Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html
August 6, 2010
1. Brief Looks at State Options for Covering Pregnant
Women in CHIP
2. Report Presents Findings on Opinion Leaders' Views of
Adolescent Health
3. Conversations Elicit Suggestions for Supporting
Parents as Partners in Decision-Making and in Advisory Roles
4. Article Examines Discrimination, Posttraumatic Stress,
and Risk Behaviors Among Mexican-American Adolescents
5. Study Investigates Dentists' Provision of Care for
Pregnant Women
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1. BRIEF LOOKS AT STATE OPTIONS FOR COVERING PREGNANT WOMEN IN CHIP
Covering Pregnant Women: CHIPRA Offers a New Option describes
provisions in the Children's Health Insurance Program Reauthorization
Act of 2009 (CHIPRA), explains what states must do to comply with the
law, and discusses the options that states have to expand access to
comprehensive health care for women with low incomes through pregnancy,
delivery, and 60 days postpartum. The brief, published as part of the
CHIPRA Implementation Series by Families USA, examines the ways that
states provided coverage to pregnant women before the enactment of
CHIPRA and current options and guidance for providing comprehensive
benefits to pregnant women in CHIP. Information on services covered and
state eligibility levels is included. Links to additional resources for
states are also provided, including a letter from the Center for
Medicaid and State Operations to state health officials on the new
option to cover pregnant women, frequently asked questions, and a
sample state plan amendment for coverage of pregnant women. This and
other briefs in the CHIPRA Implementation Series are available at http://www.familiesusa.org/issues/childrens-health/chipra-implementation-series.html
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2. REPORT PRESENTS FINDINGS ON OPINION LEADERS' VIEWS OF ADOLESCENT
HEALTH
Concern for Our Teens: Opinion Leaders Speak Out on Adolescent Health
discusses adolescent well-being from the perspectives of leaders in
business, higher education, and the military. The report is based on
interviews with opinion leaders conducted by the National Alliance to
Advance Adolescent Health in the summer and fall of 2009. Interviews
were conducted with human resource directors and managers of wellness
and benefits from a cross section of large and small firms in both
manufacturing and services sections; directors of student health
services or student services from public, private, and community
colleges; and command-level leaders (non-commissioned and commissioned)
from several branches of the military. Topics include adolescents'
health status and access to care, the role of the community in health
education and wellness, and public and private policies to improve
adolescent health. The report is available at http://www.thenationalalliance.org/Reports/Concern%20for%20Our%20Teens%20-%20Opinion%20Leaders%20Speak%20Out%20on%20Adolescent%20Health.pdf
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3. CONVERSATIONS ELICIT SUGGESTIONS FOR SUPPORTING PARENTS AS PARTNERS
IN DECISION-MAKING AND IN ADVISORY ROLES
Shared Participation: Strategies to Increase the Voice of Families from
Diverse Backgrounds as Partners and Advisors documents conversations
with parents of children and youth with special needs (CYSN) about
their perceived barriers to working in partnership with professionals
on decision-making, recommendations for supporting partnerships and
decision-making, and recommendations for parent participation on
advisory committees. The report, produced by Family Voices of
Wisconsin, is based on listening sessions with Latino and
African-American parents of CYSN and technical assistance conference
calls with Native-American parents of CYSN. Contents include common
themes across groups for recruiting and supporting parents new to
advisory roles and a checklist for recruiting and supporting parents
from diverse backgrounds for advisory roles. The report is available at http://www.fvofwi.org/Publications/SharedParticipation.pdf
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4. ARTICLE EXAMINES DISCRIMINATION, POSTTRAUMATIC STRESS, AND RISK
BEHAVIORS AMONG MEXICAN-AMERICAN ADOLESCENTS
"The findings of this study support our theoretical model that
perceived racial/ethnic discrimination is related to the development of
posttraumatic stress symptoms among Mexican American adolescents, and,
in turn, to higher levels of health risk behaviors," write the authors
of an article published in the July 2010 issue of the Journal of
Counseling Psychology. National survey data indicate that
Mexican-American adolescents engage in many health risk behaviors at
higher rates than African-American and white adolescents. Increasing
attention has been given to contextual stressors in the social
environment in which adolescents live. One important aspect of the
social environment for Mexican-American adolescents is experiences of
racial/ethnic discrimination owing to their ethnic minority status.
Mexican-American adolescents report high levels of perceived
racial/ethnic discrimination, which is the subjective experience of
being treated unfairly, disrespected, disliked, stereotyped, and
rejected relative to others in everyday experience on the basis of race
or ethnicity. The study described in this article examined perceived
racial/ethnic discrimination as a source of traumatic stress related to
health risk behaviors among Mexican-American adolescents. The authors
posit a theoretical model that suggests a mechanism by which
discrimination can lead to health risk behaviors among Mexican-American
adolescents and hypothesize that greater perceived discrimination would
be related to higher levels of health risk behaviors, including alcohol
use, marijuana use, other drug use, engaging in fights, and number of
sexual partners. They further hypothesize that posttraumatic stress
symptoms would mediate the relationship between perceived
discrimination and health risk behaviors.
Parents and adolescents who had participated in a previous study (Study
1) were re-contacted to participate in the current study (Study 2). For
Study 1 (a study that examined marital conflict and
adolescent-health-related functioning among Mexican Americans and
whites), potential participants were randomly selected from the
membership lists of a large health maintenance organization located in
a semi-urban community in Northern California. At the time of Study 1,
eligible adolescents were ages 12-15. Three years later, families were
re-contacted to participate in Study 2, a longitudinal follow-up study
examining inter-parental conflict and dating violence among
adolescents. At baseline of Study 2, 124 of the Mexican-American
adolescents participated in the research. Adolescents' mean age was
18.8 years; 54 percent were male and 46 percent were female. Study 2
measures included perceived racial/ethnic discrimination, posttraumatic
stress symptoms, alcohol use, drug use, involvement in fights, number
of sexual partners, and demographic variables.
The authors found that
- Adolescents who perceived more racial/ethnic discrimination
reported worse posttraumatic stress symptoms.
- Adolescents who experienced heightened posttraumatic stress
symptoms reported more alcohol use, more other drug use, more
involvement in fights, and more sexual partners.
- Even when posttraumatic stress was included as a mediator,
perceived racial/ethnic discrimination was related to fights;
adolescents who perceived more discrimination were involved in more
fights.
- The mediated effects of perceived racial/ethnic discrimination on
health risk behaviors were significant for alcohol use, other drug use,
involvement in fights, and number of sexual partners. Thus,
posttraumatic stress symptoms mediated the effects of perceived
racial/ethnic discrimination on alcohol use, other drug use, and number
of sexual partners and partially mediated the relationship between
perceived racial/ethnic discrimination and involvement in fights.
The authors conclude that "this study has important implications for
training counseling psychologists and mental health counselors working
with Mexican American adolescents in school and community settings."
Flores E, Tschann JM, Dimas JM, et al. 2010. Perceived racial/ethnic
discrimination, posttraumatic stress symptoms, and healthy risk
behaviors among Mexican American adolescents. Journal of Counseling
Psychology 57(3):264-273. Abstract available at http://psycnet.apa.org/journals/cou/57/3/264
Readers: More information is available from the following MCH Library
resources:
- Adolescent Violence Prevention: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_adolvio.html
- Emotional, Behavioral, and Mental Health Challenges in Children and
Adolescents: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_Mental_Conditions.html
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5. STUDY INVESTIGATES DENTISTS' PROVISION OF CARE FOR PREGNANT WOMEN
"The results of our study were encouraging because 98.5 percent of
respondents provided dental care for pregnant women each month.
However, only 48.3 percent reported providing comprehensive dental
services," state the authors of an article published in the August 2010
issue of the Journal of the American Dental Association. There is
growing recognition of the importance of women's oral health during
pregnancy but little information on the supply of dentists who provide
care for pregnant women. The article presents findings from a
cross-sectional survey of general dentists in North Carolina in 2008.
The authors examine the percentage of general dentists who provide oral
health care to pregnant women and, among those who do, the extent to
which they provide comprehensive oral health care.
The researchers developed a survey instrument based on information
obtained from a review of the literature, policy statements and
guidelines, qualitative research, and expert opinion about oral health
care for pregnant women and anticipatory guidance. They mailed the
six-page survey to 1,000 participants (27 percent of the dentists in
North Carolina) randomly selected from a database of licensed general
dentists obtained from the North Carolina State Board of Dental
Examiners. The analyses examined associations of explanatory variables
(dentists' knowledge about pregnancy and oral health, treatment
practices, barriers to providing care, opinions about possible
treatment outcomes, and personal and practice demographics) and the two
outcome variables. They also tested the effects of dentists' knowledge,
confidence, use of preconception counseling, and perception of barriers
to provision of oral health care for pregnant women, controlling for
hours in dental practice per week, solo practice vs. other practice
type, practice location (rural vs. urban or suburban), percentage of
white clients, percentage of Hispanic clients, percentage of clients
enrolled in Medicaid or North Carolina Health Choice, sex, University
of North Carolina graduate, residency completed, and years in practice.
The authors found that
- Respondents who provided preconception counseling and perceived a
lack of demand for services were less likely to provide any care for
pregnant women, compared with dentists who provided preconception
counseling and perceived a demand.
- Among respondents who provided care to pregnant women, those who
had low knowledge scores, provided preconception counseling, were male,
and had largely white client populations were less likely to provide
comprehensive oral health services than dentists who had moderate or
high knowledge scores, did not provide preconception counseling, were
female, and had largely minority client populations.
Based on the findings, the authors suggest that "policy changes to help
address the perceived lack of demand for services may be indicated . .
. [and] definitive research is needed to alleviate some of the
uncertainty so that dentists have clearer guidelines and direction
regarding how to care for pregnant women in their practices."
Prada Da Costa E, Lee JY, Rozier RG, et al. 2010. Dental care for
pregnant women: An assessment of North Carolina general dentists. The
Journal of the American Dental Association 141(8):986-994. Abstract
available at http://jada.ada.org/cgi/content/abstract/141/8/986
Readers: More information is available from the following MCH Library
resource:
- Oral Health for Infants, Children, Adolescents, and Pregnant Women:
Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_oralhealth.html
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and
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