|
|
|
Community
918 / 585-5551 phone The Council is a citizen- Questions or comments Copyright© 2009 |
Family Health - Articles, Resources, Links This page features a collection of downloadable past articles, reports, and links related to family health. Text of some of the articles is included on this page; for many others, the title is listed and a link is provided. See also: Family Health Coalition page Selected CDC resources & links CSC Data page CSC U.S. Census Information Center
TULSA AND OKLAHOMA FOCUS Covering Kids report, July '05. Go to www.oica.org to subscribe to a recommended free e-newsletter on family health. "Special Deliveries" - Summer 2004 - download the Family Health Coalition newsletter (a Word file). Summer 2003 issue Community Health Newsletter - a newsletter from Community HealthNet, Inc. and the Community HealthNet Consortium. Many thanks to Dr. Dan Plunket for the initial draft and to all the other “Net” members who contributed to formatting and editing.
Tulsa Area Immunization Coalition - website:
www.tulsaimmunize.com.
Maternal & Child Health and Social Services Update: www.healthystartassoc.org -- click the link for the Update. There is a print version you can download and circulate to staff, consumers, consortia and other interested parties. Public policy issue brief: The Uninsured in
Oklahoma: Who are they and why don't they have insurance?
- available at:
http://www.captc.org/pubpol/Medicaid/Oklahoma_uninsured.pdf.
Health Care in America: Trends in Utilization - 2004 publication from CDC Prematurity - a bigger problem than you think - new March of Dimes PowerPoint presentation by Karla Damus from Albert Einstein University
Language and Culturally Specific Guides to
Breastfeeding -
A new guide to breastfeeding for American Indian and
Alaska Native Families is available through the National Women's
Health Information Center (NWHIC). This resource explains benefits of
breastfeeding for mom, baby and society. In addition, it provides
information on how this issue is addressed in these communities, the
importance of breastfeeding in these cultures and instruction on how
to talk to a healthcare provider about breastfeeding. For this guide,
go to:
http://www.4women.gov/Breastfeeding/EasyGuide.NA.pdf.
Breastfeeding information packets are also available for free in English, Spanish and Chinese. These information sheets are available through NWHIC's toll-free number 1-800-994-9662 and online and may be reproduced as necessary. Community Health Newsletter - first edition of Community Health, a newsletter from Community HealthNet, Inc. and the Community HealthNet Consortium 11/17/03 – Articles excerpted for the CSCTulsa.org website from MCH Update e-newsletter
National Women's Health Report: Women and Depression/August 2003 Chicago report on Hispanic parents' views about child care Download the summer 2003 issue of "SPECIAL DELIVERY - Sharing Information Regarding Family Health Issues With Tulsa's Professional Community" - A Periodic Publication Of The Community Service Council’s Family Health Coalition, Subcommittee on Tulsa Community Systems Evaluation US Birth Rate Reaches Record Low
Public
Policy Brief - Public Cost of Teen Childbearing;
Teen
Pregnancy Facts and
Maps The State Health Department operates a PRAMS (Pregnancy Risk Assessment Monitoring System). That project has an "archives" with past studies available as PDF files. The address is http://www.health.state.ok.us/program/mchp&e/pramarch.html. New Birth Report Shows More Moms Get Prenatal Care. December 18, 2002 -- DHHS Press Release Post-partum depression, July 2002 article from New England Journal of Medicine A WORKING SOLUTION - Welfare Reform: The Next Generation - article by Doug Nelson, President of the Annie E. Casey Foundation, July 2002 Side Effects of Welfare Law: the No Parent Family - NY Times Article, 7/29/02 Too Many Interventions, and Too Many Preemies -- NY Times Article, 8/02 Depression, Alcohol Use Linked in Pregnant Women - 7/15/2002. Women who are depressed during their pregnancy are more likely to binge drink, a finding that could have implications for programs aimed at preventing fetal alcohol syndrome (FAS). Preventing Fetal Alcohol Syndrome -- article (available to download as a Word file), website link HHS Report Shows More American Children with Health Coverage -- article (available to download as a Word file), website link Infant Deaths, Kids Smoking Decline -- article (available to download as a Word file), website link JAMA Article 7/9/02: Hormone Therapy Study Stopped Due to Increased Breast Cancer Risk - read more May 2002 CSC publication, Depression and Pregnancy (Available to download as a Word file) Report -- Teen Births in Oklahoma -- introduction; analysis. (Available to download as two PDF files; requires Acrobat Reader.) Data reports - maternal/infant health Women's Health USA 2002. (Available to download as a PDF file; requires Acrobat Reader.) Report published by the Maternal and Child Health Bureau, U.S. Department of Health and Human Services, Health Resources and Services Administration. New report, now available here: The Uninsured in Oklahoma -----------------------------------------------------------------
11/17 --
1/6/04 -- U.S. Teens More Overweight than Youth in 14 Other Countries
U.S. teens are more likely to be overweight than are
teens from 14 other industrialized nations, according to survey
information collected in 1997 and 1998 by two agencies of the
Department of Health and Human Services as well as institutions in
13 European countries and in Israel. The study appears in the
January issue of "The Archives of Pediatrics & Adolescent Medicine".
"Overweight adolescents have an increased likelihood of being
overweight during adulthood, and adult overweight increases the risk
for such health problems as heart disease and diabetes," said Duane
Alexander, M.D., Director of the NICHD. "Since most obese
adolescents remain obese as adults, this age group is a very
important group to reach through preventive programs addressing
issues of diet and sedentary lifestyles," the study authors wrote.
The NICHD is part of the National Institutes of Health (NIH), the
biomedical research arm of the federal government. NIH is an agency
of the U.S. Department of Health and Human Services. The NICHD
sponsors research on development, before and after birth; maternal,
child, and family health; reproductive biology and population
issues; and medical rehabilitation.
10/30 -- Toolkit Helps Increase Knowledge and Awareness of Emergency Contraception Building Emergency Contraception Awareness Among Adolescents: A Toolkit for Schools and Community-Based Organizations is designed to help increase knowledge of emergency contraception (EC) and provides suggestions for increasing EC awareness among adolescents and adults in schools and communities. The report, developed by the Academy for Educational Development, provides basic information about emergency contraceptive pills, makes the case that adolescents should know about EC, prepares adults to increase access and awareness among adolescents (as well as among their own peers), identifies resources for keeping current on the issues, and suggests evaluation strategies. The report discusses EC issues specific to schools, school-based health centers, and community-based organizations, and includes sample letters, articles, forms, protocols, and instruments that can be reproduced. Highlighted boxes containing facts, tips, resources, quotes, and stories from the field are included throughout the report. It is available at http://scs.aed.org/ECtoolkit3283.pdf.
Parents continue to underestimate the influence they have over their children's decisions about sex, according to a new survey. While the majority of teens say parents most influence their sexual decisions, parents believe that teens' friends are most influential. Results from the survey of adolescents aged 12-19 and a new publication. "Parent Power: What Parents Need to Know and Do to Help Prevent Teen Pregnancy " were recently release by the National Campaign to Prevent Teen Pregnancy. The survey also reveals that most teens say that it would be easier for them to postpone sexual activity and avoid teen pregnancy if they were able to have more open, honest conversations about these topics with their parents, yet nearly one in four of teens say they have never discussed sex, contraception or pregnancy with their parents. Six out of 10 teens surveyed also said that their parents are their role models for healthy, responsible relationships. And one in five young adolescents report they have been at a party in the past six months with boys and girls where there were no adults in the house. Parent Power: What Parents Need to Know and Do to Help Prevent Teen Pregnancy, designed specifically for parents, is an easy-to-use guide that brings together the latest research on the influence of parents. It provides clear and specific advice for parents based on that research.
To view the full results
of the survey or to order the publication, visit
www.teenpregnancy.org/resources/reading/parentpower.
8/7/03 --
NEW EDITION OF THE CHILDREN AND ADOLESCENTS WITH SPECIAL HEALTH
CARE
NEEDS KNOWLEDGE PATH RELEASED
The new edition of the Children and Adolescents with Special Health Care Needs knowledge path is an electronic guide on recent, high-quality resources for health professionals and families about caring for children and adolescents with special health care needs. Produced by the MCH Library, the knowledge path includes information on (and links to) Web sites and electronic publications; journal articles; books, reports, and other print publications; databases; and discussion groups and electronic newsletters. It is intended for use by health professionals, program administrators, educators, researchers, and parents who are interested in tracking timely information on this topic. The knowledge path is available at www.mchlibrary.info/KnowledgePaths/kp_CSHCN.html. MCH Library knowledge paths on other maternal and child health topics are available at www.mchlibrary.info/KnowledgePaths/index.html. The MCH Library welcomes feedback on the usefulness and value of these knowledge paths. A feedback form is available at www.mchlibrary.info/KnowledgePaths/feedback.html.
"Many children and their families . . . may not be receiving adequate counseling about how to avoid environmental exposures," asserts the author of a review article published in the July 2003 issue of Pediatrics. Environmental exposures, the author notes, are among the numerous possible causes for the increase in asthma prevalence and for the increase in asthma attacks. This review discusses several types of environmental exposures and attempts to determine whether they contribute to asthma prevalence, asthma exacerbations, or both. The review includes studies on exposure to
outdoor air pollutants, indoor air pollutants, protective factors,
and prevention. The review reveals that much of what is known
about the relationship between outdoor air pollutants and asthma
has come to light as a result of asthma clusters in communities.
The review describes the following outdoor air pollutants that are
linked to asthma clusters: castor bean dust, grain dust, soybean
dust, wood smoke, and ambient air pollution. The review describes
the following indoor air pollutants that have been shown to have a
causal relationship or association with asthma prevalence or
exacerbation: tobacco smoke, dust mites, cockroaches, cats, molds,
and violence. The author found that
* Indoor air pollutants are more strongly linked to
the increase in asthma prevalence than are outdoor air pollutants.
* Exposures to dust mites or tobacco smoke are risk
factors for the development of asthma and may also exacerbate
existing asthma.
* Effective measures to prevent exposures to these
pollutants are available.
* With proper management, environmental exposures
can be decreased; however, it is not yet known whether decreasing
exposures will result in decreased asthma prevalence and
exacerbations.
"It is essential," the author concludes, "for clinicians to be knowledgeable about environmental precipitants of asthma, because this information may help them to counsel patients and their families." - Etzel RA. 2003. How environmental exposures influence the development and exacerbation of asthma. 2003. Pediatrics 112(SS1):233-239. Readers: More information about asthma in children and adolescents is available from the MCH Library's knowledge path at
We have received the long-anticipated release of the 2003 Seat Belt Summary. The good news is that we have increased our belt use from 70.1% in 2002 to 76.7% for 2003. Thanks to each of you for all the good work in the last year. We are finally over the national average of 75%. Pickup trucks continue to bring our number down somewhat but pickup truck use went up to 66%. We are making progress but there is still work to be done.
Between 1999 and 2002, the number of uninsured children
in the United States declined by 1.8 million to 7.8 million, a
decrease largely attributable to greater coverage through Medicaid and
SCHIP programs, according to a report to be released July 31 by
Covering Kids & Families, a project of the Robert Wood Johnson
Foundation. The report, based on a survey of 40,000 families, also
found that over the three-year time period, two million fewer children
had private health insurance as employer coverage decreased. Other
findings include the following: About four million uninsured children
likely are eligible for either Medicaid or
SCHIP; Medicaid and SCHIP programs provide health
insurance for about one-third of all black and Hispanic children; A
lower percentage of black and Hispanic children are insured compared
with white children; There was a greater increase in insurance
coverage among Hispanic children between 1999 and 2002 than among
white children; The percentage of low-income parents who were aware of
SCHIP programs increased from 47% in 1999 to 71% in 2002; and 43% of
low-income parents who reported having heard of SCHIP incorrectly
believed that they had to be eligible for welfare to qualify for SCHIP
coverage (Meckler, AP/Las Vegas Sun, 7/30).
For more information on the underinsured, please visit
Community Voices at
http://www.communityvoices.org/
6/25/03 -- U.S. BIRTH RATE REACHES RECORD LOW Births to Teens Continue 12-Year Decline; Cesarean Deliveries Reach All-Time High The U.S. birth rate fell to the lowest level since national data have been available, reports the latest Centers for Disease Control and Prevention (CDC) birth statistics released today by HHS Secretary Tommy G. Thompson. Secretary Thompson also noted that the rate of teen births fell to a new record low, continuing a decline that began in 1991. The birth rate was 13.9 per 1,000 persons in 2002, a decline of 1 percent from the rate of 14.1 per 1,000 in 2001 and down 17 percent from the recent peak in 1990 (16.7 per 1,000), according to a new CDC report, "Births: Preliminary Data for 2002." The current low birth rate primarily reflects the smaller proportion of women of childbearing age in the U.S. population, as baby boomers age and Americans are living longer. There has also been a recent downturn in the birth rate for women in the peak childbearing ages. Birth rates for women in their 20s and early 30s were generally down while births to older mothers (35-44) were still on the rise. Rates were stable for women over 45. Birth rates among teenagers were down in 2002, continuing a decline that began in 1991. The birth rate fell to 43 births per 1,000 females 15-19 years of age in 2002, a 5-percent decline from 2001 and a 28-percent decline from 1990. The decline in the birth rate for younger teens, 15-17 years of age, is even more substantial, dropping 38 percent from 1990 to 2002 compared to a drop of 18 percent for teens 18-19. "The reduction in teen pregnancy has clearly been one of the most important public health success stories of the past decade," Secretary Thompson said. "The fact that this decline in teen births is continuing represents a significant accomplishment." More than one fourth of all children born in 2002 were delivered by cesarean; the total cesarean delivery rate of 26.1 percent was the highest level ever reported in the United States. The number of cesarean births to women with no previous cesarean birth jumped 7 percent and the rate of vaginal births after previous cesarean delivery dropped 23 percent. The cesarean delivery rate declined during the late 1980s through the mid-1990s but has been on the rise since 1996. Among other significant findings: · In 2002, there were 4,019,280 births in the United States, down slightly from 2001 (4,025,933). · The percent of low birthweight babies (infants born weighing less than 2,500 grams) increased to 7.8 percent, up from 7.7 percent in 2001 and the highest level in more than 30 years. In addition, the percent of preterm births (infants born at less than 37 weeks of gestation) increased slightly over 2001, from 11.9 percent to 12 percent. · More than one-third of all births were to unmarried women. The birth rate for unmarried women was down slightly in 2002 to 43.6 per 1,000 unmarried women, reflecting the growing number of unmarried women in the population. · Access to prenatal care continued a slow and steady increase. In 2002, 83.8 percent of women began receiving prenatal care in the first trimester of pregnancy, up from 83.4 percent in 2001 and 75.8 percent in 1990. Data on births are based on information reported on birth certificates filed in state vital statistics offices and reported to CDC through the National Vital Statistics System. The report is available on CDC's National Center for Health Statistics web site at www.cdc.gov/nchs. ----------------------------------------------------------------- STUDY CONFIRMS SAFETY OF PLACING INFANTS TO SLEEP ON THEIR BACKS A team of researchers reports that infants who are placed to sleep on their backs are not at increased risk for health problems, and they are less likely to develop fevers, get stuffy noses, or develop otitis media (ear infection). Placing infants to sleep on their backs has been found to reduce the risk of Sudden Infant Death Syndrome (SIDS). The current study goes beyond earlier studies from other countries, showing not only that there do not appear to be adverse health effects from placing infants to sleep on their backs, but that the practice may confer specific benefits for infants' health. The study, appearing in the "Archives Of Pediatrics & Adolescent Medicine", was funded by the National Institute of Child Health and Human Development (NICHD) and the National Institute on Deafness and other Communication Disorders (NIDCD). "Placing infants to sleep on their backs not only reduces their risk of Sudden Infant Death Syndrome, but also appears to reduce the risk for fever, stuffy nose, and ear infections," said Duane Alexander, M.D., director of the NICHD. "Otitis media causes suffering in infants and young children, costs the American public an estimated $5 billion dollars per year, and results in overuse of antibiotics." "The research showing that putting infants on their backs to sleep is saving lives is now revealing an outstanding additional benefit, the reduction of otitis media in infants," said James F. Battey, Jr., M.D., Ph.D., Director of the NIDCD. In the 1980s, several countries conducted studies that found placing infants to sleep on their backs reduced the risk of SIDS. By 1992, Australia, New Zealand, and the United Kingdom had already campaigns urging parents and caregivers not to place infants to sleep on their stomachs. The study authors noted that in the U.S. in 1992, roughly 70 percent of U.S. infants were placed to sleep on their stomachs. The NICHD-sponsored Back to Sleep campaign, begun in 1994, urges parents and caregivers to place infants to sleep on their backs, to reduce SIDS risk. As of 1998, when the study authors finished their analysis, the percentage of stomach sleeping had declined to 17 percent. By this time, the SIDS rate also dropped by about 40 percent. In the U.S., however, many physicians and caregivers still have reservations about placing infants to sleep on their backs. For example, some fear that an infant sleeping on his or her back might be more likely to choke on vomit. Others believe that infants would sleep better on their stomachs. The researchers undertook the study to rule out the possibility that U.S. infants would react any differently to back sleeping than did infants in other countries. The first author of the study is Carl E. Hunt, M.D., who conducted the study while at the Medical College of Ohio in Toledo. He is now head of the National Center on Sleep Disorders Research at the National Heart, Lung, and Blood Institute. The researchers analyzed information collected on 3,733 U.S. infants whose mothers reported that their infants were always placed to sleep in the same position. The information collection began in 1995. At that time, the American Academy of Pediatrics (AAP) advised parents and caregivers to place infants to sleep on their backs or sides. The study authors asked the mothers who participated whether their infants had been placed to sleep on their backs, stomachs, or sides. Based on more recent information showing that side sleeping may also increase the risk of SIDS, the AAP later revised its recommendation to say that infants should be placed to sleep only on their backs. When the infants were 1, 3, and 6 months of age, the researchers questioned the infants' mothers about whether the infants had such symptoms as fever, cough, wheezing, stuffy nose, trouble breathing, trouble sleeping, and vomiting. The researchers found, that, at one month of age, infants sleeping on their backs were less likely to have come down with a fever than were infants sleeping on their stomachs. At 6 months, back sleepers were less likely to develop a stuffy nose than were stomach sleepers. At 3 and 6 months, back sleepers needed to visit the doctor less often for ear infections than did stomach sleepers. Moreover, at 6 months, the mothers of back sleepers reported fewer instances in which their infants had trouble sleeping than did the mothers of stomach sleepers. None of the infants in the study was reported to have choked on their vomit. The researchers are not sure why back sleepers had fewer symptoms than did stomach sleepers. One possibility is that stomach sleepers have higher mouth and throat temperatures than do back sleepers. These higher temperatures may be more favorable to the bacteria involved in colds and otitis media. "No identified symptom or illness was significantly increased among nonprone [not on the stomach] sleepers during the first 6 months," the study authors concluded. "These reassuring results may contribute to increased use of the supine [on the back] position for infant sleeping." The NICHD and the NIDCD are part of the National Institutes of Health (NIH), the biomedical research arm of the federal government. NIH is part of the U.S. Department of Health and Human Services. The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. NICHD publications, as well as information about the Institute, are available from the NICHD Web site, http://www.nichd.nih.gov, or from the NICHD Clearinghouse, 1-800-370-2943; e-mail NICHDClearinghouse@mail.nih.gov. The NIDCD supports and conducts research and research training on the normal and disordered processes of hearing, balance, smell, taste, voice, speech and language and provides health information, based upon scientific discovery, to the public. For more information about NIDCD programs: www.nidcd.nih.gov. U.S. Department of Health and Human Services, NATIONAL INSTITUTES OF HEALTH - 5/12/03 ----------------------------------------------------------------- 5/5/03 -- U.S. Department of Health and Human Services - NATIONAL INSTITUTES OF HEALTH - NIH News BED SHARING WITH SIBLINGS, SOFT BEDDING, INCREASE SIDS RISK Infants who share a bed with other children are at a higher risk of sudden infant death syndrome (SIDS) than are other infants, according to the most recent analysis of a study of predominantly African American SIDS deaths in Chicago. The analysis, appearing in the May, 2003 "Pediatrics", also found that two known risk factors for SIDS -- sleeping on soft bedding and sleeping on the stomach -- pose a far greater risk of SIDS when they occur together than the sum of both risk factors added together would indicate. This analysis confirms several international studies reporting that SIDS risk was lower among infants put to bed with a pacifier and reinforced earlier findings that sleeping on a sofa also increases infants' risk of SIDS. The study was supported by the National Institute of Child Health and Human Development (NICHD) and the National Institute on Deafness and other Communication Disorders (NIDCD), both at the National Institutes of Health (NIH), as well as the Centers for Disease Control and Prevention (CDC). NIH and CDC are agencies of the U.S. Department of Health and Human Services. The researchers studied all infants from the ages of birth to one year who had died of SIDS in Chicago, Illinois, between November 1993 and April 1996. There were 260 SIDS deaths during that time. "This study provides important new information regarding SIDS risk factors," said Duane Alexander, M.D., Director of the NICHD. "The next step is to get this information to the parents and families who can use it to reduce the risk of SIDS among their own infants." "The SIDS rate for African-American babies is more than twice that for white infants," said CDC Director Dr. Julie Gerberding. "Families need counseling on ways to reduce the risk of SIDS. For example, they need to know they should avoid putting an infant to sleep with other children." The research is part of the Chicago Infant Mortality Study, designed to identify risk factors for SIDS that place African American infants at roughly double the SIDS risk of Caucasians. Earlier findings of the study appear at <http://www.nichd.nih.gov/new/releases/infant_sids.cfm>. The Chicago Infant Mortality Study was directed by Fern R. Hauck, M.D. M.S., currently of the University of Virginia Health System. "Our study found a dramatic increase in SIDS risk for prone sleeping on soft surfaces, highlighting the need to eliminate these unsafe sleep practices," said Dr. Hauck. "Additionally, infants should never be placed to sleep on a couch with anyone or in a bed with other children." The researchers compared information about each SIDS case to information about a control infant -- a living infant of comparable age, who was from the same racial and or ethnic group, and who had a similar birth weight. All of the SIDS deaths were evaluated by the Cook County Medical Examiner's Office; autopsies had been conducted to rule out other causes of death. Death scene investigators conducted interviews about circumstances surrounding the deaths. The researchers used the NICHD definition of SIDS: "the sudden death of an infant under one year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history." Infants who died of SIDS were 5.4 times more likely to have shared a bed with other children than were the control infants. Sleeping with the mother alone or mother and father was associated with an increased risk of SIDS, but this finding was not statistically significant. The study concluded "the risk was primarily associated with bed sharing when the infant was sleeping with people other than the parents." The researchers also reported that sleeping with the mother alone did not reduce infants' risk of SIDS, as some researchers have concluded on the basis of earlier studies. The researchers noted that sleeping on the stomach, and sleeping on soft bedding -- both known to increase the risk of SIDS independently -- posed a much greater risk for SIDS when occurring together than might be expected. For example, soft bedding appeared to pose 5 times the risk of SIDS as firm bedding; sleeping on the stomach increased the risk of SIDS 2.4 times. Yet infants who slept stomach down on soft bedding had 21 times the risk of SIDS as infants who slept on the back on firm bedding. Of the SIDS cases, 15 were found to have slept on a sofa the last time they were placed to sleep. The researchers do not know why sleeping on a sofa would increase the risk of SIDS more than would sleeping on a bed, yet warn that the practice appears to be highly dangerous. The study authors concluded that physicians should counsel new parents not only about the benefits of placing infants to sleep on their backs, but also about the risk their study had uncovered."Parents are influenced strongly by their physicians in choosing the sleep position for their infants," they wrote. "Other infant care practices, such as bed sharing and use of soft bedding, may also be influenced by medical providers, particularly if reinforced by the media." To reduce the racial disparity in SIDS rates, the authors advised taking families' economic circumstances into consideration. For example, some parents may not be able to afford firmer mattresses or to have enough beds for all their family members. The authors called for research on how best to meet these needs. "On the basis of the findings of this study, they [parents] should receive instruction that emphasizes supine sleeping, firm bedding, not using pillows, and not sharing a bed with other children or sleeping with another person on a sofa, while being sensitive to parental concerns and cultural traditions." The current study is part of a body of research sponsored by the NICHD on infant sleep practices and the causes of SIDS. This large body of research, together with compelling scientific evidence from around the world, confirmed the safety and effectiveness of placing infants to sleep on their backs. Based on this evidence, the NICHD formed a coalition of national organizations to launch a national public awareness campaign called "Back to Sleep" in 1994. (See chart at <http://www.nichd.nih.gov/sids/sidsrates.pdf>.) Since the start of the NICHD-led campaign in 1994, the SIDS rates for African American infants and white infants have declined by about 50 percent, but a significant disparity still remains. To help eliminate this disparity, the NICHD joined with the non-profit National Black Child Development Institute in a program to reduce SIDS among African American infants in Chicago and around the country. The NICHD has also partnered with three African American women's groups to conduct a series of "Summits" on SIDS risk reduction training and outreach activities in communities around the country. The first Summit, held jointly with the National Coalition of 100 Black Women took place in Tuskegee, Alabama, <http://www.nichd.nih.gov/new/releases/sids_risk.cfm>. The second Summit, held with the Women of the NAACP, took place in Los Angeles, <http://www.nichd.nih.gov/new/releases/reduce_sids.cfm>. The next summit will be held May 30-31 in Detroit in partnership with the Alpha Kappa Alpha Sorority, Inc. The NICHD is part of the National Institutes of Health, the biomedical research arm of the Department of Health and Human Services. The Institute sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. NICHD publications, as well as information about the Institute, are available from the NICHD Web site, <http://www.nichd.nih.gov>, or from the NICHD Information Resource Center, 1-800-370-2943; e-mail NICHDClearinghouse@mail.nih.gov. CDC protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national and international organizations.
-----------------------------------------------------------------
The Maternal &
Child Health and Social Services Update
is now online. Go to
www.healthystartassoc.org and click the link to the Update.
There is a version for printing available, as well.
-----------------------------------------------------------------
Save the Children,
at www.savethechildren.org
-- among the findings:
-----------------------------------------------------------------
4/14/03 -- The following is a statement from Dr. John Douglas, incoming Director of the Division of STD Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention. Dear Colleagues,
The new HIPAA
(Health Insurance Portability and Accountability Act)
regulations take effect April 14. The attached MMWR highlights HIPAA's
impact on public health activities. There may be confusion about the
reporting of notifiable STDs by covered entities under the new
regulations. It is important to note that the HIPAA regulations do not
prohibit covered entities or their business associates from the
reporting of notifiable STDs to public health authorities. Moreover,
reporting of notifiable diseases such as STD does not require covered
entities to seek any authorization or documentation from patients
indicating that STD information will be disclosed to public health
authorities. Thus, HIPAA does not require any changes in procedures to
report notifiable STDs to public health authorities. Box 1 of the MMWR
provides a helpful summary of these issues.
If you suspect that there is confusion about this issue among public and
private health providers, health plans, commercial and governmental
laboratories, and other covered entities in your local areas, I
encourage you to communicate with them soon to clarify that HIPAA does
not prohibit notifiable STD disease reporting and does not require
covered entities to take different steps. By ensuring that this issue
is clearly understood in your local areas, you can assure the complete
and timely reporting of STDs that is essential to local, state, and
national STD prevention and control efforts.
Thank you for your help in dealing with this potentially confusing
situation.
Sincerely,
John M. Douglas, Jr., MD, Incoming Director, Division of STD Prevention,
CDC
-----------------------------------------------------------------
Interesting "Lancet"
article on the apparent
effectiveness of reducing preterm delivery/miscarriages by early
treatment of BV
----------------------------------------------------------------- NEW! Oklahoma Institute for Child Advocacy Health Newsletter -- now available by email! Below is a SAMPLE of articles from the first issue, February 23, 2003. Everyone interested in these issues is encouraged to SUBSCRIBE -- go to www.oica.org (no cost; easy process).
T here are several key indicators by which to measure overall health status in the United States: infant mortality and low birth weight. While much has been gained in the fight against infant mortality, the nation's infant mortality rate (IMR) of eight deaths per thousand births ranks the U.S. 26th in the world. Although infant mortality rates have been decreasing, low birth weight rates have been increasing on a national and local level. Preterm low birth weight is defined as infants born at less than 37 weeks gestation and weighing less than 5.5 pounds. The lower the birth weight, the higher the risk of an infant having health complications. A low birth weight baby is 23 times more likely to die before his or her first birthday and is 25 times more likely to have brain damage and birth defects. When babies are born too small they begin too far behind. Some can catch up, but it will cost them and their families tremendous time and energy, taxing them emotionally and financially. Full Story...Tulsa Gives Babies A Healthy Start The Tulsa Healthy Start in Tulsa County has assisted 1,857 pregnant women and women with infants since inception in November 1998. Approximately 650 clients are currently receiving services. The women and their families who receive health and social services have qualified for care because risk factors associated with their pregnancy and children have been identified. The Healthy Start project is coordinated by the Tulsa City- County Health Department and funded through the Department of Health and Human Services, Health Resource and Service Administration (DHHS, HRSA), and the Healthy Start Initiative. Preliminary outcomes are promising. For more information about Tulsa Healthy Start...Folic Acid is Crucial For Preventing Birth Defects The U.S. Public Health Service (PHS) has issued a recommendation for all women of childbearing age who are capable of becoming pregnant to consume 400 micrograms (0.4 milligrams) of folic acid per day. This daily consumption throughout childbearing years is critical, because the developing baby needs the folic acid before the mother would recognize the pregnancy and begin taking vitamins. Since half of all women in Oklahoma do not plan their pregnancies, daily folic acid consumption is even more crucial for prevention. The best way to obtain the necessary folic acid is to take a multivitamin containing 400 micrograms (0.4 mg) of folic acid. Folic acid supplements are also available in 400 microgram tablets. The CDC estimate 50 to 70 percent of all neural tube defects can be prevented from this recommendation. For your Oklahoma connection... Pregnancy and Oral Health Research has shown bacteria that causes dental decay can be transferred from the mother to the child. So improving the oral health of the mother will ensure better oral health for the child. Seeing your dentist early in your pregnancy can help prevent dental decay, gingivitis, and can ultimately help prevent the birth of a low birth weight baby. Full Story... Did You Know... The SoonerCare Helpline can answer general enrollment questions, help you get an Oklahoma Health Care Authority Medical I.D. card and assist you with any questions. You can reach the SoonerCare Helpline at 1- 800-987-7767. Need to fill out a SoonerCare application? You can download an application by simply going to www.okdhs.org/medapp/download.htm Not for expectant mothers only. . .The March of Dimes Resource Center welcomes calls from everyone-women planning a pregnancy, dads, grandparents, health care professionals, students, librarians-people from all walks of life and from around the world. Call toll-free at 1- 888-MODIMES 9am-8pm EST Monday-Friday or resourcecenter@modimes.org Preserving Medicaid in Tough Times: An Action Kit This recently updated kit from Families USA includes new pieces on fighting state budget cuts, getting coverage without holding a press event and dealing with negative press. http://www.familiesusa.org/ActionKitStateAdvocates/2003/actionkit2003.htm
Above is a SAMPLE of articles, from the FIRST ISSUE of the health newsletter of the Oklahoma Institute for Child Advocacy. Everyone interested in these issues is encouraged to SUBSCRIBE by emailing kmcneal@oica.org. ----------------------------------------------------------------- Economic Impact of State Medicaid Spending: Families USA January 2003 -- Friends: I wanted to make you aware of a fascinating and extremely timely new report from Families USA. Using a respected economic model developed by the US Department of Commerce (known as RIMS II), the report examines the economic impact of state Medicaid spending in light of both federal matching funds and the economic multiplier effect of increased health care spending. The report provides data specific to each state. Among the hi-lites:
As the Legislature begins to explore options to cut state
spending and (hopefully) enhance state revenue, this study should help
provide powerful information about the actual multiplier benefits
associated with Medicaid spending.
Families
USA report in PDF format - available to download
Also, the Families USA website has a simple, interactive "Medicaid Cuts Calculator" (http://www.familiesusa.org/Calculator/USmap.htm): just plug in the latest proposal for Medicaid cuts, and watch goods, services, jobs and income disappear from the Oklahoma economy!
Let me know if you have any questions about this
information.
As the subject is protecting the Medicaid program, I can't
resist sharing a link to an article from this week's Stateline.Org on
profiling
Angela Monson, who also happens to be a member of Families
USA's Board. As all who have worked with her know, there is no stronger
advocate anywhere for access to quality health care than Angela.
David Blatt
Director of Public Policy
Community Action Project of Tulsa County
(918) 382-3228 (ph.); (918) 382-3328 (fax)
717 S. Houston, Suite 200, Tulsa, OK 74127
-----------------------------------------------------------------
NEW BIRTH REPORT SHOWS
MORE MOMS GET PRENATAL CARE
A new HHS report released today shows a
significant increase in the number of women receiving prenatal care --
especially among Hispanic and black women. Too Many Interventions, and Too Many Preemies August 6, 2002 -- New York Times article
By LAURIE TARKAN
Neonatal care has been a remarkable success story. Today, babies born at 28 weeks have about a 90 percent chance of survival with no serious long-term health problems, and about half of the babies born as early as 24 weeks, weighing a mere 1.5 pounds, survive. But this very success has diverted attention from the slight progress made in preventing babies from being born prematurely in the first place. Dr. Charles Lockwood, 47, a leading researcher in the field and the chairman of the department of obstetrics and gynecology at the New York University School of Medicine, put it more bluntly. "Everything we've done so far has been a miserable failure," Dr. Lockwood said. "And it isn't only that we
haven't been helpful; we've been harmful up to this point."
Researchers have made inroads into understanding why women deliver prematurely. But most clinical studies using interventions intended to prevent early deliveries - like better prenatal care, drugs that prevent contractions and hospitalization - have failed. Many of the interventions have in fact led to higher rates of preterm babies. This is all the more frustrating to Dr. Lockwood in light of recent data showing that the rate of premature babies has risen in recent years, from 9.8 percent in 1985 to about 12 percent today. Evidence suggests that very premature babies have more health problems later in life and a higher risk of learning disabilities than their full-term peers. The March of Dimes, concerned that progress was too slow, began the Perinatal Epidemiological Research Initiative, which has offered $3.75 million to six researchers, including Dr. Lockwood. Q. Why has research into the prevention of premature births been disappointing?
A. If I knew the answer, we'd be having this Q & A in
Stockholm and I'd be about to pick up the big prize. The
simplest answer is that most preterm deliveries occur because
in all likelihood the mother or the fetus would be better off delivered.
We're trying to stop something that very often nature doesn't want us to
stop.
We, in our very naïve thinking, initially said we'll just slow down these contractions. Well you know what?
Contractions have very little to do with the story. I think
we're just beginning to appreciate the fact that there are so many parallel
pathways that can lead to prematurity, and as we try to stop one, another
one picks up the slack. Nature has built in all sorts of redundancies
to protect the mother or the baby.
Q. What accounts for the rising rates of premature births?
A. The biggest factor has been the advancements in assisted
reproductive technologies that have led to a rise in multiple births, which
tend to be delivered preterm.
Q. Many of us think of premature birth as a spontaneous event, but you believe it's the result of a process that started early in the pregnancy?
A. Exactly, and I suspect it may be genetic or may occur even
before a woman gets pregnant.
Q. Along with the twins factor, researchers have identified three other causes of preterm births: vaginal infections, uterine bleeding and stress. Can you explain these?
A. The first is due to bacteria being present in the uterus,
either before or after conception. These infections
are more common in women with bacterial vaginosis or sexually
transmitted diseases, and account for about 40 percent of preterm
deliveries. In general, infections are more common in poor, young, unmarried
and minority women.
Q. Uterine bleeding occurs when the placenta separates from the uterine wall. How does this lead to preterm labor?
A. The bleeding causes the generation of thrombin, a clotting
factor. Thrombin causes an outpouring of enzymes that can break down the
fetal membrane, leading to preterm membrane rupture. It also binds to
receptors on uterine muscle cells to trigger contractions. Cigarette
smoking, cocaine use and high blood pressure have been linked to abruptions,
but women with a genetic predisposition to clotting are at high risk.
Q. You mentioned stress as a factor in premature deliveries. What level of stress are we talking about?
A. There's good evidence that high levels of anxiety,
depression and major life events like loss of a job, death of a family
member, divorces, are associated with higher rates of prematurity. It's a
weak association, but it seems to be significant. The more striking
link, though, is with fetal stress, and there's lots of evidence that the
placentas of many women who deliver prematurely have impaired blood flow,
which we know can lead to fetal stress. Smoking, clotting abnormalities and
first pregnancies are associated with impaired flow.
Q. Is there any evidence of pregnant women having a higher incidence of prematurity after 9/11?
A. We're looking at that as we speak. My sense is that acute
stress is probably not as bad as chronic stress. So the acute adrenaline
rush that happened to those who experienced the attack probably didn't
trigger premature delivery. But for those with losses, that stress may be a
factor.
Q. If we know so much about what is going wrong in premature deliveries, why haven't attempts to prevent them been successful?
A. It seems that once the system is activated, it becomes
irreversible. We can slow things down, we can buy some time, but we can't
stop the process. We're wasting our time to invent better ways of paralyzing
the uterus. Our primary focus needs to be to identify patients who are at
risk, and that means understanding the biology and genetics better, then
designing effective testing and prevention mechanisms.
Q. In your practice, you treat women with a high risk of preterm delivery. Has your research changed the way you treat them?
A. Yes, we definitely have avoided interventions. Most of our
twin moms work right up until they go into labor,
whereas in the old days they were all put in the hospital at
28 weeks, which increased rates of preterm births. We take care of
patients with a history of prematurity, and we try to figure out what caused
that premature birth. Was it infection, a hemorrhage, stress? We're pretty
successful if we can get the patient before she gets pregnant.
Q. When you got into this field, did you know it would be so difficult to crack?
A. Initially I thought, This will be very simple. These
people all have infections, we'll give them antibiotics,
and they'll get better. But the more data we collected, the
more complicated it became, and the more I came to realize that prematurity
was just a symptom, really an end product of an incredibly complex process.
-----------------------------------------------------------------
Welfare Reform: The Next Generation
By Douglas W. Nelson
President of the Annie E. Casey Foundation
Six years into our historic experiment with welfare reform,
America has much to celebrate. We have replaced a welfare system that long
accommodated dependency with a new program that is beginning to reconnect
families to the economic mainstream.
This year's debate to reauthorize the federal welfare law -
known as Temporary Assistance for Needy Families or TANF - offers an
opportunity both to further reduce welfare dependency and to improve the
quality of life for vulnerable children and families. Capturing these
opportunities, however, will require our leaders to examine the evidence,
strengthen a bi-partisan consensus, and avoid unwarranted policy shifts that
might jeopardize the positive momentum generated since 1996.
Simply put, the next phase of welfare reform, the next assault
on family poverty, must begin with work. But it must not end there. We can
achieve wholesale improvements in the fortunes of needy children only if we
continue to insist that able-bodied parents work for a living - and if we also
provide the help those disadvantaged parents need to turn jobs into careers
and to support the healthy development of their children.
To get there from here, our nation's leaders should be guided
by three principles. First, do no harm. Second, concentrate on filling the
obvious gaps in the TANF law. Third, begin taking steps to integrate welfare
reform with other federal programs in a more unified and comprehensive system
to help low-income families. Specifically, Congress should take the following
experience-based, common-sense steps.
Create Practical Work Requirements. One byproduct of welfare reform's dramatic success since 1996 has been to take the teeth out of federal work participation requirements. The TANF law required states to engage 50 percent of adult welfare recipients in 30 hours per week of work activities. But the law gave states credit against this standard for recipients who
left the welfare caseload. As the welfare rolls plummeted, the
work requirements became irrelevant.
In retooling TANF this year, Congress should rewrite the work
participation rules and create incentives for states to engage a high
proportion of welfare recipients in work-related activities. At the same
time, however, expectations for families and for states must remain practical.
The Bush administration has proposed and the House of
Representatives has approved new work rules that would require states to
engage TANF recipients in 40 hours of work-related activities each week,
including 24 hours of paid work or unpaid work experience. The
administration would also require states to engage 70 percent of welfare
participants in work activities, up
from 50 percent in the 1996 law, and it would gradually stop
granting credit to states for welfare recipients who have left the rolls since
1996.
As written, these rules would likely do more harm than good.
Every parent knows that balancing work and childrearing responsibilities is a
delicate challenge. It is all the more difficult for single parents with young
children living in economically fragile families. Many of these parents
already juggle too many responsibilities; we should not preclude the option of
part-time employment. Indeed, many of welfare reform's successes in recent
years involve recipients who began their journey to earnings in half-time
jobs.
For states, the requirement to involve 70 percent of welfare
recipients in work activities will require substantially more spending on
child care and on supervision of unpaid work experience. This would divert
resources away from job search programs and wage supports that have been at
the heart of the states' success in recent years. As Gordon Berlin of
Manpower Demonstration Research Corporation told Congress this spring,
"Instead of focusing on getting people off of welfare, states may become
preoccupied with keeping everyone busy while they are on welfare." That would
be a move in the wrong direction.
Stop the Time Limit Clock for Working Families. As part of
welfare reform, many states now provide continuing wage supplements to TANF
parents who begin working at low-wage jobs. Research shows that these
subsidies reward work effort, help families escape poverty, and lead to
improved educational success for children. But in many states, the clock of
welfare time limits continues to tick against working families receiving these
benefits - counting against their five-year lifetime limit on welfare
eligibility. The federal government should follow the lead of states like
Illinois, New Jersey, Maryland, and Pennsylvania that have opted not to
penalize parents who work to support their children. Specifically, federal
rules should require that the five-year time limit on TANF benefits not apply
in months when families work at least 20 hours per week in unsubsidized
employment.
Provide More Child Care. Few would deny that reliable child care is essential for low-income families, especially those who leave welfare for work. Currently, however, fewer than 12 percent of eligible families receive support from the Child Care and Development Fund, the largest federal child care program, and studies tracking families leaving welfare show that only about one-third receive state-funded child care assistance.
Also, the Center for Law and Social Policy estimates that if
the Bush administration's work participation rules are enacted, states would
need almost $8 billion more over the next five years to meet the added child
care needs of families who remain on welfare. And that figure does not
include additional investments to improve the quality of child care - an
urgent priority.
The welfare reauthorization bill passed by the House in May
offers a down payment on these needed child care investments - about $2
billion over five years. Even larger increases in federal child care spending
are clearly needed.
Focus on the Well-Being of Children. In his welfare plan,
President Bush called for an historic change to make child well-being a core
goal of the TANF law. The recommendation is wise and welcome.
In their eagerness to reduce welfare dependency and encourage
work, national and state policymakers have often in recent years overlooked
the original purpose of the welfare system - protecting our nation's most
vulnerable children. The president's proposal marks an important step toward
reversing this oversight. Needed now are thoughtfully crafted indicators of
child
well-being and clear regulations that require states to monitor
and report on these outcomes every year.
The Foundation's long experience with KIDS COUNT and other
data-driven initiatives has proven that indicators of child well-being can be
powerful tools to focus policymakers' attention on the needs of low-income
families and generate momentum for effective policy responses.
Grant states sensible waiver authority. A final key to
continued progress must be a sensible measure of increased autonomy for states
to test new approaches for integrating welfare reform with other programs to
aid low-income families - both welfare recipients and the working poor. Given
that welfare payments supported six and a half million fewer children in 2001
than in 1994, and given that many former welfare families continue to struggle
in poverty, it is clearly time for a unified approach.
Just as clearly, states should be the laboratory for developing
and testing new strategies to weave TANF together with child care, job
training, higher education, tax credits, housing assistance, and other
federally funded programs for low-income families. The 1996 TANF law granted
states unprecedented latitude to design and implement welfare programs free of
extensive federal rules and oversight. This flexibility proved
well-warranted: states rose to the challenge and made welfare reform a
success.
But state flexibility must include real accountability. The
House TANF bill authorizes a new "superwaiver" that could allow governors,
with the okay of a federal cabinet secretary, to disregard thoughtful
provisions from a wide range of social welfare programs - perhaps even to
ignore the intent of some federal programs entirely. Put simply, the
superwaiver, as drafted, is too
open-ended. Instead, Congress should offer waivers on a
limited and strategic basis - requiring states to plan carefully and be held
accountable for evaluated results in better achieving the core purposes of
federal statutes. By offering a limited number of waivers - five or fewer
each year - Congress can consciously encourage innovation and integration by
states without abandoning important federal safeguards for vulnerable
families.
Conclusion. If the experience of the past six years shows us
anything, it is that work requirements are not an enemy of poor children and
families. But neither are they a salvation. Even with the great
successes of welfare reform to date - rapid reductions in the welfare rolls,
and rising employment and earnings among formerly dependent parents - many or
most
former welfare families still struggle in poverty. By
following the principles spelled out here, TANF reauthorization can help
preserve the progress achieved since 1996. It can also foster innovations
that can help millions of families to escape not only welfare, but also
hardship.
http://www.aecf.org/publications/advocasey/summer2002/welfare_reform.htm ----------------------------------------------------------------- The New York
Times Side Effect of Welfare Law: The
No-Parent Family But new research underscores a smaller, unwelcome trend: a rising share of children, particularly black children in cities, are turning up in no-parent households, left with relatives, friends or foster families without either their mother or their father. Researchers say they cannot pinpoint the forces driving parents and children apart. But among them, they said, may be the stresses of the new welfare world - loss of benefits, low-wage jobs at irregular hours and pressure from a new partner needed to pay the rent. The findings are helping reopen the debate on what shifting welfare rules are doing to families. They are contributing to second thoughts among some of the most optimistic analysts, even as the White House and some lawmakers are pushing to make the welfare law's work requirements even stricter. The law now requires 50 percent of welfare recipients to work up to 30 hours a week, with some exceptions for hardship. One important study of census data in each state, recently presented to an audience of welfare experts at Harvard, concluded that among those most affected by the welfare changes - black children in central cities - the share living without their parents had more than doubled on average, to 16.1 percent from 7.5 percent, when researchers controlled for other factors. "What we're seeing is the complex relationship between this thing we call welfare reform and the impact on families," said Wade F. Horn, the Bush administration official who oversees the welfare program. "In some cases we see positive effects on family structures, and in other cases we see more children living in no-parent families." Mr. Horn said new welfare demands might expose an unfit parent whose children are better off in foster care. On the other hand, he added, a West Virginia mother told to seek work in Ohio may feel obliged to leave a child behind to finish school. "What it tells us," he said, "is that we need to do an even better job on understanding the complexities of these programs on real people." In a support group in the Bronx, grandparents raising grandchildren spoke of the many pressures their families faced. Linda Woods, for example, finds it easy to understand how a decline in households with single mothers and a rise in children living apart from both parents could be two sides of a coin. Ms. Woods's daughter, a sickly high school dropout who once worked in sales, supported her own daughter, China, on welfare after the girl's father abandoned them. Unable to work in exchange for benefits, she eventually qualified for Social Security disability payments and found a boyfriend with a job. "She got married to him too quick," Ms. Woods recalled. "I tried to tell her, `You're making a big mistake.' " Two years ago, she added, China, then 7, telephoned from her mother's home in Queens, begging to be rescued from conflicts with her stepfather. Now Ms. Woods, 53 and retired because of ill health, is struggling to care for China without any public aid. China's mother, with a second child to support, has separated from her husband. Last year, analysts at the nonpartisan Urban Institute reported that the share of children in the United States living in households without their parents rose to 3.5 percent, or 2.3 million children, in 1999, from nearly 3.1 percent, or 1.8 million children, in 1997, a significant increase. Recently Greg Acs, an author of an upbeat Urban Institute report last year on the rise in two-adult households, titled "Honey, I'm Home," took a second look at his study's unreported results and found that among low-income children, a population more likely to be affected by welfare changes, the share living with neither parent had risen to 5.7 percent in 1999, from 4.7 percent in 1997, double the overall increase. "If the first story is the decline in kids in single-parent households, then the next story is, where are they going?" Mr. Acs said. Many, if not most, he said, are living with two parents or a mother and boyfriend. But, he added, "vulnerable children in vulnerable families are increasingly likely to be in no-parent households." The author of another report on the increase in children in two-adult families, Wendell Primus, now says he has a more nuanced view of his findings. His optimistic take had been particularly influential because he resigned in 1996 as deputy assistant secretary of Health and Human Services to protest what he feared would be the severe impact of the welfare overhaul on children. "An individual child is sometimes better off living with grandmother, but as a societal matter, more kids living with neither parent can't be viewed as a good thing," Mr. Primus said. Children who do not live with their parents do significantly worse on average than those in single-parent homes, child welfare experts say, with higher rates of school failure, mental health problems and delinquency. Some researchers, however, are not persuaded that the upturn in such children is tied to welfare changes. The share of children living without their own parents has fluctuated in the past, with peaks linked to the crack epidemic, AIDS and recessions. But the economists at the University of California and the Rand Corporation who analyzed the impact of welfare changes on children's living arrangements found a very strong link. Comparing Census Bureau surveys before and after different welfare changes in all 50 states throughout the 1990's, and controlling for other economic factors, they found that on average the share of black children living in cities without their parents more than doubled after the changes even as the share with an unmarried mother dropped to an average of 51 percent from 64 percent. The effects, researchers calculated, translate into about
200,000 more black, urban children living without a parent. Other researchers suggested that the contrast could partly reflect changing Hispanic immigration, higher marriage and fertility rates by recent immigrants and different cultural traditions in coping with adversity. One lesson emerging from other recent research, said Doug Besharov, a scholar at the conservative American Enterprise Institute, is that cumulative figures can mask very different, even contradictory effects for different groups and hide the impact of rules that vary from county to county. "It's an incomplete puzzle," Mr. Besharov said. At one point, Ms. King said, after the family was evicted from their Queens apartment and placed in a temporary shelter in the Bronx, the mother became desperate to keep her welfare-to-work job at the city's Human Resources Administration in Lower Manhattan. She left three children with their father at the shelter for lack of a baby sitter, and the youngest, a brain-damaged toddler, cut himself badly on an open can while the father was sleeping off a drinking binge. The mother, who has already turned over her two older children to their grandmother, was charged with neglect and is now at risk of losing the others to foster care. "She was always a good mother," the grandmother said. "She had
no choice, and the system didn't help her." Robert Lerman, a researcher at the Urban Institute known for his work on the benefits of marriage, said there was no consensus on the effects of welfare changes on family structure. He was disappointed recently himself, he said, when he sought confirmation of Mr. Primus's earlier finding that the share of black children living with married parents had jumped to 38.9 percent in 2000 from 34.8 percent in 1995. Looking at newly formed black families in the Urban Institute's large, nationally representative sample, Mr. Lerman instead found a drop in the share of children under a year old living with married parents, to only 26 percent in 1999, from an already low 36 percent in 1997. Over all, Census Bureau surveys indicate that the number of people in female-headed households declined to 27.4 million in 2000, from 29.2 million in 1995, Mr. Primus said. But, he added, the number mainly seems to reflect "doubling up and coupling up out of economic necessity, the way poor people have historically managed," a pattern that includes leaving children with relatives. "The number is still truly astonishing," he said, "but I think the implications of this number are not as rosy as just the number would seem."
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
