Child Public Health Resources
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Hot Reads for Child Public Health June 2007
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Prenatal smoking exposure and psychiatric symptoms in adolescence. Acta Paediatrica. Volume 96 Issue 3 Page 377 - March 2007
In a prospective population based study, 84 adolescents, of whom 32 of the mothers reported smoking during pregnancy were followed-up. The Achenbach System of Empirically Based Assessment (ASEBA), ADHD-Rating Scale IV, Autism Spectrum Screening Questionnaire (ASSQ), Children's Global Assessment Scale (CGAS), estimated IQ based on four subscales of WISC-III were administered. The study showed adolescents who were born by smokers had significantly more rule-breaking and aggressive behaviour, externalizing and total problems on the ASEBA than adolescents of non-smokers, when reported by mothers, fathers and teachers. ADHD symptoms were reported more frequently, and mothers also reported more internalizing symptoms and social problems. The ASSQ sum score was higher, and overall function as measured by the CGAS was lower for the smoking-exposed group. Associations were still present after controlling for possible confounding factors. Conclusion: Adolescents exposed to prenatal smoking had higher scores for both externalizing and internalizing psychiatric symptoms, which could not be explained by a broad range of possible psychosocial confounders. Thus, smoking in pregnancy may be a marker for increased risk of psychiatric symptoms in the offspring. -
Folic acid supplements and risk of facial clefts: national population based case-control study BMJ 2007;334(7591):464 (3 March)
Association of facial clefts with maternal intake of folic acid supplements, multivitamins, and folates in diet was studied in 377 infants with cleft lip with or without cleft palate; 196 infants with cleft palate alone; and 763 controls. Results Folic acid supplementation during early pregnancy (≥400 µg/day) was associated with a reduced risk of isolated cleft lip with or without cleft palate after adjustment for multivitamins, smoking, and other potential confounding factors (adjusted odds ratio 0.61, 95% confidence interval 0.39 to 0.96). Independent of supplements, diets rich in fruits, vegetables, and other high folate containing foods reduced the risk somewhat (adjusted odds ratio 0.75, 0.50 to 1.11). The lowest risk of cleft lip was among women with folate rich diets who also took folic acid supplements and multivitamins (0.36, 0.17 to 0.77). Folic acid provided no protection against cleft palate alone (1.07, 0.56 to 2.03). Conclusions Folic acid supplements during early pregnancy seem to reduce the risk of isolated cleft lip (with or without cleft palate) by about a third. Other vitamins and dietary factors may provide additional benefit. -
Breastfeeding and Hospitalization for Diarrheal and Respiratory Infection in the United Kingdom Millennium Cohort Study PEDIATRICS Vol. 119 No. 4 April 2007, pp. e837-e842
The study was a population-based survey (sweep 1 of the United Kingdom Millennium Cohort Study). Data on infant feeding, infant health, and a range of confounding factors were available for 15890 healthy, singleton, term infants who were born in 2000–2002. Data analysed by month of age, with adjustment for confounders, showed that exclusive breastfeeding, compared with not breastfeeding, protects against hospitalization for diarrhea and lower respiratory tract infection in the first 8 months after birth. The effect of partial breastfeeding is weaker. Population-attributable fractions suggest that an estimated 53% of diarrhea hospitalizations could have been prevented each month by exclusive breastfeeding and 31% by partial breastfeeding. Similarly, 27% of lower respiratory tract infection hospitalizations could have been prevented each month by exclusive breastfeeding and 25% by partial breastfeeding. The protective effect of breastfeeding for these outcomes wears off soon after breastfeeding cessation. CONCLUSIONS Breastfeeding, particularly when exclusive and prolonged, protects against severe morbidity in contemporary UK. A population-level increase in exclusive, prolonged breastfeeding would be of considerable potential benefit for public health. -
Twenty-Year Trends in Fatal Injuries to Very Young Children: The Persistence of Racial Disparities PEDIATRICS Vol. 119 No. 4 April 2007, pp. e875-e884
Injury analyses used national vital statistics data from January 1, 1981, to December 31, 2003. Rate calculations and χ2 test for trends (Mantel extension) used data that were collapsed into 3-year intervals to produce cell sizes with stable estimates. Percentage change for mortality rate ratios used the earliest (1981–1983) and the latest (2001–2003) study period for black, American Indian/Alaskan Native, and Asian/Pacific Islander children, with white children as the comparison group. All-cause injury rates declined during the study period, but current mortality ratios for all-cause injury remained higher in black and American Indian/Alaskan Native children and lower in Asian/Pacific Islander children compared with white children. Trend analyses within racial groups demonstrate significant improvements in all groups for unintentional but not intentional injury. Black and American Indian/Alaskan Native children had higher injury risk as a result of residential fire, suffocation, poisoning, falls, motor vehicle traffic, and firearms. Disparities narrowed for residential fire, pedestrian, and poisoning and widened for motor vehicle occupant, unspecified motor vehicle, and suffocation for black and American Indian/Alaskan Native children. CONCLUSIONS These findings identify injury areas in which disparities narrowed, improvement occurred with maintenance or widening of disparities, and little or no progress was evident. This study further suggests specific mechanisms whereby new strategies and approaches to address areas that are recalcitrant to improvement in absolute rates and/or narrowing of disparities are needed and where increased dissemination of proven efficacious injury prevention efforts to high-risk populations are indicated. -
Persistent Socioeconomic Disparities in Infant, Neonatal, and Postneonatal Mortality Rates in the United States, 1969–2001 PEDIATRICS Vol. 119 No. 4 April 2007, pp. e928-e939
A deprivation index was linked to county vital records data to derive annual infant mortality rates by deprivation quintiles from 1969 to 2000. Rates by maternal education were computed for 1986, 1991, 1996, and 2001 using national linked birth/infant death files. Log-binomial regression was used to estimate relative risks of infant mortality by deprivation and time period. Cox regression was used to model overall and birth weight–specific infant mortality risks by maternal education after adjusting for covariates. Temporal disparities were summarized by log-linear regression and inequality indices. RESULTS. Although absolute disparities have narrowed over time, relative socio-economic disparities in infant mortality have increased since 1985. In 1985–1989, infants in the most deprived group had, respectively, 36% and 57% higher risks of neonatal and postneonatal mortality than infants in the least deprived group. The corresponding relative risks increased to 43% and 96% in 1995–2000. The adjusted risk of infant mortality was 22% higher in 1986 for mothers with <12 years of education than for those with ≥16 years of education, with the relative risk increasing to 41% in 2001. Disparities were greatest among normal birth weight infants, with education-specific relative risks of neonatal and postneonatal mortality increasing significantly between 1986 and 2001. CONCLUSIONS. Dramatic declines in infant mortality among all of the socioeconomic groups during 1969–2001 represent a major public health success. However, substantial socioeconomic disparities persisted in both neonatal and postneonatal mortality. Relatively larger declines in infant and postneonatal mortality among higher socioeconomic groups have contributed to the widening gap in mortality since 1985. Persistent disparities in infant mortality may reflect increasing polarization among socioeconomic groups in material and social conditions, smoking during pregnancy, and health care services.