The Teen Suicide Epidemic & Social Media

The number of kids in the U.S. who visited emergency rooms for suicidal thoughts and suicide attempts has doubled in the last 10 years.  A new article in JAMA Pediatrics found that the number of children between 5 and 18 who received a diagnosis of suicidal ideation or suicide attempts increased from 580,000 in 2007 to 1.12 million in 2015.  The average age of a child at the time of evaluation was only 13, and 43% of the visits were in children between 5 and 11. Pretty alarming.

The authors also state that no conclusions can be drawn regarding the cause for the observed increase, which is likely multifactorial.  Possible reasons for the big increase include stress passed down from parents and caregivers, the rise of social media, and increasing rates of cyberbullying.

Is Social Media a Factor?

A study published in the journal  Clinical Psychological Science entitled Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S. Adolescents After 2010 and Links to Increased New Media Screen Time found a disturbing possible link between teen social media usage and suicide.

The authors found what appears to be a very clear link between social media usage and teen suicide rates. Adolescents who spent more time on new media (including social media and electronic devices such as smartphones) were more likely to report mental health issues, and adolescents who spent more time on non-screen activities (in-person social interaction, sports/exercise, homework, print media, and attending religious services) were less likely.

The study establishes an association between suicide and social media use- which is different from establishing cause and effect…  but it’s hard to overlook the link between social media and teen suicide. Several other studies have shown the direct link between expanded social media usage and teen depression.

Another study from 2017 in  Clinical Psychological Science found teens who use their digital devices more than 5 hours per day are 70% percent more likely to have thoughts of suicide and high school girls who use social media daily are 14% more likely to feel depressed than those who use it only sparingly.

School Suicide Prevention Training in Final Stretch at the Legislature

As the article above mentions- interventions to stem the tide of childhood suicides is multi-factoral and will require a variety of interventions. One such promising intervention that’s on the cusp of approval here is Arizona is SB 1468 which would require some suicide prevention training among some Arizona teachers and school staff.

The Bill (which passed the Senate 28-2 and awaits final approval in the House) would requires school districts, charter schools, and Arizona teacher training programs to include suicide awareness and prevention training in their continuing education curricula.  The bill would require AHCCCS to make suicide awareness and prevention training available (fortunately some evidence- based tools curricula already exist).

Starting in the 2020 school year, school districts and charter schools would need to provide training in suicide awareness and prevention to school personnel in grades 6 to 12.  The bill also establishes requirements for suicide awareness and prevention training and specifically says that the training has to use evidenced-based training materials and instruct participants on how to identify the warning signs of suicidal behavior in adolescents and teens.

Note: Another suicide prevention bill (HB 2488) which requires the ADHS to annually compile a veteran suicide surveillance and prevention report was signed this week (see below in our Legislative Update). 

Legislative Update- April 23

Legislative Update

We’re to the part of the legislative session when bills that passed one chamber are approaching the finish line in the second.  There was some decent action on good bills this week- and a few of our priority bills cleared the House this week! Here’s this week’s Legislative Tracking Spreadsheet courtesy of our public health policy interns Tim Giblin & Annissa Biggane.

Below is a summary for the bills that passed last week -t hey still need to be signed but the Governor however:

Public Health Bills on the Governor’s Desk

SB 1165 now HB 2318 Texting and Driving (Brophy McGee- Campbell)

This bill was a long time coming- but were on the precipice of having this good public policy finally happen- all that’s left is for the Gov to sign it. It will prohibit using a hand-held cell phone while driving.  There are some common-sense exemptions for example if the person is using it hands free etc.  It’ll change driving behaviors and save lives.

Violations are a civil money penalty (no driving points) with the first offense being between $75- $150 and the 2nd offense between $150 and $250.  The bill would provide a state overlay so the cell phone use laws would no longer be different from jurisdiction to jurisdiction. Warnings for a year and a half – and then the penalties kick in.

SB 1247 Residential Care Institutions (Brophy McGee)

This good bill will require more robust staffing background checks for facilities that provide services for children and will remove the “deemed status” designation for child residential behavioral health facilities.  Under current law, facilities in this category (e.g. Southwest Key) can be accredited by a third party (e.g. Council on Accreditation) and avoid annual surprise inspections by the ADHS.  This intervention will provide more oversight to ensure background checks are done and that the facilities are compliant with state regulations. 

Note: still needs to go back to the Senate for a procedure before transmittal to Gov.

SB 1211 Intermediate Care Facilities (Carter)

Like SB 1247, this bill closes a licensing loophole.  This good bill will require more robust staffing background checks for facilities that provide services to people with disabilities at intermediate care facilities.  These facilities would also require a license to operate from the Arizona Department of Health Services beginning on January 1, 2020.  Under current law these facilities (Hacienda de los Angeles and similar facilities run by the ADES are exempt from state licensing requirements)

SB 1040 Maternal Mortality Report (Brophy-McGee)

This bill passed both chambers unanimously but in slightly different forms, so while it passed the House last week 60-0 it still needs to get re vetted in the Senate- which should be no problem.  The new law will establish an Advisory Committee on Maternal Fatalities and Morbidity.

It requires ADHS and the Committee to hold a public hearing to receive public input regarding the recommended improvements to information collection concerning the incidence and causes of maternal fatalities and severe maternal morbidity and complete a report (including recommendations) by 12/31/19.

Note: still needs to go back to the Senate for a procedure before transmittal to Gov.

SB 1089 Telemedicine

Last week in a vote of 60-0 the house passed this good telemedicine parity bill which will improve healthcare access and help lower costs. With this legislation, any healthcare service covered in-person by a commercial insurer will also be covered when provided through telemedicine. Currently, Arizona law limits telemedicine coverage to a handful of medical services. The bill will now go to the Governor to sign into law.

Public Health Bills Signed by the Governor

SB 1109 Short Term Limited Health Plans- extension – AzPHA Position: Opposed

This bill has passed both chambers and has been signed by the Governor.  It authorizes the sale of short- term limited health plans in Arizona for terms up to 3 years.  The previous limit was 1 year.  These plans don’t cover pre-existing conditions and have limited consumer protection because they aren’t required to cover the essential health services under the ACA and can drop enrollees.  We urged a not vote because of the poor consumer protections.

HB 2488 Veteran Suicide Annual Report (Lawrence)

Requires ADHS (starting this year) to complete an annual report on veteran suicides in Arizona that includes the number and rate of veterans who died by suicide, trends, an analysis of the years of potential life lost, a comparison of Arizona’s resident veteran suicide rate to those of the nation, and the relative risk of suicide by race or ethnicity, age group, gender and region.  The report is also supposed to analyze patterns of drugs, or combinations of drugs, that were used by Arizona’s resident veterans when drug poisoning was the mechanism of suicide.

The idea is to create the surveillance and data linkages needed to inform suicide prevention strategies based upon medical risk factors that significantly correlate to suicide.

State Budget

Not much action above the water on the state budget. The state is expected to have a $1B surplus this year and there’s differences of opinion about how much to put in the rainy day fund and of course what other priorities rise to the top of each legislator’s list. 

Our top budget priorities are getting the needed state match for Kids Care (more on that below), an appropriation to cover a new oral health benefit for pregnant Medicaid members (SB 1088), and an increase in the state loan repayment program and residency funds to improve access to care in rural and underserved areas (SB 1354).

Here’s this week’s Legislative Tracking Spreadsheet courtesy of our public health policy interns Tim Giblin & Annissa Biggane.

Measles Communication Resources Site

With the rising number of measles cases in the US and globally- and no end in sight for the erosion of immunization rates in Arizona and elsewhere- it’s more important than ever for our public health system to have resources at their fingertips for how to prepare for and to rapidly and effectively respond to vaccine preventable diseases- measles in particular.  Sadly, this is our new reality.

I found a good resource this week that was developed by the National Public Health Information Center- which is basically a Measles Resources website. The site has a Resource Library with fact sheets, infographics, social media tools, a sample op-ed for you to use once a case is identified.  There’s also an Outbreak Communication Guide for actions you can take before, during and after an outbreak, and the CDC’s measles microsite.

Preventing Suicide: A Toolkit for High Schools

SAMHSA has a toolkit that is aimed at being part of a nationwide effort to help the one out of every fifteen high school students who attempt suicide each year. The toolkit is called Preventing Suicide: A Toolkit for High Schools and it helps high schools and school districts to design and implement strategies to prevent suicide and promote behavioral health.

It provides guidelines for school administrators, principals, mental health professionals, health educators, guidance counselors, nurses, student services coordinators, teachers and others for identifying those teenagers who are at risk and it provides resources for taking appropriate actions to provide help.

It provides high schools with useful information on the many federal, state and community programs that are available to help strengthen their suicide prevention efforts, including the National Suicide Prevention Lifeline (link is external) 1-800-273-TALK (8255). This Lifeline is a 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress.

More Bad about AZ’s Immunization Rates

School Vaccination Rates Drop Again this School Year

At the core – vaccines are really about community protection.  Our public health system depends on a solid network of providers that are available to vaccinate kids for all the nasty infectious diseases that have plagued humanity for millenia.  Vaccinating yourself and your kids is more about community protection than personal protection. It’s a social contract that we have with each other to keep all of us healthy.

We need just about everybody to participate in our shared social contract to vaccinate in order to get the herd immunity.  When communities have herd immunity, those who can’t be vaccinated and folks with weakened immune systems will still be protected because the viruses can’t circulate.  Measles needs a 95% community vaccination rate to achieve herd immunity.

As a means to maintaining herd immunity, Arizona law (ARS-872 & ARS-873) requires that all children attending school or child care have certain vaccines unless they’re exempted by a doctor for medical reasons or by a parent for personal reasons.  

Each year, schools (6th grade, kindergarten, and child care/preschool) are supposed to turn in data about the vaccine exemptions in their school to the ADHS.  

There’s bad news again in this year’s report- continuing a multi-year trend toward higher exemption rates (worse vaccination rates). For the current school year:

  • 6th grade exemption rates went from 5.4% last year to 6.1% this year

  • Kindergarten exemption rates went from 5.4% to 5.9% 

  • Child care exemption rates increased from 4.3% percent to 4.5%

This year’s results can be found on the ADHS’ Immunization Coverage Level page.  You can check out individual school exemption rates on the Arizona School Vaccine Exemption Spreadsheet.

There are some pretty discouraging results in this year’s results. For example, only 27% of Yavapai County schools (12/44) have herd immunity among 6th graders. Coconino County is only at 33% on the same measure (6/18). As in previous years, charter schools tend to have higher exemption rates than public schools. Lots of data to dive into in the spreadsheet. 

Arizona School Vaccine Exemption Spreadsheet

Sadly, several bills that would have improved rates weren’t even heard in committee this year like HB 2162 which would have removed the personal exemption and HB 2352 which would have required schools to post on their school’s immunization rates.

However, several bills were heard that would have eroded immunization rates even further including SB 1115, HB 2471, HB  2472, SB 1116, and HB 2470.  Fortunately those bills appear to be dead for this year- but may very well return.

Enough with the California Bashing

California had also been struggling to maintain herd immunity vaccination rates (just like us).  After trying a variety of interventions- and following a measles outbreak associated with Disneyland- the California Assembly passed & Governor Brown signed Senate Bill 277 (in 2015) which abolished personal exemptions in California.

The intervention worked. In the following years, CA had sharp increases in vaccination rates among kindergarteners entering school. During the 2014–2015 school year the statewide kindergarten full-vaccination rate was only 90.4%. After implementing the new law, the kindergarten full-vaccination rate rose to >95% and has stayed there.

Just saying.

Legislative Update 

House Rules Committee Moves off the Dime 

To be honest, it was another pretty slow week at the Capitol. But, there was some needed action in the House Rules Committee- and some good things happened there (the House Rules committee passed 55 Senate bills this week but 55 are still in backstock). 

The Bills that we’re interested in that were heard in House Rules all passed this week (see last week’s blog), so there will be some action on those this week in Caucus and Committee of the Whole and maybe some floor votes (3rd Read) too. 

Conference Committee Deadline Approaching

This week will be an important one – especially for bills in which there’s a difference between the House and Senate versions.  That’s because Friday (4/19) is the last day for conference committee assignments (bills that have been amended in the opposite house need to return to their house of origin for another vote…  if there isn’t agreement on the amendments a conference committee needs to meet to hammer out a solution).

State Budget

Not much action above the water on the state budget. The state is expected to have a $1B surplus this year and there’s differences of opinion about how much to put in the rainy day fund and of course what other priorities rise to the top of each legislator’s list. 

Our top budget priorities are getting the needed state match for Kids Care (more on that below), an appropriation to cover a new oral health benefit for pregnant Medicaid members (SB 1088), and an increase in the state loan repayment program and residency funds to improve access to care in rural and underserved areas (SB 1354).

Here’s this week’s Legislative Tracking Spreadsheet courtesy of our public health policy interns Tim Giblin & Annissa Biggane.

Your Task Assignment This Week

KidsCare is an important access to care program that gives lower-income families an opportunity to pay an affordable premium and receive Medicaid-like health insurance for their kids.  Right now KidsCare is providing coverage for about 35,000 children in working families. 

To keep KidsCare open, the state legislature needs to include $1.6M appropriation in this year’s budget to cover the state’s portion of this important federal program. 

Simply Click Here to ask your senator and representatives and urge them to insist on a final budget that protects KidsCare. The address you use will automatically send the email to your elected. Please edit the template language a little and personalize it- that works better.

Since the freeze was lifted in 2016, KidsCare has provided 114 children with cancer treatments, almost 8,000 children with behavioral health services, over 5,000 children services for autism, and helped nearly 3,500 children with asthma. 

Oral Health Research News

HRSA-led Study Reveals Use of Sealants Remains Low Among Children

HRSA’s National Survey of Children’s Health revealed that among children ages 6-17 years, only 1 in 5 had received dental sealants within the past year. Together with steps taken at home, in the dental office, or on a community-wide basis (e.g., water fluoridation), use of sealants among children helps prevent dental cavities. 

In the study, 82% of children ages 2-17 years had a preventive dental visit in the past year, but lower rates of specific preventive services: 75% cleanings, 46% fluoride treatments, and 44% tooth brushing/oral health care instructions. 

Research from this study shows preventive oral health services are lagging among young children and children from lower socioeconomic backgrounds. Further studies are needed to identify interventions that encourage the use of preventive services.

Read the abstract.

Posts navigation