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The Right Start: Casey Foundation, Child Trends Report on Birth Risks A special Kids Count report from the Annie E. Casey Foundation and Child Trends pulls together statistical data on births in the United States from 1990 to 1998, with special emphasis on large urban centers, where outcomes for children are generally more problematic than those for children living in other areas of the country, according to the report. "Conditions at birth often reflect the forces that will shape a young person's life," the report notes. Drawing their data from birth certificates, researchers compiled risks faced by newborns, including lack of timely prenatal care; whether mothers smoked during pregnancy; birthweight and gestation period; and the marital status, age, and education of the mother. Overall, the report cites progress in some areas during the decade--more mothers are getting prenatal care, fewer report smoking during pregnancy, and there have been slight reductions in the percentage of teen births to mothers who have borne a child earlier in adolescence. The United States lost ground, however, on three other measures--the percentage of births that were low-birthweight; the percentage of babies that were born preterm; and the percentage of total births to unmarried women. Though the focus of the report, "The Right Start," is on births in the nation's largest cities, it also reports state trends in the decade 1990-1998. Teen Births When the researchers examined teen births in the nation's 50 largest cities, they found 15 percent of births overall were to teenagers. Some cities did much better than the average; the report cites seven cities in particular--Honolulu; New York City; Seattle; Virginia Beach; and San Diego, San Francisco, and San Jose in California--where fewer than 10 percent of total births were to teens in 1998, lower than both the 50-city average and the national average of 13 percent. On the other hand, in six cities--Baltimore, Cleveland, Memphis, Milwaukee, New Orleans, and St. Louis--births to teens accounted for more than 20 percent of total births in 1998. "Children born to teenagers face multiple risks, including risks of poverty, poor school performance, and school failure," the report points out. In one of its most breathtaking compilations, the report notes that
in the United States in 1998, 32.8 percent of all births were to unmarried
women. And in some states the percentages were much higher--in the District
of Columbia, for example, 62.9 percent of all births in 1998 were to
unmarried women.
Reprinted
with permission from "The Right Start: Conditions of Babies and Their
Families" ------------------------------------------------------------- Regs on Hold, HHS Sets SCHIP Funding, Grants Waivers Two hundred pages of detailed regulations for the State Children's Health Insurance Program (SCHIP) are on hold to give the Bush administration time to review them. The regs, published January 11, just before the Clinton administration left office, were scheduled to go into effect April 11, but Secretary of Health and Human Services Tommy Thompson announced February 26 that the effective date has been delayed to June 11. The regs spell out what states must include in their proposed insurance plans when they apply for SCHIP funds, including coverage and benefits, eligibility and enrollment, enrollee's financial responsibility, and applicant and enrollee protections. Funds Available The SCHIP law passed by Congress and signed by President Clinton in 1997 called for an appropriation of $24 billion over five years as the federal contribution to help states expand health coverage to children whose families earn too much for traditional Medicaid but not enough to afford private health insurance. Federal funding is based on a formula set out in the law that takes into account the number of poor and uninsured children in a state, plus cost factors sucha as average annual wages in the health care industry in the state. Of the $4,204,312,500 allocated for SCHIP this year by Congress, states will receive amounts ranging from 17 percent of that total (California) to less than 1 percent (North and South Dakota and Wyoming). Waivers Calling SCHIP "one of the proudest achievements of the Clinton administration," former U.S. Secretary of Health and Human Services Donna Shalala announced the waivers just before she left office in January. Last summer, HHS issued guidance for states to apply for waivers that would allow them to extend SCHIP coverage to parents of eligible children. HHS noted at the time that the funding available to SCHIP isn't enough to cover all potentially eligible adults, but the department said it would welcome demonstration proposals such as those submitted by New Jersey, Rhode Island, and Wisconsin. How the waiver option will fare in the current administration is not known, though it's pointed out that Secretary of Health and Human Services Tommy Thompson is the former governor of one of the waiver states, Wisconsin. Three Million and Counting Concerned that this is a long way from the number of children who are eligible for SCHIP but not enrolled, the American Academy of Pediatrics is teaming up with Wal-Mart and the Pampers Parenting Institute to provide state-based health insurance information to shoppers in Wal-Mart stores nationwide during the month of March, in a program called "Babies First." Noting that more than 10 million parents with babies and toddlers shop at Wal-Mart stores weekly, AAP president Dr. Steve Berman called the Wal-Mart-Pampers partnership "a unique opportunity to reach out to families to get eligible children insured now." According to AAP projections, there will be 9.5 million U.S. children younger than age 19 uninsured in 2001. Of the 6.4 million of these eligible for state insurance, 1.4 million will qualify for SCHIP and 5 million will be Medicaid-eligible, the AAP estimates. ----------------------------------------------------------------- Is Child Health on Your State Legislature's Agenda? Forty-one state legislatures are currently meeting to conduct year 2001 legislative business, some for a few weeks and others for several months. That's in addition to eight states--Illinois, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, and Wisconsin--where the legislature meets year-round. According to the National Conference of State Legislatures, health care reform and efforts to insure more of their uninsured populations are among the issues weighing on state legislators' minds this year. Also, a number of legislatures will be making decisions about how proceeds of a tobacco settlement are to be spent. One state legislature--Virginia--has already adjourned, after a six-week session in which legislators disagreed with the governor on a budget for the current fiscal year, including appropriations for health. The legislature defeated a proposal that would have allowed druggists to dispense morning-after contraceptive pills without a doctor's prescription; the measure foundered when negotiators couldn't reach agreement on whether women younger than 18 should have to get parental consent before receiving the drug. Virginia law already requires that a parent be notified when a minor seeks abortion. As other state legislatures wrap up their sessions, Health and Health Care in Schools would like to hear how child health proposals fared in your states. We can be reached at robinsoneditor@attglobal.net or www.healthinschools.org.
Here are some of the health issues:
For more information or to request a copy of the "2001 NACA Member
Legislative Reference Guide," contact the National Association of Child
Advocates at www.childadvocacy.org
FDA Now Requires Pediatric Testing of New Drugs Until this year, drugs that are widely prescribed for and used by children were never tested for their effects on children's developing brains and bodies. Children and adolescents were once routinely left out of pharmaceutical research, partly for ethical reasons and partly because the pediatric market for many drugs is small. But beginning in December last year, the Food and Drug Administration is requiring pharmaceutical companies to test on children any new medicine that is likely to be prescribed for children. That's almost all medicines, according to past history, since nothing prevents doctors from prescribing for children a drug that the FDA approved only for adults--so-called "off-label" use--and many doctors do so. The off-label option is what allows Ritalin, tested originally only on adults, and antidepressants like Prozac that were never tested on children, to be prescribed even for infants and preschoolers. The Issues For one thing, clinical trials of new drugs require participants to give "informed consent," meaning they understand what's involved in the experiment. How to obtain such consent from a child is an issue; usually it's the parent who decides for the child, though researchers say children as young as seven are able to understand and agree to a procedure. Explaining to a child can be time-consuming and requires knowledge of how children think and respond. Some studies pay children to enroll, with rewards like toy store gift certificates. When clinical trials involve placebos--harmless sugar water given to a control group of sick children while another group gets the drug, for example--the question arises of whether it's ethical to withhold treatment, even an experimental one, from a child. Some studies involve healthy children who could be exposed to risks--from a new vaccine, for example--without possible benefit. Some drug studies involve taking repeated blood samples, sometimes at one-hour intervals, but you can't draw a large amount of blood from a child in a short period of time without making the child hypotensive, points out Dr. Diane Murphy of the FDA, who is leading efforts to test medications in children. "We had to wait for the technology to get accurate results from small amounts of blood to monitor a drug's effect on the liver, kidneys, and white cells. Also, we are only now starting to pin down on the molecular, receptor, and developmental level how kids are different from adults." And children don't just put out their arms and say, "Take my blood," Murphy points out. "It takes two nurses, one to talk to the child while the other one is drawing the blood. And you have to turn it into a game". Pediatric Exclusivity In return for doing pediatric testing, the drug companies were allowed to ask for what's called "pediatric exclusivity"--an extra six months of patent protection and freedom from generic competition for all formulations of the drug, not just the one being tested. That's no small incentive for a company such as Eli Lilly, which recently got a six-months patent extension for its antidepressant Prozac, or Schering Plough, which has received pediatric exclusivity for Claritin, the allergy drug. The provision is set to expire next January, but drug companies are lobbying to retain it; the FDA estimates that over 10 years, pediatric exclusivity could cost consumers $13.9 billion in added drug costs--the difference between what companies can charge when their drugs are under patent protection and what a generic version would cost. ----------------------------------------------------------------- Violence against Student Cancels Teacher's 'Qualified Immunity' A gym teacher who grabbed a student by the throat, lifted him off the ground by his neck and dragged him across the gym to the bleachers, where he slammed the boy's forehead into a metal fuse box on the gym wall and punched him in the face, cannot claim the "qualified immunity" from being sued that usually protects teachers and other school personnel who exercise discretion in performing their duties, a federal appeals court ruled January 31. The actions of the gym teacher were "conscience-shocking" and served no legitimate government objectives, the U.S. Court of Appeals for the Second Circuit ruled. The court also found the teacher's supervisors, including the district superintendent and the school principal, had lost their "qualified immunity" by failing to curb the gym teacher's previous acts of violence. The case was Johnson v. Newburgh Enlarged School District. ----- Jury Holds School Responsible for E-Coli Outbreak A jury in Benton County, Washington, has held the Finley School District responsible for money damages following 10 cases of E-Coli food poisoning caused by tacos fed to children at school lunch. The 10 schoolchildren and a younger child who played with them came down with E-Coli infection; four children required blood transfusions and the two-year-old sustained permanent kidney damage. The 12-member jury agreed unanimously that contaminated and possibly undercooked meat in the tacos had caused the illnesses and that the school district was "100 percent at fault." The parents asked for a reported $9 million in damages. ------------------------------------------------------------- Grants Grants Will Implement Child Asthma Interventions The Centers for Disease Control and Prevention announced February 5 that it has awarded grants totaling $2.9 million to 23 sites to improve the health of innercity children with asthma. The funds will be used to implement a scientifically proven asthma prevention program tailored to the needs of individual families. Key element of the program is an "asthma counselor," a social worker who will work closely with families over an extended period of time to address problems related to the physical and emotional aspects of asthma. The asthma intervention grants have been made to: University of Alabama /Children's Health Systems, Birmingham El Rio Health Center, Tucson, AZ Children's Asthma Consortium, Long Beach, CA Florida Health Choice Network, Miami Cook County Hospital, Chicago, IL Johns Hopkins Medical Services Corporation, Baltimore, MD American Lung Association of Minnesota, St. Paul Jackson-Hinds Comprehensive Health Center, Jackson, MS Children's Mercy Hospital and Clinic, Kansas City, MO Saint Barnabas Health Care System, West Orange, NJ Albert Einstein College of Medicine, Yeshiva University, Bronx, NY WakeMed, Raleigh, NC Rainbow Babies and Children's Hospital, Cleveland, OH CareOregon, Multnomah County, OR Parkland Health and Hospital System, Dallas, TX University of Texas/Health Science Center, San Antonio Howard University, Washington, DC ------- Funds Available to Educate State Legislatures on Health Issues Nonprofit organizations with membership in all the states may apply for a federal grant to educate state legislatures about priority public health issues, including "social marketing of positive messages for HIV prevention and school health, teen pregnancy prevention, and meeting adolescent and/or school health goals." The grantee must also be able to update the 50-state School Health Programs Finance Project database, including both block grant funding and state legislative appropriations information. The Centers for Disease Control and Prevention announced in February that grant applications are due by March 28. For additional information, contact CDC's grants management specialist at coc9@cdc.gov or see the announcement in the Federal Register, February 1, 2001. -------------------------------------------------------------- Worth Noting School-Based Health Centers Continue Expansion The number of school-based health centers in the United States climbed to 1,380 in school year 1999-2000, a 20 percent increase over two years and nearly a seven-fold increase over the past decade, according to a survey conducted by the Center for Health and Health Care in Schools. The centers, which provide primary care and mental health services to children and teens, are now in 45 states plus the District of Columbia. Originally created to deal with the health problems of teenagers, 38 percent of SBHCs are now found in elementary schools. Information from the survey is posted on the Center for Health and Health Care in Schools website at www.healthinschools.org. ----- EPA Reports on Environmental Risks to Child Health In its first-ever assessment of environmental factors that affect the health of children, the federal Environmental Protection Agency reported slight decreases from 1990 to 1998 in the percentage of U.S. children who live in communities where levels of critical air pollutants--ground-level ozone, particulates, carbon monoxide, lead, sulfur dioxide, or nitrogen dioxide--exceed national clean air standards. Currently, the EPA said, 23 percent of children are exposed to one or more of those air pollutants; 19 percent breathe tobacco smoke in their homes; and 8 percent are at risk of unsafe drinking water. The report, "America's Children and the Environment: A First View of Available Measures," is available online at www.epa.gov/children/indicators. On a related issue, the Healthy Schools Network, which is concerned with environmental practices and conditions in school buildings, notes that New York State Governor George Pataki in a State of the State address in January called for implementation of "school facility report cards" covering such points as the age of school buildings and their systems, capacity, energy efficiency, pest management, and radon and lead testing. The Healthy Schools Network can be contacted at www.healthyschools.org. ----- NIH Updates HIV Treatment Guide for Adolescents An updated version of HIV treatment guidelines for adolescents and adults was posted February 5 on the National Institutes of Health's HIV/AIDS Treatment Information Service (ATIS) website. The new guidelines recommend starting antiretroviral therapy when an asymptomatic HIV-infected person's CD4+ T-cell count falls below 350 cells per cubic millimeter. The guidelines also include new drug-specific recommendations and stress the importance of adherence to therapy. The updated guidelines are available at www.hivatis.org in two formats, a typeset version (PDF) and a Web version (HTML). ----- Research Confirms Oral Ritalin Increases Dopamine Research reported in the January issue of the Journal of Neuroscience confirmed that Ritalin administered orally--the way most people take the medication--increases dopamine levels in the brain. Previous research has shown that methylphenidate administered intravenously increases dopamine levels, but this was the first time researchers had looked at oral administration. Though the research measured the effect of Ritalin in the brains of healthy adult males, researchers speculated it can help explain how Ritalin works in children with attention deficit hyperactivity disorder, since dopamine imbalance appears to be closely related to the symptoms of ADHD. The full text of the article, "Therapeutic Doses of Oral Methylphenidate Significantly Increase Extracellular Dopamine in the Human Brain," by Nora Volkow and others, is available at www.jneurosci.org. ----- Many Hospitals No Longer Vaccinate Newborns for Hep B After the American Academy of Pediatrics and the U.S. Public Health
Service in July 1999 recommended reducing infant exposure to thimerosal,
a commonly used vaccine preservative that contains mercury, many hospitals
stopped vaccinating newborns against hepatitis B, including infants
born to infected mothers. When a thimerosal-free HBV vaccine became
available later that year, many of the hospitals didn't resume vaccination,
according to a report by the Centers for Disease Control and Prevention,
which warns in an article published in the February 16 issue of Morbidity
and Mortality Weekly Report that this leaves many infants at risk
of life-threatening HBV infection. "Changes in established recommendations,
especially if they occur without timely communication and education
of health care providers, may result in misinterpretation and unanticipated
changes in vaccination practices," the CDC noted. |
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