National Center for Education in Maternal and Child Health
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August 20, 2004
1. Trends Report on Health Insurance Coverage Released in
Conjunction with Covering Kids Back-to-School Campaign
2. AHRQ Redesigns Web-Based Tool for Measuring Quality in
Child Health Programs
3. Study Measures Progress Toward Meeting Healthy People
Low Birthweight and Infant Mortality Goals
4. Article Examines Association Between Adolescent
Alcohol and Drug Use and Youth Assets
5. Authors Assess Instrument Designed to Measure Parents'
Reports of Barriers to Care for Children with Special Health Care Needs
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1. TRENDS REPORT ON HEALTH INSURANCE COVERAGE RELEASED IN
CONJUNCTION WITH COVERING KIDS BACK-TO-SCHOOL CAMPAIGN
Trends in U.S. Health Insurance Coverage, 2001-2003 presents findings
from the Center for Studying Health System Change's (HSC's) Community
Tracking Study Household Survey, a nationally representative telephone
survey conducted in 1996-97, 1998-99, 2000-01 and 2003. Released at the
launch of the Covering Kids & Families Back-to-School Campaign, the
HSC Tracking Report presents information on changes in public and
employer insurance and on public insurance as a safety net, as well as
implications. Supplementary tables, notes, and data sources are also
included. The report is available at http://www.hschange.com/CONTENT/694/?topic=topic01
or http://www.hschange.com/CONTENT/694/694.pdf.
More information about the Covering Kids & Families Back-to-School
Campaign to inform families about low-cost and free health care
coverage programs for children is available at http://coveringkidsandfamilies.org/communications/bts.
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2. AHRQ REDESIGNS WEB-BASED TOOL FOR MEASURING QUALITY IN CHILD HEALTH
PROGRAMS
Child Health Care Quality Toolbox (formerly Child Health Toolbox)
contains concepts, tips, and tools for evaluating the quality of health
care for children. The redesigned toolbox, a product of the Agency for
Health Care Research and Quality, enables users to download to their
desktops all sections of the toolbox, including a new section on mental
health measures. Other sections include information on uses of quality
measurement, established child health care quality measures, emerging
quality measures, choosing quality measures, how to develop quality
measures, and resources. The toolbox is available at http://www.ahrq.gov/chtoolbx.
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3. STUDY MEASURES PROGRESS TOWARD MEETING HEALTHY PEOPLE LOW
BIRTHWEIGHT AND INFANT MORTALITY GOALS
"Although the national LBW [low birthweight] rate has been steady over
the last few years, it seems likely that most of the 100 largest cities
and suburbs will not meet the Healthy People 2010 LBW goal without a
substantial reduction in rates of preterm deliveries," write the
authors of an article published in the September 2004 issue of the
Journal of Urban Health. Healthy People focuses on increasing the span
of healthy life, reducing racial/ethnic and socioeconomic health
disparities, and achieving access to preventive health care services.
The study described in this article shows the progress of the nation's
100 largest cities and their surrounding suburban areas toward
achieving Healthy People 2000/2010 goals for two measures of infant
health: LBW and infant mortality (IM). According to the authors, these
are key measures of a nation's overall health and well-being and serve
as predictors of health status of the next generations.
The authors used data from the National Center for Health Statistics to
compare 1990 and 2000 LBW and IM rates of the 100 largest cities and
their suburbs to national rates and to Healthy People 2000 and 2010
target rates. The authors also compared city and suburban rates by
region of the country and examined LBW rates for cities and suburbs by
race/ethnicity. In addition, they used 2000 data to consider how the
relationship between LBW and IM varies for cities compared to suburbs.
The authors found that
- For both 1990 and 2000, the average LBW rate for the 100 largest
cities was well above the national average; the average suburban rate
was below the national average.
- LBW rates generally increased between 1990 and 2000 across the
100 largest cities and their suburbs. The increase for the suburbs,
however, was nearly four times that of the cities (15.7% vs. 4.1%) on
average.
- Neither cities nor their suburbs achieved the Healthy People 2000
goal for LBW.
- Suburban whites experienced the largest increase in LBW rates
(17.4%) between 1990 and 2000. Non-Hispanic blacks in the cities were
the only group to experience a decrease (4%); suburban blacks showed no
changes in rates. LBW rates for blacks, however, were nearly twice the
rates for whites in both cities and suburbs, on average.
- IM rates declined by 24% on average, with a smaller decline
(20.5%) occurring in the suburbs. By 2000, cities as a group had not
met the Healthy People IM goal, although cities in the West on average
did meet that target. The suburbs, as a group and within each region,
met the target as well.
The authors conclude that "progress at the local level is essential to
meeting our national Healthy People goals for LBW and IM."
Duchon LM, Andruis DP, Reid HM. 2004. Measuring progress in meeting
Healthy People goals for low birth weight and infant mortality among
the 100 largest cities and their suburbs. Journal of Urban Health:
Bulletin of the New York Academy of Medicine 81(3):323-339.
Readers: More information about the Healthy People 2010 leading health
indicators is available from the Healthy People 2010 Web site at http://www.healthypeople.gov/LHI
and from the MCH Library's Web site at http://www.mchlibrary.info/HP2010.html.
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4. ARTICLE EXAMINES ASSOCIATION BETWEEN ADOLESCENT ALCOHOL AND DRUG USE
AND YOUTH ASSETS
"Perhaps the most important finding of our study is that specific
assets appear to collectively reduce the odds of engaging in alcohol
and drug use," state the authors of an article published in the August
2004 issue of the American Journal of Public Health. The article
examines the relationship between nine youth assets and alcohol and
drug use in a community sample of adolescents and their parents.
The study sample included 1,255 adolescents ages 13-19 and their
parents, drawn from a random sample of households located in the
inner-city areas of two Midwestern cities with populations of
approximately 500,000 each. Interviews were conducted in the
participants' homes using a computer-assisted data-entry system.
Measures included demographic variables, risk behaviors (alcohol and
drug use), and youth assets. The nine assets examined were nonparental
adult role models, peer role models, family communication, use of time
(groups/sports), use of time (religion), community involvement,
aspirations for the future, responsible choices, and good health
practices (exercise/nutrition).
The authors found that
- Significant positive relationships were found between nonuse of
alcohol and the availability of peer role models, positive family
communication, good health practices related to exercise and nutrition,
and adolescents' aspirations for the future. An adolescent who had any
one of these assets was approximately 1.5 to 2.5 times less likely to
have used alcohol than an adolescent who did not have any one of these
assets.
- Adolescents who had any one of the assets were approximately 1.5
to 3 times more likely to report nonuse of drugs than adolescents who
did not have any of the assets.
- Adolescents who had the peer role models, use of time (religion),
family communication, and responsible choices assets were 4.44 times
more likely to report nonuse of alcohol compared with adolescents who
had three or fewer of the assets.
- Adolescents who had the peer role models, use of time (religion),
and responsible choices assets were 5.41 times more likely to report
nonuse of drugs compared with adolescents who had two or fewer of the
assets.
"These results suggest that there is a positive relationship between
presence of youth assets and the nonuse of alcohol and drugs," conclude
the authors. They also suggest that "the combinations of assets may be
more effective than any single asset for preventing risk behavior."
Oman RF, Vesely S, Aspy CB, et al. 2004. The potential protective
effect of youth assets on adolescent alcohol and drug use. American
Journal of Public Health 94(8):1425-1435.
Readers: More information is available from The NSDUH Report:
Participation in Youth Activities and Substance Use Among Youths. The
report is based on the Substance Abuse and Mental Health Services
Administration's National Survey on Drug Use and Health (NSDUH),
formerly called the National Household Survey on Drug Abuse (NHSDA)
conducted by the Office of Applied Studies. The NHSDA/NSDUH is the
primary source of information on the prevalence, patterns, and
consequences of drug and alcohol use and abuse in the general U.S.
civilian non-institutionalized population, ages 12 and older. The NSDUH
also provides estimates for drug use by state. The report is available
at http://www.oas.samhsa.gov/2k4/activities/activities.htm
or http://www.oas.samhsa.gov/2k4/activities/activities.pdf.
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5. AUTHORS ASSESS INSTRUMENT DESIGNED TO MEASURE PARENTS' REPORTS OF
BARRIERS TO CARE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS
"The data presented in this study demonstrate the feasibility,
reliability, and validity of the BCQ [Barriers to Care Questionnaire]
for CSHCN [children with special health care needs]," state the authors
of an article published in the July/August 2004 issue of Ambulatory
Pediatrics. The article describes the development and validation of the
BCQ, an instrument designed to measure parents' reports of experiences
or circumstances that may interfere with access to or use of care, with
making the most of the clinical encounter, or with adhering to medical
instructions.
The BCQ was developed through a review of the literature and through
focus groups of both Spanish- and English-speaking parents of children
with chronic health conditions. The 39-item instrument was field tested
in three samples using standard mail survey methodology: (1) a
community sample of children from a previous school-based study of
health and health care quality, (2) a clinical sample from a pediatric
hematology/oncology clinic, and (3) a clinical sample from a pediatric
rheumatology clinic. In addition to the BCQ, parents completed the
Parent's Perceptions of Primary Care measure (a validated measure of
primary care quality) and the PedsQL measure (a validated measure of
health-related quality of life). Parents also reported on whether their
child had health insurance, a regular source of care, problems getting
care, or had foregone care.
The authors found that
- The overall response rate was 77.2%, with 156 surveys returned.
- The vast majority (91.7%) of parents reported that their child
had health insurance and a regular source of care (82.1%). Parents
reported problems getting care for 23.7% of the sample and foregone
care for 17.9% of the sample.
- The internal consistency of the BCQ was strong, both for the
total scale and for the subscales.
- The BCQ subscales correlated in the expected direction with both
of the validated measures (the Parent's Perceptions of Primary Care
measure and the PedsQL measure). Most of the correlations were
statistically significant and strong enough to indicate a relationship
between the measures, although not strong enough to render the BCQ
redundant.
- Higher BCQ scores were found for parents with a personal doctor
(vs. those without) and who did not report problems getting care (vs.
those who did).
- The BCQ did not discriminate between groups defined by
race/ethnicity, language, or site of recruitment.
The data implies, the authors conclude, that "modifiable factors, such
as access, barriers, and processes of care, might be fruitful targets
for policies and programs to reduce racial and ethnic disparities."
Seid M, Sobo EJ, Gelhard LR, et al. 2004. Parents’ reports of barriers
to care for children with special health care needs: Development and
validation of the Barriers to Care Questionnaire. Ambulatory Pediatrics
4(4):323-331.
Readers: More information is available in the supplement to this issue
of Ambulatory Pediatrics, titled Child Health Status Measurement. The
supplement includes articles on topics such as scientific questions,
challenges, and recommendations; validating measures of child health
status; measuring the relationship of child health status to race,
ethnicity, and income status; and the use of quality-of-life measures
in clinical trials.
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MCH Alert © 2004 by
National Center for Education in Maternal and
Child Health and Georgetown University. MCH Alert is produced by
MCH Library Services at the National Center for Education in Maternal
and Child Health under its cooperative agreement (6U02 MC 00001) with
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Please contact us at the address below.
EDITORS: Jolene
Bertness, Tracy Lopez
COPYEDITOR: Ruth
Barzel
National Center for
Education in Maternal and Child Health
Georgetown University
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571272, Washington, DC 20057-1272
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