MCH Newsletter 8/12/05

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MCH Newsletter 8/12/05

Postby denise » Sat Aug 13, 2005 10:15 am

MCH Alert
Tomorrow's Policy Today

Maternal and Child Health Library

This and past issues of the MCH Alert are available at

August 12, 2005

1. New Edition of Women's Health Data Book Released
2. Web Site Links Child Care and After-School Providers to Physical
Activity and Nutrition Resources
3. Report Provides Estimates for National, State, and Urban-Area
Vaccination Coverage Among Young Children
4. Article Examines Variations in Preventive Dental Care and Unmet Dental
Needs Among Children from Low-Income Families
5. Authors Assess Time of Birth and Risk of Neonatal Death


Readers: The Maternal and Child Health (MCH) Thesaurus provides the MCH
professional community with a standard vocabulary that serves as a tool
for indexing and retrieving materials in MCH research centers, libraries,
or special collections. The third edition of the thesaurus, created by the
Maternal and Child Health Library, provides an introduction, an
alphabetical list of terms, a rotated list of terms, and a set of subject
categories. A search function allows users to search MCHLine® for specific
terms. The thesaurus is available at



Women's Health USA 2005, the fourth edition of the data book, presents a
profile of women's health at the national level from a variety of data
sources. The data book, developed by the Health Resources and Services
Administration's Office of Women's Health, includes information and data
on population characteristics, health status, and health services
utilization. New topics in this edition include household composition,
maternity leave, contraception, and adolescent pregnancy. The data book
also highlights racial and ethnic disparities and gender differences in
women's health. The data book is intended to be a concise reference for
policymakers and program managers at the federal, state, and local levels
to identify and clarify issues affecting the health of women. It is
available at



FitSource: A Web Directory for Providers contains a wide variety of tools
that can be used to incorporate physical activity and nutrition into child
care and after-school programs. The Web site, produced by the Child Care
Bureau, links to activities and game ideas, curricula and lesson plans,
campaigns, healthy menus and recipes, funding strategies, information for
parents, and other resources. The Web site allows users to search for
resources by keyword or by age group (infant and toddler, preschool, and
school age), and includes links to resources available in Spanish. The Web
site also contains a speaker's kit with PowerPoint slides, notes, and
handouts on the following topics: (1) childhood obesity and overweight
statistics; (2) consequences of childhood obesity; (3) why child care and
after-school settings are an ideal venue for incorporating nutrition and
physical activity; and (4) an overview of program, policy, and finance
strategies supporting nutrition and physical activity in child care and
after-school programs. The Web site is intended for use by program
administrators, directors, technical assistance providers, and others
interested in promoting proper nutrition and physical activity in child
care and after-school settings. It is available at



"These levels represent an important accomplishment by exceeding for the
first time the Healthy People 2010 goal of [greater than or equal to] 80%
coverage for the 4:3:1:3:3 vaccine series," state the authors of a report
published in the July 29, 2005, issue of Morbidity and Mortality Weekly
Report. The report summarizes results from the 2004 National Immunization
Survey (NIS), which provides vaccination coverage estimates for children
ages 19-35 months for each of the 50 states and 28 selected urban areas.

The 2004 NIS used a quarterly, random-digit-dialing sample of telephone
numbers for each of 78 survey areas to obtain health professional
vaccination records for 21,998 children. The overall survey response rate
for eligible households was 67.4%.

The authors found that

* National coverage estimates increased from 2003 to 2004 for two of the
more recently implemented vaccines (varicella vaccine and pneumococcal
conjugate vaccine), and for the combined vaccine series; coverage
estimates for all other vaccines were not substantially different from
2003 to 2004.

* As in previous years, estimated vaccination coverage levels varied
substantially among states; coverage with the 4:3:1:3:3 series ranged from
89.1% in Massachusetts to 68.4% in Nevada.

* Coverage also varied substantially among the urban areas; coverage with
the 4:3:1:3:3 series ranged from 89.7% in Davidson County, Tennessee, to
64.8% in El Paso County, Texas.

In 2005, varicella vaccination will have been recommended for universal
administration for 5 years among the survey cohort. As such, the 2005 NIS
will use the series measure 4:3:1:3:3:1 (76% in 2004) to evaluate progress
toward the Healthy People 2010 goal.

Darling N, Santibanez T, Santoli J, et al. 2005. National, state, and
urban area vaccination coverage among children aged 19-35 months -- United
States, 2004. Morbidity and Mortality Weekly Report 54(29):717-721.
Available at

Readers: A related report also published in the July 29, 2005, Morbidity
and Mortality Weekly Report, titled Immunization Information System
Progress -- United States, 2003, is available at More information
about immunizations is available from the MCH Library's annotated
bibliography at ... iz&-search.



"The present analysis suggests that a number of factors deter low-income
children from receiving needed dental care," state the authors of an
article published in the August 2005 issue of the American Journal of
Public Health. One of the Healthy People 2010 objectives is to increase
the number of children from families with low incomes who receive at least
some amount of preventive dental health care during a given year. The
article describes a study focused on how the demographic, socioeconomic,
and health characteristics of children and their families may affect
receipt of dental health care among low-income children.

The analysis focused on two dimensions of dental health care measured in
the 2002 National Survey of Families: unmet dental needs and number of
preventive dental care visits. To assess the relationships between
socioeconomic, demographic, and health factors and whether children
visited a dentist for preventive care and had unmet dental needs, the
following factors were examined: the child's age, race/ethnicity,
citizenship status, area of residence, and health insurance status;
whether the child had a functional limitation or was in poor or fair
health; whether the child was a member of a family with no parents, 1
parent, or 2 parents; the parents' mental health status, level of
education, and employment status; whether the parent was interviewed in
English or Spanish; the number of children in the family, family income,
and whether the family was experiencing economic hardship.

The authors found that

* More than half (55.6%) of uninsured children from families with low
incomes did not have a dental check-up, and 13% had unmet dental needs.

* Children from families with low incomes who had private insurance
without dental benefits were just as likely as uninsured children to have
unmet dental needs.

* Children with public coverage were significantly more likely than
privately insured children without dental benefits to receive preventive
dental care and to have no unmet dental needs.

* Children whose parents had poor mental health scores were less likely to
have received preventive dental care and more likely to have unmet dental

* Children from families with low incomes who faced economic hardship were
more likely to have unmet dental needs and less likely to have had a
preventive dental care visit.

"Improving the dental health of these low-income children is likely to
depend on increasing their access to insurance that includes dental
benefits." conclude the authors, adding that, "although identifying
factors that prevent children from receiving dental care appears critical
to achieving the objectives of Healthy People 2010, of equal importance is
reducing factors that limit the supply of dental services to low-income

Kenney GM, McFeeters JR, Yee JY. 2005. Preventive dental care and unmet
dental needs among low-income children. American Journal of Public Health
95(8):1360-1366. Abstract available at

Readers: Going Without: America's Uninsured Children details the number of
uninsured children in the United States and by state and provides national
estimates of the number of children who may be eligible for Medicaid and
the State Children's Health Insurance Program; highlights national changes
in insurance coverage among children during recent years; and looks at the
consequences of being without health insurance. The report was released by
the Robert Wood Johnson Foundation to launch the annual Covering Kids &
Families Back-to-School Campaign, a national effort to enroll eligible
children in public coverage programs during the back-to-school season. It
is available at ... tfinal.pdf. Information
on Covering Kids & Families and the Back-to-School Campaign is available

More information about children's oral health is available from the Bright
Futures in Practice: Oral Health -- Pocket Guide at and from the MCH
Library and National Maternal and Child Oral Health Resource Center's
knowledge path at ... ealth.html.



"Our study provides strong evidence that infants born at night have a
12-16% increase in mortality," state the authors of an article published
in the August 2005 issue of Obstetrics & Gynecology. The authors note that
several studies of European births during the 1990s reported increased
mortality for infants born at night, yet no reports have been published
about neonatal mortality by hour of birth in the United States. The
article describes a study to determine whether the time of birth
influenced the risk of neonatal death for infants born in California.

Data for the analyses were obtained from linked birth-infant death cohort
files. The study sample included 3,363,157 infants born (without lethal
congenital anomalies) in California between 1992 and 1997. Births were
subdivided into three 6-hour periods; day (7 a.m. to 7 p.m.), early night
(7 p.m. to 1 a.m.) and late night (1 a.m. to 7 a.m.). Analyses were
compared for multiple vs. singleton births, very-low birthweight (VLBW)
vs. non-VLBW births, and cesarean vs. vaginal deliveries. The researchers
also considered the level of neonatal care provided by the birth hospital.

The authors found that

* After adjusting for the adequacy of prenatal care, complications of
pregnancy, gender, and birthweight, mortality for infants born during
early night and those born during late night increased by 12% and 16%,
respectively, compared with mortality for infants born during the day.

* There was an increase in mortality for both VLBW infants and non-VLBW
infants born during early and late night.

* Mortality was significantly elevated for singletons born during early
and late night. For multiples, mortality was elevated only for infants
born during early night.

* During early night there was a significant increase in the mortality of
infants delivered vaginally but not in the mortality of infants delivered
by cesarean. During late night, the situation was reversed: there was a
marked increase in the mortality of infants delivered by cesarean but only
a weak increase among infants delivered vaginally.

* After adjusting for differences in risk across time, there was no
significant elevation in mortality for infants born in primary care
hospitals. In hospitals with intermediate intensive care, infants born
during early or late night had elevated mortality. In hospitals providing
community and regional intensive care, mortality was elevated only for
infants born during late night.

"We believe that the birth mortality disadvantage and its specific
expression as elevated intrapartum, early neonatal, and/or neonatal
mortality will be dependent upon both health care system and specific
hospital factors," state the authors. They conclude that "assessing the
extent to which infants born at night contribute to the national neonatal
mortality rate and addressing this temporal disparity are high priorities
for perinatal medicine."

Gould JB, Qin C, Chavez G. 2005. Time of birth and the risk of neonatal
death. Obstetrics & Gynecology 106(2):352-358. Abstract available at ... /106/2/352.

Readers: More information about infant mortality and infant mortality
prevention is available from the MCH Library's knowledge path at ... fmort.html, annotated
bibliography at ... ty&-search,
and organizations resource list ... rt&-search.


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