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  • Jan 12 / 2017
  • 0
Budget, Congress, Health Care, Personal Finance, Public Health

Survey dissects U.S. healthcare spending over the decades

Diabetes, heart disease and back pain are the priciest ailments in the United States, a new survey has found. And the cost of healthcare is rising far faster than inflation.

The issue: Americans spend more on healthcare per capita than any other nation — roughly 10 times the global average, says the World Health Organization. The amount is growing. According to U.S. government figures, healthcare spending leapt 5.8 percent in 2015 – when inflation was 0.5 percent – to reach $3.2 trillion or an average of $9,990 per person. All told, healthcare accounts for 17.8 percent of the economy.

But little is known about exactly how the money is spent. A new survey seeks to shed light on the outlays, to determine how spending is changing over time, and to identify the most expensive ailments. Such information could help drive investments in new cures and help policymakers understand where to focus attention.

An academic study worth reading: “U.S. Spending on Personal Health Care and Public Health, 1996-2013,” in JAMA, December 2016.

Study summary: A team led by Joseph Dieleman of the University of Washington looked at 183 sources of nationally representative data (including government budgets, insurance claims, a variety of national surveys and the government’s National Health Expenditure Data) to examine spending on 155 conditions, including 29 types of cancer, from 1996 to 2013. They sought to comprehensively estimate personal and public healthcare spending by condition, age and gender, and type of care.

Dieleman and colleagues grouped spending into six categories: inpatient care, ambulatory care (visits to a doctor’s office and outpatient treatment at hospitals), emergency care, nursing facilities, dentistry and prescriptions. Other spending included over-the-counter medicines, medical devices and house calls.

For public health spending by the government, the researchers examined audited appropriations for the “four primary federal agencies providing public health funding: the Health Resources and Services Administration, the Centers for Disease Control and Prevention [CDC], the Substance Abuse and Mental Health Services Administration, and the U.S. Food and Drug Administration [FDA].”


  • The costliest illness in 2013 was diabetes. Spending on diabetes totaled an estimated $101.4 billion. Roughly 57.6 percent of this figure was spent on prescription pharmaceuticals. Between 1996 and 2013, spending on diabetes increased by 6.1 percent per year.
  • The second-costliest condition was heart disease, at $88.1 billion. About 56.5 percent of this spending was on inpatient care; 61.2 percent was spent on adults aged 65 years or older. Between 1996 and 2013, spending on heart disease increased an average of 0.2 percent annually.
  • Low back and neck pain was the third-highest category, at an estimated $87.6 billion – largely on ambulatory (outpatient/walk-in) care.
  • Of all conditions, those with the fastest increase in spending were autistic spectrum disorders (17.6 percent), Vitamin A deficiency (14.7 percent), high cholesterol (10.3 percent) and obesity (9.9 percent).
  • Personal health spending (money spent on individual care) in 2013 totaled $2.1 trillion.
  • The costliest cancers were colon and rectum cancers, at $18.5 billion. The cost increased by 2 percent per year between 1996 and 2013.
  • Females spent 24.6 percent more than males overall in 2013. Spending on females was greater than males for ages 15 to 64 and above age 74.
  • Excluding infants, spending per person generally increases with age.
  • Between 1996 and 2013 healthcare spending increased between 3 percent and 4 percent per year; spending on pharmaceuticals increased, on average, by 5.6 percent annually. (By comparison, average inflation during that period was 4 percent, according to the Federal Reserve Bank of Minneapolis.)
  • Personal health spending increased for 143 of 155 conditions between 1996 and 2013.
  • Personal health spending comprised 89.5 percent of total health spending in 2013. Other spending was largely federal support for organizations like the CDC and the FDA.
  • The three conditions that received the most federal health spending were HIV/AIDS ($3.5 billion), lower respiratory tract infections ($1.8 billion), and diarrheal diseases ($0.9 billion).

The authors’ table with data for all surveyed conditions can be found here.

Helpful resources:

A number of government and multilateral organizations publish data on health spending in the U.S., including the World Health Organization, the federal Centers for Medicare and Medicaid Services, the National Institutes of Health, the CDC’s National Center for Health Statistics, and the Department of Health and Human Services, which operates the Agency for Healthcare Research and Quality.

Other research:

Journalist’s Resource has profiled a range of papers on healthcare spending, including spending by the elderly, who pays for opioids, and why Americans pay so much more than people in countries with similar economies like Canada and the United Kingdom. For more, see our healthcare archives.

We also have a syllabus on healthcare reporting for journalists.


Keywords: hospitals, doctors, Obamacare, Medicaid, Medicare, health insurance, ER, emergency room

    • Jan 12 / 2017
    • 0
    Ads, Public Opinion, Public Health, Security, Military

    Who are gun owners and do they undergo background checks?

    Millions of Americans acquire their guns without undergoing a background check, but a new survey suggests the proportion may be falling.

    The issue: Almost 89 percent of Americans support criminal history background checks on gun buyers, but such investigations remain highly contested. Under the 1993 Brady Handgun Violence Prevention Act (known often as the “Brady Bill”), the check is required at gun stores across the United States. But individual states set their own laws about private transactions, including at gun shows (“the gun-show loophole”). Some states have closed those loopholes with legislation. Others have passed laws that further deregulate gun access; so-called “right-to-carry” or “open carry” laws allow people to arm themselves in public places, including on college campuses.

    Meanwhile, almost 16 million firearms entered circulation in the U.S. in 2013, according to the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF).

    A new study tries to determine how many were acquired after a background check.

    An academic study worth reading: “Firearm Acquisition Without Background Checks: Results of a National Survey,” in the Annals of Internal Medicine, 2017.

    Study summary: A team of researchers led by Matthew Miller at Northeastern University designed a nationally representative, online panel survey of gun owners to inquire when, where and how gun owners obtain their weapons. They also collected demographic information on gun owners and asked explicitly about background checks. Prior to this study, the last estimate was carried out in 1994; it found that approximately 40 percent of gun owners had acquired firearms without a background check.

    Miller and his colleagues conducted their survey in April 2015 and asked several follow-up questions in November 2015. All in all, they collected 1,613 qualified responses (active duty service members were ineligible). They coded individual exchanges and gun show purchases as private sales because they do not fall under the provisions of the Brady Bill.


    Background checks:

    • Background checks have become more common in the last two decades.
    • Of gun owners who acquired a weapon (including gifts and inheritance) within the two years before the study, 22 percent did so without a background check (compared with approximately 40 percent in the 1994 study).
    • Of gun owners in this study who acquired weapons across all time periods, 42 percent acquired their gun without a background check.
    • 13 percent of guns were purchased without a background check (these were largely bought from friends and family).
    • Of private sales (not in a shop), 50 percent of guns are acquired without a background check.
    • In states that require background checks during private sales, 26 percent of these buyers did not undergo one; in states that do not regulate private sales, 57 percent did not undergo a check.


    • 81 percent of gun owners are non-Hispanic white (non-Hispanic whites account for 63.7 percent of the total U.S. population, according to the 2010 census).
    • 7 percent of gun owners are African-American, while African-Americans make up 12.6 percent of the total U.S. population.
    • The U.S. region with the highest number of gun owners is the southeast (21 percent of all American gun owners; 19 percent of the total population). That includes Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, the District of Columbia and West Virginia.
    • 84 percent of gun owners describe themselves as politically moderate (40 percent) or conservative (44 percent). 14 percent describe themselves as liberal.
    • 72 percent of gun owners are male.
    • Most have a spouse or domestic partner (71 percent) and no children at home (73 percent).
    • 19 percent of gun owners are veterans (by contrast, 8.3 percent of adults are veterans)

    Helpful resources:

    The ATF explains how the Brady Bill works, including its temporary and permanent provisions. The Federal Bureau of Investigation (FBI) describes how its instant background checks work.

    The American gun debate is often heated, with advocates on both sides offering passionate opinions and competing data. The Gun Violence Archive is a non-profit organization that grew out of a project at Slate.com. It collates gun-violence statistics and claims to take no position on the issue. The National Rifle Association (NRA) is one of the most visible lobbies for gun ownership and is vocally against background checks.

    Other research:

    A 2013 survey published in the New England Journal of Medicine found 89 percent of Americans — including 84 percent of gun owners — support background checks during “all gun sales.”

    A 2015 study in the Annual Review of Public Health looks at efforts to keep guns out of the hands of “high-risk individuals” between 1999 and 2014 and specifically analyzes the so-called “gun-show loophole” in the Brady Bill.

    A 2013 study in JAMA Internal Medicine found a correlation between state firearm legislation and lower rates of gun deaths.

    A 2017 study in JAMA Internal Medicine modeled how epidemics of gun violence can spread like pathogens in violent communities.

    Journalist’s Resource has written about research on right-to-carry lawsbackground checks and mental illness, the online gun marketshooting spreescarrying weapons on campus and analyses of existing gun-control legislation.

    We also profiled a controversial 2016 study in The Lancet arguing that three firearm regulations in the spirit of the Brady Bill, if applied nationwide, could cut gun deaths in the U.S. by over 98 percent without any type of ban.


    Keywords: gun owners, right to bear arms, Second Amendment, gun-show loophole; universal background checks

      • Dec 19 / 2016
      • 0
      Reporting, Tip sheets

      Digital security tips for journalists: Protecting sources and yourself

      With hacking and other digital intrusions becoming a regular feature of life in the computer age, it’s more critical than ever for journalists to protect their sources. But for many, the tech world is intimidating. This tip sheet offers free resources for journalists of all digital-comfort levels as well as links to useful tutorials.

      Whether you are concerned about eavesdropping by the National Security Agency, Russian agents or a nefarious corporate leviathan, nothing is 100 percent secure. If you are meeting a confidential source in person, someone who may be risking his or her safety by speaking with you, don’t bring your phone or laptop. A hacker could track you through your phone using GPS and cell-phone networks or turn on the microphone or camera – even, possibly, when you think the phone is off. Security wonks praise paranoia.

      Instant communications: Of the many free instant messenger apps out there, Signal is widely used by rights activists and journalists. According to the Electronic Frontier Foundation (EFF), a digital and free-speech activist group:

      Signal is an app available on both iOS and Android that offers strong encryption to protect both text messages and voice calls. This type of protection is called end-to-end encryption, which secures your communications in transit. Other apps, such as WhatsApp, have implemented underlying cryptography. But we believe Signal is the better option because it implements best practices for secure messaging. […]

      Recently, a grand jury in the Eastern District of Virginia issued a subpoena to Open Whisper Systems, the maintainers of Signal. Because of the architecture of Signal, which limits the user metadata stored on the company’s servers, the only data they were able to provide was ‘the date and time a user registered with Signal and the last date of a user’s connectivity to the Signal service.’

      Encryption: Full-disk encryption scrambles your data so that even if the device (your laptop hard drive, for example) is stolen or seized, the material on your computer cannot be read without the password. So, you need a strong password. Apple and Windows offer built-in encryption, but it needs to be turned on. There are also third-party applications available. Here are some step-by-step instructions from the University of California at San Francisco and The Intercept.

      Install an “HTTPS Everywhere” plug-in for your browser, which encrypts your traffic and makes your browsing more secure.

      A popular way to encrypt email is the PGP protocol (“Pretty Good Privacy”), though some experts are starting to abandon it. For Columbia Journalism School, tech reporter Tiffany Hsu describes an alternative, known as OTR, in an excellent tip sheet that also discusses other encryption protocols:

      This protocol, which stands for Off The Record, attaches to instant messaging programs and allows for confidential, encrypted and authenticated discussions. This is not the same thing as the off-the-record function available through Google Chat. OTR is built on a concept called perfect forward secrecy — it creates encryption keys throughout a conversation, making it impossible to retrieve old messages. It’s almost like having a face-to-face conversation. OTR only works if both chat participants have it enabled. Mac users can access OTR via Adium (download it here), while Windows users can get it via Pidgin (here).

      Hsu also suggests that users “look for systems with true end-to-end protection, where the service provider can’t circumvent the shields. It’s also a good sign if the programming is open-source, so the developer community can identify and fix potential flaws.”

      Finally, back up your data on an external, encrypted hard drive and store it somewhere (physically) safe.

      Strong passwords and two-factor authentication: A number of services such as Google, Dropbox and Amazon support two-factor authentication (“2FA”), which requires users to complete an extra step to login. In addition to using a username and password, you’ll also input a random, one-time code sent to a second device, like your cell phone. This makes it much harder for an unauthorized person to access your account.

      Use strong passwords (the kind including symbols like $*&@!<) and don’t use them in more than one place. If it’s too hard to remember them all, consider using a password manager like 1Password or LastPass. But nothing is completely secure: Some experts suggest not using a manager for the most sensitive accounts, like your email and bank.

      Searching safely: For the safest browsing experience you can use the free Tor browser. Tor conceals users’ online addresses, its makers say, “bouncing your communications around a distributed network of relays run by volunteers all around the world: it prevents somebody watching your Internet connection from learning what sites you visit, it prevents the sites you visit from learning your physical location” and it allows you to visit blocked websites. It does not need to be installed and can be opened from a flash disk. See this Lifehacker guide to getting the most out of Tor.

      This interactive chart from EFF shows how Tor and HTTPS work. British blogger Paul Bradshaw has explained how governments snoop and why Tor is as important as ever.

      Keep your software up-to-date: Software updates often fix bugs and holes that have only recently come to light.

      Cover your webcam with a band aid or tape: Your webcam or videoconferencing equipment could be hacked. Don’t believe it? Read this story in The New York Times.

      Helpful organizations:

      Other resources from JR:

      Journalist’s Resource spoke with cryptographer Bruce Schneier in 2016 about the hacking and cyberattacks that roiled that year’s presidential campaign. Schneier’s blog is also a useful resource.

      ProPublica’s Julia Angwin — author of Dragnet Nation: A Quest for Privacy, Security and Freedom in a World of Relentless Surveillance — gave a comprehensive 2014 talk on her security tips here.

        • Dec 16 / 2016
        • 0
        Ecology, Environment, Pollution, Transportation

        Lead emissions from planes may be costing billions in lost earnings

        Airplanes are now the largest source of lead pollution in the United States. A new study suggests Americans hurt by lead exposure may be suffering billions in lost wages.

        The issue: Decades of research have shown how lead correlates with aggressive behavior, lower intelligence, learning problems in children and lower earnings later in life. Cars used leaded gas until the Environmental Protection Agency (EPA) mandated it be phased out in the 1980s. Federal law banned lead in house paint in 1978. Scientists have not identified any safe amount of lead in children’s bloodstream.

        Some researchers believe that the fall in murders in the 1990s is associated with the declining use of lead over the previous 20 years, that fewer children exposed to lead in the early 1980s meant a smaller number of violent young people hitting the streets in the 1990s.

        Nowadays, we often speak about lead when there’s a big story – like the Flint water crisis or the traces found in small-town armories that are used as sports facilities. But across the country, lead remains a persistent concern – in our air.

        Most commercial airplanes use unleaded jet fuel. But piston-driven aircraft – generally small propeller planes – use aviation gasoline (“avgas”), which contains lead to prevent a chance of sudden engine failure. That’s 167,000 planes in the United States, according to the Federal Aviation Administration (FAA). Avgas is the only transportation fuel still used in the U.S. that contains lead. Fuel manufacturers have experimented with lead-free avgas for decades, but have yet to bring such a fuel to market. The FAA intends for most aircraft to use an unleaded replacement by 2018.

        An academic study worth reading: “Cost of IQ Loss from Leaded Aviation Gasoline Emissions,” in Environmental Science and Technology, 2016.

        Study summary: Philip J. Wolfe and his colleagues at MIT look at the amount of leaded avgas used in the continental U.S. in 2008 (248 million gallons) to calculate aviation-attributable lead concentrations in the atmosphere. With those amounts, they calculate the IQ impact on children and then estimate, when those children grow up, the economic impacts from their lower IQs.

        Based on government earnings data, they determine a static estimate (the net present value of future earnings reductions) and a dynamic estimate (the impacts of the children’s IQ loss on the economy as a whole). Overall, Wolfe and his colleagues examine three cases based on different airborne lead-exposure levels, offering a broad range of dollar figures and insight into the marginal costs of lead exposure.


        • At current average airborne-lead levels caused by the planes, the average cost to the American economy is $1.63 billion annually (calculated with a 3 percent discount rate over 15 years). That is the value in lost productivity.
        • To American individuals suffering lower IQ from lead exposure, the annual cost in lost wages is a combined $1.06 billion. (Some of the researchers’ models put the total figure as high as $11.3 billion.)
        • Avgas is responsible for “a wide dispersion of low concentrations of fine particulate lead emissions.” 
        • Airborne lead particles fell 94 percent between 1980 and 2013 as lead was phased out of automobile gasoline.
        • Relative to gasoline, aviation fuel was an “insignificant source” of airborne lead during the 1960s and 1970s, when driving cars with leaded fuel peaked. Today — along with lead dust in soil from the period of peak leaded driving, as well as residual lead paint — aviation fuel is one of the most significant sources of lead.

        Other research:

        Among the many papers testing the relationship between lead and aggressive crime is this 2016 study in Environmental Health.

        A 2013 EPA study, the Integrated Science Assessment for Lead, reviews the vast research on airborne lead exposure and the history of American efforts to remove the element entirely from the environment.

        Several papers have looked at the economic benefits that seem to be correlated with the elimination of lead from gasoline.

        Water packaged in glass bottles contains 26-57 times more lead that waters bottled in plastic, though those lead levels are still far below amounts allowed in Europe and North America, according to a 2012 study in Environmental Health Perspectives. 

        A widely cited 2003 paper found children more sensitive than adults to the negative health effects of lead.

        Journalist’s Resource looked at the physiological effects of lead poisoning and American health policy in light of the Flint emergency that started in 2014 and caught national attention in 2016.

        Other resources: 

        The FAA hosts data on general aviation, airport and fuel use, and industry forecasts. This 2013-2033 forecast includes data on the future consumption of leaded avgas.

        The Aircraft Owners and Pilots Association (AOPA) is a large advocacy and education organization for pilots.


        Keywords: neurotoxicity, poisoning, lead, inequality, children, pollution

          • Dec 16 / 2016
          • 0
          Criminal Justice, Inequality, Public Health

          Neighborhood crime linked to premature birth, low birthweights for babies

          Living in a crime-prone neighborhood can be stressful. Researchers in Scotland have found a link with premature births and low birthweights.

          The issue: A woman’s health has a well-documented impact on her unborn child. Stress in an expectant mother is associated with low birth weight and premature birth – two outcomes that can lead to lifelong challenges for children. Researchers have also shown that being surrounded by crime can be stressful. So, what does living in a high-crime neighborhood during pregnancy mean for the fetus?

          An academic study worth reading: “Living in Stressful Neighborhoods During Pregnancy: An Observational Study of Crime Rates and Birth Outcomes,” in The European Journal of Public Health, 2016.

          Study summary: Researchers at the University of Edinburgh, in Scotland, hypothesize that high levels of crime in the mother’s neighborhood during pregnancy will negatively impact the child’s birthweight.

          Tom Clemens and Chris Dibben use the nationally representative Scottish Longitudinal Study, which includes census data and health profiles, for the births of single children (as opposed to twins) between 1994 and 2008. They select data on births that include the mother’s postal code. They also use crime data (including violence, theft, vandalism and drug-related crimes) collected by local police matched to 6,505 postal codes.

          They are interested in the impact of crime because, unlike a tragedy such as a typhoon or a terrorist attack, being exposed to crime is usually chronic, affecting the entire pregnancy.

          Because there are so many factors that could influence a baby’s size at birth  – including low family income, which is sometimes associated with living in higher-crime neighborhoods – the authors adjust for socio-economic factors, including income, education, whether the mother was single and whether she lived, while pregnant, in a region with elevated pollution levels.


          • Babies born in the areas of Scotland with the highest crime rates are, on average, 90 grams (about 3.2 ounces) smaller than babies born in areas with the lowest crime. Babies born in these areas are 119 percent more likely than their counterparts in the areas with lowest crime to have a low birthweight.
          • After adjusting for confounding factors – such as pollution and ethnicity – the authors found an absolute reduction in average birthweight of 62 grams.
          • Crime is associated with “large and significant reductions” in birthweight and increased risks of premature birth. This was found after controlling for individual characteristics such as smoking, ethnicity and pollution.
          • Low birthweight and slower fetal development are highly associated with crime. Premature birth is not.
          • Environments with high crime “elicit heightened fear” on a chronic basis. This “should be seen as a public health concern alongside the more obvious direct experience of drug use or physical assault.”

          Helpful resources:

          • The U.S. Census Bureau publishes extensive demographic data.
          • The Bureau of Justice Statistics provides “information on crime, criminal offenders, victims of crime, and the operation of justice systems at all levels of [the U.S.] government.”
          • Data on crime in England and Wales is available from the United Kingdom’s Office of National Statistics.

          Other research:

          • The negative impact of stress from living in a high-crime area is the focus of this 2015 paper in Social Science and Medicine.
          • A 2008 paper in the Annals of Epidemiology looks at crime rates to explain low birthweights among minority children in North Carolina.
          • This 2001 paper and this 2009 paper look at how fear of crime is associated with poorer health.
          • A 2012 paper in Social Science and Medicine examines low birthweights among babies in an ethnic group targeted during Kenya’s bout of political bloodletting in 2007.
          • The County of Los Angeles sponsored research in 2010 that looked at higher rates of pregnancy complications in areas with more crime.


          Keywords: pregnancy, maternity, stress, environment, criminal justice, fear


            • Dec 15 / 2016
            • 0
            Criminal Justice, Education, Public Health

            Student bullying on school buses: Comparing teen boys and girls

            Teenage boys who take the bus to school have a greater chance of being bullied than those who use other types of transportation, according to a recent study that also suggests girls generally are more likely to be bullied than boys.

            The issue: Bullying has long been a problem in schools in the United States. But campus administrators have become more aggressive in their attempts to control bullying in recent years, as research has confirmed a link between bullying and poor mental health and the media has forced a national spotlight on student violence.

            Brandy Vela, a high school senior from Texas, is among the latest in a series of bullying victims who have taken their own lives. In late 2016, Congressman Matt Cartwright of Pennsylvania introduced a bill requiring U.S. schools to begin tracking and publishing quarterly reports on bullying among their students.

            A study worth reading: “School Bus Travel is Associated with Bullying Victimization among Canadian Male, but not Female, Middle and High School Students,” published in Child Abuse & Neglect, 2016.

            Study summary: A study led by Hugues Sampasa-Kanyinga, an epidemiologist at Ottawa Public Health in Canada, looks at the relationship between bullying and the type of transportation children use to get to and from school. He and his colleagues analyzed a sample of 10,272 students in grades 7-12 who attended Canadian public schools and participated in the 2013 Ontario Students Drug Use and Health Survey. As a part of the survey, students were asked a range of questions, including how they usually travelled between school and home and how often they were bullied. The authors note that their study is the first to investigate the relationship between school travel and reports of bullying among middle school and high school students.

            Key takeaways:

            • School bullying is common. One-fourth of students (24.7 percent) reported they had been bullied in the past 12 months.
            • Girls were more likely than boys to be bullied. About 27 percent of girls reported being bullied compared to about 22 percent of boys.
            • Low-income students – especially low-income girls — were more likely to report being bullied than children with higher family incomes. Students whose parents did not go to college were more likely to be bullied than students whose parents had some level of college education. About 34 percent of girls whose parents did not go to college reported being bullied compared to about 23 percent of boys.
            • For boys, traveling on a school bus was associated with a greater likelihood of being bullied. More than 29 percent of boys who rode the bus home from school reported being bullied compared to 16 percent of boys who traveled home in a car, 24 percent who took public transportation and 20 percent who walked or rode bikes.
            • For girls, walking or riding a bike to school was associated with a higher chance of being bullied. Almost 33 percent of girls who walked or rode bikes reported bullying compared to 31 percent who took the bus, 24 percent who traveled by car and 19 percent who used public transportation.

            Helpful resources for journalists:

            • The National Center for Education Statistics (NCES) publishes data on bullying, broken down by the type of bullying experienced by students. A 2015 NCES report shows that 21.5 percent of students aged 12 to 18 reported being bullied in 2012-13 and another nearly 7 percent reported being the victims of cyberbullying either on campus or off campus.
            • Stopbullying.gov, a website managed by the U.S. Department of Health & Human Services, offers information on bullying, including tips for identifying children who are at risk of being bullied and those who are more likely to be bullies.
            • A 2013 report from the Congressional Research Service looks at, among other things, state anti-bullying legislation and the effectiveness of anti-bullying programs.

            More research on this topic:


            Keywords: cyberbullying, crime, school violence, anti-bullying, bus stop, zero tolerance

              • Dec 15 / 2016
              • 0
              Education, Gender, Health Care, Public Health

              First national survey of lesbian, gay and bisexual teens finds risky behavior

              There are almost 1.3 million lesbian, gay, and bisexual (LGB) high school students in the United States, according to the first nationwide survey measuring their numbers and attitudes toward risk. These students – about 8 percent of the total – are nearly five times more likely than their straight peers to have attempted suicide and more than four times more likely to have experimented with hard drugs like heroin and meth.

              Another half a million high school students are not sure about their sexual orientation, according to the study by the U.S. Centers for Disease Control and Prevention (CDC). Several of the study’s authors flagged the survey in JAMA, the journal of the American Medical Association. They used a nationally representative sample of 15,624 public and private high school students in grades nine through 12 who completed an anonymous and voluntary questionnaire. According to their write-up in JAMA:

              “Compared with their straight peers, LGB students reported a significantly higher prevalence of being bullied at school (34.2 percent vs 18.8 percent), experiencing electronic bullying (28.0 percent vs 14.2 percent), being forced to have sexual intercourse (17.8 percent vs 5.4 percent), experiencing physical dating violence (17.5 percent vs 8.3 percent), and experiencing sexual dating violence (22.7 percent vs 9.1 percent). Students who were not sure of their sexual identity also reported higher rates of all of these behaviors than their straight peers.”

              Nationwide, the CDC found, “88.8 percent of students identified as heterosexual, 2.0 percent identified as gay or lesbian, 6.0 percent identified as bisexual, and 3.2 percent were not sure of their sexual identity.” The survey was conducted between September 2014 and December 2015 and measured 118 risky behaviors in total, such as whether students catch rides with drivers who have been drinking (over 20 percent of all students report they had done so at least once over the previous 30 days).

              Of students who had driven a car in the previous 30 days, those unsure about their sexual identity are twice as likely to report having driven under the influence of alcohol (16.7 percent).

              Gay, lesbian and bisexual students are more likely to engage in many of the risky behaviors the CDC measured. Though they are less likely than straight students to carry a firearm in public, they are more likely to carry a weapon to school (6.2 percent) and twice as likely to have tried marijuana before age 13 (13.9 percent). They are also more than twice as likely to skip school out of safety concerns (12.5 percent) and almost twice as likely to have been threatened with a weapon at school (10 percent).

              Other related resources:

              Journalist’s Resource has reviewed research on the effects of same-sex parents on a child’s adult outcomes, the needs of homeless youth who are sexual minorities, and, following the 2016 Orlando gay nightclub shooting, on anti-gay sentiment.


              Keywords: LGBT, gay, lesbian, bisexual, teenagers, transgender, sexuality, depression, health

                • Dec 13 / 2016
                • 0
                Environment, Finance, Lobbying, Pollution, Public Health, Sustainability

                The good and the bad of plastic bag bans: Research review

                Plastic bags kill wildlife, clog waterways and pack landfills. Discarded bags can spread malaria if they collect rainwater, offering mosquitos a casual breeding ground. In recent years, local and national governments have begun phasing out or banning lightweight plastic shopping bags. But alternatives are not necessarily greener: People buy more plastic trash bags when shopping bags are unavailable. And a British government study found single-use paper bags contribute more toward global warming than plastic bags.

                Not so straightforward:

                For some activists, the effort to reduce the use of plastic shopping bags is both urgent and too late. According to a 2008 estimate in Waste Management, people around the world discard between 500 billion and 1 trillion plastic bags a year. The National Oceanic and Atmospheric Administration (NOAA) lists single-use plastic bags as a major contributor, along with food wrappers and fishing nets, to the Great Pacific Garbage Patch — vast, shifting waves of trash that often arrive via storm drains and rivers and can entangle marine life or be ingested. According to a 2014 estimate published in PLOS ONE, more than 5 trillion pieces of plastic (not all from bags) weighing a combined 250,000 tons are floating in the world’s oceans.

                Yet substitutes also offer cause for concern. A comprehensive 2011 study by the British environmental agency argued that plastic bags are greener than many alternatives. A paper bag must be used four or more times “to reduce its global warming potential to below” that of conventional plastic bags. The reason is that paper production — from the felling of trees to the emissions and effluent from paper factories — is dirty. The study found “no significant reuse of paper bags,” not even as trash-can liners.


                With a referendum in November 2016, California became the first state to ban single-use plastic bags, according to the National Conference on State Legislatures, which keeps an active list of American laws. Thicker, reusable bags are still available for purchase for 10 cents. Before California, cities often organized the bans: In 2016, for example, Cambridge became the first Massachusetts city to ban plastic bags altogether and require merchants to offer paper bags for a fee of no less than 10 cents. By contrast, Missouri’s legislature in 2015 forbid cities and counties in the state from enacting plastic bag bans.

                The European Union passed legislation in 2015 aiming to cut plastic bag use in half by 2019 and half again by 2025. E.U.-member France went further, banning single-use plastic bags on July 1, 2016, and phasing in other, more restrictive bans in the upcoming years – including the prohibition of plastic cooking utensils by 2020.

                Do these bans work? They do appear to reduce the number of shopping bags used, but the effect on demand for (potentially pernicious) alternatives is unknown.

                • Five years after Ireland instituted a 15 Euro cent levy on plastic bags in 2002 – Irish stores had been giving out 1.2 billion each year for free – a paper published in Environmental and Resource Economics suggested a 90 percent reduction in use.
                • One year after its ban San Jose reported “a reduction in bag litter of approximately 89 percent in the storm drain system, 60 percent in the creeks and rivers, and 59 percent in city streets and neighborhoods.”
                • Researchers at Cardiff University, in the United Kingdom, found that a fee for plastic bags introduced in October 2015 has led to a sharp decline in the number of shoppers who take single-use bags at checkout, from 25 percent to 7 percent after one year.
                • China, which banned many types of plastic bags in 2008, claims some successes. But some reports suggest the rule has been difficult to enforce.

                Academics have measured consumer behavior and public opinion on plastic bags in many countries, including Turkey, Uganda and Canada. A 2016 study in Social Marketing Quarterly examines how shoppers respond to different incentives for bringing their own shopping bags – such as avoiding a fee or paying a tax – and remarks “that a penalty framed as a tax may be more effective in motivating shoppers to bring reusable bags.”

                “Biodegradable” plastic bags:

                In 2010, raw plastics production in the U.S. used the energy and natural gas equivalent of 172 million barrels of oil, government figures suggest. But some newer plastics are made from vegetable matter, allowing manufacturers to claim their plastics are biodegradable. In theory, that means these plastics can be used to feed bacteria that convert them into water, carbon dioxide and biological matter. But the process rarely works in a landfill – these products need to be composted with the right microbes. When they’re not, they may not break down at all or can release methane, a greenhouse gas. So-called starch-polyester bags, made from a blend of vegetable matter and synthetic plastics, had the highest global warming impact in the 2011 study conducted by the British environmental agency “due to the high impacts of raw material production, transport and the generation of methane from landfill[s].”

                The European Union hosts an online forum to discuss biodegradable plastic bags.

                Researchers have looked into the policy challenges of biodegradable plastics, how they break down in the ocean and wider environmental impacts.

                Our health:

                Besides assuming a deviant place in marine ecosystems, there are concerns about the synthetic compounds in plastic that may be oozing into our food. One of the main building blocks of plastics, bisphenol A (also known as BPA), has been shown to stimulate breast cancer cells and damage the quality of rat sperm. Phthalates are another subject of disquiet.


                Another plastic causing concern is the microbeads found in some exfoliating facial scrubs and toothpastes, which are rinsed down drains into rivers, lakes and oceans. A 2015 study in the Marine Pollution Bulletin estimated that between 4,594 and 94,500 microplastic particles pass into the sewer during each use (between 16 and 86 metric tons annually in Britain alone). A forthcoming study in Chemosphere finds that microbeads do not accumulate in the gut when fed to goldfish, though both studies recognize their chemical effect in the food chain is unknown. In 2015, President Obama signed the Microbead-Free Waters Act to ban microbeads in hygienic products, though they continue to be used in other countries.

                Arguments for plastic:

                Proponents of plastic bags argue that they are hygienic and cheap and preserve foods that would otherwise spoil. A number of lobbies have worked to confound legislation that would reduce the availability of plastic bags. In California, for example, The Washington Post found that the American Progressive Bag Alliance – a Washington-based group run by a plastics lobby – spent over $3 million in the fourth quarter of 2014 to oppose California’s attempts then to legislate a ban.

                Plasticfilmrecycling.org (a project of the American Chemistry Council) is supported with funds from large multinationals like Dow Chemical and ExxonMobil. Some organizations – such as the Plastics Industry Association, which directs visitors to the American Progressive Bag Alliance and bagtheban.com — support recycling as a solution, rather than less plastic.

                Plastic shopping bags are widely reused as trash-can liners, the British environmental agency study points out. When they are banned, the study adds, consumers purchase more plastic trash bags: “The reuse of conventional HDPE [plastic] and other lightweight carrier bags for shopping and/or as bin-liners is pivotal to their environmental performance and reuse as bin liners produces greater benefits than recycling bags.”

                Anti-plastic lobbying and activism:

                The California plastic bag ban received support from the California Grocers Association. Grocery stores stood to benefit because the law mandated they charge 10 cents for reusable bags.

                Other resources:

                • This 2011 E.U. study shows, among other things, that residents of eastern E.U. members and Portugal use the most plastic bags in the union.
                • Journalist’s Resource profiled a 2016 paper on gender stereotypes and environmentally friendly behavior that found some people think recycling is feminine.
                • A 2015 paper in the Journal of Marketing found that people who bring reusable grocery bags on their shopping trips may purchase more junk food.
                • NOAA has fact sheets on microplastics in the ocean and plastic marine debris.


                Keywords: Trash, pollution, waste, plastics, regulations, petrochemicals, chemical lobby

                  • Dec 13 / 2016
                  • 0
                  Health Care, Public Health, Tip sheets

                  Mining census data to better cover the health-gap story: A tip sheet from AHCJ

                  This journalism tip sheet was created by Susan Heavey, a health care reporter and former fellow at the Knight Science Journalism Program at MIT. Heavey now works for the Association of Health Care Journalists (AHCJ) as its core topic leader on social determinants and disparities in health.

                  We are reprinting this AHCJ tip sheet with permission.


                  If you are covering the social determinants of health care, chances are you will need some data on areas such as income and gender that can influence health. One place to find everything from the number of doctors in a particular part of the country to demographic information on veterans is the U.S. Census Bureau. This federal agency culls data not only from the U.S. Census taken every 10 years but also from a host of other more frequent surveys.

                  The bureau’s American Fact Finder tool lets users search for a specific set of characteristics for a particular community such as housing, income, poverty and race. It also offers various maps, charts and other visual data.

                  Experts there also routinely sift through the data to spot changes and point out other interesting finds that could help spark coverage ideas or help reporters dig deeper into any trends. Some recent examples include a look at income changes among women aged 15 to 50 who recently gave birth and Florida’s Sumter County, which is the “oldest” by population in the United States.

                  Here are some other health data from Census that you can use to cover health disparities:

                  Health insurance

                  • Each September, the Census Bureau releases its national data on health insurance coverage, including the number of uninsured and how coverage breaks down by private and government coverage. The figures are released in conjunction with statistics on poverty and median income, all for the previous calendar year.

                  Small Area Health Insurance Estimates: The SAHIE are model-based estimates of health insurance coverage for counties and states. It also includes an interactive search tool to drill down even further within a county by age, race, sex and income. It is considered the only source of single-year health insurance coverage estimates for all U.S. counties.


                  The U.S. Census Bureau offers data beyond the nation’s population. It has statistics on everything from health insurance and disability to veterans and HIV/AIDS. This map shows the proportion of doctor’s offices across the country. Source: “Number of People per Doctor’s Office by County and Counties with No Doctor’s Offices,” U.S. Census Bureau.


                  You can use the American Fact Finder to search for specific demographics and locations, but Census also pulls together data on income and income inequality, and a host of other population traits such as age, gender, race and more. There is also data on education and family living arrangements.

                  Fertility, births and deaths

                  • The Census Bureau uses birth data from the National Center for Health Statistics and state departments of vital statistics for its population estimates and projections
                  • Fertility of Women in the United States Tables Via 2014 American Community Survey: The Census Bureau releases new tables showing household income distributions for different subsets of women ages 15 to 50, focusing on trends for women with a birth in the previous 12 months.
                  • Family Planning Centers.

                  Other census data

                  • Disability: Census uses two surveys to estimate the number of people with disabilities in the United States. It breaks its data down by those who are school-aged and working age as well as employment and income among those with disabilities.
                  • HIV/AIDS Surveillance Data Base: “is a compilation of information from widely scattered small-scale surveys on HIV infection and the AIDS pandemic in population groups in developing countries. The database brings together information from medical and scientific literature, presentations at international conferences, and the press. Users can retrieve information for groups in a selected country, and print or save it to a .pdf or .csv file. The HIV/AIDS Surveillance Data Base includes all countries and areas of the world with at least 5,000 in population, except Canada, the United States and U.S. territories.”
                  • Veterans: Census tracks social and demographic statistics by state, offering statistics and infographics. The American Fact Finder also incorporates data about veterans.
                  • Census even measures “well-being.”

                  Need more help? The census bureau also has a vast training library with webinars and other tutorials to help find what you need.

                  Susan Heavey (@susanheavey) is AHCJ’s core topic leader on social determinants and disparities, providing AHCJ members the resources they need to cover the root causes of health care gaps by writing blog posts, tip sheets, articles and other material. Based in Washington, D.C., Heavey covered health care for more than a decade, reporting on health care regulation and policy before focusing on the intersection of health, poverty and demographics for Reuters.

                  The Association of Health Care Journalists offers training opportunities and resources to its 1,500 members. Tip sheets, “How I Did It” articles written by reporters, other resources and training events are available at HealthJournalism.org.


                  Keywords: reporting, style, writing, health reporting, science journalism. medical journalism, data

                    • Dec 12 / 2016
                    • 0
                    Criminal Justice, Culture, Economics, Education, Housing, Inequality, Municipal, Race, Real Estate

                    Sex offender housing and mobility: New research

                    A new study looks at the residential patterns of registered sex offenders 15 years after arrest.

                    The issue: Numerous state and local governments have adopted policies restricting where registered sex offenders can live. Often, they are prohibited from living within a certain distance of a school, daycare center, park or other place where children gather. In some parts of the country, restrictions are so strict that sex offenders have very limited housing options. News organizations nationwide have chronicled the most severe consequences of these policies — groups of sex offenders living under bridges and in hotels,  tent cities and parking lots. A decade ago, the Palace Mobile Home Park in Florida began offering housing specifically to sex offenders.

                    A study worth reading: “Sex Offender Residential Mobility and Relegation: The Collateral Consequences Continue,” published in the American Journal of Criminal Justice, December 2016.

                    Study summary: Richard Tewksbury, a professor of criminal justice at the University of Louisville, and Elizabeth Ehrhardt Mustaine, a sociology professor at the University of Central Florida, teamed up with doctoral student Shawn Rolfe to build upon previous research that Tewksbury and Mustaine did together on sex offender housing. The earlier study, published in 2006, found that the majority of registered sex offenders changed residences after conviction but that only some had difficulty finding housing that was comparable to where they lived prior to conviction.

                    For the new study, the three researchers examined the housing conditions of 212 of the sex offenders who had been investigated for the earlier study, which focused on a metropolitan community in Jefferson County, Kentucky. The authors wanted to see whether and how offenders’ circumstances had changed 15 years after their initial arrest and a decade after the previous study.

                    Key takeaways:

                    • Of the 212 offenders in the study, 76 percent are required to register in their community as a sex offender for their entire lives.
                    • Fifteen years after arrest, many offenders were living in less desirable neighborhoods. About 38 percent moved into neighborhoods that were more “socially disorganized” than where they had lived 15 years earlier. Socially disorganized areas tend to have characteristics such as higher rates of poverty and unemployment, lower rates of home ownership and a higher proportion of households headed by single mothers.
                    • Overall, more than half of offenders lived in neighborhoods with higher than average levels of social disorganization (as compared to county-level averages).
                    • The odds of moving to a more socially disorganized neighborhood are 15 percent higher for non-white sex offenders than white sex offenders.
                    • No sex offender moved to a less socially disorganized neighborhood.
                    • The findings suggest sex offenders “continue to experience the collateral consequences associated with sex offender registration a full 15 years following their arrests.”
                    • The authors argue that “the placement (or, relegation) of registered sex offenders in poor, low social capital, and often crime-ridden communities may actually be working counter to the justifications for sex offender registration and community notification. If community members are to be assisted in avoiding sexual offenders by knowing where they live and who they are, the residents of the communities into which sex offenders are relegated are perhaps the least likely to have the opportunity, resources or knowledge to know how to access and use such information.”

                    Helpful resources:

                    More research on this topic:

                    Keywords: sex crime, sexual assault, child molester, housing restrictions, rapist, bus stop, SORNA