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
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1.REPORT EXAMINES HOW YOUNG CHILDREN FARE ON KEY DEVELOPMENT MARKERS
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 http://www.cmwf.org/usr_doc/ChildTrends-Chartbk2004h.pdf.
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2. REVISED SET OF CHRONIC DISEASE INDICATORS RELEASED
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 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5311a1.htm
or http://www.cdc.gov/mmwr/PDF/RR/RR5311.pdf.
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3. BRIEF HIGHLIGHTS UNIQUE ROLE OF MEDICAID AND SCHIP IN ADDRESSING
CHILDREN'S MENTAL HEALTH NEEDS
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 http://www.urban.org/UploadedPDF/311053_B-60.pdf.
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4. STUDY IDENTIFIES ADOLESCENTS' ATTITUDES ABOUT COPING AND
HELP-SEEKING STRATEGIES IN RESPONSE TO SUICIDAL THOUGHTS AND BEHAVIORS
"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
- Two factors that approximate attitudes consistent with avoidance
and approach coping strategies were identified: a maladaptive coping
strategies (MCS) factor and a help-seeking strategies (HSS) factor,
respectively.
- Boys scored higher than girls on the MCS factor.
- Students with serious suicidal ideation and behavior, depression,
or substance use/abuse problems scored significantly higher than their
healthy counterparts on the MCS factor.
- Students with firsthand experience with a suicidal peer were
significantly more likely to be depressed, have a substance use/abuse
problem, and be seriously suicidal than students without such
experience.
- There was a negative association between serious suicidal
ideation/behavior and HSS; neither depression nor the other correlated
risks accounted for the association.
- Students who were suicidal scored significantly higher on the MCS
factor and were more likely than other students to endorse all the MCS
items.
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.
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5. ARTICLE DESCRIBES WHOLE-ENVIRONMENT INTERVENTION TO IMPROVE
ASTHMA-ASSOCIATED MORBIDITY AMONG URBAN CHILDREN
"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
- The intervention group reported significantly fewer asthma
symptoms during both the intervention year and the follow-up year. The
greater reduction in asthma-related symptoms in the intervention group
occurred within 2 months after randomization and was sustained for the
2 years of the study.
- Levels of cockroach allergens and dust-mite allergens in the
bedroom decreased in both groups over the course of the study; however,
greater reductions occurred in the intervention group.
- Relationships between the reduction in the levels of dust mite
allergens and improvements in reported asthma-associated morbidity were
similar in both groups.
"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 http://www.mchlibrary.info/KnowledgePaths/kp_asthma.html.
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6. SURVEY ASSESSES PREVALENCE AND CHARACTERISTICS OF CHILDREN WITH
SPECIAL HEALTH CARE NEEDS
"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
- Using the MCHB definition, almost 13% of U.S. children had a
special health care need. There was a higher prevalence of older
children, boys, and non-Hispanic white and black children with SHCNs.
- Eighteen percent of children with SHCNs had an unmet need for a
specific heath care service, and about 22% who needed a referral had
difficulty obtaining it.
- Non-Hispanic black and Hispanic families, families with lower
incomes, families without full health insurance coverage, and families
where the child was usually affected by his or her condition were more
likely to report access problems.
- Significant proportions of families with an SCHN child reported
major impacts on the family.
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 http://www.mchlibrary.info/KnowledgePaths/kp_CSHCN.html.
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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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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
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