Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
October 6, 2006
1. New Edition Of Child and Adolescent Health Insurance
and Access to Care Knowledge Path Available
2. Document Examines Development of Fiscal Infrastructure
to Support and Sustain Early Childhood Comprehensive Systems
3. Report Demonstrates That a Large Number of Children
Remain Uninsured and Are Going Without the Health Care They Need
4. Recommendations Released on Establishing Voluntary
National Accreditation Program for State and Local Health Departments
5. Article Explores How Female Children and Adolescents
Interpret Weight-Loss Ads
6. Analysis Assesses Children's Health Care by County
Level of Urban
Influence
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1. NEW EDITION OF CHILD AND ADOLESCENT HEALTH INSURANCE AND ACCESS
TO CARE KNOWLEDGE PATH AVAILABLE
The new edition of Knowledge Path: Child and Adolescent Health
Insurance and Access to Care is an electronic guide to a selection of
recent, high-quality resources about child and adolescent health
insurance and access to care with an emphasis on Medicaid and the State
Children's Health Insurance Program. The knowledge path, produced by
the MCH Library, includes a section on child and adolescent health
coverage campaigns. A separate section lists resources for families.
The knowledge path is intended for use by health professionals, program
administrators, policymakers, educators, researchers, and families who
are interested in obtaining timely information on this topic. The
knowledge path is available at http://www.mchlibrary.info/KnowledgePaths/kp_insurance.html.
MCH Library knowledge paths on other maternal and child health topics
are available at http://www.mchlibrary.info/KnowledgePaths/index.html.
The MCH Library welcomes feedback on the usefulness and value of these
knowledge paths. A feedback form is available at http://www.mchlibrary.info/KnowledgePaths/feedback.html.
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2. DOCUMENT EXAMINES DEVELOPMENT OF FISCAL INFRASTRUCTURE TO SUPPORT
AND SUSTAIN EARLY CHILDHOOD COMPREHENSIVE SYSTEMS
Developing Fiscal Analyses and Children's Budgets to Support ECCS
offers state Early Childhood Comprehensive System (ECCS) initiatives
practical advice on conducting fiscal scans and creating early
childhood budgets. This third Project THRIVE Short Take, published by
the National Center for Children in Poverty (NCCP) with support from
the Maternal and Child Health Bureau, builds on program-by-program
background information from NCCP's Spending Smarter report, as well as
on information from a recent report published by the Forum for Youth
Investment and the Finance Project. The document begins with a
discussion of why fiscal analyses and children's budgets are important.
Using a "how to" approach, the document presents exemplary approaches,
tables, and tools highlighting state and local experience in fiscal
analysis. The document is available at http://nccp.org/media/tst06c.pdf.
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3. REPORT DEMONSTRATES THAT A LARGE NUMBER OF CHILDREN REMAIN UNINSURED
AND ARE GOING WITHOUT THE HEALTH CARE THEY NEED
No Shelter from the Storm: America's Uninsured Children takes a close
look at children who are uninsured -- who they are and what kinds of
services they miss out on as a result of being uninsured. The report,
written by Families USA for the Campaign for Children's Health, is
based on data projections from the Annual Social and Economic
Supplement to the Current Population Survey conducted by the U.S.
Census Bureau and the 2005 National Health Interview Survey conducted
by the National Center for Health Statistics. Data and discussion are
presented on the following topics: (1) who uninsured children are; (2)
the effects of being uninsured on children's use of, and unmet need
for, health care services; (3) variations in uninsured rates across the
50 states and the District of Columbia; (4) differences in unmet health
care needs between children who were uninsured for a full year and
children with coverage gaps of less than a year; and (5) how
differences in unmet health care needs are exacerbated among children
in poorer health. A conclusion and technical appendix (methodology and
tables) are also provided. The full report, along with key findings,
charts, a press release, and state fact sheets, is available at
http://www.childrenshealthcampaign.org/tools/reports/no-shelter-from-the-storm.html.
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4. RECOMMENDATIONS RELEASED ON ESTABLISHING A VOLUNTARY NATIONAL
ACCREDITATION PROGRAM FOR STATE AND LOCAL HEALTH DEPARTMENTS
Final Recommendations for a Voluntary National Accreditation Program
for State and Local Public Health Departments presents a
first-of-its-kind recommended model for a voluntary national public
health accreditation program. The summary report was released by the
Exploring Accreditation Steering Committee, coordinated by the National
Association of County and City Health Officials and the Association of
State and Territorial Health Officials with support from the Robert
Wood Johnson Foundation and the Centers for Disease Control and
Prevention. The recommendations included in the report were informed by
four workgroups (governance and implementation, standards development,
finance and incentives, research and evaluation), as well as by public
comment gathered from public health practitioners and stakeholders via
nationwide public forums, surveys, and online feedback. A discussion of
the committee's consensus that a voluntary national accreditation
program is desirable and feasible and proposed steps for implementation
are included. The summary report is available at http://www.exploringaccreditation.org/documents/EAFinalRecommendations9-29.pdf.
A full report will be released later this fall and will include the
final recommendations, a description of a business case for the
accreditation program, a research agenda to further support the success
of a voluntary national accreditation program, and a full summary of
public comment.
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5. ARTICLE EXPLORES HOW FEMALE CHILDREN AND ADOLESCENTS INTERPRET
WEIGHT-LOSS ADS
"This research used two apriori approaches to analyze how girls
interpret and analyze weight-loss advertising, the first based on the
results of the FTC's content analysis of the most common types of
deceptive advertising and the second employing key concepts of media
literacy as analytic frames for data analysis," write the authors of an
article published in the October 2006 issue of Health Education
Research. In the United States alone, sales of weight-loss products and
dietary supplements nearly doubled between 1994 and 2002. And
adolescent girls worldwide are facing risks to their health from
increased pressures for slimness. The study described in this article
examines female children's and adolescents' (ages 9-17) (hereafter
referred to as girls) responses to print and television (TV)
weight-loss advertising to determine whether deceptive advertising
techniques were recognized and to assess pre-existing media-literacy
skills.
The study population included 42 girls from seven geographic regions in
the United States that varied in racial and ethnic composition. Working
with groups of three girls in after-school settings, researchers showed
specific examples of print and TV ads for weight-loss products, asking
participants about their interpretations of these messages and
audiotaping their responses.
The authors found that
- Consumer testimonials and before/after photos were recognized as
persuasive techniques by 71% of participants.
- Only 17% of participants recognized the persuasive technique of
claiming that products are "doctor-endorsed and scientifically proven."
- Only 11% of participants recognized the persuasive technique of
claiming that weight-loss products are "safe" and "all natural."
- About 48% of participants recognized as persuasive or deceptive
the claims of "permanent weight loss with no diet or exercise."
- More than 90% of participants were able to articulate their
perceptions or feelings toward the characters depicted in the ads.
- Most participants referred to some real-life experience with
family members when they talked about the ads.
- In analyzing the ads, 40% of participants were able to activate
some ideas about appropriate forms of weight management.
- Twenty-nine percent of participants were able to determine whom
ads were targeting.
- Seventeen percent of participants mentioned visual techniques
used to add credibility to ads.
- Few participants demonstrated the ability to spontaneously state
the message subtext of ads.
- Eleven percent of participants speculated about the financial
motives of the people appearing in the ads.
- Participants did not spontaneously generate questions or comments
that demonstrated their ability to notice an omission in an ad (e.g.,
an ad's failure to mention health risks or dangers associated with a
product).
The authors conclude that "discussion about persuasive techniques used
in weight-loss advertising may be a useful educational vehicle for
reinforcing ideas about good nutritional choices and fitness
activities."
Hobbs R, Broder S, Pope H, et al. 2006. How adolescent girls interpret
weight-loss advertising. Health Education Research 2(5):719-730.
Abstract available at http://her.oxfordjournals.org/cgi/content/abstract/21/5/719.
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6. ANALYSIS ASSESSES CHILDREN'S HEALTH CARE BY COUNTY LEVEL OF URBAN
INFLUENCE
"The division of metropolitan into large metro and small metro and the
division of nonmetro into micropolitan and noncore resulted in
additional insights into the relationships between children's health
care and county urbanicity,” state the authors of an article published
in the September-October 2006 issue of Ambulatory Pediatrics. Past
studies have examined the impact of place on children's health care
primarily by using the categories Metropolitan Statistical Area and
Non-Metropolitan Statistical Area (often referred to as urban and
rural). The authors of the article hypothesized that more detailed
county-level definitions may reveal important characteristics between
and within urban and rural settings that may affect the delivery and
quality of health care services. The article presents descriptive data
exploring the differences and similarities in children's health care
coverage, use, expenditures, and quality across a county-level measure
of urbanicity.
Data for the analysis were drawn from two leading national data sets:
the 2002 Medical Expenditure Panel Survey and the 2002 Health Care Cost
and Utilization Project. A collapsed version of the 2003 county-level
Urban Influence Codes (UICs) was used to distinguish among children's
residence and location of the hospital where care was received. The
researchers examined differences across UICs in health insurance
coverage, use, expenditures, and sources of payment for different
settings and kinds of health care services. They also examined
children's residence and location of the hospital where care was
received by diagnosis.
The authors found that
- Overall, there were no differences by county urbanicity in the
proportion of children who were uninsured, had private health
insurance, or had public insurance; however, there was a greater
proportion of children with public-only insurance in micropolitan
counties compared with large metro counties. There were also several
marked differences among racial and ethnic subgroups.
- Overall, the proportion of children with at least one dental
visit was larger in small metro counties compared with both large metro
and noncore counties; there was no significant difference in the rate
of dental use between small metro and micropolitan counties.
- Overall, children in micropolitan counties had an emergency
department (ED) visit rate higher than the rates of children in small
metro counties and in large metro counties. Additionally, children in
noncore counties had an ED visit rate higher than the rate for children
in large metro counties.
- Hospitalizations for children in large metro and small metro
counties were more likely to be billed to commercial insurers, whereas
hospitalizations for children in micropolitan and noncore counties were
more likely to be billed to Medicaid.
- Children in noncore counties were more often hospitalized for
ambulatory sensitive conditions (e.g., gastroenteritis, dehydration,
bacterial pneumonia), compared with children in large and small metro
counties.
- More than half of the hospitalizations of children in noncore
counties took place in more urban areas, whereas almost 100% of
hospitalizations of children in large metro counties took place in
large metro hospitals, and over 90% of hospitalizations for children in
small metro counties took place in small metro hospitals.
"The observance of differences in health care services between large
metro and small metro or between micropolitan and noncore areas
supports the necessity to move beyond the dichotomous notion of urban
and rural areas," conclude the authors, adding that "future research
should investigate not only differences between UIC areas, but also
reasons for differences within these communities."
Chevarley FM, Ownes PL, Zodet MW, et al. 2006. Health care for children
and youth in the United States: Annual report on patterns of coverage,
utilization, quality, and expenditures by a county level of urban
influence. Ambulatory Pediatrics 6(5):241-264. Abstract available at http://www.ambulatorypediatrics.org/article/PIIS1530156706001572/abstract.
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MCH Alert © 1998-2006 by National Center for Education in Maternal
and
Child Health and Georgetown University. MCH Alert is produced by
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