Tag: Children’s Health

Many Young Adults Who Began Vaping as Teens Can’t Shake the Habit

G Kumar’s vaping addiction peaked in college at the University of Colorado, when flavored, disposable vapes were taking off.

“I’d go through, let’s say, 1,200 puffs in a week,” Kumar said.

Vaping became a crutch for them. Like losing a cellphone, losing a vape pen would set off a mad scramble.

“It needs to be right next to my head when I fall asleep at night, and then in the morning, I have to thrash through the sheets and pick it up and find it,” Kumar recalled.

They got sick often, including catching covid-19 — and vaping through all of it.

Kumar, now 24, eventually quit. But many of their generation can’t shake the habit.

“Everyone knows it’s not good for you and everyone wants to stop,” said Jacob Garza, a University of Colorado student who worked to raise awareness about substance use as part of the school’s health promotion program.

“But at this point, doing it all these years … it’s just second nature now,” he said.

Marketing by e-cigarette companies, touting the allure of fruity or candy-like flavors and names, led many teens to try vaping. As more high schoolers and younger kids experimented with e-cigarettes, physicians and researchers warned it could lead to widespread addiction, creating a “Generation Vape.”

Research has shown nicotine is highly rewarding to the brains of young people.

New data on substance use among adults ages 18-24 suggests that many former teen vapers remain e-cigarette users. National vaping rates for young adults increased from 7.6% in 2018 to 11% in 2021.

A photo of colorful vape juice products lined up on shelves in a store.
Rows of flavored tobacco vape juice on display at a store in Fresno, California, on Oct. 18.(Marek Warszawski/Fresno Bee/Tribune News Service via Getty Images)

It’s not surprising that many of them start in high school for social reasons, for all sorts of reasons,” said Delaney Ruston, a primary care physician and documentary filmmaker. “And many of them now — we’re seeing this — have continued to college and beyond.”

Her latest film is “Screenagers Under the Influence: Addressing Vaping, Drugs & Alcohol in the Digital Age.”

In Colorado, the share of those 18 to 24 who regularly vaped rose by about 61% from 2020 to 2022 — to nearly a quarter of that age group.

“That’s an astounding increase in just two years,” Ruston said.

Trends in that state are worth noting because, before the pandemic, Colorado led the nation in youth vaping among high school students, surpassing 36 other states surveyed.

Nationally, vaping rates among high schoolers dropped from 28% in 2019 to 10% in 2023, according to the Annual National Youth Tobacco Survey. But for many young people who started vaping at the height of the trend, a habit was set.

At Children’s Hospital Colorado, pediatric pulmonologist Heather De Keyser displayed on her screen a clouded X-ray of the lung of a young adult damaged by vaping.

For years, doctors like her and public health experts wondered about the potentially harmful impact of vaping on pre-adult bodies and brains — especially the big risk of addiction.

“I think, unfortunately, those lessons that we were worried we were going to be learning, we’re learning,” said De Keyser, an associate professor of pediatrics in the Breathing Institute at Children’s Hospital Colorado.

“We’re seeing increases in those young adults. They weren’t able to stop.”

A photo of a woman pointing to an X-ray.
Heather De Keyser, a pediatric pulmonologist at Children’s Hospital Colorado, points to the X-ray of a lung of a young adult damaged by vaping.(John Daley/Colorado Public Radio)

It’s no coincidence the vaping rates soared during the pandemic, according to several public health experts.

For the past couple of years, undergraduates have talked about the challenges of isolation and using more substances, said Alyssa Wright, who manages early intervention health promotion programs at CU-Boulder.

“Just being home, being bored, being a little bit anxious, not knowing what’s happening in the world,” Wright said. “We don’t have that social connection, and it feels like people are still even trying to catch up from that experience.”

Other factors driving addiction are the high nicotine levels in vaping devices, and “stealth culture,” said Chris Lord, CU-Boulder’s associate director of the Collegiate Recovery Center.

“The products they were using had five times more nicotine than previous vapes had,” he said. “So getting hooked on that was … almost impossible to avoid.”

By “stealth culture,” Lord means that vaping is exciting, something forbidden and secret. “As an adolescent, our brains are kind of wired that way, a lot of us,” Lord said.

All over the U.S., state and local governments have filed suits against Juul Labs, alleging the company misrepresented the health risks of its products.

The lawsuits argued that Juul became a top e-cigarette company by aggressively marketing directly to kids, who then spread the word themselves by posting to social media sites like YouTube, Instagram, and TikTok.

“What vaping has done, getting high schoolers, in some cases even middle schoolers, hooked on vaping, is now playing out,” said Colorado Attorney General Phil Weiser.

Juul agreed to pay hundreds of millions in settlements. The company did not respond to requests for comment on this article.

R.J. Reynolds, which makes another popular vape brand, Vuse, sent this statement: “We steer clear of youth enticing flavors, such as bubble gum and cotton candy, providing a stark juxtaposition to illicit disposable vapor products.”

Other big vape companies, like Esco Bar, Elf Bar, Breeze Smoke, and Puff Bar, didn’t respond to requests for comment.

“If we lived in an ideal world, adults would reach the age of 24 without ever having experimented with adult substances. In reality, young adults experiment,” said Greg Conley, director of legislative and external affairs with American Vapor Manufacturers. “This predates the advent of nicotine vaping.”

A photo of colorful disposable vapes shown inside a convenience store.
Disposable vapes are displayed in a convenience store on June 23, 2022, in El Segundo, California.(Patrick T. Fallon/AFP via Getty Images)

The FDA banned flavored vape cartridges in 2020 to crack down on marketing to minors, but the products are still easy to find.

Joe Miklosi, a consultant to the Rocky Mountain Smoke-Free Alliance, a trade group for vape shops, contends the shops are not driving vaping rates among young adults in Colorado. “We keep demographic data in our 125 stores. Our average age [of customers] is 42,” he said.

He has spoken with thousands of consumers who say vaping helped them quit smoking cigarettes, he said. Vape shops sell products to help adult smokers quit, Miklosi said.

Colorado statistics belie that claim, according to longtime tobacco researcher Stanton Glantz. The data is “completely inconsistent with the argument that most e-cigarette use is adult smokers trying to use them to quit,” said Glantz, the former director of the Center for Tobacco Control Research and Education at the University of California-San Francisco.

For recent college graduate G Kumar, now a rock climber, the impetus to quit vaping was more ecological than health-related. They said they were turned off by the amount of trash generated from used vape devices and the amount of money they were spending.

Kumar got help from cessation literature and quitting aids from the university’s health promotion program, including boxes of eucalyptus-flavored toothpicks, which tasted awful but provided a distraction and helped with oral cravings.

It took a while and a lot of willpower to overcome the intense psychological cravings.

“The fact that I could just gnaw on toothpicks for weeks on end was, I think, what kept me sane,” Kumar said.

This article is from a partnership that includes CPR News, NPR, and KFF Health News.

‘I Try To Stay Strong’: Mom Struggles To Get Diagnosis for Son’s Developmental Problems

CASTRO VALLEY, Calif. — Four-year-old Ahmeir Diaz-Thornton couldn’t sit still in class and rarely ate his lunch. While his preschool classmates spoke in perfect sentences, Ahmeir had trouble pronouncing words.

Ahmeir’s preschool teacher relayed her concerns to his mother, Kanika Thornton, who was already worried about Ahmeir’s refusal to eat anything but yogurt, Chef Boyardee spaghetti, oatmeal, and applesauce. He also sometimes hit himself and others to cope with the frustration of not being able to communicate, she said.

Thornton took her son, who is on Medi-Cal, California’s Medicaid program, which covers low-income families, to his pediatrician. Then he was evaluated by a school district official, a speech therapist, and the pediatrician — again. Along the way, Thornton consulted teachers, case managers, and social service workers.

Ten months later, she still doesn’t have an accurate diagnosis for Ahmeir.

“I felt like I failed my child, and I don’t want to feel that,” said Thornton, 30, who has been juggling Ahmeir’s behavior and appointments on top of her pregnancy and caring for her two other children.

“Some days I don’t eat because he doesn’t eat,” said Thornton from her home in Alameda County in the San Francisco Bay Area. “I don’t want to hurt my unborn child. So I try to eat some crackers and cheese and stuff, but I don’t eat a meal because he doesn’t eat a meal.”

Seeking a diagnosis for a child’s behavioral problems can be challenging for any family as they navigate complicated medical and educational systems that don’t communicate effectively with parents, let alone each other.

A common obstacle families face is landing an appointment with one of a limited number of developmental specialists. It is particularly difficult for families with Medi-Cal, whose access to specialists is even more restricted than for patients with private insurance.

As they await their turn, they boomerang among counselors, therapists, and school officials who address isolated symptoms, often without making progress toward an overall diagnosis.

Obtaining a timely diagnosis for autism, anxiety, attention-deficit/hyperactivity disorder, or other behavioral disorders is important for children and their parents, said Christina Buysse, a clinical associate professor in developmental and behavioral pediatrics at Stanford University.

“Parent stress levels go down when a child is diagnosed early,” because they learn how to manage their child’s behaviors, she said.

Intervening early can also help retrain a child’s brain quickly and avoid lifelong consequences of developmental delays, said Adiaha Spinks-Franklin, president of the Society for Developmental and Behavioral Pediatrics.

“A speech and language delay at the age of 2 can put a child at risk of reading comprehension problems in the third grade,” she said.

Buysse is likely the right type of medical specialist for Ahmeir. As a developmental-behavioral pediatrician, she can often unify different symptoms into one diagnosis, and she knows what kind of therapy or medication patients need.

The Society for Developmental and Behavioral Pediatrics reports that there are only 706 actively certified developmental specialists in the nation.

“There just aren’t enough of us,” Buysse said, and some developmental specialists don’t accept Medicaid patients because they believe the reimbursement rates aren’t adequate.

A young boy rides a tricycle inside. He turns and tilts his head toward the camera and smiles.
Ahmeir Diaz-Thornton’s speech has improved with school-provided therapy. However, he is still waiting for a comprehensive medical evaluation and diagnosis. (Sejal Parekh for KFF Health News)

Thornton didn’t know her son needed to see a developmental specialist, and he had never been referred to one, despite his many medical appointments. Once she learned about this type of specialist in May, she asked his pediatrician for a referral.

Alameda Health System, which provides Ahmeir’s primary care, “does not have a developmental-behavioral pediatrician on staff at this time,” said Porshia Mack, the system’s associate chief medical officer of ambulatory services.

“We have made efforts to hire them, but recruiting and retaining pediatric subspecialists is difficult for all health systems, and public safety-net systems in particular,” she said.

Karina Rivera, a spokesperson for the Alameda Alliance for Health, Thornton’s Medi-Cal managed care plan, provided a list of nine developmental-behavioral pediatricians she said are in the plan’s network.

However, the only two in Alameda County work for Kaiser Permanente, which “is a closed system,” acknowledged Donna Carey, interim chief medical officer of the Alameda Alliance. In practice, that means “even if they have a developmental pediatrician, we don’t have access to that pediatrician,” she said.

The other seven specialists are in surrounding counties, which could pose transportation challenges for Thornton and other patients.

The Alameda Alliance for Health met state requirements for patient access to specialists in the most recent review of its network, in 2022, said Department of Health Care Services spokesperson Griselda Melgoza. The plan “was found compliant with all time or distance standards,” she said.

However, after learning from California Healthline that the plan considers Kaiser Permanente specialists part of its network, the department contacted the insurer to inquire, and will work with it “to ensure member-facing materials accurately represent their current network,” Melgoza said.

A month after starting preschool in fall 2023, Ahmeir was evaluated for speech delay through his school district. His pediatrician also began ordering tests to understand his eating habits.

But Thornton believes Ahmeir’s symptoms aren’t isolated problems that can be addressed in a piecemeal fashion. “It’s just something else. It’s his development,” she said. “I know a tantrum, but he doesn’t get tantrums. He will hit people. That’s a no-go.”

In addition to addressing medical concerns, a developmental specialist could help parents like Thornton understand what school districts offer and how to expedite school evaluations, Spinks-Franklin said. Ahmeir faces a six- to eight-month wait for a comprehensive evaluation through his school district for additional services, Thornton said.

It’s common for parents to get confused about what a school district can and can’t do for kids with developmental disabilities, said Corina Samaniego, who works at Family Resource Navigators, an organization that helps parents like Thornton in Alameda County. For instance, Samaniego said, school districts cannot provide medical diagnoses of autism, nor the therapy to address it.

Ahmeir has made significant improvement with speech therapy provided through the school district, Thornton said, and now speaks in full sentences more often. But she remains frustrated that she does not have a diagnosis that explains his persistent symptoms, especially his reluctance to eat and difficulty expressing emotions.

Thornton believes she has done everything she can to help him. She has even created elaborate food landscapes for Ahmeir with dinosaur-shaped chicken nuggets, mashed potato volcanoes, gravy lava, and broccoli trees — only to have him turn his head away.

As of late May, she continued to seek advice from teachers and counselors while she waited for an appointment with a specialist.

“I try to stay strong for my son and do the best I can and be there for him, talk to him, teach him things,” she said. “It’s been really tough.”

This article is part of “Faces of Medi-Cal,” a California Healthline series exploring the impact of the state’s safety-net health program on enrollees.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

Heat Rules for California Workers Would Also Help Keep Schoolchildren Cool

SACRAMENTO, Calif. — Proposed rules to protect California workers from extreme heat would extend to schoolchildren, requiring school districts to find ways to keep classrooms cool.

If the standards are approved this month, employers in the nation’s most populous state will have to provide relief to indoor workers in sweltering warehouses, steamy kitchens, and other dangerously hot job sites. The rules will extend to schools, where teachers, custodians, cafeteria workers, and other employees may work without air conditioning — like their students.

“Our working conditions are students’ learning conditions,” said Jeffery Freitas, president of the California Federation of Teachers, which represents more than 120,000 teachers and other educational employees. “We’re seeing an unprecedented change in the environment, and we know for a fact that when it’s too hot, kids can’t learn.”

A state worker safety board is scheduled to vote on the rules June 20, and they would likely take effect this summer. The move, which marks Democratic Gov. Gavin Newsom’s latest effort to respond to the growing impacts of climate change and extreme heat, would put California ahead of the federal government and much of the nation in setting heat standards.

The standards would require indoor workplaces to be cooled below 87 degrees Fahrenheit when employees are present and below 82 degrees in places where workers wear protective clothing or are exposed to radiant heat, such as furnaces. Schools and other worksites that don’t have air conditioning could use fans, misters, and other methods to bring the room temperature down.

The rules allow workarounds for businesses, including the roughly 1,000 school districts in the state, if they can’t cool their workplaces sufficiently. In those cases, employers must provide workers with water, breaks, areas where they can cool down, cooling vests, or other means to keep employees from overheating.

“Heat is a deadly hazard no matter what kind of work you do,” said Laura Stock, a member of the Occupational Safety and Health Standards Board. “If you have an indoor space that is both populated by workers and the public, or in this case by children, you would have the same risks to their health as to workers.”

Heat waves have historically struck outside of the school year, but climate change is making them longer, more frequent, and more intense. Last year was the hottest on record and schools across the U.S. closed sporadically during spring and summer, unable to keep students cool.

Scientists say this year could be even hotter. School officials in Vicksburg, Mississippi, last month ended the school year early when air conditioners had issues. And California’s first heat wave of the season is hitting while some schools are still in session, with temperatures reaching 105 in the Central Valley.

Several states, including Arizona and New Mexico, require schools to have working air conditioners, but they aren’t required to run them. Mississippi requires schools to be air-conditioned but doesn’t say to what temperature. Hawaii schools must have classrooms at a “temperature acceptable for student learning,” without specifying the temperature. And Oregon schools must try to cool classrooms, such as with fans, and provide teachers and other employees ways to cool down, including water and rest breaks, when the heat index indoors reaches 80 degrees.

When the sun bakes the library at Bridges Academy at Melrose, a public school in East Oakland with little shade and tree cover, Christine Schooley closes the curtains and turns off the computers to cool her room. She stopped using a fan after a girl’s long hair got caught in it.

“My library is the hottest place on campus because I have 120 kids through here a day,” Schooley said. “It stays warm in here. So yeah, it makes me grouchy and irritable as well.”

A 2021 analysis by the Center for Climate Integrity suggests nearly 14,000 public schools across the U.S. that did not need air conditioning in 1970 now do, because they annually experience 32 days of temperatures more than 80 degrees — upgrades that would cost more than $40 billion. Researchers found that same comparison produces a cost of $2.4 billion to install air conditioning in 678 California schools.

It’s not clear how many California schools might need to install air conditioners or other cooling equipment to comply with the new standards because the state doesn’t track which ones already have them, said V. Kelly Turner, associate director of the Luskin Center for Innovation at the University of California-Los Angeles.

And a school district in the northern reaches of the state would not face the same challenges as a district in the desert cities of Needles or Palm Springs, said Naj Alikhan, a spokesperson for the Association of California School Administrators, which has not taken a position on the proposed rules.

An economic analysis commissioned for the board provided cost estimates for a host of industries — such as warehousing, manufacturing, and construction — but lacked an estimate for school districts, which make up one of the largest public infrastructure systems in the state and already face a steep backlog of needed upgrades. The state Department of Education hasn’t taken a position on the proposal and a spokesperson, Scott Roark, declined to comment on the potential cost to schools.

Projections of a multibillion-dollar cost to state prisons were the reason the Newsom administration refused to sign off on the indoor heat rules this year. Since then, tens of thousands of prison and jail employees — and prisoners — have been exempted.

It’s also unclear whether the regulation will apply to school buses, many of which don’t have air conditioning. The Department of Industrial Relations, which oversees the worker safety board, has not responded to queries from school officials or KFF Health News.

Libia Garcia worries about her 15-year-old son, who spends at least an hour each school day traveling on a hot, stuffy school bus from their home in the rural Central Valley community of Huron to his high school and back. “Once my kid arrives home, he is exhausted; he is dehydrated,” Garcia said in Spanish. “He has no energy to do homework or anything else.”

The California Federation of Teachers is pushing state lawmakers to pass a climate-resilient schools bill that would require the state to develop a master plan to upgrade school heating and air conditioning systems. Newsom last year vetoed similar legislation, citing the cost.

Campaigns to cool schools in other states have yielded mixed results. Legislation in Colorado and New Hampshire failed this year, while a bill in New York passed on June 7 and was headed to the governor for approval. A New Jersey proposal was pending as of last week. Last month, a teachers union in New York brought a portable sauna to the state Capitol to demonstrate how hot it can get inside classrooms, only a quarter of which have air conditioning, said Melinda Person, president of New York State United Teachers.

“We have these temperature limits for animal shelters. How is it that we don’t have it for classrooms?” said Democratic New York Assembly member Chris Eachus, whose bill would require schools to take relief measures when classrooms and buildings reach 82 degrees. “We do have to protect the health and safety of the kids.”

Extreme heat is the No. 1 weather-related killer in the U.S. — deadlier than hurricanes, floods, and tornadoes. Heat stress can cause heatstroke, cardiac arrest, and kidney failure. The Centers for Disease Control and Prevention reported 1,600 heat-related deaths occurred in 2021, which is likely an undercount because health care providers are not required to report them. It’s not clear how many of these deaths are related to work, either indoors or outdoors.

California has had heat standards on the books for outdoor workers since 2005, and rules for indoor workplaces have been in development since 2016 — delayed, in part, because of the covid pandemic.

At the federal level, the Biden administration has been slow to release a long-awaited regulation to protect indoor and outdoor workers from heat exposure. Although an official said a draft is expected this year, its outlook could hinge on the November presidential election. If former President Donald Trump wins, it is unlikely that rules targeting businesses will move forward.

The Biden White House held a summit on school sustainability and climate change in April, at which top officials encouraged districts to apply an infusion of new federal dollars to upgrade their aging infrastructure. The administration also unveiled an 18-page guide for school districts to tap federal funds.

“How we invest in our school buildings and our school grounds, it makes a difference for our students’ lives,” Roberto Rodriguez, an assistant secretary at the U.S. Department of Education, said at the summit. “They are on the front line in terms of feeling those impacts.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

A miles de niños les hicieron pruebas de plomo con dispositivos defectuosos: qué deben saber los padres

Una empresa que fabrica pruebas para la detección de envenenamiento por plomo ha acordado resolver cargos criminales por haber ocultado durante años un mal funcionamiento que generó resultados bajos e inexactos.

Es el último capítulo de una larga saga que involucra a Magellan Diagnostics, con sede en Massachusetts, que pagará $42 millones en multas, según el Departamento de Justicia (DOJ).

Aunque muchos de los dispositivos propensos a fallas se utilizaron desde 2013 hasta 2017, algunos fueron retirados del mercado recién en 2021. El DOJ dijo que este mal funcionamiento produjo resultados inexactos para “potencialmente decenas de miles” de niños y otros pacientes.

Los médicos no consideran seguro ningún nivel de plomo en sangre, especialmente en niños.

Varias ciudades de Estados Unidos, incluyendo Washington, DC, y Flint, en Michigan, han luchado con una contaminación generalizada de plomo en sus suministros de agua en las últimas dos décadas, lo que hace que las pruebas precisas sean críticas para la salud pública.

Es posible que se hayan utilizado kits defectuosos de Magellan para analizar la exposición al plomo en niños hasta principios de la década de 2020, basándose en el retiro del mercado en 2021.

Esto es lo que los padres deben saber.

¿Cuáles pruebas eran defectuosas?

Los resultados inexactos provinieron de tres dispositivos de Magellan: LeadCare Ultra, LeadCare II y LeadCare Plus. Uno de ellos, el LeadCare II, utiliza principalmente muestras de punción en el dedo y representó más de la mitad de todas las pruebas de plomo en sangre realizadas en el país desde 2013 hasta 2017, según el DOJ.

A menudo se usaba en consultorios médicos para verificar los niveles de plomo en los niños.

Los otros dos también podían usarse extrayendo sangre de una vena y pueden haber sido más comunes en laboratorios que en consultorios médicos. La empresa “se enteró por primera vez de que un mal funcionamiento en su dispositivo LeadCare Ultra podría causar resultados inexactos de pruebas de plomo, específicamente, resultados de pruebas de plomo que eran falsamente bajos” en junio de 2013 mientras buscaba la aprobación regulatoria para vender el producto, dijo el DOJ.

Pero, según el acuerdo, no divulgó esa información y siguió comercializando las pruebas.

La agencia dijo que las pruebas de 2013 indicaron que el mismo defecto afectaba al dispositivo LeadCare II. Un retiro del mercado en 2021 incluyó la mayoría de los tres tipos de kits para pruebas distribuidos desde el 27 de octubre de 2020.

En un comunicado de prensa para anunciar la resolución, la empresa dijo que “los problemas subyacentes que afectaron los resultados de algunos de los productos de Magellan de 2013 a 2018 han sido completa y eficazmente solucionados” y que las pruebas que actualmente venden son seguras.

¿Qué significa un resultado “falsamente bajo”?

A menudo se realiza la prueba a los niños durante las visitas al pediatra al año y nuevamente a los 2 años. Los niveles elevados de plomo pueden poner a los niños en riesgo de retraso en el desarrollo, menor coeficiente intelectual y otros problemas. Y los síntomas, como dolor de estómago, falta de apetito o irritabilidad, pueden no aparecer hasta que se alcancen niveles altos.

Los resultados de pruebas falsamente bajos podrían significar que los padres y los médicos no eran conscientes del problema.

Eso es preocupante porque el tratamiento para la intoxicación por plomo es, al principio, principalmente preventivo. Los resultados que muestran niveles elevados deberían llevar a los padres y a los funcionarios de salud a determinar las fuentes de plomo y tomar medidas para prevenir una ingesta continua de este metal, dijo Janine Kerr, educadora de salud del Programa de Prevención de la Intoxicación por Plomo en la Infancia del Departamento de Salud de Virginia.

Los niños pueden estar expuestos al plomo de diversas maneras, incluyendo el consumo de agua contaminada con plomo de tuberías viejas, como en Flint y Washington; la ingestión de escamas de pintura a base de plomo que a menudo se encuentran en casas antiguas; o, como se informó recientemente, comiendo algunas marcas de puré de manzana con sabor a canela.

¿Qué deben hacer los padres ahora?

“Los padres pueden contactar al pediatra para determinar si su hijo tuvo una prueba de plomo en sangre con un dispositivo LeadCare” y discutir si es necesario repetirla, dijo Maida Galvez, pediatra y profesora en la Escuela de Medicina Icahn en Mount Sinai en Nueva York.

Durante un retiro anterior de algunos dispositivos de Magellan, en 2017, los Centros para el Control y Prevención de Enfermedades (CDC) recomendaron que se les hiciera otra prueba a los pacientes si estaban embarazadas, amamantando o eran niños menores de 6 años y tenían un nivel de plomo en sangre de menos de 10 microgramos por decilitro según lo determinado por un dispositivo Magellan de una extracción de sangre venosa.

El retiro de dispositivos Magellan en 2021 recomendó repetir la prueba a los niños cuyos resultados fueran inferiores al nivel de referencia actual de los CDC de 3.5 microgramos por decilitro. Muchas de esas pruebas eran del tipo de punción en el dedo.

Kerr, del Departamento de Salud de Virginia, dijo que su agencia no ha recibido muchas llamadas sobre ese retiro.

Las pruebas de punción en el dedo “no se utilizan tan ampliamente en Virginia”, explicó Kerr, agregando que “recibimos muchas preguntas sobre el retiro del puré de manzana”.

En cualquier caso, dijo, el “mejor curso de acción para los padres es hablar con un proveedor de atención médica”.

Thousands of Children Got Tested for Lead With Faulty Devices: What Parents Should Know

A company that makes tests for lead poisoning has agreed to resolve criminal charges that it concealed for years a malfunction that resulted in inaccurately low results.

It’s the latest in a long-running saga involving Massachusetts-based Magellan Diagnostics, which will pay $42 million in penalties, according to the Department of Justice.

While many of the fault-prone devices were used from 2013 to 2017, some were being recalled as late as 2021. The Justice Department said the malfunction produced inaccurate results for “potentially tens of thousands” of children and other patients.

Doctors don’t consider any level of lead in the blood to be safe, especially for children. Several U.S. cities, including Washington, D.C., and Flint, Michigan, have struggled with widespread lead contamination of their water supplies in the last two decades, making accurate tests critical for public health.

It’s possible faulty Magellan kits were used to test children for lead exposure into the early 2020s, based on the recall in 2021. Here’s what parents should know.

What tests were affected?

The inaccurate results came from three Magellan devices: LeadCare Ultra, LeadCare II, and LeadCare Plus. One, the LeadCare II, uses finger-stick samples primarily and accounted for more than half of all blood lead tests conducted in the U.S. from 2013 to 2017, according to the Justice Department. It was often used in physician offices to check children’s lead levels.

The other two could also be used with blood drawn from a vein and may have been more common in labs than doctor’s offices. The company “first learned that a malfunction in its LeadCare Ultra device could cause inaccurate lead test results – specifically, lead test results that were falsely low” in June 2013 while seeking regulatory clearance to sell the product, the DOJ said. But it did not disclose that information and went on to market the tests, according to the settlement.

The agency said 2013 testing indicated the same flaw affected the LeadCare II device. A 2021 recall included most of all three types of test kits distributed since October 27, 2020.

The company said in a press release announcing the resolution that “the underlying issues that affected the results of some of Magellan’s products from 2013 to 2018 have been fully and effectively remediated,” and that the tests it currently sells are safe.

What does a falsely low result mean?

Children are often tested during pediatrician visits at age 1 and again at age 2. Elevated lead levels can put kids at risk of developmental delay, lower IQ, and other problems. And symptoms, such as stomachache, poor appetite, or irritability, may not appear until high levels are reached.

Falsely low test results could mean parents and physicians were unaware of the problem.

That’s a concern because treatment for lead poisoning is, initially, mainly preventive. Results showing elevated levels should prompt parents and health officials to determine the sources of lead and take steps to prevent continued lead intake, said Janine Kerr, health educator with the Virginia Department of Health’s Childhood Lead Poisoning Prevention Program.

Children can be exposed to lead in a variety of ways, including by drinking water contaminated with lead from old pipes, such as in Flint and Washington; ingesting lead-based paint flakes often found in older homes; or, as reported recently, eating some brands of cinnamon-flavored applesauce.

What should parents do now?

“Parents can contact their child’s pediatrician to determine if their child had a blood lead test with a LeadCare device” and discuss whether a repeat blood lead test is needed, said Maida Galvez, a pediatrician and professor at the Icahn School of Medicine at Mount Sinai in New York.

During an earlier recall of some Magellan devices, in 2017, the Centers for Disease Control and Prevention recommended that patients be retested if they were pregnant, nursing, or children younger than 6 and had a blood lead level of less than 10 micrograms per deciliter as determined by a Magellan device from a venous blood draw.

The 2021 recall of Magellan devices recommended retesting children whose results were less than the current CDC reference level of 3.5 micrograms per deciliter. Many of those tests were of the finger-stick variety.

Kerr, at the Virginia health department, said her agency has not had many calls about that recall.

The finger-stick tests “are not that widely used in Virginia,” said Kerr, adding that “we did get a lot of questions about the applesauce recall.”

In any case, she said, the “best course of action for parents is to talk with a health care provider.”

White House Enlists Doctors and Hospitals To Combat Gun Violence

The White House is calling on hospital executives, doctors, and other health care leaders to take bolder steps to prevent gun violence by gathering more data about gunshot injuries and routinely counseling patients about safe use of firearms.

Biden administration officials are hosting back-to-back events Thursday and Friday at the White House for about 160 health care officials, calling gun violence a “public health crisis” that requires them to act.

The strategy also reflects a stark political reality: Congress has been deadlocked on most gun-related legislation for years, with a deep divide between Republicans and Democrats. If Democratic President Joe Biden wants to get anything done quickly, he will need to look outside the Capitol. He has already enlisted educators to talk to parents about safe gun storage and community workers to help at-risk youth.

“The president has been clear: This is a public health crisis. So, to solve it, we need the leaders from the health care sector,” Rob Wilcox, a deputy director of the White House Office of Gun Violence Prevention, told KFF Health News. “Those are the leaders that run the health systems and hospitals that we go to for treatment, and it’s those doctors, nurses, practitioners on the front lines.”

Health experts have long described gun violence as a public health crisis, one that disproportionately affects Black and Hispanic residents in poor neighborhoods.

In 2022, more than 48,000 people were killed by guns in the U.S., or about 132 people a day, and suicides accounted for more than half of those deaths, according to the Centers for Disease Control and Prevention. An additional 200-plus Americans are injured each day, according to estimates from Johns Hopkins University research.

Guns are the leading cause of death for children and teens.

Gun violence prevention advocates applauded the Biden administration for attempting to depoliticize the issue by focusing on its health impacts. The health-centric message also resonates with the public, said Fatimah Loren Dreier, executive director of the Health Alliance for Violence Intervention, who planned to attend the June 6 event.

“The idea that there can be a bipartisan-driven, apolitical way to address the gun violence problem has created tremendous opportunity,” she said.

But the initiative isn’t just about messaging. It’s about numbers and statistics. Relative to America’s other deadly threats — such as cancer, HIV, and automobile crashes — fewer federal dollars fund gun violence research, mostly because of politics.

In 1996, Congress cut federal funding for gun control research by the CDC, essentially shifting the responsibility for funding and conducting the research to the private sector and academia — and with a fraction of the previous budget. In 2019, Congress reversed course and has since agreed every year to allocate $25 million to the CDC and the National Institutes of Health for gun research, but public health experts say it’s not nearly enough. By comparison, roughly three times that amount was earmarked for research on the prevention and treatment of underage drinking in fiscal year 2023, and 10 times as much to Parkinson’s disease research.

Slashing CDC research funding for firearms created decades-long gaps in data — and hamstrung efforts to respond to the crisis, researchers and health officials say. For instance, there’s little government data available to researchers on firearms, even basic statistics such as firearm ownership by city and which guns are used in shootings.

More timely and comprehensive data could give researchers a better understanding of the trends behind gun violence — and the steps to take to prevent it, said Bechara Choucair, a senior vice president and the chief health officer at Kaiser Permanente, who planned to attend the June 6 White House event.

“Anytime you want to address a problem with a public health lens, you have to understand the data,” he said. “You have to understand the data at a granular level so you can design interventions and test interventions and see if it works or if it doesn’t work.”

The White House is asking state and local health departments, health systems, and hospitals to boost timely data collection on emergency room visits for firearm-related injuries to “support state and local jurisdictions in identifying and responding to emerging public health problems,” Wilcox said.

The goal is “to inform prevention efforts,” he said.

The data will cover fatal and nonfatal injuries. Existing CDC data focuses on deaths, while its data on injuries is limited. For instance, one person was killed in the Feb. 14 shooting at the Kansas City Chiefs Super Bowl victory parade, but the CDC data likely will not count the roughly two dozen other people who were injured.

Collecting more detailed data could be costly for hospitals, whose ERs see most gunshot injuries, said Garen Wintemute, an ER physician and the head of a violence prevention program at the University of California-Davis. Right now, hospitals gather medical information about gunshot wounds and usually don’t get into other details, such as what type of gun or ammunition might have been used.

It’s not clear exactly what data hospitals will be asked to collect.

“It’s an intensive process,” Wintemute said. “The clinicians are going to gather the data that they need in order to treat the patient, and that may not include all the data that a researcher later would want to know about what happened.”

Some of this data is already being collected on a limited basis. The CDC collects near-real-time reporting of gunshot injuries from ERs in about a dozen states. The White House wants data from across the nation.

Wilcox added that federal grant dollars are available to health systems to conduct gun data collection through the Bipartisan Safer Communities Act, which Biden signed in 2022.

This year, Biden asked Congress to again boost funding for CDC firearm research in his proposed fiscal 2025 budget, but his previous efforts have failed in the GOP-controlled House of Representatives.

Lawmakers have yet to release a draft of their spending proposal for the Department of Health and Human Services.

“We should focus our CDC resources on infectious diseases, transmittable diseases, and certainly chronic diseases rather than controversial, political-charged activities,” Rep. Robert Aderholt (R-Ala.) said of Biden’s 2024 funding proposal.

Surveys show most Americans — across political affiliations and regardless of gun ownership — support policies that could reduce violence.

At this week’s meetings with health leaders, White House officials will also encourage doctors to talk with patients and the public about gun safety and securing guns.

When Wintemute talks with patients in the ER, he sits beside them and asks about their safety and the safety of others in their home, a practice he said many doctors already use to address an array of potential risks in a person’s life. The White House’s call for physicians to talk about gun violence legitimizes that, he said.

“A health professional can do what we do about tobacco and alcohol and other sorts of potentially risky behaviors, and talk with patients about how do we minimize the risk,” Wintemute said.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

Urged on by LGBTQ+ Activists, California Cities Weigh Stricter Smoking Rules

California has long been at the forefront of the fight against smoking, but some local officials in the San Francisco Bay Area, backed by activists who are especially concerned about high rates of smoking in the LGBTQ+ community, are spearheading proposals to further restrict how tobacco is sold and where it is smoked.

In the city of Vallejo on the northeastern edge of San Pablo Bay, Council member Peter Bregenzer is leading an effort to crack down on smoke shops, which he says make it much too easy for children to smoke and vape. In Oakland, Council member Dan Kalb is weighing a new ordinance that would extend smoking bans to all apartment and condominium buildings, as well as bar patios.

The advocacy group LGBTQ Minus Tobacco, following a successful push in nearby Concord, is among the backers of the Vallejo ordinance, and is also pushing for San Francisco and Oakland to ban outdoor smoking at bars.

Joseph Hayden, a Vallejo resident and a volunteer with LGBTQ Minus Tobacco, said the time is right for the city to act.

“Some people have told me they’d ban it all — tobacco sales — if they could, like Manhattan Beach and Beverly Hills,” said Hayden, who is also a volunteer with Tobacco Free Solano. “We want to be sure this [ordinance] has teeth.”

Christina Lee, a spokesperson for Vallejo, said the City Council would likely vote on the measure this summer after a public notice period. The city held an informational workshop for tobacco retailers in February, notifying them by email, but no one attended, she added.

The National Association of Tobacco Outlets did not respond to requests for comment from KFF Health News.

California was the first state to ban smoking in all indoor public spaces and offices, in 1995, and later it raised the legal age for tobacco purchases to 21 from 18. In 2022, the state’s voters passed a ballot measure affirming a ban on flavored vapes, menthol cigarettes, and other products.

But antismoking activists want to see more action at the local level, especially when it comes to keeping cigarettes and vapes out of the hands of children. A strong push is coming from anti-tobacco campaigners in the LGBTQ+ community, which has higher rates of smoking than the population at large and historically has been a target of tobacco industry marketing.

One sore point is the notorious 1995 R.J. Reynolds effort called Project SCUM (Sub-Culture Urban Marketing) campaign, which was aimed at selling more cigarettes in San Francisco’s Castro district, a largely gay neighborhood, and in the low-income Tenderloin district.

The FDA has long recognized that certain populations, including the LGBTQ+ community, are more likely to smoke than others and has tailored public health messaging to those groups. From 2016 to 2020, the agency’s Center for Tobacco Products ran a tobacco prevention campaign that featured drag queens from the reality series “RuPaul’s Drag Race.”

However, in the 2023 California Youth Tobacco Survey, 11.4% of LGBTQ+ respondents reported current tobacco use, well above the 6.4% reported by non-LGBTQ+ respondents.

Research suggests that the pressures associated with belonging to a group that faces discrimination are likely a cause of the high smoking rates. A review of smoking studies in the journal LGBT Health recently found that “internalized queerphobia,” perceived stigma, and prejudice all increased the likelihood of cigarette use.

Smoking can also be caught up in the identity of LGBTQ+ people who associate it with the rejection of conventional mores, said Brian Davis, project director for LGBTQ Minus Tobacco.

“Queer young people may even connect queerness and smoking,” he said.

In Vallejo, Bregenzer, who is gay and said smoking killed his father, is motivated partly by a desire to protect the LGBTQ+ community. He’s also concerned about youth smoking, especially flavored vapes, which appeal to children and are illegal to sell in California but can often be found in smoke shops.

“Youth want to feel cool and fit in, and cherry- or grape-flavored tobacco products may mask the taste they don’t like,” he said.

Bregenzer’s proposed Tobacco Retail License ordinance would ban the sale of all vapes and all flavored products not covered by the state law, as well as 99-cent cigars. It would also require tobacco retailers to pay a yearly fee to be used for youth decoy operations and other enforcement mechanisms.

Vallejo’s smoking problem is apparent in the schools. Heena Bharti, a 10th grader who does not identify as LGBTQ+, said she’s seen vape smoke rise in the back of her classroom. She deftly brushes off pressure to vape with a “No thanks, I’m OK.”

Almost 31% of public schools in Vallejo are within 1,000 feet of a tobacco retailer, according to the February 2024 California Tobacco Health Assessment Tool. The 2021-22 California Healthy Kids Survey reported that 37% of Vallejo City Unified School District juniors said getting cigarettes was fairly or very easy, and 60% said that was true of e-cigarettes.

Bar patios are another frontier for local activists. Davis said more than 100 California cities, including Vallejo, already require bar patios to be smoke-free, and a top priority for his organization is to have San Francisco and Oakland join that group of cities.

“The tobacco industry uses bars to target queer people by offering event sponsorships, bar promotions, giveaways, coupons, and advertising,” Davis said.

Not everyone in the LGBTQ+ community is on board with the new rules. Tony Jasinski, board president of the San Francisco Gay Basketball League, called Davis’ push to make bar patios smoke-free a “nanny-state” proposal that didn’t consider the effect on businesses in a letter to the San Francisco Chronicle in December.

Jasinski told KFF Health News that such bans drive tourists away and send the message that “we are over-legislated against choice.”

Kalb, the Oakland Council member, doesn’t see it that way.

“It’s weird we already don’t allow smoking in outdoor seating areas of restaurants, but somehow if you’re just drinking, it’s OK?” he said.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

How a Friend’s Death Turned Colorado Teens Into Anti-Overdose Activists

Gavinn McKinney loved Nike shoes, fireworks, and sushi. He was studying Potawatomi, one of the languages of his Native American heritage. He loved holding his niece and smelling her baby smell. On his 15th birthday, the Durango, Colorado, teen spent a cold December afternoon chopping wood to help neighbors who couldn’t afford to heat their homes.

McKinney almost made it to his 16th birthday. He died of fentanyl poisoning at a friend’s house in December 2021. His friends say it was the first time he tried hard drugs. The memorial service was so packed people had to stand outside the funeral home.

Now, his peers are trying to cement their friend’s legacy in state law. They recently testified to state lawmakers in support of a bill they helped write to ensure students can carry naloxone with them at all times without fear of discipline or confiscation. School districts tend to have strict medication policies. Without special permission, Colorado students can’t even carry their own emergency medications, such as an inhaler, and they are not allowed to share them with others.

“We realized we could actually make a change if we put our hearts to it,” said Niko Peterson, a senior at Animas High School in Durango and one of McKinney’s friends who helped write the bill. “Being proactive versus being reactive is going to be the best possible solution.”

Individual school districts or counties in California, Maryland, and elsewhere have rules expressly allowing high school students to carry naloxone. But Jon Woodruff, managing attorney at the Legislative Analysis and Public Policy Association, said he wasn’t aware of any statewide law such as the one Colorado is considering. Woodruff’s Washington, D.C.-based organization researches and drafts legislation on substance use.

Naloxone is an opioid antagonist that can halt an overdose. Available over the counter as a nasal spray, it is considered the fire extinguisher of the opioid epidemic, for use in an emergency, but just one tool in a prevention strategy. (People often refer to it as “Narcan,” one of the more recognizable brand names, similar to how tissues, regardless of brand, are often called “Kleenex.”)

The Biden administration last year backed an ad campaign encouraging young people to carry the emergency medication.

Most states’ naloxone access laws protect do-gooders, including youth, from liability if they accidentally harm someone while administering naloxone. But without school policies explicitly allowing it, the students’ ability to bring naloxone to class falls into a gray area.

Ryan Christoff said that in September 2022 fellow staff at Centaurus High School in Lafayette, Colorado, where he worked and which one of his daughters attended at the time, confiscated naloxone from one of her classmates.

“She didn’t have anything on her other than the Narcan, and they took it away from her,” said Christoff, who had provided the confiscated Narcan to that student and many others after his daughter nearly died from fentanyl poisoning. “We should want every student to carry it.”

Boulder Valley School District spokesperson Randy Barber said the incident “was a one-off and we’ve done some work since to make sure nurses are aware.” The district now encourages everyone to consider carrying naloxone, he said.

Zoe Ramsey, a high school senior from Durango, Colorado, testified before state lawmakers in February 2024 about a bill to clarify that students may carry naloxone, a drug that can reverse opioid overdoses. (Rae Ellen Bichell/KFF Health News)

Community’s Devastation Turns to Action

In Durango, McKinney’s death hit the community hard. McKinney’s friends and family said he didn’t do hard drugs. The substance he was hooked on was Tapatío hot sauce — he even brought some in his pocket to a Rockies game.

After McKinney died, people started getting tattoos of the phrase he was known for, which was emblazoned on his favorite sweatshirt: “Love is the cure.” Even a few of his teachers got them. But it was classmates, along with their friends at another high school in town, who turned his loss into a political movement.

“We’re making things happen on behalf of him,” Peterson said.

The mortality rate has spiked in recent years, with more than 1,500 other children and teens in the U.S. dying of fentanyl poisoning the same year as McKinney. Most youth who die of overdoses have no known history of taking opioids, and many of them likely thought they were taking prescription opioids like OxyContin or Percocet — not the fake prescription pills that increasingly carry a lethal dose of fentanyl.

“Most likely the largest group of teens that are dying are really teens that are experimenting, as opposed to teens that have a long-standing opioid use disorder,” said Joseph Friedman, a substance use researcher at UCLA who would like to see schools provide accurate drug education about counterfeit pills, such as with Stanford’s Safety First curriculum.

Allowing students to carry a low-risk, lifesaving drug with them is in many ways the minimum schools can do, he said.

“I would argue that what the schools should be doing is identifying high-risk teens and giving them the Narcan to take home with them and teaching them why it matters,” Friedman said.

Writing in The New England Journal of Medicine, Friedman identified Colorado as a hot spot for high school-aged adolescent overdose deaths, with a mortality rate more than double that of the nation from 2020 to 2022.

“Increasingly, fentanyl is being sold in pill form, and it’s happening to the largest degree in the West,” said Friedman. “I think that the teen overdose crisis is a direct result of that.”

Gavinn McKinney died of fentanyl poisoning at a friend’s house in December 2021. McKinney was part of the Thunder Clan of the Citizen Potawatomi Nation. He also had Kickapoo and Assiniboine heritage. (Trennie Burch)

If Colorado lawmakers approve the bill, “I think that’s a really important step,” said Ju Nyeong Park, an assistant professor of medicine at Brown University, who leads a research group focused on how to prevent overdoses. “I hope that the Colorado Legislature does and that other states follow as well.”

Park said comprehensive programs to test drugs for dangerous contaminants, better access to evidence-based treatment for adolescents who develop a substance use disorder, and promotion of harm reduction tools are also important. “For example, there is a national hotline called Never Use Alone that anyone can call anonymously to be supervised remotely in case of an emergency,” she said.

Taking Matters Into Their Own Hands

Many Colorado school districts are training staff how to administer naloxone and are stocking it on school grounds through a program that allows them to acquire it from the state at little to no cost. But it was clear to Peterson and other area high schoolers that having naloxone at school isn’t enough, especially in rural places.

“The teachers who are trained to use Narcan will not be at the parties where the students will be using the drugs,” he said.

And it isn’t enough to expect teens to keep it at home.

“It’s not going to be helpful if it’s in somebody’s house 20 minutes outside of town. It’s going to be helpful if it’s in their backpack always,” said Zoe Ramsey, another of McKinney’s friends and a senior at Animas High School.

“We were informed it was against the rules to carry naloxone, and especially to distribute it,” said Ilias “Leo” Stritikus, who graduated from Durango High School last year.

But students in the area, and their school administrators, were uncertain: Could students get in trouble for carrying the opioid antagonist in their backpacks, or if they distributed it to friends? And could a school or district be held liable if something went wrong?

He, along with Ramsey and Peterson, helped form the group Students Against Overdose. Together, they convinced Animas, which is a charter school, and the surrounding school district, to change policies. Now, with parental permission, and after going through training on how to administer it, students may carry naloxone on school grounds.

Durango School District 9-R spokesperson Karla Sluis said at least 45 students have completed the training.

School districts in other parts of the nation have also determined it’s important to clarify students’ ability to carry naloxone.

“We want to be a part of saving lives,” said Smita Malhotra, chief medical director for Los Angeles Unified School District in California.

Gavinn McKinney’s mother, whose name is being withheld because they are part of a state confidentiality program for survivors of domestic violence, at the Colorado state Capitol for a hearing in February on a bill to clarify that students in the state may carry naloxone.( Rae Ellen Bichell/KFF Health News)

Los Angeles County had one of the nation’s highest adolescent overdose death tallies of any U.S. county: From 2020 to 2022, 111 teens ages 14 to 18 died. One of them was a 15-year-old who died in a school bathroom of fentanyl poisoning. Malhotra’s district has since updated its policy on naloxone to permit students to carry and administer it.

“All students can carry naloxone in our school campuses without facing any discipline,” Malhotra said. She said the district is also doubling down on peer support and hosting educational sessions for families and students.

Montgomery County Public Schools in Maryland took a similar approach. School staff had to administer naloxone 18 times over the course of a school year, and five students died over the course of about one semester.

When the district held community forums on the issue, Patricia Kapunan, the district’s medical officer, said, “Students were very vocal about wanting access to naloxone. A student is very unlikely to carry something in their backpack which they think they might get in trouble for.”

So it, too, clarified its policy. While that was underway, local news reported that high school students found a teen passed out, with purple lips, in the bathroom of a McDonald’s down the street from their school, and used Narcan to revive them. It was during lunch on a school day.

“We can’t Narcan our way out of the opioid use crisis,” said Kapunan. “But it was critical to do it first. Just like knowing 911.”

Now, with the support of the district and county health department, students are training other students how to administer naloxone. Jackson Taylor, one of the student trainers, estimated they trained about 200 students over the course of three hours on a recent Saturday.

“It felt amazing, this footstep toward fixing the issue,” Taylor said.

Each trainee left with two doses of naloxone.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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

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 feast of Our Lady of Guadalupe. 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 a growing number of teens who witness gun violence, traumatized and afraid to go outside without a gun.

Research shows that adolescents exposed to gun violence are twice as likely as others 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 far larger epidemic of gun violence — particularly among Black, Hispanic, and Native American youth — ensnaring some kids not even old enough to get a driver’s license.

Research shows that chronic exposure to trauma can change the way a child’s brain develops. 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 836 in 2019 to 1,150 in 2020.

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 teens are not driving the overall rise in gun violence, which has increased across all ages. In 2020, 7.5% of homicide arrests 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 Pittsburgh; Fulton County, Georgia; and Prince George’s County, Maryland — have debated or implemented youth curfews to curb teen violence. What’s not in dispute: More people ages 1 to 19 die by gun violence 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 sits on a chair in a hospital lobby. He wears a white doctor's coat and looks directly at the camera. The room is sunny and spacious.
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.(UChicago Medicine)

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 fully mature until age 25. Most young offenders “age out” 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 53,000 juveniles 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. Millions of American children — particularly Black, Hispanic, and Native American kids — live in environments plagued by poverty, violence, and drug use.

The covid-19 pandemic amplified all those problems, from unemployment to food and housing insecurity.

Although no one can say with certainty what spurred the surge in shootings in 2020, research has long linked hopelessness and lack of trust in police — which increased after the murder of George Floyd that year — to an increased risk of community violence. Gun sales soared 64% from 2019 to 2020, while many violence prevention programs 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 relatively small number of people.

The presence of even one supportive adult 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 stands at a reception desk in a medical building. He wears a white doctor's coat and gently smiles at the camera.
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.(UChicago Medicine)

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 “war zone mentality,” 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 constant fear 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 — including gang members — say they do so out of fear or to deter attacks, 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 Cure Violence Global, 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 plummeted 67% from 2006 to 2020, and 40 states have made it harder to charge minors as adults. States also are adopting alternatives to incarceration, 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.

Journalists Discuss Insulin Prices, Gun Violence, Distracted Driving, and More

Midwest KHN correspondent Bram Sable-Smith discussed the Eli Lilly news on insulin prices on “PBS NewsHour” and insulin prices on Slate’s “What Next” on March 1.

KHN contributor Andy Miller discussed Georgia’s legislative wrap-up including Medicaid work requirements on Georgia Public Broadcasting’s “Lawmakers” on Feb. 28. He also discussed health care for foster children on WUGA’s “The Georgia Health Report” on Feb. 3.

Senior KHN correspondent Julie Appleby discussed how the end of the public health emergency will affect costs for covid-19 vaccines, treatments, and masks on KMOX’s “Health Matters” on Feb. 25.

KHN correspondent Cara Anthony discussed the youngest victims of gun violence and those who dig their graves on America’s Heroes Group on Feb. 25.

KHN contributor Eric Berger discussed distracted driving laws and why Missouri still doesn’t have one on St. Louis Public Radio’s “St. Louis on the Air” on Feb 24.