MCH Alert

National Center for Education in Maternal and Child Health

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September 17, 2004

1. Report Examines How Young Children Fare on Key Development Markers
2. Revised Set of Chronic Disease Indicators Released
3. Brief Highlights Unique Role of Medicaid and SCHIP in Addressing Children's Mental Health Needs
4. Study Identifies Adolescents' Attitudes About Coping and Help-Seeking Strategies in Response to Suicidal Thoughts and Behaviors
5. Article Describes Whole-Environment Intervention to Improve Asthma-Associated Morbidity Among Urban Children
6. Survey Assesses Prevalence and Characteristics of Children with Special Health Care Needs



Early Child Development in Social Context: A Chartbook reviews more than 30 indicators of development and health for infants and children from birth through age 6, as well as factors in families and communities that affect children's development and health. The project was commissioned by the Commonwealth Fund and undertaken by Child Trends in partnership with the American Academy of Pediatrics' Center for Child Health Research. Topics include socioemotional development, intellectual development, child health, family functioning, parental health, health care receipt, community/neighborhood factors, child care, and demographic factors. In addition to presenting data, the chartbook includes brief research-based explanations of the importance of the indicators and considers possible steps policymakers, practitioners, and parents can take to improve children's development and health. The chartbook is available at



Indicators for Chronic Disease Surveillance, a report published in the September 10, 2004, issue of Morbidity and Mortality Weekly Report: Recommendations and Reports, describes the latest revisions to common definitions and methods for state-level chronic disease surveillance. Epidemiologists, program managers, subject matter experts, and partner organizations reviewed standard definitions for the 73 indicators released in 1999. The revised set of 92 indicators includes 63 unchanged indicators, 6 revised indicators, and 23 new ones. Four indicators from the first edition were deleted. Indicators pertaining specifically to women of childbearing age or students in grades 9 through 12 are included in the following groups: physical activity and nutrition, alcohol and tobacco use, breast and cervical cancer, and oral health. The report describes how each indicator is to be measured, why it is important, the limitations for both the indicator and its data source, and the relevant Healthy People 2010 objective. The report is available at or



Access to Children's Mental Health Services Under Medicaid and SCHIP, a review of coverage policies for mental health services in Medicaid and the State Children's Health Insurance Program (SCHIP), provides information on the prevalence of mental health problems and the use of mental health services among children enrolled in the programs. The Urban Institute assessed Medicaid's and SCHIP's child mental health coverage policies by conducting telephone interviews with officials in 13 states between mid-August and mid-October 2003. Analysis of data from the 2002 National Survey of America's Families provided information on the prevalence of emotional and behavioral problems and the use of mental health services among children nationwide, according to poverty level and insurance coverage. The brief is intended to guide Medicaid and SCHIP policymakers and others on how to best serve children. It is available at



"Suicide prevention and health promotion programs aimed at encouraging adolescents to seek appropriate help from professionals need to not only enhance [adaptive] coping strategies . . . but also explicitly address adolescents' maladaptive coping strategies," note the authors of an article published in the September 2004 issue of the Journal of the American Academy of Child & Adolescent Psychiatry. Suicide is the third leading cause of death among adolescents, yet little is known about the factors associated with adolescents' attitudes about coping with suicidal thoughts in their peers or themselves. The article presents findings from a study to identify adolescents' attitudes about coping and help-seeking strategies for suicidal ideation/behavior and to examine the demographic and clinical correlates of these attitudes.

The study sample included 2,419 adolescents ages 13 through 19 who were enrolled in the 9th through 12th grades in six New York high schools. A self-report questionnaire assessed the major psychiatric risks for adolescent suicide: depression, substance use/abuse, suicidal ideation/suicide attempts, and knowledge and attitudes about suicide and help seeking for a suicidal friend or for one's own emotional distress. Demographic data (age, grade, gender, racial/ethnic background, and household composition) were also assessed.

The authors found that
The current study's findings, the authors conclude, "underscore the recommendation that cognitive restructuring and similar change strategies are indicated as clinical approaches that should be included in our youth suicide prevention armamentarium."

Gould MS, Velting D, Kleinman M, et al. 2004. Teenagers' attitudes about coping strategies and help-seeking behavior for suicidality. Journal of the American Academy of Child & Adolescent Psychiatry 43(9):1124-1133.



"We found that a home-based intervention focused on reducing exposure to multiple indoor allergens and environmental tobacco smoke decreased reported symptoms among inner-city children with atopic asthma," state the authors of an article published in the September 9, 2004, issue of the New England Journal of Medicine. There is limited evidence of the clinical effectiveness of environmental interventions for children with asthma, particularly interventions that focus on improving the indoor environment as a whole (vs. decreasing exposure to a single allergen). The study described in the article evaluated the effectiveness of a multifaceted, home-based environmental intervention for children (ages 5 through 11) with asthma who live in urban areas. The study assessed whether an intervention tailored to each child's allergic sensitization and environmental risk profile could improve that child's asthma symptoms and decrease the use of health care services.

A total of 937 children in whom asthma had been diagnosed by a physician at research centers in the Bronx; Boston; Chicago; Dallas; New York City; the Seattle and Tacoma, WA, area; and Tucson were enrolled in the study between August 1998 and July 1999. The children were randomly assigned to either a control group or an intervention group. Following a baseline evaluation, families in the control group received home environment evaluations at 6-month intervals throughout the 1-year intervention period and for 1 year following the intervention. Families in the environmental-intervention group received visits every 2 months throughout the two-year study period. The intervention was organized into six modules focused on remediation of exposure to dust mites, passive smoking, cockroaches, pets, rodents, and mold.

The authors found that
"We have shown that remediation strategies can be implemented that result in both sustained reductions in indoor allergen levels and sustained improvements in reported asthma-associated morbidity in this high-risk population," conclude the authors.

Morgan WJ, Crain EF, Gruchalla RS, et al. 2004. Results of a home-based environmental intervention among urban children with asthma. New England Journal of Medicine 351(11):1068-1080.

Readers: More information is available from the MCH Library's knowledge path, Asthma in Children and Adolescents, at



"Although many [children with special health care needs] appear to be receiving the services they need, our findings suggest that children in low-income families, those in selected racial and ethnic minority groups, and those without health insurance experience disproportionate barriers to accessing care, have lower rates of access to care, and are less likely to be satisfied with the services they receive," write the authors of an article published in the September 2004 issue of the Archives of Pediatrics and Adolescent Medicine. The authors state that, until now, no state and nationally representative data on the prevalence and impact of special health care needs (SHCNs) has been available. Children with SHCNs are defined by the Maternal and Child Health Bureau (MCHB) as children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health-care-related services of a type or amount beyond that required by children generally. The authors used the first national and state survey of children with SHCNs, which was sponsored by MCHB in 2001, to (1) provide national estimates of the number and proportions of children with SHCNs in the United States, (2) examine the risk factors for having a child with SHCNs, and (3) assess how well the children's needs are being met.

Using a list-assisted, random-digit-dialing telephone survey method, researchers surveyed the families of 38,866 children under age 18 in a representative sample of households in each of the 50 states and the District of Columbia.

The authors found that
The authors conclude that "to address the disparities raised by the survey data, we need systemic change that establishes universal, sustainable community systems of services for all affected children and their families."

van Dyck P, Kogan MD, McPherson MG, et al. 2004. Prevalence and characteristics of children with special health care needs. Archives of Pediatrics and Adolescent Medicine 158(9):884-890.

Readers: More information is available from the MCH Library's knowledge path, Children and Adolescents 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

National Center for Education in Maternal and Child Health
Georgetown University
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