MCH Alert


Maternal and Child Health Library

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March 5, 2010

1. New Surveillance System Focuses on Medications and Vaccines and Pregnancy
2. Journal Emphasizes Need to Assure and Coordinate Dissemination and Use of Effective Tobacco-Cessation Treatments and Policies
3. Analyses Explore National Trends in Self-Reported Physical Activity and Sedentary Behaviors Among Pregnant Women
4. Study Examines Neighborhood Socioeconomic Conditions, Built Environments, and Childhood Obesity
5. Article Analyzes Adolescents' Perceived Risk of Dying

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1. NEW SURVEILLANCE SYSTEM FOCUSES ON MEDICATIONS AND VACCINES AND PREGNANCY

The Vaccines and Medications in Pregnancy Surveillance System (VAMPSS) is a new nationwide post-marketing surveillance system to monitor the use and safety of vaccines and medications during pregnancy. The system, coordinated by the American Academy of Asthma, Allergy, and Immunology (AAAAI), includes an investigative task force (ITF) and a standing independent advisory committee (IAC). The ITF includes representatives from AAAAI, the Organization of Teratology Information Specialists, and the Slone Epidemiology Center at Boston University. The IAC includes members from the Centers for Disease Control and Prevention, National Institutes of Health, American College of Obstetrics and Gynecology, and American Academy of Pediatrics, as well as a consumer representative. The system involves both prospective registry surveillance and case-control surveillance. Information is collected directly from participating mothers about over-the-counter medications, dietary supplements, and products acquired outside of traditional medical settings. VAMPSS evaluates the risk or safety of pregnancy exposures with respect to spontaneous abortions, preeclampsia, fetal deaths, preterm births, intrauterine growth restriction, total major congenital malformations, and specific major malformations. The case-control component of VAMPSS provides exposure prevalence data drawn from a population-based sample. Target vaccines and medications for the initial effort include seasonal and 2009 H1N1 influenza vaccines, antiviral medications used to treat or prevent the flu in pregnancy, and asthma medications used in pregnancy. More information on how VAMPSS will be used and how clinicians can help support the system is available at http://www.otispregnancy.org/vaccines-and-medications-in-pregnancy-surveillance-system-s13053

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2. JOURNAL EMPHASIZES NEED TO ASSURE AND COORDINATE DISSEMINATION AND USE OF EFFECTIVE TOBACCO-CESSATION TREATMENTS AND POLICIES

The March 2010 supplement to the American Journal of Preventive Medicine calls attention to bringing a consumer-oriented perspective to population-level tobacco-cessation efforts to increase the demand for, and use and reach of, evidence-based treatments and to spur wider adoption of policy changes that will make these treatments affordable, accessible, and easier to use. The supplement was produced with support from the Robert Wood Johnson Foundation and the Office of Behavioral and Social Sciences at the National Institutes of Health with additional support from the National Tobacco Cessation Collaborative, the American Cancer Society, the American Legacy Foundation, the Centers for Disease Control and Prevention, the National Cancer Institute, and the National Institute on Drug Abuse. The articles and commentaries in the supplement were stimulated by a series of roundtable meetings and a conference exploring the potential to increase consumer demand for evidence-based tobacco-cessation products and services and to chart the possible population impact of such an increase. The issue offers examples of ways that a direct-to-consumer marketing approach can be applied to develop more appealing and accessible cessation products and services. Topics include the results and population health benefits of promising clinical, community, and state interventions to reduce growing disparities in smoking prevalence and treatment use; ways to make effective programs more appealing to the smokers who need them most; the separate and combined effects of multi-level interventions; principles and directions for primary care and state and national efforts to help institutionalize a consumer-based perspective; and ways to judge the success of consumer-demand-focused efforts. The supplement is available at http://www.ajpm-online.net/issues/contents?issue_key=S0749-3797(10)X0003-4

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3. ANALYSES EXPLORE NATIONAL TRENDS IN SELF-REPORTED PHYSICAL ACTIVITY AND SEDENTARY BEHAVIORS AMONG PREGNANT WOMEN

"We found that participation in any moderate to vigorous household activities and moderate leisure activities among pregnant women increased from 1999-2002 to 2003-2006, while meeting recommendations for physical activity remained stable," state the authors of an article published in the March 2010 issue of Preventive Medicine. The most recent 2002 American College of Obstetrics and Gynecology guidelines for exercise during pregnancy recommend 30 minutes or more of moderate exercise a day on most, if not all, days of the week, provided that there are no medical or obstetric complications. In 2008, the U.S. government released physical activity guidelines for Americans, recommending that pregnant women engage in at least 150 minutes of moderate-intensity aerobic activity per week. The article describes the prevalence, trends, and correlates of physical activity among a national sample of pregnant women over an 8-year period. The results extend previous national surveillance studies by exploring a broad range of physical activities (i.e., beyond leisure activity), including gestational age, and gathering physical activity reports when women are pregnant rather than relying on distant recall.

Data for the analyses were drawn from the 1999-2006 National Health and Nutrition Examination Survey. Pregnancy was determined by either self-report of pregnancy or by a positive laboratory result. Two questions on television watching and computer usage outside of work hours were used as sedentary-behavior indicators. Self-reported physical activity measures included past-month transportation, moderate to vigorous household activities, strengthening activity, and moderate and vigorous leisure activities (frequency, duration, and type). Other self-reported measures included age, gestational age, current health insurance status, household income, education, race and ethnicity, marital status, current smoking, and prior preterm birth or low-birthweight infant. The analyses explored the association of potential correlates with moderate to vigorous leisure activity and with meeting recommendations for physical activity.

The authors found that
"These data could be used to monitor trends and set national goals for physical activity among pregnant women, assuming that the questions do not change over time," conclude the authors.

Evenson K, Wen F. 2010. National trends in self-reported physical activity and sedentary behaviors among pregnant women: NHANES 1999-2006. Preventive Medicine 50(3):123-128. Abstract available at http://www.sciencedirect.com/science/journal/00917435

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4. STUDY EXAMINES NEIGHBORHOOD SOCIOECONOMIC CONDITIONS, BUILT ENVIRONMENTS, AND CHILDHOOD OBESITY

"A major strength of our study is the estimation of the effects of a variety of neighborhood conditions on childhood obesity," state the authors of an article published in the March 2010 issue of Health Affairs. Recent research has shown considerable racial and ethnic, socioeconomic, and behavioral disparities in childhood obesity. Yet there have not been precise estimates of the extent to which neighborhood social conditions and "built" environmental factors influence childhood obesity. Although a number of studies have examined the role of neighborhood characteristics in explaining variations in physical activity and obesity levels in adults, studies examining the impact of neighborhood conditions on childhood obesity are few. The authors of the article use a large, nationally representative survey to (1) estimate obesity and overweight prevalence among children by a variety of neighborhood socioeconomic and built-environment characteristics; (2) assess whether neighborhood influences on childhood obesity and overweight persist after adjusting for individual-level socioeconomic and behavioral characteristics; and (3) examine the extent to which the obesity effects of the neighborhood environment vary by age, sex, race and ethnicity, household socioeconomic status, and geographic region.

Data for the study came from the 2007 National Survey of Children's Health. All survey data were based on parent reports. The analyses estimated the percentage of obesity and overweight (as defined by the Centers for Disease Control and Prevention's 2000 growth charts) among 44,101 children ages 10 to 17. The researchers used multiple measures to assess neighborhood environment. In addition, they developed two composite indices of neighborhood environments and assessed their relationship with childhood obesity risks: the neighborhood socioeconomic conditions index (safety, presence of garbage and litter, poor or dilapidated housing, and vandalism such as broken windows or graffiti); and the built-environment index (access to sidewalks, walking paths, parks and playgrounds, recreation centers, community centers or boys' and girls' clubs, and the presence of a library or bookmobile). Higher scores on the two indices represented more favorable neighborhood socioeconomic conditions and higher levels of health-promoting amenities, respectively.

The authors found that
"Our national and population-based findings about increased obesity and overweight risks associated with unfavorable neighborhood built environmental conditions, particularly among vulnerable groups such as girls and young children, should be viewed as a major step toward narrowing this critical gap in research," the authors conclude.
 
Singh GK, Siahpush M, Kogan MD. 2010. Neighborhood socioeconomic conditions, built environments, and childhood obesity. Health Affairs 29(3):503-512. Abstract available at http://content.healthaffairs.org/cgi/content/abstract/29/3/503

Readers: The March 2010 issue of Health Affairs describes the root causes of obesity in children and offers prescriptions for a healthier future. The issue, titled Child Obesity: The Way Forward, was produced with support from the Robert Wood Johnson Foundation. Topics include the state of childhood obesity in America, the role of agriculture policy and food marketing and distribution in reducing childhood obesity, fighting obesity in schools, lessons from states and localities, the effects of environments on childhood obesity, and the impact of childhood obesity on employers. The issue is available to subscribers at http://content.healthaffairs.org/content/vol29/issue3/index.dtl?etoc

More information is available from the following MCH Library resource:

- Overweight and Obesity in Children and Adolescents: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_overweight.html

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5. ARTICLE ANALYZES ADOLESCENTS' PERCEIVED RISK OF DYING

"If adolescents really have the sense of foreboding seen here, then its sources and remedies should be important to adults concerned with adolescents' well-being," write the authors of an article published in the March 2010 issue of the Journal of Adolescent Health. Adolescents' willingness to prepare for the future depends, in part, on their confidence in living long enough to get a return on that investment. Despite common wisdom, studies have found that adolescents are, if anything, less likely than adults to see themselves as relatively invulnerable. This is worrisome for those concerned with adolescents' well-being. In the study described in this article, the authors examined whether adolescents' beliefs about several direct threats to their survival -- including exposure to gangs, weapons, or actual violence -- are related to mortality judgments. The authors consider correlations with two aspects of the mortality judgments. The first is adolescents' actual judgments of the percent chance of dying. The second is whether adolescents say "50 percent" or "50" in the sense of "50-50." Studies have shown that people sometimes say "50" rather than a numeric probability, and that this appears to capture the epistemic uncertainty of people who are unwilling or unable to express their beliefs in a quantitative form. As a result, these responses reflect uncertainty about an event rather than certainty about it having a 50 percent chance of occurring. Therefore, such 50s might provide a window into how adolescents think about such a deeply uncertain event as their own mortality.

Data from two separate studies were used: the National Longitudinal Study of Youth, a large representative sample of adolescents ages 14 to 18 and a regional, less-representative sample of adolescent ages 12-16. Participants were asked about their chance of dying in the next year and before age 20, and about the extent of various threats to their physical well-being.

The authors found that
The authors conclude that "adolescents need faith in their future so as to invest in their own human capital, by studying, working, and avoiding risky behaviors. That faith may require both the belief that specific threats are low and the feeling that their world will protect them from unnamed threats."

Fischhoff B, Bruin de Bruin W, Parker A, et al. 2010. Adolescents' perceived risk of dying. Journal of Adolescent Health 46(3):265-269. Abstract available at http://www.jahonline.org/article/S1054-139X%2809%2900263-8/abstract

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

- Emotional, Behavioral, and Mental Health Challenges in Children and Adolescents: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_Mental_Conditions.html

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