Maternal and Child Health
Section Newsletter
FALL 2007

MESSAGE FROM THE SECTION CHAIR: CREATING A NEW AGENDA FOR MCH: INVOLVEMENT IS ESSENTIAL

Creating a new agenda for the MCH Section has been much like doing a jig-saw puzzle.  First the Leadership put together the framework at the March midyear meeting, and now the membership is being asked to fill in the actual design piece-by-piece.  The variety of issues facing professionals in the field of maternal and child health and the many types of training and experience of those individuals makes this a challenge. The timetable for further development is not as rushed as working on a puzzle during a week at the beach, but it has its pressures.

 

At the mid-year meeting in March, the MCH leadership focused on capacity building. With the help of Dee Jeffers from the Chiles Center at the University of South Florida as facilitator, the group hammered through two full days of strategic planning and resource evaluation.   The group described four Section-wide goals and five areas for development, which are the framework for the new agenda.  The entire document has been sent out through the listserv and will be available on the MCH Web site and in written form at the MCH booth at the Annual Meeting.  The goals are focused on increasing the impact of APHA in the national policy arena for maternal and child health and they include the following:

  • Influence national maternal and child health policie.s
  • Position APHA to play an active role in maternal and child health policy.
    • Submit timely and appropriate position papers related to practice, program, research, and funding.
    • Place maternal and child health professionals into APHA policy positions.
  • Develop leadership within the Section.
  • Communicate with members about policy and programmatic issues.

To accomplish this mission, the leadership has defined five strategies for change within the Section, with a number of action steps for implementation.  The strategies include:

·         Increasing MCH Section influence in APHA to affect association policy decisions. 

·         Improving membership through recruitment of new members and retention of old ones.

·         Mentoring new leadership for the Section within the membership.

·         Working on policy development.

·         Implementing advocacy.

 

The group discussed a list of emerging and persistent issues, each of which could require a year-long task force to prepare a policy statement.  This list included: workforce development; health inequities; pre-conceptual care; access to comprehensive risk appropriate care; normal birth; preventing preterm birth, including iatrogenic; maternal mortality; and children with special health care needs.  The next steps are to prioritize this list and find sponsors within the Section membership willing to develop the policy statements necessary for each one.  These are the puzzle pieces missing in the challenge.

 

Rethinking the impact of the MCH Section on national policy and creating an agenda for change will require time and commitment.  The Section leadership has set the process in motion.  The larger membership is now asked and encouraged to get involved and be active.  Feedback is necessary and will be elicited both online and in person at the Annual Meeting.

 

In November in Washington, D.C., the MCH Section will kick off the Agenda project at the afternoon session on Sunday.  The framework structured by the leadership will be introduced, and task groups will be formed to deal with areas of interest.  The task groups will have early Monday morning to map out their initial approach.  There is much to be done.  Gathering together provides a rare opportunity to draw inspiration and energy for taking on common and pressing concerns.

 

Volunteers are needed to head the task groups.  A straw poll to prioritize the issues will be held online, but the emergence of people interested in each topic will move that specific issue along. The Annual Meeting in Washington, D.C. should be energizing and exciting, but attendance is not essential for participation.  Work on this agenda will continue through the year, and much of the effort will be online or through conference calls, so please let me know if you are interested.

 

The greatest need in this project is the involvement of the larger MCH membership, and that means YOU.  You all bring a wealth of experience and vision to the enterprise. You have long been committed to working for the public interest, and the involvement and energy of this group can bring about meaningful and positive change.  Each piece in this puzzle is distinct, but together the pieces can form a coherent picture.  While planning and development are important, the actions based on this vision, the New Agenda, will lead to the improvement of maternal and child health. 

 

I am looking forward to seeing many of you in DC in November and to hearing from many others as we move forward to make this New Agenda a reality.

 

Barb Levin

Chair, MCH Section

barbl11@aol.com

MESSAGE FROM THE NEWSLETTER EDITOR

Thank you all for the unprecedented number of newsletter articles we received for this issue!  The news, both personal and professional, from our many members is exciting, and it really demonstrates the deep involvement of the membership of MCH in the Section.

 

We do not yet have any due dates for the next newsletter, but based on historical data, you should plan on getting articles and announcements to me sometime between the end of December and the middle of January.   

 

Thanks to all who contributed to this newsletter and I am looking forward to meeting many of you at the Annual Meeting this fall in my home town, Washington, D.C.

 

Clare Feinson

MCH Section Newsletter Editor

cfeinson@erols.com

HIGHLIGHTS OF THE ANNUAL MEETING

·         MCH Reception in the Presidential Suite :  Debbie Klein-Walker, president of APHA and former chair of the MCH Section, has graciously offered the Section the use of her Presidential Suite for a reception during the Annual Meeting.  This event will be held on Sunday, Nov. 4 from 8:00 to 9:30 p.m.   We do not yet know where the Presidential Suite will be, but we will be announcing the location of the reception during MCH Section meetings scheduled for earlier on Sunday.

·         MCH Booth in the Exhibit Hall:  Make sure you stop by the MCH Booth in the Exhibit Hall to see our display.  Better yet, help us publicize the Section by volunteering to sit at the booth, and contribute to our efforts to help upgrade the booth -- we have already collected close to $1,000 for this effort.  For more information, contact Chair-Elect JoAnne Fischer at JFischer@momobile.org 

·         Scientific Sessions:  The MCH Section has a great program of scientific sessions lined up.  For the full list, go to the APHA Annual Meeting Web site at: http://apha.confex.com/apha/135am/techprogram/program_765.htm.

·         Business Meetings and Social Events:  This is the place to really get involved in the Section, including the exciting New Agenda activities on Sunday afternoon.  The committees are where the Scientific Sessions for the next year are planned, so pick one (or more) in your area of interest and get involved!  For a full list, see the APHA Annual Meeting Web site at:  http://apha.confex.com/apha/135am/techprogram/nt_765.html

MARTHA MAY ELIOT FORUM TO DISCUSS FIXING HEALTH CARE SYSTEM

Four renowned leaders in maternal and child health will make up an eminent panel for the 2007 Martha May Eliot Forum at the APHA 135th Annual Meeting in Washington, D.C., on Tuesday, Nov.  6 at 2:30 p.m. The session will be moderated by Diony Young, editor of the journal Birth.  The panel is entitled:  Everyone Knows the Health Care System is Broken. How Do We Fix It? Access Beyond Health Insurance: The Politics and Policy of Maternal Child Health (Session 4239.0).

 

Each panel member brings an extraordinary wealth of experience and work in improving maternity care, for which they have been recognized and honored as former recipients of the Martha May Eliot Award. They are:

·         Eunice K.M. “Kitty”Ernst, CNM, MPH, Sc(Hon)  (1981).

·         Judith Rooks, CNM, MPH, MSc  (1993).

·         Charles Mahan, MD (2004).

·         Ruth Lubic, RN, CNM, EdD (2006).

 

The award is named for Dr. Martha May Eliot (1891-1978), whose remarkable career spanned four decades in the federal Children’s Bureau, where she served as Chief from 1951 to 1956. Dr. Eliot was also the first woman to be elected APHA president (in 1947).

 

Panel members will discuss policy and political factors that affect childbirth in North America today. Primary concerns include emphasis on the development of the family, how to retain normal childbirth in the face of a Caesarean section epidemic, how to improve quality of care and reduce costs while meeting the needs of the childbearing public, balancing high-tech and high-touch preventive health care, and examining models of care that empower women and provide them and their families with choice, access and quality in maternity care.

 

Health professionals and public health workers in maternal and child health are strongly urged to attend this special Forum and gain inspiration and knowledge from these four trailblazers in maternity care. With such a cast of speakers, it will be a memorable occasion.

INNOVATIONS IN MATERNITY HEALTH SERVICES COMMITTEE

The Innovations in Maternity Health Services Committee is focusing at the Annual Meeting this year on an agenda to campaign for an improved U.S. policy on access to maternity services for all women.   The Committee has planned several sessions to discuss these issues, and will use business sessions to organize the advocacy effort. 

 

The APHA Annual Meeting is essential to the lifeblood of this organization.  Not only does the Annual Meeting provide a large amount of the revenue for the Association, but it is the place individuals go to get recharged to meet their professional responsibilities. 

 

The timing, a year before a national election, and the site, in our nation’s capital, are perfect for such a campaign kick-off.

 

The three sessions sponsored by the Committee this year include the followings:

·         Monday, Nov. 5

o        4:30 p.m.-6:00 p.m.:  3421.0 Politics and Policy: Childbirth at the Crossroads

o        6:30 p.m.-8:00 p.m.:  296.0 Innovations in Maternity Health Services Committee Meeting

·         Tuesday, Nov. 6

o        4:30 p.m.-5:30 p.m.:  4270.0 Innovative Topics in Maternal and Child Health (Poster Session)

·         Wednesday, Nov. 7

o        12:30 p.m.-2:00 p.m.:  5126.0 Innovative Topics in Maternal and Child Health-2

 

The Innovations Committee is also organizing and co-sponsoring the Martha May Eliot Forum on Tuesday, Nov. 6, 2007 (see preceding article).  The Committee meeting will follow the Monday afternoon forum, and the groundwork for the advocacy program will be set at that time.  We are looking for increased participation and new members, who would like to help with this campaign, so please plan to join us for the Committee meeting.

 

The mission of the Innovations in Maternity Health Services Committee is to raise the “hard” questions in childbirth:  Why do maternity care providers do what they do? Is it necessary? Is it mother and child friendly?  Does it help us reach better outcomes?  The continued growth of technology has caused childbearing families to lose control of their birth options.  The focus of the Committee is on alternatives to traditional obstetrics, including midwives, birth centers, and home birth.  The present crisis in malpractice is forcing us to look at the even bigger picture:  WHO IS GOING TO CATCH THE BABIES?  The almost five-fold increase in malpractice is closing birth centers and forcing both low-risk and high-risk providers to reevaluate what they are doing.   There is a need to establish a national conversation on this vital issue. At this time, the Committee feels that the underlying structure of maternal health care delivery should be evaluated and examined for long-overdue reform.

 

Please join us in this work, and we are looking forward to seeing you in Washington, D.C.

 

Barb Levin  (BarbL11@aol.com)    

Carol Nelson (cpmcnel@usit.net)

Cecilia Wachdorf

BREASTFEEDING COMMITTEE

The Breastfeeding Committee has two very exciting issues for the November meeting. First, we will be supporting “A Call to Action on Breastfeeding: a Fundamental Public Health Issue,” as it goes through its final hearing before APHA adoption.  This awesome document was very ably prepared by committee members who bring unprecedented support from four sections:  Melissa Bartick is from MCH, Miriam Labbok is incoming chair of the International Health Section, Lissa Ong is a Section Councilor from the Food and Nutrition Section, and the Environmental Health Section has also worked with the authors to include language regarding human milk and the environment. The paper will have its final hearing at the Annual Meeting on Nov. 4. Before the meeting, please take the time to go to the APHA Web site and read it – it is a statement to bring breastfeeding into the 21st century in public health!

 

Second, there will be two invited sessions on breastfeeding, as well as three oral sessions and two poster sessions.  The invited sessions are:

·         Infant Feeding Practices Study II: Methods and Sample Characteristics, coordinated by Sara Fein.

·         WHO Growth Standards: Background and Rationale for Developing a New International Growth Standard for Infants and Young Children, coordinated by Miriam Labbok.

 

The Breastfeeding Committee meeting will be Sunday, 2:00 – 3:30 (Session 216.0). With the current discussions in the press and in Congress regarding the national breastfeeding campaign, as well as the many exciting presentations and the position paper, the meeting should be lively and interesting. Please feel free to contact Mary Tully at mrwtully@bellsouth.net if you have items to put on the agenda.

COMMITTEE ON CHILDREN WITH SPECIAL HEALTH CARE NEEDS RE-STARTED

This year, members of the MCH Section of APHA are re-establishing a Committee on Children with Special Health Care Needs within the Section’s Child and Adolescent Health cluster. Children with special health care needs are defined by the federal Maternal and Child Health Bureau as, “those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” Findings of the 2001 National Survey of Children with Special Health Care Needs indicate that this heightened level of need characterizes about 13 percent of U.S. children.  One-fifth of families responding to the survey reported having a child with special health care needs.

 

You are warmly invited to join us at a meeting to discuss the focus of the committee for the coming year.  The meeting will be from 6:30 to 8 a.m. (no, regrettably that’s not a typo) on Monday, Nov. 5, location to be announced. The preliminary agenda for this meeting includes:

 

·         Introductions.

·         Discussion of theme for the 2008 Annual Meeting and priorities for the committee’s scientific session/s at next year’s meeting.

·         Overall scope of the committee’s work, including such issues as:

o        Inclusion of the word “youth” in our name.

o        A focus on international as well as domestic issues.

o        Current policy issues of major concern.

·         Other topics of interest such as:

o        Possible future APHA resolutions.

o        Opportunities for collaboration within APHA (e.g., with the Disability SPIG).

o        Work with student members.

o        Outreach to and collaboration with relevant groups in the United States and internationally.

 

Questions or comments are welcome. If you are interested in the committee but can’t attend the meeting, please feel free to contact Deborah Allen at dallen@bu.edu.

 

Meanwhile, some issues you may want to track in your state that are particularly significant for this population are:

·         SCHIP reauthorization and eligibility;

·         States’ option to implement Medicaid buy-in programs under the federal Family Opportunity Act passed two years ago (for details, see http://www.hdwg.org/catalyst/pdf/FAQ_about_FOA_Medicaid_Buy-In1.pdf);

·         Statewide efforts to promote the medical home model of coordinated care for children with special health care needs; and

·         Initiatives to promote systematic developmental and mental health screening, and the adequacy of resources for children identified through screening.

FAMILY VIOLENCE NOW OFFICIAL FORUM

We have good news to share with all of you: the Family Violence group that has been working for several years to establish the Family Violence Prevention Forum is pleased to announce that it is now an official APHA forum.  MCH is the mother and Injury is the father of this new forum born after a four-year gestation.  About 20 Sections, special interest groups (SPIGs), and Caucuses are represented, to help connect family violence to other categories of public health resources. We have new members and full professors. Some are new to family violence and others are pioneers in the field with landmark programs, and we would like to take this opportunity to thank all those who helped to make this happen.  The new Forum comes at an opportune time, when the World Health Organization is joining CDC and other major organizations addressing violence including various forms of family violence, and the American Academy of Pediatrics is developing specialty boards in child abuse.

 

At the Annual Meeting in Washington, D.C., in November, the Family Violence Forum will hold two poster sessions and two oral sessions.  Please look for our sessions in the program and tell all your friends to come, because we want to grow.  To join, please email Vivian Ng at icanvng@gmail.com . You will receive a short questionnaire and be entered into our directory.  Our Executive Committee, which includes Michael Durfee, Pat West, Peggy Goodman, Susan Hadley, Derrick Gordon, and Martha Coulter, is busy and always looking for more people to become involved, so please join and forward this information to people who might be interested in being a part of our group.

STUDENT LEADERSHIP COMMITTEE SELECTS 2007-08 FELLOWS AND AUTHORS

The Student Leadership Program Committee of the MCH Section has selected ten Student Fellows to participate in a year-long student leadership program and five Student Authors to be featured at the upcoming Annual Meeting.  Thanks to support from the Colgate Foundation and the Association of Teachers of Maternal and Child Health (ATMATCH), the MCH Section was able to accept all 10 applicants into the Student Fellows Program and to provide cash awards to the top two Student Authors.  Student Fellows receive stipends to help support their attendance at the Annual Meeting; Student Authors receive a stipend to support Annual Meeting registration.

 

The overall goal of the Student Fellows Program is to foster the development of leaders in science, program, and policy related to the health of women, children, and their families.  The fellowship program is designed to provide Student Fellows an opportunity to enrich their professional experience by participating in professional education and policy development at a national level.  Student Fellows participate in a range of activities at the Annual Meeting and over the course of the fellowship year including assignment to a mentor from the MCH Section leadership.  The 2007-08 Student Fellows represent five different university programs from across the country and are currently enrolled in a masters or doctoral level program in public health or a related field.  The Review Committee was very impressed with the academic records and demonstrated interest in public health and MCH of this year’s applicants.

 

The MCH Section has been a leader in developing and supporting student participation in Association and Section activities.  In addition to engaging the Student Fellows in MCH Section leadership activities, the Student Leadership Committee will be working on at least three key activities this year:

·         continuing to strengthen leadership opportunities for Student Fellows within the MCH Section.

·         developing and conducting an evaluation of the Student Fellows Program.

·         identifying funding sources for continued support of the Student Fellows and Student Authors programs.

 

We encourage you to welcome the new Student Fellows to the MCH Section at the Martha May Eliot luncheon, and to attend the Student Author sessions at the Annual Meeting.  For additional information about the programs, becoming a Student Fellow mentor, or working with the Committee, please contact Karen VanLandeghem, Secretary-Elect, MCH Section, at kvanlandeghem@ameritech.net.

"UNEMBEDDED" EXHIBIT SHOWS IMPACT OF IRAQI WAR

Unembedded -- Four Independent Photojournalists on the War in Iraq is a national touring exhibit of 60 images that tells the story of the impact of the war on the lives of the Iraqi people, the environment in Iraq, and returning American veterans, their families and their communities.  The exhibit was initiated by APHA members in Arkansas and was shown earlier this year at the University of Arkansas. 

 

The opening reception for the exhibit will take place from 6-8:30 p.m. on Monday, Nov. 5, 2007 at the AFL-CIO Building, 815 16th Street NW, Washington, D.C., and the exhibit will be open every day during the Annual Meeting.  APHA, the Labor Caucus, the Peace Caucus, our colleagues in Arkansas, and volunteers from the AFL-CIO are contributing their time and in-kind support to organize this exhibit.  To contribute to the effort, contact Pat Sutton of the Peace Caucus at psutton2000@yahoo.com. 

SESSION ADDRESSES COMPLEMENTARY AND ALTERNATIVE (CAM) TREATMENTS FOR SPECIAL NEEDS CHILDREN

Family Matters: Using Bright Futures to Promote Health and Wellness for Children with Disabilities is a CDC-funded project of Family Voices, a grassroots parent organization, in partnership with Tufts University School of Medicine.  Barbara Popper of Family Voices and Paula Minihan, a professor at Tufts, will be giving a presentation at the Annual Meeting entitled Alternative and complementary health practices for children with special health care needs and disabilities: Patterns of use and communication with physicians, on Monday, Nov. 5 at 4:50. 

 

The presentation is based on findings from an online survey of parents of children with special health care needs (SHCN), which was conducted (Dec. 2006 – Jan. 2007) to inform development of supports to assist family health promotion efforts.  In the study, 860 parents, predominantly mothers, who self-identified as having children with special health care needs ages 6-18, participated in the survey. Children were age 11, on average, largely white (82.4 percent), and resided in 49 states and D.C.

 

In the study, 43.7 percent of parents overall and 50.1 percent of parents whose children had autism spectrum disorders reported using at least one alternative and complementary health practice (ACHP) with their child within the past 12 months.  Among all parents, herbal and dietary supplements were most used (23.6 percent), and 38 percent of users discussed it with their child’s doctor.  For each of the ACHP parents, only a minority reported discussing it with their child’s doctor.  Policies to improve the health status of children with special health care needs and disabilities focus on the coordinated, family-centered and conventional health services.  Children’s use of ACHP may impact overall care coordination efforts, particularly when physicians are unaware. 

 

For more information, contact the study directors at bpopper@familyvoices.org and paula.minihan@tufts.edu.

SECTION MEMBER ANNOUNCEMENTS

·         IN MEMORIAM:  Long-time MCH Section member Dr. Greg Alexander died Feb. 20, 2007 of heart failure.  He was a professor of public health and pediatrics at the University of South Florida in Tampa, where his wife, Donna Petersen, is dean of the USF College of Public Health.   As a perinatal epidemiologist, Greg was a strong advocate for children and a dedicated teacher and scientist.  He earned his bachelor’s degree at the College of Charleston, his MPH from the University of South Carolina, and his doctorate from Johns Hopkins.  In addition to USF, Greg also taught at Hopkins, the University of Hawaii, the University of Minnesota, and the University of Alabama.  He was also director of the MCH Leadership Skills Training Institute.  Donations in his memory can be made to the Greg R. Alexander Fund for Young Scholars in Maternal and Child Health, and sent to the University of South Florida, MDC-70, 12091 Bruce B. Downs Blvd., Tampa, 33612, or call (813) 974-3676.  Our condolences go out to Donna and his family.

·         MCH Section Chair-Elect JoAnne Fischer, executive director of the Maternity Care Coalition, in Philadelphia, has been selected by the students, faculty and university leadership of Thomas Jefferson University to receive their Excellence in Community Service award. The award is presented to a community leader in recognition of untiring efforts and commitment to improve the lives and health of local communities in Philadelphia and surrounding regions.  Congratulations, JoAnne!

·         Dr. Dorothy C. “Dot” Browne, the director of the Prevention Sciences Research Center at Morgan State University in Baltimore (which houses the Drug Abuse Research Center and the Center for Health Disparities Solutions) has accepted a position with Dr. Stanley Battle, the Chancellor of North Carolina A&T State University in Greensboro, N.C.  Browne, a professor of public health, will be responsible for promoting and enhancing public health research and programs on the campus of A&T.  Dot began her position with A&T on August 11, 2007.  She is happy to be returning to North Carolina, where she was a member of the tenured faculty at UNC-CH and had numerous collaborative projects with faculty from UNC-CH and other local educational institutions.  Good luck, Dot, in your new position!

·         April Stubbs-Smith of the Center for Devices and Radiological Health of the U.S. Food and Drug Administration gave birth to twins on August 8, 2007.  Congratulations to April and her family on the birth of her two charming babies, Noah Alexander Smith (left) and Victoria Noelle Smith (right).

                 

·         Erika Shankland, a recent graduate of the Maternal and Child Health program at The George Washington University School of Public Health and Health Services, began working for the Health Department of Northwest Michigan as the Family Health Supervisor in August 2007.  She is supervising the work of the health educators employed through the health department, initiating a Community Wellness project, and working on the needs assessment and program planning for the Teen Health Project, a program aimed to address adolescent health needs in northwest Michigan.  The Health Department of Northwest Michigan operates in four counties in northern Michigan — check out the Web site for more information: www.nwhealth.org/.

·         Richard Allan Aronson was honored recently by the Children’s Trust and Prevention Funds and the American Academy of Pediatrics as the 2007 recipient of the Ray Helfer, MD Award.  Dr. Aronson, whose career of MCH leadership and service in three states as MCH Medical Director (Vermont, Wisconsin, Maine) spans 30 years, remembers his early years as a developmental pediatrician in the public health system in Vermont. “A number of children whom I saw showed significant delays due to child abuse and neglect,’’ Aronson said. “I remember vividly a child who was ‘failing to thrive’ due to inadequate parenting and nutrition. It affected me very deeply, and I became determined to the prevention of and healing from such traumatic experiences.”  The award was named after a distinguished pediatrician who was a pioneer in the field of identifying and treating child abuse and neglect as a medical and public health issue. Helfer was instrumental in the founding of Children’s Trusts, which now exist in all 50 states.  “The award is humbling, because there are so many partners in Maine and throughout the world who do great work in this arena,’’ Aronson said. “I consider this a representative award. Because it is named after and honors Ray Helfer, it means even more to me. I studied his work in medical school and my early years as a pediatrician, and it has inspired me throughout my career.”  Aronson has continued his lifetime of public health service, currently as the medical director of Maternal and Child Health for Maine. He sees great value in educating parents and providing resources to help them along their journey of raising healthy, resilient, and thriving children.  He approaches the child abuse and neglect in much the same way that his colleagues address conditions such as influenza and HIV, as a major public health issue, because preventing abuse and neglect is essential to the overall health of a child and family, and for society as a whole.  Since 1993, Dr. Aronson has used and practiced Future Search as a dynamic and uniquely participatory leadership and planning tool to foster such partnerships.

·         Ndidi Amutah, a first year doctoral student at the University of Maryland, is originally from Trenton, N.J. She completed her undergraduate education at Rutgers University, where she earned a BS in Public Health and a BA in African Studies. She then attended George Washington University where she received her MPH in Maternal and Child Health. Ndidi's current research interests include maternal mortality and morbidity, health disparities, reproductive health, and HIV/AIDS in ethnic minority populations. While earning her MPH, Ndidi worked as a research intern at the Baltimore City Health Department, where she studied asthma among children living in the city. She also investigated workplace injuries in immigrant adolescents for NIOSH. After earning her doctorate, Ndidi envisions working for an agency like USAID or the World Health Organization, where she can implement and evaluate national and international MCH programs, particularly focusing on regions in sub-Saharan Africa.

HHS CHANGED BREASTFEEDING ADS AT REQUEST OF FORMULA INDUSTRY

In an attempt to raise the historically low rate of breastfeeding in the United States, federal health officials commissioned an attention-grabbing advertising campaign a few years ago to convince mothers that their babies faced real health risks if they did not breastfeed.  But a lobbyist for the politically powerful infant formula industry persuaded federal officials to tone down the ads.  The formula industry's intervention is being scrutinized by Rep. Henry A. Waxman's Committee on Oversight and Government Reform in the wake of last month's testimony by former Surgeon General Richard H. Carmona that the Bush administration repeatedly allowed political considerations to interfere with his efforts to promote public health.  The toned-down campaign had no visible impact on breastfeeding rates in the United States, and other current and former HHS officials say that this was not the only time HHS missed a chance to educate the public in an effort to raise breastfeeding rates.  To read the full article, see HHS Toned Down Breastfeeding Ads (Washington Post, Aug. 31, 2007).

DC ACTIVISTS CONVINCE CVS TO GRANT UNASSISTED ACCESS TO CONDOMS

Improving access to condoms is an important step in the fight against HIV and other STDs, and individuals are more likely to purchase and use condoms if these items are freely available in the store.  But recent surveys by the D.C. group Save Lives:  Free the Condoms Coalition found that in many CVS drugstores, the condoms are kept under lock and key, and are only accessible with employee assistance.  CVS has now promised to make condoms available in its stores through displays and dispensers that allow customers to maintain privacy by serving themselves.  The coalition will continue to push CVS to develop a nation-wide uniform written policy to provide customers with unassisted access to condoms, and to make sure that individual CVS stores maintain sufficient stocks of condoms available through open access.

 

Save Lives: Free the Condoms Coalition is a non-profit grass roots organization under the auspices of the Student Public Health Association at the George Washington University School of Public Health and Health Services.  In addition to the students, the coalition includes the D.C. Department of Health, the Metropolitan Washington Public Health Association, and D.C. Fights Back, a network of people living with HIV/AIDS.  The coalition fights to improve condom access for everyone. For more information on Save Lives, visit their Web site, http://studentorgs.gwu.edu/phsa/savelives/

SOCIAL JUSTICE THEME OF AMCHP MEETING IN MARCH

Don’t miss your opportunity to learn from your leaders and peers at the 2008 Annual Conference of the Association of Maternal and Child Health Programs (AMCHP):  We Are Making a Difference: Leadership, Innovation and Investment in Maternal and Child Health.   Join attendees from across the nation for skills-building sessions, workshops, plenary and poster sessions.  

 

This event will be held March 1-5, 2008 at the Hilton Alexandria Mark Center in Alexandria, Va. and will bring together leaders in maternal and child health, public health practitioners, and family advocates. Visit www.amchp.org to learn more!

 

Each year AMCHP develops a conference that offers an array of important topics for a broad-based audience.  This year’s program will cover topics applicable to professionals throughout the maternal and child health field, with a special focus on Social Justice.  The conference sessions will focus on:

·         health equity;

·         quality improvement and instituting quality for improving performance;

·         partnerships: family-professional, public and private;

·         leadership skills and competencies for the future workf orce;

·         the changing face of our nation and work force;

·         best practices, strategies, and positive outcomes;

·         AMCHP’s new social marketing messages, tools and resources; and

·         AMCHP’s new legislative strategy.

 

For more information, visit the AMCHP Web site at www.amchp.org.  We look forward to seeing you there!

INTERVIEW WITH MICHAEL FRASER OF AMCHP

In August, Michael Fraser, PhD, joined the Association of Maternal and Child Health Programs (AMCHP) as the chief executive officer.  AMCHP is the national organization representing state public health leaders and others working to improve the health and well-being of women, children, youth and families, including those with special health care needs.

                                 

 

Q:  How did you get involved in maternal and child health? That is a really interesting question.  My background is in sociology – my dissertation research was on social support networks for people living with HIV/AIDS.  I never “formally” studied MCH, and in fact my first public health job was a research synthesis project looking at HIV/AIDS prevention strategies.  A good friend from college went to UNC and concentrated in MCH, and eventually she helped me land my second “public health” job at NACCHO, where I worked on a study of public health infrastructure.  I remember calling her up and asking “what the heck does EPSDT stand for?” because I was too embarrassed to ask a colleague sitting next door!  As I got to know more about state and local public health departments,  I realized that MCH was at the core of public health, and MCH issues are some of the most pressing and critical concerns of our day.  I also realized that working in MCH can have a profound impact on improving the health of communities. 

 

Q: What is one of the most rewarding accomplishments from your career?  I think the most rewarding thing that I’ve experienced to date is watching the people that have worked with me grow as leaders and public health professionals.  I guess another accomplishment is finally getting my 87-year-old grandmother to understand what I do, which to her is “helping the people that keep moms and kids healthy and out of the hospital.”  Listen, if we can’t even get our own families to understand what we do, what chance do we have getting policy-makers, stakeholders and other key decision-makers to work with us and support us?

 

Q: What do you see as the challenges facing MCH today?  What keeps me going in the face of all our challenges is the importance of our shared vision - healthy families, healthy moms, healthy babies - and the incredible resources we have in this country for giving everyone a chance to succeed and live a healthy life.   All of us in MCH share this goal: I have yet to meet one person that says we should give up despite all the challenges we face.   The challenge isn’t sharing a goal – the challenge is in our strategies and tactics.  We have to get the diverse partners who have a stake in our work to figure out what each of us can do to realize our shared goal and work together to achieve it.  This is tough because we are divided.  We have to overcome this fragmentation of our work, move beyond our “silos” and realize how important we all are in reaching our shared goal.  It takes looking up from our holes, holding hands, and saying yes, we are all invested in getting to the same place.  That’s hard to do when we think the only issue in the world is the issue closest to us. 

 

Q:  How can we take them on?  We all know “partnering” is important, but what does that really mean?  Can we trust each other to truly create change in our communities, in our states and in our nation?  Can we begin to tell stories that convince the public that what we do is as important as our schools, fire departments and police departments?   There is so much potential to gain support for public health, especially MCH.  But we have to do it in partnership, and realize that we’ll never do it alone – we have to get communities behind us, policy-makers behind us, and people who disagree and may not be like us, behind us.   That means addressing our issues politically and programmatically, with both urgency and patience, and adopting what I call a “rigorous flexibility.”  We also have to change the mindset that if we all just had health insurance, we’d be healthy.  The social determinants of health go well beyond going to see a doctor.  We have to take on the social conditions that contribute to disease, and make these as important as clinical practice and health care, if we are going to be successful.  That may not be a mind shift for those of us who have been in this enterprise for a while, but believe me, it is a huge mind shift for people who don’t do public health for a living. 

 

Q:  What is your vision for the future of MCH?   Five billion dollars for Title V.  OK, just kidding, but that would be great.  Look, public health means creating the conditions through which all people can be healthy.  MCH is core to that vision – healthy children, healthy families, living in healthy communities.  My vision is a society in which we give everyone a chance to thrive and to contribute to making the world a better place.  Our MCH activities are essential to making that happen.   We are all part of that vision.

NURSES NEEDED TO STOP POLIO IN THIRD WORLD

I am a public health nurse in Delaware and have worked in Maternal Child Health Community Services for the past 15 years.  In the summer of 2005 I was accepted into the CDC STOP Polio program and was sent to Ethiopia to work on the efforts to eradicate this disease.  It was an amazing, wonderful and difficult experience and one that forever changed my life.  It opened my eyes to the wonderful resources we have here in the United States and that we have so much to be grateful for.  I will never again take for granted clean water and air, available and safe food, access to vaccines, antibiotics, and good medical care.  When I returned to Delaware with that refreshed sense of gratefulness and knowledge, I accepted a position working in an inner city Family Planning/GYN Public Health Clinic.

 

I encourage any nurse with a passion for Maternal and Child Health and global health to look into working for a period of time in a country of need.  CDC sends small teams of doctors, nurses, and IT people to the countries still working to eradicate polio.  The CDC Web site for the STOP Polio program explains the assignments and the application process.  There are numerous other organizations with varied lengths of assignments, and there is no end to all medical needs in many countries around the world. I was honored to have helped in that effort in Ethiopia and came back to public health nursing in Delaware with a refreshed sense of priorities and understanding of all people. 

 

For more information, contact me at (302)995-8590 or peg.matsen@state.de.us.

MORE THAN JUST SMILES: CHILDREN'S ORAL HEALTH

Parents and families often struggle to provide sufficient health care for their children.  Often, critical medical concerns and appointments are prioritized, leaving oral health neglected.  Many people do not realize the ramifications that this can have for children.

 

Oral health is essential to the well-being of children.  According to the Centers for Disease Control and Prevention, tooth decay is the most common chronic health problem plaguing U.S. citizens, including children.  These chronic conditions can have severe consequences.  Tooth decay, if untreated, can lead to problems speaking, eating, and even learning (Federal Bureau of Maternal and Child Health).  In addition, oral health problems are often visible problems, leading to social and other behavioral issues for children.


Oral health problems are most common in low-income populations, as well as in African American, Hispanic, and Native American populations (Rhonda Gonzales,
Dental Health and the Children’s Health Insurance Program, The National Conference of State Legislators).  Children who come from low-income families are twice as likely to experience tooth decay as their counterparts in higher income families (United States Center for Disease Control and Prevention).

 

Fortunately, oral health problems can be both treated and, perhaps more importantly, prevented. In addition to addressing these problems on an individual basis with regular dental visits, cleanings, and sealants, there are steps that a community can take as well.  Communities can add flouride to their water, which can be a safe, effective way to prevent tooth decay on a larger scale (American Dental Association).  This is a way to reach all populations equally, including low-income populations, and other populations that are often subject to health disparities.

 

In response to this growing health concern, Women In Government, a national, nonprofit, bipartisan organization of state legislators, recently featured an educational segment focused on policy issues related to children’s oral health at the organization’s Annual Southern Regional Conference in Atlanta. During this segment, state legislators and others were provided with expert presentations from American Dental Association representatives and educational resources on oral health. This segment featured an overview of state policies to improve access to dental care for children, a discussion about how states can emulate these models, and an overview of relevant federal access legislation, including SCHIP reauthorization.  Women In Government is committed to the issue of improving children’s oral health.

 

For more information about Women In Government’s programs, educational resources, and upcoming events, please visit www.womeningovernment.org.

AHRQ OPPORTUNITIES AND RESEARCH FINDINGS IN CHILDREN'S HEALTH

The Agency for Healthcare Research and Quality (AHRQ) is the component of HHS whose mission is “to improve the safety and quality, efficiency and effectiveness of health care for all Americans.”   Children are one of the agency’s congressionally stipulated priority populations as are other populations and areas of interest to the MCH Section and APHA in general; other areas of interest include racial and ethnic minorities, women, individuals with special health care needs, low-income people, and inner-city and rural areas.

 

AHRQ supports research, focusing primarily on quality improvement implementation such as patient safety improvement and initiatives using health information technology.   While the agency has general program announcements, we also issue requests for applications  and special emphasis notices to focus the research community on topics of critical importance to improving U.S. health care quality and reducing disparities (see our Web site at http://www.ahrq.gov/fund/grantix.htm).    The child health research community has been very successful in responding to AHRQ announcements.   This year, for example, new extramural projects were funded as part of a set of ambulatory safety and quality request for applications, for example:

·         development and evaluation of an integrated health information system for children, parents, and primary care providers;

·         surveillance for adverse drug events in ambulatory pediatrics;

·         automating assessment of asthma care quality;

·         evaluation of telemedicine for children with special health care needs;

·         development of an integrated engineering-based model to reduce infections in intensive care units; and

·         assessment of the effect of emergency department overcrowding on the quality of asthma care for children.

 

More projects will be announced later in the fiscal year.  We encourage research into productive linkages between mainstream health care delivery and public health, as well.   Our public health preparedness portfolio has been very active in pediatrics. For more information, visit http://www.ahrq.gov/research/pedprep/resource.htm.

 

AHRQ maintains an interest in access, this year funding an evaluation of the role of national awareness campaigns in children’s participation in public health insurance.    AHRQ has an active intramural and extramural research program on the topic of insurance coverage for children.  For more information on these programs, see http://www.ahrq.gov/child/insurbib.htm and http://www.ahrq.gov/chiri/.

 

A more comprehensive listing of extramural “new starts” for fiscal year 2007 will be posted on AHRQ’s Web site in mid-winter -- visit http://www.ahrq.gov/child/fundprj.htm for reports from the previous year.  The agency also has a state and country map online, which facilitates finding child health services research in local areas -- visit http://www.ahrq.gov/child/usamap.htm.   In response to suggestions from stakeholders who want to know not only what we fund but what the results are, several links are available, including http://www.ahrq.gov/child/childpubs.htm and http://www.ahrq.gov/research/childfind/.  Finally, to track the state of children’s health care quality and disparities, children are included in AHRQ’s National Healthcare Quality and Disparities reports, including State snapshots, at http://www.ahrq.gov/qual/measurix.htm.  To receive regular information continue about child health activities at AHRQ, sign up for our child health LISTSERV at http://www.ahrq.gov/child/flyrlist.htm.  

ONLINE MPH AT UNIVERSITY OF MINNESOTA

The program: The Maternal and Child Health Program in the School of Public Health at the University of Minnesota has an accredited online MPH program for professionals who want to attain leadership roles in MCH or related fields.  The program focuses on social justice and ensuring the health of vulnerable populations. Students will gain expertise in developing evidence-based advocacy, rigorous public health assessment, accessible and appropriate health education, and effective and innovative programs and policies that promote the health and well being of women, children, adolescents and families. 

 

The coursework: The online curriculum was developed for professionals who are comfortable with self-learning.  Web-based courses were designed to facilitate adult learners in enhancing, or developing, their expertise in MCH content and public health practice.  Students also participate in 1-2 one week on-campus courses on cutting edge issues that are held every spring on the Twin Cities campus.  The on-campus courses provide an intensive training experience and an opportunity to network with other students, faculty, and public health professionals.  Every student will be assigned to a faculty advisor who will guide the student’s academic choices, field experience, and final written MPH project.

 

Tuition: Minnesota in-state tuition, regardless of state or country of residence.

 

Eligibility: Individuals with an advanced degree (e.g., MD, MSW, MSN, MS, PhD) OR individuals without an advanced degree who have three or more years of work experience in MCH or a related field.

 

For more information: Please contact Kathryn Schwartz at gradstudies@epi.umn.edu or (612) 626-8802 or http://www.sph.umn.edu/education/mch/curriculum/online

For general information about the University of Minnesota MCH program, visit our Web site at www.epi.umn.edu/mch.

UIC-SPH MATERNAL AND CHILD HEALTH PROGRAM

Our program :  Through leadership, scholarship, and partnership, the Maternal and Child Health program at the University of Illinois at Chicago School of Public Health trains students to support and promote the health and well-being of women, children, and families.  The program emphasizes
multi-level approaches to understanding the complex factors that affect population health and health disparities.  An essential ingredient is the partnerships we have with public and private agencies serving the MCH population and the communities in which MCH problems are most
persistent and pervasive.  The program is committed to scientific rigor, evidence-based public health practice, and the principles of participatory
and collaborative research and practice.

Degrees Offered:  Master of Public Health (MPH) in MCH and MCH Epidemiology, Doctor of Philosophy (PhD) in MCH and MCH Epidemiology.

Eligibility:  Applicants must be accepted into the MPH or PhD program in either the Division of Community Health Sciences or the Division of Epidemiology and Biostatistics at the UIC-SPH and have an interest in the area of MCH or MCH Epidemiology.  Applications are due each year by
Feb.  1 for domestic students and Jan. 1 for international students.

To learn more about the UIC MCH Program and how to apply, please contact Kate Barcal at (312) 413-5625 or kbarcal@uic.edu or visit our Web site at www.uic.edu/sph/mch.

UIC OFFERS GROUND-BREAKING MCH LEADERSHIP RETREAT IN JULY 2008

The University of Illinois at Chicago Maternal and Child Health Program will hold its pioneering MCH Leadership Retreat in Chicago in July 2008.  We are currently exploring July 16-18, 2008 and July 23-26, 2008 as possible dates so if you would like to take a retreat in the beautiful city of Chicago during the summer, please save these dates!  July is a great month in the city!

 

As many of you know, in 2007, we offered our 20th annual, national UIC MCH Leadership Conference on Translating Research into MCH Practice.  The conference presented interdisciplinary research on MCH issues and provided participants with many opportunities to contribute to real-time policy development as well as opportunities to enhance their ability to work with data.  We concluded our 20th conference with an inspiring session about personal leadership development and MCH.  Participants discussed their MCH passions and left the conference with a sense of their MCH mission and the work they must do to make a difference in MCH. 

    

We have just received funding for three more years of national conferences from the Maternal and Child Health Bureau.  For this next round, however, we are planning something new and different to meet the ever-changing needs of the MCH work force, particularly the young work force.  Our MCH Leadership Retreat will continue to focus on evidence-based research and practice but will focus on personal leadership development and the development of a community of interdisciplinary MCH professionals at all levels of academia and practice, providing special opportunities for community building to new and emerging leaders in the MCH work force.  Our planning committee includes senior academic and practice professionals (8+ years) and newer (and new) academic and practice professionals (0-7 years). The committee is very excited and enthusiastic about developing and offering this new conference approach to the MCH work force. 

 

The retreat will be highly interactive with many opportunities to engage in thoughtful, intellectual conversations and activities with your MCH colleagues (new and senior).  We believe that the bringing together of wisdom, ideas, and energy from both senior and emerging MCH leaders will contribute to new ideas, new ways of thinking, new research, new collaborations and new programs to improve MCH.  Further, we are committed to the retreat concept and will offer opportunities for self-reflection, self-care and rejuvenation.  We believe that the retreat and community-building aspects of this program are as important as understanding and developing the evidence-base for MCH practice.  The MCH workf orce (academic and practice) works hard to improves the lives of our women, children, and families!  We all could use time to connect and refuel! 

 

If you find this concept interesting and exciting, please register early. Registration will be open on our Web site at www.uic.edu/sph/mch in early 2008.  If you are a new or senior interdisciplinary MCH academic or practice professional and want to know more about this retreat or would like to participate in the planning activities, please contact Kris Gupta, DrPH, at (312) 996-2875 or kygupta@uic.edu. 

ARIZONA MCH STUDENTS STUDY RURAL HEALTH


As part of a 2007 summer pre-session Masters of Public Health Maternal and Child Health course at the University of Arizona, Mel and Enid Zuckerman College of Public Health in Tucson, the graduate public health students in family and child health learned about the design, successes and challenges of rural public health programs by visiting the Navajo, Hopi and Hualapai Tribal Nations in northern Arizona.

The one-week field-based course was designed to provide MCH students culturally competent knowledge and skills for working with Native American and border communities in the rural Southwest and to increase the students’ awareness and understanding of the diverse social, cultural and health practices that exist.  This course provided MCH students with an opportunity to learn about different tribal and border health service provision models and approaches and the implications of these health care systems on health status.

 

The students met with staff from the Navajo Division of Health, Indian Health Service, the Hopi Breast and Cervical Cancer Prevention Program and the Hualapai Health Department. Students also helped with the school health fair at the Hualapai Elementary School.

Their field trip was part of the one-credit MCH course, "Creating Culturally Competent Health Care Systems in the Rural Southwest" taught this year by Nicky Teufel-Shone, Ron Watson, Yolanda Herrera, and Louis Teufel-Shone. The course is supported by an HRSA-funded MCH Training Grant (PI - Douglas Taren).

The family of Louis Teufel-Shone hosted the group at their home providing a traditional Navajo meal and conversation about family life in a remote part of the reservation. "They even shared a harrowing account of recently killing a mountain lion who was eating sheep," noted Dr. Nicky Teufel-Shone.

Students and faculty also found time to enjoy the wonders of northern Arizona.  The group visited Canyon de Chelly, Monument Valley, the south rim of the Grand Canyon, and the Colorado River.  For more information on the MCH program and the course contact Dr. Teufel-Shone at teufel@u.arizona.edu.

PA HEALTHY START PROGRAM PUBLISHES 10-YEAR OUTCOMES REPORT

In Chester County, Pa., the Healthy Start program of the Maternal and Child Health Consortium provides countywide prenatal and postpartum home visiting and case management to help promote safe pregnancies and deliveries for low-income women and prompt enrollment of children into pediatric care and health insurance programs. 

 

At the heart of Healthy Start are 11 Family Health Advocates, most of whom are bilingual and bicultural.  Reflecting the ethnic and cultural characteristics of their communities, Advocates provide a culturally sensitive link between expectant mothers and a complex health care and social service system. 

 

In a 10-year outcomes report, birth records from 2,435 births (1996 to 2005) to Healthy Start participants were compared with data of Chester County “non-participants” who gave birth during the same period.  The participants that enrolled into Healthy Start were women at highest risk for poor health outcomes (for example, 81 percent were Latino or African American).  Healthy Start participants had rates of low birth weight and preterm birth that were consistently better than national, state, and local rates.  For the time period of 1996-2005, the preterm birth rate for Healthy Start participants was 7.3 percent and surpassed the Healthy People 2010 objective to reduce preterm births to 7.6 percent of all births. 

 

For the same period, 5.6 percent of Healthy Start infants were born at a low birth weight.  This was just above the Healthy People 2010 national goal that low birth weight rates be reduced to 5 percent.  However, the average low birth weight rate for African American Healthy Start infants was 7.8 percent, much lower than the average low birth weight for African American infants residing in the community area (12 percent) that were not enrolled.  The average low birth weight rate for Latino Healthy Start infants was also significantly lower (4.5 percent than the low birth weight rate for Latino infants residing in the community area (7.9 percent).

 

The factors contributing to the success of Healthy Start include: culturally responsive staff; strong outreach component; co-location with a network of five accessible, community based offices; a comprehensive training program for home visitors; and tangible services that women value (home visits, access to health insurance, medical interpretation services, and transportation services).  For a copy of the report, please visit www.ccmchc.org. 

LACTATION SAFETY RECOMMENDATIONS FOR 10 MEDICATIONS

MCH Section member Melissa Bartick, co-author of the Call to Action on Breastfeeding (see article above on the Breastfeeding Committee), and her colleague, Monica Akus, recently published this article in the September issue of the Annals of Pharmacotherapy.

Their article found that discontinuation of breastfeeding is linked with an increased risk of acute and chronic diseases in children, as well as increased risk of maternal disease.  Mothers and physicians often depend on pharmacists for accurate drug information, but their information is only as good as the sources available to them.

 

The objective of the study was to determine the reliability of safety recommendations for drugs used during lactation, based on current research and information, and determine whether resources may be inappropriately advising the interruption of breastfeeding.  A comparison of 10 frequently used sources for information on medication used during breastfeeding was done for 14 commonly used drugs.  Sources included the databases used by two retail pharmacy chains, available text references and electronic references.

 

The authors assessed the number of drugs thought to be safe in breastfeeding for each source. The drugs reviewed included those widely accepted as safe, widely regarded as not safe and drugs that fit into neither category.  They found that many sources did consider the most recent research.  For drugs thought to be unequivocally safe, the two retail pharmacy databases gave an alternative recommendation at least 75 percent of the time.

 

The authors concluded that if health care practitioners are using outdated sources for making safety recommendations to their patients, such a practice may result in many women being inappropriately advised to stop breastfeeding, thus increasing the potential health risks to them and their infants. As the most accessible medication expert, the pharmacist needs to be well educated and continually updated using the most reliable resources for lactation recommendations.

 

To read the full article, see Ann Pharmacother 2007;41, published online, July 10, 2007, www.theannals.com, DOI 10.1345/aph.1K052.

PREGNANCY-RELATED MORTALITY ASSOCIATED WITH MATERNAL RACE AND OBESITY IN FLORIDA

INTRODUCTION :  In 1996, Florida initiated the Pregnancy-Associated Mortality Review (PAMR) process to improve surveillance and analysis of pregnancy-related mortality. PAMR uses the expanded definition of maternal mortality developed by the Centers for Disease Control and Prevention and the American College of Obstetrics and Gynecology: “…death of a woman, from any cause, while she is pregnant or within one year of termination of pregnancy, regardless of duration and site of the pregnancy.”

 

In the PAMR process, various methods are used to identify all deaths to women of reproductive age that may be pregnancy-associated. These deaths are then reviewed by a Department of Health nurse-physician team to make an initial categorization of the death as pregnancy-related, possibly pregnancy-related, or not pregnancy-related. All of the pregnancy-related deaths and a stratified, random sample of the possibly pregnancy-related and not pregnancy-related deaths are then reviewed by the PAMR team. The PAMR team is a multidisciplinary group of 31 professionals including physicians, nurses, nurse midwives, social workers, educators and researchers.

 

The PAMR process also includes case abstraction and review of the case abstracts by the PAMR review team. For more information about the PAMR process, please refer to “1999–2002 Florida Pregnancy-Associated Mortality Review (PAMR),” located at the following Web site: http://www.doh.state.fl.us/Family/mch/docs/pdf/PAMR99-02.pdf.

 

METHODS:  Pre-pregnancy height and weight data are collected in the PAMR process and are also collected for approximately 150,000 pregnant women annually on the Florida Healthy Start Prenatal Screening.  For this study, 215 pregnancy-related deaths that occurred in the period January 1999 through June 2006 were randomly matched to four prenatal screens, using marital status, age, and education as the matching criteria.  Conditional logistic regression was used to estimate the adjusted odds ratios for pregnancy-related mortality associated with black maternal race and four body mass index (BMI) categories (underweight – BMI < 18.5; overweight – BMI 25.0 to 29.9; obese – BMI 30.0 to 39.9; and morbidly obese – BMI 40.0+).  White maternal race and normal BMI (18.5 to 24.9) were used as the reference categories therefore the odds ratios for the maternal race and obesity factors are adjusted for associations between race and obesity.

 

RESULTS:  The pregnancy-related mortality adjusted odds ratio for women whose maternal race was black was 2.30 (95 percent confidence interval: 1.66 to 3.21). The adjusted odds ratios (with 95 percent confidence intervals in parentheses) for the underweight, overweight, obese, and morbidly obese categories were 1.82 (0.90 to 3.68), 1.69 (1.10 to 2.60), 2.62 (1.71 to 4.01), and 3.88 (2.17 to 6.92), respectively.  These were all statistically significant at the alpha 0.05 level except for the underweight category. 

 

 

CONCLUSION:  Increased risk of pregnancy-related death is significantly and substantially associated with black maternal race and high levels of BMI.  Encouraging women to achieve normal BMI before pregnancy may lower the risk of pregnancy complications and pregnancy-related death.  Further research is needed regarding the relationship between maternal race and obesity risk factors.

 

This research was conducted by Daniel Thompson, MPH, Angel Watson, MPH, RHIA, and Deborah Burch, RN, BS of the Florida Department of Health, Division of Family Health Services, Bureau of Family and Community Health.

 

FUROR OVER SEXUAL CONTENT IN TWO BOOKS FOR CHILDREN

Censorship and back room politics are not new to those of us providing health care to women and children.  From the Supreme Court and the Food and Drug Administration down, our ability to provide education and services, particularly those involving family planning and information about safer sexual practices, is constantly being hampered by rules, regulations and re-interpretations.  Last spring, the battle crept into the children’s and young adult literature market.  Two excellent works of fiction, both involving sexual content, were banned by Borders.  These were:

·         Pop! by Aury Wallington (New York, Penguin Books, 2006. ISBN I-59514-092-1, 248 pages) was endorsed by Planned Parenthood on its Web site. 

·         The Higher Power of Lucky by Susan Patron (New York, Simon and Shuster, 2006, Hardcover, ISBN-13: 9781416901945, 134 pages)  won a Newbery Award.

 

Pop!:  I got a copy from the public library, and I was prepared for the worst.  Wallington is a writer for such shows as Sex and the City, Veronica Mars, and Courting Alex, and anything that has to do with teenage sexuality is frequently problematic anyway.  In the book, 17-year-old Marit has decided that being a virgin is getting in the way of holding onto a boyfriend she really likes. So she decides to lose it with her best guy friend, Jamie, since it will be pressure free.

 

The book is well written and captures perfectly the trials and tribulations of being a teenage girl, including peer pressure and great expectations that turn out not to be so great.  Certain parts of the books are so real, such as Marit getting dressed just before her boyfriend, Jamie, arrives, and interacting with her father the day after - they can move the parent of a teenager to tears.  Although the book feels like “chick-lit” and there is at least one reference to Cosmopolitan, the situations are realistic, and there are clear choices and lessons to be learned.

 

The teens are not represented as mindless slaves to the ravages of hormones, but as good students, and aside from the usual nasty, cat-fighting clique, respectful of each other.  They think and plan ahead. And parents are involved, but as usual, teenagers cannot speak to them about sex -- they go to their friends first.  For example, Marit gets advice from her older sister and a condom from her stash, but she does not need it since Jamie brings his own. There is no sexual exploitation, coercion or violence in this story, and although Marit is pressuring Jamie as much or more than he is pressuring her, the reader cannot be angry at him for being an inexperienced teenage boy.  Marit wonders what all the fuss is about, until one of her friends who is pregnant has morning sickness in the bathroom at school.  After that graphic message on some of the consequences of sex, Marit decides that it might not be worth it after all.

 

Pop! is as graphic as it needs to be, but certainly not as graphic as the Cosmo sex articles that girls can pick up with their gum, breath mints, and condoms (but not their Plan B) at the counter of the local drugstore. The title refers the bubbles that com out of a can of soda.  Marit says, “I felt carbonated, like little bubbles of happiness were fizzing up inside me, pop, pop, pop.”  In the end, she is happy to discover that, “maybe, just maybe I could still end up with everything I wanted -- a boyfriend, love, sex… But the important thing was that I still had my friends.”

 

The Higher Power of Lucky:  This book, which won a Newbery Award, faces similar problems, but for a slightly different reason.  The book has already been banned from school libraries in a handful of states in the South, the West and the Northeast, and librarians in other schools have indicated in an online debate that they may well follow suit.  Pat Scales, former chair of the Newbery Award committee, said that declining to stock the book in libraries was nothing short of censorship. However, Dana Nilsson, a teacher and librarian at Sunnyside Elementary School in Durango, Colo., said she had heard from dozens of librarians who agreed with her stance. “I don't want to start an issue about censorship,” Nilsson said. “But you won't find men's genitalia in quality literature.”

 

In the book, a tough young girl named Lucky lives with her foster mother, Bridgette, in a town called Hard Pan.  Lucky has a job sweeping up the town hall where 12-step meetings are held, and during one of these meetings, she listens in as one of the attendees confesses that he stopped drinking when he saw a rattlesnake bite his dog on the scrotum.  Amazingly, it is the appropriate use of this word in context that has caused all the furor.  

 

The Higher Power of Lucky is gut-wrenching and gritty, reminiscent of Sounder by William H. Armstrong, a harrowing tale of young black boy and the victimization of his family in the Deep South.    The Higher Power of Lucky is well-written in the same tradition as many young adult classics and well deserved the Newbery Award.  It is difficult to understand how a librarian could be upset over an anatomically correct word used to educate children about sexual predation. Although the subject matter of the book is far from genteel and polite, the censorship that has followed the book is much more disturbing than any anatomical reference.  All of us in the trenches need to be vocal and vigilant as we continue to fight against the censorship and politics that threaten the health and well-being of our children in the name of decorum and decency.  Denial of the real dangers faced by children and teenagers and the real reasons for censorship is neither polite nor moral.

JOB CORNER

POSITIONS AVAILABLE

 

MATERNAL AND CHILD HEALTH FACULTY:  School of Public Health, University of Alabama at Birmingham.  The Department of Maternal and Child Health invites applicants for a tenured or tenure-track faculty position at the Professor or Associate Professor level.  Projected start date is spring or fall, 2008.  Candidates must have an earned doctorate with relevant MCH-related education and/or experience.  Evidence of good analytical skills and of success in obtaining extramural funding and publishing is essential. Current research funding with an active research program is highly preferred. Experience in the practice of public health in domestic or international settings is highly desirable, including program planning and evaluation, needs assessment, performance monitoring, systems development, and advocacy. Interested persons should submit a letter describing their qualifications for the position, curriculum vitae, and the names of three references to:  Chair, MCH Faculty Search Committee, Department of Maternal and Child Health, School of Public Health, UAB, 1530 3rd Avenue South - RPHB 320, Birmingham, AL 35294-0022, (205) 934-7161 (phone), (205) 934-8248 (fax), rkirby@uab.edu (e-mail).

 

ASSISTANT PROFESSOR IN WOMEN’S STUDIES:  California State University Long Beach, Department of Women’s Studies.  Searching for a specialist in feminist health studies, with an emphasis in urban and community public health or health policy, and sexuality and sex education.  Applicants must have a PhD in health science or related field at the time of appointment, have demonstrated excellence in teaching at the university/college level, evidence of potential for successful research and publication, and an ability to communicate effectively with an ethnically and culturally diverse campus community.  Preferred qualifications also include grant writing experience and a record of community activism. We welcome applicants interested in developing student opportunities for research and/or activism. Probably salary range is $59,000-$61,000, depending on background and experience. Send letter of application, current c.v., three current letters of recommendation, and official transcript from institution awarding highest degree. Position open until filled (or recruitment cancelled). Review of applications to begin Nov. 9, 2007.  Applications, required documentation, and/or requests for information should be addressed to Wendy Griffin, Chair, Department of Women’s Studies, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840-1601. http://www.csulb.edu/depts/womens-studies/

 

 

POSITIONS WANTED

 

Physician Seeks Position in MCH, Adolescent Health, Public Health:  Pediatrician with experience in prevention, urgent care, trauma care, and emergency ambulatory pediatrics seeks full-time position.  Licensed in California, Massachusetts, and Texas, MPH from University of California Berkeley.  Fluent in Spanish and five other languages.  Experience as a public health officer.  For full c.v. or for more information, contact Dr. Isaac Jakubowicz at greatpediatrician@yahoo.com.

HEADLINES

·         Spike in Kids' Health Issues Foretells Problems : The number of U.S. children with chronic health problems such as obesity has soared in the past four decades, foreshadowing increases in adult disability and public health-care spending, researchers said. http://www.msnbc.msn.com/id/19441193/from/ET/

 

·         Low Birth-Weight and Obesity Rates Both on the Rise in U.S. Kids:  Bethesda, Md. -- More low birthweight infants are being born, but older kids are heavier than ever, according to the federal government's latest snapshot of child health.            http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb2/6148

 

·         Child Abuse Increases When Soldier Parent is Deployed:  Research Triangle Park, N.C. --   Things may not be all quiet on the home front. When soldiers deploy for combat, child abuse and neglect increase as does stress for the spouses left behind, researchers here said. http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb2/6305

 

·         Rapid Improvement Seen in State-Mandated Newborn Screening Programs:  White Plains, N.Y. -- Nearly nine out of 10 infants are screened at birth for at least 21 life-threatening disorders, more than twice as many as in 2005,  thanks to an expansion of state-required testing programs.  http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/tb2/6129

 

·         CDC Cites Progress on Childhood Immunization Goals:  Atlanta -- Most states met national vaccination objectives for children in kindergarten during the 2006-2007 school year, according to a study by the CDC.      http://www.medpagetoday.com/InfectiousDisease/PublicHealth/tb2/6440

 

·         Underinsured Children Shut Out From Recommended Vaccines:  Boston -- Children by the millions may not be protected against meningococcal or pneumococcal infections because private insurance plans and state and federal governments have gaps in their coverage of the vaccines.          http://www.medpagetoday.com/Pediatrics/Vaccines/tb2/6359

 

·         HPV Vaccine May Stem Incidence of Throat Cancer:  Houston -- Human papilloma virus infections are likely buoying up oropharyngeal cancer rates while other head and neck cancers decline, researchers said.       http://www.medpagetoday.com/InfectiousDisease/STDs/tb2/6508

 

·         Inadequate Vitamin D Levels Common Among Children (CME/CE):  Philadelphia -- Half of otherwise healthy children and adolescents in the northeastern United States do not get enough vitamin D, researchers found. http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/dh/6105

 

·         Exercise and Nutrition Outweigh Diet in Childhood Obesity:  New Haven, Conn. --  Childhood obesity can be overcome by an intensive family-based program that includes supervised exercise and nutrition education, found researchers here. But dieting wasn't the answer.http://www.medpagetoday.com/Pediatrics/Obesity/tb2/6032

 

·         Picky Eaters Less Picky if Carrots Come in a McDonald’s Wrapper:  Stanford, Calif. -- Among the 3- to 5-year-old crowd, the happiest  and tastiest  meals are likely to be those that come in a  McDonald’s wrapper, even if the food is not from McDonald’s. http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb2/6351

 

·         Neural Tube Defects Decline After Folic Acid Fortification:  Quebec City, Quebec -- Folic acid supplementation of white flour and cereal products in Canada reduced neural tube defects by 46 percent, researchers reported.             http://www.medpagetoday.com/Neurology/GeneralNeurology/tb2/6136

 

·         Hospitals May Overfeed Newly Born Babies With Formula:  Winnipeg, Manitoba -- Physiologically appropriate infant weight loss is less for babies fed formula in the hospital than for those who are breastfed, suggesting that hospitals feed too much, researchers said. http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb2/6474

 

·         Breastfeeding Rates Only Half-Way to 2010 Goals:  Atlanta -- About 30 percent of  babies born in the United States in 2004 were exclusively breastfed for the first three months, and by six months only 11.3 percent of babies were exclusively breastfed, CDC investigators found.         http://www.medpagetoday.com/Pediatrics/Parenting/tb2/6342

 

·         Pregnancy Not a Grace Period for Junk Food:  London -- An eating for two approach to junk food during pregnancy and breastfeeding may boost baby's appetite for the same and lead to obesity, researchers said.  http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb2/6424

 

·         Pre-pregnancy Obesity a Risk for Structural Birth Defects:  Houston -- If Mom is obese before pregnancy, her newborn is at greater risk for spina bifida or one of six other structural malformations, researchers reported. http://www.medpagetoday.com/OBGYN/Pregnancy/tb2/6352

 

·         Assisted Reproduction May Increase Umbilical Abnormality Risks:  Lyon, France -- As the complexity of assisted reproduction techniques increases, so does the frequency of umbilical cord abnormalities, Belgian investigators reported here.          http://www.medpagetoday.com/MeetingCoverage/ESHREMeeting/tb2/6096

 

·         Preventive Induced Labor Slows Caesarean Section Rate:  Philadelphia -- The rising rate of Caesarean deliveries might be slowed by preventive labor induction, researchers here said.  http://www.medpagetoday.com/OBGYN/Pregnancy/tb2/6301

 

·         More U.S. Women Dying in Childbirth:  U.S. women are dying from childbirth at the highest rate in decades, new government figures show. Though the risk of death is very small, experts believe increasing maternal obesity and a jump in Caesarean sections are partly to blame.  http://www.msnbc.msn.com/id/20427256/from/ET/

 

·         Cervical Cancer Screening Goes Do-It-Yourself:  Vancouver, BC -- Asking patients to collect their own vaginal specimens for HPV testing proved an effective initial screening method among high risk women, researchers here found.  http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb2/6513

 

·         Gestational Diabetes Findings Show No Risk Cut-off:  Chicago, IL -- Elevated glucose levels during pregnancy appear to increase risks to mother and baby even at levels below current criteria for gestational diabetes, researchers reported here.  http://www.medpagetoday.com/MeetingCoverage/ADAMeeting/tb2/6003

 

·         Mothers’ Gestational Diabetes Foretells Obesity for Kids:  Oakland, Calif. -- Untreated gestational diabetes nearly doubles the risk that offspring will be obese by kindergarten age, but treatment of maternal hyperglycemia can prevent it, said investigators here.  http://www.medpagetoday.com/Endocrinology/Diabetes/tb2/6520 

 

·         Type 2 Diabetes Reaches More Into Childhood:  Denver -- Type 2 diabetes is no longer the adult onset disease it once was. More and more children with diabetes are type 2 these days, researchers found.      http://www.medpagetoday.com/Endocrinology/Diabetes/tb2/6031

 

·         New Asthma Guidelines Emphasize Disease Control and Patient Empowerment: Bethesda, Md. -- Emphasizing that asthma affects different patients in different ways, the National Asthma Education and Prevention Program has issued new evidence-based guidelines on the disease.                   http://www.medpagetoday.com/Pulmonary/Asthma/tb2/6540 

 

·         Antibiotic Use in Infants Boosts Asthma Risk:  Winnipeg, Manitoba -- Children who are given antibiotics during the first year of life may be at significantly greater risk of developing asthma, researchers here found.             http://www.medpagetoday.com/AllergyImmunology/Asthma/tb2/5905

 

·         Large Trial Shows Corticosteroids Do Not Help Against Infant Wheeze:  Salt Lake City, Utah -- Corticosteroids appear to be ineffective against first episode bronchiolitis in infants, despite frequent emergency room use, researchers said.                http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb2/6259

 

·         Adolescent Wheeze Could Be Vocal Cord Dysfunction:  Columbus, Ohio -- Spirometry can help emergency departments distinguish between the wheezing of acute asthma in adolescents and vocal cord dysfunction, found investigators here.  http://www.medpagetoday.com/Pulmonary/Asthma/tb2/6514

 

·         Poor Lung Function at Birth a Risk for Adult COPD:  Tucson, Ariz. -- For many adults with poor airway function or COPD, the genesis of the problem may have been in the womb, researchers reported. http://www.medpagetoday.com/Pulmonary/SmokingCOPD/tb2/6552 

 

·         Video Baby Brain Boosters May Not Create Einsteins:  Seattle -- A child's language development may actually suffer from early exposure to DVDs and videos, investigators here have found.         http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb2/6361

 

·         Hearing Difference May be SIDS Marker:  Seattle -- Newborn hearing tests may provide a marker for infants at risk for sudden infant death syndrome, researchers found.  http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb2/6313

 

·         Childhood Hypertension Usually Goes Undiagnosed:  Boston -- Childhood hypertension is there, if only pediatricians would look for it.  But most of the time, they do not, investigators here reported.         http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb2/6466

 

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