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Call for School Pest Management Stirs Controversy Conflict has erupted over a provision in a federal education bill that would require schools to have pest management plans in place and to tell parents at least twice a year when and where pesticides will be applied in buildings or on school grounds. The bill also encourages schools to look at alternative ways of keeping pests under control, such as sanitation, structural repair, and "mechanical, biological, and cultural strategies that minimize health and environmental risks." All of that, together with detailed instructions on how schools are to set up their pest control plans and keep parents informed, was added to the Senate’s version of H.R. 1, a bill reauthorizing the Elementary and Secondary Education Act, in a last-minute amendment offered by New Jersey Senator Robert Torricelli (D). The Torricelli amendment is now one of the points being negotiated in a conference that’s meeting to work out differences between House and Senate versions of the education bill. There is no similar provision in the House bill. Apparently concerned about the amendment, a subcommittee of the House Agriculture Committee—which doesn’t ordinarily involve itself in education legislation—took the unusual step of calling a hearing July 18 to discuss the school pesticide provision. Witnesses at the hearing expressed concern that the requirement to give parents advance notification about pesticides would interfere with community-wide spraying to control mosquitoes, or would prevent instructors from demonstrating pesticides in agriculture education classes. The subcommittee got no help from the federal Environmental Protection Agency. In a letter to subcommittee chairman Representative Bob Goodlatte (R-VA), EPA Administrator Christine Todd Whitman declined to comment on H.R. 1, saying there had not been time to study "whether new legislation is necessary to address pesticide use in schools." Rallying to the amendment’s defense, the president of the American Crop Protection Association called it a "fair, balanced approach to integrated pest management." That wasn’t the view of representatives of two major education organizations—the American Association of School Administrators and the National School Boards Association—who told the subcommittee that schools will be overwhelmed by the paperwork the Torricelli amendment requires. And the proposed new law is unnecessary, said Fulton County, Georgia, Assistant Superintendent for Support Services Michael Vanairsdale, who called the Torricelli amendment "a solution in search of a problem." Both Vanairsdale and school boards spokesman Marshall Trammel of Chesterfield County, Virginia, insisted that most school systems already have effective pest control systems in place.. In one of only a few references to child health, the executive director of the National Coalition Against the Misuse of Pesticides pointed out that children are especially vulnerable to pesticides, since they take in more pesticides relative to body weight than adults and are less able to detoxify toxic chemicals. "Low levels of pesticide exposure can adversely affect a child’s neurological, respiratory, immune, and endocrine system, as well as behavior and ability to concentrate," Jay Feldman told the subcommittee. He pointed out that hundreds of pesticide products have never been evaluated for their effects on children, and pesticide poisonings are not tracked by the EPA. He also noted that there is little information about possible interactions between pesticides and any pharmaceuticals children may be taking. Whether the Torricelli amendment will survive in the House/Senate conference on the education bill won’t be known until fall, when the conference resumes after the August congressional recess. The Torricelli amendment, titled the School Environmental Protection Act of 2001, can be read at the Library of Congress website for congressional information, http://thomas.loc.gov.
Improving HIV Testing of Adolescents The United States is making headway in reducing the rate of adolescent pregnancy, but the same can’t be said for human immunodeficiency virus (HIV) prevention, according to the Centers for Disease Control and Prevention, which reports that approximately 37 percent of reported HIV infections in the U.S. occur among adolescents and young adults. Add to that the fact that many at-risk adolescents and young people remain untested, and the incidence of HIV in this population is probably much higher, making the issue of prompt testing and early treatment an urgent personal and public health problem. But it is difficult to bring many at-risk youths into traditional testing facilities such as doctor’s offices, hospitals, or clinics, and those who do come object to and may reject the test procedures they are asked to undergo. A particular problem is any form of testing that doesn’t yield an immediate result and requires a second, follow-up visit by the teenager. To find out what kind of HIV testing adolescents find most acceptable, in the hope of encouraging more to submit to tests, a group of researchers at the University of Maryland School of Medicine in Baltimore designed a project in which a group of youths ages 12 to 24 years were asked which of six different HIV antibody collection and testing strategies (three saliva, one urine, and two fingerstick methods) they preferred. Of the 278 total participants, half were male and half female, with an average age of 15 years.The young people first attended small-group health education sessions in which the various methods were described and illustrated, and they received both pre- and post-test counseling. After they were tested using each of the six methods, they
were asked to rank them according to how much they preferred
each one relative to the others. After the first rankings
were recorded, health educators told the young people the
time required to get a result from each of the methods,
and asked them to re-rank the methods in light of that information.
The Findings The Tests
The researchers note that while the devices were provided by the manufacturers, the study was not funded by the manufacturers and the researchers have no financial interest in the devices. For fuller information, reprints of the article "Evaluation of Youth Preferences for Rapid and Innovative Human Immunodeficiency Virus Antibody Tests," which appeared in the July issue of Archives of Pediatrics and Adolescent Medicine, are available from Ligia Peralta, MD, at lperalta@peds.umaryland.edu.
Secondhand Smoke—Even a Little Is Too Much As part of its effort to slow the spread of smoke-free environments, the tobacco industry has minimized the effect of passive or secondhand smoke on nonsmokers. But researchers who tested the cardiovascular systems of healthy young nonsmokers after they spent just 30 minutes in a room with smokers say the damage to the coronary arteries of the nonsmokers was hard to distinguish from the damage sustained by the smokers themselves. The research published in the July 24 issue of the Journal of the American Medical Association prompted the journal to run an accompanying editorial calling the findings "important not only because they illustrate the importance of preventing nonsmokers from any exposure to secondhand smoke, but also because they help to explain the relatively large risk of death and other cardiac events associated with passive smoking compared with active smoking." "Passive smoking increases the risk of cardiac death or morbidity about 30 percent, compared with a doubling or quadrupling of risk associated with active smoking. Thus, the effect of passive smoking is as high as one-third the effect of active smoking, even though the doses of some of the constituents is much less than what the smoker inhales." While most people think of cancer when they think of the effects of smoking, it’s important to remember that heart disease is also an important consequence of tobacco smoke exposure, the editorial points out. That’s particularly true for passive smoke—heart disease accounts for about 37,000 of the estimated 53,000 annual deaths attributed to involuntary smoking in the United States. Data presented by the tobacco industry depicting secondhand smoke as harmless are misleading, the report indicates, since they often cite low incidence of just one of the 4,000 chemicals in secondhand smoke—possibly one that has a low absorption rate or rapid clearance. That’s different from measuring the total biological effect of breathing the secondhand smoke as researchers in the current study did. The research was conducted using only healthy young males, students at Osaka City University Medical School in Japan. Their median age was 27 years. The researchers did not hypothesize about the effects of secondhand smoke on children. The research report, "Acute Effects of Passive Smoking on the Coronary Circulation in Healthy Young Adults," and the editorial, "Even a Little Secondhand Smoke Is Dangerous," appeared in the July 24, 2001, issue of the Journal of the American Medical Association.
Examining Community Drug Treatment for Adolescents The first large-scale study designed specifically to evaluate community drug abuse treatment for adolescents has concluded that treatment can improve the lives of youngsters who have become addicted to alcohol or other drugs, but a shortage of community treatment centers that understand the special needs of teenagers prevents many from receiving appropriate treatment, and even the best facilities do not keep troubled adolescents long enough to solve their many problems. A study funded by the National Institute on Drug Abuse looked at the pre-treatment status and the results one year after treatment of 1,167 adolescents ranging in age from 11 to 18 years, two-thirds of them male and white, in four U.S. cities—Chicago, Illinois; Minneapolis, Minnesota; Pittsburgh, Pennsylvania; and Portland, Oregon. The adolescents typically had multiple problems; many were polydrug users, more than half were involved in the legal system, and two-thirds met the criteria for mental disorder. Half reported marijuana as their major addiction, almost one-fourth said the problem was alcohol. The teenagers received treatment in a variety of community programs—residential programs, where the stay ranged from three to 12 months; outpatient drug-free programs that typically lasted from one to six months; or short-term inpatient programs that ran from five to 36 days, usually with referral for continued outpatient treatment after discharge. Researchers looked at how the adolescents were doing one year after treatment with respect to drug use, psychological adjustment, criminal involvement, and school performance. "Overall, there were significant improvements" in all of those areas, the researchers reported. Fewer than half returned to regular weekly marijuana use, and there were reductions in criminality, heavy drinking, and use of other illicit drugs. Across all the modalities of treatment, the adolescents showed significant improvements in psychological adjustment and were doing better in school. But the good outcomes were not consistent; one year after treatment 20 percent of the teenagers drank heavily, 19 percent used cocaine, 42 percent used illicit drugs other than marijuana, and 52 percent committed crimes. "These outcomes were largely associated with the generally short lengths of stay in treatment programs (almost three-quarters of patients stayed less than three months)." Overall, the researchers concluded that what is needed
most to improve treatment outcomes is better understanding
of the patterns of adolescent drug use and adolescent-specific
issues that lead to drug abuse, including the roles of school,
family, and peers. The study, "An Evaluation of Drug Treatments for Adolescents in 4 US Cities," was reported in the July 2001 issue of Archives of General Psychiatry. It is part of ongoing Drug Abuse Treatment Outcomes Studies by the National Institute on Drug Abuse in the National Institutes of Health.
IN CONGRESS They are given very little chance of passing in this session,
but two bills introduced in the Senate and one in the House
in July address the problem of children and families who
lack health care insurance. ‘Medikids’ for Children West Virginia Senator Jay Rockefeller (D) in the Senate and Representative Pete Stark (D-CA) in the House proposed legislation in July that would enroll all children at birth in an insurance program that would provide benefits such as those now available to adults under Medicare, including doctor and hospital care and screening and prevention services. The bills would also cover prescriptions. Noting that he was a "proud sponsor" of the Children’s Health Insurance Program (CHIP) in 1997, Rockefeller said that while CHIP is a vehicle for insuring low-income children, it doesn’t guarantee that all children will have health insurance. "Even with perfect enrollment in CHIP and Medicaid, there would still be a great number of children without health insurance"—an estimated 10 million—he pointed out. And with the cost of health insurance steadily rising, it’s likely that many more working families will not be able to afford coverage—"all of which adds up to the fact that many of our children will not have the consistent and regular access to health care that they need to grow up healthy." Rockefeller’s bill, S. 827, the Medikids Health Insurance Act of 2001, would amend the Social Security Act to provide comprehensive coverage to all children born after December 31, 2001. Children would be insured from birth to 21 years of age. During the first two years of the program the costs would be covered by public funds, giving the Secretary of the Treasury time to develop a "package of progressive tax changes to fund the program," along the lines of Medicare. Parents would pay a small premium, adjusted as necessary for low-income families, but there would be no cost-sharing for preventive and well-child care. Children already enrolled in Medicaid or CHIP, and children who have private insurance, could remain in those programs. "Children are inexpensive to insure," Rockefeller pointed out, "yet the benefits of doing so would be enormous for our country." The Rockefeller and Stark bills have been referred to committees of the Senate and House. No action has been taken. ----------
Senator Edward Kennedy (D-MA) and cosponsors including majority leader Senator Tom Daschle (D-SD) introduced a bill July 26 that would expand the Children’s Health Insurance Program (CHIP) to allow both children and their parents to be covered under a program to be renamed "Family Care Program." In a detailed bill, S. 1244, Kennedy would give states the option of providing health coverage to parents of CHIP-enrolled children, pregnant women, and legal immigrants, with cost-sharing limited to 2.5 percent for families with incomes below 150 percent of poverty. Providing benefits to parents will increase the number of children enrolled in CHIP, Kennedy said. His bill came with a long list of endorsements by groups including the American Academy of Pediatrics, the American Hospital Association, labor unions, teacher unions, public health associations, church groups, and organizations representing women. Kennedy’s bill has been referred to the Senate Finance Committee, where he said all members of the committee support the legislation, making it possible that this bill will at least be reported out of committee and possibly reach the Senate floor this session.
WORTH NOTING Teens Turning to Internet for Health Information A study of tenth graders in an ethnically and economically diverse suburban community in New York State found that almost all of the students had access to a computer, either at home or at school, and used the Internet as a source of health information ranging from safer sex and birth control to diet, nutrition, and exercise. Most of the teens considered the information on the Internet to be reliable and trustworthy. When asked to rank their sources of health information, however, students still listed friends, siblings, parents, and magazines ahead of the Internet, with health care providers and clinics near the bottom of their lists. The study is reported in the July 2001 issue of Archives of Pediatrics and Adolescent Medicine. ---------- Screening for Chlamydia: What’s New Latest information and guidelines about screening for chlamydia
infection are posted on the website of the federal Agency
for Healthcare Research and Quality. The guidelines were
prepared by the third U.S. Preventive Services Task Force,
which systematically reviews evidence of the effectiveness
of clinical preventive services, including screening, counseling,
and chemoprevention, to develop recommendations for preventive
care in the primary care setting. Screening for Chlamydial
Infection: What’s New can be accessed on the Internet
at www.ahrq.gov/clinic/prev/chlamwh.htm.
Recommendations on Sexual and Reproductive Health Services for Young Males An Urban Institute report summarizes the consensus of a working group of experts on what reproductive health services for teen-age young men should look like and includes a set of recommendations for communities and service providers. The report suggests that adolescent males are at greater risk than had previously been supposed for a variety of sexually transmitted diseases. The report is available at www.urban.org/news/focus/focus_at-risk-teens.html. Adobe Acrobat Reader is required. ---------- Researchers Warn of Food Allergic Reactions in Schools As many as 6 percent of school-age and preschool children may have food allergies, and strict avoidance of trigger foods is the only currently available therapy. But despite the best efforts of parents and schools, accidental exposures happen to half of those children, some of them at school, according to researchers at Mount Sinai Medical Center. The researchers advise that schools identify food-allergic children and request detailed instructions from physicians for treatment of reactions. A person in charge of treating reactions, and at least one back-up person, should be clearly identified and should be comfortable with the use of injectable epinephrine devices, since prompt administration of epinephrine may be life-saving. Research findings on school food allergies are published in the July issue of Archives of Pediatrics and Adolescent Medicine. Also, the National Library of Medicine maintains a comprehensive resource on food allergies at www.nih.gov/medlineplus/foodallergy.html. ---------- Connecticut Prohibits Schools from Recommending Psychotropic Drugs A law scheduled to go into effect in Connecticut October
1 this year prohibits school personnel from recommending
the use of psychotropic drugs for any child. State representative
Lenny Winkler, who introduced the bill which became law,
said its purpose is to make sure that the first mention
of a drug for a child comes from a doctor, not a teacher
or principal. School medical personnel may recommend that
a child be evaluated by an appropriate medical practitioner,
and the school, with the consent of the parents, may consult
with the medical practitioner about the child. The text
of the Connecticut law is available from the offices of
Representative Winkler at Phyllis.Brett@po.state.ct.us.
The following publications and reports were cited in News
Alerts on this website during July: America’s Children: Key National Indicators of Well-Being, fifth annual report by the federal government on the health and well-being of U.S. children, is available at http://www.childstats.gov/ac2001/toc.asp. Guidance materials from the Department of Health and Human Services to help providers comply with new medical privacy regulations are available at www.hhs.gov/ocr/hipaa. A fact sheet summarizing the privacy rules is posted at www.hhs.gov/news/press/2001pres/01fsprivacy.html. The section of the guidance materials dealing with parents and children is at http://www.hhs.gov/ocr/hipaa/minors.html. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposure to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis are available at www.cdc.gov/mmwr. Adobe Acrobat Reader is required. Substance Abuse Prevention: What Works and What Doesn’t, published in the current issue of Advance, newsletter of the Robert Wood Johnson Foundation, is available at http://www.rwjf.org/app/rw_publications_and_links/rw_pub_advance.jsp.
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