Conclusions

Children in Iowa in 2005 have slightly lower health status than they did in 2000, as demonstrated by the increase in the proportion of children defined as having a special health care need and the decline in parent-reported overall health status. There was a health disparity by income: lower income children were more likely to have a special health care need and to be rated in lower health condition than children in higher income families. For asthma, one of the more common chronic health conditions of children, 10% of Iowa ’s children had received this diagnosis during their lifetime. Among children diagnosed with asthma, one-quarter were reported to have had symptoms in the week prior to the interview and 40% had an asthma action plan in place.

 

Iowa continues to be one of the nation’s leaders regarding the rate of insured children. Even with one of the highest insured child rates in the nation, Iowa still improved from 2000 (94%) to 2005 (97%). The expanded enrollments in the hawk-i and Medicaid public insurance programs contributed significantly to this expansion of coverage for children. Most of the remaining children without health insurance appear to be eligible for either Medicaid or hawk-i, having household incomes of less than 200% of the federal poverty level (FPL). The expansion of public health insurance did not apply to adults, and the insurance coverage rates for parents remained stagnant during the same time period.

There is an insurance paradox that may be contributing to a portion of the lower health status found in 2005. As more children receive health insurance, they may be more likely to be diagnosed with health problems. This improved ability to be appropriately diagnosed because of better access to care may make it appear that the health status of children is declining, when in fact more children are being properly cared for. Insurance aside, access to medical care appears to be good for children in Iowa . Almost all of Iowa ’s children had a regular source of medical care and were able to access the medical care system when needed. Some children had problems accessing specialty care, however, especially lower income children.

 

Because of a rising rate of obesity nationwide, the focus on nutrition and physical activities in Iowa in this study gives us a perspective from which to plan programs and activities, as well as a baseline to track future progress in this area. Most of Iowa ’s children eat breakfast, and a significant number participate in physical activity almost daily. Most children watch at least some television every day, and a significant portion spend time on the computer or playing video games daily.  Most parents report that their children weigh ‘the right amount,’ however, a significant proportion reports that their children weigh ‘too much.’

 

The health and well-being of Iowa ’s youngest children has been the focus of many recent initiatives in Iowa . Overall, the results from this study show that parents of Iowa ’s age 0-5 population are quite satisfied with their child care arrangements. Parents have a number of priorities when choosing child care for their children, but quality of the program seems to be the highest priority. When not in child care, the youngest Iowan’s have parents who are highly likely to participate in at least some (usually many) developmentally appropriate activities with their children.

 

Access to dental care is generally good in the state, and the vast majority of children over age 5 have had a dental visit in the past year. Children under age 5 are still significantly less likely to have had a dental visit, as are lower income children. Paradoxically, lower income children are more likely to have insurance. This may be in part because lower income children are more likely to have public insurance such as Medicaid; although the services covered by Medicaid are comprehensive, many dentists will not accept it in their practice because of lower reimbursement rates, and perceptions of patient behavioral issues.

 

While most children in Iowa were not reported to struggle with behavioral and emotional issues, one in ten children do have such issues. Older children and children in households with lower incomes are more likely to be reported to have behavioral and emotional issues. Children who are reported to have significant behavioral/emotional problems are far more likely to have parents who report significant stress related to parenting their child. Additionally, almost 1 of every 5 of Iowa ’s youngest children had parents  reporting symptoms suggesting poor parental mental health status. These data suggest that providing further assistance to parents with young children, as well as children with behavioral and emotional health problems, is worth investigating.

 

Almost 3 of every 10 children in Iowa are living with at least one person who smokes cigarettes. For about a third of the children living in a household with a smoker, the smoking is reported to have at least some known effect on the child. About 6% of children live in a house where alcohol use is a reported problem. Children living in most of these households were reported to have been affected by the person’s alcohol problem. Problems with drug use and gambling in Iowa households were less likely to be reported as issues for children.

 

Thus, overall, children in Iowa appear to be healthy and well-adjusted, although there are concerns that should not be ignored. Certain segments of the population, especially lower income children in the state, have unmet health needs. There are opportunities for improving everything from insurance coverage to support for young families that could improve the health and well-being of Iowa ’s children.