National Center for Education in Maternal and Child Health
Search past issues of the MCH Alert at http://www.ncemch.org:8080/mchalert.html
May 3, 2002
2. Diverse Partnership Focuses on Media-Driven Adolescent Sexual Health Campaign
3. Study Highlights Disparities in Infant Mortality Rates Among Largest U.S. Cities
4. Research Finds Significant Cognitive and Developmental Deficits Among Cocaine-Exposed Infants
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1. REPORT EMPHASIZES HEIGHTENING PEDIATRICIANS' AWARENESS AND SKILLS FOR PREVENTING CHILD MALTREATMENT
The Psychological Maltreatment of Children, a technical report produced by the American Academy of Pediatrics and published in the April 2002 issue of Pediatrics, provides practicing pediatricians with a definition and risk factors for this form of child maltreatment and details how they can prevent, recognize, and report this form of maltreatment. Noting that sufficient research and consensus now exist about the definition and consequences of psychological maltreatment to bring this form of maltreatment to the attention of pediatricians, the authors of the report suggest that pediatricians need to be made aware of predisposing risk factors in children and families and that they should also be able to recognize the types and consequences of maltreatment. Preventing psychological maltreatment (e.g., shaming, exploiting, or isolating) by offering parents developmentally appropriate anticipatory guidance about the dangers of psychological aggression and maltreatment may be the most important work of the pediatrician, suggest the authors. The report includes lists of references, suggested readings, patient education materials, and professional education materials for pediatricians and parents. It is available at http://www.pediatrics.org/cgi/content/full/109/4/e68.
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2. DIVERSE PARTNERSHIP FOCUSES ON MEDIA-DRIVEN ADOLESCENT SEXUAL HEALTH CAMPAIGN
Fight for Your Rights: Protect Yourself, MTV's new year-long campaign focusing on sexual health issues, will encompass special programming, targeted public service messages, grassroots events, and an extensive resource and referral service, including a Web site on sexual health issues for adolescents. MTV has elevated sexual health issues to its highest pro-social priority for 2002-2003 and is working with the Kaiser Family Foundation (KFF), the Centers for Disease Control and Prevention, and Planned Parenthood to inform viewers about these issues. A new national survey by KFF for MTV finds that "three in four young people say they turn to the media to get answers" to questions on sexual health issues. More information about the campaign is available at http://www.kff.org/content/2002/20020415a/.
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3. STUDY HIGHLIGHTS DISPARITIES IN INFANT MORTALITY RATES AMONG LARGEST U.S. CITIES
"This report highlights the wide disparities in the most recent overall race- and ethnicity-specific IMRs for the largest U.S. cities and describes key differences among those cities. The findings demonstrate the need to decrease infant mortality among blacks in U.S. cities," state the authors of a report published in the April 19, 2002, issue of the Morbidity and Mortality Weekly Report. As urban communities are targets for many local, state, and federal initiatives, the authors note, reporting and comparing city-specific infant mortality rates (IMRs) to understand city-level differences in child health is important. The authors used the National Center for Health Statistics' Perinatal Mortality Data for 1995-1998 and the Federal Information Processing Standards' place-of-residence codes to calculate race- and ethnicity-specific IMRs for the 60 U.S. cities in which 1990 populations were over 250,000. They then compared characteristics for non-Hispanic black, non-Hispanic white, and Hispanic infants in cities in the highest quartile for IMRs with those in the lowest quartile.
The authors found that during 1995-1998
The authors of this report suggest that city IMRs can be reduced further, and they point to the following initiatives that involve working to identify culturally sensitive strategies and to eliminate IMR disparities in urban communities:
Haynatzka V, Peck M, Sappenfield W, et al. 2002. Racial and ethnic disparities in infant mortality rates -- 60 largest U.S. cities, 1995-1998. Morbidity and Mortality Weekly Report 51(15:329).
Readers: The NCEMCH Web site includes a recent update of the Infant Mortality knowledge path (../KnowledgePaths/infmortKP.html). This knowledge path offers a selection of recent, high-quality resources that analyze data, describe public health campaigns and other prevention programs, and report on research aimed at identifying causes and promising intervention strategies. The path also identifies tools for staying abreast of new developments and conducting further research. It is aimed at health professionals, policymakers, and researchers.
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4. RESEARCH FINDS SIGNIFICANT COGNITIVE AND DEVELOPMENTAL DEFICITS AMONG COCAINE-EXPOSED INFANTS
"Our study found significant cognitive deficits, with cocaine-exposed children twice as likely to have significant delay throughout the first 2 years of life," state the authors of an article published in the April 17, 2002 issue of JAMA: The Journal of the American Medical Association. The authors note that a growing body of research on prenatal cocaine exposure has raised concerns about long-term cognitive and developmental outcomes. In this study, they compared a large cohort of cocaine-exposed infants with unexposed infants from the same population on standardized normative measures of cognitive and motor development until 24 months of age.
The authors recruited mothers and infants between 1994 and 1996 at a large urban county teaching hospital who had been identified from a high-risk population screened for drug use. A total of 415 mothers and their infants (of which 218 were positive for cocaine exposure and 197 were negative) were enrolled in the study. Both maternal self-report measures and biological assays of cocaine and other drug metabolites in maternal urine and infant meconium were used to classify infants and measure severity of prenatal exposure. The Bayley Scales of Infant Development were used to assess infant development at 6.5, 12, and 24 months of age.
The authors first considered only cocaine status, and then, if significant, examined drug, demographic, and birth variables that related to cognitive and motor outcome. They found that cocaine exposure was a significant predictor of cognitive outcome. Specifically, they found that
The authors note that the rate of mental retardation for cocaine-exposed children in this study was 4.89 times higher than that expected in the population at large, and the percentage of children with mild or more serious delays requiring intervention was almost double the corresponding percentage in the comparison group. They conclude that "these findings indicate that prenatal cocaine exposure is associated with increased risk for cognitive impairment at 2 years of age and suggest the need for public health initiatives for substance abuse prevention and treatment of pregnant women."
Singer LT, Arendt R, Minnes S, et al. 2002. Cognitive and motor outcomes of cocaine-exposed infants. JAMA: The Journal of the American Medical Association 287(15): 1952-1960.
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5. AT-RISK CHILDREN BORN TO ADOLESCENT MOTHERS ARE MORE LIKELY TO EXPERIENCE BEHAVIOR PROBLEMS WHEN THEY LIVE IN THREE-GENERATION HOUSEHOLDS, STUDY FINDS
"In attempts to help young families with multiple risks, policymakers and health care providers have often looked to grandmothers for support and stability. However, findings from this investigation showed that children confronted by multiple risks had more behavior problems when they lived in three-generational households [i.e., with their mothers and grandmothers], compared with children who lived in independent households," state the authors of an article published in the April 2002 issue of Pediatrics. For the analyses highlighted in this article, the authors examined the main effects of grandmother presence, the child's maltreatment history, and maternal depressive symptoms on internalizing behavior problems, externalizing behavior problems, and cognitive performance.
The authors studied 194 at-risk families with children who were between the ages of 4 and 5 at the time of the evaluation, who were born when their mother was age 19 or less, and who were living with their biological mother. Children and mothers were recruited from four sites across the United States.
Of this overall sample, approximately 26% of the households consisted of three generations (grandmother, mother, child), over one-third of the children had been reported to Child Protective Services for maltreatment, and almost one-third of the mothers reported depressive symptoms.
The authors found that
The authors caution that "in this investigation, as in others, there are many unanswered questions regarding adolescents' living situations." Nevertheless, they conclude that "there is a need to move away from stereotypes regarding children of adolescent parents and to examine theories regarding protective factors that can be built into intervention programs for pregnant and parenting teens and their children."
Black MM, Papas MA, Hussey JM, et al. 2002. Behavior and development of preschool children born to adolescent mothers: Risk and 3-generation households. Pediatrics 109(4):573-580.
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MCH Alert © 2002 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 (U02 MC 0001-01) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.
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EDITORS: Jolene Bertness, Tracy Lopez
COPYEDITOR: Ruth Barzel
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