Worth Noting SCHIP Funding Shortfalls Get Attention Governors of states that have used up all of the federal contribution to their State Children’s Health Insurance (SCHIP) programs are urging Congress to provide interim funding to carry them over until SCHIP is reauthorized later this year. The governors have warned that if no new federal money is forthcoming, they will be forced to cut back existing SCHIP entitlements and stop enrolling new children in the program. SCHIP was enacted by Congress in 1997 as a way of providing health insurance to children in families whose incomes are too high for Medicaid but too low to enable them to buy private health insurance—the so-called “working poor.” In a statement this month, the Robert Wood Johnson Foundation noted that most of the 8 million uninsured children in the U.S. are eligible for either Medicaid or SCHIP, but many Americans are not aware of the health coverage available for children in working families. Legislation to provide supplemental federal funds for SCHIP has been introduced in both houses of the U.S. Congress but has not yet been passed, and the Bush administration has urged states that have not used all their current SCHIP money to pass it along to states with deficits. For information on the coming reauthorization of SCHIP and budget shortfalls, see previous articles in Health and Health Care in Schools, at www.healthinschools.org. A Statement on Junk Food in Schools Noting that the Institute of Medicine is expected this month to propose new standards for foods sold in America’s public schools, U.S. Senator Tom Harkin (D-IA) called the coming standards “The latest effort to address America’s epidemic of poor nutrition, childhood obesity, and diabetes—an epidemic which, for the love of our children, we can and must stop.” Harkin pointed out that over the last three decades the obesity rate has doubled among adolescents and tripled for kids between the ages of 6 and 11, and he said, “Surely if there’s one place where a precautionary principle should be in effect, it is in our public schools.” Harkin pointed out that as the result of a decades-old court decision and subsequent congressional inaction, the United States Department of Agriculture (USDA), which has responsibility for school lunch and breakfast programs, “is virtually powerless to prevent sales from vending machines and other sources.” The senator and several co-sponsors say they will introduce a bill to be called the Child Nutrition Promotion and School Lunch Protection Act, that would require the USDA to update its current nutrition standards and would allow USDA to set standards for all foods sold in schools, including in vending machines and snack bars. The Harkin bill, when it is introduced, will appear at http://thomas.loc.gov. HHS, Ad Council Partner on Child Obesity Ads A series of public service announcements designed to get children involved in physical activity will be airing in a number of media outlets beginning this month, with the blessings of Pepsico, General Mills, Kraft Foods, Kellogg, Coca-Cola, McDonalds, and the American Heart Association. Media companies including Nickelodeon, the Outdoor Advertising Association, Univision Communications, Turner Broadcasting, and Discovery say they will donate time and space for the PSAs as part of the U.S. Health and Human Services Department’s childhood obesity prevention campaign. Titled “Be a Player: Get Up and Play an Hour a Day,” the PSAs will feature characters from DreamWorks’ Shrek who will encourage children 6 to 9 years old to get up and play for at least one hour every day and will demonstrate the fun kids can have doing that. Children and their families are invited to visit the HHS’s newly redesigned website, www.HealthierUS.gov and a kid’s website at www.smallstep.gov, for suggestions on games and activities to support the new PSAs. The following information appeared during the month of February 2007 in the News Alerts section of the website of the Center for Health and Health Care in Schools at http://www.healthinschools.org. February 5, 2007 Noting that February 7 is the seventh annual National Black HIV/AIDS Awareness and Information Day, the director of the National Institute on Allergy and Infectious Diseases in the National Institutes of Health said today that although African Americans are 13 percent of the American population, in 2005 they represented approximately 50 percent of new HIV/AIDS diagnoses. “African Americans have long been disproportionately affected by HIV/AIDS, and that disparity has only deepened over time,” Anthony Fauci said. Fauci pointed to intensive efforts now under way to improve the treatment of HIV-infected people by developing new drugs and defining the best ways to use currently available drugs, but he said that some of the biggest challenges facing researchers today are the “misperceptions and lack of knowledge about HIV/AIDS and fear related to clinical research, particularly among African Americans.” He urged African Americans to take part in the research effort as scientists, clinicians, community educators, advocates, and study volunteers, to assure that all racial and ethnic groups are included in clinical trials. Further information about National Black HIV/AIDS Awareness and Information Day is available at http://www.blackaidsday.org. Many physicians do not consider themselves obligated to provide information or to refer patients to other doctors when the physicians decline on moral or religious grounds to perform certain controversial procedures, such as administering terminal sedation to dying patients, providing abortions, or prescribing birth control to adolescents without parental approval, according to a survey reported in today’s issue of the New England Journal of Medicine. Those doctors may be in the minority, the survey found, since most (63 percent) of the doctors who responded to the survey believe it’s permissible for doctors to explain their moral objections to patients; 86 percent believe doctors must present all options to the patient; and 71 percent say doctors have a responsibility to refer a patient to another clinician who does not object to the requested procedure. But because that leaves a large number of physicians who do not feel obligated to provide patients with those alternatives, it is important for patients who want access to controversial procedures to inquire up-front whether their doctors will accommodate their requests, the survey advises. The article, “Religion, Conscience, and Controversial Clinical Practices,” is published in the February 8, 2007, issue of the New England Journal of Medicine and is available free at http://content.nejm.org/cgi/content/full/356/6/593?query=TOC. February 12, 2007 The latest issue of Morbidity and Mortality Weekly Report cites National Health Interview Surveys for the years 2003-2005 that show a higher prevalence of asthma in Puerto Rican children than in Mexican-American, non-Hispanic white, or non-Hispanic black children. The report concedes that it’s not known why the disparity exists, but notes that it was found in children of all economic levels--poor, near poor, or not poor. Next highest rates of asthma were found in black, non-Hispanic children and the incidence was lowest in Mexican American children. The statistics were determined by the number of positive responses given to two questions asked during household interviews of a sample of the civilian, non-institutionalized U.S. population: “Has a physician or other health professional ever told you that your child has asthma?” and “Does your child have asthma?” A 30-page, full-color booklet, “Drugs, Brains and Behavior: The Science of Addiction,” being released today by the National Institute on Drug Abuse (NIDA), is written in plain language that laymen will be able to understand; and NIDA hopes the publication, together with an upcoming HBO documentary on addiction, will help to reduce stigma against addictive disorders. NIDA explains that science has revolutionized understanding of drug addiction as a brain disease that affects behavior. “Like diabetes, asthma, or heart disease, drug addiction is a chronic disease that can be managed successfully,” with treatment, the NIDA press release says. The new publication can be downloaded in PDF at http://www.drugabuse.gov. The 90-minute HBO documentary is scheduled to air March 15 from 9:00 to 10:30 p.m. ET/PT. Senator Edward Kennedy (D-MA) said yesterday that legislation he has proposed in the Senate “recognizes the importance of schools as a site of delivery of health care” and would ensure that children with disabilities can obtain health services during the school day. Kennedy said his bill, S. 578, the “Protecting Children’s Health in Schools Act,” is a reaction to provisions in the Bush administration’s proposed budget for 2008 that would end Medicaid reimbursements to schools “for support services they need in order to provide medical and health-related services to disabled children.” Kennedy charged that the administration’s budget “says NO to any legitimate reimbursement to schools for costs incurred for administrative duties related to Medicaid services” and for services to children such as specialized transportation. Kennedy also said that the budget decision by the administration “follows years of resisting Medicaid reimbursements to schools that provide these services, without clear guidance on how schools should appropriately seek reimbursement.” He said his bill calls for “clear and consistent guidelines to be established, so that schools can be held accountable and seek appropriate reimbursement.” He estimated that $3.6 billion in Medicaid funds would be involved over the next five years. The bill, S. 578, can be read and followed at http://thomas.loc.gov. Senators Gordon Smith (R-OR) and Christopher Dodd (D-CT) yesterday introduced legislation that would authorize $50 million a year in federal funding to support school-based health centers (SBHCs)—an investment that Senator Smith said “could lead to a return many times over.” Noting that there are approximately 1,700 SBHCs operating across the country, the sponsors of the School-Based Health Clinic Act of 2007 pointed out that the centers currently receive little or no federal support, with most of their funding coming from state and local resources, patient revenue, and private contributions. “To realize their full potential, the federal government needs to establish a separate authorization for SBHCs,” Smith said. “Even a small amount of federal support can serve as much-needed seed money to attract funding from other sources.” Senator Smith pointed out that there are 44 SBHCs in Oregon, and Senator Dodd noted that Connecticut has 73. Smith said communities around the country are beginning to realized the “enormous benefits” of school-based health centers, “not only to the health of children, but to the broader healthcare system,” with studies showing SBHCs can help curtail inappropriate emergency room use, reduced Medicaid expenditures, and prevent costly hospitalizations. Both senators noted that Congress this year will be re-authorizing the State Children’s Health Insurance Program (SCHIP) and said the School-Based Health Clinic Establishment Act“would be a good complement to SCHIP.” The bill, S. 600, can be read and tracked at http://thomas.loc.gov. Pharmaceutical manufacturer Merck & Co. said February 20 that it will no longer try to persuade state legislatures to make vaccination against the sexually transmitted human papillomavirus (HPV) a requirement for school entry for girls 11 and 12 years old. One state has adopted and at least 20 others have been considering adding the HPV vaccine to the list of immunizations required for school attendance, and Merck has been lobbying state legislatures to put such a mandate in place. Merck manufactures the only HPV vaccine currently approved by the federal Food and Drug Administration (FDA)—Gardasil, a three-dose immunization expected to cost $400. The push to vaccinate young girls was justified as a way to protect them from the potentially serious HPV—which proceeds to cervical cancer in some women-- before they become sexually active, but Merck’s push for immunization was criticized by may parent groups on moral grounds and by public health officials who favor the vaccine but believe the controversy about giving it to school-age girls might impair wider use of the vaccine. Gardasil has been recommended for administration to women 11 to 26 years of age by the Advisory Committee on Immunization Practices, but the committee left it up to states to decide whether to make vaccination a school-entry requirement. February 22, 2007 The federal Food and Drug Administration (FDA) yesterday directed the manufacturers of all drug products approved for the treatment of attention deficit hyperactivity disorder (ADHD) to develop patient medication guides to alert patients to possible cardiovascular risks and the risk of adverse psychiatric symptoms associated with the medicines and to advise them of precautions that can be taken. “Medicines approved for the treatment of ADHD have real benefits for many patients but they may have serious risks as well,” said Steven Galson, director of the Center for Drug Evaluation and Research in the FDA. Patient medication guides are handouts given to patient, families, and caregivers when a medicine is dispensed. The FDA had earlier directed manufacturers of ADHD medications to revise product labeling for doctors to reflect concerns about possible cardiovascular or psychiatric events. The medications that must now have both revised labels and the new patient medication guides include Adderall, Adderall XR, Concerta, Daytrana, Desoxyn, Dexedrine, Focalin, Focalin XR, Metadate, Methylin, Ritalin, Ritalin SR, Ritalin LA, and Strattera. The patient medication guides for each product can be found at http://www.fda.gov/cder/drug/infopage/ADHD/default.htm. |
