Maternal and Child Health Library

This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.

July 11, 2008

1. Annual Study Released on Women's Health Outcomes in U.S. Hospitals

2. HRSA Report Studies Safety Net Health Centers

3. Article Reviews Trends in Cigarette Use Among High School Students

4. Article Evaluates Impact of a Prenatal Substance Abuse Treatment Program on Perinatal Outcomes

5. Article Assesses Utility of a Risk-Factor-Based Approach to HPV Catch-up Vaccination

************************************************************

1. ANNUAL STUDY RELEASED ON WOMEN'S HEALTH OUTCOMES IN U.S. HOSPITALS

The Fifth Annual HealthGrades Women's Health Outcomes in American Hospitals Study identifies outcomes for maternity care and inhospital treatment of cardiovascular disease (CVD) in women using data from the period 2004-2006 in 17 states. The report provides maternal complication rates for vaginal, clinically indicated Cesarean section (C section), and patient-choice (non-clinically indicated) C-section deliveries. The report also includes neonatal mortality rates for all hospitals evaluated. Risk-adjusted analysis of inhospital treatment identifies mortality rates in CVD and stroke among women. In addition, the report identifies top-performing hospitals. The report is available at http://www.healthgrades.com/media/DMS/pdf/HealthGradesWomensHealthStudy2008.pdf.

************************************************************

2. HRSA REPORT STUDIES SAFETY NET HEALTH CENTERS

Health Centers: America’s Primary Care Safety Net describes the history of safety net health center programs; safety net health centers' role in providing a medical home; the model of care used, and how connections are sustained between primary care associations, offices, and other partners. The report, produced by the Health Resources and Services Administration’s Bureau of Primary Health Care, also discusses the unprecedented growth of the health center program during the period 2002-2007 and outlines issues related to the program's future in the following areas: work force, health information technology, emergency management, quality, and performance measurement. Program successes are discussed, as well. The report is available at ftp://ftp.hrsa.gov/bphc/HRSA_HealthCenterProgramReport.pdf.

************************************************************

3. ARTICLE REVIEWS TRENDS IN CIGARETTE USE AMONG HIGH SCHOOL STUDENTS

"The findings in this report show that current cigarette use among high school students declined from 1997 to 2003, but rates remained stable from 2003 to 2007," write the authors of an article published in the June 27, 2008, issue of Mortality and Morbidity Weekly Report. Cigarette use is the leading preventable cause of death in the United States. To examine changes in cigarette use among high school students during 1991-2007, the Centers for Disease Control and Prevention (CDC) analyzed data from the national Youth Risk Behavior Survey (YRBS). The authors assessed temporal changes for three behaviors: (1) lifetime cigarette use (i.e., ever tried cigarette smoking, even one or two puffs), (2) current cigarette use (i.e., smoked cigarettes on at least 1 day during the 30 days before the survey), and (3) current frequent cigarette use (i.e., smoked cigarettes on 20 or more days during the 30 days before the survey).

The biennial YRBS, a component of CDC's Youth Risk Surveillance System, used independent, three-stage cluster samples from the 1991-2007 surveys to obtain cross-sectional data representative of public and private school students in grades 9-12 in all 50 states and the District of Columbia. Sample sizes ranged from 10,904 to 16,296. Overall response rates for the surveys ranged from 60% to 70%.

The authors found that

• The prevalence of lifetime cigarette use was stable during 1991-1999 and then declined from 70.4% in 1999 to 50.3% in 2007.
• The prevalence of current cigarette use increased from 27.5% in 1991 to 36.4% in 1997, declined to 21.9% in 2003, and remained stable from 2003 to 2007.
• The prevalence of current frequent cigarette use increased from 12.7% in 1991 to 16.8% in 1999 and then declined to 8.1% in 2007.
• Among black students overall, the prevalence of current cigarette use increased from 12.6% in 1991 to 22.7% in 1997, declined to 14.7% in 2001, and then declined more gradually to 11.6% in 2007.
• Among black male students, the prevalence of current cigarette use increased from 14.1% in 1991 to 28.2% in 1997, declined to 16.3% in 2001, and then remained stable from 2001 to 2007.
• Among black female students, the prevalence of current cigarette use increased from 11.3% in 1991 to 17.7% in 1997 and then declined to 8.4% in 2007.

The authors conclude that "to resume the declines observed in current cigarette use during 1997-2003 and achieve the 2010 [national health] objective [to reduce the prevalence of current cigarette smoking among high school students to 16% or less], communitywide comprehensive tobacco-control programs that use coordinated evidence-based strategies should be implemented and revitalized."

Office on Smoking and Health, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Cigarette use among high school students -- United States, 1991 -- 2007. MMWR 57(25):689-691. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5725a3.htm?s_cid=mm5725a3_e.

************************************************************

4. ARTICLE EVALUATES IMPACT OF A PRENATAL SUBSTANCE ABUSE TREATMENT PROGRAM ON PERINATAL OUTCOMES

"Early Start's replicable model of integrating substance abuse treatment with prenatal care is cost-effective and significantly decreases negative birth outcomes as well as maternal morbidity," state the authors of an article published in the June 26, 2008, issue of the Journal of Perinatology. Substance abuse during pregnancy is a serious problem in the United States; it results in considerable adverse effects for women and their infants. Kaiser Early Start is a coordinated prenatal substance abuse treatment program that is part of Kaiser Permanente Northern California's (KPNC's) comprehensive prenatal program. The purpose of the study described in this article was to provide a comprehensive evaluation of the effect of Early Start on maternal and neonatal outcomes.

The study cohort included 49,985 female KPNG members who completed Early Start prenatal substance abuse screening questionnaires between January 1, 1999, and June 30, 2003. Fetal and neonatal outcomes analyzed included intrauterine fetal demise (IUFD), neonatal-assisted ventilation, low birthweight, preterm delivery, completed weeks of gestation, neonatal intensive care unit admission, infant re-hospitalization within 30 days of discharge from birth hospitalization, and infant emergency department visits within 180 days of discharge from birth hospitalization. Maternal outcomes analyzed were Cesarean delivery, preterm labor, and placental abruption. The authors defined four study groups. Group 1: screened, assessed positive for substance abuse, and treated by Early Start (SAT); Group 2: screened, assessed positive, and not treated (SA); Group 3: screened only and identified as substance abusers (S), and Group 4: controls (C) (women with no evidence of substance abuse during pregnancy).

The authors found that

• Compared with controls, SAT women had similar or higher rates on most risk factors (weekly/daily use of alcohol, methamphetamines, THC [marijuana], cocaine, heroin, and cigarettes both before and after pregnancy), but lower rates than S women. For the most part, the rates of SA women were between SAT and S rates.
• In multivariate analyses, the S group had significantly worse outcomes than the SAT group in the following areas: preterm delivery (odds ratio [OR] = 2.1, 1-3-3.2), placental abruption (OR = 6.8, 3.0-15.5), and IUFD (OR = 16.2, 6.0-43.8).

The authors conclude that "The results of this study reflect the importance of widespread implementation of this model of care as a national standard."

Goler NC, Armstrong MA, Taillac CJ, et al. 2008. Substance abuse treatment linked with prenatal visits improves perinatal outcomes: A new standard. Journal of Perinatology [published online ahead of print on June 26, 2008]. http://www.nature.com/jp/journal/vaop/ncurrent/abs/jp200870a.html.

Readers: More information is available from the following MCH Library resource:

- Preconception and Pregnancy: Knowledge path at http://www.mchlibrary.info/KnowledgePaths/kp_pregnancy.html

************************************************************

5. ARTICLE ASSESSES UTILITY OF A RISK-FACTOR-BASED APPROACH TO HPV CATCH-UP VACCINATION

"Given that a risk-factor-based approach does not seem to be a reasonable option for implementing HPV catch-up vaccination, alternative solutions to meet the financial demands of universal HPV catch-up vaccination must be developed," write the authors of an article published in the July 2008 issue of Pediatrics. In June 2006, the U.S. Food and Drug Administration licensed the first vaccine against human papillomavirus (HPV) for use in females ages 9-26. Although immunization of all females in this age group would provide the most comprehensive protection against HPV infection, financial barriers could make this strategy difficult to implement. It has been suggested that individual-level risk factors could be used to target HPV catch-up vaccination preferentially to females at highest risk for acquiring HPV. The authors used data from the National Longitudinal Study of Adolescent Health (Add Health) to determine whether specific adolescent characteristics are risk factors predictive of future HPV infection among young adults. Using these data, the authors tested two hypotheses: (1) among sexually active females, the risk factors identified retrospectively in other studies as being associated with current HPV infection also would be predictive of future HPV infection and (2) among virgins, risk factors associated with the future acquisition of other sexually transmitted diseases and/or with engagement in high-risk sexual behaviors would be predictive of future HPV infection.

Add Health is a longitudinal study of females enrolled in grades 7-12 that evaluates how social factors and health-related behaviors influence health outcomes. Data collected for Add Health occurred in three waves over a period of 6 years. For this study type-specific, urine-based HPV testing was performed in wave III for a nationally representative sample of 3,483 sexually active females. The final sample consisted of 3,181 participants who were at least age 12 during wave I (1994-1995). The primary outcome measure was positive HPV test results in wave III (2001-2002, when the participants were young adults).

The authors found that 

• Forty-three percent of the sample reported being sexually active in wave I of the study. The sexually active adolescents tended to be older and in a higher grade and more likely to be black, compared to those who had not yet initiated sexual activity in wave I.
• In wave III, 9.0% of the study sample tested positive for at least one of the HPV types found in the currently licensed HPV vaccine.
• Fifty-three percent of the subjects who tested positive in wave III were virgins in wave I.
• Bivariate and multivariate analyses demonstrated that there was no significant association between adolescent sexual activity status (in wave 1) and detection of vaccine-type HPV as a young adult (in wave III).

The authors conclude that "even if the price of HPV vaccine decreases significantly, the expected addition of other vaccines to the recommended immunization schedule indicates that a long-term plan to ensure ongoing universal access to all recommended vaccines needs to be developed."

Dempsey AF, Gebremariam A, Koutsky L, et al. 2008. Behavior in early adolescence and risk of human papillomavirus infection as a young adult: Results from a population-based study. Pediatrics 122(1):1-7. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/122/1/1?etoc.

************************************************************

To subscribe to MCH Alert, send an e-mail message to MCHAlert-request@list.ncemch.org with SUBSCRIBE in the subject line. You do not need to enter any text in the body of the message.

To unsubscribe from MCH Alert, send an e-mail message to MCHAlert-request@list.ncemch.org with UNSUBSCRIBE in the subject line. You do not need to enter any text in the body of the message.

************************************************************

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 Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.
 
Permission is given to forward MCH Alert, in its entirety, to others. For all other uses, requests for permission to duplicate and use all or part of the information contained in this publication should be sent to mchalert@ncemch.org.

The editors welcome your submissions, suggestions, and questions. Please contact us at the address below.

MANAGING EDITOR: Jolene Bertness
CO-EDITOR: Tracy Lopez
COPYEDITOR/WRITER: Ruth Barzel
LIST ADMINISTRATOR: Beth DeFrancis Sun

MCH Alert
Maternal and Child Health Library
National Center for Education in Maternal and Child Health
Georgetown University
Box 571272
Washington, DC 20057-1272
Phone: (202) 784-9770
Fax: (202) 784-9777
E-mail: mchalert@ncemch.org
Web site: http://www.mchlibrary.info/alert/default.html