Pediatric research briefs from OSU


Staff Reports



Yoga Helps At-Risk Girls Cope with Trauma, Georgetown Law Report Finds

April 25, 2017 — WASHINGTON – A report released by Georgetown Law’s Center on Poverty and Inequality calls for specialized yoga programs to be offered widely to girls in the juvenile justice system amidst growing evidence that they can help them overcome the harmful effects of pervasive childhood trauma.

The first of-its kind report – which draws on original pilot studies in Pennsylvania and Connecticut, an extensive literature review, and interviews with experts and girls around the country – finds that tailored forms of yoga and mindfulness programs can be uniquely effective in supporting traumatized girls.

Benefits include better coping skills, increased emotional regulation, improved neurological and physical health outcomes, and healthier parenting practices and relationships, the report finds.

Children in the juvenile justice system have experienced disproportionately high rates of childhood trauma, which has long-term harmful effects on physical and mental health. Girls in the system are more likely than boys to have experienced all forms of abuse – but particularly sexual violence.

In light of evidence that trauma affects girls differently than boys, yoga interventions offer the juvenile justice system a cost-effective opportunity to address girls’ specific needs, the new report says.

“Girls in the juvenile justice system deserve support in healing and overcoming the devastating effects of childhood trauma that so many of them have experienced,” said lead author Rebecca Epstein, executive director of Georgetown Law’s Center on Poverty and Inequality. “Trauma-informed yoga is a powerful tool to help girls build a brighter future.”

Studies have shown that:

Nearly two thirds of girls in the juvenile justice system (65%) show signs of post-traumatic stress disorder.

Nearly twice as many girls as boys in the juvenile justice system reported past physical abuse (42% vs. 22%).

More than a third of girls reported past sexual abuse (35%), as compared to 8% of boys.

Four in five (80%) girls in the system show indications of at least one mental health diagnosis, as compared to two in three (67%) boys.

More than 40 published studies have evaluated the use of yoga and mindfulness to address mental health conditions. All, including controlled clinical trials, have reported positive benefits.

The Georgetown Law report finds that the proven benefits of yoga are well- positioned to mitigate the unique effects of trauma on girls. For instance:

Yoga practice can restore neurological pathways in a region of the brain that processes emotion awareness, and decreases in size among female trauma survivors.

Trauma-informed yoga can help girls overcome a feeling of disconnection to their body that is common among survivors of sexual violence.

The report emphasizes that yoga interventions should be trauma-informed and gender-responsive to be successful in the juvenile justice system. That can include instructors using invitational language to allow girls to feel in control of their practice, asking permission before engaging in physical contact and not approaching girls from behind.

Pilot studies conducted by Georgetown Law’s Center on Poverty and Inequality and results from programs in the juvenile justice system showed that after girls practiced trauma-informed yoga, they:

Reported greater levels of self-esteem, self-respect and general wellbeing.

Showed declines in anger, depression, flashbacks, nightmares and anxiety.

Improved their ability to identify negative behavior patterns and resolve conflicts.

Used breathing techniques to avoid aggressive responses to provocations by peers and to manage the stress of appearing in court.

Reported past incidents of sexual violence to staff.

Additionally, the report finds that trauma-informed yoga is cost-effective and sustainable. It cites successful and innovative regional programs developed in Palo Alto, Calif. and Brookline, Mass.

In order to have the greatest impact on girls in the juvenile justice systems, the reports’ authors provide these recommendations:

Build on existing law. Interpret existing health laws to allow yoga and mindfulness programs to be introduced into juvenile justice settings. The report cites promising laws in Louisiana and Nebraska.

Expand access. Evaluate existing programs and develop new ones that are geared to the unique needs of girls in the juvenile justice system who have experienced trauma. Also include sensitivity to race, ethnicity, sexual orientation, and gender identity in their design.

Increase funding and research. Support effective yoga and mindfulness programs with funding and continue to build the research base.

“Yoga is already helping girls in custody manage their emotions, build resilience and recognize the potential they have to improve their own lives,” said Thalia González, the report’s coauthor. “By expanding the reach of these powerful, low-cost programs, the juvenile justice system could help many more struggling girls overcome the harrowing pasts they have endured.”

Little kids’ regular bedtimes and ability to regulate emotions may lessen obesity risk

Study finds link between routines, emotions and weight

COLUMBUS – Family structure including regular bedtimes, mealtimes and limited screen time appear to be linked to better emotional health in preschoolers, and that might lower the chances of obesity later, a new study suggests.

“This study provides more evidence that routines for preschool-aged children are associated with their healthy development and could reduce the likelihood that these children will be obese,” said lead author Sarah Anderson of The Ohio State University.

The study – the first to look at the connections between early childhood routines and self-regulation and their potential association with weight problems in the preteen years – appears in the International Journal of Obesity.

Researchers evaluated three household routines when children were 3 years old: regular bedtime, regular mealtime and whether or not parents limited television and video watching to an hour or less daily. Then they compared those to parents’ reports of two aspects of children’s self-regulation at that same age.

Lastly, they investigated how the routines and self-regulation worked together to impact obesity at age 11, defined based on international criteria. (The U.S. criteria for childhood obesity is set lower and would have included more children.)

The research included 10,955 children who are part of the Millennium Cohort Study, a long-term study of a diverse population of children born in the United Kingdom from September of 2000 to January of 2002. At age 3, 41 percent of children always had a regular bedtime, 47 percent always had a regular mealtime and 23 percent were limited to an hour or less daily of TV and videos. At age 11, about 6 percent were obese.

All three household routines were associated with better emotional self-regulation – a measure based on parents’ responses to questions such as how easily the child becomes frustrated or over-excited. Those children with greater emotional dysregulation were more likely to be obese later.

“We saw that children who had the most difficulties with emotion regulation at age 3 also were more likely to be obese at age 11,” said Anderson, an associate professor in Ohio State’s College of Public Health.

Anderson and her colleagues also found that the absence of a regular preschool bedtime was an independent predictor of obesity at 11. Obesity risk increased even when children “usually” had a regular bedtime, as opposed to “always.” The risk was greatest for those who had the least amount of consistency in their bedtimes.

How persistent and independent children were at age 3 – another aspect of self-regulation – was not related to obesity risk, nor were routines associated with these aspects of self-regulation.

The new findings build on previous research by Anderson and her colleagues showing an association between earlier preschool bedtimes and decreased odds of obesity later. Previous work published in 2010 showed in a US national sample that obesity prevalence was lowest for children who got enough sleep, had limits on screen time and ate meals with their families.

“This research allows us to better understand how young children’s routines around sleep, meals, and screen time relate to their regulation of emotion and behavior,” Anderson said. “The large, population-based, UK Millennium Cohort Study afforded the opportunity to examine these aspects of children’s lives and how they impact future risk for obesity.”

This research should prompt future work looking at the role of emotional self-regulation in weight gain in children and how bedtime routines can support healthy development, Anderson said.

“Sleep is so important and it’s important for children in particular. Although there is much that remains unknown about how sleep impacts metabolism, research is increasingly finding connections between obesity and poor sleep,” she said.

While it’s impossible from this work to prove that routines will prevent obesity, “Recommending regular bedtime routines is unlikely to cause harm, and may help children in other ways, such as through emotion regulation,” Anderson said.

But competing family pressures including parents’ work schedules don’t always allow for consistency, Anderson pointed out.

“As a society, we should consider what we can do to make it easier for parents to interact with their children in ways that support their own and their children’s health.”

The National Institutes of Health and the U.K. Economic and Social Research Council supported the study. Researchers from the University College London and Temple University also worked on the study.

Link found between financial strain and low-birth-weight babies

Researchers say study could lead to targeted efforts to help moms-to-be cope

A financially strapped pregnant woman’s worries about the arrival and care of her little one could contribute to birth of a smaller, medically vulnerable infant, a new study suggests.

Researchers at The Ohio State University found that pregnancy-specific distress, such as concerns that the baby’s needs won’t be met, appears to be a pathway between financial strain and a higher likelihood of a low-birth-weight infant. The study appeared in the journal Archives of Women’s Mental Health.

“There is an opportunity here to look for interventions during pregnancy that could help mitigate the effects of financial strain on birth outcomes,” said lead author Amanda Mitchell, a postdoctoral researcher in Ohio State Wexner Medical Center’s Stress and Health in Pregnancy Research Program.

While larger efforts to improve access to housing, jobs and support for low-income women is critical, there are potential low-cost, stress-reduction techniques that could help reduce risk, Mitchell said. Meditation and breathing exercises could prove useful, for instance, she said.

“It’s important for all women who experience pregnancy-related stress to seek out help coping with that stress,” Mitchell said. “And ob-gyns and other medical providers should also talk about stress during their visits with expecting moms.”

The study included 138 pregnant women who filled out questionnaires to assess financial strain, depressive symptoms, pregnancy-specific distress, perceived stress and general anxiety. Moms in the racially diverse study group were between five and 31 weeks pregnant and 29 years old on average at the time of the assessment. The study, which was primarily designed to evaluate flu vaccine effectiveness, ran from 2013 to 2015.

After the participants’ babies were born, researchers were able to review medical records to compare birth weight against moms’ questionnaire responses during pregnancy.

The researchers knew from previous studies that pregnant moms who are socioeconomically disadvantaged have a higher likelihood of having smaller babies and worse birth outcomes.

What they wanted to learn was whether specific factors could be driving that connection – factors that could lead to positive interventions for women at risk of delivering low-birth-weight babies.

Statistical models designed to identify those drivers landed on one statistically significant factor: pregnancy-specific distress.

“This includes concerns about labor and delivery, about relationships changing, about working after the baby arrives, paying for medical care, and whether the baby will be unhealthy,” said study senior author Lisa Christian, associate professor of psychiatry and a member of the Institute for Behavioral Medicine Research at Ohio State.

Financial strain was assessed based on a five-point scale derived from moms’ responses to three questions: “How difficult is it for you to live on your total household income right now?” “In the next two months, how likely is it that you and your family will experience actual hardships, such as inadequate housing, food, or medical attention?” and “How likely is it that you and your family will have to reduce your standard of living to the bare necessities of life?”

Low-birth-weight babies often suffer from serious health problems and spend their first weeks or months in intensive care. About 8 percent of babies born in the United States are underweight at birth. Low birth weight is clinically defined as below 2,500 grams, or 5 pounds and 8 ounces.

“It’s important to understand the factors that make it more likely for a woman with lower socioeconomic conditions to have a baby at higher risk of complications and death,” Mitchell said.

Limitations of the study include the fact that it was a secondary analysis of data collected during a different study, and that the overall number of low-birth-weight babies was small, at 11. The researchers suggest that replicating this study in a larger group would be beneficial.

The Ohio State researchers are working on another study looking at blood biomarkers that might better explain what biological changes could be at play, including inflammation, Mitchell said.

The study was supported by the National Institutes of Health.

Most new to Medicaid have no other option if Affordable Care Act repealed

Ohioans covered under expansion primarily older, low-income, less-educated whites

COLUMBUS – Almost everyone covered through Ohio’s Medicaid expansion would have no other viable insurance option should the Affordable Care Act be repealed, a new study has found.

Law and public health researchers from The Ohio State University determined that 95 percent of newly enrolled beneficiaries would be without a plausible pathway to coverage. The research appears online in the American Journal of Public Health.

“Many of these people have nothing else to turn to,” said Eric Seiber, lead author and associate professor of health services management and policy in Ohio State’s College of Public Health.

“Their choice is Medicaid or medical bankruptcy.”

Ohio is one of 31 states (and Washington D.C.) to expand Medicaid eligibility as part of the Affordable Care Act. The move, which came in January 2014, made eligible those adults with incomes below 138 percent of the federal poverty level. (In 2015, that was about $16,243 earned annually for an individual.)

Prior to the ACA, Ohio generally did not grant Medicaid eligibility to childless adults unless they were pregnant or disabled. Parents qualified for Medicaid only if their family income was below 90 percent of the federal poverty level. By October of last year, enrollment under expansion in Ohio had reached about 712,000 people.

Efforts to repeal or substantially restructure the ACA reforms are under way.

Seiber and Micah Berman, assistant professor of public health and law at Ohio State’s College of Public Health and Moritz College of Law, evaluated data from 42,876 households that participated in Ohio’s 2015 Medicaid Assessment Survey. The telephone survey includes a set of questions to identify coverage immediately before Medicaid enrollment.

The new Ohio State research was driven by this question: “If the ACA is fully or partially repealed, who would lose their coverage and what would happen to them?”

The researchers found that the vast majority would find themselves without insurance in the case of a full ACA repeal.

Though 17.7 percent of survey participants had private health insurance prior to Medicaid enrollment, most had lost their jobs (and their coverage) or were ineligible for employer-sponsored group health plans at the time of enrollment. The researchers found that 4.8 percent of the new Medicaid recipients were eligible for insurance through their jobs, leaving 95.2 percent of new enrollees with no feasible alternative.

Seiber and Berman also found that a rollback would predominantly affect older, low-income whites with less than a college education.

“The impact of insurance is about a lot more than health care,” Berman said. “For people newly enrolled in Medicaid, it means that should they have a major health-related event, they can still pay for food, have stable housing, get out of debt. These are all things that make a huge difference in quality of life.”

A recent Ohio Medicaid analysis, which was conducted with help from Seiber and Berman and mentioned in the new study, found that that the expansion increased access to medical care, reduced unmet medical needs, improved self-reported health status and alleviated financial distress – all results found in other states that have expanded access to government coverage.

The new study shows that the majority of adults newly enrolled in Medicaid did not drop private insurance in favor of the government coverage, Seiber said.

“These are very low-income adults, many of whom lost their jobs and have nothing to go back to,” he said.

Said Berman, “It counters this perception that people have health insurance but then go on Medicaid to save money. That’s just not what the data show.”

That did happen, to an extent, with expansion of Medicaid coverage for children. But that was a different scenario because children’s eligibility begins at much higher family income levels than those in place for new adult enrollees, Seiber said.

Seiber and Berman said they hope the study offers some scientific data that will be useful during discussions of ACA repeal or revision and what it could mean for Americans now covered by Medicaid.

“I don’t think everyone realizes that if you repeal the ACA, that at the same time eliminates the Medicaid expansion,” Seiber said.

One potential weakness of the study is that the researchers were not able to evaluate how many people on Medicaid had the option to move to private insurance – because they were newly employed, for instance – but did not go that route. That type of analysis was not possible with the state-gathered data, Seiber said.

“While it is possible that some portion of these enrollees have since been hired by an employer that offers (insurance), it is unlikely that this would meaningfully improve the insurance outlook for this population,” he and Berman wrote.

The researchers said it’s important to consider the demographics of those covered under Medicaid expansion, including the fact that many are older and already have chronic health conditions that will become more costly and problematic without regular care.

“It’s a really broad cross section, and tends to be older and whiter and more rural than many would expect,” Seiber said.

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Staff Reports

Yoga Helps At-Risk Girls Cope with Trauma, Georgetown Law Report Finds

April 25, 2017 — WASHINGTON – A report released by Georgetown Law’s Center on Poverty and Inequality calls for specialized yoga programs to be offered widely to girls in the juvenile justice system amidst growing evidence that they can help them overcome the harmful effects of pervasive childhood trauma.

The first of-its kind report – which draws on original pilot studies in Pennsylvania and Connecticut, an extensive literature review, and interviews with experts and girls around the country – finds that tailored forms of yoga and mindfulness programs can be uniquely effective in supporting traumatized girls.

Benefits include better coping skills, increased emotional regulation, improved neurological and physical health outcomes, and healthier parenting practices and relationships, the report finds.

Children in the juvenile justice system have experienced disproportionately high rates of childhood trauma, which has long-term harmful effects on physical and mental health. Girls in the system are more likely than boys to have experienced all forms of abuse – but particularly sexual violence.

In light of evidence that trauma affects girls differently than boys, yoga interventions offer the juvenile justice system a cost-effective opportunity to address girls’ specific needs, the new report says.

“Girls in the juvenile justice system deserve support in healing and overcoming the devastating effects of childhood trauma that so many of them have experienced,” said lead author Rebecca Epstein, executive director of Georgetown Law’s Center on Poverty and Inequality. “Trauma-informed yoga is a powerful tool to help girls build a brighter future.”

Studies have shown that:

Nearly two thirds of girls in the juvenile justice system (65%) show signs of post-traumatic stress disorder.

Nearly twice as many girls as boys in the juvenile justice system reported past physical abuse (42% vs. 22%).

More than a third of girls reported past sexual abuse (35%), as compared to 8% of boys.

Four in five (80%) girls in the system show indications of at least one mental health diagnosis, as compared to two in three (67%) boys.

More than 40 published studies have evaluated the use of yoga and mindfulness to address mental health conditions. All, including controlled clinical trials, have reported positive benefits.

The Georgetown Law report finds that the proven benefits of yoga are well- positioned to mitigate the unique effects of trauma on girls. For instance:

Yoga practice can restore neurological pathways in a region of the brain that processes emotion awareness, and decreases in size among female trauma survivors.

Trauma-informed yoga can help girls overcome a feeling of disconnection to their body that is common among survivors of sexual violence.

The report emphasizes that yoga interventions should be trauma-informed and gender-responsive to be successful in the juvenile justice system. That can include instructors using invitational language to allow girls to feel in control of their practice, asking permission before engaging in physical contact and not approaching girls from behind.

Pilot studies conducted by Georgetown Law’s Center on Poverty and Inequality and results from programs in the juvenile justice system showed that after girls practiced trauma-informed yoga, they:

Reported greater levels of self-esteem, self-respect and general wellbeing.

Showed declines in anger, depression, flashbacks, nightmares and anxiety.

Improved their ability to identify negative behavior patterns and resolve conflicts.

Used breathing techniques to avoid aggressive responses to provocations by peers and to manage the stress of appearing in court.

Reported past incidents of sexual violence to staff.

Additionally, the report finds that trauma-informed yoga is cost-effective and sustainable. It cites successful and innovative regional programs developed in Palo Alto, Calif. and Brookline, Mass.

In order to have the greatest impact on girls in the juvenile justice systems, the reports’ authors provide these recommendations:

Build on existing law. Interpret existing health laws to allow yoga and mindfulness programs to be introduced into juvenile justice settings. The report cites promising laws in Louisiana and Nebraska.

Expand access. Evaluate existing programs and develop new ones that are geared to the unique needs of girls in the juvenile justice system who have experienced trauma. Also include sensitivity to race, ethnicity, sexual orientation, and gender identity in their design.

Increase funding and research. Support effective yoga and mindfulness programs with funding and continue to build the research base.

“Yoga is already helping girls in custody manage their emotions, build resilience and recognize the potential they have to improve their own lives,” said Thalia González, the report’s coauthor. “By expanding the reach of these powerful, low-cost programs, the juvenile justice system could help many more struggling girls overcome the harrowing pasts they have endured.”

— Written by Misti Crane of the Ohio State University.

— Written by Misti Crane of the Ohio State University.