MCH Alert

Maternal and Child Health Library

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January 28, 2005

1. Web Site Launched to Advance Booster Seat Safety Education and Advocacy
2. Report Examines State Breastfeeding and Maternity Leave Legislation
3. Authors Assess Effectiveness of Community-Based Program in Reducing Asthma-Related Child Morbidity
4. Study Explores Reasons for Delayed or Forgone Care Among Children with Special Health Care Needs
5. Article Evaluates Effectiveness of a Quality Improvement Intervention for Adolescent Depression in Primary Care Clinics



The National Partnership on Booster Seat Safety has launched a new Web site to promote the use of booster seats for children who have outgrown their child safety seats but are not ready to use standard seat belts. The Web site is managed by the National Healthy Mothers, Healthy Babies Coalition (HMHB) with support from the CarMax Foundation; the site is part of an effort to expand HMHB's work on occupant-protection issues. The Web site's resources page contains links to federal recommendations, a list of recalled products, videotape demonstrations for parents, a database of state laws, state-by-state reports of crashes involving children, creative resources for teachers, and more. The site is intended for use by families, health professionals, and policymakers in their efforts to save lives and prevent injury through booster seat safety education and advocacy. The Web site is available at



State Legislation that Protects, Promotes, and Supports Breastfeeding: An Inventory and Analysis of State Breastfeeding and Maternity Leave Legislation highlights the integral role of state legislation in breastfeeding. The report, released for public review by the United States Breastfeeding Committee, presents an analysis of state breastfeeding laws in 10 categories to include legislative updates to May 25, 2004. The report examines which state provisions currently exist, which could be strengthened through modifications, and which combinations of provisions provide the ideal or best practice legislation in their category. The first section of the report deals with legislation that refers directly to breastfeeding, and the second section presents a compilation and discussion of laws in other perinatal realms that affect breastfeeding (e.g., maternity leave laws). Appendices include information for all states (not only those with laws enacted) to show a comprehensive picture of the nation's breastfeeding and maternity leave legislation status. The report is available at



"The effectiveness of HCZAI [Harlem Children's Zone Asthma Initiative] underscores the utility of community-based public health programs in reducing asthma morbidity," state the authors of a report published in the January 14, 2005, issue of Morbidity and Mortality Weekly Report. The HCZAI was established to reduce asthma-related morbidity through improved surveillance, health care use, and health care service delivery for children ages 11 and younger living in a 60-block radius of Central Harlem, New York City, known as the Harlem Children's Zone Project. The report summarizes preliminary data collected during 2001-2004 on the effectiveness of the program in reducing asthma-related morbidity.

To identify children with asthma or asthma-like signs, a parent or guardian of all children living or attending school in the study region completed a survey, and a physician or nurse conducted a physical examination of the children. Families of children enrolled in HCZAI received medical, educational, environmental, social, and legal services from a pediatric asthma team (four community workers, a social worker, a nurse, and three physicians). Selected indicators of asthma symptoms and management strategies were monitored via in-home interviews with a parent or guardian of each enrolled child; interviews were conducted at 3-month intervals for a period of 18 months.

The authors found that
These findings indicate "improved asthma management and appropriate use of health care services by program enrollees," state the authors.

Nicholas SW, Hutchinson VE, Ortiz B, et al. 2005. Reducing childhood asthma through community-based service delivery -- New York City, 2001-2004. Morbidity and Mortality Weekly Report 54(01):11-14. Available at or Additional information about HCZAI is available at

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



"By exploring the specific reasons of delayed or forgone care, we were able to assess the barriers to health access across the diverse backgrounds of CSHCN [children with special health care needs]," state the authors of an article published in the January/February 2005 issue of Ambulatory Pediatrics. Studies have shown that CSHCN are more likely to have at least one unmet need, to be unable to obtain needed health care, and to delay obtaining health care because of cost. However, no study has examined the reasons other than cost for delayed or forgone care among CSHCN. The article describes the sociodemographic characteristics of CSHCN who had delayed or forgone care and explores reasons for delayed or forgone care and their associations with other factors.

Data for the analysis were drawn from the 2001 National Survey of Children with Special Health Care Needs, a three-part survey designed to (1) collect sociodemographic information for all children ages 17 and younger, (2) identify children who have special health care needs, and (3) provide comprehensive data on the child's health and functional status and the child's and family's experiences with the health care system. A single measure was created to screen whether the respondent (parent or legal guardian) perceived delayed or forgone care during the previous 12 months. Respondents who answered "yes" were asked an additional 12 questions, each focusing on a specific reason for delayed or forgone care. Sociodemographic variables included the child's race or ethnicity, age group, gender, poverty status, and region of residence. The functional ability of the child and the child's health insurance coverage were also assessed. The analyses tested for differences in the proportions of reasons for delayed or forgone care in different sociodemographic groups and factors.

The authors found that
The authors conclude that the study "provides insights and references for clinicians and health policy makers on how to reduce the disparities of health and health access in the population."

Huang ZJ, Kogan MD, Yu SM, et al. 2005. Delayed or forgone care among children with special health care needs. Ambulatory Pediatrics 5(1):60-67. Abstract available at



"This is the first demonstration that depression and quality-of-life outcomes can be improved through a quality improvement intervention for depressed adolescents in primary care settings," state the authors of an article published in the January 19, 2005, issue of JAMA, The Journal of the American Medical Association. The prevalence of major depression during adolescence is high, and untreated depression is associated with suicide and other negative outcomes. According to the authors, the advances that have been made in treating adolescent depression have had limited impact on community care, with current data indicating high unmet need and poorer quality and outcomes for community treatment compared with efficacy studies. The study described in this article evaluated a quality improvement intervention aimed at improving access to evidence-based treatments for adolescent depression (especially cognitive behavior therapy [CBT] and antidepressant medication) in primary care settings.

Researchers conducted a randomized controlled trial between 1999 and 2003. Study participants included 418 adolescents (ages 13-21) with current depressive symptoms. Participants were randomly assigned to receive the quality improvement intervention or usual care. The quality improvement group had access to expert leader teams, managers who supported primary care clinicians with patient evaluation, education, medication and psychosocial treatment, linkages with specialty mental health services, training of care managers in manualized CBT for depression, and clinician choice of treatment modalities. The main outcome measure was the total score on the Center for Epidemiological Studies-Depression Scale (CES-D).

The authors found that
The authors conclude that "the present results demonstrate that quality improvement interventions for adolescent depression are feasible in primary care settings and associated with benefits on measures of depression, quality of life, and satisfaction with mental health treatment."

Asarnow JR, Jaycox LH, Duan N. 2005. Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics. JAMA, The Journal of the American Medical Association 293(3):311-319. Abstract available at

Readers: More information is available from Bright Futures in Practice: Mental Health at and from the MCH Library's knowledge path, Mental Health in Children and Adolescents, at, and annotated bibliographies, Adolescent Mental Health, at, and Children's Mental Health, at


MCH Alert © 2005 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert is produced by Maternal and Child Health Library at the National Center for Education in Maternal and Child Health under its cooperative agreement (U02MC00001) 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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MANAGING EDITOR: Jolene Bertness
CO-EDITOR: Tracy Lopez

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