Maternal and Child Health Library

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December 15, 2006

1. POLICY CENTER RELEASES SECOND REPORT ON INNOVATIVE APPROACHES FOR IMPROVING PEDIATRIC SUBSPECIALTY CARE

Promising State and Regional Approaches for Extending Access to Pediatric Subspecialty Care and Coordination with Primary Care presents 13 examples of exemplary efforts to extend the geographic reach of pediatric subspecialty care and to enhance the capacity of pediatric health professionals to identify and manage chronic conditions. The report is the second in a series of promising practices reports prepared by the Federal Expert Work Group on Pediatric Subspecialty Capacity, convened by the Maternal and Child Health Policy Resource Center with support from the Maternal and Child Health Bureau. The report is divided into three sections. The first section describes the rationale for strengthening state and regional networks of pediatric subspecialty care within the context of the medical home and the major barriers affecting the expansion of state and regional pediatric specialty systems linked with primary care. The second section contains descriptions of 13 promising state and regional pediatric delivery networks. The third section identifies promising features of state and regional pediatric subspecialty arrangements. The report is available at http://www.mchpolicy.org/practice/documents/StateandRegionalPromisingPractices.pdf.

• For older students, classroom instruction and physical education can promote moderate to vigorous physical activity both in and out of school, especially for adolescent girls.
• Younger students benefit from behavior-change programs that reduce sedentary behavior.

• Classroom programming should provide behavior-modification strategies to help students and their families reduce the amount of fast food, high-sugar drinks, and high-fat foods they consume and increase fruit and vegetable consumption. In addition, food service must be involved in obesity-prevention initiatives, and sales of unhealthy foods for fundraising purposes should be restricted.
• Physical education that promotes at least 30 minutes of vigorous activity three to five times a week is the goal. Achieving this with a cumulative approach through physical education classes, intramural sports, and before- and after-school programs is recommended.
• Schools must consider the reduction of sedentary behavior as a separate issue from increasing physical activity. Classroom programs for reducing sedentary behavior should use a behavior-change approach, start in the early grades, and be repeated every few years.

• The mean age of project EAT-1 participants was 12.8 and of EAT-II participants was 17.2.
• MVPA among female adolescents declined dramatically from 5.9 to 3.9 hours per week during the transition from early to mid-adolescence and from 5.1 to 3.5 hours per week during the transition from mid- to late adolescence.
• Among female adolescents making the transition from early to mid-adolescence, television and videotape viewing time decreased significantly, by 2.2 hours per week, and leisure-time computer use showed a nonsignificant trend toward increasing.
• Computer use significantly increased among older female adolescents during the transition from mid- to late adolescence.
• MVPA among male adolescents did not decline during the transition from early to mid-adolescence but did decline significantly from mid- to late adolescence (from 6.5 to 5.1 hours per week). Leisure-time computer use increased substantially from both early to mid-adolescence (from 11.4 to 14.2 hours per week) and from mid- to late adolescence (from 10.4 to 14.2 hours per week).
• Television viewing time did not change among adolescent males across the adolescent transition period.
• Between 1999 and 2004, secular trends during mid-adolescence indicate further striking increases in computer use. Mid-adolescent males engaged in 10.4 hours of use in 1999, compared with 15.2 hours in 2004. Mid-adolescent females engaged in 2.3 more hours of use per week in 2004 than in 1999.
• There was no evidence of a secular decline in MVPA between 1999 and 2004 for either female or males adolescents.