Foreword

Thomas R. Frieden, MD, MPH
Director, CDC

Corresponding author: Thomas R. Frieden, Director, CDC, 1600 Clifton Road, NE, MS D-14, Atlanta, GA 30333. Telephone: 404-639-7000; E-mail: tfrieden@cdc.gov.

CDC has a long history of monitoring the use of clinical preventive services to provide public health agencies, health-care providers, health-care organizations, and their partners with information needed to plan and implement programs that increase use of these services and improve the health of the U.S. population. Increased use of clinical preventive services could improve the health of infants, children, and adolescents and promote healthy lifestyles that will enable them to achieve their full potential. The Affordable Care Act (ACA) expands insurance coverage, consumer protections, and access to care for the U.S. population and places a greater emphasis on prevention. Through implementation of ACA, new opportunities exist to promote and improve use of these valuable and vital services. This supplement provides a baseline assessment of the use of key services before ACA implementation.

Public health and clinical medicine complement each other and can achieve real synergies only with increased collaboration. Public health also can serve as an honest broker by providing unbiased and scientifically accurate information to providers, policy makers, the health-care community, and the public and is well equipped to monitor health systems to facilitate increases in effectiveness and efficiency.

This MMWR supplement is the second in a periodic series of reports examining use of selected clinical preventive services in the United States. Other important clinical preventive services for infants, children, and adolescents are not covered in this supplement (e.g., screening for obesity and screening and effective treatment of depression) because robust national data for these services were not available. For other important health problems among infants, children, and adolescents, including improper use of motor vehicle restraints and misuse of alcohol, no proven, recommended clinical preventive services exists, although there are effective community-level strategies that have potential for scale-up. The reports focus on the following services for infants, children, and adolescents:

• Breastfeeding counseling during the prenatal period;
• During infancy:
  • screening for hearing loss and provision of follow-up services, and
  • screening for developmental delays starting in early infancy;
• During early and middle childhood,
  • screening for lead poisoning,
  • screening for vision impairment,
  • screening for hypertension starting in early childhood, and
  • provision of dental services and preventive dental services starting in early childhood;
• During adolescence:
  • vaccination against human papillomavirus,
  • screening for tobacco use and tobacco cessation counseling and medication use among current tobacco users,
  • screening for chlamydia infection among female adolescents, and
  • provision of reproductive health services.

The findings in this supplement indicate that millions of infants, children, and adolescents in the United States have not benefitted from key clinical preventive services, and that there are large disparities by demographics, geography, and health-care coverage and access in the use of these services.

• One in six (17%) pregnant women did not receive breastfeeding counseling during prenatal care visits in 2010 (1).
• Approximately 50% of infants who failed their hearing screening were not documented to have received testing needed to diagnose hearing loss during 2009–2010 (2).
• Parents of approximately 80% of children aged 10–47 months were not asked by health-care providers to complete a formal screen for developmental delays during the preceding 12 months in 2007 (3).
• Two thirds (67%) of children aged 1–2 years were not screened and reported to CDC for lead poisoning in 2010 (4).
• According to their parents, approximately one in five (22%) children aged 5 years never had their vision checked by a doctor or other health-care provider during 2009–2010 (5).
• Approximately one in four (24%) clinic visits for preventive care made by 3–17 year-olds to office-based physicians and hospital outpatient departments during 2009–2010 had no documentation of blood pressure measurement (6).
• More than half (56%) of children and adolescents did not visit the dentist during the preceding year in 2009, and 86% of children and adolescents did not receive a dental sealant or a topical fluoride application during the preceding year in 2009. More than two thirds (69%) of 5–19 year-olds did not have a dental sealant during 2005–2010 (7).
• Nearly half (47%) of females aged 13–17 years had not received their recommended first dose of human papillomavirus vaccine in 2011, and almost two thirds (65%) had not received ≥3 doses required for series completion (8).
• Approximately one in three (31%) outpatient visits made by 11–21 year-olds to office-based physicians during 2004–2010 had no documentation of tobacco use status, and 80% of those who screened positive for tobacco use did not receive any cessation assistance including tobacco counseling and/or provision of cessation medication (9).
• Almost two thirds (60%) of sexually active females aged 15–21 years did not receive chlamydia screening during the preceding 12 months during 2006–2010 (10).
• Approximately one in four (24%) sexually experienced females aged 15–19 years and more than one in three (38%) sexually experienced males aged 15–19 years did not receive a reproductive health service from a health-care provider during the preceding 12 months during 2006–2010 (11).

Improved delivery and use of clinical preventive services during the prenatal period, infancy, and throughout childhood and adolescence can reduce illnesses, disorders, and disability among children and adolescents and can yield significant long-term benefits to help enable children to reach their full potential as healthy, productive adults.

This supplement documents the potential benefits of selected clinical preventive services for infants, children, and adolescents; the challenges related to their underuse; and effective collaborative strategies to improve use. The findings in these reports should help increase the use of these services and thereby enable infants, children, and adolescents in the United States live longer, healthier, and better quality lives.

References

1. Lind JN, Ahluwalia IB, Perrine CG, Li R, Harrison L, Grummer-Strawn LM. Prenatal breastfeeding counseling—Pregnancy Risk Assessment Monitoring System, United States, 2010. In: Use of selected clinical preventive services to improve the health of infants, children, and adolescents—United States, 1999–2011. MMWR 2014;63(No. Suppl 2).
2. Gaffney M, Eichwald J, Gaffney C, Alam S. Early hearing detection and intervention among infants—Hearing Screening and Follow-up Survey, United States, 2005–2006 and 2009–2010. In: Use of selected clinical preventive services to improve the health of infants, children, and adolescents—United States, 1999–2011. MMWR 2014;63(No. Suppl 2).
3. Rice CE, Van Naardan Braun K, Kogan MD, et al. Screening for developmental delays among young children—National Survey of Children's Health, United States, 2007. In: Use of selected clinical preventive services to improve the health of infants, children, and adolescents—United States, 1999–2011. MMWR 2014;63(No. Suppl 2).
4. Raymond J, Wheeler W, Brown MJ. Lead screening and prevalence of blood lead levels in children aged 1–2 years—Child Blood Lead Surveillance System, United States, 2002–2010 and National Health and Nutrition Examination Survey, United States, 1999–2010 and National Health and Nutrition Examination Survey, United States, 1999–2010. In: Use of selected clinical preventive services to improve the health of infants, children, and adolescents—United States, 1999–2011. MMWR 2014;63(No. Suppl 2).
5. Kemper AR, Crews JE, Strickland B, Saaddine JB. Vision screening among children aged <6 years — Medical Expenditure Panel Survey, United States, 2009-2010. In: Use of selected clinical preventive services to improve the health of infants, children, and adolescents—United States, 1999–2011. MMWR 2014;63(No. Suppl 2).
6. George MG, Tong X, Wigington C, Gillespie C, Hong Y. Hypertension screening in children and adolescents—National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, and Medical Expenditure Panel Survey, United States, 2007–2010. In: Use of selected clinical preventive services to improve the health of infants, children, and adolescents—United States, 1999–2011. MMWR 2014;63(No. Suppl 2).
7. Griffin SO, Barker LK, Wei L, Li C, Albuquerque MS, Gooch BF. Use of dental care and effective preventive services in preventing tooth decay among U.S. children and adolescents—Medical Expenditure Panel Survey, United States, 2003–2009 and National Health and Nutrition Examination Survey, United States, 2005–2010. In: Use of selected clinical preventive services to improve the health of infants, children, and adolescents—United States, 1999–2011. MMWR 2014;63(No. Suppl 2).
8. Curtis CR, Dorell C, Yankey D, et al. National human papillomavirus vaccination coverage among adolescents aged 13–17 years—National Immunization Survey-Teen, United States, 2011. In: Use of selected clinical preventive services to improve the health of infants, children, and adolescents—United States, 1999–2011. MMWR 2014;63(No. Suppl 2).
9. Jamal A, Dube SR, Babb SD, Malarcher AM. Tobacco use screening and cessation assistance during physician office visits among persons aged 11–21 years—National Ambulatory Medical Care Survey, United States, 2004–2010. In: Use of selected clinical preventive services to improve the health of infants, children, and adolescents—United States, 1999–2011. MMWR 2014;63(No. Suppl 2).
10. Hoover KW, Leichliter JS, Torrone EA, Loosier PS, Gift TL, Tao G. Chlamydia screening among females aged 15–21 years—
    Multiple data sources, United States, 1999–2010. In: Use of selected clinical preventive services to improve the health of infants, children, and adolescents—United States, 1999–2011. MMWR 2014;63(No. Suppl 2).
11. Tyler CP, Warner L, Gavin L, Barfield W. Receipt of reproductive health services among sexually experienced persons aged 15–19 years—National Survey of Family Growth, United States, 2006–2010. In: Use of selected clinical preventive services to improve the health of infants, children, and adolescents—United States, 1999–2011. MMWR 2014;63(No. Suppl 2).