Hamilton County Child Fatality Review Annual Report

Transcription

Hamilton County
Child Fatality Review Annual Report
December 2015
Every death of a child in Hamilton County matters.
This report is dedicated to the children, and their
families, friends and communities whose lives were
forever changed.
The Hamilton County Child Fatality Review Annual Report was
made possible through the collaboration, and commitment of
the numerous individuals who are members of the Hamilton
County Child Fatality Review Board. This report mirrors the
endeavors of the individuals who strive to enhance the lives of
children living in Hamilton County.
Dear Friends of Hamilton County Children:
There are few health outcomes more tragic than the loss of a child, but the fact
remains that child deaths are an important indicator of the general health of a
community. As you will read in this report, a great number of child deaths could
have been prevented.
A state-wide Child Fatality Review (CFR) program was developed by the Ohio General
Assembly in 2000. This program mandates that CFR boards be implemented in
every county in Ohio in order to review the deaths of children under 18 years of age.
Once again this year, Hamilton County’s infant mortality rates are higher than the
national average. While this report covers child deaths for all children under 18
years of age, the vast majority of child deaths in the County occur in children before
their first birthday.
The CFR annual report looks at the causes of child fatalities throughout the County.
The report focuses on child deaths from 2010 to 2014.
Creating a strategy to reduce the number of preventable child deaths is a complicated
endeavor that requires collaboration between many stakeholders. Hamilton County
Public Health partners with individuals, healthcare systems, physicians, clinics and
other support sources affecting social determinants of health in order to reduce
these numbers.
It is my sincere hope that you examine the information in this report closely. It will
require the collective effort of many to bring the rates of child mortality to levels
representative of the quality of our great communities.
Sincerely,
Tim Ingram
Health Commissioner
Table of Contents
Acknowledgments .................................................................................... Page 2
Executive Summary ................................................................................. Page 3
Limitations ................................................................................................. Page 4
Child Fatality Review Team - 2013/2014 ............................................ Page 5
CFR Membership ..................................................................................... Page 6
Cases Reviewed ....................................................................................... Page 7
Introduction ............................................................................................... Page 8
Medical Deaths ......................................................................................... Page 19
Motor Vehicle Deaths .............................................................................. Page 22
Homicides .................................................................................................. Page 27
Suicides ...................................................................................................... Page 33
Sleep-Related Deaths .............................................................................. Page 37
Drownings .................................................................................................. Page 43
Asphyxia Deaths ....................................................................................... Page 46
“Other Types of Child Death” .................................................................. Page 49
Conclusion ................................................................................................. Page 51
Appendix .................................................................................................... Page 52
Page 1
Acknowledgments
This report was prepared by Hamilton County Public Health,
Department of Community Health Services.
Hamilton County Board of Health Tracy A Puthoff, Esq., President
Mark A Rippe, Vice President
Thomas Chatham
Kenneth Amend, M.D.
Jim Brett
Health Commissioner
Timothy Ingram, M.S.
Medical DirectorStephen Bjornson, M.D., Ph.D.
Assistant Health Commissioner Craig Davidson, M.S., R.S.
Department of Community Health Services
Hamilton County Public Health Staff
David Carlson, MPH,
Director of Epidemiology & Assessment
Thomas Boeshart, MPH, Epidemiologist
Mike Samet, Public Information Officer
Special thanks to the Hamilton County Child Fatality Review Team for
their commitment to the prevention of child deaths in Hamilton County, for
without whom this report would not be possible.
All material appearing in the CFR Annual Report may be reproduced and copied without
permission; citation to Hamilton County Public Health, however, is appreciated. Due to
the sensitive and confidential manner of CFR data, data are only reported in aggregate.
Suggested Citation
Boeshart T., Carlson D., Davidson C., Samet M. Hamilton County Child Fatality Review Annual Report 2013/2014. Hamilton County, Ohio: Hamilton County Public Health. December 2015
Page 2
Executive Summary
T
he Hamilton County Child Fatality Review Team (CFRT), which currently operates under the auspices
of Hamilton County Public Health, officially began reviewing cases on January 1st, 1996. The following
report represents the eighteenth full year of the child fatality reviews by the Hamilton County Team. The
Hamilton County Child Fatality Review Annual Report presents an in-depth analysis of child deaths that
occurred between 2010 and 2014.
In 2000, the Ohio General Assembly established the Ohio Child Fatality Review program in response
to the need to better understand why children in Ohio are dying1. The law mandates that every Ohio
county create a CFR board to review all deaths of children under 18 years of age1. An online CFR data
system was developed by the National Center for Prevention and Review of Child Deaths that allows for
a thorough capture of factors that impacted the death of the child1.
The online data system has allowed for the in-depth analysis of the types of death presented within this
report. The report is broken out into 10 sections: introduction, deaths due to medical conditions, motor
vehicle deaths, homicides, suicides, drownings, asphyxia deaths, sleep-related deaths, “other types of
child death”, and a conclusion. Each section contains an in-depth look regarding the circumstances and
factors related to the deaths. Where applicable, the number of child deaths (N) is displayed on each
corresponding chart/figure. Maps will be presented throughout the report to highlight the inequities
throughout the County as they relate to child deaths.
The purpose of CFR is to prevent child deaths by examining the causes of deaths in the aggregate,
making policy recommendations from the review of child deaths in Hamilton County and increasing
coordination and communication between agencies and systems. Each section of this report concludes
with the recommendations made by the Hamilton County CFRT.
The main goals of the CFRT are to:
Compile uniform statistics on all deaths among children under 18 years of age in Hamilton
County.
Accurately identify and document the causes of death of all Hamilton County children.
Identify trends among child deaths in Hamilton County.
Identify causes of death that may be preventable, and make subsequent recommendations
about policy changes in public health and public safety for Hamilton County.
Develop uniform protocols and procedures for investigating child deaths.
This report is intended to describe the trends and patterns found across child deaths, identify areas
of child death inequities and make meaningful recommendations that improve the outcomes for all
children in Hamilton County. It is hoped that the recommendations provided throughout this report will
result in continued collaboration across the various agencies whose focus is on improving the health of
children in Hamilton County. It is through this collaborative effort that we can strive to protect the health
of the children living in Hamilton County.
Page 3
Limitations
T
he CFR data system collects information surrounding the death of the child. However, not all
information is available during the review of the child death and pieces of information can be missing
or unknown. Missing or unknown data is identified in the data tables beginning on page ii of the Appendix.
Calculation of rates is not appropriate with Hamilton County’s CFR data because not all child deaths
undergo a full team review by the Hamilton County CFRT. The overall child fatality rate is the only rate
appropriate to calculate using Hamilton County’s CFR data as it takes into account all child deaths
regardless if the child death received a full team review. CFR statistics are reported as proportions
(percentages) of all child deaths in Hamilton County from 2010 to 20141. This can make analysis of
trends over time difficult, as an increase in the percentage of one factor will result in a mathematical
decrease in the percentage of other factors1. Percentages presented throughout this report may not
equal 100 percent due to rounding.
Since the origin of the statewide data collection, the CFR data system has undergone improvements
and revisions. Due to the differences in data elements and classifications, the data presented within this
report may not be comparable to previous reports1. The in-depth evaluation of factors that contributed
to and impacted the child deaths in Hamilton County is limited by a small number of cases and/or lack of
pertinent information1. Some statistics regarding child death in Hamilton County throughout this report
are based on a small number of cases and should be interpreted with caution, as it may be difficult to
distinguish random fluctuation/changes in the incidence from true changes in the underlying risk.
Page 4
2013/2014 Child Fatality Review Team
Thomas Boeshart
Hamilton County Public Health
250 William Howard Taft, 2nd Floor
Cincinnati, Ohio 45219
Dr. Carrie McIntyre
Cincinnati Children’s Hospital Medical Center
3333 Burnet Ave
Kathryn Boller-Koch
Hamilton County Juvenile Court
800 Broadway Ave
Det. Erik Pfaffl
Hamilton County Sheriff’s Office
11021 Hamilton Ave
Sgt. Joseph Briede
Cincinnati Police Department
824 Broadway, 5th Floor
Mark Piepmeier
Hamilton County Prosecutor’s Office
230 E. Ninth Street, Suite 4000
David Carlson
Dr. Bill Ralston
Hamilton County Coroner’s Office
3159 Eden Ave
Lt. Derek Douglas
Cincinnati Fire Department
700 W. Pete Rose Way, B
Rich Schneider
Hamilton County Prosecutor’s Office
230 E. Ninth Street, Suite 4000
Rebekah Harlow
Dr. Kirsten Simonton
3333 Burnet Ave
Melissa Jimenez
3333 Burnet Ave
Carrie Stoudemire
Hamilton County Mental Health Recovery Services
2350 Auburn Ave
Pamela Krieg
UC Health
3200 Burnet Ave
Dr. Corinn Taylor
Cincinnati Health Department
3101 Burnet Ave
Dr. Karen Looman
Hamilton County Coroner’s Office
3159 Eden Ave
Vanessa Walker
Tasha McGuire
3333 Burnet Ave
Sandi Webster
Hamilton County Job and Family Services
222 E. Central Parkway
Page 5
Child Fatality Review Team Membership
Regular Child Fatality Review Team members are representatives of the following agencies:

Children’s Services Division of Hamilton County Department of Job and Family Services
Hamilton County Coroner
Cincinnati Health Department
Cincinnati Fire Department
Cincinnati Police Department
Hamilton County Prosecutor
Hamilton County Sheriff
Hamilton County Juvenile Court
Hamilton County Mental Health and Recovery Service Board
UC Health
Meetings are closed to the general public and media, and all discussion and work products are confidential.
Only CFRT members and invited guests are permitted to attend CFR meetings. Representatives of other
agencies and organizations are occasionally invited to attend when a relevant case is being discussed.
Page 6
Cases Reviewed
T
he Hamilton County CFRT screens all deaths of children under 18 years of age who are residents
of Hamilton County at the time of death. The CFRT limits death reviews to residents of Hamilton
County and does not review deaths of non-residents who die in Hamilton County.
Death certificates of all Hamilton County residents under 18 years of age are sent to Hamilton County
Public Health by each of the health departments in Hamilton County. Hamilton County Public Health
records all demographic data about all child deaths into the CFR data system developed by the National
Center for Prevention and Review of Child Deaths. The Hamilton County Coroner’s Office reviews each
death certificate to categorize the cause of death and determine whether it qualifies for a review by
meeting any of the following criteria:

Homicide
Suicide
Unintentional injuries (accidents)
Undetermined, including presumed Sudden Infant Death Syndrome (SIDS)
Unexpected outcomes (e.g., unexpected death from identified medical causes)
Unexpected clusters (e.g., unusual frequency of deaths from identified medical causes)
All cases investigated by law enforcement
If the coroner’s office determines that the case meets any of the criteria, the case is scheduled for a full
CFRT review. Case names are also sent to Hamilton County Job and Family Services (JFS) to determine
if there has been any involvement with Child Services at any time. Additionally, any CFRT member can
request a full-team review of any case they feel would benefit from a full-team review, whether or not it
meets the criteria for full review.
Full-team reviews involve an in-depth examination of the death by the entire CFRT, with members reporting
on relevant information they might have about the death. The CFRT tries to reach conclusions about
whether or not the death was preventable, based on the information available on the circumstances
leading up to the death. The information about the factors related to the death of the child is recorded
into the CFR data system. The following report is based on the analysis of the data between 2010 and
2014 from the CFR data system for Hamilton County.
Page 7
Introduction
T
he death of a child is the most profound loss a parent can experience. In order to reduce the number
of these tragic losses, we must understand why, how and where the children in our community are
dying, along with the social determinants that influence the health of children.
To understand why our children are dying and the inequities in child deaths, we must first understand
a little about the children living in Hamilton County. Children, throughout this report, are defined as
Hamilton County residents under 18 years of age.
189,640
Hamilton County Children
Population in 2010
96,340
Male child population in
2010
93,300
Female child population in
2010
Demographics: Age, Race/Ethnicity, Sex
In 2010, there were 189,640 children who called Hamilton County home. This means that nearly a
quarter of the total Hamilton County population in 2010 were children. The percent of male children (51
percent) was nearly equal to that of female children (49 percent) living in Hamilton County in 2010. The
largest percentage of children (59 percent) in Hamilton County in 2010, were white children. Thirty-two
percent of Hamilton County children in 2010 were black
2010 Child Population by Race/Ethnicity children, representing the second largest racial group
of children. Five percent of Hamilton County children
60%
59%
were multi-racial, or identified with two or more races.
Other races, such as Pacific Island or Alaskan Native,
represented four percent of children in Hamilton County.
50%
The majority of children in Hamilton County were nonHispanic, however, four percent of children living in
40%
Hamilton County in 2010 were of Hispanic or Latino
descent.
In 2010, the majority of children were between five and
14 years of age.
2010 Child Population by Age
Infants,
those
children younger
20%
6%
than one year of
18%
age, accounted for
six percent of the
23%
10%
Hamilton County
child population
5% 4% 4%
27%
in 2010. Twenty0% White Black Multi- Other Hispanic
three
percent
27%
Racial
Race
Note: Percentages of child population by race/ethnicity equal more than 100
of children in
percent. This is because racial breakdowns contain those children who are
Hamilton County
also of Hispanic descent due to the inability of the American Community
Survey to breakdown race and ethnicity by age.
were between one
10-14 Years
< 1 Year
to four years of age. Children who were between five and nine
1-4
Years
15-17 Years
and 10 and 14 years of age each accounted for 27 percent of
5-9 Years
Hamilton County children in 2010. Older children, who were 15 to
17, represented the remaining 18 percent of Hamilton County children.
Page 8
30%
32%
Overall Annual Trends
From 2010 to 2014, Hamilton County witnessed 719 of its child residents die from various causes,
many of which could have been prevented. Over the five years during 2010 to 2014, the annual number
of children who died in Hamilton
Number of Child Deaths by Year in Hamilton County, 2010-2014
County fluctuated. From 2010 to
160
2011, the number of child deaths
increased from 149 to 156, the
155
highest number of child deaths
150
in the five year time period. In
145
decreased to the lowest number
140
of child deaths (131) during the
135
five-year time period.
Since
130
in Hamilton County increased.
125
In 2014, Hamilton County
120
witnessed the third highest
N=719
number of child deaths (138)
115
during 2010 to 2014.
2010
2011
2012
2013
2014
Another way to monitor child
deaths is to look at the child fatality rate. The child fatality rate is a specific type of mortality rate that
measures the number of child deaths over a specified time frame. The child fatality rate in Hamilton
County from 2010 to 2014 was 7.7
Hamilton County Child Fatality Rate per 10,000 Children,
per 10,000 children. This means
2010-2014
8.5
that for every 10,000 children who
were living in Hamilton County from
2010 to 2014, there were nearly
8.0
eight child deaths. Much like the
number of child deaths, the child
7.5
fatality rate has fluctuated during
2010 to 2014. In 2011, the child
fatality rate was the highest (8.3
7.0
per 10,000) over the five-year time
period. After decreasing in 2012
6.5
to 7.0, the lowest rate from 2010
to 2014, the rate has been steadily
N=719
increasing. The child fatality rate
6.0
is the only rate appropriate to
2010
2011
2012
2013
2014
calculate using Hamilton County’s
CFR data as it takes into account all child deaths regardless if the child death received a full team review.
DID YOU KNOW?
1
Between 2010-2014:
Hamilton County
child died
EVERY
3
Days
Page 9
Hamilton County Child
Deaths by Sex,
2010-2014
61%
Male
N=719
Child Death Disparities: Demographic Sub-populations
Within the child population in Hamilton County, there are sub-populations
that are disproportionately affected by child deaths. From 2010 to 2014,
male children in Hamilton County were affected by higher numbers of
child deaths than their female counterparts. In the five-year time span
of 2010 to 2014, male children have consistently accounted for over 50
percent of child deaths in Hamilton County. Sixty-one percent of child
Female deaths from 2010 to 2014 were to male children, while female children
accounted for 39 percent. Male children are not the only population that is
disproportionately affected by higher percentages of child deaths. When
race is taken into account, larger disparities among the child population
emerge.
39%
Race/Ethnicity
Race and ethnicity presented throughout this report are the combined race and ethnicity of the child that
is reported at the time of death on his/her death certificate. Race and ethnicity are classified into one of
five different categories:
non-Hispanic other race
non-Hispanic white
Hispanic
non-Hispanic black
non-Hispanic multi-racial
Hamilton County children who identify with two or more racial groups are classified as being multi-racial.
If a child identifies with another race (e.g., Asian, Alaskan Native, Native American, etc.), the race is classified
as “other”. Anytime a child is identified as being of Hispanic or Latino descent, regardless of race, they are
classified as Hispanic. As shown previously, the majority of the child population in Hamilton County are
non-Hispanic, and the majority of child deaths in Hamilton County are to non-Hispanic children. Fifty-five
percent of child deaths from 2010 to 2014 were to non-Hispanic black children. Historically, non-Hispanic
black children in Hamilton County have seen inequalities when it comes to child deaths. Child deaths to
non-Hispanic black children have consistently accounted for over 50 percent of child deaths in Hamilton
County. However, since 2011, the percent of child deaths to non-Hispanic black children has begun to
trend downwards.
Thirty-four percent
of child deaths from
2010 to 2014 were
to
non-Hispanic
white
children.
Child deaths to
non-Hispanic white
children in Hamilton
County witnessed a
decrease from 2011
to 2013. However,
in 2014 the percent
of child deaths to
non-Hispanic white
children began to
increase.
Hamilton
County
children who were
non-Hispanic multiPage 10
70%
Hamilton County Child Deaths by Race/Ethnicity, 2010-2014
60%
50%
40%
30%
20%
10%
0%
N=719
2010
2011
2012
non-Hispanic Black
non-Hispanic White
non-Hispanic Other
Hispanic, Any Race
2013
2014
non-Hispanic Multi-Racial
racial accounted for five percent of child deaths from 2010 to 2014. Since 2012, the percent of deaths to
non-Hispanic multi-racial children has been slowly increasing. Prior to 2012, the percent of child deaths
to non-Hispanic multi-racial children in Hamilton County had accounted for only one percent of deaths
in 2010 and 2011. Two percent of deaths from 2010 to 2014 were to children who were non-Hispanic
and identified with another racial group. The percent of deaths to children who were non-Hispanic and
identified with another racial group also witnessed an increase in the percent of child deaths since 2012.
Child deaths to Hispanic children in Hamilton County remained relatively stable from 2010 to 2014.
Over the five years of 2010 to 2014, three percent of child deaths were to Hispanic children in Hamilton
County.
DID YOU KNOW?
3
Between 2010-2014:
out of
every
Race/Ethnicity and Sex
5
Child deaths in Hamilton
County were to non-Hispanic
black children.
As illustrated previously, male children and non-Hispanic black children in Hamilton County represented
the largest percentage of child deaths. When sex and race/ethnicity are coupled together, further
inequalities in child deaths emerge. Non-Hispanic black male children accounted for the largest
percentage of child deaths from 2010 to 2014. Thirty-two percent of child deaths in Hamilton County
between 2010 and 2014 were to non-Hispanic black males. The percent of deaths to non-Hispanic black
male children was nearly 1.5 times higher than non-Hispanic white male children and nearly seven times
higher than non-Hispanic multi-racial, non-Hispanic other races, and Hispanic male children combined.
Non-Hispanic white male children represented the second highest percentage of child deaths from 2010
to 2014 (24 percent). However, the percent of child deaths to non-Hispanic white males was nearly
equal to the percent
Hamilton County Child Deaths by Race/Ethnicity and Sex, 2010-2014
of child deaths to
35%
non-Hispanic black
females.
32%
30%
Between 2010 and
2014, 23 percent
25%
of child deaths in
Male
24%
Hamilton County
23%
20%
Female
were
to
nonHispanic
black
15%
females.
The
14%
percent of child
10%
deaths to nonHispanic
black
females
was
1.5
5%
times higher than
2%
2% 1%
1% 0.6%
0.7%
non-Hispanic white
0%
females, and nearly
non-Hispanic White non-Hispanic Black non-Hispanic Multi- non-Hispanic Other Hispanic, Any Race
nine times higher
Racial
N=719
Page 11
than non-Hispanic multi-racial, non-Hispanic other races, and Hispanic female children combined.
Two percent of child deaths in Hamilton County between 2010 and 2014 were to non-Hispanic multiracial male children. Male children who were non-Hispanic and identified with another racial group
comprised one percent of child deaths in Hamilton County from 2010 to 2014. Hispanic male children
accounted for two percent of child deaths in Hamilton County from 2010 to 2014. Female children
who were non-Hispanic and multi-racial accounted for one percent of child deaths in Hamilton County
from 2010 to 2014. Female children who were non-Hispanic and identified with another racial group
comprised the smallest percentage of child deaths in Hamilton County from 2010 to 2014, accounting
for less than one percent (0.6 percent). Hispanic female children accounted for the second smallest
percentage of child deaths in Hamilton County (0.7).
Age
Race/ethnicity and sex are not the only inequities in child deaths in Hamilton County, when the age of
the child is taken into account, further inequities among child deaths in Hamilton County emerge. Child
deaths throughout this report are classified into one of six different age groups:
5-9 Years
<28 Days
10-14 Years
28 Days - 1 Year
15-17 Years
1-4 Years
As illustrated previously, infants (children who are less than one year of age) accounted for the smallest
percentage of the child population in Hamilton County. However, infants accounted for the largest
percentage of child deaths in Hamilton County from 2010 to 2014. Seventy-three percent of child deaths
from 2010 to 2014 were to infant children. Infants’ ages are further broken down into children who are
<28 days old (neonates) and children who are between the ages of 28 days and one-year-of-age (postneonates). Historically, infants in Hamilton County have seen inequalities when it comes to child deaths.
From 2010 to 2014, infants have consistently accounted for over 60 percent of child deaths. However,
the overall number of infant deaths in Hamilton County has been trending downwards.
Since 2010, the percent
Hamilton County Child Deaths by Age, 2010-2014
of neonatal deaths
45%
has
been
slowly
40%
trending
downwards.
However, these children
35%
accounted
for
36
30%
percent of all child
deaths from 2010 to
25%
2014.
Post-neonatal
20%
deaths accounted for
an additional 36 percent
15%
of the child deaths in
10%
Hamilton County from
2010 to 2014. After a
5%
decrease in deaths in
N=719
0%
2013, the percentage
2010
2011
2012
2013
2014
of child deaths postneonates began to
<28 Days
28 Days - 1 Year
1-4 Years
5-9 Years
10-14 Years
15-17 Years
increase in 2014.
For children one-year-of-age, and older, the percent of child deaths in Hamilton County drops drastically.
The percentage of deaths to children who were between one and four remained relatively stable from
2010 to 2014, accounting for nine percent of child deaths in Hamilton County. The smallest percent
Page 12
of child deaths, four percent, were to children between five and nine. However, while these children
represent the smallest percentage of child deaths in Hamilton County, the percent of deaths each year
to children between five and nine has been increasing since 2010. The second smallest percent of child
deaths from 2010 to 2014, six percent, were to children between 10 and 14. After a decrease from 2010
to 2011, the percent of child deaths to children between 10 and 14 has been increasing. Mid-teenage
children in Hamilton County, those between 15 and 17, accounted for eight percent of child deaths from
2010 to 2014. After an increase in the percent of child deaths from 2010 to 2011, the percent of child
deaths to children between 15 and 17 has remained relatively stable. An increase in the percent of child
deaths to children in other age groups could be due to the decrease in the number of infant deaths.
DID YOU KNOW?
2
Between 2010-2014:
out of
every
Geography
3
County were to children
less than 1 year of age.
Inequities in child deaths also exist between communities in Hamilton County. Within Hamilton County,
there are 49 communities comprised of cities, villages, and townships. As illustrated by the map
below, the majority of the communities in Hamilton County have witnessed child deaths within their
communities. The urban core of Hamilton County, the City of Cincinnati, experienced the largest number
Hamilton County Child Deaths by Community, 2010-2014
!!
!
!
!!! !
!
!!
!!
!
! !!
!
!
!
!
!!
!
!
!
!
!
!
!
!!
!
!
! !
!
!! !
!
!!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
! !
!!
!
!
!
!
!
!!
!!
!
!
!
!
!
!
!!!
!
!
!
!
!
!! !!
! !!
!
!
!
!
!!
!
!
!
! !!
!
!!
!
!
!
!
!
!
!!!!
!
!
!
!
!
!
!
!!
!
!
!
!!
!
!
!
!
!!
!
!!
!
!
!
! !
!
!!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!
!!
!
!
!
!
!
!
!
!
! !!
!
!
!
! !
!
!
!
!
!! !
!
!
!
!
!
!
!
!
!
!
!
!!
!
! !
!
!!!!
!
!
! !!! !
!
!
!
!!
!
!
!
!
!
!
!
!
!!!
! ! !
!!
!
!!
!
!
! !
!!
!
!
!
!
!
! !
!!
!
!
!
!
!
!
!
!
!!
!
! !!!!!!
!
!
! !! !
!
! ! !! !
!
!
!
!
!
!
!
!!
! ! !!
!
!
! !
! !
! !
!
! !
!
!
!
!
!
!! !
! !
!!
!!
!
! ! !
!
!
!
! !
!!!!
!
!!
!
!
!!
!
! !
!
!
!!!
!
!!
!!
!!
!
!
!
!! ! !!
!
!
!
!
!
!
!
!
!!
!
!!
!
!
!!
! ! !
!
!
!
!
!! !!! !! ! !
!
!
! !
!!
!
!
!
!!
!
! !!
!
!
!
!
!
!
!
! !
!
!!
!
!!
! ! ! !
!
!
!! !
!
!
! !
!
!
!
!!
!!
!
! !! !! !
!
!!
!
!
!
!
!
!
! !
! !!
!
!
!! !
! ! !
!!
!
! ! !!
!!
!
!
! !
!
! !!! !
!
!
!
!
!
! !
!! !!
!
!! !
!! ! !
!
!
! ! !!
!
!!
! !
! !
! !
! !!
!!
!
!
!
! !!! !!
!
!
!!
!
!
!
!
!
!
!
! !
!
!
!
!!
!
!
!
!
!
!!
! !
!
!
!
!
!
!
!
!
! !
!
!
!
!
!
!
!
!
! !!
!
!
!
!
!
!
!!
!
!
!
!
!! !
!!
!
! !
! !
!
!
! ! !!
! !!
!
!
!
!
!
!
!
!
!
!
!!
!
!! !
!
!
!
!
= 1 child death
N=719
Page 13
of child deaths from 2010 to 2014. Hamilton County communities to the north also witnessed a large
number of child deaths from 2010 to 2014. To determine the location of your community, please refer
to the map on page i of the Appendix.
The child fatality rate, much like an infant mortality rate, is also an important indicator of community
health. While it is expected that an infant mortality rate may increase when a community experiences
more births, a child fatality rate is not necessarily as sensitive relative to the number of child residents
in a community.
Hamilton County Child Deaths by Community Specific Child Fatality Rate, 2010-2014
!!
!
!
!!! !
!
!!
!!
!
! !!
!
!!
!
!!
!
!
!
!
!
!
!
!
!
!
!!
!
!
! !
!!
!
!!
! !
!
!
!
!
!
!
!
! !!
!
!!
!
!
!
!
!
!!
!
!
!
!! !!
!!!
!
!
!
!
!
!
!
!
!
!
!
! !!
!
!
!
!
!
!
!!
!
!
!
!
!! !
!!
!
!
! !
! !
!
!
!
!
!
!
!!!
!!!!
!
!
!
!
!
!
!
!
!!
!
! !
!
!
!!
!
!
!
!!
!
!
!!
!!
!
!!
!
! !
!!
!
!
!
!
!
!
!
! !
!
!
!
!
!
!
!!
!
!
!
!
!
!
!
!
! !!
!
!
!
! !
!
!
! !
!
!! !
!
!
!!
!
!
!
!
!
!
!!
!
! !
!
!!!!
!
!
! !!! !
!
!
!
!!
!
!
!
!
!
!
!
!
!!!
!
! ! !
!
!
!!
!
!
! !
!!
!
!
!
!
!
! !
!!
!
!
!
!
!
!
!!
!
!
!
! !!!!!!
!! !
!
!
!
!
! ! !! !
!
!
!
!
!
!
!
!!
! ! !!
!
!
!
!
! !
! !
!
! !
!
!
!
!
!
!! !
! !
!!
!!
!
! ! !
!
!
!
! !
!!!!
!
!!
!
!
!!
!
! !
!
!
!!!
!
!!
!!
!!
!
!
!
!! ! !!
!!
!
!
!
!
!
!
!!
!
!!
!
!
!!
! ! !
!
!
!
!
!! !!! !! ! !
!
!
! !
!
!!
!
!
!
!!
!
!!
!
!
!
!
!
! !!
! !
!!
!
!!
! ! ! !
!
!! !
!
!
!
! !
!
!
!
!!
!
!
! !! !! !
!
!
!!
! !
!
!
!
!
!
!
!!
!
!
!
!! !
! ! !
!!
!!
! ! !!
!
!
!
! !
!
! !!! !
!
!
!
!
!
!
!
!
! !
!! !!!
!
!! !
!
!
! ! !!
!
! !
!!
! !
! !
! !!
!!
!
!
!
! !!! !!
!
!
!!
!
!
!
!
!
!
!
! !
!
!
!
!!
!
!
!
!
!
!!
! !
!
!
!
!
!
!
!
!
! !
!
!
!
!
!
!
!
!
!
! !
!!
!
!
!
!
!
!
!
Child Fatality Rate
per 10,000 Children
0.0-1.6
1.7-5.2
5.3-8.5
8.6-11.9
12.0-21.5
= 1 child death
N=719
!!
!
!! !
!
! !!
!
!
!
!
!
!
!
!
!
!
!!
!
!! !
!
!
!
!
Note:
Some child fatality rates are based on a small number of cases (i.e. less than 20) and
should be interpreted with caution, as it may be difﬁcult to distinguish random
fluctuations in incidence from true changes in the underlying risk.
As illustrated by the map above, communities in the western part of the County and north of the City
of Cincinnati have some of the highest child fatality rates. However, these communities have fewer
numbers of child deaths and smaller child populations than the City of Cincinnati. The largest burden of
child fatality in terms of the number of child deaths, however, lies within the City of Cincinnati.
Sociodemographics
Child deaths and, child health can be influenced by sociodemographic factors, such as poverty, and the
community in which the child lives2. One way to look at how multiple sociodemographic factors interact
to influence the health of children, and ultimately child deaths, is to look at the level of concentrated
disadvantage in the community where the child resided. Concentrated disadvantage is an indicator
that shows areas of a community that are at an economic disadvantage. Communities that have
higher levels of concentrated disadvantage often times have less mutual trust and willingness among
community members to intervene for the common good, often known as collective efficacy3. Collective
efficacy is a critical way that communities inhibit the perpetration of violence3. Children who live and
grow in disadvantaged areas are more likely to experience violence3. Communities with high levels of
concentrated disadvantage are also at an increased risk for higher rates of infant mortality3.
Page 14
Concentrated disadvantage is calculated using five indicators:
1.
2.
3.
4.
5.
Percent of individuals living below the poverty line;
Percent of individuals on public assistance;
Percent of female-headed households;
Percent of the population who are unemployed;
Percent of the population who are less than 18 years of age3
The map below shows communities that had low, medium, and high levels of concentrated disadvantage
in Hamilton County in 2012.
Hamilton County Child Deaths by Levels of Concentrated Disadvantage, 2010-2014
!!
!
!
!!! !
!
!!
!!
!
! !!
!
!!
!
!!
!
!
!
!
!
!
!
!!
!
!
! !
!
!
!
! !! !
!
!
!
!
!
! !
!
!
!
!
!
!
!
!
!
! !
!!
!
!
!
!
!
!
!
!!
Concentrated Disadvantage
!
! !!
!
!
!
!
!!!
!
!
!
!! !!
!!!
!
!
!
!
!!
!
!
!
!
!
!
!
!
!
!
!
!!!!
!
!
!
!
!
!
!!
!
!
!
!!
!
!
!
!
!!
!
!!
!
!
!
!
!
!
!!
!
!
!
!
!
!
!
! !
!
!
!
!
!
!
!!
!
!
!
!
!
!
!
!
! !!
!
!
!
! !
!
!
! !
!
!! !
!
!
!!
!
!
!
!
!
!
!!
!
! !
!
!!!!
!
!
! !!! !
!
!
!
!
!
!
!
!
!
!
!
!
!
!!!
!
! ! !
!
!
!!
!
!
! !
!!
!
!
!
!
!
! !
!!
!
!
!
!
!
!
!!
!
!
!
! !!!!!!
!! !
!
!
!
!
! ! !! !
!
!
!
!
!
!
!
!!
! ! !!
!
!
! !
! !
! !
!
! !
!
!
!
!
!
!! !
! !
!!
!!
!
! ! !
!
!
!
! !
!!!!
!
!!
!
!
!!
!
! !
!
!
!!!
!
!!
!!
!!
!
!
!
!! ! !!
!
!
!
!
!
!
!
!
!!
!
!
!
!
!!
! ! !
! !!
!
!! !!
!
!
!
!
!
!
!
!
! !
!!
!
!
!
!!
!
! !!
!
!
!
!
!
!
!
! !
!
!!
!
!!
! ! ! !
!
!! !
!
!
!
! !
!
!
!
!!
!
!
! !! !! !
!
!
!!
!
!
!
!
!
!
! !
! !!
!
!
!! !
! ! !
!!
!!
! ! !!
!
!
!
! !
!
! !!! !
!
!
!
!
! !
!!
! !!
!
!! !
!! ! !
!
!
! ! !!
!
! !
!!
! !
! !
! !!
!!
!
!
!
! !!! !!
!
!
!!
!
!
!
!
!
!
!
! !
!
!
!
!!
!
!
!
!
!
!!
! !
!
!
!
!
!
!
!
!
!!
!
!
!
!
!
!
!
!
!
!
!
! !!
!
!
!
!
!
!
!!
!
!
!
!
!! !
!!
!
! !
! !
!
!
!
!! !
!
! !!
!
!
!
!
Low Levels of Concentrated Disadvantage
!
!
!
!
!
!
!
!
!!
!
!! !
!
!
Medium Levels of Concentrated Disadvantage
!
!
High Levels of Concentrated Disadvantage
= 1 child death
N=719
Source: US Census Bureau/American FactFinder, 2012 American Community
Survey. Accessed: 10/13/2014, Available: http://factﬁnder2.census.gov
The urbanized areas in Hamilton County (City of Cincinnati and to the north), along with pockets of
residents in the western portion of
Hamilton County Child Fatality Rate (per 10,000 children) by Level the County, tend to have the highest
of Concentrated Disadvantage, 2010-2014
levels of concentrated disadvantage.
14.0
Correspondingly, the child fatality
12.0
12.8
rate in neighborhoods with high
10.0
levels of concentrated disadvantage
is nearly double the child fatality
8.0
rate in neighborhoods with medium
6.0
6.9
levels of concentrated disadvantage
4.0
and triple the child fatality rate in
4.1
neighborhoods with low levels of
2.0
concentrated disadvantage.
0.0
N=719
High Levels of Concentrated
Disadvantage
Medium Levels of Concentrated
Disadvantage
Low Levels of Concentrated
Disadvantage
It is important to identify the areas
Page 15
that have the largest inequities in child deaths so that targeted interventions may be implemented that
can improve child health and reduce deaths. However, in order to implement these targeted interventions,
we must further understand why and how our children are dying.
Manner and Cause of Death
Every child death is assigned both a manner and cause of death. The manner of death is how the death
of the child is classified based on the surrounding circumstances of the cause of death and how the
cause was brought about. The manner of death is reported as it is listed on the child’s death certificate.
There are five categories in which the manner of death is classified as:
Natural
Accident

Undetermined
Homicide
Suicide
Between 2010 and 2014, 74 percent of child deaths that occurred in Hamilton County were deaths due
to natural causes. Child deaths due to natural causes can be caused by one or more of many serious
health conditions such as congenital anomalies, genetic disorders, cancer, and preterm birth4. During
2010 to 2014, child deaths due to natural causes consistently accounted for over 70 percent of child
deaths. The percent of child deaths due to natural causes has remained relatively stable during this
period. However, in 2014 the percent of child deaths due to natural causes began to increase.
Child
deaths
in
Hamilton County Child Deaths by Manner of Death, 2010-2014
which the manner of
90%
death was deemed
80%
undetermined
accounted for 10
70%
percent
of
child
60%
deaths from 2010
to 2014. A death is
50%
classified as being
undetermined when
40%
the
information
30%
surrounding the death
(that was available at
20%
the time to authorities
10%
completing
the
N=719
investigation)
0%
was
insufficient
2010
2011
2012
2013
2014
to determine the
Natural
Accident
Suicide
Homicide
Undetermined
manner of death5.
Undetermined child
deaths have consistently accounted for over 10 percent of child deaths in Hamilton County. However,
since 2011, the percent of child deaths that were deemed as undetermined have began to trend
downward. Accidental deaths accounted for eight percent of child deaths from 2010 to 2014.
Accidental deaths are deaths in which “there is little or no evidence that the injury or poisoning occurred
with intent to harm or cause death. In essence, the fatal outcome was unintentional6.” Accidental deaths
remained relatively stable from 2010 to 2014. In 2014, the percent of accidental child deaths slowly
began to trend downward.
Child homicides in Hamilton County accounted for six percent of child deaths from 2010 to 2014.
Between 2010 and 2013, the percent of child deaths that were due to homicides slowly increased in
Hamilton County. In 2014, the percent of child deaths due to homicides began to slowly decrease.
Page 16
Suicides represent the smallest percentage of child deaths in Hamilton County. Two percent of child
deaths from 2010 to 2014 were due to suicides. From 2010 to 2013, the percent of child deaths that
were due to suicides slowly increased, and in 2014 the percent of suicide child deaths began to decrease.
DID YOU KNOW?
3
Between 2010-2014:
out of
every
4
County were due to natural
causes.
The cause of death is the actual mechanism by which the death occurred. There are four different
categories into which a cause of death can be classified:
A medical condition
Undetermined if injury or medical condition
External causes due to injury Unknown
If a cause of death was due to a medical condition, the deaths are further classified by the specific medical
condition or disease that contributed to the death of the child. If a child death was from external causes
due to injury, the nature of the injury is further classified and how the injury occurred is also detailed.
Injury is defined as being “any unintentional or intentional damage to the body resulting from acute
exposure to thermal, mechanical, electrical or chemical energy that exceeds a threshold of tolerance in
the body from the absence of such essentials as health or oxygen7.” If a cause of death is unable to be
classified as a death due to a medical condition or from external causes, the death is classified as being
undetermined if injury or a medical condition caused the child’s death. There are instances in which no
information on the primary cause of death is available or known. In these types of cases, the cause of
death is deemed unknown. There were no deaths in Hamilton County from 2010 to 2014 in which the
cause of death was unknown.
The most common cause of death for children in Hamilton County was due to a medical condition
(74 percent). Child
Hamilton County Child Deaths by Cause of Death, 2010-2014
deaths due to a
medical condition
90%
have
historically
80%
accounted for over
70 percent of child
70%
deaths.
Between
60%
2010 and 2013,
50%
the percent of child
40%
deaths due to a
medical condition
30%
remained relatively
20%
stable.
In 2014,
10%
the percent of child
deaths due to a
N=719
0%
2010
2011
2012
2013
2014
medical condition
From an External Cause of Injury
From a Medical Condition
Undetermined if Injury or Medical Cause
increased.
Child
Note: There were no child deaths in Hamilton County between 2010 and 2014 where a cause of death was unknown.
deaths in which
the cause of death was due to external causes accounted for 16 percent of child deaths from 2010
Page 17
DID YOU KNOW?
2
Between 2010-2014:
out of
every
3
County were caused by a
medical condition.
to 2014. The percent of child deaths due to external causes remained relatively stable from 2010 to
2012 at 15 percent. In 2013, there was an increase in the percent of child deaths caused by external
causes. However, in 2014, the percent of deaths decreased to 2012 levels. The percent of child deaths
whose cause was unable to be determined if the death was the result of an injury or medical condition
accounted for 10 percent of child deaths from 2010 to 2014. Since 2011, the percent of child deaths
whose cause was unable to be determined has been trending downwards.
Preventability Classification
Death rates for children are widely recognized as a valuable measure of the health and well-being of
children in a community. The Hamilton County CFRT works to reduce the number of child deaths in
Hamilton County, and to improve the health and wellbeing of children living in Hamilton County. Each
death is reviewed to determine if the death of the child was considered to have been a preventable
death. A child death is considered to have been preventable if the circumstances that caused the death
of the child could have been changed by either the parent, individual, or the community. Once the CFRT
reviews the death, it is classified as either “Yes, Probably Preventable,” “No, Probably Not Preventable”
or “Team Could Not Determine.” Oftentimes, a case may be deemed as not being able to have been
prevented, or based on the circumstances surrounding the case, it was unable to be determined as
to whether the child death was preventable. These cases are nonetheless important, as the CFRT is
able to identify areas where there are gaps in care, and community factors that could influence health
outcomes. Recommendations for these types of cases are still given by the CFRT as a way to work
toward improving health and wellness, and preventing the deaths of children in the future.
Report Sections
To prevent our children from dying, we must understand more about how and why our children are dying.
This report analyzes the following types of death in-depth to better understand child deaths in Hamilton
County:
Sleep-related deaths
Deaths due to a medical condition

Drownings
Motor vehicle deaths
Asphyxia deaths
Homicides
“Other types of child death”
Suicides
Each section will conclude with the preventability of each type of death along with the recommendations
made by the Hamilton County CFRT on how communities can work at preventing these types of death.
Page 18
Medical Deaths
A
s illustrated previously, the majority of child deaths in Hamilton County are caused by a medical
condition. When a death is due to a medical condition it i,s the result of the natural progression of
a disease, ailment, disorder, or prematurity. A death due to a medical condition is further identified and
classified into one of 17 medical conditions that contributed to the death of a child:
Asthma
Pneumonia
Cancer
Prematurity
SIDS
Cardiovascular
Congenital Anomaly
Other Infection
Other Perinatal Condition
HIV/AIDS
Other Medical Condition
Influenza
Low Birth Weight
Undetermined Medical Cause
Unknown
Malnutrition/Dehydration
Neurological/Seizure Disorder
Seventy-four percent of all child deaths in Hamilton County from 2010 to 2014 were due to a medical
condition. From 2010 to 2012, the percent of child deaths in Hamilton County due to a medical condition
remained relatively stable. In 2013, the percent of child deaths due to a medical condition was the
lowest during the 2010 to 2014 period (70 percent). However, in 2014 the percent of child deaths due
to a medical condition sharply increased to the highest percent over the five year period (81 percent).
Age
While medical conditions can affect everyone, child deaths due to a medical condition in Hamilton County
disproportionately impact infants younger than one year of age. Eighty-three percent of all child deaths
due to a medical condition
Percent of Hamilton County Child Deaths due to a Medical Condition,
were to infants (children
2010-2014
less than one year of age).
82%
80%
78%
76%
74%
72%
70%
68%
66%
64%
N=533
2010
2011
2012
2013
2014
When age is further broken
out, disparities begin to
emerge. Children who are
less than 28 days of age
(neonates) accounted for
49 percent of child deaths
due to a medical condition
from 2010 to 2014. Postneonates (infants who
are between 28 days of
age and one year of age)
accounted for the second
largest percentage of child
deaths due to a medical
condition (34 percent).
As a child gets older, the percent of deaths due to a medical condition drastically drops. Children who
are between one and four years of age accounted for six percent of child deaths due to a medical
condition. Children who are between five and nine accounted for five percent of child deaths due to a
medical condition. Four percent of child deaths due to a medical condition were to children who were
between 10 and 14, while older children who are between 15 and 17, accounted for the smallest percent
Page 19
(three percent) of child deaths due to a medical condition in
Hamilton County.
Sex
Child deaths that are due to a medical condition not only
are disproportionately higher in infants in Hamilton County,
the percent of deaths due to a medical condition are higher
among male children. Fifty-nine percent of child deaths
due to a medical condition in Hamilton County from 2010
to 2014 were to male children.
Hamilton County Child Deaths Race/Ethnicity
Sex and age are not the
due to a Medical Condition by only inequities in child
Sex, 2010-2014
deaths due to a medical
Hamilton County Child Deaths due to a
Medical Condition by Age, 2010-2014
6%
3%
4%
5%
34%
49%
condition in Hamilton
County; when the race/
ethnicity of the child
5-9 Years
<28 Days
Male
Female is taken into account,
28 Days - 1 Year
10-14 Years
further
inequities
1-4 Years
15-17 Years
emerge. As illustrated
N=533
previously, non-Hispanic
N=533
black children account for the largest percent of all child deaths in
Hamilton County. Non-Hispanic black children also account for the
highest percentage of child deaths that were due to a medical condition. From 2010 to 2014, 54 percent
of child deaths that were due to a medical condition were to non-Hispanic black children. The percent
of child deaths to non-Hispanic black children that were due to a medical condition was nearly 1.5 times
higher than for non-Hispanic white children and 6 times higher than for non-Hispanic multi-racial, nonHispanic other races, and Hispanic children combined.
59%
41%
Non-Hispanic white children accounted for the second highest percentage (38 percent) of child deaths
that were due to a medical condition in Hamilton County from 2010 to 2014. Children who were nonHispanic multi-racial accounted
Hamilton County Child Deaths due to a Medical Condition by
for three percent of child deaths
that were due to a medical 60%
Race/Ethnicity, 2010-2014
condition. Children who were
non-Hispanic and identified with 50%
54%
another racial group accounted
for the smallest percentage of 40%
child deaths due to a medical
38%
condition (two percent). Hispanic 30%
children accounted for three
percent of child deaths that were 20%
due to a medical condition from
2010 to 2014 in Hamilton County.
10%
Prematurity,
congenital
2%
3%
3%
anomalies and other types of
0%
medical conditions, not listed on N=533 non-Hispanic White non-Hispanic Black non-Hispanic Multi- non-Hispanic Other Hispanic, Any Race
Racial
page 18 of this report, were the
top three leading medical conditions that caused a child’s death from 2010 to 2014 in Hamilton County.
Page 20
The largest percentage (60 percent) of child deaths due to a medical condition in Hamilton County were
caused by prematurity. Prematurity, also known as preterm birth, is the birth of a baby that is at least
three weeks prior to the baby’s due date (<37
Hamilton County Deaths due to a Medical Condition by weeks gestation)8. Preterm birth can cause
many health complications for the child later
Top 3 Medical Conditions, 2010-2014
in life, such as long-term motor, cognitive,
visual, behavioral, and growth problems9.
Prematurity
60%
14%
6%
Congenital anomalies accounted for 14
percent of child deaths due to a medical
condition.
A congenital anomaly, more
Other Medical Condition
commonly known as a birth defect, is a
serious condition that changes the structure
of one or more parts of the body that can affect almost any part of the body (e.g., heart, brain)10. Other
types of medical conditions that are not captured by the CFR online data system accounted for six
percent of the child deaths due to a medical condition.
Congenital Anomalies
Preventability
Many health conditions can result in the death of a child, and it is believed that many of the medical
conditions cannot be considered to be preventable
in the same way an accident or homicide is Preventability of Hamilton County Child Deaths due
deemed preventable. However, there are some
to a Medical Condition, 2010-2014
instances in which the illness, disorder or deaths
60%
may have been prevented. Early screening and
50%
53%
detection, consistent and early prenatal care and
counseling that may aid in the prevention of some
46%
40%
medical conditions1. Not all medical conditions
can be prevented, however, early and appropriate
30%
detection and treatment can aid in the prevention
20%
of the death of a child due to a medical condition.
The Hamilton County CFRT deemed that 53
10%
percent of child deaths between 2010 and
1%
0%
2014 that were due to a medical condition were
Yes, Probably
No, Probably Not
Team Could Not Determine
probably not preventable. The Hamilton County N=533
CFRT could not determine, based on the circumstances surrounding the case, if the death of the child
could have been prevented in 46 percent of child deaths due to a medical condition. One percent of child
deaths due to a medical condition between 2010 and 2014 could have been prevented by changing
various circumstances that led to the death of the child.
Recommendations to prevent child deaths due to medical conditions.
Community Awareness
Community awareness around the seriousness of asthma
Community awareness on the seriousness of medical situations (i.e. if diagnosed with a
condition stress importance of keeping up with appointments and treatment plans).
Physician Awareness
Physician awareness on the importance of educating parents on the signs/symptoms of Type
I and Type II diabetes.
Physician awareness on the importance of doing diabetes and blood sugar level testing at
annual check-ups.
Page 21
Motor Vehicle Deaths
M
otor vehicle injuries are a leading cause of death among children in the United States11. However,
many of these deaths can be prevented. Between 2010 and 2014, three percent of all child deaths
in Hamilton County were due to motor vehicle accidents. Child deaths due to motor vehicle accidents
have remained relatively stabled, accounting for less than five percent of child deaths during 2010 to
2014.
Percent of Hamilton County Child Deaths due to Motor Vehicle Age
Motor
Accidents, 2010-2014
5%
vehicle accidents can happen
to anyone, however, new teen drivers
are at a high risk for causing a motor
4%
vehicle accident12. The majority of
child deaths that were due to motor
3%
vehicle accidents in Hamilton County
were among older children. Forty-one
percent of child deaths due to motor
2%
vehicle accidents between 2010 and
2014 were children between 15 and
1%
17 years of age. Younger children,
between one and four-years-of-age,
N=22
0%
accounted for the second highest
2010
2011
2012
2013
2014
percent (32 percent) of child deaths
due to motor vehicle accidents during 2010 to 2014. Fourteen percent of child deaths that were due
to motor vehicle accidents were to children who were
Hamilton County Child Deaths due to
between 10 and 14. Children who were between five and
nine also accounted for 14 percent of child deaths that
Motor Vehicle Accidents by Age,
were due to motor vehicle accidents between 2010 and
2010-2014
2014.
Sex
Child deaths that are due to motor vehicle accidents
not only are disproportionately higher in older children
in Hamilton County, but the percent of deaths due to
motor vehicle accidents are higher among male children.
Seventy-three percent of child deaths that were due to
motor vehicle accidents
Hamilton County Child Deaths between 2010 and 2014
due to Motor Vehicle Accidents in Hamilton County
were to male children.
by Sex, 2010-2014
Female
children
accounted
for
27
percent of child deaths
due to motor vehicle
Male
Female accidents in Hamilton
County.
73%
41%
32%
14%
27%
N=22
14%
1-4 Years
10-14 Years
5-9 Years
15-17 Years
Age/Sex Combined
N=22
Page 22
When sex and age of the child are coupled together, further inequalities in
child deaths due to motor vehicle
Hamilton County Child Deaths due to Motor Vehicle Accidents by
35%
accidents emerge. Male children
Age and Sex, 2010-2014
who were between 15 and 17
30%
Male
years of age accounted for the
32%
Female
largest percentage of child deaths
25%
due to motor vehicle accidents
from 2010 to 2014. Thirty-two
20%
percent of child deaths due to a
motor vehicle accident were to
18%
15%
male children between 15 and
14%
17. The percent of child deaths
14%
10%
due to motor vehicle accidents to
9%
9%
male children between 15 and 17
5%
was 3.5 times higher than their
5%
female counterparts in the same
0%
age group.
Female children
1-4 Years
5-9 Years
10-14 Years
15-17 Years
who were between 15 and 17 Note: Female children between 10 and 14 years of age are not shown because there are no child deaths due to
N=22
accounted for nine percent of motor vehicle accidents to this group of children in Hamilton County between 2010 and 2014.
child deaths due to motor vehicles accidents in Hamilton County between 2010 and 2014. Male children
who were between one and four accounted for the second largest percent of child deaths due to motor
vehicles, 18 percent. Female children between one and four accounted for 14 percent of child deaths
due to motor vehicle accidents. Male children who were between 10 and 14 also accounted for 14
percent of child deaths due to motor vehicle accidents. Nine percent of child deaths between 2010 and
2014 that were due to motor vehicle accidents in Hamilton County were to male children between five
and nine-years-of-age. Female children who were between five and nine accounted for the smallest
percentage of child deaths due to motor vehicle accidents; five percent.
Race/Ethnicity
As illustrated previously, non-Hispanic black children in Hamilton County represented the largest
percentage of child deaths. Non-Hispanic
Hamilton County Child Deaths due to Motor Vehicle
black children also accounted for the largest
Accidents by Race/Ethnicity, 2010-2014
percentage of child deaths that were due to
motor vehicle accidents. Fifty-five percent of
non-Hispanic white
child deaths due to motor vehicle accidents
from 2010 to 2014 in Hamilton County were
non-Hispanic black
to non-Hispanic black children. Non-Hispanic
white children accounted for a slightly
smaller percentage of the child deaths due to motor vehicle accidents, 45 percent.
45%
55%
DID YOU KNOW?
Between 2010-2014:
1
Car accident involving a
child as a driver, occupant,
or pedestrian occurs in
Hamilton County
EVERY
9
Days
Page 23
Geography
Hamilton County Child Deaths due to a Motor Vehicle Accident by Percent
As shown by the map
of Motor Vehicle Accidents Involving Children by Community, 2010-2014
to the right, inequities
in child deaths due to
!
appear by Hamilton
!
County
community.
!
!
Not all communities
!
!
witnessed a child death
!
!
!
!
due to a motor vehicle
!
accident between 2010
!
!
and 2014. The urban
!
!
!
core of Hamilton County,
!
the City of Cincinnati,
experienced the largest
!
Percent of Motor
!
!
!
Vehicle Accidents
number of child deaths
Involving Children*
due to motor vehicle
6-10%
11-12%
accidents from 2010 to
!
13-14%
2014. However, the areas
15-17%
with the largest number
18-33%
*Motor vehicle accidents involving children (under 18 years of age) who
were drivers, occupants or pedestrians
= 1 child death
of child deaths due to
N=22
were not the Hamilton County communities that had the largest percentage of motor vehicle accidents
that involved children (either as the driver, occupant or pedestrian).
Hamilton County Child Deaths due
to Motor Vehicle Accidents by Child
Position, 2010-2014
36%
36%
Driver
Passenger
Pedestrian
Unknown
23%
5%
N=22
Vehicle Position
In 23 percent of child deaths in Hamilton County from 2010
to 2014 that were due to motor vehicle accidents, the child
was the driver. In 36 percent of child deaths due to motor
vehicle accidents in Hamilton County from 2010 to 2014
the child was the passenger in the vehicle. Children who
were pedestrians (which include those children who were
on bicycles and struck by a car) accounted for 36 percent
of child deaths due to motor vehicle accidents from 2010 to
2014. In five percent of child deaths due to motor vehicle
accidents the position of the child at the time of the accident
was unknown.
Passenger
Location
As illustrated previously, in over one-third of all child deaths
due to motor vehicle accidents in Hamilton County from
2010 to 2014 the child was a passenger in the vehicle at the
time of the accident. In 63 percent of child deaths due to
motor vehicle accidents in which the child was a passenger,
the child was sitting in the back seat of the car at the time of
the accident. In 38 percent of child deaths in which the child
was a passenger, the child was sitting in the front seat of the
car at the time of the accident.
Page 24
Hamilton County Child Deaths due
to Motor Vehicle Accidents by Child
Passenger Location, 2010-2014
38%
Front seat
63%
Back seat
Seatbelt/Car Seat/Booster Seat Use
One of the most effective ways individuals can prevent injury or death due to a motor vehicle crash is by
using a seatbelt or booster/car seat for small children. In the State of Ohio every driver and front seat
passenger must wear a seatbelt13.
Hamilton County Child Deaths due to Motor Vehicle Accidents by In 27 percent of child deaths from
Seatbelt/Car Seat/Booster Seat Use, 2010-2014
2010 to 2014 in Hamilton County
45%
that were due to a motor vehicle
40%
accident, the child was properly
41%
restrained using a seatbelt/
35%
car seat/booster seat. In five
30%
percent of child deaths due to
motor vehicle accidents the child
25%
27%
was restrained using a seatbelt/
20%
car seat/booster seat, however, it
18%
was not used properly. Children
15%
who were not using a seatbelt/
10%
car seat/booster seat accounted
9%
for 18 percent of child deaths
5%
5%
due to motor vehicle accidents.
0%
For the majority of child deaths
Yes
Yes, Used Incorrectly
No
Not Needed
Unknown
due to motor vehicle accidents,
N=22
41 percent, a seatbelt/car-seat/
booster-seat was not needed. In these instances the child was not in a motor vehicle at the time of the
accident. In nine percent of child deaths due to motor vehicles it was unknown whether the child was
restrained using a seatbelt/car seat/booster seat.
Hamilton County Child Deaths due to Motor
Children in the State of Ohio are required to use
Vehicle Accidents to Child Passenger, <10
booster seats once they outgrow their car seat and
until they are either eight years old or at least four feet
Years of Age by Car/Booster Seat Usage,
nine inches tall14. Eighteen percent of child deaths
2010-2014
due to motor vehicle accidents in Hamilton County
from 2010 to 2014 involved a child passenger who
was younger than 10 years of age. In 25 percent
of child deaths due to motor vehicle accidents that
Were in a car-seat/
involved a child as a passenger that was 10 years of
booster-set that was
age and younger, the child was in a car seat/booster
used improperly
seat that was not properly used. This could mean
that the child was not properly restrained in the seat,
or the incorrect type of car seat/booster seat was
used for the child’s age and/or height and weight.
Did not have a carIn 75 percent of child deaths due to motor vehicle
seat/booster-seat but
accidents that involved a child as a passenger that
needed one
was 10 years of age and younger did not have a car
seat/booster seat, but based on the child’s age and/or height and weight needed one.
25%
75%
Contributing Factors
There are many factors that can cause a car accident. From 2010 to 2014, in 32 percent of child deaths
that were due to motor vehicle accidents, speeding over the posted speed limit was a factor in the car
accident. Drugs and/or alcohol was a factor in 32 percent of child deaths due to motor vehicle accidents
Page 25
in Hamilton County. In 23 percent of child
deaths due to motor vehicle accidents
reckless driving was a factor. Running
a red light or stop sign was a factor in
14 percent of child deaths due to motor
vehicle accidents. Distracted drivers were
a factor in five percent of child deaths due
to motor vehicle accidents. Drivers can
be distracted by multiple things such as
cell phones, radios, and other passengers.
Rollovers were a factor in five percent of
deaths due to motor vehicle accidents.
Thirty-two percent of child deaths had
other factors that contributed to the
death. These are factors such as darting/
walking across a road and not yielding to
traffic, and running from the police.
0%
0%
20%
Hamilton County Child Deaths due to a Motor Vehicle
Accident by Factors/Causes Involved in Accident, 2010-2014
Speeding over the limit
Drugs/Alcohol
Reckless driving
Ran a red light/stop sign
Driver Distracted
Rollover
Other Causes
32%
32%
23%
14%
5%
5%
32%
Note: Percentages of do not equal 100 percent as multiple factors can be
present for each car accident.
20%
40%
40%
60%
60%
80%
80%
100%
40%
60%
80%
100%
100%
Preventability of Hamilton County Child Deaths Preventability
Motor vehicle accidents are a public health problem,
due to 0%a Motor
2010-2014
20% Vehicle
40% Accident,
60%
80%
100%
Yes, Probably
Yes, Probably
0%
20%
95%
Yes, Probably
Yes, Probably
5%
N=22
and many deaths due to motor vehicle accidents can
be prevented. The Hamilton County CFRT deemed
that 95 percent of child deaths between 2010 and
2014 that were due to motor vehicle accidents could
have been prevented. The Hamilton County CFRT
could not determine, based on the circumstances
surrounding the case, if the death of the child could
have been prevented in five percent of child deaths
due to a motor vehicle accident.
Recommendations to prevent child deaths due to motor vehicle accidents.
Community Awareness
Community awareness around the importance that proper restraints (car seat/booster seat)
for the age and/or height and weight of a child be used while they are in a vehicle.
Community awareness on the importance of wearing your seatbelt.
Community awareness on the importance of driving cautiously in and around a school zone.
Community awareness on safe driving practices, do not drive distracted, and if you cannot
make it, or think you cannot make it in time, do not pull out into traffic, wait until there is room.
Community awareness on the importance of not letting your children play in or around
streets/roadways.
Community awareness on the importance of knowing where your children are during all times
of the night regardless of age.
Policy Change
Change in policy that courts should order mandatory drug treatment after an individual has
been arrested on drug related charges more than twice.
Continued Education
Make literature (advertise brochures, posters, flyers) available that indicate which fire
department and/or location can help check to ensure that a car-seat is fastened properly.
Continued education to high school children on the importance of not drinking, doing drugs
and driving, and not getting into a vehicle with someone who is under the influence.
Page 26
Homicides
H
omicides are a serious public
Percent of Hamilton County Child Deaths due to Homicides,
health problem and can have
2010-2014
8%
lasting effects on communities.
Homicide is an extreme outcome of
7%
the broader public health problem
6%
of interpersonal violence15.
Child
homicides can have profound long5%
term emotional consequences on
4%
families and friends of victims and
3%
witnesses to the violence16. They
can also cause excessive economic
2%
costs to residents of affected
1%
communities16. Between 2010 and
2014, six percent of all child deaths 0% N=41
in Hamilton County were due to
2010
2011
2012
2013
2014
homicides. In 2010, the percent of
child deaths due to homicides was the lowest in the five year time period of 2010 to 2014 (four percent).
From 2010 to 2013, the percent of child deaths that were due to homicides slowly increased to seven
percent, the highest in five year time period of 2010 to 2014.
Hamilton County Child Homicides by
Age, 2010-2014
17%
34%
24%
20%
5%
Age
Homicides of children are most often murders of teens by
other teens17. The majority of child homicides in Hamilton
County were to older children. Thirty-four percent of child
homicides were to children who were between 15 and 17
years of age. Children who were between one and four
accounted for the second largest percentage of child
homicides (24 percent). Twenty-percent of child homicides
were to children between 10 and 14. Infant children who
were between 28 days and one year of age accounted for 17
percent of child deaths that were due to homicides. Children
who were between five and nine accounted for the smallest
percentage (five) of homicides to Hamilton County children
from 2010 to 2014.
Sex
Child homicides are not
only
disproportionately
10-14 Years
28 Days - 1 Year
higher in older children
in Hamilton County, but
1-4 Years
15-17 Years
the percent of homicides
5-9 Years
N=41
are also higher in male
children. Sixty-six percent of child homicides between 2010 and 2014
in Hamilton County were to male children. Female children accounted
for 34 percent of child homicides in Hamilton County between 2010
and 2014.
Homicides by Sex,
2010-2014
66%
Male
34%
Female
N=41
Page 27
Race/Ethnicity
When the race/ethnicity of the child is taken into account, inequities in child homicides in Hamilton County
emerge. Non-Hispanic black children, as illustrated previously, account for the largest percentage of all
child deaths in Hamilton County. NonHamilton County Child Homicides by Race/Ethnicity,
Hispanic black children also accounted
2010-2014
for the highest percentage of child deaths
that were due to homicides. From 2010
non-Hispanic white
to 2014, 73 percent of child deaths that
were due homicides were to non-Hispanic
non-Hispanic black
black children. The percent of homicides
to non-Hispanic black children was three
Hispanic, Any Race
times higher than the homicides to nonHispanic white children and 30 times
higher than homicides to Hispanic children. Non-Hispanic white children represent the second highest
percentage of child homicides in Hamilton County from 2010 to 2014 (24 percent). Hispanic children
represented the smallest percentage (2 percent) of child homicides in Hamilton County.
24%
73%
2%
Sex and Race/Ethnicity Combined
When sex and race/ethnicity are coupled together, further inequities in child homicides in Hamilton
County emerge. Non-Hispanic black
Hamilton County Child Homicides by Race/Ethnicity and
male children accounted for the largest
50%
Sex, 2010-2014
percentage of child homicides from
45%
2010 to 2014. Forty-six percent of
46%
child homicides in Hamilton County
40%
Male
between 2010 and 2014 were to non35%
Female
Hispanic black males. The percent of
30%
homicide deaths to non-Hispanic black
25%
male children was nearly three times
27%
20%
higher than homicides to non-Hispanic
15%
white children and 19 times higher than
17%
homicides to Hispanic male children
10%
in Hamilton County. Non-Hispanic
5%
2%
7%
black females represented the second
0%
highest percentage of child homicides
non-Hispanic White
non-Hispanic Black
Hispanic, Any Race
Note: Hispanic female children are not shown as there were no child homicides to Hispanic female
from 2010 to 2014 (27 percent). The
children in Hamilton County between 2010 and 2014.
N=41
percent of deaths to non-Hispanic
black females is nearly four times higher than homicides to non-Hispanic white female children, and 1.5
times higher than homicides to non-Hispanic white male children in Hamilton County. Seventeen percent
of child homicides in Hamilton County from 2010 to 2014 were to non-Hispanic white male children.
Non-Hispanic white female children accounted for seven percent of child homicides in Hamilton County
1
DID YOU KNOW?
Between 2010-2014:
Child homicide occurred
in Hamilton County
Page 28
EVERY
45
Days
from 2010 to 2014. Hispanic male
children accounted for the smallest
percentage of child homicides (two).
Hamilton County Child Homicides by Levels of Concentrated
Disadvantage, 2010-2014
Sociodemographics
!
!
!
!
There are many community factors
that can contribute to youth violence
and child homicide.
Diminished
economic
opportunities,
high
concentrations of poor residents, and
low levels of community participation
are some of the risk factors that
can contribute to child homicide18.
Communities that have high levels
of
concentrated
disadvantage
oftentimes have less mutual trust
and collective efficacy3. Collective
= 1 child death
efficacy is critical for communities
N=41
to inhibit the perpetuation of
violence3. Children who live and grow in disadvantage areas are more likely to experience violence3. The
urbanized areas in Hamilton County (City of Cincinnati and to the north) tend to have the highest levels
of concentrated disadvantage as illustrated by the map above. Correspondingly, the majority of child
Percent of Hamilton County Child Homicides homicides occurred within the communities that have
high levels of concentrated disadvantage. Sixty-one
by Level of Concentrated Disadvantage,
percent of child homicides occurred in communities
2010-2014
70%
that had high levels of concentrated disadvantage.
60%
The percent of child homicides in communities with
61%
50%
high levels of concentrated disadvantage is double
40%
the percent of child homicides that occurred in
30%
communities with medium levels of concentrated
29%
20%
disadvantage (29 percent) and six times higher
10%
10%
than the percent of child homicides that occurred
0%
in communities with low levels of concentrated
Disadvantage
Disadvantage
Disadvantage
N=41
disadvantage (10 percent).
!
!
!
!
! !
!
!
!
!
!
!
!
!
!
!
!
!
! !
!
!
!
!
!
!
!
!
!
!
!
!!
!
!
!
!
Alcohol and Substance Use
Individual risk factors, such as involvement
with drugs, alcohol or tobacco, poor
behavior control, and exposure to violence,
can also contribute to youth violence and
child homicide18. Ninety-percent of all child
homicides in Hamilton County received a
toxicology screen at the time of death. A
toxicology screen refers to various tests that
determine the type and approximate amount of
legal and illegal drugs a person has taken19. In
34 percent of child homicides, the child tested
positive at the time of death for marijuana.
In five percent of child homicides, the child
tested positive for alcohol. In five percent of
60%
Percent of Hamilton County Child Homicides by
Toxicology Screen, 2010-2014
50%
40%
49%
34%
30%
20%
5%
10%
5%
0%
Toxicology Negative
Alcohol
Marijuana
Other Drugs/Substance
Note: Percentages do not equal 100 percent as child can test positive for multiple drugs at
the time of death.
Page 29
Percent of Hamilton County Child
Homicides by Drug/Substance Abuse
Problems, 2010-2014
child homicides, the child tested positive for another drug/
substance that is not captured by the CFR online data system.
In 49 percent of child homicides, the child had a negative
toxicology screen.
In 24 percent of child homicides in Hamilton County from
2010 to 2014, the child had a drug/substance abuse
29%
problem. In two percent of child homicides, the child did not
Yes
have a drug/substance abuse problem. It was unknown if
No
the child had a drug/substance abuse problem in 29 percent
24%
N/A
of child homicides in Hamilton County. In the majority of
44%
Unknown
child homicides, 44 percent, having a drug/substance abuse
problem was not applicable to the child. The instances in
which a drug/
2%
substance abuse
N=41
Homicides by Delinquent/Criminal
problem was not
applicable it was due to the age of the child. This means that
History 2010-2014
the child was too young (e.g., infant or toddler) to begin to use
5%
drugs to develop a drug/substance abuse problem.
Juvenile Delinquency
Yes
Delinquency is often associated with the perpetration of
No
violence, however, delinquent youth are also at risk for early
34%
49%
20
N/A
violent deaths . In 34 percent of child homicides in Hamilton
County from 2010 to 2014, the child had a delinquent or
Unknown
criminal history. In 12 percent of child homicides the child
12%
did not have a delinquent or criminal history. It was unknown
if the child had a delinquent or criminal history in five percent
N=41
of child homicides from 2010 to 2014. In the majority of child
homicides, 49 percent, having a delinquent or criminal history was not applicable to the child. In these
instances, the child was too young (e.g., infant or toddler) to have a delinquent or criminal history.
Of the child homicides where the child had a delinquent or criminal history, 50 percent had a history of
committing assaults. In 29 percent of child homicides, the child had a delinquent or criminal history
of committing robberies. In 57 percent of
Percent of Hamilton County Child Homicides with a child homicides, the child had a delinquent or
Delinquent/Criminal History by Type of Delinquent/ criminal history of using and/or abusing drugs.
In 93 percent of child homicides, the child had
Criminal Act, 2010-2014
100%
some other type of delinquent or criminal acts
90%
not captured by the CFR online data system.
93%
80%
These delinquent or criminal acts include:
70%
Carrying a concealed weapon
60%
Criminal mischief
50%
57%
Criminal damaging
50%
40%
Criminal trespassing
30%
Unauthorized use of a motor vehicle
29%
20%
Chronic truancy
10%
Obstruction
0%
Violation of court orders
Assaults
Robbery
Drugs
Other Delinquent/Criminal
Acts
Note: Percentages do not equal 100 percent as child can have multiple types of
delinquencies/criminal acts
Page 30
A child who commits delinquent or unruly acts
Percent of Hamilton County Child Homicides
with a Delinquent/Criminal History by Time
Spent in Juvenile Detention, 2010-2014
71%
21%
7%
Yes
No
Unknown
may become involved with the juvenile justice system
and spend time in juvenile detention21. In 71 of child
homicides where the child had a delinquent or criminal
history, the child spent time in juvenile detention. In
21 percent of child homicides in which the child had a
delinquent or criminal history, the child did not spend
time in juvenile detention. It was unknown if the child
spent time in juvenile detention in seven percent of
child homicides in which the child had a delinquent or
criminal history.
Criminal and antisocial parents often tend to have
delinquent and antisocial children22. Family risk factors
such as parental substance abuse or criminality can
contribute to youth violence and child homicide18. In 37
percent of child homicides, the primary caregiver of the
child had a delinquent or criminal history. The primary
caregiver is defined as the person who had responsibility
for the care, custody and control of the child the majority
of the time7. In 27 percent of child homicides, the primary
caregiver of the child did not have a delinquent or criminal
history. It was unknown if the primary caregiver had a
delinquent or criminal history in 37 percent of child
homicides.
Preventability
Homicides by Primary Caregiver
Delinquent/Criminal History 2010-2014
37%
37%
Yes
No
Unknown
27%
N=41
Child homicides are a public health problem, and many
child homicides could have been prevented. The Hamilton
Preventability of Hamilton County
County CFRT deemed that 93 percent of child homicides
Child Homicides 2010-2014
100%
between 2010 and 2014 could have been prevented. Two
90%
percent of child homicides the Hamilton County, the CFRT
93%
80%
deemed that the child homicide could not have been
70%
prevented. The Hamilton County CFRT could not determined,
60%
based on the circumstances surrounding the case, if the
50%
death of the child could have been prevented in five percent
40%
of child homicides.
30%
20%
2%
N=41
10%
0%
Yes, Probably
No, Probably Not
5%
Page 31
Recommendations to prevent child homicides.
Community Awareness
Community awareness on the safe practices of handling children (e.g., a child should never be
shaken, no matter how much the child is crying or being fussy).
Community awareness on the importance of knowing with whom you are leaving your
children (such as knowing the individual’s background and whether the individual has a
criminal history or history of abuse).
Community awareness on the importance of being careful with whom you associate with
(e.g., if a person has a history of criminal activity and being a drug dealer you become guilty
by association).
Community awareness on the dangers of guns (e.g., why they should be properly stored and
locked and kept out of the reach of children).
Community awareness on what constitutes criminal activity and how children should stay
away from any and all criminal activity.
Community awareness that marijuana is still illegal in Ohio and is considered a narcotic even
though other states have legalized it.
Community awareness on the importance of educating youth on building healthy
relationships, and good decisions/behavior.
Policy Change
Policy change where domestic violence and abuse/neglect screening should be followed
through in hospital settings.
Policy change to provide access to counseling for mothers and fathers who are experiencing
mental health problems.
Policy change where schools teach and talk about bullying and its effects from elementary
school through high school.
Delinquency and truancy policy changes in school systems where children with delinquent
and truancy concerns are kept in the school system as opposed to suspensions/expulsions.
Policy change where the caseworker for the parent(s) involve daycares and schools to alert
the caseworker to sudden changes in the demeanor, speech and mannerisms of the child’s
parent(s) to get the parent entered into counseling.
Policy change that ensures all internal protocol, are met/followed to ensure that all associated
parties are at the table when following up with case involvement.
Systems Change
Systems change to enhance the utilization of the school system to address gun violence
towards others.
Systems change to enhance school follow-up for children with delinquent and truancy
concerns.
Systems change in school systems where children with delinquent and truancy concerns are
kept in the school system as opposed to suspensions/expulsions.
Systems change where domestic violence education/training and resources should be made
available to help children recognize domestic violence and what to do when it is encountered.
Systems review of the internal processes for child services to strengthen/build upon the
social aspects of the family for the assigned social/case worker.
Child Fatality Review system change where if an incident occurred in another county that
caused the child to become disabled and the child subsequently moved to another county
and died as a result of complications associated with the incident; the county where the
incidence occurred should also review the case as information about the incident may not be
available to the review board in the county in which the child died.
Page 32
Suicides
S
uicides are a serious public health problem and can have lasting effects on communities. Suicide
rates vary by age group, and reasons for suicide are often complex. A combination of individual,
relational, community, and societal factors contribute to the risk of suicide23. Suicide is the tenth leading
cause of death in the United States, and it is
Percent of Hamilton County Child Deaths due to
estimated that more than 1 million people
Suicides, 2010-2014
6%
reported making a suicide attempt in 201224.
5%
4%
3%
2%
1%
0%
N=17
2010
2011
2012
2013
2014
Between 2010 and 2014, two percent of all
Hamilton County child deaths were suicides.
In 2011, the percent of child suicides was the
lowest in the five year time period of 2010 to
2014 (one percent). Since 2011, however, the
percent of child suicides in Hamilton County
increased to the highest percentage (five)
in 2013. Suicide can impact all children,
however, there are some groups that are at a
higher risk than others25.
Age
All child suicides in Hamilton County were to older children who
were 10 years of age and older. A majority of child suicides , 65
percent, in Hamilton County from 2010 to 2014 were to children
who were between 15 and 17. Thirty-five percent of child suicides
in Hamilton County were to children between 10 and 14.
Suicides by Sex, 2010-2014
Hamilton County Child Suicides
by Age, 2010-2014
Sex
Suicide deaths are more likely
35%
to occur in male children than
65%
female children25. In Hamilton
County male children were
disproportionately affected by
Male
Female a higher percentage of child
suicides than their female
counterparts.
Eighty-two
15-17 Years
10-14 Years
N=17
percent of child suicides in
N=17
Hamilton County between 2010 and 2014 were to male children.
Female children accounted for 18 percent of child suicides in Hamilton County for the same time period.
82%
18%
1
DID YOU KNOW?
Between 2010-2014:
Child died from suicide in
Hamilton County
EVERY
3/
1
2
Months
Page 33
Sex and Age Combined
Hamilton County Child Suicides by Age
and Sex, 2010-2014
When sex and age are coupled together, further
inequities in child suicides emerge. Male children who 60%
Male
are between 15 and 17 years of age accounted for 50%
53%
Female
the largest percentage of child suicides in Hamilton
40%
County from 2010 to 2014. Fifty-three percent of child
suicides were to male children between 15 and 17. The 30%
percent of child suicides to male children between 15
29%
and 17 was nearly double the percent of male children 20%
who were between 10 and 14. Male children who were 10%
6%
12%
between 10 and 14 accounted for 29 percent of child
0%
suicides in Hamilton County between 2010 and 2014. N=17
10-14 Years
15-17 Years
Female children who were between 10 and 14-years-ofage accounted for the lowest percentage of child suicides, six percent. The percent of child suicides
to female children between 15 and 17 (12) was double the percent of child suicides to female children
between 10 and 14.
Race/Ethnicity
As illustrated previously, non-Hispanic black children accounted for the largest percentage of child deaths
in Hamilton County between 2010 and 2014. However,
Hamilton County Child Suicides by
non-Hispanic black children accounted for the smallest
Race/Ethnicity, 2010-2014
percentage of child suicides in Hamilton County. Thirtyfive percent of child suicides were to non-Hispanic black
non-Hispanic white
children. Non-Hispanic white children accounted for the
majority of child suicides (65 percent).
non-Hispanic black
65%
35%
Child Maltreatment
Percent of Hamilton County
Several factors can place children at an increased risk for suicide, such
Child Suicides by Victim of
as stressful life events, history of depression or other mental illness,
and a history of previous suicide attempts25. However, just because Child Maltreatment, 2010-2014
a child has a risk factor for suicide does not mean that suicide will
occur25. One stressful life event a child may experience is being a victim
of child maltreatment. Child maltreatment is any act or series of acts
Yes
35%
of child abuse or child neglect by a parent or caregiver that results in
47%
No
harm, potential for harm, or threat of harm to a child26. In the majority
N/A
of the child suicides (47 percent) in Hamilton County between 2010
and 2014, the child was not a victim of child maltreatment. It was
18%
unknown if the child was a victim of child maltreatment in 18 percent of
N=17
suicides.
Percent of Hamilton County Child Suicides child
In 35 percent of child suicides, the child was a
That were Victims of Child Maltreatment by victim of child maltreatment. Of the child suicides
where70%the child was a victim of child maltreatment,
Type of 0%Child 10%
Maltreatment,
20%
30% 2010-2014
40%
50%
60%
0%
10%
20%
30%
40%
50%
60%
70%
67 percent were victims of physical abuse. Child
Physical
neglect was the type of child maltreatment in 50
Physical
67%
percent of child suicides. In 17 percent of child
Neglect
suicides, the child was a victim of sexual abuse.
Neglect
50%
Emotional and/or psychological abuse was the
Sexual
type of child maltreatment in 17 percent of child
Sexual
17%
suicides where the child was a victim of child
Emotional/Psychological
maltreatment.
Emothional/Psychological
17%
Page 34
Percent of Hamilton County Child Suicides
by Diagnosis of Mental Illness, 2010-2014
Depression and mental Illness
Having a history of depression or mental illness can
increase the risk of child suicide25. A mental illness is “a
condition that impacts a person’s thinking, feeling, mood
Yes
and may affect his or her ability to relate to others and
function on a daily basis27.” In 35 percent of child suicides
No
in Hamilton County from 2010 to 2014, the child had
been diagnosed with a mental illness. In 65 percent of child suicides, the child had not been diagnosed
with a mental illness. Mental illnesses, such as depression and anxiety, can impact an individual’s ability
to participate in healthy behaviors, and can
Percent of Hamilton County Child Suicides with a
decrease an individual’s ability to engage
Mental Illness by Treatment of Mental Illness,
in treatment and recovery for their mental
28
illness .
2010-2014
35%
65%
In 83 percent of child suicides in Hamilton
80%
Unknown
County from 2010 to 2014 where the child
83%
Yes
70%
had been diagnosed with a mental illness,
60%
67%
the child had received professional treatment
50%
for a mental health problem either near the
50% 50%
40%
time of death or in the past. In 67 percent of
30%
33%
child suicides where the child was diagnosed 20%
with a mental illness, the child was currently 10%
17%
receiving mental health services. Children 0%
Child had received prior mental health
Child was currently receiving mental
Child was on medications for mental
currently receiving mental health services,
services
health services
illness
were in treatment which includes seeing a
psychiatrist, psychologist, medical doctor, therapist or other counselor for a mental health or substance
abuse problem; receiving a prescription for an antidepressant or other psychiatric medication, or residing
in an inpatient or halfway house facility for mental health problems7. In 50 of child suicides where the
child was diagnosed with a mental illness, the child was on medications for a mental illness. This means
that the child had an active prescription for psychiatric medication at the time of death.
90%
Risk/Contributing Factors
Hamilton County Child Suicides by Risk/
Contributing Factor(s), 2010-2014
Prior suicide attempts were made
Child talked about suicide
Prior suicide threats were made
Unknown personal crisis
Suicide note was left
Victim of bullying
Breakup with boyfriend/girlfriend
Self-mutilation/Cutting oneself
Parents divorced/separated
41%
35%
35%
29%
24%
18%
18%
18%
12%
Note: Percentages do not equal 100 percent as multiple factors can
contribute to child suicide
The reasons a child commits suicides are often
complex, and may have many risk/contributing
factors that led to suicide. In 41 percent of all child
suicides in Hamilton County from 2010 to 2014, the
child had made prior suicide attempts. The child
talked about suicide in 35 percent of child suicides.
If a child talked about suicide, they only expressed
that they thought about suicide, however, they
never mentioned or described a plan for committing
suicide. Prior suicide threats were made in 35
percent of child suicides in Hamilton County. When
a child made a threat of suicide, they expressed
their intent to kill themselves verbally7.
There may be many reasons a child would commit
suicide. In some instances, a suicide note may
answer why the child committed suicide. In 24
percent of child suicides the child left a note that may
provide some insight into why the child committed
Page 35
suicide. In 29 percent of child suicides, the child was going through some form of personal crisis, but
it was unknown at the time of death what that crisis was that contributed to the child committing
suicide. In 18 percent of child suicides, the child was a victim of bullying which contributed to the child
committing suicide. Breaking up with one’s boyfriend/girlfriend was a contributing factor in 18 percent
of child suicides. Repetition of deliberate self-harm (e.g., self-mutilation/cutting oneself) is a risk factor
for suicide29. In 18 percent of child suicides in Hamilton County from 2010 to 2014, the child had a
history of self-mutilation/cutting oneself. Divorce/separation of the parents can be a large challenge for
not only the parents, but the children as well. Parents who are going through or currently are divorced/
separated was a contributing factor in 12 percent of child suicides in Hamilton County.
Preventability
While these are a few of the risk/contributing factors, suicides are complex and no one risk/contributing
factor can answer why the child committed suicide. Child suicides
Preventability of Hamilton
can have a lasting impact on family, friends and the community,
however, most of these tragic deaths could have been prevented. County Child Suicides, 2010-2014
The Hamilton County CFRT deemed that 88 percent of child suicides
88%
between 2010 and 2014 could have been prevented. The Hamilton
County CFRT could not determine, based on the circumstances
surrounding the case, if the death could have been prevented in 12
percent of child suicides.
100%
90%
80%
70%
60%
50%
40%
30%
Recommendations to prevent child suicides.
12%
20%
10%
0%
N=17
Community Awareness
Increased presence of suicide awareness that highlights the signs to look for in children and
if a child expresses suicidal ideations they should be taken seriously as this can be the child’s
call for help.
Community awareness on the importance of education to children on bullying and the effects
it can have, and that you should seek help if you are being bullied.
Community awareness on the importance of monitoring a child who is taking medication
that can cause suicidal thoughts as a side effect to ensure a child does not act upon these
thoughts.
Systems Change
Systems change in schools that the school psychologists should be proactive and rot reactive
in their work; every student should have a “drop in” session with the school psychologist to
normalize visits to talk about any problems they or their friends may have.
Policy Change
Policy change to improve the linkage to mental health services and follow-up with children
who have mental health issues.
Program Development
Creation of a text messaging service in schools that if a child is having problems or is in
distress they can send a text to a phone number and get linked to a school psychologist and
counselor to help them through the situation.
The creation of peer counseling groups in school where other students can help each other
out through tough times, as it may be easier for some students to talk with their peers.
The creation of a youth mental health first aid kit for non-mental health professionals. This
would provide education to other professionals who interact with the children on a day-to-day
basis (e.g., teachers, faculty) to identify signs and symptoms of when a child may be suffering
and are unable to, or unwilling to, speak up for themselves.
Creation of a program in which parents who are going through divorces/separation can bring
their child to aid in the transition in order to have the least amount of impact on the child’s
behavior and emotional state.
Page 36
Yes, Probably
Sleep-Related Deaths
A
sleep-related death is the death of a
Percent of Hamilton County Child Deaths that were
child that is related to the child sleeping 16%
Sleep-Related, 2010-2014
or the sleep-environment of the child. The
sleeping environment, sleeping position, 14%
sleeping location of the child, and co-sleeping 12%
all can contribute to a child suffering from 10%
a sleep-related death. Between 2010 and
8%
2014, 11 percent of child deaths in Hamilton
6%
County were sleep-related deaths. From
4%
2010 to 2013, the percent of sleep-related
child deaths in Hamilton County remained
2%
N=79
relatively stable accounting for 12 to 13
0%
percent of child deaths. In 2014, the percent
2010
2011
2012
2013
2014
of child deaths witnessed a decrease to the
lowest percentage (five) in the five year time frame of 2010 to 2014. However, while the percentage of
sleep-related child deaths decreased in 2014, recent preliminary data show an increasing trend in the
sleep-related deaths in Hamilton County. These data will be analyzed in next year’s CFR Annual Report.
Hamilton County Sleep-Related
Child Deaths by Age, 2010-2014
8%
28 Days - 1 Year
1-4 Years
92%
N=79
Age
Deaths attributed to the sleep-environment can impact a child
of any age. In Hamilton County the majority of sleep-related
deaths between 2010 and 2014 were to infants. Ninety-two
percent of sleep-related deaths were to infants who were
between 28 days and one
year of age. Children who Hamilton County Sleep-Related
Child Deaths by Sex,
were between one and four
years of age accounted
2010-2014
for eight percent of sleeprelated deaths in Hamilton
County.
Sex
Sleep-related deaths are not only disproportionately higher in infants
in Hamilton County, but the percent of sleep-related deaths are also
higher in male children. Sixty-one percent of sleep-related deaths
in Hamilton County between 2010 and 2014 were to male children.
Female children accounted for 39 percent of sleep-related deaths.
61%
Male
39%
Female
N=79
DID YOU KNOW?
Between 2010-2014:
1
Sleep-related death
occurred in Hamilton
County
EVERY
23
Days
Page 37
Race/Ethnicity
Hamilton County Sleep-Related Child Deaths by Race/
Ethnicity, 2010-2014
When the race/ethnicity of the child is taken
into account, inequities in the sleep-related
deaths in Hamilton County emerge. Over
non-Hispanic white
34%
half (57 percent) of all sleep-related deaths
non-Hispanic black
57%
in Hamilton County were to non-Hispanic
black children. The percent of sleep-related
8%
deaths to non-Hispanic black children was
Hispanic, Any race
nearly two times higher than the percent of
1%
sleep-related deaths to non-Hispanic white
children, nearly eight times higher than the percent of sleep-related deaths to non-Hispanic multi-racial
children, and 45 times higher than the percent of sleep-related deaths to Hispanic children. Non-Hispanic
white children accounted for 34 percent of sleep-related deaths between 2010 and 2014 in Hamilton
County. Eight percent of sleep-related deaths in Hamilton County were to non-Hispanic multi-racial
children. Hispanic children accounted for the smallest percentage of sleep-related deaths in Hamilton
County between 2010 and 2014 (one percent).
Sociodemographics
Hamilton County Sleep-Related Child Deaths by Level of
The sleeping arrangements of
Concentrated Disadvantage, 2010-2014
infants and children, which can
increase or decrease the risk
of a sleep-related death, can be
influenced by a combination of
parental values, socioeconomic
factors and cultural diversity30.
One way to look at how multiple
sociodemographic factors interact
to influence disparities in sleeprelated deaths is to look at the level
of concentrated disadvantage
in the community where the
child resides.
Communities
with high levels of concentrated
disadvantage are at an increased
risk for higher rates of infant
= 1 child death
N=79
mortality3. The urbanized areas
in Hamilton County (City of Cincinnati and to the north) tend to have the highest levels of concentrated
disadvantage, as illustrated by the map above. Correspondingly, half of the sleep-related child deaths
occurred within the communities that have high levels of concentrated disadvantage. Fifty-one percent
of sleep-related child deaths occurred in communities
Percent of Hamilton County Sleepthat had high levels of concentrated disadvantage. The
Related Child Death Level of Concentrated
percent of sleep-related child deaths in communities
with high levels of concentrated disadvantage is
Disadvantage, 2010-2014
60%
slightly higher than the percent of sleep-related
50%
51%
child deaths in communities with medium levels of
40%
43%
concentrated disadvantage (43 percent) and is nearly
30%
seven times higher than the percent of sleep-related
20%
child deaths that occurred in communities with low
8%
10%
levels of concentrated disadvantage (eight percent).
0%
!
!
!!
!
!
!
!
!
!
!
!
!
!
!
!!
!
!
!
!!!
!
!
!
!
! !
!
!
!
!
!
!
!
!
!!
!
!
!
!
!
!
!!
!
!
!! !
!
!
!
!
!
!
!
! !
!
! !
! !
!
!
!
!
!
!
!
!
!
!
!
!
!
N=79
Disadvantage
Page 38
Disadvantage
Disadvantage
Manner and Cause of Death
Oftentimes, no one sees sleep-related deaths occur, and there can be many questions as to what caused
the death of the child31. Identifying the manner
Hamilton County Sleep-Related Child Deaths by
and cause of death of the child can help to
Manner and Cause of Death, 2010-2014
identify what may have caused the death of the 90%
child. Between 2010 and 2014, 14 percent of
80%
85%
sleep-related child deaths in Hamilton County
70%
were due to asphyxia (i.e. suffocation). One
60%
percent of sleep-related deaths were caused
by Sudden Infant Death Syndrome (SIDS). 50%
SIDS is the sudden death of an infant less than 40%
one year of age that cannot be explained after 30%
a thorough investigation is conducted31. In the 20%
14%
majority of sleep-related deaths (85 percent), 10%
1%
it was undetermined if the death was a result 0%
Asphyxia
SIDS
Undetermiend if Injury or Medical
Cause
of injury or a medical cause. These deaths are N=79
often considered to be Sudden Unexplained
Infant Death (SUID).
There are no tests that can be done to distinguish SIDS from suffocation. It is through a thorough
investigation to gain a better understanding of the
Hamilton County Sleep-Related circumstances and events involved with the sleep-environment
associated with the sleep-related deaths that can help to
Child Deaths by Co-Sleeping,
reduce these types of deaths in the future31. The appropriate
2010-2014
safe sleep-environment (even during nap time) is to follow the
4%
ABCs of safe sleep; alone, back, crib.
Co-Sleeping
39%
57%
Yes
No
N/A
N=79
Sleeping alone means the child should be sleeping without an
adult, other children, pillows, blankets or stuffed animals in the
crib or bassinet. Between 2010 and 2014, over half (57 percent)
of sleep-related deaths in Hamilton County, the child was cosleeping with either their parent(s), sibling(s), or caregiver(s).
Co-sleeping is when a parent, sibling, or caregiver sleeps on the
same surface close enough to the child that they can see and
hear the child32. In 39 percent of sleep-related deaths in Hamilton
County, the child was not co-sleeping at the time of death. It
DID YOU KNOW?
Baby sleeps safest alone, on their back, in a crib.
Alone Back Crib
ALWAYS FOLLOW THE ABC’S OF SAFE SLEEP, EVEN DURING NAP TIME
Page 39
Items Present during Child’s Sleep, 2010-2014
Adults
53%
16%
15%
13%
11%
11%
8%
4%
3%
3%
1%
1%
was unknown, based on the investigation, if the
child was co-sleeping at the time of death in four
percent of sleep-related deaths.
Items Present During Sleep
Having items in the same crib/bassinette or
around the child can increase the risk for a
sleep-related death. In over half (53 percent)
Child(ren)
of the sleep-related deaths in Hamilton County
from 2010 to 2014, an adult was sleeping with
Comforter/Blanket
the child at the time of death, also known as cosleeping. In 15 percent of sleep-related deaths,
Other Items
another child was sleeping in the same bed or
crib with the child at the time of death. In 16
Thin Sheet
percent of sleep-related deaths, a pillow, whether
Mattress
under or next to the child, was present at the time
of death. Having items such as pillows, blankets
Wall
and sheets can increase the risk that a child,
particularly an infant, can become entangled/
Boppy Pillow
trapped in the item and suffer from a sleeprelated death. In 13 percent of sleep-related
Cushion
deaths a comforter/blanket was present in the
sleep-environment at the time of death. Other
Bumper Pads
items (e.g., food and hygiene products) were
present on the sleep surface with the child at
Clothing
the time of death in 11 percent of sleep-related
Note: Percentages of do not equal 100 percent as multiple items can be
deaths. A thin sheet was present in 11 percent
present with the child during sleep.
of sleep-related deaths. In eight percent of
sleep-related deaths a mattress was present and contributed to the death of the child (e.g., entrapment
under or between a mattress and another object). In four percent of sleep-related deaths, a wall was
present in which it contributed to the death of a child (e.g., child wedged next to wall). A boppy pillow,
a specific type of pillow used to support the child during breastfeeding and playtime, was present in
the sleep environment in three percent of sleep-related deaths in Hamilton County. A cushion, such as
couch cushion, was present in the sleep environment of three percent of sleep-related deaths. In one
percent of sleep-related deaths in Hamilton County, bumper pads were present in the sleep environment.
Clothing, whether it was the child’s or parent’s/caregiver’s, was present in the sleep environment in one
percent of sleep-related deaths.
Pillow
Sleep Position
Sleep Position, 2010-2014
The sleep position of the child is also part of the 50%
sleep environment. Placing a child on their back to 45%
44%
40%
sleep for every sleep, including nap time, can help to 35%
reduce the risk of the child suffering from SIDS and 30%
other sleep-related causes of death33. In 44 percent 25%
of sleep-related deaths in Hamilton County between 20%
2010 and 2014, the child was placed to sleep on their 15%
back. The child was placed to sleep on their stomach 10%
in 27 percent of sleep-related deaths. In eight percent 5%
0%
of sleep-related deaths, the child was placed to sleep
On Back
N=79
on their side. It was unknown in what position the
child was placed to sleep in 22 percent of sleep-related deaths.
Page 40
27%
22%
8%
On Stomach
On Side
Unknown
Of the sleep-related deaths where the child was placed
on their back to sleep, 46 percent were co-sleeping with
a parent, caregiver, or another child. It was unknown
whether the child was co-sleeping in three percent of
sleep-related deaths where the child was placed to sleep
on their back. In the majority (54 percent) of sleep-related
deaths where the child was placed on their back to sleep,
they were not co-sleeping. However, not all children
who were not co-sleeping and put to sleep on their back
were in a safe sleep environment. Thirty-two percent of
sleep-related deaths where the child was placed to sleep
on their back and were not co-sleeping had other items,
such as pillows, blankets, and/or bumper pads in their
sleep environment at the time of death.
Percent of Hamilton County Sleep-Related
Deaths to Children put on Their Backs to
Sleep by Co-Sleeping, 2010-2014
3%
54%
46%
Yes
No
Unknown
Sleep Location
A safe sleep environment includes the child sleeping in a crib and/or bassinet. In 41 percent of sleeprelated deaths in Hamilton County between 2010 and 2014, the child was sleeping in an adult bed. In
19 percent of sleep-related
Hamilton County Sleep-Related Child Deaths by Sleeping Location,
deaths, the child was put to
2010-2014
sleep in a crib. A bassinet
45%
was the sleeping location
41%
of nine percent of sleep40%
related deaths in Hamilton
35%
County. In three percent
30%
of sleep-related deaths, the
child was put to sleep in a
25%
playpen or some other type
20%
of play structure. A couch
19%
was the sleeping location of
15%
13%
13 percent of sleep-related
10%
9%
9%
deaths in Hamilton County.
The child was put to sleep
5%
3%
3%
3%
in a chair in one percent of
1%
1%
0%
sleep-related deaths. A car
Crib
Bassinet
Adult Bed
Playpen/Other
Couch
Chair
Carseat
Futon
Other
Unknown
Play Structure
N=79
seat was the location in
which the child was put to sleep in three percent of sleep-related deaths. (Car seats should only be used
during transportation of the child in a car and should not be used as sleeping areas outside of the car34.)
In one percent of sleep-related deaths, the child was put to sleep on a futon. Other sleeping locations
such as a bouncy seat, or infant swing accounted for nine percent of sleep-related deaths in Hamilton
County. It was unknown where the child was put to sleep in three percent of sleep-related deaths.
Page 41
Sleep-Related Child Deaths, 2010-2014
70%
60%
63%
50%
40%
34%
30%
20%
10%
3%
0%
N=79
Yes, Probably
No, Probably Not
Preventability
Many of the sleep-related deaths in Hamilton County
possibly could have been prevented by following the ABCs of
safe sleep. The Hamilton County CFRT determined that 63
percent of sleep-related deaths in Hamilton County between
2010 and 2014 could have been prevented. The Hamilton
County CFRT determined that sleep-related death could
not have been prevented in three percent of sleep-related
deaths. The Hamilton County CFRT could not determine,
based on the circumstances surrounding the case, if the
death of the child could have been prevented in 34 percent
of sleep-related deaths.
Recommendations to prevent sleep-related child deaths.
Community Awareness
Community awareness about the importance of not using drugs or being under the influence
of drugs when you are caring for your children.
Community awareness that a car seat is not a safe sleep environment and that it should only
be used to transport a child when in a car and should not to be used for their sleep location.
Community awareness that the ABCs of safe sleep apply to anytime the child is sleeping,
including nap time.
Community awareness about the importance that the parent(s), caregiver(s), and/or
babysitter(s) need to stay awake when they are watching the child.
Community awareness that there is no safe way to co-sleep.
Community awareness to parents of multiples (e.g., twins, triplets) that all children should be
asleep in their own crib and should not be allowed to have the babies sleep in the same crib.
Systems Change
Systems change where information is provided to all potential caregivers and care-takers not
solely the mother of the child (e.g., family members, friends, boy/girlfriends and nannies).
Systems change where any individual who reports the death (e.g., hospital or Coroner's office)
needs to report all deaths of children under 18 years of age to the appropriate child protective
services agency.
Systems change that all child protective services agencies have a standard set of screening
processes and procedures they are required to do for every sleep-related death in their county
to allow all child deaths to be screened equally so no case goes unreported to the appropriate
agency.
Change in safe sleep education that shows parents why it is important/good for the child to
be put to sleep on their back through the use of pictures/illustrations.
Standardized change back to sleep education that is targeted at fathers.
Targeted approach to safe sleep education for those parents who have to use sedative
medication for health ailments.
Policy Change
Policy change that upon discharge from the hospital at the time of birth, the parent(s) has to
sign a document that states they are now aware of safe sleep practices and if they are not
followed there is an increased risk for an infant death.
Policy change where birthing hospitals should not let the parent(s) leave until they can show
proof that the home has a crib and/or pack’n’play and they have a properly installed car seat
in which to transport the child home.
A policy change where all child services agencies investigate all sleep-related deaths.
Page 42
Drownings
D
rowning is the fifth leading cause of
unintentional injury death in the United
Drowning, 2010-2014
2.0%
States35. In Hamilton County, from 2010 to
2014, drownings are the tenth leading cause
of unintentional injury death. One percent 1.5%
of all child deaths between 2010 and 2014
in Hamilton County were due to the child 1.0%
drowning. Historically, the percent of child
deaths due to drowning in Hamilton County
has accounted for less than two percent of 0.5%
child deaths. The highest percentage of child
deaths due to drowning was two percent in 0.0% N=8
2011. The lowest percentage of child deaths
2010
2011
2012
2013
2014
in Hamilton County that were due to drowning
was in 2012, in which there were no child deaths that were due to drowning.
Hamilton County Child Drownings
by Age, 2010-2014
13%
50%
25%
13%
Age
Children between the ages of one and four years of age have the
highest rates of drowning in the United States36. In Hamilton
County, 25 percent of child drownings were to children between
one and four. Thirteen percent of child drownings were to
children between five and nine. Children who were between
10 and 14 accounted for the
majority (50 percent) of child
drownings in Hamilton County.
Drowning by Sex,
Older children between 15 and
2010-2014
17 accounted for 13 percent of
child drownings.
Sex
Child drownings in Hamilton
10-14 Years
1-4 Years
County are disproportionately
5-9 Years
15-17 Years
higher in male children. SixtyN=8
three percent of child drownings
between 2010 and 2014 in Hamilton County were to male children.
Female children accounted for 32 percent of child drownings.
63%
Male
32%
Female
N=8
Race/Ethnicity
In Hamilton County, non-Hispanic black children, as illustrated previously, account for the largest
percentage of child deaths. However, when the race/
Hamilton County Child Drownings,
ethnicity of the child is taken into account for child
2010-2014
drownings in Hamilton County, the percent of child deaths
to non-Hispanic white and non-Hispanic black children
non-Hispanic white
are equal. Fifty percent of child drownings in Hamilton
County from 2010 to 2014 were to non-Hispanic white
non-Hispanic black
children. Non-Hispanic black children accounted for the
remaining 50 percent of child drownings.
50%
50%
Page 43
Hamilton County Child Drownings by
Race/Ethnicity and Sex, 2010-2014
Sex and Race/Ethnicity Combined
When sex and race/ethnicity are coupled together,
inequities in child drownings in Hamilton County
Male
emerge. The majority of child drownings, 38 percent,
Female
38%
in Hamilton County from 2010 to 2014, were to nonHispanic black male children. The percent of child
25% 25%
drownings to non-Hispanic black male children was 1.5
times higher than the percent of non-Hispanic white
male children. Twenty-five percent of child drownings
13%
were to non-Hispanic white male children. The percent
of child drownings to non-Hispanic white male children
was equal to non-Hispanic white female children from
N=8
2010 to 2014. The percent of child drownings to nonHispanic white female children was two times higher than the percent to non-Hispanic black female
children. Non-Hispanic black females accounted for the smallest percentage (13 percent) of child
drownings in Hamilton County from 2010 to 2014.
40%
35%
30%
25%
20%
15%
10%
5%
0%
non-Hispanic White
non-Hispanic Black
Location
Individuals can drown in may different locations,
such as swimming pools, open water and even in the
bathtub. Twenty-five percent of child drownings in
Hamilton County from 2010 to 2014, happened in open
water. Open water includes ponds, lakes and rivers.
Fifty-percent of child drownings in open water occurred
in a pond, while the remaining 50 percent occurred in a
creek. An in-ground swimming pool was the location of
50 percent of child drownings in Hamilton County. The
remaining 25 percent of child drownings occurred in a
bathtub.
Percent of Hamilton County Child Drownings
by Drowning Location, 2010-2014
60%
50%
50%
40%
30%
20%
25%
25%
10%
0%
N=8
Open Water
Pool/Hot Tub/Spa
Bathtub
Flotation Device
When an individual cannot swim or is a weak swimmer wearing a life jacket can help save their lives36.
In child drownings in Hamilton County from 2010 to
Hamilton County Child Drownings in
2014 that were in open water and swimming pools, 50
percent did not use a flotation device. It was unknown
Open Water and Swimming Pools by
if a flotation device was used in 33 percent of child
Use of Flotation Device, 2010-2014
drownings in open water and swimming pools. The use
of a flotation device was not applicable in 17 percent of
child drownings in open water and swimming pools. A
Did not use a
flotation device may be deemed as not being applicable
flotation device
to wear based on the information surrounding the case
that the child didn’t need a flotation device at the time of
Unknown if a flotation
death (e.g., were in a bathtub).
device was used
50%
33%
17%
Use of flotation device
was not applicable
N=8
Page 44
Child Drownings, 2010-2014
100%
Preventability
Most deaths due to drowning are preventable37. The Hamilton
County CFRT deemed that 100 percent of child drownings
in Hamilton County from 2010 to 2014 could have been
prevented.
Yes, Probably
Recommendations to prevent child drownings.
Community Awareness
Community awareness that you need to have a fence around your pool if you have small
children.
Community awareness that you should not leave toys in the pool as this can attract toddlers
and small children to try to retrieve the toys and fall in.
Community awareness that if children are playing in a pool there should always be at least
one adult who can swim watching the children.
Community awareness that if children cannot swim, or are weak swimmers they should not
be in a pool without a life jacket.
Community awareness that if you administer a prescription drug to a child, you should follow
all of the doctor’s orders.
Community awareness that children with special medical conditions that can cause seizures
should not be left alone in a bathtub.
Community awareness that you should always know where your children are at all times,
regardless of age.
Systems Change
Systems change to not allow floats/flippers into a pool as this can cause a child to become
trapped under the water.
Systems change to restrict deep end swimming until a child reaches an appropriate age
where they no longer require a life jacket.
Systems change where in order for a child to enter a swimming pool they need to show some
form of ID/proof that they are capable of swimming.
Page 45
Asphyxia Deaths
A
sphyxia is defined as the lack of oxygen in
the body that results in unconsciousness 8%
Asphyxia, 2010-2014
and often death and is usually caused by
interruption of breathing or inadequate 7%
oxygen supply38 Asphyxia deaths captured 6%
by the CFR online data system include 5%
suffocation, strangulation and choking. 4%
Between 2010 and 2014, four percent of
3%
child deaths in Hamilton County were deaths
due to asphyxia. In 2011, the percent of child 2%
deaths due to asphyxia was the lowest in the 1%
five year time period of 2010 to 2014 (two 0% N=31
percent). Since 2011, however, the percent
2010
2011
2012
2013
2014
of child deaths due to asphyxia in Hamilton
County increased to the highest percentage (seven) in 2013.
Hamilton County Child Deaths due to
Asphyxia by Age, 2010-2014
19%
42%
16%
3%
19%
Age
Child deaths due to asphyxia can happen to children of any
age. In Hamilton County, the majority of child deaths due
to asphyxia (42 percent) between 2010 and 2014, were to
children who were between 28 days and one year of age.
Nineteen percent of child deaths due to asphyxia were
to children who were between one and four years of age.
Children who were between five and nine accounted for the
smallest percentage of child deaths due to asphyxia, three
percent. Sixteen percent of child deaths due to asphyxia in
Hamilton County from 2010 to 2014 were to older children
who were between 10 and 14 years old. Children who were
between 15 and 17 accounted for nineteen percent of child
deaths.
Sex
Child deaths due to
asphyxia are not only
10-14 Years
28 Days - 1 Year
disproportionately higher
1-4 Years
15-17 Years
in infants in Hamilton
5-9 Years
County, but the percent
N=31
of child deaths due to
asphyxia are also slightly higher in male children. Fifty-two percent
of child deaths due to asphyxia between 2010 and 2014 in Hamilton
County were to male children. Female children accounted for 48
percent of child deaths due to asphyxia in Hamilton County between
2010 and 2014.
Race/Ethnicity
Hamilton County Child Deaths
due to Asphyxia by Sex, 20102014
52%
Male
48%
Female
N=31
Inequities in child deaths due to asphyxia emerge when the race/ethnicity of the child is taken into
account. The majority of the child deaths due to asphyxia in Hamilton County from 2010 to 2014,
were to non-Hispanic black children. Sixty-five percent of child deaths due to asphyxia were to nonPage 46
Hispanic black children. The percent
Hamilton County Child Deaths due to Asphyxia by Race/
of child deaths due to asphyxia to nonEthnicity, 2010-2014
Hispanic black children was two times
higher than the percent of deaths due to
non-Hispanic white
asphyxia to non-Hispanic white children
and 20 times higher than the percent of
non-Hispanic black
deaths due to asphyxia to non-Hispanic
multi-racial children. Thirty-two percent
of child deaths due to asphyxia were to
non-Hispanic white children. Non-Hispanic multi-racial children accounted for three percent of child
deaths due to asphyxia in Hamilton County from 2010 to 2014.
32%
65%
3%
Percent of Child Deaths due to
Asphyxia that are Sleep-Related,
2010-2014
Sleep-Related Asphyxia
A child death due to asphyxia can occur at anytime, including
when the child is sleeping. Thirty-five percent of child deaths due
to asphyxia were sleep-related deaths. This means that the child
had an unsafe sleep environment such as co-sleeping, or having
pillows, blankets and/or toys in the crib/bassinette with the
child. The majority of child deaths due to asphyxia (65 percent)
Sleep-Related
were not sleep-related. These asphyxia deaths would represent
Not Sleep-Related those children who committed suicide by asphyxia, along with
accidental asphyxia by choking on a foreign object.
35%
65%
Type of Asphyxiation
Child deaths due to asphyxia are further
classified by the type of asphyxiation event.
Asphyxia by Type of Asphyxiation, 2010-2014
In nearly half of child deaths due to asphyxia 60%
(48 percent) in Hamilton County from 2010
50%
to 2014, asphyxiation was caused by the
48%
suffocation of the child. Suffocation refers 40%
to the death of a child in which oxygen was
35%
deprived and can occur in multiple different 30%
ways (e.g., sleep-related, becoming wedged
20%
or confined into a tight space, or asphyxia
by gas)7.
Sixty-seven percent of child 10%
16%
deaths where suffocation was the type of
asphyxiation event were sleep-related. Twenty 0%
Suffocation
Strangulation
Choking
N=31
percent of suffocation deaths were ruled as a
homicide. The suffocation of the child was ruled as accidental in seven percent of child deaths caused
by suffocation. In seven percent of suffocation deaths the child became wedged into a tight space and
1
DID YOU KNOW?
Between 2010-2014:
Child died due to asphyxia
in Hamilton County
EVERY
2
Months
Page 47
became unable to breath. Strangulation was the type of asphyxia in 35 percent of child deaths due to
asphyxia in Hamilton County. Strangulation is caused by a compression of the neck, such as hanging or
manual strangulation using one’s hands7. The majority of strangulation deaths (73 percent) in Hamilton
County between 2010 and 2014 were ruled as a suicide. In 27 percent of strangulation deaths, it was
determined that the strangulation of the child was an accident. In 16 percent of child deaths due to
asphyxia in Hamilton County between 2010 and 2014, asphyxiation was caused by choking. Choking
can occur when food or an object becomes lodged in the airway of the child. One-hundred percent of
deaths in which the child choked were deemed as being an accident.
Preventability of Hamilton County Child
Deaths due to Asphyxia, 2010-2014
100%
90%
80%
87%
70%
60%
50%
40%
30%
20%
3%
10%
N=31
0%
Yes, Probably
No, Probably Not
10%
Preventability
Child deaths due to asphyxiation oftentimes can have
complex and multiple risk/contributing factors, that can
determine the preventability of the death. The Hamilton
County CFRT was unable to determine, based on the
circumstances surrounding the case, if the death of
the child could have been prevented in10 percent of
child deaths due to asphyxia. In three percent of child
deaths due to asphyxia in Hamilton County from 2010
to 2014, it was deemed that the death probably could
not have been prevented based on the circumstances
surrounding the case. In the majority of child deaths
due to asphyxia, 87 percent, the Hamilton County CFRT
determined that the death could have been prevented.
Recommendations to prevent child deaths due to asphyxia.
Community Awareness
Community awareness that when young children are eating it is important to ensure that the
food is cut to the appropriate size, and if it is too large, it should be cut into smaller pieces to
avoid choking.
Community awareness on the importance of education to children on bullying and the effects
it can have, and that you should seek help if you are being bullied.
Increase in community awareness about co-sleeping and safe sleep education.
Systems Change
Systems change in birthing hospitals that a video about CPR be added to the videos that new
parents have to watch prior to being discharged from the hospital.
Systems change to have increased presence in CPR literature available and given out by
hospitals and physicians’ offices.
Policy Change
Policy change where grief support and counseling services are offered to individuals/families
after they experience the loss of a family member.
Program Development
Community classes for parents/families/caregivers on the proper way to perform CPR.
Creation of a program in which parents who are going through divorces/separation can
bring their child to aid in the transition to have the least impact on the child’s behavior and
emotional state.
Creation of a text messaging service in schools that if a child is having problems or is in
distress they can send a text to a phone number and get linked to a school psychologist and
counselor to help them through the situation.
Page 48
“Other Types of Child Death”
“O
ther types of child death” are the remaining
types of child death in Hamilton County
that have a small number of child deaths in
which an in-depth analysis was unable to
2.5%
be completed. As such these, deaths are
2.0%
grouped into an “other types of child death”
category for this report. The type of deaths
1.5%
included in this group are:
1.0%
Fire, burn or electrocution
Fall or crush
0.5%
Poisoning, overdose or acute intoxication
N=9
0.0%
Between 2010 and 2014, these other types of
2010
2011
2012
2013
2014
child death accounted for one percent of all
child deaths in Hamilton County. Since 2010,
the percent of child deaths to these “other types of child death
“decreased from nearly three percent of child deaths in 2010 to “Other Types of Child Death” in
Hamilton County by Age,
no child deaths in 2014.
“Other Types of Child Death” in Hamilton County,
3.0%
2010-2014
2010-2014
Age
Younger children in Hamilton County are disproportionately
affected by a higher percentage of these “other types of child
death”. Fifty-six percent of child deaths due to these “other types
of child death” between 2010 and 2014 were to young children
between one and five years
“Other Types of Child Death” of age. Forty-Four percent of
in Hamilton County by Sex, child deaths in Hamilton County
between 2010 and 2014 were to
2010-2014
older children between 15 and
17.
78%
Male
22%
Female
44%
56%
1-5 Years
15-17 Years
N=9
Sex
Male children, as illustrated previously, suffer from a higher percentage
of child deaths in Hamilton County than their female counterparts. Male
children are also disproportionately affected by a higher percentage of
child deaths due to these “other types of child death”. Seventy-eight
N=9
percent of child deaths in Hamilton County between 2010 and 2014 that
were due to these “other types of child death” were to male children. Female children accounted for 22
percent of deaths due to “other types of child death”.
“Other Types of Child Death” in Hamilton
Race/Ethnicity
County by Race/Ethnicity, 2010-2014
Non-Hispanic white children in Hamilton County
are also disproportionately affected by a higher
non-Hispanic white
percentage of child deaths due to these “other types
non-Hispanic black
of child death”. Eighty-nine percent of child deaths
due to these “other types of child death” were to
non-Hispanic white children. Non-Hispanic black children accounted for 11 percent of child deaths in
Hamilton County between 2010 and 2014 due to one these “other types of child death”.
89%
11%
Page 49
Manner of Death
“Other Types of Child Deaths” in Hamilton County by
While these three types of death are grouped
Manner of Death, 2010-2014
together, the manner of death can differ based 90%
on the circumstances in which the death 80%
occurred. The majority (78 percent) of these 70%
78%
other types of child death in Hamilton County
60%
between 2010 and 2014, were determined
to be accidental deaths. Eleven percent 50%
of these other types of child deaths were 40%
children committing suicide. The manner 30%
of death was deemed undetermined in 11 20%
11%
percent of child deaths due to one of these 10%
other types of death. A death is classified as 0%
Accident
Suicide
being undetermined when the information N=9
surrounding the death (that was available at
the time to authorities completing the investigation) was insufficient.
100%
Preventability of Other Types of Child
Death in Hamilton County, 2010-2014
90%
80%
89%
70%
60%
50%
40%
30%
20%
11%
10%
11%
Undetermined
Preventability
Many factors can contribute to a child dying from one
these other types of death. The majority of child deaths
in Hamilton County due to “other types of child death”
could have been prevented. The Hamilton County CFRT
determined that 89 percent of child deaths to “other
types of child death” could have been prevented. The
Hamilton County CFRT could not determine, based on
the circumstances surrounding the case, if the death
of the child could have been prevented in 11 percent of
child deaths to “other types of child death”.
0%
N=9
Yes, Probably
Recommendations to prevent child deaths due to “other types of child death”.
Community Awareness
Community awareness on how to properly child proof one’s house.
Community awareness on the proper techniques on how to store potentially dangerous
substances (e.g., gasoline tanks, prescription pills).
Community awareness on the proper procedures of what to do in the event of a fire.
Community awareness that you should not give alcohol to your underage children.
Community awareness on the importance of not leaving your children unattended in areas
that can be potentially hazardous/dangerous.
Community awareness on illicit drugs such as heroin and the dangers these drugs pose.
Community awareness on how family support during the treatment for addictions can impact
the treatment.
Policy Change
Policy change that education is provided to anyone picking up prescription drugs on how to
safely store the drugs to keep them out of the reach of children.
Policy change to improve family support during drug treatment for addictions.
Page 50
Conclusion
T
he death of a child can impact both the family and community. The goal of the Hamilton County
CFR is to decrease the number of child deaths in Hamilton County through prevention efforts. This
is accomplished through identification of groups (e.g., sex, racial/ethnic, and age groups) within the
population of Hamilton County that experience disparities in child deaths.
This report is intended to describe the trends, along with underlying risk factors, found across the child
deaths in Hamilton County and make meaningful recommendations that can be used to engage the
community of Hamilton County to work at improving the outcomes for all children. Collaboration is
needed to develop and implement policy and systems changes, and programs that can improve the lives
of children in Hamilton County, ultimately reducing the number of child deaths.
It is hoped this report will provide communities with the tools to make significant, lasting policy changes
that will have a positive effect on the children in Hamilton County for generations to come.
Page 51
APPENDICES
Community Map ...................................................................................... Page i
Data Tables ............................................................................................... Page ii
References ................................................................................................ Page viii
Community Map
Within Hamilton County there are 49 communities comprised of cities, villages, and townships. Below
is a map that illustrates the location of each community in Hamilton County.
24
43
11
24
33
36
47
31
8
35
31
21
18
42
43
48
22
9
23
17
49
1
26
39
7
44 45
28
15
5
32
27 38
4
14
6
40
19
20
37
2
12
41
44
25
29
10
16
45
10
46
30
34
13
1. Addyston
18. Forest Park
2. Amberley Village
19. Glendale
3. Anderson Township
20. Golf Manor
4. Arlington Heights
21. Green Township
5. Blue Ash
22. Greenhills
6. Cheviot
23. Harrison City
7. Cincinnati
24. Harrison Township
8. Cleves
25. Indian Hill
9. Colerain Township
26. Lincoln Heights
10. Columbia Township
27. Lockland
11. Crosby Township
28. Loveland
12. Deer Park
29. Madeira
13. Delhi Township
30. Mariemont
14. Elmwood Place
31. Miami Township
15. Evendale
32. Montgomery
16. Fairfax
33. Mount Healthy
17. Fairfield
34. Newtown
7
3
35. North Bend
36. North College Hill
37. Norwood
38. Reading
39. Saint Bernard
40. Sharonville
41. Silverton
42. Springdale
43. Springfield Township
44. Sycamore Township
45. Symmes Township
46. Terrace Park
47. Whitewater Township
48. Woodlawn
49. Wyoming
Page i
Data Tables
Please Note: Some percentages may not equal 100 percent due to rounding.
Table 1: Number of Child Deaths by Year in Hamilton County, 2010-2014
Number of Deaths
2010
2011
2012
2013
2014
2010-2014
149
156
131
138
145
719
Table 2: Child Fatality Rate, per 100,000 children by Year in Hamilton County, 2010-2014
Rate
2010
2011
2012
2013
2014
2010-2014
7.9
8.3
7.0
7.4
7.7
7.7
Table 3: Percent of Child Deaths by Sex in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
Male
53%
64%
56%
66%
63%
61%
Female
47%
36%
44%
34%
37%
39%
Table 4: Percent of Child Deaths by Race/Ethnicity in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
non-Hispanic White
39%
41%
40%
33%
35%
38%
non-Hispanic Black
56%
58%
52%
55%
52%
55%
1%
1%
5%
4%
6%
3%
non-Hispanic Other Race
1%
0%
2%
4%
3%
2%
Hispanic, Any Race
3%
1%
2%
4%
3%
3%
Table 5: Percent of Child Deaths by Age in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
<28 Days
41%
37%
36%
37%
31%
36%
28 Days - 1 Year
36%
39%
39%
32%
36%
36%
1-4 Years
10%
7%
7%
11%
9%
9%
5-9 Years
2%
3%
4%
5%
8%
4%
10-14 Years
7%
4%
6%
6%
9%
6%
15-17 Years
5%
9%
8%
9%
7%
8%
Page ii
Table 6: Percent of Child Deaths by Manner of Death in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
Natural
74%
71%
74%
70%
80%
74%
Accident
9%
8%
8%
8%
6%
8%
Suicide
2%
1%
2%
5%
3%
2%
Homicide
4%
6%
5%
7%
6%
6%
Undetermined
11%
14%
11%
10%
6%
10%
Table 7: Percent of Child Deaths by Cause of Death in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
From an External Cause of
Injury
15%
15%
15%
21%
15%
16%
From a Medical Condition
74%
72%
74%
70%
81%
74%
Undetermined if Injury or
Medical Cause
11%
13%
11%
9%
4%
10%
Table 8: Percent of Child Deaths due to a Medical Condition by Age in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
<28 Days
55%
52%
48%
53%
38%
49%
28 Days - 1 Year
3%
36%
35%
29%
37%
34%
1-4 Years
5%
4%
3%
9%
8%
6%
5-9 Years
2%
4%
4%
5%
8%
5%
10-14 Years
5%
2%
5%
3%
5%
4%
15-17 Years
2%
4%
4%
1%
4%
3%
Table 9: Percent of Child Deaths due to a Medical Condition by Sex in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
Male
52%
62%
57%
61%
63%
59%
Female
48%
38%
43%
39%
37%
41%
Table 10: Percent of Child Deaths due to a Medical Condition by Race/Ethnicity in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
non-Hispanic White
38%
43%
40%
30%
36%
38%
non-Hispanic Black
56%
57%
51%
56%
50%
54%
0%
0%
4%
3%
8%
3%
non-Hispanic Other Race
1%
0%
2%
6%
3%
2%
Hispanic, Any Race
5%
0%
3%
5%
3%
3%
Page iii
Table 11: Percent of Child Deaths due to Motor Vehicle Accidents by Year in Hamilton County, 2010-2014
Percent of Deaths
2010
2011
2012
2013
2014
2010-2014
3%
3%
4%
3%
3%
3%
Table 12: Percent of Child Deaths due to Motor Vehicle Accidents by Age in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
1-4 Years
25%
20%
40%
25%
50%
3%
5-9 Years
25%
0%
20%
0%
25%
14%
10-14 Years
25%
20%
0%
25%
0%
14%
15-17 Years
25%
60%
40%
50%
25%
41%
Table 13: Percent of Child Deaths due to Motor Vehicle Accidents by Sex in Hamilton County,
2010-2014
2010
2011
2012
2013
2014
2010-2014
Male
75%
10%
60%
50%
75%
73%
Female
25%
0%
40%
50%
25%
27%
Table 14: Percent of Child Deaths due to Motor Vehicle Accidents by Race/Ethnicity in Hamilton County,
2010-2014
2010
2011
2012
2013
2014
2010-2014
non-Hispanic White
100%
20%
40%
75%
0%
45%
non-Hispanic Black
0%
80%
60%
25%
100%
55%
Table 15: Percent of Child Homicides by Year in Hamilton County, 2010-2014
Percent of Deaths
2010
2011
2012
2013
2014
2010-2014
4%
6%
5%
7%
6%
6%
Table 16: Percent of Child Homicides by Age in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
28 Days - 1 Year
17%
22%
0%
20%
22%
17%
1-4 Years
50%
22%
43%
10%
11%
24%
5-9 Years
0%
0%
0%
10%
11%
5%
10-14 Years
17%
0%
14%
20%
44%
20%
15-17 Years
17%
56%
43%
40%
11%
34%
Table 17: Percent of Child Homicides by Sex in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
Male
50%
67%
57%
90%
56%
66%
Female
50%
33%
43%
10%
44%
34%
Page iv
Table 18: Percent of Child Homicides by Race/Ethnicity in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
non-Hispanic White
17%
11%
29%
30%
33%
24%
non-Hispanic Black
83%
89%
71%
70%
56%
73%
Hispanic, Any Race
0%
0%
0%
0%
11%
2%
Table 19: Percent of Child Suicides by Year in Hamilton County, 2010-2014
Percent of Deaths
2010
2011
2012
2013
2014
2010-2014
2%
1%
2%
5%
3%
2%
Table 20: Percent of Child Suicides by Age in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
10-14 Years
33%
0%
50%
29%
50%
35%
15-17 Years
67%
100%
50%
71%
50%
65%
Table 21: Percent of Child Suicides by Sex in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
Male
67%
100%
100%
86%
75%
82%
Female
33%
0%
0%
14%
25%
18%
Table 22: Percent of Child Suicides by Race/Ethnicity in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
non-Hispanic White
33%
0%
100%
57%
100%
65%
non-Hispanic Black
67%
100%
0%
43%
0%
35%
Table 23: Percent of Sleep-Related Deaths by Year in Hamilton County, 2010-2014
Percent of Deaths
2010
2011
2012
2013
2014
2010-2014
13%
12%
13%
12%
5%
11%
Table 24: Percent of Sleep-Related Deaths by Age in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
28 Days - 1 Year
90%
89%
94%
94%
100%
92%
1-4 Years
10%
11%
6%
6%
0%
8%
Table 25: Percent of Sleep-Related Deaths by Sex in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
Male
50%
68%
47%
81%
57%
61%
Female
50%
32%
53%
19%
43%
39%
Page v
Table 26: Percent of Sleep-Related Deaths by Race/Ethnicity in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
non-Hispanic White
3%
47%
29%
31%
29%
34%
non-Hispanic Black
65%
42%
59%
56%
71%
57%
5%
5%
12%
13%
0%
8%
Hispanic, Any Race
0%
5%
0%
0%
0%
1%
Table 27: Percent of Child Drownings by Year in Hamilton County, 2010-2014
Percent of Deaths
2010
2011
2012
2013
2014
2010-2014
1%
2%
0%
1%
1%
1%
Table 28: Percent of Child Drownings by Age in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
1-4 Years
50%
0%
0%
50%
0%
25%
5-9 Years
0%
33%
0%
0%
0%
13%
10-14 Years
50%
67%
0%
0%
100%
50%
15-17 Years
0%
0%
0%
50%
0%
13%
Table 29: Percent of Child Drownings by Sex in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
Male
50%
67%
0%
50%
100%
63%
Female
50%
33%
0%
50%
0%
38%
Table 30: Percent of Child Drownings by Race/Ethnicity in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
non-Hispanic White
50%
33%
0%
100%
0%
50%
non-Hispanic Black
50%
67%
0%
0%
100%
50%
Table 31: Percent of Child Deaths due to Asphyxia by Year in Hamilton County, 2010-2014
Percent of Deaths
2010
2011
2012
2013
2014
2010-2014
5%
2%
4%
7%
3%
4%
Table 32: Percent of Child Deaths due to Asphyxia by Age in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
28 Days - 1 Year
50%
67%
60%
20%
40%
42%
1-4 Years
25%
0%
0%
30%
20%
19%
5-9 Years
0%
0%
0%
10%
0%
3%
10-14 Years
13%
33%
20%
20%
0%
16%
15-17 Years
13%
0%
20%
20%
40%
19%
Page vi
Table 33: Percent of Child Deaths due to Asphyxia by Sex in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
Male
38%
67%
40%
80%
20%
52%
Female
63%
33%
60%
20%
80%
48%
Table 34: Percent of Child Deaths due to Asphyxia by Race/Ethnicity in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
non-Hispanic White
13%
33%
60%
20%
60%
32%
non-Hispanic Black
88%
67%
40%
70%
40%
65%
0%
0%
0%
10%
0%
3%
Table 35: Percent of Other Types of Child Deaths by Year in Hamilton County, 2010-2014
Percent of Deaths
2010
2011
2012
2013
2014
2010-2014
3%
2%
1%
1%
0%
1%
Table 36 Percent of Other Types of Child Deaths by Cause of Death in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
Fire, Burn or Electrocution
25%
33%
0%
0%
0%
22%
Fall or Crush
50%
0%
0%
100%
0%
33%
Poisoning, Overdose or
Acute Intoxication
25%
67%
100%
0%
0%
44%
Table 37: Percent of Other Types of Child Deaths by Age in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
1-4 Years
50%
67%
0%
100%
0%
56%
15-17 Years
50%
33%
100%
0%
0%
44%
Table 38: Percent of Other Types of Child Deaths by Sex in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
Male
75%
100%
100%
0%
0%
78%
Female
25%
0%
0%
100%
0%
22%
Table 39: Percent of Other Types of Child Deaths by Race/Ethnicity in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
non-Hispanic White
100%
67%
100%
100%
0%
89%
non-Hispanic Black
0%
33%
0%
0%
0%
11%
Table 40: Percent of Child Deaths by Preventability in Hamilton County, 2010-2014
2010
2011
2012
2013
2014
2010-2014
Yes, Probably
17%
19%
21%
29%
20%
21%
No, Probably Not
5%
4%
48%
69%
83%
40%
78%
78%
32%
3%
<1%
39%
Page vii
References
1. Ohio Department of Health, Ohio Children’s Trust Fund (2013, September 1). Ohio Child Fatality Review Thirteenth Annual
Report. Retrieved October 7, 2015, from
https://www.odh.ohio.gov/~/media/ODH/ASSETS/Files/cfhs/child%20fatality%20review/2013/2013%20Ohio%20
Child%20Fatality%20Review%20Updated%20Draft.pdf
2. Healthy People.gov. (n.d.). Maternal, Infant, and Child Health. Retrieved October 7, 2015, from
http://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health
3. Association of Maternal & Child Health Programs (2013, January 1). Life Course Indicator: Concentrated Disadvantage.
Retrieved October 7, 2015, from
http://www.amchp.org/programsandtopics/data-assessment/LifeCourseIndicatorDocuments/LC-06_ConcentratedDisad_
Final-4-24-2014.pdf
4. The National Center for the Review & Prevention of Child Deaths. (n.d.). Natural Deaths Over One Year of Age. Retrieved
October 7, 2015, from
https://www.childdeathreview.org/reporting/natural-deaths-over-one-year-of-age/
5. Wisconsin Department of Health Services (2014, December 19). Definitions - Violent Death Module.
Retrieved October 7, 2015, from
https://www.dhs.wisconsin.gov/wish/violent-death/define.htm
6. Harris County Institute of Forensic Sciences (n.d.) Cause and Manner of Death. Retrieved October 7, 2015, from
https://www.harriscountytx.gov/ifs/cause.aspx
7. The National Center for the Review & Prevention of Child Deaths (2015, January). Child Death Review Case Reporting
System Data Dictionary. Retrieved December 17, 2015.
8. Centers for Disease Control and Prevention (2015, November, 9). National Prematurity Awareness Month - What is
Premature Birth?. Retrieved November 11, 2015, from
http://www.cdc.gov/features/prematurebirth/
9. Behrman RE, Butler AS, editors. Preterm Birth: Causes, Consequences, and Prevention. Washington DC: National
Academies Press; 2007, Retrieved November 11, 2015 from
http://www.ncbi.nlm.nih.gov/pubmed/20669423
10. Centers for Disease Control and Prevention (2015, September 21). Birth Defects - Facts about Birth Defects. Retrieved
November 11, 2015, from
http://www.cdc.gov/ncbddd/birthdefects/facts.html
11. Centers for Disease Control and Prevention (2015, August 20). Injury Prevention & Control: Motor Vehicle Safety. Retrieved
November 13, 2015, from
http://www.cdc.gov/motorvehiclesafety/child_passenger_safety/index.html
12. The National Center for the Review & Prevention of Child Deaths. (n.d.). Motor Vehicle.
Retrieved November 13, 2015, from
https://www.childdeathreview.org/reporting/motor-vehicle/
13. Ohio Department of Public Safety (n.d.). Always...Buckle Your Seat Belt. Retrieved November 13, 2015 from
http://www.publicsafety.ohio.gov/links/HSY7742.pdf
14. Ohio Department of Health (2014, December 19). Ohio’s Child Passenger Safety Law.
Retrieved November 13, 2015, from
http://www.healthy.ohio.gov/vipp/cps/Child%20Passenger%20Safety%20Law.aspx
15. Centers for Disease Control and Prevention (n.d.). Health Disparities in Homicides: Factsheet.
Retrieved December 1, 2015, from
http://www.cdc.gov/minorityhealth/CHDIR/2011/FactSheets/Homicide.pdf
16. Logan, J., Hall, J., McDaniel, D., Stevens. M., (2013, November 22). Homicides - United States, 2007 and 2009. Morbidity
and Mortality Weekly Report, 62(03), 164-170. Retrieved December 1, 2015 from
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6203a28.htm
17. The National Center for the Review & Prevention of Child Deaths. (n.d.). Causes of Death - Homicide (Firearm). Retrieved
September 3, 2014, from
https://www.childdeathreview.org/causesHF.htm
18. Centers for Disease Control and Prevention (2015, February 12). Injury Prevention & Control: Division of Violence
Prevention - Youth Violence: Risk and Protective Factors. Retrieved December 7, 2015 from
http://www.cdc.gov/violenceprevention/youthviolence/riskprotectivefactors.html
Page viii
19. U.S. National Library of Medicine. (2015, January 26). Medical Encyclopedia - Toxicology Screen.
Retrieved December 7, 2015 from
https://www.nlm.nih.gov/medlineplus/ency/article/003578.htm
20. Teplin, L., Jakubowski, J., Abram, K., Olson, N., Stokes, M., & Welt, L. (2014). Firearm Homicide and Other Causes of Death
in Delinquents: A 16-Year Prospective Study. Pediatrics, 134(1), 163-73. Retrieved December 7, 2015, from
http://pediatrics.aappublications.org/content/134/1/63..info
21. Voices for Ohio’s Children (2008, July). Ohio’s Family & Youth Guide: The Family Guide to the Juvenile Justice System in
Ohio. Retrieved December 10, 2015, from
http://www.njjn.org/uploads/digital-library/youthguide.pdf
22. Springer, D. (2011). Chapter 10. Family Influences on Delinquency. In Juvenile Justice and Delinquency. Sudbury Mass.:
Jones and Bartlett.
23. Centers for Disease Control and Prevention (2015, April 7). Suicide Prevention. Retrieved December 14, 2015, from
http://www.cdc.gov/violenceprevention/suicide/
24. Centers for Disease Control and Prevention. (2015, August 28). Suicide; Consequences.
http://www.cdc.gov/violenceprevention/suicide/consequences.html
25. Centers for Disease Control and Prevention. (2015, March 10). Injury Prevention & Control: Division of Violence Prevention
- Suicide Prevention. Retrieved December 14, 2015 from
http://www.cdc.gov/violenceprevention/suicide/youth_suicide.html
26. Centers for Disease Control and Prevention. (2015, March 10). Injury Prevention & Control: Division of Violence Prevention
- Child Maltreatment Definitions. Retrieved December 14, 2015 from
http://www.cdc.gov/violenceprevention/childmaltreatment/definitions.html
27. National Alliance on Mental Illness (n.d.). Mental Health Conditions. Retrieved December 14, 2015, from
https://www.nami.org/Learn-More/Mental-Health-Conditions
28. Healthy People.gov. (n.d.). Mental Health and Mental Disorders. Retrieved December 14, 2015, from
http://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental-disorders
29. Zahl, DL., Hawton, K., (2004, July). Repetition of Deliberate Self-Harm and Subsequent Suicide Risk: Long-Term Follow-Up
Study of 11,583 Patients. The British Journal of Psychiatry, 185, 70-5. Retrieved December 14, 2015 from
http://www.ncbi.nlm.nih.gov/pubmed/15231558
30. Canadian Pediatric Society. (2004, November). Recommendations for Safe Sleeping Envrionments for Infants and
Children. Paediatric Child Health, 9(9), 659-63. Retrieved December 18, 2015, from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724135/
31. Centers for Disease Control and Prevention. (2015, September 28). Sudden Unexpected Infant Death and Sudden Infant
Death Syndrome - About SUID and SIDS. Retrieved December 18, 2015 from
http://www.cdc.gov/sids/aboutsuidandsids.htm
32. March of Dimes. (2015, May). Bed-Sharing. Retrieved December 18, 2015, from
http://www.marchofdimes.org/baby/co-sleeping.aspx
33. Centers for Disease Control and Prevention. (2015, October 5). CDC Features - Sudden Infant Death Syndrome (SIDS).
http://www.cdc.gov/features/sidsawarenessmonth/
34. Visser S., Bitsko, R. Et. Al. (2015, April 1). Treatment of Attention Defecit/Hyperactivity Disorder among Children with
Special Health Care Needs. Pediatrics. Retrieved December 18, 2015 from
http://www.jpeds.com/pb/assets/raw/Health%20Advance/journals/ympd/Visser.pdf
35. Centers for Disease Control and Prevention. (2014, October 24). Home & recreational Safety - Unintentional Drowning: Get
the Facts. Retrieved December 15, 2015 from
http://www.cdc.gov/HomeandRecreationalSafety/Water-Safety/waterinjuries-factsheet.html
36. Ohio Department of Natural Resources. (n.d.). Life Jackets. Retrieved December 15, 2015 from
http://watercraft.ohiodnr.gov/lifejackets
37. Centers for Disease Control and Prevention. (2013, July 2). Protect the Ones You Love: Child Injuries are Preventable - A
National Action Plan for Child Injury Prevention: Reducing Drowning Injuries in Children.
Retrieved December 15, 2015 from
http://www.cdc.gov/safechild/NAP/overviews/drowning.html
38. Spitz, W., Spitz, D. (2006). Asphyxia (From Medicolegal Investigation of Death: Guidelines for the Application of Pathology
to Crime Investigation, Fourth Edition). National Criminal Justice Reference Service. Retrieved December 15, 2015 from
https://www.ncjrs.gov/App/publications/abstract.aspx?ID=235667
Images courtesy of:
©iStockphoto.com/DenKuvaiev | ©iStockphoto.com/vladm | ©iStockphoto.com/fasphotographic |
©iStockphoto.com/alptraum | ©iStockphoto.com/MShep2 | bigstockphoto.com/6544846
Page ix
"We owe our children - the most
vulnerable citizens in any society - a life
free from violence and fear."
-Nelson Mandela-
Contact Us
Address
250 William Howard Taft Road
2nd Floor
Phone Number
(513) 946.7800
Fax Number
(513) 946.7943
Website
www.hamiltoncountyhealth.org
Follow us on Social Media
@HamCoHealth