mental health

Gun control laws can impact death rates. But we need more research to find what works.

kkrisberg — Thu, 05 Oct 2017 16:30:31 +0000

Gun control laws can impact death rates. But we need more research to find what works.

Guns are the third leading cause of injury-related death in the country. Every year, nearly 12,000 gun homicides happen in the U.S., and for every person killed, two more are injured. Whether Congress will do anything about this violence is a whole other (depressing) article. But there is evidence that change is possible.

Last year, a study published in Epidemiologic Reviews “systematically” reviewed studies examining the links between gun laws and gun-related homicides, suicides and unintentional injuries and deaths. Researchers eventually gathered evidence from 130 studies in 10 countries, finding that in certain places, gun restrictions are associated with declines in gun deaths. For instance, laws that restrict gun purchasing, such as background checks, are associated with lower rates of intimate partner homicide; while laws addressing access to guns, such as safe storage policies, are associated with lower rates of unintentional gun deaths among children. Study co-authors Julian Santaella-Tenorio, Magdalena Cerdá, Andrés Villaveces and Sandro Galea write:

This heterogeneity in approaches and implementation methods makes it critical to identify approaches that are less likely to be effective and to identify which strategies, looking forward, may be more likely to work. In addition, examining the associations between specific policies and firearm-related deaths across countries can improve our understanding about which types of laws are more likely to be successful in reducing firearm mortality rates in similar contexts or within diverse legal frameworks.

The study’s findings are a mixed bag — some of the gun laws studied seemed to reduce gun deaths, while others seemed to make no difference or increase deaths. For example, a number of studies examined found no association between concealed carry laws and gun homicides in the U.S. However, one study using injury data from southern Arizona found higher proportions of firearm injuries and deaths associated with concealed carry. Yet another study in Colombia examined the effects of laws banning the carrying of guns during weekends after paydays, holidays and elections days in two Colombian cities, Cali and Bogota. That study found a 14 percent reduction in homicide rates in Cali during no-carry days and a 13 percent reduction in Bogota.

Studies on background checks and waiting periods came in mixed as well. For example, one study cited found no association between waiting periods and homicides and suicides. On the other hand, researchers have found that gun purchase bans for people with certain mental health conditions were associated with fewer homicides. One study found more stringent background checks were linked with fewer gun homicides. States with laws banning people with domestic violence restraining orders from owning and purchasing a gun also experienced reductions in intimate partner homicide. But one study found no homicide effect for laws that restricted gun access among those convicted of domestic violence.

Two cross-sectional studies analyzed found that gun permits and licenses were associated with lower rates of gun suicide. In Missouri, researchers studied the effect of repealing requirements that people need a valid license to buy a gun, finding the repeal was associated with a 25 percent increase in homicide rates. On laws regulating gun storage, one study found that such child access prevention laws were associated with fewer unintentional gun deaths among children younger than 15, but not among older teens. Another found child access laws were linked to a reduction in all suicides among people ages 14 to 17. A study using hospital discharge data found that such storage laws were associated with lower nonfatal gun injuries among those younger than 18.

The Epidemiologic Reviews study included research on particular laws as well. For example, a study on the U.S. Gun Control Act of 1968 — which restricted the sale of so-called Saturday night specials, among many other measures — did not find associated changes in homicide rates. But a study on Washington, D.C.’s 1976 law banning ownership of automatic and semiautomatic firearms and handguns found an “abrupt” reduction in homicide and suicide rates. Globally, Australia’s 1996 National Firearms Agreement, which banned certain kinds of firearms, was linked with a significant reduction in gun death rates. In addition, Australia has not experienced a mass shooting since the law was enacted. Control gun laws in Brazil, Austria and South Africa were also associated with fewer gun deaths.

Overall, researchers were able to identify some “general observations” in combing through the 130 studies — most notably finding that the simultaneous enactment of laws targeting multiple gun regulations were associated with fewer gun deaths in certain countries. Another big finding: we simply need more research to understand what works and what doesn’t to prevent gun deaths. The researchers also noted that few studies have delved into the impact of gun safety laws on particular populations or whether such laws affect social attitudes, norms and behaviors. The authors write:

To conclude, we have provided an overview of national and international studies on the association between firearm-related laws and firearm injuries/deaths. High-quality research overcoming limitations of existing studies in this field would lead to a better understanding of what interventions are more likely to work given local contexts. This information is key for policy development aiming at reducing the burden posed to populations worldwide by violent and unintentional firearm injuries.

In more recent gun research, a study published this month in Health Affairs set out to quantify the clinical and economic burden associated with emergency room visits for gun-related injuries in the U.S. Researchers examined data from the Nationwide Emergency Department Sample, identifying 150,930 people between 2006 and 2014 who showed up to an ER alive, but with a gun-related injury. That number represents a weighted estimate (that’s a fancy term for adjusting data to represent the greater population) of 704,916 patients.

ER visits for gun injuries was lowest among those younger than 10 and highest among ages 15 to 29. Incidence of gun injury was about nine-fold higher for male patients — among men ages 20 to 24, more than 152 patients per 100,000 visited the ER for a gun injury. Most of the patients had been injured in an assault or unintentionally. The proportion injured in an attempted suicide was more than two-fold higher among Medicare beneficiaries. Handguns were the most common cause of the injury, followed by shotguns and hunting rifles.

Among the more than 150,000 cases of gun injury at the ER, 48 percent were discharged home, 7.7 percent were discharged to other care facilities, about 37 percent were admitted to the hospital and just more than 5 percent died during their ER visits. Overall, 8.3 percent of the gun injury patients either died in the ER or as an inpatient. The average charge for gun injury in the ER was about $5,250; the average charge for those admitted was more than $95,000. Over the entire study period, gun-related injuries cost $2.9 billion in ER charges and $22 billion in inpatient care.

Authors of the Health Affairs study also pointed out the need for more research, citing a 1996 federal measure known as the Dickey Amendment that said injury research funds at the Centers for Disease Control and Prevention could not be used to advocate or promote gun control. Co-authors Faiz Gani, Joseph Sakran and Joseph Canner write:

Researchers, politicians and government officials must work together to ensure that research funds are allocated to promote the understanding of the complex interplay between social, economic and medical factors associated with firearm-related injuries. Only through the adoption of an evidence-based public health approach can the resulting substantial medical and financial burden be reduced.

To request a full copy of the ER study, visit Health Affairs. For a copy of the gun policy study, visit Epidemiologic Reviews.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Thu, 10/05/2017 - 12:30

Categories

Medicine

GOP health care bills would cripple public health opioid response: ‘We’d essentially be putting up the white flag’

kkrisberg — Fri, 30 Jun 2017 04:31:02 +0000

GOP health care bills would cripple public health opioid response: ‘We’d essentially be putting up the white flag’

In Cuyahoga County, Ohio, nearly 200 people have died from opioid-related overdoses in the first five months of this year. That means that this one U.S. county is on pace to lose more than 700 people to fatal overdoses by the end of 2017.

Terry Allan, health commissioner at the Cuyahoga County Board of Health, and colleagues across the county have spent years building and scaling up a multifaceted response to the opioid addiction and overdose epidemic that includes getting people into treatment, changing clinical prescribing habits, preventing deadly overdoses, and dealing with the often-heartbreaking social and economic fallout for families and children. There’s no “one magic pathway” for dealing with this problem, Allan told me, “it’s a continuum that has to be well-supported given the trend we’re on.” Ohio now leads the nation in opioid overdose deaths.

Allan said work is paying off — for example, nearly 1,000 lives in Cuyahoga County have been saved from a fatal opioid overdose in the last few years thanks to expanded access to naloxone — but the opioid problem in no where even close to subsiding. The reality, Allan said, is “we’re not seeing this trend abate.”

He was just as honest about the kind of impact the GOP health care bills would have on the county’s opioid epidemic: “You’d end up with a lot of people being turned away from lack of services. …We’d essentially be putting up the white flag — and now is not the time to pull back.”

The most obvious impact from the GOP health care proposals, both of which severely cut Medicaid funding and are expected to result in more than 20 million additional Americans without insurance, is that people would lose access to addiction and behavioral health services. The loss of access would be the result of losing insurance, whether Medicaid or private coverage, or from scaling back the Affordable Care Act’s essential health benefits, which required insurers cover substance use disorder services along with a number of other basic health services. Both the House and Senate repeal-and-replace bills would allow states to redefine or opt out of the essential health benefits requirement.

But another, less talked about setback for those suffering from opioid addiction would be elimination of the ACA’s Prevention and Public Health Fund (PPHF), which the House bill eliminates in fiscal year 2019 and the Senate bill eliminates in fiscal year 2018. The PPHF — the nation’s first mandatory stream of funding for improving the public’s health — is now the sole source of funding for the Centers for Disease Control and Prevention’s Preventive Health and Health Services Block Grant. That block grant is a critical source of flexible funding for health departments in every state, where officials use the flexible monies to address localized problems, from improving food-borne illness outbreak response to ensuring access to emergency medical services in rural communities. If the GOP succeeds at eliminating the PPHF, the block grant goes away with it.

In Cuyahoga County, that flexible block grant money has gone to support its injury prevention work — and the biggest injury threat now facing the county is opioid addiction. Allan said his agency uses the grant money to procure and distribute naloxone (which is now being carried by police in nearly every jurisdiction in the county), educate local clinicians on better prescribing practices (this is essential, as prescribing is a main driver of the opioid epidemic) and for convening the Cuyahoga County Opiate Task Force, which coordinates a multisector response to the epidemic. Allan said the health board organizes its opioid response according to five buckets: prevention, education, treatment, enforcement and recovery. If the response effort doesn’t account for and coordinate across those five buckets, “we’re just playing whack-a-mole,” he said.

Cuyahoga’s opioid addiction and overdose problem is a complex one that requires the kind of equally complex response that public health is uniquely adept at leading. The loss of the Preventive Health and Health Services Block Grant would put all that work at risk.

“All those dollars are tied to the ACA and without those dollars, this work would really be in dire straits,” Allan told me. “I’m not sure the state would be in a position to fill in the budget gap if the block grant went away. …Our concern is that we’d likely see, on a statewide basis, the support system we’ve built begin to atrophy. We’d be at a loss to deal with the volume that we’re dealing with right now.”

Beyond the public health response, about 700,000 Ohioans have gained insurance coverage through the ACA Medicaid expansion that the GOP bills would eventually eliminate. The expansion has meant many more Ohioans are able to access addiction treatment services, Allan said. If that Medicaid coverage went away, he said, the fear is that many of those saved from a fatal overdose via naloxone would have no where to go for help after being released from the hospital. It’s a wasted opportunity to get people into treatment and keep them from ending up back on the streets and using, he said.

“The impact of this isn’t just to the individual,” Allan told me. “It has communitywide implications for families and to our economy.” To put it even more bluntly, Allan said a loss of coverage for and access to addiction services will simply mean “more people will die.”

Research has shown that the ACA Medicaid expansion has improved access to opioid addiction treatment. In a June report from the Urban Institute, researchers found that many low-income adults in the 32 expansion states have gained access to buprenorphine, which reduces the symptoms of opioid withdrawal and cravings. But while researchers found a more than 70 percent increase in buprenorphine prescriptions per enrollee in Medicaid expansion states, programs are still struggling to meet the needs of such a large addiction epidemic. Another recent report from the Urban Institute found that the ACA Medicaid expansion did indeed fill a significant access gap in substance use disorder treatment, and that efforts to repeal the ACA — such as the House GOP bill — would likely result in millions losing addiction treatment coverage.

“We feel like we’ve been able to make some significant progress with this problem because of the resources the ACA has provided,” said Jeff Duchin, health officer at Public Health — Seattle & King County. “All that would be lost if we lose the funding that’s given people access to (opioid addiction) treatment. It’s very worrisome.”

Like communities across the country, the Seattle and King County area has experienced an increasing number of people addicted to opioid drugs and heroin, with about one person dying every one-and-a-half days from an opioid overdose, Duchin told me. Because of the increasing number of deaths and rising prevalence of addiction, the opioid epidemic has become a high priority for the public health agency in the past two years. In 2016, city and county officials convened a Heroin and Prescription Opiate Addiction Task Force.

Duchin said Public Health — Seattle & King County works particularly close with its sister agency in the county, the Department of Community and Human Services, which coordinates inpatient and outpatient addiction treatment for residents. In addition, ACA-funded Community Transformation Grants are slowly enhancing the effectiveness of that care by supporting efforts to integrate physical and behavioral health services in a single location, Duchin said. Work is now underway to develop these more integrated models of care, where patients can access all the services they need at one place, including housing and social services, but such work takes time.

“It makes the most sense if you want to help people — it’s a big way to lower barriers and allow people to get all the care they need at one stop,” he said of such efforts. “We can’t achieve it overnight, but we’re moving in that direction. …But until we get there, we need to provide low-barrier access to treatment in more traditional contexts. That means increasing the treatment capacity in the community for people with addiction and at the same time, trying to make much of that treatment available where people can also get care for their physical health needs.”

Public Health — Seattle & King County now operates a number of safety net services that reach at-risk, marginalized and underinsured populations. For example, its needle exchange offers access to buprenorphine and its mobile medical units provide access to naloxone, as does its health care program for the homeless, to which Duchin said they hope to add buprenorphine access as well.

Right now, Duchin said the city and county are doing a good job of meeting demands for inpatient addiction care, “but we’re not anywhere close” to meeting demands for outpatient care. To fill that gap, Duchin and colleagues hope to recruit many more primary care physicians willing to integrate buprenorphine treatment into their practices.

“Without a doubt, the Medicaid expansion has greatly strengthened our safety net,” Duchin told me. “We can serve many more lower-income adults not only with physical medical care and preventive care, but we’re able to get them access to behavioral services too. Without that expansion, many would just lose access to those services and we don’t have the local revenues to continue to provide them. …Letting people progress untreated to more complicated stages of disease is not only inhumane and leads to unnecessary human suffering, but it’s more costly to the community.”

Allan in Ohio put it in even simpler terms: “This level of addiction is unprecedented. It needs to be a national priority, and we need to demonstrate that by putting resources toward it. We need to put our money where our mouth is.”

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Fri, 06/30/2017 - 00:31

Categories

Medicine

Study: Kids with chronic health problems will face greater financial burdens if forced out of CHIP

kkrisberg — Tue, 25 Apr 2017 21:04:14 +0000

Study: Kids with chronic health problems will face greater financial burdens if forced out of CHIP

More than 8 million U.S. children depend on the Children’s Health Insurance Program for access to timely medical care. The program is authorized through 2019, but its federal funding expires in September and it’s unclear what Congress will do.

That uncertainty stresses all the systems and families that depend on CHIP, but it may be especially risky for the 2 million chronically ill children who get care through the program, which was originally designed for families falling in the gap between market affordability and Medicaid eligibility. In a study published this month in Health Affairs, researchers found that low-income children with chronic conditions would face higher out-of-pocket costs if forced to move from CHIP to the individual marketplace.

With the future of CHIP funding unclear, researchers simulated two scenarios: one in which CHIP funding is extended, and another in which CHIP children are enrolled in the Affordable Care Act insurance markets. After analyzing health plan data from CHIP and the marketplace, they found that CHIP enrollees may face thousands of dollars in additional costs on the individual market, with families of children with diabetes, epilepsy or mood disorders facing the highest additional costs.

Study co-author Alon Peltz, a physician who cares for children with special health care needs, noted that about one in every four kids in CHIP has a chronic health condition.

“We’re coming up on the 20^th year of CHIP and there are concerns about how to maintain coverage for these children,” Peltz, also a postdoctoral fellow in the Robert Wood Johnson Foundation’s Clinical Scholars Program at Yale School of Medicine, told me. “We wanted to think more critically about different avenues policymakers could take as they think about the future of health insurance coverage.”

In conducting the study, which included more than 7,000 children with one or more chronic conditions, Peltz and colleagues assumed that ACA subsidies would still be available to help former CHIP families buy coverage on the marketplace. (Unfortunately, the future of those subsidies is also unclear.) They found that at every income level, children with chronic health problems would pay more for coverage in the marketplace than they would have in CHIP. For example, a family living at 100-150 percent of the federal poverty level (that’s about $30,000 for a family of three) would spend about $233 more in the marketplace annually, while a family at 251-400 percent of poverty (or between $51,000-$81,000 a year) would pay $1,078 more in the marketplace.

Researchers also found that marketplace costs were higher for all six of the chronic conditions studied: asthma, ADHD, developmental disorders, diabetes, epilepsy and mood disorders. Children with epilepsy experienced the biggest spending increase in shifting to the marketplace, with the difference ranging from about $400 to nearly $2,500 depending on household income. The study attributed a majority of the out-of-pocket differences to spending on prescription drugs and inpatient hospitalizations. For instance, among children with asthma or ADHD, higher prescription expenses accounted for much of difference in CHIP and marketplace spending. For kids with diabetes, epilepsy and mood disorders, higher spending was typically associated with hospitalization costs.

The study’s findings also assume that children shifted to the marketplace would continue to get all the services they need. However, researchers cautioned that “in reality, families could encounter networks that are inadequate to meet their children’s specialty care needs and (that could) lead to even higher out-of-pocket expenses.” In addition, about 2 million children now covered by CHIP don’t currently qualify for ACA subsidies due to a loophole known as the “family glitch,” which would certainly impact their ability to afford coverage outside of CHIP. (Right now, families can get ACA subsidies as long as they don’t have access to affordable employer-sponsored coverage. However, that affordability determination is based on coverage for the individual employee, not the employee and her or his family. Hence, the “family glitch.”)

The study offered three strategies for leveling affordability between CHIP and marketplace plans: enhancing cost-sharing reductions in the ACA marketplace; re-examining cost-sharing for the two big drivers — drugs and hospitalization — of CHIP-marketplace spending differences; and monitoring whether marketplace deductibles negatively impact a child’s ability to access timely care. (CHIP plans rarely include deductibles.) However, all those strategies are based on an assumption that the ACA isn’t repealed and any changes to the law are relatively small. With that in mind, the researchers concluded that keeping CHIP funded is the best option for kids who need reliable access to care.

“Given concerns about the viability of the marketplace, the legal battles regarding the cost-sharing reduction payments and the efforts to repeal the ACA, reauthorizing funding for CHIP is most likely the least disruptive strategy moving forward,” researchers wrote.

Peltz said that if federal CHIP funding did disappear, many states would likely continue the program in some form. But with only state funds — and no matching federal funds — CHIP families may see reductions in services or higher cost-sharing requirements. He also noted that the ACA increased federal CHIP reimbursement to states. If Congress eliminated that enhanced reimbursement that could negatively affect state CHIP plans as well.

Still, Peltz said he’s hopeful that policymakers can find a solution that ensures care for the 8 million children who depend on CHIP.

“With some uncertainty right now in the political landscape, the CHIP program seems to be the best option for making sure that children, particularly those with chronic conditions, can continue accessing affordable care,” he told me. “We have a strong history of providing services to this vulnerable group of children…and as both a researcher and clinician, I hope we’ll continue the tradition of caring for these children.”

For a copy of the CHIP study, visit Health Affairs.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Tue, 04/25/2017 - 17:04

Categories

Medicine

First-of-its kind health center helps firefighters struggling with PTSD, addiction

kkrisberg — Tue, 28 Mar 2017 16:30:20 +0000

First-of-its kind health center helps firefighters struggling with PTSD, addiction

Before Patrick Morrison worked for the International Association of Fire Fighters, he was a firefighter himself. He’s experienced the horrifying and profoundly saddening events that first responders see every day. And like many other firefighters, he turned to alcohol to deal with the accumulating mental trauma.

Fortunately, Morrison got help and considers himself “in recovery” today. But many firefighters don’t. In fact, an August 2016 IAFF report noted that even though firefighters experience a post-traumatic stress disorder (PTSD) rate that’s similar to soldiers returning from combat, many fire departments don’t have the behavioral health services necessary to address the problem. Research has found that up to one-fifth of fire fighters and paramedics have PTSD. This study found in a survey of firefighters that nearly half had thought about suicide and nearly one-fifth had suicide plans.

IAFF hopes to help fill that mental health service gap with a new behavioral health center designed by and for firefighters. On March 5, the IAFF Center of Excellence for Behavioral Health Treatment and Recovery officially opened its doors in Upper Marlboro, Maryland, just outside Washington, D.C. The one-of-a-kind treatment facility was specifically created to help firefighters struggling with addiction and other behavioral health conditions, including PTSD and depression, and to exclusively serve the IAFF’s more than 303,000 members. Opening week, staff welcomed the first seven patients to the center, where active and retired firefighters can stay for more than a month of inpatient treatment.

“This has become an overriding priority for IAFF,” said Morrison, assistant to the general president for health and safety at IAFF. “If you had talked to me just five years ago, I would’ve said there wasn’t really a willingness to talk about this problem. But it’s reached a pinnacle — people are realizing that we’re all in this together and we need to find a way to address it.”

The center isn’t IAFF’s first effort on the behavioral health front. The labor union has been involved in a number of efforts to increase capacity on the issue, such as training firefighters to recognize the signs of mental crisis in their peers and offer help. However, Morrison said the magnitude of the problem came into even clearer focus in January 2015, when the IAFF’s magazine published a cover story about PTSD and the stigma that prevents firefighters from seeking help. He said reader reaction was overwhelming — “the phones rang off the hook” with firefighters asking where to find services.

“They were calling in droves with the realization that they were struggling too,” he told me.

Not long after, IAFF was approached by Advanced Recovery Systems (ARS), a behavioral health care management company, about a new facility it was opening in Upper Marlboro. ARS proposed making the facility exclusively for firefighters. IAFF said yes, as long as the center addressed both addiction and PTSD.

“That was the concept,” Morrison said. “We wanted to do it, but it had to focus on PTSD with co-occurring addiction.”

On the center’s opening day in March, more than 300 firefighters showed up in support. Everything about the 64-bed facility was built with firefighters in mind, said Abby Morris, a psychiatrist and medical director of the ARS/IAFF behavioral health center. The dorm areas are referred to as station houses, patients eat together at a long table in the kitchen like they would at work, and every morning begins with chores just like it would at the firehouse.

On the flip side, medical staff from the center were brought to IAFF’s training facility and put through the same exercises a firefighter would tackle — doing CPR, cutting a car open — to help them understand the stress of the job.

“Firefighters have a very unique culture,” said Morris, who worked as a medical consultant for the Montgomery County, Maryland, SWAT team. “They work as a team, it’s like a brotherhood. They spend days away from their families — they’re home away from home is the firehouse. …We wanted them to feel at ease (at the center).”

The center has three tracks, she said: one for addiction only, another on PTSD, depression and anxiety, and a third that addresses dual diagnoses. When I talked with Morris shortly after the center opened, she said there had been a lot of interest from firefighters dealing specifically with PTSD. The center’s aftercare goal is to use telemedicine to follow up with patients for up to 18 months after discharge as well as connect them with outpatient services where they live. Morris said everyone will leave with an outpatient plan.

Some firefighters will come to the center of their own will, others at the insistence of their employers, but Morris said a huge component of the center’s work will be safely returning firefighters to the job.

“We need to build resilience,” she said. “We want to give them the skills to manage what they have to face. These are people who have multiple layers of trauma and they have to go back into traumatic environments. So (resilience) is a huge part of our programs.”

Morris went on to say: “I want to make sure every person who comes here is treated as a human being first. The came in this world as human beings and they’ll leave as human beings and I want to make sure that part isn’t lost within their identity as a firefighter.”

Morrison at IAFF said the center will engage in research and training as well, with an ultimate goal of disseminating best practices on dealing with issues like PTSD and resiliency. He described the center as a “beta test” — in other words, if the center does result in better outcomes for firefighter health and well-being, it could prove a model for additional centers around the country.

Both Morrison and Morris acknowledged that while states and municipalities often provide for mental health services for firefighters, it’s simply not enough to meet current needs.

“This center can be a catalyst,” Morrison said. “If we do this right, we can save jobs, save families — we can save firefighters.”

For more on the new center, visit www.iaffrecoverycenter.com.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years.

kkrisberg Tue, 03/28/2017 - 12:30

The ACA is safe for now, but it’s still very much in danger

kkrisberg — Sat, 25 Mar 2017 18:10:32 +0000

The ACA is safe for now, but it’s still very much in danger

Yesterday, House Republicans failed to find enough votes to pass their Affordable Care Act replacement. It was a very good day for the millions of Americans projected to lose their coverage under the GOP plan. But let’s be clear: Obamacare is not safe.

In a last-ditch effort to round up more votes, House Speaker Paul Ryan, R-Wis., proposed an amendment that would have, beginning in 2018, allowed states to determine the kinds of essential health benefits required in insurance plans purchased with tax credits. Under Obama’s health care law, insurance plans sold via the federal health care marketplace had to cover 10 essential health benefits, as did coverage via the Medicaid expansion. Those 10 benefits are: outpatient care; emergency room care; in-hospital care; pregnancy, maternity and newborn care; mental health and substance abuse; prescription drugs; rehabilitative and habilitative services; lab tests; preventive services; and pediatric services. This is basic health care coverage that provides actual value for your dollars. Fortunately, for those of us who’d prefer real value in their insurance plans and who realize there’s no such thing as a functional a la carte health insurance market, the Republican plan failed.

However, it’s not only Congress that can impact the essential health benefits. In fact, federal officials can do all kinds of things through the regulatory system to impact the ACA, including doing nothing at all. The ACA isn’t perfect — few pieces of legislation are — and without federal support to enforce its provisions, address problems and make adjustments as indicators evolve, things could begin to fray. And public support is vital to the ACA’s survival.

One core component of the ACA that’s vulnerable is the essential health benefits — a provision that set a basic bar to ensure that if you’re mandated to buy something, it should provide you with something of value. Health and Human Services Secretary Tom Price has the power to impact the essential benefits through the regulatory process. And because he tried just that as a member of the House — his ACA replacement, the “Empowering Patients First Act,” eliminated essential benefit requirements — there’s reason to believe he’d be open to attempting the same thing as HHS secretary.

In addition, Trump signed an executive order in January directing federal agencies to ease the fiscal burden that the ACA might have on people and states (that’s code for pulling back enforcement). As a result, the IRS announced that it would continue processing tax returns that don’t disclose health insurance status, which could present an easy way for people to skirt the ACA’s individual mandate. If you think of the ACA as a bicycle tire, the individual mandate is the hub. Let it quietly crumble and the spokes go too.

That’s all to say that the ACA isn’t out of the woods just yet. So, let’s briefly look at just some of the consequences of dropping or weakening the ACA’s essential health benefits and easing coverage mandates.

Hospital care and emergency care: According to a 2015 federal report, hospital uncompensated care costs were $7.4 billion lower in 2014 than they would have been if insurance coverage had remained at 2013 levels. That’s a whopping 21 percent reduction in uncompensated care spending. Five billion dollars of that reduction came from states that expanded Medicaid eligibility. This 2015 study found each additional uninsured person costs local hospitals $900 each year in uncompensated care. This one found that Medicaid expansion states experienced a decrease in uncompensated hospital costs of 3.1 to 4.1 percentage points of operating costs. (Adding this last one in there because so many states haven’t expanded Medicaid.)

Pregnancy, maternity and newborn care: According to a 2011 federal report, less than a year after the ACA was signed into law, of the then-currently marketed plans submitted by health insurance companies to Healthcare.gov, 62 percent of enrollees did not have maternity coverage. Not having maternity coverage is expensive: This study found that from 2004 to 2010, the price insurers paid for childbirth rose between 41 and 49 percent depending on the type of birth. The average price for pregnancy and newborn care was $30,000 for vaginal delivery and $50,000 for a C-section. Before the ACA — the days when the free market reigned in much of the individual market — just 6 percent of health plans available to 30-year-old women in states where maternity care wasn’t required on the individual market actually offered the benefit.

Mental health and substance abuse: That 2011 federal report of the then-currently marketed plans submitted to Healthcare.gov found that 34 percent of enrollees didn’t have substance abuse coverage and 18 percent lacked mental health coverage. This federal report found that behavioral health problems are the second-most common pre-existing health condition, affecting 45 million Americans. Thankfully, between 2010 and 2014, the number of Americans with a pre-existing condition who went uninsured for a full year dropped by 22 percent. The recent Republican plan didn’t target the ACA’s pre-existing condition protections. But a weakening of the essential health benefits could mean that even if people with behavioral health problems weren’t barred from the insurance market, the services they need might not be available.

Pediatric services: As of June 2013, more than 28 million children enrolled in Medicaid and another 5.7 million in the Children’s Health Insurance Program depended on the programs for timely access to doctors when they’re sick. This 2016 study found that 2.8 million children gained coverage under the ACA, a more than 41 percent reduction in the children’s uninsured rate. In states like Alabama, Mississippi and South Carolina, the number of uninsured children fell by more than half. In 2014, the rate of U.S. children without health coverage fell to a historic low of 6 percent. Researchers estimate that if the ACA is repealed, nearly 4 million children would lose their coverage by 2019.

This is what Trump told ABC News in January: “Just so you understand people talk about Obamacare. And I told the Republicans this, the best thing we could do is nothing for two years, let it explode. And then we'll go in and we'll do a new plan and -- and the Democrats will vote for it. Believe me.”

Let’s take him seriously.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Me and my family depend on the ACA for access to quality health care.

kkrisberg Sat, 03/25/2017 - 14:10

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" “Just so you understand people talk about Obamacare. And I told the Republicans this, the best thing we could do is nothing for two years, let it explode. And then we’ll go in and we’ll do a new plan and — and the Democrats will vote for it. Believe me.”

Exactly. There is good reason to believe that he (and the equally despicable Ryan) don't care a whit that their plan (tentatively titled Don't Care) didn't make it to a vote. They can keep playing little games like shortening enrollment times to lead it to failure one step at a time.

Occupational Health News Roundup

kkrisberg — Tue, 17 Jan 2017 18:10:29 +0000

Occupational Health News Roundup

At The New York Times, Jodi Kantor and Jennifer Medina report on Trump’s pick to head up the U.S. Department of Labor, fast food CEO Andrew Puzder, an outspoken critic of labor laws that benefit hourly workers.

Puzder is expected to face tough questioning during his confirmation hearings, especially as his company’s restaurants have been accused of multiple labor law violations. The article explores Puzder’s entry into the fast food world, his work as a lawyer, and interviews current and former workers at one of the chains that Puzder runs, Carl’s Jr. Kantor and Medina write:

In interviews and lawsuits, workers have made a graver charge: that the restaurants often broke the law by cheating them on their wages. Some said they were expected to arrive early for their shifts to clean but were not allowed to clock in until later.

Others said they would often work through their breaks, even though those rest periods, required by California law, were unpaid. When Tracy Bradshaw, who worked in a Carl’s Jr. in Bakersfield for two years, would take her 30-minute lunch break, she was often called back into the kitchen to help with a sudden rush.

“I need you back here now, I know you are on your break,” she said her manager would say. If she refused, the manager was more likely to send her home early, she said, which often meant fewer hours the next week, leaving her short on money.

After several months, Ms. Bradshaw said, she complained. Soon after that, she brought in paperwork showing that her pregnancy would prevent her from doing certain tasks. A week later, she was let go, she said. A CKE representative said the company is opposed to all forms of discrimination, including pregnancy-related.

Read the full article at The New York Times.

In other news:

Lexington Herald Leader: John Cheves and Jack Brammer report that hundreds of workers in Kentucky flooded the state Capitol earlier this month to protest anti-union legislative measures. The measures would let workers stop paying union dues even if they benefit from union bargaining; repeal the prevailing wage for construction workers on local government projects; and require workers to opt in to having union dues taken out of their checks. Cheves and Brammer write: “Bill Londrigan, president of the Kentucky AFL-CIO, said some union members who came to the Capitol in recent days to protest legislation are social conservatives who voted for Republican politicians. Now they’re watching a newly Republican-led legislature pass measures that will cut their paychecks, Londrigan said. ‘Believe me, we’re well aware that many of our members went to the polls last November and voted the straight Republican ticket to elect Donald Trump, not thinking about who else they were putting into local and state office and how that was going to impact their families,’ Londrigan said in an interview.”

Washington Post: Patricia Sullivan reports that the County Council in Montgomery County, Maryland, has voted in favor of raising the minimum wage to $15 by 2020. However, observers are unsure if the wage boost will be signed into law. If successful, Montgomery County would be the first jurisdiction in Maryland to enact a $15 minimum wage law. Sullivan writes: “Proponents of the minimum-wage increase argue that businesses adjust to rising costs all the time and publicly object only when labor costs go up. ‘It’s hard to adjust to being poor, too,’ (Council member Marc) Elrich said. ‘When you don’t have money, there’s only one adjustment — you don’t spend, you don’t buy.’”

Texas Tribune: Alex Samuels reports on Houston Police Chief Art Acevedo calling on the Texas Legislature to increase funding for mental health services for police officers, though he acknowledged that it would probably take longer than the current legislative session to pass such reform. The Texas House had already outlined challenges facing the state’s mental health system before the 2017 session kicked off, with lawmakers warning that funds were limited. Samuels reports Acevedo as saying: “It is a very stressful profession. You see a lot of ugly things. You see a lot of tragedy and whether you realize it or not, it starts to pile on. We shouldn’t wait until an officer starts calling in sick because they’ve developed a substance abuse problem. ... I want to destigmatize mental health — especially for cops.”

Arizona Republic (via Cronkite News): Sabella Scalise reports that the number of H-2A visas given to agricultural workers in Arizona has more than doubled in the last five years, with federal officials certifying nearly 5,400 H-2A workers in the state in fiscal year 2016. The number of such visas jumped substantially on a nationwide basis as well. However, farmworker advocates say one of the big problems with the visa program, which is for seasonal and migrant workers, is that the “grower controls the visa,” which can lead to efforts that suppress wages and working conditions. Scalise writes: (Bruce) Goldstein (of Farmworker Justice) said he believes farmers will continue to apply and give out H-2A visas as long as the government keeps approving them. ‘They should not be the model for this country,’ he said of the visas. ‘This is a nation of immigrants, not a nation of guest workers.’”

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years.

kkrisberg Tue, 01/17/2017 - 13:10

Study: U.S. still lags behind on health care affordability and access

kkrisberg — Tue, 29 Nov 2016 18:43:47 +0000

Study: U.S. still lags behind on health care affordability and access

The percentage of Americans who reported cost-related barriers to health care dropped from 37 percent in 2013 to 33 percent in 2016 — a change that directly corresponds to insurance expansions under the Affordable Care Act, a new study reports. On the flip side, Americans are still more likely than peers in other high-income nations to face financial obstacles to health care.

The study is based on findings from a survey of patients and providers in 11 countries and one that the Commonwealth Fund has been conducting annually since 1998. Those 11 countries are: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the U.S. The survey typically focuses on the experiences of patients and providers; however, this year the survey also collected data on self-reported health and well-being as well as material hardship, which is a significant contributor to a person’s physical and mental health status. Here’s what the study, which was recently published in the journal Health Affairs, found.

On average, American adults reported poorer health than their counterparts in other countries, with 28 percent of U.S. adults living with at least two chronic conditions. Twenty-six percent of U.S. adults reported emotional distress in the previous year that was difficult to deal with alone. Canadian adults reported similar levels of chronic conditions and emotional distress, while French and German adults reported the lowest rates of emotional distress. On the topic of material hardship, U.S. adults were more likely than adults in all other 10 nations to report they were “always” or “usually” concerned about having enough money to buy healthy foods or pay their housing expenses. Material hardship rates were lowest in Germany.

Americans were most likely to report financial barriers to health care in 2016 — at 33 percent — though that rate has declined in recent years, the study found. In comparison, between 7 and 8 percent of adults in Germany, the Netherlands, Sweden and the United Kingdom reported that costs prevented them from accessing needed medical care. About half of Canadian, German and Norwegian adults were not able to secure a medical appointment the same or next day; and about one in five adults in Canada, Germany, Norway, Sweden and the U.S. waited six or more days for an appointment. Adults in Canada were the most likely to say they waited two or more months to see a specialist; in contrast, fewer than 10 percent of adults reported similar waiting times in France, Germany, the Netherlands, Switzerland and the U.S.

In all of the countries surveyed, except the U.S., a majority of respondents with a regular doctor said their provider did not discuss healthy diets or exercise in the previous two years. Forty-one percent of Americans reported the absence of such discussions as well. On the issue of managing chronic conditions, 14 percent of chronically ill U.S. adults said they did not have the support they needed from their health care providers. Norway, Canada and France had a similar rate, while Australia, the Netherlands and New Zealand had the lowest.

Low-income adults — those living in households with less than half of the respective country’s median income — in every country were much more likely to report health problems and material hardship, the study found, noting that “their health care experiences shine a light on how well their country’s health system responds to the needs of some of its most complex and socially vulnerable patients.” The U.S. was home to the highest rate of low-income adults who reported cost barriers to care at 43 percent. Rates in other countries ranged from 8 percent to 31 percent. Low-income adults in Canada, France, Germany, Sweden, the United Kingdom and the U.S. reported longer waits for health care than the rest of the populations. In all the countries, between one-fourth and one-half of low-income adults said they used the emergency room in the previous two years. Study authors Robin Osborn, David Squires, Michelle Doty, Dana Sarnak and Eric Schneider write:

Although the United States has made significant progress in expanding coverage under the Affordable Care Act (ACA), it remains an outlier among high-income countries in ensuring access to health care. The major coverage expansions of the law were launched only in 2014 and are thus still in a ramping-up period. In addition, there are ongoing barriers to coverage, including the fact that — as of November 2016 — nineteen states have not chosen to expand eligibility for their Medicaid programs, the exclusion of undocumented immigrants from both Marketplace and Medicaid coverage, low awareness of coverage options, and concerns about affordability among those who remain uninsured. An estimated twenty-three million adults in the United States lack health insurance, while the other countries in our survey have universal coverage.

Schneider, senior vice president for policy and research at the Commonwealth Fund, told me that one possible explanation for why the U.S. spends so much on health care may be the higher levels of material hardship among its people, noting that “by not investing in the safety net or in housing, transportation and nutrition, people end up needing (health) services that are much more costly.” One way that other countries seem to be reducing the impact of material hardship, he said, was through integrating medical care and social services. For example, in the United Kingdom, the National Health Service embeds social services into its systems.

He also noted that while many provisions in the ACA offer financial incentives for hospital and health systems to engage community and social service partners toward reducing health care costs, it’s still early in the process. Making those linkages, he said, is a difficult, long-term endeavor.

“We probably do need to spend more on public health activities, social services and stress prevention so what are small health problems don’t become big health problems that require medical attention,” Schneider said of the U.S. system.

He also said that in many European countries, such as the United Kingdom and the Netherlands, the emphasis on providing no-cost primary care and ensuring timely access to primary care is making a significant difference for the health of their populations. In comparison, the U.S. devotes many more resources toward specialty care. In fact, Schneider told me that to improve America’s health, he would make two key investments: expanding population health and prevention measures and shifting more resources into strengthening primary care. Even though the ACA has certainly been a boost to primary care — for example, more people with insurance coverage as well as required coverage of preventive services benefits the bottom lines of primary care providers — the future is uncertain, Schneider said.

“Now with the change in administration, the concern is that many of those benefits, especially the essential health benefits, will be reversed,” he said. “Many of the (potential) repeals would take us backwards in terms of insurance coverage and benefits available. That would erode much of the progress we’ve made in primary care.”

Schneider said that even for Americans who can afford care and have insurance coverage, the U.S. health care delivery systems isn’t organized optimally — “we do really well at expensive treatments, but we just don’t have that cornerstone of primary care.”

“The No. 1 difference between the U.S. and other countries is that other countries either commit to universal insurance coverage or put a lot into making sure everyone (is covered),” he told me. “That universal coverage is fundamental because without it, it’s very difficult to create a high-functioning insurance market and a health care system that serves everyone.”

For a full copy of the 11-country study, visit Health Affairs or the Commonwealth Fund.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years.

kkrisberg Tue, 11/29/2016 - 13:43

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Public Health - General

health care affordability

Thanks for the information. I too wrote an article on the Affordable Care Act and I thought you might find it interesting...

http://chrissopko.wixsite.com/chrissopko/single-post/2016/11/10/The-Cas…

Study: Depression increasing among American teens, young adults

kkrisberg — Wed, 16 Nov 2016 21:10:18 +0000

Study: Depression increasing among American teens, young adults

More and more of America’s adolescents and young adults are struggling with depression, especially young women, according to a study released earlier this week.

Published in the journal Pediatrics, the study found that the rate of adolescents who reported a recent episode of clinical depression increased by 37 percent between 2005 and 2014. Among girls, one in six reported a bout of clinical depression in the last year. In particular, the 12-month prevalence of a major depressive episode increased from 8.7 percent in 2005 to 11.3 percent in 2014 among adolescents, and from 8.8 percent to 9.6 percent among young adults. The study is based on data from the National Surveys on Drug Use and Health from 2005 to 2014, which included more than 172,000 adolescents ages 12 to 17 and more than 178,000 adults ages 18 to 25.

“This shows us there are a growing number of untreated adolescents with depression and that we are making few inroads in getting mental health care to this population,” said study co-author Ramin Mojtabai, a professor in the Johns Hopkins Bloomberg School of Public Health, in a news release. “It is imperative that we find ways to reach these teenagers and help them manage their depression.”

Among its many findings, the study reported that adolescents who experience major depressive episodes were more likely to be girls than boys and more likely to be white than black. Young adults who reported 12-month major depressive episodes were more likely to be unemployed or part-time employed; widowed, divorced, separated or never married; and less likely to have a yearly income between $20,000 and $75,000. Also, compared to young adults who hadn’t experienced such depression, those who had were less likely to be male or black and more likely to have a substance use disorder.

For girls, in particular, prevalence of experiencing a major depressive episode increased from about 13 percent in 2004 to more than 17 percent in 2014, whereas prevalence among boys increased from 4.5 percent to 5.7 percent. Overall during the study period, the number of adolescents who experienced 12-month major depressive episodes increased by more than half a million young people.

But despite the increase in depression, the proportion of adolescents with 12-month major depressive episodes who received mental health care in the prior year did not significantly change during the study period. Though researchers did find a small increase among adolescents in visits to specialty mental health providers, in inpatient and day treatment use, and medication use.

Researchers noted that the study was adjusted to consider the impact of typical factors associated with depression, such as single-parent households, income or an increase in substance abuse. However, they found that such factors could not explain the increasing depression numbers. As for the greater susceptibility among girls, the authors hypothesized that girls may be facing greater exposures to risk factors such as cyberbullying.

“The growing number of depressed adolescents and young adults who do not receive any mental health treatment for their (major depressive episodes) calls for renewed outreach efforts, especially in school and college health and counseling services and pediatric practices where many of the untreated adolescents and young adults with depression may be detected and managed,” the study concluded.

Researchers estimate that depression cost the U.S. about $210 billion in 2010 in direct and indirect costs. The mental health condition is also a leading cause of disease and injury.

For a full copy of the depression study, visit Pediatrics.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.

kkrisberg Wed, 11/16/2016 - 16:10

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healthcare

mental health

Public Health - General

Witness the bitter and far-reaching fruits of contraception.

"Witness the bitter and far-reaching fruits of contraception."

You are continuing with your list of amazingly stupid and fact free posts. I know you stated that the use of birth control hurts you, but linking your asinine idea that birth control is immoral and "wrong" in some mythological sense to a serious issue affecting millions of people is simply evil.

Is there any level of despicable behavior to which you won't stoop?

Just checked the article twice and it said nothing about contraceptive use.

SN, are you saying that *other* people using contraceptives causes young people to be depressed? You know that's not how any of this works, right?

To JustaTech #3:

Kim’s article notes “Young adults who reported 12-month major depressive episodes were more likely to be unemployed or part-time employed; widowed, divorced, separated or never married…”

I wonder how many of the depressed come from families of divorce or are children of single mothers?

I wonder how many of the depressed are further destabilized mentally, emotionally, and physically in a society which
-separates sex from lifelong fruitful marital love and which
-instead glorifies an objectifying hook-up culture and which
-degrades further into a pandemic of (“clean” and necessarily contraceptive) pornography and which
- has seen a resurgence in sexually transmitted diseases?

Pope Paul VI’s encyclical “Humane Vitae”, written in 1968, foresaw these and other ills resulting from wide-spread contraceptive use.
Here are some excerpts from one of many articles on the subject:
“… the use of contraceptives leads to a breakdown of marriage…
... conjugal infidelity and the general lowering of morality…
… men would no longer respect women but would treat them as a “mere instrument of selfish enjoyment, and no longer as his respected and beloved companion…
significant rise in divorce and illegitimacy, both of which lead to other social ills like heightened rates of criminal behavior and increased high school drop out rates…
… traditional women who wanted to either abstain from sex or at least receive a promise from their boyfriend that he would marry her in the case of pregnancy could no longer compete with “modern” women who embraced contraception…
… premarital sex became the norm and women “felt free or obligated to have sex.” “Thus, many traditional women ended up having sex and having children out of wedlock, while many of the permissive women ended up having sex and contraception or aborting so as to avoid childbearing. This explains in large part why the contraceptive revolution was associated with an increase in both abortion and illegitimacy.”
… the poor have been hit even harder by the negative consequences that came about through widespread use of contraceptives.”
http://thecatholicwriter.com/catholicwriter/2006/09/26/social-science-c…

Anyone surprised that sn's arguments are baseless and fact free, or that he relies on another bigot from 1968 to support his nonsense?

Nobody is surprised?

Didn't think anyone would be.

So, "See Not" is here again, sadistically spreading his bogus philosophy. Doe he know anything about psychology? Does he mention anything about hormones or biology? Does he realize that much depression is genetic? How about depression caused by simple frustration? How does he feel about the depression caused by his religion, both now, and in the last century? The Catholic Church supported the rise of the Nazis in Germany in the 1930's. That was pretty depressing. Especially if you were a Jew. Pope Pius XII had been threatened by Nazis as a young man, and never forgave them. No, instead, he insanely, vehemently fought them, while ignoring the murder of six million jews at the hands of Catholic and Lutheran Nazis among others.

Isn't it kind of curious that "See the Sadistic" is a supporter of President Elect Pussy Grabber? He is so in love with father figures that he will worship the strongest male authoritarian in any room, even if that father figure is at odds with most of the things his religion teaches. Go figure. And even if his father figure is flirting with a Russian dictator. This is like WWII all over again. When the Pope's darling Adolf double crossed the Russians and went to war with them, then subsequently lost the war with them, and Russian troops raped and impregnated so many German girls and woman, Pope Pius demanded that those females bear the offspring of Russian brutality. Kuz souls.
.
So See the Sadistic blinds himself to evil over and over agaiin, presumably so he can make his way to his mythical father figure in the sky, whom he loves more than anything, more than any woman, more than anything else.

Have a nice day See. Enjoy your life under future president Pussy Grabber/ Schicklgruber.

Oops. Pope Pius wasn't threatened by Nazis! He embraced them! My bad. Pope Pius XII had been threatened by COMMUNISTS as a young man, and never forgave them. Rather un-Christian of him I would say. Sorry about that error!

Since the nazis fought against the Soviet union, the worst people ever (according to him ) the link between his church and the nazis is a plus for him.

He views the Holocaust as an added bonus for his religion.

This post was about the rise of depression among young people. Any thoughtful, scientific discussion of the problem was highjacked by a religious nut blaiming the problem on failure to follows the precepts of someone whom this religious nut believes to be his god's chosen spiritual leader on Earth.
Nothing the least bit unhinged there, eh?
Problem solved. No thinking involved. Just shut up and follow the Pope. No discussion about NMR, PET, medications, diet, exercise, environment, counseling. Nope. None of that.

Peace and Love

"Just shut up and follow the Pope."

Well not this Pope: sn has explained several times why this Pope isn't qualified for the job: he's too soft on "the queers", he's too easy on all the women who want to get out of marriage due to abuse ("if you don't want to be an abused wife be a better wife") and he is too willing to accept scientific issues determined later than 1200.

sn: "I'k like a chance to meet this pope and explain to him why his grasp of Catholic philosophy is wrong."

SN, it is fascinating how you assume that the only reason a young widow might be depressed is that she might have used birth control. And you also assume that "never married" are sleeping around and using birth control. What if they're young missionaries? Or nuns?

And never mind that unemployment is an obvious reason to be depressed, as is poverty.

As for that pope claiming that using birth control would cause men to not respect women - ha! That's enough to make the cat laugh. Any student of history can tell you about the treatment of women throughout the centuries. Here's a little story: a group of knights on their way out of England to the crusades demanded hospitality at a convent. The abbess was forced to let them in. The knights then raped and kidnapped the nuns, taking them onto their ship bound to the Holy Land. But then a storm came up and all the nuns were thrown overboard. So yeah, "respect women", BS.

"Here are some excerpts from one of many articles on the subject"

If all of the articles are from the only link you provide, "the catholic writer", there is no reason to think there is anything fact-based there. The folks who write to defend the morality-free positions of your favored cult have no reason to provide accurate representations of these issues - if they did they'd get fired since the facts and reality contradict the church's misogynist dogma.

Highlights from final day at APHA’s Annual Meeting

cmonforton — Thu, 03 Nov 2016 12:52:14 +0000

Highlights from final day at APHA’s Annual Meeting

Kim Krisberg and I were in Denver this week at APHA’s 2016 Annual Meeting and Exposition — the year’s largest gathering of public health professionals. In our blog posts from earlier this week (here, here, here) we recapped just a few of the scientific sessions and events from the week. Below are some highlights from the final day at the meeting. You can read many more courtesy of the APHA Annual Meeting Blog.

Public health in the headlines: How does news coverage impact health?: Media. It’s everywhere these days. So, it’s not surprising that it impacts our health and behaviors as well as our perception of serious public health problems. Such influence was the topic of a Wednesday morning Annual Meeting session on “Media News Coverage of Health and Risk,” which began with a deeper look at how the media covers community violence and safety. Presenter Laura Nixon, of the Berkeley Media Studies Group, studied news coverage of community violence in California from 2013 to 2015. She found that the kinds of community violence solutions represented in the media evolved over the years. For example, in 2013, policing was most commonly reported as a solution. But in 2014 and 2015, community prevention programs became the top solution cited in media coverage. Continue reading

For a LARC: It’s no joke — better training expands contraception access: Long-acting reversible contraceptives — intrauterine devices and birth control implants — are the most effective methods to prevent pregnancy. But too many people who want to choose LARC as their form of birth control are unable to get it in a timely manner because community health clinic staff is untrained or unprepared to perform an insertion.

But that doesn’t have to be the case. At a Wednesday morning session on “Expanding LARC Access and Training the Community Health Workforce,” reproductive health experts shared their tools for success in preparing community health clinic staff to stock, educate about and insert IUDs and implants. Continue reading

Farmers markets, community gardens improve health. And not just for rich people: Farmers markets are great for our health, especially our nutrition. But there’s one big problem. “Unfortunately, the people that shop at farmers markets are usually white, middle-to-high income, highly educated and female,” said Jennifer Casey, executive director of the Fondy Food Center in Wisconsin, at an Annual Meeting session on “Community Gardens and Food Systems to Increase Fruit and Vegetable Consumption.” “And that’s missing a huge segment of our population.”

In both Wisconsin and Wyoming, researchers have taken giant steps to increase access to healthy food systems like farmers markets and community gardens. For example, Casey and researchers from the Medical College of Wisconsin collaborated on a two-year program to improve access to healthy food for diverse populations — especially people who receive Supplemental Nutrition Assistance Program benefits. Continue reading

Taking on obesity one soda at a time: Because problems like overweight and obesity don’t respect county borders, public health agencies are finding more ways to work together. An example: the Denver area Metro Healthy Beverage Partnership that’s already had success in raising awareness about sugary beverage consumption and is helping local communities change their unhealthy ways. The partnership formed in 2013 after six health departments (which cover seven Denver area counties and more than half the population of Colorado) decided to zero in on obesity and the risk factor of sugary beverage consumption as a priority.

“I must say, I thought, writing a grant across six health departments, that’s going to be like herding cats,” said John Douglas, director of the Tri-County Health Department. But focusing on a common goal has proven easier than he expected, he told Annual Meeting attendees during a Wednesday session “A Collective Impact Approach to Reducing Sugary Beverage Consumption in Denver Metro.” Continue reading

Children who witness violence or are sexually abused are 3 and 5 times more likely to inject drugs as adults: Children who are sexually abused are nearly five times more likely to inject drugs in adulthood as those who are not — while children who witness violence are about three times more likely — according to new research released today at the American Public Health Association’s 2016 Annual Meeting and Expo in Denver.

Researchers from NYU School of Medicine and The Center for Drug Use and HIV/HCV Research used a nationally representative sample of more than 12,000 Americans to explore associations between nine childhood traumas and adult drug use. Additionally: the association between sexual abuse during childhood and injection drug use was more than seven times as strong for males as females. Continue reading

Catch up on all the news from the APHA Annual Meeting here.

cmonforton Thu, 11/03/2016 - 08:52

Categories

Medicine

Report: Black students, students with disabilities bear brunt of corporal punishment

kkrisberg — Fri, 07 Oct 2016 16:19:06 +0000

Report: Black students, students with disabilities bear brunt of corporal punishment

Corporal punishment in America’s public schools seems like a relic of the past — a practice we had surely banned long ago. The reality, however, is that it’s perfectly legal to physically discipline students as young as preschoolers in 19 states. And according to a new report, corporal punishment is most often used against black students and students with disabilities.

Released earlier this week as a “Social Policy Report” from the Society for Research in Child Development, the report found that in Alabama and Mississippi, black children are at least 51 percent more likely to be physically punished than white children in more than half of school districts, while children with disabilities are more then 50 percent more likely to be physically punished than non-disabled students in many southeastern states where the practice is legal. The findings are based on numbers from the U.S. Department of Education’s Office of Civil Rights, which collects corporal punishment data from the nearly 37,000 public schools in states where the practice is allowed. (It’s good to note right away that just because school-based physical punishment is legal in 19 states, does not mean every school in those states uses this form of discipline. In many cases, school officials prohibit the practice.)

“It is discouraging that some schools think it’s necessary to still do this in the 21^st century when there are so many other options for discipline,” report co-author Elizabeth Gershoff, an associate professor of human development and family sciences at the University of Texas-Austin, told me. “Teaching children with fear and physical control is not the way to teach children to behave.”

Gershoff has spent nearly 15 years studying parents’ use of physical punishment on children, and said she became curious about similar punishments being used in schools. And even though schools are required to report such data to federal education officials, there was still a big gap in terms of analyzing that data to gain a clearer view of patterns and trends. In turn, Gershoff and her report co-author, Sarah Font of Pennsylvania State University, decided to fill that gap. The resulting report is now the first-ever effort on the prevalence of corporal punishment at school and school-district levels, as well as on disparities in the use of such punishments.

Thankfully, according to the report, the prevalence of corporal punishment in public schools is decreasing, from 4 percent of all schoolchildren in 1978 to less than 0.5 percent today, largely driven by corporal punishment bans enacted in 25 states. Overall, schools that use corporal punishment are largely clustered in the southeastern U.S., with a “geographic concentration” in three states — Arkansas, Alabama and Mississippi — where more than half of the school districts use it. Among the 19 states where corporal punishment is allowed, 12 percent of students attend a school that uses it. During the 2011-2012 school year, most school districts where the practice is legal decided against using it.

The two researchers found that during the 2011-2012 school year, more than 163,000 schoolchildren experienced corporal punishment. However, the report noted that number only reflects how many individual students were physically punished, not how many times they may have been physically punished, meaning instances of corporal punishment may be underestimated. Mississippi took the top spot, physically punishing the highest proportion of students, at 7 percent of all students, as well as the largest number, at more than 32,000 students. Alabama and Arkansas followed in terms of prevalence rates, and Texas came in second in terms of numbers of children physically punished.

On exactly who is being punished, the report found that racial disparities in the use of corporal punishment are common, with Alabama and Mississippi home to the largest disparities. In particular, black children in those two states are at least 51 percent more likely to receive corporal punishment in over half the school districts. Black children were also three times more likely than white children to be corporally punished in Arkansas, Florida, Georgia, Louisiana and Tennessee. In finding such disparities, Gershoff and Font wondered if black children were simply more likely to attend a school that uses corporal punishment. But they found the opposite — it’s white children who are more likely to attend such a school. They write:

Racial disparities in school corporal punishment are similar to those found for suspensions and expulsions, such that black children receive all forms of school discipline at a higher rate than their white peers. Research has largely concluded that disparities in suspensions and expulsions are not explained by differences in misbehavior; rather, black children are disciplined more severely than their non-black peers for the same misbehaviors. Few studies have investigated the source of racial disparities in school corporal punishment. An analysis of one Florida school district found that black children were more likely than other children to receive corporal punishment despite committing a smaller proportion of severe offenses.

The report also found that boys are substantially more likely to experience corporal punishment than girls in more than three-quarters of school districts in Alabama, Mississippi and Arkansas. In some schools, the corporal punishment rate for boys was five times the rate for girls. Also, children with physical, cognitive or emotional disabilities were more than 50 percent more likely to be physically punished in 67 percent of public schools districts in Alabama, 44 percent of districts in Arkansas, 34 percent in Georgia, 35 percent in Louisiana, 46 percent in Mississippi and 36 percent in Tennessee. The researchers noted that because federal law allows for children with disabilities to receive extra support and assistance at school, the corporal punishment disparity may suggest that “school staff are often responding to their challenging behaviors with harsh, rather than positive, disciplinary methods.”

“Schools may believe it’s effective and think if they don’t do this, it’ll be pandemonium or that they need corporal punishment as a last resort,” Gershoff told me. “But on many occasions, it’s not being used as a last resort. It’s being used for talking in the hall or going to the bathroom without permission or not turning in homework.”

On the effectiveness question, Gershoff said previous research has found that states that banned corporal punishment didn’t experience an increase in juvenile crime. Other research has found that corporal punishment is associated with lower academic achievement and worse behavior among children — findings that are consistent with what Gershoff has documented in studying the effects of spanking by parents.

She also noted that several states exempt public school personnel from child abuse statutes, so if a child is injured while being corporally punished, prosecution isn’t an option. To put that in even clearer perspective, Gershoff said that what could constitute child abuse at home — say, injuring a child while punishing them with a wooden board — would get a legal pass at school. Gershoff’s report cited a Society of Adolescent Medicine estimate that more than 270,000 children were corporally punished in 2003, with 10,000-20,000 seeking medical care as a result.

Gershoff said the best way to protect all children is a federal ban on corporal punishment in school.

“We hope a report like this can help educate the public that children are being harmed and the federal government does have a role in preventing this,” she said. “At the very least, I hope this can educate parents, so they can find out if their school (uses corporal punishment) and opt out.”

Gershoff said she plans to continue this line of research, investigating why some school districts use corporal punishment more than others and documenting the outcomes for children who experience corporal punishment. To download a full copy of the report, visit the Society for Research in Child Development.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.

kkrisberg Fri, 10/07/2016 - 12:19

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Corporal punishment for children with disabilities. Because obviously beating them for failing to do something they can't do is a logical reaction.

What the heck is wrong with these schools? I'm guessing the teachers haven't had any training on non-violent ways to maintain order in the classroom. Or have no support from the administration. Or were beaten themselves as children.

One of my cousins teaches special ed and he occasionally has to use physicality to work with his students, but that's about not letting them hurt themselves or others, not about punishing the student.

I'd be really interested to know about the parental notification. One of my college friends was pulled out of kindergarten in Georgia (~1990) because the school was not obligated to tell the parents if a child was spanked.

Everyone in these schools, teachers, administrators, students and parents need to be educated on better ways than beating.