Emerging Issues

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Adverse Childhood Experiences

ACEs research continues, and some of the key issues identified include:

  • Toxic stress from ACEs impacts brain development as well as physical and emotional health
  • High levels of trauma over time can alter DNA and be passed from generation to generation
  • Trauma-informed care and resiliency-building interventions are both healing and preventative of future problems

Issues you may wish to consider include:

  • Diabetes self-management education (DSME) is available as a benefit through most forms of health insurance but is underutilized. Some regions have assessed DSME access to improve referrals and quality of care.
  • Short-term outcomes, including cost savings, may be more quickly achieved with interventions that decrease A1c levels in people with diagnosed diabetes. Implementing interventions that prevent diabetes, particularly with those experiencing prediabetes, may also help achieve long term cost reduction.
  • New interventions, such as group self-management support or engagement of community health workers, may be more effective with some populations than older models of self-management education. However these new models are either not covered by health insurance or not paid for equally.
  • Evidence in both clinical trials and translational studies finds that the onset of type 2 diabetes can be prevented or delayed with lifestyle change support by trained coaches and peer groups over the course of one year. As of April 2018, Medicare began to cover qualified Diabetes Prevention Programs (DPP) for eligible enrollees. Programs in Washington State are beginning to meet criteria to qualify.
  • Other insurers in Washington State, including those providing benefits for state and higher-education employees and retirees, cover DPP but not all DPP programs have contracts in place with the insurers and employers.
  • Obesity is a health issue with a complex web of causes and co-morbidities. Generally speaking, obesity is the result of social, cultural, and physical environmental factors patients experience throughout their lives, genetic factors, and the interaction between those factors.
  • The environment where patients live, learn, work and play can increase or decrease risk of obesity. For instance, a community without safe areas for kids to play will make it harder to be physically active, which will increase risk for obesity.
  • Studies have shown that trauma experienced during childhood, as well as experiencing racism in daily life, are part of the complex set of causes of obesity.
  • Epigenetics is increasingly seen as a mechanism for obesity passing down through generations, as well as adult obesity and co-morbidities.
  • Increasing evidence shows a connection between maternal nutrition during pregnancy and adult obesity.

* Sources:

Centers for Disease Control, Drug Overdose Deaths 2013

Binswager, NEJM 2017


The emergence of electronic cigarettes and vapor products has caused serious concern in Washington State. An emerging body of research indicates electronic cigarettes and vapor products have unique health risks that are not yet completely understood. A major concern of stakeholders is that these products may again normalize smoking in public places.

Juuls, a new a type of vapor product that is becoming more popular among youth includes a charger and pod. Teachers find students using them in classrooms. They are hard to detect because the charger looks like a USB flash drive.

Juuls come in an assortment of flavors that appeal to youth (such as mint, mango, crème brulee), and the amount of nicotine in one pod is the equivalent of a pack of cigarettes.

More information, including images, is available from the Truth Initiative.

Recent studies have indicated a strong association between the use of e-cigarettes and the use of other burned tobacco products by young people.

Well Child Visits

There is an increase in the number of children with insurance coverage, and in many parts of the state there are not enough providers to meet the demand.

Some families are reluctant to access healthcare due to their nationality and citizenship status. Anecdotally, clinics report experiencing this even with immigrant patients who are legal residents. There may also be barriers due to language and/or comfort level.

There is increasing awareness of the need to address Adverse Childhood Experiences (ACEs) as part of preventive care. Some healthcare systems are implementing a Trauma Informed Approach to interactions with children and parents/caregivers. This has created demand for ACEs related training and tools.