2019 - October Edition
Alice Kuo, MD, PhD, MBA, FAAP   President, AAP - CA2    2018 - 2020 
President's Message
As the weather gets cooler (at least in the evenings) and summer is officially over, our thoughts often turn towards the holidays and more charitable activities. We had an amazing strategic planning retreat last month, led by Annie Storey, from the National AAP office, and we reviewed data that demonstrated that our members value the work of our chapter and want more opportunities to network and get involved. I urge you this year to consider exploring ways you could get more involved in our chapter. We need you!! The more we can draw from the collective wisdom and experiences of our members, the stronger a chapter we will be.
This month, I wanted to highlight the multitude of opportunities you have to get involved in our chapter, to strengthen our work for pediatricians and for children's health.
Membership Committee
Chaired by the Vice-President of the Board of Directors (this year, Dr. Damodara Rajasekhar), this committee is comprised of our Members-at-Large on the Board and our Area Representatives of each of the seven counties in our chapter. This committee is responsible for welcoming new members and following up with individuals whose membership dues have lapsed. They have monthly calls to brainstorm on how to recruit new members and promote our chapter activities, such as our Annual Symposium and Life After Residency events. This committee is vital to our chapter because we want to be the go-to organization for pediatricians and children's health in our counties.
Section on Pediatric Trainees
Chaired by our SOPT liaison (this year, Dr. Lisa Gantz), this committee is comprised of medical students, pediatric and med-peds residents and pediatric-trained fellows who are currently in training. It is a very active group and is responsible for organizing the Life After Residency event each year, in addition to the trainee poster session at the Annual Symposium. Our members have indicated that supporting pediatric trainees is a priority for our chapter, and we welcome anyone who wants to get involved to support them.
Section on Early Career Physicians
Chaired by our SOECP liaisons (this year, Drs. Melissa Ruiz and Kevin Fang), this committee is comprised of physicians who are transitioning out of residency and fellowship as well as those who are within their first years of practice. After our strategic planning retreat, this was an area that members wanted more activities, particularly around work-life balance. We are hoping to plan an annual networking event in which child care would be provided to bring together the early career physicians in our chapters to discuss work-life balance and other challenges facing this group.
Physician Wellness Committee
This is a new priority for our Board, as many physician groups, including National AAP, have recognized that physician burnout and unfortunately, physician suicide is becoming an important issue. We have several members of our chapter very interested in this issue, and we want to support bringing them together to suggest what we can do as a chapter to support our members who are experiencing burnout or struggling with mental health issues. One aspect that the Board has been concerned about is the requirement to disclose whether a physician is receiving mental health treatment on the licensing renewal application for the California Medical Board, and we are pleased to report that due to physician advocacy on this topic, this question will soon be removed. Please consider joining this important committee to come up with ways to support our fellow chapter members to both prevent and address physician burnout.
Practice Management Committee
This is another area that was identified at our strategic planning retreat as an important activity for chapter members, particularly those in private practice. We are planning to hold regular conference calls for chapter members interested in learning more from each other about billing and coding, office management and operations issues, and quality improvement efforts for practice optimization. Stay tuned for more information as this committee is launched.
Immigrant Health Committee
Chaired by Dr. Sural Shah who is also an inaugural member of the national Council on Immigrant Child Health, this committee has been very active for more than a year as the AAP has been fighting for the health and welfare of immigrant children everywhere, including those detained at our borders and separated from their caregivers. This group has monthly meetings (alternating in-person with conference calls) and has activities such as planning town hall meetings, campaigns to comment on impending regulation changes from the federal government, as well as general advocacy efforts in collaboration with the Los Angeles County Office of Immigrant Affairs. Please consider getting involved if this issue is important to you.
Adverse Childhood Experiences (ACEs) Committee
Chaired by Dr. Adam Schickedanz who is a faculty researcher examining the impacts of poverty and ACEs on children's health, this committee has really taken off in the last few months educating our chapter members on ACEs and exploring how the Governor's desire to screen for ACEs can be implemented in our clinics. This committee will also attempt to align with the work of our Surgeon General, Dr. Nadine Burke-Harris in this area. If you work in a Federally Qualified Health Center (FQHC) or with vulnerable populations such as children in the foster care system or who have been abused or neglected or if this issue is important to you, please consider getting involved in this committee.
Immunizations Committee
With the recent passage of SB 276, along with the passage of SB 277 in 2015, we have a need to have a group of experts who can provide support for our chapter members in implementing the guidelines set forth in these pieces of legislation. Our chapter immunizations liaison is Dr. Candace Gragnani, who recently authored the guidelines for medical exemptions for vaccines which is being adopted throughout the state by the Health Officers in each county. We also have Dr. Ken Zangwill who is an infectious diseases specialist and member of the national Section on Infectious Diseases, along with several vaccine experts in our chapter. Please let us know if you are interested in joining this committee, as an expert or as someone who wants to learn more. We will work on bringing this committee together and providing resources for our chapter members for implementing new vaccine guidelines, along with providing support on how to address anti-vaccine sentiments in your practice.
Anti-Smoking/Vaping Committee
So much news is coming forth on the youth vaping epidemic that the narrative changes on a weekly basis. The bottom line is that vaping is now associated with serious lung injury and possible death, and many governmental leaders, including Governor Newsom and President Trump, have called for people to stop vaping. Locally, we have had many wins, as we have banned all tobacco sales in Beverly Hills and Manhattan Beach, and banned flavors in Los Angeles County and Long Beach, and many other cities are considering similar flavor bans. These local ordinances have also sparked other anti-tobacco legislation to come back, including smoking in public areas and smoking in multi-unit housing. We have a need to identify chapter members who can provide testimony about the hazards of smoking/vaping in local city council meetings around Los Angeles County and in other counties in our chapters. Please contact us if you are willing to attend your local or nearby city council meeting to provide testimony during public comment if a tobacco-related ordinance is being discussed.
I wanted to mention that these opportunities to get involved in our chapter are also great leadership opportunities that could position you for a position at National AAP, if that is an eventual goal.
We are finalizing the agenda for our Annual Symposium on March 28, 2020 at Carnesale Commons at UCLA. Please save the date! We have an outstanding program with three tracks for pediatricians of all types: general pediatrics, hospital pediatrics, and child advocacy. We are also starting to put together our Life After Residency mega-job fair for residents and recent graduates. Please contact Tomas if you are interested in advertising a position at the event.
As you can see, our chapter is very active addressing child health issues and supporting all of our work as pediatricians. Now is a good time to reach out to your pediatric colleagues who have not yet joined the chapter or paid their chapter dues. If there are pediatricians you know who would be willing to join the chapter, please direct them to our membership site (here). Also, it is possible to join our chapter to support local child health efforts without joining national AAP if there are cost prohibitions. Please contact Tomás for more information.
Please check out the rest of our newsletter for information on our Town Hall meetings and other CME opportunities, ways to get Maintenance of Certification (MOC) points with Quality Improvement (QI) projects, and statewide advocacy priorities that the AAP is working on behalf of children.
Thanks for all that you do on behalf of children in our communities!
Alice Kuo, MD, PhD, MBA, FAAP
Chapter President
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Feature Article - ACEs Committee 
Screening For ACEs in Pediatric Practice
Ariane Marie-Mitchell, MD, PhD, MPH
Ariane Marie-Mitchell, MD, PhD, MPH
In the August newsletter, we provided an overview of the definition and impact of adverse childhood experiences (ACEs). In this article, we will explore the argument in favor of screening for ACEs in pediatric practice, and describe the process and results of a California state advisory group on screening for trauma. Read more...

LAHAN: CDC Health Advisory  

Vaping Associated Pulmonary Injury (VAPI) (Oct 2, 2019)

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In case you missed it:

Since June 2019, a total of 102 cases of vaping-associated pulmonary injury (VAPI) requiring hospitalization have been reported to the California Department of Public Health (CDPH).  While the exact cause of illness is not yet known, most cases involve vaping the cannabis compounds tetrahydrocannabinol (THC) and/or cannabidiol (CBD), with some reports involving vaping nicotine products. 

View the full message here

Advocacy Against Vaping Epidemic 
Los Angeles County Board of Supervisors and City of Burbank 
The Chapter continues to be a strong voice against the current teenage Vaping epidemic in partnership with LA Families Fighting Flavored Tobacco, a coalition led by Larry Tramutola: one of the country's top political strategists, expert on grassroots organizing, and the leader behind San Francisco's successful flavor tobacco ban. 
Opposition against ordinance to ban flavored tobacco in LA County 
The Los Angeles County Board of Supervisors heard over 300 public comments on September 24th, mostly in opposition from retailers and Hookah manufacturers. Less than 20 comments were in favor of the ban. Statements supporting the ban were convincing, stating the jump from 11% of high schoolers Vaping in 2017 to the 21% Vaping today, and the increasing number of LA County students who have already tried a flavored e-cigarette. Among supporters were the American Heart Association, American Cancer Society, American Academy of Pediatrics-CA2, USC Department of Preventive Medicine, students, and parents.  On October 1st, the county's Board of Supervisors voted unanimously to adopt a ban of flavored tobacco products including e-cigarettes, chewing tobacco and menthol cigarettes. The ban does not affect online sales. The ordinance takes effect in 30 days and will affect the unincorporated areas of LA County. Retailers will then have 180 days to clear their shelves of flavored tobacco and apply for updated licenses required under the new rules. 
The City of Burbank City Council held the first reading and open forum on September 24th related to thei r ordinance to ban flavored tobacco products. AAP-CA2 Executive Director (Shown below) presented facts, stating that 29% of high school students smoked cigarettes in 1976 (see Fig 1); that it took 42 years of public health efforts to bring t he percentage down to 3.6% in 2018; and that now up to 28% of high school students in LA County have Vaped a flavored tobacco product as a result of the tobacco industry targeting youth with flavors and social campaigns.   
Vaping Related Articles

Addressing the Dangers of Increased E-Cigarette Use Among Youth: A Call to Action for Clinicians
Published by the Los Angeles County Department of Public Health, September 2019 
Alice Kuo, MD, PhD, MBA, FAAP, FACP
and the Los Angeles County Medical Societies
Many in the medical and public health communities are increasingly concerned with the use of electronic cigarette products (e-cigarettes) among youth. These electronic products, which are handheld devices designed to "deliver emissions for inhalation by heating a solution that commonly contains nicotine, a humectant, and flavoring chemicals" (i.e., designed for the act of vaping) are becoming all too common in youth sensitive areas such as schools, parks, and libraries. Read more...  

An Update on Clinical Cases of Vaping Associated Pulmonary Injury (VAPI) and Recommendations for Clinicians
Melissa Rios, B.S.
Melissa Rios, B.S. 
MD/MPH Candidate, 2020 
David Geffen School of Medicine, UCLA
Background :
            Electronic cigarette (e-cigarette) use among youth is a growing public health concern in the United States (US). Since the introduction of e-cigarettes to the US marketplace in 2007, their popularity and use has spiked, particularly among youth.1-2 Between 2017 and 2018, current e-cigarette use among high school students increased by 78%.1 In 2018, 20.8% or 3.1 million high school students reported current e-cigarette use.1
The increase in e-cigarette use among youth can likely be attributed to their sleek design, ease of accessibility through online retailers and vape shops, and appealing flavors, with more than 15,500 unique e-cigarette flavors available online as of 2017.3-5 Retailers have marketed these flavors using a variety of media channels and advertising strategies. In 2016, 20.5 million youth were exposed to e-cigarette advertising.6 Exposure to e-cigarette advertisement may contribute to youth's misperception that e-cigarettes are safer than traditional combustible cigarettes. Read more ... 
Southern California Medical Museum - Reception  
ALF Resolutions
Marsha Spitzer, MD
District IX CFMC representative
As an AAP member, you have the opportunity to advocate for and influence national AAP policy and priorities through the resolution process.  Any member or trainee can write a resolution.  Some examples of "Top 10" resolutions in recent years addressed gun safety, immigrant health, safe dental anesthesia, and immunization strategies.   
Step 1 - the idea
The process for submitting a resolution starts with an idea.   As the District IX Chapter Forum Management Committee representative, I can work with any and all District IX general pediatricians, medical subspecialists, surgical subspecialists, and trainees who would like to write a resolution.  Read the Full Article
Download the Resolution Template (Word document) 
View the AAP 2020 ALF Resolutions Guidelines 
Member - Spotlight 
View AAP-CA2 Member-At-Large Cori Cross, MD, FAAP during two recent interviews: Discussing a case of SIDS/emphasizing on the importance of vaccines, and the new beverage guidelines. 
Upcoming - Events

AAP-CA2 Presents:
"Life After Residency"
Pediatric Career Fair 2020
The Event of the Year for Pediatric Residents in Southern California  
January 30, 2020

Location TBA - Save the Date!

Attention Employers: Email chapter2@aap-ca.org to host a table. Meet graduating pediatric residents from every residency program in our region   

31st Annual AAP-CA2 Pediatric Symposium    
March 28, 2020
Carnesale Commons , at UCLA

Save The Date!
Other Upcoming - Events
Ventura County Mental Health Day
October 10th, 2019
Oxnard Wellness Center
CenterPoint Mall 
6 pm - 7:30 pm
2697 Saviers Road
Oxnard, CA 93033
Join us with a panel of mental health experts and others as we provide a platform to give hope, connect people and empower our community discussing strategies to prevent suicide in Ventura County
Turning Point Foundation, Ventura County Behavioral Health, Vista del Mar Hospital, NAMI, Turning Point's Peer Programs Director and Christine Ray, parent/advocate are working together in our community to prevent suicide.
QI Opportunities - CME and MOC Part 4
More LA Smiles CME and MOC Part 4 Opportunities
In a state-funded effort to improve the oral health of Los Angeles County children on Medi-Cal, UCLA's More LA Smiles Dental Transformation Initiative invites medical providers and their staff to participate in clinical trainings and improvement opportunities.  
Oral Health Integration in Primary Care
Primary Care Practice Quality Improvement is a program led by UCLA More LA Smiles focused on integrating oral health preventative services in well-child visits.  Participating providers receive up to 30-50 CME and 20-25 MOC Part IV credits at no cost upon meaningful participation in the program.  Participation includes the implementation of oral health assessments and fluoride varnish applications during primary care with the help of a quality improvement specialist.   Email QI@morelasmiles.org to learn more!   
Overview Training: This 1-hour training explains the Medi-Cal 2020 Dental Transformation Initiative and provides contemporary understanding of dental caries and systems-based approaches to improving children's oral health. Participating providers may earn 1 CME credit online by visiting https://morelasmiles.org/medicaloverview or can request an in-person training for their office by emailing training@morelasmiles.org.

Advanced Training: The 3-hour training includes in-depth instruction on performing caries risk assessments, applying fluoride varnish, utilizing self-management goals and contemporary approaches for prevention and management of dental caries as a chronic infectious disease. Participating providers earn 3 CME credits. We welcome the opportunity to provide an in-person training for your organization; please email training@morelasmiles.org to coordinate.
Join today!
Stay Connected!  @moreLAsmiles    
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Previous Issues  - Peds@CA2 e-News 

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Please Donate
AAP-CA2 is a 501(c)(3) non-profit organization. Please consider a tax-deductible charitable donation to one of our many programs
  • The Medicine-Biological Sciences Scholarship Program, which awards scholarships to exceptional high school students each year.
  • The Committee on Service, Education, and Mentoring, which awards scholarships to pediatric residents for outstanding research projects. 
  • The S. Michael Marcy Memorial Lecture, which helps sponsor a portion of our annual Advances in Pediatrics Conference in his honor.

Please contact Tomás Torices, MD (Chapter executive director) for all Chapter 2 related matters.
Cell. (818) 422-9877
Mailing Address: 
PO Box 94127  
Pasadena, CA 91109

Please visit our website at  http://aapca2.org/