How other countries get parents to vaccinate their kids (and what Australia can learn)



Different countries take different approaches to get parents to vaccinate their children. But saying which one works best is difficult.
from www.shutterstock.com

Katie Attwell, University of Western Australia and Mark Navin, Oakland University

Countries around the world, including Australia, are using different ways to get parents to vaccinate their children.

Our new research, published this week in the journal Milbank Quarterly, looks at diverse mandatory vaccination policies across the world. We explore whether different countries mandate many vaccines, or just a few; if there are sanctions for not vaccinating, such as fines; and how easy it is for parents to get out of vaccinating.

This is part of ongoing research to see what Australia could learn from other countries’ attempts to increase childhood vaccination rates.




Read more:
A short history of vaccine objection, vaccine cults and conspiracy theories


The shift from voluntary vaccination

Until recently, many governments preferred vaccination to be voluntary. They relied on persuasion and encouragement to try to overcome parents’ hesitancy or refusal to vaccinate their children.

However, recent measles outbreaks have made those methods less politically tenable. The rise of pro-vaccination activism and the polarisation of public debate about immunisation policy has motivated governments to take a more hard-line approach.




Read more:
Measles outbreaks show legal challenges of balancing personal rights and public good


Early evidence from Italy, France, California and Australia indicates this has led to higher vaccination rates. But different countries have pursued very different policies.

Australia’s federal “No Jab, No Pay” policy removes entitlements and childcare subsidies from unvaccinated families. Four Australian states also have “No Jab, No Play” policies to limit vaccine refusers’ access to childcare.




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California bans unvaccinated children from school, and Italy fines their parents. France classifies vaccine refusal as “child endangerment” and can impose hefty fines.

Some governments can use more than one method at once, like Australia’s mix of state and federal policies. Italy’s new policy uses a combination of excluding unvaccinated children from daycare and fines for parents.

Making it hard to refuse

Australia, Italy, France and California make it difficult for parents to refuse vaccines by only permitting medical exemptions to their mandatory policies.

However, other jurisdictions ultimately allow parents to refuse vaccines, albeit using different methods. For example, Germany and the state of Washington require parents to be counselled by medical professionals before they obtain an exemption to vaccinating their child. In Michigan, public health staff provide a mandatory education course for parents seeking non-medical exemptions.

Which policy leads parents to vaccinate?

We can assess a policy to get parents to vaccinate using a notion called “salience”. Put simply, will a vaccination policy actually make parents vaccinate?

For example, Australia’s federal vaccine mandate has become more salient since parents can no longer obtain conscientious objections and risk losing benefits for not vaccinating.

But there are other factors to consider, such as whether a policy promotes timely vaccination.

Australia’s “No Jab, No Pay” policy applies to children from birth, so it motivates parents to vaccinate on time. But the United States has state-level policies that prompt parents to have their children up-to-date with their vaccinations when they start daycare or primary school.

Who doesn’t have to vaccinate?

Another important question is who gets to duck away from the hand of government. Australia’s “No Jab, No Pay” policy leaves wealthy vaccine refusers untouched as they are ineligible for the means-tested benefits docked from unvaccinated families.

And Australian states’ policies to exclude vaccine refusers’ children from daycare doesn’t affect families who don’t use daycare.

Since France and California exclude unvaccinated children from school, these countries have the capacity to reach parents more equitably (almost everyone wants to send their kids to school so more people are incentivised to vaccinate). In both places, you can homeschool if you really don’t want to vaccinate.

Addressing the many reasons for not vaccinating

Mandatory vaccination policies also need to recognise the two types of parent whose child might be unvaccinated. Much airtime focuses on vaccine refusers. However, at least half the children who are not up-to-date with their vaccines face barriers to accessing vaccination, such as social disadvantage or logistical problems getting to a clinic. They are the children of underprivileged parents, not vaccine refusers.

When it comes to the vaccination status of disadvantaged children entering daycare, Australian states have chosen a “light touch” as part of the “No Jab, No Play” policy. Existing state policies provide grace periods or exemptions for these families.

But the federal “No Jab, No Pay” hits all parents where it hurts, and offers no exemptions or grace periods to disadvantaged families. Likewise, California’s school entry mandate makes no such exceptions. Italy and France have daycare exclusions similar to “No Jab, No Play” in their policies, but we have not found any evidence they make exceptions for disadvantaged families.




Read more:
Forget ‘no jab, no pay’ schemes, there are better ways to boost vaccination


Finally, mandatory vaccination policies vary on how much they cost for governments to deliver. Oversight of parents, such as inspections or implementing fines, can drain government resources. And educational programs for parents seeking exemptions are expensive to run.

Governments can outsource some of these costs to parents (for instance, parents may have to pay a fee to see a doctor for an exemption).

Governments can also hand over the tasks to medical professionals, but then they have less control over what these professionals do. For instance, California is now seeking tighter regulation of doctors who say children are eligible for medical exemptions. This monitoring will cost the state, but will allow greater oversight. Victoria also had problems with doctors who accommodated vaccine refusers.

So where does this leave us?

Our work investigating international strategies to get parents to vaccinate their children is ongoing. Australians seem strongly attached to our vaccine mandates. But both state and federal policies have undergone tweaks since their inception.

Any future adjustments should ensure all parents are targeted, that disadvantaged families are not further disadvantaged, and that we make it very easy for everybody to access vaccines in their communities and on time.

Globally, as more jurisdictions move away from voluntary child vaccination to mandatory policies, we need to get a clearer picture of how these policies work for families, government and the policy enforcers, including school staff and health professionals.The Conversation

Katie Attwell, Senior Lecturer, University of Western Australia and Mark Navin, Professor, Department of Philosophy, Oakland University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Electronic games: how much is too much for kids?



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When played in moderation, electronic games can be beneficial for children’s learning and development.
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Sue Walker, Queensland University of Technology and Susan Danby, Queensland University of Technology

Most parents view their children’s playing of electronic games as potentially problematic – or even dangerous. Yet many children are engaging with electronic games more frequently than ever.

Concerns about electronic gaming do not stack up against the research. So, how much gaming is too much for young children?

Electronic games (also called computer or digital games) are found in 90% of households in Australia. 65% of households have three or more game devices. Given this prevalence, it’s timely to look more closely at electronic game playing and what it really means for children’s development and learning.

A study of more than 3,000 children participating in the Growing Up in Australia: Longitudinal Study of Australian Children explored children’s electronic gaming. This national sample was broadly representative of the Australian population.

The study had two phases:

  • parents reported on their children’s use of electronic games when their children were eight or nine years of age; and

  • teachers reported two years later on these children’s social and emotional development and academic achievement, when the children were 10 or 11.

How much time do kids spend gaming?

As the table below shows, there was wide variation in the number of hours per week the children spent playing electronic games.

Most children (52%) played electronic games for four or fewer hours per week. But nearly one-year of the children (24%) were reported as playing electronic games for more than seven hours per week.

https://datawrapper.dwcdn.net/3SpPH/2/

How much time should kids spend gaming?

Taking into account family background and parental education, the good news is that low-to-moderate use of electronic games (between two and four hours per week) had a positive effect on children’s later academic achievement.

However, over-use of electronic games (more than seven hours per week) had a negative effect on children’s social and emotional development.

Children whose parents reported they played electronic games for two-to-four hours per week were identified by their teachers as showing better literacy and mathematical skills.

Surprisingly, children who were reported as playing electronic games infrequently or not at all (less than two hours per week) did not appear to benefit in terms of literacy or mathematics achievement.

However, children whose parents reported that they played electronic games for more than one hour per day were identified two years later by their teachers as having poor attention span, less ability to stay on task, and displaying more emotional difficulties.

As the graphs below show, moderate game playing was associated with the most benefits both academically and emotionally.

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Are some games better than others?

It is likely that the relationship between the use of electronic games and children’s academic and developmental outcomes is far from straightforward. The quality of electronic games and the family context play important roles.

Electronic games known as sandbox games are recognised as offering opportunities for collaboration with others while engaging in creative and problem solving activities. One of the well-known examples of a sandbox game is Minecraft.

Social interactions are important in supporting children’s engagement in electronic games. A closer examination of children’s experiences at home may be beneficial in understanding the context of gaming in everyday life.

Often viewed as a leisure activity, studies show that when parents and siblings participate in the game playing, they offer opportunities to negotiate with each other, and engage in conversations and literacy practices. All of these potentially contribute to the child’s language, literacy and social development.

It is important to note that while we know the amount of time children spent playing electronic games, we do not know the detail of the kinds of games that were being played, with whom they were being played, or even the device on which they were played.

The ConversationThis contextual information is clearly relevant for consideration in any further research that explores the relationship across children’s electronic game playing, learning, and wellbeing.

Sue Walker, Professor, School of Early Childhood, Queensland University of Technology and Susan Danby, Professor of Education, Queensland University of Technology

This article was originally published on The Conversation. Read the original article.

How we can help refugee kids to thrive in Australia


Karen Zwi, UNSW

When we think about refugee children’s health, we tend to assume bad news. But refugee children are highly resilient. This means they can thrive, mature and develop despite poor circumstances, and can adapt despite severe and long-term hardship.

Our newly published research is the first of its kind to track the long-term health of newly arrived refugee children in Australia.

We showed which children tend to do well in the community, and the factors that predict this. We also give evidence for what Australia can do to help all refugee children thrive in the longer term.

Who are these refugee children and their families?

Between May 2009 and April 2013, a total of 228 refugee children under 15 years, who were granted refugee status under Australia’s humanitarian program, arrived in our study area. We followed 61 of these children for three years. None of them had been detained for any length of time, as they had been granted refugee status overseas and flown to Australia.

The children were on average six years old, with equal numbers of boys and girls. They came from south-east Asia (46%), Africa (33%) and the eastern Mediterranean (21%) regions (as defined by the World Health Organisation).

When they arrived, 30% of children were living in a family with one parent absent (almost always the father).

Many parents had high levels of education (20% had university or trade qualifications) and had been employed before coming to Australia; only 6% had no education and 20% reported unemployment in their home countries.

What physical and mental health issues did we see?

We checked the children’s physical health when they arrived and their development and social-emotional well-being over the next two and three years after settling in Australia.

Refugee children have well known physical, mental and developmental health issues, and our research supported this.

Iron and vitamin D deficiency were the most common conditions we saw. Only a few children had infectious conditions needing treatment.

After two and three years in Australia, most parents said their child had good access to primary health care and visited their GP every one to four months. About half the children had visited a dentist.

About a quarter of young children had developmental delay (mostly delayed speech and language) at the start, but all had caught up by their third year in Australia.

However, children’s social and emotional wellbeing was most strikingly affected by their refugee experiences. After two years of being in Australia, over 20% of children were experiencing emotional symptoms (such as sadness or fear) and/or peer problems (like difficulties making friends).

But by year three, these problems had decreased to below 10%, no different to the general Australian population, illustrating their resilience.

Which children do well and not so well?

Many studies have highlighted factors that make it more likely for refugee children to have poor health and well-being. These include economic and social conditions related to where people come from and where they settle.

We cannot change certain factors before children arrive, like pre-migration violence. But we can change factors once they’re here. In fact, research suggests post-arrival factors have a bigger impact than pre-arrival factors on refugee well-being.

Post-arrival factors that lead to poor outcomes include: time in immigration detention, exposure to violence post-migration, family separation, poor mental health of carers, negative school and peer experiences, perceived discrimination, parental unemployment, fall in socio-economic status and financial stress.

The most common stressful life events children and families experienced in our study were changes in the child’s school and home, parental unemployment, marital separation and financial stress.

For instance, single parent families became more common (38%) three years after settlement, largely due to marital breakdown; almost all families were receiving government financial benefits and living in rented accommodation two and three years after settling; half of the families had a weekly income under A$800, about 30% below the average weekly income in Australia; and unemployment was high (by year three, only 12% of parents were employed, mainly in semi-skilled and unskilled jobs).

Refugee children with stable accommodation tend to do better than those forced to move home multiple times.
from shutterstock,com

Researchers have also identified factors linked with better outcomes and resilience, and that increase the chance of good health and well-being.

These include living close to the family’s own ethnic community and having external support from the general community.

In our study, most families (more than 80%) knew someone in Australia before immigrating and felt supported by either their own ethnic (more than 73%) or the general community (more than 63%). Most parents said Australians displayed tolerance towards people of other religions, cultures and nationalities (more than 78%), although several volunteered anecdotes of their perception of discrimination related to property rental.

What can we do to make a lasting difference?

By addressing the factors that predict poor health and enhancing those that predict a good outcome, we can make a significant difference to refugee children’s lives.

Our research and others’ shows what policymakers and governments can do to help refugee children thrive in Australia. We need to:

  • integrate children and families into host communities
  • support families to stay intact
  • provide stable settlement with minimal relocations
  • support children’s education
  • support parents’ employment
  • ensure access to health, social and economic resources
  • reduce post-migration exposure to violence and threat, including detention, racism and bullying.

The ConversationIf these recommendations are implemented, it is very likely refugee children can realise the resilience they bring with them to Australia.

Karen Zwi, Paediatrician and Associate Professor, UNSW

This article was originally published on The Conversation. Read the original article.

China: Quadruplets Marked with Numbers for Easier Identification


In the ‘you have to be kidding’ category, the link below is to an article about how one Chinese couple decided to make it easier to identify their kids. 

For more visit (including a picture):
http://www.inspirefusion.com/quadruplets-marked-with-numbers-to-identify-easily/