Selected findings from the cross-site evaluation of the Federal Healthy Start Program.

Initiated in 1991, the Federal Healthy Start Program includes 105 community-based projects in 39 states, the District of Columbia and Puerto Rico. Healthy Start projects work collaboratively with stakeholders to ensure participants' continuity of care during pregnancy through 2 years postpartum. This evaluation of Healthy Start projects examined relationships between implementation of nine core service and system program components and improvements in birth and project outcomes. Program components and outcomes were examined using data from a 2010 Healthy Start project director (PD) survey (N = 104 projects) and 2009 performance measure data from the Maternal and Child Health Bureau Discretionary Grant Information System (N = 98 projects). We explored bivariate relationships between the nine core program components and (a) intermediate and long-term project outcomes and (b) birth outcomes. We assessed independent associations of implementation of all core program components with birth outcomes, adjusting for project characteristics and activities. In 2010, 57 projects implemented all nine core program components: 104 implemented all five core service components and 69 implemented all four core systems components. Implementation of all core program components was significantly associated with several PD-reported intermediate and long-term project outcomes, but was not associated with singleton low birth weight or infant mortality among participants' infants. This evaluation revealed a mixed set of relationships between Healthy Start projects' implementation of the core program components and achievement of project outcomes. Although the findings demonstrated a positive impact of Healthy Start projects on birth outcomes, only a few associations were statistically significant.

A statewide strategy to battle child obesity in Delaware.

In 2006, approximately 37 percent of Delaware's children were overweight or obese. To combat Delaware's childhood obesity epidemic, Nemours, a leading child health care provider, launched a statewide program to improve child health. The "social-ecological" strategy reaches beyond clinical encounters to promote better health and behavior at multiple levels. Early results show that the initiative halted the increase in the prevalence of overweight and obese children, since no statistically significant change occurred during the two-year span between administrations of the Delaware Survey on Children's Health. The initiative also spurred increased knowledge of healthy eating and awareness of the need for increased physical activity in school, child care, and primary care settings.

Use of an electronic medical record system to support primary care recommendations to prevent, identify, and manage childhood obesity.

Many primary care physicians are not providing care that is consistent with recommendations to prevent, to identify, and to manage childhood obesity. This report presents modifications made to the electronic medical record system of a large pediatric health care system, using a quality improvement approach, to support these recommendations and office system changes. Although it is possible to make practice changes secondary to electronic medical record system enhancements, challenges to development and implementation exist.

Beyond medical care: how health systems can address children's needs through health promotion strategies.

This paper describes an innovative approach that integrates community-based health promotion and disease prevention into a well-established pediatric medical care system. System components include a population-level focus in multiple service sectors, community coalitions, knowledge dissemination, and social marketing. The combination of these components is intended to bring about widespread changes in health/social policy and professional practice, which, in turn, should improve health behavior and outcomes. Early lessons are discussed.

CSHCN in Texas: meeting the need for specialist care.

OBJECTIVE: Assuring the sufficiency and suitability of systems of care and services for children with special health care needs (CSHCN) presents a challenge to Texas providers, agencies, and state Title V programs. To meet the need for specialist care, referrals from primary care doctors are often necessary. The objective of this study was to describe the factors associated with the need for specialist care and problems associated with obtaining referrals in Texas. METHODS: Bivariate and multivariate analyses were performed using the National Survey of Children with Special Health Care Needs (NS-CSHCN) weighted sample for Texas (n = 719,014) to identify variables associated with the need for specialist care and problems obtaining referrals for specialist care. RESULTS: Medical need of the CSHCN and sensitivity to family values/customs was associated with greater need for specialist care, and Hispanic ethnicity and lower maternal education were associated with less need. Medical need, amount of time spent with doctors and sensitivity to values/customs, living in a large metropolitan statistical area, and lack of medical information were associated with problems obtaining a specialist care referral. CONCLUSIONS: Findings revealed some similarities and differences with meeting the need for specialist care when comparing Texas results to other studies. In Texas, aspects of customer satisfaction variables, especially doctors' sensitivity to family values/customs and parents' not receiving enough information on medical problems, were significantly associated with problems obtaining specialist referrals. Findings indicate a need to further research relationships and communication among doctors, CSHCN, and their families.

Contraceptive use among Jamaican teenage mothers.

OBJECTIVE: To compare the prevalence of contraceptive use among teenage mothers who were participating, and teenage mothers who were not participating, in a program in Jamaica that had been established to deal with the country's serious problem of repeat pregnancies among adolescents. METHODS: A historical cohort design was used to assess the impact that the Women's Centre of Jamaica Foundation (WCJF) Programme for Adolescent Mothers had on contraceptive use among the target population of adolescents 16 years and under who had experienced a first live birth in 1994. RESULTS: Contraceptive use at first intercourse was found to be higher among WCJF program participants (44%) than among nonparticipants (37%), but this difference was not significant (P = 0.35). Contraceptive use after first live birth was also higher among WCJF program participants (94%) than among nonparticipants (86%), and this difference was significant (P = 0.04). Contraceptive prevalence at last intercourse (in 1998) did not differ between participants and nonparticipants (both 69%). CONCLUSIONS: Contraceptive use among this population in Jamaica was highest when the respondents' perception of vulnerability to pregnancy was most acute, that is, after the first live birth. All adolescents, both males and females, need to be educated about the importance of sustained and effective use of contraception in order to reduce the risk of unintended pregnancy and sexually transmitted diseases.

Contraceptive use among Jamaican teenege mother / Uso de anticonceptivos por madres adolescentes jamaiquinas

Objetivos. Comparar la prevalencia del uso de anticonceptivos entre madres adolescentes que estaban participando o no en un programa instaurado en Jamaica para abordar el grave problema que en este país representan los embarazos repetidos en adolescentes. Métodos. Se usó un diseño de cohorte histórica para evaluar el impacto del Programa para Madres Adolescentes del Centro de Mujeres de la Fundación Jamaica (The Women's Centre of Jamaica Foundation: WCJF) sobre el uso de anticonceptivos en la población de adolescentes de 16 años o menos que habían tenido su primer niño vivo en 1994. Resultados. El uso de anticonceptivos en el primer coito fue más frecuente entre las participantes en el programa del WCJF (44%) que entre las que no participaron (37%), pero la diferencia no fue significativa (P = 0,35). El uso de anticonceptivos tras el nacimiento del primer niño vivo también fue mayor entre las participantes en el programa (94%) que entre las que no participaron (86%), y esta diferencia fue significativa (P = 0,04). La prevalencia del uso de anticonceptivos en el último coito (en 1998) fue igual en ambos grupos (69%). Conclusiones. El uso de anticonceptivos en esta población jamaiquina fue más frecuente cuando la percepción de las encuestadas de su vulnerabilidad al embarazo era más aguda, esto es, después del nacimiento del primer niño vivo. Es necesario educar a todos los adolescentes de ambos sexos acerca de la importancia del uso continuo y eficaz de anticonceptivos, con el fin de reducir el riesgo de embarazos no deseados y de enfermedades de transmisión sexual

Objective. To compare the prevalence of contraceptive use among teenage mothers who were participating, and teenage mothers who were not participating, in a program in Jamaica that had been established to deal with the country's serious problem of repeat pregnancies among adolescents. Methods. A historical cohort design was used to assess the impact that the Women's Centre of Jamaica Foundation (WCJF) Programme for Adolescent Mothers had on contraceptiveuse among the target population of adolescents 16 years and under who had experienced a first live birth in 1994. Results. Contraceptive use at first intercourse was found to be higher among WCJF program participants (44%) than among nonparticipants (37%), but this difference was not significant (P = 0.35). Contraceptive use after first live birth was also higher among WCJF program participants (94%) than among nonparticipants (86%), and this difference was significant (P = 0.04). Contraceptive prevalence at last intercourse (in 1998) did not differ between participants and nonparticipants (both 69%). Conclusions. Contraceptive use among this population in Jamaica was highest when the respondents' perception of vulnerability to pregnancy was most acute, that is, after the first live birth. All adolescents, both males and females, need to be educated about the importance of sustained and effective use of contraception in order to reduce the risk of unintended pregnancy and sexually transmitted diseases

Barriers to early detection of breast cancer among women in a Caribbean population

The purpose of this descriptive study was to identify and describe barriers to early detection of breast cancer, as well as current breast cancer screening behaviors and attitudes regarding the disease, among women aged 20 and older on the Caribbean island of Tobago. Tobago is the smaller of the two islands that make up the nation of Trinidad and Tobago. Between February and June 1996, 265 women fitting the age criteria completed a structured survey questionnaire. Women of Agrican descent made up 89 per cent of the respondents. In terms of age, 48 per cent of those surveyed were between 20 and 39, 40 per cent were between 40 and 59, and 12 per cent were 60 or older. Barriers to early detection identified were a low level of breast self-examination, infrequent clinical breast examinations as part of regular care, unavailability of mammography services on Tobago, cost of screening, and difficulty of traveling to Trinidad for mammography. Furthermore, only a minority of the study participants had ever attended early detection or public awareness programs. The results were nearly the same for individuals with a family history of breast cancer, who would have a higher risk of occurrence of the disease. In addition, the majority of the respondents reported what can be considered a cultural barrier to early detection practices, a belief that no matter what they did, if they were to get breast cancer, they would get it. The authors recommend that mammography services be made available on Tobago. The authors also intend to use the findings to help develop an appropriate, culturally sensitive breast cancer awareness and early detection program for women on the island

Barriers to early detection of breast cancer among women in a Caribbean population / Barreras que dificultan la detección temprana del cáncer de mama en una población de mujeres caribeñas

The purpose of this descriptive study was to identify and describe barriers to early detection of breast cancer, as well as current breast cancer screening behaviors and attitudes regarding the disease, among women aged 20 and older on the Caribbean island of Tobago. Tobago is the smaller of the two islands that make up the nation of Trinidad and Tobago. Between February and June 1996, 265 women fitting the age criteria completed a structured survey questionnaire. Women of Agrican descent made up 89 per cent of the respondents. In terms of age, 48 per cent of those surveyed were between 20 and 39, 40 per cent were between 40 and 59, and 12 per cent were 60 or older. Barriers to early detection identified were a low level of breast self-examination, infrequent clinical breast examinations as part of regular care, unavailability of mammography services on Tobago, cost of screening, and difficulty of traveling to Trinidad for mammography. Furthermore, only a minority of the study participants had ever attended early detection or public awareness programs. The results were nearly the same for individuals with a family history of breast cancer, who would have a higher risk of occurrence of the disease. In addition, the majority of the respondents reported what can be considered a cultural barrier to early detection practices, a belief that no matter what they did, if they were to get breast cancer, they would get it. The authors recommend that mammography services be made available on Tobago. The authors also intend to use the findings to help develop an appropriate, culturally sensitive breast cancer awareness and early detection program for women on the island

Este estudio descriptivo tuvo como objetivo reconocer y describir las barreras que dificultan la detección temprana del cáncer de mama, el comportamiento en torno al tamizaje y las actitudes hacia ese tipo de cáncer en mujeres de 20 o más años de edad de la isla caribeña de Tabago. Esta es la más pequeña de las dos islas que constituyen la nación de Trinidad y Tabago. Entre febrero y junio de 1996, 265 mujeres que cumplían con el criterio de la edad llenaron un cuestionario de encuesta estructurado. Eran de descendencia africana 89% de las que respondieron. En cuanto a edad, 48% de las encuestadas tenían entre 20 y 39 años, 40% tenían entre 40 y 59, y 12% tenían 60 o más. Las barreras que reconocieron frente a la detección temprana fueron la poca costumbre de autoexaminarse el seno, la escasa frecuencia de exámenes del seno en la atención de salud habitualmente recibida, la falta de servicios de mamografía en Tabago, el costo del tamizaje y la dificultad de tener que viajar a Trinidad para hacerseuna mamografía. Además, solo una pequeña proporción de las participantes en el estudio había jamás asistido a algún programa de detección temprana o concienciación del público. Los resultados fueron casi idénticos en las que tenían antecedentes familiares de cáncer y, por lo tanto, mayor riesgo de la enfermedad. Por añadidura, la mayoría de las que respondieron a la encuesta dejaron traslucir lo que podría interpretarse como una barrera cultural contra la práctica de detección temprana, o sea, la creencia de que si estaban destinadas a tener cáncer de mama, lo tendrían hicieran lo que hicieran. Los autores recomiendan que en Tabago se hagan asequibles al público los servicios de mamografía. También piensan usar los resultados del estudio para elaborar un programa apropiado y culturalmente sensible de concienciación sobre el cáncer de mama y su detección temprana en la isla

Contraceptive use among Jamaican teenage mothers

Objective: To compare the prevalence of contraceptive use among teenage mothers who were participating, and teenage mothers who were not participating, in a program in Jamaica that had been established to deal with the country's serious problem of repeat pregnancies among adolescents. Methods: A historical cohort design was used to assess the impact that the Women's Centre of Jamaica Foundation (WCJF) Programme for Adolescent Mothers had on contraceptive use among the target population of adolescents 16 years and under who had experienced a first live birth in 1994. Results: Contraceptive use at first intercourse was found to be higher among WCJF program participants (44 percent) than among nonparticipants (37 percent), but this difference was not significant (P=0.35). Contraceptive use after first live birth was also higher among WCJF program participants (94 percent) than among nonparticipants (86 percent), and this difference was significant (P=0.04). Contraceptive prevalence at last intercourse (in 1998) did not differ between participants and nonparticipants (both 69 percent). Conclusions. Contraceptive use among this population in Jamaica was highest when the respondents' perception of vulnerability to pregnancy was most acute, that is, after the first live birth. All adolescents, both males and females, need to be educated about the importance of sustained and effective use of contraception in order to reduce the risk of unintended pregnancy and sexually transmitted diseases (AU)

Barriers to early detection of breast cancer among women in a Caribbean population

The purpose of this descriptive study was to identify and describe barriers to early detection of breast cancer, as well as current breast cancer screening behaviors and attitudes regarding the disease, among women aged 20 and older on the Caribbean island of Tobago. Tobago is smaller of the two islands that make up the nation of Trinidad and Tobago. Between February and June 1996, 265 women fitting the age criteria completed a structured survey questionnaire. Women of African descent made up 89 percent of the respondents. In terms of age, 48 percent of those surveyed were between 20 and 39, 40 percent were between 40 and 59, and 12 percent were 60 or older. Barriers to early detection identified were a low level of breast self-examination, infrequent clinical breast examinations as part of regular care, unavailability of mammography services on Tobago, cost of screening, and difficulty of travelling to Trinidad for mammography. Furthermore, only a minority of the study participants had ever attended early detection or public awareness programs. The results were nearly the same for individuals with a family history of breast cancer, who would have a higher risk of occurrence of the disease. In addition, the majority of the respondents reported what can be considered a cultural barrier to early detection practices, a belief that no matter what they did, if they were to get breast cancer, they would get it. The authors recommend that mammography services be made available on Tobago. The authors also intend to use findings to help develop an appropriate, culturally sensitive breast cancer awareness and early detection program for women on this island.(Au)

Barriers to early detection of breast cancer among women in a Caribbean population

The purpose of this descriptive study was to identify and describe barriers to early detection of breast cancer, as well as current breast cancer screening behaviors and attitudes regarding the disease, among women aged 20 and older on the Caribbean island of Tobago. Tobago is the smaller of the two islands that make up the nation of Trinidad and Tobago. Between February and June 1996, 265 women fitting the age criteria completed a structured survey questionnaire. Women of African descent made up 89 percent of the respondents. In terms of age, 48 percent of those surveyed were between 20 and 39, 40 percent were between 40 and 59, and 12 percent were 60 or older. Barriers to early detection identified were a low level of breast self-examination, infrequent clinical breast examination as part of regular care, unavailability of mammography services in Tobago, cost of screening, and difficulty of travelling to Trinidad for mammography. Furthermore, only a minority of the study participants had ever attended early detection or public awareness programs. The results were nearly the same for individuals with a family history of breast cancer, who would have higher risk of occurence of the disease. In addition, the majority of the respondents reported what can be considered a cultural barrier to early detection practices, a belief that no matter what they did, if they were to get breast cancer, they would get it. The authors recommend that mammography services be made available on Tobago. The authors also intend to use the findings to help develop an appropriate, culturally sensitive breast cancer awareness and early detection program for women on the island (AU)