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Child and Adolescent Health—A Call for Papers
Jody W. Zylke, MD;
Catherine D. DeAngelis, MD, MPH
JAMA. 2008;300(17):2062.
Health care is a vitally important issue for all nations. However, despite health care spending in the United States rising 6.7% in 2006, exceeding $2 trillion or 16% of the gross domestic product,1 there are still 47 million Americans without health insurance and globally the United States ranks 42nd in life expectancy, down from 11th 2 decades ago.2 So what can be done? One possible way to mitigate the problem is to alter priorities from treatment of disease to prevention and start in early childhood.
In a recent commentary, Woolf seemed almost prescient when he said, "turmoil in health care and the economy may be shifting the dynamics for health promotion and disease prevention."3 According to Woolf, the potential benefits of disease prevention are profound in modifying prevalence and severity of disease and costs, yet only 1% to 3% of US health care expenditures are used for prevention.3
One of the most cost-effective interventions is immunization. A recent ranking of clinical preventive services, based on clinically preventable burden and cost-effectiveness, ranked immunizing children highest.4 However, despite the huge success of vaccination, prevention of illnesses in children (as in other areas of medicine) lags behind that of adults. In the most recent Guide to Clinical Preventive Services containing recommendations by the US Preventive Services Task Force between 2001 and March 2008, 21 services are recommended for adults but only 6 for children.5 These recommended preventive services for children and adolescents include prescription of oral fluoride to preschoolers whose primary water source is fluoride-deficient to prevent dental caries; prophylactic ocular topical medication for all newborns to prevent gonococcal ophthalmia neonatorum; HIV screening of adolescents at increased risk of infection; routine iron supplementation for children aged 6 through 12 months who are at increased risk for iron-deficiency anemia; sickle cell screening in newborns; and visual impairment screening in children younger than 5 years.
The reason for so few preventive service recommendations for children and adolescents is because studies to prove effectiveness or cost-effectiveness are not available or are of low quality. For example, the task force found insufficient evidence to recommend for or against routine screening for overweight in children and adolescents.5 In explaining the paucity of pediatric recommendations, Maciosek et al stated that "many interventions have yet to be studied in children and adolescents. Effective clinical interventions for preventing or changing negative youth behaviors related to use of tobacco, alcohol, and drugs; physical activity; and nutrition are especially needed. These interventions have the potential to be both consequential and cost saving."4
Despite being understudied, health promotion and disease prevention have huge potential in children and adolescents because the ramifications could extend over the entire life span. How much more effective would be preventing a physical disease or mental illness starting in childhood as opposed to adulthood? How much more would be gained from stopping a child from smoking rather than getting an adult to stop, or from teaching good nutrition or making exercise a habit from an early age? What would be the effects on asthma, obesity, or diabetes if breastfeeding rates were increased? What would be the impact on lifelong neurological or orthopedic morbidity if childhood injuries were avoided or mental illness were prevented or treated early in life?
Because of the great potential of health promotion and disease prevention in children and adolescents to impact the health of children and adults and the costs of health care, JAMA will devote a special theme issue to this topic in June 2009. Authors from all nations are invited to submit papers on all related topics, especially high-quality original research that presents novel findings, as well as systematic reviews and commentaries. Papers submitted by February 2, 2009, will have the best chance of being considered for the theme issue. Authors should consult the JAMA Instructions for Authors for guidelines on manuscript preparation and submission.6 All submitted manuscripts will undergo our usual rigorous editorial review.
We look forward to receiving your manuscripts.
AUTHOR INFORMATION
Financial Disclosures: None reported.
Editorials represent the opinions of the authors and JAMA and not those of the American Medical Association.
Author Affiliations: Dr Zylke (jody.zylke{at}jama-archives.org) is Contributing Editor and Dr DeAngelis is Editor in Chief, JAMA.
REFERENCES
1. Centers for Medicare & Medicaid Services. National health expenditure data, historical. http://www.cms.hhs.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp. Accessed October 7, 2008.
2. US slipping in life expectancy ratings. http://daily.iflove.com/world/2007-08/12/content_6022901.htm. Published August 12, 2007. Accessed October 7, 2008.3. Woolf SH. The power of prevention and what it requires. JAMA. 2008;299(20):2437-2439.
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4. Maciosek MV, Coffield AB, Edwards NM; et al. Priorities among effective clinical preventive services: results of a systematic review and analysis. Am J Prev Med. 2006;31(1):52-61.
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5. Agency for Healthcare Research and Quality. Guide to clinical preventive services, 2008: recommendations of the U.S. Preventive Services Task Force. http://www.ahrq.gov/clinic/pocketgd.htm. Accessed October 7, 2008.6. JAMA instructions for authors. http://www.jama.com/instructions.
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