National Healthy Start Association's MCH & Social Services Updates
The National Healthy Start Association regularly reviews research materials and other pertinent information regarding infant mortality, low birthweight, racial disparities in perinatal outcomes and other topics that relate to the field. Below are some recent findings from our review.
Two Articles from Children & Youth Funding Report
Teen Girls who Date Gang Members Exposed to Greater Risk of Pregnancy
Teenage girls who date gang members are almost twice as likely to become pregnant as their peers according to research by RTI International, the University of California San Francisco and the University of North Carolina. The study, published in the American Journal of Epidemiology, was based on relationships of 237 sexually active females between the ages of 14 to 19 in predominantly Latino neighborhoods in San Francisco.
While a girl's gang membership did not impact her chances of getting pregnant, girls whose boyfriends were gang members were twice as likely to get pregnant. Girls who dated boys who spent time in jail were also more likely than their peers to become pregnant. "Increased pregnancy incidence among young women with gang-involved partners highlights the importance of integrating reproductive health prevention into programs for gang-involved youth," the report says. "In addition, high pregnancy rates indicate a heightened risk for sexually transmitted infections." Researchers are not certain why 27.4% of the girls in the study became pregnant.
Info: http://aje.oxfordjournals.org/cgi/content/abstract/167/9/1102
Hispanic Youth Engage in Risky Behavior
Despite an overall up tick in the general health of most U.S. youth, Hispanic youth are not living healthier lives when compared to Black or White peers and continue to exhibit risky behaviors, such as drug use or risky sexual behavior, says a new government report.
Most youth in America are living healthier lives than their counterparts did in 1991, says the Centers for Disease Control and Prevention report, the 2007 National Youth Risk Behavior Survey, However, Hispanic students were more likely than their counterparts to use several kinds of illegal drugs, drink alcohol on school property, ride with a driver who had been drinking, attempt suicide, or practice unhealthy eating habits, such as going at least a day without eating to lose weight. Risky sexual behavior has remained steady for Hispanic youth, while it has dropped for White and Black students.
Among the findings:
- The number of youth that carried a weapon at least one day in the past 30 days declined from 26.1% in 1991 to 18% in 2007.
- Cigarette use declined from 23% in 2005 to 20% in 2007.
- Teens engaging in sexual intercourse with at least four partners declined from 18.7% in 1991 to 14.9% in 2007.
- Condom use increased from 46.2% in 1991 to 61.5% in 2007.
- Lifetime methamphetamine use declined from 6.2% in 2005 to 4.4% in 2007.
- Students reporting suicide attempts in the previous year declined from 8.4% in 2005 to 6.9% in 2007.
The report also noted that:
- 47.6% of Hispanics compared to 47.3% of Whites and 34.5% of Blacks reported currently using alcohol.
- 23.2% of Whites, 16.7% of Hispanics, and 11.6% of Blacks reported currently using tobacco products.
- 5.7% of Hispanics, 4.5% of Whites, and 1.9% of Black youth reported ever having used methamphetamines.
Info: www.cdc.gov/mmwr
Lead Tied to Criminal Behavior; Poisoning damages crucial brain matter, studies find
Two new studies of young adults who grew up in poor, inner-city neighborhoods in Cincinnati have found that childhood exposure to lead is linked to a significant loss of critical brain matter and to an increased risk of criminal behavior.
Researchers followed hundreds of children from the womb into their 20s and found an average loss of 1.2% in the volume of gray matter in the brain by the time they reached adulthood. That sounds minor, but researchers at the University of Cincinnati said the losses were concentrated in brain regions responsible for critical "executive" functions, such as impulse control, emotional regulation, judgment and the anticipation of consequences. That squares with previous research linking childhood lead exposure to behavioral problems. The research found that the losses were greater – 1.7% – among males.
A second study of the same young adults found evidence that such brain damage might also have grave consequences for society. The higher their blood lead concentrations during childhood, the study found, the more likely the subjects were to be arrested during adulthood, especially for violent offenses. The correlations held even when the data were controlled for such factors as the mother's IQ, education and socioeconomic status.
Taken together, the two studies provide powerful evidence for the potentially devastating consequences of childhood lead exposure, said Ellen K. Silbergeld, professor of health sciences at the Johns Hopkins Bloomberg School of Public Heath. Silbergeld has studied Baltimore's similar lead poisoning problem but was not involved in either Cincinnati study.
Because researchers followed the same group into adulthood and controlled for so many other factors, "we have … a fair degree of confidence that these findings are very likely to be related specifically to lead and are not explainable by other possible exposures these adults could have had," she said. Silbergeld said the findings also suggest that the Bush administration's recent refusal to lower key lead safety levels to standards recommended by many scientists was inconsistent with the latest research. These two studies "strongly challenge these recent decisions, and in the minds of many of us indicates there was very little scientific justification for these decisions," she said.
Both studies were published May 27th by the online journal PLoS, sponsored by the Public Library of Science, a nonprofit organization founded to provide free and immediate access to peer-reviewed studies. The first, led by Kim M. Cecil, an imaging scientist at the University of Cincinnati College of Medicine, conducted MRI scans of the brains of 157 people. All had been part of the Cincinnati Lead Study since infancy.
The scans broke each of the participants' brain images into millions of volume elements and compared them to one another. Those data were then compared with blood lead levels measured every three months until the participants were five years old, every six months until they were six or seven years old, and several more times during their teen years.
There was strong statistical evidence that those who had the highest lead exposures as children had significantly smaller brain volumes. And the deficits were focused mainly in areas of the brain called the pre-frontal cortex and anterior cingulate cortex, associated with judgment, attention, decision-making, and impulse control. That "corresponds nicely," Cecil said, with previous epidemiological and psychological studies that have found those kinds of behavioral problems among children exposed to lead.
And because they had a wealth of other data gathered during their subjects' childhood, the researchers were able to sort through potential factors that might explain the brain losses, such as birth weight, smoking, alcohol or drug use by mothers or children as they grew up. The fact that nearly all of the subjects were Black and grew up in inner-city poverty eliminated other socioeconomic variables that might obscure the links between lead and brain loss.
In the second study, researchers led by Kim N. Dietrich, also at the University of Cincinnati College of Medicine, followed the same subjects and measured their blood lead exposure against their arrests at age 18 and older. Although previous studies have found correlations between lead exposure in urban settings and crime rates, this is the first to measure lead exposure in specific children and track their criminal behavior as adults.
While 45% of the subjects had no arrest record, Dietrich's team found that for every increase of five micrograms per deciliter in a child's blood lead level, there was a 30% increase in arrest rate for violent offenses. Although children now generally have lower lead exposure than those in the 1980s, when these Cincinnati youths grew up, Dietrich said, "we have seen effects of lead below five micrograms [per deciliter]." They include attention deficit disorder, hyperactivity, and conduct and cognition disorders. The federal "action" standard for medical concern remains 10 micrograms.
The studies provide a warning, he said. "It doesn't take a lot of imagination to suspect that this [level of exposure] will also cause problems and affect conduct later on."
Roylance, Frank D., Baltimore Sun, May 28, 2008
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Germs May Play Role in Sudden Baby Deaths: Dangerous bacteria including staph, E. coli found in half of SIDS cases
A baffling phenomenon known as sudden infant death syndrome is one of the leading causes of death for children under one. Now, researchers say they may have found a contributing factor: bacteria. They found potentially dangerous bacteria such as Staphylococcus aureus and E. coli in nearly half of all babies who died suddenly and without explanation over a decade at a London hospital. Their findings are in May 30th’s Lancet medical journal. "This may be another piece to the puzzle,'' said Marian Willinger, a SIDS expert at the U.S. National Institute of Child Health and Human Development who was not connected to the British study.
The researchers cautioned, however, that while the bacteria were found in the SIDS babies, that does not necessarily mean the bugs were responsible. Bacterial infections have long been suspected by some doctors to play a role in SIDS. "We don't know whether it's a cause or if it's identifying another potential risk factor,'' said Dr. Nigel Klein, a professor at the Great Ormond Street Hospital for Children, where the study was conducted, and one of the paper's authors. He said that the higher level of bacteria might be evidence of another condition that killed the baby, such as a room that was too hot or had poor ventilation. Or it may have been coincidental.
A SIDS diagnosis means that no other cause of death can be found in an otherwise healthy infant who dies suddenly, usually in their sleep. In the United States, SIDS kills more than 2,000 infants every year.
The researchers used autopsy samples from 470 infants who died suddenly and unexpectedly between 1996 and 2005. They found dangerous bacteria in 181 babies, or nearly half of the 365 whose deaths were unexplained. There were similar bacteria in about a quarter (14 of 53) of the babies who died of known causes, excluding those who died of bacterial infections.
Bacteria found in lungs, spleens
Most of the bacteria were detected in the babies' lungs and spleens. At birth, mothers transfer some of their antibodies against infection to their babies. But when babies are from eight to 10 weeks old, the maternal antibodies have nearly run out and the babies typically have not started producing enough of their own. That could make them particularly vulnerable to bacterial infections, said James Morris, a pathologist at the Royal Infirmary in Lancaster, who co-authored an accompanying commentary in the journal. SIDS typically strikes when babies are between eight and 10 weeks old. "The study is a good indicator that certain bacteria might be involved in causing sudden infant deaths,'' he said.
Willinger suggested that bacterial infections in infants might simply aggravate other risk factors for SIDS, such as smoke exposure or babies sleeping on their stomachs. "The bacteria in combination with other co-factors might push these babies over the edge,'' she said. Recommendations for preventing SIDS include putting babies to sleep on their backs and avoiding putting too many blankets on them.
URL: http://www.msnbc.msn.com/id/24879770/
MSNBC.com, May 20, 2008
Mothers’ High Normal Blood Sugar Levels Place Infants at Risk for Birth Problems
Pregnant women with blood sugar levels in the higher range of normal – but not high enough to be considered diabetes – are more likely than women with lower blood sugar levels to give birth to babies at risk for many of the same problems seen in babies born to women with diabetes during pregnancy, according to a study funded in large part by the National Institutes of Health.
These problems included a greater likelihood for Caesarean delivery and an abnormally large body size at birth. Infants born to women with higher blood sugar levels were also at risk for shoulder dystocia, a condition occurring during birth, in which an infant’s shoulder becomes lodged inside the mother’s body, effectively halting the birth process.
The study authors declined to make recommendations for acceptable blood sugar levels for pregnant women. The researchers were unable to identify a precise level where an elevation in blood sugar increased the risk for any of the outcomes observed in the study. Rather, the chances for the outcomes were observed to increase gradually, corresponding with increases in the women’s blood sugar levels.
It is well known that high blood sugar levels characteristic of the diabetes that occurs during pregnancy present risks for expectant mothers and the infants born to them. The current study is the first to document that higher blood sugar levels, not high enough to be considered diabetes, also convey these increased risks. Furthermore, when the researchers mathematically adjusted for other potential causes of these risks – such as older maternal age, obesity, and high blood pressure – the increased risks due to higher blood sugar levels were still present.
“These important new findings highlight the risks of elevated blood sugar levels during pregnancy,” said Duane Alexander, M.D., director of the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, which provided much of the funding for the study. “NIH-supported studies now in progress will provide guidance on how to manage them. Until the results of those studies are available, all pregnant women should consult a health care professional about being screened for diabetes during pregnancy.”
Additional NIH funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Center for Research Resources. Diabetes results from difficulty transferring sugar (glucose) from the blood to the body’s tissues. It occurs in roughly 5% of all pregnancies in the United States. Mothers with diabetes during pregnancy are also at increased risk for preeclampsia, a potentially fatal disorder involving dangerously high blood pressure. Babies born to mothers with diabetes – when they reach adulthood – are at higher risk for obesity as well as diabetes, high blood pressure, and heart disease. The seven-year study involved more than 23,000 pregnant women at 15 centers in nine countries.
The results of the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study appear in the May 8 New England Journal of Medicine. The researchers were led by Boyd E. Metzger, M.D. Professor of Medicine at the Northwestern University Feinberg School of Medicine in Chicago. Dr. Metzger explained that before the current study, physicians were not sure at which point elevated maternal blood sugar posed a risk for the baby. Frequently, high maternal blood sugar levels accompany such conditions as obesity, high blood pressure and older maternal age – all known to increase the likelihood for Caesarean delivery. For this reason, it wasn’t known whether the increased risk for Caesarean delivery and other problems seen with mild elevations in blood sugar during pregnancy were caused by the elevated blood sugar levels, or by these accompanying conditions. In their study, however, the researchers made adjustments for these accompanying conditions and found that the higher blood sugar levels still conveyed increased risks.
To conduct the study, the researchers performed an oral glucose tolerance test on each woman, from the 24th through the 32nd week of pregnancy. For the test, the women fasted, after which their blood glucose level was measured. Next, the women drank a glucose solution, and then their blood glucose was measured at predetermined intervals. Women with blood sugar levels high enough to raise safety concerns were referred for treatment and were not included in the study. The remaining women were observed throughout the study until they gave birth.
The researchers found that the higher the mother’s blood sugar levels, the greater the chances that they would deliver by Caesarean section. In addition, the higher the mother’s blood sugar levels, the more likely the infants were to have high insulin levels and low blood sugar levels at birth. Both conditions indicate exposure to high glucose levels in the womb. Moreover, the higher the mother’s blood sugar levels, the more likely the women were to develop preeclampsia, and the more likely their infants were to be born prematurely, and to experience shoulder dystocia. So, for example, women with the lowest fasting blood sugar levels gave birth to abnormally large babies roughly 5% of the time, while women with the highest blood sugar level gave birth to large babies 26% of the time. “These relationships are continuous and generally increase incrementally over the range of blood glucose levels we saw in the study,” he said.
NIH News, May 7, 2008
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Healthy Start Projects Page
Click: Information for Healthy Start Projects and, then, scroll down for a list of potential funding opportunities.
June Health Observances (partial list)
• Fireworks Safety Month, www.preventblindness.org
• Home Safety Month, www.homesafetycouncil.org/homesafetymonth
Coming in July (partial list)
• Juvenile Arthritis Awareness Month, www.arthritis.org
Coming in August (partial list)
- Children’s Eye Health and Safety Month, www.preventblindness.org
- National Immunization Awareness Month, www.cdc.gov/vaccines
resources that might be of interest to you.
Women at Greater Risk of Economic Insecurity: A Gender Analysis of the Rockefeller Foundation's American Worker Survey, The Institute for Women’s Policy Research (IWPR) conducts research to address the needs of women, promote public dialogue and strengthen families, communities, and societies. Go to www.iwpr.org.
New from the Commonwealth Fund: Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help, 2008; http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=687669
Improving Breastfeeding Support in Hospitals, Centers for Disease Control & Prevention, http://www.cdc.gov/Features/WelcomingBaby/, June 16, 2008
Try Glass When Shopping for Baby Bottles, Mayo Clinic, http://www.mayoclinic.com/health.baby-bottles/MY00034, April 23, 2008
For information on gestational diabetes and links to publications on that topic, see http://www.nichd.nih.gov/health/topics/Gestational_Diabetes.cfm
Information on nutrition during pregnancy is available at http://mypyramid.gov/mypyramidmoms/index.html.
From Child Trends E-Newsletter:
Ten Promising Practices for Fatherhood Programs
An increasing number of programs focus on improving fathers' involvement with children and families. What features of fatherhood programs really matter? A new National Responsible Fatherhood Clearinghouse brief authored by Child Trends examines experimental evaluations of fatherhood and parenting programs to identify ten promising practices. A more detailed report provides additional information about the evaluated fatherhood programs.
What Works for Adolescent Reproductive Health: Lessons from Experimental Evaluations of Programs and Interventions
This Child Trends fact sheet (http://www.childtrends.org/Files/Child_Trends-2008_05_20_FS_WhatWorksRepro.pdf) reviews evaluated programs that focus on adolescent reproductive health. The fact sheet includes a table that shows whether the evaluated programs were found to work, not proven to work, or had mixed findings.
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