National Center for Education in Maternal and Child Health

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March 26, 2004

1. Working Group Presents Recommendations on FDA's Role and Responsibilities in Addressing Obesity
2. Public Health/Juvenile Justice Partnership Examines Suicide Among Children and Adolescents
3. Effectiveness of School-Based Suicide-Prevention Program Evaluated
4. Authors Discuss How Medicaid Managed Care Has Evolved in Local Markets
5. Language Barriers to Health Care Access for Children with Special Health Care Needs Assessed

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1. WORKING GROUP PRESENTS RECOMMENDATIONS ON FDA'S ROLE AND RESPONSIBILITIES IN ADDRESSING OBESITY

Calories Count: Report of the Working Group on Obesity outlines an action plan to confront the nation's obesity epidemic and help consumers lead healthier lives through better nutrition. The report was prepared by the U.S. Food and Drug Administration's (FDA's) Obesity Working Group (OWG) and represents the FDA's role and responsibilities in addressing obesity. To accomplish its goals, the OWG met eight times from August 28, 2003, to January 22, 2004; held one public meeting, one workshop, and two roundtable discussions (one with health professionals and academicians, and one with representatives of consumer groups); and solicited comments on obesity-related issues. The short- and long-term recommendations contained in the report are based on the scientific fact that weight control is achieved mainly by balancing caloric intake and energy expenditure. The recommendations, which emphasize the importance of considering consumer and other stakeholder views and needs in addressing obesity, include the underlying rationale for food labeling, enforcement activities, educational partnerships, therapeutics, and research. More information about the report is available at http://www.fda.gov/oc/initiatives/obesity.

• Students in the treatment group were approximately 40% less likely to report a suicide attempt in the past 3 months, compared with students in the control group.
• Students in the treatment group had greater knowledge of depression and suicide and more adaptive attitudes toward these problems, compared with students in the control group.
• The effects of the SOS program on help-seeking behavior did not achieve statistical significance.
• Although descriptive statistics indicated lower levels of suicidal ideation among the treatment group, compared with the control group, theses differences fell short of statistical significance.
• Girls, compared with boys, had significantly greater knowledge and more constructive attitudes about depression and suicide, were more likely to seek help when depressed and to intervene on behalf of friends, and were significantly more likely to report suicidal ideation and suicide attempts in the past 3 months.
• Students in English as a Second Language (ESL) programs had less accurate knowledge about depression and suicide and a higher prevalence of self-reported suicide attempts, compared with students not in these programs. However, ESL status was positively related to seeking help.
• White students were more knowledgeable about depression and suicide, compared with those in other racial and ethnic categories. However, black students reported lower rates of suicidal ideation and suicide attempts than did white or Hispanic students and were less likely to seek help for these problems.

• Since 1996, there has been a 30 percent decrease in the number of plans that participate in Medicaid, with the most dramatic decrease in the number of participating commercial plans.
• The number of participating plans that are Medicaid-focused has remained relatively stable since 1996; these plans have expanded their memberships as Medicaid enrollment has grown and have strengthened their hold on this line of business as other types of plans exit.
• For-profit, publicly traded health insurance companies that specialize in Medicaid are fast becoming major players in states' programs.
• Provider (often safety-net provider) sponsorship of plans that participate in Medicaid remains strong, even though this type of sponsorship has declined in other sectors.
• Cost-sharing options are more limited in Medicaid than in the commercial insurance sector, where cost sharing is actively used to encourage consumers to use fewer services or to take a more active decision-making role in service use and product choice.
• Plans participating in Medicaid managed care rely extensively on traditional utilization-management tools, including primary care gatekeeping, prior authorization, and concurrent review. This is in sharp contrast to the commercial sector, where there has been extensive movement away from restrictive product designs in recent years.
• Compared with commercial networks that have become broad and inclusive, Medicaid participating plans reported narrower networks for their Medicaid products (i.e., provider sponsors or traditional Medicaid providers such as community health centers).

• Children with non-English-speaking parents were significantly more likely to be from families with less education and lower incomes, compared with children with English-speaking parents; the former were more likely to lack health insurance and to have conditions that more dramatically impacted their activities. Children with non-English-speaking parents were also more likely to be younger and to be of Hispanic or Asian descent.
• Children with non-English-speaking parents were more likely to experience barriers to access and to face challenges to obtaining quality care. The most prevalent barrier to access was inadequate health insurance, which was reported by 86.5% of non-English-speaking parents and 33.1% of English-speaking parents.
• CSHCN with non-English-speaking parents were significantly more likely to experience barriers to access and adverse consequences based on their special needs. These children were 11 times more likely than those with English-speaking parents to have inadequate health insurance and were more likely to have an unmet need for family support services, to lack a usual source of care, to lack a personal doctor or nurse, to lack family-centered care, and to have problematic specialty referrals.
• Over 90% of children with non-English-speaking parents were Hispanic; disparities among Hispanic children compared with other children were not significant.