Abstract

Opioid abuse among teens is a very serious problem which requires further attention and action at the national and local levels. The severity of this problem can contribute to the risk of addiction and overdose, thereby leading to many deaths. Therefore, it is necessary to evaluate this issue in greater detail and to recognize the importance of implementing educational tools in high schools which can have the desired impact on teens and reduce their risk of using opioids, either via legal or illegal means. This problem must be addressed with education to provide greater awareness to teens and to promote an environment in which teens can understand how this problem can dramatically affect their lives and even lead to premature deaths by overdose. An educational program for high school students is necessary to demonstrate the importance of accomplishing specific goals and objectives to prevent teen opioid abuse and to improve health outcomes for this population group.

Healthcare Policy Concern – Prescription Drug Overdose

Overview of Healthcare Policy

Healthcare policies offer important insights and information regarding a variety of issues which impact public health and which influence outcomes for patients. In this capacity, different public health concerns requires significant attention and focus to ensure that all possible options can be conducted to facilitate outcomes and to create an environment in which change and progress can occur effectively to improve the health and wellbeing of different population groups. This process requires an examination of effective methods to educate individuals and to provide the resources required to make informed decisions regarding the practice setting which will have a positive and lasting impact on their health. Nurses play a critical role in these processes and provide opportunities to educate the public regarding issues of importance to their health within their communities. Therefore, healthcare advocacy is critical to this process and requires an effective understanding of the key factors which impact the practice setting and the patients who are seen on a regular basis. Recognizing serious health concerns is a critical priority of nurses and supports advocacy efforts which can have a positive and lasting impact on communities in different ways. In addition, the advanced practice nurse utilizes his or her knowledge in different ways to identify areas of concern for patients, to optimize health, and to support the development of practice models to advocate for patient healthcare needs by minimizing disparities and other concerns whenever possible. These tools are critical to the practice setting and provide a framework for advancing key priorities and needs for patients.

Selected Healthcare Policy Concern

There are significant risks associated with the use of prescription drugs, and specifically, the use of opioids to relieve pain. There are differences in usage rates based upon location, as some rural communities often experience higher rates of opioid use and addiction than in urban communities; therefore, it is important to identify these differences when developing different educational programs to accommodate teenagers (Monnat & Rigg, 2016). These drugs pose a high risk of addiction and potential overdose for many patients. There are several key contributing factors to this problem which include overprescribing patterns by physicians, poor monitoring of patients after prescribing these medications, stress and anxiety, and other factors which contribute to a high risk of addiction and overdose in some patients. It is possible that some patients are at risk of addiction based upon genetic makeup, but others may be at risk due to poor outcomes related to excessive prescribing methods and easy access to these medications on a regular basis. Therefore, a policy change must be established which can expand education for patients and others who may have a need for opioids in the future to ensure that they have the knowledge and resources necessary to ensure that they can prevent addiction and be mindful of the serious complications which can occur related to the use of opioids.

The implementation of a classroom-based opioid prevention course for high school students will be established in local school districts to provide knowledge regarding the dangers of opioid use and abuse among teens and adults. The target population is high school students because they are a highly vulnerable group which can be influenced by different types of behaviors and activities, including the use of different types of drugs, including opioids. They are a strong audience for which this type of educational program may shed some light on the difficulties related to stress, anxiety, and peer pressure which may impact high school students and create challenging circumstances whereby opioids may be an attractive option. Nurses will play a critical role in this process by administering the educational program and ensuring that students have the knowledge regarding opioids that is required to promote prevention.

Among high school students, 4.2 percent of this population misused pain medications in 2017, and 4,235 teens and adults between the ages of 15-24 died from drug overdoses in 2015, of which half were from opioid abuse (Department of Health and Human Services, 2017). Specifically, it is known that “Between 1999 and 2006, the annual death rate for fatal overdoses of opioids for individuals aged 15 to 24 rose 440%, from 0.7 per 100,000 to 3.8 per 100,000” (Edlund et al., 2015, p. 131). Due to the consistent risk attributed to opioid abuse and overdose among teens, it is necessary to provide educational platforms for high school students which can strengthen their knowledge and understanding of opioids and the risk of addiction to these drugs which could lead to overdoses and even fatalities in some cases. When teens die as a result of an opioid-induced drug overdose, this not only devastates his or her family, but also the surrounding community because of the shock and lack of comprehension of the severity and high risk of addiction among people who use opioids. Although access to these drugs appears to be getting more difficult in some communities, it remains a serious problem when they can be accessed via back channels and can cause harm for teens in unanticipated ways. This poses a serious problem in communities where there are limited resources to fight opioid abuse and addiction and where health disparities exist which can negatively impact individuals across different age groups.

Youth can serve as a key driving force in understanding the risks associated with opioid abuse because when they observe addiction firsthand and lose friends or family members due to overdose, it is a wakeup call on many levels and creates different opportunities for youth to share their experiences with others with the intent to warn them of the risks and dangers of opioid abuse, along with recognizing the value of understanding how opioids can destroy families, friendships, and lives. Opioid abuse among teens and the risk of overdose are serious public health concerns which require expanded education and oversight to prevent future incidents. Therefore, an educational strategy to target teens is necessary to ensure that this vulnerable population group understands the risk factors related to opioid use and abuse.

Student-Identified Solution to Healthcare Concern

There is a critical need to educate high school students regarding the risk of opioid use and abuse because of the epidemic nature of this public health problem. It is necessary to demonstrate the risk of opioid abuse among adolescents and how these risk factors are increased in some communities where opioid abuse is more common. An education program which is required for all high school students as part of the annual curriculum will expand knowledge for these students and enable them to better understand the challenges and risks of using opioids. For some students, the use of opioids is via prescription methods, while others access these drugs under other circumstances, thereby posing an even greater risk of danger to patients (Miech, Johnston, O’Malley, Keyes, & Heard, 2015). Under these conditions, it is necessary to demonstrate the importance of strategies which may be useful in addressing the most critical risks related to opioid abuse among teens by emphasizing the prevalence of this and providing examples of its widespread impact on this population group. It is known that “An association between legitimate opioid use before high school completion and an increased risk of subsequent misuse after high school could change the risk/benefit considerations for clinicians who treat pediatric patients with painful conditions” (Miech et al., 2015, p. e2). Under these conditions, it is likely that some teens who might have been prescribed opioids may not receive them after all, but in cases where they can be accessed illegally without an actual prescription, this can be very problematic for teens and cause greater harm and the risk of addiction and overdose. In addition, the educational program must also emphasize the importance of opioids as a gateway to other drugs, such as heroin, which a much stronger and more potent opiate (Cerda, Santaella, Marshall, Kim, & Martins, 2015).

The risk factors associated with opioid use and abuse are critical to the development of an educational program which can target high school students and support knowledge and resources to prevent overdose and other poor outcomes among teens. The likely positive outcome is lower utilization of opioids among teens, along with an understanding of why these medications can cause serious harm to this population group. The school district and the community must support this initiative so that it can be implemented in local high schools, along with understanding the value of education to curb opioid prescribing methods among physicians. These objectives are likely to reduce the economic burden associated with opioid abuse and reduce the number of overdoses among teens (Groenewald, Rabbitts, Gebert, & Palermo, 2016). In addition, this program will enable teens to understand that there are not only physical side effects to opioid use and abuse, but also psychological implications which can contribute to addiction, and other problems; therefore, community and clinical support are essential in reducing this risk and in fostering increased knowledge of opioid abuse that occurs directly within the community (Boyd, Young, & McCabe, 2014). A reduced number of overdoses in the target communities will demonstrate that the initiative has had some impact on teens and create opportunities to expand the program to other areas. Nonetheless, there are potential challenges to consider which impact decision-making among local community members, such as financing the program and gaining the support of parents, both of which can be accomplished through exposure to real-world statistics and needs for this program.

Identification of Elected Official

To promote the potential effectiveness of the program in the community, Senator Rob Portman of Ohio will be presented with the strategy and will have the chance to understand its potential impact and its benefits for teens in some of the local high schools. This individual was selected because he represents Ohio and has a strong track record on opioid abuse, including recent efforts to enact bipartisan legislation to address the opioid epidemic at the state and national levels. His role in the project will be important in bringing greater attention to the issue and why education for teens is critical as part of a larger strategy to reduce opioid use and abuse among teens.

Conclusion

Opioid use and abuse among teens is very high in some communities and can lead to the risk of overdose and death. Therefore, this is a serious public health epidemic which has serious implications for many communities and requires expanded efforts to reduce this problem at the national level. However, on a local scale, there is evidence to support new programmatic efforts which can educate teens in high school and provide greater oversight regarding their use of opioids. An educational program will attract their attention and that of community members to recognize the serious nature of this problem and its impact on individuals, families, and others within the surrounding areas.

References

Boyd, C. J., Young, A., & McCabe, S. E. (2014). Psychological and drug abuse symptoms

associated with nonmedical use of opioid analgesics among adolescents. Substance abuse, 35(3), 284-289.

Cerdá, M., Santaella, J., Marshall, B. D., Kim, J. H., & Martins, S. S. (2015). Nonmedical

prescription opioid use in childhood and early adolescence predicts transitions to heroin use in young adulthood: a national study. The Journal of Pediatrics, 167(3), 605-612.

Department of Health and Human Services (2017). Opioids and adolescents.

Edlund, M. J., Forman-Hoffman, V. L., Winder, C. R., Heller, D. C., Kroutil, L. A., Lipari, R.

N., & Colpe, L. J. (2015). Opioid abuse and depression in adolescents: Results from the National Survey on Drug Use and Health. Drug & Alcohol Dependence, 152, 131-138.

Groenewald, C. B., Rabbitts, J. A., Gebert, T., & Palermo, T. M. (2016). Trends in opioid

prescriptions among children and adolescents in the United States: A nationally representative study from 1996 to 2012. Pain, 157(5), 1021.

Miech, R., Johnston, L., O’Malley, P. M., Keyes, K. M., & Heard, K. (2015). Prescription

opioids in adolescence and future opioid misuse. Pediatrics, peds-2015.

Monnat, S. M., & Rigg, K. K. (2016). Examining rural/urban differences in prescription opioid

misuse among US adolescents. The Journal of Rural Health, 32(2), 204-218.

Institutional Solutions to Domestic Violence against Women

Abstract

Institutional Solutions to Domestic Violence against Women is an emotive issue. Although the topic has been addressed many times before, the high rates of domestic abuse in the US highlight the importance of searching for new solutions to the problem. The issue of domestic abuse needs to be addressed on the institutional level through the change of gun legislation, a more active involvement of the government, and the expansion of domestic violence services. The role of gun legislation, government involvement, and existing services is critiqued and the shortfalls identified. It emerges that resources, services, and attitudes are critical factors for institutions to succeed in addressing the problem. The endeavors proposed are higher prioritization of the problem as a major public health concern, increase of funding towards institutions and services, and provision of amenities and legal services to minimize the burden on the victims as well as reduce dependency on abusive partners.

Institutional Solutions to Domestic Violence against Women

Introduction

Kysha (her code name), a 28 year old African American woman living in Detroit is involved in a support group for victims dealing with domestic abuse. She has managed to obtain a full restraining order for her irate husband who claims that she is his source of ‘bad fortune.’ She narrates how she still fears for her life and that of her two tear old son, currently living with her parents within the city. In spite of the restraining order, her husband still accesses her and the child in what she describes as cold ‘gangster visits,’ all without regard for the law. Hers is the plight of numerous other women in the US to whom protection against domestic violence is all on paper. In a single day in 2016, about 67,646 requests for help from domestic violence against women received a positive response. Approximately a sixth of the number (10,871) was not met due to lack of adequate resources. The issue of domestic abuse needs to be addressed on the institutional level through the change of gun legislation, a more active involvement of the government, and the expansion of domestic violence services.

Legislation and Domestic Violence against Women

In 1996, the Lautenberg Amendment was enacted. It considers a criminal offense, the possession of a firearm or ammunition by any individual convicted in a court of a misdemeanor crime of domestic violence (Harvard Business Review Association, 2014). The spirit of the law is evident. David Kelley’s mass shooting incident in Texas at the Sutherland Springs Church triggered an inquiry that revealed his conviction for domestic violence in 2012. Before the mass shooting in 2016, he had just been adversely discharged from the military for assaulting his wife and their child, following which he had be given a 12 month confinement sentence (Lopez, 2017). The author observes that numerous mass shooting convicts have been found to have a criminal history of domestic violence. Therefore, it is difficult to disengage gun legislation from domestic violence. Notably, federal law only revokes the rights to a firearm for spouses serving a full restraining order. However, Vox authors observe that domestic violence victims usually face the greatest risk as the perpetrators retaliate for obtaining temporary restraining orders. Therefore, by the time a full restraining order is granted, the perpetrator still has a chance to use the gun because the temporary restraining order comes first. Secondly, although an individual may not be granted a Firearm Owner Identification (FOID) card, it does little to deter the perpetrators from gun possession. They may acquire guns irregularly through illicit cross-border purchases, as well as private purchases which may be out of the scrutiny of law enforcement. Lopez (2017) proposes that law makers should consider relaxing laws that lead to firearm confiscation. As such, there is no outright alienation of the right to hold firearms, but there are laws governing the conditions of possession. For instance, they laws would allow a police officer to confiscate a gun from an individual who is deemed dangerous to self or others.

Government’s Involvement in Domestic Violence Cases against Women

Several institutional services exist for the resolution of domestic violence. However, the recent trends in the US decry their conclusiveness and efficacy. There is discontentment with the lackluster fashion of handling cases of domestic violence against women and children since many feel that their processes are not rigorous enough to produce objective conclusions (Francis, Loxton, & James, 2017). These institutions include family justice courts, supervised visitation centers, domestic violence courts, and the civil courts. The major problem is that they tend to be misconstrued by those who lead them as conduits of women denying their husbands custody of children. Consequently, most rulings are inadequately dismissed on the basis of alienating children from their husbands. For more objective rulings to ensue, women are held at extremely high legal standards. Civil courts usually produce the opposite result from the victims’ expectations. Women end up spending time in jail for failing to appear during prosecution. Another consequence of citing violence is involvement of Child Protective Services that result in alienation of children from the parents (Brickman, 2016).

Expansion of Domestic Violence Services for the Successful Prevention and Solutions

It is, therefore, clear that the existing institutions and services are not adequately addressing the problem of domestic violence against women. Two broad causes for the poor performance of the services include lack of adequate resources, and poor legal representation. Resources are required to provide services required by abused victims that eliminate dependency on the perpetrator for their needs. These include but are not limited to temporary housing facilities, money, and other amenities. On the matter of legal representation, navigating the court system is a complex task that becomes even more daunting for already abused women. It is further exacerbated by the gun legislation shortcomings earlier discussed, which leaves the abusive spouse with options to further victimize the abused woman. A solution proposed for dealing with the two issues is prioritization of domestic violence against women as a major public health issue and allocation of sufficient funds. The funds can be used to roll out projects such as transitional housing, legal services, and such others (Jeltsen, 2017).

Conclusion

The current institutions and state services for serving victims of domestic violence are not effective; hence the need to increase resources, prioritize the problem as a major public health issue, and review the federal firearm legislation. The legislation should relax restrictions on law enforcement’s capacity to confiscate weapons, rather than alienating the rights to hold firearms. More elaborate facilities such as transitional homes for victims, money, and dependable legal representation should be provided by the state for domestic violence meetings. There is also a need for changes in attitudes and perceptions on the part of the population and judicial officers.

References

Brickman, J.  (2016). Victims of Domestic Violence Need Greater System Support. Vera Institute of Justice. ]

Francis, L., Loxton, D., & James, C. (2017). The culture of pretence: a hidden barrier to recognising, disclosing and ending domestic violence. Journal Of Clinical Nursing, 26(15-16), 2202-2214.

Harvard Business Review Association, (2014). GUN CONTROL ACT — DOMESTIC VIOLENCE MISDEMEANANTS’ FIREARMS DISABILITIES — ILLINOIS SUPREME COURT CONSTRUES FEDERAL GUN CONTROL ACT TO PERMIT STATE COURT TO REMOVE DOMESTIC VIOLENCE MISDEMEANANT’S FEDERAL FIREARMS DISABILITY. (2014). Harvard Law Review, 127(7), 2146-2153.

Jeltsen, M. (2017). Why So Many Domestic Violence Survivors Don’t Get Help — Even When They Ask For It. The Huffington Post.

Lopez, G. (2017). America’s domestic violence problem is a big part of its gun problem. Vox.

The changing family meal experience

Across our country and others, families sit down together to enjoy a family dinner together.  It can be joyful or even argumentative.  It has changed through the years from being a reserved dining experience to a time for families to express themselves (Griffin, 2016).  In the past, it was considered a tradition.  It was a time where the family became unified.  Do the majority of families still eat together?  Do they eat away from home more?  Do they consume more take-out food rather than home cooked meals?  Is this tradition fading?  Has technology and hectic lifestyles brought us away from this tradition?  Does this affect our children and our futures? Having family dinners is more important today than in the past because there are so many more distractions such as technology and a variety of activities to chose from outside of the home.  We meet and interact with many different types of people during the day and our children are learning about the world from various places without input or filters from parents.  Family meals can provide a secure place to discuss ideas, current events, and daily happenings.  These meals provide opportunities to parents to be role models for communication and manners, give children a sense of security, monitor their emotional, educational, and even spiritual growth, prevent destructive behaviors, nourish and expand their worlds one food at a time, and save money (Hand, 2005).  They provide children with structure and routine and can improve overall well being and language and literacy development.  There have been several large studies that have shown that regular family meals are highly associated with increased eating of fruits, vegetables, grains and other healthy food choices and linked to lesser consumption of fried or fatty foods, soft drinks or other less healthy food choices (NDSU, 2009).  Shared family mealtimes can benefit the family, the children, and our health (NDSU, 2009).  While some people think this tradition is becoming lost, that does not seem to be true.  There were two different studies that showed that 79 percent of teenagers stated that they enjoyed eating meals with their families. There was also 64 percent of the teens that said eating at least one meal a day as a family was very important to them.  Finally, there were 98 percent of parents who agreed that having their family eat together at least once a day was very important (NDSU, 2009).  The National Center on Addiction and Substance Abuse (CASA) at Columbia University recently reported on a national phone survey of 1,000 teens and 829 parents of teens that eating dinner as a family helped kids in many ways such as helping them get better grades, and keeping them away from cigarettes, alcohol, and marijuana, and more (Davis).  CASA reported that teens who eat fewer than three family dinners per week in comparison to  those who eat five to seven family dinners a week are two times as likely to use alcohol and tobacco and one and a half times more likely to use marijuana (Banschick, 2013).  Another report from CASA, the Importance of the Family Dinner IV stated that 59% of families reported eating dinner together at least five times a week, which was an increase from only 47% in 1998 (Klein).  A  Pew Research Center report on family issues included information on the frequency of family meals, taken from a survey of adults in October 2010.  Among parents of children under 18 years of age, half of them say they have dinner every day with some or all of their children, 34% say they have family meals a few times a week, 11% say they do so occasionally and 3% say they never do (Cohn, 2011).  In the last ten years, the biggest change has been the movement of women’s work from their families to the paid labor market (Cohen, 2015) Family meals allow us to play catch up, return to our roots, and connect over food (Banschick, 2013). Before the late 18th century, dining rooms and dining tables were not used or thought of and it made it difficult for families to dine together regularly.  Tables and rooms had multiple uses and families would sometimes eat in shifts.  If there were not enough chairs, the men would sit and the women and children would stand (Griffin, 2016).  The rise of American family dinners began in the late 1700’s.  One of the first American homes to have a room specifically for dining was Thomas Jefferson’s Monticello, which was built in 1772. The dining room with the dining table at its center, began to become a part of wealthy homes across the country and eventually began coming into middle class homes (Griffin, 2016).  With a designated space for family meals and enough seating, family meals had a set time and parents used this time to educate children about manners and religion.  In 1943, the sociologist James H.S. Bossard wrote that “it is at the dining table, and particularly at dinner time, that the family is apt to be at its greatest ease.” (Griffin, 2016)  In the same year, The Saturday Evening Post published Norman Rockwell’s Freedom from Want, where a family is dining around a Thanksgiving table.  It  represented the strength of American values during World War II. The people in the painting not only have food, but are very happy, smiling at each other and the viewer (Griffin, 2016).   Family dinners were shown on TV shows such as Father Knows Best, Leave It to Beaver, and Happy Days. There weren’t many TV shows that showed family mealtime with African Americans or minorities; except for Good Times which represented African American families, however  you hardly ever saw the whole family sit at the table while eating their meal. Family mealtime is still important in our society.   Research shows that family meals help nurture children’s social, cognitive, emotional, and nutritional development. The normal family mealtime has changed because of changes to the definition of what a family unit can be, the necessity for women to work outside of the home, or that the food is from a fast-food restaurant in front of the TV, or some other kind of distraction, due to the use of technology.  Despite the changes, family mealtime is still a historic tradition.

References

Banschick, M. (2013, June 21). The Family Dinner.

Becky Hand, Licensed & Registered Dietician. (2005, June 11). The Benefits of Eating Together.

Cohen, P. N. (2015). The family: diversity, inequality, and social change. New York: Norton.

Cohn, D. (2011, April 08). Family Meals, Cohabitation and Divorce.

Davis, J. L. (n.d.). Family Dinners Are Important.

Griffin, M. (2016, February 16). ‘No Place For Discontent’: A History Of The Family Dinner In America.

1. (2010, March 16). Interesting Statistics on Family Dinners.

Klein, S. (n.d.). Make Time for Family Dinner.

North Dakota State University. (2009).