Pre-K

Early childhood education (“pre-K”) is still controversial and a heavy lift for our society.  And, honestly, I don’t understand why.  The evidence for its cost savings benefits is so strong.  The National Institute of Early Education Research at Rutgers University has found that children who attend high quality pre-K have 20-40% improved test scores and are 40% less likely to be held back or require special education services.  Moreover, pre-K educated students are 3/4 of an academic year ahead of non-pre-K students by 5th grade.  “Babysitting,” it ain’t.

Economist James Heckman has published extensively in this field.  His research concludes that pre-K children start school with larger vocabularies, better impulse control and motivation, as well as stronger social and work/collaborative skills.  Heckman calculates a 7-10% return on investment for every dollar spent on pre-K.  

A recent Monmouth University poll found that 87% of NJ residents feel that it is “important” and 57% felt is it “very important” to increase access to pre-K for NJ children.  And there is already a law on the books to address the issue.  The School Funding Reform Act (SFRA) was passed by the legislature and signed into law in 2008.  Thanks to SFRA, 30 poor NJ school districts now have high quality pre-K programs.  However, the law’s intention to expand to an additional 90 districts has been thwarted by a lack of funding for the project in subsequent years.

To address this problem, the New Jersey chapter of the American Academy of Pediatrics has partnered with Pre-K Our way.  This nonpartisan group is chaired by former Republican governor Thomas Kean and former Democratic governor James Florio and includes on it’s board many  important state business and political leaders.  Pre-K our way is not a school but rather an advocacy group that assists communities in developing and implementing high quality pre-K programs for its children.

You can aid in this effort by visiting pre-K our way, following them on Facebook and twitter, and contacting your state legislators to express your support for statewide pre-K education.  The future of our youngest citizens and our entire state will be better for your efforts.

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E-cigarettes

“E-cigarette” use (“vaping”) is increasing dramatically among middle and high schoolers in recent years.  E-cigarettes are hollow tubes with a battery, heating element, and cartridge that can be filled with “vape juice”–a concoction of nicotine, chemicals like ethylene glycol and vegetable glycerin, and various flavorings.  The heating element burns the fluid which is inhaled.  Keep in mind 2 important facts about “vape juice”–no testing is required and no standards to meet, and nicotine liquids are unregulated.  So its completely “buyer beware”–for chemicals our children might breath into their lungs.

Another point to note about e-cigs: websites promoting vaping and vape juice stress that these chemicals are approved as “food grade” by various very official sounding regulatory agencies.  The important thing to remember is that these approvals are for foods to be taken into the GI tract, not the respiratory tract.  Now, I drink cranberry juice and most studies consider it to be quite healthful.  But I don’t want it in my lungs.

According to the Food and Drug Administration, ecig use in high schoolers increased from 4.5% in 2013 to 13.4% in 2014 (from 600,000 to 2 million teens) and in middle schoolers from 1.1% 5o 3.9% (120,000 to 350,000).  Currently, more students vape (13.4%) than use hookah(9.4.%) or tobacco cigarettes (9.2%); as a result there has been no overall decrease in the rate of nicotine product use in the adolescent population during this time.

Ecig enthusiasts stress that vaping is safer than regular tobacco cigarettes.  Given the list of dangerous chemicals in tobacco smoke this is technically true; but its a very low bar.  The nicotine in both substances has a variety of effects on the developing adolescent central nervous system, and in particular the prefrontal cortex where ‘executive functioning”–higher thinking –occurs.  So “safer” is relative and, at best, overstated.

Another assertion from vape enthusiasts is that it can be a useful “interim” step on the way to cigarette smoking cessation.  Again, probably true as far as it goes.  But, firstly, most middle and high schoolers do not have a perhaps decades long nicotine habit with which to contend.  So I think that the focus in this age group should be on avoidance rather than withdrawal/quitting these products.  I think that dilutes that important message.  Furthermore, from nicotine gums and patches, drugs(chantix or zyban), even acupuncture and hypnosis–there are so many other methods to quit that do not employ sucking noxious chemicals into one’s lungs that I cannot see vaping  as such an important option.

A recent study from Hong Kong of 45,000 adolescents divided subjects into – “negative” “experimenters” “ex” or “current” users.  The e-smokers were more likely to have respiratory symptoms compared to nonusers (“experimenters” using only occasionally had no greater risk).  So–“safer?” I suppose.  But I still vote “no.”  That is why I now make a point of asking my adolescents both if they “smoke” or “vape.” And I encourage all of my parents to be informed and vigilant about both of these risky behaviors.

Questions?  Comments?  Thanks for following.

Lead Poisoning

Lead poisoning in children has been all over the news lately.  Fortunately, modern chemistry has eliminated most lead from the principle sources of environmental lead contamination–paint and gasoline–and that has resulted in significant decreases in the incidence and severity of the problem.

But, let’s not relax and declare victory just yet. As we can seen, there are still communities at risk.  Toddlers 9-72 months, children who’s siblings are diagnosed with elevated blood lead levels, or children with unexplained neurologic symptoms, delayed development, or learning disabilities should be screened, as well as any child who is exposed to old lead based paint or who lives in older housing (no hypothetical concern: 64% of Ocean County homes were built before 1980, `10% before 1950).   Lead exposure has both short and long term effects.

Everyone should be outraged and alarmed by the events uncovered in Flint, Michigan.  Unfortunately, Flint is no isolated outlier.  Here in New Jersey, our political leaders have not been virtuous with respect to environmental lead contamination.  Governor Christie is only the latest to carry on the shameful tradition of diverting money from the Lead Hazard Control Fund into the general treasury to assist in balancing the state books without leveling with restive taxpayers about what is happening.  To add insult to injury, Mr. Christie “pocket vetoed” a bill that included $10 million to improve lead prevention efforts this year; during his tenure little money has been spent on lead exposure prevention.  Since 2004, >$50 million intended for lead prevention has been siphoned away for political expediency.  Thus we still have >5,000 NJ children diagnosed with high lead levels yearly.

This is no political rant and I am not targeting any individual politician or party.  As I mentioned above, this has been a long time bipartisan failure and there is plenty of blame to go around all across the country.  Ultimately, this comes down to us citizens: if we don’t demand that this be a societal priority we can hardly complain if our elected officials fail to do so.

And please don’t pretend that this is somebody else’s problem.  Estimates place annual costs to the US economy at > $50 billion.  Every microgram increase in blood lead lowers IQ by 0.52 points and lowers lifetime earnings by $16,809.  Every $1 investment saves society $24.  And here’s more: recent research demonstrates a clear link between early lead exposure and crime and in particular violent criminal activity.  Any citizen who prioritizes personal or public safety, or is a “traditional law and order voter” should be all over this.

None of us can completely shield ourselves from the effects of lead toxicity.  Like it or not, we are all neighbors in the same community and we are all in this together.  I urge everyone to use the events in Flint as a wake up call.  Let’s make every child’s safety and future success each of our priority and make sure our institutions have the resources to do the right thing here.

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Fetal Alcohol Syndrome

The Center for Disease Control (CDC) has issued important, if controversial, new guidelines regarding alcohol consumption and pregnancy.

First, some background.  Fetal Alcohol Syndrome (FAS) is a serious, and one of the most common, neurodevelopmental disorders diagnosed in the US.  It’s incidence in the population is still unclear–anywhere from 0.5-2/1,000 to 6-9/1000 people.  There is a related disorder–Fetal Alcohol Spectrum Disorder (FASD)– which is somewhat less specific and severe, and occurs in an estimated 24-28/1,000.  Both conditions are more commonly associated with heavy/binge drinking during pregnancy.  But here is a very important point: there is no amount of alcohol consumption considered “safe” during pregnancy.

FAS causes a spectrum of abnormalities;

  • Facial–small eyes, flat cheekbones, underdeveloped upper lip
  • Nervous system–small head, low intelligence, developmental delay
  • Growth– low birth weight, poor growth
  • Other–heart defects, sometimes severe

There is no cure for FAS and FASD, of course.  Children with these conditions will require early and intensive learning and behavior therapies to maximize their achievement potential.  Nevertheless many of these people will struggle with lifelong disabilities.  And we should note that the cost to society–in remedial education and training, lost income from unsuccessful lives and its effects on those in the family, as well as the costs to society of criminal activities from too may of those unfortunately affected by FAS– is vast.

So the only real treatment is prevention and that’s where the latest CDC recommendations come in .  They now say that women of child bearing years who are sexually active and not using birth control should refrain from any alcohol consumption.  The basis for this new, strong position are 3 important facts:

  1. As mentioned, any alcohol consumption can be associated with FAS or FASD
  2. 50% of pregnancies are unplanned
  3. The earliest a woman is likely to become aware of her pregnancy is 4-6 weeks of gestation.

So the above makes for considerable uncertainty and that is the nature of the risk and the subsequent strong proscription.  Now, I understand that these recommendations seem somewhat unrealistic in the real world.  Young women have a right to live their lives and, as mature citizens, to “the pursuit of happiness.”  And, there are lots of legitimate reasons why various birth control methods may prove problematic in given young women’s lives.  But on the other side , with FAS and FASD, we are talking a lifetime of difficulty and disability, and not just for some random person but rather for the most important person in that young woman’s life–her own child.

So, yes, these rec’s may seem a bit over the top.  But I applaud the CDC for having the courage to state the case in such direct terms to highlight the importance of the issue.  Hopefully, it will help our younger citizens to educate themselves about FAS/FASD and can lower the risk for our society and for people themselves and their families.

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