Maternal Child Health Newsletter 5/28/04

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Maternal Child Health Newsletter 5/28/04

Postby laura » Fri May 28, 2004 08:48 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

May 28, 2004

1. Workshop Report Summarizes Economics Research on Obesity Among
Children, Adolescents, and Adults
2. Authors Assess Hospitals' Race, Ethnicity, and Primary Language
Data-Collection Practices
3. Article Examines the Relationship Between Risk Factors and Dental Care
Use During Pregnancy
4. Literature Review Highlights the Complexity of Suicide Risk Assessment
and the Paucity of Research on the Topic
5. Analysis Determines Effects of Changes in Hepatitis B Recommendations
on Childhood Vaccination Coverage


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The Economics of Obesity: A Report on the Workshop Held at USDA's Economic
Research Service presents a summary of the papers and the discussions
presented at the April 2003 workshop jointly hosted by the U.S. Department
of Agriculture's Economic Research Service and the University of Chicago's
Irving B. Harris Graduate School of Public Policy Studies and the George
J. Stigler Center for the Study of the Economy and the State. The purpose
of the workshop was to provide an overview of leading health economics
research on the causes and consequences of rising obesity among children,
adolescents, and adults in the United States. Topics included the role of
technological change in explaining both long- and short-term obesity
trends, the role of maternal employment in child obesity, the impact of
obesity on wages and health insurance, behavioral economics as applied to
obesity, and the challenges in measuring energy intakes and physical
activity. The workshop also discussed policy implications and future
directions for obesity research. The report is available at



Who, When, and How: The Current State of Race, Ethnicity, and Primary
Language Data Collection in Hospitals identifies current practices and
lays the groundwork for creating a framework for the systematic and
comparable collection of data on race, ethnicity, and primary language in
health care organizations. Working with a consortium of six leading
hospitals and health systems to address racial and ethnic disparities in
treatment and outcomes, the Health Research and Educational Trust (HRET)
conducted site visits to each consortium member site and asked questions
about their data-collection practices. Site visits were coupled with a
seven-page survey which was sent to 1,000 hospitals nationwide. In
addition, the most recent (2003) American Hospital Association Annual
Survey included two questions asking hospitals whether they gather
information on patient race/ethnicity and primary language. The report
presents the hospital survey findings, including what is collected, how it
is collected and why, which racial/ethnic categories are used, and
barriers and concerns. Site visit findings, recommendations, and next
steps are also included. The report is available at ... ow_726.pdf.



"There is a need for enhanced education and training of physicians,
midwives, and other practitioners concerning oral health in pregnancy,"
state the authors of an article published in the May 2004 issue of the
American Journal of Public Health. The authors point out that although
there have been recent increases in research on maternal oral health
during and after pregnancy, little is known about amenable factors that
could be addressed during the prenatal period by maternity care
clinicians, oral health professionals, public health policymakers, and
women themselves. The present study was undertaken to examine the
association between selected sociodemographic, pregnancy, and health
service factors amenable to intervention and the likelihood of dental care
use during pregnancy.

Data for the study were derived from the Washington State Department of
Health Pregnancy Risk Assessment Monitoring System. The authors assessed
women according to absence or presence of self-reported dental problems.
The primary risk factors of interest were household monthly income,
participation or nonparticipation in WIC, type of prenatal care insurance
coverage, trimester in which prenatal care was initiated, prenatal care
site, counseling on oral health care, body mass index (BMI), smoking
status before pregnancy, smoking status during the final 3 months of
pregnancy, and history of ever having smoked.

The authors found that

* Overall, 58% of the women reported receiving no dental care during their
* Fifteen percent of the women reported that they had no dental problems
but received dental care, 38% reported that they had no dental problems
and did not receive care, 26% reported that they had dental problems and
received care, and 21% reported that they had dental problems but did not
receive care.
* Women without dental problems but who received care were more likely
than women in the other groups to be older, married, white, and
primiparous; to be at higher educational and income levels; to have
private insurance coverage; and to have received care from a private
physician or a health maintenance organization. They were less likely to
be obese or to smoke.
* Among women reporting no dental problems, those who did not receive
dental care were at markedly increased risk, relative to those who did
receive care, of receiving no oral health care counseling during their
* Among women without dental problems, risk of not receiving dental care
was significantly associated with BMI.
* Among women without dental problems, measures of smoking appeared
strongly associated with risk of not receiving dental care.

The authors conclude that "since women who do not receive dental care
during their pregnancy are more likely to be obese or to smoke, lack of
dental care may be a marker for poor health."

Lydon-Rochelle M, Krakowiak P, Hujoel P, et al. 2004. Dental care use and
self-reported dental problems in relation to pregnancy. American Journal
of Public Health 94(5):765-771.

Readers: More information is available from the National Maternal and
Child Oral Health Resource Center's fact sheet, Oral Health and Health in
Women: A Two-Way Relationship, available at



"Despite the public health import of suicide and the Surgeon General's
call to action, evidence to guide the primary care clinician's assessment
and management of suicide risk is extremely limited," state the authors of
an article published in the May 18, 2004, issue of the Annals of Internal
Medicine. The Surgeon General's Call to Action to Prevent Suicide
underscores the public health significance of suicide. Although relevant
demographic and clinical risk factors have been identified, the clinical
management of suicide risk is complicated. The article presents the
results of a literature review with the goal of defining the clinician's
role in screening for suicide risk in primary care settings.

The authors identified relevant articles by searching the MEDLINE database
for the period 1966 to October 17, 2002. The authors also searched
PsycINFO and the Cochrane Collaboration Library, conducted hand searches
of bibliographies, and consulted experts. To meet the criteria for
inclusion, screening studies had to have been performed in a primary care
setting, but treatment studies could have been performed in either primary
or specialty care settings.

The authors found that

* No studies addressed the overarching question of whether screening for
suicide risk in primary care settings improves outcome.
* Very little is known about the use of screening instruments for suicide
risk in primary care populations.
* The poor generalizability of the studies identified makes the overall
strength of evidence for whether interventions for those at risk reduce
suicide attempts or completions fair, at best.
* Several studies showed improvement for interventions addressing
intermediate outcomes (suicidal ideation, decreased depressive severity,
decreased hopelessness, improved level of function), primarily for persons
at high risk for deliberate self-harm.

"Our review highlights several important issues involving research on
assessing and managing suicide risk," conclude the authors. They add that
"evidence for or against the value of screening for suicide risk in
primary care settings must be considered within a complex practice and
epidemiologic context."

Gaynes BN, West SL, Ford CA, et al. 2004. Screening for suicide risk in
adults: A summary of the evidence for the U.S. Preventive Services Task
Force. Annals of Internal Medicine 140(10):822-837.

Readers: The U.S. Preventive Services Task Force statement summarizing the
current recommendations on screening for suicide risk and the supporting
scientific evidence is also available in the May 18, 2004, issue of the
Annals of Internal Medicine.



"Although thimerosal-related changes in hepatitis B recommendations were
implemented quickly, unintended consequences did result," state the
authors of an article published in the May 19, 2004, issue of JAMA, The
Journal of the American Medical Association. In July 1999 the American
Academy of Pediatrics and the U.S. Public Health Service responded to
concerns about potential health problems associated with the vaccine
preservative thimerosal, as well as to loss of public confidence in
vaccination policies, by advising clinicians to temporarily postpone the
first dose of the hepatitis B vaccine, which had previously been
administered at birth, until age 2-6 months for infants born to
HBsAg-negative mothers. Recommendations to resume previous birth-dose
practices were issued in September 1999. The article compares vaccination
coverage of children born before, during, and after the suspension period
and evaluates the impact of recommendation changes.

The study sample included 41,589 children who took part in the 2001 and
2002 National Immunization Survey and who were born between July 1, 1998,
and December 31, 2000. Five birth cohorts were defined relative to the
period in which the hepatitis B birth-dose recommendation was suspended.
Children born in months 7 to 12 before the suspension period were
considered as a baseline for comparison. The authors first assessed the
associations between birth cohort, age at receipt of the first dose of the
hepatitis B vaccine, and receipt of vaccinations by age 19 months. The
final analysis evaluated the effect of birth cohort, along with
sociodemographic factors, on receipt of the birth dose and on
undervaccination for hepatitis B at age 19 months.

In the final analysis, the authors found that

* Children born during the suspension period, or in the 12 months
afterwards, were less likely to receive the birth dose than children born
before the suspension period. Other significant factors associated with
not receiving the birth dose included having a mother who was more than 30
years old, having only one vaccination provider, having a private
provider, living in a suburban area, or living in a household with no
other children.
* Children born during the suspension period, or in the 6 months
afterwards, were also significantly less likely to receive three doses of
hepatitis B vaccine by age 19 months than children born before the
suspension period. However, the other factors associated with
undervaccination at age 19 months differed from those associated with not
receiving the birth dose and included having a mother who was age 20-29 or
unmarried, having two or more vaccination providers, living in an urban
area, or living with more than one child.
* Coverage by age 19 months for the recommended doses of DTaP, MMR, and
Hib vaccines and the 4:3:1:3 series did not vary significantly by birth

The authors suggest that "careful assessment of the communication
strategies used during and after the suspension of the birth dose of
hepatitis B vaccine may provide insights for developing general strategies
for disseminating rapid changes in vaccine recommendations."

Lunan ET, Fiore AE, Strine TW, et al. 2004. Impact of thimerosal-related
changes in Hepatitis B vaccine birth-dose recommendations on childhood
vaccination coverage. JAMA, The Journal of the American Medical
Association 291(19):2351-2358.

Readers: On May 17, 2004, the Institute of Medicine released Immunization
Safety Review: Vaccines and Autism, the eighth and final report of the
Immunization Safety Review Committee. The report examines the hypothesis
that vaccines, specifically the MMR vaccine and vaccines containing
thimerosal, are causally associated with autism. The report is available


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