Objective. Previous work has focused at-tention on the prevalence of specific maternal health problems known to affect children, such as smoking or depression. However, the cumulative health burden ex-perienced by mothers and the potential for a practical pediatric health services response have not been exam-ined. The aims of this study were to characterize: 1) the prevalence and cumulative burden of maternal health behaviors and conditions, 2) maternal access to a source of comprehensive adult primary care, and 3) maternal perceptions of a pediatric role in screening and referral. Methods. We surveyed 559 consecutive women bring-ing a child 18 months of age or less to one of four pediatric primary care sites between July 1996 and May 1997. The pediatric sites included one outpatient program in an academic hospital, one in a community health cen-ter, and two in-staff model practices of a managed care organization (these last two were combined for analysis). The self-administered questionnaire contained previ-ously validated questions to assess health behaviors and conditions (smoking, alcohol abuse, depression, vio-lence, risk for unintended pregnancy, serious illness, self-reported health) and access to care (regular source, regular provider, health insurance, care delayed or not received). Maternal attitudes toward a pediatric role in screening and referral were also elicited. Results. In the three settings, response rates ranged from 75% to 84%. The average age of the women ranged from 25.1 to 32.1 years and the average age of the children ranged from 6.5 to 8.0 months. Across the settings, the percentage of women reporting at least one health con-dition (66%–74%) was similarly high, despite significant demographic differences among sites. Many women re-ported more than one condition (31%–37%); among all women who smoked, 33% also screened positive for al-cohol abuse, 31% for emotional or physical abuse, and 48% for depression. Access to comprehensive adult pri-mary care was variable with 23% to 58% of women re-porting one or more barriers depending on the site. Across all sites, >85% of mothers reported they would " not mind " or " would welcome " a pediatric role in screening and referral. Conclusions. Two-thirds of women bringing their children for pediatric care had health problems regard-less of the site of care. Many women also reported sub-stantial barriers to comprehensive health care. Most women reported acceptance of a pediatric role in screen-ing and referral. Given the range and depth of maternal health needs, strategies to connect or reconnect mothers to comprehensive adult primary care from a variety of pediatric settings should be explored. Pediatrics 1999;103: 576 –581; maternal and child health, access to care, health status. ABBREVIATIONS. AHP, academic hospital practice; CHC, com-munity health center; MCO, managed care organization.
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