SURVEY DESCRIBES PREVALENCE OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS AND IMPACT ON THE FAMILY

CHICAGO—Approximately 13 percent of U.S. children have had a special health care need (SHCN), and significant proportions of their families experience financial problems related to the child's condition, according to an article in the September issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Children with SHCNs are defined as "those children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health care-related services of a type or amount beyond that required by children generally," according to the federal Maternal and Child Health Care Bureau. These children are also at risk for mental and behavioral problems, and missing school days, according to the article. Parents of children with SHCNs are less likely to be employed full time and are more likely to have Medicaid insurance, the article states.

Peter C. van Dyck, M.D., M.P.H., from the Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Md., and colleagues designed a study to estimate the number of children with SHCNs in the United States and to evaluate how well their needs were being met. The researchers conducted telephone interviews with the families of 38,866 children with SHCNs younger than 18 years.

The researchers found that an estimated 12.8 percent of U.S. children had an SHCN in 2001. The prevalence of SHCNs was highest among boys, school-age children, and children in lower-income families. Of these children, 17.7 percent experienced unmet health care needs. Almost 30 percent of the families interviewed reported that their child's condition had caused them to cut back on or quit work, and 20.9 percent of the families reported that their child's health care caused financial problems.

"Perhaps our most important findings concern the disparities we found in access, satisfaction, and impact on the family," the authors write. "We found consistent patterns of disparities whereby children disadvantaged by low family income, minority racial and ethnic status, lack of health insurance, and greater severity of functional limitations also experienced significantly worse access to care than their more advantaged counterparts," write the researchers.

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To contact Sharon G. Humiston, M.D., M.P.H., call Leslie Orr at 585/275-5774.

MOST PHYSICIANS AGREE THAT WIDESPREAD ROUTINE INFLUENZA VACCINATION FOR YOUNG CHILDREN IS FEASIBLE

CHICAGO—Most pediatricians and family physicians who completed a nationwide survey agreed that universal influenza vaccination for infants is feasible, according to an article in the September issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

In 2003, the Advisory Committee on Immunization Practices published a new recommendation for children 6 to 23 months old to routinely receive the influenza vaccine. According to background information in the article, the influenza vaccine must be given annually, and for children younger than nine years old receiving the vaccine for the first time, a second dose should be given at least four weeks after the first. However, little is known about the feasibility of adding universal influenza vaccination to the already complex recommended pediatric schedule of vaccinations.

Sharon G. Humiston, M.D., M.P.H., of the University of Rochester, New York, and colleagues surveyed 458 pediatricians and family physicians nationwide (306 pediatricians, 152 family physicians) on the feasibility of universal influenza vaccination for children 12 through 35 months old. In February 2001, the researchers mailed the 20-item survey to a random sampling of 972 U.S. pediatricians and family physicians.

Of physicians surveyed, 80 percent of pediatricians and 69 percent of family physicians agreed that a universal influenza vaccination program for infants would be feasible. The majority of pediatricians and family physicians surveyed also agreed that universal vaccination would greatly decrease sickness during the influenza season (67 percent and 57 percent, respectively). When asked about vaccinating children as young as six months old, only 50 percent of pediatricians and 40 percent of family physicians felt a vaccination implementation program was viable.

Those surveyed noted some possible impediments: "Physicians considered the major barriers to implementation of universal influenza vaccination to be costs to practices and parents, parental concerns about vaccine safety, and the need for additional vaccinations or visits without the practices having reminder-recall capabilities, or efficient methods to handle the large volume of visits."

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To contact Rosalind Brannigan, M.P.H., call Mathea Falco at 415/225-3366.

MANY TEEN SUBSTANCE ABUSE PROGRAMS LACK KEY COMPONENTS DEEMED NECESSARY FOR EFFECTIVE TREATMENT

CHICAGO—Many highly regarded adolescent substance abuse treatment programs lack several key elements believed to be necessary for effective treatment, including strategies for engaging and retaining teens, showing gender and culture sensitivity, and evaluating the success of treatment, according to an article in the September issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

According to information in the article, drug and alcohol abuse and dependence are the most common causes of adolescent illness and death in the United States, and effective treatment programs are urgently needed. "Only 10 percent of the estimated 1.4 million adolescents (aged 12 to 17 years) with an illicit drug problem are receiving treatment, compared with one in five adults," the article states. Adolescents have different needs than adults when it comes to drug treatment programs - adolescent drug users often have additional health problems, different developmental needs and are more likely to be binge drug users (as opposed to long-term, steady users).

Rosalind Brannigan, M.P.H., of Drug Strategies, Washington, D.C., and colleagues recruited an advisory panel of 22 experts to identify nine key elements of effective treatment for adolescent substance abuse. The panel also identified 144 highly regarded adolescent substance abuse treatment programs in the United States. Leaders of these programs were interviewed and surveyed regarding the nine key elements. There was a 100 percent response rate to the interviews, and a 65 percent response rate to the follow-up surveys. Programs were scored, with a possible total score of 45. The nine key elements included assessment at the beginning of the programs, treatment matching (providing tailored treatment for teens with psychiatric disorders, medical problems, etc.), qualified staff, competence in addressing gender and cultural differences, continuity of care, and evaluating the outcomes of treatment.

The researchers found that the average score for the treatment programs was 23.8, and programs that scored in the top quartile were not more likely to be accredited. Most programs scored at least a four out of five on only one of the nine key elements (qualified staff). The elements with the poorest scores were assessment and treatment matching, engaging and retaining teens in the program, gender and cultural competence, and evaluating treatment outcomes.

"Most of the 144 highly regarded programs we surveyed are not addressing the key elements of effective adolescent substance abuse treatment," the authors write. "More than 40 percent of the reviewed programs fulfilled fewer than half of the 45 components that make up the key elements, and only 3 percent of programs fulfilled four fifths of these components. However, high scores were achieved on individual key elements by several programs in our sample, suggesting that implementing the key elements in practice is already within reach of existing programs."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 6, 2004
To contact Bankole A. Johnson, M.D., Ph.D., call Will Sansom at 210/567-2570.

DRUG HELPS REDUCE DRINKING AND IMPROVE QUALITY OF LIFE AMONG PATIENTS WITH ALCOHOL DEPENDENCE

CHICAGO—The drug topiramate helps reduce drinking and improves overall quality of life among patients with alcohol dependence, according to an article in the September issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

According to information in the article, topiramate (a drug used to help prevent seizures among patients with epilepsy) is effective at reducing craving and heavy drinking and improves abstinence among people with alcohol dependence. Alcohol dependence is associated with several harmful psychosocial consequences, including negative effects on social, occupational and recreational activities.

Bankole A. Johnson, M.D., Ph.D., of The University of Texas Health Science Center at San Antonio, and colleagues investigated whether topiramate could reduce the harmful psychosocial consequences associated with alcohol dependence and could improve quality of life.

The researchers recruited 150 alcohol-dependent individuals between the ages of 21 and 65 years old. Seventy-five participants received topiramate, and 75 received placebo over the course of twelve weeks (between 1998 and 2001). Three elements of psychosocial functioning were measured at the beginning of the study, and several times throughout the duration of the study: overall well-being and alcohol-dependence severity, quality of life, and harmful drinking consequences.

Averaged over the duration of the study, participants receiving topiramate were more than twice as likely to experience improved well-being than participants taking placebo. Participants receiving topiramate were also more than two and one half times more likely to report abstinence from alcohol, and were more than twice as likely to report overall satisfaction with life. They also reported fewer instances of harmful drinking consequences than participants receiving placebo.