Mary dissed by lamb; see Jane disappear, Children and welfare reform: Two stories to tell? When dating turns violent, Race does matter. Eye on Washington



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Mary dissed by lamb; see Jane disappear

Mary had a little lamb—or is that Madison who's getting followed everywhere these days? Don't take my hand, Barbara Ann—I've already asked Brianna Hannah for the favor. Pediatricians—and just about everyone else—have noticed that children's names are changing. The extent to which parents have broken with the past when they name their children may not be apparent, however, until one looks at the list of the most popular birth names the Social Security Administration publishes every year. The ranking is based on a 100% sampling of Social Security card applications for newborns.

A look back over the annual lists shows that names for boys are more stable than names parents pick out for girls. Michael, for example, has been in first or second place since 1953. Christopher, David, Joseph, and Matthew pick out for girls. Michael, for example, has been in first or second place since 1953. Christopher, Davis, Joseph, and Matthew have retained their popularity for decades. Girls' names, on the other hand, come and go. Barbara, which ranked 4th in 1951, plummeted to 511th in 2000, and poor Jane—the archetypal female name in everything from children's primers to FBI sketches—now ranks 437th.


Top 20 children's names, 2000


For a complete list of the most popular names in 2000, and for links to name data from earlier years, visit http://www.ssa.gov/OACT/NOTES/note139/2000/top1000_of_2000.html


Children and welfare reform: Two stories to tell?

According to new research from Child Trends, a nonprofit, nonpartisan research center that studies children and families, welfare reform has been a mixed blessing for poor children. In a research brief, Working Poor Families with Children, Child Trends reports that, since welfare reform was enacted in 1996, parents in 1.3 million families who were formerly on welfare are now employed, giving their children the benefit of working adults as role models.

However, the brief points out, these new jobs for parents have not lifted their children out of poverty. Rather, the number of children classified as living in "working poor" families increased by more than 650,000 between 1995 and 1998. (Families are classified as "working poor" when one or both parents are working full time and family income is below the poverty line—calculated in 1998 as annual family income of $16,640 for a family of four.)

If so many working families were poor during the boom years of the 90s, asks Richard Wertheimer, PhD, economist and author of the Child Trends brief, "What is on the horizon for working poor families should the economy continue to slow?"

A second Child Trends brief, Welfare Reform's Impact on Adolescents, also presents disquieting findings. Data from large studies in Florida, Minnesota, and Canada indicate that, when a parent enrolled in a welfare-to-work program, their adolescent children showed increased behavioral problems and lower academic achievement. The brief's authors speculate that this deteriorating behavior in teens may be the result of work stress on single working parents, less parental supervision, or burdens of child care and housework falling on adolescent family members. Both reports are available in full on the Child Trends Web site, www.childtrends.org .

When dating turns violent

Teenage couples are cute, according to the TV sitcoms we're all familiar with. They talk on the phone, hang out together at school, go to dances and movies and McDonald's. More realistically, pediatricians and others interested in adolescent behavior are also aware that many adolescents are sexually active and that some teens are parents themselves.

But few adults are aware of the dark side of adolescent relationships: the recently published finding that one in five female high school students has been physically or sexually abused by her boyfriend (Silverman JG et al: JAMA 2001;286[5]). Data from the 1997 and 1999 Youth Risk Behavior Surveys, gathered in randomly selected public high school classrooms in Massachusetts, indicate that young women in abusive relationships are also at increased risk of substance abuse, bulimia, sexual initiation before 15 years of age, pregnancy, and attempted suicide.

The authors propose that these findings have significant implications for prevention programming and services specific to teen dating violence. Health-care professionals have a crucial role to play in identifying victims of dating violence and offering assistance.

Race does matter

Despite an increasing degree of public scrutiny, racial disparities continue to characterize the state of the nation's health. The causes are complex and intertwined, and rectifying the situation is a monumental task. Two recently released findings make the point:

n Recent decades have seen a steady lengthening of the life span of people with Down syndrome—the result of better medical care and the trend to provide family and small group care. The increase in life span is not racially neutral, however. Between 1968 and 1997, the median age at death for white people with Down syndrome increased from 2 years to 50 years. In the same time period, the median age for blacks went from zero to 25 years (MMWR 2001;50:463).

n The Pediatric Section of the National Medical Association conducted an online discussion last month, "Racial disparities and Hib disease," that focused on the higher infection rate and under-immunization in the black community. To learn more about disparities in the Hib immunization level and disease, go to the NMA's Web site, www.nmanet.org .

Despite findings like these, increased awareness of racial and ethnic disparities in health status is, in some places, making a difference. Case in point: New York City's Childhood Asthma Initiative, an educational program that sends nurses into third-grade classrooms to teach asthmatic children how to manage their disease and supports community groups that carry the message to families in high-risk neighborhoods like East Harlem. Asthma specialists and health department officials credit the initiative for the sharp drop in hospitalizations for asthma that has been observed since the program was implemented.

Eye On Washington

Sensibly, Congress and President Bush spent last month as far outside the beltway as they could get: The President vacationing on his Texas ranch, and members of Congress mostly in their districts, resting up from the fray and listening to their constituents. Before Congress departed for the August recess, some interesting pieces of legislative business were transacted:

• A version of the so-called Patients' Bill of Rights narrowly passed the House (218 to 213), after the bill's sponsor, Charlie Norwood (R-Ga.), struck a deal with the president on limiting patients' rights to sue their health maintenance organization for damages. The bill will face its next hurdle in the Senate, when Congress reconvenes.

• The Senate Commerce Committee voted 12 to 11 to deny confirmation to Mary Sheila Gall to head the Consumer Product Safety Commission. Ms. Gall's opponents charge that, as a member of the CPSC, she was overly reluctant to push for federal oversight of faulty baby walkers, baby bathtubs, and bunk beds.

• In the midst of Congressional debate and presidential soul-searching on the issue of federal funding for stem cell research, the House Judiciary Committee voted 18 to 11 to outlaw "therapeutic" cloning, for the purpose of obtaining genetically compatible human stem cells. Federal funding of human embryo research is supported by the American Academy of Pediatrics.

• Senator Lincoln Chafee (R-R.I.) and Representative Nita Lowey (D-N.Y.) introduced the "Family Planning State Empowerment Act" to allow states to expand family planning coverage under Medicaid. The proposed legislation is a response to an administrative decision to refuse such state requests.

• House Resolution 1271, also known as "The Family Privacy Protection Act," would require written parental consent for all confidential surveys of minors conducted by federally funded government programs. The American Academy of Pediatrics is opposed to this legislation, fearing that it will restrict legitimate and much needed research into adolescent behavior.

While the president and Congress got out of the capital's August heat, administrative agencies went about their usual tasks. Last month,

• The Centers for Disease Control and Prevention released findings showing that the incidence of neural tube defects has declined by 19% since 1996, the year that regulations requiring folic acid fortification of foods made from enriched grains went into effect.

• The National Institute of Child Health and Development released the fifth annual report on America's Children: Key Indicators of Well-being, 2001. The report shows child poverty down (16%, a drop of 2% in the last two years); the immunization rate up (78% fully immunized, compared with 69% in 1994); and adolescent births at a record low (29/1,000 births to women 15 to 17 years of age in 1999). To download the full report, go to www. childstats.gov/ac2001 .

• The Office for Human Research Protections suspended all federally funded research on human subjects at Johns Hopkins University after a 24-year-old volunteer in an asthma study died after inhaling an experimental compound that caused her lungs and kidneys to fail. Four days later the agency relented, allowing some Hopkins research to proceed but imposing tighter controls. According to a statement released by the university, both the researcher who conducted the experiment and the ethics committee that approved it had failed to take adequate precautions to protect human subjects.

• The surgeon general released a long-awaited report, The Call to Action to Promote Sexual Health and Responsible Sexual Behavior, that is based on extensive searches of the scientific literature. One conclusion: Claims for the efficacy of abstinence education in delaying adolescent sexual activity are not backed by sufficient research. In introducing the report, Surgeon General Satcher called for mature discussion, more research, and respect for diversity in a national discussion of sexual health. Copies of the Call to Action can be downloaded from www.surgeongeneral.gov .

• The Department of Health and Human Services announced an award of $17.1 million in new grants to communities to develop and implement abstinence-only education programs.

• The National Library of Medicine has developed a new search engine to help physicians and consumers obtain access to medical information more easily. Called "Gateway," the new service will allow users to search multiple databases from a single interface. Gateway is scheduled to come online next month. To use it, go to http://gateway.nlm.nih.gov .


October 23–28, American Academy of Child and Adolescent Psychiatry,
Honolulu. For information, go to www.aacap.org/meetings .

November 5–7, Developmental Interventions in Neonatal Care.
Washington, D.C. To register, fax Contemporary Forums, 900-320-9923.

November 16–20, American College of Allergy and Immunology,
Orlando. For information, go to www.allergy.mcg.edu .

November 30–December 2, Zero to Three National Training Institute,
San Diego. To register, go to www.zerotothree.org .

December 6–8, Second International Congress on Immunosuppression,
San Diego. For information, e-mail kzavetz@pwcg.com.

December 9–12, Institute for Healthcare Improvement,
Orlando. For information, go to www.ihi.org .

Judith Asch-Goodkin
Contributing Editor
with Daniel Ten Kate
Editorial Associate



Contemporary Pediatrics


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