MCH Newsletter 7/29/95

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MCH Newsletter 7/29/95

Postby denise » Fri Jul 29, 2005 10:39 am

MCH Alert
Tomorrow's Policy Today

Maternal and Child Health Library

This and past issues of the MCH Alert are available at

July 29, 2005

1. Task Force Releases Recommendations on Screening in Pregnant Women,
Children, and Adolescents
2. Series of Reports Reviews Recent Research on the Effects of Safety-Net
3. Report Highlights Findings on Youth Exposure to Televised Alcohol
Industry Messages
4. Study Examines Measures of Language Barriers in Children's Health Care
5. Authors Evaluate Factors Used in Successful School-Based Hepatitis B
Immunization Initiative
6. Article Examines Health Outcomes of School-Age Children Born with
Extremely Low Birthweight



This month, the U.S. Preventive Services Task Force released two
recommendation statements of particular relevance to the maternal and
child health community. In the first statement, titled Screening for Human
Immunodeficiency Virus Infection, the task force recommends that
clinicians screen all pregnant women for HIV. The statement, a review of
the evidence, and an evidence synthesis are available at In the second statement,
titled Screening and Interventions for Overweight in Children and
Adolescents, the task force concludes that the evidence is insufficient to
recommend for or against routine screening for overweight in children and
adolescents as a means to prevent adverse health outcomes. The statement,
a commentary, a summary of the evidence, and an evidence synthesis are
available at



What Does the Safety Net Accomplish? is a series of reports that examine
research on the impacts and accomplishments of public benefit programs
that assist individuals and families with low incomes. Each report in the
series, published by the Center on Budget and Policy Priorities, includes
state-by-state data on the number of people assisted by the program. The
first set of reports cover Medicaid and the State Children's Health
Insurance Program, food and nutrition programs, the Supplemental Security
Income Program, and the Earned Income Tax Credit. A separate report
examines the combined impact of the nation's system of public benefit
programs. Forthcoming reports will cover areas such as housing, child
care, and child support enforcement. The reports are available at



"America's youth are currently far more likely to see paid messages
promoting alcoholic beverages than public-health-funded or industry-funded
messages about the dangers of underage drinking," state the authors of a
report published by the Center on Alcohol Marketing and Youth at
Georgetown University. As a companion to its reports on youth exposure to
alcohol product advertising on television, in magazines, and on the radio,
the Center commissioned a media planning and research firm to analyze the
alcohol industry's televised "responsibility" and alcohol product
advertisements in 2001, 2002, and 2003. For the purposes of this report,
"responsibility" advertisements were defined as those that had as their
primary focus a message about drinking responsibly (not drinking and
driving or underage drinking). Product advertisements did not have
responsibility as their primary focus.

A two-stage method (identification and verification) was used to select a
set of advertisements and classify them into either the product category
or the responsibility category. The analysis included all advertising
bought on network, national cable, and local broadcast stations. The
advertisements were analyzed in terms of spending and youth and adult
audiences reached for each of the years from 2001 to 2003 as well as for
the entire period.

The authors found that

* Alcohol companies placed 761,347 product advertisements on television
from 2001 to 2003, compared to 24,161 responsibility advertisements.

* Spending on alcohol product advertising on television totaled more than
$2.5 billion over the 3-year period; spending on responsibility
advertising totaled less than $92 million.

* Only 4 alcohol companies placed “responsibility” advertisements on
television in all 3 years analyzed for this report; in contrast, 31
companies put alcohol product advertisements on television in all 3 years.

* Over the 3 years, youth ages 12 to 20 were 96 times more likely to see a
product advertisement for alcohol than an alcohol industry advertisement
about underage drinking on television. They were 43 times more likely to
see a product advertisement than an advertisement about drunk driving.

* While the number of product advertisements for alcohol on cable
television during this period exploded—from 645 to 29,396—the number of
responsibility ads bought by alcohol companies grew from 188 (29% of
alcohol product advertisements on cable television) in 2001 to 5,634 (19%
of alcohol product advertisements on cable television) in 2003.

The authors conclude that "these findings underscore the need for an
independently funded national media campaign to reduce and prevent
underage drinking, the central recommendation of the National Research
Council and Institute of Medicine's report on underage drinking released
in September 2003."

Center on Alcohol Marketing and Youth. 2005. Alcohol industry
"responsibility" advertising on television, 2001 to 2003. Washington, DC:
Georgetown University. Available at ... 3Final.pdf.

Readers: A related study in which researchers examined exposure, response
to, and awareness of beer advertising in two age groups found that
television beer ads result in high levels of beer advertising awareness in
children as young as age 9, and even higher awareness among 14-year-olds.
See: Collins RL, Ellickson PL, McCaffrey DF, et al. 2005. Saturated in
Beer: Awareness of Beer Advertising in Late Childhood and Adolescence.
Journal of Adolescent Health, Vol. 37, No. 1, July 2005, pp. 29-36.
Abstract available at ... 0f5a525fa0.



"Parental LEP [limited English proficiency] is more useful than primary
language spoken at home as a measure of children's health and health
care," state the authors of an article published in the July/August 2005
issue of Public Health Reports. Between 1980 and 2000, the number of
people in the United States who were limited in English proficiency
(defined as self-reporting speaking English less than very well) more than
doubled, as did the number of Americans speaking a language other than
English at home. The article focuses on study findings concerning parental
LEP and the primary language spoken at home, and how these factors are
associated with children's health status, access barriers to health care,
and use of health services.

The study was part of a larger community-based project examining access
barriers to health care for Latino children. Participants included primary
caregivers of children (from birth to age 18) in six communities in the
Boston, MA, metropolitan area with the highest proportion of Latinos. From
February 2, 2000, to December 22, 2000, parents were interviewed as they
exited selected community sites (supermarkets, bodegas, laundromats,
beauty salons, restaurants, a homeless shelter, and a day care center).
The study questionnaire (in English and Spanish) assessed the family's
sociodemographic characteristics; the children's health insurance, access
barriers to health care, health status, and use of health services; the
parents' knowledge and practices regarding managed care; parental English
proficiency (ability to speak English very well, well, not very well, or
not at all); and the primary language spoken at home (English, Spanish,
both, or other).

The authors found that

* Parental LEP was associated with triple odds of fair/poor health status
in children and double odds of at least one bed day for illness in the
past year, while primary language spoken at home was not significantly
associated with children's health status.

* Parental LEP was associated with higher odds of not bringing children in
for care for six of nine barriers studied, but the primary language spoken
at home was not associated with increased odds for any of the barriers,
and for one barrier reduced odds were noted.

The authors conclude that "consistent data collection on parental English
proficiency by health care institutions and state and federal governments
and referral of LEP parents to ESL [English as a second language] classes
by pediatric providers have the potential to contribute substantial
progress toward reduction and elimination of disparities in health and
health care for the children of LEP parents."

Flores G, Abreu M, Tomany-Korman SC, 2005. Limited English proficiency,
primary language spoken at home, and disparities in children's health and
healthcare: How language barriers are measured matters. Public Health
Reports 120(4):418–30.

Readers: The July/August 2005 issue of Public Health Reports, titled
Disparities in Children's Health and Health Care, presents other available
evidence to support decisions addressing disparities in U.S. child health
and health care. Additional topics include: (1) children's access to
primary care, mental health, and dental care; (2) the intergenerational
and life course effects of socioeconomic disparities on child health; and
(3) prioritizing a research agenda for understanding and eliminating child
health disparities. The issue is available at



"The support of various school members can help with the success of
school-based hepatitis B immunization initiatives," state the authors of
an article published in the July 2005 issue of the Journal of Adolescent
Health. While the efficacy and importance of school-based vaccination
programs in immunizing the adolescent population has been established,
additional studies are needed to determine how various factors affect the
establishment of successful school-based vaccination programs. The article
describes a study designed to identify what school-level factors may be
effective in increasing (1) the percentage of signed consent/refusal forms
that are returned, (2) the percentage of students enrolled in the
vaccination program, and (3) the percentage of those enrolled who received
all three doses in the vaccine series through the program.

Data for the study were drawn from the 1999-2000 program year of a
school-based initiative to increase hepatitis B vaccination rates among
students (grades 5 and 6) attending low-socioeconomic-status schools in
Houston, TX. All eligible students (N=8,918) received consent/refusal
forms and an educational packet to take home to their parents. Multiple
opportunities to complete the vaccine series were provided, vaccines were
free, and students who had received part of the vaccine series elsewhere
were eligible to complete the series through the program. At the end of
the project year, a brief survey asked school nurses to (1) rate the level
of support they perceived they had received from teachers, the principal,
parents, and students; (2) identify all school-level factors that were
utilized to motivate students to return parent consent/refusal forms; and
(3) describe to whom signed consent/refusal forms were to be returned.

The authors found that

* Eighty percent of the eligible students returned signed consent/refusal
forms, and 61% received at least one vaccine dose through the program.

* Of the students who enrolled in the program and received their first
vaccine dose, 59% received all three doses in the series through the

* Sixty-nine of 75 (90%) school nurses returned surveys.

* The percentage of signed consent/refusal forms that were returned was
more likely to be higher when teachers helped with the publicity and
promotion of the program and with educational packet distribution.

* The percentage of signed consent/refusal forms that were returned and
the percentage of vaccination series that were completed were more likely
to be higher when students returned the forms to their teacher only or to
their teacher and/or the school nurse (vs. to the school nurse only).

* A significant correlation was found between the percentage of signed
consent/refusal forms that were returned in each school and the percentage
of students who received all three doses in the vaccination series through
the program.

* The percentage of students who received at least one vaccine dose was
more likely to be higher when students helped with educational packet

"With this knowledge, schools can focus their limited resources on
educating and enlisting the help of teachers and students to create a more
successful hepatitis B immunization program," conclude the authors.

Tung CS, Middleman AB. 2005. An evaluation of school-level factors used in
a successful school-based hepatitis B immunization initiative. Journal of
Adolescent Health 37(1):61-68. Abstract available at ... fabb44f001.

Readers: More information about immunizations is available from the MCH
Library's annotated resource list at ... iz&-search.



"Our results reveal that ELBW [extremely low-birthweight] children have
extremely high rates of chronic conditions compared with NBW [normal
birthweight] children," write the authors of an article published in the
July 20, 2005, issue of JAMA, The Journal of the American Medical
Association. Advances in perinatal care in the 1990s resulted in dramatic
increases in the survival of ELBW infants (<1,000 g). This has been
accompanied by an increase in the rates of neonatal complications and
early childhood neurodevelopmental problems. However, there is little
information about how these children function at school age. The study
described in this article examines health outcomes of 8-year-olds in a
cohort of ELBW children born from 1992 through 1995. Outcomes included
functional limitations and special health care needs together with the
more traditional measures of neurological and developmental status.

The study group included 238 survivors of the cohort of 344 ELBW children
admitted to the neonatal intensive care unit at Rainbow Babies and
Children's Hospital in Cleveland, OH, between 1992 and 1995. NBW children
were used as controls. Parents completed a questionnaire, children
underwent a complete physical and neurological examination, and academic
achievement was measured using achievement tests.

The authors found that

* Thirty-six ELBW children (16%) had neurosensory impairments, including
cerebral palsy, deafness, and blindness, compared with none of the NBW

* There were significant differences in mild hearing loss and uncorrected
vision of less than 20/20, even when comparisons were restricted to
neurosensory intact ELBW children.

* Asthma requiring therapy was reported in 21% of ELBW children vs. 9% of
NBW children.

* ELBW children differed significantly from NBW children in rates of
suboptimal academic achievement, motor skills, and adaptive functioning.
The differences remained significant after excluding ELBW children with
major neurosensory defects.

* ELBW children had significantly higher rates of functional limitations
(e.g., mental or emotional delay, trouble understanding simple
instructions, difficulty feeding him/herself) compared with the NBW group.

* Overall, 48% of the ELBW children, 40% of the neurosensory intact ELBW
children, and 23% of the NBW children had one or more compensatory
dependent need (e.g., takes regularly prescribed medication, needs special
equipment to walk, follows physician-ordered special diet).

* ELBW children had a significantly greater need for services above
routine than NBW children.

* Overall, 76% of the ELBW children, 72% of the neurosensory intact ELBW
children, and 42% of the NBW children were identified with a chronic

The authors conclude that "proactive planning for the long-term health and
educational needs of all ELBW survivors is essential to optimally treat
and possibly improve outcomes through preventive and early intervention

Hack M, Taylor GH, Drotar D. 2005. Chronic conditions, functional
limitations, and special health care needs of school-age children born
with extremely low-birth-weight in the 1990s. JAMA, The Journal of the
American Medical Association 294(3):318-325. Abstract available at

Readers: The National Survey of Children with Special Health Care Needs:
Using State-Level Data to Improve Systems of Care for Children, a special
supplement to the June 2005 issue of the Maternal and Child Health
Journal, includes articles from 11 states about how they have used the
2001 survey findings to improve programs or policies for children with
special health care needs (SHCN). The issue also includes articles that
examine (1) whether rates of functional limitations are associated with
access to care, (2) methods for comparing state outcomes for children with
SHCN, and (3) the use of survey data in meetings with program managers and
policy makers. The article abstracts are available at ... 1:105600,1.


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