FARGO, N.D. - A new report confirms that vulnerable families in North Dakota are experiencing more struggles as the pandemic drags on. Households with children say housing payments and health coverage are becoming increasingly out of reach.

This week's report from the Annie E. Casey Foundation looked at all states, using weekly census survey data to get a better sense of what families are experiencing. Fifteen percent of North Dakota households said they're worried they won't be able to cover their rent or mortgage payments in the near future. One in eight households said they can't afford health insurance for their kids.

Leslie Boissiere, vice president for external affairs at the Casey Foundation, said it all adds up to an overwhelming sense of pressure.

"They're also struggling with their mental and their physical health," she said. "Twelve percent of families don't have health insurance, one in three has postponed getting needed medical care, and one in five have experienced depression since the pandemic."

The number of North Dakota households that report feeling down or depressed is one in seven. In addition to boosting mental-health services, the report recommended guaranteeing COVID-19 vaccines be available at no cost, boosting investments in education and ensuring schools are more equitably funded.

Also in North Dakota, 6% of households with children said they didn't have enough food to eat. Xanna Burg, who coordinates the Kids Count program for North and South Dakota and Montana, said that need more than likely runs deeper, since the survey data only covers short periods of time.

"So really, we think that hunger is something that families are struggling with in North Dakota," she said, "even though the snapshot of data in this report maybe indicates a lower percentage."

Burg said these problems of overall family instability stand to have long-term effects on a child's development, but she says that can be mitigated through short-term responses by policymakers, including a new COVID relief package being debated in Congress.

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.