8. Children’s Health
Table 8‑1: Children's Health Summary Table
|
Measure |
County Data |
Recent Change |
U.S. Comparison |
IN Comparison |
HP 2010 |
||||
|
Yrs |
% Change |
DC |
U.S. Data |
DC |
IN Data |
DC |
|||
|
Positive Indicators for Marion County |
|||||||||
|
Maternal Smoking during pregnancy |
16.6% (2005) |
5 |
-21% |
C |
10.7% (2003) |
D |
17.9% (2005) |
DC |
16-7c <1% |
|
Neutral Indicators for Marion County |
|||||||||
|
% of 2 yr olds with complete immunizations* |
70.8% (2005) |
4 |
+21% |
DC |
77.% (2004) |
DC |
75.4% (2004) |
DC |
14-24a 80% |
|
Post-neonatal mortality per 1,000 births |
2.8 (2005) |
5 |
-7% |
DC |
2.6 (2002) |
DC |
2.3 (2005) |
DC |
16-1e 1.2 |
|
Neonatal mortality per 1,000 births |
7.2 (2005) |
5 |
+9% |
DC |
4.7 (2002) |
D |
5.5 (2005) |
D |
16-1d 2.9 |
|
Perinatal mortality per 1,000 births and fetal deaths |
11.2 (2005) |
5 |
-6% |
DC |
6.7 (2003) |
D |
NA |
|
16-1b 4.5 |
|
Low birth weight rate |
9.4% (2005) |
5 |
+9% |
DC |
8.2% (2005) |
D |
8.3% (2005) |
D |
16-10a 5.0% |
|
Women starting PNC in the 1st trimester |
71.7% (2005) |
5 |
-8% |
DC |
83.8% (2005) |
D |
79.9% (2005) |
D |
16-6a 90% |
|
Negative Indicators for Marion County |
|||||||||
|
Child mortality (1-14 yrs) per 100,000** |
53.9 (2006) |
6 |
+9.8% |
DC |
20.4 (2004) |
D |
24.5 (2005) |
D |
16-2a <18.6 *** |
|
Infant mortality per 1,000 births |
10.0 (2005) |
4 |
+33% |
D |
6.8 (2004) |
D |
8.0 (2005) |
D |
16-1c 4.5 |
|
% of high school students at risk for overweight (self-report) |
17.5% (2005) |
NA |
|
|
15.7% (2005) |
D |
14.3% (2005) |
D |
16-3b 5% |
|
% of overweight high school students (self-report) |
20.3% (2005) |
NA |
|
|
13.1% (2005) |
D |
15.0% (2005) |
D |
16-3b 5% |
* Complete immunization as defined by HP 2010 is the 4:3:1:3:3 series, excluding the varicella vaccine because it had not been recommended for universal administration for at least 5 years when the objectives were set; U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. Objective 14-24a. http://www.healthypeople.gov/document/html/objectives/14-24.htm; Marion County data for immunization coverage is from 2004.
** Marion County child mortality rate is from 2006.
*** HP 2010 splits child mortality into 2 intervals: The objective for children age 1-4 is 18.6/100,000; the objective for children 5-9 is 12.3/100,000. U.S. Department of Health and Human Services. Healthy People 2010. 2nd ed. Objectives 16-2a and 16-2b. http://www.healthypeople.gov/document/html/objectives/16-02.htm
Table notes: County data: Is for 2005 unless otherwise noted. Recent Change: Percent change of most recent measurement from a measurement the noted number of years prior. Changes of more than 5 percent in either direction are denoted by thumbs up or thumbs down symbolsthumbs up or thumbs down. Neutral thumbs indicate no change, even though no change may be a negative outcome; U.S. or IN population data: Is for most recent year available; U.S. (or IN) Comparison: Comparison of most recent data using thumbs up or thumbs down symbols to denote differences that are statistically significant or deemed to be noteworthy from the analysts’ professional perspective. Note: When there is no public health implication associated with a measure, directional arrows replace thumb icons to indicate the direction of change or the relationship of the Marion County measure (higher/lower/not different) to the U.S./IN measure.
Births
The total number of births to Marion County residents declined between 2004 and 2005, after steadily increasing from 2001 to 2004 (Table 8‑2). The number of births to Marion County resident Non-Hispanic White[228] mothers decreased every year between 2001 and 2005. The decline was shallowest from 2001 to 2002 (0.4%) and steepest between 2004 and 2005 (7.3%). While births to White mothers decreased, births to Hispanic mothers increased dramatically over the five-year period. Births to Hispanic mothers increased by almost 60 percent from 2001 to 2005, rising from 9.9 percent of all births in 2001 to 16 percent in 2005. The number of resident Black1 births fluctuated only slightly from 2001 to 2005.
Infant Mortality
Infant mortality is a common, internationally accepted indicator of the health status of a community, as it is influenced by factors such as a community’s access to primary care, general socioeconomic and educational status, and quality of housing, water and nutritional resources.[229]
The infant mortality rate is expressed as the number of infant deaths in a population per 1,000 live births in that same population. Small changes in the numbers of infant deaths can greatly influence the rate.
Improving the health status of mothers and infants has been a high priority for the Marion County health community for the past two decades. However, Marion County’s infant mortality rates have shown an upward trend in recent years. Nationally, rates have not risen, but have more or less stagnated since 2000 when the rate was 6.89 per 1,000. In 2004 the national infant mortality rate was 6.78.[230] The IMR in Marion County was 7.5 in 2000 and 10.5 in 2004. Among the 53 largest U.S. cities, Indianapolis had the 17th highest infant mortality rate in 2003.[231]
Table 8‑2: Number of Births, Infant Deaths, and Infant Mortality Rates* by Race, Marion County Residents, 2001-2005
|
Race/Ethnic Group |
Statistic |
2001 |
2002 |
2003 |
2004 |
2005 |
|
White (Non-Hispanic) |
Births |
8219 |
8187 |
8012 |
7851 |
7278 |
|
Infant Deaths |
49 |
55 |
59 |
60 |
58 |
|
|
Infant Mortality Rate |
6.0 |
6.7 |
7.4 |
7.6 |
8.0 |
|
|
Black (Non-Hispanic) |
Births |
3994 |
3917 |
3937 |
4025 |
3990 |
|
Infant Deaths |
50 |
62 |
62 |
72 |
57 |
|
|
Infant Mortality Rate |
12.5 |
15.8 |
15.7 |
17.9 |
14.3 |
|
|
Hispanic |
Births |
1382 |
1625 |
1820 |
1980 |
2210 |
|
Infant Deaths |
5 |
4 |
6 |
16 |
22 |
|
|
Infant Mortality Rate |
3.6 |
2.5 |
3.3 |
8.1 |
10.0 |
|
|
Other |
Births |
312 |
300 |
366 |
372 |
308 |
|
Infant Deaths |
1 |
0 |
3 |
2 |
1 |
|
|
Infant Mortality Rate |
3.2 |
0.0 |
8.1 |
5.4 |
3.3 |
|
|
TOTAL |
Births |
13929 |
14047 |
14158 |
14245 |
13809 |
|
Infant Deaths |
105 |
121 |
130 |
150 |
138 |
|
|
Infant Mortality Rate |
7.5 |
8.6 |
9.2 |
10.5 |
10.0 |
* Infant mortality rates are per 1,000 live births.
Source: Marion County Birth and Death Certificates, Marion County Health Department (DR0422).
In 2001, Marion County’s overall infant mortality rate was roughly comparable with that for the U.S., Indiana and Wisconsin, and lower than the rate for Tennessee (Figure 8‑1). By 2004, however, the overall infant mortality rate for Marion County was greater than the rate for those other geographies.
Figure 8‑1: Total Infant Mortality Rates Marion County (MC) and Comparison Populations, 2000-2005
Source: Marion County Birth and Death Certificates, Marion County Health Department (DR0422); IN: Indiana Mortality Report 2004 and 2005, ISDH[232],[233] & Indiana Infant Mortality Report 1990-2003, ISDH;[234] WI: WISH Data Query System, Wisconsin Dept. of Health & Family Services;[235] TN: Infant Mortality Stats & Facts, Tennessee Dept. of Health;[236] U.S.: CDC, National Center for Health Statistics.[237]
Neonatal mortality
Neonatal deaths are those deaths that occur before an infant reaches 28 days of age, while post-neonatal deaths are those deaths that occur among infants 28 days to 1 year old. Neonatal deaths are typically attributed to biological problems present at birth, while post-neonatal deaths are more likely to be due to post-partum causes.[238]
Neonatal deaths typically contribute about two-thirds of the infant deaths in a population. In Marion County, neonatal mortality rates have been relatively constant since 1993, hovering between 6.2 and 7.2 deaths per 1,000 live births, with the exception of two low points in 1998 and 2001, when the rate hit 5.8 and 4.6 deaths per 1,000 live births, respectively (Figure 8‑2). Between 80 and 100 infants die each year before they reach four weeks of age. In 2005, the neonatal mortality rate in Marion County was 7.2, which was higher than the rate in Indiana (5.5), the U.S. (4.7), and Healthy People 2010 objective 16-1d (2.9). The rate among Black infants was nearly twice the rate among White infants in Marion County, which is similar to what is seen at the state and national level. Reporting of Black and White rates for Marion County differed slightly depending on whether Hispanics were included in the categories. The Hispanic rate was in between the Black and White rate in 2005, but has varied widely (between 1.6 and 10.7) over the past 10 years due to the relatively small Hispanic population in Marion County.
Table 8‑3: Neonatal Mortality Rates per 1,000 by Race
|
|
Marion County 2005a |
Indiana 2005b |
U.S. 2002c |
|
Total |
7.2 |
5.5 |
4.7 |
|
White |
4.4 |
4.5 |
3.9 |
|
Non-Hispanic White |
5.6 |
|
3.9 |
|
Black |
11.2 |
12.5 |
9.3 |
|
Non-Hispanic Black |
10.5 |
|
9.3 |
|
Hispanic |
6.8 |
6.1 |
3.8 |
Source: aMarion County Birth Certificates, (DR0538), bIndiana Mortality Report—2005, Indiana State Department of Health, Epidemiology Resource Center. Available at http://www.in.gov/isdh/dataandstats/mortality/2005/table08/tbl08.htm#IDX13, cMathews TJ, Menacker F, MacDorman MF. “Infant Mortality Statistics from the 2002 Period Linked Birth/Infant Death Data Set.” National Vital Statistics Report. 53(10):2004. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_10.pdf
Post-neonatal Mortality
Post-neonatal deaths account for about one-third of infant mortality (between 30 and 50 deaths per year), but often have causes that may be more preventable, such as unsafe sleep conditions. The post-neonatal mortality rate in Marion County trended slightly downward from 1992 to between 1998 and 2002, but appears to have leveled off since, settling between 2.4 and 3.2 over the past few years (Figure 8‑2). The 2005 rate for Marion County was 2.8. Post-neonatal death rates for Marion County were about the same as Indiana rates and U.S. rates for Whites, lower for Blacks, and higher for Hispanics.
Table 8‑4: Post-neonatal Mortality Rates per 1,000, by Race
|
|
Marion County 2005a |
Indiana 2005b |
U.S. 2002c |
|
Total |
2.8 |
2.6 |
2.3 |
|
White |
1.8 |
2.3 |
1.9 |
|
Non-Hispanic White |
2.3 |
|
1.9 |
|
Black |
3.7 |
4.4 |
4.5 |
|
Non-Hispanic Black |
3.8 |
|
4.6 |
|
Hispanic |
3.2 |
-- |
1.8 |
Source: aMarion County Birth Certificates, (DR0538), bIndiana Mortality Report—2005, Indiana State Department of Health, Epidemiology Resource Center. Available at http://www.in.gov/isdh/dataandstats/mortality/2005/table08/tbl08.htm#IDX13, cMathews TJ, Menacker F, MacDorman MF. “Infant Mortality Statistics from the 2002 Period Linked Birth/Infant Death Data Set.” National Vital Statistics Report. 53(10):2004. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_10.pdf
Figure 8‑2: Infant Mortality Rates by Death Period, Marion County, 1992-2006
Source: Marion County Birth and Death Certificates, Marion County Health Department (DR0538)
Perinatal Mortality
Perinatal mortality includes late fetal deaths (fetal deaths after 28 weeks gestation) and early neonatal deaths (infant deaths before 7 days of age). Perinatal mortality rates are reported because fetal and neonatal deaths are both thought to share similar causes. Perinatal mortality rates also give a more complete picture of perinatal health than do neonatal, post-neonatal, or infant mortality alone, since perinatal mortality includes fetal deaths that would not be included in an examination limited to deaths following live births.
The 2005 perinatal mortality rate in Marion County is similar to the rate in 2000 (11.9). It is more than 1.5 times the U.S. rate and close to 2.5 times greater than Healthy People 2010 objective 16-1b of 4.5 perinatal deaths per 1,000 live births.[239]
Table 8‑5: Perinatal Mortality Rates[240] per 1,000 Live Births
|
|
Marion County 2005a |
Marion County 2003a |
U.S. 2003b |
|
Total |
11.2 |
10.1 |
6.74 |
|
Non-Hispanic White |
7.9 |
7.3 |
5.6 |
|
Non-Hispanic Black |
18.8 |
17.6 |
12.3 |
|
Hispanic |
7.7 |
2.7 |
6.0 |
Source: aMarion County Vital Records, (DR0589) b“Fetal and Perinatal Mortality, United States 2003.” National Vital Statistics Reports. February 21, 2007. 55(6). Available at http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_06.pdf
White Infant Mortality
Marion County’s White infant mortality rate rose from 6.0 in 2001 to 8.0 in 2005, an increase of 33 percent. In 2001, Marion County’s rate was less than Indiana’s, and similar to that of Wisconsin and the U.S. overall. By 2004, however, the Marion County rate had surpassed the rates for all three of these comparison areas (Figure 8‑3).
Figure 8‑3: Non-Hispanic White Infant Mortality Rates, Marion County (MC) and Comparison Populations, 2000-2005
Source: Marion County Birth and Death Certificates, Marion County Health Department (DR0422); IN: Indiana Mortality Report 2004 and 2005, ISDH[241],[242] & Indiana Infant Mortality Report 1990-2003, ISDH;[243] WI: WISH Data Query System, Wisconsin Dept. of Health & Family Services;[244] U.S.: CDC, National Center for Health Statistics.[245]
The increase in White infant mortality over the past 5 years is due more to an increase in neonatal mortality (<28 days of age) than to an increase in post neonatal mortality (Figure 8‑4).
Figure 8‑4: White Infant Mortality Rates by Death Period, Marion County, 2001-2006
Source: Marion County Birth and Death Certificates, Marion County Health Department (DR0538)
Black Infant Mortality
The Black infant mortality rate for Marion County fluctuated between 2001 and 2005, peaking at 17.9 in 2004 and reaching its lowest point over the five-year period at 12.5 in 2001. The Black infant mortality rate was below the U.S. rate in 2001, but had exceeded it by 2004. Marion County’s rate generally remained below Wisconsin’s during the six-year period from 2000 through 2005 (Figure 8‑5). The close relationship between the Black infant mortality rates for Marion County and Indiana over this period may be attributed to the relatively high proportion of Indiana’s African-American population concentrated in Marion County.
Figure 8‑5: Non-Hispanic Black Infant Mortality Rates*, Marion County (MC) and Comparison Populations, 2000-2005
* TheU.S rates for Blacks include Black Hispanics. According to Census 2000, approximately 2 percent of Americans who classify themselves as Black also classify themselves as Hispanic. Black Hispanic births and infant deaths will appear in both the Black and Hispanic categories.
Source: Marion County Birth and Death Certificates, Marion County Health Department (DR0422); IN: Indiana Mortality Report 2004 and 2005, ISDH[246],[247] & Indiana Infant Mortality Report 1990-2003, ISDH;[248] WI: WISH Data Query System, Wisconsin Dept. of Health & Family Services;[249] U.S.: CDC, National Center for Health Statistics.[250]
The disparity between Black and White infant mortality rates has continued to be significant during the last six-years. From 2000 to 2005, the Black rate fluctuated between 2.1 and 2.4 times that of the White rate (Figure 8‑6). In 2005, the Black rate fell to 1.8 times that of the White rate.
Figure 8‑6: Disparity Between Non-Hispanic Black and Non-Hispanic White Infant Mortality Rates, Marion County, 2000-2005
Source: Marion County Birth and Death Certificates, Marion County Health Department (DR0422)
The CDC Healthy People 2010 infant mortality objective 16-1c calls for reducing rates to no more than 5 deaths per 1,000 live births. To have met the Healthy People 2010 objective, the total number of Black infant deaths in 2005 would have to have been about 20, rather than the 57 deaths that occurred. Such a reduction would mean a 65 percent decrease in the number of Black infant deaths.
In 1984, Indianapolis had the highest African-American infant mortality rate (24.5) among 18 comparable U.S. cities, according to The Health of America’s Children, a 1987 report by The Children’s Defense Fund (CDF). Although the CDF no longer conducts such rankings, the African-American infant mortality rate for Indianapolis has since improved, both in absolute terms and relative to other communities. Based on an average of four years’ worth of data (1999 to 2002), Indianapolis’ Black infant mortality rate is slightly below the median for other metropolitan areas with large African-American populations (Table 8‑6).
Table 8‑6: Non-Hispanic Black Infant Mortality Rates by County Linked Birth/Infant Death Records, 1999-2002
|
County |
Non-Hispanic Black Infant Mortality Rate |
|
Hennepin County, MN (Minneapolis) |
10.5 |
|
Fulton County, GA (Atlanta) |
12.5 |
|
Jackson County, MO (Kansas City) |
13.2 |
|
U.S. |
13.8 |
|
Franklin County, OH (Columbus) |
14.0 |
|
Marion County, IN (Indianapolis) |
14.6 |
|
Cuyahoga County, OH (Cleveland) |
15.0 |
|
St. Louis County, MO* |
16.3 |
|
Davidson County, TN (Nashville) |
17.0 |
|
Milwaukee County, WI (Milwaukee) |
17.0 |
|
Hamilton County, OH (Cincinnati) |
17.5 |
|
Allegheny County, PA (Pittsburgh) |
18.0 |
|
St. Louis City, MO* |
19.1 |
*The independent city of St. Louis, Missouri, is reported separately from St. Louis County.
Source: CDC WONDER, CDC, National Center for Health Statistics.[251]
Hispanic Infant Mortality
Marion County’s Hispanic infant mortality rate increased sharply over the past 4 years from a low of 1.2 in 2002 to 9.0 in 2005 (20 deaths). Although Hispanic infant mortality rates had been lower than rates for Whites or Blacks, in 2005 the Hispanic rate rose above the White rate. National data from 2000 to 2004 show a fairly stable Hispanic infant mortality rate of about 5.8. Another Midwest state may be a better comparator for Marion County than is the nation overall, since much of the Hispanic population nationally is well established, whereas much of the local Hispanic population is new to our region. Infant mortality rates from Wisconsin, another Midwest state for which detailed infant mortality rates were available, were more stable than those of Marion County. Hispanic infant mortality rates for Indiana have an inverted relationship with those for Marion County from 2000 until 2003, when they began to move in tandem (Figure 8‑7).
The standard calculation of IMR is a count of death certificates divided by a count of birth certificates. On birth certificates, infants’ race is often entered as the self-reported ethnicity given by one of the parents, while on the infant’s death certificate race is generally coded by a funeral home director or health care provider, based on infant’s surname or observation. The marked increase in recent Hispanic IMRs might have reflected increased recording of ‘Hispanic’ race on death certificates, as hospital observers became increasingly aware of the growing numbers of Hispanic community members in local hospital services. Therefore, the Hispanic IMR reported here is calculated based on the race listed on the infant’s birth certificate. The resulting rates were, in fact, slightly less than those calculated using race as reported on the death certificate, but the increase from 2002 to 2005 was steeper than the increase originally calculated.
Figure 8‑7: Hispanic Infant Mortality Rates, Marion County (MC) and Comparison Populations, 2000-2005
Source: Marion County Birth and Death Certificates, Marion County Health Department (DR0422); IN: Indiana Mortality Report 2004 and 2005, ISDH[252],[253] & Indiana Infant Mortality Report 1990-2003, ISDH;[254] WI: WISH Data Query System, Wisconsin Dept. of Health & Family Services;[255] U.S.: CDC, National Center for Health Statistics.[256]
Infant Mortality Risk Factors
The risk factors associated with infant mortality include being a single mother, having a low birth weight infant, having increasing number of infants in the pregnancy, lacking prenatal care or starting prenatal care after the first trimester, being a teenager or forty years and older, having a low level of education, and smoking during pregnancy.[257] The following tables show these factors’ six-year trends among Marion County resident births.
Marital Status of The Mother
Marital status is thought to be an indicator of other risk factors that may impact a birth outcome, including health status and behaviors during pregnancy, as well as social, emotional, and financial resources. Nationally, in 2002, unmarried women were 80 percent more likely to experience an infant loss than were married women. This relationship is less strong for teens and increases with increasing age, and the increase is more dramatic among Black mothers than among White mothers. In Marion County, the overall percentage of babies born to married women declined steadily over the six-year period from 2000 through 2005 (Table 8‑7). The decline was most precipitous among Hispanic births, and least dramatic for births to Blacks. The percentage of births to married Hispanics declined by about one-fourth from 2001 to 2005; the percentage of births to Non-Hispanic Whites experienced a drop of nearly one-tenth. The percentage of babies born to married Non-Hispanic Blacks increased slightly from 2002 to 2003, and from 2004 to 2005, although it too declined over the six-year period.
Table 8‑7: Percent of Babies Born to Married Women, Marion County Resident Births by Race, 2000-2005
|
Group |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
|
White (Non-Hispanic) |
67.9 |
67.1 |
66.2 |
65.0 |
63.5 |
61.2 |
|
Black (Non-Hispanic) |
26.8 |
26.9 |
25.9 |
26.3 |
23.2 |
24.2 |
|
Hispanic |
48.6 |
44.0 |
43.1 |
41.4 |
38.0 |
36.2 |
|
Total |
54.9 |
53.4 |
52.6 |
51.5 |
48.8 |
46.7 |
Source: Marion County Birth Certificates, Marion County Health Department (DR0489-T28)
Low Birth Weight
A low birth weight infant is one born weighing less than 2500 grams, or less than 88 ounces (5.5 pounds). Low birth weight is a strong predictor of adverse birth outcomes, health problems, and disabilities later in life, and is strongly associated with infant mortality. Overall in the U.S. in 2002, low birth weight infants were nearly 25 times more likely to die than were infants weighing more than 2500 grams. The percentage of low birth weight babies born in Marion County gradually increased between 2000 and 2004 before declining between 2004 and 2005 (Table 8‑8). A somewhat similar pattern occurred among White births. The percentage of low birth weight babies for Blacks stayed within a narrow range from 2000 through 2005, rising or falling slightly from one year to the next. Although the percentage of Hispanic low birth weight babies has fluctuated greatly, it has been consistently lower than that for Whites or Blacks. [258]
Table 8‑8: Percent of Low Birth Weight Babies, Marion County Resident Births by Race, 2000-2005
|
Group |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
|
White (Non-Hispanic) |
7.0 |
7.7 |
7.4 |
8.1 |
9.1 |
8.4 |
|
Black (Non-Hispanic) |
13.1 |
12.1 |
13.4 |
12.7 |
13.2 |
12.7 |
|
Hispanic |
5.8 |
6.7 |
5.3 |
4.8 |
5.9 |
6.5 |
|
Total |
8.6 |
8.8 |
8.9 |
9.0 |
9.8 |
9.4 |
Source: Marion County Birth Certificates, Marion County Health Department (DR0489-T29)
Lacking Prenatal Care
Numerous studies have shown that women who receive no or inadequate prenatal care are at a nearly two fold increased risk of adverse birth outcomes, and the effect of no or inadequate prenatal care is even more dramatic among minorities and underserved or vulnerable populations.[259],[260] Early entry into medical care, accompanied by the appropriate number of physician visits, can positively influence the outcomes of many pregnancies. There are some worrisome trends for Marion County in this regard. The percentage of babies born with no prenatal care to Non-Hispanic Whites and Blacks doubled between 2000 and 2005, and nearly doubled for the population overall (Table 8‑9). On the other hand, the percentage of Hispanic babies born with no prenatal care generally fell during the six-year period.
Table 8‑9: Percent of Babies Born with no Prenatal Care, Marion County Resident Births by Race, 2000-2005
|
Group |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
|
White (Non-Hispanic) |
0.6 |
0.7 |
0.6 |
0.6 |
0.9 |
1.2 |
|
Black (Non-Hispanic) |
1.7 |
2.0 |
2.7 |
2.9 |
2.9 |
3.4 |
|
Hispanic |
2.3 |
2.0 |
1.4 |
1.2 |
1.7 |
1.5 |
|
Total |
1.0 |
1.2 |
1.3 |
1.3 |
1.6 |
1.9 |
Source: Marion County Birth Certificates, Marion County Health Department (DR0489-T30-31)
Starting Prenatal Care in the First Trimester
Early entry into prenatal care is important in assuring good birth outcomes. Early entry into care and an adequate number of visits is associated with 50 percent fewer infant deaths and preterm births than are seen when mothers do not get adequate prenatal care.[261] Unfortunately, during the six-year period from 2000 through 2005, there was a gradual decline in the percentage of Marion County resident births whose mothers entered prenatal care in the first trimester of their pregnancy (Table 8‑10). This decline occurred among both White and Black births. As an exception to the above patterns of near-continual decline, the percentage of Hispanic mothers entering care in the first trimester rose from 2000 to 2003, but then fell over the next two years.[262]
Table 8‑10: Percent of Mothers Entering Prenatal Care in the First Trimester, Marion County Residents, by Race, 2000-2005
|
Group |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
|
White (Non-Hispanic) |
85.2 |
84.2 |
84.0 |
83.3 |
82.6 |
81.2 |
|
Black (Non-Hispanic) |
68.4 |
69.4 |
69.2 |
68.7 |
67.1 |
64.3 |
|
Hispanic |
52.6 |
56.7 |
59.8 |
60.2 |
55.0 |
53.9 |
|
Total |
77.5 |
77.0 |
76.9 |
76.1 |
74.2 |
71.8 |
Source: Marion County Birth Certificates, Marion County Health Department (DR0489-T30-31)
Births Among Adolescent Women
The problems associated with teenage pregnancy are severe and well documented. Births to teenagers have been associated with late entry into prenatal care, inadequate prenatal care, reduced educational attainment, fewer employment opportunities, increased likelihood of poverty, and poorer infant health and development outcomes. Infants born to teenage mothers are up to two times more likely to be low birth weight[263] and to suffer abuse and neglect,[264],[265] and around 50 percent more likely to die before their first birthday[266] than infants born to women over the age of 19. Overall, and for Whites and Blacks, the percentage of teenage births generally fell during the six-year period from 2000 though 2005 (Table 8‑11), although it turned up slightly overall and for Whites between 2004 and 2005. The percentage of teen births among Hispanics held fairly steady over that time, with a low point in 2003 and a high point 2005.
Table 8‑11: Percent of Births to Mothers Under Age 19, Marion County Residents by Race, 2000-2005
|
Group |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
|
White (Non-Hispanic) |
6.6 |
6.0 |
5.9 |
5.9 |
5.6 |
5.7 |
|
Black (Non-Hispanic) |
13.1 |
13.9 |
13.1 |
12.1 |
11.7 |
10.8 |
|
Hispanic |
8.4 |
8.3 |
8.3 |
7.1 |
8.3 |
8.8 |
|
Total |
8.6 |
8.5 |
8.1 |
7.8 |
7.6 |
7.7 |
Source: Marion County Birth Certificates, Marion County Health Department (DR0489-T32)
Maternal Smoking
Smoking has been associated with many adverse birth outcomes, especially low birth weight. Infants born to mothers that smoked were 1.5 to 4.8 times more likely to die before their first birthday than infants born to non-smoking mothers.[267],[268] They were 2.7 times more likely to be born low birth weight.[269] The increased risk was greatest for frequent smokers, older mothers, and non-whites.[270]Overall and by race and ethnicity, the number of mothers reporting smoking during pregnancy fell from 2000 to 2005 (Table 8‑12). Smoking during pregnancy has been decreasing nationally and locally for over 15 years.[271] A gradual decline in smoking percentages overall and for Non-Hispanic Whites between 2000 and 2004 was followed by a slight increase from 2004 to 2005. Smoking percentages for Non-Hispanic Blacks fell fairly consistently over the six-year period. The percentage of Hispanic pregnant women smoking, already quite low compared to Non-Hispanics, was cut by more than half between 2000 and 2003, although it subsequently increased somewhat over the next two years. While the decline is encouraging, the prevalence of smoking during pregnancy in Marion County remains high relative to national levels. Compared to 44 of the largest U.S. cities, for the most recent comparison year (2003) Indianapolis had the 3nd highest prevalence of maternal smoking, 17.6 percent.[272] The national prevalence of smoking in 2003 was 10.7 percent.[273]
Table 8‑12: Percent of Mothers Smoking During Pregnancy, Marion County Residents by Race, 2000-2005
|
Group |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
|
White (Non-Hispanic) |
24.8 |
24.2 |
23.5 |
23.3 |
21.6 |
23.2 |
|
Black (Non-Hispanic) |
15.2 |
14.8 |
14.3 |
14.4 |
13.7 |
13.5 |
|
Hispanic |
3.2 |
3.8 |
2.7 |
1.4 |
1.8 |
1.9 |
|
Total |
20.1 |
19.1 |
18.2 |
17.6 |
16.2 |
16.6 |
Source: Marion County Birth Certificates, Marion County Health Department (DR0489-T33)
Maternal smoking varied greatly by age and race. Young White mothers were very likely to smoke while young Black mothers were very unlikely to smoke (40% versus 7.1%). As the age of the mother increased, the prevalence of smoking became somewhat similar between Whites and Blacks (Table 8‑13). The high proportion of Black mothers over age 44 smoking during pregnancy (33%) is based on a very small number of births, and may not indicate any specific problem.
Self-reported cigarette use during pregnancy is believed to be underreported on the birth certificate, which is the source of the data in Table 8‑12 and Table 8‑13. These data probably reflect only the minimum level of smoking that may have occurred during pregnancy. Women underreport their cigarette use for a variety of reasons, but most likely due to the negative public sentiment toward smoking during pregnancy. The actual prevalence of maternal smoking during pregnancy is estimated to be 18 to 30 percent higher than what is reported.[274],[275]
Table 8‑13: Percent of Marion County Mothers Smoking During Pregnancy by Age and Race, 2005
|
Age of Mother |
Non-Hispanic Black |
Non-Hispanic White |
Hispanic |
Total |
|
10-14 |
0.0 |
37.5 |
0.0 |
10.3 |
|
15-17 |
4.6 |
36.0 |
2.8 |
16.1 |
|
18-19 |
8.6 |
41.1 |
2.0 |
21.8 |
|
10-19 |
7.1 |
39.6 |
2.2 |
19.8 |
|
20-24 |
15.0 |
37.3 |
2.3 |
23.0 |
|
25-29 |
15.1 |
19.0 |
1.2 |
14.7 |
|
30-34 |
13.6 |
11.4 |
1.8 |
10.3 |
|
35-39 |
16.9 |
12.0 |
2.3 |
11.8 |
|
40-44 |
12.5 |
19.8 |
0.0 |
15.2 |
|
45+ |
33.3 |
14.3 |
0.0 |
16.7 |
|
Total |
13.5 |
23.2 |
1.9 |
16.6 |
Source: Marion County Birth Certificates, Marion County Health Department (DR0489-T34)
Child Mortality
Child mortality is of particular public health concern due to the large proportion of childhood deaths that are due to external, preventable causes, such as motor vehicle accidents, fires, drowning, and incidents involving firearms (accidental deaths, homicides, and suicides).[276] The child mortality rate in Marion County has fluctuated over the past 5 years, but the changes have not been statistically significant. In 2006 the child mortality rate was 53.9 deaths per 100,000 children age 1 to 14 years, with a total of 45 deaths. The child mortality rate in Marion County was higher than in Indiana or in the U.S. population for the most recent years available (Table 8‑14). Given small numbers of deaths in this age group, changes over time can be very unstable and comparisons across years or between populations should be made with caution.
Table 8‑14: Mortality Rates per 100,000 for Youth Age 1-14, by Race
|
|
Marion County 2001a |
Marion County 2006a |
Indiana 2005b |
U.S. 2004c |
|
White |
39.6 |
27.0 |
23.5 |
18.6 |
|
Black |
62.7 |
70.1 |
40.1 |
29.4 |
|
Other |
-- |
-- |
-- |
17.4 |
|
Total |
49.1 |
53.9 |
24.5 |
20.4 |
Source: a(DR0588). bFile emailed from Michele Starkey, Indiana State Department of Health, Epidemiology Resource Center, Data Analysis Team on 5/30/2007, will be available on web shortly in the 1996-2005 MCH Outcomes Report cMiniño AM, Heron MP, Smith BL. “Deaths: Preliminary Data for 2004.” National Vital Statistics Reports. June 28, 2006: 54(19). Available at http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_19.pdf
In each year from 2001 through 2006, there have been 45 fewer deaths of children ages one through 14 years. The few causes of child deaths with an average of more than two deaths annually over that period were accidents (average of 10.3), cancer (average of 5.3), homicide (average of 4.2), and congenital abnormalities (average of 3.2).[277]
Table 8‑15: Leading Causes of Child Mortality, Ages 1 Through 14 Years, 2001-2006
|
Cause of death |
Year of Death |
|||||
|
2001 |
2002 |
2003 |
2004 |
2005 |
2006 |
|
|
Accident |
15 |
6 |
5 |
11 |
11 |
14 |
|
Malignant neoplasm |
5 |
7 |
5 |
2 |
5 |
8 |
|
Assault (homicide) |
3 |
9 |
2 |
0 |
3 |
8 |
|
Congenital malformation, deformation & chromosomal abnormality |
3 |
5 |
3 |
4 |
3 |
1 |
|
Chronic lower respiratory disease |
1 |
1 |
2 |
0 |
1 |
1 |
|
Septicemia |
0 |
0 |
1 |
3 |
1 |
1 |
|
Influenza & pneumonia |
1 |
0 |
1 |
2 |
0 |
0 |
|
Other causes |
13 |
13 |
16 |
7 |
14 |
12 |
|
TOTAL |
41 |
41 |
35 |
29 |
38 |
45 |
Includes all causes of death associated with an average of at least one death per year over the years displayed.
Source: Marion County Death Certificates (DR0483-T36.4)
Youth Tobacco Use
Cigarette smoking is the leading cause of preventable death in the U.S. Over 80 percent of all lung cancer is attributable to cigarette smoking. Nine out of ten adult smokers began smoking during their teen years or earlier, and nearly two-thirds became daily smokers before they reached the age of 19,[278] so early interventions are essential. Over 80 percent of teen smokers reported they wanted to quit. Unfortunately nearly one in four (23.2%) students are current smokers by the time they leave high school.[279] On average, over 17 percent of all smoking-caused healthcare expenditures are paid for by a state's Medicaid program[280] (ranging 10%-36%).
In Indiana in 2005, the prevalence of lifetime cigarette use was 56.9 percent, similar to that of the U.S. population. One in five (21.9%) Indiana high school students reported current cigarette use. This was also similar to the prevalence of current smoking in the U.S. population (23.0%). Teen smoking rates for Marion County were not available, but school population surveys by the Indiana Prevention Resource Center (IPRC) find the lifetime smoking prevalence in central Indiana[281] in 2006 (46.3%) was slightly lower than that of Indiana in 2005. Confidence levels were not available for this data, and it should not be assumed to be significantly lower than the state or national prevalence. The 2006 prevalence of current smoking for central Indiana was reported by the IPRC to be 23.2 percent, which is similar to the state and the nation.[282]
Table 8‑16: Youth (<18 Years) Lifetime Cigarette Use
|
|
Central Indiana[283] 2006a % |
Indiana 2005b % (CI) |
United States 2005b % (CI) |
|
Female |
|
54.0% (47.2%-60.8%) |
52.7% (49.3%-56.1%) |
|
Male |
|
59.7% (55.6%-63.8%) |
55.9% (53.1%-58.7%) |
|
Total |
46.3% |
56.9% (52.6%-61.2%) |
54.3% (51.3%-57.3%) |
Source: aGassman, R., Jun, M. K., Samuel, S., Martin, E. V., McCarthy-Jean, J. A., Lee, J., Kim, N., Konchada, S., Kondapuram, S. P., Morrison, A., Nautiyal, V., Pardue, N., Rayaprolu, S., Roby, R., Wang, T., and Zhou, B. (2006). Alcohol, Tobacco, and Other Drug Use by Indiana Children and Adolescents: The Indiana Prevention Resource Center Survey – 2006 (IDAP Monograph No. 06-01). Bloomington, IN: Indiana Prevention Resource Center. bYouth Risk Behavioral Surveillance System. National Center for Chronic Disease Prevention and Health Promotion. Results available at http://www.cdc.gov/healthyyouth/yrbs/
Table 8‑17: Youth Current Cigarette Use
|
|
Central Indiana[284] 2006a % |
Indiana 2005b % (CI) |
United States 2005b % (CI) |
|
Female |
|
20.5% (15.8%-25.2%) |
23.0% (20.4%-25.6%) |
|
Male |
|
23.2% (18.7%-27.7%) |
22.9% (20.7%-25.1%) |
|
Total |
23.2% |
21.9% (17.9%-25.9%) |
23.0% (20.7%-25.3%) |
Source: aGassman, R., Jun, M. K., Samuel, S., Martin, E. V., McCarthy-Jean, J. A., Lee, J., Kim, N., Konchada, S., Kondapuram,S. P., Morrison, A., Nautiyal, V., Pardue, N., Rayaprolu, S., Roby, R., Wang, T., and Zhou, B. (2006). Alcohol, Tobacco, and Other Drug Use by Indiana Children and Adolescents: The Indiana Prevention Resource Center Survey – 2006 (IDAP Monograph No. 06-01). Bloomington, IN: Indiana Prevention Resource Center. bYouth Risk Behavioral Surveillance System. National Center for Chronic Disease Prevention and Health Promotion. Results available at http://www.cdc.gov/healthyyouth/yrbs/
Youth Alcohol Use
Alcohol use in adolescence is associated with numerous adverse sequelae. In nearly a quarter of all automotive accidents involving an adolescent, the adolescent had consumed alcohol prior to the accident.[285] Heavy alcohol use is also associated with intentional and unintentional injuries, alcohol poisoning, sexual activity, unplanned pregnancy, high blood pressure, stroke, cardiovascular disease, liver disease, and neurological damage.[286]
In 2005, 75 percent of Indiana high school students reported having ever drunk alcohol and 41.4 percent reported current alcohol use. Both statistics were slightly lower than, but comparable to, the percents in 2003 (77.8% and 44.9%, respectively). Indiana youth were similar to U.S. youth on both of these indicators (74.3 percent and 43.3 percent of U.S. youth reported lifetime and current alcohol use, respectively, in 2005).[287]
The percentage of Indiana youth in 2005 that reported having had five or more drinks of alcohol within a couple of hours on one or more days in the month prior to the survey was 24.6 percent, slightly lower than in 2003 (28.9%). This difference was not significant[288].
Table 8‑18: Youth Reporting Binge Drinking
|
|
Indiana 2005 % (CI) |
United States 2005 % (CI) |
|
Female |
21.7% (16.6%-26.8%) |
23.4% (21.2%-25.8%) |
|
Male |
27.4% (23.1%-31.7%) |
27.5% (24.9%-30.1%) |
|
Total |
24.6% (20.5%-28.7%) |
25.5% (23.3%-27.7%) |
Source: Youth Risk Behavioral Surveillance System. National Center for Chronic Disease Prevention and Health Promotion. Results available at http://www.cdc.gov/healthyyouth/yrbs/
Childhood Obesity
In 2005, the Marion County Health Department (MCHD) worked with ten of the eleven public school districts in Marion County to measure the height and weight of the students. The measurements were converted to measures of body mass index (BMI), and compared to BMI percentiles from the CDC’s standard, age and gender-appropriate distributions for children’s BMIs. The CDC’s standard distributions are based on United States (U.S.) children’s BMI distributions from the 1970s.
A body mass index distribution similar to U.S. children's BMIs in the 1970s would have had 5 percent overweight, 10 percent at risk for overweight, 5 percent underweight, and 80 percent in the normal BMI range. Overall:
· 22 percent of the measured Marion County children were overweight
· 18 percent were at risk of overweight
· 1 percent were underweight
· The remaining 58 percent were in the normal BMI range for their age and gender
Of the demographic groups with over 100 members, the heaviest was Hispanic males, with 31 percent overweight, 20 percent at risk, and one percent underweight. The lightest group was Asian and Pacific Islander females, with 13 percent overweight and 16 percent at risk, with 3 percent underweight. By age, the heaviest groups were in the 9 to 15 year old range. Most demographic sub-groups were within a two or three percent of the overall percentages. The prevalence of overweight or risk of overweight by gender, race, and age is shown in Figure 8‑8 and Table 8‑19.
Figure 8‑8: Percentage of Marion Countya Public School Students Who Were Overweight or At Risk of Becoming Overweight, by Sex, Race/Ethnicity, and Age, 2005
aDoes not include students in the Metropolitan School District of Wayne Township
Source: 2005 Marion County Health Department Child Health and Wellness Initiative (DR0442) http://www.mchd.com/CHWI_results_report.htm
Table 8‑19: Percentage of Marion Countya students who were overweight or at risk of becoming overweight, 2005, by age group, race, and gender
|
Age in years/Race |
Number of Students Measured |
Male No. (%) |
Female No. (%) |
Total No. (%) |
|
|
5-9 (Elementary School) |
|
|
|
|
|
|
|
White |
16,027 |
2,836 (36%) |
2,688 (33%) |
5,524 (34%) |
|
|
Black |
12,214 |
2,274 (37%) |
2,384 (39%) |
4,659 (38%) |
|
|
Hispanic |
3,504 |
925 (51%) |
743 (44%) |
1,668 (48%) |
|
|
Other |
2,415 |
437 (36%) |
451 (38%) |
888 (37%) |
|
|
Total |
34,160 |
6,472 (38%) |
6,267 (37%) |
12,739 (37%) |
|
10-13 (Middle School) |
|
|
|
|
|
|
|
White |
14,454 |
3,033 (42%) |
2,841 (39%) |
5,874 (41%) |
|
|
Black |
12,272 |
2,791 (44%) |
2,879 (48%) |
5,670 (46%) |
|
|
Hispanic |
2,358 |
667 (55%) |
549 (48%) |
1,216 (52%) |
|
|
Other |
1,714 |
389 (46%) |
369 (43%) |
758 (44%) |
|
|
Total |
30,798 |
6,880 (44%) |
6,638 (44%) |
13,518 (44%) |
|
14-17 (High School) |
|
|
|
|
|
|
|
White |
11,717 |
2,367 (40%) |
2,062 (36%) |
4,429 (38%) |
|
|
Black |
8.937 |
1,822 (41%) |
2,053 (45%) |
3,875 (43%) |
|
|
Hispanic |
1,251 |
307 (47%) |
275 (46%) |
582 (47%) |
|
|
Other |
918 |
160 (36%) |
160 (34%) |
320 (35%) |
|
|
Total |
22,823 |
4,656 (41%) |
4,550 (40%) |
9,206 (40%) |
|
5-17 (Total) |
|
|
|
|
|
|
|
White |
42,198 |
8,236 (39%) |
7,591 (36%) |
15,827 (38%) |
|
|
Black |
33,423 |
6,887 (41%) |
7,317 (44%) |
14,204 (42%) |
|
|
Hispanic |
7,113 |
1,899 (52%) |
1,567 (46%) |
3,466 (49%) |
|
|
Other |
5,047 |
986 (39%) |
980 (39%) |
1,966 (39%) |
|
|
Total |
87,781 |
18,008 (41%) |
17,455 (40%) |
35,462 (40%) |
aDoes not include students in the Metropolitan School District of Wayne Township
Source: 2005 Marion County Health Department Child Health and Wellness Initiative (DR0442) http://www.mchd.com/CHWI_results_report.htm
Few places have population-based measures of children’s BMIs with which we might compare those of Marion County. Overweight among Marion County children was similar though a little worse than what was found in Arkansas in 2003 (Table 8‑20).[289] The difference between Marion County and Arkansas may be accounted for by a national trend of about one percentage point annual increase overweight prevalence among children. This national data indicates that in 2003 to 2004, 18 percent of children ages six to nineteen years were overweight (four percentage points lower than Marion County’s 2005 prevalence), and about 18 percent more were at risk for overweight (similar to Marion County’s 2005 prevalence).[290] The Marion County results indicated a greater prevalence of overweight than was found in the national Youth Risk Behavior Surveillance System (YRBS) survey from 2005 (Table 8‑21), but that may be due to the YRBS using self-reported height and weight.
Table 8‑20: Percent of School Population by BMI Category
|
|
Marion County public schools (K-12), 2005 |
Arkansas schools (K-12), 2003 |
Reference (U.S. children in the 1970s) |
|
Underweight |
1% |
2% |
5% |
|
Normal |
58% |
60% |
80% |
|
At Risk for Overweight |
18% |
17% |
10% |
|
Overweight |
22% |
21% |
5% |
|
N |
90,147 |
~350,000 |
|
Sources: 2005 Marion County Health Department Child Health and Wellness Initiative (DR0228 & DR0340); 2003 Arkansas school children height and weight assessment http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5501a2.htm . Totals may not equal the sum of categories due to rounding.
Table 8‑21: Percent of High School Population by BMI Category
|
|
Marion County public schoolchildren age 15-19 years, 2005 |
IN High Schools sample (self-report), 2005 |
U.S. High Schools sample (self-report), 2005 |
Reference (U.S. children in the 1970s) |
|
Underweight |
1.4% (0.0) |
Combined with Normal |
Combined with Normal |
5% |
|
Normal |
60.8% (0.4) |
74.3% |
71.2% |
80% |
|
At Risk for Overweight |
17.5% (0.3) |
14.3% (1.3) |
15.7% (0.9) |
10% |
|
Overweight |
20.3% (0.3) |
15.0% (2.5) |
13.1% (0.9) |
5% |
Plus or minus 95 percent confidence interval in parentheses. Marion County statistic 95 percent confidence interval calculated as +/-1.98*p(1-p)/sqrt(n). Marion County n=11,499
Sources: 2005 Marion County Health Department Child Health and Wellness Initiative (DR0228 & DR0340); CDC Youth Risk Behavior Surveillance System, http://apps.nccd.cdc.gov/yrbss/CategoryQuestions.asp?Cat=5&desc=Dietary%20Behaviors (IN & U.S.)
Totals may not equal the sum of categories due to rounding.
Injury Prevention
Research has shown that for front seat passengers, proper use of lap and shoulder seat belts reduces the risk of fatal injury by 45 percent and reduces the risk of moderate to severe injury by 50 percent.[291]
Compared to 2003, the proportion of Indiana high school students in 2005 that did not wear a seatbelt most or all of the time decreased from 10.6 percent to 8.2 percent. This was not a statistically significant decrease. Compared to the U.S population, however, Indiana did have a statistically significant difference in the prevalence of seat belt use among high school girls.
The Healthy People 2010 objective 15-19 is that 92 percent of the population will use safety belts. [292] Indiana high school girls meet that benchmark, but Indiana high school boys continue to fall short. Indiana as a whole had a prevalence of seat belt usage that was just short of the Healthy People 2010 objective.
Table 8‑22: Rarely or Never Wore Seat Belt
|
|
Indiana 2005 % (CI) |
United States 2005 % (CI) |
|
Female |
3.8% (2.2%-5.4%) |
7.8% (6.3%-9.3%) |
|
Male |
12.5% (9.9%-15.1%) |
12.5% (10.3%-14.7%) |
|
Total |
8.2% (6.7%-9.7%) |
10.2% (8.4%-12.0%) |
Source:Youth Risk Behavioral Surveillance System. National Center for Chronic Disease Prevention and Health Promotion. Results available at http://www.cdc.gov/healthyyouth/yrbs/
Head injuries are the most serious type of injury that cyclists sustain. New York City Government, in reporting results of a bicycle safety study, noted that nearly three-quarters of all fatal bicycle crashes they investigated involved a head injury and nearly all of the cyclists that were involved in a fatal crash (97%) were not wearing a helmet.[293] The Bicycle Helmet Safety Institute estimates that the use of a helmet can reduce the risk for serious head and brain injuries by 85 percent.[294]
Among Indiana high school students who had ridden a bicycle in 2005, 92.3 percent reported rarely or never wearing a bicycle helmet. This was slightly worse than in 2003, when 93.8 percent reported rarely or never wearing a helmet. The prevalence was virtually unchanged between the two years for males (92.8% to 92.9%); the slight overall decrease was the result of a slight decrease among females (94.9% to 91.7%). Indiana rates of bicycle helmet use are significantly lower than national rates.[295]
Table 8‑23: Rarely or Never Wore Bicycle Helmets
|
|
Indiana 2005 % (CI) |
United States 2005 % (CI) |
|
Female |
91.7% (88.0%-95.4%) |
79.9% (75.9%-83.9%) |
|
Male |
92.9% (90.3%-95.5%) |
86.1% (83.3%-88.9%) |
|
Total |
92.3% (89.9%-94.7%) |
83.4% (80.2%-86.6%) |
Source:Youth Risk Behavioral Surveillance System. National Center for Chronic Disease Prevention and Health Promotion. Results available at http://www.cdc.gov/healthyyouth/yrbs/
Sexual Behaviors
Compared to older adults, youth engaging in sexual activity are at a higher risk for contracting a sexually transmitted infection for biological, behavioral, and cultural reasons. It is estimated that while 15-24 year olds make up only a quarter of the population, they represent half of all new sexually transmitted diseases (STDs).[296] STDs can have many adverse sequelae beyond the initial infection and disease including but not limited to, cancer, adverse pregnancy outcomes, infertility, or death. Aside from abstinence or mutual long-term monogamy between uninfected partners, consistent condom use is the only method available to prevent human immunodeficiency virus (HIV) and other STD infections among sexually active individuals.
Another major potentially adverse outcome of adolescent sexual activity is unplanned pregnancy. In 2004, the cost of teenage pregnancy to taxpayers was estimated at approximately $1,430 per teen mother.[297] The cost to the teen mother is also not insignificant. Women who had a baby before the age of 18 had only a 40 percent probability of graduating from high school, compared to 75 percent for their similarly situated peers who waited until turning 20 or 21 to start a family.[298] The children born to teenage mothers are more likely to be born low birth weight[299], to suffer abuse and neglect,[300] and to die before their first birthday[301] compared with children born to women over age 19. Children of teenage mothers are more likely to do worse in school, daughters are more likely to become teen mothers themselves, and sons are more likely to end up in prison.[302] Abstinence and consistent condom use are the most reliable ways to prevent unwanted pregnancy.
In a 2005 survey, forty-four percent of Indiana high school students reported having ever had sex. The proportions of males and females reporting were similar. Slightly more than a third (34.6%) of students indicated that they were currently sexually active at the time of the survey.[303]
In 2005, 62 percent of Indiana high school students reported using a condom during their most recent episode of sexual intercourse. The proportion of youth using condoms during every episode of sexual intercourse, and using them correctly, is expected to be lower than that. The prevalence of condom use was lower in 2003 (55.4%), although not significantly so.[304]
Table 8‑24: Condom Use During Last Sexual Intercourse
|
|
Indiana 2005 % (CI) |
United States 2005 % (CI) |
|
Female |
62.2% (56.0%-69.2%) |
55.9% (53.1%-58.7%) |
|
Male |
62.2% (56.0%-69.2%) |
70.0% (66.9%-73.1%) |
|
Total |
62.2% (57.2%-68.0%) |
62.8% 60.7%-64.9%) |
Source: Youth Risk Behavioral Surveillance System. National Center for Chronic Disease Prevention and Health Promotion. Results available at http://www.cdc.gov/healthyyouth/yrbs/
Immunizations
The benefits associated with vaccination include individual benefits, such as protection against infection, morbidity, and mortality, and societal benefits, such as the prevention of disease outbreaks and reduction in health-care related costs. The societal benefits are dependent, in large part, upon herd-immunity[305], which occurs when high vaccination coverage levels are maintained. Risks from vaccinations are typically minor, but in rare events, severe and life-threatening conditions may result.
The Advisory Committee on Immunization Practices (ACIP), American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) make science-based recommendations for vaccination practices after considering the benefits and potential costs, and outline precautions or contraindications for vaccination of individuals. The current complete vaccination schedule for children less than 24 months includes 4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP), 3 doses of any type of poliovirus vaccine, 1 dose of a measles containing vaccine (i.e. Measles-mumps-rubella, or MMR), 3 doses of Haemophilus influenzae type b (Hib) vaccine, and 1 dose of varicella vaccine (Figure 8‑9).
Figure 8‑9: 2007 Child Immunization Schedule
Source: Centers for Disease Control and Prevention 2007 Child Immunization Schedule http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2007/child-schedule-image-0-6-ppt.jpg
According to the National Immunization Survey in 2004 (the most recent year in which Marion County data were reported separate from Indiana), just over two-thirds of Marion County two-year olds had received the complete series of recommended vaccines. Just over three-quarters of two-year olds had received the three core recommended vaccines, DTaP, Polio, and MMR. These coverage levels are lower than those seen in Indiana and the U.S. for 2004, although the difference is not significant (Table 8‑25).
From 2004 to 2006, the national immunization rates did not change, but Indiana’s rates increased by about 5 percent (not a statistically significant increase) (Table 8‑25).
Table 8‑25: Percentage of 2 year olds with age-appropriate immunizations
|
|
4:3:1[306] % (CI) |
4:3:1:3[307] % (CI) |
4:3:1:3:3[308] % (CI) |
4:3:1:3:3:1[309] % (CI) |
|
2004 |
||||
|
Marion County |
75.9% (67.8%-84.0%) |
75.9% (67.8%-84.0%) |
70.8% (62.3%-79.3%) |
67.9% (59.2%-76.6%) |
|
Indiana |
78.2% (71.9%-84.5%) |
78.2% (71.9%-84.5%) |
75.4% (68.9%-81.9% |
67.9% (60.8%-75.0%) |
|
U.S. |
80.0% (78.9%-81.1%) |
79.1% (77.9%-80.3%) |
77.3% (76.1%-78.5%) |
72.9% (71.7%-74.1%) |
|
2006 |
||||
|
Indiana |
82.7% (76.3%-89.1%) |
81.5% (75.0%-88.0%) |
81.4% (74.9%-87.9%) |
77.8% (70.9%-84.7%) |
|
U.S. |
80.0% (78.9%-81.1%) |
79.1% (78.3%-80.5%) |
77.2% (76.0%-78.4%) |
73.7% (72.5%-74.9%) |
Source: “Indiana Maternal and Child Health Outcomes and Performance Measures Data Book; State and Selected County Data 1994-2003.” Indiana State Department of Health. July 2006. http://www.in.gov/isdh/dataandstats/mch_outcomes/1994-2003/mch_outcomes_report_1994-2003.pdf
Dental Health
The Marion County Health Department sponsored a study conducted by the Indiana University School of Dentistry Oral Health Research Institute to assess the oral health of children attending school in Marion County during the 2002-2003 school year. A random sample of 1,236 6-8 year old children and 14-15 year old adolescents who live and attend school in Marion County were examined for oral health status, and their parents were surveyed about their children’s oral health practices. The conclusions from that study are as follows:
· The percentage of 6-8 year old White, African American and Hispanic children with untreated dental decay was similar: 49 percent, 44 percent and 53 percent respectively. The differences among the groups were not statistically significant.
· Children enrolled in Medicaid/Hoosier Healthwise were more likely to have had caries experience and to have untreated decay than children with private dental insurance.
· Children enrolled in Medicaid/Hoosier Healthwise were more likely to have sealants than children with private dental insurance; 25 percent vs. 16 percent.
· Children with Medicaid/Hoosier Healthwise coverage were less likely than children with private insurance to have visited a dentist in the past year. Among the children ages 6-8, 74 percent of those with Medicaid/Hoosier Healthwise had a dental visit within the past year compared with 81 percent of those with private insurance and 56 percent of those who reported no or unknown insurance coverage.
· Among the children 6 to 8 years old, 10 percent of those with Medicaid, 8 percent of those with private insurance and 23 percent of those with unknown coverage never had a dental visit. Among the 15-year-old adolescents, 3 percent of those with Medicaid/Hoosier Healthwise, 4 percent of those with private insurance and 11 percent of those with unknown or no coverage had never seen a dentist.
Although each molar and premolar has five vulnerable surfaces, 61 percent of untreated decay in 6-8 year olds and 66 percent of untreated decay in 14 and 15 year olds was found in the occlusal (biting) surfaces of permanent teeth. This decay could have been prevented by the application of pit and fissure sealants. [310]