Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
June 8, 2007
1. Report Identifies Policy Options to Better Serve
Adolescents Who Age Out of Foster Care
2. Toolkit Offers Resources for Providing Reproductive
Health Services to Women Affected by Conflict
3. Web Tool Demonstrates Variety of Approaches for Health
Care Quality Reports Cards
4. Article Investigates Influenza Vaccination Strategies
to Protect a Vulnerable Subpopulation
5. Analysis Examines the Relative Importance of Alcohol
Sources Among Young Adolescents
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1. REPORT IDENTIFIES POLICY OPTIONS TO BETTER SERVE ADOLESCENTS WHO
AGE OUT OF FOSTER CARE
Time for Reform: Aging Out and on Their Own briefly discusses the
history of permanency and federal child welfare policy, presents the
latest state-by-state data on the number of adolescents who have aged
out of foster care, and offers recommendations for public policy
reforms to decrease the number of adolescents who age out of care each
year. The report, published by the Pew Charitable Trusts, draws on
findings from focus groups conducted with adolescents who aged out or
expect to age out of foster care, research studies, and interviews to
document the adverse long-term effects that aging out of foster care
has had on a growing number of adolescents each year. The appendix
contains charts depicting the number and percentage of adolescents
aging out and length of stay by state, describes the characteristics of
focus group participants and methodology, and presents selected
outcomes for adolescents who age out of foster care (education, health,
employment and income, living arrangements, contact with the criminal
justice system). The report is intended for use by program
administrators, policymakers, and others to improve the system so that
all children in foster care achieve permanency with families, and to
ensure that proper support is in place for those who may age out of the
system without a permanent family. The report is available at http://www.pewtrusts.org/pdf/Aging_Out_May2007.pdf.
More information is available from Kids Are Waiting: Fix Foster Care
Now at http://www.kidsarewaiting.org.
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2. TOOLKIT OFFERS RESOURCES FOR PROVIDING REPRODUCTIVE HEALTH SERVICES
TO WOMEN AFFECTED BY CONFLICT
Reproductive Health Assessment Toolkit for Conflict-Affected Women
provides resources to enable field agencies to quantitatively assess
reproductive health risks, services, and outcomes among women (ages
15-49) affected by conflict and to compare a population across points
in time or to make comparisons across populations. The toolkit was
produced by the Centers for Disease Control and Prevention with support
from the U.S. Agency for International Development in response to an
increasing focus on the reproductive health of refugees, including
those in the emergency phase, those in post-emergency camps, those
returning to their countries of origin, and those who have integrated
into the local host community. Selected topics include safe motherhood,
family planning, marriage and live-in partnerships, sexual history,
sexually transmitted infections, gender-based violence, and emotional
health. A planning checklist, sampling instructions, a training manual,
an analysis guide, suggestions for data use, and resources for
evaluating survey implementation are provided, along with information
on required resources and technical assistance. The appendices contain
a budget template, a random number table and instructions, training
handouts, a questionnaire guide, practice exercises, a locator and a
consent form, a toolkit questionnaire, a final report template, a group
discussion guide, and an exit survey. The toolkit is intended for use
by government and non-government organizations, United Nations
agencies, independent research consultants, and field staff in
collecting reproductive health data and improving the reproductive
health of women affected by conflict. The toolkit is available at
http://www.cdc.gov/reproductivehealth/Refugee/ToolkitDownload.htm.
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3. WEB TOOL DEMONSTRATES VARIETY OF APPROACHES FOR HEALTH CARE QUALITY
REPORT CARDS
The Health Care Report Card Compendium is a Web-based, searchable
directory of reports produced by a range of sponsors, primarily to meet
the information needs of health care consumers. The compendium, which
was developed as a resource to supplement guidance provided on the
Agency for Healthcare Research and Quality's (AHRQ's) TalkingQuality
Web site, contains over 200 samples that demonstrate a range of
approaches to reporting data on the quality of health plans, medical
groups, individual physicians, and other providers. A profile of each
report card provides a comprehensive description, including the types
of measures and presentation strategies used in the report, geographic
coverage, the availability of educational information or a
decision-support tool, comments on the measures and presentation
strategies, and other details. The compendium is intended for use by
report developers (e.g., health professionals, program administrators,
researchers) in exploring the scope and types of health-care-quality
information to cover as well as various approaches to presenting
comparative data. The compendium is available at http://www.talkingquality.gov/compendium.
AHRQ's TalkingQuality Web site is available at http://www.talkingquality.gov.
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4. ARTICLE INVESTIGATES INFLUENZA VACCINATION STRATEGIES TO PROTECT A
VULNERABLE SUBPOPULATION
"Our analysis . . . supports the argument that vaccination of children
[against influenza] may be a good way to protect the elderly.
Nevertheless, our analysis also shows that the outcome of a vaccination
policy is very sensitive to disease transmissibility and to the
structure of mixing within a population," write the authors of an
article published in the May 2007 issue of PLoS Medicine. Most
influenza-associated deaths in the developed world occur in the elderly
population, and current U.S. vaccination policy gives the highest
priority to vaccination of persons ages 65 and older, but also children
under age 2 and those with respiratory problems and their contacts.
Recently, some authors have renewed suggestions that vaccinating
schoolchildren, who respond well to vaccination and may have an
important role in transmission to the population, could be an important
component of a strategy to protect the whole population, including
elderly people. In this article, the authors investigate the general
question of the effects of vaccination in an infectious disease system
in which the population has a "core" group that is particularly
effective at spreading disease and is distinct from a "victim" or
"vulnerable" group that is more vulnerable to the effects of disease
(although not necessarily more susceptible to infection).
The authors use a simple mathematical model to illustrate some of the
complexities that arise. They assume assortative mixing: individuals
are most likely to mix with other individuals in the same group.
The authors found that
- The effects of vaccine allocation in the example are complicated
and sensitive to parameter values.
- When transmission is low, switching vaccine from the vulnerable
group to the core group first increases incidence in the vulnerable
group, since fewer individuals are directly protected. As more vaccine
is allocated to the core group, however, a turning point is reached
after which fewer vulnerable individuals are infected because the
overall size of the epidemic is sharply reduced.
- With high transmission, transmission within the vulnerable group
is sufficiently important that it is always better to vaccinate this
group (under the assumption that cases in the vulnerable group have
much more severe consequences than those in the core group). This is
true even though transmission rates in the core group are higher than
in the vulnerable group.
- With moderate transmission, the situation is more complicated:
shifting vaccine from the vulnerable to the core group make things
first worse, then better, then worse again.
The authors conclude that "given the level of uncertainty about
population structure -- as well as the risk of an elderly-driven
epidemic -- prudent policy for influenza should focus on supplementing
rather than replacing the vaccination of the elderly."
Dushoff J, Plotkin JB, Viboud C. 2007. Vaccinating to protect a
vulnerable population. PLoS Medicine 4(5):0921-0927. Abstract available
at http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040174.
Readers: More information is available from the MCH Library's
bibliography, Immunizations, 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. ANALYSIS EXAMINES THE RELATIVE IMPORTANCE OF ALCOHOL SOURCES AMONG
YOUNG ADOLESCENTS
The present study findings "highlight the need for alcohol prevention
efforts to address . . . social sources of alcohol, particularly
before high school; a major challenge for alcohol prevention efforts,"
state the authors of an article published in the June 2007 issue of
Preventive Medicine. Prevention of early-onset alcohol use is a
critical component of ensuring the short- and long-term health and
safety of adolescents. One strategy to reduce alcohol use by
adolescents focuses on reducing or eliminating the primary sources of
alcohol access. Efforts to date have largely targeted commercial access
among underage drinkers (adolescents ages 20 and younger). Compelling
but limited evidence exists that social sources of alcohol are
important. The article examines sources of alcohol consumed by young
adolescents over time in a large, ethnically diverse population of
mostly poor, urban adolescents.
Data for the study were drawn from Project Northland Chicago, a
multi-component, group-randomized trial for the prevention of
adolescent alcohol use involving 63 schools and their surrounding
neighborhoods. Surveys were administered in the classroom at four time
points: (T1) fall 2002, at the beginning of 6th grade; (T2) spring
2003, at the end of 6th grade; (T3) spring 2004, at the end of 7th
grade; and (T4) spring 2005, at the end of 8th grade. Students who
completed a survey at all four data-collection time periods and who
reported alcohol use in the past year were included in the present
study. The analysis assessed changes in alcohol sources (parents,
friend's parent, another adult age 21 or older, someone age 20 or
younger, took it from home, took it from friend's home, commercial
sources of alcohol) over time by ethnicity and by gender. Models were
tested for the entire sample of alcohol users and then within a
subsample of consistent alcohol users (those who reported alcohol use
in the past year in at least three of four waves of data).
The authors found that
- At the beginning of 6th grade, parents and guardians were the
most common source of alcohol (32.7%), followed by another adult age 21
or older (15.7%) and someone age 20 or younger (9.7%).
- By the end of 8th grade, another adult age 21 or older (22.7%)
surpassed parents and guardians (18.9%) as the most prevalent source
reported.
- Consistent users followed a pattern similar to that of the entire
sample, with social sources outstripping commercial sources.
- Over time, student reports of taking alcohol from home or a
friend's home, receiving alcohol from a friend's parent or guardian,
and purchasing alcohol from commercial sources were lower in prevalence
compared to accessing alcohol from parents or guardians, another adult
age 21 or older, or someone age 20 or younger.
- Among the entire sample of alcohol users, increases over time
were observed across the following sources of alcohol: another adult
age 21 or older, someone age 20 or younger, took it from home, and
commercial.
- Parents as a source of alcohol use decreased over time.
- Males were more likely than females to get alcohol from
commercial sources. Among consistent users, males were more likely than
females to get alcohol from a friend's parent.
- No significant racial and ethnic differences (white adolescents
vs. African-American or Hispanic adolescents) were observed across
sources of alcohol use over time.
"Recognizing the importance of social sources of alcohol and how social
sources change as children age offers an ideal opportunity for primary
prevention," the authors conclude.
Hearst MO, Fulkerson JA, Maldonado-Molina MM, et al. 2007. Who needs
liquor stores when parents will do? The importance of social sources of
alcohol among young urban teens. Preventive Medicine 44(6):471-476.
Abstract available at http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_urlVersion=4&_origin=SDVIALERTHTML&_version=1&_uoikey=B6WPG-4N5CX5V-1&md5=5ddb007f2a84e51572a0b117e3c71403.
Readers: More information is available from the MCH Library's
organizations resource list, Substance Use, at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_subuse.html&-MaxRecords=all&-DoScript=auto_search_subuse&-search.
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MCH Alert © 1998-2007 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
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