National Center for Education in Maternal and Child Health

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July 18, 2003

1. Online Workshop on Infectious Disease Prevention Launched

2. Report Highlights Lessons Learned in Delivery of Coordinated Behavioral Health Care Services and Contracting

3. Data on Traumatic Brain Injury-Related Hospital Discharges in 14 States Summarized

4. Study Evaluates Association Between School Food Environment and Students' Dietary Behaviors

5. Authors Examine the Impact of Treatment on Low-Income and Minority Women with Depression

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1. ONLINE WORKSHOP ON INFECTIOUS DISEASE PREVENTION LAUNCHED

The PKIDS (Parents of Kids with Infectious Diseases) Infectious Disease Workshop is a free, online educational tool focusing on how to prevent infections. This train-the-trainer workshop was developed in collaboration with leading physicians and public health educators for use by people of all ages and with all levels of understanding about infectious diseases. The master Instructor's Background Text includes six units: (1) Introduction to Infectious Diseases, (2) Disease Prevention, (3) Sports and Infectious Diseases, (4) Stigma and Infectious Diseases, (5) Civil Rights and Infectious Diseases, and (6) Bioterrorism and Infectious Diseases. Each unit includes age-appropriate activities for participants (ages 2 to 6, 6 to 9, 9 to 12, and 13 to 18, and adults). Parents, teachers, health educators, coaches, child care providers, and others interested in effective disease prevention practices are encouraged to use the materials. The workshop is available at http://www.pkids.org/idw.htm (also available on CD-ROM).

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2. REPORT HIGHLIGHTS LESSONS LEARNED IN DELIVERY OF COORDINATED BEHAVIORAL HEALTH CARE SERVICES AND CONTRACTING

Contracting for Coordination of Behavioral Health Services in Privatized Child Welfare and Medicaid Managed Care explores the issue of coordination between privatized child welfare initiatives and Medicaid managed care systems for the delivery of behavioral health services for children and families in the child welfare system. The report, supported by the Center for Health Care Strategies, Inc., under the Robert Wood Johnson Foundation's Medicaid Managed Care Program, includes both an analysis of contractual language related to coordination of care and interagency collaboration and the results of interviews conducted at four sites in Colorado, Ohio, Massachusetts, and Missouri. Common themes and implications for policy and practice are also presented. The report is intended for use by state child welfare, behavioral health, and Medicaid agencies; managed care organizations; family organizations; and state and federal policymakers in designing and implementing similar contracts for systems of care. It is available at http://www.chcs.org/publications/pdf/ips/childwelfare.pdf.

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3. DATA ON TRAUMATIC BRAIN INJURY-RELATED HOSPITAL DISCHARGES IN 14 STATES SUMMARIZED

"Data in this report . . . indicate the importance of TBI [traumatic brain injury] as a public health problem," state the authors of a report published in the June 26, 2003, issue of Morbidity and Mortality Weekly Report Surveillance Summaries. This report summarizes data from a multistate, population-based TBI surveillance system in the United States from January through December 1997.

This analysis focuses on persons who are hospitalized and survive a TBI (vs. TBI-related mortality). Hospital discharge data were collected from 14 states that were funded in 1997 to conduct TBI surveillance. Core data collected from all states included demographics, ICD-9-CM diagnosis codes, and cause of injury (E codes). Supplementary data were collected from 11 states and included information on personal protective equipment (PPE) use, alcohol use, acute severity, and early indicators of disability.

The authors found that

• The age-adjusted TBI-related hospital discharge rate for the 14 states combined was 69.7/100,000 population. This rate varied widely by state.
• The overall age-adjusted rate for males was nearly twice that for females.
• Rates were highest for the 15-19-year-old age group and for those ages 65 or above.
• For the 20-44-year-old age group, American Indians and Alaska Natives had the highest rates. Within the 0-4-year-old age group, blacks had the highest rate, and among those ages 65 or above, whites had the highest rate.
• The 15-19-year-old age group had the highest motor-vehicle traffic-related rate.
• An estimated 40-50% of those injured as motor-vehicle occupants, motorcyclists, or pedal cyclists reportedly were not using PPE at the time of injury.
• An estimated one-fourth of persons with TBI discussed in this report had an acute brain injury classified as moderate or severe.

"These findings emphasize the importance of TBI as a public health problem by focusing on persons who survive the injury, often with long-term disability," conclude the authors. They suggest that "this information can be used by states to help ensure that persons at high risk of disability have access to appropriate rehabilitative and community-based services."

Langlois JA, Kegler SR, Butler JA, et al. 2003. Traumatic brain injury-related hospital discharges: Results from a 14-state surveillance system, 1997. Morbidity and Mortality Surveillance Summary 52(SS4):1-18. Available at http://www.cdc.gov/mmwr/PDF/ss/ss5204.pdf.

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4. STUDY EVALUATES ASSOCIATION BETWEEN SCHOOL FOOD ENVIRONMENT AND STUDENTS' DIETARY BEHAVIORS

"This study is one of the first to examine and demonstrate a negative and adverse association between physical factors in the school food environment . . . and young adolescents' overall consumption of fruits, vegetables, and dietary fat," state the authors of an article published in the July 2003 issue of the American Journal of Public Health. The study described in this article examined the influence of selected factors in the school environment on the eating behaviors of adolescents.

The study sample included middle-school students who participated in the Teens Eating for Energy and Nutrition Study (TEENS), a school-based intervention designed to promote healthy eating behaviors among adolescents to reduce future cancer risk. Before TEENS was implemented, school-level data were collected from 16 schools in the St. Paul-Minneapolis, MN, metropolitan area in fall 1998. Individual-level data were obtained from a sample of seventh-grade students who attended these schools and who completed a single 24-hour dietary recall interview. Valid recall data were provided by 598 students (71%). Analyses assessed the association between five daily outcome measures (total fruit servings, total vegetable servings, total fruit and vegetable servings, and percentage of total energy from total fat and saturated fat) and four school-level predictor variables (amounts of fried potatoes served to students at school lunch, number of snack machines/school stores, number of beverage machines, and presence of an a la carte program). All models included adjustment for potential confounders (e.g., sex, race, ethnicity, participation in the free/reduced lunch program).

The authors found that

• On average, students from schools without a la carte programs consumed more than half a serving more of fruit per day and nearly an entire serving more of fruit and vegetables per day than did students in schools with these programs.
• Students from schools without a la carte programs reported a mean percentage of daily calories from total fat that met the United States Department of Agriculture dietary recommendations, whereas students from schools with these programs exceeded the recommendations. For saturated fat, both groups exceeded the recommendations; however, students from schools without a la carte programs exceeded recommendations by less than 0.5%, whereas students from schools with these programs exceeded recommendations by 1.5%.
• With each snack vending machine present in a school, students' mean intake of fruit servings declined by 11%. Beverage vending machines were not associated with any of the outcome measures.
• Fried potatoes being served to students at school lunch was positively associated with average total daily vegetable intake and with average total daily fruit and vegetable intake.

The authors conclude that "strategies that target school-level environmental factors, including not only the school lunch program but also other common food venues, such as vending machines and a la carte programs, [are needed] if healthy eating is to become normative childhood behavior."

Kubik MY, Lytle LA, Hannan PJ, et al. 2003. The association of the school food environment with dietary behaviors of young adolescents. American Journal of Public Health 93(7):1168-1172.

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5. AUTHORS EXAMINE THE IMPACT OF TREATMENT ON LOW-INCOME AND MINORITY WOMEN WITH DEPRESSION

"Engaging impoverished minority women in care is demanding, but outcomes are clearly beneficial," write the authors of an article published in the July 2, 2003, issue of JAMA, The Journal of the American Medical Association. The authors point out that ethnic minority individuals are less likely to obtain care for depression than white individuals and are less likely to receive appropriate treatment when they do seek care. The authors also state that efficacy trials of major depression treatments have been conducted primarily on white, upper-socioeconomic-status participants. This study tests whether guideline-based care for depression improves depressive symptoms and functioning in low-income minority women compared with their counterparts receiving community referrals for care.

A total of 267 women (117 black women, 134 Latina women, and 16 white women) recruited from county-run WIC programs and Title X family planning clinics in suburban Washington, DC, were randomized into the intervention trial. Women were randomized as follows: (1) antidepression medication, (2) cognitive behavior therapy, and (3) referral to community mental health services.

The authors found that

• The mean age of study participants was 29.3. More than one-third had not completed high school, more than half lived at or below the federal poverty line, and the women experienced very high rates of trauma exposure.
• Results of repeated-measure analyses assessing change across time revealed a significant decrease in depressive symptoms for women in the medication and psychotherapy interventions compared with those in the community referral group.
• Results on instrumental role functioning revealed a significant impact of the medication intervention, but not the psychotherapy intervention, compared with community referral.
• Both the medication and the psychotherapy interventions were effective in improving social functioning, compared with community referral.
• The women in the medication intervention were twice as likely to achieve a Hamilton Depression Rating Score (HDRS) of 7 or less by month 6 as were those in the community referral group.
• By month 6, 44.4% of the women in the medication intervention had achieved an HDRS score of 7 or less, compared with 32.2% of those in the psychotherapy intervention and 28.1% of those in the community referral group.

The authors conclude that "our results demonstrate that treating depression in this population has clear advantages, both in terms of reducing personal suffering and [in terms of] improving the ability of these young women to function."

Miranda J, Chung J, Green B, et al. 2003. Treating Depression in Predominantly Low-Income Young Minority Women. JAMA, The Journal of the American Medical Association 290(1):57-65.

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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 (6U02 MC 00001) 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

National Center for Education in Maternal and Child Health
Georgetown University
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