Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
June 20, 2008
1. Brief Presents Results of an Assessment of Early
Childhood System Indicators
2. Analysis Explores Why Young Adults Are Uninsured and
Outlines Policies to Address the Problem
3. Report Summarizes Results from the First Survey of
Breastfeeding-Related Maternity Practices Conducted in the United States
4. Study Examines Sexual Violence Victimization History
and Sexual Risk Indicators in "Mostly Heterosexual" and Heterosexual
Young Women
5. Article Looks at Racial Disparities in Diabetes
Mellitus Care
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Special Notice: The American Association of Suicidology recently
launched the School Suicide Prevention Accreditation Program for school
psychologists, social workers, counselors, nurses, and others dedicated
to or responsible for reducing the incidence of suicide and suicidal
behaviors among school-age children and adolescents. More information
is available at http://www.suicidology.org/displaycommon.cfm?an=1&subarticlenbr=239.
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1. BRIEF PRESENTS RESULTS OF AN ASSESSMENT OF EARLY CHILDHOOD SYSTEM
INDICATORS
State Indicators for Early Childhood reviews the characteristics of
indicators for monitoring program performance and child outcomes
related to early childhood systems and proposes an indicator set for
state Early Childhood Comprehensive Systems (ECCS). The brief is the
seventh in the Short Take series published by the National Center for
Children in Poverty's (NCCP's) Project THRIVE, with support from the
Maternal and Child Health Bureau. It is based on a review of the
literature, an analysis of key national indicator sets, and a
comparative review of indicators set out in State ECCS reports and
plans from 2006 and 2007. Project THRIVE's 36 recommended indictors are
listed according to over-arching categories and ECCS's core components.
The proposed indicators include outcome; process, program, and policy;
and population risk measures. Promising state-level ECCS indicators not
found in national sets are also highlighted, along with examples of
state strategies for implementing the use of indicators. Conclusions
and recommendations are provided. The brief is available at http://nccp.org/publications/pdf/text_822.pdf.
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2. ANALYSIS EXPLORES WHY YOUNG ADULTS ARE UNINSURED AND OUTLINES
POLICIES TO ADDRESS THE PROBLEM
Health Insurance Coverage of Young Adults: Issues and Broader
Considerations examines the root causes of uninsurance among young
adults. The brief, published by the Urban Institute, also explores
policy options and tradeoffs associated with addressing coverage gaps
for young adults, including expanding employer coverage of dependents,
extending Medicaid coverage, extending coverage to more students,
providing tax credits or deductions, and enforcing individual mandates.
Statistical data on uninsurance rates, health insurance coverage,
access to employer-sponsored insurance and Medicaid or State Children's
Health Insurance Program coverage, and attitudes toward health
insurance coverage are included. A summary, background information, and
conclusions are also presented. The brief is available at http://www.urban.org/UploadedPDF/411691_young_adult_insurance.pdf.
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3. REPORT SUMMARIZES RESULTS FROM THE FIRST SURVEY OF
BREASTFEEDING-RELATED MATERNITY PRACTICES CONDUCTED IN THE UNITED STATES
"These results highlight the need for U.S. hospitals and birth centers
to implement changes in maternity practices that support
breastfeeding," state the authors of a report published in the June 13,
2008, issue of Morbidity and Mortality Weekly Report. Breastfeeding
provides optimal nutrition for infants and is associated with decreased
risk for infant and maternal morbidity and mortality; however, only
four states (Alaska, Montana, Oregon, and Washington) have met all five
Healthy People 2010 targets for breastfeeding. Maternity practices in
hospitals and birth centers throughout the intrapartum period can
influence breastfeeding behaviors during a period critical to the
successful establishment of lactation. In 2007, to characterize
maternity practices related to breastfeeding, the Centers for Disease
Control and Prevention conducted the first national Maternity Practices
in Infant Nutrition and Care (mPINC) Survey. This report summarizes
results of that survey.
The mPINC Survey was mailed to 3,143 hospitals and 138 birth centers
with registered maternity beds, with the request that the survey be
completed by the person most knowledgeable about the facility's infant
feeding and maternity practices. Questions about maternity practices
were grouped into seven categories that served as subscales in the
analyses: (1) labor and delivery, (2) breastfeeding assistance, (3)
mother-newborn contact, (4) newborn feeding practices, (5)
breastfeeding support after discharge, (6) nurse-birth attendant
breastfeeding training and education, and (7) structural and
organizational factors related to breastfeeding. Researchers assigned
scores to facility responses on a 0-100 scale, with 100 representing a
practice most favorable toward breastfeeding. Responses were received
from 2,690 facilities (82%); however, data from three respondent
facilities in Guam and the U.S. Virgin Islands were excluded from this
analysis because of disclosure concerns, resulting in a sample size of
2,687 facilities (2,546 hospitals and 121 birth centers) in the 50
states, the District of Columbia, and Puerto Rico. The response rate
among birth centers (88%) was higher than among hospitals (82%).
The authors found that
- A substantial proportion of facilities used maternity practices
that are not evidence-based and are known to interfere with
breastfeeding. For example, 24% of birth facilities reported
supplementing more than half of healthy, full-term, breastfed newborns
with something other than breast milk during the postpartum stay, a
practice shown to be unnecessary and detrimental to breastfeeding. In
addition, 70% of facilities reported giving breastfeeding mothers gift
bags containing infant formula samples.
- States in the southern United States generally had lower mPINC
scores, including certain states previously determined to have the
lowest 6-month breastfeeding rates.
"Improving maternity practices in these facilities affords an
opportunity to support establishment and continuation of breastfeeding.
Establishing these practices as standards of care in birth facilities
throughout the United States can improve progress toward meeting the
Healthy People 2010 breastfeeding objectives and improve maternal and
child health nationwide," note the authors.
DiGirolamo AM, Manninen DL, Cohen JH, et al. 2008.
Breastfeeding-related maternity practices at hospitals and birth
centers -- United States, 2007. Morbidity and Mortality Weekly Report
57(23):621-625. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5723a1.htm?s_cid=mm5723a1_e.
Readers: More information is available from the following MCH Library
resource:
- Breastfeeding: Selected Resources at
http://www.mchlibrary.info/guides/breastfeeding.html
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4. STUDY EXAMINES SEXUAL VIOLENCE VICTIMIZATION HISTORY AND SEXUAL RISK
INDICATORS IN "MOSTLY HETEROSEXUAL" AND HETEROSEXUAL YOUNG WOMEN
"Our findings add to the evidence that the health experience of 'mostly
heterosexual' girls and women is distinct from that of heterosexual
peers in a range of health domains," state the authors of an article
published in the June 2008 issue of the American Journal of Public
Health. According to research findings about the effects of sexual
violence victimization on subsequent risk behaviors in multiple health
domains, it appears possible that violent victimization in childhood
may be a contributor to elevated health risks experienced by "mostly
heterosexual" girls and women (those who report having attractions to
both genders but who may not describe themselves as bisexual). The
article presents findings from a study to examine patterns in sexual
violence and victimization in heterosexual and mostly heterosexual
young women and the possible contribution of childhood sexual abuse
history to disparities in sexual risk among groups of young women with
differing sexual orientations.
Data for the study were collected as part of the Project on Human
Development in Chicago Neighborhoods (PHDCN), a multilevel, prospective
cohort study of 6,226 children and adolescents, their caregivers, and
their neighborhoods. For the current study, the researchers used data
from 1,328 adolescents ages within 6 months of 15 or 18 at baseline in
1994. In the baseline sample, 671 participants were female.
Participants were primarily Latina or Black, of diverse socioeconomic
position, and representative of families with adolescents of the
eligible ages living in Chicago. In 2000, a comprehensive, in-person
interview and self-report questionnaire that assessed sexual
orientation, sexual risk indicators, and sexual abuse victimization was
administered to PHDCN participants who were ages 18-24 at that time.
Among those who participated at baseline, 70% completed their second
follow-up interview in 2000-2001. The final analytic sample comprised
410 young women who responded to the questions that addressed sexual
abuse victimization in the 2000 PHDCN survey.
The authors found that
- Among young women participating in the PHDCN, those describing
themselves as mostly heterosexual reported higher rates of childhood
sexual abuse than did those describing themselves as heterosexual.
- Nearly half of mostly heterosexual young women reported having
experienced sexual violence victimization before age 18.
- Mostly heterosexual young women were more likely to have ever
been diagnosed with a sexually transmitted infection and reported an
earlier age of first intercourse and a greater number of sexual
partners in their lifetimes, compared with heterosexual young women.
"Public health professionals and health care providers need to be aware
that 'mostly heterosexuals' represent an underrecognized population not
identified by standard sexual orientation identity questions that
include only the options heterosexual, bisexual, and lesbian/gay.
Further investigation into the reasons underlying the high rates of
violence victimization in this subgroup of young women is of paramount
importance," conclude the authors.
Austin SB, Roberts AL, Corliss HL, et al. 2008. Sexual violence
victimization history and sexual risk indicators in a community-based
cohort of "mostly heterosexual" and heterosexual young women. American
Journal of Public Health 98(6):1015-1020. Abstract available at http://www.ajph.org/cgi/content/abstract/98/6/1015.
Readers: More information is available from the following MCH Library
resource:
- Adolescent Violence Prevention: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_adolvio.html
- Emotional, Behavioral, and Mental Health Challenges in Children and
Adolescents: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_Mental_Conditions.html
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5. ARTICLE LOOKS AT RACIAL DISPARITIES IN DIABETES MELLITUS CARE
"We found that a substantial proportion of racial disparities in DM
[diabetes mellitus] care are primarily related to within-physician
differences in outcomes," write the authors of an article published in
the June 9, 2008, issue of Archives of Internal Medicine. Racial
disparities in the quality of DM care are well documented. Although
earlier studies have focused on the role of hospitals, health plans,
and regions as mediators of racial disparities, little is known about
the role of variation among individual physicians. The study described
in this article had the two following main objectives: (1) to assess
the extent to which racial disparities in intermediate outcomes of DM
care are related to within-physician vs. between-physician effects and
(2) to determine whether overall quality or a more diverse patient
panel are associated with decreased racial disparities within
individual physicians' patient panels.
The authors studied patients ages 18 or older as of May 2007 who had a
DM diagnosis and who had had a visit with a Harvard Vanguard Medical
Association primary care physician within the previous 2 years. The
authors identified 6,814 eligible patients with DM treated by 90
primary care physicians. Outcome measures included HbA1c level, LDL-C
level, and blood pressure (BP).
The authors found that
- The median number of white patients treated per physician was
15.5, and of black patients was 44.5. There was substantial clustering
of care for black patients, with 39% of physicians caring for 75% of
black patients. Black patients were younger than white patients, less
likely to be male, and lived in communities with lower median household
incomes.
- Rates of achieving ideal and adequate control of HbA1c, LDL-C,
and BP were significantly lower among black patients compared with
white patients.
- Results consistently indicated that adjustment for patients'
sociodemographic factors played a substantial role in explaining racial
disparities in control of HbA1c and LDL-C, accounting for 13% to 38% of
observed racial disparities in achieving ideal control.
- Adjustment for patients' clinical factors uniformly explained
little to none of the observed overall racial differences in outcomes,
and adjustment for between-physician effects explained only a small
proportion of the disparities.
- In contrast to the small between-physician effects,
within-physician effects explained a large percentage of racial
disparities in achieving DM outcomes, ranging from 66% for HbA1c
control to 68% for LDL-C control to 75% for BP control.
- Between-physician effects played an important role in achieving
ideal BP control, where they accounted for 23% of the disparity.
- Among individual primary care physicians, there was notable
variation in the magnitude of racial disparities in ideal DM outcomes
after adjusting for patient characteristics. However, no statistically
significant association was found between the magnitude of racial
disparities in a physician's panel of patients and the number of black
patients treated by that physician.
The authors conclude that "system-wide interventions will be needed to
improve care for minority patients across all physicians."
Sequist TD, Fitzmaurice GM, Marshall R. 20087. Physician performance
and racial disparities in diabetes mellitus care. Archives of Internal
Medicine 168(11):1145-1151. Abstract available at http://archinte.ama-assn.org/cgi/content/abstract/168/11/1145.
Readers: More information is available from the following MCH Library
resource:
- Racial and Ethnic Disparities in Health: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_race.html
- Culturally Competent Services: Selected Resources at
http://www.mchlibrary.info/guides/culturalcompetence.html
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MCH Alert © 1998-2008 by National Center for Education in Maternal
and
Child Health and Georgetown University. MCH Alert is produced by
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MCH Alert
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