Healthy people 2010 leading health indicators: how children with special health care needs fared.

OBJECTIVES: We compared estimates for children with and without special health care needs (SHCN) at 2 time periods for national health objectives related to the Healthy People 2010 leading health indicators (LHIs). METHODS: Data were from the 2003 and 2007 National Surveys of Children's Health. Seven survey items were relevant to the LHIs and available in both survey years: physical activity, obesity, household tobacco use, current insurance, personal health care provider, past-month depressive symptoms, and past-year emergency department visits. RESULTS: In 2003 and 2007, children with SHCN fared worse than those without SHCN with respect to physical activity, obesity, household tobacco exposure, depressive symptomology, and emergency department visits, but fared better on current insurance and having a personal health care provider. Physical activity and access to a personal health care provider increased for all children, whereas the absolute disparity in personal provider access decreased 4.9%. CONCLUSIONS: Significant disparities exist for key population health indicators between children with and without SHCN. Analyses illustrated how population-based initiatives could be used to frame health challenges among vulnerable populations.

A new framework for childhood health promotion: the role of policies and programs in building capacity and foundations of early childhood health.

Although the connection between early life experiences and later health is becoming increasingly clear, what is needed, now, is a new organizing framework for childhood health promotion, grounded in the latest science. We review the evidence base to identify the steps in the overall pathway to ensuring better health for all children. A key factor in optimizing health in early childhood is building capacities of parents and communities. Although often overlooked, capacities are integral to building the foundations of lifelong health in early childhood. We outline a framework for policymakers and practitioners to guide future decision-making and investments in early childhood health promotion.

Residency training and use of strategies to promote community child health one year after graduation.

OBJECTIVE: Training pediatricians to understand child health in the context of community and to develop skills to engage with community organizations remain priorities for residency education in the United States. Our objectives were to: 1) determine use of strategies to influence community child health by graduates of the Community Pediatrics Training Initiative (CPTI); and 2) to identify personal, practice, and residency program factors associated with use of strategies 1 year after residency. METHODS: Analysis of data from the Dyson Initiative National Evaluation included surveys of physicians ("graduates") 1 year after residency and surveys of CPTI program leaders. Graduates reported personal and practice characteristics and use of one or more strategies to influence community child health. Chi-square and logistic regression were used to examine associations between personal, practice, and programmatic factors with use of strategies. RESULTS: Of the 511 graduates (68% participation), 44% reported use of one or more strategies. After adjusting for residency site, time spent in general pediatrics, and program emphasis on individual level advocacy, we found that graduates were more likely to report using strategies if they felt responsible for improving community child health (adjusted odds ratio [aOR] 4.1, 95% confidence interval [95% CI] 2.5-6.9), had contact with a person who provides guidance about community pediatrics (aOR 1.8, CI 1.2-2.6), or trained in a program that places great emphasis on teaching population level advocacy skills (aOR 2.3, CI 1.3-4.2). CONCLUSIONS: Personal perspectives and residency education influence community involvement, even early in pediatricians' careers. Efforts are needed to understand how content and delivery of training influence community engagement over time.

Reducing exposure to environmental toxicants before birth: moving from risk perception to risk reduction.

In this study, we considered approaches to reducing maternal exposure to hazardous environmental toxicants, focusing on risk communication to pregnant women and providers, but also considering identification of environmental toxicants in the community and reduction of environmental toxicants. We addressed the following questions: (1) What do pregnant women and their providers know about environmental toxicants and perinatal health? and (2) What policy strategies are needed (should be considered) to move forward in risk reduction in this area? We reviewed the literature on knowledge of pregnant women and providers regarding these issues. While there is limited research on what pregnant women and their providers know about environmental toxicants and perinatal health, there is evidence of reproductive and perinatal toxicity. This article describes a wide range of policy strategies that could be implemented to address environmental toxicants in the context of perinatal health. Effective leadership in this area will likely require collaboration of both environmental health and maternal and child health leaders and organizations.

Community pediatrics: a consistent focus in residency training from 2002 to 2005.

OBJECTIVE: To assess changes in community pediatrics training from 2002 to 2005. METHODS: Pediatric residency program directors were surveyed in 2002 and 2005 to assess resident training experiences in community pediatrics. Program directors reported on the following: provision of training in community settings; inclusion of didactic and practical teaching on community health topics; resident involvement in legislative, advocacy, and community-based research activities; and emphasis placed on specific resources and training during resident recruitment. Cross-sectional and matched-pair analyses were conducted. RESULTS: A total of 168 program directors participated in 2002 (81% response rate), and 161 participated in 2005 (79% response rate). In both years, more than 50% of programs required resident involvement with schools, child care centers, and child protection teams. Compared with 2002, in 2005, more programs included didactic training on legislative advocacy (69% vs 53%, P < .01) and offered a practical experience in this area (53% vs 40%, P < .05). In 2005, program directors reported greater resident involvement in providing legislative testimony (P < .05), and greater emphasis was placed on child advocacy training during resident recruitment (P < .01). CONCLUSIONS: In the last several years, there has been a consistent focus on legislative activities and child advocacy in pediatric residency programs. These findings suggest a strong perceived value of these activities and should inform efforts to rethink the content of general pediatric residency training in the future.

The association between women's health information use and health care visits.

OBJECTIVE: To determine the effect of the type of information sources used on health services use. METHODS: Population-based random-digit dialing survey of 498 women, between December 1999 and January 2000, on use of health information sources and health visits. RESULTS: After adjustment for sociodemographic and medical factors, use of print health media and computer-based resources was associated with 1.9 and 1.6 more visits, respectively compared to non-use (Regression coefficients 1.9; [95% confidence interval {CI} 0.1, 3.7] and 1.6; [95% CI 0.3, 3.0]). CONCLUSIONS: Print health media and computer-based sources are associated with a higher number of health care visits.

Local health department perspectives on linkages among birthing hospitals.

OBJECTIVES: To describe perinatal linkages among hospitals, changes in their numbers and their impact on relationships among high-risk providers in local communities. STUDY DESIGN: Data were obtained about the organization of perinatal services in 1996-1999 from a cross-sectional study evaluating fetal and infant mortality review (FIMR) programs nationwide. Geographic areas were sampled based on region, population density, and the presence of a FIMR. A local health department representative was interviewed in 76% (N=193) of eligible communities; 188 provided data about hospitals. RESULTS: Linkages among all hospitals were reported in 143 communities and with a subspecialty hospital in 122. All but 12 communities had a maternity hospital, and changes in the number of hospitals occurred in 49 communities. Decreases in the number of Level II hospitals were related to changes in relationships among providers of high-risk care for mothers and newborns; they were associated with changing relationships only for mothers in Level I hospitals. These relations were noted only where established provider relationships existed. CONCLUSIONS: Decreases in the number of maternity hospitals affect provider relationships in communities, but only where there are established linkages among hospitals.

The relationship of race to women's use of health information resources.

OBJECTIVE: The purpose of this study was to examine, among the general public, the independent effect of race on women's use of health information resources. STUDY DESIGN: A population-based random-digit dialing survey of adult women, aged 18 to 64 years, was conducted between October 1999 and January 2000. Subjects included 509 women (341 white women, 135 black women, and 33 women of other races). The response rate was 66%. The main outcome variable was the use of health information resources (print health or news media, broadcast media, computer resources [Internet], health organizations, organized health events). Logistic regression was used to determine the independent effect of race/ethnicity on the use of different information resources, with an adjustment for age, income, education, and marital status. RESULTS: After the adjustment for socioeconomic factors, black women had <50% odds of using print news media (odds ratio, 0.5; 95% CI, 0.4-0.8), <60% odds of using computer-based resources (odds ratio, 0.4; 95% CI, 0.2-0.6), and <70% odds of using health policy organizations (odds ratio, 0.3; 95% CI, 0.2-0.7), compared with white women. CONCLUSION: There is a large racial disparity in women's use of health information resources. Traditional sources that are used to provide patient information may not be effective in certain populations.

Associations between maternal and child health status and patterns of medical care use.

OBJECTIVE: To determine associations in health status and health care utilization between mothers and their children. METHODS: Cross-sectional analysis of the 1996-97 Community Tracking Study Household Survey. Separate logistic regression models describing each type of service use were conducted and adjusted for child age, health status, mother age, race, education, and respondent type. Models incorporated maternal health care use, employment, poverty, child's insurance status, and family type as independent variables. RESULTS: Sample included 9803 mother-child pairs, for a weighted sample of 35 651 048 pairs. Compared to mothers reporting excellent health, mothers reporting very good to good health status and fair or poor health were more likely to have children in good, fair, or poor health (odds ratio 2.00, 95% confidence interval 1.63-2.45; and odds ratio 4.16, 3.36-5.15, respectively). For each of 5 types of service use, mothers' and children's use were strongly associated: 1+ physician visits (2.42, 2.07-2.84); 6+ physician visits (2.07, 1.80-2.37); emergency department use (2.01, 1.75-2.31); hospitalizations (1.56, 1.10-2.22); and mental health visits (7.07, 5.67-8.82). CONCLUSIONS: Associations in health service use were noted across a broad array of services for women and their children. These associations may reflect similar tendencies to seek care and suggest the need to consider patterns of maternal use in trying to understand and improve patterns of health care utilization for children.