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)
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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