Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
February 1, 2008
1. Fact Sheet on Health Care Access and Utilization Among
Adolescents And Young Adults Released
2. Online Series Designed to Facilitate Leadership Skills
Training in "Real World" MCH Settings
3. Study Reviews Costs of Health Problems in Young
Children and Interventions to Address Them
4. Article Assesses Cost-Effectiveness of
Child-Restraint-System Program
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1. FACT SHEET ON HEALTH CARE ACCESS AND UTILIZATION AMONG
ADOLESCENTS AND YOUNG ADULTS RELEASED
The 2008 Fact Sheet on Health Care Access and Utilization: Adolescents
and Young Adults contains the most recent available data on health
insurance coverage, preventive and other health services, and unmet
need among adolescents and young adults ages 12-24, including those
with special health care needs. The fact sheet, produced by the
National Adolescent Health Information Center at the University of
California, San Francisco, with support from the Maternal and Child
Health Bureau, highlights trends and presents data by age, gender,
income level, and race and ethnicity. Information on trends and data
sources is included. The fact sheet is available at http://nahic.ucsf.edu/download.php?f=/downloads/HCAU2008.pdf.
A list of other NAHIC-produced briefs and fact sheets is available at http://nahic.ucsf.edu/index.php/data/article/briefs_fact_sheets.
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2. ONLINE SERIES DESIGNED TO FACILITATE LEADERSHIP SKILLS TRAINING IN
"REAL WORLD" MCH SETTINGS
The Maternal and Child Health Leadership Skills Development Series
synthesizes leadership-development materials into modular formats to
help maternal and child (MCH) professionals and students facilitate
leadership-skills training within the context of their own work
settings. The series, developed by the Women and Children's Health
Policy Center at Johns Hopkins School of Public Health, is a compendium
of both original content and resources adapted from a variety of
sources. Each module offers a mix of presentation and exploration in
different learning formats, including (1) video “mini-lectures”
presenting key content and themes, (2) interactive group discussion
questions and exercises, (3) case studies with discussion prompts and
hands-on exercises, (4) video clips from interviews with MCH leaders,
(5) individual self-reflection exercises, and (6) individual
leadership-development planning worksheets. The series is intended for
use by emerging MCH leaders at all levels of career and organizational
development in responding in new ways to the daily challenges of work
and committing new energy to the achievement of common goals. More
information about the series and a user guide are available at http://www.jhsph.edu/wchpc/MCHLDS/index.html.
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3. STUDY REVIEWS COSTS OF HEALTH PROBLEMS IN YOUNG CHILDREN AND
INTERVENTIONS TO ADDRESS THEM
Investments to Promote Children's Health: A Systematic Literature
Review and Economic Analysis of Interventions in the Preschool Period
examines the short- and long-term impacts of health-promotion and
disease-prevention interventions on selected health problems in infants
and young children from birth to age 5. The report, published by the
Partnership for America's Economic Success with support from the Zanvyl
and Isabelle Krieger Fund, reviews the patterns and monetary burden of
poor child health, the cost implications of preventing and treating
child health problems, and cost-benefit analyses related to the
interventions. Summaries of studies of interventions during pregnancy
that report child health and economic outcomes are included.
Information on cost-benefit analyses for interventions on tobacco use,
obesity, unintentional injury, and mental health problems is provided.
The full report is available at
http://www.partnershipforsuccess.org/uploads/200801_HopkinsPaperFINAL.pdf.
A research brief titled Early Childhood Health Problems and Prevention
Strategies: Costs and Benefits is also available at http://www.partnershipforsuccess.org/uploads/200801_HopkinsBriefFINAL.pdf.
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4. ARTICLE ASSESSES COST-EFFECTIVENESS OF CHILD-RESTRAINT-SYSTEM PROGRAM
"This analysis demonstrates that a Medicaid-based child restraint
system disbursement and education program is cost saving to society and
cost-effective to Medicaid, with a cost-effectiveness comparable or
superior to childhood immunization programs," state the authors of an
article published in the January-February 2008 issue of Ambulatory
Pediatrics. Children from families with low incomes are
disproportionately at risk for both preventable diseases and
unintentional injury. Despite recent adoption of child passenger safety
legislation and increased community focus on proper child passenger
safety practices, children from families with low incomes are
disproportionately unrestrained when riding in motor vehicles.
Consequently, rates of injury and death are higher than for children of
higher socioeconomic status, and this places a substantial economic
burden on state Medicaid programs. The goal of the study described in
this article was to evaluate the cost-effectiveness of Medicaid-based
reimbursement for child restraint system (CRS) disbursement and
education for children from low-income families and to compare it with
the cost-effectiveness of vaccinations covered under Congress's
Vaccinations for Children program.
The authors created a decision model for two scenarios to compare
outcomes and costs after motor-vehicle crashes: (1) no CRS disbursement
or education and (2) a universal Medicaid-based disbursement and
education program. Data were derived from public and private databases
and were adjusted by age, insurance status, vehicle model year, and
years of data collected. Outcome-associated costs included direct
medical costs (acute physician care and hospital services), indirect
medical costs (emergency transportation, emergency medical technician
services, and rehabilitation), and nonmedical costs (future
productivity-loss costs and parental-work-loss costs).
The authors found that
- For the recommended 8-year cycle of CRS use, the program would
cost $13 per beneficiary per year.
- The societal break-even point would be reached after 3 years, at
which time program costs would be balanced by savings in averted
medical, parental, and work-loss costs and by future productivity
costs.
- The net cost of Medicaid (excluding savings from work loss and
productivity loss averted) over the 8 years would be $4 per beneficiary
per year.
- From Medicaid's perspective, the program would cost $561,534 per
death averted and $16,928 per life year saved, but the program would be
cost-saving from society's perspective, primarily because of future
productivity costs and savings.
- From an insurer's perspective, the program would be as
cost-effective as childhood vaccinations for varicella, hepatitis B,
and pneumococcus, or more cost-effective than these vaccinations.
The authors conclude that "this analysis both underscores the need for
and demonstrates the clinical and economic feasibility of action to
reduce the burden of injury among low-income children."
Goldstein JA, Winston FK, Kallan MJ, et al. 2008. Medicaid-based
restraint system disbursement and education and the Vaccines for
Children program: Comparative cost-effectiveness. Ambulatory Pediatrics
8(1)58-65. Abstract available at http://www.ambulatorypediatrics.org/article/PIIS1530156707002067/abstract.
Readers: More information is available from the MCH Library's list of
selected resources on Child Safety and Injury Prevention at http://www.mchlibrary.info/guides/childsafety.html.
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5. AUTHORS EXAMINE THE IMPACT ON BREASTFEEDING OF INFANT FORMULA
MARKETING THROUGH HOSPITALS
"This study indicates that provision of CHDPs [commercial hospital
discharge packs] to new mothers who have initiated breastfeeding may be
associated with early discontinuation of exclusive breastfeeding,"
state the authors of an American Journal of Public Health article
published ahead of print on January 2, 2008. Despite well-documented
evidence that supports breastfeeding, only 66% of U.S. women initiate
breastfeeding, and only 33% exclusively or partially breastfeed for 6
months. These figures fall short of the Healthy People 2010 goals to
increase the proportion of women who initiate breastfeeding to 75% and
to increase the proportion of those who breastfeed for at least 6
months to 50%. International discussions about the role of formula
manufacturers and ways in which hospitals could increase support for
breastfeeding culminated in the Baby-Friendly Hospital Initiative, a
1991 codification of practices by the World Health Organization. In an
earlier study of newborn hospital breastfeeding support practices in
Oregon, the authors of this article found low compliance with
Baby-Friendly hospital practices for supplementation (including
providing mothers with formula-promotion items). The current study
estimates the proportion of new mothers in Oregon who received CHDPs
after initiation of breastfeeding and examines the association between
receipt of CHDPs and exclusive breastfeeding duration.
Data for the study were drawn from Oregon's Pregnancy Risk Assessment
Monitoring System (PRAMS) for the years 2000 and 2001. A total of 3,985
women who delivered a live-born infant in Oregon completed the study
survey (unweighted response rate of 71.6%). In addition to the primary
independent variable of interest (receipt of CHDP), the researchers
also analyzed demographic and prenatal characteristics of respondents
that might have been associated with exclusive breastfeeding. The PRAMS
datasets were the source for duration and exclusivity of breastfeeding,
annual pre-pregnancy family income, maternal pre-pregnancy body mass
index, and smoking status at the time of the survey. Birth certificate
data were used to obtain maternal age; education; race and ethnicity;
parity; marital status; and enrollment status in the Special
Supplemental Nutrition Program for Women, Infants, and Children (WIC)
program during pregnancy. The final sample for analysis included
responses from 2,684 women. The researchers examined the relationship
between sustained exclusive breastfeeding for at least 10 weeks and the
receipt of CHDPs and the relationship between the receipt of CHDPs and
nonexclusive breastfeeding for at least 10 weeks.
The authors found that
- Among PRAMS respondents who initiated breastfeeding, 66.8%
reported having received a CHDP from the hospital.
- Women who received a CHDP were more likely to exclusively
breastfeed for shorter durations, compared with women who did not
receive a CHDP.
- After adjusting for maternal age, race and ethnicity, education,
and family income, women who received a CHDP were more likely to
exclusively breastfeed their infants for less than 10 weeks than were
women who did not receive a CHDP.
- CHDPs did not have a significant effect on nonexclusive
breastfeeding for at least 10 weeks.
"One way to increase exclusive breastfeeding may be to halt the
provision of CHDPs at the time of newborn hospital discharge," the
authors conclude.
Rosenberg KD, Eastham CA, Kasehagen L, et al. 2007. Infant formula
through hospitals: The impact of commercial hospital discharge packs on
breastfeeding. American Journal of Public Health [Published ahead of
print on January 2, 2008]. Available at http://www.ajph.org/cgi/doi/10.2105/AJPH.2006.103218.
Readers: More information is available from the MCH Library's Selected
Resources, Breastfeeding, at http://www.mchlibrary.info/guides/breastfeeding.html.
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MCH Alert © 1998-2008 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
in Maternal and Child Health under its cooperative agreement
(U02MC00001) with the Maternal and Child Health Bureau, Health
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MANAGING EDITOR: Jolene Bertness
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COPYEDITOR/WRITER: Ruth Barzel
LIST ADMINISTRATOR: Beth DeFrancis Sun
MCH Alert
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