CHILDREN’S HEALTH

Circumcision and Infection

In August, the Centers for Disease Control and Prevention issued a report examining the impact of male circumcision on HIV infection rates. Based on international clinical trials and observations, the report states that circumcised men have significantly lower rates of HIV infection than do uncircumcised men. In the circumcised population, infection rates were 44 percent lower for HIV and 71 percent lower for other sexually transmitted diseases. Currently, however, the number of American boys who are undergoing the procedure is dropping. In part, this is because the American Academy of Pediatrics (AAP) released two reports (in 1999 and 2005) that stated, “Scientific studies show some medical benefits of circumcision. However, these benefits are not sufficient for AAP to recommend that all infant boys be circumcised.” Since 1999, 16 states have eliminated Medicaid coverage of circumcisions that were not deemed medically necessary. In 2006, two states—Hawaii and Vermont—introduced resolutions questioning the need for public funding of male circumcision.

Coverage Drops

The number of children younger than age 18 who lack health insurance has increased for the first time since 1998, according to the U.S. Census Current Population Survey released Sept. 5. Out of the nation's nearly 74 million children, about 8.3 million, or 11.2 percent, lacked insurance in 2005, compared with nearly 8 million children, or 10.8 percent, in 2004. Some experts attribute the uptick in the number of uninsured kids to the decline in employer-sponsored health insurance, reports the Washington Post. According to the survey, one-quarter of 25-to-34-year-olds are uninsured, and 19 percent of 35-to-44-year-olds are uninsured. “These are unheard of percentages of those age cohorts that are uninsured. And, of course, if they have kids, their kids are not going to have health insurance either,” Katherine Swartz, professor at the Harvard School of Public Health, told the New York Times. Economic difficulties have led some states to increase SCHIP premiums, reduce outreach efforts and create enrollment limits, the end result of which is flattened enrollment in the program. John Lumpkin, a senior vice president at the Robert Wood Johnson Foundation, said, “The only reason that (the) number (of uninsured children) isn't worse is because we have Medicaid and SCHIP...We continue to have a crisis in this country with kids who have no health insurance.” The Post anticipates that the increase in the number of uninsured children will play a major role in next year's debate in Congress over whether to renew SCHIP.

PUBLIC HEALTH

Lay Advisors Boost Screening

Trained lay advisors can dramatically increase the number of women who receive mammograms, according to a study in the Sept. 6 Journal of the American Cancer Institute. Rural, poor and minority women are typically rarely or never screened for cancer and so are considered high-risk, said Electra Paskett, principal researcher and professor at Ohio State University’s cancer center. The four-year study in rural North Carolina assigned 851 rural, low-income white, black or Native American women to one of two groups: those who received three home visits from lay health advisers who provided information and encouragement, and those who got only a letter and National Cancer Institute brochure about the need for cancer screenings. In all, 42 percent of the women who received home visits got a mammogram versus 27 percent in the control group. Participants said one or more of these barriers prevented their getting screened: cost (identified by 54 percent of study participants), lack of encouragement (45 percent), and beliefs that radiation from mammograms cause cancer (41 percent) and that the procedure hurts (41 percent).

PAIN MANAGEMENT

DEA Reverses Policy

On Sept. 6, the Drug Enforcement Administration(DEA) announced it will reverse a two-year-old policy that limited how doctors may prescribe pain medications. Specifically, the new policy allows doctors to write multiple prescriptions in a single office visit for patients who need a constant supply of morphine-based painkillers. Doctors can now write three 30- day prescriptions at a time, future-dating two of them. Previously, the DEA forbade this practice, allowing only one 30-day prescription at a time. The agency believed that medications were being diverted to the black market and used illegally, leading to a large increase in the number of prosecutions of doctors and patients. Doctors and patients complained that those with chronic pain were going untreated and that doctors would prescribe too few medications because of fear of prosecution. The new policy will go into effect after 60 days, allowing time for public comment.

PRISON HEALTH

Inmates and Mental Health

More than half of prison and jail inmates in the United States reported symptoms of mental health conditions, including depression, mania and psychotic disorders, within the last year, according to a survey released Sept. 6 by the Bureau of Justice Statistics. The report was based on a sample of about 25,000 inmates and came from personal interviews and prisoners' own reports of symptoms, treatments and medications. The study found that one in three state inmates, one in four federal inmates and one in six jail inmates had received some form of mental health treatment during their current incarceration. Women reported higher rates of mental health problems than men, and whites had higher rates than black or Latino inmates. The study also found that mentally ill inmates were more likely to have had at least three prior incarcerations and to have broken prison rules; twice as likely as others to have been injured in a prison fight; and more likely to have been abused as children and homeless in the year before incarceration. Three out of four were dependent on drugs and/or alcohol, and 37 percent said they were abusing drugs at the time of their crime. The study is available online.