Indiana’s children face many significant health issues, with our opioid crisis and an alarming increase in nicotine use being two of the most urgent. Our state needs all its children to be healthy and have the opportunity to become the strong workforce and leaders of tomorrow.
Children are often the unseen victims of the opioid crisis, with kids of all ages both directly and indirectly affected. Family and community opioid abuse often affects younger children, while older youth may combat opioid addiction themselves. Hoosier children whose parents struggle with substance use disorder are more likely to experience abuse or neglect than other children.
Research shows a clear connection between parents’ substance abuse and child maltreatment, and the number of Indiana kids negatively affected by substance use disorder is growing. Parental substance abuse is the primary factor in more than half (52.2%) of Indiana cases where a child was removed from their home. The addictions crisis also has contributed to a crisis in foster care for the state, with the number of children in foster care having risen 50.2 percent from 2012 to 2015.
Although we may not hear as much about Indiana’s alarmingly high rates of tobacco use, the toll it is taking on our kids is no less dire. The use of any type of tobacco product is unsafe for young people. Experts agree that whether a teen smokes or vapes, the nicotine is both addictive and damaging to their developing brains.
Youth are sensitive to nicotine addiction and feel dependence earlier than adults. Each year, over 3,500 Hoosier children under 18 become new daily smokers. Nearly 9 out of 10 smokers start before age 18, and three out of four teen smokers become adult smokers. The brain continues developing until age 25 and adolescent use of products containing nicotine can harm the part of the brain responsible for mood, learning, and impulse control.
Today, the most commonly used tobacco product among teens are e-cigarettes. When adolescents use vaping products, they are both more likely to use cigarettes, and more likely to increase their use of cigarettes and vaping products over time. Teens who would otherwise be deterred from tobacco cigarettes may be attracted to e-cigarettes because of their unique qualities such as flavorings, design, and perceived social acceptance. The top reasons why teens use e-cigarettes are the use of the product by a friend of family member, availability of flavors, and the belief that vaping is less harmful than other forms of tobacco.
Smoking and substance use are just two of the health issues impacting young Hoosiers – overall, we rank 34th in kids health. We can, and must, do better. We will not change these trends without investing in our kids and our communities. Distressingly, we are 49th out of the 50 states in per-capita spending on public health issues like smoking, drug addiction and obesity.
The Indiana Youth Institute is part of a broad coalition of health, business and youth leaders that are coming together around a plan that calls for improving health outcomes by raising the state cigarette tax as part of next year’s biennial budget. A $2 increase in the state cigarette tax—which is currently under $1 and even lower than Kentucky—would significantly lower the appeal of cigarettes to young, price-sensitive people. It also would generate $360 million in the first year alone that could go toward funding opioid treatment and prevention, educating and protecting youth from e-cigarettes and smoking, addressing our state’s infant mortality concerns and strengthening the Healthy Indiana Plan.
Kids and families benefit from these initiatives. We have the potential to move from bottom ten states in public health spending to the top 10. By raising cigarette user fees in next year’s budget, we can make meaningful and transformative investments to improve our kids’ health.
Our kids are our future. They have limitless potential. Let’s ensure they have the good health needed to become Indiana’s next generation of citizens, innovators, and leaders.
(Tami Silverman is the president and CEO of the Indiana Youth Institute)
The homeless enrollment in Indiana public schools has increased by 34.2% since the 2010-11 school year.
Who Is Considered Homeless? Under the McKinney-Vento Act, schools are required to keep track of the number of children whom they know lack a fixed, regular, adequate nighttime residence. Students experiencing housing instability may be living in motels, trailer parks, campgrounds, transitional shelters, or sharing housing with others because of economic hardship.
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For many of us, it is easy to see how our childhood experiences influence our adult choices, behaviors, and preferences. Perhaps you like basketball because all the kids on your street played together after school. Or you learned to cook by helping a beloved grandparent make special family meals. Years spent in a scouting program can create a lasting love of exploration. Examples of positive experiences are endless and unique to each of us.
In the same way, stressful or traumatic childhood events also have lasting impact. The importance of Adverse Childhood Experiences, or “ACEs”, was first discovered 20 years ago as a result of a large-scale research study led by Kaiser Permanente and the Centers for Disease Control and Prevention. The resulting ACEs screening tool established a way to gauge the cumulative effect of different types of childhood abuse, neglect or stressful events.
While adverse childhood experiences are very common, as the number of ACEs experienced by a child increase, so does that child’s risk for chronic disease as an adult. Unfortunately, as documented in the Indiana Youth Institute’s September data brief, Hoosier youth have a higher prevalence than their peers nationally in eight of out nine ACEs as measured by the National Survey of Children’s Health.
The good news is that the earlier we can identify a child’s ACEs score, the sooner we can connect them to services to prevent, reverse, or heal the effects. Both physicians and educators are building systems to screen and respond to ACEs.
In many cases, positive childhood experiences can mitigate the stressful or traumatic events. All children need adults that support, trust and love them. Caring adults, whether parents, grandparents, teachers, coaches or mentors, are key to helping children build long-term resilience.
Find more information about ACEs from the following resources:
Indiana Youth Institute ACEs Data Brief
Substance Abuse and Mental Health Services Administration
American Academy of Pediatrics
The cumulative effect of Adverse Childhood Experiences (ACEs) has a lifelong impact on children. As the number of ACEs increases, there is a greater likelihood of negative wellbeing outcomes such as obesity, depression, and other chronic conditions throughout life.
What are ACEs? Adverse childhood experiences are stressful or traumatic events occurring in childhood and are used to assess the long-term impact of abuse and household dysfunction on later-life health.
- Nearly half (47.3%) of Hoosier children have experienced one or more ACEs.
- Indiana has a higher prevalence of children experiencing at least one ACE (47.3%) than half of our neighboring states: Illinois (39.7%), Michigan (46.2%), Ohio (49.5%), and Kentucky (53.1%).
- Hoosier youth have a higher prevalence than their peers nationally in eight of out nine ACEs as measured by the National Survey of Children’s Health.
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Our kids are going back to school and many of us are thinking about backpacks, school supplies and physicals. With bus schedules, class schedules and afterschool activities, our kids can easily get stressed about the beginning of a new school year. For some children, especially teens, this stress and anxiety exists at a dangerous level.
In Indiana suicide is the 2nd leading cause of death for youth ages 15-24 and the 4th leading cause of death for youth ages 5-14. Experts and teens list several reasons for the increase, including insufficient mental health screening, poor access to mental health services and resistance to seeking care. Suicide ideation and attempt rates are also found to be higher during the school year than in the summer.
Sadly, Hoosier youth are significantly more likely to consider or attempt suicide than their peers nationally, and Indiana faces significant disparities in youth suicide among vulnerable groups.
- 1 in 5 Indiana high school students seriously considered attempting suicide in the past year. The percentage of students who seriously considered suicide increased from 18.0% in 2005 to 19.8% in 2015.
- Indiana ranks 2nd out of 34 states in the percentage of students who made a suicide plan and ranks 3rd out of 37 states in the percentage of students who seriously considered attempting suicide.
- Among our neighboring states, Indiana has the highest percentage of students who seriously considered attempting suicide and the highest percentage of students who made a suicide plan.
For more data on Youth Suicide in Indiana, read IYI’s Data Brief.
Based on these pressing needs, the Indiana General Assembly has passed youth suicide prevention legislation in the past two sessions. Effective June 30, 2018, all teachers and educators for students in grades 5-12 are required to participate in at least two hours of youth suicide awareness and prevention training every three years.
For details about the required training, school responses and effective interventions, go to the Indiana Department of Education’s website.
Childhood obesity presents a critical and widespread issue for Indiana children.
One in three Hoosier children ages 10-17 are overweight or obese (33.9%). While childhood obesity presents a concern nationally, this issue is especially relevant in Indiana. Hoosier children are 14.9% more likely to be obese than their peers nationwide. This ranks Indiana as the 9th highest rate of childhood overweight and obesity. In comparison to all neighboring states, Indiana has the highest rate.
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As parents, caring adults and community leaders, we must create the conditions for healthy kids to thrive. This means recognizing and addressing the dangers children face when they live in unhealthy environments, reducing health-harming behaviors like smoking and substance use by children and around children, and building communities that make it easier for kids and families to make healthy choices about food and physical activity.
Unfortunately, Indiana comes in 35th for overall children’s health in the U.S. Recognizing this, a new statewide collaboration, the Alliance for a Healthier Indiana, is bringing together business and community leaders to address the health of our citizens. The Indiana Youth Institute is joining this important effort to support building a healthier state from the child up.
Growing up in an environment with trauma and abuse creates lasting negative effects on children’s health, including slowing a child’s social and cognitive growth, raising their likelihood for obesity, tobacco and drug use, and inflicting long term consequences to their health and life opportunities. By understanding the co-occurrence and impact of these Adverse Childhood Experiences (ACEs)*, we are better able to create positive interventions and conditions for change.
If we can reduce child and adult smoking rates, we can have a significant effect on Hoosier health. Indiana ranks 41st in the nation for the percentage of smokers, and an estimated 95 percent of adult smokers start smoking before age 21. More than 4,100 Hoosiers under age 18 become new daily smokers each year. In 2017, nine percent of Indiana high school students smoked cigarettes in the past month, and 14.9 percent of Indiana high school students used electronic vapor products. This is especially concerning, as teens who use e-cigarettes are more likely to subsequently take up cigarette smoking.
Governor Holcomb has challenged Indiana to lower its infant mortality rate, as Hoosier kids infants are 24 percent more likely to die before their first birthday than the national average. Smoking is a significant contributor to problems arising during pregnancy and in the child’s development and health. Almost 1 out of every 7 pregnant women in Indiana smokes during pregnancy, a rate that is 68 percent higher than the national average. Smoking while pregnant is associated with a higher risk of miscarriage, low birthweight, premature birth, some birth defects and Sudden Infant Death Syndrome (SIDS).
Our state’s struggle with opioid use disorder is also taking a tremendous toll on our babies and children. Newborns exposed to opioids in utero have a 60-80 percent likelihood of suffering from Neonatal Abstinence Syndrome, a condition which impacts the child’s long-term growth, behaviors, language abilities, cognitive development, and academic achievement. Last year, Indiana had one of the nation’s greatest percentage increases in the number of children being placed in foster care. The Indiana Department of Child Services reported a sizable increase in the number of substantiated cases of abuse or neglect, with over half of the removals due to parental substance abuse.
Parental overdoses have both an immediate as well as a cumulative impact on children in the home. Children double their likelihood of developing addictive disorders when they come from homes where one or more adults abuse alcohol or drugs. While we do not yet know precisely how many Indiana children are living with adults struggling with opioid use disorder, we do know that these children are suffering and that immediate interventions are needed.
The prevalence of substance use disorder has captured recent headlines, but Indiana’s struggle with obesity is a longstanding problem that we have yet to effectively address. Indiana is the 10th worst state for adult obesity rates, and 1 in 3 Indiana youth ages 10-17 are overweight or obese. According to Julie Burns, CEO of Jump IN for Healthy Kids, in central Indiana the obesity/overweight rate is 25 percent higher than the national average, and three times higher than the goal of 15 percent. Burns stresses the importance of focusing on young children, as habits around food and physical activity are developed by age 5.
Healthy kids grow up with greater chances to be healthy adults, and are more likely to become productive and successful citizens. Far too many Hoosier children face the issues caused by ACEs, smoking, opioid use, obesity and are lost due to infant mortality. We support and applaud the efforts of the Alliance for a Healthier Indiana. Local events to improve Hoosier health are taking place across the state, and we encourage everyone to find a way to contribute by going to www.healthierindiana.org. By collectively dedicating ourselves to these efforts, and by taking a multi-generational approach, we hope to increase the health and success of all Indiana residents.
The well-being of mothers and infants determines the health of the next generation.
In the 2018 State of the State address, Governor Eric Holcomb set the goal for Indiana to become the best state in the Midwest for infant mortality rates by 2024, challenging us to work together to improve conditions for infants. The governor labeled our current infant mortality rate as “unacceptable.” In 2016, 623 Hoosier children died before their first birthday. Indiana ranks 41st nationally for infant mortality, with our babies being 24% more likely to die before their first birthday than infants nationally. Indiana has lagged behind the national average for the past two decades.
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The scene from Marjory Stoneman Douglas High School in Parkland, Florida is one we have seen far too often: terrified students fleeing a school, parents frantically searching for their children, law enforcement swarming a campus. While our immediate concern is for those directly involved in these tragedies, instinctively we also wonder if our own children are safe. Safety is the top school-related concern of parents, above academic performance, student services, facilities or educator quality. Parents must have an accurate understanding of the safety plans in place in our schools. We also must work to ensure that students, and their families, feel that their schools are safe.
School administrators are keenly aware of the need to protect students, with the range of threats including not only active shooters but also weather and natural disasters, noncustodial parent abductions, and everyday issues like bullying and fighting. Although mass school shootings understandably garner intense media coverage, all threats to school safety are cause for concern. Research shows that any instance of crime or violence at school not only affects the students directly involved but can also negatively impact bystanders, the larger school environment and the community.
The good news is that Indiana is leading the nation in school security and safety planning. Indiana is one of only two states with a school safety specialist law, and is the only state in which the program is fully implemented. Every public school corporation in Indiana is required to have a certified school safety specialist, and 88% of districts have two or more specialists.
David Woodward has worked at the Indiana Department of Education (IDOE) for over 20 years and is architect of the state’s School Safety Academy. Started in 1999, the Academy’s five-day basic training covers national and state best practices on topics such as cyberbullying, digital threats, active shooters, safe and effective drills, student suicide and school entrance security. Each district specialist must also complete two additional days of training annually and are tasked with starting the multi-step process of updating and implementing their district’s safety plan. As Woodward notes, “The threats to our schools are always changing, so our response always needs to be updated.”
Although our state is proactive in addressing the safety needs of schools, challenges remain. Fear at school can contribute to an unhealthy school climate and lead to negative student behavior. Students who feel unsafe at school are more likely to miss days of class, and students who witness school violence are more likely to experience health problems, social and emotional difficulties, and poor academic performance. According to the National Survey of Children’s Health, 78.1 percent of Indiana parents say they “definitely agree” that their child is safe at school. This is compared to the Healthy People 2020 initiative’s goal that 95 percent of parents will consider their children to be safe at school. We all have a role to play in creating and sustaining a climate of safety through our schools.
At the leadership and policy level, more can be done to increase both the actual and perceived levels of safety. In late February, State Superintendent of Public Instruction Dr. Jennifer McCormick called on the General Assembly and our Congressional Delegation to pass additional school safety policies. Her two main requests were increased resources for mental and behavioral wellbeing, and ensuring that our private and charter schools all have the same requirements to keep our schools and students safe. Late in the legislative session, Governor Holcomb requested a $5 million increase in the state’s school safety grant fund, but the bill died in the final minutes of this year’s session. The May special session will be a time to finalize additional school safety actions and funding.
At the community level, effective communication is critical. Although schools understandably cannot publish their specific safety plans, they can and should talk with parents and community members about the steps they are taking to ensure students are safe. Experts suggest directly calling your school principal with safety concerns, noting that many people erroneously first call local law enforcement. Student voice is also important in shaping and maintaining a safe school environment. Ask your school how they are supporting student engagement in their safety planning. Finally, do not underestimate the impact these national traumas have on our students’ sense of safety.
The horrific mass shooting in Florida has once again heightened our concerns for school safety. Indiana has proactively taken steps to ensure our schools have updated safety plans in place and yet even the best plans are not guarantees. All Hoosier parents and families should have a clear understanding of what is going on at the state and local levels, especially inside their individual schools. Students are understandably and admirably stepping up to not only regain their sense of safety but also to call for increased action. But as community leaders, parents and citizens, it is our shared responsibility to provide safe learning environments for all of our educators, administrators and, most importantly, our students.