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COM 0329.001 2022-2024
OF if Mitchell D. Rothi its Douglass S. Adams Mayor Director Frecia Cevallos art cF•wr..A Deputy Director JL_ County of Hawail DEPARTMENT OF RESEARCH AND DEVELOPMENT 25 Aupuni Street,Room 1301 ® Hilo, Hawai'i 96720-4252 (808)961-8366• Fax(808)935-1205 E-mail: chresdev@co.hawaii.hi.us June 28,2023 J Heather Kimball Council Chair and Members of the Hawaii County Council Hawaii County Council 25 Aupuni Street Hilo, Hawaii 96720 Re: Research and Development Early Childhood Resource Coordinator's PowerPoint to the County Council on July 5,2023. Please see the attached PowerPoint Presentation which will be presented to the Council Along with the attached Early Childhood Community Profile on behalf of Research and Development. If you have any questions,please do not hesitate to contact our office at(808) 887-6078. Sincerely, Angela C. Thomas Early Childhood Resource Coordinator Research and Development Comrn. No.. Ref. To:- _2023 Hawaii County is an Equal Opportunity Provider and Employer JUNE 2023 HAWAI ' l COUNTY EARLY �. •'� CHILDHOOD COMMUNITY PROFILE earlychildhood ACTION STRATEGY TAKINGACTION FOR HAWAII'S CHILDREN �o- INTRODUCTION A strong early childhood network of support can help to strengthen families and assure that young keiki have the best start possible in life. A strong foundation for early childhood development involves the collaboration of families, providers, governments, businesses, and the community.The Hawaii County Early Childhood Community Profile was undertaken to improve our understanding of the context in which families with young children (from birth through age eight) live and work, and to provide a more comprehensive understanding of the wellbeing of young children in Hawai'i County. This resource was developed to help to strengthen our understanding of the issues facing young children and their families in Hawai'i County, and help to identify where additional data is needed in order to better understand the community's strengths and where there is need for improvement. The Hawai'i County community profile was commissioned by Early Childhood Action Strategy(ECAS), a statewide partnership designed to strengthen the systems that support young children and their families. More information on ECAS can be found at: https://hawaiiactionstrategy.org/. Technical Note This report draws from publicly available data, including the U.S. Census Bureau, American Community Survey(ACS). Most data points presented are drawn from ACS 5-Year estimates,which are considered to be the most reliable estimates of population data for counties and sub-county regions with smaller populations. Please see the ACS handbook on Understanding and Using American Community Survey Data for more information. Other key data sources used include: • Hawaii State Department of Health, Hawaii Health Data Warehouse, Birth Data • Hawaii State Department of Health, Hawaii Health Data Warehouse, Behavioral Risk Factor Surveillance System • Hawaii State Department of Health, Hawaii State Department of Education, Hawaii Health Data Warehouse,Youth Risk Behavior Survey(YRBS) • Hawaii State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System • Community Action Partnership • Hawai'i State Data Book 2021 • Hawaii Department of Human Services 2021 Databook Page 01 TABLE OF CONTENTS 1. ENVIRONMENT/ PLACE 7 Geography 7 Governing Structure 7 Environment 8 Air and Water Quality 8 Drinking Water 9 Ocean Water 9 Environmental Health 10 Access to Green Space/Outdoor Recreation 10 Road & Highways 10 Transportation 10 Road Safety 11 Motor Vehicle Collisions 11 Modes of Commuting 11 Commute Time 11 Vehicle Ownership 11 Public and "Active"Transportation 12 Public Transportation 12 2. PEOPLE/ POPULATION 14 Population Demographics 14 Population by Age 15 Population Density 17 Children 0-17 Years Old 19 Children 0-5 Years Old 19 Racial & Ethnic Demographics of Children and Families in Hawai'i County 20 The Native Hawaiian Population is Counted Two Different Ways 21 Census Race of Children Under 18 Years Old 21 3. HOUSEHOLDS& FAMILIES 23 Composition of Households & Families 23 Family Structure 25 Page 02 Grandparents& Grandchildren 27 4. ECONOMICS& POVERTY 28 Employment 28 Workforce 28 Unemployment 30 Income 32 Characteristics of Household & Family Income 32 Poverty 34 5. HOUSING/HOMELESSNESS 39 Housing 39 Housing Availability 39 Home Sales 41 Housing Mobility 41 Overcrowding 42 Homelessness 44 Homeless Children and Youth Enrolled in Public School 45 6. FOOD SECURITY 47 Food Insecurity 47 Grocery Stores, Access to Food Shopping 48 Food Desert Map 49 Food Distribution Programs 50 The State of Hawai'i's Participation in Child Nutrition Programs 50 7. PUBLIC ASSISTANCE 51 Public Assistance Access 51 Food Assistance 52 SNAP (Supplemental Nutrition Assistance Program) 52 WIC(Special Supplemental Nutrition Program for Women, Infants& Children) 53 National School Lunch Program 54 Community Eligibility Provision 55 Child and Adult Care Food Program 56 Temporary Assistance for Needy Families (TANF)/Temporary Assistance for Other Needy Families (TAONF) Cash Assistance 56 Page 03 Housing Support 57 Publicly Funded Housing 58 Federal & State Rental Subsidies for the State of Hawai'i 58 Health Insurance 59 Child Care Assistance 60 Tuition Support 60 8. AFFORDABLE CHILD CARE 61 Child Care Needs 61 Family Income Levels 62 Cost of Child Care 64 Housing Costs 65 High & Severe Housing Cost Burden 66 9. MATERNAL HEALTH & BIRTHS 67 Birth Rates& Demographics 67 Teen Births 69 Pre-Pregnancy Health 70 Pregnancy 70 Healthy Practices before and during pregnancy 71 Maternal Drug&Alcohol Use 71 Alcohol Consumption 71 Prenatal Visit Depression Screening 71 Prenatal Care 72 Birth Outcomes 74 Breastfeeding 75 10. CHILD WELL-BEING RISK FACTORS 76 Health & Social Service Needs 76 Adverse Childhood Experiences 76 Domestic Violence &Child Abuse and Neglect 77 Domestic Violence 77 Child Abuse and Neglect(CAN) 78 Infant Mortality Rate 82 Infant Mortality Rate 82 Page 04 11. CHILD HEALTH & DEVELOPMENT 84 Children's Health 84 Mental Health 84 Disabilities 84 Dental Care 84 Medical Home 85 Immunization 86 Health Care Access 86 12. EDUCATION 87 Kindergarten Readiness 87 Kindergarten Entry Assessment 87 Kindergarten Enrollment 87 K-12 School Enrollment 88 Special Education 89 K-12 Student Performance 90 3rd &4th Grade Achievement 90 High School Achievement Levels 92 Educational Attainment 93 Adult Literacy 94 13. EARLY CHILDHOOD CAPACITY& ENROLLMENT 95 Child Care Capacity 95 Quality Early Childhood Education 97 Access to Early Learning Programs 99 Early Childhood Education Enrollment 100 Enrollment in Public Early Childhood Education Programs 101 14. EARLY CHILDHOOD WORKFORCE& SERVICES 102 Early Childhood Careers& Compensation 102 Certification Program 103 Early Intervention/Screening 103 Developmental Screening 103 Early Intervention 103 Home Visiting 107 Page 05 15. STRONG FAMILIES& COMMUNITIES 108 Family Early Childhood Language and Literacy Development Activities 108 Language Spoken at Home 109 Citizenship 110 Adult Health 110 Dental Care 110 Obesity 110 Diabetes 110 Mental Health 111 Community Safety 112 Crime 112 Juvenile Crime 112 Risky Teen Behaviors 113 Teen Drug&Alcohol Use 113 Teen Sexual Activity 113 Foster Care 113 List of Figures 115 List of Tables 117 Endnotes 120 Appendix: Hawai'i County Indicator Report Page 06 1 . ENVIRONMENT PLACE Geography The island of Hawai'i comprises the whole County of Hawai'i, which is the largest county by land area in the State of Hawai'i. It is also commonly referred to as the "Big Island."The island of Hawai'i has the second largest population in the state. Hawai'i Island has a land area of 4,028 square miles. Measured from its sea floor base to its highest peak, Mauna Kea is the world's tallest mountain, over 10,000 meters from its base, making it taller than even Mount Everest.The island is built from 5 distinct shield volcanoes (Kohala, Mauna Kea, Hualalai, Mauna Loa, Kilauea). Tourism is the largest sector of the Hawai'i County economy, primarily located on the western coast of the island in North Kona and South Kohala districts. Diversified agriculture is a growing sector. The economic centers for Hawai'i County are located in Hilo and Kailua-Kona,which are also home to the majority of the county's residents and businesses. The seat of County government is in Hilo. Governing Structure Hawai'i County has operated under the Mayor-County Council form of municipal government since 1968. Executive authority is vested in the mayor, elected by the voters on a non-partisan basis to a four- year term (with a limit of two consecutive full terms).The mayor is the chief executive officer of the County and is responsible for overseeing the day-to-day operations and for appointing the heads of various departments. The legislative branch is the County Council, which is composed of nine members each elected from one of Hawaii County's nine council districts and serving two-year terms. As the policy making body,the council appoints the County Clerk, County Auditor, and the Office of Council Services. Members of the council are elected on a non-partisan basis to two-year terms (with a limit of five consecutive full terms). The nine residency areas reflect the districts: Puna, South Hilo, North Hilo, Hdmdkua, North Kohala, South Kohala, North Kona,South Kona, and Ka'u. Voter turnout in Hawaii County at the 2022 general election was 41.1%. 1 This is comparable to other counties in Hawai'i. Statewide, rates of voting in Hawai'i are lower than the national rate of 66.8%.Z In Hawai'i County, as well as the rest of the state,there are no subordinate or separate municipal entities. The state government administers the school system, airports, harbors, hospitals,judicial system and the state highway system. Most non-federal taxes are administered and collected by the state under Hawai'i's centralized tax system.The major sources of state revenue are the general excise tax and Page 07 corporate and personal income taxes. Direct sources of county revenue include property taxes, service and use fees for water, sewer and waste disposal, licenses, and permits, including building permits. The County of Hawai'i provides a broad range of services including public safety (police,fire, and public prosecutor), sanitation, culture and recreation,transportation, planning and zoning, and the construction and maintenance of some streets and highways. Environment Air and Water Quality Clean air is an important factor for health. People who live in areas with poor air quality are at greater risk for conditions such as asthma. According to the American Lung Association, Hawai'i has some of the best air quality in the nation. Hawai'i Island receives lower air quality scores due to hazy air pollution caused by volcanic emissions commonly known as "vog."3 Asthma symptoms can be brought on by exposure to inhaled allergens (like dust, pollen, cigarette smoke, pollution, and animal dander) or exertion and stress. Hawai'i County has the lowest rate of children under 18 years old with asthma. In 2019, 6.9%of children under 18 in Hawai'i County were noted to have asthma.This is slightly lower than the state rate of 7.5%.4 In 2019, Hawai'i County had the lowest rate of childhood asthma in the state. r o Page 08 Figure 1: Children with Current Asthma 15 10 a� HI State Value: 7.5 L C CL 5 0 4 °a a oc `E County Source_Behavioral Risk Factor Surveillance System(2019) 5 Drinking Water Access to safe drinking water is fundamental to a healthy life, particularly for young children and those with health conditions who may be more susceptible to contaminants.The Hawai'i County Department of Water Supply(DWS) serves the majority of customers in the county. Each year, DWS provides customers with an Annual Water Quality Report informing them whether their supply meets all established federal and state drinking water standards.6 In 2021, all water systems met the requirements.'The Department alerts customers to the possibility that lead levels in individual homes may be higher due to the home's plumbing and encourages anyone with concerns to have their water tested. Residents are also advised to flush tap water for 30 seconds to 2 minutes before consuming. Ocean Water Swimming and other water related activities are a large part of life for people in Hawai'i County. However, natural water sources can be contaminated with high levels of disease-causing microorganisms or other forms of pollution, including sewage and chemical run-off. Swimming in these conditions may result in illness, especially for children,the elderly, and individuals with weakened immune systems. Monitoring beach water quality is essential for maintaining a safe and healthy environment. Page 09 Environmental Health Access to Green Space/Outdoor Recreation Outdoor play has a positive impact on child health and development.' Many children in Hawai'i County live near beaches, surf spots, beautiful mountains, parks, and swimming pools. All beaches in Hawai'i County are public.There are 73 county parks (including swimming pools, community centers, and gymnasiums) in Hawai'i County. Public recreational facilities are abundant across Hawai'i County. Table 1: Number of County Parks Hawai'i County, 2023 Beach parks& Gyms, Parks, & Districts Campgrounds' Pools" Centers" Hamakua 1 2 5 Hilo 13 2 13 Ka'u 2 1 5 Kohala 4 1 4 Kona 8 2 3 Puna 1 1 5 Total 29 9 35 Road & Highway- Hawai'i County has approximately 1,517 miles of streets and highways, of which approximately 1,456 are paved.12 Many people reside in rural areas or at a considerable distance from work centers. Access to reliable transportation is crucial to Hawai'i County residents.The majority of residents rely on personal vehicles to reach work, school, health care,food, and recreation, despite consistently high gasoline prices. Statewide, Hawai'i has the highest gas prices in the country.13 Transportation Access to reliable, affordable transportation supports the wellbeing for young children and their families.Transportation access expands families' options for employment, childcare, groceries and healthcare. Page 10 Road Safety Many families with young children spend a significant amount of time on the road each day traveling to and from work, childcare, and activities. Since June 27, 2022 (Act 122) rear facing child safety seats are required for children less than two years of age, and child passenger restraints or booster seats are required up to age 10.14 Motor Vehicle Collisions Motor vehicle-related injuries kill more children and young adults than any other single cause in the United States. According to the State Department of Health,the motor vehicle collision death rate in Hawai'i County for the period 2018-2021 was 12.9 deaths/100,000 population,which is the highest in the state.15 Hawai'i County had the highest rate in the state of motor vehicle related deaths. Table 2: Motor Vehicle Death Rate by County, 2018-202116 County Death Rate Hawai'i County 12.9 Honolulu County 6.6 Kauai County 9.7 Maui County 10.2 Modes of Commuting A majority of workers in Hawai'i County commute alone to work by car. According to County Health Rankings& Roadmaps, 37.1%of Hawai'i County commuters commute alone for 30 minutes or more. This figure has increased steadily since 2014.17 Only 3.7%of the commuting population used alternative forms of transportation such as walking or public transportation. Commute Time The average travel time to work in Hawai'i County is 26.8 minutes.18 This may have implications for the child care choices made by families. Vehicle Ownership 33.1%of Hawai'i County households have one car, 36.5%of households have two cars, and 26.7% have three or more cars. 3.6%percent of households do not have a car. Page 11 Public and "Active" Transportation The use of alternative forms of transportation, such as walking and public transit, has benefits for the environment,the individual, and the population. Motor vehicle emissions contribute to the degradation of our environment and to adverse respiratory and cardiovascular health effects. 3.7%of Hawai'i County workers use public transportation, walk, or ride their bikes to work. Table 3:Workers Commuting to Work by Form of Transportation Hawai'i County, 2016-2020 Bicycle:19 0.4% Public Transportation:21 1.0% Walking:21 2.3% Public Transportation Public transportation can be an important resource for families, providing a lower cost option to get to work, access services, and enjoy recreational activities. On Hawai'i Island,the Hele-On Bus public transit service consists of 24 bus routes, all operated by Roberts Hawaii. Routes are operated 7 days a week, including all holidays.The routes serve major population centers in East Hawai'i, West Hawai'i, and North Hawai'i. Page 12 Figure 2: Hawai'i Island Hele-On Bus Route Map County of Hawaii Mass Transit Agency Bus Relates ............... L,4 Oa in r KOJI na ualoa 02.55 10 15 20 A-1 I les 17C:JCk JCJ.pns.whi ..�2.Egic tIl¢ �JGa.11.Yt.Y�Y}1 INa 0.rac cn€c V —JC4.40N J i. —2C'.Kony TmWe vaAao d0.ry:OPyg5i iC .LBV�S,CmLoKaJ�K1 ��� 6G.rw :0 r a?,WwR —2264.SA�u'.ry Ka'a,c4mm=]aa 7G.wa'd'Kahi1i m SwM Yui"ka".0'[s 8r—.i-1 ft., 75.limit^kohvr W twaa SKR Raw7 Kona 4C7.r„r vm n 94r y+tV herr rwxlc5or.�hx aaa�76.,Stc Uw 4C?.h,w is n P&wmR'�r4;]Yc*.�S*d liY.vb Sn�Acesf AWaba T^Sa.tw :8&O-K1 K"a Fbnl'3 4Ca.F6 n Aa,T-"r RiM1 q Ed415 ka[ 22 Page 13 2. PEOPLE/ POPULATION Hawai'i County is home to 200,468 people, almost 14%of the state population.2'There are 43,129 children and youth (under 18 years of age) living in Hawaii County, including 11,336 keiki under the age of 5 (5.6%of the County population). 56%of children under 5 in Hawai'i County, live within the Kona and Puna Districts. 29.7%of individuals in Hawai'i County are Native Hawaiian or Native Hawaiian in combination with another race.zn Population Demographics Hawai'i County is home to 200,468 people, almost 14%of the state population. Table 4: Hawai'i State Population by County2s 2021 County Total Population Hawai'i County 200,468 Honolulu County 1,015,167 Kalawao County 48 Kauai County 73,247 Maui County 164,568 Hawai'i State Total 1,453,498 Honolulu County makes up almost 70%of the state's population,with the remaining 4 counties combined totaling the remaining 30%. Hawai'i County represents 13.8%of the state's population. Page 14 Figure 3: Ratio of Hawaii State Population by County, 2021 Kalawao County Maui County 0.0% 11.3% Hawaii County 13.8% Kaua'i County 5.0% a : oa.nt.' 26 Population by Age In 2021,the total population of Hawai'i County was 200,468, including 11,358 keiki under 5 years old. Young children make up the largest share of the population of Ka'u District (at 9%), and the smallest share of the population of Hilo District (at 4.4%). Page 15 Table 5:Total Population by District& Percentage of County's Population 27 Hawai'i County, 2021 Hawai'i Hamakua Hilo Ka'O Kohala Puna County District District District District Kona District District Total Under 5 Years Old 578 5.9% 2,252 4.4% 1,223 9.0% 918 5.1% 3,877 6.0% 2,510 5.8% 11,358 5-19 Years Old 1,672 17.0% 10,251 20.1% 1,969 14.4% 3,055 17.1% 11,117 17.1% 7,927 18.4% 35,991 20-34 Years Old 1,510 15.4% 9,604 18.8% 2,018 14.8% 2,762 15.5% 10,934 16.8% 6,228 14.5% 33,056 35-64 Years Old 3,895 39.7% 18,427 36.1% 5,394 39.6% 6,885 38.6% 25,444 39.1% 17,277 40.1% 77,322 65 Years Old 2,159 22.0% 10,552 20.7% 3,026 22.2% 4,228 23.7% 13,645 21.0% 9,131 21.2% 42,741 &Over Total 9,814 51,086 13,630 17,848 65,017 43,073 200,468 Overall,the population of Hawai'i County is aging. Over the past 10 years, Hawaii County's child population has declined slightly whereas the population of seniors (over 65) has increased by 6.7%. Figure 4: Population Under Age 18 County: Hawaii 22.4% 22.2°% 22.1°% 21.9°% 21.8% 21.8°% 21.7% 21.4°% 21.4°% 21.2°% 20 15 v a 10 5 0 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Source U.S.Census Bureau Population and Housing Unit Estimates(2021) 28 Page 16 Figure 5: ,.A fl a rIrnit Y';itIT1 Population Over Age 65 County: Hawaii 25 21.9% 22.0% 22.7% 20.9% 20.1°/ 20 18.5% 19.3% 17.7% 16.8% 16.0% 15 v v` m 10 5 0 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Source: U.S.Census Bureau Population and Housing Unit Estimates(2021) 29 Population Density There are 49.8 people per square mile in Hawai'i County.This is less than half of the population density of Kaua'i (at 118.2 people per square mile), Maui (140.5 per sq mile), or Honolulu (1,692 per sq mile)." Hilo and Kailua-Kona have the highest population density within Hawai'i County. Page 17 Figure 6: Population Density by Census Tract, Hawai'i County, 2016-2020 a ie zo I Miles t I C \[,I'S Map Legena Population.Oenslty�Persms pet Sq MIle16y TtaR.ACS 209620 Orer 5,000 1.001-5.000 Sot-I,o00 X51-500 unset s No data or Data Suppl—ld mys�icvP-en4v8ernervnetwvrkv�5/mvA J'-cwnmPnrtyieapmvpmwrv:iit3/N23 31 Page 18 Children 0-17 Years Old 57%of children (0-17) in Hawai'i County live in the Kona & Hilo Districts.The largest share of children under 3 live in the Kona District. the Puna District has one of the fastest growing populations of families with young children (including close to 1,800 children younger than three). Table 6: Population of Children 0-17 Years Old 31 Hawai'i County, 2021 Hamakua Kohala Hawai'i Hilo District Ka'u District Kona District Puna District District District County Total Under 3 Years Old 328 1,377 616 657 2,303 1,792 7,073 3-4 Years Old 250 862 607 261 1,565 718 4,263 5 Years Old 97 559 288 143 801 379 2,267 6-8 Years Old 389 1,943 438 707 2,245 1,561 7,283 9-11 Years Old 355 2,223 452 648 2,932 1,742 8,352 12-14 Years Old 331 2,121 280 576 2,065 1,615 6,988 15-17 Years Old 299 1,870 377 760 1,955 1,642 6,903 Total Children 2,049 10,955 3,058 3,752 13,866 9,449 43,129 Children 0-5 Years Old 11,336 children under 5 live on Hawai'i Island. 56%of young children live in the Kona and Puna Districts. Table 7: Population of Children Under 5 Years Old 33 Hawai'i County, 2021 Hamakua Kohala Hawai'i Hilo District Ka'u District Kona District Puna District District District County Total Under 3 Years Old 328 1,377 616 657 2,303 1,792 7,073 3-4 Years Old 250 862 607 261 1,565 718 4,263 Total Children Under 5 578 2,239 1,223 918 3,868 2,510 11,336 52%of young children in Hawai'i County are male and 48%are female. Page 19 Figure 7: Demographics of Population Under 5 Year Old by Gender, Hawai'i County, 2021 Demographics of Population Under 5 Year Table 8: Gender-Makeup of Young Old by Gender, Maui County, 2020 Children Under 5 Years Old34 Hawai'i County, 2021 Male 5,889 Female Female 5,469 48 2",- Male Total 11,358 Families with young children are more likely to live in certain communities. Kailua-Kona & Hilo are home to the largest numbers of young children. Table 9: Communities with the Largest Population of Children <5 Years Old 31 Hawai'i County, 2021 Number of Children Under 5 Share of All Children Under 5 in Community Years Old the community Kailua-Kona 2,612 23.0% Hilo 2,203 19.4% Kea'au 1,103 9.7% Pahoa 737 6.5% Kamuela 732 6.5% Mountain View 637 5.6% Racial & Ethnic Demographics of Children and Families in Hawaii County In Hawai'i County, 22.1%of residents identify as Asian (22.1%), 32.6%identify as White, and 29.7% identify as Native Hawaiian (either Hawaiian alone or in combination with another race).36 Page 20 As a percent of total population, Hawai'i County has the largest share of residents who identify as White, Native Hawaiian, or 2 or More Races in the state. Figure 8: Census Racial Demographics of State of Hawai'i & Hawai'i County, 2021 Census Racial Demographics of State of Hawaii & Haw°ai`i County, 2021 State of Hawaii N Hawai,'i County 40.0% 37.5% 32.6% 29.8% 30.0% 23.7% 24.4% 22.1% 20.0% 119.1% 10.0% 6.4 1.9% 4.2 2.9% 2.3% 0.7% 0.3% 0.5 1.6% White Black/African American Asian Native Hawaiian Pacific Islander Some Other Race 2 or More Races American Indian/Alaska Native 37 The Native Hawaiian Population is Counted Two Different Ways The US Census count of Native Hawaiians includes only those respondents who identify as Native Hawaiian alone. In comparison,The Office of Hawaiian Affairs includes both residents who identify as Native Hawaiian Alone as well as those who identify as Native Hawaiian in combination with another race, in the Native Hawaiian Category. Using this broader definition, 29.7%of residents of Hawai'i County identify as Native Hawaiian or Native Hawaiian in combination with another race.38 Census Race of Children Under 18 Years Old The largest racial and ethnic groups represented in the population of children under 18 in Hawai'i County are mixed-race (53.8%),White (16.5%) or Asian (13.8%). Page 21 Figure 9: Census Race of Children Under 18 Years Old, Hawaii County, 2021 White 16.5% Black/African American 0.1% American Indian and Alaska Native Asian 13.8% 2 or More Races 53.8% Native Hawaiian 1 Pacific Islander 12.0% Some Other Race 3.2% 39 Page 22 3. HOUSEHOLDS & FAMILIES Children are born and raised in many different types of families, and families can help to build young children's resilience and support children's early development. Aspects of family structure (i.e.families raised by single parents,families raised by grandparents, etc.) are associated with measures of child development, school readiness and later life success. Composition of Households & Families In Hawai'i County, 20,677 households (29%) include children under age 18.40 A quarter of all children (23.4%) live in households that also contain a grandparent, other relatives or other adults. County-wide, roughly 1 in 5 households (19%) include a young child (under 6), and 2 in 5 households with a young child (43%) are headed by single parents.41 Table 10: Households with Children by County42 2020 Households with Children Total Households Percentage Hawai'i County 20,677 71,402 29.0% Honolulu County 104,577 330,393 31.7% Kauai County 6,912 22,668 30.5% Maui County 17,505 53,919 32.5% State of Hawai'i 149,671 478,413 31.3% There are 20,677 households with children in Hawai'i County. Pahala has the highest share of households that are made up of families with children (42.6%). Page 23 Table 11: Households with Children by Zip Code&Town" Hawai'i County,2021 Total Households Percentage of Households with Zip Code Town with Children Total Households Children Hawai'i County, Hawai'i 20,677 71,402 29.0% 96704 Captain Cook 843 2,935 28.7% 96710 Hakalau* 5 135 3.7% 96719 Haw'i 100 434 23.0% 96720 Hilo 4,962 17,038 29.1% 96725 Holualoa 381 1496 25.5% 96726 Honaunau* 0 9 0.0% 96727 H6noka'a 431 1511 28.5% 96728 Honomu 39 155 25.2% 96737 Ocean View 497 1740 28.6% 96738 Waikoloa 1,038 2841 36.5% 96740 Kailua Kona 4,070 14272 28.5% 96743 Kamuela 1,460 4662 31.3% 96749 Kea'au 2,074 6234 33.3% 96750 Kealakekua 322 1246 25.8% 96755 Kapa'au 330 1215 27.2% 96760 Kurtistown 345 1332 25.9% 96764 Lapahoehoe* 26 220 11.8% 96771 Mountain View 651 2386 27.3% 96772 N5'51ehu 284 990 28.7% 96773 Ninole* 11 80 13.8% 96774 O'okala* 0 85 0.0% 96776 Pa'auilo 175 518 33.8% 96777 Pahala 258 605 42.6% 96778 Pahoa 1,604 5838 27.5% 96780 Papa'aloa 47 250 18.8% 96781 Papai'kou 83 459 18.1% 96783 Pepe'ekeo 228 594 38.4% 96785 Volcano 413 2132 19.4% *Due to small population sizes, estimates have a low confidence level and can vary in these communities Page 24 Family Structure Families with children need quality childcare, healthcare, adequate housing, and other resources. Most parents face the challenge of having to balance parenting with work demands. Low wages, unstable work schedules, a lack of paid leave, high housing costs, and a severe shortage of high quality, affordable childcare often intensify the challenges that many families with children face." Across Hawai'i County, there are 43,114 children under the age of 18 and 13,624 children younger than 6. The majority of children (56.6%) live in families headed by married couples. Table 12: Number of Children by Householder'Type 41 Hawai'i County, 2021 #of Children #of Children 0-17 under 6 Family Headed households 43,114 13,624 Married-couple 26,049 7,684 Single Mother 11,776 3,721 Single Father 5,206 2,161 Householder:The person (or one of the people) in whose name the housing unit is owned or rented (maintained) or, if there is no such person,any adult member,excluding roommates, boarders,or paid employees. Census.gov Householder Definition Page 25 Figure 10: Family Structure of Households with Children Under 6 Years Old, Hawaii County, 2021 Single Mother Married-Couple Family 56.6% Si-g'e Frt"er 46 15.7%of children live with grandparents (approximately 6,782 children). 5.3%of children (2,279) live with aunts and uncles or other relatives. Table 13: Children Under 18 Years Old in Households by Relationship to Householder 47,48 Hawai'i County, 2021 Number of Child Relationship to Householder Children Percentage Own Child (Biological, Adopted, Stepchild) 33,033 76.6% Grand Child 6,782 15.7% Other Relatives 2,279 5.3% Foster child or other unrelated child 1,020 2.4% Total Children 43,114 Page 26 Grandparents & Grandchildren In Hawai'i,there are many family households with more than 2 generations living together.This is consistent with the spirit of Aloha and the commitment to 'ohana. Multi-generational families can take many forms. In some, it is the middle generation that is both raising children and caring for aging parents. In other families, grandparents are shouldering the financial and caretaking burden for both younger generations. Many grandparents raising grandchildren are living on fixed incomes.These households face a high financial burden when limited incomes are stretched to care for children as well. Grandparents can share the responsibilities of working parents by providing additional support in caring for their grandchildren thus reducing the need for childcare expenses.Watching grandchildren while parents are at work, grandparents who watch grandchildren have a 37%decreased mortality rate than adults of the same age who don't watch children.49 Close to 7,000 grandparents in Hawai'i County live with grandchildren under the age of 18. In a third of those households, grandparents have principal responsibility for supporting their grandchildren. Table 14: Grandparents Raising Grandchildren" Hawai'i County, 2021 Grandparents living with 6,908 grandchildren under 18 Grandparents responsible for 2,260 32.7% grandchildren Grandparent lives with but does not have primary responsibility 4,648 67.3% for grandchildren Page 27 4. ECONOMICS & POVERTY When children experience poverty in early childhood,they face a harder road to school readiness and later life success. Children at every age and developmental stage are impacted by impoverished environments, and those impacts build upon one another and continue across time. In 2021, one in five young children in Hawai'i County were living below the Federal Poverty Line.51 The current poverty line for the State of Hawaii for a family of 4 is$34,500.52 Communities with high concentrations of families with children living in poverty include Papa'aloa, Ocean View, Haw'i, Mountain View, Pa'auilo, Pahoa, and Pepe'eke6. Employment Access to jobs that pay a living wage is a core component of family safety and security. When parents are unemployed or underemployed, it is difficult for them to meet their family's basic needs and can undermine physical and mental health, and heighten family stress.sa Workforce In 2021, 59.4%of Hawai'i County residents 16 and over were employed. An estimated 70.5%of the people employed were private and salary workers; 17.6%were federal, state, or local government workers, and 11.6%were self-employed. At b; h Page 28 Figure 11:54 Share of Hawaii County Residents 16 Years and Older by Workforce Participation, 2021 Not in Labor Force 40.016 In the Labor Force 59.4% Figure 12:55 Share of Civilian Employed Persons by Classification Hawaii County, 2021 Unpaid Family Worker Self employed 11.6% Government 17.6% Private The majority of residents are employed in the visitor industry or in jobs supported indirectly by tourism. Page 29 Figure 13:" Mean Annual Wage for the Top 10 Most Common Occupations Hawaii County, 2021 0 Number Employed 0 Mean Annual Wage $100,000 2,500 2,180 2,210 1,870 1,930 2,000 $75,000 1,460 1,340 1,260 1,500 CU 1,190 1,190 1,160 $50,000 cu o 1,000 C W cu G 2 $25,000 500 E z $0 0 Gasr\ec °`e °`\`ops s Ge°e�a� °J°aS0eeQe� p(ae(�\�e�s a0'0 el �a G\ea�ece `et°aN J See aha`esse5 acdGt e�5 a°d e<ati`Oc �to`Sa �Fdo, Fas �a°as`9 Geo'a\ Table 15:Top Five Principal Employers in Hawai'I County, 2021 Principal Private Sector Employers in Hawai'i County Number of Employees Mauna Kea Resort 1,357 KTA Super Stores 900 Kamehameha Schools Hawai'i 686 Fairmont Orchid 588 Goodwill Hawai'i 436 Unemployment During periods of unemployment, individuals are likely to feel severe economic strain and mental stress. Unemployment is also related to access to health care, as many individuals receive health insurance through their employer. A high unemployment rate places strain on financial support systems, as unemployed persons qualify for unemployment benefits and food stamp programs.17 During the COVID-19 pandemic,the unemployment rate in Hawai'i County spiked to almost 25%. By September 2022,the unemployment rate in Hawai'i County had returned to 3.5%.58,59 Page 30 Table 16: Unemployment Rate for Hawai'i Counties, 202260 SEP AUG SEP* 2022 2022 2021 Seasonally Adjusted STATE 3.5 4.0 4.8 U. S. 3.5 3.7 4.7 Not Seasonally Adjusted STATE 3.4 3.6 5.3 HONOLULU 3.3 3.4 5.0 HAWAII COUNTY 3.5 3.6 5.1 KAUAI 4.0 4.2 6.5 MAUI COUNTY 3.7 3.9 6.3 Maui Island 3.7 3.7 6.3 Molokai 7.4 10.4 7.8 Lanai 1.8 1.8 3.6 U. S. 3.3 3.8 4.6 county&island rates are not seasonally adjusted *benchmarked data Page 31 Figure 14:61 U;ip ployed Workers in Civilian Labor Force County: Hawaii v 20 :o :o y •< rx 10 J 0 �� ti� �o �o -1 �ti ^� do €I; �T o T ,Vo 1� do do ,go o do 1� 1� do ,Vo T �`r Unemployment data through December 2011 were based on BLS's preliminary monthly estimates. Data for January 2012 and beyond are based on BLS's final monthly estimates. Source: U.S. Bureau of Labor Statistics(October 2022) Income Characteristics of Household & Family Income In Hawai'i County and across the country,family income varies with family structure. On Hawai'i Island, the median household income is$64,399.That figure rises to$101,780 for married couple families with children (56.6%of families with young children in Hawai'i County) and falls to $25,327 for single mothers with young children (27.4%of families with young children in Hawai'i County).62 Hawai'i County's median household income is almost$20,000 below the state average. Page 32 Table 17: Median Household Income in 202163 Hawai'i County State of Hawai'i National Average Median Household $68,399 $88,005 $69,021 Income Median Family Income $81,910 $103,593 $85,028 Median Income for Families with Their $71,773 $97,843 $82,767 Own Children Families headed by married couples earn almost tripe the income of single fathers and four times the income of single mothers. Table 18: Median Income of Families with Own Children Under 18 Years Old by Family Structure, Hawai'i County, 202164 Married Couple $101,780 Single Father $38,200 Single Mother $25,327 The median income in Hawai'i County of households with grandparents raising grandchildren is $38,417. Table 19: Median Family Income of households in which a Grandparent is Responsible for Grandchildren Under 18,with No Parent Present, 202161 Hawai'i County $38,417 Maui County $60,347 Honolulu County $76,583 Kaua'i County $68,571 Native Hawaiians and other Pacific Islander families raising children are likely to live on lower incomes than Asian or White families with children. Page 33 Table 20: Median Household Income by Race" Hawai'i County, 2021 Percent of Children living in this Household Income type of family Asian $78,559 13.8% White $68,007 16.5% Native Hawaiian and Other $60,086 12.0% Pacific Islander 2 or More Races $68,383 53.9% Other Race $55,000 3.2% Poverty When children experience poverty in early childhood,they face a harder road to school readiness and later life success.These kids are less likely to have stable homes, regular meals and bed times,fewer books and developmental toys, spend fewer minutes reading and playing with parents and family, as a result,they are more likely to reach school behind their middle class peers.67 Hawai'i County has several communities with high concentrations of families living in poverty. The federal poverty line is updated each year by the Department of Health and Human Services (HHS). Federal poverty levels are used to determine eligibility for certain programs and benefits, including savings on Marketplace health insurance, and Medicaid and CHIP coverage.68 The Federal Poverty Threshold for a family of 4 (2 adults and 2 children) is$34,500.69 Hawai'i County has several communities with high concentrations of families living in poverty. Over 20%of children under age 5 in Hawai'i County live in poverty. Over 30%of children living in Papa'aloa, Ocean View, Haw'i, Mountain View, Pa'auilo, Pahoa, and Pepe'eke6 are living in high poverty communities. In Papa'aloa, 8 in 10 children live in families below the poverty threshold. Page 34 Table 21: Poverty Status in the Past 12 Months, Hawai'i County, 202170 Percent of each group living in Total poverty in Hawai'i County Individuals 27,243 13.8% Children 0-4 Years Old 2,305 20.7% Children 0-17 Years Old 7,752 18.3% Page 35 Table 22: Percentage of Individuals &Children Living in Poverty by Zip Code 71 Hawai'i County, 2021 Percentage of Individuals Living in Percentage of Children Living in Town Zip Code Poverty Poverty Captain Cook 96704 14.3% 16.2% Hakalau* 96710 - - Haw'i 96719 18.1% 47.6% Hilo 96720 15.7% 20.5% Holualoa 96725 9.4% 10.9% Honaunau* 96726 - - Honoka'a 96727 6.4% 6.9% Honomu 96728 6.5°% 7.8% Ocean View 96737 39.2% 52.9% Waikoloa 96738 7.5°% 7.7% Kailua Kona 96740 10.1% 12.5% Kamuela 96743 9.3°% 9.8% Kea'au 96749 8.9°% 9.7% K2alak2ku5 96750 6.5°% 8.7% Kapa'au 96755 8.6% 8.4% Ku rtistown 96760 18.9% 23.0% Lapahoehoe* 96764 8.3% 9.6% Mountain View 96771 26.1% 41.2% N5'51ehu 96772 9.8% 12.3% Ninole* 96773 - - O'okala* 96774 - - Pa'auilo 96776 20.2% 39.7% Pahala 96777 11.1% 14.9% Pahoa 96778 25.2% 36.5% Papa'aloa 96780 35.9°% 79.2% Papai'kou 96781 9.2% 14.3% Pepe'ekeo 96783 19.6% 31.6% Volcano 96785 8.4% 4.0% Page 36 In Hawai'i County,the poverty rate among 2-parent families as well as for single-parent families is higher than the state average. Table 23: Children Living in Poverty by Family Structure 72 Hawai'i County& State of Hawai'i, 2021 Hawai'i County State of Hawai'i Poverty rate for children living 6.5% 5.3% with 2 parents Poverty rate for children living 21.7% 15.4% with a single father Poverty rate for children living 43.0% 31.9% with a single mother Almost 400 multi-generational families in Hawai'i County are living in poverty.While most households with grandparents living with grandchildren are living at or above the poverty level,they may still be living on fixed incomes and have limited resources to cover their expenses. Table 24: Income Level of Households with Grandparent Living with Grandchildren in Hawai'i County, 202173 Total Families Percentage Living below poverty level 394 5.7% Living at or above the poverty 6,514 94.3% level In Hawai'i County, 81%of African American children live in poverty; 33.9%of Native Hawaiian and Pacific Islander(NHPI) children live in poverty; and 24.1%of Latino children live in poverty. Page 37 Figure 15: Children Living Below Poverty Level by Race/Ethnicity County: Hawaii Hispanic/Latino 24.1% American IrdianfAlaska Native 21.7% Asian _ 6.8% BlacklAfrican American 81.0% Native Hawaiiani'Pacific Islander 33.9% White,non-Hispanic - 9.3% Two or More Races 18.7% Other 1 1,256 Overall 18.1% 0 20 40 60 80 100 percent Source:American Community Survey 5-Year(2016-2020) +e�,.111 ,tl `1Y 3C :itCP 1'i'.-'•a Significantly better than the overall value 74 Significantly worse than the overall value C No significant difference with the overall value No data on significance available Page 38 5. HOUSING/ HOMELESSNESS There are approximately 88,259 housing units, including both homes and apartments in Hawai'i County.75 Having sufficient housing is important because it allows families to build wealth, attend good schools, and live in communities that are more conducive to long-term success.76 While residential stability can support early childhood development, more than 1 in 8 young children (13%ages 1 to 4 live in families that have moved in the past year." Many young children are also likely to experience homelessness.The most current data from the Homeless Service Utilization Report from 2023 shows us that there are 131 children 0-17 years old who are homeless in Hawai'i County.78 Of those 131 homeless children, 50 are under the age of 6 years old." 1 in 8 young children (13%live in families that have moved in the past year.8"There are 131 children who are homeless in Hawai'i County.81 Of those 131 homeless children, 50 are under the age of 6.12 Housing Housing Availability The high cost of housing in Hawai'i County puts homeownership out of the reach of many families.The median housing unit value for Hawai'i County was$385,900 in 2021.83 Currently, 1 in 5 housing units in Hawai'i County (19.1%are vacant.14 Housing units may be vacant for a variety of reasons. Some are second homes for part-time residents and illegal short-term rentals. a a s Page 39 Figure 16:85 Share of Housing Occupancy & Ownership in Hawaii County, 2021 Vacant 19.1% Own with no mortgage 2r_. Rent with no cost 2.7% Rented Own with mortgage Table 25: Locations of Vacant Housing Units, Hawai'i County, 202186 Captain Cook 4,625 Hilo 2,359 W5ik6loa 1,898 Kamuela 1,535 Pahoa 1,100 547 new housing units were authorized to be built in 2020 across Hawai'i County. Table 26: New Authorized Housing Units, Hawai'i County, 2017-202087 Year Total Units 2017 796 2018 1,054 2019 787 2020+ 547 +4th Quarter 2020 data not included Page 40 Home Sales The high cost of housing in Hawaii puts homeownership beyond the reach of many families. Local buyers tend to purchase lower valued properties, with mainland buyers and foreign buyers on average purchasing properties more than double the price of local buyers. Table 27: Home Sales by Origin of Buyer, Hawai'i County, 2018-2020$$ Year Local Buyer Mainland Buyer Foreign Buyer Number of Average Price Number of Average Price Number of Average Price Homes of Homes Homes of Homes Homes of Homes Purchased Purchased Purchased Purchased Purchased Purchased 2018 2,002 $394,462 1,329 $704,015 81 $1,343,417 2019 2,404 $373,210 1,419 $728,322 66 $1,008,839 2020+ 1,867 $368,010 940 $802,451 32 $1,175,568 +4th Quarter 2020 data not included Housing Mobility When families move frequently,this dislocation can add to the level of chaos experienced by children as they are uprooted, lose access to their supportive institutions like schools, and lose connections to family and friends. Housing stability allows a family to stay in their home without unplanned or unwanted disruptions or moves, such as those caused by foreclosures or evictions. Residential stability allows people to establish stable home lives, relationships with friends and neighbors, become part of their communities, and engage in healthy activities including exercise, and raise their levels of education. On the other hand, housing instability can lead to stress,job loss, and distances residents from each other and undermines social and civic engagement. Eviction is a particularly destabilizing event for families with long lasting negative social and psychological effects.89 Page 41 Table 28: Housing Mobility in Hawai'i County(moves in the past year), 202190 Total Population Percentage Same House 174,629 88.1% Different House; Same County 13,368 6.7% Different County; Same State 1,992 1.0% Different County; Different State 6,813 3.4% Abroad 1,325 0.7% Most families with young children in Hawai'i County have not moved in the past year.Those who have moved are likely to have moved nearby. Table 29: Housing Mobility of Children 1-4 Years Old in Hawai'i County, 202191 Percent of families with young Families with young children children Same Home 7,739 86.3% Different House; Same County 878 9.8% Different County: Same State 117 1.3% Different County; Different State 237 2.6% Abroad Overcrowding Overcrowdingb occurs when more people are living within a dwelling than the space allows, or when there are more people than there are room S.12 Overcrowding housing is associated with low-paying jobs and high housing costs and a shortage of available housing stock.93 b Overcrowding is defined as more than one occupant per room in a home. Page 42 Within Hawai'i County, 7.7%of homes are overcrowded. Overcrowding in Hawai'i County has slowly been on the rise since 2017. Renters are more likely to experience overcrowded housing than homeowners (13.4%vs 5.2%). Figure 17:94 Overcrowded Households HI State Value: 8.7 8 O .0 a 6 a O «, 4 a V L CL 2 0 ro er moo` County Source: American Community Survey 5-Year(2016-2020) Page 43 Figure 18:95 Overcrowded Households by Type of Household County: Hawaii Renters 13.4% Owners 5.2% Overall 7.7% 2 4 6 8 10 12 14 percent of households Source:American Community Survey 5-Year(2016-2020) Homelessness Homelessness is lacking fixed, regular, and adequate nighttime residence, including sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason.The rate of homelessness for Hawai'i County in 2022 is 41.7 per 10,000 people.96The largest share of homeless families with children are headed by single parents.97 In 2023, 131 children in Hawai'i County were considered homeless. More than half of the homeless were female and the majority were either Native Hawaiian or Micronesian. Table 30: Homeless Families with Children by Age Range for Hawai'i County, 202398 Total 220 Birth to 5 Years 50 22.7% 6 to 17 Years 81 36.8% 18 and over 89 40.5% Page 44 Table 31: Homeless Adults with Children by Sex, Hawai'i County, 202399 Male 99 45% Female 121 55% Table 32: Primary Race of Homeless Families with Children by Race/Ethnicity, Hawai'i County, 2023100 Race/Ethnicity Total Individuals Percentage Hawaiian/Part Hawaiian 88 40% Micronesian 28 12.7% Caucasian 21 9.5% Marshallese 21 9.5% Filipino 16 7.3% Samoan 12 5.4% Japanese 8 3.6% American Indian/Alaskan Native 8 3.6% Unknown 7 3.1% Black 4 1.8% Portuguese 3 1.4% Tongan 2 0.9% Guamanian/Chamorro 1 0.4% Other Asian 1 0.4% Homeless Children and Youth Enrolled in Public School According to the National Center for Homeless Education, in Hawai'i for the 2020-2021 school year an estimated 3,080 students across the State of Hawai'i were enrolled in a public school and had unstable housing.121This includes those living in shelters,transitional housing, with another family (doubled-up), in unsheltered settings (car, parks, campgrounds, abandoned building), and hotel/motels. In the 2020- 2021 school year, statewide,there were 3,080 homeless students in public school.101 74.7%of housing insecure children are in families that are doubled-up with another family, 17.4%are living in shelters,transitional housing or awaiting foster care, 7.1%are unsheltered and 0.8%are living in hotels or motels. Page 45 Figure 19: "' Homeless Children/Youth Enrolled in Public School, State of Hawaii, 2020-2021 Hotels/Motels Shelters,Transitional Housing,awa'rtlrg foster care Unsheltered 7j lk Doubled-up 74.7 Information on the number of young, housing insecure children who have access to early care and learning opportunities is limited. 14 of the 235 children (6%) enrolled in PACT Head Start (on Oahu and Hawaii Islands)were homeless. Of the 248 pregnant moms and children served by PACT Early Head Start program, 14%(35 individuals) were homeless.113 Bridging the Gap (BTG): Is a group of diverse stakeholders working to end homelessness across the rural counties of Kaua'i, Maui, and Hawaii Island. In Hawaii County the following organizations participate in BTG: HOPE West Hawaii, Hawaii Affordable Properties, Inc., County of Hawaii, Hawaii Island Home for Recovery, Neighborhood Place of Puna, Salvation Army Family Intervention Services, Steadfast Housing Development Corporation, USVETS.104 In 2021-2022 Bridging the Gap served 288 individuals and families on Hawaii Island. Figure 20: los Population Cluents and House---Ids Served by County I F—ililas - County Kauai Maui Total Prog ram Type (Al l; 1,504. 1,449 Legend 1,479 Clients 1,000 Households. 500 387 288 2 160 10 o I 45 �4 ... 1 jw Clie':t Households Clients Householcs Cliers -louseholcs Clients Households Page 46 • . FOOD SECURITY A quarter of Hawai'i County children are projected to experience food insecurity at some point during the year." 'Thirty-five percent of those children are estimated to be ineligible for nutrition programs because their income is too high to qualify for public assistance programs but not sufficient to provide quality food daily."' Food Insecurity Across Hawai'i County, many families are unable to afford enough food to meet their needs. Estimates suggest that a quarter of all children live in families that are "food insecure." Table 33: Share of People who are Food Insecure, Hawai'i County, 2020108 Total Number Percentage Hawai'i County: 29,120 14.5% Food Insecure Children(0-17): 11,110 25.7% 35%of food insecure children are likely to be ineligible for nutrition programs because of their family's income level. ,; a N j* . F ' i'R 3 trl d . Page 47 a ' Figure 21: 109 Projected Child Food Insecurity Rate �n RRRRRRRRIIII HI State Value: 24.6 C VIII L 20 a� a 1V � County SourceFeeding America(2021) Figure 22: 110 Estimated Program Eligibility* Among Food Insecure Children in Hawaii County, 2020 Ineligible E *Eligibility for nutrition programs is based on income at or below 185%of the federal poverty limit Grocery Stores, Access to Food Shopping USDA data estimates that there is one grocery store for every 4,545 people in Hawai'i County.111 Access to nutritious foods that support healthy dietary patterns supports health not only at that point in time but also across the lifespan and possibly for future generations.112 Evidence demonstrates that a healthy diet is associated with beneficial outcomes for all-cause mortality, cardiovascular disease, overweight Page 48 and obesity,type 2 diabetes, bone health, and certain types of cancer(breast and colorectal).113,114 Having access to healthy, safe, and affordable food is crucial for a healthy diet. Residents of the Kohala and Hilo Districts have limited access to groceries stores locally.This suggests that transportation is a vital component of food access for these individuals. Roughly 3,426 (4.8%) households in Hawai'i County have no car and must rely on other sources of transportation to shop for food."' Figure 23:Total Number of Grocery Stores&Supermarkets by Zip Code, Hawai'i County, 2020 20 116 Fr The USDA defines a food desert as a low-income tract in which a substantial share of the population has low access (1 mile for urban areas& 10 miles for rural areas)to supermarkets or large grocery stores. By this definition, close to half(49.7%) of people in Hawai'i County live in food deserts.117 This is much higher than the state estimate of 10.3%. Feeding America, a non-profit working to end hunger, estimates that an additional $20M would be needed each year to close the food budget shortfall.1 ' Page 49 The majority of Hilo and Ka'u Districts are considered to be food deserts (highlighted in orange on Figure 26). Two areas in Kohala and Kona Districts were removed from the food desert list in 2019 (highlighted in blue). Figure 24: Food Desert by Census Tract, Hawai'i County, 2019119 ■o ma.a, os Food Distribution Programs In Hawai'i County,there are several programs designed to ensure that families and children have access to nutritious food. Many of these programs have limited reach in Hawai'i County. The State of HawaiTs Participation in Child Nutrition Programs • 44th in the Summer Food Service Program (SFSP)121 • 50th for the School Breakfast Program (SBP)121 • 51St in the nation for the At-Risk Afterschool Supper Program through the Child and Adult Care Food Program (CACFP)122 Page 50 In Hawai'i County, over 16,804 children (40%of all children) live in a household that has received public assistance in the past 12 months.12' Fewer than half of these children live in households receiving SNAP (Supplemental Nutrition Assistance Program)funds.124 46 schools participate in the Community Eligibility Provision (CEP) Program, providing the whole student body with free breakfast and lunch.12' For most of the past decade, more than half of all public school students in Hawai'i County have been eligible for the federal free& reduced price lunch program. In academic year 2020-2021, 55.1%of students in Hawaii County were eligible.121 Public Assistance Access In Hawai'i County, 16,804(38.9%) children under 18 live in households that have received public assistance in the past 12 months (year).127 These government programs provide either cash assistance or in-kind benefits to individuals and families. Types of public assistance include:121 • Supplemental Nutrition Assistance Program (SNAP)-provides crucial food and nutritional support to qualifying low-income and needy households, and those making the transition from welfare to self-sufficiency • Special Supplemental Nutrition Program for Women, Infants, &Children (WIC)-assists low- income pregnant, postpartum, and breastfeeding women, infants, and children up to age 5 who are at nutritional risk. • National School Lunch Programs (NSLP) is a federally assisted meal program operating in public and nonprofit private schools and residential child care institutions through the Community Eligibility Provision, Free& Reduced-Price Lunch, and the Child &Adult Care Food Programs.129 • Temporary Assistance for Needy Families(TANF)- help lower income families with minor children with cash assistance, particularly while parents are seeking employment.TANF funds can be used for a variety of other activities (for example, administrative costs, child care and pre-K programs, child welfare services, and work support activities) • Supplemental Security Income- provides monthly cash payments to adults and children who have low income and resources, and who are blind or disabled. • General Assistance- provides cash benefits for food, clothing, shelter, and other essentials to adults ages 18 through 64,without minor dependents, who are temporarily disabled and who do not qualify for Social Security Page 51 Food Assistance SNAP (Supplemental Nutrition Assistance Program) The Supplemental Nutrition Assistance Program (SNAP) is recognized as the nation's most effective anti- hunger program, providing low-income households with supplemental resources to purchase food."' The Supplemental Nutrition Assistance Program is a federal program that provides nutrition benefits to low-income individuals and families that are used at stores to purchase food. The program is administered by the USDA Food and Nutrition Service (FNS)through its nationwide network of FNS field offices. Local FNS field offices are responsible for the licensing and monitoring of retail food stores participating in SNAP."' Approximately 1 in 5 (19%) of all households in Hawai'i County receive SNAP benefits, and 1 in 3 households with children in Hawai'i County(33.5%) receive SNAP benefits (C.f.:Table 34) Table 34: Households with Children under 18 Receiving SNAP by Household Type 132 Hawai'i County, 2021 Total Households with children receiving SNAP 6,932 33.5% Married couple family household 2,566 Single mother 3,208 Single father 1108 Page 52 Figure 25:the Location of SNAP Authorized Retailers in Hawai'i County, 2023 UFood and Nutrition ServiceJ.5.DEPART MENT OF�WCULTU RE SNAP r. o w l , _ s Mauna Kea Forest, Reseros G] 0, pmuuIa Po ga Piihonua r miff alaoa Training Area Kalkua K40 Ha.vs ii UPper)Aaialaea olualoa Mauna Forest%E,a e Loa Forest Reserve V�ao Ks le O. r; ++tA SNA LOA Puna Forest H anami Reserve Uo L arrow a National Park ,. Kau.Forest Re rte rve 6 ir, 133 WIC (Special Supplemental Nutrition Program for Women, Infants & Children) The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional support low-income pregnant, postpartum, and breastfeeding women, infants, and children up to age 5 who are at nutritional risk. WIC provides participants with nutritious foods, nutrition education, and referrals to health and other social services.134 According to the Hawai'i State Department of Health, pregnant women who enroll in WIC are less likely to give birth prematurely,they experience fewer fetal and infant deaths, seek prenatal care earlier in pregnancy, and consume more of such key nutrients as iron, protein, calcium, and Vitamin C. It has been estimated that every dollar spent on pregnant women in WIC produces$1.92 to $4.21 in Medicaid savings for newborns and their mothers.131 An estimated 43.5%of pregnant mothers within Hawai'i County participate in WIC during pregnancy.136 Page 53 Across the State of Hawai'i there are 25,000 WIC participants in a typical month, including 20,000 infants and children. Table 35: Average monthly participation for 2021 WIC Recipients 131 State of Hawai'i, 2021 Total Number of Participants: 25,907 Total Women: 5,431 21.0% Total Infants: 5,305 20.5% Total Children: 15,171 58.6% National School Lunch Program The National School Lunch Program (NSLP) is a federally assisted meal program operating in public and nonprofit private schools and residential child care institutions. It provides nutritionally balanced, low- cost or no-cost lunches to children each school day through the Community Eligibility Provision, Free & Reduced-Price Lunch Programs, and the Child &Adult Care Food Program.138 Children are eligible for reduced price lunch if their family's income is below 185% of the federal poverty line. They are eligible for free lunch if their family income is below 130% FPL. In the 2020-2021 school year, 55.1%of students in Hawai'i County received free or reduced price lunch. Hawai'i County has the highest rate of participation in the FPL program in the state, above Kaua'i (42.3%), Maui (40.9%), & Honolulu (34.5%) counties.139 Page 54 Figure 26: 140 Students Eligible for the Free Lunch Program County: Hawaii SO 60 51.7°6 54..8% 55.8% 55.8% 54.5% 53.9% 55.1% ._ 57.4% 57.9% 58.3% 44.9% 41.4% ;v 40 a 20 0 do do -° Source National Center for Education Statistics(2020-2021) Figure 27: 141 Student Participation in Free or Reduced-Price Lunch Program 2021-2022.Hawaii County 100% 94n�'4i 98 a Sax 98t994100e100.100'.100'.100%700°100°.100'•100`d OU`.100`,100°,100'.i00`IDO°: 43'e .Sfi°q 88%90"t 84%84°z 77°,77%78%78 79•.79'4.89% 75% 65:66%68%6B<fi9"°7147P°e 74°a 54°e Sha 49%50%50°e 51 52 p 50'0 42% 29% 25% 0% s 6' 0 e. v 0 „a - a r v e, c e 5,9 1 Q Q Q (� ��i e' e y1",r0 lr' 0 Aa}0 S 1' ��cx 101 t- 4� Qe a° �e E s Community Eligibility Provision Schools participating in the Community Eligibility Provision (CEP) Program provide free breakfast and lunch to all students.142 A school district, a group of schools or a single school to serve free meals to all Page 55 students, even if they do not qualify for free or reduced- priced lunch in low-income areas. Below are the participating schools in Hawai'i County for the 2022-2023 school year. Chiefess Kapiolani EI. Kealakehe High Connections PCS Hilo High Keaukaha EI. Hawai'i Academy of Arts& Hilo Inter. Keonepoko EI. Science PCS Hilo Union EI. Kohala Elementary Ka Umeke Kaeo PCS Honaunau EI. Kohala Middle Ke Ana Laahana PCS Honokaa EI. Konawaena Elementary Ke Kula Niihau O Kekaha Honokaa High & Inter. Konawaena Middle Learning Center PCS Hookena EI. Konawaena High Ke Kula O Kahakai EI. Mountain View EI. Nawahiokalaniopuu Iki Kalanianaole EI. & Inter. Naalehu EI. Kua O Ka La Charter School Kau High & Pahala EI. Paauilo EI. and Inter. Kualapuu PCS Ke Kula O Ehunuikaimalino Pahoa EI. Laupahoehoe Community Keaau EI. Pahoa High and Inter. PCS Keaau High Waiakea EI. Na Wai Ola PCS Keaau Middle Waiakeawaena EI. Volcano School of Arts& Kealakehe EI. Waikoloa EI. Sciences PCS Kealakehe Inter. Waimea EI. Waimea Middle School Child and Adult Care Food Program The Child and Adult Care Food Program (CACFP) is a federal program that provides reimbursements for nutritious meals and snacks to eligible children and adults who are enrolled for care at participating child care centers, day care homes, and adult day care centers. CACFP also provides reimbursements for meals served to children and youth participating in afterschool care programs, children residing in emergency shelters, adults over the age of 60 or living with a disability and enrolled in daycare facilities. CACFP contributes to the wellness, healthy growth, and development of young children and adults in the United States.143 In 2022, CACFP provided a total of 4,168,979 meals across Hawai'i.144 Temporary Assistance for Needy Families (TANF)/ Temporary Assistance for Other Needy Families (TAONF) Cash Assistance The TANF program assists families with children when the parents or other responsible relatives cannot provide for the family's basic needs.The Federal government provides grants to States to run the TANF program.These State TANF programs are designed to accomplish four goals: 1. to aid needy families so that children maybe cared for in their own homes or in the homes of relatives, Page 56 2. to end the dependency of needy parents on government benefits by promoting job preparation, work, and marriage, 3. to prevent and reduce the incidence of out-of-wedlock pregnancies and establish annual numerical goals for preventing and reducing the incidence of these pregnancies, and 4. to encourage the formation and maintenance of two-parent families. States have broad flexibility to carry out their programs.The States, not the Federal government, decide on the design of the program,the type and amount of assistance payments,the range of other services to be provided, and the rules for determining who is eligible for benefits.141 Across the State of Hawai'i more than 20,000 individuals participate in TANF during any given month. 62%of beneficiaries are children under the age of 18. The State of Hawai'i has established a companion program to the federal TANF program.TANOF provides subsidy support to additional family members who may not be US citizens. A small portion of TANF/TAONF participants are non-US citizens and 10%are Compact of Free Association (COFA) migrants. Table 36:TANF/TAONF Recipients 146 State of Hawai'i, 2021 Average Monthly Clients: 20,885 Recipients under age 18: 12,948 62% Table 37:TANF/TAONF Recipients by Citizenship 141 State of Hawai'i, 2021 US Citizenship- 88.0% Compact of Free Association (COFA) 10.0% Non-US/ Unspecified 2.0% Housing Support Families struggling to cover the cost of rent and utilities may be eligible to access systems of support provided by the federal, state, and county governments, and by utilities such as Hawaiian Electric.The following section outlines the support available for public housing, rental subsidies, and energy assistance programs. Page 57 In 2020,the Hawai'i Public Housing Authority (HPHA) provided 5,600 housing units to a total of 19,000 occupants across the State of Hawai'i. As seen in Table 38,the average rent charged per month by HPHA was$301, with some units paying zero rent. HPHA also provides rental subsidies for eligible families, elderly,veterans, and low-income households. Publicly Funded Housing Table 38: Federal & State Public Housing 148 State of Hawai'i, 2021 Total number of Total units occupied: occupants: Average Rent Charged per unit per month: 5,600 19,000 $301 Federal & State Rental Subsidies for the State of HawaiIi149 Section 8 Receipt among eligible families Families served: 2,726 Average Housing Assistance Payment(State) $1,327/month Average Tenant Payment: $470/month Non-Elderly Disabled Vouchers (NED) Vouchers Administered: 133 Average Payment: $1,074/month Average Tenant Payment: $321/month Veterans Affairs Supportive Housing WASH) Clients Served: 425 Average Payment: $838/month Average Tenant Payment: $309/month State Rent Supplement Program Clients Served: 239 Average Payment: $425/month Average Tenant Payment: $584/month Page 58 Health Insurance Quality healthcare access is the foundation for a child's overall wellbeing and readiness for early learning.This starts with prenatal care and includes home visitation for newborn children and their families, regular health and wellness screening, referrals for needed services, and convenient access to those services. Med-QUEST is the State of Hawai'i's public health insurance program for children in low-income families. In Hawai'i County there were a total of 87,650 Med-QUEST recipients in 2021.150 Of the 13,638 children 0-5 years old in Hawai'i County, 1.4%were not covered by any health insurance. The majority of young children are covered by public health insurance (59.9%), as seen in Table 40, with the remaining 42.5% having some form of private insurance. Table 39: Children 0-5 Years Old by Health Insurance Coverage 151 Hawai'i County, 2021 Covered by health insurance 13,445 98.6% Not covered by any health insurance 193 1.4% Table 40: Health Insurance of Children 0-5 Years Old by Insurance Type (Alone or in Combination) Hawai'i County, 2021 Uninsured:152 1.4% Private (Employer, Direct Purchase, 42.5% Tricare/Military);153 Public (Medicaid, Medicare, VA):154 59.9% The share of families insured by MedQuest has increased by almost 40%over the past decade. Page 59 Figure 28: "' State Med-Quest Enrollment in Hawaii County by Year 90,000 V 80,000 87,650 70,000 69,975 72,591 74,108 75,258 73,452 76,304 60,000 69,081 62,145 a 50,000 C W 40,000 m C ° En 30,000 a ° 20,000 CD E 10,000 z 0 2013 2014 2015 2016 2017 2018 2019 2020 2021 Year Child Care Assistance Tuition Support The Center for American Progress (CAP) estimates that in the State of Hawai'i, only 7.4%of subsidy- eligible children 0-5 years old actually receive child care assistance."' In Hawai'i,there are a number of early care and learning options that are available at no cost to families. These include: • Head Start(Center based care for 3 and 4 year olds) • Early Head Start(Home and Center based care for keiki 0-2) • Executive Office on Early Learning Pre-Kindergartens and Public Charter School Pre- Kindergartens • Early Intervention Services Tuition Support Subsidies • DHS The Child Care Connection Hawaii • DHS The Preschool Open Door • Kamehameha Schools Pauahi Keiki Scholars • Samuel N. & Mary Castle Foundation and Weinberg Foundation grants • Help for Child Care Programs- Keiki O Ka 'Aina Page 60 • AFFORDABLE CHILD CARE Almost 65%of young children in Hawai'i County have all available parents in the workforce.15' Residents of Hawai'i County carry a high housing cost burden (defined as>30%of income devoted to housing). 26%of owners have high mortgage costs, and more than half of renters carry high housing costs."' Child Care Needs Without reliable and affordable child care options, parents must often choose between spending a huge portion of their budget on child care, using less convenient or lower-quality care arrangements, cutting back their work hours, or patching together some combination of these options. Many mothers are forced to leave the workforce altogether because of child care struggles, which can cost them hundreds of thousands of dollars over the course of their careers.159 A total of 8,797 out of 13,603 (64.7%) children under 6 years old living with their parents in Hawai'i County have all available parents in the workforce. More than 3,700 young children live with two parents, both of whom are in the workforce, and more than 5,000 young children live with one parent, and that parent works full time. The National Survey for Children's Health estimates for the State of Hawai'i,that 12,114 (12.1%) of parents make career sacrifices due to issues with child care issues."' Table 41: Children Under 6 Years Old with All Available Parents in the Workforce"' Hawai'i County, 2021 Total number of Children under 6 years old with all available 8,797 64.7% parents in the workforce Living with two parents, both of 3,746 28.8% whom are working Living with one parent, who is 5,051 38.8% working Page 61 Table 42: Children 6-17 Years Old with All Available Parents in the Workforce 112 Hawai'i County, 2021 Total number of Children 6-17 years old with all available 20,471 69.33% parents in the workforce Children 6 to 17 years with both 11,941 parents in the labor force Single mothers who are 5,830 employed Single fathers that are employed 2,700 Family Income Levels Income is a vital resource for families with young children. Families with insecure or inadequate incomes have a difficult time accessing secure housing, sufficient nutrition, and quality child care, among other vital needs. In Hawai'i County 17%of households live in poverty and another 31%of households are working, but still have an extremely difficult time making ends meet.These families are considered to be in the "ALICE" population (Asset Limited, Income Constrained, Employed). Another 52%of households above the ALICE threshold. Page 62 Figure 29:163 Hawaii County Households by Income, 2018 Households in Poverty 17.0% Households Above ALICE Threshold ALICE Hmiseholds Table 43: 164 AUW ALICE Household Survival Budget 2018 Housing $1,322 Child Care $476 Food $1,186 Transportation $802 Health Care $756 Technology $75 Miscellaneous $548 Taxes $867 Monthly Total $6,032 Annual Total $72,384 Hourly Wage $36.19 Page 63 Cost of Child Care The average price for child care tuition for 2 children in the State of Hawai'i is$20,945 annually.165 Hawai'i is one of the least affordable states for center-based infant care and center-based care for 4- year olds. Table 44: Affordability Ranking Child Care, State of Hawai'i, 2021166 Percent of Median State Ranking (least Income of Married Percent of Median Income affordable) Families of Single Parents Cost of Center-Based #4 15.6% 43.7% Infant Care Cost of Family Child o 0 Care (FCC)for Infants #39 8.0% 22.5/ Cost of Center-Based #23 11.4% 31.8% Toddler Care Cost of Family Child #35 7.8% 21.8% Care (FCC)for Toddlers Cost of Center-Based #8 11.3% 31.7% Care for 4 Year Old Cost of Family Child Care (FCC)for 4 Year #30 22.0°% 7.9% Old Families with multiple children spend more on child care. A two parent family with income at the federal poverty level of$34,500 would spend 80.8%of their income on the market cost for preschool for two children. Table 45: Percent of Income Spent on of 2 Children Child Care 161 State of Hawai'i, 2020 Center Home Two children-single parents 67.5% 51.5% Two children-married couple family 23.7% 18.1% Married family with two children at the 80.8% 61.7% poverty level Page 64 Tables 46 &47 display monthly average rates for child care homes and child care centers. Prices are listed as averages of West and East Hawai'i provider rates. Table 46: Monthly Average Full-Time Rate for Child Care Homes"' Hawai'i County, 2022 Child Care Homes (Family Child Care& Group Homes) West Hawai'i East Hawai'i 0-12 months $884.79 $727.98 12-24 months $885.50 $710.68 2-3 years $887.87 $689.35 4-5 years $884.47 $692.53 Table 47: Monthly Average Full-Time Rate for Child Care Centers"' Hawai'i County, 2022 Child Care Centers West Hawai'i East Hawai'i 0-12 months $2,380.00 N/A 12-24 months $1,985.00 $650.00 2-3 years $1,121.83 $1,055.74 4-5 years $1,057.81 $1,247.92 Housing Costs The characteristics of a child's home including cost, condition, residential mobility and surrounding neighborhood can affect all aspects of their health, social, and emotional wellbeing.Yet high housing costs complicate housing decisions,forcing families to make tradeoffs between housing quality, safety and location. In Hawai'i County,the average monthly mortgage cost is $1,867, and the average monthly rent is $1,250. Page 65 Table 48: Median Monthly Cost of Occupied Housing... Hawai'i County, 2021 Number of Units Average Monthly Cost Own with mortgage 28,370 $1,867 Own with no mortgage 21,452 $367 Rent 19,215 $1,250 High & Severe Housing Cost Burden As housing costs have outpaced local incomes, households not only struggle to acquire and maintain adequate shelter, but also face difficult trade-offs in meeting other basic needs. When most of a paycheck goes toward the rent or mortgage, it makes it hard to afford child care, doctor visits, healthy foods, utility bills, and reliable transportation to work or school.This can, in turn, lead to increased stress levels and emotional strain.171 This is known as housing cost burden 112 Households are considered "cost burdened" if they pay more than 30 percent of their income for housing. In Hawai'i County 50.1%of renters and 26.6%of homeowners are cost burdened.113 For some households, housing costs are even more severe.The federal definition of"severe housing costs" is a household spending over half their income on housing. In Hawai'i County, 23%of households meet this definition.174 Page 66 The birth rate for Hawai'i County is currently at 10 per 1,000 persons and has been declining since 2010.175 There has been a notable decline in births to teen mothers (from 40 per 1,000) a decade ago to 16.8 (per 1,000 girls aged 15-19) in 2020. Reasons for this decline include more effective contraception, and more information about pregnancy prevention.176,177 Bi Over the past decade the number of babies born in Hawai'i County each year has been declining. Figure 30: 178 Live Births by Year, Hawaii County 2,500 2,254 2,323 2,254 2,294 2,310 2,240 2,233 2,133 2,093 1,924 1,909 2.000 1.500 1,000 500 0 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Page 67 Table 49: Birth rate for Hawai'i County, 2010-2020179 Year Birth Rate (per 1,000 Persons) 2010 12.9 2011 13.2 2012 12.7 2013 12.6 2014 12.6 2015 12.1 2016 11.8 2017 11.4 2018 11.0 2019 10.1 2020 10.0 The largest share of births in Hawai'i County were to Native Hawaiian mothers (852 births), followed by White mothers (426 births). The highest birth rate in Hawai'i County is to Other Pacific Islanders who accounted for 216 births in 2020, but gave birth at a rate of 38.7 per 1,000 people. Table 50: Number of Live Births & Birth Rate by Mother's Ethnicity" Hawai'i County, 2020 Birth Rate Race/Ethnicity #of Live Births (per 1,000 Persons) White 426 6.8 Native Hawaiian 852 14.9 Other Pacific Islander 216 38.7 Filipino 230 11.2 Chinese 34 19.0 Japanese 109 5.4 Other Asian 37 14.0 Black or African American 22 11.4 Native Alaskan/American Indian 55 25.0 Other 52 3.8 *Data suppressed due to small population and not appropriate for publication. Page 68 Teen birth is of concern for the health outcomes of both the mother and the child. Babies born to teen mothers are more likely to be born preterm and/or have low birth weight.181 Mirroring national trends,there has been a steady decline in teen births over the last decade. For Hawai'i County there were 16.8 births per 1,000 girls aged 15-19 in 2020. Figure 31: Teen Birth Rate in Hawaii County 40.0 6 30.0 m U) 0 20.0 CZ) F 0 0 `m d 10.0 0.0 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Year 182 Table 51:Teen Births Rate Girls Aged 15-19 by County, 2020183 County Births Rate per 1,000 Girls Aged 15-19 Hawai'i County 16.8 Honolulu County 12.4 Kauai County 11.4 Maui County 12.8 *More information on teen habits found in Section 15.Strong Families& Communities Page 69 Pre-Pregnancy Health In 2020, nearly pregnant women (46.7%) in Hawai'i County had a healthy body weight prior to pregnancy.184 All counties in Hawai'i have a higher rate of women with healthy body weights prior to pregnancy than the national average. Table 52: Women with a Healthy Weight Prior to Pregnancy by County... 2020 Hawaii County 46.7% Honolulu County 44.1% Kauai County 51.1% Maui County 47.6% U.S. Average 43.0% Pregnancy Access to quality prenatal care early in pregnancy can help prevent complications for women during pregnancy, reduce harm to the health of the fetus, and provide critical information and resources to families to ensure the healthiest possible start for their child. In Hawai'i County,47.2%of new mothers report that their pregnancies were intended."' This share has been increasing over the past 10 years. Page 70 Figure 32: 187 •,< � •,� „-air r .;��rr; Pregnancies that Are Intended County: Hawaii 6() 5o 46.5% 47.7% ° ° 40.1.6 41.1.6 38.1% 38.0% 40 36.1% 39.21 383°x6 3;9.5% _�- . 34.5° . 30.4,% 30 Y v 20 10 0 Source: Pregnancy Risk Assessment Monitoring System(2020) Healthy Practices before and during pregnancy Healthy behaviors during pregnancy are vital for the best start of a child. This includes substance abuse, mental health and development before, during and after pregnancy. Maternal Drug&Alcohol Use In Hawai'i County 4.4%of mothers report using marijuana during pregnancy.188 4%of mothers reported smoking cigarettes during the last 3 months of pregnancy.18' 20.6%of mothers lived with a cigarette smoker during pregnancy and were exposed to secondhand smoke.19' Alcohol Consumption Within the 3 months prior to pregnancy, 52.7%of mothers consumed alcohol, and 20.2%of mothers reported binge drinking (drinking 4 or more alcoholic drinks on one occasion).191,192 During the last 3 months of pregnancy, 7.1%of mothers drank alcohol.193 Prenatal Visit Depression Screening Hawai'i County has the second highest rate of screening and depression identification, 83.4%and 10.3% respectively, supporting the importance of depression screening of expecting and new mothers. Page 71 Figure 33: ..ales Prenatal Visit Depression Screening & Identification by County, 2020 100.0% 75.0% 50.0% 25.0% 0.0% Hawaii County Honolulu County Kauai County Ntaui Courty Asked about Depression by Healthcare Provider M Experiencing Depression Du nc P Prenatal Care Women who receive early and adequate prenatal care are more likely to give birth to healthy infants. Approximately 60%of mothers in Hawai'i County receive early and adequate prenatal care. Native Hawaiian mothers are least likely to receive early and adequate prenatal care. Page 72 Figure 34: 196 Mothers who Received Early and Adequate Prenatal Care 100 U.S. Value: 87.1 75 50 25 0 County Source: Pregnancy Risk Assessment Monitoring system(2020) Figure 35: 197 Prenatal Care for Mothers, Hawaii County, 2020 Late or No Prenatal Care 40.1% Early and Adequate Prenatal Care 59.9% Am 1111111111111111111111111111/1.111111111111111111111 ................................................. ..................................................... Page 73 Birth Outcomes Babies born premature are more likely to require specialized medical care, and often require intensive care stays.While there have been many medical advances enabling premature infants to survive, infants that are premature remain at greater risk of mortality or long-term disability.The most important things an expectant mother can do to prevent prematurity and very low birth weight are to take prenatal vitamins, stop smoking, stop drinking alcohol and using drugs, and most importantly, get prenatal care.198 In Hawai'i County, 6.8%of births were preterm ( before 37 weeks of gestation).199 A total of 4.2%of babies were born with low birth weights (less than 5.5 lbs.).200 Low birthweight (less than 5.5 pounds) is associated with poor developmental outcomes, beginning in infancy but extending into adult life. Low birthweight is often associated with preterm delivery but can occur also with full-term births. Research points to several factors that can contribute to the likelihood of low weight at birth, including smoking during pregnancy; low weight gain during pregnancy, or low pre-pregnancy weight; and the pregnant parent's stress during pregnancy. 201 Table 53: Birth Weight Range 202 Hawai'i County, 2020 Birthweight Percentage Low Birth Weight(less than 5.5 lbs.) 4.2% Normal Birth Weight 87.3% High Birth Weight (8.8 lbs. and above) 8.6% 92.5%of mothers in Hawai'i County discussed contraception during their postpartum visit, and 71.8%of new mothers report using some form of birth control after giving birth. Table 54: Postpartum Contraception Discussion & Use 203 Hawai'i County, 2020 Percentage Discussed 92.5% Inserted or Prescribed after Pregnancy 71.8% Page 74 Breastfeeding Breast milk has benefits for both infants and mothers. Breastfeeding helps babies and mothers to bond and can help build a baby's immune system. Breast milk also provides complete nutrition for infants and is easier to digest than breast milk alternatives and is free and cost-effective for families. Almost 80%of new parents in Hawai'i County breastfeed their newborns for 3 months or more. Table 55: Breastfeeding Duration" Hawai'i County, 2020 Percentage Never Breastfed 5.3% Breastfed<1 Week 2.2% Breastfed 1-4 Weeks 12.4% Breastfed 5-8 Weeks 1.7% Breastfed 9+Weeks 78.4% dr y - _ .......: Page 75 10. CHILD WELL- BEING RISK FACTORS Health & Social Service Needs Over 14.6%of children under 18 years old in Hawai'i have experienced 2 or more Adverse Childhood Experiences (ACEs).205 ACE's play a key role in the health outcomes of adults. ACE's are offset by protective factors that strengthen families and increase family resilience through difficult situations. Adverse Childhood Experiences Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). ACEs are linked to chronic health problems, mental illness, and substance use problems in adolescence and adulthood. ACEs can also negatively impact education,job opportunities, and earning potentia 1.211 Adverse Childhood Experiences include: • Difficulty covering basics on family's income • Parent or guardian divorced or separated • Parent or guardian died • Parent or guardian served time in jail • Saw or heard parents or adults slap, hit, kick punch one another in the home • Was a victim of violence or witnessed violence in their neighborhood • Lived with anyone who was mentally ill, suicidal, or severely depressed • Lived with anyone who had a problem with alcohol or drugs • Treated or judged unfairly due to race/ethnicity • Treated or judged unfairly due to sexual orientation or gender identity Statewide in Hawai'i, 5.4%of infants and toddlers (0-2 years old) have experienced 2 or more adverse childhood experiences, 6.7%of children under 6 years of age and 14.6%for all children. Table 56: Children Experiencing Two or More Adverse Childhood Experiences, by age State of Hawai'i, 2020-2021 Number of Children Percentage of All Children Infant/Toddlers201 2,673 5.4% Children under 6208 6,784 6.7% Children under 18209 43,287 14.6% Page 76 Domestic Violence & Child Abuse and Neglect Children who are exposed to domestic violence are more likely to experience emotional, mental, and social damage that can affect their developmental wellbeing.2lo Across the State of Hawai'i the rate of CAN for infants and toddlers is 7.2 per 1,000.211 Table 57: Infant/Toddlers Removed from Home 212 State of Hawai'i, 2020 Rate of Infant/Toddlers(0-2) removed from home 7.5 per 1,000 Time in out-of-home placement(less than 12 months) 25.6% Permanency Reunified 65.9% Permanency Adopted 26.6% Permanency Guardian 7.1% Domestic Violence Information on intimate partner violence is collected by the National Incident-Based Reporting System. Currently, only Honolulu, Maui and Kauai Counties contribute to the NIBRS system. Across Honolulu, Maui and Kauai counties,there were a total of 2,690 reported offenses of intimate partner violence in 2021. 93%of these offenses were assault,the remaining 7%were either kidnapping/abduction or sex offenses.The majority of victims of intimate partner violence were girlfriends or boyfriends of the perpetrators. Figure 36: Number of Intimate Partner Violence Victims by Partner Relationship for the State of Hawai'i, 2021 Victim'Nas Soyrffiend;Girtfriero 1.400 Victim wa=-Commor-Law SpouSe14 Victim Wa=-Ex-Relationship 545 Victim was Spoue 627 Vctimwa=-Ex-Spot Be 104 i- r a-- C. 20C SOC 30C SCC 1,000 1,200 1,400 1,1600 213 Page 77 Children who are abused or neglected may suffer both immediate harm and they may also develop lasting emotional and psychological problems, such as anxiety or posttraumatic stress. Over the long term, children who are abused or neglected are also at increased risk for experiencing future violence victimization and perpetration, substance abuse, sexually transmitted infections, delayed brain development, lower educational attainment, and limited employment opportunities."' Hawai'i County has a CAN rate for children (0-17 years old) of 6.5 per 1,000 children.This is 50% higher than the State of Hawai'i CAN rate of 4.0.115 Hawai'i County has had a higher rate of CAN than the state average across the past decade. Figure 37:116 CHILD ABUSE AND NEGLECT(BIRTH TO AGE 17)(RATE)- 2020 TOTAL Nawai`i Children Action Network=ram cava:=n:r.kidscount.org Page 78 Figure 38:Z1' CHILD ABUSE AND NEGLECT (BIRTH TO AGE 17) (RATE)- 2011-2020 6 4 1 l 20-1 2012 2413 2014 2015 2016 2017 2018 2019 t C&C HONOLULU +HAWAII COUNTY t KAUAI COUNTY MAUICOUNTY HAWAII Hawaii Children's Action Network from datacenter.kidscount.arg In 2021 there were a total of 618 reported cases of suspected CAN in Hawai'i County. 241 of these cases were confirmed to be instances of CAN. Among those cases of child abuse and neglect where a community was identified,the largest share of reports and confirmed cases were from Puna and South Hilo. Table 58:Total Reported &Confirmed Victims of Child Abuse& Neglect by District218 Hawai'i County, 2021 District Reported Confirmed North Hilo 8 5 South Hilo 126 43 Puna 169 96 Ka'u 24 10 South Kona 6 4 North Kona 35 4 South Kohala 19 9 North Kohala 14 1 Hamakua 15 6 Unspecified 670 257 Total 1,086 435 Page 79 75%of cases of child abuse and neglect in Hawai'i County are instances coded as"threatened harm." Another 15%were coded as cases of neglect, and 5%were coded as victims of physical abuse. Table 59:Total Confirmed Victims of Child Abuse& Neglect by Maltreatment Type21' Hawai'i County, 2021 Maltreatment Type Confirmed (Unique Count) Physical Abuse 28 Neglect 83 Medical Neglect 7 Sexual Abuse 14 Psychological Abuse 5 Sex Trafficking 0 Threatened Harm 418 Total 555 Statewide, Native Hawaiian children are over-represented among child victims. Table 60:Top 5 Races of Confirmed CAN VlCtimS220 State of Hawai'i, 2021 Race Victims Percent of Victims Hawaiian/ Part-Hawaiian 552 39.8% White 299 21.6% Mixed 108 7.8% Filipinx 106 7.6% Samoan 36 2.6% In 2021, 26.1%of confirmed victims statewide were under age 3, and 42.3%of confirmed victims were younger than five. Page 80 Table 61: Confirmed Child Victims of CAN by Age... State of Hawai'i, 2020 Age Children (unique count) Percentage of all Confirmed CAN cases Less Than One Year 223 16.1% 1 Year 78 5.6% 2 Years 61 4.4% 3 Years 79 5.7% 4 Years 76 5.5% 5 Years 70 5.1% Total 0-5 Years Old 587 Table 62 presents the top 5 causes of death from 2015-2019 among babies, children aged 1-14 years old and youth 15-24 years old. Unintentional injuries for babies less than a year old is the 4th leading cause, behind perinatal conditional, congenital abnormalities, and Sudden Infant Death Syndrome. Between 2015-2019,there were a total of 7 cases. For children 1 years old to adults 24 years old there were a total of 183 cases of unintentional injury that resulted in death. Table 62:Top 5 Leading Causes of Death Among Hawai'i Residents 0-24 Years Old 222 State of Hawai'i, 2015-2019 <1 (492 total) 1-14y(174 total) 15-24y (460 total) Perinatal conditions Unintentional injuries Unintentional injuries 1 262 40 163 Congenital anomalies Malignant neoplasm Suicide 2 77 30 136 Sudden infant death synd. Congenital anomalies Malignant neoplasm 3 23 14 37 Unintentional injuries Suicide Homicide 4 7 <10 20 Heart disease Homicide Heart disease 5 11 <10 20 Page 81 Infant Mortality Rate Birth outcomes are a critical indicator of a community's health status. Infant death is usually reported as the Infant Mortality Rate (IMR)-the number of infant (first year of life) deaths per 1,000 live births. IMR is utilized worldwide as a measure of community health.The Infant Mortality Rate for Hawai'i County in 2019 was 5.2/1,000 babies, above the state rate of 4.6.223 Infant Mortality Rate The Infant Mortality Rate for Hawai'i County in 2019 was 5.2 deaths/1,000 infants.This is higher than the state rate of 4.6 deaths/ 1,000 infants.224 The Infant Mortality Rate in Hawai'i County has fallen over the past decade. Statewide,the leading cause of infant death is unintentional suffocation. Figure 39: Infant Mortality Rate County: Hawaii 10 8 7.7 �6.96.5 6.86.5 6 3 6.4 6.1 6 5.8 5.5 5.3 5.4 5.7 2 5.2 0 4.6 0 3.9 3.6 4 2 0 07 O� a� ah Or° °1 a� 00 tiO �N til ��i N N N gO y'1 ti� poi �o oo �o yo do �o �o �o �o yo do �o oti oti Source- Hawaii State Department of Health,Vital Statistics(2017-2019) 225 Page 82 Table 63: Infant Death Rates by Cause State of Hawai'i, 2020 Due to All Birth Defects:221 1/1,000 live births Due to Congenital Heart Defects:221 0.1 death/1,000 live births Due to Sudden Infant Death Syndrome 0.3 deaths/1,000 live births (SIDS):228 Due to Sudden Unexpected Infant Deaths:229 0.8/1,000 live births Due to Unintentional Suffocation:231 14.1 deaths/1,000 live births Page 83 11 . CHILD HEALTH & DEVELOPMENT Children's Health Across the state, 88.4%of children under age 6 received a well-child check-up in the past year."' For children (aged 0-17) in Hawai'i with special needs,just under half(49.3%) have a medical home.13'A medical home is a more holistic approach to the health of the child through a partnership between the patient,family, and primary care provider in cooperation with specialists and support from the community.133 Mental Health Parental mental illness and depression can impact the lives of dependent children in direct and indirect ways including attachment formation,the cognitive, social and behavioral development of children. In 2020, 54.3%of adults in Hawai'i County reported good physical and mental health in the past month, slightly lower than the state average of 57.4%, but higher than the national average of 49.6%.134 Statewide, 67.7%of children aged 3-17 years are diagnosed with emotional, developmental, or behavioral problems for which they received treatment or counseling from a mental health professional in the past year.231 Disabilities An estimated 1.91%of young children (0-4 years old) in Hawai'i County live with a disability.236 According to the U.S. Department of Education, more than six million children with disabilities receive special education and related services annually through their school system. As children with disabilities approach adulthood,they may have difficulties living independently or fulfilling work responsibilities without sufficient accommodation S.237 Dental Care Oral health has been shown to impact overall health and well-being. Nearly one-third of all adults in the United States have untreated tooth decay and one in seven have gum disease. Because untreated cavities and other dental concerns can have serious implications for health including infections, it is recommended that adults and children see a dentist on a regular basis. Statewide, 84.9%of all children had a preventative dental care visit in 2021. 72%of younger children (under 5) had a visit to the dentist in the same year. Page 84 Table 64: Children with a Preventative Dental Care Visit by Age Group... State of Hawai'i, 2020-2021 Age Group Percentage All Children (1-17) 84.9% 1-5 72.0% 6-11 91.8% 12-17 89.4% In 2021, 79 children from Hawai'i County were transported off-island by Medicaid for dental care, due to the limited dental services available on the island. Table 65: Number of Children Transported off Island by Medicaid for Dental Services by County, 2021239 County Number of children Honolulu: 0 children Kaua'i 11 children Hawai'i 79 children Maui 166 children Medical Home According to the American Academy of Pediatrics, a medical home is an approach to providing comprehensive primary care that facilitates partnerships between patients, clinicians, medical staff, and families.24'A medical home extends beyond the four walls of a clinical practice. It includes specialty care, educational services,family support and more.241 Across Hawai'i, half of children (49.3%) 0-5 have a medical home.242 Numbers are lower for young children with special healthcare needs,43.7%have access to a medical home.243 Page 85 Immunization Vaccines protect the community by preventing the spread of disease from one person to the next. Vaccines can prevent serious diseases that once killed or harmed many infants, children, and adults. Without vaccines, children are at risk for serious illness or even death from diseases like measles and whooping cough."' Statewide, 73.7%of 2-year-olds have received their full set of recommended vaccines, below the national average of 75.1%. Figure 40:245 2-YEAR-OLDS WHO WERE IMMUNIZED (PERCENT) - 2010-2019 40% 80% 0% 60% 50% 40% 30% 20% 10% 0% 'O1J 2011 3012 2113 2014 2015 2016 _ 2.-1 +HAWAII +UNITED STATES The Annie E.Casey Foundation from data—t—kids—t.org Health Care Access In Hawai'i, Medicaid coverage is offered to individuals and families living below 138%of the federal poverty level (FPL).24e The State Medicaid policy recommends maternal depression screening in well child visits and covers social emotional screening for young children.24' Page 86 12. EDUCATION 92.4%of adults in Hawai'i County have completed a high school degree. Meanwhile, 29.4%of adults in Hawai'i County have a 4-year college degree. Kindergarten Readiness Kindergarten readiness includes exposure to activities that extend far beyond learning the letters of the alphabet or how to hold a crayon. It involves a basic understanding of core subjects as well as acquiring language skills, self-care skills, and social skills kindergartners need going into a classroom with other children. Research also tells us that providing a high-quality education for children before the age of five results in significant long-term benefits for students.The more prepared children are both academically and emotionally for kindergarten,the more successful learners they will become.The first few years are critical to help young children navigate and transition through a variety of settings and situations,while developing their emotional skills.241 Kindergarten Entry Assessment Starting July 1st, 2023,the Hawai'i Department of Education will implement a Kindergarten Entry Assessment(KEA)within the first 30 days of each child's admission into kindergarten. English medium schools will utilize the Johns Hopkins University Ready for Kindergarten Tool.A KEA tailored to Hawaiian medium schools will be developed and implemented in the following year. The KEA will include the following domains: Social Foundations, Language and Literacy, Mathematics, Science, Social Studies, Physical Well-Being and Motor Development, and Fine Arts.24e Kindergarten Enrollment Kindergarten provides young students with positive experiences that are important in establishing the foundation for future school attitudes and success. Kindergarten is mandatory in the state of Hawai'i for all children who are 5 years of age.zso In the 2021-2022 school year,there were almost 1,900 kindergarteners in Hawai'i County. The majority of kindergartners (73.9%) attend public school, 15.5%attend public charter schools, and 10.6%attend private schools. Page 87 Table 66: Kindergarten Enrollment* by School Type Hawai'i County, 2021-2022 School Year Public251 Charter 252 Private 251 Total Hamakua 126 21 0 147 Hilo 447 69 41 557 Ka'u 49 18 0 67 Kohala 52 42 41 135 Kona 445 50 53 548 Puna 278 94 65 437 Total 1,397 294 200 1,891 Percentage 73.9% 15.5% 10.6% 100% *Homeschool data not available or reported K-12 School Enrollment There are 70 schools in Hawai'i County serving children in Kindergarten through 12th grade, including 41 public schools, 15 public charter schools, and 14 private school S.254 There were 30,560 students in grades K-12 in the 2020-2021 school year in Hawai'i County 75.6%of the student population attended public DOE schools. Table 67: K-12 Enrollment, Hawai'i County, 2021-2022 School Year Public255 Charter 251 Private 251 Total Hamakua 1,687 333 0 2,020 Hilo 7,710 795 368 8,873 Kau 940 266 0 1,206 Kohala 768 730 993 2,491 Kona 7,269 727 491 8,487 Puna 4,739 1,303 1,441 7,483 Total 23,113 4,154 3,293 30,560 Percentage 75.6% 13.6% 10.8% 100% *Homeschool data not publicly available Page 88 Figure 41: Hawai'i Public Schools Hawai'i District Map }HA1 An PUBLIC SCHOOLS Hawaii District r H Itahat�E s� � 1GN+ikS1 E ®wzirrae poE&, A W�E M ECaranunanYr E&I E M,lo unimf tWo-H � kapierxd E W f.1 , IG}s4dWtp E KnlLlki�hc! S�+a E^—• WA*U H er�auaxu.x N r h,EJ"o x y°�kVasSkp:,r< "�"ICeaUlwchn f 1Yak+3t`ca I `-�-Y�F'aee'cnrrc.kn,F KIM M-"' KY;tw 4i maw h7o,rts�Ver E�,�, ,,.�kk Wura 4E�,u,wa 6 KN%awar+a tr M Pam]H8! V496 p" !'eE ra m&M E � 6r-f Eieravr5su E ps-w E ,,�tb*V,wE Eren,EM1t&}School H II .6 Erementdy t interrtmeoiale school Inteimed4at 4ddre School ln(armetdjate&High 9Ch0gJ Kau H panau E High schcd E I�m$nt llttt ln@ a2tQ$High SChbt1 # Special Sctroal Ns*1wE wti9id 0516.P:in�+-�-i]t5 258 Special Education In 2021, 11.3%of Hawai'i County students in grades K-12 were enrolled in special education programs in public schools.259 Mon .Lfta a1► a Page 89 Figure 42:260 OF IK-12 IN SPECIAL EDUCATION (PERCENT)- 2021 ,2% n% 10.5% lo% 5.s% 9% s% 7% 6% 5% 4% 3% 2% l% C% La 1. H—ii C6C H—WW Hawaii C.,- Nauai Cou.ty Maui County TOTAL Hawai9 Children's Action Network from datacenter.ktdscount.arg K-12 Student Performance 3rd &4th Grade Achievement Children who struggle to read are more likely to struggle in school more generally.There are significant disparities in reading skills among 3rd &4th graders by race/ethnicity, school type, and eligibility for the National School Lunch Program. Reading skills are a crucial component of health literacy later in life.This indicator monitors the ability of educational systems to give children the knowledge and skills necessary to be productive members of society.261 Close to half of third and fourth graders in Hawai'i County score at or above grade level on assessments of reading and mathematics. Page 90 Table 68: 3rd &4th Grade Achievement Scores, Hawai'i County, 2021-2022262 Green=scores met or exceeded state average 3rd graders at or 4t"graders at or 4t"graders at or 4th graders at above proficiency on above above proficiency on or above English/ Language proficiency on the English/ proficiency on Arts (ELA) Math Language Arts the Math School Assessment Assessment assessment Assessment State Average Met/Exceeded 49.0% 51.0% 52.0% 46.0% Achievement Connections NCPCS Not Reported Not Reported 20.8% 25.0% de Silva Elem 60.3% 76.1% 72.7% 71.1% Haaheo Elem Not Reported Not Reported 52.1% 52.0% Hawaii Academy of Arts 48.8% 48.9% 44.4% 33.3% & Science PCS Hilo Union Elem 42.7% 24.4% 30.5% 30.6% Holualoa Elem 45.1% 41.8% 51.1% 43.2% Honaunau Elem 35.0% 30.0% Not Reported Not Reported Honokaa Elem 37.4% 74.9% 58.3% 64.5% Hookena Elem Not Reported Not Reported Not Reported Not Reported Innovations PCS 81.8% 63.6% 65.3% 69.2% Ka Umeke Kaeo PCS 50.0% 61.5% 28.0% 8.0% Kahakai Elem 34.6% 31.8% 44.9% 35.8% Kalanianaole EI & Int 24.9% 33.3% 16.0% 12.0% Kanu O Ka Aina NCPCS 50.0% 25.7% 53.2% 40.6% Kapiolani Elem 23.1% 16.0% 32.7% 18.1% Kau High & Pahala Elem Not Reported Not Reported Not Reported Not Reported Kaumana Elem 58.2% 75.0% 53.6% 48.6% Ke Kula Nawahiokalaniopuu Iki Not Reported Not Reported Not Reported Not Reported Lab PCS Page 91 Ke Kula o 8.3% 20.8% 28.0% 12.0% Ehunuikaimalino Keaau Elem 42.1% 38.1% 33.2% 24.5% Kealakehe Elem 22.8% 13.5% 25.3% 15.0% Keaukaha Elem 44.6% 40.3% 32.6% 31.1% Keonepoko Elem 17.6% 11.2% 32.1% 15.5% Kohala Elem 19.0% 27.6% 37.2% 30.4% Kona Pacific PCS 55.0% 50.0% 75.0% 70.0% Konawaena Elem 27.7% 33.9% 44.2% 38.7% Kua O Ka La PCS Not Reported Not Reported Not Reported Not Reported Laupahoehoe Not Reported Not Reported Not Reported Not Reported Community PCS Mountain View Elem 22.7% 24.0% 21.1% 28.3% Na Wai Ola NCPCS Not Reported Not Reported Not Reported Not Reported Naalehu Elem 23.1% 17.8% 36.3% 24.9% Paauilo EI & Int Not Reported Not Reported 52.0% 48.0% Pahoa Elem 18.1% 15.8% 31.2% 19.3% Volcano School of Arts & Sciences PCS 33.3% 23.7% Not Reported Not Reported Waiakea Elem 60.2% 59.4% 44.1% 35.3% Waiakeawaena Elem 42.7% 43.8% 55.2% 43.0% Waikoloa EI & Middle 46.3% 52.1% 52.1% 34.2% Waimea Elem 43.6% 30.9% 30.7% 23.0% High School Achievement Levels Graduating high school is an important personal achievement and is essential for an individual's social and economic advancement. Graduation rates are also an important indicator of the performance of the educational system. Attainment of a higher level of education is associated with higher income, better working conditions, and more opportunities for promotion.zea Rates of high school graduation in Hawai'i County range from 73.8 to 90.4%. Page 92 Table 69: High School On-Time Graduation by School, Hawai'i County, 2021-2022 School Year 264 Students who are Economically %of Students who %Graduated on Time School Name Disadvantaged Received Diploma (within 4 Years) Hilo High School 70.8°% 93.8% 78.7% Honokaa High & 67.9% 93.5% 87.3% Intermediate Kau High & Pahala 97.7% 87.3% 73.8% Elementary Keaau High School 84.3% 94.3% 88.4% Kealakehe High School 50.3% 79.0% 77.3% Kohala High School 59.8% 98.3% 90.4% Konawaena High School 55.5% 93.9% 72.4% Pahoa High & 93.2% 79.5% 77.2% Intermediate Waiakea High School 41.5% 95.5% 87.5% Educational Attainment Census data shows that across the State of Hawai'i, 92.3%of people 25 years and over have graduated from high school, and 29.5%of adults have a 4-year college degree.261 Across the State of Hawai'i, high school graduation rates are above 90% Table 70: People 25+with a High School Degree or Higher by County, 2020266 Hawai'i County 91.1% Honolulu County 92.4% Kaua'i County 92.0% Maui County 92.3% Page 93 Figure 46:26' People 25+ with a Bachelor's Degree or Higher County: Hawaii 40 ° 28.6% 29.5% 29.4% 29.5°% 25.9/ 26.2% 26.6% ° 25.6%° 25.6,6 o 25.9x6 26.8°% 27.6% ,.. - v 20 a 10 0 �� o �a Source American Community Survey 5-Year(2016-2020) 268 Adult Literacy Assessments by the US Program for the International Assessment of Adult Competencies (PIAAC) indicate that 17%of adults in Hawai'i County lack basic literacy skills.269 These adults have difficulty using printed and written information to function in society.270 When individuals learn how to read,write, do basic math, and use computers,they have the power to lift themselves out of poverty, lower health care costs,find and keep sustainable employment, and ultimately change their lives.271 Page 94 Over the past decade, between 41%and 56%of children in Hawai'i County that had access to early childhood education programs."'Over the past 5 years the share of 3 &4 year olds enrolled in preschool has hovered around 50%. Child Care Capacity As of April, 2023, early care and learning providers in Hawai'i County reported that they had the capacity to care for 2,474 children, including family child cares, infant/toddler programs, and preschool programs.213 Table 71: Child Care by Type &Capacity, Hawai'i County, 2022274,275 Pre-pandemic Difference Desired from Pre- Facilities by Licensed Desired Capacity Dec. pandemic License Type Number Capacity Capacity 2019 capacity Family Child Interactive Learning Licensed 52 304 291 338 -47 Family Home Licensed Group 0 0 0 0 0 Home Licensed Infant/Toddler 6 78 78 93 -15 Center Licensed Preschool 53 2,388 2,233 2,683 -450 Public Pre- Kindergarten 19 400 295 380 -85 Classroom Total 130 3,170 2,897 3,494 -597 Page 95 There are 105 child care providers on Hawai'i Island registered with the Department of Human Services, including 53 center-based programs and 52 home child care programs. A number of early care and learning providers are not registered with DHS.These include informal (friend,family and neighbor) care providers. Additionally, pre-kindergarten classrooms offered by the Executive Office of Early Learning are not registered with DHS as child care providers. Table 72: DHS Licensed Child Care Providers by Zip Code 211 Hawai'i County, 2023 Number of Center Number of FCC Town Zip Code Based Providers Providers Captain Cook 96704 1 1 Haw'i 96719 1 0 Hilo 96720 19 16 H61ualoa 96725 1 0 H6noka'a 96727 1 2 W5ik6loa 96738 1 4 Kailua Kona 96740 8 5 Kamuela 96743 6 7 Kea'au 96749 5 8 Kealakekua 96750 3 0 Kapa'au 96755 0 1 Mountain View 96771 1 3 Pa'auilo 96776 1 3 Pahala 96777 1 0 Pahoa 96778 3 1 Papai'kou 96781 1 1 Hawai'i County Total 53 52 There are very few child care options available in many communities across Hawai'i Island.Z" County- wide,there is one available child care seat for every 4.5 children under age 5. Page 96 Table 73: Number of Young Children and Number of Early Learning Seats, Hawai'i County, 2022278,279 Number of Children 0-4* Number of Early Learning Seats Ratio Hawai'i County 11,336 2,507 4.5 : 1 *Population Estimates are based on 20205 Yr estimate from American Community Survey Data Quality Early Childhood Education There are 14 early are and learning centers on Hawai'i Island accredited by the National Association for the Education of Young Children (NAEYC), and one center: Ka Hale o Na Keiki,that has NECPA(National Early Childhood Program Association) accreditation. Table 74: Locations of National Association for the Education of Young Children (NAEYC) or Natiional Early Childhood Program Association (NECPA) Accredited Preschools, Hawai'i County, 2023280 Ka Hale o Na Keiki Honokaa Kamehameha Schools Hilo Hilo Kamehameha Schools Honaunau Captain Cook Kamehameha Schools Kona Kailua-Kona Kamehameha Schools Piihouna Hilo Kamehameha Preschool Hamakua Pa'auilo Kamehameha Preschool Pahoa Pahoa YWCA Hawaii Island Developmental Preschool Hilo Hawaii Community College Children's Center Hilo Kamehameha Preschool Keaukaha Hilo Kamehameha Schools Waimea Preschool Kamuela Kamehameha Schools Kailua-Kona Preschool Kailua-Kona Kamehameha Preschool Waianuenue Hilo Kamehameha Preschool Kea'au Kea'au Kamehameha Preschool-Kohala Haw'i Page 97 Table 85: Locations of Head Start and Early Head Start Programs, Hawai'i County, 2023281 Hilo Child Development Center (HCDC) Hilo Keauhou Holualoa Kalanianaole Elementary Papai'koG Puueo Hilo Mt. View PrePlus Elementary Mountain View Hawaiian Beaches Pahoa Keonepoko Pre-Plus Elementary Pahoa Hawaiian Beaches Pahoa Hilo EHS Home Base Hilo Easter Seals Hilo Kona Clusters Kailua Kona Greenwell Child Development Center Kealakekua Waimea Cluster Kamuela Ka'u Cluster N5'51ehG Currently,there are 11 public pre-kindergarten classrooms in Hawai'i County. Table 76: Locations of ECEL Public Pre-Kindergarten Classrooms, Hawai'i County, 2023282 Chiefess Kapi'olani Hilo Elementary Hilo Union Elementary Hilo Honaunau Elementary Captain Cook Honoka'a Elementary Honoka'a Kea'au Elementary Kea'aG Keonepoko Elementary Pahoa Kohala Elementary Kapa'aG Konawaena Elementary Kealakekua Mountain View Elementary Mountain View N5'51ehu Elementary N5'51ehG Pahoa Elementary Pahoa Waimea Elementary Waimea (August 2023) Page 98 Access to Early Learning Programs The Center on the Family at the University of Hawai'i has undertaken a major study of child care access, affordability and quality across the State of Hawai'i. As the following maps indicate,there are few child care options in many regions of Hawai'i Island. Access is relatively better in Hilo and Hamakua and in parts of the Kona District. Figure 44:183 Nearby Seats Index by Census Tract Nearby Seats Index Number of children per nearby ECE seat. >5 >4-5 vp Fnauna xea:r F� >2-3 Forrest Ri3ertie s2 upperwaiatea- HawaH Forest aeserve Mauna Loa ° Hawaii r ,..._ .1k" I 20 km 20 mi Note:Low index scores(darker colors)are desirable. Powered by Esri The following map depicts levels of child care affordability across Hawai'i County.As the map indicates, the cost of child care is out of reach for many families county-wide. Page 99 Figure 45:184 Affordability Index by Census Tract Prcximityt 11 Affordability Index ;t. Cost of a nearby ECE seat as } a percentage of family k r5sl¢ income. 7+ >20 41 V 15-20 +( rerestr<eserve a7-10 Upper Wala kea Hawaii Fa rest R-- MaVna 102 fH�aawai'i kesery I 22L- . mi Note:Low index scores(darker l Ea'.CC AE,LSGS.��i,H'3E,Ga-n-.n,Se`eGrac' 'dETI:AGSA,USG-°'- Powered 5y Esri coors)are desirable. Early Childhood Education Enrollment Even before the pandemic, rates of enrollment in ECE programs hovered around 50%in Hawai'i County. m Page 100 Figure 46:2ss Number and Percentage of 3 & 4 Year Olds Enrolled in school — Population 3&4 years old enrolled in a nursery or preschool Percentage of 3&4 year olds enrolled in school 4,000 60.0% 0 56.3% 55.4% 6 54.1% = 53.0% u 51.8 3,000 49.7% E o iu43.7% 43.6% 44.1% 43.2% 40.0% W 2,854 2,747 41.7% r 2,691 2,648 2,644 2 W ° 2,468 2,000 Q 2,169 2,178 2,218 a } 1,868 1,845 v � 20.0% y ch v ° 1,000 N M Q E O z � V W IL 0 0.0% 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Year Enrollment in Public Early Childhood Education Programs The State of Hawai'i has embraced Ready Keiki, a major initiative designed to extend access to early care and learning to all 3 and 4 year olds statewide.Today,there is much work to be done to reach that goal. Today, 8%of 3 year old's and 14%of 4 years old's are enrolled in public early childhood education programs, including Head Start, Special Education pre-kindergarten programs, Executive Office on Early Learning (EOEL) pre-kindergarten classrooms, or a Public Charter Pre-Kindergarten classroom Page 101 People who have careers with young children make less than other professions working with the same children.28'Child care workers make on average$13.79 an hour. When adjusted for cost of living, a 2020 study found that child care workers make the equivalent of$9.42 per hour.287 Across Hawai'i, 41.2%of infants and toddlers aged 9-35 months have received developmental screening in the past 12 month S.211 In Hawai'i, a total of 20,424 children received early intervention services from the Individuals with Disabilities Education Act (IDEA). Also found in this section of early childhood workforce& services you will find information on early childhood careers and compensation, early intervention, developmental screening, and home visiting. Early Childhood Careers & Compensation Many children spend long hours in the care of other caregivers while their parents are at work.The professionals that make up Hawai'i County's early care workforce are responsible for safeguarding and facilitating the development and learning of young children yet, across the state and the nation, early care is among the lowest paid profession S.21'Although Hawaii has a highly qualified early learning workforce compared to other states, child care workers' compensation is the lowest in the nation when adjusted for the cost of living. At the adjusted rate, a 2020 study found Hawai'i's child care workers make the equivalent of$9.42 per hour,which was the 5th lowest in the nation.290 Table 77: Median Hourly Wages by Occupation 291 State of Hawai'i, 2021 Early Care & Learning Careers Employment Rate per 1,000 Jobs Childcare workers $13.79 2.3 Preschool teachers $17.83 1.7 Preschool Administrators j $22.84 0.5 Health Careers Dental Hygienist $37.37 2.4 Registered Nurses $53.40 20.2 Pediatricians, General $62.22 0.4 Dentist $80.19 1.1 Family Support Careers Child, Family, and School Social $28.97 2.4 Worker Librarians $29.84 0.5 Lawyers $48.02 3.9 Page 102 Early Childhood Education Workforce Training Certification Program University of Hawai'i: Hawai'i Community College Degree Program The University of Hawai'i- Hawai'i Community College offers an Associate of Science in Early Childhood Education Degree program that prepares students to work with young children from birth to age 5 and their families.The curriculum is organized around a core of courses that provide skills and knowledge needed by early childhood educators. Students can earn a Certificate of Competence (CO), Certificate of Achievement (CA), an Associate in Science (AS) or a Child Development Associate (CDA).zez Early Intervention/Screening Developmental Screening Regular well-child visits with a health care provider are an integral part of promoting the healthy growth and development°of children. During these visits, doctors monitor and screen for delays or problems in the child's development. In 2020-2021, 41.2%of parents of infants and toddlers (aged 9-35 months) in Hawai'i reported that they had completed a developmental screening of their child in the past year.293 Early Intervention Early intervention for infants and toddlers aims to lessen the effects of a disability or delay and minimize the need for special education through the provision of services to meet a child's developmental needs. High quality early intervention services can change a child's developmental trajectory and may be more effective and less costly when provided earlier in life rather than later.294 The Individuals with Disabilities Education Act (IDEA) is designed to provide needed services to children with disabilities across the nation. IDEA mandates that states and public agencies provide early intervention, special education, and related services to millions of eligible infants,toddlers, children, and youth with disabilities. IDEA ensures that all children are entitled to free public education to meet their individual needs and to prepare them for additional education,future employment, and independent living.295 Section 618 Part C serves children 0-2 years old, and Part B serves children 3-21 years of age. In the State of Hawai'i a total of 407 children 0-3 years old are served by the IDEA Section 618 part C. 5 Domains of Development(Communication,Gross Motor Skills, Fine Motor Skills, Problem Solving, Personal- Social Development);Ages&Stages Questionnaire-3: Domains of Development Page 103 Table 78: Children 0-3 Years Old Served by Individuals with Disabilities Education Act IDEA Section 618 Part C by Age, State of Hawai'i, 2020-2021296 Total 407 Birth to 1 Year 5 1 Year to 2 Years 99 2 Years to 3 Years 303 There are more than 20,000 children served by IDEA Section 618 Part B Statewide in Hawai'i. Table 79:Age of children receiving Individuals with Disabilities Education Act (IDEA) Section 618 Part B services, State of Hawai'i, 2020-2021297 Ages Served Number of Children All Children served by Part B (3-21) 20,017 3-5 (Not In Kindergarten) 1,988 5 (In Kindergarten)-11 8,582 12-17 8,622 18-21 825 The majority of children receive services for developmental delays (1,420),followed by autism (260), and speech or language impairments (140). Page 104 Table 80: Children 3-5 Years Old Served by IDEA Section 618 Part B by Disability Type298 State of Hawai'i, 2020-2021 All Disabilities 1,988 Autism 260 13.1% Deaf-blindness 0 0.0% Developmental Delay 1,420 71.4% Emotional Disturbance 1 0.1% Hearing Impairments 30 1.5% Intellectual disabilities 8 0.4% Multiple disabilities 44 2.2% Orthopedic impairments 8 0.4% Other health impairments 69 3.5% Specific learning disabilities 0 0.0% Speech or language impairments 140 7.0% Traumatic brain injury 5 0.3% Visual impairments 3 0.2% Children receiving early intervention services make substantial progress in achieving developmentally appropriate behaviors. Both Hilo Easter Seals and Kona Early Childhood Services scored above the state target for each of the reported measures. Page 105 Table 81: Early Intervention Outcome Measures by Program299 Hawai'i County, 2020-2021 Substantially increased Functioning within Outcome Measure Program their rate of growth age expectations Hilo Easter Seals 75.0% 86.6% Infant/Toddlers in an early Intervention Program who Kona Early Childhood 66.7% 76.9% demonstrate improved use Services Program of appropriate behaviors to North Hawai'i Early meet their needs by the Childhood Services 61.5% 52.9% time they turned 3 years of Program age: State Target 59.3% 67.6% Substantially increased Functioning within Outcome Measure Program their rate of growth age expectations Hilo Easter Seals 42.3% 73.9% Infant/Toddlers in an early Kona Early Childhood 66.7% 84.6% Intervention Program who Services Program demonstrate improved positive social-emotional North Hawai'i Early skills by the time they Childhood Services 33.3% 41.2% Program turned 3 years of age: State Target 47.5% 65.0% Hilo Easter Seals 55.6% 66.9% Infant/Toddlers in an early Intervention Program who Kona Early Childhood o 54.5/ 46.20 demonstrate improved Services Program acquisition and use of knowledge and skills by the North Hawai'i Early time they turned 3 years of Childhood Services 47.1% 23.5% age: Program State Target 52.4% 42.7% Page 106 Home Visiting High-quality home visiting programs can reduce rates of child abuse and neglect, improve maternal and child health, equip caregivers with useful knowledge of child development, ensure early developmental screening, and refer families to health and social supports that match their needs. Programs that offer home visiting programs in Hawai'i County: include"' • Parents And Children Together (PACT) • Family Support Hawai'i (FSH) • Strong Families Home Visiting, offered by Child & Family Service (CFS) • YWCA • He Lei Piko He Lei Piko-Home Instruction for Parents of Preschool Youngsters (HIPPY) • Parents As Teachers (PAT) w 12 , x Vii, ti .. Page 107 15. STRONG FAMILIES & COMMUNITIES Family Early Childhood Language and Literacy Development Activities Young children grow and develop in an environment of relationships. There are many things that families can do support their children's early language and literacy development, including talking, singing,telling stories, and reading together. Statewide, 44.8%of families with a child under 5 read with their children every day (2020-2021 data). Over 50%sing or tell stories with their children daily.aoi,aoz Over 60%of families in Hawai'i eat dinner together every day.aoa Figure 47:104 Frequency of Family Member Reading to Young Children State of Hawaii 2020-2021 0 days 6-7% Every day 1-3 days 44.8% 30.9% 4-6 days Page 108 52.5%of families across the state sing and tell stories with their young children every day(2020-2021). Figure 48:aos Frequency that Family Member Sings and Tells Stories to Young Children, State of Hawaii, 2020-2021 0 days 32% 1-3 days 29.4% Every day 52.5% 4-6 days 14.9% Language Spoken at Home 3.9%of households in Hawai'i County live in language isolation from the rest of the community, meaning that all members within that household aged 14 years and older have difficulty speaking English.aoe 73.3%of the Hawai'i County population (age 5 and over) speak English at home. 8.9%of residents report that they speak English "less than very well." Page 109 Table 82: Language Spoken at Home, Hawai'i County, 2021307 Language Spoken in Home Speaks English "less than very well" English 73.3% N/A Language other than English Spoken 26.7% 8.9% at Home -Asian&Pacific Islander 17.6% 6.4% -Spanish 3.2% 1.0% -Indo-European 1.6% 0.4% -Other 4.2% 1.1% Citizenship 87%of residents of Hawai'i County are U.S. citizens.308 13% (approximately 26,000 residents) are estimated to be non-citizens. Adult Health Dental Care Oral health has been shown to impact overall health and well-being. Nearly one-third of all adults in the United States have untreated tooth decay and one in seven have gum disease. Because untreated cavities and other dental concerns can have serious implications for health including infections, it is recommended that adults and children see a dentist on a regular basis. In Hawai'i County 32.8%of adults are overdue for a visit to the dentist.309 Statewide,the average is 25.3%.310 Obesity Obesity is one of the most common, chronic diseases in the United States and is a leading cause of mortality, morbidity, disability, and high healthcare costs. Approximately 34.2%of adults in Hawai'i County are overweight. An additional 25.2%of adults are obese.311 Diabetes Diabetes can lead to heart disease, stroke, and other serious complications, but can be controlled using medications, exercise, and diet. Diabetes disproportionately affects minority populations and the Page 110 elderly, and its incidence is likely to increase as minority populations grow and the US population becomes older. In Hawai'i County, 9.3%of adults reported having diabetes in 2020.312 The share of the population with diabetes has grown over the past decade. Figure 49:313 Adults with Diabetes County: Hawaii :a 11.5% 11.7% 103°6 `10.6% 10 9.6% a / 99.3% ° 8.7% $.8iii 8.2% .�° 8.2/ '83 7 a 5 0 Due to methodology changes, BRFSS results from 2011 forward should not be directly compared with previous years. Source Behavioral Risk Factor Surveillance System(2020) Mental Health Mental and emotional well-being is essential to overall health. Positive mental health allows people to realize their full potential, cope with the stresses of life, work productively, and make meaningful contributions to their communities. Early childhood experiences have lasting measurable consequences later in life;therefore,fostering emotional well-being from the earliest stages of life helps build a foundation for overall health. In 2020, 54.3%of adults in Hawai'i County reported being in good physical and mental health.314 This is lower than the rate in other counties in Hawai'i. Page 111 Community Safety Community safety supports the well-being of young children and their families. When communities face crime and violence, or residents fear for the safety of their homes and families,their quality of life is diminished.The perception of neighborhood safety affects a family's daily behavior such as whether children play outdoors and the nature of families' activities and interactions near their home."' Crime In 2019, Hawai'i County had the lowest rate of violent crimes and the lowest rate of property crimes in the State, adjusted for population size. Table 83: Crime Rates for Counties in Hawai'i, 2019* 316 2019 C&C of Honolulu Hawai'i County Maui County Kaua'i County Violent Crime 280.3 181.3 268.1 325.6 Property Crime 3,031.8 2,099.5 2,976.0 2,458.3 *Number of reported offenses per 100,000 residents Juvenile Crime In Hawai'i County,the rate of arrests of juveniles (between 10 and 17)was 2,228 per 100,000 youth (2019).317 The juvenile violent crime rate in Hawai'i County was 64 per 100,000 youth (2019). In 2019, Hawai'i County had the lowest rate in the state of juvenile arrests for drug-related offenses (at 188 per 100,000 arrests of individuals aged 10-17).There has been a decline in the number of arrests of juveniles for drug-related offenses over the past decade. Table 84:Juvenile Drug-Related Arrests by County and Year 311 Hawaii Rate 437 416 417 361 321 351 339 341 270 NA CB:C Honolulu Rate 309 298 259 223 246 264 256 247 205 47 Hawaii County Rate 874 520 548 369 309 362 349 268 188 53 Kauai County Rate 918 736 810 755 684 855 720 730 490 323 Maui County Rate 449 833 984 954 592 601 618 768 617 NA Page 112 Risky Teen Behaviors Alcohol and other drug use among the nation's youth remains a major public health problem. Substance use and abuse can increase the risk for injuries, violence, HIV infection, and other diseases. Moreover, alcohol and drug use in adolescence is a predictor of substance use behavior and disorders for the lifespan.319 Teen Drug & Alcohol Use In 2019, 57.3%of teens in Hawai'i County reported trying alcohol (57.3%) 320 51%of teens reported trying street drugs.32' 56.5%of high school students reported that they had tried vaping.322 Teen Sexual Activity In 2019, 36.9%of high school students in Hawai'i County reported that they were sexually active. In 2019, 72.8%of high school students in Hawai'i County who were sexually active reported using birth contro1.323 Figure 50:321 Percentage of Sexually Active Teens by County, 2019 40.0% 35.4% 36.9° 30.0% 0� 24.0% 20.0% 10.0% 0.0% Maui County Hawaii County Honolulu County Kauai County Foster Care In 2021, 2,566 children were in foster care statewide. Page 113 Table 95: Children in Foster Care, State of Hawai'i, 2021325 2019 2020 2021 #of Children in Foster Care 2,843 2,721 2,566 The largest group of children in foster care are under age 5. Table 96:Age of Children in Foster Care, State of Hawai'i, 2021326 0-5 years old 1,020 6-11 years old 728 12-18 years old 817 Unknown 1 Total 2,566 Across the State of Hawai'i,the largest share of children in foster care are Native Hawaiian. Table 97: Children in Foster Care, by Race, State of Hawai'i, 2021 RACE Number of Children Percent of all children in Foster Care Hawaiian/ Part Hawaiian 1,145 44.6 White 498 19.4 Mixed 230 9.0 Filipino 147 5.7 Samoan 106 4.1 327 Page 114 LIST OF FIGURES Figure 1: Children with Current Asthma ...................................................................................................................................9 Figure 2: Hawai'i Island Hele-On Bus Route Map...................................................................................................................13 Figure 3: Hawai'i State Population by County,2021. ...........................................................................................................15 Figure 4: Hawai'i County Population Under Age 18...............................................................................................................16 Figure 5: Hawai'i County Population Over Age 65.................................................................................................................17 Figure 6: Population Density by Census Tract, Hawai'i County,2016-2020........................................................................18 Figure 7: Demographics of Population Under 5 Year Old by Gender,Hawai'i County,2021............................................20 Figure 8:Census Racial Demographics of State of Hawai'i&Hawai'i County,2021...........................................................21 Figure 9: Census Race of Children Under 18 Years Old, Hawai'i County,2021.................................................................22 Figure 10: Family Structure of Households with Children Under 6 Years Old, Hawai'i County,2021..............................26 Figure 11:Share of Hawai'i County Residents 16 Years and Older by Workforce Participation,2021...........................29 Figure 12:Share of Civilian Employed Persons by Classification, Hawai'i County,2021...................................................30 Figure 13:Mean Annual Wage for the Top 10 Most Common Occupations,Hawai'i County,2021.................................30 Figure 14:Hawai'i County Unemployment Rate Trend..........................................................................................................32 Figure 15:Children Living Below Poverty Level by Race/Ethnicity,Hawai'i County,2016-2020......................................38 Figure 16:Share of Housing Occupancy&Ownership in Hawai'i County,2021..............................................................40 Figure 17:Overcrowded Households by County,2016-2020...............................................................................................43 Figure 18:Overcrowded Households by Type of Household,Hawai'i County,2016-2020...............................................44 Figure 19:Homeless Children/Youth Enrolled in Public School,State of Hawai'i,2020-2021..........................................46 Figure 20:Bridging the Gap Clients and Households Served by County,2021-2022..........................................................46 Figure 21: Projected Child Food Insecurity Rate by County,2021........................................................................................48 Figure 22:Estimated Program Eligibility Among Food Insecure Children in Hawai'i County,2020..................................48 Figure 23:Total Number of Grocery Stores&Supermarkets by Zip Code, Hawai'i County,2020...................................49 Figure 24: Food Desert by Census Tract, Hawai'i County,2019...........................................................................................50 Figure 25: Locations of SNAP Authorized Retailers in Hawai'i County,2023......................................................................53 Figure 26:Students Eligible for the Free Lunch Program,Hawai'i County..........................................................................55 Figure 27:Student Participation in Free or Reduced-Price Lunch Programs,Hawai'i County,2021-2022.....................55 Figure 28:State Med-Quest Enrollment in Hawai'i County by Year.....................................................................................60 Figure 29: Hawai'i County Households by Income,2018......................................................................................................61 Figure 30: Live Births by Year, Hawai'i County.......................................................................................................................67 Figure 31:Teen Birth Rate in Hawai'i County.........................................................................................................................69 Figure 32: Pregnancies of Mother Who Were Trying to Get Pregnant in Hawai'i County...............................................71 Figure 33:Prenatal Visit Depression Screening&Identification by County,2020..............................................................72 Figure 34: Mothers who Received Early and Adequate Prenatal Care by County,2020...................................................73 Figure 35: Prenatal Care for Mothers,Hawai'i County,2020................................................................................................73 Figure 36: Number of Intimate Partner Violence Victims by Partner Relationship for the Stateof Hawai'i,2021................................................................................................................................................................77 Figure 37:Child Abuse and Neglect of All Children(0-17 Years Old)by County,2020.......................................................78 Figure 38:Child Abuse and Neglect of All Children (0-17 Years Old) by County................................................................79 Figure 39: Hawai'i County Infant Mortality Rate....................................................................................................................82 Figure 40: Percentage of 2 Year Old Children Who Were Immunized State of Hawai'i&United States..............................................................................................................................................86 Figure 41: Hawai'i Public Schools Hawai'i District Map.........................................................................................................89 Page 115 Figure 42: Percentage of Public K-12 Students in Special Education by County...............................................................90 Figure 43: People 25 and Older with a Bachelor's Degree or Higher in Hawai'i County...................................................94 Figure 44: Nearby Early Childhood Education Seat Index by Census Tract,Hawai'i County 2019....................................99 Figure 45: Early Childhood Education Affordability Index by Census Tract,Hawai'i County 2019.................................100 Figure 46: Population of Children 3 Years and Over by School Enrollment, Hawai'i County.........................................101 Figure 47: Frequency of Family Member Reading to Young Children,State of Hawai'i 2020-2021..............................108 Figure 48: Frequency that Family Member Sings and Tells Stories to Young Children Stateof Hawai'i,2020-2021....................................................................................................................................................109 Figure 49:Adults with Diabetes in Hawai'i County...............................................................................................................111 Figure 50: Percentage of Sexually Active Teens by County,2019......................................................................................113 Page 116 LIST OF TABLES Table 1: Number of County Parks Hawai'i County,2023.......................................................................................................10 Table 2: Motor Vehicle Death Rate by County 2018-2021...................................................................................................11 Table 3:Workers Commuting to Work by Form of Transportation Hawai'i County,2016-2020.....................................12 Table 4: Hawai'i State Population by County 2021................................................................................................................14 Table 5:Total Population by District&Percentage of County's Population Hawai'i County,2021.................................16 Table 6: Population of Children 0-17 Years Old Hawai'i County,2021................................................................................19 Table 7: Population of Children Under 5 Years Old Hawai'i County,2021..........................................................................19 Table 8:Gender-Makeup of Young Children Under 5 Years Old Hawai'i County,2021...................................................20 Table 9:Communities with the Largest Population of Children<5 Years Old Hawai'i County,2021.............................20 Table 10: Households with Children by County 2020............................................................................................................23 Table 11:Households with Children by Zip Code&Town Hawai'i County,2021................................................................24 Table 12: Number of Children by Householder Type Hawai'i County,2021......................................................................25 Table 13:Children Under 18 Years Old in Households by Relationship to Householder Hawai'i County,2021.............26 Table 14:Grandparents Raising Grandchildren Hawai'i County,2021................................................................................27 Table 15:Top Ten Principal Employers in Hawai'i County 2021............................................................................................30 Table 16:Unemployment Rate for Hawai'i Counties,2022...................................................................................................31 Table 17: Median Household Income in 2021........................................................................................................................33 Table 18: Median Income of Families with Own Children Under 18 Years Old by Family Structure Hawai'i County,2021.. ..............................................................................................................................................................33 Table 19: Median Family Income in the Past 12 Months of Grandparent Householder and/or Spouse Responsible for Grandchildren Under 18 Years Old and No Parent Present(dollars)2021.........................................................................33 Table 20: Median Household Income by Race Hawai'i County,2021.................................................................................34 Table 21: Poverty Status in the Past 12 Months Hawai'i County,2021..............................................................................35 Table 22: Percentage of Individuals&Children Living in Poverty by Zip Code Hawai'i County,2021............................36 Table 23:Children Living in Poverty by Family Structure Hawai'i County&State of Hawai'i, 2021...............................37 Table 24: Income Level of Households with Grandparent Living with Grandchildren in Hawai'i County 2021.............37 Table 25:Top 5 Locations of Vacant Housing Units Hawai'i County,2021........................................................................40 Table 26: New Authorized Housing Units in Hawai'i County,2017-2020...........................................................................40 Table 27: Home Sales by Origin of Buyer Hawai'i County,2018-2020................................................................................41 Table 28: Housing Mobility in Hawai'i County(Residence 1 year ago)2021......................................................................42 Table 29: Housing Mobility of Children 1-4 Years Old in Hawai'i County(Residence 1 year ago)2021... ......................42 Table 30: Homeless Families with Children by Age Range for Hawai'i County,2023.......................................................44 Table 31: Homeless Families with Children by Sex Hawai'i County,2023..........................................................................45 Table 32: Primary Race of Homeless Families with Children by Race/Ethnicity Hawai'i County,2023...........................45 Table 33:Share of Food Insecure Persons Hawai'i County,2020........................................................................................47 Table 34: Households with Children under 18 Receiving SNAP by Household Type Hawai'i County,2021..................52 Table 35:Average monthly participation for 2021 WIC Recipients State of Hawai'i,2021.............................................54 Table 36:TANF/TAONF Recipients State of Hawai'i,2021.....................................................................................................57 Table 37:TANF/TAONF Recipients by Citizenship State of Hawai'i,2021...........................................................................57 Table 38: Federal&State Public Housing State of Hawai'i,2021.........................................................................................58 Table 39:Children 0-5 Years Old by Health Insurance Coverage Hawai'i County,2021.....................................................59 Table 40: Health Insurance of Children 0-5 Years Old by Insurance Type (Alone or in Combination) Hawai'i County,2021.................................................................................................................................................................59 Page 117 Table 41: Children Under 6 Years Old with All Available Parents in the Workforce Hawai'i County,2021..................61 Table 42:Children 6-17 Years Old with All Available Parents in the Workforce Hawai'i County,2021..........................62 Table 43: Estimated Survival Budget Comparison-2 Parent&2 Children Household Comparison Hawai'i County.......63 Table 44:Affordability Ranking Child Care State of Hawai'i,2021.......................................................................................64 Table 45: Percent of Income Spent on of 2 Children Child Care State of Hawai'i,2020...................................................64 Table 46: Monthly Average Full-Time Rate for Child Care Homes Hawai'i County,2022.................................................65 Table 47: Monthly Average Full-Time Rate for Child Care Centers Hawai'i County,2022................................................65 Table 48: Median Monthly Cost of Occupied Housing Hawai'i County,2021.....................................................................66 Table 49:Annual Live Births Hawai'i County Residents........................................................................................................68 Table 50: Number of Live Births& Birth Rate by Mother's Ethnicity Hawai'i County,2020............................................68 Table 51:Teen Births Rate Girls Aged 15-19 by County 2020..............................................................................................69 Table 52:Women with a Healthy Weight Prior to Pregnancy by County 2020.................................................................70 Table 53: Birth Weight Range Hawai'i County,2020..............................................................................................................74 Table 54: Postpartum Contraception Discussion&Use Hawai'i County,2020..................................................................74 Table 55: Breastfeeding Duration Hawai'i County,2020.......................................................................................................75 Table 56:Two or more Adverse Childhood Experiences State of Hawai'i,2020-2021.....................................................76 Table 57: Infant/Toddlers Removed from Home State of Hawai'i,2020...........................................................................77 Table 58:Total Reported &Confirmed Victims of Child Abuse& Neglect by District Hawai'i County,2021................79 Table 59:Total Confirmed Victims of Child Abuse& Neglect by Maltreatment Type Hawai'i County,2021................80 Table 60:Top 5 Races of Confirmed CAN Victims State of Hawai'i,2021..........................................................................80 Table 61:Confirmed Child Victims of CAN by Age State of Hawai'i,2020..........................................................................81 Table 62:Top 5 Leading Causes of Death Among Hawai'i Residents 0-24 Years Old State of Hawai'i,2015-2019.......81 Table 63: Infant Death Rates by Cause State of Hawai'i,2020.............................................................................................83 Table 64:Children with a Preventative Dental Care Visit by Age Group State of Hawai'i,2020-2021...........................85 Table 65: Number of Children Transported off Island by Medicaid for Dental Services by County 2021........................85 Table 66: Kindergarten Enrollment by School Type Hawai'i County,2021-2022 School Year.........................................88 Table 67: K-12 Enrollment Hawai'i County,2020-2021 School Year...................................................................................88 Table 68:3rd&4th Grade Achievement Scores Hawai'i County,2021-2022 School Year...............................................91 Table 69: High School On-Time Graduation Achievement by School Hawai'i County 2021-2022 School Year..............93 Table 70: People 25+with a High School Degree or Higher by County 2020.....................................................................93 Table 71:Child Care by Type&Capacity Hawai'i County,2022...........................................................................................95 Table 72: DHS Licensed Child Care Providers by Zip Code Hawai'i County,2023..............................................................96 Table 73: Ratio of Number of Children per Early Learning Seats Hawai'i County,2022...................................................97 Table 74: Locations of National Association for the Education of Young Children (NAEYC)Accredited PreschoolsHawai'i County,2023.............................................................................................................................................97 Table 75: Locations of Head Start and Early Head Start Programs Hawai'i County,2022................................................98 Table 76: Locations of EOEL and Privately Funded Public Pre-Kindergarten Programs by Hawai'i County,2023........98 Table 77: Median Hourly Wages by Occupation State of Hawai'i,2021............................................................................102 Table 78: Children 0-3 Years Old Served by Individuals with Disabilities Education Act IDEA Section 618 Part C by Age Stateof Hawai'i,2020-2021....................................................................................................................................................104 Table 79: Children 3-21 Years Old Served by Individuals with Disabilities Education Act (IDEA)Section 618 Part B by Age Band State of Hawai'i,2020-2021..................................................................................................................................104 Table 80:Children 3-5 Years Old Served by IDEA Section 618 Part B by Disability Type State of Hawai'i, 2020-2021.................................................................................................................................................................................105 Table 81: Early Intervention Outcome Measures by Program Hawai'i County,2020-2021...........................................106 Table 82: Language Spoken at Home Hawai'i County,2021...............................................................................................110 Page 118 Table 83: Index Crime Rates 2019..........................................................................................................................................112 Table 84:Juvenile Drug-Related Arrests by County and Year............................................................................................112 Table 85: Children in Foster Care State of Hawai'i,2021...................................................................................................114 Table 86:Age of Children in Foster Care State of Hawai'i,2021........................................................................................114 Table 87:Top 5 Races of Children in Foster Care,State of Hawai'i,2021........................................................................114 Page 119 ENDNOTES 1 State of Hawai'i Office of Elections: Registration &Turnout Statistics 2 Ibid 3 American Lung Association State of the Air 2022 4 Hawaii State Department of Health, Hawaii Health Data Warehouse, Behavioral Risk Factor Surveillance System; Hawaii Health Matters Children Asthma I Hawaii State Department of Health, Hawaii Health Data Warehouse, Behavioral Risk Factor Surveillance System; Hawaii Health Matters Adult Asthma 'County of Hawai'i; Hawaii County Water Quality Report 2021 7 Ibid $Harvard Health Publishing. "6 reasons children need to play outside". 2020. e County of Hawai'i Parks& Recreation: Hawaii County Beach Parks&Campgrounds 10 County of Hawai'i: Hawai'i County Pools 11 County of Hawai'i: Hawai'i County Centers 12 2020 Maui County Data Book:Transportation, Length of Streets and Highways Search Section 6:Communications & Transportation 13 AAA Gas Prices Highest state for Regular, Mid-grade,& Premium,Second highest for Diesel. Accessed on: January 17,2023 14 Hawai'i Department of Transportation:Act 122:Child Care Set Law 1s Center for Disease Control& Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 2018-2021 on CDC WONDER Online Database, released in 2021.Search Death Rate by motor vehicle by County 16 Ibid 17 County Health Ranking 2016-2020:Solo Drivers with a Long Commute: Hawaii Health Matters Solo Drivers with Long Commute 18 ACS 2020: 5 Yr Estimate: Hawaii Health Matters Travel Time to Work 1e ACS 2020: 5 Yr Estimate: Hawaii Health Matters Bicycle Commute 20 ACS 2020: 5 Yr Estimate: Hawaii Health Matters Public Transport to Work 21 ACS 2020: 5 Yr Estimate; Hawaii Health Matters Walking to Work 22 County of Hawai'i Mass Transit Agency: Hele-On Bus Route Maps 23 ACS 2021:5 Yr Estimate Table DP05 Search by Zip Code 24 Office of Hawaiian Affairs Wiki Native Hawaiian Data 2010 Section 1.08 Racial Composition by County 2s ACS 2021:5 Yr Estimate Table DP05 26 Ibid 27 ACS 2021:5 Yr Estimate Table DP05 Search by Zip Code 28 ACS 2021: 5 Yr Estimate Table DP05: Hawaii Health Matters Population Under Age 18 21 ACS 2021:5 Yr Estimate Table DP05: Hawaii Health Matters Population Over Age 65 30 2021 Hawai'i State Databook Search Section 1.10 31 Community Action Partnership CAP Population Density Map Search Population Density ACS 2016-2020 32 ACS 2021:5 Yr Estimate Table B09001 Search by Zip Code 33 Ibid 34 ACS 2021:5 Yr Estimate Table 50101 Search by Zip Code 3s Ibid 36 Office of Hawaiian Affairs Wiki Native Hawaiian Data 2010_Section 1.08 Racial Composition by County 37 ACS 2021:5 Yr Estimate Table DP05 38 Office of Hawaiian Affairs Wiki Native Hawaiian Data 2010 Section 1.08 Racial Composition by County 3'ACS 2021:5 Yr Estimate Table 50901 40 ACS 2020 5 Yr Estimate:Table 51101 41 Ibid Page 120 41 ACS 20215 Yr Estimate:Table B11005 48 ACS 20215 Yr Estimate:Table B11005 Search by Zip code 44 Annie E. Casey Foundation Kids Count: Percent of Families with Children in Hawaii 45 ACS 20215 Yr Estimate,Table 50901 46 Ibid 4'ACS 20215 Yr Estimate:Table B09018 48 ACS 20215 Yr Estimate:Table 50901 49 The Berlin Base Study 11 ACS 20215-Year Estimate Table DP02 51 ACS 2021:5 Yr Estimate:Table 51701 52 US Department of Health and Human Services:ASPE: 2023 Poverty Guidelines Hawaii 53 Annie E Casey Kids Count: Employment 54 ACS 2020:5 Yr Estimate Table DP03 55 Ibid 56 2021 State of Hawai'i Occupational Employment and Wage Data- DBEDT: May 2021- Hawaii County 57 Hawaii Health Matters: Unemployed Workforce 58 U.S. Bureau of Labor Statistics; Hawaii Health Matters Unemployment Workers in Civilian Labor Force 59 Hawaii Department of Business, Economic Development&Tourism:September Unemployment Rate 60 Hawaii Department of Business, Economic Development&Tourism:September Unemployment Rate 61 U.S. Bureau of Labor Statistics; Hawaii Health Matters Unemployment Workers in Civilian Labor Force 62 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Behavioral Risk Factor Surveillance System: Hawaii Health Matters Income Greater than $50,000 63 ACS 2021:5 Yr Estimates Table 51903 64 Ibid 65 ACS 2021:5 Yr Estimate:Table B10010 66 ACS 2021:5 Yr. Estimates Table 51903 67 Children's Bureau: Poverty and its Effects on Children 68 Definition From HealthCare.gov 69 US Department of Health and Human Services:ASPE: 2023 Poverty Guidelines Hawaii 7'ACS 2021:5 Yr Estimate:Table 51701 71 Ibid 'Z ACS 2021:5 Yr Estimate:Table 50901 73 ACS 2021:5 Yr Estimate Table 51002 74 ACS 2020: 5 Yr Estimate: Hawaii Health Matters Children Living in Poverty 75 ACS 2021:5 Yr Estimate Table DP04 76 Relationship Between Housing&Overall Quality of Life: Housing Availability 77 ACS 2021:5 Yr Estimate Table: B07401 78 Bridging the Gap:Active Homeless Families on Neighbor Islands Dashboard Accessed March 23,2023 79 Ibid 8°ACS 2021:5 Yr Estimate Table: B07401 81 Bridging the Gap:Active Homeless Families on Neighbor Islands Dashboard_Accessed March 23,2023 82 Ibid 83 ACS 2021:5 Yr Estimate Table DP04 84 ACS 2021:5 Yr Estimate Table DP04 85 Ibid 86 ACS 2021:5 Yr Estimate Table DP04 Search by Zip Code 87 Private Residential Building Permits: Number of Units Authorized Hawai'i County 2020 88 Hawaii Department of Natural Resources, Bureau of Conveyances data: Home Sales by Origin of Buyer Hawai'i County 8e Urban Institute: Housing Stability 9°ACS 2021:5 Yr Estimate Table DP02 91 ACS 2021:5 Yr Estimate Table: B07401 Page 121 92 Hawaii Health Matters:Overcrowding 93 Hawaii Health Matters:Overcrowding 94 ACS 2020:5 Yr Estimate Table DP04: Hawaii Health Matters Overcrowded Households 9s ACS 2020: 5 Yr Estimate: Hawaii Health Matters Overcrowded Households 96 Bridging the Gap:Active Homeless Families on Neighbor Islands Dashboard Accessed March 23,2023 97 Ibid 98 Ibid 99 Ibid 100 Ibid 101 National Center for Homeless Education, Hawaii State Overview 102 National Center for Homeless Education, Hawaii State Overview 103 Parents and Children Together Head Start& Early Head Start 2020-2021 Annual Report 104 Bridging The Gap https://www.btghawaii.org/esg-cv/numbers-served/ los Bridging The Gap https://www.btghawaii.org/esg-cv/numbers-served/ Search Families 1012020 Map the Meal Gap: Feeding America,Current Population Survey(CPS),American Community Survey (ACS), Bureau of Labor Statistics 107 2020 Map the Meal Gap: Feeding America,Current Population Survey(CPS),American Community Survey (ACS), Bureau of Labor Statistics Search Children(<18 years) los 2020 Map the Meal Gap: Feeding America,Current Population Survey(CPS),American Community Survey (ACS), Bureau of Labor Statistics 109 Feeding America: Hawaii Health Matters Protected Child Food Insecurity Rate 110 2020 Map the Meal Gap: Feeding America,Current Population Survey(CPS),American Community Survey (ACS), Bureau of Labor Statistics Search Children(<18 years) 111 USDA 2016 Economic Research Service, Food Environment Atlas Search Grocery Stores/1,000 pop, 2016 112 U.S. Department of Health and Human Services and U.S Department of Agriculture. (2020). 2020-2025 Dietary Guidelines for Americans:9th Edition. 113 Ibid 114 Penney,T. L., Brown, H. E., Maguire, E. R., Kuhn, I., &Monsivais, P. (2015). Local food environment interventions to improve healthy food choice in adults:A systematic review and realist synthesis protocol. BMJ Open,5(4),e007161. doi: 10.1136/bmjopen-2014-007161 11s ACS 2020: 5 Yr Estimate:Table 52504 111 Community Action Partnership: Map My Community: Map Room Search Grocery Stores and Supermarkets, Total Establishments by ZCTA, CBP 2020 117 Community Action Partnership: Map My Community: Map Room Search Food Desert Census Tracts, 1 Mi./ 10Mi. by Tract, USDA-FARA 2019 11s 2020 Map the Meal Gap: Feeding America,Current Population Survey(CPS),American Community Survey (ACS), Bureau of Labor Statistics 119 Community Action Partnership: Map My Community: Map Room Search Food Desert Census Tracts, Change, 1 Mi/10Mi. By Tract, USDA-FARA 2015-2019 120 Hayes,Clarissa and Crystal Fitzsimons, "Hunger Doesn't Take a Vacation:Summer Nutrition Status Report" Food Research &Action Center,August 2020 121 Hayes,Clarissa and Crystal Fitzsimons, "School Breakfast Scorecard 2019-2020," Food Research&Action Center, February 2021 122 Hayes,Clarissa and Crystal Fitzsimons, "Afterschool Suppers:A Snapshot of Participation 2019-2020," Food Research &Action Center,October 2021 123 ACS 2021: 5 Yr Estimate Table B09010 124 ACS 2021: 5 Yr Estimate Table B22002 12s HiDOE Community Eligibility Provision Program 2022-2023 School Year 121 National Center for Education Statistics(2020-2021): Hawaii Health Matters Lunch Program 127 ACS 2021: 5 Yr Estimate Table B09010 12s Hawai'i Department of Human Services 2021 Databook 129 National School Lunch Program Fact Sheet Page 122 13o Policy Basics:The Supplemental Nutrition Assistance Program (SNAP) 131 SNAP Frequently Asked Questions 13z ACS 2021: 5 Yr Estimate Table B22002 133 USDA Food & Nutrition Service SNAP Retailer Locator Interactive Map 134 WIC Fact Sheet 135 State of Hawai'i Department of Health Women, Infants,&Children Webpage 136 2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: PRAMS WIC Participation Modify Query 2020 and Maui County 131 US Food& Nutrition Service WIC Participant and Program Characteristics 2020 131 National School Lunch Program Fact Sheet 139 National Center for Education Statistics(2020-2021): Hawaii Health Matters Lunch Program 140 Ibid 141 State of Hawai'i Department of Education Hawai'i Child Nutrition Program Area Eligibility Data October 2021 142 HiDOE Community Eligibility Provision Program 2022-2023 School Year 143 USDA Food & Nutrition Service:Child &Adult Care Food Program Information Page 144 USDA Food & Nutrition Service Nutrition Tables: Child and Adult Care Food Meals Served 145 HHS.GOV TAN 146 Hawai'i Department of Human Services 2021 Databook 147 Ibid 141 Ibid 149 Hawai'i Public Housing Authority Annual Report Fiscal Year 2021-2022 150 Hawai'i Department of Human Services 2021 Databook 151 ACS 2021: 5 Yr. Estimate Table 52701 152 ACS 2021: 5 Yr. Estimate Table 52702 153 ACS 2021: 5 Yr. Estimate Table 52703 154 ACS 2021: 5 Yr. Estimate Table 52704 155 Hawai'i Department of Human Services 2021 Databook 156 Center for American Progress, December 2,2021, "Build Back Better Act Substantially Expands Child Care Assistance" 157 ACS 2021: 5 Yr Estimate Table B23008 151 ACS 2021:5 Yr Estimate Table DP04 159 Center for American Progress Costly and Unavailable:America Lacks Sufficient Child Care Supply for Infants and Toddlers Aug,4,2020 160 2020-2021 National Survey of Children's Health: Hawaii Career Sacrifice Due to Child Care Issues 161 ACS 2021: 5 Yr Estimate Table B23008 162 Ibid 163 United for ALICE Research Center Hawai'i 2018 County Profile Hawai'i County 164 Ibid 165 Center for American Progress. Child Care Aware of America. Hawaii Early Learning Fact Sheet 2021 166 Child Care Aware of America. (2021). Child Care Prices as a Percentage of Median Household Income,2020. 167 Child Care Aware of America, Price of Child Care in Hawaii. Accessed on Sep. 9,2022 161 PATCH Hawai'i Average Full Time Rate Report Accessed December 2022 Report 169 Ibid 170 ACS 2021: 5 Yr Estimate Table DP04 171 County Health Rankings:Severe Housing Cost Burden 172 County Health Rankings: Housing Cost Burden Definition 173 ACS 2021: 5 Yr Estimate Table DP04 174 Defined as the percentage of households that spend more than 30%of their income on housing costs.Severe Housing Cost Burden is classified as a household spending over 50%of their income on housing cost. County Health Rankings: Hawai'i County 2022 175 2010-2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: PRAMS Live Births Modify Query 2010-2020 and Mother's Residence Maui County Page 123 176 2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System:Teen Births Rate Modify Query 2010-2020 and Maui County 17 Pew Research Center:"Why is the Teen Birth Rate Falling?' (2019) 1712010-2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: PRAMS Live Births Modify Query 2010-2020 and Mother's Residence Hawaii County 179 2010-2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse,Office of Health Status Monitoring, Birth Data. Modify Query 2010-2020 and Mother's Residence Hawai'i County Iso Hawaii State Department of Health, Hawaii Health Data Warehouse,Office of Health Status Monitoring, Birth Data. DOH Birth Rate by Ethnicity Search Hawaii County and DOH Ethnicity 181 World Health Organization: "Adolescent Pregnancy" (2022) 182 2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System:Teen Births Ratty Modify Query 2010-2020 and Hawaii County 183 2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System:Teen Births Rate Modify Query 2020 and All Counties 184 2020 Hawaii State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: Hawaii Health Matters Healthy Body Weight 1812020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: Hawaii Health Matters Healthy Body Weight 186 2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: PRAMS Intended Pregnancies Modify Query 2020 and Hawaii County 187 2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: Hawaii Health Matters Trying to Get Pregnant 1882020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: Marijuana Use During Pregnancy Modify Query 2020 and Hawaii County 189 2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System:Smoke Last 3 Months of Pregnanc: Modify Query 2020 and Hawaii County 1912020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System:Second Hand Smoke During Pregnancy Modify Query 2020 and Hawaii County 1912020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: Brink Prior to Pregnancy Modify Query 2020 and Hawaii County 192 2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: Binge Drink Prior to Pregnancy Modify Query 2020 and Hawaii County 193 2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: Drank Alcohol Last 3 Months Pregnancy Modify Query 2020 and Hawaii County 194 2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: PRAMS Asked About Depression Modify Query 2020 and Maui County 195 2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: PRAMS Experiencing Depression Modify Query 2020 and Maui County 196Kotelchuck Index,also called the Adequacy of Prenatal Care Utilization (APNCU), uses two crucial elements obtained from birth certificate data-when prenatal care began (initiation)and the number of prenatal visits from when prenatal care began until delivery(received services). 2020 Pregnancy Risk Assessment and Monitoring System (PRAMS), Hawai'i State Department of Health, Family Health Services Division in collaboration with the Centers for Disease Control and Prevention (CDC): Hawaii Health Matters Prenatal Care 197 Ibid 198 Hawaii Health Matters: Premature Births 199 2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: PRAMS Preterm Births Modify Query 2020 and Hawaii County 2112020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: PRAMS Birth Weight Modify Query 2020 and Hawaii County 201 State of Babies: Low Birth Weight 202 2020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: PRAMS Birth Weight Modify Query 2020 and Hawaii County Page 124 "12020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: PRAMS Discussed Contraception Modify Query 2020 and Hawai'i County 2112020 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk Assessment Monitoring System: PRAMS Breastfeeding Duration Modify Query 2020 and Hawai'i County 205 2020-2021 National Survey of Children's Health:ACES Children 0-17 Zoe Center for Disease Control and Prevention:ACEs Facts 201 Child and Adolescent Health Measurement Initiative. (2020). 2020 National Survey of Children's Health (NSCH) Stata Constructed Data Set; State of Babies Yearbook 2022 Hawaii Report 208 2020-2021 National Survey of Children's Health:ACES Children 0-5 209 2020-2021 National Survey of Children's Health:ACES Children 0-17 210 US Department of Health and Human Services. Child Welfare Information Gateway. Impact of Domestic Violence 211 Child and Adolescent Health Measurement Initiative. (2020). 2019 National Survey of Children's Health (NSCH); State of Babies Yearbook 2022 Hawaii Report 212 Children's Bureau,Administration on Children,Youth and Families,Administration for Children and Families, U. S. Department of Health and Human Services(2020).Adoption and Foster Care Analysis and Reporting System (AFCARS), Foster Care File 2019. National Data Archive on Child Abuse and Neglect. State of Babies Yearbook 2022 Hawaii Report 211 Hawai'i National Incident-Based Reporting System (NIBRS): Query Persons Offense Victims Involving Intimate Partner Relationship by Relationship Type 214 Center for Disease Control and Prevention: Child Abuse& Neglect Facts 215 Hawai'i State Department of Human Services. "A statistical report on child abuse and neglect in Hawai'i," various years.Audit,Quality Control,and Research Office. Kids Count CAN Rate 0-5 211 Hawai'i State Department of Human Services. "A statistical report on child abuse and neglect in Hawai'i," various years.Audit,Quality Control,and Research Office. Kids Count CAN Rate 0-17 County 217 Ibid 218 Ibid 219 Ibid 220 Ibid 221 Ibid 222 Hawai'i Department of Health Injury Prevention 2020: Injury-A Major Public Health Problem in Hawaii 223 Hawaii State Department of Health,Vital Statistics: Hawaii Health Matters Infant Mortality Rate 224 Hawaii State Department of Health,Vital Statistics: Hawaii Health Matters Infant Mortality Rate 225 Ibid 226 Hawaii State Department of Health,Vital Statistics: Hawaii Health Matters Infant Deaths Birth Defects 227 Hawaii State Department of Health,Vital Statistics: Hawaii Health Matters Infant Deaths Heart 228 Hawaii State Department of Health,Vital Statistics: Hawaii Health Matters SIDS 229 Hawaii State Department of Health,Vital Statistics: Hawaii Health Matters Unexpected 230 Hawaii State Department of Health,Vital Statistics: Hawaii Health Matters Suffocation 2312020-2021 National Survey of Children's Health:Children with Preventative Care Visit 232 2020-2021 National Survey of Children's Health: Medical Home,Children with Special Health Care Needs 233 Hawaii Health Matters: Children with Access to a Medical Home 234 Hawaii Behavioral Risk Factor Surveillance System Survey 2020: Hawaii Health Matters Adult with Good Physical& Mental Health 235 2019-2020 National Survey of Children's Health: Hawaii Health Matters Mental Health 236 ACS 2021: 5 Yr Estimate Table 51810 237 Hawaii Health Matters:Children With Disabilities 23s 2020-2021 National Survey of Children's Health:Children with Preventative Dental Visit in Last Year 239 2021 Hawai'i Med-Quest CMS 416 Reports: Hawaii Health Matters 240 American Academy of Pediatrics: Medical Home Definition 241 American Academy of Pediatrics: Medical Home Definition 242 2020-2021 National Survey of Children's Health: Medical Home,Children Without Special Health Care Needs Page 125 243 2020-2021 National Survey of Children's Health: Medical Home,Children with Special Health Care Needs 244 Center for Disease Control& Prevention:Vaccines 241 Annie E Casey Foundation Kids Count:2-Year-Olds Who Were Immunized 246 HealthCare.gov: Medicaid Expansion&What it Means for You 241 Med Quest Hawai'i: Early Periodic Screening, Diagnostic,&Treatment(EPSDT) 248 Gale Research: Kindergarten Readiness 249 Hawaii Department of Education Early Learning Board Presentation 10.13.22 21'Hawaii Department of Education Kindergarten Information Page: Kindergarten Enrollment 211 Hawaii Department of Education Kindergarten SY 21-22 Enrollment Data 212 Ibid 213 Hawai'i Association of Independent Schools,SY 21-22 Enrollment Report 214 Hawaii Department of Education Kindergarten SY 21-22 Enrollment Data 211 Hawai'i Department of Education Official Enrollment Count SY21-22 216 Ibid 217 Maui County Data Book 2020 Section 2: Education 211 Hawai'i Department of Education Hawai'i County DOE Map 219 Hawai'i State Department of Education. Accountability Resource Center Hawaii Search "Trend Report: Educational&Fiscal Accountability"by Complex 261 Hawaii State Department of Education. "Trend Report: Educational& Fiscal Accountability,"various years, various districts.Annie E. Casey Kids Count K-12 Special Education 261 Hawaii Health Matters: 3rd &4th Grade Reading Skills 262 SY 2021-2022 State of Hawaii Department of Education:ARCH Accountability Data Center 263 Hawaii Health Matters:Adults without a High School Degree 264 State of Hawai'i Department of Education Accountability Resource Center Hawai'i-School Year 2021-22 261 ACS 2020 5 Yr Estimate Table 51501; Hawaii Health Matters 25+with Bachelors 266 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Behavioral Risk Factor Surveillance System: Hawaii Health Matters Adult with No HS Diploma 267 ACS 2020 5 Yr Estimate Table 51501; Hawaii Health Matters 25+with Bachelors 26s ACS 2020 5 Yr Estimate Table 51501; Hawaii Health Matters 25+with Bachelors 2692012-2017 National Center for Educational Statistics: U.S>: Program for the International Assessment of Adult Competencies(PIAAC) Literacy Proficiency:County Summary Card 270 National Assessment of Adult Literacy: Definition of Literacy 271 Pro Literacy:Adult Literacy Facts 272 Ibid 273 Hawai'i Child Care Capacity, Early Childhood Action Strategy. March 30,2023. 274 PATCH Hawai'i Child Care Capacity Report Oct. 31,2022 271 PATCH Hawai'i Child Care Capacity unpublished data request for Dec. 2019 Report 276 Unpublished data from PATCH Hawai'i Data Request 1/12/23 277 2020 Hawai'i Early Childhood Comprehensive Needs Assessment:Child Care Desert 278 ACS 2021: 5 Yr Estimate Table B09001 279 PATCH Hawai'i Child Care Capacity Report Oct. 31,2022 2111 NAEYC Accredited Programs:Accessed on 10/13/22 281 National Head Start Association: Head Start Center Locations Hawaii Accessed Dec. 2022 282 Data request to Executive Office of Early Learning Nov. 2022 283 UH Center on the Family: Nearby Seats within 5 Miles by Driving: Hawaii ECE Mapping 2021 284 UH Center on the Family: Cost of ECE Seat as a Percentage of Family Income: Hawaii ECE Mapping 2021 281 ACS 2021: 5 Yr Estimate Table 51401 286 U.S. Bureau of Labor Statistics-Hawai'i May 2021 State Occupational Employment and Wage Estimates 287 Center for the Study of Child Care Employment: Early Childhood Workforce Index 2020 Appendix Table 2.2 288 2020-2021 National Survey of Children's Health: Developmental Screening 289 Center for the Study of Child Care Employment: Early Childhood Workforce Index 2020 290 Center for the Study of Child Care Employment: Early Childhood Workforce Index 2020 Appendix Table 2.2 Page 126 291 U.S. Bureau of Labor Statistics-Hawaii May 2021 State Occupational Employment and Wage Estimates 292 University of Hawai'i: Hawai'i Community College Early Childhood Education Program 293 National Survey of Children's Health 2020-2021: Developmental Screening 294 National Early Childhood Technical Assistance Center(2011)The Importance of Early Intervention. 295 IDEA Data Center 296 2020-2021 US Office of Special Education Programs: IDEA Section 618 Part C 297 2020-2021 US Office of Special Education Programs: IDEA Section 618 Part B 298 2020-2021 US Office of Special Education Programs: IDEA Section 618 Part B 3-5 Year Olds 299 Ibid 300 EOEL Low-to No-Cost Early Childhood Development& Learning Programs: October 2022 3012020-2021 National Survey of Children's Health (NSCH): Family Reads to Children,0-5 years 302 2020-2021 National Survey of Children's Health (NSCH): Family Sings/Tells Stories to Children,0-5 years 303 2021 Claritas Consumer Profiles: Hawaii Health Matters 304 2020-2021 National Survey of Children's Health (NSCH): Family Reads to Children,0-5 years 305 2020-2021 National Survey of Children's Health (NSCH): Family Sings/Tells Stories to Children,0-5 years 306 ACS 2020:5 Yr Estimate: Hawaii Health Matters Linguistic Isolation 307 ACS 2021: 5 Yr Estimate:Table DP02, Hawaii Health Matters Language 308 ACS 20215 Yr Estimate Table DP02 309 2020 Hawai'i Behavioral Risk Factor Surveillance System Survey: Hawaii Health Matters 310 Center for Disease Control and Prevention: Oral& Dental Health 3112020 Hawaii Behavioral Risk Factor Surveillance System Survey: Hawaii Health Matters Obese 312 2020 Hawaii Behavioral Risk Factor Surveillance System Survey: Hawaii Health Matters Diabetes 313 2020 Hawaii Behavioral Risk Factor Surveillance System Survey: Hawaii Health Matters Diabetes 314 2020 Hawaii Behavioral Risk Factor Surveillance System Survey: Hawaii Health Matters Mental Health 315 Robert Wood Johnson Foundation. County Health Rankings& Roadmaps Hawai'i:Community Safety 316 Ibid 317 Hawai'i Department of the Attorney General's Annual Uniform Crime Report,Crime in Hawaii,2019;Annie E Casey Kids Count Total Crime Index 318 Hawai'i Department of the Attorney General's Annual Uniform Crime Report,Crime in Hawaii,2019;Annie E Casey Kids Count Juvenile Drug Related Arrests 319 National Survey on Drug Use and Health; Hawaii Health Matters:Adolescent Use of Alcohol& Illicit Drugs 320 2019 Hawai'i State Departments of Education and Health, Hawaii Health Data Warehouse, Hawaii School Health Survey:Youth Risk Behavior Survey:YRBS Teens Alcohoi Modify Query 2019 and Hawai'i County 321 Illicit Drugs include: Marijuana,Cocaine, Ecstasy, Methamphetamines, Illegal Drugs Injected by a Needle,or Prescription Pain Medicine without a Doctor's direction;2019 Hawaii State Departments of Education and Health, Hawaii Health Data Warehouse, Hawaii School Health Survey:Youth Risk Behavior Survey:YRBS Teen Illicit Drugs Modify Query 2019 and Hawaii County 322 2019 Hawai'i State Departments of Education and Health, Hawaii Health Data Warehouse, Hawaii School Health Survey:Youth Risk Behavior Survey:YRBS Teen Vape Modify Query 2019 and Hawaii County 323 2019 Hawai'i State Departments of Education and Health, Hawaii Health Data Warehouse, Hawaii School Health Survey:Youth Risk Behavior Survey:YRBS Teen Birth Control Modify Query 2019 and Hawai'i County 324 2019 Hawai'i State Departments of Education and Health, Hawaii Health Data Warehouse, Hawaii School Health Survey:Youth Risk Behavior Survey:YRBS Teen Sexually Active Modify Query 2019 and Maui County 325 Hawai'i Department of Human Services 2021 Databook 326 Ibid 327 Ibid Page 127 MAY 2023 HAWAI ' l COUNTY EARLY CHILDHOOD INDICATOR REPORT earl childhood ,j ', ACTION STKHFEGY TAKING ACTION FOR HAWAII'S CHILDREN N. J��Y•'�'F''yq r �i '•''<'qo;�•� .4rF."p F'M.►P INTRODUCTION The Hawai'i County Early Childhood Indicator report was developed to accompany the Hawai'i County Early Childhood Community Profile.This report includes indicators of child wellbeing for Hawai'i County. Indicators are organized into the domains discussed in the 2023 Hawai'i County Early Childhood Community Profile. These indicators are intended to help us understand the condition of young children and their families, identify trends in children's wellbeing, and assessing the effectiveness of efforts to improve the conditions of families with young children. The Hawai'i County Early Childhood Indicator Report was commissioned by the Early Childhood Action Strategy(ECAS) More information on the work of ECAS can be found at: https://hawaiiactionstrategy.org/. This report is divided into five sections: • Basic Demographics includes basic demographic information on children in Hawai'i County, including age, ethnicity, island of residence, household living arrangements, and multigenerational households. • Economic Well-Being presents indicators of economics, poverty, housing, homelessness,food security, public assistance, and affording childcare. • Health includes indicators of maternal and newborn health, and children's access to health care and healthy development. • Early Learning includes K-12 education, early childhood capacity and enrollment. • Community includes indicators of family and community strength and safety. Data Used This report draws on publicly available data, primarily from the U.S. Census Bureau, American Community Survey(ACS), 5-year estimates. A list of all data sources used can be found in the resource section. Page 01 Demographic Pr• - Table 1: Population of Children Under 5 Years Old in Hawai'i County by District' 2021 Hamakua Hilo Ka'u Kohala Kona Puna Hawai'i County District District District District District District Total Under 3 328 1,377 616 657 2,303 1,792 7,073 Years old 3&4 Years old 250 862 607 261 1,565 718 4,263 5 Years 97 559 288 143 801 379 2,267 Olds Total 675 2,798 1,511 1,061 4,669 2,889 13,603 Table 2: Population Under 6 by Table 3: Race/Ethnicity of Children Under 18 County, Years Old in Hawai'i County$ 2021' 2021 Total Race/Ethnicity Percentage County Population Percentage White 16.5% Hawai'i 13,603 13.1% County Black/African American 0.1% Honolulu 74,015 71.2% American Indian and Alaska Nati%e 0.6% County Kauai 5,024 4.8% Asian 13.8% County Native Hawaiian/ Pacific Islander 12% Maui 11,361 10.9% County Some Other Race 3.2% Hawaii State 104,003 2 or More Races 53.9% Page 02 Table 4: Number of Children Under 6 by Living Arrangement Hawai'i County, 2021$ Number of Children under 6 Total Children 13,624 Married-couple Household 7,684 56.4% Single Mother Household 3,721 27.3% Single Father Household 2,161 15.9% Table 5: Grandparents Raising Hawai'i County, 2021 Grandparents living with grandchildren under 18 6,908 Grandparents responsible for 2,260 32.7% grandchildren Grandparent not responsible for own grandchildren under the 4,648 67.3% age of 18 Page 03 Economic Well-being Indicators Indicator Table =Negative trend that is lower than state average =Negative trend that is higher than state average =Positive trend that is lower than state average =Positive trend that is higher than state average =Equal or similar to the state average *Data not available Indicators Hawai'i County State of Hawai'i Compared Source to State Economics & Poverty Civilians Unemployed 3.6% 3.5% ® 35 Median Family(with children) Income $71,773 $97,843 12 z W CD Married Couple Family Median Income $101,780 $116,051 13 J J W Single Father Family Median Income $38,200 $64,315 13 U Single Mother Family Median Income $25,327 $39,573 13 C G Children 0-4 years old living below 0 2,305 10.6% 11,147 13.1% 12 z poverty level OMulti-generational families living in 397 5.7% 3,087 5.8% ® 9 W poverty Housing & Homelessness Occupied Housing units that are owner 7 49,822 69.8% 291,814 61.0% occupied Page 04 Vacant Housing 16,857 19.1% 78,524 14.1% 7 Housing Mobility of families with young 1,232 13.7% 12,668 18.1% 1 children Living in overcrowded dwellings 5,566 7.8% 41,290 8.6% ® 7,42 Homeless Population 0-5 years old 182 12.6% 1,622 10.4% ® 32 Indicators Hawai'i County State of Hawai'i Compared Source to State Food Security Children (0-17 years old)who are food 11,110 25.7% 50,180 16.6% T 46 insecure Share of the population living in a Food 91,892 49.7% 140,491 10.3% 46 z Desert W pp Public Assistance J J Children in families receiving public 16,804 38.9% 76,945 24.7% T 3 W assistance U SNAP households with children 61932 33.5% 25,862 17.3% 14 G 0 WIC participation 43.5% 29.5% T 31 z 0 Students Eligible for the Free Lunch 55.1% 38.9% 47 W Program Children 0-5 years old with no health 193 1.4% 2,515 2.4% u, 15 insurance coverage Children 0-5 years old with Public 8,171 59.9% 39,124 37.5% 16 Insurance(ex. Med-Quest) Page 05 Indicators Hawai'i County State of Hawai'i ComparedSource to State Affording Child Care All parents in the Workforce 8,797 67.5% 63,875 65.4% 5 (� Annual cost of center-based care z_ W Infants $28,560 $20,750 T 51 m J Toddlers of ages 1-2 $16,028 $17,431 ® 51 W Preschoolers of ages 3-4 $13,856 $13,528 ® 51 U_ 75;G Annual cost of licensed family child care homes: O Z Infants $9,685 $10,399 ® 51 O U Toddlers of ages 1-2 $9,540 $10,159 ® 51 W Preschoolers of ages 3-4 $9,475 $10,039 ® 51 Households with a high housing cost 22,691 33.4% 182,840 39.6% 7 burden .�.=Negative trend that is lower than state average =Positive trend that is lower than state average =Negative trend that is higher than state average =Positive trend that is higher than state average =Equal or similar to the state average *Data not available Page 06 Health Indicators Indicators Hawai'i County State of Hawai'i ComparedSource to State Maternal Health & Births Healthy Weight prior to pregnancy 46.7% 45.2% ® 27 Born to a mother who received late or no prenatal care 40.1% 38.5% ® 43,53 Born to a mother who smoked during the last trimester of pregnancy 4.0% 3.0% ® 25 Born to a mother who drank alcohol 7.1% 6.6% ® 26 during the last trimester of pregnancy Preterm Births 6.8% 9.2% 30 Born low birth weight 4.2% 7.0% 28 Ever breastfed 94.7% 96.5% ® 29 J Q Child Well-being Risk Factors LU Child Abuse&Neglect per 1,000 6.5 4 20,33 Child Health & Development Overweight or Obese among high school 30.0% 30.8% ® 45 students Children 0-5 who had a medical home - 46,694 49.3% * 49 Children 0-5 with special health needs - 3,277 43.7% 48 who had a medical home Rate of children transported off-island by Medicaid for dental services per 18.3 8.5 T 22,39 10,000 Children 0-4 years old that live with a 118 1.0% 529 0.6% 4 disability =Negative trend that is lower than state average =Positive trend that is lower than state average =Negative trend that is higher than state average i =Positive trend that is higher than state average =Equal or similar to the state average *Data not available Page 07 Education I • • • Indicators Hawaii County State of HawaiComparedi Source to State Education Children enrolled in special education 3,071 11.3% 17,979 10.4% ® 24 Proficiency in 3rd grade reading scores 35.1% 48.9% 23 Proficiency in 3rd grade math scores 39.6% 51.3% 23 z O Proficiency in 4th grade reading scores 34.5% 51.6% 23 a U Proficiency in 4th grade math scores 31.9% 46.0% 23 LU High school seniors graduating with a 92.2% 93.7% 17,44 diploma High school students graduating on time 84.8% 86.2% ® 18,44 Adults(aged 25+)who have a high school 92.8% 92.7% ® 11,37 diploma or higher Adults(aged 25+)who have a 30.2% 34.3% 36 Bachelor's degree or more education Indicators Hawai'i County State of Hawai'i Compared Source to State Early Childhood Capacity & Enrollment z Percent of 3&4 Year olds enrolled in 43.2% 42.2% ® 10 Oearly childhood education Number of registered childcare facilities 2,770 23,85 52 U Ratio to population aged under 6 4.1 : 1 4.4 : 1 2,52 W Desired capacity of licensed child care 2,602 20,857 52 facilities Ratio to population aged under 6 4.4: 1 5.0 : 1 2,52 .l.=Negative trend that is lower than state average q, =Positive trend that is lower than state average =Negative trend that is higher than state average 'r=Positive trend that is higher than state average ®=Equal or similar to the state average *Data not available Page 08 Community • • • Indicators Hawai'i County State of Hawai'i ComparedSource to State Strong Families & Communities Speaks English less than very well 8.9% 11.2% 'Ie 6,41 z C� Adults who are obese 25.2% 24.5% ® 34 G C Persons with a disability 14.4% 11.4% 4 O Index Crime Rates per 100,000 population 4,643 3,130 21 U Juvenile Drug-Related Arrests per 188 270 19,21 100,000 juveniles .�.=Negative trend that is lower than state average =Positive trend that is lower than state average =Negative trend that is higher than state average =Positive trend that is higher than state average =Equal or similar to the state average *Data not available Page 09 Resources Consulted Aloha United Way. 2018. United for ALICE Research Center Hawai'i 2018 County Profile Hawai'i County Retrieved January 6, 2023 American Academy of Pediatrics. n.d. What is a Medical Home Retrieved January 6, 2023 Center for Disease Control and Prevention. n.d. Child Abuse& Neglect Facts Retrieved January 6, 2023 Child Crime Prevention & Safety Center. n.d. Juvenile Crime and Substance Abuse Retrieved January 6, 2023 Children's Bureau. 2019. Children in Poverty- Poverty and its Effects on Children Retrieved January 6, 2023 Dunn,James R. 2020. Housing and Healthy Child Development: Known and Potential Impacts of Interventions: Annual Review of Public Health 2020 41:1, 381-396 Retrieved January 6, 2023 Evans, G. W. 2006. Child Development and the Physical Environment. Annual Review of Psychology, 57, 423-451. Retrieved January 6, 2023 First Five Years Fund. n.d. Why It Matters Retrieved January 6, 2023 Hawaii Health Matters. 2019. Preterm Births Retrieved January 6, 2023 Hawaii Health Matters. 2020a. Adults without a High School Degree Retrieved January 6, 2023 Hawaii Health Matters. 2020b. Children 10-13 Who are Obese Retrieved January 6, 2023 Hawaii Health Matters. 2020c. Persons with a Disability Retrieved January 6, 2023 Hawaii Health Matters. 2020d. Households with Cash Public Assistance Income Retrieved January 6, 2023 Hawaii Health Matters. 2020e. Population Age 5+with Language Other than English Spoken at Home Retrieved January 6, 2023 Hawaii Health Matters. 2022. Unemployed Workers in Civilian Labor Force Retrieved January 6, 2023 Hawaii State Department of Human Services. (n.d.). Homeless Programs Office, Homeless Service Utilization Report and Statistical Supplement FY 203.; Table 2 on Page 7 Retrieved January 6, 2023 Johnson, A.J. 2016. The Relationship Between Housing and Overall Quality of Life Retrieved January 6, 2023 National Center for Education Statistics. n.d. Students with Disabilities Retrieved January 6, 2023 Nurture Daily. n.d. Protective Factors Retrieved January 6, 2023 Robert Wood Johnson Foundation. n.d. County Health Rankings& Roadmaps Hawai'i: Community Safety Retrieved January 6, 2023 Page 10 Stanford Medicine. n.d. Children's Health: Nutrition Before Pregnancy Retrieved January 6, 2023 State of Babies Yearbook. 2022. Percentage of Babies with Low Birthweight Retrieved January 6, 2023 U.S. Department of Agriculture, Economic Research Service. (n.d.). Definitions of food security. Retrieved January 6, 2023 U.S. Department of Health and Human Services. 2022. ASPE: 2022 Poverty Guidelines Hawai'i Retrieved January 6, 2023 Page 11 Resources Consulted: (US Census, American Community Survey) # Data Source 1 American Community Survey 2021: 5 Yr Estimate Table B07401 2 American Community Survey 2021: 5 Yr Estimate Table B09001 Search by Zip Code 3 American Community Survey 2021: 5 Yr Estimate Table B09010 4 American Community Survey 2021: 5 Yr Estimate Table B18101 5 American Community Survey 2021: 5 Yr Estimate Table B23008 6 American Community Survey 2021: 5 Yr Estimate Table DP02 7 American Community Survey 2021: 5 Yr Estimate Table DP04 8 American Community Survey 2021: 5 Yr Estimate Table 50901 9 American Community Survey 2021: 5 Yr Estimate Table 51002 10 American Community Survey 2021: 5 Yr Estimate Table 51401 11 American Community Survey 2021: 5 Yr Estimate Table 51501 12 American Community Survey 2021: 5 Yr Estimate Table 51701 13 American Community Survey 2021: 5 Yr Estimate Table 51903 14 American Community Survey 2021: 5 Yr Estimate Table 52201 15 American Community Survey 2021: 5 Yr Estimate Table 52701 16 American Community Survey 2021: 5 Yr Estimate Table 52704 17 Annie E Casey Kids Count Data Center: High School Seniors Graduating with a Diploma 18 Annie E Casey Kids Count Data Center: On-time Graduation 19 Annie E Casey Kids Count Juvenile Drug Related Arrests 20 Annie E. Casey Kids Count CAN Rate 0-17 County Hawai'i Department of the Attorney General's Annual Uniform Crime Report, Crime in 21 Hawai'i, 2019 22 Hawai'i Med-Quest CMS 416 Reports 2021 23 Hawaii State Department of Education. Accountability Resource Center Hawaii ARCH Accountability Data Center SY 2021-2022 24 Hawaii State Department of Education. Accountability Resource Center Hawaii Search "Trend Report: Educational & Fiscal Accountability" by Complex Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk 25 Assessment Monitoring System 2020: Smoke Last 3 Months of Pregnane Modify Query 2020 and Hawaii County Page 12 Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk 26 Assessment Monitoring System 2020: Drank Alcohol Last 3 Months Pregnancy Modify Query 2020 and Hawaii County Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk 27 Assessment Monitoring System 2020: Healthy Body Weight Prior to Pregnancy Modify Query 2020 and Hawaii County Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk 28 Assessment Monitoring System 2020: PRAMS Birth Weight Modify Query 2020 and Hawai'i County Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk 29 Assessment Monitoring System 2020: PRAMS Breastfeeding Duration Modify Query 2020 and Hawaii County Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk 30 Assessment Monitoring System 2020: PRAMS Preterm Births Modify Query 2020 and Hawai'i County Hawai'i State Department of Health, Hawaii Health Data Warehouse, Pregnancy Risk 31 Assessment Monitoring System 2020: PRAMS WIC Participation Modify Query 2020 and Hawai'i County Hawaii State Department of Human Services, Homeless Programs Office, Homeless Service 32 Utilization Report and Statistical Supplement FY 2017 33 Hawaii State Department of Human Services. "A statistical report on child abuse and neglect in Hawai'i,"various years. Audit, Quality Control, and Research Office. 34 Hawaii Behavioral Risk Factor Surveillance System Survey 2020: Adults who are Obese Hawaii Department of Business, Economic Development&Tourism: September 35 Unemployment Rate 36 Hawaii Health Matters 25+with Bachelors 37 Hawaii Health Matters 25+with HS Degree or Higher 38 Hawaii Health Matters Adults with Diabetes 39 Hawaii Health Matters Children Transported by Medicaid for Dental Services. 40 Hawaii Health Matters Children with a Disability 41 Hawaii Health Matters Language 42 Hawaii Health Matters Overcrowded Households 43 Hawaii Health Matters Prenatal Care 44 Hawaii State Department of Education. "School Status and Improvement Report" (SSIR), various years, various districts. Accountability Section, Assessment and Accountability Page 13 Branch, Office of Strategy, Innovation and Performance, Honolulu, HI. 45 Hawaii State Departments of Education and Health, Hawaii Health Data Warehouse, Hawaii School Health Survey 2019:Youth Risk Behavior Survey Obese and Overweight Students 46 Map the Meal Gap 2020: Feeding America, Current Population Survey (CPS), American Community Survey(ACS), Bureau of Labor Statistics 47 National Center for Education Statistics 2020-2021: Hawaii Health Matters Lunch Program 48 National Survey of Children's Health 2020-2021: Medical Home, Children with Special Health Care Needs 49 National Survey of Children's Health 2020-2021: Medical Home, Children Without Special Health Care Needs Office of Hawaiian Affairs Wiki 50 Native Hawaiian Data 2010 Section 1.08 Racial Composition by County 51 PATCH Hawaii Child Care Average Monthly Full-Time Rates January 2023 52 PATCH Hawaii Child Care Capacity January 2023 Report Pregnancy Risk Assessment and Monitoring System (PRAMS) 2020, Hawai'i State 53 Department of Health, Family Health Services Division in collaboration with the Centers for Disease Control and Prevention (CDC): Mother Who Receive Early and Adequate Prenatal CauC 54 US Department of Agriculture Economic Research Service: Food Access Research Atlas Data Download 2019 Page 14 1000 0 0.7 0011 IWO Lot w = v o w z cm o� o ani v �+ 0 mc � OC L °ate is •- a � z W C) 0 0 R _am cc - = >1}rOoR � O0 .y �+ � vd = RRp 0 � d O . _ '> 3 R 3 y R 0 = i= i R - > iCL MEMOS O .p - MmeNims .= � uR3 � MEMOSG� O d ow af'y 3 �' = y � p �_ =ppR0G�� MO = O ,d G� = 0 � *+ NO *+ R�= y3 � = = = d O = N � = RNonoU yC3 . = _NG� Ri 'O � uoc p 0 0 = _ ._ 3 0 �- ._ ._ y v 0 > U. 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