Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
June 6, 2008
1. Report Calls for Health Care Stakeholders' Commitment
to Halting Childhood Obesity
2. Analysis Reveals Critical Areas in Which Policies Are
Needed to Improve Child Health System Performance
3. Report Examines Mothers' Participation in Selected
Public Assistance Programs
4. Article Explores Recent Trends in High BMI for U.S.
Children and Adolescents
5. Study Investigates Whether an Independent Association
Exists Between Child Maltreatment and Underimmunization
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1. REPORT CALLS FOR HEALTH CARE STAKEHOLDERS' COMMITMENT TO HALTING
CHILDHOOD OBESITY
Childhood Obesity: The Role of Health Policy lays a foundation for the
health care system's response to the challenge of childhood obesity and
guides the activities of the Childhood Obesity Action Network (COAN).
The report, developed by the National Initiative for Children's
Healthcare Quality (NICHQ) and the Child Policy Research Center at
Cincinnati Children's Hospital Medical Center with support from the
Robert Wood Johnson Foundation and Nemours Health and Prevention
Services, synthesizes input from a 2006 meeting to bring together the
leaders of stakeholder groups that have the potential to support
continuing work to combat pediatric obesity. The long-term objective is
to create a large group of health professionals to collaborate, share
learning, and be more effective at changing the way the health care
system currently manages childhood obesity. Contents include background
information on childhood obesity and the role of health care policy,
methods, findings, and proposed goals and strategies. Appendices
include a summary of relevant recommendations from the Institute of
Medicine, lists of organizations and NICHQ's COAN policy subcommittee
members, and a map of state overweight prevalence rankings and report
card grades for childhood-obesity-related activities. The report is
available at http://www.nichq.org/NR/rdonlyres/971DFA0A-C2B7-4245-82FD-0A6286D340FA/0/obesity_policy_report_v5.pdf.
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2. ANALYSIS REVEALS CRITICAL AREAS IN WHICH POLICIES ARE NEEDED TO
IMPROVE CHILD HEALTH SYSTEM PERFORMANCE
U.S. Variations in Child Health System Performance: A State Scorecard
examines variations among states' child health systems, focusing on 13
indicators of child health system performance along the dimensions of
access, quality, costs, equity, and the "potential to lead healthy
lives." The report builds on the State Scorecard on Health Performance
prepared for the Commonwealth Fund Commission on a High Performance
Health System. All 50 states, plus the District of Columbia, are ranked
on each indicator and the five dimensions of performance. The rankings
for each dimension are then summed to derive an overall ranking for
child health system performance. Gaps in performance by income, race
and ethnicity, and insurance are discussed. Additional topics include
national cumulative impact if all states achieved top-state rates and a
call to action for federal and state collaboration. The executive
summary, fund report, methodology and appendix tables, and chartpack
are available at http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=687113.
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3. REPORT EXAMINES MOTHERS' PARTICIPATION IN SELECTED PUBLIC ASSISTANCE
PROGRAMS
Participation of Mothers in Government Assistance Programs: 2004
focuses on the fertility and socioeconomic characteristics of mothers
in 2004 related to participation in six public assistance programs:
Temporary Assistance for Needy Families (TANF); the Food Stamp Program;
the Special Supplemental Nutrition Program for Women, Infants, and
Children (WIC); Medicaid; housing assistance programs; and other
assistance programs. The report is part of the U.S. Census Bureau's
Current Population Reports series, which provides a long-range view of
mothers' participation in these programs since the 1996 Personal
Responsibility and Work Opportunity Reconciliation Act (PRWORA) was
enacted. Data for the report were drawn from Wave 2 of the 2004 Survey
of Income and Program Participation, conducted from June through
September 2004. The authors discuss the characteristics of mothers
receiving assistance (age and marital status; living arrangements;
adolescent childbearing; race, Hispanic origin, and nativity) and their
labor force participation, education, and economic status. Findings on
the independent effects of each characteristic on the odds of receiving
public assistance are also presented. Highlights, descriptions of
assistance programs, and a summary are included. Statistical data is
presented in tables and graphs throughout the document. The report is
available at http://www.censusbureau.biz/prod/2008pubs/p70-116.pdf.
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4. ARTICLE EXPLORES RECENT TRENDS IN HIGH BMI FOR U.S. CHILDREN AND
ADOLESCENTS
"No statistically significant trend in high BMI [body mass index] for
age was found over the time periods 1999-2000, 2001-2002, 2003-2004,
and 2005-2006," state the authors of an article published in the May
28, 2008, issue of JAMA, The Journal of the American Medical
Association. In the United States, the prevalence of overweight among
children increased between 1980 and 2004, and the heaviest children
have been getting heavier. This article reports on a study conducted to
update the most recent national estimates of high BMI among U.S.
children and adolescents (ages 2-19) using data from 2005-2006.
Estimates of high BMI at three different levels are presented, trends
between 1999 and 2006 are examined, and racial and ethnic differences
are evaluated.
The authors used data from the National Health and Nutrition
Examination Survey (NHANES), a complex, multistage probability sample
of the U.S. civilian, noninstitutionalized population. This article
includes data for 4,207 children and adolescents from 2005 to 2006 and
3,957 children and adolescents from 2003 to 2004.
The authors found that
- In 2006, 10.9% of children and adolescents were at or above the
97th percentile of the 2000 Centers for Disease Control and Prevention
BMI-for-age growth charts, 15.5% were at or above the 95th percentile,
and 30.1% were at or above the 85th percentile.
- Analyses of trends showed no statistically significant trend over
the four time periods (1999-2000, 2001-2002, 2003-2004, and 2005-2006)
for either boys or girls. Trends were not statistically significant for
any racial or ethnic group.
- No statistically significant change in high BMI for age was found
between 2003-2004 and 2005-2006.
- Because no significant differences were found between 2003-2004
and 2005-2006, these two 2-year survey periods were combined to make
detailed population estimates for the prevalence of high BMI for age by
sex, age, and race and ethnicity. For 2003-2006, 11.3% of children or
adolescents were at or above the 97th percentile of BMI for age, 16.3%
were at or above the 95th percentile, and 31.9% were at or above the
85th percentile.
- For each of the three cutoffs, high BMI for age differed
significantly by age and racial and ethnic group, but not by sex.
The authors conclude that "the increase in the prevalence of high BMI
for age among US children that was previously seen between NHANES III
(1988-1994) and NHANES 2003-2004 was not observed between 2003-2004 and
2005-2006, either overall or by racial/ethnic group. Data from
2007-2008 are needed to further examine the trends."
Odgen CL, Carroll MD, Flegal KM. 2008. High body mass index for age
among US children and adolescents, 2003-2006. JAMA, The Journal of the
American Medical Association 299(20):2401-2405. Abstract available at
http://jama.ama-assn.org/cgi/content/short/299/20/2401.
Readers: More information is available from the following MCH Library
resource:
- Overweight and Obesity in Children and Adolescents: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_overweight.html
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5. STUDY INVESTIGATES WHETHER AN INDEPENDENT ASSOCIATION EXISTS BETWEEN
CHILD MALTREATMENT AND UNDERIMMUNIZATION
"In this study of children referred to a CAC [child advocacy center]
for suspected maltreatment, children who were underimmunized at 3 and 7
months of age were more likely to have confirmed maltreatment than
children with up-to-date immunizations, even after controlling for
factors known to affect immunization timeliness such as race and
ethnicity, insurance status, and maternal education," state the authors
of an article published in the May-June 2008 issue of Ambulatory
Pediatrics. There is some evidence of a relationship between inadequate
primary care such as underimmunization and child maltreatment in
children referred for evaluation of maltreatment. However, the observed
relationship may have been confounded by common socioeconomic and
access issues. To understand whether underimmunization is associated
with child maltreatment among infants and young children referred for
maltreatment evaluation, the authors of the article assessed
maltreatment outcomes for infants while controlling for race and
ethnicity, insurance status, and maternal education.
Infants and children were retrospectively identified from an existing
clinical database of all cases evaluated at a CAC in an urban academic
medical center. The study focused on children from New York City seen
between January 2001 and October 2005 who were age 3-48 months by the
end of the last year of the study period. Of the 399 infants and
children who met the age criterion, 285 had reliable immunization data
available. The initial analysis compared the relationship between
immunization status at ages 3, 7, and 19 months with child maltreatment
confirmation (confirmed, suspected, ruled out).
The authors found that
- At ages 3 and 7 months, there were significant differences in
immunization status between infants with confirmed maltreatment vs.
those for whom maltreatment was ruled out (32% vs. 17.6% at age 3
months; 23.7% vs. 8.6% at age 7 months).
In additional analyses stratified by maltreatment type (sexual or
physical abuse) and controlling for race and ethnicity, insurance
status, and maternal education, the authors found that
underimmunization at ages 3 and 7 months remained significantly
associated with confirmed maltreatment. Specifically, they found that
- At age 3 months, underimmunized infants were four times as likely
to have confirmed maltreatment as infants with up-to-date immunizations.
- At age 7 months, underimmunized infants were almost five times as
likely to have confirmed maltreatment as infants with up-to-date
immunizations.
- These relationships were significant for infants evaluated for
physical abuse, but not for those evaluated for sexual abuse.
"We found that at 3 and 7 months of age, underimmunized children
evaluated at a CAC were more likely to have confirmed maltreatment,
specifically physical abuse, than those who were fully immunized,"
state the authors. They conclude that "the association between
underimmunization and child abuse in the general population deserves
further study."
Stockwell MS, Brown J, Chen S, et al. 2008. Is underimmunization
associated with child maltreatment? Ambulatory Pediatrics 8(3):210-213.
Abstract available at http://www.ambulatorypediatrics.org/article/S1530-1567(08)00003-8/abstract.
Readers: More information is available from the following MCH Library
resources:
- Child Abuse (organizations resource list) at
http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_childabuse.html&-MaxRecords=all&-DoScript=auto_search_childabuse&-search
- Immunizations: Selected Resources at
http://www.mchlibrary.info/guides/immunization.html
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and
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