United Health Foundation, a nonprofit group in Minnesota, issued its 2005 state health rankings on Monday. Utah has never been outside the top 10 since the reports began in 1990, and the Beehive State moved up one place to the fourth healthiest in the latest study.

However, Utah ranks No. 49 - the second worst after Nevada - in the percentage of children aged 19 to 35 months who receive the government's suggested immunizations for such diseases as polio. On the high end, more than 89 percent of children in Massachusetts were vaccinated, compared with 71.3 percent in Utah.

"Some parents believe such diseases as measles, mumps and whooping cough are a thing of the past and don't feel an urgency to immunize their children against them," said Steve McDonald, spokesman for the Utah Department of Health. "Every year we have another 50,000 babies born, and it's a constant battle to remind and encourage parents not to delay getting their kids immunized."

A small number of parents refuse to vaccinate their children on religious or philosophical grounds, said Murray pediatrician Bill Cosgrove.

The most likely reason that Utah children don't get vaccinated earlier is "because of our large family size," he said. "The first child gets their vaccines on time, but that decreases as parents have more children, and they put it off because of time away from work" and other obligations.

This year, the health department, in partnership with the federal government and other contributors, will spend $210,500 on its "Immunize by Two" media campaign. McDonald said the recent outbreak of whooping cough might persuade more parents to take action. Cases have increased from about 227 at this time last year to 593 this year.

The health department has unveiled a new e-mail tool to help increase vaccinations. Parents can enter their children's information at http://www.immunize-utah.org to receive automatic e-mail reminders of when shots are due.

A problem area in past years, prenatal care improved dramatically, with the state moving from 49th to 24th place. The report indicates that 76.9 percent of women received adequate prenatal care in Utah based on birth certificate data, an increase from the 60.9 percent adequate in the 2004 report.

"The Utah Department of Health and health care providers have put a lot of effort into improving the rate at which Utahns use prenatal care," McDonald said. "One of those efforts was the 'Baby Your Baby' campaign, which tells women to get their first prenatal visit before 13 weeks and have 13 visits during their pregnancy."

Utah hospitals and vital records workers are keeping more accurate and complete records about prenatal care as well, McDonald added.

Experts say that women who enter prenatal care after the first trimester are at a higher risk for earlier delivery or having a baby with low birth weight.

Utah also excelled when it came to the low prevalence of smoking and deaths from cancer, and the high percentage of high school graduates.

chamilton@sltrib.com