The Untapped Power of Schools to Improve the Health of Teens
A report released April 24 cites data from the National Longitudinal Study of Adolescent Health (AddHealth) to show that "school connectedness"—a student’s feeling of being part of and cared for at school—is a key to reducing teenagers’ risk for violence, substance abuse, suicide, and pregnancy.
"The concept of school health promotion should be expanded beyond health education, physical education, and health services," the researchers said. "Adolescent health may also be promoted by fostering a school environment that meets adolescents’ developmental need to feel like they belong and are cared for at school."
"The challenge for public health professionals and school leaders is to identify and promote school attributes and policies that correspond to adolescents’ developmental needs," said study head Dr. Robert Blum, director of the University of Minnesota’s Center for Adolescent Health and Development. "The main developmental needs of middle and high school students include steadily increasing opportunities for autonomy, opportunities to demonstrate competence, caring and support from adults, developmentally appropriate supervision, and acceptance by peers."
In their analysis of the AddHealth data, researchers noted school characteristics that do—or in some cases do not—seem to affect whether students feel connected to school. For example:
"What goes on in the classroom is key to keeping kids from becoming disenchanted with school," Blum said. "It doesn’t matter if you have 20 or 30 kids in a class. It doesn’t matter whether the teacher has an advanced degree. What matters is the environment that a student enters when he walks through the classroom door."
Whether zero-tolerance school discipline policies such as out-of-school suspensions or expulsions for first-time offenses damage students’ feelings of connectedness is not entirely clear from the data, Blum said, but it appears that such policies fail to have one of their expected effects. "Students in schools with harsh discipline policies actually report feeling less safe at school than do students in schools with more moderate policies."
The findings released April 24 are available in two articles.
"Improving the odds: The untapped power of schools to improve the health of teens," by Blum, McNeely, and Rinehart, is available from the Center for Adolescent Health at the University of Minnesota, e-mail aph@umn.edu. "Promoting Student Connectedness to School: Evidence from the National Longitudinal Study of Adolescent Health," by the same authors, is published in the Journal of School Health, Vol. 72(4).
-----------------------------------------------------
This Year’s Influenza: Recommendations from the Advisory Committee on
Immunization
The 2002 influenza season will not begin until October, but the vaccines to be administered this year are already in production, and the Advisory Committee on Immunization Practices (ACIP) has issued recommendations for who should be vaccinated, and when.
In creating this year’s vaccine, public health authorities are betting that Americans will need to be protected against three worldwide virus strains: A/Moscow/10/99 (H3N2)-like; A/New Caledonia/20/99 (H1N1)-like; and B/Hong Kong/330/2001-like. In addition to identifying those strains, the 2002 immunization recommendations include four principal changes or updates, as follows:
As in the past, the CDC strongly recommends early (October or before) influenza vaccination of health care workers, including physicians, nurses, and other personnel in both hospital and outpatient care settings.
Antiviral Agents for Influenza
They are not a substitute for vaccination, but four licensed influenza antiviral agents are available in the United States—amantadine, rimantadine, zanamivir, and oseltamivir. When administered within one or two days of illness onset, they seem to be effective in preventing complications, and taken after a known exposure, they may prevent illness. The CDC lists specific dosages of these drugs for children, for either treatment or prophylaxis.
For the complete text of the CDC’s recommendations for prevention
and control of influenza in the 2002-2003 season, see "Recommendations
and Reports, Morbidity and Mortality Weekly Report," April 12,
2002 at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5103a1.htm.
-----------------------------------------------------
Inhalants Revisited: An Update
The National Inhalant Prevention Coalition and a number of federal agencies provided updated statistics about the prevalence of "sniffing" and the deaths that can occur as the result of inhaling common household and commercial products, during National Inhalants and Poison Awareness Week in March this year.
As of the year 2000, said Dr. Wesley Clark, director of the Center for Substance Abuse Treatment in the federal Substance Abuse and Mental Health Services Administration (SAMHSA), some 9 percent of young people ages 12 to 17—that’s approximately 2.1 million youths—admit to having used inhalants at some time in their lives, sniffing products that include glue, shoe polish, gasoline, lighter fluid, paint thinners, spray paints, deodorants, nail polish, magic markers, and pressurized whipped cream containers. Sixth graders in Howard County, Maryland, in suburban Washington, D.C., reported inhalant use triple that of 1998, a trend SAMHSA notes in other parts of the country, as well.
The Center for Substance Abuse Treatment currently funds the nation’s only treatment facility dedicated to inhalant abuse, the Tundra Swan Inhalant Treatment Center in Bethel, Alaska, where the Yukon-Kuskokwim Health Center has been providing treatment for the past two years, including outpatient clinics and a residential facility for young, chronic Alaskan native inhalant abusers. "We are hopeful that what we learn in Alaska can be translated into treatment protocols that can be used in all 50 states to treat inhalant abuse," Clark said.
The unique feature of inhalant abuse, the coalition points out, is the almost inexhaustible supply and easy availability of products that can be "sniffed"—over 1,000 have been identified—and the fact that young people do not need money or complex paraphernalia to use those products, many of which are readily accessible at home, in school, or in convenience, grocery, and auto supply stores. In general, inhalation is by nose or mouth ("bagging" or "huffing"), directly from containers or from plastic bags over the head or alternative containers such as balloons. Aerosols may be sprayed into the mouth or nose, or youngsters may inhale vapors emitted by heating substances. Use is often hard to detect, though there are common links between inhalant abuse and problems in school, such as failing grades, chronic absences, and general apathy, and more specific signs such as paint or stains on body or clothing, spots or sores around the mouth, red or runny eyes or nose, a chemical breath odor, a dizzy or dazed appearance, and anxiety or irritability.
Inhalants are unique in another way, also, the coalition points out, in that death can occur the first time an experimenting youngster inhales a substance, which increasingly is in late childhood or early adolescence, often before the onset of tobacco or alcohol use. The top two chemicals causing "sudden sniffing death syndrome" are toluene (found in airplane glue, paint remover or thinner, and correction fluid), and butane (a component of gasoline, lighter fluid, paint and hair sprays, and deodorants); these chemicals and others such as freon affect the heart’s rhythm and can cause cardiac arrest. Users who survive a first experience and become regular sniffers risk a range of other damages, to the brain, blood, nervous system, lungs, liver, kidneys, bone marrow, and muscle.
What To Do
It’s hard to warn young people about inhalant abuse without at the same time introducing them to substances and techniques for inhaling, the coalition concedes. But a brochure for parents prepared by a number of federal agencies suggests talking to youngsters openly and discussing the devastating consequences of inhalant abuse "can help prevent a tragedy."
Meanwhile, if a parent, teacher, or other adult comes upon a child who is "huffing," remember that activity or stress may cause heart problems, so do not confront or argue with the abuser. If conscious, keep the person calm and in a well ventilated room. If unconscious or not breathing, call for help and administer CPR. Do not leave the person alone. Once the person recovers, seek professional help from a school nurse, counselor, physician, or other health care worker.
For further information about inhalants, the National Inhalant Prevention
Coalition can be contacted at www.inhalants.org.
The federal government’s National Clearinghouse for Alcohol and Drug
Information is at www.health.org.
-----------------------------------------------------
IN CONGRESS
Abstinence Education
Legislation introduced in the House of Representatives April 9 would extend abstinence education funding under the maternal and child health program through fiscal year 2007. Originally authorized as part of welfare reforms enacted in 1996, abstinence education programs have received as much as $50 million from the federal government and $37.5 million from states each year since 1998, and President Bush’s proposed 2003 budget calls for an additional boost in the federal contribution. Unless reauthorized, the program is scheduled to expire this year.
Coincident with moves in Congress to reauthorize the program, the Department of Health and Human Services April 23 released the first interim report by a research group, Mathematica Policy Research, that is under contract to HHS to conduct a five-year longitudinal study of abstinence education. Overall, the report says, "Section 510 abstinence funds are changing the local landscape of approaches to preventing teen pregnancy."
"All states have applied for these funds," the report notes, and most have reapplied in each succeeding year. There currently are more than 700 abstinence education programs, most of them in public schools, and many focused on middle schools. The research report concludes that—in addition to the money—schools are supporting abstinence education because the programs "address a broad range of issues, from building self-esteem, to understanding and aspiring to healthy marriages and parenthood, to teaching skills that will help youth make and follow through on good decisions."
Mathematica says future reports will assess the impact of the programs on reducing early sexual activity, with a short-term-impact report expected early next year, "when sufficient data have become available."
The bill to extend the abstinence education program, H.R. 4122, has been referred to committee.
Mental Health Parity
A bill that would require employers who offer health insurance to provide coverage for mental illness equal to that for physical illness may finally get congressional approval, after President Bush endorsed the idea in a speech to a job training facility for persons recovering from mental illness April 29, in the home state of the bill’s main sponsor, Senator Pete Domenici (R-NM).
Domenici, who has a child with schizophrenia, has championed mental health parity legislation for many years, but has met opposition from fellow Republicans in the House and Senate who argued that adding mental health protection would increase the cost of health insurance and cause many employers to drop coverage altogether. The Senate passed a bill last year requiring group health plans at businesses with more than 50 employees to provide mental health coverage with no higher premiums and co-payments than for other illnesses, but the provision, which was added to a Labor-HHS-Education spending bill, was removed in conference.
Still in dispute in the new legislation is whether "mental illness" for purposes of insurance will be defined as meaning all of the more than 200 disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, or only major diseases such as schizophrenia and bipolar disorder.
The "Mental Health Equitable Treatment Act," S. 543, was originally introduced by Domenici and co-sponsors March 15 last year.
Language Assistance in Health Centers
A bill introduced in the House of Representatives April 10 would increase the availability of language-assistance services for patients of health centers, including community health centers, under section 330 of the Public Health Service Act.
Noting that the uninsured population in the United States continues to grow by over 100,000 individuals per month, and that a substantial number of them are persons with limited English-speaking ability, the bill points out that "Access to health care for individuals with limited English-speaking ability has been greatly improved when translation and interpretation services are provided to health center patients and providers and when patient information (enrollment forms, educational materials) are available in the language spoken by the patient population."
The bill, H.R. 4134, would authorize $10 million for fiscal year 1003 and such sums as necessary for each of fiscal years 2004 through 2007 for hiring translation and interpretation services and compensating staff of the health centers who provide language-assistance services.
Medicaid
Concerned that states are struggling to fund their share of the state/federal Medicaid programs, two Senators introduced legislation April 22 that would temporarily increase the federal contribution to Medicaid by increasing matching rates by 1.5 percent for the next three years, with double that amount to the most needy states. The bill would also hold states harmless at their 2003 Federal Medical Assistance Program levels, meaning no state would experience a decrease in federal Medicaid funds.
Saying it’s no mystery that if Congress doesn’t act, states will be
forced to cut their Medicaid programs and more Americans will lose health
coverage, Senators Jay Rockefeller (D-WV) and Gordon Smith (R-OR) said
their goal is "to prevent erosion of health insurance coverage
and maintain a strong health care safety net for vulnerable people during
the economic downturn." Their bill is S. 2221.
-----------------------------------------------------
WORTH NOTING
A Little Prevention Won’t Kill You, HHS Says
Secretary of Health and Human Resources Tommy Thompson announced April
30 that his department will launch a major media campaign aimed at young
people this summer, using sophisticated marketing techniques to sell
kids on healthy choices, including physical activity. In a speech introducing
a new HHS program. "A Little Prevention Won't Kill You," aimed at preventing
diseases associated with a sedentary life style and poor eating habits,
Thompson said, “What scares me most is that diseases caused by lack
of activity and good nutrition are beginning to maim our children.”
He cited type 2 diabetes, “a disease once reserved for adults 40 and
older and now found in children as young as eight.” Noting that this
can be linked to the fact that children are more sedentary and overweight
than ever before, Thompson suggested, “We need to get our children off
Play Stations and onto the playgrounds.”
-----------------
Study Finds Mental Skills Deficits in Toddlers Exposed to Prenatal Cocaine
In the latest development in the ongoing debate about "crack babies,"
researchers from Case Western Reserve University in Cleveland, Ohio,
reported in the April 17 issue of the Journal of the American Medical
Association that they found children exposed to cocaine before birth
were twice as likely to have significant delays in mental skills before
age two as toddlers with similar backgrounds whose mothers did not use
the drug. The investigators followed the development of 415 infants
whose mothers were recruited into a study at a large urban teaching
hospital between 1994 and 1996. Of the group, 218 infants were found
to be cocaine-exposed and 197 cocaine-free. Describing the study as
"the first report of a clear-cut relationship between prenatal
cocaine and mental test performance at age two," the researchers
suggested that the cocaine-exposed children will continue to have learning
difficulties and may need special education services when they reach
school age.
-----------------
Incorrect Use of Inhalers and Peak Flow Meters by Children with Asthma
Many children and adolescents with acute asthma use their metered dose
inhalers or peak flow meters incorrectly, according to a study published
in Archives of Pediatrics and Adolescent Medicine. Young
patients who came to a hospital emergency room with an asthma attack
were asked to show whether they follow six recommended steps in using
an inhaler (shake the inhaler before use, exhale completely before actuation,
actuate once at the start of an inhalation, inhale slowly, hold your
breath after inhalation, and ensure a ratio of inhalation to actuation
of 1.1). Youngsters who reported having a peak flow meter at home to
manage their asthma were asked to demonstrate if they (1) move the indicator
to zero, (2) take the deepest breath possible, (3) close their lips
around the mouthpiece, and (4) blow hard and fast. Because the researchers
found so much improper use of the devices, they recommend that doctors,
nurses, and respiratory therapists focus asthma education efforts on
this issue. The research findings appear in the April 2002 issue of
the Archives.
-----------------
Clonidine Exposures Increasing
Clonidine, a medication currently approved only for management of hypertension,
is increasingly being prescribed for children with attention deficit
hyperactivity disorder who don’t respond to stimulants such as Ritalin.
That increasing use is putting more children at risk of clonidine poisoning,
say researchers, with many of the exposures reported by hospital emergency
rooms and poison control centers involving an overdose of the child’s
own medication or accidental use by younger siblings. Often there are
only minimal toxic effects from clonidine ingestion, but an overdose
can be serious or even fatal, and "the serious nature of some of
these cases are causes for concern," the researchers say. An article,
"Trends and Toxic Effects from Pediatric Clonidine Exposures,"
appears in the April 2002 issue of Archives of Pediatrics and Adolescent
Medicine.
-----------------
Study Finds More Children on Psychotropic Drugs
A study funded by the Agency for Healthcare Research and Quality and
published in the journal Ambulatory Pediatrics found the proportion
of children receiving psychotropic medications increased substantially
in the late 1990s, with drugs to mitigate attention deficit hyperactivity
disorder most commonly prescribed but antidepressant prescriptions increasing
at an ever-quickening pace. The popularity of Ritalin declined from
80 percent to 56 percent of ADHD prescriptions between 1995 and 1999,
while dextroamphetamine (Adderall) became relatively more popular. Pediatricians
wrote half of all ADHD prescriptions, with family practitioners accounting
for another 20 percent. The number of children taking new antidepressant
drugs such as bupropion (Wellbutrin) and venlafaxine (Effexor) jumped
195 percent between 1995 and 1999, though serotonin reuptake inhibitors
remained more popular overall. The study looked at 750,000 children
and adolescents in the United States covered by employer-sponsored insurance.
-----------------
Are School Bus Emissions Hazardous to Children’s Health?
Children are exposed to diesel exhaust from school buses at levels
far above those predicted by current government monitoring efforts,
according to researchers from Yale University and the University of
Connecticut who monitored school buses and a group of children throughout
the day. Exposure to soot and other particles was highest when the children
were on board buses, or waiting to get on or off them at school, where
the buses were parked with engines idling. At such times, the concentrations
of diesel pollutants were sometimes 10 times above that in unpolluted
air. A Yale professor of environmental risk analysis who headed the
study pointed out that components of diesel exhaust such as airway-blocking
benzene produce symptoms of allergy, including inflammation and irritation
of the airways, and may help explain the mysterious and rapid rise in
incidence of asthma, which currently affects 4.8 million school children,
many of whom spend an average of 180 hours a year on school buses. A
report on the research appeared in the April 2002 issue of the Yale
alumni magazine
-----------------
Resources
Bright Futures Offers Mental Health Guide and Tool Kit
"Bright Futures: Mental Health," a guide and tool kit for health professionals and families concerning specific mental health problems in children and adolescents, is available from the National Center for Education in Maternal and Child Health. Both the guide and the tool kit focus on screening, care management, and education, and the kit offers hands-on tools for addressing those issues. "Bright Futures in Practice: Mental Health" is available at website www.brightfutures.org.
Oral Health Grants Available
The Center for Health Care Strategies (CHCS) released a call for proposals April 22 for "State Action for Oral Health Access," a $6 million competitive grant program of the Robert Wood Johnson Foundation (RWJF) to test innovative, comprehensive state approaches to improving access to oral health services for low-income, minority, and disabled populations. Funding of up to $1 million each will be available for five to seven states. A conference call for prospective grantees will be conducted May 16, 2002; grant applications are due June 21, 2002, no later than 5:00 p.m. EST. Complete grant information is available at www.chcs.org/grantinfo/applyoralhealth.html
What Every Clinician Should Know about Smallpox
A notice to readers in the April 26 issue of Morbidity and Mortality
Weekly Report suggests that although smallpox disease was eradicated
in 1977, smallpox virus could be used as an agent of bioterrorism, and
health care providers should familiarize themselves with the disease
and the vaccine that prevents it. A program, "Smallpox: What Every
Clinician Should Know," is available on the Internet and on videotape,
with continuing education credits available through 2003. Additional
information and the webcast are available at www.phppo.cdc.gov/phtn/1213smallpox.asp,
and a videotape of the program is available from the Public Health Foundation
by telephone at 877-252-1200.
-----------------
April News Alerts
The following information was provided during the month of April in the News Alerts section of this website.
NCI Reports on Youth Smoking
In what the National Cancer Institutes describes as the first major update of adolescent smoking behavior since 1994, 30 public health experts from around the United States reported April 2 that almost 32 percent of 12th graders are current smokers, with initiation rates declining slightly for males and females under 16 but increasing for older females. Smoking rates vary by racial and ethnic groups, with American Indian and Alaska Native adolescents showing the highest rates and African American adolescents the lowest. The monograph, the 14th in the NCI’s series on smoking and tobacco control, addresses large-scale influences on smoking behavior of adolescents, including access and marketing. The complete monograph may be viewed online at http://cancercontrol.cancer.gov/tcrb/nci_monographs.
SBHCs Included in Senate Health Safety Net Bill
The United States Senate April 16 passed legislation to reauthorize and strengthen the health centers program and the National Health Service Corps and to establish a Healthy Communities Access Program to help coordinate services for the uninsured and underinsured. Among its provisions, the bill, S. 1533, includes a subtitle on School-Based Health Center Networks, which authorizes $5 million for fiscal 2002 for awards to nonprofit organizations, including state school-based health center associations, to:
The full text of S. 1533 can be read and downloaded from website http://thomas.loc.gov. See Daily Digest section of the Congressional Record for April 16 and go to "Text of Amendments."
HHS Backs Continued Testing of Drugs Used to Treat Children
The U.S. Department of Health and Human Services announced April 19 that the Food and Drug Administration will continue to require drug companies to conduct scientific studies of the effects on children of new drugs that are likely to be prescribed for and used by children. The FDA had said it was planning to cease enforcing the so-called "pediatric rule," which went into effect in 1999, after drug companies argued that the cost of pediatric testing was keeping useful drugs from the marketplace. That move by FDA caused an outcry from medical groups and child advocates, who called for continued testing. In an April 19 press release, HHS Secretary Tommy Thompson made no reference to the controversy, but said the FDA will now seek public comment on updating the 1999 rule, and the National Institutes of Health will request proposals for contracting out tests when manufacturers choose not to conduct them themselves. "Children need access to the same kinds of safe, effective treatments that are available to their parents, and that means conducting appropriate clinical trials," Thompson said.