More than what we see: the role of fathers in the wellbeing of children

This past June 17th, Father’s Day was celebrated around the country and globe. Even with a day dedicated to commemorating fathers, we often overlook the crucial role fathers play in the development of their children, beyond what is conventionally considered or is traditionally applied to mothers.

In any type of family, traditional or nontraditional, the family unit involves teamwork in a child’s upbringing regardless of who raises the child. For those families with a father present, recent research showcases that the involvement of a father in his child’s life can have a large impact on the child’s diet, discipline, and exercise, among other aspects of the child’s immediate well-being. More engaged fathers can also affect long-term development of children, such as improving self-esteem, enhancing performance in school, and leading to lower rates of depression, anxiety, or teenage pregnancy.  

This does not mean that a father’s involvement in his child’s life is required to be of the same nature as a mother’s. A father can occupy his own “unique role” in a child’s upbringing, different from the mother’s--in fact, recent studies show that the way mothers and fathers interact with a child stimulates “different parts of a child’s brain.”

For many fathers, it can be difficult to be highly involved in a child’s life, especially in a country like the United States, where most states and companies do not provide paid paternal leave. In fact, the United States is the only country in the industrialized world that has no paid family leave for mothers or fathers. This can make it especially challenging for fathers to spend quality time with their children after birth, or even cope with the stressors that afflict many families after welcoming a new child. For instance, many new fathers face similar challenges to new mothers, such as gaining weight or experiencing depressive symptoms after the birth of a child.

However, countries like Sweden are trailblazers when it comes to addressing these issues. Sweden has sought to increase the involvement of fathers in family roles and improve gender equality by legally providing 480 days off from work (to be shared by both parents) for each child in their home. The goal of such policies is to improve “social benefits” while also allowing women more freedom to “become more active members of the workforce.” Paid family leave is the norm in Sweden--many Swedes claim that it can even be looked down upon if a father does not take days off from work after the arrival of a new child. Regardless of whether such policies will eventually come to the U.S., one thing is for certain--in families with dads, fathers play a more crucial role than we realize.

CHIL’s Guide to Community Health Clinics

In CHIL’s blog post last week, we mentioned Mary’s Center, a community health clinic in Washington D.C. This week, we want to emphasize that clinics like this one are available all over the nation. In fact, there are about 1,400 community health clinics (CHCs) in the U.S. While undocumented immigrants and Dreamers are ineligible to enroll in the federally-subsidized health insurance plans provided via the Affordable Care Act, CHCs often offer a good alternative for anyone seeking affordable health care—both citizens and non-citizens alike.

Additionally, these clinics do not operate under any low-income or insurance coverage eligibility requirements; that is, a family with a working parent covered by some form of health insurance is welcome at places like Mary’s Center, too. Medical costs in the United States’ largely privatized system indeed can be overwhelmingly burdensome, even for people with steady employment.

So, how do CHCs operate? What services do they provide for individuals and families, and at what cost?

CHCs are nonprofits that receive funding from a myriad of sources including federal, state, or local grants and/or Medicaid payments. Some may partially rely on private funding sources as well. Because several institutions finance each CHC, in most cases, this provides the centers with a safety net. If one funding source is compromised—something common in the U.S. as administrations shift—CHCs have other means to remain afloat.

In order to qualify for public funds, CHCs must:

  • Be located in a medically underserved area or serve medically underserved populations (determined by the federal government)

  • Provide comprehensive primary care

  • Adjust fees according to a sliding scale based on patient income

  • Be governed by a community board, of which at least 51% of members are patients of the CHC themselves

Apart from providing comprehensive primary care, CHCs may address local needs like care in foreign languages or medical translators (for which their local community board can advocate). Another example is Mary’s Center partnership with Briya Public Charter School. Briya holds classes at Mary’s Center, providing an educational space for both parents and their children. Briya’s model works well for teenage parents who otherwise may have had to forgo public education. They also offer a counseling and educational group for (future) parents to attend throughout pregnancy; a program called "centering." These two programs are particularly useful for the areas Mary’s Center serves, where there are many young families.

The localized care many CHCs provides sets them apart from other medical facilities and makes them integral to the health of thousands of children living in the U.S. today, particularly living in vulnerable and underprivileged families. If you or your kids are in need of affordable health care, CHIL recommends looking into your local CHCs for medical services. This search tool can help:

The detrimental and lingering effects of migrant family separations

In the past couple weeks, immigrant officials at the U.S.-Mexico border have separated migrant children from their parents, prompting national outcry. Despite the signing of an executive order last week to halt the practice, evidence shows that trauma from separation can persist in a child, even after reuniting with their parents.

Children are susceptible to the same stress response as adults. However, not having a parent to comfort or alleviate their stress can cause harmful and sometimes irreversible effects. Their immune systems may become weaker and less able to fend off infections. In addition, the stress response in children can induce long-term effects such as post-traumatic stress disorder (PTSD), depression, or substance abuse.

Some migrant children are able to join foster parents; however, many others are held at detention centers across the country. The detention centers’ ability to provide support to children is often complex and ambiguous, due to strict rules sometimes limiting physical contact between staff workers and children. Although children crossing the border in the past couple years were predominantly adolescents, many children detained recently are younger than age five and  have very different needs. In addition, even if placed with foster families, children with trauma display abnormal behavior for their age, such as crying constantly, having separation anxiety, and being unable to leave their foster parents’ side. It surely does not help that some of these children are also fleeing violence in their home countries, facing residual trauma from those experiences as well.

A recent executive order now allows families to be kept together when taken to detention facilities at the U.S. border. Moreover, a recent court ruling requires previously separated minors to be reunited with their families within thirty days by U.S. officials. Of utmost importance is the provision of mental health services to migrant children--not only to those separated in the past month, but also those crossing the border today, with or without family. Programs like the Mary’s Center in Washington D.C. work toward this goal, by providing therapy and assisting migrant children in schools. However, public services to aid undocumented individuals are oftentimes limited in the U.S. In addition, many undocumented individuals may find it difficult to seek help due to fear of retaliation. Given the adverse health effects migrant children may face, efforts to alleviate the long-term traumatic consequences of immigration on inculpable and vulnerable minors is imperative.

Helmets provide protection, but they get a bad rep. How can adults encourage kids to wear them?

Summertime and bike riding go hand in hand. The pleasant weather invites cyclists of all ages, and for kids, bikes grant independence. They can get from place to place using environmentally friendly transportation and without relying on Mom or Dad for rides. This can be especially important during long summer days because, unfortunately, most parents and/or caretakers don’t get a summer vacation from work. Moreover, they are free to use! Even if the initial investment is a financial burden, many cities offer free or subsidized bike-sharing programs.

CHIL encourages kids to take advantage of this prime bike-riding time. At the same time, we support the use of bike helmets as they improve safety. We know they’re hot and sweaty, they give you helmet hair, and the chances of getting in an accident, statistically, are small. We get it. Wearing a helmet requires taking on a short-term cost with an unknown reward.

In fact, one of the major fears of policy-makers considering requiring helmet usage is that the reluctance to wear a one will actually reduce bike-riding popularity altogether. This would be an unwanted consequence given biking is such an accessible form of exercise. Nonetheless, the research gathered on helmets, bike accidents, and fatality are in largely in agreement. In her review of bicycle helmet research, including five well conducted case‐control studies, Dr. Rebecca Ivers found that “helmets provide a 63–88% reduction in the risk of head, brain and severe brain injury for all ages of bicyclists” and “the review authors concluded that bicycle helmets are an effective means of preventing head injury.”

Ivers makes it clear that wearing a helmet is good for your health—so much so that some health insurance companies even offer monetary incentives (both positive and negative) to helmet-wearing, like covering the cost of helmet or revoking coverage in accidents where the rider is without helmet. We want to emphasize that wearing a helmet while bike riding makes an already-healthy activity even more healthy.

When it comes to children, the bike-riding beginners, it’s important to instill the habit of helmet-wearing perhaps before they even think of it as a short-term cost. We’ve gathered the following tips to incentivize kids to wear helmets:

  • Encourage good habits. From the first time they start riding with training wheels, have them where a helmet. Make it clear that putting the helmet on and getting on the bike should happen simultaneously, just like putting on a seatbelt in the car.

  • Let them pick out the helmet they would like. Many retailers carry a plethora of options with different colors and décor. Stickers are also fair game. The helmet can become a fun accessory, and unlike clothes, kids won’t outgrow them every year!

  • Set an example for them by always wearing a helmet when you ride.

  • Point out celebrity cyclists (or other admirable figures in their lives) wearing helmets.

  • Be sure to use positive reinforcement—praise children when they do wear their helmets rather than only scolding when they don’t.

Bike riding should be fun, but it also should be done safely—especially when it comes to younger riders. Wearing helmet should not have to compromise the enjoyment of biking for kids, and with the right encouragement, it doesn’t have to.


Prioritizing Well-Being Over Stress

It’s important to motivate children and teens to succeed and do what they love, but a recent newscast in NPR talks about the risks of pushing kids too hard to do well. (The NPR newscast includes a 7-minute talk about this topic which you might find interesting!) It is not a stretch to say that students today feel immense pressure to compete against their classmates and friends to do well, and this stress can be a major contributing factor to anxiety and depression.


Some parents admit that they “totally bought into the idea” that their job is to push their kids to succeed and overcome obstacles. But if the pressure is too much, this effort can backfire. One high school in New York invited a psychologist to evaluate the student body using the Youth Self-Report, and found evidence of high levels of stress. This includes internalizing symptoms, or feelings of sadness, anxiety and depression; physical symptoms like headaches and stomachaches, and drug and alcohol use.


According to experts, substance abuse is actually something that affluent teenagers may use even more than inner-city kids, as “a form of self-medication” against the stress of high expectations to do as well as peers or parents.  This means that the need for conversation around mental health applies to inner-city and wealthy suburban schools alike.


Parents can play a huge role in promoting well-being as a priority that takes precedence over grades. They can have constructive conversations about stresses their families face, which are not likely to be ones they face in isolation. They can also work with schools in order to improve environments at school and at home. Research-based “resilience training programs” that teach “coping and happiness skills” are taking off at school, even for elementary students. Researchers today are finding that “resilience training can help reduce symptoms of depressive or negative thinking among children”


Student-directed initiatives also give students an opportunity to talk with each other about topics they might not readily share with parents or teachers, and gives them an active role in their own mental health.


All of these efforts should be directed towards valuing well-being and celebrating diverse kinds of passion and success. As a society, we should acknowledge that “a culture shift” is necessary to value all kinds of success instead of prioritizing and zeroing in on certain academic successes or career paths.


#WhereAreTheChildren: concerns for the well-being of immigrant children in the age of viral hashtags

As #WhereAreTheChildren flooded Facebook and Twitter posts this past week, CHIL is taking a closer look at the role of social media in issues like child immigration policy and why such policies are relevant to children’s health in the first place. Given the nuanced nature and diverse moving parts, we will cover this topic in a series of posts.

There are millions of immigrant children living in the U.S., some of whom have undertaken incredibly risky journeys along the way. From on-the-ground Border Patrol agents to broad, federal immigration policy, how our government treats minors upon arrival can impact their health and well-being. The #WhereAreTheChildren trend caught America’s attention by exposing the alarming number of 1,475 children unaccounted for on the part of the Department of Health and Human Services (HHS).

Much confusion followed this news. The New York Times clarified that the 1,475 are a fraction of 7,635 children who migrated mainly from “Honduras, El Salvador and Guatemala, and were fleeing drug cartels, gang violence and domestic abuse, according to government data.”  

So where are these 1,475 kids?

In the worst-case scenario, some kids may have fallen victim to smugglers or human trafficking. However, experts caution many of these children are likely still safe with their sponsors, who are often parents or family members already living in the U.S. Eric Hargan, secretary for HHS, said in a statement that often sponsors cannot be reached because they themselves may be living as undocumented immigrants and are hesitant to talk with federal authorities.

The lack of sponsor communication raises concerns about the health and safety of the children for whom they’re responsible. Even if a child is out of harm’s way, the sponsor could still fear using beneficial federal resources for the children. For example, undocumented children have the same right to public education as American citizens. In some states, there are federally-funded health clinics which are required to treat all people regardless of documentation status. However, if sponsors are reluctant to use federal systems in effort to avoid governmental authority, they and their children lose access to necessities like basic education and medicine. The 1,475 missing follow-up calls manifest the prevalence of this reluctance.

Moreover, while interest in the well-being of immigrant children has spiked in recent weeks, the issue itself is decades old. Albeit much misinformation followed #WhereAreTheChildren, at the very least the hashtag drew much-needed attention to this vulnerable population of young kids. It forces us, as children’s health advocates and more broadly as Americans, to reflect on how we can better fight for the health of vulnerable populations; that is, fight for vulnerable populations not based on the media or political attention they accrue but rather based on their genuine need for allyship and aid.

In the coming weeks, CHIL will take a look at current immigration policies in place to protect the health of immigrant children. Stay tuned.

Let’s keep our minds engaged over the summer!

School’s almost out, and as families prep for the summer, it can be good to help kids’ brains stay active and healthy. Stimulating the mind over the summer, which of course can be combined with relaxation and play, makes it easier for kids to transition back into school mode in August. As we all know, the mind and body are linked, so we came up with some ideas that can keep your child engaged inside or outside the house during the long summer days! Definitely check out our previous blog on some good ideas to make exercise fun and motivating for children over the warmer months.

  • Blow bubbles: It can teach deep breathing, which is healthy for the heart and mind. Besides bringing a calming energy, it can also get your child out and about!

  • Visit the local library: There are always fun summer activities planned at the library, as well as reading challenges and the opportunity to win prizes. It gets kids using their brains and some time out of the house!

  • Visit museums and local parks: Maybe you can check out a book from the library about a topic from the museum that interests your child, or a book about nature to take with them to the park!

  • Try learning Yoga: Not only does it involve both the mind and body, but just like blowing bubbles, it can be a good start or end to an active day. Cosmic Kids Yoga even has videos up for kids to follow and have fun with!

  • Teach your child how to use a stopwatch: This mom tried it and surprisingly it got her daughter to stay engaged with her own experiments in the house, like how long she could stand on one foot for!

  • Try cooking together: Have you checked out our recipe post on making blueberry muffins yet? When it gets too hot outside, this can be a perfect indoor activity!

  • Encourage volunteering: If your child loves animals, call your local animal shelter if they accept young volunteers! Some may accept children within a certain age to volunteer, or if they come with an adult. Habitat for Humanity has a youth program that offers volunteer opportunities to students as young as age five. Some other ideas include nursing homes, soup kitchens, or the local zoo. Here is also a resource guide with some websites to search for civic engagement opportunities: it’s never too early!

With that, happy summer!

Children’s health news updates from the White House

The month of May has brought a host of new actions from the White House regarding children’s health. CHIL breaks down the recent news below.

First, the President has called on Congress to cut $7 billion in funding from the Children’s Health Insurance Plan (CHIP). CHIP is a federal program that provides health insurance to 9 million otherwise-uncovered kids and over 300,000 pregnant mothers. (CHIL covered this issue in several posts if you need a refresher). It’s particularly special because it’s one of the few programs that has had bipartisan support for decades.

After a hard fought congressional battle in 2017, CHIP received a necessary decade-long funding extension in January 2018  (CHIP CHIP Hooray!). Despite the win for children’s health in the beginning of the year, the Washington Post reports, “Congress can ‘rescind’ money it has previously authorized if it secures a majority of votes in the House and then the Senate using powers under the Congressional Budget and Impoundment Control Act of 1974.” This is the act President Trump would rely on to cut money from CHIP at this point, though the law hasn’t been employed to rescind funding in over 20 years.

If faced with a ex post facto funding cut from the federal government, many states may be left with no choice but to scale back their CHIP enrollments and/or benefits. We caught a glimpse of the detrimental impact jeopardized federal resources can have on CHIP back in late 2017, when some states took preemptive measures in anticipation of losing their CHIP funding. Connecticut, for instance, froze enrollment in December. Colorado and Virginia had plans to phase out coverage for pregnant women starting in January.

CHIP is an extremely important measure for child health, as CHIL expressed back in September and October, and it heavily relies on federal government money. We hope that the vital health insurance program will continue to receive the Congressional support it needs to adequately aid its worthy beneficiaries: disadvantaged women and children. Notably, while President Trump has operated at odds with CHIP this month, by contrast First Lady Melania Trump unveiled her “Be Best” initiative to improve child well-being on May 17th. She has followed many of her predecessors--namely, Michelle Obama, Laura Bush, Barbara Bush, and Nancy Reagan--in specifically focusing on children’s issues. As mothers themselves, after all, children’s topics hit close to home regardless of political ideology.

Though the details of the “Be Best” campaign have yet to unveil, the initiative’s three goals are to improve child well-being, take on cyber bullying amidst today’s increased social media presence, and tackle the opioid crisis so as to reduce the number of children born with addictions (an ongoing issue CHIL wrote about last week). Ms. Trump’s outlined goals are promising, and CHIL is looking forward to learning the specifics of her children-centered plans in the coming months.

The forgotten children

Note: the following post discusses drug use and abuse

It has gripped the nation for the past couple years, with media outlets, local mayors, school systems, and community leaders all talking about it. The president even declared it a “national public health emergency” last year. The opioid epidemic has penetrated the very fabric of America, regardless of race, age, and socioeconomic background, yet most have forgotten the infants and children affected as collateral damage.

The New York Times recently reported on these children, discussing the struggles many opioid-addicted women face when encountering an unexpected pregnancy. How can they circumvent their child from being born with Neonatal Abstinence Syndrome (NAS), a condition in which babies experience opioid withdrawal?

Many expectant mothers attempt to curb their drug use patterns; however, it often proves to be difficult. Doctors recommend that opioid-addicted pregnant women use methadone or buprenorphine, both substitutes of opioids, to help wean them off their addiction while also helping their baby experience a better birth and potentially better health outcomes. However, there is a caveat--the child may still be born with NAS, as both replacement drugs are also opioids.

Limited research exists regarding NAS’s long term effects, however preliminary data from ongoing studies suggest that NAS-born infants may hit the normal developmental range in their early childhood. In addition, even if there is a risk for NAS, mothers are able to obtain treatment by using methadone or buprenorphine, which will ultimately improve both the child’s and mother’s health in the long run. Some mothers have even indicated that becoming pregnant gave them an added responsibility and urgency that positively impacted their lives--even turning some of them sober.

However, our society still deals with drug-addicted pregnant mothers punitively. In some states, babies born with NAS may be taken away from their mothers under the pretense of child abuse. The child may either be placed with other family members or in foster care as a result. However, children in foster care can enter an endless cycle into the welfare system, where they are more likely to grow up to become homeless, experience a teen pregnancy, or even abuse their own children if they were abused as a child.

With all this information, it is crucial we take a hard look at how we treat mothers who may be addicted to drugs, and its potential impact on their children. By making these efforts, we can look towards a future where regardless of background, babies grow up to have bright and healthy childhoods.

The Great Cooking Challenge: Update!

The Great Cooking Challenge, a program developed by our Small Grants Program 2017 winner Jessica Trinh, recently wrapped up and we are so excited to share one mom's story about her son's dedication to this project. We hope you enjoy Qiran's story (pictures are below)! 

My name is Ganlin. My son, Qiran, is in 3rd grade at East Rock School and has been cooking for a couple weeks. I want to share some cooking photos with you. This has been a fun experience for us. Qiran started to enjoy the joy of making food and stops thinking cooking is something kids cannot do. He was not very interested at the beginning but was attracted by the soda juice recipe. Over time, he enjoys more and more to turn ingredients into real dishes. He made banana pancakes earlier this week and shared with our neighborhood. He was very proud of that! Besides that, I am also very glad to see the cooking experience bring new/healthy food into his daily life. He started to have avocado toast for breakfast recently. We have been having avocado toast for ourselves for years and he always wanted to have jam on his toast. I am very happy to see he decided to put avocado on his toast lately (and shared with his 1 yr old brother)!



A blueberry muffin recipe for kids and adults…

…exists, and it’s here! This delicious muffin recipe published by the Harvard School of Public Health makes for a yummy, healthy baked good—a balance the usual pre-packaged muffin or even other homemade muffins often can’t match. No need to choose between taste and the doctor’s recommendations anymore. The blueberry delight has only 120 calories, no butter, double the fresh fruit, minimal added sugar, and will make an excellent snack or breakfast on-the-go option that both you and the kids you care for will love. Follow the instructions below when you’re ready to get baking!


  • 1 cup (120 g) whole wheat pastry flour

  • ¾ cup (90 g) white whole wheat flour

  • ¼ cup (26 g) almond flour (can be made by grinding almonds in a food processor)

  • 1 tsp. (4 g) baking powder

  • ½ tsp. (4 g) baking soda

  • ½ tsp. (2 g) salt

  • 1 tsp. (2 g) orange zest (adds tang and flavor that will make your muffins last longer)

  • 1 ½ cups (200 g) fresh blueberries (frozen can substitute if needed)

  • 2 eggs

  • 1¼ cups (286 g) low fat (1%) buttermilk

  • 4 Tbsp. (42 g) brown sugar

  • 6 Tbsp. (78 g) canola oil

  • 1 Tbsp. (14 g) orange juice, freshly squeezed

  • ½ tsp. (4 g) vanilla


  1. Place the rack in the top third of the oven and preheat the oven to 400 degrees Fahrenheit Line muffin tins with paper liners.

  2. In a large mixing bowl, combine the flours, baking powder, baking soda, salt, and orange zest. Add the fresh blueberries and toss gently to coat the blueberries in flour. This will help keep the blueberries suspended in the batter versus falling to the bottom.

  3. In a medium mixing bowl, lightly beat the eggs, then whisk in the buttermilk, brown sugar, canola oil, orange juice, and vanilla. Don’t worry if the mixture looks curdled or lumpy.

  4. Pour the wet ingredients into the dry ingredients and stir until most of the flour is incorporated. The mixture can be slightly lumpy; don’t over mix. Divide the batter among the 18 prepared muffin cups.

  5. Bake 12 to 14 minutes, until the muffins are golden brown around the edges.


Nutrition information per serving (1 muffin, or 1/18 of the recipe):

120 calories, 3 g protein, 14 g carbohydrate, 2 g fiber, 5 g sugar (2 g added sugar), 125 mg sodium, 20 mg potassium, 5 g fat (0.5 g sat, 3 g mono, 1.5 g poly, 0 g trans), 20 mg cholesterol

Recipe courtesy of The Culinary Institute of America


Mother’s Day: A day for celebration and reflection

With Mother’s Day coming up on May 13th, many may not know the origins of the holiday celebrated across the world. In the 19th century, a community organizer named Ann Reeves Jarvis hosted “Mother’s Day work clubs” to help decrease infant mortality. We might assume that health outcomes have drastically improved since then, due to better quality of life and medical advancements. However, despite an improved trend overall in infant mortality rates in the United States, the disparity between white and black mothers has actually widened.

A recent article in  the New York Times titled “Why America’s Black Mothers and Babies Are in a Life-or-Death Crisis” details the disparity in not only infant mortality rates among black and white mothers, but also in maternal mortality. Black babies in the United States die at a rate of 11.3 per 1,000 black infants, while the rate is less than half for white babies at 4.9 per 1,000 white infants. This gap in infant mortality is actually worse now than it was in 1850. What is even more shocking is that this disparity does not decrease with higher education or social status. According to the article and the Brookings Institution, babies born to black mothers from a middle-class background with advanced degrees are more likely to die than babies born to low-income white mothers with a high school or middle school education.

Research in recent decades has started to uncover the reasons for such a disparity--that the “experience of being a black woman in America”, one in which systemic and institutional racism persists in all walks of life and induces persistent stress, has resulted in worse health outcomes for black mothers. In addition to the physiological effects of racism, there is also the prevalence of racial bias in healthcare, which can result in misdiagnoses. Even with all the resources and money in the world, we know that black mothers are still not immune to these biases. For instance, tennis athlete Serena Williams discussed her own story recently of how healthcare providers initially disregarded her life-threatening symptoms of a pulmonary embolism before giving birth to her daughter.

Racial biases in the healthcare system and its effects on children, mothers, and families is something we hope to explore in the upcoming months in further blog posts. One thing to keep in mind this Mother’s Day is that as much as we celebrate our mothers for everything they do, our healthcare system may be failing them in certain ways. However, despite the setback the United States has experienced in infant and maternal mortality rates for racial and ethnic minorities, steps are being taken by local municipalities to combat this issue. Research is starting to show the potential benefits of having a doula to provide emotional support and physical care for expecting mothers, which many providers and organizations are beginning to suggest for pregnant patients. Nonprofits like Make Your Date Detroit, which helps women in Detroit enroll in classes for prenatal education and partner with a mentor during their pregnancy, have shown promising outcomes as well. We hope similar discussions and initiatives continue to help improve the health outcomes of all mothers.

Kids like things that are fun. How can adults make exercise fun?

Given our posts in the past couple months about health technology and its incentive potential for children, we’ve also noted technology isn’t necessarily a prerequisite to encourage kids to get moving! This is especially important to keep in mind as health technology may have unintended, unhealthy consequences. Plus, there are plenty of other options that are easier on the wallet! We’ve compiled some easy, timeless ways to motivate children and teenagers to exercise below.

Time Magazine reports that “For a child to be active, they have to really enjoy the activity.” One of the best ways to ensure this is to encourage kids to decide what activity they will do. Whether it’s supporting children in participating in the sports that interest them or asking them where they’d like to go hiking, giving young kids the autonomy to choose will allow them to look forward to it.

Another way to foster fun is by framing activity as a reward. Experts agree exercise should never be a punitive measure. After all, this would take the enjoyment out of activity, causing negative associations with healthy behavior. Try creating reward incentives like “once homework is finished, we can play a game of H-O-R-S-E at the basketball courts.”

Inviting friends is also an excellent way to create a positive environment for physical activity. Going on a bike ride? Invite a classmate. Playing a pick-up game of soccer? Tell the neighbors. It’s much harder for kids to turn down their friends’ excitement than their parents’.

On a similar note, parents or caretakers joining in on the activity can be a game changer, especially when friends or neighbors aren’t around. Kids love to be able to show someone their mastsery and receive affirmation, and affirmation from a respected adult goes a long way. Moreover, it adds to enjoyment and satisfaction when Mom or Dad tries, say, the new hop-scotch challenge.

These are just a few (of many) tips that we found repeatedly appearing when parsing through suggestions online. That being said, a plethora of other ideas are available with just a simple Google search! Every kid is different, so CHIL recommends trying out different methods and going with the ones that stick. As the weather gets warmer, take full advantage of the outdoor activity interests and positive young energy it brings!


E-cigarettes: An unforeseen problem

You may have noticed kids or adults carrying it around: in the subway, on the walk to school, or outside an office building. It’s a long, skinny, metal-like object--something you may even think is a pen if you don’t look at it hard enough. Even with its different colors, it’s not a writing utensil or a tool. It’s an e-cigarette, commonly known as a “vape”. Although some experts previously supported its use to help adult smokers decrease their cigarette habit, the e-cigarette market has unfortunately expanded from adult smokers to young kids in middle and high school.

According to the New York Times, e-cigarettes are deceptive--not only because they come in different appealing flavors, but they are also easily concealable. Manufacturers have made them easily clippable to clothing or look like flash drives. E-cigarettes also contain a higher concentration of nicotine, an extremely addictive chemical, than actual cigarettes do. Despite this knowledge, limited research surrounds the long-term risks of e-cigarettes on health due to the newness of the product. There is also a gap in awareness among adults of the harmful effects of e-cigarettes. A report released by the Centers for Disease Control and Prevention showed that approximately 30% of surveyed adults did not know if secondhand exposure to aerosol, which contains nicotine and other hazardous chemicals, was harmful to children. In addition, about 40% of the surveyed adults indicated that secondhand aerosol exposure results in “little or some” harm to kids. All of these factors make it even more difficult to market a campaign against e-cigarette use.

In addition, many manufacturers claim that their products are not intended for children, especially when federal law indicates e-cigarettes can only be purchased for those over 18 years of age. However, their marketing campaigns indicate otherwise. The New York Times states how companies advertise clothing lines that display their vape brand and sell “vape sauce”, which can be attractive to many teens.

To combat the rise of e-cigarette use in educational settings, especially with limited federal regulation of vapes, many schools take it upon themselves to enact more stringent policies. Schools have started suspending students, putting monitors in bathrooms, and sometimes even requiring drug testing for those found with e-cigarettes, since marijuana can be smoked using a vape. However, the effect of stricter school policies on reduced use is still largely unknown.

One thing we know for certain is that although cigarette use and popularity has drastically declined from a century ago, more than 3 million middle school and high school students still smoke regular cigarettes. A recent published study indicated how 12th grade e-cigarette smokers were 4 times more likely to use cigarettes, a year after indicating they had never smoked cigarettes before. Thus, a growing population of nicotine-addicted youth is possible, making it even more imperative that local, state, and national-level administrators take action in policy and research--either by further regulating the tobacco industry, or studying the health effects of e-cigarettes. Some states, like California, recently raised the age to buy e-cigarettes from 18 to 21, indicating a step in the right direction. Here is to hoping more states will follow.  

Are we doing health campaigns right?: the vaccination story

“Never give up until they buckle up”

“Quit smoking before smoking quits you”

“It’s the little prick you can deal with”

Whether it’s getting kids to wear seatbelts, trying to reduce the number of smokers, or motivating people to get tested for HIV, public health campaigns are all around us. Some campaigns have been around for decades, like the Safe to Sleep campaign to prevent Sudden Infant Death Syndrome (SIDS), while some have been fairly recent pushes, like promoting a soda tax to reduce added sugar consumption. New or not, almost all campaigns are similarly constructed: each contain a catchy slogan, a captivating image, and sometimes even a celebrity endorsement.

Although there hasn’t been a plethora of empirical research detailing the effectiveness of such campaigns, it is commonly assumed that a successful public health intervention needs a persuasive element to it. One of the most famous and successful campaigns in the last century has been the one for vaccines, whether it be for polio, measles, or chickenpox. Vaccination has become such an important national topic that at any point during the school year, parents will inevitably see a poster saying Don’t Wait, Vaccinate.

But are slogans and campaigns effective in getting people to do what health officials want them to do, like wearing a seatbelt or getting vaccinated?

A recent study published in the issue of Psychological Science in the Public Interest has looked specifically at vaccination interventions, showing that contrary to popular belief, “shaping” the behavior of patients and parents to get vaccinated is more effective than persuasion itself.

The researchers noted that the frenzy behind “anti-vaccers”, or those against vaccinations, has been perpetuated by the media, giving off an image that a high proportion of parents are refusing to get their kids vaccinated. However, there is not as much pushback as people assume. Rather, most people consider child and adult vaccinations as favorable, and children almost universally receive their physician-recommended vaccines. However, many adults do not consistently uptake their vaccines. In response, the researchers indicated that many adults’ “favorable intentions” towards vaccinations can be successfully translated to proper vaccine use when interventions include the following:

  • Using “behavioral strategies to facilitate action”, such as sending out reminders or prompts via an annual postcard from a healthcare clinic;

  • Decreasing clinical barriers to vaccine access, such as automating routine doctor appointments;

  • Shaping” behavior, such as requiring all kids at a preschool to have the flu vaccine, or incentivizing teenages to receive an HPV vaccine.

Although this study specifically examines  the role of persuasion in the success of vaccination interventions, other public health campaigns have been researched as well. For instance, when it comes to mass media campaigns, single behavior campaigns (such as vaccination or breast cancer screening) have a higher likelihood of success than campaigns targeting ongoing behaviors (such as exercising every day or eating healthy).

Although translating  research findings is not as easy when it comes to the nuances of different behaviors and health campaigns, there is one thing we know for sure: more research needs to be done--until then, we can stick to proactive behaviors like vaccinating as much as we can.

With new product, Fitbit seeks previously-untapped consumer: 8-to-13 year olds. What are the implications?

Back in February, we wrote about the whispers in the health technology industry of a wearable tracking device for kids. Now, Fitbit has done it. The company has officially launched Ace, a fitness tracker targeted for children aged 8-13 years, available for pre-order now.

Fitbit publicizes the device as a tool to get kids moving, motivating them to reach the 60 minutes of daily activity recommended by the Center for Disease Control and sending celebration messages when they reach their goals. In the advertisement linked on Fitbit’s website, two children engage in friendly exercise competitions within their everyday life. The device also aims to be family-friendly, allowing family members to sync together on the Fitbit app. Parents can monitor kids’ numbers, from steps to sleep stats, for the price of $99.95.

The advent of Ace marks a new era of health incentives for young children, but also a new era of numbers monitoring, both on the part of kids themselves and their parents.

While one can dream up a creative dystopian future where this tracking gets out of control, there are potentially unsettling realities in the present that don’t require such imagination.

For instance, we could look  to children (or adults) who have already been paying attention to their health data for years, without the help of a special wristlet. Given its ability to fluctuate and ease in measuring, weight is often the easiest parameter for these children to track. But it is well-known that relying on the numbers of the scale can lead to or exacerbate dangerous outcomes like eating disorders and body dysmorphia. Would the increasing  convenience in measuring daily activity have the counterintuitive effect of intensifying unhealthy tracking behavior?

Another example is the increased distraction such  technology poses in the classroom. In the past decade, teachers have had to adapt to the growing presence of cell phones in class, dealing with the new handheld screen that captures the attention of pre-teens far more effectively than pre-algebra does. What kind of impact would Ace have for the 8-year-old user? Will third-graders now be running around the halls in the name of their Fitbit friendly competitions?

There are also many school-children whose families can’t afford the new technology. The Ace could serve as a signal of wealth and perpetuate socioeconomic segregation from an even earlier age. If a child’s family cannot pay for the wearable device, undoubtedly, she would  be excluded from step competitions at recess.

Fitbit’s Ace may be an excellent way to incentivize kids to exercise—as demonstrated in the company’s picture-perfect commercial—but it also may not work for every child. CHIL encourages parents considering this new device to think about how it will be incorporated into your child’s day-to-day life. If wary of the health outcomes or if the price tag is too high, bear in mind there are many other (time-tested) methods out there to encourage kids to get moving! CHIL is working on a list of ideas to share with you in the coming weeks.


The complexity of healthy eating: How does it relate to food deserts and food stamps?

The Academy of Nutrition and Dietetics celebrates March as National Nutrition Month, and the 2018 theme is Go Further with Food. The theme emphasizes adopting healthier eating lifestyles, a topic we’ve discussed before, while also attempting to minimize food waste. As National Nutrition Month comes to an end, we hope to reflect on the intersection of healthy eating and healthy living with some hot topics at the moment: food deserts and food stamps.

The U.S. Department of Agriculture (USDA) defines food deserts as neighborhoods without “ready access to fresh, healthy, and affordable food” that meet general nutritional guidelines. Generally, food deserts lack access to fresh food retailers and residents have poorer health outcomes, such as a higher prevalence of obesity. With the abundance of research detailing the presence of food deserts in low-income communities, many have focused the conversation on eliminating these food deserts to better health outcomes. Experts discuss the importance of opening fresh food grocery retailers through incentives, and stalling the proliferation of fast food chains in low-income communities. Communities are even innovating to improve access to fresh food, such as building community gardens, developing online grocery delivery systems, and opening up farmers’ markets and mobile food vans.

However, recent evidence indicates that food deserts may not be as significant as previously thought. In fact, a recent study from NYU explored how increasing the number or supply of fresh food options in low-income communities does not necessarily reduce nutritional disparities. This is because there is still little demand for fresh food products. Researchers found that when the same grocery options were present in low-income and high-income populations, “nutritional inequality” only decreased by 9%. In summary, increasing fresh food options did not have much influence on shopping habits or improving nutritional purchases at the grocery store. Without changing shopping and eating habits, increasing fresh food accessibility may have little impact.

These results lead us to question current popular approaches to promote healthy eating for our nation’s children and families. In an attempt to evaluate and improve this landscape, the government’s 2019 fiscal budget proposes to cut the Supplemental Nutrition Assistance Program (SNAP) by $214 billion in the next decade. SNAP, also known as food stamps, is a voucher program that allows low-income families to purchase food items at grocery stores. The program serves over 40 million people in the U.S., of which 70% are families with children. The SNAP program has long been regarded as a crucial pillar of the fight against poverty and hunger.

Along with this spending cut, the budget also plans to provide certain food stamp benefits through a “Harvest Box”. Proponents of the Box say it promotes nutritious eating by providing a pre-determined package of food. Many nutrition experts criticize the Harvest Box as being paternalistic, and point out the proposal’s irony of promoting healthy eating using exclusively non-perishable items.

What will be the best way to address healthy eating in the landscape of consumerism? There is no single answer--we need to do more research, and our nation should consider a multi-pronged approach that takes into account supply, demand, food culture, nutrition knowledge, poverty, and education.

Continued discussion: intersection of kids, tech, and well-being

About three months ago, Facebook rolled out a controversial mobile messenger app for kids. The app, which targets children aged 6-13 years, allows users to send texts online after connecting with a parent’s Facebook account. Its key features include sending pictures, edited pictures (think colorful drawings transposed over selfies, etcetera), videos, and emojis, all without the usual clutter of advertisements.

While Facebook argues their new novelty encourages kids to connect rather than spend time on passive mobile applications like games, health experts say the young children Messenger Kids targets are just beginning to grasp written communication and are developmentally unprepared for the app’s interactions. Facebook further claims kids increased involvement with technology in this modern age is inevitable, so parents might as well embrace platforms like Messenger Kids, which requires their consent and doesn’t subject young users to harmful advertisements. On the other hand, health experts ask if Facebook is truly acting in the best interest of children, or just trying to exploit parents’ loyalty to their platform while hooking kids early on.

At the core of this debate is the question of how young is too young for kids to begin using and relying on digital communication. It is reminiscent of the Fitbit for kids case covered in February: are children too young to be wearing health-tracking devices? As new technology like these challenge traditional notions of childhood, it’s no wonder parents and pediatric specialists alike are divided.

Reflecting on our article from two weeks ago, too, regarding the adverse happiness effects of increased screen time on teens, Messenger Kids critics’ can add another layer to their argument. In light of Twenge et. al.’s research, it’s hard to see how Facebook’s new app could improve health.  The app gives young children yet another reason to use a screened device, setting them up for more phone dependency as they enter adolescence. Even if we say that increased social media time reduces  happiness, and not messaging apps or screens themselves, this point only goes so far when considering Messenger Kids as a gateway for younger users until they reach Facebook’s minimum required age for an account. Facebook guidelines state users should be 13, conveniently right at the recommended age cap for Messenger Kids users. If Messenger Kids preps users to join the Facebook community as soon as they are 13, then the introduction of the app would in fact increase social media time (thus reducing happiness, according to Twenge et. al.). As early as age 6, Messenger Kids ropes children into social media.

Another argument could be made for the better health outcomes associated with kids being more communicative with their parents and friends. Yet digital communication can only go so far. This point has no more validity than one that notes greater ease of texting could lead to fewer genuine interactions. More research on the topic is necessary to stake such claims.

Finally, Facebook’s defense that they are offering a connective, active app in contrast to other “passive” options does nothing to actually reduce time spent in front of the screen. Perhaps the answer to passive mobile applications is not an “active” app like Messenger Kids, but rather encouraging non-screen activities. Viewing all technology adoption as “inevitable” is a rather unproductive stance. If a new app for children could lead to decreased happiness down the line, potentially compromising mental health, it is insufficient to stand by idly, saying it’s the lesser of two evils. We encourage parents who do use this app for their kids to explore other options out there, encouraging positive, non-digital interaction. After all, with regard to the collective behavior we noted two weeks ago, the app is only as good as its popularity.

Interested in Behavioral Economics and Health?

The decision making of children, parents, and families can have a profound impact on the trajectory of an individual’s life. Understanding these behaviors can help change the way we think about and address the challenges that plague our healthcare system. How do people behave when it comes to making decisions about their health, and why do they behave a certain way? Are certain behaviors modifiable, and if so, what can we do to change them? If these are questions that you find interesting, check out the reading list below!

A New York Times best-selling author and professor, Dan Ariely explores the hidden yet foreseeable “forces that shape our decisions” in his book Predictably Irrational. Using common insights and experiments from his classroom, Ariely narrates each chapter with a question on how behaviors are often influenced, ranging from “The Power of Price: Why a 50-Cent Aspirin Can Do What a Penny Aspirin Can't” to “The Problem of Procrastination and Self-Control: Why We Can't Make Ourselves Do What We Want to Do”. This book may provide insight into motivation and behavior--for instance, why is it difficult for a child to take their medicine or exercise consistently? Watch an animated synopsis of the book here.

  • Nudge by Richard Thaler, Cass Sunstein

Nudge offers an individual and systemic look on daily decision-making, poor choices, and how this affects health outcomes and overall wellbeing. Nudge specifically focuses on how people can make easier choices if “choice architecture,” or the options given to people, is engineered with careful thought and precision. If you’re interested in large-scale behavior modification--for instance, how people can be “nudged” to purchase healthy food options at a grocery store--this book may be of interest to you! Watch a quick visual summary of the book here.

Daniel Kahneman, a Nobel Prize winner in economics, uses his research to explain cognitive biases, prospect theory, and happiness in his book Thinking, Fast and Slow. He describes two types of thinking through the lens of his academic research: “System 1”, which is quick and intuitive, and “System 2”, which is slower yet more logical. Kahneman’s writing allows readers to recognize their own miscalculations in decision-making, and how common errors in human judgment can explain much of the world. If you are seeking to understand how people frame their thoughts and biases, such as with self-esteem or self-image, you may find this book interesting!

"Would requiring everyone to buy health insurance make us better off?"

“Why would giving consumers lots of choices in their health care plans be a bad idea?”

Author Douglas E. Hough discusses these hard-hitting topics, amongst others, in his book Irrationality in Health Care. Using a behavioral economics perspective, Dr. Hough considers why the U.S. spends so much on healthcare yet lags in health outcomes compared to other nations. With CHIP being reauthorized for another 6 years, this book may provide insight into why certain healthcare policies are important to implement, especially when it comes to children’s health. Watch a crash course of this book’s topic here.


Look out for an impending book review soon!

On Screen Time, Health, and Collective Behavior

Continuing in the spirit of exploring the heath-technology intersection we wrote about two weeks ago, researchers at San Diego State University recently found that teenagers who spend more time on screen devices are less happy than their less-screen-time counterparts. Specifically, non-screen activities like sports, reading, and face-to-face interaction were more common among those who spent little time on their phones and TVs. Psychologist Jean M. Twenge and her colleagues further remarked their confidence that screens were causing unhappiness, not the other way around, evidenced by a growing body of literature on the topic.

The next logical question for Twenge et. al.’s “Monitoring the Future” longitudinal study would  look into possible explanations for the screen-time and unhappiness correlation. Perhaps it could be a lack of satisfaction with digital interaction, or the even negative impacts of social media—it doesn’t take a scientist to know the dangers of constant self-comparison to peers’ Instagram images. Maybe it’s something simpler: for example, the more time spent in front of the TV —even if it’s not a happiness-drain—the less time to spend on other activities that are more positively correlated with happiness. Either way, the findings certainly have implications for the mental well-being of teens. Adolescence is already a time of inner turmoil as the body goes through puberty and fluctuating hormones. This new research suggests screens could inflate these effects.

But what’s the deal with differential screen usage? Why do some teens use screens more than others?

A theory arising from observing many platforms is that networks behind screens thrive when more people are using them. For example, having a cell phone with a messenger app is useless unless other people also have a cell phone with the same app. The same goes for nearly all social media and remote gaming platforms. To some degree, the same logic also follows with TV shows or YouTube videos. If other people have watched the newest episode of, say, The Bachelor on a Monday night, it adds to an individual’s value of watching the show; they can now participate in Tuesday-morning conversation.

In other words, an increase in people using screens encourages even more people to join them as the value of doing so increases. Likewise, if fewer people use it, the value of screens decreases. A teenager may be swayed to spend as much time in front screen as her friends, and different friend groups could have different norms of screen time.

Twenge et. al.’s study found that the happiness-optimal level was an hour or less in front of screens. Their work begs the question: how can other teens have incentives to reduce TV time to this peak-happiness amount?

Maybe a change in group mentality can help reach a healthier equilibrium. Teens could find value in non-screen activities and collectively, perhaps without much thought at all, hold themselves accountable to limited digital interaction so as to maximize happiness. These are speculations, but nonetheless, asking what drives teens to use screens is imperative following studies like “Monitoring the Future.”