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By Tony Gonzalez, The Tennessean

Kids in Tennessee rank as the healthiest in the South - to the surprise of even some state officials - in the latest state-by-state comparison of the well-being of children.

The 2012 Kids Count Data Book, released today by the Annie E. Casey Foundation, shows fewer teens abusing alcohol and drugs, fewer kids living without health insurance and fewer babies being born at low birth weights in the Volunteer State.

Those measures placed Tennessee 16th in the nation in children's health, one place ahead of Virginia and far above other southern states. Measures the state has struggled with in past Kids Count studies, including childhood obesity, infant mortality and access to dental care, were not considered.

Going beyond health, the foundation considered 16 total factors, and ranked the state at 36th overall for child well-being, the state's best placement to date and an improvement on last year's 39th-place ranking.

But the news wasn't all good.

The study found economic hardship still rising, with one of four Tennessee kids now living in poverty. And Tennessee lingered among the bottom 10 states for education. Three-fourths of fourth graders fail to read proficiently, a decline that goes against a national trend of improvement.

"The ranking lets us know many of the things we're doing now are heading in the right direction," said Michael Warren, director of maternal and child health in the Tennessee Department of Health. "I don't think anybody is happy with 36th, or even if you look at our health ranking of 16, so I think we need to keep pushing."

Official reactions to the education category ranking of 42nd, based on dropout rate, preschool attendance, and math and reading performance, ranged from "awful" to "sad."

"Certainly, the education area is troubling - the fact that 74 percent of fourth graders in Tennessee are not reading proficiently," said Laura Speer, Kids Count coordinator with the foundation. "That has long-term implications for educational attainment for kids and how educated the workforce will be."

Rankings changed

Tennessee scored higher than ever in the children's health category in large part because the foundation eliminated infant mortality rate and added health insurance coverage to the mix. That effectively swapped out one of the state's worst areas for one of its best.

With only 5 percent of children living without health insurance, Tennessee surpassed the national average.

Speer said the foundation changed measurements to focus on data proven to predict well-being in the long run. She also said low birthweight and infant mortality tell similar stories, creating a "double whammy" for some states. Researchers chose to eliminate infant mortality from their rankings formula.

"Babies born at low birthweight are more likely to struggle to meet the developmental milestones as they go through their infant years," Speer said. "In that indicator, Tennessee is lagging behind the rest of the country."

Tennessee has also seen declining rates of child and teen death, attributable to good policies regarding child safety restraints, life preservers in boats and use of helmets, said Pam Brown, director of the Kids Count Project for the Tennessee Commission on Children and Youth.

"The fact that we've improved in all of these indices is significant," she said.

Education and poverty scores contained fewer surprises, officials said.

"The recession is still incredibly painful," said Mary Graham, president of United Ways of Tennessee. "There's still a tremendous need for the safety net."

Graham said child advocates must resist pitting services against one another.

New Hampshire, Massachusetts and Vermont ranked highest in overall child well-being. Nevada, New Mexico and Mississippi ranked lowest.