Maternal Child Health Newsletter 9/10/04

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Maternal Child Health Newsletter 9/10/04

Postby laura » Fri Sep 10, 2004 05:48 pm

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

September 10, 2004

1. MCH Library Releases New Resources on Bullying and Maternal Morbidity
and Mortality
2. New Report Maps Women's Health in the United States
3. Authors Investigate Association Between Mental and Physical Distress
and High-Risk Behaviors Among Women of Reproductive Age
4. Article Assesses Impact of Home Visiting Program in Preventing Rapid
Repeat Births



The Maternal and Child Health (MCH) Library is pleased to announce two new
resources on key MCH topics: an annotated bibliography on bullying and an
organizations resource list on maternal morbidity and mortality. Annotated
bibliography entries include print, audiovisual, and electronic resources
drawn from MCHLine. Organizations resource list entries include topical
contact information and activities drawn from the MCH Organizations
database. Because the lists are automatically generated from databases
each time they are requested, they are always current. The annotated
bibliography is available at ... ng&-search.
The organizations resource list is available at ... rt&-search.



The Women's Health and Mortality Chartbook is a statistical resource on
women's health in each of the states, the District of Columbia, and Puerto
Rico. The chartbook, produced by the U.S. Department of Health and Human
Services' Office on Women's Health, was developed to provide a collection
of current state data on critical issues relevant to women. A total of 27
featured health indicators highlight some key women's-health-related
issues that are measured regularly at the state level. The chartbook
contains U.S. maps for each featured health indicator; women's health
profiles for each of the 52 geographic areas presented; and information on
data sources, terminology, and analytic issues. It is intended for use by
policymakers and program managers at the federal and state levels to
identify key health issues in each state, and it may also stimulate
readers to ask new questions. The chartbook is available at Data files may be
downloaded from the National Center for Health Statistics' Web site at The complete data collection is
also available on CD-ROM.



"Our findings show that women of reproductive age experience substantial
amounts of physical and mental distress," state the authors of an article
published in the September 2004 issue of Obstetrics and Gynecology. The
purpose of the study described in this article was to examine the
prevalence of mental and physical health distress indicators and the
association between these indicators and cigarette and alcohol consumption
among reproductive-age women.

Data for the analysis were drawn from the Behavioral Risk Factor
Surveillance System for 1998, 2000, and 2001. The study sample included
147,532 women for whom information on pregnancy status was available. The
researchers used self-reports of health status and recent physical health,
mental health, and activity limitation due to poor physical or mental
health from the core set of health-related quality-of-life measures
collected by all states. Indicators for recent depression, stress and
anxiety, and lack of rest were assessed from optional modules selected by
certain states. A number of demographic variables were considered,
including the women's age, race, education, and marital status; whether
they had any children; their income; and their health insurance coverage.
Women were considered to have a history of cigarette smoking if they
reported smoking at least 100 cigarettes in their lifetime and to be
current smokers if they reported smoking "every day" or "some days."
Alcohol use was defined as having had at least one drink of an alcoholic
beverage during the previous month. Binge drinking was defined as having
consumed five or more drinks on one occasion during the previous month.

The authors found that

* Overall, 6.7% of the women reported frequent physical distress, 12.3%
reported frequent mental distress, and 7.1% reported frequent activity
limitation due to poor mental or physical health.

* The magnitude of the association between three of the health-related
quality-of-life indicators (fair or poor health, frequent mental distress,
and frequent lack of rest) and smoking was stronger among pregnant women
than among nonpregnant women.

* Rates of alcohol use and binge drinking were lower among pregnant women
than among nonpregnant women.

* Most health-related quality-of-life measures were not found to be
significantly associated with alcohol use among pregnant women.

The authors conclude that "interventions that integrate social and
behavioral health along with physical health would be useful for long-term
behavior change that would benefit not only women but also their

Ahluwalia IB, Mack KA, Mokdad A. 2004. Mental and physical distress and
high-risk behaviors among reproductive-age women. Obstetrics and
Gynecology 104(3):477-483.



"Our findings are valuable for guiding the future development of home
visiting in general and this widely replicated paraprofessional model in
particular," write the authors of an article published in the September
2004 issue of Pediatrics Electronic Pages. The authors state that rapid
repeat birth (RRB) (a birth occurring within 24 months after a previous
birth, or, for an adolescent mother, a repeat birth while still a teen,
regardless of the interval between births) has been identified as a risk
factor for adverse perinatal outcomes. Home visiting has been recommended
as a means to prevent child abuse and neglect and improve pregnancy
outcomes; however, scientific evidence of the impact of home visiting on
RRB is scarce. The study described in this article focuses on Hawaii's
Healthy Start Program (HSP), a widely replicated paraprofessional home
visiting model for families at risk for child abuse and neglect. The
article describes the program's effect on RRB and its malleable
determinants (maternal desire to have RRB, access to a family planning
site, and use of birth control) and assesses the influence of RRB on
mothers and children.

The study was a randomized, controlled trial of Hawaii's HSP, in which
eligible families were randomly assigned to home-visited and control
groups. A total of 643 families at risk for child abuse were enrolled
between November 1994 and December 1995. Data to measure RRB and malleable
determinants were collected through structured maternal interviews and
observation of the home environment. Follow-up data were collected
annually for 3 years.

The authors found that

* There was no program impact on RRB for mothers overall, after adjustment
for the significant baseline differences in demographic variables.

* For mothers overall, RRB was significantly more likely among those who
desired to have a child within 2 years after the index birth.

* Lack of access to a family planning site at baseline was not associated
with RRB, but there was a trend toward a greater likelihood of RRB among
those lacking a site at 1 year.

* Women who had never used birth control before the index birth were more
likely to have RRB, and there was a trend toward a greater likelihood of
RRB among women who did not use birth control in the year following the
index birth.

* When the index children were age 3, families with RRB were more likely
to have adverse maternal and index child outcomes (severe parenting
stress, maternal neglect, poor warmth toward index child, internalizing
behavior in index child, and externalizing behavior in index child).

The authors conclude that "lack of program effects can be traced to the
program's design and implementation system. Additional research is needed
to test the effectiveness of interventions to refine the model, strengthen
staff competence, and improve service quality."

El-Kamary SS, Higman SM, Fuddy L, et al. 2004. Hawaii's Healthy Start Home
Visiting Program: Determinants and impact of rapid repeat birth.
Pediatrics Electronic Pages 114(3):e317-e326.


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MCH Alert © 2004 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.

Permission is given to forward MCH Alert to individual colleagues. For all
other uses, requests for permission to duplicate and use all or part of
the information contained in this publication should be sent to MCH Alert
Editor, National Center for Education in Maternal and Child Health, at

The editors welcome your submissions, suggestions, and questions. Please
contact us at the address below.

EDITORS: Jolene Bertness, Tracy Lopez

National Center for Education in Maternal and Child Health
Georgetown University
Mailing address: Box 571272, Washington, DC 20057-1272
Street address: 2115 Wisconsin Avenue, N.W., Suite 601, Washington, DC
Phone: (202) 784-9770
Fax: (202) 784-9777
Web site:


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