Archive for the ‘Child Health’ Category

LGBTQ-Inclusive Sex Education for Maryland Schools

March 12, 2018

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In Maryland, all youth, regardless of gender identity or sexuality, deserve the right live healthy lives and thrive in school. For lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth, this can be difficult.

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Research shows that this population is disproportionality at risk of experiencing dating violence and contracting sexually transmitted infections (STIs), including HIV. The CDC furthers this by stating that in 2015, 81% of the youth ages 13-24 who were diagnosed with HIV were gay or bisexual men.

Additionally, a survey on school climate conducted in 2015 found that Maryland public schools are not safe for most LGBTQ students, with 61% of LGBTQ students reporting that they were verbally harassed because of their sexual identity and 45% because of their gender expression. Furthermore, only 1 in 4 students reported being taught positive information about LGBTQ people in school. A hostile school environment can lead to mental health issues for LBGTQ youth, higher absentee and drop-out rates, and even suicide.

Providing LGBTQ-inclusive sex education to middle and high school students is a vital component in empowering this population to thrive.

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With an inclusive curriculum, students obtain medically accurate and age-appropriate information on sexual health that integrates LGBTQ needs. LGBTQ youth learn about health risk behaviors that impact them and how to protect themselves against STIs. Equally important, all students are given the opportunity to explore topics related to sexuality and gender identity in a setting that positively depicts LBGTQ individuals. This helps dispel stigmas and negative stereotypes frequently tied to the LGBTQ community and builds a more welcoming and inclusive school environment.

Picture4Four states and Washington D.C. have passed legislation that mandates public schools provide sex education that respects and addresses the needs of all genders and sexual orientations.

It’s time for Maryland to follow suit and create similar legislation mandating inclusive sex education. In addition, funds should be allocated for the development of supporting materials, resources, and training for educators and school administrators. Research should be conducted alongside these changes to evaluate the impact LGBTQ inclusive-sex education has onSTI/HIV infection rates and bullying in Maryland schools. With these actions, we can help bridge the gap to providing LGBTQ youth with an equal opportunity to live healthy and successful lives.

 

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Bridging the Gap – Immediate Action Required to Provide Adequate Mental Health Services to Canada’s Indigenous Youth

March 11, 2018

There are countless examples of health care disparities among Canada’s First Nation populations – tuberculosis rates up to 38 times higher, diabetes rates 4 times higher and poor housing conditions 3 times higher than non-Aboriginal communities.  One of the most significant deficiencies is provision of mental health services, particularly to Canada’s Indigenous youth.  Alarmingly, the suicide rates of First Nations youth is 5-6 times higher than the non-aboriginal population.

Suicide Rate

Delivery of health services to Canada’s Indigenous populations is complex, as funding is divided between provincial/territorial and federal governments.  The lack of clarity in legislation around this division has led to significant delays in patient care.  In 2005, Jordan River Anderson, a 5-year-old Cree boy with a neuromuscular disorder died in hospital.  It had been determined several years before that he could have been cared for at home, however the dispute over funding for this care extended longer than Jordan survived.  This lead to the development of Jordan’s Principle with the intent to prevent First Nations children from being denied services or experiencing delays receiving them.

Despite Jordan’s Principle being passed in 2007, the Canadian Human Rights Tribunal recently ruled that the federal government is discriminating against First Nation children by failing to provide equivalent health services compared to non-Aboriginal communities.  When a suicide pact was uncovered among youth in Wapekeka, an urgent request for support was issued to Health Canada – it was not provided until after the deaths of two local teenagers.  The Canadian Paediatric Society has found significant discrepancies in how Jordan’s principle is implemented in each province/territory.

Supported by several First Nations and advocacy groups (Chiefs of OntarioAssembly of First Nations, Nishnawbe Aski NationAmnesty International), the tribunal has called for immediate action to address the gaps in mental health services.  The steps required include:

 

  • Analysis of the current programs for mental health services for First Nation youth to identify gaps.  The tribunal has given this a deadline of April 2, 2018.
  • Reallocation of funding specifically to support First Nation youth mental health services.
  • Communities identifying specific resources needed to bridge the gap and how to provide them in a culturally appropriate manner.

Improving Childhood Nutrition One Breakfast at a Time

March 11, 2018

The United States Centers for Disease Control and Prevention (CDC) has highlighted the positive effects of school breakfast programs. The CDC has recognized nutritional benefits of “school meal programs” including the inclusion of more fruits and vegetables in meals, and the overall improvement of the nutritional components in meals. The CDC also has noted that school breakfast programs have been associated with improvements in academic performance measures, including “better attendance rates, fewer missed school days, and better test scores.”

The earliest form of the School Breakfast Program (SBP) was created in 1966 as a “pilot project,” and provided financial support for designated regions. During the following decade, the program itself underwent numerous revisions, and ultimately became a permanent program in 1975.

The United States Department of Agriculture (USDA) has published literature explaining not only the components of school breakfasts, but also providing educational material for both students and families to learn about nutrition.

In 2017, the School Nutrition Association (SNA) and the American Commodity Distribution Association (ACDA) drafted a joint letter of support for the expansion of resources to support school breakfast programs. In this letter, they noted that while the Healthy, Hunger-Free Kids Act of 2010 set guidelines for school breakfasts, it did not allocate additional resources to support SBPs. They therefore offered support for H.R. 3738, the Healthy Breakfasts Help Kids Learn Act of 2017 proposed by Representatives Jim McGovern and Rodney Davis, which would increase “commodity support” for school breakfast programs. This proposal is currently under review.

This resolution shows one approach by which legislators and organizations are working to support improvements in childhood nutrition. What can you do? Contact your school district to find out more information about your local school breakfast program, and other ways in which you can support initiatives to improve childhood nutrition.

Naloxone in every school is the new rule By: S.Blake

March 11, 2018

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According to the Centers for Disease and Control and Prevention, drug overdose deaths and opioid-involved deaths continue to increase in the United States. From 2000 to 2016, more than 600,000 people died from drug overdoses. Even more alarming is the fact that teen drug overdose deaths in the United States climbed 19% from 2014 to 2015, from 3.1 deaths per 100,000 teens to 3.7 per 100,000. These numbers involve teen ages 15 to 19 and were released by the National Center for Health Statistics.

Also, in 2015 the American Society of Addiction Medicine reported 276,000 adolescents were current nonmedical users of pain reliever, with 122,000 having an addiction to prescription pain relievers. In 2015, an estimated 21,000 adolescents had used heroin in the past year, and an estimated 5,000 were current heroin users.

In 2017, the General Assembly passed the Heroin and Opioid Education and CommunityAction Act of 2017, also known as the “Start Talking Maryland Act.” The Act requires county boards to establish policies for obtaining and storing overdose-reversing medications, including naloxone, and for school nurses, and other school staff to administer those medications if a student is reasonably believed to be experiencing an opioid overdose. This requirement went into effect July 1, 2017. Naloxone (Narcan) is a medication to prevent overdose by opioids. Because an opioid overdose can be fatal within minutes it is imperative to have over-dose reversal medications on-site as time is of the essence.

The producer of Narcan-ADAPT Pharma understands the crucial role that schools can play to change the course of the opioid overdose epidemic. ADAPT is committed to working with each State Department of Education and Health or individual school to help prepare schools for an opioid overdose emergency by providing NARCAN® Nasal Spray. ADAPT will provide access to 1 carton of NARCAN® Nasal Spray to high schools throughout the country.

As a registered nurse serving in the state of Maryland and former school nurse in two public school systems in the state of Maryland, I confidently support the “Start Talking Maryland Act.” I stand with the Maryland Board of Nursing, the National Association of School Nurses, the Maryland State Department Board of Education and ADAPT Pharma in the promotion of naloxone in schools across the state of Maryland and call on parents, educators and health professionals to support this life saving act as well by becoming aware of over-dose statistics, ensuring schools in their district are adhering to the “Start Talking Maryland Act” and educating others regarding the fatal preventable epidemic.

Why 21 to Purchase Tobacco Products?

March 11, 2018

The Master Settlement Agreement of 1999 imposed major restrictions on tobacco industries, proved to be a victory for public health workers in the United States and their efforts in tackling the tobacco epidemic.

However, the rise of the use of electronic cigarettes prove to be yet another strategy with tobacco companies in promoting tobacco use. The NIH defines electronic cigarettes, or e-cigs, as battery operated devices that contain aerosol flavorings and other chemicals that mixes with health, producing a vapor.

Due to its’ lack of long term consequences and it’s gateway to adult smoking, I support the bill for increasing tobacco sales from 18 to 21 years old in Washington state.

According to Washington21, 17, 800 Washington kids try smoking for the first time each year, 3, 900 kids become daily smokers with a third of them dying prematurely. The marketing of flavors for electronic cigarettes makes this product more appealing, with majority of teens not knowing exactly what is even in these e-cigs which makes e-cigs all the more dangerous in this population. The IOM Report in 2013 reported that there would be a 25% reduction in 15-17 year olds smoking tobacco and a 10% decrease in smoking related deaths if the age was raised to 21.

Like the effects of increasing the drinking age to 21, I believe that we would see similar effects when raising the age of 21 in purchasing tobacco in Washington, including e-cigs. By supporting the Washington21 campaign we are able to prevent further use of tobacco products among teens and also reduce health related tobacco issues such as cardiovascular/lung diseases, and cancer Participating in advocacy campaigns will also help with providing advocacy tools that can be used at your own state to enact policies to save lives.

On March 8, 2018, Washington house has passed SB 6048  raising the age to buy tobacco products to 21.Given this victory, it is promising that Washington state’s bill will hopefully pass the Washington senate! To support this cause and to protect the health of the youth, contact your district legislator and vote for Tobacco 21!

Sweet home Alabama? Criminalization of Drug Use During Pregnancy

March 10, 2018

Alabama has some of the toughest criminal drug laws in the country. The conservative state legislature has introduced a myriad of acts targeting drug use in the past decade, including a  “Chemical Endangerment of a Child,” law in 2006. Originally written to reduce children’s exposed to drug addiction, a 2012 case in the Supreme Court of Alabama interpreted the law to include unborn infants, even if the fetus is not viable.

While the law was created with good intentions, the criminalization of drug use during pregnancy has led to several negative consequences. Among them, pregnant women must choose between their health and risking conviction. The fear is compounded by the fact that women in Alabama have been drug tested at medical facilities without their knowledge. Women interviewed by Amnesty international in Alabama expressed fear in seeking care at professional offices, leading to delays in critical antenatal care. One woman stated, “In my town, I was worried about going to the doctor because if you test positive [for drugs], bam, you’re slapped with a ‘chemical endangerment’ charge.”   Once convicted, women face jail time, even while pregnant, and revocation of parental custody. Incarcerated women may have not access to critical drug treatment and antenatal care.

Alabama is an extreme example, but child assault laws for drug use during pregnancy has become more common. Given the bleak outlook of women convicted with the law, several recommendations can be made:

  • Alabama legislature should take steps to decriminalize drug use during pregnancy, as supported by many key stakeholder organizations, including the American Medical Association, American Academy of Pediatrics, and the American Public Health Association.
  • Clear procedures should be made for health providers in states that criminalize drug use during pregnancy. Recommendations can include open discussions with patients on drug use during pregnancy, and full transparency on drug testing procedures. The American College of Obstetrics and Gynecology already provides standards of care and could provide this guidance.
  • Expansion of residential drug treatment programs targeting pregnant women, that accept Medicaid insurance. A pilot study for federal grants to support drug treatment programs is already underway with the Improving Treatment for Pregnant and Postpartum Women Act of 2016, but should be fast-tracked and expanded to include more states

Florida High Schools Initiative for Community Engagement (ICE)

August 20, 2017

At a time when interracial turmoil and ideological divides are at a boiling point, it is incumbent upon us to introduce our young people to an alternative to bigotry and violence. What better way to do this than provide a platform from which students can engage their communities through mutually transformative service projects?

We are proposing the implementation of a service-learning program that will be fully integrated into Florida’s high school curriculum – the Florida High Schools Initiative for Community Engagement (ICE). Students will be introduced to the skills of community engagement in the classroom and linked with organizations in the community with whom they can collaborate.

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The evidence for the benefits of service-learning abound.  Other states have successfully adopted similar initiatives.  While currently there are no statewide community service requirements for high school students in Florida, aspects of the infrastructure for the initiative are already in place through the Florida Bright Futures Scholarship Program (BFSP), making Florida ripe for the roll-out of the initiative.

Important stakeholders include high school students, parents, The Florida School Boards Association, the Florida Department of Education (DOE), the Corporation for National and Community Service (CNCS) and local businesses that employ high school students. Students will be introduced to the program through student champions recruited from BFSP. Parents will be engaged through newsletters, parent-teacher conferences and special forums. A grant proposal submitted to CNCS will request funding and logistical support.

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Florida AmeriCorps volunteer. AmeriCorps is one of many initiatives of  CNCS

What Can I do to support the Initiative?

We’re so glad you asked!

  1. Contact your local school board and let them know you support the ICE program!
  2. Call or email  the Florida DOE and tell them you support the initiative!

Expanding National Influenza Immunization Program to Adolescents in South Korea – A social justice perspective

August 20, 2017

Influenza, or “the flu”, is a common infectious disease that ranges in severity, with some cases even resulting in death.

graph 1In South Korea, the number of the flu patients in 2016 was a record high, and more importantly, the flu season started 7 weeks earlier than usual (See Graph 1).

In an effort to curtail the effects of influenza, the Korean government introduced a Free Influenza Immunization Program for children ages 6-12 months in October 2016, and expanded the coverage up to 59 month-old children from September 2017.

In response to this, many people are now arguing for the expansion of the program to include school-aged children and teenagers (up to ages 18 years) as well.

Cost and Parental Concerns

The Korean government expressed its strong concerns at a policy forum held last month, and stated that covering 6,500,000 school-aged children every year is not practical due to a limited workforce and budget. However the socioeconomic cost of influenza is $25 billion USD, and it was also reported that vaccination in this age group could save the cost up to 7 billion USD.

Additionally any side effects from the vaccines are taken seriously by parents. However, the influenza vaccine safety has already been proven.

My position

Despite these concerns – which should be taken seriously – I, as a primary care physician and public health advocate, support the expansion of the program.

Regarding cost, it would be reasonable to cover younger children first and then expand to teens. Various parental concerns need to be fully addressed through community or school level meetings.

imageMore importantly, I would like to introduce the notion of social justice highlighting ‘herd immunity. Children respond well to the vaccine. Even though they are just a fraction of the population, immunizing them could significantly diminish the chance of a widespread outbreak.

This effort is part of being a good citizen, and enhancing our social benefit by protecting more people.

Teen Pregnancy Prevention Program Defunded in Baltimore…and Beyond

August 20, 2017

The teen pregnancy rate in Baltimore is 2-3 times the national average, with rates reaching upwards of 64 pregnant teens for every 1,000 female adolescents in 2009. According to the Center for Disease Control, teen pregnancy costs taxpayers $10 billion annually in health care and foster care costs. On the personal level, unplanned pregnancies significantly reduce life opportunities for teen moms, with the CDC finding that only 50% of teen moms graduating from high school by age 22. This lack of education causes a ripple effect, and teen moms have more chronic health problems and higher rates of incarceration.

Courtesy of the Baltimore Sun

Courtesy of Baltimore Sun

Teen pregnancy in Baltimore has seen a steady decline over the last decade, joining a national downward trend. This comes in no small part to programs such as the Health and Human Services’s Teen Pregnancy Prevention Program (TPPP). With funding from the TPPP, 80 city health departments have been empowered to create science-based prevention programs for teens to understand contraception and sexuality.

Unfortunately, the TPPP was abruptly defunded last week. The Trump administration offered little explanation, leaving pro-abstinence groups such as The Abstinence and Marriage Education Partnership to justify such cuts with claims that abstinence is correlated to lower rates of teen drug abuse.

Here in Maryland, the Baltimore City Health Department expressed frustration at losing $3.5 million out of the $214 milling being cut. Health Commissioner Leana Wen called the cuts “shocking.” The Health Department has joined the Big Cities Health Coalition, comprised of the 80 beneficiary cities of TPPP funds, in decrying the budget cuts. Even the American Academy of Pediatrics has joined the plea, adding a link to its website for pediatricians to contact their congressmen in protest.

There’s good news. The National Campaign to Prevent Teen and Unplanned Pregnancy found that 83% of adults support teen pregnancy prevention programs. Now is the time to tell Congress that the constituency wants the TPPP funded. Call your congressman today!

Optimal Infant & Young Child Feeding (IYCF) In Nigeria: Starting out right

August 20, 2017

Optimal nutrition in the early years is an essential ingredient for children to attain their full potential physically and intellectually. Hence, the WHO/UNICEF developed the Global Strategy for IYCF aimed at reawakening the attention to benefits of optimal childhood nutrition.

In August 2011, the Nigerian Federal Ministry of Health (FMOH) adopted this strategy as a National Policy for IYCF. It actively encourages Exclusive Breastfeeding (EBF) for the first six months of life and thereafter, introduction of safe and age-appropriate complementary foods based on locally available food materials; and continued breastfeeding for two years or more.

Even with the implementation of IYCF, malnutrition continues to be a concern. Stunting declined by only 4%, while the rates of wasting and underweight increased to 18% and 29%. These rates are indicative of nutritional deficiency due to suboptimal feeding practices. The causes of malnutrition in the first 2 years of life include inappropriate breastfeeding and complementary feeding as well as high rates of infections. Only 17% of children are exclusively breastfed at six months with median duration of EBF being 0.5 months in Nigeria.

In addition, infants are introduced to complementary food too early/late and only about 10% of children aged 6-23 months meet the recommendations of the IYCF practices. These feeds are often inadequate in energy, protein, vitamins/minerals such as iron, vitamin A, iodine and zinc.

Intervention

While treatment of malnutrition remains important, Federal and state governments through the ministries of health must pay attention to the important aspect of promotive and preventive health for effectiveness and sustainability. Healthcare professionals must educate pregnant women during ante/postnatal classes on the importance of EBF and implications of starting complementary feeding too early/late. Community health workers should be trained to go into the community to encourage mothers, their spouses and other family/social support groups on EBF, continued breastfeeding and age-appropriate complementary feeding based on locally available food materials.

Also, the FMOH should adopt policies to increase maternity leave to a minimum of 6 months, and mandating employers to provide baby-friendly environment to encourage EBF.

All levels of government need to collaborate to provide leadership, coordination and funding by involving the ministries of education, agriculture, social development, women affairs and information. Resources must be allocated and all strategies must be adequately implemented to support and enhance the capacity to address infant and young child feeding practices in different situations and circumstances.

(by @seunowoniyi and @okowamildred)