“Thanks to decades of neuroscience research on brain development, adversity and toxic stress, we now understand how a child who is exposed to violence, or neglect, or homelessness at an early age may develop behavioral and physical health problems later in life,” said Jane Lowe, Senior Adviser for Program Development at the Robert Wood Johnson Foundation (RWJF). “We can now use this rapidly evolving knowledge to create real-world solutions.”

RWJF.org recently pulled together a collection of resources on “adverse childhood experiences”—how common they are and what they can mean for the adults those traumatized children become. The website includes an infographic that illustrates the subject:

NewPublicHealth has previously written about the importance of addressing and changing youth violence, so that these behaviors don’t become even more severe—and more damaging—while spreading from act to act and person to person. In a Q&A, Kristin Schubert, MPH and then-interim director of RWJF’s Public Health, spoke about the Foundation’s approach to the issue of violence prevention and strategies in the field that are working to create change.

“We know that the child who was abused is that much more likely to be a victim or perpetrator of bullying a few years down the line, and then is that much more likely to be a victim or perpetrator of dating violence a few years later in high school, and then is much more likely to be a part of more family violence later on. There’s no form of violence that stands alone,” she said. “It’s a multigenerational phenomenon that is passed down.

“This context is so essential—in considering why someone engages in violent behavior, it’s important to recognize that it’s not just the ‘bad apple,’ it’s not the person. It’s the behavior. As Gary Slutkin of CeaseFire says, ‘Violence is a learned behavior.’”

Schubert pointed to the Adverse Childhood Experiences Study, which found that the more “adverse” events a child faces in their youth—from maltreatment to neglect to abuse to witnessing violence—the more likely they are to have health problems later in life. That includes hypertension, diabetes and heart disease.

>>Read the full NewPublicHealth interview.

>>Read more about Adverse Childhood Experiences.

Every baby should have a chance to celebrate a healthy, happy first birthday. Unfortunately, that is not always the case. And that risk disproportionately affects people with lower income and people of color. This Infant Mortality Awareness Month, we can celebrate some progress in helping more babies reach that first milestone, according to health officials who shared successes at the Association of State and Territorial Health Officials (ASTHO) Annual Meeting in Orlando, Fla., this week.

>>Follow our ASTHO Annual Meeting coverage throughout the week.

“We are collectively moving forward in improving birth outcomes across the nation,” said David Lakey, MD, Commissioner of the Texas Department of State Health Services and former ASTHO president, who took on healthier babies as his President’s Challenge during his tenure. Lakey set out a goal of an 8 percent reduction in premature births by 2014.

“There is a high human cost of prematurity,” said Lakey, and that cost includes low birth weight, increased morbidity and mortality, and an impact on standardized test scores and other outcomes later in life for those who do survive. “Those who are born early have a much lower chance of having a healthy, happy first birthday.”

There is also an economic and societal cost of premature birth, the cost of which is largely paid for by Medicaid. Lakey said that 57 percent of all Texas births are paid for by Medicaid. Extreme preterm birth costs an average of $71,000—while a full-term birth costs an average of $420.

Despite decades of outreach around car seat safety, car crashes remain the number one cause of death for children under the age of 12, according to the U.S. National Highway and Traffic Safety Administration (NHTSA). The numbers from the U.S. Centers for Disease Control and Prevention (CDC) are also stark and troubling: more than 1,200 U.S. children ages 14 years and younger died in motor vehicle crashes in 2010, and approximately 171,000 were injured.

What makes these statistics even more tragic is the fact that many of these deaths and injuries are preventable by following these simple edicts—put kids in the right seat and use it the right way. In fact, NHTSA has identified child seat safety restraints as the most effective way to protect young children in motor vehicle crashes.

Child safety seats reduce the risk of death in passenger cars by 71 percent for infants and by 54 percent for kids ages 1 to 4, according to the CDC. For children ages 4 to 8, booster seats cut the risk of serious injury by 45 percent.

This week is Child Passenger Safety Week. It also marks the launch of the new BuckleUpForLife.org, Cincinnati Children’s and Toyota’s community-based safety program designed to educate families on critical safety behaviors and provide child car seats to families in need.

The website features the “Making Safety a Snap” online tool—a series of quick questions and videos that demonstrate exactly how parents and caregivers can make sure their child has the right safety seat and is using it properly.

You can follow a live Buckle Up for Life Twitter Q&A starting at 2 p.m. today. Use the hashtag #BuckleUpforLife to join the discussion and have your child car seats questions answered by their experts.

U.S. Youth Exercise, Diet Improved Over Past Decade
Exercise and dietary habits of U.S. kids and teenagers seems to have improved over the past decade, according to a new study in the journal Pediatrics. The study found that from 2001-2002 to 2009-2010, the average number of days per week being physically active for at least 60 minutes for sixth through tenth graders climbed from 4.3 to 4.5; the days eating breakfast before school climbed from 3 to 3.3; and hours per day watching television dropped from 3.1 to 2.4. The findings suggest that it takes time for public health efforts to translate into behavioral changes. "I would like to believe that all the public health efforts focusing on increasing physical activity and increasing fruit and vegetable consumption are having an effect, because that seems to be a pattern," said Ronald Iannotti, study author from the University of Massachusetts Boston. "The fact that (obesity) is leveling off, that's a surprise and a major change from the steady increase that we've seen over time.” Read more on pediatrics.

Study: Kids of Same-sex Couples Less Likely to Have Private Health Insurance
Children of same-sex parents are less likely to have private health insurance, although the rates improve in states that recognize same-sex marriages or unions, according to a new study in the journal Pediatrics. Approximately two-thirds of U.S. youth with same-sex parents have private health insurance, compared to approximately 78 percent of U.S. youth with married heterosexual parents. When accounting for additional factors such as parental incomes and education level, researchers determined that youth living with same-sex parents were as much as 45 percent less likely to have private health insurance than were youth living with married heterosexual parents. The findings indicate yet another public health benefit of same-sex marriage, as access to health insurance directly affects a child’s health; previous studies have shown a connection between legal unions and improved mental health for gay and lesbian adults. A likely cause for the disparity is the fact that employers have not had to extend coverage to an employee’s same-sex partner or that employee’s children. "I think we are going to see more and more research like this that shows how marriage-equality laws have far-reaching health consequences," said Richard Wight, a researcher at the University of California, Los Angeles, who was not a part of the study. Read more on LGBT issues.

HHS: $67M for Expanded Preventive and Primary Care for 130,000 Americans
The U.S. Department of Health and Human Services (HHS) has awarded approximately $67 million for the creation of 32 new health service delivery sites to expand access to individuals, families and communities across the country. The sites will provide improved preventive and primary health care to more than 130,000 people. Another $48 million will go toward the approximately 1,200 existing centers. “Health centers have a proven track record of success in providing high quality health care to those who need it most,” said HHS Secretary Kathleen Sebelius. “New health center sites in some of the neediest communities in the country will provide access to health care for individuals and families who otherwise may have lacked access to high quality, affordable and comprehensive primary care services.” Read more on access to health care.

‘Hyper-vigilance’ Over Racial Disparities May Be a Factor in Higher Hypertension Rates for Black Americans
“Hyper-vigilance” related to race consciousness may be a factor in why black Americans have a disproportionately high rate of hypertension, according to a new study in the American Journal of Hypertension from researchers at the Johns Hopkins University School of Medicine. While it’s long been known that blacks have, on average, higher blood pressure, the exact environmental factors that contribute to the higher rates are not fully understood, according to Lisa A. Cooper, MD, MPH, a professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine and the study’s senior author. “Hyper-vigilance [is] a heightened awareness of their stigmatized status in society and a feeling that they need to watch their backs constantly,” she said. “African-Americans have higher blood pressure, and it has been difficult to explain why this is true. It doesn’t appear to be genetic, and while things like diet, exercise and reduced access to health care may contribute, we think that a tense social environment, the sense of being treated differently because of your race, could also possibly explain some of what’s behind the higher rates.” Read more on health disparities.

Survey: Most Women Don’t Know their Personal Breast Cancer Risk
A new survey of more than 9,000 women shows that far too few have an accurate idea of their personal risk of developing breast cancer in their lifetime. Study researcher Jonathan Herman, MD, an obstetrician and gynecologist at Hofstra North Shore-LIJ Medical School in New Hyde Park, N.Y., found that only 9.4 percent knew their risk level, nearly 45 percent underestimated their level and nearly 46 percent overestimated their level. The survey also found that about four in 10 women had never even discussed their personal breast cancer risk with a physician. On average, women have a 12 percent lifetime risk of breast cancer, with that number climbing 20 percent if their mother had breast cancer. The BRCA mutations that increase breast cancer risk push the risk to about 70 percent. Mary Daly, MD, chair of clinical genetics at Fox Chase Cancer Center, in Philadelphia, and director of its risk assessment program, said it is critical that women researcher their family history related to breast cancer in order to determine whether they are following the best possible screening schedule. Read more on cancer.

Harsh Verbal Discipline of Teens Only Makes Behavior Worse
Harsh verbal discipline of teenagers not only isn’t effective at changing bad behaviors, but can in fact make them worse, according to a new study in the journal Child Development. "Most parents who yell at their adolescent children wouldn't dream of physically punishing their teens," said study author Ming-Te Wang, an assistant professor with the department of psychology at the University of Pittsburgh School of Education. "Yet, their use of harsh verbal discipline—defined as shouting, cursing or using insults—is just as detrimental to the long-term well-being of adolescents.” A recent survey indicates that about nine in 10 parents have admitted to such behavior. The study found that the emotional pain and discomfort cause by harsh parental verbal abuse can increase anger while dropping inhibition, which in turn can promote behaviors such as lying, cheating, stealing and fighting. It also found that the concept of “parental warmth”—as in a parent was yelling out of love or for the child’s own good—didn’t make things any better. "Parents who wish to modify their teenage children's behavior would do better by communicating with them on an equal level…and explaining their rationale and worries to them,” said Wang. “Parenting programs are in a good position to offer parents insight into how behaviors they may feel the need to resort to, such as shouting or yelling, are ineffective and or harmful, and to offer alternatives to such behaviors." Read more on pediatrics.

CDC: U.S. School Districts Seeing Improvements in Multiple Health Policies
U.S. school districts are seeing continued improvements in measures related to nutritional policies, physical education and tobacco policies, according to the U.S. Centers for Disease Control and Prevention (CDC). The findings are part of the 2012 School Health Policies and Practices Study, a periodic national survey assessing school health policies and practices at the state, district, school, and classroom levels. "Schools play a critical role in the health and well-being of our youth," said CDC Director Tom Frieden, MD, MPH. "Good news for students and parents – more students have access to healthy food, better physical fitness activities through initiatives such as ‘Let’s Move,’ and campuses that are completely tobacco free."

Among the key findings:

• The percentage of school districts that allowed soft drink companies to advertise soft drinks on school grounds decreased from 46.6 percent in 2006 to 33.5 percent in 2012.
• Between 2006 and 2012, the percentage of districts that required schools to prohibit junk food in vending machines increased from 29.8 percent to 43.4 percent.
• The percentage of school districts that required elementary schools to teach physical education increased from 82.6 percent in 2000 to 93.6 percent in 2012.
• The percentage of districts with policies that prohibited all tobacco use during any school-related activity increased from 46.7 percent in 2000 to 67.5 percent in 2012.

Read more on school health.

Poor Oral Health Linked to Increased Risk for Oral HPV Infection
Poor oral health is associated with increased risk of the oral human papillomavirus (HPV) infection responsible for as many as 80 percent of oropharyngeal cancers, according to a new study in the journal Cancer Prevention Research. Researchers found that people who reported poor oral health had a 56 percent higher prevalence oral HPV, people with gum disease had a 51 percent higher prevalence and people with dental problems had a 28 percent higher prevalence. “The good news is, this risk factor is modifiable—by maintaining good oral hygiene and good oral health, one can prevent HPV infection and subsequent HPV-related cancers.” said Thanh Cong Bui, MD, postdoctoral research fellow at the University of Texas School of Public Health. Other factors also increased the risk, such as being male, smoking tobacco or using marijuana. Read more on cancer.

Study: Hospital Pediatric Readmission Rates Not an Effective Measure of Quality of Care
Hospital readmission rates for children are not necessarily an effective measurement of the quality of care, according to a new study in the journal Pediatrics. "As a national way of assessing and tracking hospital quality, pediatric readmissions and revisits, at least for specific diagnoses, are not useful to families trying to find a good hospital, nor to the hospitals trying to improve their pediatric care," study author Naomi Bardach, MD, an assistant professor of pediatrics at the University of California, San Francisco, Benioff Children's Hospital. "Measuring and reporting them publicly would waste limited hospital and health care resources." After analyzing 30- and 60-day readmission rates for seven common pediatric conditions, researchers found that at 30 days readmission for mood disorders was most common, at 7.6 percent, followed by 6.1 percent for epilepsy and 6 percent for dehydration. Readmission rates for asthma, pneumonia, appendicitis and skin infections were all below 5 percent. Bardach said the low rates leave “little space for a hospital to be identified as having better performance.” Further study could improve the way readmission rates are utilized to assess the quality of pediatric care. Read more on pediatrics.

Preschoolers’ Stuttering Does Not Hurt Social, Emotional Development
Stuttering is a common issue and does not negatively impact the social and emotional development of preschoolers, according to a new study in the journal Pediatrics. Sheena Reilly, associate director of clinical and public health research at Murdoch Children’s Research Institute in Australia and the study's lead author, called the study’s conclusion that stuttering or stammering did not serve to make kids more withdrawn a “very positive finding” and said that parents "can be reassured that developmental stuttering is not associated with a range of poorer outcomes in the preschool years." Researchers found that the rate of kids stuttering by age four was 11 percent and the recovery rate from stuttering after 12 months was 6.3 percent. The former was higher than previous studies have indicated and the latter was lower than the researchers expected; Reilly said further research into recovery is needed. The study also found that children who stutter had higher verbal and non-verbal scores. Read more on pediatrics.

NIH: Parents Fully Informed on Blood Transfusion Trial on Premature Infants
The U.S. National Institutes of Health (NIH) late last week responded to an advocacy group’s call for the end of a government study of blood transfusion levels in premature infants with firm insistence that parents are given complete and accurate information about the risks. The organization, Public Citizen, contends that the study exposes the infants to risks without giving parents full information and should be stopped. Under the study, half of the children will receive transfusions at a high hemoglobin level and half at a low level; according to Public Citizen, a restrictive approach risks serious complications such as neurological injury. As reported by Reuters, "The NIH said it is committed to ensuring that prospective research participants — and the people who speak for and love them — are given clear complete, and accurate information about the risks and benefits of participating in research." Public Citizen earlier called for a closer look at a previous NIH study on the effectiveness of different levels of oxygen in the treatment of premature infants. Read more on research.

Report: Most Medications Safe to Take While Breastfeeding
Most medications taken by breastfeeding moms will have no harmful impact on nursing infants, according to a new report from the American Academy of Pediatrics in consultation with the U.S. Food and Drug Administration (FDA). The study appears in the journal Pediatrics. "Because we know that breast-feeding has both developmental and health benefits for the mom and the baby, we are encouraging research in this area so physicians can make informed decisions about how best to treat their patients," said study author Hari Cheryl Sachs, MD, a pediatrician and leader of the pediatric and maternal health team within the FDA's Center for Drug Evaluation and Research. FDA is proposing new regulations that would replace “Nursing Mothers” sections on drug labels with a “Lactation” section that would provide more detailed information about potential effects on a nursing infant. Most drugs currently carry a blank legal statement warning against any use by breastfeeding mothers. "The general takeaway message—that most drugs are compatible with breast-feeding, that mothers don't have to wean to take drugs and that the labels should accurately reflect the science—is really great news and progress for breast-feeding mothers," said Diana West, a lactation consultant and spokesperson for La Leche League International. Read more on maternal and infant health.

Chemicals in Plastic Food Containers Could be Adding to Childhood Obesity Problem
Unhealthy foods kept in plastic food wraps and containers may be even more unhealthy for kids because of the chemicals in the plastic, according to two new studies in the journal Pediatrics. The studies linked phthalates to increased insulin resistance in children and bisphenol A (BPA) with high body-mass index (BMI). Leonardo Trasande, MD, an associate professor of pediatrics and environmental medicine at the NYU School of Medicine and author of the phthalates study, said certain chemicals can affect how the body reacts to glucose influence the release of insulin. "There is increasing concern that environmental chemicals might be independent contributors to childhood diseases related to the obesity epidemic," he said. "Our research adds to these growing concerns." He recommends against using certain types of plastic containers and against microwaving any plastic containers. He also says parents should wash plastic containers by hand instead of putting them in the dishwasher, and should throw them out when they’ve been damaged. Hugh Taylor, MD, chair of the Yale School of Medicine's department of obstetrics, gynecology and reproductive sciences, said that while the two studies "point out the vulnerability of children to environmental chemicals,” parents should also be working to move their kids’ diets to healthier and natural food. Read more on obesity.

CDC: As Many as 300,000 Infected with Lyme Disease Annually
The actual number of U.S. cases of Lyme disease is as much as ten times higher than the reported figure, according to the U.S. Centers for Disease Control and Prevention (CDC). Three ongoing CDC studies put the number of cases of the tick-borne illness at around 300,000 annually. This major difference between reported and actual cases emphasizes the need for greater and more diverse prevention efforts. Traditional preventive measures at the personal level include wearing repellent, checking for ticks daily, showering soon after being outdoors and alerting a doctor if you get a fever or rash. “We know people can prevent tick bites through steps like using repellents and tick checks. Although these measures are effective, they aren’t fail-proof and people don’t always use them,” said Lyle R. Petersen, MD, MPH, director of CDC’s Division of Vector-Borne Diseases. “We need to move to a broader approach to tick reduction, involving entire communities, to combat this public health problem.” Read more on infectious disease.

Study Links Kids’ Trouble Sleeping, Poor School Performance
Trouble sleeping is tied to trouble in the classroom for kids, according to a new study in the journal Sleep Medicine. Researchers analyzed kids age seven to 10 in Sao Paulo, Brazil schools, finding that 13 percent with difficulty sleeping were failing Portuguese, compared to 9 percent for kids who did not have sleep problems. They also found that 25 percent of kids with trouble sleeping were failing math, compared to eight percent for kids who have no trouble sleeping. U.S. experts estimate that approximately 25 percent of U.S. kids have trouble sleeping, either due to sleep disorders such as insomnia and nightmares, or from other factors such as erratic bedtime hours and anxiety. While noting that the study was "far from perfect," Carl Bazil, MD, a neurologist and director of the division of epilepsy and sleep at New York Presbyterian/Columbia University Medical Center in New York City, said “It's a first step in emphasizing that sleep in children is something that's important, not only to prevent them from being sleepy but to make sure that they learn. I think this study will help raise awareness that sleep is particularly important in children." Read more on pediatrics.

The following post originally appeared on the Harvard Law School blog, Bill of Health, launched in September 2012 by Harvard's Petrie-Flom Center. The blog explores news, commentary, and scholarship in the fields of health law policy, biotechnology, and bioethics. This post examines the policies that impact proper use of child car seats and booster seats.

Author Kathleen West is an intern with the Public Health Law Research program. Her summer work has included researching and creating a comprehensive dataset on child restraint systems across the United States using LawAtlas, a gateway database to key laws aimed at improving our health or access to health care. Read more on LawAtlas.

As the world watched Prince William place the new royal baby, reluctantly snug in his car seat, into a vehicle a few weeks ago, my thoughts were not limited to, “Oh, how cute!” After two months researching and collecting a dataset to capture the U.S. laws and regulations for child passenger restraint systems, I also thought, “I wonder if he took a class and knows how to do that correctly?” Perhaps an odd thought, but misuse and faulty installation of child restraint systems is actually a major concern.

According to the CDC, proper restraint use can reduce the risk of death or injury by more than 50 percent. Yet, ongoing studies by the National Highway Traffic Safety Administration (NHTSA) are finding that as many as 20 percent of drivers with child passengers are not reading any of the instructions regarding proper installation, while 90 percent of drivers of child passengers are reporting that they are confident that they are properly installing and using child restraint systems.

Kids’ Chronic Stomach Pain Could Be Sign of Anxiety Disorder
Kids with chronic stomach pain without a clear medical explanation— such as inflammatory bowel disease or celiac disorder—are more likely to suffer from an anxiety disorder, according to a new study in the journal Pediatrics. Previous research indicates as many as one in four youth have what is known as functional abdominal pain. Lynn Walker, from the Vanderbilt University School of Medicine in Nashville, Tenn., and researchers found that about 51 percent of people with stomach pain as children had experienced an anxiety disorder and 30 percent at the present met the diagnostic criteria for a diagnosis; only 20 percent of people without stomach pain had experienced an anxiety disorder and 12 percent currently had one. In addition to helping identify present and later anxiety disorders, knowing and treating the issue is also critical for kids because of how the chronic pain can impact their lives and education. "It's very prevalent, and it's one of the most common reasons that children and adolescents end up in their pediatrician's office. It's one of the most common reasons kids are missing school," said Eva Szigethy, MD, head of the Medical Coping Clinic at the Children's Hospital of Pittsburgh Inflammatory Bowel Disease Center. Read more on pediatrics.

Study: Genetic Overlap in Common Mental Disorders
A shared, common inherited genetic variation was seen in an analysis of five major mental disorders, which could ultimately help improve the classification and treatment of the disorders, according to a new study in the journal Nature Genetics. The greatest overlap was between schizophrenia and bipolar disorder with about 15 percent, followed by bipolar disorder and depression with about 10 percent; attention-deficit/hyperactivity disorder and depression with about 10 percent; and schizophrenia and autism with about 3 percent. Researchers noted that as they only looked at common gene variants, the actually genetic overlap could be much greater. "Such evidence quantifying shared genetic risk factors among traditional psychiatric diagnoses will help us move toward classification that will be more faithful to nature," said Bruce Cuthbert, director of the U.S. National Institute of Mental Health's (NIMH) adult translational research and treatment development division, as well as coordinator of an NIMH project to develop a mental disorders classification system for research based more on underlying causes. Read more on mental health.

FDA: Nationwide Voluntary Recall of Drug to Treat Low Calcium
The U.S. Food and Drug Administration has announced a nationwide voluntary recall of all products for sterile use manufactured by Specialty Compounding, LLC, of Cedar Park, Texas, related to possible bacterial bloodstream infections due to calcium gluconate infusions. The drug, which is used to treat low calcium levels, has been linked to 15 infections in two Texas hospitals. Facilities, health care providers and patients who have received the products after May9 should immediately quarantine them and return them to the manufacturer. The products were shipped to patients, hospitals and physicians’ offices, depending on the area of the country. “The FDA believes that use of these products would create an unacceptable risk for patients," said Janet Woodcock, M.D., director of FDA’s Center for Drug Evaluation and Research. "Giving a patient a contaminated injectable drug could result in a life-threatening infection.” Read more on infectious disease.