Don't Fix What Ain't Broke

One of the major political and public health issues facing our country today is Children’s Health Insurance. There has been a big push to cover all children in the US. It would be huge if we could figure out how to provide adequate and equal access to health services for all American children.

In recent years, there’s been some forward progress. But I learned recently that some states, such as North Carolina, are looking to take a big step backward by cutting school-based dental programs for children.

According to the CDC (www.cdc.gov) and ADA (www.ada.org), findings from several scientific studies show that school-based sealant programs work. These programs reach children at high risk for tooth decay, especially those who don’t have access to private dental care. Why would a state see an effective program as expendable?

Here’s why states should NOT cut school-based dental services:

1. According to the CDC, tooth decay (dental disease) is the most common health problem for school-aged children.

2. According to the state oral health survey in North Carolina, 1 in 4 children entering kindergarten show obvious signs of tooth decay. In many states, the percentage of 3rd graders with untreated tooth decay is upwards of 44%!

3. Recent studies conducted by researchers at Harvard and the University of Puerto Rico found a link between periodontal disease and obesity. These findings also have implications for links between oral health and heart disease and type 2 diabetes. Therefore, we ought to think of school-based dental services as preventive health services that extend beyond the teeth.

I’m not an economist, I’m a health educator. Do I understand that states have budget shortfalls? Yes. Do I understand why a state would cut a program that is effective and is good for the health of its future workforce? No. In my opinion, the economic returns of keeping a program of this nature far outweigh the costs…

Healthiest Nation in One Generation

I think this little video is very clever - check it out!



To find out more, visit http://www.generationpublichealth.org/

Travel Woes

I’ve finally returned from a long week of travel. After 8 flights and 6 airports, I’m thankful to be back to my stomping grounds.

In traveling, I only saw a handful of people wearing masks covering their mouths and noses. I had been expecting more based on the swine flu media frenzy. Of course, it’s unclear whether these mask-donning folks were trying to avoid swine flu, allergy or respiratory disease sufferers, or immuno-compromised.

Perhaps all air travelers should wear masks since international hubs like Dulles pack a lot of people in small terminals and the recycled air on planes may make us all more susceptible to infection.

If I had a nickel for every time someone told me they got sick after air travel, I’d be a millionaire. But the looming question is “why?” Why does air travel make us sick? I’ve already mentioned recycled air and small terminals, but I think there are key mistakes travelers make that cause them to be more susceptible to illness.

• Not drinking enough water. The truth of the matter is when you fly on an air plane you become dehydrated. Staying hydrated may help you avoid upper respiratory and GI illness.

My suggestion: bring a water bottle with you on the plane. The flight attendants can only provide you with so much water on a flight, so bring your own. Yes, it means you may have to ask your neighbor to move so you can get to the lavatory, but trust me, it’s worth it.

• Not eating enough or healthful foods. Many travelers choose to not keep a regular meal schedule when traveling. Yes, airport food prices are expensive, but not getting the calories and nutrients you need for your body to properly function can be detrimental to your health.

My suggestion: bring snacks from home. Many travelers are under the impression that you are not allowed to bring outside food through security. Well, this is not a movie theater, and that rule never stopped you before. Granola bars, nuts, and dried fruit hold up really well and will also provide nutrition that will help keep you “regular”.

• Being stressed out. I get it. Air travel is a stressful thing. Between rushing to a connecting flight, delays, lost baggage, and squishing into a tight space between strangers, air travel can be a major trigger of elevated blood pressure and anxiety. Did you know that elevated stress levels are related to weakened immune functioning? It has to do with elevated hormone (Cortisol) levels and inflammation and little things called cytokines. It’s kind of complicated so I won’t explain in detail, but all you need to know is that stress can make you susceptible to disease.

My suggestion: deal with your stress! I know, easier said than done. Try some deep breathing in your seat. Close your eyes and focus on how your stomach expands and contracts with every breath. Take a walk in the terminal or find a space to do some stretches. Exercise is a great way to combat stress, not to mention it feels great to stretch your legs after sitting for several hours.

If you have any travel tips for avoiding illness, please comment!

May is Asthma Awareness Month!

Did you know that asthma is the most common chronic disease among children? Approximately 6.7 million children are currently living with asthma in the United States (CDC, 2009). Asthma disproportionately affects:

• African Americans
• People with lower income
• People living in urban areas

Unfortunately, children with asthma must live with this condition for their entire lives. If asthma is poorly controlled, it can lead to:

• Restricted activity
• More sick days (from school or work)
• Emergency room visits
• Decreased quality of life

However, if asthma is properly and effectively controlled, children with asthma can live healthy and active lives no different from children without asthma. Here are some tips for helping your child control his or her asthma and avoid hospital visits:

• Visit the doctor regularly
• Develop an asthma action plan with your primary care provider
• Make sure your child regularly takes any prescribed asthma controller medication
• Always carry a rescue inhaler wherever you and your child go
• Identify your child’s asthma triggers (e.g. dust mites, mold, pets, pollen, cigarette smoke, etc.)
• Help your child avoid contact with their asthma triggers

*Note: If your child experiences an asthma attack that cannot be alleviated by a rescue inhaler, take them to the emergency room immediately.

These tips may seem simple, but in practice, they carry some degree of difficulty and I’ll tell you why. Controlling a child’s asthma often relies on a behavior change with the parent or other members of the household. This can include reminding a child to take their medication, quitting smoking, regular cleaning, or getting rid of a pet. As with any behavior change, there are a number of internal and external factors that come into play, such as time, motivation, and social support.

I once worked on an asthma control pilot study targeting children with asthma and their caregivers who lived in rural mountain areas of North Carolina and were on Medicaid. Participants came in and developed an asthma action plan and a set of short-term goals related to reducing asthma triggers with their health care provider. Participants were supposed to return one and three months later for follow-up on their goals and other variables, such as use of rescue inhaler and emergency room visits. But participants never returned . When we found out why, it primarily came down to lack of finances, time, and knowledge.

· Follow-up visits required a parent to take off work – they could not afford to take time to not work

· Follow-up visits required round-trip drive times of up to 2 hours due to the mountainous, rural landscape

· Parents did not see a reason to bring their child into the doctor for follow-up if the child was not experiencing any immediate asthma complications

But there’s hope! There is some recent research regarding caregiver behavior change. A study published in the Archives of Pediatric and Adolescent Medicine in March 2009 by Fisher, et al showed that asthma coaches were effective in reaching low-income parents of African American children (http://archpedi.ama-assn.org/cgi/content/abstract/163/3/225 ). Asthma coaches consisted of trained community members who provided information and social support by regular contact (monthly or bi-weekly) with parents over a two year time period. As a result, parents who had regular contact with asthma coaches experienced 50% less hospitalizations among their children compared to a control group.

There are two things I’d like you to ponder:

1. Our choices and health behaviors as parents can have a significant impact on the health status of our children.

2. Could social support be the key ingredient that’s been missing from the medical model?

Hmmm...