March News

March 10th, 2006 marks the first National Women and Girls HIV/AIDS Awareness Day aimed at raising awareness of the increasing impact of the HIV/AIDS epidemic on women and girls. In the United States, women represent a rising share of AIDS cases, increasing from only 8% of new AIDS diagnoses in 1985 to 27% by 2004. The impact of the epidemic on women of color, particularly African American women, is striking. In advance of National Women and Girls HIV/AIDS Awareness Day, the Kaiser Family Foundation has an updated fact sheet that provides the latest data on women and HIV/AIDS in the U.S. The fact sheet is available at http://www.kff.org/hivaids/6092.cfm .

* Women’s Health on KaiserEDU: This site includes narrated slide tutorials, background reference libraries, and issue modules on current topics and policy debates related to women’s health and can be found at http://www.kaiseredu.org/redirect/womenshealth .

* StateHealthFacts.org: This site includes data on various topics of women’s health and the HIV/AIDS epidemic broken down by state and can be found at www.statehealthfacts.org/r/women'shealth.cfm .

* Women and Health Care: A National Profile: This national survey of women on their health also examines women’s health care costs, insurance, access to care, prevention, and their role in family health care and can be found at http://www.kff.org/womenshealth/whp070705pkg.cfm .

* Kaiser Health Poll Report: Public opinion on the HIV/AIDS Epidemic in the United States can be found at http://www.kff.org/spotlight/worldaidsday2005/index.cfm .

* Women and HIV/AIDS in the United States: Setting an Agenda for the Future: This package of resources includes a discussion of the growing HIV/AIDS epidemic among women and the video "Hidden Crisis: Women and AIDS in America," a documentary created by Rory Kennedy and Moxie Firecracker films that profiles three women living with HIV/AIDS. This is available at http://www.kff.org/hivaids/hiv102303package.cfm .

We hope you find the information useful, and we welcome your feedback. For media inquiries please contact Rob Graham in our communications office at 650-854-9400 ext. 237 or by email at rgraham@kff.org.

State Politics & Policy | State Parental Notification, Consent Laws Have No 'Significant Impact' on Number of Abortions Among Minors, New York Times Analysis Says [Mar 06, 2006]

State parental notification and consent laws have not had a "significant impact" on the number of unplanned pregnancies and abortions among minors, according to a New York Times analysis reported on Monday. The analysis examined six states -- Arizona, Idaho, South Dakota, Tennessee, Texas and Virginia -- that enacted parental notification or consent laws from 1995 to 2004. The Times found that the implementation of a notification or consent law in the six states produced varying results. For example, the abortion rate among pregnant minors in Tennessee appeared to decrease when the state's consent law was suspended by a federal court, only to increase when the law was reinstated. In Virginia, the abortion rate among pregnant minors did not change much when parental notification was introduced in 1998, but the rate declined after the law was changed to parental consent in 2003. The analysis finds that, when comparing the year before a notification or consent law went into effect with the following year, the number of abortions among pregnant minors decreased an average 9% in the six states. However, the analysis also finds that the number of abortions among pregnant women ages 18 and 19, who are not affected by the laws, also decreased 5%, which suggests other factors influenced the decrease, according to the Times. "There are ongoing trends that are pushing both birth rates and abortion rates down significantly, and those larger trends are more important than the effect of these laws," Ted Joyce, an economist at Baruch College who studies notification and consent laws, said. Joyce added that minors traveling out of state to access abortion services also could be contributing to the decrease. Supporters of notification and consent say the laws are meant to involve parents in their child's health care decisions, the Times reports. Mary Spaulding Balch, director of state legislation for the National Right to Life Committee, said she believes the laws are effective, adding, "It's one of the few areas that the U.S. Supreme Court has allowed states to legislate, so it's become a key for lowering the abortion rate." Opponents say that parental notification laws restrict abortion rights and potentially put minors' lives at risk. Renee Chelian, director of Northland Family Planning Centers in Detroit, Mich., said that she has had to call the police "because [parents] threaten physical violence on the kids" after they find out the minor plans to undergo an abortion (Lehren/Leland, New York Times, 3/6).

FDA on Thursday announced it will launch an "exhaustive review" of the safety of medicated patches, including the Ortho Evra birth-control patch, the Philadelphia Inquirer reports. Medicated patches were cited as the primary cause of death in eight cases in 2004 and in three cases in 2003, according to an Inquirer analysis of FDA's Adverse Event Reporting System. In addition, in at least 30 cases where patients were disabled, hospitalized or diagnosed with a life-threatening condition, the patch was a "primary suspect," the Inquirer reports. FDA's review -- which first will focus on the fentanyl pain patch and birth-control patch Ortho Evra, both manufactured by Johnson & Johnson -- will examine the effects of heat on the patches. Heat from hot tubs or high fevers can increase the patches' absorption rates to potentially dangerous levels, according to medical experts. Douglas Stokke, a J&J spokesperson, said he was unclear on the details of the FDA study. In response to a question as to whether physicians should tell patients about the possible risks of heat exposure while wearing the patch, he said, "Physicians should be knowledgeable about the prescribing information for these products and should be prescribing them according to labeling." Bozena Michniak of the Center for Biomaterials at Rutgers University said that patch users should be careful of increasing the skin's temperature for an extended period, such as when sitting in the sun or using a heating pad (Fallik, Philadelphia Inquirer, 3/5).

*http://www.kaisernetwork.org/daily_reports/rep_repro_recent_reports.cfm?dr_cat=2&show=yes&dr_DateTime=03-07-06#35820

State Politics & Policy | Time Examines Wal-Mart's Decision to Stock Plan B, Effects on EC Access [Mar 08, 2006]

Time magazine in its March 13 issue examined Wal-Mart's announcement that by March 20 it will begin to stock and fill prescriptions for Barr Laboratories' emergency contraceptive Plan B -- which can prevent pregnancy if taken up to 72 hours after sexual intercourse. Time called the action "the latest in a string of developments expanding access to [EC, and] one of the few arenas in which abortion-rights groups seem to be gaining ground." According to Time, "[n]ow that Wal-Mart has agreed to stock [Plan B], so will every major pharmacy chain in the country." FDA has delayed a decision on Barr's application to provide nonprescription access to Plan B to girls and women ages 17 and older, and a decision seems "unlikely" before the November elections, Time reports. Therefore, some abortion-rights groups have focused efforts on expanding EC access at the state level, according to Time. Eight states allow pharmacists to dispense EC without a prescription if they are specially trained and follow specific guidelines, and seven states are considering similar legislation. Massachusetts and Illinois have requirements improving pharmacy access to EC, and Connecticut and New York are considering similar requirements. Some abortion-rights opponents are "deeply disappointed" in Wal-Mart's "about face" on stocking Plan B, Time reports (Thottam, Time, 3/13).

Election 2006 | New York Senatorial Candidate McFarland Says She Supports Abortion Rights With Restrictions [Mar 09, 2006]

Kathleen Troia McFarland (R), who is seeking the Republican nomination to run against incumbent Sen. Hillary Rodham Clinton (D-N.Y), in a recent interview said she supports abortion rights but also supports laws that require parental notification and a ban on so-called "partial-birth" abortion, the White Plains Journal-News reports. McFarland, who was a Department of Defense spokesperson during the Reagan administration, said she favors exceptions allowing abortion in cases that protect the health of the pregnant woman. "I think I am where the majority of the electorate is and the majority of the Republican Party as well," McFarland said (Blain, White Plains Journal-News, 3/8). McFarland is running for the Republican nomination against former Yonkers, N.Y., Mayor John Spencer, who opposes abortion rights (Humbert, AP/Long Island Newsday, 3/7). Rodham Clinton on her Web site says she supports abortion rights as defined by Roe v. Wade -- the 1973 Supreme Court case that effectively barred state abortion bans -- and believes that abortion should be "safe, legal and rare" (Rodham Clinton Web site, 3/8).

Pregnancy & Childbirth | ABCNews' 'Nightline' Profiles Louisiana Nurse Providing In-Home Care to Low-Income Pregnant Women, Mothers [Mar 09, 2006]

ABCNews' "Nightline" on Wednesday profiled Luwana Marts, a nurse in Louisiana who makes in-home visits to low-income women from pregnancy until their infants are age two. Marts works with the Nurse-Family Partnership, a government-supported program that seeks to break the cycles of poverty, domestic abuse and addiction as well as reduce the number of teen pregnancies in the state, where the teen pregnancy rate is 30% higher than the national average, according to ABCNews. NFP provides a "total intervention" for women on subjects such as nutrition, exercise, budgeting and career development, according to ABCNews. In addition, there is a focus on relationship counseling, sexual behavior and birth control because a goal of the program is to lengthen the amount of time between pregnancies, ABCNews reports. The segment includes comments from Marts and some of her clients ("Nightline," ABCNews, 3/8).

The complete segment is available online.

Pregnancy & Childbirth | New York Times Magazine Examines Issues Surrounding Induced Labor [Mar 27, 2006]

The New York Times Magazine on Sunday examined the increasing frequency of induced labor and the related health and economic issues. The American College of Obstetricians and Gynecologists' guidelines say that labor should be induced if the pregnant woman has maternal high blood pressure, a problem with the placenta or early rupture of the amniotic sac or has carried the fetus past 40 weeks' gestation. In the U.S., a woman carrying past her "due date" is "far and away the most common reason" for inducing labor, and "elective" inductions -- inductions at the woman's request -- seem to be the second most common reason, according to the Times. Physicians estimate that elective inductions likely account for 30% or more of all inductions at some hospitals. Induction increases the risk of fetal distress or a ruptured uterus, as well as the likelihood of a caesarean birth, the Times reports. Hospitals do not "find induced births handy" because of the increased resources needed to care for women whose labor is induced, such as the increased time required to deliver the infant -- an induced labor can take from 24 to 36 hours -- and the care a woman requires after a c-section delivery. The increased frequency of induction means that "hospitals are using more resources on fewer patients," the Times reports. "[M]any hospitals are evaluating how best to control elective inductions, and some are requiring that specific guidelines be met before starting elective inductions," Sarah Kilpatrick, vice chair of the OB practice committee at ACOG and head of the OB/GYN department at the University of Illinois, said, adding that ACOG currently is not attempting to limit elective induction (Cassidy, New York Times Magazine, 3/26).

March 28, 2006 -- Report Cites Health Status of Children in Immigrant Families

Children who are born in the United States to noncitizen parents, foreign-born children with noncitizen parents, and foreign-born children who are naturalized citizens are all likely to have limited access to health insurance and health care, according to a research report in the April 2006 issue of the American Journal of Public Health. Using data from the 1999 National Survey of American Families, the researchers found that parental citizenship plays a strong role in children’s health care, with children of citizen parents faring slightly better than those of non-citizens. That may be so, they speculated, because to become citizens, parents have to have lived in the United States for from 5 to 10 years and are therefore more familiar with the health care system than more recent arrivals, and also because citizen parents are more likely than non-citizens to access public insurance such as Medicaid and the Children’s Health Insurance Program, which many non-citizens avoid because of fear of possible entanglements with authorities on unrelated issues. They note that recent welfare reforms that tightened eligibility rules for legal immigrants until they become citizens are encouraging parents "to avoid Medicaid." The researchers point to a need for outreach to encourage immigrant families to enroll their children when they are eligible, and they urge that existing law be modified to restore health insurance coverage to legal immigrants and pregnant women. Reprints of the article, "Health Status and Health Service Access and Use Among Children in U.S. Immigrant Families," published in the April 2006 issue of the American Journal of Public Health, are available at zh34@georgetown.edu.

Fluoride in Drinking Water: A Scientific Review of EPA's Standards focuses on what constitutes a safe level of naturally occurring fluoride. The report in brief, produced by the National Research Council, does not address the practice of intentionally adding fluoride to public drinking-water supplies for the prevention of tooth decay.
Topics include exposure to fluoride, dental effects of fluoride, skeletal effects of fluoride, studies of fluoride and cancer, implications for the Environmental Protection Agency's drinking water standards, and recommended research. The news release, full report, opening statement, briefing, and report in brief are available at http://www.nationalacademies.org/morenews/20060322.html.
*From: mchalert-bounces@list.ncemch.org-Sent: Friday, March 31, 2006 11:41 AM

ARTICLE LOOKS AT THE RELATIONSHIP BETWEEN REMISSIONS IN MATERNAL DEPRESSION AND CHILD PSYCHOPATHOLOGY

"From a clinical vantage point, our findings suggest that vigorous treatment of depressed mothers to achieve remission is associated with positive outcomes in their children as well, whereas failure to treat depressed mothers may increase the burden of illness in their children," write the authors of an article published in the March 22/29, 2006, issue of JAMA, the Journal of the American Medical Association. Parental depression is among the most consistent and well-replicated risk factors for childhood anxiety and disruptive behavior disorders and for major depressive disorder, with more than a
2- to 3-fold increase in children of depressed parents compared with controls. The study described in this article focused on the symptomatic and behavioral functioning of children assessed 3 months after the initiation of treatment with medication of their mothers'
depression.

The study sample consisted of 151 mother/child pairs who were enrolled in Star*D, a multi-site U.S. study designed to determine the comparative effectiveness and acceptability of different treatment options for a broadly representative group of outpatients with nonpsychotic major depressive disorder. Children's psychiatric disorders at baseline and at the 3-month evaluation were established by a direct interview of mothers and children using the Kiddie Schedule for Affective Disorders and Schizophrenia -- Present and Lifetime Version, the Child Behavior Checklist (CBCL), and the Child Global Assessment Scale. Two main outcomes were analyzed: change in overall rates of children's diagnoses from baseline to 3 months and change in CBCL scored from baseline to 3 months.

* At the 3-month follow-up, there was an overall 11% decrease in rates of diagnoses in children of mothers who met remission criteria vs. an 8% increase in children of mothers with continuing depression. After controlling for the child's age and sex, the change in rates was statistically significant for children of mothers whose depression remitted, but not for children of mothers with continuing depression.

* Of the 37 children with psychiatric diagnoses at baseline whose mothers' depression had remitted, one-third of the children's own diagnoses had remitted, whereas only 12% of the children of mothers with continuing depression lost their diagnoses. However, this difference was not statistically significant.

* All of the 68 children with no psychiatric diagnosis at baseline whose mothers' depression had remitted remained free of psychiatric disorders at the 3-month follow-up, whereas 17% of these children whose mothers remained depressed had an onset or relapse during this period.

The authors conclude that "at a time when there are many questions about the appropriate and safe treatment of psychiatric disorders in children, these findings suggest that it is important to provide vigorous treatment to mothers if they are depressed."

Weissman MM, Pilowsky DJ, Wickramaratne PJ, et al. 2006. Remissions in maternal depression and child psychopathology. JAMA, the Journal of the American Medical Association 295(12):1389-1398. Abstract available at http://jama.ama-assn.org/cgi/content/short/295/12/1389.

FDA Will Review Safety of Medicated Patches, Including Ortho Evra [Mar 07, 2006]

FDA Will Review Safety of Medicated Patches, Including Ortho Evra
[Mar 07, 2006]