Health

Women and Children receiving WIC is the percentage of eligible women, infants and children served by the Special Supplemental Food Program for Women, Infants and Children (WIC)

The Special Supplemental Food Program for Women, Infants and Children is a preventive program providing nutritious food, nutrition education, and improved access to health care. WIC links the distribution of food to other health services, including prenatal and pediatric care.

This federally funded program serves pregnant, postpartum and breastfeeding women; infants; and children less than five years of age. Household income must be below 185% of the poverty level. Participants must have a specified nutritional risk, such as abnormal weight gain during pregnancy or iron-deficiency anemia, or other health risk.

WIC is not an entitlement program and is not funded at a level that is sufficient to serve all eligible women and children. In Rhode Island, the funded allocation of 22,025 can serve up to 67% of eligible women, infants and children.

7.5%		Postpartum Women
2.0%		Breastfeeding Women
10.3%		Pregnant Women
22.9%		Infants
57.3%		Children Ages 1 through 4

Total Served is 23,046

Source: Rhode Island department of Health,
Division of Family Health, WIC Program,
December 1996.

Increases Access to Health Care

Participation in WIC increases the likelihood that women will receive early, regular prenatal care, and that their children will get regular pediatric care and immunizations. Mothers and children who are poor, minority, or poorly educated benefit most.¹

Reduces Fetal Deaths, Infant Mortality, and Low Birthweight

Participation in WIC during pregnancy significantly reduces fetal death and reduces by 22% the risk of death before one month of age. Low-income mothers participating in WIC have 25% fewer low birthweight babies (less than 5.5 pounds) and 44% fewer very low birthweight babies (less than 3.3 pounds) than mothers with similar income who were not participating in the WIC program.²

Protects Child Health and Cognitive Development

WIC protects infants and children from iron-deficiency anemia and other nutrition-related health problems. By protecting a child's cognitive development, WIC results in savings for special education that may have otherwise been incurred due to malnutrition in infancy and early childhood.³

Reduces Costs

The General Accounting Office has estimated that for every dollar spent on the WIC program, $3.50 is saved in federal, state, and local government program benefits for the new child's first eighteen years. This is money saved from hospital care, special services, and special education. The greatest cost-savings associated with the WIC program occur during the first year of life due to reduced medical costs.⁴

Women with delayed prenatal care is the percentage of women beginning prenatal care in the second or third trimester of pregnancy or receiving no prenatal care at all. Data are reported by place of mother's residence, not place of infant's birth.

Timely and comprehensive prenatal care, focused on the whole family and the living environment, increases the likelihood of delivering a healthy infant or normal birthweight. Women who receive adequate prenatal care are more likely to get preventive care for their infants.¹ Delaying the start of prenatal care to the second trimester increases health risks for both mother and baby.²

Prenatal care offers the opportunity to screen for and treat disease conditions that increase the risk for poor outcomes. Effective prenatal care also screens for and intervenes with non-medical conditions including smoking, substance abuse, physical abuse, nutritional deficiencies, needs for food, clothing and shelter, and information needs related to infant and child development.³

Source: The Rhode Island Department of Health, Division of Family Health, Maternal and Child Health Database, 1989-1993.

African-American, Hispanic, Asian, and Native American women in Rhode Island are considerably less likely to receive prompt prenatal care than white women. Adolescents, regardless of race, are less likely to receive early prenatal care than older mothers. Early prenatal care is especially important for women at increased medical and social risk.⁴

Barriers to receiving care are greatest to poor, young, and minority women due to lack of health insurance, transportation, and child care, and because of socioeconomic, language and cultural barriers with the health care system.⁵

Increasing the number of women who receive early prenatal care results in fewer complications at birth and reduces health care costs.⁶

Low birthweight infants is the percentage of live births weighing under 2,500 grams (5.5 pounds). The data are reported by place of mother's residence, not place of infant's birth.

A baby's birthweight is a key indicator of newborn health and is directly related to infant survival, health and development. A baby is small at birth either because it was born too soon, because it grew too slowly, or some combination of the two.

Babies born weighing less than 5.5 pounds are at greater risk for physical and developmental problems. Babies born weighing less than 1,500 grams (3.3 pounds) are at especially high risk for chronic lung and respiratory problems, mental retardation, and developmental and learning disabilities. Almost 60% of infants who die in the first year of life were born with low birthweight.¹

Prevention of low birthweight focuses on smoking cessation, adequate nutrition and weight gain, and comprehensive prenatal care. Smoking during pregnancy has been linked to 20% to 30% of low birthweight births.²

Underlying the high rate of low birthweight among African-Americans in the U.S. is the higher rate of preterm delivery (babies born before 37 weeks gestation). The causes of preterm delivery are not well understood; higher rates are not completely explained by differences in scoio-economic status, health status, and use of tobacco or other drugs.³

Source: The Rhode Island Department of Health, Division of Family Health, Maternal and Child Health Database, 1989-1993.

Low birthweight rates for black infants in Rhode Island are almost twice those for white infants, and are higher than those for other racial groups.

Children who are now 6 to 15 years old, who were born low birthweight, are almost 50% more likely than normal birthweight children to be enrolled in a special education program.⁴

Low birthweight babies are 20 time more likely to die as infants. Those who survive are at greater risk for metal retardation, blindness, deafness, cerebral palsy and other health problems.⁵

Infant mortality is the number of deaths occurring to infants under one year of age per 1,000 live births. The data are reported by place of mother's residence, not place of infant's birth.

Infant mortality rates are closely linked to a community's social and economic conditions. Communities with multiple problems such as poverty, poor housing conditions, and unemployment tend to have higher infant mortality rates than more advantaged communities.¹ In the United States, infant death is closely linked to low birthweight an preterm delivery.²

Risk factors contributing to infant deaths include a lack of preventive health and prenatal care, inadequate nutrition, and poor living conditions. Some of the health factors associated with infant deaths include congenital birth defects, complications resulting from early delivery and low birthweight, and respiratory problems.³

Infant mortality has two components: neonatal mortality, which is the number of deaths of infants younger than 28 days, and postneonatal mortality, the number of deaths of infants between 28 days and one year old. In 1995 in Rhode Island, 101 infants died before their first birthday; of these, 80 were younger than 28 days old. Twenty-eight were live births less than 500 grams (1.1 pounds), 26 of whom died within the first day.⁴

Preliminary data for 195 show that the infant mortality rate for the U.S. dropped to 7.5 infant deaths, a record low.⁵

In 1995 the overall United States infant mortality rate ranked twentieth worldwide. The U.S. infant mortality rate for black infants ranked thirty-seventh when compared with other countries overall rates.⁶

Over the past ten years, Rhode Island's black infant mortality rate has declined. Despite this progress, the black infant mortality rate continues to be twice that of white infants.⁷

Children with lead poisoning is the percentage of three-year old children screened positive for lead poisoning due to elevated blood lead levels (>=15 ug/dL) as of November 30, 1996. These data are for children eligible to enter kindergarten in the fall of 1998 (i.e. born between September 1, 1992 and August 31, 1993).

Childhood lead poisoning is one of the most common pediatric health problems and is entirely preventable. Infants and young children are most susceptible to the toxic effects of lead. Lead's effects on the developing central nervous system may be irreversible.¹ Learning disabilities, hyperactivity, antisocial behavior, attention deficit disorder, hearing and speech impediments, and loss of intelligence can be attributed to elevated lead levels of 10 micrograms per deciliter of blood (ug/dL). Higher level of lead exposure can result in serious health problems and can lead to comma, convulsions, and death.²

Deteriorating lead-based paint and lead-contaminated dust are the main causes of childhood lead poisoning.³

While children of all backgrounds are at risk, low-income children and children of color are particularly likely to be affected by lead poisoning. Low-income children are more than 3 time as likely to have blood lead levels of 10 ug/dL or greater than middle-income children.⁴ The lack of affordable housing has forced low-income families to live in older dwellings with deteriorating lead paint, thus placing children at risk from lead poisoning.⁵ Inadequate nutrition and anemia, more common in poor children, further increases a child's susceptibility to lead poisoning.⁶

More than half of the three year-old children with lead poisoning in the state live in Providence and Central Falls.

Rhode Island law requires regular screening of all children under age six, 33,177 Rhode Island children under age 6 were screened for lead in fiscal year 1996, and the findings were:

Twenty percent (6,620) were found to have blood lead levels >=10ug/dL, which can have effects on IQ, cognitive ability, and neurobehavioral development.

609 children were found to have blood lead levels greater than 25 ug/dL, which can result in learning disability, antisocial behavior, and/or decreased hearing ability. Upon confirmation of blood lead levels >=25ug/dL, the child's home is referred for a comprehensive lead inspection by the RI Department of Health.

Source: Rhode Island Department of Health, Division of Family Health; Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control (1991); Pueschel, S.M., et. al. Lead Poisoning in Childhood (1996).

Births to teens is the number of births to teen girls ages 15 to 17 per 1,000 teen girls. Data are reported by the mother's place of residence, not the place of birth.

Teen pregnancy threatens the development of teens as well as their children. Teen mothers are less likely to obtain adequate prenatal care and are less likely to have financial resources and social supports needed for healthy child development.¹ Only a small proportion of unwed fathers of children born to teen mothers provide ongoing economic support to their children.² The fathers often do not participate in the lives of their children.³

Being a teen parent seriously limits subsequent education and employment prospects.⁴ Nationally, three out of five teen mothers drop out of school. Lifetime earnings are less than half of those of women who wait until age twenty before bearing their first child. Children born to teen parents are more likely to suffer poor health, have learning and behavioral problems, live in poverty, go to prison, and become teen parents themselves.⁵

The problem of teen pregnancy is complex. 51% of births to girls ages 15 to 17 were fathered by men aged 20 or older; one survey of poor and pregnant teens conducted among Washington State's public health clinics revealed that two-thirds reported prior sexual abuse, usually by parents, guardians or relatives.⁶ In 1995 in Rhode Island there were 1,273 births to teens ages 12 to 19; 24 of these babies were born to girls ages 12 to 14.⁷

Source: Rhode Island Department of Health, Maternal and Child Health Database. 1989-1993 average.

Between 1989 and 1993 in Rhode Island, there were 8,486 pregnancies to teens between ages 14-18. 56% resulted in live births, 41% of the pregnancies resulted in induced abortions, and 3% were spontaneous abortions.⁸

Risk factors for teen pregnancy develop during childhood and include early school failure, early behavioral problems, poverty, and family dysfunction.⁹ Both male and female teens are less likely to be teen parents when they have a range of positive life options and economic opportunities.¹⁰

Alcohol, drug, and cigarette use by teens is the percentage of seventh-grade, ninth-grade, and twelfth-grade students who have used alcohol or marijuana in the past month or are current smokers, based on the 1995 Rhode Island Adolescent Substance Abuse Survey.

The use of substances threatens the health and safety of children and families. Children and teens are negatively affected by the emotional and financial hardships caused by parents with substance abuse problems.¹ The 1995 Rhode Island Department of Health Substance Abuse Survey found that 21% of the 7th to 12 graders surveyed reported that the drinking of one or both their parents caused problems.²

Young people who abuse drugs and alcohol are more likely to drop out of school, become teen parents, engage in high risk sexual behavior, experience injuries, and become involved with the criminal justice system.³ Substance abuse has been shown to cause dependency, mood changes, impaired judgment, memory loss, and prolonged aimlessness.⁴ Suicide, homicides and unintentional injuries account for approximately 80% of U.S. adolescent deaths, and many involve alcohol or drugs. Studies show that about 30% of drivers ages 15 to 20 who were involved in fatal crashes were alcohol involved.⁵

n=6,060 (grade 7); n=4,629 (Grade 9); n=2,627 (Grade 12)
*Student is a current cigarette smoker.

Teens who smoke are three times more likely than nonsmokers to use alcohol, eight times more likely to use marijuana, and 22 time more likely to use cocaine. Smoking is associated with a host of other high risk behaviors, such as fighting and engaging in unprotected sex.⁶

the younger people start smoking cigarettes, the more likely they are to become strongly addicted to nicotine. Eighty-nine percent of adult daily smokers tried their first cigarette by age 18.⁷

A 1995 Centers for Disease Control survey found that 45% of minors who ever tried to purchase cigarettes and 75% of minors who ever tried to purchase smokeless tobacco reported that they were never asked to show proof of age.⁸

n=6,060 (grade 7); n=4,629 (Grade 9); n=2,627 (Grade 12)
*Student had used alcohol or marijuana in the past month.

Source: The 1995 Rhode Island Adolescent Substance Abuse Survey: Report of Statewide Results (1996), Providence; Rhode Island Department of Health.

Alcohol is the leading substance of abuse at all grade levels in Rhode Island. The prevalence of alcohol use is higher than national rates.⁹

The 1995 National Monitoring the Future Study of 8th, 10th and 12th graders found that the use of illicit drugs has increased from the previous year, driven in part by a sharp increase in the use of marijuana.¹⁰

The number of Rhode Island juvenile arrests for drug abuse violations in 1995 was the highest recorded total since 1977.¹¹ Drug and alcohol offenses referred to Family Court increased 50% between 1994 and 1996, from 691 offenses in 1994 to 1,033 offenses in 1996.¹² Ninety percent of the incarcerated population of the Training School had been regular abusers of illicit substances and alcohol.¹³

Rhode Island KIDS COUNT is dedicated to providing a comprehensive profile of the well-being of children in Rhode Island. However, there are some important issues affecting children for which there is a lack of available city and town data. Some of these critical health issues are as follows:

Children who receive and inadequate level of dental care or no dental care at all can develop long-term oral health problems and are more likely to experience dental conditions that require emergency treatment. Chronic dental problems can lead to a poor self-image, a lack of concentration, absenteeism, and reduced school performance. Minorities have the greatest extent of untreated dental problems for all age groups.¹ Low-income children are at greater risk for decay and other symptoms of malnutrition.²

Access to dental care is a major obstacle confronting children from poor, working poor, and uninsured families. There is a shortage of private providers willing to accept Medical Assistance patients due to the low level of reimbursement for services. Only five community health centers in the state provide dental care, and all have waiting lists for new patients. Dental check-ups through Head Start, Donated Dental Services of Rhode Island (for children with disabilities), Traveler's Aid's program for homeless teens, a targeted school-based sealant program, and a new clinic at St. Joseph's Hospital help to increase access. Nonetheless, children's unmet needs for dental care are substantial.

Immunization is an important medical intervention to prevent disease.¹ Children need to be immunized on schedule to guard against a variety of preventable illnesses. It is estimated that every dollar spent on immunization saves ten dollars in later medical costs.² Efforts are underway in communities across the country to increase the number of fully-immunized children through neighborhood outreach programs that communicate directly with parents and provide easy access to immunization sites.³

According to the National Immunization Survey conducted by the Centers for Disease Control between July 1994 and December 1995, Rhode Island's immunization rate for two-year-olds has reached 83%, exceeding the national average of 75%.⁴

Retrospective surveys conducted by the Rhode Island Department of Health revealed lower immunization rates among children in high risk communities and the rest of the state.* These discrepancies appear as early as three months of age, widen by seven months, and persist through the first two years of life.⁵ Efforts to raise immunization rates include collaboration with the WIC program, assessment of immunization rates in individual practice settings, and the development of computerized tracking systems to remind parents and health care providers that an inoculation is due.⁶

* The high risk communities identified by the Department of Health for the retrospective survey were Central Falls, East Providence, Newport, Pawtucket, Providence, and Woonsocket.

Children's emotional well-being is essential to their growth and development. an estimated 12 to 15 percent of American children suffer from mental disorders. While the most frequent disorders treated include hyperactivity, attention deficit disorder, more than five percent of school-age children and adolescents suffer from depression and anxiety problems.¹ By age 14, girls are twice as likely as boys to suffer from depression, a gender difference that persists through adulthood. Seventy percent of children with disorders do not access mental health services.²

In Rhode Island, the eight Community Mental Health Centers provided services to a total of 6,064 children and youth during the 1996 fiscal year.³ Bradley Hospital, Rhode Island's largest psychiatric center for children and adolescents, admitted 697 children and youth to its hospital programs for the treatment of emotional disorders in fiscal year 1996.⁴ Butler Hospital admitted 538 children and youth.⁵

Mental health professionals emphasize early intervention in order to keep children's emotional problems from intensifying.

Children with mental health problems are found in all areas of children's services, including education, health, child welfare, and juvenile justice. Multi-agency planning for coordinated care is critical. The Rhode Island Child and Adolescent Services System Program (CASSP) promotes local systems of care that are family-focused, multi-disciplinary, and tailor individual support services to meet the needs of the child and family.

RIte Care, Rhode Island's Medicaid managed care program, includes coverage for some mental health services. There are significant numbers of children who do not qualify for RIte Care whose families are unable to pay for mental health services in the private market.

Disabilities in childhood whether mild or severe, have the potential to create special needs related to physical and mental health, parent support, child care, education, recreation, and career preparation.¹

Infants and toddlers from age 3, who have a developmental delay or a physical or mental condition likely to result in developmental problems, are eligible for support through the statewide Early Intervention program.² This program provides developmental and therapeutic assessments, evaluation and services for 1,639 Rhode Island children.³

All children with disabilities or suspected disabilities become eligible for special education services from the school district at age 3.⁴ In Rhode Island, there are 25,143 children (17% of the student population) who receive special education services; more than 56% of these children are classified as learning disabled; 22% speech disorder; 7% behavioral disorder; 4% mental retardation; 4% developmental delay; and 7% other physical disabilities.⁵

As of April 1996, there were 3,140 disabled children under age 18 receiving Supplemental security Income (SSI).⁶ Some children who do not qualify for SSI receive Medicaid funds for therapeutic and health care services, as well as wheelchairs, communication devices, home-based therapy, respite care, and home modifications. Without these services, parents might have to give up their jobs or seek institutional placements for children.⁷