Chartbook on Healthy Living

• Early and adequate prenatal care.
• Receipt of recommended immunizations by young children.
• Children's vision screening.
• Well-child visits in the last year.
• Receipt of meningococcal vaccine by adolescents.
• Receipt of human papillomavirus (HPV) vaccination by adolescents.

Prevention: Early and Adequate Prenatal Care

• A Healthy People 2020 objective is for 77.6% of pregnant women to receive early and adequate prenatal care:
  • Based on Adequacy of Prenatal Care Utilization Index.
  • For a given pregnancy, target number of prenatal visits considered adequate determined by prenatal care start date and infant's gestational age at birth.

Infants Whose Mothers Had Adequate Prenatal Care

Infants born in 2012 whose mothers had obtained early and adequate prenatal care, by State quartiles

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 2012.

Note: Because of changes between the 1998 and 2003 versions of birth certificates, prenatal care timing and adequacy were evaluated only for the District of Columbia and the 38 States using the 2003 standard birth certificate for all of 2012. Data for 2012 were only available for these 39 State-equivalent jurisdictions, so national estimates were not generated. However, these 39 jurisdictions accounted for more than 86% of live births in the United States in 2012. The State-equivalent jurisdictions (AK, AL, AR, AZ, CT, HI, ME, MS, NJ, PR, RI, VA, and WV) not using the 2003 version of the birth certificate did not have data available for this measure and are categorized as "missing" on the map.

To classify the adequacy of prenatal care services, the reported number of visits is compared to the expected number of visits for the period between when care began and the delivery date. Completeness of reporting varies by item and State. Two States were missing responses on more than 10% of the birth certificates (GA-13.4%; NV-17.2%). The impact of the comparatively high level of unknown data is not clear. Comparisons that include information from these States should be made with caution. More detailed information is available in the 2012 Natality Data Users Guide: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/natality/UserGuide2012.pdf (1.43 MB).

• Overall: This map shows overall rankings by quartiles in the percentage of infants born to women who received early and adequate prenatal care in 2012, for Washington, DC, and 38 States. Values ranged from 63.5% to 87.2%.
• Differences by State: Interquartile ranges follow:
  • First quartile (worst): 63.5%-69.8% (CO, DC, MD, NM, NV, OK, SD, TX, WA).
  • Second quartile (second worst): 70.1%-73.0% (DE, FL, GA, IN, MT, NY, OH, PA, TN, WY).
  • Third quartile (second best): 73.4%-77.8% (ID, IL, LA, MI, MN, MO, NC, ND, NE, SC).
  • Fourth quartile (best): 78.0%-87.2% (CA, IA, KS, KY, MA, NH, OR, UT, VT, WI).

Disparities in Receipt of Adequate Prenatal Care

Absolute differences in receipt of early and adequate prenatal care between White and Black infants born in 2012, by State quartiles

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Vital Statistics, National Vital Statistics System, 2012.

Note: Because of changes between the 1998 and 2003 versions of birth certificates, prenatal care timing and adequacy were evaluated only for the District of Columbia and the 38 States using the 2003 standard birth certificate for all of 2012. Data for 2012 were only available for these 39 State-equivalent jurisdictions, so national estimates were not generated. However, these 39 jurisdictions accounted for more than 86% of live births in the United States in 2012. The State-equivalent jurisdictions (AK, AL, AR, AZ, CT, HI, ME, MS, NJ, PR, RI, VA, and WV) not using the 2003 version of the birth certificate did not have data available for this measure and are categorized as "missing" on the map.

• Overall: This map shows overall State-equivalent rankings by quartiles for the absolute differences between percentages of White and Black infants born in 2012 whose mothers obtained early and adequate prenatal care.
• Differences by State: Interquartile ranges follow:
  • First quartile (smallest absolute difference): 2.6%-7.8% (CA, CO, DE, ID, KY, MA, MD, NM, SC).
  • Second quartile: 8.6%-10.0% (FL, KS, NC, NE, NV, NY, OR, TX, WA, WY).
  • Third quartile: 10.1%-14.9% (GA, IN, LA, MI, MT, NH, OH, OK, PA, TN).
  • Fourth quartile (largest absolute difference): 16.6%-24.8% (DC, IA, IL, MN, MO, ND, SD, UT, VT, WI).

Prevention: Receipt of Recommended Vaccinations by Young Children

• Immunizations reduce mortality and morbidity by:
  • Protecting recipients from illness and.
  • Protecting others in the community who are not vaccinated.
• Beginning in 2007, seven vaccines were recommended to be completed by ages 19-35 months:
  • Diphtheria-tetanus-pertussis vaccine.
  • Polio vaccine.
  • Measles-mumps-rubella vaccine.
  • Haemophilus influenzae type B vaccine.
  • Hepatitis B vaccine.
  • Varicella vaccine.
  • Pneumococcal conjugate vaccine.

  These vaccines constitute the 4:3:1:3:3:1:4 vaccine series tracked in Healthy People 2020.

• The Healthy People 2020 target is 80% coverage in the population ages 19-35 months.
• The U.S. Surgeon General, Dr. Vivek H. Murthy, and Elmo want everyone to stay healthy and get vaccinated! https://youtu.be/viS1ps0r4K0.

Children Who Received the 4:3:1:3:3:1:4 Vaccine Series

Children ages 19-35 months who received the 4:3:1:3:3:1:4 vaccine series, by household income and race/ethnicity, 2009-2012

Left Chart:

2012 Achievable Benchmark: 72%.

Right Chart:

2012 Achievable Benchmark: 72%.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics and National Center for Immunization and Respiratory Diseases, National Immunization Survey, 2009-2012.

Note: White and Black are non-Hispanic. Hispanic includes all races. The 4:3:1:3:3:1:4 vaccine series refers to 4 or more doses of diphtheria and tetanus toxoids and pertussis vaccine, or diphtheria and tetanus toxoids;3 or more doses of poliovirus vaccine; 1 or more doses of measles antigen-containing vaccine, including measles-mumps-rubella; 3 or more doses of Haemophilus influenza (Hib) type b vaccine; 3 or more doses of hepatitis B vaccine; 1 or more doses of varicella vaccine; and 4 or more doses of pneumococcal conjugate vaccine. Full series of Hibvaccine is ≥3 or ≥4 doses, depending on brand type.

• Trends: From 2009 to 2012, the percentage of children ages 19-35 months who received the 4:3:1:3:3:1:4 vaccination series improved from 44.3% to 68.4%.
• Groups With Disparities:
  • From 2009 to 2012, the percentage of children who received all recommended vaccinations improved for high-income households (49.3% to 77.7%), middle-income households (44.6% to 68.1%), low-income households (43.1% to 68%), and poor households (41.6% to 63.1%).
  • In 2012, children from high-income households were more likely to receive all the recommended vaccinations than those from poor, low-income, and middle-income households.
  • From 2009 to 2012, the percentage of children who received all recommended vaccinations improved for Blacks (39.6% to 64.8%), Hispanics (45.9% to 67.8%), and Whites (45.2% to 69.3%).
  • In 2012, there were no statistically significant differences between Hispanic children and White children in the percentage who received all recommended vaccines, while Black children were less likely than White children to receive all recommended vaccines.
  • The 2012 top 5 State achievable benchmark was 72%. The top 5 States that contributed to the achievable benchmark are Louisiana, Maryland, Massachusetts, New Hampshire, and Ohio.
  • Children from high-income households have achieved the benchmark.
  • Children from poor, low-income, and middle-income households could achieve the benchmark in approximately a year. White, Black, and Hispanic children also could achieve the benchmark within a year.

Prevention: Children's Vision Screening

• Vision checks for children may detect problems of which children and their parents were previously unaware.⁶
• Early detection also improves the chances that corrective treatments will be effective.⁶

Children Who Had Their Vision Checked

Children ages 3-5 years who ever had their vision checked by a health provider, by race/ethnicity, United States, 2002-2012

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002-2012.

Note: White and Black are non-Hispanic. Hispanic includes all races.

• Trends:
  • From 2002 to 2012, the percentage of children ages 3-5 years who had ever received a vision check by a health provider increased from 53.9% to 61.4%.
  • Among White children ages 3-5 years, the percentage who had ever received a vision check by a health provider increased from 53.6% in 2002 to 61.5% in 2012. The percentage also increased for Hispanic children from 47.9% in 2002 to 61.1% in 2012. However, there was no statistically significant increase for Black children (61.4% in 2002 and 63.7% in 2012).
• Groups With Disparities:
  • In 2012, there were no statistically significant differences between White, Black, and Hispanic children in the percentage who had ever received a vision check (61.5%, 63.7%, and 61.1%, respectively).

Prevention: Well-Child Visits in the Last Year

• Annual preventive health care visits for all children are recommended by American Academy of Pediatrics.⁷
• Insurance plans are required by Affordable Care Act to cover well-child visits with no copayments or deductibles.⁸
• Current (2014) recommendations:
  • 7 well-child visits before 12 months of age.
  • 6 well-child visits between 12 and 36 months of age.
  • 1 well-child visit per year from ages 3 to 21 years.
• A Healthy People 2020 goal is to improve the rate of adolescent well visits.⁹

Children With a Well-Child Visit

Children ages 0-17 with a well-child visit in the last 12 months, by race/ethnicity and family income, 2000-2013

Left Chart:

Right Chart:

Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 1997-2013.

Note: White and Black are non-Hispanic. Hispanic includes all races.

• Trends:
  • Overall, the percentage of children ages 0-17 years who had a well-child visit (as distinct from a symptom-driven visit) in the last 12 months increased from 71% in 2000 to 83% in 2013.
  • From 2000 to 2013, the percentage of children who had a well-child visit increased significantly for Whites (71.3% to 83.3%), Blacks (75.4% to 87.8%), and Hispanics (65.3% to 79%).
  • The percentage of children who had a well-child visit also increased for all income groups. From 2000 to 2013, the percentage of children with a well-child visit increased from 67.7% to 80.8% for poor families; from 65.8% to 79.5% for low-income families; from 71.3% to 82.5% for middle-income families; and from 76.8% to 88.6% for high-income families.
• Groups With Disparities:
  • In 2013, Black children were more likely than White children to have at least one well-child visit (87.8% vs. 83.3%).
  • White children were more likely than Hispanic children to have had at least one well-child visit during the year (83.3% vs. 79.0%).
  • In 2013, children in high-income families were more likely than children in poor, low-income, and middle-income families to have had at least one well-child visit during the year (88.6% vs. 80.8%, 79.5%, and 82.5%, respectively).
  • In addition, in 2013, children in middle-income families (82.5%) were more likely than children in poor families (80.8%) to have had a well-child visit.
  • There were no statistically significant changes in disparities over time by race/ethnicity or income.

Prevention: Adolescent Meningitis Vaccine

• In 2010, children ages 10-14 years made up 6.7% of the U.S. population, and teens ages 15-19 made up 7.1%.¹⁰
• Youth ages 10-19 years are at risk of contracting meningitis, a possibly fatal¹¹ infection.
• Meningococcal diseases are infections caused by the bacteria Neisseria meningitidis:
  • Causes various infections but most important as a potential cause of meningitis.¹²
  • Can also cause meningococcemia, a bloodstream infection.¹²
• The meningococcal vaccine can prevent most cases of meningitis caused by Neisseria meningitidis:
  • Recommended for all children ages 11-12 years.
  • Effective January 2011, a second dose recommended at age 16.¹³

Adolescents Who Received Meningococcal Vaccine

Adolescents ages 13-15 who ever received at least 1 dose of the meningococcal vaccine, by race/ethnicity and family income, 2008-2012

Left Chart:

Right Chart:

Source: Centers for Disease Control and Prevention, National Center for Health Statistics and National Center for Immunization and Respiratory Diseases, National Immunization Survey, 2008-2012.

Note: White and Black are non-Hispanic. Hispanic includes all races.

• Trends: The percentage of adolescents ages 13-15 who ever received at least 1 dose of the meningococcal vaccine improved from 43.9% in 2008 to 73.8% in 2012.
• Groups With Disparities:
  • In 2008 and from 2010 to 2012, Hispanic adolescents were more likely to receive the meningococcal vaccine than White adolescents.
  • From 2009 to 2012, there were no statistically significant differences between Blacks and Whites in the percentage of adolescents who received the vaccine.
  • In all years, adolescents from high-income households were more likely to receive the meningococcal vaccine than those from poor, low-income, and middle-income households.
  • From 2008 to 2012, there were no statistically significant differences in between males and females in the percentage of adolescents who received the meningococcal vaccine (data not shown).
  • In all years, adolescents ages 13-15 who lived in nonmetropolitan areas were less likely than those living in metropolitan areas to receive the meningococcal vaccine (data not shown).

Adolescents Who Received Meningococcal Vaccine, by State

Adolescents ages 13-17 years who ever received at least 1 dose of the meningococcal vaccine, by State quartiles, 2013

Source: National Immunization Survey-Teen, United States, 2013. http://www.cdc.gov/vaccines/imz-managers/coverage/nis/teen/data/tables-2013.html.

• Overall: This map shows estimated vaccination coverage with at least 1 dose of meningococcal vaccine among adolescents ages 13-17 years, by State. State values (including District of Columbia) ranged from 40.4% (Arkansas) to 93.7% (North Dakota).
• Differences by State: Interquartile ranges follow:
  • First quartile (lowest): 40.4%-64.2% (AK, AR, IA, KS, MO, MS, MT, NV, SD, UT, VA, WY).
  • Second quartile (second lowest): 65.3%-72.4% (AL, FL, ID, KY, ME, MN, NC, NM, OH, OK, OR, SC, TN).
  • Third quartile (second highest): 73.6%-83.3% (CA, CO, DE, GA, HI, IL, MD, NE, NY, VT, WA, WI, WV).
  • Fourth quartile (highest): 85.6%-93.7% (AZ, CT, DC, IN, LA, MA, MI, ND, NH, NJ, PA, RI, TX).

Adolescents Who Received Meningococcal Vaccine, by Race/Ethnicity

Adolescents ages 13-17 years who ever received at least 1 dose of the meningococcal vaccine, by race/ethnicity, 2013

Key: AI/AN = American Indian or Alaska Native.
Source: National Immunization Survey-Teen, United States, 2013. http://www.cdc.gov/vaccines/imz-managers/coverage/nis/teen/data/tables-2013.html.

• Overall Rate: In 2013, the estimated vaccination coverage for the meningitis vaccine among all adolescents ages 13-17 was 77.8%.
• Groups With Disparities:
  • Hispanics had the highest coverage (83.4%).
  • American Indians and Alaska Natives (71.7%) and Asians (71.7%) had the lowest coverage.

Human Papillomavirus Vaccination Coverage for Adolescents

• A licensed HPV vaccine has been available since 2006. It is recommended by the Advisory Committee on Immunization Practices (ACIP) for routine vaccination of adolescent girls at age 11 or 12 years.^14,15
• In 2011, ACIP recommended quadrivalent HPV (HPV4) for routine vaccination of adolescent boys at age 11 or 12 years.¹⁶
• The vaccine can be safely co-administered with other routinely recommended vaccines; administration of all age-appropriate vaccines during a single visit is recommended by ACIP.¹⁷

Adolescents Ages 13-15 Who Received Human Papillomavirus Vaccine

Adolescents ages 13-15 years who received 3 or more doses of human papillomavirus vaccine, by race/ethnicity, stratified by sex, 2012

Source: National Immunization Survey-Teen, United States, 2013. http://www.cdc.gov/vaccines/imz-managers/coverage/nis/teen/data/tables-2013.html

Note: White and Black are non-Hispanic. Hispanic includes all races.

• Overall Rate: In 2012, 17.2% of adolescents ages 13-15 years received 3 or more doses of the human papillomavirus (HPV) vaccine.
• Groups With Disparities:
  • There were no statistically significant differences by race/ethnicity in the percentage of adolescents ages 13-15 who received 3 or more doses of the HPV vaccine.
  • Female adolescents ages 13-15 were more likely than male adolescents to receive 3 or more doses of the vaccine.
  • There were no statistically significant differences by family income or geographic location (metropolitan vs. nonmetropolitan) in the percentage of adolescents ages 13-15 who received 3 or more doses of the HPV vaccine (data not shown).

Adolescents Ages 16-17 Who Received Human Papillomavirus Vaccine

Adolescents ages 16-17 years who received 3 or more doses of human papillomavirus vaccine, by family income, stratified by sex, 2012

Source: National Immunization Survey-Teen, United States, 2013. http://www.cdc.gov/vaccines/imz-managers/coverage/nis/teen/data/tables-2013.html.

• Overall Rate: In 2012, 23.8% of adolescents ages 16-17 years received 3 or more doses of the HPV vaccine.
• Groups With Disparities:
  • Female adolescents ages 16-17 were more likely than male adolescents to receive 3 or more doses of the vaccine.
  • There were no statistically significant differences by income in the percentage of adolescents ages 16-17 who received 3 or more doses of the HPV vaccine.
  • There were no statistically significant differences between Asian, Black, and White adolescents ages 16-17 in the percentage who received 3 or more doses of the vaccine (data not shown).
  • There were no statistically significant differences between adolescents who lived in metropolitan areas and adolescents who lived in nonmetropolitan areas in the percentage who received 3 or more doses of the vaccine (data not shown).

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