hearing loss, reduced height, and hyperactivity.10 Exposure to lead affects people of all socioeconomic backgrounds, but children living in poverty are at the greatest risk. Lower income families are more likely to live in older houses that are more likely to have lead paint and hazards. Homes built before 1950 most commonly contain lead-based paint. Near-ly 40% of homes in Madison County were built before 1950 and 60% before 1970.11

The incidence of children less than 6 years old with confirmed blood lead levels greater or equal to 10 decreased from 10.5 to 8.4 per 1,000 in Madison County (2002 - 2003 and 2009-2011, respective-ly) while during the same period, NYS decreased from 13.3 to 5.3 per 1,000.


Health Insurance Health insurance is key to assuring children’s access to appropriate and necessary health care and preventive services. Research shows that uninsured children are more likely to lack a consistent source of care, to go without needed care, and to experience worse health outcomes than insured children.12

The percent of insured children ages 0-17 has increased since 2008 from 90.1% to 94.2%.

The percent of third grade children with dental insurance increased from 80.0% to 93.6% between 2002-2004 and 2008-2010 whereas NYS as a whole increased from 80.1% to 81.8% during the same time peri-od .

Percent of Insured Children (ages 0-17 years), 2010

Figure 15

Source: Data and Statistics, New York State Department of Health, http://www.health.ny.gov/statistics/chac/indicators/ses.htm. Accessed: February 5, 2013

Figure 16

Source: Bureau of Dental Health Data, New York State Department of Health, http://www.health.ny.gov/statistics/chac/indicators/ora.htm. Accessed June 10, 2013

Children with special health care needs (CSHCN) are defined by the Department of Health and Human Services as: “those who have or are at increased risk for a chronic phys-ical, developmental, behavioral, or emotional condition and who also require health and re-lated services of a type or amount beyond that required by children generally.” Children’s ac-cess to needed health and support services is influenced by the availability and adequacy of health insurance coverage. CSHCN are more likely than the population of children as a whole to have insurance. However, one-third (34.3 percent) of those insured report that this insurance is not always adequate to meet their children’s needs, either because the benefits do not meet their needs, the charges are not reasonable, or they do not have access to the specialist they need.13


Chronic Disease Management

Asthma is one of the most common chronic diseases in childhood. Without effective management, asthma can have serious negative consequences for the health and functioning of involved children. Effective management in-cludes control of exposure to environ-mental factors that trigger exacerba-tions, adequate pharmacological treat-ment, continual monitoring of the dis-ease and patient (or parent) education. Traditionally, high asthma hospitaliza-tion rates have been an indication of problems with access to or utilization of primary health care that provides such management.7

The asthma hospitalization rate for children ages 5 to 14 years in Madison County increased from 5.8 per 10,000 (2004-2006) to 9.9 per 10,000 (2008-2010) but is less than NYS as a whole (23.4 to 20.9) during the same time period.

Figure 17

Source: Data and Statistics, New York State Department of Health, http://www.health.ny.gov/statistics. Accessed: June 5, 2013


Figure 18

Source: Student Weight Status Category Reporting System Data, New York State Department of Health, http://www.health.ny.gov/statistics/chac/indicators/cah.htm. Accessed: March 15, 2013

HEALTHY BEHAVIOR

Healthy Eating & Healthy Weight Good nutrition is important to the growth and development of children. Immediate health effects of poor nutrition and diet include: high cholesterol or high blood pressure; pre-diabetes; bone and joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem. Long-term health effects: obese as adults and therefore more at risk for heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis.8

Height and weight measurements for children between Pre-K and twelfth grade are being meas-ured and BMI values calculated among students from participating schools.

In 2009 Morrisville State College study found that 41.1% of children ages 2 to 11 surveyed in Madi-son County were overweight or obese in 2008-2009.


Oral Health Tooth decay (dental caries) affects children in the United States more than any other chronic disease. Untreated tooth decay causes pain and infections that may lead to problems with eat-ing, speaking, playing, and learning. The good news is that tooth decay and other oral diseases that can affect children are preventable. The combination of dental sealants and fluoride has the potential to nearly eliminate tooth decay in school-age children.

The percentage of third grade chil-dren that reported taking fluoride tablets on a regular basis increased from 48.4% to 79.8% between 2002-2004 and 2008-2010 which is greater than NYS as whole (19.1% to 41.9%) during the same time period.

The percentage of third grade chil-dren with a dental caries experience increased from 46.0% to 74.4% be-tween 2002-2004 and 2008-2010 whereas NYS as a whole decreased from 54.1% to 45.4% during the same time period.

The percentage of third grade children with dental sealants increased from 38.4% to 71.1% be-tween 2002-2004 and 2008-2010 whereas NYS as a whole increased from 27.0% to 41.9% during the same time period.

The percentage of third grade children with untreated caries increased from 10.5% to 24.6% be-tween 2002-2004 and 2008-2010 whereas NYS as a whole decreased from 33.1% to 24.0% during the same time period.

Source: Bureau of Dental Health Data, New York State Department of Health, http://www.health.ny.gov/statistics/chac/indicators/ora.htm. Accessed: June 10, 2013

Figure 19

Source: Bureau of Dental Health Data, New York State Department of Health, http://www.health.ny.gov/statistics/chac/indicators/ora.htm. Accessed: February 5, 2013

Figure 20


Injury Free Living Unintentional injury is the leading cause of death for children and is highly preventable. In public health, unintentional injuries are characterized as predictable and preventa-ble if the proper safety measures are in place. Not only do unintentional injuries cause significant morbidity and mortality among children, but they cost society a great deal of money. Unintentional injuries cost $14 billion in lifetime medical spend-ing, $1 billion in other resource costs, and $66 billion in present and future work is-sues. Associated risk factors include age, gender, psychosocial disorders, low socioeconomic status, temperament , parents did not com-plete high school, parents are unmarried or single, and children without co-resident fa-thers.9

Injuries that cause hospitalization may re-sult in temporary or permanent disability. On a three year average, the rate of hospi-talizations for children/youth birth to 19 years of age is less in Madison County than in NYS.

Figure 21

Source: Data and Statistics, New York State Department of Health, http://www.health.ny.gov/statistics. Accessed February 5, 2013

Figure 22

Source: Data and Statistics, New York State Department of Health, http://www.health.ny.gov/statistics. Accessed February 5, 2013


DATA TABLES

Social Determinates of Health Data Years

Madison County

New York State

Data Years Madi-

son County

New York State

Sta-tus

Child Abuse/Maltreatment - Children/Youth Indi-cated in Reports of Abuse/Maltreatment 2007 27.5 16.2 2008-2010 21.4 18.6

Child Abuse/Maltreatment - Indicated Reports of Child Abuse and Maltreatment (%) 2007 29.6 32.4 2008-2010 23.0 30.4

Children and Youth Living Below Poverty (%) 2005 13.8 19.7 2011 17.5 22.8

Children and Youth Receiving Public Assistance (%) 2007 1.4 6.4 2011 2.7 7.0

Children and Youth Receiving Supplemental Security Income (%)

2007 1.2 1.7 2011 1.2 2.1 ~

Children Receiving Free or Reduced-price School Lunch- Public Schools (%) 2006-2007 34.4 48.9 2008-2010 39.8 52.4

Children and Youth Receiving Food Stamps (%) 2007 13.6 17.1 2008-2010 21.4 27.5

Foster Care Admissions - Children/Youth Admit-ted to Foster Care 2007 4.5 2.9 2011 2.1 2.6

Foster Care Adoption Milestone - Children/Youth Discharged to Adoption (%) 2007 22.2 40.2 2011 75.0 43.3

Foster Care Adoption Milestone - Children/Youth Freed for Adoption (%) 2007 3.0 5.3 2011 3.3 5.9

Foster Care Adoption Milestone - Children/Youth with Adoption Goal Set (%) 2004 8.1 2011 8.1 7.4 ~

Foster Care Children In Care - Children/Youth 0-21 years 2007 3.7 4.9 2011 2.6 4.0

Foster Care Discharges - Children/Youth Dis-charged from Foster Care (%) 2007 38.4 33.7 2011 43.5 37.1

Foster Care TPR Judgments - other judgments (%) 2007 50.0 5.4 2011 0.0 5.0 ~

Foster Care TPR Judgments - Suspended Judg-ments (%) 2007 0.0 7.2 2011 0.0 8.1 ~

Foster Care TPR Judgments - Terminated Judg-ments (%) 2007 50.0 58.7 2011 100.0 52.7 ~

Foster Care TPR Judgments (%) 2007 0.0 30.7 2011 0.0 34.1 ~

Student Performance in English Language Arts - Public Schools - Grade 3 (%) 2006-2007 70.1 67.3 2011 62.8 55.9



Student Performance in Mathematics-Public Schools - Grade 3 (%) 2006-2007 86.2 85.3 2011 64.0 59.6



Student Performance in Science - Public Schools Grade 4 (%) 2006-2007 92.1 85.3 2011 93.1 88.5

Student Performance in Social Studies - Public Schools, Grade 5 (%) 2006-2007 89.1 78.3 2011 91.0 86.3

Missed days of school N/A N/A N/A 2011-2012 9.3 12.6

Enrollment of school-age students with disabili-ties on the first Wednesday in October N/A N/A N/A 2011-2012 12.0 N/A ~

% of 4 year-olds attending Pre-K N/A N/A N/A 2011-2012 13.0 31.0

% of Pre-K students with disability N/A N/A N/A 2011-2012 12.0 N/A ~

Students with Limited English Proficiency - Pub-lic and Non-Public Schools, percent students enrolled in Pre-K-grade 12

N/A N/A N/A 2010-2011 0.2 9.6 ~

Source: New York State Kids’ Well-being Indicators Checklist: http://www.nyskwic.org/get_data/county_report_detail.cfm?countyID=36053

http://www.nyskwic.org/get_data/county_report_detail.cfm?countyID=36053


Healthy Care

Data

Years Madison

County

New York State Data Years

Madison County

New York State Status

Healthy Eating & Healthy Weight Percent of elementary students that are overweight but not obese (85th-less than 95th percentile) N/A N/A N/A 2008-2010 10.7 N/A ~ Percent of elementary students that obese (95th percentile or higher ) N/A N/A N/A 2008-2010 16.1 N/A ~ Percent of elementary students that are overweight or obese (85th percentile or higher) N/A N/A N/A 2008-2010 26.8 N/A ~ Percent of obese children (>95th percentile) for K N/A N/A N/A 2008-2010 N/A 13.0 ~ Percent of obese children (>95th percentile) for 2nd grade N/A N/A N/A 2008-2010 N/A 17.0 ~ Percent of obese children (>95th percentile) for 4th grade N/A N/A N/A 2008-2010 N/A 17.0 ~ Percent of overweight but not obese children (85th - <95th percentile) for Pre-K to 4th grade N/A N/A N/A 2008-2010 10.7 N/A ~ Percent of overweight or obese children (85th percentile and higher) for Pre-K to 4th grade N/A N/A N/A 2008-2010 26.8 N/A ~ Healthy Teeth Percent of Medicaid enrollees ( 2-20) who had at least 1 dental visit within the last year N/A N/A N/A 2008-2010 36.9 40.8

Percent of 3rd grade children reported taking fluoride tablets on a regular basis 2002-2004 48.4 19.1 2008-2010 79.8 41.9 Percent of 3rd grade children with at least one dental visit in last year 2002-2004 86.0 73.4 2008-2010 81.2 83.4 Percent of 3rd grade children with caries experience 2002-2004 46.0 54.1 2008-2010 74.4 45.4 Percent of 3rd grade children with dental sealants 2002-2004 38.4 27 2008-2010 71.1 41.9 Percent of 3rd grade children with untreated caries 2002-2004 10.5 33.1 2008-2010 24.6 24.0

Injury Free Living Unintentional injury mortality rate for 0-19 year olds 2004-2006 12.2 7.5 2008-2010 10.4 6.1 Unintentional Injuries - Hospitalizations 0-19 years, rate/100,000 children/youth ages birth-19 years N/A N/A N/A 2010 187.4 259.3

Healthy Behaviors

Source: Madison County Health Assessment Indicators http://www.health.ny.gov/statistics/chac/chai/chai_25.htm.

Data Years

Madison County

New York State Data Years

Madison County


Primary & Preventive Care

Mortality rates for children (5-14 years) 2004-2006 7.7 12.5 2008-2010 8.3 11.7

Mortality for ages 10-14 (per 100,000) N/A N/A N/A 2008-2010 7.2 13.3

Chronic Disease Management

Asthma – Hospitalizations 5-14 years 2004-2006 5.8 23.4 2008-2010 9.9 20.9

Asthma ED visits for ages 5 to 14 N/A N/A N/A 2008-2010 531 69,115 Diabetes prevalence for ages 6 to 17 (per 10,000) N/A N/A N/A 2008-2010 1.0 3.0

Insurance Coverage Percent of children without health insurance coverage N/A N/A N/A 2010 94.2 94.9

Percent of 3rd grade children with dental insurance 2002-2004 80.0 80.1 2008-2010 93.6 81.8


http://www.health.ny.gov/statistics/chac/chai/chai_25.htm



Data Year Madison

New York State Data Year Madison


Mental & Emotional Well-being

Percent of Children (0-17)with Medicaid with Severe Emotional Disturbance NA NA NA 2008-2010 19.9% 22.4%

Emergency Mental Health Service Use among Children aged 0 to 17 NA NA NA 2008-2010 0 2.2 ~

Inpatient Mental Health Service Use among Children aged 0 to 17 NA NA

2008-2010 0 4.3 ~

Outpatient Mental Health Service Use among Children aged 0 to 17 NA NA NA 2008-2010 0 6.5 ~

Residential Mental Health Service Use among Children aged 0 to 17 NA NA NA 2008-2010 0 0.7 ~

Support Mental Health Service Use among Children aged 0 to 17 NA NA NA 2008-2010 2.0 1.7 ~


Data Year Madison

New York State Data Year Madison


Percentage of children that had at least one lead screening by age 36 months 2004 80.8 82.8 2008-2010 86.8 85.3 Incidence of children < 72 months with confirmed blood lead level >= 10 (per 100 tested), per 1,000 2003-2005 1.1 1.3 2008-2010 25.3 15.8 Percent of children born in 2007 with lead screening by 9 months NA NA NA 2008-2010 0.6 6.8

Percent of children born in 2007 with at least 2 led screenings by 36 months NA NA NA 2008-2010 43.7 52.9

Percent of children born in 2007 with a lead screening by 18 months NA NA NA 2008-2010 75.5 69.5

Healthy Environments


Key

Indicates a favorable status compared to New York State and/or when compared to

Madison County’s previous data.

Indicates an unfavorable but similar status compared to New York State and/or when

compared to Madison County’s previous data (difference within 10%).

Indicates an unfavorable and worse status compared to New York State and/or when

compared to Madison County’s previous data (difference greater than 10%).

~ Neither favorable nor unfavorable; comparison unavailable




REFERENCES 1 U.S. Census Bureau. 1980, 1990, 2000, 2010. http://www.census.gov/. Accessed: June 3, 2013. 2 Vital Statistics, New York State Department of Health, http://www.health.ny.gov/statistics/chac/indicators/cah.htm. Accessed: February 5, 2013. 3 Vital Statistics. New York State Department of Health - Bureau of Biometrics and Health Statistics. http://www.health.ny.gov/statistics/leadingcauses_death/gender.htm. Accessed: November 27, 2013 4 CDC. Lead: What Do Parents Need to Know to Protect Their Children? http://www.cdc.gov/nceh/lead/ACCLPP/blood_lead_levels.htm. Accessed: May 2, 2013. 5 New York State Department of Health. Childcare Programs and School Requirements. http://www.health.ny.gov/prevention/immunization/schools/. Accessed: November 27, 2013. 6 Stagman S and Cooper JL. (2010). National Center for Children in Poverty. Children’s Mental Health: What Every Policymaker Should Know. http://www.nccp.org/publications/pub_929.html. June 12 2013. 7 CDC. Asthma. http://www.cdc.gov/asthma/faqs.htm. Accessed: June 12 2013. 8 CDC. Basics of Childhood Obesity. http://www.cdc.gov/obesity/childhood/basics.html. Accessed: June 12, 2013. 9 Schwebel, DC and J Gaines. “Pediatric Unintentional Injury: Behavioral Risk Factors and Implications for Preven-tion.” Journal of Developmental and Behavioral Pediatrics. 28.3 (June 2007): 245-254. 10 CDC. Lead: What Do Parents Need to Know to Protect Their Children? http://www.cdc.gov/nceh/lead/ACCLPP/blood_lead_levels.htm. Accessed: May 2, 2013. 11 U.S. Census Bureau, 2010-2012 American Community Survey. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_12_3YR_DP04&prodType=table. Accessed: May 2, 2013. 12 Garfield, Rachel and Paradise, Julia. Kasier Family Foundation. What is Medicaid's Impact on Access to Care, Health Outcomes, and Quality of Care? Setting the Record Straight on the Evidence. April 2013. http://kff.org/report-section/what-is-medicaids-impact-on-access-to-care-health-outcomes-and-quality-of-care-setting-the-record-straight-on-the-evidence-issue-brief/. Accessed: June 15, 2013. 13 National Survey of Children with Special Health Care Needs. NS-CSHCN 2009/10. Data query from the Child and Adolescent Health Measurement Initiative, Data Resource Center for Child and Adolescent Health website: www.childhealthdata.org. Accessed: June 15, 2013. 14 Stagman S and Cooper JL. (2010). National Center for Children in Poverty. Children’s Mental Health: What Every Policymaker Should Know. http://www.nccp.org/publications/pub_929.html. Accessed: June 12 2013. 15 http://www.nyskwic.org/get_data/indicator_narrative_details.cfm?numIndicatorID=3. Accessed: June 15, 2013. 16 http://www.nyskwic.org/get_data/indicator_narrative_details.cfm?numIndicatorID=2. Accessed: June 15, 2013 17 Cook, Frank, Leveson, Neault, Heeren, Black, Berkowitz, Casey, Meyers, Cutts, and Chilton (2006) Child food insecurity increases risks posed by household food insecurity to young children’s health. Journal of Nutrition, 136, 1073-1076.

http://www.census.gov/

http://www.health.ny.gov/statistics/chac/indicators/cah.htm

http://www.health.ny.gov/statistics/chac/indicators/cah.htm


http://www.health.ny.gov/prevention/immunization/schools/

http://www.health.ny.gov/prevention/immunization/schools/

http://www.nccp.org/publications/pub_929.html

http://www.cdc.gov/asthma/faqs.htm

http://www.cdc.gov/nceh/lead/ACCLPP/blood_lead_levels.htm

http://www.cdc.gov/nceh/lead/ACCLPP/blood_lead_levels.htm

http://www.nccp.org/publications/pub_929.html


18 Murphy, Wehler, Pagano, Little, Kleinman and Jellinek (1998) Relationship Between Hunger and Psychosocial Functioning in Low-Income American Children. Journal of American Academy of Child and Adolescent Psychiatry, 37 (2), 163-170. 19 Skalicky, Meyers, Adams, Yang, Cook, and Frank (2006) Child Food Insecurity and Iron Deficiency Anemia in Low-Income Infants and Toddlers in the United States. Maternal and Child Health Journal, 10 (2), 177-185. 20 Kirkpatrick, McIntyre, and Potestio (2010) Child hunger and long-term adverse consequences for health. Ar-chive of Pediatric Adolescent Medicine, 164 (8), 754-762. 21 Slopen, N., Fitzmaurice, G., Williams, D.R., & Gilman, S.E. (2010). Poverty, food insecurity, and the behavior of childhood internalizing and externalizing disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 49,444-452. 22 http://www.nyskwic.org/get_data/indicator_narrative_details.cfm?numIndicatorID=31. Accessed: June 13, 2013.

23 Hartline-Grafton, Heather, Vollinger, Ellen, and Weill, James. Food Research and Action Center. A Review of Strategies to Bolster SNAP’s Role in Improving Nutrition as well as Food Security. http://frac.org/wp-content/uploads/2011/06/SNAPstrategies.pdf. Accessed June 8, 2013. 24 Egerter, Susan et al. University of California, San Francisco, Center on Social Disparities in Health. Education Matters for Health. Issue Brief 6: Education and Health. September 2009. http://www.rwjf.org/content/dam/web-assets/2009/09/education-matters-for-health. Accessed June 18, 2013. 25 D'Onise K, Lynch JW, Sawyer MG, McDermott RA. Can preschool improve child health outcomes? A systematic review. Soc Sci Med. 2010 May;70(9):1423-40. 26 Missouri Department of Elementary and Seconday Eduacation. Benefits of Early Childhood Education: the Facts. March 2012. http://nowforlater.org/files/2013/03/The-Facts.pdf. Accessed: October 3, 2013. 27 http://www.nyskwic.org/get_data/indicator_narrative_details.cfm?numIndicatorID=26. Accessed June 10, 2013. 28 http://www.nyskwic.org/get_data/indicator_narrative_details.cfm?numIndicatorID=40. Accessed: June 10, 2013. 29 Simms, Mark D., Dubowitz, Howard, and Szilagyi, Moira A. Health Care Needs of Children in the Foster Care System. PEDIATRICS, Vol. 106 No. Supplement 3, October 1, 2000. pp. 909 -918. http://www.pediatricsdigest.mobi/content/106/Supplement_3/909.full. Accessed May 8, 2013.

http://www.nyskwic.org/get_data/indicator_narrative_details.cfm?numIndicatorID=26

http://www.nyskwic.org/get_data/indicator_narrative_details.cfm?numIndicatorID=40


For Report Information please contact:

Madison County Department of Health

www.healthymadisoncounty.org © 2013


PO Box 605 • Wampsville, NY 13163

Tel: 315‐366‐2361 • Fax: 315‐366‐2697

[email protected]

For Report Information please contact:


www.healthymadisoncounty.org © 2013


PO Box 605 • Wampsville, NY 13163

Tel: 315‐366‐2361 • Fax: 315‐366‐2697

[email protected]

Documents

3 - CHA Healthy Children