High school graduation rates and preventive health care make Iowa one of the nation’s top 10 states for women, infant and children’s health, according to a recently released study.

Iowa was ranked ninth in the nation in the 2018 Health of Women and Children Report by America’s Health Rankings.

The state’s ranking, while high, was pulled down by behaviors associated with substance abuse.

Several factors played into the rankings, including people’s behavior, public policy, clinical care and environment.

The study ranked Iowa No. 1 in the country for high school graduation rate — 91.3 percent.

The graduation rate is an indication of a good social structure, which is key for overall health, said Deneen Vojta, UnitedHealth Group’s executive vice president of research and development.

“We know, for an example, high school education is a leading indicator for a healthy child and a healthy environment, so it really goes toward the full picture of a solid foundation for children,” she said.

The study also said Iowa did “remarkably well” in preventive care, Vojta said.

That includes several indicators, such as a 96.2 percent rate of women who receive prenatal care before the third trimester; a 94.9 percent rate of well-baby checkups; and low rates of uninsured, which dropped to 5.9 percent from 9 percent in the 2016 study.

Iowa’s ranking was brought down largely due to substance abuse.

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The state is 43rd nationwide in the rate of excessive drinking. The study did not quantify what constitutes excessive drinking, but the Centers for Disease Control and Prevention defines it as women consuming four or more drinks in a single occasion or having 8 or more drinks per week.

The study ranked Iowa 31st for the rate of smoking among women between the ages of 18 and 44. The state also has one of the highest rates of tobacco use among women during pregnancy, at 13.7 percent.

The 2018 Health of Women and Children Report is intended to serve as a road map to inform policy and decision-making.

Vojta recommended Iowa focus on improving its low rankings in tobacco and substance use.

With a number of reports indicating excessive drinking among the millennial generation, she said the state could expect negative impacts, such as increased rates of fetal alcohol syndrome.

“It’s worth our time and resources to begin to look at it,” she said.

The annual assessment is put out through a partnership between the American Public Health Association and the United Health Foundation, a for-profit company that includes the insurer UnitedHealthcare.

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