Indiana State Health Commissioner Dr. Kristina Box spoke Friday in Terre Haute. Staff photo by Howard Greninger
Indiana State Health Commissioner Dr. Kristina Box spoke Friday in Terre Haute. Staff photo by Howard Greninger
Indiana State Health Commissioner Dr. Kristina Box told members of Better Health Wabash Valley that community based programs are the most successful at tackling health issues.

Getting support from major corporations as well as other organizations can help communities better fund efforts to target health issues, Box said Friday in a roundtable discussion held at Harsha Behaviorial Center in Terre Haute

"I think the programs that work the best are community-based, that there is buy in from the community and support. There are business support, health care providers, mental health providers, faith base organizations" to look at ways to address health concerns, said Box, an obstetrician-gynecologist for more than 30 years.

Box was appointed state health commissioner in 2017. Box said she lived in Terre Haute from age 3 to 18, graduating in 1976 from Terre Haute North Vigo High School. She went on to graduate from Indiana University and IU's medical school.

Her father, Carl McKee, was a dentist with a practice on East Wabash Avenue and still lives in Terre Haute. Her brother and sister-in-law also live in Terre Haute. Since 1979, Box has lived in Indianapolis. Her husband, David Box, is also from Terre Haute. His father worked as an insurance agent in Terre Haute.

Better Health Wabash Valley was initially established in 2009 as a branch committee of the Terre Haute Chamber of Commerce. The effort was relaunched this year to bring together regional health-related, education-related and business organizations to collectively find ways to improve the health in six counties in the Wabash Valley.

Terre Haute Regional Hospital CEO Nathan Vooys now leads Better Health Wabash Valley.

"We have 50 professionals who are dedicated to meeting and sharing best health practices," Vooys said. "It is a quality of life issue ... but also from a cost perspective."

Vooys said Better Health Wabash Valley has supported increasing the state's cigarette tax $2 and legislation addressing vaping, as well as legislation such as proposed from U.S. Sen. Todd Young, R-IN, is raising the federal smoking age to 21.

Box said "when we look at tobacco and the use of tobacco, specifically smoking, it the single most preventable cause of death and disease," adding that an increased number of Indiana youth are now vaping, also known as JUUling after the name brand, she said.

"Pretty soon our [state] youth tobacco survey will come out and it will show you how severely we have seen increases in our middle schools and high schools" on JUUling, Box said. "As far as I am concerned, that is just recruiting that next generation of smokers for the state of Indiana, which is the eighth highest smoking state in the Nation. We have almost 22 percent of our adults smoking every day."

That leads to heart disease as well as other health issues, Box said.

Additionally, Indiana was among the highest states prescribing opioids in the nation and had some of the highest number of deaths. "We are seeing significant trends down in that in the first six months on preliminary data in 2018, which indicates probably an 18 percent to 20 percent in overdose deaths this year compared to this time last year," Box said.

Roopam Harshawat, CEO/president and co-founder of Harsha Behaviorial Center, a psychiatric hospital, said prior to the roundtable discussion she would like to see state legislation that mandates drug programs during pregnancy.

"One of the main thing I would like to talk about is women abusing drugs — opoid, alcohol — all during pregnancy, because the consequences it has on the children that are born after that," Harshawat said. The center takes in children as young as 3 years and sometimes younger.

"Unfortunately, we have seen an escalation in the admissions we have since the time we started the hospital. It has more than tripled the admissions rate in the children's wing. These are children whose brain chemistry is completely messed up, they are very aggressive and completely out of control...their quality of life is totally compromised and have very little hope of leading a normal and productive life.

"These are children that are born to women who have abused drugs during pregnancy," Harshawat said.

Harshawat said "there has to be some way of preventing pregnant women from abusing drugs. And once it has been identified that they are using drugs, there has to be a mandatory requirement for them to follow treatment plan so they can be off of drugs and we can have children who do not have these disabilities."

"There has to be some kind of legislative work done on this front where we can prevent women from abusing drugs during pregnancy," Harshawat said.

Dr. Box said such mandates are problematic.

"That is a very difficult thing to do, to mandate that a pregnant woman do anything or than anyone get medical care. We can offer that. I think Indiana has taken the approach, this year with legislation, and the governor supported it as part of his agenda, a mandatory verbal screen for every pregnant woman as early as possible and throughout pregnancy," Box said.

Housed Enrolled Act 1007, passed this year in the Indiana General Assembly, requires health care providers to use a verbal screening tool for substance-use disorder with all pregnant patients. Under that law, to maintain confidentiality, providers may not disclose the results of these screenings to law enforcement or the Indiana Department of Child Services unless required by a court order.

Additionally, that law requires the Indiana State Department of Health to establish a Perinatal Navigator Program that engages pregnant woman in early prenatal care and refers them to available services, such as home visiting programs.

Vigo County has health issues, ranking 83rd out of 92 counties in a comparison of healthiest communities.

"Terre Haute is a microcosm of what the state overall has and that is a lot poor metric when we are compared to other states," Box said. "When you look at a lot of the surrounding areas of Terre Haute there is increased substance use disorder, higher smoking rates, some areas higher obesity rates, all of those things that contribute significantly to health.

Substance abuse contributes "significantly to what we call adverse childhood experiences. Children are growing up with violence and being exposed to a lot of poverty in certain areas, just like we have in other parts of the state and those adversely affect their health as they go forward then and grow into adults."
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