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Maternal, Infant, and Child Health Data Details

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  • MICH-1 Reduce the rate of fetal and infant deaths

    • MICH-1.1 Reduce the rate of fetal deaths at 20 or more weeks of gestation

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Vital Statistics System-Natality
      National Vital Statistics System-Fetal Death
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000 live births plus fetal deaths
      Baseline (Year): 
      6.2 (2005)
      Target: 
      5.6
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of fetal deaths (20 or more weeks of gestation)

      Denominator: 

      Number of live births plus fetal deaths (20 or more weeks gestation)

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        A description of the primary measurement used to determine gestational age—the interval between the first day of the last normal menstrual period (LMP) and the date of delivery—has been published by NCHS.

        States are required to report fetal deaths if they occur in the 20th week of pregnancy or later, or if they weigh at least 350 grams. The number of fetal deaths may be underreported in part because of variations in state reporting requirements.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. National vital statistics reports; vol 57 no 8. Hyattsville, MD: National Center for Health Statistics. 2009.
    • MICH-1.2 Reduce the rate of fetal and infant deaths during perinatal period (28 weeks of gestation to less than 7 days after birth)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Linked Birth/Infant Death Data Set
      National Vital Statistics System-Fetal Death
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000 live births plus fetal deaths
      Baseline (Year): 
      6.6 (2005)
      Target: 
      5.9
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of fetal and infant deaths during the perinatal period (28 weeks of gestation to 7 days after birth)

      Denominator: 

      Number of live births plus fetal deaths of at least 28 weeks of gestation

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        To create linked data files, death certificates are linked with corresponding birth certificates for infants who die in the U.S. before their first birthday. The linked file is used for calculating infant mortality rates by mother's race and ethnicity because these variables are more accurately collected on the birth certificate than the death certificate.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. MacDorman MF, Kirmeyer S. Fetal and perinatal mortality, United States, 2005. National vital statistics reports; vol 57 no 8. Hyattsville, MD: National Center for Health Statistics. 2009.
      2. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. National vital statistics report; vol 58 no 17. Hyattsville, MD: NCHS; 2010.
    • MICH-1.3 Reduce the rate of all infant deaths (within 1 year)
      LHI

      Leading Health Indicators are a subset of Healthy People 2020 objectives selected to communicate high-priority health issues.

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Linked Birth/Infant Death Data Set
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000 live births
      Baseline (Year): 
      6.7 (2006)
      Target: 
      6.0
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of deaths of infants under 1 year of age

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Leading Health Indicator:
      Methodology Notes: 

        To create linked data files, death certificates are linked with corresponding birth certificates for infants who die in the U.S. before their first birthday. The linked file is used for calculating infant mortality rates by mother's race and ethnicity because these variables are more accurately collected on the birth certificate than the death certificate.

        Depending upon county population size, the period county percent for the most recent 3, 5, or 10 years is reported.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. National vital statistics report; vol 58 no 17. Hyattsville, MD: NCHS; 2010.
    • MICH-1.4 Reduce the rate of neonatal deaths (within the first 28 days of life)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Linked Birth/Infant Death Data Set
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000 live births
      Baseline (Year): 
      4.5 (2006)
      Target: 
      4.1
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of deaths of infants aged 27 days and under

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        To create linked data files, death certificates are linked with corresponding birth certificates for infants who die in the U.S. before their first birthday. The linked file is used for calculating infant mortality rates by mother's race and ethnicity because these variables are more accurately collected on the birth certificate than the death certificate.

        Depending upon county population size, the period county percent for the most recent 3, 5, or 10 years is reported.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. National vital statistics report; vol 58 no 17. Hyattsville, MD: NCHS; 2010.
    • MICH-1.5 Reduce the rate of postneonatal deaths (between 28 days and 1 year)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Linked Birth/Infant Death Data Set
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000 live births
      Baseline (Year): 
      2.2 (2006)
      Target: 
      2.0
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of deaths of infants aged 28 days to less than 1 year

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        To create linked data files, death certificates are linked with corresponding birth certificates for infants who die in the U.S. before their first birthday. The linked file is used for calculating infant mortality rates by mother's race and ethnicity because these variables are more accurately collected on the birth certificate than the death certificate.

        Depending upon county population size, the period county percent for the most recent 3, 5, or 10 years is reported.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. National vital statistics report; vol 58 no 17. Hyattsville, MD: NCHS; 2010.
    • MICH-1.6 Reduce the rate of infant deaths related to birth defects (all birth defects)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Linked Birth/Infant Death Data Set
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000 live births
      Baseline (Year): 
      1.4 (2006)
      Target: 
      1.3
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of infant (under age 1 year) deaths due to birth defects (ICD-10 codes Q00-Q99)

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        To create linked data files, death certificates are linked with corresponding birth certificates for infants who die in the U.S. before their first birthday. The linked file is used for calculating infant mortality rates by mother's race and ethnicity because these variables are more accurately collected on the birth certificate than the death certificate.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. National vital statistics report; vol 58 no 17. Hyattsville, MD: NCHS; 2010.
    • MICH-1.7 Reduce the rate of infant deaths related to birth defects (congenital heart defects)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Linked Birth/Infant Death Data Set
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000 live births
      Baseline (Year): 
      0.38 (2006)
      Target: 
      0.34
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of infant (under age 1 year) deaths due to congenital heart (ICD-10 codes Q20-24) and vascular defects (ICD-10 codes Q25-Q28)

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        To create linked data files, death certificates are linked with corresponding birth certificates for infants who die in the U.S. before their first birthday. The linked file is used for calculating infant mortality rates by mother's race and ethnicity because these variables are more accurately collected on the birth certificate than the death certificate.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. National vital statistics report; vol 58 no 17. Hyattsville, MD: NCHS; 2010.
    • MICH-1.8 Reduce the rate of infant deaths from sudden infant death syndrome (SIDS)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Linked Birth/Infant Death Data Set
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000 live births
      Baseline (Year): 
      0.55 (2006)
      Target: 
      0.50
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of infant (under age 1 year) deaths due to SIDS (ICD-10 code R95)

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        To create linked data files, death certificates are linked with corresponding birth certificates for infants who die in the U.S. before their first birthday. The linked file is used for calculating infant mortality rates by mother's race and ethnicity because these variables are more accurately collected on the birth certificate than the death certificate.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. National vital statistics report; vol 58 no 17. Hyattsville, MD: NCHS; 2010.
    • MICH-1.9 Reduce the rate of infant deaths from sudden unexpected infant deaths (includes SIDS, Unknown Cause, Accidental Suffocation, and Strangulation in Bed)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Linked Birth/Infant Death Data Set
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 1,000 live births
      Baseline (Year): 
      0.93 (2006)
      Target: 
      0.84
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of infant (under age 1 year) deaths due to sudden unexpected infant death (SUID) [ICD-10 codes: R95 (SIDS), R99 (Unknown Cause) and W75 (Accidental Suffocation and Strangulation in Bed)]

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        To create linked data files, death certificates are linked with corresponding birth certificates for infants who die in the U.S. before their first birthday. The linked file is used for calculating infant mortality rates by mother's race and ethnicity because these variables are more accurately collected on the birth certificate than the death certificate.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. National vital statistics report; vol 58 no 17. Hyattsville, MD: NCHS; 2010.
  • MICH-2 Reduce the 1-year mortality rate for infants with Down syndrome

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Birth Defects Prevention Network
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    per 1,000 infants with Down syndrome
    Baseline (Year): 
    48.6 (2005–06)
    Target: 
    43.7
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of live born infants with a confirmed Down syndrome diagnosis who died in the first year of life

    Denominator: 

    Number of live born infants with a confirmed Down syndrome diagnosis

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Down syndrome includes cytogenetically confirmed full trisomy and translocation but excludes mosaic Down syndrome. Down syndrome diagnosis is obtained using either ICD-9 (confirmed 758.0, EXCLUDE mosaic Down syndrome) or CDC/BPA (758.000, 758.010, 758.020, 758.030, EXCLUDE 758.040 (mosaic Down syndrome), 758.090 (Down syndrome, NOS) codes. Fourteen state birth defects surveillance programs contributed data.

  • MICH-3 Reduce the rate of child deaths

    • MICH-3.1 Reduce the rate of deaths among children aged 1 to 4 years

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Bridged-race Population Estimates
      National Vital Statistics System-Mortality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 100,000
      Baseline (Year): 
      29.4 (2007)
      Target: 
      26.5
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of deaths among children aged 1 to 4 years

      Denominator: 

      Number of children aged 1to 4 years

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      Bridged-race Population Estimates
      National Vital Statistics System-Mortality
      Measure: 
      per 100,000
      Numerator: 

      Number of deaths among children aged 1 to 4 years

      Denominator: 

      Number of children aged 1to 4 years

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, rates for 2007–2009 were revised using intercensal population estimates based on the 2000 and 2010 censuses instead of the postcensal estimates for the denominator to provide more accurate rates for the period. Thus, the original baseline was revised from 28.6 to 29.4 deaths per 100,000 children aged 1-4 years. The target was adjusted from 25.7 to 26.5 deaths per 100,000 to reflect the revised baseline using the original target-setting method. Note that all mortality rates shown here for 2001–2009 (or any subset of those years) are based on intercensal population estimates and may differ from those previously published on the Internet or in print. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged. In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.
    • MICH-3.2 Reduce the rate of deaths among children aged 5 to 9 years

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Bridged-race Population Estimates
      National Vital Statistics System-Mortality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 100,000
      Baseline (Year): 
      13.8 (2007)
      Target: 
      12.4
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of deaths among children aged 5 to 9 years

      Denominator: 

      Number of children aged 5 to 9 years

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      Bridged-race Population Estimates
      National Vital Statistics System-Mortality
      Measure: 
      per 100,000
      Numerator: 

      Number of deaths among children aged 5 to 9 years

      Denominator: 

      Number of children aged 5 to 9 years

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, rates for 2007–2009 were revised using intercensal population estimates based on the 2000 and 2010 censuses instead of the postcensal estimates for the denominator to provide more accurate rates for the period. Thus, the original baseline was revised from 13.7 to 13.8 deaths per 100,000 children aged 5-9 years. The target was adjusted from 12.3 to 12.4 deaths per 100,000 to reflect the revised baseline using the original target-setting method. Note that all mortality rates shown here for 2001–2009 (or any subset of those years) are based on intercensal population estimates and may differ from those previously published on the Internet or in print. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged. In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.
  • MICH-4 Reduce the rate of adolescent and young adult deaths

    • MICH-4.1 Reduce the rate of deaths among adolescents aged 10 to 14 years

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Bridged-race Population Estimates
      National Vital Statistics System-Mortality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 100,000
      Baseline (Year): 
      16.5 (2007)
      Target: 
      14.8
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of deaths among persons aged 10 to 14 years

      Denominator: 

      Number of persons aged 10 to 14 years

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      Bridged-race Population Estimates
      National Vital Statistics System-Mortality
      Measure: 
      per 100,000
      Numerator: 

      Number of deaths among persons aged 10 to 14 years

      Denominator: 

      Number of persons aged 10 to 14 years

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, rates for 2007–2009 were revised using intercensal population estimates based on the 2000 and 2010 censuses instead of the postcensal estimates for the denominator to provide more accurate rates for the period. Thus, the original baseline was revised from 16.9 to 16.5 deaths per 100,000 adolescents aged 10-14 years. The target was adjusted from 15.2 to 14.8 per 100,000 to reflect the revised baseline using the original target-setting method. Note that all mortality rates shown here for 2001–2009 (or any subset of those years) are based on intercensal population estimates and may differ from those previously published on the Internet or in print. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged. In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.
    • MICH-4.2 Reduce the rate of deaths among adolescents aged 15 to 19 years

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Bridged-race Population Estimates
      National Vital Statistics System-Mortality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 100,000
      Baseline (Year): 
      60.3 (2007)
      Target: 
      54.3
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of deaths among persons aged 15 to 19 years

      Denominator: 

      Number of persons aged 15 to 19 years

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      Bridged-race Population Estimates
      National Vital Statistics System-Mortality
      Measure: 
      per 100,000
      Numerator: 

      Number of deaths among persons aged 15 to 19 years

      Denominator: 

      Number of persons aged 15 to 19 years

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, rates for 2007–2009 were revised using intercensal population estimates based on the 2000 and 2010 censuses instead of the postcensal estimates for the denominator to provide more accurate rates for the period. Thus, the original baseline was revised from 61.9 to 60.3 deaths per 100,000 persons aged 15-19 years. The target was adjusted from 55.7 to 54.3 deaths per 100,000 to reflect the revised baseline using the original target-setting method. Note that all mortality rates shown here for 2001–2009 (or any subset of those years) are based on intercensal population estimates and may differ from those previously published on the Internet or in print. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged. In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.
    • MICH-4.3 Reduce the rate of deaths among young adults aged 20 to 24 years

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Bridged-race Population Estimates
      National Vital Statistics System-Mortality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 100,000
      Baseline (Year): 
      98.1 (2007)
      Target: 
      88.3
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of deaths among persons aged 20 to 24 years

      Denominator: 

      Number of persons aged 20 to 24 years

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      Bridged-race Population Estimates
      National Vital Statistics System-Mortality
      Measure: 
      per 100,000
      Numerator: 

      Number of deaths among persons aged 20 to 24 years

      Denominator: 

      Number of persons aged 20 to 24 years

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          FOR SINGLE DATA YEARS: Death rates are calculated based on the resident population of the United States for the data year involved. For census years (e.g. 2010), population counts enumerated as of April 1 are used. For all other years, populations estimates as of July 1 are used. Postcensal population estimates are used in rate calculations for years after a census year and match the data year vintage (e.g. July 1, 2011 resident population estimates from Vintage 2011 are used as the denominator for 2011 rates). Intercensal population estimates are used in rate calculations for the years between censuses (e.g. 1991-1999, 2001-2009). Race-specific population estimates for 1991 and later use bridged-race categories.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, rates for 2007–2009 were revised using intercensal population estimates based on the 2000 and 2010 censuses instead of the postcensal estimates for the denominator to provide more accurate rates for the period. Thus, the original baseline was revised from 98.3 to 98.1 deaths per 100,000 persons aged 20-24 years. The target was adjusted from 88.5 to 88.3 deaths per 100,000 to reflect the revised baseline using the original target-setting method. Note that all mortality rates shown here for 2001–2009 (or any subset of those years) are based on intercensal population estimates and may differ from those previously published on the Internet or in print. In 2015, the denominator data source name was revised from Population Estimates to Bridged-Race Population Estimates for Census 2000 and 2010. The numerator data source, baseline estimate, target, and target-setting method remain unchanged. In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.
  • MICH-5 Reduce the rate of maternal mortality

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Vital Statistics System-Mortality
    National Vital Statistics System-Natality
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    per 100,000 live births
    Baseline (Year): 
    12.7 (2007)
    Target: 
    11.4
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of female deaths due to obstetric causes (ICD-10 codes A34, O00-O95, O98-O99) within 42 days of a pregnancy

    Denominator: 

    Number of live births

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      The maternal mortality rate indicates the likelihood of a pregnant woman dying of maternal causes. It is calculated by dividing the number of maternal deaths in a calendar year by the number of live births registered for the same period and is presented as a rate per 100,000 live births. The number of live births used in the denominator is an approximation of the population of pregnant women who are at risk of a maternal death. “Maternal deaths” are defined by the World Health Organization as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes." Included in these deaths are ICD–10 codes A34, O00-O95, and O98-O99.

    Caveats and Limitations: 
    These rates are based on data from the 50 states and D.C. The 2003 revision of the U.S. Standard Certificate of Death includes an item on pregnancy status at the time of death and in the 42 days and year preceding death. As of 2007, 23 states and DC had adopted the 2003 revision. An additional 10 states had a separate question related to the pregnancy status of female decedents around the time of death, while 2 states had a prompt encouraging certifiers to report recent pregnancies on the death certificate; 15 states had no pregnancy-related question or prompt.
    Changes Between HP2010 and HP2020: 
    This objective differs from Healthy People 2010 objective 16-4 in that for Healthy People 2020, states have been encouraged to adopt the 2003 revision of the U.S. Standard Certificate of Death, which includes an item on the pregnancy status of female decedents.
  • MICH-6 Reduce maternal illness and complications due to pregnancy (complications during hospitalized labor and delivery)

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Hospital Discharge Survey
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent
    Baseline (Year): 
    31.1 (2007)
    Target: 
    28.0
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of hospital discharges for females with any listed diagnosis of maternal complications (ICD-9-CM codes 641, 642.0, 642.7, 642.9, 643.2, 646.2, 646.6, 646.7, 648.0, 648.5, 648.6, 648.8, 658.4, 659.2, 659.3, 664.2, 664.3, 664.5, 665.0, 665.9, 666, 668, 669.0, 669.4, 670, 671.3, 671.5, 672, 673, 674.0, 674.3, 674.50, 674.54, 674.8, 674.9)

    Denominator: 

    Number of hospital discharges for females who delivered one or more infants (principal diagnosis of ICD-9-CM code V27)

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Principal diagnosis is the diagnosis chiefly responsible for admission of the person to the hospital.

      Data by race and ethnicity may be underreported in the National Hospital Discharge Survey (NHDS).

  • MICH-7 Reduce cesarean births among low-risk (full-term, singleton, and vertex presentation) women

    • MICH-7.1 Reduce cesarean births among low-risk women with no prior cesarean births

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Vital Statistics System-Natality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      26.5 (2007)
      Target: 
      23.9
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of births delivered by cesarean section to low-risk females (full-term, singleton, vertex presentation)

      Denominator: 

      Number of live births to low-risk females (full-term, singleton, vertex presentation)

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        A low-risk female is defined as one with a full-term (at least 37 weeks since the first day of the last normal menstrual period [LMP]) singleton (not a multiple) pregnancy, with a vertex fetus (head facing in a downward position in the birth canal). A description of the primary measurement used to determine the fetus’s gestational age, the interval between the first day of LMP and the birth, has been published by NCHS.

      Caveats and Limitations: 
      Estimates were calculated with data supplied by states that had adopted the 2003 version of the U.S. Standard Certificate of Live Birth. Trends over time cannot be evaluated until all states implement the 2003 Standard Certificate and provide data in the same format.
      Trend Issues: 
      Estimates for 2007 are based on 22 states (representing 53 percent of all U.S. births), excluding AL, AK, AZ, AR, CT, GA, HI, IL, LA, ME, MD, MA, MI, MN, MS, MO, MT, NV, NJ, NM, NC, OK, OR, RI, UT, VA, WV, WI, DC, and New York City. Estimates for 2008 are based on 27 states (representing 65 percent of all U.S births), excluding AL, AK, AZ, AR, CT, HI, IL, LA, ME, MD, MA, MN, MS, MO, NV, NJ, NC, OK, RI, UT, VA, WV, WI, and DC. Estimates for 2009 are based on 28 states (representing 66 percent of all U.S. births), excluding AL, AK, AZ, AR, CT, HI, IL, LA, ME, MD, MA, MN, MS, MO, NV, NJ, NC, OK, RI, VA, WV, WI, and DC. Estimates for 2010 are based on 33 states and DC (representing 76 percent of all U.S. births), excluding AL, AK, AZ, AR, CT, HI, LA, ME, MA, MN, MS, NJ, NC, RI, VA, WV, and WI.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. Osterman MJK, Martin JA, Menacker F. Expanded health data from the new birth certificate, 2006. National vital statistics reports; vol 58 no 5. Hyattsville, MD: National Center for Health Statistics. 2009.
    • MICH-7.2 Reduce cesarean births among low-risk women giving birth with a prior cesarean birth

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Vital Statistics System-Natality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      90.8 (2007)
      Target: 
      81.7
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of births delivered by cesarean section to low-risk females with a prior cesarean birth

      Denominator: 

      Number of live births to low-risk females with a prior cesarean birth

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        A low-risk female is defined as one with a full-term (at least 37 weeks since the first day of the last normal menstrual period [LMP]) singleton (not a multiple) pregnancy, with a vertex fetus (head facing in a downward position in the birth canal). A description of the primary measurement used to determine the fetus’s gestational age, the interval between the first day of LMP and the birth has been published by NCHS.

      Caveats and Limitations: 
      Estimates were calculated with data supplied by states that had adopted the 2003 version of the U.S. Standard Certificate of Live Birth. Trends over time cannot be evaluated until all states implement the 2003 Standard Certificate and provide data in the same format.
      Trend Issues: 
      Estimates for 2007 are based on 22 states (representing 53 percent of all U.S. births), excluding AL, AK, AZ, AR, CT, GA, HI, IL, LA, ME, MD, MA, MI, MN, MS, MO, MT, NV, NJ, NM, NC, OK, OR, RI, UT, VA, WV, WI, DC, and New York City. Estimates for 2008 are based on 27 states (representing 65 percent of all U.S births), excluding AL, AK, AZ, AR, CT, HI, IL, LA, ME, MD, MA, MN, MS, MO, NV, NJ, NC, OK, RI, UT, VA, WV, WI, and DC. Estimates for 2009 are based on 28 states (representing 66 percent of all U.S. births), excluding AL, AK, AZ, AR, CT, HI, IL, LA, ME, MD, MA, MN, MS, MO, NV, NJ, NC, OK, RI, VA, WV, WI, and DC. Estimates for 2010 are based on 33 states and DC (representing 76 percent of all U.S. births), excluding AL, AK, AZ, AR, CT, HI, LA, ME, MA, MN, MS, NJ, NC, RI, VA, WV, and WI.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      References

      Additional resources about the objective

      1. Osterman MJK, Martin JA, Menacker F. Expanded health data from the new birth certificate, 2006. National vital statistics reports; vol 58 no 5. Hyattsville, MD: National Center for Health Statistics. 2009.
  • MICH-8 Reduce low birth weight (LBW) and very low birth weight (VLBW)

    • MICH-8.1 Reduce low birth weight (LBW)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Vital Statistics System-Natality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      8.2 (2007)
      Target: 
      7.8
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      With the exception of a slight decrease in 2007, the low birth weight (LBW) rate has increased steadily over the past two decades. LBW is influenced by multiple factors, including obstetric intervention earlier in pregnancy, older maternal age at childbearing, and greater use of infertility therapies that result in more multiple births. A reduction of 5 percent in the next 10 years is the proposed target.
      Numerator: 

      Number of live births with birth weight of less than 2,500 grams (5 lbs, 8oz)

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Information on birthweight is available for the entire United States. Birthweight is reported in some areas in pounds and ounces and in other areas as grams. However, the metric system is used to tabulate and present the statistics to facilitate comparison with data published by other groups. The categories for birthweight are consistent with the recommendations in the International Statistical Classification of Diseases, Tenth Revision (ICD–10). ICD–10 defines low birthweight as less than 2,500 grams. Very low birthweight is defined as less than 1,500 grams.

        To establish the continuity of class intervals needed to convert pounds and ounces to grams, the end points of these intervals are assumed to be half an ounce less at the lower end and half an ounce more at the upper end. For example, 2 lb 4 oz–3 lb 4 oz is interpreted as 2 lb 3 ½ oz–3 lb 4 ½ oz.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.
    • MICH-8.2 Reduce very low birth weight (VLBW)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Vital Statistics System-Natality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      1.5 (2007)
      Target: 
      1.4
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      The rate of very low birth weight (VLBW) births has increased steadily since 1981. VLBW is influenced by increasingly common factors, including older maternal age at childbearing and increased use of infertility therapies that result in multiple births. A reduction of 5 percent in the next 10 years is the proposed target.
      Numerator: 

      Number of live births with birth weight of less than 1,500 grams (3 lbs, 4oz)

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Information on birthweight is available for the entire United States. Birthweight is reported in some areas in pounds and ounces and in other areas as grams. However, the metric system is used to tabulate and present the statistics to facilitate comparison with data published by other groups. The categories for birthweight are consistent with the recommendations in the International Statistical Classification of Diseases, Tenth Revision (ICD–10). ICD–10 defines low birthweight as less than 2,500 grams. Very low birthweight is defined as less than 1,500 grams.

        To establish the continuity of class intervals needed to convert pounds and ounces to grams, the end points of these intervals are assumed to be half an ounce less at the lower end and half an ounce more at the upper end. For example, 2 lb 4 oz–3 lb 4 oz is interpreted as 2 lb 3 ½ oz–3 lb 4 ½ oz.

        A description of the very low birth weight measurement has been published by NCHS.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. Heck, K.E., and Klein, R.J. Operational definitions for year 2000 objectives: Priority area 14, Maternal and Infant Health. Healthy People 2000 Statistical Note. No. 14. Hyattsville, MD: NCHS, 1998.
  • MICH-9 Reduce preterm births

    • MICH-9.1 Reduce total preterm births
      LHI

      Leading Health Indicators are a subset of Healthy People 2020 objectives selected to communicate high-priority health issues.

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Vital Statistics System-Natality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      10.4 (2007)
      Target: 
      9.4
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of infants born before 37 completed weeks of gestation

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Leading Health Indicator:
      Methodology Notes: 

        The Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) has measured vital statistics gestational age data based primarily on the difference between the date of the last normal menses (LMP) and the date of infant’s birth since national LMP data first became available in 1981. However, the quality of LMP-based data has long been of concern. Imperfect maternal recall, misinterpretation of bleeding early in pregnancy, irregular menstrual cycles, and data entry errors have been shown to result in the misclassification of gestational age, particularly at preterm (under 37 completed weeks) and postterm (42 weeks and over).

        An alternative measure of gestational age, the clinical estimate (CE), was added to the 1989 U.S. Standard Certificate of Live Birth. Detailed definitions and instructions for the new measure were not developed or released, however. Concerns with data quality and the lack of national reporting (California did not report the CE) precluded the estimate from being used as a national measure of gestational age. The CE was replaced with the similar item, the ‘‘obstetric estimate of gestation at delivery’’ (OE) with the 2003 birth certificate revision. More detailed definitions and instructions were developed and distributed for the OE, which in brief is defined as ‘‘the best estimate of the infant’s gestation in completed weeks based on the birth attendant’s final estimate of gestation’’. Despite differences in definitions and instructions, data for the CE and OE appear comparable and are combined in natality public-use files. National data for a combined OE-CE item did not become available until the 2007 data year, however.

        Compared with LMP-based estimates, recent studies suggest higher consistency between OE-CE-based estimates and birthweight and better agreement between the OE-CE-based estimates and estimates of gestational age based on an early ultrasound (considered the gold standard). Agreement was also closer between the OE-CE estimates and gestational ages for births conceived using assisted reproductive technology, for which dates of conception were well documented. Studies also indicate high to moderate agreement between OE reporting on the birth certificate and information on best estimates of gestational age and estimated delivery dates on hospital medical records.

        Increasing evidence of the greater validity of OE-based data compared with LMP-based data, and the national availability of OE data, have prompted NCHS to transition to the use of the OE as its standard, primary measure of gestational age.

        Data for the obstetric estimate measure are based primarily on the 2003 U.S. Standard Certificate of Live Birth item ‘‘Obstetric estimate of gestation.’’ The obstetric estimate of gestation is defined as ‘‘the best obstetric estimate of the infant’s gestation in completed weeks based on the birth attendant’s final estimate of gestation’’.

        Data for the remaining states are based on the 1989 revision of the U.S. Standard Certificate of Live Birth item ‘‘Clinical estimate of gestation.’’ The instructions to hospitals for the 1989 revision simply state that the birth attendant should provide a clinical estimate of gestation not based on the date of LMP and the date of birth. Despite differences in terminology and instructions, studies and NCHS’ own internal review of CE and OE data for the study period (available upon request; e-mail births@cdc.gov) suggest that estimates based on the obstetric estimate and the clinical estimate of gestation are comparable. Accordingly, data for these two measures are combined for and are referred to as the OE.

        The following report outlines how gestational age is measured in vital statistics data using LMP and the transition to the OE.

        National Vital Statistics Reports, Volume 64, Number 5, (06/01/2015)

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      The baseline and target for this objective was revised in 2017 due to a change in the methodology used to track this measure. The 2007 baseline was revised from 12.7% to 10.4%. In keeping with the original target setting method (10% improvement), the target was revised from 11.4% to 9.4%. In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. CDC-Preterm Birth

      2. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. The Lancet, Volume 371, Issue 9606, 5 January 2008-11 January 2008, Pages 75-84.
      3. National Center for Health Statistics. User guide to the 2010 natality public use file. Hyattsville, MD.
    • MICH-9.2 Reduce late preterm or live births at 34 to 36 weeks of gestation

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Vital Statistics System-Natality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      7.5 (2007)
      Target: 
      6.8
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of infants born between 34 and 36 completed weeks of gestation

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) has measured vital statistics gestational age data based primarily on the difference between the date of the last normal menses (LMP) and the date of infant’s birth since national LMP data first became available in 1981. However, the quality of LMP-based data has long been of concern. Imperfect maternal recall, misinterpretation of bleeding early in pregnancy, irregular menstrual cycles, and data entry errors have been shown to result in the misclassification of gestational age, particularly at preterm (under 37 completed weeks) and postterm (42 weeks and over).

        An alternative measure of gestational age, the clinical estimate (CE), was added to the 1989 U.S. Standard Certificate of Live Birth. Detailed definitions and instructions for the new measure were not developed or released, however. Concerns with data quality and the lack of national reporting (California did not report the CE) precluded the estimate from being used as a national measure of gestational age. The CE was replaced with the similar item, the ‘‘obstetric estimate of gestation at delivery’’ (OE) with the 2003 birth certificate revision. More detailed definitions and instructions were developed and distributed for the OE, which in brief is defined as ‘‘the best estimate of the infant’s gestation in completed weeks based on the birth attendant’s final estimate of gestation’’. Despite differences in definitions and instructions, data for the CE and OE appear comparable and are combined in natality public-use files. National data for a combined OE-CE item did not become available until the 2007 data year, however.

        Compared with LMP-based estimates, recent studies suggest higher consistency between OE-CE-based estimates and birthweight and better agreement between the OE-CE-based estimates and estimates of gestational age based on an early ultrasound (considered the gold standard). Agreement was also closer between the OE-CE estimates and gestational ages for births conceived using assisted reproductive technology, for which dates of conception were well documented. Studies also indicate high to moderate agreement between OE reporting on the birth certificate and information on best estimates of gestational age and estimated delivery dates on hospital medical records.

        Increasing evidence of the greater validity of OE-based data compared with LMP-based data, and the national availability of OE data, have prompted NCHS to transition to the use of the OE as its standard, primary measure of gestational age.

        Data for the obstetric estimate measure are based primarily on the 2003 U.S. Standard Certificate of Live Birth item ‘‘Obstetric estimate of gestation.’’ The obstetric estimate of gestation is defined as ‘‘the best obstetric estimate of the infant’s gestation in completed weeks based on the birth attendant’s final estimate of gestation’’.

        Data for the remaining states are based on the 1989 revision of the U.S. Standard Certificate of Live Birth item ‘‘Clinical estimate of gestation.’’ The instructions to hospitals for the 1989 revision simply state that the birth attendant should provide a clinical estimate of gestation not based on the date of LMP and the date of birth. Despite differences in terminology and instructions, studies and NCHS’ own internal review of CE and OE data for the study period (available upon request; e-mail births@cdc.gov) suggest that estimates based on the obstetric estimate and the clinical estimate of gestation are comparable. Accordingly, data for these two measures are combined for and are referred to as the OE.

        The following report outlines how gestational age is measured in vital statistics data using LMP and the transition to the OE.

        National Vital Statistics Reports, Volume 64, Number 5, (06/01/2015)

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 16-11b in that objective 16-11b tracked preterm births of 32 to 36 weeks gestation. For Healthy People 2020, objective 16-11b was divided into two objectives: objective 9.2, which tracks preterm births of 34 to 36 weeks gestation and objective 9.3, which tracks preterm births of 32 to 33 weeks gestation.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      he baseline and target for this objective was revised in 2017 due to a change in the methodology used to track this measure. The 2007 baseline was revised from 9.0% to 7.5%. In keeping with the original target setting method (10% improvement), the target was revised from 8.1% to 6.8%. In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. CDC-Preterm Birth

      2. National Center for Health Statistics. User guide to the 2010 natality public use file. Hyattsville, MD.
    • MICH-9.3 Reduce live births at 32 to 33 weeks of gestation

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Vital Statistics System-Natality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      1.2 (2007)
      Target: 
      1.1
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of infants born between 32 and 33 completed weeks of gestation

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) has measured vital statistics gestational age data based primarily on the difference between the date of the last normal menses (LMP) and the date of infant’s birth since national LMP data first became available in 1981. However, the quality of LMP-based data has long been of concern. Imperfect maternal recall, misinterpretation of bleeding early in pregnancy, irregular menstrual cycles, and data entry errors have been shown to result in the misclassification of gestational age, particularly at preterm (under 37 completed weeks) and postterm (42 weeks and over).

        An alternative measure of gestational age, the clinical estimate (CE), was added to the 1989 U.S. Standard Certificate of Live Birth. Detailed definitions and instructions for the new measure were not developed or released, however. Concerns with data quality and the lack of national reporting (California did not report the CE) precluded the estimate from being used as a national measure of gestational age. The CE was replaced with the similar item, the ‘‘obstetric estimate of gestation at delivery’’ (OE) with the 2003 birth certificate revision. More detailed definitions and instructions were developed and distributed for the OE, which in brief is defined as ‘‘the best estimate of the infant’s gestation in completed weeks based on the birth attendant’s final estimate of gestation’’. Despite differences in definitions and instructions, data for the CE and OE appear comparable and are combined in natality public-use files. National data for a combined OE-CE item did not become available until the 2007 data year, however.

        Compared with LMP-based estimates, recent studies suggest higher consistency between OE-CE-based estimates and birthweight and better agreement between the OE-CE-based estimates and estimates of gestational age based on an early ultrasound (considered the gold standard). Agreement was also closer between the OE-CE estimates and gestational ages for births conceived using assisted reproductive technology, for which dates of conception were well documented. Studies also indicate high to moderate agreement between OE reporting on the birth certificate and information on best estimates of gestational age and estimated delivery dates on hospital medical records.

        Increasing evidence of the greater validity of OE-based data compared with LMP-based data, and the national availability of OE data, have prompted NCHS to transition to the use of the OE as its standard, primary measure of gestational age.

        Data for the obstetric estimate measure are based primarily on the 2003 U.S. Standard Certificate of Live Birth item ‘‘Obstetric estimate of gestation.’’ The obstetric estimate of gestation is defined as ‘‘the best obstetric estimate of the infant’s gestation in completed weeks based on the birth attendant’s final estimate of gestation’’.

        Data for the remaining states are based on the 1989 revision of the U.S. Standard Certificate of Live Birth item ‘‘Clinical estimate of gestation.’’ The instructions to hospitals for the 1989 revision simply state that the birth attendant should provide a clinical estimate of gestation not based on the date of LMP and the date of birth. Despite differences in terminology and instructions, studies and NCHS’ own internal review of CE and OE data for the study period (available upon request; e-mail births@cdc.gov) suggest that estimates based on the obstetric estimate and the clinical estimate of gestation are comparable. Accordingly, data for these two measures are combined for and are referred to as the OE.

        The following report outlines how gestational age is measured in vital statistics data using LMP and the transition to the OE.

        National Vital Statistics Reports, Volume 64, Number 5, (06/01/2015)

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      The baseline and target for this objective was revised in 2017 due to a change in the methodology used to track this measure. The 2007 baseline was revised from 1.6% to 1.2%. In keeping with the original target setting method (10% improvement), the target was revised from 1.4% to 1.1%. In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. National Center for Health Statistics. User guide to the 2010 natality public use file. Hyattsville, MD.
    • MICH-9.4 Reduce very preterm or live births at less than 32 weeks of gestation

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Vital Statistics System-Natality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      1.7 (2007)
      Target: 
      1.5
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of infants born at less than 32 completed weeks of gestation

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) has measured vital statistics gestational age data based primarily on the difference between the date of the last normal menses (LMP) and the date of infant’s birth since national LMP data first became available in 1981. However, the quality of LMP-based data has long been of concern. Imperfect maternal recall, misinterpretation of bleeding early in pregnancy, irregular menstrual cycles, and data entry errors have been shown to result in the misclassification of gestational age, particularly at preterm (under 37 completed weeks) and postterm (42 weeks and over).

        An alternative measure of gestational age, the clinical estimate (CE), was added to the 1989 U.S. Standard Certificate of Live Birth. Detailed definitions and instructions for the new measure were not developed or released, however. Concerns with data quality and the lack of national reporting (California did not report the CE) precluded the estimate from being used as a national measure of gestational age. The CE was replaced with the similar item, the ‘‘obstetric estimate of gestation at delivery’’ (OE) with the 2003 birth certificate revision. More detailed definitions and instructions were developed and distributed for the OE, which in brief is defined as ‘‘the best estimate of the infant’s gestation in completed weeks based on the birth attendant’s final estimate of gestation’’. Despite differences in definitions and instructions, data for the CE and OE appear comparable and are combined in natality public-use files. National data for a combined OE-CE item did not become available until the 2007 data year, however.

        Compared with LMP-based estimates, recent studies suggest higher consistency between OE-CE-based estimates and birthweight and better agreement between the OE-CE-based estimates and estimates of gestational age based on an early ultrasound (considered the gold standard). Agreement was also closer between the OE-CE estimates and gestational ages for births conceived using assisted reproductive technology, for which dates of conception were well documented. Studies also indicate high to moderate agreement between OE reporting on the birth certificate and information on best estimates of gestational age and estimated delivery dates on hospital medical records.

        Increasing evidence of the greater validity of OE-based data compared with LMP-based data, and the national availability of OE data, have prompted NCHS to transition to the use of the OE as its standard, primary measure of gestational age.

        Data for the obstetric estimate measure are based primarily on the 2003 U.S. Standard Certificate of Live Birth item ‘‘Obstetric estimate of gestation.’’ The obstetric estimate of gestation is defined as ‘‘the best obstetric estimate of the infant’s gestation in completed weeks based on the birth attendant’s final estimate of gestation’’.

        Data for the remaining states are based on the 1989 revision of the U.S. Standard Certificate of Live Birth item ‘‘Clinical estimate of gestation.’’ The instructions to hospitals for the 1989 revision simply state that the birth attendant should provide a clinical estimate of gestation not based on the date of LMP and the date of birth. Despite differences in terminology and instructions, studies and NCHS’ own internal review of CE and OE data for the study period (available upon request; e-mail births@cdc.gov) suggest that estimates based on the obstetric estimate and the clinical estimate of gestation are comparable. Accordingly, data for these two measures are combined for and are referred to as the OE.

        The following report outlines how gestational age is measured in vital statistics data using LMP and the transition to the OE.

        National Vital Statistics Reports, Volume 64, Number 5, (06/01/2015)

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      The baseline and target for this objective was revised in 2017 due to a change in the methodology used to track this measure. The 2007 baseline was revised from 2.0% to 1.7%. In keeping with the original target setting method (10% improvement), the target was revised from 1.8% to 1.5%. In 2017, the estimates for geographic location were updated to reflect the 2013 urban/rural classification scheme.

      References

      Additional resources about the objective

      1. National Center for Health Statistics. User guide to the 2010 natality public use file. Hyattsville, MD.
  • MICH-10 Increase the proportion of pregnant women who receive early and adequate prenatal care

    • MICH-10.1 Increase the proportion of pregnant women who receive prenatal care beginning in the first trimester

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Vital Statistics System-Natality
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      70.8 (2007)
      Target: 
      77.9
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of births to females receiving prenatal care in the first trimester (three months) of pregnancy in states that use the 2003 standard certificate of birth

      Denominator: 

      Number of live births in states that use the 2003 standard certificate of birth

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Caveats and Limitations: 
      Estimates were calculated with data supplied by states that had adopted the 2003 version of the U.S. Standard Certificate of Live Birth. Trends over time cannot be evaluated until all states implement the 2003 Standard Certificate and provide data in the same format.
      Trend Issues: 
      Estimates for 2007 are based on 22 states (representing 53 percent of all U.S. births), excluding AL, AK, AZ, AR, CT, GA, HI, IL, LA, ME, MD, MA, MI, MN, MS, MO, MT, NV, NJ, NM, NC, OK, OR, RI, UT, VA, WV, WI, DC, and New York City.
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 16-06a in that for objective 16-06a, the trimester prenatal care began was based on the month of first prenatal visit as entered on the 1989 edition of the birth certificate. For this objective, the trimester prenatal care began is calculated from the date of LMP and the date of the first prenatal visit as entered on the 2003 edition of the birth certificate.

      References

      Additional resources about the objective

      1. Osterman MJK, Martin JA, Menacker F. Expanded health data from the new birth certificate, 2006. National vital statistics reports; vol 58 no 5. Hyattsville, MD: National Center for Health Statistics. 2009.
    • MICH-10.2 Increase the proportion of pregnant women who receive early and adequate prenatal care

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Vital Statistics System-Natality
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      70.5 (2007)
      Target: 
      77.6
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of births to females receiving adequate prenatal care by the Adequacy of Prenatal Care Utilization Index (APNCU) in states that use the 2003 standard certificate of birth

      Denominator: 

      Number of live births in states that use the 2003 standard certificate of birth

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The Adequacy of Prenatal Care Utilization Index (APNCU) is a measure of prenatal care utilization that combines the month of pregnancy prenatal care begun with the number of prenatal visits. Rates can be classified as “intensive use,” “adequate,” “intermediate,” or “less than adequate.” For this measure, adequate prenatal care is defined as a score of either “adequate” or “intensive use.” A discussion of the APNCU has been published.

      Caveats and Limitations: 
      Estimates were calculated with data supplied by the states that had adopted the 2003 version of the U.S. State Certificate of Live Birth. Trends over time cannot be evaluated until such time as all states provide data in the same format.
      Trend Issues: 
      Estimates for 2007 are based on 22 states (representing 53 percent of all U.S. births), excluding AL, AK, AZ, AR, CT, GA, HI, IL, LA, ME, MD, MA, MI, MN, MS, MO, MT, NV, NJ, NM, NC, OK, OR, RI, UT, VA, WV, WI, DC, and New York City.
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 16-06b in that for objective 16-06b, prenatal care adequacy was based on the month of first prenatal visit and number of visits as entered on the 1989 edition of the birth certificate. For this objective, prenatal care adequacy is calculated from the date of LMP, date of the first prenatal visit, and number of visits, as entered on the 2003 edition of the birth certificate.

      References

      Additional resources about the objective

      1. Kotelchuch, M. An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. American Journal of Public Health 84(9): 1414-1420, 1994.
      2. Osterman MJK, Martin JA, Menacker F. Expanded health data from the new birth certificate, 2006. National vital statistics reports; vol 58 no 5. Hyattsville, MD: National Center for Health Statistics. 2009.
  • MICH-11 Increase abstinence from alcohol, cigarettes, and illicit drugs among pregnant women

    • MICH-11.1 Increase abstinence from alcohol among pregnant women

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Survey on Drug Use and Health
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      89.4 (2007–08)
      Target: 
      98.3
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of pregnant females aged 15 to 44 years reporting no alcohol use in past 30 days

      Denominator: 

      Number of pregnant females aged 15 to 44 years

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2007-08 National Survey on Drug Use and Health:

        [NUMERATOR:]

        How long has it been since you last drank an alcoholic beverage?

        1. Within the past 30 days - that is, since [DATE]
        2. More than 30 days ago but within the past 12 months
        3. More than 12 months ago

        Are you currently pregnant?

        1. Yes
        2. No

        [If yes:]

        How many months pregnant are you?

        • Number of months pregnant _____
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        To ensure adequate precision of estimates for pregnant women, estimates are based on combined data from two years.

      Trend Issues: 
      Estimates prior to data year 2015 were removed for country of birth and geographic location due to a questionnaire redesign of the National Survey on Drug Use and Health (NSDUH) beginning in data year 2015, which resulted in a break in trend. Estimates were removed for both national level, and state-level data including the category ‘all reporting states’.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Survey on Drug Use and Health
      Measure: 
      percent
      Numerator: 

      Number of pregnant females aged 15 to 44 years reporting no alcohol use in past 30 days

      Denominator: 

      Number of pregnant females aged 15 to 44 years

      Questions Used to Obtain the State Data: 

          From the 2007-08 National Survey on Drug Use and Health:

          [NUMERATOR:]

          How long has it been since you last drank an alcoholic beverage?

          1. Within the past 30 days - that is, since [DATE]
          2. More than 30 days ago but within the past 12 months
          3. More than 12 months ago

          Are you currently pregnant?

          1. Yes
          2. No

          [If yes:]

          How many months pregnant are you?

          • Number of months pregnant _____
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          To ensure adequate precision of estimates for pregnant women, estimates are based on combined data from two years.

      Trend Issues: 
      Estimates prior to data year 2015 were removed for country of birth and geographic location due to a questionnaire redesign of the National Survey on Drug Use and Health (NSDUH) beginning in data year 2015, which resulted in a break in trend. Estimates were removed for both national level, and state-level data including the category ‘all reporting states’.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      During regular data collection and processing checks, errors were identified in the NSDUH data. These errors affected the data for Pennsylvania (2006-2010) and Maryland (2008-2009). These errors had minimal impact on the national estimates and no effect on direct estimates for the other 48 states and the District of Columbia. Comparing estimates for Pennsylvania, Maryland, the mid-Atlantic division, and the Northeast region were of most concern. However, the baseline and target values did not change as a result.
    • MICH-11.2 Increase abstinence from binge drinking among pregnant women

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Survey on Drug Use and Health
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      95.0 (2007–08)
      Target: 
      100
      Target-Setting Method: 
      Total coverage
      Target-Setting Method Justification: 
      The importance of getting all women to abstain from binge drinking during pregnancy warrants this proposed target.
      Numerator: 

      Number of pregnant females aged 15 to 44 years reporting no past month binge drinking (4 or more drinks per occasion on at least 1 day within the past 30 days)

      Denominator: 

      Number of pregnant females aged 15 to 44 years

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2008 National Survey on Drug Use and Health:

        [NUMERATOR AND DENOMINATOR:]

        Are you currently pregnant?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        [NUMERATOR:]

        The next few questions return to the topic of alcohol. Remember that by a “drink,” we mean a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it. We are not asking about times when you only had a sip or two from a drink.

        Earlier, the computer recorded that you drank at least one alcoholic beverage within the past 30 days, that is, since [FILLDATE]. Please think about the last time you drank any alcoholic beverage. How many drinks did you have at that time?

        1. Number of Drinks______________(0-90)
        2. Don’t know
        3. Refused

        Have you ever had 5 or more drinks on the same occasion? By “occasion” we mean at the same time or within a couple of hours of each other.

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        Have you ever had 4 or more drinks on the same occasion?

        1. Yes
        2. No
        3. Don’t know
        4. Refused
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Binge drinking for women is defined as drinking 4 or more alcoholic beverages at the same time or within a couple of hours of each other during the past 30 days. To ensure adequate precision of estimates for pregnant women, estimates are based on combined data 2 years.

      Trend Issues: 
      Estimates prior to data year 2015 were removed for country of birth and geographic location due to a questionnaire redesign of the National Survey on Drug Use and Health (NSDUH) beginning in data year 2015, which resulted in a break in trend. Estimates were removed for both national level, and state-level data including the category ‘all reporting states’.
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 16-17b in that for objective 16-17b, binge drinking was defined as 5 or more drinks on one occasion. For this objective, binge drinking is defined as 4 or more drinks on one occasion.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Survey on Drug Use and Health
      Measure: 
      percent
      Numerator: 

      Number of pregnant females aged 15 to 44 years reporting no past month binge drinking (4 or more drinks per occasion on at least 1 day within the past 30 days)

      Denominator: 

      Number of pregnant females aged 15 to 44 years

      Questions Used to Obtain the State Data: 

          From the 2008 National Survey on Drug Use and Health:

          [NUMERATOR AND DENOMINATOR:]

          Are you currently pregnant?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          [NUMERATOR:]

          The next few questions return to the topic of alcohol. Remember that by a “drink,” we mean a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it. We are not asking about times when you only had a sip or two from a drink.

          Earlier, the computer recorded that you drank at least one alcoholic beverage within the past 30 days, that is, since [FILLDATE]. Please think about the last time you drank any alcoholic beverage. How many drinks did you have at that time?

          1. Number of Drinks______________(0-90)
          2. Don’t know
          3. Refused

          Have you ever had 5 or more drinks on the same occasion? By “occasion” we mean at the same time or within a couple of hours of each other.

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          Have you ever had 4 or more drinks on the same occasion?

          1. Yes
          2. No
          3. Don’t know
          4. Refused
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          Binge drinking for women is defined as drinking 4 or more alcoholic beverages at the same time or within a couple of hours of each other during the past 30 days. To ensure adequate precision of estimates for pregnant women, estimates are based on combined data 2 years.

      Trend Issues: 
      Estimates prior to data year 2015 were removed for country of birth and geographic location due to a questionnaire redesign of the National Survey on Drug Use and Health (NSDUH) beginning in data year 2015, which resulted in a break in trend. Estimates were removed for both national level, and state-level data including the category ‘all reporting states’.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      During regular data collection and processing checks, errors were identified in the NSDUH data. These errors affected the data for Pennsylvania (2006-2010) and Maryland (2008-2009). These errors had minimal impact on the national estimates and no effect on direct estimates for the other 48 states and the District of Columbia. Comparing estimates for Pennsylvania, Maryland, the mid-Atlantic division, and the Northeast region were of most concern. However, the baseline and target values did not change as a result.
    • MICH-11.3 Increase abstinence from cigarette smoking among pregnant women

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Vital Statistics System-Natality
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      89.6 (2007)
      Target: 
      98.6
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      The number of women giving birth in states that use the 2003 U.S. Standard Certificate of Live Birth who report not smoking during pregnancy

      Denominator: 

      Number of women giving birth in states that use the 2003 U.S. Standard Certificate of Live Birth

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Caveats and Limitations: 
      Estimates were calculated with data supplied by states that had adopted the 2003 version of the U.S. Standard Certificate of Live Birth. Trends over time cannot be evaluated until all states implement the 2003 Standard Certificate and provide data in the same format.
      Trend Issues: 
      Estimates for 2007 are based on 22 states (representing 53 percent of all U.S. births), excluding AL, AK, AZ, AR, CT, GA, HI, IL, LA, ME, MD, MA, MI, MN, MS, MO, MT, NV, NJ, NM, NC, OK, OR, RI, UT, VA, WV, WI, DC, and New York City.
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 16-17c in that the data for objective 16-17c came from the 1989 edition of the standard certificate of live birth which collected less detailed information on maternal smoking than does the 2003 edition of the standard certificate (the source for this objective).
    • MICH-11.4 Increase abstinence from illicit drugs among pregnant women

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Survey on Drug Use and Health
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      94.8 (2007–08)
      Target: 
      100
      Target-Setting Method: 
      Total coverage
      Target-Setting Method Justification: 
      The importance of getting all women to abstain from using illicit drugs during pregnancy warrants this proposed target.
      Numerator: 

      Number of pregnant females aged 15 to 44 years reporting not using any illicit drugs in the past month (30 days)

      Denominator: 

      Number of pregnant females aged 15 to 44 years

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2007-08 National Survey on Drug Use and Health:

        [NUMERATOR:]

        [The following question is asked separately for each illicit drug: marijuana or hashish, cocaine, "crack," heroin, hallucinogens, and inhalants:]

        How long has it been since you last used [marijuana or hashish, cocaine, "crack," heroin, hallucinogens, inhalants]?

        • Marijuana or Hashish______
        • Cocaine______
        • Heroin______
        • Hallucinogens______
        • Inhalants______

        [The following questions are asked separately for nonmedical use of analgesics (prescription pain killers), tranquilizers, stimulants, and sedatives:]

        How long has it been since you last used (a pain killer, tranquilizers, stimulants, sedatives) that was not prescribed for you, or that you took only for the experience or feeling it caused?

        • Pain killer______
        • Tranquilizers______
        • Stimulants______
        • Sedatives ______

        Are you currently pregnant?

        1. Yes
        2. No

        [If yes:]

        How many months pregnant are you?

        • Number of months pregnant _____
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Illicit drugs are defined as marijuana or hashish, cocaine (including crack), inhalants, hallucinogens (including PCP and LSD), heroin, and nonmedical use of psychotherapeutics. To ensure adequate precision of estimates for pregnant women, estimates are based on combined data from two years.

      Trend Issues: 
      Estimates prior to data year 2015 were removed for country of birth and geographic location due to a questionnaire redesign of the National Survey on Drug Use and Health (NSDUH) beginning in data year 2015, which resulted in a break in trend. Estimates were removed for both national level, and state-level data including the category ‘all reporting states’.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Survey on Drug Use and Health
      Measure: 
      percent
      Numerator: 

      Number of pregnant females aged 15 to 44 years reporting not using any illicit drugs in the past month (30 days)

      Denominator: 

      Number of pregnant females aged 15 to 44 years

      Questions Used to Obtain the State Data: 

          From the 2007-08 National Survey on Drug Use and Health:

          [NUMERATOR:]

          [The following question is asked separately for each illicit drug: marijuana or hashish, cocaine, "crack," heroin, hallucinogens, and inhalants:]

          How long has it been since you last used [marijuana or hashish, cocaine, "crack," heroin, hallucinogens, inhalants]?

          • Marijuana or Hashish______
          • Cocaine______
          • Heroin______
          • Hallucinogens______
          • Inhalants______

          [The following questions are asked separately for nonmedical use of analgesics (prescription pain killers), tranquilizers, stimulants, and sedatives:]

          How long has it been since you last used (a pain killer, tranquilizers, stimulants, sedatives) that was not prescribed for you, or that you took only for the experience or feeling it caused?

          • Pain killer______
          • Tranquilizers______
          • Stimulants______
          • Sedatives ______

          Are you currently pregnant?

          1. Yes
          2. No

          [If yes:]

          How many months pregnant are you?

          • Number of months pregnant _____
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          Illicit drugs are defined as marijuana or hashish, cocaine (including crack), inhalants, hallucinogens (including PCP and LSD), heroin, and nonmedical use of psychotherapeutics. To ensure adequate precision of estimates for pregnant women, estimates are based on combined data from two years.

      Trend Issues: 
      Estimates prior to data year 2015 were removed for country of birth and geographic location due to a questionnaire redesign of the National Survey on Drug Use and Health (NSDUH) beginning in data year 2015, which resulted in a break in trend. Estimates were removed for both national level, and state-level data including the category ‘all reporting states’.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      During regular data collection and processing checks, errors were identified in the NSDUH data. These errors affected the data for Pennsylvania (2006-2010) and Maryland (2008-2009). These errors had minimal impact on the national estimates and no effect on direct estimates for the other 48 states and the District of Columbia. Comparing estimates for Pennsylvania, Maryland, the mid-Atlantic division, and the Northeast region were of most concern. As a result in 2013, the original baseline was revised from 94.9 to 94.8 percent. However, the 100 percent target was retained.
  • MICH-12 (Developmental) Increase the proportion of pregnant women who attend a series of prepared childbirth classes

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Numerator: 

    Number of women with a live birth who ever attended a childbirth class

    Denominator: 

    Number of women with a live birth

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From 2012 Pregnancy Risk Assessment Monitoring System:

      [NUMERATOR:]

      During your most recent pregnancy, did you get any of these services?

      For each one, circle Y (Yes) if you got the service or circle N (No) if you did not get it.

      Classes to prepare you for childbirth and what to expect during labor and delivery

      • Yes
      • No

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2015, this objective was archived because the data are no longer being collected by the Pregnancy Risk Assessment Monitoring System (PRAMS) and California's Maternal and Infant Health Assessment (MIHA).
  • MICH-13 (Developmental) Increase the proportion of mothers who achieve a recommended weight gain during their pregnancies

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Potential Data Source: 
    National Vital Statistics System-Natality
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent
    Numerator: 

    *** Missing ***

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Data Collection Frequency: 
    Annual
  • MICH-14 Increase the proportion of women of childbearing potential with intake of at least 400 µg of folic acid daily from fortified foods or dietary supplements

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health and Nutrition Examination Survey
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent
    Baseline (Year): 
    23.8 (2003–06)
    Target: 
    26.2
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of non-pregnant women aged 15 to 44 years with usual daily total intake of folic acid of  greater than or equal to 400 micrograms

    Denominator: 

    Number of non-pregnant women aged 15 to 44 years

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      The proportion of non-pregnant women aged 15 to 44 years with usual daily folic acid intake of 400 mg or more is estimated from questionnaire and dietary recall data as part of the standard NHANES protocol. The method of calculation of dietary folic acid for this objective involves estimating the daily usual intake of synthetic folic acid from foods reported in two 24-hour dietary recalls using a specialized statistical program, PC-SIDE (Nusser et al., 1996).

    References

    Additional resources about the objective

    1. Centers for Disease Control and Prevention. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR Recomm Rep 1992 41(RR-14):1-7.
    2. Food and Drug Administration. Food Standards: Amendment of Standards of Identity For Enriched Grain Products to Require Addition of Folic Acid. Federal Register 1996;61:8781-8797.
    3. Nusser SM, Carriquiry AL, Dodd KW, Fuller WA. A semiparametric transformation approach to estimating usual nutrient intake distributions. J Am Stat Assoc 1996;91:1440-9.
  • MICH-15 Reduce the proportion of women of childbearing potential who have lower (below the 25th percentile) red blood cell folate concentrations

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Health and Nutrition Examination Survey
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    24.9 (2007–10)
    Target: 
    22.4
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of non-pregnant women aged 15 to 44 years with red-blood-cell (RBC) folate concentration <337 ng/mL, below the 25th percentile of RBC concentrations among this group in 2007-2010

    Denominator: 

    Number of non-pregnant women aged 15 to 44 years with RBC concentrations

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Lower RBC folate concentration is a population weighted estimate from the blood specimens collected from women aged 15 to 44 years as part of the standard NHANES protocol. According to data from the National Health and Nutrition Examination Survey (NHANES), median RBC folate concentrations increased substantially between 1988-94 and 1999-2000, pre- and post-fortification with folic acid, and then declined slightly in the post-fortification period (Pfeiffer et al., 2007, CDC, 2007).

    Changes Between HP2010 and HP2020: 
    This objective differs from Healthy People 2010 objective 16-16b in that objective 16-16b tracked the median RBC folate level among non-pregnant women aged 15–44 years, while this objective tracks the percentage of non-pregnant women aged 15–44 with an RBC folate level below the 25th percentile at baseline.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2013, the baseline was revised from 24.5% (2003-06) to 24.9% (2007-10) because the assay that was used to measure RBC folate concentrations changed after the 2005-2006 NHANES cycle. Through survey year 2006 the Bio-Rad Quantaphase II radioassay (BR) was used, and from 2007 forward the microbiological assay (MA) was used. Although regression equations are provided in the NHANES documentation for converting BR values to MA values, they are dependent on methylenetetrahydrofolate reductase(MTHFR) genotype information, which is not available in the continuous NHANES data. MTHFR genotypes have been found to vary by race/ethnicity and without taking these differences into account the converted BR data do not reflect the true differences between race/ethnicity sub-groups. However, the MA does not have this issue and will be used in future NHANES. The target was adjusted from 22.1% to 22.4% to reflect the revised baseline using the original target-setting method. Also, the objective text was changed from ‘Reduce the proportion of women of childbearing potential who have low RBC folate concentrations’ to ‘Reduce the proportion of women of childbearing potential who have lower RBC folate concentrations.’ Finally the numerator was changed from ‘Number of non-pregnant women aged 15-44 years with red-blood-cell (RBC) foliate concentration <195 ng/ml, the 25th percentile of RBC concentrations among this group in 2003-2006’ to ‘Number of non-pregnant women aged 15-44 years with red-blood-cell (RBC) folate concentration <337 ng/mL, below the 25th percentile of RBC concentrations among this group in 2007-2010.’

    References

    Additional resources about the objective

    1. Blood Folate Levels: The Latest NHANES Results

    2. CDC. Folate status in women of childbearing age, by race/ethnicity---United States, 1999---2000, 2001-2002, and 2003-2004. MMWR 2007;55:1377-1380.
    3. Daly LE, Krik PN, Molloy A et al. Folate levels and neural tube defects. JAMA 1995;274:1698-1702.
    4. Pfeiffer CM, Johnson CL, Jain RB, et al. Trends in blood folate and vitamin B-12 concentrations in the United States, 1988-2004. Am J Clin Nutr; 86:718-27
  • MICH-16 Increase the proportion of women delivering a live birth who received preconception care services and practiced key recommended preconception health behaviors

    • MICH-16.1 Increase the proportion of women delivering a live birth who discussed preconception health with a health care worker prior to pregnancy

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      California's Maternal and Infant Health Assessment
      Pregnancy Risk Assessment Monitoring System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      24.5 (2012)
      Target: 
      27.0
      Target-Setting Method: 
      10 percent improvement
      Target-Setting Method Justification: 
      Given the current prevalence of preconception health care visits, the workgroup believes that a 10% improvement over baseline as a target setting method is both realistic and aspirational. In addition, given that we are half way through the decade for Healthy People 2020, setting a target at a level of 10% improvement over baseline is meaningful. There will be 4 additional data points to measure this objective over the decade.
      Numerator: 

      Women with a recent live birth who reported discussing preconception health with a health care worker prior to pregnancy

      Denominator: 

      Number of women with a recent live birth

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the Pregnancy Risk Assessment Monitoring System:

        [NUMERATOR:]

        Before you got pregnant with your new baby, did a doctor, nurse, or other health care worker talk to you about how to improve your health before pregnancy?

        From the California Maternal and Infant Health Assessment:

        [NUMERATOR:]

        Before you got pregnant with your new baby, did a doctor, nurse, or other health care worker talk to you about how to improve your health before pregnancy?

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The following PRAMS states were included in preparing the 2012 estimate: AK, AR, CO, DE, GA, HI, IL, ME, MD, MA, MI, MN, MO, NE, NJ, NM, NYC, OH, OK, OR, PA, RI, TN, UT, VT, WA, WV, WI, and WY. These data were combined with data from the California's Maternal and Infant Health Assessment to produce the displayed estimate.

        Health Insurance status data reflect prepregnancy insurance coverage of mother.

      Trend Issues: 
      The set of states on which this estimate is based will vary over time as only states that meet established response rate thresholds are included. 30 sites were included in preparing the baseline estimate for 2012.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2017, the objective was moved from developmental to measurable. The baseline is 24.5 percent based on 2012 data from PRAMS and MIHA. The target was set at 27.0 percent using the 10% improvement target-setting method.

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention. Recommendations to improve preconception health and health care – United States: a report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR 2006; 55 (No. RR-6).
      2. Institute of Medicine. Preventing low birth weight. Washington, DC: National Academy Press; 1985.
      3. Korenbrot C, Steinberg A, Bender C, Newberry S (2002). Preconception care: A systematic Review. MCH Journal, Vol. 7, No 2, pp.75-88.
    • MICH-16.2 Increase the proportion of women delivering a live birth who took multivitamins/folic acid prior to pregnancy

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      California's Maternal and Infant Health Assessment
      Pregnancy Risk Assessment Monitoring System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      30.3 (2007)
      Target: 
      33.3
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Women with a recent live birth who reported taking multivitamin/folic acid every day in the month prior to pregnancy

      Denominator: 

      Number of women with a recent live birth

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2007 Pregnancy Risk Assessment Monitoring System and California Maternal and Infant Health Assessment:

        [NUMERATOR:]

        Took multivitamins/folic acid

        During the month before you got pregnant with your new baby, how many times a week did you take a multivitamin, a prenatal vitamin, or a folic acid vitamin?

        1. I didn't take a multivitamin, prenatal vitamin, or folic acid vitamin at all
        2. 1 to 3 times a week
        3. 4 to 6 times a week
        4. Every day of the week
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        A woman was considered to have taken multivitamins/folic acid if she reported taking it every day of the week during the month before she got pregnant. Data from participating PRAMS states (28 states and New York City in 2007) were combined with data from the California's Maternal and Infant Health Assessment (MIHA) to produce the displayed estimate. The PRAMS response category was “every day” while the MIHA response category was “every day or almost every day.”

        Health Insurance status data reflect prepregnancy insurance coverage of mother.

      Trend Issues: 
      The 2007 estimate is based on data from CA plus the following PRAMS states: AK, AR, CO, DE, GA, HI, IL, ME, MD, MA, MI, MN, MO, NJ, NC, NY, NYC, OH, OK, OR, PA, RI, SC, UT, VT, WA, WV, WI, and WY.
    • MICH-16.3 Increase the proportion of women delivering a live birth who did not smoke prior to pregnancy

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      California's Maternal and Infant Health Assessment
      Pregnancy Risk Assessment Monitoring System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      79.8 (2011)
      Target: 
      87.8
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Women with a recent live birth who reported not smoking in the three months prior to pregnancy

      Denominator: 

      Number of women with a recent live birth

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2011 Pregnancy Risk Assessment Monitoring System:

        [NUMERATOR:]

        In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day? (A pack has 20 cigarettes.)

        1. 41 cigarettes or more
        2. 21 to 40 cigarettes
        3. 11 to 20 cigarettes
        4. 6 to 10 cigarettes
        5. 1 to 5 cigarettes
        6. Less than 1 cigarette
        7. I didn't smoke then

        From the 2011 California Maternal and Infant Health Assessment:

        [NUMERATOR:]

        During the 3 months before you got pregnant, how many cigarettes or packs of cigarettes did you smoke on an average day? (A pack has 20 cigarettes.)

        1. ___ cigarettes OR ___ packs
        2. Less than one cigarette a day
        3. I didn't smoke at all during the 3 months before I got pregnant
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Data from participating PRAMS states (26 states and New York City in 2011) were combined with data from the California's Maternal and Infant Health Assessment (MIHA) to produce the displayed estimate.

      Trend Issues: 
      The 2011 estimate is based on data from CA plus the following PRAMS states: AR, CO, DE, GA, HI, IL, ME, MD, MA, MI, MN, MO, NE, NJ, NM, NY, NYC, OK, OR, PA, RI, UT, VT, WA, WV, WI, and WY.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2015, the baseline was changed from 2007 to 2011 due to the availability of California MIHA data. California smoking rates are lower than many other states, improving the baseline estimate from 77.6% to 79.8%. As a result the target was proportionally revised from 85.4% to 87.8%.
    • MICH-16.4 Increase the proportion of women delivering a live birth who did not drink alcohol prior to pregnancy

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      California's Maternal and Infant Health Assessment
      Pregnancy Risk Assessment Monitoring System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      50.6 (2007)
      Target: 
      55.6
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Women with a recent live birth who reported not drinking alcohol at all in the 3 months prior to pregnancy

      Denominator: 

      Number of women with a recent live birth

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2007 Pregnancy Risk Assessment Monitoring System:

        [NUMERATOR:]

        During the 3 months before you got pregnant, how many alcoholic drinks did you have in an average week?

        1. 14 drinks or more a week
        2. 7 to 13 drinks a week
        3. 4 to 6 drinks a week
        4. 1 to 3 drinks a week
        5. Less than 1 drink a week
        6. I didn't drink then

        From the 2007 California Maternal and Infant Health Assessment:

        [NUMERATOR:]

        During the 3 months before you got pregnant, about how many drinks with alcohol did you have in an average week?

        1. I didn't drink at all during the 3 months before I got pregnant
        2. Less than one drink per week
        3. 1 to 3 per week
        4. 4 to 6 per week
        5. 7 -13 per week
        6. 14 or more drinks per week
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Data from participating PRAMS states (28 states and New York City in 2007) were combined with data from the California's Maternal and Infant Health Assessment (MIHA) to produce the displayed estimate.

        Health Insurance status data reflect prepregnancy insurance coverage of mother.

      Trend Issues: 
      The 2007 estimate is based on data from CA plus the following PRAMS states: AK, AR, CO, DE, GA, HI, IL, ME, MD, MA, MI, MN, MO, NJ, NC, NY, NYC, OH, OK, OR, PA, RI, SC, UT, VT, WA, WV, WI, and WY.
    • MICH-16.5 Increase the proportion of women delivering a live birth who had a healthy weight prior to pregnancy

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      California's Maternal and Infant Health Assessment
      Pregnancy Risk Assessment Monitoring System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      52.5 (2007)
      Target: 
      57.8
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Women with a recent live birth who reported having a healthy weight (BMI: 18.5 - 24.9) prior to pregnancy

      Denominator: 

      Number of women with a recent live birth

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2007 Pregnancy Risk Assessment Monitoring System:

        [NUMERATOR:]

        Just before you got pregnant with your new baby, how much did you weigh?
        _____ Pounds  OR &nbsp_____ Kilos

        How tall are you without shoes?
        _____ Feet _____ Inches  OR  _____ Meters

        From the 2007 California Maternal and Infant Health Assessment:

        [NUMERATOR:]

        Just before you got pregnant, how much did you weigh?
        _____ Pounds  OR  _____ Kilos

        How much weight did you gain during your most recent pregnancy?
        _____ Pounds  OR  _____ Kilos
        _____ I LOST weight during my pregnancy
        _____ I stayed the same
        _____ I don't know

        How tall are you without shoes?
               _____ Feet  and  _____ Inches
        OR _____ Meters  and  _____ cms

      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The most current IOM recommendations were used to determine BMI categories:

        Prepregnancy BMI BMI* (kg/m²)
        Underweight <18.5
        Normal weight 18.5-24.9
        Overweight 25.0-29.9
        Obese ≥30.0

        * To calculate BMI go to Calculate Your BMI - Standard BMI Calculator.

        Data from participating PRAMS states (28 states and New York City in 2007) were combined with data from the California's Maternal and Infant Health Assessment (MIHA) to produce the displayed estimate.

      Trend Issues: 
      The 2007 estimate is based on data from CA plus the following PRAMS states: AK, AR, CO, DE, GA, HI, IL, ME, MD, MA, MI, MN, MO, NJ, NC, NY, NYC, OH, OK, OR, PA, RI, SC, UT, VT, WA, WV, WI, and WY.

      References

      Additional resources about the objective

      1. Institute of Medicine (2009). Weight Gain During Pregnancy: Reexamining the Guidelines, National Academies Press, Washington DC. Available online at: www.iom.edu/Reports/2009/Weight-Gain-During-Pregnancy-Reexamining-the-Guidelines.aspx.
    • MICH-16.6 Increase the proportion of women delivering a live birth who used a most effective or moderately effective contraception method postpartum

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      California's Maternal and Infant Health Assessment
      Pregnancy Risk Assessment Monitoring System
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      53.2 (2012)
      Target: 
      58.5
      Target-Setting Method: 
      10 percent improvement
      Target-Setting Method Justification: 
      Given the current prevalence of this health behavior, a 10% improvement over baseline as a target setting method is both realistic and aspirational. In addition, given that we are half way through the decade for Healthy People 2020, setting a target at a level of 10% improvement over baseline is meaningful.
      Numerator: 

      Number of women with a recent live birth who reported using a most effective or moderately effective contraception method 2-8 months after delivery

      Denominator: 

      Number of women with a recent live birth

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2011 Pregnancy Risk Assessment Monitoring System:

        [NUMERATOR:]

        Are you or your husband or partner doing anything now to keep from getting pregnant? (Some things people do to keep from getting pregnant include using birth control pills, condoms, withdrawal, or natural family planning.)

        • Yes
        • No

        What are your reasons or your husband’s or partner’s reasons for not doing anything to keep from getting pregnant now? Check all that apply

        1. I am not having sex
        2. I want to get pregnant
        3. I don’t want to use birth control
        4. I am worried about side effects from birth control
        5. My husband or partner doesn’t want to use anything
        6. I have problems getting birth control when I need it
        7. I had my tubes tied or blocked
        8. My husband or partner had a vasectomy
        9. I am pregnant now
        10. Other

        What kind of birth control are you or your husband or partner using now to keep from getting pregnant? Check ALL that apply.

        1. Tubes tied or blocked (female sterilization, Essure®, Adiana®)
        2. Vasectomy (male sterilization)
        3. Birth control pills
        4. Condoms
        5. Injections (Depo-Provera®)
        6. Contraceptive implants (Implanon®)
        7. Contraceptive patch (OrthoEvra®) or vaginal ring (NuvaRing®)
        8. IUD (including Mirena® or ParaGard®)
        9. Natural family planning (including rhythm method)
        10. Withdrawal (pulling out)
        11. Not having sex (abstinence)
        12. Other

        From the 2012 Maternal and Infant Health Assessment:

        [NUMERATOR:]

        Are you or your husband or partner doing anything now to keep from getting pregnant?
        (Some things people do to keep from getting pregnant include using birth control pills,
        condoms, withdrawal, or natural family planning.)

        • Yes
        • No

        What are your reasons for not doing anything to keep from getting pregnant now?
        Check ALL that apply

        1. I am not having sex
        2. I want to get pregnant
        3. I don’t want to use birth control
        4. I am worried about side effects from birth control
        5. My husband or partner doesn’t want to use anything
        6. I can’t pay for birth control
        7. I have problems getting birth control when I need it
        8. I had my tubes tied or blocked
        9. My husband or partner had a vasectomy
        10. I am pregnant now
        11. Other

        What kind of birth control are you or your husband or partner using now to keep from getting pregnant? Check ALL that apply.

        1. Tubes tied or blocked (female sterilization)
        2. Vasectomy (male sterilization)
        3. Birth control pills, patch, vaginal ring
        4. Condoms
        5. Shots or injections (Depo-Provera, Lunelle)
        6. Implants (Implanon)
        7. IUD (Mirena or ParaGard)
        8. Natural family planning (rhythm, temperature)
        9. Withdrawal (pulling out)
        10. Not having sex (abstinence)
        11. Other
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        The following PRAMS states were included in preparing the 2012 estimate: AK, AR, CO, DE, GA, HI, IL, ME, MD, MA, MI, MN, MO, NE, NJ, NM, NYC, OH, OK, OR, PA, RI, TN, UT, VT, WA, WV, WI, and WY. These data were combined with data from the California's Maternal and Infant Health Assessment to produce the displayed estimate.

        Contraception use is reported at the time the survey was completed between 2 and 8 months postpartum. Women who reported they were currently pregnant or had a hysterectomy were excluded.

        The most effective methods of contraception are male or female sterilization, implants, and intrauterine devices or systems (IUD/IUS). Moderately effective methods of contraception are injectables, oral pills, patch, ring, or diaphragm.

        Health Insurance status data reflect postpartum insurance coverage of mother.

      Trend Issues: 
      The set of states on which this estimate is based will vary over time as only states that meet established response rate thresholds are included. 30 sites were included in preparing the baseline estimate for 2012.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      The wording for this objective was revised twice, and it was promoted from developmental to measureable in 2015. The initial wording “Increase the proportion of women delivering a live birth who used contraception to plan pregnancy” was modified to “Increase the proportion of women delivering a live birth who used postpartum contraception to plan their next pregnancy” in 2015. The wording was again revised in 2017 to “Increase the proportion of women delivering a live birth who used a most effective or moderately effective contraception method postpartum”. The wording change in 2017 resulted in a revised baseline from 88.6% to 53.2% and a revised target value from 97.5% to 58.5%.

      References

      Additional resources about the objective

      1. Centers for Disease Control and Prevention. Recommendations to improve preconception health and health care – United States: a report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR 2006; 55 (No. RR-6).
      2. Institute of Medicine. Preventing low birth weight. Washington, DC: National Academy Press; 1985.
      3. Korenbrot C, Steinberg A, Bender C, Newberry S (2002). Preconception care: A systematic Review. MCH Journal, Vol. 7, No 2, pp.75-88.
  • MICH-17 Reduce the proportion of persons aged 18 to 44 years who have impaired fecundity (i.e., a physical barrier preventing pregnancy or carrying a pregnancy to term)

    • MICH-17.1 Reduce the proportion of women aged 18 to 44 years who have impaired fecundity

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Survey of Family Growth
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      12.7 (2002)
      Target: 
      11.4
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Females aged 18 to 44 years with impaired fecundity

      Denominator: 

      Females aged 18 to 44 years

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Impaired fecundity is a common measure of fertility impairment and most commonly described as a physical inability to have a child.  This measure encompasses both infertility (i.e. difficulty with conceiving a pregnancy) and difficulty with carrying a pregnancy to term, as with recurrent pregnancy loss. Impaired fecundity as defined in the National Survey of Family Growth (NSFG) has 3 components: nonsurgical sterility (i.e,. physically impossible to have a child), subfecundity (i.e. physically difficult but not impossible), and "long interval without conception" (i.e. 36-months infertility).

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, the original baseline was revised from 11.8 to 12.7 (2002) percent due to a change in the methodology. The target was adjusted from 10.8 to 11.4 percent to reflect the revised baseline using the original target-setting method.
    • MICH-17.2 (Developmental) Reduce the proportion of men aged 18 to 44 years who have impaired fecundity

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Potential Data Source: 
      National Survey of Family Growth
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Numerator: 

      Males aged 18 to 44 years with impaired fecundity

      Denominator: 

      All U.S. males aged 18 to 44 years

      Comparable Healthy People 2010 Objective: 
      Not applicable
  • MICH-18 Reduce postpartum relapse of smoking among women who quit smoking during pregnancy

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    California's Maternal and Infant Health Assessment
    Pregnancy Risk Assessment Monitoring System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    42.4 (2011)
    Target: 
    38.2
    Target-Setting Method: 
    10 percent improvement
    Target-Setting Method Justification: 
    Given the current prevalence of postpartum relapse of smoking, a 10% improvement over baseline as a target setting method is both realistic and aspirational. In addition, given that we are half way through the decade for Healthy People 2020, setting a target at a level of 10% improvement over baseline is meaningful.
    Numerator: 

    Number of women with a recent live birth who quit smoking during pregnancy and resumed smoking after delivery

    Denominator: 

    Number of women with a recent live birth who quit smoking during pregnancy

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Questions Used to Obtain the National Baseline Data: 

      From the 2011 Pregnancy Risk Assessment Monitoring System:

      [NUMERATOR:]

      In the 3 months before you got pregnant, how many cigarettes did you smoke on an average day? (A pack has 20 cigarettes.)

      1. 41 cigarettes or more
      2. 21 to 40 cigarettes
      3. 11 to 20 cigarettes
      4. 6 to 10 cigarettes
      5. 1 to 5 cigarettes
      6. Less than 1 cigarette
      7. I didn't smoke then

      In the last 3 months of your pregnancy, how many cigarettes did you smoke on an average day? (A pack has 20 cigarettes.)

      1. 41 cigarettes or more
      2. 21 to 40 cigarettes
      3. 11 to 20 cigarettes
      4. 6 to 10 cigarettes
      5. 1 to 5 cigarettes
      6. Less than 1 cigarette
      7. I didn't smoke then

      How many cigarettes do you smoke on an average day now? (A pack has 20 cigarettes.)

      1. 41 cigarettes or more
      2. 21 to 40 cigarettes
      3. 11 to 20 cigarettes
      4. 6 to 10 cigarettes
      5. 1 to 5 cigarettes
      6. Less than 1 cigarette
      7. I don't smoke now

      From the 2011 Maternal and Infant Health Assessment:

      [NUMERATOR:]

      During the 3 months before you got pregnant, how many cigarettes or packs of cigarettes did
      you smoke on an average day? (A pack has 20 cigarettes.)

      • __ cigarettes OR ____ packs
      • Less than one cigarette a day
      • I didn't smoke at all during the 3 months before I got pregnant

      During the last 3 months of your pregnancy, how many cigarettes or packs of cigarettes did
      you smoke on an average day? (A pack has 20 cigarettes.)

      __ cigarettes OR ____ packs
      Less than one cigarette a day
      I didn't smoke at all during the 3 months before I got pregnant

      How many cigarettes do you smoke on an average day now? (A pack has 20 cigarettes.)

      __ cigarettes OR ____ packs
      Less than one cigarette a day
      I didn't smoke at all during the 3 months before I got pregnant

    Methodology Notes: 

      The following PRAMS states were included in preparing the 2011 estimate: AR, CO, DE, GA, HI, IL, ME, MD, MA, MI, MN, MO, NE, NJ, NM, NY, NYC, OK, OR, PA, RI, UT, VT, WA, WV, WI, and WY. These data were combined with data from the California's Maternal and Infant Health Assessment to produce the displayed estimate.

      Health Insurance status data reflect prenatal care insurance coverage of mother.

    Trend Issues: 
    The set of states on which this estimate is based will vary over time as only states that meet established response rate thresholds are included. 28 sites were included in preparing the baseline estimate for 2011.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2015, the objective was moved from developmental to measurable.
  • MICH-19 Increase the proportion of women giving birth who attend a postpartum care visit with a health care worker

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    California's Maternal and Infant Health Assessment
    Pregnancy Risk Assessment Monitoring System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Baseline (Year): 
    90.1 (2012)
    Target: 
    90.8
    Target-Setting Method: 
    Minimal statistical significance
    Target-Setting Method Justification: 
    Given the high prevalence of postpartum care visits (>90%), the ten percent improvement over baseline would not be a good target setting method. The workgroup believes that a minimal statistical significance target setting method is both realistic and would demonstrate meaningful improvement in the subpopulation of women where the postpartum care visit is under-utilized. There will be 4 additional data points estimated for this objective over the remainder of the decade.
    Numerator: 

    Number of women with a recent live birth who attended a postpartum care visit with a health care worker 4-6 weeks after the birth

    Denominator: 

    Number of women with a recent live birth

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Questions Used to Obtain the National Baseline Data: 

      From the Pregnancy Risk Assessment Monitoring System:

      [NUMERATOR:]

      Since your new baby was born, have you had a postpartum checkup for yourself? (A postpartum checkup is the regular checkup a woman has about 4-6 weeks after she gives birth.)

      1. Yes
      2. No

      From the California Maternal and Infant Health Assessment:

      [NUMERATOR:]

      Since your most recent birth, have you had a postpartum checkup for yourself (the medical
      checkup a woman has about 4 to 6 weeks after she gives birth)?

      1. Yes
      2. No
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      The following PRAMS states were included in preparing the 2012 estimate: AK, AR, CO, DE, GA, HI, IL, ME, MD, MA, MI, MN, MO, NE, NJ, NM, NYC, OH, OK, OR, PA, RI, TN, UT, VT, WA, WV, WI, and WY. These data were combined with data from the California's Maternal and Infant Health Assessment to produce the displayed estimate.

      Health Insurance status data reflect postpartum insurance coverage of mother.

    Trend Issues: 
    The set of states on which this estimate is based will vary over time as only states that meet established response rate thresholds are included. 30 sites were included in preparing the baseline estimate for 2012.

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2017, the objective was moved from developmental to measurable. The baseline is 90.1 percent based on 2012 data from PRAMS and MIHA. The target was set at 90.8 percent using the Minimal Statistical Significance target-setting method.
  • MICH-20 Increase the proportion of infants who are put to sleep on their backs

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    California's Maternal and Infant Health Assessment
    Pregnancy Risk Assessment Monitoring System
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent
    Baseline (Year): 
    68.9 (2007)
    Target: 
    75.8
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    The number of infants who are put down to sleep on their backs

    Denominator: 

    Number of women with a recent live birth

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Questions Used to Obtain the National Baseline Data: 

      From the 2007 Pregnancy Risk Assessment Monitoring System:

      [NUMERATOR:]

      How do you most often lay your baby down to sleep now? [Check one answer.]

      • (__) On his/her side
      • (__) On his/her back
      • (__) On his/her stomach

      From the 2007 Maternal and Infant Health Assessment:

      [NUMERATOR:]

      How do you put your new baby down to sleep most of the time? [Check only one answer].

      • (__) On his/her side
      • (__) On his/her back
      • (__) On his/her stomach
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Data from participating PRAMS states (28 states and New York City in 2007) were combined with data from the California's Maternal and Infant Health Assessment (MIHA) to produce the displayed estimate.

      Health Insurance status data reflect prepregnancy insurance coverage of mother.

    Trend Issues: 
    The 2007 estimate is based on data from CA plus the following PRAMS states: AK, AR, CO, DE, GA, HI, IL, ME, MD, MA, MI, MN, MO, NJ, NC, NY, NYC, OH, OK, OR, PA, RI, SC, UT, VT, WA, WV, WI, and WY.
    Changes Between HP2010 and HP2020: 
    This objective differs from Healthy People 2010 objective 16-13 in that the data source for objective 16-13 was the National Infant Sleep Study, NIH, NICHD, an annual telephone survey of approximately 1,000 parents of infants. Data for this objective come from the Pregnancy Risk Assessment Monitoring System and the California Maternal and Infant Health Assessment.
  • MICH-21 Increase the proportion of infants who are breastfed

    • MICH-21.1 Increase the proportion of infants who are ever breastfed

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      74.0 (2006)
      Target: 
      81.9
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      The trend for the proportion of infants’ ever breastfed for each year of births from 1999 to 2006 predicts an increase of 0.74 percentage points per year. A target of 81.9 percent is reasonable for this indicator given the trend projection.
      Numerator: 

      Number of caregivers of children born in a cohort year who indicate their child was ever breastfed or fed breast milk

      Denominator: 

      Number of children aged 19 to 35 months born in the same cohort year

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2007 through 2009 National Immunization Surveys:

        [NUMERATOR:]

        Was [child] ever breastfed or fed breast milk?

        1. Yes
        2. No
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Using a computer-generated list, the National Immunization Survey (NIS) identifies households across the United States with children aged 19–35 months and interviews the person who is most knowledgeable about the child’s immunization status (“caregiver”). Survey years are combined to calculate breastfeeding statistics by year of child’s birth (cohort) instead of the year in which the participant was surveyed. To calculate breastfeeding indicators by year of child birth, data are combined across all relevant survey years. Because children are 19—35 months of age at the time of the parent interview, each survey year represents children born over three years. For example, breastfeeding data for children in the 2006 birth cohort are obtained from NIS 2007, 2008, and 2009.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of caregivers of children born in a cohort year who indicate their child was ever breastfed or fed breast milk

      Denominator: 

      Number of children aged 19 to 35 months born in the same cohort year

      Questions Used to Obtain the State Data: 

          From the 2007 through 2009 National Immunization Surveys:

          [NUMERATOR:]

          Was [child] ever breastfed or fed breast milk?

          1. Yes
          2. No
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          Using a computer-generated list, the National Immunization Survey (NIS) identifies households across the United States with children aged 19–35 months and interviews the person who is most knowledgeable about the child’s immunization status (“caregiver”). Survey years are combined to calculate breastfeeding statistics by year of child’s birth (cohort) instead of the year in which the participant was surveyed. To calculate breastfeeding indicators by year of child birth, data are combined across all relevant survey years. Because children are 19—35 months of age at the time of the parent interview, each survey year represents children born over three years. For example, breastfeeding data for children in the 2006 birth cohort are obtained from NIS 2007, 2008, and 2009.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2012, the word 'breastfeed' was changed to 'breastfed' to reflect the data collected in the survey. Specifically, the NIS data relate to infants who are breastfed, not mothers who breastfeed.

      References

      Additional resources about the objective

      1. CDC. NIS survey methods.
      2. Smith PJ, Zhao Z, Wolter KM, Singleton JA, Nuorti JP. Age-period-cohort analyses of public health data collected from independent serial cross-sectional complex probability sample surveys. Seattle, WA: Joint Statistical Meeting; 2006.
    • MICH-21.2 Increase the proportion of infants who are breastfed at 6 months

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      43.5 (2006)
      Target: 
      60.6
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      The trend for the proportion of infants’ breastfeeding at 6 months of age for each year of births from 1999 through 2006 predicts an increase of 1.63 percentage points per year. The proposed target of 60.6 percent is reasonable given this trend.
      Numerator: 

      Number of caregivers of children born in a cohort year who indicate their child was breastfed any amount at 6 months of age

      Denominator: 

      Number of children aged 19 to 35 months born in the same cohort year

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2007 through 2009 National Immunization Surveys:

        [NUMERATOR:]

        Was [child] ever breastfed or fed breast milk?

        1. Yes
        2. No

        How old was [child's name] when (he/she) completely stopped breastfeeding or being fed breast milk?

        1. ≥6 months
        2. Still breastfeeding
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Using a computer-generated list, the National Immunization Survey (NIS) identifies households across the United States with children aged 19-35 months and interviews the person who is most knowledgeable about the child’s immunization status (“caregiver”). Survey years are combined to calculate breastfeeding statistics by year of child’s birth (cohort) instead of the year in which the participant was surveyed. To calculate breastfeeding indicators by year of child birth, data are combined across all relevant survey years. Because children are 19-35 months of age at the time of the parent interview, each survey year represents children born over three years. For example, breastfeeding data for children in the 2006 birth cohort are obtained from NIS 2007, 2008, and 2009.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of caregivers of children born in a cohort year who indicate their child was breastfed any amount at 6 months of age

      Denominator: 

      Number of children aged 19 to 35 months born in the same cohort year

      Questions Used to Obtain the State Data: 

          From the 2007 through 2009 National Immunization Surveys:

          [NUMERATOR:]

          Was [child] ever breastfed or fed breast milk?

          1. Yes
          2. No

          How old was [child's name] when (he/she) completely stopped breastfeeding or being fed breast milk?

          1. ≥6 months
          2. Still breastfeeding
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          Using a computer-generated list, the National Immunization Survey (NIS) identifies households across the United States with children aged 19-35 months and interviews the person who is most knowledgeable about the child’s immunization status (“caregiver”). Survey years are combined to calculate breastfeeding statistics by year of child’s birth (cohort) instead of the year in which the participant was surveyed. To calculate breastfeeding indicators by year of child birth, data are combined across all relevant survey years. Because children are 19-35 months of age at the time of the parent interview, each survey year represents children born over three years. For example, breastfeeding data for children in the 2006 birth cohort are obtained from NIS 2007, 2008, and 2009.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2012, the word 'breastfeed' was changed to 'breastfed' to reflect the data collected in the survey. Specifically, the NIS data relate to infants who are breastfed, not mothers who breastfeed.

      References

      Additional resources about the objective

      1. CDC. NIS survey methods.
      2. Smith PJ, Zhao Z, Wolter KM, Singleton JA, Nuorti JP. Age-period-cohort analyses of public health data collected from independent serial cross-sectional complex probability sample surveys. Seattle, WA: Joint Statistical Meeting; 2006.
    • MICH-21.3 Increase the proportion of infants who are breastfed at 1 year

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      22.7 (2006)
      Target: 
      34.1
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      The trend for the proportion of infants’ breastfeeding at 1 year for each year of births from 1999 through 2006 predicts an increase of 1.11 percentage points per year. The proposed target of 34.1 percent is reasonable given this trend.
      Numerator: 

      Number of caregivers of children born in a cohort year who indicate their child was breastfed any amount at 1 year of age

      Denominator: 

      Number of children aged 19-35 months born in the same cohort year

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2007 through 2009 National Immunization Surveys:

        [NUMERATOR:]

        Was [child] ever breastfed or fed breast milk?

        1. Yes
        2. No

        How old was [child's name] when (he/she) completely stopped breastfeeding or being fed breast milk?

        1. ≥1 year
        2. Still breastfeeding
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Using a computer-generated list, the National Immunization Survey (NIS) identifies households across the United States with children aged 19–35 months and interviews the person who is most knowledgeable about the child’s immunization status (“caregiver”). Survey years are combined to calculate breastfeeding statistics by year of child’s birth (cohort) instead of the year in which the participant was surveyed. To calculate breastfeeding indicators by year of child birth, data are combined across all relevant survey years. Because children are 19—35 months of age at the time of the parent interview, each survey year represents children born over three years. For example, breastfeeding data for children in the 2006 birth cohort are obtained from NIS 2007, 2008, and 2009.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of caregivers of children born in a cohort year who indicate their child was breastfed any amount at 1 year of age

      Denominator: 

      Number of children aged 19-35 months born in the same cohort year

      Questions Used to Obtain the State Data: 

          From the 2007 through 2009 National Immunization Surveys:

          [NUMERATOR:]

          Was [child] ever breastfed or fed breast milk?

          1. Yes
          2. No

          How old was [child's name] when (he/she) completely stopped breastfeeding or being fed breast milk?

          1. ≥1 year
          2. Still breastfeeding
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          Using a computer-generated list, the National Immunization Survey (NIS) identifies households across the United States with children aged 19–35 months and interviews the person who is most knowledgeable about the child’s immunization status (“caregiver”). Survey years are combined to calculate breastfeeding statistics by year of child’s birth (cohort) instead of the year in which the participant was surveyed. To calculate breastfeeding indicators by year of child birth, data are combined across all relevant survey years. Because children are 19—35 months of age at the time of the parent interview, each survey year represents children born over three years. For example, breastfeeding data for children in the 2006 birth cohort are obtained from NIS 2007, 2008, and 2009.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2012, the word 'breastfeed' was changed to 'breastfed' to reflect the data collected in the survey. Specifically, the NIS data relate to infants who are breastfed, not mothers who breastfeed.

      References

      Additional resources about the objective

      1. CDC. NIS survey methods.
      2. Smith PJ, Zhao Z, Wolter KM, Singleton JA, Nuorti JP. Age-period-cohort analyses of public health data collected from independent serial cross-sectional complex probability sample surveys. Seattle, WA: Joint Statistical Meeting; 2006.
    • MICH-21.4 Increase the proportion of infants who are breastfed exclusively through 3 months

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      33.6 (2006)
      Target: 
      46.2
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      The trend for the proportion of infants’ exclusively breastfeeding through 3 months of age for each year of births from 2003 through 2006 predicts an increase of 1.26 percentage points per year. The proposed target of 46.2 percent is reasonable given this trend.
      Numerator: 

      Number of caregivers of children born in a cohort year who indicate their child was exclusively breastfed (given nothing but breast milk) through 3 months of age

      Denominator: 

      Number of children aged 19 to 35 months born in the same cohort year

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2007 through 2009 National Immunization Surveys:

        [NUMERATOR:]

        Exclusively through 3 months

        Was the child ever breastfed or fed breast milk?

        1. Yes
        2. No

        How old was [child's name] when [child's name] completely stopped breastfeeding or being fed breast milk?

        1. ≥3 months
        2. Still breastfeeding

        How old was [child's name] when (he/she) was first fed formula?

        1. ≥3 months
        2. Never fed formula

        This next question is about the first thing that [child] was given other than breast milk or formula. Please include juice, cow's milk, sugar water, baby food, or anything else that [child] may have been given, even water.

        How old was [child's name] when (he/she) was first fed anything other than breast milk or formula?

        1. ≥3 months
        2. Never given anything but breast milk
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Infants are considered to have been breastfed exclusively through 3 months if the responses to questions about age when first fed formula AND age when first fed something other than breast milk or formula both indicate that the child was ≥3 months when either occurred OR that the child has never had formula nor anything but breast milk.

        Using a computer-generated list, the National Immunization Survey (NIS) identifies households across the United States with children aged 19–35 months and interviews the person who is most knowledgeable about the child’s immunization status (“caregiver”). Survey years are combined to calculate breastfeeding statistics by year of child’s birth (cohort) instead of the year in which the participant was surveyed. To calculate breastfeeding indicators by year of child birth, data are combined across all relevant survey years. Because children are 19—35 months of age at the time of the parent interview, each survey year represents children born over three years. For example, breastfeeding data for children in the 2006 birth cohort are obtained from NIS 2007, 2008, and 2009.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of caregivers of children born in a cohort year who indicate their child was exclusively breastfed (given nothing but breast milk) through 3 months of age

      Denominator: 

      Number of children aged 19 to 35 months born in the same cohort year

      Questions Used to Obtain the State Data: 

          From the 2007 through 2009 National Immunization Surveys:

          [NUMERATOR:]

          Exclusively through 3 months

          Was the child ever breastfed or fed breast milk?

          1. Yes
          2. No

          How old was [child's name] when [child's name] completely stopped breastfeeding or being fed breast milk?

          1. ≥3 months
          2. Still breastfeeding

          How old was [child's name] when (he/she) was first fed formula?

          1. ≥3 months
          2. Never fed formula

          This next question is about the first thing that [child] was given other than breast milk or formula. Please include juice, cow's milk, sugar water, baby food, or anything else that [child] may have been given, even water.

          How old was [child's name] when (he/she) was first fed anything other than breast milk or formula?

          1. ≥3 months
          2. Never given anything but breast milk
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          Infants are considered to have been breastfed exclusively through 3 months if the responses to questions about age when first fed formula AND age when first fed something other than breast milk or formula both indicate that the child was ≥3 months when either occurred OR that the child has never had formula nor anything but breast milk.

          Using a computer-generated list, the National Immunization Survey (NIS) identifies households across the United States with children aged 19–35 months and interviews the person who is most knowledgeable about the child’s immunization status (“caregiver”). Survey years are combined to calculate breastfeeding statistics by year of child’s birth (cohort) instead of the year in which the participant was surveyed. To calculate breastfeeding indicators by year of child birth, data are combined across all relevant survey years. Because children are 19—35 months of age at the time of the parent interview, each survey year represents children born over three years. For example, breastfeeding data for children in the 2006 birth cohort are obtained from NIS 2007, 2008, and 2009.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2012, the word 'breastfeed' was changed to 'breastfed' to reflect the data collected in the survey. Specifically, the NIS data relate to infants who are breastfed, not mothers who breastfeed.

      References

      Additional resources about the objective

      1. CDC. NIS survey methods.
      2. CDC. Provisional exclusive breastfeeding rates by socio-demographic factors, among children born in 2009.
      3. Smith PJ, Zhao Z, Wolter KM, Singleton JA, Nuorti JP. Age-period-cohort analyses of public health data collected from independent serial cross-sectional complex probability sample surveys. Seattle, WA: Joint Statistical Meeting; 2006.
    • MICH-21.5 Increase the proportion of infants who are breastfed exclusively through 6 months

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Immunization Survey
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      14.1 (2006)
      Target: 
      25.5
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      The trend for the proportion of infants’ exclusively breastfeeding through 6 months of age for each year of births from 2003 through 2006 predicts an increase of 1.16 percentage points per year. The proposed target of 25.5 percent is reasonable given this trend.
      Numerator: 

      Number of caregivers of children born in a cohort year who indicate their child was exclusively breastfed (given nothing but breast milk) through 6 months of age

      Denominator: 

      Number of children aged 19-35 months born in the same cohort year

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2007 through 2009 National Immunization Surveys:

        [NUMERATOR:]

        Was the child ever breastfed or fed breast milk?

        1. Yes
        2. No

        How old was [child's name] when [child's name] completely stopped breastfeeding or being fed breast milk?

        1. ≥6 months
        2. Still breastfeeding

        How old was [child's name] when (he/she) was first fed formula?

        1. ≥6 months
        2. Never fed formula

        This next question is about the first thing that [child] was given other than breast milk or formula. Please include juice, cow's milk, sugar water, baby food, or anything else that [child] may have been given, even water.

        How old was [child's name] when (he/she) was first fed anything other than breast milk or formula?

        1. ≥6 months
        2. Never given anything but breast milk
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Infants are considered to have been breastfed exclusively through 6 months if the responses to questions about age when first fed formula AND age when first fed something other than breast milk or formula both indicate that the child was ≥6 months when either occurred OR that the child has never had formula nor anything but breast milk.

        Using a computer-generated list, the National Immunization Survey (NIS) identifies households across the United States with children aged 19–35 months and interviews the person who is most knowledgeable about the child’s immunization status (“caregiver”). Survey years are combined to calculate breastfeeding statistics by year of child’s birth (cohort) instead of the year in which the participant was surveyed. To calculate breastfeeding indicators by year of child birth, data are combined across all relevant survey years. Because children are 19—35 months of age at the time of the parent interview, each survey year represents children born over three years. For example, breastfeeding data for children in the 2006 birth cohort are obtained from NIS 2007, 2008, and 2009.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Immunization Survey
      Measure: 
      percent
      Numerator: 

      Number of caregivers of children born in a cohort year who indicate their child was exclusively breastfed (given nothing but breast milk) through 6 months of age

      Denominator: 

      Number of children aged 19-35 months born in the same cohort year

      Questions Used to Obtain the State Data: 

          From the 2007 through 2009 National Immunization Surveys:

          [NUMERATOR:]

          Was the child ever breastfed or fed breast milk?

          1. Yes
          2. No

          How old was [child's name] when [child's name] completely stopped breastfeeding or being fed breast milk?

          1. ≥6 months
          2. Still breastfeeding

          How old was [child's name] when (he/she) was first fed formula?

          1. ≥6 months
          2. Never fed formula

          This next question is about the first thing that [child] was given other than breast milk or formula. Please include juice, cow's milk, sugar water, baby food, or anything else that [child] may have been given, even water.

          How old was [child's name] when (he/she) was first fed anything other than breast milk or formula?

          1. ≥6 months
          2. Never given anything but breast milk
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

          Infants are considered to have been breastfed exclusively through 6 months if the responses to questions about age when first fed formula AND age when first fed something other than breast milk or formula both indicate that the child was ≥6 months when either occurred OR that the child has never had formula nor anything but breast milk.

          Using a computer-generated list, the National Immunization Survey (NIS) identifies households across the United States with children aged 19–35 months and interviews the person who is most knowledgeable about the child’s immunization status (“caregiver”). Survey years are combined to calculate breastfeeding statistics by year of child’s birth (cohort) instead of the year in which the participant was surveyed. To calculate breastfeeding indicators by year of child birth, data are combined across all relevant survey years. Because children are 19—35 months of age at the time of the parent interview, each survey year represents children born over three years. For example, breastfeeding data for children in the 2006 birth cohort are obtained from NIS 2007, 2008, and 2009.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2012, the word 'breastfeed' was changed to 'breastfed' to reflect the data collected in the survey. Specifically, the NIS data relate to infants who are breastfed, not mothers who breastfeed.

      References

      Additional resources about the objective

      1. CDC. NIS survey methods.
      2. CDC. Provisional exclusive breastfeeding rates by socio-demographic factors, among children born in 2009.
      3. Smith PJ, Zhao Z, Wolter KM, Singleton JA, Nuorti JP. Age-period-cohort analyses of public health data collected from independent serial cross-sectional complex probability sample surveys. Seattle, WA: Joint Statistical Meeting; 2006.
  • MICH-22 Increase the proportion of employers that have worksite lactation support programs

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Employee Benefits Survey
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent
    Baseline (Year): 
    25 (2009)
    Target: 
    38
    Target-Setting Method: 
    Projection/trend analysis
    Target-Setting Method Justification: 
    Returning to work is a common reason mothers cite for having to discontinue or reduce breastfeeding. Worksite lactation support is a strategy that may help working mothers continue. According to data from the Society for Human Resource Management, the trend for the proportion of employers providing worksite lactation support each year from 2001 through 2009 predicts an increase of about 1.2 percentage points per year. The proposed target of 38 percent is reasonable given this trend.
    Numerator: 

    Number of employers indicating they provide an on-site lactation/mother's room

    Denominator: 

    Number of employers responding to the survey

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Questions Used to Obtain the National Baseline Data: 

      From the 2009 Employee Benefits Survey:

      [NUMERATOR:]

      Do you provide employees an on-site lactation/mother's room?

      1. Yes
      2. No
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Employers who answer "yes" are included as providing worksite lactation support.

      In February 2009, the Society for Human Resource Management (SHRM) conducted its annual survey to gather information on the types of benefits employers offer to their employees. The report provides an analysis of the 2009 SHRM Employee Benefits Survey results. The survey instrument listed 274 benefits and asked human resource (HR) professionals to indicate whether they offered these benefits to their employees.

    References

    Additional resources about the objective

    1. Society for Human Resource Management. 2009 Employee Benefits: A Survey Report by SHRM. June 2009.
    2. Society for Human Resource Management.
  • MICH-23 Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life

    About the Data: National

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    National Immunization Survey
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent
    Baseline (Year): 
    24.2 (2006)
    Target: 
    14.2
    Target-Setting Method: 
    Projection/trend analysis
    Target-Setting Method Justification: 
    The proportion of breastfed infants supplemented with infant formula within the first 2 days of life increased from 22.3 percent of infants born in 2003 to 24.2 percent of infants born in 2006. Supplementation of newborn breastfed infants with formula has an important influence on breastfeeding after hospital discharge. The Joint Commission, an organization that accredits hospitals, recently added a performance measure for which hospitals report the proportion of newborns who leave the hospital having had nothing but breast milk. This measure is expected to help drive hospitals to improve practices to decrease formula supplementation of breastfed newborns when not medically indicated. A target of 14.2 percent is proposed because current efforts are expected to result in an absolute 10-percentage point decrease over the next 10 years. Although ambitious, the target is reasonable.
    Numerator: 

    Number of caregivers of breastfed infants born in cohort year (for current baseline, year 2006) who indicate their infant received formula supplementation within the first 2 days of life

    Denominator: 

    Number of children aged 19-35 months born in one calendar year (e g , baseline refers to the 2006 birth cohort) who were breastfeeding at 2 days of life

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Questions Used to Obtain the National Baseline Data: 

      From the 2006 National Immunization Survey

      [NUMERATOR:]

      Was [child] ever breastfed or fed breast milk?

      1. Yes
      2. No

      How old was [child's name] when (he/she) was first fed formula?

      1. ≤ 2 days of age
      2. Other
    Methodology Notes: 

      If the response to the first question (Was child ever breastfed or fed breast milk?) is No, the child is not considered a breastfed newborn and is not included in the denominator.

      The National Immunization Survey (NIS) is conducted annually and collects data on children through age 35 months, and enables CDC to calculate breastfeeding rates each year. Because children are 19-35 months of age at the time of the NIS interview, each cross-sectional survey includes children born in three different calendar years. Using a computer-generated list, the NIS identifies households across the United States with children aged 19–35 months and interviews the person who is most knowledgeable about the child’s immunization status (“caregiver”). Starting January 2003, all respondents to the household telephone survey were asked questions related to breastfeeding, with modification of breastfeeding questions in 2004 and 2006. Survey years are combined to calculate breastfeeding by year of child’s birth (cohort) instead of year in which the participant was surveyed. To calculate breastfeeding indicators by year of child birth, data are combined across all available survey years.

    About the Data: State

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

    Data Source: 
    National Immunization Survey
    Measure: 
    percent
    Numerator: 

    Number of caregivers of breastfed infants born in cohort year (for current baseline, year 2006) who indicate their infant received formula supplementation within the first 2 days of life

    Denominator: 

    Number of children aged 19-35 months born in one calendar year (e g , baseline refers to the 2006 birth cohort) who were breastfeeding at 2 days of life

    Questions Used to Obtain the State Data: 

        From the 2006 National Immunization Survey

        [NUMERATOR:]

        Was [child] ever breastfed or fed breast milk?

        1. Yes
        2. No

        How old was [child's name] when (he/she) was first fed formula?

        1. ≤ 2 days of age
        2. Other
    Methodology Notes: 

        If the response to the first question (Was child ever breastfed or fed breast milk?) is No, the child is not considered a breastfed newborn and is not included in the denominator.

        The National Immunization Survey (NIS) is conducted annually and collects data on children through age 35 months, and enables CDC to calculate breastfeeding rates each year. Because children are 19-35 months of age at the time of the NIS interview, each cross-sectional survey includes children born in three different calendar years. Using a computer-generated list, the NIS identifies households across the United States with children aged 19–35 months and interviews the person who is most knowledgeable about the child’s immunization status (“caregiver”). Starting January 2003, all respondents to the household telephone survey were asked questions related to breastfeeding, with modification of breastfeeding questions in 2004 and 2006. Survey years are combined to calculate breastfeeding by year of child’s birth (cohort) instead of year in which the participant was surveyed. To calculate breastfeeding indicators by year of child birth, data are combined across all available survey years.

    References

    Additional resources about the objective

    1. Smith PJ, Zhao Z, Wolter KM, Singleton JA, Nuorti JP. Age-period-cohort analyses of public health data collected from independent serial cross-sectional complex probability sample surveys. Seattle, WA: Joint Statistical Meeting; 2006.
  • MICH-24 Increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Breastfeeding Report Card
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent
    Baseline (Year): 
    2.9 (2009)
    Target: 
    8.1
    Target-Setting Method: 
    Projection/trend analysis
    Target-Setting Method Justification: 
    The 2007 to 2009 trend for the proportion of U.S. live births that occurred in hospitals and birth centers that provide all the recommended elements of care for breastfeeding mothers and their babies predicts an increase of 0.54 percentage points per year. The proposed target of 8.1 percent is ambitious but reasonable given this trend.
    Numerator: 

    Number of live births that occur in hospitals and birth centers designated as providing all the recommended elements of care for lactating mothers and their babies

    Denominator: 

    Number of live births

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Data Collection Frequency: 
    Annual
    Methodology Notes: 

      Hospital and birth center practices significantly affect whether a woman chooses to start breastfeeding and how long she continues to breastfeed. Several specific policies and practices, in combination, determine how much overall support for breastfeeding a mother giving birth in a particular hospital or birth center is likely to receive. The recommended elements of care for lactating mothers and their babies are those that are required for a hospital or birth center to be designated as “Baby-Friendly.” These elements are: (1) Have a written breastfeeding policy that is routinely communicated to all health care staff; (2) Train all health care staff in skills necessary to implement the policy; (3) Inform all pregnant women about the benefits and management of breastfeeding; (4) Help mothers initiate breastfeeding within one hour of birth; (5) Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants; (6) Give newborn infants no food or drink other than breast milk, unless medically indicated; (7) Practice “rooming in” – allow mothers and infants to remain together 24 hours a day; (8) Encourage breastfeeding on cue; (9) Give no pacifiers or artificial nipples to breastfeeding infants; (10) Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

      The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for lactation based on the WHO/UNICEF Ten Steps to Successful Breastfeeding for Hospitals. In the United States, the nonprofit organization Baby-Friendly USA oversees this program. To be designated as “Baby-Friendly,” facilities undergo external evaluation to demonstrate that the facility meets all ten of the recommended elements of care. All types and sizes of birth facilities can seek the Baby-Friendly designation. Some states have several small Baby-Friendly facilities, others have only one or two large Baby-Friendly facilities, and still others have none at all. Because birth facilities vary in size and the number of annual births, measuring the effect of their maternity care and practices on public health requires more than just counting the number of Baby-Friendly facilities per state. Thus, the public health impact is assessed by using the proportion of annual live births in the U.S. that occurred at facilities that have earned the Baby-Friendly designation.

    References

    Additional resources about the objective

    1. Baby-Friendly USA. The Ten Steps to Successful Breastfeeding.
    2. CDC. Breastfeeding Report Card – United States, 2009.
    3. Protecting, promoting and supporting breast-feeding: The special role of maternity services. A Joint WHO/UNICEF Statement. Geneva, World Health Organization, 1989.
  • MICH-25 Reduce the occurrence of fetal alcohol syndrome (FAS)

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Fetal Alcohol Surveillance System Network
    National Vital Statistics System-Natality
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    per 10,000 live births
    Baseline (Year): 
    3.6 (2001–04)
    Target: 
    Not applicable
    Target-Setting Method: 
    This measure is being tracked for informational purposes. If warranted, a target will be set during the decade.
    Numerator: 

    Number of children born in 2001-04 with suspected or confirmed Fetal Alcohol Syndrome

    Denominator: 

    Number of live births in 2006 to women residing in the selected surveillance area as determined by birth certificate data

    Comparable Healthy People 2010 Objective: 
    Adapted from HP2010 objective
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Fetal alcohol syndrome (FAS) is caused by maternal alcohol used during pregnancy and is one of the leading causes of preventable birth defects and developmental disabilities. The 2001-2004 estimate for FAS was determined using data from seven state-based FAS surveillance programs. The analyses included children who were born during 2001-2004 to a mother residing in a surveillance area at the time of the birth of the child, and who met the surveillance case definition for confirmed or probable FAS. The denominator consisted of live births to women residing in the selected surveillance area as determined by birth certificate data. Race/ethnic specific prevalence were calculated using mother’s race/ethnicity from birth certificates. Child’s race/ethnicity was used if mother’s race/ethnicity was not available. Prevalence calculations were standardized to the race/ethnic distribution of the 2006 US live births according to NCHS.

  • MICH-26 Reduce the proportion of children diagnosed with a disorder through newborn bloodspot screening who experience developmental delay requiring special education services

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Metropolitan Atlanta Developmental Disabilities Surveillance Program
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent
    Baseline (Year): 
    15.1 (1988–96)
    Target: 
    13.6
    Target-Setting Method: 
    10 percent improvement
    Numerator: 

    Number of 3-10 year-old children diagnosed with a disorder through newborn bloodspot screening who experience developmental delay requiring special education services

    Denominator: 

    Number of 3-10 year-old children diagnosed with a disorder through newborn bloodspot screening

    Comparable Healthy People 2010 Objective: 
    Not applicable
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      The Autism and Developmental Disabilities Monitoring Network (ADDM) provides reliable, population-based prevalence estimates of the number of school-aged children with developmental disabilities over time and is the only program in the US conducting active surveillance for serious developmental disabilities using data on individual children. ADDM sites with access to both education records and newborn bloodspot screening data will contribute to these data points. Data from newborn bloodspot screening will be used to establish the denominator and these data will be linked to special education data obtained annually by each ADDM site with access to education records.

    References

    Additional resources about the objective

    1. Powell KK, Van Naarden Braun K, Singh RH, Shapira SK, Olney RS, Yeargin-Allsopp M. Long-term speech and language developmental issues among children with Duarte galactosemia. Genetics Med. 2009; (12):874-9.
    2. Powell, K. K., Van Naarden Braun, K., Singh, R. H., Shapira, S. K., Olney, R. S., Yeargin-Allsopp, M. Prevalence of developmental disabilities and receipt of special education services among children with an inborn error of metabolism. J of Pediatrics 2010 156:420-426.
  • MICH-27 Reduce the proportion of children with cerebral palsy born low or very low birth weight

    • MICH-27.1 Reduce the proportion of children aged 8 years with cerebral palsy born low birth weight (less than 2,500 grams)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Autism and Developmental Disabilities Monitoring Network
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      50.0 (2006)
      Target: 
      45.0
      Target-Setting Method: 
      10 percent improvement
      Target-Setting Method Justification: 
      The default target-setting method was chosen as there are limited data for modelling projections and there are no existing national programs/regulations/policies/laws related specifically to birth weight and cerebral palsy to use for setting a specific target method and estimate.
      Numerator: 

      Number of 8-year-old children with cerebral palsy born low birth weight (<2500 grams)

      Denominator: 

      Number of 8-year-old children with cerebral palsy born in surveillance areas with birth weight information

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Children with cerebral palsy included in this objective are those with birth weight information available through linkage with birth certificates. Children with cerebral palsy with a documented post-neonatal (>28 days after birth to age 8 years) etiology are included in this objective.

        The Autism and Developmental Disabilities Monitoring (ADDM) Network provides reliable, population-based prevalence estimates of the number of school-aged children with cerebral palsy and other developmental disabilities over time and is the only program in the US conducting active surveillance for serious developmental disabilities using data on individual children. For the majority of children with cerebral palsy (CP) the cause of their cerebral palsy is unknown. The effects of improved neonatal care overtime which differ dramatically by birth weight have had particular implications for CP. This indicator focuses on one of the leading risk factors for cerebral palsy. Monitoring potentially modifiable, major risk factors is an area ripe for introducing interventions and improving outcomes.

        The denominator for this objective reflects the number of 8-year-old children with CP who were born in the participating ADDM states and resided in the respective surveillance areas at 8 years of age.

      Caveats and Limitations: 
      The ADDM Cerebral Palsy Network represents surveillance in three large population-based sites within three states, yet is not nationally representative as the sites were funded based on a competitive grant process. The ADDM Network is the only data source in the US that can examine the topic of this objective.
      Trend Issues: 
      As the ADDM Cerebral Palsy Network is funded based on a competitive grant process, the participating sites have changed over time which may influence trends in measurement of this objective. Analyses restricting the population of children with cerebral palsy to the common geographic ascertainment area over time demonstrate consistent suggestion of trends across the three surveillance years.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      MICH-27: children with cerebral palsy born low birth weight was retained as MICH-27.1 and MICH-27.2 was added to monitor children with cerebral palsy born very low birth weight.
    • MICH-27.2 Reduce the proportion of children aged 8 years with cerebral palsy born very low birth weight (less than 1,500 grams)

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Autism and Developmental Disabilities Monitoring Network
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      32.5 (2006)
      Target: 
      25.7
      Target-Setting Method: 
      Minimal statistical significance
      Target-Setting Method Justification: 
      Minimal statistical significance was chosen as there are limited data for modelling projections and there are no existing national programs/regulations/policies/laws related specifically to birth weight and cerebral palsy to use for setting a specific target method and estimate.
      Numerator: 

      Number of 8-year-old children with cerebral palsy born very low birth weight infants (<1500 grams)

      Denominator: 

      Number of 8-year-old children with cerebral palsy born in surveillance areas with birth weight information.

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Children with cerebral palsy included in this objective are those with birth weight information available through linkage with birth certificates. Children with cerebral palsy with a documented post-neonatal (>28 days after birth to age 8 years) etiology are included in this objective.

        The Autism and Developmental Disabilities Monitoring (ADDM) Network provides reliable, population-based prevalence estimates of the number of school-aged children with cerebral palsy and other developmental disabilities over time and is the only program in the US conducting active surveillance for serious developmental disabilities using data on individual children. For the majority of children with cerebral palsy (CP) the cause of their cerebral palsy is unknown. The effects of improved neonatal care overtime which differ dramatically by birth weight have had particular implications for CP. This indicator focuses on one of the leading risk factors for cerebral palsy. Monitoring potentially modifiable, major risk factors is an area ripe for introducing interventions and improving outcomes.

        The denominator for this objective reflects the number of 8-year-old children with CP who were born in the participating ADDM states and resided in the respective surveillance areas at 8 years of age.

      Caveats and Limitations: 
      The ADDM Cerebral Palsy Network represents surveillance in three large population-based sites within three states, yet is not nationally representative as the sites were funded based on a competitive grant process. The ADDM Network is the only data source in the US that can examine the topic of this objective.
      Trend Issues: 
      As the ADDM Cerebral Palsy Network is funded based on a competitive grant process, the participating sites have changed over time which may influence trends in measurement of this objective. Analyses restricting the population of children with cerebral palsy to the common geographic ascertainment area over time demonstrate consistent suggestion of trends across the three surveillance years.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      MICH-27: children with cerebral palsy born low birth weight was retained as MICH-27.1 and MICH-27.2 was added to monitor children with cerebral palsy born very low birth weight.
  • MICH-28 Reduce occurrence of neural tube defects

    • MICH-28.1 Reduce the occurrence of spina bifida

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Birth Defects Prevention Network
      National Vital Statistics System-Natality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 100,000 live births
      Baseline (Year): 
      34.2 (2005–06)
      Target: 
      30.8
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Cases of spina bifida

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Biennial
      Methodology Notes: 

        CDC's National Center for Birth Defects and Developmental Disabilities (NCBDDD) is collaborating with states in the National Birth Defects Prevention Network (NBDPN) to systematically collect population-based birth defects data on neural tube defects in a timely manner. Twenty-four state birth defects surveillance programs that collect spina bifida cases for any pregnancy outcome were included in the dataset. Spina bifida cases are identified using either ICD-9 (740.0 – 740.1) or CDC/BPA (740.00 – 740.10) codes.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, the words “live births and/or fetal deaths” were replaced with “cases” and the phrase “were diagnosed”' was removed from the data label to reflect the data collected in the surveillance instrument. Data for spina bifida from any pregnancy outcome were aggregated from multiple population-based surveillance systems across the U.S. Some of these cases might have resulted in a termination. Additionally, the cases were occurrences and may not have necessarily been diagnosed in the base line or target year.
    • MICH-28.2 Reduce the occurrence of anencephaly

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Birth Defects Prevention Network
      National Vital Statistics System-Natality
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      per 100,000 live births
      Baseline (Year): 
      24.6 (2005–06)
      Target: 
      22.1
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Cases of anencephaly

      Denominator: 

      Number of live births

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Biennial
      Methodology Notes: 

        CDC's National Center for Birth Defects and Developmental Disabilities (NCBDDD) is collaborating with states in the National Birth Defects Prevention Network (NBDPN) to systematically collect population-based birth defects data on neural tube defects in a timely manner. Nine state birth defects surveillance programs that can collect anencephaly cases for all pregnancy outcomes were included in the dataset. Anencephaly cases are identified using either ICD-9 (741.0, 741.9) or CDC/BPA (741.00 – 741.99) codes.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2013, the words “live births and/or fetal deaths” were replaced with “cases” and the phrase “were diagnosed”' was removed from the data label to reflect the data collected in the surveillance instrument. Data for anencephaly from any pregnancy outcome were aggregated from multiple population-based surveillance systems across the U.S. Some of these cases might have resulted in a termination. Additionally, the cases were occurrences and may not have necessarily been diagnosed in the base line or target year.
  • MICH-29 Increase the proportion of young children with autism spectrum disorder (ASD) and other developmental delays who are screened, evaluated, and enrolled in special services in a timely manner

    • MICH-29.1 Increase the proportion of children (aged 10-35 months) who have been screened for Autism Spectrum Disorder (ASD) and other developmental delays

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Survey of Children's Health
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      22.6 (2007)
      Target: 
      24.9
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of children (10-35 months of age) who are screened for autism and other developmental delays in the past year

      Denominator: 

      Number of children (10-35 months of age)

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2007 National Survey of Children's Health:

        [NUMERATOR:]

        Sometimes a child's doctor or other health care provider will ask a parent to fill out a questionnaire at home or during their child's visit. During the past 12 months, did a doctor or other health care provider have you fill out a questionnaire about specific concerns or observations you may have about (Specific Child)'s developmental, communication or social behaviors?

        1. Yes
        2. No

        Did this questionnaire ask about your concerns or observations about how (Specific Child) talks or makes speech sounds?

        1. Yes
        2. No

        Did this questionnaire ask about your concerns or observations about how (Specific Child) interacts with you and others?

        1. Yes
        2. No

        Did this questionnaire ask about your concerns or observations about words and phrases (Specific Child) uses and understands?

        1. Yes
        2. No

        Did this questionnaire ask about your concerns or observations about how (Specific Child) behaves and gets along with you and others?

        1. Yes
        2. No
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Autism Spectrum Disorders (ASD) are defined as a constellation of behaviors indicating social, communicative, and behavioral impairment or abnormalities. The essential features of ASD are (a) impaired reciprocal social interactions, (b) delayed or unusual communication styles, and (c) restricted or repetitive behavior patterns.
        A child is included as a confirmed case of ASD if he or she displays behaviors (as described by a doctor or other health care provider) consistent with the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) diagnostic criteria for Autistic Disorder, Pervasive Developmental Disorder-Not Otherwise Specified (including Atypical Autism), or Asperger's Disorder. Behavioral descriptions are reviewed by autism experts using a coding scheme based on DSM-IV criteria to determine autism case status.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 16-14c, which tracked the median age, in months, at first identification of an autism spectrum disorder using data from the Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP). This objective tracks screening for autism and other developmental delays in children aged 10-35 months using data from the National Survey of Children's Health (NSCH).

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Survey of Children's Health
      Measure: 
      percent
      Numerator: 

      Number of children (10-35 months of age) who are screened for autism and other developmental delays in the past year

      Denominator: 

      Number of children (10-35 months of age)

      Questions Used to Obtain the State Data: 

          From the 2007 National Survey of Children's Health:

          [NUMERATOR:]

          Sometimes a child's doctor or other health care provider will ask a parent to fill out a questionnaire at home or during their child's visit. During the past 12 months, did a doctor or other health care provider have you fill out a questionnaire about specific concerns or observations you may have about (Specific Child)'s developmental, communication or social behaviors?

          1. Yes
          2. No

          Did this questionnaire ask about your concerns or observations about how (Specific Child) talks or makes speech sounds?

          1. Yes
          2. No

          Did this questionnaire ask about your concerns or observations about how (Specific Child) interacts with you and others?

          1. Yes
          2. No

          Did this questionnaire ask about your concerns or observations about words and phrases (Specific Child) uses and understands?

          1. Yes
          2. No

          Did this questionnaire ask about your concerns or observations about how (Specific Child) behaves and gets along with you and others?

          1. Yes
          2. No
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

          Autism Spectrum Disorders (ASD) are defined as a constellation of behaviors indicating social, communicative, and behavioral impairment or abnormalities. The essential features of ASD are (a) impaired reciprocal social interactions, (b) delayed or unusual communication styles, and (c) restricted or repetitive behavior patterns.
          A child is included as a confirmed case of ASD if he or she displays behaviors (as described by a doctor or other health care provider) consistent with the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) diagnostic criteria for Autistic Disorder, Pervasive Developmental Disorder-Not Otherwise Specified (including Atypical Autism), or Asperger's Disorder. Behavioral descriptions are reviewed by autism experts using a coding scheme based on DSM-IV criteria to determine autism case status.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2012, the original baseline was revised from 19.5% (2007) to 22.6% (2007) because the objective text did not accurately reflect what is measured by the data source. The objective text was revised from screening of “young children” by age 24 months to screening within the past year of children aged 10 to 35 months. The target was adjusted from 21.5% to 24.9% to reflect the revised baseline using the original target-setting method.
    • MICH-29.2 Increase the proportion of children with ASD having a first evaluation by 36 months of age

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Autism and Developmental Disabilities Monitoring Network
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      42.7 (2006)
      Target: 
      47.0
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of non-migrant 8-year-old children with ASD having a first evaluation by 36 months of age

      Denominator: 

      Number of non-migrant 8-year-old children with Autism Spectrum Disorder (ASD)

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        The baseline (2006) and subsequent data points for this sub-objective have been revised to measure the proportion of children with ASD having a first evaluation by 36 months among non-migrant children. The term “non-migrant” is defined as children who were born in the ADDM surveillance state and resided in the respective surveillance area at the time of ascertainment (age 8 years), determined by birth certificate linkage. This population is expected to have better availability of early records due to a greater likelihood of residing in the surveillance area prior to 36 months of age. Both the numerator and denominator for this sub-objective are restricted to the non-migrant population of children with ASD. Reporting this proportion restricted to non-migrant children is consistent with the ADDM Network 2010 prevalence report.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, the original baseline was revised from 39.0 to 42.7 (2006) percent due to a change in the methodology. The target was adjusted from 42.9 to 47.0 percent using the original target setting method. Also the the words “an” and “with” were removed from the objective text and the word “having” was added to reflect how the term ASD currently used.
    • MICH-29.3 Increase the proportion of children with ASD enrolled in special services by 48 months of age

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Metropolitan Atlanta Developmental Disabilities Surveillance Program
      Changed Since the Healthy People 2020 Launch: 
      Yes
      Measure: 
      percent
      Baseline (Year): 
      52.4 (2006)
      Target: 
      57.6
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of 8-year-old children with Autism Spectrum Disorder (ASD) enrolled in special education services by 48 months of age

      Denominator: 

      Number of 8-year-old children with Autism Spectrum Disorder

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Autism Spectrum Disorders (ASD) are defined as a group of behaviors indicating social, communicative, and behavioral impairment or abnormalities. The essential features of ASD are (a) impaired reciprocal social interactions, (b) delayed or unusual communication styles, and (c) restricted or repetitive behavior patterns.

        A child is included in the Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) as a confirmed case of ASD if he or she displays behaviors (as described on a comprehensive evaluation by a qualified professional) that are consistent with the diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) for any of the following conditions: Autistic Disorder, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS, including Atypical Autism), or Asperger's Disorder.

        To determine MADDSP case status, information is abstracted from health and education records and then reviewed by an ASD clinician reviewer using a coding scheme based on DSM-IV-TR criteria for Autistic Disorder, PDD-NOS, and Asperger’s Disorder.

        A qualified professional is defined as a medical, clinical, or educational professional in a position to observe children with developmental disabilities (including, but not limited to, psychologist, physician, teacher, learning specialist, speech/language pathologist, occupational therapist, physical therapist, nurse, social worker).

        An ASD clinician reviewer is defined as a qualified diagnostician with specialized training and experience in autism assessment and diagnosis.

      Caveats and Limitations: 
      The Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) estimates the prevalence of children with one or more developmental disabilities, including ASD, in five counties (Clayton, Cobb, DeKalb, Fulton, and Gwinnett) of the metropolitan Atlanta area.

      Revision History

      Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

      Description of Changes Since the Healthy People 2020 Launch: 
      In 2014, the word “an” was removed from the objective text to reflect how the term ASD is currently used.
    • MICH-29.4 (Developmental) Increase the proportion of children with a developmental delay with a first evaluation by 36 months of age

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Potential Data Source: 
      National Survey of Children's Health
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Numerator: 

      Number of children (10-48 months of age) with a developmental delay with a first evaluation by 36 months of age

      Denominator: 

      Number of children (10-48 months of age) with a developmental delay

      Comparable Healthy People 2010 Objective: 
      Not applicable
    • MICH-29.5 (Developmental) Increase the proportion of children with a developmental delay enrolled in special services by 48 months of age

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Potential Data Source: 
      National Survey of Children's Health
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Numerator: 

      Number of children (10-60 months of age) with a developmental delay with a first IEP/IFSP by 48 months of age

      Denominator: 

      Number of children (10-60 months of age) with a developmental delay

      Comparable Healthy People 2010 Objective: 
      Not applicable
  • MICH-30 Increase the proportion of children, including those with special health care needs, who have access to a medical home

    • MICH-30.1 Increase the proportion of children who have access to a medical home

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Survey of Children's Health
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      57.5 (2007)
      Target: 
      63.3
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of children under 18 years of age receiving care in medical homes

      Denominator: 

      Number of children under 18 years of age

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Questions Used to Obtain the National Baseline Data: 

        From the 2007 National Survey of Children's Health:

        [NUMERATOR:]

        Child has one or more health care providers considered to be personal doctor or nurse (PDN)

        During past 12 months, how often did all child's doctors and other health providers:

        Spend enough time with child?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Listen carefully to parent?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Provide needed information?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Help parents feel like partner in child's care?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Referrals for specialist care

        During past 12 months:

        Needed a referral to see any doctors or receive any services?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        [IF yes:] any problems getting the referral that was needed?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        Usual sources for care

        Is there a place child usually goes when he/she is sick?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        [IF yes:] What kind of place is it?

        1. Doctor's office
        2. Emergency room
        3. Hospital outpatient department
        4. Clinic
        5. Some other place
        6. Don’t know
        7. Refused

        Help with care coordination

        Does anyone help family to arrange or coordinate child's care?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        Did family need extra help arranging or coordinating child's health care?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        [IF yes:] How often got as much help as needed arranging or coordinating child's health care?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Provider communication

        How satisfied with communication between child's doctors and other providers?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Needed doctors or other providers to communicate with child's school or other programs?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        [IF yes;:] How satisfied with that communication?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Respect for diversity

        During past 12 months, how often were child's doctors and other health providers:

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Sensitive to family's values and customs?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Language services

        During past 12 months:

        Needed an interpreter to help speak with child's doctors or nurses?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        [IF yes:] How often able to get someone other than a family member to help speak with child's doctors or nurses?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        The measurement of medical home access in the 2007 National Survey of Children’s Health has been described in detail elsewhere. In brief, the overall medical home measure from the 2007 NSCH is a composite of five different sub-component topics assessing the following: Child has at least one personal doctor or nurse; Family-centered care; Getting needed referral; Usual source(s) for care; Effective care coordination.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Survey of Children's Health
      Measure: 
      percent
      Numerator: 

      Number of children under 18 years of age receiving care in medical homes

      Denominator: 

      Number of children under 18 years of age

      Questions Used to Obtain the State Data: 

          From the 2007 National Survey of Children's Health:

          [NUMERATOR:]

          Child has one or more health care providers considered to be personal doctor or nurse (PDN)

          During past 12 months, how often did all child's doctors and other health providers:

          Spend enough time with child?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Listen carefully to parent?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Provide needed information?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Help parents feel like partner in child's care?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Referrals for specialist care

          During past 12 months:

          Needed a referral to see any doctors or receive any services?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          [IF yes:] any problems getting the referral that was needed?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          Usual sources for care

          Is there a place child usually goes when he/she is sick?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          [IF yes:] What kind of place is it?

          1. Doctor's office
          2. Emergency room
          3. Hospital outpatient department
          4. Clinic
          5. Some other place
          6. Don’t know
          7. Refused

          Help with care coordination

          Does anyone help family to arrange or coordinate child's care?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          Did family need extra help arranging or coordinating child's health care?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          [IF yes:] How often got as much help as needed arranging or coordinating child's health care?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Provider communication

          How satisfied with communication between child's doctors and other providers?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Needed doctors or other providers to communicate with child's school or other programs?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          [IF yes;:] How satisfied with that communication?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Respect for diversity

          During past 12 months, how often were child's doctors and other health providers:

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Sensitive to family's values and customs?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Language services

          During past 12 months:

          Needed an interpreter to help speak with child's doctors or nurses?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          [IF yes:] How often able to get someone other than a family member to help speak with child's doctors or nurses?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

          The measurement of medical home access in the 2007 National Survey of Children’s Health has been described in detail elsewhere. In brief, the overall medical home measure from the 2007 NSCH is a composite of five different sub-component topics assessing the following: Child has at least one personal doctor or nurse; Family-centered care; Getting needed referral; Usual source(s) for care; Effective care coordination.

    • MICH-30.2 Increase the proportion of children with special health care needs who have access to a medical home

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Survey of Children with Special Health Care Needs
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      47.1 (2005–06)
      Target: 
      51.8
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of children under 18 years of age with special health care needs receiving care in medical homes

      Denominator: 

      Number of children under 18 years of age with special health care needs

      Comparable Healthy People 2010 Objective: 
      Retained from HP2010 objective
      Questions Used to Obtain the National Baseline Data: 

        From the 2007 National Survey of Children's Health:

        [NUMERATOR:]

        Child has one or more health care providers considered to be personal doctor or nurse (PDN)

        During past 12 months, how often did all child's doctors and other health providers:

        Spend enough time with child?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Listen carefully to parent?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Provide needed information?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Help parents feel like partner in child's care?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Referrals for specialist care

        During past 12 months:

        Needed a referral to see any doctors or receive any services?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        [IF yes:] any problems getting the referral that was needed?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        Usual sources for care

        Is there a place child usually goes when he/she is sick?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        [IF yes:] What kind of place is it?

        1. Doctor's office
        2. Emergency room
        3. Hospital outpatient department
        4. Clinic
        5. Some other place
        6. Don’t know
        7. Refused

        Help with care coordination

        Does anyone help family to arrange or coordinate child's care?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        Did family need extra help arranging or coordinating child's health care?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        [IF yes:] How often got as much help as needed arranging or coordinating child's health care?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Provider communication

        How satisfied with communication between child's doctors and other providers?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Needed doctors or other providers to communicate with child's school or other programs?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        [IF yes;:] How satisfied with that communication?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Respect for diversity

        During past 12 months, how often were child's doctors and other health providers:

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Sensitive to family's values and customs?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        Language services

        During past 12 months:

        Needed an interpreter to help speak with child's doctors or nurses?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        [IF yes:] How often able to get someone other than a family member to help speak with child's doctors or nurses?

        1. Never
        2. Sometimes
        3. Usually
        4. Always
        5. Never
        6. Don’t know
        7. Refused

        [NUMERATOR AND DENOMINATOR:]

        Presence of a special health care need

        The next questions are about any kind of health problems, concerns, or conditions that may affect [S.C.]’s behavior, learning, growth, or physical development.

        Does [S.C.] currently need or use medicine prescribed by a doctor, other than vitamins?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        Is [his/her] need for prescription medicine because of ANY medical, behavioral, or other health condition?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        Does [S.C.] need or use more medical care, mental health, or educational services than is usual for most children of the same age?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        Is [his/her] need for medical care, mental health or educational services because of ANY medical, behavioral, or other health condition?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        Is [S.C.] limited or prevented in any way in [his/her] ability to do the things most children of the same age can do?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        Is [his/her] limitation in abilities because of ANY medical, behavioral, or other health condition?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        Does [S.C.] need or get special therapy, such as physical, occupational, or speech therapy?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        Is [his/her] need for special therapy because of ANY medical, behavioral, or other health condition?

        1. Yes
        2. No
        3. Don’t know
        4. Refused

        Does [S.C.] have any kind of emotional, developmental, or behavioral problem for which [he/she] needs treatment or counseling?

        1. Yes
        2. No
        3. Don’t know
        4. Refused
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        The measurement of medical home access in the 2007 National Survey of Children’s Health has been described in detail elsewhere. In brief, the overall medical home measure from the 2007 NSCH is a composite of five different sub-component topics assessing the following: Child has at least one personal doctor or nurse, Family-centered care;, Getting needed referral;, Usual source(s) for care; Effective care coordination.

        Children with Special Health Care Needs are defined using questions k2q10-k2q23 of the children with special health care needs screener (see QUESTIONS USED TO OBTAIN THE NATIONAL DATA).

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Survey of Children with Special Health Care Needs
      Measure: 
      percent
      Numerator: 

      Number of children under 18 years of age with special health care needs receiving care in medical homes

      Denominator: 

      Number of children under 18 years of age with special health care needs

      Questions Used to Obtain the State Data: 

          From the 2007 National Survey of Children's Health:

          [NUMERATOR:]

          Child has one or more health care providers considered to be personal doctor or nurse (PDN)

          During past 12 months, how often did all child's doctors and other health providers:

          Spend enough time with child?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Listen carefully to parent?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Provide needed information?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Help parents feel like partner in child's care?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Referrals for specialist care

          During past 12 months:

          Needed a referral to see any doctors or receive any services?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          [IF yes:] any problems getting the referral that was needed?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          Usual sources for care

          Is there a place child usually goes when he/she is sick?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          [IF yes:] What kind of place is it?

          1. Doctor's office
          2. Emergency room
          3. Hospital outpatient department
          4. Clinic
          5. Some other place
          6. Don’t know
          7. Refused

          Help with care coordination

          Does anyone help family to arrange or coordinate child's care?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          Did family need extra help arranging or coordinating child's health care?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          [IF yes:] How often got as much help as needed arranging or coordinating child's health care?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Provider communication

          How satisfied with communication between child's doctors and other providers?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Needed doctors or other providers to communicate with child's school or other programs?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          [IF yes;:] How satisfied with that communication?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Respect for diversity

          During past 12 months, how often were child's doctors and other health providers:

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Sensitive to family's values and customs?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          Language services

          During past 12 months:

          Needed an interpreter to help speak with child's doctors or nurses?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          [IF yes:] How often able to get someone other than a family member to help speak with child's doctors or nurses?

          1. Never
          2. Sometimes
          3. Usually
          4. Always
          5. Never
          6. Don’t know
          7. Refused

          [NUMERATOR AND DENOMINATOR:]

          Presence of a special health care need

          The next questions are about any kind of health problems, concerns, or conditions that may affect [S.C.]’s behavior, learning, growth, or physical development.

          Does [S.C.] currently need or use medicine prescribed by a doctor, other than vitamins?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          Is [his/her] need for prescription medicine because of ANY medical, behavioral, or other health condition?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          Does [S.C.] need or use more medical care, mental health, or educational services than is usual for most children of the same age?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          Is [his/her] need for medical care, mental health or educational services because of ANY medical, behavioral, or other health condition?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          Is [S.C.] limited or prevented in any way in [his/her] ability to do the things most children of the same age can do?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          Is [his/her] limitation in abilities because of ANY medical, behavioral, or other health condition?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          Does [S.C.] need or get special therapy, such as physical, occupational, or speech therapy?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          Is [his/her] need for special therapy because of ANY medical, behavioral, or other health condition?

          1. Yes
          2. No
          3. Don’t know
          4. Refused

          Does [S.C.] have any kind of emotional, developmental, or behavioral problem for which [he/she] needs treatment or counseling?

          1. Yes
          2. No
          3. Don’t know
          4. Refused
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

          The measurement of medical home access in the 2007 National Survey of Children’s Health has been described in detail elsewhere. In brief, the overall medical home measure from the 2007 NSCH is a composite of five different sub-component topics assessing the following: Child has at least one personal doctor or nurse, Family-centered care;, Getting needed referral;, Usual source(s) for care; Effective care coordination.

          Children with Special Health Care Needs are defined using questions k2q10-k2q23 of the children with special health care needs screener (see QUESTIONS USED TO OBTAIN THE NATIONAL DATA).

  • MICH-31 Increase the proportion of children with special health care needs who receive their care in family-centered, comprehensive, and coordinated systems

    • MICH-31.1 Increase the proportion of children aged 0 to 11 years with special health care needs who receive their care in family-centered, comprehensive, and coordinated systems

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Survey of Children with Special Health Care Needs
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      20.4 (2005–06)
      Target: 
      22.4
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of children aged 0 to 11 years with special health care needs who receive their care in family-centered, comprehensive, and coordinated systems

      Denominator: 

      Number of children aged 0 to 11 years with special health care needs

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Five indicators are used to measure the quality of a system of care for CSHCN aged 0-11: Families of children and youth with special health care needs partner in decision making at all levels and are satisfied with the services they receive; Children and youth with special health care needs receive coordinated Updated: Ongoing comprehensive care within a medical home; Families of CSHCN have adequate private and/or public insurance to pay for the services they need; Children are screened early and continuously for special health care needs; Community-based services for children and youth with special health care needs are organized so families can use them easily; A child is considered to be served by a “service system,” as described in the Healthy People objective, if his or her care met all relevant criteria for his or her age. For children from birth through age 11 years, the first five outcomes were included; and additional outcome related to transition planning is included for children from age 12 through 17 years. Children with Special Health Care Needs CSHCN were identified using the CSHCN Screener, which consists of five questions concerning common health care consequences experienced by CSHCN.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Survey of Children with Special Health Care Needs
      Measure: 
      percent
      Numerator: 

      Number of children aged 0 to 11 years with special health care needs who receive their care in family-centered, comprehensive, and coordinated systems

      Denominator: 

      Number of children aged 0 to 11 years with special health care needs

      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

          Five indicators are used to measure the quality of a system of care for CSHCN aged 0-11: Families of children and youth with special health care needs partner in decision making at all levels and are satisfied with the services they receive; Children and youth with special health care needs receive coordinated Updated: Ongoing comprehensive care within a medical home; Families of CSHCN have adequate private and/or public insurance to pay for the services they need; Children are screened early and continuously for special health care needs; Community-based services for children and youth with special health care needs are organized so families can use them easily; A child is considered to be served by a “service system,” as described in the Healthy People objective, if his or her care met all relevant criteria for his or her age. For children from birth through age 11 years, the first five outcomes were included; and additional outcome related to transition planning is included for children from age 12 through 17 years. Children with Special Health Care Needs CSHCN were identified using the CSHCN Screener, which consists of five questions concerning common health care consequences experienced by CSHCN.

    • MICH-31.2 Increase the proportion of children aged 12 to 17 years with special health care needs who receive their care in family-centered, comprehensive, coordinated systems

      About the Data: National

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Survey of Children with Special Health Care Needs
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      13.8 (2005–06)
      Target: 
      15.1
      Target-Setting Method: 
      10 percent improvement
      Numerator: 

      Number of children aged 12 to 17 years with special health care needs who receive their care in family-centered, comprehensive, and coordinated systems

      Denominator: 

      Number of children aged 12 to 17 years with special health care needs

      Comparable Healthy People 2010 Objective: 
      Not applicable
      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

        Six indicators are used to measure the quality of a system of care for CSHCN aged 12-17 years: Families of children and youth with special health care needs partner in decision making at all levels and are satisfied with the services they receive; Children and youth with special health care needs receive coordinated Updated: Ongoing comprehensive care within a medical home; Families of CSHCN have adequate private and/or public insurance to pay for the services they need; Children are screened early and continuously for special health care needs; Community-based services for children and youth with special health care needs are organized so families can use them easily; Youth with special health care needs receive the services necessary to make transitions to all aspects of adult life, including adult health care, work, and independence. A child is considered to be served by a “service system,” as described in the Healthy People objective, if his or her care met all relevant criteria for his or her age. For children from birth through age 11 years, the first five outcomes were included, and all six outcomes were counted for children from age 12 through 17 years. Children with Special Health Care Needs CSHCN were identified using the CSHCN Screener, which consists of five questions concerning common health care consequences experienced by CSHCN.

      About the Data: State

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the state-level data.

      Data Source: 
      National Survey of Children with Special Health Care Needs
      Measure: 
      percent
      Numerator: 

      Number of children aged 12 to 17 years with special health care needs who receive their care in family-centered, comprehensive, and coordinated systems

      Denominator: 

      Number of children aged 12 to 17 years with special health care needs

      Data Collection Frequency: 
      Periodic
      Methodology Notes: 

          Six indicators are used to measure the quality of a system of care for CSHCN aged 12-17 years: Families of children and youth with special health care needs partner in decision making at all levels and are satisfied with the services they receive; Children and youth with special health care needs receive coordinated Updated: Ongoing comprehensive care within a medical home; Families of CSHCN have adequate private and/or public insurance to pay for the services they need; Children are screened early and continuously for special health care needs; Community-based services for children and youth with special health care needs are organized so families can use them easily; Youth with special health care needs receive the services necessary to make transitions to all aspects of adult life, including adult health care, work, and independence. A child is considered to be served by a “service system,” as described in the Healthy People objective, if his or her care met all relevant criteria for his or her age. For children from birth through age 11 years, the first five outcomes were included, and all six outcomes were counted for children from age 12 through 17 years. Children with Special Health Care Needs CSHCN were identified using the CSHCN Screener, which consists of five questions concerning common health care consequences experienced by CSHCN.

  • MICH-32 Increase appropriate newborn bloodspot screening and follow-up testing

    • MICH-32.1 Increase the number of States and the District of Columbia that verify through linkage with vital records that all newborns are screened shortly after birth for conditions mandated by their State-sponsored screening program

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      National Newborn Screen and Global Resource Center
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      number
      Baseline (Year): 
      21 (2010)
      Target: 
      45
      Target-Setting Method: 
      Projection/trend analysis
      Target-Setting Method Justification: 
      Vital records linked with newborn bloodspot screening data are key to ensuring that all children are screened. Such records also can provide the much needed platform for electronic health records (EHRs). This target will encourage States to prioritize EHRs as the standard for health care systems and public health programs.
      Numerator: 

      Number of states and DC that verify through linkage with vital records that all newborns are screened shortly after birth for conditions mandated by their State-sponsored screening program

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 16-20a in that objective 16-20a remained developmental throughout Healthy People 2010. Since that time a data source has been identified and this objective is measurable.
    • MICH-32.2 Increase the proportion of screen-positive children who receive followup testing within the recommended time period

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Data Source: 
      Title V Information System
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Baseline (Year): 
      98.3 (2003–06)
      Target: 
      100
      Target-Setting Method: 
      Total coverage
      Target-Setting Method Justification: 
      The baseline of 98.3 percent is high. However, further improvement in 10 years is anticipated, justifying a target of 100 percent.
      Numerator: 

      Number of screen-positive children identified through newborn bloodspot screening who receive follow-up testing within the recommended time period

      Denominator: 

      Number of screen-positive children identified through newborn bloodspot screening

      Comparable Healthy People 2010 Objective: 
      Adapted from HP2010 objective
      Data Collection Frequency: 
      Annual
      Methodology Notes: 

        Data are submitted using Form 6 of the Title V Block Grant application submitted annually by all states and the District of Columbia well as Territories.

        As such, estimates reflect data from 59 states and jurisdictions. While the National Center for Health Statistics (NCHS) traditionally presents data for 50 States and DC, an exception was made to remain consistent with published reports of these data.

      Changes Between HP2010 and HP2020: 
      This objective differs from Healthy People 2010 objective 16-20b in that objective 16-20b remained developmental throughout Healthy People 2010. Since that time a data source has been identified and this objective is measurable.
    • MICH-32.3 (Developmental) Increase the proportion of children with a diagnosed condition identified through newborn screening who have an annual assessment of services needed and received

      About the Data

      Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

      Potential Data Source: 
      National Newborn Screen and Global Resource Center
      Changed Since the Healthy People 2020 Launch: 
      No
      Measure: 
      percent
      Numerator: 

      Number of children with a diagnosed condition identified through newborn screening that have an annual assessment of services needed and received

      Denominator: 

      Number of children with a diagnosed condition identified through newborn screening

      Comparable Healthy People 2010 Objective: 
      Not applicable
  • MICH-33 Increase the proportion of very low birth weight (VLBW) infants born at Level III hospitals or subspecialty perinatal centers

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Data Source: 
    Title V Information System
    Changed Since the Healthy People 2020 Launch: 
    No
    Measure: 
    percent
    Baseline (Year): 
    75.0 (2003–06)
    Target: 
    83.7
    Target-Setting Method: 
    Projection/trend analysis
    Numerator: 

    Number of infants born very low birth weight (VLBW) at a subspecialty perinatal facilities (Level III facilities)

    Denominator: 

    Number of infants born VLBW

    Comparable Healthy People 2010 Objective: 
    Retained from HP2010 objective
    Data Collection Frequency: 
    Periodic
    Methodology Notes: 

      Very low birth weight (VLBW) is defined as a birth weight of less than 1,500 grams (3 lbs 4 ounces). Data are reported by states each year as part of the Maternal and Child Health Block Grant application. A national weighted average is calculated by summing the numerator and denominator information reported by each jurisdiction.

      Estimates reflect data from 59 states and jurisdictions. While the National Center for Health Statistics (NCHS) traditionally presents data for 50 States and DC, an exception was made to remain consistent with published reports of these data.

      Before 2006, states reported on the following: The percent of newborns who are screened and confirmed with condition(s) mandated by their state-sponsored newborn screening programs (e.g., phenylketonuria and hemoglobinopathies) who receive appropriate follow-up as defined by their state. After 2006, states reported on the following: The percent of screen positive newborns who received timely follow up to definitive diagnosis and clinical management for condition(s) mandated by their State-sponsored newborn screening programs.

  • MICH-34 (Developmental) Decrease the proportion of women delivering a live birth who experience postpartum depressive symptoms

    About the Data

    Description of the data source, numerator, denominator, survey questions, and other relevant details about the national estimate.

    Potential Data Source: 
    California's Maternal and Infant Health Assessment
    Pregnancy Risk Assessment Monitoring System
    Changed Since the Healthy People 2020 Launch: 
    Yes
    Measure: 
    percent
    Numerator: 

    *** Missing ***

    Revision History

    Any change to the objective text, baseline, target, target-setting method or data source since the Healthy People 2020 launch.

    Description of Changes Since the Healthy People 2020 Launch: 
    In 2014 this objective was added as a new Developmental objectives for the MICH topic area. It appeared in the Fall/Winter public comment period, and permanently on HealthyPeople.gov in 2015.