Forget pink or blue. It turns out that the best color for baby may be green.
In a study recently published in Environmental Health Perspectives, researchers found that mothers living in neighborhoods with plenty of greenness — grass, trees and other types of lush vegetation — were more likely to carry their pregnancies to full term and deliver babies at healthier weights. Specifically, the study found that very pre-term births were 20 percent lower and moderate pre-term births were 13 percent lower among mothers living in greener neighborhoods. Also, babies from greener neighborhoods were less likely to be classified as “small” for their gestational age than babies in less green neighborhoods. And the association between greenness and better birth outcomes stood up even after researchers adjusted for factors such as income, noise, neighborhood walkability and poor air quality.
“This was a surprise,” said study lead author Perry Hystad, an environmental epidemiologist in Oregon State University’s College of Public Health and Human Services, in a news release. “We expected the association between greenness and birth outcomes to disappear once we accounted for other environmental exposures such as air pollution and noise. The research really suggests that greenness affects birth outcomes in other ways, such as psychologically or socially.”
To conduct the study, researchers used satellite-derived data on vegetation and compared it with birth outcomes among 64,705 births in Vancouver, British Columbia. They noted in the study that with half of the world’s population living in urban areas — and with that number expected to grow — it’s important to understand the characteristics of urban environments that contribute to positive health outcomes. They found that birthweight was 20.6 grams higher on average with each 0.1 increase in greenness, with babies in the greenest neighborhoods weighing 45 grams more at birth than infants with moms living in the least green neighborhoods. In the news release, Hystad noted that even though the birthweight differences seem small on an individual basis, “those are substantial differences that would have a significant impact on the health of infants in a community.”
Why is this important? According to the Centers for Disease Control and Prevention, low birthweight is the “single most important factor” in newborn mortality and those babies who do survive can experience serious, long-term health problems. Overall, the study concluded that living within 100 meters of increased greenness was linked to healthier birthweights and a lower likelihood of preterm birth. Study authors Hystad, Hugh Davies, Lawrence Frank, Josh Van Loon, Ulrike Gehring, Lillian Tamburic and Michael Brauer write:
The fact that residential greenness exposure remained associated with birth outcomes after adjusting for a number of hypothesized environmental exposures suggests that alternative pathways may link greenness exposure to birth outcomes. Two well-hypothesized pathways that were not examined in this study include psychosocial and psychological influences. Greenness may facilitate positive psychosocial influences by providing shared spaces for interactions. For example, exposure to greenness has been associated with social support and increased social ties and community belonging. …While we were unable to examine these pathways, our findings of a persistent greenness association with birth outcomes that was independent of previously observed associations with noise and air pollution suggests more research is required that includes all potential pathways potentially linking greenness to birth outcomes.
The study authors noted that it’s unclear just how much green space and what type of greenery is of greatest benefit to newborns, but they did say that one or two potted plants won’t make a difference. And that’s the next step for researchers — examining exactly why greenness seems to make a difference and determining how much greenness it takes to impact newborn health. The answer could lead to one of the more low-cost and enjoyable ways to promote child health — planting more trees.
“We know that green space is good,” Hystad said. “How do we maximize that benefit to improve health outcomes? The answer could have significant implications for land use planning and development.”
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
During the past year, not one state experienced a decrease in adult obesity rates and, in fact, six states are home to even higher rates than before, according to a new report released today.
This morning, Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) released “The State of Obesity: Better Policies for a Healthier America,” finding that adult obesity rates rose in Alaska, Delaware, Idaho, New Jersey, Tennessee and Wyoming. Mississippi and West Virginia tied to take the unenviable top spot, both with an adult obesity rate of 35.1 percent, while Colorado is home to the lowest rate of 21.3 percent. For the first time, obesity rates exceeded 35 percent in two states, while 20 states were home to rates at or above 30 percent. In addition, more than one in 10 children become obese as early as ages 2 to 5 years old.
The new report is an updated version of TFAH’s annual “F As in Fat” report, however the authors write that the “’F’ no longer stands for failure.” There is some progress, such as a stabilization of childhood obesity rates in some communities (for example, see this study on declines in New York City and Los Angeles); still, the report notes that any progress at this point is too early to describe as a stable trend, and adult obesity rates are still far too high and continue to put people’s health at severe risk.
Not all communities are experiencing obesity the same — as with many chronic diseases, significant disparities exist. According to the report, obesity rates are higher among black and Hispanic adults than among white adults. Specifically, obesity among black adults is at or higher than 40 percent in 11 states, 35 percent in 29 states and 30 percent in 41 states. For Hispanic adults, the obesity rate exceeded 35 percent in five states and 30 percent in 23 states. Obesity rates among white adults topped 30 percent in 10 states. Black and Hispanic children also had higher obesity rates than white children. People ages 45 to 64 years old experienced the highest obesity rate of any age group, low-income adults were more likely to be obese than higher-income adults, and those without a high school diploma were more likely to be obese than those with a college or technical school education.
The new report also examines policies and actions to address obesity, such as increasing access to affordable and healthy foods, creating safe places to be outside and physically active, and limiting junk food marketing toward children. Like many health problems facing America, the report notes that curbing obesity will take much more than a one-on-one approach. Instead, making real inroads into the nation’s obesity epidemic will truly require a community-based approach and a focus on reaching those communities most at risk. In the report’s introduction, TFAH Executive Director Jeffrey Levi and RWJF President and CEO Risa Lavizzo-Mourey write:
Through the years, we’ve also learned that reversing the obesity epidemic is not enough; we need to support strategies to assure that everyone in America can be as healthy as they can through regular physical activity and good nutrition. This will only happen if and when all of our children and families are able to make healthy choices where they live, learn, work and play.
We know we still have much more work to do. We must spread approaches that work to every community. This report is an urgent call to action for our nation and an essential step for building a strong, vibrant Culture of Health that provides everyone in America with the opportunity to maintain a healthy weight and live a healthy life.
For instance, while national recommendations call for children and teens to get at least an hour of physical activity each day, recent data finds that only about a quarter of children ages 6 to 15 years old meet that goal. The report recommends a number of actions to address the problem, including providing regular opportunities to be physically active in school, finding ways to provide access to school recreational facilities after school hours, and encouraging after-school programs to adopt exercise and nutrition standards.
Another issue the report examines is food deserts, noting that 29 million American face significant geographical barriers to accessing healthy foods, with low-income communities particularly hard hit. For example, one study examined food accessibility in Native American reservations in Washington state, finding that 15 reservations did not have a local supermarket or grocery store, and the cost of shopping outside the reservation was about 7 percent higher than national averages. In Mississippi, 70 percent of families that are eligible for nutrition assistance live 30 miles from the closest large grocery store. However, the report notes that healthy food financing programs are active and successful in a number of states. For example:
The most successful program to date is the Pennsylvania Fresh Food Financing Initiative, which since 2004 has financed supermarkets and other fresh food outlets in 78 urban and rural areas serving 500,000 city residents. In the process, (Fresh Food Financing Initiative) has created or retained 4,860 jobs in underserved neighborhoods. Home values near new grocery stores have increased from 4 percent to 7 percent, and local tax revenues also have increased.
Nationwide, the states with the lowest obesity rates include Colorado, Hawaii, Massachusetts, Utah and California, while states with the highest rates include Mississippi, West Virginia, Arkansas, Tennessee and Kentucky. Nine out of 10 states with the highest obesity rates are in the South.
“Obesity in America is at a critical juncture,” said Levi in a news release. “Obesity rates are unacceptably high and the disparities in rates are profoundly troubling. We need to intensify prevention efforts starting in early childhood, and do a better job of implementing effective policies and programs in all communities.”
To download a full copy of the new 136-page obesity report, which offers an in-depth exploration of policy solutions and opportunities, click here.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Read the interview.
Researchers who assess the impact of working conditions on health have had a busy year publishing their findings in the peer-reviewed literature. The final section of our report The Year in US Occupational Health & Safety: Fall 2013 – Summer 2014—which we wrote about on Monday and Tuesday—profiles some of the best papers published in the last 12 months that provide insight into the scores of different workplace hazards and their relationship with injuries and illnesses.
Especially prominent in the literature were studies involving Latino workers, healthcare workers, construction workers, and those who responded to the 2001 World Trade Center attacks. In all, we provide brief summaries of 25 studies that address these four worker groups. We include, for example, a study by von Ehrenstein and colleagues who investigated the relationship between maternal occupation and birth outcomes. Using data from births in Los Angeles County, the authors report that work in food prep and serving, production jobs, among others, increased the odds for Latina mothers by as much as three times of having a full-term, but low birth weight newborn. We also provide citations to more than 75 papers as a way to tip our hats to OHS researchers and recognize their contribution to public health. The diversity of their topics of research is impressive and includes:
- Trends in back injuries among drywall installers
- The influence of shift work on female workers getting recommended cancer screenings
- Physical assaults among education workers
- Perspectives of workers on providing biospecimens for research
- Effect of production pressure on injury reporting
“New Research on Worker Health and Safety” (p. 37-46 and 49-53) is the section of our annual report where we also recap publications from non-profit organizations and a few papers published in law reviews. These include reports by the UC Berkeley Labor Center and U of Illinois Urbana-Champaign on the economic impact on public assistance programs (e.g., Medicaid, TANF, SNAP) of low-wage work in the fast-food industry; Public Citizen’s report on the cost of unsafe construction projects in New York City; and a US Senate majority staff report on labor law violations by companies with major federal contracts. The latter is a topic that was addressed in July 2013 by a new Executive Order signed by President Obama (which is also described in The Year in US Occupational Health & Safety: Fall 2013 – Summer 2014.
The previous posts in this series are:
A Labor Day look back at the year in worker health and safety (here)
A Labor Day look at state and local actions for worker health (here)
Yesterday, the nation celebrated its workers. However, new research finds that most workers face fewer and fewer reasons to rejoice.
Last week, the Economic Policy Institute (EPI) released a new report finding that hourly wages fell in the first half of 2014 when compared to the first half of 2013. And those wages fell for nearly all groups of workers, including those with bachelor’s degrees and higher. This isn’t a new trend, just one that’s quickly heading toward crisis proportions. The report, “Why America’s Workers Need Faster Wage Growth — And What We Can Do About It,” states that between 1979 and 2007, more than 90 percent of American households had incomes that grew more slowly than average income growth.
The report finds that from 1979 to 2013, productivity grew by nearly 65 percent, while hourly pay for more than 80 percent of the workforce grew just 8 percent. Similar to the last four decades, middle class households saw their wages decline over the past year — a trend that the report notes is a central contributor to growing income inequality. Surprisingly, the only group of workers that didn’t experience declining wages in the past year were the lowest wage earners — a finding that the report attributed to state efforts to raise the minimum wage.
“Despite a recovering economy and growing productivity, employers are not putting anything more in their employees’ paychecks. Over the past forty years, corporations, and their CEOs and lobbyists, have used public policy to stack the deck in their favor,” said Elise Gould, the report’s author, in a news release. “The only way to strengthen the middle class is to grow wages, and for that we need policies that deal workers a stronger hand.”
The EPI report also found that if income inequality had not grown between 1979 and 2007, middle-class incomes in 2007 would have been $18,000 higher. At the root of many of the report’s findings is a growing divide between increased productivity and wages — in other words, workers aren’t reaping the financial benefits of the economic gains they’re helping to produce. So who is reaping those benefits? Gould writes that a “significant portion of it went to higher corporate profits and increased income accruing to capital and business owners. But much of it went to those at the very top of the wage distribution.”
Perhaps most interestingly, Gould rebuffs the popular theory that wage inequality is fueled by a shortage of skilled or college-educated workers. Instead, she points to policy as the main driver of inequality, noting that even workers with college and advanced degrees are experiencing wage stagnation. She writes:
Importantly, this wage slowdown is not simply the sad outcome of inevitable and irreversible changes in the economy (e.g., technological change or the “flattening” of the global economy). Instead, policy changes that have shifted bargaining power from workers to corporations and CEOs have played a large role.
The list of policies that impact wages is long—much longer than generally realized. For example, macroeconomic stabilization policy (fiscal and monetary and exchange rate policies), regulatory policy (especially financial regulation), policies concerning corporate governance, and tax policy all have significant impacts on wages.
However, labor market policies and business practices have also had large, though often underappreciated, potential impacts on wages. While this set of policies and practices includes many discrete parts, the common thread of the past generation is that practices, institutions, and standards that have boosted bargaining power for low- and moderate-wage workers have been targeted for weakening—and have been replaced by policies that put more leverage in the hands of those with the most economic power.
Another report on wage growth released last month was from the National Employment Law Project (NELP), which found that wage declines continued for each quintile in 2012 and 2013. In “An Unbalanced Recovery: Real Wage and Job Growth Trends,” NELP found that across all occupations, real median hourly wages declined by 3.4 percent between 2009 and 2013, with lower- and mid-wage earners experiencing greater declines than higher-wage earners. The report found that declines in real median hourly wages were especially pronounced among some of the lowest-paying occupations, such as restaurant cooks, home health aides, retail workers and house cleaners. And it’s those types of jobs that are growing the fastest: NELP reports that in the last year, lower-wage industries accounted for 41 percent of employment growth. In fact, there were nearly 1.2 million fewer jobs within the mid- and higher-wage industries today than before the recession.
Unfortunately, most Americans aren’t optimistic about the nation’s economic future. According to a new national survey from researchers at Rutgers University, seven in 10 people believe the impacts of the recession are permanent, which is up from only half of survey respondents just a few years ago. The survey also found that only one is six Americans thinks the next generation will inherit better job opportunities, and most Americans do not believe the economy has improved. A majority of respondents said American workers are “not secure in their jobs” and “highly stressed.” The report noted that many of the survey responses stemmed from participants’ real-life experiences.
All of these recent findings remind me of a fantastic article published earlier this summer in Politico — “The Pitchforks Are Coming…For Us Plutocrats.” If you haven’t read it, it’s definitely worth the time. The author is billionaire businessman Nick Hanauer, and it’s such a compelling perspective on income inequality that I think it’s quite appropriate to end this round-up of wage findings with a quote from Hanauer’s article:
At the same time that people like you and me are thriving beyond the dreams of any plutocrats in history, the rest of the country—the 99.99 percent—is lagging far behind. The divide between the haves and have-nots is getting worse really, really fast. In 1980, the top 1 percent controlled about 8 percent of U.S. national income. The bottom 50 percent shared about 18 percent. Today the top 1 percent share about 20 percent; the bottom 50 percent, just 12 percent.
But the problem isn’t that we have inequality. Some inequality is intrinsic to any high-functioning capitalist economy. The problem is that inequality is at historically high levels and getting worse every day. Our country is rapidly becoming less a capitalist society and more a feudal society. Unless our policies change dramatically, the middle class will disappear, and we will be back to late 18th-century France. Before the revolution.
And so I have a message for my fellow filthy rich, for all of us who live in our gated bubble worlds: Wake up, people. It won’t last.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade
As Celeste Monforton and I were putting together 2014 edition of The Year in U.S. Occupational Health and Safety (which she introduced yesterday), we noticed that a lot of the good news about workers winning better conditions was coming from cities and states. Victories include:
Cities and states raise minimum wages: Thanks to laws passed over the past year, eight states and four other jurisdictions will have minimum wages at or above $10 per hour. (They’ll join cities that already have minimum wages at or above $10/hour, like San Francisco and San Jose.) Some of these jurisdictions take the important step of indexing the wages to inflation, which allows workers to get future raises without tedious legislative battles.
Cities expand access to paid sick leave: New Jersey’s biggest cities, Jersey City and Newark, joined the list of jurisdictions requiring some or all employers to allow workers to earn paid sick leave. New York City and Washington, DC amended their existing paid-leave laws to cover more workers.
California and Massachusetts adopt protections for domestic workers: Over the past year, both California and Massachusetts passed laws strengthening the rights of domestic workers. They join New York and Hawaii in legislating protections for nannies, housekeepers, and other in-home workers, in response to reports of household employees who have experienced wage theft, round-the-clock shifts, abuse, and harassment from employers.
Texas and Maryland take steps to protect healthcare workers: Over the past year, a Texas law that makes it a felony offense to assault emergency-department personnel took effect, while Maryland passed the Health Care Facilities Workplace Violence Prevention Act. Several states have already passed laws designed to protect healthcare workers from violence; the American Nurses Association summarizes different state laws that cover nurses here.
Minnesota bill package aims to level the playing field for working women: Minnesota’s legislature gave bipartisan approval to, and the Governor signed, the Women’s Economic Security Act, which combines nine separate bills “designed to break down barriers to economic progress facing women ─ and all Minnesotans.” The law includes an increase in the minimum wage, requirements for reasonable accommodations for pregnant women, provisions addressing the gender pay gap, and more.
Houston takes a stand against wage theft: A new City of Houston ordinance contains substantial penalties for any person or firm who is criminally convicted of wage theft and exhausts all appeals. Convicted wage thieves will be barred from renewing 46 types of city permits and licenses for five years. The ordinance also prohibits the city from hiring those who are criminally convicted or who are assessed civil penalties for wage theft. A group of 13 workers filed the first complaint under the ordinance in April 2014.
When occupational health and safety problems arise, advocates and journalists both play important roles in bringing them to light and pressing for resolution. Organizations across the country (and the world) drew attention to unsafe workplaces during Workers Memorial Week, and released reports highlighting how on-the-job hazards kill workers in California, Massachusetts, Houston, Syracuse, Wyoming, Tennessee, and nationwide.
Media outlets covered unsafe conditions in local workplaces, including oil and gas fields in Texas; tank-cleaning operations in Houston and elsewhere; a lack of basic safety precautions at a Massachusetts hummus plant; and overloaded asbestos inspectors in Iowa.
We couldn’t cover all of the key developments over the past year, so we’d love to hear from commenters what kinds of important developments you’ve seen for worker health and safety at the state and local levels over the past year.
Our Labor Day tradition continues with the third edition of The Year in US Occupational Health & Safety: Fall 2013 – Summer 2014. Liz Borkowski and I produce it to serve as a resource for activists, researchers, regulators and anyone else who wants a refresher on what happened in the previous 12 months on worker health and safety topics. We prepare it as a complement to the AFL-CIO’s excellent annual Death on the Job report which has been released each spring for the last 23 years.
We divide the report into three sections: Happenings at the federal level, activities in state and local agencies, and new research published by academics and organizations. We also profile what we consider some of the best reporting by journalists on worker health and safety issues. Here’s a snapshot of what stood out to us over the last year:
- The Federal Government: The 16-day “government shutdown” in October 2013 demonstrated the dysfunction of the current US Congress. MSHA and OSHA took important regulatory steps to protect workers from dust-related diseases, but the Obama Administration remains reluctant about advancing many other new worker safety rules.
- State and Local Activities: Progress on new worker-friendly laws continues at the state and local level. The most impressive reforms occurred in Massachusetts, with an increase in the minimum wage, a bill of rights for domestic workers, new health and safety protections for public sector workers, and an improvement in workers’ compensation with respect to burial benefits.
- New Research: Dozens of informative articles were published in the peer-reviewed literature that advanced our knowledge of both workplace hazards and the effectiveness of interventions to prevent injuries and illnesses. Research involving particular groups of workers—Latinos, healthcare and farmworkers—were especially prominent.
Liz and I will write several posts this week that will highlight each section of the report. We invite you to browse through it and add a comment to our posts with your own ideas about notable worker health and safety events over the past 12 months. I’ll start off below with some of what we think were the key happenings at the federal level.
MSHA issued a new regulation to better protect coal mine workers from developing black lung disease. Labor Secretary Tom Perez announced the new rules in April 2014 at a gathering of coal miners in Morgantown, WV. MSHA also completed a rulemaking which allows it to target the worst of the worst mine operators with a “pattern of violation” designation. Four mining operations were the first to receive the designation and the enhanced scrutiny that results from it.
OSHA moved into the heart of the public rulemaking process on its proposed rule to protect workers who are exposed to respirable crystalline silica. Stakeholders had 137 days to submit written comments to the agency, followed by 13 days of public hearings. A highlight of the hearings was the testimony by workers, including those with silica-related disease and those who made their statements in Spanish—a first in OSHA rulemaking history. OSHA also took outreach and enforcement steps to address working conditions for temp workers and those who work at heights on communication towers.
A coalition of poultry workers, civil rights, public health and unions earned modest concessions from the USDA in its new regulation on poultry slaughter inspections. The agency scaled back its plan to increase line speeds from 140 birds per minute (bpm) to 175 (bpm), and will require poultry processors to “attest” they have a program to monitor and document work-related injuries.
The Chemical Safety Board issued investigation reports and case studies on explosions at the Chevron Richmond and Tesoro Anacortes refineries, AL Solutions, among others, but leadership failures overshadowed that work. CSB member Beth Rosenberg, ScD resigned in May 2014. Cong. Darrell Issa, chairman of the House Committee on Oversight and Government Reform, issued a report and held a hearing on management failures and whistleblower reprisals at the agency.
NIOSH engaged stakeholders in discussions on a proposed policy on carcinogens. The agency also drew more attention to the public health consequences of fracking, with findings of worker deaths from exposure to fracking’s “flow back” fluids.
Journalists made significant contributions to raise public awareness about worker health and safety issues. Most notably, the Center for Public Integrity’s (CPI) Chris Hamby won the Pulitzer Prize for his reporting on law firm Jackson Kelly’s practice of withholding key medical evidence in their challenges against coal miners who are seeking compensation under the federal black lung benefits program. CPI’s Jim Morris, a veteran of worker H&S journalism, reported on Georgia-Pacific’s research program to challenge the scientific evidence on the health effects of asbestos exposure, as well as the serious backlog of workers’ compensation cases for longshore and harbor workers. Some of the other national news coverage we recap in the report include: the challenges faced by temp workers which were featured in reporting by ProPublica’s Michael Grabell; teen workers and sexual harassment which was investigated by The Oregonian’s Laura Gunderson; and the H&S risks faced by young farm workers which was reported by The Nation’s Mariya Strauss and Gabriel Thompson.
Our report highlights work by other journalists and much more on happenings over the last 12 months at the federal level. The report covers a lot, but it is not exhaustive. Liz and I made some tough decisions about what to include and what to omit. We hope you will download the report, and let us know what you think were some of the most important worker health and safety events or reporting since last fall.
P.S.: The first and second editions of our reports are available here:
The Year in U.S. Occupational Health & Safety: Fall 2012 – Summer 2013
The Year in U.S. Occupational Health & Safety: Fall 2011 – Summer 2012
Just before Memorial Day—the kickoff of the summer season—the Obama Administration released its agenda for upcoming regulatory action. In the worker safety world of OSHA, “regulatory action” rarely means a new regulation. Rather, it refers to a step along the long, drawn-out process to (maybe) a new rule to protect workers from occupational injuries, illnesses or deaths.
The items identified by the Labor Department suggested that OSHA planned a productive summer of 2014. Here’s what OSHA outlined for its summer tasks.
In May 2014:
- Convene a meeting of small business representatives to review a draft proposed regulation to better protect workers employed in healthcare, correctional facilities, homeless shelters and other settings from infectious diseases.
In June 2014:
- Publish a request for information from stakeholders to address the hazards faced by those who work on communication towers, in particular the risk of working at heights.
In July 2014:
- Publish a proposed rule to protect workers who are exposed to beryllium, which can cause lung cancer and chronic beryllium disease. More than two years ago, in February 2012, the world’s largest producer and supplier of beryllium AND the United Steelworkers handed OSHA the regulatory text of a proposed rule on beryllium. It was a document that the two key stakeholders had thoughtfully negotiated. They expected their effort would expedite OSHA’s work on a rule.
In August 2014:
- Publish a final rule to address confined space hazards for construction workers. In 1993, OSHA issued a confined space standard but it did not cover construction workers. The agency proposed a regulation in 2007 that would apply to the construction industry and the public comment stage of the rulemaking concluded in October 2008.
- Convene a meeting of small business representatives to review a draft proposed regulation to address the hazard of workers being struck when construction vehicles and other equipment are operating in reverse (backing up.) OSHA notes that in 2011, 75 workers were fatally injured in backing incidents.
- Publish a proposed regulation that would clarify employers’ obligation under an existing regulation to make and maintain accurate records of work-related injuries and illnesses.
- Publish a request for information from stakeholders to better protect shipyard workers from fall hazards and make existing regulations consistent with industry consensus standards.
It’s hard for me to believe that OSHA was unable to accomplish a single one of these seven tasks. I have to wonder whether something else is going on. For all I know, the agency has completed its work on some of them and tied them up with a nice red bow, but higher ups in the Obama Administration have put the brakes on them. It wouldn’t be the first time the Administration has shown its aversion to new OSHA regulations. In 2010, OSHA proposed a change to the form on which just a fraction of employers are required to record work-related injuries and illnesses. The only modification was that employers would have been required to place a check mark—-a check mark—in a column on the form to distinguish musculoskeletal disorders from other injuries, such as burns or amputations. After completing the public comment period and extra stakeholder meetings, OSHA submitted the final rule for review to the White House’s Office of Information and Regulatory Affairs (OIRA). It sat there for six months and then the Administration forced OSHA to ditch withdraw the rule. Then there was OSHA’s proposed rule on silica which was “under review” at OIRA for 2 1/2 years.
Whatever is going on—whether performance problems at OSHA or anti-regulatory obstruction higher up in the Obama Administration—OSHA set expectations of what it would accomplish over the summer months. Now Labor Day is upon us and it was a disappointing summer for progress by OSHA on new worker safety regulations.
The San Jose Mercury News has begun publishing a multi-part series on the alarming use of psychotropic medications among youth in California’s foster-care system. Karen de Sá writes:
With alarming frequency, foster and health care providers are turning to a risky but convenient remedy to control the behavior of thousands of troubled kids: numbing them with psychiatric drugs that are untested on and often not approved for children.
An investigation by this newspaper found that nearly 1 out of every 4 adolescents in California’s foster care system is receiving these drugs — 3 times the rate for all adolescents nationwide. Over the last decade, almost 15 percent of the state’s foster children of all ages were prescribed the medications, known as psychotropics, part of a national treatment trend that is only beginning to receive broad scrutiny.
The first part of the series includes interviews with former foster children who’ve experienced long-term adverse effects after having been given psychotropic drugs while in foster care. It also presents some results of the Mercury News analysis of aggregate data on pharmacy benefit claims paid by the state’s Medicaid program for foster children (covering 2004-5 2013-14). The newspaper received the data months after de Sá filed a California Public Records Act request for 10 years of claims data; negotiations as to how much more data they might receive are ongoing.
Among the findings of the Mercury News analysis: Nearly 60% of California foster children were prescribed an antipsychotic, one of the psychotropic drugs of most concern.
Antipsychotics can have serious adverse effects such as rapid weight gain and diabetes. Often, foster children are given antipsychotics not because they have been diagnosed with schizophrenia or bipolar disorder, but because caregivers want to control children’s behavior. de Sá explains:
For children, the FDA has approved antipsychotics only to treat schizophrenia, bipolar disorder and severe autism — serious mental health conditions found in just 1 to 2 percent of the child population. But University of Maryland professor of pharmacy and psychiatry Julie Zito has found that the drugs often are prescribed off-label to control children’s behavior.
In a rare look at diagnoses of children covered by Medi-Cal, California’s public health system, Zito found that almost one-half of the antipsychotics used were off-label and about a third were for behavior problems such as ADHD, “conduct disorder” or “oppositional defiant disorder.” Her yet-to-be-published study found that in 2009 there was an 18-fold greater use of antipsychotics on foster children than on non-foster kids receiving Medi-Cal because of their families’ income levels. These findings were presented to the FDA in April.
All too often, foster children with behavioral issues risk losing their foster placements and ending up in a worse situation. It’s understandable why a physician considering such a scenario might prescribe an antipsychotic, with the goal of helping a child achieve a stable situation. But with too few providers who can offer foster children therapy to address their underlying mental-health needs, foster children often just keep taking the drugs — and if their situations get worse, the response is often to add another medication to the regimen. The Mercury News investigation found that “12.2 percent of California foster children who received a psych drug in 2013 were prescribed two, three, four or more psychotropic medications at a time — up from 10.1 percent in 2004.”
This is not the first investigation into the prescribing of antipsychotic drugs to foster children (or children in general). Most notably, a December 2011 report from the Government Accountability Office analyzed the patterns of psychotropic-drug prescribing to foster children in selected states (Florida, Maryland, Massachusetts, Michigan, Oregon, and Texas). The GAO found prescriptions of psychotropic drugs for children under one year old, as well as hundreds of children prescribed five or more psychotropic drugs simultaneously. Since then several states, including California, have adopted policies that give extra scrutiny to the prescription of antipsychotics to children with Medicaid coverage, or to the subset of Medicaid beneficiaries who are also in the foster-care system.
Recent progress is worth noting, but de Sá and her colleagues demonstrate how far we still have to go to assure that foster children get appropriate care for their mental-health needs, rather than being doped with cocktails of drugs that leave them sedated but at high risk of health problems. I look forward to reading the rest of the Mercury-News series as it is published, and hope it will give us a glimpse of what a better system might look like and how we can achieve it.