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Recruiting Foster Parents


ASTHMA INITIATIVE

A Harlem Hospital study is producing an alarming finding: as many as one in four children in Harlem have asthma. Only halfway through an ambitious effort to test every child within a 24-block area, doctors expected to find rates higher than the national average of 6 percent, perhaps even percentages approaching the high teens, but nothing reaching these heights.

A studyof Philadelphia school children actually produced similar numbers a few years ago, but the children were never examined by doctors. Instead, over 5000 5th and 6th graders were shown a video that dramatized various asthma symptoms and they were asked if they had ever experienced these symptoms or had been told they had asthma: 25 percent said they had, but it was never documented.

Indications were present here in New York that the situation was bad even a decade ago when hospitalization discharge records for children treated for asthma were four times higher than the national average.

But the Asthma Initiative is the first documented study in the nation to get such high results. Many of the children tested, and their parents, were not even aware that they had the disease, a dangerous situation because asthma symptoms tend to get worse if left untreated.

Triggers for asthma include exposure to smoking, cockroaches, dust mites, mold, and dampness. Deteriorating building stock, diesel fumes, as well as cheap home heating oils that contain a high sulfur content are among other factors suspected of contributing to the problem.

The Asthma Initiative is a collaboration between Harlem Hospital's Department of Pediatrics, the Harlem Children's Zone, Columbia University's Harlem Health Promotion Center, Touchpoints and the New York City Department of Health and Mental Hygiene.

INFANT MORTALITY

New Yorkers recently discoveredthat they have a higher life expectancy than the rest of the country, and that includes a 9 percent decline in infant mortality rates, from 6.7 to 6.1 deaths for every 1000 babies born. This number has been declining for years: in 1984, 13.6 children out of every 1000 born had died before the age of one. New York's infant mortality rate is now lower than the national average of 6.9, and compared to other cities for the same period, the rate of 6.1 is less than Cleveland at 9.7, Chicago at 7.5, or Dallas-Ft. Worth at 6.9, but higher than Los Angeles at 5.4 and San Francisco's 4.3.

However, if you look inside the average to its highs and lows, it becomes clear that not every New York family is benefiting from decreased infant mortalities. If you live in Kips Bay in Manhattan or Red Hook, Brooklyn, infant deaths are the lowest in the city: 1.4 to 2.2 per 1000 births, respectively. If you happen to give birth to a child in Central Harlem, however, the death rate more than doubles from the city average to 13.1 babies dying for every 1000 born. In Bedford, Brooklyn, 10 out of every 1000 infants die, and in Flatbush, 7.4. In Manhattan as a whole, the rates actually rose by 6 percent. The New York City Department of Health and Mental Hygiene provides a table (pdf) that breaks down infant mortality rates by neighborhood throughout the city.

Thomas Frieden, commissioner of the Department of Health and Mental Hygiene, acknowledged this disparity in a recent Letter to New Yorkers. "Babies born in poor neighborhoods are 10 times more likely to die than babies born in the most economically advantaged neighborhoods," wrote Frieden, promising to "prioritize public health efforts to communities that need them the most."

The most common causes of infant deaths are premature births/low birth weight, birth defects, and Sudden Infant Death Syndrome.

LACK OF MENTAL HEALTH SERVICES

"Federal Agencies could play a stronger role in helping states to reduce the number of children placed solely to obtain mental health services". An April 2003 reportfrom the General Accounting Office estimates that the families of at least 12,700 children across the country were driven to give up their kids to child welfare agencies or juvenile justice systems because they knew of no other way to obtain mental health services for them. The report suggests that a reduction in costs for mental health services, as well as improved access to these services, could change this situation.

A CAMPAIGN TO RECRUIT FOSTER PARENTS

Foster parents wanted. Mayor Bloomberg and the Administration for Children's Services (ACS) are kicking off a massive campaign to recruit foster parents. There are currently 25,400 children in foster care in the city. In a press conference with the mayor, William Bell, commissioner of the Administration for Children's services, said they are particularly in pursuit of people willing to parent siblings, teenagers, and mentally fragile children. The agency is hoping to attract a foster parent pool from Bedford-Stuyvesant, Jamaica, Queens, Central Harlem, and Concourse/Highbridge in the Bronx, neighborhoods where many of the children come from, so that the children can remain within their own communities.

Severe Acute Respiratory Syndrome


If it weren't for the daily drama of the televised war in Iraq, the mysterious flulike illness from Asia known as SARS, for Severe Acute Respiratory Syndrome, would probably be capturing more local interest.

But, aside from a flurry of rumor-fueled panic in Chinatown, which has experienced a dropoff in tourism due to fears about SARS, New Yorkers seem phlegmatic about the risk posed by the new disease. "It sounds like the flu," said Katherine Bruni, 35. "You know, it'll kill the people the flu kills... the very old, the very young, people with compromised immune systems... I'm not that worried about it, personally."

SARS, may, in fact, be worse than the flu - although there have been no deaths among the 148 suspected SARS cases spread over 30 states in the U.S., SARS has so far shown a mortality rate of about four percent elsewhere in the world, as compared to about one percent for common influenza.

According to the World Health Organization, there were 2,671 suspected SARS cases in 19 countries as of April 8, and 103 people have died. China, where the illness emerged about three weeks ago in Guandong Province, has been hardest hit, with 1259 cases and 53 deaths, according to the health organization. Other countries in Southeast Asia, including Hong Kong, Vietnam and Singapore, are also experiencing substantial outbreaks. On March 15, the World Health Organization issued a global travel alert, cautioning that travel to Vietnam or Hong Kong might pose a health risk. It was the first time the U.N. agency had ever issued such a global alert. The U.S. Centers for Disease Control and Prevention have also issued a travel advisory urging people to avoid discretionary visits to Hong Kong, Singapore, Vietnam, and mainland China.

Seven New York City residents have contracted the disease, all while traveling in Asia recently, city health officials report. Ranging from a one-year-old boy to a 91-year-old woman, they all had mild cases and are recovering. So far, there have been no cases of SARS spreading from person to person in New York City.

Rumors of His Death Exaggerated

Chivy Ngo, owner of the Bo Ky restaurant on Bayard St. in Chinatown, notes that he is very much alive and well, despite rumors last week that he and several workers at his restaurant had died of SARS after Ngo supposedly traveled to Asia. Ngo's "death" was falsely reported last week in a mass-circulated e-mail, and business at his restaurant dropped off to nearly nothing for several days, though it has rebounded since the hoax was exposed, according to Robert Weber, a spokesman for the group Asian Americans for Equality. Weber adds that while tourists and visitors appeared to avoid Chinatown out of fear of SARS last week, leading to empty restaurants and deserted street markets, trade seems to be returning to the area now. "But, business-wise, Chinatown really didn't need a SARS scare. After September 11, that was like having a root canal after a heart attack," Weber says. "No one here is spreading SARS. People should come eat here and enjoy what we have to offer."

U.S. Senator Hilary Rodham Clinton, New York City Health Commissioner Thomas Frieden, and New York City Councilmember John Liu held a joint press conference to discuss how $16 million that Senator Clinton secured on behalf of the Centers for Disease Control to help combat SARS will be used. The conference attendees ate at a Chinatown restaurant.

What Is SARS?

The U.S. Centers for Disease Control has said the cause of the disease appears to be a new mutation of the coronavirus, a member of a virus family which also causes some forms of the common cold. Symptoms of the illness include a high fever (over 104 degrees Fahrenheit), cough, and shortness of breath.

There is no cure for SARS at this time, although the CDC is working on an antiviral agent, a vaccine, and a diagnostic test for the illness.

While the disease is clearly contagious, it is not clear exactly how it is spread -- whether it requires personal contact, or can be spread through the air, as through droplets from a sneeze. It is also not clear whether people can be carriers but not show signs of infection themselves.

"Most of what everyone is saying is based on sketchy data, so it's going to be a while before we know what's going on with this disease," says Arthur Rheingold, head of the Division of Epidemiology at U.C.-Berkeley's School of Public Health. "We don't know the primary routes of transmission yet. We don't understand whether people can be carriers without showing symptoms. Investigators are frantically trying to find these things out."

Don't Panic

Jerry Hauer, acting assistant secretary for public health preparedness at the U.S. Department of Health and Human Services, told the Associated Press on April 7 that health officials are baffled as to why U.S. patients have become less sick than those in, say, neighboring Canada, where SARS has killed 10 people and forced thousands of people in Toronto to be quarantined.

"It might be that some of these folks in Canada just got more of the virus, were in closer contact," Hauer told the AP. "Any theory I give you at this point in time would just be a theory."

Hauer also said the spread of the illness may be slowing. ``I think we've started to stabilize in the number of cases. We're not seeing these large jumps every day,'' he said. But "[w]e don't know yet whether ... we're through act one of a two-act play or whether we're just four lines into a three-act play."

President Bush signed an executive order adding SARS to a short list of diseases requiring mandatory quarantine under the Public Health Service Act. But no one in the United States has been quarantined for the illness, and there are no plans to do so at this time, experts testified before a Senate committee on April 7. Although some experts warn that SARS could yet turn out to be a deadly global pandemic, Berkeley's Rheingold says he doubts it could have the kind of lethal potential as, say, the deadly Spanish flu epidemic of 1918, which killed tens of millions worldwide.

"We have better medical care these days, antibiotics for treating secondary infections, better public health systems in place," Rheingold says. "I would expect that even if we find we have an organism of comparable lethality on our hands, we would do much better, mortality-wise."

To avoid contracting SARS, he says, "Don't travel to Asia unless you have to." Otherwise, he says, take the same precautions as you would to avoid the common cold: "Wash your hands a lot." The average person, he believes, has a "vanishingly small risk of catching SARS on the street."

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.

Diabetes


Diabetes rates have doubled in adults in New York City in the last eight years, according to a recent report from the Department of Health (pdf file), which says the disease is now "epidemic" in people of all ages. Eight percent of the population now suffers the condition, which is the sixth leading cause of death in the city. Amongst children, however, the rate may have risen even more sharply, according to physicians who treat the condition in the community.

"The increase has been dramatic," says Dr. Yolaine St. Louis, chief of pediatric endocrinology at Bronx-Lebanon Hospital and a spokesperson for the American Diabetes Association. Nationwide estimates put the rise at between four and tenfold amongst kids.

Diabetes is a condition in which the body stops responding to insulin, a hormone produced by the pancreas which tells cells to remove sugar from the blood for use as energy and for storage. Two forms are most common: type I, which is a genetic condition in which the immune system kills off insulin-producing cells and type II, which is associated with obesity. In type II diabetes, cells become unable to properly respond to insulin. Type II accounts for up to 90 percent of all cases — and is the form that has been increasing.

In fact, type I is also called juvenile diabetes, because it was once believed that Type II never, or only rarely, affected children. Recently, however, the proportion of children with Type II diabetes has skyrocketed.

Says St. Louis, "I have been working in this area for fourteen years. When I first started, about two to ten percent of cases amongst children were type II, now it's 30 to 35 percent."

The epidemic has hit hardest people of color, and those who are poor — populations which greatly overlap in New York. There seem to be both cultural and genetic reasons why African Americans and Latinos are at higher risk for both obesity and diabetes, and there are environmental reasons why in developed countries, the poor are vulnerable.

"I see a population in Nassau County as well as in the Bronx," says St. Louis. "Even amongst the kids who are more well-to-do, those with an [African American or Latino] background still have more obesity and diabetes." This could be due to a "thrifty" gene, which tells the body to store large amounts of fat in case of famine. In the past, this gene would have given people a survival advantage because people with the gene could store more food from times of plenty for times of scarcity. Now, of course, it can harm.

Cultural factors — such as a common belief amongst Hispanics that thin children are unhealthy — could also play a part. "Black and Hispanic people don't want to be thin like models and it's positive not to worship thinness, but there's also a healthy limit. We cannot as a community be getting this overweight. It has serious health consequences."

The highest diabetes rate in the city is in East Harlem, where 14.9 percent of adults are affected. The hardest hit ethnic group is Hispanics; 12.2 percent of Latino adults have the condition.

Rising rates amongst children foretell an even greater epidemic in the future, if steps are not taken to fight it. St. Louis says that when she first started practicing in the Bronx, it was rare for her to see a child who weighed 250 pounds. These days, she sees such a new patient monthly, sometimes weekly. "You have to be close to 500 pounds to impress me now," she says, sadly.

So what has changed recently to spur such a shocking increase in obesity and its consequences? Genetics, of course, and many cultural practices, do not change rapidly. But recent research has shown that food portion sizes have grown tremendously in the last decade and that people are becoming less and less active.

Lack of safe streets and play areas reduce opportunities for poor kids to exercise even further. Budget cuts now mean that in many city schools, kids have gym class just once a week. "One kid told me that in his school, some grades have no gym. Grades 3, 5 and 7 have gym-but 2, 4 and 6 don't," says St. Louis, who adds, "If gym class is over-filled, the teacher is probably not making sure that the fat kid in the back is participating."

School lunches, however, are not a big culprit. St. Louis says, "No one is getting fat on school lunch. They all hate it." Also, though the food tends to be fatty, the portion sizes are not overly large and schools have recently added things like skim milk, which help.

"After school, they do all this academic stuff," says St. Louis, "And that's great but there is very little physical activity." St. Louis says that while there are organizations like the Police Athletic League and the Boys and Girls' Club in the Bronx, many parents don't know how to get their children involved and need to be given more information.

For adults, making major lifestyle changes in diet and exercise is difficult. For poor children, there are even more barriers. Fast food is cheap and readily available, while fresh fruit and vegetables are more expensive and harder to find in poor neighborhoods.

Fortunately, with diabetes, small changes can make a big difference, and that is how St. Louis is able to help her patients. "A lot of parents don't realize that going from 300 pounds to 280, that's a big deal. It may make the difference between taking one medication or two and the difference between eye disease later in life or none."

St. Louis doesn't tell a patient, for example, that he has to lose 100 pounds or start exercising every day. Research finds that people told to make such huge changes are usually too daunted to start, and get discouraged. Instead, she praises kids for small steps — walking home from school once a week, losing one pound, or even just stabilizing and not gaining.

Since it is hard to get kids to worry about future consequences, which with diabetes are particularly dire and can include blindness, limb amputation and shortened lifespan, St. Louis focuses on teaching them about how diabetes could hurt them in the near term. If it is not properly controlled, diabetes in children can lead to lifelong short stature, because it hinders development. Also, the disease can dramatically affect school performance because blood sugar problems can cause headaches and difficulty concentrating.

St. Louis runs a support group called Sugar Babes, for kids with diabetes and their families. In it, participants discuss how to make small, manageable changes and what to do when kids are resistant. She mentions making more such groups available, getting more fresh fruits and vegetables into schools and poor communities, improving public safety so that kids can play outside, more gym classes as important steps to fight the epidemic. "All of these are issues that as a city we need to address," she says.

Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.



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