Government and Regulations

TRICARE recently announced it will cover transcranial magnetic stimulation (TMS) as a treatment for major depressive disorder. Transcranial magnetic stimulation is used when other depression treatments have not been effective. Only half the patients treated for major depressive disorder with medication and talk therapy show lasting results.

Transcranial magnetic stimulation is noninvasive, and treatments are typically outpatient, not requiring anesthesia. An electromagnetic coil placed against the scalp delivers a magnetic pulse through the skull, inducing a low-level current. The patient receives multiple pulses over several seconds. The electrical pulses stimulate nerve cells in the region of the brain that controls mood and depression. Each treatment session lasts about 40 minutes.

The new benefit is effective now. It is not part of a pilot or demonstration program but is part of the basic TRICARE benefit.

TRICARE recently announced it will cover transcranial magnetic stimulation (TMS) as a treatment for major depressive disorder. Transcranial magnetic stimulation is used when other depression treatments have not been effective. Only half the patients treated for major depressive disorder with medication and talk therapy show lasting results.

Transcranial magnetic stimulation is noninvasive, and treatments are typically outpatient, not requiring anesthesia. An electromagnetic coil placed against the scalp delivers a magnetic pulse through the skull, inducing a low-level current. The patient receives multiple pulses over several seconds. The electrical pulses stimulate nerve cells in the region of the brain that controls mood and depression. Each treatment session lasts about 40 minutes.

The new benefit is effective now. It is not part of a pilot or demonstration program but is part of the basic TRICARE benefit.

TRICARE recently announced it will cover transcranial magnetic stimulation (TMS) as a treatment for major depressive disorder. Transcranial magnetic stimulation is used when other depression treatments have not been effective. Only half the patients treated for major depressive disorder with medication and talk therapy show lasting results.

Transcranial magnetic stimulation is noninvasive, and treatments are typically outpatient, not requiring anesthesia. An electromagnetic coil placed against the scalp delivers a magnetic pulse through the skull, inducing a low-level current. The patient receives multiple pulses over several seconds. The electrical pulses stimulate nerve cells in the region of the brain that controls mood and depression. Each treatment session lasts about 40 minutes.

The new benefit is effective now. It is not part of a pilot or demonstration program but is part of the basic TRICARE benefit.

It is a brilliant, practical, and lifesaving option for kidney transplant candidates who have a living donor who is not compatible: Someone who is compatible donates while the candidate’s “first choice” donor gives a kidney to someone else on the list.

“Kidney-paired donation,” as it is called, has been bringing hope to thousands of hard-to-match patients. Now, veterans will be eligible to participate. Walter Reed National Military Medical Center is piloting a program to pioneer kidney-paired donation chains via the military share program. Family members of active-duty military service members can donate to patients listed for transplant at the Walter Reed campus. Those kidneys also will be available to veterans and their dependents as well as civilian patients.

Walter Reed surgeons perform an average of 25 transplants per year on patients from across the country.

Because a kidney-paired program can also extend through 3, 4, and higher numbers of participants, it extends the possibilities. Experts at Johns Hopkins University,  which has an exchange program, estimate that 45% of donor/recipient pairs could find a perfectly matched donor by entering the national paired kidney exchange program.

It is a brilliant, practical, and lifesaving option for kidney transplant candidates who have a living donor who is not compatible: Someone who is compatible donates while the candidate’s “first choice” donor gives a kidney to someone else on the list.

“Kidney-paired donation,” as it is called, has been bringing hope to thousands of hard-to-match patients. Now, veterans will be eligible to participate. Walter Reed National Military Medical Center is piloting a program to pioneer kidney-paired donation chains via the military share program. Family members of active-duty military service members can donate to patients listed for transplant at the Walter Reed campus. Those kidneys also will be available to veterans and their dependents as well as civilian patients.

Walter Reed surgeons perform an average of 25 transplants per year on patients from across the country.

Because a kidney-paired program can also extend through 3, 4, and higher numbers of participants, it extends the possibilities. Experts at Johns Hopkins University,  which has an exchange program, estimate that 45% of donor/recipient pairs could find a perfectly matched donor by entering the national paired kidney exchange program.

It is a brilliant, practical, and lifesaving option for kidney transplant candidates who have a living donor who is not compatible: Someone who is compatible donates while the candidate’s “first choice” donor gives a kidney to someone else on the list.

“Kidney-paired donation,” as it is called, has been bringing hope to thousands of hard-to-match patients. Now, veterans will be eligible to participate. Walter Reed National Military Medical Center is piloting a program to pioneer kidney-paired donation chains via the military share program. Family members of active-duty military service members can donate to patients listed for transplant at the Walter Reed campus. Those kidneys also will be available to veterans and their dependents as well as civilian patients.

Walter Reed surgeons perform an average of 25 transplants per year on patients from across the country.

Because a kidney-paired program can also extend through 3, 4, and higher numbers of participants, it extends the possibilities. Experts at Johns Hopkins University,  which has an exchange program, estimate that 45% of donor/recipient pairs could find a perfectly matched donor by entering the national paired kidney exchange program.

Births among all American teenagers have dropped > 40% during the past decade, according to a CDC analysis reported in MMWR. Births among Hispanic and black teens have dropped by almost half since 2006.

But despite those dramatic drops—51% among Hispanic teens and 44% among blacks—their birth rates remain twice as high than among whites. In some states, birth rates among Hispanic and black teens are more than 3 times as high as those of whites. For example, in Nebraska, the birth rate for white teens (16%) approximated the national rate; rates for black and Hispanic teens (43% and 54%, respectively) far exceeded the national rate, the MMWR report notes. Counties with higher teen birth rates were clustered in southern and southwestern states and in areas with higher unemployment and lower income and education.

“These data underscore that the solution to our nation’s teen pregnancy problem is not going to be a one-size-fits-all—teen birth rates vary greatly across state lines and even within states,” said Lisa Romero, DrPH, a health scientist in the CDC’s Division of Reproductive Health and lead author of the analysis.

The HHS’s Office of Adolescent Health partnered with the CDC from 2010 to 2015 to fund community-wide initiatives in 9 communities with some of the highest teen birth rates in the U.S., focusing on black and Hispanic teens. Projects included offering evening and weekend hours for health care and low-cost services to increase access. Preliminary data suggest that each community increased the number of teens who received reproductive health services and contraceptive methods.

Researchers attribute some of the drop in births to prevention interventions that address socioeconomic conditions such as unemployment and lower education levels. State and community leaders, their report advises, can use local data to better understand teen pregnancy in their communities and direct programs and resources to areas with the greatest need.

Births among all American teenagers have dropped > 40% during the past decade, according to a CDC analysis reported in MMWR. Births among Hispanic and black teens have dropped by almost half since 2006.

But despite those dramatic drops—51% among Hispanic teens and 44% among blacks—their birth rates remain twice as high than among whites. In some states, birth rates among Hispanic and black teens are more than 3 times as high as those of whites. For example, in Nebraska, the birth rate for white teens (16%) approximated the national rate; rates for black and Hispanic teens (43% and 54%, respectively) far exceeded the national rate, the MMWR report notes. Counties with higher teen birth rates were clustered in southern and southwestern states and in areas with higher unemployment and lower income and education.

“These data underscore that the solution to our nation’s teen pregnancy problem is not going to be a one-size-fits-all—teen birth rates vary greatly across state lines and even within states,” said Lisa Romero, DrPH, a health scientist in the CDC’s Division of Reproductive Health and lead author of the analysis.

The HHS’s Office of Adolescent Health partnered with the CDC from 2010 to 2015 to fund community-wide initiatives in 9 communities with some of the highest teen birth rates in the U.S., focusing on black and Hispanic teens. Projects included offering evening and weekend hours for health care and low-cost services to increase access. Preliminary data suggest that each community increased the number of teens who received reproductive health services and contraceptive methods.

Researchers attribute some of the drop in births to prevention interventions that address socioeconomic conditions such as unemployment and lower education levels. State and community leaders, their report advises, can use local data to better understand teen pregnancy in their communities and direct programs and resources to areas with the greatest need.

Births among all American teenagers have dropped > 40% during the past decade, according to a CDC analysis reported in MMWR. Births among Hispanic and black teens have dropped by almost half since 2006.

But despite those dramatic drops—51% among Hispanic teens and 44% among blacks—their birth rates remain twice as high than among whites. In some states, birth rates among Hispanic and black teens are more than 3 times as high as those of whites. For example, in Nebraska, the birth rate for white teens (16%) approximated the national rate; rates for black and Hispanic teens (43% and 54%, respectively) far exceeded the national rate, the MMWR report notes. Counties with higher teen birth rates were clustered in southern and southwestern states and in areas with higher unemployment and lower income and education.

“These data underscore that the solution to our nation’s teen pregnancy problem is not going to be a one-size-fits-all—teen birth rates vary greatly across state lines and even within states,” said Lisa Romero, DrPH, a health scientist in the CDC’s Division of Reproductive Health and lead author of the analysis.

The HHS’s Office of Adolescent Health partnered with the CDC from 2010 to 2015 to fund community-wide initiatives in 9 communities with some of the highest teen birth rates in the U.S., focusing on black and Hispanic teens. Projects included offering evening and weekend hours for health care and low-cost services to increase access. Preliminary data suggest that each community increased the number of teens who received reproductive health services and contraceptive methods.

Researchers attribute some of the drop in births to prevention interventions that address socioeconomic conditions such as unemployment and lower education levels. State and community leaders, their report advises, can use local data to better understand teen pregnancy in their communities and direct programs and resources to areas with the greatest need.

Culture-independent diagnostic tests (CIDTs) are a boon, helping to identify infections from foodborne illness faster. Without a bacterial culture, CIDTs cut the time needed to diagnose to mere hours.

The CIDTs are making it easier to find cases that were not previously diagnosed, according to an MMWR report on findings from the CDC’s Foodborne Diseases Active Surveillance Network (FoodNet). In 2015, the percentage of foodborne infections diagnosed only by CIDT was “markedly higher”—about double, compared with the percentage in 2012-2014, the report says. For instance, the incidence of Cryptosporidium was significantly higher in 2015 than the average for the previous 3 years.

But without a bacterial culture, public health officials can’t get all the detailed information they need to track outbreaks and trends. The CDC is working with partners to develop advanced testing methods that, without culture, will still give the needed data for diagnosis as well as the preventive clues. In the short term, the CDC advises clinical laboratories to work with public health laboratories to make sure a culture is done whenever a CIDT indicates that someone with diarrheal illness has a bacterial infection.

Culture-independent diagnostic tests (CIDTs) are a boon, helping to identify infections from foodborne illness faster. Without a bacterial culture, CIDTs cut the time needed to diagnose to mere hours.

The CIDTs are making it easier to find cases that were not previously diagnosed, according to an MMWR report on findings from the CDC’s Foodborne Diseases Active Surveillance Network (FoodNet). In 2015, the percentage of foodborne infections diagnosed only by CIDT was “markedly higher”—about double, compared with the percentage in 2012-2014, the report says. For instance, the incidence of Cryptosporidium was significantly higher in 2015 than the average for the previous 3 years.

But without a bacterial culture, public health officials can’t get all the detailed information they need to track outbreaks and trends. The CDC is working with partners to develop advanced testing methods that, without culture, will still give the needed data for diagnosis as well as the preventive clues. In the short term, the CDC advises clinical laboratories to work with public health laboratories to make sure a culture is done whenever a CIDT indicates that someone with diarrheal illness has a bacterial infection.

Culture-independent diagnostic tests (CIDTs) are a boon, helping to identify infections from foodborne illness faster. Without a bacterial culture, CIDTs cut the time needed to diagnose to mere hours.

The CIDTs are making it easier to find cases that were not previously diagnosed, according to an MMWR report on findings from the CDC’s Foodborne Diseases Active Surveillance Network (FoodNet). In 2015, the percentage of foodborne infections diagnosed only by CIDT was “markedly higher”—about double, compared with the percentage in 2012-2014, the report says. For instance, the incidence of Cryptosporidium was significantly higher in 2015 than the average for the previous 3 years.

But without a bacterial culture, public health officials can’t get all the detailed information they need to track outbreaks and trends. The CDC is working with partners to develop advanced testing methods that, without culture, will still give the needed data for diagnosis as well as the preventive clues. In the short term, the CDC advises clinical laboratories to work with public health laboratories to make sure a culture is done whenever a CIDT indicates that someone with diarrheal illness has a bacterial infection.

Compared with that of the national average, American Indian/Alaska Natives (AI/ANs) have about double the incidence of acute hepatitis C virus (HCV) infection and HCV-associated mortality. That may be changing, at last—and fairly quickly.

In 2012, the IHS began implementing the national recommendations for onetime HCV testing in people at highest risk (those born between 1945 and 1965). And as of June 2015, the proportion of the birth cohort screened for HCV had shot up from 7.9% to 33%—a 4-fold increase in testing in just 3 years.

With better screening comes a need for better follow-up care. Because IHS facilities are decentralized, the CDC says, implementation of HCV testing is a local decision, based on capacity and priorities. Several IHS facilities have established follow-up care and treatment for people with HCV infection, but clinical capacity remains a “substantial barrier to providing the care and treatment necessary for cure,” the CDC says. Moreover, some primary care providers remain hesitant to provide treatment because they associate current HCV medications with complicated, lengthy, and poorly tolerated interferon-based treatments.

The majority of IHS patients obtain HCV medication at no cost through Medicaid and pharmaceutical assistance programs. It is unclear, the CDC says, whether this approach will be sustainable as a larger number of AI/AN people with HCV infection are identified and linked to care.

In the meantime, support for HCV testing has been integrated into existing programs, using methods and strategies (such as electronic health records as clinical decision support tools) that have been documented as successful in IHS facilities. Based on national best practices, IHS has also implemented clinical trainings and obtained telehealth support. Testing coverage in individual IHS facilities ranged from 1.9% to 75%—the largest increase was seen in facilities that used an electronic clinical decision support tool for testing.

Compared with that of the national average, American Indian/Alaska Natives (AI/ANs) have about double the incidence of acute hepatitis C virus (HCV) infection and HCV-associated mortality. That may be changing, at last—and fairly quickly.

In 2012, the IHS began implementing the national recommendations for onetime HCV testing in people at highest risk (those born between 1945 and 1965). And as of June 2015, the proportion of the birth cohort screened for HCV had shot up from 7.9% to 33%—a 4-fold increase in testing in just 3 years.

With better screening comes a need for better follow-up care. Because IHS facilities are decentralized, the CDC says, implementation of HCV testing is a local decision, based on capacity and priorities. Several IHS facilities have established follow-up care and treatment for people with HCV infection, but clinical capacity remains a “substantial barrier to providing the care and treatment necessary for cure,” the CDC says. Moreover, some primary care providers remain hesitant to provide treatment because they associate current HCV medications with complicated, lengthy, and poorly tolerated interferon-based treatments.

The majority of IHS patients obtain HCV medication at no cost through Medicaid and pharmaceutical assistance programs. It is unclear, the CDC says, whether this approach will be sustainable as a larger number of AI/AN people with HCV infection are identified and linked to care.

In the meantime, support for HCV testing has been integrated into existing programs, using methods and strategies (such as electronic health records as clinical decision support tools) that have been documented as successful in IHS facilities. Based on national best practices, IHS has also implemented clinical trainings and obtained telehealth support. Testing coverage in individual IHS facilities ranged from 1.9% to 75%—the largest increase was seen in facilities that used an electronic clinical decision support tool for testing.

Compared with that of the national average, American Indian/Alaska Natives (AI/ANs) have about double the incidence of acute hepatitis C virus (HCV) infection and HCV-associated mortality. That may be changing, at last—and fairly quickly.

In 2012, the IHS began implementing the national recommendations for onetime HCV testing in people at highest risk (those born between 1945 and 1965). And as of June 2015, the proportion of the birth cohort screened for HCV had shot up from 7.9% to 33%—a 4-fold increase in testing in just 3 years.

With better screening comes a need for better follow-up care. Because IHS facilities are decentralized, the CDC says, implementation of HCV testing is a local decision, based on capacity and priorities. Several IHS facilities have established follow-up care and treatment for people with HCV infection, but clinical capacity remains a “substantial barrier to providing the care and treatment necessary for cure,” the CDC says. Moreover, some primary care providers remain hesitant to provide treatment because they associate current HCV medications with complicated, lengthy, and poorly tolerated interferon-based treatments.

The majority of IHS patients obtain HCV medication at no cost through Medicaid and pharmaceutical assistance programs. It is unclear, the CDC says, whether this approach will be sustainable as a larger number of AI/AN people with HCV infection are identified and linked to care.

In the meantime, support for HCV testing has been integrated into existing programs, using methods and strategies (such as electronic health records as clinical decision support tools) that have been documented as successful in IHS facilities. Based on national best practices, IHS has also implemented clinical trainings and obtained telehealth support. Testing coverage in individual IHS facilities ranged from 1.9% to 75%—the largest increase was seen in facilities that used an electronic clinical decision support tool for testing.

The 2015 National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of halving inappropriate outpatient antibiotic use by 2020. The CDC researchers analyzed the 2010-2011 National Ambulatory Medical Survey and the National Hospital Ambulatory Medical Care Survey to figure out whether we’re getting closer to the goal.

About 1 in 3 antibiotic prescriptions is unneeded, according to the CDC study. Those 47 million excess prescriptions each year put patients at risk for allergy reactions or sometimes deadly diarrhea. Many of the unnecessary antibiotics are prescribed for respiratory conditions caused by viruses.

To help shift momentum in the right direction, the researchers suggest that outpatient health care providers (HCPs) can evaluate their prescribing habits and implement antibiotic stewardship activities, such as watchful waiting or delayed prescribing. Health systems can provide communications training, clinical decision support, and patient and HCP education. Patients also can talk with their HCPs about when antibiotics are needed and when they aren’t.

For more information on antibiotic stewardship, visit www.cedc.gov/getsmart.

The 2015 National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of halving inappropriate outpatient antibiotic use by 2020. The CDC researchers analyzed the 2010-2011 National Ambulatory Medical Survey and the National Hospital Ambulatory Medical Care Survey to figure out whether we’re getting closer to the goal.

About 1 in 3 antibiotic prescriptions is unneeded, according to the CDC study. Those 47 million excess prescriptions each year put patients at risk for allergy reactions or sometimes deadly diarrhea. Many of the unnecessary antibiotics are prescribed for respiratory conditions caused by viruses.

To help shift momentum in the right direction, the researchers suggest that outpatient health care providers (HCPs) can evaluate their prescribing habits and implement antibiotic stewardship activities, such as watchful waiting or delayed prescribing. Health systems can provide communications training, clinical decision support, and patient and HCP education. Patients also can talk with their HCPs about when antibiotics are needed and when they aren’t.

For more information on antibiotic stewardship, visit www.cedc.gov/getsmart.

The 2015 National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of halving inappropriate outpatient antibiotic use by 2020. The CDC researchers analyzed the 2010-2011 National Ambulatory Medical Survey and the National Hospital Ambulatory Medical Care Survey to figure out whether we’re getting closer to the goal.

About 1 in 3 antibiotic prescriptions is unneeded, according to the CDC study. Those 47 million excess prescriptions each year put patients at risk for allergy reactions or sometimes deadly diarrhea. Many of the unnecessary antibiotics are prescribed for respiratory conditions caused by viruses.

To help shift momentum in the right direction, the researchers suggest that outpatient health care providers (HCPs) can evaluate their prescribing habits and implement antibiotic stewardship activities, such as watchful waiting or delayed prescribing. Health systems can provide communications training, clinical decision support, and patient and HCP education. Patients also can talk with their HCPs about when antibiotics are needed and when they aren’t.

For more information on antibiotic stewardship, visit www.cedc.gov/getsmart.

Despite efforts to change the results, the American Indian infant mortality rate is still nearly twice that of the nation. The Great Plains area—South Dakota, North Dakota, Iowa, and Nebraska—is particularly hard-hit. There, babies are 2 to 3 times more likely than white babies to die within their first year. A recent article in Native Health News Alliance (NHNA)provides some background.

In South Dakota, American Indian babies accounted for 23 of 73 infant deaths reported in 2014, according to the South Dakota Department of Health, quoted in NHNA. In fact, between 2013 and 2014, although the number dropped of white babies dying, the number rose slightly for American Indians. Usually the postneonatal period (starting on day 28) marks the end of the “danger zone,” when the risk of infant death tends to go down. But for American Indian babies in South Dakota, the rate jumps from 4.2 per 1,000 births to 7.9.

In the NHNA article, Carol Iron Rope Herrera, who teaches parents about Lakota birthing and child-rearing traditions, says the Lakota tradition considers all babies sacred. She believes infant death in American Indian communities reflects lifestyle changes: “a shift in the cultural and spiritual ways of Native people.”

Linda Littlefield, manager of the Northern Plains Healthy Start program, agrees about lifestyle issues, specifically citing smoking. The NHNA article cites a report by the Northern Plains Tribal Epidemiology Center that found that between 2008 and 2012, > 30% of American Indian women in the Great Plains reported using tobacco during pregnancy.

Many American Indian traditions and beliefs support infant health and well-being, according to Christy Hacker, director of Maternal and Child Health programs for the Great Plains Tribal Chairmen’s Health Board, quoted in the NHNA article. Healthy Start communities often incorporate Lakota traditions about life and the sacredness of babies at powwows and other ceremonies.

But Hacker believes it is also important to encourage and support good care for women. According to research by the CDC and Northern Plains Tribal Epidemiology Center, only half of American Indian mothers in the Great Plains began prenatal care within the first trimester. “If mothers can take care of themselves,” Hacker says, “they can take care of the baby when it’s born.”

Despite efforts to change the results, the American Indian infant mortality rate is still nearly twice that of the nation. The Great Plains area—South Dakota, North Dakota, Iowa, and Nebraska—is particularly hard-hit. There, babies are 2 to 3 times more likely than white babies to die within their first year. A recent article in Native Health News Alliance (NHNA)provides some background.

In South Dakota, American Indian babies accounted for 23 of 73 infant deaths reported in 2014, according to the South Dakota Department of Health, quoted in NHNA. In fact, between 2013 and 2014, although the number dropped of white babies dying, the number rose slightly for American Indians. Usually the postneonatal period (starting on day 28) marks the end of the “danger zone,” when the risk of infant death tends to go down. But for American Indian babies in South Dakota, the rate jumps from 4.2 per 1,000 births to 7.9.

In the NHNA article, Carol Iron Rope Herrera, who teaches parents about Lakota birthing and child-rearing traditions, says the Lakota tradition considers all babies sacred. She believes infant death in American Indian communities reflects lifestyle changes: “a shift in the cultural and spiritual ways of Native people.”

Linda Littlefield, manager of the Northern Plains Healthy Start program, agrees about lifestyle issues, specifically citing smoking. The NHNA article cites a report by the Northern Plains Tribal Epidemiology Center that found that between 2008 and 2012, > 30% of American Indian women in the Great Plains reported using tobacco during pregnancy.

Many American Indian traditions and beliefs support infant health and well-being, according to Christy Hacker, director of Maternal and Child Health programs for the Great Plains Tribal Chairmen’s Health Board, quoted in the NHNA article. Healthy Start communities often incorporate Lakota traditions about life and the sacredness of babies at powwows and other ceremonies.

But Hacker believes it is also important to encourage and support good care for women. According to research by the CDC and Northern Plains Tribal Epidemiology Center, only half of American Indian mothers in the Great Plains began prenatal care within the first trimester. “If mothers can take care of themselves,” Hacker says, “they can take care of the baby when it’s born.”

Despite efforts to change the results, the American Indian infant mortality rate is still nearly twice that of the nation. The Great Plains area—South Dakota, North Dakota, Iowa, and Nebraska—is particularly hard-hit. There, babies are 2 to 3 times more likely than white babies to die within their first year. A recent article in Native Health News Alliance (NHNA)provides some background.

In South Dakota, American Indian babies accounted for 23 of 73 infant deaths reported in 2014, according to the South Dakota Department of Health, quoted in NHNA. In fact, between 2013 and 2014, although the number dropped of white babies dying, the number rose slightly for American Indians. Usually the postneonatal period (starting on day 28) marks the end of the “danger zone,” when the risk of infant death tends to go down. But for American Indian babies in South Dakota, the rate jumps from 4.2 per 1,000 births to 7.9.

In the NHNA article, Carol Iron Rope Herrera, who teaches parents about Lakota birthing and child-rearing traditions, says the Lakota tradition considers all babies sacred. She believes infant death in American Indian communities reflects lifestyle changes: “a shift in the cultural and spiritual ways of Native people.”

Linda Littlefield, manager of the Northern Plains Healthy Start program, agrees about lifestyle issues, specifically citing smoking. The NHNA article cites a report by the Northern Plains Tribal Epidemiology Center that found that between 2008 and 2012, > 30% of American Indian women in the Great Plains reported using tobacco during pregnancy.

Many American Indian traditions and beliefs support infant health and well-being, according to Christy Hacker, director of Maternal and Child Health programs for the Great Plains Tribal Chairmen’s Health Board, quoted in the NHNA article. Healthy Start communities often incorporate Lakota traditions about life and the sacredness of babies at powwows and other ceremonies.

But Hacker believes it is also important to encourage and support good care for women. According to research by the CDC and Northern Plains Tribal Epidemiology Center, only half of American Indian mothers in the Great Plains began prenatal care within the first trimester. “If mothers can take care of themselves,” Hacker says, “they can take care of the baby when it’s born.”