Adolescent Suicide: A PREVENTABLE public health crisis. Take Action Now

Adolescent suicide is an international public health crisis. According to the National Council for Suicide Prevention, more people in the world die from suicide than by war and murder combined.  In the United States,  suicide is the tenth leading cause of death among all persons and is the second leading cause of death in persons aged 10-34.  According to the 2017 Youth Risk Behavior Survey from the CDC, more than 1 in 6 U.S. high school students reported having seriously considered suicide and 7.4 percent of youth in grades 9-12 reported that they had made at least one suicide attempt in the past 12 months. Furthermore, for every one suicide there are many more attempts with some estimates as many 50 -100 attempts to one suicide.   

 Suicide is a growing problem that has increased by almost 30% in the last couple of decades according to the CDC. 

https://www.cdc.gov/vitalsigns/suicide/infographic.html

   Despite these startling statistics, there is hope.  Suicide is preventable.  Risk factors and warning signs are clearly established and it is estimated that four of five youth that have attempted suicide have given clear warning signs. That means in 80% of cases there is an opportunity to intervene to potentially SAVE A LIFE. 

American Foundation for Suicide Prevention

Prevention can take place at the individual, community and national level.  Schools are in a key position to take action. Teachers interact with students daily and see behaviors and trends over time. They have a responsibility to promote the well-being and safety of their students. The Jason Foundation, a non-profit suicide prevention advocacy group recognizes Triangle of Prevention which includes teachers/youth workers, family and other youth. Educating the persons who are the most influential to teens can make a difference.

In support of this idea, the Jason Flatt Act is legislation that requires mandatory in-service prevention and awareness education for teachers.  Since its first passage in 2007, 40% of states passed the Jason Flatt Act.  In other states, teacher education on suicide is encouraged but not mandated.  In addition to mandatory suicide education programs for teachers, schools need to have comprehensive policies and programs that support awareness and interventions.

So What Can You Do? What is your call to action?

1. Advocate for policies and legislation (like the Jason Flatt Act) that supports suicide awareness and education for teachers, parents and youth.
2. Spread the word about suicide prevention.
3. Join a suicide awareness or advocacy group- there are several
4. Help Someone by Asking, Keep them safe, Be there, Help them connect and Follow-up

A Sweet but Serious Threat: Chloroform is Still in DC Communities, but Who’s Paying Attention?

Photo: istockphoto/kozorog.

In 2015, four utilities in Washington, DC serving more than 660,000 people reported chloroform contamination levels in their domestic water supply that was 60 times higher than the recommended health levels–but still legal. You may have seen chloroform used in old murder mysteries to knock people out. In reality, the health impacts could be much worse—but often go unmeasured and unregulated.

Chloroform, or trichloromethane, is a colorless, sweet-smelling organic compound commonly formed when disinfectants like chlorine are used to treat drinking water, and organic materials in the water supply are chlorinated but either released or not removed during water treatment. That contaminated drinking or tap water can end up in our foods and beverages. Chloroform can also get released into the air when drinking, waste or pool water is chlorinated, or during industrial processes. So you might be exposed to chloroform through the skin, or by ingesting or inhaling it–even in the shower!

Photo: Science Source.

Industry and government recognize chloroform’s harms and have taken positive steps to protect the environment. But are we paying enough attention to its health threats? The EPA considers chloroform a probable human carcinogen: lifetime cancer risk from ingesting, inhaling, and absorbing chloroform could be 79 times the risk of just one exposure type. Exposure has also been linked to heart attacks, depression, and liver, blood, and kidney problems–even miscarriages in animals. This is why federal and DC municipal water authorities should test all exposure pathways to routinely monitor the total potential dangers of chloroform in our water–but currently, they don’t.

One thing is certain: chloroform is hardly gone for good. So whether you own a restaurant, run a manufacturing business or just live in DC like me, keeping DC’s water safe from chloroform is everyone’s concern. DC’s Department of Energy and Environment should follow California’s lead and revise DC’s Water Quality Standards to include more rigorous, enforceable water quality criteria and management processes, using all exposure routes to assess total health risks from chloroform in our water supply. If you agree and want your voice heard, contact the DC Water Stakeholder Alliance.

Don’t get sick after June? – A call for Native American Healthcare Equity and Data Sovereignty

In 1887, an important relationship was established between the US Federal Government and Tribal Nations to establish health services to members of federally recognized Tribes. Out of this agreement, the Indian Health Services (IHS) was established as the primary healthcare for most Native American Tribal Nations in the United States. This agency currently serves approximately 1.6 million out of 2.56 million Tribally Enrolled Native Americans (IHS Profile Data 2015-2019).

It is no secret that IHS is chronically underfunded despite glaring health disparities among Tribal Nations. Among these, are high rates of diabetes, obesity, heart disease, and substance abuse disorders.

 The current US administration recently approved a budget that falls $600 million below the recommended funding for the agency. There is a running joke among communities utilizing IHS services – “Don’t get sick after June” or “commit a crime, you’ll get better healthcare.” By June, funding has normally run out. Joking aside, these fears associated with using IHS services are backed by stories of family members misdiagnosed, cases of malpractice and death, mismanagement of funds, and other administrative disasters.  

Wayne Boyd Monday, Oct. 15, in Rosebud. Wayne lost his first wife to cancer. When Kathy went into surgery all he could do was wait.
BRIANA SANCHEZ / ARGUS LEADER

IHS: Wayne Boyd talks about how Indian Health Service hospital treated his wife

Source: Argus Leader, Ferguson 2019.

IHS funds provide important and lifesaving services that improve the lives of Native communities. They are also the backbone for collecting relevant data necessary for improving services, and enabling effective decision making. This comes at a particularly important time when data is becoming a force for improving healthcare.

In recent years, it has become apparent both within IHS and Tribal Nations that such Healthcare Information Technology is out of date and not capturing relevant data. As a result, limited data is being collected, analyzed and managed to make effective healthcare decisions in affected communities.

Sustainable investments in both healthcare and data infrastructure within Tribal Nations are part of federal trust responsibility. It is important to note, that IHS is not an entitlement program, and that adequate resource availability is part of a long-term federal agreement that will allow agencies and communities the support needed to update healthcare information technology and develop forms of data research and collection that are culturally relevant and self-determined.

We can do something. Stepping up to advocate for the tribal consultation is essential for making data related decisions for Native Americans, and for improving the current situation of healthcare in Native communities. Who’s land are you on? Educate yourself, and support Tribal healthcare facilities by donating to networks that support sovereignty recognition, such as the Native American Data Sovereignty Network, and healthcare reform networks, such as TribalHealthcare.org.

HPV Vaccination to prevent cervical cancer in Port-au-Prince, Haiti

Courtesy of St. Boniface Haiti Foundation

Cervical cancer is linked to infection with the HPV virus, with more than 90% of cases being associated. HPV vaccine is administered in the United States and has led to decreased rates of infection. Haiti has the largest amount of cases of cervical cancer in the Western hemisphere. Cervical cancer is the most common cancer in women ages 15-44 in Haiti, with 835 diagnosed every year and 563 dying from the disease annually. Programs from groups such as Partners in Health, a nonprofit organization with major influence in Haiti, have been initiated targeting girls ages 10-14 in rural areas. Their goal was to vaccinate 20,000 girls and screen 20,000 more. In 2019, Haiti has a population of 11.2 million people, with 2.3 million people living in the larger metropolitan area of Port-au-Prince. In a country with the majority of the population within the affected age group, larger measure should be undertaken.

Courtesy of Pan American Health Organization/ World Health Organization

Screening and therapeutic options for cervical cancer are limited in Haiti. Screening is limited as patients have to undergo multiple visits as well as bringing their specimen to an equipped Port-au-Prince laboratory. Similarly, radiation which is the preferred treatment for cervical cancer is not offered in the country and current treatment therefore consists of surgery and chemotherapy which are expensive. Preventative measures should be explored. The vaccine is not offered in Haiti on a nationwide basis. The Food and Drug Administration (FDA) in the United States has found the HPV virus vaccine to be efficacious up to age 45. With the help of the World Health Organization (WHO) and MSPP, Haiti’s Ministry of Health, funding should be attained to help align the country with the 2030 Sustainable Developmental Goals of providing sexual and reproductive care to all women as well as providing access to affordable vaccines and medications. As the greatest impact would be in the most populous areas of the country, the HPV vaccine should be administered to girls and women ages 10-26 years of age in the larger metropolitan area of Port-au-Prince, the capital of Haiti, with eventual availability to the entire country.

With the stroke of a pen, the State of Georgia can address the high rates of HIV cases with statewide expansion of Medicaid instead of passing waivers.

In 2011, communities across our country celebrated the 30^th anniversary of AIDS highlighting the significant advances that have been made in HIV research and drug development. What was considered to be a fatal disease is now viewed by many to be a chronic disease, that is managed much like diabetes or hypertension. In the 2019 proposal by the Department of Health and Human Services  “Ending the HIV Epidemic: A Plan for America”, the state of Georgia is recognized, albeit for the wrong reasons. Georgia is one of the three states in the United States with the highest rates of new diagnoses of HIV and rated 5^th highest in the nation for HIV incidence. As of the end of 2017, there were almost 60,000 people living with HIV in Georgia, and 2,698 persons diagnosed in that year alone resulting in one major city’s HIV epidemic being compared to third world African countries. 

https://www.wsbtv.com/news/2-investigates/atlantas-hiv-epidemic-compared-to-third-world-african-countries/263337845

HIV prevention can address this epidemic, but there is inadequate insurance coverage for at-risk individuals.  Over 35, 000 people are at risk of HIV in Georgia and experience challenges in accessing pre-exposure prophylaxis (PrEP) services. Georgia remains one of the southern states that have resisted Medicaid expansion as recently as the 2018-2019 legislative session. If Medicaid was expanded up to 138% of the federal poverty level (FPL), this would encompass another 190,000 people in the State of Georgia currently uninsured and also include those at-risk individuals. Instead, a health care waiver law is under review which increases uncertainty on the issue of access to care for individuals with incomes up to 138% of the FPL and this should be cause for concern. Instead of increasing access to care, the proposed waiver law in Ohio included provisions that would have undermined health coverage for many low-income residents if not for Ohioans who said NO!. The success of grassroots campaigns in Ohio provide a blueprint for advocacy groups in Georgia, to confront this challenge with urgency. Georgians can change the fate of thousands with HIV or those at-risk for HIV by contacting their legislators today. Tell them that HIV prevention will not happen with a Medicaid waiver and demand full Medicaid expansion.

Find your Georgia State Senator http://www.senate.ga.gov/senators/en-US/SenateMembersList.aspx

Find your Georgia State Representative http://www.house.ga.gov/Representatives/en-US/HouseMembersList.aspx?Sort=District&Session

Hey Washington D.C.! It’s your turn! Time to allow minors receive PrEP without parental consent.

“Like many other people in the LGBT community, I have heard about PrEP and how effective it is in preventing HIV. As a minor, I need my parents’ consent to get PrEP and I just don’t feel comfortable discussing my personal life with them.”

AIDS rally in Washington D.C. (July 22, 2012). Source: InsideHook 

Years after the HIV epidemic peak, and despite the emergence of effective methods for treatment and prevention, HIV/AIDS continues to be a major public health problem in the United States and worldwide. According to the Centers for Disease Control and Prevention (CDC), Washington D.C. has the highest rate of new HIV diagnoses in the United States; 54 per 100,000 individuals are diagnosed with HIV every year, which is four times higher than the nationwide rate. Remarkable efforts in the past decade have brought down the prevalence of HIV in D.C. from 3% in its peak to 2% today. However, more policy and evidence-based work is needed to control the HIV epidemic in Washington D.C. – a city filled with law makers and public health professionals.

Source: Washington Post

Source: The Totten Life

One of the most reliable interventions to prevent HIV transmission is PrEP (Truvada) – a medication taken by individuals who do not have HIV but are at high risk of acquiring HIV. PrEP can be remarkably effective. For example, daily use of PrEP reduces the risk of sexual HIV transmission by 99%. However, minors (individuals who do not have the legal rights and responsibilities of an adult due to their age) face different barriers, such as the necessity of parental/guardian consent, which clearly limits their access to PrPE. Minors and young adults are at particularly high risk of acquiring HIV: 40% of new HIV diagnoses in Washington D.C. are among youth (people between 13 to 24 years old), while the same national rate is approximately 20%. This means young people in Washington D.C. are diagnosed with HIV at twice the national rate. Two out of three new HIV cases among youth in Washington D.C. are men who have sex with men.

Some of the materials that have been handed out about PrEP. Source: Houston Chronicle

In order to control and prevent the spread of HIV among youth, some states have passed bills to allow minors receive PrEP without parental/guardian consent. Up until November 2018, sixteen states had passed jurisdictions that explicitly allow minors to independently access PrEP. Recently, Maryland and Connecticut have also joined this movement. Despite high rates of HIV/AIDS in Washington D.C., and youth being at high risk, lawmakers have not made an effort to allow health care providers give HIV preventive services, such as PrEP, to minors without the need for parental/guardian consent. This will be an important step toward decreasing the rate of HIV transmission in Washington D.C., especially among youth, reducing the social, economic, and medical burden associated with HIV/AIDS, and achieving the goal of 50% reduction in new HIV diagnoses by 2020.

Source: Washington AIDS Partnership

All D.C. residents are encouraged to contact (via phone, email, or in-person) the office of Mayor Muriel Bowser, the city council, and the D.C. Department of Health and request that a new law be introduced to facilitate minors’ access to HIV prevention services, especially PrEP, without parental/guardian consent. Given that D.C. is a federal district, not a state, it receives funding from the federal government and relies on directives from Congress to approve its laws. D.C. residents lack full democratic representation in the Congress (limited to a non-voting delegate in the House of Representatives and a shadow Senator). It is, therefore, the responsibility of all Americans to contact their Congressmen/Congresswomen and request their support for a bill to halt the need of parental/guardian consent for minor’s access to PrEP in Washington D.C. Community-based organizations, such as Supporting and Mentoring Youth Advocates and Leaders (SMYAL) and D.C. Center of the LGBT Community, should also inform/educate the public, including minors, about HIV and empower youth to seek and fight for their healthcare rights.

The rate of HIV infection in Washington D.C. is higher than five countries in Africa

Five Ways Communities Can Prevent Human Trafficking through Education

“It is easier to build strong children than to repair broken men” – Frederick Douglass

Human trafficking is a public health issue, victimizing people through forced labor and commercial sexual exploitation in 187 countries and all 50 states in the United States. In 2018, nearly 11,000 cases of trafficking were reported into the U.S. National Human Trafficking Hotline, a 25 percent increase from the prior year.

National Human Trafficking Hotline 2018 Call Location Heat Map (Credit: Polaris)

Although it can happen to anyone, traffickers proactively target the vulnerable, including children and youth. According to the National Hotline, 32 percent of survivors who contacted the Hotline last year were children and the majority of trafficking exploitation began when individuals were under 18 years. Early and prolonged exposure to human trafficking, like many other forms of violence, can have life-long physical, mental, and developmental health consequences, including higher mortality.

National Human Trafficking Hotline Reports Majority of Human Trafficking Exploitation Began Prior to 18 Years of Age (Credit: Polaris)

Primary prevention efforts through education develops proactive and reactive resilience by increasing knowledge among youth on how to resist common recruitment tactics and on how students, families, and schools can respond to the trauma of human trafficking and break the cycles of victimization. Prevention education also supports long-term cost savings related to housing and health support, lost workforce productivity, and criminal justice costs associated with human trafficking victimization.

The U.S. federal government passed a law to train school personnel on human trafficking, a law authorizing grant programs for prevention education for students, and a resolution with 54 countries to educate children to avoid trafficking. However, the national efforts have been unfunded to date and local commitments vary in levels of support. Schools without trafficking prevention education cite concerns from parents that raising awareness will put students at higher risk to exploitation, from school administrators of increased cost and burden, and from community leaders that human trafficking is not a problem they experience.

While some states passed legislation requiring human trafficking prevention education for school personnel and students, others only require training for school staff or do not require any trafficking training. Advocates claim that most schools are not prepared to identify and respond to human trafficking, yet a national environmental scan notes high interest in human trafficking training for both school staff and students.

(Credit: San Diego Youth Services)

Even in states without comprehensive legislation, you can take action:

1. State legislators can seek technical assistance
2. School administrators can review options for no-cost/low-cost curriculum
3. Teachers can take free, accredited, online training
4. Parent-Teacher Associations can invite experts to present on local trafficking trends
5. Students can present at school assemblies and clubs

Half the Battle Won: The Infectious Disease Elimination Act (IDEA), a Needle Exchange Program

Due to the ongoing opioid crises in the United States, the number of infections associated with unsanitary injection behaviors and sharing contaminated equipment is on the rise. People who inject drugs are at a higher risk of contracting viral hepatitis, human immunodeficiency virus (HIV), bacterial and fungal infections. In 2017, the state of Florida had one of the three highest rates of new HIV diagnosis in the US, and a 5.9 percent increase in drug overdose deaths.

Drug overdose deaths, rate per 100,000 persons, in the U.S. and Florida. Source: CDC WONDER.

The Center of Diseases and Control recommends Safe Syringe Practices as a top intervention for disease control and harm reduction; but in some states, the programs are illegal. Policies regarding the legalization of SEPs have been rejected by Florida’s policymakers until recently.  Bill 366, the Infectious Disease Elimination Act (IDEA), passed unanimously in the Florida Senate this past summer and went to effect July 1^st , 2019. The policy provides county commissions the right to launch NEPs in their localities. Requirements includes a contract with a licensed hospital, health care clinic, medical school, licensed addictions receiving facility, or HIV/AIDS service organization and the enlistment of local health department for advice, consultation and recommendations.

The operation site is expected to provide:

• Free exchange of clean, unused needles and hypodermic syringes for used needles
• Maximum security at sites
• Educational materials
• Counseling and referrals for drug abuse prevention, education, and treatment
• HIV and viral hepatitis screening and referrals
• Opioid antagonist kits

The foundation of the policy originates from the IDEA Exchange program, a University of Miami pilot program that provides care to South Miami. According to its annual 2018 report, the program enrolled over 800 participants, exchanged 173,532 clean needles for 186,167 used needles, distributed over 1,300 boxes of Narcan, made 682 overdose referrals and administered 600 HIV tests and 500 Hepatitis C tests. Results observed include a lower number of fatal overdoses and HIV/AIDS related death rates in Miami Dade.  

https://www.cdc.gov/ssp/docs/Syringe-Services-Program-Infographic_508.pdf

Years of research show that NEPs are safe, effective and cost saving harm reduction interventions with no association to increased crime or illegal use of drugs. The legislation does not allocate funding for the program; therefore, to further advance in the fight against opioids and HIV/AIDS, Florida counties are in need of grants and private donations.

Restoring Trust in Pakistan

Mollie Young and Nicholas Rice

Poliomyelitis, a highly infectious disease, is caused by the poliovirus and can lead to irreversible paralysis. Spread of the virus occurs from person-to-person contact, with proliferation of the virus commonly occurring in environments with poor sanitation and hygiene practices. Vaccination against the polio virus has been key to eradication of the virus globally, with the global incidence of cases of poliomyelitis having decreased by over 99% since 1988. However, these global elimination efforts have been unsuccessful in addressing reservoirs for this virus in three countries: Pakistan, Nigeria and Afghanistan.

Wild Poliovirus Cases from 2017-2019 with Karachi

Resistance to vaccination, stemming from ethno-cultural beliefs, has been identified as a major health behavior in Pakistan. Beliefs fueling the refusal to vaccinate include suspicion and fear about vaccination being used for sterilization of Muslims, misconceptions about the efficacy and harms of vaccination, and the belief that vaccination is haram due to its contamination with porcine products. This resistance to vaccination has resulted in not only persistently elevated rates of poliomyelitis and an increasing presence of environmental contamination with poliovirus, but also local civil unrest resulting in violent attacks against local providers of vaccination, including individual health workers and health centers providing vaccinations.

Women and their children gathered in Abbottabad, the city where a vaccine worker was used by the CIA to extract a DNA sample from Osama bin Laden, setting the stage for widespread suspicion of foreign health workers in the country. Photo Source: Nicholas Rice

A remote and difficult to reach village in Pakistan, it is places like these that present health authorities with immense challenges in achieving complete vaccine coverage. Photo Source: Nicholas Rice

Given the initial success of the mass vaccination campaign at reducing the prevalence of poliomyelitis in Pakistan, interventions should focus on restoring the local population’s faith in the success and safety record of the polio vaccine. Reducing the number of questions and alleviating the intensity of the follow-up visits are a few suggestions Barbar Bin Atta, the prime minister’s contact person for polio eradication, has for the vaccinators. In Pakistan, resistance to vaccination poses a significant global health threat by preventing adequate immunization rates to achieve herd immunity and enabling persistence of poliovirus reservoirs, ultimately obstructing the achievement of global poliomyelitis elimination.

Community Involvement Needed in the Fight Against Obesity

Obesity has been a worldwide epidemic of tremendous social and economic impacts, and the US has been hit the hardest by this epidemic. At the state level, Louisiana is seeing one of the highest rates of obesity, currently at 36%. A number of policies have been enacted to counter various factors that contribute to this growing issue, ranging from breastfeeding, physical activity, healthy eating, to nutrition labeling, education requirements, etc..

However, obesity in Louisiana has not decreased and there is mounting recognition for comprehensive policies. Advocates have been calling for more coordinated programs that span prevention, education, treatment, supported and reinforced by community resources, in order to achieve and sustain the intended changes over the long run.

Various high-level stakeholders have voiced their positive takes on the strategy against obesity. The Louisiana Obesity Prevention and Management Commission, a branch under the state Department of Health, fully supports the integration of community resources into obesity control. The LOPMC leverages multi-sector input and community involvement, and prioritizes comprehensive and collaborative approaches to fight obesity. Also, the American Diabetes Association has always emphasized the importance of community and social involvement through local events, fundraising, volunteer work, grassroots advocacy, educational webinars. Social network development, and public awareness of obesity would not only help reduce the rate of obesity, but also lead to reduced prevalence of diabetes associated with obesity. Implementation could lead to savings in direct medical costs, and indirect improvements in overall productivity. In addition, CMS has indicated that intensive behavioral therapy for obesity was necessary for the prevention or early detection of illness, and promoted preventive care including obesity-related services and coverage. Obesity patients would have better access early in their primary care experience, preventing costs associated with conditions attributable to obesity. Another stakeholder with vested interest is the Department of Education. Several child nutrition programs are administered by the DOE in the State, to provide nutritional foods and act as a channel through which children learn about healthy eating and establish healthy behavioral habits.

Taken together, the development of a state-wide obesity prevention, education and treatment program that leverages community resources would produce enormously positive results in Louisiana. Currently, much of the effort in the fight against obesity is isolated and fragmented, but with increasing levels of services, social network development, and public awareness, there will be a healthier and leaner Louisiana.