Category Archives: Child & Youth Health

Childhood trauma’s affect on health throughout life – Event Feb. 25

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Dr. Anda

Dr. Anda

A national expert on child abuse, Dr. Robert Anda, will discuss how childhood trauma can have effects that last throughout life at an event being held February 25th in Lynnwood.

The event is sponsored by Ryther, a provider of behavioral health services to children and their families, the Comprehensive Health Education Foundation and Coordinated Care.

Dr. Anda’s talk will be followed with a panel discussion. The event is free but registration is required.  Continue reading

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Health news headlines – February 8th

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Typewriter-Spelling-NEWS

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Rich or poor, schools fall short on providing physical activity

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Soccer BallBy Milly Dawson
HBNS Contributing Writer

Schools in wealthier areas are more likely to have a physical education (PE) teacher on staff than are schools in poorer areas, but students in both wealthy and less affluent areas are coming up short with regard to physical activity, finds a new study in the American Journal of Health Promotion.

The researchers used data on students from elementary schools in San Diego and Seattle.

Continue reading

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Treating head lice — every parent’s nightmare

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Two lice viewed under an electron microscope. Note the claws used to grasp onto individual hairs. Credit: CDC

Lice viewed under an electron microscope, their claws grasping onto individual hairs. – CDC

Consumer Update from the FDA

Head lice. Every parent’s nightmare.

A year-round problem, the number of cases seems to peak when the kids go back to school in the fall and again in January, says Patricia Brown, M.D., a dermatologist at the Food and Drug Administration (FDA).

An estimated 6 to 12 million cases of head lice infestation occur each year in the United States in children 3 to 11 years of age, according to the Centers for Disease Control and Prevention.

Head lice are most common among preschool children attending child care, elementary school children, and household members of children who have lice.

Contrary to myth, head lice are not caused by poor hygiene, Brown says. They are spread mainly by direct head-to-head contact with a person who already has head lice. You cannot get head lice from your pets; lice feed only on humans. Continue reading

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Health law adds coverage needed by people with developmental disabilities

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PrintBy Michelle Andrews
KHN

January 14, 2014 — A little remarked upon requirement in the health law expands treatments for people with cerebral palsy, autism and other developmental disabilities. But some advocates and policy experts are concerned that insurers may find ways to sidestep the new requirement.

The health law requires that individual and small group plans sold on or off the health insurance marketplaces cover 10 essential health benefits, including “rehabilitative and habilitative services and devices.” Continue reading

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Making palliative care more available to children

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Conversations matter palliative care

From the National Institute of Nursing Research

January 10, 2014 — New Palliative Care: Conversations Matter campaign helps ensure children with serious illnesses and their families get supportive care

A campaign just launched by the National Institute of Nursing Research (NINR) aims to increase the use of palliative care — comprehensive treatment of the discomfort, symptoms, and stress of serious illness — for children with serious illness.

Palliative care can reduce a child’s pain, help manage other distressing symptoms, and provide important emotional support to the child and family throughout the course of an illness. Continue reading

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lesson one

Oregon schools use ‘behavioral vaccine’ to reduce smoking

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Blackboard with "Lesson one" written on it.

Photo: Krzysztof “Kriss” Szkurlatowski

By Kristian Foden-Vencil
Oregon Public Broadcasting

Behaving well in elementary school could reduce smoking in later life. At least, that’s what Trillium Community Health Plan hopes, and it’s putting money behind the idea.

Danebo Elementary in Eugene, Ore., is one of 50 schools receiving money to teach classes while integrating something called the “Good Behavior Game.”

Teacher Cami Railey sits at a small table, surrounded by four kids. She’s about to teach them the “s” sound and the “a” sound. But first, as she does every day, she goes over the rules.

“You’re going to earn your stars today by sitting in the learning position,” she says. “That means your bottom is on your seat, backs on the back of your seat. Excellent job, just like that.”

For good learning behavior, like sitting quietly, keeping their eyes on the teacher and working hard, kids get a star and some stickers.

Railey says the game keeps the kids plugged in and therefore learning more. That in turn makes them better educated teens and adults who’re less likely to pick up a dangerous habit, like smoking.

The Washington, D.C., nonprofit Coalition for Evidence Based Policy says it works. It did a study that found that by age 13, the game had reduced the number of kids who had started to smoke by 26 percent — and reduced the number of kids who had started to take hard drugs by more than half.

The fact that a teacher is playing the Good Behavior Game isn’t unusual. What is unusual is that Trillium is paying for it. Part of the Affordable Care Act involves the federal government giving money to states to figure out new ways to prevent people from getting sick in the first place.

So Trillium is setting aside nearly $900,000 a year for disease prevention strategies, like this one. Jennifer Webster is the disease prevention coordinator for Trillium Community Health, and she thinks it’s a good investment.

“The Good Behavior Game is more than just a game that you play in the classroom. It’s actually been called a behavioral vaccine,” she says. “This is really what needs to be done. What we really need to focus on is prevention.”

Trillium is paying the poorer schools of Eugene’s Bethel School District to adopt the strategy in 50 classrooms.

Trillium CEO Terry Coplin says changes to Oregon and federal law mean that instead of paying for each Medicaid recipient to get treatment, Trillium gets a fixed amount of money for each of its 56,000 Medicaid recipients. That way Trillium can pay for disease prevention efforts that benefit the whole Medicaid population, not just person by person as they need it.

“I think the return on investment for the Good Behavior Game is going to be somewhere in the neighborhood of 10 to one,” Coplin says.

So, for each dollar spent on playing the game, the health agency expects to save $10 by not having to pay to treat these kids later in life for lung cancer because they took up smoking.

Coplin concedes that some of Trillium’s Medicaid recipients will leave the system each year. But he says prevention still makes medical and financial sense.

“All the incentives are really aligned in the right direction. The healthier that we can make the population, the bigger the financial reward,” he says.

The Oregon Health Authority estimates that each pack of cigarettes smoked costs Oregonians about $13 in medical expenses and productivity losses.

Not all the money Trillium is spending goes for the Good Behavior Game. Some of it is earmarked to pay pregnant smokers cold, hard cash to give up the habit. There’s also a plan to have kids try to buy cigarettes at local stores, then give money to store owners who refuse to sell.

This story is part of a reporting partnership that includes NPROregon Public Broadcasting and Kaiser Health News

Photo courtesy of Krzysztof “Kriss” Szkurlatowski

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Will health law help cover my braces?

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Question Q&ABy Michelle Andrews

It turns out that readers of all ages have questions about the health law, from teenagers to seniors. Here are several of those.

Q. I’m 15 years old and I really want braces. If my mom signs me up for Obamacare, will it cover it?

A. It depends. Under the health law, pediatric dental coverage is one of 10 “essential health benefits” that must be offered to people who shop for plans on the health insurance marketplaces.

Depending on the state, dental coverage may be offered on a standalone basis rather than as part of a regular health plan. If it is, you wouldn’t necessarily get dental insurance coverage unless your mom buys a standalone plan.

Under the law, plans are required to cover only medically necessary orthodontia, says Colin Reusch, a senior policy analyst at the Children’s Dental Health Project. States or insurers may define medical necessity differently.

To determine whether you qualify, a dentist would generally refer you to an orthodontist to evaluate how misaligned your teeth are or whether you have difficulty chewing, for example.

“It’s probably worth contacting a couple of plans his mom is considering and asking how they define medically necessary orthodonia,” says Reusch.

Insurance typically pays 50 percent of the cost of braces; the total cost can exceed $5,000. For this kind of pricey care, your family might be better off with a standalone dental plan, says Reusch, because the deductible and out-of-pocket maximums will generally be lower than those of a standard insurance policy.

Q. I’m on Medicare, but my wife is 63 and has no health insurance. Our income is $51,000 and we can’t afford the health plan premiums offered in Oklahoma. My wife’s income is $10,000 per year, and it’s all Social Security. To avoid the penalty for not having insurance, can we file separately?

A. If you file separate income tax returns, your wife’s income would be significantly lower and she might avoid owing a penalty for not having health insurance.

But the financial ramifications of taking that step could be much more costly than the penalty itself, says Tara Straw, a senior policy analyst at the Center on Budget and Policy Priorities.

The penalty for not having insurance next year is $95 or 1 percent of income, whichever is greater. Your wife could avoid owing the penalty if her income is below the threshold for filing a tax return ($10,000 for an individual in 2013) or if buying a plan would cost more than 8 percent of her income.

Our tax system favors married couples who file their income taxes jointly, however. In general, joint filers pay a lower income tax rate overall. What’s more, if your wife files separately her Social Security benefits will be taxed.

Some tax credits can’t be used at all if a married couple files separately, including premium tax credits to buy health insurance on the state marketplaces.

These are available to people with incomes between 100 and 400 percent of the federal poverty level ($15,510 to $62,040 for a couple in 2013).

While your wife’s income alone would be too low for a premium tax credit, under your combined income she should be eligible.

“This is a good example of why we can’t look at health care in isolation,” says Straw. “At the end of the day they would probably lose money [if they filed separately]. You may solve one problem only to create another for yourself.”

Q. I will be able to keep the insurance available through my employer next year, but the deductibles and out-of-pocket limits in 2014 are frightening. Not only are some of my medications expensive, but my employer plan will be excluding coverage for 14 drugs. Is it acceptable under the ACA for me to purchase a prescription plan to stack with my employer plan?

A. There’s nothing in the health law that would prohibit you from beefing up your drug coverage with a drug discount card or buying supplemental insurance like a dental, vision, accident or single illness plan, for example, says Anne Waidmann, a director in human resource services at PwC.

None of those types of plans count as health insurance for the purpose of satisfying the requirement that people have “minimum essential coverage” starting in January.  If you want to add to your existing coverage, you can.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Remembering the Sandy Hook tragedy, protecting kids from gun violence – Seattle Children’s

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From Seattle Children’s On the Pulse blog

GunOn Dec. 14 of last year, 20 children and seven adults lost their lives in the senseless tragedy that took place at Sandy Hook Elementary School in Newtown, Conn.

As we approach the anniversary of this horrific event, we remember and mourn the victims and the families who have been affected by this tragedy.

No parent should ever have to suffer through the pain of losing a child to gun violence. And with guns in more than one third of all U.S. households, firearms present a real, everyday danger to children, especially when improper safety techniques are followed.

Frederick Rivara, MD, MPH, division chief of general pediatrics and vice chair of the Department of Pediatrics at Seattle Children’s Hospital, and Dimitri Christakis, MD, MPH, director of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute, offer the following tips and advice for parents looking to keep kids safe from firearms, and to help reduce their exposure to gun violence in the media.

Gun safety in the home

Less than half of U.S. families with children and guns store their guns unloaded and locked away. Each year just in Washington state, about 25 children are hospitalized and four to five die due to unintentional gun injuries.  Most of these shootings occur in or around the home.

The best way to protect children from firearms injury in the home is to remove the firearms entirely. However, if this is not an option, Rivara says there are a number of ways that you can minimize the risk:

Store your guns safely:

  • All weapons should be stored in a securely locked case, well out of the reach of children, and make sure children do not have access to the key or combination.
  • Stored firearms should be unloaded and in the uncocked position.
  • Store ammunition separate from the weapon, also in a securely locked location out of the reach of children.
  • Use trigger locks or chamber locks on weapons. Even a padlock can be used to prevent the cylinder of a weapon from locking into place.
  • Remove guns from your home if a family member is depressed, suicidal or is abusing drugs or alcohol.

With the popularity of shooting video games and toy guns, the lines between these weapons and their very real consequences are often blurred. Parents should talk with their children and make them aware that weapons are not toys and that if they ever do come into contact with a weapon, they are not to touch it under any circumstances. The National Rifle Association (NRA) recommends teaching children four things about what to do when finding a gun: stop, don’t touch, leave the area and tell an adult.

Gun violence in the media

Whether or not you keep a weapon in your home, children will be exposed to gun violence in the media at some point, often very early in life. In fact, a recent study found that the rate of violence in movies is increasing, and that this violence is now more predominant in the PG-13 movies your teens are watching than in R-rated movies. And with the medical consensus being that exposure to violent media can increase aggression in children, and that children often imitate what they see on the screen, parents must be mindful of their children’s exposure to gun violence in the media.

While it’s challenging to prevent your child from encountering this violence, you can help to limit it while you talk to them about its real-world consequences. Here are a few tips to help:

Implement a media diet. Christakis recently conducted a study that found that children reproduce what they see on television or in the movies, both bad and good. He suggests staying aware of what your children are watching by keeping a media diary. He also advises to watch more TV and movies with your children so you’re always aware of the content they’re consuming and can discuss it with your kids.

Be available. When events like the Sandy Hook tragedy occur, these stories of violence are plastered all across the news. Each child responds to this in a different way. Many become fearful and have questions about these events. Some end up angry or grief-stricken, while others feel a sense of betrayal. Be sure to talk with your children about these events to reinforce that they are safe and to assuage their fears. Doing this will also show that you are available to talk with them about anything, no matter how difficult it may be.

Keep an eye out for red flags. Pretend gun play, violent video games and movies and other aggressive influences are a part of our lives, and finding the right balance between limiting children’s exposure to these stimuli and not keeping them entirely in the dark can be difficult. However, it can help to look out for potential red flags, such as a child “accidentally” hurting another, aggressive behavior, or a lack of empathy or remorse for their actions. Please discuss these concerns with your child’s doctor.

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Seattle Children’s doctor offers tips to keep kids safe this holiday season

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Photo courtesy of Jay-Simmons

Photo courtesy of Jay Simmons

From Seattle Children’s On the Pulse blog

Tis the season for mistletoe, gingerbread and carefully strung lights. It’s the most wonderful time of the year, but also a potentially dangerous one for children. And although festivities, candles and garland may make the holiday season more cheerful, with them come some serious safety concerns.

Tony Woodward, MD, MBA, medical director of emergency medicine at Seattle Children’s Hospital, says the most important thing to remember this holiday season is supervision.

“The holidays are a fun and exciting time, but there are a few more things inserted into the environment, like holiday plants, electrical cables, new toys and festive beverages, which are potentially dangerous,” says Woodward.

Holiday safety tips

To keep kids out of the emergency room this year, Woodward recommends some basic safety tips to ensure an injury-free, but still festive holiday season.

Lights, trees and décor. Sparkly ornaments, shiny holiday decorations and small holiday figurines are potential choking hazards for small children. If an object can fit through a toilet paper tube, it can obstruct the airway of a small child and prevent breathing.

“Think like a child,” says Woodward. “Get down on your hands and knees and look around the house. If something looks shiny and enticing, a child may want to put it in their mouth. Keep decorations high and out of reach.”

Make sure trees and decorations are properly secured, either by a sturdy stand or to the wall. Also, talk to children about holiday decorations and explain that they are not toys. Set limits and supervise children.

Poisoning potential. Holiday plants like mistletoe, holly and poinsettias are commonly used as decorations, but they can be hazardous to children. These plants are considered potentially poisonous and should be kept away from children and out of reach. If a child ingests any part of these plants call a pediatrician or the Poison Help Line immediately at (800) 222-1222. Symptoms from poisoning may include vomiting, diarrhea, nausea or rash.

Medicines and vitamins can also be hazardous for children. Keep an eye out for medicine, vitamins and other personal products found in purses or suitcases that guests visiting for the holidays may bring into the home. Also, be aware when visiting other houses this holiday with your family, especially households without young children because the house may not be child proofed.

Be cautious of raw or undercooked foods during the holidays. Wash hands frequently when handling raw meat or eggs, and don’t leave foods out in reach of children.

Holiday parties. Hosting a holiday gathering this year? Plan for a party’s youngest guests first. Take small children into consideration when planning a party’s food and beverage menu, and before adorning the home with festive décor.

“Decorating the home with garland and strung beads may look great for the holidays, but children can mistake the brightly colored beads and floral arrangements for candy or food, which may cause choking or poisoning,” says Woodward.

Alcohol is another common risk for children around the holidays and during holiday gatherings.

“Kids see adults drinking alcohol and become curious. If glasses are left sitting out in reach of children they may ingest the alcohol, which even in small amounts can be dangerous to kids. Use common sense and always keep an eye on children,” says Dr. Woodward.

Also, stay home from parties or gatherings if children aren’t feeling well. Don’t risk spreading germs to others. Talk to children about proper hand washing and coughing techniques. Germs are easily spread, but these techniques can help prevent the transmission of germs from one person to another.

Fire safety. Keep decorations and trees away from heat sources within the home, which includes fireplaces, radiators, space heaters or electrical outlets. Also, avoid using candles if there are small children in the home.

When buying an artificial tree, make sure it is “fire retardant,” and also make sure a child’s sleepwear is labeled “fire retardant” as well. Be sure to also remove dry trees after the holiday season to reduce fire risk.

Use socket covers to baby-proof electrical outlets and make sure extension cords are well hidden and out of reach. Ensure cords are all the way in the outlets so kids don’t get shocked. Also, do not have water around outlets and wires.

Cooking is the leading cause of home fires in the U.S. Try to keep small children out of the kitchen while cooking or preparing food. Turn pot handles in so they can’t be accidently knocked over and stay in the kitchen while frying, grilling and broiling.

Toy safety. Many toys and holiday decorations require button batteries, which can pose fatal risks for young kids. Be sure batteries cannot be removed easily from toys and gadgets. If a battery is swallowed, it can cause life-threatening injuries. Also, avoid magnets. Toys that contain small magnets are especially dangerous for young kids. If swallowed, magnets can attract to one another in a child’s intestine and cause serious complications and even death.

“Make sure toys are appropriate for the age of a child, but also think about other children,” says Woodward. “Think about the worst case scenario. If a 1-year-old or 2-year-old will be in the home visiting for the holidays, ask if there are toys that could potentially be harmful to them.”

Just like checking a food’s ingredient list, parents should read toy and product labels. Avoid toys and products that contain PVC plastic, xylene, toluene or dibutyl phthalate.

Cold weather. With temperatures dropping, make sure children are properly dressed for the weather with hands, feet and heads covered. Dress children in layers and make sure they come in out of the cold periodically. The nose, ears, feet and hands are at the biggest risk of frostbite if temperatures are below freezing.

Supervise children while they play. Activities like sledding can be dangerous without proper supervision and safety gear. Also, be extremely cautious around water. Never allow children to walk across frozen lakes or ponds.

Lastly, wear sunscreen. It may be cold, but children are still at risk for sunburn.

The holidays are a time for celebration and fun. By following these simple safety tips, families can enjoy the holiday season without injury. Happy Holidays!

Photograph courtesy of Jay Simmons

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Firearm retailers join with King County to promote safe gun storage

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GunFrom Public Health – Seattle & King County: 

New research into youth firearm deaths in King County has prompted a partnership with ten national and local retailers to promote the secure storage of guns as a means of preventing deadly shootings.

“Gun violence is a public safety crisis. It is also a public health crisis, and I directed our staff to develop innovative strategies to reduce gun violence using a data-driven public health approach,” said King County Executive Dow Constantine. “The evidence is clear: Safe storage can save lives.”

The “Safe Storage Saves Lives” campaign, developed by Public Health – Seattle & King County, also includes 20 participating law enforcement agencies.

The new data is contained in a report released today by Public Health – Seattle & King County, The Impact of Firearms on King County’s Children: 1999 – 2012, which documents the current risk of suicides and accidental shootings in King County and urges local leaders to promote safe storage:

  • More than 30,000 King County homes have a loaded and unlocked firearm.
  • More than 5,000 of King County’s children live in homes where firearms are loaded and unlocked.
  • The risk of a youth suicide in King County is nine times higher in homes where firearms are kept unlocked, compared to homes where firearms are locked.

“Protecting our communities from gun violence is one of our top priorities. Making it easier for people to safely store a gun helps us reach that goal,” said Seattle Mayor Mike McGinn.

How the partnership will reach out to gun owners

The “Safe Storage Saves Lives” campaign features the LOK-IT-UP website and key partners who will expand the use of safes and lockboxes:

  • Retailers will offer 10 to 15 percent discounts on select firearm-storage devices when they mention LOK-IT-UP or Public Health from November 25, 2013 through the end of 2014. Retailers will also distribute information about how to store a firearm safely.
  • Law enforcement agencies will promote locking devices to anyone seeking a Concealed Pistol License or visiting their customer service desks. Officers and deputies will also promote safe storage at community events.

“We are thrilled to have firearm retailers involved in the safety message, and we hope this partnership helps change the norms around storing firearms,” said Dr. David Fleming, Director and Health Officer for Public Health – Seattle & King County.

Participating retailers include national chains such as Sports Authority and Costco, along with prominent local stores.

“We are glad to partner with King County to offer reduced-price safe-storage devices to make it easier for gun owners to make their homes and communities safer – and protect their investment, too,” said Mike Coombs, co-owner of Outdoor Emporium, Sportco and FARWEST Sports.

A secure lockbox can prevent thefts as well as suicides. Last year, more than $4.5 million worth of firearms were reported stolen in Washington state, according to the Washington State Association of Sheriffs and Police Chiefs.

“It’s time for lockboxes and gun safes to become as normal as wearing a seatbelt – which would reduce firearm thefts and prevent school-based threats. That improves community safety,” said King County Sheriff John Urquhart.

Law enforcement officers all too often are the first-responders who witness tragedy when firearms are left loaded and unlocked – and a curious or impulsive child is nearby.

“I have never forgotten when I responded to a 9-1-1 call and found a boy had unintentionally shot and killed his best friend with a rifle they were playing with and thought was unloaded,” said Bothell Police Chief Carol Cummings. “What was so tragic to me was that this death could have been averted by safely storing the firearm.”

Developing innovative strategies using a data-driven public health approach

In his State of the County address earlier this year, Executive Constantine directed Public Health – Seattle & King County to develop innovative strategies to reduce gun violence using a data-driven “public health approach,” a process that’s proven effective with other safety and prevention challenges, such as automobile and boating safety. Key facts from the report include:

  • Between 1999 and 2012, 68 children in King County under the age of 18 died from gun violence, and 25 of those were suicides.
  • Another 125 children were injured by firearms and had to be hospitalized.
  • In King County, nearly one-quarter of all households have at least one firearm, and among those with firearms, an estimated 17% (31,200 households) stored them loaded and unlocked.
  • During the 2011–2012 school year, 52 King County students were suspended or expelled for possessing a firearm on public school grounds.

The report also finds that further progress on reducing firearm violence is hampered by scattered and incomplete data on gun violence, especially pertaining to children.  Basing new policies and programs on data and evidence will depend on creating new systems for sharing data across agencies.

In the meantime, the report says safe storage is an important first step toward eliminating firearm deaths among King County’s youth. Research has shown that parents can become complacent as their children get older and don’t realize it could be their child or a friend who accesses their firearms.

“We want gun retailers to talk as much about safe-storage as a car dealer talks about the air-bags and safety features in a new car,” said Dr. Fleming.

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Teens and steroids: a dangerous combo

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anabolic steroids DEA

Contraband anabolic steroids seized by the Drug Enforcement Agency. (Photo: DEA)

US Food and Drug Administration
Consumer Update

The abuse of anabolic steroids can cause both temporary and permanent injury to anyone using them.

Teenagers, whose bodies are still developing, are at heightened risk. An alarming number of them are trying steroids in hopes of improving their athletic prowess or their appearance.

Ali Mohamadi, M.D., a medical officer in the Food and Drug Administration’s Division of Metabolism and Endocrinology Products, warns teens and parents about the dangers of steroid use.

Q: What are anabolic steroids and how many teens use them?

A: They are drugs that mimic the actions of the male sex hormone testosterone. This includes promoting the growth of cells, especially in muscle, and maintaining or increasing male physical characteristics. Various studies have been conducted and generally reflect the findings of a Youth Risk and Behavior Surveillance System study, which estimated that among U.S. high school students, 4.9% of males and 2.4% of females have used anabolic steroids at least once in their lives. That’s 375,000 young men and 175,000 young women.

Q. What are the side effects of taking anabolic steroids?

A: They are known to have a range of serious adverse effects on many organ systems, and in many cases the damage is not reversible. They include fertility problems, impotence, high blood pressure and cholesterol, and heart and liver abnormalities. Boys may experience shrinkage of the testes or the development of breast tissue; girls may experience menstrual irregularities and development of masculine qualities such as facial and body hair. Both may experience acne. Both boys and girls may also experience mood swings and aggressive behavior, which can impact the lives not only of those taking steroids, but of everyone around them.

Q: Are prescriptions needed to get steroids?

A: Yes, in fact anabolic steroids are classified as Schedule III Controlled Substances by the U.S. Drug Enforcement Administration with strict regulations, meaning that not only is a prescription required, but there are extra controls. For example, it is illegal to possess them without a prescription in the United States, and in most circumstances the prescription must be in written form and cannot be called in to a pharmacist. Labels on some steroids recommend testing of hormone levels during use.

The number of FDA-approved uses is limited. Most are prescribed as a replacement for sub-normal levels of steroids. They are also prescribed for conditions such as muscle wasting, poor wound healing, and very specific pulmonary or bone marrow disorders.

A health care professional can prescribe steroids off-label, meaning for conditions other than those that are FDA-approved. But children, particularly teens, are getting access to steroids and taking them for reasons far outside of their intended use.

Q: So how are teens getting access?

A: Some get prescriptions from a licensed practitioner for such purposes as introducing puberty to boys who are “late bloomers” or to stimulate growth among teens who are failing to grow. Some may be dealing with unscrupulous clinics or street dealers on the black market. Unfortunately, a number of vendors sell anabolic steroids online without a prescription. Individuals should also be aware that some dietary supplements advertised for body building may unlawfully include steroids or steroid-like substances, and the ingredient statement on the label may not include that information.

Q: What is the FDA doing to prevent those illegal sales?

A: FDA is taking a number of steps to discourage these practices. Action has been taken against illegal online distributors who sell steroids without valid prescriptions, but an ongoing problem is that you can take one site down and another pops up.

The challenge is intensified by the fact that many online providers don’t accurately advertise the contents of the products they sell, they may be operating outside the U.S., and the drugs aren’t prescribed by a licensed practitioner who can help individuals weigh the risks and benefits. In such cases, individuals may have no idea what they are taking, what the appropriate dose should be, or what levels of control and safety went into the manufacturing process. These facts make the risks of taking anabolic steroids bought without a prescription even greater than they otherwise would be.

Q: What would you say to a teen you knew was tempted by steroids?

A: I would emphasize both the short and long-term potential for serious harm to their health. Rather than making you look or perform better, steroids will more likely cause unfavorable results that could affect you for life. I would also remind them that there are a number of ways to increase muscle mass and athletic performance, including a sensible regimen of exercise and diet, without resorting to extreme and dangerous therapies.

Q: What would you like to say to parents?

A: Parents tend not to believe their teens would consider taking anabolic steroids, but the truth is that the frequency of steroid use in this age group is far greater than many would guess.

During this time of year, when children are in school and getting back into their athletic routines, parents should watch for potential signs of abuse. Mood swings are among the first side effects to show up, and steroid use may lead to mania or depression. Acne is also an early side effect and can be followed by breast development in boys or increased body hair in girls. A surprising gain of muscle mass should also raise questions. It’s a problem that is as real as it is surprising.

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Nov. 4, 2013

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Pedestrian injuries on the rise amongst teens due to inattention

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Walklight_phasesFrom the Washington State Department of Health

Inattention can be just as dangerous for pedestrians as it is for drivers. And as more teens tune into music, text, and check the Internet while on the go, they’re tuning out potential hazards — prompting the state Department of Health to ask kids to tune out those devices.

Nationally, pedestrian injuries among 16 to 19-year-olds have increased 25 percent in the past five years according to Safe Kids, which works to prevent accidental injuries to children. That late-teen group accounts for half of all pedestrian deaths among youths 19 and younger.

A new Safe Kids study of more than 34,000 middle and high school students showed that of those who were distracted, about 40 percent were texting, about 40 percent were wearing headphones, and 20 percent were talking on phones.

From 2006 to 2010, the most recent period for which figures are available, Washington had 43 teen pedestrian deaths, ranking number 18 among the 37 states with more than 10 such deaths. It’s close to the national per capita average.

“Those texts and calls can wait, and kids can listen to music at other times,” said State Health Officer Dr. Maxine Hayes, a pediatrician. “It’s more important to walk safely. And if you’re driving, of course, keep your eyes on the road and your hands on the wheel.”

With daylight saving time nearing an end for the year, it’s darker outside when many teens go to or from school. That makes it even more important to pay close attention while walking.

Safe Kids Washington suggests that parents talk to kids, especially teens, about the danger of distracted walking. Start the discussion early about safe use of technology — and keep talking about it. Parents can set a good example by showing what crossing the street safely looks like, and by avoiding texting while driving and other distractions.

Teens should put devices down and turn headphones off; look, listen, and make eye contact with drivers before crossing a street. They should also be on the lookout for cars that are turning or backing up. Driveways and parking lots can be especially dangerous.

Other safety tips for teens while walking:

  • Use sidewalks or paths, and cross at street corners with traffic signals and crosswalks when possible.
  • Be aware of others who may be distracted — and speak up when you see someone who is distracted.

Some Washington kids already get the message. The Rams in Action Club at Lacey’s North Thurston High School won the Safe Kids Worldwide Pedestrian Safety high school contest for its members’ work to educate peers.

Illustration courtesy of Brett Caven

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