Bill to leave children's Covid-19 vaccination decisions entirely with parents and guardians is approved by a House committee

By Melissa Patrick
Kentucky Health News

Kentucky lawmakers have sent the House a bill to ensure that the state's children are not required to get a Covid-19 vaccine and that this decision is the responsibility of the child's parents and guardians.

The bill is designed to keep the Kentucky Department of Education from imposing the requirement by regulation, the bill's sponsor told the March 2 House Health Services committee.  

“What my fear is,” said Rep. Shawn McPherson, R-Scottsville, “is if we don’t decide that the parents or guardian is the one responsible for these children to receive Covid shots, then possibly when we get out of session, the KDE could recommend based on CDC recommendations that before kids go back to school next fall, they have to have a Covid shot.”

Kentucky Department for Public Health graph

Fewer than half of Kentucky's school-aged children are fully vaccinated against Covid-19 and this rate decreases with age. The state Department for Public Health's latest weekly report said 17 percent of the 3,289 new coronavirus cases in Kentucky were in people 18 and younger. 

The committee approved a revised bill that expanded the groups that cannot require a child to get the Covid-19 vaccination from the original bill, which only involved the education department. 

It says: "No person, entity, corporation, company, organization, or government agency, public or private, shall require or coerce in any manner any child to receive a vaccination for Covid-19 or any mutated strain of the Covid-19 virus, other than the child's parents, de facto or legal custodians or guardians." 

Rep. Rachel Roarx, D-Louisville, said she opposed the bill because government officials have a "social responsibility" to make sure people in public spaces are vaccinated against contagious diseaes.

"It's of utmost importance for us to ensure that folks are vaccinated for public-health reasons. . . . For a long time in terms of public settings and public schools, we have required vaccinations, and there are alternatives if a family member does not wish to vaccinate, that's why we have homeschool," she said. 

The committee chair, Rep. Kim Moser, R- Taylor Mill, said this bill is about parental choice.

"This in no way diminishes the value of vaccines, this just gives parents a choice in K-12 on for this specific vaccine," she said. "This is being treated much like the flu vaccine, where the variant is different every season . . . That's why we felt like it was important to give parents a choice and not mandate this." 

The committee approved the bill 14-3, with Roarx and fellow Democrats Lamin Swann of Lexington and Roarx and Lisa Willner of Louisville voting no.

House Bill 101 has received two of its three required readings and is posted for passage on the House floor Tuesday, March 7.

Study of 40 first-time fathers finds that fatherhood changed their brains in ways that could help them be better parents

Centers for Disease Control and Prevention photo

A growing body of research finds that children with engaged fathers do better on a range of outcomes, including physical health and cognitive performance, and a new study finds that fatherhood causes changes in the brain in ways that could influence their parenting, Darby Saxbe and Magdalena Martinez Garcia report for The Conversation, a platform for journalistic writing by academics.

Garcia, who works at the Instituto de Investigación Sanitaria Gregorio Marañón in Madrid, Spain, was the lead author on the study. Saxbe, of the University of Southern California in Los Angeles, contributed to the research.

Despite fathers' increasing participation in child care, they note, there is surprisingly little research about how fatherhood affects men, and even fewer studies focus on the brain and biological changes that might support fathering. Since pregnancy-related hormonal changes help explain why a new mother's brain might change, they explored whether fatherhood also reshapes the brains and bodies of men, in a study of first-time fathers in Spain and California.

Spanish researchers had scanned first-time mothers before conception and two months after delivery, and found that compared to childless women, "The new mothers’ brain volume was smaller, suggesting that key brain structures actually shrank in size across pregnancy and the early postpartum period," Saxbe and Garcia report. "The brain changes were so pronounced that an algorithm could easily differentiate the brain of a woman who had gone through a pregnancy from that of a woman with no children." They also found changes across the brain's gray matter, the layer that is rich in neurons, and changes in the cortex, which is linked to thinking about others, and the subcortex, which is linked to more primitive functions, including emotion and motivation.

The authors say experience-induced brain plasticity happens when you learn a new language or master a new musical instrument, and suggest that this could also happen with the new experience of caring for an infant. They note that there is a small, but growing body of research being done on this topic. 

To learn more about plasticity in new dads’ brains, the researchers studied 40 expectant fathers who were put into an MRI scanner twice: during their partner’s pregnancy, and after their baby was 6 months old. The study also included a control group of 17 childless men.

"We found several significant changes in the brains of fathers from prenatal to postpartum that did not emerge within the childless men we followed across the same time period," they report. "In both the Spanish and Californian samples, fathers’ brain changes appeared in regions of the cortex that contribute to visual processing, attention and empathy toward the baby." They offer the possibility that the brain plasticity in fathers may be tied to how much they interact with their baby, and say that raises the question of whether family policies that increase the amount of time a father can spend with their child during the early postpartum period could help to support the development of the fathering brain. 

"Spanish fathers, who, on average, have more generous paternity leaves than fathers have in the U.S., displayed more pronounced changes in brain regions that support goal-directed attention, which may help fathers attune to their infants’ cues, compared with Californian fathers," they write. However, men who show more remodeling of the brain and hormones may be more motivated to participate in hands-on care. The authors called for more research, noting that future studies with more detailed measures of postpartum caregiving can reveal more about parental brain plasticity in both men and women.

Connections between education and better health to be examined in Foundation for a Healthy Ky.'s day-long online forum Monday

The annual health-policy forum of the Foundation for a Healthy Kentucky, to be held online all day Monday, Oct. 17, will examine the connections between education and better health.

The Howard L. Bost Memorial Health Policy Forum will run from 9:30 a,m. to 4:30 p.m. ET and is free. To register, click here.

“There are many facets of education – often well beyond the four walls of a school building – that impact the long-term health of Kentuckians,” said Ben Chandler, president and CEO of the foundation, promising “a productive conversation around the situation here in Kentucky, including where there are gaps and potential solutions.”

The forum will begin with presentation of the foundation's annual Gil Friedell Health Policy Award, followed by:

9:45 a.m. Making the Case for Funding: Education and Beyond: Considering education as a social determinant of health, panelists will discuss school funding, social safety-net programs’ impact on education, and real examples from urban and rural schools. Mark Neikirk, executive director of the Scripps Howard Center for Civic Engagement at Northern Kentucky University, will moderate a panel of Pam Thomas, senior fellow, Kentucky Center for Economic Policy; Collin Groth, executive vice president of strategy and development, StriveTogether; and Supts. Mike Borchers of Ludlow Independent Schools and Patricia L. Sheffer of Union County Schools.

11:20 a.m. Keynote address from Willie Carver, academic advisor, University of Kentucky Gatton College of Business & Economics, and the 2022 Kentucky Teacher of the Year. (Lunch break follows.)

12:30 p.m. Literacy for Life: Critical Lessons for Positive Health: They’re lessons most don’t receive in school but can mean the difference between addressing and overcoming life’s challenges or becoming overwhelmed. Panelists will discuss mental health and emotional literacy, financial literacy and navigating systems, and how nutrition education impacts hunger long-term: Matthew B. Courtney, state Department of Education; Nichole Huff, Extension specialist for family finance and resource management, UK; and Heather Gibbs, Department of Dietetics & Nutrition, University of Kansas; moderated by Stephanie Gastauer, director, Stober Drives, Maysville.

1:45 p.m. Linked But Addressable: Helping Families Overcome Obstacles: A look at how family income plays a critical role in the academic outcomes of students, and therefore, the lifelong health of individuals. Brad Hershbein, senior economist, W.E. Upjohn Institute for Employment Research; Felicia C. Smith, president and CEO, National Center for Families Learning (moderator) and Ashley Spalding, research director, KCEP.

3 p.m. Breaking Down Barriers: Real Examples of Kentucky Communities Making Positive Change: Panelists will share about connecting families with early childhood intervention services; public schools and public health collaborating on mental health services; and, how a community is working to chart paths for non-traditional career building: Ashley Brandt, director of early care and education, Metro United Way; Jen Harris, director, Todd County Health Department; Dr. Robert Boone, chief officer, National Workforce Solutions, Career Team, Bowling Green; moderated by Rufus Friday, executive director, the Hope Center, Lexington.

4:15 p.m. Closing session, led by Allison Adams, vice president for policy, Foundation for a Healthy Kentucky.

The forum was created in memory of Dr. Howard L. Bost, a notable health economist and founding member of the foundation’s board of directors.

Annual policy forum will focus on role of education in health

Individual and public health are influenced by many things, including the educational characteristics of people and their communities. Education will be the focus of the Foundation for a Healthy Kentucky’s 2022 Howard L. Bost Memorial Health Policy Forum, to be held virtually from 9:30 a.m. to 4:30 p.m. Oct. 17.

The forum will look at the connection between educational opportunities and health outcomes of Kentuckians, as one of the social determinants of health. Presenters and panelists will consider education as a cornerstone of Kentucky’s health outcomes. It is offred free of charge. Register here.

“Education is more than what happens between the four walls of a school building,” said Ben Chandler, president and CEO of the foundation. “Educational factors that influence health outcomes include everything from life skills — mental health, emotional literacy, financial literacy, and nutritional literacy — to local community programs, such as out-of-school care and workforce training, to equity issues. It’s important we consider all the factors of health to find ways to make a positive impact.”

Looking beyond the K-12 education system, panelists and presenters will discuss programs that can enhance education and provide more equitable access, while leading to better health outcomes for individuals and communities. Attendees will learn about replicable community-oriented collaborations and coordination between sectors that have led to improved health overall.

The 2022 Kentucky Teacher of the Year, Willie Carver, will give the keynote address. Sessions will include:

• Making the Case for Funding, in Education and Beyond: Considering education as a social determinant of health, panelists will discuss school funding, social safety net programs’ impact on education, and real examples from urban and rural schools.
• Literacy for Life (Critical Lessons for Positive Health): They’re lessons most don’t receive in school but can mean the difference between addressing and overcoming life’s challenges or becoming overwhelmed. Panelists will discuss mental health and emotional literacy, financial literacy and navigating systems, and how nutrition education impacts hunger long-term.
• Linked but Addressable; Helping Families Overcome Obstacles: A look at how family income plays a critical role in the academic outcomes of students, and therefore, the lifelong health of individuals.
• Breaking Down Barriers; Real Examples of Kentucky Communities Making Positive Change: Learn how local communities are lifting up families. Panelists will share about connecting families with early childhood intervention services; public schools and public health collaborating on mental health services; and, how a community is working to chart paths for non-traditional career building.

The forum is designed to raise awareness of the health issues impacting Kentuckians and highlights model strategies and policy opportunities to improve Kentucky’s health. The foundation created it to honor Dr. Howard L. Bost, a notable health economist and a founding member of the foundation’s board of directors. It welcomes a range of audiences, inside and outside the health industry – including health care advocates, providers and educators, business professionals, civic leaders, policy makers and more.

Updates on the forum are at Healthy-KY.org/bost-forum-2022.

 

Doctor shares how to support your child in a Covid-19 vaccination

Photo illustration from Sussex Travel Clinic

By Dr. Lindsay Ragsdale
University of Kentucky

If you have with children under the age of 5, you may be now looking to bring your child to a vaccination clinic to receive the Covid-19 vaccine following the recent emergency-use authorization from the Food and Drug Administration and the recommendation from the Centers for Disease and Control Prevention Advisory Committee on Immunization Practices.

The Pfizer and Moderna vaccines are the two vaccines authorized for children ages 6 months to 5 years old. The Moderna vaccine is a two-dose series separated by 28 days and the Pfizer vaccine is a three-dose series separated by 21 days and 60 days, respectively. At many clinics, parents will be offered the choice of either Moderna or Pfizer for their child.

Here are some helpful tips to support your child before and during COVID-19 vaccination:

• Be honest and calm. Talk to your child in simple terms before vaccination about where the shot will go, and what they can expect to feel when receiving a shot.
• Role-play before the appointment. Planning and practicing what exactly will happen can help reduce fear in children who may be afraid of needles.
• Bring items that comfort your child, such as a favorite blanket, toy or book.
• Distract your child. Bringing your child’s attention away from the professional administering the shot can help relieve stress and lessen fear.
• Ask your doctor for a numbing cream or spray.
• Ask your child to sit or lay down during vaccination to prevent fainting. Younger children can also be held in recommended ways that gives comfort and support.

After your child receives the Covid-19 vaccine, it is important to stay for 15 to 30 minutes so your child can be observed in case they have a severe allergic reaction. You can ask your child’s health care provider for steps you can take at home to relieve pain and comfort your child after vaccination. Also, make sure that your child receives their Covid-19 Vaccination Record card before leaving the clinic.

Mild reactions, such as some pain and swelling where the shot was administered, or a fever are common symptoms. If any occurring symptom after the vaccination concerns you, contact your child’s doctor.

For families who are undecided about the Covid-19 vaccination for younger children, we encourage open conversations with their pediatrician or primary care provider. More information can be found at the CDC website and American Academy of Pediatrics website.

Lindsay Ragsdale, M.D., is chief medical officer for Kentucky Children's Hospital.

Coronavirus numbers continue on a rough plateau in Kentucky; officials cite safety and effectiveness of vaccine for kids

Kentucky Health News graph, from state data

By Melissa Patrick and Al Cross
Kentucky Health News

With Wednesday's coronavirus metrics about the same as Tuesday's, the pandemic in Kentucky remains on a rough plateau.

The state reported 1,669 new coronavirus cases on Wednesday, bringing its seven-day average down to by just four, to 1,212. Of today's cases, 25% were in Kentuckians 18 and younger. 

The percentage of Kentuckians testing positive for the virus in the last seven days is 5.05%, the same level that was reported Tuesday. 

Kentucky hospitals reported 762 Covid-19 patients, 14 fewer than Tuesday; 232 of them ion intensive care, down seven; and 137 Covid-19 patients in need of mechanical ventilation, up four.  

Fewer hospitals are using more than 80% of their intensive-care capacity. The daily report shows only five of the state's 10 hospital regions above that level, but four were above 90%. 

Kentucky Health News graph from state data

The state's seven-day infection rate is 22.19 daily cases per 100,000 residents. Counties with rates more than double that rate are Russell, 95.6; Green, 94; Clinton, 75.5; Adair, 71.4; Powell, 54.3; Jackson, 50.4; and Trigg, 44.9. Forty-six of the 120 counties are in the red zone, for those with more than 25 daily cases per 100,000. 

Kentucky's infection rate ranks 25th among the states, according to Centers for Disease Control and Prevention data analyzed by The New York Times. 

The deaths of 22 more more Kentuckians were officially attributed to Covid-19, bringing the pandemic death toll to 9,856. 

Wednesday was the first day that children between the ages of 5 and 11 can get the Pfizer-BioNTech Covid-19 vaccine. Evelyn Schultz of WLEX-TV tells the story of 11-year-old Wyatt who, along with his siblings, was one of the first in his age group to get it. "It didn't even hurt!," he said. 

"It's a really big deal" to have a vaccine for kids 5 to 11 because many infections are occurring in this age group, National Institutes of Health Director Francis Collins told Andrea Mitchell of NBC News. He said the vaccine "should make it more feasible for kids to say in school without having outbreaks."

Collins said federal officials are making a big effort to get the vaccine to pediatricians because "that's where parents are used to taking their kids. . . . We want to be sure it's not hard for parents to get their kids immunized."

Asked what he would say to the many parents who are reluctant to get their children vaccinated, Collins said, "I hope parents who are still in the wait-and-see will have a chance to look at the data . . . There were no serious side effects" in the clinical trials.

The trials weren't large enough to nail down the rate of myocarditis, a heart condition that has been found in mostly young, vaccinated males, but Collins said it happens in 1 of 10,000 cases, and the disease is "easily treatable" and reversible. He said that small risk should be balanced with the "substantial" risk from Covid-19, which has hospitalized more than 1,000 kids 5 to 11 and killed 145, and also poses the risk of multisystem inflammatory syndrome, while the vaccination risk is "mostly limited to sore arms."

"Here's where we have some work to do with many parents," Collins acknowledged, but said they may come around, noting that when vaccines for adults first came out, only 34% said they wanted one but their vaccination rate is now more than double that.

President Biden touted the vaccine at a news conference. "For parents all over this country this is a day of relief and celebration," no longer "having to worry what's coming on" if a child develops a cough or a sniffle, he said. "Children make up one-quarter of the cases in this country, and while rare, children can get very sick from Covid-19."

Sense of community and common sacrifice missing among many in pandemic, especially some politicians, Silas House writes

House (Berea College photo)

In a 1,634-word article for The Atlantic, Appalachian Kentucky writer Silas House explores the resistance to masking to fight the coronavirus. He begins by recalling his grandmother's stories of sacrifice during the Great Depression and World War II, and his parents' help for the less fortunate, and the lessons he learned from them.

"I was taught to sacrifice my own comfort for the good of others, whether it be by volunteering my seat to elders in a crowded waiting room, letting a pregnant woman go in front of me in the grocery line, or giving half of my sandwich to a hungry classmate," House writes. "Sacrificing for the common good was something most of us were taught when I was growing up. Just a few decades later, I’m seeing people in my hometown, and all over the country, thinking only of themselves. They’re not just unwilling to make sacrifices for others during a pandemic; they’re angry about being asked to."

House's object example is Gov. Andy Beshear's mask mandate for schools, and he goes beyond his usual craft to commit journalism, interviewing upset parents and Science Hill Independent Schools Supt. Jimmy Dyehouse, who called Beshear a "liberal lunatic" in a message to parents. "He said that many studies had proved that masks were ineffective," House reports. "He didn’t cite any sources, but at least 49 scientific studies go against his claims."

Conversing with parents on Facebook, "Two of them said that their children broke down in tears at the news of having to go to school in a mask," House reports. "Others say the masks hamper social life, hinder education by being a distraction, and keep students from understanding their teachers. Several told me the masks are making kids sick because they are breathing in the same carbon dioxide repeatedly, a claim that has been widely debunked."

After noting recent statements of U.S. Sen. Rand Paul and Fourth District Rep. Thomas Massie, House says his grandmother "would have been disgusted by the politicization of a virus that has now killed more than 620,000 Americans. . . . Maybe too few people today understand the necessity of putting aside one’s own comforts to help others. Perhaps our sense of community has suffered in the digital age. It seems to me, however, that most of the blame should go to politicians who care more about stirring up fear to defeat their opponents than they do about people’s lives or the economy. And I blame anyone who intentionally spreads misinformation to further their own agenda."

With less than half the year gone, Kentucky has already had more drownings than it had all last year; top cause of death, ages 1-4

Photo from The Indianapolis Star 

With public swimming pools closed due to the pandemic, and some families having more free time from work, the number of drownings in Kentucky this year, 33, has already surpassed the number for all of last year, 32, according to the state Department of Fish and Wildlife Resources.

The causes aren't clear, but "With pools now scheduled to open at the end of June, parents and guardians need to keep an eye on their children to ensure their safety in any body of water," Norton Healthcare says in a news release, citing the state figures.

The fish-and-wildlife agency says there have been 14 drownings in lakes, reservoirs and streams in Kentucky since May 23, the start of the Memorial Day weekend.

“It’s concerning that we’ve seen a rise in drownings even before many pools are open,” said Brit L. Anderson, pediatric emergency medicine physician at Norton Children’s Hospital in Louisville. “While many people are aware of the risks of swimming pools, it’s important to remember that other bodies of water can be dangerous, including ponds, rivers, drainage ditches and even bathtubs or backyard wading pools.” 

Drowning is top cause of accidental death in children ages 1 to 4 in the U.S., according to SafeKids.org. Two-thirds of toddlers' drownings occur from May to August, so the summer is the time to safeguard children, the Norton release says. And the safeguarding need to be vigilant; the National Drowning Prevention Alliance says nearly 90 percent of child drownings happen when at least one adult is present.

“Children require constant, attentive supervision when they are in water,” Anderson said. “If there are multiple adults, they need to communicate to make sure someone is watching the water without distraction. Drowning is often silent and can happen quickly.”

Here are safe swimming reminders from Norton:

• Don’t swim alone, especially children. Use the buddy system so there’s always someone looking out for you and loved ones.
• At least one adult should supervise children around water at all times. Don’t let yourself get distracted by talking with friends, reading, drinking alcohol or using your phone when it’s your turn to supervise. Adult supervisors should be trained in CPR.
• If you own a pool, make sure it has a fence completely surrounding it, separating it from the house.
• Teach children lifesaving skills, such as how to float on their back, tread water and move to the side of the pool to climb out.
• Don’t rely on inflatable toys and water wings to keep a child safe. Children can easily fall off of toys or slide out of wings and slip under the water. If the child is using inflatables, you should be right there with a child, especially if he or she cannot swim.
• Kentucky law requires each occupant of a boat to have ready access to a U.S. Coast Guard-approved life jacket. Children younger than 12 must wear a life jacket while in the open portion of a boat that is underway.
• Most boating accidents, particularly among teens, are related to alcohol. Be sure teens know about the dangers of alcohol, on and off the water.

Students will be expected to wear masks if they can't stay six feet apart, education chief tells superintendents; guidelines due Wed.

Senior Jordan Alvarez wore a mask as he adjusted his cap for a portrait during cap-and-gown distribution for seniors at STEAM Academy in Lexington. (Photo by Matt Goins, Lexington Herald-Leader)

Read more here: https://www.kentucky.com/news/coronavirus/article243713727.html#storylink=cpy

"If Kentucky public school students can’t stay six feet apart, they will likely be expected to wear face masks at school to curb the covid-19 pandemic when buildings reopen in the fall, Kentucky Education Commissioner Kevin Brown said Monday during a virtual meeting with superintendents," Valarie Honeycutt Spears reports for the Lexington Herald-Leader.

“The mask may be the number-one thing we can do,” Deputy Health Commissioner Connie White told the superintendents, some of whom had warned in an earlier conference with the state officials that a mask requirement would be difficult to enforce because of parental opposition.

"Brown said while state officials know that students won’t be able to wear a mask every minute of every school day, he hopes that district officials will give it their best effort," Spears reports.

Education officials said Gov. Andy Beshear plans to announce guidelines Wednesday for school openings.

Those guidelines may include "serving meals in the classroom, in the gymnasium, and even the hallway," Spears reports. "The state guidance on school meals released Monday also said that chairs should face in the same direction during meals, that deep cleaning would be required of food service areas, and that extra time would be given for students to wash their hands. Precautions, such as social distancing and temperature taking, will be used by food-service workers."

Coping with covid-19: It's important to maintain mental and behavioral health, especially among children, experts say

Sandra Wilson logged into a school-supplied iPad at Klondike Elementary in Louisville. Students are getting lessons remotely while not attending school. (Courier Journal photo by Michael Clevenger)

By Al Cross
Kentucky Health News

The covid-19 disease and the coronavirus that causes it have caused much uncertainty: How long will it last? How bad will it get? What do I need to do to protect myself, my loved ones and my neighbors?

"The most difficult thing about this is uncertainty, and uncertainty leads to anxiety," Dr. Allen Brenzel, the Department of Behavioral Health medical director, said at Gov. Andy Beshear's Saturday afternoon press conference.

Anxiety isn't all bad, Brenzel said: It can make us pay attention and do things, but "We have to be careful not to be overwhelmed by our anxiety." He offered suggestions:

• Get information from reliable sources.
• "Don't over-expose yourself to too much information." Take a break from social media and online searches "to try to live your life."
• "Preserve your routine as much as possible."
• Take care of your basic health, to remain resistant to disease: practice social distancing, get enough sleep and exercise, preferably outdoors.
• While social distancing is important, don't become isolated. "Being together is really important for us to reduce our anxiety."
• Look for other ways to reduce stress, and if you get overwhelmed, get help.

"Mental health is going to be critically important in getting through this," Beshear said Sunday.

Children deserve special attention. "The onslaught of information about covid-19 can be overwhelming even for grown-ups. For the newest generation, plugged in nearly 24/7, it can be downright frightening," writes Mandy McLaren of the Louisville Courier Journal.

For example, children may see events in other countries and think those things are happening in their locality, Brenzel said. "Limiting media contact for children can be very, very important," he said.

McLaren quotes Sandra Wilson, a Louisville nine-year old who turns on the TV for news updates as soon as she wakes up": "I'm really scared ‘cause I really don't want to die."

Brenzel said parents should help children "feel comfortable asking questions," and give answers that are age-appropriate -- and don't mislead or lie, to maintain trust.

McClatchy Co. newspapers, including the Lexington Herald-Leader, published a story saying essentially that, and giving details.

Parents first need to take care of themselves, so they can properly care for kids, Brenzel said, and "model things they need to do," such as washing hands and keeping distance.

"Studies confirm that looking at adorable
animals is good for your health," says the
Cincinnati Zoo, showing this red panda.

With schools closed and children separated from friends and social supports, he said, parents should find ways to help them interact, perhaps online. For example, the Cincinnati Zoo says it is starting a "Home Safari Facebook Live each weekday at 3 p.m. ET where we will highlight one of our amazing animals and include an activity you can do from home."

And if parents see behavioral changes in their children, they should seek advice from mental-health professionals, Brenzel said.

Over 1/3 of Ky. students in violation of rule requiring hepatitis A shots; other immunizations fall short; report has county figures

Photo illustration from NaturalHealthNews.com

More than a third of Kentucky school students are in violation of the year-old state law requiring them to be vaccinated for the liver disease hepatitis A, according to the annual report by the state Department for Public Health on student immunizations.

"While hepatitis A rates were the lowest of all required vaccines, they reflect a broader trend: Kentucky students still aren’t getting the required number of shots," reports Alex Acquisto of the Lexington Herald-Leader. "Kindergartners, who have the highest compliance rates to meet, failed to meet state standards in all categories."

Only 65 percent of students in kindergarten, seventh grade and the 11th and 12th grades had received at least two doses of the hepatitis A vaccine. Only kindergartners, at 84.3%, came close to "meeting the state’s target compliance rate of 85%," Acquisto notes. "Rates were lowest among high school seniors, at 46 percent, followed by high school juniors at nearly 50%, and seventh graders at 76%."

Among high-school students, Hickman County was the only one that met the 85% hep-A standard; it also was the only one where juniors met the target compliance rates for all immunizations. Nearby Ballard County was the only one to meet all of the target compliance rates for seniors.

In Johnson County, only 9 percent got two hepatitis A shots, and the county was out of compliance with every immunization requirement for high schoolers, according to the county-by-county report.

In adjoining Magoffin County, where 21% of high school seniors and 14% of juniors got two hep-A shots, School Supt. Scott Helton told Acquisto there isn't a sense of urgency. “When it’s change, it’s always hard at first,” Helton said. “Most people seem to think it won’t happen to them.”

The state required hepatitis A vaccination for the current school year after an outbreak of the disease, which began in late 2017 and has infected 4,943 Kentuckians and killed 61. "One health official says initially low rates of compliance are normal, even in the face of a public-health crisis," Acquisto reports, quoting Dr. Sean McTigue, a University of Kentucky infectious disease pediatrician.

“Anytime there’s a vaccine that’s added to school requirements there’s some hesitancy among parents, even though this is not by any stretch of the imagination a new vaccine,” McTigue said, adding that it will take “at least two years,” to get close to 85%, because immunization requires two shots six months apart and the school year lasts nine to 10 months. "Most children and teens get vaccines from their pediatricians, who they might only otherwise see once a year," Acquisto notes.

Stigma is also an obstacle, because other strains of hepatitis "are spread primarily by sharing needles for injection of drugs," Acquisto reports. Unlike blood-borne hepatitis C, hepatitis A "is spread primarily through contact with an infected person, or through consumption of fecal material, usually by way of unclean food or water."

Reporting and exemptions

In addition to the lack of vaccinations, there is a lack of reporting, Acquisto notes: "State law requires immunization records to be filed within two weeks of when a student begins attending school, but the report shows 796 high school seniors didn’t provide vaccination records to their schools at all, along with 1,087 11th-graders, 674 seventh-graders, and 1,696 kindergartners — 8%, total.

"Some counties reported significant numbers of students who had no vaccination certificate on file. In Robertson County, 23 percent of high school seniors had no immunization record on file. The same went for 25 percent of Wolfe County kindergartners, 10 percent of Magoffin County seventh-graders, and 15 percent of Clark County juniors."

The report does not include the estimated 19,250 students who are home-schooled, because the state law requiring immunization does not apply to them.

In 2017 the state made it easier to claim a religious exemption from the immunization law. "Roughly 4%, or 2,040 students, claimed a religious exemption, while 2.3%, or 1,175, claimed a medical exemption," Acquisto reports. "Carlisle County had the most high-school seniors, 6%, who claimed a religious exemption, followed by 3.4% of Jessamine County eleventh graders, 5.5 percent of Clinton County seventh graders, and 5% of Crittenden County kindergartners.

Public-health experts worry that the exemptions and the anti-vaccination movement threaten "herd immunity," which occurs when enough people have been immunized against a disease to protect others who are not immunized. (Some can't get vaccinations because their immune systems are too weak to allow them to get shots, or because they are too young.)

The report quoted research that has found high immunization rates are “particularly difficult” to maintain “as populations become more sophisticated and more likely to question recommendations. Unless direct communication about the social benefits of vaccinations are relayed to parents, there will continue to be increases in ‘free-ride’ or reliance on herd immunity to avoid vaccination within school settings. Therefore, more education needs to be provided to parents about the public health impacts vaccinations have within schools, especially for the protection of vulnerable students who are immunocompromised.”

Louisville campaign works to decrease high suicide rate among LGBTQ+ youth; focuses on importance of parental support

A new campaign in Louisville is working to decrease the high suicide rate among high school students who identify as lesbian, gay, bisexual, transgender and questioning by emphasizing the importance of parental support.

In the United States, high school students who identify as LGBTQ are almost five times more likely to attempt suicide than their cisgender, heterosexual peers, according to the National Alliance on Mental Illness. (Cisgender is the term for a person whose sense of personal identity and gender corresponds with their birth sex.)

“Though educating their parents can’t solve everything LGBTQ+ youth face, it’s a great place to start especially when the statistics speak so loudly for themselves,” Ryan Combs said in the news release. “When parents support their kids, youth have better mental health outcomes.”

The project, called "Embrace the Journey," is led by Combs, an assistant professor in the School of Public Health and Information Sciences at the University of Louisville, and Maurice Gattis, associate professor in the university's Kent School of Social Work. It was developed through the guidance of local health providers, public health professionals, LGBTQ+ youth and community members, says the release. (The + at the end of LGBTQ stands for "and others" and ensures an inclusiveness of all identities.)

Combs told Kentucky Health News that the campaign will start in Louisville and includes a 40-mile radius, with hopes of expanding it if successful.

The project stems from the findings of the U of L 2017 LGBTQ+ Adolescent Health Study, which found that 100 percent of the participants had heard homophobic or transphobic language, 61 percent felt unsafe and 27 percent had experienced physical violence at school, according to the release.

“We wanted to understand the health needs of LGBTQ adolescents in Louisville. We learned that the largest concern locally is mental health, especially depression, anxiety and suicidality,” said Combs. “We designed a campaign to target parents because they play such a key role in the mental health of LGBTQ youth."

The reason LGBTQ+ adolescents report higher levels of poor mental health than heterosexual and cisgender youth isn't because of their identity, "but rather that LGBTQ+ youth are often bullied and mistreated for their sexual orientation and / or gender identity / expression, feel misunderstood by other peers and adults in their lives, lack access to affirming health and social services, and are made to feel that who they are is wrong, shameful or politicized," according to the campaign's website.

It continues, "Studies show that when LGBTQ+ adolescents have support from even one adult – especially support from a parent or guardian – they are much more likely to maintain mental healthiness."

The campaign launched at a recent Louisville Pride Foundation event, where organizers spoke to participants and handed out posters that read: “LGBTQ+ youth are more likely to experience depression, anxiety, and suicide – supportive parents greatly reduce this risk.”

Parents of LGBTQ youth can find more information about this campaign and additional resources at
embracethejourneylou.org, including advice from other parents, personal narratives from youth and a glossary of LGBTQ vocabulary.

The campaign was developed with grants from the Cooperative Consortium for Transdisciplinary Social Justice Research at U of L and JustFundKY, an anti-discrimination foundation, and works closely with Louisville Youth Group.

The poorer the household, the more likely its kids are to inhale secondhand smoke; Ky. is poor and has 2nd highest smoking rate

Study charts show less exposure among older youth, who tend to spend more time outside the home.

Children who live in poverty are nearly three and a half times more likely to be exposed to secondhand cigarette smoke than their counterparts in high-income households, a new study says.

The National Health and Nutrition Examination study, released by the National Center for Health Statistics, found that from 2013 to 2016, nearly 55 percent of children aged 3 to 17 whose families are below the federal poverty level were exposed to secondhand smoke. That was the case for only 16 percent of those living in well-to-do households, those with incomes at or above 400% of the poverty level, which for a family of four is income of $103,000 a year.

Secondhand smoke exposure is defined by the presence of a metabolite of nicotine, in blood, urine or saliva. African American youth, at all income levels, had the highest levels of exposure; overall, 62% were exposed. After declining for decades following the 1980s, these percentages have remained steady in recent years; Kentucky has the nation's second-highest adult-smoking rate, 26%, and its household-poverty rate of 17.2% is the fifth highest among the states.

"These children and teens are sicker, they miss more days of school, and they're at higher risk for heart disease, stroke and lung cancer as adults," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky. "One of the most important health benefits of Kentucky's new tobacco-free schools law is that it reduces kids' exposure to secondhand smoke where they spend a significant chunk of their time, both during the school day and at after-school events. We urge every Kentucky school district to move quickly to adopt and implement a tobacco-free policy in compliance with the new law." The law takes effect statewide in August 2020, except in school districts that opt out of it.

Specialists give parent-education campaigns credit for big decline in Sudden Infant Death Syndrome in Kentucky

Fewer babies in Kentucky are dying from Sudden Infant Death Syndrome, and wellness specialists are crediting a multi-pronged educational campaign by hospitals and other health-care providers, reports Ann Bowdan of Louisville's WLKY-TV.

In 2016, 103 Kentucky children died of SIDS. By 2018 the number had dropped by more than half, to 49.

"We have done everything from teaching in our prenatal classes, there is literature that goes home, it’s on our website," Norton's Children's Hospital wellness specialist Erkia Janes told Bowdan. "It’s seeped through every class we have."

For many years, parents were given the wrong advice, "For decades, it was thought a baby sleeping on its back could choke on reflux, or vomiting," Bowdan reports. "But in 1994 the American Academy of Pediatrics reversed that way of thinking," based on research. Janes said, "The research clearly shows that a baby on their belly is desperately as risk for SIDS."

The educational materials use "ABC" to describe how a baby should sleep: "alone, on your back, in a safe crib," Janes said. "Meaning no blankets, bumpers, and no sleeping in a bed with parents."

Anecdotal reports suggest that injured teen athletes who are prescribed opioids are getting addicted, but research is conflicted

By Melissa Patrick
Kentucky Health News

Three high-school athletes, two playing football and one a swimmer, recently told NBC News how they got hooked on opioids after being prescribed them for sports injuries. The news story warned parents to ask questions before allowing their children to be prescribed opioids.

John Haskell was one of those teens. He said at age 15 he was prescribed a powerful painkiller after his fourth concussion playing football to treat his excruciating headache.

"He looked in my ears, checked my hearing, checked my eyes. And the next thing I know, I'm at CVS getting Vicodin," Haskell told Jenna Bush Hager and Aliza Nadi of NBC News.

After going through his third refill of Vicodin, Haskell said he started buying it illegally, but eventually switched to heroin because it was cheaper.

A health expert encouraged parents to talk to their doctors about alternative treatments to opioids.

"As a parent, you need to take a more advocating role and ask your provider why are they going this route," Dr. Harold Shinitzky, a sports psychologist, told NBC. "Why is it automatically an opioid or a painkiller?"

After going through treatment, Haskell, now 18, is sober, as are the other two teens in the video.

What the research says

While a study published in Pediatrics released earlier this year found that teen athletes are less likely to abuse prescription painkillers than those who don't play sports or exercise, other research, published in the American Journal of Public Health, says that teen athletes participating in high-injury sports have a 50 percent higher odds of doing so.

Philip Veliz ,the lead author of both studies said that while anecdotal evidence that prescribing opioids to teens after a sports injury is leading some of them to becoming heroin addicts, current research does not support this claim, James Bernstein of HealthDay News reports.

Bernstein writes, "Veliz said, no large-scale studies have assessed whether abuse of recommended painkillers is actually leading to an "epidemic" of heroin use among teens who frequently engage in sports and exercise. On the contrary, this new study suggests there may be "positive social connections embedded in sports that can deter youth from serious types of illicit substance use," such as heroin or cocaine."

However, Veliz also noted that more research is needed to determine why some intense contact sports, like football and wrestling, place teens "at greater risk" for painkiller abuse,

The 2015 Youth Behavior Risk Behavior Survey found that almost 13 percent of Kentucky's high school students said they have ever taken a prescription drug without a doctor's prescription. Nationally, that number is closer to 17 percent.

Got a virus? You don't need an antibiotic but you might get one; Kentucky leads the nation in outpatient antibiotic prescriptions

Antibiotics don't cure illnesses caused by viruses, and can even cause "dire consequences" when used inappropriately, so it's important to take them only when necessary, says a news release from the state Cabinet for Health and Family Services.

"Antibiotics are the only drugs where use in one patient can impact the effectiveness in another patient," Andrea Flinchum, a registered nurse and coordinator for the Kentucky Department for Public Health’s Healthcare-Associated Infection Prevention program. "They are wonderful tools in fighting bacterial or fungal infections – but prescribing them for viruses or taking them for illnesses they do not treat, can cause bacteria to become resistant to these drugs."

Parents need to know that illnesses like the common cold, the flu, runny noses (even with yellow and green mucus), coughs, bronchitis, sore throats, most sinus infections and some ear infections are usually viral and antibiotics won't cure them, says the federal Centers for Disease Control and Prevention. In addition, antibiotics won't help your child feel better and won't keep others from catching your child's illness. Viral illnesses usually go away without treatment in a week or two.

The problem is that when your child takes an antibiotic when they don't need it it kills the good bacteria in your child's body, which can lead to complications, like diarrhea or yeast infections.

Overuse can also lead to bacteria developing resistance to a medication, making infections stronger and harder to kill. Sometimes these infections are so severe that they cannot be cured with antibiotics and thus require stronger treatments, and possibly hospitalization. The CDC estimates that each year 2 million Americans get an infection with antibiotic-resistant bacteria and every year 23,000 of those patients die.

The CDC estimates that more than half of the antibiotics given for upper respiratory infections and nearly a third of antibiotics used in hospitals are prescribed inappropriately. Kentucky has the highest prescribing rate for antibiotics in the outpatient setting in the U.S., Flinchum noted.

"It is critical to use these life-saving drugs when truly necessary, while also using the right drug at the right dose and duration to protect the effectiveness of antibiotics," said Flinchum. "We encourage clinicians to improve prescribing habits and patients to ask their providers if antibiotics are truly needed for their care."

Tips for smart antibiotic use:

• Don't insist on an antibiotic if your health care provider diagnoses your child's illness as a virus.
• Remember, antibiotics only treat bacterial infections.
• Some ear infections DO NOT require antibiotics.
• Most sore throats DO NOT require an antibiotic, unless it's strep throat.
• Green colored mucus is NOT a sign that an antibiotic is needed.
• Take as prescribed, not doing so can cause antibiotic resistant infections.
• Don't save half-used bottles of antibiotics for future use.
• Don't share antibiotics.
• Prevent infections by keeping your hands washed.
• Get a flu vaccine.
• If taking an antibiotic, call your doctor if you don't see improvement within three days.

Talking to teens about sex makes them (especially girls) have safer behavior, here's expert advice on how to talk about it

As uncomfortable as it may be to talk about safe sex with a teenager, it can have a positive impact, especially for girls, according to a new study published in the Pediatric Journal of the American Medical Association.

"Sexual communication with parents, particularly mothers, plays a small protective role in safer sex behavior among adolescents; this protective effect is more pronounced for girls than boys," says the study report.

The study examined the link between parent-adolescent communication about sex and safer sex practices among youth. It analyzed 52 studies on the topic from more than 30 years of data and included more than 25,000 adolescents.

"Our results confirm that, across more than 50 studies, parent-adolescent sexual communication is positively associated with adolescents' use of contraceptives and condoms regardless of communication topic or format," says the report.

It is a message many Kentucky teens need to hear.

According to the 2013 High School Youth Risk Behavior Survey, 44.7 percent of Kentucky's students have had sex at least once, and almost one-third (31.7 percent) of them are sexually active. Almost half of them (46.9 percent) did not use a condom during their last sexual intercourse and 15.1 percent of them did not use any method to prevent pregnancy. And while Kentucky's teen pregnancy rate is at an all time low of 39.5 per 1,000 girls between 15 and 19, it's still much higher than the national rate of 26.6 per 1,000, according to the federal Centers for Disease Control and Prevention.

In addition, young people between the ages of 15 and 24 account for about half of all new cases of sexually transmitted diseases in the U.S. each year, says the CDC.

Despite the risk of disease and pregnancy, nearly one-fourth of youth report that they have not discussed sexual topics with their parents, and even fewer report they have meaningful, open conversations with them about this subject, the study found.

The study attributes this poor communication to parental embarrassment, parents' lack of accurate knowledge of the subject, and poor self-efficacy. It suggest physicians and other health care professionals should encourage these discussions and encourages parents to seek formal instruction on how to discuss safe sex practices with their children.

CBS News asked several experts for some do's and dont's to help parents talk about sex with their teens.

Dr. Anna-Barbara Moscicki, chief of Adolescent and Young Adult Medicine and professor of pediatrics at Mattel Children's Hospital UCLA, told CBS that parents should start talking about sex early "so it's never awkward." She said parents should answer all their children's questions about sex, but "keep it age-appropriate." She reassured parents that "talking about sex does not make your kid want to have sex."

Moscicki also advised that you should never confront a teen with questions such as, "Are you having sex? Are you using condoms?" Instead, she says you should be a resource and ask, "Do you know where to get condoms or get birth control?"

Dr. Leslie Walker, division chief of adolescent medicine at Seattle Children's Hospital, told CBS that "parents need to be informed before they talk with their kids about sex," including accurate information about modern and efficient methods of birth control than weren't available when they were younger.

She said parents should not be afraid to share their family values and that talking about safe sex should not be a "one time chat," but instead an ongoing conversation.

Walker also said that parents need to push through the awkwardness of the conversation and not be judgmental or punitive, which she said will allow teens to know they can rely on their parents for help if something were to happen, like an unplanned pregnancy or a sexual assault.

"Don't shut kids down," Walker told CBS. "Don't shut down the lines of communication, like saying, 'If you ever do this, then you're out of the house.'"

Both experts agreed that parents shouldn't overshare. Walker said, "Kids don't want to know about their parents' sex life, or what happened to you when you were a teen." But they might if you lecture them about their behavior and make them defensive.

Help prevent leading cause of child death: unintentional injury

Every day 2,000 children die from preventable injuries, making unintentional injuries the leading cause of death for children in the United States. More of these injuries occur during the summer than any other season.

"Kids are outside more, out of school and less supervised," said Greg Ozark, associate professor of pediatrics and internal medicine at Loyola University Chicago Stritch School of Medicine. "This leads to an increased risk of injuries, from drowning to head injuries to skin infections from bug bites and poison ivy.

Serious injuries and death can happen in an instant; most drownings occur when a parent hasn't been watching a child for only five minutes.

Ozark said the best method for injury prevention is adult supervision including not only watching the kids, but setting safety rules and leading by example. "Your children are watching you," Ozark said. "They are more likely to do what they see you doing than to do what they hear you saying."

Water safety:
1. An adult should be supervising children spending time around any source of water including pools and lakes; infants and toddlers should be supervised while they are in the bathtub.
2. Children 5 and older should take swim lessons.
3. Young children should always be in arm's reach of an adult.
4. Home pools have to have a four-foot fence surrounding them including a self-locking gate.
5. People of all ages should wear lifejackets while boating, and children should wear lifejackets even on docks and piers.

Wheeled activities like bike riding:
1. Each child needs to wear a helmet approved by the American National Standards Institute. The helmet should fit snugly, sit over the forehead and cover the back of the head. Helmets should be replaced if they get dented or cracked.
2. Children should wear knee and elbow pads and wrist guards while skateboarding.
3. Tell children to be particularly careful around driveways, and children younger than 10 should not be permitted to ride in the street.
4. Always be aware of wear your children are going and do not let them go too far from home.

Playground:
1. Supervise your children while they play on the playground.
2. Playground surfaces should be filled with wood chips or sand, not grass or cement.
3. Report broken equipment immediately, and don't let your children play on it.
4. Home swing sets can pose a strangulation hazard, so check them carefully before children use them.
5. Playground equipment should not be higher than six feet off the ground.

"Be wary, supervise and think about what are potential consequences that could occur by your child's activity," Ozark said. "Whether they are toddlers or teens, there is no age that doesn't need to be supervised."

Obese children's parents say kids are 'about the right weight,' likely comparing them to other kids instead of growth standards

Most parents of overweight children consider them to be "about the right weight," which poses a real concern because parents aren't likely to help their children change their behaviors toward weight reduction if they don't recognize there is a problem, according to a study from the NYU Langone Medical Center.

Photo: nydailynews.com

"Parental recognition of their child's overweight status is paramount in childhood obesity prevention efforts," says the report. "Previous research has shown that parents with accurate perceptions have a greater readiness to make weight-related changes in health-related behaviors and are more effective in doing so.

Kentucky ranks sixth among the states for obesity among preschoolers, with 15.5 percent of 2-to 4-year-olds from low-income families considered obese, according to the "States of Obesity" report. This percentage has remained consistent for several years, but it's worth noting that in 1989, only 9.4 percent of of this population was considered obese. "Children who are overweight or obese as preschoolers are five times as likely as normal-weight children to be overweight or obese as adults," says the federal Centers for Disease Control and Prevention.

The study, published in the journal Childhood Obesity, analyzed data from two groups of children over two time periods from the National Health and Nutrition Examination Survey, one between 1988 and 1994 and the other between 2007 and 2012, both samples had over 3,000 children. The survey asked parents whether they considered their child, ages 2–5-years-old, to be overweight, underweight, or just about the right weight.

Nearly 97 percent of parents of overweight boys in the earlier group identified their sons as "just about the right weight," compared to 95 percent in the second group; 88 percent of parents of overweight girls thought they were "just about the right weight" in the first group, compared to 93 percent in the later group. Experts have dubbed this misperception "The Goldilocks syndrome."

Notably, the researchers said that "the children in the second study group were significantly more overweight than the children in the first study group, yet the parents’ perception of their children remained relatively unchanged." In fact, "the misperception became more prevalent in the recent survey given that an estimated 30 percent reduction in correct perception was observed, compared to the earlier survey," says the report.

"It shows that essentially we're more obese as a society and we're not recognizing our obesity as a society, in this case in children," Dustin Duncan, lead author of the study and assistant professor in the Department of Population Health at NYU Langone, told Lisa Flam on NBC's "Today" show. "Obesity is a well-known medical condition associated with immediate and long-term health risks for children. This is an alarming finding."

The study also found that these misperceptions were more pronounced among the African-American families. "This was especially concerning because African-American and low-income children in the U.S. have the highest rates of obesity," Duncan said in the release.

One reason given for these misperceptions is that parents often compare their own child to other kids in deciding if their child is overweight instead of using science-backed growth charts. The authors also noted that poor communication between parents and their pediatricians could also contribute to these misperceptions.

“We need effective strategies to encourage clinician discussions with parents about appropriate weight for their child. This will be critical for childhood weight management and obesity prevention," Jian Zhang, senior author of the study, said in the release.

A leading authority on bullying in schools offers ideas for recognizing, preventing and dealing with it

By Melissa Landon
Institute for Rural Journalism and Community Issues

How do we recognize, deal with and prevent bullying, particularly in schools? A leading authority on bullying offered some ideas June 12 in a University of Kentucky training session called "The Meanest Generation: Teaching Civility, Empathy, Kindness and Compassion to our Angriest Children," at Eastern State Hospital in Lexington.

Malcolm Smith, right, between sessions

Malcolm Smith, founder and director of the Courage to Care Project who serves on the faculty of Plymouth State University, said one myth about bullying is that it only occurs in large schools. "Actually, I'm more worried about children in a rural school," Smith said. In rural areas, he said, bullying can be a huge problem because there's nowhere to hide, everyone is often into everyone else's business, and an issue can escalate into a feud when families get involved.

Smith defined bullying as a single incident or pattern of written, verbal, electronic or physical actions intended to harm a pupil or his or her property; cause emotional stress; interfere with that student's right to an education; or disrupt the school's operation. Smith debunked a common theory about bullying that became popular in the 1980s—that bullies lack self-esteem. "Bullies are not kids who have low-self-esteem," Smith said. "The average bully is the kid who is a narcissist." Smith believes that a person becomes narcissistic if he or she never learned to bond and love as a child.

He argued that a lack of empathy and rising narcissism—which is characterized by an overinflated view of one's talents and a high level of selfishness—are the true causes of bullying. Empathy is the tendency to react to other people's observed experiences. Research shows that 70 percent of current students score higher in narcissism and lower in empathy than they did 35 years ago. Smith believes this is related to the rise in technology, the culture of self-esteem, the decline of time spent playing—which is often when children gain social competencies—and the overexposure of children to meanness and violence through the media.

Bullies are more likely to have been involved in domestic violence and child abuse; are more likely to commit crimes, drink and smoke; and have a greater propensity toward becoming anti-social adults. Signs that a child is a victim of a bully include exclusion, fear, lack of friends, erratic attendance, depression, withdrawal or clinging to teachers and staff.

Because bullying is characterized by an imbalance of power between the perpetrator and the victim, Smith urged school counselors and teachers not to try mediating a bullying situation, especially not by talking to both the victim and the bully in the same room or worse, leaving them to "work it out." Smith said, "You have to educate the social-emotional deficit in the bully, and you have to comfort the victim." Instead of simply punishing the bully, an authority must discipline him or her, which involves teaching.

To properly discipline a bully, he or she must be required to take responsibility for the behavior and explain to the authority why the behavior was wrong. Then the student must discuss alternative actions that could have been employed. Finally, the student must not only apologize but also perform an act of kindness toward the student he or she bullied.

Smith urged teachers and counselors to recognize and address bullying, explaining that it is not ever a good thing or a positive part of a growing experience, as some people think. He pointed out that adults in the workplace are protected by harassment laws and don't have to face bullying alone, so children shouldn't have to, either. He said to combat bullying, "model good social skills yourself, advocate for safer schools and better laws, work with your school parent-teacher organization, engage parents and students in prevention and work on culture and climate."