February 3, 2012
- Fact Sheet Reviews Social Interventions to Address Internalizing Problems in Adolescents
- Authors Focus on Federal Policy Advances Related to Health Literacy
- Report Examines Why Adolescents Wishing to Avoid Pregnancy Become Pregnant
- Study Estimates Obesity Prevalence and Investigates Trends Among Children and Adolescents
- Article Analyzes Rural-Urban Cervical Cancer Trends and Patterns
1. Fact Sheet Reviews Social Interventions to Address Internalizing Problems in Adolescents
What Works to Prevent or Reduce Internalizing Problems of Socio-Emotional Difficulties in Adolescents: Lessons from Experimental Evaluations of Social Interventions describes lessons learned from rigorously evaluated programs designed to prevent or treat internalizing problems in adolescents. The fact sheet, published by Child Trends through a partnership with the National Adolescent Health Information and Innovation Center, describes internalizing problems (defined as "problems or disorders of emotion or mood caused by difficulties regulating negative emotions") and findings from a review of 37 random-assignment social intervention programs for adolescents. Programs that impact specific internalizing behaviors are presented according to whether they were found to work, had mixed findings, or were found to not work. Implications of the findings and needed research are also discussed. The fact sheet is available at http://www.childtrends.org/Files//Child_%20Trends-2011_12_01_FS_%20WWInternalizing.pdf
2. Authors Focus on Federal Policy Advances Related to Health Literacy
"The time is right to accelerate our national commitment to providing the American people with clear, understandable, and actionable science-based health information," write the authors of an article published in Health Affairs online on January 18, 2012. The article reviews opportunities that recent federal policies have created to improve health literacy. In particular, the authors discuss three 2010 initiatives that collectively catalyzed attention to the consequences of, and remedies for, limited health literacy. These are the Affordable Care Act, the health care reform law of 2010; the National Action Plan to Improve Health Literacy of the Department of Health and Human Services; and the Plain Writing Act of 2010, which requires all new publications, forms, and publicly distributed documents produced by the federal government to be written in a "clear, concise, well-organized" manner. Topics include effective actions from randomized trials demonstrating that system changes focused on health literacy issues can support preventive and client-centered care. These actions include simplifying and making written materials easier to understand, improving providers' communication skills, and improving clients' self-management skills. The authors also discuss the implications of improving access, quality, and cost.
Koh HK, Berwick DM, Clancy CM, et al. 2012. New federal policy initiatives to boost health literacy can help the nation move beyond the cycle of costly 'crisis care.' Health Affairs [published online on January 18, 2012]. Abstract available at http://content.healthaffairs.org/content/early/2012/01/18/hlthaff.2011.1169
3. Report Examines Why Adolescents Wishing to Avoid Pregnancy Become Pregnant
"To reduce teen birth rates, efforts are needed to reduce or delay the onset of sexual activity, provide factual information about the conditions under which pregnancy can occur, increase teens' motivation and negotiation skills for pregnancy prevention, improve access to contraceptives, and encourage use of more effective contraceptive methods," state the authors of a report published in the January 20, 2012, issue of Morbidity and Mortality Weekly Report. The article describes estimated rates of self-reported pre-pregnancy contraceptive use among white, black, and Hispanic adolescent females ages 15-19 with unintended pregnancies resulting in live births.
The researchers drew data for their analysis from the 2004-2008 Pregnancy Risk Assessment Monitoring System (PRAMS). For the purposes of this study, contraceptive methods were categorized by effectiveness based on published effectiveness rates for preventing pregnancy in typical use. Weighted results were calculated within the PRAMS subpopulations of non-Hispanic white, non-Hispanic black, and Hispanic adolescent females (ages 15-19) who delivered a live infant and reported that their pregnancy was unintended.
The authors found that
- During 2004-2008, 73.2 percent of adolescent mothers within 19 PRAMS states who delivered a live infant reported that their pregnancy was unintended. Of these, approximately one half (50.1 percent) reported not using contraception before becoming pregnant.
- During 2004-2008, the rates of not using contraception among non-Hispanic white adolescents (49.7 percent), non-Hispanic black adolescents (50.5 percent), and Hispanic adolescents (50.6 percent) were not significantly different.
- Among adolescents not using contraception, 31.4 percent thought they could not become pregnant at the time. Eight percent thought they or their partners were sterile. Nearly one quarter (23.6 percent) reported that their partner did not want to use contraception. Some (22.2 percent) indicated that they would not mind if they became pregnant.
- In the five states reporting contraceptive methods, 21.0 percent of adolescents reported using a highly effective method when they became pregnant, less than one quarter (24.2 percent) used a moderately effective method, and few (5.1 percent) used the least effective methods.
- Twenty-one percent used a highly effective contraceptive method (although less than 1 percent used one of the most effective methods, such as an IUD); 24.2 percent used the moderately effective method of condoms; and 5.1 percent used the least effective methods, such as rhythm and withdrawal.
- Non-Hispanic black adolescents were significantly less likely to use highly effective methods of contraception (14.1 percent) compared with non-Hispanic white (23.0 percent) and Hispanic (20.4 percent) adolescents.
Centers for Disease Control and Prevention. 2012. Prepregnancy contraceptive use among teens with unintended pregnancies resulting in live births--Pregnancy Risk Assessment Monitoring System (PRAMS), 2004-2008. Morbidity and Mortality Weekly Report 61(2):25-29. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6102a1.htm?s_cid=mm6102a1_x
Readers: More information is available from the following MCH Library resource:
- Adolescent Pregnancy Prevention: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_adolpreg.html
4. Study Estimates Obesity Prevalence and Investigates Trends Among Children and Adolescents
"There was no change in obesity prevalence between 2007-2008 and 2009-2010. Overall trends in obesity prevalence between 1999-2000 and 2009-2010 among children and adolescents aged 2 through 19 years were significant for males but not for females," write the authors of an article published in the February 2012 issue of JAMA, The Journal of the American Medical Association. In epidemiological studies, obesity is often defined based on body mass index (BMI). But trends in obesity prevalence based on a BMI cut point do not describe changes in BMI for the entire population. Trends in the distribution of BMI can show how the entire population has changed over time. New U.S. data on weight and height from 2009-2010 are now available. The purpose of this study was to (1) analyze the most recent estimates of high weight-for-recumbent length or obesity prevalence in U.S. infants, children, and adolescents for 2009-2010; (2) investigate trends in high weight-for-recumbent length or obesity prevalence among infants, children, and adolescents between 1999-2000 and 2009-2010; and (3) evaluate trends in BMI among children and adolescents ages 2 through 19 between 1999-2000 and 2009-2010.
The researchers obtained the study data from the National Health and Nutrition Examination Survey (NHANES) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention (CDC). Because there is no universally agreed-on definition of obesity in infants and toddlers from birth to age 2, high weight was defined as weight-for-recumbent length at or above the 95th percentile on the CDC's 2000 growth charts. Weight status among children and adolescents ages 2 through 19 was defined as a BMI at or above the sex-specific 95th percentile. Prevalence estimates at a higher cut point (at or above the 97th percentile) were also studied.
The researchers analyzed the prevalence of high weight-for-recumbent length and obesity in 2009-2010 by sex, age, and race-ethnic subgroups. They investigated mean and median BMI for sex-specific age groups (ages 2-5, 6-11, 12-19) for six survey periods (1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, and 2009-2010). They also studied change in obesity prevalence and BMI distributions.
The authors found that
- The prevalence of high weight-for-recumbent length among infants and toddlers was 9.7 percent in 2009-2010.
- Among children and adolescents ages 2 through 19, 16.9 percent were obese in 2009-2010, and 31.8 percent were either overweight or obese. Also, 12.3 percent were at or above the 97th percentile of BMI for age.
- There was no difference in obesity prevalence for males or females between 2007-2008 and 2009-2010. Similarly, comparison of 2009-2010 estimates with 2003-2008 showed no significant change among males or females. However, there was a significant change between 1999-2002 and 2009-2010 among males but not among females.
- There was a significant change in BMI among adolescent males ages 12 through 19 but not among males in the other age groups or among females in any age group during the 12-year period.
"Results from NHANES indicate that the prevalence of childhood obesity in the United States remains unchanged at approximately 17 [percent], although increases in obesity prevalence may be occurring among males," conclude the authors.
Ogden CL, Carroll MD, Kit BK, et al. 2012. Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA, The Journal of the American Medical Association 307(5):483-490. Abstract available at http://jama.ama-assn.org/content/early/2012/01/11/jama.2012.40.abstract
Readers: 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
5. Article Analyzes Rural-Urban Cervical Cancer Trends and Patterns
"Racial-ethnic disparities in cervical cancer mortality remain quite marked in both metropolitan and non-metropolitan areas of the United States," writes the author of an article published in the February 2012 issue of the Journal of Community Health. The article examines the extent to which differences in cervical cancer mortality among U.S. women in metropolitan and non-metropolitan areas have changed during the past six decades. They also analyze the magnitude of contemporary rural-urban disparities in cervical cancer incidence, stage of disease at diagnosis, and patient survival among major racial-ethnic groups to explain disparities in mortality.
The author used the national vital statistics mortality database to examine long-term trends in metropolitan-nonmetropolitan disparities in U.S. cervical cancer mortality from 1950 through 2007. In order to better understand trends and patterns of disparities in mortality, the author also analyzed rural-urban patterns in cervical cancer incidence, stage of disease at diagnosis, and patient survival using data from 17 population-based cancer registries (from the National Cancer Institute's Surveillance, Epidemiology, and End Results database).
The author found that
- Rural-urban disparities in cervical cancer mortality persisted between 1950 and 2007.
- Long-term trends in metropolitan and non-metropolitan disparities in cervical cancer mortality were generally similar for white and black women. Despite constantly declining mortality rates, both white and black women in non-metropolitan areas experienced higher mortality risks than their metropolitan counterparts throughout 1969-2007. In both 1969 and 2007, white as well as black women in non-metropolitan areas had an approximately 24 to 29 percent higher cervical cancer mortality than their counterparts in metropolitan areas.
- During 1950-2007, cervical cancer mortality decreased at a rate of 3.34 percent per year in metropolitan areas, significantly faster than the annual rate of decrease of 3.07 percent in non-metropolitan areas.
- Contemporary mortality and incidence data indicate that cervical cancer rates increased in relation to increasing levels of rurality for all racial-ethnic groups except Hispanics.
- During 2000-2008, women in small-urban as well as in rural areas had, respectively, 6 percent and 15 percent higher cervical cancer incidence rates than women in metropolitan areas.
- The 5-year survival rate for black women diagnosed with cervical cancer was 50.8 percent in non-metropolitan areas, significantly lower than the survival rate of 60.2 percent for black women in metropolitan areas and 71.0 percent for non-Hispanic white women in metropolitan areas. Rural-urban disparities in survival existed even after controlling for stage of disease at diagnosis.
The author concludes that "health policy interventions (e.g., cancer prevention and early detection programs through increased cervical cancer screening) aimed at reducing cervical cancer disparities should continue to target women in rural and medically underserved areas as well as high-risk populations in the metropolitan areas of the country."
Singh GK. 2012. Rural-urban trends and patterns in cervical cancer mortality, incidence, stage, and survival in the United States, 1950-2008. Journal of Community Health 37(1):217-223. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21773819
Readers: More information is available from the following MCH Library resource:
- Racial and Ethnic Disparities in Health: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_race.html
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