MCH Alert

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



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



Juvenile Suicides, 1981-1998 examines trends and characteristics of suicides committed by children and adolescents in the United States. The report appears in the March 2004 issue of the Youth Violence Research Bulletin, a series published by the Office of Juvenile Justice and Delinquency Prevention and the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control. The authors analyzed data on suicides and deaths among children and adolescents ages 7-17. The data were drawn from the National Vital Statistics System and the Federal Bureau of Investigation for the period 1981-1998. The report includes information on suicide rates and suicide/homicide ratios by state, gender, race/ethnicity, and age. The report also includes information about the percentage of firearm- and non-firearm-related suicides. The report is intended for use by practitioners, service providers, parents, and policymakers in focusing attention on a critical topic related to child and adolescent violence. It is available at or at



"It is clear . . . that the SOS [Signs of Suicide] suicide prevention program has a substantively important short-term impact on the attitudes and behaviors of high school-aged youths in high-risk settings," state the authors of an article published in the March 2004 issue of the American Journal of Public Health. The authors state that suicide among young people is one of the most serious public health problems in the United States, and that, while a number of approaches to suicide prevention have been incorporated into high school curricula during the past 15 years, few have been subject to rigorous evaluation, and those that have been evaluated have produced mixed results. The purpose of the study described in this article was to assess the short-term impact of the school-based SOS program on suicidal behavior, seeking help, and knowledge of and attitudes toward depression and suicide in a diverse student population.

The study population consisted of 2,100 public high school students in three high schools in Hartford, CT, and Columbus, GA. The schools provided a racially mixed and economically diverse sample of students. Students were randomly assigned to treatment or control groups. Students in both groups completed a questionnaire approximately 3 months after implementation of the program.

The authors found that

The authors conclude that "this is the first school-based suicide prevention program for which a reduction in self-reported suicide attempts has been documented with a randomized experimental design."

Aseltine RH, DeMartino R. 2004. An outcome evaluation of the SOS suicide prevention program. American Journal of Public Health 94(3):446-451.

Readers: More information is available from the Bright Futures Web site at and from the MCH Library's knowledge path, Adolescent Violence Prevention, at; from the bibliography, Adolescent Mental Health, at; and from the organizations resource list, Adolescent Violence Prevention, at



"In today's context of a changing managed care marketplace and tight budgets, states face major challenges in operating Medicaid managed care programs," state the authors of an article published in the March/April 2004 issue of Health Affairs. The article presents an analysis of data collected since 1996 from a nationally representative sample of Medicaid managed care markets to describe how Medicaid managed care is evolving in local U.S. markets and the implications of this evolution for policymakers.

Data for the analysis was drawn from the Community Tracking Study (CTS), a longitudinal study conducted by the Center for Studying Health Systems Change, which uses multiple data sources to examine changes in local health care systems. The authors relied on data collected in structured interviews with leaders of plans that participate in Medicaid, policymakers, providers, and other relevant Medicaid stakeholders in the 12 CTS markets (AZ, AR, CA, FL, IN, MA, MI, NJ, NY, OH, SC, and WA).

The authors found that

"Today's Medicaid managed care is different from most commercial managed care in a number of different ways," state the authors. They conclude that "in states' Medicaid programs, cost control is key, a factor that states find more compatible with the underlying theory of managed care -- some restrictions on care in return for reasonable access and comprehensive benefits at a fairly predictable cost."

Draper DA, Hurley RE, Short AC. 2004. Medicaid managed care: The last bastion of the HMO? Health Affairs 23(2):155-167.



The study findings "illustrate the substantial effect that language can have on families of children whose needs for health care are greatest," state the authors of an article published in the March-April 2004 issue of Ambulatory Pediatrics. The article describes a study designed to (1) assess the prevalence of selected health care access characteristics by the language of interview, (2) isolate the effect of language on access, and (3) demonstrate the effect of language on access among Hispanic children with special health care needs (CSHCN).

Data for the study were drawn from the 2001 National Survey of Children with Special Health Care Needs, sponsored by the Maternal and Child Health Bureau and the National Center for Health Statistics (NCHS). NCHS conducted the survey using the State and Local Area Integrated Telephone Survey mechanism to collect information on the child's health and functional status, access to care, insurance coverage, and demographic and financial information. Those who participated in an English interview were classified as English-speaking respondents. Of the 38,866 interviews completed for CSHCN, 38,011 were conducted in English and 855 were conducted in other languages. Researchers assessed (1) characteristics of the CSHCN population as a whole and by respondent language and (2) the relationship between barriers to access and respondent language. The analyses controlled for the child's age, gender, race or ethnicity, poverty level, insurance status, impact of condition, maternal education, and region of residence.

The authors found that

The authors conclude that "the findings of this study emphasize the need for outreach and identification of CSHCN whose families experience language barriers that affect their children's access to care."

Yu SM, Nyman RM, Kogan MD, et al. 2004. Parent's language of interview and access to care for children with special health care needs. Ambulatory Pediatrics 4(2):181-187.

Readers: More information is available from the MCH Library's knowledge paths, Children and Adolescents with Special Health Care Needs and Child and Adolescent Health Insurance and Access to Care at; from the bibliographies, Children with Special Health Care Needs and Outreach Programs and Strategies, at; and from the organizations resource list, Children with Special Health Care Needs at


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MCH Alert © 2004 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
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