CDC Supports Vigorous Promotion of Child Safety Restraints

Although child fatalities from motor vehicle crashes declined from 1978 to 2004, partially because of the use of child safety restraints, nearly 1,200 children younger than 12 years died in motor vehicle crashes in 2004. The Centers for Disease Control and Prevention (CDC) analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). The full report was published in the June 9, 2006, issue of Morbidity and Mortality Weekly Report and is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5522a2.htm.

The NEISS-AIP included data on injury and restraint use in children younger than 12 years who presented to an emergency department after a motor vehicle crash. The data showed that children who were unrestrained were twice as likely to have multiple diagnoses and more than three times as likely to require hospitalization than those who were restrained. Fifty-nine percent of the children were restrained appropriately, compared with 40 percent who were not. The CDC supports vigorous promotion and enforcement of appropriate child motor vehicle restraints to further reduce child fatalities from motor vehicle crashes.

CDC Reports on Racial and Socioeconomic Disparities in Breastfeeding

The Centers for Disease Control and Prevention (CDC) analyzed data from the 2004 National Immunization Survey to find current estimates of racial and economic disparities in breastfeeding in the United States. Its report was published in the March 31, 2006, issue of MMWR Weekly and is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5512a3.htm.

Although breastfeeding initiation rates increased and breastfeeding disparities decreased in past decades, the 2004 data showed substantial racial and economic disparities in breastfeeding initiation and continuation rates to at least age six months. Race and demographic factors were associated with breastfeeding independently of each other. About 72 percent of white children and 50 percent of black children were ever breastfed. Rates of ever-breastfeeding were 10 to 17 percentage points lower among black children than white children in each income group. Within each race, the proportion of children ever breastfed was 23 to 26 percentage points higher in the highest income group than in the lowest. About 54 percent of white children who were ever breastfed were being breastfed at six months of age, compared with about 43 percent of black children.

The greatest differences between breastfeeding rates in each race occurred among children in rural areas. Children were more likely to have ever been breastfed if they were not eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); if their mothers were 20 years or older, married, or had some college education; if they lived in the West or in urban areas; or if their families were above the federal poverty threshold. Factors positively associated with breastfeeding at six months in both races were older maternal age, higher maternal education, mother being married, and living in the Northeast.

Increasing breastfeeding rates is crucial to improving children’s health, reducing childhood overweight, and reducing health care costs. Barriers to initiation and continuation of breastfeeding include lack of social support, lack of proper guidance from health care professionals, lack of adequate and timely postpartum follow-up care, and disruptive hospital maternity-care practices (e.g., delays in breastfeeding initiation, use of pacifiers for newborns, promotion of formula through discharge packs). Public health measures to promote breastfeeding should target those with low initiation rates, including black mothers living in rural areas or those who are younger than 20 years, mothers who have not completed high school, and participants in the WIC program. Breastfeeding interventions should take into account racial, ethnic, and socioeconomic variations in attitudes. The CDC’s Guide to Breastfeeding Interventions provides an introduction to interventions that promote and support breastfeeding.

ACOG Releases Guideline on Tamoxifen for Postmenopausal Women

Tamoxifen (Nolvadex) is a nonsteroidal antiestrogen agent commonly used to treat and prevent breast cancer. However, tamoxifen may be associated with endometrial proliferation, hyperplasia, polyp formation, invasive carcinoma, and uterine sarcoma in postmenopausal women. The American College of Obstetricians and Gynecologists (ACOG) Committee on Gynecologic Practice has reviewed the risks of tamoxifen in postmenopausal women and released recommendations on its use in this population. The full guideline was published in the June 2006 issue of Obstetrics & Gynecology.

The guideline includes the following recommendations for postmenopausal women taking tamoxifen:

• Patients should be monitored closely for endometrial hyperplasia or cancer and be informed about the risks associated with the drug.

• Abnormal vaginal bleeding, bloody discharge, and staining or spotting should be evaluated.

• Because some evidence suggests a higher risk in women who had benign endometrial polyps before tamoxifen therapy, pretherapy screening may have a role.

• Routine endometrial surveillance is not recommended unless the patient is at high risk of endometrial cancer.

• Tamoxifen should not be used for more than five years.

• If atypical endometrial hyperplasia develops, patients should receive appropriate treatment, and the use of tamoxifen should be reassessed. Hysterectomy should be considered if tamoxifen must be continued.