National Center for Education in Maternal and Child Health
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August 15, 2003
3. Authors Review Evidence on Primary Care-Based Interventions to Promote Breastfeeding
6. Article Examines Relationship Between School Functioning and Student Behavior
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Readers: MCH Alert will not be published for the next 2 weeks. The next issue is scheduled for September 5, 2003.
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1. MATERNAL AND CHILD HEALTH BUREAU TO SPONSOR DISCUSSION OF EPSDT EXPERIENCES AND RECOMMENDATIONS FOR IMPROVEMENT
On September 10, 2003 the Maternal and Child Health Bureau will sponsor a Webcast discussion, titled Enhancing Partnerships Between Title V, Medicaid, and Local Health Departments Through EPSDT. The discussion will feature multiple presenters from federal, state and local agencies and will focus on experiences and recommendations for improving the Early Periodic Screening, Diagnostic and Treatment program (EPSDT) rates through state and local partnerships. The Webcast will combine video/audio broadcasting with PowerPoint slides, and participants will be able to ask the presenters questions. The Webcast requires prior online registration. The agenda and information on how to register are available at http://www.mchcom.com/epsdt_frame.htm. An archived version will be available a week following the live event.
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2. PUBLIC CAMPAIGN LAUNCHED TO IMPROVE SAFETY AND ENCOURAGE DIALOGUE BETWEEN PATIENTS AND HEALTH PROFESSIONALS
5 Steps to Safer Health Care is a new campaign sponsored by the U.S. Department of Health and Human Services (DHHS), in partnership with the American Hospital Association and the American Medical Association, to reduce the risks that patients may face in the course of receiving health care services. Evidence-based, practical tips on the role patients can play in making their care safer were developed through a joint effort of the Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services, the Office of Personnel Management, and the Department of Labor. The tips emphasize dialogue between patients and health professionals about health care safety and include information on how to avoid errors related to prescription medicines, laboratory tests and procedures, and surgery. The tips, in the form of posters and fact sheets, will be distributed to health professionals and patients across the country and are intended to complement patient safety initiatives currently under way. The tips are available at http://www.ahrq.gov/consumer/5steps.htm or http://www.ahrq.gov/consumer/5steps.pdf (in English), and at http://www.ahrq.gov/consumer/cincorec.htm (in Spanish).
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3. AUTHORS REVIEW EVIDENCE ON PRIMARY CARE-BASED INTERVENTIONS TO PROMOTE BREASTFEEDING
"This review provides encouraging evidence that educational programs and support services provided in research settings can improve breastfeeding initiation and duration rates in the United States and other developed countries," state the authors of an article published in the July/August 2003 issue of the Annals of Family Medicine. This article describes a systematic literature review conducted by the U.S. Preventive Services Task Force to determine whether primary care-based interventions improve initiation and/or duration of breastfeeding. This analysis is the first to assess all breastfeeding interventions singly, and in combination, in developed countries.
To identify trials and review articles, the task force conducted a search of MEDLINE (1996-2001), HealthSTAR, the Cochrane Database of Systematic Reviews, the National Health Service Centre for Reviews and Dissemination Databases, and bibliographies. They identified 30 randomized and nonrandomized controlled trials and 5 systematic reviews of breastfeeding counseling.
Based on the review of evidence and meta-analysis, the task force found that
"One challenge for translating these findings into clinical practice will be to make breastfeeding classes more accessible to all patients," state the authors.
Guise J, Palda V, Westhoff C, et al. 2003. Effectiveness of primary care-based interventions to promote breastfeeding. Annals of Family Medicine 1(2):79-80.
Readers: A statement summarizing the task force recommendations, titled Behavioral Interventions to Promote Breastfeeding: Recommendations and Rationale, appears in this issue of the Annals of Family Medicine. The task force recommendations on this topic are also presented in a fact sheet published by the Agency for Healthcare Research and Quality. The fact sheet is available at http://www.ahrq.gov/clinic/3rduspstf/brstfeed/brfeedwh.htm.
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4. STUDY COMPARES STATE AND NATIONAL ESTIMATES OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS ENROLLED IN THE STATE CHILDREN'S HEALTH INSURANCE PROGRAM
"These findings demonstrate greater numbers of children with special health needs in the Title XXI program [the State Children's Health Insurance Program or SCHIP] than would be expected from the national data," state the authors of an article published in the August issue of Pediatrics Electronic Pages. The authors hypothesized that children enrolled in SCHIP may have more health conditions than a general population of children. To test their hypothesis, they compared data from children enrolled in SCHIP in one state to data from a nationally representative sample of children in the United States.
Florida SCHIP enrollment data provided information on the number of months children were enrolled in the program, as well as on their age, gender, household size, family income, and health care use from October 1, 1998, through September 30, 1999. To determine whether the child had any chronic health conditions, a random subsample of Florida parents were asked to respond to a structured telephone survey (the Questionnaire for Identifying Children With Chronic Conditions). Demographic data for the national sample were obtained from the 1994 National Health Interview Survey (NHIS). Items extracted from the NHIS Core Interview survey and from the disability supplement were used to determine the presence of a chronic condition. Both the Florida and the NHIS data sets had comparable information on parental ratings of children's health status and on school absences, bed days, and restricted activity days in the previous 2 weeks.
Initial comparisons were conducted using two age-matched samples. To determine whether any differences might be related to the program's financial eligibility requirements, the Florida sample was compared to an NHIS subsample that also reflected Florida's SCHIP financial eligibility.
The authors found that
"The comparisons of statewide data to the national samples suggest that the children being enrolled in SCHIP are not the largely healthy population that was envisioned," conclude the authors. They suggest that "this could have important implications for the long-term fiscal viability of the current SCHIP program."
Stein REK, Shenkman E, Wegener DH, et al. 2003. Health of children in Title XXI: Should we worry? Pediatrics Electronic Pages 112(2):e112-e118.
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5. STUDY ASSESSES EFFECT OF SCHOOL CLIMATE ON INSTITUTIONALIZATION OF SCHOOL-BASED HEALTH PROMOTION PROGRAMS
"This study shows a clear relationship between school climate and what occurs in the classroom," state the authors of an article published in the July/August 2003 issue of Health Education and Behavior. Following an effort to develop and evaluate school-based health promotion programs, the authors of this article sought to determine how these programs were maintained in schools after the intervention trial was completed. The Child and Adolescent Trial for Cardiovascular Health institutionalization study (CATCH-ON) described in this article examined measures of school climate and their relationships to continued implementation of the CATCH program.
The CATCH multicenter study involved 96 elementary schools (56 intervention schools and 40 control schools) in four geographic locations. This quantitative analysis focused on the 56 intervention schools. School climate was measured using the Organizational Climate Description Questionnaire for Elementary Schools and the Organizational Health Inventory for Elementary Schools, which emphasize principals' and teachers' openness to organizational change as well as schools' integrity and resources. The school-level outcomes investigated in this study included continued teaching of the CATCH curricula, continued preparation of lower-fat and lower-saturated-fat school meals, and continued moderate-to-vigorous activity in physical education (PE). The authors also assessed process variables between school climate and CATCH school-level outcomes. These included whether CATCH materials were available, whether staff had been trained to implement CATCH, and how much class time and menu planning were based on CATCH materials. All measures were conducted from October 1998 to May 1999.
The authors found that
The authors conclude that "addressing school climate as a potential determinant of institutionalization of classroom instruction is an important factor in the sustainability of innovative programs over time."
Parcel GS, Perry CL, Kelder SH, et al. 2003. School climate and the institutionalization of the CATCH program. Health Education and Behavior 30(4):489-502.
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6. ARTICLE EXAMINES RELATIONSHIP BETWEEN SCHOOL FUNCTIONING AND STUDENT BEHAVIOR
"This work supports the feasibility of combining multiple school-level indicators to create a measure of overall school functioning," write the authors of an article published in the August 2003 issue of the Journal of School Health. The authors of this article point out that, despite widespread recognition of schools' role in the healthy development of youth, surprisingly little research has examined the relationship between schools' overall functioning and the health-related behavior of students. The article describes development and testing of the School Functioning Index (SFI) as a first step in investigating this question. The SFI was initially conceived as a predictor of students' violent behavior, with the potential for extending its research applications to additional health and social behaviors.
Data were obtained from the Teens Eating for Energy and Nutrition at School (TEENS) study, a group randomized intervention trial conducted in 16 middle and junior high schools to reduce cancer-related dietary risk among young adolescents. TEENS was designed for a lower-income population, and only school districts with at least 20% of students receiving free or reduced-price lunches were eligible. Sixteen schools participated in the study.
The authors used social cognitive theory, social ecological theory, and social disorganizational theory to identify three domains to operationalize school functioning and select items for the SFI: (1) resources available to the school and students, (2) stability of the school population, and (3) schools' performance as a socializing agent for students. Within these three domains, 17 candidate items for the SFI were selected based on substantive considerations and the projected feasibility of data collection. As a preliminary test of construct validity, correlations of the SFI with health behaviors measured in TEENS were examined. The final SFI included 9 items.
The authors found that collecting precise, accurate data from schools, particularly concerning students' aggressive behavior, was a challenge. They state that "validity of the SFI remains in question . . . ; yet, we see inherent value and validity to the composite score that the nine final items yielded." The authors conclude that "exploring associations between school functioning and health-risk/health-promoting behaviors can help establish an empirical base for understanding the multiple roles of schools in students' lives."
Birnbaum AS, Lytle LA, Perry DM, et al. 2003. Developing a school functioning index for middle schools. Journal of School Health 73(6):232-238.
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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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