MCH Alert - 03/02/01

National Center for Education in Maternal and Child Health

March 02, 2001

1. Study Claims That "Developmental Assets" Reduce Risky Eating Behaviors in Adolescents

2. Sleeping on Stomach and Bed-Sharing Associated with Sudden Infant Deaths, Suggests Study

3. Report Reviews Title X and Its Effects on Family Planning Services

4. Study Indicates That Family Connectedness Protects Against Adolescent Suicide

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Readers: The National Institute for Health Care Management (NIHCM) Foundation will hold a forum titled "Perspectives on Implementing Bright Futures" on Tuesday, April 24, 2001, from 8:30 a.m. to 4:30 p.m. at the Phoenix Park Hotel in Washington, DC. The forum will address approaches to implementing the Bright Futures system of health supervision in various settings and by various different types of health professionals. This meeting is one in a series of interactive forums titled "Bright Futures and Managed Care." The series is part of NIHCM Foundation's cooperative agreement with the U.S. Health Resources and Services Administration's Maternal and Child Health Bureau. Additional available at <http://www.nihcm.org/childframe.html>.

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1. STUDY CLAIMS THAT "DEVELOPMENTAL ASSETS" REDUCE RISKY EATING BEHAVIORS IN ADOLESCENTS

Adolescents with "developmental assets" such as positive family communication, positive peer influence, resistance skills, and positive identity are less likely to engage in binge/purge and weight loss behaviors, compared to those without such assets, indicates a study published in the March issue of the Journal of Adolescent Health. The authors of the study also point out that these assets may protect against a broad range of other health risk behaviors, as well.

Surveys of 95,395 adolescents in grades 6 through 12 in public and alternative schools from 213 cities and towns across the United States were conducted for the study. The purpose of the study was to examine binge/purge and weight loss behaviors in relation to the presence of developmental assets among a community-based sample of adolescents and to identify which assets might be most important in terms of potential buffering from disordered eating behaviors.

The study found that

15% of the girls reported binge/purge behavior; among those, 48% also reported weight loss;
9.3% of the boys reported binge/purge behavior; among those, 30.2% also reported weight loss;
Girls and boys who reported binge/purge and weight loss behaviors were less likely to report having a sense of purpose, self-esteem, personal power, and a positive view of personal future, compared to those who did not report these behaviors; and
Both positive peer influence and restraint involved values and friendship choices related to abstinence from alcohol, drugs, and sexual intercourse.

The authors conclude that "interventions that modify the social environment of adolescents, including available peer and adult role models, may serve to decrease the likelihood of youth engaging in a variety of health risk behaviors, including binge/purge and weight loss behaviors." They also suggest that intervention focused at individual-level factors, such as self-esteem, assertiveness, and resistance skills, could be effective.

French SA, Leffert N, Story M, et al. 2001. Adolescent binge/purge and weight loss behaviors: Associations with developmental assets. Journal of Adolescent Health 28(3):211-221.

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2. SLEEPING ON STOMACH AND BED-SHARING ASSOCIATED WITH SUDDEN INFANT DEATHS, SUGGESTS STUDY

Infants placed to sleep on their stomachs (prone position) are more likely to die inexplicably than those placed to sleep on their backs (supine position), indicates a study published in the February issue of the Journal of Pediatrics. The authors of the study looked at how sleeping position, bed-sharing, and the American Academy of Pediatrics' Back to Sleep campaign have influenced the rate of sudden infant deaths.

For the study, the authors reviewed the Palm Beach County Medical Examiner database to identify infants under age 1 who died between January 1, 1986, and September 30, 1999. They identified 217 such cases.

According to the study findings,

64.1% of the deaths were classified as sudden infant death syndrome (SIDS) deaths;
62.7% of the infants were found or reported to be in the prone position;
At the time of their death, 89.1% of the infants had been sleeping in the prone position, had been bed-sharing, or both;
Infant deaths associated with supine or side sleeping were more likely to be classified as deaths resulting from a natural cause other than SIDS, compared to deaths associated with prone sleeping; and
The proportion of sudden infant deaths associated with prone sleeping fell slightly between 1994 and 1999 (after the introduction of the Back to Sleep campaign in 1994) compared to the period 1986 to 1993.

Sudden infant deaths are just as likely to be associated with the prone position today as they were in 1986, and bed-sharing appears to increase the proportion of unexplained infant deaths, state the authors. However, they conclude that the Back to Sleep campaign seems to be effective in reducing the number of sudden infant deaths.

Thogmartin JR, Siebert CF, Pellan WA. 2001. Sleep position and bed-sharing in sudden infant deaths: An examination of autopsy findings. The Journal of Pediatrics 138(2):212-217.

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3. REPORT REVIEWS TITLE X AND ITS EFFECTS ON FAMILY PLANNING SERVICES

Title X is a vital component of access to care for millions of women who need family planning services each year, states a report published recently in The Guttmacher Report on Public Policy. Title X supports the establishment and maintenance of family planning clinics nationwide, provides financial support to the clinics to pay personnel and purchase contraceptives and other supplies, and subsidizes the delivery of contraception and other services to clients who cannot pay for the services.

According to the report

In 1999, 84 Title X grantees spread across all 50 states and the District of Columbia distributed Title X funds to local clinics;
Of the roughly 7,000 family planning clinics that exist in the United States, more than 4,500 received Title X funds in 1999;
Clinics that receive Title X funding serve over 4 million women each year, or one-fourth of all U.S. women who need subsidized family planning services;
Each year, Title X-supported clinics enable 1 million women to avoid unintentional pregnancy, and women served at Title X-supported clinics have prevented almost 20 million pregnancies over the last two decades; and
For every dollar that the federal and state governments spend on family planning services, $3 are saved in Medicaid costs for pregnancy-related and newborn care.

The author of the report argues that "the program's three decades of accomplishments underscore its vital role in reducing abortion and unintended pregnancy and in improving the health of women and teens by providing them with a range of key reproductive health services, in sharp contrast to the claims of many of its opponents."

Gold RB. 2001. Title X: Three decades of accomplishment. The Guttmacher Report on Public Policy 4(1):5-8. Report available at <http://www.agi-usa.org/journals/toc/gr0401toc.html>.

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4. STUDY INDICATES THAT FAMILY CONNECTEDNESS PROTECTS AGAINST ADOLESCENT SUICIDE

Perceived parent and family connectedness reduces adolescents' risk for attempting suicide, reports a study published in the March issue of Pediatrics. The study also suggests that a variety of factors increase adolescents' risk for attempting suicide.

For the study, the authors interviewed 13,110 non-Hispanic black, Hispanic, and non-Hispanic white adolescents in grades 7 through 12 who took part in the National Longitudinal Study of Adolescent Health. The adolescents were interviewed twice, once in 1995 and again in 1996. The purpose of the study was to identify risk factors and protective factors for suicide attempts among white, black, and Hispanic male and female adolescents.

The study findings included the following:

5.1% of the girls and 2% of the boys attempted suicide during the 12 months preceding the 1996 survey;
White and Hispanic girls were most likely to have attempted suicide during the 12 months preceding the 1996 survey;
Risk factors for suicide attempts included a previous suicide attempt, violence victimization, violence perpetration, alcohol use, marijuana use, and school problems;
Among girls, emotional well-being and preceived parent and family connectedness were protective against suicide attempts; and
Among boys, grade point average and perceived parent and family connectedness were protective against suicide attempts.

The authors propose that health care providers and clinicians identify risk factors and protective factors for suicidal behavior among adolescents and that they educate parents about restricting access to guns and illicit substances in the home. The authors conclude that "applying family level interventions to adolescents at high risk for suicidal behavior, including those with previous suicidal behavior or depression, is also supported by the significant protective effect of parent-family connectedness on attempting suicide in this study, an effect that cross-cut all of the gender and racial/ethnic groups studied."

Borowsky IW, Ireland M, Resnick MD. 2001. Adolescent Suicide Attempts: Risks and Protectors. Pediatrics 107(3):485-493.

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MCH Alert. 2001. 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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(703) 524-7802
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The MCH Alert is produced by the National Center for Education in Maternal and Child Health under its cooperative agreement (MCU-119301) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services.

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