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For example, introduction of folic acid in grain-based products decreased the risk of neural tube defects Fletcher and Fairfield, The Back to Sleep campaign, aimed at educating adults on proper infant sleeping position, has been credited with a dramatic reduction in the occurrence of sudden infant death syndrome Willinger et al. Where services can effect change in healthy development. Adapted from Halfon and Lawrence Services can modify the relationship between exposure and the onset of disease once the child has been exposed—thereby altering the nature of the exposure outcome pathway.

Children exposed to a case of meningitis may receive prophylactic antibiotics to avoid coming down with the disease themselves.

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Newborn screening identifies infants with phenylketonuria, enabling dietary modification that avoids adverse manifestations of the disorder. Another way in which services influence health outcomes is to modify or reduce a disease or to promote a specific rehabilitation or habilitation process. For example, the lives of children with cystic fibrosis have been transformed and their prognoses improved as a result of service delivery systems that have lengthened life expectancy and improved functional capacity Schechter, They include specific health interventions, such as immunizations, as well as programs of integrated services that systematically address prevention, promotion, treatment, and risk reduction simultaneously, as is the case in model chronic disease management programs American Academy of Pediatrics, Services function at several different levels, including the level of the individual child, family, and community, as well as larger social, physical, and policy environments.

While not exhaustive, this list depicts a continuum of services designed to improve the health of children and the functions they serve. It includes services provided by the personal and public health system, as well as the environmental health, education, and social service systems. Prevention-oriented services are shown to include health promotion services that are focused at the population level e. Treatment-oriented services include those that are provided in clinical encounters and ambulatory care settings e.

Long-term, home, and community-based care includes community-based rehabilitative services designed to restore function e. Research is warranted to tease out the role that a range of services play in mediating and modifying influences so children can stay healthy, as well as supporting and promoting their optimal health. Improved specification of the effects of services, better targeting and customizing of services for specific populations, and improved monitoring of the effect of specific services on population health measures should be considered important research and analysis priorities.

The health of children in the United States is affected by laws, rules, and regulations developed at the national, state, and local levels. These governmental actions determine the availability of publicly supported services and often regulate the provision of privately administered services. They are integral to how communities operate. Policies directed specifically at health or health care services, such as eligibility for publicly funded insurance Currie and Gruber, a or requiring a child to be immunized prior to starting school Briss et al. Innumerable serious injuries and deaths have been prevented by traffic safety standards, such as car seats and speed limits Sleet et al.

Fluoridation of drinking water has contributed to reductions in dental caries in both children and adults National Research Council, , and the Centers for Disease Control and Prevention CDC has highlighted water fluoridation as a significant public health achievement Centers for Disease Control and Prevention, b. Cross-sectional studies conducted in the mids showed water fluoridation to have an effect on dental caries and prompted policies to fluoridate water in many cities throughout the United States.

A review of studies on the effectiveness of water fluoridation conducted in the United States between and found that caries were reduced between 8 and 37 percent among adolescents Newbrun, There is some evidence that water fluoridation has been particularly beneficial for communities of low socioeconomic status National Research Council, ; Riley, Lennon, and Ellwood, , perhaps attributable to their disproportionate burden and lower access to dental care.

Evidence of the effectiveness of water fluoridation in reducing dental caries has led to other approaches to introduce fluoride, including the addition of fluoride in toothpastes and topical fluoride treatment by dental professionals.

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There has been some debate about whether water fluoridation increases the risk of a range of other health conditions, including cancer, osteoporosis, and Down syndrome. A review by the National Research Council NRC in concluded that there was no credible evidence to support these claims. The NRC is currently conducting a study to review the evidence since and advise EPA on the adequacy of its current water fluoride standards in the context of the variety of fluoride sources now available. In contrast to all other industrialized nations and despite frequent incremental attempts to expand health insurance coverage, a substantial proportion of children remain uninsured, and many more have inconsistent or inadequate health insurance http: While health insurance is an important contributor to access to and use of health services Starfield, a ; Currie and Gruber, a , it is far from the only factor.

The availability and distribution of providers, the functioning of the primary care system, and multiple nonfinancial barriers are also important variables that affect health care access and use Starfield et al. The two primary publicly funded programs that provide health insurance for children—Medicaid and the State Child Health Insurance Program SCHIP —require families to demonstrate initial and continuing financial eligibility.

Implemented in the s, Medicaid coverage increased dramatically during the s and early s as a result of major policy changes in laws that sought to expand Medicaid eligibility Currie and Gruber, a. Although participation in Medicaid programs is far from universal Cutler and Gruber, , and most uninsured children still receive medical care, the increased access to health care afforded by Medicaid has been associated with better birth outcomes Currie and Gruber, b , lower rates of preventable illness Starfield, a and improved efficiency of medical care delivery Dafny and Gruber, in press.

SCHIP provided additional funds to states to expand their health insurance coverage by either using Medicaid expansion or, alternatively, developing state-run health insurance programs for children. Despite these efforts to expand insurance coverage, far-from-universal SCHIP program take-up and other factors still left 9.

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An additional number lack insurance for part of the year. States with policies that facilitate eligibility and certification procedures have been shown to have higher rates of enrollment Dick et al. Health insurance of any type cannot facilitate access to health care services when the necessary resources are not present. In the absence of national health insurance, national health policy has supported the development of a safety net of services in the form of community health centers in areas with a shortage of health facilities and personnel.

Currently there are about such centers across the country, all of which provide high-quality primary care services. Recent evaluations indicate that the presence of these centers improves the health of children and reduces racial disparities among the populations who receive services from them Politzer et al. We illustrate this kind of policy analysis with the welfare reform law the Personal Responsibility and Work Opportunity Reconciliation Act of , which was directed first and foremost at increasing the employment and reducing the welfare dependence of mothers.

Evidence on the likely effects of welfare reforms comes both from random-assignment experiments and from longitudinal survey studies National Research Council and Institute of Medicine, A key finding from the experiments is that effects on the achievement and behavior of younger children were consistently more positive in programs that provided financial and in-kind supports earnings supplements for work than in those that did not.

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The packages of work supports were quite diverse, ranging from generous earnings supplements provided alone to more comprehensive packages of earnings supplements, child care assistance, health insurance, and even temporary community service jobs. At the same time, these experiments produced evidence of negative effects on adolescent achievement across all types of programs, although a prominent nonexperimental study did not replicate the negative adolescent results Chase-Lansdale et al. Systematic approaches to evaluate the effect of policies on children of this sort are the exception, rather than the rule, and few other systematic attempts can be identified.

This chapter provides a discussion of evidence concerning the influence of various types of characteristics on the health of children. Although imperfectly understood, the important role of interactions of these influences, which may differ in kind and amount at different ages and stages of development, is amply supported by the evidence.

For the most part, evidence for the influences comes from studies of the relative risk imposed by them. However, exposure to influences differs in frequency from one influence to another. Influences that have a high relative risk may be of only minor importance to the health of the population of children if they are relatively uncommon. In order to understand the effect of these factors on the health of children, such information is critical see Goodman et al. For example, prematurity Herbst, ; Kaufman et al.


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Policies focused on improving the quality of health services available to children in the United States are equally important. Because there is an extensive literature on the importance of appropriate health care treatments to improve health in the face of disease, we do not review that here, but underscore the importance of access to care based on the information that health can be enhanced through health care. Turn recording back on.

National Center for Biotechnology Information , U. OVERVIEW Biological influences as discussed in this chapter include genetic expressions, prenatal influences, as well as biological constraints and possibilities created by perinatal and postnatal events plus prior states of health. Genes DNA provides the blueprint for life.


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  6. Characteristics of Gene-Environment Interactions The expression of certain genetic characteristics depends on the environment in which they occur. Gene Expression Understanding of the genome has rapidly expanded the study of the ways in which genes interact with diverse influences e.

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    Body Stores Chemicals in the environment air, water, dirt, dust, food move into the body across such biological barriers as skin, lungs, and the gastrointestinal system. Early Programming While not without controversy Huxley et al. Behavioral Adaptations The hallmark of childhood is the constant exposure to new developmental challenges. Attitudes, Beliefs, and Circumstances The effects of individual, family, and community attitudes and beliefs on health behavior have been well described. Emotion, Cognition, and External Influences The importance of cognitive ability and understanding inappropriate health-related behaviors must also be considered.

    Prenatal Exposures Although exposures of the ovum or the sperm prior to conception may have profound health effects on a child, including development of an abnormal fetus, 1 in this section we focus on prenatal influences. Childhood Exposures Characterization of exposures over time depends on developmental stage and the mechanism by which the agent produces its effect EPA exposure guidelines, Water Pollutants Some water pollutants are biological agents, some are chemical agents, and some are radionuclides physical agents.

    Food Contaminants Food contaminants can be broadly categorized as either pathogenic or toxic. Infectious Agents Children also are a demographic subgroup prone to infectious diseases because of their exploratory behavior, lack of prior exposure to most infectious agents, and association with other children. Radiation Exposure to ultraviolet B radiation from sunlight exposure and the use of tanning equipment during childhood can result in substantial morbidity and mortality later in life. Child Injury and the Provision of Safe Environments Injuries are the leading cause of death among children between ages 1 and 19, accounting for more deaths than homicide, suicide, congenital anomalies, cancer, heart disease, respiratory illness, and HIV combined Centers for Disease Control, 10 leading causes of death, The Built Environment The built environment may be defined as the part of the physical environment created by human actions—buildings and parks, roads and trails, neighborhoods and cities.

    Injuries The built environment contributes to motor-vehicle-related morbidity and mortality among children by creating places that rely heavily on increasing driving time in cars and by developing certain kinds of roads that may be unusually hazardous for drivers, pedestrians, or both. My daughter started K4 this week and I am finding out that I have not prepared her the best that I could have so now we will be working harder to catch up but thankfully my child is easy to teach and quick to learn. Unfortunately, kindergarten has become very academic.

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    The list above is a pretty accurate one. As a kindergarten teacher there is so much disparity between the ability levels of the children who enter my classroom each year. So even though we are very capable of teaching them all these things and will willingly do so, a child who does not have these skills will be behind. My 5 yr old is basicly failing kindergarten because she cannot read by the 2nd month.