National Center for Education in Maternal and Child Health

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June 16, 2000

1. Research Looks at Association Between Soft Drink Consumption and Bone Fractures in Teenage Girls

2. Article Examines Gender Differences in Health Care Access

3. Supreme Court Will Hear Case on Drug Testing of Pregnant Women

4. Study Investigates Women's Feelings About Early Breastfeeding Cessation

5. Youth Injury-Related and Sexual Behaviors Declined in the '90s, According to CDC Report

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The National Maternal and Child Oral Health Resource Center's Web site has been updated. Go to <oralhealth> to view the Center's new publication, Dental Sealant Resource Guide, and for expanded links to organizations, state oral health programs, and agencies.
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1. RESEARCH LOOKS AT ASSOCIATION BETWEEN SOFT DRINK CONSUMPTION AND BONE FRACTURES IN TEENAGE GIRLS

A study whose results appear in the Archives of Pediatrics & Adolescent Medicine concludes that there is an association between carbonated beverage consumption and bone fractures in teenage girls. The author notes that causality cannot be inferred from the study but states that the study supports "national concern and alarm about the health impact of carbonated beverage consumption on teenaged girls." Self-administered questionnaires completed by 460 9th- and 10th-grade girls were used for the cross-sectional (retrospective) study.

According to the study, the risk of bone fractures in girls who consumed carbonated beverages was three times higher than those of girls who did not drink carbonated beverages. Physically active girls who consumed cola beverages were at particular risk, according to an accompanying editorial note.

The editorial note mentions two possible explanations for an association between carbonated beverage consumption and bone fractures: 1) the high phosphorus concentration in cola beverages can cause bone loss, and 2) those who drink a lot of carbonated beverage consume fewer dairy products and therefore less calcium.

The article and editorial note highlight the following study limitations: 1) because of the cross-sectional study design, causality cannot be inferred, 2) there was no objective measure of bone mineral density, 3) calcium intake was not assessed, and 4) there are limitations resulting from the fact that the data was self-reported.

The editorial note states that a national campaign promoting calcium consumption and encouraging regular physical activity for girls ages 9 to 18 will soon be launched. The campaign is being sponsored by the Centers for Disease Control and Prevention, the US Public Health Service Office on Women's Health, and the National Osteoporosis Foundation.

Wyshak G. 2000. Teenaged girls, carbonated beverage consumption, and bone fractures. Archives of Pediatrics & Adolescent Medicine 154(6):610-613.

Golden NH. 2000. Osteoporosis prevention: A pediatric challenge. Editorial note. Archives of Pediatrics & Adolescent Medicine 154(6):542-543.

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2. ARTICLE EXAMINES GENDER DIFFERENCES IN HEALTH CARE ACCESS

Women are more likely than men to have both health insurance and a usual source of health care but the causes of these differences are not well understood. A study in the current American Journal of Public Health concludes that, although no strong patterns were found to explain gender differences in insurance coverage and usual source of health care, differences in insurance coverage may be related to gender differences in job opportunities for men and women.

The study was based on a survey of a representative sample of nearly 700 adult residents of Central Harlem in New York City. Fifty-nine percent of respondents were women, and 84% were African American.

Women employed full time had increased odds of insurance coverage, whereas employment had no similar effect among men. Other findings include:

For both men and women in this study, access to insurance coverage was related to public assistance, a contrast with national studies, which have found this to be the case only for women. Socioeconomic advantage, including factors such as income, also predicted access to health care. The author wrote, "Gender differences in insurance coverage in the Harlem sample stemmed from economic barriers to employment, which give women an advantage over men, rather than greater access to public benefits among women."

Factors related to having a regular health care provider were less clear for both sexes. Nonetheless, the fact that women were more likely to have health insurance was not thought to be the cause, as this possibility was controlled for in the study.

The author acknowledges that the study's findings may be unique to the Harlem community. Other limitations of the study include the author's decision not to measure periods of no insurance coverage or of undercoverage; also, "the study predated the influence of managed care and welfare reform."

The author concludes that "expanding the availability of both public insurance and affordable private coverage for men living in low-income communities is an important means of reducing gender disparities in access to health care."

Merzel C. 2000. Gender differences in health care access indicators in an urban, low-income community. American Journal of Public Health 90(6):909-916

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3. SUPREME COURT WILL HEAR CASE ON DRUG TESTING OF PREGNANT WOMEN

This fall the US Supreme Court will hear a case about whether public hospitals can test pregnant women for drug use and turn the results over to police, states the Kaiser Daily Reproductive Health Report. The case, Ferguson v. City of Charleston, involves 10 women who allege that their Fourth Amendment rights were violated when police arrested them on the basis of drug use evidence the hospital had provided. (The Fourth Amendment prohibits unreasonable search and seizure.)

The Reproductive Health Report states that the defendants in the case, the South Carolina public hospitals, maintain that the searches were justifiable because of the "clinical necessity for drug screens, the health problems associated with maternal cocaine use and the astronomical economic costs of caring for infants suffering [from the effects of maternal cocaine use]." Several legal and medical organizations (including the American Public Health Association and the California Medical Association) have filed amicus curiae briefs, arguing that the law violates patient-doctor confidentiality. The Supreme Court is expected to issue a ruling in 2001.

Henry J. Kaiser Family Foundation. 2000. Drug testing: US Supreme Court will review policy of testing pregnant women. Available at <http://report.kff.org/archive/repro/2000/02/kr000229.1.htm>.

The Henry J. Kaiser Family Foundation. 2000. Drug testing: CRLP, Women's Law Project file Supreme Court brief on behalf of South Carolina women. Available at <http://report.kff.org/archive/repro/2000/02/kr000229.1.htm>.

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4. STUDY INVESTIGATES WOMEN'S FEELINGS ABOUT EARLY BREASTFEEDING CESSATION

Women who stop breastfeeding their infants within 2 weeks after birth report a range of problems, states a qualitative study published in the current issue of the American Journal of Maternal and Child Nursing. According to the authors, these problems can be addressed through changes in clinical practice.

The study's objective was to learn about these women's "subjective experience" in order to supplement the literature demonstrating that many women breastfeed their infants for only short periods. The authors recorded and evaluated the descriptions of efforts to breastfeed from 9 women between the ages of 20 and 32.

The difficulties and problems reported by the women in this study included 1) disparity between expectations that breastfeeding would be easy or come naturally and "the reality of their early breastfeeding experience"; 2) feelings of discomfort either with breastfeeding or with the assistance provided by nurses and lactation consultants; and 3) feelings of guilt, shame, and stress associated with discontinuing breastfeeding.

In response to feelings and concerns reported by these women, the authors encourage health professionals to

1) Provide prenatal and postnatal education to women who intend to breastfeed, particularly about common breastfeeding problems;

2) Be sensitive to emotional distress and in responding to requests for assistance with breastfeeding;

3) Use infant formula "only when medically indicated";

4) "Respect women's personal boundaries and ask permission before touching the breasts"; and

5) Ensure that all nursing staff "offer consistent, evidence-based advice about breastfeeding techniques."

The authors conclude, "Nurses in maternal child care have an obligation to develop skills such as calming techniques, ways to wake sleepy babies, methods to encourage latching on, and how to perform an assessment of positioning, grasp, and suck at the breast.... However, when 'it just doesn't work,' and the decision is made to stop breastfeeding, mothers should be reassured that bonding, attachment, and infant health are not irreversibly damaged and that the quality of their mothering is not somehow linked incontrovertibly to the feeding method chosen. The anger, guilt, and lingering self-doubts reported by our mothers should not be an outcome of our efforts to promote breastfeeding."

Mozingo JN et al. 2000. "It wasn't working": Women's experiences with short-term breastfeeding. Journal of Maternal and Child Nursing 25(3):120-126.

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5. YOUTH INJURY-RELATED AND SEXUAL BEHAVIORS DECLINED IN THE '90S, ACCORDING TO CDC REPORT

The incidence of many youth injury-related and sexual behaviors has decreased during the past decade, states the Centers for Disease Control and Prevention's 1999 Youth Risk Behavior Surveillance System (YRBSS) report released last Friday. The YRBSS, which is administered every 2 years to US high-school students, focuses on six priority areas: 1) behaviors that lead to intentional and unintentional injuries, 2) tobacco use, 3) alcohol and other drug use, 4) sexual behaviors, 5) dietary behaviors, and 6) physical activity. For the 1999 report, students in grades 9 through 12 completed 15,349 questionnaires.

Between 1991 and 1999 there were decreases in the percentages of students who never or rarely wore seatbelts (37% decrease), carried a weapon (34% decrease), and had ever had sexual intercourse (8% decrease). The percentage of sexually active students who used a condom at last intercourse increased by 26%.

Results from the 1999 YRBSS indicate the following:

The YRBSS also found that almost 1 in 10 high-school students were overweight and 16% were at risk for being overweight. Less than one quarter of high-school students ate the recommended daily allowance of fruits and vegetables.

An accompanying press release states that almost three-fourths of all deaths for people ages 10 to 24 result from 4 causes: motor vehicle crashes, unintentional injuries, homicide, and suicide. The 1999 YRBSS indicates that many high-school students engage in risky behaviors (e.g., drinking and driving, carrying a weapon) that may increase their likelihood of dying from these causes.

The press release notes that the percentages of high-school students who engaged in certain risky behaviors varied greatly among states, cities, and some student subgroups.

Centers for Disease Control and Prevention. 2000. Youth risk behavior surveillance--United States, 1999. Press release. Available at <http://www.cdc.gov/od/oc/media/pressrel/r2k0609a.htm>.

The full report is available at <http://www2.cdc.gov/mmwr/mmwr_ss.html>.

 

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SENIOR EDITOR: Jessica Grumet
EDITOR: Jennifer Burek Pierce
CONTRIBUTING STAFF: Susan Lorenzo
EDITORIAL STAFF: Ruth Barzel
FOUNDING EDITOR: Laura Kavanagh


National Center for Education in Maternal and Child Health
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Arlington, VA 22201
(703) 524-7802
(703) 524-9335 FAX
Email: jgrumet@ncemch.org or jpierce@ncemch.org
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The MCH Alert is produced by the National Center for Education in Maternal and Child Health under its cooperative agreement (MCU-119301) with the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services.

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