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National Center for Education in Maternal and Child Health

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February 28, 2003

1. New Knowledge Path on Oral Health and Children and Adolescents Now Available

2. Research Brief Focuses on the Use of Indicators in the Social Policy Arena

3. Racial Disparity in Pregnancy-Related Mortality Persists, Analysis Finds

4. Study Finds Significant Differences In Hispanic Women's Lengths of Labor

5. School-Based Health Centers Improve Outcomes of Elementary School Children with Asthma, Study Finds

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1. NEW KNOWLEDGE PATH ON ORAL HEALTH AND CHILDREN AND ADOLESCENTS NOW AVAILABLE

The new edition of the Oral Health and Children and Adolescents knowledge path is an electronic resource guide on current, high-quality resources and information tools. This recently updated knowledge path was produced by the National Maternal and Child Oral Health Resource Center and the MCH Library for Children's Dental Health Month. It includes information on (and links to) Web sites and electronic publications; journal articles; books, reports, and other print publications; databases; and discussion groups and electronic newsletters that contain relevant information on the topic. The knowledge path is intended for use by policymakers, health professionals, researchers, and families who are interested in tracking timely information on oral health. It is available at http://www.mchlibrary.info/KnowledgePaths/kp_oralhealth.html.

MCH Library knowledge paths on other maternal and child health topics are available at http://mchlibrary.info/KnowledgePaths/index.html. The MCH Library welcomes feedback on the usefulness and value of these knowledge paths. A feedback form is available at http://www.mchlibrary.info/KnowledgePaths/feedback.html.

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2. RESEARCH BRIEF FOCUSES ON THE USE OF INDICATORS IN THE SOCIAL POLICY ARENA

The Uses (and Misuses) of Social Indicators: Implications for Public Policy, a Child Trends research brief, discusses the use of social indicators as tools for policymakers, program developers, and opinion shapers. The brief presents information on (1) how using social indicators differs from other types of research methods in the social sciences, (2) five purposes for which social indicators are best suited (description, monitoring, setting goals, increasing accountability, and "reflective practice"), and (3) when using indicators is inappropriate. The brief is intended to raise awareness and encourage further discussion about this research method and how it can be helpful to policymakers and others concerned with improving the well-being of children and their families. The brief is available at http://www.childtrends.org/PDF/SocialIndicatorsRB.pdf.

Moore KA, Brown BV, Scarupa HJ. 2003. The uses (and misuses) of social indicators: Implications for public policy. Washington, DC: Child Trends.

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3. RACIAL DISPARITY IN PREGNANCY-RELATED MORTALITY PERSISTS, ANALYSIS FINDS

"Pregnancy-related mortality has the largest racial disparity among the maternal and child health indicators," state the authors of a report published in the February 21, 2003, issue of Morbidity and Mortality Weekly Report Surveillance Summaries. The authors point out that pregnancy complications are an important concern for clinical medicine and health care systems. They note that, since 1940, maternal mortality ratios for blacks have been at least three to four times higher than those for whites. The authors sought to quantify progress toward reducing this disparity and meeting the Healthy People 2010 objective by analyzing surveillance data on pregnancy-related deaths in the United States from 1991 through 1999.

Data for this analysis were drawn from the Pregnancy Mortality Surveillance System (PMSS). PMSS collects copies of death certificates and available linked outcome records of all deaths occurring during or within 1 year of pregnancy from individual state health departments. A limited number of deaths not otherwise identified are reported by maternal mortality review committees, the media, and individual providers. Data are reviewed by clinically experienced epidemiologists.

For this study, pregnancy-related mortality ratios were calculated by using the number of deaths obtained from the PMSS (numerator) and live-birth data (denominator) obtained from the 1991-1999 national natality files. The authors also collected data on the women's race, age, education, marital status, prenatal care, and live-birth order.

The authors found that

"Pregnancy-related deaths are underreported, and the true number of deaths might increase . . . with active surveillance," note the authors. However, they conclude, "the continuing disparity in pregnancy-related mortality between white and black women indicates the need to identify the differences that contribute to excess mortality among black women."

Chang J, Elam-Evans LD, Berg CJ, et al. 2003. Pregnancy-related mortality surveillance -- United States, 1991-1999. Morbidity and Mortality Weekly Report Surveillance Summaries 52(SS02). Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5202a1.htm or http://www.cdc.gov/mmwr/PDF/ss/ss5202.pdf.

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4. STUDY FINDS SIGNIFICANT DIFFERENCES IN HISPANIC WOMEN'S LENGTHS OF LABOR

"These research findings add to a growing body of evidence that normal uncomplicated active phase of labor in Hispanic women is appreciably longer than [the established means and statistical guidelines for normal lengths of labor]," state the authors of an article published in the January/February 2003 issue of the Journal of Midwifery and Women's Health. The authors note that current clinical practice guidelines upon which labor in progress is measured are based on research that does not take into consideration racial and ethnic characteristics. Because the numbers and birth rates of Hispanic women in the United States are rising, the authors of this study determined that there was a need to examine the relationship between ethnicity and duration of labor and to compare results with established guidelines.

The authors documented the lengths of the first and second stages of labor for a random sample of Hispanic women who had normal spontaneous, uncomplicated vaginal births of singleton term infants from January 1995 through December 1998 in New York State. Data were compiled on 240 Hispanic nulliparous and multiparous women who immigrated to the United States from 12 countries in Central and South America. Variables examined were maternal age, parity, gestational age, infant birthweight, and country of origin. Results were compared with the statistical guidelines for labor as reported by Emmanuel Friedman.

In contrast to Friedman's findings, the authors found that

In support of Friedman's findings, the authors found that

The authors conclude that "there is a critical need for clinical research addressing the expanding demographic group of Hispanic Americans in the United States to better serve this population during the childbirth experience."

Jones M, Larson E. 2003. Length of normal labor in women of Hispanic origin. Journal of Midwifery and Women's Health 48(1):2-9.

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5. SCHOOL-BASED HEALTH CENTERS IMPROVE OUTCOMES OF ELEMENTARY SCHOOL CHILDREN WITH ASTHMA, STUDY FINDS

"This study reports a strikingly lower asthma-related hospitalization rate in children who attend schools with SBHCs [school-based health centers] compared with those attending comparison schools. In addition, . . . we also document a gain of 3 days of school for asthmatic children attending schools with an SBHC compared with asthmatic children attending a comparison school," state the authors of an article published in the February 2003 issue of the Archives of Pediatrics & Adolescent Medicine. The authors point out that, while the number of SBHCs nationwide has increased from 150 to about 1,400 over the past decade, to their knowledge, no evaluative study using a quasi-experimental design has been conducted to assess the effect of SBHCs on the health and well-being of elementary school children. The purpose of the study described in this article was to examine differences in emergency department (ED) visits; hospitalizations; medication use by sex, age, or ethnicity; health insurance coverage; and availability of SBHCs.

Data for this study were obtained from surveys completed by the parents or guardians of children attending kindergarten through fifth grade in six elementary schools in The Bronx, NY. Four of the schools have SBHCs, in which, on average, 86% of children are enrolled. The two comparison schools do not have SBHCs. Of the 6,433 families surveyed, 74.2% returned completed questionnaires.

The authors found that

The authors conclude that "our findings support the efficacy of SBHCs for inner-city schoolchildren with asthma and have implications for access to and funding of school-based primary care."

Webber MP, Carpiniello KE, Oruwariye T, et al. 2003. Burden of asthma in inner-city elementary schoolchildren: Do school-based health centers make a difference? Archives of Pediatrics & Adolescent Medicine 157(2):125-129.

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MCH Alert © 2003 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) 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.

Permission is given to forward MCH Alert to individual colleagues. For all other uses, requests for permission to duplicate and use all or part of the information contained in this publication should be sent to MCH Alert Editor, National Center for Education in Maternal and Child Health, at mchalert@ncemch.org.

The editors welcome your submissions, suggestions, and questions. 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
Mailing address: Box 571272, Washington, DC 20057-1272
Street address: 2115 Wisconsin Avenue, N.W., Suite 601, Washington, DC 20007-2292
Phone: (202) 784-9770
Fax: (202) 784-9777
E-mail: mchalert@ncemch.org
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