demographic characteristics of delaware’s children and …...delaware children and youth ages...

Chapter 3 provides an overview of the general characteristics ofDelaware children and youth ages 3–17. This chapter is dividedinto two sections. The first section, “Delaware Findings Versus

National Findings,” compares demographic data for Delaware’s childrenand youth with their counterparts nationwide and includes comparisonsof insurance coverage, family structure, the prevalence of special healthcare needs, and the severity of emotional or behavioral difficulty. Thesecond section, “Emotional or Behavioral Difficulties of Delaware’sChildren and Youth,” describes and compares demographic characteris-tics of Delaware’s children and youth in relation to the level of severityof emotional or behavioral difficulty, as reported by parents.

Data used in this chapter are from the National Survey of Children’sHealth (NSCH), a survey module under the State and Local AreaIntegrated Telephone Survey (SLAITS). The NSCH is a telephone surveyof parents conducted every two years that examines the physical andemotional health of children and youth ages 0–17.

Demographic Characteristics of Delaware’s Children and Youth

11D e m o g r a p h i c C h a r a c t e r i s t i c s

Key findings based on a comparison between data reportedby parents in Delaware and data reported by parentsnationwide indicate the following:• Generally, Delaware’s children are similar to the nation’s children on

most demographic measures.

• Overall, Delaware has a larger proportion of Black/AfricanAmerican children and youth and a smaller proportion of Hispanicchildren and youth than the nation.

• More children and youth in Delaware have private health insurancecompared to the nation.

Based on parent-reported data, key findings related to indicators of emotional or behavioral difficulties for Delaware’s children, youth, and families include the following:• Delaware children and youth with minor or moderate/severe difficulties

were more likely to be covered by public health insurance thanthose with no difficulties.

• Older children were more likely to have emotional and behavioraldifficulties than younger children.

• Boys were more likely to have emotional or behavioral difficultiesthan girls.

• Emotional or behavioral difficulties among children and youths inDelaware did not differ significantly by race/ethnicity.

Delaware Findings Versus NationalFindingsThere were 193,004 children and youth underthe age of 18 living in Delaware at the time of the survey, comprising approximately 23.9% ofDelaware’s total population.1 Nationally, childrenand youth under the age of 18 represent 25.5%of the total U.S. population.2 In Delaware, 25.5%of all males and 22.5% of all females were underthe age of 18 at the time of the survey.

Figure 3.1 compares demographic data for children and youth ages 3–17 in Delaware withdata for children nationwide. Some of the datapresented here are key demographic indicatorsidentified in scientific literature as particularlyimportant for describing the issue of emotionaland behavioral health, while other data presentedprovide a more detailed picture of the characteris-tics of children and youth in Delaware.

D e m o g r a p h i c C h a r a c t e r i s t i c s12

* On specific indicators, Delaware is designated as“Higher,” “Comparable,” and “Lower,” based on itsexperience relative to the nation. These categories aredetermined by examining the 95% Confidence Interval(CI) around the percentages for Delaware and the nation.If the CIs overlapped partially or completely, the percent-age for the indicator was categorized as “Comparable.” If the CIs were separate, the percentage for the indicatorwas categorized as either “Higher” or “Lower” than thenation, depending on which was appropriate based onthe data. Appendix A: Technical Notes discusses the methods used in the 2006 Chartbook.

Figure 3.1: Comparison of Demographic Characteristics of National and DelawarePopulations Ages 3–17

Age and SexOf children in Delaware ages 3–17, approximately 20% of children inDelaware are ages 3–5, 40% of children and youth in Delaware are ages6–11, and 40% are ages 12–17. These percentages are similar to nationalfigures. There are more boys than girls ages 3–17 in Delaware, which isalso comparable to national figures. Approximately 52% of children andyouth ages 3–17 in Delaware are male and 48% are female.

Race/EthnicityThe population of children and youth under age 18 in Delaware, like that of the U.S., is predominately Non-Hispanic White. Overall,Delaware has larger proportions of Non-Hispanic White and Black/African American children and youth, but a smaller proportion ofHispanic children (6.4%) than the nation (16.9%). Despite being a relatively small segment of the population, the Hispanic population is growing rapidly within Delaware.3

Household Income and Living in Working Poor HouseholdsHousehold income level can have a substantial impact on the health status of children living in the household. For example, children livingin low-income households may not have adequate health insurance oraccess to primary care.

Household income is divided into four categories based on the FederalPoverty Guidelines, which are issued annually by the U.S. Departmentof Health and Human Services and are designed to help estimate thenumber of Americans who live in poverty. In Figure 3.2, households areassigned to categories according to the year they were surveyed, eitherin 2002 or 2003. In 2003, a family of four with an income of less than$18,400 would be considered living under the Federal Poverty Level(FPL). A family of four with an income of $36,800 would be at 200% of the FPL, or twice the poverty level.4

Figure 3.2: Yearly Income for Family of Four in 2002 and 2003 in Relation to the Federal Poverty Level

Overall, a smaller percentage of children and youth in Delaware livebelow 100 percent FPL (13.5%) when compared to the national rate of children living in poverty (17.1%). More than 60% of Delaware’schildren and youth live in households with incomes at or above 200%of the poverty level. Many families have a primary wage earner but stillmeet the federal definition of a family “in poverty.” The term “workingpoor” is used to describe families where a parent is employed full-timebut have a household income below the official federal poverty level.Overall, Delaware has fewer working poor families than the rest of thenation (9.1% vs. 11.9%).

Education LevelEducation level is widely used among health and social researchers asone indicator of socioeconomic status.5 A 2002 study released by theU.S. Census Bureau shows that people with a higher level of educationearn more than those with a lower level of education.6 Availability ofeconomic resources can have an impact on a parent’s coping ability and stress and parent support systems. The issues of parent coping andstress and parent support systems are covered in more detail in chapters4 and 5. Overall, 67.4 percent of Delaware households have a memberwho has completed more than high school, comparable to national statistics (65.9%).


100% of FPL $18,100 $18,400200% of FPL $36,200 $36,800300% of FPL $54,300 $55,200400% of FPL $72,400 $73,600

Percent of theFederal Poverty Level 2002 2003

English as Primary LanguageResearch has shown that individuals with a language barrier are lesslikely to have a usual source of medical care; lack access to care for children with special health care needs; and are at increased risk ofunintended or negative consequences during hospitalization, resultingin poorer health status.7, 8, 9, 10 Much of the inadequate care and resultingpoor health status is due to the lack of adequate translation and cultur-ally competent services in many health care systems.11 In many clinicalsettings, family members (including children) or staff not trained inmedical interpretation act as interpreters during medical encounters,increasing the risk of errors in interpretation with clinical consequences.12

In the United States, nearly 50 million people ages 5 and over speak a language other than English at home, representing a 47% increasebetween 1990 and 2000.13 More than 22 million (8.4%) report limitedEnglish proficiency (speaking English less than “very well”). Among 5- to 17-year-olds in the United States, 18.4% live in a householdwhere a language other than English is the primary language. Delawarehas fewer non-English speaking households, with 9.3% of children andyouth ages 5–17 speaking a language other than English at home.14 InDelaware, more than 3,000 children and youth ages 5–17 are consid-ered “linguistically isolated,” meaning that they live in a householdwhere no person over the age of 14 speaks English “very well.”15

Health Insurance CoverageChildren who have health insurance typically have better access to pre-ventive services, such as vaccinations, routine screenings, and medicaltreatment. Different methodologies can be employed to estimate thenumber of children who are uninsured. There are slight variations inthese estimates; however, the trends and major findings are consistent.16

Nine out of ten children and youth in Delaware have health insurancecoverage, either through a private source or public health insuranceprogram such as Medicaid.17 The proportion of uninsured children inDelaware is lower (5.7%) when compared to national figures (9.4%).18

Family StructureMost children and youth in Delaware live in households with two parents, either biological, adopted, or stepparents. However, almost onein four Delaware children live with a single mother. This is comparableto the national proportion of children and youth living with singlemothers. Current research suggests a link between family structure andhousehold income, showing that single parent households are morelikely to have lower levels of income and higher rates of poverty.19

Children with Special Health Care Needs (CSHCN)Although comparisons between the various levels of emotional orbehavioral difficulties are not made for children and youth with specialhealth care needs (CYSHCN) in the 2006 Chartbook, the information is included here to provide a more detailed picture of the characteristicsof Delaware children. The federal Maternal and Child Health Bureau(MCHB) defines CYSHCN as “those who have or are at increased riskfor a chronic physical, developmental, behavioral, or emotional condi-tion and who also require health and related services of a type oramount beyond that required by children generally.”20 The termCYSHCN typically includes, but is not limited to, children and youthwith diabetes, asthma, cerebral palsy, cystic fibrosis, sickle cell disease,spina bifida, epilepsy, attention deficit hyperactivity disorder, and mental retardation. Overall, Delaware has a similar proportion of children and youth with special health care needs (21.5%) as the nation (19.5%).


Emotional or Behavioral Difficulties of Delaware’s Childrenand YouthThe presence of an emotional or behavioral difficulty is defined basedon the best available question in the National Survey of Children’sHealth: “Overall, do you think that [your child] has difficulties with one or more of the following areas: emotions, concentration, behavior,or being able to get along with other people?”

Parents who responded “yes” to the previous question were asked,“Would you describe these difficulties as minor, moderate, or severe?”Using responses from these two questions, children and youth weregrouped into three categories of severity for analysis:

• Children and youth identified by their parents as having moderateor severe emotional or behavioral difficulties were classified into a single category called “moderate or severe,” also referred to asmoderate/severe difficulties in the text.

• The second category consists of those children and youth whoseparents indicated they had minor emotional or behavioral difficul-ties, labeled “minor” and referred to as minor difficulties in the text.

• The remaining category, “none,” referred to as no difficulties in the text, consists of children and youth who do not have parent-reported emotional or behavioral difficulties.

Interpreting Demographic CharacteristicsAlthough the information in this section may show that a particulardemographic characteristic is associated with the presence or absence ofemotional or behavioral problems, this cannot be interpreted to mean thatthe demographic characteristic is the cause of the problems. For example,parents reported emotional or behavior problems more often for olderchildren and youth than for younger children. This does not mean thatgrowing older is the cause of the problems. It may mean, for example,that parents have had more time to observe potential problems in olderchildren or that parents have a different set of behavioral expectations aschildren age.

Figure 3.3: Percent of Delaware Children and Youth With Parent-Reported Emotional or Behavioral Difficulties


81.7%

8.6%

9.7%

NoneMinorModerate/Severe

Age and Emotional or Behavioral DifficultiesOverall, 8.6% of Delaware parents reported that their children ages 3–17 had moderate or severe difficulties in emotions, concentration,behavior, or being able to get along with other people. Parents reportedmoderate/severe difficulties more often for older children than for youngerchildren. Of all children with parent-reported moderate/severe difficulties,8.1% were ages 3–5, 43.9% were ages 6–11, and 48% were ages 12–17.

Figure 3.4: Percent of Children and Youth in Delaware withEmotional or Behavioral Difficulties by Age

Sex and Emotional or Behavioral DifficultiesParents of boys were more likely to report that their child had emotionalor behavioral difficulties than parents of girls. Of all children ages 3–17with parent-reported moderate/severe difficulties, 59.1% were males and40.9% were females.

Figure 3.5: Percent of Delaware Children and Youth withEmotional or Behavioral Difficulties by Sex


0

10

20

30

40

50

0

60

3–5 years

14.0%

8.1%

48.0%

42.7%38.9%

21.6%

39.5%

43.9% 43.3%

6–11 years

NoneMinorModerate/Severe

12–17 years

Data Source: National Survey of Children’s Health, 2003. Note: All data are parent-reported.

0

10

20

30

40

50

60

70

80

59.1%

40.9% 38.6%

50.0%

61.4%

50.0%

Male Female

Moderate/Severe Minor None


Race/Ethnicity and Emotional or Behavioral DifficultiesParental reports of emotional or behavioral difficulties among childrenand youth in Delaware did not differ significantly by race/ethnicity. Ofall children ages 3–17 with parent-reported moderate/severe difficulties,7.3% were of Hispanic origin, 66.9% were Non-Hispanic White, 20.9%Non-Hispanic Black, 4% Multi-racial, and less than 1% of otherrace/ethnic origin.

Figure 3.6: Percent of Delaware Children and Youth withEmotional or Behavioral Difficulties by Race or Ethnicity

Household Income and Emotional or Behavioral DifficultiesParental reports of emotional or behavioral difficulties among childrenand youth in Delaware did not differ significantly by household income.Of all children ages 3–17 with parent-reported moderate/severedifficulties, 13% lived in households with incomes below 100% of thefederal poverty level (0–99% FPL), 26% in households with incomesbelow 200% FPL, 32% in households with incomes below 400% FPLand 28.5% in households with incomes at or above 400% FPL.

Figure 3.7: Percent of Delaware Children and Youth withEmotional or Behavioral Difficulties by FederalPoverty Level (FPL)


0

10

20

30

40

50

60

70

80

Hispanic White, Non Hispanic

Black, Non Hispanic

Multi-racial Other

7.3%9.5%

20.9% 23.1%

4.0% 6.0%2.5% 0.9% 1.2% 1.4%

34.8%

5.9%

66.9% 67.1%

48.5%

Moderate/Severe Minor None


0

20

40

60

80

100

Moderate/Severe

28.5%

32.0%

26.5%

13.0%

21.8%

29.6%

23.1%

25.5%

32.6%

37.3%

17.9%

12.2%

Minor None

0–99% FPL

100–199% FPL

200–399% FPL

400% FPL or More


Type of Insurance and Emotional or Behavioral DifficultiesIn Delaware, children with minor or moderate/severe difficulties weremore likely to be covered by public health insurance than children withno difficulties. Approximately 59% of all children ages 3–17 with parent-reported moderate/severe difficulties were covered by private insurance,35% by public insurance, and 6% were without coverage. Most childrenwith no difficulties (71.9%) were covered by private insurance.

Figure 3.8: Percent of Delaware Children and Youth withEmotional or Behavioral by Insurance Type

Family Structure and Emotional or Behavioral DifficultiesChildren with no difficulties were more likely to live in a two-parent bio-logical or adopted family structure than children with moderate/severe orminor difficulties. Children with minor difficulties were more likely to beliving in a household with a single mother; however, children with nodifficulties and those with moderate/severe difficulties did not differ withrespect to living in a household with a single mother.

Figure 3.9: Percent of Delaware Children and Youth withEmotional or Behavioral Difficulties by FamilyStructure


Moderate/Severe

0

20

40

60

80

100

None

5.9%

35.3%

58.8%

6.5%

40.4%

53.1%

5.6%

22.5%

71.9%

Minor

None

Public

Private


Moderate/Severe

0

20

40

60

80

100

None

4.8%

32.6%

14.9%

47.7%

6.6%

36.5%

12.4%

44.5%

4.2%

22.8%

10.4%

62.5%

Minor

Two Parent Stepfamily

Other

Signal Mother, No Father Present

Two Parent Biological/Adopted


Highest Level of Education in Household and Emotional orBehavioral DifficultiesCompared to children and youth with minor difficulties, children andyouth in Delaware with no difficulties were more likely to live in ahousehold where the highest level of education was “more than highschool.” Children and youth with no difficulties differed significantlyfrom those with minor difficulties but did not differ significantly fromthose with moderate/severe difficulties where the highest level of educa-tion in the household was “more than high school.”

Figure 3.10: Percent of Delaware Children with Emotional orBehavioral Difficulties by Highest Level ofEducation in Household

References1 U.S Census Bureau, American Community Survey 2004. Accessed July 19, 2006.

http://www.factfinder.census.gov.

2 Ibid.

3 2000 Census data indicate that approximately 4.8 percent of Delaware’s population

was Hispanic. By 2004, the American Community Survey, administered by the U.S.

Census Bureau, estimated that 5.9 percent of Delaware’s population was Hispanic.

For more information, see: http://www.factfinder.census.gov.

4 Prior HHS poverty guidelines and Federal Register references. Washington, DC:

U.S. Department of Health and Human Services, 2005. For more information,

see: http://aspe.hhs.gov/poverty/figures-fed-reg.shtml.

5 Liberatos P., Link, B.G., & Kelsey, J.L. (1988). The measurement of social class in

epidemiology. Epidemiologic Reviews, 10, 87–121.

6 Day, J.C. & Newburger, E.C. (2002). The big payoff: Education attainment and

synthetic estimates of work-life earnings. In Current Population Reports, Special

Studies, pp. 23–210. Census Bureau. July 2002. For more information, see:

http://www.census.gov/prod/2002pubs/p23-210.pdf.

7 Flores, G., Abreu, M., & Tomany-Korman, S. C. (2005). Limited English proficiency,

primary language at home, and disparities in children’s health care: How language

barriers are measured matters. Public Health Reports, 120(4): 418–430.

8 Cohen, A. L., Rivara, F., Marcuse, E. K., McPhillips, H., & Davis, R. (2005). Are

language barriers associated with serious medical events in hospitalized pediatric

patients? Pediatrics, 116(3), 575–579.

9 Kirkman-Liff, B., & Mondragon, D. (1991). Language of interview: relevance for

research of Southwest Hispanics. American Journal of Public Health, 81, 1399–1404.

10 Weinick, R.M., & Krauss, N.A. (2001). Racial and ethnic differences in children’s

access to care. American Journal of Public Health, 90, 1771–1774.


Moderate/Severe

0

20

40

60

80

100

None

33.2%

58.5%

8.3%

56.1%

33.9%

10.0%

69.6%

27.2%

3.2%

Minor

More than High School

High School Graduate

Less than High School


11 Jacobs, E. A., Shepard, D. S., Suaya, J. A., & Stone, E. (2004). Overcoming language

barriers in health care: costs and benefits of interpreter services. American Journal of

Public Health, 94(5), 886–869.

12 Flores, G., Laws, M. B., Mayo, S. J., Zuckerman, B., Abreu, M. Medina, L., &

Hardt, E. J. (2003). Errors in medical interpretation and their potential clinical

consequences in pediatric encounters. Pediatrics, 111, 6–14.

13 U.S Census Bureau, United States Census 2000. Accessed July 19, 2006.

http://www.factfinder.census.gov.

14 Ibid.

15 Ibid.

16 The Delaware Health Care Commission generally tracks rates of insurance coverage

in the state using data primarily from the U.S. Census Bureau’s Current Population

Survey (CPS). The CPS data on uninsured children in Delaware shows a slightly

higher proportion for this time period; however, the trends and major findings are

consistent for both CPS and the National Survey of Children’s Health. The difference

in estimates may be explained by variations in survey methodology, including differ-

ent sampling strategies, different modes of survey administration, different ways of

operationalizing the concept of being uninsured, and different reference periods.

17 In Delaware, Medicaid income eligibility levels vary by age. Infants under 1 year of

age are eligible for Medicaid if their household income is at or below 200 percent

of the FPL, while children ages 1–5 are eligible at or below 133 percent of the FPL.

Children and youth ages 6–19 are eligible for Medicaid if their household income

is at or below 100 percent of the FPL. For the State Children’s Health Insurance

Program (SCHIP) in Delaware, children and youth are eligible if their household

income is at or below 200 percent of the FPL. Source: Income eligibility levels for

children under Medicaid and SCHIP, as a percent of Federal Poverty Level (FPL),

2004. Washington, DC: The Henry J. Kaiser Family Foundation, 2004. Accessed

October 18, 2005. http://www.statehealthfacts.kff.org.

18 It should be noted that while the National Survey of Children’s Health estimates that

53,748 children in Delaware are covered by public insurance, Centers for Medicare

and Medicaid Services Medicaid Statistical Information System (MSIS) data indicate

that 70,159 children ages 18 and under were eligible for enrollment in the Medicaid

program in 2002. Nationally, 42% of low-income children are on Medicaid.

19 Thomas, A. & Sawhill, I. (2005). For love and money? The impact of family

structure on family income. Future of Children;15(2): 57–74.

20 McPherson, M., Arango, P., Fox, H., et al. (1998). A new definition of children with

special health care needs. Pediatrics, 102, 137–140.


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