FARGO, N.D. -- North Dakota ranks first in the U.S. when it comes to economic stability for children, according to an annual report measuring child wellbeing.

But policy experts worry the pandemic has set some families back, while other indicators don't fare as well.

The Annie E. Casey Foundation issued its annual Kids Count Data Book this week, which analyzes how states stack up in areas such as education, health, and economic factors for families with children.

The report, which mostly includes 2019 data, noted North Dakota had only 18,000 kids living in poverty.

Xanna Burg, KIDS COUNT coordinator for North Dakota, said, however, racial gaps persist.

"And unfortunately, children of color are more likely to live in poverty," Burg observed. "And so, if we base the ranking instead on the wellbeing of children of color, North Dakota would fall toward the bottom."

The report does include some post-COVID data from the Census Bureau's Household Pulse Survey. At one point during the pandemic, 16% of North Dakota households with children were unsure they could pay their next rent or mortgage payment.

As for education, the state ranked 31st, with two-thirds of fourth-graders not reading at grade level, the same as a decade ago.

And while some impact from the pandemic became less of a factor going into 2021, the report's authors pointed out it will take time to know the full weight of the crisis.

Leslie Boissiere, vice president of external affairs for the Foundation, added childhood poverty has an effect that can last for decades.

"We know that children who grow up in poverty have lower health outcomes," Boissiere explained. "They live in substandard housing that has issues like mold and lead that go untreated. Lower-income families live in poorer neighborhoods that have poorer-resourced schools, so their education outcomes tend to be worse."

She noted the expansion of the Child Tax Credit under the American Rescue Plan will boost struggling families, as it provides monthly payments starting in July.

But the expansion is only a temporary hike, and there are calls for Congress to make the expansion permanent. At the state level, the Foundation recommends North Dakota boost its minimum wage, and to make stronger investments in early childhood education.

PIERRE, S.D. -- A new study links premature deaths in adulthood with people who experience abuse as children, and South Dakota groups say it reinforces the need for prevention work.

Researchers in England found adults who were sexually abused by age 16 are more than twice as likely to die in middle age. In cases of physical abuse, the risk is 1.7 times higher.

Tifanie Petro, director of advocacy and prevention at the Children's Home Child Advocacy Center, said the findings align with past research. She added the state is doing more to raise awareness about the long-term effects of adverse childhood experiences (ACEs).

"The Adverse Childhood Experiences curriculum is designed so that it can be consumable by somebody with a lot of 'letters' behind their name, or no letters behind their name," Petro explained.

She pointed out groups spreading the message are reaching many stakeholders, including schools and law enforcement. Petro, also a board member for the Center for the Prevention of Child Maltreatment, cautioned community buy-in is sometimes hard, if people think the issue does not affect them.

Data show 24-percent of South Dakota children are in families with at least one qualifying ACE event.

Training rooted in Adverse Childhood Experiences was brought to South Dakota by the two centers in 2018. Petro described the movement as a way for people to be more open about their past, and know they have support to help overcome any trauma.

"We're trying to move from, 'Why do you keep doing what you're doing?' and move into how we understand how we got here," Petro emphasized. "'I want to walk alongside with you.'"

Outreach groups noted there is a particular concern among Indigenous communities, with the historical trauma tied to Native American boarding schools.

Katie Edwards, associate professor of educational psychology at the University of Nebraska-Lincoln, added no matter a child's background, an abusive situation can shorten their lifespan in a variety of ways.

"Mental health consequences, suicidality, substance abuse problems that we know lead to early death," Edwards outlined. "There's also a growing body of literature showing that individuals who experience child maltreatment are at greater risk for diabetes, hypertension."

As for tribal communities, Edwards is involved in a program working to prevent adverse childhood experiences in the Rapid City area. She said it's a culturally-grounded approach shared by Native leaders.

ALBUQUERQUE, N.M. -- As the pandemic wanes, hunger and food insecurity are also on the decline, but the need is still far above pre-pandemic levels, especially for people of color.

Ami McReynolds, chief equity and programs officer for Feeding America, said despite recent decreases, the amount of food being distributed by the organization's partner food banks remained more than 55% above pre-pandemic levels.

"The pandemic seemed to worsen the conditions for people of color in this country. African Americans went from 2.5 times to 3.2 times more likely to be food insecure."

McReynolds added Latinos went from 2.0 to 2.5 times more likely to be food insecure during the same time period.

Feeding America reports 38 million people were food insecure before the pandemic, and almost 60 million people turned to a charitable feeding system for assistance in 2020. Feeding America works with more than 200 food banks across the country.

She is confident various interventions allowed people to have enough to eat, but worries food insecurity could increase all over again if more setbacks occur, such as the expiration of eviction moratoriums and expanded unemployment benefits.

"The racial wealth gap just really continues to widen for people of color who are seeing higher rates of unemployment, limited learning potential and continued lack of homeownership," McReynolds outlined.

In addition to food banks, the government-led Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, saw an increase of seven million users between 2019 and 2021.

COLUMBUS, Ohio - Children's advocacy groups are making the case that school-based health centers are a worthy investment for Ohio's kids.

Tracy Najera, executive director of the Children's Defense Fund-Ohio, said being able to get health-care needs met at school gives children and families a "medical home" for primary care and other services. She said a child's physical and mental wellness is foundational for success in academics and life.

"Especially during this pandemic, children and families have been struggling and truly suffering," she said. "Behavioral-health issues have reached crisis levels - and many children, in general, haven't been receiving their well-child visits."

Ohio has at least $3 billion in recovery funds from the American Rescue Plan Act not yet allocated, and the Ohio Children's Budget Coalition is asking the governor's office to invest $25 million per year over two years to help school districts around the state expand or establish school-based health programs. Najera said that investment could fund between 15 and 30 projects.

The convenience of a school-based health center not only helps improve access to care, Najera said, but it also reduces absenteeism.

"That's one less day of work that the parent misses, and one day less of school that a child is missing," she said. "So, really bringing the services to where the children are makes a whole lot of sense."

Najera added that the centers are a part of a "whole-child" agenda being promoted by the Ohio Children's Budget Coalition.

"Children need food, they need housing, they need education, they need health care - they need all these things to really thrive and flourish," she said. "Children don't come in pieces, and neither should our budget and policy decisions."

A new American Academy of Pediatrics report said the number of school-based health centers has more than doubled in the United States since 1998. There are more than 60 in Ohio schools.