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AJPH NEWS Release

EMBARGOED UNTIL November 26, 2002, 4:00 PM (ET)
CONTACT: For copies of articles, call Natalie Raynor, (202) 777-2511

All articles are online at www.ajph.org

American Journal of Public Health: December 2002 Highlights

• Racial disparities in prenatal care are decreasing overall
• School-based tuberculosis screening an important tool
• Immigrants often more at risk for HIV once they enter the United States
• Most states fall short when it comes to tobacco treatment for the poor

The articles highlighted below appear in the December 2002 issue of the American Journal of Public Health, the Journal of the American Public Health Association.

Racial disparities in prenatal care are decreasing overall
While black women still do not receive prenatal care at the same rates as their white counterparts, the gap is narrowing, according to a new study. Researchers who looked at national birth data collected from 1989-1998 also found that the percentage of women receiving prenatal care during the first trimester of pregnancy has steadily increased. During the study period, the proportion of mothers with "adequate use of prenatal care" increased from 34 percent to 50 percent for whites and from 27 percent to 44 percent for blacks. The percentages of women beginning care in the first trimester increased from 80 percent to 85 percent for whites and from 61 percent to 73 percent for blacks. The Healthy People 2010 goal is for 90 percent of women to receive prenatal care during the first trimester. While the increasing numbers are encouraging, the researchers caution that racial disparities in prenatal care are increasing for young mothers. They suggest greater emphasis on follow-up for black teens who initially seek prenatal care. To reach the national goal for all women to receive adequate prenatal care, the study's authors point to universal health coverage for all pregnant women, ongoing education of providers regarding cultural factors that affect the use of care and comprehensive preconception women's health care programs. [From: "Racial Differences in Prenatal Care Use in the United States: Are Disparities Decreasing?" Contact: Greg R. Alexander, Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, alexandg{at}uab.edu ]

Targeted school-based tuberculosis screening an important tool
Even in low prevalence areas, tuberculosis (TB) continues to be a public health concern. In the United States, early case identification and treatment of latent infection have become key to controlling the disease. A recent study evaluates school based targeted screening in TB control. In 1987, active TB in a child born abroad led to transmission of latent TB infection to classmates. A program was begun to screen foreign-born children for TB at school entry. In a retroactive study of data collected during screenings from 1993-1998, researchers found that the program not only is cost-effective, it pinpointed latent TB cases during a time when treatment may be more acceptable and safer. Those children treated for latent TB suffered no health effects from the treatment and reduced their lifetime risk of active TB and the United States of infecting others. "As U.S. rates decline, the treatment of [latent TB] and the control of imported TB become priorities," the researchers wrote. [From: "Public Health Impact of Targeted Tuberculosis Screening in Public Schools." Contact: Soju Chang, MD, MPH, Atlanta, schang1@cdc.gov or Katherine Farrell MD, MPH, Annapolis, farrellkf{at}pol.net ]

Immigrants often more at risk for HIV once they enter the United States
In a study of 61,000 Californians who sought treatment for sexually transmitted diseases, researchers found that those foreign-born immigrants who were infected with HIV most likely contracted the virus once they arrived on U.S. soil. The study examined clients at several Los Angeles County public health centers from January 1993 through December 1999. Of the approximately 61,000 patients in the study, 23,000 were foreign-born, with the largest percentage of those patients born in Central America/Mexico. HIV infection was highest among female immigrants from Sub-Saharan Africa at almost 6 percent but also significant among male immigrants from North Africa/Middle East and the Caribbean/West Indies at about 4 percent. Immigrants from Central America/Mexico were not more likely to be infected than U.S.-born patients, but represented the largest number of foreign-born HIV-positive patients because that immigrant group was the largest. The researchers believe most of those who were HIV-positive contracted the virus after arriving in the United States based on their age, the age they immigrated and the number of years they lived in the United States. "Our findings suggest a need to ensure that HIV prevention and treatment interventions reach African and possibly Caribbean and Middle Eastern immigrant communities, because they appear to be most heavily affected by HIV," the researchers wrote. Culturally appropriate Spanish-language HIV-prevention interventions are also crucial because the at-risk and infected Latino immigrant population is "large and growing." [From: "HIV-1 Prevalence Among Foreign-Born and U.S.-Born Public STD Clinic Clients." Contact: Nina T. Harawa, PhD, MPH, HIV Epidemiology Program, Los Angeles, nharawa{at}dhs.co.la.ca.us]

Most states fall short when it comes to tobacco treatment for the poor
Although tobacco dependence treatment has been proven effective in helping people quit smoking, most states do not provide such treatment for pregnant women, children and their parents living at or below the federal poverty level. In a 2000 survey of all 50 states and the District of Columbia, researchers at the University of California, Berkeley found that most state Medicaid programs do not provide these clinically proven effective treatments for these populations. Only 10 state Medicaid programs offer any tobacco dependence treatment programs for pregnant women. Less than one third of the states offer Medicaid coverage for pharmacotherapy treatments or counseling services to treat tobacco dependence among children and their parents. Similarly, the number of state Medicaid programs that require providers to screen for tobacco use and provide brief health education is unacceptably low. Coverage for tobacco dependence treatments is currently an optional benefit under Medicaid guidelines, but the study's authors suggest that such services should be federally mandated to "make a significant difference in the health of low-income pregnant women and their children."[From: "Coverage of Tobacco Dependence Treatments for Pregnant Women and for Children and Their Parents." Contact: Jennifer K. Ibrahim, Ph.D., University of California, San Francisco, Center for Tobacco Control Research and Education, ibrahim{at}itsa.ucsf.edu ]

The American Journal of Public Health is the monthly Journal of the American Public Health Association, the oldest and largest organization of public health professionals in the world and the foremost publisher of public health-related books and periodicals promoting high scientific standards, action programs and policy for good health. The Journal is online at www.ajph.org.

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