Marijuana use up in adults, not teens

Communities Count recently completed updating all health indicators, and has added some new ones.  Findings include:

  • Since recreational use of marijuana in Washington became legal in 2012, marijuana use increased among adults, but not among teens. [New indicator]
  • Substance use among teens: Teens’ self-reported use of alcohol, marijuana, painkillers, or other illegal drugs declined from 34% in 2004 to 24% in 2016, with significant declines across all race/ethnicity groups and regions. [New indicator]
  • Teens also reported declines in overall tobacco use (excluding e-cigarettes) and cigarette smoking. Among adults, cigarette smoking has declined across all regions, although the decline among South Region adults has stalled. In teens and adults, smoking rates for American Indians/Alaska Natives and Blacks are above the King County average.
  • Across all substance-use indicators (those listed above, plus teen and adult binge drinking), rates were higher for people who identified as lesbian, gay, or bisexual (LGB). The just-released LGBTQ Community Spotlight offers some context for this pattern, noting that LGB youth were more likely than heterosexual youth to report feeling unsafe at school and on dates, and to report that they had been bullied and that an adult had intentionally hurt them. These findings are consistent with established links between traumatic experience and substance use.
  • Since expansion of coverage through the Affordable Care Act, the percentage of King County adults without health insurance has dropped by half. However, 1 in 3 Latinos did not have coverage in 2017 – 8 times the rate for non-Hispanic whites and 3 times the rate for African Americans and Native Hawaiians / Pacific Islanders.

Recent updates have also been posted for disability, infant mortality, and adolescent birth.

 

Pediatricians urged to tackle poverty head-on

For the first time ever, The American Academy of Pediatrics (AAP) has issued a policy statement on poverty.  As affirmed by AAP President Benard P. Dreyer, “research shows that living in deep and persistent poverty can have detrimental health consequences that are severe and lifelong.”  Acknowledging that “almost half of young children in the United States live in poverty or near poverty,” the AAP has emerged as a strong advocate for programs and policies that improve health and quality of life for children and families living in poverty.

Pediatricians are being asked to do more than increase their awareness of poverty.  In the context of a family-centered medical home that coordinates strategies to address social determinants of health (poverty, for example), physicians are urged to:

  • Assess family financial stability (perhaps by asking if the family has trouble making ends meet at the end of the month).
  • Screen for risks for adversity (food insecurity, maternal depression, family instability, unemployment, frequent moves).
  • Identify family strengths that protect against adversity (secure attachment to caretakers; strong family and social connections; responsive, nurturing, and consistent parenting).
  • Coordinate care with community partners (such as those providing legal aid and job training, and addressing issues like food, energy, and housing insecurity).
  • Participate in programs that integrate behavioral health into primary care (Incredible Years and Triple P) and promote literacy (Reach Out and Read and the Video Interaction Project [VIP]).
  • Link families to community resources that support and assist families in need.
  • Advocate for programs/policies that buffer children against adverse effects of poverty. Examples include:
    • Earned Income Tax Credit (EITC)
    • Temporary Assistance for Needy Families (TANF)
    • Raising the minimum wage
    • Supports for quality child care and early childhood education
    • Access to comprehensive health care
    • Nutrition support such as WIC (the Supplemental Nutrition Program for Women, Infants, and Children), SNAP (formerly “food stamps”), and the National School Lunch Program
    • Home visiting programs such as the Nurse-Family Partnership

Does this go “above and beyond” what should be expected of a pediatrician?  The AAP affirms that it’s all in the line of duty:  prevention of childhood diseases – an accepted pediatric mandate – depends in part on “early detection and management of poverty-related disorders.”

Of course pediatricians cannot tackle poverty on their own. In King County, they can expect support from a wide assortment of community-based organizations and effective programs already in place. They should also be able to tap into the expertise and community networks that continue to evolve around regional efforts such as Communities of Opportunity and Best Starts for Kids, which are already aligned with the goals of the AAP’s war against child poverty.

For data on poverty-related indicators, see Communities Count updates on food, housing, income, qualification for free/reduced-price school meals, and the relationship between adult health outcomes and adverse childhood experiences.  Communities Count has recently added several years of data on student homelessness, making it easier to look at trends (by school district) from 2007-08 through 2014-15 school years.  For data on child, maternal, and adult health, see King County’s Community Health Indicators.

Resilience builds on early childhood experience.

A new report from the Robert Wood Johnson Foundation makes a strong case for early childhood as the best time to intervene for optimal social, emotional, intellectual, and yes, even health outcomes. Evidence continues to accrue supporting the effectiveness of early interventions – from the Nurse-Family Partnership to quality early childhood education programs. Until recently, we haven’t known much about the health benefits of these programs. This report brings us up to date with findings about reductions in teen pregnancy and alcohol consumption and, in adulthood, decreases in depressive symptoms and risks for heart disease and diabetes. Communities Count presents King County data on the relationship between adverse childhood experiences and adult health outcomes.

Early Childhood Key to Education & Health

In a New Public Health Q & A, the director of Virginia Commonwealth University’s Center on Society and Health goes beyond simplistic explanations of the stronger-than-ever link between education and health. He points out that “health education” is less important than economic opportunity, family-friendly benefits, and early childhood interventions that help children get on a path to success. See Communities Count data on links between education and adverse childhood experiences (ACEs), obesity, tobacco use, physical activity, and health insurance.