National Center for Education in Maternal and Child Health

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December 20, 2002

1. New Edition of the Adolescent Pregnancy Prevention Knowledge Path Released

2. Issue Brief Highlights State Efforts to Improve Children's Oral Health

3. Authors Examine Well-Being of Children in Immigrant Families

4. Report Examines State-Specific Trends in U.S. Live Births to Women Born Outside the 50 States

5. Study Examines Factors Influencing Children's Receipt of Recommended Medical and Dental Care

6. School-Based Asthma Screening Does Not Increase the Rate of Asthma Diagnosis, Study Finds

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Readers: MCH Alert will not be published for the next 2 weeks. The next issue is scheduled for January 10, 2003. Happy holidays!

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1. NEW EDITION OF THE ADOLESCENT PREGNANCY PREVENTION KNOWLEDGE PATH RELEASED

The new edition of the Adolescent Pregnancy Prevention Knowledge Path, an electronic resource guide produced by MCH Library Services, offers a selection of current, high-quality resources and information tools about adolescent pregnancy prevention. The knowledge path is aimed at policymakers, health professionals, researchers, and parents who are interested in tracking timely information on this topic. The knowledge path is available at http://mchlibrary.info/KnowledgePaths/kp_adolpreg.html. Knowledge paths on other maternal and child health topics are available at http://mchlibrary.info/KnowledgePaths/index.html.

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2. ISSUE BRIEF HIGHLIGHTS STATE EFFORTS TO IMPROVE CHILDREN'S ORAL HEALTH

State Efforts to Improve Children's Oral Health, an issue brief published by the National Governors' Association Center for Best Practices, presents information on the problems, costs, and access and workforce issues confronting children's oral health. The staff of the center's health policy studies division compiled information on how specific states are addressing problems in promoting education and prevention, increasing coverage and access, enhancing the dental work force, improving financing and reimbursement, and improving the quality of data and surveillance. The authors suggest that states can use a combination of approaches to improve the quality of children's oral health. The issue brief is intended to provide governors and others interested in child oral health policy with tools and information on innovative and cost-effective services. It is available at http://www.nga.org/cda/files/1102CHILDORALHEALTH.pdf.

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3. AUTHORS EXAMINE WELL-BEING OF CHILDREN IN IMMIGRANT FAMILIES

The Health and Well-Being of Children in Immigrant Families, a brief by the Urban Institute, presents a comparison of children in immigrant families with those in native-born families, focusing on a number of key indicators of child well-being. Findings were based on the 1999 National Survey of America's Families, which includes data on 11 million children of immigrants. The brief includes information on family income and environment, child physical and emotional health, and access to needed benefits and services. The brief is intended for use by policymakers, health professionals, and child advocates in designing social welfare policy that meets the needs of children of immigrants, whose numbers are increasing. The brief is available at http://www.urban.org/media/310584_norelease.pdf.

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4. REPORT EXAMINES STATE-SPECIFIC TRENDS IN U.S. LIVE BIRTHS TO WOMEN BORN OUTSIDE THE 50 STATES AND DC

"Women born outside the 50 states and DC had better birth outcomes than their state-born racial/ethnic counterparts," state the authors of a report published in the December 12, 2002, issue of Morbidity and Mortality Weekly Report. This report presents state-specific comparisons of live births in 1990 and 2000 to women born outside the 50 states and DC and compares maternal characteristics and live-birth outcomes for these women with those for state-born mothers.

Data were drawn from the National Center for Health Statistics' natality files for 1990 and 2000, which included a record of the mother's place of birth. Maternal characteristics and reported birth outcomes (preterm births and low birthweight) were analyzed by race/ethnicity.

The authors found that

• During 1990-2000, the percentage of all live births in the United States to women born outside the 50 states and DC increased from 15.6% to 21.4%.
• While six states (California, Florida, Illinois, New Jersey, New York, and Texas) accounted for 75.5% of live births to women born outside the 50 states and DC in 1990, the percentage increased by 10% or more in six states (Arizona, Colorado Georgia, Nevada, North Carolina, and Oregon) between 1990 and 2000; births to Hispanics accounted for the majority of the increase.
• Women born outside the 50 states and DC were more than twice as likely as their state-born racial/ethnic counterparts to have less than a high school education and were less likely to have completed 12 years of education.
• State-born women were more likely than those born outside the 50 states and DC to be adolescents when they gave birth; however, the magnitude of this difference varied by race/ethnicity.
• State-born women across all racial/ethnic groups were more likely to be unmarried than their counterparts born outside the 50 states and DC.
• Except for Puerto Ricans, Cubans, Filipinas, and other Asian Pacific Islanders, women born outside the 50 states and DC were more likely than their state-born counterparts to begin prenatal care late or to have no prenatal care.
• Overall, state-born women were more likely to give birth to a preterm infant or a low-birthweight infant than were those born outside the 50 states and DC.

The authors conclude that these findings may reflect economic, cultural, and language barriers, highlighting the need for U.S. maternal and child health services to understand and adapt to the needs of an increasingly diverse population.

Sappenfield B, Iyasu S, Martin JA, et al. 2002. State-specific trends in U.S. live births to women born outside the 50 states and the District of Columbia. Morbidity and Mortality Weekly Report 51(48):1091-1095. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5148a3.htm.

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5. STUDY EXAMINES FACTORS INFLUENCING CHILDREN'S RECEIPT OF RECOMMENDED MEDICAL AND DENTAL CARE

"A substantial portion of all U.S. children do not receive preventive care according to professionally recommended standards," state the authors of an article published in the December 2002 issue of Pediatrics. Using these standards, the authors explored the receipt of both medical and dental care by children ages 3 through 18.

Data from the 1999 National Survey of America's Families Public Use File provided information on the health, economic, and social characteristics of 35,938 children. The authors determined whether the children had met American Academy of Pediatrics (AAP) recommendations for well-child care (defined as one or more well-child visit[s] in the year preceding the survey or no well-child visit and was 7 or 9 years of age), and the American Academy of Pediatric Dentistry/Bright Futures recommendations for dental visits (defined as two or more visits to a dental professional in the year preceding the survey). Further analysis examined the association between the child's receipt of recommended well-child care and dental care and the child's health insurance status, race and ethnicity, health status, postponement of dental care, family income, and parents' age and educational attainment.

An analysis of the receipt of well-child visits indicated that

• Overall, 23.4% of children had not met the AAP's well-child visit recommendation.
• Being uninsured, having a parent with low educational attainment, and having poor health status were risk factors for not obtaining recommended care, whereas Hispanic ethnicity, black race, public coverage, and having a parent who was younger than 30 were protective.

An analysis of the receipt of dental visits revealed that

• Nearly half (46.8%) of U.S. children had not seen a dentist or dental hygienist at least twice during the preceding year.
• While being uninsured was a predictor for being less likely to meet the dental-visit recommendation, publicly insured children were at approximately the same risk for not meeting the recommendation as privately insured children.
• Each income category below 300% of poverty was significantly associated with not meeting the dental-visit recommendation, as was having a parent under age 30, black and Hispanic race/ethnicity, postponing dental care in the past year, and having a parent whose educational attainment was less than college.

Although the findings suggest that publicly insured children do comparatively well in meeting the recommendation for well-child care, the authors assert that "much improvement is needed among public programs regarding access to recommended dental care."

Yu SM, Bellamy HA, Kogan MD, et al. 2002. Factors that influence receipt of recommended preventive pediatric health and dental care. Pediatrics Electronic Pages 110(6):1-8e.

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6. SCHOOL-BASED ASTHMA SCREENING DOES NOT INCREASE THE RATE OF ASTHMA DIAGNOSIS, STUDY FINDS

"The lack of success in our screening program suggests that, at least in the short term, it may be more appropriate to use school and community resources to improve asthma management in children with known asthma and frequent symptoms, rather than screening for unrecognized asthma," state the authors of an article published in the December 2002 issue of the Archives of Pediatrics & Adolescent Medicine. The authors of this article evaluated the feasibility of implementing a school-based asthma screening process and the effectiveness of this screening process on the rate of new asthma diagnoses in the community setting.

Surveys were sent to the homes of 6,401 students in kindergarten through 12th grade from public schools and Catholic schools in Rochester, MN, in March 2000. A control group comprising 2,906 comparable students received no screening. Following receipt of the completed surveys, letters recommending evaluation for possible asthma were sent to parents of students in the intervention group considered at increased risk for unrecognized asthma. A postcard asking parents to report their intentions regarding the recommendation was included with the letter. Medical record reviews were used to identify new diagnoses of asthma, reactive airway disease (RAD), and exercise-induced asthma (EIA) in the six months after referral letters were sent.

The authors found that

• The response rate to the mailed questionnaires was 79.9%.
• Parents of 388 children (6.1% of all children in the intervention group or 9.4% of those without unreported asthma) were sent letters recommending evaluation for possible asthma, however, only about half of the parents who received such letters returned a postcard stating their intentions for follow-up care.
• Overall, 57 new diagnoses were reported among the children screened, (1.1% in the group responding to the survey), while 34 were reported among the children not screened (1.2%).

The authors note that while school-based asthma screening is feasible (80% response rate), few parents actually follow-up on referral recommendations. The measure of greatest importance (i.e., how many children receive new diagnoses and new treatment) was not affected by the screening project. They conclude that "future studies of school-based screening will need to go beyond the usual methods of survey validation and screening efficacy and begin evaluating other screening outcomes important to children and schools."

Yawn BP, Wollan P, Scanlon P, et al. 2002. Are we ready for universal school-based asthma screening? Archives of Pediatrics & Adolescent Medicine 156(12):1256-1262.

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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
Mailing address: Box 571272, Washington, DC 20057-1272
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Phone: (202) 784-9770
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