Obesity and poverty: major concerns for Montana's children.

Twenty years ago, 5 percent of American children were overweight. Today, 15 percent are, and another 15 percent are headed that way. Even very young children weigh more than they should, with about 8 percent of all preschoolers considered overweight. Nearly double that number of children between

Montana is no exception. Statewide, across all age groups, obesity increased from 9 percent of the population in 1990 to 19 percent in 2001. According to a national study released in January 2004, Montanans spent about $175 million last year on medical care related to obesity.

In looking at how children are faring in Montana, the 2003 National Montana Youth Risk Behavior Survey found that nearly 6 percent of children in grades 9-12 are overweight. Just 62.3 percent of Montana high school students spent 20 minutes exercising or participating in physical activities that made them sweat and breathe hard on three or more days each week. The gender breakdown showed that only 56.2 percent of females regularly exercised or participated in physical activities.

Obesity is just one measure of childhood well-being included in the Montana KIDS COUNT 2004 report, an attempt to provide policymakers and citizens with the information needed to secure an improved future for all children. KIDS COUNT is a project of the Annie E. Casey Foundation, and is intended to track the progress of children throughout the United States. At the national level, one of the principal activities of the KIDS COUNT program is the publication of the annual KIDS COUNT Data Book: State Profiles of Child Well-Being, which reports 10 leading indicators of child well-being in every state.

In Montana, the KIDS COUNT project is a statewide collaborative effort bringing together a wide range of organizations, including businesses, nonprofits, and government agencies interested in or involved with children and families. Montana KIDS COUNT is based in the Bureau of Business and Economic Research in the School of Business Administration at The University of Montana-Missoula (www.bber.umt.edu).

Montana's 2004 Data Book takes a deeper look at the issue of childhood obesity. If Montanans do not take an interest in promoting healthy eating and increasing physical activity among youth, obesity rates here will soon be comparative to national rates. Eating too much and exercising too little can lead to obesity-related health problems, as children who are overweight are more likely to become overweight adults. They may develop Type 2 diabetes, high blood pressure, heart disease, and other illnesses. Obesity in children can also lead to stress and low self-esteem. Overweight kids get teased more, can't or won't participate with their peer groups, and feel left out and excluded. They also tend to be lonelier and sadder than other kids.

Many studies show that parents play a big role in shaping children's eating habits. A child with one overweight parent has a 40 percent chance of being overweight; if both parents are overweight, the child has an 80 percent chance of being overweight. All of the latest research underscores the need for parents to become involved in their children's eating behaviors, physical activity, and general weight control. (U.S. National Institute of Diabetes & Digestive & Kidney Diseases, National Institute of Health http://www.niddk.nih.gov/index.htm.)

Efforts to prevent obesity are underway in Montana. Of particular note are two programs run by the Missoula City-County Health Department, the MOVE Program and the CATCH Program. MOVE coordinates three community networks targeting families with children from birth to 18 years of age; it focuses on fostering healthier food systems, increasing physical activity, and working with health-care providers to lessen barriers to addressing weight issues and to educate patients working to address weight issues. CATCH is a curriculum used in five elementary schools to educate kids on healthy diets. The goal of CATCH is to change policies and practices of schools in order to effect changes in health-risk factors and risk-related behaviors. The program includes goal setting and incentives, a family component, snack preparation, and taste testing. Students learn heart-healthy food choices, how to read food labels, and the importance of regular physical activity. (http:// www.co.missoula.mt.us/healthpromo/MOVE.CATCH.htm).

Children in Poverty

Montana shows distressingly high rates of children living in poverty. Between 1996 and 2001, the state ranked 43rd in the percentage of children in families where no parent has full-time, year-round employment and 38th in the percentage of children living in poverty. The lack of full-time employment for parents has far-reaching implications for children living in these households (Figures 1, 2, and 3). These kids are much more likely to lack access to the health and family benefits that usually go along with full-time, stable jobs. Parents lacking secure employment are often forced to take two or three jobs to cobble together enough income to support a family.

[FIGURES 1-3 OMITTED]

The good news is that Montana continues to show improvement in infant mortality rates, although the rate of improvement slowed between 1996 and 2001, improving by 4 percent compared to the national improvement of 7 percent. Other areas of improvement have been teen birth rates and the percentage of teens (ages 16-19) not attending school and not working. Teen birth rates dropped and showed an 18 percent improvement, with Montana ranking 10th in the nation on this indicator. The percentage of teens neither at school nor at work dropped by 13 percent in Montana.

Public Assistance and Food Stamps

Two important indicators of the economic well-being of Montana families are their participation in two federal assistance programs, Temporary Assistance for Needy Families (TANF) and the Food Stamp program. TANF is administered by the state and is intended as short-term assistance for women with children younger than age 18. The benefit level is set according to family size and income level.

During fiscal year 2003, TANF caseloads grew by 8.9 percent to an average monthly caseload of 6,163 (Table 1). However, in August 2003, cash benefits were cut by 25 percent for all families, resulting in the average three-member TANF family seeing a reduction of $132 per month in their benefit. At the same time, TANF eligibility levels were tightened. Following the cuts, caseloads dropped by 1,600 children and about 800 adults. There has been a continuing decline until recently. As of June 2004, the average monthly caseload for TANF was 5,425.

There are ongoing efforts to restore cutbacks in assistance programs; those will play out during the 2005 Montana Legislature. Included in those efforts are proposals to create a program that provides family stability and access to meaningful work activities, such as counting parenting as work, educational opportunities, and financial literacy programs for asset development.

Enrollment in the Food Stamp program has grown from 63,766 to 68,779; the latter number represents 7.56 percent of Montana's population. A recent Bureau of Business and Economic Research poll found that one in every eight Montana households (12.6 percent) was either uncertain of having or unable to acquire adequate food over the past year. The survey reported that 5.2 percent of these households experienced the more severe form of food insecurity; that is, one or more members were hungry at some time during the year because they could not afford enough food. Montana hunger levels are slightly higher than national levels. Nationwide, 11.1 percent of households were food insecure during 2002 and 3.5 percent were food insecure with hunger.

American Indian households in Montana were more likely than white households to be uncertain of having or unable to acquire adequate food, the poll found. In fact, 36.1 percent of American Indian households in Montana were food insecure in the year prior to June 2004, compared with 12.4 percent of white households. This measurement of food insecurity among American Indian households may underestimate actual levels since it is drawn from a telephone sample.

In Montana, households with children are more likely than households with no children to be food insecure. Almost 18 percent of households with children were food insecure in the year prior to June 2004, compared with 10.1 percent of households with no children.

Hunger and Obesity

How can hunger and obesity co-exist in the same families or individuals? With fewer resources to buy food or to obtain health care or other preventative or remedial interventions, people with limited incomes are particularly susceptible to damage from hunger/food insecurity, obesity, or both. Lack of access to adequate food can result in weight gain because of:

* The need to maximize caloric intake by stretching food dollars, resulting in purchases of foods with higher amounts of calories per dollar,

* The tradeoff between food quantity and quality resulting in a diet that fails to promote health and avert obesity,

* Overeating when food is available as a logical response to food insecurity,

* Physiological changes to help the body conserve energy when diets are periodically inadequate.

For more information, consult www.centeronhunger.org or www.frac.org.

Montana's Changing Demographics

One of the more dramatic demographic developments in Montana is the declining number of children under the age of 18. According to Census Bureau estimates for 2003, the number of children in Montana went from a little over 230,000 in 2000 to about 215,774 (Table 2). Pre-school-age children under the age of 5 dropped by 2.5 percent, from almost 55,000 in 2000 to 53,500 in 2003. Montana's decline in pre-school-aged children contrasts with other Western states such as Arizona, Nevada, California, Colorado, and Utah where the number of children under the age of 5 increased by more than 10 percent. All of these states have quite different types of economies and are also, with the exception of Utah, states with much larger Hispanic and American Indian populations.

Declines in the number of children are not pervasive in all areas of the state or in American Indian communities. The population of American Indian children, who account for almost I0 percent of Montanans under age 18, is growing faster than the white youth cohort in many parts of the state. Moreover, American Indian children are heavily represented in rural areas, where they represent 18 percent of the youth population compared to urban areas where they represent less than 4 percent of the population under age 18.

The American Indian population on reservations is very young, with 38 percent of the total population represented by children. This youthful demographic pattern has significant implications for the region's school systems, its future work force, and for economic development opportunities.

The decline in young Montanans is also more pronounced in some areas of the state than in others. Many of the rural, farm-ranch-based counties are experiencing decreases in the number of children along with declines in the number of live births, and they represent population declines where death rates and net out-migration are much larger than the number of births. Montana counties in urban areas and on the western side of the state are showing--in most cases-increases in the population under age 18. These are also areas that typically have an excess of births over deaths, plus net in-migration.

Education

The number of public school districts in Montana saw a substantial decline between the 2002-2003 and 2003-2004 school years--from 531 to 450. During the same period, however, the total number of schools increased from 817 to 859. Overall, the state of Montana only saw slight changes in enrollment for the 2003-2004 school year (Table 3). Public school grades pre-kindergarten-12 dropped by 639 students, continuing a downtrend dating to the mid-1990s. Private school enrollment fell by 339 students, but still represented about 5 percent of the statewide enrollment. The number of children in home schools saw a small increase, up 129 for a total of 3,917 students.

According to Montana Public School Enrollment Data, 10,978 students graduated from high school in 2002-03, with a completion rate of 84.9 percent. During the same school year, 1,901 students dropped out of high school, a dropout rate of 3.6 percent and a slight decrease from the previous year's 3.8 percent dropout rate. Over the past five years, the high school dropout rate has improved from the 4.1 percent rate in 1998-99--with a five-year average of 4 percent.

Montana's Youngest Kids

Poverty rates for Montana's young children are high. Twenty-three percent live in households below the federal poverty level and another 15 percent are in households just above poverty (100 percent-149 percent). Many children in poverty households are in families where at least one, if not both, parents are employed. Head Start and other educational opportunities for young children in daycare programs become even more important for Montana's working-poor families. These high return programs help kids prepare for the transition into kindergarten.

High poverty goes hand in hand with limited access to health care for little children. Although we like to think most children have health insurance or a public health program such as Medicaid or CHIP, the fact is there are 5,000 little children who meet the poverty guidelines for such programs who do not have any access to health care, either from private insurance or public health coverage.

Even if they have health insurance, most of these young children do not have a "medical home," that is a regular physician, dentist, or mental-health provider who they can rely upon for health care. A goal of Montana's Early Childhood Comprehensive System is to ensure children consistent access to one doctor.

American Indian, Latino and White Children in Montana

As the largest racial/ethnic group in Montana, American Indians represent more than 6 percent of the state's population and have experienced significant growth in their youth population. The more than 22,000 American Indian youth under age 18 represent about 10 percent of all youth in Montana and, in some rural areas, represent one in every five children.

American Indian children dominate population age profiles in tribal communities and reservations throughout the state, with 38 percent of the total American Indian population on reservations represented by kids younger than 18. The high percentage of children in Montana's American Indian population is even higher than the national rate of 34 percent - and is well above the white population's 24 percent contingent of children (Figure 4).

[FIGURE 4 OMITTED]

The youthful orientation of American Indian populations will continue over the next decade, particularly in reservation communities such as the Northern Cheyenne, Fort Peck, Blackfeet, and Crow communities where children under age 18 represent slightly more than 40 percent of the population. The counties encompassing these reservations typically have high natural population growth in the Indian population, in contrast to the white population's negative natural growth and in spite of out-migration.

Latino kids under the age of 18 represent 41 percent of Montana's total Latino population of 18,000, according to the 2000 Census. That's a proportion higher than national Latino youth population shares (Figure 5).

[FIGURE 5 OMITTED]

The dominance of youth in Montana's American Indian and Latino populations compared to the state's white population has important implications for education, health care, and social policy. More than 80 percent of American Indian children are located in rural areas, presenting challenges for access to health care and employment opportunities. Higher poverty rates for both American Indian and Latino kids argue for greater investments in early childhood education and school readiness so they are on a more equal playing field when they start school.

There are a number of KIDS COUNT indicators recently calculated from 2000 Census Data and available in an American Indian Children Pocket Guide from the Annie E. Casey Foundation at www.aecf.org/publications.

As shown in Table 4, a fairly high percentage of Montana's American Indian and Latino children live in single-parent families (33 percent) compared to non-Hispanic white children (19 percent). The family structure and household composition of Montana's American Indian children is similar to national patterns for some measures--except in the number of households headed by grandparents. Sixteen percent of Montana's American Indian children lived with one or two grandparents, compared to 11 percent nationally. Non-Hispanic white children were much less likely to live in households headed by grandparents.

Median family incomes in American Indian households were 58 percent of white median family incomes in Montana, an income disparity also showed up in the U.S. data. Latino family income was higher than Indian family incomes. The lower household income of Montana's Indian and Latino families also translates into higher poverty rates. More than one-fourth of American Indian kids lived in a married couple family that fell below the federal poverty level, compared to an 8 percent rate for non-Hispanic kids. Montana's greater income disparity between American Indian and non-Hispanic whites is also shown in comparisons with national data, although the disparity is not as great.

Children in female-headed families were much more likely to live below the poverty level, an income disadvantage that was more likely to be true of Montana's American Indian and Latino children. Female-headed families with either American Indian or Latino children had poverty rates of 59 and 54 percent respectively, far greater than the poverty rate for white female-headed families.

It is also important to note that poverty rates in Montana's single female-headed families, regardless of race or ethnic group, were significantly higher than corresponding rates at the national level.

Employment is a key element of income and poverty, and reflects a number of local and statewide economic conditions. Participation in the labor force, either being employed or looking for work, characterized a high percentage of all households. These percentages drop, though, when examining the labor force participation of single moms in Montana. Seventy-one percent of Montana's American Indian moms and 81 percent of Latino morns were in the labor force. The labor force participation rates for Montana's single moms of all race and ethnic groups compared to national participation rates.

What Now?

This article contains some of the salient points in the 2004 Montana KIDS COUNT. The book is presented with the hope that Montana's decision makers use it to celebrate the gains in the well-being of children and, more importantly, that they take note of where Montana falls behind in supporting the healthy development of all kids.

Numerous studies show that investment in children-especially kids age 5 and under--have high returns to communities and state governments. Some long-term follow-up studies show high economic returns, in some cases returns of $7 for every $1 dollar invested, as well as an array of positive education and--later in life--employment outcomes for children. These reports show that basic things like nutrition, health care, pre-Kindergarten education, and programs to prepare and support parents are benefical for kids, and they provide a real return to taxpayers. Early childhood investment also reduces the incidence of poverty in later life. All of these outcomes are very relevant to Montana when looking at the dramatic changing demographics of the state.

Table 1
Montana Kids Social and Economic Opportunity Data

Social and Economic Opportunity                  2002          2003

People under age 18 in poverty                 41,256        37,760
Estimated median household income             $34,835       $34,108
Monthly average number of families with         5,659         6,163
  dependent children that participated
  in TANF
Monthly average number of children that        10,501        10,382
  participated in TANF
Monthly average number of recipients of        63,766        68,779
  all ages that received Food Stamps
Percent of children enrolled in                   33%           35%
  pre-kindergarten to 12th grade that
  were eligible for free/reduced lunch
  (2002-2003)
Number of women, infants, and children         21,475        21,320
  enrolled in the WIC Program
Per Capita personal income                    $24,044       $25,920
Total dollar amount allocated to          $20,274,713   $17,372,333
  children that participated in the
  daycare program (child care)
Total number of child care slots used          69,886        75,189
  in FY 2003 in all programs (numbers
  will duplicate kids who are in more
  than one program)
Overall unemployment rate                         4.6           4.7
Civilian labor force                          463,516       474,910
Civilian labor force between 16 and 19         28,000        31,000
  years of age, (numbers in thousands)
Civilian non-institutional population          53,000        55,000
  between 16 to 19 years of age 53,000
Teen unemployment rate, 16 to 19 years           11.9          13.5
  of age

Sources: U.S. Census Bureau, www.census.gov; U.S. Bureau of Labor
Statistics, www.bls.gov; Montana Department of Health and Human
Services, www.dphhs.mt.us.gov.

Table 2
Selected Demographic Characteristics for Montana Children,
2000, 2002, and 2003

State Summary Statistics for
the Population Under Age 18       2000   2002 *    2003 *

Total population               902,195   909,453   917,621
  Population under age 18      230,062   216,000   215,774
  Males under age 18           118,245   111,249   110,045
  Females under age 18         111,817   105,071   105,729
  Children under age 5          54,869    52,793    53,510
  Children ages 5 to 17        175,193   163,207   162,264

Source: U.S. Census Bureau, www.census.gov.

* Estimates

Table 3
Montana Kids Education and Schooling

                                     2002-2003           2003-2004
Education and Learning for
2003-2004 Academic Year           Number   Percent    Number   Percent

Total School Enrollment (K-12)   161,404    100.0%   159,244    100.0%
Public Enrollment                149,330     92.5%   147,509     92.6%
Private Enrollment                 8,286      5.1%     7,818      4.9%
Home School                        3,788      2.3%     3,917      2.5%
Special Education Enrollment      19,162      N/A     19,209      N/A
Student Dropout                               3.9%                3.6%

2003-2004 Public School Enrollment

Pre-Kindergarten                     665      N/A        659     67.3%
K-8                              100,567     67.3%    99,317     32.7%
8-12                              48,763     32.7%    48,192    100.0%
K-12                             149,330    100.0%   147,509

2003-2004 Private School Enrollment

K-8                                6,137     74.1%     5,721     73.2%
8-12                               2,149     25.9%     2,097     26.8%
K-12                               8,286    100.0%     7,818    100.0%

2003-2004 Home Schooling

K-8                                2,893     76.4%     3,028     77.3%
8-12                                 895     23.6%       889     22.7%
K-12                               3,788    100.0%     3,917    100.0%

Education and Learning for
2003-2004 Academic Year          Percent Change

Total School Enrollment (K-12)       -1.34%
Public Enrollment                    -1.22%
Private Enrollment                   -5.65%
Home School                           3.41%
Special Education Enrollment          0.25%
Student Dropout

2003-2004 Public School Enrollment

Pre-Kindergarten                     -1.24%
K-8                                  -1.17%
8-12                                 -1.22%
K-12

2003-2004 Private School Enrollment

K-8                                  -6.78%
8-12                                 -2.42%
K-12                                 -5.65%

2003-2004 Home Schooling

K-8                                   4.67%
8-12                                 -0.67%
K-12                                  3.41%

Source: Montana Office of Public Instruction, www.opi.state.mt.us.

Table 4
Household, Income, Poverty, and Employment Indicators for U.S. and
Montana Children Under 18 Years of Age, by Race and Ethnicity, 2000

                                             MONTANA

                                  American             Non-Hispanic
Households                          Indian    Latino          White

% in Single Parent Families            44%       55%            75%
% in Grandparent Household             33%       32%            19%
% in Grandparent Household             16%        6%             3%

Poverty
Median Family Income 1999          $24,412   $31,484        $41,517
% Children in Married Couple           26%       13%             8%
  Poverty Family
% Children in Female Head              59%       54%            38%
  Poverty Family

Employment
% Children in Families--Both           64%       61%            69%
  Parents in Labor Force
% in Female Head Family--Mother        71%       81%            85%
  in Labor Force
16-19 Year Olds Unemployed             42%       13%            20%

                                            UNITED STATES

                                  American             Non-Hispanic
Households                          Indian    Latino          White

% in Single Parent Families            50%       60%            75%
% in Grandparent Household             32%       24%            18%
% in Grandparent Household             11%        7%             4%

Poverty
Median Family Income 1999          $33,144   $34,397        $54,698
% Children in Married Couple           16%       17%             4%
  Poverty Family
% Children in Female Head              46%       45%            26%
  Poverty Family

Employment
% Children in Families--Both           54%       45%            63%
  Parents in Labor Force
% in Female Head Family--Mother        67%       65%            81%
  in Labor Force
16-19 Year Olds Unemployed             28%       21%            15%

Source: Annie E. Casey Foundation, www.kidscount.org.

Poverty Levels

Poverty: Income below $18,850 per year for a family of four (below 100%).

Near-poverty: Income between $18,850-$23,563 for a family of four (100%-125%).

Low-income: Income between $23,563-$28,275 for a family of four (126%-150%)

Source: U.S. Department of Health and Human Services, 2004.

Steve Seninger is the Bureau's director of economic analysis and director of Montana KIDS COUNT Daphne Herling is the Montana KIDS COUNT director of development and community outreach.