Maternal and Child Health Library

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

December 4, 2009

1. MCH Library Releases Online Resource Brief on Immunizations
2. Review Addresses Challenges to Financing Delivery of Childhood and Adolescent Vaccines and Considerations for Stakeholders
3. Pediatrics Supplement Highlights Findings from the National Survey of Children with Special Health Care Needs
4. Article Describes How Policy Advocacy Grantees Strengthened Adolescent-Pregnancy-Prevention Policies in California
5. Authors Evaluate Cost-Effectiveness of a Comprehensive Teenage Pregnancy Prevention Program

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1. MCH LIBRARY RELEASES ONLINE RESOURCE BRIEF ON IMMUNIZATIONS

Immunizations: Resource Brief is a guide to Web sites and other resources on immunization-related topics for health professionals, the media, policymakers, and the public. The brief, produced by the Maternal and Child Health (MCH) Library at Georgetown University, lists and describes federal agency, professional organization, and advocacy Web sites containing electronic publications that provide information on child, adolescent, and adult vaccinations and immunizations, including materials in non-English languages, policy statements, recommendations, and reports. Audio and video files, blogs, news, photos, research tools, and statistics are also presented. Selected topics include vaccine-preventable diseases; how vaccines work, types of vaccines, and availability; the benefits and risks of the most common vaccines; immunizations for specific populations; and clinical trials, immunization laws, and registries. Information on state and local resources and links to a bibliography of materials and an annotated list of organizations on immunizations and vaccines developed by the MCH Library are also provided. The brief is available at http://www.mchlibrary.info/guides/immunization.html.

MCH Library resource briefs on other topics are available at http://mchlibrary.info/products.html#select. The MCH Library welcomes feedback on the usefulness and value of the resource briefs. A feedback form is available at http://www.mchlibrary.info/feedback/index.html.

"This review of the literature suggests that innovative strategies and efforts will be required to support implementation of newly recommended vaccines and to accommodate vaccines developed for routine use in the future," state the authors of an article published in a supplement to the December 2009 issue of Pediatrics. Since 1999, there have been eight new recommendations for routine vaccination among children and adolescents in the United States. The cost to administer vaccines has increased, along with the number of recommended vaccine doses. Increased costs have raised concerns about the ability of the current vaccine financing and delivery systems to maintain access without financial barriers to all vaccines recommended for routine use for children and adolescents. The article reviews the current state of U.S. financing for vaccine delivery to children and adolescents and identifies challenges that should be addressed to ensure continued access without financial barriers to routinely recommended vaccines.

The authors begin with a discussion of the U.S. vaccine financing system. Topics include definitions, health insurance coverage for vaccination, vaccine purchase financing, and vaccine administration financing. Next, they outline the challenges to financing delivery of childhood and adolescent vaccines, including increasing costs, underinsured children and adolescents, pressure on private-sector providers, and other considerations. Finally, considerations for key stakeholders are presented. Perspectives are based on input from organizations representing the interests of the following five groups: physicians and other health professionals; state and local governments; insurers, employers, and other health care purchasers; vaccine manufacturers; and consumers (parents).

The authors conclude that "although current coverage rates are high for most vaccines, recent research documents building tensions resulting from increasing vaccine costs, variable reimbursements for vaccine providers, and practice expenses. The potential for these tensions to disrupt the current vaccine financing and delivery systems demonstrates a need for cooperative action by all stakeholders." 

Lindley MC, Shen AK, Orenstein WA, et al. 2009. Financing the delivery of vaccines to children and adolescents: Challenges to the current system. Pediatrics 124(Suppl. 5):S548-S557. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/124/Supplement_5/S54.

Readers: In response to the issues presented in this review, the National Vaccine Advisory Committee (NVAC) issued a set of vaccine financing recommendations to facilitate access to all routinely recommended vaccinations without financial barriers for all children and adolescents. The review, along with the NVAC recommendations, are included in a supplement to the December 2009 issue of Pediatrics titled Financing of Childhood and Adolescent Vaccines. Additional content includes original research, stakeholder commentaries, and resources for physicians. The table of contents and abstracts are available at http://pediatrics.aappublications.org/content/vol124/Supplement_5.

The supplement to the December 2009 issue of Pediatrics is dedicated to findings from the 2005-2006 National Survey of Children With Special Health Care Needs. The supplement, sponsored by the Health Resources and Services Administration's Maternal and Child Health Bureau, contains 15 articles selected from those submitted after a national solicitation. Topics include demographic and socioeconomic correlates of special health care needs, high-risk demographic groups, and the health care environment for this population. Factors associated with increased prevalence of select chronic conditions and comparisons of state or regional data are also discussed. Collectively, the articles provide examples of how data can be used to inform policy and practice. The supplement is available to subscribers at http://pediatrics.aappublications.org/content/vol124/Supplement_4.

"The PAs [policy advocacy grantees] worked through each of the five stages of our theoretical model of policy change to successfully transform FLE [family life education] policies in California," state the authors of an article published in the December 2009 issue of Health Education and Behavior. During a 4-year period, The California Wellness Foundation (TCWF) funded 18 PAs to build the capacity of organizations and institutions to educate policymakers to facilitate development, implementation, and advocacy of policies and regulations that promote healthy adolescent sexuality and reduce adolescent pregnancies. The article describes how a subset of these PAs (N=5) successfully achieved changes in FLE policies at both state and local levels by focusing on (1) strengthening statewide and local FLE programs and policies and (2) preventing passage of legislation that would have required the state to implement abstinence-only programs. TCWF provided PAs with guidelines regarding what constituted advocacy and lobbying. Specifically, they could present relevant information but could not lobby for passage of a particular piece of legislation.

To analyze how the PAs successfully achieved changes in FLE policies, the researchers developed a modified theoretical model of the policy change continuum to include the following five stages: (1) institutional capacity and leadership building, (2) policy issue recognition, (3) policy prioritization, (4) policy adoption, and (5) policy maintenance. Both quantitative and qualitative data were collected between January 2001 and December 2004 to document PAs' impact on the FLE policy issue. In 2002 and 2003, pre- and post-policy leadership surveys were administered to advocacy training participants to assess the degree to which their knowledge of adolescent-pregnancy-prevention policies, as well as their advocacy and leadership skills, changed as a result of the training (71 percent response rate). In 2003, high school interns were hired, trained, and monitored in administering a policymaker survey to 21 state senators and staff and 29 state assembly members and staff to assess their knowledge of adolescent pregnancy, as well as their level of support for specific policy options (45 percent response rate). Data were also gathered through the PAs' quarterly progress reports, an annual online survey, and annual telephone interviews.

The following results reflect the policy stage framework and the ongoing nature of policy advocacy, from background preparation and prioritization to policy maintenance:

• The PAs increased their own capacity to engage in advocacy through research, advocacy training of both adolescent and adult advocates, and networking with other advocates.
• The PAs increased awareness of adolescent pregnancy as a problem through the dissemination of informational materials, engaging in media advocacy and policymaker education, and hosting policy forums.
• Policymakers came to regard FLE as a key policy issue.
• New policies were enacted, including passage of the California Comprehensive Sexual Health and HIV/AIDS Prevention Education Act (SB71), as well as local school policies that expanded FLE education.
• The PAs worked to prevent the erosion of existing FLE policies and laws by convincing California not to accept federal abstinence-only education and, at the local level, not to implement an abstinence-only sex education curriculum. 

"Effective policy advocacy requires a specific set of strategies at all stages of the policy change process, including adequate preparation among advocates, the right combination of diverse constituents, awareness of the policy and political climate, prioritizing and pursuing a realistic policy goal, active engagement of young people, and adequate funding and/or other resources," state the authors. They add, "establishing a shared policy agenda can facilitate grantees' working together in a more focused way."

Brindis CD, Geierstanger SP, Faxio A. 2009. The role of policy advocacy in assuring comprehensive family life education in California. Health Education and Behavior 36(6):1095-1108. Abstract available at http://heb.sagepub.com/cgi/content/abstract/36/6/1095.

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

- Sexuality Education: Bibliography of Materials from MCHLine at
http://mchlibrary.info/databases/bibliography.php?target=auto_search_sexeduc

"Our analysis suggests that from a societal perspective, the total benefits from participating in the Pathways/Senderos Center would exceed the total costs of the program once enrollees reach age 20.1 years, while costs modestly exceed benefits by about $1600 per teen per year during participation," write the authors of an article published in the December 2009 issue of the American Journal of Preventive Medicine. Although some programs have been found effective in reducing adolescent pregnancy, limited evidence exists on their cost-effectiveness. The study described in this article estimated the cost-effectiveness of the Greater New Britain Teen Pregnancy Prevention's Pathways/Senderos Center, a comprehensive neighborhood-based program to prevent unintended pregnancies and promote positive youth development for middle and high school students in an impoverished, largely Latino neighborhood in New Britain, Connecticut. For the period 1997-2003, the center enrolled 50 students per year in a year-round curriculum with expected daily participation for 7 years.

Total program costs and benefits were estimated from a societal perspective over the 7-year period for which adolescents were enrolled. Total societal costs were defined as the total operating costs of the program. Total societal benefits included the sum of (1) the total costs averted from prevention of the estimated number of births to adolescent girls that would have occurred without the program and (2) the additional economic benefits from participating, independent from prevention of births.

The authors found that

• From 1997 to 2003, the inflation-adjusted program operating costs totaled $3,285,128.08 for 7 years, for a cost per student per year of $9,386.08 and a 7-year total cost of $65,702.56.
• A calculation was made of an expected pre-high-school-graduation birthrate in New Britain of 94.10 per 1,000 adolescent girls, or 2.35 for the 25 girls in a cohort of 50 students between enrollment at age 11 and high school graduation. In comparison, from 1997 to 2003, the adolescent childbearing rate was 40.00 per 1,000, an estimated reduction of 54.10 adolescent births per 1,000 girls.
• The societal costs averted by reducing adolescent births were estimated at $52,297.84 during program years, while the added economic benefits of participation were $2,673,153.11.
• Total operating costs exceeded economic benefits by $559,677.05 during program years, or $1,599.08 per student. By age 30, net benefits were estimated to be $10,474.77 per student.

The authors conclude that "this . . . study offers a perspective to policymakers, program planners, and communities to consider longer-term goals when investing in programs that address challenging problems such as teenage pregnancy in underserved youth."

Rosenthal MS, Ross JS, Bilodeau R, et al. 2009. Economic evaluation of a comprehensive teenage pregnancy prevention program: Pilot program. American Journal of Preventive Medicine 37(6, Suppl. 1):S280-S287. Abstract available at http://www.ajpm-online.net/article/S0749-3797%2809%2900528-5/abstract.

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

- Adolescent Pregnancy Prevention: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_adolpreg.html