Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
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
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1. WEB SITE LAUNCHED TO ADVANCE BOOSTER SEAT SAFETY EDUCATION AND
ADVOCACY
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 http://www.boostkids.org.
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2. REPORT EXAMINES STATE BREASTFEEDING AND MATERNITY LEAVE LEGISLATION
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 http://www.usbreastfeeding.org/Issue-Papers/State-Legislation-2004.pdf.
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3. AUTHORS ASSESS EFFECTIVENESS OF COMMUNITY-BASED PROGRAM IN REDUCING
ASTHMA-RELATED CHILD MORBIDITY
"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
- A total of 3,132 children were screened, of which 982 (31.4%) had
asthma or asthma-like signs and 314 (10.0%) were enrolled in HCZAI.
- School absences reported by the enrollees' parents/guardians
declined both for any reason (from 34.4% to 16.0% in 18 months) and
because of asthma (from 23.3% to 8.0% in 18 months).
- Emergency department and unscheduled physician office visits for
asthma treatment decreased from 35.0% to 8.0% in 18 months.
- Reported use of asthma management strategies (e.g., using a
spacer device, having an asthma action plan) by parents/guardians of
enrolled children increased substantially over time.
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 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a5.htm
or http://www.cdc.gov/mmwr/PDF/wk/mm5401.pdf.
Additional information about HCZAI is available at http://www.hcz.org.
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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4. STUDY EXPLORES REASONS FOR DELAYED OR FORGONE CARE AMONG CHILDREN
WITH SPECIAL HEALTH CARE NEEDS
"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
- CSHCN comprised 12.8% of all the children surveyed; among
these, 9.7% reported delayed or forgone care in the past 12 months.
- The predominant reason for delayed or forgone care was financial
problems (7.82%); followed by time conflicts (4.01%); provider not
accessible (2.97%); lack of an appropriate medical specialty (2.65%);
and language, communication, or cultural problems with the providers
(0.49%).
- Adolescents ages 12-17 were 60% more likely to have delayed or
forgone care than were infants and children from birth through age 5;
CSHCN in the West and South were 50% and 60% more likely, respectively,
to have delayed or forgone care than were CSHCN in the Northeast and
Midwest; for CSHCN from poor or near-poor families and those with
greater functional limitations, the risk of delayed or forgone care was
three times as high as for other CSHCN; and CSHCN who did not have
health insurance were five times more likely to have delayed or
foregone care, compared to those with insurance.
- Hispanics were more likely than non-Hispanics to report "lack of
medical specialty" and "language, communication, and cultural problems
with provider" as reasons for delayed or forgone care. Hispanics and
non-Hispanic others also cited "provider not accessible" significantly
more than did non-Hispanic whites or blacks.
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 http://ampe.allenpress.com/ampeonline/?request=get-abstract&doi=10.1367%2FA04-073R.1.
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5. ARTICLE EVALUATES EFFECTIVENESS OF A QUALITY IMPROVEMENT
INTERVENTION FOR ADOLESCENT DEPRESSION IN PRIMARY CARE CLINICS
"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
- At the 6-month follow-up, adolescents receiving the quality
improvement intervention reported significantly higher rates of mental
health care than those receiving usual care.
- At the 6-month follow-up, adolescents receiving the quality
improvement intervention had significantly lower mean (SC) CES-D scores
than those receiving usual care.
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 http://jama.ama-assn.org/cgi/content/abstract/293/3/311.
Readers: More information is available from Bright Futures in Practice:
Mental Health at http://www.brightfutures.org/mentalhealth/index.html
and from the MCH Library's knowledge path, Mental Health in Children
and Adolescents, at http://www.mchlibrary.info/KnowledgePaths/kp_mentalhealth.html,
and annotated bibliographies, Adolescent Mental Health, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_adolmenhlth.html&-MaxRecords=all&-DoScript=auto_search_adolmenhlth&-search,
and Children's Mental Health, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_chldmenhlth.html&-MaxRecords=all&-DoScript=auto_search_chldmenhlth&-search.
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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
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MANAGING EDITOR: Jolene Bertness
CO-EDITOR: Tracy Lopez
COPYEDITOR/WRITER: Ruth Barzel
MCH Alert
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