Tag Archives: The Centers for Disease Control

New Jersey bill to require teachers get more suicide prevention training

25 Jan

The New Jersey legislature wants to give teachers more training in suicide prevention. According to the National Conference of State Legislatures (NCSL):

  • 19.3 percent of high school students have seriously considered killing themselves.

  • 14.5 percent of high school students made actual plans for committing suicide,

  • 900,000 youth planned their suicides during an episode of major depression.

While suicide does not seem terribly common, it is nevertheless a major cause of death. The CDC reports that it is the third leading cause of death for youth ages 15 to 24. The only two things that cause more death among teenagers are accidents (usually in the car) and homicide. And even younger children do not escape. Suicide is the fourth leading cause of death for young people between the ages of 10 and 14.

Gender differences in teen suicide

Teen suicide statistics show differences in the ways boys and girls handle suicide. While girls think about attempted suicide about twice as much as boys, boys are actually four times more likely than girls to actually die by killing themselves….                                   http://www.teensuicidestatistics.com/statistics-facts.html

The Centers for Disease Control list some risk factors for teen suicide:

Several factors can put a young person at risk for suicide. However, having these risk factors does not always mean that suicide will occur.

Risk factors:

  • History of previous suicide attempts

  • Family history of suicide

  • History of depression or other mental illness

  • Alcohol or drug abuse

  • Stressful life event or loss

  • Easy access to lethal methods

  • Exposure to the suicidal behavior of others

  • Incarceration                                                                                                                                                                    http://www.cdc.gov/violenceprevention/pub/youth_suicide.html

The goal of a proposed bill in New Jersey is early identification and intervention for children at risk of suicide.

Michael Catalini of Associated Press reported in Teachers would get more training on suicide under bill:

Public school teachers would undergo more suicide prevention education under a proposal from a bipartisan group of New Jersey lawmakers.

An Assembly committee approved the measure late last year while Republican state Sen. Diane Allen introduced a similar bill in the Senate this month.

The bill requires public school teachers and staff to receive two hours of suicide prevention training from a licensed health care professional every year, up from the current requirement of two hours over five years.

Democratic Assemblywoman Pamela Lampitt said she and her colleagues are pursuing the change now because of the increased use of technology by students and the rise of bullying over text messages that could contribute to suicides.

The requirement that teachers undergo suicide prevention education reaches back to 2005 legislation that established the current requirement. Gov. Richard Codey signed the bill into law in 2006, making New Jersey the first state in the country to enact such a requirement.

New Jersey has a youth suicide rate of about 5 per 100,000 people, compared with nearly 8 per 100,000 nationally in 2012, the most recently available statistics from the New Jersey Department of Children and Families. The report defines youth as people from ages 10 to 24.

Suicide is the third leading cause of death among 10- to 24-year-olds in New Jersey. From 2011 to 2013, 232 people in that age group committed suicides, according to the department….                           http://www.deseretnews.com/article/765667095/Teachers-would-get-more-training-on-suicide-under-bill.html

People of all ages may have feelings of profound sadness, loss, and depression. There is no one on earth, despite what the ads attempt to portray, who lives a perfect life. Every life has flaws and blemishes; it is just that some cope better than others. For every person who lives to a ripe old age, during the course of that life they may encounter all types of loss from loss of a loved one through death, divorce or desertion, loss of job, financial reverses, illness, dealing with A-holes and twits, plagues, pestilence, and whatever curse can be thrown at a person. The key is that they lived THROUGH whatever challenges they faced AT THAT MOMENT IN TIME. Woody Allen said something like “90% of life is simply showing up.” Let me add a corollary, one of the prime elements of a happy life is to realize that whatever moment you are now in, it will not last forever and that includes moments of great challenge. A person does not have to be religious to appreciate the story of Job. The end of the story is that Job is restored. He had to endure much before the final victory, though.

Resources:

Suicide Prevention                                                                                                                             http://www.cdc.gov/violenceprevention/pub/youth_suicide.html

Teen Suicide Overview                                                                                                                     http://www.teensuicidestatistics.com/

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Are we missing the danger caused by knives brought to school with the focus on gun control?

23 Apr

If a person is intent on harm, there are a variety of methods. Table 20 of the Uniform Crime Report provides those statistics. http://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2011/crime-in-the-u.s.-2011/tables/table-20

Table 20
Murder
by State, Types of Weapons, 2011
 Data Declaration
 Download Excel
State Total
murders1 Total
firearms Handguns Rifles Shotguns Firearms
(type
unknown) Knives or
cutting
instruments Other
weapons Hands, fists,
feet, etc.2
Alaska 29 16 5 0 3 8 6 5 2
Arizona 339 222 165 14 9 34 49 59 9
Arkansas 153 110 52 4 6 48 22 17 4
California 1,790 1,220 866 45 50 259 261 208 101
Colorado 147 73 39 3 5 26 22 31 21
Connecticut 128 94 54 1 1 38 18 10 6
Delaware 41 28 18 0 3 7 8 2 3
District of Columbia 108 77 37 0 1 39 21 9 1
Georgia 522 370 326 16 16 12 61 83 8
Hawaii 7 1 0 1 0 0 2 1 3
Idaho 32 17 15 1 0 1 4 8 3
Illinois3 452 377 364 1 5 7 29 29 17
Indiana 284 183 115 9 12 47 36 43 22
Iowa 44 19 7 0 2 10 10 10 5
Kansas 110 73 31 3 5 34 11 16 10
Kentucky 150 100 77 6 5 12 13 24 13
Louisiana 485 402 372 10 8 12 28 29 26
Maine 25 12 3 1 1 7 4 7 2
Maryland 398 272 262 2 5 3 75 34 17
Massachusetts 183 122 52 0 1 69 30 22 9
Michigan 613 450 267 29 15 139 43 89 31
Minnesota 70 43 36 3 3 1 12 12 3
Mississippi 187 138 121 6 4 7 26 14 9
Missouri 364 276 158 13 9 96 28 42 18
Montana 18 7 2 3 1 1 4 5 2
Nebraska 65 42 35 2 1 4 7 9 7
Nevada 129 75 46 2 1 26 20 25 9
New Hampshire 16 6 1 2 1 2 4 6 0
New Jersey 379 269 238 1 5 25 51 41 18
New Mexico 121 60 45 2 2 11 21 32 8
New York 774 445 394 5 16 30 160 143 26
North Carolina 489 335 235 26 19 55 60 57 37
North Dakota 12 6 3 0 0 3 4 0 2
Ohio 488 344 187 8 13 136 44 80 20
Oklahoma 204 131 99 8 9 15 26 21 26
Oregon 77 40 13 1 2 24 22 10 5
Pennsylvania 636 470 379 8 19 64 73 66 27
Rhode Island 14 5 1 0 0 4 5 4 0
South Carolina 319 223 126 10 12 75 38 40 18
South Dakota 15 5 3 1 0 1 4 3 3
Tennessee 373 244 172 7 13 52 51 62 16
Texas 1,089 699 497 37 48 117 175 134 81
Utah 51 26 15 4 1 6 5 9 11
Vermont 8 4 2 0 0 2 2 2 0
Virginia 303 208 110 10 15 73 33 41 21
Washington 161 79 58 1 3 17 29 36 17
West Virginia 74 43 23 10 3 7 11 13 7
Wisconsin 135 80 60 7 3 10 21 13 21
Wyoming 15 11 7 0 0 4 0 1 3
Virgin Islands 38 31 27 0 0 4 5 2 0
• 1 Total number of murders for which supplemental homicide data were received.
• 2 Pushed is included in hands, fists, feet, etc.
• 3 Limited supplemental homicide data were received.
Data Declaration
Provides the methodology used in constructing this table and other pertinent information about this table.

Guns are not the only instruments of harm.

Evie Blad reported in the Education Week article, School Stabbings Signal Need for Broad Safety Plans: Experts question hyperfocus on guns:

Large-scale shootings have been a dominant driver of school safety debates, but a stabbing spree at a Pennsylvania high school this month should serve as a reminder that educators need to be prepared for a range of situations—including smaller, nonfatal incidents that don’t involve guns at all, school safety experts say.
Following most school shootings—like the December 2012 killings at Sandy Hook Elementary School in Newtown, Conn.—conversation quickly turns to the polarizing subject of gun policy.
And while some districts work to implement comprehensive safety plans that address mental-health concerns, school climate, and security procedures, policymakers often direct efforts and resources specifically toward the prevention of gun-related incidents, experts say.
“When we focus our policy responses almost entirely on firearms in these events, we overlook major things and we aren’t going to address the root of the problem,” said Laura E. Agnich, an assistant professor of criminal justice and criminology at Georgia Southern University in Statesboro.
That narrow focus can lead to “knee jerk” responses such as overly broad zero-tolerance policies and costly building upgrades, instead of research-based school climate measures and carefully practiced safety procedures, Ms. Agnich said.
In the 2010-11 school year, U.S. public schools reported 5,000 cases of student possession of a firearm or explosive device, and 72,300 cases of possession of a knife or other sharp object, according to the most recent information available from the U.S. Department of Education…. http://www.edweek.org/ew/articles/2014/04/23/29knives_ep.h33.html

NI Direct of Northern Ireland has some great information for parents about knife crimes.

In the article, Keeping your child safe from knife crime, NI Direct advises:

Know the law
Before talking to your child about knives, you need to know the facts:
• it is illegal for anyone to carry a knife if they intend to use it as a weapon – even in self defence
• police can search anyone they suspect of carrying a knife
• carrying a knife could mean being arrested, going to court and getting a criminal record, or even a prison sentence
• Knives, offensive weapons and the law (crime, justice and the law section)
Knives in school
It is a criminal offence to have a knife or other weapon on school premises. If a knife or other weapon is found on a pupil, the police will be called and it is likely the pupil will be arrested.
• School attendance and absence: the law
• If your child is arrested and charged
Talking to your child about knives
The best way to stop your child getting involved with knives is to talk to them about the dangers. This may not be easy as they may not want to talk about it, but keep trying as this is the first step to keeping your child safe.
You should remind them that by carrying a knife they are:
• giving themselves a false sense of security
• potentially arming an attacker, increasing the risk of getting stabbed or injured
• breaking the law
Keep a look out
Sometimes there might be obvious reasons for you to think your child is carrying a knife – such as a knife going missing from the kitchen.
However, there are other more subtle signs that you and the parents of your child’s friends can look out for such as:
• school’s not going well or they don’t want to go in to school at all
• they’ve been a recent victim of theft/bullying/mugging
• a different network of friends who may be older than your child…
http://www.nidirect.gov.uk/keeping-your-child-safe-from-knife-crime

The American Knife and Tool Institute (AKTI) has a great discussion about the laws governing knives.

In A Guide to Understanding the Laws of America Regarding Knives, AKTI says:

Our Federal government became involved in firearms regulation in the early part of this century and continues to assume an increasing level of control as to firearms. Given the relatively long period of Federal involvement, the doctrine of Federal preemption, and the fact that firearms laws are for the most part based on purely objective factors, such as barrel length or action type, there is a greater degree of consistency among the laws of the various states as to firearms.
Such is not the case with knives. Laws regarding knives are a hodgepodge of legislative action, some of which dates back to the 1800’s.
A handgun “legal” in a given state would in all probability be “legal” in the vast majority of states. The law regarding what a person may or may not do with a legal handgun, for example, would vary considerably from state to state. The situation is slightly more complex in the case of knives. What constitutes a legal knife varies greatly from state to state and may depend upon objective standards, such as blade length, or more subjective standards, such as the shape or style of the blade or handle. As is the case with firearms, the law of the different states regarding what one may do with a legal knife varies.
The Consequences
Criminal prosecutions based exclusively on the simple possession of an “illegal” knife are rare. At least the cases that become reported seem to involve coalescent criminal activity. As a practical matter, the constitutional prohibition against unreasonable searches and seizures protects the otherwise law-abiding citizen who happens to be walking down the street with a pocketknife having a blade one-eighth of an inch over the limit.
This may give rise to a false sense of security based upon the “it can’t happen to me . . . I’m not a criminal” mentality….
However, a knife law violation is generally considered to be a “weapon” violation, which can lead to all sorts of disqualifications, ranging from acquiring or owning firearms to military service, as well as public and/or private sector employment. As an example, in Pennsylvania, it is a misdemeanor to possess any knife or cutting instrument on school property. There is also a law in Pennsylvania which disqualifies persons convicted of any one of a long list of crimes, from possessing, using, manufacturing, controlling, etc. any firearms….
Attend a PTA meeting or a high school football game with a small folding knife in your pocket or handbag, or even a tiny knife on your key chain, and you are subject to the same legal disqualifications meted out to murderers and rapists. If there is even a small knife in your pocket or car when you drive your child to school, or perhaps exercise your right to vote (many jurisdictions’ polls are located in school buildings), various rights which you may have thought to be “inalienable” may be in jeopardy…
Finding the Law
Knife laws vary from state to state, as discussed above. Laws are also changed or amended from time to time…
The individual interested in learning about the laws involving or pertaining to knives in a given state, or perhaps more importantly, in avoiding difficulty with the laws, should turn to the state statutes or legislative enactments, and in particular, those dealing with crimes. You may find that for a given state this would be described or referred to as the Penal Code or Crimes Code. Within this Code, you will likely find laws regarding knives under any of the following headings:
• Prohibited Weapons – Typically there will be a statute defining listing various weapons which are prohibited. As to knives, there may be specific size/blade length limitations. Often times there will be prohibitions against “dirks or daggers.” Switchblades or other knives, the blade of which is exposed by gravity or mechanical action, are frequently prohibited.
• Possessing Instruments of Crime – This type of law deals with the possession of an instrument not otherwise illegal but possessed under circumstances indicating intent to employ the instrument for criminal purposes. For example, a 12-inch butcher knife would be commonplace and unquestionably legal in a butcher shop or meat packing plant, but might be questionable in the proverbial dark alley at 3:00 o’clock a.m. This type of law is sometimes found under the heading of “inchoate crimes.”
• Possession of a weapon in a prohibited area – In most states, it is a crime to possess a knife on school grounds. In some instances, exceptions are made for small pocketknives. It is also a crime in many states to possess a weapon to include a knife in a court facility or some other government buildings.
• Transactions – In many states, it is a crime to engage in certain transactions regarding knives and other prohibited weapons or to furnish such items to children or persons known to be incompetent or intemperate.
Many state statutes can be found on the Internet. One good site is FindLaw.com. Click on “US State Resources” to find statutes and cases (if any) for your state. State laws can also be researched on the Internet…
Federal
The Federal government has cognizance over matters involving commerce among the states, Federal property and federally-regulated activities, such as aviation. This does not mean that if you drive from New York to California, Federal law governs the legality of a knife you may be carrying or your use of it along the way. The law of the individual states would prevail, although in many instances, there are exceptions for persons engaged in travel.
The Federal Crimes Code is set forth at Title 18 of the U.S. Code, and in particular, 18 U.S.C. ’930. There you will find provisions dealing with dangerous weapons on Federal facilities, as well as definition of what constitutes a dangerous weapon. Interestingly, there is an exception for a pocketknife with a blade of less than two and one-half inches in length. However, you must also observe that there is a difference between a Federal facility where a small pocketknife would be tolerated and a Federal Court facility, where there is a policy of “zero tolerance” regarding tools such as knives….
https://www.akti.org/legislation/guide-understanding-knife-laws-america

School violence is a complex set of issues and there is no one solution. The school violence issue mirrors the issue of violence in the larger society. Trying to decrease violence requires a long-term and sustained focus from parents, schools, law enforcement, and social service agencies.

Resources:

A Dozen Things Students Can Do to Stop School Violence http://www.sacsheriff.com/crime_prevention/documents/school_safety_04.cfm

A Dozen Things. Teachers Can Do To Stop School Violence http://www.ncpc.org/cms-upload/ncpc/File/teacher12.pdf

Preventing School Violence: A Practical Guide http://www.indiana.edu/~safeschl/psv.pdf

Related:

Violence against teachers is becoming a bigger issue https://drwilda.com/2013/11/29/violence-against-teachers-is-becoming-a-bigger-issue/

Hazing remains a part of school culture https://drwilda.com/2013/10/09/hazing-remains-a-part-of-school-culture/

FEMA issues Guide for Developing High-Quality School Emergency Operations Plans
https://drwilda.com/2013/07/08/fema-issues-guide-for-developing-high-quality-school-emergency-operations-plans/

Study: 1 in 3 teens are victims of dating violence https://drwilda.com/2013/08/05/study-1-in-3-teens-are-victims-of-dating-violence/

Pediatrics article: Sexual abuse prevalent in teen population
https://drwilda.com/2013/10/10/pediatrics-article-sexual-abuse-prevalent-in-teen-population/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART© http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews © http://drwildareviews.wordpress.com/

Dr. Wilda © https://drwilda.com/

Brown University – Hasbro Children’s Hospital study: School violence is a very big issue

19 Jan

The Centers for Disease Control (CDC) writes about school violence:

In the United States, an estimated 50 million students are enrolled in pre-kindergarten through 12th grade. Another 15 million students attend colleges and universities across the country. While U.S. schools remain relatively safe, any amount of violence is unacceptable. Parents, teachers, and administrators expect schools to be safe havens of learning. Acts of violence can disrupt the learning process and have a negative effect on students, the school itself, and the broader community.
2013 Understanding School Violence Fact Sheet Adobe PDF file [PDF 250KB]
http://www.cdc.gov/violenceprevention/pdf/school_violence_fact_sheet-a.pdf
School violence is youth violence that occurs on school property, on the way to or from school or school-sponsored events, or during a school-sponsored event.
What is School Violence?
School violence is a subset of youth violence, a broader public health problem. Violence is the intentional use of physical force or power, against another person, group, or community, with the behavior likely to cause physical or psychological harm. Youth Violence typically includes persons between the ages of 10 and 24, although pathways to youth violence can begin in early childhood.
Examples of violent behavior include:
Bullying
Fighting (e.g., punching, slapping, kicking)
Weapon use
Electronic aggression
Gang violence
School violence occurs:
On school property
On the way to or from school
During a school-sponsored event
On the way to or from a school-sponsored event
Data Sources:
Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance System (YRBSS) 2009 National Youth Risk Behavior Survey Overview. Available from URL: http://www.cdc.gov/healthyyouth/yrbs/pdf/us_overview_yrbs.pdf.

School violence is a growing issue.

Linda Carroll of NBC News reported in the story, School violence lands more than 90,000 a year in the ER, study finds:

Despite all the lip service given to battling bullying, many kids are still being seriously hurt while on school grounds, a new study shows. Each year more than 90,000 school children suffer “intentional” injuries severe enough to land them in the emergency room, according to the study published in Pediatrics.
Though there was a decrease in the number of intentional injuries at school over the last 10 years, it was minor, said study co-author Dr. Siraj Amanullah, an assistant professor of emergency medicine and pediatrics at the Alpert Medical School at Brown University.
“We were surprised,” Amanullah said. “With so much emphasis on school safety and bullying now, we expected a bigger decline. Ninety-thousand per year is quite huge.”
And keep in mind, Amanullah said, the study was only looking at kids who turned up in the ER. This could just be the tip of the iceberg.
“Bullying is so underreported,” said Amanullah, adding that children are still reluctant to tell anyone because often little gets done about it. “We were hoping this study would bring more attention to the problem.”
Amanullah and his colleagues pored through data from the National Electronic Injury Surveillance System — All Injury Program collected from January of 2001 through December of 2008. The ER reports include a plethora of detail, including the type of injury, whether it occurred at school and whether it was the result of an accident or was intentional.
While cuts and bruises were the most common injuries at 40 percent, fractures accounted for 12 percent, brain injuries for 10 percent and sprains and strains another 7 percent. The vast majority of injuries — 96 percent — were the result of an assault, with most perpetrators identified as friends or acquaintances. A full 10 percent of the assaults involved multiple perpetrators.
Part of the problem may be the adults that kids model themselves after. An article published in the same issue of Pediatrics reported that bullying behavior by coaches is quite high — and that the schools often make excuses for the behavior if it’s a winning coach.
A survey cited in the article found that 45 percent of kids “reported verbal misconduct by coaches, including name-calling and insulting them during play.”
During the study period, a total of 7,397,301 injuries occurred at school, of which 736,014 were intentional. The new study shows “that almost 10 percent of injuries are intentional, which means there’s a lot of violence going on in the schools that doesn’t include football, or hockey, or volleyball or tripping and falling and getting hurt,” said Patrick Tolan, a professor at the University of Virginia and director of Youth-Nex, the U.Va. Center to Promote Effective Youth Development.
Part of the solution may be increased monitoring of the kids, Tolan said. “Every school should assume they have an issue,” he added. “They should be looking at where and how both intentional and unintentional injuries are occurring….” http://www.nbcnews.com/health/school-violence-lands-more-90-000-year-er-study-finds-2D11898820

Citation:

Emergency Department Visits Resulting From Intentional Injury In and Out of School
1. Siraj Amanullah, MD, MPHa,b,c,
2. Julia A. Heneghan, MDc,d,
3. Dale W. Steele, MD, MSa,b,
4. Michael J. Mello, MD, MPHa,c, and
5. James G. Linakis, PhD, MDa,b,c
+ Author Affiliations
1. Departments of aEmergency Medicine and
2. bPediatrics, Alpert Medical School of Brown University, Providence, Rhode Island;
3. cInjury Prevention Center, Rhode Island Hospital, Providence, Rhode Island; and
4. dDepartment of Pediatrics, Rainbow Babies and Children’s Hospital, University Hospitals Case Medical Center, Cleveland, Ohio
Abstract
BACKGROUND AND OBJECTIVE: Previous studies have reported concerning numbers of injuries to children in the school setting. The objective was to understand temporal and demographic trends in intentional injuries in the school setting and to compare these with intentional injuries outside the school setting.
METHODS: Data from the National Electronic Injury Surveillance System–All Injury Program from 2001 to 2008 were analyzed to assess emergency department visits (EDVs) after an intentional injury.
RESULTS: There were an estimated 7 397 301 total EDVs due to injuries sustained at school from 2001 to 2008. Of these, an estimated 736 014 (10%) were reported as intentional (range: 8.5%–10.7% for the study time period). The overall risk of an EDV after an intentional injury in school was 2.33 (95% confidence interval [CI]: 1.93–2.82) when compared with an EDV after an intentional injury outside the school setting. For intentional injury–related EDVs originating in the school setting, multivariate regression identified several demographic risk factors: 10- to 14-year-old (odds ratio [OR]: 1.58; 95% CI: 1.10–2.27) and 15- to 19-year-old (OR: 1.69; 95% CI: 1.01–2.82) age group, black (OR: 4.14; 95% CI: 2.94–5.83) and American Indian (OR: 2.48; 95% CI: 2.06–2.99) race, and Hispanic ethnicity (OR: 3.67; 95% CI: 2.02–6.69). The odds of hospitalization resulting from intentional injury–related EDV compared with unintentional injury–related EDVs was 2.01 (95% CI: 1.50–2.69) in the school setting. These odds were found to be 5.85 (95% CI: 4.76–7.19) in the outside school setting.
CONCLUSIONS: The findings of this study suggest a need for additional prevention strategies addressing school-based intentional injuries.

Here is the press release from Hasbro Children’s Hospital:

Hasbro Children’s Hospital National Study Finds High Number of Pediatric Injuries Caused by Violence at School
1/14/2014
________________________________________
Siraj Amanullah, MD, MPH, an emergency medicine attending physician at Hasbro Children’s Hospital, recently led a study that found children between the ages of five and 19 still experience a substantial number of intentional injuries while at school. The study, titled “Emergency Department Visits Resulting from Intentional Injury In and Out of School,” has been published online ahead of print in the journal Pediatrics.
Amanullah’s team analyzed data from the National Electronic Injury Surveillance System All Injury Program from 2001 to 2008 to assess emergency department (ED) visits after an intentional injury. Of an estimated 7.39 million emergency department visits due to injuries occurring at school, approximately 736,014 (10 percent) were reported as intentional, such as those from bullying and peer-to-peer violence.
“This study is the first of its kind to report such a national estimate,” said Amanullah. “The 10 percent number may not seem large, but it is alarmingly high when you consider that such a significant number of intentional injuries are occurring in the school setting, where safety measures meant to prevent these sorts of injuries, are already in place.”
The study also identified gender and age disparities. Boys were most likely to be identified as at risk for intentional injury-related ED visits from within the school setting, along with all students in the 10- to 14-year age group; whereas girls were most at risk for intentional injury-related ED visits from outside of the school setting, along with the 15- to 19-year age group.
Additionally, both African-American and Hispanic ethnicities were found to be associated with higher risks for intentional injury in the school setting compared to outside school. “The important point about these disparities related to specific ethnicities and specific age groups is that the findings suggest that preventive safety efforts in the school setting may need to be tailored for the groups that carry much of this injury burden,” said Amanullah.
James Linakis, MD, PhD, associate director of pediatric emergency medicine at Hasbro Children’s Hospital and co-author of the study, added, “We know that the risk of hospitalization was found to be higher from intentional injury-related ED visits versus unintentional injuries.” Linakis continued, “In supervised environments such as schools, we have a great opportunity to implement additional prevention strategies and reduce the number of seriously injured children who we are seeing in emergency departments nationwide.”
The study highlights the continued public health impact of bullying and peer-to-peer violence. While there are substantial numbers of emergency department visits due to intentional injuries occurring in U.S. schools, there are still likely many others that do not result in ED visits.
Michael Mello, MD, MPH, director of the Injury Prevention Center at Hasbro Children’s Hospital who also contributed to the study, added a reminder that these injuries not only affect the physical health, but also the emotional health of children, families and both victim and perpetrator. “As parents, guardians and physicians we need to keep talking to our children and patients about this physical and mental health burden. It is our responsibility to address the issue of violence and bullying, both in and out of school, just like prevention efforts for any other medical illness,” said Mello. http://www.lifespan.org/Newsroom/News.aspx?NewsId=64730/Hasbro-Children%E2%80%99s-Hospital-National-Study-Finds-High-Number-of-Pediatric-Injuries–Caused-by-Violence-at-School/#null

One of the best concise guides to preventing school violence is the National PTA Checklist.

The National PTA Checklist recommends the following actions:

1. Talk to Your Children
Keeping the lines of communication open with your children and teens is an important step to keeping involved in their schoolwork, friends, and activities. Ask open-ended questions and use phrases such as “tell me more” and “what do you think?” Phrases like these show your children that you are listening and that you want to hear more about their opinions, ideas, and how they view the world. Start important discussions with your children—about violence, smoking, drugs, sex, drinking, death—even if the topics are difficult or embarrassing. Don’t wait for your children or teens to come to you.
2. Set Clear Rules and Limits for Your Children
Children need clearly defined rules and limits set for them so that they know what is expected of them and the consequences for not complying. When setting family rules and limits, be sure children understand the purpose behind the rules and be consistent in enforcing them.
Discipline is more effective if children have been involved in establishing the rules and, oftentimes, in deciding the consequences. Remember to be fair and flexible—as your children grow older, they become ready for expanded rights and changes in rules and limits. Show your children through your actions how to adhere to rules and regulations, be responsible, have empathy toward others, control anger, and manage stress.
3. Know the Warning Signs
Knowing what’s normal behavior for your son or daughter can help you recognize even small changes in behavior and give you an early warning that something is troubling your child. Sudden changes—from subtle to dramatic—should alert parents to potential problems. These could include withdrawal from friends, decline in grades, abruptly quitting sports or clubs the child had previously enjoyed, sleep disruptions, eating problems, evasiveness, lying, and chronic physical complaints (stomachache or headaches).
4. Don’t Be Afraid to Parent; Know When to Intervene
Parents need to step in and intervene when children exhibit behavior or attitudes that could potentially harm them or others. And you don’t have to deal with problems alone—the most effective interventions have parent, school, and health professionals working together to provide on-going monitoring and support.
5. Stay Involved in Your Child’s School
Show your children you believe education is important and that you want your children to do their best in school by being involved in their education. Get to know your child’s teachers and help them get to know you and your child. Communicate with your child’s teachers throughout the school year, not just when problems arise. Stay informed of school events, class projects, and homework assignments. Attend all parent orientation activities and parent-teacher conferences. Volunteer to assist with school functions and join your local PTA. Help your children seek a balance between schoolwork and outside activities. Parents also need to support school rules and goals.
6. Join Your PTA or a Violence Prevention Coalition
According to the National Crime Prevention Council, the crime rate can decrease by as much as 30 percent when a violence prevention initiative is a community-wide effort. All parents, students, school staff, and members of the community need to be a part of creating safe school environments for our children. Many PTAs and other school-based groups are working to identify the problems and causes of school violence and possible solutions for violence prevention.
7. Help to Organize a Community Violence Prevention Forum
Parents, school officials, and community members working together can be the most effective way to prevent violence in our schools.
8. Help Develop A School Violence Prevention and Response Plan
School communities that have violence prevention plans and crisis management teams in place are more prepared to identify and avert potential problems and to know what to do when a crisis happens. The most effective violence prevention and response plans are developed in cooperation with school and health officials, parents, and community members. These plans include descriptions of school safety policies, early warning signs, intervention strategies, emergency response plans, and post-crisis procedures.
9. Know How to Deal With the Media in a Crisis
Good public relations and media relations start with understanding how the media works and what they expect from organization’s that issue press releases, hold press conferences, and distribute media kits.
10. Work to Influence Lawmakers
Writing an editorial for the local newspaper, holding a petition drive, speaking before a school board meeting, or sending a letter to your legislator can be effective ways to voice your opinion and gain support from decision makers for violence prevention programs in your community. Working with other concerned parents, teachers, and community members, you can influence local, state and even federal decisions that affect the education, safety, and well-being of our children. http://www.pta.org/content.cfm?ItemNumber=984

School violence is a complex set of issues and there is no one solution. The school violence issue mirrors the issue of violence in the larger society. Trying to decrease violence requires a long-term and sustained focus from parents, schools, law enforcement, and social service agencies.

Resources:
A Dozen Things Students Can Do to Stop School Violence http://www.sacsheriff.com/crime_prevention/documents/school_safety_04.cfm

A Dozen Things. Teachers Can Do To Stop School Violence. http://www.ncpc.org/cms-upload/ncpc/File/teacher12.pdf

Preventing School Violence: A Practical Guide http://www.indiana.edu/~safeschl/psv.pdf

Related:

Violence against teachers is becoming a bigger issue https://drwilda.com/2013/11/29/violence-against-teachers-is-becoming-a-bigger-issue/

Hazing remains a part of school culture https://drwilda.com/2013/10/09/hazing-remains-a-part-of-school-culture/

FEMA issues Guide for Developing High-Quality School Emergency Operations Plans https://drwilda.com/2013/07/08/fema-issues-guide-for-developing-high-quality-school-emergency-operations-plans/

Study: 1 in 3 teens are victims of dating violence https://drwilda.com/2013/08/05/study-1-in-3-teens-are-victims-of-dating-violence/

Pediatrics article: Sexual abuse prevalent in teen population https://drwilda.com/2013/10/10/pediatrics-article-sexual-abuse-prevalent-in-teen-population/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

Children’s Hospital of Philadelphia study: Parent’s attitudes determine ADHD treatment

6 Sep

Many parents will be presented with a diagnosis of ADHD regarding their child. Yahoo medical reported in the article, Top 10 Myths About ADHD:

Myth #1: Only kids have ADHD.
Although about 10% of kids 5 to 17 years old have been diagnosed with ADHD, at least 4% of adults have it, too — and probably many more, since adult ADHD is often undiagnosed or misdiagnosed. That’s partly because people think only kids get it.

Myth #2: All kids “outgrow” ADHD.
Not nearly always. Up to 70% of children with ADHD continue to have trouble with it in adulthood, which can create relationship problems, money troubles, work strife, and a rocky family life.

Myth #3: Medication is the only treatment for ADHD.
Medication can be useful in managing ADHD symptoms, but it’s not a cure. And it’s not the only treatment. Lifestyle changes, counseling, and behavior modification can significantly improve symptoms as well. Several studies suggest that a combination of ADHD treatments works best.

Myth #4: People who have ADHD are lazy and lack intelligence and willpower.
This is totally not true. In fact, ADHD has nothing to do with intelligence or determination. It’s a neurobehavioral disorder caused by changes in brain chemicals and the way the brain works. It presents unique challenges, but they can be overcome — which many successful people have done. Even Albert Einstein is said to have had symptoms of ADHD.

Myth #5: ADHD isn’t a real disorder.
Not so. Doctors and mental-health professionals agree that ADHD is a biological disorder that can significantly impair functioning. An imbalance in brain chemicals affects brain areas that regulate behavior and emotion. This is what produces ADHD symptoms.

Myth #6: Bad parenting causes ADHD.
Absolutely not! ADHD symptoms are caused by brain-chemical imbalances (see #4 and #5) that make it hard to pay attention and control impulses. Good parenting skills help children deal with their symptoms.

Myth #7: Kids with ADHD are always hyper.
Not always. ADHD comes in three “flavors”: predominantly inattentive; predominantly hyperactive-impulsive; and combined, which is a mix of inattentive and hyperactive-impulsive symptoms. Although kids with hyperactive-impulsive or combined ADHD may be fidgety and restless, kids with inattentive ADHD are not hyper.

Myth #8: Too much TV time causes ADHD.
Not really. But spending excessive amounts of time watching TV or playing video games could trigger the condition in susceptible individuals. And in kids and teens who already have ADHD, spending hours staring at electronic screens may make symptoms worse.

Myth #9: If you can focus on certain things, you don’t have ADHD.
It’s not that simple. Although it’s true that people with ADHD have trouble focusing on things that don’t interest them, there’s a flip side to the disorder. Some people with ADHD get overly absorbed in activities they enjoy. This symptom is called hyperfocus. It can help you be more productive in activities that you like, but you can become so focused that you ignore responsibilities you don’t like.

Myth #10: ADHD is overdiagnosed.
Nope. If anything, ADHD is underdiagnosed and undertreated. Many children with ADHD grow up to be adults with ADHD. The pressures and responsibilities of adulthood often exacerbate ADHD symptoms, leading adults to seek evaluation and help for the first time. Also, parents who have children with ADHD may seek treatment only after recognizing similar symptoms in themselves.
http://shine.yahoo.com/parenting/top-10-myths-about-adhd-2528710.html

Whether drug or behavior therapy is chosen to treat ADHD depends upon the goals of the parents.

Genevra Pittman reported in the article, ADHD Treatment: Parents’ Goals Tied To Choice Of Behavior Therapy Or Medication (STUDY):

(Reuters Health) – Parents’ goals and concerns for their children with attention-deficit/hyperactivity disorder may influence their decision to start behavior therapy or medication, according to a new study that researchers say supports a shared decision-making approach to ADHD treatment.
Researchers found parents who were focused on their child’s academic achievement were twice as likely to have the child started on medications, which include Adderall and Ritalin, as other parents.
Parents who expressed goals of improved behavior and interpersonal relationships were 60 percent more likely to start behavior therapy – which involves parents meeting with a counselor to learn how to manage a child’s behavior.
“Studies like this really suggest that taking a shared decision-making approach may be one way to match the kids for whom (treatment) is warranted to the best treatment,” Dr. Alexander Fiks, from The Children’s Hospital of Pennsylvania in Philadelphia, said.
“For parents, the real thing is to ask pediatricians to really explain the pluses and minuses of all of the different options, and to make sure they can articulate what they’re really most hoping to achieve,” Fiks, the study’s lead author, told Reuters Health.
http://www.huffingtonpost.com/2013/09/02/adhd-treatment-parents-goals_n_3857116.html?utm_hp_ref=email_share

The medical Xpress article, Engaging parents leads to better treatments for children with adhd reported about the ADHD study:

Pediatricians and researchers at The Children’s Hospital of Philadelphia’s(CHOP) have developed a first-of-its kind tool to help parents and health care providers better treat ADHD (attention deficit-hyperactivity disorder). The new, three-part survey helps steer families and doctors toward “shared decision-making”, an approach proven to improve healthcare results in adults, but not widely used in pediatric settings. The results of the CHOP study are published in the journal Academic Pediatrics.
“Shared decision-making in health care means that doctors and families make decisions together. Doctors contribute their professional knowledge, and families weigh their values and personal experience,” explained lead author Alexander Fiks, M.D., M.S.C.E, an urban primary care pediatrician at CHOP and a faculty member at CHOP’s PolicyLab. “We chose to focus on ADHD for this study, because it is a relatively common diagnosis with two recommended treatment options – prescription medication and behavioral therapy – that require the family to make decisions about what will work best for them. Choosing a treatment that doesn’t ‘fit’ can lead to unsuccessful results. We wanted to see if we could create a tool to help guide families and physicians through this process.”
According to a study published earlier this year, the number of physician outpatient visits in which ADHD was diagnosed in children under age 18 was 10.4 million. Psychostimulants were used in 87 percent of treatments prescribed during those visits.
The CHOP study involved 237 parents of children aged 6-12 who were diagnosed with ADHD within the past 18 months. Using a combination of parent interviews, current research, and input from parent advocates and professional experts, researchers developed a standardized three-part questionnaire to help parents define and prioritize their goals for treatment; attitudes toward medication; and comfort with behavioral therapies. The completed survey serves as a guide to support families and health care providers to reach the most effective and workable treatment for a child’s ADHD.
“It’s important to know whether a parent’s primary goal is to keep a child from getting in trouble at school, improve academic performance, or maintain more peace with family members or peers,” said Fiks. “We also need to learn about the family’s lifestyle and attitudes toward behavioral therapy and medication. All of these factor into making the best treatment decision for each individual child and family.” http://medicalxpress.com/news/2012-10-engaging-parents-treatments-children-adhd.html

Citation:

Contrasting parents’ and pediatricians’ perspectives on shared decision-making in ADHD.
Fiks AG, Hughes CC, Gafen A, Guevara JP, Barg FK.
Source
Pediatric Research Consortium, Children’s Hospital of Philadelphia, 3535 Market St, Room 1546, Philadelphia, PA 19104, USA. fiks@email.chop.edu
Abstract
OBJECTIVE:
The goal was to compare how parents and clinicians understand shared decision-making (SDM) in attention-deficit/hyperactivity disorder (ADHD), a prototype for SDM in pediatrics.
METHODS:
We conducted semi-structured interviews with 60 parents of children 6 to 12 years of age with ADHD (50% black and 43% college educated) and 30 primary care clinicians with varying experience. Open-ended interviews explored how pediatric clinicians and parents understood SDM in ADHD. Interviews were taped, transcribed, and then coded. Data were analyzed by using a modified grounded theory approach.
RESULTS:
Parents and clinicians both viewed SDM favorably. However, parents described SDM as a partnership between equals, with physicians providing medical expertise and the family contributing in-depth knowledge of the child. In contrast, clinicians understood SDM as a means to encourage families to accept clinicians’ preferred treatment. These findings affected care because parents mistrusted clinicians whose presentation they perceived as biased. Both groups discussed how real-world barriers limit the consideration of evidence-based options, and they emphasized the importance of engaging professionals, family members, and/or friends in SDM. Although primary themes did not differ according to race, white parents more commonly received support from medical professionals in their social networks.
CONCLUSIONS:
Despite national guidelines prioritizing SDM in ADHD, challenges to implementing the process persist. Results suggest that, to support SDM in ADHD, modifications are needed at the practice and policy levels, including clinician training, incorporation of decision aids and improved strategies to facilitate communication, and efforts to ensure that evidence-based treatment is accessible.
PMID:
21172996
[PubMed – indexed for MEDLINE]
PMCID:
PMC3010085
Free PMC Article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010085/

The Centers for Disease Control provides great information in the article, Attention-Deficit / Hyperactivity Disorder (ADHD):
Treatment

On This Page
• Medications
• Behavioral intervention strategies
• Parent Education and Support
• Behavior Treatment for Preschoolers
• ADHD and School
• Related Pages
My Child Has Been Diagnosed with ADHD – Now What?
It is understandable for parents to have concerns when their child is diagnosed with ADHD, especially about treatments. It is important for parents to remember that while ADHD can’t be cured, it can be successfully managed. There are many treatment options, so parents and doctors should work closely with everyone involved in the child’s treatment — teachers, coaches, therapists, and other family members. Taking advantage of all the resources available will help you guide your child towards success. Remember, you are your child’s strongest advocate!
In most cases, ADHD is best treated with a combination of medication and behavior therapy. Good treatment plans will include close monitoring, follow-ups and any changes needed along the way.
Following are treatment options for ADHD:
Behavior Treatment for Preschoolers
Click here to learn more »
• Medications
• Behavioral intervention strategies
• Parent training
• ADHD and school

To go to the American Academy of Pediatrics (AAP) policy statement on the treatment of school-aged children with ADHD, visit the Recommendations page.
Medications
Medication can help a child with ADHD in their everyday life and may be a valuable part of a child’s treatment. Medication is one option that may help better control some of the behavior problems that have led to trouble in the past with family, friends and at school.
Several different types of medications may be used to treat ADHD:
• Stimulants are the best-known and most widely used treatments. Between 70-80 percent of children with ADHD respond positively to these medications.
• Nonstimulants were approved for treating ADHD in 2003. This medication seems to have fewer side effects than stimulants and can last up to 24 hours.
Medications can affect children differently, where one child may respond well to one medication, but not another. When determining the best treatment, the doctor might try different medications and doses, so it is important to work with your child’s doctor to find the medication that works best for your child.
For more information on treatments, please click one of the following links:
National Resource Center on ADHD
National Institute of Mental Health
Behavioral Therapy
Research shows that behavioral therapy is an important part of treatment for children with ADHD. ADHD affects not only a child’s ability to pay attention or sit still at school, it also affects relationships with family and how well they do in their classes. Behavioral therapy is another treatment option that can help reduce these problems for children and should be started as soon as a diagnosis is made.
Following are examples that might help with your child’s behavioral therapy:
• Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime.
• Get organized . Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them.
• Avoid distractions. Turn off the TV, radio, and computer, especially when your child is doing homework.
• Limit choices. Offer a choice between two things (this outfit, meal, toy, etc., or that one) so that your child isn’t overwhelmed and overstimulated.
• Change your interactions with your child. Instead of long-winded explanations and cajoling, use clear, brief directions to remind your child of responsibilities.
• Use goals and rewards. Use a chart to list goals and track positive behaviors, then reward your child’s efforts. Be sure the goals are realistic—baby steps are important!
• Discipline effectively. Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior.
• Help your child discover a talent. All kids need to experience success to feel good about themselves. Finding out what your child does well — whether it’s sports, art, or music — can boost social skills and self-esteem.
Parent Education and Support
Parent education and support are other important parts of treatment for a child with ADHD. Children with ADHD might not respond as well as other children to the usual parenting practices, so experts recommend additional parent education. This approach has been successful in teaching parents how to help their children become better organized, develop problem-solving skills, and cope with their ADHD symptoms.
Parent education can be conducted in groups or with individual families and is offered by therapists or in special classes. Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) offers a unique educational program to help parents and individuals with ADHD navigate the challenges of ADHD across the lifespan. Find more information about CHADD’s “Parent to Parent” program by visiting CHADD’s website .
Behavior Treatment for Preschoolers
The 2011 clinical practice guidelines from the American Academy of Pediatrics recommend that doctors prescribe behavior interventions that are evidence based as the first line of treatment for preschool-aged children (4–5 years of age) with ADHD. Parents or teachers can provide this treatment.
The Agency for Health Care Research and Quality (AHRQ) conducted a review in 2010 of all existing studies on treatment options for preschoolers. The review found enough evidence to recommend parent behavioral interventions as a good treatment option for preschoolers with disruptive behavior in general and as helpful for those with ADHD symptoms.
The AHRQ review found that effective parenting programs help parents develop a positive relationship with their child, teach them about how children develop, and help them manage negative behavior with positive discipline. The review also found four programs for parents of preschoolers that include these key components:
• Triple P (Positive Parenting of Preschoolers program),
• Incredible Years Parenting Program
• Parent-Child Interaction Therapy
• New Forest Parenting Program—Developed specifically for parents of children with ADHD [Abstract ] [Authors ]
Read the full AHRQ report here .
ADHD and the Classroom
Just like with parent training, it is important for teachers to have the needed skills to help children manage their ADHD. However, since the majority of children with ADHD are not enrolled in special education classes, their teachers will most likely be regular education teachers who might know very little about ADHD and could benefit from assistance and guidance.
Here are some tips to share with teachers for classroom success:
• Use a homework folder for parent-teacher communications
• Make assignments clear
• Give positive reinforcement
• Be sensitive to self-esteem issues
• Involve the school counselor or psychologist
What Every Parent Should Know…
As your child’s most important advocate, you should become familiar with your child’s medical, legal, and educational rights. Kids with ADHD might be eligible for special services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) and an anti-discrimination law known as Section 504. To learn more about Section 504, click here .
Related Pages
• Child Development
• Positive Parenting Tips
• Injury, Violence, and Safety
• Safe and Healthy Kids and Teens
• CDC’s National Center on Birth Defects and Developmental Disabilities
http://www.cdc.gov/ncbddd/adhd/treatment.html

A Healthy Child In A Healthy Family Who Attends A Healthy School In A Healthy Neighborhood. ©

If you suspect that your child might have ADHD, you should seek an evaluation from a competent professional who has knowledge of this specialized area of medical practice.

Related:
Studies: ADHD drugs don’t necessarily improve academic performance
https://drwilda.com/2013/07/14/studies-adhd-drugs-dont-necessarily-improve-academic-performance/

ADHD coaching to improve a child’s education outcome
https://drwilda.com/2012/03/31/adhd-coaching-to-improve-a-childs-education-outcome/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:
COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

Virginia Mason Hospital study: Carbon monoxide can pass through dry wall

21 Aug

Carbon monoxide poisoning can kill. Marijke Vroomen Durning wrote in the Forbes article, Carbon Monoxide, A Silent Killer: Are You Safe At Home?

Every year, 20,000 to 30,000 people in the United States are sickened by accidental carbon monoxide poisoning and approximately 500 people die, many in their own home. Carbon monoxide is colorless, odorless, and tasteless. It cannot be detected by humans without the help of a detector.
A new study, released today in the Journal of the American Medical Association (JAMA), has found that carbon monoxide easily passes through gypsum wallboards (also called drywall), the material used to finish walls and ceilings in most residential homes. The porous material does nothing to stop the gas from seeping through.
Here’s where the problem gets worse: Twenty-five states require that residents have a carbon monoxide alarm in their homes but in December 2012, 10 states exempted residences that don’t have an internal carbon monoxide-producing source, such as a gas stove or fireplace, or an attached garage in which a car could be left idling. This move worries toxicologists who fear that these exemptions may give people a false sense of security. It’s believed that removing the requirement for all homes to have such alarms will lead to an increased number of accidental carbon monoxide poisonings, particularly in multi-unit buildings.
http://www.forbes.com/sites/marijkevroomendurning/2013/08/20/carbon-monoxide-a-silent-killer-are-you-safe/

Here is the press release from Virginia Mason Hospital:

News Releases
Researchers Prove Carbon Monoxide Penetrates Gypsum Wallboard
SEATTLE – (Aug. 21, 2013) — Carbon monoxide (CO) from external sources can easily penetrate gypsum wallboard (drywall) commonly used in apartments and houses, potentially exposing people indoors to the toxic, odorless, tasteless gas within minutes, concludes a study conducted at Virginia Mason Medical Center.
These findings, which underscore the importance of CO alarms in single-family and multi-family homes, are published in today’s edition of the Journal of the American Medical Association. Authors of the study are Neil B. Hampson, MD; James R. Holm, MD; and engineer Todd G. Courtney, of the Virginia Mason Center for Hyperbaric Medicine.
Their research casts doubt on the assumption that the risk for CO poisoning inside a residence is eliminated if there is no apparent internal source of the gas. They determined that carbon monoxide from an external source, such as an electrical generator operating in an adjacent apartment or an automobile engine running in an attached garage, can pass through drywall ceilings and walls because gypsum wallboard is highly porous. CO also penetrates painted drywall, albeit more slowly, the researchers determined.
Their study is believed to be the first to examine the ability of carbon monoxide to diffuse through gypsum wallboard. Gypsum particles contain microscopic pores that are many times larger than CO molecules, allowing these dangerous molecules to easily penetrate drywall.
“There are numerous media reports describing simultaneous CO poisonings in different units of multifamily dwellings,” the authors note. Even though carbon monoxide might have traveled through ventilation ducts, hallways, elevator shafts or stairways in some cases, this was not possible in every case due to configurations of the buildings, they add. This raised the question whether CO could pass through drywall.
Many states are enacting legislation mandating residential CO alarms, although some have exempted structures if there is no apparent indoor carbon monoxide source (i.e., fuel-burning appliances, fireplaces, etc.). This action is dangerous, authors of the study caution, because occupants of multifamily dwellings, for example, can bring sources of CO production into their units and put themselves and people in neighboring units in harm’s way.
Since January 2013, Washington state law has required carbon monoxide alarms be installed in most existing single-family homes, as well as hotels, motels and apartments. The alarms must be located outside, and near, each separate sleeping area.
Carbon monoxide poisoning causes about 500 accidental deaths annually in the U.S.
About Virginia Mason Medical Center
Virginia Mason Medical Center, founded in 1920, is a nonprofit regional health care system in Seattle that serves the Pacific Northwest. Virginia Mason employs more than 5,300 people and includes a 336-bed acute-care hospital; a primary and specialty care group practice of more than 460 physicians; satellite locations throughout the Puget Sound area; and Bailey-Boushay House, the first skilled-nursing and outpatient chronic care management program in the U.S. designed and built specifically to meet the needs of people with HIV/AIDS. Benaroya Research Institute at Virginia Mason is internationally recognized for its breakthrough autoimmune disease research. Virginia Mason was the first health system to apply lean manufacturing principles to health care delivery to eliminate waste and improve quality and patient safety.
To learn more about Virginia Mason Medical Center, please visit Facebook.com/VMcares or follow @VirginiaMason on Twitter. To learn how Virginia Mason is transforming health care and to join the conversation, visit our blog at VirginiaMasonBlog.org.
Media Contact:
Gale Robinette
Virginia Mason Media Relations
(206) 341-1509
gale.robinette@vmmc.org

See:

Drywall No Barrier Against CO Poisoning http://www.medpagetoday.com/PublicHealthPolicy/EnvironmentalHealth/41091

The Centers for Disease Control and Prevention posted information about Carbon Monoxide Poisoning:
Frequently Asked Questions

What is carbon monoxide?

Carbon monoxide, or CO, is an odorless, colorless gas that can cause sudden illness and death.
Where is CO found?
CO is found in combustion fumes, such as those produced by cars and trucks, small gasoline engines, stoves, lanterns, burning charcoal and wood, and gas ranges and heating systems. CO from these sources can build up in enclosed or semi-enclosed spaces. People and animals in these spaces can be poisoned by breathing it.
What are the symptoms of CO poisoning?
The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and confusion. High levels of CO inhalation can cause loss of consciousness and death. Unless suspected, CO poisoning can be difficult to diagnose because the symptoms mimic other illnesses. People who are sleeping or intoxicated can die from CO poisoning before ever experiencing symptoms.
How does CO poisoning work?
Red blood cells pick up CO quicker than they pick up oxygen. If there is a lot of CO in the air, the body may replace oxygen in blood with CO. This blocks oxygen from getting into the body, which can damage tissues and result in death. CO can also combine with proteins in tissues, destroying the tissues and causing injury and death.

Who is at risk from CO poisoning?

All people and animals are at risk for CO poisoning. Certain groups — unborn babies, infants, and people with chronic heart disease, anemia, or respiratory problems — are more susceptible to its effects. Each year, more than 400 Americans die from unintentional CO poisoning, more than 20,000 visit the emergency room and more than 4,000 are hospitalized due to CO poisoning. Fatality is highest among Americans 65 and older.
How can I prevent CO poisoning from my home appliances?
• Have your heating system, water heater and any other gas, oil, or coal burning appliances serviced by a qualified technician every year.
• Do not use portable flameless chemical heaters (catalytic) indoors. Although these heaters don’t have a flame, they burn gas and can cause CO to build up inside your home, cabin, or camper.
• If you smell an odor from your gas refrigerator’s cooling unit have an expert service it. An odor from the cooling unit of your gas refrigerator can mean you have a defect in the cooling unit. It could also be giving off CO.
• When purchasing gas equipment, buy only equipment carrying the seal of a national testing agency, such as the CSA Group .
• Install a battery-operated or battery back-up CO detector in your home and check or replace the battery when you change the time on your clocks each spring and fall.

How do I vent my gas appliances properly?

• All gas appliances must be vented so that CO will not build up in your home, cabin, or camper.
• Never burn anything in a stove or fireplace that isn’t vented.
• Have your chimney checked or cleaned every year. Chimneys can be blocked by debris. This can cause CO to build up inside your home or cabin.
• Never patch a vent pipe with tape, gum, or something else. This kind of patch can make CO build up in your home, cabin, or camper.
• Horizontal vent pipes to fuel appliances should not be perfectly level. Indoor vent pipes should go up slightly as they go toward outdoors. This helps prevent CO or other gases from leaking if the joints or pipes aren’t fitted tightly.

How can I heat my house safely or cook when the power is out?

• Never use a gas range or oven for heating. Using a gas range or oven for heating can cause a build up of CO inside your home, cabin, or camper.
• Never use a charcoal grill or a barbecue grill indoors. Using a grill indoors will cause a build up of CO inside your home, cabin, or camper unless you use it inside a vented fireplace.
• Never burn charcoal indoors. Burning charcoal — red, gray, black, or white — gives off CO.
• Never use a portable gas camp stove indoors. Using a gas camp stove indoors can cause CO to build up inside your home, cabin, or camper.
• Never use a generator inside your home, basement, or garage or near a window, door, or vent.
How can I avoid CO poisoning from my vehicle?
• Have a mechanic check the exhaust system of my car every year. A small leak in your car’s exhaust system can lead to a build up of CO inside the car.
• Never run a car or truck in the garage with the garage door shut. CO can build up quickly while your car or truck is running in a closed garage. Never run your car or truck inside a garage that is attached to a house and always open the door to any garage to let in fresh air when running a car or truck inside the garage.
• If you drive a vehicle with a tailgate, when you open the tailgate, you also need to open vents or windows to make sure air is moving through your car. If only the tailgate is open CO from the exhaust will be pulled into the car.
http://www.cdc.gov/co/faqs.htm

It is more important than ever for those living in multi-unit homes to have carbon monoxide detectors in each unit.

Consumer Search offers tips about buying a carbon monoxide monitor in How to Buy a Carbon Monoxide Detector:

What the best carbon monoxide detector has
• Audio alarm. Devices certified by Underwriters Laboratories (UL) have a minimum 85-decibel horn that can be heard within 10 feet.
• Interconnectivity. Interconnecting units are helpful in large homes because they communicate with one another; when one alarm detects a hazard, it triggers them all to sound an alarm. To work properly, all units must be made by the same manufacturer. While traditionally hardwired, battery-operated wireless interconnecting units are now available.
• Five-year sensor lifespan. The sensors on carbon monoxide detectors do wear away over time. Expect your unit to last at least five years. The better models have an end-of-life timer to alert you when the unit needs to be replaced. Kidde’s newest CO detectors, released in March, last for 10 years.
• Long warranty. Carbon monoxide detectors can malfunction, and the best units come with a warranty of at least five to seven years.
• Digital display. UL-certified carbon monoxide detectors are designed to sound an alarm if they sense CO levels of 70 parts per million (ppm) or higher. Exposure of 100 ppm for 20 minutes may not affect healthy adults. However, people with cardiac or respiratory problems, infants, pregnant women and the elderly may be harmed by lower concentrations. A device with a digital display can show these concentrations and give you the peace of mind.
• Testing functionality. CO detectors should be tested once a month. The best detectors have a test/silence button to test the device and also silence the alarm in the event of a false alarm.
Know before you go
What are the regulations in your state or municipality? Most states require a carbon monoxide detector to be installed in new homes or before the sale of a home. Some require hardwired or plug-in units to have battery backup in the case of a power outage. The National Conference of State Legislatures is a good resource for determining what regulations apply to you.
How are your current carbon monoxide detectors installed? Detectors may be hardwired, plugged into an outlet or battery operated, depending on the model. Some plug-in and hardwired units use batteries as a backup during a power failure and will not operate if they are not installed. If your current carbon monoxide detectors are hardwired, you will most likely want to keep that system. Otherwise, battery-operated and plug-in models are the easiest to install.
Do you need a smoke alarm, too? If you also need a smoke alarm, a combination smoke and carbon monoxide alarm might be best. Decide whether you need the smoke alarm to use ionization or photoelectric technology. The U.S. Fire Administration provides background on the different technologies.
How many alarms do you need? CO alarms should be installed in a central location outside each sleeping area and on every level of the home, according to the National Fire Protection Association, which also recommends interconnecting all alarms.
Does your unit meet safety standards? Check to see that the detector is certified by an independent testing agency such as Underwriters Laboratories or Canadian Standards Association.
http://www.consumersearch.com/carbon-monoxide-detectors/how-to-buy-a-carbon-monoxide-detector

The Virginia Mason study shows how important carbon monoxide detectors are.

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FEMA issues Guide for Developing High-Quality School Emergency Operations Plans

8 Jul

As the Sandy Hook massacre demonstrated, unfortunately, schools have to prepare for school violence and school emergencies. The Centers for Disease Control (CDC) provides the following statistics in School Violence: Data & Statistics:

Fact Sheets
Understanding School Violence Fact Sheet  [PDF 254 KB]
This fact sheet provides an overview of school violence.
Behaviors that Contribute to Violence on School Property  [PDF 92k]
This fact sheet illustrates the trends in violence-related behaviors among youth as assessed by CDC’s Youth Risk Behavior Surveillance System (YRBSS). YRBSS monitors health risk behaviors that contribute to the leading causes of death and disability among young people in the United States, including violence.
Understanding Youth Violence  [PDF 313KB]
This fact sheet provides an overview of youth violence.
Youth Violence: Facts at a Glance  [PDF 128KB]
This fact sheet provides up-to-date data and statistics on youth violence.
Data Sources
School Associated Violent Death Study
CDC has been collecting data on school-associated violent deaths since 1992. This data system, which was developed in partnership with the Departments of Education and Justice, monitors school-associated violent deaths at the national level. Information is collected from media databases, police, and school officials. A case is defined as a fatal injury (e.g., homicide or suicide) that occurs (1) on school property; (2) on the way to/from school; or (3) during or on the way to/from a school sponsored event. Only violent deaths associated with U.S. elementary and secondary schools, public and private, are included.  Data obtained from this study play an important role in monitoring and assessing national trends in school-associated violent deaths, and help to inform efforts to prevent fatal school violence.
Indicators of School Crime and Safety
The U.S. Department of Education and Department of Justice publish a report on school crime and student safety each year. The report provides the most recent data available from many independent sources, including findings from national surveys of students, teachers, and principals. The report covers topics such as victimization, teacher injury, bullying, school conditions, fights, weapons, and student use of drugs and alcohol. The indicators of crime and safety are compared across different population subgroups and over time. Data on crimes that occur away from school are also offered as a point of comparison where available.
School Health Policies and Programs Study
The School Health Policies and Programs Study (SHPPS) is the largest, most comprehensive assessment of school health policies and programs. It is conducted at state, district, school, and four classroom levels across the country. The CDC-sponsored study provides data to help improve school health policies and programs. SHPPS is conducted every six years; the first administration was in 1994 and the most recent, in 2006. The study assesses eight components of school health programs at the elementary, middle/junior, and senior high school levels that are related to adolescent risk behaviors, including violence. These components are health education; physical education; health services; mental health and social services; school policy and environment; food services; faculty and staff health promotion; and family and community involvement.
Youth Risk Behavior Surveillance System
CDC monitors risk behaviors, such as violence, that contribute to the leading causes of death among youth in the United States. CDC administers a nationwide survey every two years in public and private high schools so investigators can examine behaviors related to fighting, weapon carrying, bullying, dating and sexual violence, and suicide.
Youth Violence National and State Statistics at a Glance
This web site provides statistics that illustrate trends and patterns in youth violence. Users will find national and state-level data on youth homicide, nonfatal assaults, and violent crime arrests.
References
1.Centers for Disease Control and Prevention. School-associated student homicides—United States, 1992–2006. MMWR 2008;57(02):33–36.
http://www.cdc.gov/violenceprevention/youthviolence/schoolviolence/data_stats.html

The Federal Emergency Management Agency (FEMA) has released Guide for Developing High-Quality School Emergency Operations Plans.

Jaclyn Zubrzycki and Nirvi Shah write about FEMA’s guidelines for emergencies in schools in the Education Week article, Feds’ Advice on School Intruders Worries Some Experts:

New guidelines from the Obama administration for planning for emergencies at schools following the December shooting at Sandy Hook Elementary School in Newtown, Conn., touch on everything from school design and storm shelters to planning emergency drills and balancing privacy and safety.
But one facet of the plan, released June 18, is on active-shooting situations, and some of the recommendations in those scenarios make school safety experts nervous—namely, a suggestion that school employees try to fight an intruder when given no other choice.
While the White House document says this should be done as a last resort, that message is easily lost, said Michael Dorn, the executive director of the Atlanta-based Safe Havens International, which advises schools on safety and emergency planning. In his experience, when school employees are given the idea that in rare circumstances, fighting or disarming a shooter is an option, it’s the only thing that comes to mind for far less serious scenarios. In drills, school employees have become so focused on fighting a shooter they have forgotten to take the basic step of locking their classroom doors.
“Though [school shootings] are catastrophic, they’re rare,” Mr. Dorn said.
The new guidelines were written jointly by the U.S. departments of Education, Homeland Security, Justice, and Health and Human Services, the Federal Bureau of Investigation, and the Federal Emergency Management Agency.
What’s Inside
President Barack Obama promised the agencies would join forces on the advice as part of a larger set of promises and recommendations he made in January on curbing gun violence. The 75-page guide deals with prevention, protection, mitigation, response, and recovery from technological, human-caused, natural, and biological threats.
A student helps block the classroom door with furniture during a mock lockdown drill in January at Moody High School in Corpus Christi, Texas. “This is our first time empowering [students] not to be victims,” said Principal Sandra Clement of the drill.
—Rachel Denny Clow/Corpus Christi Caller-Times/AP
The document is meant to be a guide and contains no mandates for schools. It compiles lessons and best practices from agencies and schools that have had to cope with various emergencies in the past and from previous federal guidance on school emergency planning.
The publication details a six-part process for schools looking to develop emergency plans: forming a collaborative team, understanding threats, determining goals and objectives, developing specific courses of action, reviewing plans, and implementing and maintaining the plan. Schools are encouraged to reach out to other local agencies as they assess the threats they face and their capacity to respond. http://www.edweek.org/ew/articles/2013/07/10/36safety.h32.html?tkn=UPTFcbIk8VXWICr054xiiTeDXhOZPalcsoT0&cmp=clp-edweek

Citation:

Guide for Developing High-Quality School Emergency Operations Plans  [open pdf – 2MB]
“Each school day, our nation’s schools are entrusted to provide a safe and healthy learning environment for approximately 55 million elementary and secondary school students1in public and nonpublic schools. Families and communities expect schools to keep their children and youths safe from threats (human-caused emergencies such as crime and violence) and hazards (natural disasters, disease outbreaks, and accidents). In collaboration with their local government and community partners, schools can take steps to plan for these potential emergencies through the creation of a school Emergency Operations Plan (school EOP). Lessons learned from school emergencies highlight the importance of preparing school officials and first responders to implement emergency operations plans. By having plans in place to keep students and staff safe, schools play a key role in taking preventative and protective measures to stop an emergency from occurring or reduce the impact of an incident. Although schools are not traditional response organizations, when a school-based emergency occurs, school personnel respond immediately. They provide first aid, notify response partners, and provide instructions before first responders arrive. They also work with their community partners, i.e., governmental organizations that have a responsibility in the school emergency operations plan to provide a cohesive, coordinated response. Community partners include first responders (law enforcement officers, fire officials, and emergency medical services personnel) as well as public and mental health entities. We recommend that planning teams responsible for developing and revising school EOPs use this document to guide their efforts. It is recommended that districts and individual schools compare existing plans and processes against the content and processes outlined in this guide. To gain the most from it, users should read through the entire document prior to initiating their planning efforts and then refer back to it throughout the planning process.”
Publisher:
United States. Federal Emergency Management Agency
Date:
2013-06
Copyright:
Public Domain
Retrieved From:
U.S. Department of Homeland Security: http://www.dhs.gov/
Format:
pdf
Media Type:
application/pdf
URL:
https://www.hsdl.org/?view&did=739248

School EOP dissects the guide in High-Quality School Emergency Operations Plans:

Lessons learned from school emergencies highlight the importance of preparing school officials and first responders to implement emergency operations plans. By having plans in place to keep students and staff safe, schools play a key role in taking preventative and protective measures to stop an emergency from occurring or reduce the impact of an incident. Although schools are not traditional response organizations, when a school-based emergency occurs, school personnel respond immediately. They provide first aid, notify response partners, and provide instructions before first responders arrive. They also work with their community partners, i.e., governmental organizations that have a responsibility in the school emergency operations plan to provide a cohesive, coordinated response. Community partners include first responders (law enforcement officers, fire officials, and emergency medical services personnel) as well as public and mental health entities.
We recommend that planning teams responsible for developing and revising school EOPs use this document to guide their efforts. It is recommended that districts and individual schools compare existing plans and processes against the content and processes outlined in this guide. To gain the most from it, users should read through the entire document prior to initiating their planning efforts and then refer back to it throughout the planning process.
The guide is organized in four sections:
1.The principles of school emergency management planning.
2.A process for developing, implementing, and continually refining a school EOP with community partners (e.g., first responders and emergency management personnel) at the school building level.
3.A discussion of the form, function, and content of school EOPs.
4.“A Closer Look,” which considers key topics that support school emergency planning, including addressing an active shooter, school climate, psychological first aid, and information-sharing.
As the team that developed this guide began its work to respond to the president’s call for model emergency management plans for schools, it became clear that there is a need to help ensure that our schools’ emergency planning efforts are aligned with the emergency planning practices at the national, state, and local levels. Recent developments have put a new emphasis on the process for developing EOPs.
National preparedness efforts, including planning, are now informed by Presidential Policy Directive (PPD) 8, which was signed by the president in March 2011 and describes the nation’s approach to preparedness. This directive represents an evolution in our collective understanding of national preparedness, based on the lessons learned from terrorist attacks, hurricanes, school incidents, and other experiences.
PPD-8 defines preparedness around five mission areas: Prevention, Protection, Mitigation, Response, and Recovery.
Prevention,2 for the purposes of this guide, means the capabilities necessary to avoid, deter, or stop an imminent crime or threatened or actual mass casualty incident. Prevention is the action schools take to prevent a threatened or actual incident from occurring.
Protection means the capabilities to secure schools against acts of violence and manmade or natural disasters. Protection focuses on ongoing actions that protect students, teachers, staff, visitors, networks, and property from a threat or hazard.
Mitigation means the capabilities necessary to eliminate or reduce the loss of life and property damage by lessening the impact of an event or emergency. In this document, “mitigation” also means reducing the likelihood that threats and hazards will happen.
Response means the capabilities necessary to stabilize an emergency once it has already happened or is certain to happen in an unpreventable way; establish a safe and secure environment; save lives and property; and facilitate the transition to recovery.
Recovery means the capabilities necessary to assist schools affected by an event or emergency in restoring the learning environment.
Emergency management officials and emergency responders engaging with schools are familiar with this terminology. These mission areas generally align with the three timeframes associated with an incident: before, during, and after.
The majority of Prevention, Protection, and Mitigation activities generally occur before an incident, although these three mission areas do have ongoing activities that can occur throughout an incident. Response activities occur during an incident, and Recovery activities can begin during an incident and occur after an incident. To help avoid confusion over terms and allow for ease of reference, this guide uses “before,” “during,” and “after.”
As schools plan for and execute response and recovery activities through the emergency operations plan, they should use the concepts and principles of the National Incident Management System (NIMS). One component of NIMS is the Incident Command System (ICS), which provides a standardized approach for incident management, regardless of cause, size, location, or complexity. By using ICS during an incident, schools will be able to more effectively work with the responders in their communities. For more information on ICS and NIMS, please see the Resources section.
While some of the vocabulary, processes, and approaches discussed in this guide may be new to the education community, they are critical. The vocabulary, processes, and approaches are critical to the creation of emergency management practices and plans that are integrated with the efforts of first responders and other key stakeholders, and that incorporate everything possible to keep children safe. If a school system has an existing plan, revising and adapting that plan using the principles and process described in this guide will help ensure alignment with the terminology and approaches used across the nation.
http://schooleop.org/

Unfortunately, schools are forced to think about and prepare for the worst and the unthinkable.

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Many young people don’t know they are infected with HIV

27 Nov

Moi wrote about HIV in the article, People MUST talk: AIDS epidemic in Black community:

Aside from the devastation that a poor economy has wrecked upon the Black community, a scourge that few are talking about is the AIDS epidemic in the Black community. NPR reports in the story, AIDS In Black America: A Public Health Crisis:

Of the more than 1 million people in the U.S. infected with HIV, nearly half are black men, women and children — even though blacks make up about 13 percent of the population. AIDS is the primary killer of African-Americans ages 19 to 44, and the mortality rate is 10 times higher for black Americans than for whites.

A new Frontline documentary, Endgame: AIDS in Black America, explores why the HIV epidemic is so much more prevalent in the African-American community than among whites. The film is produced, written and directed by Renata Simone, whose series The Age of AIDS appeared on Frontline in 2006.

On Thursday’s Fresh Air, Simone is joined by Robert Fullilove, a professor of clinical sociomedical studies at Columbia University’s Mailman School of Public Health, and chairman of the HIV/AIDS advisory committee at the Centers for Disease Control and Prevention.

When I started doing this work in 1986, roughly 20 percent of all of the people in the United States who were living with AIDS were African-American,” Fullilove tells Fresh Air‘s Terry Gross. “The most recent statistics from the Centers for Disease Control indicate that 45 percent of all the new cases of HIV infection are amongst African-Americans. … If we continue on the current trend, in the year 2015, especially in the South, it will probably be the case that 5 to 6 percent of all African-American adults who are sexually active will be infected with the virus.”

Endgame explores how politics, social factors and cultural factors allowed the AIDS epidemic to spread rapidly in the African-American community over the past three decades. The film — shot in churches, harm-reduction clinics, prisons, nightclubs and high school classrooms — tells personal stories from children who were born with the virus, public health officials and educators who run HIV clinics, and clergy members around the country, many of whom have been divided on their response to the epidemic.

The film also explores how the war on drugs in the 1980s and 1990s affected the spread of HIV in communities where large percentages of African-American men were incarcerated. http://www.npr.org/2012/07/05/156292172/aids-in-black-america-a-public-health-crisis

The Centers for Disease Control (CDC) and Preventions studies a variety of diseases. https://drwilda.com/2012/08/02/people-must-talk-aids-epidemic-in-black-community/

Nirvi Shah is reporting in the Education Week article, Disproportionate Numbers of Young People Have HIV, Don’t Know It:

About 1 in 15 people living in the United States who has HIV is 13 to 24 years old—and more than half of these young people don’t know they have the disease, new estimates from the Centers for Disease Control and Prevention show, and the agency says schools must work harder to prevent HIV’s spread.

These estimates, shared today by the CDC, are from 2009. In all, about 1.1 million people in the United States have HIV, the agency reported.

The CDC estimates that about 70 out of 100,000 teenagers and young adults have HIV and they accounted for 12,000 cases—about 26 percent—diagnosed in 2010. Meanwhile, 13- to 24-year-olds represent only about 21 percent of the total population. The majority of the new cases, about 60 percent, were among black teens and young adults. Another 20 percent of the new cases were among Latinos of the same age.

The infection rate among young people is disproportionately high, the CDC said, while the percentage of people in the same age group tested was disproportionately low.

In 2009, people ages 13 to 24 comprised 6.7 percent of persons living with HIV, but more than half, nearly 60 percent, didn’t know they were infected, the CDC said, the highest rate for any age group. http://blogs.edweek.org/edweek/rulesforengagement/2012/11/disproportionate_numbers_of_yo.html

Here is a portion of press release from the Centers for Disease Control:

Vital Signs: HIV Infection, Testing, and Risk Behaviors Among Youths — United States

Early Release

November 27, 2012 / 61(Early Release);1-6

Abstract

Background: In 2009, 6.7% of the estimated 1.1 million persons living with human immunodeficiency virus (HIV) infection in the United States were youths (defined in this report as persons aged 13–24 years); more than half of youths with HIV (59.5%) were unaware of their infection.

Methods: CDC used National HIV Surveillance System data to estimate, among youths, prevalence rates of diagnosed HIV infection in 2009 and the number of new infections (incidence) in 2010. To assess the prevalence of risk factors and HIV testing among youths, CDC used the 2009 and 2011 Youth Risk Behavior Surveillance System for 9th–12th grade students and the 2010 National Health Interview Survey (NHIS) for persons 18–24 years.

Results: Prevalence of diagnosed HIV was 69.5 per 100,000 youths at the end of 2009. Youths accounted for 12,200 (25.7%) new HIV infections in 2010. Of these, 7,000 (57.4%) were among blacks/African Americans, 2,390 (19.6%) among Hispanics/Latinos, and 2,380 (19.5%) among whites; 8,800 (72.1%) were attributed to male-to-male sexual contact. The percentage of youths tested for HIV overall was 12.9% among high school students and 34.5% among those aged 18–24 years; it was lower among males than females, and lower among whites and Hispanics/Latinos than blacks/African Americans.

Conclusions: A disproportionate number of new HIV infections occurs among youths, especially blacks/African Americans, Hispanics/Latinos, and men who have sex with men (MSM). The percentage of youths tested for HIV, however, was low, particularly among males.

Implications for Public Health: More effort is needed to provide effective school- and community-based interventions to ensure all youths, particularly MSM, have the knowledge, skills, resources, and support necessary to avoid HIV infection. Health-care providers and public health agencies should ensure that youths are tested for HIV and have access to sexual health services, and that HIV-positive youths receive ongoing health-care and prevention services.

Introduction

The risk for acquiring human immunodeficiency virus (HIV) infection during adolescence and early adulthood starts with initiation of sexual behavior or injection drug use, and initiation of contributing behaviors such as use of alcohol and other drugs. The prevalence of HIV in potential sex partners, the percentage of HIV-infected persons unaware of their status, and the frequency of risky sexual behaviors and injection drug use contribute to the level of risk. In 2009, youths (defined in this report as persons aged 13–24 years), who represented 21% of the U.S. population, comprised 6.7% of persons living with HIV. More than half (59.5%) were unaware of their infection, the highest for any age group (1). All persons need to understand the threat of HIV and how to prevent it (2). Youths, particularly those at highest risk, need effective school-based, school-linked, and community-based interventions (3) that make them aware of their risk for HIV and help delay initiation of sexual activity, increase condom use for those who are sexually active, and decrease other behaviors, such as alcohol and drug use, that contribute to HIV risk. This report describes, among youths, 1) rates of those living with a diagnosis of HIV infection at the end of 2009, 2) the estimated number of new HIV infections in 2010, 3) the percentage that have been tested for HIV, and 4) the percentage that engage in selected risk behaviors.

Conclusions and Comment

Based on the most recent data available from 2009 and 2010, youths represent 6.7% of persons living with HIV in the United States and account for 25.7% of new HIV infections. Of new HIV infections among youths, 45.9% were among black/African American males, the majority of which were attributed to male-to-male sexual contact. Nationwide, the percentage of youths who had ever been tested for HIV was low compared with other age groups (1): 12.9% among high school students (22.2% among those who ever had sexual intercourse) and 34.5% among persons aged 18–24 years.

The higher HIV prevalence among blacks/African Americans overall (nearly three times higher than among Hispanics/Latinos and nearly eight times higher than among whites [1]) and MSM overall (nearly 40 times higher than other men [5]) contributes to the disproportionate number of new HIV infections among black/African American youths and young MSM. Because of this disparity, black/African American youths are at higher risk for infection even with similar levels of risk behaviors (6). Other research has found that among young MSM, other factors such as stigma, discrimination (7), less condom use, more alcohol and drug use, and having sex with older partners (8) contribute to even higher risk for HIV acquisition. This analysis also found that young MSM were significantly less likely to use condoms during last sexual intercourse, more likely to drink alcohol or use drugs before last sexual intercourse, and more likely to have four or more partners during their lifetime compared with young men who had sexual intercourse only with females. These behaviors are associated with substantial risk for infection. In one study among MSM, the attributable risk for new HIV infection was 29% for using alcohol or drugs before sex and 32% for having four to nine sex partners (9). Further, in a study of primarily young MSM, 75% of those with acute HIV infection reported sex under the influence of drugs or alcohol compared with 31% of HIV-uninfected MSM. Moreover, the risk for HIV infection doubled for MSM with a sex partner 5 years older and quadrupled with a sex partner 10 years older (8).

More than half (59.5%) of youths with HIV are unaware of their infection (1). Although the number of new HIV infections is highest among males, fewer males have been tested for HIV than females. Routine HIV testing as part of regular medical care is recommended by CDC for all persons aged 13–64 years (10) and by the American Academy of Pediatrics for all youths by age 16–18 years and all sexually active youths regardless of age (11). Better adherence to these guidelines, especially for males, is needed to increase early HIV diagnosis and facilitate treatment that improves health and reduces transmission.

Interventions for youths have been proven effective for delaying initiation of sexual activity, increasing condom use, and reducing other risk behaviors, such as drug and alcohol use.¶¶ The Community Preventive Services Task Force recommends risk reduction interventions in school and community settings to prevent HIV among adolescents (3). Individual- and group-level HIV prevention interventions provide knowledge, skill building, and increased motivation to adopt behaviors that protect against HIV infection, and some are designed specifically for youths at high risk for HIV.

For young MSM (those aged 18–29 years), “Mpowerment” is an effective community-level intervention that has been shown to reduce unprotected anal intercourse, the sexual behavior that carries the greatest risk for HIV transmission (12). However, additional individual- and group-level interventions specifically designed for young MSM, and young black/African American MSM in particular, are needed. Evidence-based behavioral HIV interventions for high risk youths can be adapted to address the unique needs of young MSM and to communicate the substantial risks associated with having sex with partners who are more likely to be infected, particularly those who are older.

Multicomponent school-based interventions, including classroom-based curricula and school-wide environmental changes, have been shown to decrease unprotected sex and increase condom use among youths (3). Policies can support these efforts by promoting in schools an inclusive environment for sexual minorities that reduces stigma and discrimination (13) and requiring evidence-based HIV prevention education (3) for all students. In addition, community organizations, schools, and health-care providers can establish procedures that reduce barriers and protect confidentiality (i.e., procedures that do not disclose information to unauthorized persons unless required under state law) for youths seeking sexual health services (14) and facilitate access to education and other HIV prevention services.

Early diagnosis and treatment can reduce HIV progression and prevent transmission, but youths are less likely to be tested, access care, remain in care, and achieve viral suppression (15). Youth-friendly, culturally competent, confidential, and convenient health services facilitate access to and retention in care.*** Comprehensive health services, including HIV/sexually transmitted infection screening, treatment, and prevention services, and adjunct services, such as mental health, drug and alcohol treatment, and housing assistance, are necessary for youths at highest risk of acquiring or transmitting HIV. Because young MSM often acquire HIV from older, HIV-positive partners (8), regular testing, care, and treatment for adult MSM also are essential to prevent HIV infections among youths.

Limitations of the estimates of new HIV infections have been described previously (15). In addition, the findings in this report are subject to at least three more limitations. First, YRBS data apply only to youths who attend school and therefore are not representative of all persons in this age group. Nationwide, in 2009, of persons aged 16–17 years, approximately 4% were not enrolled in a high school program and had not completed high school (4). Second, NHIS excludes active military personnel and those who live outside of households (e.g., persons who are incarcerated, in long-term–care institutions, or homeless), who might be at greater risk for HIV infection than persons in households. Finally, data from YRBS and NHIS are self-reported and subject to recall bias and potential underreporting of sensitive information, such as HIV risk factors and HIV testing.

To achieve the goals of the National HIV/AIDS Strategy for the United States (i.e., to reduce the number of persons who become infected with HIV and reduce disparities), public health agencies, in conjunction with families, educators, and health-care practitioners, must educate youths about HIV before they begin engaging in risk behaviors, especially young gay and bisexual males, particularly blacks/African Americans, who face a disproportionately higher risk (2). To delay the onset of sexual activity, increase condom use among those who are sexually active, and decrease injection drug use, multicomponent school- and community-based approaches that provide access to condoms, HIV testing and treatment, and behavioral interventions for those at highest risk are needed.

Reported by

Suzanne K. Whitmore, DrPH, Laura Kann, PhD, Joseph Prejean, PhD, Linda J Koenig, PhD, Bernard M. Branson, MD, H. Irene Hall, PhD, Amy M. Fasula, PhD, Angie Tracey, Jonathan Mermin, MD, Linda A. Valleroy, PhD, Div of HIV/AIDS Prevention, Div of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC. Corresponding contributor: Suzanne K. Whitmore, swhitmore@cdc.gov, 404-639-1556. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm61e1127a1.htm?s_cid=mm61e1127a1_e

The Centers for Disease Control has many resources about HIV testing:

Positive? Negative? Not sure?

What You Need to Know About HIV:

Frequently Asked Questions About HIV and STD Testing

There is nothing more frightful than ignorance in action.”
Johann Wolfgang von Goethe,
Collected Works

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