— A new report released Tuesday ranks North Carolina in the bottom half of states in the health and well-being of children, a higher percentage of whom now live in poverty.

As of 2013, one in four children in North Carolina lived in poverty, compared with one in five in 2008, according the the study from the Baltimore-based Annie E. Casey Foundation. But the Tar Heel State made gains in nine of the report's 16 indicators, including higher reading and math proficiency rates, lower teen drug abuse rates and significantly lower rates of uninsured children.

Economic well-being NC: 25% | US: 22%

Children in poverty NC: 32% | US: 31%

Children whose parents lack secure employment NC: 33% | US: 36%

Children living in households with a high housing cost burden N:C 9% | US: 8%

Teens not in school and not working Education NC: 58% | US: 54%

Children not attending preschool NC: 65% | US: 66%

Fourth-graders not proficient in reading NC: 64% | US: 66%

Eighth-graders not proficient in math NC: 21% | US: 19%

High school students not graduating on time Health NC: 8.8% | US: 8%

Low-birth-weight babies NC: 6% | US: 7%

Children without health insurance NC: 26 | US: 24

Child and teen deaths per 100,000 NC: 6% | US: 6%

Teens who abuse alcohol or drugs Family & community NC: 38% | US: 35%

Children in single-parent families NC: 14% | US: 14%

Children in families where the household head lacks a high school diploma NC: 14% | US: 14%

Children living in high-poverty areas NC: 28 | US: 26

Teen births per 1,000 SOURCE: Annie E. Casey Foundation

Now in its 25th year, the Casey Foundation's Kids Count Data Book uses data from the U.S. Census, Department of Education and other federal agencies to measure a series of indicators experts link with children's long-term success.

Laila Bell, director of research and data with N.C. Child, a local nonprofit that worked with the Casey Foundation on the study, said the main take-away is that many children and families have been left behind in the economic recovery since 2008.

"We saw a lot of North Carolina children and families lose their footing in the Great Recession, and we've not seen them rebound from that," Bell said.

North Carolina ranks 35th in the country for children's overall well-being, a measure that includes rankings for education, economic well-being, health and family/community.

In economic well-being, where the state ranks 34th, the study says 32 percent of children have parents who lack secure employment and about 9 percent of teens are both out of school and out of work. The percentage of children living in households with a high "housing cost burden," those that spend more than 30 percent of their income on housing, remained unchanged at 33 percent.

Laura Speer, the Casey Foundation's associate director of policy reform and advocacy, said the trends in North Carolina are mirrored by many other states, which saw economic gains in the 1990s backtrack after the recession. Since 2008, the number of children in poverty nationally went from 18 percent to 22 percent in 2013.

"Economic recovery has definitely not lifted all boats," Speer said. "There are millions of children who have been left behind."

Advocates say the stubborn trend is particularly troubling given what a growing body of research shows about the long-term impacts of poverty on children.

"Poverty really is the single most damaging experience in terms of a child's growth and development," Bell said.

But there are signs of improvement in the 2015 report.

North Carolina ranks highest in the categories associated with education and health, where it improved in every measure except the percentage of children not attending preschool – 58 percent.

The state's rate of on-time graduation rates improved, as did fourth-grade reading proficiency and eighth-grade math proficiency, which are both better than the national average.

Also notable in North Carolina, Speer said, is that the number of uninsured children dropped from 10 percent in 2008 to 6 percent in 2013.

"What's most encouraging to me is that this is happening when fewer people have employer-sponsored health insurance than ever before," she said.

Many of the gains in health and family categories have continued to improve nationally since the 1990s despite the recession, Speer said. North Carolina saw that trend continue with declines in teen pregnancy, alcohol and drug abuse and mortality.

"Children are safer, more likely to finish school and less likely to have kids themselves," she said. "There are a lot of good things."

Read the report