Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
October 20, 2006
1. Manual Outlines Coordinated, Statewide System of Early
Detection and Intervention for Children
2. Web Site Features Two New Programs Proven to Improve
Outcomes for Adolescents
3. NIH Launches New HIV Vaccine Awareness Campaign
4. Article Investigates Effects of State Policies on
Nonmedical Exemptions to Immunization Requirements
5. Authors Explore Causes of Mortality Disparities That
Can Inform Specific Health Intervention Policies and Programs
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1. MANUAL OUTLINES COORDINATED, STATEWIDE SYSTEM OF EARLY DETECTION
AND INTERVENTION FOR CHILDREN
How to Develop a Statewide System to Link Families with Community
Resources: A Manual Based on Help Me Grow offers guidance for
exploring, creating, or enhancing a statewide single-point-of-access
system to connect children with community resources. The manual is
available in its entirety on the Commonwealth Fund Web site. It is
based on Connecticut's Help Me Grow initiative, a program that assists
families and providers in identifying developmental concerns, finding
appropriate resources, and helping families connect with programs and
services. Topics include recruitment, retention, and recognition of
partners; call centers; community-based liaisons; data collection;
evaluation; and continuous quality improvement. The manual is available
at http://www.cmwf.org/General/General_show.htm?doc_id=381829.
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2. WEB SITE FEATURES TWO NEW PROGRAMS PROVEN TO IMPROVE OUTCOMES FOR
ADOLESCENTS
Two proven programs were recently added to RAND's Promising Practices
Network (PPN) Web site: the Coping with Stress Course and the
Adolescents Coping with Depression Course (CWD-A).
The Coping with Stress Course targets adolescents who are at risk for
developing depression. The program focuses on teaching coping
strategies in an effort to provide adolescents with the skills needed
to counteract their vulnerability to depression and other mood
disorders later in life. Participants in the program have experienced
significant reductions in depressive episodes and symptoms as well as
in other depression-related measures. More information is available at
http://www.promisingpractices.net/program.asp?programid=151.
CWD-A shows promising effects for adolescents who are already
experiencing high levels of depression. CWD-A teaches a variety of
skills to cope with and relieve depression, including techniques for
assertiveness, relaxation, cognitive restructuring, and mood
monitoring. The program also includes a group intervention for parents
to encourage their support and reinforce the adolescent's use of these
coping skills, and to teach parents communication and problem-solving
techniques. More information is available at
http://www.promisingpractices.net/program.asp?programid=152.
Each program was carefully screened for quality and to ensure that
there is evidence for the program's positive effects. The PPN site
contains information on outcome areas, indicators, topic areas, and
level of evidence for each featured program. Additional summary
components include the program overview and information about program
participants, evaluation methods, key evaluation findings, probable
implementers, funding, implementation details, issues to consider,
example sites, contact information, available resources, a
bibliography, and date of last review.
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3. NIH LAUNCHES NEW HIV VACCINE AWARENESS CAMPAIGN
Be the Generation is a new public-awareness campaign designed to build
understanding and support of HIV vaccine research, as well as trust and
participation in the research. The campaign, launched by the National
Institute of Allergy and Infectious Diseases, works with community
leaders, community-based and national organizations, health
professionals, and educators to provide communities most affected by
HIV with information about preventive HIV vaccine research and what
they should know about HIV vaccine. The campaign Web site, which
features background information, how to get involved, an HIV vaccine
quiz, frequently asked questions, and resources, is available at http://www.bethegeneration.org.
A campaign toolkit containing brochures, stickers, fact sheets, and
customizable posters (many of which are available in English and
Spanish) is also available at http://www.bethegeneration.org/toolkit.htm.
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4. ARTICLE INVESTIGATES EFFECTS OF STATE POLICIES ON NONMEDICAL
EXEMPTIONS TO IMMUNIZATION REQUIREMENTS
"States must balance parental autonomy with the tremendous public
health benefit of vaccines when considering the types of exemptions
allowed and how policies are implemented," state the authors of an
article published in the October 11, 2006, issue of JAMA, The Journal
of the American Medical Association. State-mandated school immunization
requirements have played a major role in achieving and maintaining low
rates of vaccine-preventable diseases in the United States. However, 48
states permit nonmedical (religious, philosophical, and any other
unspecified) exemptions to these requirements. The primary objectives
of the study described in this article were to determine if (1) the
rates of nonmedical exemptions differ and have been increasing in
states that offer only religious vs. personal belief exemptions, (2)
the rates of nonmedical exemptions differ and have been increasing in
states that have easy vs. medium and easy vs. difficult procedures for
obtaining exemptions, and (3) pertussis incidence is associated with
the policies of granting personal belief exemptions, ease of obtaining
exemptions, and acceptance of parental signature as sufficient proof of
compliance with school immunization requirements. The main outcomes
measures were state-level exemption rates and pertussis incidence.
The authors analyzed state-level exemption rates for the 1991-1992
through 2004-2005 school years for the 48 states that permit nonmedical
exemptions and the District of Columbia (DC). The authors also analyzed
pertussis incidence (for children and adolescents ages 18 or younger)
and state policies for these 48 states and DC for the years 1986
through 2004.
The authors found that
- States that offered personal belief exemptions had higher rates
of exemption than states that offered only religious exemptions for
each year from 2001 through 2004.
- From 2002 through 2003, states that easily permitted exemptions
at baseline had higher mean nonmedical exemption rates than states that
had medium and difficult procedures for granting exemptions.
- In unadjusted analyses, pertussis incidence in states allowing
personal belief exemptions were more than twice as high as in states
that offered only religious exemptions.
- States that easily permitted exemptions were associated with a
90% higher incidence of pertussis compared with states with difficult
procedures for granting exemptions, and states with medium procedures
were associated with a 27% higher incidence of pertussis compared with
states with difficult procedures.
- Easily granting exemptions and availability of personal belief
exemptions remained associated with higher pertussis incidence in the
multivariate analysis.
- Mean exemption rates increased in states that easily permitted
exemptions and remained fairly constant in states that had medium and
difficult procedures for granting exemptions.
The authors conclude that "Our findings support the need for effective
administrative controls over granting nonmedical exemptions. Moreover,
state-level policies on nonmedical exemptions should be viewed as part
of the efforts to control or eliminate vaccine-preventable diseases."
Omer SB, Pan WKY, Halsey NA. 2006. Nonmedical exemptions to school
immunization requirements: Secular trends and association of state
policies with pertussis incidence. JAMA, The Journal of the American
Medical Association 296(14):1757-1763. Abstract available at http://jama.ama-assn.org/cgi/content/abstract/296/14/1757.
Readers: More information about immunizations is available from the MCH
Library's bibliography at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_immuniz.html&-MaxRecords=all&-DoScript=auto_search_immuniz&-search.
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5. AUTHORS EXPLORE CAUSES OF MORTALITY DISPARITIES THAT CAN INFORM
SPECIFIC HEALTH INTERVENTION POLICIES AND PROGRAMS
"Mortality disparities are most concentrated in young and middle-aged
males and females, and are a result of a number of chronic diseases and
injuries with well-established risk factors," state the authors of an
article published in the September 2006 issue of PLoS Medicine. Data
limitations have severely hampered efforts to characterize the
contributions to mortality disparities of specific diseases and
injuries; risk factors such as tobacco, alcohol use, or obesity; access
to effective health care; and the broader socioeconomic determinants of
health and disease. The article examines the role of particular
diseases in age-specific and all-age mortality disparities and
identifies distinct subgroups, based on a small number of
sociodemographic and geographical indicators, toward whom public health
and medical interventions may be targeted.
The largest measurable gaps in life expectancy observed in the United
States to date are those revealed by examining inequalities by the
combination of race and county of residence. To investigate the causes
of the observed race-county mortality disparities, within the
limitations posed by existing data, the researchers divided U.S.
race-counties into eight subgroups, referred to as the "eight
Americas." The division of the eight subgroups was based on a number of
variables, including race, the location of the county of residence,
population density, race-specific county-level per-capita income, and
cumulative homicide rate.
Using data from the Bureau of the Census and the National Center for
Health Statistics, the researchers estimated life expectancy, risk of
mortality from specific diseases, health insurance, and health care
utilization for the eight Americas.
The authors found that
- The gap between the life expectancies for the 3.4 million black
males in high-risk urban areas and the life expectancies for the 5.5
million Asian females in 2001 was 20.7 years.
- Within the sexes, the gap in life expectancies between the
best-off and the worst-off groups was 15.4 years for males (Asians vs.
blacks in high-risk urban areas) and 12.8 years for females (Asians vs.
low-income southern rural blacks).
- The mortality disparities in the eight Americas were largest for
young (ages 15-44) and middle-aged (ages 45-64) adults. The major
mortality gradients in these age groups were observed for injuries,
cardiovascular diseases, and other noncommunicable causes.
- Native Americans in the West reported the lowest health plan
coverage, followed by low-income southern rural blacks.
- Basic health system encounter, measured as the fraction reporting
a routine checkup in the past 12 months, showed relatively small
variation across the eight Americas.
"The emphasis on children and the elderly has treated many of the
diseases that are important contributors to young and middle-aged adult
health disparities, and their risk factors, as either the
responsibilities of individuals . . . or in the domain of clinical
care," state the authors. They conclude that "a number of important
steps are needed to broaden the current perspective," including (1) the
use of systematic epidemiological and economic analyses to identify
effective and cost-effective health interventions that would make the
biggest difference to those with the worst health, (2) the development
of monitoring systems by the states and territories to provide local
but benchmarked information on the fraction of the population in each
community who would benefit from these interventions and are receiving
them, and (3) public reporting of information on the delivery of
interventions for different communities.
Murray CJL, Kulkarni SC, Michaud C, et al. 2006. Eight Americas:
Investigating mortality disparities across races, counties, and
race-counties in the United States. PLoS Medicine 3(9, e260):1513-1524.
Full text (open access) available at
http://medicine.plosjournals.org/perlserv?request=get-document&doi=10.1371/journal.pmed.0030260.
Readers: More information is available from the MCH Library's
bibliography, Infant Mortality, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_infmortality.html&-MaxRecords=all&-DoScript=auto_search_infmortality&-search;
and from the organizations resource lists, Child, Adolescent, and
Maternal Mortality, at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_mortality.html&-MaxRecords=all&-DoScript=auto_search_mortality&-search
and Maternal Morbidity and Mortality, at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_matmort.html&-MaxRecords=all&-DoScript=auto_search_matmort&-search.
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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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