SIOUX FALLS, S.D. -- Despite a pre-pandemic period of economic stability, the number of South Dakota children lacking health coverage spiked between 2016 and 2019.

And amid the COVID-19 crisis, a new report raises concerns about the situation worsening.

The latest findings from the Georgetown University Center for Children and Families show South Dakota's rate of uninsured children skyrocketed by more than 60%, the largest increase in the nation.

Xanna Burg, KIDS COUNT coordinator for South Dakota, said because this data is pre-pandemic, they don't know how many more families have lost coverage. But she added there's real concern the number is growing.

"We do know that families are struggling," Burg asserted. "You know people are losing their jobs and with it, the health insurance that came with those jobs. "

Prior to the increase, the rate of uninsured children in South Dakota had fallen to its lowest level.

The report cites constant changes to the Affordable Care Act and more red tape in various states as possible factors for rate spikes.

The data comes as some groups call for a Medicaid expansion in South Dakota. Petitions will soon be circulated for a ballot question in 2022.

Joan Alker, executive director of the Georgetown Center for Children and Families, pointed to the Trump administration's efforts to dismantle the Affordable Care Act.

She said a key factor has been eliminating most of the funding for outreach and "navigators" to help people enroll.

"Families have been getting negative messages that coverage is going away at the same time that community-based resources to help them find public coverage have shrunk," Alker contended.

Burg said that's why a Medicaid expansion, and enhanced outreach from the state for initiatives like the Children's Health Insurance Program, might help stem the tide of children and families going without coverage.

"South Dakota should double down on outreach to families who are eligible but not enrolled in Medicaid or CHIP, particularly during the pandemic when we know more families are struggling," Burg urged.

The report's authors say states have a lot of power to help reverse the situation.

According to the Centers for Medicare and Medicaid Services, South Dakota hasn't adopted any of the targeted strategies designed to boost enrollment in Medicaid and the Children's Health Insurance Program.

Advocacy groups said they are concerned about the lack of accountability surrounding Ohio Gov. Mike DeWine's $388 million proposal to staff schools with police officers known as school resource officers.

Cyan Blackwell, policy strategist for the ACLU of Ohio, explained the increased presence of police in schools over the past few decades has led to students being criminalized for behavior once handled by a principal, such as using a cell phone in class or disrespecting a teacher.

"We've been relying heavily on police officers to respond to these minor infractions," Blackwell pointed out. "Which has often led to exclusionary discipline practices such as suspending a student from school or expelling a student, as well as school-based arrests and referrals to juvenile court."

She noted research showed Black students in Cincinnati are nearly five times more likely to face discipline and law enforcement referrals than their white peers, beginning what has been described as a school to prison pipeline.

TaKasha Smith, executive director of the Juvenile Justice Coalition, believes there should be guardrails around the proposed funding to help determine the effectiveness of adding school resources officers, and to boost transparency for families.

"Some really simple first steps to increase trust for the community, for the schools, for the children is that police officers who have excessive use of force, who have those claims on the record, should not be dealing primarily with our kids," Smith contended.

Alison Paxson, senior policy associate for the Children's Defense Fund-Ohio, acknowledged school safety is not a one-size-fits-all issue, and said school administrators need funding flexibility to best serve students.

"We need to ensure local control is honored for schools to choose to hire a school counselor instead of a police officer based on their own local contexts and needs," Paxson urged.

According to the ACLU, Ohio schools average one school counselor for every 500 students in the classroom.

New findings suggest health effects stemming from child maltreatment can be passed on to the next generation.

In South Dakota, leaders in early-childhood support said there are ways to limit the impact of traumatic events within a family's history.

The research was led by the Environmental influences on Child Health Outcomes Program and the National Institutes of Health. It said children of mothers exposed to childhood maltreatment had higher rates of asthma, ADHD and autism.

Darbi Hunt, family lead for South Dakota's Early Childhood Comprehensive System's Collaborative, said guidance and early screening are vital in reversing such outcomes.

"It's important that we look for ways to help understand better practices," Hunt stressed. "Provide them the resources, the knowledge and the skills so that we can try and break that cycle."

The state is expanding its Bright Start visiting program for income-eligible households, where a personal nurse supports mothers during and after birth. And there are parenting classes, too. But Hunt noted awareness and accessibility can be a challenge in a rural state like South Dakota, and she urged agencies to team up to prevent families from falling through the cracks.

Darla Biel, assistant director of the Center for the Prevention of Child Maltreatment, said the findings add to the long history of research showing how a surrounding environment can impact child development. But she emphasized a history of abuse or neglect does not mean a family is permanently broken.

"They may have experienced adversity," Biel acknowledged. "That doesn't mean that they're not able to be supported, and not able to move forward in healthy and safe ways with their children and their families."

Biel added parents navigating adversity should feel no shame in asking for help, noting they are not alone in trying to cope with stress while raising a child.

According to last year's State of Babies data summary, 22% of South Dakota mothers reported less than optimal mental health. Parenting classes are offered through the state's Social Services department.

Youth advocates continue to sound the alarm over the impact flavored tobacco products have on teenagers, and hope Minnesota lawmakers take another close look at a proposed statewide ban.

Following attempts in previous legislative sessions, a bill has surfaced to prohibit the sale of all flavored tobacco products, including menthol cigarettes, flavored cigars, smokeless tobacco and e-cigarettes.

The coalition Minnesotans for a Smoke-Free Generation said the region faces a youth tobacco epidemic.

Bethlehem Yewhalawork, program manager for NorthPoint Health and Wellness Center, said enacting proposed restrictions can prevent things from getting worse.

"Passing a comprehensive flavor policy will really prevent youth addiction and improve health for all Minnesotans," Yewhalawork contended.

According to the coalition, one in seven 11th graders in Minnesota reports using e-cigarettes, and 88% of those students use flavored products.

Proposed bans often encounter pushback from the tobacco industry and retailers. A similar ban in the city of Edina recently survived a court challenge. Currently, 25% of Minnesotans are covered by a local flavored tobacco policy.

Preethika Naveen, a senior at Eagan High School, said while overall smoking rates have declined, use of flavored tobacco is prevalent among her peers.

"Many kids use menthol chew and vape e-cigarettes. Why? Because of the flavors," Naveen observed.

Advocates also argued the tobacco industry continues to use menthol products to target Black Americans, LGBTQ communities and youth. Groups such as the Children's Defense Fund have noted early exposure to nicotine can have lasting effects on a child's brain development.