National Center for Education in Maternal and Child Health
October 20, 2000
1. Report Gives the United States Low Marks for Oral Health
2. Health Care Coverage for Legal Immigrant Children Has Declined Significantly, According to Report
3. Administering Influenza Vaccines to Children In Child Care May Benefit Household Members
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Readers: The U.S. Department of Health and Human Services recently reported that the National Institute for Child Health and Human Development at the National Institutes of Health has developed a resource kit for reducing the incidence of sudden infant death syndrome (SIDS) in African-American communities. The kit contains culturally appropriate materials such as fact sheets, brochures, magnets, and a leader's guide to encourage individuals to lead community discussion groups on ways to reduce the incidence of SIDS. A press release about the kit is available at <www.hhs.gov/news/press/2000pres/20001012.html>. The resource kit will be available at the end of October and can be obtained by calling the Back to Sleep program at (800) 505-CRIB (505-2742).
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1. REPORT GIVES THE UNITED STATES LOW MARKS FOR ORAL HEALTH
The nation gets a C- for oral health, according to a report on a study conducted by Oral Health America. All 50 states and the District of Columbia scored poorly in the three categories measured: prevention, access to oral health care, and oral health status. A grade from A to F (based on levels of achievement for oral health) was given to each state for subcategories such as the percentage of the population using fluoridated water, the percentage of children with one or more dental sealant, the prevalence of dental clinics, and children's oral health. Data were collected primarily from the Centers for Disease Control and Prevention, the National Institute of Dental and Craniofacial Research, and state dental directors.
Children's oral health is an area of concern because too many children have dental caries, according to the report. The authors state that "the poor oral health of children often translates to more cavities for children, increased adult tooth loss and eventually the total loss of teeth as people age."
The authors point out that improvement to oral health is needed because
The authors conclude that "failure to [improve oral health] will result in serious, long-term health consequences to our nation, especially our children."
Oral Health America. 2000, October 10. Press release available at <www.oralhealthamerica.org/OHA%20site/Report%20Card.html>. The full report can also be downloaded from the same page.
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2. HEALTH CARE COVERAGE FOR LEGAL IMMIGRANT CHILDREN HAS DECLINED SIGNIFICANTLY, ACCORDING TO REPORT
The proportion of low-income immigrant children who have health insurance fell significantly between 1996 and 1999, states an October report published by the Center on Budget and Policy Priorities. The authors of the report point out that immigrant children's lack of insurance means that they lack access to health care. In other words, this population is less likely to have a usual place to get care, to be able to see a doctor or nurse, and to receive primary care or dental care.
The authors also indicate that a large proportion of immigrant children who are eligible for Medicaid are not enrolled in the program. According to the report, the U.S. General Accounting Office has found that one-third of all low-income children who are eligible for Medicaid but not enrolled are children from immigrant families. This may be because the application process is too difficult for many immigrants to complete, especially in light of the fact that eligibility requirements for immigrants are more complicated than eligibility requirements for citizens.
The report (which draws from the Census Bureau's Current Population Survey), states that
The authors contend that legislation needs to be changed to ensure that insurance coverage is provided for immigrant children and pregnant women who entered the United States on or after August 22, 1996, so that these individuals do not have to wait until they are eligible for Medicaid or the State Children's Health Insurance Program (SCHIP), which require enrollees to have been U.S. residents for 5 years. Furthermore, enrollment procedures and outreach efforts should be simplified. The authors state that "pending legislation to grant states the option of extending Medicaid and SCHIP coverage to immigrant children and pregnant women . . . would help provide coverage to some of the nation's most vulnerable uninsured individuals."
Ku L, Blaney S. Health coverage for legal immigrant children: New census data highlight importance of restoring Medicaid and SCHIP coverage. Washington, DC: Center on Budget and Policy Priorities. Report available at <www.cbpp.org/10-4-00health.htm>.
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3. ADMINISTERING INFLUENZA VACCINES TO CHILDREN IN CHILD CARE MAY BENEFIT HOUSEHOLD MEMBERS
Vaccinating children who attend child care centers against influenza may benefit members of their households, according to a study published in the October issue of the Journal of the American Medical Association. The authors reported dramatic decreases in the incidence of febrile respiratory illnesses among household members who came into contact with vaccinated children who attended child care centers, compared with those who came into contact with unvaccinated children who attended child care centers.
The study was conducted during the 1996-1997 influenza period. Children ages 24 to 60 months attending 10 U.S. Navy-affiliated child care centers in the San Diego, CA, area were invited to participate. The study group was given the influenza vaccine, and the control group was given a placebo. Participants' parents were not told which group their child had been assigned to. The authors obtained information about household members' respiratory illnesses by conducting telephone interviews with parents using a standardized questionnaire.
The authors found that
The authors note that the study had some limitations. Because of the military setting, the number of reported transmissions of influenza among unvaccinated household members may have been reduced, since, in most cases, at least one adult per household was required to receive the vaccination, according to military regulations. In addition, only a small number of children under age 5 were available for analysis, and for the under-5 age group that was analyzed, it was difficult to distinguish between influenza-related illnesses and other infections because of the similarity of symptoms.
The authors suggest that additional studies are needed to "elucidate the cost-effectiveness and potential benefits in preventing household and community spread of influenza and the possible role of such programs in reducing morbidity during influenza pandemics."
Hurwitz ES, Haber M, Chang T, et al. 2000. Effectiveness of influenza vaccination of day care children in reducing influenza-related morbidity among household contacts. Journal of the American Medical Association 284(13):1677-1682.
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4. SCHOOL-BASED HIV, STD, AND PREGNANCY PREVENTION PROGRAMS CAN BE COST-EFFECTIVE, ACCORDING TO STUDY
For every dollar spent on the Safer Choices program, $2.65 will be saved on medical and social costs, according to a study published in the October issue of the Archives of Pediatrics & Adolescent Medicine. Safer Choices is a school-based intervention program designed to reduce the incidence of HIV, other sexually transmitted diseases (STDs), and unintended pregnancy among high school students. Baseline data, and data from three follow-ups at 7, 19, and 31 months after the program's launch, were collected. The program's cost-effectiveness was measured according to HIV prevalence and STD incidences rates, program costs, medical care cost for HIV and STDs, and medical care costs for pregnancy. This study was limited to an analysis of the 7-month follow-up because results for the later follow-ups have not yet been published.
The intervention was administered from 1993 to 1995 at 10 schools in northern California and 10 schools in southeast Texas. The cohort for the 7-month effectiveness evaluation consisted of 3,677 ninth-grade students. Of these students, 47.5% were male and 52.5% were female. Ethnic and racial representation was mixed.
The authors found that by 7 months after the program's launch the number of students participating in the program who reported using condoms or other contraceptives at last intercourse (among those who reported having sex in the previous 3 months) had increased significantly. They also found that in most scenarios the program saved money. They state that "a school-based sexual risk intervention can be cost-effective; thus, school-based prevention programs of this type warrant careful consideration by policy makers and school administrators."
The study has some limitations, according to the authors. First, the 1-year cumulative probability method that was used to estimate the number of HIV infections and STDs that were averted as a result of the program does not take into consideration the long-term and dynamic infections that were avoided. In addition, there were limited data for some variables that were analyzed, all sexual relationships were assumed to be heterosexual, and there were few cost studies done on adolescent pregnancy and pregnancy outcomes.
The authors conclude that "economic evaluation should become a routine part of adolescent health research to better enable policy makers and program planners to determine which intervention programs will most efficiently decrease adolescent risk behaviors and at what cost."
Wang LY, Davis M, Robin L, et al. 2000. Economic evaluation of Safer Choices. Archives of Pediatrics & Adolescent Medicine 154(10):1017-1024.
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5. STUDY EXAMINES THE EFFECTIVENESS OF ANTI-INFLAMMATORY MEDICATION FOR CONTROL OF ASTHMA SYMPTOMS IN CHILDREN
Budesonide, a corticosteroid inhalant, improves airway responsiveness and helps control asthma symptoms in children with mild-to-moderate asthma, according to a study published in the most recent issue of the New England Journal of Medicine. The authors of the study compared the effects of budesonide and nedocromil (two forms of anti-inflammatory therapy) to matching placebo groups in 1,041 children ages 5 to 12 with mild-to-moderate asthma over a 4- to 6-year period. Lung growth, degree of airway responsiveness, morbidity, physical growth, and psychological development were also measured.
The study found that, compared to the placebo group,
An unexpected finding of the study was that neither budesonide nor nedocromil improved lung function. The authors suggest that this could be due to lung function deterioration that took place before the study began and that the medication could not correct. They recommend that the effects of anti-inflammatory medication on children younger than the study population be evaluated to measure its impact on lung function.
The authors conclude, "In children with mild-to-moderate asthma, neither budesonide nor nedocromil is better than placebo in terms of lung function, but inhaled budesonide improves airway responsiveness and provides better control of asthma than placebo or nedocromil."
The Childhood Asthma Management Program Research Group. 2000. Long-term effects of budesonide or nedocromil in children with asthma. New England Journal of Medicine 343(15):1054-1063.
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MCH Alert. 2000. Arlington, VA: National Center for Education in Maternal and Child Health. <alert>.
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EDITOR: Phuong Huynh
COPY EDITOR: Ruth Barzel
FOUNDING EDITOR: Laura Kavanagh
National Center for Education in Maternal and Child Health
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