MCH Alert


Maternal and Child Health Library

This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.


January 19, 2007

1. Report Presents Framework to Guide Communication and Knowledge Transfer Between Health Services Researchers and State Policymakers
2. Briefing Summarizes Literature About Factors Affecting Levels of Physical Activity Among Children and Adolescents
3. Randomized Controlled Trial Evaluates Intervention Aimed at Preventing Alcohol-Exposed Pregnancies
4. Authors Assess Patterns of Depressive Symptomatology and Mental-Health-Seeking Behaviors of U.S. and Foreign-Born Mothers

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Special Notice: A diverse coalition of 16 leading, national health care organizations, the Health Coverage Coalition for the Uninsured, has forged an agreement to expand health coverage for individuals who are uninsured. The two-phased consensus proposal includes a balance of private and public initiatives and is the culmination of meetings among the groups over approximately two years. More information about the agreement, the coalition, and the organizations involved is available at http://www.coalitionfortheuninsured.org.

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1. REPORT PRESENTS FRAMEWORK TO GUIDE COMMUNICATION AND KNOWLEDGE TRANSFER BETWEEN HEALTH SERVICES RESEARCHERS AND STATE POLICYMAKERS

Toward a More Effective Use of Research in State Policymaking presents a conceptual framework to support effective use of health services research in health policymaking and to improve communication between researchers and state policymakers and program administrators. The report, published by the Commonwealth Fund, discusses four key steps that can help to ensure an effective, symbiotic relationship between the health services research and health policymaking worlds: (1) understanding the scope and extent of the problem, (2) developing options, (3) implementing a program or policy, and (4) evaluating the program or policy. Practical lessons and communication strategies gleaned from interviews with health services researchers working on state issues and with state health policymakers are presented. A case study of the creation and launch of Massachusetts' health care reform act is also included. The report is intended to inform researchers seeking to create new and improved conduits to reach state policymakers and, in turn, to provide state policymakers with guidance in building effective relationships with researchers. The report is available at http://www.cmwf.org/usr_doc/Meyer_towardmoreeffectiveusestatepolicymaking_980.pdf.

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2. BRIEFING SUMMARIZES LITERATURE ABOUT FACTORS AFFECTING LEVELS OF PHYSICAL ACTIVITY AMONG CHILDREN AND ADOLESCENTS

Childhood Obesity: Factors Affecting Physical Activity presents findings from a literature review to identify factors affecting rates of physical activity for children and adolescents. The report, prepared by the Government Accountability Office (GAO), follows a previous GAO report that identified "increasing physical activity" as the program strategy experts deemed most important to prevent or reduce childhood overweight and obesity. The current report is based on 53 selected articles published from 2003 to 2006 that focus on factors affecting levels of physical activity in school-age children and adolescents, supplemented with information obtained from organizations that recently published information on childhood overweight and obesity. The factors presented in the articles are discussed in three groups: (1) demographic factors, (2) cognitive and behavioral factors, and (3) community factors. Additional research needs and concluding observations are also provided. The report is available at http://www.gao.gov/cgi-bin/getrpt?GAO-07-260R.

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3. RANDOMIZED CONTROLLED TRIAL EVALUATES INTERVENTION AIMED AT PREVENTING ALCOHOL-EXPOSED PREGNANCIES

"This randomized trial found that a brief motivational intervention considerably decreased the risk of AEP [alcohol-exposed pregnancy] in high risk women by altering the targeted behaviors of risky drinking and ineffective contraception use," state the authors of an article published in the American Journal of Preventive Medicine. The Project CHOICES Feasibility Study, a single-arm trial, evaluated a motivational intervention for women determined to be at risk for an AEP. At 6 months post-enrollment, 68.5% of the women had reduced their risk for AEP by reducing drinking, using effective contraception methods, or both. The article presents major findings from a randomized controlled trial following the feasibility study.

Project CHOICES was conducted in six community-based settings in Florida, Texas, and Virginia. The risk of AEP in these combined settings was estimated to be 12.5%, compared with 2% of fertile women of childbearing age in the United States overall. Recruitment strategies included flyers, newspaper and radio announcements, and group presentations. Recruitment was conducted from July 1, 2002, to January 30, 2004. Inclusion criteria were as follows: (1) 18-44 years old; (2) no condition causing infertility; (3) not pregnant or planning to become pregnant in the next 9 months; (4) had vaginal intercourse during the previous 3 months with a fertile man without using effective contraception; (5) engaged in risky drinking; and (6) available for the follow-up period. Participants (N=830) were randomized into two groups: information only (IO; the control group) and information plus counseling (IPC; the intervention group). Women assigned to the IO group received brochures on alcohol use and women's health in general and a referral guide to local resources. Intervention visits comprising four motivational interviewing counseling sessions and one contraception counseling session were delivered to the IPC group for 45 to 60 minutes each over a 14-week period, with approximately 2 to 3 weeks between sessions. Participants were contacted at 3, 6, and 9 months for follow-up assessments. At baseline, all women reported risky drinking (defined as consuming five or more drinks on any day, or on average eight or more drinks per week) and ineffective contraception (any occurrence of vaginal intercourse without effective contraception use). At follow-up, women were categorized as "at reduced risk of AEP" if they reported no risky drinking, effective contraception use, or both.

The authors found that
The authors conclude that "this study demonstrated that a brief behavioral motivational intervention produced significant reductions in risk for AEP among women who met high-risk criteria prior to the study."

Floyd RL, Sobell M, Velasquez MM, Ingersoll K, et al. 2007. Preventing alcohol-exposed pregnancies: A randomized controlled trial. American Journal of Preventive Medicine 32(1):1-10. Abstract available at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VHT-4MSJ7K5-1&_coverDate=01%2F31%2F2007&_alid=521566272&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=6075&_sort=d&view=c&_acct=C000035538&_version=1&_urlVersion=0&_userid=655954&md5=c46d6ab5e0f0c02abb6c222a08f0f247.

Readers: More information is available from the MCH Library's knowledge path, Preconception and Pregnancy, at http://www.mchlibrary.info/KnowledgePaths/kp_pregnancy.html and from the bibliography, Substance Use During Pregnancy, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_subusepreg.html&-MaxRecords=all&-DoScript=auto_search_subusepreg&-search.

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4. AUTHORS ASSESS PATTERNS OF DEPRESSIVE SYMPTOMATOLOGY AND MENTAL-HEALTH-SEEKING BEHAVIORS OF U.S. AND FOREIGN-BORN MOTHERS

"This study . . . shows significant differences for depressive symptomatology in new mothers by race/ethnicity and nativity," state the authors of an article published in the December 15, 2006, issue of the Maternal and Child Health Journal Online First. The article presents national estimates of the burden of maternal depression and health-seeking behaviors by multiple racial and ethnic groups, and specifically, the role of nativity on rates of depressive symtomatology. The article also describes the distributions of key risk factors for maternal depression by nativity and by racial and ethnic groups.

Data for the study was drawn from the Early Childhood Longitudinal Study-Birth Cohort Nine-Month Survey, a study of the home and care experiences of a nationally representative cohort of children from birth through first grade who were born in the United States in 2001. For the present study, the analysis was limited to mothers with infants under age 1 who participated in the home interview and had a valid CES-D (Center for Epidemiological Studies-Depression Scale) score (N=7,676). A sub-sample of mothers who had "moderate" or "severe" depression symptomatology was used for analysis on help-seeking patterns. The study tested for differences in the proportion of degree of depressive symptomatology and mental health help-seeking patterns among racial and ethnic groups, stratified by nativity. Distributions of socioeconomic status, physical health, and marriage characteristics were also examined by depression category and nativity, as well as by the independent effects of race and ethnicity on various outcomes in mental-health-seeking patterns.

The authors found that
This study reports "the burden of maternal depression in 30 sub-ethnic/nativity groups using recent national survey data," state the authors. The findings suggest the need for future research "to delineate the determinants of perinatal depression in certain high prevalence sub-ethnic and nativity groups," they conclude, adding that more efforts are also needed "to overcome the barriers in mental health services access and utilizations, especially in minority and foreign-born populations."

Huang ZJ, Wong FY, Ronzio CR, et al. 2007. Depressive symptomatology and mental health help-seeking patterns of U.S.- and foreign-born mothers. Maternal and Child Health Journal Online First, published online December 15, 2006. Available to subscribers at http://springer.metapress.com/content/a715m0580l24123g/fulltext.pdf.

Readers: More information is available from the MCH Library's knowledge paths, Postpartum Depression, at http://www.mchlibrary.info/KnowledgePaths/kp_postpartum.html and Racial and Ethnic Disparities in Health, at http://www.mchlibrary.info/KnowledgePaths/kp_race.html.

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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 Maternal and Child Health Library at the National Center for Education in Maternal and Child Health under its cooperative agreement (U02MC00001) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.
 
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