Charles N. Oberg

Adolescent Suicide: Risk Factors and Prevention Strategies

Suicide represents a major concern for pediatricians and other health professionals dedicated to ensuring the medical and psychological health and well-being of youth. Suicide remains the third leading cause of death for adolescents and is associated with a multitude of other significant mental health conditions and high-risk behaviors. Suicide and these comorbid factors contribute not only to mortality but to morbidities that affect the lives of adolescents and their families. There are many factors that increase an adolescent’s risk for suicide. These risk factors are categorized into individual, familial, sociodemographic, and life stressors. Each risk factor potentially increases the likelihood that an adolescent may attempt or commit suicide. Strategies to reduce the likelihood that an adolescent will attempt suicide can be seen in the context of a public health approach of primary, secondary, and tertiary prevention. Prevention strategies have been implemented to increase the recognition and referral of suicidal youth. Primary prevention strategies provide education and awareness to identify the risk factors associated with adolescent suicide. Secondary prevention strategies screen adolescents at risk and provide tools for adolescents, schools, and health providers to address these risk factors. Finally, tertiary prevention consists of treatment for those who attempt suicide to provide the necessary health, social service, and mental health services to assist the youth, the family, and the community in its healing and recovery. It is estimated that each day about 18 adolescents in the United States will succeed in taking their own lives. 1 This statistic highlights the present gap in the identification of adolescents at risk and the difficulty in implementing effective prevention strategies. Suicide is the third-leading cause of death among 15 to 19 year olds. 2,3 According to Beautrais, there has been a

Asthma and behavior in homeless 4- to 7-year-olds.

OBJECTIVE: Low-income, urban, ethnic minority children have higher rates of asthma, more severe symptoms, and more management issues, as well as high risk for academic and behavior problems. This study focused on asthma reported in young children who resided in a family emergency homeless shelter. Asthma rates were considered along with their relation to hospitalization and emergency department use and behavior that is important for school success, including cognitive function, conduct, and academic functioning. METHODS: A total of 104 children (age 4.0–7.5 years) and parents were recruited while residing in an urban emergency homeless shelter for families. Children had no previously identified developmental delays and spoke English proficiently. Parents reported whether the child experienced asthma, as well as emergency department use and hospitalization. Parents and teachers completed measures of child inattention/hyperactivity and behavior problems. Cognitive function of children was directly assessed. RESULTS: Asthma was reported for 27.9% of children, ∼3 times the national average. Children with asthma had been hospitalized more often, showed higher levels of inattention/hyperactivity and behavior problems, and evidenced lower academic functioning. CONCLUSIONS: Young children in homeless family emergency shelters have high rates of asthma and related problems that could lead to higher hospitalization rates, more behavioral problems, and lower academic functioning at school. Screening and treatment of children who stay in emergency family shelters may be particularly important for reducing risks associated with asthma in highly mobile, low-income families.

Peanut allergy diagnoses among children residing in Olmsted County, Minnesota

BACKGROUND Peanut allergy is a major health concern, particularly in developed countries. Research indicates that as many as 2% of children are allergic to peanuts, which represents a 3-fold increase in diagnoses over the past 2 decades. OBJECTIVE This population-based descriptive study used the Rochester Epidemiology Project to estimate the prevalence in 2007 and annual incidence rates of peanut allergy diagnoses from 1999 to 2007 among children residing in Olmsted County, Minnesota. METHODS Residents of Olmsted County from January 1, 1999, through December 31, 2007, who received medical care at a Rochester Epidemiology Project facility and provided research authorization were eligible for the study. A medical chart review of 547 potential diagnoses resulted in 244 prevalent and 170 incident cases. Annual rates, crude and adjusted for age and sex, were standardized with the use of the indirect method to the Olmsted County population data in 1999. Incidence rate ratios were estimated with Poisson regression. RESULTS The prevalence in 2007 was 0.65%. Female children were less likely to be diagnosed than male children (incidence rate ratio = 0.18; 95% CI, 0.07-0.48). Children aged birth to 2 years were significantly more likely to be diagnosed than older children aged 3-17 years (incidence rate ratio = 0.001; 95% CI, 0.0004-0.004). A significant 3-fold increasing trend was observed in diagnoses over time from 2.05 cases per 10,000 children in 1999 to 6.88 cases per 10,000 in 2007. CONCLUSIONS Peanut allergies are an increasing concern in Olmsted County, Minnesota, as indicated by a 3-fold increase in diagnoses from 2.05 per 10,000 children in 1999 to 6.88 per 10,000 children in 2007.

Prenatal care use and health insurance status.

Many observers explain the prevalence of inadequate prenatal care in the United States by citing demographic or psychosocial factors. But few have evaluated the barriers faced by women with different health insurance status and socioeconomic backgrounds. In this study of 149 women at six hospitals in Minneapolis, insurance status was significantly related to the source of prenatal care (p<.0001). Private physicians cared for 52 percent of privately insured, 23 percent of Medicaid-insured, and two percent of uninsured women. Public clinics were the primary source of care for Medicaid and uninsured women, who, compared to privately insured women, experienced longer waiting times (p<.001) during prenatal visits and were more likely (p<.01) to lack continuity of care with a provider. Multiple measures, including expanding Medicaid eligibility, may help correct these problems.

Asthma and Adaptive Functioning among Homeless Kindergarten-Aged Children in Emergency Housing

Background. Children who experience homelessness have elevated rates of asthma, a risk factor for other problems. Purpose. Examine rates of asthma and its relation to health care use and adaptive functioning among young children staying in family emergency shelters. Methods. Children and caregivers (N = 138) completed assessments in shelters, including measurement of child cognitive functioning, parent report of child health care service utilization and asthma diagnosis, and teacher report of child school functioning. Results. Asthma diagnosis was reported for 21% of 4-to-6-year-old children, about twice the national and state prevalences. Children with asthma used more health care services and had worse peer relationships. Asthma did not relate to cognitive test performance or subsequent academic performance, or to other behavior problems in school. Conclusions. High rates of asthma remain an important issue for children in emergency family housing, a context with high levels of child risk for toxic stress exposure and developmental problems.

The Association between Maternal Perception of Obstetric and Pediatric Care Providers’ Attitudes and Exclusive Breastfeeding Outcomes:

Background: Exclusive breastfeeding is recommended for 6 months. Successful breastfeeding requires support from family members, peers, and health care professionals. Objective: This study aimed to determine the association between maternal perception of the attitudes of obstetric and pediatric care providers about infant feeding during the neonatal period and exclusive breastfeeding at 1, 3, and 6 months. Methods: The study sample consisted of 1602 women from the Infant Feeding Practices Study II (2005-2007), a longitudinal study of women in the United States. Analyses included chi-square and Fisher’s exact tests and logistic regression models. Results: Mothers who perceived that the obstetric care provider favored exclusive breastfeeding were significantly more likely to exclusively breastfeed their infants at 1 and 3 months (odds ratio [OR] = 1.73, 95% confidence interval [CI], 1.33-2.24; and OR = 1.41, 95% CI, 1.09-1.80, respectively) as compared to mothers who perceived that the obstetric care provider was neutral about the type of infant feeding. Similarly, mothers who perceived that the pediatric care provider favored exclusive breastfeeding had higher odds of exclusively breastfeeding their infants at 1 and 3 months (OR = 1.53, 95% CI, 1.17-1.99; and OR = 1.51, 95% CI, 1.17-1.95, respectively) as compared to mothers who perceived that the pediatric care provider was neutral about the type of infant feeding. The association was no longer significant at 6 months. Conclusion: Maternal perception of obstetric and pediatric care providers’ preference for exclusive breastfeeding during the neonatal period is associated with exclusive breastfeeding until 3 months.

Childhood poverty and the social safety net.

Childhood poverty in the USA remains an issue that concerns the child, the family, the community, each state, and the nation. It also is a topic that pediatricians must become cognizant of because of the impact it has on the children we care for daily. It goes beyond the specific income threshold that sets the federal poverty level; rather it impacts on the ability of families to acquire lifes basic needs to allow their children the opportunity to reach their full potential. These basic needs include adequate nutrition to grow and develop in an optimal fashion and a secure and stable home in a safe neighborhood, which allows for play, exploration, and physical activity. It must also include access to health insurance coverage as well as a physician, health center, and health system to meet their medical needs. In addition, we must provide early education opportunities to nurture the social and emotional health of our children and prepare each child for school. The school environment must promote academic achievement and the broader community must foster opportunities to minimize violence and reduce the need for incarceration. The integration of such provisions represents a broadening and redefinition of the Social Safety Net that incorporates both public and private sector efforts to maximize the life potential of each child.

Adversity and children experiencing family homelessness: implications for health

ABSTRACT This study tests links between adversity and health problems among children in family emergency housing. Children who experience family homelessness are at risk to also experience high levels of stress, health problems, and need for pediatric care. Understanding the connection between stress and health holds the potential to reduce persistent health disparities. Analyses tested whether experiencing a greater number of stressful life events during the early years of life was related to worse health conditions, emergency health-care utilization, and hospitalizations. Parents noted children’s experience of negative stressful life events, health problems, emergency room (ER) use, and hospitalization. Two cohorts of kindergarten-aged children staying in emergency family housing participated in the study in 2006–2007 (n = 104) and in 2008–2009 (n = 138), with the results examined separately. In both cohorts, more health problems were acknowledged for children exposed to more negative stressful life events. Stressful life events were not related to ER use but did relate to hospitalization for the 2006–2007 cohort. Results affirm links between stress in early childhood and health problems among children living in emergency housing. Findings are consistent with the hypothesis that adversity in early childhood contributes to income and racial disparities in health.

Child Health Disparities in the 21st Century

The topic of persistent child health disparities remains a priority for policymakers and a concern for pediatric clinicians. Health disparities are defined as differences in adverse health outcomes for specific health indicators that exist across sub-groups of the population, frequently between minority and majority populations. This review will highlight the gains that have been made since the 1990s as well as describe disparities that have persisted or have worsened into the 21st century. It will also examine the most potent social determinants and their impact on the major disparities in mortality, preventive care, chronic disease, mental health, educational outcomes, and exposure to selected environmental toxins. Each section concludes with a description of interventions and innovations that have been successful in reducing child health disparities.

Children of genocide: a legacy of lost dreams.

Dr Janusz Korczak was a European pediatrician, educator, and childrens author from the first half of the 20th century. First as a pediatrician and then as a teacher he dedicated his life to impoverished and vulnerable children. He formed a progressive orphanage and school in Warsaw, Poland, during the 1930s to care for orphaned children of both Jewish and Catholic descent. In 1940, after the German invasion of Poland by the Nazis, Dr Korczak was ordered to close the orphanage. Instead, he moved the 200 to 300 Jewish children for whom he cared into the Warsaw ghetto and attempted to establish a safe haven within the turmoil, uncertainty, and fear of the new location. Eventually, the children were ordered to be relocated to the death camp of Treblinka. Despite being a Jew, because of his fame as Polands “old doctor” he was encouraged on several occasions to abandon the children and return to the Aryan side of Warsaw. He refused, and on August 6, 1942, he quietly marched with his children to the trains for relocation and eventually to death at the hands of the Nazis.1 His story and the fate of these children are but an example of the many silent others who attempted to protect men, women, and especially children from the ravages of the Holocaust. This commentary has three overall goals. The first is to encourage us to not think of genocide solely as a historical event such as the Holocaust but, rather, a persistent reality that requires constant vigilance and action as it transitions from our past into the current affairs of the 21st century. Second, to realize that as part of genocidal denial, we frequently forget that the burden of these atrocities is disproportionally placed on children. Finally, as pediatricians, to advocate by being … Address correspondence to Charles Oberg, MD, FAAP, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S Second St, West Bank Office Building, Suite 300, Minneapolis, MN 55454. E-mail: oberg001{at}umn.edu