Children's health

New HPIO publication details strategies to prevent adverse childhood experiences

Aces4_Fig9Standalone
A new publication
from the Health Policy Institute of Ohio details the state’s progress in taking action on four key evidence-informed strategies to prevent adverse childhood experiences (ACEs): Early childhood education, early childhood home visiting, medical-legal partnerships and family income supports.
 
“Ensuring a strong start for children and strengthening economic supports for families both contribute to making sure that every child in Ohio has the opportunity to reach their full health potential” the publication states.
 
Among the findings in the brief are that the need for home visiting services is greater among groups of Ohioans most at risk for childhood adversity (as illustrated in the graphic above). For example, while 38.2% of Hispanic children, ages 0-5, in Ohio were exposed to ACEs, only 8.7% of the pregnant women and primary caregivers receiving ODH- and ODM-funded home visiting services were Hispanic in Federal fiscal year 2021.
 
The publication released today is the first of three examining opportunities to prevent ACEs in Ohio. ACEs are potentially traumatic events that occur during childhood and can generally be grouped into three categories: abuse, household challenges and neglect. 
 
In 2020 and 2021, HPIO released a series of policy briefs on the health and economic impacts of ACEs and elevated 12 evidence-based, cost-effective strategies (programs, policies and practices) that prevent ACEs before they happen and improve health. HPIO’s new series is focused on analyzing the implementation status of these strategies in Ohio.
 
HPIO’s previous research found that Ohio can eliminate more than $10 billion in annual healthcare and related spending attributable to ACEs exposure.


CDC: Teen vaping rising again after pandemic drop

The latest government study on teen vaping suggests there’s been little progress in keeping e-cigarettes out of the hands of high school students (Source: “New survey suggests little progress against U.S. teen vaping,” Associated Press, Oct. 7).
 
The new data from the Centers for Disease Control and Prevention seems to show more teens are vaping, with 14% saying they had done so recently, according to survey results released Thursday. In last year’s survey, about 11% said they had vaped recently.
 
But experts cautioned that a change in the survey makes it difficult to compare the two: This year, a much higher percentage of participants took the survey in schools, and vaping tends to be reported more in schools than in homes.
 
Despite its persistence, vaping appears to be less popular than it was: In 2019, 28% of high schoolers said they had recently vaped.


Four of five pregnancy-related deaths are preventable, CDC finds

Eighty percent of pregnancy-related deaths, including those caused by opioid overdose, excessive bleeding, heart problems and infections, are preventable, according to a new federal report (Source: “Majority of pregnancy-related deaths can be prevented, CDC says,” WKSU radio via WOSU, Sept. 27).

According to the report from the Centers for Disease Control and Prevention, the leading underlying cause of death varied by race and ethnicity. Cardiac and coronary conditions were the leading underlying cause of pregnancy-related deaths among non-Hispanic Black people, mental health conditions were the leading underlying cause for Hispanic and non-Hispanic White people, and hemorrhage was the leading underlying cause for non-Hispanic Asian people.

Earlier this year, the CDC released a report highlighting evidence-informed state strategies for preventing pregnancy-related deaths.


Graphic of the week

HomeVisitingUnmetNeed_StandaloneGraphic_09.23.2022

A critical aspect of preventing adverse childhood experiences (ACEs) is ensuring that children have a strong start in life and home visiting is a key prevention strategy.

According to an estimate from the Ohio Department of Health, more than 83% of Ohioans who need home visiting are not enrolled in a program identified as “evidence-based” by the U.S. Department of Health and Human Services Home Visiting Evidence of Effectiveness (HomVEE) review (as illustrated in the graphic above).

Analysis from HPIO has found that home visiting programs are an evidence-based, multi-generational strategy proven to prevent and mitigate the impacts of ACEs. Trained providers (home visitors) visit expectant parents and families with infants and young children, providing one-on-one support for healthy parent and child development, early education and family needs. Participation in home visiting programs is typically voluntary.

These findings will be included in a new policy brief that HPIO plans to release next month as part of its Ohio ACEs Impact project.


Uninsured rate for children dropped during pandemic, federal data shows

The rate of children without health insurance declined during the COVID-19 pandemic, likely the result of a provision passed by Congress that barred states from dropping anyone from Medicaid during the public health emergency (Source: “More Children Have Gained Health Insurance During Pandemic,” Pew Stateline, Sept. 21).

According to an analysis of new U.S. Census Bureau data by Georgetown University’s Center for Children and Families, the child uninsurance rate in 2021 was 5.4%, compared with 5.7% in 2019, the year before the pandemic took hold.

The center described that change as a “small but significant decline,” equating to 200,000 more children with health insurance in 2021 than in 2019. Overall, about 4.2 million children were uninsured in 2021, according to the analysis.

The data comes from the Census Bureau’s American Community Survey, which provides annual estimates of income, education, employment, health insurance coverage and housing costs and conditions for U.S. residents. The Census Bureau did not release standard results in 2020 because of difficulties in data collection in the pandemic’s first year.

The Georgetown analysis speculated that the downward trend in child uninsurance was the result of Congress’s provision in the Families First Coronavirus Response Act, passed in March 2020, that prohibited states from involuntarily dropping anyone from Medicaid, the health plan covering lower-income Americans.


CMS proposes rule change to simplify Medicaid, CHIP enrollment

A proposed federal rule change was introduced last week that aims to make the Children’s Health Insurance Program (CHIP) and Medicaid enrollment easier (Source: “Proposed CMS rule would streamline Medicaid, CHIP enrollment,” Healthcare Dive, Sept. 1).

The Centers for Medicare and Medicaid Services on Aug. 31 issued a proposed rule with the goal of reducing coverage gaps by streamlining the application and renewal process for Medicaid enrollees and other programs such as CHIP by limiting renewals to once a year, establishing standardized statewide renewal processes and giving applicants 30 days to respond to information requests.

The proposed rule comes as states begin to notify Medicaid beneficiaries about potential losses of coverage due to the impending end of the COVID-19 public health emergency.

Earlier this year, HPIO released an Ohio Medicaid Basics update, Trends in Enrollment and Expenditures During the COVID-19 Pandemic, that provides information on enrollment and spending changes to the Ohio Medicaid program during the pandemic.


Ohio infant mortality rates dropped in 2020, new ODH report finds

Ohio saw a slight dip in its infant mortality rate in the first year of the COVID-19 pandemic, according to new 2020 data released by the Ohio Department of Health (Source: “State report: Ohio infant mortality rate 'lowest it has been in past decade',” Columbus Dispatch, Aug. 19).

According to the ODH report, there were 6.7 infant deaths per 1,000 live births in 2020, down from 6.9 the year prior. Black infants specifically saw a bigger decrease in that time frame, from 14.3 deaths per 1,000 births to 13.6, which is 2.7 times the rate of white infants. In total, 864 infants died before their first birthday in 2020.

The new infant mortality rate is "the lowest it has been in the past decade," according to the report, but it's still far above from the 2028 target of 6 or fewer deaths per 1,000 births for every racial group that was set out in the 2020-2022 State Health Improvement Plan.

"Racial and socio-economic inequities persist," the report acknowledged. "The infant mortality rate not only serves as a key indicator of maternal and infant health but is also an important measure of the health status of a community."


CMS approves Ohio Medicaid coverage extension for new moms

Federal officials have approved Ohio Medicaid’s plan to extend benefits for new mothers from 60 days to 12 months after the birth of their child (Source: “Ohio Medicaid extends postpartum coverage for new mothers,” Dayton Daily News, Aug. 17).

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), on Tuesday approved the state’s request to extend the coverage.

“Maternal health is a strong predictor of a child’s health, so by extending health coverage for new moms, we are helping to provide the healthiest possible start in life for Ohio’s children,” said Gov. Mike DeWine.

The American Rescue Plan Act (ARPA) provided the option for states to expand this Medicaid coverage for new moms from 60 days to 12 months. The state of Ohio’s budget included this expanded coverage in its portion of Medicaid funding. DeWine said the state of Ohio began this extended coverage on April 1 and CMS’s final approval is the last step to continuing those services.


Study finds race, ethnicity are seldom mentioned in pediatric clinical guidelines

Race and ethnicity were unexplored in most American pediatric clinical practice guidelines published in the last 5 years, according to the results of a systematic review (Source: “Race unexplored in most pediatric clinical care guidelines, review finds,” Helio, June 13).

According to the study, which was published in JAMA Pediatrics, 70% of the guidelines did not mention race or ethnicity at all. The researchers also found that when race or ethnicity was mentioned, 57% of the time it was used in a way that could exacerbate or have a negative impact on inequities and only 15.1% of clinical practice guidelines include language specifically intended to reduce disparities in medicine.

“I think that shows a missed opportunity for us as medical organizations to be proactive in talking about health care inequities and systemic racism in our field,” said Courtney A. Gilliam, MD, a member of the division of hospital medicine in the department of pediatrics at Seattle Children’s Hospital and a co-author of the review. “We have a long way to go in interrogating clinical practice guidelines.”


Ohio set for rollout of COVID vaccines for children younger than 5

With federal approval of pediatric COVID-19 vaccines expected soon, vaccine providers in Ohio have begun placing orders for vaccines for children less than 5 years old, and the first deliveries are expected on Monday, state health officials said (Source: “Ohio ready for rollout of pediatric COVID-19 vaccines when approved, state health official says,” Cleveland.com, June 16).

“The one group that has still been waiting has been our youngest children, those less than 5 years of age and now that appears likely to change,” Ohio Department of Health director Dr. Bruce Vanderhoff said Thursday in a press briefing.

The vaccine advisory committee to the U.S. Food and Drug Administration recently voted unanimously to recommend approval of Pfizer’s application for a vaccine for those ages 6 months through 4 years old. Moderna has applied for a COVID-19 vaccine for ages 6 months through 5 years old.

Next, FDA leadership is expected to issue its approval. On Friday and Saturday, the U.S. Centers for Disease Control and Prevention advisory committee will meet to make recommendations for the vaccines’ uses. The CDC director must then approve the committee’s recommendations.