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Abstract
Preventive pediatrics remains the foundation for pediatricians to offer benefits for future generations. Social conditions often complicate health status and bureaucracies pose challenges for families and children to navigate service systems. Therefore, it is crucial to emphasize a host of topics that children and families face in addition to highlighting opportunities for overcoming some of those challenges. In this issue, an array of authors will update pediatricians on the prevalence and management of chronic health and social conditions such as childhood poverty, youth violence, oral health, asthma, foster care, toxin exposures including tobacco, and childhood obesity. Promising interventions that pediatricians should continue to examine include: how pediatricians can advocate for breastfeeding as a wellness concept for working mothers in the workplace; promotion of childhood literacy development; maximizing immunization compliance; monitor the impact of public policy such as the Affordable Care Act (ACA) on children’s health; and how community health workers (CHWs) can be vital to community health improvement. Proposed interventions include a description of how the medical and legal partnership model can be an empowering strategy for families to address social determinants of health (SDH) when lawyers are included as a member of the health care team. In addition, pediatricians and all other child healthcare professionals must investigate epigenetic mechanisms that might predispose children to risk factors or good health outcomes.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Pediatric Prevention | i | ||
| Copyright\r | ii | ||
| PROGRAM OBJECTIVE | iii | ||
| TARGET AUDIENCE | iii | ||
| LEARNING OBJECTIVES | iii | ||
| ACCREDITATION | iii | ||
| DISCLOSURE OF CONFLICTS OF INTEREST | iii | ||
| UNAPPROVED/OFF-LABEL USE DISCLOSURE | iv | ||
| TO ENROLL | iv | ||
| METHOD OF PARTICIPATION | iv | ||
| CME INQUIRIES/SPECIAL NEEDS | iv | ||
| Contributors | v | ||
| CONSULTING EDITOR | v | ||
| EDITOR | v | ||
| AUTHORS | v | ||
| Contents | ix | ||
| Foreword: Pediatric Prevention\r | ix | ||
| Preface: Preventive Pediatrics Issues for Child Health Care Providers\r | ix | ||
| Breastfeeding and the Affordable Care Act\r | ix | ||
| Overcoming Challenges to Childhood Immunizations Status\r | ix | ||
| Childhood Poverty: Understanding and Preventing the Adverse Impacts of a Most-Prevalent Risk to Pediatric Health and Well-B ..\r | ix | ||
| Youth Violence Prevention and Safety: Opportunities for Health Care Providers\r | x | ||
| Systematic Review to Inform Dual Tobacco Use Prevention\r | x | ||
| Developmental Exposure to Environmental Toxicants\r | x | ||
| Childhood Asthma Management and Environmental Triggers\r | x | ||
| Children’s Oral Health Assessment, Prevention, and Treatment\r | xi | ||
| Epigenetics and Understanding the Impact of Social Determinants of Health\r | xi | ||
| Addressing Childhood Obesity: Opportunities for Prevention\r | xi | ||
| Legal Care as Part of Health Care: The Benefits of Medical-Legal Partnership\r | xii | ||
| Early Literacy Promotion in the Digital Age\r | xii | ||
| Children, Families, and Disparities: Pediatric Provisions in the Affordable Care Act\r | xii | ||
| Community Health Workers as a Component of the Health Care Team\r | xii | ||
| Foster Care and Child Health\r | xiii | ||
| PEDIATRIC CLINICS OF\rNORTH AMERICA\r | xiv | ||
| FORTHCOMING ISSUES | xiv | ||
| December 2015 | xiv | ||
| February 2016 | xiv | ||
| April 2016 | xiv | ||
| June 2016 | xiv | ||
| RECENT ISSUES | xiv | ||
| August 2015 | xiv | ||
| June 2015 | xiv | ||
| April 2015 | xiv | ||
| February 2015 | xiv | ||
| Foreword\r | xv | ||
| Preface\r | xvii | ||
| Breastfeeding and the Affordable Care Act | 1071 | ||
| Key points | 1071 | ||
| INTRODUCTION | 1071 | ||
| DISPARITIES IN BREASTFEEDING | 1072 | ||
| ROLE OF LEGISLATION | 1074 | ||
| PATIENT PROTECTION AND AFFORDABLE CARE ACT | 1074 | ||
| MEDICAID PROGRAM | 1078 | ||
| Traditional Medicaid | 1078 | ||
| Medicaid Expansion and Alternative Benefit Plans | 1079 | ||
| WOMEN, INFANTS, AND CHILDREN PROGRAM | 1079 | ||
| COMPARISON OF COVERAGE OF BREASTFEEDING ITEMS AND SERVICES | 1080 | ||
| Medicaid Breastfeeding Items and Services | 1082 | ||
| Women, Infants, and Children Breastfeeding Items and Services | 1082 | ||
| GAPS IN COVERAGE | 1086 | ||
| RECOMMENDATIONS | 1087 | ||
| REFERENCES | 1088 | ||
| Overcoming Challenges to Childhood Immunizations Status | 1093 | ||
| Key points | 1093 | ||
| INTRODUCTION | 1093 | ||
| BARRIERS TO IMMUNIZATION | 1095 | ||
| Provider/System Barriers | 1095 | ||
| Financial barriers | 1095 | ||
| Access to immunization | 1097 | ||
| Missed opportunities for immunization | 1097 | ||
| Family/Social Barriers | 1097 | ||
| Socioeconomic barriers | 1097 | ||
| Vaccine hesitancy | 1097 | ||
| RECOMMENDATIONS | 1099 | ||
| Provider/System Barriers | 1099 | ||
| Addressing financial barriers | 1099 | ||
| Improving access to immunization | 1099 | ||
| Decreasing missed opportunities for immunization | 1101 | ||
| Reminder recall interventions | 1102 | ||
| Expanded use of immunization information systems | 1102 | ||
| Legal requirements for immunizations: school requirements, vaccine mandates, and vaccine exemptions | 1103 | ||
| Family/Social Barriers | 1103 | ||
| Socioeconomic barriers | 1103 | ||
| Vaccine hesitancy | 1104 | ||
| SUMMARY/DISCUSSION | 1105 | ||
| REFERENCES | 1105 | ||
| Childhood Poverty | 1111 | ||
| Key points | 1111 | ||
| INTRODUCTION | 1111 | ||
| DEFINING THE EXTENT OF CHILDHOOD POVERTY | 1112 | ||
| THE IMPACT OF POVERTY ON HEALTH AND WELL-BEING | 1115 | ||
| Child Health | 1115 | ||
| Child Well-Being | 1115 | ||
| Learning and Development | 1115 | ||
| Exposure to Trauma | 1118 | ||
| Biochemical Mechanisms, Developmental Windows, and Adult Health | 1119 | ||
| PREVENTION OF CHILD POVERTY AND ITS ADVERSE EFFECTS ON HEALTH AND WELL-BEING | 1119 | ||
| A Prevention Framework for Action to Reduce Child Poverty and Its Harms to Health and Well-Being | 1120 | ||
| Primary Child Poverty Prevention: Public Advocacy and Leadership from Pediatricians | 1120 | ||
| Secondary Child Poverty Prevention: Preserving Health and Well-Being for Poor Children | 1122 | ||
| Tertiary Child Poverty Prevention: Healing the Harms to Child Health and Well-Being | 1124 | ||
| Engineering Pediatric Care and Practice for Child Poverty Prevention | 1124 | ||
| SUMMARY | 1126 | ||
| REFERENCES | 1127 | ||
| Youth Violence Prevention and Safety | 1137 | ||
| Key points | 1137 | ||
| INTRODUCTION | 1137 | ||
| YOUTH VIOLENCE OVERVIEW: SCOPE OF THE PROBLEM | 1138 | ||
| CHILDHOOD EXPERIENCES AND EXPOSURES: IMPACT ON YOUTH VIOLENCE POTENTIAL | 1140 | ||
| Risk Factors for Youth Violence Involvement | 1142 | ||
| Protective Factors Against Youth Violence Involvement | 1144 | ||
| Resilience and Youth Violence Prevention | 1144 | ||
| YOUTH VIOLENCE PREVENTION: BACKGROUND AND OPPORTUNITIES FOR HEALTH CARE PROVIDERS | 1145 | ||
| The Office Setting: Screening and Referral | 1146 | ||
| The Office Setting: Messages and Resources to Foster Resilience in Youth | 1151 | ||
| Advocacy and Collaboration Beyond the Office | 1155 | ||
| SUMMARY | 1155 | ||
| REFERENCES | 1155 | ||
| Systematic Review to Inform Dual Tobacco Use Prevention | 1159 | ||
| Key points | 1159 | ||
| INTRODUCTION | 1159 | ||
| MATERIALS AND METHODS | 1160 | ||
| Search Protocol | 1160 | ||
| Inclusion/Exclusion Criteria | 1161 | ||
| Coding Form | 1161 | ||
| Health Communication Intervention Development | 1161 | ||
| Marketing Execution | 1162 | ||
| Evaluation and Outcomes Reporting | 1163 | ||
| Study Quality | 1163 | ||
| RESULTS | 1163 | ||
| Summary of Reviewed Articles | 1163 | ||
| Types of Tobacco | 1164 | ||
| Communication Intervention or Campaign Development | 1164 | ||
| Marketing Execution | 1164 | ||
| Evaluation and Outcome Reporting | 1165 | ||
| Quality Scale | 1165 | ||
| DISCUSSION | 1166 | ||
| Achieving Consensus on Dual Use Definitions | 1166 | ||
| Applying Proven Tobacco Control Health Communication Strategies to Dual Use | 1166 | ||
| Use of Sound Research Design and Evidence of Impact on Behavioral Outcomes | 1167 | ||
| Recommendations for Future Research Agenda | 1168 | ||
| Limitations | 1169 | ||
| SUMMARY | 1169 | ||
| REFERENCES | 1170 | ||
| Developmental Exposure to Environmental Toxicants | 1173 | ||
| Key points | 1173 | ||
| OVERVIEW AND DEVELOPMENTAL ASPECTS | 1173 | ||
| Introduction | 1173 | ||
| The Epigenome | 1174 | ||
| Preconception | 1174 | ||
| The Fetus | 1175 | ||
| Newborns | 1175 | ||
| Infants and Toddlers | 1176 | ||
| Preschool and School-Aged Children | 1176 | ||
| Adolescents | 1177 | ||
| SPECIFIC ENVIRONMENTAL EXPOSURES | 1177 | ||
| Environmental Tobacco Smoke | 1177 | ||
| Sources of exposure | 1178 | ||
| Toxic effects | 1178 | ||
| Prevention strategies | 1178 | ||
| Ethanol | 1179 | ||
| Sources of exposure | 1179 | ||
| Toxic effects | 1180 | ||
| Preventive strategies | 1180 | ||
| Plasticizers | 1181 | ||
| Sources of exposure | 1181 | ||
| Toxic effects | 1181 | ||
| Preventive strategies | 1182 | ||
| Heavy Metals | 1182 | ||
| Sources of exposure | 1183 | ||
| Childhood Asthma Management and Environmental Triggers | 1199 | ||
| Key points | 1199 | ||
| INTRODUCTION | 1199 | ||
| EPIDEMIOLOGY | 1200 | ||
| Genetics of Asthma | 1200 | ||
| Hypotheses on the Origins of Asthma | 1201 | ||
| The hygiene hypothesis | 1201 | ||
| The vitamin D hypothesis | 1202 | ||
| The acetaminophen hypothesis | 1202 | ||
| ASTHMA PATHOPHYSIOLOGY | 1202 | ||
| Risk Factors and Natural History | 1203 | ||
| PREVENTION STRATEGIES | 1203 | ||
| Asthma Prevention | 1203 | ||
| Dust mite exposure and asthma development | 1203 | ||
| Respiratory tract infections and asthma development | 1204 | ||
| Environmental tobacco smoke and asthma development | 1204 | ||
| Asthma Exacerbation Prevention | 1204 | ||
| Dust mite and asthma exacerbations | 1204 | ||
| Cat allergen exposure and asthma exacerbations | 1205 | ||
| Cockroach exposure and asthma exacerbations | 1205 | ||
| Fungi and asthma exacerbations | 1206 | ||
| Dampness and asthma exacerbations | 1206 | ||
| Environmental tobacco smoke exposure and asthma exacerbations | 1206 | ||
| Asthma Exacerbation Prevention Strategies | 1206 | ||
| Asthma Trigger Remediation | 1207 | ||
| Dust mite | 1207 | ||
| Environmental tobacco smoke | 1207 | ||
| Integrated pest management | 1207 | ||
| Moisture and mold interventions | 1208 | ||
| REFERENCES | 1208 | ||
| Children’s Oral Health Assessment, Prevention, and Treatment | 1215 | ||
| Key points | 1215 | ||
| INTRODUCTION | 1215 | ||
| BARRIERS TO CHILDREN’S ORAL HEALTH | 1216 | ||
| EPIDEMIOLOGY OF DENTAL CARIES | 1216 | ||
| CARIES RISK ASSESSMENT | 1217 | ||
| PREVENTION OF DENTAL CARIES | 1218 | ||
| TREATMENT OF DENTAL CARIES | 1220 | ||
| INVOLVEMENT OF PEDIATRICIANS | 1222 | ||
| REFERENCES | 1222 | ||
| Epigenetics and Understanding the Impact of Social Determinants of Health | 1227 | ||
| Key points | 1227 | ||
| SOCIAL DETERMINANTS OF CHILD HEALTH | 1227 | ||
| Social Determinants of Child Mental Health | 1228 | ||
| Social Determinants of Asthma | 1228 | ||
| BIOLOGICAL UNDERPINNINGS OF SOCIAL DETERMINANTS | 1228 | ||
| DESCRIPTION OF EPIGENETICS | 1229 | ||
| DNA METHYLATION | 1229 | ||
| MEASUREMENT OF DNA METHYLATION | 1232 | ||
| DESCRIPTION OF TELOMERES | 1233 | ||
| MEASUREMENT OF TELOMERE LENGTH | 1234 | ||
| SOCIAL DETERMINANTS OF EPIGENETIC MARKS | 1235 | ||
| SOCIAL DETERMINANTS OF TELOMERE LENGTH | 1235 | ||
| EPIGENETIC ASSOCIATION WITH CHILD MENTAL HEALTH | 1236 | ||
| EPIGENETIC ASSOCIATION WITH ASTHMA | 1237 | ||
| CURRENT RECOMMENDATIONS | 1237 | ||
| REFERENCES | 1238 | ||
| Addressing Childhood Obesity | 1241 | ||
| Key points | 1241 | ||
| INTRODUCTION | 1241 | ||
| RISK FACTORS | 1243 | ||
| Genetic Risk Factors | 1243 | ||
| Environmental/Societal Risk Factors | 1243 | ||
| Behavioral Risk Factors | 1243 | ||
| Nutrition and diet | 1243 | ||
| Physical activity | 1244 | ||
| Sleep | 1244 | ||
| Stress | 1244 | ||
| DEVELOPMENTAL APPROACH TO OBESITY PREVENTION | 1245 | ||
| ROLE OF THE PRIMARY CARE PROVIDER | 1248 | ||
| POLICY AND ENVIRONMENTAL INTERVENTIONS | 1251 | ||
| THE FAMILY | 1252 | ||
| SUMMARY | 1255 | ||
| REFERENCES | 1256 | ||
| Legal Care as Part of Health Care | 1263 | ||
| Key points | 1263 | ||
| MANY SOCIAL DETERMINANTS ARE LEGAL NEEDS WITH LEGAL REMEDIES | 1263 | ||
| PREVALENCE OF LEGAL NEEDS IN LOW-INCOME POPULATIONS | 1264 | ||
| BRIDGING THE DIVIDE: THE LEGAL AND HEALTH CARE SYSTEMS/COMMUNITIES | 1264 | ||
| ACCESSING LEGAL SUPPORT | 1265 | ||
| THE MEDICAL-LEGAL PARTNERSHIP RESPONSE | 1265 | ||
| BENEFITS OF MEDICAL-LEGAL PARTNERSHIP FOR PATIENTS AND FAMILIES | 1266 | ||
| Treatment of Chronic Disease | 1266 | ||
| Asthma | 1266 | ||
| Sickle Cell Disease | 1266 | ||
| Compliance with Health Care | 1266 | ||
| Reduction of Stress | 1268 | ||
| Beyond Clinics: Healthy Start | 1268 | ||
| BENEFITS FOR HEALTH CARE STAFF | 1268 | ||
| Innovative Tools | 1268 | ||
| Improved Health Care Staff Knowledge and Screening Efficacy | 1269 | ||
| SUMMARY | 1270 | ||
| REFERENCES | 1270 | ||
| Early Literacy Promotion in the Digital Age | 1273 | ||
| Key points | 1273 | ||
| EARLY LITERACY AS A SOCIAL DETERMINANT OF HEALTH | 1274 | ||
| DIGITAL MEDIA EXPOSURE DURING EARLY CHILDHOOD | 1276 | ||
| PARENTS AND ADULT CAREGIVERS: THE GATEKEEPERS TO EMERGENT LITERACY | 1277 | ||
| EARLY LITERACY PROMOTION AS STANDARD PEDIATRIC CARE | 1278 | ||
| Reach Out and Read: the Evidence | 1282 | ||
| Reach Out and Read: Changing Child Outcomes | 1282 | ||
| Mendelsohn et al., Pediatrics | 1282 | ||
| High et al., Pediatrics | 1282 | ||
| Theriot et al., Clinical Pediatrics | 1282 | ||
| Sharif et al., Journal of the National Medical Association | 1282 | ||
| Diener et al., Journal of Community Medicine and Health Education | 1282 | ||
| Reach Out and Read: Changing Parental Attitudes and Practices | 1283 | ||
| High et al., Archives of Pediatrics and Adolescent Medicine | 1282 | ||
| Needlman, et al., American Journal of Diseases of Children | 1282 | ||
| Weitzman et al., Pediatrics | 1282 | ||
| Needlman et al., Ambulatory Pediatrics | 1282 | ||
| Silverstein et al., Pediatrics | 1283 | ||
| Sanders et al., Archives of Pediatrics and Adolescent Medicine | 1283 | ||
| Golova et al., Pediatrics | 1283 | ||
| The ABCs of Reach Out and Read | 1284 | ||
| Reach Out and Read: Toward Better Primary Care | 1284 | ||
| Jones et al., Clinical Pediatrics | 1282 | ||
| King et al., Academic Pediatrics | 1282 | ||
| Byington et al., Journal of Health Care for the Poor and Underserved | 1282 | ||
| Principles of Book Selection | 1285 | ||
| Considerations on Digital Media | 1285 | ||
| BEYOND REACH OUT AND READ | 1285 | ||
| A PRESCRIPTION FOR INNOVATIVE PEDIATRIC PRIMARY CARE | 1288 | ||
| REFERENCES | 1293 | ||
| Children, Families, and Disparities | 1297 | ||
| Key points | 1297 | ||
| SETTING THE STAGE: A REVIEW OF CHILDREN’S HEALTH INSURANCE PROGRAMS | 1298 | ||
| Private Insurance | 1298 | ||
| Medicaid | 1298 | ||
| Children’s Health Insurance Program | 1299 | ||
| Military | 1299 | ||
| Indian Health Service | 1300 | ||
| A BRIEF HISTORY OF HEALTH REFORM | 1300 | ||
| AN OVERVIEW OF THE AFFORDABLE CARE ACT | 1300 | ||
| AFFORDABLE CARE ACT PROVISIONS AFFECTING CHILDREN AND FAMILIES | 1301 | ||
| Access to Coverage | 1301 | ||
| Medicaid | 1301 | ||
| Young adults and foster youth | 1302 | ||
| Parents | 1303 | ||
| Children with special health care needs | 1303 | ||
| Better Insurance | 1303 | ||
| Preventive care without cost sharing | 1303 | ||
| Essential health benefits | 1303 | ||
| Consumer Protections | 1304 | ||
| Insurance market reforms | 1304 | ||
| EFFORTS TO ADDRESS RACIAL AND ETHNIC HEALTH DISPARITIES | 1305 | ||
| American Indians and Alaska Natives | 1305 | ||
| Home Visiting for Communities at Risk | 1305 | ||
| ONGOING CHALLENGES | 1306 | ||
| Children’s Health Insurance Program Funding Extension | 1306 | ||
| Pediatric Dental Care | 1306 | ||
| The “Family” or “Kid” Glitch | 1307 | ||
| Network Adequacy | 1307 | ||
| IMPLICATIONS: WHAT SHOULD PEDIATRIC CLINICIANS DO? | 1308 | ||
| SUMMARY | 1308 | ||
| REFERENCES | 1308 | ||
| Community Health Workers as a Component of the Health Care Team | 1313 | ||
| Key points | 1313 | ||
| INTRODUCTION | 1313 | ||
| HISTORICAL PERSPECTIVE | 1314 | ||
| Community Health Workers in the United States | 1315 | ||
| TRAINING AND CERTIFICATION | 1315 | ||
| EVIDENCE OF EFFECTIVENESS | 1316 | ||
| Facilitating Access to Health Care: Patient Navigators | 1316 | ||
| Improving Health Care Quality and Outcomes by Community Health Workers | 1316 | ||
| Community Health Workers Enable Culturally Relevant Medical Care Through Patient-Centered Medical Homes and Accountable Car ... | 1317 | ||
| Financial Impact of Community Health Workers | 1318 | ||
| CHALLENGES AND FUTURE MODELS | 1319 | ||
| Expanded Scope from a Disease Focus to Include Social Influences on Health Outcomes | 1319 | ||
| Use of Community Health Workers as a Component of the Care Delivery Team | 1321 | ||
| Practice Considerations | 1322 | ||
| SUMMARY | 1323 | ||
| REFERENCES | 1324 | ||
| Foster Care and Child Health | 1329 | ||
| Key points | 1329 | ||
| FOSTER CARE IN THE UNITED STATES | 1329 | ||
| THE NUMBERS | 1330 | ||
| THE PEDIATRICIAN’S ROLE | 1331 | ||
| THE CHILD ENTERING THE FOSTER CARE SYSTEM | 1331 | ||
| NEED FOR MENTAL HEALTH SERVICES | 1333 | ||
| ADVERSE CHILDHOOD EXPERIENCE | 1334 | ||
| CENTERING CARE | 1334 | ||
| EXITING THE FOSTER CARE SYSTEM | 1334 | ||
| DOCUMENTATION | 1335 | ||
| ACKNOWLEDGMENTS | 1347 | ||
| REFERENCES | 1347 | ||
| APPENDIX 1 POTENTIAL INFLUENCES THROUGHOUT THE LIFE SPAN OF ADVERSE CHILDHOOD EXPERIENCES | 1348 | ||
| Index | 1349 |