Liz Szabo, Author at ��ýҕ�l Health News

Women and Minorities Bear the Brunt of Medical Misdiagnosis

Liz Szabo — Thu, 18 Jan 2024 10:00:00 +0000

Charity Watkins sensed something was deeply wrong when she experienced exhaustion after her daughter was born.

At times, Watkins, then 30, had to stop on the stairway to catch her breath. Her obstetrician said postpartum depression likely caused the weakness and fatigue. When Watkins, who is Black, complained of a cough, her doctor blamed the flu.

About eight weeks after delivery, Watkins thought she was having a heart attack, and her husband took her to the emergency room. After a 5½-hour wait in a North Carolina hospital, she returned home to nurse her baby without seeing a doctor.

When a physician finally examined Watkins three days later, he immediately noticed her legs and stomach were swollen, a sign that her body was retaining fluid. After a chest X-ray, the doctor diagnosed her with heart failure, a serious condition in which the heart becomes too weak to adequately pump oxygen-rich blood to organs throughout the body. Watkins spent two weeks in intensive care.

She said a cardiologist later told her, “We almost lost you.”

Watkins is among every year in the U.S.

Charity Watkins’ health took a bad turn in the weeks after her daughter was born. Her doctor blamed postpartum depression and then the flu. Those misdiagnoses put Watkins’ life at risk; she actually had heart failure. (Kate Medley for ��ýҕ�l Health News)

In a in JAMA Internal Medicine, researchers found that nearly 1 in 4 hospital patients who died or were transferred to intensive care had experienced a diagnostic error. Nearly 18% of misdiagnosed patients were harmed or died.

In all, an estimated 795,000 patients a year die or are permanently disabled because of misdiagnosis, according to a in the BMJ Quality & Safety periodical.

Some patients are at higher risk than others.

Women and racial and ethnic minorities are 20% to 30% more likely than white men to experience a misdiagnosis, said David Newman-Toker, a professor of neurology at Johns Hopkins School of Medicine and the lead author of the BMJ study. “That’s significant and inexcusable,” he said.

Researchers call misdiagnosis an urgent public health problem. The study found that rates of misdiagnosis range from 1.5% of heart attacks to 17.5% of strokes and 22.5% of lung cancers.

Weakening of the heart muscle — which led to Watkins’ heart failure — is the one week to one year after delivery, and is .

Charity Watkins experienced deep exhaustion for weeks after giving birth to her daughter. Her doctor thought she was depressed. She had undiagnosed heart failure. (Kate Medley for ��ýҕ�l Health News)

Heart failure “should have been No. 1 on the list of possible causes” for Watkins’ symptoms, said Ronald Wyatt, chief science and chief medical officer at the Society to Improve Diagnosis in Medicine, a nonprofit research and advocacy group.

Maternal mortality for Black mothers in recent years. The United States has the among developed countries. According to the Centers for Disease Control and Prevention, non-Hispanic Black mothers are as non-Hispanic white moms. More than half of these deaths take place within a year after delivery.

Research shows that Black women with childbirth-related heart failure are typically , said Jennifer Lewey, co-director of the pregnancy and heart disease program at Penn Medicine. That can allow patients to further deteriorate, making Black women less likely to fully recover and more likely to suffer from weakened hearts for the rest of their lives.

Watkins said the diagnosis changed her life. Doctors advised her “not to have another baby, or I might need a heart transplant,” she said. Being deprived of the chance to have another child, she said, “was devastating.”

Racial and gender disparities are widespread.

Women and minority patients suffering from heart attacks are more likely than others to be discharged without diagnosis or treatment.

Black people with depression to be .

Minorities are less likely than whites to be , depriving them of the opportunities to receive treatments that work best in the early stages of the disease.

Misdiagnosis isn’t new. Doctors have to estimate the percentage of patients who died with undiagnosed diseases for more than a century. Although those studies show some improvement over time, life-threatening mistakes remain all too common, despite an array of sophisticated diagnostic tools, said Hardeep Singh, a professor at Baylor College of Medicine who studies ways to improve diagnosis.

“The vast majority of diagnoses can be made by getting to know the patient’s story really well, asking follow-up questions, examining the patient, and ordering basic tests,” said Singh, who is also a researcher at Houston’s Michael E. DeBakey VA Medical Center. When talking to people who’ve been misdiagnosed, “one of the things we hear over and over is, ‘The doctor didn’t listen to me.’”

Racial disparities in misdiagnosis are sometimes explained by noting that minority patients are than white patients and often . But the picture is more complicated, said Monika Goyal, an emergency physician at Children’s National Hospital in Washington, D.C., who has documented racial bias in children’s health care.

Charity Watkins’ daughter recently drew portraits of her parents, which they display with her baby photo. (Kate Medley for ��ýҕ�l Health News)

In a 2020 study, Goyal and her colleagues found that Black kids with appendicitis were to be correctly diagnosed, even when both groups of patients visited the same hospital.

Although few doctors deliberately discriminate against women or minorities, Goyal said, many are biased without realizing it.

“Racial bias is baked into our culture,” Goyal said. “It’s important for all of us to start recognizing that.”

Demanding schedules, which prevent doctors from spending as much time with patients as they’d like, can contribute to diagnostic errors, said Karen Lutfey Spencer, a professor of health and behavioral sciences at the University of Colorado-Denver. “Doctors are more likely to make biased decisions when they are busy and overworked,” Spencer said. “There are some really smart, well-intentioned providers who are getting chewed up in a system that’s very unforgiving.”

Doctors make better treatment decisions when they’re more confident of a diagnosis, Spencer said.

In researchers asked doctors to view videos of actors pretending to be patients with heart disease or depression, make a diagnosis, and recommend follow-up actions. Doctors felt far more certain diagnosing white men than Black patients or younger women.

“Sharing my story is part of my healing,” says Charity Watkins, a doctor whose misdiagnosed heart failure proved life-threatening. She speaks to medical groups to help others improve their care. “It has helped me reclaim power in my life.” (Kate Medley for ��ýҕ�l Health News)

“If they were less certain, they were less likely to take action, such as ordering tests,” Spencer said. “If they were less certain, they might just wait to prescribe treatment.”

It’s easy to see why doctors are more confident when diagnosing white men, Spencer said. For more than a century, medical textbooks have of white men. Only 4.5% of images in general medical textbooks .

That may help explain why patients with darker complexions are with conditions that affect the skin, from to , which causes a red or pink rash in the earliest stage of infection. Black patients with Lyme disease are more likely to be diagnosed with more , which can cause arthritis and damage the heart. Black people with melanoma are about within five years.

The covid-19 pandemic helped raise awareness that pulse oximeters — the fingertip devices used to measure a patient’s — for people with dark skin. The devices work by ; their failures have delayed critical care for many Black patients.

Seven years after her misdiagnosis, Watkins is an assistant professor of social work at North Carolina Central University in Durham, where she experienced by Black mothers who survive severe childbirth complications.

“Sharing my story is part of my healing,” said Watkins, who speaks to medical groups to help doctors improve their care. “It has helped me reclaim power in my life, just to be able to help others.”

��ýҕ�l Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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Children Who Survive Shootings Endure Huge Health Obstacles and Costs

Liz Szabo — Mon, 06 Nov 2023 21:01:00 +0000

Oronde McClain was struck by a stray bullet on a Philadelphia street corner when he was 10.

The bullet shattered the back of his skull, splintering it into 36 pieces. McClain’s heart stopped, and he was technically dead for two minutes and 17 seconds.

Although a hospital team shocked him back to life, McClain never fully recovered. Doctors removed half his skull, replacing it with a gel plate, but shrapnel remains.

The shooting left him in a coma for seven weeks and in a wheelchair for nearly two years. School bullies magnified his pain, laughing at his speech and the helmet he wore to protect his brain. McClain said he repeatedly attempted suicide as a teenager. He remains partly paralyzed on his right side and endures seizures and post-traumatic stress disorder.

“People who die, they get funerals and balloon releases,” said McClain, now 33. “Survivors don’t get anything.”

After getting shot, McClain repeatedly attempted suicide as a teenager, he says. “People who die, they get funerals and balloon releases,” he says. “Survivors don’t get anything.” (Jim MacMillan)

Yet the ongoing medical needs of gun violence survivors and their families are vast.

In the year after they were shot, child and adolescent survivors were more than twice as likely as other kids to experience a pain disorder, said Zirui Song, an associate professor of health care policy and medicine at Harvard Medical School and the co-author of a The shooting survivors in the study — age 19 and younger — were found to be 68% more likely than other kids to have a psychiatric diagnosis and 144% as likely to develop a substance use disorder.

Across the United States, firearm injuries were the leading cause of death for people ages 1 to 19 in 2020 and 2021, according to the Centers for Disease Control and Prevention. More than 48,000 Americans of all ages were in 2022. And an average of about 85,000 Americans every year.

“The public hears about mass shootings and the number of people who died,” Song said. “The population of people affected by firearm violence is much larger than deaths alone.”

Most Americans say they or a family member has experienced gun violence, including witnessing a shooting, being threatened by a person with a gun, or being shot, according to a KFF survey.

“We are now a nation of survivors, and we have an unmet obligation to help families and communities heal, both physically and emotionally,” said Megan Ranney, dean of the Yale School of Public Health.

Being shot added an average of $35,000 to the health care costs of each young person studied, compared with the expenses of those who weren’t shot. The more serious the injury, the greater the cost and extent of medical complications, according to the study, based on data from employer-sponsored health insurance plans.

Although McClain’s mother had health insurance through her employer, the plan did not cover the cost of his wheelchair. Insurance didn’t pay for dance or theater classes, which his therapists recommended to improve his speech and movement. Although his grandparents helped pay the medical bills, his family still held fundraisers to cover additional out-of-pocket costs.

The study is one of the first to assess the effects of a child’s shooting on the entire family, said Ranney, who was not involved in the research.

Psychiatric disorders were 30% more common among the parents of the gun-injured children, compared with parents of uninjured kids. Their mothers made 75% more mental health visits than other moms.

Ranney noted that caregivers of shooting survivors often neglect their own needs. In the study, parents and siblings of the injured children made fewer visits for their own routine medical care, lab tests, and procedures.

Doctors can now save most gunshot victims, said Jessica Beard, a trauma surgeon at Temple University Hospital who was not involved in the study.

“We have more experience with bullet wounds than even many battlefield surgeons,” said Beard, who is also director of research for the Philadelphia Center for Gun Violence Reporting. “Surgeons from the military in Philadelphia to learn how to do combat surgery.”

Survivors of gunshot wounds often need continuing care from physical therapists, occupational therapists, makers of prosthetics, and others, which can pose additional hardships for rural residents, who may need to travel long distances multiple times a week for specialized services. Even in major U.S. cities, the hospitals and health systems best equipped to treat shooting survivors may be out of range for families who rely on public transportation.

Using public transportation would have been especially difficult when McClain was in a wheelchair. He said he feels lucky that his grandfather could drive him to the hospital for the first couple of years after his shooting. Later, when McClain could walk, he took two buses and a subway to the hospital. Today, McClain drives himself to get care and receives health insurance through his employer.

The psychological damage from child shootings may be even greater than the study indicates, Ranney said. Negative attitudes surrounding mental illness may have prevented some patients from acknowledging they’re depressed, so their struggles weren’t recorded in doctors’ notes or payment records, she said. Likewise, children afraid of punishment may not have told their doctors about illegal substance use.

McClain said he saw a therapist only once or twice. “I would scream at the doctors,” McClain said. “I said, ‘Don’t tell me you know how I feel, because you don’t understand.’”

Yet McClain has found purpose in his experience.

Last year, he co-produced a documentary called “” with the Philadelphia Center for Gun Violence Reporting, where he works. In the film, young survivors talk about wearing hoodies to hide their scars, navigating the world in a wheelchair, and combating infertility caused by their injuries. McClain is now working to of gun violence by creating a directory of shooting survivors willing to share their stories.

(Oronde McClain)

“My therapy is helping people,” he said. “I have to wake up and save somebody every day.”

Survivors are the forgotten victims of the nation’s gun violence epidemic, McClain said. Many feel abandoned.

“They push you out of the hospital like you have a normal life,’’ McClain said. “But you will never have a normal life. You are in this club that you don’t want to be in.”

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Suzanne Somers’ Legacy Tainted by Celebrity Medical Misinformation

Liz Szabo — Wed, 18 Oct 2023 20:55:00 +0000

Before there was Gwyneth Paltrow or Jenny McCarthy or Dr. Oz, there was Suzanne Somers.

Somers, who died from complications of breast cancer Oct. 15 at age 76, pioneered the role of celebrity wellness guru, using her sitcom television fame as a springboard to a second career as a self-professed health and beauty expert.

Although younger generations might have never heard of Somers, they still feel her influence, said Timothy Caulfield, a professor at the University of Alberta’s School of Public Health and author of “Is Gwyneth Paltrow Wrong About Everything?”

Somers “created the template that we see over and over again,” Caulfield said.

Somers, a star of the 1970s-’80s show “Three’s Company,” sold millions of ThighMasters to people hoping to achieve the Barbie-like figure for which Somers was famous. Her fans also connected with Somers on a personal level and appreciated the bravery it took to discuss growing up with an alcoholic father or being diagnosed with cancer.

But Somers drew criticism for urging women to defy the medical establishment. She revealed she had skipped chemotherapy against the advice of her doctor. She also championed potentially risky “,” which she touted as a more natural alternative to pharmaceutical treatments for menopause. Somers went on “” to describe an elaborate daily routine, which involved injecting hormones into her vagina and taking 60 pills a day in an effort to remain young-looking and sexy.

“She became an influencer on menopause before being an influencer was even a thing,” obstetrician-gynecologist Jen Gunter on Oct. 17. “Somers almost single-handedly vaulted a fringe, untested medical hypothesis into the mainstream.”

for any menopausal woman, particularly women with a common type of breast cancer fueled by estrogen.

Somers’ advice was dangerous then and remains so today, said Gunter, who noted that internet searches for bioidentical hormones would spike after the release of the actress’s books and television appearances.

Searches surged again after Somers’ death was announced, according to Google Trends.

Oncologist Otis Brawley, a professor at Johns Hopkins Medicine, said he other breast cancer patients from receiving chemotherapy, which increases the odds of survival despite difficult side effects, such as nausea, vomiting, and hair loss.

“I personally know of several women who have died” after rejecting breast cancer treatment “that had a high likelihood of curing them,” Brawley said.

Although Somers cultivated a bright and sunny image, “she was literally scathing if someone suggested something be tested scientifically,” he said.

Somers’ publicist declined to comment for this article.

In her books and media interviews, Somers also championed alternative medical providers, including ones who sell . One of those providers, Stanislaw Burzynski, a Houston oncologist, was for misleading terminal cancer patients and failing to disclose potential risks associated with his treatment.

And while the natural products industry markets its products with photographs of beaches and spring meadows, “underneath that is a lot of fear-mongering and anger and rage,” said Caulfield.

Like Somers, actress and former Playboy model Jenny McCarthy reinvented herself in 2007 as a health advocate, trumpeting the baseless notion that vaccines cause autism and casting doubt on the motives of pediatricians who recommend them. McCarthy famously told Oprah Winfrey that she went to “ for her information about vaccine safety, a phrase echoed by modern-day anti-vaccine activists who eschew expert opinion in favor of doing their own research.

The alternative therapies Somers promoted and the conspiracy theories swirling around the internet today go hand in hand, said Gunter, author of “The Menopause Manifesto.”

“If alternative medicine worked, everyone would be using it,” Gunter said. “So there has to be an excuse for not using it, like a conspiracy.”

Some celebrities “truly believe they have this special ability to suss out the truth about medicine,” Gunter said. “You can only believe that if you have a narcissistic belief in yourself.”

Actress Gwyneth Paltrow also has built a beauty and wellness empire, selling a wide range of dubious products on her website Goop.

Paltrow has endorsed placing jade, or yoni, eggs in the vagina to boost orgasms, for example, and steaming the vagina with mugwort to “balance” female hormones and to cleanse the uterus.

Yet today, people don’t need to be famous to become health influencers; they need only a TikTok account.

Social media contains a cacophony of medical misinformation, some of it dangerous. describe DIY mole removal, ingrown toenail removal, or using nail files to sharpen teeth.

Today’s health influencers speak directly to the camera, “breaking the fourth wall,” a technique Somers used that can create a stronger bond between speaker and viewer, said Jessica Gall Myrick, a professor of media studies at Pennsylvania State University.

“That’s probably why Somers was so influential,” Myrick said. “She talked directly to people through mass media. She was using mass media then the way people use social media today.”

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‘All We Want Is Revenge’: How Social Media Fuels Gun Violence Among Teens

Liz Szabo — Fri, 25 Aug 2023 09:00:00 +0000

Juan Campos has been working to save at-risk teens from gun violence for 16 years.

As a street outreach worker in Oakland, California, he has seen the pull and power of gangs. And he offers teens support when they’ve emerged from the juvenile justice system, advocates for them in school, and, if needed, helps them find housing, mental health services, and treatment for substance abuse.

(Oona Tempest/��ýҕ�l Health News)

But, he said, he’s never confronted a force as formidable as social media, where small boasts and disputes online can escalate into deadly violence in schoolyards and on street corners.

Teens post photos or videos of themselves with guns and stacks of cash, sometimes calling out rivals, on Facebook, Instagram, Snapchat, or TikTok. When messages go viral, fueled by “likes” and comments, the danger is hard to contain, Campos said.

“It’s hundreds of people on social media, versus just one or two people trying to guide youth in a positive way,” he said. Sometimes his warnings are stark, telling kids, “I want to keep you alive.” But, he said, “it doesn’t work all the time.”

Shamari Martin Jr. was an outgoing 14-year-old and respectful to his teachers in Oakland. Mixed in with videos of smiling friends on his Instagram feed were images of Shamari casually waving a gun or with cash fanned across his face. In March 2022, he was shot when the car he was in took a hail of bullets. His body , and emergency medical workers pronounced him dead at the scene.

(Oona Tempest/��ýҕ�l Health News)

In Shamari’s neighborhood, kids join gangs when they’re as young as 9 or 10, sometimes carrying guns to elementary school, said Tonyia “Nina” Carter, a violence interrupter who knew Shamari and works with Youth Alive, which tries to prevent violence. Shamari “was somewhat affiliated with that culture” of gangs and guns, Carter said.

Shamari’s friends poured out their grief on Instagram with broken-heart emojis and comments such as “love you brother I’m heart hurt.”

One post was more ominous: “it’s blood inna water all we want is revenge.” Rivals posted videos of themselves kicking over flowers and candles at Shamari’s memorial.

Such online outpourings of grief often presage additional violence, said Desmond Patton, a University of Pennsylvania professor who studies social media and firearm violence.

(Oona Tempest/��ýҕ�l Health News)

More than a year later, Shamari’s death remains unsolved. But it’s still a volatile subject in Oakland, said Bernice Grisby, a counselor at the East Bay Asian Youth Center, who works with gang-involved youth.

“There’s still a lot of gang violence going on around his name,” she said. “It could be as simple as someone saying, ‘Forget him or F him’ — that can be a death sentence. Just being affiliated with his name in any sort can get you killed.”

The U.S. surgeon general last month about social media’s corrosive effects on child and adolescent mental health, warning of the “profound risk of harm” to young people, who can spend hours a day on their phones. The 25-page report highlighted the risks of cyberbullying and sexual exploitation. It failed to mention social media’s role in escalating gun violence.

Acutely aware of that role are researchers, community leaders, and police across the country — including in , , , , , , and They describe social media as a relentless driver of gun violence.

(Oona Tempest/��ýҕ�l Health News)

Michel Moore, the Los Angeles police chief, called its impact “dramatic.”

“What used to be communicated on the street or in graffiti or tagging or rumors from one person to another, it’s now being distributed and amplified on social media,” he said. “It’s meant to embarrass and humiliate others.”

Many disputes among insecure young adults who may lack impulse control and conflict-management skills, said LJ Punch, a trauma surgeon and director of the Bullet-Related Injury Clinic in St. Louis.

“Social media is an extremely powerful tool for metastasizing disrespect,” Punch said. And of all the causes of gun violence, social media-fueled grudges are “the most impenetrable.”

Calls for Regulation

Social media companies are that for content posted on their platforms. Yet the deaths of young people have led to calls to change that.

(Oona Tempest/��ýҕ�l Health News)

“When you allow a video that leads to a shooting, you bear responsibility for what you put out there,” said Fred Fogg, national director of violence prevention for Youth Advocate Programs, a group that provides alternatives to youth incarceration. “Social media is addictive, and intentionally so.”

People note that social media can have a particularly pernicious effect in communities with high rates of gun violence.

“Social media companies need to be better regulated in order to make sure they aren’t encouraging violence in Black communities,” said Jabari Evans, an assistant professor of race and media at the University of South Carolina. But he said social media companies also should help “dismantle the structural racism” that places many Black youth “in circumstances that resign them to want to join gangs, carry guns to school, or take on violent personas for attention.”

L.A.’s Moore described social media companies as serving “in a reactionary role. They are profit-driven. They don’t want to have any type of control or restrictions that would suppress advertising.”

Social media companies say that violates their policies against or as quickly as possible. In a statement, YouTube spokesperson Jack Malon said the company “prohibits content reveling in or mocking the death or serious injury of an identifiable individual.”

(Oona Tempest/��ýҕ�l Health News)

Social media companies said they act to , especially children.

Rachel Hamrick, a spokesperson for Meta, which owns Facebook and Instagram, said the company has spent about $16 billion in the past seven years to protect the safety of people who post on its apps, employing 40,000 people at Facebook who work on safety and security.

“We remove content, disable accounts and work with law enforcement when we believe there is a genuine risk of physical harm or direct threats to public safety,” Hamrick said. “As a company, we have every commercial and moral incentive to try to give the maximum number of people as much of a positive experience as possible on Facebook. That’s why we take steps to keep people safe even if it impacts our bottom line.”

Meta platforms of over $116 billion in 2022, most of which came from advertising.

A spokesperson for Snapchat, Pete Boogaard, said the company deletes violent content within minutes of being notified of it. But, Fogg noted, by the time a video is removed, hundreds of people may have seen it.

(Oona Tempest/��ýҕ�l Health News)

Even critics acknowledge that the sheer volume of content on social media is difficult to control. Facebook has nearly 3 billion monthly users worldwide; YouTube has ; Instagram has 2 billion. If a company shuts down one account, a person can simply open a new one, said Tara Dabney, a director at the Institute for Nonviolence Chicago.

“Things could be going great in a community,” Fogg said, “and then the next thing you know, something happens on social media and folks are shooting at each other.”

Playing With Fire

At a time when virtually , many have access to guns, and many are coping with some say it’s not surprising that violence features so heavily in children’s social media feeds.

High school “fight pages” are now common on social media, and teens are quick to record and share fights as soon as they break out.

“Social media puts everything on steroids,” said the Rev. Cornell Jones, the group violence intervention coordinator for Pittsburgh.

(Oona Tempest/��ýҕ�l Health News)

Like adults, many young people feel validated when their posts are liked and shared, Jones said.

“We are dealing with young people who don’t have great self-esteem, and this ‘love’ they are getting on social media can fill some of that void,” Jones said. “But it can end with them getting shot or going to the penitentiary.”

While many of today’s teens are technologically sophisticated — skilled at filming and editing professional-looking videos — they remain naive about the consequences of posting violent content, said Evans, of the University of South Carolina.

Police in Los Angeles now monitor social media for early signs of trouble, Moore said. Police also search social media after the fact to gather evidence against those involved in violence.

“People want to gain notoriety,” Moore said, “but they’re clearly and giving us an easy path to bring them to justice.”

In February, New Jersey police used a video of a 14-year-old girl’s vicious school beating to against four teens. The victim of the assault, Adriana Kuch, died by suicide two days after the video went viral.

Preventing the Next Tragedy

(Oona Tempest/��ýҕ�l Health News)

Glen Upshaw, who manages outreach workers at Youth Alive in Oakland, said he encourages teens to express their anger with him rather than on social media. He absorbs it, he said, to help prevent kids from doing something foolish.

“I’ve always offered youth the chance to call me and curse me out,” Upshaw said. “They can come and scream and I won’t fuss at them.”

Workers at Youth Advocate Programs in their communities to de-escalate conflicts. “The idea is to get on it as soon as possible,” Fogg said. “We don’t want people to die over a social media post.”

It’s sometimes impossible, Campos said. “You can’t tell them to delete their social media accounts,” he said. “Even a judge won’t tell them that. But I can tell them, ‘If I were you, since you’re on probation, I wouldn’t be posting those kinds of things.’”

When he first worked with teens at high risk of violence, “I said if I can save 10 lives out of 100, I’d be happy,” Campos said. “Now, if I can save one life out of 100, I’m happy.”

For an illustrated version of this article, click here.

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Illustrated Report: How Gun Violence Goes Viral

Liz Szabo — Fri, 25 Aug 2023 09:00:00 +0000

As chatter and images about guns and violence slip into the social media feeds of more teens, viral messages fueled by “likes” can lead to real-world conflict and loss.

This illustrated report has been adapted from a ��ýҕ�l Health News article, “‘All We Want Is Revenge’: How Social Media Fuels Gun Violence Among Teens,” by Liz Szabo.

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Doctors Sound Alarm About Child Nicotine Poisoning as Vapes Flood the US Market

Liz Szabo — Thu, 03 Aug 2023 09:00:00 +0000

Hospital toxicologist Ryan Marino has seen up close the violent reactions of children poisoned by liquid nicotine from electronic cigarettes. One young boy who came to his emergency room experienced intense nausea, diarrhea, and vomiting, and needed intravenous fluids to treat his dehydration.

Kids can also become dizzy, lose consciousness, and suffer dangerous drops in blood pressure. In the most severe case he’s seen, doctors put another boy on a ventilator in the intensive care unit because he couldn’t breathe, said Marino, of Case Western Reserve University School of Medicine.

Thousands of kids a year are in e-cigarettes, also known as vapes. For a toddler, even a few drops can be fatal.

Cases of vaping-related nicotine exposure reported to poison centers in 2022 — despite a , the Child Nicotine Poisoning Prevention Act, that requires child-resistant packaging on bottles of vaping liquid. In what doctors call a major oversight, the law doesn’t require protective packaging on devices themselves.

Refillable vapes are designed to hold liquid nicotine in a central reservoir, making them dangerous to kids, Marino said. Even vapes that appear more child-resistant — because their nicotine is — present a risk, because the cartridges can be pried open. And some disposable e-cigarettes, now the top-selling type on the market, allow users to take and as multiple packs of cigarettes.

Many e-cigarettes and liquids seem , with pastel packages, names such as “,” and flavors such as bubble gum and blue raspberry. That makes vapes far more tempting — and hazardous — than traditional cigarettes, which have lower doses of nicotine and a bitter taste that often prompts children to quickly spit them out, said Diane Calello, the executive and medical director of the New Jersey Poison Information and Education System.

“Nicotine liquid is an accident waiting to happen,” Calello said. “It smells good and it’s highly concentrated.”

Sen. Richard Blumenthal (D-Conn.), who co-sponsored the 2016 legislation, said he would push to expand the childproof packaging requirement to disposable and pod-based e-cigarettes.

“Every day that FDA allows flavored e-cigarette products to remain on the market is another day that children can be enticed by these dangerous, and sometimes deadly, products,” he said.

Although the FDA declined to comment for this article, on Aug. 2 the agency included a special feature about in children in its “CTP Connect” newsletter.

The number of reports to poison control centers about e-cigarettes has more than doubled since 2018, according to an FDA analysis. Poison control centers reported more than 7,000 vaping-related exposures in people of all ages from April 1, 2022, to March 31, 2023.

According to the FDA, 43 of those exposures resulted in hospitalization and an additional 582 in other medical treatment. About half of poison center reports had no information about whether patients needed medical care.

Nearly 90% of exposures involved children under 5. Authors of the report say their numbers likely underestimate the problem, given that poison control centers aren’t contacted in every case.

A from vaping-related nicotine poisoning in 2014. The new FDA report also mentions the apparent suicide of an adult via e-cigarette poisoning.

A spokesperson for the vaping industry said companies take safety seriously.

“All e-liquid bottles manufactured in the United States conform to U.S. law,” said April Meyers, the president of the board of directors and CEO of the Smoke-Free Alternatives Trade Association, which represents the vaping industry. “Not only are the caps child-resistant, but the flow of liquid is restricted so that only small amounts can be dispensed.”

Yet many vaping products are made outside the U.S., which has recently been flooded with illegal e-cigarettes, mostly from China.

The increasing number of nicotine exposures among kids — especially curious toddlers who put virtually everything they can grab into their mouths — likely reflects the sheer volume of e-cigarette sales, said Natalie Rine, the director of the Central Ohio Poison Center at Nationwide Children’s Hospital.

E-cigarette unit sales from January 2020 to December 2022, rising from 15.5 million every four weeks to 22.7 million, according to a report published by the Centers for Disease Control and Prevention.

“This isn’t something that parents see as a really big risk,” Marino said. “But with the popularity of e-cigarettes, the risk isn’t going away anytime soon.”

One effective strategy to reduce e-cigarette sales has been to ban flavored products. California, Massachusetts, New Jersey, New York, Rhode Island, and Washington, D.C., , while Utah and Maryland have banned some flavors. A study showed overall e-cigarette sales in states after flavor bans, compared with states that didn’t ban them.

Some doctors say the country needs to do more to protect children.

“If the numbers are rising, then the law ain’t working,” said Carl Baum, a professor of pediatrics and emergency medicine at Yale School of Medicine.

Pediatrician Gary Smith said the lack of child safety requirements for e-cigarette devices is a major problem. Refillable e-cigarettes are relatively easy for kids to open.

Although most poison control center reports don’t include brand information, disposable e-cigarettes — including Elfbar, Puff Bar, and Pop Vape — were some of the most common products mentioned in the FDA analysis. Elfbar is now known as EB Design.

Expanding the federal law to include devices would be “an important step,” said Smith, president of the Child Injury Prevention Alliance, an Ohio-based advocacy group that works to prevent injuries in children.

In addition, federal officials should limit the nicotine concentration in vape juices to make them less toxic, as well as ban candy-like flavors and colors on packaging, Smith said.

“The public health response should be comprehensive,” Smith said.

Kids have been known to pick up a vape and begin puffing, in imitation of their parents, Calello said.

Even if children don’t inhale the aerosol, sucking on a vape exposes their skin to nicotine, which can be absorbed into the bloodstream, said Robert Glatter, an assistant professor of emergency medicine at Lenox Hill Hospital in New York City. Glatter noted that e-cigarette liquids also , including arsenic and lead, which is toxic at any dose; carcinogens such as acetaldehyde and formaldehyde; and benzene, a volatile organic compound found in auto exhaust.

Fortunately, children who inhale nicotine get a much lower dose than those who ingest it, reducing the risk of serious harm, said Marc Auerbach, a professor of pediatric emergency medicine at Yale School of Medicine.

Only about 2% of exposures in the FDA study were recorded as having a moderate or major effect.

That may be because little kids who get into dangerous liquids — from vape juice to household cleaning products or gasoline — usually spill most of it, Baum said. “They often end up wearing it rather than swallowing it,” Baum said.

Although Stephen Thornton has seen a lot of children with nicotine exposure, he said, the human body has ways of protecting itself from toxic substances. “Fortunately, when kids do ingest these e-cig nicotine products, they self-decontaminate. They vomit — a lot — and this keeps the mortality rate very low, but these kids still often end up in emergency departments due to all the nausea and vomiting,” said Thornton, an emergency medicine physician and medical director of the Kansas Poison Control Center.

The FDA of young children to keep e-cigarettes and vaping liquid out of reach and in its original container.

For emergency assistance, call Poison Help at 800-222-1222 to speak with a poison expert, or visit poisonhelp.org for support and resources.

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E-Cigs Are Still Flooding the US, Addicting Teens With Higher Nicotine Doses

Liz Szabo — Mon, 26 Jun 2023 09:00:00 +0000

When the FDA first asserted the authority to regulate e-cigarettes in 2016, many people assumed the agency would quickly get rid of vapes with flavors like cotton candy, gummy bears, and Froot Loops that appeal to kids.

Instead, the FDA allowed all e-cigarettes already on the market to stay while their manufacturers applied for the OK to market them.

Seven years later, vaping has ballooned into an , and manufacturers are flooding the market with thousands of products — most sold illegally and without FDA permission — that can be far more addictive.

“The FDA has failed to protect public health,” said Eric Lindblom, a former senior adviser to the director of the FDA’s Center for Tobacco Products. “It’s a tragedy.”

Yet the FDA isn’t the only entity that has tolerated the selling of vapes to kids.

Multiple players in and out of Washington have declined to act, tied the agency’s hands, or neglected to provide the FDA with needed resources. Former Presidents Barack Obama and Donald Trump both have prevented the FDA from broadly banning candy-flavored vapes.

Meanwhile, today’s vapes have become “bigger, badder, and cheaper” than older models, said Robin Koval, CEO of the Truth Initiative, a tobacco control advocacy group. The enormous amount of nicotine in e-cigarettes — up — can addict kids in a matter of days, Koval said.

E-cigarettes in the U.S. now contain nicotine concentrations that are, on average, more than twice the level allowed in Canada and The U.S. sets no limits on the nicotine content of any tobacco product.

“We’ve never delivered this level of nicotine before,” said Matthew Myers, president of the Campaign for Tobacco-Free Kids, which opposes youth vaping. “We really implications.”

Elijah Stone was 19 when he tried his first e-cigarette at a party. He was a college freshman, grappling with depression and attention-deficit/hyperactivity disorder, and “looking for an escape.” Store clerks never asked for his ID.

Stone said he was “hooked instantly.”

“The moment I felt that buzz, how was I supposed to go back after I felt that?” asked Stone, now 23, of Los Angeles.

The e-cigarette industry maintains that higher nicotine concentrations can help adults who smoke heavily switch from combustible cigarettes to vaping products, which are relatively less harmful to them. The FDA has approved high-nicotine, tobacco-flavored e-cigarettes for that purpose, said April Meyers, CEO of the Smoke-Free Alternatives Trade Association.

“The goal is to get people away from combustible products,” said Nicholas Minas Alfaro, CEO of Puff Bar, one of the most popular brands with kids last year. Yet Alfaro acknowledged, “These products are addictive products; there’s no hiding that.”

Although e-cigarettes don’t produce tar, they do contain harmful chemicals, such as nicotine and formaldehyde. The U.S. Surgeon General has warned that vaping poses significant risks: including damage to , , and parts of the brain that control attention and learning, as well as an increased risk of addiction to other substances.

More than 2.5 million kids , including 14% of high school students, according to the Centers for Disease Control and Prevention.

Most U.S. teen vapers of waking up, according to a survey of e-cigarette users ages 16 to 19 presented at the Society for Research on Nicotine and Tobacco in March.

The potential for profits — and — has led to a gold rush. The number of unique vaping products, as measured by their bar codes, , rising from 453 in June 2021 to 2,023 in June 2022, according to a Truth Initiative review of U.S. retail sales data.

FDA officials say they’ve been overwhelmed by the volume of e-cigarette marketing applications — 26 million in all.

“There is no regulatory agency in the world that has had to deal with a volume like that,” said Brian King, who became director of the FDA’s Center for Tobacco Products in July 2022.

The agency has struggled to stop e-cigarette makers who continue selling vapes despite the FDA’s rejection of the products, as well as manufacturers who never bothered to apply for authorization, and counterfeiters hoping to earn as much money as possible before being shut down.

In 2018, public health groups , charging that the delay in reviewing applications put kids at risk. Although a court ordered the FDA to finish the job by September 2021, the FDA . An estimated 1.2 million people under the legal age of 21 began vaping over the next year, according to a study in the American Journal of Preventive Medicine.

Recently, the FDA announced it has of e-cigarette applications, noting that it had rejected millions and authorized 23. All authorized products have traditional tobacco flavors, and were deemed “appropriate for the protection of public health” because tobacco-flavored products aren’t popular with children but provide adult smokers with a less dangerous alternative, King said.

The agency has yet to make final decisions on the most popular products on the market. Those applications are longer and need more careful scientific review, said Mitch Zeller, former director of the FDA’s Center for Tobacco Products and a current advisory board member for Qnovia, which is developing smoking-cessation products.

The FDA said it would not complete reviewing applications by the end of June, as it but would need

Before the FDA can announce new tobacco policies, it needs approval from the president — who doesn’t always agree with the FDA’s priorities.

For example, Obama rejected FDA officials’ proposal to ban kid-friendly flavors in 2016.

And in 2020, Trump backpedaled on his own plan to pull most flavored vapes off the market. Instead of banning all fruit and minty flavors, the Trump administration such as Juul. The flavor ban didn’t affect vapes without cartridges, such as disposable e-cigarettes.

The result was predictable, Zeller said.

Teens from Juul to brands that weren’t affected by the ban, including disposable vapes such as , which were allowed to continue selling candy-flavored vapes.

After letter from the FDA last year, Puff Bar now sells only zero-nicotine vapes, Alfaro said.

When the FDA does attempt bold action, legal challenges often force it to halt or even reverse course.

The FDA from the market in June 2022, for example, but was immediately hit with a lawsuit. The U.S. Court of Appeals for the D.C. Circuit sided with Juul and issued a temporary stay on the FDA’s order. Within weeks, the FDA announced it would hold off on enforcing its order because of “scientific issues unique to the JUUL application that warrant additional review.”

E-cigarette makers Logic and R.J. Reynolds Vapor Co. both after the agency ordered them menthol vapes, a flavor popular with teens. In both cases, court-imposed stays halted the FDA’s orders pending review and the companies’ menthol products remain on the market.

Luis Pinto, a spokesperson for parent company Reynolds American, said, “We remain confident in the quality of all of Reynolds’ applications, and we believe that there is ample evidence for FDA to determine that the marketing of these products is appropriate for the protection of public health.”

Under the Biden administration, the FDA has begun to step up enforcement efforts. It more than $19,000 each, and has issued more than 1,500 warning letters to manufacturers. The FDA also issued warnings to 120,000 retailers for selling illegal products or selling to customers under 21, King said. Five of the companies that made vapes decorated with cartoon characters, such as Minions, or were shaped like toys, including Nintendo Game Boys or walkie-talkies.

In May, the FDA put Elfbar and other unauthorized vapes from China on its “red list,” which allows to without inspection at the border. On June 22, the FDA announced it has issued for selling unauthorized tobacco products, specifically Elfbar and Esco Bars products, noting that both brands are disposable e-cigarettes that come in flavors known to appeal to youth, including bubblegum and pink lemonade.

In October, the Justice Department for the first time against six e-cigarette manufacturers on behalf of the FDA, seeking “to stop the illegal manufacture and sale of unauthorized vaping products.”

Some lawmakers say the Justice Department should play a larger role in prosecuting companies selling kid-friendly e-cigarettes.

“Make no mistake: There are more than six e-cigarette manufacturers selling without authorization on the market,” Sen. Dick Durbin (D-Ill.) said in a . Children are “vaping with unauthorized products that are on store shelves only because FDA has seemingly granted these illegal e-cigarettes a free pass.”

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Study Reveals Staggering Toll of Being Black in America: 1.6M Excess Deaths Over 22 Years

Liz Szabo — Tue, 16 May 2023 15:00:00 +0000

Research has long shown that Black people live sicker lives and die younger than white people.

Now a new study, , casts the nation’s racial inequities in stark relief, finding that the higher mortality rate among Black Americans resulted in 1.63 million excess deaths relative to white Americans over more than two decades.

Because so many Black people die young — with many years of life ahead of them — their higher mortality rate from 1999 to 2020 resulted in a cumulative loss of more than 80 million years of life compared with the white population, the study showed.

Although the nation made progress in closing the gap between white and Black mortality rates from 1999 to 2011, that advance stalled from 2011 to 2019. In 2020, the enormous number of deaths from covid-19 — which — erased two decades of progress.

Authors of the study describe it as a call to action to improve the health of Black Americans, whose early deaths are fueled by higher rates of heart disease, cancer, and infant mortality.

“The study is hugely important for about 1.63 million reasons,” said Herman Taylor, an author of the study and director of the cardiovascular research institute at the Morehouse School of Medicine.

“Real lives are being lost. Real families are missing parents and grandparents,” Taylor said. “Babies and their mothers are dying. We have been screaming this message for decades.”

High mortality rates among Black people have less to do with genetics than with the country’s long history of discrimination, which has undermined educational, housing, and job opportunities for generations of Black people, said Clyde Yancy, an author of the study and chief of cardiology at Northwestern University’s Feinberg School of Medicine.

Black neighborhoods that were redlined in the 1930s — designated too “high risk” for mortgages and other investments — , Yancy said. Formerly redlined ZIP codes also . “It’s very clear that we have an uneven distribution of health,” Yancy said. “We’re talking about the freedom to be healthy.”

A companion study estimates that racial and ethnic inequities at least $421 billion in 2018, based on medical expenses, lost productivity, and premature death.

In 2021, non-Hispanic white Americans had a life expectancy at birth of 76 years, while non-Hispanic Black Americans could . Much of that disparity is explained by the fact that non-Hispanic Black newborns are 2½ times before their 1st birthdays as non-Hispanic whites. Non-Hispanic Black mothers are as non-Hispanic white mothers to die from a pregnancy-related complication. (Hispanic people can be of any race or combination of races.)

Racial disparities in health are so entrenched that even education and wealth don’t fully erase them, said Tonia Branche, a neonatal-perinatal medicine fellow at Lurie Children’s Hospital of Chicago who was not involved in the JAMA study.

Black women with a college degree from pregnancy complications than white women without a high school diploma. Although researchers can’t fully explain this disparity, Branche said it’s possible that stress, including from systemic racism, takes a greater toll on the health of Black mothers than previously recognized.

Death creates ripples of grief throughout communities. Research has found that every death in mourning.

Black people shoulder a great burden of grief, which can undermine their mental and physical health, said Khaliah Johnson, chief of pediatric palliative care at Children’s Healthcare of Atlanta. Given the high mortality rates throughout the life span, Black people are to be grieving the death of a close family member at any point in their lives.

“We as Black people all have some legacy of unjust, unwarranted loss and death that compounds with each new loss,” said Johnson, who was not involved with the new study. “It affects not only how we move through the world, but how we live in relationship with others and how we endure future losses.”

Johnson’s parents lost two sons — one who died a few days after birth and another who died as a toddler. In an essay , Johnson recalled, “My parents asked themselves on numerous occasions, ‘Would the outcomes for our sons have been different, might they have received different care and lived, had they not been Black?’”

Johnson said she hopes the new study gives people greater understanding of all that’s lost when Black people die prematurely. “When we lose these lives young, when we lose that potential, that has an impact on all of society,” she said.

And in the Black community, “our pain is real and deep and profound, and it deserves attention and validation,” Johnson said. “It often feels like people just pass it over, telling you to stop complaining. But the expectation can’t be that we just endure these things and bounce back.”

Teleah Scott-Moore said she struggles with the death of her 16-year-old son, Timothy, an athlete who hoped to attend Boston College and study sports medicine. He died of sudden cardiac arrest in 2011, a rare condition that a year. Research that can lead to sudden cardiac death, hypertrophic cardiomyopathy, often goes unrecognized in Black patients.

Scott-Moore still wonders if she should have recognized warning signs. She also has blamed herself for failing to protect her two younger sons, who found Timothy’s body after he collapsed.

At times, Scott-Moore said, she wanted to give up.

Instead, she said, the family created a foundation to promote education and health screenings to prevent such deaths. She hears from families all over the world, and supporting them has helped heal her pain.

“My grief comes back in waves, it comes back when I least expect it,” said Scott-Moore, of Baltimore County, Maryland. “Life goes on, but it’s a pain that never goes away.”

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Most Americans Say They or a Family Member Has Experienced Gun Violence

Liz Szabo — Tue, 11 Apr 2023 09:01:00 +0000

A majority of Americans say they or a family member has experienced gun violence, such as witnessing a shooting, being threatened by a person with a gun, or being shot, according to a .

The national survey of 1,271 adults conducted by KFF revealed the severe physical and psychological harm exacted by firearm violence, especially in minority communities.

Nearly 1 in 5 respondents , including 34% of Black adults, 18% of Hispanic adults, and 17% of white adults, said a family member had been killed by a gun.

The survey “confirms that firearm-related injuries are ubiquitous,” said Dr. Selwyn Rogers, a surgeon and founding director of the UChicago Medicine trauma center. “For every person killed, there are two or three people harmed. These are people who have had fractures, who may have been paralyzed or disabled.”

Beyond causing physical injuries, gun violence has left many Americans living with trauma and fear, Rogers said.

Just over half of adults say gun-related crimes, injuries, and deaths are a “constant threat” or “major concern” in their communities. Black and Hispanic adults were more likely than white adults to describe gun violence as a constant threat or major concern. About 3 in 10 Black or Hispanic adults say they feel “not too safe” or “not safe at all” from gun violence in their neighborhoods. (Hispanics can be of any race or combination of races.)

Women also reported high rates of concern about firearm violence, with 58% saying gun-related crimes are a constant threat or major concern, compared with 43% of men. More than half of intimate partner homicides are .

Parents are worried about their children as well.

About 1 in 4 parents of children under 18 say they worry daily or almost daily about gun violence, the KFF survey found, and 84% of adults report having taken at least one precaution to reduce their family’s risk from gun violence. More than one-third of adults say they have avoided large crowds, such as at music festivals or crowded bars, for example.

Gun violence surged during the pandemic. There were a record 48,830 firearm-related deaths in 2021, , according to an analysis by the Pew Research Center. The increase among children was even sharper. Firearm deaths among Americans under 18 — which include those due to homicide, suicide, and gun-related accidents — increased 50%, from 1,732 in 2019 to 2,590 in 2021.

Guns have among children and adolescents ages 1 to 19, according to the Centers for Disease Control and Prevention.

The pandemic also coincided with a huge increase in gun purchases, which from 2019 to 2020.

According to the KFF survey, 29% of adults have purchased a gun at some point to protect themselves or their families, with 44% of parents of children under 18 keeping a gun in the home. Yet 78% of parents in gun-owning households fail to , such as locking guns and ammunition, storing guns unloaded, and storing guns and ammunition separately, practices that have been shown to reduce the risk of thefts, accidents, and suicides.

Dr. Abdullah Pratt, an emergency physician at the UChicago Medicine trauma center, has lost a dozen close friends to gun violence, including his brother. His father never recovered from that loss and died about seven years later, at age 64.

“As soon as my brother got killed, he stopped taking his medications and started chain-smoking out of nowhere,” Pratt said.

Gun violence also wears away communities, Pratt said.

In neighborhoods with high crime rates, the daily drumbeat of loss can lead residents to conclude there’s no point in voting, going to school, or trying to improve their lives. “They think, ‘What am I voting for if I can’t have basic access to safety on a day-to-day basis?’” Pratt said.

And while mass shootings and homicides grab headlines, Rogers, the surgeon, noted that suicides of firearm-related deaths in the U.S. and cause ripples of grief throughout a community. Researchers estimate that .

Pratt said he feels guilty he wasn’t able to help a close friend who died by suicide with a gun several years ago. The man had recently lost a job and had his car repossessed and came to Pratt to talk about his troubles. Instead, Pratt spent the visit asking for parenting advice, without realizing how much his friend was hurting.

“There were no red flags,” Pratt said. “A couple days later, he died.”

Gun violence has also shaped the trajectory of Bernice Grisby’s life.

Grisby, now 35, was shot for the first time when she was 8, while playing on the swings at her school in Oakland, California. She was shot a second time at age 15, when she was talking to friends after school. One of her friends died that day, while another lost an eye; Grisby was shot in the hip and experiences chronic pain from the wound.

Two of her brothers were fatally shot in their 20s. Her 15-year-old daughter was recently robbed at gunpoint.

Rather than leaving Oakland, Grisby is trying to save it. She works as a street counselor to young people at high risk of gun violence through Oakland’s East Bay Asian Youth Center, which aims to help young people living in poverty, trauma, and neglect.

“My life is a gift from God,” Grisby said. “I am happy to be here to support the youth and know that I am making a difference.”

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Pandemic Stress, Gangs, and Utter Fear Fueled a Rise in Teen Shootings

Liz Szabo — Tue, 14 Mar 2023 09:00:00 +0000

Diego never imagined he’d carry a gun.

Not as a child, when shots were fired outside his Chicago-area home. Not at age 12, when one of his friends was gunned down.

Diego’s mind changed at 14, when he and his friends were getting ready to walk to midnight Mass for the . But instead of hymns, Diego heard gunfire, and then screaming. A gang member shot two people, including one of Diego’s friends, who was hit nine times.

“My friend was bleeding out,” said Diego, who asked KHN not to use his last name to protect his safety and privacy. As his friend lay on the ground, “he was choking on his own blood.”

The attack left Diego’s friend paralyzed from the waist down. And it left Diego, one of of teens who witness gun violence, to go outside without a gun.

Research shows that adolescents exposed to gun violence are to perpetrate a serious violent crime within two years, perpetuating a cycle that can be hard to interrupt.

Diego asked his friends for help finding a handgun and — in a country supersaturated with firearms — they had no trouble procuring one, which they gave him free.

“I felt safer with the gun,” said Diego, now 21. “I hoped I wouldn’t use it.”

For two years, Diego kept the gun only as a deterrent. When he finally pulled the trigger, it changed his life forever.

Disturbing Trends

The news media focuses heavily on mass shootings and the mental state of the people who commit them. But there is a of gun violence — particularly among youth — ensnaring some kids not even old enough to get a driver’s license.

Research shows that can change the way . Trauma also can play a central role in explaining why some young people look to guns for protection and wind up using them against their peers.

The number of children under 18 who killed someone with a firearm jumped from

In New York City, the number of young people who killed someone with a gun more than doubled, rising from 48 juvenile offenders in 2019 to 124 in 2022, according to data from the city’s police department.

Youth gun violence increased more modestly in other cities; in many places, the number of teen gun homicides rose in 2020 but has since fallen closer to pre-pandemic levels.

Researchers who analyze crime statistics stress that the overall rise in gun violence, which has . In 2020, involved children under 18, a slightly smaller share than in previous years.

Local leaders have struggled with the best way to respond to teen shootings.

A handful of communities — including ; and — have debated or implemented youth curfews to curb teen violence. What’s not in dispute: More people ages 1 to 19 than by any other cause.

A Lifetime of Limits

The devastating toll of gun violence shows up in emergency rooms every day.

At the UChicago Medicine trauma center, the number of gunshot wounds in children under 16 has doubled in the past six years, said Dr. Selwyn Rogers, the center’s founding director. The youngest victim was 2. “You hear the mother wail, or the brother say, ‘It’s not true,’” said Rogers, who works with local youth as the hospital’s executive vice president for community health engagement. “You have to be present in that moment, but then walk out the door and deal with it all over again.”

Dr. Selwyn Rogers is the founding director of UChicago Medicine’s trauma center. In the past six years, the trauma center has seen the number of gunshot wounds in children under 16 double.

In recent years, the justice system has struggled to balance the need for public safety with compassion for kids, based on research that shows a young person’s brain doesn’t . Most young of criminal or violent behavior around the same time, as they develop more self-control and long-range thinking skills.

Yet teens accused of shootings are often charged as adults, which means they face harsher punishments than kids charged as juveniles, said Josh Rovner, director of youth justice at the Sentencing Project, which advocates for justice system reform.

About in 2019 were charged as adults, which can have serious health repercussions. These teens are more likely to be victimized while incarcerated, Rovner said, and to be arrested again after release.

Young people can spend much of their lives in a poverty-imposed lockdown, never venturing far beyond their neighborhoods, learning little about opportunities that exist in the wider world, Rogers said. — particularly kids — live in environments plagued by poverty, violence, and drug use.

The covid-19 pandemic amplified all those problems, from to and .

Although no one can say with certainty what spurred the surge in shootings in 2020, research has long and — which increased after the murder of George Floyd that year — to an increased risk of community violence. Gun sales from 2019 to 2020, while many shut down.

One of the most serious losses children faced during the pandemic was the closure of schools — institutions that might provide the only stabilizing force in their young lives — for a year or more in many places.

“The pandemic just turned up the fire under the pot,” said Elise White, deputy director of research at the nonprofit Center for Justice Innovation, which works with communities and justice systems. “Looking back, it’s easy to underplay now just how uncertain that time [during the pandemic] felt. The more that people feel uncertain, the more they feel there’s no safety around them, the more likely they are to carry weapons.”

Of course, most children who experience hardship never break the law. Multiple studies have found that most gun violence is perpetrated by a .

The presence of even one can protect children from becoming involved with crime, said Dr. Abdullah Pratt, a UChicago Medicine emergency physician who lost his brother to gun violence.

Pratt also lost four friends to gun violence during the pandemic. All four died in his emergency room; one was the son of a hospital nurse.

Although Pratt grew up in a part of Chicago where street gangs were common, he benefited from the support of loving parents and strong role models, such as teachers and football coaches. Pratt was also protected by his older brother, who looked out for him and made sure gangs left the future doctor alone.

“Everything I’ve been able to accomplish,” Pratt said, “is because someone helped me.”

Growing Up in a ‘War Zone’

Diego had no adults at home to help him feel safe.

His parents were often violent. Once, in a drunken rage, Diego’s father grabbed him by the leg and swung him around the room, Diego said, and his mother once threw a toaster at his father.

At age 12, Diego’s efforts to help the family pay overdue bills — by selling marijuana and stealing from unlocked cars and apartments — led his father to throw him out of the house.

At 13, Diego joined a gang made up of neighborhood kids. Gang members — who recounted similar stories about leaving the house to escape abuse — gave him food and a place to stay. “We were like a family,” Diego said. When the kids were hungry, and there was no food at home, “we’d go to a gas station together to steal some breakfast.”

Dr. Abdullah Pratt is a UChicago Medicine emergency physician who lost his brother to gun violence. Pratt says the presence of even one supportive adult can protect children from becoming involved with crime.

But Diego, who was smaller than most of the others, lived in fear. At 16, Diego weighed only 100 pounds. Bigger boys bullied and beat him up. And his successful hustle — selling stolen merchandise on the street for cash — got the attention of rival gang members, who threatened to rob him.

Children who experience chronic violence can develop a becoming hypervigilant to threats, sometimes sensing danger where it doesn’t exist, said James Garbarino, an emeritus professor of psychology at Cornell University and Loyola University-Chicago. Kids who live with are more likely to look to firearms or gangs for protection. They can be triggered to take preemptive action — such as firing a gun without thinking — against a perceived threat.

“Their bodies are constantly ready for a fight,” said Gianna Tran, deputy executive director of the East Bay Asian Youth Center in Oakland, California, which works with young people living in poverty, trauma, and neglect.

Unlike mass shooters, who buy guns and ammunition because they’re intent on murder, most teen violence is not premeditated, Garbarino said.

In surveys, most young people who carry guns — — say they do so out of fear or to , rather than perpetrate them. But fear of community violence, both from rivals and the police, can stoke an urban arms race, in which kids feel that only the foolish walk around without a weapon.

“Fundamentally, violence is a contagious disease,” said Dr. Gary Slutkin, founder of , which works to prevent community violence.

Although a small number of teens become hardened and remorseless, Pratt said, he sees far more shootings caused by “poor conflict resolution” and teenage impulsivity rather than a desire to kill.

Indeed, firearms and an immature teenage brain are a dangerous mix, Garbarino said. Alcohol and drugs can magnify the risk. When confronted with a potentially life-or-death situation, kids may act without thinking.

When Diego was 16, he was walking a girl to school and they were approached by three boys, including a gang member who, using obscene and threatening language, asked if Diego was also in a gang. Diego said he tried to walk past the boys, one of whom appeared to have a gun.

“I didn’t know how to fire a gun,” Diego said. “I just wanted them to get away.”

In news accounts of the shooting, witnesses said they heard five gunshots. “The only thing I remember is the sound of the shots,” Diego said. “Everything else was going in slow motion.”

Diego had shot two of the boys in the legs. The girl ran one way, and he ran another. Police arrested Diego at home a few hours later. He was tried as an adult, convicted of two counts of attempted homicide, and sentenced to 12 years.

A Second Chance

In the past two decades, the justice system has made major changes in the way it treats children.

Youth arrests for violent crime from 2006 to 2020, and have made it harder to charge minors as adults. States also are adopting , such as group homes that allow teens to remain in their communities, while providing treatment to help them change their behavior.

Because Diego was 17 when he was sentenced, he was sent to a juvenile facility, where he received therapy for the first time.

Diego finished high school while behind bars and went on to earn an associate’s degree from a community college. He and other young inmates went on field trips to theaters and the aquarium — places he had never been. The detention center director asked Diego to accompany her to events about juvenile justice reform, where he was invited to tell his story.

Those were eye-opening experiences for Diego, who realized he had seen very little of Chicago, even though he had spent his life there.

“Growing up, the only thing you see is your community,” said Diego, who was released after four years in detention, when the governor commuted his sentence. “You assume that is what the whole world is like.”

KHN data editor Holly K. Hacker and researcher Megan Kalata contributed to this report.

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