Findings Successes | 2018 Annual Report

Executive Summary IntroductionFindingsState Rankings Successes Challenges Health Equity International ComparisonCore MeasuresBehaviors Community & Environment Policy Clinical Care OutcomesSupplemental MeasuresBehaviors Community & Environment Policy Clinical Care OutcomesState Summaries

Alabama

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2018 Annual Report 2018 Annual Report - Executive Summary

Percentage of Children in Poverty Decreasing
Children in poverty — the percentage of children younger than age 18 who live in households below the poverty threshold — decreased 19 percent from 22.6 percent in 2013 to 18.4 percent in 2018. Children in poverty decreased 6 percent since 2017 from 19.5 percent. Exposure to chronic stress — including unreliable access to food, health care and stable housing — may impair childhood development and affect health into adulthood.
The decrease in children in poverty was not equal across states (Figure 4). Children in poverty is 2.7 times higher in Louisiana, the least healthy state for this measure, at 28.0 percent versus 10.3 percent of children in New Hampshire, the healthiest state for this measure. Since 2013, children in poverty decreased most in Mississippi and Maine, dropping 7.8 percentage points. Colorado and Oregon declined 6.5 percentage points. Arizona and Georgia dropped 6.2 percentage points and Arkansas by 6.0 percentage points (not shown). During the same time frame, children in poverty increased most in West Virginia (+1.3 percentage points), Delaware (+1.1 percentage points) and Alaska (+1.0 percentage points).
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Mental Health and Primary Care Physicians Increasing
Mental Health Providers 
In the past year, mental health providers increased 8 percent from 218.0 to 234.7 per 100,000 population. Mental health providers are the number of psychiatrists, psychologists, licensed clinical social workers, counselors, marriage and family therapists, professionals treating alcohol and other drug abuse and advanced practice nurses specializing in mental health care per 100,000 population. 
Mental health providers have increased in all 50 states in the past year with six states increasing by 25 providers or more per 100,000 (Figure 5). These are Ohio (+45.9 per 100,000), Massachusetts (+43.6 per 100,000), Oregon (+38.6 per 100,000), Alaska (+27.0 per 100,000), Vermont (+26.1 per 100,000) and Colorado (+25.6 per 100,000). The smallest increases occurred in Arizona (+7.4 per 100,000), Alabama and Texas (+7.6 per 100,000), Georgia (+7.7 per 100,000) and Kansas (+8.3 per 100,000). 
Despite these improvements, the number of mental health providers varies widely across states. The number of mental health providers per 100,000 population is 6.4 times greater in Massachusetts, the healthiest state for this measure at 590.9 per 100,000, compared with Alabama, the least healthy state for this measure at 92.6 per 100,000. According to the Kaiser Family Foundation, 124 million Americans live in mental health shortage areas, leaving a large population without access to treatment providers. 
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Primary Care Physicians
In the past year, primary care physicians increased 5 percent from 149.7 to 156.7 per 100,000 population. These are the number of active primary care physicians per 100,000 population, including general practice, family practice, obstetrics and gynecology, pediatrics, geriatrics and internal medicine. The Health Services & Resource Administration estimates that an additional 6,900 primary care physicians are needed to meet current health care needs in the United States.
The largest increases in primary care physicians in the past year occurred in North Dakota (+9.0 per 100,000), West Virginia and Pennsylvania (+8.9 per 100,000), Illinois (+8.7 per 100,000), and Vermont, Rhode Island and New York (+8.2 per 100,000) (not shown) (Figure 6). Florida, Nevada, Utah and Idaho experienced small declines. The number of primary care physicians per 100,000 population varies widely by state and is 2.8 times greater in Rhode Island, the healthiest state for this measure at 264.5 per 100,000, compared with Idaho, the least healthy state for this measure at 95.7 per 100,000.
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Air Pollution Decreasing
Since 2015, air pollution decreased 12 percent from 9.5 to 8.4 micrograms of fine particles per cubic meter. Air pollution is the average exposure of the general public to particulate matter of 2.5 microns (PM2.5) or less in size (three-year average). Studies show that decreasing the concentration of fine particulates in the air leads to lower risk of all-cause mortality, lung cancer and death from cardiovascular disease. This year’s value is the lowest to date as air pollution has decreased yearly since it was introduced in the 2003 rankings.
Air pollution varies widely depending on location. In North Dakota, the healthiest state for this measure, there are 4.5 micrograms of fine particles per cubic meter versus California, the least healthy state for this measure, at 11.9 micrograms of fine particles per cubic meter. Since 2015, Idaho experienced the largest improvement, dropping 5.0 micrograms of fine particles per cubic meter, followed by Indiana and Arkansas, each decreasing 2.6 micrograms per cubic meter (Figure 7). Wisconsin decreased 2.3 micrograms per cubic meter and New Hampshire dropped 2.2 micrograms per cubic meter since 2015. Not all states have improved: Alaska’s, Montana’s and Oregon’s air pollution increased +1.0 to +1.4 micrograms per cubic meter. 
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HPV Immunization Males
HPV immunization among males significantly increased 18 percent since 2017 from 37.5 percent to 44.3 percent. This is the percentage of males aged 13 to 17 who are current on all recommended doses of human papillomavirus (HPV) vaccine. The HPV vaccine, recommended for preteens, can prevent HPV infection and associated cancers into adulthood. More than 13,000 men are diagnosed with HPV-associated cancers annually. 
Significant differences among males exist by race/ethnicity and poverty status as seen here.
HPV immunization is higher among Hispanic males at 54.6 percent than non-Hispanic black males at 44.9 percent and non-Hispanic white males at 40.2 percent. 
HPV immunization among males living below the poverty threshold is higher at 49.5 percent than males living at or above the poverty threshold at 41.7 percent.
HPV immunization among adolescent males varies widely by state. It is 3.4 times higher in Rhode Island, the healthiest state for this measure at 78.4 percent, than the least healthy state for this measure, Mississippi, at 23.4 percent. The largest increase in the past year was in Montana (+20.2 percentage points), followed by North Carolina (+18.0 percentage points), Nebraska (+14.0 percentage points), Michigan (+13.9 percentage points) and Virginia (+13.0 percentage points) (Figure 8). Increases in HPV immunization among males were significant in Montana and Texas (+9.5 percentage points) (not shown). HPV immunization among males decreased in several states in the past year, but none significantly. 
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HPV Immunization Females
In the past year, HPV immunization among females increased 7 percent (not significant) from 49.5 percent to 53.1 percent. This is the percentage of females aged 13 to 17 who are current on all recommended doses of HPV vaccine. The current two-dose HPV vaccine protects against nine strains of HPV, covering the majority of HPV-associated cancers as well as most genital warts. 
Similar to HPV immunization among males, significant differences among females exist by race/ethnicity and poverty status as seen here.
HPV immunization is higher among Hispanic females at 58.1 percent than non-Hispanic white females at 49.7 percent.
HPV immunization among females living below the poverty threshold is higher at 58.1 percent than females living at or above the poverty threshold at 51.8 percent.
HPV immunization among females is 2.3 times higher in Rhode Island, the healthiest state for this measure at 76.8 percent, than the least healthy state for this measure, Wyoming, at 33.6 percent. The District of Columbia is highest, at 79.4 percent. In the past year, HPV immunization among females increased in many states but only significantly in Virginia (+26.9 percentage points) and Iowa (+18.1 percentage points) (Figure 9). HPV immunization among females decreased in several states in the past year, but none significantly.
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Meningococcal Immunization
In the past year, meningococcal immunization significantly increased 4 percent from 82.2 percent to 85.1 percent of adolescents aged 13 to 17, and increased 9 percent since the measure was introduced in 2014. This is the percentage of adolescents aged 13 to 17 who received one or more doses of meningococcal conjugate vaccine. This vaccine, known as MenACWY, protects against four of the five most common meningococcal types in the United States. Meningococcal disease is potentially life-threatening and is caused by the bacterium Neisseria meningitidis. Unlike HPV immunization, there are no significant differences by race/ethnicity or poverty status for meningococcal immunization.
Since 2014, significant increases occurred in 20 states (Figure 10) along with the nation. The largest increases occurred in Arkansas (+51.3 percentage points), Utah (+24.1 percentage points), South Dakota (+22.8 percentage points), Minnesota (+21.2 percentage points) and Iowa (+20.0 percentage points) (Figure 11). While many states are making great improvements in this measure, a large gap remains between the healthiest state for this measure, Georgia at 95.3 percent, and the least healthy state for this measure, Wyoming at 60.7 percent. 
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Tdap, the fourth immunization measure included in the adolescent immunization composite measure, has increased significantly nationally and in eight states since 2014. But in the past year, Tdap immunization increased significantly in only Mississippi (+10.4 percentage points) and South Carolina (+11.9 percentage points).