Category Archives: Health

Community environments protect against child maltreatment

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On November 19, an international coalition of NGOs used World Day for Prevention of Child Abuse to host events about and bring attention to a threat faced by children all over the world. While most child abuse and neglect prevention strategies focus on parents – by educating them on parenting methods or treating underlying risk factors such as alcohol abuse – this coalition instead addresses the wider culture. This strategy holds that a supportive community can lead parents to make better parenting choices and can help them overcome challenges, whereas negative societal influence can overwhelm even well-intentioned parents.
In the latest The Future of Children volume, Preventing Child Maltreatment, one article looked at the community’s role in preventing child abuse from taking place. The authors found that social environment affects norms about appropriate child-raising behaviors and the acceptability of parents seeking external support when encountering challenges. In addition, positive interactions between neighbors increase the likelihood that parents will feel responsible for and act to protect all children in the neighborhood, whereas isolating and unfriendly neighborhoods may increase parental stress and their tendencies to neglect or mistreat their children. Formal community services can improve parents’ mental health and parenting capabilities and provide temporary relief from parental responsibilities.
The article highlights some innovative community programs that are designed to change a community’s atmosphere and norms to reduce child maltreatment. For instance, Triple-P in South Carolina has offered community-level information campaigns and parenting advice sessions through existing institutions such as child care centers and preschools. The Durham Family Initiative in North Carolina expands the availability of community services and uses outreach workers to build relationships in at-risk communities, address neighborhood needs, and build human capital through leadership and mentoring programs. Both these and other programs have shown promising results in reducing child abuse and neglect cases — suggesting that well-informed, well-equipped, and socially cohesive neighborhoods aid child wellbeing.
These programs face major challenges, however; costs can be significant, and changing behavior and investing in social networks can be difficult. In addition, more work needs to focus on which communities are most in need of such programs and most likely to benefit from them. Of course, individual factors play a major role in child maltreatment cases, so a community approach alone cannot solve problems of child abuse and neglect. Still, building up a supportive community is an important step toward protecting children.

Substance Abuse Treatment Alone Often Not Enough to Stem Child Abuse and Neglect

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Evidence linking alcohol and other drug abuse with child maltreatment, particularly neglect, is strong. But does substance abuse cause maltreatment? In a recent article in The Future of Children volume Preventing Child Maltreatment, authors Mark Testa and Brenda Smith found that co-occurring risk factors such as parental depression, social isolation, homelessness, or domestic violence may be more directly responsible than substance abuse itself for maltreatment. Interventions to prevent substance abuse–related maltreatment, say the authors, must attend to the underlying direct causes of both.

Research on whether prevention programs reduce drug abuse or help parents control substance use and improve their parenting has had mixed results, at best. The evidence raises questions generally about the effectiveness of substance abuse services in preventing child maltreatment. Such services, for example, raise only marginally the rates at which parents are reunified with children who have been placed in foster care. The primary reason for the mixed findings is that almost all the parents face not only substance abuse problems but the co-occurring issues as well. To prevent recurring maltreatment and promote reunification, programs must ensure client progress in all problem areas.
At some point in the intervention process, attention must turn to the child’s permanency needs and well-being. The best evidence to date suggests that substance-abusing parents pose no greater risk to their children than do parents of other children taken into child protective custody. It may be sensible to set a six-month timetable for parents to engage in treatment and allow twelve to eighteen months for them to show sufficient progress in all identified problem areas. After that, permanency plans should be expedited to place the child with a relative caregiver or in an adoptive home.
Investing in parental recovery from substance abuse and dependence should not substitute for a comprehensive approach that addresses the multiple social and economic risks to child well-being beyond the harms associated with parental substance abuse.
Drawn from “Prevention and Drug Treatment,” by Mark Testa and Brenda Smith.

Limiting Competitive Foods in Schools is Key to Combating Obesity

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Snap peas and lettuce are flourishing in the new White House garden, a project Michelle Obama hopes will call attention to American eating habits. The first family often leads both political and social trends, and child nutrition experts hope Michelle Obama’s influence translates into higher quality school food that helps prevent obesity. Upcoming legislation addresses a growing problem schools are facing: unhealthy foods and drinks impede student health, but they often contribute to school coffers.

School lunches heavily influence nutrition among children and youth. For this reason, The Future of Children addressed school meal programs in the Childhood Obesity issue. The National School Lunch program served 30.5 million school children a day in 2008. In schools participating in the program, sixty percent of children eat school lunches. The federal government heavily subsidizes these lunches and sets minimum nutrition standards that guarantee an adequate provision of protein, Vitamins A and C, calcium, and iron. Still, in many districts these lunches supply too many calories from fat and too few fresh fruits and vegetables. Even more problematic, some districts contract with private companies to sell competitive foods such as fast food in cafeterias and snack vending machines. “Pouring rights” – contracts with companies to sell soda in schools – are also popular. As a result, kids consume a huge amount of unhealthy food and drink items during the school day, and schools have no incentive to change because they benefit financially from the competitive food contracts.
Three significant challenges loom for nutrition advocates. First, school lunches should provide higher-quality food, including fresher produce. Second, the influence of competitive foods must be decreased. Finally, schools need money to afford more expensive food items and supplant income lost from the sale of competitive foods.
One way to bring more healthful food options into cafeterias is to raise standards on school lunches. The federal government’s proposal of one billion more dollars for the National School Lunch Program can reimburse schools for the costs of this improvement. Such national actions would ensure that all children can eat well at school, not just children in more health-conscious or wealthy districts that have already improved their lunch quality.
Moreover, schools should decrease their reliance on competitive foods contracts. The Child Nutrition Act, soon to be revised and reauthorized (House and Senate bills are currently in committee), can impose regulations that limit what outside foods or vending machines may be on school grounds. Ninety-eight percent of high schools have vending machines and such rules could decrease their ubiquity. On their own, schools can look to models in Maine, California, Minnesota, and Pennsylvania that replaced soft drinks with more healthful options, without losing revenue.
U.S. schoolchildren eat nineteen to fifty percent of their daily food while at school, and current regulations allow too much of this food to be unhealthy and fattening. Through increased standards and fewer competitive food contracts, we can make nutritious school lunches a reality for our children.

Social Marketing to Teens Thrives Through Web 2.0 Technology

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YouTube videos for a new public health campaign are going viral: the Boston Public Health Commission hopes its messages on sexual safety, disseminated through new internet media, will spread as markedly among city youth as sexually transmitted diseases have. As highlighted in the Boston Globe, this campaign understands that adolescents today are deeply entrenched in media sources that constantly bombard them with messages about how to live; rather than fighting against media exposure, Boston is responding with a positive message sent through the same channels.
The media is a ubiquitous presence in our lives, from radio to TV to the internet. American teens are particularly influenced by their access to the web, which offers chances both to absorb information from outside sources (“Web 1.0”) and to actively contribute to the internet’s offerings through social networking sites, videos, blogs, or message boards and forums (“Web 2.0”). By capitalizing on these many options that play such a large role in adolescent life, social campaigns such as the STI Prevention Drive in Boston can connect with teens on their own terms.
This concept has been explored in an article in Children and Electronic Media, “Social Marketing Campaigns and Children’s Media Use,” and the companion policy brief “Using the Media to Promote Adolescent Well-Being.” Both of these recognize the positive ways that online media can be used to promote healthy behaviors, and they detail successful Web 2.0 campaigns.
With internet available in schools, homes, and even on cell phones, preventing teens from viewing objectionable content is virtually impossible. Some have worried that teens’ web use will lead to more dangerous sexual behavior, including becoming sexually active at a younger age and being less cautious about disease and pregnancy prevention – issues that are explored in another FOC article, “Media and Risky Behaviors.” While such concerns are not unfounded, the designers of Web 2.0 media campaigns recognize that rather than prohibiting internet access, it is far more successful to fight fire with fire – using the same media that promote unhealthy behaviors to promote healthy ones.
While parental guidance and school programs can play a role in discouraging unhealthy behaviors, Web 2.0 media campaigns acknowledge the reality that adolescents are heavily influenced by their peers. The new Boston campaign uses YouTube videos generated by and starring teens, and it also recruits teens to spread the message through other forums, such as street theater and visual advertisements. By having the teens design the content, the messages are more accessible than if they were created and imposed on teens by adults.

Web 2.0 campaigns also offer social organizations increased potential for spreading their messages. For example, the Boston Public Health Commission will field anonymous Facebook questions to experts, allowing teens to ask and get information without embarrassment or social stigma. The internet allows for viral messaging as well – videos can be passed around through blogs, Twitter, emails, or even news coverage, greatly increasing their reach. Marketers know that casual but frequent exposure to a message makes consumers more likely to buy their products; Web 2.0 campaigns use the same methods to promote healthy lifestyle choices among teens.

Health Care Coverage for Adults Improves Children’s Health

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A new health care bill is taking form in Congress, setting off a national conversation about what an ideal health care plan for the country should look like. Two recent volumes of The Future of Children address the importance of health care for children: “Children’s Health and Social Mobility” in Opportunity in America, and “A Health Plan to Reduce Poverty” in The Next Generation of Antipoverty Programs.
The nation’s health care concerns are not just about coverage, but also about having healthier citizens – and healthy lifestyles begin in childhood. One way to increase child health is to increase their parents’ access to healthcare—parents who are proactive about their own health are often better at getting their kids preventative care too, rather than just going to hospital emergency rooms when problems emerge. Although nearly all children in families with incomes under 200 percent of poverty are eligible for either Medicaid or the State Children’s Health Insurance Program (SCHIP), the parents of these poor and near-poor children often lack health insurance.
Parents who leave welfare normally lose coverage after one year unless their employer provides it, and many employers of low-wage workers do not offer health insurance. As a result, many of the working poor and near-poor have no coverage at all, and the idea of losing Medicaid even discourages adults from working. More available and affordable health care would both remove this disincentive from work and benefit children’s health. Beyond increasing health care coverage for parents, a government plan should also educate parents as “the primary gatekeepers for their children’s health.” Even if health care is available, parents must learn how to make the best use of preventative care and medical information.
Health issues of low-income children have major consequences for both them and society at large. These children may miss more classes or be less able to concentrate on studies, ultimately making them less likely to stay in school. Education challenges and health issues persisting into adulthood may decrease earnings and socioeconomic status. This has wider consequences, as lower-income families may require more state support while contributing fewer tax dollars. In addition, education is often seen as “the great equalizer” and the means by which the American Dream operates, so if the poor health of lower-income children limits their social mobility then America may not be living up to its full promise. These situations are problems for all of society, not just those most directly affected, so health care reform that improves child health should be universally appealing.

Obesity Report Cards — A good idea or waste of money?

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As recently reported in The Boston Globe, Massachusetts Governor Deval Patrick has proposed a far reaching anti-obesity campaign in an effort to reverse the trend of growing waistlines. The initiative includes a proposal to provide “BMI Report Cards” to Massachusetts school children. Under this plan, public schools would be required to measure the height and weight of 1st, 4th, 7th, and 10th grade students and calculate their Body Mass Index (BMI) with this data to determine if a student is overweight. That information would be sent home with the student, along with detailed advice on proper nutrition and exercise.

According to a Future of Children article on the role of schools in obesity prevention, BMI Report Cards have shown some promise in school districts where they have been implemented, but they are not without controversy. In particular, if they are delivered in a vacuum without other environmental changes, they can be a wasted effort. Specifically, they must be part of a comprehensive approach that includes providing healthy food choices and eliminating junk food offerings in the schools, making health education part of the curriculum, providing quality physical education on a regular basis, and making time for recess.
These changes are not easy, as noted in our policy brief, “Fighting Obesity in the Public Schools.” But they must be part of the overall effort. Providing BMI Report cards while continuing to offer junk food in school or cutting recess and P.E. is not only counterintuitive, but potentially a waste of education dollars. In this time of drastic school budget cuts, we cannot afford to throw money at an effort that is unlikely to yield comprehensive benefits. Without a doubt, we need to address the issue of childhood obesity. But we need to do so holistically, realizing that providing information without a supportive environment in which to make needed changes is a waste of time and money.
For information on childhood obesity trends, see "Childhood Obesity: Trends and Potential Causes," Patricia Anderson and Kristen Butcher
For a comprehensive overview, see The Future of Children: Childhood Obesity

Teen Birth Rates on the Rise — Policies to Reverse Course

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As recently reported in USA Today, a report issued by the National Center for Health Statistics shows that between 2005 and 2006, the teen birth rate increased in 26 states, reversing a 14-year decline in teen birth rates. While states that historically had the lowest birth rates showed non-significant changes (New Hampshire, Vermont, Massachusetts, and Connecticut), states with already high teen birth rates (Arkansas, Mississippi, New Mexico, Texas) showed increases, leaving Mississippi with the highest rate of 68.4 births for every 1,000 female teen ages 15-19. Alaska showed the greatest increase in teen birth rates (up 19%), while the District of Columbia reported the most dramatic decline in rates (down 24%).

The numbers do not bode well for child wellbeing. In study after study, research has shown that children born and raised in single mother households are poorer than other children, and that other negative child outcomes follow. Children born to teen unmarried mothers, who often interrupt schooling to have their babies, are most vulnerable. A Hoffman and Foster study cited in a recent volume of the Future of Children volume on Poverty estimated that delaying childbearing among teens would increase median family income by a factor of 1.5 to 2.2, and reduce poverty rates by even more.

The policy goal, therefore, is to reverse course and return to the downward trend in teen pregnancy. But how do we do that? In their Future of Children article on this topic, Greg Duncan and Katherine Magnuson demonstrate that programs to prevent teen childbearing by reducing sexual activity and promoting contraceptive use have NOT been proven to be successful. More often than not, programs designed to postpone sexual behavior fail to delay its onset or reduce its frequency. Some more intensive interventions that provide mentoring and constructive after-school activities have had more positive results, but it is unclear whether these can be replicated on a larger scale.
Two other Future of Children authors, Paul Amato and Rebecca Maynard agree that the evidence on the effectiveness of programs is slim, and what we do know is not encouraging. However, they note that the programs have never truly been tested in an experimental setting. Therefore, they argue that schools should continue to offer health and sex education, starting no later than middle school, and that promising programs should be tested using the “gold standard” of research, where the comparison group is truly “treatment free.” Armed with good social science data, the federal government could provide school districts with tested curriculum models.
Since some teens, particularly low-income youth, still get pregnant despite access to contraception, we need to consider and challenge the social norms that have led to acceptance of teen child bearing. Education programs and public service campaigns (some of which are profiled in “Using the Media to Promote Adolescent Wellbeing") can support the message that nonmarital childbearing, particularly in the teenage years, is NOT an expected stage in life.
The investment in good, research based programs would be worth it. If a universal program initiative succeeded in cutting the teenage birth rate in half, the estimated return on the investment would be approximately 20 percent.
For more information, see