
Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
December 14, 2007
1. HRSA Unveils Free Online Health Literacy Training for
Health Professionals
2. Supplement Highlights New Recommendations on Child and
Adolescent Overweight and Obesity
3. Article Assesses State and Regional Disparities in
Childhood and Adolescent Obesity
4. Authors Examine Unmet Mental Health Need Among
Children with Special Health Care Needs
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1. HRSA UNVEILS FREE ONLINE HEALTH LITERACY TRAINING FOR HEALTH
PROFESSIONALS
Unified Health Communication 101: Addressing Health Literacy, Cultural
Competency, and Limited English Proficiency is a free online learning
experience designed to help health professionals improve their
patient-communication skills, increase their awareness and knowledge of
factors that affect their communication with patients, and implement
patient-centered communication practices. The course, developed by the
Health Resources and Services Administration, comprises five modules
and is estimated to take a total of 5 hours to complete. The course may
be completed at the user's own pace and may be taken for credit
(CEU/CE, CHES, CME, and CNE) or not for credit. More information,
including registration instructions, is available at
http://www.hrsa.gov/healthliteracy/training.htm.
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2. SUPPLEMENT HIGHLIGHTS NEW RECOMMENDATIONS ON CHILD AND ADOLESCENT
OVERWEIGHT AND OBESITY
Assessment of Child and Adolescent Overweight and Obesity presents a
review of the literature and recommends revised approaches to the
prevention, assessment, and treatment of childhood obesity. The
December 2007 supplement to Pediatrics was supported in part by an
educational grant from Gerber Products Company and by the Centers for
Disease Control and Prevention's Division of Nutrition, Physical
Activity, and Obesity; the American Medical Association; and the Health
Resources and Services Administration's Maternal and Child Health
Bureau grant to the University of Alabama at Birmingham. Contents
include four articles, one on each of three obesity-management areas
and one overarching support document. Recommendations cited in the
supplement were developed using both available evidence and expert
opinion. The recommendations recognize the importance of social and
environmental change to reduce the obesity epidemic and also identify
ways health professionals and health care systems can be part of
broader efforts. The supplement is available at http://pediatrics.aappublications.org/content/vol120/Supplement_4.
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3. ARTICLE ASSESSES STATE AND REGIONAL DISPARITIES IN CHILDHOOD AND
ADOLESCENT OBESITY
"Documenting and monitoring of geographic variation is crucial to the
understanding of the extent of existing disparities in childhood
obesity that go beyond the disparities commonly shown by such social
groups as those characterized by sex, race/ethnicity, and socioeconomic
status," write the authors of an article published in the Journal of
Community Health, Online First (November 30, 2007). The prevalence of
childhood obesity has risen almost three-fold in the past three
decades. While gender and racial and ethnic disparities in the
prevalence of U.S. childhood obesity are frequently examined,
geographic disparities are rarely analyzed. The purpose of the study
described in this article is to (1) estimate current obesity prevalence
among children and adolescents ages 10-17 in nine geographic locations
using a large, nationally representative sample of U.S. children; (2)
examine the extent of regional and state disparities in childhood and
adolescent obesity; and (3) identify individual- and area-level
socioeconomic, demographic, and behavioral predictors of these
geographic disparities.
Data for this study came from the National Survey of Children's Health,
conducted by the National Center for Health Statistics with funding and
direction from the Maternal and Child Health Bureau. The sample of the
present analysis was 46,707 children and adolescents ages 10-17.
The authors found that
- Obesity prevalence for children and adolescents ages 10-17 varied
from a low of 8.5% in Utah to a high of 22.8% in Washington, DC (DC).
- After adjusting for socioeconomic and behavioral factors,
children and adolescents in the south (specifically West Virginia,
Kentucky, Texas, Tennessee, and North Carolina; adjusted prevalence =
18.3%) had over twice the odds of being obese compared with their
counterparts of comparable socioeconomic and behavioral characteristics
in Utah (adjusted prevalence = 10.4%). The other states showing at
least 75% higher odds of obesity than Utah included Indiana, South
Carolina, Oregon, DC, Missouri, and Illinois. Children in Wyoming, on
the other hand, had 32% lower odds of being obese than their Utah
counterparts.
- After adjusting for socioeconomic and behavioral factors,
children and adolescents in all regions except the Mountain region had
significantly higher odds of obesity than their counterparts in the
Pacific region.
- Besides geographic disparities, the substantial effects of
several socioeconomic and behavioral factors are worth considering. The
adjusted odds of obesity increased significantly in relation to
decreased levels of household education and income, neighborhood and
social capital, physical activity, and sports participation and
increased levels of television viewing.
The authors conclude that "prevention efforts should target both
individual socioeconomic and behavioral risk factors as well as
modifying the contextual social and environmental factors in order to
reduce geographic disparities in childhood obesity."
Singh GK, Kogan MD, van Dyck PC. 2007. A multilevel analysis of state
and regional disparities in childhood and adolescent obesity in the
United States. Journal of Community Health Online First (November 30,
2007), http://www.springerlink.com/content/101596/?Content+Status=Accepted.
Readers: More information is available from the following MCH Library
resources:
- Overweight and Obesity in Children and Adolescent (knowledge path) at
http://www.mchlibrary.info/KnowledgePaths/kp_overweight.html
- Racial and Ethnic Disparities in Health (knowledge path) at
http://www.mchlibrary.info/KnowledgePaths/kp_race.html
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4. AUTHORS EXAMINE UNMET MENTAL HEALTH NEED AMONG CHILDREN WITH SPECIAL
HEALTH CARE NEEDS
"Although perceived need for mental health treatment was greatest among
CSHCN [children with special health care needs] with a chronic EBDP
[emotional, behavioral, or developmental problem], mental health needs
were also reported for 9 [percent] of [U.S.] children with chronic
medical conditions that are not emotional or behavioral in nature,"
state the authors of an article published in the November-December 2007
issue of Ambulatory Pediatrics. The article describes rates of need
among a national sample of CSHCN, distinguishing children with chronic
EBDPs from children with primarily medical chronic conditions. The
authors specifically examine whether race and ethnicity and language
are associated with unmet need for the child and family members who
have a mental health need attributed to the child's special health care
needs. Additional possible factors associated with unmet need for
children and family members are also explored.
Data for the study were drawn from the National Survey of Children with
Special Health Care Needs, which included a sample of 38,866 CSHCN
(ages 17 and younger) and provided information about functional
limitations, impact of the condition on the family, sociodemographics,
health insurance, and access to care. Dependent variables included
parental report of (1) the child's need for mental health treatment or
counseling, (2) family member need for treatment or counseling
resulting from the child's special health care needs, (3) the child's
unmet need for mental health services, and (4) family members' unmet
need for mental health services. Covariates included health condition
characteristics (type, impact, and stability of the child's condition),
sociodemographics (gender, family income, maternal education), presence
and type of health insurance, and medical home characteristics (having
a usual source of care and a regular clinician). The analysis examined
rates of need and unmet need for children and family members overall
and by presence of an EBDP.
The authors found that
- Having a higher-impact condition and experiencing family burden
were each associated with greater mental health need.
- Race and ethnicity were associated with need only among children
with a chronic EBDP.
- In a multivariate analysis of unmet need, greater condition
impact, lower household income, and lacking insurance were each
associated with higher odds of unmet need for CSHCN both with and
without a chronic EBDP.
- Unmet need was greatest for CSHCN who lack both a usual source of
care and a personal doctor or nurse.
"Our study shows that unmet need for mental health treatment [or]
counseling is greatest among CSHCN with chronic emotional, behavioral
and developmental problems but also affects children with primarily
medical chronic conditions and family members of CSHCN," state the
authors. They add that "underserved populations, as indicated by
greater parental perception of unmet need, include African-American
CSHCN and family members of Hispanic children with potential limited
English proficiency."
Inkelas M, Raghavan R, Larson K, et al. 2007. Unmet mental health need
and access to services for children with special health care needs and
their families. Ambulatory Pediatrics 7(6):431-438. Abstract available
at http://www.ambulatorypediatrics.org/article/PIIS1530156707001438/abstract.
Readers: More information is available from the following MCH Library
resources:
- Children and Adolescents with Special Health Care Needs (knowledge
path) at
http://www.mchlibrary.info/KnowledgePaths/kp_CSHCN.html
- Children and Adolescents with Emotional, Behavioral, and Mental
Health Challenges (knowledge path) at
http://www.mchlibrary.info/KnowledgePaths/kp_Mental_Conditions.html
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and
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