Child and Child and Adolescent HealthAdolescent Health

Cheryl Duncan De Pinto, Cheryl Duncan De Pinto, M.D., M.P.H.M.D., M.P.H.

Medical Director, Child, Medical Director, Child, Adolescent, and School HealthAdolescent, and School HealthCenter for Maternal and Child Center for Maternal and Child

HealthHealth

Children and Adolescents in Children and Adolescents in MarylandMaryland

Age Distribution of Children in Maryland, 2008<1 year

5%

1-4 years20%

5-9 years24%

10-14 years24%

15-19 years27%

Source: MD Vital Statistics Administration, 2008 N=1,506, 879

Family Structure and Living Family Structure and Living ArrangementsArrangements

33% (nearly 500,000) of Maryland children under 18 live 33% (nearly 500,000) of Maryland children under 18 live in a single parent home. in a single parent home.

In December 2009, 8,429 children were in out-of-home In December 2009, 8,429 children were in out-of-home placement through the MD Department of Human placement through the MD Department of Human Resources.Resources.– 11.8% were in group homes11.8% were in group homes– 76.9% were in family foster homes76.9% were in family foster homes

In 2009, 4,968 youth were admitted to secure detention In 2009, 4,968 youth were admitted to secure detention facilitiesfacilities

Source: Kids Count Data Center; MD Department of Juvenile ServicesSource: Kids Count Data Center; MD Department of Juvenile Services

Health Insurance CoverageHealth Insurance Coverage10% of Maryland youth, birth-18 years, are uninsured.10% of Maryland youth, birth-18 years, are uninsured.

Source: MD Health Care Commission, Health Insurance Coverage in Maryland Through 2007Source: MD Health Care Commission, Health Insurance Coverage in Maryland Through 2007

Age Distribution of Uninsured Children, Maryland, 2005-2006

7-12 years28%

0-6 years34%13-18 years

38%

Source: MD Health Care Commission, Health Insurance Coverage in Maryland Through 2007

Medical HomeMedical Home

The American Academy of The American Academy of Pediatrics' description of a Pediatrics' description of a "medical home" lists seven "medical home" lists seven

defining components:defining components:

– AccessibleAccessible– ContinuousContinuous– ComprehensiveComprehensive– Family-centeredFamily-centered– Coordinated Coordinated – Compassionate Compassionate – Culturally effectiveCulturally effective

41.4% of Maryland 41.4% of Maryland children do not meet the children do not meet the AAP criteria for having a AAP criteria for having a medical home.medical home.

However, 93.9% of However, 93.9% of Maryland children have a Maryland children have a usual place for sick and usual place for sick and well care.well care.

Source: 2007 National Survey of Source: 2007 National Survey of Children’s HealthChildren’s Health

ImmunizationsImmunizations

Estimated Percentage of Children, 19-35 M onths of Age , Who Have Rece ived Full Vaccination Schedule , M aryland

and U.S., 2000-2008

0

20

40

60

80

100

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Per

cent Maryland

UnitedStates

Source: National Immunization Survey, 2000-2008

Vaccination Coverage Among Vaccination Coverage Among AdolescentsAdolescents

Estimated Vaccination Coverage Among Adolescents Aged 13-17 Years, Maryland and U.S., 2008

92.3

91.2

86.7

79

54.6

41.1

0 20 40 60 80 100

Measles, mumps, rubella

Hepatitis B

Varicella

Td or Tdap

Meningococcal conjugate vaccine

HPV

Va

cc

ine

Percent

Maryland

United States

Source: "National, State, and Local Area Vaccination Coverage Among Adolescents Aged 13-17 Years-United States, 2008," MMWR September 18, 2009 58(36); 997-1001.

Lead PoisoningLead Poisoning

Percentage of Children with Elevated Blood Lead Leve ls Compared to Percentage of Children Tested, M aryland, 1993-2008

0

5

10

15

20

25

30

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Pe

rce

nt

of

ch

ild

ren

% with elevated bloodlead level

% of children tes ted

Source: MD Department of the EnvironmentElevated: Blood Lead>/=10mcg/dl

Oral Health: StatusOral Health: Status• • 31% of school children in Kindergarten and Grade 3 had 31% of school children in Kindergarten and Grade 3 had

at least one tooth with dental caries.at least one tooth with dental caries. • • 27% of school children in Kindergarten and Grade 3 had 27% of school children in Kindergarten and Grade 3 had

at least one tooth with a dental sealant.at least one tooth with a dental sealant.

Oral Health: DisparitiesOral Health: DisparitiesChildren more likely to have dental caries and less likely to have Children more likely to have dental caries and less likely to have dental sealants:dental sealants:– Black, non-Hispanic childrenBlack, non-Hispanic children– Children receiving free or reduced price mealsChildren receiving free or reduced price meals– Children residing on the Eastern Shore (both sealants and caries) or in Children residing on the Eastern Shore (both sealants and caries) or in

Central Baltimore (sealants only)Central Baltimore (sealants only)– Children covered by Medicaid rather than private insurance (sealants)Children covered by Medicaid rather than private insurance (sealants)– Children with either Medicaid or no insurance coverage (caries)Children with either Medicaid or no insurance coverage (caries)

Source: Survey of the Oral Health Status of Maryland School Children, 2005-2006Source: Survey of the Oral Health Status of Maryland School Children, 2005-2006

Oral Health: Access to CareOral Health: Access to Care

Dentist visit in the past 12 Dentist visit in the past 12 months:months:

Yes: 83.1 %Yes: 83.1 %No: 15.6 %No: 15.6 %Unknown: 1.3 %Unknown: 1.3 %

Dental care service availability:Dental care service availability:Yes: 90.3 %Yes: 90.3 %No: 8.1 %No: 8.1 %Unknown: 1.6 %Unknown: 1.6 %

Source: 2005-2006 Survey of the Oral Health Source: 2005-2006 Survey of the Oral Health Status of Maryland Children, University of Status of Maryland Children, University of Maryland School of DentistryMaryland School of Dentistry

Dental Coverage for Dental Coverage for School Children in School Children in Kindergarten or 3Kindergarten or 3rdrd

GradeGrade

MedicaidMedicaid 28.4%28.4%

PrivatePrivate 59.6%59.6%

No No CoverageCoverage 11.1%11.1%

UnknownUnknown 0.9%0.9%

MortalityMortalityIn 2007, there were 366 deaths to children In 2007, there were 366 deaths to children ages 1-17 in Maryland and the child death ages 1-17 in Maryland and the child death rate was 28.6 deaths per 100,000 rate was 28.6 deaths per 100,000 population. population.

– Highest child death rates (2005-2007):Highest child death rates (2005-2007):

Black, non-Hispanic youth: 33.4 per 100,000Black, non-Hispanic youth: 33.4 per 100,000

Older youth (15-17 years): 51.1 per 100.000Older youth (15-17 years): 51.1 per 100.000

Source: MD DHMH, Vital Statistics AdministrationSource: MD DHMH, Vital Statistics Administration

Mortality: Unintentional InjuriesMortality: Unintentional Injuries

Top 3 Leading Causes of Death, by Age Group, 2005-2007Top 3 Leading Causes of Death, by Age Group, 2005-2007

1-4 years1-4 years 5-9 years5-9 years 10-14 years10-14 years 15-19 years15-19 years

11Unintentional Unintentional

injuriesinjuriesUnintentional Unintentional

injuriesinjuriesUnintentional Unintentional

injuriesinjuriesUnintentional Unintentional

injuriesinjuries

22Congenital Congenital

malformationsmalformationsMalignant Malignant neoplasmsneoplasms

Malignant Malignant neoplasmsneoplasms HomicideHomicide

33 HomicideHomicide Congenital Congenital malformationsmalformations

Diseases of the Diseases of the circulatory circulatory

systemsystemSuicideSuicide

Source: MD DHMH, Vital Statistics AdministrationSource: MD DHMH, Vital Statistics Administration

Injury-related deathsInjury-related deaths

Top 5 Causes of Fatal Injury to Youth, 1-17, Maryland, Top 5 Causes of Fatal Injury to Youth, 1-17, Maryland, 2005-20072005-2007

Cause of Fatal InjuryCause of Fatal Injury # of Deaths# of Deaths % of injury-related % of injury-related deathsdeaths

Motor vehicle Motor vehicle accidentsaccidents 193193 37.4%37.4%

Homicide by firearmHomicide by firearm 8585 16.5%16.5%

Homicide by other Homicide by other meansmeans 4444 8.5%8.5%

DrowningDrowning 3838 7.4%7.4%

FireFire 3535 6.8%6.8%

Source: MD DHMH, Vital Statistics AdministrationSource: MD DHMH, Vital Statistics Administration

HospitalizationsHospitalizations

% of Hospitalizations due to Asthma% of Hospitalizations due to Asthma

Children, 1-4 yearsChildren, 1-4 years 16.5%16.5%

Children, 5-9 yearsChildren, 5-9 years 17.5%17.5%

Children, 10-14 yearsChildren, 10-14 years 9.3%9.3%

Other Leading Causes of Hospitalizations:Other Leading Causes of Hospitalizations:

Young children (1-4 years) : Common childhood infections Young children (1-4 years) : Common childhood infections

Middle children (5-9 years): InjuriesMiddle children (5-9 years): Injuries

Older children (10-14 years): InjuriesOlder children (10-14 years): Injuries

Source: HSCRC Hospital Inpatient Data, 2007Source: HSCRC Hospital Inpatient Data, 2007

Mental Health: HospitalizationsMental Health: Hospitalizations

Hospitalizations of Children Due to Mental Health Concerns, Maryland, Hospitalizations of Children Due to Mental Health Concerns, Maryland, 20072007

Child AgeChild Age % of hospitalizations due to % of hospitalizations due to affective disorderaffective disorder

% of hospitalizations % of hospitalizations due to “other mental due to “other mental

conditions”conditions”

5-9 Years5-9 Years 3.3% (150 hospitalizations)3.3% (150 hospitalizations) **

10-14 Years10-14 Years 8.3% (414 hospitalizations)8.3% (414 hospitalizations) 2.9% (143 2.9% (143 hospitalizations)hospitalizations)

Source: HSCRC Hospital Inpatient Data, 2007Source: HSCRC Hospital Inpatient Data, 2007*Not a Top 10 Reason for Hospitalization for this Age Group*Not a Top 10 Reason for Hospitalization for this Age Group

Mental Health: Early ChildhoodMental Health: Early Childhood

1,094 of 30,094 children, ages 0-5 years cared 1,094 of 30,094 children, ages 0-5 years cared for in child care sites* were identified as having a for in child care sites* were identified as having a mental health concernmental health concern– Of those, 414 children with more serious mental Of those, 414 children with more serious mental

health concerns have been referred to other services.health concerns have been referred to other services.

*Child care centers, family child care homes, Head Start centers, preschools, and unregistered sites *Child care centers, family child care homes, Head Start centers, preschools, and unregistered sites

Source: MSDE, Early Childhood Mental Health ProjectSource: MSDE, Early Childhood Mental Health Project

School Readiness: School Readiness: The Seven DomainsThe Seven Domains

Personal and Social DevelopmentPersonal and Social Development

Language and literacyLanguage and literacy

Mathematical thinkingMathematical thinking

Scientific thinkingScientific thinking

Social studiesSocial studies

The artsThe arts

Physical developmentPhysical developmentSource: MSDE Report, Children Entering School Ready to Learn: School Readiness Source: MSDE Report, Children Entering School Ready to Learn: School Readiness Information for School Year 2008-2009Information for School Year 2008-2009

School ReadinessSchool Readiness

Percentage of Children Entering School Ready to Learn, by Race/Ethnicity, Sex, and Family Income Level, Maryland, 2008-2009

71 8069 78

63 69 7865

79

020406080

100

AmericanIndian

Asian AfricanAmerican

White Hispanic Male Female FARMS NoFARMS

Per

cen

t

Source: MSDE Report, Children Entering School Ready to Learn: School Readiness Information for School Year 2008-2009*FARMS is the Free And Reduced-price Meals program. Students are eligible for FARMS if their family income is under 185 percent of the federal poverty level

Health of School-aged ChildrenHealth of School-aged ChildrenSchool Health Services Annual Survey School Health Services Annual Survey

SY 2006-2007SY 2006-2007

AsthmaAsthma 64,44164,441

ADHDADHD 34,31934,319

Seizure disorderSeizure disorder 3,713 3,713

Heart conditionHeart condition 3,0603,060

DiabetesDiabetes 1,7931,793

Source: Maryland State Department of EducationSource: Maryland State Department of Education

Current Asthma Prevalence Among Children Ages 0-17 by Race/Ethnicity, Maryland,

2005-2007 Combined

11.6

14.5

6.98.87.3

0

3

69

12

15

White, Non-Hisp

Black, Non-Hisp

Hispanic Asian, Non-Hisp

Other, Non-Hisp

Per

cen

t

Source: Maryland, BRFSS, 2001-2007Source: Maryland, BRFSS, 2001-2007*Survey question changed in 2005. *Survey question changed in 2005.

Childhood AsthmaChildhood Asthma

Childhood AsthmaChildhood Asthma

Current Asthma Prevalence Among Children Ages 0-17 by Age, Maryland, 2005-2007 Combined

10.4

3.0

9.5 9.7

0.0

3.0

6.0

9.0

12.0

15.0

< 2 yrs 2-5 yrs 6-10 yrs 12-17 yrs

Per

cen

t

Source: Maryland, BRFSS, 2001-2007Source: Maryland, BRFSS, 2001-2007*Survey question changed in 2005. *Survey question changed in 2005.

Childhood AsthmaChildhood Asthma

Sources: HSCRC ambulatory care data, 2007; Sources: HSCRC ambulatory care data, 2007;

HSCRC hospital discharge data, Maryland Health Care Commission, West Virginia Health Care Authority, HSCRC hospital discharge data, Maryland Health Care Commission, West Virginia Health Care Authority,

Pennsylvania Health Care Cost Containment Council, and Delaware Department of Health, 2005-2007.Pennsylvania Health Care Cost Containment Council, and Delaware Department of Health, 2005-2007.

Asthma Hospitalization Rates by Race, Sex, and Age, Maryland Children, 5-18yrs, 2004-2006

0

5

10

15

20

25

30

White Black Other Male Female 5-14 yrs 15-17 yrs 18 yrs Total

Rate

per 1

0,000

2004 2005 2006

Childhood AsthmaChildhood Asthma

Sources: HSCRC ambulatory care data, 2007; Sources: HSCRC ambulatory care data, 2007;

HSCRC hospital discharge data, Maryland Health Care Commission, West Virginia Health Care Authority, HSCRC hospital discharge data, Maryland Health Care Commission, West Virginia Health Care Authority,

Pennsylvania Health Care Cost Containment Council, and Delaware Department of Health, 2005-2007.Pennsylvania Health Care Cost Containment Council, and Delaware Department of Health, 2005-2007.

Asthma Emergency Department Visit Rates by Race, Sex and Age, Maryland Children, 5-18yrs, 2004-2006

0

50

100

150

200

250

White Black Other Male Female 5-14 yrs 15-17 yrs 18 yrs Total

Rate

per 1

0,000

2004 2005 2006

Childhood ObesityChildhood ObesityPercent of Children Obese, Ages 2-4, Maryland and United

States, 1998-2008

12.014.4 15.7

12.414.5 14.6

0

5

10

15

20

1998 2003 2008

Year

Perc

ent w

ith B

MI≥

95t

h pe

rcen

tile

for a

ge a

nd

sex

MarylandU.S.

Source: CDC. Obesity Prevalence Among Low-Income, Preschool-Aged Children--United States, 1998-2008. MMWR July 24, 2009/ 58(28); 769-773.

Childhood ObesityChildhood Obesity

Percent of Children (2-19 years) with BMI ≥ 95th Percentile, Maryland Healthy Kids Study Participants, 2004-2007, NHANES Participants, 2003-2006

24.4 25.112.1 15.8 16.818.0 22.1 27.0

12.8 18.0 18.215.3

0

20

40

60

80

100

2-5 Yrs 6-11 Yrs 12-19 Yrs

Age

Pe

rce

nt

wit

h B

MI

≥ 9

5th

P

erc

en

tile

Females MD HK

Females NHANES

Males MD HK

Males NHANES

Data Source: Healthy Kids MCO Review, Ogden et al, 2008: NHANES

Mental Health: Depression and SuicideMental Health: Depression and SuicideYRBS, Maryland 2007YRBS, Maryland 2007

Felt sad or hopeless (signs of depression)Felt sad or hopeless (signs of depression) 23%23%

Seriously considered attempting suicide during the past 12 Seriously considered attempting suicide during the past 12 monthsmonths

13%13%

Attempted suicide in the past 12 monthsAttempted suicide in the past 12 months 7.5%7.5%

Required medical attention due to suicide attemptRequired medical attention due to suicide attempt 2.3%2.3%

Source: MD Youth Risk Behavior Survey, 2007Source: MD Youth Risk Behavior Survey, 2007

Substance Use-Related Risk BehaviorsSubstance Use-Related Risk Behaviors YRBS, Maryland 2007YRBS, Maryland 2007

Rode in a vehicle driven by someone who had been Rode in a vehicle driven by someone who had been drinking alcohol, at least once in the past 30 daysdrinking alcohol, at least once in the past 30 days

29%29%

Tried cigarettesTried cigarettes 50%50%

Currently smoke cigarettesCurrently smoke cigarettes 17%17%

Reported binge drinking at least once in the previous 30 Reported binge drinking at least once in the previous 30 daysdays

24%24%

Currently use marijuanaCurrently use marijuana 20%20%

Have tried cocaineHave tried cocaine 6%6%

Have tried heroineHave tried heroine 2%2%

Have tried inhalants (glue, aerosol cans, paint)Have tried inhalants (glue, aerosol cans, paint) 13%13%

Source: MD Youth Risk Behavior Survey, 2007Source: MD Youth Risk Behavior Survey, 2007

Violence and BullyingViolence and Bullying YRBS, Maryland 2007YRBS, Maryland 2007

In a physical fight at least once in the past year.In a physical fight at least once in the past year. 36%36%

Carried a gun at least once in the past 30 days.Carried a gun at least once in the past 30 days. 5%5%

Carried a weapon on one or more of the past 30 daysCarried a weapon on one or more of the past 30 days 19%19%

Harassed or bullied on school property during the past 12 Harassed or bullied on school property during the past 12 months.months.

26%26%

Victims of teasing or name-calling because of their weight, Victims of teasing or name-calling because of their weight, size or physical appearance during the past 30 days.size or physical appearance during the past 30 days.

29%29%

Victims of teasing or name-calling in the past 30 days Victims of teasing or name-calling in the past 30 days because of their race or ethnic background.because of their race or ethnic background.

17%17%

Harassed or bullied during the past 12 months due to their Harassed or bullied during the past 12 months due to their perceived sexual orientation.perceived sexual orientation.

13%13%

Source: MD Youth Risk Behavior Survey, 2007Source: MD Youth Risk Behavior Survey, 2007