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.


March 16, 2007

1. Survey Focuses on Public View on Adolescent Sexual Behavior and Strategies for Reducing Early Pregnancy and Childbearing
2. Acting Surgeon General Issues National Call to Action on Underage Alcohol Use
3. Theme Journal Issue Focuses on Children's Health and Health Care
4. Authors Explore Adolescent Risk Characteristics Associated with Foregoing Health Care for Reasons of Confidentiality Concern
5. Article Examines Whether Social Change Might Save More Lives Than Medical Advances

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Special Notice: The Maternal and Child Health Leadership Competencies, Version 2.0, were released during the Association of Maternal and Child Health Programs Annual Meeting held on March 3-5, 2007, in Washington, DC. The competencies described in the document, prepared by the MCH Leadership Competencies Workgroup, were drawn from both theory and practice and are designed to support and promote maternal and child health (MCH) leadership among interdisciplinary training programs and practicing professionals. Topics include a definition of MCH leadership, core MCH leadership competencies, knowledge and skill areas required of an MCH leader, and how MCH leadership competencies might be used by a variety of audiences. A development time line, an MCH Pyramid, and references and resources are included. The document is available at http://leadership.mchtraining.net/custom/MCH%20Leadership%20Comp%20doc_final_1.pdf?fc469ad6c4001051adb3ba20b6df67c5=0b35b0fa636615dcdb089020e791d2be.

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1. SURVEY FOCUSES ON PUBLIC VIEW ON ADOLESCENT SEXUAL BEHAVIOR AND STRATEGIES FOR REDUCING EARLY PREGNANCY AND CHILDBEARING

With One Voice 2007: America's Adults and Teens Sound Off About Teen Pregnancy assesses public opinion on adolescent pregnancy. The survey is the fifth in a series of nationally representative surveys conducted by the National Campaign to Prevent Teen Pregnancy that have asked adolescents (ages 12-19) and adults (ages 20 and older) a consistent, core set of questions about adolescent pregnancy and related issues. Topics include parental and other adult influence; abstinence and contraception; regret, virginity, older partners, and attitudes about adolescent sex; gender differences; religion; social norms and beliefs; and media. Data are presented in charts and, where available, results from previous surveys (2001-2006) are included. A description of the survey methodology and a summary are also provided. The survey is intended to provide insights for policymakers, program administrators, families, and others about adolescent pregnancy and factors that influence adolescents' decisions about sex. The survey is available at http://www.teenpregnancy.org/resources/data/pdf/WOV2007_fulltext.pdf.

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2. ACTING SURGEON GENERAL ISSUES NATIONAL CALL TO ACTION ON UNDERAGE ALCOHOL USE

The Surgeon General's Call to Action to Prevent and Reduce Underage Drinking focuses national attention on the social costs and personal consequences of underage alcohol use and the process of solving this public health problem. The call to action, published by the Office of the Surgeon General, presents research that offers new opportunities for prevention and intervention by furthering an understanding of underage alcohol use as a developmental phenomenon -- a behavior directly related to maturational processes in adolescence. Topics include the scope of the problem, alcohol use and adolescent development, and prevention and reduction of alcohol use and alcohol use disorders in adolescents. Action steps, a conclusion, and references are also presented. The appendix contains a definition of a "standard drink" and diagnostic criteria for alcohol abuse and dependence.  The call to action is available at http://www.surgeongeneral.gov/topics/underagedrinking/calltoaction.pdf.

The agenda and remarks of Acting Surgeon General Kenneth P. Moritsugu at the launch of the call to action, a press release, and three fact sheets (About the Call to Action, Six Goals of the Call to Action, and Federal Initiatives to Prevent and Reduce Underage Drinking) are also available at http://www.surgeongeneral.gov/topics/underagedrinking.

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3. THEME JOURNAL ISSUE FOCUSES ON CHILDREN'S HEALTH AND HEALTH CARE

The March-April 2007 issue of Health Affairs is dedicated to children's health topics and, specifically, to the design of children's health care. The papers in the opening section of the thematic issue discuss why children count, how they are counted, and what is unique about children's health and well-being that requires accounting for them in new, evidence-based ways. The authors of the lead paper (Halfon, et al.) present a vision and rationale for reform of the U.S. child health system based on paradigmatic changes in the conceptualization of child health development. Many of the other papers in the volume focus on the multiple challenges that children from families with low incomes face in reaching adulthood in a healthy state. Other contributions include a discussion of the role of schools in preventing and treating illnesses; the reauthorization of the State Children's Health Insurance Program; and the case of Medicaid's Early and Periodic Screening, Diagnostic, and Treatment benefit. The issue is available at http://www.healthaffairs.org.

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4. AUTHORS EXPLORE ADOLESCENT RISK CHARACTERISTICS ASSOCIATED WITH FOREGOING HEALTH CARE FOR REASONS OF CONFIDENTIALITY CONCERN

"The study findings suggest that U.S. adolescents who forgo care due in whole or in part to confidentiality concern are a particularly high-risk population in need of health care services," state the authors of an article published in the March 2007 issue of the Journal of Adolescent Health. Forgone health care is prevalent among U.S. adolescents. Although confidentiality concern is understood to be an important barrier to adolescents' utilization of health care services, prior studies have not investigated characteristics of adolescents who have forgone care specifically due, in whole or in part, to confidentiality concern. The study described in this article addressed this gap by examining risk characteristics of adolescents who report confidentiality concern (i.e., not wanting parents to know) as a reason for forgone health care, using a national sample of U.S. middle and high school students.

The study used Wave I home interview data from the National Longitudinal Study of Adolescent Health. The study sample included 1,123 boy and 1,315 girls ages 13-17 who reported having forgone needed health care in the past year.

The authors found that
The authors conclude that "decreasing confidentiality concern as a barrier to health care utilization among adolescents will likely require a multifaceted approach that includes: (a) education of health care providers, parents, and adolescents regarding the availability and parameters of confidential health care services; (b) provider encouragement of parent-teen communication regarding health-care topics; (c) education of parents and adolescents regarding the importance of a confidential relationship between provider and adolescent; and (d) increase in providers' initiative in speaking alone with adolescents and providing screening, counseling, and referral regarding sensitive health topics.

Lehrer JA, Pantell RP, Tebb K, et al. Forgone health care among U.S. adolescents: Association between risk characteristics and confidentiality concern. Journal of Adolescent Health 40(3):218-226. Abstract available at http://www.jahonline.org/article/PIIS1054139X06003752/abstract.


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5. ARTICLE EXAMINES WHETHER SOCIAL CHANGE MIGHT SAVE MORE LIVES THAN MEDICAL ADVANCES

"The basic notion that more lives would be saved by eliminating education-associated excess mortality than by medical advances is sufficiently robust to justify a change in policy priorities," state the authors of an article published online ahead of print by the American Journal of Public Health. In the past few decades, there have been heavy investments in technological advances intended to reduce morbidity and increase life expectancy. However, the pace of progress has been modest. Minority groups have higher mortality rates than whites, and people of low socioeconomic status have higher mortality rates and poorer health status than the general population. This article explores the possibility that addressing social determinants of health might do more to save lives than the incremental advancements in the technology of care that consume the bulk of societal investments in health. The authors examined death rates among adults with inadequate education, a group known to have excess mortality rates.

The authors examined mortality data for 1996 through 2002 reported by the National Center for Health Statistics. They compared (1) the maximum number of deaths averted by the downward secular trend in mortality and (2) the number of deaths that would have been averted had mortality rates among adults with less than a high-school education (LHS adults) been the same as those among adults with some college education.

The authors found that
The authors conclude that "our data suggest that correcting the conditions that cause people with inadequate education to die in greater numbers will do far more to save lives than making incremental improvements in the technology of medical care."

Woolf SH, Johnson RE, Phillips, RL, et al. 2007. Giving everyone the health of the educated: An examination of whether social change would save more lives than medical advances. AJPH First Look, published online ahead of print, February 28, 2007. American Journal of Public Health. Abstract available at http://www.ajph.org/cgi/content/abstract/AJPH.2005.084848v1.

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