Environmental Health in Early Childhood Systems Building: Opportunities for States

Exposure to environmental hazards has negative outcomes for healthy child development. Household and community pollutants affect people of all ages, but for a number of important reasons young children face a significantly higher risk of developing disease and experiencing cognitive and psychomotor developmental delays. Fortunately, many common forms of exposure are preventable, and there are abundant opportunities for state-level stakeholders to initiate and support effective interventions. This brief identifies some of the substances that threaten young children inside and nearby the home or early care and learning setting. It describes the importance of early intervention for disease prevention, and provides examples of strategic approaches to regional policy and program reform. Finally, it explores specific actions states can take to successfully address environmental health issues affecting children. Statewide environmental health initiatives can play an important role in broader early childhood systems-building efforts. Coordinating cross-agency interventions requires some preparation to learn the basics of the issue, and there are many resources available to get started on a path to prevent and remediate environmental threats to the health of young children

Improving Supports for Parents of Young Children: State-level Initiatives

Most states are working to strengthen supports for young children's health and development across the different systems that affect family and child wellbeing. Increasingly, efforts to support parenting are an important focus of this work. While states' strategies are varied, most strive to provide families with information and access to programs that help parents keep their children safe and healthy while nurturing their development and promoting their school readiness. These efforts make a great deal of sense in view of growing evidence that parents and young children can benefit in many ways from parent education, and that children in families experiencing economic hardship are at higher risk of poor health and educational outcomes in the absence of parenting supports. New federal funding for home-visiting programs, along with the cross-systems planning being carried out by states' Early Childhood Comprehensive Systems (ECCS) initiatives and Early Childhood Advisory Councils, create new opportunities for states to strengthen supports for parents with young children. At the same time, this area of work is likely to pose special challenges for states. One challenge is the still limited evidence concerning effective programs. Another is that stakeholders may lack information about the full array of existing programs in their state and the extent to which these programs are meeting the needs of different types of families. States also face the complex task of identifying resources and opportunities in different systems that could be marshaled to strengthen parenting supports along the continuum from promotion to intervention. This issue brief presents information that states can use as they address these challenges and opportunities

State-level Indicators for Social-emotional Development: Building Better Systems

Research repeatedly suggests that experiences and skills acquired early in life have a long lasting effect. Many interventions that promote social-emotional well-being and preventing mental health problems in children and their caregivers are clinically sound and cost effective. Social-emotional well-being is also seen as a crucial determinant of school readiness, while school readiness is critical to educational and health outcomes. Research evaluating appropriate interventions and investigating the importance of school readiness makes a strong case for creating a system to monitor social-emotional development in the effort to improve the well-being of young children. Indicators are a key part of this monitoring system and promote accountability by providing decision-makers and researchers with information they need to understand and meet local and state needs, to assess the provision and quality of interventions, and to address gaps in services to young children and families. The ability to track and assess social-emotional development of young children in a community poses a special challenge to policymakers. For many other areas within early childhood it is possible to understand the status and trends for child well-being at the population level. For instance, data on infant mortality, immunizations, and child welfare at the local, state and national level can be accessed to inform health promotion and prevention efforts. Currently, such multi-level data on social-emotional development for young children is not easily available. The challenge to quantify social-emotional wellness at a population level stems in part from the lack of universally accepted indicators and infrastructure for collecting information in this domain of child development. This report addresses the process of creating a system of indicators for social-emotional wellness, examines recent state experiences in this area, and describes a framework for moving forward in the development of social-emotional indicators for state policymakers

Indicators for Social-emotional Development in Early Childhood: A Guide for Local Stakeholders

Social-emotional development in young children encompasses how young children feel about themselves, how they behave and how they relate to people close to them, such as caregivers, teachers, and peers. Although infant and early childhood mental health are often used in the same way, the term social-emotional development illustrates the importance of prevention and early intervention. There is strong evidence linking social-emotional health in the early childhood years (birth to 6) to subsequent school success and health in preteen and teen years, and to long term health and wellbeing in adulthood. However, research also shows that effective programs that address social-emotional health early in life can promote resilience and actually prevent mental health problems later in life

Posttraumatic stress disorder among female street-based sex workers in the greater Sydney area, Australia

BACKGROUND: This paper examines rates of exposure to work-related violence and other trauma, and the prevalence of lifetime and current posttraumatic stress disorder (PTSD) among female street-based sex workers. It also investigates associations between current PTSD symptoms and: demographic characteristics, psychiatric comorbidity, injecting and sex risk behaviours, and trauma history. METHODS: Cross sectional data collected from 72 women via face to face structured interviews. The interview included structured diagnostic assessment of DSM-IV PTSD; drug dependence; depression; experience of childhood trauma; and an assessment of sex working history. RESULTS: All but one of the women interviewed reported experiencing trauma, with the majority reporting multiple traumas that typically began in early childhood. Child sexual abuse, adult sexual assault and work related violence were commonly reported. Just under half of the women met DSM-IV criteria for PTSD and approximately one-third reported current PTSD symptoms. Adult sexual assault was associated with current PTSD symptoms. Depression and drug dependence were also highly prevalent; cocaine dependence in particular was associated with elevated rates of injecting risk and sexual risk behaviours. CONCLUSION: These women reported complex trauma histories and despite ongoing opportunities for clinical intervention, they continued to experience problems, suggesting that current models of treatment may not be appropriate. More targeted interventions, and integrated mental health and drug treatment services are needed to address the problems these women are experiencing. Outreach services to these women remain a priority. Education strategies to reduce risky injecting and sexual behaviours among sex workers should also remain a priority

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Long-Term Effects of an HIV/STI Sexual Risk Reduction Intervention for Heterosexual Couples

This randomized clinical trial examined the relative efficacy of a relationship-based HIV/STI prevention intervention for women and their regular male sexual partners at 12 months post-intervention. A total of 217 couples were randomized to (1) a six-session intervention provided to the woman and her sexual partner together (n = 81); (2) the same intervention provided to the woman alone (n = 73); or (3) a one-session health information education “control” provided to the woman alone (n = 63). Findings suggest the intervention was efficacious in reducing unprotected sex at 12 months post-intervention, compared with the education control group. No significant differences were observed when comparing whether couples received the intervention together or when the woman received it alone