A new study shows that North Carolina continues to perform below average when it comes to overall child health conditions.

The 2019 report by the nonprofit groups N.C. Child and the N.C Institute of Medicine was released in February.

The state received an “F” grade for housing and economic security for the third consecutive report. According to the Winston-Salem Journal, this reflects a high percentage of children living in low-income homes and neighborhoods.

The study also points to an increase in youth suicides over the past 10 years. Black high school students in 2017 were twice as likely to have attempted suicide in the past year, and much less likely to receive treatment for depression.

The study did show progress in breastfeeding, oral health, HPV vaccinations for teens, and decreasing the number of teen births.

While the state earned top marks for insurance coverage, the report says many more children could be covered with an expansion of the Medicaid program.