Nat'l Ctr for Education in Maternal & Child Dec 03

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Nat'l Ctr for Education in Maternal & Child Dec 03

Postby annegarrett » Fri Dec 12, 2003 10:16 am

MCH Alert
Tomorrow's Policy Today

National Center for Education in Maternal and Child Health Search past issues of the MCH Alert, and other MCH Library resources, at

December 12, 2003

1. Diabetes in Children and Adolescents Knowledge Path Released 2. New Book Presents Information and Tools for Treating and Preventing Obesity in Children and Adolescents 3. Issue Brief Highlights Findings from Study of Children Who Enroll in SCHIP 4. Paper Examines Self-Care Among U.S. Children 5. Study Investigates Childhood and Adolescent Predictors of Major Depression



The Diabetes in Children and Adolescents knowledge path is an electronic guide on current, high-quality resources about preventing and controlling diabetes in children and adolescents and lowering the risk of complications. Produced by the MCH Library, the knowledge path also identifies tools for staying abreast of new developments in diabetes care and conducting further research. The knowledge path is intended for use by health professionals, program administrators, educators, researchers, and parents who are interested in tracking timely information on this topic. It is available at ... betes.html.

MCH Library knowledge paths on other maternal and child health topics are available at The MCH Library welcomes feedback on the usefulness and value of these knowledge paths. A feedback form is available at



Childhood and Adolescent Overweight: The Health Professional's Guide to Identification, Treatment, and Prevention provides background, information, and tools for health professionals to confront and address the serious issues relating to childhood overweight. The book, a November 2003 publication of the American Dietetic Association (ADA), includes (1) an overview of the obesity epidemic and the health risks associated with being overweight; (2) recent recommendations regarding screening, assessment, and treatment for children and adolescents who are overweight; and (3) an update on the most current overweight-prevention strategies and resources available. Chapter topics include trends, etiology, health consequences, assessment, management, and tools and resources. Dietary Reference Intakes/Recommended Allowances; Healthy People 2010 Nutrition and Physical Activities for Children and Adolescents; and additional resources for health professionals, families, schools, and communities are also included. The book is intended to help health professionals in a variety of counseling and intervention settings to successfully prevent obesity and treat children and adolescents who are overweight. Available for online purchase at ... _17782.cfm.

Mullen MC, Shield J. 2003. Childhood and adolescent overweight: The health professional's guide to identification, treatment, and prevention. Chicago, IL: American Dietetic Association. ISBN 0-88091-335-5. $45.00 ADA members, $58.50 nonmembers.

The ADA also offers a revised version of the book titled, If Your Child Is Overweight: A Guide for Parents, which provides nutritional information for helping children ages 4-12 with obesity. The book provides how-to instructions to help guide children to change the way they eat; family-centered tips for making healthy nutritional changes; reachable goals for children to achieve in a positive and healthful manner; nutritional information parents need to know, including portion sizes and sample menus; the food guide pyramid adapted for kids; physical activity tips; calculating children’s BMI; charts for hunger and weekly goals; and options for eating out, school lunches and dealing with special occasions. Available for online purchase at ... 4_8443.cfm.

Kosharek S. 2003. If your child is overweight: A guide for parents. Chicago, IL: American Dietetic Association. ISBN 0-88091-303-7. $10.00 ADA members, $15.00 nonmembers.

Contact: American Dietetic Association, 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606-6995. Phone: (800) 877-1600, ext. 5000, (312) 895-0040, ext. 5000; E-mail:; Web site:

Readers: More information about obesity and children and adolescents is available on the Bright Futures Web site at and ... about.html. Information can also be found in the following MCH Library knowledge paths: (1) Child and Adolescent Nutrition, available at ... dnutr.html and (2) Physical Activity and Children and Adolescents, available at ... ivity.html.



"These CHIRI [Child Health Insurance Research Initiative] findings reveal that new SCHIP [State Health Insurance Program] enrollees resemble other low-income uninsured children in many respects, but they also depart from some expectations about who should enroll in SCHIP," state the authors of Who's Enrolled in SCHIP? The issue brief summarizes findings from a study of five states with separate SCHIPs to determine whether there were differences among children in different racial/ethnic groups and among children with different health care needs. The brief was published by CHIRI, a partnership of the Agency for Healthcare Research and Quality, The David and Lucile Packard Foundation, and the Health Resources and Services Administration. Findings highlighted in the brief were drawn from a group of articles published in the December 2003 supplement to Pediatrics.

CHIRI researchers asked families of children newly enrolled in SCHIP in Alabama, Florida, Indiana, Kansas, and New York about demographic characteristics and health care experiences before enrollment. The five states represented 30% of SCHIP enrollment in 2001. Findings were produced for each state and then compared across states.

The researchers found that

* The majority of the children (80-87%) enrolled in SCHIP in the five study states lived in a household with a working adult, and most (63-74%) were from families with adults who worked full time.
* Between 65% and 79% of the children lived in families with incomes equal to or below 150% of the federal poverty line ($27,600 for a family of four in 2003).
* Between one-fourth and nearly three-fourths of the children were uninsured during the entire year before they enrolled in SCHIP.
* Between one-fourth and nearly one-half of the children had unmet health care needs at the time of enrollment. Unmet needs were most frequently noted for mental health, specialty, dental, and vision care, and for prescription medications.
* In most states, a significant proportion of the children were black or Hispanic.
* Between 17% and 25% of the children had special health care needs (vs. 12-15% in the general population for the study states).

"These CHIRI findings indicate that SCHIP is indeed insuring the population intended by Congress. It is important to note, however, that more children with special health care needs and children from lower income families enrolled in SCHIP than some policymakers might have predicted when SCHIP was enacted," state the authors. The issue brief concludes with strategies that states can use to improve children's access to care and to better inform SCHIP design, monitoring and evaluation.

VanLandeghem K, Brach C. 2003. Who's enrolled in SCHIP? CHIRI Issue Brief No. 3. Rockville, MD: Agency for Healthcare Research and Quality. Available at



"The sizeable number of school-age children spending time unsupervised warrants increased public attention to the issue of self-care," state the authors of Unsupervised Time: Family and Child Factors Associated with Self-Care, a November 2003 publication of the Urban Institute. The paper provides a snapshot of the prevalence and extent of self-care (defined as regularly spending time alone or with a sibling younger than 13) in the United States; presents a set of family and child characteristics that are likely to be associated with self-care; and, using data from the 1999 National Survey of America's Families (NSAF), reports on how the prevalence of self-care varies for children with different characteristics.

The NSAF asked the parents of children ages 6-12 about a range of topics, including their children's nonparental care arrangements in the past month. Arrangements included self-care, before- and after-school programs, family child care (care by a nonrelative provider in the provider's home), relative care (care by a relative in the child's or the relative's home), and nanny/babysitter care (care by a nonrelative in the child's home). Parents also answered questions about the hours per week that their children spent in self-care and in these types of nonparental care arrangements. Researchers examined associations between the use of self-care and family and child characteristics (parents' available time, family resources, child demographic characteristics, child health and behavior, and family risk).

The authors found that

* Older children and children whose parents are employed full-time are more likely than other children to use self-care.
* Self-care is more prevalent among children from families with higher incomes.
* Among children ages 6-9, full-time parental employment, parental symptoms of poor mental health, and the presence of adolescents in the household are related to an increased likelihood of using self-care; the presence of a limiting physical, mental, or health condition is related to a decreased likelihood of using self-care.
* Among children from families with low incomes, parental symptoms of poor mental health, full-time parental employment, and child age are positively related to using self-care; Hispanic ethnicity and the presence of other children under age 13 are related to a decreased likelihood of using self-care.
* The full range of family and child characteristics analyzed in this study account for only 17% of the variations in the amount of time children spend in self-care.

"It is unlikely that any single policy or programmatic solution can comprehensively address the issue of self-care," conclude the authors. Policy objectives may involve (1) minimizing the gaps between the hours that children spend in out-of-school programs and activities and the hours that parents and other adults are available to care for their school-age children and (2) continuing to develop formal before- and after-school programs for children.

Vandivere S, Tout K, Zaslow M, et al. 2003. Unsupervised time: Family and child factors associated with self-care. Washington, DC: Urban Institute. Available at ... MenuID=141.



"In the current study, multiple childhood and adolescent predictors clearly identified participants who experienced depression in the transition period [to adulthood]," write the authors of an article published in the December 2003 issue of the American Journal of Psychiatry. The authors point out that the period from late adolescence to the mid-20s, known as the transition to adulthood, is marked by high rates of major depression, and that individuals experiencing depression during this period often suffer from significant levels of postdepression dysfunction and face substantial risk for recurrent depressive episodes in adulthood. The study described in this article investigated the family and behavioral-emotional factors in childhood and adolescence that predict depression from ages 18 through 26.

Study participants included 170 males and 184 females, of whom 98% were white and most were working or lower-middle class at age 26. Data were used from a community-based study that traced the life course of these individuals from childhood to adulthood. Data were collected from multiple informants, including mothers and participants, at seven points between age 5 and age 26.

The authors found that

* Among the participants, 23.2% met the diagnostic criteria for major depression in the transition to adulthood, while 76.8% did not.
* Bivariate analysis showed that having a depressed parent or sibling, having a sibling with a substance use disorder by age 15, having a sibling who attempted suicide, being born into a large family and/or to older parents, and self-reports of family violence and low family cohesion were all significant risk factors for experiencing major depression in the transition period.
* Bivariate analysis also showed that participant- and mother-rated internalizing problems at age 15, self-reports of anxious-depressed behavior at ages 9 and 15, and self-reports of depressive symptoms in mid-adolescence were significant risk factors.
* Multivariate analysis showed that family violence, family composition, self- and mother-rated internalizing problems at age 15, and lower family cohesion were significant risk factors.

The authors conclude that "our findings suggest clear markers [for major depression during the transition to adulthood] apparent in childhood and adolescence, presenting opportunity to those working with and treating this population."

Reinherz HZ, Paradis AD, Giaconia RM, et al. 2003. Childhood and adolescent predictors of major depression in the transition to adulthood. American Journal of Psychiatry 160(12):2141-2147.

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MCH Alert © 2003 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert is produced by MCH Library Services at the National Center for Education in Maternal and Child Health under its cooperative agreement (6U02 MC 00001) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.

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EDITORS: Jolene Bertness, Tracy Lopez

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Anne Garrett
Executive Director
Preeclampsia Foundation

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