
Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
February 23, 2007
1. Booklet Describes How Science Has Revolutionized the
Understanding of Drug Addiction
2. New Data on Autism Spectrum Disorders from Multiple
Communities in the United States Released
3. Study Finds Improved Health Care Among Children with
Special Health Care Needs After Enrollment in State Children's Health
Insurance Program
4. Article Examines Conjoined Effects of Low Birthweight
and Childhood Abuse on Adaptation and Well-Being Later in Life
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1. BOOKLET DESCRIBES HOW SCIENCE HAS REVOLUTIONIZED THE
UNDERSTANDING OF DRUG ADDICTION
Drugs, Brains, and Behavior: The Science of Addiction provides
information about drug addiction, including the many harmful
consequences of drug abuse and the basic approaches that have been
developed to prevent and treat it. The 30-page, full-color booklet,
published by the National Institutes on Drug Abuse, discusses the
reasons people take drugs, why some people become addicted while others
do not, how drugs work in the brain, and how addiction can be prevented
and treated. Information about NIDA's addiction-research program and
efforts to share findings with professional audiences and the general
public are provided, along with information about NIDA's special
initiatives to target students and teachers, designated populations,
and ethnic groups. The booklet is intended for use by health
professionals and the general public in making informed choices in
their own lives, adopting science-based policies and programs that
reduce drug abuse and addiction in their communities, and supporting
scientific research that improves the nation's well-being. The booklet
is available at http://www.drugabuse.gov/scienceofaddiction/sciofaddiction.pdf.
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2. NEW DATA ON AUTISM SPECTRUM DISORDERS FROM MULTIPLE COMMUNITIES IN
THE UNITED STATES RELEASED
Prevalence of the Autism Spectrum Disorders in Multiple Areas of the
United States, Surveillance Years 2000 and 2002, discusses findings on
autism spectrum disorders (ASDs) prevalence recently reported by the
Autism and Developmental Disabilities Monitoring (ADDM) Network. The
fact sheet draws from two ADDM Network reports published in the
February 9, 2007, issue of the Morbidity and Mortality Weekly Report
(MMWR) Surveillance Summaries. The studies evaluated the prevalence of
ASDs over several time points and compared the number of children with
ASDs in different areas or groups of people. The fact sheet is
available at http://www.cdc.gov/od/oc/media/pressrel/2007/f070208.htm.
The February 9, 2007, issue of Morbidity and Mortality Weekly Report
Surveillance Summaries is available at http://www.cdc.gov/mmwr/PDF/ss/ss5601.pdf.
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3. STUDY FINDS IMPROVED HEALTH CARE AMONG CHILDREN WITH SPECIAL HEALTH
CARE NEEDS AFTER ENROLLMENT IN STATE CHILDREN'S HEALTH INSURANCE PROGRAM
"These findings extend our prior work to demonstrate that for
special-needs children who enrolled onto SCHIP, access and quality of
care improved after enrollment," state the authors of an article
published in the January-February 2007 issue of Ambulatory Pediatrics.
Despite evidence that the State Children's Health Insurance Program
(SCHIP) improves care for the general population of children, few
studies have assessed whether children with special health care needs
(CSHCN) experience similar benefits. The article discusses findings
from an assessment of the impact of New York's SCHIP on access and
quality of care among CSHCN.
The study was part of a larger evaluation of CSHCN who enrolled in New
York's SCHIP between 2001 and 2002. New York's SCHIP administrative
files were analyzed to identify new enrollees, from which a stratified
random sample of new enrollees was selected from four geographic
regions, three age groups, and three racial and ethnic groups (based on
parent self-report). Parents were interviewed shortly after enrollment
(baseline) and again 13 months after enrollment (follow-up).
Before-after cohort analyses were conducted to assess the following:
(1) demographic and health characteristics of SCHIP enrollees with
special health care needs, (2) health care measures before and after
enrollment in SCHIP by prior insurance and by type of special health
care needs. (3) parent rating of the quality of medical care, and (4)
reasons for unmet health care need before and after enrollment in
SCHIP. To assess secular trends, baseline measures for the study group
were also compared to baseline measures for a comparison group that
enrolled 1 year later.
The authors found that
- At baseline, 454 (17%) of 2,644 children were identified as
CSHCN; 398 (88%) of 454 CSHCN completed the follow-up interview and
made up the analytical group.
- Most of the CSHCN had been enrolled in SCHIP for more than 9
months.
- Among CSHCN with physical conditions, improvements after SCHIP
were noted for those having a usual source of health care (USC), having
unmet needs for prescription medications, and having all or most visits
to the USC.
- Improvements were noted regardless of prior insurance status or
type of chronic condition.
- Although unmet health care need declined after enrollment in
SCHIP, it remained relatively high even during enrollment. The number
of parents citing reasons for unmet needs related to costs or to health
insurance (e.g., "costs too much" or "didn't have health insurance")
declined markedly after enrollment in SCHIP, whereas the number citing
reasons related to access to health care or to family factors (e.g.,
transportation or language) remained about the same after enrollment.
One measure of successful care for CSHCN, as outlined by the Maternal
and Child Health Bureau, is having adequate private or public insurance
to pay for needed services. "Our study suggests," the authors conclude,
"that SCHIP improved health care for CSHCN by changing the pattern of
health services for CSHCN to greater reliance on the USC."
Szilagyi PG, Shone LP, Klein JD, et al. 2007. Improved health care
among children with special health care needs after enrollment in the
State Children's Health Insurance Program. Ambulatory Pediatrics
7(1):10-17. Abstract available at http://www.ambulatorypediatrics.org/article/PIIS1530156706002097/abstract.
Readers: More information is available from the MCH Library's knowledge
path, Children and Adolescents with Special Health Care Needs, at http://www.mchlibrary.info/KnowledgePaths/kp_CSHCN.html;
the bibliographies, Adolescents with Special Health Care Needs, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_adolshn.html&-MaxRecords=all&-DoScript=auto_search_adolshn&-search
and Children with Special Health Care Needs, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_cshcn.html&-MaxRecords=all&-DoScript=auto_search_cshcn&-search;
and the organizations resource list, Children with Special Health Care
Needs, at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_cshn.html&-MaxRecords=all&-DoScript=auto_search_cshn&-search.
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4. ARTICLE EXAMINES CONJOINED EFFECTS OF LOW BIRTHWEIGHT AND CHILDHOOD
ABUSE ON ADAPTATION AND WELL-BEING LATER IN LIFE
"The present data suggest that children born with LBW [low birthweight]
did as well as their counterparts as long as they did not face serious
adversity, such as child abuse. However, when faced with both
adversities, these children had substantially poorer outcomes than
children facing either adversity alone," write the authors of an
article published in the February 2007 issue of Archives of Pediatrics
and Adolescent Medicine. LBW is associated with increased risk of
depression, suicidal ideation, and poor well-being among young adults.
Similarly, childhood abuse is associated with increased risk of adult
psychopathological conditions such as depression, substance use,
posttraumatic stress disorder, and suicidal ideation. The study
described in this article examined the possible conjoined effects of
LBW and childhood abuse on adaptation and on the development of
psychiatric and medical problems.
The authors used data from the Johns Hopkins Collaborative Perinatal
Study, an epidemiological study that followed children from birth for
more than 25 years. The Pathways to Adulthood Study collected data from
inner-city families for 34 years (1960-1994). Of the 2,694
second-generation (G2) children from the Johns Hopkins Collaborative
Perinatal study who were eligible for the Pathways to Adulthood Study,
1,748 participated in a complete interview. Most of the participants
(81.5%) were African American; 18.3% were white, and the rest were
Asian.
The authors compared outcomes in the transition to adulthood among four
groups of children: (1) those with LBW and childhood abuse, (2) those
with LBW alone, (3) those with childhood abuse alone, and (4) those
with neither.
The authors found that
- For G2 with LBW alone, the prevalence of problems was comparable
with that of individuals without either LBW or abuse.
- G2 with abuse alone and those with both LBW and abuse had poorer
adult functioning, well-being, and health in general than those with
LBW alone and than those with neither.
- Compared with G2 with neither LBW nor abuse, those with both LBW
and abuse were at a substantially elevated risk for psychological
problems: nearly a 10-fold increased risk for depression, nearly a
7-fold increased risk for social dysfunction, and a 4-fold risk for
somatization. No such increased risk was found for medical problems.
"The present findings . . . suggest that LBW infants should
receive continued public health surveillance and that their caretakers
should receive targeted support to mitigate the effects of subsequent
environmental adversities on child adaptation and productivity,"
conclude the authors.
Nomura Y, Chemtob CM. 2007. Conjoined effects of low birth weight and
childhood abuse on adaptation and well-being in adolescence and
adulthood. Archives of Pediatrics and Adolescent Medicine
161(2):186-192. Abstract available at http://archpedi.ama-assn.org/cgi/content/abstract/161/2/186.
Readers: More information is available from the MCH Library's
bibliography, Child Developmental Screening, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_devscrn.html&-MaxRecords=all&-DoScript=auto_search_devscrn&-search
and from the organizations resource list, Child Abuse, at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_childabuse.html&-MaxRecords=all&-DoScript=auto_search_childabuse&-search.
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and
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