Children’s Health – Lister Hill Center for Health Policy

Student Reflection: 2024 United to Beat Malaria Summit

Student Reflection: 2024 United to Beat Malaria Summit

Tayyaba Khan, an MPH student with an emphasis on global health, utilized LHC’s Health and Policy Conference Travel Scholarship in the spring semester. In this article, she reflects on her experience attending the United to Beat Summit.

Malaria is a life-threatening disease transmitted to humans through the bites of infected Anopheles mosquitoes. Despite being preventable and treatable, malaria remains a significant public health challenge. In 2022 alone, there were an estimated 249 million cases and 608,000 malaria-related deaths globally, with the vast majority occurring in sub-Saharan Africa. Tragically, a child dies from malaria every minute worldwide, highlighting the urgent need for effective interventions and increased funding.

I was honored to receive an invitation to the 2024 United to Beat Malaria Summit to advocate for increased funding for critical malaria intervention programs, such as the U.S. President’s Malaria Initiative; CDC’s Division of Parasitic Diseases and Malaria; the Global Fund to Fight AIDS, TB and Malaria; Gavi, the Vaccine Alliance; and UNICEF. Having experienced malaria three times during my childhood in Pakistan, I strongly believe in the lifesaving impact of these programs and the importance of advocating for global health initiatives that not only save lives but also strengthen public health infrastructure in resource-limited settings both domestically and internationally. This was the first time Alabama had representation at this platform, providing a vital opportunity to raise awareness and engage with state representatives who may not have previously heard from constituents on this issue, which strengthened my passion and purpose to attend even more.

Though I have attended national conferences before, this was my first time attending a UN-organized gathering. I expected to hear from experts in the field, network with like-minded individuals, and identify additional resources to advocate for the fight against malaria. The Summit truly exceeded my expectations on content, speakers, and activities we participated in. Moreover, I must commend the conference organizers for their accommodations, support, and understanding as observing Ramadan impacted some attendees’ ability – including my own – to fully engage with conference activities.

Tayyaba and colleagues in a meeting with a Congressional staffer Hill Day was my favorite experience in attending the Summit. This was my first time meeting members of Congress at the Capitol to advocate for a cause that I firmly believe in. It was a very empowering experience to see democracy in action and recognize the power our voices have. After a day and a half of insightful sessions, presentations, panels, and preparation, the opportunity to visit Capitol Hill and meet with our Congressional representatives and their staff was truly impactful. What I particularly liked about this experience was the genuine interest shown by our elected officials in hearing directly from their constituents. They welcomed our perspectives and were receptive to our advocacy efforts. We had the chance to engage in meaningful conversations, answer their questions, and present our specific asks, which centered on maintaining current funding levels for critical malaria intervention programs without any anticipated cuts. This was especially timely given the ongoing budget discussions for the next fiscal year. It was truly inspiring to directly contribute to the dialogue and advocate for sustained support for malaria initiatives at such a critical time.

The Hill Day experience not only strengthened my understanding of the policymaking process but also highlighted the importance of grassroots advocacy in influencing decision-makers and driving impactful change in global public health. The Summit helped me develop skills for effectively engaging with members of Congress, including how to communicate clearly, stay focused, and express our requests concisely within a limited timeframe during our interactions on Capitol Hill. I also learned more about the implications of malaria on health outcomes and economy, both locally and globally, which deepened my understanding and passion for the fight against malaria. I was also able to network with other like-minded individuals, especially from Alabama and Mississippi, as we were in the same group. Additionally, representing Alabama on a national platform renewed the sense of commitment in me to work for this cause at UAB and across the state.

Tayyaba Khan, MPH student I would recommend this event to anyone who is passionate about the fight against malaria and is looking for a platform and resources to make a difference in this area. These programs have saved over 11 million lives in the past two decades. In addition, they help build more stable and resilient economies and workforces, they lead to fewer missed school and workdays, and they empower local health systems to respond to infectious disease outbreaks. Coming together to support this cause, raise our voices, and advocate for increased support is not only empowering but also incredibly impactful. To prepare for this event, I recommend submitting the application on time and planning travel well in advance to avoid availability issues and price hikes. Additionally, conducting research on your members of Congress will allow you to tailor your conversations accordingly and prepare specific talking points ahead of time. Approach these discussions with confidence, respect, clarity about your requests, and authenticity. Bringing business cards is also beneficial, as you’ll have the opportunity to network with inspiring individuals throughout the summit. Overall, be prepared to engage, connect, and advocate passionately for this important cause—it’s an experience that will leave a lasting impact on both you and the fight against malaria.

Policy Watch: Alabama Launches Childcare Tax Credit System for Workforce Development Initiative

May 31, 2024 | Kimberly Randall

Background

Childcare costs are one of the most widespread barriers to preventing parents from re-entering or staying in the workforce. According to the Economic Policy Institute, in Alabama, the average cost of childcare for a single child is over $6,000 per year, accounting for almost 12% of a median family’s income of $50,335. According to a study by Alabama State University, those numbers are unlikely to improve, as roughly 17% of childcare facilities surveyed said they increased prices due to the pandemic, and prices in those facilities went up by an average of 17%.

An estimated 13,000 parents who are work-eligible are currently unemployed due to childcare restrictions. As Alabama’s economic infrastructure continues to grow, offering affordable solutions for childcare in the state is necessary to access the workforce needed to sustain corporate development. While Alabama has a historically low unemployment rate of 2.2%, workforce participation is among the lowest in the country at just 57.1%, continuing a trend of being under the national average that goes back to the mid-1970s.

Proposed legislation

According to the bill text, HB358 “serves a public purpose by conferring a direct public benefit … through the promotion of public health, safety, morals, security, prosperity, contentment, and the general welfare of the community [by] increasing the quality of childcare to the general public, which has the effect of encouraging high-quality care and education for children and facilitating greater workforce participation throughout the state.” Through a series of tax credits to businesses, the legislation hopes to have more Alabamians enter the workforce and gain employment by improving the quality and availability of childcare options for working parents.

At its core, the legislation offers an incentivized tax credit to employers who assist with the childcare needs of their employees. The tax credit is eligible for employers for:

The construction, renovation, expansion, or repair of a childcare facility, or for the purchase of equipment for such facility, or for the maintenance and operation thereof.
Payments made to childcare facilities or employees for the provision of childcare at childcare facilities for children of employees.
Payments made to childcare facilities to reserve services for children of employees.

The bill specifically defines children as direct dependents under the age of 5 and restricts the tax credit to individuals who make less than $80,000 per year before overtime or bonuses. Additionally, the tax credit is tiered depending on the quality rating of the childcare providers, pressuring facilities to increase or maintain their ratings for increased funding opportunities. Each decreasing quality rating results in a decreased tax credit:

(1) Five-star quality rating – two thousand dollars ($2,000) per eligible child.
(2) Four-star quality rating – one thousand seven hundred fifty dollars ($1,750) per eligible child.
(3) Three-star quality rating – one thousand five hundred dollars ($1,500) per eligible child.
(4) Two-star quality rating – one thousand two hundred fifty dollars ($1,250) per eligible child.
(5) One-star quality rating – one thousand dollars ($1,000) per eligible child.

Companies are eligible to apply for 75% of their expenses as a tax credit if a medium or large-sized organization, and 100% of their expenses in this area if they are small businesses. The bill provides special consideration of funding for small businesses, rural providers, and grants for non-profits. The total tax credits awarded shall not exceed $15,000,000 in its first year but have steady increases year over year until its sundown clause in 2027.

Impact

Many solutions for childcare accessibility have been suggested over the years, however, Alabama elected for an employer-first method rather than a direct-to-employee method, largely because of the vast number of Alabamians who file taxes using the standard deductions rather than itemized where the tax credit would appear. Because of this, a large portion of the intended population had the potential to not receive the benefits. Childcare has been highlighted as one of the key barriers in increasing Alabama’s workforce participation rate, alongside transportation and vocational training.

Women are more dominantly affected by childcare limitations. A growing body of research shows that access to quality childcare in early development results in long-term health outcomes for children, such as improved cardiovascular and metabolic health, and reduced smoking in adulthood. Center-based care, specifically, shows an increase in kindergarten readiness and social skills, allowing for potential educational benefits of this program.

At an economic level, the childcare tax credit is expected to offer a $1.3 billion of economic activity in the state.

Next Steps

HB358 was largely bipartisan, with public support from both the Speaker of the House and the Minority House Leader, who was also the champion, and passed on April 18 unanimously. It was signed into law by Governor Ivey on May 8th.

The legislation will go into effect on January 1, 2025, and has a current sundown clause of December 31, 2027, if not renewed. The legislation text specifically states that a review of the data collected during this initiative must be analyzed and considered prior to any extensions.

Overcoming Needle Fear: Strategies to Minimize Vaccination Pain

April 1, 2024 | Miriam Calleja, LHC Staff

Needle phobia is more than just a minor concern; it’s a legitimate issue that can lead to avoidance of essential medical care, including vaccination. For parents and healthcare professionals, understanding how to alleviate this fear is pivotal to ensuring that children and adults receive necessary immunizations and other interventions that involve the poke of a needle. Industry experts can help decrease the pain and anxiety associated with vaccinations.

The Painful Truth Behind Needle Phobia

Needle phobia can strike at any age, but it often takes root in childhood. The sheer sight of a needle can trigger fear, escalating into an aversion that persists into adulthood. This dread isn’t just psychological; the anticipation of pain plays a significant role. The snowball effect distresses the individual and complicates the job of healthcare providers. The fear can be associated with the pain of the needle piercing the skin, but it can be more complex, such as associating the pain of a needle with an operation that occurred soon after.

It is estimated that around 25% of adults have a fear of needles, known as trypanophobia, with most fears developing during childhood. The implications are widespread, as needle fear has been known to lead to the postponement or outright refusal of vaccinations. This can have dire consequences on public health, herd immunity, and individual well-being.

The problem isn’t confined to immunization either. Children who require surgery such as a bone marrow transplant or heart surgery due to serious illness can become highly distressed and agitated due to their fear of needles. “This is so bad that many children and many parents decide not to continue the treatment,” says Dr. Stefan Friedrichsdorf, a specialist at the University of California San Francisco’s Stad Center for Pediatric Pain, Palliative and Integrative Medicine, speaking at the End Well conference in Los Angeles last November.

The distress experienced by those with needle phobia is not just psychological. Physical effects such as difficulty breathing, increased heart rate and blood pressure, trembling, and chest tightness have been reported. Patients have been known to faint at the sight of a needle.

Although several studies have investigated the issue, the avoidance of pain in children remains underrecognized. Of the top pain-causing procedures in hospitalized children, needle pokes remain the top quoted one, coming in at approximately 40% of pain experienced. Addressing the problem requires a compassionate, multi-faceted approach.

A Case Study in Comfort

Physicians used to be taught almost to ignore vaccination pain and see it as a necessary evil. The approach is different nowadays, and this new philosophy could be a game-changer in avoiding needle phobia. Now, pain and fear associated with needles were deemed to be significant enough barriers to vaccination in children to warrant attention.

Reducing the stress around vaccination is particularly important with neurodiverse patients who tend to have lower childhood immunization rates than their peers, leaving them vulnerable to vaccine-preventable diseases.

Friedrichsdorf spoke to NPR about what he is calling “Ouchless Jab Challenge.” He has worked with these practices at Children’s Minnesota and is now leading the rollout of new protocols for all children at UCSF Benioff Children’s Hospitals in San Francisco and Oakland. The Children’s Hospital of Philadelphia has also led similar campaigns, highlighting various methods to alleviate the anxiety and discomfort associated with shots. These approaches aim to provide a less daunting experience for both patients and caregivers.

Distraction Techniques – One of the simplest but most effective tactics is distraction. Engaging children in conversation, playing music or videos, or allowing them to play with toys during the injection can significantly defuse tension. For teenagers and adults, deep breathing or focusing on a picture or an object in the room might serve the same purpose.

Topical Anesthetics – A more direct way to minimize vaccine discomfort is by applying topical anesthetics to numb the skin before injection. Products like lidocaine creams or patches can be placed on the injection site about 30 to 60 minutes before the vaccination, reducing the pain sensation.

Cognitive Behavioral Strategies – Cognitive behavioral techniques also play a role in managing needle fears. By educating patients on what to expect using vocabulary they understand and teaching them coping strategies, healthcare providers can help transform a scary experience into a manageable one.

The Role of Technology – The advancement of technology paves the way for innovative solutions such as the Buzzy Bee device, which employs a combination of cold and vibration to confuse the body’s pain nerves, making the injection less painful. These types of solutions can be valuable tools in a healthcare provider’s repertoire.

Adapt the position – No child should be pinned down by the healthcare professional. Instead, the caregiver should hold the child in a comfortable position. Patients known to feel faint or experience a drop in blood pressure should be vaccinated lying down.

Guidance for Parents and Caregivers

Parents can prepare their children by talking to them honestly about vaccinations calmly and reassuringly. Practicing with a toy doctor’s kit can demystify the process for young children. It’s also helpful to plan a fun activity after the appointment, giving the child a positive event to look forward to.

For older children and teenagers, involving them in the discussion about their health and the importance of vaccines can make them feel more in control of the situation. Validating their feelings while offering encouragement and support can also ease apprehension.

Adaptation and Empathy

A study conducted on 194 children and their parents in 2018, after initiating the new pain-reducing protocol, showed its effectiveness compared to the same survey conducted two years earlier. Both meaurements resulted from a single-day, hospital-wide survey of children’s pain and its treatment. A higher percentage of children reported no pain (33% vs 24%), and fewer children experienced severe pain (a score of ≥ 7 out of 10) after the protocol was put into effect. While needles remained the highest reported cause of pain of the experience overall, fewer children identified needle pain as the cause of the worst pain (21% vs 30%).

Acknowledging and understanding the individual’s fear can help with decision-making. Does the patient prefer to look at the injection site to know that the needle didn’t get stuck inside the arm? Do they prefer to look away and avoid the sight of blood?

Healthcare professionals can tailor their approach based on age groups and individual needs. For instance, adolescents might appreciate a quick, matter-of-fact process, while younger children may need more time to be comforted. Maintaining a gentle, empathetic bedside manner is crucial throughout.

Overcoming the fear of needles to ensure timely vaccinations is a collaborative effort. It combines clinical interventions with psychological support from healthcare professionals and parents. By incorporating these research-backed methods, we can transform the narrative around vaccinations from fear to empowerment. Through understanding, innovation, and empathy, everyone plays a role in making the vaccination process more comfortable—and therefore more effective—for those with needle phobia.

Sources:

Free Program for Needle Anxiety. “Symptoms of Needle Phobia.” Accessed February 29, 2024. https://www.idontlikeneedles.com/symptoms-of-needle-phobia.

Taddio, Anna, Christine T. Chambers, Scott A. Halperin, Moshe Ipp, Donna Lockett, Michael J. Rieder, and Vibhuti Shah. “Inadequate Pain Management during Routine Childhood Immunizations: The Nerve of It.” Clinical Therapeutics 31 Suppl 2 (2009): S152-167. https://doi.org/10.1016/j.clinthera.2009.07.022.

Friedrichsdorf, Stefan J., Andrea Postier, Donna Eull, Christian Weidner, Laurie Foster, Michele Gilbert, and Fiona Campbell. “Pain Outcomes in a US Children’s Hospital: A Prospective Cross-Sectional Survey.” Hospital Pediatrics 5, no. 1 (January 2015): 18–26. https://doi.org/10.1542/hpeds.2014-0084.

Hamilton, J. G. “Needle Phobia: A Neglected Diagnosis.” The Journal of Family Practice 41, no. 2 (August 1995): 169–75.

Postier, A. C., Eull, D., Schulz, C., Fitzgerald, M., Symalla, B., Watson, D., Goertzen, L., & Friedrichsdorf, S. J. (2018). Pain Experience in a US Children’s Hospital: A Point Prevalence Survey Undertaken After the Implementation of a System-Wide Protocol to Eliminate or Decrease Pain Caused by Needles. Hospital Pediatrics, 8(9), 515–523. https://doi.org/10.1542/hpeds.2018-0039

Student Submission: Ocular Trauma and Nonpowder Firearms

August 11, 2023 | Ayaka Fujihashi, Medical Student

Amidst the political climate on gun control and gun safety, there is another aspect of public safety that is often overlooked: nonpowder guns. Firearms such as BB guns, airsoft guns, and paintball guns. These guns differ from their powdered counterparts in their mechanisms. Nonpowder firearms use plastic or pellet bullets, and, instead of relying on the high pressures created from chemical reactions using powder, nonpowder guns utilize springs, compressed air, or CO2 to send their projectiles flying. Nonpowder firearms are often seen as toys, with marketing campaigns specifically targeting male children. Yet, these devices are deceptively dangerous.

Between 1990 and 2016, roughly 360,000 cases of nonpowder firearm related injuries were treated in emergency departments, which equates to about 13,500 cases annually.¹ Most injuries occur in children between 6 and 12 years old, and 87% occur in boys. The majority of the injuries occur in the head and neck region, and many injuries specifically involve the eye. Of the total, 16% suffered an open injury to the eye. 3.5% were left with legal blindness—defined as visual acuity of 20/200 or less in the better eye with correction—and 11.1% were left with visual defects.²

While accidents do happen, 98% of these ocular injuries occur without eye protection and could have been prevented.¹ Currently, there are no federal law regulations on the use, possession, or transfer of nonpowder firearms. Because these forms of firearms are considered a consumer product, the regulating body would be the Consumer Product Safety Commission (CPSC), but it has not adopted any specific regulations. Some states have laws limiting the possession, use, or sales to minors, but there are no laws at any government level mandating the use of eyewear protection.

The American Academy of Pediatrics and American Academy of Ophthalmology issued a joint statement recommending the use of protective eyewear for all participants in sports in which there is a risk of eye injury. Nonpowder firearms were categorized in the “high risk” category, meaning an increased risk of the eye being impacted with sufficient energy to cause injury.³

However, statements of recommendation with no actionable authority can only go so far. In order to help reduce needless injuries, legislation on the state/federal level is necessary. While these laws may be difficult to enforce, especially considering that many of these injuries occur in private homes, laws could provide a motivator for proper safety. The implementation of such a change can bring about awareness on the importance of eye protection, be the instigator of changes in social norms, and create a culture of social responsibility.

Ocular trauma is the leading cause of monocular blindness in the United States. But it doesn’t have to be. Well written legislation addressing this could be the difference between full, binocular vision or a life of permanent disability.

References:

Lee R, Fredrick D. Pediatric eye injuries due to nonpowder guns in the United States, 2002-2012. J Am Assoc Pediatr Ophthalmol Strabismus. 2015;19(2):163-168.e1. doi:10.1016/j.jaapos.2015.01.010
Jones M, Kistamgari S, Smith GA. Nonpowder Firearm Injuries to Children Treated in Emergency Departments. Pediatrics. 2019;144(6):e20192739. doi:10.1542/peds.2019-2739
Protective eye wear for young athletes. A joint statement of the American Academy of Pediatrics and the American Academy of Ophthalmology. Ophthalmology. 1996;103(8):1325-1328.