Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
August 24, 2007
1. New Edition of Child Health USA Released
2. Report Examines Trends in Children's Access to Health
Insurance and Health Care Since SCHIP
3. Authors Investigate Impact of Welfare Reform on
Insurance Coverage Before Pregnancy and Timing of Prenatal Care
4. Study Explores Vaccine Financing for Children Who Are
Underinsured
5. Article Assesses the Effects of an Early Childhood
Education Program on Adult Health and Well-Being
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Special Notice: On August 15, 2007, the National Board of Public Health
Examiners launched registration for the first public health
certification exam. Graduates from schools and programs accredited by
the Council for Education in Public Health are encouraged to register
and sit for the exam. The exam dates are August 11-30, 2008.
Registration for the exam is open from August 15, 2007, to April 30,
2008. Fees are $300 if professionals register by October 15, 2007; $350
by December 31, 2007; or $400 by April 30, 2008. More information is
available at http://www.publichealthexam.org.
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1. NEW EDITION OF CHILD HEALTH USA RELEASED
Child Health USA 2006 reports on the health status and service needs
for the target population of Title V funding: infants, children,
adolescents, children with special health care needs, and women of
childbearing age. The book, published by the Health Resources and
Services Administration's Maternal and Child Health Bureau, comprises
secondary data for more than 50 health status and health care
indicators, provides both graphical and textual summaries of relevant
data, and addresses long-term trends where applicable and feasible. The
first section, Population Characteristics, presents statistics on
factors (including poverty, education, and child care) that influence
children's well-being. The second section, Health Status, contains
vital statistics and health behavior information for the maternal and
child health population. Health Services Financing and Utilization, the
third section, includes data on health care financing and newly
implemented health policies. The final sections, State Data and City
Data, contain information on selected indicators at state and city
levels. The book is available at http://www.mchb.hrsa.gov/chusa_06/pages/pdf/c06.pdf.
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2. REPORT EXAMINES TRENDS IN CHILDREN'S ACCESS TO HEALTH INSURANCE AND
HEALTH CARE SINCE SCHIP
Protecting America's Future: A State-by-State Look at SCHIP &
Uninsured Kids presents a comprehensive state-by-state analysis of
children's and adolescents' access to health insurance and health care,
including how that has changed since the State Children's Health
Insurance Program (SCHIP) was introduced. The analysis was prepared for
the Robert Wood Johnson Foundation by the State Health Access Data
Assistance Center located at the University of Minnesota School of
Public Health. Data for the analysis were drawn from the 1998, 1999,
2005, and 2006 Current Population Surveys; the Centers for Medicare and
Medicaid Services Web site (2002-2006); the National Survey of
Children's Health (2003); and the National Health Interview Survey
(2006). The report comprises a series of six tables containing the
following data: (1) the total number of children and adolescents ever
enrolled in SCHIP in fiscal years 2002-2006; (2) the percentage of
children and adolescents from birth through age 18 without health
insurance coverage by state, 1997-1998 and 2004-2005; (3) the
percentage of children and adolescents from birth through age 17 not
receiving any medical care by state, 2003; (4) the percentage of
children and adolescents from birth through age 17 in the United States
who visited a doctor's office within the past 12 months, 2006; (5) the
percentage of children and adolescents from birth through age 17 in the
United States who received a well-child check-up within the past 12
months, 2006; and (6) the percentage of children and adolescents from
birth through age 18 without health insurance coverage by race and
ethnicity, 1997-1998 and 2004-2005. Information about methods and
resources are provided. The report is available at
http://covertheuninsured.org/pdf/americasfuture.pdf.
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3. AUTHORS INVESIGATE IMPACT OF WELFARE REFORM ON INSURANCE COVERAGE
BEFORE PREGNANCY AND TIMING OF PRENATAL CARE
"We found that welfare reform had a significant negative impact on
Medicaid coverage before pregnancy among welfare-related Medicaid
eligibles. This drop resulted in a small decline . . . in
first-trimester PNC [prenatal care] initiation for these women," state
the authors of an article published in the August 2007 issue of HSR:
Health Services Research. Healthy People 2000 includes a target that
90% of pregnant women initiate PNC in their first trimester. When the
target was not met, it was reiterated in Healthy People 2010. The
authors of the article hypothesize that welfare reform lowered
first-trimester PNC initiation by increasing the costs of seeking PNC
through (1) decreased insurance coverage and (2) increased time and
income barriers. The article presents an analysis of first-trimester
PNC initiation among pregnant women financially eligible for Medicaid
at welfare income levels using data from the Pregnancy Risk Assessment
Monitoring System (PRAMS) before and after the implementation of
welfare reform. PRAMS includes information on women's family income and
health insurance coverage before pregnancy not available from data used
in prior studies of the effects of welfare reform on PNC initiation.
PRAMS data was pooled from eight states (Alaska, Florida, Maine, New
York, Oklahoma, South Carolina, Washington, and West Virginia) for the
period 1996 to 1999. The target population included single women with
prior births or minor children living in the household and with family
incomes equal to or less than the income category closest to the
state's July 1996 Aid to Families with Dependent Children income limit.
Women with incomes under $25,000 who were not previously identified as
eligible for welfare (i.e., women eligible for expansion-related
Medicaid) served as a comparison group. Women with incomes of $25,000
or more (i.e., non-eligible) served as a second comparison group. Each
woman was categorized into one of three mutually exclusive categories
based on her insurance coverage before pregnancy: (1) private coverage,
(2) Medicaid coverage, and (3) uninsured.
The authors found that
- There was a statistically significant negative effect of welfare
reform on Medicaid coverage before pregnancy among women financially
eligible for Medicaid at welfare income levels.
- Welfare reform lowered first-trimester PNC initiation among women
financially eligible for Medicaid at welfare income levels by
approximately 1.1%.
- There was no evidence for an impact of welfare reform on
first-trimester PNC initiation beyond its effect through lower Medicaid
coverage before pregnancy; however, the estimated effects of time and
income barriers to care resulting from welfare reform varied by state.
"Although the number of welfare-related Medicaid women is relatively
small and therefore the adverse effect on progress toward the Healthy
People goal of 90 percent of all pregnant women initiating PNC in the
first trimester may be minor, the affected women are among the neediest
and the most likely to benefit from early PNC," state the authors. They
continue, "improved outreach for eligible women within the current
Medicaid program and the development of expanded Medicaid-like
insurance options for women of childbearing age meeting welfare
eligibility criteria should receive high priority in our political and
legislative agendas."
Gavin NI, Adams EK, Manning WG, et al. 2007. The impact of welfare
reform on insurance coverage before pregnancy and the timing of
prenatal care initiation. Health Services Research 42(4):1564-1588.
Abstract available at http://www.blackwell-synergy.com/doi/abs/10.1111/j.1475-6773.2006.00667.x.
Readers: More information is available from the MCH Library's knowledge
path, Preconception and Pregnancy, at http://www.mchlibrary.info/KnowledgePaths/kp_pregnancy.html;
bibliographies, Adolescent Prenatal Care, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_adolprenatal.html&-MaxRecords=all&-DoScript=auto_search_adolprenatal&-search,
and Prenatal Care, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_prenatal.html&-MaxRecords=all&-DoScript=auto_search_prenatal&-search;
and organizations resource list, Prenatal Care, at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_prenat.html&-MaxRecords=all&-DoScript=auto_search_prenat&-search.
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4. STUDY EXPLORES VACCINE FINANCING FOR CHILDREN WHO ARE UNDERINSURED
"Our study demonstrates gaps in the financing of new vaccines for
children who are underinsured with respect to vaccination," state the
authors of an article published in the August 8, 2007, issue of JAMA,
The Journal of the American Medical Association. Recent declines in
funding combined with increases in the number of vaccines and higher
costs have led to concerns over the availability of new vaccines for
children who are underinsured. The article presents findings from a
study to evaluate the status of financing and distribution of new
pediatric vaccines at the state level.
Ten state immunization program managers were recruited and interviewed
by telephone in November 2005 and December 2005. Respondents' comments
were organized according to two common themes (barriers to vaccine
implementation and consequences of these barriers) and were used to
formulate questions for a subsequent national survey of program
managers conducted from January 2006 to June 2006. A 1-hour telephone
interview was also conducted with program managers not previously
interviewed. The written survey included quantitative questions on
vaccine implementation, presence of financial and supply barriers to
implementation, availability of publicly purchased vaccine, strategies
used to address limitations in financing, and characteristics of the
state immunization program. Questions were focused on five of the most
recent vaccine recommendations including varicella, conjugate
pneumococcal, conjugate meningococcal, Tdap, and hepatitis A
(universal). The analysis describes variations among states in the
provision of publicly purchased vaccines to children who were
underinsured, and it identifies barriers to state purchase and
distribution of new vaccines.
The authors found that
- For vaccines given in the private sector, 46% of states did not
provide publicly purchased varicella vaccine to children who were
underinsured, and 70% of states did not provide publicly purchased
meningococcal conjugate vaccine.
- For vaccines given in the public sector, 17% of states did not
provide publicly purchased pneumococcal conjugate vaccine to children
who were underinsured, and 40% did not provide publicly purchased
meningococcal conjugate vaccine.
- Ten states reported that between 2004 and early 2006, new
limitations in their ability to provide publicly purchased vaccines for
children who were underinsured had arisen as a consequence of
limitations in federal and state financing for vaccine purchase.
- Limitations in both federal and state vaccine financing were
reported as the dominant barriers to states' providing vaccines to
children who were underinsured.
The authors suggest that strategies to address the current needs of
children who are underinsured "should include efforts to enhance
immunization benefits through requirements or incentives for insurers
and employers." They conclude that "until such enhancements in private
insurance coverage for immunization are implemented, however, support
of the public sector safety net is critical to ensure the protection of
this vulnerable group of children in the United States."
Lee GM, Santoli JM, Hannan C, et al. 2007. Gaps in vaccine financing
for underinsured children in the United States. JAMA, The Journal of
the American Medical Association 208(6):638-643. Abstract available at http://jama.ama-assn.org/cgi/content/abstract/298/6/638?etoc.
Readers: More information is available from the MCH Library's knowledge
path, Child and Adolescent Health Insurance and Access to Care, at http://www.mchlibrary.info/KnowledgePaths/kp_insurance.html;
and bibliographies, Children's Health Insurance, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_chldhlthins.html&-MaxRecords=all&-DoScript=auto_search_chldhlthins&-search,
and Immunizations, 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. ARTICLE ASSESSES THE EFFECTS OF AN EARLY CHILDHOOD EDUCATION PROGRAM
ON ADULT HEALTH AND WELL-BEING
"This study provides evidence that established early educational
interventions can positively influence the adult life course in several
domains of functioning," write the authors of an article published in
the August 2007 issue of Archives of Pediatric and Adolescent Medicine.
Early childhood interventions have demonstrated consistent positive
effects on children's health and well-being. However, there is only a
small amount of evidence that large-scale public programs have
long-term effects into adulthood. In this article, the authors describe
a follow-up study at age 24 to assess Child-Parent Center (CPC) program
links with measures of educational attainment, economic status, crime,
health status and behavior, and mental health. The CPC provides
comprehensive services to children ages 3-9 and their families and has
been administered through the Chicago public school system since 1967.
Data for the study come from the Chicago Longitudinal Study, a
prospective investigation of the life course of a cohort of 1,539
children with low incomes and from minority groups (93% black, 7%
Hispanic) born in 1979 or 1980 who attended early childhood programs in
25 sites between 1985 and 1986. The original sample included 989
children who attended the CPC. The comparison group consisted of 550
children who participated in alternative full-day kindergarten programs
that were available to families with low incomes.
Relative to the comparison group and controlling for pre-program
characteristics, individuals who participated in the CPC in preschool
- Had significantly higher rates of high-school completion and
4-year college attendance and more years of education.
- Had significantly lower rates of felony arrest and incarceration
and were less likely than the comparison group to be found guilty of a
crime both overall and for a felony.
- Were somewhat more likely to have a stable employment history or
to have attended college by age 24.
- Were less likely to have one or more depressive symptoms.
The authors conclude that "the scope and magnitude of intervention
effects reveal not only the benefits to participants in fundamental
indicators of health and well-being but also the potential returns to
society for investments in early educational programs."
Reynolds AJ, Temple JA, Ou S, et al. 2007. Effects of a school-based,
early childhood intervention on adult health and well-being. Archives
of Pediatric and Adolescent Medicine 161(8):730-739. Abstract available
at http://archpedi.ama-assn.org/cgi/content/abstract/161/8/730.
Readers: More information is available from the MCH Library's
bibliographies, Early Childhood Development, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_earlychdev.html&-MaxRecords=all&-DoScript=auto_search_earlychdev&-search,
and Effective Program Practices, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_effective.html&-MaxRecords=all&-DoScript=auto_search_effective&-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
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