National Center for Education in Maternal and Child Health

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June 14, 2002

1. Research Brief Summarizes What Is Known About the Outcomes of Child Maltreatment

2. Web Site Highlights Approaches to Improving and Promoting the Health of Children in Foster Care

3. Funds Available to Establish and Expand Children's Advocacy Centers for Children Who Are Abused

4. Study Finds Surveillance Tool Useful in Analyzing Data on Fetal Alcohol Syndrome

5. Article Discusses Mental Health Challenges Among Women, Adolescents, and Children Living with HIV

6. Study Examines Factors Associated with Smoking Cessation Among U.S. Pregnant Women

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1. RESEARCH BRIEF SUMMARIZES WHAT IS KNOWN ABOUT THE OUTCOMES OF CHILD MALTREATMENT

The Multiple Dimensions of Child Abuse and Neglect: New Insights into an Old Problem draws on available data and recent research studies to summarize what is known about the outcomes of child maltreatment in several critical areas -- physical and mental health, cognitive and education attainment, and social and behavioral development. The authors of this research brief, which was produced by Child Trends in partnership with several foundations, also sketch the dimensions and severity of the child maltreatment problem and the demographic characteristics of its victims. In addition, they consider the need to develop reliable indicators to assess and monitor the outcomes of children reported for maltreatment and suggest incorporating child well-being indicators into the existing databases of local and state social service agencies. The brief is available at http://www.childtrends.org/PDF/ChildAbuseRB.pdf.

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2. WEB SITE HIGHLIGHTS APPROACHES TO IMPROVING AND PROMOTING THE HEALTH OF CHILDREN IN FOSTER CARE

Researchers working on the Meeting the Health Care Needs of Children in the Foster Care System study, a 3-year study conducted by the Georgetown University Child Development Center, used phone interviews and site visits to identify promising approaches for meeting the health care needs of children in foster care. This study is part of a larger effort by the Public-Private Partnership for the Health of Children in Out-of-Home Care to improve and promote the health of children in foster care and their families. The study, as well as the effort as a whole, was supported by the Maternal and Child Health Bureau, Health Resources and Services Administration, and by the Children's Bureau, Administration for Children and Families. As a result of the study, several different types of products have been created to assist states and communities in their attempts to improve health care services for children in foster care. The Framework for a Comprehensive Approach: Critical Components defines 11 critical components to address in developing a comprehensive system of health care for children in foster care. This document, along with a project description, individual site visit reports, and fact sheets describing individual approaches, is available at http://www.georgetown.edu/research/gucdc/foster.html.

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3. FUNDS AVAILABLE TO ESTABLISH AND EXPAND CHILDREN'S ADVOCACY CENTERS FOR CHILDREN WHO ARE ABUSED

National Children's Alliance, under a cooperative agreement with the Office of Juvenile Justice and Delinquency Prevention (OJJDP), U.S. Department of Justice, will administer $4,989,000 in federal funds for the establishment and expansion of children's advocacy centers (CACs) during 2003. CACs provide a comprehensive approach to serving children who are abused through coordination of investigation and intervention services. Grants are available for team and leadership training and for program development and support, including tribal program development. The request for proposals and grant application will be released on June 20, 2002. Competitive applications are due by September 6, 2002, and competitive applicants will be notified by November 20, 2002. Grant information is available at http://www.nca-online.org/grants.html. All current and sample forms related to grants are available at http://www.nca-online.org/funds1.html.

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4. STUDY FINDS SURVEILLANCE TOOL USEFUL IN ANALYZING DATA ON FETAL ALCOHOL SYNDROME

"This study demonstrates that FASSNet [Fetal Alcohol Syndrome Surveillance Network] is a useful tool that enables health care professionals to monitor the occurrence of FAS and to evaluate the impact of prevention, education, and intervention efforts," state the authors of a report published in the May 24, 2002, issue of Morbidity and Mortality Weekly Report. Noting variances in estimates of FAS (fetal alcohol syndrome) prevalence, the Centers for Disease Control and Prevention collaborated with five states (Alaska, Arizona, Colorado, New York, and Wisconsin) to develop FASSNet to monitor the occurrence of FAS. In this report, the authors summarize the results of an analysis of FASSNet data on children who (1) were born during 1995-1997 to a mother then residing in a surveillance area and (2) met the surveillance case definition for confirmed or probable FAS, based on medical record information abstracted during June 1998 through March 2002. The mothers' race/ethnicity on the birth certificate was used to classify the child's race/ethnicity.

Records for a total of 1,489 children were reviewed and abstracted. From these records, the authors found that

• A total of 185 children born within the surveillance area met the surveillance case definition for confirmed or probable FAS;
• A health professional's documentation of maternal alcohol use during pregnancy existed in at least one abstracted record for 170 (92%) of these children (although such documentation was not needed for a child to meet the surveillance case definition);
• The overall 3-year prevalence of FAS varied only slightly in three of the four sites, from 0.3 to 0.4 per 1,000 live-born infants; and
• The highest FAS prevalence rates observed during the surveillance period were among blacks in two states (range = 0.9-1.6 per 1,000 live-born infants) and among American Indians/Alaska Natives in two states (range = 2.5-5.6 per 1,000 live-born infants).

According to the article, FAS "is caused by maternal alcohol use during pregnancy and is one of the leading causes of preventable birth defects and developmental disabilities in the United States." Based on the findings of this study, the editors conclude in an editorial note that "this report demonstrates that maternal alcohol use during pregnancy continues to affect children."

Miller L, Tolliver R, Druschel C, et al. 2002. Fetal alcohol syndrome -- Alaska, Arizona, Colorado, and New York, 1995-1997. Morbidity and Mortality Weekly Report 51(20):433-435. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5120a2.htm or http://www.cdc.gov/mmwr/PDF/wk/mm5120.pdf.

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5. ARTICLE DISCUSSES MENTAL HEALTH CHALLENGES AMONG WOMEN, ADOLESCENTS, AND CHILDREN LIVING WITH HIV

"A critical key to successful treatment is a level of collaboration among clients and health providers that promotes the continuum of care while enhancing the quality of life," state the authors of an article published in the Spring 2002 issue of The Source, the newsletter of the National Abandoned Infants Assistance Resource Center. This article provides a brief introduction to mental health challenges among women, adolescents, and children living with HIV. The article broadly outlines the scope of the epidemic while providing a general overview of psychological and psychosocial issues, and it concludes by proposing treatment approaches to mental health problems and disorders for this population.

The article is divided into three main sections devoted to (1) women, (2) adolescents, and (3) children. Highlights from each section appear below.

Women

• In the United States, women now comprise 23% of all AIDS cases, and women of color account for 77% of all women diagnosed.
• Women living with HIV may be challenged by an array of preexisting mental health issues or those resulting from HIV diagnosis and life circumstances; depression and substance abuse are common among these women.
• As HIV rates among young women have risen, HIV infection and AIDS have increasingly affected entire families. Mothers frequently face issues of permanency planning, disclosure of their status to their children, and guilt over past behavior; mothers of HIV-infected children also carry the burden of caring for their ill children while experiencing their own physical deterioration.
• As HIV can directly infect the central nervous system, mental health professionals should be aware of possible neurological complications in their patients living with HIV, and they should note changes in their patients' mental status or psychological symptoms.

Adolescents

• Adolescents are the fastest-growing group of individuals newly diagnosed with HIV in the United States, and African-American females -- who represent 73% of 13- to 19-year-olds diagnosed with HIV and 66% of 13- to 19-year-olds diagnosed with AIDS -- are at particular risk for HIV.
• Most adolescents living with HIV contracted the infection through sexual or drug-using behavior; substance abuse is common among adolescents living with HIV.
• Adolescents living with HIV may fear rejection by family members and friends and may be concerned about being stigmatized by peers or potential partners; consequently, they may isolate themselves from important sources of social and emotional support.
• Adolescents often feel invincible and immortal, which may present particular problems for health professionals seeking to elicit their compliance with HIV treatment.

Children

• In 2000, approximately 11,000 HIV diagnoses of children (under age 13) were reported to the Centers for Disease Control and Prevention.
• Although HIV transmission from mother to child accounts for 91% of all AIDS cases among U.S. children, the rate of maternal-to-infant transmission of HIV declined 66% between 1995 and 1999.
• Language and cognitive delays, as well as high rates of emotional and behavioral disturbance, have been documented in children living with HIV. It is likely that both environmental and HIV-related stresses account for many such problems, as children living with HIV frequently have other risk factors for poor performance, including poor prenatal care, poor nutrition, neglect secondary to maternal drug use, and possible drug/alcohol exposure in utero.
• Parental issues seem to be central to children living with HIV, as most of these children have or had an HIV-infected mother; illness and fear about their own mortality complicate concerns about parental illness and death.
• Caregivers often need guidance on how to tell children about the children's diagnosis in a developmentally appropriate way and on how to help them cope with the diagnosis.

"While the biopsychosocial stressors facing HIV positive women, adolescents and children are great," the authors conclude, "interventions are clearly helpful to reduce psychological distress, promote social support, enhance medication adherence, and diminish risk behaviors." For women, an assessment should identify current psychological symptoms, strengths and weaknesses, and coping style. Case management; individual, couple, or family counseling; medication; and in-patient services can be used to help remit and relieve psychiatric conditions. Ongoing treatment for adolescents includes providing emotional support for coping with HIV infection and working to increase treatment adherence and decrease situations of risk. Finally, the authors suggest that children's issues be treated in the context of their major systems (i.e., families and schools) and that services be directed to families rather than to parents or to children.

National Abandoned Infants Assistance Resource Center. 2002. Mental health challenges in HIV positive women, adolescents and children. The Source 11(2):1-4 and 30.

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6. STUDY EXAMINES FACTORS ASSOCIATED WITH SMOKING CESSATION AMONG U.S. PREGNANT WOMEN

"The findings of this study indicate that the strongest factors associated with attempts to quit [smoking] were Hispanic ethnicity and the combined effect of age and smoking duration," state the authors of an article published in the June 2002 issue of the Maternal and Child Health Journal. This study, which is based on a contemporary large U.S. national probability sample of women, aims to examine the sociodemographic correlates of smoking cessation during pregnancy by analyzing the smoking behavior of women in four categories: (1) those who do not smoke (nonsmokers), (2) those who smoke throughout pregnancy (persistent smokers), (3) those who quit but resume smoking during pregnancy (unsuccessful quitters), and (4) those who quit and do not resume smoking during pregnancy (successful quitters). The study also aims to identify risk and protective factors associated with attempted smoking cessation and successful cessation in a subset of pregnant smokers.

Using data from the 1998 National Health Interview Survey Supplement on Pregnancy and Smoking, this analysis is based on a series of questions asked of 5,288 women who reported that they had given birth within the past 5 years. The questions concern these women's most recent pregnancy. Results are weighted to reflect smoking behavior of 13,714,358 U.S. women who had a live birth within 5 years before 1998.

The authors found that

• Of the women who had a live birth within the past 5 years, 19.1% reported smoking at the start of their most recent pregnancy;
• Sociodemographic groups that are significantly overrepresented among smokers include non-Hispanic white women, young women, women who are not currently married, women with a high school education or less, and women in poverty;
• In every age category, longer smoking duration was associated with a lower percentage of attempted quitters and with a lower percentage of successful quitters; and
• Women of Hispanic ethnicity were three times as likely as non-Hispanic white women to attempt to quit.

Based on these findings, the authors suggest that "smoking cessation interventions should emphasize the importance of smoking cessation before pregnancy and advice and support for smoking cessation should continue throughout the course of prenatal care." They go on to state that "future smoking cessation and relapse prevention programs should be developed, taking into consideration the critical factors of age, ethnicity, income, geography and addiction."

Yu SM, Park CH, Schwalberg R. Factors associated with smoking cessation among U.S. pregnant women. Maternal and Child Health Journal 6(2):89-97.

Readers: More information on tobacco-use cessation, including materials developed to help health professionals introduce this issue to their patients, is available from the Office of the Surgeon General at http://www.surgeongeneral.gov/tobacco/.

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MCH Alert © 2002 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert is produced by MCH Library Services at the National Center for Education in Maternal and Child Health under its cooperative agreement (U02 MC 0001-01) 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 to individual colleagues. 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 MCH Alert Editor, National Center for Education in Maternal and Child Health, at mchalert@ncemch.org.

The editors welcome your submissions, suggestions, and questions. Please contact us at the address below.

EDITORS: Jolene Bertness, Tracy Lopez

COPYEDITOR: Ruth Barzel

National Center for Education in Maternal and Child Health
Georgetown University
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Arlington, VA 22201
(703) 524-7802
(703) 524-9335 (fax)
E-mail: mchalert@ncemch.org
Web site: <http://www.ncemch.org>

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