Tag Archives: adolescent health

Juvenile Detention Centers Miss Key Health Indicators for Girls

I listened to a great NPR report this afternoon by Jenny Gold about juvenile detention centers and how they’re missing some key indicators of the health status of girls that enter into the system. As someone specializing in adolescent girls’ health, I was pretty fascinated – it detailed the personal experiences of a few girls being seen in a New Mexico facility and also tried to address ways it could be rectified. Detention centers can actually be helpful entry points for girls and young women to be connected to healthcare resources (we’re talking mental and physical health, so everything from counseling to substance abuse help to medical attention if they are victims of assault or violence or have seen physicians only irregularly).

One of the biggest issues facing these girls was confidential disclosure of their health status and any social, emotional, and physical issues they were facing. Developing rapport with a provider at a detention facility can be difficult in and of itself, but the girls reported having to answer personal questions in an open-door location, often with men and boys – staff or other teens – present; unsurprisingly, this made it difficult for many girls to feel that they could answer questions of a personal nature (sexual behavior, drug and alcohol use, history of assault, abuse or violence) honestly and openly. What we do know about these girls – 41% have vaginal injury consistent with sexual assault, 8% have positive skin tests for tuberculosis, and 30% need glasses but don’t have them – shows that getting all of this information early on is essential for appropriate and timely care.

One proposed solution to this – getting as much information as possible from these girls about their health status and the best ways to then help them, treat them, and connect them with resources – was to have them fill out a survey themselves. Currently, girls are asked 35 questions by an intake nurse when they arrive, that cover things like current medications, alcohol or drug use in the last 24 hours, and whether they have a history of self-destructive behavior. The proposed survey in the New Mexico facility is 132 questions, and according to one facility employee the time that would take is just not feasible given the traffic and business of the facility. Researchers and providers implemented a pilot study of the survey for 30 girls at the detention facility.

Of course, I can’t comment on the actual level of frantic activity in the specific facility at hand, but I can say that having a questionnaire that catches health issues which can be immediately and effectively addressed can prevent a host of issues from getting worse as time goes on without treatment – potential injuries from abuse or assault, needing STI screenings for victims of rape or girls who are sexually active without access to contraceptives or regular gynecological care, and of course mental health resources and immediate connection with social workers or therapists for those girls in need. Either having the girls fill out the survey via computer themselves or having a nurse help them would also be enormously helpful in the long run. This can also be a great way to track the care progress of these girls over the years, as many go in and out of detention centers. For girls who have experienced assault or abuse or multiple infections and injuries, this can be an easy way to follow-up with them without having to go through essentially baseline assessments of their well-being every time they enter a facility.

Some of the sobering stats about the girls from this particular New Mexico facility from this report: Of the 30 girls who participated in the piloting of implementing this survey, 12 needed immediate medical care, and 23 were coded as needing medical care within 24 hours, based on the survey’s questions. Intakes without this survey missed essential things, like burns on one girl’s torso and chest.

Check out the whole report here. I have no doubt that detention centers are in dire need of additional resources and likely way more staff than they have, for more than just this particular issue of adolescent girls’ health, but if the issue is there being one nurse for multiple intakes, having the girls fill out the survey on a computer themselves – when they’re more likely to be honest than in discussion with a nurse anyway, seems like the best solution to these kind of initial entry screenings. Especially since poor physical health is an indicator of recidivism, increasing the likelihood of girls ending up back in a facility.

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Filed under Child Development and Child Health, Health Behavior, Health Education, Mental Health, Women's Health

American Graduate, American Dropout

I don’t know how many of you educators were able to catch parts of PBS’ ‘American Graduate‘ series this year. It’s a great series that’s focused on the major issues of (mostly public) education in America, including urban versus rural education struggles, mentoring and counseling, adolescent health issues like substance use and sexual activity, ensuring that we’re serving the needs of immigrant students, social and economic class issues and how they impact opportunity and subsequently achievement (measured most commonly as high school graduation) and what’s behind some of the alarming and rising rates of dropping out across the country.

The latter three issues were behind a documentary that I was featured in and that aired in September. It was pioneered by a group of teen filmmakers at an organization based in Brooklyn called Reel Works, a group with a great mission that I encourage you to check out. If you want more background on the piece, check out the PBS brief before the video, which also includes a great interview with some of the teen filmmakers. Hope you find it interesting!

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Filed under Child Development and Child Health, Education, Health Behavior, Media

Lots of Rest Can Prevent STD Transmission! At Least, That’s What Fresno is Telling Kids

In case you wanted to read something today that will make make you fume, check out ThinkProgress’ report about an abstinence-only education program in Fresno (for shame, California). It is massively, massively irresponsible.

Did you know that getting a lot of rest can prevent you from getting STDs? And that HIV can be spread by kissing? Let that marinate for a bit, because that’s what kids in Clovis, CA, are going to come out of school thinking.

Condoms? Not addressed. Contraception? Not covered.

This curriculum is actually against California law, which requires medically accurate sexual health education to be delivered to students. The ACLU is suing.

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Filed under Child Development and Child Health, Education, Health Education, Public Health, Reproductive and Sexual Health

This Fight is Literally Never-Ending

The Center for Disease Control’s Division of Adolescent and School Health (DASH) will lose $10 million in funding if the Fiscal Year 2012 Omnibus Appropriations bill, which sailed through the House of Reps, comes to be. And to kick the prevention specialists at DASH while they’re down, the funding for absitence-only “sex education” will make an unwelcome return.

The DASH has proven time and again that the CDC, as well as state health agencies, are capable of creating health education initiatives that teach students and adolescents the best ways to stay healthy and prevent both chronic and infectious diseases. They have worked with school districts as well as other governmental organizations to not only create effective STI-prevention and teen pregnancy prevention initiatives, but also do an incredible job of monitoring the risky behaviors that teens are currently engaging in across the United States – including substance use and abuse, sexual behavior, drunk driving, physical violence, and depression and suicide, as well as tracking the rates of victimization that teens experience in the form of sexual assault and dating violence. Understanding how common these behaviors are, knowing in what areas and regions they seem to erupt more intensely, and determining what demographics on a national level are at greatest risk for some of these behaviors is essential for targeted education and prevention initiatives.

Without these prevention strategies, and without the ability to track the rates of risky behaviors to know how to develop such strategies, we will be left to treat the consequences (STI care, HIV treatement and care, babies born to teen moms), which are of course ultimately far more expensive. The CDC has (or had) the resources as well as the expertise with its impressive body of scientists and researchers, to do so. And lest we forget, abstinence only education? Doesn’t do teens any favors, and in fact leaves them woefully misinformed in how they should protect themselves when they do ultimately engage in sexual activity.

RH Reality Check details this upsetting news here. On the heels of Sebelius’ decision, this has been a pretty devastating month for adolescents.

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Filed under Child Development and Child Health, Education, Epidemiology and Population Health, Health Education, Politics, Public Health, Sexism, Women's Health

Sebelius Caves, Girls Pay the Price

By now, I’m sure you’ve all heard that Kathleen Sebelius, the Secretary of Health and Human Services, has blocked the recommendation of the Food and Drug Administration that the over the counter (OTC) drug Plan B, commonly known as the ‘morning after pill,’ be made available without a prescription for girls of all ages. It is currently available without a prescription to girls ages 17 and up, and requires a prescription for girls ages 16 and below.

It is worth noting that this is the first time a Secretary of HHS has overruled the FDA. This is not insignificant. The purpose of HHS is to promote the health, safety, and well-being of Americans. The FDA is an obvious component of this. While the FDA is an agency of HHS, the purpose of the FDA is to promote and protect public health, through the regulation of OTC and prescription medications, vaccines, food safety, medical devices, and more. They do this through clinical trials and testing, which is how we come to know of drugs’ side effects as well as how significantly they aid in the relief of what they purport to treat. The FDA recruits researchers who understand both the purpose of and execution of this research. Attempts have been made to loosen the regulations of the FDA; for example, some terminally ill patients have petitioned the FDA to allow them to access experimental drugs after Phase I of a trial – the FDA has denied these requests due to the lack of research regarding a drug’s long-term effects post- Phase I. The FDA is not without criticisms; they have been accused of being both too hard and too lax on the pharmaceutical industry. Members of the FDA have also expressed feeling pushed to present certain results. Scientists at the FDA complained to Obama in 2009 that they felt pressured under the Bush administration to manipulate data for certain devices, and the Institute of Medicine also appealed for greater independence of the FDA from the powers of political management.

The commissioner of the FDA, who is a physician, reports to the Secretary of HHS. Sebelius’ job is not one of medicine or research, and requires a background in neither. It does require a background in politicking, which is exactly what we’re seeing here. The purpose of pointing that out, and of articulating that this is the first time a Secretary of HHS has overruled an FDA recommendation, is that Sebelius’ refute would not be based on differing scientific results, or research that opposes the FDA’s recommendations – because there is none. The override has different drivers, and the assumption floating out there – for good reason, since there is little alternate explanation – is to appease social conservatives and the anti-abortion contingents.

Plan B is not the abortion pill. It is the equivalent of an increased dose of a daily birth-control pill, and has no effect on already established pregnancies – it prevents pregnancy from occurring. Scientists within the FDA unanimously approved the access of the drug without a prescription for girls of all ages, after an expert panel put the recommendation forward. It is, to quote a USC pharmacist, one of few drugs that is so “simple, convenient, and safe.”

The conservative Family Research Council claims that requiring a prescription will protect girls from sexual exploitation and abuse – I fail to see how requiring a girl to get a prescription will protect against sexual violence, especially since girls may be attempting to get Plan B because sexual violence has already occurred. This comment is also a flagrant indication of misunderstanding of sexual violence and abuse – a young girl is not likely to disclose to an unknown physician that she is being sexually abused or assaulted and that’s why she needs a prescription for Plan B. Make no mistake, this ban is a victory for anti-abortion rights activists. If a girl cannot prevent a pregnancy from occurring, she is subsequently faced with trying to terminate an existing pregnancy (again – that could have been prevented!). Given how reproductive and abortion rights have been systematically chipped away at for the past few years, this girl who did not want the pregnancy and tried to prevent it from happening but was denied because she is shy of 17 years, will be in an even worse position. This is what anti-abortion activists are counting on – that once she is pregnant she will have to carry to term.

Plan B can prevent abortions from happening. HHS, with its mission of protecting the health and welfare of all citizens, should do everything they can to protect the health of girls’ reproductive development, which includes the prevention of unwanted pregnancy at its earliest stage. The girls under the age of 17 who need Plan B the most are the ones who also need it to be as easily accessible as possible. Much like requiring parental permission for abortions for girls under the age of 18, this ban actually can put girls at risk. Many girls will not have the family support, financial means, or healthcare to manage a pregnancy; some girls may face parental and familial abuse if they have to admit to needing to prevent a pregnancy with Plan B. What if a girl is a victim of sexual assault within her family? Should she be forced to deal not only with this trauma, but also have to determine how to prevent herself from being forced to carry a fetus to term as a result of this tragedy? Most girls under the age of 17 do not have easy access to clinicians and hospitals on their own, nor are they able to navigate our increasingly complex healthcare system on their own, which they would not only need to do to access Plan B, but would need to do within 72 hours for the pill to be effective. Girls whose bodies are not ready for pregnancy, girls who were victims of assault and rape and incest, girls whose futures will be dramatically changed and opportunities truncated – they all become casualties of this ban. Before we start sex-shaming and proclaiming that they shouldn’t have had sex if they didn’t want to deal with the consequences, let’s remember that these girls were not miraculously impregnated. Whether consensual or not, a boy was involved. This is a gendered issue – the girls are the ones who will have to deal with the lack of access to Plan B, physically, mentally, and emotionally.

Originally, advocates in 2003 successfully petitioned Plan B to be available OTC for girls 18 and up (after having been available with a prescription since 1999), but a judge overruled that decision and lowered the age to 17 after he deemed the decision had been made politically, not for scientific reasons. It appears that history is repeating itself.

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Filed under Education, Feminism, Health Education, Politics, Public Health, Rape and Sexual Assault, Reproductive and Sexual Health, Sexism, Women's Health