Investing in the health of future generations

Why minority communities are disproportionately affected with chronic diseases?

Chronic diseases are on the rise nationally and internationally. Rising incidence of hypertension increases the risk for heart disease and stroke in a given population. In the US, Hypertension and its contributing conditions are developing faster in minority communities than in non-minority communities.  Smoking and exposure to air pollution causes asthma and other lung diseases. Nationally the obesity epidemic and poor nutrition has led to increasing Type 2 diabetes rates, especially in minority youth. The emerging epidemic of Type 2 diabetes in minority pediatric population in the US poses a serious public health challenge. The impact of this will be felt in a few years as this population deals with the complications of diabetes. The age at which adverse health and disparities for these conditions begin is often overlooked. Poor health and risk for disease begins at younger ages in minority communities. Challenges with health promotion, disease prevention, chronic disease management, and addressing health disparities in minority communities compounds the effect.

What are the challenges when risk for poor health begins in the adolescent period?

Communication about health and risk to adolescents and young adults is challenging because they are generally in good health during this time period and think they are “invincible”. Venues for health promotion and disease prevention are different. It is usually not the doctor’s office. In addition, lower rates of health insurance and provision of prevention services impact youth making it challenging to manage the early on-set of chronic diseases. Studies have shown that adolescents and young adults have the lowest rates of ambulatory care utilization and use of preventive services in the healthcare setting. Furthermore, organization of medical care for prevention and treatment of chronic conditions are not optimal for youth and young adults due to lack of awareness among clinicians and inability to meet patients where and how they seek care. Economic costs when chronic diseases develop in young adulthood are significant in terms of wages lost from disability and premature death, and direct healthcare costs.

What are the opportunities of managing chronic conditions in the adolescent period?

Developing approaches to health promotion and chronic disease prevention in youth and young adults will yield considerable health benefits with additional effects on the next generation. Focusing on this age period is important for addressing disparities in health. The earlier disparities are addressed the better the chances of reducing or eliminating disparities. Studies in this area generate new knowledge about how various factors intersect to promote health and cause disease.

What is the impact of asthma in children in the US?

One of the most common chronic diseases in American children is asthma. In 2011, 25.9 million Americans were diagnosed with asthma, of which 7.1 million were children. In 2008, 14.4 million school days were missed. Up to 44% of the asthma burden can be attributable to modifiable environmental factors. Air pollution is linked to emergency hospitalizations, reduced lung function, increased asthma severity, and reduced response to medications. In the US, Puerto Ricans have the highest asthma prevalence followed by African Americans with lowest prevalence in Mexican Americans. Early life exposure to NO2 air pollution is associated with asthma. There may be genetic, socioeconomic, or behavioral traits that make African Americans more susceptible to pollution-induced asthma.

Why is it important to address smoking in youth?

In the US, every day more than 3800 youth try their first cigarette, and over 1000 youth become daily smokers. 88% of smokers smoke their first cigarette before age 18. Most who don’t start by age 25 will never start smoking. Of every 3 young smokers, one will eventually die of smoking-related cause. Children who start tobacco use young are likely to persist use into adulthood and have an approximately 50% chance of becoming a lifetime smoker. It is known that most youth smokers want to quit but tobacco marketing encourages and drives youth smoking. Nationally, studies have shown that African-Americans are more impacted by overall smoking-related disease and death. In California, American Indians have the highest smoking prevalence and highest rates of heart disease. Smoking prevalence in Vietnamese and Korean males is 31-36% and 17% in Latino males.

What is the impact of Type 2 diabetes on youth?

According to a recent study published in the American Journal of Pediatrics, nearly one in four youth ages 12 – 19 have pre-diabetes, and 50% of these youth are at greater risk of developing full-blown diabetes within 5 years. 50% of African American youth and 33% of Latino youth will contract type 2 diabetes in their lifetime. The emerging epidemic of Type 2 diabetes in pediatric and youth population, especially in minority communities presents a serious public health challenge. We will feel the full effect of this in a few years when we address the long-term complications of diabetes in this population.