UPDATES

D.A.R.E. redux

Pediatricians concerned about keeping children away from drugs may already be aware that D.A.R.E.—the well-known substance abuse prevention program that brings police into 80% of the nation's elementary school classrooms to lecture children about the dangers of drugs—isn't much help. Despite D.A.R.E.'s widespread acceptance, a large body of research has demonstrated that the program's effects are minimal and wear off by the time kids are high school age. In the past two months alone, both the surgeon general and the National Academy of Sciences have issued reports saying that D.A.R.E.'s "Just say No" approach is ineffective. Several cities, most recently Salt Lake City, have stopped using the program and the federal Department of Education has said schools may not spend money from the Department's Safe and Drug-free Schools program on D.A.R.E. If the school district in which you practice is still committed to D.A.R.E., perhaps it's time to advocate for a better program.

By now, even D.A.R.E.'s partisans agree that a change of approach is in order. Last month, D.A.R.E. officials announced that the organization is introducing a new, scientifically based curriculum developed with a $13.7 million grant from the Robert Wood Johnson Foundation by researchers at the Institute for Health and Social Policy at the University of Akron (Ohio). According to Zili Sloboda, principal investigator for the project, the new program will "draw on what we have learned from research about the elements of effective prevention by addressing the normative beliefs, personal attitudes, and problem-solving and resistance skills of students." The new program is aimed at seventh- and ninth-grade students (older than those now targeted by D.A.R.E.) and makes use of active student participation rather than passive listening. A rigorous evaluation is planned, involving an estimated 50,000 students during a five-year period. For the Robert Wood Johnson Foundation, a revamped program offers the possibility of harnessing scientifically proven approaches in prevention education to the extensive network and public recognition D.A.R.E. already commands. Cities tentatively selected to try the new D.A.R.E. program are New York, Baltimore, Houston, Denver, San Francisco, and Los Angeles.

Foodborne illness: An old problem takes new forms

In many ways, providing a healthy and attractive diet for families has never been easier. Global suppliers provide the supermarket shopper with a year-round choice of meat, fish, poultry, and produce—variety enough to suit the tastes of the most finicky eater. But there's a worm in this cornucopia: the increasing prevalence of foodborne pathogens new and old in familiar and exotic foodstuffs. According to Art Liang, MD, the assistant director for foodborne disease at the Centers for Disease Control and Prevention (CDC), "there are an estimated 76 million cases of foodborne illness each year, resulting in more than 5,000 deaths and 325,000 hospitalizations." Consumers and health-care providers need help in combating this threat to health.

In response, the American Medical Association has joined forces with the CDC, the FDA, and the Department of Agriculture to produce a new information kit for physicians and families. Called Diagnosis and Management of Foodborne Illness, A Primer for Physicians, the kit is designed to update health professionals on recognizing and treating food-related disease. It provides easy-to-understand patient information for physicians to distribute on safe food handling, as well as a chart of recommended cooking temperatures for various foods.

The entire information packet is available on line at www.ama-assn.org/foodborne .

Follow-up

Last month, Updates reported the case of a 5-year-old taken from his mother by the Illinois Department of Children and Family Services because he was still breastfed. This month, the Associated Press (AP) reports the child, now 6, has been returned to his mother but is no longer nursing. The AP story quoted the judge in the case as saying that mother and child are making progress toward what the judge termed "an appropriate level of independence." So be it.

Eye On Washington

The Bush administration has been in office for a little more than a month now, and major policy changes in the scope and the administration of federally funded health and welfare services may be in the offing. First, the $1.6 trillion tax cut President Bush sent to Capitol Hill last month is bound to have serious ramifications for government social welfare programs. The fate of the president's plan is, at this early date, impossible to predict, but most observers believe that a tax cut of considerable magnitude will emerge from this session of Congress. Exactly how sharp the administration's ax will be and how deeply it will cut, remain to be seen. Second, President Bush has proclaimed his desire to expand the participation of "faith-based" organizations in the provision of federally funded social services. To that end, he has proposed revisions to the tax code that make it easier to take a deduction for charitable contributions on the federal income tax return and created a new federal office to integrate religious organizations into federally financed social service programs.

With reference to particular health-related matters, the administration is reviewing the new regulations protecting the privacy of medical records, which were issued in the waning days of the Clinton administration; waffling on support for the bipartisan Patients' Bill of Rights previously sponsored by Representative Charlie Norwood of Georgia; and backing state laws that allow for independent review of HMO denials of medical care, an issue also before the Supreme Court.

Meanwhile, in other offices of federal government:

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released a series of new resource guides for parents, teachers, researchers, and program directors on topics related to substance abuse and violence. Pediatric topics include Children Witnessing Violence and Substance Abuse; Gangs; Violence in Schools; and Youth Firearm Violence. The guides are available free on the SAMHSA Web site, www.samhsa.gov .

The Centers for Disease Control and Prevention (CDC) has a new Web-based resource for professionals, parents, and young people interested in the prevention of violence and suicide among children and youth. The National Youth Violence Prevention Resource Center provides information on prevention programs, publications, research and statistics, via its Web site, www.safeyouth.org . A toll-free hot line (866-SAFEYOUTH) is also available on weekdays from 8 a.m. to 6 p.m.

The CDC has also released a study at the National STD Prevention Conference reporting that most health-care providers do not discuss pregnancy or prevention of sexually transmitted disease when performing routine physical examinations on high school students.

The Department of Health and Human Services unveiled a plan for a comprehensive approach to combat antimicrobial resistance. The plan designates priorities, identifies responsible agencies, and creates timelines for action. Agencies participating in the task force that designed the plan include the CDC, National Institutes of Health, the Food and Drug Administration, and the Agency for Healthcare Research and Quality. The plan is available online at www.cdc.gov/drugresistance .

The US Census Monitoring Board, reviewing results of the 1990 census to see what light they might shed on the just-concluded 2000 head count, found that 20% of all infants and approximately 11% of 6-year-olds were missed in the count 10 years ago. If the same methodology is applied to the 2000 census, the board fears, infants and children may once again be severely undercounted, which would hurt funding for programs such as Medicaid that are allocated on the basis of census results. The review is a plea for statistical correction of the 2000 census data.

The National Institute of Allergy and Infectious Diseases announced the award of $2.9 million in grant funds to 23 sites to improve the health of inner-city children with asthma. The intervention program that the grants will fund is based on the findings of the National Cooperative Inner-City Asthma Study and will have as its key component an asthma counselor to work closely with affected families over extended periods. In a similar effort, the Robert Wood Johnson Foundation has announced $12.5 million in grants to eight communities that are developing ways to improve quality and access to pediatric asthma care.

Called Allies Against Asthma, the grantees are community coalitions in Albuquerque, N.M.; Hampton Roads, Va.; Long Beach, Calif.; Milwaukee; Philadelphia; Seattle; Washington, D.C.; and San Juan, Puerto Rico.

The Food and Drug Administration (FDA) approved a new oral formulation of prednisolone as treatment for pediatric asthma. Called Orapred, the grape-flavored compound's claim to fame is that it tastes good, so children will be willing to take it. According to surveys done by Ascent Pediatrics, Orapred's manufacturer, existing formulations of liquid corticosteroids taste so unpleasant that many children refuse to take prescribed medication.

Calendar

March 15-16, NAPNAP (National Association of Pediatric Nurse Associates and Practitioners) Conference on Pediatric Primary Care, Phoenix, AZ. For more information, call 856-667-1773 or visit the NAPNAP Web site, www.napnap.org .

April 23-25, Fourth Annual Conference on Vaccine Research, Arlington, Va. For information, call 301-656-0003, extension 19, or e-mail info@nfid.org.

April 27-May 1, Pediatric Academic Societies Annual Meeting, Baltimore, Md. To register, call 281-296-0244.

May 29-June 1, 35th National Immunization Conference, Atlanta, Ga. For information, call Rick Nelson, CDC, 404-639-82225, or e-mail mrn2@cdc.gov.

Judith Asch-Goodkin
Contributing Editor

 

Updates. Contemporary Pediatrics 2001;0:13.