Karen G. Duderstadt

The Impact of Public Insurance Expansions on Children’s Access and Use of Care

OBJECTIVE. Our goal was to examine the impact of the State Children’s Health Insurance Program nationally on children’s access and use of health care. OBJECTIVE. Our data source was the National Health Interview Survey, using 1997 as a baseline, which predates the implementation of the State Children’s Health Insurance Program, and 2003 as the end point of the analysis. We analyzed 25 734 children aged 0 to 18 years (1997 and 2003 combined) to examine changes in health insurance coverage rates, health care access, and utilization for children in the State Children’s Health Insurance Program target population, defined here as those living in families with incomes between 100% and 199% of the federal poverty level. RESULTS. Children in the State Children’s Health Insurance Program target income group showed the largest reduction in rates of uninsurance among 3 income groups (<100%, 100%–199%, and ≥200% of the federal poverty level) between 1997 and 2003 (15.1%–8.7%). Significant reductions occurred in the proportion of children without a usual source of care in the target income group (9.4%–7.3%) and in the proportion of children without a provider visit in the past year (10.8%–9.8%). Other measures (unmet needs, delayed care, volume of provider visits, receipt of well-child care, and dental care) showed no significant changes over this time period. A separate multivariate analysis restricted to the State Children’s Health Insurance Program target population in 2003 showed that children with continuous public coverage had significantly better access and utilization on all measures studied when compared with uninsured children and performed as well or better than children with continuous private coverage. CONCLUSIONS. Implementation of the State Children’s Health Insurance Program is associated with substantial gains in public coverage for children in the target income group. Although some of these gains were offset by losses in private coverage, our findings demonstrate that public health insurance provides significant benefits in terms of access and utilization for children living in the target income group.

Disparities in Children's Use of Oral Health Services

Objectives. We sought to determine if the recent expansions in Medicaid and the State Childrens Health Insurance Program (SCHIP) have resulted in a narrowing of income disparities over time with the use of dental care in children 2 to 17 years of age. Methods. Six years of data from the National Health Interview Survey were utilized. A trend analysis was conducted using 1983 as a baseline, which predates the expansions, and 2001–2002, the endpoint, which postdates implementation of the expansions. In addition, we examined two intermediate time points (1989 and 1997–1998). We conducted unadjusted and adjusted analyses using logistic regression. Results. Overall, use of ambulatory dental care has increased dramatically for children over the past two decades. In 1983, more than one in three children (38.5%) had no dental care within the previous 12 months. By 2001–2002, about one-quarter of children (26.3%) were reported to have no dental care within the year, a reduction of 12.2% from 1983 (p<0.001). Frequency of unmet dental care remained unchanged between 1997–1998 (the first year this measure was available) and 2001–2002. A reduction in income disparities for use of dental care was found in our unadjusted analysis but this difference became statistically insignificant in the adjusted analysis. No changes in income disparities occurred for unmet dental needs in either the unadjusted or adjusted analyses. Conclusions. A substantial overall improvement in dental care use has occurred among all income groups, including poor and near poor children. This “keeping up” with their higher-income counterparts represents an important public health accomplishment for children in low-income families. Nevertheless, additional efforts are needed to close remaining disparities in access to dental care.

Faculty practice: What do the data show? Findings from the NONPF Faculty Practice Survey

Abstract This article reports on the findings of the NONPF (National Organization of Nurse Practitioner Faculties) Faculty Practice Survey regarding promotion and tenure. Relevant issues related to tenure for practicing faculty are identified and discussed. Faculty practice has become an increasingly important and complex issue for academic institutions in relation to promotion and tenure. The purpose of this article is to examine the role and patterns of practice among tenured and nontenured faculty in academic nursing institutions and the variables associated with faculty promotion and tenure in these institutions. Method: A survey was mailed to the membership of the National Organization of Nurse Practitioner Faculties to examine the differences between practicing faculty who were tenured and those who were nontenured and to identify predictors of tenure. A 50% response rate (N = 452) was obtained. Findings indicate that only 37% of the practicing faculty were tenured, and more than half (51%) reported that practice was not considered in promotion and tenure decisions at their institutions. The predictors of tenure included practice being considered in promotion and tenure and support for practice at the school of nursing level. Data on reasons faculty practice are also presented. Recommendations for including practice in promotion and tenure guidelines are discussed as well as the ramifications of administrative support for practice. Nurs Outlook 2002;50:238-246.

State legislators lead fight against childhood obesity.

Few child health policy issues are as complex as the current epidemic of childhood overweight and obesity in the United States. Recent studies indicate that the rapid rise in the rate of overall childhood overweight and obesity may be reaching a plateau, but rates remain alarming, particularly in young children (Ogden, Carroll, & Flegal, 2008). The prevalence of obesity in the early years is now one in five children in the United States. The overall rate of obesity in 4year-olds is 18.4%, with 22% of Hispanic children and 20.8% of African American children identified as obese (Anderson & Whitaker, 2009). These findings indicate the urgent need for focusing child health policy efforts on prevention. Federal and state health policy recommendations to date have focused on school nutrition issues, physical activity initiatives or physical education in schools, healthy community design, and access to healthy foods. State legislatures have considered or adopted laws on ‘‘complete streets,’’ ’’food deserts,’’ and farm-to-school programs (Winterfeld, Shinkle, & Morandi, 2009). Following is a review of these programs and some of the proposed and enacted state and federal legislation that is shaping an important governmental response to the call for action. STATE LEGISLATURES Food and Physical Activity Policy States such as California and Arkansas have led regulatory efforts in enacting improved child health policies related to healthy eating and increased physical activity in the school-age years. California was thefirst state to enact nutritional standards for food sold in schools. Twenty-five states have now set nutritional standards on food sold in schools in vending machines and school stores. Eighteen states have set requirements for school food programs to exceed the nutritional standards set by the U.S. Department of Agriculture. Seventeen states have passed body mass index or assessment of other weightrelated screening requirements in schools to monitor the health of school-aged children. Many states have legislation pending to enact similar laws in 2009. You can access the information on your state at http://healthyamericans.org/reports/ obesity2008/. States continue to consider the option of taxes and tax credits to encourage healthy lifestyles. Seventeen states and the District of Columbia have enacted a tax on foods of low nutritional value such as soft drinks, candy, gum, and snack foods. Seven states currently have proposed legislation Karen G. Duderstadt, Clinical Professor, University of California–San Francisco.

Interprofessional Oral Health Education Improves Knowledge, Confidence, and Practice for Pediatric Healthcare Providers

Dental caries is the most prevalent chronic childhood disease in the United States. Dental caries affects the health of 60–90% of school-aged children worldwide. The prevalence of untreated early childhood dental caries is 19% for children 2–5 years of age in the U.S. Some factors that contribute to the progression of dental caries include socioeconomic status, access to dental care, and lack of anticipatory guidance. The prevalence of dental caries remains highest for children from specific ethnic or racial groups, especially those living in underserved areas where there may be limited access to a dentist. Although researchers have acknowledged the various links between oral health and overall systemic health, oral health care is not usually a component of pediatric primary health care. To address this public health crisis and oral health disparity in children, new collaborative efforts among health professionals is critical for dental disease prevention and optimal oral health. This evaluation study focused on a 10-week interprofessional practice and education (IPE) course on children’s oral health involving dental, osteopathic medical, and nurse practitioner students at the University of California, San Francisco. This study’s objective was to evaluate changes in knowledge, confidence, attitude, and clinical practice in children’s oral health of the students completed the course. Thirty-one students participated in the IPE and completed demographic questionnaires and four questionnaires before and after the IPE course: (1) course content knowledge, (2) confidence, (3) attitudes, and (4) clinical practice. Results showed a statistically significant improvement in the overall knowledge of children’s oral health topics, confidence in their ability to provide oral health services, and clinical practice. There was no statistically significant difference in attitude, but there was an upward trend toward positivity. To conclude, this IPE evaluation showed that offering an interprofessional course on children’s oral health to graduate students in dentistry, nursing, and osteopathic medicine can improve their knowledge, confidence, and practice toward children’s oral health and expand their professional goals to include caring for underserved, minority children.

E-Cigarettes: Youth and Trends in Vaping

Public policy on

Affordable Care Act: States Move Forward With Health Reform

Since the Supreme Court decision in June 2012 to uphold the provisions of the Affordable Care Act (ACA), states legislators legislators began to take a second look at the provisions in the law. Americans are already familiar with the provisions of the law that expanded health insurance benefits to youth up to 26 years of age, eliminated preexisting conditions as a barrier to health insurance coverage, and implemented health insurance coverage for preventive health care services. However, many of the provisions of the new law are to be implemented by the States in partnership with the federal government, and the impact on children

Medicaid Reform: Key Considerations for Children's Health Care

Medicaid is the largest provider of public health insurance for children and adults in the United States and provides critical financial support for the nation’s safety net of clinics, hospitals, and long-term care facilities serving the poor and uninsured. Medicaid is a federal entitlement program that is administered by the states and funded through state and federal partnerships (Turner, McKee, Chen, & Coursolle, 2017). Under current federal regulations, all states must provide Medicaid coverage for children under 6 years of age with family income up to 133% of federal poverty level (FPL) and children ages 6 to 18 years with family income at or less than 100%of FPL (Kaiser Family Foundation, 2013). Children whose family incomes are between 100% and 200% of FPL are eligible for health care coverage through either Medicaid or the state

Vaccination Exemption and the Pediatric Health Care Provider

www.jpedhc.org costs and

Faculty practice: what do the data show? Findings from the NONPF Faculty Practice Survey. National Organization of Nurse Practitioner Faculties.

1.4 trillion in total societal costs (Whitney, Zhou, Singelton, & Schuchat, 2014). Although U.S. vaccination rates among young children 19 to 35 months of age is more than 90% for four types of vaccines, coverage remains below target for several others (Table 1; Elam-Evans, Yankey, Singleton, & Kolasa, 2014b). Moreover, vaccination rates for teens aged 13 to 17 years fall well below public health goals (Table 2). Notably, wide variation in coverage exists for all ages based on geographic location, as well as selected demographic characteristics (Elam-Evans, Yankey, Jeyarajah, et al., 2014a). In one California county, vaccination rates at kindergarten entry range from 75.4% to 97.5% (Orange County Children’s Partnership, 2013).