Journal Highlights: International Child Health Priorities

Newswise — The articles below will be published online December 28, 2006, at 4 p.m. (EST) by the American Journal of Public Health under "First Look" at http://www.ajph.org/first_look.shtml, and will appear in the February 2007 print issue of the Journal. "First Look" articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, http://www.apha.org, and is available at http://www.ajph.org.

(1) KIDS' OBESITY PROBLEMS BEGIN AS YOUNG AS AGE 3, MOTHER'S WEIGHT A BIG FACTORChildren's problems with overweight and obesity begin as early as age 3, and Hispanic children and those with obese mothers are especially at risk.

Researchers looked at a national sample of 2,271 urban, low-income 3-year-olds and found the highest rates of obesity and overweight among Hispanic children. Black children were also more likely to be overweight or obese than white children. The study's authors said they could not explain the disparities, but some factors did increase a child's likelihood of being overweight at age 3, including taking a bottle to bed, having an obese mother and having a higher than average birth weight (more than 4,500 grams, or approximately 10 pounds).

Parents who do not regularly shop at a grocery store also increase their preschoolers' odds of being overweight or obese. Having been breastfed for at least six months significantly decreased the odds that a child of an obese mother would be overweight or obese, but did not affect children of non-obese mothers. In those children surveyed, 42 percent of white children with obese mothers were themselves overweight or obese, compared to 36 percent of black children and 56 percent of Hispanic children (for normal-weight mothers, the figures were 26 percent, 25 percent and 40 percent, respectively). "Clearly, maternal weight status is a key determinant of children's obesity at age 3, either via household levels of nutrition and exercise or genetic factors," the study's authors said.

[From: "Children's Overweight and Obesity at Age Three: Examining the Racial and Ethnic Differentials." ]

(2) LABOR POLICIES PUTTING KIDS AT INJURY RISK, ESPECIALLY ON FAMILY FARMSChild labor practices in developing countries are putting children at significant risk for death and injury, and on American farms, the practice of allowing young family members to work raises their risk of injury as well.

One study that looked at the impact of child labor in developing countries found that allowing children ages 10-14 to work significantly increases child death rates, lowers a population's nutritional status and even increases the prevalence of infectious disease. In another study, researchers examined more than 1,000 pediatric farm injuries in the United States and Canada and found that raising the working age for "hazardous jobs" on farms from 16 to 18 would "be efficacious in preventing the most serious injuries experienced by young family workers. Potential reductions in injury would meet Healthy People 2010 goals for reducing traumatic injury in the agricultural sector." A current exemption allows teens to work at so-called "hazardous jobs" on farms as young as 16 if their family owns the farm.

[From: "The Health Impact of Child Labor in Developing Countries: Evidence From Cross-Country Data." Contact: Paola A. Roggero, MD, PhD, Bocconi University, Milano, Italy, [email protected] and "Changing the Child Labor Laws for Agriculture: Impact on Injury." ]

(3) AS PEOPLE ARE LIVING LONGER, CAREGIVING IS BECOMING A BIGGER HEALTH ISSUE Caregiving is an emerging public health issue with fluctuating care requirements that must touch on both the psychological and the physical needs of the caregiver and the care recipient.

In an analytical essay, public health scientists Ronda C. Talley and John E. Crews look at caregiving as a growing concern in the health field as America ages. While historically scientists and health practitioners have not recognized caregiving as a public health issue, the authors assert there is a need to do so. Caregiving is becoming a widespread concern not only with the "graying of America," but also because of increased life expectancy among people with disabilities. For example, the first-year survival rate of children born with Down syndrome increased from 50 percent in 1942-52 to 91 percent in 1980-1996.

The authors note that the "nature and complexity of caregiving will become more intense and more complex as increasing lifespan among multiple groups taxes the ability to provide care. It is clear that caregivers do suffer a significant burden and face many potentially serious problems. The challenge for public health systems is to understand more about which caregivers are particularly vulnerable and why, then to design and implement evidence-based interventions to address identified needs."

[From: "The Public Health of Caregiving." ]

(4) BLACK WOMEN ARE UP TO FOUR TIMES MORE LIKELY TO DIE FROM PREGNANCY-RELATED CONDITIONS THAN WHITE WOMENBlack women are much more likely to die from certain pregnancy-related complications than white women, yet the deaths cannot be explained by higher rates of those complications.

Researchers calculated prevalence and case-related fatality rates for five pregnancy-related conditions: preeclampsia, eclampsia, abruptio placentae, placenta previa and postpartum hemorrhage. Those five conditions account for 26 percent of all pregnancy-related deaths. The study was based on data from the National Hospital Discharge Survey and from the Pregnancy Mortality Surveillance System collected 1988-1999. While the prevalence of complications was not significantly different between black and white mothers, case-fatality rates among black women were 2 to 3 times higher than for white women.

"To understand why black women have higher case-fatality rates for the conditions examined in this study, a complex interaction of biological and health services factors must be untangled," the study's authors wrote. "We hope that research will advance beyond the descriptive epidemiology of racial disparities in pregnancy-related mortality to studies that will help elucidate the causes of disparity."

[From: "The Black: White Disparity in Pregnancy-Related Mortality From Five Conditions: Differences in Prevalence and Case-Fatality Rates." ]

(5) CHANGES NEEDED TO PREVENT MILLIONS OF CHILD DEATHSResearch aimed at preventing the estimated 10 million yearly child deaths worldwide is not aimed in the right direction.

According to an analysis of research on the principle causes of child mortality supported by the National Institutes of Health and the Bill and Malinda Gates Foundation between 2000 and 2004, most grants were for developing new technologies, which would reduce child deaths by an estimated 22 percent. The analysis estimates that reduction is three times less than what could be achieved if current medical technologies were fully utilized. A mere 3 percent of child mortality grants were directed to research on health delivery and utilization.

"[R]esearch on utilization and delivery can yield insights that lead to new strategies to identify and break the bottlenecks that prevent current technologies from achieving their potential," wrote Jef L. Leroy of Mexico's National Institute of Public Health. "It is time to invest adequate resources for research in delivery and utilization in order to support the same kinds of advances in these areas that we have experienced in the development of health technologies."

[From: "Current Priorities in Health Research Funding Cannot Prevent the 10 Million Child Deaths Each Year." ]

The American Journal of Public Health is the monthly journal of the American Public Health Association (APHA), the oldest organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting sound scientific standards, action programs and public policy to enhance health. More information is available at http://www.apha.org