Health Affairs’ October Issue: Children’s Health

The October edition of Health Affairs is a theme issue on children’s health. As articles in the issue show, the US lags behind other developed countries in key indicators of child health and well-being. Studies in the issue provide a road map for future improvement.

The October issue was supported by Nemours, Blue Shield of California Foundation, Children’s Hospital Association, the Episcopal Health Foundation, and the W. K. Kellogg Foundation.

DATAWATCH: One in ten North Carolina teenagers fill at least one opioid prescription a year.

According to government data, opioid exposures in childhood are responsible for the majority of drug-related pediatric fatalities and are potentially linked to opioid misuse in adulthood. To understand the extent of pediatric opioid use, Kelby Brown and coauthors from Duke University reviewed North Carolina Medicaid claims data from 2016 to 2018. They found that among children (ages 1–17), adolescents ages 15–17 were most often prescribed opioids, with 10.8 percent of adolescents that age filling at least one opioid prescription per year. The study also found that nearly 280 of every 100,000 teenagers that age experienced one or more opioid-related harms each year (see exhibit below). The data show that of the 137,710 prescription fills examined, physicians (35.5 percent), dentists (33.3 percent), and advance practice providers (17.7 percent) were the most common prescribers. The most frequently prescribed opioid types were hydrocodone (44.9 percent), oxycodone (28.7 percent), and codeine (20.0 percent). The authors also found that Black youth and urban youth were less likely than their counterparts to fill opioid prescriptions or experience other opioid-related harms such as opioid abuse and dependence. The authors conclude that these findings highlight the need for public health and policy measures that prioritize children, including pediatric-specific opioid prescribing guidelines, youth screening and treatment, and stratifying population-level opioid surveillance reports by age and race.

Obesity and behavioral health conditions in military children.  

To build and maintain an effective US military force, at least 150,000 medically fit new personnel must be recruited annually. Because military dependents are more likely to serve than the broader population of US children, keeping them physically and mentally fit is important for meeting military recruiting goals, and is therefore critical for US national security. To evaluate the health of this group of young Americans, Tracey Pérez Koehlmoos of the Uniformed Services University of the Health Sciences and coauthors evaluated the Department of Defense’s Military Health System administrative data for almost half a million (n=489,859) military dependents ages 13–18 for fiscal years 2017 and 2018. According to the data, 13.01 percent of the 144,189 adolescents in the sample for whom a body mass index was recorded were overweight and 21.95 percent were obese. Girls were more likely than boys to be overweight or obese, and White youths were the least likely to be overweight or obese. For those adolescents diagnosed with a behavioral health disorder (19.52 percent of the total sample), the majority were female (51.54 percent), White (74.28 percent), and from the South (60.55 percent). Because these conditions disqualify a significant segment of the potential pool of military service applicants, the authors conclude that improving the fitness of the nation’s military children could help the military achieve its recruiting goals.

Upward “health mobility” can elude some minorities and vulnerable Americans.

Because poor health in childhood can set the stage for a variety of challenges throughout life, understanding the origin of child health status is an important topic of research. The relationship between child health and family background, often measured by socioeconomic status, has gained particular attention. To better understand that connection, Jason Fletcher and Katie Jajtner, both from the University of Wisconsin–Madison, examine data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998–99 (independent data funded by the Department of Education) to analyze child development through the lens of intergenerational mobility—or the degree to which children’s outcomes diverge from or follow those of their parents. The authors found that for children whose parents are in poorer health, upward health mobility is limited if those parents are also socioeconomically disadvantaged. When parents are in better health, downward health mobility is more likely if the parents are also socioeconomically disadvantaged. The authors conclude that both individual and community characteristics help shape health mobility. Because Medicaid expansion at young ages has been shown to decouple intergenerational income mobility, access to health insurance could be particularly valuable. The authors recommend the further consideration of health mobility as a metric of health equity in the United States.

Also interest in the October issue:

  • Spreading Fear: The Announcement Of The Public Charge Rule Reduced Enrollment In Child Safety-Net Programs; Jeremy Barofsky and coauthors from ideas42.

The October issue also includes COVID-19-related content, including:

  • ENTRY POINT: How COVID-19 Threatens The Safety Net For US Children; Jessica Bylander, Senior Editor at Health Affairs.
  • Severe Staffing And Personal Protective Equipment Shortages Faced By Nursing During The COVID-19 Epidemic; Brian McGarry from the University of Rochester Medical Center and coauthors.

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