Child Health Advocacy Research Articles

Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches

Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches

Who Is Talking About Adverse Childhood Experiences? Evidence From Twitter to Inform Health Promotion.

Growing availability of research about addressing adverse childhood experiences (ACEs) has recently been embraced by the mainstream media and public. Social media, especially Twitter, provides a unique forum and platform for the public to access and share information about this topic. This study aims to better understand how the public is framing, sharing, and using research about ACEs on Twitter and to examine the information being commonly discussed about ACEs. We obtained tweets on the topics of ACEs, childhood resilience, and childhood trauma between January 1, 2018, and December 31, 2019. This timeframe was determined based on key related events in the mainstream media. Crimson Hexagon, a social media analytics system using Boolean logic, was used to identify salient topics, influencers, and conduct a content analysis. A total of 195,816 relevant tweets were obtained from our search. The weekly volume was approximately 1,864 tweets. Key topics included general use of the term ACEs (23%), trauma and ACEs (19%), long-term impact of ACEs (12%), preventing ACEs (11%), short-term effects of ACEs (8%), the 1997 ACE Study (5%), and students with ACEs (5%). The top two sentiments were fear and joy. Top conversation influencers included pediatricians, child health advocacy organizations, California's state government, the Centers for Disease Control and Prevention, and National Public Radio. This analysis provides insight to the ways the public is conversing about ACEs and related topics. Results indicated that conversations focus on increasing awareness of ACEs by content experts and public health organizations. This presents an opportunity to leverage social media tools to increase public engagement and awareness.

Preferred Child Obesity Message Frames and Their Perceived Strength among State Policymakers.

Background: Health message framing, including gain or loss frames, can influence perceptions of child health messaging. It is unknown how characteristics such as political party and education may impact policymakers' message frame preference and perceived strength of child obesity messages. The purpose of this study was to examine preferred child obesity message frame, perceived strength of child obesity messages, and group differences among state policymakers. Methods: A cross-sectional online survey was administered in-person to state representatives and senators via electronic tablet between February and May, 2019, at a midwest State Capitol building. Participants were asked their message frame preference and perceived strength of child obesity messages related to long-term health, school, geographic region, military readiness, cost-savings, and the workforce. They were also asked who was responsible for preventing child obesity and strategies to prevent it. Data were analyzed descriptively and via chi-square tests for group differences. Results: One hundred fifteen state policymakers completed the survey. Participants overall favored gain-framed messages, which were perceived as stronger than loss-framed. Parents were viewed as most responsible overall for preventing child obesity, with Republicans (vs. Democrats; χ2 = 8.54; p = 0.008) and those with less education (vs. more; χ2 = 5.97; p = 0.029) perceiving them as more responsible (χ2 = 8.54; p = 0.008). Democrats viewed the food industry as more responsible (χ2 = 11.4; p = 0.001) than Republicans. Increasing physical activity, nutrition education, and fresh fruits and vegetables in schools were the most preferred prevention strategies. Conclusions: Child health advocates should consider using gain-framed messages related to child obesity when communicating with policymakers, and targeting their preferred strategies may enhance policy development.

A National Analysis of State Policies on Lesbian, Gay, Bisexual, Transgender, and Questioning/Queer Inclusive Sex Education.

Many youth engage in risky sexual behaviors that are associated with adverse sexual health outcomes. Lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) youth are disproportionately affected. Comprehensive sex education is instrumental to minimize these outcomes; however, each state varies in the topics taught. This paper is a comprehensive review of all 50 states and the District of Columbia's policies, including laws and education standards, for LGBTQ inclusive material in school-based sex education for youth in K-12. Overall, 48 states have policies that mandate sex education in the public schools. This review describes policy differences relevant to students who identify as LGBTQ, by comparing required topics, parental/guardian permission, LGBTQ inclusion, and normative language requirements. There is a lack of uniformity and presence of discrimination in school-based sex education policies in the United States, particularly related to LGBTQ topics. Therefore, young people, especially LGBTQ students, face geographical barriers to accessing sexual health information and schools are limited in implementing curriculum essential for students to optimize sexual health outcomes. State policymakers, school administrators, child health advocates, and parents should work to eliminate barriers for comprehensive sex education.

The George Washington University School of Medicine and Health Sciences.

The George Washington University School of Medicine and Health Sciences.

Unmet Health Care Needs Among Children with Special Health Care Needs Enrolled in Tricare

TRICARE provides health care benefits to nearly two million children of active duty, retired, National Guard, and reserve service members. Child health advocates and congressional reports have raised questions regarding the adequacy access to care for children with military health benefits, particularly children with special health care needs (CSHCN). The objective of this study was to compare the health care experiences of CSHCN in TRICARE with those of CSHCN with other sources of health insurance.A cross‐sectional analysis comparing unmet health care needs among CSHCN with TRICARE versus CSHCN with other sources of health insurance using nationally representative data from three years of the National Survey of Children’s Health (NSCH), 2016‐2018. The NSCH includes a broad range of questions related to child health and health care to provide national level estimates, and the data allow for comparisons between insurance coverage groups and TRICARE. The survey data contain responses from over 100,000 parents or primary caregivers (parents) of children, representative of over 73 million children annually. This includes 804 children who were representative of approximately 367,000 CSHCN covered by TRICARE annually.Children with special health care needs.Overall, 21 percent (95% CI 19‐24 percent) of parents of children covered by TRICARE reported their child had a special health care need, compared to 16 percent of children with commercial insurance (95% CI 15‐16 percent) and 24 percent of children with public insurance (95% CI 23‐25 percent). Eight percent of parents of CSHCN covered by TRICARE (95% CI 4‐16 percent) reported any unmet health care needs in the prior 12 months, compared to 4 percent of CSHCN with private insurance (95% CI 4‐5 percent) and 9 percent of CSHCN with public insurance (95% CI 8‐11 percent). Among specific needs, 3 percent or fewer CSHCN covered by TRICARE had unmet needs for medical, dental, vision, hearing, or mental health care. Similarly, 5 percent or fewer reported difficulty or delays in getting services because of eligibility for coverage of the service, availability in the area, difficulty in getting an appointment, or cost.About 11 percent of parents of CSHCN covered by TRICARE reported usually or always being frustrated in getting needed services for their child during the prior 12 months, compared to 4 percent of those with private insurance and 9 percent of those with public insurance. About 12 percent of parents of CSHCN covered by TRICARE reported problems with paying for their child’s health care needs in the prior 12 months, compared to 23 percent of those with private insurance and 8 percent of those with public insurance.TRICARE is largely meeting the needs of the CSHCN for whom it provides benefits, but there are opportunities for improvement. CSHCN in TRICARE face higher rates of unmet needs than privately insured children, and their parents face higher levels of frustration in getting needed services.TRICARE should continue to work with families of CSHCN to identify specific unmet needs and sources of frustration with getting needed services.

Pediatricians as Child Health Advocates: The Role of Advocacy Education.

In this article, we discuss the role of formal advocacy education with high-effort advocacy activities among pediatricians. We discuss the historical role of advocacy in the field of pediatrics and the changing role of advocacy education in pediatric training programs. We describe our survey of pediatricians in New York, in which we asked about a history of formal child health advocacy education, current high- and low-effort advocacy activities, perceived barriers to advocacy work, and child health advocacy issues of interest. Our findings demonstrate an association between a history of formal child health advocacy education and recent participation in high-effort advocacy activities on behalf of children's health. We also found that practicing pediatricians were more likely to participate in high-effort advocacy work than individuals still in pediatric residency training. Our findings imply that education in child health advocacy should be considered an important part of pediatric training. Advocacy education should not only be included in residency and fellowship training programs but also made available as part of continuing medical education for pediatricians. Time for professional advocacy work should be allotted and encouraged.

Assessing the newborn screening education needs of families living in medically underserved areas.

Newborn screening (NBS) is a public health service available to all babies born in the United States (US). NBS is one of the first experiences families have in the US healthcare system with a new baby. A positive experience with NBS can give families a strong start to their child's health care and build trusting relationships with providers. A lack of easily accessible NBS education for families can exacerbate health inequalities through negative interactions with the healthcare system. Expecting Health, a maternal and child health education and advocacy initiative of Genetic Alliance, partnered with RTI International to implement an online survey assessing needs and preferences around NBS-related health education, with a particular interest in those of families living within medically underserved areas (MUAs). A total of 500 participants completed the survey, including 200 participants living in MUAs. The results of the survey showed that, compared with US families living outside of MUAs, families living in MUAs are generally less aware of NBS and do not receive NBS education at the optimal time (i.e., before birth), which could indicate they experience inequities in NBS education. While families across different geographic areas seem to have similar preferences in terms of content for NBS education, the results show that somedistinct communication methods are needed to reach families living in MUAs. To bridge the gap in NBS education to families living in MUAs, the Expecting Health team built an online NBS educational module, using preferred communication methods-specified through the survey-for families living in MUAs.

Advancing Advocacy: Implementation of a Child Health Advocacy Curriculum in a Pediatrics Residency Program

ACGME program requirements for graduate medical education state that pediatric residency programs should include elements of child advocacy education. Finding readily available, easily implementable advocacy curricula for pediatric residency programs is challenging. We conducted a generalized curricular needs assessment via literature review and a targeted needs assessment with health care providers and advocacy leaders and developed and implemented a child health advocacy curriculum in a pediatrics residency program. Delivered across 9 months, the curriculum included three components: electronic resources, didactic sessions, and interactive workshops aimed at developing advocacy skills in the context of pressing child health issues. The learner audience was PGY 1 through PGY 4. The curriculum was evaluated using pre- and postcurriculum surveys. Our curriculum advanced child advocacy locally by establishing partnerships with state and federal American Academy of Pediatrics and pediatric residency programs, teaching residents to generate advocacy action plans, and implanting a longitudinal advocacy curriculum in the residency program. Sixty-four of 70 residents participated in the curriculum: 33% were PGY 1, 31% were PGY 2, 30% were PGY 3, and 6% were PGY 4. Pre- and postcurriculum surveys demonstrated improved knowledge of and comfort level with advocacy after curriculum completion. Child advocacy teaching improved resident and faculty awareness about child health issues in the community, as well as understanding of pathways to advocate for child health. The curriculum is reproducible and feasible and can assist other institutions to develop advocacy education and skill development programs.

Child health, infant formula funding and South African health professionals: Eliminating conflict of interest

Despite clear evidence of the benefits of exclusive and continued breastfeeding for children, women and society, far too few children in South Africa (SA) are breastfed. One of the major impediments to improving this situation is the continued and aggressive marketing of breastmilk substitutes (BMSs) and infiltration of the BMS industry into contexts with exposure to health professionals. In this article we, as academics, practitioners and child health advocates, describe contraventions of the regulations that protect breastfeeding in SA and argue that bold, proactive leadership to eliminate conflict of interest in respect of the BMS industry is urgently required, together with far greater investments in proven interventions to promote and support breastfeeding.

TRICARE For Children: Between Medicaid And Marketplace Plans For Comprehensiveness And Cost Sharing.

TRICARE provides health care benefits to nearly two million children of active duty, retired, National Guard, and reserve service members. Child health advocates and congressional reports have raised questions regarding the adequacy of these benefits, compared with other sources of children's health insurance. To help address these questions, we compared TRICARE benefits with benefits from Medicaid and Marketplace plans because they represent alternative sources of coverage for many of the families enrolled in TRICARE. Overall, we found that TRICARE benefits fell in the middle-between Medicaid plans' more comprehensive benefits with no cost sharing and Marketplace plans' more restrictive benefits with higher cost sharing.

Child Mortality in the United States: Bridging Palliative Care and Public Health Perspectives.

* Abbreviations: ED — : emergency department PPC — : pediatric palliative care Child and adolescent mortality rates in the United States have fallen fairly consistently since the 1960s.1 And yet, infant mortality and deaths in adolescents and young adults are not infrequent. In 2015, 1 out of every 270 infants in the United States died before their first birthday, while 1 out of every 1438 Americans aged 15 to 24 died.2 Among children and adolescents, nonintentional injuries, suicide, and homicide are leading causes of death (Table 1). These cause-of-death statistics provide powerful data to inform public health initiatives, preventive medicine programs, and child health advocacy around end-of-life care. View this table: TABLE 1 2015 Child and Adolescent Mortality in the United States, Both Overall and Due to Unintentional Injuries, Suicide, and Homicide (Grouped Together as Injuries) In this issue of Pediatrics , Trowbridge et al3 take the novel approach of studying modes of death rather than causes of death. Following chart review of all deaths at a freestanding children’s hospital from 2011 to 2014, they created the following 5 mutually exclusive categories: (1) withdrawal of life-sustaining technology, (2) nonescalation of care, (3) failed … Address correspondence to JoAnna K. Leyenaar, MD, PhD, MPH, Dartmouth-Hitchcock Medical Center, WTRB, 1 Medical Center Way, Lebanon, NH 03766. E-mail: joanna.k.leyenaar{at}hitchcock.org

Offline: It's time to hold the private sector accountable

Once a central focus of global development goals, the field of women's, children's, and adolescents' health has now been pushed to the margins of international concern. Maternal and child health advocates have been victims of their own success. Steep declines in under-5 mortality and steady progress in reducing maternal mortality have suggested the job is done. While advances in reproductive, maternal, newborn, and child health should be celebrated, this week's report by the Independent Accountability Panel for Women's, Children's, and Adolescents' Health (IAP) proves that such complacency is a grave mistake. The IAP, co-chaired by Carmen Barroso and Kul Gautam, describes how progress, while real, has been desperately uneven. The equity gaps between and within countries should be a source of deep shame for all political leaders and development partners. Children born in the poorest communities are almost twice as likely to die compared with those born in richer settings. 1 million children aged 5–14 years, together with 1·2 million adolescents, die annually, most from preventable causes. 830 women die from pregnancy-related complications every day. And 4·3 billion people will lack access to at least one essential sexual and reproductive health service in their lifetime. These figures are unacceptable. Yet such preventable tragedies have become normalised in our thinking about global health today. Too few people are angry about the fate of women and children in our societies. This year's IAP report focuses on the part played by the private sector in advancing women's and children's health. The Sustainable Development Goals (SDGs) put a premium on strengthening international cooperation (SDG 17 calls for revitalised global partnerships). As the IAP notes, the global health community increasingly looks to the private sector for help in achieving these goals—delivering services, increasing access to medicines, providing food, and developing new technologies. Here lies a contradiction. The private sector creates and sells goods and services. But health is not a commodity to be bought and sold. It is a fundamental human right. How can a private sector dedicated to profit distributed among a small number of shareholders be compatible with the health of all people in all communities? This incompatibility means that private and public sectors will always exist in opposition to one another. While not putting these paradoxical positions quite so starkly, the IAP recognises that this tension must be managed. Its five recommendations—on access to services, the pharmaceutical and food industries, the UN Global Compact, and business engagement—share common principles: the private sector must be subject to higher standards, stronger regulation, minimum legal requirements, increased judicial oversight, greater transparency, and more robust independent national and global accountability. Most importantly, “businesses engaging in the context of universal health coverage must be aligned with one central objective: improving people's health”. The IAP report and its recommendations are important. I hope that WHO's Director-General will make the private sector a special focus of next year's World Health Assembly. It is time for the private sector to be drawn out of the shadows of global health and held accountable for its decisions and actions. What of the IAP itself? Three improvements might be considered. First, although focusing on one specific issue is welcome, the absence of recommendations to address inequitable progress in women's, children's, and adolescents' health is disappointing. Second, governments have primary responsibility for protecting and advancing the health of their citizens. The lack of attention given by the IAP to government failures feels like punches being pulled. The IAP should not be afraid to name and criticise governments (and political leaders) whose decisions have failed to accelerate progress towards better health. Finally, the UN's Every Woman Every Child initiative, valuable as it is, has enabled the private sector to polish its philanthropic credentials. The IAP report would have been stronger if it had evaluated and judged specific private sector promises and commitments. This lack of scrutiny feels like a self-imposed and unnecessary restraint. Independent accountability sometimes means delivering unpalatable and undiplomatic truths. The future health of women and children depends on such unvarnished honesty.

Using a Community Bus Tour for Pediatric Residents to Increase Their Knowledge of Health Disparities

A community bus tour with a focus on social determinants of health created through a partnership between the pediatric residency program and the hospital's Child Health Advocacy Institute was shown to increase knowledge of health disparities among pediatric interns.

The Familias Saludables partnership: Engaging the Latino community to address early childhood obesity.

Darcy A Thompson is an Associate Professor of pediatrics at the University of Colorado School of Medicine.Her main research seeks to address early childhood obesity in low-income children. She works in the Lifestyle Medicine clinic at Children's Hospital Colorado, a clinic focused on caring for children with obesity and related comorbidities. She is also an Associate Medical Director for the Research Institute at Children's Hospital Colorado. Her training includes a Master of Public Health degree, a medical degree (Yale University) and the Robert Wood Johnson Clinical Scholars Fellowship (University of Washington). Deborah (Deb) A Federspiel has been leading child health advocacy and community health improvement initiatives in support of Children's Hospital Colorado's mission for the past 15years. Her professional background includes experience developing and managing teams, programs and operations, as well as building partnerships and coalitions to drive key strategic initiatives and advance positive change on behalf of children and families. An active member of a number of community advisory committees and nonprofit boards, she has worked in the Colorado nonprofit sector since 1999. She has a Bachelor of Science in business administration from the University of Dayton.

Children's health in Europe - challenges for the next decades.

These reflections from a Child Public Health perspective underline the dramatic changes in children's conditions in Europe over this last century, including a considerable improvement in health. However, we still face problems, disturbing facts and alarming signs. There are important gaps in our knowledge about essential areas of children's health panorama and about particularly vulnerable sub-groups of children, which are less healthy, less well cared for and not enjoying the good conditions of life. We also see an evident lack of the child's perspective, implying acknowledgement and action on the views of the children themselves. Moreover, in spite of the generally improving standard, societal inequity in economy, education and health is increasing and the recent economic crises have struck hard on families with children. There are many good signs implying continuing progress for children and their conditions and also an improved respect for their rights. But with the increasing segregation in our societies, the risk is imminent that the health problems will increase, and that some groups get left far behind. Although actions on this field are primarily a political responsibility, people working with children can make a difference. There are also many examples of projects, particularly on local levels, where professionals act to promote children's health, prevent their ill-health and facilitate their health behaviour, rather than to repair their diseases. Children's particular needs and protection is now generally accepted, and the growing concern for their rights opens a window to the future for a more powerful child health advocacy.

The JeffSTARS Advocacy and Community Partnership Elective: A Closer Look at Child Health Advocacy in Action.

Advocacy and service-learning increasingly are being incorporated into medical education and residency training. The Jefferson Service Training in Advocacy for Residents and Students (JeffSTARS) curriculum is an educational program for Thomas Jefferson University and Nemours trainees. The JeffSTARS Advocacy and Community Partnership Elective is one of two core components of the larger curriculum. The elective is a monthlong rotation that provides trainees in their senior year of medical school or residency training the opportunity to learn about health advocacy in depth. Trainees develop a basic understanding of social determinants of health, learn about health policy, participate in legislative office visits, and work directly with community agencies on a mutually agreeable project. The elective provides advocacy training to self-selected trainees from area medical schools and residency programs to develop a cadre of physicians empowered to advocate for child health. JeffSTARS has advanced the field of child health advocacy locally by forging new partnerships and building a network of experts, agencies, and academic institutions. After this experience, trainees realize that their health expertise is very valuable to health advocacy and policy development. JeffSTARS is recognized nationally as one of a growing number of advocacy training programs for students and residents, with trainees presenting selected projects at national meetings. Teaching advocacy has raised awareness about social determinants of health, community resources, and the medical home. One of the many benefits of the elective has been to strengthen the skills and expertise of trainees and faculty members alike.

Researchers', Regulators', and Sponsors' Views on Pediatric Clinical Trials: A Multinational Study.

The last decade has seen dramatic changes in the regulatory landscape to support more trials involving children, but child-specific challenges and inequitable conduct across income regions persist. The goal of this study was to describe the attitudes and opinions of stakeholders toward trials in children, to inform additional strategies to promote more high-quality, relevant pediatric trials across the globe. Key informant semi-structured interviews were conducted with stakeholders (researchers, regulators, and sponsors) who were purposively sampled from low- to middle-income countries and high-income countries. The transcripts were thematically analyzed. Thirty-five stakeholders from 10 countries were interviewed. Five major themes were identified: addressing pervasive inequities (paucity of safety and efficacy data, knowledge disparities, volatile environment, double standards, contextual relevance, market-driven forces, industry sponsorship bias and prohibitive costs); contending with infrastructural barriers (resource constraints, dearth of pediatric trial expertise, and logistical complexities); navigating complex ethical and regulatory frameworks ("draconian" oversight, ambiguous requirements, exploitation, excessive paternalism and precariousness of coercion versus volunteerism); respecting uniqueness of children (pediatric research paradigms, child-appropriate approaches, and family-centered empowerment); and driving evidence-based child health (advocacy, opportunities, treatment access, best practices, and research prioritization). Stakeholders acknowledge that changes in the regulatory environment have encouraged more trials in children, but they contend that inequities and political, regulatory, and resource barriers continue to exist. Embedding trials as part of routine clinical care, addressing the unique needs of children, and streamlining regulatory approvals were suggested. Stakeholders recommended increasing international collaboration, establishing centralized trials infrastructure, and aligning research to child health priorities to encourage trials that address global child health care needs.

Discourse, ideas and power in global health policy networks: political attention for maternal and child health in the millennium development goal era.

BackgroundMaternal and child health issues have gained global political attention and resources in the past 10 years, due in part to their prominence on the Millennium Development Goal agenda and the use of evidence-based advocacy by policy networks. This paper identifies key factors for this achievement, and raises questions about prospective challenges for sustaining attention in the transition to the post-2015 Sustainable Development Goals, far broader in scope than the Millennium Development Goals.MethodsThis paper relies on participant observation methods and document analysis to develop a case study of the behaviours of global maternal and child health advocacy networks during 2005–2015.ResultsThe development of coordinated networks of heterogeneous actors facilitated the rise in attention to maternal and child health during the past 10 years. The strategic use of epidemiological and economic evidence by these networks enabled policy attention and promoted network cohesion. The time-bound opportunity of reaching the 2015 Millennium Development Goals created a window of opportunity for joint action. As the new post-2015 goals emerge, networks seek to sustain attention by repositioning their framing of issues, network structures, and external alliances, including with networks that lay both inside and outside of the health domain.ConclusionsIssues rise on global policy agendas because of how ideas are constructed, portrayed and positioned by actors within given contexts. Policy networks play a critical role by uniting stakeholders to promote persuasive ideas about policy problems and solutions. The behaviours of networks in issue-framing, member-alignment, and strategic outreach can force open windows of opportunity for political attention -- or prevent them from closing.

"Lives in the balance": The politics of integration in the Partnership for Maternal, Newborn and Child Health.

A decade ago, the Partnership for Maternal, Newborn and Child Health (PMNCH) was established to combat the growing fragmentation of global health action into uncoordinated, issue-specific efforts. Inspired by dominant global public-private partnerships for health, the PMNCH brought together previously competing advocacy coalitions for safe motherhood and child survival and attracted support from major donors, foundations and professional bodies. Today, its founders highlight its achievements in generating priority for ‘MNCH’, encouraging integrated health systems thinking and demonstrating the value of collaboration in global health endeavours. Against this dominant discourse on the success of the PMNCH, this article shows that rhetoric in support of partnership and integration often masks continued structural drivers and political dynamics that bias the global health field towards vertical goals. Drawing on ethnographic research, this article examines the Safe Motherhood Initiative’s evolution into the PMNCH as a response to the competitive forces shaping the current global health field. Despite many successes, the PMNCH has struggled to resolve historically entrenched programmatic and ideological divisions between the maternal and child health advocacy coalitions. For the Safe Motherhood Initiative, the cost of operating within an extremely competitive policy arena has involved a partial renouncement of ambitions to broader social transformations in favour of narrower, but feasible and ‘sellable’ interventions. A widespread perception that maternal health remains subordinated to child health even within the Partnership has elicited self-protective responses from the safe motherhood contingent. Ironically, however, such responses may accentuate the kind of fragmentation to global health governance, financing and policy solutions that the Partnership was intended to challenge. The article contributes to the emerging critical ethnographic literature on global health initiatives by highlighting how integration may only be possible with a more radical conceptualization of global health governance.