National Center for Education in Maternal and Child Health

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September 12, 2003

1. Report Cites Need for Continuing Care for Childhood Cancer Survivors

2. Study Supports Previous Findings on Relationship Between Obesity and Food Insecurity

3. Article Examines Vitamin-Mineral Supplement Use Among U.S. Women

4. Authors Review Variation in Eligibility Criteria for Children with Special Health Care Needs

5. Study Presents Baseline Measures on Service Use Among Children with Special Health Care Needs

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1. REPORT CITES NEED FOR CONTINUING CARE FOR CHILDHOOD CANCER SURVIVORS

Childhood Cancer Survivorship: Improving Care and Quality of Life, a report of the Institutes of Medicine, focuses on the experience of childhood cancer survivors following treatment and presents a systematic review of policy implications in a new era of childhood cancer survivorship. Recognizing cancer as a chronic disease with implications for continuing care, the National Cancer Policy Board proposes a comprehensive policy agenda that links improved health care delivery, investments in education and training, and expanded research to improve the long-term outlook for childhood cancer survivors. The report includes information on the epidemiology of childhood cancer; the course of childhood cancer care; complications, disabilities, or adverse outcomes resulting from the disease process, treatment, or both; delivering survivorship care; ensuring appropriate education support services; employment, insurance, and economic issues; and research issues. Review findings and recommendations are also included. The report is intended for use by policymakers, researchers, and others interested in improving quality of life for childhood cancer survivors. The report brief is available at http://www.iom.edu/includes/DBFile.asp?id=14852. The full report is available to read or purchase online at http://www.iom.edu/report.asp?id=14782.

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2. STUDY SUPPORTS PREVIOUS FINDINGS ON RELATIONSHIP BETWEEN OBESITY AND FOOD INSECURITY

The results of this analysis "indicate that concern about food security is associated with obesity," state the authors of a report published in the September 5, 2003, issue of Morbidity and Mortality Weekly Report. The authors note that previous studies have suggested a possible relationship between obesity and food insecurity, defined as not having access at all times to enough safe and nutritious food for an active, healthy lifestyle because such foods are not available consistently or because household resources are insufficient to meet the cost of such foods. The report summarizes the results of an analysis of Washington state data from the 1995-1999 Behavioral Risk Factor Surveillance System (BRFSS) to assess the relationship between obesity and concern about food security.

The Washington BRFSS sample included 17,371 respondents ages 18 or older. Self-reported data on height and weight were used to determine obesity. Having concerns about food security was defined as answering "yes" to the question, "In the past 30 days have you been concerned about having enough food for you or your family?" Each potential risk factor was analyzed separately to identify risk factors for obesity. Additional analyses to control for potential confounders were also conducted.

The authors found that

• A total of 3,252 (18.7%) of the respondents were classified as obese.
• Respondents who reported concern about food security, whose annual household income was less than or equal to $20,000, who had no college education, or who were female, black, American Indian/Alaska Native, Hispanic, or 45 years of age or older were more likely to be obese than other respondents.
• Asian/Pacific Islanders were less likely to be obese than whites.
• Respondents who were obese were more likely to report a sedentary lifestyle, to eat fewer fruits and vegetables, to have poorer health, and to have a diagnosis of asthma.
• Controlling for income and education, respondents who reported concerns about food security were more likely to be obese than those who did not report such concerns.

The authors conclude that "longitudinal studies are needed to determine whether food insecurity causes obesity so appropriate interventions can be designed and implemented."

Centers for Disease Control and Prevention. 2003. Self-reported concern about food security associated with obesity -- Washington, 1995-1999. Morbidity and Mortality Weekly Report 52(35):840. Available at http://www.cdc.gov/mmwr/PDF/wk/mm5235.pdf.

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3. ARTICLE EXAMINES VITAMIN-MINERAL SUPPLEMENT USE AMONG U.S. WOMEN

"We found a consistent pattern of who was significantly more likely to take the most commonly reported vitamin-mineral supplements: women who were non-Hispanic white, married, older, more educated, not poor, former smokers, alcohol users, and regular exercisers," state the authors of an article published in the summer 2003 issue of the Journal of the American Medical Women's Association. The authors write that, although the use of vitamin-mineral supplements is of particular interest for the health of women because specific conditions throughout a woman's life cycle are associated with special vitamin-mineral supplement needs, no study has examined the factors associated with the use of vitamin-mineral supplements in a nationally representative sample of U.S. women. In the study described in this article, the authors (1) estimated the prevalence of vitamin-mineral and herbal supplement use in U.S. women; (2) examined the association of the use of different types of supplements with sociodemographic, health status, and health behavior characteristics; and (3) isolated the factors associated with different patterns of use by multivariate analysis.

The data used in this study were derived from the 2000 National Health Interview Survey. The study population consisted of 18,388 women ages 18-85+ from all regions of the United States.

The authors found that

• More than half of U.S. women had taken a vitamin-mineral supplement within the past 12 months.
• The highest proportion of supplement users were among women who were non-Hispanic white, currently married, middle-aged or older, college educated, residents of the West and urban areas, and who had high incomes.
• In general, use of supplements was highest among women who were former smokers, exercised, consumed alcohol, had functional limitations with chronic conditions, and had healthy weights. Those who had a usual source of health care and those who had had contact with a health professional in the past 12 months also had higher levels of use.

The authors state that "this study indicates high levels of vitamin-supplement use among U.S. women" and that "we also found that women taking vitamin-mineral supplements are more likely to pursue other activities associated with a healthier lifestyle and to have more resources than women who don't take supplements." They conclude that, "given women's special nutritional requirements throughout the life cycle, more explicit guidance for vitamin-mineral supplement use is especially needed."

Yu SM, Kogan MD, Huang ZJ. 2003. Vitamin-mineral supplement use among US women, 2000. Journal of the American Medical Women's Association 58(3):157-164.

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4. AUTHORS REVIEW VARIATION IN ELIGIBILITY CRITERIA FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS

"This review has reinforced the notion that definitions can have a profound effect on outcome," state the authors of an article published in the September-October 2003 issue of Public Health Reports. The authors of this article note that multiple agencies at the federal and state level provide for children with special health care needs (CSHCN), with variation in eligibility criteria. This article explores the state-level variations and provides an analysis of current practices in defining CSHCN.

Following a review of theoretical approaches to defining the population of children with chronic illness and disability, the authors delineated the current operating definitions of the three federal agencies primarily responsible for ensuring the provision of health and social services or funds to children with chronic illness and disability: the Social Security Administration (SSA), the Maternal and Child Health Bureau (MCHB), and the Centers for Medicare and Medicaid Services (CMS). To understand the complexities of the definitions used, the authors collated and analyzed available state-level data about child eligibility and about the number of children classified and funded under the three programs.

Statistics on children receiving monthly supplemental security income (SSI) and the amount of funding available under the SSI program were obtained from the SSI Web site. This information was compared to information on children served by Title V from the MCHB Web site, as well as to Title V eligibility definitions published by the Institute of Child Health Policy. CMS definitions were obtained through interviews with state Medicaid agencies and confirmed with state regulations.

The authors found that

• Both SSA and MCHB are mandated to provide services for children with special health care needs.
• SSA uses a rigid, federally determined definition, whereas MCHB uses a federally sanctioned state-by-state discretionary approach.
• There has been a fairly uniform capture of a population of children who are receiving SSI; by comparison, the size and composition of the population of children served by state MCHB programs vary significantly.
• SSI spending per child has a relatively tight distribution; on the other hand, there is significant variation in Title V per-child spending between states, depending on the number of children a state chooses to enroll in Title V.
• CMS has not issued any recommendations about the classification of CSHCN, and few state Medicaid programs categorize CSHCN. Therefore, it was not possible to derive a comprehensive picture of Medicaid funding for CSHCN.

"It may be a good time for a new iteration of a standard approach to the classification of children with special health care needs," conclude the authors. A discussion of the implications of the current situation and a series of considerations for next steps are presented.

Beers NS, Kemeny A, Sherritt L, et al. 2003. Variations in state-level definitions: Children with special health care needs. Public Health Reports 118(5):434-447.

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5. STUDY PRESENTS BASELINE MEASURES ON SERVICE USE AMONG CHILDREN WITH SPECIAL HEALTH CARE NEEDS

"The data presented in this study provide baseline measurements of the use of a variety of services that are recognized as important in the care of CSHCN [children with special health care needs]," state the authors of an article published in the September 2003 issue of Pediatrics. The study described in this article was undertaken as part of an effort to help guide future allocation decisions and to monitor access to care for CSHCN. Specifically, the authors sought to develop a comprehensive, nationally representative health-care-utilization profile of CSHCN.

The authors used data from the 1994 National Health Interview Survey, which included special supplemental surveys on childhood disability, to examine the use of four medical services (physician, hospital, emergency department, and mental health/substance abuse out-patient) and seven health-related services (transportation, social work, medical care coordination, therapeutic, assistive devices, nonmedical care coordination, and housing modifications) among CSHCN ages 5 through 17. They also examined the use of medical and health-related services as a function of predisposing, enabling, and need characteristics of the child and family. Finally, they examined the impact of insurance status on determining the use of services.

The authors found that

• Most children (89%) had seen a physician, while 24% had had an emergency department visit, 11% had had a mental health outpatient visit, and 6% had been hospitalized.
• Health-related service use ranged from less than 5% (transportation and social work) to 65% (medical care coordination); 20% to 30% of children used the remaining services.
• Children with public insurance were significantly more likely than those with private insurance to use two of the four medical services and five of the seven health-related services.
• Non-Hispanic black children and children from less-educated families were significantly less likely than their counterparts to use many of the services.

"Providing adequate insurance coverage for all CSHCN remains an appropriate and important priority," conclude the authors. In addition, they add, "continued efforts are needed to identify and remove financial and nonfinancial barriers to comprehensive medical and health-related services for particularly vulnerable subgroups of CSHCN."

Weller WE, Minkovitz CS, Anderson GF. 2003. Utilization of medical and health-related services among school-age children and adolescents with special health care needs (1994 National Health Interview Survey on Disability [NHIS-D] Baseline Data). Pediatrics 112(3):593-603.

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MCH Alert © 2003 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 (6U02 MC 00001) 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.

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EDITORS: Jolene Bertness, Tracy Lopez

COPYEDITOR: Ruth Barzel

National Center for Education in Maternal and Child Health
Georgetown University
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