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Earlier this week the American Academy of Pediatrics (AAP) hosted a daylong Symposium on Child Health, Resilience & Toxic Stress in Washington, D.C. that brought together federal government officials, national thought leaders and medical professionals to discuss the emerging science of toxic stress.
According to the AAP, science shows that adversity experienced in childhood has long-lasting physical and emotional effects that have come be known as "toxic stress.” Toxic stress can occur when a child experiences chronic adversity without access to stable, supportive relationships with caring adults. These adverse childhood experiences can include physical and emotional abuse; neglect; exposure to violence; food insecurity; and economic hardship. An AAP 2011 policy statement found that toxic stress can affect a child's brain development and lead to the presence of many adult diseases, including heart disease, cancer, chronic lung disease and liver disease.
“[Currently], there are more randomized trials for leukemia than for effects of stress on children,” said James S. Marks, MD, MPH, senior vice president of the Robert Wood Johnson Foundation, at the symposium. “This is about more than our children—it’s about our future as a people and a society, and the earlier you invest in children the better the return to society and to those children and families.”
During the symposium, the AAP announced the formation of the Center on Healthy, Resilient Children to launch in the next year or so, which will be a national effort coordinated by the AAP and many partners to support healthy brain development and prevent toxic stress. In addition to prevention efforts to keep children healthy, the Center will focus on ways to help pediatricians and others identify children who have experienced adversity and toxic stress and ensure they have access to appropriate interventions and supports.
"Pediatricians envision a world in which every child has every opportunity to become a healthy, successful adult," said James M. Perrin, MD, president of the AAP. "Achieving this will require strong, sustained investments in the health of the whole child, brain and body. It will require building upon our existing work and forging new partnerships across sectors and fields of expertise.”
NewPublicHealth spoke with Perrin following the symposium
NewPublicHealth: How familiar are pediatricians with the evidence surrounding the burden and response to toxic stress in children and families?
James Perrin: I think there is increasing awareness of toxic stress in pediatric practice, not only in community practice, but in our specialty practices, too. I think people are recognizing how critically important toxic stress is to the developing child and developing brain. And the increasing science in this area has been incredibly helpful for us to understand the potential permanent effects of toxic stress. But we also want to focus on positive ways to affect brain development. Reading to children, for example, affects brain development and brain growth in positive ways.
“At 10 a.m. on any given morning, the kids at low-income San Francisco schools are starting to fidget. Their teachers report they’re having trouble concentrating, asking how long ‘til they eat...Then the snacks arrive, delivered by volunteers from the San Francisco-Marin Food Bank. They serve string cheese one week; baby carrots, mandarin oranges or apple slices the next.”
Because of this and other programs, Marin County, Calif. tops the U.S. News & World Report’s new rankings of “America’s 50 Healthiest Counties for Kids,” part of its annual guide on the nation’s Best Children’s Hospitals. The new rankings, for children 18 and younger, are calculated in cooperation with the University of Wisconsin Population Health Institute, which also evaluates health data for the U.S. population as part of its County Health Rankings & Roadmaps program, a collaboration with the Robert Wood Johnson Foundation (RWJF).
The rankings analyze U.S. counties according to several key measures, including:
- Infant deaths
- Low birth weight babies
- Deaths from injuries
- Teen births
- Children in poverty
- Percentage of children without health insurance
- Air quality in most states
- Rates of adult smoking and adult obesity
- Access to physicians
- Exercise opportunities
In addition to the rankings, the U.S. News story also highlights six communities that have made significant advancements toward improving the health of their kids, including:
- Santa Clara, Calif., where a policy stipulates that 50 percent of food and beverages sold in countywide vending machines must meet nutrition guidelines.
- Washington County, R.I., where the policy organization Kids Count is dedicated to improving children’s health, education, economic well-being and safety.
- Middlesex County, Mass., which includes the city of Cambridge—one of RWJF’s Culture of Health Prize winners last year—and where fun physical education classes keep kids active while healthy school meals celebrate cultural diversity.
Read the full story, “America's 50 Healthiest Counties for Kids.”
Overly Clean Homes Can Increase Child’s Risk of Asthma, Allergies
Living in an overly clean home can actually increase an infant’s risk of developing allergies or asthma as they grow older, as their bodies are not given the chance to develop appropriate responses, according to a new study in the Journal of Allergy and Clinical Immunology. The researchers behind the study were surprised by the results, as they had been looking deeper into data that found that exposure to roach, mouse and pet droppings and other allergens increased asthma risk. "What we found was somewhat surprising and somewhat contradictory to our original predictions," said study co-author Robert Wood, MD, chief of the Division of Allergy and Immunology at the Johns Hopkins Children's Center in Baltimore, according to HealthDay. "It turned out to be completely opposite—the more of those three allergens you were exposed to, the less likely you were to go on to have wheezing or allergy." Approximately 40 percent of the allergy- and wheeze-free children in the study were raised in homes with high amounts of allergens and bacteria, while only 8 percent who suffered from both conditions had been exposed to allergens and bacteria while infants. Read more on pediatrics.
Study: Prenatal Medicaid Policy Reduces Smoking, But Doesn’t Improve Preterm Birthweights
While a Medicaid policy that fast-tracks applications of pregnant women helps reduce smoking during pregnancy, it has no significant effect on improving preterm birth rates or low birth weights, according to a new study in the journal Health Affairs. The study specifically looked at Medicaid’s presumptive eligibility and unborn-child option, which provides coverage for prenatal care. “Although the prevalence of prenatal smoking in the United States has declined in recent decades, it is nearly twice as high among low-income women enrolled in Medicaid than it is in the U.S. population as a whole,” said Marian Jarlenski, PhD, lead author of the paper. “Our research shows that Medicaid’s presumptive eligibility policy led to a nearly 8 percentage-point decrease in smoking during pregnancy, but neither policy significantly improved rates of preterm birth or babies born small for their gestational age.” Read more on maternal and infant health.
CDC: Watercress Tops ‘Powerhouse’ Fruits and Vegetables List
With a “nutrient density score” or 100.00, watercress tops the U.S. Centers for Disease Control and Prevention’s (CDC) new list of “powerhouse” fruits and vegetables. The list of 41 foods was created as a tool for nutrition education and dietary guidance. The study defined “powerhouse” as foods most strongly associated with reduced chronic disease risk, which are often green leafy, yellow/orange, citrus and cruciferous items. Chinese cabbage, chard, beet green and spinach rounded out the top five. The full list is available here. Read more on nutrition.
Application Problems Mean 2.2M People Risk Losing ACA Coverage
Inconsistencies in their application data means that approximately 2.2 million people who enrolled for coverage under the Affordable Care Act could risk losing their coverage in isolated cases. A report from the U.S. Centers for Medicare and Medicaid Services (CMS) found that 1.2 million people filed health insurance enrollment applications with questionable income data, 461,000 had issues with citizenship and another 505,000 had issues with immigration. However, CMS also noted that 59 percent of the applications were within a 90-day window allowing them to resolve the problems. “Consumers experience regular changes in income and various life circumstances and the law accounts for these kinds of situations," said CMS, according to Reuters. "It is not surprising that there are income discrepancies given that this is a brand new process." As of mid-April more than 8 million people had enrolled for health coverage. Read more on the Affordable Care Act.
Study: Skipping Breakfast Doesn’t Hurt Efforts to Lose Weight
Common wisdom holds that people who skip breakfast actually increase their risk of obesity. However, a new study in the American Journal of Clinical Nutrition found that passing up on the first meal of the day neither helps nor hurts a person’s efforts to lose weight. The study involved 309 overweight and obese adults between the ages of 20 and 65—who were told to either eat or skip breakfast—and a control group provided with health nutrition information. Researchers found no difference when it came to efforts to lose weight. "The field of obesity and weight loss is full of commonly held beliefs that have not been subjected to rigorous testing; we have now found that one such belief does not seem to hold up when tested," senior investigator David Allison, director of the UAB Nutrition Obesity Research Center, said in a university news release. "This should be a wake-up call for all of us to always ask for evidence about the recommendations we hear so widely offered." Read more on obesity.
HHS: $300M Available to Expand Services at Community Health Centers
An additional $300 million in funding is available to community health centers as part of the Affordable Care Act, U.S. Health and Human Services Secretary Kathleen Sebelius announced this week. The funds will go toward expanding service hours and the hiring of more medical providers, as well as the expansion or addition of oral health, behavioral health, pharmacy and vision services. There are approximately 1,300 health centers operating more than 9,000 service delivery sites and providing care for more than 21 million U.S. patients. Read more on community health.
FDA Initiative Gives Developers Easy Access to Public Health Data
A new online initiative from the U.S. Food and Drug Administration (FDA), openFDA, will give mobile application creators, web developers, data visualization artists and researchers access to the agency’s vast public health datasets in order to streamline the creation of their own applications. The structured, computer-readable format allows researchers to determine what types of data they want to search and how they want to present that data to end-users. “The openFDA initiative leverages new technologies and methods to unlock the tremendous public data and resources available from the FDA in a user-friendly way,” said Walter S. Harris, the FDA’s chief operating officer and acting chief information officer. “OpenFDA is a valuable resource that will help those in the private and public sectors use FDA public data to spur innovation, advance academic research, educate the public, and protect public health.” Read more on technology.
Study: 24 Million U.S. Youth Exposed to E-cigarette Advertisements
Unlike with traditional cigarettes, the U.S. Food and Drug Administration (FDA) does not regulate the marketing of e-cigarettes unless they are advertised as a smoking cessation aid. As a result, e-cigarette companies currently market their products to an audience that includes 24 million youth, according to a new study in the journal Pediatrics. Researchers determined that, from 2011 to 2013, youth exposure to e-cigarette advertisements climbed 256 percent and young adult exposure climbed 321 percent. They also determined that approximately 76 percent of the youth exposure came from advertisements on cable networks. Read more on tobacco.
Study: Global Investment in Midwives Needed to Save the Lives of Mothers, Newborns
Investments in midwifery could save the lives of millions of mothers and newborns, according to a new report from the United Nations Population Fund (UNFPA), the International Confederation of Midwives (ICM) and the World Health Organization (WHO). The report determined that 73 African, Asian and Latin American countries experienced 96 percent of the world’s maternal deaths, 91 percent of stillbirths and 93 percent of newborn deaths, with lack of access to midwives a significant contributing factor. Those countries have only 42 percent of the world’s midwives, nurses and doctors.
- Among the report’s recommendations:
- Increased access to preventive and supportive care from a collaborative midwifery team
- Immediate access to emergency services when needed
- Completing post-secondary education
- And, from a broader perspective, women should delay marriage, have access to healthy nutrition and receive four pre-birth care visits
"Midwives make enormous contributions to the health of mothers and newborns and the well-being of entire communities. Access to quality health care is a basic human right. Greater investment in midwifery is key to making this right a reality for women everywhere," said Babatunde Osotimehin, UNFPA Executive Director, in a release. Read more on maternal and infant health.
EPA Plans to Cut Carbon Emissions 30 Percent by 2030
The U.S. Environmental Protection Agency (EPA) announced plans today to reduce carbon emissions by 30 percent by 2030. The new Clean Power Plant proposal would be the first to cut emissions from existing power plants, which produce approximately one-third of the country’s domestic greenhouse gas emissions. The EPA estimates the proposed changes will help the United States avoid up to 6,600 premature deaths, up to 150,000 asthma attacks in children and up to 490,000 missed work or school days. "Climate change, fueled by carbon pollution, supercharges risks to our health, our economy, and our way of life,” said EPA Administrator Gina McCarthy, adding “By leveraging cleaner energy sources and cutting energy waste, this plan will clean the air we breathe while helping slow climate change so we can leave a safe and healthy future for our kids.” Read more on air and water quality.
Study: Tax on Total Calories in Sugary Drinks the Most Effective Way to Reduce Consumption
Tying a sugary drink tax to the amount of calories in a drink rather than its serving size would be more effective at reducing their consumption, according to a new study in the American Journal of Agricultural Economics. The study, which was financed by the Robert Wood Johnson Foundation, determined that such a tax of four-hundredths of a penny for every calorie would reduce calorie consumption by 9.3 percent; a tax of half a cent for each ounce in a can or bottle would reduce consumption by only 8.6 percent. “It provides a better incentive to the consumer to switch to lower-calorie drinks, which would be taxed at a lower rate than higher-calorie drinks,” said Chen Zhen, MD, a research economist at the food and nutrition policy research program at Research Triangle Institute and the lead author of the study, according to The New York Times. “One of the concerns about taxing ounces of sugar-sweetened beverages is that consumers are paying the same tax whether they buy 12 ounces of a drink with 150 calories or 12 ounces of a drink with 50 calories.” Read more on nutrition.
CDC: $19.5M for Innovative Public Health Prevention Research
Late last week the U.S. Centers for Disease Control and Prevention (CDC) awarded $19.5 million to 26 academic institutions for innovative public health prevention research to reduce health disparities. The grants will help the communities develop new methods to avoid or counter risks for chronic health care issues such as heart disease, obesity and cancer. “Prevention Research Centers have reached up to 31 million people in 103 partner communities, some of which are the most underserved in the country,” said Ursula E. Bauer, PhD, MPH., director of CDC’s National Center for Chronic Disease Prevention and Health Promotion, in a release. “By involving communities in conducting and disseminating research, this network of centers ensures that effective and innovative health strategies can be readily shared and applied where most needed.” Read more on prevention.
Mental Health Patients with Primary Care Physicians are Better at Managing their Health
Mental health patients who receive primary care from a physician’s office are generally more engaged in the active management of their mental health than are people who rely on outpatient clinics or emergency departments, according to a new study in the journal Health Education & Behavior. Using data from a large nationally representative survey, researchers assessed patient activation among patients diagnosed with depression in relation to variables such as the site of their usual source of care, community characteristics and other demographic characteristics. “Patients with mental disorders are less engaged in their health care than patients with other chronic diseases, so it is important to activate this group,” said Jie Chen, PhD, assistant professor in the department of health services administration at the University of Maryland School of Public Health. “In communities where patient activation is low, such as low-income communities with a large population of foreign-born individuals, there is an even greater need for interventions at mental health care institutions to engage residents in their health.” Read more on mental health.
Study: Low Cost of Food a Contributor to U.S. Obesity Epidemic
One of the driving factors in America’s growing obesity epidemic may very well be the increased access to cheap food, according to a new study. The average American spends only about one-tenth of their disposable income on food, compared to the 1930s, when the rate was about one-quarter. In addition, the average per capita consumption of calories has climbed approximately 20 percent since 1970. “Not only has food been getting cheaper, but it is easier to acquire and easier to prepare,” said Roland Sturm, lead author of the report and a senior economist at RAND, a nonprofit research organization. “It's not just that we may be eating more high-calorie food, but we are eating more of all types of food.” Possible public health solutions for this trend include imposing taxes on foods with low-nutritional value, as well as subsidies or discounts for healthier foods, according to the researchers. Read more on nutrition.
Expensive Co-pays a Barrier for Some Kids to Proper Asthma Treatments
Parents with higher health insurance co-pays report using less expensive asthma drugs, giving their children less medication than prescribed and even putting off doctor visits or trips to the emergency department for the respiratory disorder, according to a new study in the journal JAMA Pediatrics. Approximately 1 in 10 U.S. children suffer from asthma, and the prevalence of the illness is greater in low-income populations. "It is concerning that the children we deal with are sometimes more vulnerable in areas we didn't recognize," said Jefry Biehler, MD, chairman of pediatrics at Miami Children's Hospital in Florida. "We have to be careful that we don't create a void for those families that can't afford all the things they need for their child, but who are above the financial level that gives them government insurance that will provide everything at no or minimal cost.” Read more on pediatrics.
Faster Mass Vaccination Response Could Save Lives, Costs in a Flu Pandemic
A faster response of mass vaccinations after the start of a severe flu outbreak would save both lives and health care costs, according to a new study in Annals of Internal Medicine. Researchers created a computer model of a how an outbreak of H7N9 or H5N1 would affect a U.S. metropolitan city with characteristics similar to New York City, depending on when public health officials were able to vaccinate 30 percent of the population. They determined that reaching that vaccination target in 12 months would mean 48,254 persons would die; at 9 months would save an additional 2,365 lives; at 6 months would save an additional 5,775 lives and $51 million at a city level; and at 4 months would save an additional 5,633 lives and $50 million. Read more on the flu.
Study: Current Weight at 25 a Better Indicator of Later Obesity Risk than Duration of Obesity
In a study of the relationship between body mass index (BMI) at age 25, obesity later in life and biological indicators of health, researchers determined current weight—and not the duration of obesity—was a more effective indicator of cardiovascular and metabolic risk, according to a new study in the American Journal of Preventive Medicine. They did also note that people who were obese by age 25 were in fact at higher risk of more severe obesity later in life. Using data from the 1999-2010 U.S. National Health and Nutrition Examination Survey (NHANES), the study found that men who were obese at age 25 had a 23.1 percent estimated probability of class III obesity (BMI greater than 40) after age 35, compared to a 1.1 percent chance for men of a normal weight at age 25. For women who were obese at age 25 the risk of later class III obesity was 46.9 percent, compared to only 4.8 percent for women of a normal weight. “This is good news in some respects, as overweight and obese young adults who can prevent additional weight gain can expect their biological risk factors to be no worse than those who reach the same level of BMI later in life,” said study lead author Jennifer B. Dowd, MD, associate professor, epidemiology and biostatistics, City University of New York (CUNY) School of Public Health, Hunter College. Read more on obesity.
Higher High School GPAs Linked to Greater Earnings in Adulthood
A one-point increase in high school grade point average (GPA) can raise annual earnings in adulthood by approximately 12 percent for men and 14 percent for women, according to a new study in the Eastern Economic Journal. Researchers also determined that a 1-point increase in GPA increased the likelihood of completing college from 21 percent to 42 percent for both genders. “Conventional wisdom is that academic performance in high school is important for college admission, but this is the first study to clearly demonstrate the link between high school GPA and labor market earnings many years later,” said Michael T. French, director of the Health Economics Research Group (HERG) in the Department of Sociology at the UM College of Arts and Sciences, and corresponding author of the study, adding, “High school guidance counselors and teachers can use these findings to highlight the importance of doing well in high school for both short term (college admission) and longer term (earnings as an adult) goals.” Read more on education.
Study: Kids’ Cereals Average 40 Percent More Added Sugar than Adult Cereals
One bowl of kids’ cereal every morning would total as much as 10 pounds of sugar in a year, according to a new study from the Environmental Working Group (EWG). The organization assessed the sugar content of 1,500 cereals. While almost all had added sugar, the levels were higher in the 181 cereals specifically marketed to children—an average of 40 percent higher. “When you exclude obviously sugar-heavy foods like candy, cookies, ice cream, soft and fruit drinks, breakfast cereals are the single greatest source of added sugars in the diets of children under the age of eight,” said nutritionist and EWG consultant Dawn Undurraga, co-author of the organization’s new report, Children’s Cereals: Sugar by the Pound, in a release. “Cereals that pack in as much sugar as junk food should not be considered part of a healthy breakfast or diet. Kids already eat two to three times the amount of sugar experts recommend.” Read more on nutrition.
HHS, EU Making Progress in Fight Against Antimicrobial Resistance
This week the U.S. Department of Health and Human Services (HHS) and the European Commission released a progress report of the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR), a joint effort to combat antimicrobial resistance. In 2009, TATFAR identified and adopted 17 recommendations; the progress report includes one new recommendation to go along with 15 existing recommendations.
Notable TATFAR activities from 2011-2013 include:
- Adoption of procedures for timely international communication of critical events that might indicate new resistance trends with global public health implications
- Publication of a report on the 2011 workshop, “Challenges and solutions in the development of new diagnostic tests to combat antimicrobial resistance” to the TATFAR website
- Joint presentations to the scientific community to increase awareness about the available funding opportunities on both sides of the Atlantic
There are an estimated 25,000 deaths in Europe and 23,000 deaths in the United States linked to drug-resistant infections each year. Such infection also cost the United States and the European Union billions of dollars annually in avoidable health care costs and productivity losses. Read more on global health.
Women with Unintended Pregnancies Take the Shortest Maternity Leaves
Women with unintended pregnancies also take the shortest maternity leaves, according to a recent study from the University of Maryland School of Public Health published in the journal Women’s Health Issues. “We know that it’s better for women to take time off after childbirth to take care of their physical and mental health,” said Rada K. Dagher, MD, assistant professor of health services administration. “Returning to work soon after childbirth may not be good for these women or for their children.” Dagher’s previous research has indicated that six months of maternity leave is optimal for reducing a woman’s risk of postpartum depression. In addition to policies that enable women to take longer maternity leaves, she said there is also a need to counsel both women and men who are at risk for unintended pregnancies about effective contraceptive methods. Read more on maternal and infant health.
CDC: Parasitic Diseases a Significant U.S. Public Health Issue
Although the perception is that parasitic diseases only occur in poor and developing countries, people in the United States are also at risk for the diseases, which can cause serious illnesses, including seizures, blindness, pregnancy complications, heart failure and even death, according to the U.S. Centers for Disease Control and Prevention (CDC). The CDC has designated five neglected parasitic infections (NPIs) as U.S. public health priorities: Chagas disease, cysticercosis, toxocariasis, toxoplasmosis and trichomoniasis. While they can be treated when identified, there remains difficulty in correctly diagnosing the diseases, according to the CDC.
The estimates of the burden of NPIs include:
- More than 300,000 people living in the United States are infected with Trypanosoma cruzi, the parasite that causes Chagas disease, and more than 300 infected babies are born every year.
- There are at least 1,000 hospitalizations for symptomatic cysticercosis per year in the United States.
- At least 14 percent of the U.S. population has been exposed to Toxocara, the parasite that causes toxocariasis, and each year at least 70 people—most of them children—are blinded by resulting eye disease.
- More than 60 million people in the United States are chronically infected with Toxoplasma gondii, the parasite that causes toxoplasmosis; new infections in pregnant women can lead to birth defects and infections in those with compromised immune systems can be fatal.
- Trichomoniasis can cause pregnancy problems and increase the risk of other sexually transmitted infections including HIV. The Trichomonas parasite is extremely common, affecting 3.7 million people in the United States, although it is easily treatable.
Read more on global health.
Study: Many People Who Believe They Are Sensitive to Gluten Do Not Get Tested for Celiac Disease
Despite the increasing number of gluten-free products on grocery store shelves, many people who believe they are sensitive to gluten do not undergo tests to rule out celiac disease, according to a new study in the journal Nutrition in Clinical Practice. The autoimmune disorder damages the lining of the intestines, resulting in digestive symptoms and potential complications, and left untreated can lead to significant health problems. “There is a great deal of hype and misinformation surrounding gluten and wheat allergies and sensitivities. The group of so-called ‘non-celiac gluten sensitivity’ remains undefined and largely ambiguous because of the minimal scientific evidence,” said study author Jessica R. Biesiekierski, according to Reuters. “This non-celiac gluten sensitivity entity has become a quandary, as patients are powerfully influenced by alternative practitioners, Internet websites and mass media who all proclaim the benefits of avoiding gluten- and wheat-containing foods.” Read more on nutrition.
Study: ECGs Should Be Added to Health Screenings for High School Athletes
Electrocardiograms should be added to the health screening programs for high school athletes, according to a new study presented at the Heart Rhythm Society's annual meeting in San Francisco. The test would increase the odds of detecting medical conditions that could lead to sudden cardiac arrest and death. Researcher used data on approximately 5,000 athletes, ages 13-19, who underwent standard American Heart Association screening and also received an electrocardiogram, finding that while 23 were found to have significant heart abnormalities that required further evaluation, seven would not have been detected without an electrocardiogram. Read more on heart health.