National
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April 2, 2004
1. Online Resource Targeted to
Health Policy/Public Health Academic Community Launched
2. Series Presents Information on
Performance Measures Used to Evaluate Out-of-School Time Programs
3. Report Presents Updates on
Trends in Child Well-Being
4. Study Assesses Trends in Health
Insurance Coverage For Adolescents
5. Authors Discuss Challenges in Conducting Medical
Records Research During HIPAA Transition
6. Article
Assesses the Effect of Word Choice in Summary Statements About Dental
Caries Prevalence
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1. ONLINE RESOURCE TARGETED
TO HEALTH POLICY/PUBLIC HEALTH ACADEMIC COMMUNITY LAUNCHED
kaiserEDU is a new online resource for faculty and students that
provides access to data, literature, news, and developments relevant to
health policy topics and debates. The Web site, developed by the Kaiser
Family Foundation, contains a compilation of work conducted by the
foundation as well as by the larger health policy community. Features
include issue modules, reference libraries, tutorials, and a syllabus
library. The Web site also offers users the opportunity to receive
e-mail notification of content updates and the capacity to organize and
save links to frequently visited Web pages. The information can be used
by health policy and public health faculty and students as an integral
part of an academic course or as an additional source for independent
research. The Web site is available at http://www.kaiseredu.org.
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2. SERIES PRESENTS
INFORMATION ON PERFORMANCE MEASURES USED TO EVALUATE OUT-OF-SCHOOL TIME
PROGRAMS
Out-of-School Time Evaluation Snapshot: Performance Measures in
Out-of-School Time Evaluation provides the academic, youth development,
and prevention performance measures currently being used by
out-of-school time (OST) programs to assess their progress. The report
is based on a review of the outcomes reported in the evaluations posted
in the Harvard Family Research Project Out-of-School Time Program
Evaluation Database. In addition to a comprehensive list of the
performance measures that OST programs nationwide are currently using,
the report includes the corresponding data sources for the measures and
information on selecting performance measures for evaluation. The
report is intended for use by OST programs in making evaluation
decisions as well as by researchers, evaluators, and others seeking to
help programs build evaluation capacity and improve performance. The
report is available at http://www.gse.Harvard.edu/hfrp/projects/afterschool/resources/snapshot3.html.
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3. REPORT PRESENTS UPDATES
ON TRENDS IN CHILD WELL-BEING
"Overall, children and youth in today's society are doing better than
they were in 1975," state the authors of a report released at the March
24, 2004, public forum sponsored by the Brookings Institution, in
cooperation with the Foundation for Child Development and Duke
University. The report presents an update on measures of trends in the
well-being, or quality of life, of children ages 1 to 19 in the United
States over a 27-year period, 1975 to 2002, with projections for 2003.
The Foundation for Child Development Index of Child Well-Being Project
analyzed data from vital statistics and sample surveys on 28
national-level key indicators in seven quality-of-life domains
(material well-being, health, safety/behavioral concerns, educational
attainment, place in community, social relationships, and
emotional/spiritual well-being). A composite measure, the Child
Well-Being Index (CWI), was then computed for each year. Information
for this report was based on observed data on the key indicators
through the year 2001. The report also includes information on some key
indicators available for the year 2002. The remaining indicators for
2002, and all the components for 2003, were projected using statistical
time series models.
The authors found that
* Over the past three decades, children have seen improvements in three
domains: safety/behavioral concerns, place in community, and material
well-being.
* One domain, educational attainment, has remained relatively steady at
levels slightly above the 1975 baseline levels.
* In 2002, three domains remained below baseline levels:
emotional/spiritual well-being, health, and social relationships.
* The health domain has declined the most dramatically since 1975; in
2002 it was at 83% of its baseline level. This decline is primarily due
to large increases in the prevalence of obesity among U.S. children.
* The safety/behavioral concerns domain has shown the most improvement
since 1975; in 2002 it was 44% higher than its baseline level. This
large improvement is due to decreases in the rate of children and youth
who are serious criminal offenders and victims of violent crimes.
* The social relationships domain remains below baseline levels across
all years of the index. This is primarily due to increases in the
percentage of children under age 18 who live in single parent
households.
"These results indicate that . . . many aspects of the lives of
children . . . in the United States show improvements compared to
1975," conclude the authors. They note, however, that because "the
Index appears to follow trends in the overall economic climate in the
United States, the well-being of children in America may see stagnation
and/or declines over the next few years."
Duke University. 2004. The Foundation for Child Development Index of
Child Well-Being (CWI), 1975-2002, with Projections for 2003: A
composite index of trends in the well-being of our nation's children.
Durham, NC: Duke University. Available at
http://www.brookings.edu/comm/events/20040324index.pdf.
Readers: The PowerPoint presentation from the public forum is available
at http://www.brookings.edu/comm/events/20040324index.ppt; the event
summary is available at
http://www.brookings.edu/comm/op-ed/20040324wellbeing.htm; and the
event transcript is available at
http://www.brookings.edu/comm/events/20040324.htm. More information
about the CWI, its construction, and the scientific papers and
publications on which it is based are available at
http://www.soc.duke.edu/~smeadows/cwi/cwi_webpage.
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4. STUDY ASSESSES TRENDS IN
HEALTH INSURANCE COVERAGE FOR ADOLESCENTS
"This study has demonstrated an overall reduction in the size of the
uninsured adolescent population, with the gains being concentrated
within the low-income population," state the authors of an article
published in the March 10, 2004, issue of JAMA, The Journal of the
American Medical Association. The article presents new data on the
health insurance coverage characteristics of adolescents ages 10 to 18.
The authors (1) assess the health insurance status of adolescents and
the demographic and socioeconomic correlates of insurance coverage and
(2) examine trends in adolescent health care coverage between 1984 and
2002.
The study sample was drawn from that of the 2002 National Health
Interview Survey (NHIS) and included 13,118 adolescents from 8,604
families. The adolescents in the sample were classified as insured if
they were reported to be covered by Tricare, Medicare, Medicaid, the
State Children’s Health Insurance Program (SCHIP), the Indian Health
Service, other public assistance programs, or private health insurance.
Adolescents with no coverage from these sources were classified as
uninsured. The income status of the adolescents' families was also
determined and categorized as poor (less than 100% of the federal
poverty level [FPL]), near poor (100% to 199% of FPL), and middle and
higher income (greater than or equal to 200% of FPL). Findings from the
2002 sample were compared with results from the authors' previously
published work based on the 1984, 1989, and 1995 NHIS data sets.
Trend data on adolescent health insurance for 1984, 1989, 1995, and
2002 indicate that
* The proportion of adolescents with no health insurance coverage
remained essentially unchanged between 1984 and 1995.
* By 2002, the proportion of adolescents with no coverage decreased
from a 1989 peak of 15.5% to 12.2%.
* Between 1984 and 2002, the proportion of adolescents with private
insurance declined from 75.9% to 66.4% (including those with dual
private and public coverage), while the proportion of those with public
coverage increased from 11.9% to 22.8% (including those with dual
coverage).
* While both older (ages 15-18) and younger (ages 10-14) adolescents
were subject to losses of private health insurance coverage, younger
adolescents disproportionately benefited from expanded public coverage.
The findings "provide an initial assessment of the effects of expanded
offerings of public insurance through SCHIP as well as an assessment of
the extent to which declines in private coverage have offset gains in
public coverage," conclude the authors, adding that "careful
longitudinal monitoring of the effects of changing policies is needed."
Newacheck P, Park MJ, Brindis CD, et al. 2004. Trends in private and
public health insurance for adolescents. JAMA, The Journal of the
American Medical Association 291(10:1231-1237.
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5. AUTHORS DISCUSS
CHALLENGES IN CONDUCTING MEDICAL RECORDS RESEARCH DURING HIPAA
TRANSITION
"We observed that the new HIPAA [Health Insurance Portability and
Accountability Act] rule may present new challenges for those who rely
on the release of medical record information for epidemiologic
research," state the authors of an article published in the March 2004
issue of the Maternal and Child Health Journal. The authors note that
researchers have expressed concern over the impact on medical records
availability of the newly effective medical information privacy rule
authorized by HIPAA. The article describes the authors' experiences in
seeking access to medical records as hospitals anticipated,
interpreted, and implemented the requirements of the new rule. The
article is intended to inform the research community of the likely
effects of the new rule on the conduct of multi-institution studies
that require access to medical record information without explicit
informed patient consent and specific authorization.
The article draws from the authors' experiences in conducting a
multisite medical record validation study designed to assess the
accuracy of maternally linked birth data compared to medical records.
The study sought information from 5,000 medical records of births
during the year 2000. Conditions for waiver of patient consent under
the federally-regulated common rule were met (i.e., the research posed
no more than minimal risk to subjects, the research needed the
requested information, and without the waiver the study could not
practically be carried out). The Human Subjects Protection Review
Boards (IRBs) of the University of Washington, the State of Washington
Department of Health, and the Centers for Disease Control and
Prevention had approved the study independently.
Beginning in April 2002, letters were sent describing the study to 23
eligible hospitals. Subsequently, the study project coordinator
contacted hospital representatives to explain the study goals and
procedures, to answer questions, to determine the hospital's
enrollment, and to initiate the human subjects review process.
The authors found that
* The designated hospital representative often held various positions;
representatives included chief executive officers, medical directors,
directors of nursing, directors of medical records, IRB chairs, and
privacy officers.
* Of the 23 hospitals contacted by mail, only one declined to
participate owing to the fact that its medical records department was
being remodeled during the study period. The remaining 22 hospitals
agreed to participate contingent on human subjects approval.
* Two hospitals were excluded because of unanticipated financial
requirements that had not been budgeted for (i.e., costs associated
with review outsourcing and fees for pulling medical record charts).
* Only one hospital indicated a willingness to rely on earlier obtained
IRB approvals. The rest chose to use their own research oversight.
* All hospitals required clarification and interpretation on HIPAA
privacy regulations and expressed concern about protected health
information confidentiality.
* Ten of the participating hospitals used expedited in-house IRB
review, and nine required full IRB review. Each of the nine full IRB
reviews employed markedly different application forms, content, and
procedures for referencing HIPAA.
The authors point out that it was not possible to determine whether the
problems they encountered were directly attributable to the HIPAA rule
or to the common rule. They conclude that although "hospital interest
in participation remained high through the HIPAA transition period . .
. researchers should anticipate increased costs and plan accordingly
when budgeting for human subjects review processes."
Lydon-Rochelle M, Holt VL. 2004. HIPAA transition: Challenges of a
multisite medical records validation study of maternally linked birth
records. Maternal and Child Health Journal 8(1):35-38.
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6. ARTICLE ASSESSES THE EFFECT OF WORD CHOICE IN SUMMARY STATEMENTS
ABOUT DENTAL CARIES PREVALENCE
"Our findings showed that the precise use of language when describing
the disease burden in a population is critical," state the authors of
an article published in the winter issue of the Journal of Public
Health Dentistry. The authors of this article explain that summary
statements such as "80 percent of decayed, missing, or filled permanent
teeth is found in 25 percent of the population" have been used
extensively by researchers and policymakers to guide the reallocation
of funds and bring attention to the unequal distribution of dental
caries in the United States. They add that "despite the best intentions
of these researchers and policymakers, however, the summary statements
have been applied too broadly, with little regard for age or the type
of dentition that is involved in the research or policy." The purpose
of the investigation described in this article was to provide
cumulative frequency distributions of dental caries for the primary and
permanent dentitions and selected age cohorts.
Data for this investigation were derived from Phases I and II of the
Third National Health and Nutrition Examination Survey.
The authors found that
* Seventy-five percent (cumulative) of the total decayed or filled
primary teeth (dft) was in a substantially smaller proportion of
2-year-old children (3.3%) than in children ages 3-5 (9.8%) and ages
2-5 (8.1%).
* The proportion of persons exhibiting 75% (cumulative) of the total
decayed, missing, or filled permanent teeth (DMFT) increased with each
incremental change in age. Whereas 11.4% of children ages 6-11
exhibited 75% (cumulative) of the DMFT, the proportions for person ages
20-29, 40-49, 60-69, and 80 or older were 38.4%, 49.8%, 57.0%, and
61.5%, respectively.
* In general, the weighted proportions of persons exhibiting 75%
(cumulative) of the total dft and DMFT increased with age, with greater
changes appearing among younger cohorts and smaller changes appearing
among older cohorts.
* The weighted proportions of persons exhibiting 75% (cumulative) of
the total dental caries experience was higher for the permanent
dentition than it was for the primary dentition.
The authors conclude that "future studies must untangle the complex and
interrelated factors which determine who has dental caries and why."
They continue, "Precision is the first step, but a long walk still
might be necessary."
Macek MD, Heller KE, Selwitz RH, et al. 2004. Is 75 percent of dental
caries really found in 25 percent of the population? Journal of Public
Health Dentistry 64(1):20-25.
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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
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The editors welcome your
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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
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