Maternal Child Health Newsletter 04/01/05

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Maternal Child Health Newsletter 04/01/05

Postby denise » Fri Apr 01, 2005 04:37 pm

MCH Alert
Tomorrow's Policy Today

Maternal and Child Health Library

This and past issues of the MCH Alert are available at

April 1, 2005

1. Model Policies Provide Guidance to Local School Districts in Promoting
Nutrition and Physical Activity
2. Issue Brief Highlights Racial Disparities in Health Care
3. Report Summarizes History and Accomplishments of the Rubella
Vaccination Program
4. Article Explores Ethical Implications of Health Literacy and the Steps
Needed to Promote It
5. Authors Describe Development of Tool to Assess Quality of State Public
Health Plans



Model School Wellness Policies is a comprehensive set of model nutrition
and physical activity policies intended to provide guidance to local
school districts on promoting nutrition and physical activity and
addressing obesity. The model policies were developed by the National
Alliance for Nutrition and Activity in response to requests for guidance
in meeting the new federal requirements of the Child Nutrition and WIC
Reauthorization Act of 2004. (The act requires that all school districts
with federally funded school meals programs develop and implement wellness
policies by the start of the 2006-2007 school year.) The policies are
based on nutrition science, public health research, and existing practices
from exemplary states and local school districts around the county. Topics
include school health councils, nutritional quality of foods and beverages
sold and served on campus, nutrition and physical activity promotion and
food marketing, physical activity opportunities and physical education,
and monitoring and policy review. Links to additional resources are also
provided, along with information on using the model policies,
self-assessment and planning tools, and a list of supporting
organizations. School districts may use the model policies as written or
revise them to meet local needs and reflect community priorities. The
model policies and additional resources are available at



Policy Challenges and Opportunities in Closing the Racial/Ethnic Divide in
Health Care highlights policy challenges and opportunities for addressing
racial and ethnic disparities in health care. The issue brief, produced by
the Kaiser Family Foundation, reviews evidence underpinning five broad
areas of policy initiatives that flow from recommendations made in the
Institute of Medicine's 2002 report, Unequal Treatment: Confronting Racial
and Ethnic Disparities in Care. These areas include (1) raising public and
provider awareness, (2) expanding health coverage, (3) improving the
number and capacity of providers in underserved communities, (4) improving
health care quality, and (5) increasing the knowledge base. The brief also
presents information on next steps in addressing health care disparities.
The brief is available at

Readers: More information about racial and ethnic disparities in maternal
and child health is available from the MCH Library's knowledge path at and bibliography at ... ar&-search.



"Rubella is no longer endemic in the United States," state the authors of
a report published in the March 21, 2005, issue of Morbidity and Mortality
Weekly Report. Usually a mild rash illness, rubella (also called German
measles) can have devastating effects when a pregnant woman is infected,
especially during the first trimester of pregnancy. In October 2004, the
Centers for Disease Control and Prevention convened an independent panel
of internationally recognized authorities on public health, infectious
disease, and immunization to assess progress toward eliminating rubella
and congenital rubella syndrome (CRS) in the United States,. Eliminating
rubella and CRS is a national health objective for 2010. This report
summarizes the history and accomplishments of the rubella vaccination
program in the United States and the Western Hemisphere and the challenges
posed by rubella for the future.

The authors report that

* Since 2001, the annual numbers of rubella cases have been the lowest
ever recorded in the United States: 23 in 2001, 18 in 2002, 7 in 2003, and
9 in 2004. Approximately half of these cases have occurred among persons
born outside the United States, most of whom were born outside the Western

* As of 2004, a total of 43 of 44 countries and territories in the Western
Hemisphere had included rubella-containing vaccine in their routine
national immunization programs. For countries reporting rubella cases to
the Pan American Health Organization, the number of reported rubella cases
dropped from 135,947 in 1998 to fewer than 1,000 in 2003.

* According to a survey of the member countries in the World Health
Organization, the number of countries that have incorporated
rubella-containing vaccine into their routine national immunization
programs increased from 65 (33%) in 1996 to 110 (57%) in 2003. However,
rubella continues to be endemic in many parts of the world.

The authors conclude that the "United States should continue its vigilance
against rubella and CRS by 1) maintaining high vaccination rates among
children; 2) ensuring vaccination among women of childbearing age,
especially women born outside the United States; 3) continuing
surveillance of both rubella and CRS; and 4) responding rapidly to any

Centers for Disease Control and Prevention. 2005. Achievements in public
health: Elimination of rubella and congenital rubella syndrome -- United
States, 1969-2004. Morbidity and Mortality Weekly Report 54(Early
Release):1-4. Available at



"Progress in public health literacy will yield an informed, motivated
public with the skills and resources to make positive choices that enhance
individual and community health," state the authors of an article
published in the April 2005 issue of the American Journal of Preventive
Medicine. The authors point out that almost half of U.S. adults have
deficiencies in reading or computation skills and that minority
populations and older adults, who share the greatest burden of health
disparities, have the lowest literacy skills. This article describes the
role of health literacy (i.e., the degree to which individuals can obtain,
process, and understand basic health information and services needed to
make appropriate health decisions) for individuals, explores the ethical
imperatives of health literacy, and outlines the steps needed to create a
more health-literate society.

* The Role of Health Literacy
Research has consistently demonstrated far-reaching consequences for
people with low health literacy. For example, people with low health
literacy make more medical errors; are less likely to understand insurance
coverage rules; and fail to comply with treatments, obtain preventive
services, or manage their own care effectively. The gap between the
requisite skills and the actual skills of many adults to process and
understand health messages is growing. People with the greatest health
care needs often cannot comprehend the information required to
successfully navigate and function in the U.S. health care system.

* Ethical Imperatives of Health Literacy
Often, public health messages do not provide information the intended
audience can understand. Individuals should be able to understand health
messages without having to study the text closely or consult an expert, as
is often the case.

* The Vision: A Health-Literate America
Steps for achieving a more health-literate society are multifaceted and
involve at least the following six components: (1) define the meaning of
health literacy more comprehensively, (2) develop measures of public
health literacy, (3) critically evaluate communication efforts, (4) build
on health literacy efforts focused on the health care system by
emphasizing the verbal communication and listening skills of health
professionals, (5) recognize that health-related knowledge is necessary
but not sufficient for engaging in health behaviors, and (6) determine the
appropriate roles that public health and other professionals can play in a
collaborative effort to achieve increased health literacy.

The authors conclude that "we cannot ignore Americans who do not manage
their health nor improve their quality of life because they do not
understand how to do so. We must build a society where people can
understand and act on health information."

Gazmarian J, Curran J, Parker RM, et al. 2005. Public health literacy in
America: An ethical imperative. American Journal of Preventive Medicine
28(3):317-322. Abstract available at ... ec7e0ce264.



The SPI [State Planning Index] fills the need for an evaluation tool that
can be used to systematically evaluate the quality of state [public
health] plans," state the authors of an article published in the April
2005 issue of Preventing Chronic Disease. The article describes the
development of the SPI, an evaluation instrument to measure the quality of
public health plans at the state level. In an effort to understand the
relationship between plan quality and health outcomes in the long term,
the SPI was developed as part of the evaluation of the Centers for Disease
Control and Prevention's Nutrition and Physical Activity Program to
Prevent Obesity and Other Chronic Diseases. The SPI was needed to evaluate
state plans that were developed by state public health practitioners and
their community partners using a variety of public health planning models.

The authors reviewed published professional public health literature and
other relevant materials (guidelines, reports, and existing state plans)
and conducted key informant interviews with planning experts to identify
public health planning models. Planning processes that were considered
critical across the models were also identified, and a set of key
indicators of plan quality grouped within major components was developed.
Several rounds of formative evaluation were then conducted to assess item
inclusion, coverage, weighting, organization of items, and content
validity. The SPI was field tested by public health practitioners at the
federal and state levels who used it to rate 10 state public health
obesity-prevention plans.

The authors found that

* The final SPI included 60 items organized within nine components: (1)
involvement of stakeholders, (2) presentation of data on disease burden
and existing efforts to control obesity, (3) goals, (4) objectives, (5)
selecting population(s) and strategies for intervention, (6) integration
of strategies with other programs and implementation of plan, (7)
resources for implementation of plan, (8) evaluation, and (9)
accessibility of plan. A 5-point Likert scale ranging from 1 (low) to 5
(high) was used to score each item, each component, and overall plan
quality. A "not addressed" rating option was also provided. Items were
weighted equally, as were the nine SPI components.

* SPI field testers reported that the instrument was easy to use and
consistent with the judgments they apply as public health professionals in
assessing state plans.

"As public health practitioners continue to engage in planning to address
the growing burden of chronic disease in the United States, we hope that
the SPI will prove a useful tool to guide and evaluate planning," conclude
the authors.

Butterfoss FD, Dunet DO. 2005. State Plan Index: A tool for assessing the
quality of state public health plans. Preventing Chronic Disease
2(2):1-10. Full text available at


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Child Health and Georgetown University. MCH Alert is produced by Maternal
and Child Health Library at the National Center for Education in Maternal
and Child Health under its cooperative agreement (U02MC00001) with the
Maternal and Child Health Bureau, Health Resources and Services
Administration, U.S. Department of Health and Human Services. The Maternal
and Child Health Bureau reserves a royalty-free, nonexclusive, and
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The editors welcome your submissions, suggestions, and questions. Please
contact us at the address below.

MANAGING EDITOR: Jolene Bertness
CO-EDITOR: Tracy Lopez

MCH Alert
Maternal and Child Health Library
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Phone: (202) 784-9770
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Denise (29) Co-coordinator for WI
Jason (32)
Ariana (22 months)5/3/03-just shy of 35 weeks: Class 1 HELLP

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