NY Senate Proposal Gives Teens Agency in Vaccine Decisions

Public health officials and advocates have long decried studies which link vaccines and autism. For background on the troubling impacts that vaccine conspiracies have on children’s health, see CHIL’s blog post from last month. Recently in New York, one student with measles infected at least 21 others with the disease, reigniting vaccine campaigns. Advocates have been encouraging everyone to get vaccinated and discrediting the arguments of their anti-vaccination opponents.

Moreover, relevant industries beyond the field of public health are getting involved. Amazon, for example, is halting the sale of books which back autism cures and falsehoods about vaccines. New York lawmakers, too, are getting involved by proposing a bill which would allow teenagers to obtain vaccinations without parental consent.

If passed, the legislation would stipulate that minors over 14 years old may be given vaccines and boosters for prevention of diseases like mumps, diphtheria, influenza, hepatitis B, and more. Proponents say at 14, teens are mature enough to make vaccination decisions for themselves and may even be better at identifying vaccines misinformation often circulated on online platforms. This is an important measure for minors with parents prejudiced against vaccines, and also for those without active adult figures in their lives.

While supporters recognize parents have certain authority over decisions impacting their children’s health care, the decision to get vaccinated extends beyond an individual child’s health. That is, unvaccinated children put both themselves and others in their communities at risk for infection. Those ineligible for vaccines due to special medical circumstances become particularly vulnerable when more and more people around them remain unvaccinated by choice. Proposals like this one utilize our legal system to prioritize broader public health goals for people of all ages.

New education models cater to STEAM fields

Schools across the country are constantly integrating new technology into their curriculum--for example, Smart Boards in every class, tablets for every student, or computer science courses. The New York Times recently published an article on the Brooklyn STEAM Center (an acronym for Science, Technology, Engineering, Arts, and Mathematics), a New York City public school that is trying out a novel education structure where students learn real-world tech skills necessary for STEAM fields. The Center is located in the Brooklyn Navy Yard, a hub for over 400 tech and manufacturing companies.

High schools select students to attend the STEAM Center, and the large majority are students of color from underprivileged backgrounds. The Center looks like a start-up—there are conference rooms, recording studios, ample white boards, and even a teaching kitchen. As one of only two schools in New York City located in a workplace setting, students learn by taking hands-on approach in a curriculum designed largely by industry experts.

This modern model is a new form of vocational schooling that allows students who otherwise may not have had opportunities to learn in the ever-growing STEAM field. The center emphasizes literacy in the modern tech world, complemented by soft skills like timeliness, responding to emails, teamwork, and networking.

The Brooklyn STEAM Center is one of the first of its kind; however, there is a growing movement supporting better STEAM preparation for teens.  For instance, Amazon started their own “Future Engineer Program,” which gives grants to qualifying high schools to implement better computer science education. They are specifically targeting schools “in lower-income communities and in states that have made computer science education a clear priority.”

For now, the students’ opinions reflected in the NYT piece are all positive--similar to the those who designed the curriculum, the students see their STEAM Center education as preparing them for survival in real-world industry. Nonetheless, this movement has not come without some reservations. While these programs seem promising for improving economic mobility for disadvantaged students, critics worry they set kids on a career track too early, at worst driving students away from a college education. It is imperative STEAM vocational education continues to prioritize students’ needs first, rather than those of employers. Regularly collecting feedback from students can help with this, as well as examining the medium-to-long term trajectories of alumni as programs age.

Telemedicine and children’s health: what you need to know

Children’s Health defines telemedicine as “the use of technology to exchange medical information among providers.” The innovation allows for doctors to discuss patients and their cases together from any two or more places in the country, using video and other electronic communication. Telemedicine is especially promising given rural access to healthcare in the U.S.—and internationally—is often limited. Where there are healthcare facilities, they may lack specialization in areas like pediatric care or mental health.

Several large hospitals in Dallas, Philadelphia, Boston, and soon northern California have integrated telemedicine into their practices. Early studies show patients consider telehealth visits as equal or better than in-person visits, and there is high potential for improving children’s health in particular. For example, teens who see certain mental health physicians throughout high school can continue receiving care from the same familiar face if they move away for college. Another opportunity for telemedicine involves connecting physicians with school nurses, which can hugely benefit diabetic students.

Of course, with any new health technology, there are challenges. Insurance coverage is an ongoing struggle for health innovations in the U.S. and telemedicine is no different. However, in the past two years, legislatures in Pennsylvania and New Jersey have been working to pass bills requiring insurers to reimburse remote telemedicine care.

Other struggles represent fundamental limitations in telemedicine intervention. Physicians may miss key elements of a patient’s condition when communicating through a screen. For certain diagnoses, patients may have to travel to specialized care centers anyway. Moreover, telemedicine brings up questions of data security and potential privacy breaches with medical data. Finally, telemedicine may bring an incomprehensive quick-fix and/or false sense of resolution to the broader issue of poor rural healthcare access.

For now, telemedicine is offering innovative options for children and teens who need to see their doctors remotely. As more and more hospitals adapt to this new technology, CHIL encourages patients take advantage telemedicine, while continuing to be mindful of its limitations.

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.”

Mental Health and Social Good: A Partnership?

This week, we would like to continue our focus on discussing ways to actively improve our mindsets and mental health overall. A recent post in NPR discusses a new psychology study that suggests that teenagers benefit from a confidence boost if they help strangers or volunteer. While helping a friend or family member is obviously a positive experience, it is more difficult challenging, and maybe even intimidating, to help someone you do not know - and this is why teens can derive confidence boosts from helping others. Given the diversity of teens’ interests, it’s a wonderful thing that spending time helping strangers - even people one doesn’t meet - can happen in all facets of society.


Confidence boosts are always good, but teenagers today may benefit from them the most. Current research tells us that today’s teenagers live in challenging times — both socially and economically — and the numbers show it. The NPR article cites that “by the age of fourteen, 25% of teenage girls and 10% of boys struggle with depression.” Students of all ages seek out help for depression, anxiety, and other difficulties. The idea that they might help themselves and others at the same time by devoting time or energy to social good is wonderful.


Altruism has always had a somewhat broad definition, and the way today’s teenagers help others might look differently than the way their parents might envision it from their own experience. For example, teenagers can harness social media to spread awareness and raise funds for campaigns or causes they care about. Parents and teachers can introduce opportunities to get involved or answer questions about navigating ways students can positively contribute to society.


At CHIL, we are always trying to link health to many actors: children, parents, teachers, doctors, and officials all play a part in physical, mental, and social health. Linking children’s and teens’ mental well-being to social initiatives, and vice versa, could be very promising!

The Parent's Role Amid a Sea of Opinions

A few weeks ago, we wrote about the significance of the language we use when we talk with children about weight. The words that parents and doctors use can have a great impact on how children and teens think about, or perceive, their weight and overall health.


Recently, the New York Times published an article by a physician titled, “Do Parents Make Kids Fat?” This rather startling question can be thought of as an extreme example of the influence parents could have on their children’s weight and how they think about weight.


The first thing the article pointed out was the “tremendous stigma” we direct at parents of overweight children, whether we intend to or not. As Dr. Julie Lumeng at the University of Michigan, who was interviewed in the article, puts it, “‘Everyone looks at the parent and thinks: That parent is incompetent. They don’t care about their child. Why can’t they just make the child eat less and exercise?’”


These questions illustrate several assumptions people may easily make about parents of overweight children. For example, people may think that the parents do not care about their children’s health, or they simply lack the willpower to enforce healthy habits at home or read the nutrition information on the back of food packages.  However, we simply cannot make these assumptions without knowing the full story of a child’s health. This involves family history, health history, and degree of exposure to what doctors today call an “obesogenic” environment in which unhealthy fast food is more accessible and cheaper than healthy food made from scratch.


There are many different opinions out there about how to raise healthy children, and while there are general guidelines that indicate what healthy weight ranges may be, different families and children need different things. The physicians mentioned in the article, who even consult each other with questions, agree that a parent must trust their instinct when it comes to their child. Being mindful about the child’s environment can help with this instinct.


This is where our campaign with eMindful can be helpful - through increased awareness of our circumstances, we can make healthier decisions for ourselves and for our children.

Weight, Language, and Self-Image

The language we use when talking to a child about their weight is very important. Doctors say that they themselves take great care in the words they choose when they talk to a child or their family member about weight and body mass index, even if their official classification falls under obesity.


The New York Times recently published a piece by pediatrician Dr. Perri Klass, who writes that physicians try to take care in order to avoid further hurting a child who may already be unhappy about their weight. A new policy statement jointly issued from the American Academy of Pediatrics and the Obesity society urges pediatricians to use seemingly neutral words instead of words like “overweight” and “fat.”


Past and ongoing research into the social and emotional effects of obesity agree that comments on weight can have a large impact on a child’s self esteem. According to Dr. Rebecca Puhl, a clinical psychologist who is one of the lead authors of the policy statement, “Weight is now one of the most frequent reasons kids are teased or bullied.” One of her studies followed more than a thousand teenagers into their early thirties, and found that children who were bullied because of weight were correlated with binge eating, poor body image, and eating to cope with emotions (not to mention other eating disorders). These correlations, in turn, were linked to obesity in adulthood as well. The effect was present for men and women, but more pronounced for women.


Dr. Puhl says that healthcare professionals might be some of the few allies overweight children and teenagers can have. After all, they are most likely teased by family members as well as their peers. Another ally that comes to mind is teachers - where appropriate, they can intervene in a bullying situation, as well as promote body positivity and physical activity.


We can all be allies if we understand and recognize that making comments about a weight does not encourage positive change; instead, making comments about weight can result in negative, longterm impacts. It is important to make sure that children and teens have access to healthy, positive influences for their physical, mental, and emotional health.

Mindfulness - Something for Everyone

The timing couldn’t be better - not long after our recent post on ways to be in the present, the New York Times published a piece on “Mindfuless for Children.” The author defines mindfulness as “the simple practice of bringing a gentle, accepting attitude to the present moment,” and argues that even the youngest children can benefit from this approach.


The graphics in this article are beautiful and worth checking out, but we’ve condensed some of the main points here:


Mindfulness starts young. Even infants can notice the difference between a stressed, distracted parent and a smiling, “present” parent. Mindfulness experts say that eye contact is important to establish a connection between an infant and a parent; unfortunately, smartphones have become a huge distraction in establishing that connection. Experts recommend putting down the phone, however briefly, to interact with infants. The same goes for raising toddlers - as they start to learn to express themselves, helping them identify and describe their feelings is very important.


Mindfulness is important throughout childhood, from infancy to early childhood to teenage years. The appearance of mindfulness can evolve. For example, a focus on gratitude and recognizing happy moments for young children evolves to a focus on healthy interpersonal relationships in teenage years. A surprising number of diverse factors are involved in mindfulness. For example, increase in movement and activity relieves stress and improves physical health for guardians and children alike.

Mindfulness can’t be “outsourced.” People who work with children and teens to bring mindfulness into their lives emphasize the key role parents and guardians can have in contributing to children’s health. Mindfulness “isn’t like piano lessons,” where parents can simply drop off their kids to get their weekly lesson. The author of the article concedes that parenting is hard work, and often very stressful, but they are the main figures in their children’s young lives. Caregivers don’t have to be expert meditators; instead, they can focus on things like forgiveness and appreciation of the present along with their children. Having this approach will have positive mental health impacts for everyone involved.

Friends for Life - They're Lifesaving

A quick Google search on friendships and its correlation to health results in many articles concerning the elderly, but a new study has focused on studying teens, for whom the conversation around mental health is especially important. Child Development recently found that close friends among adolescents can have lasting mental health benefits, which can be carried into adulthood, according to NPR.


The study, conducted over 10 years, followed 169 15-year-olds until they were 25-years-old. At age 15 and 16, researchers asked participants to record conversations with their friends. Teenage friends discussed the importance and level of trust and communication that was in their relationship at the time. Then, the participants completed annual surveys about their levels of anxiety and self-worth.


Researchers found that after 10 years, teenagers with strong, close friendships were more likely to report an improvement in anxiety and self-worth at age 25 than adults who did not have strong emotional links to their friends as teenagers. Stable friendships - especially same pairs of friends who showed up together year after year - seemed to provide participants with the greatest mental health gains.


The implications are fairly strong here. Teenagers who find support among each other are more likely to be able to weather challenges that they may face, according to the authors of the study. They also learn how to maintain close, important relationships from a young age, which lays the foundation for future healthy relationships.


At CHIL, our projects encourage friends to engage with each other as they participate in activities that can benefit their health. Friendships and teamwork go hand in hand, and a close friendship can be an extra incentive for children and students to invest time in themselves and each other. The importance of friends is a theme that pops up over and over again, but it should not become a cliche - it can really have an impact on a young person’s health in the long-term.

Feeding Mind and Body: A New Role for Schools

Back in April, we wrote about how American households are not immune to the phenomenon of food insecurity. A recent New York Times piece discusses the importance of school meals in students’ development and learning. The benefits of having ready access to nutritious meals are, according to a research team at the University of California-Berkeley, threefold: “physical development” (e.g. eyesight), “cognition” (concentration and memory), and “behavior” (hyperactivity) are all directly impacted by what a student eats during the crucial formative years between kindergarten and high school.


When Michelle Obama was the first lady, she started health initiatives in school districts nationwide by setting up programs that incentivize schools to invest in healthier options for students. These programs did indeed have an impact: one study found that simply moving the salad bar from the margins to the middle of the serving area increased uptake. However, the current Congress has taken steps to dismantle many of these initiatives. It is surprising that a topic as seemingly uncontroversial as student nutrition could be treated as a partisan issue, especially given the fact that experts from multiple disciplines agree on its importance.


In states that have prioritized school nutrition, the results have been clear. Students at schools that work with healthy lunch vendors score significantly higher on standardized tests than their counterparts at schools without healthy options. Some schools have even ventured into providing breakfast and dinner for students that might otherwise go hungry outside of school hours (e.g. during after school activities.)


Funding is certainly always a factor, as school budgets face real challenges in delivering quality education with limited resources. However, research shows that some of the objections to healthy meals are untrue. If we think of student nutrition as an investment in their academic and personal development, and by extension, an investment in the future of society, prioritizing student health should be a no-brainer. It’s as clear as the very benefits of healthy food.





Sleep, School, and the Teenager

The New York Times recently reported that biology may be to blame when it comes to teenagers’ sleep schedules. Young children who wake up early usually grow into teenagers who are difficult to rouse in time for school even though middle and high schools classes start earlier. Apparently, “adolescent bodies” naturally want to operate on a schedule shifted later than those of young children: they want to go to bed late, and get up late. This phenomenon - adolescent sleep delay - is not limited to humans; in fact, other mammals display it as well.


The consequence of this relative incompatibility between a teen’s body clock and school schedule appears in performance. Students tend to do better in tests - both cognitive and coursework related - taken in the afternoon. To catch up on alertness, adolescents might turn to caffeine for help during the day, leading to a “tired but wired” state that one clinical psychologist said led to more risk-taking behavior. Even without specific risk-taking, tired adolescents in general are in more danger than if they were well-rested, especially if they drive amid such fatigue.


Sleep is important in the discussion about adolescent health because of its link to what experts call the “adolescent health paradox:” teenagers, who are in a “developmental period of physical strength and resilience, face disproportionately high mortality rates.” According to the article, programs aimed at specific issues like substance abuse or unsafe sex are expensive and not always successful. Approaching sleep as one of the facets of overall health that can support teenagers during their development would be much more meaningful.


It is difficult to think of ways to feasibly incorporate sleep support into, say, the academically-rigorous nature of high school and even middle school. However, it is important for schools and parents to remember the effect a 24-hour sleep cycle can have on a student’s concentration, mood, or emotional decisions and health. The link between sleep health and behavioral health is real, and there is evidence for the connection to academic performance as well. There are some sleep scientists or child psychologists who actually advocate later school start times. While it may be difficult to implement such structural changes, it is important to remember the importance of the science behind such proposals impacting students and classrooms every day.

Smartphones: A True Addiction?

A recent blog post talked about the need for mobile app designers to consider the active role that teens can and should play in staying safe online. It’s not just the responsibility of parents to restrict a teenager’s online presence. Instead, it’s much more productive for parents to team up with their children in order to start a conversation about Internet safety.


This week’s post involves one of the risks that parents are undoubtedly concerned about - the risk that teenagers are addicted to their smartphones. Anecdotally, we all can think of a parent disapproving of their children’s inability to look away from their phones for an extended period of time. This problem certainly is not unique to teenagers. Researchers are only beginning to find out what impact smartphones have on our health and our social networks.


An article in the NYTimes poses a compelling question: are teenagers replacing other addictive substances with their smartphones? There is good news and bad news that might suggest this is the case. The good news is that teen drug use (trying or regularly using drugs, including alcohol) has gone down in the past decade. This trend is true for all students overall regardless of their demographics. The bad or neutral news, depending on how you look at it, is that this is the same time period that smartphones have exploded onto the scene.


There is no way to prove that this coincidence is definitely a causal effect. There are far too many factors at play, including, but not limited to the financial crisis in the past decade, and the extensive anti-drug educational campaigns that might have started to pay off. Also, drug use among college students has not fallen in the same time period.


But it’s important to think about the implications of what some experts call a “portable dopamine pump” in a teenager’s everyday life. In the article, the writer explained that smartphones and their various apps provide feedback loops for users and the members of their social networks. Teens have said that they feel “really good” when using their phones for social media.  

Researchers are looking into this trend with a lot of interest, and so should we. The new “high” formed by excessive phone usage could shape teenagers’ social priorities and experiences for years to come.

Navigating Sick Days

The question of whether or not a child should stay home when they’re feeling under the weather inspires a lot of varying advice. According to an article recently published in NPR, rules in elementary schools about when to keep a sick child at home are more liberal than those in daycare centers. Also, surveyors of 1,442 parents with kids who are 6 to 18 years old found that parents had different attitudes about their children missing school based on their children’s age.


Some common reasons cited by parents for keeping their kids at home included: diarrhea, a single episode of vomiting or a slight fever. Interestingly, parents of older children were more likely to worry about their kids missing tests at school than parents of younger children did, suggesting that tests and exams might complicate the stay-at-home decision for parents when their children are sick. My own parents definitely also strictly adhered to the “No fever? No skipping” rule.


Another important factor parents consider is how contagious they perceive their children’s conditions to be. Evidence on how contagious kids can be are less definitive in older school children since they are usually not confined in a single space all day with ill classmates. For younger children who are in daycare all day, however, they may be prone to stomach bugs, ear infections, and colds than young children who stay at home.


Different daycare centers may also have varying suggestions for parents when it comes to children’s attendance. Some daycare facilities may have guidelines that recommend children to stay at home even though their rules don’t always align with pediatricians’ suggestions. This can be aggravating especially if parents cannot stay at home with their sick children, or cannot bring their kids with them to work.


Sick days are something we all experience at one point or another growing up. Since there is little uniformity about what symptoms are considered severe or contagious, it’s challenging to find or apply one suggestion to all parents or all students. Keeping an eye out for further research is probably the best thing to do as we continue to adhere to healthy behaviors such as washing our hands, staying hydrated, eating nutritious food, and getting plenty of exercise.

Sunlight and Your Eyes: A New Link?

Here’s a quirky idea: computer and television screens can damage eyes because the lack of sunlight can reshape the eyes and impair vision over time, according to a growing community of researchers. A new article in the New York Times cites a study published recently in the Journal of the American Medical Association (JAMA Ophthalmology) that offers an explanation for the growing prevalence of myopia, or nearsightedness, especially in children and young adults.


Nearsightedness is a condition in which the eyeball is longer than normal, altering the angle at which light meets the eye, which can cause problems for people when focusing on faraway objects. It is a condition that really illustrates the debate between “nature and nurture” -- even if you develop it as a child, nearsightedness can progress as you become an adult depending on a complex calculus of genetics factors and the environment.


Volunteers were given eye exams and asked how much time they spent outside during their childhood. Researchers found a strong correlation between “current eyesight and lifelong exposure to sunlight.” It’s important to remember that this particular study was a survey and not an experiment where the researchers imposed certain conditions to, say, measure the effect of sunlight exposure on prescriptions for eyeglasses. The researchers observed a trend where those who had been exposed to the most sun as teenagers were less likely to be nearsighted in middle age.


The link is not necessarily a causal one, but the implications are clear. Despite the fact that excessive exposure to sunlight certainly poses its own dangers, such as the risk of skin cancer, a healthy amount of exposure can really be positively correlated to multiple aspects of health, including vision. The observed correlation between sun exposure and healthy vision only strengthens the case against excessive exposure to screens and monitors indoors. Moderation is key, but it looks as if we are still unlocking the many benefits the sun has to offer.

The Truth About Headphones

Consumers are always looking for the latest technology even when it comes to the latest audio equipment. As of late, there has been a lot of debate about the safety of headphones and earphones, and how they affect our hearing ability. A recent New York Times article discusses what this means for children’s headphones and music listening today.


According to a 2015 report, half of 8- to 12-year-olds in the U.S.listen to music daily, as do nearly two-thirds of teenagers. Unfortunately for them, Dr. Papsin, the otolaryngologist interviewed in the article, said “Headphone manufacturers aren’t interested in the health of your child’s ears.” Products are advertised to be noise-cancelling, “safe for young ears,” or provide “100 percent safe listening.” However, recent studies of the kinds of earphones on the market found that some of them were so unsafe that they damaged ears within minutes of producing loud music.


In a study to determine the relative rankings of the many kinds of earphones and earbuds available to children, researchers used two types of sounds. They used a recently released pop song and compared it to “pink noise” (usually used to test the output levels of equipment, according to the article), and found that playing the chosen pop song at maximum volume made it more likely for headphones to exceed healthy decibel levels than they did playing pink noise.


This means that music that adolescents prefer to play generally produce loud sound at high volume, and is impacting boys and girls alike. The gap in hearing loss rates between boys and girls is decreasing, with the rate of girls’ hearing damage catching up to that of boys. Experts agree that no headphone can replace the most effective means of controlling damage, which is adult supervision. Some practical advice from pediatricians include: “If a parent is an arm’s length away, a child wearing headphones should still be able to hear when asked a question.” In other words, according to Dr. Jim Battey, the director of the National Institute on Deafness and Other Communication Disorders, “if they can’t hear you, ‘that level of noise is unsafe and potentially damaging.’”