Introduction
By 1984, more than 51 million children (one-fifth of the U.S. population) were in the 1-14 year-old age group. An additional 40 million children were between the ages of 15-24. In examining the health of this segment of the U.S. population, it is important to recognize that many factors help shape its health status. There is a trend to start children in school at younger ages. Along with this trend, and perhaps strongly associated with it, is the return to the workforce of the traditional caregiver. There is also an increase in the number of single-parent families and increases in the number of families living at the poverty level.
Demographic Data
Along with the increase in the median age of the U.S. population, there has been a corresponding decrease in the number of children. There were 2.5 million fewer children of school age in 1984 than there were in 1980.
The under 5 population rose 9% between 1980 and 1984, from 16.3 million to 17.8 million. This is the largest under 5 population since the 17.9 million recorded in 1968.
As of 1984, approximately 40 million Americans were between the ages of 15-24. Since 1960, the percentage of the population in this age cohort has increased from 13.4%-16%.
Of this age group, approximately 83% are white, and 16% are Black and other races.
Socioeconomic Data
The proportion of children with mothers in the labor force has increased dramatically over the last decade. For all children under age 18 in 1970, 39% had mothers in the workforce, compared to 55% in 1982.
The percentage of families headed by women with children under age 18 has increased from 7% in 1960 to 19% in 1982. The proportion headed by Black women (46%) exceeds that headed by white women (15%).
As of 1982, 22% of all children under 18 were living in a single-parent family with either their mother or father.
Children are more likely than other age groups to be living in poverty. In 1981, 19.5% of children under 18, compared to 14% of persons of all ages, were below the poverty level. Significant differences are found among racial groups: while 14.7% of whites were below poverty level, 44.9% of Blacks and 35.4% of Hispanics were below this economic level.
The percentage of high school graduates among 18 year-olds has increased from 56% in 1950 to 71.8% in 1983.
Mortality
In 1983, the leading causes of death among children were accidents, cancer, and congenital anomalies.
| Cause of Death | Death Rate per 100,000 |
| Accidents and adverse effects | 8.5 |
| Motor vehicle crashes | 7.7 |
| Malignant neoplasms | 3.7 |
| Congenital anomalies | 2.8 |
| Diseases of the heart | 1.9 |
| Homicide and legal interventions | 1.4 |
| Pneumonia and influenza | 0.7 |
| Suicide | 0.3 |
| Cerebrovascular diseases | 0.2 |
| COPD and allied conditions | 0.2 |
The death rates of children under 14 years old have declined significantly; by as much as half to one-third of the rate 30 years ago.
Unintentional injuries are the leading cause of death in the first decade of life. The motor vehicle fatality rate for children has declined over the past several years in part because all states now require child safety seat use.
The development and widespread use of vaccines for the prevention of infectious diseases dramatically improved the national health status. Most children are now being adequately immunized. However, the importance of these preventive measures should be continually promoted since an unimmunized child faces the possibility of contracting a serious disease.
The leading causes of mortality among adolescents are accidents, suicide, homicide, cancer and heart disease.
Accidental death rates for adolescents peaked in 1978 and are now slightly below the 1950 rate. Motor vehicle accidents account for more than 70% of all accidental deaths in this age group. In 1984, the death rate for motor vehicle accidents was 36.5 per 100,000 and 14.0 per 100,000 for all other accidents.
Drivers in the 20-24 age group had the largest conviction and alcohol-related accident rates of any age group: 40.5 convictions per 1,000 drivers and 7.53 alcohol-related accidents per 1,000 drivers.
Suicide is now the second leading cause of death among adolescents, with the rate triple that of 30 years ago. 20-24 year-olds have a rate almost twice as high (14.8 per 100,000) as 15-19 year-olds (8.7 per 100,000). White males accounted for 70% of all suicides.
The leading cause of death among Black males in this age group is homicide. In 1983, their death rate from homicide was 6 times greater than for white males: 66.8 per 100,000 compared to 11.3 per 100,000.
While the death rates for homicide and suicide increased between 1950-1984, the rates for cancer and diseases of the heart have declined.
Morbidity
Morbidity data are not generally available for the specific age cohort 15-24 year-olds. The NCHS and HANES surveys report data for the ages 17 and younger and 18-44.
Data are available on dental disease experienced by children. Progress has been made in reducing the proportion of 9 year-old children who have dental caries in their permanent teeth from 71% in 1971-1974 to 49% in 1979-1980. A national survey on gum disease indicated that 92% of children had moderate gingival treatment needs and 3% had severe needs.
Risk Factor Prevalence
Smoking
Cigarette smoking is declining for all age groups except adolescent women. The percent of 12-15 year-olds who smoke has declined from 19% in 1974 to 6.5% in 1982.
While the percentage of 20-24 year-olds who smoke has decreased from 1965-1983, the percentage of female smokers increased from 1980-1983. There has been a greater decline in the percentage of male smokers than female smokers.
In 1980, 40% of married teenage mothers smoked during pregnancy, compared to 25% of married mothers 20 years of age and over. Smoking during pregnancy is associated with increasing the risk of premature delivery, respiratory and cardiovascular problems and death.
Use of Alcohol and Drugs
Among 12-17 year-olds, the use of alcohol and drugs has declined after increases during the past decade. In 1974, 12% reported using alcohol in the past month, increasing to 16.6% in 1979, and dropping to 11.5% in 1982. There has been a greater decline in drug use from 34% in 1974 to 26.9% in 1982.
More recent school-age cohorts have started using alcohol at earlier ages. 56% reported starting the use of alcohol before high school.
The use of drugs, including alcohol, by adolescents is decreasing, according to the NIDA Household and High School Senior Surveys.
The use of marijuana, alcohol and many other illicit drugs has declined. Particularly noteworthy is the change in marijuana use. Between 1975-1978, use rose from 6%-11% among high school seniors. However, there was a significant decline in use to 5.5% by 1983.
Since 1974, the percentage of high school seniors using alcohol has remained relatively stable at high levels. Binge drinking, defined as consuming five or more drinks at one occasion during the previous two weeks, increased from 37% in 1975 to 41% in 1979.
The use of cocaine among high school seniors more than doubled between 1975-1979. The usage rate was 12% in 1980-1981. While there has been a slight decline, the rates continued to remain at a high level of 11% in 1983.
Many high school seniors are aware of the health risks associated with drug use. In 1984, 63.8% perceived great risk in smoking cigarettes; 66.9% with marijuana; 68.5% with barbiturates; and 41.7% with five or more drinks.
Exercise and Physical Fitness
Young Americans have become fatter since the 1960s. In 1984, both boys and girls in grades 5-12 had median skinfold sums that were 2-3 millimeters thicker than a 1960 sample.
In 1984, 36.3% of 10-17 year-olds participated in daily physical education classes.
In 1984, 66% of 10-17 year-olds were involved in cardiovascular exercises that could be carried into adulthood.
Teenage Pregnancy and Birth Rates
In 1978, there were 10,772 recorded births to girls 14 years of age and under, compared to 9,965 in 1984. While the number of births has declined, there has also been a decline in the number of girls in this age group.
The age-specific birth rate was 1.2 births per 1,000 in 1984. The birth rate for this age group has not been below the low of 0.8 per 1,000 ovserved in the 1940s.
Approximately 50% of teens age 15-17 and 60% age 18 and older use contraception at first intercourse.
By their 18th birthdays, 22% of Black females and 8% of white females have become mothers. By their 20th birthday, 41% of Black females and 19% of white females have become mothers.
Teens are more likely to be unmarried, have lower educational attainment, less prenatal care, increased welfare dependency and a larger percentage of low birthweight infants than mothers in their twenties.
Unmarried teens also experience high rates of infant and maternal mortality, and low birthweight babies, due in part to receiving less prenatal care. For various reasons, teens are less likely to seek early prenatal care.
In 1960, births to women under 20 out-of-wedlock was 15.4% compared, to 54.1% in 1983.
High Blood Pressure
High blood pressure is defined as cystolic of 140 or greater, or diastolic of 90 or greater.
Percent with High Blood Pressure; Age—6-11—0.4%; Age—12-17—3.6%
Trends
In addition to unintentional injuries, some of the key health issues facing children today are: immunizations from infectious diseases; infant mortality; dental disease; child abuse; smoking; and physical fitness.
School-Based Programs
Target Group Data
As of 1985, 56.9 million youth out of a total population of 238.6 million attended public or private educational institutions. 95% of all children in the U.S. were in elementary or secondary schools.
Out of 56.9 million students in educational institutions, 38.9 million of these are enrolled in public schools.
Approximately 115,000 public and private schools exist in the U.S.
As of 1985, there were nearly 16,000 school districts with a total of 15,947 superintendents in public schools.
On an average, the nation's 56.9 million children will spend a total of 12,000 hours in grades K-12.
Annually, the U.S. spends $105 billion on education.
Program Operations
Requirements for health instruction vary from state to state. Education codes in 43 states address health education in some fashion. 37 states require health education or specific aspects of health instruction.
37 state boards of education and the District of Columbia School Board have developed policies or position statements regarding school health education.
Curriculum or planning guides for health education have been published in 34 states and the District of Columbia.
24 states require health instruction as a graduation requirement. The national average for health education requirements for high school graduation is 43.73 hours. This represents approximately 1% of total high school instruction time or 30% of a child's total schooling.
The financial outlay for school health education represents roughly 20% of the total cost of a public education.
Roughly 34% of the nation's children receive comprehensive health instruction.
14 states have mandated comprehensive school health programs.
Health certification or endorsement for health teachers at the secondary level is now provided for by 41 states. The majority of states in the U.S. do not offer health education certification to teachers in grades K6. In grades 1-6, 81% of health programs are taught by teachers who have no special training in health education. About 50% of junior and senior high school health education classes are taught by certified health education teachers.
In 75% of school districts, local school funds are the sole source of support for health education programs. State funding is involved in almost 20% of health education programs throughout the nation's school districts. Federal, private, or special funds contributed 3% to school health education programs nationwide. Regional variation does exist in the source of funding.
89% of all schools, or 85,222 schools (public and private), offer the national school lunch program.
As of January 1986, 60.5% of all students within these schools participate in the National School Lunch Program, or 23,731,000 children.
Program Outcome Data
Estimates indicate that a 2% reduction in the incidence of teenage pregnancy, auto accidents, and need for alcoholism treatment would result in a net savings of roughly $480 billion.
An evaluation of the School Health Curriculum Project (SHCP) concluded that the program increased knowledge and changed attitudes in the area of smoking. By extrapolation of the results from the SHCP that was provided to seventh graders, it is estimated that each year 146,000 seventh grade students would delay the onset of smoking.
Operation of a school-based health clinic at one U.S. high school resulted in a 56% decline in fertility rates, a reduction from 45% to 10% in the dropout rate among teen mothers, and an increase to 100% in contraceptive use by adolescent mothers.
Based on the results of the 1985 National Children and Youth Fitness Study, American children have become fatter since the 1960s. Median skinfold sums were 2-3 millimeters thicker than in the 1960s sample studied.
Over 80% of students in grades 5-12 are enrolled in physical education; however, enrollment drops off from a level of 97% in grades 5 and 6 to 50% in grades 11 and 12.
For 12th grade girls, enrollment in physical education is below 50%. 36.3% of students take physical education daily.
A typical student reports spending 80% of his/her physical activity time outside physical education class.
58.9% engage in appropriate physical activity year round ("appropriate" is defined as exercise involving large muscle groups in dynamic movement for periods of 20 minutes or longer, 3 or more times weekly).
For school-age mothers at nine months following childbirth, 17% of white mothers were enrolled in school in 1979 as compared with 5% in 1968; for Black mothers, the proportions were 39% and 15% respectively.
In 1984, at five months before their first child's birth, 20% of white school-age mothers-to-be were enrolled in school, as compared with 42% in 1979. For Blacks, the proportions were 45% and 70% respectively. Overall, in 1979, 27% of white women and 55% of Black women aged 14-22 were still enrolled in school as of the month of the first birth.