Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html
February 18, 2011
1. MCH Library Updates Resource Brief on Culturally Competent Services
2. Trial Adds to Growing Body of Research Aimed at Preventing Childhood Obesity
3. Research Examines Quality of Life Among Parents of Children with Cancer
4. Article Analyzes Patterns of Comorbidity, Functioning, and Service Use for Children with ADHD
************************************************************
1. MCH LIBRARY UPDATES RESOURCE BRIEF ON CULTURALLY COMPETENT SERVICES
Culturally Competent Services Resource Brief, a guide to websites and
related professional resources, was updated in February 2011 by the
Maternal and Child Health Library (MCH Library) at Georgetown
University. The updated brief contains links to federal agency and
other organizational websites, along with descriptions of selected
resources. Also featured are selected resources developed by the MCH
Library such as an annotated bibliography on culturally competent
services, links to minority health organizations and
non-English-language materials and resources, and a knowledge path on
racial and ethnic disparities in health. The brief is available at http://www.mchlibrary.info/guides/culturalcompetence.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
************************************************************
2. TRIAL ADDS TO GROWING BODY OF RESEARCH AIMED AT PREVENTING CHILDHOOD OBESITY
"By equipping postpartum mothers with sound parenting practices, stress
management techniques, and skills for creating behavior change in
herself and her child, a family-based obesity prevention program such
as KAN-DO may prove to be an effective mechanism for reducing the
incidence of childhood obesity," state the authors of an article
published in Contemporary Clinical Trials online on February 5, 2011.
Family-based intervention continues to be an important area of
research, and there is recognition of the value of targeting parents as
agents of change. However, few trials have focused specifically on
parenting skills or practices as intervention targets. The article
presents the design, rationale, and key baseline participant
characteristics of Kids and Adults Now! Defeat Obesity (KAN-DO), a
family-based behavioral intervention for the prevention of childhood
obesity.
The target population consisted of postpartum women who were overweight
or obese before they became pregnant and their children ages 2-5 in 14
counties of the Triangle and Triad regions of North Carolina.
Participants randomized to the control arm received monthly newsletters
emphasizing pre-reading skills in the child; the information was based
on publicly available pamphlets created through the Reading Is
Fundamental program. Participants randomized to the intervention arm
received eight interactive family kits. Kits were mailed monthly, and
each was followed by a 20-30 minute supportive telephone counseling
session based on motivational interviewing techniques. Mailed modules
and telephone calls were supplemented with a group session where skills
were reinforced by the counselor and study nutritionist. Assessments
were collected at entry to the study (2-6 months postpartum, baseline),
at the end of the intervention (10 months post-baseline, follow-up 1),
and 1 year post-intervention (22 months post-baseline, follow-up 2).
Primary analyses related to changes in the child’s weight, diet, and
physical activity levels. Secondary analyses related to the same
outcomes in the mother, changes in the mother’s parenting skills
(emotional regulation, authoritative parenting), and the possible
impact of "teachable moments" (i.e., the birth of an infant) on
intervention effects.
To date, the authors have found that
- Four hundred mother-child dyads were randomized to the trial between September 2007 and November 2009.
- About 40 percent of mothers were overweight at baseline, and the
rest were obese at baseline; 75 percent were white and 22 percent were
black; 19 percent reported an income of $30,000 or below; and 25
percent were uninsured or insured through Medicaid.
- At baseline, 24 percent of children were overweight or obese.
- Valid accelerometry data were collected on 84 percent of the
sample. Of these, no children in the study had at least 1 hour of
moderate/vigorous activity per day.
- Forty-four percent of the children watched more than 2 hours of television daily.
The authors conclude that "our primary endpoint (BMI z-score change at
approximately 2 years post-baseline) strikes the balance between
following the preschoolers and their mothers long enough to assess
long-term outcomes with what is feasible within a 5 year study period."
Ostbye T, Zucker N, Krause KM, et al. 2011. Kids and Adults Now! Defeat
Obesity (KAN-DO): Rationale, design and baseline characteristics.
Contemporary Clinical Trials [published online on February 5, 2011].
Abstract available at http://dx.doi.org/10.1016/j.cct.2011.01.017
Readers: More information is available from the following MCH Library resources:
- Overweight and Obesity in Children and Adolescents: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_overweight.html
- Nutrition in Kids and Teens: Resources for Families at
http://www.mchlibrary.info/families/frb_childnutr.html
- Nutrition and Physical Activity for Women: Bibliography of Materials from MCHLine at
http://www.mchlibrary.info/databases/bibliography.php?target=auto_search_nutpawomen
************************************************************
3. RESEARCH EXAMINES QUALITY OF LIFE AMONG PARENTS OF CHILDREN WITH CANCER
"This study extends previous research on the impact of childhood cancer
on the family," state the authors of an article published in Quality of
Life Research online on February 2, 2011. The authors of the article
recently published a study implicating stress as a mediator between
caring for a child with cancer and poor parental quality of life (QOL).
This previous study, however, addressed only differences between
parents of children with cancer and parents caring for children without
cancer. It did not assess potential sources of variation in parental
QOL among parents caring for children with cancer. The article examines
which specific cancer- and treatment-related factors are associated
with adverse parental QOL outcomes and whether caregiver burden and
stress mediate these relationships.
The case-only sample was drawn from the larger longitudinal study of
parents of children with or without cancer or a brain tumor. The final
sample included 75 children with cancer and their parent who was most
involved in caregiving, of whom all but 3 were the child's biological
parent. Key diagnosis and treatment variables were abstracted from the
child's medical record. All participating parents completed an
in-person interviewer-assisted survey that included items about
sociodemographic characteristics, health behaviors, and a series of
validated self-reported measures. Participants also completed a
follow-up interviewer-assisted phone survey 3-6 months after their
initial interview. Data were analyzed cross-sectionally.
The authors found that
- Having a child with an activity limitation was associated with
significantly worse mental health-related QOL, as was having a child on
active or maintenance cancer treatment. Controlling for time since
diagnosis and other treatment factors did not impact these results.
- Being married or partnered was associated with significantly better mental health-related QOL.
- Having a college degree or a more advanced degree and reporting
poor sleep were associated with significantly worse mental
health-related QOL.
- When burden was included in the model of poor mental
health-related QOL, the effect of having a child with an activity
limitation was attenuated but remained significant. The effect of
having a child on active or maintenance treatment was no longer
statistically significant. Including caregiver burden in the model also
attenuated the effects of being married or partnered, being highly
educated, and reporting poor sleep.
- After adding stress to the model, the effect of having a child
with an activity limitation was further attenuated but remained
marginally significant, while the effect of caregiver burden was
completely explained. The effect of poor sleep was also attenuated by
controlling for stress.
- Children's symptom severity was associated with parental physical
health-related QOL. This relationship was not mediated by parental
psychosocial factors.
"The findings show that caregiver burden and stress mediate the effect
of caring for a child who is in active cancer treatment or has activity
limitations on parental mental health-related QOL," conclude the
authors. They suggest that "screening parents for excessive burden,
stress, or mental health problems, and assisting them to find
appropriate support services or treatment may be essential in improving
the health and QOL of both parents and children."
Litzelman K, Catrine K, Gangnon R, et al. 2011. Quality of life among
parents of children with cancer or brain tumors: The impact of child
characteristics and parental psychosocial factors. Quality of Life
Research [published online on February 2, 2011]. Abstract available at http://www.springerlink.com/content/34828106577669l6
Readers: More information is available from the following MCH Library resources:
- Children and Youth with Special Health Care Needs: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_CSHCN.html
- Kids and Teens with Special Health Care Needs: Resources for Families at
http://www.mchlibrary.info/families/frb_CSHCN.html
************************************************************
4. ARTICLE ANALYZES PATTERNS OF COMORBIDITY, FUNCTIONING, AND SERVICE USE FOR CHILDREN WITH ADHD
"Professionals and parents need to be aware of the high prevalence of
mental health/neurodevelopmental comorbidities among school-age
children with ADHD [attention-deficit hyperactivity disorder] in the
United States," write the authors of an article published in Pediatrics
online on February 7, 2011. ADHD is one of the most common cognitive
and behavioral disorders currently diagnosed in U.S. school-age
children, with an estimated annual societal cost of $34 billion to $52
billion. Children with ADHD have elevated problems in many areas,
including academic functioning and strained social and family
relationships. Studies also show that children with ADHD commonly
exhibit additional mental health and neurodevelopmental comorbidities,
including learning disabilities, epilepsy, tic and communication
disorders, conduct disorder, anxiety, and depression. The study
described in this article uses data from the National Survey of
Children's Health (NSCH) to examine patterns of comorbidity,
functioning, and service use for children with ADHD.
The final study sample includes 61,779 children ages 6 to 17 from NSCH.
There were 5,028 children available for the analyses that examined
factors associated with outcomes for children with ADHD. Measures
included ADHD and comorbidities, child and family functioning, and
service use.
The authors found that
- Parent-reported diagnosed prevalence of ADHD for all children
ages 6 to 17 was 8.2 percent, corresponding with more than 4,010,000
cases nationwide.
- Children with ADHD were more likely than other children to have
each of 10 other mental health and neurodevelopmental disorders. Nine
of the disorders remained significant after adjustment for
sociodemographics. In total, 67 percent of the children with ADHD had
at least 1 other reported mental health/neurodevelopmental disorder,
compared with 11 percent of other children.
- Among children with ADHD, 33 percent had 1 comorbidity, 16 percent had 2, and 18 percent had 3 or more.
- Children from families with low incomes were approximately 1.4
times more likely to have ADHD than were children from families with
incomes of 400 percent of the federal poverty level (FPL) or greater.
The risk for having 3 or more comorbidities among children with ADHD
was 3.8 times higher for children from families with low incomes vs.
those from the most affluent families (30 percent vs. 8 percent.)
- Children with ADHD had more reported problems across every indicator of functioning than other children.
- Children with ADHD had higher odds of activity restriction,
school problems, grade repetition, and poor communication; their social
competence scores were lower and parent aggravation higher. For
children with ADHD, the odds of poorer functioning increased in a
step-wise fashion with increasing numbers of comorbidities.
- Among children with ADHD, functioning was consistently lower for
children from families with lower incomes than for those from families
with incomes of 400 percent FPL or greater.
- Children with ADHD consistently used more health, mental health,
and education services than did other children. Among children with
ADHD, service use increased with each additional comorbidity.
The authors conclude that "comparative effectiveness studies of primary
care treatment strategies for ADHD in children have been identified as
an Institute of Medicine priority. Our findings indicate that such
studies are urgently needed."
Larson K, Russ SA, Kahn RS, et al. 2011. Patterns of comorbidity,
functioning, and service of use for US children with ADHD, 2007.
Pediatrics [published online on February 7, 2011]. Abstract available
at http://pediatrics.aappublications.org/cgi/content/abstract/peds.2010-0165v1
Readers: More information is available from the following MCH Library resources:
- Emotional, Behavioral, and Mental Health Challenges in Children and Adolescents: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_Mental_Conditions.html
- Mental Health in Primary Care: Bibliography of Materials in MCHLine at
http://www.mchlibrary.info/databases/bibliography.php?target=auto_search_mental
************************************************************
To subscribe to MCH Alert, send an e-mail message to
MCHAlert-request@lists.mchgroup.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@lists.mchgroup.org
with UNSUBSCRIBE in the subject
line. You do not need to enter any text in the body of the message.
************************************************************
MCH Library shares notices of new issues of MCH Alert on Twitter at http://bit.ly/OKv5Y
************************************************************
MCH Alert © 1998-2011 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.
We welcome your submissions, suggestions, and
questions.
Please contact us at the address below.
The MCH Alert
Team
Ruth Barzel,
M.A., Senior Editor
Jolene Bertness,
M.Ed., MCH Alert Editor
Beth DeFrancis,
M.L.S., Associate Librarian
Tracy Lopez,
M.S.L.S., Associate Librarian
Susan Lorenzo,
M.L.S., Associate Librarian
Rochelle Mayer,
Ed.D., NCEMCH Director
Melinda Nash,
Web Developer
Olivia Pickett,
M.A., M.L.S., Director of Library Services
John Richards,
M.A. A.I.T.P., Director of Technology
Michael
Wilkinson, Technology Developer
Maternal and Child Health Library
National Center
for Education in Maternal and Child Health
Georgetown
University
Box 571272
Washington, DC 20057-1272
Telephone: (202) 784-9770
Fax: (202) 784-9777
E-mail: mchalert@ncemch.org
Website: http://www.mchlibrary.info/alert
Twitter: http://www.twitter.com/mch_library