Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
January 23, 2009
1. Study Focuses on the Impact of Citizenship
Documentation Rules
2. Report Examines the Media's Influence on Adolescent
Sexual Behavior
3. Brief Explores Eligibility Thresholds for Public
Coverage
4. Article Investigates Live-Birth Rates After in Vitro
Fertilization
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1. STUDY FOCUSES ON THE IMPACT OF CITIZENSHIP DOCUMENTATION RULES
Getting and Keeping Coverage: States' Experiences with Citizenship
Documentation Rules examines the impact citizenship documentation rules
have had on coverage stability in public programs for children and
families in seven states (Alaska, Arizona, Kansas, Louisiana, Ohio,
Virginia, and Washington). The report is based on a study conducted by
Georgetown University's Health Policy Institute with support from the
Commonwealth Fund. The authors primarily focus on the consequences of
implementing federal regulations, which took effect in mid-2006, that
require individuals to show proof of citizenship when applying for or
renewing coverage under public health insurance options such as
Medicaid. Contents include information provided by state officials
about local circumstances and program policies as well as analyses of
each state's data related to program-application activity, enrollment,
service use, and administrative costs for the periods immediately
before and after implementation of the citizenship documentation rules.
The report and a chartpack containing data tables and figures are
available at http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=781956.
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2. REPORT EXAMINES THE MEDIA'S INFLUENCE ON ADOLESCENT SEXUAL BEHAVIOR
Managing the Media Monster: The Influence of Media (from Television to
Text Messages) on Teen Sexual Behavior and Attitudes is intended to
inform practitioners and programs about what research says about
adolescents and media influence. The report, published by the National
Campaign to Prevent Teen and Unplanned Pregnancy with support from the
Centers for Disease Control and Prevention, examines how the media
influences sexual knowledge, attitudes, and behavior -- both positively
and negatively. Topics include (1) an overview of what is currently
known about the effects of sexual content in the entertainment media
young people typically use; (2) a review of 25 evaluated, peer-reviewed
interventions from 19 countries on how effective media interventions
have been in addressing adolescents' reproductive health and
recommendations to consider when developing media interventions; and
(3) a review of more than 20 media-based-interventions for sexual and
reproductive health that have been conducted in the United States. A
snapshot of health behavior theories and additional resources are
included. The report is available at http://www.thenationalcampaign.org/resources/monster/Media_Monster.pdf.
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3. BRIEF EXPLORES ELIGIBILITY THRESHOLDS FOR PUBLIC COVERAGE
Setting Income Thresholds in Medicaid/SCHIP: Which Children Should Be
Eligible? examines the extent to which increases in the cost of
employer-sponsored insurance have outstripped income growth since the
enactment of the State Children's Health Insurance Program (SCHIP). The
brief also discusses the implications of cost-of-living differences.
The brief, published by the Urban Institute with support from the
Robert Wood Johnson Foundation, draws information on the cost of
employer-sponsored insurance premiums from the Medical Expenditure
Panel Survey Insurance Component to assess how the affordability of
private health insurance coverage has been changing over the past
decade. The analysis focuses on changes in the average premium relative
to family income and also examines alternative affordability measures.
Implications of area-variation on cost of living are addressed, as
well. The brief is available at http://www.urban.org/UploadedPDF/411817_setting_income_thresholds.pdf.
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4. ARTICLE INVESTIGATES LIVE-BIRTH RATES AFTER IN VITRO FERTILIZATION
"The cumulative live-birth rate in our population of more than 6000
patients undergoing up to six cycles of IVF was between 51% and 72%,"
write the authors of an article published in the January 15, 2009,
issue of the New England Journal of Medicine. When couples present to
physicians for fertility evaluations and require in vitro fertilization
(IVF), their main question is whether the treatment will result in an
infant. The statistic commonly quoted to such couples is the outcome
per cycle according to maternal age. However, this estimate has limited
value for individuals because it does not account for the potential
need for multiple IVF cycles and the likely difference in success
between first-time patients and those who did not become pregnant in
previous attempts. The purpose of this study was to provide accurate,
evidence-based estimates of the likelihood that a couple presenting for
IVF will have a pregnancy resulting in a live birth. The authors report
cumulative live-birth rates among more than 6,000 women undergoing
multiple IVF cycles (both fresh and frozen) in a single large center.
The authors performed a retrospective cohort study including all women
undergoing their first fresh-embryo, non-donor IVF cycle during the
period 2000-2005 at Boston IVF in Waltham, MA. Women were followed
during treatment at the center for at least 1 year until either
discontinuation of treatment or delivery of a live infant. The primary
outcome was delivery of one or more live infants in up to six IVF
cycles. Data were stratified according to maternal age using both
conservative and optimistic methods (i.e., assuming that women who did
not return for subsequent IVF treatments had no chance of a pregnancy
resulting in a live birth [conservative] and assuming that these women
had the same chance of pregnancy as those who did return for treatment
[optimistic]).
The authors found that
- After three IVF cycles, the conservative cumulative live-birth
rate was 45%, and the optimistic rate was 53%. After six cycles, the
conservative and optimistic rates were 51% and 72%, respectively.
- Among women younger than age 35, the optimistic cumulative
live-birth rate after six IVF cycle was 86%, and the conservative rate
was 65%. Both rates decreased with increasing age, and the age-specific
ratios were significantly different from one another.
- Women who did not return for cycles 2 through 4 tended to have
poorer potential for fertility due to their older age, higher levels of
follicle-stimulating hormone on day 3 of the menstrual cycle and higher
gonadotropin doses received, lower peak estradiol levels, and fewer
oocytes retrieved and embryos frozen, compared with women who did
return for a subsequent cycle.
The authors conclude that "these age specific optimistic and
conservative cumulative live-birth rates can facilitate individualized
counseling in a large population of patients considering IVF treatment."
Malizia BA, Hacker MR, Penzias AS. 2009. New England Journal of
Medicine 360(3):236-243. Abstract available at http://content.nejm.org/cgi/content/short/360/3/236.
Readers: More information is available from the following MCH Library
resource:
- Assisted Reproductive Technologies: Resource Brief at
http://www.mchlibrary.info/guides/ART.html
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