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Children with health insurance coverage are more likely to miss necessary health-care services if their parents are uninsured, new research shows.

These children are at greater risk of having difficulty seeing a doctor, getting dental care and accessing prescription medications than kids in families where children and parents are insured. They’re also less likely to receive counseling on healthy eating, routine exercise, use of a safety or booster seat, and use of seatbelts and bike helmets, the study found.

The findings highlight the need to improve the current model of extending health insurance to children, but not necessarily to their parents, the study authors said.

“We’ve been incrementally covering more and more kids, and that’s important, but we can’t stop there,” said study lead author Dr. Jennifer E. DeVoe, an assistant professor in the Department of Family Medicine at Oregon Health and Science University in Portland. “We need to make sure that families are covered — kids and parents.”

More than one in four children in the United States — 29 percent — have health coverage through either Medicaid or the Children’s Health Insurance Program (CHIP), according to the Henry J. Kaiser Family Foundation. Currently, some 29 million children are enrolled in Medicaid, and another 7 million are covered through CHIP, the foundation said.

While these public programs are considered vital for improving children’s health, they are only part of the solution, experts say.

“In the public-policy arena, there is often a tendency to consider children a ‘deserving’ population who should have greater access than adults to publicly sponsored health insurance,” said Shana Alex Lavarreda, a research scientist for the Center for Health Policy Research at the University of California, Los Angeles, and director of health insurance studies. CHIP is a prime example, she explained.

“But if you really care about improving access to health care for children, their parents’ needs for health insurance coverage shouldn’t be ignored,” Lavarreda said.

For the study, DeVoe and her colleagues pooled five years of data from a national survey of U.S. households. The sample included more than 43,000 children ages 2 to 17.

To assess children’s access to health care, the researchers looked at a number of variables, including gaps in coverage over the previous 12 months, no usual source of care, no doctor visits in the past year, fewer than yearly dental visits, and other problems accessing health care and preventive counseling services.

Not surprisingly, uninsured children had the highest rates of unmet health-care needs. But the study also showed an association between parents’ insurance status and children’s access to health care.

“Parents who are themselves uninsured may have other constraints on whether they can get health care for their children,” Lavarreda noted. They may not be able to take time from work to take their children to the doctor, for example, she said.

“Additionally, parents who are uninsured may have difficulties navigating the health-care system and may be unfamiliar with how to obtain services,” Lavarreda said.

The authors found no significant difference in preventive counseling services by race or ethnicity. Hispanic children were actually less likely to miss out on preventive counseling compared with non-Hispanic whites. DeVoe said she suspects that these families are accessing care through community health centers, where nurses, nursing assistants and other non-physician clinicians are spending time counseling families.

Even in families where the parents and children are insured, significant percentages lack preventive counseling, which suggests that the problem isn’t just one of insurance status. The model of care can also make a difference, the researchers said.

“The way that care is set up in the majority of clinics across the country is the child checks in for their visits, sees a physician for a very short period of time and, increasingly, there’s more and more counseling and medical information that’s required to be communicated to the family,” DeVoe said.

Heavy drinking is a growing problem among university students, but an Internet-based intervention may help them control their alcohol use, a new study finds.

Researchers analyzed data from a Web-based alcohol-use screening test taken by more than 7,200 undergraduate university students, aged 17 to 24, in Australia, and found that more than 2,400 qualified as hazardous/harmful drinkers. Of these students, about half were placed in a Web-based intervention group and received motivational assessments and personalized feedback, while the other half were placed in a control group that received no feedback.

The intervention included information about reducing alcohol-associated health risks, an estimated blood alcohol concentration for each student’s heaviest drinking episode, an estimate of the money spent on drinking, comparison to other students’ drinking, and links to resources to help people with alcohol problems.

The researchers followed-up with the participants at one and six months after initial screening.

“After one month, participants receiving intervention drank less often, smaller quantities per occasion and less alcohol overall than did controls,” wrote Kypros Kypri of the University of Newcastle in Australia and the University of Otago in New Zealand, and colleagues. “Differences in alcohol-related harms were nonsignificant. At six months, intervention effects persisted for drinking frequency and overall volume but not for other variables.”

Noting that university students drink more heavily and exhibit more clinically significant alcohol-related problems than their non-student peers, the researchers suggested that there could be great potential in alcohol counseling over the Internet.

“Given the scale on which proactive Web-based electronic screening and brief intervention (e-SBI) can be delivered and its acceptability to student drinkers, we can be optimistic that a widespread application of this intervention would produce a benefit in this population group,” they concluded. “The e-SBI, a program that is available free for nonprofit purposes, could be extended to other settings, including high schools, general practices, and hospitals.”

If you’re uncomfortable giving mouth-to-mouth resuscitation, you may actually do a better job of cardiopulmonary resuscitation (CPR) if you do less mouth-to-mouth, according to a new study: The odds that someone whose heart has stopped beating goes up markedly when rescuers doing spend more time giving chest compressions, research released this week indicates.

CPR consists of chest compressions and mouth-to-mouth resuscitation, and is performed on people whose hearts have stopped beating. Mouth-to-mouth resuscitation moves oxygen into the lungs of someone who can’t breathe on his own, while chest compressions move blood carrying that oxygen to the heart and the brain.

The findings emphasize that “the chest compressions you do on a loved one are one of the most important things that can be done,” Dr. Jim Christenson, one of the authors of the study, said in a statement.

“If you feel rusty or are not confident giving mouth-to-mouth ventilation along with chest compressions then just do chest compressions,” he continued. “Even by themselves, chest compressions can make a difference.”

Christenson, from the University of British Columbia, Vancouver and colleagues examined CPR tracings in 506 patients who suffered “out-of-hospital” cardiac arrest in the US and Canada.

There was roughly a 10 percent increase in the chance of survival for every 10 percent increase in amount of time that rescuers spend giving chest compressions, Christenson and colleagues found.

Specifically, his team found that the heart began pumping blood effectively on its own about 80 percent of the time when rescuers spent most of their time on chest compressions, compared to just shy of 60 percent of time when they spent most of their efforts on mouth-to-mouth resuscitation.

Similarly, about one in eight patients survived long enough to go home from the hospital when rescuers spent most of their time on mouth-to-mouth resuscitation, but that rate of survival doubled when rescuers spent most of their time on chest compressions.

The study appears in the latest issue of the American Heart Association’s journal Circulation.

The current study supports another study, which found that cardiac resuscitation designed to maintain nearly uninterrupted chest compressions triples the rate of survival when someone’s heart stops beating outside of a hospital. (See Reuters Health report, March 11, 2008).

Collectively, the data from this and other studies suggest that chest compressions should be performed “as much as possible,” Christenson said.

Children who are spanked as 1-year-olds are more likely to behave aggressively and perform worse on cognitive tests as toddlers than children who are spared the punishment, new research shows.

Though the negative effects of spanking were “modest,” the study adds to a growing body of literature that’s finding spanking isn’t good for children.

“Age 1 is a key time for establishing the quality of the parenting and the relationship between parent and the child,” said study author Lisa J. Berlin, a research scientist at the Center for Child and Family Policy at Duke University. “Spanking at age 1 reflects a negative dynamic, and increases children’s aggression at age 2.”

The study is published in the September/October issue of Child Development.

Berlin and her colleagues looked at data on 2,500 white, Mexican American and black children from low-income families. The data included parents’ reports about their children’s behavior, their use of spanking, as well as home visits by trained observers to document parent-child interactions at ages 1, 2 and 3.

About one-third of mothers of 1-year-olds reported they or someone in their household had spanked their child in the last week, while about half of the mothers of 2- and 3-year-olds reported that their child had been spanked.

The average number of spankings for 1-year-olds was 2.6 per week, while the average for 2-year-olds was nearly three.

The study found that children who were spanked at age 1 had more aggressive behaviors at age 2 and performed worse on measures of thinking abilities at age 3.

Being spanked at age 2, however, did not predict more aggressive behaviors at age 3, possibly because the spanking had begun at age 1 and by age 2 the kids were already more aggressive, Berlin said.

Researchers also looked at the effects of verbal punishment, defined as yelling, scolding or making derogatory comments. Verbal punishment was not associated with negative effects if the mother was otherwise attentive, loving and supportive.

Researchers controlled for family characteristics such as race, ethnicity, mother’s age, education, family income and the child’s gender.

Previous research has shown spanking is more common among low-income households than high-income households.

Researchers chose a sample of low-income families because some child behavior experts have argued that when spanking is “cultural normative” — that is, it’s expected for parents to use physical discipline — the detrimental effects of spanking may be lessened.

“We did not find that,” Berlin said. “Even in a sample of low-income people where presumably it’s more normative to spank your kids, we found negative effects.”

The study also found that mothers who said their children were “fussy” babies were more likely to spank them at ages 1, 2 and 3. But children who were more aggressive at 2 were not more likely to get spanked.

“The implication or the suggestion in past arguments is that some kids who are more aggressive or difficult to control might elicit more spanking, but that’s not what we found,” Berlin said.

Researchers found that black children were spanked and verbally punished the most, possibly because of cultural beliefs about the importance of respecting elders and in the value of physical discipline, or because parents feel they have to prepare their children for a racist and potentially dangerous world.

Of all the debates over child-rearing, spanking “definitely touches a nerve,” Berlin said.

“It’s a parenting practice that has been around for a long time, and that’s also in transition,” Berlin said. “In general, the use of spanking is going down. But there is also a contingent of people who really believe in it, who say that’s how they were raised and it’s a tradition they want to continue.”

Elizabeth T. Gershoff, an associate professor in the department of human development and family sciences at University of Texas at Austin, said the study adds to a growing body of research showing negative effects of spanking.

“Almost all the studies point to negative effects of spanking,” Gershoff said. “It makes kids more aggressive, more likely to be delinquent and to have mental health problems. The more kids are spanked, the more they are likely to be physically abused by their parents. This does not mean everyone who spanks physically abuses, but that risk is there.”

Because children tend to mimic parental behaviors, it’s possible spanking “creates a model for using aggression,” Gershoff said. “Spanking is just hitting.”

Less is known why spanking could inhibit cognitive development. One possibility is that parents who spank are less likely to use reasoning with their children, something that’s good for development, Gershoff said.