Health – 2018

60% of uninsured Nebraska kids are low-income and likely

eligible for Medicaid/CHIP.1

88.6% of Nebraska children are in very good or excellent health.2

1. U.S. Census Bureau, 2016 American Community Survey 1-year estimates, Table B17016.
2. 2016 National Survey of Children’s Health.

Why does it matter?

All children deserve access to affordable, quality physical and behavioral health care.

Quality and consistent preventive health care, beginning even before birth, gives children the best chance to grow up to be healthy and productive adults.

Adequate levels of immunization, public health efforts to prevent disease and disability, and support for maternal health and positive birth outcomes are examples of measures that help children now and later. Good health, both physical and behavioral, is an essential element of a productive and fulfilling life.

Births

25,833 babies were born in 2016.

Births by race & ethnicity (2017)

  • White (75.9%)
  • Other/Unknown Race (10.8%)
  • Black/African American (7.7%)
  • Asian/Pacific Islander (3.7%)
  • American Indian/Alaska Native (1.9%)
  • Not Hispanic (83.0%)
  • Hispanic (17.0%)
16.6% of babies received inadequate prenatal care.

Women who see a health care provider regularly during pregnancy have healthier babies and are less likely to deliver prematurely or to have other serious pregnancy-related problems. The ideal time for a woman to seek out prenatal care is during her first trimester or even prior to getting pregnant.

Barriers to care can include a lack of any of the following:
• insurance,
• transportation,
• knowledge of where to find care,
• quality treatment at care center,
• translation services, and
• knowledge of importance of care.

Trimester prenatal care began (2016)

  • First (72.8%)
  • Second (21.0%)
  • Third (5.1%)
  • None (1.0%)
Source: Vital Statistics, Department of Health and Human Services (DHHS).

Pre/post-natal health

Folic acid use prior to pregnancy (2016)1

  • 4 or more times/week before pregnancy (43.4%)
  • 3 or fewer times/week before pregnancy (56.6%)

Mother’s BMI prior to pregnancy (2016)1

  • Underweight before pregnancy (10.4%)
  • Normal weight before pregnancy (45.6%)
  • Overweight before pregnancy (14.7%)
  • Obese before pregnancy (29.2%)

Tobacco use (2017)2

  • Did not use tobacco during most recent pregnancy (86.6%)
  • Used tobacco during most recent pregnancy (9.6%)
  • Smoked in the three months prior to pregnancy (3.8%)

Pregnancy intendedness (2016)*1

  • Unintended pregnancy (38.8%)
  • Intended Pregnancy (61.2%)

Breastfeeding (2016)1

  • Mothers who did not breastfeed at any time (7.6%)
  • Mothers who breastfed at any time (92.4%)

Low birth weight (2017)*1

  • Not low birth weight (92.5%)
  • Moderately low birth weight (6.3%)
  • Very low birth weight (1.2%)
Domestic violence1 2015
Experienced physical abuse from husband or partner in the 12 months before pregnancy 2.4%
Experienced physical abuse by someone other than husband or partner in the 12 months before pregnancy 2.0%
Child birth classes1 2015
Participated in child birth classes during most recent pregnancy 21%
Maternal depression1 2015
New mothers who experienced maternal depression related to most recent pregnancy 12%
*This data is not comparable to years 2011 and prior due to changes in methodology.
1. PRAMS, 2016.
2. Vital Statistics, Department of Health and Human Services (DHHS).

Teen births & sexual behavior

Teen parenting

Teen birth is highly correlated with child poverty. While teen pregnancy occurs at all socioeconomic levels, teen moms are more likely to come from economically-disadvantaged families or to be coping with substance abuse and behavioral problems.

In turn, children born to teenage parents are more likely to live in poverty, experience health problems, suffer from maltreatment, struggle in school, run away from home, and serve time in prison. Children of teen parents are also more likely to become teen parents themselves, thus perpetuating the cycle of teen pregnancy and generational poverty.

Teen births are at the lowest point in a decade. In 2017 there were 1,168 babies born to teen mothers, 299 to mothers who were 14-17 years old, 869 to mothers who were 18 or 19.2.2

Teen births (2008-2017)

  • Ages 10-17
  • Ages 18-19
Source: Vital Statistics, Department of Health and Human Services (DHHS).

Teen births by age (2017)

  • Ages 18-19 (74.4%)
  • Ages 16-17 (22.8%)
  • Ages 14-15 (2.8%)
Source: Vital Statistics, Department of Health and Human Services (DHHS).
Teen sexual behavior1
2017
Ever had sexual intercourse 29.1%
Reported having sexual intercourse before age 13 2.8%
Had sex with four or more people 6.0%
Had sex in the past 3 months 20.5%
Drank alcohol or used drugs before last sexual intercourse 13.7%
Did not use a condom during last sexual intercourse 46.7%
Did not use any method to prevent pregnancy during last sexual intercourse 7.0%

HIV/AIDS3

In 2017, 12 children ages 0-11 and 21 children ages 12-19 were living with HIV.

Since 2008, 0 children with a diagnosis of HIV or AIDS have died from the disease.

1. Center for Disease Control and Prevention, Youth Risk Behavior Survey, 2015.
2. Vital Statistics, Department of Health and Human Services (DHHS).
3. HIV Surveillance, Nebraska Department of Health and Human Services (DHHS).

Sexually transmitted infections (STIs) (2008-2017)2

There were 2,660 cases of sexually transmitted infections reported in children ages 19 and under in Nebraska in 2017.

Infant & child deaths

Infant mortality

Infant mortality decreased to 5.6 per 1,000 births in 2017 from 6.2 per 1,000 births in 2016.

Causes of infant deaths (2017) Number Percent
Maternal and Perinatal 38 26.4%
Birth Defects 29 20.1%
SIDS/SUDI 20 13.9%
Respiratory and Heart 18 12.5%
Prematurity 8 5.6%
Infection 7 4.9%
Accident 8 5.6%
Homicide 2 1.4%
Other 14 9.7%
Total 144

Child deaths

In 2017, 137 children and youth ages one to 19 died of various causes, the most common of which were accidents and suicide.

Causes of child deaths (2016) Number Percent
Accidents 41 29.9%
Suicide 30 21.9%
Cancer 17 12.4%
Birth Defects 8 5.8%
Homicide 5 3.6%
Other 36 26.3%
Total 137

Rate of infant mortality per 1,000 births by race and ethnicity (2017)

Child deaths, ages 1-19 (2007-2016)

Source: Vital Statistics, Department of Health and Human Services (DHHS).

Health Insurance

Health coverage for Nebraska’s children, ages 18 & under (2017)1

  • Public Insurance
  • Employer-Based Insurance
  • Direct-Purchase Insurance
  • Uninsured

Access to health care

In 2016, there were 23,514 (5.1%) uninsured children in Nebraska. Of those, 14,856 (66%) were low-income (below 200% of the federal poverty level) and likely eligible, yet unenrolled, in the Children’s Health Insurance Program (CHIP).1

Percent uninsured children by race/ethnicity (2012-2016)2
American Indian and Alaska Native 17.0%
Asian or Pacific Islander 4.2%
Black/African American 4.6%
Hispanic 10.8%
Other, Unknown, or Multi-racial 8.5%
White, non-Hispanic 3.9%

5.2% of kids did not have health insurance in 2017.1

Medicaid and CHIP served a monthly average of 163,466 children in SFY 2017.3

79.3% of those eligible for Medicaid/CHIP are children, but children only make up 27% of Medicaid costs.3

Nebraska Medicaid average monthly eligible persons by age (SFY 2017)3

  • Blind/Disabled (15.4%)
  • Aged (2.7%)
  • Adults (2.7%)
  • Children (79.3%)

Nebraska Medicaid expenditures by age (SFY 2017)3

  • Blind/Disabled (43.9%)
  • Aged (20.8%)
  • Adults (8.2%)
  • Children (27.0%)

CHIP/Medicaid enrollment (SFY 2017)3

  • Medicaid (80.5%)
  • CHIP (19.5%)
1. U.S. Census Bureau, 2017 American Community Survey 1-year estimates, Table B27016.
2. U.S. Census Bureau, 2016 American Community Survey 5-year estimates, Tables C27001B-I.
3. Financial and Program Analysis Unit, Nebraska Department of Health and Human Services (DHHS).
Notes: “Children” category combines Medicaid and CHIP coverage. “Adults” are those aged 19-64 receiving Aid to Dependent Children, or temporary cash assistance through the state of Nebraska.

Behavioral Health

Estimating mental health needs

Many children in Nebraska deal with behavioral health problems that may affect their ability to participate in normal childhood activities.

The National Survey of Children’s Health estimated the number of Nebraska children facing the following disorders:

  • Anxiety: 16,462
  • ADD/ADHD: 25,323
  • Depression: 13,600
  • Autism Spectrum Disorder: 10,367
  • Children diagnosed with mental/behavioral condition needing treatment: 44,543
Source: 2016-2017 National Survey of Children’s Health
Considered suicide in last 12 months (2017)3
Seriously considered suicide 16.1%
Had suicide plan 14.1%
Made suicide attempt 8.0%

Children receiving community-based mental health services (2017)1

  • Mental Health
  • Substance Abuse
  • Mental Health and Substance Abuse
1. Division of Behavioral Health, Department of Health and Human Services (DHHS).
2. Centers for Disease Control and Prevention, Youth Risk Behavior Survey, 2017.
3. 2016-2017 National Survey of Children’s Health.

27.0% of teens felt sad or hopeless (every day for 2+ weeks so that activity was stopped in last 12 months).2

57.6% of children needing mental health counseling actually received it.3

68% of children six months to five years met all four measures of “flourishing.”3

  1. Child is affectionate with parent/s
  2. Child shows interest and curiosity in learning new things
  3. Child smiles and laughs a lot
  4. Child bounces back quickly when things do not go his or her way.

Regional centers (2017)1

106 males

received services at Hastings Regional Center, a chemical dependency program for youth from the Youth Rehabilitation & Treatment Center (YRTC) in Kearney.

51 males

received services from Lincoln Regional Center at the Whitehall Campus.

Health Risks

Motor vehicle behavior among high schoolers 2017
Rarely or never wore a seat belt 11.3%
In past 30 days, drove a motor vehicle after drinking alcohol 6.3%
In past 30 days, texted or emailed while driving a car or other vehicle 48.3%
Gunshot wound injuries 2017
Children ages 1-18 injured by a firearm
necessitating hospitalization
26
Injuries due to accidental discharge 15
Injuries due to assault 5
Injuries due to intentional self-harm 3
Injuries were undetermined 2
Injury was due to legal intervention by a law enforcement officer 1
Injuries and violence among high schoolers 2017
In past 12 months, was physically hurt on purpose by someone they were dating 7.4%
In the past 12 months, was threatened or injured with a weapon on school property 7.1%
In past 12 months, was bullied on school property 22.4%
Has ever been physically forced to have sexual intercourse 10.1%
In past 12 months, was in a physical fight 19.2%
In past 12 months, was electronically bullied 17.5%
Source: Centers for Disease Control and Prevention, Youth Risk Behavior Survey, 2017.
Alcohol and other drugs among high schoolers 2017
Ever used marijuana 25.4%
Ever used any form of cocaine 4.1%
Ever used inhalants to get high 6.0%
Ever used meth 3.0%
Ever used ecstasy or MDMA 3.9%
In past 12 months, offered, sold, or given illegal drugs by someone on school property 18.5%
Currently smokes cigarettes 7.4%
Currently uses smokeless tobacco 5.3%
Currently uses an electronic vapor product 9.4%
In past 30 days, had at least one drink of alcohol 24.4%
In past 30 days, had five or more drinks in a row within a couple of hours 10.5%
Ever took prescription drugs without a doctor’s prescription 14.3%
Currently smokes cigarettes, cigars, smokeless tobacco, or electronic vapor product 16.1%

Motor vehicle accidents (2017)

23 children died and 158 children suffered disabling injuries in motor vehicle accidents.

  • 38% were not using a seatbelt
  • Alcohol was involved in 23
Source: Nebraska Department of Roads.

Blood Lead Level Testing (2017)

Exposure to lead may harm a child’s brain and central nervous system. Even low blood lead concentrations can cause irreversible damage such as:

  • impaired physical and cognitive development,
  • delayed development,
  • behavioral problems,
  • hearing loss, and
  • malnutrition.

The Statewide Blood Lead Testing Plan has detailed guidance on recommendations for when children should have their blood tested for lead. The Centers for Disease Control uses a reference level of 5 micrograms per deciliter to identify children as having an elevated blood lead level.

In 2017:

36,268 children were tested.

493 had elevated blood
lead levels,
representing 1.4% of
all children tested.

Source: Nebraska Department of Health and Human Services (DHHS).

Obesity, dieting, activity, and eating habits

In past seven days did not eat fruit or drink 100% fruit juice 7.6%
In past seven days did not eat vegetables 5.8%
Were currently overweight or obese according to CDC growth charts 31.2%
In past seven days did not participate in at least 60 minutes of physical activity on any day 14.8%
Source: Centers for Disease Control and Prevention, Youth Risk Behavior Survey, 2015.

Adverse Childhood Experiences

Adverse childhood experiences (ACEs) are potentially traumatic events that can have negative, lasting effects on health and well-being.

Number of ACEs (2017)

  • 0 ACEs (58%)
  • 1-2 ACEs (22%)
  • 3+ ACEs (20%)
Source: 2016 National Survey of Children’s Health.

Percent of children by ACE (2016)

Among children with 1 or more ACE, the following were displayed:
Chronic health condition 26%
Ongoing emotional, developmental, and/or behavioral health condition 13%
Mother’s physical and mental health is very good to excellent 45%
Parents can handle day-to-day demands 57%
Engaged in school 63%
Demonstrates resilience 43%
Live in a supportive neighborhood 50%
Parents cut back on work or stopped working because of child’s health 7%
Lack demonstrated positive family habits and routine 25%

Domestic violence & sexual assault*

Nebraska’s Network of Domestic Violence/Sexual Assault Programs includes 20 community-based programs. There are also five tribal programs which comprise the Nebraska Tribal Coalition Ending Family Violence.

Service Participants (2016)*

  • Children
  • Women
  • Men
*Data does not include information from the Nebraska Tribal Coalition Ending Family Violence.
Source: Nebraska Domestic Violence and Sexual Assault Coalition (FY 2017).

Services provided to children served (2016)*

Health Services

Medical provider shortage

Health professional shortage areas are designated as having too few primary medical, dental, or mental health care providers.

Immunizations (2017)3

77.9% of Nebraska children had received the primary immunization series* by age three.
84.8% of Nebraska teens were immunized against meningitis caused by types A, C, W, and Y.
61.4% of Nebraska teen girls and 55.3% of Nebraska teen boys completed their HPV vaccine series.

34.7% of children had one or more current health conditions.2

79.2% of children had a preventive medical visit in the past year.2

88.6% of children had a preventive dental visit in the past year.2

Medical home (2017)2

A patient-centered medical home is a primary care physician or provider that serves as a child’s usual source of care. It is an important mechanism for coordination of all segments of health – physical, behavioral, and oral.

  • 43% do not have a medical home
  • 57% have a medical home
1. Shortage Designation, Health Resources and Services Administration, U.S. Department of Health and Human Services.
2. 2016 National Survey of Children’s Health.
3. Immunization Program, Nebraska Department of Health and Human Services (DHHS).
*Series 4:3:1:3:3:1:4