Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html
March 19, 2010
1. Partners Develop Resources for Programs Serving
Populations at Moderate to High Risk for Dental Caries
2. Guide Highlights Strategies for Developing
Family-Provider Partnerships to Reduce the Risk of Child Maltreatment
3. Healthy Teen Network Launches Resource Center to
Support Implementation of Effective Pregnancy Prevention Program
4. Alliance Releases Findings on Adolescents' Health
Behaviors and Their Perceptions of the Health Care System
5. Article Assesses State Variations in Underinsurance
Among Children with Special Health Care Needs
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1. PARTNERS DEVELOP RESOURCES FOR PROGRAMS SERVING POPULATIONS AT
MODERATE TO HIGH RISK FOR DENTAL CARIES
The Association of State and Territorial Dental Directors and the
National Maternal and Child Oral Health Resource Center have published
four new resources to stimulate thinking about and the use of
professionally applied fluoride varnish by programs serving populations
at moderate to high risk for dental caries. The resources were produced
with support from the Health Resources and Services Administration's
Maternal and Child Health Bureau and include the following:
Fluoride Varnish Policy Statement supports the use of fluoride varnish
beginning with tooth eruption for individuals at moderate to high risk
for tooth decay as an effective adjunct in programs designed to reduce
lifetime dental caries experience. Topics include the impact of dental
caries on health over the life span, dental caries control, systemic
and topical fluoride methods, caries reduction attributable to fluoride
varnish, caries risk assessment, and fluoride varnish safety and
efficacy. The policy statement is available at http://www.astdd.org/docs/FluorideVarnishPolicyStatement(ECFebruary12010).pdf
Fluoride Varnish: An Effective Tool for Preventing Dental Caries (fact
sheet) provides information about fluoride varnish and its uses,
effectiveness, safety, service delivery, and reimbursement for medical
professionals as well as for oral health professionals. The fact sheet
is available at http://www.mchoralhealth.org/PDFs/FlVarnishfactsheet.pdf
Fluoride Varnish: A Resource Guide provides an annotated list of
resources on the use and application of fluoride varnish, including (1)
journal articles; (2) materials on meetings; policy; professional
education, tools, and training; public education; and state and local
programs; and (c) organizations. The guide is available at http://www.mchoralhealth.org/PDFs/ResGuideFlVarnish.pdf
Resource Highlight: Focus on Fluoride Varnish offers a short list of
journal articles, materials, and Web sites on this topic. Resource
Highlights is available at http://www.mchoralhealth.org/highlights/flvarnish.html
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2. GUIDE HIGHLIGHTS STRATEGIES FOR DEVELOPING FAMILY-PROVIDER
PARTNERSHIPS TO REDUCE THE RISK OF CHILD MALTREATMENT
Strengthening Families and Communities: 2010 Resource Guide highlights
strategies to strengthen families by promoting key protective factors
that help reduce the risk of child abuse and neglect. The guide is
produced annually by the Children's Bureau, Child Welfare Information
Gateway, and the FRIENDS National Resource Center for Community-Based
Child Abuse Prevention. The 2010 guide was written to support service
providers in their work with families and was developed with input from
national organizations, federal partners, and parents and other
caregivers. The content focuses on strategies for changing how
communities support families as well as on evidence-informed practices.
The guide offers suggestions for enhancing protective factors in
families, tools to build awareness and develop community partnerships,
information about child abuse and neglect, a directory of national
organizations that work to strengthen families, and tip sheets in
English and Spanish on specific parenting topics. The guide is
available at http://www.childwelfare.gov/pubs/res_guide_2010
Additional materials are available in the Preventing Child Abuse and
Neglect section of the Information Gateway Web site. These include
resources for National Child Abuse Prevention Month, as well as
information on evaluating and funding prevention programs, enhancing
protective factors, and effective parenting. More information is
available at http://www.childwelfare.gov/preventing
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3. HEALTHY TEEN NETWORK LAUNCHES RESOURCE CENTER TO SUPPORT
IMPLEMENTATION OF EFFECTIVE PREGNANCY PREVENTION PROGRAMS
The Healthy Teen Network's Evidence-Based Resource Center is designed
to help communities implement evidence-based or innovative approaches
to reducing adolescent pregnancy. The Web site was developed to support
organizations by providing information about (1) training in
evidence-based programs for trainers, program educators, and
facilitators; (2) technical assistance on program selection,
implementation, teaching methods, evaluation, and sustainability; and
(3) resources such as research publications, fact sheets, and resource
guides. A link to the National Campaign to Prevent Teen and Unplanned
Pregnancy's portal on federal funding for adolescent pregnancy
prevention programs is included. More information is available at http://healthyteennetwork.org/index.asp?Type=B_BASIC&SEC={5E80FC23-E52F-4B64-8E81-C752F7FF3DB6}
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4. ALLIANCE RELEASES FINDINGS ON ADOLESCENTS' HEALTH BEHAVIORS AND
THEIR PERCEPTIONS OF THE HEALTH CARE SYSTEM
The National Alliance to Advance Adolescent Health has published two
new resources to support improvements in the health care delivery model
for adolescents and the infrastructure changes needed to support it.
The resources include the following:
* Significant Multiple Risk Behaviors Among U.S. High School Students
(fact sheet) provides information on multiple health risk behaviors
among high school students, based on an analysis of 12 types of
significant health risk behaviors including unsafe sexual behaviors,
unhealthy eating and exercise patterns, mental health and substance use
problems, and behaviors that contribute to violence. The authors report
on the prevalence of risk-taking behaviors in the high school
population and also on the likelihood that students who engage in one
risk behavior are engaging in others. Differences by gender, race and
ethnicity, and grade level are examined. In addition, implications for
prevention interventions are considered in light of the findings. The
fact sheet is available at http://www.thenationalalliance.org/jan07/factsheet8.pdf
* Adolescents' Experiences and Views on Health Care (report) presents
findings from focus groups and supplemental questionnaires structured
to learn about adolescents' own perceptions of the health problems
facing adolescents, their experiences receiving care, and their ideas
about how best to structure care for the adolescent population. The
study documents the perspectives of 204 young people ages 14 to 20 from
disadvantaged neighborhoods in Los Angeles, Miami, Chicago, and
Washington, DC. The report is available at http://www.thenationalalliance.org/jan07/report2-2010.pdf
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5. ARTICLE ASSESSES STATE VARIATIONS IN UNDERINSURANCE AMONG CHILDREN
WITH SPECIAL HEALTH CARE NEEDS
"Our results indicate that where a child lives is strongly related to
the likelihood that his or her health insurance is adequate," according
to the authors of an article published in Pediatrics (ahead of print)
on March 8, 2010. Underinsurance, or having insurance that does not
sufficiently meet a child's needs, is a particularly critical issue for
children with special health care needs (CSHCN). Underinsurance among
CSHCN has been associated with increased risks for lacking a personal
doctor or nurse, having unmet health care needs, reporting difficulty
in obtaining specialty referrals, and experiencing financial problems.
In the study described in this article, the authors addressed the
following questions: (1) Does the rate of underinsurance for CHSCN vary
across states? (2) Is the rate of underinsurance similar for those with
public vs. private insurance? (3) Do state-level factors influence the
level of underinsurance?
For the study, the authors used data from the 2005-2006 National Survey
of Children with Special Health Care Needs, a nationally representative
study of 40,000 CSHCN, to address variations in underinsurance. CSHCN
with health insurance were considered underinsured when a parent
reported that the child’s insurance did not usually or always cover
needed services and health professionals or reasonably cover costs. The
authors calculated the unadjusted prevalence of underinsurance for each
state. Using logistic regression, they then estimated state-specific
odds and prevalence for underinsurance after adjusting for poverty
level, race/ethnicity, gender, family structure, language use,
insurance type, and severity of the child’s health condition. They also
conducted multilevel analyses incorporating state-level contextual data
on Medicaid and the Children’s Health Insurance Program.
The authors found that
- Nationally, approximately one-third of CSHCN were underinsured.
- There was substantial state variation in underinsurance. The
weighted but unadjusted state estimates for being underinsured ranged
from 24 percent in Hawaii to almost 38 percent in Illinois. After
adjusting for all covariates, the lowest rate of underinsurance was
still in Hawaii (22.9 percent), whereas the highest rate was in New
Jersey (37.7 percent).
- Families of CSHCN who had private-sector insurance were more
likely to be underinsured, compared to those with public insurance
(33.5 percent for private vs. 30.9 percent for public). Furthermore,
the state variations were wider within the publicly and privately
insured categories compared with the overall variations.
- Multivariate analysis indicated that even after controlling for
all covariates, where a child lived still had a strong association with
whether he or she was underinsured.
- CSHCN living in states where maximum Medicaid eligibility for
children ages 16-19 was less than twice the federal poverty level (FPL)
had at least 11 percent high odds of being underinsured, compared with
CSHCN in states where maximum eligibility was at least 200 percent of
FPL.
The authors conclude that "these findings suggest that current efforts
to add coverage incrementally for the uninsured, although important,
will do little to address the problems of the underinsured or the state
disparities mentioned here." They continue, "if policy makers are
interested in ensuring equitable treatment in the health care system
for CHSCN, then policy initiatives aimed at reducing underinsurance and
increasing uniformity of coverage across states are also needed."
Kogan MD, Newacheck PW, Blumberg SJ, et al. 2010. State variation in
underinsurance among children with special health care needs in the
United States. Pediatrics [published online ahead of print on March 8,
2010]. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1055v1
Readers: More information is available from the following MCH Library
resources:
- Children and Youth with Special Health Care Needs: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_CSHCN.html
- Health Insurance and Access to Care for Children and Adolescents:
Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_insurance.html
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and
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