MCH Alert

Maternal and Child Health Library

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May 27, 2005

1. New Edition of Overweight in Children and Adolescents Knowledge Path Released
2. Brief Reviews Efforts to Increase Women's Awareness and Use of Preventive Care
3. Educational Materials Promote Communication from Birth
4. Report Presents Findings from Assessment of Epidemiologic Capacity in State and Territorial Health Departments
5. Survey Explores Emergence of Doulas as Childbirth Paraprofessionals
6. Article Examines Immigrant Families' Awareness of Health and Community Resources



The new edition of Knowledge Path: Overweight in Children and Adolescents is an electronic guide to recent, high-quality resources and information tools for identifying, preventing, managing, and treating overweight in children and adolescents. Produced by the MCH Library, the knowledge path includes information on (and links to) Web sites and electronic publications, databases, and electronic newsletters. It is intended for use by health professionals, policymakers, educators, and families who are interested in tracking timely information on this topic. The knowledge path is available at

MCH Library knowledge paths on other maternal and child health topics are available at The MCH Library welcomes feedback on the usefulness and value of these knowledge paths. A feedback form is available at



Women's Health: Successes and Challenges in Prevention and Promotion summarizes new policies and programs on women's health at the federal and state levels, research and evidence-based efforts, and successful prevention and treatment options. The National Institute for Health Care Management Foundation (NICHM), with support from the Health Resources and Services Administration's Maternal and Child Health Bureau, convened a forum of leaders in women's health from federal government offices on women's health, along with medical directors and those working on programs related to women's health within health plans. The action brief recaps forum presentations on the successes and challenges faced in the development and implementation of women's health prevention and promotion programs. A list of additional resources for women's health information is provided. NIHCM has also published a background paper, Women's Health: Prevention and Promotion, which highlights current programs and research on successful women's health prevention and treatment options. The action brief and paper are available at



The Centers for Disease Control and Prevention's Early Hearing Detection and Intervention (EHDI) Program has released several educational materials to help promote communication from birth for all children. Two spiral-bound booklets, titled Just in Time for Pediatric Primary Care Providers and Just in Time for Families, provide an overview of the EHDI process, 1-3-6 plan, risk factors, communication choices, and early intervention. Other materials include a CD-ROM, a fact sheet, posters, and parent guides. A brochure about CDC's EHDI programs in states to identify infants with hearing loss through universal screening has also been produced. The materials are available at



"Further attention to recruitment and training are needed to increase the number of trained epidemiologists and improve the public health infrastructure in the United States," state the authors of a report published in the May 13, 2005, issue of Morbidity and Mortality Weekly Report. In November 2001, the Council of State and Territorial Epidemiologists conducted a survey of state and territorial health departments to assess their core epidemiologic capacity. The survey was completed just before distribution of approximately $1 billion in terrorism preparedness and emergency response funds in fiscal year 2002. The funds were intended to improve the U.S. public health infrastructure. Results of the 2001 survey, published in 2003, indicated inadequate capacity among health departments to fully perform essential public health services in six of eight key epidemiology program areas. The report summarizes the results of a 2004 follow-up survey to (1) assess epidemiologic capacity in the United States and its territories in the same eight program areas, (2) estimate the number of additional epidemiologists needed for full performance, and (3) identify education and training needs.

Study participants, (state epidemiologists or their designees in all 50 states, three of eight territories, and the District of Columbia) completed an online survey during May-September 2004. The response rate was 91.5%.

The authors found that
The authors conclude that "creation of a strong public health infrastructure fully capable of performing essential services will require additional trained epidemiologists in state and territorial health departments."

Boulton ML, Abellera J, Lemmings J, et al. 2005. Assessment of epidemiologic capacity in state and territorial health departments -- United States, 2004. Morbidity and Mortality Weekly Report 54(18):457-459. Available at



"Our survey findings suggest that a number of challenges . . . present significant obstacles to the further growth of doulas as childbirth paraprofessionals in the United States," state the authors of an article published in the May/June 2005 issue of Women's Health Issues. The number of people who are seeking doula certification and who are offering doula services for a fee or as part of a hospital-based maternity care team is growing. However, little sociological or health services research focuses on doulas or how they are practicing. The article presents findings from the first national survey of doulas in the United States. The authors (1) present descriptive information about doulas' sociodemographic and practice characteristics, (2) compare the background and practice characteristics of certified and not-yet-certified doulas to identify similarities and differences, (3) document doulas' attitudes toward and perspectives on salient aspects of their work, and (4) identify important questions for future research.

The study population was drawn from all current members (N=5,109) of five professional doula associations who were residents of the United States and who were either certified doulas or had started the certification process. In June 2003, study participants were asked to answer a mailed questionnaire. Surveys were completed by 626 doulas (471 certified and 155 not-yet certified), for an overall response rate of 64.4%.

The authors found that
The authors conclude that "additional research is needed to better understand the unique role and contributions of doulas/labor assistants to maternity care teams in the 21st century."

Lantz PM, Low LK, Varkey S, et al. 2005. Doulas as childbirth paraprofessionals: Results from a national survey. Women's Health Issues 15(3):109-116. Abstract available at!&_cdi=5192&view=c&_acct=C000035538&_version=1&_urlVersion=0&_userid=655954&md5=d1647b74c3db762917d37f2867083db7.

Readers: More information on the provision of continuous caregiver support during childbirth is available from the MCH Library's knowledge path, Preconception and Pregnancy, at



"Immigrant parents are at particularly high risk of alienation from systems of health care and support services that are available to low-income and other vulnerable populations in the United States," write the authors of an article published in the March 2005 issue of the Maternal and Child Health Journal. U.S. census data indicate that 20% of children lived with a foreign-born householder in 2002; these children tended to be younger and more likely to be living in poverty than those living with U.S.-born householders. Despite studies showing lower mortality and morbidity risks among immigrants compared to U.S.-born infants, children, and adults, other measures of well-being have been less favorable. The study described in this article discusses the prevalence of resource awareness by immigrant status of parents and isolates the independent risk factors that contribute to immigrants' lack of awareness of family resources in their communities.

The study used data from the 1999 National Survey of America's Families, which includes 35,938 children under age 18. The analysis assessed parents' immigrant status (U.S.-born citizens, naturalized U.S. citizens, and noncitizens) and parents' knowledge of specific programs in the community where they or their families can go for six types of support services, including (1) for a teenager to get help to stay out of trouble with pregnancy, drugs, or crime; (2) for a family to go for help getting housing, food, or money in an emergency; (3) for a family to go if the parents and children are arguing a lot; (4) resources that step in if parents cannot or will not take care of their children; (5) resources that can help if a family member is being violent to a child or adult in the family; and (6) for someone to go to get help to stop abusing drugs or alcohol.

The authors found that
The authors conclude that "it is critical that community resources use all available means to reach immigrant communities in their languages and with culturally acceptable messages, to alert them to the availability of the essential services that they can provide."

Yu SM, Huang ZJ, Schwalber RH, et al. 2005. Parental awareness of health and community resources among immigrant families. Maternal and Child Health Journal 9(1):27-34. Abstract available at,5,14;journal,1,33;linkingpublicationresults,1:105600,1.

Readers: More information about culturally competent services is available from the MCH Library's bibliography at and organizations resource list at


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