National Center for Education in
Maternal and Child Health
February 5, 1999
1. GAO Examines Screening and Treatment of Lead Poisoning in Federal Health Programs
2. KIDS COUNT Report Tracks Effects of Teen Pregnancies in the States
3. Coalition Cites Need for State and Local Data on Gun Violence
4. Two Outreach Resources Available
5. Researchers Study Relationship Between Reading Ability and Family Planning Knowledge
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1. GAO EXAMINES SCREENING AND TREATMENT OF LEAD POISONING IN FEDERAL HEALTH PROGRAMS
The children served by federal health care programs remain at significant risk for elevated blood lead levels, according to a General Accounting Office's (GAO) analysis of the Centers for Disease Control and Prevention's (CDC) most recent blood lead level and screening survey data. GAO notes that a disproportionate number of children with elevated blood lead levels are served by federal health care programs. Also, children in federal health care programs are largely not receiving lead screenings, despite federal policies to the contrary.
The report discusses factors contributing to the low screening rates in state and national data: 1) Federal screening policies are often not followed or monitored by states and localities. The reported screening rates were highest in states that combined their screening law with mechanisms to ensure screening (i.e., requiring proof of screening to enter school); 2) Many physicians perceive that lead poisoning is not prevalent or serious; and 3) Children are still not receiving preventive health care services -- thus missing an opportunity for screening.
GAO also finds that several barriers are hindering timely treatment and follow-up services. These include: 1) The absence of a federal database to determine the extent to which recommended follow-up services are actually provided; 2) Difficulties in tracking a transient group of children; and 3) Difficulty in determining appropriate "medical treatments" under Medicaid because lead poisoning is an environmentally-caused condition.
Specific recommendations to the Secretary of Health and Human Services include:
United States General Accounting Office. Lead Poisoning: Federal
Health Care Programs Are Not Effectively Reaching At-Risk Children.
GAO/HEHS-99-18. January, 1999.
<http://www.gao.gov/new.items/he99018.pdf>
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2. KIDS COUNT REPORT TRACKS EFFECTS OF TEEN PREGNANCIES IN THE STATES
Approximately 40% of young American women become pregnant before age 20, states a new KIDS COUNT report from the Annie E. Casey Foundation. Furthermore, the one million pregnancies that occur each year among adolescents ages 15 to 19 result in almost 500,000 births, causing the United States to have the highest teen birth rate among all developed nations. While much of the data demonstrate improvements across all states and racial groups, the report also notes that current demographic trends suggest that the number of births to teens is likely to increase 14% by 2005.
"When Teens Have Sex: Issues and Trends" examines the consequences of teen pregnancies and births on young parents, children, health outcomes, and society. The report provides state-by-state data on sexual activity, pregnancy, childbearing, prenatal care and STD rates among teens. The report also highlights the strategies developed by successful community-based programs across the country, include the Casey Foundation's Plain Talk programs in Atlanta, Hartford, New Orleans, San Diego and Seattle.
The report concludes with the recommendations that communities and families can utilize:
When Teens Have Sex: Issues and Trends, A KIDS COUNT Special
Report. The Annie E. Casey Foundation. 1999.
<http://www.aecf.org/aecpub/teen/>.
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3. COALITION CITES NEED FOR STATE AND LOCAL DATA ON GUN VIOLENCE
Public health efforts to prevent the increasing number of firearm injuries are hampered by a lack of fundamental data, according to a new report produced by a coalition of physicians and public health professionals. Researchers from the Handgun Epidemic Lowering Plan (HELP) Network at Children's Memorial Medical Center determined that most state and local health departments do not collect vital information about the circumstances and nature of firearm injuries, a program which disproportionately affects adolescents and young adults.
The HELP Network survey found that 62% of state health departments and 54% of city and county departments reported that they conduct some firearm injury surveillance. Fewer than half of the states collect information on mortality, hospitalizations, emergency department visits, type of firearm, circumstances in which the violent injuries occurred, and collaboration with other agencies. Approximately one-third of all city and county departments collect both firearm injury mortality and morbidity data, and less than one-quarter collect information on weapon type. The state, county and city departments all highlighted staffing and funding constraints as the primary obstacle to firearm surveillance.
To begin more widespread and complete tracking of firearm mortality and morbidity data, the authors suggest that a coordinating body of experts be appointed to oversee the standardization of surveillance and the dissemination of reports. They also conclude that federal funding is essential to developing and maintaining modern, detailed surveillance systems, stating that "[f]or a modest investment of $4 million annually, health care agencies would be equipped to better understand how to reduce a modern plague that costs the country an estimated $33 billion annually."
Hayes, Roger; LeBrun, Emile; Kaufer Chrisoffel, Katherine.
"Missing in Action: Health Agencies Lack Critical Data Needed for
Firearm Injury Prevention." Handgun Epidemic Lowering Plan (HELP)
Network. 1999.
<http://www.childmmc.edu/help/mia.htm>
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4. TWO OUTREACH RESOURCES AVAILABLE
The National Center for Education in Maternal and Child Health recently published "MCH Program Interchange: Focus on Outreach," which consolidates outreach documents from a variety of state and local sources and provides contact information to obtain the actual materials. The Interchange contains descriptive information about outreach programs, training manuals and handbooks, policy briefs on the State Children's Health Insurance Program, surveys used for program development, reports of program evaluations, and outreach efforts geared toward special populations. This resource also contains a comprehensive list of web site resources on outreach and related topics.
To order, contact:
National Maternal and Child Health Clearinghouse, 2070 Chain Bridge
Road, Suite 450, Vienna, VA 22182-2536. Phone: (703) 356-1964; Fax:
(703) 8221-2098; Email: nmchc@circsol.com.
Available at no charge. <http://www.nmchc.org>
The Center for Budget and Policy Priorities released an Outreach Kit as part of its Start Healthy, Stay Healthy Campaign. This kit contains an Income Eligibility Screening Tool, posters in English and Spanish, and a handbook called "Free & Low-Cost Health Insurance: Children You know are Missing Out." The handbook contains two sections on outreach strategies, focusing on steps states and organizations can take, and also contains a third section on approaches to reaching out to special populations.
To order, contact:
Center on Budget and Policy Priorities, 820 First Street, NE, Suite
510, Washington, DC 20002. Phone: (202) 408-1080; Fax: (202)
408-1056; Email: shsh@cbpp.org.
The cost per kit is $7.50, plus handling. <http://www.cbpp.org/shsh/kit.htm>
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5. RESEARCHERS STUDY RELATIONSHIP BETWEEN READING ABILITY AND FAMILY PLANNING KNOWLEDGE
Health providers and organizations serving historically underserved populations must understand that some individuals have a low level of reading ability that limits family planning education, according to a study in this month's Obstetrics & Gynecology. Researchers studied 406 women age 19-45 enrolled in TennCare in Memphis, Tennessee and found that women with low reading skills were 2.2 times more likely to want more information on birth control options and were 4.4 times more likely to not know when in their cycle they were likely to become pregnant. Woman who had used an intrauterine device, douching, the rhythm method, or levonorgestrel implants for birth control had higher rates of low reading skills than women who used other birth control methods.
According to the article, no previous study has explicitly examined the connection between an individual's reading level and use of contraception services. The researchers find encouragement in the fact that the women with lower literacy levels and knowledge of contraception were more likely to express that they wanted to learn more about family planning options. They state that this indicates that innovative educational strategies are welcome, and that "[e]ducation, beyond package inserts, is needed." Also, "[p]roviders and payers should be aware of the prevalence of low literacy in their target population and modify educational messages and health services delivery accordingly."
Gazmararian, Julie A., et al. "Reading Skills and Family Planning Knowledge and Practices in a Low-income Managed-care Population." Obstetrics & Gynecology. 1999; 93(2): 239-244.
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