Maternal & Child Health Newsletter 5/6/05

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Maternal & Child Health Newsletter 5/6/05

Postby denise » Mon May 09, 2005 11:40 am

MCH Alert
Tomorrow's Policy Today

Maternal and Child Health Library

This and past issues of the MCH Alert are available at

May 6, 2005

1. Report Reviews State Planning and Strategies to Cover Uninsured
2. Updated Briefs Provide Tools to Help Families Communicate About Sexuality
3. Brief Documents National Security Roots of Medicaid Child Health Policy
4. Study Examines the Relationship Between Virginity Pledges and
Adolescent Sexual Behavior
5. Article Assesses Organizational Systems That Support Publicly Funded
Tobacco Treatment Services


Readers: MCH Library Services is pleased to announce New Arrivals, the
latest enhancement to its Web site. New Arrivals highlights recently added
materials (that have not been summarized in the MCH Alert) on a variety of
topics of interest to the maternal and child health community. The list
will change on a regular basis, so check it often at



HRSA State Planning Grant Update: A Review of Coverage Strategies and
Pilot Planning presents a synthesis of state experiences in examining
options and crafting policies to cover their uninsured residents. The
report, produced by the Economic and Social Research Institute with
support from the Commonwealth Fund, contains summaries of grantee activity
as reported to the Health Resources and Services Administration's State
Planning Grant program. In the last 4 years, the program has awarded
grants to 46 states, four U.S. territories, and the District of Columbia
to analyze their uninsured residents and health care marketplaces and to
develop solutions to ensure health coverage for all residents. Each
grantee activity summary contained in the report includes information on
data collection and analysis, consensus building and policy development,
findings, policy options, next steps, and contact information. The report
also includes a summary of pilot planning projects awarded to a subset of
states and territories for the grant period September 2005 through August
2005. The report is intended for use by health policy stakeholders at all
levels to enhance their understanding of uninsurance and possible
solutions. The report is available at or

Readers: More information is available from the Cover the Uninsured Week
(May 1-8, 2005) Web site at and from
the MCH Library's knowledge path, Child and Adolescent Health Insurance
and Access to Care, available at



As part of its From Research to Practice series, Advocates for Youth has
published two updated briefs on translating research into science-based
practices to prevent adolescent pregnancy and HIV and other sexually
transmitted infections. Resources for Families on Parent-Child
Communication provides a selected list of resources and materials to help
parents talk with their children and adolescents about sexuality.
Resources are arranged according to the following topics: (1) Web sites
for parents, (2) Web sites for children and adolescents, (3) books and
videotapes, and (4) organizations. The brief is available at Are You
an Askable Parent? discusses what it means to be a parent that children
and adolescents feel comfortable about coming to with questions and also
provides tips for parents on talking with children and adolescents about
sexuality. The brief is available at



National Security and U.S. Child Health Policy: The Origins and Continuing
Role of Medicaid and EPSDT examines Medicaid's role in financing health
care for members of the U.S. military and their families. The policy brief
was published by the Department of Health Policy at George Washington
University, with support from The Robert Wood Johnson Foundation's program
to study Changes in Health Care Financing and Organization. The brief
begins with an overview of Medicaid and child health, examining Medicaid's
early eligibility structure as well as the advent of Medicaid's special
benefit for children, which is known as early and periodic screening,
diagnosis and treatment (EPSDT). The brief then describes findings from a
seminal 1964 study that influenced Medicaid's child health policy, One
Third of a Nation: A Report of Young Men Found Unqualified for Military
Service. The brief concludes with a discussion of the continued relevance
of this history to Medicaid reforms.
It is available at



"An informal promise or commitment to oneself to wait to have sexual
intercourse until one is older appears to reduce the likelihood that
adolescents will initiate oral sex and sexual intercourse over a 1-year
period," state the authors of an article published in the May 2005 issue
of the Journal of Adolescent Health. While findings from the National
Longitudinal Study of Adolescent Health (Add Health) indicate that
elements of abstinence-only education, specifically the virginity pledge,
may delay the initiation of sexual intercourse among some adolescents, few
studies have explored this relationship further, and none have examined
whether the effect of the pledge extends to other sexual behaviors. The
study described in this article builds upon previous research by assessing
formal vs. private non-formal virginity pledges and by examining their
association with the initiation of genital play, oral sex, and vaginal
intercourse in early and middle adolescence.

Data were drawn from the first three waves of Add Health, a 3-year,
five-wave longitudinal study. Data were collected at 6-month intervals
using a combination of in-home computer-assisted self-administered
interviews and mail surveys. A single item was used to identify
adolescents who had taken a formal virginity pledge: "Have you ever taken
a public pledge (written or spoken) to wait to have sexual intercourse
until you are married?" Adolescents were asked to respond to two items to
assess their personal commitment to remaining a virgin by making a private
non-formal pledge: (1) "Have you made a promise to yourself to wait to
have sexual intercourse until you are married?" and (2) "Have you made a
promise to yourself to wait to have sexual intercourse until you are
older?" A total of 870 California adolescents ages 12-16 completed all of
the study interviews and surveys.

The authors found that

* Seventy percent of the adolescents had made a private non-formal pledge
to delay intercourse until they were older, and 46% had made such a pledge
to delay intercourse until they were married.

* The effects of a private non-formal pledge to delay intercourse until
adolescents were older did not extend to genital play.

* Adolescents who had made a private non-formal pledge to delay
intercourse until they were older were significantly less likely to have
initiated oral sex than those who had not made such a pledge.

* Having made a private non-formal pledge to delay intercourse until they
were older significantly reduced the likelihood that an adolescent would
initiate vaginal intercourse over a 1-year period, even after controlling
for important demographic and psychosocial variables.

* Making a private non-formal pledge to delay intercourse until they were
married, making a formal virginity pledge, and having friends who had
taken a virginity pledge were not significantly associated with adolescent
vaginal intercourse.

The authors conclude that "future longitudinal research on the effects of
virginity pledges will enable researchers to investigate the potential
causal role of pledging in the development of adolescent behavior . . .
[and] will also allow an examination of the relationship between
psychosocial factors, pledging, and the progression of adolescent sexual

Bersamin M, Walker S, Waiters E, et al. Promising to wait: Virginity
pledges and adolescent sexual behavior. Journal of Adolescent Health
38(5):428-436. Abstract available at!&_cdi=5072&view=c&_acct=C000035538&_version=1&_urlVersion=0&_userid=655954&md5=6934c68878fc18375e9894082664f8e6.



"While progress has been made in the development of systems to support
tobacco treatment services, many challenges remain to translate the
evidence about system support into routine clinical practice," state the
authors of an article published in the May 2005 issue of the American
Journal of Preventive Medicine. Professional societies and government
organizations have promoted guidelines and best practices that encourage
clinicians to routinely integrate smoking cessation counseling into client
encounters. However, for preventive services and chronic disease
management, there is growing evidence that institutionalization of office
systems is key. These systems include implementing procedures for
identifying and documenting tobacco users, prompting providers to
intervene, providing resources and feedback to providers to support
intervention, providing dedicated staff and performance evaluation, and
ensuring benefit coverage and reimbursement. This article reports on a
structured assessment of the prevalence and patterns of organized
procedures and systems to support tobacco treatment services adopted by
health organizations that are funded by a state public health initiative.
Specifically, the article (1) describes the extent of organizations'
adoption of office system elements for smoking cessation reflective of
national consensus guidelines, (2) describes the variability in the
implementation methods of selected systems elements, (3) explores the
extent and nature of variability of systems strategies among types of
service delivery sites, and (4) explores how the systems in place for
tobacco compare (in thoroughness and strategy) with systems that
organizations have in place for their self-selected "model" clinical
preventive screening service. Model preventive services chosen by the
sites included cancer screening, substance abuse screening,
depression/mental health screening, diabetes screening, and others.

Data were collected via face-to-face interviews from November 2001 to
October 2002 with representatives from 83 state-funded agencies including
hospitals, community centers, and other organizations such as substance
abuse, mental health, WIC, and multiservice clinics.

The authors found that

* A majority of the respondents answered affirmatively about whether their
organization has in place supportive systems for tobacco treatment such as
a clinical intake or medical history form, written policies or protocols,
routine distribution of self-help materials, and pharmacotherapy
recommendations or prescriptions, among others.

* Some system elements were reported by less than half of the respondents,
notably those for tracking a smoker's progress and the feedback loop
mechanism from the tobacco treatment specialist to the referring provider.

* There were significant differences by referral site type in reported
systems in place.

* There was no correlation between a site's model preventive service's
score (which was based on the systems elements in place for that service)
and their tobacco systems score.

The authors conclude that "quality improvement efforts can explore
alternative, feasible, and reliable strategies to enhance and ensure
tobacco treatment."

Zapka JG, White MJ, Reed G, et al. 2005. Organizational systems to support
publicly funded tobacco treatment services. American Journal of Preventive
Medicine 28(4):338-345. Abstract available at!&_cdi=6075&view=c&_acct=C000035538&_version=1&_urlVersion=0&_userid=655954&md5=19b77982f3a4cc3d40086f50ca6bc6fb.


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and Child Health Library at the National Center for Education in Maternal
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MANAGING EDITOR: Jolene Bertness
CO-EDITOR: Tracy Lopez

MCH Alert
Maternal and Child Health Library
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