National Center for Education in Maternal and Child Health
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November 2, 2001
1. Report Urges More Collection of Health Data by Race, Ethnicity, and Primary Language
2. Institute of Medicine Releases Report on the Consequences of Lacking Health Insurance
3. Study Weighs Evidence on Universal Versus Selective Newborn Hearing Screening
4. Considerable Variability Exists in Prenatal Care Use Among Asian Americans
5. Study Evaluates Benefits of Increasing Measles Immunization Rates
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1. REPORT URGES MORE COLLECTION OF HEALTH DATA BY RACE, ETHNICITY, AND PRIMARY LANGUAGE
Evidence of racial and ethnic disparities in medical treatment and health outcomes has led to a greater recognition of the importance of collecting and reporting health data by race, ethnicity, and primary language. The report Racial, Ethnic, and Primary Language Data Collection in the Health Care System: An Assessment of Federal Policies and Practices presents findings and recommendations of a study designed to delineate the context in which health-related data collection and reporting by these factors take place at the federal level, particularly within the U.S. Department of Health and Human Services. With a grant from The Commonwealth Fund, the Summit Health Institute for Research and Education in partnership with the National Health Law Program conducted a survey of the statutes, regulations, policies, and procedures of federal agencies to identify when the collection and reporting of such data are required. The researchers also assessed current understanding and implementation of existing laws and regulations. The report is available at <http://www.cmwf.org/programs/minority/perot_racialethnic_492.pdf>.
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2. INSTITUTE OF MEDICINE RELEASES REPORT ON THE CONSEQUENCES OF LACKING HEALTH INSURANCE
The Institute of Medicine's Committee on the Consequences of Uninsurance released a report, Coverage Matters: Insurance and Health Care, the first in a series of six reports to evaluate and consolidate what is known about the causes and consequences of uninsurance. The report provides an overview of health insurance in the United States, describes the dynamic and often unstable nature of insurance coverage, profiles populations that frequently lack coverage, and identifies factors that make it more likely or less likely that a person will be uninsured at some point in life. Copies of the report are available from the National Academy Press at (202) 334-3313, (800) 624-6242, or <http://www.nap.edu>.
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3. STUDY WEIGHS EVIDENCE ON UNIVERSAL VERSUS SELECTIVE NEWBORN HEARING SCREENING
"Modern screening tests for hearing impairment can improve identification of newborns with PHL [moderate-to-profound bilateral hearing loss], but the efficacy of UNHS [universal newborn hearing screening] to improve long-term language outcomes remains uncertain," state the authors of an article published in the October 24/31 issue of JAMA, The Journal of the American Medical Association. The authors conducted a literature review to identify strengths, weaknesses, and gaps in the evidence supporting UNHS and to compare the additional benefits and harms of UNHS with those of selective screening of high-risk newborns.
Each year, approximately 5,000 infants with PHL are born in the United States. UNHS has been proposed as a way to speed diagnosis and treatment and thereby improve language outcomes in these children. The authors found
The authors attest to the importance of longitudinal studies of UNHS in addressing knowledge gaps, and assert that speech, language, and scholastic achievement of deaf and hard-of-hearing children should be followed over time. They suggest that better evidence about the effectiveness of UNHS could be obtained via population-based studies that begin with inception cohorts and by carefully reporting outcomes in all possible patients, as well as rates of loss to follow-up. According to the authors, states that have UNHS should conduct such population-based studies to evaluate whether the long-term language outcomes of deaf children improve as the age of identification decreases.
Thompson DC, McPhillips H, Davis RL, et al. 2001. Universal newborn hearing screening: Summary of evidence. JAMA, The Journal of the American Medical Association 286(16):2000-2010.
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4. CONSIDERABLE VARIABILITY EXISTS IN PRENATAL CARE USE AMONG ASIAN AMERICANS
There are significant differences in the use of prenatal care among Asian American ethnic groups, according to the authors of a study published in the November issue of the American Journal of Public Health. The study, the first to examine the use of prenatal care by Asian Americans at the national level, investigated the sociodemographic predictors of three patterns of prenatal care use--no care, late initiation of care, and inadequate use of care after early initiation--for the four largest Asian American ethnic groups in the United States.
Single live births to U.S. resident mothers of Chinese, Japanese, Korean, and Vietnamese ancestry were selected from the 1992-1996 U.S. natality files to analyze the effects of maternal characteristics on the three prenatal care use patterns. The analysis revealed the following:
The authors note their inability to examine sociocultural determinants of the use of prenatal care among Asian Americans: cultural acceptability of aspects of prenatal care, availability of culturally and linguistically competent prenatal services, and women's knowledge and beliefs about the importance of care during a normal pregnancy. They suggest that future studies of the determinants of prenatal care focus on the role of the spouse and acculturation.
Yu SM, Alexander GR, Schwalberg R, et al. 2001. Prenatal care use among selected Asian American groups. American Journal of Public Health 91(11):1865-1868.
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5. STUDY EVALUATES BENEFITS OF INCREASING MEASLES IMMUNIZATION RATES
"Programs to raise measles immunization rates are not cost-effective, except possibly during an outbreak of the disease or in areas with very low immunization rates," according to the authors of a study published in the October issue of HSR: Health Services Research. Using published and unpublished data and expert opinion, the authors calculated the benefits of a supplemental immunization intervention to increase the local preschool measles immunization rate. They accomplished this by doing the following:
1. Determining the cost savings and health benefits derived from averting a single case of measles;
2. Examining the relationship between preschool measles immunization rates and incidence rates in portions of major metropolitan areas in the United States; and
3. Deriving the cost-effectiveness ratios of a successful program to eradicate measles in the area.
The authors found the following:
The authors assert that as new childhood vaccines are developed, the linked policy issues of appropriate strategic objectives (elimination or control of measles) and program design (narrowly increasing measles immunization rates as opposed to providing a package of valuable primary care services) become increasingly critical. They conclude, "[Immunization] programs do have the potential to be cost-effective if the program design and evaluation also recognize the benefits associated with the primary and preventive care that can accompany immunizations. Such programs may also be cost-effective if they are components of a global eradication of measles."
Zwanziger J, Szilagyi PG, Kaul P. 2001. Evaluating the benefits of increasing measles immunization rates. HSR: Health Services Research 36(5):885-909.
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MCH Alert © 2001 by National Center for Education in Maternal and Child Health and Georgetown University. 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, 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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